To assess the comparative effectiveness and ranking of minimally invasive treatments (MITs) for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH).
We searched multiple databases up to 24 February 2021. We included randomized controlled trials assessing the following treatments: convective radiofrequency water vapour thermal therapy (WVTT or Rezum); prostatic arterial embolization (PAE); prostatic urethral lift (PUL or Urolift); temporary implantable nitinol device (TIND); and transurethral microwave thermotherapy (TUMT) compared to transurethral resection of the prostate (TURP) or sham surgery. We performed a frequentist network meta-analysis.
We included 27 trials involving 3017 men. The overall certainty of the evidence of most outcomes according to GRADE was low to very low. Compared to TURP, PUL and PAE may result in little to no difference in urologic symptoms while WVTT, TUMT, and TIND may result in worse urologic symptoms. MITs may result in little to no difference in the quality of life (QoL), compared to TURP. MITs may result in a large reduction of major adverse events compared to TURP. We are uncertain about the effects of PAE and PUL on retreatment compared to TURP, however, TUMT may result in higher retreatment rates. We are very uncertain of the effects of MITs on erectile function and ejaculatory function. Among MITs, PUL and PAE have the highest likelihood of being the most efficacious for urinary symptoms and QoL, TUMT for major adverse events, WVTT and TIND for erectile function and PUL for ejaculatory function. Excluding WVTT and TIND, for which there were only studies with short-term (three months) follow-up, PUL had the highest likelihood of being the most efficacious for retreatment.
MITs may result in similar or worse effects concerning urinary symptoms and QoL compared to TURP at short-term follow-up.
BJU international. 2021 Nov 25 [Epub ahead of print]
Juan Va Franco, Jae Hung Jung, Mari Imamura, Michael Borofsky, Muhammad Imran Omar, Camila Micaela Escobar Liquitay, Shamar Young, Jafar Golzarian, Areti Angeliki Veroniki, Luis Garegnani, Philipp Dahm
Associate Cochrane Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea., Health Services Research Unit, University of Aberdeen, Aberdeen, UK., Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA., Guidelines Office, European Association of Urology, Arnhem, Netherlands., Central Library, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Department of Radiology, Division of Interventional Radiology & Vascular Imaging, University of Minnesota, Minneapolis, Minnesota, USA., Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece., Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.