首页良性前列腺增生治疗及预后证据详情

Safety and Feasibility of Outpatient Surgery in Benign Prostatic Hyperplasia: a Systematic Review and Meta-Analysis

原文:2021年 发布于 J Endourol 35卷 第4期 395-408 浏览量:634次 原文链接

作者: Salciccia S. Del Giudice F. Maggi M. Eisenberg M. L. Chung B. I. Conti S. L. Kasman A. M. Vilson F. L. Ferro M. Lucarelli G. Viscuso P. Di Pierro G. Busetto G. M. Luzi M. Sperduti I. Ricciuti G. P. De Berardinis E. Sciarra A.

作者单位: Department of Maternal Infant and Urologic Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy. Department of Urology, Stanford University School of Medicine, Stanford, California, USA. Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy. Department of Emergency and Organ Transplantation-Urology and Kidney Transplantation Unit, University of Bari, Bari, Italy. Department of Cardiovascular Surgery, Respiratory Medicine, Nephrology, Anesthesiology and Geriatrics, Policlinico Umberto I, Rome, Italy. Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy.

归属分类: 良性前列腺增生治疗及预后证据

DOI: 10.1089/end.2020.0538

关键词: Ambulatory Surgical Procedures Feasibility Studies Humans *Laser Therapy *Lasers Solid-State Male *Prostatic Hyperplasia/surgery *Transurethral Resection of Prostate Treatment Outcome *Green-light *HoLEP *Turp *benign prostatic hyperplasia *laser surgery *outpatient surgery

文献简介

Purpose: Most of the endourologic procedures along the urinary tract have been widely practiced as outpatient operations, including surgery for benign prostatic hyperplasia (BPH). This systematic review and meta-analysis was conducted to assess safety and feasibility of outpatient surgery for patients suffering from symptomatic BPH candidate for endoscopic disobstruction. Materials and Methods: PubMed, Web of Science, Cochrane, and Embase were searched up until March 30, 2020. Methodological index for nonrandomized studies (MINORS) tool was utilized to assess the quality of included studies, and a pooled measure of failure rate (FR) or event rate (ER) estimate was calculated. Further sensitivity analysis, subgroup analysis, and meta-regression were conducted to investigate contribution of moderators to heterogeneity. Results: Twenty studies with a total of 1626 patients treated according to outpatient criteria for endoscopic BPH surgery were included. In total, 18 studies reporting data on immediate hospital readmission and/or inability to discharge after endoscopic procedure presented FR estimates ranging from 1.7% to 51.1%. Pooled FR estimate was 7.8% (95% confidence interval [CI]: 5.2-10.3); Heterogeneity: Q = 76.85; degree of freedom = 17, p < 0.001; I(2) = 75.12%. Subgroup analysis according to surgical technique revealed difference among the three approaches with pooled FR of 3% (95% CI: 1-4.9), 7.1% (95% CI: 3.9-10.4), and 11.8% (95% CI: 7-16.7) for transurethral resection of the prostate, Green-light, and holmium laser vaporesection, respectively (p < 0.001). At meta-regression analysis, none of the retrieved covariates was able to significantly influence the cumulative outcomes reported. ER for postoperative complications and early outpatient visit showed a pooled estimate of 18.6% (95% CI: 13.2-23.9) and 7.7% (95% CI: 4.3-11), respectively. Conclusions: Our analysis revealed how transurethral procedures for BPH on an outpatient setting are overall reliable and safe. Of note, there were significant outcome differences between groups with regard to type of surgical procedure, perioperative prostate volume, and discharge protocol suggesting the need for further prospective analysis to better elucidate the best strategy in such outpatient conduct.

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