Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China.
Syst Rev. 2024 Mar 22;13(1):93. doi: 10.1186/s13643-024-02514-3.
The efficacy of surgical treatment for benign prostatic hyperplasia (BPH) patients with detrusor underactivity (DU) remains controversial.
To summarize relevant evidence, three databases (PubMed, Embase, and Web of Science) were searched from database inception to May 1, 2023. Transurethral surgical treatment modalities include transurethral prostatectomy (TURP), photoselective vaporization of the prostate (PVP), and transurethral incision of the prostate (TUIP). The efficacy of the transurethral surgical treatment was assessed according to maximal flow rate on uroflowmetry (Q), International Prostate Symptom Score (IPSS), postvoid residual (PVR), quality of life (QoL), voided volume, bladder contractility index (BCI) and maximal detrusor pressure at maximal flow rate (PdetQ). Pooled mean differences (MDs) were used as summary statistics for comparison. The quality of enrolled studies was evaluated by using the Newcastle-Ottawa Scale. Sensitivity analysis and funnel plots were applied to assess possible biases.
In this study, 10 studies with a total of 1142 patients enrolled. In BPH patients with DU, within half a year, significant improvements in Q (pooled MD, 4.79; 95% CI, 2.43-7.16; P < 0.05), IPSS(pooled MD, - 14.29; 95%CI, - 16.67-11.90; P < 0.05), QoL (pooled MD, - 1.57; 95% CI, - 2.37-0.78; P < 0.05), voided volume (pooled MD, 62.19; 95% CI, 17.91-106.48; P < 0.05), BCI (pooled MD, 23.59; 95% CI, 8.15-39.04; P < 0.05), and PdetQ (pooled MD, 28.62; 95% CI, 6.72-50.52; P < 0.05) were observed after surgery. In addition, after more than 1 year, significant improvements were observed in Q (pooled MD, 6.75; 95%CI, 4.35-9.15; P < 0.05), IPSS(pooled MD, - 13.76; 95%CI, - 15.17-12.35; P < 0.05), PVR (pooled MD, - 179.78; 95%CI, - 185.12-174.44; P < 0.05), QoL (pooled MD, - 2.61; 95%CI, - 3.12-2.09; P < 0.05), and PdetQ (pooled MD, 27.94; 95%CI, 11.70-44.19; P < 0.05). Compared with DU patients who did not receive surgery, DU patients who received surgery showed better improvement in PVR (pooled MD, 137.00; 95%CI, 6.90-267.10; P < 0.05) and PdetQ (pooled MD, - 8.00; 95%CI, - 14.68-1.32; P < 0.05).
Our meta-analysis results showed that transurethral surgery can improve the symptoms of BPH patients with DU. Surgery also showed advantages over pharmacological treatment for BPH patients with DU.
PROSPERO CRD42023415188.
对于逼尿肌活动低下（DU）的良性前列腺增生（BPH）患者，手术治疗的疗效仍存在争议。
为了总结相关证据，我们从数据库建立之初到 2023 年 5 月 1 日，在 PubMed、Embase 和 Web of Science 三个数据库中进行了检索。经尿道手术治疗方式包括经尿道前列腺切除术（TURP）、前列腺选择性光汽化术（PVP）和经尿道前列腺切开术（TUIP）。根据尿流率（Q）、国际前列腺症状评分（IPSS）、剩余尿量（PVR）、生活质量（QoL）、排空量、膀胱收缩力指数（BCI）和最大尿流率时逼尿肌压力（PdetQ）评估经尿道手术治疗的疗效。汇总均数差值（MDs）作为比较的汇总统计量。使用纽卡斯尔-渥太华量表评估纳入研究的质量。应用敏感性分析和漏斗图评估可能存在的偏倚。
本研究共纳入 10 项研究，总计 1142 例患者。在逼尿肌活动低下的 BPH 患者中，术后半年内，Q（汇总 MD，4.79；95%CI，2.43-7.16；P<0.05）、IPSS（汇总 MD，-14.29；95%CI，-16.67-11.90；P<0.05）、QoL（汇总 MD，-1.57；95%CI，-2.37-0.78；P<0.05）、排空量（汇总 MD，62.19；95%CI，17.91-106.48；P<0.05）、BCI（汇总 MD，23.59；95%CI，8.15-39.04；P<0.05）和 PdetQ（汇总 MD，28.62；95%CI，6.72-50.52；P<0.05）均显著改善。此外，在 1 年以上，Q（汇总 MD，6.75；95%CI，4.35-9.15；P<0.05）、IPSS（汇总 MD，-13.76；95%CI，-15.17-12.35；P<0.05）、PVR（汇总 MD，-179.78；95%CI，-185.12-174.44；P<0.05）、QoL（汇总 MD，-2.61；95%CI，-3.12-2.09；P<0.05）和 PdetQ（汇总 MD，27.94；95%CI，11.70-44.19；P<0.05）也显著改善。与未接受手术的 DU 患者相比，接受手术的 DU 患者的 PVR（汇总 MD，137.00；95%CI，6.90-267.10；P<0.05）和 PdetQ（汇总 MD，-8.00；95%CI，-14.68-1.32；P<0.05）改善更好。
我们的荟萃分析结果表明，经尿道手术可以改善逼尿肌活动低下的 BPH 患者的症状。与药物治疗相比，手术对逼尿肌活动低下的 BPH 患者也具有优势。
PROSPERO CRD42023415188。
Zotero 插件
