| 評 論 |
良性攝護腺增生（BPH）是50歲以上的中老年男性的普遍慢性疾病，會導致排尿和下尿路阻塞症狀。Rezūm®系統的水蒸氣消融治療（WVTT）是一種新型的微創外科技術，作為用來治療BPH的新方法。
此篇研究共納入了7篇觀察性研究和1項隨機對照試驗，共包括1015名患者。在成效方面，統計顯示以下幾項結果：
用水蒸氣消融治療後一年，
- 國際前列腺症狀評分(IPSS)降低了11.37分
- IPSS生活質量評分降低了2.59分
- 最大尿流率增加了5.26毫升/秒
- 殘尿減少了13.18毫升
在安全性方面，最常見的併發症是排尿困難，匯總發生率為21%，第二常見的併發症是血尿，匯總發生率為14%。再治療的匯總發生率為3%。
結論來說，水蒸氣消融治療（WVTT）可用作BPH男性的藥物治療或更侵入性手術的替代方案，甚至可以作為首選治療方法。
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| abstract |
Background
Benign prostatic hyperplasia (BPH) is a common chronic condition among men aged 50 or older, causing voiding and obstructive lower urinary tract symptoms. Water vapor thermal therapy (WVTT) using the Rezūm® system is a new minimally invasive surgical technique that is increasingly reported as a treatment for BPH.
Methods
The protocol was submitted to the PROSPERO registry. We searched PubMed, Web of Science, Embase, Cochrane Library and ClinicalTrials.gov up to July 29, 2022. Quality assessment was carried out by a 20-item checklist form prepared by the Institute of Health Economics (IHE). Double arcsine transformation was performed to stabilize the variance of the original ratio. When I2 > 50%, the random effect model was used to calculate the pooled parameters. Otherwise, the fixed effect model was used. 95% confidence intervals (CIs) were calculated. A leave-one-out sensitivity analysis was performed to evaluate the impact of each study on the pooled outcomes, and finally, Egger’s test was used to assess publication bias.
Results
A total of seven single-arm observational studies and one random controlled trial, including 1015 patients, were included. One year after WVTT, the International Prostate Symptom Score decreased by 11.37 (95% CI: -12.53, -10.21), the IPSS Quality of Life scale decreased by 2.59 (95% CI: -2.92, -2.26), the maximum urine flow rate increased by 5.26 ml/s (95% CI: 4.53, 5.99), and the postvoid residual decreased by 13.18 ml (95% CI: -24.32, -2.03). The most common complication was dysuria, with a pooled incidence of 21% (95% CI: 14%, 29%), and the second most common complication was hematuria, with a pooled incidence of 14% (95% CI: 10%, 18%). The pooled incidence of retreatment was 3% (95% CI: 2%, 5%).
Conclusions
WVTT is an attractive alternative to medication or more invasive surgical procedures and can serve as first-line therapy for men with BPH.
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