Authors' objectives:

To compare the safety and efficacy of several minimally invasive techniques for the relief of bladder outflow obstruction with standard transurethral resection of the prostate (TURP).

Authors' results and conclusions: The small sample size and poor evidence quality of many studies meant that no definitive conclusion could be made regarding the safety and efficacy of: 1. Visual laser ablation of the prostate (VLAP), interstitial laser coagulation (ILC) or contact vaporisation of the prostate (LCV), in comparison to TURP. - Nonetheless, the current limited evidence suggested that safety favoured VLAP, ILC and LCV whereas effectiveness favoured TURP. All three laser techniques achieved generally comparable improvements in symptom score, maximum urinary flow rate (Qmax) and post void residual urine volume (PVR) but LCV appeared to be safer than VLAP and ILC. 2. High intensity focused ultrasound (HIFU), transurethral microwave therapy (TUMT) or transurethral needle ablation (TUNA), in comparison to TURP. - Nonetheless, the current evidence suggested that safety favoured HIFU, TUMT and TUNA whereas effectiveness favoured TURP. A meta-analysis of TURP versus transurethral electrovaporisation of the prostate (TUVP) trials showed that TUVP offered a similar degree of symptomatic relief over a one to two year period, compared to TURP, but with less morbidity.

Authors' recommendations: The ASERNIP-S Review Group concluded that the evidence base for VLAP, ILC and LCV was inadequate, and recommended that a controlled clinical trial of ILC be conducted and an audit of VLAP and LCV be undertaken. In relation to non-laser techniques, the Review Group concluded that TUVP was a suitable alternative to TURP for certain patient groups. The evidence base for HIFU, TUMT and TUNA was found to be inadequate; recommendations were made that a controlled clinical trial of HIFU and TUMT be conducted and an audit of TUNA be undertaken.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.surgeons.org/asernip-s/

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Australian Safety and Efficacy Register of New Interventional Procedures-Surgical

Contact Address: ASERNIP-S 24 King William Street, Kent Town SA 5067 Australia Tel: +61 8 8219 0900

Contact Name: racs.asernip@surgeons.org

Contact Email: racs.asernip@surgeons.org

Copyright: Australian Safety and Efficacy Register of New Interventional Procedures - Surgical