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International Braz J Urol : Official... 2023COVID-19 continues to be an urgent World issue. Receptors of angiotensin converting enzyme 2 (ACE2), gateway of SARS-CoV-2, are present in the lungs, bladder, prostate,... (Review)
Review
PURPOSE
COVID-19 continues to be an urgent World issue. Receptors of angiotensin converting enzyme 2 (ACE2), gateway of SARS-CoV-2, are present in the lungs, bladder, prostate, and testicles. Therefore, these organs face high risk of damage caused by the virus and this mechanism may explain non-respiratory symptoms of the disease.
MATERIALS AND METHODS
This systematic review, guided by the PRIMSA statement, was proposed to elucidate possible urological complications of COVID-19. Searches were carried out in Medline (PubMed), Cochrane (CENTRAL), Embase, MedRxiv and LILACS. Bias analysis was made using the specific Newcastle-Ottawa Scale for each study design.
RESULTS
Search was carried out until April 2022, and 8,477 articles were identified. Forty-nine of them were included in this systematic review. There is evidence that lower urinary tract symptoms and acute scrotum may be signs of COVID-19 in men, although in a small proportion. Also, the disease may have a transitory impact on male fertility, evidenced by several alterations in sperm counts. However, it must be clarified whether this impact is transitory, or may last for longer periods. Several patients showed reduction of total value of testosterone. Two authors linked low levels of testosterone with worse outcomes of COVID-19, suggesting that the hormone may be used as an early biomarker of the severity of the disease. Moreover, it is extremely unlikely that SARS-CoV-2 is transmitted by semen.
CONCLUSION
This systematic review identified possible repercussions of COVID-19 in the urinary as well as in the male reproductive system.
Topics: Male; Humans; COVID-19; SARS-CoV-2; Semen; Testosterone
PubMed: 36512453
DOI: 10.1590/S1677-5538.IBJU.2022.0281 -
World Journal of Urology Sep 2016To evaluate the efficacy and safety of transurethral enucleation of the prostate (TUEP) versus transvesical open prostatectomy (OP) for the management of large benign... (Comparative Study)
Comparative Study Meta-Analysis Review
Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials.
PURPOSE
To evaluate the efficacy and safety of transurethral enucleation of the prostate (TUEP) versus transvesical open prostatectomy (OP) for the management of large benign prostatic hyperplasia (BPH).
METHODS
Randomized controlled trials (RCTs) comparing TUEP and OP were identified from PubMed, Embase and Web of Science up to February 28, 2015. A meta-analysis was conducted with the STATA 12.0 software.
RESULTS
Nine RCTs including 758 patients were enrolled in our meta-analysis. There were no significant differences between the two groups in the maximum urinary flow rate at 1, 3, 6 months, 1 and 2 years: postvoiding residual urinary volume, prostate-specific antigen, international prostate symptom score and quality of life score at 1, 3, 6 months and 1 year; or international index of erectile function at 3, 6 months and 1 year. Perioperative outcomes including hemoglobin level drop, catheter period, irrigation length and hospital stay favored TUEP, while operative time and resected prostate weight favored OP. There was significantly less blood transfusion with TUEP, but no significant differences were found in other complications such as recatheterization, urinary tract infection, reintervention for clots and bleeding control, incidence of pneumonia and infarction, transient incontinence, bladder neck contracture, urethral stricture and recurrent adenoma.
CONCLUSIONS
TUEP can be performed effectively and safely with functional outcomes and complications similar to OP for large BPH, whereas it has the advantages of a shorter catheter period, shorter hospital stays and less blood transfusion. These findings seem to support TUEP as the next-generation "gold standard" of surgery for large BPH.
