ß3-Adrenoceptor Agonist for the Treatment of Bladder Dysfunction in Children: A Systematic Review and Meta-Analysis.

PURPOSE: ß3-adrenergic receptor agonists (ß3 agonists) have been used in treatment of overactive bladder (OAB) and neurogenic detrusor overactivity (NDO) in adults. However, their use in children has only recently been approved by the U.S. Food and Drug Administration for patients with NDO. As in adults, the role of ß3 agonists in children may include conditions such as OAB. This systematic review and meta-analysis aims to understand the intended use, efficacy and safety of ß3 agonists in the pediatric population. MATERIALS AND METHODS: A literature search was performed in February 2021 across MEDLINE®, Embase®, Scopus®, the Cochrane Library and ClinicalTrials.gov. No language restrictions were placed. All records describing the clinical use of ß3 agonists in pediatric patients (<18 years of age) were included, regardless of the methodological design or outcomes assessed. The identified records were screened by 2 independent authors. The reporting was compliant with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Data extraction was performed by 2 independent reviewers, blinded to each other's extractions. The data were pooled using the fixed effects model. RESULTS: Of 367 records identified, 8 studies were included in the review (3 prospective and 5 retrospective). ß3 agonists led to improvements in both urodynamics parameters and self-reported outcomes such as incontinence. Commonly reported side effects were headaches (3%‒5.9%), constipation (3.5%‒5.7%), rhinitis/nasopharyngitis (1.7%‒5.8%) and blurred vision (1.7%‒2.9%). Clinically meaningful changes in safety outcomes (blood pressure, heart rate, electrocardiogram-related changes, liver function) were rare. Before and after ß3 agonist use, pooled effect estimates for maximum cystometric capacity for 171 patients were mean difference of +98.84 ml (95% CI 74.72, 122.96); for complete dryness, assessment of 235 patients showed a Peto odds ratio of 8.68 (95% CI 5.22, 14.45). CONCLUSIONS: ß3 agonists appear to be a promising, effective and safe alternative/adjunctive therapy in management of pediatric NDO or OAB, with improvements in both objective urodynamics parameters and subjective patient-reported outcomes following their use.

Diagnostic accuracy of contrast-enhanced voiding urosonogram using second-generation contrast with harmonic imaging (CEVUS-HI) study for assessment of vesicoureteral reflux in children: a meta-analysis.

PURPOSE: To assess the diagnostic accuracy and safety of contrast-enhanced voiding urosonogram using second-generation contrast with harmonic imaging (CEVUS-HI) in detecting vesicoureteral reflux (VUR) among children. METHODS: A systematic literature search was performed in March 2018. Relevant comparative studies from Medline, EMBASE, World of Science, Scopus, CENTRAL, WHO trial registry and Clinicaltrials.gov were identified and appraised using QUADAS-2. Diagnostic accuracy parameters were determined using VCUG as the reference standard. Adverse effects related to ultrasound contrast were summarized. The heterogeneity and inter-study variability were determined. After appropriate subgroup diagnostic accuracy parameters were investigated, summarizing receiver operator characteristics was constructed using the bivariate model meta-regression to determine the area under the curve (AUC). RESULTS: A total of 12 studies with low-high risk of bias, including 1917 ureteral units from 953 patients were assessed for this meta-analysis. The included studies reported no serious adverse events associated with the ultrasound contrast. The pooled diagnostic accuracy parameters of CEVUS-HI in detecting VUR amongst children were: sensitivity 90.43 (95% CI 90.36-90.50), specificity 92.82 (95% CI 92.76-92.87), the calculated (+) likelihood-ratio 12.59 (95% CI 12.49-12.68), (-) likelihood-ratio of 0.103 (95% CI 0.102-0.104) and extrapolated pooled diagnostic odds-ratio was 122.12 (95% CI 120.75-123.49). Heterogeneity with interstudy variability was noted (p < 0.0001, I-squared > 70%). The AUC was determined to be 0.965 for VUR detection. CONCLUSIONS: The pooled diagnostic accuracy parameters from low-moderate quality of evidence have illustrated that the CEVUS-HI study has an excellent safety profile and acceptable diagnostic accuracy. It may be considered as an alternative diagnostic modality for assessment of VUR among children.

Circumcision-incision orchidopexy: A novel technique for palpable, low inguinal undescended testis.

Given that both orchidopexy and circumcision are commonly done in a single operative setting, we adopted a technique of combined orchidopexy and circumcision using a single circumcision incision. We applied this new technique to boys with palpable, low inguinal cryptorchidism. Here we describe a case series of 7 boys who underwent concurrent orchidopexy via the circumcision site. We present this novel technique and discuss our preliminary outcomes, including the anatomic basis and feasibility. The technique appears to be an alternative for concurrent circumcision and cryptorchid cases with palpable, low inguinal testes.

