Carnevale 2016.

Study characteristics
Methods	Study design: prospective, randomized, controlled study Study dates: November 2010 to December 2012 Setting: single center, national, outpatient/inpatient Country: Brazil
Participants	Inclusion criteria: men aged > 45 years; IPSS > 19; symptoms refractory to medical treatment for at least 6 months; negative screening for prostate cancer; prostate volume between 30 and 90 mL on magnetic resonance imaging; and bladder outlet obstruction confirmed by urodynamic examination. Exclusion criteria: men with renal failure, bladder calculi or diverticula, suspected prostate cancer, urethral stenosis, or neurogenic bladder disorders. Total number of participants randomly assigned:30 Group A (PAE) Number of all participants randomly assigned: 15 Age (years): 63.5 ± 8.7 Prostate volume (mL): 63.0 ± 17.8 PSA (ng/mL): 3.4 ± 2.2 IPSS: 25.3 ± 3.6 Qmax (mL/s): 7.0 ± 3.6 Group B (TURP) Number of all participants randomly assigned: 15 Age (years): 66.4 ± 5.6 Prostate volume (mL): 56.6 ± 21.5 PSA (ng/mL): 3.2 ± 2.5 IPSS: 27.6 ± 3.2 Qmax (mL/s): 9.7 ± 3.8
Interventions	Group A: PAE Group B: monopolar TURP Follow‐up: 12 months
Outcomes	Urologic symptom scores How measured: IPSS Time points measured: baseline and 1 year Time points reported: baseline and 1 year Subgroups: none Quality of life How measured: IPSS QoL Time points measured: baseline and 1 year Time points reported: baseline and 1 year Subgroups: none Erectile function How measured: IIEF‐5 Time points measured: baseline and 1 year Time points reported: baseline and 1 year Subgroups: none Retreatment How measured: Number of participants that received TURP Time points measured: baseline and 1 year Time points reported: baseline and 1 year Subgroups: none Minor and major adverse event (including ejaculatory function) How measured: National Cancer Institute Common Toxicity Criteria for Adverse Events, version 4.0 Time points measured: not reported Time points reported: not reported Subgroups: none Relevant outcomes not reported in this study: Indwelling urinary catheter (beyond 1 case due to hematuria) Acute urinary retention
Funding sources	No financial disclosure
Declarations of interest	None
Notes	Protocol: not available Language of publication: English
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Judgement: not described.
Allocation concealment (selection bias)	Unclear risk	Judgement: not described.
Blinding of participants and personnel (performance bias) Subjective outcomes	High risk	Judgement: not described; blinding highly unlikely to have taken place.
Blinding of outcome assessment (detection bias) Subjective outcomes	High risk	Judgement: not described; blinding highly unlikely to have taken place.
Blinding of outcome assessment (detection bias) Objective outcomes	Low risk	Judgement: objective outcomes are likely not affected by lack of blinding.
Incomplete outcome data (attrition bias) Urologic symptom scores/Quality of life	Low risk	Judgement: all randomized participants were included in the analysis (short term).
Incomplete outcome data (attrition bias) Major adverse events/minor adverse events	Low risk	Judgement: all randomized participants were included in the analysis (short term).
Incomplete outcome data (attrition bias) Retreatment	Low risk	Judgement: all randomized participants were included in the analysis (short term).
Incomplete outcome data (attrition bias) Erectile function	Low risk	Judgement: all randomized participants were included in the analysis (short term).
Incomplete outcome data (attrition bias) Ejaculatory function	Low risk	Judgement: all randomized participants were included in the analysis (short term).
Selective reporting (reporting bias)	Unclear risk	Judgement: study outcomes were well pre‐defined and described, but protocol was not found.
Other bias	Low risk	Judgement: statistical differences in baseline IIEF and Qmax, but those likely underestimates the effect size of PAE (more conservative).