Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
College of Biological Science, University of California, Davis, CA, USA.
Aging Male. 2022 Dec;25(1):145-155. doi: 10.1080/13685538.2022.2069238.
Postprostatectomy urinary incontinence (PPUI) is a serious complication despite surgical advances. Treatment options for PPUI include conservative care like Pelvic floor muscle exercise (PFME), which is a physiotherapy performed by the patients themselves; Pelvic floor muscle therapy (PFMT), a physiotherapy performed under the guidance of a therapist, and duloxetine treatment; and surgical interventions. In this study, network meta-analysis (NMA) was performed for direct comparison of these treatment options.
The NMA pooled the odds ratios and 95% credible intervals using the number of patients achieving urinary continence and the total number of patients in an intention-to-treat population. The treatments were ranked based on the surface under the cumulative ranking curve (SUCRA) probabilities and the rankograms.
The pooled overall ORs of patients achieving urinary continence compared with no treatment was 1.73 (95% CrI: 0.657, 4.71) in PFME, 2.62 (95% CrI: 0.553, 13.5) in PFME plus Duloxetine, and 4.05 (95% CrI: 1.70, 10.2) in PFMT. The SUCRA values of ranking probabilities for each treatment showed high rates of continence in the order of PFMT, PFME plus Duloxetine, and PFME.
The results suggest that patients with PPUI should undergo PFMT and consider duloxetine as an additional treatment option.
尽管手术技术有所进步，但前列腺切除术后尿失禁（PPUI）仍是一种严重的并发症。PPUI 的治疗选择包括保守治疗，如骨盆底肌肉运动（PFME），这是一种由患者自行进行的物理治疗；在治疗师指导下进行的骨盆底肌肉治疗（PFMT），以及度洛西汀治疗；以及手术干预。在这项研究中，进行了网络荟萃分析（NMA），以直接比较这些治疗选择。
NMA 通过使用达到尿控的患者人数和意向治疗人群中的总患者人数，对优势比和 95%可信区间进行汇总。根据累积排序曲线下面积（SUCRA）概率和排序图对治疗方法进行排名。
与不治疗相比，PFME 中达到尿控的患者总体 OR 为 1.73（95% CrI：0.657，4.71），PFME 加度洛西汀为 2.62（95% CrI：0.553，13.5），PFMT 为 4.05（95% CrI：1.70，10.2）。每种治疗方法的排序概率 SUCRA 值显示，PFMT、PFME 加度洛西汀和 PFME 的尿控率较高。
结果表明，PPUI 患者应接受 PFMT，并考虑将度洛西汀作为附加治疗选择。
