Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis
AbstractObjectiveTo assess the efficacy and safety of different endoscopic surgical treatments for benign prostatic hyperplasia.DesignSystematic review and network meta-analysis of randomised controlled trials.Data sourcesA comprehensive search of PubMed, Embase, and Cochrane databases from inceptio...
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| description | AbstractObjectiveTo assess the efficacy and safety of different endoscopic surgical treatments for benign prostatic hyperplasia.DesignSystematic review and network meta-analysis of randomised controlled trials.Data sourcesA comprehensive search of PubMed, Embase, and Cochrane databases from inception to 31 March 2019.Study selectionRandomised controlled trials comparing vapourisation, resection, and enucleation of the prostate using monopolar, bipolar, or various laser systems (holmium, thulium, potassium titanyl phosphate, or diode) as surgical treatments for benign prostatic hyperplasia. The primary outcomes were the maximal flow rate (Qmax) and international prostate symptoms score (IPSS) at 12 months after surgical treatment. Secondary outcomes were Qmax and IPSS values at 6, 24, and 36 months after surgical treatment; perioperative parameters; and surgical complications.Data extraction and synthesisTwo independent reviewers extracted the study data and performed quality assessments using the Cochrane Risk of Bias Tool. The effect sizes were summarised using weighted mean differences for continuous outcomes and odds ratios for binary outcomes. Frequentist approach to the network meta-analysis was used to estimate comparative effects and safety. Ranking probabilities of each treatment were also calculated.Results109 trials with a total of 13 676 participants were identified. Nine surgical treatments were evaluated. Enucleation achieved better Qmax and IPSS values than resection and vapourisation methods at six and 12 months after surgical treatment, and the difference maintained up to 24 and 36 months after surgical treatment. For Qmax at 12 months after surgical treatment, the best three methods compared with monopolar transurethral resection of the prostate (TURP) were bipolar enucleation (mean difference 2.42 mL/s (95% confidence interval 1.11 to 3.73)), diode laser enucleation (1.86 (−0.17 to 3.88)), and holmium laser enucleation (1.07 (0.07 to 2.08)). The worst performing method was diode laser vapourisation (−1.90 (−5.07 to 1.27)). The results of IPSS at 12 months after treatment were similar to Qmax at 12 months after treatment. The best three methods, versus monopolar TURP, were diode laser enucleation (mean difference −1.00 (−2.41 to 0.40)), bipolar enucleation (0.87 (−1.80 to 0.07)), and holmium laser enucleation (−0.84 (−1.51 to 0.58)). The worst performing method was diode laser vapourisation (1.30 (−1.16 to 3.76)). Eight new methods were be |
| doi_str_mv | 10.1136/bmj.l5919 |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7223639</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2314482887</sourcerecordid><originalsourceid>FETCH-LOGICAL-b498t-9a1af70cc8b112c11e1803dd4ee1949215aa78e3496f76a288485f5d7cdcd4b93</originalsourceid><addsrcrecordid>eNp1kV2L1DAUhoMo7jDuhX9AAnqhF12bpm0SLwQZ_IIFb_Q6nKYnsxnbpiaZWfoP_NlmZtZFBa8COU8e3pOXkKesvGKMt6-7cXc1NIqpB2TFRNMWTHL-kKxK1ahCMi4vyGWMu7IsKy6kapvH5IIzUYm2Eivyc-PHGQIkd0CK1joDZqEw9TSCxbRQb-mEtzTuwzbPBpoCQhpxSpFaH2iHk9tOdA4-piwx9GaZMcwDRAdvaFxiwvF0H_DgsudonjDd-vCdjpiggAmGJbr4hDyyMES8vDvX5NuH9183n4rrLx8_b95dF12tZCoUMLCiNEZ2jFWGMWSy5H1fIzJVq4o1AEIir1VrRQuVlLVsbNML05u-7hRfk7dn77zvRuxN3iTAoOfgRgiL9uD035PJ3eitP2hRVbzlR8HLO0HwP_YYkx5dNDgMMKHfR11x1rCS8QyvyfN_0J3fh7zwiaprmeOJTL06UyZ_Ygxo78OwUh8r1rlifao4s8_-TH9P_i40Ay_OwPHN_z2_AKvvsZQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2314482887</pqid></control><display><type>article</type><title>Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis</title><source>Jstor Complete Legacy</source><source>MEDLINE</source><creator>Huang, Shi-Wei ; Tsai, Chung-You ; Tseng, Chi-Shin ; Shih, Ming-Chieh ; Yeh, Yi-Chun ; Chien, Kuo-Liong ; Pu, Yeong-Shiau ; Tu, Yu-Kang</creator><creatorcontrib>Huang, Shi-Wei ; Tsai, Chung-You ; Tseng, Chi-Shin ; Shih, Ming-Chieh ; Yeh, Yi-Chun ; Chien, Kuo-Liong ; Pu, Yeong-Shiau ; Tu, Yu-Kang</creatorcontrib><description>AbstractObjectiveTo assess the efficacy and safety of different