Department of Urology, The Royal Melbourne Hospital, Parkville, VIC, Australia.
Investig Clin Urol. 2022 May;63(3):273-284. doi: 10.4111/icu.20210391.
Urethral stricture disease is common and has high associated morbidity and impact on quality-of-life. This systematic review and meta-analysis aims to summarise current evidence on the efficacy of local urethral steroids post-direct vision internal urethrotomy (DVIU) for the treatment of urethral strictures in males.
A comprehensive search was performed using reputable databases and registries, up to 22 February 2022. Only randomised control trials in which participants were randomised to DVIU plus local urethral steroids versus DVIU only were included. Statistical analyses were performed using a random-effects model. Quality of evidence was rated according to the GRADE approach.
The search identified seven studies in which 365 participants were randomised to DVIU plus local urethral steroids versus DVIU only. The application of local steroids appeared to reduce recurrence rates (risk ratio, 0.67; 95% confidence interval [CI], 0.49-0.90) and time-to-recurrence (hazard ratio, 0.58; 95% CI, 0.39-0.85). Qmax also improved following steroid application (mean difference, 0.82; 95% CI, -1.02-2.66); however, this was not statistically significant. No heterogeneity was identified between included studies for all outcomes. The certainty of evidence was downgraded due to study limitations with a small sample size and unclear risk-of-bias related to insufficient trial information.
Compared to DVIU alone, adjuvant steroids applied to the urethra may reduce risk of recurrence and time-to-recurrence. These findings were statistically significant and likely also clinically significant given low associated costs and risk. However, more robust randomised trials are necessary to enhance the validity of these outcomes.
尿道狭窄疾病较为常见，且与较高的发病率和生活质量下降相关。本系统评价和荟萃分析旨在总结目前关于直接视觉尿道内切开术（DVIU）后局部尿道内应用类固醇治疗男性尿道狭窄的疗效的证据。
我们使用多个著名数据库和注册处进行了全面检索，检索时间截至 2022 年 2 月 22 日。仅纳入将参与者随机分配至 DVIU 加局部尿道内类固醇组与 DVIU 组的随机对照试验。采用随机效应模型进行统计学分析。根据 GRADE 方法对证据质量进行评级。
检索共确定了 7 项研究，其中 365 名参与者被随机分配至 DVIU 加局部尿道内类固醇组与 DVIU 组。局部应用类固醇似乎可降低复发率（风险比，0.67；95%置信区间 [CI]，0.49-0.90）和复发时间（风险比，0.58；95% CI，0.39-0.85）。应用类固醇后 Qmax 也得到改善（平均差值，0.82；95% CI，-1.02-2.66）；但差异无统计学意义。所有结局均未发现纳入研究间存在异质性。由于样本量小且与试验信息不足相关的偏倚风险不明确，因此证据质量被降级。
与单纯 DVIU 相比，尿道内应用类固醇辅助治疗可能降低复发风险和复发时间。这些发现具有统计学意义，且鉴于其相关成本低且风险低，可能也具有临床意义。但是，需要进行更有力的随机试验来提高这些结局的有效性。
