RESUMO
OBJECTIVE: To investigate the feasibility of autologous bone marrow mesenchymal stem cells(BMSCs) seeded on bladder acellular matrix graft (BAMG) for bladder reconstruction in a canine model. METHODS: This study included 25 mongrel dogs. Five dogs were sacrificed for the preparation of BAMG. Twenty dogs were randomly divided into two groups and received partial cystectomy. In group A, the bladder defect was repaired with unseeded BAMG. In group B, the bladder defect was repaired with autologous BMSCs-seeded BAMG. The bladders were retrieved and studied histologically and immunohistochemically at the time point of 1, 2, 4, 8, 12 weeks after surgery to evaluate tissue regeneration. RESULTS: All dogs survived the procedure. Histopathological examination in group B showed there was urothelium developed at the end of the 2 weeks. By 8 and 12 weeks all bladder wall components were regenerated in the repaired area, which were similar to normal bladder tissue. In group A, urothelium regeneration was observed at the end of the 4 weeks, whereas smooth muscle was still not well-formed by 12 weeks. CONCLUSION: Autologous BMSCs-seeded BAMG could promote the repair of bladder defect, which is superior to unseeded BAMG in regenerative properties.
Assuntos
Citoesqueleto , Células-Tronco Mesenquimais , Procedimentos de Cirurgia Plástica , Bexiga Urinária , Animais , Cistectomia , Cães , Transplante de Células-Tronco Mesenquimais , Músculo Liso , Regeneração , UrotélioRESUMO
OBJECTIVES: Epidemiological findings regarding the association between total fluid intake and bladder cancer risk have yielded varying results. Our objective is to examine the possible associations between total fluid intake and bladder cancer risk. METHODS: Databases searched include the EMBASE and PUBMED, from inception to February 2014, with no limits on study language. We also reviewed the reference lists of identified studies. Stratified analyses were performed. A random-effect model was used to summarize the estimates of odds ratio (OR) with 95% confidence intervals (CI). RESULTS: Overall,17 case-control and four cohort studies were included. The overall OR of bladder cancer for the highest versus the lowest fluid intake was 1.06 (95% CI: 0.88-1.27). In the subgroup analyses, the overall ORs for coffee, green, and black tea intake were 1.17 (95% CI: 1.03-1.33), 0.76 (95% CI: 0.66-0.95), and 0.80 (95% CI: 0.65-0.97), respectively. A significantly decreased risk was observed in Asian people (OR 0.27; 95% CI: 0.10-0.72). Among smokers, a suggestive inverse association was observed between total fluid intake and overall bladder cancer risk (OR 0.80; 95% CI: 0.62-1.02). CONCLUSIONS: Although this meta-analysis suggested that greater consumption of fluid may have a protective effect on bladder cancer in Asian people, there was no convincing evidence on this association because of the limitations of the individual trials.
Assuntos
Bebidas , Ingestão de Líquidos , Neoplasias da Bexiga Urinária/prevenção & controle , China/epidemiologia , Estudos Epidemiológicos , Humanos , Prognóstico , Neoplasias da Bexiga Urinária/epidemiologiaRESUMO
BACKGROUND: Transurethral laser therapy techniques are increasingly being used in the management of bladder tumors. It has reportedly been associated with good outcomes in small case series. The objective of the present study was to review the published literature and compare transurethral laser therapy for non-muscle-invasive bladder cancer (NMIBC) and conventional transurethral resection of bladder tumor (TURBT). METHODS: We performed a systematic review and meta-analysis based on randomized controlled trials (RCTs) and controlled clinical trials (CCTs) to assess the two techniques. The eligible RCTs and CCTs were identified in the following electronic databases: PubMed, the Cochrane Central Register of Controlled Trials and Embase. RESULTS: Seven studies were included in this systematic review. The baseline characteristics of these studies are comparable. We found no statistical difference between the two techniques regarding operative time. The intra- and postoperative complications showed that the laser procedure was better than TURBT for NMIBC, including obturator nerve reflex, bladder perforation, bladder irrigation rate, duration of catheterization and length of hospital stay. In addition, the 2-year recurrence-free survival improved in the laser group than in the TURBT group. CONCLUSIONS: Our systematic review and meta-analysis suggests that laser techniques are feasible, safe, effective procedures that provide an alternative treatment for patients with NMIBC. Given that some limitations cannot be overcome, well-designed RCTs are needed to confirm our findings.
