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Cancer Investigation Oct 2021The impact of radiation-related lymphopenia on clinical outcomes has been reported in various solid malignancies such as high grade gliomas, head and neck cancers,...
BACKGROUND
The impact of radiation-related lymphopenia on clinical outcomes has been reported in various solid malignancies such as high grade gliomas, head and neck cancers, thoracic malignancies and gastro-intestinal malignancies but its impact is not clearly known in the context of common genito-urinary (GU) malignancies.
METHODOLOGY
To better understand the effect of radiation-associated lymphopenia in prostate and bladder cancer, we undertook this systematic review of clinical studies that have studied radiation-related lymphopenia in GU malignancies. A systematic methodology search of PubMed, Embase, and Cochrane library resulted in 2125 abstracts. Ten studies fulfilled the inclusion criteria which included any prospective, retrospective study or cohort study of prostate, urinary bladder, kidney, ureter, urethra, penile cancer in humans, and radiation should be part of treatment and intent has to be in definitive or adjuvant settings. Finally the study should have data on radiation-related lymphopenia.
RESULTS
Four studies reported on the cancer-specific outcomes related to the lymphopenia. The incidence of low lymphocyte counts were documented in all the studies. Three studies analyzed the factors associated with the Lymphocyte depletion. Pooled incidence of severe lymphopenia was 29.25% and mild to moderate lymphopenia was 60.75%. Bone marrow volume receiving 40 Gy was associated with the incidence of lymphopenia.
CONCLUSION
One-third of the patients suffer from severe lymphopenia after radiation in prostate and bladder cancer. There are no clear data to support the correlation between severe lymphopenia and disease outcomes. Bone marrow dosimetry can affect the incidence and severity of lymphopenia. There is need of prospective datasets to identify the impact of radiation-related lymphopenia in GU malignancies focusing on long-term side effects, recurrence rates, and overall survival.
Topics: Humans; Lymphocyte Count; Lymphopenia; Male; Prostatic Neoplasms; Radiation Injuries; Radiotherapy; Survival Analysis; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 34313522
DOI: 10.1080/07357907.2021.1960992 -
International Journal of Molecular... Dec 2021Penile squamous cell carcinoma (PSCC) is a rare but aggressive neoplasm with dual pathogenesis (human papillomavirus (HPV)-associated and HPV-independent). The...
Penile squamous cell carcinoma (PSCC) is a rare but aggressive neoplasm with dual pathogenesis (human papillomavirus (HPV)-associated and HPV-independent). The development of targeted treatment is hindered by poor knowledge of the molecular landscape of PSCC. We performed a thorough review of genetic alterations of PSCC focused on somatic mutations and/or copy number alterations. A total of seven articles have been identified which, overall, include 268 PSCC. However, the series are heterogeneous regarding methodologies employed for DNA sequencing and HPV detection together with HPV prevalence, and include, in general, a limited number of cases, which results in markedly different findings. Reported top-ranked mutations involve , , , and . Numerical alterations involve gains in and , as well as amplifications in HPV integration loci. A few genes including , , and harbor both somatic mutations and copy number alterations. Notch, RTK-RAS and Hippo pathways are frequently deregulated. Nevertheless, the relevance of the identified alterations, their role in signaling pathways or their association with HPV status remain elusive. Combined targeting of different pathways might represent a valid therapeutic approach in PSCC. This work calls for large-scale sequencing studies with robust HPV testing to improve the genomic understanding of PSCC.
Topics: Carcinoma, Squamous Cell; DNA Copy Number Variations; Geography; Humans; Male; Molecular Targeted Therapy; Mutation; Papillomaviridae; Penile Neoplasms; Prognosis; Signal Transduction
PubMed: 35008677
DOI: 10.3390/ijms23010251 -
World Journal of Surgery Apr 2023Inguinal lymph node dissection (ILND) plays a crucial role in the oncological management of patients with melanoma, penile, and vulvar cancer. This study aims to... (Meta-Analysis)
Meta-Analysis Review
Assessment and Reporting of Perioperative Adverse Events and Complications in Patients Undergoing Inguinal Lymphadenectomy for Melanoma, Vulvar Cancer, and Penile Cancer: A Systematic Review and Meta-analysis.
