Minimally invasive treatments for benign prostatic hyperplasia: a Cochrane network meta-analysis

Area of Science:

• Urology
• Surgical Innovation

Background:

• Benign prostatic hyperplasia (BPH) commonly causes lower urinary tract symptoms (LUTS) in men.
• Minimally invasive treatments (MITs) offer alternatives to traditional surgery like transurethral resection of the prostate (TURP).

Purpose of the Study:

• To compare the effectiveness and rank various MITs for LUTS in BPH.
• To evaluate MITs against TURP and sham surgery.

Main Methods:

• A frequentist network meta-analysis of 27 randomized controlled trials (RCTs) involving 3017 men.
• Included treatments: convective radiofrequency water vapour thermal therapy (WVTT), prostatic arterial embolization (PAE), prostatic urethral lift (PUL), temporary implantable nitinol device (TIND), and transurethral microwave thermotherapy (TUMT).

Main Results:

• Most evidence had low to very low certainty (GRADE).
• Compared to TURP, PUL and PAE showed little symptom difference; WVTT, TUMT, and TIND showed worse symptoms.
• MITs generally reduced major adverse events versus TURP but had uncertain effects on sexual function.

Conclusions:

• MITs may offer similar or worse outcomes for urinary symptoms and quality of life compared to TURP in the short term.
• Prostatic urethral lift (PUL) and prostatic arterial embolization (PAE) showed potential for efficacy in urinary symptoms and quality of life among MITs.