Introduction

1. No. 041 Non-Steroidal anti-inflammatory Drugs for LUTS in BPH: Systematic Review and Meta-analysis of Randomised Controlled Trials Kahokehr A†, Vather R ‡, Naidoo T†, Nixon A†, Barker S†, Hill AG‡. †Department of Urology, Northland District Health Board, Whangarei, New Zealand ‡South Auckland Clinical School, University of Auckland, New Zealand Introduction Benign prostatic hyperplasia (BPH) is the most frequent benign neoplasm in ageing men and one of the most common chronic conditions in the male population. BPH is one of the most important causes of lower urinary tract symptoms (LUTS). The interrelationships between BPH and prostatic inflammation have been well studied. Past and recent histological studies have shown that intra-prostatic inflammatory infiltration is seen in 43-98% of BPH tissues indicating that BPH may be an immune mediated disease (1,2). Results One hundred and eighty three men from three randomized, placebo-controlled trials (lasting 4 to 24 weeks) were assessed. One trial used celexocib, one utilized tenoxicam and one utilised rofecoxib. NSAID improved urinary symptom scores and flow measures. The weighted mean difference (WMD) for the IPSS was -2.89 IPSS points (95% CI = -3.84 to -1.95, P<0.00001, n = 3 studies)(Fig 1). The WMD for peak urine flow was 0.89 mL/s (95% CI = 0.21 to 1.58, P=0.01, n = 3 studies)(Fig 2). The Mantel-Haenszel odds radio for improvement of IPSS score by >2 points was 17.86 (95% CI = 6.27 to 50.90, P<0.00001, n = 2 studies) and reported side effects was 1.51 (95% CI = 0.66 to 3.43, P=0.32, n = 3 studies)(Fig 3) . All patients assigned to NSAID continued the treatment. There were no serious side effects and there were no withdrawals or loss to follow up. Aim This systematic review aimed to assess the effects of Non-Steroidal anti-inflammatory drugs (NSAID) on urinary symptoms and flow measures in men with BPH. Methods All aspects of the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) statement were followed. Trials were eligible for inclusion provided they (1) randomized men with BPH to receive NSAID in comparison to placebo or other BPH medications, and (2) included clinical outcomes such as urologic symptom scales, symptoms, or urodynamic measurements. Comprehensive searches were conducted without language restriction. Studies were identified from the following databases from inception to November 2011: Cochrane Central Register of Controlled Trials (CENTRAL/CCTR), Cochrane Library, Medline, PubMed, EMBASE and CINHAL. Relevant meeting abstracts and reference lists were manually searched. Appropriate methodology, as per Cochrane Collaboration hand book, was utilised. Data analysis was performed using Review Manager Version 5.0 software. Fig 1: Forest plot of average IPSS score 4-6 weeks after NSAID treatment Fig 2: Forest plot of peak urinary flow (Qmax) 4-6 weeks after NSAID treatment Fig 3: Forest plot of adverse event incidence after NSAID treatment References 1- Di Silverio F, Gentile V, De Matteis A. et al. Distribution of inflammation, pre-malignant lesions, incidental carcinoma in histologically confirmed benign prostatic hyperplasia: a retrospective analysis. Euro Uro 43: 164-175, 2003. 2- Kohnen PW and Drach GW. Patterns of inflammation in prostatic hyperplasia: a histologic and bacteriologic study. J Uro 121: 755-760, 1979. Conclusions The evidence suggests NSAIDs improve urinary symptoms and flow measures. Their long term effectiveness, safety and ability to prevent BPH complications are yet not known. Acknowledgements The authors would like to thank the Whangarei Hospital Library staff for their help in this study. Poster presentation sponsor