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European Urology Sep 2012Perioperative complications are a major surgical outcome for radical prostatectomy (RP). (Meta-Analysis)
Meta-Analysis Review
CONTEXT
Perioperative complications are a major surgical outcome for radical prostatectomy (RP).
OBJECTIVE
Evaluate complication rates following robot-assisted RP (RARP), risk factors for complications after RARP, and surgical techniques to improve complication rates after RARP. We also performed a cumulative analysis of all studies comparing RARP with retropubic RP (RRP) or laparoscopic RP (LRP) in terms of perioperative complications.
EVIDENCE ACQUISITION
A systematic review of the literature was performed in August 2011, searching Medline, Embase, and Web of Science databases. A free-text protocol using the term radical prostatectomy was applied. The following limits were used: humans; gender (male); and publications dating from January 1, 2008. A cumulative analysis was conducted using Review Manager software v.4.2 (Cochrane Collaboration, Oxford, UK).
EVIDENCE SYNTHESIS
We retrieved 110 papers evaluating oncologic outcomes following RARP. Overall mean operative time is 152 min; mean blood loss is 166 ml; mean transfusion rate is 2%; mean catheterization time is 6.3 d; and mean in-hospital stay is 1.9 d. The mean complication rate was 9%, with most of the complications being of low grade. Lymphocele/lymphorrea (3.1%), urine leak (1.8%), and reoperation (1.6%) are the most prevalent surgical complications. Blood loss (weighted mean difference: 582.77; p<0.00001) and transfusion rate (odds ratio [OR]: 7.55; p<0.00001) were lower in RARP than in RRP, whereas only transfusion rate (OR: 2.56; p=0.005) was lower in RARP than in LRP. All the other analyzed parameters were similar, regardless of the surgical approach.
CONCLUSIONS
RARP can be performed routinely with a relatively small risk of complications. Surgical experience, clinical patient characteristics, and cancer characteristics may affect the risk of complications. Cumulative analyses demonstrated that blood loss and transfusion rates were significantly lower with RARP than with RRP, and transfusion rates were lower with RARP than with LRP, although all other features were similar regardless of the surgical approach.
Topics: Chi-Square Distribution; Evidence-Based Medicine; Humans; Laparoscopy; Male; Odds Ratio; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Risk Assessment; Risk Factors; Robotics; Surgery, Computer-Assisted; Time Factors; Treatment Outcome
PubMed: 22749853
DOI: 10.1016/j.eururo.2012.05.044 -
Andrologia Dec 2017The aim of this study was to investigate the relationship between mean platelet volume (MPV), platelet distribution width (PDW), platelet count (PC) and erectile... (Meta-Analysis)
Meta-Analysis Review
The aim of this study was to investigate the relationship between mean platelet volume (MPV), platelet distribution width (PDW), platelet count (PC) and erectile dysfunction (ED). We searched for observational studies from PubMed, EMBASE, Web of Science and CNKI up to 31 March 2016. Two reviewers independently selected the studies and extracted the data. MPV, PDW, and PC and mean differences in these platelet indices between healthy subjects and ED patients were explored using the Comprehensive Meta-Analysis software package. Seven studies including 795 patients and 524 healthy subjects met the inclusion criteria. The MPV was significantly larger in patients with ED than controls with the standardised mean difference of 0.596 fL (95% CI: 0.378, 0.815, p < 0.001). In ED patients, the pooled mean difference in MPV between vasculogenic ED patients and nonvasculogenic ED patients was 0.706 fL in case-control studies (95% CI: 0.410, 1.002, p < 0.001). There was no significant difference in PDW and PC between healthy subjects and ED patients. The available data suggest that larger MPV was associated with ED. Patients with vasculogenic ED tend to have higher MPV than nonvasculogenic ED patients. Further studies are needed to assess whether increased MPV in ED patients is associated with increased cardiovascular disease.
