UroScience and Department of Urology, Faculty of Medical Sciences, State University of Campinas - UNICAMP, Campinas, São Paulo, Brazil.
Doctoral Program in Medical Pathophysiology, Faculty of Medical Sciences, State University of Campinas - UNICAMP, Campinas, São Paulo, Brazil.
BJU Int. 2024 Jul;134(1):13-21. doi: 10.1111/bju.16180. Epub 2023 Sep 28.
To apply a new evidence-gathering methodology, called reverse systematic review (RSR), to analyse the influence of different continence classification criteria on urinary continence rates among open retropubic radical prostatectomy (RRP), laparoscopic RP (LRP) and robot-assisted RP (RARP).
A search was carried out in eight databases between 2000 and 2020 through systematic reviews (SRs) studies referring to RRP, LRP or RARP (80 SRs). All references used in these SRs were captured referring to 910 papers in an overall database called the 'EVIDENCE Database'. A total of 422 studies related to post-RP urinary continence were selected for the final analysis, totalling 782 reports referring to 193 618 patients.
Overall, 206 (26.4%) reports for RRP, 243 (31.0%) reports for LRP, and 333 (42.6%) reports for RARP were found. Mean overall continence rates, respectively for RRP, LRP and RARP, were: 42%, 34% and 42% at 1 month; 62%, 64% and 65% at 3 months; 73, 77 and 79% at 6 months; and 81%, 85% and 86% at 12 months. The most used criterion was 'No pad' (53.3%), followed by 'Safety pad' (19.3%), 'Not described' (10.6%), and 'No leak' (9.9%). 'No pad' showed the lowest discrepancy in continence rates in each period compared to the overall average for each technique, demonstrating less ability to influence the final results favouring any of the techniques.
The RSR demonstrated that the 'No pad' criterion was the most used in the literature and showed the lowest bias capable of influencing the results and favouring any of the techniques and is the fairest option for future comparisons.
应用一种新的证据收集方法，称为反向系统评价（RSR），分析不同的控尿分类标准对开放耻骨后前列腺切除术（RRP）、腹腔镜前列腺切除术（LRP）和机器人辅助前列腺切除术（RARP）术后尿控率的影响。
通过对 2000 年至 2020 年期间的 8 个数据库进行系统评价（SR）研究，共检索到 80 篇关于 RRP、LRP 或 RARP 的文献。这些 SR 中使用的所有参考文献均通过对一个名为“EVIDENCE Database”的总数据库中的 910 篇论文进行追溯而获得。最终分析共选择了 422 项与 RP 后尿控相关的研究，共涉及 193618 例患者的 782 份报告。
RRP 共发现 206 份（26.4%）报告，LRP 共发现 243 份（31.0%）报告，RARP 共发现 333 份（42.6%）报告。RRP、LRP 和 RARP 的总体平均控尿率分别为：1 个月时 42%、34%和 42%；3 个月时 62%、64%和 65%；6 个月时 73%、77%和 79%；12 个月时 81%、85%和 86%。使用最广泛的标准是“无尿垫”（53.3%），其次是“安全尿垫”（19.3%）、“未描述”（10.6%）和“无漏尿”（9.9%）。“无尿垫”在每个时期与每种技术的总体平均控尿率的差异最小，表明其对最终结果的影响最小，有利于任何一种技术。
RSR 表明，文献中最常用的标准是“无尿垫”，其偏倚最小，能够影响结果，有利于任何一种技术，是未来进行比较的最佳选择。