BACKGROUND
Inguinal lymph node dissection (ILND) plays a crucial role in the oncological management of patients with melanoma, penile, and vulvar cancer. This study aims to systematically evaluate perioperative adverse events (AEs) in patients undergoing ILND and its reporting.
METHODS
A systematic review was conducted according to PRISMA. PubMed, MEDLINE, Scopus, and Embase were queried to identify studies discussing perioperative AEs in patients with melanoma, penile, and vulvar cancer following ILND.
RESULTS
Our search generated 3.469 publications, with 296 studies meeting the inclusion criteria. Details of 14.421 patients were analyzed. Of these studies, 58 (19.5%) described intraoperative AEs (iAEs) as an outcome of interest. Overall, 68 (2.9%) patients reported at least one iAE. Postoperative AEs were reported in 278 studies, combining data on 10.898 patients. Overall, 5.748 (52.7%) patients documented ≥1 postoperative AEs. The most reported ILND-related AEs were lymphatic AEs, with a total of 4.055 (38.8%) events. The pooled meta-analysis confirmed that high BMI (RR 1.09; p = 0.006), ≥1 comorbidities (RR 1.79; p = 0.01), and diabetes (RR 1.81; p = < 0.00001) are independent predictors for any AEs after ILND. When assessing the quality of the AEs reporting, we found 25% of studies reported at least 50% of the required criteria.
CONCLUSION
ILND performed in melanoma, penile, and vulvar cancer patients is a morbid procedure. The quality of the AEs reporting is suboptimal. A more standardized AEs reporting system is needed to produce comparable data across studies for furthering the development of strategies to decrease AEs.
Topics: Male; Female; Humans; Penile Neoplasms; Vulvar Neoplasms; Lymph Node Excision; Melanoma; Lymphatic Vessels
PubMed: 36709215
DOI: 10.1007/s00268-022-06882-6 -
International Journal of Impotence... Jan 2020Several strategies to optimize penile length in the presence of Peyronie's Disease (PD) have been described so far. In case of severe curvature and preserved erectile...
Several strategies to optimize penile length in the presence of Peyronie's Disease (PD) have been described so far. In case of severe curvature and preserved erectile function, plaque incision/excision (PIG/PEG) are advisable in order to maximize penile length, despite the risk of postoperative erectile dysfunction (ED), recurrent curvature, or penile shortening. For men with PD deformities associated to a certain degree of ED several lengthening techniques associated to penile prosthesis (PPI) implantation can be considered. Because of the potential postoperative complications, the indication must be balanced between patient's risk factors and surgeon's experience. Furthermore, adjuvant surgeries, such as prepubic V-Y plasty, suspensory ligament release, suprapubic lipectomy, and ventral phalloplasty, can be performed simultaneously or in a staged fashion to maximize the outcomes. Restoration a decent penile length in the case of a severe PD represents a real challenge for reconstructive surgeons. We present a systematic review of the literature on the current practices for penile lengthening in severe PD, providing the reader with a practical overview on the existing surgical strategies and their surgical and functional outcomes.
Topics: Erectile Dysfunction; Humans; Male; Patient Satisfaction; Penile Erection; Penile Implantation; Penile Induration; Penile Prosthesis; Penis; Postoperative Complications; Postoperative Period; Risk Factors
PubMed: 31481708
DOI: 10.1038/s41443-019-0189-9 -
Journal of Toxicology and Environmental... Aug 2020Exposure to environmental pollutants may produce impairment of male reproductive health. The epidemiological literature evaluating potential consequences of human...
Exposure to environmental pollutants may produce impairment of male reproductive health. The epidemiological literature evaluating potential consequences of human exposure to per- and polyfluoroalkyl substances (PFAS) has grown in recent years with concerns for both pre- and postnatal influences. The aim of this systematic review was to assess available evidence on associations between PFAS exposures in different stages of life and semen quality, reproductive hormones, cryptorchidism, hypospadias, and testicular cancer. A systematic search of literature published prior to March 9th, 2020, was performed in the databases PubMed and Embase®. Predefined criteria for eligibility were applied by two authors screening study records independently. Among the 242 study records retrieved in the literature search, 26 studies were eligible for qualitative assessment. While several investigations suggested weak associations for single compounds and specific outcomes, a lack of consistency across studies limited conclusions of overall evidence. The current gap in knowledge is particularly obvious regarding exposures prior to adulthood, exposure to combinations of both PFAS and other types of environmental chemicals, and outcomes such as cryptorchidism, hypospadias, and testicular cancer. Continued efforts to clarify associations between PFAS exposure and male reproductive health through high-quality epidemiological studies are needed.
