[Stress urinary incontinence. Evidence for 4 minimally invasive methods of treating - systematic overview]. / Belastungsinkontinenz. Evidenz zu 4 minimal-invasiven Behandlungsmethoden mit fragwürdigem Nutzen - systematische Ubersichtsarbeit.

BACKGROUND: Stress urinary incontinence is a common problem. A systematic review of 4 minimally invasive methods (Safyre, ACT, Argus, and ProACT) was undertaken to evaluate these methods and formulate recommendations. MATERIALS AND METHODS: Medline, EMBASE, databases of the University of York Centre for Reviews and Dissemination, databases of the International Network of Agencies for Health Technology Assessment, and other web sites were searched for relevant literature. Nine studies were selected. Their core data were translated to extraction tables under peer review, the quality of evidence was assessed by the GRADE scheme, and for each method a recommendation was made. RESULTS: For 2 of the methods (Safyre and ProACT), a restricted positive recommendation was made; for the other 2 methods, the quality of evidence was too low for a recommendation to be expressed. CONCLUSION: The Safyre sling and the ProACT microballoon are methods for which the available evidence indicates a net benefit, but new studies may have a significant impact on the estimate of their effect. A later assessment of the evidence is therefore recommended.

[Kyphoplasty and vertebroplasty for the management of osteoporotic vertebral compression fractures: a systematic review]. / Kyphoplastie und Vertebroplastie bei osteoporotischen Wirbelkörperkompressionsfrakturen: Systematischer Review.

BACKGROUND: We evaluated the efficacy and safety of kyphoplasty and vertebroplasty using the data presented in recently published papers with respect to pain relief, function, complication rate, and incidence of new vertebral fractures. METHODS: Detailed searches for English-language and German-language articles published between 2002 and 2009 were performed in a number of electronic databases. Because of the large number of case series, we considered only systematic reviews and controlled studies. The internal validity of reviews and studies was judged by two authors independently. Data extraction was performed by one author, and extracted data were checked for completeness and correctness by a second author. RESULTS: A total of eight systematic reviews, primarily summarizing results from case series, and 11 controlled studies, two of which were randomized controlled trials (RCTs), were included. Both kyphoplasty and vertebroplasty significantly reduce pain in the majority of patients and can lead to short-term and possibly long-term improvement of function. Kyphoplasty induces fewer clinically relevant complications than vertebroplasty does, and there is presently stronger evidence for its efficacy compared with vertebroplasty. There is inconclusive evidence about the risk of new fractures after kyphoplasty and vertebroplasty. CONCLUSION: Both procedures seem to be equally effective, but kyphoplasty is safer than vertebroplasty. New results, specifically from RCTs comparing the two procedures, are needed to provide more definitive data.

[Endovascular deployment of stent graft in the ascending aorta. A systematic review]. / Stentgraftimplantation bei Erkrankungen der Aorta ascendens. Systematische Ubersichtsarbeit zu Wirksamkeit und Sicherheit.

The endovascular deployment of stent graft in the ascending aorta was proposed for inclusion in the benefit catalogue of the Austrian Federal Ministry of Health. The efficacy and safety of this intervention was unclear, and therefore a systematic review was performed to support evidence-based decision making. Detailed searches for English- or German-language articles published between 2002 and 2008 were performed in a number of electronic databases. Internal validity of studies was judged by two authors independently. A total of 11 case reports but no prospective studies were identified through literature search. The case reports showed the technical feasibility of this intervention but allow no conclusions about its efficacy and safety. Therefore the endovascular deployment of stent graft in the ascending aorta must be considered as experimental and its inclusion in the benefit catalogue cannot be recommended.

[Rheopheresis for age-related macular degeneration]. / Rheopherese bei altersbedingter Makuladegeneration.

BACKGROUND: In Austria, Rheopheresis for non-exudative age-related macular degeneration (AMD) has been proposed for inclusion into the benefit catalogue. Decisions on the inclusion of new medical interventions in reimbursement schemes or benefit catalogues are increasingly based on systematic reviews of clinical studies and their patient-relevant results. MATERIAL AND METHODS: A systematic literature search in five databases identified two randomised clinical trials (RCTs). A systematic analysis of the evidence based on the critical appraisal of the RCTs was carried out. RESULTS: Both RCTs, having a total of 238 included patients, show that to date, evidence for the effectiveness of Rheopheresis for AMD is not available, and predictions for exact indications cannot be made. The bigger RCT showed no effect at all, and the smaller one showed a small effect with questionable clinical relevance. CONCLUSION: Available clinical data suggest considering Rheopheresis an experimental intervention. Its inclusion in the benefit catalogue is not recommended.