Dehong Cao

A systematic review and meta-analysis of circumcision with Shang Ring vs conventional circumcision.

Herein, we conduct a systematic review and meta-analysis of the current evidence to compare the safety and efficacy of Shang Ring circumcision (SRC) with conventional circumcision (CC) for male patients. Articles were searched by 2 independent reviewers. Overall, 8 randomized controlled trials involving 3314 patients were included. Compared with the CC group, SRC is associated with shorter operative time, lower intraoperative pain score, higher satisfaction with penile appearances, less intraoperative blood loss, lower adverse event rate, and lower wound bleeding rate. SRC appears to be a safer and more effective choice in comparison with CC for male patients.

A comparison of nifedipine and tamsulosin as medical expulsive therapy for the management of lower ureteral stones without ESWL

Administration of nifedipine or tamsulosin has been suggested to augment stone expulsion rates. We aimed to compare the stone expulsion rates and adverse effects associated with the use of nifedipine or tamsulosin as medical expulsive therapy (MET) for the management of lower ureteral stones (LUS) without extracorporeal shock wave lithotripsy (ESWL) via a literature review and meta-analysis. Relevant randomized controlled trials (RCTs) were identified from the Medline, EMBASE, Cochrane CENTRAL, and Google Scholar databases. Finally, a total of 7 RCTs with 3897 patients were included. Our meta-analysis showed that tamsulosin could significantly increase the stone expulsion rate relative to nifedipine in patients with LUS (random-effects model; risk ratio [RR] = 0.81; 95% confidence interval [CI] = 0.75–0.88; P < 0.00001). The subgroup analysis indicated no statistically significant difference between the drugs with regard to minor or major adverse effects (fixed-effect model; RR = 1.19, 95% CI = 0.91–1.54, P = 0.20; and RR = 1.63, 95% CI = 0.22–11.82, P = 0.63, respectively). This meta-analysis demonstrated that tamsulosin was more effective than nifedipine in patients with LUS, as evidenced by the higher stone expulsion rate. Tamsulosin treatment should therefore be considered for patients with LUS.

The effect of statins on prostate cancer recurrence and mortality after definitive therapy: a systematic review and meta-analysis

In this work, we aim to further analyze the association of statins use with biochemical recurrence (BCR) of prostate cancer (PCa) and PCa-specific mortality after definitive therapy. A systematic literature search of PubMed, MEDLINE, and EMBASE through Jul 2015 was conducted. Pooled Hazard ratio (HR) estimates with corresponding 95% confidence intervals (CIs) were calculated using random-effects model. STATA version 10 (Stata corporation, college station, TX) was employed to conduct all statistical analyses. A total of 22 and 8 studies contributed to the biochemical recurrence analysis and PCa-specific mortality, respectively. 13 trials were included for BCR-free survival analysis. The combined result showed statins users had lowered 12% BCR risk of PCa compared with non-users (HR = 0.88, 95%CI: 0.765–0.998) (p < 0.05). The association was null among the men who underwent radical prostatectomy as primary therapy (HR = 0.96, 95%CI: 0.83–1.09), while the improved outcomes had be seen among patients who received radiation therapy (HR = 0.67, 95%CI: 0.48–0.86). After excluding the patients undergoing ADT, participants did not benefit from statins use (HR = 0.94, 95%CI: 0.77–1.11). Meanwhile, long-term statins using did not alter recurrence risk. A lower risk of prostate cancer-specific mortality was observed among statins users (HR = 0.68, 95%CI: 0.56–0.80). There was a plausible trend towards increasing the BCR-free survival rate among statins users.

Paraganglioma in the renal pelvis.

