Association between antibiotic exposure and adverse outcomes of children and pregnant women: evidence from an umbrella review.

BACKGROUND: Antibiotics are widely prescribed among children and pregnant women, but their safety profile is controversial. This study aimed to summarize and appraise current evidence for the potential impact of antibiotic exposure on pregnancy outcomes and children's health. METHODS: PubMed, Embase, Web of Science and the Cochrane Database of Systematic Reviews were searched from inception to June 2022. Meta-analyses of any study design comparing the impact of antibiotic exposure with nonexposure among children, pregnant women and prepregnant women on adverse health outcomes of children and pregnancy were retrieved. The quality of evidence was assessed by a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR2) and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Data were reanalyzed, and the credibility of the evidence was determined. RESULTS: Out of 2956 studies identified, 19 articles with 39 associations were included. Totally 19 of the associations (48.72%) were statistically significant with a P value ≤ 0.05, while only six were supported by highly suggestive evidence. Children with postnatal antibiotic exposure had a higher risk of developing asthma odds ratio (OR): 1.95, 95% confidence interval (CI): 1.76-2.17, wheezing (OR: 1.81, 95% CI 1.65-1.97) and allergic rhinoconjunctivitis (OR: 1.66, 95% CI 1.51-1.83), with prediction intervals excluding the nulls. Quality assessed by both AMSTAR2 and GRADE of included meta-analyses were very low in general. CONCLUSIONS: Antibiotic exposure in early life was associated with children's long-term health, especially in cases of allergic diseases. Prenatal exposure might also influence children's health in some aspects but requires more high-quality evidence. Potential adverse effects of antibiotics on pregnancy outcomes were not observed in our study. Studies with higher quality and better quantification of antibiotic exposure are needed in the future.

YAP/Smad3 promotes pathological extracellular matrix microenviroment-induced bladder smooth muscle proliferation in bladder fibrosis progression.

Fibrosis is a chronic inflammation process with excess extracellular matrix (ECM) deposition that cannot be reversed. Patients suffer from bladder dysfunction caused by bladder fibrosis. Moreover, the interactive mechanisms between ECM and bladder fibrosis are still obscure. Hence, we assessed the pivotal effect of Yes-associated protein (YAP) on the proliferation of bladder smooth muscle in fibrosis process. We identified that stiff ECM increased the expression and translocation of YAP in the nucleus of human bladder smooth muscle cell (hBdSMC). Sequencings and proteomics revealed that YAP bound to Smad3 and promoted the proliferation of hBdSMC via MAPK/ERK signaling pathway in stiff ECM. Moreover, CUT and TAG sequencing and dual-luciferase assays demonstrated that Smad3 inhibited the transcription of JUN. The YAP inhibitor CA3 was used in a partial bladder outlet obstruction (pBOO) rat model. The results showed that CA3 attenuated bladder smooth muscle proliferation. Collectively, YAP binding with Smad3 in the nucleus inhibited the transcription of JUN, and promoted the proliferation of bladder smooth muscle through the MAPK/ERK signaling pathway. The current study identified a novel mechanism of mechanical force induced bladder fibrosis that provided insights in YAP-associated organ fibrosis.

Development of a novel predictive model for a successful stone removal after flexible ureteroscopic lithotripsy based on ipsilateral renal function: a single-centre, retrospective cohort study in China.

OBJECTIVES: The aims of this study were to investigate the effect of preoperative ipsilateral renal function on the success of kidney stone removal with flexible ureteroscopic lithotripsy and to develop a predictive model based on the results. DESIGN: Retrospective cohort study. SETTING: Data from the 2001-2012 period were collected from the electronic records of West China Hospital, Sichuan University. PARTICIPANTS: 576 patients who underwent flexible ureteroscopic lithotripsy were included in the study. PRIMARY OUTCOME: Stone-free rate (SFR) after the procedures. RESULTS: In patients with suspected impaired kidney function, the overall SFR was 70.1%. Stone volume (OR 1.46; 95% CI 1.18 to 1.80), lower calyx stones (OR 1.80; 95% CI 1.22 to 2.65), age (OR 1.02; 95% CI 1.00 to 1.04), body mass index (OR 1.10; 95% CI 1.04 to 1.17) and estimated glomerular filtration rate of the affected kidney (OR 0.95; 95% CI 0.94 to 0.97) were identified as independent predictors of SFR. Lasso regression selected the same five predictors as those identified by univariate and multivariate logistic regression analyses, thus verifying our model. The mean area under the curve, based on 1000 iterations and 10-fold validation, was 0.715 (95% CI 0.714 to 0.716). The Hodges-Lehmann test and calibration curve analysis revealed no significant mismatch between the prediction model and the retrospective cohort. CONCLUSION: Ipsilateral renal function may be a novel independent risk factor for kidney stone removal with flexible ureteroscopic lithotripsy. A novel nomogram for predicting SFR that uses stone volume, lower calyx stones, age, body mass index and estimated glomerular filtration rate was developed, but remains to be externally validated.

