Service d'Urologie, Hospices Civils de Lyon, Hôpital Lyon Sud, Lyon, France.
Service de Biostatistiques, Hospices Civils de Lyon, Lyon, France.
BJU Int. 2024 Mar;133(3):237-245. doi: 10.1111/bju.16141. Epub 2023 Aug 8.
To perform a systematic review and meta-analysis of endoscopic procedures for treating vesico-urethral anastomotic stenosis (VUAS) after prostatectomy, as initial VUAS management remains unclear.
A search of the MEDLINE database, the Cochrane database, and clinicaltrials.gov was performed (last search February 2023) using the following query: (['bladder neck' OR 'vesicourethral anastomotic' OR 'anastomotic'] AND ['stricture' OR 'stenosis' OR 'contracture'] AND 'prostatectomy'). The primary outcome was the success rate of VUAS treatment, defined by the proportion (%) of patients without VUAS recurrence at the end of follow-up.
The literature search identified 420 studies. After the screening, 78 reports were assessed for eligibility, and 40 studies were included in the review. The pooled characteristics of the 40 studies provided a total of 1452 patients, with a median (interquartile range [IQR]) follow-up of 23.7 (13-32) months and age of 66 (64-68) years. The overall success rate (95% confidence interval [CI]) of all endoscopic procedures for VUAS treatment was 72.8% (64.4%-79.9%). Meta-regression models showed a negative influence of radiotherapy on the overall success rate (P = 0.012). After trim-and-fill (addition of 10 studies), the corrected overall success rate (95% CI) was 62.9% (53.6%-71.4%).
This first meta-analysis of endoscopic treatment success rate after VUAS reported an overall success rate of 72.8%, lowered to 62.9% after correcting for significant publication bias. This study also highlighted the need for a more thorough reporting of post-prostatectomy VUAS data to understand the treatment pathway and provide higher-quality evidence-based care.
对前列腺切除术后治疗膀胱颈-尿道吻合口狭窄（VUAS）的内镜手术进行系统回顾和荟萃分析，因为初始 VUAS 管理仍不清楚。
对 MEDLINE 数据库、Cochrane 数据库和 clinicaltrials.gov 进行了检索（最后一次检索时间为 2023 年 2 月），使用了以下查询：（['bladder neck' OR 'vesicourethral anastomotic' OR 'anastomotic'] AND ['stricture' OR 'stenosis' OR 'contracture'] AND 'prostatectomy'）。主要结局是 VUAS 治疗的成功率，定义为在随访结束时无 VUAS 复发的患者比例（%）。
文献检索共确定了 420 项研究。经过筛选，有 78 份报告符合纳入标准，有 40 项研究纳入了综述。40 项研究的综合特征共纳入了 1452 名患者，中位（四分位距 [IQR]）随访时间为 23.7（13-32）个月，年龄为 66（64-68）岁。所有内镜治疗 VUAS 的总体成功率（95%置信区间 [CI]）为 72.8%（64.4%-79.9%）。Meta 回归模型显示放射治疗对总体成功率有负面影响（P=0.012）。经修剪和填充（添加 10 项研究）后，校正后的总体成功率（95%CI）为 62.9%（53.6%-71.4%）。
这是第一项关于 VUAS 内镜治疗成功率的荟萃分析报告，总体成功率为 72.8%，在纠正显著发表偏倚后降至 62.9%。本研究还强调需要更全面地报告前列腺切除术后 VUAS 数据，以了解治疗途径并提供更高质量的循证护理。