Topics: Blood Platelets; Erectile Dysfunction; Humans; Male; Mean Platelet Volume; Platelet Count
PubMed: 28271535
DOI: 10.1111/and.12777 -
Platelets Dec 2016The aim of this study was to elucidate the diagnostic and prognostic roles of the mean platelet volume (MPV) in various malignant tumors through a systematic review and... (Meta-Analysis)
Meta-Analysis Review
The aim of this study was to elucidate the diagnostic and prognostic roles of the mean platelet volume (MPV) in various malignant tumors through a systematic review and meta-analysis. The current study included 2,053 patients and 1,396 healthy subjects in 18 eligible studies. We performed a meta-analysis of MPV levels and the mean difference between healthy subjects and pre- and post-treatment patients. Subgroup analysis was conducted based on specific organs and platelet counts. In addition, the correlation between MPV and survival was investigated. The pooled MPVs of healthy subjects, pre-treatment, and post-treatment patients were 8.428 fL (95% confidence interval [CI] 8.118-8.738), 8.831 fL (95% CI 8.582-9.087), and 8.521 fL (95% CI 8.162-8.880), respectively. The mean difference in MPV between healthy subjects and pre-treatment patients was 0.502 (95% CI 0.285-0.719, P < 0.001). However, in lung cancer, the mean difference between pre-treatment patients and healthy subjects was -0.352 (95% CI -0.763-0.060, P = 0.094). The pooled MPV of post-treatment patients was significantly decreased compared to pre-treatment patients. There was no correlation between MPV and disease-free survival rate (hazard ratio 1.033, 95% CI 0.369-2.895). Our results showed that the MPV level was significantly higher in malignant tumors than in healthy subjects and was decreased after treatment. Further cumulative studies will be required before MPV levels can be applied for screening malignant tumors and predicting prognosis.
Topics: Case-Control Studies; Humans; Mean Platelet Volume; Neoplasms; Platelet Count; Prognosis; Treatment Outcome
PubMed: 27162007
DOI: 10.3109/09537104.2016.1169265 -
Anesthesia and Analgesia Mar 2016Xenon anesthesia has been studied for decades. However, no meta-analysis of randomized controlled trials (RCTs) on xenon anesthesia has been conducted. The aim of this... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Xenon anesthesia has been studied for decades. However, no meta-analysis of randomized controlled trials (RCTs) on xenon anesthesia has been conducted. The aim of this study was to systematically review all available evidence from RCTs comparing xenon and other inhaled and IV anesthetics on anesthetic outcomes. Our meta-analysis attempted to quantify the effects of xenon anesthesia on clinical outcomes in relation to other anesthetics.
METHODS
We found 43 RCTs from PubMed, MEDLINE, CENTRAL, EMBASE, and CINAHL (until January 2015). A total of 31 studies comparing xenon (841 patients) with other inhaled agents (836 patients) and 12 studies comparing xenon (373 patients) with propofol (360 patients) were found. We evaluated clinical outcomes, such as intraoperative hemodynamics, emergence, and postoperative nausea and vomiting (PONV).
RESULTS
Patients undergoing xenon anesthesia had a lower heart rate and higher mean arterial pressure (MAP) intraoperatively than those receiving volatile anesthesia (mean difference = -6 min⁻¹ [99% confidence interval {99% CI} -10.0 to -2.3]; mean difference = 9 mm Hg [99% CI 3.1-14.4]) and propofol anesthesia (mean difference = -10 min⁻¹ [99% CI -12.4 to -6.6]; mean difference = 7 mm Hg [99% CI 0.85-13.2]). Compared with baseline, intraoperative MAP remained relatively stable (change < 5.5%, 99% CI within ±20% of the baseline) under xenon anesthesia, but MAP decreased by ≥15% under volatile (mean difference = -17 mm Hg [99% CI -29.5 to - 4.9], percentage change = -17.5%) and propofol (mean difference = -14 mm Hg [99% CI -26.1 to -2.5], percentage change = -15.0%) anesthesia. Patients had faster emergence from xenon than from volatile anesthesia: eyes opening (versus all volatile agents: mean 4 vs 7 minutes, percentage change = -49.8% [99% CI -55.1% to -44.0%]), tracheal extubation (versus all volatile agents: mean 4 vs 8 minutes percentage change = -44.6% [99% CI -57.3% to -28.1%]), orientation (versus sevoflurane: mean 5 vs 10 minutes, percentage change = -45.1% [99% CI -58.5% to -28.1%]), countdown (versus sevoflurane: mean 6 vs 10 minutes, percentage change = -41.7% [99% CI -50.3% to -31.6%]; versus isoflurane: mean 6 vs 14 minutes, percentage change = -57.7% [99% CI -65.7% to -48.3%]), and reaction on demand (versus sevoflurane: mean 4 vs 8 minutes, percentage change = -53.2% [99% CI -65.7% to -35.6%]). However, xenon anesthesia increased the risks of PONV (incidence 34.4% vs 19.9%; risk ratio = 1.72 [99% CI 1.10-2.69], risk difference = 0.19 [99% CI 0.04-0.33]).
