Systematic review of surgical treatments for benign prostatic hyperplasia and presentation of an approach to investigate therapeutic equivalence (non-inferiority)
Identifieur interne : 000163 ( Pascal/Corpus ); précédent : 000162; suivant : 000164Systematic review of surgical treatments for benign prostatic hyperplasia and presentation of an approach to investigate therapeutic equivalence (non-inferiority)
Auteurs : Katharina Biester ; Guido Skipka ; Rebecca Jahn ; Barbara Buchberger ; Volker Rohde ; Stefan LangeSource :
- BJU international : (Papier) [ 1464-4096 ] ; 2012.
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- Pascal (Inist)
English descriptors
- KwdEn :
Abstract
OBJECTIVE • To assess the potential additional benefit of non-standard vs standard surgical treatments for benign prostatic hyperplasia (BPH) and to present a new methodological approach to investigate therapeutic equivalence (non-inferiority) regarding symptom reduction. PATIENTS AND METHODS • We conducted a systematic review and searched MEDLINE, Embase and the Cochrane Library (last search: 10/2009) for randomized controlled trials (RCTs) and non-randomized controlled clinical trials (CCTs). • Eligible studies were those that included patients with symptomatic BPH requiring surgical treatment and which compared non-standard procedures (e.g. minimally invasive technologies) with standard ones (e.g. transurethral resection of the prostate, TURP). In addition, only studies analysing patient-relevant outcomes were considered (e.g. irritative and obstructive symptoms, length of hospital stay, quality of life and adverse events). • The main outcome of interest for the present analysis was superiority or non-inferiority for symptom reduction. • As no trial investigated non-inferiority, we defined a non-inferiority threshold (0.25 standard deviation) on the basis of published literature. If a non-standard procedure showed non-inferiority for symptom reduction, additional outcomes were assessed. Meta-analyses were conducted if feasible and meaningful. RESULTS • In all, 43 mainly low-quality trials (RCTs only) compared nine non-standard surgical treatments with standard ones. • Mean follow-up ranged from 6 to 84 months. • No non-standard procedure was superior for symptom reduction. Non-inferiority for symptom reduction was shown in patients who had undergone holmium laser resection of the prostate (HoLRP) or thulium laser resection of the prostate (TmLRP). • As procedural advantages (e.g. no occurrence of transurethral resection syndrome) and other advantages (e.g. shortened hospital stay) were found, an indication of an additional benefit of HoLRP and TmLRP was determined. CONCLUSIONS • No proof of superiority for symptom reduction has been shown for non-standard surgical treatments in patients with BPH. • There is a lack of high-quality RCTs and trials designed to investigate non-inferiority. • Future studies should define a non-inferiority threshold (ideally, uniform) a priori, so that results of individual studies are interpretable and comparable, and future systematic reviews should consider this issue.
