Summary of findings 2. PUL compared to TURP for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia (long term).

PUL compared to TURP for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia (long term)
Participants: men with BPH Setting: multicentre in 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 (long term)	Risk difference with PUL
Urological symptom scores assessed with: International Prostate Symptom Score Scale from: 0 (best; not at all) to 35 (worst; almost always) Follow‐up: mean 24 months	69 (1 RCT)	⊕⊕⊝⊝ Lowa,b	—	The mean change of urological symptom scores was –15.3	MD 6.1 higher (2.16 higher to 10.04 higher)
Quality of life assessed with: International Prostate Symptom Score – Quality of Life Scale from: 0 (best; delighted) to 6 (worst; terrible) Follow‐up: mean 24 months	69 (1 RCT)	⊕⊕⊝⊝ Lowa,b	—	The mean change of quality of life was –3.3	MD 0.8 higher (0 to 1.6 higher)
Major adverse events	—	—	—	—	Not reported
Retreatment Follow‐up: mean 24 months	79 (1 RCT)	⊕⊝⊝⊝ Very lowc,d	RR 2.39 (0.51 to 11.10)	Study population
				57 per 1000	79 more per 1000 (28 fewer to 577 more)
				Assumed baseline risk
				40 per 1000e	56 more per 1000 (20 fewer to 404 more)
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 24 months	57 (1 RCT)	⊕⊕⊕⊝ Moderatea	—	The mean change of erectile function was –1.8	MD 1.6 higher (0.8 lower to 4 higher)
Ejaculatory function assessed with: Male Sexual Health Questionnaire for Ejaculatory Dysfunction Scale from: 1 (worst) to 15 (best) Follow‐up: mean 24 months	56 (1 RCT)	⊕⊕⊝⊝ Lowa,b,f	—	The mean change of ejaculatory function was –4	MD 4.3 higher (2.17 higher to 6.43 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 level for imprecision: wide confidence interval crossed assumed threshold of clinically important difference.
 ^eEstimates for control event rates for retreatment come from Strope 2015.
 ^fMinimal clinically important difference: 25% improvement (greater than 2.5 points) from the baseline (PUL: 11; TURP: 9).