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Erectile Function Following Surgery for Benign Prostatic Obstruction: A Systematic Review and Network Meta-analysis of Randomised Controlled Trials

原文:2021年 发布于 Eur Urol 80卷 第2期 174-187 浏览量:292次 原文链接

作者: Light A. Jabarkhyl D. Gilling P. George G. Van Hemelrijck M. Challacombe B. Malde S. Popert R. Dasgupta P. Elhage O.

作者单位: Department of Surgery, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. Faculty of Life Sciences and Medicine, King's College London, London, UK. Department of Urology, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand. Translational Oncology & Urology Research, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK. Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK. Faculty of Life Sciences and Medicine, King's College London, London, UK Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK. Electronic address: prokar.dasgupta@kcl.ac.uk. Faculty of Life Sciences and Medicine, King's College London, London, UK Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.

归属分类: 良性前列腺增生治疗及预后证据

DOI: 10.1016/j.eururo.2021.04.012

关键词: *Erectile Dysfunction/etiology Humans *Lower Urinary Tract Symptoms/diagnosis/etiology/surgery Male Network Meta-Analysis *Prostatic Hyperplasia/complications/surgery *Transurethral Resection of Prostate *Benign prostatic hyperplasia *Benign prostatic obstruction *Ejaculation *Ejaculatory dysfunction *Erectile dysfunction *Erectile function *International Index of Erectile Function-5 *Network meta-analysis *Prostatic urethral lift *Sexual function

文献简介

CONTEXT: Benign prostatic obstruction (BPO) is associated with sexual dysfunction. Furthermore, numerous BPO interventions may themselves impact sexual function. OBJECTIVE: To perform a systematic review with network meta-analysis to evaluate how BPO interventions affect erectile function. EVIDENCE ACQUISITION: Three databases were searched for randomised controlled trials (RCTs) comparing surgical interventions for BPO. The primary outcome was postoperative International Index of Erectile Function-5 (IIEF-5) score at ten time points up to 72 mo. A random-effects Bayesian network meta-analysis with meta-regression was performed. In comparison to monopolar transurethral resection (mTURP), the mean difference (MD) with 95% credible interval (CrI) and rank probability (rank p) were calculated for interventions. The mean baseline score was studied in meta-regression. τ(2) values were used to quantify heterogeneity. EVIDENCE SYNTHESIS: A total of 48 papers (33 RCTs, 5159 patients, 16 interventions) were included. Prostatic urethral lift (PUL) ranked highest at 1 mo (MD 3.88, 95% CrI -0.47 to 8.25; rank p = 0.742), 6 mo (MD 2.43, 95% CrI -0.72 to 5.62; rank p = 0.581), 12 mo (MD 2.94, 95% CrI -0.26 to 6.12, rank p = 0.782), and 24 mo (MD 3.63, 95% CrI 0.14 to 7.11; rank p = 0.948), at which point statistical significance was reached. At time points up to 60 mo, there were no statistically significant comparisons for other interventions. Analyses were not possible at 18, 48, or 72 mo. β did not reach statistical significance in meta-regression. τ(2) was highest at 1 mo (0.56) and 60 mo (0.55). CONCLUSIONS: PUL ranked highly and resulted in erectile function improvement at 24 mo compared to mTURP, but direct evidence is lacking. We did not observe significant differences in erectile function following other interventions up to 60 mo. Owing to heterogeneity, our conclusions are weakest at 1 and 60 mo. Further RCTs comparing sexual function outcomes are recommended, such as PUL versus holmium laser or bipolar enucleation. PATIENT SUMMARY: Different surgical treatments can be used to treat benign enlargement of the prostate causing urinary problems. We compared the effects of various treatments on erectile function at time points up to 5 years after surgery. Compared to surgical removal of some of the prostate gland (transurethral resection of the prostate, TURP), a technique called prostatic urethral lift resulted in better erectile function scores at 24 months. However, other treatments did not differ in their effect on erectile function.

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