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. 2021 Jul 15;2021(7):CD013656. doi: 10.1002/14651858.CD013656.pub2

Summary of findings 1. Urologic symptoms scores ‐ short term.

Minimally invasive treatments versus transurethral resection of the prostate
Patient or population: men with moderate to severe lower urinary symptoms due to benign prostatic hyperplasia
Interventions: minimally invasive treatments
Comparator (reference): transurethral resection of the prostate
Setting: hospital procedure – outpatient follow‐up
Outcome: urinary symptoms scores
Measured by: IPSS range 0‐35 (lower scores indicate fewer symptoms)
Follow‐up: 3 to 12 months (most of the data is at 3 months follow‐up)
19 studies
1847 participants
Anticipated absolute effect (95% CI) * Certainty of the evidence Ranking (SUCRA) **
With TURP With a minimally invasive procedure
PUL (UroLift)
(mixed estimate)
Mean score in the included studies: 6.82 (range 5.1 to 12.6)a 1.47 higher (4.00 lower to 6.93 higher) ⊕⊕⊝⊝
LOW b c
2.8
(70.5%)
PAE
(mixed estimate)
1.55 higher (1.23 lower to 4.33 higher) ⊕⊕⊝⊝
LOW b d
2.9
(69.2%)
CRFWVT (Rezūm)
(indirect estimate)
3.60 higher (4.25 lower to 11.46 higher) ⊕⊕⊝⊝
LOW b c
3.9
(52.4%)
TUMT
(mixed estimate)
3.98 higher (0.85 higher to 7.10 higher) ⊕⊕⊝⊝
LOW b e
4.4
(43.0%)
TIND
(indirect estimate)
7.50 higher (0.68 lower to 15.69 higher) ⊕⊕⊝⊝
LOW b e
5.5
(21.5%)
CI: confidence interval; CRFWVT: convective radiofrequency water vapor therapy; IPSS: International Prostate Symptom Score; MD: mean difference; PAE: prostatic arterial embolization; PUL: prostatic urethral lift; SUCRA: surface under the cumulative ranking curve; TIND: temporary implantable nitinol device; TUMT: transurethral microwave thermotherapy; TURP: transurethral resection of prostate.
Network meta‐analysis summary of findings table definitions:
* Estimates are reported as mean difference and CI.
** Rank statistics is defined as the probability that a treatment out of n treatments in a network meta‐analysis is the best, the second, the third, and so on until the least effective treatment. Between brackets are the surface under the curve (SUCRA) estimates.
GRADE Working Group grades of evidence (or certainty of the 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.

aTURP was the highest‐ranked intervention for this outcome with a mean rank of 1.7 (SUCRA 88.9%)

bDowngraded by one level due to major concerns on within‐study bias: nearly all studies contributing to this estimate had an overall high risk of bias.

cDowngraded by one level due to major concerns on imprecision: the estimate crosses the threshold for minimally important difference (three points for IPSS) and the line of no effect.

dDowngraded by one level due to some concerns on imprecision and inconsistency (heterogeneity): the estimate and prediction interval cross one threshold for minimally important difference (three points for IPSS)

eDowngraded by one level due to some concerns regarding inconsistency (heterogeneity): the prediction interval crosses one threshold for minimally important difference (three points for IPSS).