Topics: Humans; Male; Prostatectomy; Prostatic Hyperplasia; Randomized Controlled Trials as Topic; Urethra; Urinary Bladder
PubMed: 26699627
DOI: 10.1007/s00345-015-1735-9 -
BJU International May 2016To compare the incidence of infective complications after transrectal ultrasonography (TRUS)-guided biopsy with either empirical fluoroquinolone or culture-based... (Review)
Review
To compare the incidence of infective complications after transrectal ultrasonography (TRUS)-guided biopsy with either empirical fluoroquinolone or culture-based targeted antimicrobial prophylaxis, and the prevalence of fluoroquinolone resistance (FQ-R) in men undergoing prostate biopsy. A systematic review of the literature was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included studies of patients undergoing TRUS-guided biopsy that compared infective outcomes of those who received targeted antimicrobial therapy based on the results of pre-procedural rectal swab cultures, with those receiving empiric fluoroquinolone antimicrobial prophylaxis. The prevalence of FQ-R was recorded as a secondary outcome measure. Studies with no control group were excluded. From 125 studies screened, nine studies (4 571 patients) met the inclusion criteria. All studies were of cohort design, and included a combination of retrospective and prospective data. Six studies included were undertaken in North America. The remaining studies were undertaken in Spain, Turkey and Columbia. Within these studies, 2 484 (54.3%) patients received empirical fluoroquinolone prophylaxis, whilst 2 087 (45.7%) patients had pre-biopsy rectal swabs and targeted antibiotics. The mean FQ-R was 22.8%. Post-biopsy infection and sepsis rates were significantly higher in groups given empirical prophylaxis (4.55% and 2.21%) compared with groups receiving targeted antibiotics (0.72% and 0.48%). Based on these results 27 men would need to receive targeted antibiotics to prevent one infective complication. Our systematic review suggests that targeted prophylactic antimicrobial therapy before TRUS-guided prostate biopsy is associated with lower rates of sepsis. We therefore recommend changing current pathways to adopt this measure.
Topics: Anti-Infective Agents; Antibiotic Prophylaxis; Drug Resistance, Microbial; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Fluoroquinolones; Humans; Infections; Male; Prevalence; Prostate; Prostatic Neoplasms
PubMed: 26709240
DOI: 10.1111/bju.13402 -
European Urology Dec 2013Prostate biopsy is commonly performed for cancer detection and management. The benefits and risks of prostate biopsy are germane to ongoing debates about prostate cancer... (Review)
Review
CONTEXT
Prostate biopsy is commonly performed for cancer detection and management. The benefits and risks of prostate biopsy are germane to ongoing debates about prostate cancer screening and treatment.
OBJECTIVE
To perform a systematic review of complications from prostate biopsy.
EVIDENCE ACQUISITION
A literature search was performed using PubMed and Embase, supplemented with additional references. Articles were reviewed for data on the following complications: hematuria, rectal bleeding, hematospermia, infection, pain, lower urinary tract symptoms (LUTS), urinary retention, erectile dysfunction, and mortality.
EVIDENCE SYNTHESIS
After biopsy, hematuria and hematospermia are common but typically mild and self-limiting. Severe rectal bleeding is uncommon. Despite antimicrobial prophylaxis, infectious complications are increasing over time and are the most common reason for hospitalization after biopsy. Pain may occur at several stages of prostate biopsy and can be mitigated by anesthetic agents and anxiety-reduction techniques. Up to 25% of men have transient LUTS after biopsy, and <2% have frank urinary retention, with slightly higher rates reported after transperineal template biopsy. Biopsy-related mortality is rare.
CONCLUSIONS
Preparation for biopsy should include antimicrobial prophylaxis and pain management. Prostate biopsy is frequently associated with minor bleeding and urinary symptoms that usually do not require intervention. Infectious complications can be serious, requiring prompt management and continued work into preventative strategies.
Topics: Bacterial Infections; Biopsy, Needle; Erectile Dysfunction; Humans; Male; Pain; Prostate
PubMed: 23787356
DOI: 10.1016/j.eururo.2013.05.049 -
Frontiers in Oncology 2022We aimed to conduct a systematic review and meta-analysis of studies reporting functional and oncologic outcomes of combining whole-gland high-intensity focused...
Whole-gland high-intensity focused ultrasound ablation and transurethral resection of the prostate in the patients with prostate cancer: A systematic review and meta-analysis.
BACKGROUND
We aimed to conduct a systematic review and meta-analysis of studies reporting functional and oncologic outcomes of combining whole-gland high-intensity focused ultrasound ablation (HIFU) with transurethral resection of the prostate (TURP) in prostate cancer (PCa) patients.
METHODS
PubMed, Embase, Web of Science, Scopus, and Cochrane Library were systematically searched until June 30, 2022. The ROBINS-I tool scale was used to evaluate quality of eligible studies. Biochemical failure was defined according to the criteria used in each raw study. The presence of any cancer on follow-up biopsy was classified as "positive biopsy". Patients able to penetrate their partner without pharmacologic support were rated potent. Meta-analysis was performed to evaluate functional outcomes using R project.
