Christensen Veronika S, Skow Marius, Flottorp Signe A, Strømme Hilde, Mdala Ibrahimu, Vallersnes Odd Martin
Faculty of Medicine University of Oslo Oslo Norway.
The Antibiotic Centre for Primary Care University of Oslo Oslo Norway.
BJUI Compass. 2024 May 14;5(8):732-747. doi: 10.1002/bco2.369. eCollection 2024 Aug.
To compare the success of establishing spontaneous micturition following immediate trial without catheter (TWOC) to delayed TWOC in males catheterized for acute urinary retention.
In this systematic review, we included studies reporting success rates of immediate TWOC or delayed TWOC (≤30 days) among males ≥18 years of age catheterized for acute urinary retention. We excluded studies on suprapubic catheterization, postoperative/perioperative catheterization and urinary retention related to trauma. We searched the following databases: MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Open Grey and Clinicaltrials.gov. The search was concluded on 30 November 2022. There were no restrictions on language or publication date. Risk of bias was assessed using the ROB 2.0 and ROBINS-I tools. We did random-effects restricted maximum likelihood model meta-analyses. Certainty of evidence was assessed using GRADE.
We included 61 studies. In two randomized controlled trials (RCTs), both with some concerns for risk of bias, including in total 174 participants, the relative success rate was 1.22 (95% CI 0.84-1.76) favouring delayed TWOC. In two comparative cohort studies, both with serious risk of bias, including 642 participants, the relative success rate was 1.18 (0.94-1.47) favouring delayed TWOC. One study was excluded from this meta-analysis because of critically low quality. Four studies reporting success rates for cohorts with immediate TWOC, all with serious risk of bias, including 409 participants, had an overall success rate of 47% (29-66). Fifty-two studies reporting success rates for cohorts with delayed TWOC, all with serious risk of bias, including 12 489 participants, had an overall success rate of 53% (49-56). The certainty of the evidence was considered low for the RCTs and very low for the rest.
There was a limited number of appropriately designed studies addressing the research question directly. The evidence favours neither approach.
比较急性尿潴留男性患者立即试行拔除导尿管（TWOC）与延迟TWOC后自主排尿成功的情况。
在本系统评价中，我们纳入了报告18岁及以上因急性尿潴留留置导尿管男性患者立即TWOC或延迟TWOC（≤30天）成功率的研究。我们排除了耻骨上膀胱造瘘术、术后/围手术期导尿以及与创伤相关的尿潴留的研究。我们检索了以下数据库：MEDLINE、Embase、Cochrane系统评价数据库、Cochrane对照试验中心注册库、Open Grey和Clinicaltrials.gov。检索于2022年11月30日结束。对语言或出版日期没有限制。使用ROB 2.0和ROBINS - I工具评估偏倚风险。我们进行了随机效应限制最大似然模型的荟萃分析。使用GRADE评估证据的确定性。
我们纳入了61项研究。在两项随机对照试验（RCT）中，两者均存在一些偏倚风险问题，共纳入174名参与者，相对成功率为1.22（95%CI 0.84 - 1.76），支持延迟TWOC。在两项比较队列研究中，两者均存在严重偏倚风险，共纳入642名参与者，相对成功率为1.18（0.94 - 1.47），支持延迟TWOC。一项研究因质量极低而被排除在该荟萃分析之外。四项报告立即TWOC队列成功率的研究，均存在严重偏倚风险，共纳入409名参与者，总体成功率为47%（29 - 66）。五十二项报告延迟TWOC队列成功率的研究，均存在严重偏倚风险，共纳入12489名参与者，总体成功率为53%（49 - 56）。RCT的证据确定性被认为较低，其余研究的证据确定性非常低。
直接针对该研究问题进行适当设计的研究数量有限。证据对两种方法均无支持倾向。