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| NO : | PASCAL 12-0153781 INIST |
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| ET : | Systematic review of surgical treatments for benign prostatic hyperplasia and presentation of an approach to investigate therapeutic equivalence (non-inferiority) |
| AU : | BIESTER (Katharina); SKIPKA (Guido); JAHN (Rebecca); BUCHBERGER (Barbara); ROHDE (Volker); LANGE (Stefan) |
| AF : | Institute for Quality and Efficiency in Health Care/Cologne/Allemagne (1 aut., 2 aut., 6 aut.); Institute for Health Care Management and Research, University of Duisburg/Essen/Allemagne (3 aut., 4 aut.); Helios Agnes Karll Hospital/Bad Schwartau/Allemagne (5 aut.) |
| DT : | Publication en série; Niveau analytique |
| SO : | BJU international : (Papier); ISSN 1464-4096; Royaume-Uni; Da. 2012; Vol. 109; No. 5; Pp. 722-730; Bibl. 35 ref. |
| LA : | Anglais |
| EA : | OBJECTIVE • To assess the potential additional benefit of non-standard vs standard surgical treatments for benign prostatic hyperplasia (BPH) and to present a new methodological approach to investigate therapeutic equivalence (non-inferiority) regarding symptom reduction. PATIENTS AND METHODS • We conducted a systematic review and searched MEDLINE, Embase and the Cochrane Library (last search: 10/2009) for randomized controlled trials (RCTs) and non-randomized controlled clinical trials (CCTs). • Eligible studies were those that included patients with symptomatic BPH requiring surgical treatment and which compared non-standard procedures (e.g. minimally invasive technologies) with standard ones (e.g. transurethral resection of the prostate, TURP). In addition, only studies analysing patient-relevant outcomes were considered (e.g. irritative and obstructive symptoms, length of hospital stay, quality of life and adverse events). • The main outcome of interest for the present analysis was superiority or non-inferiority for symptom reduction. • As no trial investigated non-inferiority, we defined a non-inferiority threshold (0.25 standard deviation) on the basis of published literature. If a non-standard procedure showed non-inferiority for symptom reduction, additional outcomes were assessed. Meta-analyses were conducted if feasible and meaningful. RESULTS • In all, 43 mainly low-quality trials (RCTs only) compared nine non-standard surgical treatments with standard ones. • Mean follow-up ranged from 6 to 84 months. • No non-standard procedure was superior for symptom reduction. Non-inferiority for symptom reduction was shown in patients who had undergone holmium laser resection of the prostate (HoLRP) or thulium laser resection of the prostate (TmLRP). • As procedural advantages (e.g. no occurrence of transurethral resection syndrome) and other advantages (e.g. shortened hospital stay) were found, an indication of an additional benefit of HoLRP and TmLRP was determined. CONCLUSIONS • No proof of superiority for symptom reduction has been shown for non-standard surgical treatments in patients with BPH. • There is a lack of high-quality RCTs and trials designed to investigate non-inferiority. • Future studies should define a non-inferiority threshold (ideally, uniform) a priori, so that results of individual studies are interpretable and comparable, and future systematic reviews should consider this issue. |
| CC : | 002B14D02; 002B20B02 |
| FD : | Adénome de la prostate; Article synthèse; Revue bibliographique; Chirurgie; Traitement; Voie transurétrale; Equivalence; Voie abord; Résection chirurgicale; Prostate; Norme; Etalon; Néphrologie; Urologie |
| FG : | Pathologie de l'appareil génital mâle; Pathologie de l'appareil urinaire; Tumeur bénigne; Pathologie de la prostate; Appareil urogénital |
| ED : | Benign prostatic hyperplasia; Review; Bibliographic review; Surgery; Treatment; Transurethral route; Equivalence; Surgical approach; Surgical resection; Prostate; Standards; Standard; Nephrology; Urology |
| EG : | Male genital diseases; Urinary system disease; Benign neoplasm; Prostate disease; Urogenital system |
| SD : | Hiperplasia prostática benigna; Artículo síntesis; Revista bibliográfica; Cirugía; Tratamiento; Via transuretral; Equivalencia; Vía abordaje; Resección quirúrgica; Prostata; Norma; Marco; Nefrología; Urología |
| LO : | INIST-1050.354000502845880130 |
