In a meta-analysis of 23 studies ¹ , α-blockers compared with placebo were associated with significant improvement in symptoms with standardized mean differences of total symptom -1.7 (95% CI, -2.8 to -0.6), pain -1.1 (95% CI -1.8 to -0.3), voiding -1.4 (95% CI -2.3 to -0.5) and quality-of-life scores -1.0 (95% CI -1.8 to -0.2). Patients receiving α-blockers or anti-inflammatory medications had a higher chance of favorable response compared with placebo, with pooled RRs of 1.6 (95% CI 1.1-2.3) and 1.8 (95% CI 1.2-2.6), respectively. Contour-enhanced funnel plots suggested the presence of publication bias for smaller studies of α-blocker therapies.

The network meta-analysis suggested benefits of antibiotics in decreasing total symptom scores (-9.8; 95% CI -15.1 to -4.6), pain scores (-4.4; 95% CI -7.0 to -1.9), voiding scores (-2.8; 95% CI -4.1 to -1.6), and quality-of-life scores (-1.9; 95% CI -3.6 to -0.2) compared with placebo. Combining α-blockers and antibiotics yielded the greatest benefits compared with placebo, with corresponding decreases of -13.8 (95% CI -17.5 to -10.2) for total symptom scores, -5.7 (95% CI -7.8 to -3.6) for pain scores, -3.7 (95% CI -5.2 to -2.1) for voiding, and -2.8 (95% Cl -4.7 to -0.9) for quality-of-life scores.

Comment: The level of evidence is downgraded by potential reporting bias.