Associate Cochrane Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Department of Urology, Yonsei University Wonju College of Medicine, Wonju, South Korea.
BJU Int. 2022 Aug;130(2):142-156. doi: 10.1111/bju.15653. Epub 2021 Dec 6.
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).
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 Rezūm); 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, we found that PUL and PAE may result in little to no difference in urological symptoms, while WVTT, TUMT and TIND may result in worse urological symptoms. MITs may result in little to no difference in quality of life, compared to TURP. MITs may result in a large reduction in major adverse events compared to TURP. We were uncertain about the effects of PAE and PUL on retreatment compared to TURP, however, TUMT may result in higher retreatment rates. We were very uncertain of the effects of MITs on erectile function and ejaculatory function. Among MITs, PUL and PAE had the highest likelihood of being the most efficacious for urinary symptoms and quality of life, 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 (3-month) follow-up, PUL had the highest likelihood of being the most efficacious for retreatment.
Minimally invasive treatments may result in similar or worse effects concerning urinary symptoms and quality of life compared to TURP at short-term follow-up.
评估微创治疗（MIT）在下尿路症状（LUTS）男性前列腺增生（BPH）中的比较效果和排名。
我们检索了多个数据库，截至 2021 年 2 月 24 日。我们纳入了评估以下治疗的随机对照试验：对流射频水蒸汽热疗（WVTT；或 Rezūm）；前列腺动脉栓塞术（PAE）；前列腺尿道提升术（PUL；或 Urolift）；临时可植入的镍钛诺装置（TIND）；经尿道微波热疗（TUMT）与经尿道前列腺切除术（TURP）或假手术相比。我们进行了似然比网络荟萃分析。
我们纳入了 27 项涉及 3017 名男性的试验。根据 GRADE，大多数结局的证据总体确定性为低到极低。与 TURP 相比，我们发现 PUL 和 PAE 可能导致泌尿系统症状无差异或差异较小，而 WVTT、TUMT 和 TIND 可能导致泌尿系统症状更差。与 TURP 相比，MIT 可能导致生活质量无差异或差异较小。与 TURP 相比，MIT 可能导致主要不良事件的大量减少。我们不确定 PAE 和 PUL 与 TURP 相比在复发方面的效果，但 TUMT 可能导致更高的复发率。我们非常不确定 MIT 对勃起功能和射精功能的影响。在 MIT 中，PUL 和 PAE 最有可能对泌尿系统症状和生活质量最有效，TUMT 对主要不良事件最有效，WVTT 和 TIND 对勃起功能最有效，PUL 对射精功能最有效。排除 WVTT 和 TIND，因为它们只有短期（3 个月）随访的研究，PUL 最有可能在复发方面最有效。
微创治疗在短期随访中可能与 TURP 相比导致类似或更差的泌尿系统症状和生活质量效果。
