Scolaris Content Display Scolaris Content Display

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 1

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 1 International Prostate Symptom Score (IPSS): 6 mos ‐ 1 year follow‐up.
Figures and Tables -
Analysis 1.1

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 1 International Prostate Symptom Score (IPSS): 6 mos ‐ 1 year follow‐up.

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 2 Madsen‐Iversen Symptom Score (range 0 to 27): 6 mos ‐ 1 year follow‐up.
Figures and Tables -
Analysis 1.2

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 2 Madsen‐Iversen Symptom Score (range 0 to 27): 6 mos ‐ 1 year follow‐up.

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 3 50% Improvement in AUA Symptom Score: # subjects.
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Analysis 1.3

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 3 50% Improvement in AUA Symptom Score: # subjects.

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 4 Peak Flow Rate (Qmax): 6 mos ‐ 1 year follow‐up.
Figures and Tables -
Analysis 1.4

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 4 Peak Flow Rate (Qmax): 6 mos ‐ 1 year follow‐up.

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 5 Hematuria (requiring additional treatment/judged to be serious).
Figures and Tables -
Analysis 1.5

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 5 Hematuria (requiring additional treatment/judged to be serious).

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 6 Urinary retention.
Figures and Tables -
Analysis 1.6

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 6 Urinary retention.

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 7 Dysuria/Urgency.
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Analysis 1.7

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 7 Dysuria/Urgency.

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 8 Urinary tract infections/epididymitis/orchitis.
Figures and Tables -
Analysis 1.8

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 8 Urinary tract infections/epididymitis/orchitis.

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 9 Retrograde ejaculation (sexually active men only).
Figures and Tables -
Analysis 1.9

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 9 Retrograde ejaculation (sexually active men only).

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 10 Erectile dysfunction.
Figures and Tables -
Analysis 1.10

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 10 Erectile dysfunction.

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 11 Repeat treatments/Reoperations up to 1 year.
Figures and Tables -
Analysis 1.11

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 11 Repeat treatments/Reoperations up to 1 year.

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 12 Urethral/bladder neck strictures.
Figures and Tables -
Analysis 1.12

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 12 Urethral/bladder neck strictures.

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 13 Transfusions.
Figures and Tables -
Analysis 1.13

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 13 Transfusions.

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 14 Clot retention.
Figures and Tables -
Analysis 1.14

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 14 Clot retention.

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 15 TURP Syndrome.
Figures and Tables -
Analysis 1.15

Comparison 1 Microwave thermotherapy versus transurethral resection of the prostate (TURP), Outcome 15 TURP Syndrome.

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 1 International Prostate Symptom Score (IPSS).
Figures and Tables -
Analysis 2.1

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 1 International Prostate Symptom Score (IPSS).

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 2 Madsen Symptom Score.
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Analysis 2.2

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 2 Madsen Symptom Score.

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 3 Peak Flow Rate (Qmax).
Figures and Tables -
Analysis 2.3

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 3 Peak Flow Rate (Qmax).

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 4 Hematuria (post‐procedure).
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Analysis 2.4

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 4 Hematuria (post‐procedure).

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 5 Urinary retention.
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Analysis 2.5

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 5 Urinary retention.

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 6 Dysuria (self‐limited).
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Analysis 2.6

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 6 Dysuria (self‐limited).

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 7 UTI/epididymitis.
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Analysis 2.7

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 7 UTI/epididymitis.

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 8 Ejaculatory disorders.
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Analysis 2.8

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 8 Ejaculatory disorders.

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 9 Retreatment.
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Analysis 2.9

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 9 Retreatment.

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 10 Quality of Life.
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Analysis 2.10

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 10 Quality of Life.

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 11 Bladder spasm.
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Analysis 2.11

Comparison 2 Microwave thermotherapy versus sham treatment, Outcome 11 Bladder spasm.

Transurethral microwave thermotherapy (TUMT) compared with transurethral resection of the prostate (TURP) for symptomatic benign prostatic hyperplasia

Patient or population: men with symptomatic benign prostatic hyperplasia

Settings: office (TUMT) or hospital (TURP)

Intervention: Transurethral microwave thermotherapy (TUMT)

Comparison: Transurethral resection of the prostate (TURP)

Outcomes

Illustrative comparative risks* (95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

TURP

TUMT

International Prostate Symptom Score (IPSS).

Range: 0 to 35 points.

