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The Systematic Review of Simultaneous Transurethral Resection of Non-Muscle Invasive Bladder Tumor and Benign Prostate Hyperplasia

Author: LuoShengJun
Tutor: ZhangWeiLi
School: Chongqing Medical University
Course: Surgery
Keywords: non-muscle invasive bladder cancer benign prostate hyperplasia simultaneous operation recurrence meta-analysis
CLC: R737.14
Type: Master's thesis
Year: 2011
Downloads: 41
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Abstract

ObjectiveTo evaluate the recurrence and progression rate of simultaneous transurethral resection in the treatment of non-muscle invasive bladder cancer (NMIBC) with benign prostatic hyperplasia (BPH) using the method of evidence based medicine.MethodsSystematic review of the published data from random controlled trail (RCT) or comparative studies on simultaneous transurethral resection of bladder tumor and transurethral resection of the prostate (TURBT and TURP) versus TURBT alone in the treatment of NMIBC with BPH. Following the predefined standards to select studies and perform quality assessment of involved studies, and combined analysis of extraction data using Meta-analysis. The endpoint were overall recurrence rate、recurrence rate in bladder neck or prostatic fossa、progression rate and the mean elapsed time to recurrence in the maximum follow-up period. Odds ratio (OR) and 95% confidence intervals (CI) were used as the primary effect size to estimate the outcomes.Results9 clinical trials were eligible, 6 in English, 3 in Chinese, 2 was RCT, 7 was case-control study. Totally 1257 patients were involved, 643 patients were treated with simultaneous resection and 614 with TURBt alone. Within the follow-up period, 39.3%(253/643)of patients in the simultaneous group and 49.1%(302/614)of the patients in the control group developed tumor recurrence, the combined analysis showed the recurrence of simultaneous group statistically significant lower than control group in the overall pooled data (OR 0.68,95%CI 0.53～0.85); 6.4%(41/643) patients in simultaneous group and 7.3%(45/614) patients in control group developed tumor recurrence in bladder neck/prostatic fossa, no statistically significant was found in two groups (OR 0.92,95%CI 0.58～1.45). 5 studies reported the progression rate, 7.6%(21/277) patients in simultaneous group and 7.7%(22/284) patients in control group developed tumor progression, no statistically significant was found in two groups (OR 0.98,95%CI 0.52～1.84). 5 reported the mean elapsed time to recurrence, meta-analysis showed the elapsed time to recurrence of simultaneous group was longer than control group(OR 1.05,95%CI 0.59～1.52). Analysis of confounding factors and based characters showed the mean age of simultaneous group higher than control group, mean follow-up time was longer in simultaneous group, no statistically significant was found. Constituent ratios of low grade/high grade tumor and single/multiple tumor was no statistically significant. Sensitivity analysis showed good stability and strength.ConclusionThe evidence from this formal meta-analysis suggests that simultaneous TURBt and TURP have decreased the incidence of overall tumor recurrence rate and elapsed time to recurrence, while no effect on incidence of implantation in bladder neck/prostatic fossa and progression rate. For limitation of our study, large sample、multiple center and high quality RCTs are needed to prove the conclusion and select the patients.

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CLC: > Medicine, health > Oncology > Genitourinary tumors > Urinary tumors > Bladder tumor
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