Ureteroscopic Minimally Invasive And Traditional Surgery For Urethral Injury:a Meta Analysis

Objective:Urethral injuries were divided into two types:open injury and closed injury,most of which were seen in men(97%).The urinary genital diaphragm was divided into the anterior and posterior segments.Urethral injury is a common emergency in urology.If not handled properly in the early stage,complications such as urethral stricture,urinary leakage and erectile dysfunction will occur.At present,many studies have shown that early endoscopic intervention can improve the effectiveness of treatment and reduce the incidence of complications,but the sample size is small.Some literatures have reached the opposite conclusion.In this study,meta analysis was used to further explore the feasibility of minimally invasive ureteroscopy in the treatment of urinary tract injury.Methods:Through computer retrieval,Cochrane Library,PubMed,EMBASE,VIP,CNKI,CBM and Wanfang Data were published on December 1,2019.Manually search the references of qualified articles.Two professional scholars independently carry out data extraction,selection and exclusion.Use Review Manager 5.3 and Stata 13.0 for data analysis.The combined effect was measured by odds ratio(or),95%confidence interval(CI)and standardized mean difference(SMD).Sensitivity analysis was used to explore the stability of the conclusion.The evaluation of publication bias of the literature was determined by egger linear regression method and Galbraith chart.Results:This meta-analysis included 14 articles and 839 cases of urinary tract injury.The therapeutic effectiveness of the two groups were compared:operation time(min),intraoperative bleeding volume(ML),hospitalization days(d)and three-month maximum urinary flow rate(MFR),The postoperative complications of the two groups were compared:postoperative bleeding,postoperative leakage of urine,postoperative infection,postoperative erectile dysfunction,postoperative urinary incontinence and postoperative stenosis.The results showed that ureteroscopic minimally invasive treatment group can reduce the operation time[SMD=-3.96(-5.09,-2.82),P<0.00001],reduce the amount of intraoperative bleeding[SMD=-4.60(-5.93,-3.27),P<0.00001],reduce the length of stay[SMD=-1.52(-1.82,-1.22),P<0.00001],but there was no significant difference in MFR after operation compared with the traditional treatment group[SMD=0.74(-0.10,1.59),P=0.09].The incidence of postoperative bleeding[OR=0.43(0.15,1.22),p=0.11],postoperative infection[OR=0.52(0.22,1.23),p=0.14],but postoperative urinary leakage[OR=0.23(0.09,0.71),p=0.002],postoperative erectile dysfunction[OR=0.17(0.09,0.35),p<0.00001],postoperative urinary incontinence[OR=0.11(0.04,0.34),The incidence of postoperative stenosis[OR=0.25(0.17,0.37),p<0.00001].Conclusion:Statins have no significant effect on the incidence of BPH,but statins can reduce the risk of BPH in patients over 60 years old.For patients with hyperlipidemia,more than one year of medication can slow down the progress of lower urinary tract symptoms.