RESULTS
A total of 1861 patients in 15 eligible studies were included. All studies were identified as moderate or high quality. There were 1388 (74.6%) patients with low-risk or intermediate-risk PCa in 15 studies and 473 (25.4%) patients with high-risk PCa in 12 studies. The mean PSA nadir postoperatively ranged from 0.20 to 1.90 ng/mL within average time of 1.9-12 months. Biochemical failure rates in all 15 studies ranged from 6.3% to 34% within average time of 1.9-60 months. Eleven studies reported the rates of positive biopsy ranged from 3% to 29.7% within average time of 3-12 months postoperatively. Based on the results of single-arm meta-analysis, the pooled rates of any degree urinary incontinence, acute urinary retention, urinary tract infections, and urethral stricture were 9.4% (95% CI: 6.1%-12.6%), 0.9% (95% CI: 0%-2%), 2.6% (95% CI: 0.8%-4.3%), and 4.3% (95% CI: 1.4%-7.1%), respectively. The pooled rate of being potent after procedure in previously potent patients was 43.6% (95% CI: 27.3%-59.8%). The sensitivity analysis revealed all the pooled results was relatively reliable. Egger's tests for the pooled results of acute urinary retention ( = 0.0651) and potency ( = 0.6749) both did not show significant publication bias.
CONCLUSIONS
It appears that the combination treatment of whole-gland HIFU and TURP could be applied for PCa patients. It might have potential advantages of decreasing catheterization time and improving urinary status. Prospective and comparative studies are needed to validate our findings.
PubMed: 36313706
DOI: 10.3389/fonc.2022.988490 -
The Journal of Urology Mar 2021We identify which nonantibiotic strategies could reduce the risk of infectious complications following prostate biopsy. (Meta-Analysis)
Meta-Analysis
PURPOSE
We identify which nonantibiotic strategies could reduce the risk of infectious complications following prostate biopsy.
MATERIALS AND METHODS
We performed a literature search on MEDLINE®, Embase® and the Cochrane Database for randomized controlled trials (inception to May 2020) assessing nonantibiotic interventions in prostate biopsy. Primary outcome was pooled infectious complications (fever, sepsis and symptomatic urinary tract infection) and secondary outcome was hospitalization. Cochrane risk of bias tool and GRADE approach were used to assess the bias and the certainty of evidence. The study protocol was registered with PROSPERO (CRD42015026354).
RESULTS
A total of 90 randomized controlled trials (16,941 participants) were included in the analysis, with 83 trials being categorized into one of 10 different interventions. Transperineal biopsy was associated with significantly reduced infectious complications as compared to transrectal biopsy (RR 0.55, 95% CI 0.33-0.92, p=0.02, I=0%, 1,330 participants, 7 studies). Rectal preparation with povidone-iodine was also shown to reduce infectious complications (RR 0.50, 95% CI 0.38-0.65, p <0.000001, I=27%, 1,686 participants, 8 studies) as well as hospitalization (RR 0.38, 95% CI 0.21-0.69, p=0.002, I=0%, 620 participants, 4 studies). We found no difference in infectious complications/hospitalization for 6 other interventions, ie number of biopsy cores, periprostatic nerve block, number of injections for periprostatic nerve block, needle guide type, needle type and rectal preparation with enema. In 2 interventions (needle diameter, rectal preparation with chlorhexidine) meta-analysis was not possible. Finally, 7 studies had unique interventions. The certainty of evidence was rated as low/very low for all interventions.
CONCLUSIONS
Transperineal biopsy significantly reduces infectious complications compared to transrectal biopsy and should therefore be preferred. If transrectal biopsy is performed, rectal preparation with povidone-iodine is highly recommended. The other investigated nonantibiotic strategies did not significantly influence infection and hospitalization after prostate biopsy.
Topics: Anti-Infective Agents, Local; Bacterial Infections; Biopsy; Humans; Male; Postoperative Complications; Povidone-Iodine; Prostate; Randomized Controlled Trials as Topic; Urinary Tract Infections
PubMed: 33026903
DOI: 10.1097/JU.0000000000001399 -
International Urology and Nephrology Aug 2016Although frequent use of prophylactic antibiotics for patients undergoing transrectal prostate biopsy (TRPB), incidences of urinary tract infection (UTI) and bacterial... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Although frequent use of prophylactic antibiotics for patients undergoing transrectal prostate biopsy (TRPB), incidences of urinary tract infection (UTI) and bacterial resistance are still increasing. We evaluated the efficacy of augmented prophylactic antibiotics in patients undergoing TRPB.
