Warli Syah Mirsya, Ikram Muhammad Fahmi, Sarumpaet Raja Gerald, Tala Zaimah Zulkarnaini, Putrantyo Ignatius Ivan
Department of Urology, Universitas Sumatera Utara Hospital, Universitas Sumatera Utara, Medan; Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara-Haji Adam Malik General Hospital, Medan.
Faculty of Medicine, Universitas Sumatera Utara, Medan.
Arch Ital Urol Androl. 2024 Mar 7;96(1):12066. doi: 10.4081/aiua.2024.12066.
Benign prostatic hyperplasia (BPH) is prevalent among elderly men, necessitating focused attention. The Prostatic Urethral Lift (PUL) procedure, a minimally invasive intervention, has emerged as a promising option for BPH management. It has shown remarkable results in ameliorating lower urinary tract symptoms (LUTS), enhancing quality of life, and preserving sexual function. This study aims to evaluate the effectiveness and safety of PUL in BPH patients.
Key databases (MEDLINE, Cochrane CENTRAL, ScienceDirect, EBSCO, Google Scholar) were systematically searched using pertinent terms related to PUL and BPH. Following the PRISMA checklist, we considered only randomized controlled trials (RCTs) from 2013 to 2023. The assessment focused on LUTS, quality of life, sexual function, and adverse events within three months. Follow-up post-treatment mean values compared with controls (Sham) and the improvement from baseline to post-treatment follow-up duration were considered. Statistical analysis and risk of bias evaluation were conducted using Review Manager 5.4.1, presenting results as difference of mean values (MD) and risk ratios (RR).
A meta-analysis with a Random Effects Model of 7 RCTs involving 378 confirmed BPH patients demonstrated significant improvements in the PUL arm including International Prostate Symptom Score (IPSS) (MD 5.51, p<0.0001), maximum urinary flow rate (Qmax) (MD 2.13, p=0.0001), BPH Impact Index (BPHII) (MD 2.14, p=0.0001), and IPSS-QoL (MD 1.50, p<0.0001), without significant increase of adverse events (RR 1.51; p=0.50). Positive outcomes were observed in sexual function variables and post-void residual measurements when post-treatment values were compared to baseline.
PUL holds advantages over control interventions, providing encouraging prospects for BPH management. This study underscores the need for further exploration of PUL's efficacy and safety in BPH patients.
良性前列腺增生（BPH）在老年男性中普遍存在，需要重点关注。前列腺尿道悬吊术（PUL）作为一种微创干预措施，已成为治疗BPH的一种有前景的选择。它在改善下尿路症状（LUTS）、提高生活质量和保留性功能方面显示出显著效果。本研究旨在评估PUL治疗BPH患者的有效性和安全性。
使用与PUL和BPH相关的相关术语系统检索主要数据库（MEDLINE、Cochrane CENTRAL、ScienceDirect、EBSCO、谷歌学术）。按照PRISMA清单，我们仅考虑2013年至2023年的随机对照试验（RCT）。评估重点为三个月内的LUTS、生活质量、性功能和不良事件。将治疗后随访的平均值与对照组（假手术组）进行比较，并考虑从基线到治疗后随访期间的改善情况。使用Review Manager 5.4.1进行统计分析和偏倚风险评估，结果以平均值差异（MD）和风险比（RR）表示。
一项对7项RCT进行随机效应模型的荟萃分析，涉及378例确诊的BPH患者，结果显示PUL组有显著改善，包括国际前列腺症状评分（IPSS）（MD 5.51，p<0.0001）、最大尿流率（Qmax）（MD 2.13，p=0.0001）、BPH影响指数（BPHII）（MD 2.14，p=0.0001）和IPSS-生活质量（MD 1.50，p<0.0001），不良事件无显著增加（RR 1.51；p=0.50）。将治疗后值与基线相比，性功能变量和残余尿量测量结果呈阳性。
PUL比对照干预措施具有优势，为BPH治疗提供了令人鼓舞的前景。本研究强调需要进一步探索PUL在BPH患者中的疗效和安全性。
