Lim Sean, Lim Kylie Yen-Yi, Qu Liang, Ranasinha Sanjeeva, Dat Anthony, Brown Matthew, Manohar Paul, Harper Matthew, Donnellan Scott, Ranasinghe Weranja
Department of Urology Monash Health Melbourne Victoria Australia.
Department of Medicine, Nursing and Health Sciences Monash University Clayton Victoria Australia.
BJUI Compass. 2024 May 8;5(8):748-760. doi: 10.1002/bco2.366. eCollection 2024 Aug.
Voiding dysfunction remains a common side effect postprostate biopsy leading to significant morbidity. Alpha blockers have emerged as a potential therapeutic option to mitigate this risk, with various centres already incorporating its use in practice. Despite this, the literature regarding its efficacy remains inconclusive. Hence, a systematic review was performed to quantify the effect of perioperative alpha blockers on prostate biopsy-related voiding function.
A systematic search in MEDLINE, Embase and PubMed between January 1989 and July 2023 was performed to identify relevant articles. Two independent reviewers independently screened abstracts, full texts and performed data extraction. Data including International Prostate Symptom Scores (IPSS), voiding flow rates (Qmax), postvoid residuals (PVR), rates of acute urinary retention (AUR) and quality of life (QoL) scores were extracted. Results were combined in an inverse variance random effects meta-analysis.
A total 808 patients from six randomised controlled trials (RCTs) comparing alpha blockers to controls were included. All articles excluded patients with pre-existing voiding dysfunction. Pooled outcomes demonstrated statistically significant differences favouring alpha blocker usage in all objective and subjective measures including IPSS (mean difference 4.21, 95% confidence interval [CI] 2.58-5.84, 0.00001), PVR (mean difference 20.41 mL, 95% CI 3.44-37.39, 0.02), Qmax (mean difference 3.07 mL/s, 95% CI 2.55-3.59, 0.00001), QoL (weighted-mean difference 0.82, CI 0.17-1.48, 0.01) as well as overall risk of AUR (odds ratio 0.22, CI 0.09-0.55, 0.001). There was variable heterogeneity ( = 0-86%) between outcomes.
This review highlights the potential role of alpha blockers in improving urinary function and reducing adverse voiding outcomes postprostate biopsy. The standard practice of incorporating the usage of perioperative alpha blockers may be considered to reduce the morbidity of voiding complications secondary to prostate biopsy.
排尿功能障碍仍然是前列腺活检后常见的副作用，会导致严重的发病率。α受体阻滞剂已成为减轻这种风险的一种潜在治疗选择，多个中心已在实践中采用。尽管如此，关于其疗效的文献仍无定论。因此，我们进行了一项系统评价，以量化围手术期α受体阻滞剂对前列腺活检相关排尿功能的影响。
在1989年1月至2023年7月期间，对MEDLINE、Embase和PubMed进行了系统检索，以确定相关文章。两名独立的评审员独立筛选摘要、全文并进行数据提取。提取的数据包括国际前列腺症状评分（IPSS）、排尿流速（Qmax）、残余尿量（PVR）、急性尿潴留（AUR）发生率和生活质量（QoL）评分。结果通过逆方差随机效应荟萃分析进行合并。
纳入了6项比较α受体阻滞剂与对照组的随机对照试验（RCT）中的808例患者。所有文章均排除了已有排尿功能障碍的患者。汇总结果显示，在所有客观和主观指标上，使用α受体阻滞剂均有统计学显著差异，包括IPSS（平均差4.21，95%置信区间[CI]2.58 - 5.84，P < 0.00001）、PVR（平均差20.41 mL，95% CI 3.44 - 37.39，P = 0.02）、Qmax（平均差3.07 mL/s，95% CI 2.55 - 3.59，P < 0.00001）、QoL（加权平均差0.82，CI 0.17 - 1.48，P = 0.01）以及AUR的总体风险（比值比0.22，CI 0.09 - 0.55，P = 0.001）。各指标之间存在不同程度的异质性（I² = 0 - 86%）。
本综述强调了α受体阻滞剂在改善前列腺活检后尿功能和减少不良排尿结局方面的潜在作用。可以考虑采用围手术期使用α受体阻滞剂的标准做法，以降低前列腺活检继发排尿并发症的发病率。