METHODS
A systematic search of Embase(®), PubMed(®), and the Cochrane Library was executed to identify all eligible studies that compared the effects of augmented antibiotic prophylaxis (combined drugs) with single antibiotic prophylaxis on behalf of patients undergoing TRPB. Outcomes qualified in this review included bacteriuria, bacteremia, drug-resistant bacteria on urine culture, drug-resistant bacteria on blood culture, fever, UTI, sepsis, and hospitalization.
RESULTS
A total of eight publications were identified and included in the review, including three randomized controlled trials with 659 patients and five case-control studies involving 3404 patients. All outcomes, including bacteriuria [relative risk (RR) 4.25, 95 % confidence interval (CI) 1.96-9.22, P = 0.0003], bacteremia (RR 4.96, 95 % CI 2.31-10.67, P < 0.0001), drug-resistant bacteriuria (RR 3.52, 95 % CI 1.41-8.78, P = 0.007), drug-resistant bacteremia (RR 4.94, 95 % CI 2.17-11.24, P = 0.0001), fever (RR 2.75, 95 % CI 1.63-4.62, P = 0.0001), UTI (RR 3.76, 95 % CI 2.57-5.48, P < 0.00001), and hospitalization (RR 3.90, 95 % CI 2.64-5.75, P < 0.00001) significantly favored the augmented antibiotic use.
CONCLUSIONS
One additional type of antibiotic (usually one single dose) added to the basic antibiotic prophylaxis modality, defined as augmented prophylaxis, could contribute to the reduction in severe infection and drug resistance, particularly in high-risk patients.
Topics: Antibiotic Prophylaxis; Biopsy; Humans; Male; Prostatic Neoplasms; Rectum; Treatment Outcome; Urinary Tract Infections
PubMed: 27160220
DOI: 10.1007/s11255-016-1299-7 -
World Journal of Urology Mar 2024To characterize patient outcomes following visually directed high-intensity focused ultrasound (HIFU) for focal treatment of localized prostate cancer. (Meta-Analysis)
Meta-Analysis
PURPOSE
To characterize patient outcomes following visually directed high-intensity focused ultrasound (HIFU) for focal treatment of localized prostate cancer.
METHODS
We performed a systematic review of cancer-control outcomes and complication rates among men with localized prostate cancer treated with visually directed focal HIFU. Study outcomes were calculated using a random-effects meta-analysis model.
RESULTS
A total of 8 observational studies with 1,819 patients (median age 67 years; prostate-specific antigen 7.1 mg/ml; prostate volume 36 ml) followed over a median of 24 months were included. The mean prostate-specific antigen nadir following visually directed focal HIFU was 2.2 ng/ml (95% CI 0.9-3.5 ng/ml), achieved after a median of 6 months post-treatment. A clinically significant positive biopsy was identified in 19.8% (95% CI 12.4-28.3%) of cases. Salvage treatment rates were 16.2% (95% CI 9.7-23.8%) for focal- or whole-gland treatment, and 8.6% (95% CI 6.1-11.5%) for whole-gland treatment. Complication rates were 16.7% (95% CI 9.9-24.6%) for de novo erectile dysfunction, 6.2% (95% CI 0.0-19.0%) for urinary retention, 3.0% (95% CI 2.1-3.9%) for urinary tract infection, 1.9% (95% CI 0.1-5.3%) for urinary incontinence, and 0.1% (95% CI 0.0-1.4%) for bowel injury.
CONCLUSION
Limited evidence from eight observational studies demonstrated that visually directed HIFU for focal treatment of localized prostate cancer was associated with a relatively low risk of complications and acceptable cancer control over medium-term follow-up. Comparative, long-term safety and effectiveness results with visually directed focal HIFU are lacking.
Topics: Male; Humans; Aged; Prostate-Specific Antigen; Treatment Outcome; Ultrasound, High-Intensity Focused, Transrectal; Prostatic Neoplasms; Erectile Dysfunction
PubMed: 38507093
DOI: 10.1007/s00345-024-04840-6 -
European Urology Open Science Jun 2023Rectal injury (RI) is a dreaded complication after radical prostatectomy (RP), increasing the risk of early postoperative complications, such as bleeding and severe... (Review)
Review
CONTEXT
Rectal injury (RI) is a dreaded complication after radical prostatectomy (RP), increasing the risk of early postoperative complications, such as bleeding and severe infection/sepsis, and late sequelae, such as a rectourethral fistula (RUF). Considering its traditionally low incidence, uncertainty remains as to predisposing risk factors and management.