| ID : | 12-0153781 |
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Pascal:12-0153781Le document en format XML
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Management and Research, University of Duisburg</s1><s2>Essen</s2><s3>DEU</s3><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Rohde, Volker" sort="Rohde, Volker" uniqKey="Rohde V" first="Volker" last="Rohde">Volker Rohde</name><affiliation><inist:fA14 i1="03"><s1>Helios Agnes Karll Hospital</s1><s2>Bad Schwartau</s2><s3>DEU</s3><sZ>5 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Lange, Stefan" sort="Lange, Stefan" uniqKey="Lange S" first="Stefan" last="Lange">Stefan Lange</name><affiliation><inist:fA14 i1="01"><s1>Institute for Quality and Efficiency in Health Care</s1><s2>Cologne</s2><s3>DEU</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>6 aut.</sZ></inist:fA14></affiliation></author></analytic><series><title level="j" type="main">BJU international : (Papier)</title><title level="j" type="abbreviated">BJU int. : (Print)</title><idno type="ISSN">1464-4096</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">BJU international : (Papier)</title><title level="j" type="abbreviated">BJU int. : (Print)</title><idno type="ISSN">1464-4096</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Benign prostatic hyperplasia</term><term>Bibliographic review</term><term>Equivalence</term><term>Nephrology</term><term>Prostate</term><term>Review</term><term>Standard</term><term>Standards</term><term>Surgery</term><term>Surgical approach</term><term>Surgical resection</term><term>Transurethral route</term><term>Treatment</term><term>Urology</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Adénome de la prostate</term><term>Article synthèse</term><term>Revue bibliographique</term><term>Chirurgie</term><term>Traitement</term><term>Voie transurétrale</term><term>Equivalence</term><term>Voie abord</term><term>Résection chirurgicale</term><term>Prostate</term><term>Norme</term><term>Etalon</term><term>Néphrologie</term><term>Urologie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">OBJECTIVE • To assess the potential additional benefit of non-standard vs standard surgical treatments for benign prostatic hyperplasia (BPH) and to present a new methodological approach to investigate therapeutic equivalence (non-inferiority) regarding symptom reduction. PATIENTS AND METHODS • We conducted a systematic review and searched MEDLINE, Embase and the Cochrane Library (last search: 10/2009) for randomized controlled trials (RCTs) and non-randomized controlled clinical trials (CCTs). • Eligible studies were those that included patients with symptomatic BPH requiring surgical treatment and which compared non-standard procedures (e.g. minimally invasive technologies) with standard ones (e.g. transurethral resection of the prostate, TURP). In addition, only studies analysing patient-relevant outcomes were considered (e.g. irritative and obstructive symptoms, length of hospital stay, quality of life and adverse events). • The main outcome of interest for the present analysis was superiority or non-inferiority for symptom reduction. • As no trial investigated non-inferiority, we defined a non-inferiority threshold (0.25 standard deviation) on the basis of published literature. If a non-standard procedure showed non-inferiority for symptom reduction, additional outcomes were assessed. Meta-analyses were conducted if feasible and meaningful. RESULTS • In all, 43 mainly low-quality trials (RCTs only) compared nine non-standard surgical treatments with standard ones. • Mean follow-up ranged from 6 to 84 months. • No non-standard procedure was superior for symptom reduction. Non-inferiority for symptom reduction was shown in patients who had undergone holmium laser resection of the prostate (HoLRP) or thulium laser resection of the prostate (TmLRP). • As procedural advantages (e.g. no occurrence of transurethral resection syndrome) and other advantages (e.g. shortened hospital stay) were found, an indication of an additional benefit of HoLRP and TmLRP was determined. CONCLUSIONS • No proof of superiority for symptom reduction has been shown for non-standard surgical treatments in patients with BPH. • There is a lack of high-quality RCTs and trials designed to investigate non-inferiority. • Future studies should define a non-inferiority threshold (ideally, uniform) a priori, so that results of individual studies are interpretable and comparable, and future systematic reviews should consider this issue.