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Systematic reviews in BPH

 

A number of reviews (more or less systematic) have been done in BPH. A brief description of each is in the table below. THis may be difficult to read if you have a small screen, and in any event for some people a paper copy may be more useful. A PDF of this table can be downloaded by clicking here . If you know of other reviews we may have missed, please let Bandolier know.

Table: Systematic reviews in BPH

Reference

Question

Searching

Included papers

Quality/sensitivity

Inclusion criteria

Treatment

Duration

Outcomes

Eri & Tveter : Alpha-blockage in the treatment of symptomatic BPH. J Urol 1995 154: 923-934 Efficacy and harm associated with alpha-blockers in BPH MEDLINE to Jan 95, plus reference lists and personal files 29 randomised placebo-controlled trials with 3,464 men. Only three appeared to be double blind No quality analysis
No sensitivity analysis
Maximum flow rate of less than 15 mL/second in 15 studies, less than 20 in one and not reported in 13 Seven different alpha blockers 24 weeks or longer in five studies Change in maximum flow rate
% change in residual volume
% change in symptoms
Dropout rate
Adverse effects mentioned
Boyle et al . Prostate volume predicts outcome of treatment of BPH with finasteride. Urology 1996 48: 398-405.
Effect of finasteride on symptoms and examine predictors of outcomes All randomised trials comparing finasteride 5 mg with placebo at one year Six trials with 2601 men. No information about methodological quality, though unlikely to be a problem No quality analysis
No sensitivity analysis
Maximum flow rate of 15 or less in five studies, 12-20 in sixth.
Moderate symptoms entry criterion of all
Finasteride 5 mg 52 weeks Change in maximum flow rate
% change in symptoms
Analysis by prostate volume
Byrnes et al . Combined analysis of two multicentre studies of finasteride 5 mg in treatment of symptomatic BPH. Prostate Cancer and Prostatic Disease 1997 1: 26-31. Analysis by age older and younger than 65 years No searching Two randomised placebo controlled trials with 4,732 men No quality analysis
No sensitivity analysis
BPH with moderate to sever symptoms (AUA scores 8 or more) Finasteride 5 mg 52 weeks Change in symptom score
Adverse events
PSA
DHT
Roehrborn . Meta-analysis of randomised clinical trials of finasteride. Urology 1998 51 Suppl 4A: 46-49. Duplicate of Boyle et al   Includes analysis of prostate size distribution          
Wilt et al . Saw palmetto extracts for treatment of benign prostatic hyperplasia. JAMA 1998 280: 1604-1609
Efficacy and harm associated with Saw palmetto (serenoa repens) in BPH MEDLINE, EMBASE, Cochrane Library and fields registers, plus reference lists, reviews and trialists. To mid 1997 18 randomised comparisons with placebo with 2,939 men lasting at least 30 days. Mean age 65 years. 16 studies were double blind. Quality analysis (Schulz)
No sensitivity analysis
Initial symptoms consistent with moderate BPH. Baseline mean urinary flow was 5.7 mL/sec and prostate volume was 44 mL. No information Mean duration was 9 weeks Peak urinary flow rate vs placebo (8 trials, 642 men)
Nocturia vs placebo (10 trials, 634 men)
IPSS vs placebo (2 trials, 1440 men)
Wilt et al . Beta-sitosterol for the treatment of benign prostatic hyperplasia: a systematic review. BJU International 1999 83: 976-983.
Efficacy with beta-sitosterol in BPH MEDLINE, EMBASE, Cochrane Library and fields registers, plus reference lists, reviews and trialists. To mid 1998 4 randomised comparisons with placebo in 519 men. Mean age about 65 years. All studies double-blind Quality analysis (Schulz)
No sensitivity analysis
Initial symptoms consistent with moderate BPH. Maximum flow rate under 15 ml/sec in two, under 20 mL/sec on one No information Three studies lasted 24-26 weeks, one of 4 weeks. Peak urinary flow rate vs placebo
Symptom score vs placebo
Residual volume vs placebo
Mean change in above
Macdonald et al. A systematic review of cernilton for the treatment of BPH. BJU International 1999 85: 836-841. Efficacy and safety of rye grass pollen extract (cernilton) for BPH MEDLINE, EMBASE, Cochrane Library and fields registers, plus reference lists, reviews and trialists. To mid 1997 4 randomised comparisons (2 with placebo, 2 with other complementary therapies) in 444 men. Mean age about 65 years. Three studies double-blind Quality analysis (Schulz)
No sensitivity analysis
Men with BPH No information One study lasted 24 weeks, the others being 12-16 weeks Peak urinary flow rate
Symptom score
Residual volume
Nocturia