Assuntos
Terapia a Laser , Neoplasias da Bexiga Urinária/terapia , Humanos , Prognóstico , SegurançaRESUMO
In this study, a lysosomal targeting fluorescent probe recognition on CEs was designed and synthesized. The obtained probe BF2-cur-Mor demonstrated excellent selectivity, sensitivity, pH-independence, and enzyme affinity towards CEs within 5 min. BF2-cur-Mor could enable recognition of intracellular CEs and elucidate that the CEs content of different cancer cells follows the rule of HepG2 > HCT-116 > A549 > HeLa, and the CEs expression level of hepatoma cancer cells far exceeds that of normal hepatic cells, being in good agreement with the previous reports. The ability of BF2-cur-Mor to monitor CEs in vivo was confirmed by zebrafish experiment. BF2-cur-Mor exhibits some pharmacological activity in that it can induce apoptosis in hepatocellular carcinoma cells but is weaker in normal hepatocyte cells, being expected to be a potential "diagnostic and therapeutic integration" tool for the clinical diagnosis of CEs-related diseases.
Assuntos
Corantes Fluorescentes , Peixe-Zebra , Humanos , Corantes Fluorescentes/química , Corantes Fluorescentes/síntese química , Animais , Carboxilesterase/metabolismo , Carboxilesterase/antagonistas & inibidores , Apoptose/efeitos dos fármacos , Desenho de FármacosRESUMO
OBJECTIVE: This systematic review was performed to evaluate the efficacy and safety of phosphodiesterase-5 inhibitors (PDE5i) in the treatment of erectile dysfunction (ED) after radiotherapy for prostate cancer (PCa). METHODS: A systematic search of PubMed, Embase and the Cochrane Library was performed to identify all randomized controlled trials (RCTs). All relevant studies on the outcomes and complications of PDE5i in the treatment of ED after radiotherapy for PCa were assessed. The outcomes and complications analyzed for this study included the International Index of Erectile Function (IIEF) questionnaire, Global Efficacy Questions (GEQs), Sexual Encounter Profile (SEP) diary and side effects. The Cochrane Collaboration Review Manager software (RevMan 5.1.4) was used for statistical analysis of the outcomes and complications. RESULTS: A total of 4 RCTs were identified from the search strategy. Compared with placebo, the trials indicated that PDE5i significantly improved the IIEF scores, with the exception of two questions (questions 6 and 13), and statistically significantly more positive answers for the GEQs and SEP diary were acquired in intervention groups. Furthermore, almost all the side effects in both groups were mild or moderate, transient and well tolerated. Except for headache, flushing and dyspepsia, all other adverse events did not differ significantly between the two groups. CONCLUSIONS: The systematic review suggested significant advantages in the efficacy and safety of PDE5i in the treatment of ED after radiotherapy for PCa. PDE5i should be considered as the first choice for the treatment of PCa patients with ED after radiotherapy.
Assuntos
Disfunção Erétil/tratamento farmacológico , Ereção Peniana/efeitos dos fármacos , Inibidores da Fosfodiesterase 5/uso terapêutico , Neoplasias da Próstata/radioterapia , Lesões por Radiação/tratamento farmacológico , Distribuição de Qui-Quadrado , Disfunção Erétil/diagnóstico , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Inibidores da Fosfodiesterase 5/efeitos adversos , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Lesões por Radiação/fisiopatologia , Radioterapia/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Fatores de Risco , Inquéritos e Questionários , Resultado do TratamentoRESUMO
OBJECTIVE: This systematic review was performed to evaluate the efficacy and safety of tramadol in patients with premature ejaculation (PE). METHODS: A systematic search of PubMed®, Embase® and the Cochrane Library was performed to identify all randomized controlled trials (RCTs) that compared the effects of tramadol with placebo or no drug for patients with PE. The outcomes included post-therapeutic intravaginal ejaculation latency time (IELT), increases in IELT, satisfaction with sexual intercourse, control over ejaculation and side effects (SEs). The Cochrane Collaboration Review Manager software (RevMan 5.1.4) was used for statistical analysis. RESULTS: A total of 5 trials, involving 715 patients, met the inclusion criteria. The synthesized data from these RCTs indicated that compared with the control, tramadol significantly increased IELT values post-therapeutically (SMD 3.51, 95% CI 2.14-4.88, p < 0.00001) and changes in IELT values were more pronounced in the tramadol group (SMD 2.87, 95% CI 2.63-3.10, p < 0.00001). Satisfaction with sexual intercourse and the ability to control ejaculation were both improved in patients in the tramadol group (p < 0.05). The incidence of SEs in the tramadol group were significantly higher than in the control group (RR 3.55, 95% CI 1.34-9.40, p = 0.01), however most SEs were mild or moderate and transient. CONCLUSIONS: Tramadol may be effective in PE treatment, especially when patients have failed therapies, like selective serotonin reuptake inhibitors. However, the possibility of drug addiction and SEs should still be considered before initial use or after chronic use of this agent. More high-quality (clear randomization sequences, allocation concealment and blinding introduction), long-term, RCTs with a large number of PE patients are expected.
