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European Urology Mar 2017Prostate biopsy (PB) represents the gold standard method to confirm the presence of cancer. In addition to traditional random or systematic approaches, a magnetic... (Review)
Review
CONTEXT
Prostate biopsy (PB) represents the gold standard method to confirm the presence of cancer. In addition to traditional random or systematic approaches, a magnetic resonance imaging (MRI)-guided technique has been introduced recently.
OBJECTIVE
To perform a systematic review of complications after transrectal ultrasound (TRUS)-guided, transperineal, and MRI-guided PB.
EVIDENCE ACQUISITION
We performed a systematic literature search of Web of Science, Embase, and Scopus databases up to October 2015, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Complications and mortality following random, systematic, and image-guided PBs were reviewed. Eighty-five references were included.
EVIDENCE SYNTHESIS
The most frequent complication after PB was minor and self-limiting bleeding (hematuria and hematospermia), regardless of the biopsy approach. Occurrence of rectal bleeding was comparable for traditional TRUS-guided and image-guided PBs. Almost 25% of patients experienced lower urinary tract symptoms, but only a few had urinary retention, with higher rates after a transperineal approach. Temporary erectile dysfunction was not negligible, with a return to baseline after 1-6 mo. The incidence of infective complications is increasing, with higher rates among men with medical comorbidities and older age. Transperineal and in-bore MRI-targeted biopsy may reduce the risk of severe infectious complications. Mortality after PB is uncommon, regardless of biopsy technique.
CONCLUSIONS
Complications after PB are frequent but often self-limiting. The incidence of hospitalization due to severe infections is continuously increasing. The patient's general health status, risk factors, and likelihood of antimicrobial resistance should be carefully appraised before scheduling a PB.
PATIENT SUMMARY
We reviewed the variety and incidence of complications after prostate biopsy. Even if frequent, complications seldom represent a problem for the patient. The most troublesome complications are infections. To minimize this risk, the patient's medical condition should be carefully evaluated before biopsy.
Topics: Biopsy; Endosonography; Erectile Dysfunction; Hematuria; Hemospermia; Humans; Image-Guided Biopsy; Lower Urinary Tract Symptoms; Magnetic Resonance Imaging; Male; Postoperative Complications; Postoperative Hemorrhage; Prostate; Prostatic Neoplasms; Recovery of Function; Rectal Diseases; Surgical Wound Infection; Urinary Retention
PubMed: 27543165
DOI: 10.1016/j.eururo.2016.08.004 -
American Journal of Clinical and... 2021Hematospermia is an uncommon symptom but can cause significant anxiety among the patient and his partner. The available data on the underlying etiology, management and... (Review)
Review
INTRODUCTION
Hematospermia is an uncommon symptom but can cause significant anxiety among the patient and his partner. The available data on the underlying etiology, management and outcome are variable and inconsistent. This systematic review was aimed to describe the clinical characteristics, etiology, treatment and outcomes of hematospermia.
METHODS
Keywords were searched in PubMed, Scopus, LILACS and Google Scholar. Relevant articles were manually added from the list of references of eligible articles. Studies with a considerable assessment of patients with hematospermia were included. Qualitative analysis was performed using the available data.
RESULTS
Twenty studies (Fifteen prospective and five retrospective, n=2079 patients, mean age =46.2 (range: 15-89) years) were eligible. Community screening reported a 0.5% prevalence of hematospermia (one study). Majority had hematospermia as the main/only symptom while dysuria (n=38/232, 16.4%), lower urinary tract symptoms (n=113/833, 13.6%), Hematuria (65/566, 11.5%) and testicular pain (n=68/631, 10.7%), were associated in some patients. Suspicious rectal examination (one study) and elevated PSA (Prostate Specific Antigen) levels (four studies) were indicative of sinister pathologies. Common etiologies were urogenital infections/inflammatory conditions followed by prostatic, seminal vesicular or urethral calculi. Malignancies were detected in 5.4% (n=74/1362, 11 studies) of patients >40 years old and the majority had prostate cancers (67/74, 90.5%). Etiology was unknown in 51.8% (n=603/1163). Definitive treatment of the underlying etiology (n=260/347, 74.9%) resolved the symptoms while spontaneous resolution occurred in the vast majority 88.9% (n=168/189) with unknown etiology.
CONCLUSIONS
Hematospermia is relatively an innocent symptom. Malignancies are rare and occurred in men over 40 years. Clinical assessment including a rectal examination and a PSA level would be sufficient to identify most causes. Urogenital infections/inflammation and prostatic calculi are the commonly found etiologies. There was no identifiable cause in almost half of those with hematospermia. The majority has a benign course.
