Department of Urology, University of Turin-San Luigi Gonzaga Hospital, Turin, Italy.
Division of Urology, McGuire VA Medical Center, Virginia Commonwealth University, 1210 Broad Block Blvd, Richmond, VA, 23249, USA.
World J Urol. 2018 Sep;36(9):1365-1372. doi: 10.1007/s00345-018-2275-x. Epub 2018 Mar 29.
To provide latest evidence on the use of suprapubic catheter (SPC) versus urethral catheter (UC) after robot-assisted laparoscopic radical prostatectomy (RARP).
A systematic revision of literature was performed up to September 2017 using different search engines (Pubmed, Ovid, Scopus) to identified studies comparing the use of SPC versus standard UC after RARP. Identification and selection of the studies were conducted according to the preferred reporting items for systematic reviews and meta-analysis criteria. For continuous outcomes, the weighted mean difference (WMD) was used as a summary measure, whereas the odds ratio (OR) or risk ratio (RR) with 95% confidence interval (CI) was calculated for binary variables. RR was preferred in cases of a high number of events to avoid overestimation. Pooled estimates were calculated using the random-effect model to account for clinical heterogeneity. All statistical analyses were performed using Review manager 5 (Cochrane Collaboration, Oxford, UK).
Eight studies were identified and included in this systematic review, namely 3 RCTs, 4 non-randomized prospective studies, and one retrospective study. A total of 966 RARP cases were collected for the cumulative analysis. Among them, 492 patients received standard UC and 474 SPC placement after RARP. UC patients had higher baseline PSA (WMD 0.44 ng/ml; p = 0.02). Visual Analog Scale (VAS) score was found to be significantly lower in patients with SPC at postoperative day 7 (WMD 0.53; 95% CI 0.13-0.93; p = 0.009). Regarding penile pain, a significant difference in favor of the SPC group was found at postoperative day 7 assessment (WMD 1.2; 95% CI 0.82-1.6; p < 0.001). More patients in the SPC group reported "not at all" or "minimal pain" at this time point (OR 0.17, 95% CI 0.06, 0.44; p < 0.001). No significant differences were found in terms of continence recovery rate at 6-12 weeks between the groups (UC 78.7%, 88.2%; RR 0.92, 95% CI 0.84, 1.01; p = 0.09). Similarly, no differences were found in terms of catheter-related issues (p = 0.17). However, UC patients had lower likelihood of overall complications (OR 0.44, 95% CI 0.21-0.89, p = 0.02).
Available evidence suggests that the use of SPC can be a viable option for postoperative urine drainage after RARP, as it can translate into decreased postoperative pain without carrying a significant higher risk of catheter-related complications. Further investigation seems to be warranted, ideally within the framework of a multicentre randomized study with standardized analysis of outcomes.
提供关于机器人辅助腹腔镜前列腺根治术后使用耻骨上导管（SPC）与尿道导管（UC）的最新证据。
我们使用不同的搜索引擎（Pubmed、Ovid、Scopus）对文献进行了系统的复习，以确定比较机器人辅助腹腔镜前列腺根治术后使用 SPC 与标准 UC 的研究。根据系统评价和荟萃分析的首选报告项目标准，对研究进行了识别和选择。对于连续变量，使用加权均数差（WMD）作为汇总测量值，而对于二分类变量，则计算优势比（OR）或风险比（RR）和 95%置信区间（CI）。在事件数量较高的情况下，倾向于使用 RR 以避免高估。使用随机效应模型计算汇总估计值，以考虑临床异质性。所有统计分析均使用 Review Manager 5（Cochrane 协作组，英国牛津）进行。
共确定了 8 项研究，并将其纳入本系统评价，其中包括 3 项 RCT 和 4 项非随机前瞻性研究以及 1 项回顾性研究。总共收集了 966 例接受 RARP 的病例进行累积分析。其中，492 例患者接受标准 UC 治疗，474 例患者接受 SPC 治疗。UC 患者的基线 PSA 较高（WMD 0.44ng/ml；p=0.02）。术后第 7 天，SPC 组的视觉模拟量表（VAS）评分显著降低（WMD 0.53；95%CI 0.13-0.93；p=0.009）。在阴茎疼痛方面，SPC 组在术后第 7 天评估时的差异具有统计学意义（WMD 1.2；95%CI 0.82-1.6；p<0.001）。此时，更多的 SPC 组患者报告“一点也不”或“轻微疼痛”（OR 0.17，95%CI 0.06，0.44；p<0.001）。两组在 6-12 周时的控尿恢复率无显著差异（UC 78.7%，88.2%；RR 0.92，95%CI 0.84，1.01；p=0.09）。同样，导管相关问题也无差异（p=0.17）。然而，UC 患者总体并发症的可能性较低（OR 0.44，95%CI 0.21-0.89，p=0.02）。
现有证据表明，SPC 可作为 RARP 术后尿液引流的一种可行选择，因为它可以减轻术后疼痛，而不会显著增加导管相关并发症的风险。似乎需要进一步的研究，理想情况下是在具有标准化结局分析的多中心随机研究框架内进行。