Assuntos
Analgésicos Opioides/uso terapêutico , Ejaculação Precoce/tratamento farmacológico , Disfunções Sexuais Fisiológicas/tratamento farmacológico , Tramadol/uso terapêutico , Analgésicos Opioides/efeitos adversos , Coito , Ejaculação , Humanos , Masculino , Satisfação do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Fatores de Tempo , Tramadol/efeitos adversos , Resultado do TratamentoRESUMO
In this work, three novel dual-targeting fluorescent probes were designed with modification by imidazole and one galactose (IM-Gal-1), by imidazole and two galactoses (IM-Gal-2), and by imidazole and three galactoses (IM-Gal-3), separately. These probes showed good selectivity and sensitivity toward Fe3+ with 1:2 stoichiometry recognition mode. The detection limits toward Fe3+ were (1.293 ± 0.005) × 10-7 M for IM-Gal-1, (7.735 ± 0.005) × 10-8 M for IM-Gal-2, and (1.325 ± 0.023) × 10-7 M for IM-Gal-3. These low-toxic probes exhibited excellent hepatic targeting capacity, which is attributed to the specific recognition of asialoglycoprotein receptor (ASGPR) overexpressed on hepatocytes by the galactose group of probes. The hepatic targeting capacity followed IM-Gal-1 < IM-Gal-2< IM-Gal-3 trend due to the galactose cluster effect. Under the attraction between acidic lysosome and basic imidazole group, these imidazole-modified probes were confirmed to possess good lysosome-targeting capacities, earlier demonstrating imidazole as a lysosome-targeting group. Overall, these dual-targeting probes co-modified by galactose and imidazole exhibited unique advantages in precise diagnosis and treatment of liver lysosomal iron-related diseases.
Assuntos
Técnicas Biossensoriais , Galactose , Corantes Fluorescentes , Hepatócitos , Imidazóis , LisossomosRESUMO
One antitumor ß-elemene derivative W-105 and three novel hepatocyte-targeting prodrugs (W-1-5, W-2-9, and W-3-8) were designed and synthesized. W-105 (IC50 6.107 µM) could cause cell apoptosis through upregulating the activity of caspase-3. The hepatocyte-targeting capacities of the aimed compounds followed the W-105 (parent compound) < W-1-5 (monodentate-galactose) < W-2-9 (bidentate-galactose) < W-3-8 (tridentate-galactose) order, which is attributed to the excellent affinity of the galactose ligand to ASGPR and the galactose-cluster recognition effect. Furthermore, prodrugs W-3-8 exhibited good antitumor activity and low toxic side effects. The liquid chromatography-mass spectrometry (LC-MS) assays revealed that prodrugs (W-1-5, W-2-9, and W-3-8) could release the antitumor pharmacophore in the presence of GSH (mimic the condition of the tumor cell) and maintain the low-toxic structures in the absence of GSH (mimic the condition of the normal cell). The release mechanisms of prodrugs were also proposed. Overall, these prodrugs developed in this study had potential in the treatment of liver cancer.
