-
Urology Jun 2023To synthesize existing evidence to evaluate the outcomes of different urinary catheter removal timing (early vs late) after urethroplasty. (Review)
Review
OBJECTIVE
To synthesize existing evidence to evaluate the outcomes of different urinary catheter removal timing (early vs late) after urethroplasty.
METHODS
We performed a comprehensive search of PubMed, Embase, the Cochrane Library, and Web of Science from inception to August 7, 2022. Articles were initially screened by title, abstract, and subsequently by a full paper review before being included in the final analysis. All comparative studies that assessed the association between urethral catheterization duration and frequency of extravasation and recurrence rate in patients who underwent urethroplasty were included in the analysis. Exclusion criteria were case reports, case series, letters to editors, and non-English studies. The risk of bias was assessed using the Newcastle-Ottawa Scale.
RESULTS
Of the 439 relevant records in the literature databases, 5 studies involving 634 patients were included. In all 5 studies, the extravasation rate was not significantly different between the early and late catheter removal groups. Among the 3 studies that reported recurrence rates, the recurrence rate was low, with no statistically significant difference between the early and late catheter removal groups. Wound and urinary tract infections were among the most common complications, with a higher rate in patients with late catheter removal.
CONCLUSION
Early catheter removal following urethroplasty does not increase the rate of extravasation or recurrence during long-term follow-up. The existing evidence can serve as the foundation for additional research with a larger sample size.
Topics: Humans; Urinary Catheters; Urinary Catheterization; Urethra; Urinary Tract Infections; Device Removal
PubMed: 36963670
DOI: 10.1016/j.urology.2023.03.009 -
Neurourology and Urodynamics Aug 2021To perform a systematic review to assess and compare the efficacy and safety of all urethral bulking agents (UBAs) available for the treatment of stress urinary... (Review)
Review
AIMS
To perform a systematic review to assess and compare the efficacy and safety of all urethral bulking agents (UBAs) available for the treatment of stress urinary incontinence (SUI) in women.
METHODS
This systematic review was conducted in accordance with the PRISMA guideline. A systematic search was conducted using the Ovid Medline, Embase and PubMed databases. Studies were included if they involved women who underwent either Bulkamid®, Macroplastique®, Durasphere®, Coaptite®, or Urolastic® injections for the treatment of SUI. A total of 583 articles were screened with 56 articles included. A qualitative analysis was performed.
RESULTS
The newer synthetic UBAs are not inferior to Contigen®, with variable mean success rates of 30%-80% in the short-term. Better long-term success rates were found with Bulkamid® (42%-70%), Coaptite® (60%-75%), and Macroplastique® (21%-80%) on qualitative review. Urinary tract infection rates were similar between bulking agents (4%-10.6%) although temporary acute urinary retention was more commonly associated with Coaptite® (mean: 34.2%), and de novo urgency in Durasphere® (mean: 24.7%). Significant complications such as migration into lymph nodes was reported with Durasphere®. Erosion was reported with Macroplastique®, Coaptite®, and Urolastic®, with a rate as high as 24.6% in one study of Urolastic®.
CONCLUSION
Available data support the use of Bulkamid® and Macroplastique®, which has shown a short-term efficacy of 30%-90% and 40%-85% respectively, and long-term efficacy of 42%-70%, and 21%-80%, respectively. Bulkamid® appears to have a more favorable safety profile, with no cases of erosion or migration of product associated with its use. Direct comparisons of UBAs have not been performed.
Topics: Female; Humans; Injections; Male; Treatment Outcome; Urethra; Urinary Incontinence, Stress
PubMed: 34015151
DOI: 10.1002/nau.24696 -
European Urology Focus Mar 2021Genital reconstructive surgery (GRS) is a necessary part of transitioning for many transwomen, and there is evidence of positive effects on a person's well-being and... (Review)
Review
Genital Reconstructive Surgery in Male to Female Transgender Patients: A Systematic Review of Primary Surgical Techniques, Complication Profiles, and Functional Outcomes from 1950 to Present Day.