CONCLUSIONS
Xenon anesthesia provides relatively more stable intraoperative blood pressure, lower heart rate, and faster emergence from anesthesia than volatile and propofol anesthesia. However, xenon is associated with a higher incidence of PONV.
Topics: Anesthesia, Inhalation; Anesthetics, Inhalation; Humans; Postoperative Complications; Postoperative Nausea and Vomiting; Randomized Controlled Trials as Topic; Xenon
PubMed: 26273750
DOI: 10.1213/ANE.0000000000000914 -
Journal of Contemporary Brachytherapy Jun 2021The aim of this study was to evaluate the efficacy and vision-threatening complications of brachytherapy with ruthenium-106 (Ru) plaque to treat uveal melanoma. (Review)
Review
PURPOSE
The aim of this study was to evaluate the efficacy and vision-threatening complications of brachytherapy with ruthenium-106 (Ru) plaque to treat uveal melanoma.
MATERIAL AND METHODS
A literature review was performed based on results from searching PubMed, Embase, Web of Science, Scopus, and Cochrane databases, using the following key words: "choroidal melanoma", "uveal melanoma", "brachytherapy", and "ruthenium-106". We included studies performed on more than 30 patients since 1986, reporting on local control rate, complications rate, mean radiation dose, and mean tumor thickness. The cumulative analysis was performed using Metaprop command of Stata v.16, and meta-regression was conducted based on mean tumor thickness and mean radiation dose to tumor's apex.
RESULTS
Twenty-one retrospective studies were selected, involving 3,913 patients treated primarily with Ru plaque brachytherapy. The range of radiation dose to tumor apex was from 70 Gy to 250 Gy. The local control rate following brachytherapy ranged from 59% to 98%, and the overall weighted mean of local control was 84%. However, the heterogeneity between studies' reports was remarkable ( = 95.40%). Meta-regression based on tumor thickness and mean dose of radiation to the apex showed that the studies' heterogeneity was minimally related to the difference in mean tumor size ( = 92%). The correlation between larger tumor size and lower local control rate was statistically significant (-value = 0.024). There was no significant correlation between the mean radiation dose and local control rate (-value = 0.679). The most commonly reported complications were cataract and radiation-related retinopathy.
CONCLUSIONS
Although the studies' heterogeneity was high, in a prescription dose ranging from 70 Gy to 250 Gy to the tumor apex, Ru brachytherapy seems to be successful in local control of uveal melanoma. The efficacy of Ru in controlling uveal melanomas decreased with the increase in tumor thickness. However, these outcomes should be verified in randomized comparative studies.
PubMed: 34122577
DOI: 10.5114/jcb.2021.106191 -
The Journal of Obstetrics and... Jul 2022To determine the effect of salpingectomy on ovarian reserve. (Meta-Analysis)
Meta-Analysis Review
AIM
To determine the effect of salpingectomy on ovarian reserve.
METHODS
PubMed, EMBASE, Web of Science, Dynamed plus, and Cochrane Controlled Trials Register databases were searched from their inception to December 2020 to identify relevant studies, including cross-sectional studies, retrospective studies, and randomized controlled trials. Studies that compared anti-Müllerian hormone (AMH) levels and/or antral follicle count (AFC) between the control and salpingectomy groups or before and after surgery were included.
