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. 2019 May 25;5(5):CD012832.
doi: 10.1002/14651858.CD012832.pub2.

Prostatic urethral lift for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia

Jae Hung Jung  1 , Balaji Reddy, Karen Ann McCutcheon, Michael Borofsky, Vikram Narayan, Myung Ha Kim, Philipp Dahm
Affiliations

Prostatic urethral lift for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia

Jae Hung Jung et al. Cochrane Database Syst Rev. .

Abstract

Background: A variety of minimally invasive surgical approaches are available as an alternative to transurethral resection of prostate (TURP) for the management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). A recent addition to these is prostatic urethral lift (PUL).

Objectives: To assess the effects of PUL for the treatment of LUTS in men with BPH.

Search methods: We performed a comprehensive search of multiple databases (the Cochrane Library, MEDLINE, Embase, LILACS, Scopus, Web of Science, and Google Scholar), trials registries, other sources of grey literature, and conference proceedings with no restrictions on the language of publication or publication status up until 31 January 2019.

Selection criteria: We included parallel group randomized controlled trials (RCTs). While we planned to include non-RCTs if RCTs had provided low-certainty evidence for a given outcome and comparison, we could not find any non-RCTs.

Data collection and analysis: Two review authors independently screened the literature, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We planned subgroup analyses by age, prostate volume, and severity of baseline symptoms. We used the GRADE approach to rate the certainty of the evidence.

Main results: We included two RCTs with 297 participants comparing PUL to sham surgery or TURP. The mean age was 65.6 years and mean International Prostate Symptom Score was 22.7. Mean prostate volume was 42.2 mL. We considered review outcomes measured up to and including 12 months after randomization as short-term and later than 12 months as long-term. For patient-reported outcomes, lower scores indicate more urological symptom improvement and higher quality of life. In contrast, higher scores refers to better erectile and ejaculatory function.PUL versus sham: based on one study of 206 randomized participants with short follow-up (up to three months), PUL may lead to a clinically important improvement in urological symptom scores (mean difference (MD) -5.20, 95% confidence interval (CI) -7.44 to -2.96; low-certainty evidence) and likely improves quality of life (MD -1.20, 95% CI -1.67 to -0.73; moderate-certainty evidence). We are uncertain whether PUL increases major adverse events (very low-certainty evidence). There were no retreatments reported in either study group by three months. PUL likely results in little to no difference in erectile function (MD -1.40, 95% CI -3.24 to 0.44; moderate-certainty evidence) and ejaculatory function (MD 0.50, 95% CI -0.38 to 1.38; moderate-certainty evidence).PUL versus TURP: based on one study of 91 randomized participants with a short follow-up (up to 12 months), PUL may result in a substantially lesser improvement in urological symptom scores than TURP (MD 4.50, 95% CI 1.10 to 7.90; low-certainty evidence). PUL may result in a slightly reduced or similar quality of life (MD 0.30, 95% CI -0.49 to 1.09; low-certainty evidence). We are very uncertain whether PUL may cause fewer major adverse events but increased retreatments (both very low-certainty evidence). PUL probably results in little to no difference in erectile function (MD 0.80, 95% CI -1.50 to 3.10; moderate-certainty evidence), but probably results in substantially better ejaculatory function (MD 5.00, 95% CI 3.08 to 6.92; moderate-certainty evidence).With regards to longer term follow-up (up to 24 months) based on one study of 91 randomized participants, PUL may result in a substantially lesser improvement in urological symptom score (MD 6.10, 95% CI 2.16 to 10.04; low-certainty evidence) and result in little worse to no difference in quality of life (MD 0.80, 95% CI 0.00 to 1.60; low-certainty evidence). The study did not report on major adverse events. We are very uncertain whether PUL increases retreatment (very low-certainty evidence). PUL likely results in little to no difference in erectile function (MD 1.60, 95% CI -0.80 to 4.00; moderate-certainty evidence), but may result in substantially better ejaculatory function (MD 4.30, 95% CI 2.17 to 6.43; low-certainty evidence).We were unable to perform any of the predefined secondary analyses for either comparison.We found no evidence for other comparisons such as PUL versus laser ablation or enucleation.