CONTEXT
Genital reconstructive surgery (GRS) is a necessary part of transitioning for many transwomen, and there is evidence of positive effects on a person's well-being and sexual function. Surgical techniques have evolved, from pursuing aesthetic outcome to now functional outcome with natal females as the standard.
OBJECTIVE
To systematically review the evidence, identifying the surgical techniques used in primary GRS, their complications, functional outcomes, and the tools used to assess them.
EVIDENCE ACQUISITION
The clinical question was designed using the standard PICOS format. The search complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 statement and was performed by two independent reviewers.
EVIDENCE SYNTHESIS
Europe, USA, and Thailand favour the penoscrotal technique for vaginoplasty, whereas in the UK, the penile inversion (PI) technique predominates. Primary vaginoplasty using a segment of bowel is less common, and all three techniques have comparable rates of intraoperative rectal injury. The incidence of rectovaginal fistula is reportedly higher in the PI technique. Wound haematoma and vaginal prolapse rates are comparable. Higher rates of clitoral necrosis, urethral meatal stenosis, and wound infection are reported in PI. However, the ability to orgasm, ability to have penetrative sexual intercourse, and satisfaction with aesthetic result are better with PI.
CONCLUSIONS
The evidence for GRS complications and functional outcomes is of low level. Standardised nomenclature reporting of adverse events and robust patient-reported outcome measures (PROMs) are lacking. PROMs are a powerful assessment tool, and standardised definitions of adverse events and functional outcomes should be a priority of future research.
PATIENT SUMMARY
We looked at all studies published on genital reconstructive surgery from 1950 to the present day. We assessed each surgical technique and their associated complication rates, sexual and urinary function outcomes, and how they were reported. We found the evidence to be low and weak. We suggest more robust ways of reporting complications, and the impact on patients' quality of life should be investigated.
Topics: Europe; Female; Genitalia; Genitalia, Female; Genitalia, Male; Humans; Male; Quality of Life; Plastic Surgery Procedures; Transgender Persons
PubMed: 32061539
DOI: 10.1016/j.euf.2020.01.004 -
Journal of the American Academy of... Sep 2017Cryotherapy is one of the most commonly used therapeutic modalities to treat anogenital warts (AGWs), but this treatment was not clearly established in the recent... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Cryotherapy is one of the most commonly used therapeutic modalities to treat anogenital warts (AGWs), but this treatment was not clearly established in the recent international recommendations.
OBJECTIVE
To compare the efficacy and safety of cryotherapy versus other AGW treatments.
METHODS
Through a systematic search of 12 electronic databases, we identified 11 randomized controlled trials, screened from database inception through October 2016, that met the inclusion criteria (including immunocompetent adults with AGWs receiving cryotherapy in 1 of the comparison groups). Primary endpoint was complete clearance of AGW. Risk-for-bias assessment was based on Cochrane Handbook recommendations. Meta-analyses used Review Manager v5.3 software.
RESULTS
Cryotherapy efficacy did not appear to differ from that of trichloroacetic acid, podophyllin, or imiquimod. Electrosurgery was weakly associated with better AGW clearance than cryotherapy (risk ratio [RR] 0.80, 95% confidence interval [CI] 0.65-0.99). Cryotherapy was associated with more immediate low-level adverse events (erythema, stinging, or irritation; RR 3.02, 95% CI 1.38-6.61) and immediate pain requiring oral analgesics (RR 2.11, 95% CI 1.07-4.17) but fewer erosions (RR 0.57, 95% CI 0.36-0.90).
LIMITATIONS
All but 1 randomized-controlled trial had a high risk for bias.
CONCLUSION
With low-level quality of the evidence, cryotherapy is an acceptable first-line therapy to treat AGWs.
