Abstract:
Objective: To perform a systematic review to assess the incidence of reoperation rate for residual/regrowth adenoma after transurethral surgeries for benign prostatic enlargement. Materials and Methods: A systematic literature search was performed on November 12, 2023, using Cochrane Central Register of Controlled Trials, PubMed, and Scopus. We only included randomized studies comparing monopolar (M)/bipolar (B) transurethral resection of the prostate (TURP) vs ablation vs enucleation procedures. Incidence of reoperation was assessed using the Cochran-Mantel-Haenszel Method and reported as risk ratio (RR), 95% confidence interval (CI), and p-values. Statistical significance was set at p < 0.05. Evidence synthesis: Forty-eight studies were included. Six studies compared enucleation vs TURP, 41 ablation vs TURP, and 1 study enucleation vs ablation vs TURP, encompassing 457 patients in enucleation, 2259 in ablation, and 2517 in the TURP group. The pooled incidence of reoperation was 6.2%, 0.7%, 2.3%, and 4.3% after ablation, enucleation, M-TURP, and B-TURP, respectively. Meta-analysis showed that the incidence of reoperation was significantly lower in the enucleation group (RR 0.28, 95% CI 0.10-0.81, p = 0.02), but the difference accounted only in studies with follow-up between 1 and 3 years (RR 0.18, 95% CI 0.04-0.85, p = 0.03). The incidence of reoperation was significantly lower in the enucleation compared with the B-TURP group (RR 0.14, 95% CI 0.03-0.77, p = 0.02). Meta-analysis showed that the incidence of reoperation was significantly higher in the ablation group (RR 1.81, 95% CI 1.33-2.47, p = 0.0002), but there was no difference in studies with follow-up up to 1 year (odds ratio 1.78 95% CI 0.97-3.29, p = 0.06) longer than 5 years (RR 2.02, 95% CI 0.71-5.79, p = 0.19). The incidence of reoperation was significantly higher in the ablation compared with the M-TURP group (RR 1.91, 95% CI 1.44-2.54, p < 0.0001). Conclusions: In mid-term follow-up, reoperation rate for residual/regrowth adenoma was significantly lower after enucleation, although was significantly higher after ablation compared with TURP.
摘要:
目的系统评价经尿道前列腺良性肿大手术后残留/再生腺瘤的再手术率。材料和方法2023年11月12日,使用Cochrane中央对照试验登记册进行了系统的文献检索,PubMed,还有Scopus.我们仅纳入比较单极(M)/双极(B)TURP与消融与摘除手术的随机研究。使用Cochran-Mantel-Haenszel方法评估再次手术的发生率,并报告为风险比(RR)。95%置信区间(CI),和p值。统计学显著性设定为p<0.05。证据合成包括48项研究。6项研究比较了摘除与TURP,41消融与TURP,和一项研究摘除与消融与TURP,包括457例眼球摘除患者,消融中的2259,和2517在TURP组中。再次手术的合并发生率为6.2%,0.7%,2.3%,消融后4.3%,摘除,M-TURP,B-TURP,分别。Meta分析显示,再手术的发生率在眼球摘除术组明显较低(RR0.28,95%CI0.10-0.81,p=0.02),但差异仅在随访1至3年的研究中(RR0.18,95%CI0.04-0.85,p=0.03)。与B-TURP组相比,眼球摘除术组的再手术发生率显着降低(RR0.14,95%CI0.03-0.77,p=0.02)。Meta分析显示,消融组的再手术发生率明显较高(RR1.81,95%CI1.33-2.47,p=0.0002),但随访1年(OR1.7895CI0.97-3.29,p=0.06)超过5年的研究没有差异(RR2.02,95%CI0.71-5.79,p=0.19)。与M-TURP组相比,消融组再次手术的发生率明显更高(RR1.91,95%CI1.44-2.54,p<0.0001)。结论在中期随访中,在中期随访中,残存/再生腺瘤的再手术率显着降低,而消融后明显高于TURP。