endoscopic surgical treatments for benign prostatic hyperplasia.DesignSystematic review and network meta-analysis of randomised controlled trials.Data sourcesA comprehensive search of PubMed, Embase, and Cochrane databases from inception to 31 March 2019.Study selectionRandomised controlled trials comparing vapourisation, resection, and enucleation of the prostate using monopolar, bipolar, or various laser systems (holmium, thulium, potassium titanyl phosphate, or diode) as surgical treatments for benign prostatic hyperplasia. The primary outcomes were the maximal flow rate (Qmax) and international prostate symptoms score (IPSS) at 12 months after surgical treatment. Secondary outcomes were Qmax and IPSS values at 6, 24, and 36 months after surgical treatment; perioperative parameters; and surgical complications.Data extraction and synthesisTwo independent reviewers extracted the study data and performed quality assessments using the Cochrane Risk of Bias Tool. The effect sizes were summarised using weighted mean differences for continuous outcomes and odds ratios for binary outcomes. Frequentist approach to the network meta-analysis was used to estimate comparative effects and safety. Ranking probabilities of each treatment were also calculated.Results109 trials with a total of 13 676 participants were identified. Nine surgical treatments were evaluated. Enucleation achieved better Qmax and IPSS values than resection and vapourisation methods at six and 12 months after surgical treatment, and the difference maintained up to 24 and 36 months after surgical treatment. For Qmax at 12 months after surgical treatment, the best three methods compared with monopolar transurethral resection of the prostate (TURP) were bipolar enucleation (mean difference 2.42 mL/s (95% confidence interval 1.11 to 3.73)), diode laser enucleation (1.86 (−0.17 to 3.88)), and holmium laser enucleation (1.07 (0.07 to 2.08)). The worst performing method was diode laser vapourisation (−1.90 (−5.07 to 1.27)). The results of IPSS at 12 months after treatment were similar to Qmax at 12 months after treatment. The best three methods, versus monopolar TURP, were diode laser enucleation (mean difference −1.00 (−2.41 to 0.40)), bipolar enucleation (0.87 (−1.80 to 0.07)), and holmium laser enucleation (−0.84 (−1.51 to 0.58)). The worst performing method was diode laser vapourisation (1.30 (−1.16 to 3.76)). Eight new methods were better at controlling bleeding than monopolar TURP, resulting in a shorter catheterisation duration, reduced postoperative haemoglobin declination, fewer clot retention events, and lower blood transfusion rate. However, short term transient urinary incontinence might still be a concern for enucleation methods, compared with resection methods (odds ratio 1.92, 1.39 to 2.65). No substantial inconsistency between direct and indirect evidence was detected in primary or secondary outcomes.ConclusionEight new endoscopic surgical methods for benign prostatic hyperplasia appeared to be superior in safety compared with monopolar TURP. Among these new treatments, enucleation methods showed better Qmax and IPSS values than vapourisation and resection methods.Study registrationCRD42018099583.</description><identifier>ISSN: 0959-8138</identifier><identifier>ISSN: 1756-1833</identifier><identifier>EISSN: 1756-1833</identifier><identifier>DOI: 10.1136/bmj.l5919</identifier><identifier>PMID: 31727627</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Benign ; Bladder ; Blood transfusion ; Clinical trials ; Enucleation ; Evidence-based medicine ; Genital diseases ; Hemoglobin ; Humans ; Hyperplasia ; Lasers ; Male ; Meta-analysis ; Methods ; Outcome Assessment, Health Care ; Potassium ; Prostate ; Prostatic Hyperplasia - surgery ; Safety ; Systematic review ; Transurethral Resection of Prostate - adverse effects ; Transurethral Resection of Prostate - methods ; Transurethral Resection of Prostate - statistics & numerical data ; Treatment Outcome ; Tumors ; Urinary incontinence ; Urogenital system ; Urology</subject><ispartof>BMJ (Online), 2019-11, Vol.367, p.l5919</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions 2019 BMJ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to 2019 