Efficacy of peripheral electrical nerve stimulation on improvements of urodynamics and voiding diary in patients with neurogenic lower urinary tract dysfunction: a systematic review and meta-analysis.

BACKGROUND: Peripheral electrical nerve stimulation is a routinely recommended treatment for non-neurogenic overactive bladder but has not been approved for patients with neurogenic lower urinary tract dysfunction (NLUTD). This systematic review and meta-analysis was to elucidate the efficacy and safety of electrostimulation and thus provide firm evidence for treating NLUTD. MATERIALS AND METHODS: We systematically performed the literature search through PubMed, Web of Science, and Cochrane Library databases in March 2022. The eligible studies were identified across the inclusion criteria and the data on urodynamic outcomes, voiding diary parameters, and safety was collected to quantitatively synthesize the pooled mean differences (MDs) with 95% CIs. Subgroup analyses and sensitivity analyses were subsequently used to investigate the possible heterogeneity. This report was achieved in accordance with the preferred reporting items for systematic reviews and meta-analyses statement. RESULTS: A total of 10 studies involving 464 subjects and 8 studies with 400 patients were included for systematic review and meta-analysis, respectively. The pooled effect estimates indicated that electrostimulation could significantly improve urodynamic outcomes, including maximum cystometric capacity (MD=55.72, 95% CI 15.73, 95.72), maximum flow rate (MD=4.71, 95% CI 1.78, 7.65), maximal detrusor pressure (MD=-10.59, 95% CI -11.45, -9.73), voided volume (MD=58.14, 95% CI 42.97, 73.31), and post-void residual (MD=-32.46, 95% CI -46.63, -18.29); for voiding diary parameters, patients undergoing electrostimulation showed lower MDs of incontinence episodes per 24 h (MD=-2.45, 95% CI -4.69, -0.20) and overactive bladder symptom score (MD=-4.46, 95% CI -6.00, -2.91). In addition to surface redness and swelling, no stimulation-related severe adverse events were reported else. CONCLUSIONS: The current evidence demonstrated that peripheral electrical nerve stimulation might be effective and safe for managing NLUTD, whereas more reliable data from large-scale randomized controlled trials are necessary to strengthen this concept.

[Clinical appraisal of laparoscopic inguinal lymphadenectomy with preservation of the great saphenous vein through subcutaneous approach via umbilical cord for the treatment of penile carcinoma: Report of 27 cases].

OBJECTIVE: To explore the clinical efficacy and advantages of laparoscopic inguinal lymphadenectomy (IL) with preservation of the great saphenous vein through subcutaneous approach via umbilical cord for the treatment of penile carcinoma patients. METHODS: The data of 27 patients with penile cancer underwent the laparoscopic inguinal lymph adenectomy with preservation of the great saphenous vein through subcutaneous via umbilical cord approach in the General Hospital of Eastern Theater Command from 2014 May to 2022 May were analyzed retrospectively.All patients underwent partial penile resection, with a pathological diagnosis of squamous cell carcinoma and 20 cases were highly differentiated, 7 cases were moderately differentiated, with the average age was 54 ± 7.5 years old. All patients were in supine position, and a subcutaneous space was established under visualization to establish a laparoscopic operation channel. The scope of cleaning included the superficial and deep inguinal lymph nodes, while the key aspects of the procedure was the preservation of the main trunk of the great saphenous vein. The external boundary of bilateral inguinal lymph node dissection was the line between the anterior superior iliac spine and 20cm lower, the inner boundary was pubic tubercle and its 15cm medical lower measurement, and the line between the inner boundary and the external lower edge was the lower boundary. RESULT: All the 27 patients were successfully completed without transfer to open surgery. The average operation time was (115 ± 26) minutes, the average blood loss during operation was (40 ± 8) ml, postoperative hospital stays was (6.8 ± 1.5) days, and postoperative drainage tube removal time was (6.4 ± 1.2) days. The average number of lymph nodes was 12.5 (5-21) on the left side, and 11.4 (2-19) on the right side. No skin necrosis and subcutaneous hematoma was occurred in all patients. Three patients had postoperative lymphatic leakage and two patients had lymphatic cysts. All patients were cured by conservation treatment. No recurrence and metastasis were occurred during 14-28 months follow up postoperatively. Conclusion： Laparoscopic inguinal lymphadenectomy with preservation of the great saphenous vein through subcutaneous approach via umbilical cord can achieve the expected surgical outcome. It has some advantages of shorter operation time, less blood loss，low incidence of complication ,especially avoid skin flap necrosis and subcutaneous hematoma．.

Neoadjuvant Chemohormonal Therapy in Prostate Cancer Before Radical Prostatectomy: A Systematic Review and Meta-Analysis.

Objective: This meta-analysis was to investigate the effects of neoadjuvant chemohormonal therapy (NCHT) on patients with prostate cancer (PCa) before radical prostatectomy (RP) and attempt to provide meaningful evidence. Methods: A systematic search was performed using the PubMed, Web of Science, and Cochrane Library databases in February 2022 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The relevant studies were critically screened and we extracted the data of demography, postoperative pathology, and survival to calculate the pooled effect sizes. Subgroup analyses and sensitivity analyses were used to explore the source of heterogeneity. Results: Six identified studies involving 1717 subjects were included according to the selection criteria. There was no significant difference between NCHT plus RP and RP alone groups regarding lymph node involvement (risk ratio [RR]=1.03, 95% confidence interval [CI]: 0.57-1.87, P=0.92). However, NCHT prior to RP significantly decreased the rates of positive surgical margin (PSM, RR=0.35, 95% CI: 0.22-0.55, P<0.0001) and seminal vesicle invasion (SVI, RR=0.78, 95% CI: 0.65-0.95, P=0.01), and increase pathological downstaging (RR=1.64, 95% CI: 1.17-2.29, P=0.004). Additionally, biochemical recurrence-free survival (BRFS) and overall survival (OS) were significantly prolonged under the administration of NCHT (HR=0.54, 95% CI: 0.34-0.85, P=0.008 and HR=0.67, 95% CI: 0.48-0.94, P=0.02, respectively). Conclusions: Compared to the RP alone group, patients with NCHT plus RP showed significant improvements in PSM, SVI, pathological downstaging, BRFS, and OS, whereas further multicenter randomized controlled trials are needed to consolidate this concept.