Analysis of lncRNAs profiles associated with ferroptosis can predict prognosis and immune landscape and drug sensitivity in patients with clear cell renal cell carcinoma.

Ferroptosis is a novel kind of iron- and reactive oxygen-induced cell death, investigation into ferroptosis-associated long noncoding RNAs (FALs) in clear cell renal cell carcinoma (ccRCC) is scarce. The goal of the research was to look at FALs' possible predictive significance, as well as their interaction with the immune microenvironment and therapeutic responsiveness of ccRCC. The Cancer Genome Atlas database was employed to retrieve RNA sequencing data from 530 individuals with ccRCC. Patients with ccRCC were randomly assigned to one of two groups: training or testing. Pearson's correlation analysis through the identified ferroptosis-related genes was implemented to screen for FALs. Finally, a FALs signature composed of eight lncRNAs was discovered for predicting survival outcomes in ccRCC patients. ccRCC patients in the training, testing, and overall cohorts were separated into low-risk and high-risk groups based on their risk score. The FALs signature was identified to be an independent factor for overall survival in the multivariate Cox analysis (hazard ratio = 1.013, 95% confidence interval = 1.008-1.018, p < 0.001). A clinically prognostic nomogram was created depending on the FALs signature and clinical characteristics. The nomogram provides greater clinical practicability and may reliably estimate patients' overall survival. The FALs signature may additionally precisely represent ccRCC's immunological environment, immunotherapy reaction, and drug sensitivity. The eight FALs and their signature provide precise and reliable methods for evaluating the clinical effects of in ccRCC patients, and they could be biological markers and targets for therapy.

Clinical study of the effects of deep brain stimulation on urinary dysfunctions in patients with Parkinson's disease.

Purpose: To evaluate the effect of deep brain stimulation (DBS) on urinary dysfunctions in Parkinson's patients. Patients and methods: A total of 416 patients, diagnosed with Parkinson's disease (PD) based on the UK Parkinson's Disease Society Brain Bank Diagnostic Criteria, were enrolled in the study, including 307 males and 109 females. The effects of DBS treatment on urinary functions during urination and bladder storage of these patients were evaluated using testing and assessment scales, such as the American Urological Association Symptom Index (AUA-SI), Overactive Bladder Symptom Scores (OAB-SS), Quality Of Life Scale (QOL), and urodynamic tests. The data were statistically analyzed with the chi-square test and  both independent-samples t-test and paired-samples t-test were used in this study. Results: Symptoms of urinary dysfunctions, such as urinary frequency, urgency, and incontinence, in the patients with PD were notably relieved by DBS treatment (P<0.05), and the OAB-SS and bladder storage problems were greatly improved as well (P<0.05). Compared with those in male patients, DBS surgery significantly improved the AUA-SI, urinary symptom scores, and QOL in female PD patients (P<0.05), as well as other functional indicators related to the urinary tract, including the maximum urinary flow rate, detrusor pressure at peak flow, and residual urine volume in female PD patients (P<0.05). Conclusion: DBS surgery is effective in improving urinary functions in PD patients, as primarily reflected by the alleviation of urinary symptoms such as urinary frequency, urgency, and incontinence. Female PD patients displayed better urinary function outcomes from DBS treatment than did male patients.

[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.

Effect of Varicocelectomy on Serum FSH and LH Levels for Patients with Varicocele: a Systematic Review and Meta-analysis.

Varicocelectomy can improve the function of testicular Leydig cell for patients with varicocele. We carried out a systematic review and meta-analysis to assess effect of varicocelectomy on serum FSH and LH levels for patients with varicocele. A literature review was performed to identify all published randomized preoperation-postoperation clinical trials of assessing serum FSH and LH levels before and after varicocelectomy. The search included the following databases: PUBMED and EMBASE. The reference lists of retrieved studies were also investigated. A systematic review and meta-analysis were conducted. Five studies were selected from 149 studies, including 312 patients. The meta-analysis showed that serum FSH level (95% confidence interval 0.19-0.77, P = 0.001) and serum LH level (95% confidence interval 0.25-0.91, P = 0.0005) were higher preoperation than postoperation. Serum FSH level decreased by 0.48 ng/dL after varicocelectomy. The mean decrease of the serum FSH was from 0.1 to 4.8 ng/dL. And serum LH decreased by 0.58 ng/dL. The mean decrease of the serum LH was from 0.2 to 2.1 ng/dL. This meta-analysis proves that varicocelectomy perhaps can decrease serum FSH and LH levels in patients with varicocele. And it might be related to the improvement of the function of Leydig cell. But it remains to need a large-scale multicenter randomized controlled study to be further confirmed.

Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults.

BACKGROUND: Various techniques have been employed for the early detection of perioperative cerebral ischaemia and hypoxia. Cerebral near-infrared spectroscopy (NIRS) is increasingly used in this clinical scenario to monitor brain oxygenation. However, it is unknown whether perioperative cerebral NIRS monitoring and the subsequent treatment strategies are of benefit to patients. OBJECTIVES: To assess the effects of perioperative cerebral NIRS monitoring and corresponding treatment strategies in adults and children, compared with blinded or no cerebral oxygenation monitoring, or cerebral oxygenation monitoring based on non-NIRS technologies, on the detection of cerebral oxygen desaturation events (CDEs), neurological outcomes, non-neurological outcomes and socioeconomic impact (including cost of hospitalization and length of hospital stay). SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 12), Embase (1974 to 20 December 2016) and MEDLINE (PubMed) (1975 to 20 December 2016). We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing studies on 20 December 2016. We updated this search in November 2017, but these results have not yet been incorporated in the review. We imposed no language restriction. SELECTION CRITERIA: We included all relevant randomized controlled trials (RCTs) dealing with the use of cerebral NIRS in the perioperative setting (during the operation and within 72 hours after the operation), including the operating room, the postanaesthesia care unit and the intensive care unit. DATA COLLECTION AND ANALYSIS: Two authors independently selected studies, assessed risk of bias and extracted data. For binary outcomes, we calculated the risk ratio (RR) and its 95% confidence interval (CI). For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. As we expected clinical and methodological heterogeneity between studies, we employed a random-effects model for analyses and we examined the data for heterogeneity (I2 statistic). We created a 'Summary of findings' table using GRADEpro. MAIN RESULTS: We included 15 studies in the review, comprising a total of 1822 adult participants. There are 12 studies awaiting classification, and eight ongoing studies.None of the 15 included studies considered the paediatric population. Four studies were conducted in the abdominal and orthopaedic surgery setting (lumbar spine, or knee and hip replacement), one study in the carotid endarterectomy setting, and the remaining 10 studies in the aortic or cardiac surgery setting. The main sources of bias in the included studies related to potential conflict of interest from industry sponsorship, unclear blinding status or missing participant data.Two studies with 312 participants considered postoperative neurological injury, however no pooled effect estimate could be calculated due to discordant direction of effect between studies (low-quality evidence). One study (N = 126) in participants undergoing major abdominal surgery reported that 4/66 participants experienced neurological injury with blinded monitoring versus 0/56 in the active monitoring group. A second study (N = 195) in participants having coronary artery bypass surgery reported that 1/96 participants experienced neurological injury in the blinded monitoring group compared with 4/94 participants in the active monitoring group.We are uncertain whether active cerebral NIRS monitoring has an important effect on the risk of postoperative stroke because of the low number of events and wide confidence interval (RR 0.25, 95% CI 0.03 to 2.20; 2 studies, 240 participants; low-quality evidence).We are uncertain whether active cerebral NIRS monitoring has an important effect on postoperative delirium because of the wide confidence interval (RR 0.63, 95% CI 0.27 to 1.45; 1 study, 190 participants; low-quality evidence).Two studies with 126 participants showed that active cerebral NIRS monitoring may reduce the incidence of mild postoperative cognitive dysfunction (POCD) as defined by the original studies at one week after surgery (RR 0.53, 95% CI 0.30 to 0.95, I2 = 49%, low-quality evidence).Based on six studies with 962 participants, there was moderate-quality evidence that active cerebral oxygenation monitoring probably does not decrease the occurrence of POCD (decline in cognitive function) at one week after surgery (RR 0.62, 95% CI 0.37 to 1.04, I2 = 80%). The different type of monitoring equipment in one study could potentially be the cause of the heterogeneity.We are uncertain whether active cerebral NIRS monitoring has an important effect on intraoperative mortality or postoperative mortality because of the low number of events and wide confidence interval (RR 0.63, 95% CI 0.08 to 5.03, I2= 0%; 3 studies, 390 participants; low-quality evidence). There was no evidence to determine whether routine use of NIRS-based cerebral oxygenation monitoring causes adverse effects. AUTHORS' CONCLUSIONS: The effects of perioperative active cerebral NIRS monitoring of brain oxygenation in adults for reducing the occurrence of short-term, mild POCD are uncertain due to the low quality of the evidence. There is uncertainty as to whether active cerebral NIRS monitoring has an important effect on postoperative stroke, delirium or death because of the low number of events and wide confidence intervals. The conclusions of this review may change when the eight ongoing studies are published and the 12 studies awaiting assessment are classified. More RCTs performed in the paediatric population and high-risk patients undergoing non-cardiac surgery (e.g. neurosurgery, carotid endarterectomy and other surgery) are needed.