BMJ</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b498t-9a1af70cc8b112c11e1803dd4ee1949215aa78e3496f76a288485f5d7cdcd4b93</citedby><cites>FETCH-LOGICAL-b498t-9a1af70cc8b112c11e1803dd4ee1949215aa78e3496f76a288485f5d7cdcd4b93</cites><orcidid>0000-0002-2461-474X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31727627$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huang, Shi-Wei</creatorcontrib><creatorcontrib>Tsai, Chung-You</creatorcontrib><creatorcontrib>Tseng, Chi-Shin</creatorcontrib><creatorcontrib>Shih, Ming-Chieh</creatorcontrib><creatorcontrib>Yeh, Yi-Chun</creatorcontrib><creatorcontrib>Chien, Kuo-Liong</creatorcontrib><creatorcontrib>Pu, Yeong-Shiau</creatorcontrib><creatorcontrib>Tu, Yu-Kang</creatorcontrib><title>Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis</title><title>BMJ (Online)</title><addtitle>BMJ</addtitle><description>AbstractObjectiveTo assess the efficacy and safety of different endoscopic surgical treatments for benign prostatic hyperplasia.DesignSystematic review and network meta-analysis of randomised controlled trials.Data sourcesA comprehensive search of PubMed, Embase, and Cochrane databases from inception to 31 March 2019.Study selectionRandomised controlled trials comparing vapourisation, resection, and enucleation of the prostate using monopolar, bipolar, or various laser systems (holmium, thulium, potassium titanyl phosphate, or diode) as surgical treatments for benign prostatic hyperplasia. The primary outcomes were the maximal flow rate (Qmax) and international prostate symptoms score (IPSS) at 12 months after surgical treatment. Secondary outcomes were Qmax and IPSS values at 6, 24, and 36 months after surgical treatment; perioperative parameters; and surgical complications.Data extraction and synthesisTwo independent reviewers extracted the study data and performed quality assessments using the Cochrane Risk of Bias Tool. The effect sizes were summarised using weighted mean differences for continuous outcomes and odds ratios for binary outcomes. Frequentist approach to the network meta-analysis was used to estimate comparative effects and safety. Ranking probabilities of each treatment were also calculated.Results109 trials with a total of 13 676 participants were identified. Nine surgical treatments were evaluated. Enucleation achieved better Qmax and IPSS values than resection and vapourisation methods at six and 12 months after surgical treatment, and the difference maintained up to 24 and 36 months after surgical treatment. For Qmax at 12 months after surgical treatment, the best three methods compared with monopolar transurethral resection of the prostate (TURP) were bipolar enucleation (mean difference 2.42 mL/s (95% confidence interval 1.11 to 3.73)), diode laser enucleation (1.86 (−0.17 to 3.88)), and holmium laser enucleation (1.07 (0.07 to 2.08)). The worst performing method was diode laser vapourisation (−1.90 (−5.07 to 1.27)). The results of IPSS at 12 months after treatment were similar to Qmax at 12 months after treatment. The best three methods, versus monopolar TURP, were diode laser enucleation (mean difference −1.00 (−2.41 to 0.40)), bipolar enucleation (0.87 (−1.80 to 0.07)), and holmium laser enucleation (−0.84 (−1.51 to 0.58)). The worst performing method was diode laser vapourisation (1.30 (−1.16 to 3.76)). Eight new methods were better at controlling bleeding than monopolar TURP, resulting in a shorter catheterisation duration, reduced postoperative haemoglobin declination, fewer clot retention events, and lower blood transfusion rate. However, short term transient urinary incontinence might still be a concern for enucleation methods, compared with resection methods (odds ratio 1.92, 1.39 to 2.65). No substantial inconsistency between direct and indirect evidence was detected in primary or secondary outcomes.ConclusionEight new endoscopic surgical methods for benign prostatic hyperplasia appeared to be superior in safety compared with monopolar TURP. Among these new treatments, enucleation methods showed better Qmax and IPSS values than vapourisation and resection methods.Study registrationCRD42018099583.