-
Frontiers in Medicine 2022Infections in the male genitourinary system with bacterial and viral agents may play a significant role in male infertility. These agents usually infect the urethra,...
OBJECTIVES
Infections in the male genitourinary system with bacterial and viral agents may play a significant role in male infertility. These agents usually infect the urethra, seminal vesicles, prostate, epididymis, vas deferens, and testes retrograde through the reproductive system. A meta-analysis review study was performed to evaluate the presence of bacterial and viral agents in the semen of infertile men and its correlation with infertility.
METHODS
Relevant cross-sectional and/or case-control studies were found by an online review of national and international databases (Web of Science, PubMed, Scopus, Science Direct, and Google scholar), and suitable studies were selected. A checklist determined the qualities of all studies. Heterogeneity assay among the primary studies was evaluated by Cochran's test and I index (significance level 50%). A statistical analysis was conducted using the Comprehensive Stata ver. 14 package (StataCorp, College Station, TX, United States).
RESULTS
Seventy-two studies were included in this meta-analysis. Publication bias was compared with Egger's test, and the impact of each research on overall estimate was evaluated by sensitivity analysis. In 56 studies, the rate of bacterial infections in the semen of infertile men was 12% [95% confidence interval (CI): 10-13]. Also, in 26 case-control studies, the association of infertility in men with bacterial infections was evaluated. The results show that the odds ratio of infertility in men exposed to bacterial infections is 3.31 times higher than that in non-infected men (95% CI: 2.60-4.23). Besides, in 9 studies that examined the prevalence of human papillomavirus (HPV), herpes simplex virus 1 (HSV1), herpes simplex virus 2 (HSV2), and herpes simplex virus 1-2 (HSV1-2) in infertile men, the frequency of these viruses was 15% (95% CI: 9-21). In 6 case-control studies, the association between human cytomegalovirus (HCMV), Cytomegalovirus (CMV), and HPV and male infertility was evaluated. The chance of male infertility due to exposure to these viruses was 2.24 times higher than those without exposure to these viruses (CI 95%: 1.9-4.52). The results show that the chance of infertility in men exposed to bacteria was significantly higher than that in the uninfected population.
CONCLUSION
This meta-analysis showed that viral and bacterial infections are a risk factor and could impair male fertility potential. Moreover, our study supports the hypothesis that bacterial and viral infections of the genital tract correlate positively with impairment of sperm quality in the male population.
PubMed: 35602502
DOI: 10.3389/fmed.2022.835254 -
Genetics in Medicine : Official Journal... Aug 2022Polygenic risk influences susceptibility to cancer. We assessed whether polygenic risk scores could be used in conjunction with other predictors of future disease status... (Review)
Review
PURPOSE
Polygenic risk influences susceptibility to cancer. We assessed whether polygenic risk scores could be used in conjunction with other predictors of future disease status in cost-effective risk-stratified screening for cancer.
METHODS
We undertook a systematic review of papers that evaluated the cost-effectiveness of screening interventions informed by polygenic risk scores compared with more conventional screening modalities. We included papers reporting cost-effectiveness outcomes with no restriction on type of cancer or form of polygenic risk modeled. We evaluated studies using the Quality of Health Economic Studies checklist.
RESULTS
A total of 10 studies were included in the review, which investigated 3 cancers: prostate (n = 5), colorectal (n = 3), and breast (n = 2). Of the 10 papers, 9 scored highly (score >75 on a 0-100 scale) when assessed using the quality checklist. Of the 10 studies, 8 concluded that polygenic risk-informed cancer screening was likely to be more cost-effective than alternatives.
CONCLUSION
Despite the positive conclusions of the included studies, it is unclear if polygenic risk stratification will contribute to cost-effective cancer screening given the absence of robust evidence on the costs of polygenic risk stratification, the effects of differential ancestry, potential downstream economic sequalae, and how large volumes of polygenic risk data would be collected and used.
