Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy.
Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom.
J Endourol. 2024 Jun;38(6):605-628. doi: 10.1089/end.2023.0766. Epub 2024 Apr 22.
To perform a systematic review to assess the incidence of reoperation rate for residual/regrowth adenoma after transurethral surgeries for benign prostatic enlargement. A systematic literature search was performed on November 12, 2023, using Cochrane Central Register of Controlled Trials, PubMed, and Scopus. We only included randomized studies comparing monopolar (M)/bipolar (B) transurethral resection of the prostate (TURP) ablation enucleation procedures. Incidence of reoperation was assessed using the Cochran-Mantel-Haenszel Method and reported as risk ratio (RR), 95% confidence interval (CI), and -values. Statistical significance was set at < 0.05. Forty-eight studies were included. Six studies compared enucleation TURP, 41 ablation TURP, and 1 study enucleation ablation TURP, encompassing 457 patients in enucleation, 2259 in ablation, and 2517 in the TURP group. The pooled incidence of reoperation was 6.2%, 0.7%, 2.3%, and 4.3% after ablation, enucleation, M-TURP, and B-TURP, respectively. Meta-analysis showed that the incidence of reoperation was significantly lower in the enucleation group (RR 0.28, 95% CI 0.10-0.81, = 0.02), but the difference accounted only in studies with follow-up between 1 and 3 years (RR 0.18, 95% CI 0.04-0.85, = 0.03). The incidence of reoperation was significantly lower in the enucleation compared with the B-TURP group (RR 0.14, 95% CI 0.03-0.77, = 0.02). Meta-analysis showed that the incidence of reoperation was significantly higher in the ablation group (RR 1.81, 95% CI 1.33-2.47, = 0.0002), but there was no difference in studies with follow-up up to 1 year (odds ratio 1.78 95% CI 0.97-3.29, = 0.06) longer than 5 years (RR 2.02, 95% CI 0.71-5.79, = 0.19). The incidence of reoperation was significantly higher in the ablation compared with the M-TURP group (RR 1.91, 95% CI 1.44-2.54, < 0.0001). In mid-term follow-up, reoperation rate for residual/regrowth adenoma was significantly lower after enucleation, although was significantly higher after ablation compared with TURP.
为评估经尿道前列腺切除术治疗良性前列腺增生后残余/复发性腺瘤的再次手术率，我们进行了系统评价。2023 年 11 月 12 日，我们对 Cochrane 对照试验中心注册库、PubMed 和 Scopus 进行了系统文献检索。我们仅纳入了比较单极（M）/双极（B）经尿道前列腺切除术（TURP）消融切除术与前列腺剜除术的随机研究。使用 Cochran-Mantel-Haenszel 方法评估再次手术的发生率，并报告风险比（RR）、95%置信区间（CI）和 -值。统计显著性设为 < 0.05。共纳入 48 项研究。其中 6 项研究比较了剜除术与 TURP、41 项消融术与 TURP、1 项剜除术与消融术与 TURP，共纳入 457 例剜除术、2259 例消融术和 2517 例 TURP 患者。剜除术、消融术、M-TURP 和 B-TURP 后再次手术的发生率分别为 6.2%、0.7%、2.3%和 4.3%。Meta 分析显示，剜除术组的再次手术发生率显著较低（RR 0.28，95%CI 0.10-0.81，= 0.02），但差异仅见于随访 1-3 年的研究中（RR 0.18，95%CI 0.04-0.85，= 0.03）。与 B-TURP 组相比，剜除术组的再次手术发生率显著较低（RR 0.14，95%CI 0.03-0.77，= 0.02）。Meta 分析显示，消融术组的再次手术发生率显著较高（RR 1.81，95%CI 1.33-2.47，= 0.0002），但在随访时间不超过 1 年的研究中（比值比 1.78，95%CI 0.97-3.29，= 0.06）与随访时间超过 5 年的研究中（RR 2.02，95%CI 0.71-5.79，= 0.19）之间没有差异。与 M-TURP 组相比，消融术组的再次手术发生率显著较高（RR 1.91，95%CI 1.44-2.54，< 0.0001）。在中期随访中，尽管与 TURP 相比，剜除术后残留/复发性腺瘤的再次手术率明显较低，但消融术后的再次手术率明显较高。
