Twenty-three RCTs (2,245 participants) were included in the review.
HoLEP had a statistically significantly higher IPSS reduction than TURP (mean difference 1.309, 95% CI 0.747 to 1.870). Other MISTs were not statistically significantly different from TURP for this measure. No statistically significant differences were found between treatments in terms of quality of life. KTP data could not be pooled and analysed.
HoLEP had a statistically significant higher increase in maximum flow rate compared to TURP (mean difference 1.687, 95% CI 0.711 to 2.664). No other statistically significant differences were found between treatments for this outcome. No statistically significant differences were found between TURP and any of the MISTs for PVRU.
Type, category (minor versus major) and number of complications varied specifically for each of the transurethral techniques. KTP laser showed statistically fewer intraoperative complications than TURP (OR 0.220, 95% CI 0.086 to 0.563). Other treatments were not significantly different from TURP.
Compared to TURP, bipolar TURP (OR 0.647, 95% CI 0.438 to 0.956) and bipolar transurethral vaporisation of the prostate (OR 0.525, 95% CI 0.303 to 0.910) had statistically fewer perioperative complications; other comparisons were not significantly different. No statistically significant differences were noted for late complications. There were no statistically significant differences between treatments in overall morbidity. Specific adverse events related to the techniques were detailed in the paper.