RESULTS
Twenty-one articles were included in the systematic review. Meta-analyses were performed on 16 studies in which data were presented as mean ± SD values. A meta-analysis comparing AMH levels before and after surgery in the same patients showed no significant decrease in all cases, irrespective of whether it was unilateral or bilateral salpingectomy. There was no significant decrease in the AFC in the meta-analysis comparing levels before and after bilateral salpingectomy, either. In contrast, in the case-controlled study the salpingectomy group had significantly lower levels of AMH in all meta-analyses of unilateral and bilateral surgery (mean difference: -0.31, 95% confidence interval [CI]: -0.55, -0.07), only unilateral cases (mean difference: -0.28, 95% CI: -0.50, -0.06), and only bilateral cases (mean difference: -0.71, 95% CI: -1.19, -0.23). The salpingectomy group that included unilateral and bilateral cases had significantly lower AFC compared with no-surgery controls (mean difference: -1.31, 95% CI: -2.13, -0.48).
CONCLUSION
Although not conclusive, it does appear that patients who underwent salpingectomy (either unilateral or bilateral) have a decreased ovarian reserve.
Topics: Anti-Mullerian Hormone; Cross-Sectional Studies; Female; Humans; Ovarian Reserve; Retrospective Studies; Salpingectomy
PubMed: 35624527
DOI: 10.1111/jog.15316 -
Diagnostics (Basel, Switzerland) Jun 2022Mean Platelet Volume (MPV) has been suggested as a biomarker for acute appendicitis (AA) in the adult population. The utility of MPV in pediatric AA remains vague. This... (Review)
Review
BACKGROUND
Mean Platelet Volume (MPV) has been suggested as a biomarker for acute appendicitis (AA) in the adult population. The utility of MPV in pediatric AA remains vague. This systematic review and meta-analysis aimed to systematically summarize and compare all relevant data on MPV as a diagnostic biomarker for AA in children.
METHODS
Databases were systematically searched using keywords ((mean platelet volume) OR mpv) AND (appendicitis). The inclusion criteria were all comparative studies of MPV in children aged less than 18 years and diagnosed with AA. Two authors independently assessed the methodological quality using the Downs and Black scale.
RESULTS
We included fourteen studies in the final meta-analysis; most were retrospective. Eight studies compared the MPV values between AA and non-AA; four studies compared the same between AA and healthy controls; two studies compared the MPV values among all three groups. The estimated heterogeneity among the studies for all outcomes was high and statistically significant. The pooling the data showed no statistically significant difference in MPV (weighted mean difference (WMD) = -0.42, 95% CI = (-1.04, 0.20), = 0.19) between AA and healthy controls or AA and non-AA cases (WMD = 0.01, 95% CI = (-0.15, 0.17), = 0.90).
CONCLUSION
While MPV levels seem to have some utility in adult AA diagnosis, MPV levels should not dictate treatment options in pediatric AA.
PubMed: 35885500
DOI: 10.3390/diagnostics12071596 -
Maturitas Sep 2023In addition to a range of physiological and psychological symptoms, menopause causes a decrement to balance performance and risk of falls. This review aimed to determine... (Meta-Analysis)
Meta-Analysis Review
The comparative effect of exercise interventions on balance in perimenopausal and early postmenopausal women: A systematic review and network meta-analysis of randomised, controlled trials.
In addition to a range of physiological and psychological symptoms, menopause causes a decrement to balance performance and risk of falls. This review aimed to determine the effects of exercise interventions on balance in perimenopausal and early postmenopausal women. Web of Science, PubMed, CINAHL, SPORTDiscus and Cochrane Central Register of Controlled Trials databases were searched. Randomised, controlled trials of exercise interventions in perimenopausal or early postmenopausal populations with an average age of 65 years or younger reporting balance measures were included. Risk of bias was assessed using Cochrane RoB 2. A random effects model network meta-analysis was performed to assess the effect of exercise on balance. Standardised mean differences with 95 % confidence intervals were used as the measure of effect. Twenty-six studies were included after screening. Network meta-analyses were conducted for 5 balance variables. Whole-body vibration (standardised mean difference: 2.25, confidence interval: 0.08; 4.43), balance (standardised mean difference: 1.84, confidence interval: 0.15; 3.53), balance + nutrition (standardised mean difference: 3.81, confidence interval: 1.57; 6.05) and resistance (standardised mean difference: 1.43, confidence interval: 0.41; 2.46) exercise improved Berg balance scale performance. Resistance + aerobic + balance exercise improved one-leg stance (standardised mean difference: 0.80, confidence interval: 0.39; 1.22) and whole-body vibration improved anterior-posterior (standardised mean difference: -0.89, confidence interval: -1.48; -0.31), medio-lateral (standardised mean difference: -0.58, confidence interval: -1.15; -0.01) postural sway and falls indices (standardised mean difference: -0.75, confidence interval: -1.45; -0.04). Exercise improved all balance measures and should be considered as an adjunct therapy in perimenopausal and postmenopausal women. Whole-body vibration was most frequently the highest ranked intervention; resistance and balance training also improved balance.
