膀胱肿瘤与前列腺梗阻的同期内镜手术：我们能否安全地一举两得？一项系统评价与Meta分析
Concomitant Endoscopic Surgery for Bladder Tumors and Prostatic Obstruction: Are We Safely Hitting Two Birds with One Stone? A Systematic Review and Meta-Analysis.
作者信息
Savvides Eliophotos, Pyrgidis Nikolaos, Langas Georgios, Symeonidis Evangelos N, Dimitriadis Georgios, Sountoulides Petros
机构信息
1st Department of Urology, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, GR-55134 Thessaloniki, Greece.
Department of Urology, 'Martha-Maria' Hospital Nuremberg, 90402 Nuremberg, Germany.
出版信息
J Clin Med. 2022 Oct 21;11(20):6208. doi: 10.3390/jcm11206208.
BACKGROUND
Lower urinary tract symptoms (LUTS) caused by benign prostatic obstruction (BPO) and bladder tumors may co-exist, especially among elderly patients. Transurethral resection of bladder tumors (TURBT) and endoscopic surgery for benign prostatic obstruction in the same setting are avoided by many surgeons due to concerns for tumor cell seeding and recurrences in the prostatic urethra.
AIM
The aim of this study was assess the effect of concomitant TURBT and endoscopic BPO surgery on oncological safety and patient quality of life via systematic review and meta-analysis.
METHODS
We searched the PubMed, Cochrane Library, EMBASE, Scopus, and Clinicaltrials.gov databases and sources of grey literature published before June 2021 for relevant studies. We performed a random-effects meta-analysis of odds ratios (ORs) or weighted mean differences (WMD) to compare concomitant TURBT and BPO surgery versus TURBT alone in terms of recurrence and progression rates. Accordingly, we undertook multiple subgroups and sensitivity analyses (PROSPERO: CRD42020173363).
RESULTS
Three randomized and twelve retrospective observational studies with 2421 participants were included. Across studies with good methodological quality, no statistically significant differences were demonstrated regarding overall bladder tumors recurrence rates between concomitant endoscopic BPO surgery and TURBT versus TURBT alone (OR: 0.81, 95% CI: 0.60-1.09, I = 42%). Similarly, no significant differences were observed in recurrences located at the bladder neck and/or prostatic urethra (OR: 1.06, 95% CI: 0.76-1.47, I = 0%), time to first recurrence (WMD: -0.2 months, 95% Cl: -2.2-1.8, I = 48%), and progression rate (OR: 1.05, 95% CI: 0.67-1.64, I = 0%). Subgroup analyses based on tumor grade, number of tumors, and utilization of single-instillation chemotherapy post-TURBT did not detect any significant differences in overall bladder tumor recurrence. The level of evidence was estimated as low for all outcomes. Concomitant surgery improved lower urinary tract symptoms.
CONCLUSION
Concomitant endoscopic BPO surgery and TURBT are oncologically safe and improve LUTS-related quality of life.
背景
由良性前列腺梗阻（BPO）和膀胱肿瘤引起的下尿路症状（LUTS）可能同时存在，尤其是在老年患者中。由于担心肿瘤细胞种植和前列腺尿道复发，许多外科医生避免在同一情况下进行经尿道膀胱肿瘤切除术（TURBT）和良性前列腺梗阻的内镜手术。
目的
本研究的目的是通过系统评价和荟萃分析评估同期TURBT和内镜下BPO手术对肿瘤学安全性和患者生活质量的影响。
方法
我们检索了PubMed、Cochrane图书馆、EMBASE、Scopus和Clinicaltrials.gov数据库以及2021年6月之前发表的灰色文献来源，以查找相关研究。我们对比值比（OR）或加权平均差（WMD）进行随机效应荟萃分析，以比较同期TURBT和BPO手术与单独TURBT在复发率和进展率方面的差异。相应地，我们进行了多个亚组分析和敏感性分析（PROSPERO：CRD42020173363）。
结果
纳入了3项随机对照研究和12项回顾性观察性研究，共2421名参与者。在方法学质量良好的研究中，同期内镜下BPO手术联合TURBT与单独TURBT相比，总体膀胱肿瘤复发率无统计学显著差异（OR：0.81，95%CI：0.60-1.09，I² = 42%）。同样，在膀胱颈和/或前列腺尿道的复发、首次复发时间（WMD：-0.2个月，95%CI：-2.2-1.8，I² = 48%）和进展率（OR：1.05，95%CI：0.67-1.64，I² = 0%）方面也未观察到显著差异。基于肿瘤分级、肿瘤数量和TURBT后单次灌注化疗的使用情况进行的亚组分析未发现总体膀胱肿瘤复发有任何显著差异。所有结局的证据水平估计为低。同期手术改善了下尿路症状。
结论
同期内镜下BPO手术和TURBT在肿瘤学上是安全的，并改善了与LUTS相关的生活质量。
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