In recent years, several studies have reported promising results of Yohimbine as a natural supplement for erectile dysfunction (ED). However, several studies suggested that the aphrodisiac effects of the extract were only a placebo or due to the increase in peripheral vascular congestion. In contrast, other studies reported that it could provide excellent curative effects on organic impotence. We aimed to review the efficacy of Yohimbine as a pharmacological treatment for ED and performed a comprehensive systematic search of published articles in PubMed and Science Direct databases for eligible randomized controlled trials comparing Yohimbine to placebo or no treatment for ED patients. A total of eight studies out of 543 studies were included in this review. Both Yohimbine alone (odds ratio [OR] ¼ 2.08, 95% CI 1.30-3.32, P ¼ .002) and combined (OR ¼ 6.35, 95% CI 3.01-13.41, P < .001) showed a significantly greater probability of erectile function improvement compared to the placebo group (OR ¼ 2.87, 95% CI 1.94-4.25, P < .001). Yohimbine alone did not show a significant difference in the rate of improved sexual function (P ¼ .07); however, the pooled results of both subgroups indicated a higher rate of improved sexual function (OR ¼ 2.65, 95% CI 1.43-4.92, P ¼ .002). Sole administration of Yohimbine and its combination with other supplements can improve the erectile function in ED patients. However, it is not able to improve the sexual function if not combined with other treatments.
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Objective: This study aimed to translate the IIEF-5 questionnaire into Indonesian and perform a validity and reliability assessment of the translated instrument. Material and Methods: A methodological study on 106 male outpatients, recruited consecutively, was carried out in a tertiary hospital in Surabaya, East Java from January to March 2020. This study was conducted in two stages: translation and validation. Two independent sworn translators performed a forward and backward translation of the first draft. The final version was synthesized by a team of experts comprised two urologists and another sworn translator. The validity of the questionnaire is determined through a Pearson correlation analysis. Cronbach’s a internal consistency measurement was used to assess its reliability. Interrater reliability between the patient and the physician was measured using the Cohen’s j coefficient. Results: Pearson’s “r” value is significantly higher than the critical value table and indicates a high to a very high level of validity based on Guilford’s interpretation (r ¼ 0.70-1.00). A good internal consistency is shown by the Cronbach’s a coefficient value (a ¼ 0.828). An almost perfect agreement between the patient’s results and the assessment made by the physicians is shown by the Cohen’s j coefficient value (j ¼ 0.879, P < .001). Conclusion: The Indonesian IIEF-5 is a valid and reliable patient-reported outcome measure for evaluating erectile dysfunction in the literate middle-aged and older adult male population in Indonesia.
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Objective: This pilot study aimed to objectively assess the osteoporotic effect caused by androgen deprivation therapy (ADT) in patients with prostate cancer and compare this effect in surgical versus medical castration, specifically with luteinizing hormone-releasing hormone (LHRH) antagonists. Material and methods: The study included 60 patients with metastatic prostate adenocarcinoma treated with either bilateral orchidectomy (group I) or LHRH antagonist (Degarelix) injection (group II). The patients had a baseline bone mineral density (BMD) assessment before the start of ADT using dual energy X-ray absorptiometry (DEXA) scan and then follow-up assessment after 6 months. BMD was measured at the spine (lumbar vertebrae L2–L4), femur (total), and forearm (one-third radius). Results: Group I included 33 patients and group II 27 patients. Both the groups showed significant reduction in BMD at the spine and femur after 6 months, whereas the forearm did not show a significant reduction. Spine BMD showed 5.9%±2.6% and 4.7%±2.6% reduction whereas the femur BMD showed 6%±7.4% and 6%±4.7% reduction in the orchiectomy and the Degarelix groups, respectively. There was no statistically significant difference between the groups at the 3 measured sites. Conclusion: Both surgical castration and LHRH antagonists were associated with significant accelerated osteoporotic effect at the spine and femur after 6 months without difference between both the methods. Assessment of osteoporotic risk together with preventive or management measures should be started early during ADT.
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Objective: This study aimed to assess the perioperative and the 12-month efficacy and safety of 140 W highpowered holmium laser for enucleation of the prostate (HP-HoLEP) for the treatment of benign prostatic obstruction. Material and methods: The data of 540 patients who underwent HoLEP by a single surgeon were analyzed retrospectively. Preoperative evaluation included a physical examination with a digital rectal examination, measurement of maximum urinary flow rate (Qmax), postvoid residual volume (PVR) and prostate volume by transabdominal ultrasonography, serum prostate-specific antigen (PSA), international prostate symptom score (I-PSS) and international index of erectile function-5 (IIEF-5) questionnaires, and urine analysis. Morcellation, enucleation, and operation efficiencies were calculated with the resected weight divided by morcellation, enucleation, and operative times, respectively. The patients were reassessed at 1, 3, 6, and 12 months after surgery by I-PSS, IIEF-5, Qmax, PSA, and the occurrence of complications. Results: The mean operative time was 65.2±20.9 minutes. The mean enucleation time and efficiency were 53±15.1 minutes and 1.72±0.4 g/min, respectively. The mean morcellation time and efficiency were 12.3±15.1 minutes and 7.4±3.2 g/min respectively. Clavien grade 1 complications were observed in 102 (18.9%) patients, Clavien grade 2 complications in 20 (3.7%) patients, and Clavien grade 3b complications in 23 (5.4%) patients. I-PSS, Qmax, and IIEF-5 at postoperative 1, 3, 6, and 12 months were significantly better than baseline results. Conclusion: Our study demonstrated that 140 W HP-HoLEP can be performed with high enucleation efficiency, low perioperative and postoperative complication rates, and excellent functional results.
