Three Strategies for Glandular Cystitis: Efficiency and Safety Based on Network Meta-Analysis

Objective This network meta-analysis was conducted to assess the efficiency and safety of transurethral resection alone and postoperative chemotherapeutics bladder irrigation for glandular cystitis. Method We searched databases including PubMed, MEDLINE , Cochrane Library, CNKI and CBM to enroll all available randomized controlled trials （RCTs）about the effects of transurethral resection alone （TUR）, postoperative irrigation of bladder with Pirarubicin （TUR+THP） or Mitomycin （THP+MMC） for glandular cystitis. The cure rate, overall response rate （ORR）, recurrence rate and adverse effects rate were set to be the outcomes. ADDIS software was adopted to achieve the network meta-analysis. Result 22 RCTs with 1 544 patients were enrolled. There was no significant inconsistence between direct and indirect evidence. TUR+THP and TUR+MCC were proved superior to TUR in cure rate and ORR. TUR+THP was found to be the better choiceOR_{cure rate}=1.63, 95%CI（1.10,2.46）; OR_ORR=1.79, 95%CI（1.10,3.07）. Postoperative chemotherapeutics bladder irrigation significantly reduced the recurrence rate OR_TUR+MMC=0.26, 95%CI（0.14,0.49）; OR_TUR+THP=0.14, 95%CI（0.07, 0.25）. The difference of adverse effects rate was not statistically significant among three treatments. Conclusion Based on available evidence, the rank of cure rate and overall response rate was TUR+THP, TUR+MMC, TUR. Postoperative chemotherapeutics bladder irrigation significantly reduced the recurrence rate. However, there were no significant differences for three therapies in terms of adverse effects rate. The confidence of this network meta-analysis needs to be further confirmed by future large, high quality RCTs.