Wang Wei, Huang Qing Mei, Liu Feng Ping, Mao Qi Qi
Nursing Education Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang 310003, People's Republic of China.
BMC Urol. 2014 Dec 16;14:99. doi: 10.1186/1471-2490-14-99.
Radical prostatectomy (RP) is the most common treatment for patients with localized prostate cancer. Urinary incontinence (UI) is a significant bothersome sequela after radical prostatectomy that may dramatically worsen a patient's quality of life. Pelvic floor muscle training (PFMT) is the main conservation treatment for men experiencing urinary incontinence; however, whether additional preoperative PFMT can hasten the reestablishment of continence is still unclear. The objective of this meta-analysis is to determine whether the effectiveness of preoperative plus postoperative PFMT is better than postoperative PFMT only for the re-establishment of continence after RP.
A meta-analysis was performed after a comprehensive search of available randomized controlled trials (RCTs). Quality of the included studies was assessed by the Cochrane Risk of Bias tool. Efficacy data were pooled and analyzed using Review Manager (RevMan) Version 5.0. Pooled analyses of continence rates 1, 3, 6, and 12 months postoperatively, using relative risk (RR) and 95% confidence intervals (CIs), were conducted. For data deemed not appropriate for synthesis, a narrative overview was conducted.
Five eligible studies were ultimately included in this analysis. No significant differences in continence rates were detected at the early (1- and 3-month) time points: RR = 1.21, 95% CI = 0.71-2.08, P = 0.48; RR = 1.1, 95% CI = 0.09-1.34, P = 0.34, respectively), interim (6-month time point: RR = 0.98, 95% CI = 0.93-1.04, P = 0.59), or late recovery stage (RR = 0.93, 95% CI = 0.67-1.29, P = 0.66). Outcomes reported were time to continence in two trials and quality of life in three, but results were inconclusive because of insufficient data.
According to this meta-analysis, additional preoperative PFMT did not improve the resolution of UI after RP at early (≤3-month), interim (6-month), or late (1-year) recovery stages. However, the results of time to continence and quality of life were inconclusive because of insufficient data. More high-quality RCTs are needed for better evaluation of the effectiveness of preoperative PFMT on post-prostatectomy UI.
根治性前列腺切除术（RP）是局限性前列腺癌患者最常见的治疗方法。尿失禁（UI）是根治性前列腺切除术后一种严重困扰患者的后遗症，可能会显著降低患者的生活质量。盆底肌训练（PFMT）是尿失禁男性的主要保守治疗方法；然而，术前额外进行PFMT是否能加速控尿功能的恢复仍不明确。本荟萃分析的目的是确定术前加术后PFMT在RP术后恢复控尿功能方面的效果是否优于单纯术后PFMT。
在全面检索现有随机对照试验（RCT）后进行荟萃分析。采用Cochrane偏倚风险工具评估纳入研究的质量。使用Review Manager（RevMan）5.0软件汇总并分析疗效数据。采用相对危险度（RR）和95%置信区间（CI）对术后1、3、6和12个月的控尿率进行汇总分析。对于认为不适合进行综合分析的数据，进行叙述性概述。
本分析最终纳入了五项符合条件的研究。在早期（1个月和3个月）时间点，控尿率无显著差异：RR = 1.21，95% CI = 0.71 - 2.08，P = 0.48；RR = 1.1，95% CI = 0.09 - 1.34，P = 0.34），中期（6个月时间点：RR = 0.98，95% CI = 0.93 - 1.04，P = 0.59）或晚期恢复阶段（RR = 0.93，95% CI = 0.67 - 1.29，P = 0.66）。两项试验报告了达到控尿的时间，三项试验报告了生活质量，但由于数据不足，结果尚无定论。
根据本荟萃分析，术前额外进行PFMT在早期（≤3个月）、中期（6个月）或晚期（1年）恢复阶段并未改善RP术后尿失禁的解决情况。然而，由于数据不足，达到控尿的时间和生活质量的结果尚无定论。需要更多高质量的RCT来更好地评估术前PFMT对前列腺切除术后尿失禁的有效性。
