ObjectiveTo systematically review the association between 5α-reductase inhibitors (5ARIs) and risk of sexual dysfunction in subjects with benign prostatic hyperplasia (BPH).MethodsPubMed, Web of Science, The Cochrane Library, EMbase, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect studies on the association between 5ARIs and risk of sexual dysfunction in subjects with BPH from inception to October 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed by using Stata 12.0 software.ResultsA total of 15 studies involving 17 774 subjects were included. The results of the meta-analysis showed that compared with the placebo group, 5ARIs could significantly increase risk of erectile dysfunction (RR=1.52, 95%CI 1.36 to 1.69, P<0.000 1), while decrease libido (RR=1.79, 95%CI 1.37 to 2.32, P<0.000 1) and ejaculation disorder (RR=2.97, 95%CI 1.82 to 4.83, P<0.000 1) in subjects with BPH. Subgroup analysis of the type of 5ARIs, intervention period, publication year and sample size showed that the 5ARIs had a higher risk of sexual dysfunction than the placebo group.ConclusionsCurrent evidence shows that 5ARIs can increase risk of erectile dysfunction, decrease libido and ejaculation disorder in subjects with BPH. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.
Objective To evaluate the effect of pretreatment with epristeride on decreasing intraoperative bleeding during transurethral resection of prostate (TURP) and to study its mechanism. Methods A total of 60 patients with benign prostatic hyperplasia undergoing TURP were divided into two groups: 30 patients were pretreated with epristeride 5 mg×2 daily for 7 to 11 days before TURP, and 30 patients did not receive any pretreatment. The operations for the two groups of patients were conducted by the same doctors. The operation time, the weight of resected prostatic tissue, and the volume of irrigating fluid were recorded. Blood loss, bleeding index, and bleeding intensity were calculated. Microvessel density (MVD), vascular endothelial growth factors (VEGF), and nitric oxide synthase type III (eNOS) expression were measured by the immunohistochemistry SPmethod in prostatic tissue. Results In the epristeride and control groups, the mean blood loss was 179.51±78.29 ml and 237.95±124.38 ml (Plt;0.05); the mean bleeding index was 7.68±3.94 ml/g and 9.73±3.42 ml/g (Plt;0.05); the mean bleeding intensity was 2.43±1.03 ml/min and 3.30±1.50 ml/min (Plt;0.05); the mean value of MVD was 18.80±5.68 and 23.70±4.91 (Plt;0.05); the mean rank of VEGF was 23.48 and 31.77 (Plt;0.05); and the mean rank of eNOS was 22.36 and 31.14 (Plt;0.05), respectively. Conclusion Pretreatment with epristeride decreases intraoperative bleeding during TURP. The preliminary results suggest that angiogenesis in the prostatic tissue is suppressed.
Objective To assess the efficacy of finasteride in treating perioperative bleeding in patients undergoing transurethral resection of the prostate (TURP). Methods We searched MEDLINE (1966 to 2005), EMBase (1984 to 2004), CBM (1980 to 2005), The Cochrane Library (Issue 4, 2005) and relevant journals to identify cl inical trials involving finasteride in patients undergoing TURP. We also checked the references in the reports of each included trial. The qual ity of randomized controlled trials (RCTs) was assessed according to the methods recommended by The Cochrane Collaboration, and the qual ity of non-RCTs was assessed based on the methods recommended by Jiang-ping Liu, Stroup and Hailey. Two reviewers extracted data independently and data analyses were conducted with The Cochrane Collaboration’ s RevMan 4.2. Result We included 4 RCTs and 1 non-RCT. The qual ity of 3 RCTs was graded C and the other one was graded B. The quality of the non-RCT was relatively high. Meta-analyses showed that with comparable age, international prostate symptom score, prostate specific antigen, preoperative volume of prostate and excision volume between the two groups (Pgt;0.05), the perioperative bleeding volume (WMD –85.44, 95%CI –117.31 to –53.58), the bleeding volume per gram of resected prostate tissue (WMD –3.5, 95%CI –6.34 to –0.58) and hemoglobin reduction (WMD –1.61, 95%CI –1.96 to –1.26) of the finasteride group were significantly smaller than those of the control group. Conclusion The evidence currently available indicates that preoperative use of finasteride may reduce bleeding in patients undergoing TURP.