Authors' conclusions: PUL appears less effective than TURP in improving urological symptoms both short-term and long term, while quality of life outcomes may be similar. The effect on erectile function appears similar but ejaculatory function may be better. We are uncertain about major adverse events short-term and found no long-term information. We are very uncertain about retreatment rates both short-term and long-term. We were unable to assess the effects of PUL in subgroups based on age, prostate size, or symptom severity and also could not assess how PUL compared to other surgical management approaches. Given the large numbers of alternative treatment modalities to treat men with LUTS secondary to BPH, this represents important information that should be shared with men considering surgical treatment.

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Conflict of interest statement

JHJ: none.

BR: none.

KAM: none.

MB: Boston Scientific (consultant for endourology and stone management), Auris Health (consultant for robotic surgery and endourology).

VN: none.

MHK: none.

PD: none.

Figures

1
1
PRISMA flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Prostatic urethral lift (PUL) versus sham (short term), Outcome 1 Urological symptom scores.
1.2
1.2. Analysis
Comparison 1 Prostatic urethral lift (PUL) versus sham (short term), Outcome 2 Quality of life.
1.3
1.3. Analysis
Comparison 1 Prostatic urethral lift (PUL) versus sham (short term), Outcome 3 Major adverse events.
1.4
1.4. Analysis
Comparison 1 Prostatic urethral lift (PUL) versus sham (short term), Outcome 4 Ejaculatory function.
1.5
1.5. Analysis
Comparison 1 Prostatic urethral lift (PUL) versus sham (short term), Outcome 5 Erectile function.
1.6
1.6. Analysis
Comparison 1 Prostatic urethral lift (PUL) versus sham (short term), Outcome 6 Minor adverse events.
1.7
1.7. Analysis
Comparison 1 Prostatic urethral lift (PUL) versus sham (short term), Outcome 7 Acute urinary retention.
1.8
1.8. Analysis
Comparison 1 Prostatic urethral lift (PUL) versus sham (short term), Outcome 8 Hospital stay (days).
2.1
2.1. Analysis
Comparison 2 Prostatic urethral lift (PUL) versus transurethral resection of prostate (TURP) (short term), Outcome 1 Urological symptom scores.
2.2
2.2. Analysis
Comparison 2 Prostatic urethral lift (PUL) versus transurethral resection of prostate (TURP) (short term), Outcome 2 Quality of life.
2.3
2.3. Analysis
Comparison 2 Prostatic urethral lift (PUL) versus transurethral resection of prostate (TURP) (short term), Outcome 3 Major adverse events.
2.4
2.4. Analysis
Comparison 2 Prostatic urethral lift (PUL) versus transurethral resection of prostate (TURP) (short term), Outcome 4 Retreatment.
2.5
2.5. Analysis
Comparison 2 Prostatic urethral lift (PUL) versus transurethral resection of prostate (TURP) (short term), Outcome 5 Erectile function.
2.6
2.6. Analysis
Comparison 2 Prostatic urethral lift (PUL) versus transurethral resection of prostate (TURP) (short term), Outcome 6 Ejaculatory function.
2.7
2.7. Analysis
Comparison 2 Prostatic urethral lift (PUL) versus transurethral resection of prostate (TURP) (short term), Outcome 7 Minor adverse events.
2.8
2.8. Analysis
Comparison 2 Prostatic urethral lift (PUL) versus transurethral resection of prostate (TURP) (short term), Outcome 8 Acute urinary retention.
2.9
2.9. Analysis
Comparison 2 Prostatic urethral lift (PUL) versus transurethral resection of prostate (TURP) (short term), Outcome 9 Indwelling urinary catheter.
2.10
2.10. Analysis
Comparison 2 Prostatic urethral lift (PUL) versus transurethral resection of prostate (TURP) (short term), Outcome 10 Hospital stay (days).
3.1
3.1. Analysis
Comparison 3 Prostatic urethral lift (PUL) versus transurethral resection of prostate (TURP) (long term), Outcome 1 Urological symptom scores.
3.2
3.2. Analysis
Comparison 3 Prostatic urethral lift (PUL) versus transurethral resection of prostate (TURP) (long term), Outcome 2 Quality of life.
3.3
3.3. Analysis
Comparison 3 Prostatic urethral lift (PUL) versus transurethral resection of prostate (TURP) (long term), Outcome 3 Retreatment.
3.4
3.4. Analysis
Comparison 3 Prostatic urethral lift (PUL) versus transurethral resection of prostate (TURP) (long term), Outcome 4 Erectile function.
3.5
3.5. Analysis
Comparison 3 Prostatic urethral lift (PUL) versus transurethral resection of prostate (TURP) (long term), Outcome 5 Ejaculatory function.
3.6
3.6. Analysis
Comparison 3 Prostatic urethral lift (PUL) versus transurethral resection of prostate (TURP) (long term), Outcome 6 Minor adverse events.
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References

