PDF(Pubmed)
Abstract：
UNASSIGNED: This work aims to determine the efficacy and safety of preoperative alpha-blocker therapy on ureteroscopy (URS) outcomes.
UNASSIGNED: In this systematic review and meta-analysis of randomised trials of URS with or without preoperative alpha-blocker therapy, outcomes included the need for ureteral dilatation, stone access failure, procedure time, residual stone rate, hospital stay, and complications. Residual stone rates were reported with and without adjustments for spontaneous stone passage, medication noncompliance, or adverse events leading to patient withdrawal. Data were analysed using random-effects meta-analysis and meta-regression. Certainty of evidence was assessed using the GRADE criteria.
UNASSIGNED: Among 15 randomised trials with 1653 patients, URS was effective and safe with a stone-free rate of 81.2% and rare (2.3%) serious complications. The addition of preoperative alpha-blockers reduced the need for ureteral dilatation (risk ratio [RR] = 0.48; 95% CI = 0.30 to 0.75; p = 0.002), access failure rate (RR = 0.36; 95% CI = 0.23 to 0.57; p < 0.001), procedure time (mean difference [MD] = -6 min; 95% CI = -8 to -3; p < 0.001), risk of residual stone in the primary (RR = 0.44; 95% CI = 0.33 to 0.66; p < 0.001) and adjusted (RR = 0.52; 95% CI = 0.40 to 0.68; p < 0.001) analyses, hospital stay (MD = -0.3 days; 95% CI = -0.4 to -0.1; p < 0.001), and complication rate (RR = 0.46; 95% CI = 0.35 to 0.59; p < 0.001). Alpha-blockers increased ejaculatory dysfunction risk and were less effective for renal/proximal ureter stones. The certainty of evidence was high or moderate for all outcomes. The main limitation of the review was inconsistency in residual stone assessment methods.
UNASSIGNED: While URS is an effective and safe treatment for stone disease, preoperative alpha-blocker therapy is well tolerated and can further improve patient outcomes.
UNASSIGNED: In this systematic review and meta-analysis of randomised trials of URS with or without preoperative alpha-blocker therapy, outcomes included the need for ureteral dilatation, stone access failure, procedure time, residual stone rate, hospital stay, and complications. Residual stone rates were reported with and without adjustments for spontaneous stone passage, medication noncompliance, or adverse events leading to patient withdrawal. Data were analysed using random-effects meta-analysis and meta-regression. Certainty of evidence was assessed using the GRADE criteria.
UNASSIGNED: Among 15 randomised trials with 1653 patients, URS was effective and safe with a stone-free rate of 81.2% and rare (2.3%) serious complications. The addition of preoperative alpha-blockers reduced the need for ureteral dilatation (risk ratio [RR] = 0.48; 95% CI = 0.30 to 0.75; p = 0.002), access failure rate (RR = 0.36; 95% CI = 0.23 to 0.57; p < 0.001), procedure time (mean difference [MD] = -6 min; 95% CI = -8 to -3; p < 0.001), risk of residual stone in the primary (RR = 0.44; 95% CI = 0.33 to 0.66; p < 0.001) and adjusted (RR = 0.52; 95% CI = 0.40 to 0.68; p < 0.001) analyses, hospital stay (MD = -0.3 days; 95% CI = -0.4 to -0.1; p < 0.001), and complication rate (RR = 0.46; 95% CI = 0.35 to 0.59; p < 0.001). Alpha-blockers increased ejaculatory dysfunction risk and were less effective for renal/proximal ureter stones. The certainty of evidence was high or moderate for all outcomes. The main limitation of the review was inconsistency in residual stone assessment methods.
UNASSIGNED: While URS is an effective and safe treatment for stone disease, preoperative alpha-blocker therapy is well tolerated and can further improve patient outcomes.
摘要：
■这项工作旨在确定术前α受体阻滞剂治疗对输尿管镜检查（URS）结果的疗效和安全性。
■在本系统综述和荟萃分析中，对有或没有术前α受体阻滞剂治疗的URS的随机试验，结果包括需要输尿管扩张，石材访问失败，程序时间,残石率，住院,和并发症。报告了残余结石率，有或没有对自发结石通过进行调整，用药不合规,或导致患者戒断的不良事件。使用随机效应荟萃分析和荟萃回归分析数据。使用等级标准评估证据的确定性。
■在包含1653名患者的15项随机试验中，URS是有效和安全的，无结石率为81.2％，罕见（2.3％）严重并发症。术前添加α-受体阻滞剂减少了输尿管扩张的需要（风险比[RR]=0.48;95％CI=0.30至0.75;p=0.002），接入失败率(RR=0.36；95%CI=0.23至0.57；p<0.001)，手术时间(平均差[MD]=-6分钟；95%CI=-8至-3；p<0.001)，主要（RR=0.44;95％CI=0.33至0.66;p<0.001）和调整（RR=0.52;95％CI=0.40至0.68;p<0.001）分析中的残余结石风险，住院时间（MD=-0.3天；95%CI=-0.4至-0.1；p<0.001），和并发症发生率(RR=0.46;95%CI=0.35至0.59;p<0.001)。α受体阻滞剂增加射精功能障碍风险，对肾/近端输尿管结石的疗效较差。对于所有结果，证据的确定性都是高或中等的。审查的主要局限性是残石评估方法不一致。
■虽然URS是一种有效且安全的治疗结石的方法，术前α受体阻滞剂治疗耐受性良好,可进一步改善患者预后.
■在本系统综述和荟萃分析中，对有或没有术前α受体阻滞剂治疗的URS的随机试验，结果包括需要输尿管扩张，石材访问失败，程序时间,残石率，住院,和并发症。报告了残余结石率，有或没有对自发结石通过进行调整，用药不合规,或导致患者戒断的不良事件。使用随机效应荟萃分析和荟萃回归分析数据。使用等级标准评估证据的确定性。
■在包含1653名患者的15项随机试验中，URS是有效和安全的，无结石率为81.2％，罕见（2.3％）严重并发症。术前添加α-受体阻滞剂减少了输尿管扩张的需要（风险比[RR]=0.48;95％CI=0.30至0.75;p=0.002），接入失败率(RR=0.36；95%CI=0.23至0.57；p<0.001)，手术时间(平均差[MD]=-6分钟；95%CI=-8至-3；p<0.001)，主要（RR=0.44;95％CI=0.33至0.66;p<0.001）和调整（RR=0.52;95％CI=0.40至0.68;p<0.001）分析中的残余结石风险，住院时间（MD=-0.3天；95%CI=-0.4至-0.1；p<0.001），和并发症发生率(RR=0.46;95%CI=0.35至0.59;p<0.001)。α受体阻滞剂增加射精功能障碍风险，对肾/近端输尿管结石的疗效较差。对于所有结果，证据的确定性都是高或中等的。审查的主要局限性是残石评估方法不一致。
■虽然URS是一种有效且安全的治疗结石的方法，术前α受体阻滞剂治疗耐受性良好,可进一步改善患者预后.