【摘要】 目的 探討經尿道超脈沖等離子體腔內逆行剜除汽化切除術治療良性前列腺增生的有效性和安全性。 方法 2008年4月－2009年4月，應用Gyrus超脈沖等離子體行經尿道前列腺腔內逆行剜除汽化切除術124例，前列腺重量為（62.3±21.7） g。術中首先用電切鏡鞘、電切環鈍銳性相結合將前列腺增生腺體沿外科包膜逆行剝離、剜除，同時斷血供，然后推至膀胱頸處后切除。統計手術時間、術中出血量及收集到的前列腺組織質量，術后留置尿管時間、住院時間、手術后前列腺特異性抗原（prostatic specific antigen，PSA）、殘余尿量（post voiding residual volume，PVR）、最大尿流率（Qmax）、國際前列腺癥狀評分（international prostatic symptom scores，IPSS）及生活質量評分（quality of life，QOL）等指標的變化。 結果 124例手術順利完成。手術時間（48.1±19.4） min，腺體組織質量（57.6±19.6） g，平均失血量（86.2±20.7） mL，僅1例需要輸血，出血量和手術時間隨前列腺體積和重量的增加而相應增加和延長。術后留置尿管時間（3.1±1.6） d，住院時間（5.8±1.4） d。隨訪6～18個月，所有患者術后1、6個月Qmax、PVR、IPSS、QOL均較術前得到改善，與術前比較差異均有統計學意義（Plt;0.05）。術后6個月血清PSA降至（0.90±0.26） ng/mL，與術前比較差異有統計學意義（Plt;0.05）。繼發尿道外口狹窄3例，經尿道擴張治療后恢復排尿通暢；繼發尿失禁2例，經保守治療分別于術后1～6個月恢復；無永久性尿失禁、再次手術止血患者，無手術死亡者，未發生經尿道前列腺電切綜合征。 結論 經尿道超脈沖等離子體腔內逆行剜除汽化切除術治療良性前列腺增生安全有效，值得臨床推廣使用。【Abstract】 Objective To evaluate the safety and clinical efficacy of superpulse plasmakinetic body in transurethral intracavitary retrograde enucleation and vaporization resection of the prostate (TUEVRP) for the treatment of benign prostatic hyperplasia (BPH). Methods Between April 2008 and April 2009, Gyrus TUEVRP was performed on 124 patients with obstructive BPH whose mean prostatic weight was (62.3±21.7) g. The hyperplasia prostate glands were retrogradely dissected and enucleated along surgical capsule to the bladder neck by sharp and blunt dissection combination of the resectoscope tip or loop. Simultaneously, the blood supply of the gland was clamped. The changes of such indexes as operating time, perioperative blood loss, collected prostatic specimen weight, postoperative catheterization time, hospitalization time, prostatic specific antigen (PSA), post voiding residual volume (PVR), maximum urinary flow rate (Qmax), international prostatic symptom score (IPSS), and quality of life (QOL) were assessed. Results All surgeries were successfully carried out with an average operation time of (48.1±19.4) minutes ranged from 25 to 175 minutes. The mean collected prostatic specimen weight was (57.6±19.6) g ranged from 20.2 to 125.7 g. The blood loss was ranged from 45 to 350 ml, averaging at (86.2±20.7) mL during the operation. Blood transfusion was needed in only one case. Blood loss and operation time were increased and prolonged in accordance with the increase of prostatic volume and weight. The postoperative catheterization time was ranged from 2 to 5 days, averaging at 3.1±1.6. The mean hospitalization time was (5.8±1.4) days ranged from 5 to 8 days. All patients were followed up for 6 to 18 months. Qmax, PVR, IPSS and QOL-score six months after operation were significantly improved compared with those before operation (Plt;0.05). There were three cases of external urethral stricture, and they were treated with urethral dilatation successfully. Two cases of urinary incontinence recovered 1 and 6 months later, respectively, by traditional treatment. There were no cases of permanent urinary incontinence, reoperation for hemostasis, operative death, or transurethral resection syndrome. Conclusion TUEVRP is safe and clinically efficacious in the treatment of BPH, and is worthy of clinical promotion.
【摘要】 目的 探討良性前列腺增生癥（benign prostatic hyperplasia，BPH）應用經尿道前列腺普通電切鏡剜除術（transurethral electro enucleation of the prostate，TUEP）的方法及療效。 方法 2007年12月－2010年7月，應用TUEP治療BPH患者201例，并根據前列腺腺體的大小及形狀的不同采用不同的剜除方法以提高手術的成功率。 結果 全部患者均順利完成手術，切除前列腺重量平均38 g，平均手術時間100 min，術后平均留置導尿管時間5~7 d，術后平均住院時間5.5 d。 結論 TUEP是治療良性前列腺增生癥的一種有效方法。【Abstract】 Objective To evaluate the therapeutic effect of transurethral enucleation of prostate on benign prostatic hyperplasisa. Methods From December 2007 to July 2010, 201 patients with benign prostatic hyperplasia underwent transurethral enucleation. According to the size and shape of the gland, different enucleation ways were used to improve the surgical success rate. Results All of the enucleations were successful. The average weight of the resected prostate was 38 grams, the mean operation duration was 100 minutes, the average days of indwelling catheter was 5-7 days, and the average hospital staying was 5.5 days. Conclusion Transurethral enucleation of prostate for benign prostatic hyperplasia is effective.
ObjectiveTo assess the methodological and reporting quality of systematic reviews/Meta-analyses (SRs/MAs) of transurethral procedure for benign prostatic hyperplasia (BPH).
MethodWe electronically searched databases including PubMed, The Cochrane Library (Issue 12, 2014), Sciverse, CNKI, VIP and WanFang Data from inception to December 2014 to collect SRs/MAs of transurethral procedure about BPH. Two reviewers independently screened literature and assessed the methodological and reporting quality of included SRs/MAs by AMSTAR and PRISMA checklists.
ResultsA total of 33 SRs/MAs were included. The results of qualitative analysis showed that:the main methodological weakness of included SRs/MAs included the lack of protocol, disappropriate conclusion formulation, the lack of publication bias assessment, and the lack of stating the conflict of interest. The average score of AMSTAR scale was 6.27±2.14. There were 11 items in PRISMA checklist with coincidence rate over 80%, 8 items between 50% to 80%, and 8 items less than 50%.
ConclusionThe methodological and reporting quality of SR/MA of transurethral procedure for BHP is low, and that may decrease the reliability and value of results from SRs/MAs in the field. Future SRs/MAs should strictly follow the related reporting guidelines in order to improve the methodological and reporting quality, so as to provide more reliable evidence for clinical decision.
