Non-steroidal anti-inflammatory drugs for lower urinary tract symptoms in benign prostatic hyperplasia: systematic review and meta-analysis of randomized controlled trials
Kahokehr A, Vather R, Nixon A, Hill AG. BJU Int. 2013 Feb;111(2):304-11. doi: 10.1111/j.1464-410X.2012.11559.x.


Department of Urology, Northland District Health Board, Whangarei Hospital, Whangarei.


WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: 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 in vitro after treatment with NSAIDs. 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.


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.


Men treated with NSAIDs in comparison with placebo or other BPH medications.


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 Review Manager Version 5.0 software. Study weight was calculated by the inverse variances of the study effect estimates.


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, P < 0.001, n = 3 studies). The weighted mean difference for peak urine flow was 0.89 mL/s (95% CI 0.21-1.58, P = 0.01, n = 3 studies) and for reported adverse effects was 1.51 (95% CI 0.66-3.43, P = 0.32, n = 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.


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.