Assuntos
Antineoplásicos/farmacologia , Assialoglicoproteínas/metabolismo , Desenvolvimento de Medicamentos , Glutationa/metabolismo , Hepatócitos/efeitos dos fármacos , Pró-Fármacos/farmacologia , Antineoplásicos/química , Cromatografia Líquida/métodos , Sistemas de Liberação de Medicamentos , Espectrometria de Massas/métodos , Pró-Fármacos/químicaRESUMO
OBJECTIVE: To test the hypothesis that sexual dysfunction in elderly men with benign prostatic hyperplasia leads to prostatic inflammation, diagnosed by prostatic fluid interleukin-8 (IL-8), which lowers the positive predictive value of prostate-specific antigen (PSA). METHODS: Overall, 160 men with lower urinary tract symptoms between 50 and 75 years of age with an elevated PSA level of more than 4ng/ml with normal digital rectal examination and 50 age-matched controls with normal PSA level were prospectively evaluated for prostatic fluid IL-8 levels. Erectile dysfunction was measured by self-administered questionnaire of the Sexual Health Inventory for Men. Total and free serum PSA levels and IL-8 in prostatic fluid were measured 6 to 8 weeks after a course of 400mg of ofloxacin and 20mg of piroxicam given daily for 2 weeks. Transrectal ultrasonography-guided biopsy was done only when PSA level did not decrease less than 4ng/ml. RESULTS: Mean ages of patients and controls were 63.18 (standard deviation [SD]±7.10) and 60.18 (SD+6.02) years, respectively. Mean concentration of IL-8 in prostatic fluid of the patients was significantly higher, i.e., 6,678pg/ml (SD±1,985.7) than in control, i.e., 1,543pg/ml (SD±375.7) (P<0.001). Following anti-inflammatory treatment, there was a significant decrease in the mean level of IL-8 from baseline to 5,622pg/ml (SD±1,870.66) (P<0.001). Corresponding to this, a significant decrease was noted in total PSA levels to less than 4ng/ml in 105 (65.62%) patients. Men with the highest levels of IL-8 had a greater degree of erectile dysfunction. CONCLUSION: Men with symptomatic benign prostatic hyperplasia and erectile dysfunction had significant inflammation of the prostate to cause spurious rise in PSA level resulting in an unnecessary biopsy.
Assuntos
Disfunção Erétil/complicações , Antígeno Prostático Específico/sangue , Hiperplasia Prostática/sangue , Prostatite/sangue , Humanos , MasculinoRESUMO
OBJECTIVE: To evaluate the efficacy and safety of combination therapy with selective serotonin reuptake inhibitors (SSRIs) and phosphodiesterase-5 (PDE-5) inhibitors for the treatment of premature ejaculation (PE). METHODS: A systematic search of EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews was undertaken to identify articles that referred to the use of a combination of SSRIs and PDE-5 inhibitors for the treatment of PE. A meta-analysis of these clinical studies was performed. The post-treatment intravaginal ejaculatory latency time (IELT) and adverse events (AEs) were used in this meta-analysis. RESULTS: Six publications involving 971 patients were included in the meta-analysis. In the analysis, we found significantly improved IELT in the combination use group compared with the use of SSRIs (mean differences [MD], 1.01; 95% confidence interval [CI], 0.61-1.41; P <.01) or PDE-5 inhibitors alone (MD, 1.11; 95% CI, 0.79-1.43; P <.01) for PE whether or not these patients suffered from erectile dysfunction. Combined treatment was more efficacious than use of PDE-5 inhibitors alone on sexual satisfaction. Although the occurrence of drug-related AEs in the combination use group was higher than that in the use of SSRIs or PDE-5 inhibitors alone group (37.5% vs 25.63%, P <.01), the most common AEs were mild and tolerable. CONCLUSION: The combined use of SSRIs and PDE-5 inhibitors provided additive favorable effects in men with PE compared with SSRIs or PDE-5 inhibitors monotherapy and was generally well tolerated.
Assuntos
Nucleotídeo Cíclico Fosfodiesterase do Tipo 5/uso terapêutico , Ejaculação/efeitos dos fármacos , Ejaculação Precoce/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Quimioterapia Combinada , Humanos , Masculino , Ejaculação Precoce/fisiopatologia , Resultado do TratamentoRESUMO
OBJECTIVE: To examine the effectiveness of barbed suture (BS) compared with conventional sutures for vesicourethral anastomosis (VUA) during minimally invasive radical prostatectomy (RP). METHODS: Relevant studies comparing the safety and efficacy of BS with conventional sutures during minimally invasive RP were identified through a literature search using MEDLINE, EMBASE, and the Cochrane Library. The outcome measures included baseline characteristics, primary outcomes, and secondary outcomes. RESULTS: Ten studies (378 cases and 369 controls) were included. No significant differences between the 2 groups were detected in any of the baseline variables except for age (P = .02). The BS group had a shorter operation time (mean difference [MD], 10.54; 95% confidence interval [CI], -14.38 to -6.69; P <.01), a shorter VUA time (MD, -5.35; 95% CI, -7.44 to -3.25; P <.01), and a shorter posterior reconstruction time (MD, -0.56; 95% CI, -1.10 to -0.02; P = .04) than those in the conventional sutures group. No significant differences were detected between the 2 groups in other outcomes of interest. In subgroup and sensitivity analyses, there was no change in the significance of any of the outcomes. CONCLUSION: This meta-analysis indicates that VUA using BS as opposed to conventional suture is associated with a shorter operative time, comparable postoperative complication rate, and convenience for manipulation, which is of benefit to the surgeon learning robot-assisted RP and laparoscopic RP. Given that the inherent limitations, future well-designed randomized controlled trials are required to confirm our findings.
