Minimally invasive treatments for benign prostatic enlargement: systematic review of randomised controlled trials

The Benign Prostatic Enlargement Team

Research output: Contribution to journalArticle

50 Citations (Scopus)
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Abstract

Objective To compare the effectiveness and risk profile of minimally invasive interventions against the current standard of transurethral resection of the prostate.

Design Systematic review and meta-analysis of randomised controlled trials.

Data sources Electronic and paper records up to March 2006.

Review methods We searched for all relevant randomised controlled trials. Two reviewers independently extracted data and assessed quality. Meta-analyses of prespecified outcomes were performed with fixed and random effects models and reported using relative risks or weighted mean difference.

Results 3794 abstracts were identified; 22 randomised controlled trials met the inclusion criteria. These provided data on 2434 participants. The studies evaluated were of moderate to poor quality with small sample sizes. Minimally invasive interventions were less effective than transurethral resection of the prostate in terms of improvement in symptom scores and increase in urine flow rate, with most comparisons showing significance despite wide confidence intervals. Rates of reoperation were significantly higher for minimally invasive treatments. The risk profile of minimally invasive interventions was better than that of transurethral resection, with fewer adverse events. The results, however, showed significant heterogeneity.

Conclusion Which minimally invasive intervention is the most promising remains unclear. Their place in the management of benign prostate enlargement will continue to remain controversial until well designed and well reported randomised controlled trials following CONSORT guidelines prove they are superior and more cost effective than drug treatment, or that strategies of sequential surgical treatments are preferred by patients and are more cost effective than the more invasive but more effective tissue ablative interventions such as transurethral resection.
Original languageEnglish
Article numbera1662
Number of pages8
JournalBritish Medical Journal
Volume337
DOIs
Publication statusPublished - 9 Oct 2008

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Randomized Controlled Trials
Transurethral Resection of Prostate
Meta-Analysis
Drug Costs
Information Storage and Retrieval
Reoperation
Sample Size
Prostate
Therapeutics
Urine
Guidelines
Confidence Intervals
Costs and Cost Analysis

Keywords

  • catheter ablation
  • endoscopy
  • prostatic hyperplasia

Cite this

Minimally invasive treatments for benign prostatic enlargement : systematic review of randomised controlled trials. / The Benign Prostatic Enlargement Team.

In: British Medical Journal, Vol. 337, a1662, 09.10.2008.

Research output: Contribution to journalArticle

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abstract = "Objective To compare the effectiveness and risk profile of minimally invasive interventions against the current standard of transurethral resection of the prostate.Design Systematic review and meta-analysis of randomised controlled trials.Data sources Electronic and paper records up to March 2006.Review methods We searched for all relevant randomised controlled trials. Two reviewers independently extracted data and assessed quality. Meta-analyses of prespecified outcomes were performed with fixed and random effects models and reported using relative risks or weighted mean difference.Results 3794 abstracts were identified; 22 randomised controlled trials met the inclusion criteria. These provided data on 2434 participants. The studies evaluated were of moderate to poor quality with small sample sizes. Minimally invasive interventions were less effective than transurethral resection of the prostate in terms of improvement in symptom scores and increase in urine flow rate, with most comparisons showing significance despite wide confidence intervals. Rates of reoperation were significantly higher for minimally invasive treatments. The risk profile of minimally invasive interventions was better than that of transurethral resection, with fewer adverse events. The results, however, showed significant heterogeneity.Conclusion Which minimally invasive intervention is the most promising remains unclear. Their place in the management of benign prostate enlargement will continue to remain controversial until well designed and well reported randomised controlled trials following CONSORT guidelines prove they are superior and more cost effective than drug treatment, or that strategies of sequential surgical treatments are preferred by patients and are more cost effective than the more invasive but more effective tissue ablative interventions such as transurethral resection.",
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AU - Pickard, Robert

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AU - Fraser, Cynthia

AU - MacLennan, Graeme

AU - N'Dow, James

AU - The Benign Prostatic Enlargement Team

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N2 - Objective To compare the effectiveness and risk profile of minimally invasive interventions against the current standard of transurethral resection of the prostate.Design Systematic review and meta-analysis of randomised controlled trials.Data sources Electronic and paper records up to March 2006.Review methods We searched for all relevant randomised controlled trials. Two reviewers independently extracted data and assessed quality. Meta-analyses of prespecified outcomes were performed with fixed and random effects models and reported using relative risks or weighted mean difference.Results 3794 abstracts were identified; 22 randomised controlled trials met the inclusion criteria. These provided data on 2434 participants. The studies evaluated were of moderate to poor quality with small sample sizes. Minimally invasive interventions were less effective than transurethral resection of the prostate in terms of improvement in symptom scores and increase in urine flow rate, with most comparisons showing significance despite wide confidence intervals. Rates of reoperation were significantly higher for minimally invasive treatments. The risk profile of minimally invasive interventions was better than that of transurethral resection, with fewer adverse events. The results, however, showed significant heterogeneity.Conclusion Which minimally invasive intervention is the most promising remains unclear. Their place in the management of benign prostate enlargement will continue to remain controversial until well designed and well reported randomised controlled trials following CONSORT guidelines prove they are superior and more cost effective than drug treatment, or that strategies of sequential surgical treatments are preferred by patients and are more cost effective than the more invasive but more effective tissue ablative interventions such as transurethral resection.

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