Integrating single-cell RNA sequencing with spatial transcriptomics reveals immune landscape for interstitial cystitis.

Interstitial cystitis (IC) is a severely debilitating and chronic disorder with unclear etiology and pathophysiology, which makes the diagnosis difficult and treatment challenging. To investigate the role of immunity in IC bladders, we sequenced 135,091 CD45+ immune cells from 15 female patients with IC and 9 controls with stress urinary incontinence using single-cell RNA sequencing (scRNA-seq). 22 immune subpopulations were identified in the constructed landscape. Among them, M2-like macrophages, inflammatory CD14+ macrophages, and conventional dendritic cells had the most communications with other immune cells. Then, a significant increase of central memory CD4+ T cells, regulatory T cells, GZMK+CD8+ T cells, activated B cells, un-switched memory B cells, and neutrophils, and a significant decrease of CD8+ effector T cells, Th17 cells, follicular helper T cells, switched memory B cells, transitional B cells, and macrophages were noted in IC bladders. The enrichment analysis identified a virus-related response during the dynamic change of cell proportion, furthermore, the human polyomavirus-2 was detected with a positive rate of 95% in urine of patients with IC. By integrating the results of scRNA-seq with spatial transcriptomics, we found nearly all immune subpopulations were enriched in the urothelial region or located close to fibroblasts in IC bladders, but they were discovered around urothelium and smooth muscle cells in control bladders. These findings depict the immune landscape for IC and might provide valuable insights into the pathophysiology of IC.

Stone removing efficiency and safety comparison between single use ureteroscope and reusable ureteroscope: a systematic review and meta-analysis.

BACKGROUND: Urologists are gradually beginning to use single-use ureteroscopes (sufURSs), despite a lack of high-level evidence as to their efficacy and safety. This systematic review was registered on PROSPERO (no. CRD42020181808). METHODS: The PubMed, Embase, Web of Science, and Cochrane Library databases were searched for studies published before October 1, 2020. Jadad score tools were used to evaluate the quality of the included randomized controlled trials (RCTs) and the Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included nonrandomized studies. Two researchers independently extracted data according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) principles. A data synthesis was performed using Stata 15.0. Heterogeneity was mainly evaluated with I2 tests. In addition to funnel plots, Egger's and Begg's tests were used to detect publication bias. A sensitivity analysis was also performed. Stone-free rates and postoperative complications were the 2 primary outcomes; operation-time data were also extracted. RESULTS: Six studies (comprising 887 patients) containing the efficacy data and 5 studies (comprising 952 patients) containing the safety data that were finally included in the quantitative analysis. In relation to stone removal, no significant difference was found in terms of efficacy [Mantel-Haenszel statistic (M-H), relative risk (RR): 1.01, 95% confidence interval (CI): 0.96-1.07, P=0.658) or safety (M-H, RR: 1.30, 95% CI: 0.96-1.75, P=0.093) between the sufURS and the reusable flexible ureteroscope (rfURS), and no significant heterogeneity was found. A publication bias was detected in the efficacy comparison; however, the trim-and-fill analysis indicated that the original synthesis results remained stable. CONCLUSIONS: In relation to stone removal, sufURSs were found to be comparable to rfURS, and no compromising complications were found. However, the results should be treated with caution due to limitations related to the small number of studies included in the analysis.