Assuntos
Prostatectomia/métodos , Técnicas de Sutura , Uretra/cirurgia , Bexiga Urinária/cirurgia , Anastomose Cirúrgica , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente InvasivosRESUMO
OBJECTIVE: Despite the various treatment and prevention options for catheter-related bladder discomfort (CRBD), many uncertainties persist in clinical practice. To systematically review the literature on the management of CRBD in patients who underwent surgery. MATERIALS AND METHODS: Eligible, randomized controlled trials were identified from electronic databases (Cochrane Central Register of Controlled Trials, Medline, and EMBASE) without language restrictions. Selection criteria, methodological rigor, and risk of bias were evaluated by two independent reviewers using Cochrane Collaboration's tools. RESULTS: A total of 1441 patients from 14 articles published between 2005 and 2014 were included. Data heterogeneity precluded meta-analysis; therefore, data were synthesized narratively. Compared with nonurological surgery, CRBD is frequent and occurred immediately after urological surgery, especially after transurethral resection of the bladder tumor (TURBT). Data from included studies suggested that muscarinic antagonists, anesthetics, antiepileptics, and analgesics were associated with significant improvement in symptoms and reducing the incidence of CRBD, compared with placebo. Anticholinergic agents and antiepileptics (gabapentin and pregabalin) administered 1 hour before surgery reduced the incidence and severity of CRBD in the immediate postoperative period. Tramadol and ketamine are centrally acting opioid analgesics with antimuscarinic actions, which effectively prevent CRBD when administered intravenously. Paracetamol administered was also effective for the management of CRBD. Additionally, we perceived that TURBT is the surgical procedure that is the most refractory to treatment. CONCLUSIONS: Muscarinic antagonists, anesthetics, antiepileptics, and paracetamol appear to achieve the greatest improvement in the clinical symptoms and a significant reduction in the incidence of CRBD compared with placebo. Although these studies observed a high incidence of intervention-related side effects, in general, patients tolerated these treatments well.
Assuntos
Dor Pós-Operatória/prevenção & controle , Neoplasias da Bexiga Urinária/cirurgia , Cateterismo Urinário/efeitos adversos , Analgésicos/administração & dosagem , Analgésicos/uso terapêutico , Analgésicos Opioides/administração & dosagem , Humanos , Masculino , Antagonistas Muscarínicos/administração & dosagem , Antagonistas Muscarínicos/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
This meta-analysis was performed to evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) under regional anesthesia (RA) vs. general anesthesia (GA). A systematic literature search in the electronic databases (Cochrane CENTRAL, Medline and EMBASE) was performed up to April 2014. Twelve trials, including 1954 patients, met the inclusion criteria and were included in the final analysis. Our pooled analysis showed that PCNL under RA could reduce surgical duration (MD, -2.47; 95 % CI, -3.51 to -1.44), hospitalization period (MD, -0.48; 95 % CI -0.93 to -0.04), fluoroscopy time (MD, -0.48; 95 % CI, -0.83 to -0.14), blood transfusion (OR, 0.59; 95 % CI, 0.38-0.92), postoperative pain (MD, -1.99; 95 % CI, -2.2 to -1.78), and analgesic requirements (MD, -19.14; 95 % CI, -26.64 to -11.63). However, there was no difference between RA and GA groups with regard to stone-free rate (OR, 1.09; 95 % CI, 0.86-1.37) and postoperative complications associated with PCNL (OR, 0.95; 95 % CI 0.58-1.54). Our results show that PCNL under RA offers several potential advantages over GA in terms of surgical duration, hospitalization period, fluoroscopy time, blood transfusion, postoperative pain, and analgesic requirements, but both anesthetic techniques appear to be equivalent with regard to the stone-free rate and complication rate. Along with the suggested favorable hemodynamic profile and lower cost, RA may prove a better alternative than GA.