</description><subject>Benign</subject><subject>Bladder</subject><subject>Blood transfusion</subject><subject>Clinical trials</subject><subject>Enucleation</subject><subject>Evidence-based medicine</subject><subject>Genital diseases</subject><subject>Hemoglobin</subject><subject>Humans</subject><subject>Hyperplasia</subject><subject>Lasers</subject><subject>Male</subject><subject>Meta-analysis</subject><subject>Methods</subject><subject>Outcome Assessment, Health Care</subject><subject>Potassium</subject><subject>Prostate</subject><subject>Prostatic Hyperplasia - surgery</subject><subject>Safety</subject><subject>Systematic review</subject><subject>Transurethral Resection of Prostate - adverse effects</subject><subject>Transurethral Resection of Prostate - methods</subject><subject>Transurethral Resection of Prostate - statistics & numerical data</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><subject>Urinary incontinence</subject><subject>Urogenital system</subject><subject>Urology</subject><issn>0959-8138</issn><issn>1756-1833</issn><issn>1756-1833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kV2L1DAUhoMo7jDuhX9AAnqhF12bpm0SLwQZ_IIFb_Q6nKYnsxnbpiaZWfoP_NlmZtZFBa8COU8e3pOXkKesvGKMt6-7cXc1NIqpB2TFRNMWTHL-kKxK1ahCMi4vyGWMu7IsKy6kapvH5IIzUYm2Eivyc-PHGQIkd0CK1joDZqEw9TSCxbRQb-mEtzTuwzbPBpoCQhpxSpFaH2iHk9tOdA4-piwx9GaZMcwDRAdvaFxiwvF0H_DgsudonjDd-vCdjpiggAmGJbr4hDyyMES8vDvX5NuH9183n4rrLx8_b95dF12tZCoUMLCiNEZ2jFWGMWSy5H1fIzJVq4o1AEIir1VrRQuVlLVsbNML05u-7hRfk7dn77zvRuxN3iTAoOfgRgiL9uD035PJ3eitP2hRVbzlR8HLO0HwP_YYkx5dNDgMMKHfR11x1rCS8QyvyfN_0J3fh7zwiaprmeOJTL06UyZ_Ygxo78OwUh8r1rlifao4s8_-TH9P_i40Ay_OwPHN_z2_AKvvsZQ</recordid><startdate>20191114</startdate><enddate>20191114</enddate><creator>Huang, Shi-Wei</creator><creator>Tsai, Chung-You</creator><creator>Tseng, Chi-Shin</creator><creator>Shih, Ming-Chieh</creator><creator>Yeh, Yi-Chun</creator><creator>Chien, Kuo-Liong</creator><creator>Pu, Yeong-Shiau</creator><creator>Tu, Yu-Kang</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group Ltd</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2461-474X</orcidid></search><sort><creationdate>20191114</creationdate><title>Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis</title><author>Huang, Shi-Wei ; Tsai, Chung-You ; Tseng, Chi-Shin ; Shih, Ming-Chieh ; Yeh, Yi-Chun ; Chien, Kuo-Liong ; Pu, Yeong-Shiau ; Tu, Yu-Kang</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b498t-9a1af70cc8b112c11e1803dd4ee1949215aa78e3496f76a288485f5d7cdcd4b93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Benign</topic><topic>Bladder</topic><topic>Blood transfusion</topic><topic>Clinical trials</topic><topic>Enucleation</topic><topic>Evidence-based medicine</topic><topic>Genital diseases</topic><topic>Hemoglobin</topic><topic>Humans</topic><topic>Hyperplasia</topic><topic>Lasers</topic><topic>Male</topic><topic>Meta-analysis</topic><topic>Methods</topic><topic>Outcome Assessment, Health Care</topic><topic>Potassium</topic><topic>Prostate</topic><topic>Prostatic Hyperplasia - surgery</topic><topic>Safety</topic><topic>Systematic review</topic><topic>Transurethral Resection of Prostate - adverse effects</topic><topic>Transurethral Resection of Prostate - methods</topic><topic>Transurethral Resection of Prostate - statistics & numerical data</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><topic>Urinary incontinence</topic><topic>Urogenital system</topic><topic>Urology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huang, Shi-Wei</creatorcontrib><creatorcontrib>Tsai, Chung-You</creatorcontrib><creatorcontrib>Tseng, Chi-Shin</creatorcontrib><creatorcontrib>Shih, Ming-Chieh</creatorcontrib><creatorcontrib>Yeh, Yi-Chun</creatorcontrib><creatorcontrib>Chien, Kuo-Liong</creatorcontrib><creatorcontrib>Pu, Yeong-Shiau</creatorcontrib><creatorcontrib>Tu, Yu-Kang</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ (Online)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huang, Shi-Wei</au><au>Tsai, Chung-You</au><au>Tseng, Chi-Shin</au><au>Shih, Ming-Chieh</au><au>Yeh, Yi-Chun</au><au>Chien, Kuo-Liong</au><au>Pu, Yeong-Shiau</au><au>Tu, Yu-Kang</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis</atitle><jtitle>BMJ (Online)</jtitle><addtitle>BMJ</addtitle><date>2019-11-14</date><risdate>2019</risdate><volume>367</volume><spage>l5919</spage><pages>l5919-</pages><issn>0959-8138</issn><issn>1756-1833</issn><eissn>1756-1833</eissn><abstract>AbstractObjectiveTo assess the efficacy and safety of different endoscopic surgical treatments for benign prostatic hyperplasia.DesignSystematic review and network meta-analysis of randomised controlled trials.Data sourcesA comprehensive search of PubMed, Embase, and Cochrane databases from inception to 31 March 2019.Study selectionRandomised controlled trials comparing