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>1464-4096</s0></fA01><fA03 i2="1"><s0>BJU int. : (Print)</s0></fA03><fA05><s2>109</s2></fA05><fA06><s2>5</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Systematic review of surgical treatments for benign prostatic hyperplasia and presentation of an approach to investigate therapeutic equivalence (non-inferiority)</s1></fA08><fA11 i1="01" i2="1"><s1>BIESTER (Katharina)</s1></fA11><fA11 i1="02" i2="1"><s1>SKIPKA (Guido)</s1></fA11><fA11 i1="03" i2="1"><s1>JAHN (Rebecca)</s1></fA11><fA11 i1="04" i2="1"><s1>BUCHBERGER (Barbara)</s1></fA11><fA11 i1="05" i2="1"><s1>ROHDE (Volker)</s1></fA11><fA11 i1="06" i2="1"><s1>LANGE (Stefan)</s1></fA11><fA14 i1="01"><s1>Institute for Quality and Efficiency in Health Care</s1><s2>Cologne</s2><s3>DEU</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>6 aut.</sZ></fA14><fA14 i1="02"><s1>Institute for Health Care Management and Research, University of Duisburg</s1><s2>Essen</s2><s3>DEU</s3><sZ>3 aut.</sZ><sZ>4 aut.</sZ></fA14><fA14 i1="03"><s1>Helios Agnes Karll Hospital</s1><s2>Bad Schwartau</s2><s3>DEU</s3><sZ>5 aut.</sZ></fA14><fA20><s1>722-730</s1></fA20><fA21><s1>2012</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>1050</s2><s5>354000502845880130</s5></fA43><fA44><s0>0000</s0><s1>© 2012 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>35 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>12-0153781</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>BJU international : (Papier)</s0></fA64><fA66 i1="01"><s0>GBR</s0></fA66><fC01 i1="01" l="ENG"><s0>OBJECTIVE • To assess the potential additional benefit of non-standard vs standard surgical treatments for benign prostatic hyperplasia (BPH) and to present a new methodological approach to investigate therapeutic equivalence (non-inferiority) regarding symptom reduction. PATIENTS AND METHODS • We conducted a systematic review and searched MEDLINE, Embase and the Cochrane Library (last search: 10/2009) for randomized controlled trials (RCTs) and non-randomized controlled clinical trials (CCTs). • Eligible studies were those that included patients with symptomatic BPH requiring surgical treatment and which compared non-standard procedures (e.g. minimally invasive technologies) with standard ones (e.g. transurethral resection of the prostate, TURP). In addition, only studies analysing patient-relevant outcomes were considered (e.g. irritative and obstructive symptoms, length of hospital stay, quality of life and adverse events). • The main outcome of interest for the present analysis was superiority or non-inferiority for symptom reduction. • As no trial investigated non-inferiority, we defined a non-inferiority threshold (0.25 standard deviation) on the basis of published literature. If a non-standard procedure showed non-inferiority for symptom reduction, additional outcomes were assessed. Meta-analyses were conducted if feasible and meaningful. RESULTS • In all, 43 mainly low-quality trials (RCTs only) compared nine non-standard surgical treatments with standard ones. • Mean follow-up ranged from 6 to 84 months. • No non-standard procedure was superior for symptom reduction. Non-inferiority for symptom reduction was shown in patients who had undergone holmium laser resection of the prostate (HoLRP) or thulium laser resection of the prostate (TmLRP). • As procedural advantages (e.g. no occurrence of transurethral resection syndrome) and other advantages (e.g. shortened hospital stay) were found, an indication of an additional benefit of HoLRP and TmLRP was determined. CONCLUSIONS • No proof of superiority for symptom reduction has been shown for non-standard surgical treatments in patients with BPH. • There is a lack of high-quality RCTs and trials designed to investigate non-inferiority. • Future studies should define a non-inferiority threshold (ideally, uniform) a priori, so that results of individual studies are interpretable and comparable, and future systematic reviews should consider this issue.