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As one of the earliest surgeries applying knotless barbed suture, the minimally invasive radical prostatectomy (MIRP) was reported to have various effects on the patients and the surgeons. This study reviewed the available evidence about the efficacy and safety of barbed sutures in MIRP. We searched ClinicalTrials.gov, Cochrane Register of Clinical Studies, PubMed, and Embase to identify randomized controlled trials (RCTs) and cohort studies addressing the application of barbed sutures and conventional sutures in MIRP (until August 2016). Quality assessment was performed according to Cochrane recommendations. The data were analyzed using Review Manager (Version 5.3), and sensitivity analysis was performed by sequentially omitting each study. A total of 12 studies, including three RCTs (low to moderate risk of bias, 211 patients) and nine cohort studies (low to moderate risk of bias, 698 patients), fulfilled the study criteria. The pooling of trials did not show statistical difference. Pooling data of cohort studies showed that suture time [mean difference (MD) = −8.52, 95% confidence interval (CI) = −12.60 to −4.43, p

Extracellular matrix (ECM) accumulation plays a key role in the progression of bladder outlet obstruction (BOO). Muscarinic receptors have been widely reported to serve as pivotal regulators in lung tissue remodeling. However, the influence of them on human bladder smooth muscle cells (HBSMCs) and the underlying molecular mechanisms have not yet been evaluated. The purposes of the present study are to investigate the effect of muscarinic receptors on the synthesis of ECM in HBSMCs and the involvement of intracellular signal transducers. The results indicated that M

INTRODUCTION AND OBJECTIVES:Bladder outlet obstruction (BOO) promotes the hyperplasia of bladder detrusor, increases bladder pressure and decreases bladder compliance in clinic. To extensively expl...

Background Barbed sutures can avoid knot tying and speed the suture placement in the PN(partial nephrectomy). On account of the impact on clinical outcomes are ambiguous, this study is determined to identify the application of barbed suture during PN. Methods ClinicalTrials.gov, Cochrane Register of Clinical Studies, PubMed and EMBASE were searched for RCTs(randomized controlled trials) and cohort studies focusing on the comparison of barbed and traditional sutures in PN(last updated on Feb in 2015). According to Cochrane Library’s suggestion, quality assessment was performed. Review Manager was applied to analyze all the data and sensitivity analyses were performed through omitting each study sequentially. Results Eight cohort studies and none of RCTs proved eligible (risk of bias: moderate to low,431 patients). Warm ischemia time(MD = − 6.55,95% CI -8.86 to − 4.24, P

Figure S1. Flow chart showing literature searching process of meta-analysis. The search keywords are (renal cell carcinoma) AND [(tyrosine kinase inhibitor) OR sunitinib OR axitinib OR sorafenib OR pazopanib] AND [hypertension OR (blood pressure). (DOCX 140 kb)

Figure S1. A forest plot of sensitivity analysis of warm ischemia time with or without barbed suture. Figure S2. A forest plot of sensitivity analysis of Estimate blood loss with or without barbed suture. Figure S3. A forest plot of subgroup analysis of perioperative blood transfusion with or without barbed suture. Figure S4. A forest plot of subgroup analysis of postoperative complications with or without barbed suture. Table S1. Quality assessment of studies in the meta-analysis based on Newcastle-Ottawa Scale (NOS). (DOCX 92 kb)

Whether midurethral sling (MUS) procedures are as effective in obese women as they are in women of normal weight is still a matter of controversy. The objective of this study was to determine if body mass index (BMI) influences the outcome of MUS procedures for stress urinary incontinence (SUI). We searched electronic databases including EMBASE, MEDLINE, Web of Science and Ovid evidence-based medicine reviews to identify studies that explored the association between BMI and outcomes of MUS procedures. The studies were rated using the Newcastle-Ottawa scale; the meta-analysis was performed using Review Manager 5.3 software. This review included 11 studies, 6 prospective cohort studies and 5 retrospective studies, with a total of 2,846 patients. The objective success rates of MUS in patients with BMI >25 kg/m2 (overweight and obese) were lower than in patients with BMI 18.5 – 25 kg/m2 as a risk factor when discussing the suitability of the MUS procedure in a patient with SUI.