Efficacy and safety comparison of pharmacotherapies for interstitial cystitis and bladder pain syndrome: a systematic review and Bayesian network meta-analysis.

INTRODUCTION AND HYPOTHESIS: The objective was to compare the clinical efficacy and safety of pharmacological interventions for interstitial cystitis and bladder pain syndrome (IC/BPS) with direct and indirect evidence from randomized trials. METHODS: We searched PubMed, the Cochrane library, and EMBASE for randomized controlled trials (RCTs) that assessed the pharmacological therapies for IC/BPS. Primary efficacy outcomes included ICSI (O'Leary Sant Interstitial Cystitis Symptom Index), ICPI (O'Leary Sant Interstitial Cystitis Problem Index), 24-h micturition frequency, visual analog scale (VAS), and Likert score for pain. Safety outcomes are total adverse events (AEs, intravesical instillation, and others), gastrointestinal symptoms, headache, pain, and urinary symptoms. A systematic review and Bayesian network meta-analysis were performed. RESULTS: A total of 23 RCTs with 1,871 participants were identified. The ICSI was significantly reduced in the amitriptyline group (MD = -4.9, 95% CI: -9.0 to -0.76), the cyclosporine A group (MD = -7.9, 95% CI: -13.0 to -3.0) and the certolizumab pegol group (MD = -3.6, 95% CI:-6.5 to -0.63) compared with placebo group. Moreover, for ICPI, cyclosporine A showed superior benefit compared to placebo (MD = -7.6, 95% CI: -13 to -2.3). VAS score improved significantly in cyclosporine A group than pentosan polysulfate sodium (MD = 3.09, 95% CI: 0.13 to 6.07). None of the agents revealed a significant alleviation of 24-h micturition frequency. In terms of safety outcomes, the incidence rate on urinary symptoms for botulinum toxin A was the only variate higher than chondroitin sulfate (MD = -2.02, 95% CI: -4.99 to 0.66) and placebo (MD = -1.60, 95% CI:-3.83 to 0.17). No significant difference was found among the other treatments. CONCLUSIONS: Cyclosporine A might be superior to other pharmacological treatments in efficacy. Amitriptyline and certolizumab pegol were capable of lowering the ICSI as well.

Preoperative urine nitrite versus urine culture for predicting postoperative fever following flexible ureteroscopic lithotripsy: a propensity score matching analysis.

PURPOSE: Multiple studies have reported that preoperative positive urine culture is an independent risk factor for postoperative fever (POF) after ureteroscopy (URS). Urine nitrite is associated urinary tract infections (UTIs). However, none of studies has explored the role of urine nitrite in the prediction of POF after flexible URS (fURS). METHODS: Patients who underwent fURS by the same surgeon between 2009 and 2019 were screened. Sensitivity and specificity of urine culture and urine nitrite were calculated. Propensity score (PS) matching was performed to get a baseline-balanced retrospective cohort to avoid potential bias. Receiver operating characteristic-area under the curve (ROC-AUC) calculated was used to determine the predictive power of models. Decision curve analysis (DCA) was plotted to obtain the clinical benefit of the models. RESULTS: Poseoperative fever (POF) is defined as the temperature of the patient higher than 38 ℃ within 72 h after operation, with no sign of infection in other systems. 31(2.8%) of 1095 cases had POF after fURL. Urine nitrite had a better specificity than urine culture for POF diagnosis (P < 0.001). After the PS matching, a well-balanced cohort of 24 POF group and 96 no-POF group was produced. The mean AUC from the bootstrap resampling method for urine nitrite model (AUC: 0.8736; 95% CI: 0.8731-0.8743) was significantly increased than that of the urine culture model (AUC: 0.8385; 95% CI: 0.8378-0.8392). The application of two kinds of POF predicting models could bring clinical net benefit when the probability is < 35%. However, urine nitrite model showed a better clinical net benefit acquirement compared to the urine culture model. CONCLUSION: Preoperative positive urine nitrite may play a pivotal role in the prediction of POF after fURS and needs to be validated by future evidence.

Risk Factors of Infectious Complications after Ureteroscopy: A Systematic Review and Meta-Analysis Based on Adjusted Effect Estimate.