OBJECTIVE
To examine the incidence of RI after RP in contemporary series and to propose a pragmatic algorithm for its management.
EVIDENCE ACQUISITION
A systematic literature search was performed using the Medline and Scopus databases. Studies reporting data on RI incidence were selected. Subgroup analyses were conducted to assess the differential incidence by age, surgical approach, salvage RP after radiation therapy, and previous benign prostatic hyperplasia (BPH)-related surgery.
EVIDENCE SYNTHESIS
Eighty-eight, mostly retrospective noncomparative, studies were selected. The meta-analysis obtained a pooled RI incidence of 0.58% (95% confidence interval [CI] 0.46-0.73) in contemporary series with significant across-study heterogeneity (I = 100%, < 0.00001). The highest RI incidence was found in patients undergoing open RP (1.25%; 95% CI 0.66-2.38) and laparoscopic RP (1.25%; 95% CI 0.75-2.08) followed by perineal RP (0.19%; 95% CI 0-276.95) and robotic RP (0.08%; 95% CI 0.02-0.31). Age ≥60 yr (0.56%; 95% CI 0.37-06) and salvage RP after radiation therapy (6.01%; 95% CI 3.99-9.05), but not previous BPH-related surgery (4.08%, 95% CI 0.92-18.20), were also associated with an increased RI incidence. Intraoperative versus postoperative RI detection was associated with a significantly decreased risk of severe postoperative complications (such as sepsis and bleeding) and subsequent formation of a RUF.
CONCLUSIONS
RI is a rare, but potentially devastating, complication following RP. RI incidence was higher in patients ≥60 yr of age, and in those who underwent open/laparoscopic approach or salvage RP after radiation therapy. Intraoperative RI detection and repair apparently constitute the single most critical step to significantly decrease the risk of major postoperative complications and subsequent RUF formation. Conversely, intraoperatively undetected RI can lead more often to severe infective complications and RUF, the management of which remains poorly standardised and requires complex procedures.
PATIENT SUMMARY
Accidental rectum tear is a rare, but potentially devastating, complication in men undergoing prostate removal for cancer. It occurs more often in patients aged 60 yr or older as well as in those who underwent prostate removal via an open/laparoscopic approach and/or prostate removal after radiation therapy for recurrent disease. Prompt identification and repair of this condition during the initial operation are the key to reduce further complications such as the formation of an abnormal opening between the rectum and the urinary tract.
PubMed: 37213241
DOI: 10.1016/j.euros.2023.03.017 -
Anticancer Research Feb 2017To present a summary of the updated guidelines of the Italian Prostate Biopsies Group following the best recent evidence of the literature. (Review)
Review
AIM
To present a summary of the updated guidelines of the Italian Prostate Biopsies Group following the best recent evidence of the literature.
MATERIALS AND METHODS
A systematic review of the new data emerging from 2012-2015 was performed by a panel of 14 selected Italian experts in urology, pathology and radiology. The experts collected articles published in the English-language literature by performing a search using Medline, EMBASE and the Cochrane Library database. The articles were evaluated using a systematic weighting and grading of the level of the evidence according to the Grading of Recommendations Assessment, Development and Evaluation framework system.
RESULTS
An initial prostate biopsy is strongly recommended when i) prostate specific antigen (PSA) >10 ng/ml, ii) digital rectal examination is abnormal, iii) multiparametric magnetic resonance imaging (mpMRI) has a Prostate Imaging Reporting and Data System (PIRADS) ≥4, even if it is not recommended. The use of mpMRI is strongly recommended only in patients with previous negative biopsy. At least 12 cores should be taken in each patient plus targeted (fusion or cognitive) biopsies of suspicious area (at mpMRI or transrectal ultrasound). Saturation biopsies are optional in all settings. The optimal strategy for reducing infection complications is still a controversial topic and the instruments to reduce them are actually weak. The adoption of Gleason grade groups in adjunction to the Gleason score when reporting prostate biopsy results is advisable.
CONCLUSION
These updated guidelines and recommendations are intended to assist physicians and patients in the decision-making regarding when and how to perform a prostatic biopsy.
Topics: Biopsy; Humans; Male; Practice Guidelines as Topic; Prostatic Neoplasms
PubMed: 28179286
DOI: 10.21873/anticanres.11333