Aspirin use improves the biochemical control of prostate cancer in Chinese men.

PURPOSE: Aspirin may improve treatment outcomes and increase the survival of patients with prostate cancer, but the results remain controversial. METHODS: This study consisted of 483 patients who underwent radical prostatectomy for localized prostate cancer, 231 of whom were in the aspirin group. The associations between aspirin use and freedom from biochemical failure (FFBF), overall survival (OS) and relative factors were evaluated. RESULTS: Multivariate analysis showed that aspirin therapy, T classification, Gleason score (GS), and prostate-specific antigen (PSA) were associated with biochemical failure. The aspirin group had a significantly better FFBF rate (91.1%) at 5 years than the control group (82.3%, p=0.000). Among patients with high-risk disease, the FFBF rate for patients in the aspirin group was 79.1% at 5 years compared to 52.2% in the control group (p=0.000). CONCLUSIONS: We demonstrate that the use of aspirin may be beneficial for the biochemical control of prostate cancer. The mechanism of the antineoplastic effect of aspirin is not fully understood. Further clinical trials and large-scale studies will be necessary to confirm the relationship between aspirin use and prostate cancer risk.

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.

The efficacy and safety of adrenergic alpha-antagonists in treatment of distal ureteral stones in pediatric patients: A systematic review and meta-analysis.

OBJECTIVE: We carried out a systematic review and meta-analysis to evaluate the efficacy and safety of adrenergic alpha-antagonists as a medical expulsive therapy for ureteral stones in pediatric patients. METHODS: The PubMed, EMBASE and Cochrane Controlled Trials Register databases were searched up to January 2016. All randomized controlled trials and all cohort studies in which patients were randomized to receive either adrenergic alpha-antagonists or placebo for ureteral stones were identified. The outcome measures assessed were overall stone expulsion rate (primary), expulsion time (secondary), and treatment-emergent adverse events. RESULTS: Five trials with a total of 406 pediatric patients met the inclusion criteria. According to the doses of adrenergic alpha-antagonists, the pooling effects of adrenergic alpha-antagonists were analyzed, with a higher expulsion rate obtained than in controls, the stone expulsion rate (OR=2.70, 95% CI 1.49 to 4.91, P=0.001). Adrenergic alpha-antagonists statistically did not significantly decrease the number of the stone expulsion time with the placebo, the stone expulsion time (SMD=-4.65, 95% CI -9.76 to 0.45, P=0.07). Safety assessments included common treatment-emergent adverse events (TEAEs) (OR=2.01, 95% CI 0.74 to 5.48, P=0.17). Compared with placebos, there was a higher stone expulsion rate with the adrenergic alpha-antagonists; in addition, fewer adverse effects were observed. CONCLUSIONS: This meta-analysis may suggest that adrenergic alpha-antagonists are a safe and effective medical expulsive therapy choice for ureteral stones in pediatric patients. As the level of classification of evidence-based medicine, the level of evidence of our article is Ia. But it remains to need a large-scale multicenter randomized controlled study to be further confirmed. LEVEL OF EVIDENCE: The level of evidence of our study is V.

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 silodosin in the medical expulsion therapy for distal ureteral calculi: a systematic review and meta-analysis.

