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Minimally invasive treatments for benign prostatic enlargement: systematic review of randomised controlled trials

Objective To compare the effectiveness and risk profile of minimally invasive interventions against the current standard of transurethral resection of the prostate. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Electronic and paper records up to March 2006....

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Autores principales: Lourenco, Tania, Pickard, Robert, Vale, Luke, Grant, Adrian, Fraser, Cynthia, MacLennan, Graeme, N’Dow, James
Formato: Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2008
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565752/
https://www.ncbi.nlm.nih.gov/pubmed/18845591
http://dx.doi.org/10.1136/bmj.a1662
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author Lourenco, Tania
Pickard, Robert
Vale, Luke
Grant, Adrian
Fraser, Cynthia
MacLennan, Graeme
N’Dow, James
author_facet Lourenco, Tania
Pickard, Robert
Vale, Luke
Grant, Adrian
Fraser, Cynthia
MacLennan, Graeme
N’Dow, James
author_sort Lourenco, Tania
collection PubMed
description Objective To compare the effectiveness and risk profile of minimally invasive interventions against the current standard of transurethral resection of the prostate. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Electronic and paper records up to March 2006. Review methods We searched for all relevant randomised controlled trials. Two reviewers independently extracted data and assessed quality. Meta-analyses of prespecified outcomes were performed with fixed and random effects models and reported using relative risks or weighted mean difference. Results 3794 abstracts were identified; 22 randomised controlled trials met the inclusion criteria. These provided data on 2434 participants. The studies evaluated were of moderate to poor quality with small sample sizes. Minimally invasive interventions were less effective than transurethral resection of the prostate in terms of improvement in symptom scores and increase in urine flow rate, with most comparisons showing significance despite wide confidence intervals. Rates of reoperation were significantly higher for minimally invasive treatments. The risk profile of minimally invasive interventions was better than that of transurethral resection, with fewer adverse events. The results, however, showed significant heterogeneity. Conclusion Which minimally invasive intervention is the most promising remains unclear. Their place in the management of benign prostate enlargement will continue to remain controversial until well designed and well reported randomised controlled trials following CONSORT guidelines prove they are superior and more cost effective than drug treatment, or that strategies of sequential surgical treatments are preferred by patients and are more cost effective than the more invasive but more effective tissue ablative interventions such as transurethral resection.
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spelling pubmed-25657522008-10-15 Minimally invasive treatments for benign prostatic enlargement: systematic review of randomised controlled trials Lourenco, Tania Pickard, Robert Vale, Luke Grant, Adrian Fraser, Cynthia MacLennan, Graeme N’Dow, James BMJ Research Objective To compare the effectiveness and risk profile of minimally invasive interventions against the current standard of transurethral resection of the prostate. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Electronic and paper records up to March 2006. Review methods We searched for all relevant randomised controlled trials. Two reviewers independently extracted data and assessed quality. Meta-analyses of prespecified outcomes were performed with fixed and random effects models and reported using relative risks or weighted mean difference. Results 3794 abstracts were identified; 22 randomised controlled trials met the inclusion criteria. These provided data on 2434 participants. The studies evaluated were of moderate to poor quality with small sample sizes. Minimally invasive interventions were less effective than transurethral resection of the prostate in terms of improvement in symptom scores and increase in urine flow rate, with most comparisons showing significance despite wide confidence intervals. Rates of reoperation were significantly higher for minimally invasive treatments. The risk profile of minimally invasive interventions was better than that of transurethral resection, with fewer adverse events. The results, however, showed significant heterogeneity. Conclusion Which minimally invasive intervention is the most promising remains unclear. Their place in the management of benign prostate enlargement will continue to remain controversial until well designed and well reported randomised controlled trials following CONSORT guidelines prove they are superior and more cost effective than drug treatment, or that strategies of sequential surgical treatments are preferred by patients and are more cost effective than the more invasive but more effective tissue ablative interventions such as transurethral resection. BMJ Publishing Group Ltd. 2008-10-09 /pmc/articles/PMC2565752/ /pubmed/18845591 http://dx.doi.org/10.1136/bmj.a1662 Text en © Lourenco et al 2008 http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Lourenco, Tania
Pickard, Robert
Vale, Luke
Grant, Adrian
Fraser, Cynthia
MacLennan, Graeme
N’Dow, James
Minimally invasive treatments for benign prostatic enlargement: systematic review of randomised controlled trials
title Minimally invasive treatments for benign prostatic enlargement: systematic review of randomised controlled trials
title_full Minimally invasive treatments for benign prostatic enlargement: systematic review of randomised controlled trials
title_fullStr Minimally invasive treatments for benign prostatic enlargement: systematic review of randomised controlled trials
title_full_unstemmed Minimally invasive treatments for benign prostatic enlargement: systematic review of randomised controlled trials
title_short Minimally invasive treatments for benign prostatic enlargement: systematic review of randomised controlled trials
title_sort minimally invasive treatments for benign prostatic enlargement: systematic review of randomised controlled trials
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565752/
https://www.ncbi.nlm.nih.gov/pubmed/18845591
http://dx.doi.org/10.1136/bmj.a1662
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