Topics: Cost-Benefit Analysis; Early Detection of Cancer; Humans; Male; Mass Screening; Neoplasms; Risk Factors
PubMed: 35575786
DOI: 10.1016/j.gim.2022.04.020 -
International Journal of Molecular... Apr 2022Positron emission tomography (PET) uses radioactive tracers and enables the functional imaging of several metabolic processes, blood flow measurements, regional chemical... (Review)
Review
Positron emission tomography (PET) uses radioactive tracers and enables the functional imaging of several metabolic processes, blood flow measurements, regional chemical composition, and/or chemical absorption. Depending on the targeted processes within the living organism, different tracers are used for various medical conditions, such as cancer, particular brain pathologies, cardiac events, and bone lesions, where the most commonly used tracers are radiolabeled with 18F (e.g., [F]-FDG and NA [F]). Oxygen-15 isotope is mostly involved in blood flow measurements, whereas a wide array of C-based compounds have also been developed for neuronal disorders according to the affected neuroreceptors, prostate cancer, and lung carcinomas. In contrast, the single-photon emission computed tomography (SPECT) technique uses gamma-emitting radioisotopes and can be used to diagnose strokes, seizures, bone illnesses, and infections by gauging the blood flow and radio distribution within tissues and organs. The radioisotopes typically used in SPECT imaging are iodine-123, technetium-99m, xenon-133, thallium-201, and indium-111. This systematic review article aims to clarify and disseminate the available scientific literature focused on PET/SPECT radiotracers and to provide an overview of the conducted research within the past decade, with an additional focus on the novel radiopharmaceuticals developed for medical imaging.
Topics: Fluorodeoxyglucose F18; Humans; Male; Positron-Emission Tomography; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed
PubMed: 35563414
DOI: 10.3390/ijms23095023 -
Journal of Clinical Medicine Mar 2022The detection of emerging pathogens responsible for genitourinary infections has increased with technological advances. We conducted a systematic review of publications...
Emerging Presence of Culturable Microorganisms in Clinical Samples of the Genitourinary System: Systematic Review and Experience in Specialized Care of a Regional Hospital.
The detection of emerging pathogens responsible for genitourinary infections has increased with technological advances. We conducted a systematic review of publications on the involvement of these microorganisms in genitourinary samples, and we also investigated their presence and antibiotic susceptibility in samples from patients at our regional hospital (Granada, Spain). The MEDLINE database was searched up to 31 December 2020, and a cross-sectional descriptive study was performed of results obtained in urine samples and genital exudates from January 2016 through December 2019. The review highlighted the frequent involvement of in genital infections, while the data on other microorganisms were consistent with findings in our patient series. The emerging microorganisms most often responsible for urinary tract infections were (58.5%) and (23.6%) in females, and (32.3%), (18.6%), and spp. (16.9%) in males; those most frequently reported in genital infections were (36.4%) in females and (32.2%) and (35.6%) in males. In general, emerging pathogens are resistant to conventional antibiotics such as penicillin. However, there has also been an increase in beta-lactam resistance by the group and spp. The systematic review showed that emerging microorganisms are responsible for only a small percentage of genitourinary infections but are of major clinical interest, with a predominance of the group, , spp., spp., and spp. in urine samples and of and in genital samples. Given the increasing resistance to antibiotics empirically prescribed in patients with genitourinary infections, it is recommended to create an antibiogram in all cases.
PubMed: 35268439
DOI: 10.3390/jcm11051348 -
European Urology Open Science Mar 2022Transperineal prostate biopsy is associated with a significantly lower risk of infectious complications than the transrectal approach. In fact, the risk of infectious... (Review)
Review
CONTEXT
Transperineal prostate biopsy is associated with a significantly lower risk of infectious complications than the transrectal approach. In fact, the risk of infectious complications with transperineal prostate biopsy is so low that the utility of administering periprocedural antibiotics with this procedure has come under question.
OBJECTIVE
To perform a systematic review and meta-analysis to assess for differences in the rates of infectious complications (septic, nonseptic, and overall) after performing transperineal prostate biopsy with and without the administration of periprocedural antibiotic prophylaxis.
EVIDENCE ACQUISITION
Three electronic databases (PubMed, Embase, and MEDLINE) were searched, and studies were included if they included patients who underwent transperineal prostate biopsy, were published after January 2000, included information on periprocedural antibiotic administration, and reported postbiopsy complications. Preferred Reporting Items for Systematic Reviews and Meta-analyses and Agency for Healthcare Research and Quality guidelines were utilized.