vapourisation, resection, and enucleation of the prostate using monopolar, bipolar, or various laser systems (holmium, thulium, potassium titanyl phosphate, or diode) as surgical treatments for benign prostatic hyperplasia. The primary outcomes were the maximal flow rate (Qmax) and international prostate symptoms score (IPSS) at 12 months after surgical treatment. Secondary outcomes were Qmax and IPSS values at 6, 24, and 36 months after surgical treatment; perioperative parameters; and surgical complications.Data extraction and synthesisTwo independent reviewers extracted the study data and performed quality assessments using the Cochrane Risk of Bias Tool. The effect sizes were summarised using weighted mean differences for continuous outcomes and odds ratios for binary outcomes. Frequentist approach to the network meta-analysis was used to estimate comparative effects and safety. Ranking probabilities of each treatment were also calculated.Results109 trials with a total of 13 676 participants were identified. Nine surgical treatments were evaluated. Enucleation achieved better Qmax and IPSS values than resection and vapourisation methods at six and 12 months after surgical treatment, and the difference maintained up to 24 and 36 months after surgical treatment. For Qmax at 12 months after surgical treatment, the best three methods compared with monopolar transurethral resection of the prostate (TURP) were bipolar enucleation (mean difference 2.42 mL/s (95% confidence interval 1.11 to 3.73)), diode laser enucleation (1.86 (−0.17 to 3.88)), and holmium laser enucleation (1.07 (0.07 to 2.08)). The worst performing method was diode laser vapourisation (−1.90 (−5.07 to 1.27)). The results of IPSS at 12 months after treatment were similar to Qmax at 12 months after treatment. The best three methods, versus monopolar TURP, were diode laser enucleation (mean difference −1.00 (−2.41 to 0.40)), bipolar enucleation (0.87 (−1.80 to 0.07)), and holmium laser enucleation (−0.84 (−1.51 to 0.58)). The worst performing method was diode laser vapourisation (1.30 (−1.16 to 3.76)). Eight new methods were better at controlling bleeding than monopolar TURP, resulting in a shorter catheterisation duration, reduced postoperative haemoglobin declination, fewer clot retention events, and lower blood transfusion rate. However, short term transient urinary incontinence might still be a concern for enucleation methods, compared with resection methods (odds ratio 1.92, 1.39 to 2.65). No substantial inconsistency between direct and indirect evidence was detected in primary or secondary outcomes.ConclusionEight new endoscopic surgical methods for benign prostatic hyperplasia appeared to be superior in safety compared with monopolar TURP. Among these new treatments, enucleation methods showed better Qmax and IPSS values than vapourisation and resection methods.Study registrationCRD42018099583.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>31727627</pmid><doi>10.1136/bmj.l5919</doi><orcidid>https://orcid.org/0000-0002-2461-474X</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | BMJ (Online), 2019-11, Vol.367, p.l5919 |
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| source | Jstor Complete Legacy; MEDLINE |
| subjects | Benign Bladder Blood transfusion Clinical trials Enucleation Evidence-based medicine Genital diseases Hemoglobin Humans Hyperplasia Lasers Male Meta-analysis Methods Outcome Assessment, Health Care Potassium Prostate Prostatic Hyperplasia - surgery Safety Systematic review Transurethral Resection of Prostate - adverse effects Transurethral Resection of Prostate - methods Transurethral Resection of Prostate - statistics & numerical data Treatment Outcome Tumors Urinary incontinence Urogenital system Urology |
| title | Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-05T01%3A07%3A01IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Comparative%20efficacy%20and%20safety%20of%20new%20surgical%20treatments%20for%20benign%20prostatic%20hyperplasia:%20systematic%20review%20and%20network%20meta-analysis&rft.jtitle=BMJ%20(Online)&rft.au=Huang,%20Shi-Wei&rft.date=2019-11-14&rft.volume=367&rft.spage=l5919&rft.pages=l5919-&rft.issn=0959-8138&rft.eissn=1756-1833&rft_id=info:doi/10.1136/bmj.l5919&rft_dat=%3Cproquest_pubme%3E2314482887%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2314482887&rft_id=info:pmid/31727627&rfr_iscdi=true |