Topics: Cryptorchidism; Environmental Exposure; Environmental Pollutants; Fluorocarbons; Gonadal Steroid Hormones; Humans; Hypospadias; Male; Reproductive Health; Semen; Testicular Neoplasms
PubMed: 32741292
DOI: 10.1080/10937404.2020.1798315 -
Molecular Diagnosis & Therapy Mar 2022Primary mucosal melanomas (PMMs) are rare and clinically heterogeneous, including head and neck (HNMs), vulvovaginal (VVMs), conjunctival (CjMs), anorectal (ARMs) and...
BACKGROUND
Primary mucosal melanomas (PMMs) are rare and clinically heterogeneous, including head and neck (HNMs), vulvovaginal (VVMs), conjunctival (CjMs), anorectal (ARMs) and penile (PMs) melanomas. While the prognosis of advanced cutaneous melanoma has noticeably improved using treatments with immune checkpoint inhibitors (ICIs) and molecules targeting BRAF and MEK, few advances have been made for PMMs because of their poorer response to ICIs and their different genetic profile. This prompted us to conduct a systematic review of molecular studies of PMMs to clarify their pathogenesis and potential therapeutic targets.
METHODS
All articles that examined gene mutations in PMMs were identified from the databases and selected based on predefined inclusion criteria. Mutation rate was calculated for all PMMs and each location group by relating the number of mutations identified to the total number of samples analysed.
RESULTS
Among 1,581 studies identified, 88 were selected. Overall, the frequency of KIT, BRAF and NRAS mutation was 13.5%, 12.9% and 12.1%, respectively. KIT mutation ranged from 6.4% for CjMs to 16.6% for ARMs, BRAF mutation from 8.6% for ARMs to 31.1% for CjMs, and NRAS mutation from 6.2% for ARMs to 18.5% for CjMs. Among 101 other genes analysed, 33 had mutation rates over 10%, including TTN, TSC1, POM121, NF1, MTOR and SF3B1.
CONCLUSION
In addition to BRAF, NRAS and KIT genes commonly studied, our systematic review identified significantly mutated genes that have already been associated (e.g., TSC1, mTOR, POLE or ATRX) or could be associated with (future) targeted therapies.
PROSPERO ID
CRD42020185552.
Topics: Humans; Melanoma; Membrane Glycoproteins; Mutation; Proto-Oncogene Proteins B-raf; Proto-Oncogene Proteins c-kit; Skin Neoplasms; TOR Serine-Threonine Kinases
PubMed: 35195858
DOI: 10.1007/s40291-021-00572-0 -
The Journal of Sexual Medicine Jun 2022Erectile dysfunction (ED) may be common in patients with inflammatory bowel disease (IBD), but its prevalence and risk factors still remain debatable. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Erectile dysfunction (ED) may be common in patients with inflammatory bowel disease (IBD), but its prevalence and risk factors still remain debatable.
AIM
To evaluate the prevalence of ED in the IBD population and the potential role of risk factors in the development of ED.
METHODS
An extensive search in the PubMed, Cochrane Library, and Web of Science was performed to identify relevant English-language articles published up to December 2021 that evaluated the prevalence of ED on IBD patients. The included studies were evaluated by 2 independent reviewers for eligibility. We used an adapted Assessment Tool for Prevalence Studies to evaluate the quality of enrolled studies. Data were analyzed and graphed using the STATA software (version 16.0; Stata Corporation, College Station, TX, USA). The ORs with 95% CIs were pooled using a fixed or random-effects model according to heterogeneity. Subgroup analysis was performed to explore the source of heterogeneity. Sensitivity analysis was conducted to evaluate the stability of the results.
OUTCOMES
The pooled prevalence of ED in IBD patients was calculated, and the OR value and 95% CIs were used to assess the strength of the association between IBD-related risk factors and ED.
