Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Urology, University Hospital Leuven, Leuven, Belgium.
PLoS One. 2021 Oct 6;16(10):e0258256. doi: 10.1371/journal.pone.0258256. eCollection 2021.
Urethral stricture disease is a common problem amongst men in Western countries often leading to a decreased quality of life. Current endoscopic treatment procedure shows an unsatisfying stricture recurrence rate which could be improved by addition of local therapies.
To provide an overview of both preclinical and clinical studies in order to investigate current level of evidence on the addition of local therapy to improve urethral stricture recurrence rates after endoscopic procedures.
We performed a literature search in December 2020 and August 2021 using Cochrane, Embase, PubMed, Scopus and Web of Science and identified articles through combinations of search terms for 'urethral stricture disease', 'stricture formation' and 'local interventions'. We used the SYRCLE, RoB-2 and ROBINS-I tools to assess risk of bias across included studies. We did not perform a meta-analysis due to methodological differences between studies.
We included 32 articles in the qualitative analysis, 20 of which were preclinical studies and 12 clinical studies. Regarding preclinical articles using an animal model, nearly all interventions showed to have a positive effect on either urethral fibrosis, urethral stricture formation and/or fibrotic protein expression levels. Here, immunosuppressants and chemotherapeutics seemed most promising for possible clinical purposes. Regarding clinical studies, mitomycin-C and hyaluronic acid and carboxymethylcellulose showed positive effects on urethral stricture recurrence rates with low to intermediate risk of bias across studies. However, the positive clinical effects of mitomycin-C and steroids seemed to decrease in studies with a longer follow-up time.
Although local adjuvant use of mitomycin-C or hyaluronic acid and carboxymethylcellulose may carry clinical potential to improve urethral structure recurrence rates after endoscopic procedures, we believe that a large, well-designed RCT with a yearlong follow-up time is necessary to identify the true clinical value.
尿道狭窄疾病是西方国家男性常见的问题，常导致生活质量下降。目前的内镜治疗方法显示狭窄复发率不令人满意，局部治疗的加入可能会改善这一情况。
提供临床前和临床研究的概述，以调查目前关于在内镜治疗后加入局部治疗以提高尿道狭窄复发率的证据水平。
我们于 2020 年 12 月和 2021 年 8 月使用 Cochrane、Embase、PubMed、Scopus 和 Web of Science 进行文献检索，并通过搜索术语“尿道狭窄疾病”、“狭窄形成”和“局部干预”的组合来识别文章。我们使用 SYRCLE、RoB-2 和 ROBINS-I 工具来评估纳入研究的偏倚风险。由于研究之间存在方法学差异，我们未进行荟萃分析。
我们对 32 篇文章进行了定性分析，其中 20 篇为临床前研究，12 篇为临床研究。关于使用动物模型的临床前文章，几乎所有干预措施都显示出对尿道纤维化、尿道狭窄形成和/或纤维化蛋白表达水平有积极影响。在这里，免疫抑制剂和化疗药物似乎最有希望用于可能的临床用途。关于临床研究，丝裂霉素 C 和透明质酸和羧甲基纤维素显示出对尿道狭窄复发率的积极影响，研究的偏倚风险较低至中等。然而，丝裂霉素 C 和类固醇的阳性临床效果似乎在随访时间较长的研究中降低。
虽然局部使用丝裂霉素 C 或透明质酸和羧甲基纤维素可能具有改善内镜治疗后尿道结构复发率的临床潜力，但我们认为需要进行一项具有 1 年随访时间的大型、精心设计的 RCT，以确定其真正的临床价值。
