Effect of testosterone replacement therapy on lower urinary tract symptoms: A systematic review and network meta-analysis

IF 3.6 2区医学 Q1 MEDICINE, GENERAL & INTERNAL Journal of Evidence‐Based Medicine Pub Date : 2024-07-14 DOI:10.1111/jebm.12628

Xiang Yuan, Xingyu Xiong, Jianxin Xue

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Abstract

Objective

In this study, we aimed to perform a network meta-analysis (NMA) to investigate the effects of different testosterone replacement therapy (TRT) administration routes on lower urinary tract symptoms (LUTS) in aging men with late-onset hypogonadism (LOH).

Methods

A systematic search of PubMed, Embase, The Cochrane Library, CNKI, WanFang Data, and VIP was conducted to identify randomized controlled trials (RCTs) reporting data on International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA) level, or prostate volume. NMA was performed, and subgroup analysis was conducted to assess the impact of TRT duration on outcomes.

Results

A total of 21 RCTs involving 2453 participants were included. For pairwise meta-analysis, p values for TRT delivered by transdermal, intramuscular, and oral routes were as follows: IPSS: 0.93, 0.20, and 0.76; PSA level: 0.20, 0.27, and 0.98; prostate volume: 0.18, 0.04, and 0.16. There were no significant differences in IPSS, PSA level, or prostate volume between TRT routes. In subgroup analysis, long-term intramuscular TRT significantly decreased IPSS (p = 0.03), short-term transdermal TRT increased PSA levels (p < 0.001), and short-term intramuscular TRT increased the prostate volume (p = 0.04). Other forms of TRT showed no significant change in IPSS, PSA level, and prostate volume compared with the placebo. Indirect comparison of the three administration routes demonstrated no significant differences in IPSS, PSA level, and prostate volume. Nevertheless, surface under the cumulative ranking curve analysis indicated that intramuscular TRT had an 83% probability of being the best method for decreasing IPSS.

Conclusions

The results demonstrate that TRT does not worsen LUTS regardless of the administration route. Intramuscular TRT may be the preferred treatment for aging men with LOH and LUTS. Intramuscular TRT may be the preferred treatment for men with LOH and LUTS. Further research is warranted to validate these findings and optimize TRT management strategies.

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睾酮替代疗法对下尿路症状的影响：系统综述和网络荟萃分析。

研究目的本研究旨在进行网络荟萃分析（NMA），探讨不同睾酮替代疗法（TRT）给药途径对晚发性腺功能减退症（LOH）老年男性下尿路症状（LUTS）的影响：对PubMed、Embase、The Cochrane Library、CNKI、万方数据和VIP进行了系统检索，以确定报告了国际前列腺症状评分（IPSS）、前列腺特异性抗原（PSA）水平或前列腺体积数据的随机对照试验（RCT）。进行了NMA和亚组分析，以评估TRT持续时间对结果的影响：结果：共纳入了 21 项 RCT，涉及 2453 名参与者。在配对荟萃分析中，通过透皮、肌肉注射和口服途径进行 TRT 的 p 值如下：IPSS：0.93、0.20 和 0.76；PSA 水平：0.20、0.27 和 0.98；前列腺体积：0.18、0.04 和 0.16。不同 TRT 途径的 IPSS、PSA 水平或前列腺体积没有明显差异。在亚组分析中，长期肌肉注射 TRT 可明显降低 IPSS（p = 0.03），短期透皮 TRT 可提高 PSA 水平（p 结论：TRT 对前列腺的影响并不明显：研究结果表明，无论通过何种给药途径，TRT 都不会加重 LUTS。肌肉注射 TRT 可能是患有 LOH 和 LUTS 的老年男性的首选治疗方法。肌肉注射 TRT 可能是 LOH 和 LUTS 男性患者的首选治疗方法。为了验证这些发现并优化TRT管理策略，我们有必要开展进一步的研究。

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来源期刊

Journal of Evidence‐Based Medicine MEDICINE, GENERAL & INTERNAL-

CiteScore

11.20

自引率

1.40%

发文量

期刊介绍： The Journal of Evidence-Based Medicine (EMB) is an esteemed international healthcare and medical decision-making journal, dedicated to publishing groundbreaking research outcomes in evidence-based decision-making, research, practice, and education. Serving as the official English-language journal of the Cochrane China Centre and West China Hospital of Sichuan University, we eagerly welcome editorials, commentaries, and systematic reviews encompassing various topics such as clinical trials, policy, drug and patient safety, education, and knowledge translation.