Djavan & Marberger . A meta-analysis of the efficacy and tolerability of alpha1-adrenoreceptor antagonists in patients with lower urinary tract symptoms suggestive of BPH. European Urology 1999 36: 1-13. Distinguishing between members of drug class for efficacy and harm MEDLINE, for English language papers to mid 98 21 studies, "most" of which were randomised and double-blind", 6,333 men in placeb0-controlled studies. No quality analysis
No sensitivity analysis
No information Any dose 1 month to 1 year Percentage improvement in symptom score (end vs baseline)
Percentage improvement in maximum flow rate
Percentage with bothersome adverse effects
Percentage with adverse effects related to vasodilator properties
Ishani et al . Pygeum africanum for treatment of patients with BPH: a systematic review and quantitative meta-analysis. American Journal of Medicine 2000 109: 654-664. Efficacy and safety of Pygeum africanum for BPH MEDLINE, EMBASE, Cochrane Library and fields registers, plus reference lists, reviews and trialists. To mid 2000 18 randomised trials with 1,562 men lasting at least 30 days. Mean age 66 years. 17 studies were double blind. Quality analysis (including Schulz)
No sensitivity analysis
Men with BPH 14 studies used a standardise extract Mean duration was 9 weeks Peak urinary flow rate
Symptom score
Residual volume
Nocturia
Boyle et al . Meta-analysis of clinical trials of permixon in the treatment of symptomatic BPH. Urology 2000 55: 533-539. Clinical efficacy of permixon (an extract of serenoa repens) versus placebo No formal search strategy 13 trials (11 randomised) with 2,859 men No quality analysis
Sensitivity analysis of all versus randomised studies
Men with BPH 320 mg a day Duration 3 to 26 weeks Peak urinary flow rate
Nocturia
Baseline, end, and change
McNeill et al . Postvoid residual urine in patients with lower urinary tract symptoms suggestive of BPH: pooled analysis of eleven controlled studies with alfuzosin. Urology 2001 57: 459-465. Effect of alpha-blocker on residual volume and other outcomes. No formal search strategy, but data from clinical trials 11double blind randomised trials comparing alfuzosin with placebo. 953 men aged 42-89 years (mean 65 years). No quality analysis
No sensitivity analysis
Men with BPH and residual volume 50-350 mL. Peak flow rate less than 15 mL/sec 7.5 mg (immediate release) or 10 mg (sustained release) 4-24 weeks Change in residual volume
Yang et al . Transurethral incision compared with transurethral resection of the prostate for bladder outlet obstruction: a systematic review and meta-analysis of randomized controlled trials. Journal of Urology 2001 165: 1526-1532. Efficacy of incision compared with resection MEDLINE, EMBASE, ISA, Cochrane Library, plus Cochrane Review Group databases, to 1999 9 randomised trials with 691 men. Mean ages 60s to early 70s Two quality scores Lower urinary tract symptoms suggestive of bladder outlet obstruction Not applicable Follow up at various times from 3-60 months. 12 month data analysed Maximum flow rate (4 trials, 226 men)
Symptom score (4 trials, 243 men)
Actual baseline and 3/12 month scores and flow rates where available
Roehrborn et al . Clinical predictors of spontaneous acute urinary retention in men with LUTS and clinical BPH: a comprehensive analysis of the pooled placebo groups of several large clinical trials. Urology 2001 58: 210-216. Clinical predictors of acute retention No formal search strategy, but data from clinical trials 3,780 men, mean age 64 years, peak flow 11 mL/sec, IPSS 15 Not applicable - all four studies randomised and double-blind. Men with BPH. Baseline mean data given Placebo 2-4 years Predictive factors for acute urinary retention.
Edward & Moore . Finasteride in the treatment of clinical benign prostatic hyperplasia: a systematic review of randomised trials. BMC Urology 2002 2:14. Efficacy and adverse events Wide, including Cochrane and PubMed 14,720 men in placebo controlled trials Trials had to be randomised and double blind. Sensitivity analyses doen Men with BPH. Placebo 2-4 years Symptoms, maximum flow rate, prostate volume, AUR, surgery, adverse events
Wilt et al. Terazosin for treating symptomatic benign prostatic obstruction: a systematic review of efficacy and adverse effects. BJU International 2002 89: 214-225. Efficacy and adverse events Wide, including Cochrane and specialist registers 5151 men in 17 trials Trials had to be randomised, and of at least 4 weeks duration Men with symptomatic benign prostatic obstruction Placebo and active 4-52 weeks Symptoms, maximum flow rate, prostate volume, adverse events