Assuntos
Anestesia por Condução/estatística & dados numéricos , Anestesia Geral/estatística & dados numéricos , Nefrostomia Percutânea/estatística & dados numéricos , Cálculos Urinários/cirurgia , Analgésicos/administração & dosagem , Humanos , Tempo de Internação , Duração da Cirurgia , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Resultado do TratamentoRESUMO
CONTEXT: The standard management of upper urinary tract urothelial carcinoma (UUT-UC) is nephroureterectomy with bladder cuff excision, but after surgery, approximately 22-47% of patients with UUT-UC develop subsequent bladder tumour recurrence, potentially because of the implantation of cancer cells from the primary tumour. OBJECTIVE: To conduct a meta-analysis to evaluate the effect of prophylactic intravesical chemotherapy in the prevention of bladder recurrence after nephroureterectomy for UUT-UC. DATA ACQUISITION: An electronic database search of Medline, Embase, the Cochrane Library, CancerLit and ClinicalTrials.gov was performed to identify appropriate studies prior to March 2013.All studies comparing nephroureterectomy alone with prophylactic intravesical chemotherapy after nephroureterectomy were included. The main outcome measure for this meta-analysis was the rate of bladder recurrence after nephroureterectomy. The search was not limited by language. The review process followed the guidelines of the Cochrane Collaboration. The analysis was conducted using the Review Manager Version RevMan 5.0 software (The Nordic Cochrane Centre, The Cochrane Collaboration). RESULTS: A total of 592 patients were included in this study, of whom 257 underwent intravesical instillation after nephroureterectomy and 335 underwent nephroureterectomy alone. Our meta-analysis demonstrated that the rate of recurrence after 12 months was significantly lower in the intravesical instillation after nephroureterectomy group than in the nephroureterectomy-alone group [odds ratio (OR): 0.48; 95% confidence interval (CI): 0.28-0.81; P = 0.006]. A significant decrease in bladder recurrence after at least 24â months was also observed in the intravesical instillation after nephroureterectomy group (OR: 0.40; 95% CI: 0.24-0.67; P = 0.0004). A subgroup analysis demonstrated that the pattern of differences was similar to those from the total group analysis. CONCLUSIONS: Prophylactic intravesical chemotherapy was effective for the prevention of bladder recurrence after nephroureterectomy. Therefore, we suggest that prophylactic intravesical chemotherapy should be performed in patients with UUT-UC after nephroureterectomy, but the optimal chemotherapy regimen and the initial time of instillation should be explored in future studies.
Assuntos
Antineoplásicos/administração & dosagem , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias Urológicas/tratamento farmacológico , Neoplasias Urológicas/cirurgia , Administração Intravesical , Ensaios Clínicos como Assunto , Humanos , Recidiva Local de Neoplasia/patologia , Nefrectomia/métodos , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/patologia , Neoplasias Urológicas/patologiaRESUMO
PURPOSE: To evaluate the efficacy of povidone-iodine (PI) in reducing the risk of infectious complications following transrectal prostate biopsy (TRPB). METHODS: Eligible randomized controlled trials (RCTs) were identified from electronic databases (Cochrane CENTRAL, MEDLINE, and EMBASE). The database search, quality assessment, and data extraction were performed independently by two reviewers. The main outcome for the efficacy of PI was the incidence of infectious complications after TRPB. RESULTS: Seven trials, including 2,049 patients, met the inclusion criteria. Data from the seven included RCTs favored the use of PI before TRPB to prevent infectious complications. PI for "PI versus blank control" significantly reduced fever, bacteriuria, and bacteremia compared with that for control [relative risk (RR) 0.31; 95 % confidence interval (CI) 0.21-0.45, P < 0.00001]. With PI versus antibiotics (ATB), patients treated with ATB alone had a significantly greater risk of bacteremia (RR 0.38; 95 % CI 0.16-0.90, P = 0.03). In "PI plus ATB versus ATB" trials, the risk of fever (RR 0.11; 95 % CI 0.02-0.85, P = 0.03) and bacteremia (RR 0.25; 95 % CI 0.08-0.75, P = 0.01) was diminished in the "PI plus ATB" group. CONCLUSIONS: Rectal disinfection with PI provides a safe and effective method to reduce the risk of infectious complications following TRPB, regardless of mono-prophylaxis and combined prophylaxis with PI and ATB. Large, multicenter, and prospective RCTs of good quality trials are needed to confirm the efficacy of PI.
