Xiang Peng, Wang Mingdong, Guan Di, Liu Dan, Wang Yonghui, Hao Yongxiu, Li Shuang, Liu Yuexin, Ping Hao
Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
Eur Urol Open Sci. 2020 Jun 4;19:3-15. doi: 10.1016/j.euros.2020.05.001. eCollection 2020 Jul.
Recently, prostatic urethral lift (PUL) is being used to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Although preliminary clinical studies on PUL are increasing, the long-term efficacy and safety of this procedure are still not well evaluated.
The objective of our study is to synthesize the existing literature evidence, and make a comprehensive and long-term systematic review for the PUL procedure.
A systematic search was performed from the electronic databases including PubMed, Embase, and OVID. The search period was up to January 1, 2020. Comprehensive retrospective and prospective studies on PUL were collected in accordance with specific inclusion and exclusion criteria. Pooled prostatic symptom scores, sexual health scores, and functional outcomes were calculated by using a fixed or random-effect model.
Nineteen articles meet our determined inclusion and exclusion criteria, and 11 independent patient series were included in the final analysis. Meta-analysis results indicated improvement after the PUL procedure, including International Prostate Symptom Score improvement of 9.73-12.16 points, BPH Impact Index improvement of 3.74-4.50 points, maximum flow rate improvement of 3.44-4.26 ml/s, and quality of life improvement of 2.20-2.55 points. Postvoid residual volume at most of the intervals was not significantly variable. Data regarding sexual function remained stable or improved slightly during the 24-mo follow-up period. Pooled estimates were largely heterogeneous except for sexual function.
PUL can continue to relieve prostatic symptoms for 24 mo without causing serious complications. The extremely important advantage of the PUL procedure is that it can preserve or slightly improve sexual function. Longer-term and more comprehensive clinical trials are still needed to further clarify the functional outcomes and cost effectiveness of PUL.
Prostatic urethral lift is an attractive option for selected patients who seek rapid and durable relief of lower urinary tract symptoms with complete preservation of sexual function.
最近，前列腺尿道悬吊术（PUL）被用于治疗良性前列腺增生（BPH）继发的下尿路症状（LUTS）。尽管关于PUL的初步临床研究不断增加，但该手术的长期疗效和安全性仍未得到充分评估。
我们研究的目的是综合现有文献证据，对PUL手术进行全面的长期系统评价。
从包括PubMed、Embase和OVID在内的电子数据库进行系统检索。检索期截至2020年1月1日。根据特定的纳入和排除标准收集关于PUL的综合回顾性和前瞻性研究。使用固定或随机效应模型计算合并的前列腺症状评分、性健康评分和功能结局。
19篇文章符合我们确定的纳入和排除标准，最终分析纳入了11个独立的患者系列。荟萃分析结果表明PUL手术后有改善，包括国际前列腺症状评分改善9.73 - 12.16分，BPH影响指数改善3.74 - 4.50分，最大尿流率改善3.44 - 4.26毫升/秒，生活质量改善2.20 - 2.55分。大多数时间点的排尿后残余尿量无显著变化。在24个月的随访期内，性功能数据保持稳定或略有改善。除性功能外，合并估计值在很大程度上存在异质性。
PUL可在24个月内持续缓解前列腺症状，且不引起严重并发症。PUL手术极其重要的优势在于它可以保留或轻微改善性功能。仍需要更长期、更全面的临床试验来进一步阐明PUL的功能结局和成本效益。
对于那些寻求快速、持久缓解下尿路症状并完全保留性功能的特定患者，前列腺尿道悬吊术是一个有吸引力的选择。
