Summary of findings for the main comparison. PUL compared to TURP for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia (short term).
| PUL compared to TURP for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia (short term) | |||||
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Participants: men with BPH Setting: multicentre/Europe Intervention: PUL Control: TURP | |||||
| Outcomes | No of participants (studies) | Certainty of the evidence (GRADE) | Relative effect (95% CI) | Anticipated absolute effects* (95% CI) | |
| Risk with TURP | Risk difference with PUL | ||||
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Urological symptom scores
assessed with: International Prostate Symptom Score
Scale from: 0 (best; not at all) to 35 (worst; almost always) Follow‐up: mean 12 months |
72 (1 RCT) | ⊕⊕⊝⊝ Lowa,b | — | The mean change of urological symptom scores was –15.4 | MD 4.5 higher (1.1 higher to 7.9 higher) |
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Quality of life
assessed with: International Prostate Symptom Score – Quality of Life
Scale from: 0 (best; delighted) to 6 (worst; terrible) Follow‐up: mean 12 months |
72 (1 RCT) | ⊕⊕⊝⊝ Lowa,b | — | The mean change of quality of life was –3.1 | MD 0.3 higher (0.49 lower to 1.09 higher) |
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Major adverse events Follow‐up: mean 12 months |
79 (1 RCT) | ⊕⊝⊝⊝ Very lowc,d | RR 0.64 (0.18 to 2.19) | Study population | |
| 143 per 1000 | 51 fewer per 1000 (117 fewer to 170 more) | ||||
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Retreatment Follow‐up: mean 12 months |
79 (1 RCT) | ⊕⊝⊝⊝ Very lowc,d | RR 1.19 (0.21 to 6.75) | Study population | |
| 57 per 1000 | 11 more per 1000 (45 fewer to 329 more) | ||||
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Erectile function
assessed with: Sexual Health Inventory for Men
Scale from: 1 (worst; severe erectile dysfunction) to 25 (best; no erectile dysfunction) Follow‐up: mean 12 months |
59 (1 RCT) | ⊕⊕⊕⊝ Moderatea | — | The mean change of erectile function was –0.9 | MD 0.8 higher (1.5 lower to 3.1 higher) |
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Ejaculatory function
assessed with: Male Sexual Health Questionnaire for Ejaculatory Dysfunction
Scale from: 1 (worst) to 15 (best) Follow‐up: mean 12 months |
59 (1 RCT) | ⊕⊕⊕⊝ Moderatea,e | — | The mean change of ejaculatory function was –3.7 | MD 5 higher (3.08 higher to 6.92 higher) |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). BPH: benign prostatic hyperplasia; CI: confidence interval; MD: mean difference; PUL: prostatic urethral lift; RCT: randomized controlled trial; RR: risk ratio; TURP: transurethral resection of prostate. | |||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | |||||
aDowngraded one level for study limitations: high risk of performance or detection bias, or both; high or unclear risk of attrition bias. bDowngraded one level for imprecision: confidence interval crossed assumed threshold of clinically important difference. cDowngraded one level for study limitations: high risk of performance bias. dDowngraded two levels for imprecision: wide confidence interval crossed assumed threshold of clinically important difference. eMinimal clinically important difference: 25% improvement (greater than 2.5 points) from the baseline (PUL: 11; TURP: 9).