Minimally invasive treatments for benign prostatic hyperplasia: a Cochrane network meta-analysis

Juan Victor Ariel Franco, Jae Hung Jung, Mari Imamura, Michael Borofsky, Muhammad Imran Omar, Camila Micaela Escobar Liquitay, Shamar J Young, Jafar Golzarian, Areti Angeliki Veroniki, Luis Garegnani, Philipp Dahm

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations


Objective: To assess the comparative effectiveness and ranking of minimally invasive treatments (MITs) for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Materials and Methods: We searched multiple databases up to 24 February 2021. We included randomized controlled trials assessing the following treatments: convective radiofrequency water vapour thermal therapy (WVTT; or Rezūm); prostatic arterial embolization (PAE); prostatic urethral lift (PUL; or Urolift); temporary implantable nitinol device (TIND); and transurethral microwave thermotherapy (TUMT) compared to transurethral resection of the prostate (TURP) or sham surgery. We performed a frequentist network meta-analysis. Results: We included 27 trials involving 3017 men. The overall certainty of the evidence of most outcomes according to GRADE was low to very low. Compared to TURP, we found that PUL and PAE may result in little to no difference in urological symptoms, while WVTT, TUMT and TIND may result in worse urological symptoms. MITs may result in little to no difference in quality of life, compared to TURP. MITs may result in a large reduction in major adverse events compared to TURP. We were uncertain about the effects of PAE and PUL on retreatment compared to TURP, however, TUMT may result in higher retreatment rates. We were very uncertain of the effects of MITs on erectile function and ejaculatory function. Among MITs, PUL and PAE had the highest likelihood of being the most efficacious for urinary symptoms and quality of life, TUMT for major adverse events, WVTT and TIND for erectile function and PUL for ejaculatory function. Excluding WVTT and TIND, for which there were only studies with short-term (3-month) follow-up, PUL had the highest likelihood of being the most efficacious for retreatment. Conclusions: Minimally invasive treatments may result in similar or worse effects concerning urinary symptoms and quality of life compared to TURP at short-term follow-up.

Original languageEnglish (US)
Pages (from-to)142-156
Number of pages15
JournalBJU International
Issue number2
StatePublished - Aug 2022

Bibliographical note

Funding Information:
This project was funded by the National Institute for Health Research (NIHR; Cochrane Incentive Award [NIHR130819]). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. We are very grateful to Cochrane Urology, especially Managing Editor Robert Lane, as well as Cochrane Urology Korea, for supporting this review. We are also grateful for the constructive feedback from the Cancer Network and the Methods Support Unit. We also thank Gretchen Kuntz for revising and providing feedback on the search strategies, Marco Blanker, Sevann Helo and Murad Mohammad for their peer review input on the protocol, Dominik Abt, Bilal Chughtai and Ahmed Higazy for providing details of the outcomes of their trials so they could be incorporated accurately in our review, and Marc Sapoval, Deepak Agarwal, Cameron Alexander, Harris Foster and Mitchell Humphreys for their peer review input on the review. Juan Víctor Ariel Franco is a PhD candidate in the Programme of Methodology of Biomedical Research and Public Health, Universitat Autònoma de Barcelona (Spain).

Publisher Copyright:
© 2021 The Authors BJU International © 2021 BJU International


  • #UroBPH
  • #UroUTI
  • #Urology
  • benign prostatic hyperplasia
  • lower urinary tract symptoms
  • minimally invasive treatments
  • network meta-analysis
  • prostatic arterial embolization
  • prostatic urethral lift
  • temporary implantable nitinol device
  • transurethral microwave thermotherapy

PubMed: MeSH publication types

  • Journal Article
  • Meta-Analysis
  • Review
  • Research Support, Non-U.S. Gov't


Dive into the research topics of 'Minimally invasive treatments for benign prostatic hyperplasia: a Cochrane network meta-analysis'. Together they form a unique fingerprint.

Cite this