Yang Q, Peters T J, Donovan J L, Wilt T J, Abrams P
Bristol Urological Institute, Southmead Hospital and Department of Social Medicine, University of Bristol, Bristol, United Kingdom.
J Urol. 2001 May;165(5):1526-32.
Transurethral prostatic resection is the gold standard surgical treatment in men with lower urinary tract symptoms suggestive of bladder outlet obstruction but it has also been related to some risks, such as a relatively high rate of blood transfusion, sexual function problems and so forth. Transurethral prostatic incision is a simpler and less invasive procedure than transurethral prostatic resection. However, it is underused. We systematically reviewed all published randomized controlled trials comparing the effectiveness of transurethral prostatic incision with standard transurethral prostatic resection for bladder outlet obstruction and performed a meta-analysis of the available relevant data.
Nine randomized controlled trials comparing the treatment effectiveness of transurethral prostatic resection and transurethral prostatic incision were identified, evaluated and reviewed in a meta-analysis. The quality of these studies was also appraised.
Each treatment achieved clear improvements in subjective and objective outcomes. The improvement in symptoms was equivalent 12 months postoperatively for transurethral prostatic incision and resection. For maximum flow rate transurethral prostatic resection resulted in greater improvement than transurethral prostatic incision. However, transurethral prostatic incision had several advantages over transurethral prostatic resection, such as lower incidence of complications, fewer blood transfusions, decreased risk of retrograde ejaculation, and shorter operative time and hospital stay. Also, the treatments had an equivalent incidence of postoperative catheterization duration and reoperation rate within the first 12 months. Furthermore, patients in each group had a similar subjective view of the treatments received.
In the first 12 months after surgery transurethral prostatic incision has effectiveness that is equivalent to transurethral prostatic resection for treating patients with suspected benign prostatic obstruction who have a relatively small prostate. However, there is little evidence on the relative long-term effectiveness of the 2 treatments 2 to 5 or 10 years after surgery. There is no clear cutoff point for prostate size that leads to good results after transurethral prostatic incision. A large-scale, multicenter randomized controlled trial is now required to evaluate comprehensively the effectiveness, impact on quality of life and overall cost of transurethral prostatic incision compared with transurethral prostatic resection.
经尿道前列腺切除术是治疗有膀胱出口梗阻迹象的男性下尿路症状的金标准手术方法,但它也存在一些风险,如输血率相对较高、性功能问题等。经尿道前列腺切开术比经尿道前列腺切除术更简单、侵入性更小。然而,它的应用并不广泛。我们系统回顾了所有已发表的比较经尿道前列腺切开术与标准经尿道前列腺切除术治疗膀胱出口梗阻有效性的随机对照试验,并对可用的相关数据进行了荟萃分析。
在一项荟萃分析中,我们识别、评估并回顾了9项比较经尿道前列腺切除术和经尿道前列腺切开术治疗效果的随机对照试验。这些研究的质量也进行了评估。
两种治疗方法在主观和客观结果上均取得了明显改善。经尿道前列腺切开术和切除术在术后12个月时症状改善程度相当。对于最大尿流率,经尿道前列腺切除术的改善程度大于经尿道前列腺切开术。然而,经尿道前列腺切开术比经尿道前列腺切除术有几个优势,如并发症发生率较低、输血较少、逆行射精风险降低、手术时间和住院时间较短。此外,两种治疗方法术后导尿持续时间和12个月内再次手术率的发生率相当。此外,每组患者对所接受治疗的主观评价相似。
在手术后的前12个月,经尿道前列腺切开术治疗前列腺相对较小的疑似良性前列腺梗阻患者的有效性与经尿道前列腺切除术相当。然而,关于这两种治疗方法在术后2至5年或10年的相对长期有效性,几乎没有证据。经尿道前列腺切开术后取得良好效果的前列腺大小没有明确的分界点。现在需要一项大规模、多中心的随机对照试验,以全面评估经尿道前列腺切开术与经尿道前列腺切除术相比的有效性、对生活质量的影响和总体成本。