医学
荟萃分析
置信区间
科克伦图书馆
子群分析
外科
系统回顾
下尿路症状
梅德林
内科学
泌尿科
前列腺
癌症
政治学
法学
作者
Stefano Salciccia,Francesco Del Giudice,Martina Maggi,Michael L. Eisenberg,Benjamin I. Chung,Simon Conti,Alex M. Kasman,Fernandino L. Vilson,Matteo Ferro,Giuseppe Lucarelli,Pietro Viscuso,G. Di Pierro,Gian Maria Busetto,Marta Luzi,Isabella Sperduti,Gian Piero Ricciuti,Ettore De Berardinis,Alessandro Sciarra
出处
期刊:Journal of Endourology
[Mary Ann Liebert]
日期:2021-04-01
卷期号:35 (4): 395-408
被引量:21
标识
DOI:10.1089/end.2020.0538
摘要
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; I2 = 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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