</s0></fC01><fC02 i1="01" i2="X"><s0>002B14D02</s0></fC02><fC02 i1="02" i2="X"><s0>002B20B02</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Adénome de la prostate</s0><s2>NM</s2><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Benign prostatic hyperplasia</s0><s2>NM</s2><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Hiperplasia prostática benigna</s0><s2>NM</s2><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Article synthèse</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Review</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Artículo síntesis</s0><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Revue bibliographique</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Bibliographic review</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Revista bibliográfica</s0><s5>03</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Chirurgie</s0><s5>05</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Surgery</s0><s5>05</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Cirugía</s0><s5>05</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Traitement</s0><s5>06</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Treatment</s0><s5>06</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Tratamiento</s0><s5>06</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Voie transurétrale</s0><s5>07</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>Transurethral route</s0><s5>07</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>Via transuretral</s0><s5>07</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Equivalence</s0><s5>08</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>Equivalence</s0><s5>08</s5></fC03><fC03 i1="07" i2="X" l="SPA"><s0>Equivalencia</s0><s5>08</s5></fC03><fC03 i1="08" i2="X" l="FRE"><s0>Voie abord</s0><s5>09</s5></fC03><fC03 i1="08" i2="X" l="ENG"><s0>Surgical approach</s0><s5>09</s5></fC03><fC03 i1="08" i2="X" l="SPA"><s0>Vía abordaje</s0><s5>09</s5></fC03><fC03 i1="09" i2="X" l="FRE"><s0>Résection chirurgicale</s0><s5>11</s5></fC03><fC03 i1="09" i2="X" l="ENG"><s0>Surgical resection</s0><s5>11</s5></fC03><fC03 i1="09" i2="X" l="SPA"><s0>Resección quirúrgica</s0><s5>11</s5></fC03><fC03 i1="10" i2="X" l="FRE"><s0>Prostate</s0><s5>12</s5></fC03><fC03 i1="10" i2="X" l="ENG"><s0>Prostate</s0><s5>12</s5></fC03><fC03 i1="10" i2="X" l="SPA"><s0>Prostata</s0><s5>12</s5></fC03><fC03 i1="11" i2="X" l="FRE"><s0>Norme</s0><s5>17</s5></fC03><fC03 i1="11" i2="X" l="ENG"><s0>Standards</s0><s5>17</s5></fC03><fC03 i1="11" i2="X" l="SPA"><s0>Norma</s0><s5>17</s5></fC03><fC03 i1="12" i2="X" l="FRE"><s0>Etalon</s0><s5>18</s5></fC03><fC03 i1="12" i2="X" l="ENG"><s0>Standard</s0><s5>18</s5></fC03><fC03 i1="12" i2="X" l="SPA"><s0>Marco</s0><s5>18</s5></fC03><fC03 i1="13" i2="X" l="FRE"><s0>Néphrologie</s0><s5>19</s5></fC03><fC03 i1="13" i2="X" l="ENG"><s0>Nephrology</s0><s5>19</s5></fC03><fC03 i1="13" i2="X" l="SPA"><s0>Nefrología</s0><s5>19</s5></fC03><fC03 i1="14" i2="X" l="FRE"><s0>Urologie</s0><s5>20</s5></fC03><fC03 i1="14" i2="X" l="ENG"><s0>Urology</s0><s5>20</s5></fC03><fC03 i1="14" i2="X" l="SPA"><s0>Urología</s0><s5>20</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Pathologie de l'appareil génital mâle</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Male genital diseases</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Aparato genital macho patología</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Pathologie de l'appareil urinaire</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Urinary system disease</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Aparato urinario patología</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Tumeur bénigne</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Benign neoplasm</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Tumor benigno</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Pathologie de la prostate</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Prostate disease</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Prostata patología</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="FRE"><s0>Appareil urogénital</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="ENG"><s0>Urogenital system</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="SPA"><s0>Aparato urogenital</s0><s5>41</s5></fC07><fN21><s1>114</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard><server><NO>PASCAL 12-0153781 INIST</NO><ET>Systematic review of surgical treatments for benign prostatic hyperplasia and presentation of an approach to investigate therapeutic equivalence (non-inferiority)</ET><AU>BIESTER (Katharina); SKIPKA (Guido); JAHN (Rebecca); BUCHBERGER (Barbara); ROHDE (Volker); LANGE (Stefan)</AU><AF>Institute for Quality and Efficiency in Health Care/Cologne/Allemagne (1 aut., 2 aut., 6 aut.); Institute for Health Care Management and Research, University of Duisburg/Essen/Allemagne (3 aut., 4 aut.); Helios Agnes Karll Hospital/Bad Schwartau/Allemagne (5 aut.)