PubMed: 33816690
DOI: No ID Found -
Clinical Microbiology and Infection :... May 2017Zika virus (ZIKV) is transmitted to humans primarily by Aedes mosquito bites. However, circumstantial evidence points to a sexual transmission route. (Review)
Review
BACKGROUND
Zika virus (ZIKV) is transmitted to humans primarily by Aedes mosquito bites. However, circumstantial evidence points to a sexual transmission route.
OBJECTIVES
To assess the sexually acquired ZIKV cases and to investigate the shedding of ZIKV in genital fluids.
DATA SOURCES
PubMed, Scopus, Pro-MED-mail and WHO ZIKV notification databases from inception to December 2016.
SELECTION CRITERIA
Reports describing ZIKV acquisition through sex and studies reporting the detection or isolation of ZIKV in the genital fluids were included.
RISK-OF-BIAS ASSESSMENT
The risk of bias was assessed using the National Institute of Health Tool.
RESULTS
Eighteen studies reporting on sex-acquired ZIKV and 21 describing the presence of ZIKV in genital fluids were included. The overall risk of bias was moderate. Sexual transmission was male-female (92.5%), female-male (3.7%) and male-male (3.7%). Modes of sexual transmission were unprotected vaginal (96.2%), oral (18.5%) and anal (7.4%) intercourse. The median time between onset of symptoms in the index partner and presumed sexual transmission was 13 days (range 4-44 days). ZIKV RNA was detected in semen as late as 188 days (range 3-188 days) following symptom onset, and infectious virus was isolated in semen up to 69 days after symptom onset. No study reported ZIKV isolation from female genital samples, but detection did occur up to 13 days after symptom onset.
CONCLUSIONS
ZIKV is potentially sexually transmitted and persists in male genital secretions for a prolonged period after symptom onset. PROSPERO systematic review registration number CRD42016041475.
Topics: Aedes; Animals; Databases, Factual; Female; Hemospermia; Humans; Male; Observational Studies as Topic; Saliva; Sexually Transmitted Diseases; Vagina; Zika Virus; Zika Virus Infection
PubMed: 28062314
DOI: 10.1016/j.cmi.2016.12.027 -
Frontiers in Oncology 2021To relieve prostate biopsy-related pain, various local anesthetic methods have been used. The best approach was periprostatic nerve block (PNB) in the past decade....
BACKGROUND
To relieve prostate biopsy-related pain, various local anesthetic methods have been used. The best approach was periprostatic nerve block (PNB) in the past decade. Recently, pelvic plexus block (PPB) was employed to ultrasound-guided prostate biopsy. Compared with the PNB, the PPB may block a more extensive area. Therefore, PPB may be more effective in relieving prostate biopsy-related pain. However, several prospective randomized controlled trials (RCTs) comparing PPB and PNB drew conflicting conclusions, so we compared the difference of pain control between PPB and PNB for prostate biopsy.
METHODS
The following databases were retrieved up to October 2020: PubMed, Chinese biomedicine literature database, the Cochrane Library, China National Knowledge Internet databases, Wan fang databases and Google Scholar. Only the RCTs were included. The main outcome measures were Visual Analog Scale (VAS) score and complications. The literature quality and extracted data were evaluated by two authors independently. The software Review Manager (version 5.3) was used to perform the data analysis that comparing the difference of VAS score and complications between PPB and PNB.
RESULTS
After screening, six articles including 336 patients from PPB group and 337 patients from PNB group were performed meta-analysis in this study. The results showed that there were no significant difference of pain control in probe insertion and local anesthetic injection between PPB and PNB, while compared with PNB, patients with PPB experienced less pain during biopsy and 30 min after biopsy, respectively(MD = -0.57, 95% CI: -1.11 to -0.03, Z = 2.06, P = 0.04; MD = -0.21, 95% CI: -0.40 to -0.02, Z = 2.15, P = 0.03). In subgroup analysis, the pooled results showed that PPB was superior to PNB in 12-cores biopsy (pooled MD = -1.16, 95% CI: -1.61 to -0.71, P < 0.00001), and more than 40-ml prostate size, regardless of transrectal or transperineal prostate biopsy. The reported major complications were urinary retention, hematuria, infection and hemospermia. The pooled results showed that there were no obvious difference in complications between PPB group and PNB group.
CONCLUSIONS
Overall, this meta-analysis suggests that PPB provides safe and effective pain control of ultrasound-guided prostate biopsy, and PPB is superior to PNB. In future, it also needs more high quality, large samples RCTs to verify.
