Summary of findings 6. Ejaculatory function ‐ 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: ejaculatory function Defined as: men with ejaculatory dysfunction ‐ loss or substantial reduction in ejaculation (as an indication of retrograde ejaculation) Follow‐up: 3 to 12 months
8 studies 461 participants	Anticipated absolute effect (95% CI) *		Relative effect (95% CI)	Certainty of the evidence	Ranking (SUCRA) **
	With TURP	With a minimally invasive procedure
PUL (UroLift) (mixed estimate)	Median rate of ejaculatory dysfunction: 550 per 1000a	521 fewer per 1000 (549 fewer to 32 more)	RR 0.05 (0.01 to 1.06)	⊕⊝⊝⊝ VERY LOW b c d	1.2 (92.1%)
TUMT (mixed estimate)		364 fewer per 1000 (458 fewer to 173 fewer)	RR 0.34 (0.17 to 0.68)	⊕⊝⊝⊝ VERY LOW b c d	2.3 (55.1%)
PAE (mixed estimate)		356 fewer per 1000 (476 fewer to 42 fewer)	RR 0.35 (0.13 to 0.92)	⊕⊝⊝⊝ VERY LOW b c d	2.5 (51.1%)
CRFWVT (Rezūm) (pairwise)	Based on one study with 131 participants, CRFWVT may result in little to no difference in events of ejaculatory dysfunction compared to sham at short‐term follow‐up (RR 4.01, 95% CI 0.22 to 72.78).			⊕⊝⊝⊝ VERY LOW e	Data could not be included in NMA to preserve the transitivity of each network
TIND (pairwise)	The study assessing TIND compared to sham reported no events of ejaculatory dysfunction.			⊕⊝⊝⊝ VERY LOW e	Data could not be included in NMA to preserve the transitivity of each network
CI: confidence interval; CRFWVT: convective radiofrequency water vapor therapy; IPSS: International Prostate Symptom Score; NMA: network meta‐analysis; 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 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 (55%) or 550 per 1000. TURP was the lowest‐ranked intervention for this outcome with a mean rank of 4 (SUCRA 1.4%)

^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 concerns on inconsistency (heterogeneity): predictive intervals include substantial benefits and harms.

^dDowngraded by one level due to major concerns on incoherence: the network does not present close loops to assess incoherence.

^eDowngraded by two levels due to concerns on within‐study bias (single study at high risk of bias) and imprecision (wide confidence interval crossing the minimally importance difference).