Yin Tang

Assessing the Impact of Barbed Suture on Vesicourethral Anastomosis During Minimally Invasive Radical Prostatectomy: A Systematic Review and Meta-analysis

OBJECTIVE To examine the effectiveness of barbed suture (BS) compared with conventional sutures for vesicourethral anastomosis (VUA) during minimally invasive radical prostatectomy (RP). METHODS Relevant studies comparing the safety and efficacy of BS with conventional sutures during minimally invasive RP were identified through a literature search using MEDLINE, EMBASE, and the Cochrane Library. The outcome measures included baseline characteristics, primary outcomes, and secondary outcomes. RESULTS Ten studies (378 cases and 369 controls) were included. No significant differences between the 2 groups were detected in any of the baseline variables except for age (P = .02). The BS group had a shorter operation time (mean difference [MD], 10.54; 95% confidence interval [CI], -14.38 to -6.69; P <.01), a shorter VUA time (MD, -5.35; 95% CI, -7.44 to -3.25; P <.01), and a shorter posterior reconstruction time (MD, -0.56; 95% CI, -1.10 to -0.02; P = .04) than those in the conventional sutures group. No significant differences were detected between the 2 groups in other outcomes of interest. In subgroup and sensitivity analyses, there was no change in the significance of any of the outcomes. CONCLUSION This meta-analysis indicates that VUA using BS as opposed to conventional suture is associated with a shorter operative time, comparable postoperative complication rate, and convenience for manipulation, which is of benefit to the surgeon learning robot-assisted RP and laparoscopic RP. Given that the inherent limitations, future well-designed randomized controlled trials are required to confirm our findings.

Relationship between bladder cancer and total fluid intake: a meta-analysis of epidemiological evidence.

ObjectivesEpidemiological findings regarding the association between total fluid intake and bladder cancer risk have yielded varying results. Our objective is to examine the possible associations between total fluid intake and bladder cancer risk.MethodsDatabases searched include the EMBASE and PUBMED, from inception to February 2014, with no limits on study language. We also reviewed the reference lists of identified studies. Stratified analyses were performed. A random-effect model was used to summarize the estimates of odds ratio (OR) with 95% confidence intervals (CI).ResultsOverall,17 case-control and four cohort studies were included. The overall OR of bladder cancer for the highest versus the lowest fluid intake was 1.06 (95% CI: 0.88-1.27). In the subgroup analyses, the overall ORs for coffee, green, and black tea intake were 1.17 (95% CI: 1.03-1.33), 0.76 (95% CI: 0.66-0.95), and 0.80 (95% CI: 0.65-0.97), respectively. A significantly decreased risk was observed in Asian people (OR 0.27; 95% CI: 0.10-0.72). Among smokers, a suggestive inverse association was observed between total fluid intake and overall bladder cancer risk (OR 0.80; 95% CI: 0.62-1.02).ConclusionsAlthough this meta-analysis suggested that greater consumption of fluid may have a protective effect on bladder cancer in Asian people, there was no convincing evidence on this association because of the limitations of the individual trials.

Phosphodiesterase type 5 inhibitors for the treatment of post-nerve sparing radical prostatectomy erectile dysfunction in men

Prostate cancer (PCa) is the most common solid neoplasm diagnosed in developed countries. Nerve-sparing radical prostatectomy (NS-RP) has been widely accepted as the best choice treatment for localised PCa. However, erectile dysfunction (ED) and urinary incontinence are commonly observed after NS-RP. Using meta-analysis, we examined if phosphodiesterase type 5 inhibitors (PDE5-Is) could improve the symptoms of ED in patients undergoing NS-RP. This review contained seven randomised placebo-controlled trials with a total of 2,655 male patients. Patients in PDE5-Is group showed significant improvement in the International Index of Erectile Function-Erectile Function domain score (IIEF-EF), Global Assessment Questionnaire (GAQ), Sexual Encounter Profile question 2 (SEP-2) and SEP-3. Although the incidence of treatment-emergent adverse events (TEAEs) were high in both groups (56.44% vs. 40.63%), the safety profile were acceptable, with low incidence of discontinuation rate due to adverse events. Therefore, PDE5-Is are recommended for the treatment of post-NS-RP ED. Patients should be informed of possible adverse events.