References to studies included in this review

Gratzke 2017 {published data only}
    1. Barber N, Sønsken J, Gratze C, Speakman M, Berges R, Wetterauer U, et al. BPH6 randomized study of prostatic urethral lift (PUL) vs transurethral resection of the prostate (TURP): outcomes and patient satisfaction. Journal of Urology 2015;193(Suppl 4):e19. [DOI: 10.1016/j.juro.2015.02.104] - DOI
    1. Chin P, Sønsken J, Barber N, Gratzke C, Speakman M, Berges R, et al. BPH6 trial: a multi‐centre, prospective, randomised study of the prostatic urethral lift vs. transurethral resection of the prostate (TURP). BJU International 2015;115(Suppl 4):10. [DOI: 10.1111/bju.13072] - DOI
    1. Chin P, Woo H, Speakman M, Sønksen J, Gratzke C. Improved sleep after TURP and prostatic urethral lift (PUL): prospective, randomized study. BJU International 2017;119(Suppl 2):82. [DOI: 10.1111/bju.13752] - DOI - PubMed
    1. Gratzke C, Barber N, Speakman MJ, Berges R, Wetterauer U, Greene D, et al. Prostatic urethral lift vs transurethral resection of the prostate: 2‐year results of the BPH6 prospective, multicentre, randomized study. BJU International 2017;119(5):767‐75. [DOI: 10.1111/bju.13714] - DOI - PubMed
    1. Gratzke C, Barber NJ, Speakman MJ, Berges R, Wetterauer U, Greene D, et al. Two year results of the BPH6 trial: a multi‐center, prospective, randomized study of the prostatic urethral lift (PUL) vs transurethral resection of the prostate (TURP). European Urology Supplements 2016; Vol. 15, issue 3:e1076‐a. [DOI: 10.1016/S1569-9056(16)61077-1] - DOI
Roehrborn 2013 {published data only}
    1. Barkin J. Prospective, randomized, controlled study of five‐year results on prostatic urethral lift (PUL). Canadian Urological Association Journal 2017;11(9):S326. [DOI: 10.5489/cuaj.4896] - DOI
    1. McVary KT, Gange SN, Shore ND, Bolton DM, Cowan BE, Brown BT, et al. Treatment of LUTS secondary to BPH while preserving sexual function: randomized controlled study of prostatic urethral lift. Journal of Sexual Medicine 2014; Vol. 11, issue 1:279‐87. [DOI: 10.1111/jsm.12333] - DOI - PubMed
    1. NCT01294150. The safety and effectiveness of UroLift: LIFT Pivotal Study (LIFT). clinicaltrials.gov/ct2/show/NCT01294150. https://ClinicalTrials.gov/show/NCT01294150, (first received 11 February 2011). [https://clinicaltrials.gov/ct2/show/NCT01294150]
    1. Rane A, McNicholas T, Woo H, Roehrborn C. 4 year results of the randomized, controlled, blinded, multi‐center study for the prostatic urethral lift: the L.I.F.T. study. Journal of Endourology 2017; Vol. 30, issue Suppl 2:A105‐6.
    1. Rashid P. Multi‐center prospective study of the prostatic urethral lift with two year durability. BJU International 2014;113(Suppl 4):14‐5. [DOI: 10.1111/bju.12618] - DOI

