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针对下泌尿道症状的新型最小侵入性治疗方法:系统性审查和网络元分析
Robertus Arnoldus Antonius van Kollenburg1, Luigi Antonio Maria Johannes Gerardus van Riel1, Daniel Martijn de Bruin1
1Department of Urology, Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Netherlands.
概括
针对下泌尿道症状 (LUTS) 的新型最小侵入性治疗 (MIT) 比通过尿道切除前列腺 (TURP) 提供更好的安全性. 水和前列腺动脉栓塞 (PAE) 显示出有希望的功能结果,与TURP相比.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 最少侵入性的手术
- 医疗技术评估 医疗技术评估
背景情况:
- 下尿道症状 (LUTS) 显著影响男性的生活质量.
- 通过尿道切除前列腺 (TURP) 是对LUTS的传统治疗方法,但存在风险.
- 新的最小侵入性治疗 (MIT) 已经成为TURP的潜在替代品.
研究的目的:
- 系统地审查和比较各种MITs与 TURP治疗男性LUTS的疗效.
- 评估与这些治疗相关的功能结果,安全性和性功能.
主要方法:
- 在Medline,Embase和Cochrane数据库 (2010年1月至2022年12月) 中进行了全面的文献搜索.
- 包括随机对照试验 (RCT),将MIT与TURP或假冒程序进行比较.
- 进行了网络元分析 (NMA),根据功能结果改善概率对MIT进行排名,使用尿液流量计和IPSS作为主要结果.
主要成果:
- 十个RCT评估了水化,前列腺尿道升降,前列腺动脉栓塞 (PAE),对流式水蒸气热处理和临时植入式尼醇装置.
- 与TURP相比,所有评估的MIT都显示出更高的安全性.
- 水产生了与TURP相似的功能结果,PAE在改善功能结果方面排名第二.
结论:
- 确定了五种用于LUTS治疗的MIT,其中水化表现出与TURP最相似的功能结果.
- PAE作为一个强大的第二个选择出现了,值得注意的是不需要全身或脊髓麻醉.
- 虽然麻省理工学院提供了更好的安全性,但证据的低到非常低水平和高的研究异质性需要谨慎地解释结果.
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