Alternative approaches to endoscopic ablation for benign enlargement of the prostate

systematic review of randomised controlled trials

Tania Lourenco, Robert Pickard, Luke Vale, Adrian Grant, Cynthia Fraser, Graeme MacLennan, James N'Dow, Benign Prostatic Enlargement Team

Research output: Contribution to journalArticle

62 Citations (Scopus)
4 Downloads (Pure)

Abstract

Objective To compare the effectiveness and risk profile of newer methods for endoscopic ablation of the prostate against the current standard of transurethral resection.

Design Systematic review and meta-,analysis.

Data sources Electronic and paper records in,subject area up to March 2006.

Review methods We searched for randomised controlled trials of endoscopic ablative interventions that included transurethral resection of prostate as one of the treatment arms. Two reviewers independently extracted data and assessed quality. Meta-analyses of prespecified outcomes were done using fixed and random effects models and reported using relative risk or weighted mean difference.

Results We>dentified 45 randomised, controlled trials meeting the inclusion criteria and reporting on 3970 participants 'The reports were of moderate to poor quality, with small sample sizes. None of the newer technologies resulted in significantly greater improvement in symptoms than transurethral resection at 12 months, although a trend suggested a better outcome with holmium laser nucleation (random effects weighted mean difference -0.82, 95% confidence interval 1.76 to 0.12) and worse outcome with laser vaporisation (1.49, -0.40 to 3.39). Improvements in secondary measures, such as peak urine flow rate, we're consistent with change in symptoms. Blood transfusion rates were higher for transurethral resection than for the newer methods (4.8% v 0.7%) and men undergoing laser vaporisation or diathermy vaporisation were more likely to experience urinary retention (6.7% v 2.3% and 3.6% v 1.1%). Hospital stay was up to one day shorter for the newer technologies.

Conclusions Although men undergoing more modern methods of removing benign prostatic enlargement have similar outcomes to standard transurethrat resection of prostate along with fewer requirements for blood transfusion and shorter hospital stay, the quality of current evidence is poor. The lack of any clearly more effective procedure,suggests that transurethral-resection should remain the standard approach.

Original languageEnglish
Number of pages9
JournalBritish Medical Journal
Volume337
DOIs
Publication statusPublished - 30 Jun 2008

Keywords

  • methodological quality
  • publication bias
  • clinical-trials
  • health-care
  • metaanalysis

Cite this

Alternative approaches to endoscopic ablation for benign enlargement of the prostate : systematic review of randomised controlled trials. / Lourenco, Tania; Pickard, Robert; Vale, Luke; Grant, Adrian; Fraser, Cynthia; MacLennan, Graeme; N'Dow, James; Benign Prostatic Enlargement Team.

In: British Medical Journal, Vol. 337, 30.06.2008.

Research output: Contribution to journalArticle

Lourenco, Tania ; Pickard, Robert ; Vale, Luke ; Grant, Adrian ; Fraser, Cynthia ; MacLennan, Graeme ; N'Dow, James ; Benign Prostatic Enlargement Team. / Alternative approaches to endoscopic ablation for benign enlargement of the prostate : systematic review of randomised controlled trials. In: British Medical Journal. 2008 ; Vol. 337.
@article{d6705741ba374bb4b1d37b23bdaa20dc,
title = "Alternative approaches to endoscopic ablation for benign enlargement of the prostate: systematic review of randomised controlled trials",
abstract = "Objective To compare the effectiveness and risk profile of newer methods for endoscopic ablation of the prostate against the current standard of transurethral resection.Design Systematic review and meta-,analysis.Data sources Electronic and paper records in,subject area up to March 2006.Review methods We searched for randomised controlled trials of endoscopic ablative interventions that included transurethral resection of prostate as one of the treatment arms. Two reviewers independently extracted data and assessed quality. Meta-analyses of prespecified outcomes were done using fixed and random effects models and reported using relative risk or weighted mean difference.Results We>dentified 45 randomised, controlled trials meeting the inclusion criteria and reporting on 3970 participants 'The reports were of moderate to poor quality, with small sample sizes. None of the newer technologies resulted in significantly greater improvement in symptoms than transurethral resection at 12 months, although a trend suggested a better outcome with holmium laser nucleation (random effects weighted mean difference -0.82, 95{\%} confidence interval 1.76 to 0.12) and worse outcome with laser vaporisation (1.49, -0.40 to 3.39). Improvements in secondary measures, such as peak urine flow rate, we're consistent with change in symptoms. Blood transfusion rates were higher for transurethral resection than for the newer methods (4.8{\%} v 0.7{\%}) and men undergoing laser vaporisation or diathermy vaporisation were more likely to experience urinary retention (6.7{\%} v 2.3{\%} and 3.6{\%} v 1.1{\%}). Hospital stay was up to one day shorter for the newer technologies.Conclusions Although men undergoing more modern methods of removing benign prostatic enlargement have similar outcomes to standard transurethrat resection of prostate along with fewer requirements for blood transfusion and shorter hospital stay, the quality of current evidence is poor. The lack of any clearly more effective procedure,suggests that transurethral-resection should remain the standard approach.",
keywords = "methodological quality , publication bias, clinical-trials, health-care, metaanalysis",
author = "Tania Lourenco and Robert Pickard and Luke Vale and Adrian Grant and Cynthia Fraser and Graeme MacLennan and James N'Dow and {Benign Prostatic Enlargement Team}",
year = "2008",
month = "6",
day = "30",
doi = "10.1136/bmj.39575.517674.BE",
language = "English",
volume = "337",
journal = "BMJ",
issn = "0959-8146",
publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Alternative approaches to endoscopic ablation for benign enlargement of the prostate

