Sirisreetreerux Pokket, Wattanayingcharoenchai Rujira, Rattanasiri Sasivimol, Pattanaprateep Oraluck, Numthavaj Pawin, Thakkinstian Ammarin
Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
Ther Adv Urol. 2021 Jun 17;13:17562872211022296. doi: 10.1177/17562872211022296. eCollection 2021 Jan-Dec.
To assess the efficacy in lowering post-operative urinary retention, urinary tract infection and lower urinary tract symptoms and the incidence of adverse events among 12 interventions and to perform risk-benefit analysis.
Previous randomized controlled trials were identified from , and database up to January 2020. The interventions of interest included early ambulation, fluid adjustment, neuromodulation, acupuncture, cholinergic drugs, benzodiazepine, antispasmodic agents, opioid antagonist agents, alpha-adrenergic antagonists, non-steroidal anti-inflammatory drugs (NSAIDs) and combination of any interventions. The comparators were placebo or standard care or any of these interventions. Network meta-analysis was performed. The probability of being the best intervention was estimated and ranked using rankogram and surface under the cumulative ranking curve. Risk-benefit analysis was done. Incremental risk-benefit ratio (IRBR) was calculated and risk-benefit acceptability curve was constructed.
A total of 45 randomized controlled trials with 5387 patients was included in the study. Network meta-analysis showed that early ambulation, acupuncture, alpha-blockers and NSAIDs significantly reduced the post-operative urinary retention. Regarding urinary tract infection and lower urinary tract symptoms, no statistical significance was found among interventions. Regarding the side effects, only alpha-adrenergic antagonists significantly increased the adverse events compared with acupuncture and opioid antagonist agents from the indirect comparison. According to the cluster ranking plot, acupuncture and early ambulation were considered high efficacy with low adverse events, corresponding to the IRBR.
Early ambulation, acupuncture, opioid antagonist agents, alpha-adrenergic antagonists and NSAIDs significantly reduce the incidence of post-operative urinary retention with no difference in adverse events. Regarding the risk-benefit analysis of the medical treatment, alpha-adrenergic antagonists have the highest probability of net benefit at the acceptable threshold of side effect of 15%, followed by opioid antagonist agents, NSAIDs and cholinergic drugs.
评估12种干预措施在降低术后尿潴留、尿路感染和下尿路症状方面的疗效以及不良事件的发生率，并进行风险效益分析。
从截至2020年1月的 、 和 数据库中识别先前的随机对照试验。感兴趣的干预措施包括早期活动、液体调整、神经调节、针灸、胆碱能药物、苯二氮䓬类药物、解痉剂、阿片类拮抗剂、α-肾上腺素能拮抗剂、非甾体抗炎药（NSAIDs）以及任何干预措施的组合。对照为安慰剂或标准护理或这些干预措施中的任何一种。进行网状Meta分析。使用排序图和累积排名曲线下的面积估计并排列成为最佳干预措施的概率。进行风险效益分析。计算增量风险效益比（IRBR）并构建风险效益可接受性曲线。
该研究共纳入45项随机对照试验，涉及5387例患者。网状Meta分析表明，早期活动、针灸、α受体阻滞剂和NSAIDs显著降低了术后尿潴留。关于尿路感染和下尿路症状，各干预措施之间未发现统计学意义。关于副作用，从间接比较来看，与针灸和阿片类拮抗剂相比，仅α-肾上腺素能拮抗剂显著增加了不良事件。根据聚类排名图，针灸和早期活动被认为疗效高且不良事件少，这与IRBR一致。
早期活动、针灸、阿片类拮抗剂、α-肾上腺素能拮抗剂和NSAIDs显著降低了术后尿潴留的发生率，不良事件无差异。关于药物治疗的风险效益分析，在15%的可接受副作用阈值下，α-肾上腺素能拮抗剂的净效益概率最高，其次是阿片类拮抗剂、NSAIDs和胆碱能药物。
