Bates Anthony S, Martin Richard M, Terry Tim R
Department of Urology, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
School of Social and Community Medicine, University of Bristol, Bristol, UK.
BJU Int. 2015 Oct;116(4):623-33. doi: 10.1111/bju.13048. Epub 2015 Mar 12.
To conduct a systematic review and meta-analysis of artificial urinary sphincter (AUS) placement after radical prostatectomy (RP) and external beam radiotherapy (EBRT).
There were 1 886 patients available for analysis of surgical revision outcomes and 949 for persistent urinary incontinence (UI) outcomes from 15 and 11 studies, respectively. The mean age (sd) was 66.9 (1.4) years and the number of patients per study was 126.6 (41.7). The mean (sd, range) follow-up was 36.7 (3.9, 18-68) months. A systematic database search was conducted using keywords, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Published series of AUS implantations were retrieved, according to the inclusion criteria. The Newcastle-Ottawa Score was used to ascertain the quality of evidence for each study. Surgical results from each case series were extracted. Data were analysed using CMA statistical software.
AUS revision was higher in RP + EBRT vs RP alone, with a random effects risk ratio of 1.56 (95% confidence interval [CI] 1.02-2.72; P < 0.050; I(2) = 82.0%) and a risk difference of 16.0% (95% CI 2.05-36.01; P < 0.080). Infection/erosion contributed to the majority of surgical revision risk compared with urethral atrophy (P = 0.020). Persistent UI after implantation was greater in patients treated with EBRT (P < 0.001).
Men receiving RP + EBRT appear at increased risk of infection/erosion and urethral atrophy, resulting in a greater risk of surgical revision compared with RP alone. Persistent UI is more common with RP + EBRT.
对根治性前列腺切除术（RP）和体外放疗（EBRT）后人工尿道括约肌（AUS）置入进行系统评价和荟萃分析。
分别有1886例患者可用于手术翻修结果分析，15项研究中的949例患者可用于持续性尿失禁（UI）结果分析。平均年龄（标准差）为66.9（1.4）岁，每项研究的患者数量为126.6（41.7）例。平均（标准差，范围）随访时间为36.7（3.9，18 - 68）个月。根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，使用关键词进行系统数据库检索。根据纳入标准检索已发表的AUS植入系列研究。采用纽卡斯尔 - 渥太华量表确定每项研究的证据质量。提取每个病例系列的手术结果。使用CMA统计软件进行数据分析。
RP + EBRT组的AUS翻修率高于单纯RP组，随机效应风险比为1.56（95%置信区间[CI]1.02 - 2.72；P < 0.050；I² = 82.0%），风险差异为16.0%（95%CI 2.05 - 36.01；P < 0.080）。与尿道萎缩相比，感染/侵蚀是手术翻修风险的主要原因（P = 0.020）。接受EBRT治疗的患者植入后持续性UI发生率更高（P < 0.001）。
与单纯RP相比，接受RP + EBRT的男性出现感染/侵蚀和尿道萎缩的风险增加，导致手术翻修风险更高。持续性UI在RP + EBRT中更常见。
