An Indirect Comparison of Newer Minimally Invasive Treatments for Benign Prostatic Hyperplasia: A Network Meta-Analysis Model.

Tanneru, Karthik; Jazayeri, Seyedbehzad; Muhammad, Alam; Kumar, Jatinder; Bazargani, Soroush; Kuntz, Gretchen; PalayapalayamGanapathi, Hariharan; Bandyk, Mark; Marino, Robert; Koochekpour, Shahriar; Gautam, Shiva; K C, Balaji; Costa, Joseph

Objective This study was designed to provide an indirect comparison of the urinary and sexual domain outcomes and complications following newer minimally invasive surgical therapy (MIST) of Aquablation, Rezum, and UroLift for benign prostatic hyperplasia (BPH) to transurethral resection of prostate (TURP). Methods We searched Embase, Medline, and Cochrane in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA), in December 2019. Only randomized clinical trials (RCTs) that reported outcomes following treatment of BPH for prostate less than 80g with Aquablation, Rezum, or UroLift, were included in the analysis. Results A total of 4 RCTs reporting the outcomes after treatment with newer MIST for BPH were identified. Patients undergoing the resective procedures i.e. TURP and Aquablation, had greater improvement in urinary domain outcomes: International Prostate Symptom Score, Quality of Life, peak flow rate and Post Voiding Residual compared to patients undergoing non-resective procedures: UroLift and Rezum. Patients in UroLift group maintained a higher sexual function domain score compared to TURP but not Aquablation. Our multiple comparison analysis did not reveal a significant difference in urinary and sexual domain scores between patients undergoing UroLift and Rezum at 24 months of follow-up. Conclusions Aquablation and TURP necessitate general or regional anesthesia, both produced significantly better urinary domain scores compared to Rezum and UroLift. On the other hand, UroLift demonstrated better sexual function domain scores compared to TURP but not Aquablation. There was no significant difference in urinary domain scores between UroLift and Rezum at 24 months follow up.