Fu Yujia, Wen Xiaomiao, Yin Yanhai, Wang Chaoqun, Mai Jiren
Department of Nuclear Medicine, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China.
Department of Urology, Danzhou People's Hospital, DanZhou, China.
Transl Androl Urol. 2022 Jun;11(6):842-858. doi: 10.21037/tau-22-377.
More and more new surgical procedures for the treatment of benign prostate hyperplasia (BPH) are proposed creatively. However, the existing clinical evidence shows that the effectiveness and safety of various procedures exist inconsistent.
The randomized controlled trials comparing the international prostate score, length of hospital stay, maximum urinary flow rate, operation time, and complication rates of prostatic artery embolization (PAE), Greenlight-XPS Laser prostate vaporization procedure (GLL PVP), diode laser enucleation of prostate (DILEP) and plasmakinetic resection of the prostate (PKRP), transurethral resection of the prostate (TURP) in patients with BPH were screened out in databases. The primary outcome was pooled using a restricted maximum likelihood-based random-effect model and inverse variance-based fixed-effect model. Cochrane Q statistics and I2 statistics were computed to quantify between-study heterogeneity. The risk of bias of each included study was assessed using the revised Cochrane risk of bias tool.
This meta-analysis ultimately included 14 original research papers, with 1,940 participants enrolled. Eight studies were considered to be at moderate risk of bias, while the others were at mild risk of bias. Although the improvement in functional outcome of the DILEP procedure was equivalent to that of the PKRP procedure, the DILEP procedure group had fewer hospital stays than the PKRP group (P=0.01). In addition, even though the performance of the GLL PVP procedure in the improvement of functional outcome was inferior to the counterpart of TURP (P=0.64), it had a much fewer hospital stays (P=0.01). Moreover, there is still insufficient evidence for the improvement of subjective functional indicators of postoperative patients with PAE compared with TURP [international prostate symptom score (IPSS): P=0.73; IPSS QoL: P=0.91], but achieved less satisfactory objective functional outcomes (Qmax: P=0.06; PVR: P=0.00).
New surgical procedures such as GLL PVP, PAE, and DILEP were safer than traditional TURP procedures. However, it is not superior to traditional surgery in the improvement of clinical symptoms. In clinical practice, the pros and cons of the new operation and the traditional operation should be carefully weighed, and the operation that is most suitable for the patient's condition should be selected.
越来越多治疗良性前列腺增生（BPH）的新型外科手术被创新性地提出。然而，现有临床证据表明，各种手术的有效性和安全性存在不一致性。
在数据库中筛选比较国际前列腺评分、住院时间、最大尿流率、手术时间以及前列腺动脉栓塞术（PAE）、绿激光前列腺汽化术（GLL PVP）、二极管激光前列腺剜除术（DILEP）、等离子前列腺切除术（PKRP）和经尿道前列腺切除术（TURP）治疗BPH患者并发症发生率的随机对照试验。主要结局采用基于限制最大似然法的随机效应模型和基于逆方差法的固定效应模型进行合并。计算Cochrane Q统计量和I²统计量以量化研究间的异质性。使用修订后的Cochrane偏倚风险工具评估每项纳入研究的偏倚风险。
本荟萃分析最终纳入14篇原创研究论文，共1940名参与者。8项研究被认为存在中度偏倚风险，其他研究存在轻度偏倚风险。虽然DILEP手术在功能结局改善方面与PKRP手术相当，但DILEP手术组的住院时间比PKRP组少（P = 0.01）。此外，尽管GLL PVP手术在功能结局改善方面不如TURP手术（P = 0.64），但其住院时间要少得多（P = 0.01）。而且，与TURP相比，PAE术后患者主观功能指标改善的证据仍不足[国际前列腺症状评分（IPSS）：P = 0.73；IPSS生活质量评分：P = 0.91]，但客观功能结局较差（最大尿流率：P = 0.06；残余尿量：P = 0.00）。
GLL PVP、PAE和DILEP等新型外科手术比传统TURP手术更安全。然而，在改善临床症状方面并不优于传统手术。在临床实践中，应仔细权衡新手术和传统手术的利弊，选择最适合患者病情的手术方式。