Safety and efficacy of transurethral laser therapy for bladder cancer: a systematic review and meta-analysis

BackgroundTransurethral laser therapy techniques are increasingly being used in the management of bladder tumors. It has reportedly been associated with good outcomes in small case series. The objective of the present study was to review the published literature and compare transurethral laser therapy for non–muscle-invasive bladder cancer (NMIBC) and conventional transurethral resection of bladder tumor (TURBT).MethodsWe performed a systematic review and meta-analysis based on randomized controlled trials (RCTs) and controlled clinical trials (CCTs) to assess the two techniques. The eligible RCTs and CCTs were identified in the following electronic databases: PubMed, the Cochrane Central Register of Controlled Trials and Embase.ResultsSeven studies were included in this systematic review. The baseline characteristics of these studies are comparable. We found no statistical difference between the two techniques regarding operative time. The intra- and postoperative complications showed that the laser procedure was better than TURBT for NMIBC, including obturator nerve reflex, bladder perforation, bladder irrigation rate, duration of catheterization and length of hospital stay. In addition, the 2-year recurrence-free survival improved in the laser group than in the TURBT group.ConclusionsOur systematic review and meta-analysis suggests that laser techniques are feasible, safe, effective procedures that provide an alternative treatment for patients with NMIBC. Given that some limitations cannot be overcome, well-designed RCTs are needed to confirm our findings.

Management of Catheter-Related Bladder Discomfort in Patients Who Underwent Elective Surgery

OBJECTIVE Despite the various treatment and prevention options for catheter-related bladder discomfort (CRBD), many uncertainties persist in clinical practice. To systematically review the literature on the management of CRBD in patients who underwent surgery. MATERIALS AND METHODS Eligible, randomized controlled trials were identified from electronic databases (Cochrane Central Register of Controlled Trials, Medline, and EMBASE) without language restrictions. Selection criteria, methodological rigor, and risk of bias were evaluated by two independent reviewers using Cochrane Collaborations tools. RESULTS A total of 1441 patients from 14 articles published between 2005 and 2014 were included. Data heterogeneity precluded meta-analysis; therefore, data were synthesized narratively. Compared with nonurological surgery, CRBD is frequent and occurred immediately after urological surgery, especially after transurethral resection of the bladder tumor (TURBT). Data from included studies suggested that muscarinic antagonists, anesthetics, antiepileptics, and analgesics were associated with significant improvement in symptoms and reducing the incidence of CRBD, compared with placebo. Anticholinergic agents and antiepileptics (gabapentin and pregabalin) administered 1 hour before surgery reduced the incidence and severity of CRBD in the immediate postoperative period. Tramadol and ketamine are centrally acting opioid analgesics with antimuscarinic actions, which effectively prevent CRBD when administered intravenously. Paracetamol administered was also effective for the management of CRBD. Additionally, we perceived that TURBT is the surgical procedure that is the most refractory to treatment. CONCLUSIONS Muscarinic antagonists, anesthetics, antiepileptics, and paracetamol appear to achieve the greatest improvement in the clinical symptoms and a significant reduction in the incidence of CRBD compared with placebo. Although these studies observed a high incidence of intervention-related side effects, in general, patients tolerated these treatments well.

Selective Serotonin Reuptake Inhibitors Plus Phosphodiesterase-5 Inhibitors for Premature Ejaculation: A Systematic Review and Meta-analysis.

