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

Summary of findings 3. Major adverse events.

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: major adverse events Defined as: Clavien‐Dindo Grade III, IV, and V, including hospitalizations and procedures to treat complications related to the initial intervention. Follow‐up: 3‐36 months
15 studies 1573 participants	Anticipated absolute effect (95% CI) *		Relative effect (95% CI)	Certainty of the evidence	Ranking (SUCRA) **
15 studies 1573 participants	With TURP	With a minimally invasive procedure	Relative effect (95% CI)	Certainty of the evidence	Ranking (SUCRA) **
TUMT (mixed estimate)	Median rate of major adverse events: 130 per 1000^a	104 fewer per 1000 (118 fewer to 74 fewer)	RR 0.20 (0.09 to 0.43)	⊕⊕⊕⊝ MODERATE ^b	2.7 (72.1%)
PUL (UroLift) (mixed estimate)		90 fewer per 1000 (125 fewer to 159 more)	RR 0.30 (0.04 to 2.22)	⊕⊕⊝⊝ LOW ^{b c}	3.6 (56.9%)
CRFWVT (Rezūm) (indirect estimate)		81 fewer per 1000 (129 fewer to 870 more)	RR 0.37 (0.01 to 18.68)	⊕⊕⊝⊝ LOW ^{b c}	4.0 (50.0%)
TIND (indirect estimate)		63 fewer per 1000 (129 fewer to 870 more)	RR 0.52 (0.01 to 24.46)	⊕⊕⊝⊝ LOW ^{b c}	4.3 (44.7%)
PAE (mixed estimate)		45 fewer per 1000 (97 to 89 more)	RR 0.65 (0.25 to 1.68)	⊕⊕⊝⊝ LOW ^{b c}	5.0 (33.6%)
CI: confidence interval; CRFWVT: convective radiofrequency water vapor therapy; IPSS: International Prostate Symptom Score; MD: mean difference; QoL: quality of life; PAE: prostatic arterial embolization; PUL: prostatic urethral lift; RR: risk ratio; 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 risk difference and confidence interval (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.

^aAverage rate of retreatment in the control group (13%) or 130 per 1000. TURP was the lowest‐ranked intervention for this outcome with a mean rank of 5.9 (SUCRA 17.9%)

^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: wide confidence interval.