References to studies excluded from this review

Gratzke 2018 {published data only}
    1. Gratzke C, Barkin J, Roehrborn C. Predictors of response to the prostatic urethral lift (PUL) treatment. European Urology, Supplements 2018;17(2):e1041. [DOI: 10.1016/S1569-9056(18)31556-2] - DOI

References to studies awaiting assessment

Pereira 2018 {published data only}
    1. NCT03043222. Innovative minimally invasive options in treatment of urinary problems related to prostate enlargement (BPH) in men. clinicaltrials.gov/show/NCT03043222 (first received 3 February 2017).
    1. Pereira K, Ford‐Glanton S, Johar R, Xu P, Pham K, Gadani S, et al. Prostatic artery embolization (PAE) and prostatic urethral lift (PUL) procedures for symptomatic benign prostatic enlargement (BPH): a retrospective, single‐center comparison of outcomes. Journal of Vascular and Interventional Radiology 2018; Vol. 29, issue 4 Supplement 1:S6. [DOI: 10.1016/j.jvir.2018.01.010] - DOI

Additional references

Agarwal 2014
    1. Agarwal A, Eryuzlu LN, Cartwright R, Thorlund K, Tammela TL, Guyatt GH, et al. What is the most bothersome lower urinary tract symptom? Individual‐ and population‐level perspectives for both men and women. European Urology 2014;65(6):1211‐7. - PMC - PubMed
Barry 1992
    1. Barry MJ, Fowler FJ Jr, O'Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. Journal of Urology 1992;148(5):1549‐57; discussion 1564. - PubMed
Barry 1995
    1. Barry MJ, Williford WO, Chang Y, Machi M, Jones K, Walker‐Corkery E, et al. Benign prostatic hyperplasia specific health status measures in clinical research: how much change in the American Urological Association symptom index and the benign prostatic hyperplasia impact index is perceptible to patients?. Journal of Urology 1995;154(5):1770‐4. - PubMed
Barry 1997
    1. Barry MJ, Fowler FJ Jr, Bin L, Pitts JC 3rd, Harris CJ, Mulley AG Jr. The natural history of patients with benign prostatic hyperplasia as diagnosed by North American urologists. Journal of Urology 1997;157(1):10‐4; discussion 14‐5. - PubMed
Bhojani 2014
    1. Bhojani N, Gandaglia G, Sood A, Rai A, Pucheril D, Chang SL, et al. Morbidity and mortality after benign prostatic hyperplasia surgery: data from the American College of Surgeons national surgical quality improvement program. Journal of Endourology 2014;28(7):831‐40. - PubMed
Brasure 2016
    1. Brasure M, MacDonald R, Dahm P, Olson CM, Nelson VA, Fink HA, et al. AHRQ comparative effectiveness reviews. Newer Medications for Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: a Review. Rockville (MD): Agency for Healthcare Research and Quality (US), 2016. - PubMed
Chapple 2017
    1. Chapple C, Castro‐Diaz D, Chuang YC, Lee KS, Liao L, Liu SP, et al. Prevalence of lower urinary tract symptoms in China, Taiwan, and South Korea: results from a cross‐sectional, population‐based study. Advances in Therapy 2017; Vol. 34, issue 8:1953‐65. - PMC - PubMed
Chin 2012
    1. Chin PT, Bolton DM, Jack G, Rashid P, Thavaseelan J, Yu RJ, et al. Prostatic urethral lift: two‐year results after treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Urology 2012;79(1):5‐11. - PubMed
Cornu 2010
    1. Cornu JN, Cussenot O, Haab F, Lukacs B. A widespread population study of actual medical management of lower urinary tract symptoms related to benign prostatic hyperplasia across Europe and beyond official clinical guidelines. European Urology 2010;58(3):450‐6. - PubMed
Covidence 2013 [Computer program]