Topics: Anus Diseases; Condylomata Acuminata; Cryotherapy; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Male; Randomized Controlled Trials as Topic
PubMed: 28651824
DOI: 10.1016/j.jaad.2017.04.012 -
International Journal of Impotence... Mar 2022COVID-19 pandemic is associated with devastating effects on social, psychological, and economical aspects of survivors. We assume that erectile function (EF) is affected... (Review)
Review
COVID-19 pandemic is associated with devastating effects on social, psychological, and economical aspects of survivors. We assume that erectile function (EF) is affected as well. We performed a systematic review of the published articles about the change in EF among patients and health care providers during the COVID-19 pandemic. We searched PubMed and Cochrane databases for English literature using a combination of medical subject headings (MeSH) terms and keywords. We extracted data of erectile dysfunction (ED) rate, international index of erectile function (IIEF), changes related to exposure to the pandemic (Primary objectives), and factors affecting these differences (Secondary objectives). Twenty articles were included in the screening phase. Only 3 articles were eligible for primary objectives, and 2 articles were included for the secondary objective. Three articles revealed an increase in ED cases and a reduction in IIEF-5 scores during the pandemic. Rates of ED have ranged from 32% to 87% of the study populations. Anxiety, depression, and post-traumatic stress disorder (PTSD) were associated with increased ED rates. We conclude that the COVID-19 pandemic is associated with increased rates of ED. Anxiety and depression augment this increase. Health care providers are at higher risk for PTSD, which increases the risk of ED.
Topics: COVID-19; Erectile Dysfunction; Health Personnel; Humans; Male; Pandemics; Penile Erection
PubMed: 34992226
DOI: 10.1038/s41443-021-00504-w -
Actas Urologicas Espanolas Jun 2020Penile prosthesis surgery is currently the most effective treatment for erectile dysfunction when medical treatment is ineffective or contraindicated. Among the surgical...
CONTEXT
Penile prosthesis surgery is currently the most effective treatment for erectile dysfunction when medical treatment is ineffective or contraindicated. Among the surgical approaches described in the literature, the scrotal, infrapubic and subcoronal are the most common in the daily clinical practice.
OBJECTIVES
The main objectives were to describe the infrapubic surgical technique evaluating its indications and complications, as well as comparing its advantages and disadvantages with the penoscrotal approach.
ACQUISITION AND SYNTHESIS OF THE EVIDENCE
A literature review from 1983 until current date was carried out in Medline (PubMed and Cochrane Library databases) following PRISMA standards. Sixteen studies were included: 4 prospective, 4 retrospective, one systematic review, one randomized trial, one original article, 5 expert opinion/surgical technique descriptive paper.
DISCUSSION
According to the literature reviewed, although the penoscrotal approach is the most applied, the infrapubic approach showed a shorter operative time and a tendency for an earlier recovery of sexual activity after surgery. Complications are rare, having similar rates to the penoscrotal approach; no cases of glans hypoesthesia have been reported and peri-prosthetic infection rates were less than 3%. Satisfaction rates of infrapubic penile prosthesis were higher than 80%.
CONCLUSIONS
Penile prosthesis implantation requires of a profound knowledge of the different surgical approaches in order to best adapt each technique based on each individualized case. The infrapubic approach, even if it is not the most used, is as feasible and reliable as the penoscrotal approach. The infrapubic approach is effective and safe, with high level of both, patients and partners' satisfaction.
Topics: Erectile Dysfunction; Humans; Male; Penile Implantation; Pubic Bone
PubMed: 32115278
DOI: 10.1016/j.acuro.2019.10.010 -
Clinics (Sao Paulo, Brazil) Feb 2016To evaluate the efficacy and safety of different bulking agents for treating urinary incontinence in women, a systematic review including only randomized controlled... (Review)
Review
To evaluate the efficacy and safety of different bulking agents for treating urinary incontinence in women, a systematic review including only randomized controlled trials was performed. The subjects were women with urinary incontinence. The primary outcomes were clinical and urodynamic parameters. The results were presented as a weighted mean difference for non-continuous variables and as relative risk for continuous variables, both with 95% confidence intervals. Initially, 942 studies were identified. However, only fourteen eligible trials fulfilled the prerequisites. Altogether, the review included 1814 patients in trials of eight different types of bulking agents, and all studies were described and analyzed. The measured outcomes were evaluated using a large variety of instruments. The most common complications of the bulking agents were urinary retention and urinary tract infection. Additionally, there were certain major complications, such as one case of death after use of autologous fat. However, the lack of adequate studies, the heterogeneous populations studied, the wide variety of materials used and the lack of long-term follow-up limit guidance of practice. To determine which substance is the most suitable, there is a need for more randomized clinical trials that compare existing bulking agents based on standardized clinical outcomes.
