Academic Urology Unit, University of Aberdeen, Aberdeen, UK.
BJU Int. 2014 Jan;113(1):24-35. doi: 10.1111/bju.12281. Epub 2013 Oct 24.
To compare monopolar and bipolar transurethral resection of the prostate (TURP) for clinical effectiveness and adverse events. We conducted an electronic search of MEDLINE, Embase, CENTRAL, Science Citation Index, and also searched reference lists of articles and abstracts from conference proceedings for randomised controlled trials (RCTs) comparing monopolar and bipolar TURP. Two reviewers independently undertook data extraction and assessed the risk of bias in the included trials using the tool recommended by the Cochrane Collaboration. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. From the 949 abstracts that were identified, 94 full texts were assessed for eligibility and a total of 24 trials were included in the review. No statistically significant differences were found in terms of International Prostate Symptom Score (IPSS) or health-related quality of life (HRQL) score. Results for maximum urinary flow rate were significant at 3, 6 and 12 months (all P < 0.001), but no clinically significant differences were found and the meta-analysis showed evidence of heterogeneity Bipolar TURP was associated with fewer adverse events including transurethral resection syndrome (risk ratio [RR] 0.12, 95% confidence interval [CI] 0.05-0.31, P < 0.001), clot retention (RR 0.48, 95% CI 0.30-0.77, P = 0.002) and blood transfusion (RR 0.53, 95% CI 0.35-0.82, P = 0.004) Several major methodological limitations were identified in the included trials; 22/24 trials had a short follow-up of ≤1 year, there was no evidence of a sample size calculation in 20/24 trials and the application of GRADE showed the evidence for most of the assessed outcomes to be of moderate quality, including all those in which statistical differences were found. Whilst there is no overall difference between monopolar and bipolar TURP for clinical effectiveness, bipolar TURP is associated with fewer adverse events and therefore has a superior safety profile. Various methodological limitations were highlighted in the included trials and as such the results of this review should be interpreted with caution. There is a need for further well-conducted, multicentre RCTs with long-term follow-up data.
比较单极和双极经尿道前列腺切除术（TURP）的临床效果和不良事件。我们对 MEDLINE、Embase、CENTRAL、科学引文索引进行了电子检索，并对会议论文摘要的参考文献进行了检索，以寻找比较单极和双极 TURP 的随机对照试验（RCT）。两名评审员独立进行数据提取，并使用 Cochrane 协作组织推荐的工具评估纳入试验的偏倚风险。使用推荐评估、制定与评价（GRADE）方法评估证据质量。从确定的 949 篇摘要中，评估了 94 篇全文的纳入资格，共有 24 项试验纳入综述。在国际前列腺症状评分（IPSS）或健康相关生活质量（HRQL）评分方面，没有发现统计学差异。最大尿流率的结果在 3、6 和 12 个月时具有统计学意义（均 P <0.001），但没有发现临床显著差异，且荟萃分析显示存在异质性。双极 TURP 与较少的不良事件相关，包括经尿道前列腺电切综合征（风险比 [RR] 0.12，95%置信区间 [CI] 0.05-0.31，P <0.001）、血块残留（RR 0.48，95% CI 0.30-0.77，P = 0.002）和输血（RR 0.53，95% CI 0.35-0.82，P = 0.004）。纳入的试验存在多种主要方法学局限性；24 项试验中有 22 项的随访时间短于 1 年，24 项试验中没有证据表明进行了样本量计算，应用 GRADE 显示，大多数评估结果的证据质量为中等，包括所有存在统计学差异的结果。虽然单极和双极 TURP 在临床效果方面没有总体差异，但双极 TURP 与较少的不良事件相关，因此具有更好的安全性。纳入的试验中突出了多种方法学局限性，因此应谨慎解读本综述的结果。需要进一步进行精心设计、多中心、具有长期随访数据的 RCT。
