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机器人辅助根治性前列腺切除术后耻骨上造瘘管引流与尿道导管引流的系统评价和荟萃分析

Suprapubic tube versus urethral catheter drainage after robot-assisted radical prostatectomy: a systematic review and meta-analysis.

作者信息

Jian Zhongyu, Feng Shijian, Chen Yuntian, Wei Xin, Luo Deyi, Li Hong, Wang Kunjie

机构信息

Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China.

出版信息

BMC Urol. 2018 Jan 5;18(1):1. doi: 10.1186/s12894-017-0312-5.

DOI:10.1186/s12894-017-0312-5
PMID:29304797
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5756422/
Abstract

BACKGROUND

Prostate cancer is one of the most common cancers in the elderly population. The standard treatment is radical prostatectomy (RARP). However, urologists do not have consents on the postoperative urine drainage management (suprapubic tube (ST)/ urethral catheter (UC)). Thus, we try to compare ST drainage to UC drainage after robot-assisted radical prostatectomy regarding to comfort, recovery rate and continence using the method of meta-analysis.

METHODS

A systematic search was performed in Dec. 2017 on PubMed, Medline, Embase and Cochrane Library databases. The authors independently reviewed the records to identify studies comparing ST with UC of patients underwent RARP. Meta-analysis was performed using the extracted data from the selected studies.

RESULTS

Seven studies, including 3 RCTs, with a total of 946 patients met the inclusion criteria and were included in our meta-analysis. Though there was no significant difference between the ST group and the UC group on postoperative pain (RR1.73, P 0.20), our study showed a significant improvement on bother or discomfort, defined as trouble in hygiene and sleep, caused by catheter when compared two groups at postoperative day (POD) 7 in ST group (RR2.05, P 0.006). There was no significant difference between the ST group and UC group on urinary continence (RR0.98, P 0.74) and emergency department visit (RR0.61, P 0.11). The rates of bladder neck contracture and other complications were very low in both groups.

CONCLUSION

Compared to UC, ST showed a weak advantage. So it might be a good choice to choose ST over RARP.

摘要

背景

前列腺癌是老年人群中最常见的癌症之一。标准治疗方法是根治性前列腺切除术（RARP）。然而，泌尿外科医生对于术后尿液引流管理（耻骨上管（ST）/尿道导管（UC））并未达成共识。因此，我们试图通过荟萃分析的方法比较机器人辅助根治性前列腺切除术后ST引流与UC引流在舒适度、恢复率和控尿方面的差异。

方法

2017年12月在PubMed、Medline、Embase和Cochrane图书馆数据库进行了系统检索。作者独立审查记录以确定比较接受RARP患者的ST与UC的研究。使用从选定研究中提取的数据进行荟萃分析。

结果

七项研究，包括三项随机对照试验，共946例患者符合纳入标准并纳入我们的荟萃分析。虽然ST组和UC组术后疼痛无显著差异（RR1.73，P 0.20），但我们的研究表明，在术后第7天比较两组时，ST组因导管引起的困扰或不适（定义为卫生和睡眠方面的问题）有显著改善（RR2.05，P 0.006）。ST组和UC组在尿失禁（RR0.98，P 0.74）和急诊就诊（RR0.61，P 0.11）方面无显著差异。两组膀胱颈挛缩和其他并发症的发生率都非常低。

结论

与UC相比，ST显示出微弱优势。因此，在RARP中选择ST可能是一个不错的选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec63/5756422/ff51f745ea82/12894_2017_312_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec63/5756422/6369d16e4c3f/12894_2017_312_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec63/5756422/dea8e7c3f0e5/12894_2017_312_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec63/5756422/2cd7a14e9cd3/12894_2017_312_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec63/5756422/8a99d9929029/12894_2017_312_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec63/5756422/d84193e92cc9/12894_2017_312_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec63/5756422/ff51f745ea82/12894_2017_312_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec63/5756422/6369d16e4c3f/12894_2017_312_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec63/5756422/dea8e7c3f0e5/12894_2017_312_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec63/5756422/2cd7a14e9cd3/12894_2017_312_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec63/5756422/8a99d9929029/12894_2017_312_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec63/5756422/d84193e92cc9/12894_2017_312_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec63/5756422/ff51f745ea82/12894_2017_312_Fig6_HTML.jpg

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