In late April 2021, the European Network for Health Technology Assessment, EUnetHTA, released a final report on the comparative effectiveness of surgical techniques and devices for the treatment of benign prostatic hyperplasia. The evaluation was initiated in May 2020 in partnership with the Austrian Institute for HTA (AIHTA) and aimed to assess 21 minimally invasive surgical treatments for benign prostatic hyperplasia, either comparing minimally invasive treatments to each other or a standard surgical treatment such as transurethral resection of the prostate or open prostatectomy, in patients with an indication for surgical treatment.
The following conclusions are provided:
- Few comparisons revealed statistically significant differences among functional outcomes, although the results in most cases are below the minimal clinically important difference threshold. The quality of the related evidence has been graded as low to very low, suggesting limited confidence in the estimates and that further research is likely to change these estimates;
- The thulium laser enucleation of the prostate, transurethral incision of the prostate, aquablation, and prostatic urethral lift may provide some advantage over transurethral resection of the prostate in terms of the impact on sexual activity: evidence quality ranges from moderate (reduced impact on retrograde ejaculation for patients with small prostates undergoing transurethral incision of the prostate) to low or very low;
- For safety concerns and side effects, some newer technologies may offer some advantage over transurethral resection of the prostate by reducing the transfusion requirement; a few technologies showed evidence of a positive or negative effect on urinary tract infection and incontinence;
- Small sample sizes, biases in study design, heterogeneous populations, and an undefined primary hypothesis indicate the need for more and better research so that the advantages and disadvantages of all these technologies can be more clearly defined.
The full details in English can be found here.
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