Background: Multiple studies have reported that gender, pre-operative stent insertion, positive pre-operative urine culture results, and diabetes mellitus are associated with infectious complication after ureteroscopy. A previous meta-analysis focused on this topic is based, however, on crude estimate. Further analysis based on adjusted estimates is needed. Methods: PubMed, Web of Science, Embase, and the Cochrane Library database were searched with ureteroscopy, ureteroscopies, ureteroscopic surgical procedures, ureteroscopic surgery, ureteroscopic lithotripsy, flexible ureteroscopic lithotripsy, ureteroscopy (URS), flexible ureterorenoscopy, risk factor, predictor, predicting model, and nomogram until December 15, 2019. The quality of research was evaluated by Newcastle-Ottawa Scale system. Odds ratio (OR) and 95% confidence intervals (CI) of each risk factor were extracted. Meta-analysis was performed with Stata 15.0 software. Heterogeneity was assessed by I2. Publication bias was tested by the Egger test, and funnel plot. Meta-regressions and subgroup analysis were further performed. Results: There were 16 studies; 12,357 patients finally were included in this meta-analysis. The association between gender (OR = 1.82, 95% CI: 1.48-2.23, I2 = 0%, p = 0.701), pre-operative ureteric stent insertion (OR = 1.91, 95% CI: 1.26-2.91, I2 = 40.4%, p = 0.109), diabetes mellitus (OR: 1.40, 95% CI: 1.07-1.85, I2 = 34.1%, p = 0.168), positive urine culture before URS (OR: 2.18, 95% CI: 1.34-3.57, I2 = 47.2%, p = 0.092), operation duration (OR: 1.03, 95% CI: 1.01-1.04, I2 = 70.6%, p = 0.001) and infectious complications was positively significant. All four pooled results were different from results of meta-analysis based on crude estimate. Conclusion: Female gender, pre-operative ureteric stent insertion, diabetes mellitus, positive urine culture results before URS, and operation duration are risk factors for infectious complications after URS. Meta-analysis based on adjusted estimates may be more convincing.

Transurethral endoscopic enucleation of the prostate using a diode laser versus bipolar plasmakinetic for benign prostatic obstruction: a meta-analysis.

To evaluate the clinical efficacy and safety of diode laser enucleation of the prostate (DiLEP) versus bipolar plasma kinetic enucleation of the prostate (PKEP) in the management of benign prostatic hyperplasia (BPH). A systematic literature search was undertaken using PubMed, Embase, Web of Science, Cochrane Library, and CKNI databases to identify eligible studies published before April 2019. The quality of evidence and methodology was assessed. Primary outcomes were clinical and demographic characteristics and postoperative efficacy including maximum flow rate (Qmax), postvoid residual (PVR), quality of life (QoL), and International Prostate Symptom Score (IPSS); secondary outcomes were intraoperative variables and major complications. Meta-analyses of extracted data were performed with the RevMan version 5.2. The overall effects were determined by the Z-test, and a p value less than 0.05 was considered with significant difference. A fixed- or random-effect model was chosen to fit the pooled heterogeneity (determined by Chi-squared test and I2). As qualified trials were few, subgroup analyses were not performed. Four randomized controlled trials (RCTs) involving 451 patients were enrolled in our meta-analysis. In the included trials, all the diode (wavelength at 980 nm and 1470 nm) lasers applied output at continuous wave mode; the energy settings ranged from 120 to 160 W for enucleation and 30 to 60 W for coagulation. DiLEP provided less perioperative hemoglobin decrease (MD = - 3.22; 95% CI (- 5.15, - 1.29); p = 0.001; I2 = 65%), less postoperative catheterization time (MD = - 17.82; 95% CI (- 32.74, - 2.90); p = 0.02; I2 = 96%), less postoperative irrigation time (MD = - 7.15; 95% CI (- 13.67, - 0.62); p = 0.03; I2 = 98%), and lower incidence of urinary irritative symptoms (OR = 0.31; 95% CI (0.14, 0.67); p = 0.003; I2 = 0%) compared with PKEP. During the 1, 3, 6, and 12-month postoperative follow-up, no statistically significant difference was found in Qmax, IPSS, QoL, and PVR between the procedures. As regards other perioperative and postoperative parameters and major complications, we found no significant difference. Both DiLEP and PKEP are safe and efficient methods for the treatment of BPH. However, DiLEP showed less perioperative hemoglobin decrease, less postoperative catheterization time, less postoperative irrigation time, and lower rates of postoperative irritative symptoms compared with the PKEP group.