Topics: Acrylic Resins; Adult; Collagen; Dimethylpolysiloxanes; Female; Glucans; Humans; Hydrogels; Injections; Randomized Controlled Trials as Topic; Silicones; Treatment Outcome; Urethra; Urinary Incontinence; Zirconium
PubMed: 26934239
DOI: 10.6061/clinics/2016(02)08 -
Sexual Medicine Reviews Jun 2024Refractory priapism, characterized by persistent and prolonged painful erections despite initial treatment maneuvers, can significantly impair erectile function... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Refractory priapism, characterized by persistent and prolonged painful erections despite initial treatment maneuvers, can significantly impair erectile function secondary to ischemia-induced corporal tissue fibrosis. These patients will likely require subsequent penile prosthesis (PP) surgery to regain sexual activity, yet consensus regarding the optimal timing of implantation remains lacking.
OBJECTIVES
To evaluate and compare the clinical outcomes associated with early vs delayed PP implantation in individuals with priapism-induced erectile dysfunction (ED).
METHODS
We included studies that focused on refractory priapism leading to ED and its management with PP implantation. We assessed cohort study bias with a risk-of-bias tool and case series bias with the modified Newcastle-Ottawa Scale. Pooled odds ratios (ORs) were calculated by a fixed-effect model.
RESULTS
We included 9 studies, comprising 4 cohort studies and 5 case series, involving a total of 278 patients. Total complications were higher in the delayed group (OR, 4.16; 95% CI, 2.77-6.26). Fibrosis was significantly more pronounced in the delayed group (OR, 118.18; 95% CI, 20.06-696.32). The odds of erosion, infections, and penile injury did not show statistically significant differences between the groups (OR, 2.52 [95% CI, 0.67-9.49], 0.89 [0.38-2.10], 1.83 [0.79-4.26], respectively). Patients' satisfaction resulted in a pooled OR of 0.15 (95% CI, 0.04-0.49) in favor of the early PP insertion group.
CONCLUSION
The results from this study favor an early approach to ED (within 30 days) following ischemic priapism. However, it is important to consider patients' preferences, values, and psychological factors to make an informed decision.
Topics: Humans; Male; Erectile Dysfunction; Penile Implantation; Penile Prosthesis; Priapism; Time Factors; Time-to-Treatment
PubMed: 38465856
DOI: 10.1093/sxmrev/qeae007 -
The Lancet. Oncology Jan 2019Although previous meta-analyses have examined human papillomavirus (HPV) DNA prevalence in penile cancer, none, to our knowledge, have assessed pooled HPV DNA prevalence... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Although previous meta-analyses have examined human papillomavirus (HPV) DNA prevalence in penile cancer, none, to our knowledge, have assessed pooled HPV DNA prevalence in penile intraepithelial neoplasia or p16 percent positivity in penile cancer and penile intraepithelial neoplasia. Therefore, we aimed to examine the prevalence of HPV DNA and p16 positivity in penile cancer and penile intraepithelial neoplasia worldwide.
METHODS
In this systematic review and meta-analysis, we searched PubMed, Embase, and the Cochrane Library until July 24, 2017, for English-language articles published from Jan 1, 1986, onwards reporting the prevalence of HPV DNA and p16 positivity, either alone or in combination, in at least five cases of penile cancer or penile intraepithelial neoplasia. Only studies that used PCR or hybrid capture for the detection of HPV DNA and immunohistochemical staining or methylation for the detection of p16 were included. Data were extracted and subsequently crosschecked, and inconsistencies were discussed to reach consensus. Using random-effects models, we estimated the pooled prevalence and 95% CI of HPV DNA and p16 positivity in penile cancer and penile intraepithelial neoplasia, stratifying by histological subtype and HPV DNA or p16 detection method. Type-specific prevalence of HPV6, HPV11, HPV16, HPV18, HPV31, HPV33, and HPV45 in penile cancer was estimated.
