Efficacy of surgical treatment for post-prostatectomy urinary incontinence: a systematic review and network meta-analysis.

OBJECTIVES: Post-prostatectomy urinary incontinence (PPUI) is a major complication that reduces the quality of life in patients undergoing prostatectomy for benign prostatic hyperplasia and prostate cancer. However, there are currently limited guidelines on which surgical techniques are preferred after conservative treatment for PPUI. In this study, a systematic review and network meta-analysis (NMA) that can help determine the priority for the selection of surgical methods were performed. MATERIALS AND METHODS: We retrieved data from electronic literature searches of PubMed and the Cochrane Library through August 2021. We searched for randomized controlled trials studies on the surgical treatment of PPUI after surgery for benign prostatic hyperplasia or prostate cancer and included the terms artificial urethral sphincter (AUS), adjustable sling, nonadjustable sling, and injection of the bulking agent.The NMA pooled the odds ratios and 95% credible intervals (CrIs) using the number of patients achieving urinary continence, weight of pads used per day, number of pads used per day, and the International Consultation on Incontinence Questionnaire score. The therapeutic effect of each intervention on PPUI was compared and ranked using the surface under the cumulative ranking curve. RESULTS: A final 11 studies, including 1116 participants, were included in our NMA. The pooled overall odds ratios of patients achieving urinary continence compared with no treatment was 3.31 (95% CrI: 0.749, 15.710) in AUS, 2.97 (95% CrI: 0.412, 16.000) in adjustable sling, 2.33 (95% CrI: 0.559, 8.290) in nonadjustable sling, and 0.26 (95% CrI: 0.025, 2.500) in injection of bulking agent. In addition, this study shows the surface under the cumulative ranking curve values of ranking probabilities for each treatment performance, which indicated that AUS ranked first in terms of continence rate, International Consultation on Incontinence Questionnaire, pad weight, and pad use count. CONCLUSION: The results of this study suggested that only AUS had a statistically significant effect compared to the nontreatment group and the highest PPUI treatment effect ranking among other surgical treatments.

Effects of Sexual Rehabilitation on Sexual Dysfunction in Patients with Cardiovascular Disease: A Systematic Review and Meta-Analysis.

PURPOSE: Cardiovascular disease (CVD) is one of the leading causes of death, accounting for one-third of all deaths worldwide. Patients with CVD are three times more likely to complain of sexual dysfunction than healthy people. Causes of sexual dysfunction in patients with CVD include physical/mental changes and drug side effects. The prevalence of sexual dysfunction in patients with CVD has been estimated to be up to 89%. Ordinary treatments such as pharmacotherapy cannot effectively reduce sexual problems. Therefore, sexual rehabilitation has a broad spectrum, including exercise therapy such as pelvic floor muscle treatment, appropriate counseling, a multidisciplinary approach, and partner rehabilitation. In this study, systematic review and meta-analysis was performed to investigate the effect of sexual rehabilitation on sexual problems in patients with CVD. MATERIALS AND METHODS: Comprehensive literature searches were conducted using MEDLINE, Cochrane Library electronic database, and EMBASE through June 2022. Questionnaire scores at the end point as outcomes of the study were recorded as were standardized mean difference (SMD) with their 95% confidence intervals (CIs). Meta-regression analysis was conducted for each moderator. We performed a risk of bias evaluation for included studies using the RoB 2 tool. RESULTS: The overall SMD in the meta-analysis for sexual rehabilitation versus no-sexual rehabilitation was 0.430 (95% CI, 0.226-0.633). There was a statistical difference between groups. SMD changes were 0.674 (95% CI, 0.308-1.039) at one month and 0.320 (95% CI, 0.074-0.565) at six months. The regression analysis with all variables (number of patients, study duration, and questionnaire types) revealed no significance. CONCLUSIONS: This study indicates that sexual rehabilitation is an effective method with high therapeutic potential for sexual dysfunction of patients with CVD. However, for clinical application, well-designed studies with many patients should be conducted in the future and the standardization of rehabilitation protocols is required.

Efficacy of pelvic floor muscle exercise or therapy with or without duloxetine: a systematic review and network Meta-analysis.

OBJECTIVES: Postprostatectomy urinary incontinence (PPUI) is a serious complication despite surgical advances. Treatment options for PPUI include conservative care like Pelvic floor muscle exercise (PFME), which is a physiotherapy performed by the patients themselves; Pelvic floor muscle therapy (PFMT), a physiotherapy performed under the guidance of a therapist, and duloxetine treatment; and surgical interventions. In this study, network meta-analysis (NMA) was performed for direct comparison of these treatment options. MATERIALS AND METHODS: The NMA pooled the odds ratios and 95% credible intervals using the number of patients achieving urinary continence and the total number of patients in an intention-to-treat population. The treatments were ranked based on the surface under the cumulative ranking curve (SUCRA) probabilities and the rankograms. RESULTS: The pooled overall ORs of patients achieving urinary continence compared with no treatment was 1.73 (95% CrI: 0.657, 4.71) in PFME, 2.62 (95% CrI: 0.553, 13.5) in PFME plus Duloxetine, and 4.05 (95% CrI: 1.70, 10.2) in PFMT. The SUCRA values of ranking probabilities for each treatment showed high rates of continence in the order of PFMT, PFME plus Duloxetine, and PFME. CONCLUSION: The results suggest that patients with PPUI should undergo PFMT and consider duloxetine as an additional treatment option.

Efficacy of Pelvic Floor Exercise for Post-prostatectomy Incontinence: Systematic Review and Meta-analysis.

OBJECTIVE: To determine the effect of pelvic floor muscle exercise (PFME) for post-prostatectomy urinary incontinence (PPUI), which has a major impact on the quality of life of patients undergone radical prostatectomy (RP). METHODS: A systematic search was conducted in the PubMed, Embase, and Cochrane Library databases from the inception of each database until April 2021. We performed a meta-analysis separately using the number of patients achieving urinary continence as binary data, and the patients' ICIQ-SF scores as continuous data. Odds ratios (ORs) and mean difference (MD) with 95% confidence intervals (CI) and a random-effects model were utilized to adequately analyze the overall recovery of UI. We performed a risk of bias evaluation on the included studies using the RoB 2 tool. RESULTS: Twenty-one studies met our selection criteria for quantitative synthesis. Eight studies were on the effects of PFME, and 13 studies were on the effects of assistant interventions added to PFME. The overall continence OR in the meta-analysis for PFME vs no-PFME was 2.971 (95% CI: 1.278, 6.907). The overall ICIQ-SF score in the meta-analysis for PFME vs no-PFME was -1.012 (95% CI: -2.379, 0.355). In case of assistant interventions added to PFME, the overall continence OR in the meta-analysis for assistant interventions vs conventional PFME only was 2.128 (95% CI: 1.357, 3.336). CONCLUSION: In our study, a positive effect of PFME on the recovery of PPUI was observed. However, more research with higher quality is needed to confirm the real efficacy of PFME.