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Objectives

To perform a systematic review and meta‐analysis aiming to improve the level of evidence and determine the efficacy and safety of low‐intensity shockwave therapy (LiST) in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

Methods

We searched PubMed, Cochrane Library and Scopus databases from inception to November 2020 for randomised controlled trials (RCTs) exploring the role of LiST for the management of CP/CPPS. We performed a random‐effects meta‐analysis of RCTs comparing LiST vs sham therapy on CP/CPPS symptoms at different time‐points after treatment. Weighted mean differences (WMDs) with the corresponding confidence intervals (CIs) were estimated. Furthermore, we assessed the strength of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system (International Prospective Register of Systematic Reviews [PROSPERO]: CRD42020208813).

Results

We included five sham RCTs and one non‐sham RCT. In the meta‐analysis of sham RCTs, both the National Institute of Health Chronic Prostatitis Symptom Index (NIH‐CPSI) pain domain score and the numeric pain rating scale improved significantly after LiST vs sham therapy at the assessment directly after treatment protocol completion (WMD 3.2, 95% CI 0.88–5.52, I
² = 90%; and WMD 1.43, 95% CI 0.85–2.01, I
² = 32%, respectively), at 1 month (WMD 4.4, 95% CI 2.84–5.95, I
² = 68%, and WMD 2.59, 95% CI 1.92–3.27, I
² = 83%, respectively), and at 3 months after last treatment session (WMD 3.61, 95% CI 1.49–5.74, I
² = 90%, and WMD 2.64, 95% CI 2.13–3.16, I
² = 71%, respectively). Similarly, the NIH‐CPSI total and quality‐of‐life domain scores improved significantly after LiST compared to sham therapy for the same time‐points. Conversely, the long‐term efficacy of LiST, as well as the effect of LiST on lower urinary tract symptoms and erectile function, was clinically insignificant.

Conclusions

LiST is an effective treatment modality for the improvement of pain and quality of life in patients with CP/CPPS. Therefore, it should be recommended as a part of individualised treatment strategies in such patients.

Objective

To determine the long‐term outcome of endoscopic urethrotomy for primary urethral strictures based on a population‐based approach.

Patients and Methods

We analysed a nationwide database of all patients with urethral stricture disease who underwent endoscopic urethrotomy as a primary intervention between January 2006 and December 2007. All patients were followed individually for 7–9 years. Frequencies and types of surgical re‐interventions were documented. Repeat surgical interventions were stratified into three treatment types: urethrotomy, urethroplasty, and end‐to‐end urethral anastomosis.

Results

A total of 1203 men underwent urethrotomy during the index period. The median (SD, range) patient age was 63 (15.7, 20–85) years. A total of 136 patients (11%) died during follow‐up. Within the follow‐up period, 932 patients (78%) received no further surgical re‐intervention for recurrent disease, and 176 patients (14.6%) required one, 53 (4.5%) two, and 41 (3.4%) three or more procedures. The mean number of re‐interventions was 1.5/patient and the lowest re‐intervention rate was in patients aged ≥80 years (13.9%). In 236 cases (68%) at least one repeat urethrotomy was performed. An open reconstruction was performed in 87 cases (32%), with urethroplasty in 21 patients (24%), and end‐to‐end anastomosis in 66 patients (76%). The mean interval until re‐intervention was 29.5 months.

Conclusions

This long‐term population‐based study suggests that the invasive re‐treatment rate in men following initial urethrotomy is 22% within 8 years and lowest in the advanced age cohort.

Objective

To determine the long‐term outcome of endoscopic urethrotomy for primary urethral strictures based on a population‐based approach.

Patients and Methods

We analysed a nationwide database of all patients with urethral stricture disease who underwent endoscopic urethrotomy as a primary intervention between January 2006 and December 2007. All patients were followed individually for 7–9 years. Frequencies and types of surgical re‐interventions were documented. Repeat surgical interventions were stratified into three treatment types: urethrotomy, urethroplasty, and end‐to‐end urethral anastomosis.

Results

A total of 1203 men underwent urethrotomy during the index period. The median (SD, range) patient age was 63 (15.7, 20–85) years. A total of 136 patients (11%) died during follow‐up. Within the follow‐up period, 932 patients (78%) received no further surgical re‐intervention for recurrent disease, and 176 patients (14.6%) required one, 53 (4.5%) two, and 41 (3.4%) three or more procedures. The mean number of re‐interventions was 1.5/patient and the lowest re‐intervention rate was in patients aged ≥80 years (13.9%). In 236 cases (68%) at least one repeat urethrotomy was performed. An open reconstruction was performed in 87 cases (32%), with urethroplasty in 21 patients (24%), and end‐to‐end anastomosis in 66 patients (76%). The mean interval until re‐intervention was 29.5 months.

Conclusions

This long‐term population‐based study suggests that the invasive re‐treatment rate in men following initial urethrotomy is 22% within 8 years and lowest in the advanced age cohort.

