[Efficacy and safety of Serenoa repens extract combined with α-receptor blocker in the treatment of benign prostatic hyperplasia].

OBJECTIVE: To evaluate the effect and safety of Serenoa repens extract (SR) combined with α-receptor blocker (αRB) in the treatment of BPH. METHODS: We included 7 published randomized controlled trials (RCT) studying the effect and safety of SR+αRB versus αRB monotherapy in the treatment of 1 009 BPH patients, and performed a meta-analysis on the data obtained using the RevMan 5.1.3 software. RESULTS: The baseline data from the RCTs were all comparable. Compared with the patients treated by αRB monotherapy, those of the SR+αRB group showed significant decreases in the total IPSS, sub-IPSS in the storage and voiding stages, quality of life score (QOL) and PSA level (all P < 0.05), an increase in the maximum urinary flow rate (Qmax) (P = 0.04), but no statistically significant differences in the prostate volume and postvoid residual urine volume (P > 0.05). CONCLUSIONS: Serenoa repens extract combined with α-receptor blocker is safe and effective, and even better than α-receptor blocker monotherapy, in the treatment of BPH.

Efficacy and safety of short- and long-term, regular and on-demand regimens of phosphodiesterase type 5 inhibitors in treating erectile dysfunction after nerve-sparing radical prostatectomy: a systematic review and meta-analysis.

BACKGROUND: We performed a meta-analysis to evaluate the efficacy and safety of short-term (≤6 months) and long-term (>6 months), regular (OaD) and on-demand (PRN) regimens of phosphodiesterase type 5 inhibitors (PDE5-Is) in treating erectile dysfunction (ED) after nerve-sparing radical prostatectomy (NSRP). METHODS: We conducted a literature search in August 2016. Sources included PubMed, EMBASE, and MEDLINE databases. The main outcome was International Index of Erectile Function-Erectile Function (IIEF-EF) domain score, and the secondary outcome was treatment-emergent adverse events (TEAEs). RESULTS: Eight articles involving 13 randomized controlled trials (RCTs) were used in this analysis: they suggested that PDE5-Is can improve the IIEF-EF distinctly in comparison with placebo in short and long term (mean difference [MD]: 2.26, 95% confidence interval [CI]: 1.45-3.08, P<0.00001, and MD: 4.5, 95% CI: 3.6-5.4, P<0.00001), and long-term use of PDE5-Is (>6 months) can improve the IIEF-EF distinctly in comparison with short-term use of PDE5-Is (≤6 months) (MD: 3.9, 95% CI: 3.01-4.8, P<0.00001). OaD of PDE5-Is significantly improved the IIEF-EF compared to placebo in short and long term (MD: 4.08, 95% CI: 3.2-4.97, P<0.00001, and MD: 4.74, 95% CI: 3.79-5.69, P<0.00001). No significant differences were found in IIEF-EF changes between PRN and placebo (≤6 months) (MD: 2.64, 95% CI: -0.87 to 6.14, P=0.14), and between PRN and OaD group (>6 months) (MD: -0.58, 95% CI: -9.86 to 8.74, P=0.91). There were more TEAEs in PDE5-Is group in comparison with placebo (odds ratio [OR]: 1.55, 95% CI: 1.26-1.91, P<0.0001), and TEAEs in OaD group were not significantly different from those seen in PRN group (OR: 1.05, 95% CI: 0.78-1.4, P=0.77). CONCLUSION: Our meta-analysis suggests that PDE5-Is are efficient and safe for treatment of ED after NSRP, and we should choose the regular regimen for short term and regular or on-demand regimen for long term. Further high-quality RCTs are needed to validate this result.

Efficacy and safety of prostate artery embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: a systematic review and meta-analysis.

