背景:良性前列腺增生(BPH)患者逼尿肌活动不足(DU)的手术治疗效果仍存在争议。
方法:总结相关证据,三个数据库(PubMed,Embase,和WebofScience)从数据库开始到2023年5月1日进行搜索。经尿道手术治疗方式包括经尿道前列腺切除术(TURP),前列腺光选择性汽化术(PVP),经尿道前列腺切开术(TUIP)。经尿道手术治疗的疗效根据尿流图的最大流速(Qmax)进行评估。国际前列腺症状评分(IPSS)后空隙残留物(PVR),生活质量(QoL),作废的音量,膀胱收缩指数(BCI)和最大流速下的最大逼尿肌压力(PdetQmax)。汇总平均差异(MD)用作汇总统计量进行比较。采用纽卡斯尔-渥太华量表评价入选研究的质量。应用敏感性分析和漏斗图评估可能的偏差。
结果:在这项研究中,10项研究,共纳入1142例患者。在患有DU的BPH患者中,半年内,Qmax显著改善(合并MD,4.79;95%CI,2.43-7.16;P<0.05),IPSS(池化MD,-14.29;95CI,-16.67-11.90;P<0.05),QoL(合并MD,-1.57;95%CI,-2.37-0.78;P<0.05),空体积(合并MD,62.19;95%CI,17.91-106.48;P<0.05),BCI(合并MD,23.59;95%CI,8.15-39.04;P<0.05),和PdetQmax(合并MD,28.62;95%CI,6.72~50.52;P<0.05)。此外,一年多之后,Qmax显著改善(合并MD,6.75;95CI,4.35-9.15;P<0.05),IPSS(池化MD,-13.76;95CI,-15.17-12.35;P<0.05),PVR(合并MD,-179.78;95CI,-185.12-174.44;P<0.05),QoL(合并MD,-2.61;95CI,-3.12-2.09;P<0.05),和PdetQmax(合并MD,27.94;95CI,11.70-44.19;P<0.05)。与未接受手术的DU患者相比,接受手术的DU患者在PVR方面表现出更好的改善(合并MD,137.00;95CI,6.90-267.10;P<0.05)和PdetQmax(合并MD,-8.00;95CI,-14.68-1.32;P<0.05)。
结论:我们的荟萃分析结果表明,经尿道手术可以改善BPH伴DU患者的症状。对于患有DU的BPH患者,手术也显示出优于药物治疗的优势。
背景:PROSPEROCRD42023415188。
BACKGROUND: The efficacy of surgical treatment for benign prostatic hyperplasia (BPH) patients with detrusor underactivity (DU) remains controversial.
METHODS: To summarize relevant evidence, three databases (PubMed, Embase, and Web of Science) were searched from database inception to May 1, 2023. Transurethral surgical treatment modalities include transurethral prostatectomy (TURP), photoselective vaporization of the prostate (PVP), and transurethral incision of the prostate (TUIP). The efficacy of the transurethral surgical treatment was assessed according to maximal flow rate on uroflowmetry (Qmax), International Prostate Symptom Score (IPSS), postvoid residual (PVR), quality of life (QoL), voided volume, bladder contractility index (BCI) and maximal detrusor pressure at maximal flow rate (PdetQmax). Pooled mean differences (MDs) were used as summary statistics for comparison. The quality of enrolled studies was evaluated by using the Newcastle-Ottawa Scale. Sensitivity analysis and funnel plots were applied to assess possible biases.
RESULTS: In this study, 10 studies with a total of 1142 patients enrolled. In BPH patients with DU, within half a year, significant improvements in Qmax (pooled MD, 4.79; 95% CI, 2.43-7.16; P < 0.05), IPSS(pooled MD, - 14.29; 95%CI, - 16.67-11.90; P < 0.05), QoL (pooled MD, - 1.57; 95% CI, - 2.37-0.78; P < 0.05), voided volume (pooled MD, 62.19; 95% CI, 17.91-106.48; P < 0.05), BCI (pooled MD, 23.59; 95% CI, 8.15-39.04; P < 0.05), and PdetQmax (pooled MD, 28.62; 95% CI, 6.72-50.52; P < 0.05) were observed after surgery. In addition, after more than 1 year, significant improvements were observed in Qmax (pooled MD, 6.75; 95%CI, 4.35-9.15; P < 0.05), IPSS(pooled MD, - 13.76; 95%CI, - 15.17-12.35; P < 0.05), PVR (pooled MD, - 179.78; 95%CI, - 185.12-174.44; P < 0.05), QoL (pooled MD, - 2.61; 95%CI, - 3.12-2.09; P < 0.05), and PdetQmax (pooled MD, 27.94; 95%CI, 11.70-44.19; P < 0.05). Compared with DU patients who did not receive surgery, DU patients who received surgery showed better improvement in PVR (pooled MD, 137.00; 95%CI, 6.90-267.10; P < 0.05) and PdetQmax (pooled MD, - 8.00; 95%CI, - 14.68-1.32; P < 0.05).
CONCLUSIONS: Our meta-analysis results showed that transurethral surgery can improve the symptoms of BPH patients with DU. Surgery also showed advantages over pharmacological treatment for BPH patients with DU.
BACKGROUND: PROSPERO CRD42023415188.