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Almsaoud NA, Safar O, Alshahrani ST, Alwadai R, Alkhaldi SM, Almurayyi M, Alrweili HH, Assiri HM, Al Jubran A, Hakami B, Alzahrani MA. The effect of penile traction device in men with Peyronie's disease on penile curvature, penile length, and erectile dysfunction: a systematic review and meta-analysis. Transl Androl Urol 2023; 12:1673-1685. [PMID: 38106680 PMCID: PMC10719764 DOI: 10.21037/tau-23-310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 10/20/2023] [Indexed: 12/19/2023] Open
Abstract
Background Peyronie's disease (PD) results in curvature, pain, and erectile dysfunction (ED). Penile traction devices (PTDs) are a non-invasive treatment option for PD by applying mechanical forces to elicit biochemical responses that reduce curvature and improve penile function. In the present study, we systematically reviewed and analyzed the literature investigating the use of PTD to treat PD. Methods We have conducted electronic and manual search strategies within the databases and included articles to find relevant studies. A total of Five studies met all the predefined inclusion criteria and were selected for inclusion in the review. Outcomes assessed are penile length, penile curvature, and erectile function (EF). The study population consisted of patients with PD, the intervention was penile traction therapy (PTT), the comparison was matched placebo or follow-up, and the study design was randomized controlled trials (RCTs) or cohort studies. The Cochrane risk of bias assessed the studies' quality for randomized studies and the Newcastle-Ottawa scale (NOS) for non-randomized observational studies. All statistical analyses were performed using R software. Results were considered statistically significant for P<0.05. Results Only five studies met inclusion and exclusion criteria and were published between 2014 and 2021. The sample sizes range [51-110], totaling 419, with a mean of 83.8 patients-the follow-up with a mean of 6.75 months. This meta-analysis evaluated the efficacy of PTD on curvature degree, penile length, and EF in patients. There is a significant positive effect on the curvature degree (P=0.0373), while there is no significant effect on penile length and EF (P=0.5315 and 0.1010), respectively. They are Indicating low heterogeneity with an estimated total heterogeneity of 0. Overall, the available evidence does not support the efficacy of the intervention for penile length or EF. Conclusions The current evidence suggests that PTDs can be a safe and effective treatment option for men with PD to reduce penile curvature. However, further research, including more RCTs with extended follow-up periods, is needed to fully understand their efficacy and determine the ideal timing and patient subtypes that would benefit from PTD.
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Affiliation(s)
- Nazal A. Almsaoud
- Urology Department, Prince Mutaib Bin Abdulaziz Hospital, Sakaka, Al-Jouf Region, Saudi Arabia
| | - Omar Safar
- Urology Department, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia
| | | | - Raed Alwadai
- Urology Department, King Abdullah Hospital, Bishah, Assir, Saudi Arabia
| | - Sulaiman M. Alkhaldi
- Urology Department, Prince Mutaib Bin Abdulaziz Hospital, Sakaka, Al-Jouf Region, Saudi Arabia
| | - Muath Almurayyi
- Urology Department, King Khaled University Medical city-Abha, Assir, Saudi Arabia
| | - Hana Hazi Alrweili
- Urology Department, Prince Mutaib Bin Abdulaziz Hospital, Sakaka, Al-Jouf Region, Saudi Arabia
| | - Hassan M. Assiri
- Urology Department, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia
| | - Abdulkareem Al Jubran
- Urology Department, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia
| | - Basel Hakami
- Urology Department, King Faisal Medical City for Southern Region (KFMCity), Abha, Saudi Arabia
- Urology Department, King Fahad Central Hospital, Jazan, Saudi Arabia
| | - Meshari A. Alzahrani
- Urology Department, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