T2 - systematic review of randomised controlled trials

AU - Lourenco, Tania

AU - Pickard, Robert

AU - Vale, Luke

AU - Grant, Adrian

AU - Fraser, Cynthia

AU - MacLennan, Graeme

AU - N'Dow, James

AU - Benign Prostatic Enlargement Team

PY - 2008/6/30

Y1 - 2008/6/30

N2 - Objective To compare the effectiveness and risk profile of newer methods for endoscopic ablation of the prostate against the current standard of transurethral resection.Design Systematic review and meta-,analysis.Data sources Electronic and paper records in,subject area up to March 2006.Review methods We searched for randomised controlled trials of endoscopic ablative interventions that included transurethral resection of prostate as one of the treatment arms. Two reviewers independently extracted data and assessed quality. Meta-analyses of prespecified outcomes were done using fixed and random effects models and reported using relative risk or weighted mean difference.Results We>dentified 45 randomised, controlled trials meeting the inclusion criteria and reporting on 3970 participants 'The reports were of moderate to poor quality, with small sample sizes. None of the newer technologies resulted in significantly greater improvement in symptoms than transurethral resection at 12 months, although a trend suggested a better outcome with holmium laser nucleation (random effects weighted mean difference -0.82, 95% confidence interval 1.76 to 0.12) and worse outcome with laser vaporisation (1.49, -0.40 to 3.39). Improvements in secondary measures, such as peak urine flow rate, we're consistent with change in symptoms. Blood transfusion rates were higher for transurethral resection than for the newer methods (4.8% v 0.7%) and men undergoing laser vaporisation or diathermy vaporisation were more likely to experience urinary retention (6.7% v 2.3% and 3.6% v 1.1%). Hospital stay was up to one day shorter for the newer technologies.Conclusions Although men undergoing more modern methods of removing benign prostatic enlargement have similar outcomes to standard transurethrat resection of prostate along with fewer requirements for blood transfusion and shorter hospital stay, the quality of current evidence is poor. The lack of any clearly more effective procedure,suggests that transurethral-resection should remain the standard approach.

AB - Objective To compare the effectiveness and risk profile of newer methods for endoscopic ablation of the prostate against the current standard of transurethral resection.Design Systematic review and meta-,analysis.Data sources Electronic and paper records in,subject area up to March 2006.Review methods We searched for randomised controlled trials of endoscopic ablative interventions that included transurethral resection of prostate as one of the treatment arms. Two reviewers independently extracted data and assessed quality. Meta-analyses of prespecified outcomes were done using fixed and random effects models and reported using relative risk or weighted mean difference.Results We>dentified 45 randomised, controlled trials meeting the inclusion criteria and reporting on 3970 participants 'The reports were of moderate to poor quality, with small sample sizes. None of the newer technologies resulted in significantly greater improvement in symptoms than transurethral resection at 12 months, although a trend suggested a better outcome with holmium laser nucleation (random effects weighted mean difference -0.82, 95% confidence interval 1.76 to 0.12) and worse outcome with laser vaporisation (1.49, -0.40 to 3.39). Improvements in secondary measures, such as peak urine flow rate, we're consistent with change in symptoms. Blood transfusion rates were higher for transurethral resection than for the newer methods (4.8% v 0.7%) and men undergoing laser vaporisation or diathermy vaporisation were more likely to experience urinary retention (6.7% v 2.3% and 3.6% v 1.1%). Hospital stay was up to one day shorter for the newer technologies.Conclusions Although men undergoing more modern methods of removing benign prostatic enlargement have similar outcomes to standard transurethrat resection of prostate along with fewer requirements for blood transfusion and shorter hospital stay, the quality of current evidence is poor. The lack of any clearly more effective procedure,suggests that transurethral-resection should remain the standard approach.

KW - methodological quality

KW - publication bias

KW - clinical-trials

KW - health-care

KW - metaanalysis

U2 - 10.1136/bmj.39575.517674.BE

DO - 10.1136/bmj.39575.517674.BE

M3 - Article

VL - 337

JO - BMJ

JF - BMJ

SN - 0959-8146

ER -