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ABSTRACT: The aim of this study was to systematically review the evidence on the efficacy and safety of silodosin treatments on lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) from randomized controlled trials. We searched PubMed (1966-December 2011), Embase (1974-December 2011) and the Cochrane Library Database (2011, Issue 12). The assessed outcome measures were the change from baseline for the International Prostate Symptom Score (IPSS), quality of life (QoL) score, peak urine maximum flow rate (Q(max)), QoL related to urinary symptoms and adverse effects. Two authors independently assessed the study quality and extracted data. All data were analysed using RevMan 5.1. The meta-analysis included four randomized controlled trials with a total of 2504 patients. The study durations were each 12 weeks. At the follow-up end points, the pooled results showed that the change from baseline for the silodosin group was significantly higher than the placebo group for the IPSS, QoL score and Q(max)(mean difference (MD)=-2.78, P<0.00001; MD=-0.42, P=0.004; MD=1.17, P<0.00001,respectively) and patients felt more satisfied with QoL related to urinary symptoms in the silodosin group than the placebo group. Ejaculation disorder was the most commonly reported adverse effect. The pooled results also showed that the silodosin group was superior to the 0.2 mg tamsulosin group with respect to the IPSS and QoL score (IPSS: MD=-1.14, P=0.02; QoL score: MD=-0.26, P=0.02) and inferior to the 0.2 mg tamsulosin group with respect to Q(max) (MD=-0.85, P=0.01). In contrast, there was no significant difference in the incidence of ejaculation disorder and dizziness between the silodosin and 0.2 mg tamsulosin groups. The current meta-analysis suggested that silodosin is an effective therapy for LUTS in men with BPH and is not inferior to 0.2 mg tamsulosin.Asian Journal of Andrology advance online publication, 10 December 2012; doi:10.1038/aja.2012.102.
Cellular & molecular immunology 12/2012; · 2.99 Impact Factor
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ABSTRACT: This study sought to evaluate the efficacy and safety of photoselective vaporisation (PVP) vs. transurethral resection of the prostate (TURP) for patients with benign prostatic hyperplasia (BPH). Eligible studies were identified from electronic databases (Cochrane Library, PubMed and EMBASE). The database search, quality assessment and data extraction were performed independently by two reviewers. Efficacy (primary outcomes: maximum urinary flow rate (Q(max)), international prostate symptom score (IPSS), postvoid residual urine (PVR) and quality of life (QoL); secondary outcomes: operative time, hospital time and catheter removal time) and safety (complications, such as transfusion and capsular perforation) were explored by using Review Manager 5.0. Six randomized controlled trials (RCTs) and five case-controlled studies of 1398 patients met the inclusion criteria. A meta-analysis of the extractable data showed that there were no differences in IPSS, Q(max), QoL or PVR between PVP and TURP (mean difference (MD): prostate sizes <70 ml, Q(max) at 24 months, MD=0.01, P=0.97; IPSS at 12 months, MD=0.18, P=0.64; QoL at 12 months, MD=-0.00, P=0.96; PVR at 12 months, MD=0.52, P=0.43; prostate sizes >70 ml, Q(max) at 6 months, MD=-3.46, P=0.33; IPSS at 6 months, MD=3.11, P=0.36; PVR at 6 months, MD=25.50, P=0.39). PVP was associated with a shorter hospital time and catheter removal time than TURP, whereas PVP resulted in a longer operative time than TURP. For prostate sizes <70 ml, there were fewer transfusions, capsular perforations, incidences of TUR syndrome and clot retentions following PVP compared with TURP. These results indicate that PVP is as effective and safe as TURP for BPH at the mid-term patient follow-up, in particular for prostate sizes <70 ml. Due to the different energy settings available for green-light laser sources and the higher efficiency and performance of higher-quality lasers, large-sample, long-term RCTs are required to verify whether different energy settings affect outcomes.