RESULTS
Fourteen studies included 32,858 individuals totally were enrolled for this meta-analysis. The overall pooled prevalence estimate of ED in IBD patients was 27% (95% CI: 20-34%). Operation (OR 1.28; 95% CI: 1.17-1.39; P < .00001; I = 0.0%), disease activity (OR 2.06; 95% CI: 1.07-3.05; P < .00001), and depression (crude OR 3.31; 95% CI: 1.08-5.54; P = .004; I = 0.0%) significantly increase the risk of ED in people with IBD. The association of depression and ED was further confirmed by calculating the pooled estimates of adjusted OR (1.58; 95% CI: 0.05-3.12; P < .05; I = 0.0%). The pooled prevalence estimates of ED were 30, 33, and 17% in the age <40, IIEF diagnostic tool, and IPAA surgery subgroups, respectively.
CLINICAL IMPLICATIONS
IBD patients had a significantly increased prevalence of ED, indicating that erectile function in men with IBD should be concerned by clinicians.
STRENGTHS & LIMITATIONS
The strength of this study is that this is the first meta-analysis to assess the global prevalence and risk factors of ED in IBD patients. A limitation is that the results after pooling the included articles showed significant heterogeneity.
CONCLUSION
The results of our meta-analysis and systematic review provide evidence of the high prevalence and risk factors of ED in IBD patients. Wu X, Zhang Y, Zhang W, et al. The Prevalence and Associated Risk Factors of Erectile Dysfunction in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. J Sex Med 2022;19:950-960.
Topics: Chronic Disease; Erectile Dysfunction; Humans; Inflammatory Bowel Diseases; Male; Penile Erection; Prevalence; Risk Factors
PubMed: 35491378
DOI: 10.1016/j.jsxm.2022.03.615 -
Journal of Pediatric Urology Jun 2021Dorsal inlay graft urethroplasty (DIGU) has been described as an effective method for hypospadias repair with the proposed advantage of reducing the risk of... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Dorsal inlay graft urethroplasty (DIGU) has been described as an effective method for hypospadias repair with the proposed advantage of reducing the risk of complications. We aimed to systematically assess whether DIGU has any additional advantages over standard tubularized incised plate urethroplasty (TIPU) repair in children with primary hypospadias.
MATERIALS AND METHODS
This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The a priori protocol is available at the PROSPERO database (CRD42020168305). A literature search was conducted for relevant publications from 1946 until January 10, 2020 in seven different databases. Randomized controlled trials (RCTs), comparative studies (TIPU vs DIGU) and single arm case series (>20 cases) of DIGU were eligible for inclusion. Secondary hypospadias, two-stage repairs, disorders of sex development, significant curvature of >30°, and a mean or median follow-up of less than 12 months were excluded.
DISCUSSION
A total of 499 articles were screened and 14 studies (3 RCTs, 5 non-randomized studies (NRSs), and 6 case series) with a total of 1753 children (distal: 1334 (76%) and proximal: 419 (24%)) were found eligible. Mean follow-up of the studies was between 16 and 77 months. DIGU was found superior to TIPU in decreasing meatal/neourethral stenosis (p = 0.02, 95% CI 0.02-0.78). All other parameters were found comparable including overall complications, fistula and glans dehiscence rates. Success rates were similar among the groups ranging between 48% and 96% for DIGU and 43-96% in the TIPU group. The lack of standardization in the definition of complications and success was the major limitation of this study.
CONCLUSIONS
Using an inlay graft during primary hypospadias repair decreases the risk of meatal/neourethral stenosis. However, current evidence does not demonstrate superiority of DIGU over TIPU in terms of treatment success and overall complication rates.
Topics: Child; Humans; Hypospadias; Infant; Male; Plastic Surgery Procedures; Surgical Flaps; Treatment Outcome; Urethra; Urologic Surgical Procedures, Male
PubMed: 33691984
DOI: 10.1016/j.jpurol.2021.02.013 -
European Urology Focus May 2023A dynamic sentinel lymph node biopsy (DSNB) is used for inguinal lymph node staging in patients presenting with primary penile cancer with clinically impalpable inguinal... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
A dynamic sentinel lymph node biopsy (DSNB) is used for inguinal lymph node staging in patients presenting with primary penile cancer with clinically impalpable inguinal lymph nodes (cN0). Further completion radical inguinal lymph node dissection (RLND) is offered to patients diagnosed with metastatic inguinal nodes following a DSNB.