Follow‐up: 6 mos ‐ 1 year

The mean IPSS scores ranged across control groups from 3.4 to 7.1 points

The mean IPSS in the intervention group was 1 point higher (95% CI, 0.03 lower to 2.03 higher)

306
(studies)

⊕⊕⊕⊝
moderate1

Madsen‐Iversen Symptom Score Range 0 to 27 points

Follow‐up: 6 mos ‐ 1 year

The mean Madsen‐Iversen Symptom scores ranged across control groups from 0.62 to 2.7 points

The mean Madsen‐Iversen Symptom score in the intervention group was 1.59 points higher (95% CI, 0.69 lower to 2.48 higher)

338
(5 studies)

⊕⊕⊕⊝
moderate1

Peak Flow Rate (Qmax):

Measurement: mL per second

Follow‐up: 6 mos ‐ 1 year

The mean Peak Flow Rate ranged across control groups from 14.6 to 20.6 mL/s

The mean urinary peak flow rate in the intervention group was 5.08 mL/s lower (95% CI, 3.88 to 6.28 lower)

108
(2 studies)

⊕⊕⊕⊝
moderate1

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk Ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 <400 subjects evaluated for this outcome which is a non‐optimal information size

Figures and Tables -
Comparison 1. Microwave thermotherapy versus transurethral resection of the prostate (TURP)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 International Prostate Symptom Score (IPSS): 6 mos ‐ 1 year follow‐up Show forest plot

4

306

Mean Difference (IV, Random, 95% CI)

1.00 [‐2.03, 0.03]

1.1 ProstaLund Feedback Treatment

1

136

Mean Difference (IV, Random, 95% CI)

‐0.10 [‐2.44, 2.24]

1.2 Prostatron (high‐energy Prostasoft 2.5)

2

104

Mean Difference (IV, Random, 95% CI)

‐0.95 [‐2.40, 0.51]

1.3 Prostatron (Prostasoft 2.0 and 2.5)

1

66

Mean Difference (IV, Random, 95% CI)

‐2.7 [‐5.87, 0.47]

2 Madsen‐Iversen Symptom Score (range 0 to 27): 6 mos ‐ 1 year follow‐up Show forest plot

2

108

Mean Difference (IV, Fixed, 95% CI)

1.59 [0.69, 2.48]

2.1 Prostatron (high‐energy Prostasoft 2.5)

1

44

Mean Difference (IV, Fixed, 95% CI)

1.5 [‐1.07, 4.07]

2.2 Prostatron (low‐energy Prostasoft 2.0)

1

64

Mean Difference (IV, Fixed, 95% CI)

1.6 [0.64, 2.56]

3 50% Improvement in AUA Symptom Score: # subjects Show forest plot

2

121

Risk Ratio (M‐H, Random, 95% CI)

0.74 [0.50, 1.09]

4 Peak Flow Rate (Qmax): 6 mos ‐ 1 year follow‐up Show forest plot

5

338

Mean Difference (IV, Fixed, 95% CI)

5.08 [3.88, 6.28]

4.1 ProstaLund Feedback Treatment

1

104

Mean Difference (IV, Fixed, 95% CI)

1.90 [‐1.17, 4.97]

4.2 Prostatron (high‐energy Prostasoft 2.5)

2

104

Mean Difference (IV, Fixed, 95% CI)

5.26 [3.67, 6.85]

4.3 Prostatron (low‐energy Prostasoft 2.0)

1

64

Mean Difference (IV, Fixed, 95% CI)

6.30 [3.80, 8.80]

4.4 Prostatron (Prostasoft 2.0 and 2.5)

1

66

Mean Difference (IV, Fixed, 95% CI)

7.40 [1.68, 13.12]

5 Hematuria (requiring additional treatment/judged to be serious) Show forest plot

3

258

Risk Difference (M‐H, Random, 95% CI)

‐0.05 [‐0.15, 0.05]

6 Urinary retention Show forest plot

4

343

Risk Ratio (M‐H, Fixed, 95% CI)

2.94 [1.52, 5.70]

7 Dysuria/Urgency Show forest plot

3

277

Risk Ratio (M‐H, Fixed, 95% CI)

2.22 [1.28, 3.86]

8 Urinary tract infections/epididymitis/orchitis Show forest plot

5

395

Risk Ratio (M‐H, Fixed, 95% CI)

1.15 [0.70, 1.86]

9 Retrograde ejaculation (sexually active men only) Show forest plot

2

78

Risk Difference (M‐H, Fixed, 95% CI)

‐0.34 [‐0.55, ‐0.13]

10 Erectile dysfunction Show forest plot

3

212

Risk Ratio (M‐H, Fixed, 95% CI)

0.41 [0.16, 1.05]