Asian Journal of Andrology 08/2012; 14(5):720-5. · 1.52 Impact Factor
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ABSTRACT: Study Type - Therapy (systematic review) Level of Evidence 1a What's known on the subject? and What does the study add? There are several surgical techniques for the treatment of varicocele in infertile men, including open non-microsurgical, laparoscopic and microsurgical varicocelectomy. It is currently unclear, however, which is the most beneficial method for patients. The present meta-analysis found that microsurgical varicocelectomy is the most effective and least morbid method among the three varicocelectomy techniques for treating varicocele in infertile men. OBJECTIVE: • To compare various techniques of open non-microsurgical, laparoscopic or microsurgical varicocelectomy procedures to describe the best method for treating varicocele in infertile men. PATIENTS AND METHODS: • We searched PubMed, Embase, the Cochrane Library, the Institute for Scientific Information (ISI) - Science Citation Index and the Chinese Biomedicine Literature Database up to June 2011. Only randomized controlled trials (RCTs) were included in the present study. • The outcome measures assessed were pregnancy rate (primary), the incidence of recurrent varicocele, time to return to work, the incidence of postoperative hydrocele and operation duration (secondary). • Two authors independently assessed the study quality and extracted data. All data were analysed using Review Manager (version 5.0). RESULTS: • The present study included four randomized controlled trials comprising 1,015 patients in total. • At the follow-up endpoints, patients who had undergone microsurgery showed a significant advantage over those who had undergone open varicocelectomy in terms of pregnancy rate (odds ratio [OR]= 1.63, 95% confidence interval [CI]: 1.19-2.23]. • There was no significant difference between laparoscopic and open varicocelectomy (OR = 1.11, 95% CI: 0.65-1.88) or between microsurgery and laparoscopic varicocelectomy (OR = 1.37, 95% CI: 0.84-2.24). • The incidences of recurrent varicocele and postoperative hydrocele were significantly lower after microsurgery than after laparoscopic or open varicocelectomy. • The time to return to work after microsurgery and laparoscopic varicocelectomy was significantly shorter than that after open varicocelectomy. • The operation duration of microsurgical varicocelectomy was longer than that of laparoscopic or open varicocelectomy. CONCLUSIONS: • Current evidence indicates that microsurgical varicocelectomy is the most effective and least morbid method among the three varicocelectomy techniques for treating varicocele in infertile men. • More high-quality, multicentre, long-term RCTs are required to verify the findings.
BJU International 05/2012; · 2.84 Impact Factor
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ABSTRACT: To systematically review the evidence on the efficacy and safety of udenafil as treatment of erectile dysfunction from randomized controlled trials.
We searched PubMed, Embase, and the Cochrane Library database up to October 2011. The outcome measures assessed were the change from baseline for the International Index of Erectile Function erectile function domain score (primary), the change from baseline for Sexual Encounter Profile questions 2 and 3, the shift to normal rate (erectile function domain ≥ 26), the response to the Global Assessment Questionnaire and adverse effects (secondary). Two of us independently assessed the study quality and extracted data. All data were analyzed using Review Manager, version 5.0.2.
Five randomized controlled trials totaling 1109 patients were included. At the follow-up endpoints, udenafil was found to be more effective than placebo, and the tolerability was good. The pooled results showed that the udenafil group was significantly greater than the placebo group in the change from baseline for the International Index of Erectile Function erectile function domain score (mean difference 5.65, 95% confidence interval 4.41-6.89, P < .00001). All included studies indicated that most adverse events were mild or moderate in severity, and no serious adverse events were reported during the study period. The most common drug-related adverse events were flushing and headache (udenafil vs placebo, 5.6% vs 1.8% and 3.1% vs 0%, respectively).
The results from the current meta-analysis have suggested that udenafil is an effective and well-tolerated therapy for erectile dysfunction. The findings of the present review highlight the need for more efficient performance of higher quality, large-sample, various-race, long-term, randomized controlled trials to verify the efficacy and safety of udenafil.
Urology 04/2012; 80(1):134-9. · 2.43 Impact Factor
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ABSTRACT: To evaluate the effectiveness of NTrap in the prevention of stone migration during ureteroscopic lithotripsy for proximal ureteral stones.
Eligible studies were identified from electronic databases (PubMed, Embase, the Cochrane Library, ISI - Science Citation Index, and Chinese biomedicine literature database). The database search, quality assessment, and data extraction were independently performed by two reviewers. Our primary outcomes were the stone-free (SF) and incidence of stone migration. Secondary outcomes were operative time and the rate of auxiliary procedures. The outcomes were explored by using Review Manager 5.0. Sensitivity analysis was performed to explore the influence of low-quality studies.
Two randomized controlled trials and one case-control study including 456 patients met the inclusion criteria. Meta-analysis of extractable data showed that patients who underwent ureteroscopic lithotripsy with the use of the NTrap demonstrated a significant advantage over without the use of the NTrap in terms of the stone-free rate (odds ratio [OR]=3.08, 95% confidence interval [CI] [1.45-6.53], P=0.003); the incidence of stone migration was significantly lower in NTrap treatment than without NTrap (OR=0.23, 95% CI: 0.10-0.53, P=0.0006, while there was no significant difference in operative time between NTrap and control (mean difference=-3.25, 95% CI: -16.11-9.62, P=0.62). Our pooled meta-analysis showed that the incidence of auxiliary shockwave lithotripsy was significantly lower in NTrap treatment than control (OR=0.29, 95% CI: 0.12-0.70, P=0.006).
The results of this meta-analysis suggested that the NTrap stone occlusion device is efficient at preventing stone retropulsion during ureteroscopic lithotripsy of proximal ureteral calculi. The findings of this review highlight the need for more efficient performance of higher quality, more rigorous, large sample, long-term randomized controlled trials where outcomes are detailed in description.
Journal of endourology / Endourological Society 11/2011; 26(2):130-4. · 1.75 Impact Factor
