Login to Access Video or Poster Abstract: MP09-16
Sources of Funding: Departmental

Introduction

5-alpha reductase inhibitors (5ARIs) are being promoted as an integral part of the armamentarium to treat male LUTS attributed to benign prostatic hyperplasia (BPH). To establish the benefits and harms in the least biased manner, we conducted a rigorous Cochrane review.

Methods

Based on an a priori, protocol we searched the published and unpublished literature for randomized controlled trials (RCTs) in any language. Primary outcomes were: Mean change in urologic symptom scores using validated questionnaires, mean change in quality of life and the number of participants who experienced a major adverse effect; secondary outcomes included episodes of urinary retention and need for surgical intervention. We performed meta-analysis using RevMan 5.3 and rated the quality of evidence using GRADE. All steps were performed independently and in duplicate.

Results

Among 2604 screened records identified from multiple database, 28 unique studies ultimately met inclusion criteria. Based on 18 studies with 16,142 patients, 5ARIs resulted in a small reduction of symptom score with a mean difference (MD) of -1.5 (95% CI -1.9 to -1.1; low quality evidence) compared to placebo (Table 1). The rate of major adverse events was similar with a risk ratio (RR) of 0.9 (95 CI 0.8 to 1.1; low quality evidence). Compared to alpha blockers (ABs) based on 9 trials with 7954 participants (Table 2), symptoms scores were higher with a MD of +1.1 (95 CI 0.5 to -1.7; moderate quality evidence) and was associated possible reduction in the absolute risk of acute urinary retention (23 fewer per 1,000; 95% CI 35 fewer to 5 more; low quality evidence) and a small reduction in the need for surgical intervention (32 fewer per 1,000; 95% CI 38 fewer to 23 fewer; moderate quality evidence).

Conclusions

5ARIs alone may reduce urological symptom scores and the absolute risk of acute urinary retention slightly compared to placebo. Compared to ABs, they probably reduce the need for surgical intervention slightly and may reduce the risk of acute urinary retention slightly.

Funding

Departmental