Division of Pediatric Urology, Children's National Health System, 111 Michigan Ave, NW, Washington, DC, 20010, USA.
School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.
World J Urol. 2018 Aug;36(8):1181-1190. doi: 10.1007/s00345-018-2257-z. Epub 2018 Mar 8.
We sought to examine the literature reporting the effect of urinary tract infection (UTI) on non-schistosomiasis-related UBC (UBC) through a systematic review and meta-analysis.
A predefined study protocol was developed according to PRISMA. Medline and Scopus were searched for all studies investigating exposure to UTI with UBCNS as the primary outcome. Potential studies were screened against eligibility criteria. Clinical heterogeneity was assessed and groups with more than two studies were evaluated by random effect meta-analysis. Study-level bias was assessed with the Newcastle-Ottawa Scale (NOS). In cases of substantial between study heterogeneity (I > 50%), predefined sensitivity and subgroup analyses were performed.
Of 16 eligible studies, eight case-control studies spanning four decades and five countries were suitable for quantitative analysis. Main analysis favored exposure to UTI increasing risk of subsequent UBC (RR 1.33 [95% CI 1.14-1.55]). This effect was no longer statistically significant after excluding studies published prior to year 2000 and at high risk of bias. Between study heterogeneity was considerable for nearly all analyses and not reduced by predefined sensitivity or subgroup analyses.
Exposure to UTI favors increased risk for UBC, particularly in men, but these effects were statistically insignificant when pooling data from the most recent and highest quality studies. These data do not support findings of previously published studies, that report on heterogenous populations with poor definitions of UTI and minimal control for important confounders. Results from previous studies should be viewed as hypothesis generating. This review highlights the need for higher quality investigation.
通过系统评价和荟萃分析，我们旨在研究报道尿路感染（UTI）对非血吸虫病相关 UBC（UBC）影响的文献。
根据 PRISMA 制定了预先设定的研究方案。通过 Medline 和 Scopus 搜索了所有研究，这些研究调查了 UTI 暴露与 UBCNS 作为主要结局的关系。根据入选标准筛选潜在的研究。评估临床异质性，并对超过两项研究的组进行随机效应荟萃分析。使用 Newcastle-Ottawa 量表（NOS）评估研究水平的偏倚。在存在显著研究间异质性（I>50%）的情况下，进行了预定的敏感性和亚组分析。
在 16 项符合条件的研究中，有 8 项病例对照研究跨越四个十年和五个国家，适合进行定量分析。主要分析表明，UTI 暴露增加了随后发生 UBC 的风险（RR 1.33 [95% CI 1.14-1.55]）。在排除发表于 2000 年以前和存在高偏倚风险的研究后，这种效应不再具有统计学意义。几乎所有分析的研究间异质性都相当大，并且通过预定的敏感性或亚组分析无法降低。
UTI 暴露会增加 UBC 的风险，特别是在男性中，但当汇总最新和质量最高的研究的数据时，这些影响没有统计学意义。这些数据不支持以前发表的研究报告，这些研究报告涉及异质人群，UTI 的定义较差，对重要混杂因素的控制不足。以前研究的结果应被视为产生假说。本综述强调了需要进行更高质量的调查。