AIMS: Using a selective α-adrenoceptor blocker for medical expulsive therapy (MET) is an effective treatment approach widely used for ureteral stones. The aim of the review was to assess the efficacy and safety of silodosin in medical expulstion therapy compared with placebo and tamsulosin. METHODS: A systematic search was performed in PubMed, Cochrane Library and Embase to identify randomized controlled trials that compared silodosin with a placebo or tamsulosin for ureteral calculi. RESULTS: Eight publications involving a total of 1048 patients were used in the analysis, which compared silodosin with placebo and tamsulosin. We found that silodosin was effective in treating ureteral calculi in our meta-analysis and was superior to tamsulosin in its efficacy. The expulsion rate of all ureteral stones (OR 1.59, 95% CI 1.08, 2.36, P = 0.02), the expulsion rate of distal ureteral stones (OR 2.82, 95% CI 1.70, 4.67, P < 0.0001) and the expulsion time (days) of distal ureteral stones (standard mean difference (SMD) -4.71, 95% CI -6.60, -2.83, P < 0.00001) indicated that silodosin was more effective than the placebo. Moreover, expulsion rate (OR 2.54, 95% CI 1.70, 3.78, P < 0.00001), expulsion time (days) (SMD -2.64, 95% CI -3.64, -1.64, P < 0.00001) and pain episodes (P < 0.00001) indicated that silodosin was more effective than the tamsulosin. Even though silodosin had a significant increase in abnormal ejaculation compared with tamsulosin, no significant differences were observed for complications (OR 1.00, 95% CI 0.58, 1.74, P = 1.00). CONCLUSIONS: This meta-analysis indicated that silodosin was superior to placebo or tamsulosin in the efficacy for distal ureteral calculi with better control of pain. The safety profile of silodosin was similar to tamsulosin though retrograde ejaculation was worse for silodosin use. We conclude that silodosin might have potential as a MET for ureteral stones.

The Efficacy of Continuous Positive Airway Pressure Therapy on Nocturia in Patients With Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis.

PURPOSE: To assess the efficacy of the continuous positive airway pressure (CPAP) on nocturia in patients with obstructive sleep apnea (OSA). METHODS: A literature review was performed to identify all published clinical trials of CPAP for the treatment of nocturia. The search included the following databases: MEDLINE, Embase, and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also investigated. RESULTS: Five publications involving a total of 307 patients were used in the analysis, which compared the number of incidents of nocturia before and after CPAP treatment. We found that patients with OSA and nocturia who were treated with CPAP had a significant decrease in the frequency of nocturia and the volume of urine associated with it. The mean number of nocturia incidents (standardized mean difference [SMD], -2.28; 95% confidence interval [CI], -2.42 to -2.15; P<0.00001) and the associated urine volume (SMD, -183.12; 95% CI, -248.27 to -117.98; P<0.00001) indicated that CPAP was effective. Besides, the Epworth Sleepiness Scale (SMD, -5.88; 95% CI, -6.56 to -5.21; P<0.00001) and the CPAP apnea-hypopnea index (SMD, -31.57; 95% CI, -33.87 to -29.28; P<0.00001) indicated that CPAP significantly improved the quality of sleep. CONCLUSIONS: This meta-analysis indicates that CPAP maybe an effective treatment for reducing nocturia associated with OSA and improving the quality of life of such patients.

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.

Efficacy and safety of imidafenacin for overactive bladder in adult: a systematic review and meta-analysis.

PURPOSE: We carried out a systematic review and meta-analysis to assess the efficacy and safety of imidafenacin for treating overactive bladder in adult. METHODS: A literature review was performed to identify all published randomized placebo-controlled trials of imidafenacin for the treatment of OAB. The search included the following databases: MEDLINE, EMBASE. The reference lists of retrieved studies were also investigated. RESULTS: Five publications involving a total of 1,428 patients were used in the analysis, which compared imidafenacin with propiverine and solifenacin. We found that imidafenacin was effective in treating OAB in our meta-analysis, which was similar to propiverine in its efficacy. The mean number of UI per week (the standardized mean difference (SMD) = 1.23, 95% CI -0.19 to 2.65, p = 0.09), the mean number of urgency episodes per day (SMD = 0.26, 95% CI -0.11 to 0.63, p = 0.17), the mean number of micturitions per day (SMD = 0.01, 95% CI -0.30 to 0.31, p = 0.96), and the mean urine volume (ml) per micturition (SMD = -13.04, 95% CI -20.45 to -5.62, p = 0.0006) indicated that imidafenacin was similar to propiverine in its efficacy. Mean OABSS (SMD = 0.48, 95% CI -0.08 to 1.03, p = 0.09) indicated that imidafenacin was also similar to solifenacin in its efficacy. Besides, imidafenacin was better tolerated than propiverine in the safety, indicated by dry mouth (OR 0.73, 95% CI 0.54-0.98, p = 0.04) and any adverse events (OR 0.63, 95% CI 0.46-0.88, p = 0.006). Moreover, imidafenacin was also better tolerated than solifenacin in the safety, indicated by constipation (OR 0.21, 95% CI 0.08-0.53, p = 0.001) and any adverse events (OR 0.33, 95% CI 0.15-0.71, p = 0.004). CONCLUSIONS: This meta-analysis indicates that imidafenacin was similar to propiverine or solifenacin in its efficacy for OAB and was better tolerated than propiverine or solifenacin in the safety for OAB. We conclude that imidafenacin is preferable to propiverine or solifenacin from a perspective of safety.