Paraganglioma is a rare tumor originating from the primitive neural crest, and can develop at many locations, such as the abdomen, aortic bifurcation, neck, pelvis, and thorax. However, the renal pelvis is an extremely rare location for paragangliomas to occur. Here, we report a case initially suspected to be a renal mass in a 59-year-old patient with paroxysmal hypertension, heart palpitation, and sweating. However, the mass was pathologically confirmed to be a paraganglioma in the renal pelvis. This report describes its rarity as well as its clinical and therapeutic characteristics. The patient, a 59-year-old Chinesewoman, had a 2-month history of paroxysmal hypertension, heart palpitation, and sweating. Her blood pressure measured 137/77 mmHg, and the remainingphysical examination resultswerenormalupon admission. Her blood metanephrine and normetanephrine levels were 322 ng/L and 632 ng/L, respectively, and other laboratory test results were normal. The left renal mass, measuring 4 cm in diameter, was detected by a computed tomographic (CT) scan without border differentiation, and enhanced CT results showed images of enhanced kidney only but not the mass. It was difficult, however, to determine the origin of the mass. The patient then underwent a preoperative preparationwith a and b blockers for 2weeks. During the surgery, we determined that both the mass and the left kidney had the same origin; therefore, radical excision of the left kidney and the tumor was performed. Paraganglioma in the renal pelvis was diagnosed pathologically, with Pan Cytokeratin (PCK) being negative, whereas synaptophysin, chromogranin A, and S-100 were positive immunohistochemically (Fig. 1). The patient’s postoperative recovery waswithout complications. During 3months of follow-up, her

Simple tumor enucleation may not decrease oncologic outcomes for T1 renal cell carcinoma: A systematic review and meta-analysis

OBJECTIVE To evaluate the clinical efficacy and safety of simple tumor enucleation (TE) for clinical T1 renal cell carcinoma. MATERIALS AND METHODS A systematic search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases was performed to identify all trials that compared TE and traditional partial nephrectomy (PN) for patients with clinical T1 renal cell carcinoma. RESULTS A total of 7 studies involving 3,218 patients were identified and included in this meta-analysis. Compared with the PN group, the TE group had significantly shorter estimated operation times (mean difference [MD] = -21.93; 95% CI: -31.07 to -12.78; P< 0.001), shorter warm ischemia times (MD = -1.96; 95% CI: -3.80 to -0.13; P = 0.04), less blood loss (MD = -36.63; 95% CI: -57.49 to -15.77; P = 0.0006), and lower surgical complication rates (odds ratio [OR] = 0.66; 95% CI: 0.47-0.92; P = 0.02). Furthermore, there was no significant difference between the 2 groups in hospital stay duration (MD = -0.46; 95% CI: -0.93 to 0.02; P = 0.06), changes in estimated glomerular filtration rate (MD = 3.35; 95% CI: -2.78 to 9.48; P = 0.28), positive surgical margin rates (OR = 0.34; 95% CI: 0.10-1.14; P = 0.08), and local recurrence rates (OR = 0.71; 95% CI: 0.24-2.06; P = 0.52). CONCLUSION Compared to traditional PN, TE is an effective and safe treatment for T1 renal tumors, and TE appears to have acceptable early oncology outcomes. Owing to the limited number of clinical trials and the predominantly retrospective data on this subject, there is a need for properly designed studies to confirm our findings.

Supine versus Prone Position during Extracorporeal Shockwave Lithotripsy for Treating Distal Ureteral Calculi: A Systematic Review and Meta-Analysis

Purpose: We aimed at evaluating the efficacy of extracorporeal shockwave lithotripsy (SWL) for treating distal ureteral calculi performed in supine vs. prone position. Materials and Methods: Eligible studies were identified by 2 reviewers using PubMed, Embase, and Web of Science databases. Outcomes included stone-free rate after the first and the final SWL session, the mean number of shocks per SWL session, the mean percentage of power used in the first SWL session, and the mean number of SWL sessions per patient. Results: Pooled data among the 647 included patients showed that supine SWL was associated with a significantly higher stone-free rate than prone SWL. This difference was consistent for both the first SWL session (OR 4.17; 95% CI 2.53-6.87; p < 0.00001) and the final session (OR 3.02; 95% CI 1.96-4.67; p < 0.00001). No differences in the mean number of shocks per SWL session, the mean percentage of power used in the first SWL session, and the mean number of SWL sessions per patient were observed between the positions. SWL complications were infrequent and the incidence was insufficient for further analysis. Conclusion: SWL is safe and effective for the management of distal ureteral calculi, and supine SWL is more effective than prone SWL for achieving a stone-free status.