OBJECTIVE
To identify the diagnostic accuracy of a DSNB and RLND to detect lymph node metastasis.
EVIDENCE ACQUISITION
A systematic literature search was performed on PubMed Medscape, EMBASE, Google Scholar, and Cochrane database for relevant studies between January 1, 2000 and April 30, 2022. Studies were included if a DSNB was offered to cN0 patients and if RLND was offered to patients with positive histology at the DSNB. Risk of bias and confounding assessments were performed. Diagnostic odds ratio, pooled sensitivity/specificity, and heterogeneity analyses were displayed.
EVIDENCE SYNTHESIS
Overall, 2893 patients in the 28 studies analysed underwent a DSNB. Twenty-one studies reported patients undergoing RLND for a positive DSNB. A DSNB showed pooled weighted sensitivity of 0.87 (95% confidence interval [CI]: 0.82-0.91) and pooled log diagnostic odds ratio of 6.17 (95% CI: 5.47-6.87). A DSNB showed pooled weighted sensitivity of 0.50 (95% CI: 0.24-0.59), specificity of 0.82 (95% CI: 0.78-0.87), and a log diagnostic odds ratio of 1.18 (95% CI: 0.29-2.97) for detecting further positive lymph nodes at RLND. High heterogeneity, mostly caused by study design, characteristics of the included patients, DSNB technique used, surgical experience/centre case volumes, and follow-up schedule, represents the main limitation of this meta-analysis. Several sensitivity analyses to address these issues support our findings.
CONCLUSIONS
A positive DSNB is poorly able to discriminate which patients will have further metastatic involvement at completion RLND. Better stratification of these patients would avoid unnecessary overtreatment and possible postoperative comorbidities.
PATIENT SUMMARY
This analysis of the data from the published literature provides evidence that the diagnostic accuracy of a dynamic sentinel lymph node biopsy (DSNB) requires further improvement. Moreover, a high proportion of patients with a positive DSNB undergo unnecessary radical lymph node dissection; better stratification of these patients might help determine avoidable overtreatment and postoperative comorbidities.
Topics: Male; Humans; Sentinel Lymph Node Biopsy; Penile Neoplasms; Carcinoma, Squamous Cell; Lymphatic Metastasis; Lymph Nodes
PubMed: 36470729
DOI: 10.1016/j.euf.2022.11.018 -
Archivio Italiano Di Urologia,... May 2023Penile fracture (PF) with associated urethral injury has been described as a rare condition yet a serious urological emergency. We conducted this systematic review to...
PURPOSES
Penile fracture (PF) with associated urethral injury has been described as a rare condition yet a serious urological emergency. We conducted this systematic review to address the current literature concerning the etiology, presentations, intra-operative findings, site of injury, and complications of PF with associated urethral injury, Materials and Methods: The present systematic review was limited to human-based studies published in English language, and reporting clinical data on PF cases with associated urethral injuries. A comprehensive search of the literature was conducted on five electronic databases from their inception to May 2022: Medline via PubMed, Web of Science, Google Scholar, Scopus, and EBSCO host.
RESULTS
A total of 15 studies were included encompassing 1671 patients with PF. Out of 1665 patients with PF retrieved from the case series studies, 65 patients had associated urethral injuries giving a point prevalence of 3.9%. The vast majority of the patients had blood on the meatus and hematuria suggestive of urethral injury (57/59; 96.6%). Forty patients had partial urethral disruption and the rest of the patients had a complete rupture. All patients received primary urethroplasty as the main modality of treatment. The median hospital stay was two days and the median duration of transurethral catheterization was 21 days. Five patients (8.5%) developed urethral stricture; other complications included penile curvature (6.7%), palpable fibrosis (6.7%), and erectile dysfunction (3.4%).
CONCLUSIONS
Urethral injuries are uncommon, but serious findings, in patients with PF. Primary urethroplasty appears to achieve satisfactory outcomes with a low incidence of short and long-term complications.
Topics: Male; Humans; Penile Diseases; Urethra; Penis; Erectile Dysfunction; Urethral Stricture; Rupture
PubMed: 37259814
DOI: 10.4081/aiua.2023.11082