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Journal of Pediatric Surgery Apr 2022Laparoscopic orchiopexy (LO) was recently described as superior to open orchiopexy (OO) for palpable undescended testes (UDT). We aimed to investigate the outcomes of LO... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/PURPOSE
Laparoscopic orchiopexy (LO) was recently described as superior to open orchiopexy (OO) for palpable undescended testes (UDT). We aimed to investigate the outcomes of LO of palpable UDT in relation to high retroperitoneal dissection, Prentiss maneuver and intrascrotal testis fixation; also, to identify evidence for the safety, efficacy and cost of LO compared with OO in palpable UDT.
METHODS
Systematic search was performed for all studies on LO for palpable UDT, and for all comparative studies between LO and OO in palpable UDT. Fisher's test was used to assess associations between success/complications rates and different LO approaches and meta-analysis to compare LO and OO.
RESULTS
In LO, success rates were not affected by regular high dissection (p = 1.0), Prentiss maneuver (p = 1.0) or intrascrotal fixation (p = 1.0); in fact, higher complications rates were noticed with regular high dissection (p = 0.002) and Prentiss maneuver (p = 0.01). Meta-analysis showed no significant differences between LO and OO in success (p = 0.17) and complications (p = 0.14) rates, while LO cost was higher in all comparative studies.
CONCLUSIONS
Evidence shows higher benefit-cost ratio for OO and, therefore, the latter should remain the procedure of choice. LO can be alternatively used, as it shows comparable safety/efficacy, but it should not include high dissection, Prentiss maneuver and testis fixation, when unnecessary.
TYPE OF STUDY
Systematic review and meta-analysis LEVEL OF EVIDENCE: III.
Topics: Cryptorchidism; Dissection; Humans; Infant; Laparoscopy; Male; Orchiopexy
PubMed: 34304904
DOI: 10.1016/j.jpedsurg.2021.07.003 -
Physiological and pathological functions of βB2-crystallins in multiple organs: a systematic review.Aging Jun 2021Crystallins, the major constituent proteins of mammalian lenses, are significant not only for the maintenance of eye lens stability, transparency, and refraction, but...
Crystallins, the major constituent proteins of mammalian lenses, are significant not only for the maintenance of eye lens stability, transparency, and refraction, but also fulfill various physiopathological functions in extraocular tissues. βB2-crystallin, for example, is a multifunctional protein expressed in the human retina, brain, testis, ovary, and multiple tumors. Mutations in the βB2 crystallin gene or denaturation of βB2-crystallin protein are associated with cataracts, ocular pathologies, and psychiatric disorders. A prominent role for βB2-crystallins in axonal growth and regeneration, as well as in dendritic outgrowth, has been demonstrated after optic nerve injury. Studies in βB2-crystallin-null mice revealed morphological and functional abnormalities in testis and ovaries, indicating βB2-crystallin contributes to male and female fertility in mice. Interestingly, although pathogenic significance remains obscure, several studies identified a clear correlation between βB2 crystallin expression and the prognosis of patients with breast cancer, colorectal cancer, prostate cancer, renal cell carcinoma, and glioblastoma in the African American population. This review summarizes the physiological and pathological functions of βB2-crystallin in the eye and other organs and tissues and discusses findings related to the expression and potential role of βB2-crystallin in tumors.
Topics: Black or African American; Humans; Lens, Crystalline; Neoplasms; Organ Specificity; beta-Crystallin B Chain
PubMed: 34118792
DOI: 10.18632/aging.203147 -
Journal of Pediatric Surgery Jul 2022Cryptorchidism associated with gastroschisis has been poorly investigated. We aimed to assess the prevalence of this association, and to address the management and... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Cryptorchidism associated with gastroschisis has been poorly investigated. We aimed to assess the prevalence of this association, and to address the management and outcome of cryptorchidism in this context.
MATERIALS AND METHODS
In this systematic review, we searched electronic databases (PubMed, Web of Science, and Google Scholar), without language restrictions from inception to March 31, 2021, for studies on cryptorchidism and gastroschisis co-occurrence. Random effects meta-analysis was used to calculate pooled prevalence estimates of cryptorchidism in gastroschisis and spontaneous testicular descent in this population.
RESULTS
Twenty-five studies were included for the systematic review. All were retrospective case reports or series for a total of 175 patients. Pooled prevalence estimate for cryptorchidism in gastroschisis was 19% (95% CI 13-26). Complete data sets for management and outcome analysis were available in 94 patients, involving 120 undescended testes [63 (52.5%) nonpalpable, 34 (28.3%) prolapsed outside the abdominal wall defect, and 23 (19.2%) palpable]. Fifty-five descended spontaneously, with a pooled prevalence estimate of 50% (95% CI 31-69). Twelve testes/remnants were primarily removed or absent, while 49 testes underwent orchiopexy (success rate, 63%). Excluding 4 testes still awaiting orchiopexy, 30 of the remaining 116 (25.8%) testes had a dismal outcome, including testicular loss (19), hypoplasia (8) or recurrent cryptorchidism (3).
