Published 9 October 2008, doi:10.1136/bmj.a1662
Cite this as: BMJ 2008;337:a1662

Research

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

¹ Health Services Research Unit, Institute of Applied Health Sciences, University of Aberdeen , ² Department of Urology, School of Surgical and Reproductive Sciences, Newcastle University, Newcastle upon Tyne, ³ Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, ⁴ Academic Urology Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD

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.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Surgical treatments for men with benign prostatic enlargement: cost effectiveness study

Nigel Armstrong, Luke Vale, Mark Deverill, Ghulam Nabi, Samuel McClinton, James N’Dow, Robert Pickard, and for the BPE Study Group
BMJ 2009 338: b1288. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• Armstrong, N., Vale, L., Deverill, M., Nabi, G., McClinton, S., N'Dow, J., Pickard, R., for the BPE Study Group, (2009). Surgical treatments for men with benign prostatic enlargement: cost effectiveness study. BMJ 338: b1288-b1288 [Abstract] [Full text]  
• (2008). Minimally Invasive Treatments vs. Transurethral Resection for BPH. JWatch General 2008: 6-6 [Full text]  

Rapid Responses:

Read all Rapid Responses

Failing to include data from unpublished trials limits the findings of systematic reviews

Lorna M Gibson
bmj.com, 12 Oct 2008 [Full text]

Re: Failing to include data from unpublished trials limits the findings of systematic reviews

Tania Lourenco, et al.
bmj.com, 20 Oct 2008 [Full text]

Online poll

Find out more >>