A systematic review and network meta‐analysis comparing Rezūm with transurethral needle ablation and microwave thermotherapy for the management of enlarged prostate
Abstract
Objectives: We aim to compare efficacy and safety of water vapour therapy (Rezūm), transurethral needle ablation (TUNA) and transurethral microwave therapy (TUMT) for treating men with moderate to severe benign prostatic hyperplasia (BPH) symptoms. Materials: PubMed/MEDLINE, EMBASE and Cochrane Library were searched from inception to 30 July 2023, followed by reference searching and dual-independent study selection. We analysed only randomized clinical trials. RoB-2, NIH-quality assessment tool and GRADE guidelines were used for quality-of-evidence (QoE) assessment. Relevant prospective studies without a critical risk-of-bias were included. Results: At 12 months, Rezūm showed similar efficacy to TUNA and TUMT for improvement in International Prostate Symptoms Score - Rezūm versus TUMT: 1.33 points (95% CI: -1.66 to 4.35) favouring TUMT (QoE: Moderate) and Rezūm versus TUNA: 0.07 points (95% CI: -3.64 to 3.88) favouring TUNA (QoE: Low). Rezum had similar outcomes to TUNA and TUMT for Maximum Peak-Flow Rate (Qmax): Rezūm versus TUMT: 1.05 mL/s (95% CI: -4.88 to 2.82) favouring Rezūm (QoE: Low) and Rezūm versus TUNA: 0.37 mL/s (95% CI: -4.61 to 4.21) favouring TUNA (QoE: Low). Furthermore, post-void residual volume (PVR) comparisons demonstrated that Rezūm was similar, or inferior to other techniques at 12 months - Rezūm versus TUMT: 11.20 mL (95% CI: -32.40 to 10.30) favouring TUMT (QoE: Low) and Rezūm versus TUNA: 24.10 mL (95% CI: 2.81 to 45.10) favouring TUNA (QoE: Low).…
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