背景:疗效,安全,同时行勃起功能障碍(ED)和压力性尿失禁(SUI)同步手术的术后结局尚不清楚.
目的:我们进行了系统评价和荟萃分析,以评估合并ED和SUI的可用同步手术入路,并评估与非同步手术和仅针对ED或SUI的手术相比的再手术率。
方法:我们搜索了PubMed,科克伦图书馆,和Embase数据库,直到2022年6月进行相关研究。根据数据可用性,我们进行了一项比较合并ED和SUI与异步手术患者同步手术后再手术率的比值比(ORs)的荟萃分析,以及仅用于ED或SUI的手术(PROSPERO:CRD42022326941)。
结果:我们在系统评价中纳入了18项研究(16,517例患者),在荟萃分析中纳入了5项。比较同步植入阴茎假体和人工尿道括约肌(AUS)与异步手术,再次手术率无统计学差异[OR:0.98,95%置信区间(CI):0.52~1.84,I2:0%).比较阴茎假体和AUS的同步植入与仅阴茎假体或AUS的植入,联合手术的再手术率较高(OR:2.02,95CI:1.29-3.16,I2:36%和OR:1.7,95CI:1.25-2.32,I2:0%,分别)。同步手术导致了较高的满意率和ED和SUI的显着改善。阴茎假体与男性吊带或ProACT装置组合的证据较低,但数据显示它可能是安全有效的.Mini-Jupette吊带和阴茎假体的同步放置代表了矫正ED和轻度SUI和/或气胸的有希望的治疗方式。
结论:在严重ED和SUI患者中,同步阴茎假体和AUS植入似乎安全有效。进一步的高质量研究是强制性的,以加强目前对ED和SUI患者进行同步手术的稀缺证据。
The efficacy, safety, and postoperative outcomes of synchronous surgery for concomitant erectile dysfunction (ED) and stress urinary incontinence (SUI) remain unclear.
We performed a systematic
review and meta-analysis to evaluate the available synchronous surgical approaches for concomitant ED and SUI and to assess the reoperation rates compared to asynchronous surgery and surgery only for ED or SUI.
We searched PubMed, Cochrane Library, and Embase databases until June 2022 for relevant studies. Based on data availability, we performed a meta-analysis of odds ratios (ORs) comparing reoperation rates after synchronous surgery in patients with concomitant ED and SUI versus asynchronous surgery, as well as surgery solely for ED or SUI (PROSPERO: CRD42022326941).
We included 18 studies in the systematic
review (16,517 patients) and 5 in the meta-analysis. Comparing synchronous implantation of penile prosthesis and artificial urinary sphincter (AUS) versus asynchronous surgery, no statistically significant differences were observed in the reoperation rates [OR:0.98, 95% confidence interval (CI): 0.52-1.84, I2:0%). Comparing synchronous implantation of both penile prosthesis and AUS versus implantation of only a penile prosthesis or an AUS, combined surgery was associated with higher reoperation rates (OR:2.02, 95%CI: 1.29-3.16, I2:36% and OR:1.7, 95%CI: 1.25-2.32, I2:0%, respectively). Synchronous surgery led to high satisfaction rates and significant improvement in ED and SUI. Evidence for the combination of penile prosthesis with a male sling or the ProACT device is low, but data suggests it may be safe and effective. The synchronous placement of a Mini-Jupette sling and penile prosthesis represents a promising treatment modality for the correction of ED and mild SUI and/or climacturia.
Synchronous penile prosthesis and AUS implantation appears safe and effective in patients with severe ED and SUI. Further high-quality studies are mandatory to strengthen the current scarce evidence for synchronous surgery in patients with ED and SUI.