EVIDENCE SYNTHESIS
A total of 106 unique studies describing 112 cohorts of patients were identified, of which 98 (37 805 men) received antibiotic prophylaxis and 14 (4772 men) did not receive it. All patients were included in the analysis of septic complications. In total, there were 19/37 805 (0.05%) episodes of sepsis in the group of men who received antibiotics, which was similar to the no antibiotic group with 4/4772 (0.08%) episodes ( = 0.2). For overall infections (septic plus nonseptic), there were 403/29 880 (1.35%) versus 58/4772 (1.22%) events among men with evaluable data who received and did not receive antibiotic prophylaxis, respectively ( = 0.8). Restricting our analysis to studies with a comparable low number of biopsy cores (<25 cores), there remained no difference in the rates of sepsis between groups, but there was a small, statistically significant lower risk of infectious complications with antibiotic administration-67/12 140 (0.55%) versus 58/4772 (1.22%; < 0.01).
CONCLUSIONS
The likelihood of septic infections after transperineal prostate biopsy is low with and without antibiotic prophylaxis. The omission of periprocedural antibiotics with this procedure stands to benefit patients by avoiding potential drug reactions. Furthermore, this practice is in line with calls throughout the medical community for improved antibiotic stewardship.
PATIENT SUMMARY
In a large systematic review and meta-analysis, we evaluated infectious complications after transperineal prostate biopsy with or without the administration of prophylactic antibiotics. We conclude that prophylactic antibiotics do not decrease the rate of postbiopsy sepsis but may have a small benefit in terms of preventing less serious infections.
PubMed: 35243391
DOI: 10.1016/j.euros.2022.01.001 -
Frontiers in Surgery 2022To compare incontinence rates and complications in patients receiving artificial urinary sphincter (AUS) with or without radiotherapy (RT).
BACKGROUND
To compare incontinence rates and complications in patients receiving artificial urinary sphincter (AUS) with or without radiotherapy (RT).
METHODS
PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases were searched for studies comparing outcomes of AUS between patients with and without RT. Search limits were from 1st January 2002 to 15th September 2021.
RESULTS
Eighteen studies were included. Meta-analysis revealed statistically significant reduced odds of the absence of incontinence in the RT group (OR: 0.35 95% CI: 0.21, 0.59 = 51% < 0.0001) as compared to the no-RT group. We also noted statistically significant increased risk of revision surgery in the RT group (OR: 1.74 95% CI: 1.16, 2.60 = 73% = 0.07). There was increased risk of infections (OR: 2.51 95% CI: 1.00, 6.29 = 46% = 0.05) and erosions (OR: 2.00 95% CI: 1.15, 3.45 = 21% = 0.01) in the RT group, but the difference was significant only for erosions. Meta-analysis revealed a statistically significant increased risk of explantation in patients with RT (OR: 3.00 95% CI: 1.16, 7.75 = 68% = 0.02) but there was no difference in the risk of urethral atrophy (OR: 1.18 95% CI: 0.47, 2.94 = 46% = 0.72) and mechanical failure (OR: 0.90 95% CI: 0.25, 3.27 = 54% = 0.87) between the two groups.
CONCLUSIONS
Our meta-analysis of recent studies indicates that RT significantly reduces the odds of achieving complete continence after AUS placement. History of RT does not increase the risk urethral atrophy or mechanical failure in patients with AUS. However, the risk of revision surgery, erosions and explantations is significantly increased in patients with RT with a non-significant but increased tendency of infections.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier: NCT02612389.
PubMed: 35237650
DOI: 10.3389/fsurg.2022.825239 -
Investigative and Clinical Urology Nov 2021To review safety and efficacy of robotic-assisted simple prostatectomy (RASP) compared to open simple prostatectomy (OP). (Meta-Analysis)
Meta-Analysis
PURPOSE
To review safety and efficacy of robotic-assisted simple prostatectomy (RASP) compared to open simple prostatectomy (OP).
MATERIALS AND METHODS
A comprehensive literature search was performed to assess the differences in perioperative course and functional outcomes in patients with benign prostatic hyperplasia and surgical indication. The incidences of complications were pooled using the Cochran-Mantel-Haenszel Method and expressed as odds ratio (OR), 95% confidence interval (CI), and p-values. Perioperative course and functional outcomes were pooled using the inverse variance of the mean difference (MD), 95% CI, and p-values. Analyses were two-tailed and the significance was set at p<0.05.