</AF><DT>Publication en série; Niveau analytique</DT><SO>BJU international : (Papier); ISSN 1464-4096; Royaume-Uni; Da. 2012; Vol. 109; No. 5; Pp. 722-730; Bibl. 35 ref.</SO><LA>Anglais</LA><EA>OBJECTIVE • To assess the potential additional benefit of non-standard vs standard surgical treatments for benign prostatic hyperplasia (BPH) and to present a new methodological approach to investigate therapeutic equivalence (non-inferiority) regarding symptom reduction. PATIENTS AND METHODS • We conducted a systematic review and searched MEDLINE, Embase and the Cochrane Library (last search: 10/2009) for randomized controlled trials (RCTs) and non-randomized controlled clinical trials (CCTs). • Eligible studies were those that included patients with symptomatic BPH requiring surgical treatment and which compared non-standard procedures (e.g. minimally invasive technologies) with standard ones (e.g. transurethral resection of the prostate, TURP). In addition, only studies analysing patient-relevant outcomes were considered (e.g. irritative and obstructive symptoms, length of hospital stay, quality of life and adverse events). • The main outcome of interest for the present analysis was superiority or non-inferiority for symptom reduction. • As no trial investigated non-inferiority, we defined a non-inferiority threshold (0.25 standard deviation) on the basis of published literature. If a non-standard procedure showed non-inferiority for symptom reduction, additional outcomes were assessed. Meta-analyses were conducted if feasible and meaningful. RESULTS • In all, 43 mainly low-quality trials (RCTs only) compared nine non-standard surgical treatments with standard ones. • Mean follow-up ranged from 6 to 84 months. • No non-standard procedure was superior for symptom reduction. Non-inferiority for symptom reduction was shown in patients who had undergone holmium laser resection of the prostate (HoLRP) or thulium laser resection of the prostate (TmLRP). • As procedural advantages (e.g. no occurrence of transurethral resection syndrome) and other advantages (e.g. shortened hospital stay) were found, an indication of an additional benefit of HoLRP and TmLRP was determined. CONCLUSIONS • No proof of superiority for symptom reduction has been shown for non-standard surgical treatments in patients with BPH. • There is a lack of high-quality RCTs and trials designed to investigate non-inferiority. • Future studies should define a non-inferiority threshold (ideally, uniform) a priori, so that results of individual studies are interpretable and comparable, and future systematic reviews should consider this issue.</EA><CC>002B14D02; 002B20B02</CC><FD>Adénome de la prostate; Article synthèse; Revue bibliographique; Chirurgie; Traitement; Voie transurétrale; Equivalence; Voie abord; Résection chirurgicale; Prostate; Norme; Etalon; Néphrologie; Urologie</FD><FG>Pathologie de l'appareil génital mâle; Pathologie de l'appareil urinaire; Tumeur bénigne; Pathologie de la prostate; Appareil urogénital</FG><ED>Benign prostatic hyperplasia; Review; Bibliographic review; Surgery; Treatment; Transurethral route; Equivalence; Surgical approach; Surgical resection; Prostate; Standards; Standard; Nephrology; Urology</ED><EG>Male genital diseases; Urinary system disease; Benign neoplasm; Prostate disease; Urogenital system</EG><SD>Hiperplasia prostática benigna; Artículo síntesis; Revista bibliográfica; Cirugía; Tratamiento; Via transuretral; Equivalencia; Vía abordaje; Resección quirúrgica; Prostata; Norma; Marco; Nefrología; Urología</SD><LO>INIST-1050.354000502845880130</LO><ID>12-0153781</ID></server></inist></record>Pour manipuler ce document sous Unix (Dilib)
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