FINDINGS
Our searches identified 1836 non-duplicate records, of which 73 relevant papers (71 studies) were found to be eligible. The pooled HPV DNA prevalence in penile cancer (52 studies; n=4199) was 50·8% (95% CI 44·8-56·7; I=92·6%, p<0·0001). A high pooled HPV DNA prevalence was seen in basaloid squamous cell carcinomas (84·0%, 95% CI 71·0-93·6; I=48·0%, p=0·0197) and in warty-basaloid carcinoma (75·7%, 70·1-81·0; I=0%, p=0·52). The predominant oncogenic HPV type in penile cancer was HPV16 (68·3%, 95% CI 58·9-77·1), followed by HPV6 (8·1%, 4·0-13·7) and HPV18 (6·9%, 2·9-12·4). The pooled HPV DNA prevalence in penile intraepithelial neoplasia (19 studies; n=445) was 79·8% (95% CI 69·3-88·6; I=83·2%, p<0·0001). The pooled p16 percent positivity in penile cancer (24 studies; n=2295) was 41·6% (95% CI 36·2-47·0; I=80·6%, p<0·0001), with a high pooled p16 percent positivity in HPV-related squamous cell carcinoma (85·8%, 95% CI 72·1-95·4; I=56·4%, p=0·0011) as compared with non-HPV-related squamous cell carcinoma (17·1%, 7·9-29·1; I=78·3%, p<0·0001). Moreover, among HPV-positive cases of penile cancer, the p16 percent positivity was 79·6% (95% CI 65·7-90·7; I=89·9%, p<0·0001), compared with 18·5% (9·6-29·6; I=89·3%, p<0·0001) in HPV-negative penile cancers. The pooled p16 percent positivity in penile intraepithelial neoplasia (six studies; n=167) was 49·5% (95% CI 18·6-80·7).
INTERPRETATION
A large proportion of penile cancers and penile intraepithelial neoplasias are associated with infection with HPV DNA (predominantly HPV16), emphasising the possible benefits of HPV vaccination in men and boys.
FUNDING
None.
Topics: Carcinoma in Situ; Cyclin-Dependent Kinase Inhibitor p16; DNA, Viral; Humans; Male; Papillomaviridae; Papillomavirus Infections; Penile Neoplasms; Prevalence
PubMed: 30573285
DOI: 10.1016/S1470-2045(18)30682-X -
Journal of Robotic Surgery Feb 2019Lymphadenectomy represents the standard treatment for various types of cancer. The introduction of robotics in lymph node dissection may have an important impact on...
BACKGROUND
Lymphadenectomy represents the standard treatment for various types of cancer. The introduction of robotics in lymph node dissection may have an important impact on post-lymphadenectomy complications.
METHODS
A systematic literature review was performed.
RESULTS
In our review, robotic inguinal lymphadenectomy was performed on 51 patients. Penile squamous cell carcinoma was the most common histological type of the primary neoplasia. No intra-operative complications were reported. One case of conversion to open was reported. The mean duration of hospitalization was 2 days. The duration of drainage ranged from 7 to 72 days. The most common postoperative complications were lymphocele (13.7%), lymphedema (7.8%), cellulitis (7.8%), seroma (3.9%), abscess (3.9%), wound breakdown/wound infection (3.9%), sepsis (1.9%), prolonged lymphorrhea (1 out of 51 patients, 1.9%) and skin necrosis (1 out of 51 patients, 1.9%).
CONCLUSIONS
Until now there has not been sufficient evidence regarding the role of robotics in groin lymph node dissection, though this approach appears to be safe and oncologically effective, with morbidity rates relatively lower compared to open surgery.
Topics: Carcinoma, Squamous Cell; Cellulitis; Databases, Bibliographic; Female; Groin; Humans; Incidence; Length of Stay; Lymph Node Excision; Lymph Nodes; Lymphedema; Lymphocele; Male; Penile Neoplasms; Postoperative Complications; Robotic Surgical Procedures; Time Factors; Treatment Outcome
PubMed: 29730734
DOI: 10.1007/s11701-018-0823-4