Department of Surgery, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Faculty of Life Sciences and Medicine, King's College London, London, UK.
Eur Urol. 2021 Aug;80(2):174-187. doi: 10.1016/j.eururo.2021.04.012. Epub 2021 Jun 12.
Benign prostatic obstruction (BPO) is associated with sexual dysfunction. Furthermore, numerous BPO interventions may themselves impact sexual function.
To perform a systematic review with network meta-analysis to evaluate how BPO interventions affect erectile function.
Three databases were searched for randomised controlled trials (RCTs) comparing surgical interventions for BPO. The primary outcome was postoperative International Index of Erectile Function-5 (IIEF-5) score at ten time points up to 72 mo. A random-effects Bayesian network meta-analysis with meta-regression was performed. In comparison to monopolar transurethral resection (mTURP), the mean difference (MD) with 95% credible interval (CrI) and rank probability (rank p) were calculated for interventions. The mean baseline score was studied in meta-regression. τ values were used to quantify heterogeneity.
A total of 48 papers (33 RCTs, 5159 patients, 16 interventions) were included. Prostatic urethral lift (PUL) ranked highest at 1 mo (MD 3.88, 95% CrI -0.47 to 8.25; rank p = 0.742), 6 mo (MD 2.43, 95% CrI -0.72 to 5.62; rank p = 0.581), 12 mo (MD 2.94, 95% CrI -0.26 to 6.12, rank p = 0.782), and 24 mo (MD 3.63, 95% CrI 0.14 to 7.11; rank p = 0.948), at which point statistical significance was reached. At time points up to 60 mo, there were no statistically significant comparisons for other interventions. Analyses were not possible at 18, 48, or 72 mo. β did not reach statistical significance in meta-regression. τ was highest at 1 mo (0.56) and 60 mo (0.55).
PUL ranked highly and resulted in erectile function improvement at 24 mo compared to mTURP, but direct evidence is lacking. We did not observe significant differences in erectile function following other interventions up to 60 mo. Owing to heterogeneity, our conclusions are weakest at 1 and 60 mo. Further RCTs comparing sexual function outcomes are recommended, such as PUL versus holmium laser or bipolar enucleation.
Different surgical treatments can be used to treat benign enlargement of the prostate causing urinary problems. We compared the effects of various treatments on erectile function at time points up to 5 years after surgery. Compared to surgical removal of some of the prostate gland (transurethral resection of the prostate, TURP), a technique called prostatic urethral lift resulted in better erectile function scores at 24 months. However, other treatments did not differ in their effect on erectile function.
良性前列腺梗阻（BPO）与性功能障碍有关。此外，许多 BPO 干预措施本身也可能影响性功能。
进行系统评价和网络荟萃分析，评估 BPO 干预措施如何影响勃起功能。
在三个数据库中搜索比较 BPO 手术干预的随机对照试验（RCT）。主要结局是术后 10 个时间点至 72 个月的国际勃起功能指数-5（IIEF-5）评分。采用随机效应贝叶斯网络荟萃分析和荟萃回归。与单极经尿道前列腺切除术（mTURP）相比，计算了干预措施的平均差异（MD）及其 95%可信区间（CrI）和秩概率（rank p）。在荟萃回归中研究了平均基线评分。τ 值用于量化异质性。
共纳入 48 篇论文（33 项 RCT，5159 例患者，16 项干预措施）。前列腺尿道提升术（PUL）在 1 个月（MD 3.88，95%CrI -0.47 至 8.25；rank p=0.742）、6 个月（MD 2.43，95%CrI -0.72 至 5.62；rank p=0.581）、12 个月（MD 2.94，95%CrI -0.26 至 6.12，rank p=0.782）和 24 个月（MD 3.63，95%CrI 0.14 至 7.11；rank p=0.948）时排名最高，此时达到统计学意义。在长达 60 个月的时间内，其他干预措施没有统计学意义的比较。在 18、48 或 72 个月时无法进行分析。荟萃回归中β未达到统计学意义。τ 在 1 个月（0.56）和 60 个月（0.55）时最高。
与 mTURP 相比，PUL 在 24 个月时排名较高，且能改善勃起功能，但缺乏直接证据。我们没有观察到其他干预措施在长达 60 个月时对勃起功能有显著差异。由于存在异质性，我们的结论在 1 个月和 60 个月时最薄弱。建议进行比较性功能结局的进一步 RCT，例如 PUL 与钬激光或双极前列腺切除术。
不同的手术治疗可以用于治疗导致尿路问题的良性前列腺增大。我们比较了不同治疗方法在术后至 5 年时间点对勃起功能的影响。与切除部分前列腺（经尿道前列腺切除术，TURP）相比，一种名为前列腺尿道提升术的技术在 24 个月时可获得更好的勃起功能评分。然而，其他治疗方法在对勃起功能的影响上没有差异。