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The presence of lymph node metastasis is the most important prognostic indicator for patients with penile cancer. However, predicting which clinically node negative patients will harbor lymph node metastases remains unclear. The aim of this systematic review is to provide an overview of biomarkers p53, Ki-67, and SCCAg in predicting lymph node metastasis (LNM) and cancer-specific survival (CSS) in penile squamous cell carcinoma (SCC). MEDLINE, EMBASE, Cochrane Library, Scopus, and ClinicalTrials.gov were searched from inception until 15 October 2020. Eligible studies were identified by three independent reviewers. Outcome measures included the presence of penile LNM and CSS. Extracted data were narratively synthesized with GRADE criteria utilized to evaluate the quality of evidence. In total, 999 articles were screened with 20 selected for inclusion. Studies reporting the use of p53 to predict LNM and CSS were rated as having the highest quality of evidence using the GRADE criteria, and the majority showed a positive association between p53 expression and LNM and CSS. All biomarkers and outcome combinations had at least one study showing a significant effect on predicting the outcome. However, studies were heterogeneous, and many reported nonsignificant effects. Identifying p53 overexpression may help one to identify patients at higher risks of LNM to be considered for early inguinal lymphadenectomy. There is contradictory and unreliable evidence for the prognostic value of Ki-67 and SCCAg in penile SCC for LNM and CSS. Larger studies are required with more rigorous methods and reports to improve the evidence base
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Pain and discomfort may occur in catheterization during a urodynamic examination. A lidocaine gel combined with a water-based lubricant is sometimes used to reduce pain during catheterization. Several studies claimed that intraurethral lidocaine administration could cause inaccurate urodynamic parameters results. However, its definite effects in urodynamics testing on humans are still not clear. We aimed to evaluate the effects of intraurethral lidocaine on pain and urodynamic study parameters in patients undergoing an invasive urodynamic examination. A systematic search adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was performed in the MEDLINE, PubMed, and ScienceDirect databases for randomized controlled trials (RCTs). The bias of the studies is evaluated using the Cochrane risk of bias tool by two independent reviewers. The analyses of continuous outcomes were displayed as mean difference (MD), whereas odds ratio is used to analyze dichotomous data. Heterogeneity between studies is determined using the I2 value. A total of three RCTs out of 622 discovered that articles were eligible for analysis. Forest plot analysis of the mean visual analogue scale difference of the studies indicated an insignificant difference between the lidocaine and placebo group (MD –7.68; 95% CI –34.04 to –18.68, P ¼ .57). All urodynamic parameter results were also similar between the two groups (P > .05). Routine intraurethral lidocaine injection prior to a urodynamic study does not affect pain intensity and urodynamic parameters.
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Andrea COCCI ,
Alessia Celeste BOCCHINO ,
Gianmartin CITO ,
Antonello De LISA ,
Giorgio Ivan RUSSO ,
Arturo Lo GIUDICE ,
Francesco SESSA ,
Lorenzo VIOLA ,
Luca CINDOLO ,
Bhaskar SOMANİ ,
Giampaolo SIENA
The aim of this study was to review the available literature on the efficacy and safety of the Rezum system for the treatment of symptomatic benign prostatic hyperplasia (BPH). A revision of literature up to January 2021 was carried out. Medline, Scopus, Web of Science, and PubMed archives were screened to identify all the relevant studies investigating the role of Rezum in the treatment of BPH. Randomized controlled trial (RCT), retrospective, prospective, observational, and comparative studies were included. Finally, 17 studies were included, five of which reporting data of a double blind Rezum RCT. Overall, 1,451 patients underwent Rezum procedure. All the studies performed a minimum of 3 months follow-up. Preoperatively, the mean International Prostate Symptom Score (IPSS) score was 19.8, mean Qmax was 9.2mL s 1, and mean PVR was 142 cc. At 3 months after surgery, the mean IPSS score was 1.5, mean Qmax was 13.7mL s 1, and mean PVR was 74 cc. Six studies investigated sexual function, most of them using the International Index of Erectile Function (IIEF)-5 questionnaire and a few also the Male Sexual Health Questionnaire (MSHQ). Preoperative mean IIEF-5 score was 18.5, and the mean MSHQ score was 7.4. At the 3 months follow-up, the mean IIEF-5 score was 16.4, and the mean MSHQ score was 9.62. None of the studies reported intraoperative complications. Rezum system is a novel minimally invasive treatment for symptomatic BPH using transurethral water vapor thermal energy. It represents a cost-effective and safe procedure with durable relief of lower urinary tract symptom, preservation of sexual function, low complications rate, and short recovery time.