Relationship of dietary intake of omega-3 and omega-6 Fatty acids with risk of prostate cancer development: a meta-analysis of prospective studies and review of literature.

Objective. To determine the relationship between dietary omega-3 fatty acids (n-3 PUFA) and omega-6 fatty acids (n-6 PUFA) with prostate cancer risk from meta-analysis of prospective studies. Design. The literature retrieved from electronic biomedical databases up to June 2011 was critically appraised. General variance-based method was used to pool the effect estimates at 95% confidence interval. Heterogeneity was assessed by Chi(2) and quantified by I(2). Results. Eight cohort studies were included for meta-analysis. n-3 PUFA, n-6 PUFA, and their derivatives were not significantly associated with risk of prostate cancer in general. A significant negative association between high dietary intake of alpha-linolenic acid (ALA) and prostate cancer risk (pooled RR: 0.915; 95% CI: 0.849, 0.985; P = 0.019) was noted. Likewise, a slightly positive association was noted on dietary long-chain n-3 PUFA, composed of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) with prostate cancer risk (pooled RR: 1.135; 95% CI: 1.008, 1.278; P = 0.036); however, when two other cohort studies with data of EPA and DHA, both analyzed separately, were included into the pool, the association became not significant (RR: 1.034; 95% CI: 0.973, 1.096; P = 0.2780). Conclusion. Intake of n-3 PUFA and n-6 PUFA does not significantly affect risk of prostate cancer. High intake of ALA may reduce risk of prostate cancer, while intake of long-chain omega-3 fatty acids does not have a significant effect.

Relationship of dietary intake of omega-3 and omega-6 fatty acids with risk of prostate cancer development: A meta-analyis of cohort studies

OBJECTIVE: To determine the relationship between dietary omega-3 fatty acid(n-3PUFA) and omega-6 fatty acids (n-6PUFA) with prostate cancer risk from a meta-analysis of prospective cohort studies. DESIGN: Cohort studies that investigated the relationship of dietary omega fatty acids and prostate cancer risk were retrieved from MEDLINE, Unbound MEDLINE, EMBASE, OVID, Cochrane Library and Science direct up to June 2011, and were critically appraised using Newcastle-Ottawa Quality Assessment for cohorts. General variance-based method was used to the pool the effect estimates at 95% confidence interval. Heterogeneity was assessed by chi square and quantified by I2. RESULTS: Eight cohort studies were included for meta-analysis. n-3PUFA, n-6PUFA and their derivatives were not significantly associated with risk of prostate cancer in general. A significant heterogeneity (P=0.023,I2=63%) between studies was noted. After inter-study variability adjustment was done, repeat analysis showed a significant negative association between high dietary intake of alpha-linolenic acid(ALA) and prostate cancer risk (pooled RR:0.915;95% CL:0.849, 0.985;P=0.019) Likewise, a slightly positive association was noted on dietary long chain omega-3 fatty acids (EPA+DHA) and prostate cancer risk (pooled RR: 1.135; 95% CI:1.008, 1.278 P=0.036), however when two other cohort studies with data of EPA and DHA both analyzed separately was included into the pool, the association became not significant (RR=1.034;95%CI:0.973,1.096;P=0.2780). CONCLUSION: The intake of n-3PUFA and n-6PUFA does not significantly affect the risk of prostate cancer. High intake of ALA may reduce risk of prostate cancer, while intake of long-chain omega-3 fatty acids does not have a significant effect.

Benign intrascrotal lipoblastoma in a child.

Lipoblastoma of the scrotum is a rare clinical entity in children. It represents one of several differential diagnoses of scrotal masses that include malignant tumors. Surgical extirpation is mandatory. We present a rare case.

Metanephric adenoma in a 32 year old female

A metanephric adenoma is one of the extemely rare benign renal cortical tumors and usually discovered incidentally after a definitive procedure. It can mimic a benign or a malignant neoplasm in terms of clinical and radiological presentation. In fact, it is commonly mistaken as an adult Wilms tumor or a Papillary Renal Cell Carcinoma. Further knowledge about this benign tumor is emphasized in order to avoid unnecessary radical nephrectomyThis is a case of a 31 year old female with history of right flank pain. Ultrasound and CT scan detected a right renal mass. Total nephrectomy was performed on the suspicion of a Renal Cell Carcinoma. The histologic report revealed a well-circumscribed tumor on the right kidney composed of small tubular structures with a well-demarcated pseudocapsule. The tumor cells proved to be diploid on flow cystometry and immunohistochemical staining showed positive for neuron specific enolase (NSE), vimentin and keratin. These findings were consistent with metanephric adenoma. (Author)