CONCLUSION
Cryptorchidism in gastroschisis appears to occur more frequently than in the normal population. The overall mediocre testicular outcome seems to reflect the most unfavorable presentation of cryptorchidism in gastroschisis, which is represented by originally intrabdominal or prolapsed testis in the majority of cases.
LEVEL OF EVIDENCE
IV.
Topics: Cryptorchidism; Gastroschisis; Humans; Infant; Male; Orchiopexy; Prevalence; Retrospective Studies; Testis
PubMed: 34344532
DOI: 10.1016/j.jpedsurg.2021.07.006 -
European Urology Oncology May 2024Mutations in the speckle-type POZ (SPOP) gene are frequently identified in prostate cancer (PC); yet, prognostic implications for affected patients remain unclear.... (Review)
Review
CONTEXT
Mutations in the speckle-type POZ (SPOP) gene are frequently identified in prostate cancer (PC); yet, prognostic implications for affected patients remain unclear. Limited consensus exists regarding tailored treatments for SPOP-mutant (SPOPmut) PC.
OBJECTIVE
To elucidate the prognostic and predictive significance of SPOP mutations across distinct PC stages and treatments.
EVIDENCE ACQUISITION
A systematic literature search of PubMed, Embase, and Scopus was conducted up to January 29, 2024. The meta-analysis included studies comparing survival outcomes between SPOPmut and SPOP wild-type (SPOPwt) PC.
EVIDENCE SYNTHESIS
From 669 records, 26 studies (including five abstracts) were analyzed. A meta-analysis of metastasis-free survival in localized (hazard ratio [HR]: 0.72, 95% confidence interval [CI]: 0.59-0.88; p < 0.01) and overall survival (OS) in metastatic PC (HR: 0.64, 95% CI: 0.53-0.76; p < 0.01) showed a favorable prognosis for patients with SPOPmut PC. In metastatic settings, SPOP mutations correlated with improved progression-free survival (PFS) and OS in patients undergoing androgen deprivation therapy ± androgen receptor signaling inhibitor (HR: 0.51, 95% CI: 0.35-0.76, p < 0.01, and HR: 0.60, 95% CI:0.46-0.79, p < 0.01, respectively). In metastatic castration-resistant PC, only abiraterone provided improved PFS and OS to patients with SPOP mutations compared with patients with SPOPwt, but data were limited. SPOP mutations did not correlate with improved PFS (p = 0.80) or OS (p = 0.27) for docetaxel.
CONCLUSIONS
Patients with SPOPmut PC seem to exhibit superior oncological outcomes compared with patients with SPOPwt. Tailored risk stratification and treatment approaches should be explored in such patients.
PATIENT SUMMARY
Speckle-type POZ (SPOP) mutations could be a favorable prognostic factor in patients with prostate cancer (PC) and may also predict better progression-free and overall survival than treatment with hormonal agents. Therefore, less intensified treatments omitting chemotherapy for patients with SPOP-mutant PC should be explored in clinical trials.
PubMed: 38704358
DOI: 10.1016/j.euo.2024.04.011 -
Robot-assisted retroperitoneal lymph node dissection: a systematic review of perioperative outcomes.BJU International Jul 2023To assess the safety and feasibility of robot-assisted retroperitoneal lymph node dissection (R-RPLND) and to compare the perioperative outcomes of R-RPLND with open... (Review)
Review
OBJECTIVE
To assess the safety and feasibility of robot-assisted retroperitoneal lymph node dissection (R-RPLND) and to compare the perioperative outcomes of R-RPLND with open RPLND (O-RPLND), as RPLND forms an integral part of the management of testis cancer and R-RPLND is a minimally invasive treatment option for this disease.
MATERIALS AND METHODS
The PubMed , Scopus , Cochrane Central Register of Controlled Trials, and Web of Science™ databases were searched for studies reporting perioperative outcomes of primary and post-chemotherapy R-RPLND and studies comparing R-RPLND with O-RPLND.