Abstract

Introduction

The novel optical techniques such as blue light cystoscopy (BLC) during transurethral resection of bladder tumor (TURBT) has been shown to improve the tumor detection rate and recurrence rate. Whether a single immediate intravesical chemotherapy (SIIC) still has an additive therapeutic effect in the setting of these novel optical techniques (e.g., photodynamic diagnosis (PDD) and narrow band imaging (NBI)) remains unclear. The main aim of this systematic review and network meta‐analysis was to assess whether SIIC still adds value to bladder tumor management in combination with optical techniques‐ enhanced TURBT.

Methods

A systematic search was performed using PubMed and Web of Science databases in September 2020 according to the Preferred Reporting Items for Systematic Review and Meta‐analysis (PRISMA) extension statement for network meta‐analysis. Studies that compared recurrence rates between intervention groups (TURBT by PDD ± SIIC, NBI ± SIIC, or WLC + SIIC) and control group (TURBT by WLC alone) were included. We used the Bayesian approach in the network meta‐analysis.

Results

Twenty‐two studies (n= 4,519) met our eligibility criteria. Out of six different interventions including three different optical techniques, compared to WLC alone, BLC plus SIIC (odds ratio (OR): 0.349, 95% credible interval (CrI):0.196‐0.601) and BLC alone (OR: 0.668, 95% CrI:0.459‐0.931) were associated with a significantly lower likelihood of 12‐month recurrence rate. In the sensitivity analysis, out of eight different interventions compared to WLC alone, PDD by 5‐aminolevulinic plus SIIC (OR: 0.327, 95% CrI:0.159‐0.646) and by hexaminolevulinic acid plus SIIC (OR: 0.376, 95% CrI:0.172‐0.783) were both associated with a significantly lower likelihood of 12‐month recurrence rate. NBI with and without SIIC were not associated with a significantly lower likelihood of 12‐month recurrence rate (OR: 0.385, 95% CrI:0.105‐1.29 and OR: 0.653, 95% CrI:0.343‐1.15).

Conclusion

BLC during TURBT with concomitant SIIC seems to yieled superior recurrence outcomes in patients with non‐muscle invasive bladder cancer. The Use of PDD was able to reduce the 12‐month recurrence rate; moreover, a concomitant SIIC increased this risk benefit by 32% additional reduction of odds ratio. Although using PDD could reduce the recurrence rate, SIIC remains necessary. Moreover, the ranking analysis showed that both PDD and NBI, plus SIIC were better than these techniques alone.

Abstract

Objectives

To determine the predictive and prognostic value of a panel of systemic inflammatory response (SIR) biomarkers relative to established clinicopathological variables in order to improve patient selection for a more efficient delivery of perioperative systemic therapy. Several blood‐based systemic inflammatory response SIR‐biomarkers have previously been evaluated with respect to their predictive and prognostic value in urothelial carcinoma of the bladder (UCB). Despite promising results, all single SIR‐biomarkers failed to meaningfully improve the discriminatory ability of established models.

Material and methods

The preoperative serum levels of a panel of SIR‐biomarkers, including the albumin‐globulin ratio, neutrophil‐lymphocyte ratio, De Ritis ratio, monocyte‐lymphocyte ratio and the modified Glasgow Prognostic Score were assessed in 4,199 patients treated with radical cystectomy for clinically non‐metastatic UCB. Patients were randomly divided in a training and testing cohort. A machine‐learning based variable selection approach (LASSO regression) was used for the fitting of several multivariable predictive and prognostic models. The outcomes of interest included prediction of upstaging to MIBC, lymph node involvement, pT3/4 disease, cancer‐specific survival and recurrence‐free survival. The discriminatory ability of each model was either quantified by the area under the curve (AUC) of receiver operating curves (ROC) or by the C‐index. After validation and calibration of each model, a nomogram was created and decision curve analysis (DCA) was used to evaluate the clinical net‐benefit.

Results

For all outcome parameters, at least one SIR‐biomarker was selected by the machine‐learning process to be of high discriminatory power during the fitting of the models. In the testing cohort, model performance evaluation for preoperative prediction of lymph node metastasis, ≥pT3 disease and upstaging to MIBC showed a 200‐fold bootstrap corrected AUC of 67.3%, 73% and 65.8%, respectively. For postoperative prognosis of cancer‐specific survival and recurrence‐free survival, a 200‐fold bootstrap corrected C‐index of 73.3% and 72.2%, respectively, was found. However, even the most predictive combinations of SIR‐biomarkers only marginally increased to discriminatory ability of the respective model in comparison to established clinicopathological variables.

Conclusion

While our machine‐learning approach for fitting of the models with the highest discriminatory ability incorporated several previously validated SIR‐biomarkers, these failed to improve the discriminatory ability of the models to a clinically meaningful degree. While the prognostic and predictive value of such cheap and ready‐available biomarkers warrants further evaluation in the age of immunotherapy, additional novel biomarkers are still needed to improve risk stratification.