A systematic review and network meta-analysis comparing Rezūm with transurethral needle ablation and microwave thermotherapy for the management of enlarged prostate

IF 1.6 Q3 UROLOGY & NEPHROLOGY BJUI compass Pub Date : 2024-04-29 DOI:10.1002/bco2.361

Ansh Bhatia, Joao G. Porto, Renil S. Titus, Vishal Ila, Khushi Shah, Ankur Malpani, Diana M. Lopategui, Robert Marcovich, Thomas R. W. Herrmann, Hemendra N. Shah

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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). Rezūm also had a similar surgical retreatment rate with TUMT and TUNA up to 3-years – TUMT versus Rezūm RR: 1.21 (95% CI: 0.20 to 15.90) (QoE: Low) and TUNA versus Rezūm showed RR: 1.81 (95% CI: 0.2 to 24.60) (QoE: Low). In the first 12 months after treatment, Rezūm had a higher rate of serious adverse events (Clavien-Dindo ≥ Grade 3) than TUMT and TUNA. TUMT versus Rezūm with RR = 0.53 (95% CI: 0.13 to 3.14) (QoE: Low) and TUNA versus Rezūm with RR = 0.38 (95% CI: 0.04 to 3.49) (QoE: Low).

Conclusions

Moderate to weak evidence suggests that Rezūm is not superior to TUNA and TUMT in all domains studied.

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系统性综述和网络荟萃分析：比较 Rezūm 与经尿道针头消融术和微波热疗在治疗前列腺肥大方面的效果

目的我们旨在比较水蒸气疗法（Rezūm）、经尿道针消融术（TUNA）和经尿道微波疗法（TUMT）治疗中重度良性前列腺增生症（BPH）男性患者的疗效和安全性。材料我们对 PubMed/MEDLINE、EMBASE 和 Cochrane 图书馆进行了检索，检索时间从开始到 2023 年 7 月 30 日，然后进行了参考文献检索和双重独立研究筛选。我们仅分析了随机临床试验。证据质量（QoE）评估采用了 RoB-2、NIH 质量评估工具和 GRADE 指南。我们纳入了没有严重偏倚风险的相关前瞻性研究。结果 12个月后，Rezūm与TUNA和TUMT相比，在改善国际前列腺症状评分方面显示出相似的疗效--Rezūm与TUMT相比：1.33分（95% CI：-1.66至4.35），TUMT更胜一筹（QoE：中度）；Rezūm与TUNA相比：0.07分（95% CI：-3.64至3.88），TUNA更胜一筹（QoE：低度）。在最大峰值流速（Qmax）方面，Rezum 的结果与 TUNA 和 TUMT 相似：Rezūm 与 TUMT 相比：1.05 mL/s（95% CI：-4.88 至 2.82），Rezūm 更优（QoE：低）；Rezūm 与 TUNA 相比：0.37 mL/s（95% CI：-4.61 至 4.21），TUNA 更优（QoE：低）。此外，排卵后残余容积（PVR）比较显示，12 个月时，Rezūm 与其他技术相似或逊于其他技术--Rezūm 与 TUMT 相比：11.20 mL（95% CI：-32.40 至 10.30），TUMT 更胜一筹（QoE：低）；Rezūm 与 TUNA 相比：24.10 mL（95% CI：2.81 至 45.10），TUNA 更胜一筹（QoE：低）。Rezūm与TUMT和TUNA的3年手术再治疗率也相似--TUMT与Rezūm相比RR：1.21（95% CI：0.20至15.90）（QoE：低），TUNA与Rezūm相比RR：1.81（95% CI：0.2至24.60）（QoE：低）。在治疗后的头 12 个月，Rezūm 的严重不良事件发生率（Clavien-Dindo ≥ 3 级）高于 TUMT 和 TUNA。TUMT与Rezūm相比，RR=0.53（95% CI：0.13至3.14）（QoE：低）；TUNA与Rezūm相比，RR=0.38（95% CI：0.04至3.49）（QoE：低）。结论中度到微弱的证据表明，Rezūm 在所有研究领域均不优于 TUNA 和 TUMT。

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