RESULTS
The search yielded 42 articles describing R-RPLND, including five comparative studies. The systematic review included 4222 patients (single-arm studies, n = 459; comparative studies, n = 3763). Of 459 patients in the single-arm studies, 271 underwent primary R-RPLND and 188 underwent post-chemotherapy R-RPLND. For primary R-RPLND, the operative time ranged from 175 to 540 min and the major complication rate was 4.1%. For post-chemotherapy R-RPLND, the operative time ranged from 134 to 550 min and the major complication rate was 8.5%. The conversion rate to open surgery was 2.2% in primary R-RPLND and 9.0% in post-chemotherapy R-RPLND. In comparison with O-RPLND, R-RPLND was associated with a lower transfusion rate (14.5% vs 0.9%, P < 0.001) and a lower complication rate (18.5% vs 7.8%, P = 0.002).
CONCLUSION
Robot-assisted RPLND has acceptable perioperative outcomes in both the primary and post-chemotherapy settings but a notable rate of conversion to open surgery in the post-chemotherapy setting. Compared with O-RPLND, R-RPLND is associated with a lower transfusion rate and fewer overall complications. Given the potential impact of selection bias, the optimal patient selection criteria for R-RPLND remain to be elucidated.
Topics: Male; Humans; Robotics; Retroperitoneal Space; Neoplasms, Germ Cell and Embryonal; Lymph Node Excision; Testicular Neoplasms; Retrospective Studies; Treatment Outcome
PubMed: 36754376
DOI: 10.1111/bju.15986 -
Andrologia Nov 2020Nonylphenol (NP) is known as an environmental pollutant that has adverse effects on the spermatogenesis process. In this review, we focus on (1999-2020) studies on the... (Review)
Review
Nonylphenol (NP) is known as an environmental pollutant that has adverse effects on the spermatogenesis process. In this review, we focus on (1999-2020) studies on the effect of this pollutant on the sperm parameters and the male reproductive system. Spermatogenesis is a process in which male spermatogonia (primary germ cells) is divided into meiosis and produce spermatozoa. NP and its isomers can cause oxidative stress and alter the production of sex hormones, and thereby disrupting this vital process. By searching in the scientific databases of PubMed, Google Scholar, Science Direct, Springer and Web of Science related articles were extracted. As a result, all observations have confirmed that NP can cause multiple damages to the spermatogenesis and male reproductive system.
Topics: Humans; Male; Phenols; Spermatogenesis; Spermatozoa; Testis
PubMed: 32662580
DOI: 10.1111/and.13748 -
Toxicology May 2023Eutrophication of water bodies can lead to cyanobacterial blooms, with the resultant release of microcystins (MCs), posing a threat to the ecosystem and human health.... (Review)
Review
Eutrophication of water bodies can lead to cyanobacterial blooms, with the resultant release of microcystins (MCs), posing a threat to the ecosystem and human health. MCs are environmental toxins with male reproductive toxicity. However, there is a dearth of reviews focusing on sperm or spermatogenesis. In this paper, studies on sperm toxicity caused by MCs in recent 20 years were collected and summarized, aiming at revealing the toxic effects and potential mechanisms of MCs on sperm. Based on the previous findings, MCs can decline sperm quality and count, and cause malformation in vertebrates and invertebrates. The reason might be that MCs cause indirect damage to sperm through impairing the structure and function of the testis. The mechanisms of MCs-induced sperm toxicity mainly result from alterations in genetic material, abnormalities in the structure and function of sperm. The epigenetic modifications such as miRNA and piRNA were also involved in MC-LR-induced sperm damage. In conclusion, MCs exposure is harmful to sperm, but its direct effects and mechanisms on sperm are still not known, which remains a significant research direction. Our review will provide a basis for the protection of male reproductive health damage caused by microcystins.
Topics: Animals; Male; Humans; Microcystins; Ecosystem; Semen; Testis; Spermatozoa
PubMed: 37030550
DOI: 10.1016/j.tox.2023.153507 -
Cureus May 2023is a rare but serious condition characterized by twisting both testicles around their respective spermatic cords, leading to reduced blood flow and potential loss of... (Review)
Review
is a rare but serious condition characterized by twisting both testicles around their respective spermatic cords, leading to reduced blood flow and potential loss of the testicles. Treatment of this condition may involve surgical detorsion of the affected testicles and fixation to prevent recurrence and, in some cases, removal of severely damaged testicles. In April 2023, a systematic review of case reports was performed to examine the presentation, clinical features, diagnostic process, and management of bilateral testicular torsion. Our search encompassed the following databases: PubMed, ScienceDirect, and Google Scholar. Out of 340 studies, only eight cases met our criteria. However, this review discusses bilateral testicular torsion symptoms, investigation, and outcome.
PubMed: 37303345
DOI: 10.7759/cureus.38861 -
Journal of Pediatric Surgery Sep 2021Laparoscopic surgery is increasingly used to repair paediatric inguinal hernias and can be divided into intra- or extra-corporeal closing techniques. No statement... (Review)
Review
BACKGROUND
Laparoscopic surgery is increasingly used to repair paediatric inguinal hernias and can be divided into intra- or extra-corporeal closing techniques. No statement regarding the superiority of one of the two techniques can be made. This study aims to provide evidence supporting the superiority of intra- or extra-corporeal suturing technique.