BACKGROUND: Prostate artery embolization (PAE) is emerging and is a promising minimally invasive therapy that improves lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). The purpose of this article was to evaluate the efficacy and safety of PAE on LUTS related to BPH. MATERIALS AND METHODS: A literature review was performed to identify all published articles of PAE for BPH. The sources included MEDLINE, EMBASE and Cochrane Library from 1980 to 2016. A systematic review and meta-analysis was conducted. The outcome measurements were combined by calculating the mean difference with 95% confidence interval. Statistical analysis was carried out using Review Manager 5.3.0. RESULTS: Twelve studies involving 840 participants were included. Compared with baseline, the International Index of Erectile Function (IIEF-5; International Prostate Symptom Score) scores, the quality of life scores, peak urinary flow rate (Qmax) and postvoid residual volume all had significant improvements during the 24-month follow-up (all P<0.00001). Both prostate volume (PV) and prostate-specific antigen had significant decrease during the 12-month follow-up (P<0.00001 and P=0.005, respectively), except postoperative 24 months (P=0.47 and P=0.32, respectively). The IIEF-5 short form scores had significant increase at postoperative 6 months (P=0.002) and 12 months (P<0.0001), except postoperative 1 month (P=0.23) and 24 months (P=0.21). For large volume (PV ≥80 mL) BPH, the results were similar. There were no life-threatening complications. CONCLUSION: PAE is an effective, safe and well-tolerable treatment for LUTS related to BPH, including large volume (PV ≥80 mL) BPH, with a good short-term follow-up. Studies with large number of cases and longer follow-up time are needed to validate our results.

Efficacy and safety of onabotulinumtoxinA in treating neurogenic detrusor overactivity: a systematic review and meta-analysis.

BACKGROUND: OnabotulinumtoxinA is widely used in treating neurogenic detrusor overactivity (NDO). We carried out a systematic review and meta-analysis to assess the efficacy and safety of the drug for treating NDO. METHODS: We searched the following databases: Medline, EMBASE, and the Cochrane Controlled Trials Register. All published randomized double-blind, placebo-controlled trials of onabotulinumtoxinA for the treatment of NDO were identified in the analysis. The reference lists of the retrieved studies were also investigated. RESULTS: Four publications involving a total of 807 patients were identified in the analysis, which compared onabotulinumtoxinA with placebo. The changes of the mean number of urinary incontinence per week (the standardized mean difference [SMD] = -10.91, 95% confidence intervals [CIs] = -14.18--7.63, P < 0.0001); maximum cystometric capacity (SMD = 146.09, 95% CI = 126.19-165.99, P < 0.0001) and maximum detrusor pressure (SMD = -32.65, 95% CI = -37.83--27.48, P < 0.0001) indicated that onabotulinumtoxinA was more effective than the placebo, despite the doses of onabotulinumtoxinA. Safety assessments primarily localized to the urinary tract indicated onabotulinumtoxinA were often associated with more complications. Urinary tract infections (relative risk [RR] =1.48, 95% CI = 1.20-1.81, P = 0.0002); hematuria (RR = 1.81, 95% CI = 1.00-3.24, P = 0.05) and urinary retention (RR = 5.87, 95% CI = 3.61-9.56, P < 0.0001). CONCLUSIONS: This meta-analysis indicates that onabotulinumtoxinA to be an effective treatment for NDO with side effects primarily localized to urinary tract.

Avanafil for male erectile dysfunction: a systematic review and meta-analysis.

Avanafil, a potent new selective phosphodiesterase type 5 (PDE5) inhibitor, has been developed for the treatment of erectile dysfunction (ED). We carried out a systematic review and meta-analysis to assess the efficacy and safety of this drug for the treatment of ED. A literature review was performed to identify all published randomized, double-blind, placebo-controlled trials of avanafil for the treatment of ED. The search included the following databases: MEDLINE, EMBASE and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also investigated. Four publications, involving a total of 1381 patients, were used in the analysis, including four randomized controlled trials (RCTs) that compared avanafil with a placebo. Among the co-primary efficacy end points indicating that avanafil 100 mg was more effective than a placebo were successful vaginal penetration (SEP2) (the odds ratio (OR) =5.06, 95% confidence interval (CI) =3.29-7.78, P< 0.00001) and successful intercourse (SEP3) (OR = 3.99, 95% CI = 2.80-5.67, P< 0.00001). Men randomized to receive avanafil were less likely than those receiving the placebo to drop out due to an adverse event (AE) (OR = 1.48, 95% CI = 0.54-4.08, P= 0.44). Specific AEs with avanafil included headache and flushing, which were significantly less likely to occur with placebo. This meta-analysis indicates that avanafil 100 or 200 mg is an effective and well-tolerated treatment for ED. Compared with avanafil 100 mg, patients who take avanafil 200 mg are more likely to experience headaches.

