Zhang Li, Xu Yanwen
Department of Pelvic Floor Comprehensive Diagnosis and Treatment Center, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, China.
Department of Endocrine, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, China.
Front Surg. 2022 Feb 14;9:825239. doi: 10.3389/fsurg.2022.825239. eCollection 2022.
To compare incontinence rates and complications in patients receiving artificial urinary sphincter (AUS) with or without radiotherapy (RT).
PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases were searched for studies comparing outcomes of AUS between patients with and without RT. Search limits were from 1st January 2002 to 15th September 2021.
Eighteen studies were included. Meta-analysis revealed statistically significant reduced odds of the absence of incontinence in the RT group (OR: 0.35 95% CI: 0.21, 0.59 = 51% < 0.0001) as compared to the no-RT group. We also noted statistically significant increased risk of revision surgery in the RT group (OR: 1.74 95% CI: 1.16, 2.60 = 73% = 0.07). There was increased risk of infections (OR: 2.51 95% CI: 1.00, 6.29 = 46% = 0.05) and erosions (OR: 2.00 95% CI: 1.15, 3.45 = 21% = 0.01) in the RT group, but the difference was significant only for erosions. Meta-analysis revealed a statistically significant increased risk of explantation in patients with RT (OR: 3.00 95% CI: 1.16, 7.75 = 68% = 0.02) but there was no difference in the risk of urethral atrophy (OR: 1.18 95% CI: 0.47, 2.94 = 46% = 0.72) and mechanical failure (OR: 0.90 95% CI: 0.25, 3.27 = 54% = 0.87) between the two groups.
Our meta-analysis of recent studies indicates that RT significantly reduces the odds of achieving complete continence after AUS placement. History of RT does not increase the risk urethral atrophy or mechanical failure in patients with AUS. However, the risk of revision surgery, erosions and explantations is significantly increased in patients with RT with a non-significant but increased tendency of infections.
https://www.crd.york.ac.uk/prospero/, identifier: NCT02612389.
比较接受或未接受放疗（RT）的人工尿道括约肌（AUS）患者的尿失禁发生率和并发症。
检索PubMed、Embase、ScienceDirect、CENTRAL和谷歌学术数据库，查找比较接受RT和未接受RT患者AUS治疗结果的研究。检索时间范围为2002年1月1日至2021年9月15日。
纳入18项研究。荟萃分析显示，与未接受RT组相比，RT组无尿失禁的几率显著降低（比值比：0.35，95%置信区间：0.21，0.59；降低51%；P<0.0001）。我们还注意到，RT组翻修手术风险显著增加（比值比：1.74，95%置信区间：1.16，2.60；增加73%；P=0.07）。RT组感染风险（比值比：2.51，95%置信区间：1.•00，6.29；增加46%；P=0.05）和侵蚀风险（比值比：2.00，95%置信区间：1.15，3.45；增加21%；P=0.01）增加，但仅侵蚀差异具有统计学意义。荟萃分析显示，接受RT患者的取出风险显著增加（比值比：3.00，95%置信区间：1.16，7.75；增加68%；P=0.02），但两组间尿道萎缩风险（比值比：1.18，95%置信区间：0.47，2.94；增加46%；P=0.72）和机械故障风险（比值比：0.90，95%置信区间：0.25，3.27；增加54%；P=0.87）无差异。
我们对近期研究的荟萃分析表明，RT显著降低了AUS植入后实现完全控尿的几率。RT病史不会增加AUS患者尿道萎缩或机械故障的风险。然而，RT患者翻修手术、侵蚀和取出的风险显著增加，感染风险有增加趋势但无统计学意义。