Will the resection of pheochromocytoma improve preoperative diabetes mellitus?

OBJECTIVE: To explore the likelihood of resolution of diabetes postoperatively. Besides, we would like to determine the risk factors associated with development and prognosis of diabetes. METHODS: All patients in our hospital undergoing surgical removal of pheochromocytoma (PHEO) from 10 October 2010 to 21 July 2017 were retrospectively analyzed to determine those with preoperative diabetes. Preoperatively demographic data and information on diabetes were recorded. The median follow-up was 45.2 months. RESULTS: Finally, 67 (36.2%) patients were with diabetes among 185 patients undergoing surgery. Furthermore, 47 patients had complete follow-up. And 37 (78.7%) patients had improvement of diabetes after resection of PHEO. In details, 29 (61.7%) patients had complete resolution. Older patients were more likely to develop diabetes, and symptomatic patients with longer course of PHEO were also more susceptible to preoperative diabetes. Elevated body mass index (BMI) was a risk factor of persistent diabetes postoperatively after surgery. CONCLUSIONS: 36.2% of PHEO patients might be with preoperative diabetes mellitus. Older patients were more likely to present diabetes preoperatively. And the increasing length of PHEO course might be another risk factor on developing diabetes preoperatively. Resection of tumors improved diabetes in 78.7% of patients, with resolution in 61.7%. Patients with higher BMI might need treatment for diabetes postoperatively.

Enucleation of the prostate for benign prostatic hyperplasia thulium laser versus holmium laser: a systematic review and meta-analysis.

To evaluate the clinical efficacy and safety of thulium laser vapoenucleation/enucleation of the prostate (ThuEP) versus holmium laser enucleation of the prostate (HoLEP) in the management of benign prostatic hyperplasia (BPH). A systematic literature search was performed using PubMed, Embase, and Web of Science to identify eligible studies published before July 2018. Meta-analysis of extracted data was performed with RevMan version 5.3. We chose the fixed- or random-effect model to fit the pooled heterogeneity. Five eligible studies including two randomized controlled trials (RCTs) and three non-RCTs involving 1010 patients were enrolled in our meta-analysis. ThuEP provided less enucleation time when compared with HoLEP (WMD = - 7.73, 95% CI - 14.39-1.07, P = 0.02). During the 1st, 6th, and 12th months of postoperative follow-ups, statistically significant differences were found in Qmax (WMD = 2.05, 95% CI 0.52~3.58) and PVR (WMD = - 6.50, 95% CI - 7.35~- 5.66, P < 0.001) in the 1st month after the operation, also in IPSS (IPSS: WMD = - 1.29, 95% CI - 2.39~- 0.19, P = 0.02) in the 12th month after the operation. As regards other perioperative, postoperative parameters, and complication rates, we found no significant difference. Both ThuEP and HoLEP provided satisfactory micturition improvement with low morbidity after the 1st and 6th months of the operation. However, ThuEP showed higher enucleation efficacy and less intraoperative blood loss and may get a better outcome as compared to the HoLEP group in the early postoperative period with regard to Qmax/PVR and IPSS after the 1st and 12th months of the operation respectively.

Is there a relationship between phosphodiesterase type 5 inhibitors and biochemical recurrence after radical prostatectomy: a systematic review and meta-analysis.