    1. Veritas Health Innovation. Covidence. Version accessed 16 August 2017. Melbourne, Australia: Veritas Health Innovation, 2013.
Crawford 2006
    1. Crawford ED, Wilson SS, McConnell JD, Slawin KM, Lieber MC, Smith JA, et al. Baseline factors as predictors of clinical progression of benign prostatic hyperplasia in men treated with placebo. Journal of Urology 2006;175(4):1422‐6; discussion 1426‐7. - PubMed
Deeks 2011
    1. Deeks JJ, Higgins JP, Altman DG. Chapter 9: Analysing data and undertaking meta‐analyses. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Dindo 2004
    1. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of Surgery 2004;240(2):205‐13. - PMC - PubMed
Dunphy 2015
    1. Dunphy C, Laor L, Te A, Kaplan S, Chughtai B. Relationship between depression and lower urinary tract symptoms secondary to benign prostatic hyperplasia. Reviews in Urology 2015;17(2):51‐7. - PMC - PubMed
EAU 2017
    1. European Association of Urology. Treatment of non‐neurogenic male LUTS. uroweb.org/guideline/treatment‐of‐non‐neurogenic‐male‐luts/ (accessed 17 August 2017).
Egan 2016
    1. Egan KB. The epidemiology of benign prostatic hyperplasia associated with lower urinary tract symptoms: prevalence and incident rates. Urologic Clinics of North America 2016;43(3):289‐97. - PubMed
EndNote 2016 [Computer program]
    1. Clarivate Analytics. EndNote. Version 7.5. Philadelphia (PA): Clarivate Analytics, 2016.
GRADEpro GDT 2015 [Computer program]
    1. McMaster University (developed by Evidence Prime). GRADEpro GDT. Version accessed 16 August 2017. Hamilton (ON): McMaster University (developed by Evidence Prime), 2015.
Guyatt 2008
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck‐Ytter Y, Schünemann HJ, et al. GRADE: what is "quality of evidence" and why is it important to clinicians?. BMJ (Clinical Research Ed) 2008;336(7651):995‐8. - PMC - PubMed
Guyatt 2011a
    1. Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso‐Coello P, Rind D, et al. GRADE guidelines 6. Rating the quality of evidence – imprecision. Journal of Clinical Epidemiology 2011;64(12):1283‐93. - PubMed
Guyatt 2011b
    1. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction – GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology 2011;64(4):383‐94. - PubMed
Higgins 2002
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Statistics in Medicine 2002;21(11):1539‐58. - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ (Clinical Research Ed) 2003;327(7414):557‐60. - PMC - PubMed
Higgins 2011a
    1. Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Higgins 2011b
    1. Higgins JP, Altman DG, Sterne JA. Chapter 8: Assessing risk of bias in included studies. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Higgins 2011c
    1. Higgins JP, Deeks JJ, Altman DG. Chapter 16: Special topics in statistics. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Homma 1997
    1. Homma Y, Kawabe K, Tsukamoto T, Yamanaka H, Okada K, Okajima E, et al. Epidemiologic survey of lower urinary tract symptoms in Asia and Australia using the international prostate symptom score. International Journal of Urology 1997;4(1):40‐6. - PubMed
Jaeschke 1989
    1. Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Controlled Clinical Trials 1989;10(4):407‐15. - PubMed
Johnston 2013
    1. Johnston BC, Patrick DL, Busse JW, Schünemann HJ, Agarwal A, Guyatt GH. Patient‐reported outcomes in meta‐analyses – Part 1: assessing risk of bias and combining outcomes. Health and Quality of Life Outcomes 2013;11:109. - PMC - PubMed
