The efficacy and safety of mirabegron for adult and child patients with neurogenic lower urinary tract dysfunction: A systematic review and meta-analysis.

AIMS: We aimed to investigate the effectiveness and safety of mirabegron for adult and child patients with neurogenic lower urinary tract dysfunction (NLUTD). METHODS: A comprehensive search for articles about mirabegron treatment of NLUTD patients was conducted in PubMed, EMBASE, MEDLINE, Cochrane Library, Medicine, and clinicaltrials.gov databases. Retrospective studies and randomized-controlled studies were included if they met the inclusion criteria and were evaluated by different quality evaluation methods according to study types. Mean difference (MD) and 95% confidence intervals (CIs) were calculated using fixed-effects models or random models depending on heterogeneity. Clinical and urodynamic parameters were pooled to evaluate the efficacy, and safety was measured by adverse events rate. RESULTS: A total of 10 studies with 314 participants were finally included. Four retrospective and six prospective studies containing two randomized-control trials met the inclusion criteria with moderate and high evidence levels. Compared to the baseline date, the pooled results suggested that patients who underwent mirabegron treatment presented less urinary frequency (MD = -0.70; 95% CI: -1.08 to -0.32; p < 0.01) and less incontinence (MD = -1.62; 95% CI: -2.20 to -1.03; p < 0.01), showed conspicuous improvements in adult and child patients' urodynamic parameters, while the incidence of adverse events (10.0% on average, 0%-31.25%) also demonstrated the safety of mirabegron. CONCLUSION: Mirabegron can significantly improve urodynamic parameters and quality of life in adult and child patients with NLUTD, and increase patient compliance with a smaller complication rate.

Efficacy and Safety of Robot-assisted AUS Implantation Surgery in Treating Severe Stress Urinary Incontinence: A Systematic Review and Meta-Analysis.

OBJECTIVE: To investigate the effectiveness and safety of robot-assisted artificial urinary sphincter (AUS) implantation surgery for female patients with severe stress urinary incontinences (SUI) by performing a systematic literature review. METHODS: A comprehensive search was carried out across multiple databases, including PubMed, EMBASE, Web of Science Clarivate, Cochrane library, Medicine and clinicaltrials.gov between inception to March 2022. Studies were included if they met the inclusion criteria and were evaluated by different quality evaluation methods according to study types. P value and 95% confidence intervals (CI) of outcome measures mainly including continence rates, intraoperative and postoperative complication rates were pooled to present the efficacy and safety. RESULTS: A total of 9 studies with 157 participants were finally included. Eight retrospective and 1 prospective study met the inclusion criteria with moderate and high evidence levels. The pooled results showed that patients with robot-assisted AUS implantation treatment, presented great continence rate (P = .83, 95%CI:0.76-0.89) but high complication rate (Intraoperation: 0.21 95%CI:0.11-0.34; Postoperation: 0.20 95%CI: 0.12-0.29). In addition, subgroup analysis of 2 approaches showed that compared with the posterior approach, the traditional surgical approach had better efficacy and safety. CONCLUSION: The results of this study indicated that robot-assisted AUS implantation surgery improved SUI patients' urinary continence, but the complication rates were high, which mainly included intraoperative vaginal and bladder injury and postoperative acute urinary retention. More evidence from prospective studies is needed to provide guidance for clinical practice.