A systematic review and network meta-analysis comparing Rezm with transurethral needle ablation and microwave thermotherapy for the management of enlarged prostate

ObjectivesWe aim to compare efficacy and safety of water vapour therapy (Rez & umacr;m), transurethral needle ablation (TUNA) and transurethral microwave therapy (TUMT) for treating men with moderate to severe benign prostatic hyperplasia (BPH) symptoms.MaterialsPubMed/MEDLINE, EMBASE and Cochrane Library were searched from inception to 30 July 2023, followed by reference searching and dual-independent study selection. We analysed only randomized clinical trials. RoB-2, NIH-quality assessment tool and GRADE guidelines were used for quality-of-evidence (QoE) assessment. Relevant prospective studies without a critical risk-of-bias were included.ResultsAt 12 months, Rez & umacr;m showed similar efficacy to TUNA and TUMT for improvement in International Prostate Symptoms Score - Rez & umacr;m versus TUMT: 1.33 points (95% CI: -1.66 to 4.35) favouring TUMT (QoE: Moderate) and Rez & umacr;m versus TUNA: 0.07 points (95% CI: -3.64 to 3.88) favouring TUNA (QoE: Low). Rezum had similar outcomes to TUNA and TUMT for Maximum Peak-Flow Rate (Qmax): Rez & umacr;m versus TUMT: 1.05 mL/s (95% CI: -4.88 to 2.82) favouring Rez & umacr;m (QoE: Low) and Rez & umacr;m versus TUNA: 0.37 mL/s (95% CI: -4.61 to 4.21) favouring TUNA (QoE: Low). Furthermore, post-void residual volume (PVR) comparisons demonstrated that Rez & umacr;m was similar, or inferior to other techniques at 12 months - Rez & umacr;m versus TUMT: 11.20 mL (95% CI: -32.40 to 10.30) favouring TUMT (QoE: Low) and Rez & umacr;m versus TUNA: 24.10 mL (95% CI: 2.81 to 45.10) favouring TUNA (QoE: Low). Rez & umacr;m also had a similar surgical retreatment rate with TUMT and TUNA up to 3-years - TUMT versus Rez & umacr;m RR: 1.21 (95% CI: 0.20 to 15.90) (QoE: Low) and TUNA versus Rez & umacr;m showed RR: 1.81 (95% CI: 0.2 to 24.60) (QoE: Low). In the first 12 months after treatment, Rez & umacr;m had a higher rate of serious adverse events (Clavien-Dindo >= Grade 3) than TUMT and TUNA. TUMT versus Rez & umacr;m with RR = 0.53 (95% CI: 0.13 to 3.14) (QoE: Low) and TUNA versus Rez & umacr;m with RR = 0.38 (95% CI: 0.04 to 3.49) (QoE: Low).ConclusionsModerate to weak evidence suggests that Rez & umacr;m is not superior to TUNA and TUMT in all domains studied.