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Almasoud NA, Safar O, Elatreisy A, Alshahrani ST, Libdah SB, Alkhaldi SM, Alsoliman NF, Alderaan AM, Abdel-Al I, Abouelgreed TA, Alabeedi M, Al-Aown A. Super pulsed thulium fiber laser outcomes in retrograde intrarenal surgery for ureteral and renal stones: a systematic review and meta-analysis. BMC Urol 2023; 23:179. [PMID: 37936133 PMCID: PMC10631031 DOI: 10.1186/s12894-023-01355-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Laser lithotripsy using a thulium fiber laser (TFL) has become an effective treatment option for small renal stones with low complication rates. TFL has a higher absorption coefficient, smaller fibers, and better pulse rate capability. METHODS We conducted a systematic review and meta-analysis to evaluate the published evidence regarding TFL's lithotripsy performance in retrograde intrarenal surgery (RIRS), for which we primarily assessed the outcomes of stone-free rate, operation time, and complications. We searched different databases from inception to April 2023. We assessed the methodological quality and risk of bias using the Cochrane Risk of Bias tool for randomized trials and the ROBINS-I tool for non-randomized studies. We used a random-effects model for meta-analysis and assessed heterogeneity using the I2 statistic. RESULTS Twelve published studies evaluated the efficacy of RIRS using a TFL for treating renal and ureteral stones. The meta-analysis revealed a predicted stone-free rate of 89.37% (95% CI: 83.93% to 93.12%), indicating that, on average, approximately 89.37% of patients achieved a stone-free state after treatment. The substantial heterogeneity among the studies was evident, as shown by a Q-value of 33.1174 and a p-value of 0.0003. The I2 value of 69.80% (95% CI: 25.91% to 92.02%) highlighted the proportion of variability attributed to genuine heterogeneity across the studies. Moreover, the H2 value 3.31 (95% CI: 1.35 to 12.53) indicated significant heterogeneity beyond random chance. The estimated overall effect size (logit-transformed) of 2.1289 was highly statistically significant (z = 8.7648, p < 0.0001) with a confidence interval of 1.6528 to 2.6049. The reported complications varied across studies, encompassing Clavien grade I-II complications in most cases, with a subset experiencing more severe Clavien grade III-V complications. Additionally, other studies noted a range of complications, such as haematuria, fever, transient creatinine elevation, and postoperative issues like bleeding, pain, and sepsis. CONCLUSION This meta-analysis suggests that RIRS using TFL is an effective and safe treatment option for renal and ureteral stones, with high stone-free and low complication rates. The included studies exhibited a low risk of bias and were of high quality. However, more extensive randomized controlled trials with extended follow-up periods are needed to investigate this technique's efficacy and safety.
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Affiliation(s)
- Nazal A Almasoud
- Urology Department, Prince Mutaib Bin Abdulaziz Hospital, Sakaka, Aljouf province, Saudi Arabia
| | - Omar Safar
- Urology Department, Armed Forces Hospital Southern Region, Khamis Mushayt, Aseer Province, Saudi Arabia.
| | - Adel Elatreisy
- Urology Department, Armed Forces Hospital Southern Region, Khamis Mushayt, Aseer Province, Saudi Arabia
- Urology Department, Faculty of Medicine, Al-Azher University, Cairo, Egypt
| | - Saad Thamer Alshahrani
- Urology Department, Armed Forces Hospital Southern Region, Khamis Mushayt, Aseer Province, Saudi Arabia
| | - Saud Bin Libdah
- Urology Department, Armed Forces Hospital Southern Region, Khamis Mushayt, Aseer Province, Saudi Arabia
| | - Sulaiman M Alkhaldi
- Urology Department, Prince Mutaib Bin Abdulaziz Hospital, Sakaka, Aljouf province, Saudi Arabia
| | - Nezar F Alsoliman
- Urology Department, Prince Mutaib Bin Abdulaziz Hospital, Sakaka, Aljouf province, Saudi Arabia
| | - Abdulrahman M Alderaan
- Urology Department, Prince Mutaib Bin Abdulaziz Hospital, Sakaka, Aljouf province, Saudi Arabia
| | - Ibrahim Abdel-Al
- Urology Department, Faculty of Medicine, Al-Azher University, Assiut Branch, Assiut, Egypt
| | | | - Mohammed Alabeedi
- Urology Department, Armed Forces Hospital Southern Region, Khamis Mushayt, Aseer Province, Saudi Arabia
| | - Abdulrahman Al-Aown
- Urology Department, Armed Forces Hospital Southern Region, Khamis Mushayt, Aseer Province, Saudi Arabia
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