坦索罗辛是α-肾上腺素能拮抗剂的治疗药物。先前的随机对照试验和回顾性分析证明了坦索罗辛对许多泌尿系统疾病的疗效。然而,关于坦索罗辛能否预防术后尿潴留(POUR)仍存在争议.这项荟萃分析旨在探讨坦索罗辛与安慰剂相比预防POUR的功效。我们搜索了MEDLINE,EMBASE,和Cochrane图书馆从1999年12月31日至2022年4月30日进行随机对照试验(RCT)。排除不是RCTs或没有阴性对照的研究。Cochrane协作协调标准用于评估纳入研究的偏倚风险。邀请Revman(5.3版)软件合成结果。我们进行了亚组分析,以探讨可能影响坦索罗辛预防POUR疗效的因素。我们的荟萃分析汇集了13项RCTs,共2163例患者。我们得出结论,坦索罗辛与安慰剂相比,POUR的风险显着降低(坦索罗辛与安慰剂的13.54%vs20.88%,RR=0.63,95%CI0.47~0.84,P=0.002)。坦索罗辛可以显着降低腹部POUR的风险(坦索罗辛与安慰剂的11.52%vs20.25%,RR=0.52,95%CI0.31至0.88,P=0.02)和女性骨盆手术(坦索罗辛与安慰剂的15.57%vs31.50%,RR=0.51,95%CI0.31至0.82,P=0.006),但在脊柱手术中没有(坦索罗辛与安慰剂的13.45%vs12.75%,RR=1.07,95%CI0.72至1.60,P=0.73)和下肢手术(坦索罗辛和安慰剂的21.43%vs33.33%,RR=0.64,95%CI0.35~1.14,P=0.13)。术后的预防效果(坦索罗辛与安慰剂的17.70%vs33.93%,RR=0.53,95%CI0.33至0.85,P=0.008)和术前坦索罗辛术后(坦索罗辛与安慰剂的13.96%vs23.44%,POUR的RR=0.64,95%CI0.43至0.93,P=0.02)明显优于术前管理(坦索罗辛与安慰剂的11.95%vs14.63%,RR=0.62,95%CI0.23~1.65,P=0.34)。术后导管放置似乎对坦索罗辛的POUR预防作用产生负面影响。(坦索罗辛和安慰剂分别为9.37%和16.46%,RR=0.51,95%CI0.31至0.83,P=0.007)坦索罗辛对脊柱患者的POUR预防有显着影响(坦索罗辛与安慰剂的15.07%vs26.51%,RR=0.52,95%CI0.31至0.90,P=0.02)和硬膜外麻醉(坦索罗辛与安慰剂的12.50%vs29.79%,RR=0.42,95%CI0.18至1.00,P=0.05),但在全身麻醉中没有(坦索罗辛与安慰剂的12.40%vs18.52%,RR=0.68,95%CI0.45至1.03,P=0.07)。坦索罗辛对预防POUR的效果优于安慰剂。此外,坦索罗辛对各种手术部位的POUR预防有不同的效果,麻醉,药物管理,和导管使用。然而,由于缺乏证据,我们的结论仍有一定的局限性.
Tamsulosin is a therapeutic drug of alpha-adrenergic antagonists. Previous randomized controlled trials and retrospective analyses have proved the efficacy of tamsulosin on many urinary system diseases. However, there is still a conflict about whether tamsulosin could prevent postoperative urinary retention (POUR). This meta-analysis aims to probe into the efficacy of tamsulosin for preventing POUR versus placebo. We searched MEDLINE, EMBASE, and Cochrane Library from December 31, 1999 to April 30, 2022, for randomized controlled trials (RCTs). Studies that were not RCTs or without negative controls were excluded. Cochrane Collaboration harmonized criteria were used to assess the risk of bias in included studies. Revman (version 5.3) software was invited to synthesize the results. We performed subgroup analyses to explore the factors that could influence tamsulosin\'s efficacy in POUR prevention. Our meta-analysis pooled 13 RCTs with 2163 patients. We concluded that tamsulosin brought about a significant reduction in the risk of POUR versus placebo (13.54% vs 20.88% for tamsulosin vs placebo, RR = 0.63, 95% CI 0.47 to 0.84, P = 0.002). Tamsulosin could significantly reduce the risk of POUR in abdominal (11.52% vs 20.25% for tamsulosin vs placebo, RR = 0.52, 95% CI 0.31 to 0.88, P = 0.02) and female pelvic surgery (15.57% vs 31.50% for tamsulosin vs placebo, RR = 0.51, 95% CI 0.31 to 0.82, P = 0.006) but not in spinal surgery (13.45% vs 12.75% for tamsulosin vs placebo, RR = 1.07, 95% CI 0.72 to 1.60, P = 0.73) and lower limb surgery (21.43% vs 33.33% for tamsulosin vs placebo, RR = 0.64, 95% CI 0.35 to 1.14, P = 0.13). The preventive effect of postoperative (17.70% vs 33.93% for tamsulosin vs placebo, RR = 0.53, 95% CI 0.33 to 0.85, P = 0.008) and postoperative with preoperative tamsulosin (13.96% vs 23.44% for tamsulosin vs placebo, RR = 0.64, 95% CI 0.43 to 0.93, P = 0.02) on POUR were significantly better than preoperative management (11.95% vs 14.63% for tamsulosin vs placebo, RR = 0.62, 95% CI 0.23 to 1.65, P = 0.34). Postoperative catheter placement appears to have a negative impact on the POUR-preventive effect of tamsulosin. (9.37% vs 16.46% for tamsulosin vs placebo, RR = 0.51, 95% CI 0.31 to 0.83, P = 0.007) Tamsulosin showed significantly effect on POUR prevention in patients during spinal (15.07% vs 26.51% for tamsulosin vs placebo, RR = 0.52, 95% CI 0.31 to 0.90, P = 0.02) and epidural anesthesia (12.50% vs 29.79% for tamsulosin vs placebo, RR = 0.42, 95% CI 0.18 to 1.00, P = 0.05) but not in general anesthesia (12.40% vs 18.52% for tamsulosin vs placebo, RR = 0.68, 95% CI 0.45 to 1.03, P = 0.07). Tamsulosin shows better outcomes for preventing POUR than placebo. Besides, tamsulosin showed a different effect on POUR prevention in the various surgical sites, anesthesia, medication management, and catheter use. However, our conclusions still have some limitations due to the lack of evidence.