RESULTS
Eight studies were accepted. Meta-analysis showed significantly longer surgical time (MD, 43.72; 95% CI, 30.57-56.88; p<0.00001) with a significantly lower estimated blood loss (MD, -563.20; 95% CI, -739.95 to -386.46; p<0.00001) and shorter postoperative stay (MD, -2.85; 95% CI, -3.72 to -1.99; p<0.00001) in RASP. Catheterization time did not differ (MD, 0.65; 95% CI, -2.17 to 3.48; p=0.65). The risk of blood transfusion was significantly higher in OP (OR, 0.23; 95% CI, 0.17-0.33; p<0.00001). The risk of recatheterization (OR, 1.96; 95% CI, 0.32-11.93; p=0.47), postoperative urinary infections (OR, 0.89; 95% CI, 0.23-3.51; p=0.87) and 30-day readmission rate (OR, 0.96; 95% CI, 0.61-1.51; p=0.86) did not differ. At 3-month follow-up, functional outcomes were similar.
CONCLUSIONS
RASP demonstrated a better perioperative outcome and equal early functional outcomes as compared to OP. These findings should be balanced against the longer operative time and higher cost of robotic surgery.
Topics: Comparative Effectiveness Research; Cost-Benefit Analysis; Humans; Male; Operative Time; Postoperative Complications; Prostatectomy; Prostatic Hyperplasia; Recovery of Function; Robotic Surgical Procedures
PubMed: 34729963
DOI: 10.4111/icu.20210297 -
Journal of Clinical Orthopaedics and... Nov 2021The primary intention of this review being to produce an updated systematic review of the literature on published outcomes of decompressive surgery for metastatic spinal... (Review)
Review
OBJECTIVE
The primary intention of this review being to produce an updated systematic review of the literature on published outcomes of decompressive surgery for metastatic spinal disease including metastatic spinal cord compression, using techniques of MIS and open decompressive surgery.
METHODS
The authors conducted database searches of OVID MEDLINE and EMBASE identifying those studies that reported clinical outcomes, surgical techniques used along with associated complications when decompressive surgery was employed for metastatic spinal tumors. Both retrospective and prospective studies were analysed. Articles were assessed to ensure the required inclusion criteria was met. Articles were then categorised and tabulated based on the following reported outcomes: predictors of survival, predictors of ambulation or motor function, surgical technique, neurological function, and miscellaneous outcomes.
RESULTS
2654 citations were retrieved from databases, of these 31 met the inclusion criteria. 5 studies were prospective, the remaining 26 were retrospective. Publication years ranged from 2000 to 2020. Study size ranged from 30 to 914 patients. The most common primary tumors identified were lungs, breast, prostate and renal cancers. One study ( Lo and Yang, 2017) reported that in those patients with motor deficit, survival was significantly improved when surgery was performed within 7 days of the development of motor deficit compared to situations when surgery was carried out 7 days after onset. This was the only study that showed that the timing of surgery plays a significant role w.r.t. survival following the onset of spinal cord compression symptoms. Four articles identified that a pre-operative intact motor function and or ambulatory status conferred a higher likelihood of a better post-operative outcome, not just in relation to survival but also in relation to post-operative ambulation as well as a greater tendency towards suitability for adjuvant treatment. Even for the same scoring system e.g. tokuhashi and its effectiveness in predicting survival, results from different studies varied in their outcome. The Karnofsky Performance Status (KPS) being the most commonly used tool to assess functional impairment, the Eastern Cooperative Oncology Group (ECOG) performance status being used in two studies. 23 studies identified an improvement in neurological function following surgery. The most common functional scale used to assess neurological outcome was the Frankel scale, 3 studies used the American Spinal Injury Association (ASIA) impairment scale for this purpose. Wound problems including infection and dehiscence appeared to be the most commonly reported surgical complication. (25 studies). The most commonly used surgical technique involved a posterior approach with decompression, with or without stabilisation. Less commonly employed techniques included percutaneous pedicle screw fixation associated with or without mini-decompression as well as anterior approaches involving corpectomy and instrumentation. 9 studies included in their data, the effect of radiation therapy in combination with surgery or as a comparison used as an alternative to surgery in spinal metastases.