PURPOSE: Conduct a systematic review and meta-analysis of studies to evaluate the association between the use of PDE5I and biochemical recurrence (BCR) after radical prostatectomy (RP). METHODS: We searched Embase (from 1996 to Feb 2018), PubMed (from 1996 to Feb 2018), and Cochrane library (from 1999 to Feb 2018), then manually searched the reference lists of key retrieved articles. Original studies that reported the risk of postoperative BCR for PDE5I users, as compared with non-PDE5I users, were included. Data including the characteristic of participants, the risk of BCR after RP and key criteria of study quality were collected. The pooled relative risks (RRs) were calculated with random-effects model. RESULTS: A total of 5 cohort studies and 1 case-control study were conducted for data analysis (a total of 17752 participants). Only 1 cohort study reported adjusted RR greater than 1 (range for all derived RRs, 0.7-1.47). The meta-analysis revealed that the PDE5I users had no higher risk of BCR after RP (RR = 1.04, 95% confidence interval [CI], 0.79-1.36). Sensitivity analysis showed that the remaining pooled RR and 95% CI were not changed significantly by omitting each study. In addition, the 5-year BCR rate had no significant difference between PDE5I users and non-PDE5I users. CONCLUSIONS: Our meta-analysis indicated that PDE5I treatment in men following RP did not increase the risk of BCR. The results preliminarily suggested that the use of PDE5I for erectile dysfunction after RP was oncologically safe. Nevertheless, more large sample cohort studies are needed to validate this conclusion.

The Antimuscarinic Agent Tolterodine Regulates Bladder Extracellular Matrix in Partial Bladder Outlet Obstruction in Rats.

BACKGROUND/AIMS: Antimuscarinic agents can delay the progression of bladder dysfunction caused by bladder outlet obstruction (BOO). To date, the relationship between muscarinic receptor activity and the bladder extracellular matrix (ECM) remains unclear. Thus, an animal model of partial BOO (PBOO) in female rats was established to explore the variation in bladder wall ECM proteins under PBOO conditions with antimuscarinic agent administration. METHODS: Rats were randomly divided into three groups: sham, PBOO, and PBOO plus tolterodine. Picrosirius red staining was used to examine the smooth muscle and collagen content of bladder samples. Gene microarray and RT-PCR were performed to survey the expression of ECM proteins, receptors, and metabolism regulators in the rat bladder. Positive results were further evaluated by immunohistochemistry. RESULTS: Picrosirius red staining showed that smooth muscle volume significantly increased in the PBOO and PBOO plus tolterodine groups (p < 0.05), while collagen significantly increased in the PBOO group (p < 0.05) but not in the PBOO plus tolterodine group. Gene microarray and RT-PCR revealed that none of the collagen subtypes exhibited significant changes after PBOO establishment and tolterodine administration. However, matrix metalloproteinases (MMPs) increased significantly in the PBOO plus tolterodine group (p < 0.05). Additionally, PBOO inhibited the expression of non-collagen ECM proteins in the rat bladder wall, while tolterodine induced the expression of non-collagen ECM proteins and ECM receptors. CONCLUSIONS: Tolterodine decreased the volume of collagen in PBOO rat bladder wall, possibly via MMPs, and regulated the expression of ECM proteins and receptors.

Paraneoplastic Cerebellar Degeneration Associated with Pelvic Liposarcoma: A Rare Case Report.

Paraneoplastic cerebellar degeneration (PCD) is one of the most common paraneoplastic neurological syndromes characterized by the rapid development of severe cerebellar ataxia. In this report, a 23-year-old female with noticeable dizziness and gait instability was described. The enhanced CT scanning suggested the presence of a pelvic tumor. Then, PCD was established. Postoperative pathological result defined it as a liposarcoma (LS) with dedifferentiation. Interestingly, clinical symptoms disappeared after the surgical removal of the pelvic tumor. To our knowledge, this was the first case report with PCD due to LS.

Protective Effects of Antimuscarinics on the Bladder Remodeling After Bladder Outlet Obstruction.