Assuntos
Anti-Infecciosos Locais/uso terapêutico , Infecções Bacterianas/prevenção & controle , Povidona-Iodo/uso terapêutico , Próstata/patologia , Biópsia/efeitos adversos , Biópsia/métodos , Humanos , Masculino , Reto , RiscoRESUMO
PURPOSE: Dapoxetine is the first oral agent approved for the treatment of premature ejaculation (PE). However, some countries have not approved its use. The goal of this meta-analysis was to provide more information about the efficacy and safety of dapoxetine in patients with PE. METHODS: We performed a meta-analysis of randomized controlled trials (RCTs) comparing dapoxetine with a placebo in patients with PE. Relevant eligible RCTs were identified through comprehensive searches of the Cochrane Central Register of Controlled Trials, EMBASE, and PubMed. Efficacy (intravaginal ejaculatory latency time (IELT), patient global impression of change, perceived control over ejaculation, and satisfaction with sexual intercourse) and safety (treatment-emergent adverse events and discontinuation rates) were studied by using Review Manager version 5.1.0. FINDINGS: Six RCTs involving 5934 patients met the inclusion criteria. The main outcome (IELT) in the dapoxetine group was improved significantly compared with IELT in the placebo group (mean difference, 1.59 [95% CI, 1.30 to 1.88]; P < 0.00001). The 60-mg dose of dapoxetine was more beneficial than the 30-mg dose for IELT (mean difference, -0.47 [95 % CI, -0.73 to -0.20]; P = 0.0005). Although the occurrence of treatment-emergent adverse events in the dapoxetine group was nearly twice that in the placebo group (50.5% vs 27.9%), reports of severe adverse events were rare. IMPLICATIONS: Data from the meta-analysis revealed that treatment with dapoxetine was significantly efficacious in patients with PE. Although adverse events such as nausea, dizziness, diarrhea, insomnia, and headache were common, dapoxetine's overall safety profile was acceptable.
Assuntos
Benzilaminas/uso terapêutico , Naftalenos/uso terapêutico , Ejaculação Precoce/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Benzilaminas/efeitos adversos , Diarreia/induzido quimicamente , Método Duplo-Cego , Cefaleia/induzido quimicamente , Humanos , Masculino , Naftalenos/efeitos adversos , Náusea/induzido quimicamente , Ensaios Clínicos Controlados Aleatórios como Assunto , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Resultado do TratamentoRESUMO
Alpha-adrenoceptor antagonists (alpha-blockers) are widely prescribed to treat lower urinary tract symptoms (LUTS) in men but fail to ameliorate LUTS sufficiently, especially the storage symptoms related to frequency, urgency and nocturia. We performed a meta-analysis of randomised controlled trials (RCTs) comparing an alpha-blocker plus muscarinic antagonist with an alpha-blocker alone in male LUTS patients who were treated with alpha-blocker prior to randomisation. The review contained six randomised controlled trials (RCTs) that included a total of 2,208 male patients who were randomised to receive alpha-blocker plus muscarinic antagonist or alpha-blocker alone. The add-on group experienced significantly greater improvement in both total IPSS (International Prostate Symptom Score) and storage IPSS. Adverse events (AEs) were commonly experienced by both groups (41.6 vs. 33.3%) though they were not severe. Our meta-analysis indicated that muscarinic antagonists as add-on therapy alleviate LUTS, especially storage symptoms. The add-on therapy demonstrated safety and tolerability comparable with alpha-blocker monotherapy in male with LUTS.
