Rédacteurs : Johan Nguyen, Henri Truong

Benign Prostatic Hyperplasia

Hyperplasie bénigne de la prostate : évaluation de l'acupuncture

1. Systematic Reviews and Meta-Analysis

1.1. Zhang 2017 ☆☆

Zhang W, Ma L, Bauer BA, Liu Z, Lu Y. Acupuncture for benign prostatic hyperplasia: A systematic review and meta-analysis. PLoS One. 2017;12(4):. [28350].

PURPOSEThis systematic review and meta-analysis aims to assess the therapeutic and adverse effects of acupuncture for benign prostatic hyperplasia (BPH) in randomized controlled trials (RCTs).
METHODSWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, the Chinese Biomedical Database, the China National Knowledge Infrastructure, the VIP Database and the Wanfang Database. Parallel-group RCTs of acupuncture for men with symptomatic BPH were included. Data from the included trials were extracted by two independent reviewers and were analyzed with The Cochrane Collaboration Review Manager software (RevMan 5.3.5) after risk of bias judgments. The primary outcome measure of this review was a change in urological symptoms.
RESULTS Eight RCTs, which involved 661 men with BPH, were included. Follow-up varied from 4 weeks to 18 months. Pooling of the data from three trials that compared acupuncture with sham-acupuncture revealed that in the short term (4-6 weeks), acupuncture can significantly improve IPSS (MD -1.90, 95% CI -3.58 to -0.21). A sensitivity analysis of the short-term endpoint showed the same result (MD -3.01, 95% CI -5.19 to -0.84) with a borderline minimal clinical important difference (MCID). Qmax of the short-term endpoint indicated statistically positive beneficial effects of acupuncture (MD -1.78, 95%CI -3.43, -0.14). A meta-analysis after medium-term follow-up (12-18 weeks) indicated no significant effect on IPSS when the data from two trials were combined (MD -2.04, 95% CI -4.19, 0.10).
CONCLUSION Statistically significant changes were observed in favor of acupuncture in moderate to severe BPH with respect to short-term follow-up endpoints. The clinical significance of these changes needs to be tested by further studies with rigorous designs and longer follow-up times.

1.2. Chen 2010 ☆

Chen Yuanwu, Du Yuanhao, Xiong Jun, Sun Pan, Gao Xiang, Lin Xiaomiao, Xiao Li. [Acupuncture and moxibustion versus western medicine for benign prostatic hyperplasia: a systematic review]. China Journal of Traditional Chinese Medicine and pharmacy. 2010;6:902-906. [186926].

ObjectiveTo evaluate the quality of prostate hyperplasia related literature in acupuncture and moxibustion, and to compare the curative effect on prostate hyperplasia between acupuncture and moxibustion and western medicine.
MethodsRetrieving Pubmed, Cochrane Library, CBM database, CNKI database Etc. to collect the literature of prostate hyperplasia of clinical randomized or quasi-randomized control trials of comparative study between western medicine and acupuncture treatment. The data was extracted independently by two valuers from literatures fitting the selection criteria. Cochrane evaluation manual 4. 2. 6 was used to evaluate quality, and RevMan 4. 2. 8 was used in statistical analysis.
ResultsA total of six randomized or quasi-randomized controlled trials (total 546 examples) were adopted. 6 study adopted the total effective rate of evaluation indexes, Meta-analysis showed that there was a significant difference between acupuncture treatment group and western medicine group [merger RR (fixed effects model) =1. 26, 95%CI (1. 15, 1. 37), Z=5. 13, P<0. 00001]. 3 studies using cure rate for evaluation, Meta-analysis showed that there was a significant difference between acupuncture treatment group and western medicine group [merger RR (fixed effects model) =4. 53, 95%CI (2. 16, 9. 50), Z=4. 00, P<0. 0001].
ConclusionAcupuncture treatment of prostate hyperplasia was safe and effective, there was probably a great advantage compared with western medicine. But because of the limited quality and low quantity of literature, the conclusion was uncertain, it needed further verification by high quality of a double-blind randomized controlled trial.

2. Clinical Practice Guidelines

2.1. National Institute for Health and Clinical Excellence (NICE, UK) 2010

Lower urinary tract symptoms in men: management (CG97). Evidence-based recommendations on managing lower urinary tract symptoms (LUTS) in men, London (UK): National Institute for Health and Clinical Excellence (NICE). 2010. [159041].

14.3.1 In men who report LUTS, what is the effect of acupuncture vs. no acupuncture or other conservative therapy on patient related and biometric outcomes and adverse events? No clinical or economic studies were identified.
1.8 Alternative and complementary therapies 1.8.1 Do not offer homeopathy, phytotherapy or acupuncture for treating LUTS in men. [2010]