Topics: Humans; Female; Aged; Network Meta-Analysis; Postmenopause; Perimenopause; Exercise; Exercise Therapy; Randomized Controlled Trials as Topic
PubMed: 37343343
DOI: 10.1016/j.maturitas.2023.107790 -
Arab Journal of Urology Feb 2020To evaluate the complications and results of artificial urinary sphincter (AUS) implantation in women with stress urinary incontinence (SUI). (Review)
Review
OBJECTIVE
To evaluate the complications and results of artificial urinary sphincter (AUS) implantation in women with stress urinary incontinence (SUI).
METHODS
A selective database search using keywords (1990-2019) was conducted to validate the effectiveness of the AUS in women. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilised. The meta-analysis included 964 women (15 studies) with persistent SUI. The Newcastle-Ottawa score was used to determine the quality of the evidence in each study. The success rate and complications associated with the AUS were analysed.
RESULTS
Meta-analysis of the published studies showed that complete continence was achieved at a mean rate of 79.6% (95% confidence interval [CI] 72.2-86.6%) and a significant improvement was achieved in 15% (95% CI 10-25%). The mean (range) follow-up was 22 (6-204) months. The mean number of patients per study was 68. The mean (range) explantation rate was 13 (0-44)%. Vaginal erosion occurred in a mean (range) of 9 (0-27)% and mechanical complications in 13 (0-47)%. Infections accounted for 7% of the complications. The total mean (range) revision rate of the implanted AUS was 15.42 (0-44)%. The mean (range) size of the cuff used was 6.7 (5-10) cm.
CONCLUSION
Our present analysis showed that implantation of an AUS in women with severe UI is an effective treatment option after failure of first-line therapy. However, the currently available study population is too small to draw firm conclusions.
ABBREVIATIONS
AMS: American Medical Systems; AUS: artificial urinary sphincter; EAU: European Association of Urology; LE: Level of Evidence; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; QoL: quality of life; SHELTER: Services and Health for Elderly in Long TERm care (study); SUI: (stress) urinary incontinence.
PubMed: 33029411
DOI: 10.1080/2090598X.2020.1716293 -
Journal of Laparoendoscopic & Advanced... Dec 2017This systematic review and meta-analysis were designed to evaluated the efficacy and safety of stented versus stentless laparoscopic ureterolithotomy (LU). (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
This systematic review and meta-analysis were designed to evaluated the efficacy and safety of stented versus stentless laparoscopic ureterolithotomy (LU).
METHODS
We conducted a systematic review and meta-analysis that included six trials that investigated the outcomes, including the rate of prolonged urine leakage, operative time, time to drain removal, and estimated blood loss, between stented versus stentless LU.
RESULTS
Four studies with 289 participants were included in the study. There was no significant difference between two groups in rate of prolonged urine leakage (odds ratios [OR] 0.35, 95% confidence intervals [CI] 0.09-1.46, p = 0.15). Significant longer operative time was detected in patients who underwent stented LU compared with stentless group (mean difference 11.36, 95% CI 7.53-15.20, P < .00001). There was no significant difference between two groups in day of drain removal (mean difference -1.09, 95% CI -2.33-0.15, P = .08). No significant difference in blood loss in patients who underwent stented LU compared with stentless group was detected (mean difference 7.67, 95% CI -0.29-15.64, P = .06).
CONCLUSION
Our study demonstrated that the rate of prolonged urine leakage, time to drain removal, and estimated blood loss were not significantly different between stented and stentless LU.
Topics: Female; Humans; Male; Operative Time; Postoperative Complications; Stents; Treatment Outcome; Ureter; Ureterolithiasis; Ureteroscopy
PubMed: 28631946
DOI: 10.1089/lap.2017.0183