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Endoscopic enucleation of the prostate (EEP) techniques for the treatment of benign prostatic hyperplasia (BPH) have become increasingly popular among urologists over the past 23 years. Despite the energy source employed, the aim of all these procedures is to endoscopically remove the prostatic lobes by enucleating them from the prostate surgical capsule. The reasons for which EEP has gained popularity among urologists are the reduction in complications and hospital stay compared to endoscopic gold standard Transurethral Resection of the Prostate (TURP), but especially the possibility to treat large prostates, allowing to abandon open simple prostatectomy (OP) and to avoid the burden related to open surgery. Holmium laser enucleation of the prostate (HoLEP) sets the basic principles of all EEP techniques in 1998 and has become the treatment of reference for BPH. Since then, various lasers have been developed and applied to prostatic enucleation. The thulium laser has a slightly shorter wavelength compared to the holmium laser and a continuous wave output, which increase vaporization and reduce penetration depth. These features make it ideal for prostatic enucleation. A vapoenucleating technique called Thulium Laser Vapoenucleation of the Prostate was presented in 2009, followed by a blunt enucleating technique called Thulium Laser Enucleation of the Prostate in 2010. These techniques have become alternatives to HoLEP and TURP; however, the amount of literature and randomized controlled trials available are inferior compared to HoLEP. The aim of this review is to outline, describe, and discuss current evidence on thulium enucleating techniques.
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Objective: The protective effect of androgen deprivation therapy (ADT) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel hypothesis. ADT may protect patients with prostate cancer through the inhibition of androgen receptor-dependent transmembrane serine protease type 2. We analyzed the role of ADT on SARS-CoV-2 infection risk and disease severity. Material and methods: Between August 2020 and June 2021, patients with prostate cancer were included in our study. Patients were divided into two groups as men receiving ADT or not. Patients’ characteristics such as prostate cancer grade and stage, comorbidities, SARS-CoV-2 infection status, and infection severity were assessed. SARS-CoV-2-infected close relatives and patients’ compliance with the precautions against SARSCoV- 2 were also analyzed. Results: A total of 365 patients, 138 (37.8%) with ADT and 227 (62.2%) without ADT, were included in our analysis. Patients with ADT were older (71.8 vs 66.9 years, P ¼ .001) and had a higher rate of chronic obstructive pulmonary disease (11.6% vs 5.7%, P ¼ .044). Patients receiving ADT were more often locally advanced and metastatic (80.4% vs 32.6%, P ¼ .001). SARS-CoV-2 infection rates were statistically similar between patients who received and did not receive ADT (9.4% vs 13.2%, P ¼ .275, respectively). There was no significant difference between two groups in terms of hospitalization rates (2.9% vs 0.9%, P ¼ .205). In multivariate analysis, the presence of SARS-CoV-2-infected close relatives and precautions score were only independent predictors for both risk of SARS-CoV-2 infection and infection severity. Conclusion: We could not find any effect of ADT on risk and severity of SARS-CoV-2 infection. SARSCoV- 2 infection and hospitalization rates were similar between patients with and without ADT.
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Objective: To investigate an adapted enhanced recovery after surgery (ERAS) protocol in adult augmentation cystoplasty (AC). Material and methods: A total of 33 consecutive cases with a history of refractory idiopathic detrusor overactivity (IDO) or neurogenic bladder (NGB) with low capacity, poor compliance, high sustained detrusor pressure, and whose previous therapeutic methods had failed were enrolled. The adapted ERAS fasting 8 hours, high protein, low carbohydrate diet, antibiotics, did not use narcotics as much as possible during anesthesia, acetaminophen, early nasogastric tube removal, neostigmine injection postoperation, metoclopramide, early oral diet, and mobilization were applied, and morbidity and hospital stay duration were analyzed. Results: Twenty-two patients had IDO, and the remained cases were NGB or had low bladder capacity or compliance. The mean age of patients in the IDO group was higher than in NGB cases (P ¼ .020). Following the adapted ERAS protocol implementation, more than two-third of patients returned to a regular diet on the second day postoperation in both groups. The mean (SD) hospital stay duration was 7.7 (1.5) days. Postoperative fasting time was 8.8 6 3. 7 hours, and bowel function was returned 1 day postoperation in 82% of patients. Only 33.3% of adults need postprocedure acetaminophen for 2 days, and in 11 cases, it prescribed for 1 day. All subjects except paraplegic patients had early mobilization 1 day postoperation. Conclusion: Our findings revealed that adapted ERAS protocol could be safe and effective in adult AC. It accompanied by few complications, reduced intestinal motility problems, and a short length of hospital stay.
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