Erectile Dysfunction is a Transient Complication of Prostate Biopsy: A Systematic Review and Meta-Analysis.

PURPOSE: Because the association between erectile dysfunction and prostate biopsy is variable in the available literature, we sought to perform a systematic review and meta-analysis of sexual dysfunction in males within 6 months of prostate biopsy. MATERIALS AND METHODS: We conducted a systematic literature search in 4 databases: MEDLINE® (via PubMed®), Embase® (via Ovid®), Web of Science™ and the Cochrane Library. We included studies focused on sexual dysfunction in men of all age groups undergoing transrectal or transperineal prostate biopsy for suspicion of prostate cancer. We included studies with International Index of Erectile Function 5 scores pre-biopsy and post-biopsy at 1, 3 or 6 months. We performed an effect size meta-analysis comparing patient baseline International Index of Erectile Function 5 (IIEF-5) scores with post-biopsy IIEF-5 scores. RESULTS: We identified 9 studies that met our inclusion criteria, of which 6 examined transrectal prostate biopsy, 2 examined transperineal prostate biopsy and 1 examined both. At 1 month after biopsy, the mean IIEF-5 score decreased by approximately 2.2 points as determined by the effect size (-0.43, p=0.002). However, at 3 and 6 months after biopsy, there was no difference compared to baseline (effect size=-0.08, p=0.52 and effect size=-0.11, p=0.18, respectively). An exploratory subgroup analysis examining transrectal prostate biopsy at 3 months showed a statistically significantly lower mean IIEF-5 score compared to baseline (p=0.047), corresponding to an approximately 1.25-point decrease in IIEF-5. CONCLUSIONS: Prostate biopsy does cause a mild, transient decrease in average IIEF-5 scores at 1-month post-biopsy. However, this resolves at 3 months on average, and average IIEF-5 remains at baseline at 6 months post-biopsy.

Hernia repair with polypropylene mesh is not associated with an increased risk of autoimmune disease in adult men.

PURPOSE: Synthetic mesh for herniorrhaphy has been placed under critical observation regarding the potential association of mesh placement and the subsequent development of autoimmune diseases. We sought to evaluate whether there is a link between synthetic polypropylene mesh repairs and the subsequent development of systemic/autoimmune disorders (SAID). STUDY DESIGN: Adult men undergoing hernia repair with mesh between January 2008 and December 2009 in New York State were identified using International Classification of Diseases, Ninth Revision, Modification procedure codes and Current Procedural Terminology Coding System, Fourth Edition codes. A control cohort of men undergoing colonoscopy was created with whom to compare outcomes. RESULTS: A total of 29,712 patients underwent hernia repair between January 2008 and December 2009. In the control cohort, 79,265 patients underwent colonoscopy. During the entire follow-up, 475 patients undergoing hernia repair and 1305 patients in the control cohort were diagnosed with autoimmune disease. When patients were matched based on demographics, comorbidities and procedure date, hernia repair was not associated with an increased risk of developing autoimmune disease over the entire follow-up time period. 1.6% of those in the hernia group vs. 1.7% of those in the colonoscopy group developed SAID [risk ratio (95% CI): hernia vs. colonoscopy 0.93(0.79-1.09)]. No association between mesh surgery and increased risks of SAID was found at any of the specified time points (6 months, 1 year, and 2-year follow-up). CONCLUSIONS: Mesh-based hernia repair was not associated with the development of autoimmune diseases compared to those undergoing routine screening colonoscopy.

Midurethral sling is the dominant procedure for female stress urinary incontinence: analysis of case logs from certifying American Urologists.

OBJECTIVE: To investigate contemporary trends in the use of midurethral sling procedures for the surgical correction of female stress urinary incontinence over the past decade. METHODS: Annualized case log data for female incontinence surgeries from certifying and recertifying urologists were obtained from the American Board of Urology. Descriptive analysis of the number and type of cases per year was performed. Associations between surgeon characteristics and the use of female incontinence procedures were evaluated. RESULTS: A total of 6355 nonpediatric urologists applied for certification or recertification between 2003 and 2012. Two-thirds (4185) reported performing any procedures for female incontinence. Procedures sharply increased from 4632 in 2003 to 7548 in 2004, then remained relatively stable between 2005 and 2012 (range, 8014-10,238 cases). Traditional procedures decreased from 17% of female incontinence procedures in 2003 to 5% in 2004 to <1% since 2010 (P <.0005). Midurethral sling procedures have risen sharply from 3210 procedures in 2003 to 7200 in 2012 (P <.0005). Endoscopic injection treatments have remained stable. CONCLUSION: Midurethral slings have been widely adopted by urologists over the last decade. Increase in sling usage coincided with a drastic decline in traditional repairs, implying that the newer midurethral slings were replacing these traditional procedures for the treatment of female incontinence. In addition, the fact that the use of periurethral injections did not change significantly during this time period indicates that increased sling usage is responsible for most of the decline in traditional repairs.