Efficacy and Safety of Propiverine Hydrochloride for Overactive Bladder in Adult: a Systematic Review and Meta-analysis.

We carried out a systematic review and meta-analysis to assess the efficacy and safety of propiverine for treating overactive bladder (OAB) in adult. A literature review was performed to identify all published randomized placebo-controlled trials (RCT) of propiverine for the treatment of OAB. The search included the following databases: PUBMED and EMBASE. The reference lists of retrieved studies were also investigated. A systematic review and meta-analysis were conducted. Ten publications involving nine different RCTs were used in the analysis. We found that propiverine was effective in treating OAB in our meta-analysis. The decrease in number of micturitions/24 h (P < 0.00001, the mean decrease was from 1.80 to 2.57) indicated that propiverine was more effective than the placebo. Propiverine also decrease the number of urgency, urgency incontinence, and nocturia and increase urine volume. However, the incidence of difficulty in voiding was higher with propiverine therapy compared with the placebo (P = 0.05, the mean percentage range from 0.34 to 4.93 %). The decrease of total international prostate symptom score (IPSS) (P < 0.0001, the mean decrease was from 12.5 to 16.1) indicated that propiverine add a1-adrenoceptor antagonist was more effective in decreasing the lower urinary tract symptom (LUTS). The combination therapy also decreases the voiding symptom and storage symptom scores and increases maximum flow rate. This meta-analysis shows that propiverine is a safe and effective treatment for OAB. The major adverse event associated with propiverine treatment was difficulty in voiding. Propiverine add a1-adrenoceptor antagonist was more effective in terms of decreasing difficulty in voiding.

Efficacy and Safety of Tension-Free Vaginal Tape-Secur Mini-Sling Versus Standard Midurethral Slings for Female Stress Urinary Incontinence: A Systematic Review and Meta-Analysis.

PURPOSE: To assess the efficacy and safety of tension-free vaginal tape (TVT)-Secur for stress urinary incontinence (SUI). METHODS: A literature review was performed to identify all published trials of TVT-Secur. The search included the following databases: MEDLINE, Embase, and the Cochrane Controlled Trial Register. RESULTS: Seventeen publications involving a total of 1,879 patients were used to compare TVT-Secur with tension-free obturator tape (TVT-O) and TVT. We found that TVT-Secur had significant reductions in operative time, visual analog score for pain, and postoperative complications compared with TVT-O. Even though TVT-Secur had a significantly lower subjective cure rate (P<0.00001), lower objective cure rate (P<0.00001), and higher intraoperative complication rate, compared with TVT-O at 1 to 3 years, there was no significant difference between TVT-Secur and TVT-O in the subjective cure rate (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.22-1.08; P=0.08), objective cure rate (OR, 0.49; 95% CI, 0.22-1.09; P=0.08), or complications at 3 to 5 years. Moreover, TVT-Secur had significantly lower subjective and objective cure rates compared with TVT. CONCLUSIONS: This meta-analysis indicates that TVT-Secur did not show an inferior efficacy and safety compared with TVT-O for SUI in 3 to 5 years, even though displaying a clear tread toward a lower efficacy in 1 to 3 years. Considering that the safety is similar, there are no advantages in using TVT-Secur.

The efficacy and safety of onabotulinumtoxinA in treating idiopathic OAB: A systematic review and meta-analysis.

AIM: We carried out a systematic review and meta-analysis to assess the efficacy and safety of the drug for treating idiopathic OAB. METHODS: A literature review was performed to identify all published randomized double-blind, placebo-controlled trials of onabotulinumtoxinA for the treatment of idiopathic OAB. The search included the following databases: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also investigated. RESULTS: Eight publications involving a total of 1,320 patients were used in the analysis, including six RCTs that compared onabotulinumtoxinA with placebo. OnabotulinumtoxinA significantly decreased the mean number of urinary incontinence (UI) per day -2.77 versus -1.01 (the standardized mean difference (SMD) = -1.68, 95% CI = -2.06 to -1.31, P < 0.00001); the mean number of micturitions per day -1.61 versus -0.87 (SMD = -1.82, 95% CI = -2.61 to -1.02, P < 0.00001); maximum cystometric capacity (MCC) 91.39 versus 32.32 (SMD = 63.82, 95% CI = 38.14 to 89.50, P < 0.00001) and volume voided 44.29 versus 7.36 (SMD = 33.05, 95% CI = 22.45 to 43.66, P < 0.00001) versus placebo and 29.20% versus 7.95% of patients became incontinence-free (odds ratio [OR] = 4.89, 95% confidence interval [CI] = 3.11 to 7.70, P < 0.00001). Safety assessments primarily localized to the urinary tract indicated onabotulinumtoxinA were often associated with complications resulting from postvoid residuals (PVR; P < 0.00001), urinary tract infections (UTI; P < 0.00001) and clean intermittent catheterization (CIC; P < 0.00001). CONCLUSION: This meta-analysis indicates that onabotulinumtoxinA to be an effective treatment for idiopathic overactive bladder symptoms with side effects primarily localized to urinary tract.