11 Repeat treatments/Reoperations up to 1 year Show forest plot

4

335

Risk Ratio (M‐H, Fixed, 95% CI)

1.76 [0.54, 5.70]

12 Urethral/bladder neck strictures Show forest plot

3

197

Risk Ratio (M‐H, Fixed, 95% CI)

0.13 [0.02, 0.71]

13 Transfusions Show forest plot

2

128

Risk Difference (M‐H, Fixed, 95% CI)

‐0.11 [‐0.21, ‐0.02]

14 Clot retention Show forest plot

3

283

Risk Ratio (M‐H, Fixed, 95% CI)

0.27 [0.06, 1.31]

15 TURP Syndrome Show forest plot

3

274

Risk Difference (M‐H, Fixed, 95% CI)

‐0.05 [‐0.11, ‐0.00]

Figures and Tables -
Comparison 1. Microwave thermotherapy versus transurethral resection of the prostate (TURP)
Comparison 2. Microwave thermotherapy versus sham treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 International Prostate Symptom Score (IPSS) Show forest plot

4

482

Mean Difference (IV, Fixed, 95% CI)

‐5.15 [‐6.04, ‐4.26]

1.1 LEO Microthermer: 3 months follow‐up

1

40

Mean Difference (IV, Fixed, 95% CI)

‐9.1 [‐15.64, ‐2.56]

1.2 Prostatron (Prostasoft 2.0): 3/6 months follow‐up

1

94

Mean Difference (IV, Fixed, 95% CI)

‐5.0 [‐8.09, ‐1.91]

1.3 Dornier Urowave: 6 months follow‐up

1

193

Mean Difference (IV, Fixed, 95% CI)

‐5.30 [‐6.32, ‐4.28]

1.4 Urologix Targis system: 6 months follow‐up

1

155

Mean Difference (IV, Fixed, 95% CI)

‐3.80 [‐6.26, ‐1.34]

2 Madsen Symptom Score Show forest plot

2

196

Mean Difference (IV, Fixed, 95% CI)

‐5.10 [‐6.42, ‐3.79]

2.1 Prostatron (Prostasoft): 3 months follow‐up

1

108

Mean Difference (IV, Fixed, 95% CI)

‐4.50 [‐6.37, ‐2.63]

2.2 Prostatron (Prostasoft 2.0): 3 months follow‐up

1

88

Mean Difference (IV, Fixed, 95% CI)

‐5.7 [‐7.56, ‐3.84]

3 Peak Flow Rate (Qmax) Show forest plot

6

643

Mean Difference (IV, Random, 95% CI)

2.01 [0.85, 3.16]

3.1 LEO Microthermer: 3 months follow‐up

1

40

Mean Difference (IV, Random, 95% CI)

4.80 [1.98, 7.62]

3.2 Prostatron (Prostasoft): 3 months follow‐up

1

108

Mean Difference (IV, Random, 95% CI)

2.10 [0.56, 3.64]

3.3 Prostatron (Prostasoft 2.0): 3/6 months follow‐up

2

168

Mean Difference (IV, Random, 95% CI)

1.94 [‐1.29, 5.16]

3.4 Dornier Urowave: 6 months follow‐up

1

195

Mean Difference (IV, Random, 95% CI)

0.90 [‐0.45, 2.25]

3.5 Urologix Targis system: 6 months follow‐up

1

132

Mean Difference (IV, Random, 95% CI)

2.0 [0.14, 3.86]

4 Hematuria (post‐procedure) Show forest plot

4

684

Risk Difference (M‐H, Fixed, 95% CI)

0.07 [0.01, 0.13]

5 Urinary retention Show forest plot

7

812

Risk Ratio (M‐H, Fixed, 95% CI)

6.04 [2.51, 14.52]

6 Dysuria (self‐limited) Show forest plot

2

403

Risk Ratio (M‐H, Fixed, 95% CI)

2.06 [1.03, 4.13]

7 UTI/epididymitis Show forest plot

3

486

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [0.70, 2.39]

8 Ejaculatory disorders Show forest plot

2

389

Risk Ratio (M‐H, Fixed, 95% CI)

6.10 [0.83, 45.08]

9 Retreatment Show forest plot

2

209

Risk Ratio (M‐H, Fixed, 95% CI)

0.12 [0.03, 0.48]

10 Quality of Life Show forest plot

2

347

Mean Difference (IV, Fixed, 95% CI)

‐0.95 [‐1.14, ‐0.77]

11 Bladder spasm Show forest plot

3

443

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.71, 1.47]

Figures and Tables -
Comparison 2. Microwave thermotherapy versus sham treatment