Department of Urology, Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Netherlands.
Int Braz J Urol. 2023 Jul-Aug;49(4):411-427. doi: 10.1590/S1677-5538.IBJU.2023.0016.
To review and compare the effectivity of novel minimally invasive treatments (MITs) to transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms (LUTS) in men.
Medline, Embase, and Cochrane databases were searched from January 2010 to December 2022 for randomized controlled trials (RCTs) evaluating MITs, compared to TURP or sham, in men with LUTS. Studies were assessed by risk of bias tool, and evidence by GRADE. Functional outcomes by means of uroflowmetry and IPSS were the primary outcomes, safety and sexual function were secondary outcomes. As part of this review, a network meta-analysis (NMA) was conducted. MITs were ranked based on functional outcome improvement probability.
In total, 10 RCTs were included, evaluating aquablation, prostatic urethral lift, prostatic artery embolization (PAE), convective water vapor thermal treatment or temporary implantable nitinol device. All MITs showed a better safety profile compared to TURP. Functional outcome improvement following aquablation were comparable to TURP. In the NMA, aquablation was ranked highest, PAE followed with the second highest probability to improve functional outcomes. Other novel MITs resulted in worse functional outcomes compared to TURP. Level of evidence was low to very low.
Five MITs for treatment of LUTS were identified. Aquablation is likely to result in functional outcomes most comparable to TURP. Second in ranking was PAE, a technique that does not require general or spinal anesthesia. MITs have a better safety profile compared to TURP. However, due to high study heterogeneity, results should be interpreted with caution.
回顾和比较新型微创治疗（MIT）与经尿道前列腺切除术（TURP）治疗男性下尿路症状（LUTS）的疗效。
从 2010 年 1 月至 2022 年 12 月，检索 Medline、Embase 和 Cochrane 数据库，以评估 MIT 与 TURP 或 sham 治疗 LUTS 男性的随机对照试验（RCT）。使用偏倚风险工具评估研究，使用 GRADE 评估证据。尿流率和 IPSS 等功能结果是主要结局，安全性和性功能是次要结局。作为本综述的一部分，进行了网络荟萃分析（NMA）。根据功能结果改善的概率对 MIT 进行排名。
共纳入 10 项 RCT，评估了水刀消融术、前列腺尿道提升术、前列腺动脉栓塞术（PAE）、对流水蒸汽热疗或临时可植入镍钛诺装置。与 TURP 相比，所有 MIT 均显示出更好的安全性。水刀消融术后的功能改善与 TURP 相当。在 NMA 中，水刀消融术排名最高，PAE 紧随其后，改善功能结果的概率第二高。其他新型 MIT 的功能结果比 TURP 差。证据水平为低至极低。
确定了 5 种治疗 LUTS 的 MIT。水刀消融术可能会产生与 TURP 最相似的功能结果。PAE 排名第二，该技术不需要全身或脊髓麻醉。MIT 的安全性优于 TURP。然而，由于研究异质性较高，结果应谨慎解释。