The impact of transurethral procedures for benign prostate hyperplasia on male sexual function: a meta-analysis.

The effect of transurethral procedures for benign prostate hyperplasia (BPH) on male sexual function is still controversial, and we conducted this meta-analysis to compare the effects of different transurethral surgical procedures for the treatment of symptomatic BPH on male erectile function (EF) and ejaculatory function (EJF). Databases, including MEDLINE, EMBASE, and the Cochrane Controlled Trial Register, were searched to identify randomized controlled trials (RCT) that compared watchful waiting, transurethral electrovaporization (TUEVP) or holmium laser treatment (HLT) with transurethral resection of the prostate (TURP). Trials were included if they were RCTs, contained fully available data, compared with conventional TURP for BPH, and referred to male EF and EJF. A total of 12 RCTs involving a total of 1889 subjects were selected for analysis, including 2 trials comparing TURP and watchful waiting, 6 comparing TURP with TUEVP, and 4 comparing TURP with HLT. TURP was associated with a higher occurrence of retrograde ejaculation compared with watchful waiting but not to TUEVP (P = .95) or HLT (P = .37) and associated with a lower incidence of male erectile dysfunction compared with TUEVP (P = .04) but not HLT. According to the analysis, TURP lead to a higher prevalence of retrograde ejaculation compared with watchful waiting but had less of an effect on EF than TUEVP. TURP did not have a significantly different effect on EF or EJF compared with HLT.

[Impacts of different transurethral prostatic resection procedures on male sexual function: meta-analysis of randomized controlled trials].

OBJECTIVE: To compare the impacts of transurethral resection of the prostate (TURP), transurethral electrovaporization of the prostate (TUEVP) and holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) on male sexual function. METHODS: We identified randomized controlled trials on the influence of TURP, TUEVP and HoLEP on the sexual function of BPH patients, and performed meta-analysis on the included data using Revman 5.0.25. RESULTS: Nine randomized controlled trials involving 1 050 BPH patients were included in the meta-analysis. The baseline of the study was comparable. TURP affected erectile function less than TUEVP (P = 0.04), but the two had no significant difference in their influence on ejaculatory function. Nor was any significant difference found between HoLEP and TURP in their influence on either erectile or ejaculatory function at 12 and 24 months after surgery. CONCLUSION: TUEVP induces a higher incidence of erectile dysfunction than TURP, but its influence on ejaculatory function is not significantly different from the latter. HoLEP and TURP have no significant difference in their influence on erectile function and ejaculatory function.

A systematic review of the effects and mechanisms of preoperative 5α-reductase inhibitors on intraoperative haemorrhage during surgery for benign prostatic hyperplasia.

5α-reductase inhibitors (5α-RIs), including finasteride and dutasteride, are commonly used medical therapies for benign prostatic hyperplasia (BPH). Many studies reported that preoperative 5α-RI had impact on intraoperative haemorrhage during surgery for BPH, but it was still in controversial. So, we conducted a systematic review of the effects and mechanisms of 5α-RIs on intraoperative bleeding for BPH. MEDLINE, EMBASE, the Cochrane Controlled Trail Register of Controlled Trials and the reference lists of retrieved studies were searched in the analysis. Sixteen publications involving 15 different randomized controlled trials (RCTs) and a total of 1156 patients were used in the analysis, including 10 RCTs for finasteride and five RCTs for dutasteride. We found that preoperative finasteride treatment decreases microvessel density (MVD) in resected prostate specimens. Total blood loss, blood loss per gram of resected prostate tissue and decreases in haemoglobin were all greatly reduced in the finasteride group as compared to controls. Dutasteride appeared to have no effect on bleeding. This meta-analysis shows that preoperative finasteride treatment could decrease intraoperative haemorrhage during surgery for BPH. Preoperative dutasteride had no effect on intraoperative haemorrhage, but further high-quality prospective studies are still needed to confirm this observation.