METHODS
A systematic literature search was conducted using PubMed, Embase, MEDLINE, and Cochrane Library databases. Randomised controlled trials and prospective studies comparing different laparoscopic techniques were eligible for inclusion. Data were pooled using a random-effects model, comparing single-port extra-peritoneal closure to intra-peritoneal purse string suture closing. Primary outcome was recurrence rate. Secondary outcomes were duration of surgery (min), peri‑ and post-operative complications (i.e. injury of spermatic vessels or spermatic cord, tuba lesions, bleeding and apnoea, haematoma/scrotal oedema, hydrocele, wound infection, iatrogenic ascent of the testis and testicular atrophy), contralateral patent processus vaginalis (CPPV) rate, post-operative pain, length of hospital stay and cosmetic appearance of the wound.
RESULTS
Fifteen studies (n = 3680 patients, age range 0.5-12 years, follow-up range 3-10 months) were included is this systematic review. Intra-corporeal hernia repair was performed in 738 children and extra-corporeal repair was performed in 2942 children. A pooled data analysis could only be performed for the single port extra-corporeal closing technique and the three port intra-corporeal closing technique. We found that recurrence rate was lower in the single-port extra-corporeal closing technique compared to the intra-corporeal purse suture closing technique (0.6% vs 5.5%, 95% CI 0.107 (0.024-0.477); p < 0.001). Operation time was shorter for extra-corporeal unilateral and bilateral inguinal hernia repair compared with intra-corporeal approach, but no pooled data analysis could be performed. Due to the presence of substantial heterogeneity, it was not possible to assess other outcome measures.
CONCLUSION
Single-port extra-corporeal closure seems to result in less recurrent hernias and a shorter operative time compared to intra-corporeal purse suture closing technique. No difference regarding peri‑ and post-operative complications could be found and no statements regarding the length of hospital admission, post-operative pain and cosmetics could be made due to substantial heterogeneity.
LEVEL OF EVIDENCE
Level II.
Topics: Child; Data Analysis; Hernia, Inguinal; Herniorrhaphy; Humans; Infant; Infant, Newborn; Laparoscopy; Male; Prospective Studies; Treatment Outcome
PubMed: 33674123
DOI: 10.1016/j.jpedsurg.2021.01.049 -
Journal of Pediatric Urology Dec 2021The exact correlation of testicular microlithiasis (TM) with benign and malignant conditions remains unknown, especially in the paediatric population. The potential... (Review)
Review
The prognostic value of testicular microlithiasis as an incidental finding for the risk of testicular malignancy in children and the adult population: A systematic review. On behalf of the EAU pediatric urology guidelines panel.
INTRODUCTION
The exact correlation of testicular microlithiasis (TM) with benign and malignant conditions remains unknown, especially in the paediatric population. The potential association of TM with testicular malignancy in adulthood has led to controversy regarding management and follow-up.
OBJECTIVE
To determine the prognostic importance of TM in children in correlation to the risk of testicular malignancy or infertility and compare the differences between the paediatric and adult population.
STUDY DESIGN
We performed a literature review of the Medline, Embase and Cochrane controlled trials databases until November 2020 according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) Statement. Twenty-six publications were included in the analysis.
RESULTS
During the follow-up of 595 children with TM only one patient with TM developed a testicular malignancy during puberty. In the other 594 no testicular malignancy was found, even in the presence of risk factors. In the adult population, an increased risk for testicular malignancy in the presence of TM was found in patients with history of cryptorchidism (6% vs 0%), testicular malignancy (22% vs 2%) or sub/infertility (11-23% vs 1.7%) compared to TM-free. The difference between paediatric and adult population might be explained by the short duration of follow-up, varying between six months and three years. With an average age at inclusion of 10 years and testicular malignancies are expected to develop from puberty on, testicular malignancies might not yet have developed.
CONCLUSION
TM is a common incidental finding that does not seem to be associated with testicular malignancy during childhood, but in the presence of risk factors is associated with testicular malignancy in the adult population. Routine monthly self-examination of the testes is recommended in children with contributing risk factors from puberty onwards. When TM is still present during transition to adulthood a more intensive follow-up could be considered.
Topics: Adult; Calculi; Child; Humans; Incidental Findings; Lithiasis; Male; Prognosis; Testicular Diseases; Testicular Neoplasms; Ultrasonography; Urology
PubMed: 34217588
DOI: 10.1016/j.jpurol.2021.06.013