PubMed: 34055622
DOI: 10.3389/fonc.2021.655906 -
Annals of the Royal College of Surgeons... Jul 2006Haematospermia (or haemospermia) is a distressing symptom in sexually active men. In most cases, it is caused by non-specific inflammation of the prostate and seminal... (Review)
Review
Haematospermia (or haemospermia) is a distressing symptom in sexually active men. In most cases, it is caused by non-specific inflammation of the prostate and seminal vesicles. In a small percentage of men, however, it may be a manifestation of genito-urinary or systemic malignancy, in particular prostate cancer. The purpose of this review is to explain the causes and management of patients with haematospermia.
Topics: Algorithms; Hemospermia; Humans; Male; Physical Examination; Referral and Consultation
PubMed: 16834849
DOI: 10.1308/003588406X114749 -
Danish Medical Journal May 2015The objective of this study was to investigate the evidence for positive predictive value (PPV) of alarm symptoms and combinations of symptoms for colorectal cancer,... (Review)
Review
INTRODUCTION
The objective of this study was to investigate the evidence for positive predictive value (PPV) of alarm symptoms and combinations of symptoms for colorectal cancer, breast cancer, prostate cancer and lung cancer in general practice.
METHODS
This study is based on a literature search performed in PubMed, Embase, the Cochrane database and at ClinicalTrials.gov in accordance with the PRISMA guidelines. The main outcome measure used was PPV.
RESULTS
A total of 16 eligible studies were identified. The intervals in the brackets refer to the variation of the results in the studies. Colorectal cancer: The PPV of "rectal bleeding" was high for patients > 60 years (6.6-21.2%), but much lower in younger age groups. For "change in bowel habits" and "significant general symptoms", the PPV was 3.5-8.5%. Breast cancer: "Palpable suspected tumour" was well supported (8.1-24%). No studies on the predictive value of "pitting of the skin", "papil-areola eczema/ulceration" and "suspect axillary lymph nodes" were found. Prostate cancer: One study showed a high PPV for positive rectal examination (12%). The value for "lower urinary tract symptoms" was low (1.0-3.0%). PPV for "perianal pain" and "haemospermia" were not found. Lung cancer: For "haemoptysis" the PPV increased from 8.4 in patients aged 55 years to 20.4 at the age of > 85 years. PPV for "cough", "pain in the thorax", "dyspnoea" and "general symptoms" were low (0.4-1.1%). Using a new algorithm that estimates the PPV of combinations of symptoms and risk factors, a higher PPV may be achieved.
CONCLUSION
A few of the alarm symptoms show a high PPV, whereas the PPV for some symptoms currently remains unknown. To improve the GPs' diagnostic judgment, a new algorithm for calculating the PPV for combinations of symptoms and risk factors seems promising.
Topics: Breast Neoplasms; Colorectal Neoplasms; Early Detection of Cancer; Female; General Practice; Humans; Lung Neoplasms; Male; Predictive Value of Tests; Prostatic Neoplasms; Symptom Assessment
PubMed: 26050833
DOI: No ID Found -
Therapeutic Advances in Urology Oct 2013A better understanding of ejaculatory disorders has led to an increasing interest in nonpremature ejaculatory dysfunction (non-PE EjD). Current reviews on the subject...
INTRODUCTION
A better understanding of ejaculatory disorders has led to an increasing interest in nonpremature ejaculatory dysfunction (non-PE EjD). Current reviews on the subject use a symptom-based classification to describe ejaculatory dysfunction even when it is a single case report. While these reviews provide important information on the disorder, a clearer picture of the prevalence of non-PE EjD in relation to the community and various pathophysiologic states is needed.
OBJECTIVES
The objective of this study was to provide a systematic review of studies of non-PE EjD excluding single case reports.
METHODS
A systematic review of Medline for terms including ejaculation, orgasm or hematospermia. Association with terms delay, pain or headache was made. The search was restricted to male gender and articles written in English. Abstracts were reviewed and those mainly concerned with premature ejaculation were excluded.
RESULTS
A total of 333 articles on non-PE EjD were identified. The condition was reported in community-based studies. In certain patient populations, non-PE EjD was commonly reported in association with antidepressant and antipsychotic treatments, in patients with chronic prostatitis/chronic pelvic pain syndrome, patients with lower urinary tract symptoms particularly in association with medical or surgical treatment, patients with retroperitoneal surgery and in patients with neurological diseases. Few articles were concerned with treatment options.
CONCLUSION
There is a significant prevalence of non-PE EjD in the community and in association with particular disease states or as a side effect of medical or surgical interventions. There is a need to direct efforts to prevent and treat these conditions.
PubMed: 24082920
DOI: 10.1177/1756287213497231