The characteristics of circular disposable devices and in situ devices for optimizing male circumcision: a network meta-analysis

In situ device (ISD) and circular disposable device (CDD) are used for optimizing male circumcision (MC), but evidence to explore the characteristics of these two devices is insufficient. In order to explore this issue systematically and provide reliable evidence, ten published randomized controlled trials (RCTs) exploring the safety and efficacy of ISDs and CDDs were included (involving 4649 men). Moderate quality of the RCTs included was found after assessment. Pairwise meta-analyses and network meta-analyses were processed in stata 13.0 and AIDDS v1.16.6 respectively. According to the outcomes that were statistically significant in both pairwise and network meta-analyses, ISD was found to have less intraoperative blood loss (IB), less operative time (OT) and less incidence of wound bleeding (WB) than conventional circumcision (CC); ISD was found to have less WB but more wound healing time (WHT) than CDD; CDD was found to have less IB and less OT than CC. CDD tended to have the best wound healing condition and least pain experience; ISD tended to have the least IB, least OT, least WB, and highest satisfaction rate. With their own superiorities in many aspects, CDD and ISD are both safe and effective devices for optimizing MC.

Ureteral calculi combined with xanthogranulomatous pyelonephritis mimicking renal tuberculosis in a male child

Xanthogranulomatous pyelonephritis (XGP) is a severe, uncommon form of chronic inflammatory renal parenchymal infection, and it accounts for 0.6% of cases of histologically confirmed chronic pyelonephritis [1]. Xanthogranulomatous pyelonephritis occurs at any age, but ismore common among females, particularly middle-aged women [2]. Hendrickson et al. [3] report that it is very rare in children. A 14-year-old boy presented with a 6-month history of right flank pain, frequent urination, and intermittent hematuria and pyuria. At another hospital, he had previously been diagnosed as having right ureteral calculi and renal tuberculosis (TB). He was then treated with oral antiinflammatory and anti-TB drugs (e.g., isoniazid, rifampicin, and pyrazinamide). His condition gradually improved after 4 weeks. However, he subsequently presented to our institution with hematuria and pyuria that had been progressively worsening for 2 days. On examination, he had a low-grade fever (37.5 C). Blood analysis revealed an elevated leukocyte count (11.2 10/L) and a decreased hemoglobin level (95 g/L). Urinalysis showed hematuria and the presence of leukocytes (24 cells per high-powered field). A urine culture showed a bacterial count of >10,000/mL and an erythrocyte sedimentation rate (ESR) of 24 mm/hour. Purified protein derivative (PPD) testing and acid-fast staining of urinary sediment yielded positive results. Ultrasonography and computed tomography (CT) showed right ureteral calculi combined with renal TB (Fig. 1A). Single-photon emission CT indicated a nonfunctioning right kidney. The right kidney and right upper ureter were resected and a taupe-colored stone was detected. Postoperative

Author Correction: Microsatellite analysis for differentiating the origin of renal angiomyolipoma and involved regional lymph node

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.

The Efficiency and Safety of Intrarectal Topical Anesthesia for Transrectal Ultrasound-Guided Prostate Biopsy: A Systematic Review and Meta-Analysis

Objective: The study aims to review the current evidence to determine the efficiency and safety of intrarectal topical anesthesia (ITA) for transrectal ultrasound-guided prostate biopsy. Materials and Methods: A comprehensive search of the literature was performed using Medline, Embase and Cochrane central register of controlled trials. All randomized controlled trials (RCTs) comparing the efficacy and safety of periprostatic nerve block (PNB), ITA, and PNB combined with ITA were included. The mean pain scores after the biopsy procedure, the mean pain scores after the probe insertion and adverse events were evaluated. Results: Thirty-2 RCTs were identified in the meta-analysis. ITA could significantly reduce pain during probe insertion compared to control and placebo. The PNB group had less pain after the prostate biopsy than the ITA group. PNB combined with ITA could significantly reduce pain during the biopsy procedure compared to ITA alone. No significant differences were found in adverse events in ITA versus control, ITA versus placebo, and ITA versus PNB. Conclusions: ITA could reduce pain after probe insertion and pain after biopsy although it was inferior to PNB in reducing pain during prostate biopsy. ITA combined with PNB was more effective than ITA alone. In addition, it was safe to perform ITA for prostate biopsy.