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).
Materials and methods
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
This project was funded by the National Institute for Health Research (NIHR) [Cochrane Incentive Award (NIHR130819)]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. We are very grateful to Cochrane Urology, especially Managing Editor Robert Lane, as well as Cochrane Urology Korea, for supporting this review. We are also grateful for the constructive feedback from the Cancer Network and the Methods Support Unit. We also thank Gretchen Kuntz for revising and providing feedback on the search strategies; Marco Blanker, Sevann Helo, and Murad Mohammad for their peer review input of the protocol; Dominik Abt, Bilal Chughtai, and Ahmed Higazy for providing details on the outcomes of their trials, for them to be incorporated accurately in our review; Marc Sapoval, Deepak Agarwal, Cameron Alexander, Harris Foster, and Mitchell Humphreys for their peer review input of the review. Juan Víctor Ariel Franco is a PhD candidate in the Programme of Methodology of Biomedical Research and Public Health, Universitat Autònoma de Barcelona (Spain)
- benign prostatic hyperplasia
- lower urinary tract symptoms
- minimally invasive treatments
- network meta-analysis
- transurethral microwave thermotherapy
- prostatic urethral lift
- temporary implantable nitinol device
- prostatic arterial embolisation