Jones 2016
    1. Jones P, Rajkumar GN, Rai BP, Aboumarzouk OM, Cleaveland P, Srirangam SJ, et al. Medium‐term outcomes of UroLift (minimum 12 months follow‐up): evidence from a systematic review. Urology 2016;97:20‐4. - PubMed
Jung 2017
    1. Jung JH, McCutcheon KA, Reddy B, Borofsky M, Narayan V, Kim MH, et al. Prostatic urethral lift for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database of Systematic Reviews 2017, Issue 10. [DOI: 10.1002/14651858.CD012832] - DOI - PMC - PubMed
Kozminski 2015
    1. Kozminski MA, Wei JT, Nelson J, Kent DM. Baseline characteristics predict risk of progression and response to combined medical therapy for benign prostatic hyperplasia (BPH). BJU International 2015;115(2):308‐16. - PMC - PubMed
Lee 2017
    1. Lee SWH, Chan EMC, Lai YK. The global burden of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a systematic review and meta‐analysis. Scientific Reports 2017;7(1):7984. - PMC - PubMed
Leissner 1979
    1. Leissner KH, Tisell LE. The weight of the human prostate. Scandinavian Journal of Urology 1979;13(2):137‐42. - PubMed
Liberati 2009
    1. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta‐analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Medicine 2009;6(7):e1000100. - PMC - PubMed
Magistro 2018
    1. Magistro G, Stief CG, Woo HH. Mini‐review: what is new in UroLift?. European Urology Focus 2018;4(1):36‐9. - PubMed
Martin 2014
    1. Martin S, Lange K, Haren MT, Taylor AW, Wittert G. Risk factors for progression or improvement of lower urinary tract symptoms in a prospective cohort of men. Journal of Urology 2014;191(1):130‐7. - PubMed
McNicholas 2016
    1. McNicholas TA. Benign prostatic hyperplasia and new treatment options – a critical appraisal of the UroLift system. Medical Devices 2016;9:115‐23. - PMC - PubMed
McVary 2011
    1. McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. Journal of Urology 2011;185(5):1793‐803. - PubMed
NICE 2015
    1. National Institute for Health and Care Excellence. UroLift for treating lower urinary tract symptoms of benign prostatic hyperplasia. www.nice.org.uk/guidance/mtg26 (accessed 28 September 2017).
Nickel 2015
    1. Nickel JC, Brock GB, Herschorn S, Dickson R, Henneges C, Viktrup L. Proportion of tadalafil‐treated patients with clinically meaningful improvement in lower urinary tract symptoms associated with benign prostatic hyperplasia – integrated data from 1,499 study participants. BJU International 2015;115(5):815‐21. - PubMed
Pariser 2015
    1. Pariser JJ, Pearce SM, Patel SG, Bales GT. National trends of simple prostatectomy for benign prostatic hyperplasia with an analysis of risk factors for adverse perioperative outcomes. Urology 2015;86(4):721‐5. - PubMed
Perera 2015
    1. Perera M, Roberts MJ, Doi SA, Bolton D. Prostatic urethral lift improves urinary symptoms and flow while preserving sexual function for men with benign prostatic hyperplasia: a systematic review and meta‐analysis. European Urology 2015;67(4):704‐13. - PubMed
Rees 2015
    1. Rees J. Patients not P values. BJU international 2015;115(5):678‐9. - PubMed
Reich 2008
    1. Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, et al. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. Journal of Urology 2008;180(1):246‐9. - PubMed
Review Manager 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Roehrborn 2003
