Re: Comparative Efficacy and Safety of New Surgical Treatments for Benign Prostatic Hyperplasia: Systematic Review and Network Meta-Analysis

Abstract Objective To assess the efficacy and safety of different endoscopic surgical treatments for benign prostatic hyperplasia. 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 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. Results 109 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. Conclusion Eight 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 registration CRD42018099583.

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The efficacy and safety of desmopressin acetate applied for nocturia in benign prostatic hyperplasia patients: A systematic review and meta‐analysis

LUTS Lower Urinary Tract Symptoms ◽

10.1111/luts.12423 ◽

2022 ◽

Author(s):

Qihua Wang ◽

Rami Alshayyah ◽

Bo Yang

Keyword(s):

Systematic Review ◽

Benign Prostatic Hyperplasia ◽

Meta Analysis ◽

Prostatic Hyperplasia ◽

Efficacy And Safety

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Systematic review and meta-analysis of efficacy and safety of silodosin in treatment of benign prostatic hyperplasia patients with lower urinary tract symptoms

10.21203/rs.2.23577/v1 ◽

2020 ◽

Author(s):

Chi Yuan ◽

Zhongyu Jian ◽

Yucheng Ma ◽

Menghua Wang ◽

Qibo Hu ◽

...

Keyword(s):

Systematic Review ◽

Urinary Tract ◽

Benign Prostatic Hyperplasia ◽

Lower Urinary Tract ◽

Meta Analysis ◽

Prostatic Hyperplasia ◽

Efficacy And Safety ◽

P Values ◽

Urinary Tract Symptoms ◽

Lower Urinary

Abstract Background: Silodosin is a new high-selective α1A-adrenoceptors antagonist. A systematic review of literature and meta-analysis were performed to compare the clinical efficacy and safety outcomes of silodosin with placebo, tamsulosin, naftopidil and alfuzosin in treating benign prostatic hyperplasia (BPH) males with lower urinary tract symptoms (LUTS). Materials and Methods: We systematically searched literature among EMBASE, PubMed, Cochrane Library, ScienceDirect and Web of Science databases until April 2019. 18 related randomized controlled trials were included according to eligibility criteria. Random-effects model were applied for data analysis. Results: 5,985 patients were included in our study. Silodosin presented superiority to placebo in improving LUTS and better efficacy than tamsulosin and naftopidil in improving IPSS void subscore and post-void residual urine volume with statistically significance (all P values < 0.05). Greater QoL index improvement were found in silodosin than alfuzosin groups (MD = -0.44, 95%CI: [-0.83, -0.05], P = 0.03) while no differences in total IPSS score and Qmax changes between these two groups. Retrograde ejaculation was significantly frequent in silodosin than placebo, tamsulosin and naftopidil groups (all P values < 0.05). Besides, silodosin increased incidence of upper respiratory tract infection compared to tamsulosin groups (RR = 0.69, 95%CI: [0.50, 0.96], P = 0.03). A higher rate of nasal congestion (RR = 7.76, 95%CI: [1.80, 33.41], P = 0.006) were found in silodosin than placebo groups while no difference for nasopharyngitis ((RR = 1.16, 95%CI: [0.54, 2.47], P = 0.71). Prevalence of headache (RR = 0.54, 95%CI: [0.27, 1.06], P = 0.07) and postural hypotension (RR = 0.14, 95%CI: [0.03, 0.77], P = 0.02) were lower in silodosin than tamsulosin groups, although dizziness and vertigo was more frequent in silodosin than placebo (RR = 2.26, 95%CI: [1.21, 4.21], P = 0.009). Conclusions: Our study demonstrated silodosin’s possible superiority to placebo and naftopidil while noninferiority to tamsulosin and alfuzosin in LUTS improvement of BPH males. Better cardiovascular safety was in silodosin groups, although incidence of retrograde ejaculation and respiratory adverse events were higher.

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