Non‐steroidal anti‐inflammatory drugs for lower urinary tract symptoms in benign prostatic hyperplasia: systematic review and meta‐analysis of randomized controlled trials. (29th January 2013)

• Record Type: Journal Article
• Authors: Kahokehr, Arman; Vather, Ryash; Nixon, Anthony; Hill, Andrew G.
• Is Part Of: BJU international. Volume 111:Number 2(2013:Jan.)
• Page Start: 304
• Page End: 311
• Publication Date: 2013-01-29
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/j.1464-410X.2012.11559.x
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju11559-sec-0001" sec-type="section"> <title>What's known on the subject? and What does the study add?</title> <p> <list id="bju11559-list-1001" list-type="bullet"> <list-item> <p>Benign prostatic hyperplasia (BPH) is the most frequent benign neoplasm in ageing men. Histological studies have shown that intraprostatic inflammatory infiltration is seen in 43–98% of BPH tissues. Preclinical investigations have shown inhibition of growth in the BPH cell line <italic>in vitro</italic> after treatment with NSAIDs.</p> </list-item> <list-item> <p>This review provides evidence that NSAIDs result in improved symptoms and urinary flow associated with BPH. Further research and larger clinical trials are needed to assess the safety and long‐term impact of NSAID use in men with BPH. From the clinical viewpoint, the development of substances that can inhibit inflammatory changes in the hyperplastic prostate may provide new treatment strategies.</p> </list-item> </list> </p> </sec> <sec id="bju11559-sec-0002" sec-type="section"> <title>Objective</title> <p> <list id="bju11559-list-0001" list-type="bullet"> <list-item> <p>To assess the effects of non‐steroidal anti‐inflammatory drugs (NSAIDs) in men with benign prostatic hyperplasia (BPH) using systematic review and meta‐analysis of clinical trials.</p> </list-item> </list> </p> </sec> <sec id="bju11559-sec-0003" sec-type="section"> <title>Subjects</title> <p> <list id="bju11559-list-0002" list-type="bullet"> <list-item> <p>Men treated with NSAIDs in comparison with placebo or other BPH medications.</p> </list-item> </list> </p> </sec> <sec id="bju11559-sec-0004" sec-type="section"> <title>Methods</title> <p> <list id="bju11559-list-0003" list-type="bullet"> <list-item> <p>All aspects of the Preferred Reporting for Systematic Reviews and Meta‐Analyses (PRISMA) statement were followed. Trials were eligible for inclusion provided they (i) randomized men with BPH to receive NSAIDs in comparison with placebo or other BPH medications, and (ii) included clinical outcomes such as urological symptom scales, symptoms or urodynamic measurements. Data analysis was performed using R<sc>eview</sc> M<sc>anager</sc> Version 5.0 software. Study weight was calculated by the inverse variances of the study effect estimates.</p> </list-item> </list> </p> </sec> <sec id="bju11559-sec-0005" sec-type="section"> <title>Results</title> <p> <list id="bju11559-list-0004" list-type="bullet"> <list-item> <p>In all, 183 men from three randomized, placebo‐controlled trials (lasting 4–24 weeks) were assessed. NSAIDs improved urinary symptom scores and flow measures. The weighted mean difference for the International Prostate Symptom Score (IPSS) was −2.89 IPSS points (95% CI −3.84 to −1.95, <italic>P</italic> < 0.001, <italic>n</italic> = 3 studies). The weighted mean difference for peak urine flow was 0.89 mL/s (95% CI 0.21–1.58, <italic>P</italic> = 0.01, <italic>n</italic> = 3 studies) and for reported adverse effects was 1.51 (95% CI 0.66–3.43, <italic>P</italic> = 0.32, <italic>n</italic> = 3 studies, ). All patients assigned to NSAIDs continued the treatment. There were no serious adverse effects and there were no withdrawals or losses to follow‐up.</p> </list-item> </list> </p> </sec> <sec id="bju11559-sec-0006" sec-type="section"> <title>Conclusion</title> <p> <list id="bju11559-list-0005" list-type="bullet"> <list-item> <p>The evidence suggests that NSAIDs improve urinary symptoms and flow measures. Their long‐term effectiveness, safety and ability to prevent BPH complications are not known.</p> </list-item> </list> </p> </sec> </abstract>