    1. Roehrborn C, McConnell J, Barry M, Benaim E, Bruskewitz R, Blute ML, et al. American Urological Association guideline: management of benign prostatic hyperplasia (BPH). www.auanet.org/documents/education/clinical‐guidance/Benign‐Prostatic‐Hy... (accessed 28 September 2017).
Roehrborn 2008a
    1. Roehrborn CG. Pathology of benign prostatic hyperplasia. International Journal of Impotence Research 2008;20 Suppl 3:S11‐8. - PubMed
Roehrborn 2008b
    1. Roehrborn CG. Current medical therapies for men with lower urinary tract symptoms and benign prostatic hyperplasia: achievements and limitations. Review in Urology 2008;10(1):14‐25. - PMC - PubMed
Rosen 1997
    1. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997;49(6):822‐30. - PubMed
Rosen 2007
    1. Rosen RC, Catania JA, Althof SE, Pollack LM, O'Leary M, Seftel AD, et al. Development and validation of four‐item version of Male Sexual Health Questionnaire to assess ejaculatory dysfunction. Urology 2007;69(5):805‐9. - PubMed
Sanchez‐Gomez 2015
    1. Sanchez‐Gomez LM, Polo‐deSantos M, Gomez‐Sancha F, Luengo‐Matos S. Efficacy and safety of the UroLift ® system for the treatment of benign prostate hyperplasia symptoms: systematic review. Actas Urológicas Españolas 2015;39(5):311‐9. - PubMed
Schünemann 2011a
    1. Schünemann HJ, Oxman AD, Higgins JP, Vist GE, Glasziou P, Guyatt GH. Chapter 11: Presenting results and 'Summary of findings' tables. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Schünemann 2011b
    1. Schünemann HJ, Oxman AD, Vist GE, Higgins JP, Deeks JJ, Glasziou P, et al. Chapter 12: Interpreting results and drawing conclusions. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Schünemann 2013
    1. Schünemann HJ, Tugwell P, Reeves BC, Akl EA, Santesso N, Spencer FA, et al. Non‐randomized studies as a source of complementary, sequential or replacement evidence for randomized controlled trials in systematic reviews on the effects of interventions. Research Synthesis Methods 2013;4(1):49‐62. - PubMed
Spaliviero 2010
    1. Spaliviero M, Strom KH, Gu X, Araki M, Culkin DJ, Wong C. Does Greenlight HPS (™) laser photoselective vaporization prostatectomy affect sexual function?. Journal of Endourology 2010;24(12):2051‐7. - PubMed
Sterne 2016
    1. Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, et al. ROBINS‐I: a tool for assessing risk of bias in non‐randomised studies of interventions. BMJ 2016;355:i4919. - PMC - PubMed
Strope 2015
    1. Strope SA, Vetter J, Elliott S, Andriole GL, Olsen MA. Use of medical therapy and success of laser surgery and transurethral resection of the prostate for benign prostatic hyperplasia. Urology 2015;86(6):1115‐22. - PMC - PubMed
Walsh 2017
    1. Walsh LP. State of the art: advanced techniques for prostatic urethral lift for the relief of prostate obstruction under local anesthesia. Canadian Journal of Urology 2017;24(3):8859‐64. - PubMed
WHO 2002
    1. World Health Organization. Proposed working definition of an older person in Africa for the MDS project. www.who.int/healthinfo/survey/ageingdefnolder/en (accessed 17 August 2017).
Woo 2012
    1. Woo HH, Bolton DM, Laborde E, Jack G, Chin PT, Rashid P, et al. Preservation of sexual function with the prostatic urethral lift: a novel treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Journal of Sexual Medicine 2012;9(2):568‐75. - PubMed
Yoo 2012
    1. Yoo TK, Cho HJ. Benign prostatic hyperplasia: from bench to clinic. Korean Journal of Urology 2012;53(3):139‐48. - PMC - PubMed

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