CONCLUSIONS
We provide a systematic literature review on the outcomes of decompressive surgery for spinal metastases. We analyse survival data, motor function, neurological function, as well as the techniques of surgery used. Where appropriate complications of surgery are also highlighted. It is the authors' intention to provide the reader with a reference text where this information is ready to hand, allowing for the consideration of means and methods to improve and optimise the standard of care in patients undergoing surgical intervention for metastatic spinal disease.
PubMed: 34631409
DOI: 10.1016/j.jcot.2021.101596 -
The Journal of Urology Jan 2022We performed a systematic review comparing the incidence of infectious complications following transperineal ultrasound-guided prostate biopsy (TPB) in cases utilizing... (Comparative Study)
Comparative Study Meta-Analysis
PURPOSE
We performed a systematic review comparing the incidence of infectious complications following transperineal ultrasound-guided prostate biopsy (TPB) in cases utilizing antibiotic prophylaxis (AP) vs cases not utilizing antibiotic prophylaxis (NAP).
MATERIALS AND METHODS
The incidences of complications were pooled using the Cochran-Mantel-Haenszel method with the random effect model and expressed as risk ratio (RR). RR higher than 1 indicates an increased risk of complication in patients undergoing TPB without antibiotics. Statistical significance was set at p <0.05 and 95% CI.
RESULTS
A total of 1,748 papers were retrieved. After the screening process, 8 studies were included in the quantitative analysis (4 retrospective, and 4 prospective and nonrandomized), reporting on 3,662 patients. A total of 2,368 patients underwent TPB utilizing AP and 1,294 underwent TPB utilizing NAP. The pooled rates of post-biopsy fever from 6 available studies reporting this parameter were 0.69% in the AP group and 0.47% in the NAP group (RR: 1.02, 95% CI: 0.02-44.55, p=0.99). The pooled rates of post-biopsy genitourinary infections from 8 available studies reporting this parameter were 0.11% in the AP group and 0.31% in the NAP group (RR: 2.09, 95% CI: 0.54-8.10, p=0.29). The pooled rates of post-biopsy sepsis over 8 studies reporting this parameter were 0.13% in the AP group and 0.09% in the NAP group (RR: 1.09, 95% CI: 0.21-5.61, p=0.92). The pooled rates of post-biopsy readmission for infections over 8 studies reporting this parameter were 0.13% in the AP group and 0.23% in the NAP group (RR: 1.29, 95% CI: 0.31-5.29, p=0.73). Death due to post-biopsy sepsis did not occur in any study.
CONCLUSIONS
This systematic review found no significant difference in infection rate, fever, sepsis or readmission rate after TPB between those cases utilizing AP and those cases without AP.
Topics: Antibiotic Prophylaxis; Bacterial Infections; Humans; Image-Guided Biopsy; Incidence; Male; Perineum; Postoperative Complications; Prostate; Ultrasonography, Interventional
PubMed: 34555932
DOI: 10.1097/JU.0000000000002251 -
Arab Journal of Urology 2021: To systematically review the available literature on the long-term effects of sexually transmitted diseases (STIs) on male reproductive functions. A PubMed search was... (Review)
Review
: To systematically review the available literature on the long-term effects of sexually transmitted diseases (STIs) on male reproductive functions. A PubMed search was conducted on 3 January 2021, and as a result, 952 articles were retrieved. Exclusion of irrelevant articles resulted in 36 articles, dating from 1998 to 2020, which were analysed. Only 52.8% of these articles described original research, while the rest were reviews. The majority (26) of the articles dealt with bacterial infections, of which 20 described . There were 11 articles that described research on viruses, with five on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The analysis of the articles showed further that not much new knowledge on the long-term effects on male reproductive functions has been added. The existing knowledge that ascending infections can cause epididymo-orchitis, prostatitis or urethritis was confirmed. Due to epithelial inflammatory responses these infections can result in scarring with resulting infertility due to obstruction. These effects were described for or , as well as for the Zika and SARS-CoV-2 viruses. Even trichomoniasis can lead to long-term compromised male fertility if not treated. In conclusion, problem awareness needs to be raised and more research on this important topic needs to be conducted.
PubMed: 34552793
DOI: 10.1080/2090598X.2021.1942414