Probabilistic Multicriteria Decision Analysis of Minimally Invasive Treatments for Benign Prostatic Obstruction: A...

To compare minimally invasive surgical therapies (MISTs) for benign prostatic obstruction (BPO) using probabilistic multicriteria decision analysis that integrates heterogeneous clinical outcomes under varying stakeholder priorities.

This secondary analysis was derived from a published network meta-analysis. Three treatments-monopolar transurethral resection of the prostate (mTURP), prostatic urethral lift (PUL), and water vapor thermal therapy (WVTT)-were compared across six criteria: International Prostate Symptom Score (IPSS), IPSS Quality of Life, maximum urinary flow rate (Q_max), postvoid residual urine volume (PVR), and two domains of the Male Sexual Health Questionnaire Short Form. Treatment effects were sampled using a Monte Carlo simulation (50 000 iterations) and mapped to a 0-1 scale using clinically interpretable anchors. Five weighting scenarios produced preference probabilities and net advantages with 95% uncertainty intervals (UI). Anchor perturbation and correlation sensitivity analyses assessed robustness.

Under equal weights, WVTT had the highest P(best) (54.1%), followed by mTURP (25.8%) and PUL (20.1%); all pairwise UIs crossed zero. Under efficacy weights, mTURP had the highest P(best) (88.0%; net advantage vs. PUL: 0.124, 95% UI: 0.034-0.214), driven by superiority in Q_max and PVR. Under sexual function weights, mTURP was rarely preferred (P[best] < 0.1%), whereas PUL and WVTT achieved P(best) of 45.3% and 54.7%, respectively. Rankings were robust in both anchor perturbation and correlation sensitivity analyses.

Within short-term (3-6 month) data, MIST preference for BPO depends on clinical priorities. mTURP is favored when urodynamic outcomes are emphasized; PUL and WVTT are preferred when preservation of sexual function is prioritized. This framework supports preference-sensitive shared decision-making, although the findings are provisional pending long-term data.