Buckley Brian S, Lapitan Marie Carmela M
Department of General Practice, National University of Ireland, Galway, Ireland.
Cochrane Database Syst Rev. 2010 Oct 6(10):CD008023. doi: 10.1002/14651858.CD008023.pub2.
Post-operative urinary retention, the inability to void following surgery despite a full bladder, is usually transitory but can be prolonged in some cases. It can lead to several complications including urinary tract infection, long term bladder dysfunction and kidney damage leading to chronic kidney disease. Catheterisation, generally regarded as the optimal management method, is associated with risks and so pharmacological treatment of post-operative urinary retention that could remove or reduce the need for catheterisation is desirable.
To assess the effectiveness of drugs for treatment of post-operative urinary retention either alone or as an adjunct to catheterisation.
We searched the Cochrane Incontinence Group Specialised Register (searched 10 February 2010), CENTRAL (2010, Issue 1), MEDLINE (January 1950 to Week 1 January 2010), EMBASE (January 1980 to 2010 Week 5) and the reference lists of relevant articles.
Randomised and quasi randomised controlled trials in which at least one arm of the study included a drug treatment for post-operative urinary retention.
Published reports of all potentially eligible studies were evaluated by two reviewers independently. No language or other limitations were applied. Standardised data extraction forms were used by two reviewers independently and cross-checked. Where insufficient data were reported authors were contacted where possible for further information. The risk of bias in eligible trials was assessed independently by two reviewers using the Cochrane risk of bias tool.
Seven studies including 494 participants formed the evidence base for this review. Drug treatments assessed in studies in the review included cholinergic agents, alpha-blockers, sedatives and prostaglandin on their own or in combinations. No statistically significant associations were reported between successful treatment or any other outcome and cholinergic agents, alpha-blockers and sedatives as monotherapies. A statistically significant association between intravesically administered prostaglandin and successful voiding was detected, Risk Ratio 3.07 (95% CI 1.22 to 7.72). A statistically significant association was detected between cholinergic agents combined with sedative and an improved likelihood of spontaneous voiding compared with placebo, Risk Ratio 1.39 (95% CI 1.07 to 1.82). Significant heterogeneity was identified between the two studies in this analysis, however.
AUTHORS' CONCLUSIONS: Whilst it may appear that cholinergic agents and intravesically administered prostaglandin offer most promise in the treatment of post-operative urinary retention, the evidence is weak. There is a need for further research into pharmacological alternatives to catheterisation in the treatment of this common surgical complication.
术后尿潴留是指术后尽管膀胱充盈但无法排尿，通常是暂时的，但在某些情况下可能会持续较长时间。它可能导致多种并发症，包括尿路感染、长期膀胱功能障碍和肾脏损害，进而导致慢性肾病。导尿术通常被视为最佳治疗方法，但存在风险，因此，能够消除或减少导尿需求的术后尿潴留药物治疗是可取的。
评估单独使用药物或作为导尿术辅助手段治疗术后尿潴留的有效性。
我们检索了Cochrane尿失禁专题注册库（检索日期为2010年2月10日）、Cochrane系统评价数据库（2010年第1期）、医学期刊数据库（1950年1月至2010年1月第1周）、荷兰医学文摘数据库（1980年1月至2010年第5周）以及相关文章的参考文献列表。
随机和半随机对照试验，其中至少有一个研究组采用了治疗术后尿潴留的药物治疗。
两名评价员独立评估所有可能符合条件的研究的发表报告。未设置语言或其他限制。两名评价员独立使用标准化数据提取表并进行交叉核对。若报告数据不足，尽可能与作者联系以获取更多信息。两名评价员使用Cochrane偏倚风险工具独立评估符合条件的试验中的偏倚风险。
七项研究共494名参与者构成了本综述的证据基础。本综述中研究评估的药物治疗包括胆碱能药物、α受体阻滞剂、镇静剂和前列腺素，单独使用或联合使用。未报告胆碱能药物、α受体阻滞剂和镇静剂作为单一疗法在成功治疗或任何其他结局方面有统计学意义的关联。检测到膀胱内给予前列腺素与成功排尿之间存在统计学意义的关联，风险比为3.07（95%可信区间为1.22至7.72）。与安慰剂相比，检测到胆碱能药物与镇静剂联合使用与自发排尿可能性增加之间存在统计学意义的关联，风险比为1.39（95%可信区间为1.07至1.82）。然而，该分析中的两项研究之间存在显著异质性。
虽然胆碱能药物和膀胱内给予前列腺素在治疗术后尿潴留方面似乎最有前景，但证据不足。需要进一步研究治疗这种常见手术并发症的导尿术的替代药物。