The efficacy of PDE5 inhibitors alone or in combination with alpha-blockers for the treatment of erectile dysfunction and lower urinary tract symptoms due to benign prostatic hyperplasia: a systematic review and meta-analysis.

INTRODUCTION: Erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) are both highly prevalent in aging men. Alpha-blockers and PDE-5 inhibitors are widely used for the treatment of LUTS/benign prostatic hyperplasia (BPH) and ED. AIM: The purpose of this meta-analysis was to evaluate the efficacy of phosphodiesterase type 5 (PDE5) inhibitors alone or in combination with alpha-blockers for the treatment of ED and LUTS. METHODS: The databases MEDLINE, EMBASE, PubMed, the Cochrane Controlled Trial Register of Controlled Trials, and the Chinese Biological Medical Database were searched to identify randomized controlled trials that referred to the use of a combination of PDE5 inhibitors and alpha-blockers for the treatment of ED and LUTS associated with BPH. A systematic review and meta-analysis was conducted. MAIN OUTCOME MEASURES: International Prostate Symptom Score (IPSS), the maximum flow rate (Qmax), and International Index of Erectile Function-Erectile Function (IIEF-EF) domain score were used in this meta-analysis. RESULTS: Seven publications involving 515 patients were included in the meta-analysis. In the analysis, we found significantly improved IIEF, IPSS, and Qmax values in the combination use group compared with the use of PDE5 inhibitors alone (P = 0.04, 0.004, 0.007, respectively). CONCLUSIONS: The combined use of PDE5 inhibitors and alpha-blockers results in additive favorable effects in men with ED and LUTS suggestive of BPH compared with PDE5 inhibitor monotherapy. The alpha-blockers may enhance the efficacy of the PDE5 inhibitors, which is beneficial for the treatment of ED and LUTS.

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 effect of statins on erectile dysfunction: a systematic review and meta-analysis.

INTRODUCTION: It is not known if statins will improve symptoms in patients with established erectile dysfunction (ED). AIM: We carried out a systematic review and meta-analysis to assess the effect of statins on ED. METHODS: A literature review was performed to identify all published randomized double-blind, placebo-controlled trials of statins 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. A systematic review and meta-analysis were conducted. MAIN OUTCOME MEASURES: Six publications involving a total of 462 patients were used in the analysis, including three randomized controlled trials (RCTs) that compared statins with placebo and three RCTs that compared statins plus sildenafil with placebo plus sildenafil. RESULTS: For the comparison of statins (+/- sildenafil) with placebo (+/- sildenafil), the mean International Index of Erectile Function (IIEF-5) (the standardized mean difference [SMD] = 3.23, 95% confidence interval [CI] = -1.65 to 4.80, P < 0.0001) indicated that statins (+/- sildenafil) showed statistically significantly greater improvements in the mean IIEF-5 compared with placebo (+/- sildenafil). For the comparison of statins with placebo, the mean IIEF-5 (SMD = 2.13, 95% CI = -1.46 to 5.73, P = 0.24) indicated that there was no significant difference in erectile function between the statins and placebo. For the comparison of statins plus sildenafil with placebo plus sildenafil, the mean IIEF-5 (SMD = 3.60, 95% CI = 2.64 to 4.56, P < 0.00001), the IIEF domain (SMD = 4.88, 95%CI = 3.01 to 6.74, P < 0.00001), and the global efficacy question (odds ratio = 6.44, 95% CI = 2.92 to 14.23, P < 0.00001) showed that compared with placebo plus sildenafil, statins plus sildenafil clearly improved erectile function. CONCLUSIONS: This meta-analysis indicates that statins (+/- sildenafil) may improve ED compared with placebo (+/- sildenafil).