PD56-04 COMPARATIVE EFFICACY OF NOVEL SURGICAL TREATMENTS FOR BENIGN PROSTATIC HYPERPLASIA: SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III (PD56)1 Apr 2020PD56-04 COMPARATIVE EFFICACY OF NOVEL SURGICAL TREATMENTS FOR BENIGN PROSTATIC HYPERPLASIA: SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS Chung-You Tsai* and Shi-Wei Huang Chung-You Tsai*Chung-You Tsai* More articles by this author and Shi-Wei HuangShi-Wei Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000966.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess the efficacy and safety of different endoscopic surgical treatments for benign prostatic hyperplasia. METHODS: Design Systematic review and network meta-analysis of randomised controlled trials. Data sources: A comprehensive search of PubMed, Embase, and Cochrane databases from inception to 31 March 2019. Study selection: Randomised 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 synthesis: Two 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 risk 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. RESULTS: 109 trials with a total of 13 676 participants were identified. Nine new 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 2.53)), 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)). 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. CONCLUSIONS: Eight novel 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. Source of Funding: Nil © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1189-e1189 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chung-You Tsai* More articles by this author Shi-Wei Huang More articles by this author Expand All Advertisement PDF downloadLoading ...