OBJECTIVE To evaluate the efficacy and safety of combination therapy with selective serotonin reuptake inhibitors (SSRIs) and phosphodiesterase-5 (PDE-5) inhibitors for the treatment of premature ejaculation (PE). METHODS A systematic search of EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews was undertaken to identify articles that referred to the use of a combination of SSRIs and PDE-5 inhibitors for the treatment of PE. A meta-analysis of these clinical studies was performed. The post-treatment intravaginal ejaculatory latency time (IELT) and adverse events (AEs) were used in this meta-analysis. RESULTS Six publications involving 971 patients were included in the meta-analysis. In the analysis, we found significantly improved IELT in the combination use group compared with the use of SSRIs (mean differences [MD], 1.01; 95% confidence interval [CI], 0.61-1.41; P <.01) or PDE-5 inhibitors alone (MD, 1.11; 95% CI, 0.79-1.43; P <.01) for PE whether or not these patients suffered from erectile dysfunction. Combined treatment was more efficacious than use of PDE-5 inhibitors alone on sexual satisfaction. Although the occurrence of drug-related AEs in the combination use group was higher than that in the use of SSRIs or PDE-5 inhibitors alone group (37.5% vs 25.63%, P <.01), the most common AEs were mild and tolerable. CONCLUSION The combined use of SSRIs and PDE-5 inhibitors provided additive favorable effects in men with PE compared with SSRIs or PDE-5 inhibitors monotherapy and was generally well tolerated.

Efficacy and safety of muscarinic antagonists as add-on therapy for male lower urinary tract symptoms

Alpha-adrenoceptor antagonists (alpha-blockers) are widely prescribed to treat lower urinary tract symptoms (LUTS) in men but fail to ameliorate LUTS sufficiently, especially the storage symptoms related to frequency, urgency and nocturia. We performed a meta-analysis of randomised controlled trials (RCTs) comparing an alpha-blocker plus muscarinic antagonist with an alpha-blocker alone in male LUTS patients who were treated with alpha-blocker prior to randomisation. The review contained six randomised controlled trials (RCTs) that included a total of 2,208 male patients who were randomised to receive alpha-blocker plus muscarinic antagonist or alpha-blocker alone. The add-on group experienced significantly greater improvement in both total IPSS (International Prostate Symptom Score) and storage IPSS. Adverse events (AEs) were commonly experienced by both groups (41.6 vs. 33.3%) though they were not severe. Our meta-analysis indicated that muscarinic antagonists as add-on therapy alleviate LUTS, especially storage symptoms. The add-on therapy demonstrated safety and tolerability comparable with alpha-blocker monotherapy in male with LUTS.

Effects of Fine Particulate Matter on Erectile Function and Its Potential Mechanism in Rats

OBJECTIVE To investigate whether the exposure to fine particulate matter (PM2.5) in a rat model can impair erectile function and the possible mechanism. MATERIALS AND METHODS Sprague-Dawley rats were distributed into 4 groups (n = 9 each): 1 control group and 3 groups exposed to different levels of PM2.5. Rats were exposed to PM2.5 (0.0 [saline control], 0.8, 1.6, and 3.2 mg/rat). After exposure period, the ratio of maximum intracavernosal pressure to mean arterial pressure, molecular-biological indicators in corpus cavernosum tissue and plasma, and the pathologic changes of the lung tissue and penile tissue were detected and compared between the control group and the 3 exposure groups. RESULTS The ratio of maximum intracavernosal pressure to mean arterial pressure in 2 groups exposed to PM2.5 was significantly lower than that of the control group only (P <.05). Exposure to PM2.5 could trigger the significant increase of plasma malondialdehyde, vascular endothelial growth factor, C-reactive protein, and tumor necrosis factor-α in experimental groups than that of the control group (P <.05). Expression of endothelial nitric oxide synthase (NOS), neuronal NOS, cyclic guanosine monophosphate, NOS activity, and content of reactive oxygen species in penile tissue were higher than that of the control group in a dose-response way (P <.05). CONCLUSION The function of penile erection is impaired by exposure to PM2.5. The decrease in the expression of endothelial NOS and NOS activity in penile cavernous tissue caused by systemic inflammatory and oxidative stress status induced by exposure to PM2.5 may be one of the important risk factors of erectile dysfunction.

