Salciccia Stefano, Viscuso Pietro, Bevilacqua Giulio, Tufano Antonio, Casale Paolo, De Berardinis Ettore, Di Pierro Giovanni Battista, Cattarino Susanna, Gentilucci Alessandro, Lourdes Lia Francesca, Ivan Di Giulio, Rosati Davide, Del Giudice Francesco, Sciarra Alessandro, Mariotti Gianna
Department of Maternal-Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy.
Department of Urology, Humanitas, Milan, Italy.
Adv Urol. 2022 Jun 21;2022:8736249. doi: 10.1155/2022/8736249. eCollection 2022.
To compare different forms of invasive treatments for postradical prostatectomy (RP) urinary incontinence (UI) in terms of quantitative and qualitative parameters and continence recovery rate.
We distinguished five categories of treatment: = bulking agents, = fixed slings, = adjustable slings, = circumferential compressor devices (artificial sphincter), and = noncircumferential compressor devices (ProACT). A literature search was performed following the PRISMA guidelines. We performed a cumulative meta-analysis to explore the trend in the effect sizes across groups at postoperative follow-up. We compared the available treatment arms using standardized mean difference (SMD) and event rate (ER) for questionnaire results, number of pads/day, and percentage of pad-free patients. . 36 clinical trials were selected. At baseline, in the different populations, mean number of pad-day varied from 1.1 to 8.8, 24-hour pad weight varied extremely from 17.3 to 747.0 , and mean ICIQ-UI-SF questionnaire score varied from 4.8 to 18.6. Considering a random effect model among eligible studies, ER of continence recovery was 0.33 (95% CI -0.12-0.78), 0.63 (95% CI 0.55-0.71), 0.65 (95% CI 0.58-0.72), 0.50 (95% CI 0.34-0.66), and 0.53 (95%CI 0.36-0.70), respectively, in groups A, B, C, D, and E ( 85.87%; 249.82- > 0.01) (test of group differences =0.22).
In our analysis, the use of adjustable and fixed slings is associated with the highest whereas the use of bulking agents is associated with the lowest recovery rate of continence after treatment. Results are conditioned by an elevated rate of heterogeneity in part explained with a high variability of consistence in urinary leakage at baseline among populations.
从定量和定性参数以及控尿恢复率方面比较根治性前列腺切除术后（RP）尿失禁（UI）的不同侵入性治疗方式。
我们区分了五类治疗：=填充剂，=固定吊带，=可调节吊带，=环形压迫装置（人工括约肌），以及=非环形压迫装置（ProACT）。按照PRISMA指南进行文献检索。我们进行了累积荟萃分析，以探究术后随访时各治疗组效应量的变化趋势。我们使用标准化均数差（SMD）和事件发生率（ER）来比较可用的治疗组，用于问卷结果、每日使用尿垫数以及无尿垫患者的百分比。共选择了36项临床试验。在基线时，不同人群中，每日尿垫平均使用数从1.1到8.8不等，24小时尿垫重量差异极大，从17.3到747.0，平均国际尿失禁咨询委员会尿失禁问卷简表（ICIQ-UI-SF）评分从4.8到18.6不等。考虑到符合条件的研究中的随机效应模型，A、B、C、D和E组控尿恢复的ER分别为0.33（95%CI -0.12 - 0.78）、0.63（95%CI 0.55 - 0.71）、0.65（95%CI 0.58 - 0.72）、0.50（95%CI 0.34 - 0.66）和0.53（95%CI 0.36 - 0.70）（=85.87%；=249.82 -> 0.01）（组间差异检验=0.22）。
在我们的分析中，使用可调节和固定吊带与最高的控尿恢复率相关，而使用填充剂与治疗后最低的控尿恢复率相关。结果受到异质性率升高的影响，部分原因是不同人群基线时尿漏程度的高度变异性。
