Re: Comparative Efficacy and Safety of New Surgical Treatments for Benign Prostatic Hyperplasia: Systematic Review and Network Meta-Analysis
Abstract
available at http://www.ncbi.nlm.nih.gov/pubmed/31727627 Editorial Comment: In his book, The Tyranny of Metrics, historian Jerry Muller writes about our reliance on data and how this may lead us astray. While his work focused on government and misinterpretation of studies leading to faulty programs, it has become readily apparent that the use and misuse of statistics often lead to overrepresentation of results and to downstream recommendations about diagnoses and treatments. This report examines the comparative efficacy of various surgical therapies for benign prostatic hyperplasia compared to monopolar transurethral prostatectomy (TURP). The authors analyzed 109 well-done studies of 13,676 men and evaluated changes in symptoms using International Prostate Symptom Score and peak flow rate. The study is a great example of intense and well-done statistical analyses using some of my favorite terms (many of which I utterly don’t understand), including Cochrane Collaboration risk of bias tool and the GRADE approach (grading of recommendations assessment, development and evaluation) to assess evidence quality. They conclude that most of the new procedures, including various laser iterations and bipolar TURP, fare better than monopolar TURP, although transient urinary incontinence may be of concern with enucleation methods. The article contains lots of lovely graphs and lines and bullet points going in every which direction. So what does this all mean? Part of the challenge of…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 13,676 participants or records.
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