TY - JOUR
T1 - Erectile Function Following Surgery for Benign Prostatic Obstruction
T2 - A Systematic Review and Network Meta-analysis of Randomised Controlled Trials
AU - Light, Alexander
AU - Jabarkhyl, Dost
AU - Gilling, Peter
AU - George, Gincy
AU - Van Hemelrijck, Mieke
AU - Challacombe, Ben
AU - Malde, Sachin
AU - Popert, Rick
AU - Dasgupta, Prokar
AU - Elhage, Oussama
N1 - Publisher Copyright:
© 2021 European Association of Urology
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/8
Y1 - 2021/8
N2 - Context: Benign prostatic obstruction (BPO) is associated with sexual dysfunction. Furthermore, numerous BPO interventions may themselves impact sexual function. Objective: To perform a systematic review with network meta-analysis to evaluate how BPO interventions affect erectile function. Evidence acquisition: Three databases were searched for randomised controlled trials (RCTs) comparing surgical interventions for BPO. The primary outcome was postoperative International Index of Erectile Function-5 (IIEF-5) score at ten time points up to 72 mo. A random-effects Bayesian network meta-analysis with meta-regression was performed. In comparison to monopolar transurethral resection (mTURP), the mean difference (MD) with 95% credible interval (CrI) and rank probability (rank p) were calculated for interventions. The mean baseline score was studied in meta-regression. τ2 values were used to quantify heterogeneity. Evidence synthesis: A total of 48 papers (33 RCTs, 5159 patients, 16 interventions) were included. Prostatic urethral lift (PUL) ranked highest at 1 mo (MD 3.88, 95% CrI −0.47 to 8.25; rank p = 0.742), 6 mo (MD 2.43, 95% CrI −0.72 to 5.62; rank p = 0.581), 12 mo (MD 2.94, 95% CrI −0.26 to 6.12, rank p = 0.782), and 24 mo (MD 3.63, 95% CrI 0.14 to 7.11; rank p = 0.948), at which point statistical significance was reached. At time points up to 60 mo, there were no statistically significant comparisons for other interventions. Analyses were not possible at 18, 48, or 72 mo. β did not reach statistical significance in meta-regression. τ2 was highest at 1 mo (0.56) and 60 mo (0.55). Conclusions: PUL ranked highly and resulted in erectile function improvement at 24 mo compared to mTURP, but direct evidence is lacking. We did not observe significant differences in erectile function following other interventions up to 60 mo. Owing to heterogeneity, our conclusions are weakest at 1 and 60 mo. Further RCTs comparing sexual function outcomes are recommended, such as PUL versus holmium laser or bipolar enucleation. Patient summary: Different surgical treatments can be used to treat benign enlargement of the prostate causing urinary problems. We compared the effects of various treatments on erectile function at time points up to 5 years after surgery. Compared to surgical removal of some of the prostate gland (transurethral resection of the prostate, TURP), a technique called prostatic urethral lift resulted in better erectile function scores at 24 months. However, other treatments did not differ in their effect on erectile function.
AB - Context: Benign prostatic obstruction (BPO) is associated with sexual dysfunction. Furthermore, numerous BPO interventions may themselves impact sexual function. Objective: To perform a systematic review with network meta-analysis to evaluate how BPO interventions affect erectile function. Evidence acquisition: Three databases were searched for randomised controlled trials (RCTs) comparing surgical interventions for BPO. The primary outcome was postoperative International Index of Erectile Function-5 (IIEF-5) score at ten time points up to 72 mo. A random-effects Bayesian network meta-analysis with meta-regression was performed. In comparison to monopolar transurethral resection (mTURP), the mean difference (MD) with 95% credible interval (CrI) and rank probability (rank p) were calculated for interventions. The mean baseline score was studied in meta-regression. τ2 values were used to quantify heterogeneity. Evidence synthesis: A total of 48 papers (33 RCTs, 5159 patients, 16 interventions) were included. Prostatic urethral lift (PUL) ranked highest at 1 mo (MD 3.88, 95% CrI −0.47 to 8.25; rank p = 0.742), 6 mo (MD 2.43, 95% CrI −0.72 to 5.62; rank p = 0.581), 12 mo (MD 2.94, 95% CrI −0.26 to 6.12, rank p = 0.782), and 24 mo (MD 3.63, 95% CrI 0.14 to 7.11; rank p = 0.948), at which point statistical significance was reached. At time points up to 60 mo, there were no statistically significant comparisons for other interventions. Analyses were not possible at 18, 48, or 72 mo. β did not reach statistical significance in meta-regression. τ2 was highest at 1 mo (0.56) and 60 mo (0.55). Conclusions: PUL ranked highly and resulted in erectile function improvement at 24 mo compared to mTURP, but direct evidence is lacking. We did not observe significant differences in erectile function following other interventions up to 60 mo. Owing to heterogeneity, our conclusions are weakest at 1 and 60 mo. Further RCTs comparing sexual function outcomes are recommended, such as PUL versus holmium laser or bipolar enucleation. Patient summary: Different surgical treatments can be used to treat benign enlargement of the prostate causing urinary problems. We compared the effects of various treatments on erectile function at time points up to 5 years after surgery. Compared to surgical removal of some of the prostate gland (transurethral resection of the prostate, TURP), a technique called prostatic urethral lift resulted in better erectile function scores at 24 months. However, other treatments did not differ in their effect on erectile function.
KW - Benign prostatic hyperplasia
KW - Benign prostatic obstruction
KW - Ejaculation
KW - Ejaculatory dysfunction
KW - Erectile dysfunction
KW - Erectile function
KW - International Index of Erectile Function-5
KW - Network meta-analysis
KW - Prostatic urethral lift
KW - Sexual function
UR - http://www.scopus.com/inward/record.url?scp=85107843029&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2021.04.012
DO - 10.1016/j.eururo.2021.04.012
M3 - Review article
AN - SCOPUS:85107843029
SN - 0302-2838
VL - 80
SP - 174
EP - 187
JO - European Urology
JF - European Urology
IS - 2
ER -