Assuntos
Antagonistas Adrenérgicos alfa/uso terapêutico , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Antagonistas Muscarínicos/uso terapêutico , Antagonistas Adrenérgicos alfa/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas Muscarínicos/efeitos adversosRESUMO
Prostate cancer (PCa) is the most common solid neoplasm diagnosed in developed countries. Nerve-sparing radical prostatectomy (NS-RP) has been widely accepted as the best choice treatment for localised PCa. However, erectile dysfunction (ED) and urinary incontinence are commonly observed after NS-RP. Using meta-analysis, we examined if phosphodiesterase type 5 inhibitors (PDE5-Is) could improve the symptoms of ED in patients undergoing NS-RP. This review contained seven randomised placebo-controlled trials with a total of 2,655 male patients. Patients in PDE5-Is group showed significant improvement in the International Index of Erectile Function-Erectile Function domain score (IIEF-EF), Global Assessment Questionnaire (GAQ), Sexual Encounter Profile question 2 (SEP-2) and SEP-3. Although the incidence of treatment-emergent adverse events (TEAEs) were high in both groups (56.44% vs. 40.63%), the safety profile were acceptable, with low incidence of discontinuation rate due to adverse events. Therefore, PDE5-Is are recommended for the treatment of post-NS-RP ED. Patients should be informed of possible adverse events.
Assuntos
Disfunção Erétil/tratamento farmacológico , Disfunção Erétil/etiologia , Inibidores da Fosfodiesterase 5/uso terapêutico , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Humanos , Masculino , Metanálise como Assunto , Prognóstico , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
PURPOSE: After radical nephroureterectomy (RNU), approximately 22% to 47% of patients with upper tract urothelial carcinoma (UTUC) develop a subsequent intravesical recurrence (IVR). Considering this high incidence of occurrence, several risk factors were reported as predictive of IVR after RNU. Until recently, most of the risk factors were still under debate. The aim of study was to conduct a meta-analysis based on the recent literature to explore the risk factors for IVR after RNU for UTUC. PATIENTS AND METHODS: An electronic search of the Medline, Embase, Cochrane Library, CancerLit, and ClinicalTrials.gov databases was performed to identify relevant studies published before May 2013. The studies were included if they reported risk factors related to bladder or IVR after RNU for UTUC. RESULTS: Overall, 40 studies, with 12,010 patients, were included in our meta-analysis. Our study indicated that a statistically significant difference in IVR after RNU was found in the male vs. female patients (odds ratio [OR] = 0.72, 95% CI: 0.59-0.85), ureteral vs. renal pelvis (OR = 1.18, 95% CI: 1.00-1.36), T2-4 vs. Tis, Ta, and T1 (OR = 0.53, 95% CI: 0.40-0.66), larger vs. smaller tumor size (OR = 1.02, 95% CI: 1.01-1.03), and previous/synchronous bladder cancer vs. the absence of bladder cancer (OR = 1.59, 95% CI: 1.26-1.9). No significant differences in IVR after RNU were found in the younger vs. older age groups, multifocal tumors vs. single tumor, G3 vs. G1 and G2, high vs. low grade, N0 vs. N+, concomitant carcinoma in situ vs. the absence of carcinoma in situ, positive vs. negative lymphovascular invasion, open vs. laparoscopic nephroureterectomy, and endoscopic vs. transvesical technique. CONCLUSIONS: Our study showed that female patient; ureteral tumor; larger tumor; Tis, Ta, and T1; and the history of bladder cancer were significant risk factors related to IVR after RNU.
Assuntos
Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Neoplasias Renais/patologia , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Ureterais/patologia , Feminino , Humanos , Neoplasias Renais/cirurgia , Pelve Renal/patologia , Pelve Renal/cirurgia , Masculino , Nefrectomia , Fatores de Risco , Ureter/cirurgia , Neoplasias Ureterais/cirurgia , Neoplasias da Bexiga Urinária/epidemiologia , Neoplasias da Bexiga Urinária/patologiaRESUMO
OBJECTIVE: To sum up the common mode in urinary diversion after radical cystectomy. METHODS: The recent original articles about the common mode in urinary diversion after radical cystectomy were extensively reviewed. RESULTS: Urinary diversion includes no continent ureterocutaneostomy, continent ureterocutaneostomy and orthotopic neobladder. Ileal conduit, an ideal procedure of urinary diversion, has been widely used in patients after radical cystectomy and it is uncertain whether the health related quality of life in patients undergoing orthotopic ileal neobladder is superior to those undergoing ileal conduit. A series of basic researches of tissue engineering show a wide prospect of clinical application in the future. CONCLUSION: Intestinal segment will remain the main material for urinary diversion and bladder reconstruction in a long time. Tissue engineering materials may be ideal for the substitution of bladder, and tissue engineering becomes the ultimate approach to solve the problem of missing bladder.