Erectile function following surgery for benign prostatic hyperplasia: a systematic review and network meta-analysis of randomised-controlled trials
BAUS ePoster online library. Light A. 11/10/20; 304191; P8-10
Dr. Alexander Light
Dr. Alexander Light
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Erectile function following surgery for benign prostatic hyperplasia: a systematic review and network meta-analysis of randomised-controlled trials

Light A1,2, Jabarkhyl D3, Elhage O4, Dasgupta P4
1Department of Surgery, University of Cambridge, Addenbrooke's Hospital, United Kingdom, 2Bedford Hospital NHS Trust, United Kingdom, 3GKT School of Medical Education, King's College London, United Kingdom, 4Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom

Introduction:
Benign prostatic hyperplasia (BPH) is an independent risk factor for erectile dysfunction. Numerous treatment modalities have recently emerged for BPH. These all risk erectile dysfunction yet may also improve function. A systematic review with network meta-analysis is crucial for identifying which modality produces greatest erectile function benefit.
Materials and Methods: In October 2019, MEDLINE, Embase, and Web of Science were searched for randomised-controlled trials comparing BPH surgical interventions. The primary outcome was post-operative International Index of Erectile Function-5 (IIEF-5) score at 6, 12, 24, and 36 months. Bayesian network meta-analysis was performed with meta-regression using baseline IIEF-5 score as the covariate. Mean differences (MD) with 95% credible intervals (95% CrI) and rank probabilities (p) were calculated. PROSPERO registration: CRD42019155506.

Results:
48 studies (5156 patients) were included. Prostatic urethral lift (PUL) ranked highest for IIEF-5 score at 6 months (11 techniques; p=0.581; MD 2.4, 95% CrI -0.71-5.6), 12 months (12 techniques; p=0.782; MD 2.9, 95% CrI -0.26-6.1), and 24 months (9 techniques; p=0.948; MD 3.6, 95% CrI 0.14-7.1). At 36 months (6 techniques, not including PUL), bipolar transurethral resection of the prostate ranked highest (p=0.424; MD 0.25, 95% CrI -0.53-0.91). Lowest ranking treatments were laparoscopic simple prostatectomy at 6 months (p=0.360) and 36 months (p=0.461), prostatic arterial embolisation at 12 months (p=0.709), and Aquablation at 24 months (p=0.464).

Conclusions:
Based on network meta-analysis, PUL produces superior erectile function benefit up to 24 months. PUL data with longer follow-up is required, plus further RCTs analysing other new modalities.
Erectile function following surgery for benign prostatic hyperplasia: a systematic review and network meta-analysis of randomised-controlled trials

Light A1,2, Jabarkhyl D3, Elhage O4, Dasgupta P4
1Department of Surgery, University of Cambridge, Addenbrooke's Hospital, United Kingdom, 2Bedford Hospital NHS Trust, United Kingdom, 3GKT School of Medical Education, King's College London, United Kingdom, 4Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom

Introduction:
Benign prostatic hyperplasia (BPH) is an independent risk factor for erectile dysfunction. Numerous treatment modalities have recently emerged for BPH. These all risk erectile dysfunction yet may also improve function. A systematic review with network meta-analysis is crucial for identifying which modality produces greatest erectile function benefit.
Materials and Methods: In October 2019, MEDLINE, Embase, and Web of Science were searched for randomised-controlled trials comparing BPH surgical interventions. The primary outcome was post-operative International Index of Erectile Function-5 (IIEF-5) score at 6, 12, 24, and 36 months. Bayesian network meta-analysis was performed with meta-regression using baseline IIEF-5 score as the covariate. Mean differences (MD) with 95% credible intervals (95% CrI) and rank probabilities (p) were calculated. PROSPERO registration: CRD42019155506.

Results:
48 studies (5156 patients) were included. Prostatic urethral lift (PUL) ranked highest for IIEF-5 score at 6 months (11 techniques; p=0.581; MD 2.4, 95% CrI -0.71-5.6), 12 months (12 techniques; p=0.782; MD 2.9, 95% CrI -0.26-6.1), and 24 months (9 techniques; p=0.948; MD 3.6, 95% CrI 0.14-7.1). At 36 months (6 techniques, not including PUL), bipolar transurethral resection of the prostate ranked highest (p=0.424; MD 0.25, 95% CrI -0.53-0.91). Lowest ranking treatments were laparoscopic simple prostatectomy at 6 months (p=0.360) and 36 months (p=0.461), prostatic arterial embolisation at 12 months (p=0.709), and Aquablation at 24 months (p=0.464).

Conclusions:
Based on network meta-analysis, PUL produces superior erectile function benefit up to 24 months. PUL data with longer follow-up is required, plus further RCTs analysing other new modalities.
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