BACKGROUND/AIMS: Overactive bladder associated with bladder outlet obstruction (BOO) is a highly prevalent condition, which is usually treated with antimuscarinics. However, the potential effects of antimuscarinics on the structure and function of bladder have not been investigated thus far. METHODS: Sprague-Dawley(R) rats accepted bladder neck obstruction surgery or sham surgery, and then received treatment of three different antimuscarinics (Solifenacin, Darifenacin, and Tolterodine) or vehicle. After 3, 6 and 12 weeks, the bladder function and structure were measured. The effect of antimuscarinics on cellular alteration in vitro was observed under mechanical stimulation. Bladder morphology were examined by immunohistochemistry, and the bladder function were investigated by cystometry and strip contractility test. The expression of muscarinic receptors and inflammatory cytokines were measured by PCR and Western blotting. RESULTS: Here we demonstrate, both in vitro and in vivo, that antimuscarinics are protective regulators for the bladder structure and function. Antimuscarinics decrease the weight of bladders with BOO. Antimuscarinics improve the voiding parameter and enhance the contraction of bladder smooth muscle. The results also show that antimuscarinics inhibit the proliferation of bladder smooth muscle cells both in vivo and in vitro, it can reduce the collagen deposition and inflammatory cytokines in bladders with BOO. During this process, the expression of M2 and M3 receptors was altered by antimuscarinics. CONCLUSION: Antimuscarinics could reverse the structural and functional changes of BOO bladder wall at cellular and tissue level, and the alteration of M2 and M3 receptors may be involved in this biological process.

A network meta-analysis on the beneficial effect of medical expulsive therapy after extracorporeal shock wave lithotripsy.

We applied a newly introduced method, network meta-analysis, to re-evaluate the expulsion effect of drugs including tamsulosin, doxazosin, nifedipine, terazosin and rowatinex after extracorporeal shock wave lithotripsy (ESWL) as described in the literature. A systematic search was performed in Medline, Embase and Cochrane Library for articles published before March 2016. Twenty-six studies with 2775 patients were included. The primary outcome was the number of patients with successful stone expulsion. The data were subdivided into three groups according to duration of follow-up. A standard network model was established in each subgroup. In 15-day follow-up results, SUCRA outcome showed the ranking of effects was: doxazosin > tamsulosin > rowatinex > nifedipine > terazosin (88.6, 77.4, 58.6, 32.2 and 30.4, respectively). In 45-day follow-up results, SUCRA ranking was: tamsulosin > nifedipine > rowatinex (69.4, 67.2 and 62.6, respectively). In 90-day follow-up results, SUCRA ranking was: doxazosin > rowatinex > tamsulosin (84.1, 68.1 and 49.1, respectively). In conclusion, doxazosin and tamsulosin have potential to be the first choice for pharmacological therapy to promote the expulsion of urinary stone fragments after ESWL, with this doxazosin can improve the SFR in the long term, while tamsulosin may result more in accelerating the process of expulsion.

Different Tract Sizes of Miniaturized Percutaneous Nephrolithotomy Versus Retrograde Intrarenal Surgery: A Systematic Review and Meta-Analysis.

PURPOSE: Miniaturized percutaneous nephrolithotomy (MPCNL), including minipercutaneous nephrolithotomy (PCNL), ultramini-PCNL, and micro-PCNL, have been developed recently. The aim of this meta-analysis was to compare the safety and efficacy of different tract sizes of MPCNL with retrograde intrarenal surgery (RIRS) in the management of kidney stones. MATERIALS AND METHODS: We searched PubMed, Embase, and Web of Science to identify case-control trials and randomized controlled trials, which evaluated MPCNL vs RIRS before February 2017. Two reviewers independently evaluated the methodologic quality of the included studies, and the disagreements were solved by discussion. Meta-analysis was performed with Review Manager version 5.3 software. RESULTS: Fourteen publications involving 1279 patients were included. Mini-PCNL provided a significantly higher stone-free rate (SFR; odds ratio [OR] OR 1.66; p = 0.005), especially for lower pole renal stones (OR 2.65; p = 0.003), but brought longer hospital stay (weighted mean difference [WMD] 1.23; p = 0.0001) and larger hemoglobin drop (WMD 0.77; p < 0.00001). There were no statistically significant differences between mini-PCNL and RIRS in the complications (OR 0.77; p = 0.23) and operative time (WMD: -6.52; p = 0.42). For ultramini-PCNL and micro-PCNL, the safety and efficacy were similar to RIRS. CONCLUSIONS: Mini-PCNL offers a significantly higher SFR than RIRS, for lower pole renal stones, the advantage of mini-PCNL is more obvious. However, RIRS is associated with shorter hospital stay and less hemoglobin drop. For ultramini-PCNL and micro-PCNL, tract size is smaller than mini-PCNL, and the SFR is similar to RIRS. In terms of the evidence at present, we recommend mini-PCNL for patients focusing more on the high SFR.