Newer minimally invasive surgical treatments (MIST) like UroLift®, Rezūm™, and Aquablation have shown to be effective in improving urinary symptoms with the advantage of preserving sexual function. UroLift® and Rezūm™ have the added advantage of being offered as office-based procedures under local anesthesia, enabling an early return to normal activity.
Despite the advantages of MIST, many physicians across the world are apprehensive to choose these procedures due to lack of comparison with the gold standard TURP and head to head comparison of the newer MIST. To overcome this challenge, we used a network meta-analysis framework to indirectly compare the outcomes between these procedures. We limited our study to a prostate size of less than 80 grams and a follow-up period of two years as the data for the comparator TURP arm is not available beyond two years in the available literature.
The findings from our study can be used to develop index patients and facilitate easy discussion by the clinicians with their patients.
- TURP and Aquablation require general/regional anesthesia whereas UroLift® and Rezūm™ can be performed under local anesthesia/sedation in the office setting
- TURP and Aquablation have superior outcomes in the urinary domain scores compared to UroLift® and Rezūm™
- For patients who prefer office-based procedures and want better preservation of sexual function, UroLift® or Rezūm™ can be offered as an alternative to TURP
- For patients who want greater improvement in urinary domain scores, Aquablation can be offered as an alternative to TURP
Written by: Karthik Tanneru, MD, Jatinder Kumar, MD, Seyed Behzad Jazayeri, MD, Joseph Costa, MD, Department of Urology, University of Florida, Jacksonville, Florida
- Tanneru, Karthik, Seyedbehzad Jazayeri, Alam Muhammad, Jatinder Kumar, Soroush Bazargani, Gretchen Kuntz, Hariharan PalayapalayamGanapathi et al. "An Indirect Comparison of Newer Minimally Invasive Treatments for Benign Prostatic Hyperplasia: A Network Meta-Analysis Model." Journal of Endourology ja (2020).
- Tanneru, Karthik, Shiva Gautam, Daniel Norez, Jatinder Kumar, Muhammad Umar Alam, Shahriar Koocheckpour, K. C. Balaji, and Costa Joseph. "Meta-analysis and systematic review of intermediate-term follow-up of prostatic urethral lift for benign prostatic hyperplasia." International Urology and Nephrology (2020): 1-10.
- Gilling, Peter, Neil Barber, Mohamed Bidair, Paul Anderson, Mark Sutton, Tev Aho, Eugene Kramolowsky et al. "Two-year outcomes after aquablation compared to TURP: efficacy and ejaculatory improvements sustained." Advances in therapy 36, no. 6 (2019): 1326-1336.
- Roehrborn, Claus, Jack Barkin, Steven N. Gange, Neal D. Shore, Jonathan L. Giddens, Damien M. Bolton, Barrett E. Cowan et al. "Five year results of the prospective randomized controlled prostatic urethral LIFT study." Canadian Journal of Urology 24, no. 3 (2017): 8802-8813.
- “Five-Year Rezūm Outcomes Demonstrate Effective Long-Term BPH Treatment.” Accessed December 23, 2020. https://www.urotoday.com/recent-abstracts/men-s-health/bph-benign-prostatic-enlargement/120618-rezum-water-vapor-therapy-five-year-outcomes-demonstrate-effective-long-term-treatment-of-benign-prostatic-hyperplasia.html.