Minimally invasive treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia: a network meta-analysis.

Franco JVA, Jung JH, Imamura M, Borofsky M, Omar MI, Escobar Liquitay CM, Young S, Golzarian J, Veroniki AA, Garegnani L, Dahm P. Minimally invasive treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia: a network meta-analysis. invasive treatment: a network meta-analysis. Cochrane Database of Systematic Reviews 2021, no. 7. Art. No.: CD013656. doi: 10.1002 /14651858.CD013656.pub2. Accessed July 30, 2021.

Commentary

This study was designed to evaluate the comparative effectiveness of minimally invasive treatments for lower urinary tract symptoms in men with BPH through a network meta-analysis.

The main results reviewed included 27 trials involving 3017 men (mostly over 50 years of age) with severe LUTS due to BPH, and the overall certainty of the evidence was very low due to concerns about bias, imprecision, inconsistency (heterogeneity), and lack of consistency.

For urinary symptoms (19 studies, 1847 participants), higher scores for PUL and PAE than TURP indicate worse symptoms.

CRFWVT, TUMT, and TIND may result in worse urological symptom scores compared to TURP at short follow-up, but there is no difference in CI at all.

For quality of life (QoL) (13 studies, 1459 participants), there may be no difference at all in QoL scores compared to TURP for all interventions. Higher scores indicate worse symptoms.

For major adverse events (15 studies, 1573 participants), it appears that TUMT may possibly lead to a significant reduction in major adverse events compared to TURP; PUL, CRFWVT, TIND, and PAE may also lead to a significant reduction in major adverse events, but the CI and include substantial benefits and harms of 3 to 36 months.

For retreatment (10 studies, 799 participants), the effect of PAE and PUL on retreatment compared with TURP is unknown, and TUMT may result in higher retreatment rates.

For erectile function (6 studies, 640 participants), the effect of minimally invasive treatments on erectile function is very uncertain.

For ejaculatory dysfunction (8 studies, 461 participants), the effect of PUL, PAE, and TUMT on ejaculatory dysfunction compared to TURP is also unknown.

TURP is the treatment most likely to be effective for urinary tract symptoms, QoL, and re-treatment, but has also been shown to be unfavorable for major adverse events, erectile function, and ejaculatory function. Among minimally invasive procedures, PUL and PAE are most likely to be effective for urinary tract symptoms and QoL, TUMT for major adverse events, PUL for retreatment, CRFWVT and TIND for erectile function, and PUL for ejaculatory function.

The authors conclude that

Minimally invasive treatment may have similar or worse effects on urinary symptoms and QoL compared to TURP with a short follow-up. They may result in fewer major adverse events, especially in the case of PUL and PAE. This may result in better symptom score ranking; PUL may result in fewer retreatments compared to other interventions, especially TUMT, which has the highest retreatment rate at long-term follow-up. We are very uncertain about the effects of these interventions on erectile function. In particular, long-term data on CRFWVT and TIND were limited. Future high-quality studies with more extensive follow-up that compare different active treatments and adequately report important patient-relevant outcomes, including those related to sexual function, and