Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan.
School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
Medicina (Kaunas). 2022 Oct 13;58(10):1441. doi: 10.3390/medicina58101441.
Trials to evaluate the effect and safety of rapid and gradual urinary decompression have been published for decades. Due to inconclusive results, this study aimed to assess whether rapid bladder decompression increased complications in adults with acute urinary retention. We searched the , , and databases for articles published from the database inception to 31 August 2021. Studies that compared the effects and complication rates of rapid and gradual urinary decompression in adults with acute urinary retention were included. The primary outcome was post-decompression hematuria, while the secondary outcome was circulatory collapse. Meta-analyses were conducted using random effects models. Sensitivity analyses, tests for publication bias, and trial sequential analyses were conducted. The PROSPERO registration number is CRD42021233457. Overall, four articles were included in the comprehensive analysis, and 435 participants met all the eligibility criteria. In the primary meta-analysis of all four study groups, rapid urinary decompression did not increase the risk of post-decompression hematuria (RR = 0.91; 95% CI: 0.62 to 1.35; = 0.642). The statistic was 0.0% ( = 0.732), indicating no substantial heterogeneity. In the meta-analysis of randomized controlled studies, the result did not change (RR = 0.89; 95% CI: 0.31 to 2.52; = 0.824). The Egger's test and Begg test ( = 0.339 and 0.497, respectively) indicated the absence of statistical evidence of publication bias. Leave-one-out sensitivity analysis was conducted and showed the pooled results were robust. In secondary outcome, there were no reported events of circulatory collapse in the current studies. The currently available data suggest that rapid urinary decompression is an effective and safe method with a complication rate similar to that of gradual decompression in an acute urinary retention population. Further large-scale randomized studies are required.
几十年来，已经发表了许多评估快速和逐渐解除尿潴留效果和安全性的试验。由于结果不确定，本研究旨在评估急性尿潴留成人中快速膀胱减压是否会增加并发症。我们在 、 、 和 数据库中搜索了从数据库建立到 2021 年 8 月 31 日发表的文章。纳入了比较急性尿潴留成人快速和逐渐解除尿潴留效果和并发症发生率的研究。主要结局是减压后血尿，次要结局是循环崩溃。使用随机效应模型进行荟萃分析。进行敏感性分析、发表偏倚检验和试验序贯分析。PROSPERO 注册号为 CRD42021233457。 总体而言，有 4 篇文章被纳入全面分析，有 435 名参与者符合所有纳入标准。在对所有 4 组研究的主要荟萃分析中，快速解除尿潴留并未增加减压后血尿的风险（RR = 0.91；95%CI：0.62 至 1.35； = 0.642）。I 2 统计量为 0.0%（ = 0.732），表明无实质性异质性。在随机对照研究的荟萃分析中，结果没有改变（RR = 0.89；95%CI：0.31 至 2.52； = 0.824）。Egger 检验和 Begg 检验（分别为 0.339 和 0.497）表明没有发表偏倚的统计证据。逐一剔除敏感性分析表明，汇总结果稳健。次要结局中，当前研究中没有报告循环崩溃事件。 目前可用的数据表明，快速解除尿潴留是一种有效且安全的方法，其并发症发生率与急性尿潴留人群中逐渐解除尿潴留相似。需要进一步开展大规模的随机研究。
