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。
