Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, China.
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
J Endourol. 2019 Sep;33(9):767-776. doi: 10.1089/end.2019.0306. Epub 2019 Jul 26.
Although previous studies have compared the minimally invasive simple prostatectomy (MISP) with open simple prostatectomy (OSP) for large prostates, there is still controversy. This study aims to provide the latest evidence for clinical practice. We systematically searched Science, EMBASE, PubMed, and Clinicalkey databases for articles comparing MISP and OSP for large prostates. Result parameters including International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urine flow rate (), postvoid residual urine volume (PVR), operative time (OT), estimated blood loss (EBL), irrigation time (IT), catheterization time (CT), length of hospital stay (LOS), transfusion rate (TR), and complications were evaluated using RevMan 5.3. A total of 995 patients were included in 10 studies. No statistically significant differences were found between two groups in IPSS (weighted average difference [WMD] = -0.36, = 0.26), QoL (WMD = -0.22, = 0.05), (WMD = 0.46, = 0.62), and PVR (WMD = -2.14, = 0.65). The MISP group had similar IT (WMD = -1.52, = 0.06), lesser EBL (WMD = -292.22, < 0.001), shorter CT (WMD = -1.89, < 0.0001), shorter LOS (WMD = -2.52, < 0.001), lower TR (odds ratio [OR] = 0.21, < 0.001), and lower complications (OR = 0.49, < 0.001) compared with OSP group. However, the OT (WMD = 43.07, < 0.001) of MISP was longer than that of OSP. The present results demonstrated that MISP provided similar efficacy to those of OSP while maintaining a better security. Our findings imply that MISP is a feasible and effective alternative to the OSP.
虽然先前的研究已经比较了微创单纯前列腺切除术（MISP）与开放单纯前列腺切除术（OSP）治疗大前列腺，但仍存在争议。本研究旨在为临床实践提供最新证据。我们系统地检索了 Science、EMBASE、PubMed 和 Clinicalkey 数据库，以获取比较 MISP 和 OSP 治疗大前列腺的文章。结果参数包括国际前列腺症状评分（IPSS）、生活质量（QoL）、最大尿流率（）、残余尿量（PVR）、手术时间（OT）、估计失血量（EBL）、灌洗时间（IT）、导尿时间（CT）、住院时间（LOS）、输血率（TR）和并发症，使用 RevMan 5.3 进行评估。共有 995 名患者纳入了 10 项研究。两组患者在 IPSS（加权平均差异 [WMD]=-0.36， =0.26）、QoL（WMD=-0.22， =0.05）、（WMD=0.46， =0.62）和 PVR（WMD=-2.14， =0.65）方面无统计学差异。MISP 组的 IT（WMD=-1.52， =0.06）、EBL（WMD=-292.22， ＜0.001）、CT（WMD=-1.89， ＜0.0001）、LOS（WMD=-2.52， ＜0.001）、TR（比值比 [OR]=0.21， ＜0.001）和并发症（OR=0.49， ＜0.001）均较低。然而，与 OSP 组相比，MISP 的 OT（WMD=43.07， ＜0.001）较长。本研究结果表明，MISP 在保持更好安全性的同时，提供了与 OSP 相似的疗效。我们的发现表明，MISP 是 OSP 的一种可行且有效的替代方法。
