Pranata Firmantya Hadi, Hidayatullah Furqan, Kloping Yudhistira Pradnyan, Rahman Zakaria Aulia, Rizaldi Fikri, Soebadi Doddy Moesbadianto
Department of Urology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General-Academic Hospital, Indonesia.
Department of Urology, Faculty of Medicine, Universitas Airlangga, Universitas Airlangga Teaching Hospital, Indonesia.
Ann Med Surg (Lond). 2022 Apr 4;77:103576. doi: 10.1016/j.amsu.2022.103576. eCollection 2022 May.
Direct Vision Internal Urethrotomy (DVIU) is regarded as the most popular and frequently used minimal invasive approach for treating urethral stricture. However, the application of this procedure is limited due to the high recurrence rate. Recent trials have the benefit of mitomycin C as adjuvant therapy to reduce the stricture recurrence in DVIU procedures. In this meta-analysis, we aim to determine the efficacy of mitomycin C as adjuvant therapy for DVIU.
A systematic literature search was carried out from Embase, ScienceDirect, and PubMed published up to September 2021. Relevant Randomized Controlled Trials (RCTs) were screened using our eligibility criteria. The quality assessment of the RCT was assessed using Cochrane RoB 2. The outcome was measured as an Odds Ratio (OR) with 95% Confidence Intervals (CIs). Statistical analyses were performed using RevMan 5.4.
We included four RCTs in the meta-analysis, with a total of 392 patients with urethral strictures undergoing DVIU. The pooled analysis showed a significantly lower recurrence rate in patients undergoing DVIU with additional treatment of mitomycin C compared to the control group (OR 0.27, 95% CI 0.16-0.45, p < 0.0001).
Our findings highlight the benefit of adjuvant treatment with mitomycin C to reduce the incidence of urethral stricture recurrence after DVIU procedures.
直视下尿道内切开术（DVIU）被认为是治疗尿道狭窄最常用且最受欢迎的微创方法。然而，由于高复发率，该手术的应用受到限制。最近的试验表明，丝裂霉素C作为辅助治疗有助于降低DVIU手术中狭窄的复发率。在这项荟萃分析中，我们旨在确定丝裂霉素C作为DVIU辅助治疗的疗效。
对截至2021年9月发表在Embase、ScienceDirect和PubMed上的文献进行系统检索。使用我们的纳入标准筛选相关的随机对照试验（RCT）。采用Cochrane RoB 2对RCT进行质量评估。结果以比值比（OR）及95%置信区间（CI）衡量。使用RevMan 5.4进行统计分析。
我们在荟萃分析中纳入了四项RCT，共有392例尿道狭窄患者接受了DVIU。汇总分析显示，与对照组相比，接受DVIU并额外使用丝裂霉素C治疗的患者复发率显著降低（OR 0.27，95% CI 0.16 - 0.45，p < 0.0001）。
我们的研究结果突出了丝裂霉素C辅助治疗在降低DVIU手术后尿道狭窄复发率方面的益处。