The effect of intravesical chemotherapy in the prevention of intravesical recurrence after nephroureterectomy for upper tract urothelial carcinoma: a meta-analysis

Abstract Context: The standard management of upper urinary tract urothelial carcinoma (UUT-UC) is nephroureterectomy with bladder cuff excision, but after surgery, approximately 22–47% of patients with UUT-UC develop subsequent bladder tumour recurrence, potentially because of the implantation of cancer cells from the primary tumour. Objective: To conduct a meta-analysis to evaluate the effect of prophylactic intravesical chemotherapy in the prevention of bladder recurrence after nephroureterectomy for UUT-UC. Data acquisition: An electronic database search of Medline, Embase, the Cochrane Library, CancerLit and ClinicalTrials.gov was performed to identify appropriate studies prior to March 2013.All studies comparing nephroureterectomy alone with prophylactic intravesical chemotherapy after nephroureterectomy were included. The main outcome measure for this meta-analysis was the rate of bladder recurrence after nephroureterectomy. The search was not limited by language. The review process followed the guidelines of the Cochrane Collaboration. The analysis was conducted using the Review Manager Version RevMan 5.0 software (The Nordic Cochrane Centre, The Cochrane Collaboration). Results: A total of 592 patients were included in this study, of whom 257 underwent intravesical instillation after nephroureterectomy and 335 underwent nephroureterectomy alone. Our meta-analysis demonstrated that the rate of recurrence after 12 months was significantly lower in the intravesical instillation after nephroureterectomy group than in the nephroureterectomy-alone group [odds ratio (OR): 0.48; 95% confidence interval (CI): 0.28–0.81; P = 0.006]. A significant decrease in bladder recurrence after at least 24 months was also observed in the intravesical instillation after nephroureterectomy group (OR: 0.40; 95% CI: 0.24–0.67; P = 0.0004). A subgroup analysis demonstrated that the pattern of differences was similar to those from the total group analysis. Conclusions: Prophylactic intravesical chemotherapy was effective for the prevention of bladder recurrence after nephroureterectomy. Therefore, we suggest that prophylactic intravesical chemotherapy should be performed in patients with UUT-UC after nephroureterectomy, but the optimal chemotherapy regimen and the initial time of instillation should be explored in future studies.

Dapoxetine for Premature Ejaculation: An Updated Meta-Analysis of Randomized Controlled Trials

PURPOSE Dapoxetine is the first oral agent approved for the treatment of premature ejaculation (PE). However, some countries have not approved its use. The goal of this meta-analysis was to provide more information about the efficacy and safety of dapoxetine in patients with PE. METHODS We performed a meta-analysis of randomized controlled trials (RCTs) comparing dapoxetine with a placebo in patients with PE. Relevant eligible RCTs were identified through comprehensive searches of the Cochrane Central Register of Controlled Trials, EMBASE, and PubMed. Efficacy (intravaginal ejaculatory latency time (IELT), patient global impression of change, perceived control over ejaculation, and satisfaction with sexual intercourse) and safety (treatment-emergent adverse events and discontinuation rates) were studied by using Review Manager version 5.1.0. FINDINGS Six RCTs involving 5934 patients met the inclusion criteria. The main outcome (IELT) in the dapoxetine group was improved significantly compared with IELT in the placebo group (mean difference, 1.59 [95% CI, 1.30 to 1.88]; P < 0.00001). The 60-mg dose of dapoxetine was more beneficial than the 30-mg dose for IELT (mean difference, -0.47 [95 % CI, -0.73 to -0.20]; P = 0.0005). Although the occurrence of treatment-emergent adverse events in the dapoxetine group was nearly twice that in the placebo group (50.5% vs 27.9%), reports of severe adverse events were rare. IMPLICATIONS Data from the meta-analysis revealed that treatment with dapoxetine was significantly efficacious in patients with PE. Although adverse events such as nausea, dizziness, diarrhea, insomnia, and headache were common, dapoxetines overall safety profile was acceptable.