Ahmed 1997.

Study characteristics
Methods	Study design: prospective, randomized parallel study. Study dates: study dates not available Setting: outpatient, single‐centre, national Country: United Kingdom
Participants	Inclusion criteria: men with: Symptomatic uncomplicated BPH: > 1‐year history American Urological Association (AUA) score ≥ 12 Flow rate < 15 mL/s Post‐void residual urine volume (PVR) < 300 mL Voiding pressure at maximal flow (Pdet max) 70 cmH2O Prostate volume 25‐100 mL Obstructed as assessed on the Abrams‐Griffith nomogram Aged ≥ 55 years Informed consent Suitable for either treatment Exclusion criteria: men with: General (e.g. mental incapacity, severe cardiovascular disease, ‘active’ drugs); technically unsuitable; metallic implants; cardiac pacemaker; rectal surgery or disease (except hemorrhoids); pelvic mass or surgery; previous prostatic surgery; prostatic abscess; uncontrolled coagulation disorder; active UTI Urological: prominent middle lobe; meatal stricture; previous drug treatment for BPH ‘Complicated’ BPH: acute or chronic urinary retention; upper tract dilatation; obstructive uropathy (serum creatinine > 150 mmol/L); bladder calculi; bladder diverticulae; recurrent UTI; recurrent prostatic haematuria Total number of participantsrandomized: 60 Group 1: n = 30 transurethral microwave thermotherapy (TUMT) AUA score, median (range): 18.5 (17.1‐20.1) Age, median (range): 69.36 years (56‐88) Prostate volume, Median (IQR): 36.6 mL (31.8‐41.4) Qmax, median (range): 10.1mL/s (9.2‐10.9) Group 2: n = 30 transurethral resection of the prostate (TURP) AUA score, median (range):18.4 (16.7‐20.1) Age, median (range): 69.45 years (58‐82) Prostate volume, Median (IQR): 46.1 (38.1‐54.1) Qmax, median (range): 9.5 mL/s (8.9‐10.1)
Interventions	Group 1 (n = 30): TUMT Done by a single operator using the Prostatron treatment catheter using the Prostasoft software (TechnoMed, Lyon, France) in a single 60‐min session under topical anesthesia with Instillagel(r) (FarcoPharma GmBH, Cologne, Germany). Group 2 (n = 30): TURP Performed on the routine operating lists by a surgeon of Senior Registrar grade or above using a standard technique. No post‐operative irrigation was used and all the resected tissue was submitted for histological examination. The urethral catheter was removed 3 or 4 days after surgery. Co‐interventions: “Intramuscular gentamicin (80 mg) was given before the treatment and oral trimethoprim (200 mg twice daily) was continued for 5 days. The patients were followed up at 6 weeks, 3 and 6 months, with a detailed evaluation performed at the last assessment.”
Outcomes	Urologic symptom scores How measured: AUA symptom score Time points measured: baseline, 6 weeks, 3 and 6 months Time points reported: not reported (probably 6 months) Subgroups: none Indwelling urinary catheter/acute urinary retention How measured: number of patients requiring an indwelling catheter after treatment due to acute urinary retention Time points measured: 6 weeks, 3 and 6 months Time points reported: not reported Subgroups: none Major adverse event How measured: number of patients requiring blood transfusions after treatment. Time points measured: not reported Time points reported: not reported Subgroups: none Minor adverse event / Erectile function / Ejaculatory function How measured: number of patients developing urinary tract infections or meatal narrowing that required dilatation. Furthermore, adverse events related to erectile function and ejaculation are described under adverse events. Time points measured: not reported Time points reported: not reported Subgroups: none Relevant outcomes not reported in this study: Quality of life Retreatment
Funding sources	Not available
Declarations of interest	Not available
Notes	No contact information available. Protocol: not available Language of publication: English
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: “[...] patients were randomized to each treatment by selecting a sealed envelope. [...] Patients failing to complete treatment or return for follow‐up were substituted.” Insufficient information to permit judgement of ‘Low risk’ or ‘High risk’.
Allocation concealment (selection bias)	High risk	Quote: “[...] patients were randomized to each treatment by selecting a sealed envelope. [...] Patients failing to complete treatment or return for follow‐up were substituted.” Whereas envelopes might be sealed, substitution might indicate tampering of allocation.
Blinding of participants and personnel (performance bias) Subjective outcomes	High risk	Whereas blinding was not mentioned, the interventions were visibly different (surgery versus outpatient procedure). The subjective outcomes were likely to be influenced by lack of blinding.
Blinding of outcome assessment (detection bias) Subjective outcomes	High risk	Whereas blinding was not mentioned, the interventions were visibly different (surgery versus outpatient procedure). The subjective outcomes were likely to be influenced by lack of blinding.
Blinding of outcome assessment (detection bias) Objective outcomes	Low risk	Whereas blinding was not mentioned, the interventions were visibly different (surgery versus outpatient procedure). The objective outcomes were unlikely to be influenced by lack of blinding.
Incomplete outcome data (attrition bias) Urologic symptom scores/Quality of life	Unclear risk	Due to “substitution” noted above, the number of participants with missing outcome data was not provided.
Incomplete outcome data (attrition bias) Major adverse events/minor adverse events	Unclear risk	Due to “substitution” noted above, the number of participants with missing outcome data was not provided.
Incomplete outcome data (attrition bias) Erectile function	Unclear risk	Due to “substitution” noted above, the number of participants with missing outcome data was not provided.
Incomplete outcome data (attrition bias) Ejaculatory function	Unclear risk	Due to “substitution” noted above, the number of participants with missing outcome data was not provided.
Incomplete outcome data (attrition bias) Acute urinary retention	Unclear risk	Due to “substitution” noted above, the number of participants with missing outcome data was not provided.
Incomplete outcome data (attrition bias) Indwelling catheter	Unclear risk	Due to “substitution” noted above, the number of participants with missing outcome data was not provided.
Selective reporting (reporting bias)	Unclear risk	No protocol available. Insufficient information to permit judgement of ‘Low risk’ or ‘High risk’.
Other bias	Low risk	No other sources of bias were detected.