Background Conflicting evidence exists regarding the effect of hypertension on the prognosis of metastatic renal cell carcinoma (mRCC) patients treated with tyrosine kinase inhibitors (TKIs). This study aimed to assess the predictive value of TKIs-induced hypertension in patients with mRCC. Methods This study was registered in PROSPERO (CRD42019129593). PubMed, Embase, Web of Science and the Cochrane Library database were searched with terms: “renal cell carcinoma”, “hypertension”, “blood pressure”, “tyrosine kinase inhibitor”, “sunitinib”, “axitinib”, “sorafenib” and “pazopanib” until March 21, 2019. Hazard Ratios (HR) and 95% confidence intervals (CI) for progression-free survival (PFS) or overall survival (OS) were extracted and analyzed with Stata 15.0 software. Heterogeneity was assessed using the I2 value. Meta-regression, subgroup analysis and sensitivity analysis were also performed to explore heterogeneity. Publication bias was assessed with funnel plots and precisely assessed by Egger’s and Begg’s tests. The quality of evidence of outcomes was generated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results A total of 4661 patients from 22 studies were included in the study. The results showed that the increase of blood pressure was an effective predictor for longer PFS (HR = 0.59, 95% CI: 0.48–0.71, p < 0.001; I2 = 77.3%) and OS (HR = 0.57, 95% CI: 0.45–0.70, p < 0.001; I2 = 77.4%) of patients with mRCC. Subgroup analysis revealed that patients receiving sunitinib and pazopanib could have longer PFS and OS. Conclusions This study indicated that TKIs-induced hypertension may be a good predictor for better prognosis of patients with mRCC receiving TKIs treatment, especially using sunitinib or pazopanib. Electronic supplementary material The online version of this article (10.1186/s12894-019-0481-5) contains supplementary material, which is available to authorized users.

There are a variety of ureteral access sheath (UAS) lengths (13-55 cm) and diameters (9.5/11.5F-16/18F) available in the market. However, urologists are faced with a dilemma when choosing the ideal UAS diameter. Thus, we evaluated a case-control study of the efficacy and safety of 12/14F and 14/16F UASs in flexible ureteroscopic lithotripsy.A retrospective case-control study was evaluated with patients who were treated with flexible ureteroscopic lithotripsy for urinary calculi in a West China hospital from 2008 to 2017. Patients deployed a 12/14F UAS were divided into group A, and the others were divided into group B. The primary outcome was the postoperative infectious complication rate after the operation, including fever and sepsis. The second outcome included safety, lithotripsy time, and the stone-free rate.There were 1139 patients in total included in our study, with 593 patients divided into group A and 546 divided into group B. There was no significant difference between the baselines of the two groups' patients. The patients in group A had a significantly lower postoperative rate compared to the patients in group B (6.4% vs 1.6%). The 14/16F UAS also worked better in high-risk patients, such as patients with stones2 cm or patients with infectious stones (7.6% vs 1.6%, 15.0% vs 3.1%, respectively).Our study found that the 14/16F UAS showed an obvious advantage in preventing postoperative infectious complications in flexible ureteroscopic lithotripsy compared to the 12/14F UAS.

Conduct a systematic review and meta-analysis of studies to evaluate the association between the use of PDE5I and biochemical recurrence (BCR) after radical prostatectomy (RP). We searched Embase (from 1996 to Feb 2018), PubMed (from 1996 to Feb 2018), and Cochrane library (from 1999 to Feb 2018), then manually searched the reference lists of key retrieved articles. Original studies that reported the risk of postoperative BCR for PDE5I users, as compared with non-PDE5I users, were included. Data including the characteristic of participants, the risk of BCR after RP and key criteria of study quality were collected. The pooled relative risks (RRs) were calculated with random-effects model. A total of 5 cohort studies and 1 case–control study were conducted for data analysis (a total of 17752 participants). Only 1 cohort study reported adjusted RR greater than 1 (range for all derived RRs, 0.7–1.47). The meta-analysis revealed that the PDE5I users had no higher risk of BCR after RP (RR = 1.04, 95% confidence interval [CI], 0.79–1.36). Sensitivity analysis showed that the remaining pooled RR and 95% CI were not changed significantly by omitting each study. In addition, the 5-year BCR rate had no significant difference between PDE5I users and non-PDE5I users. Our meta-analysis indicated that PDE5I treatment in men following RP did not increase the risk of BCR. The results preliminarily suggested that the use of PDE5I for erectile dysfunction after RP was oncologically safe. Nevertheless, more large sample cohort studies are needed to validate this conclusion.

We conducted a systematic network meta-analysis to review the relevant literature evaluating the therapeutic efficacy of upfront docetaxel (Doc) or abiraterone (Abi) plus androgen deprivation therapy (ADT) on oncological outcome in patients with castration-naive prostate cancer (CNPC). An attempt to identify subgroups of patients who would benefit most either from Doc or Abi plus ADT and further compare the efficacy and safety between these two combination therapies was made. A comprehensive search of the PubMed/Medline, Embase databases, International Clinical Trial Registration Platform (ICTRP), Clinical Trial, and Cochrane Central Register of Controlled Trials to December 2017 was performed. Six studies, involving 6480 patients, were included in this meta-analysis, consisting of over 60% (4462/6480) of patients with metastatic CNPC (mCNPC, M1), and 31.1% (2018/6480) of patients with non-metastatic CNPC (M0). In total, combination therapies (ADT plus Doc or Abi) significantly improved overall survival (OS) and failure-free survival (FFS) for all CNPC patients. For M1 patients, combination therapies were dramatically associated with improved OS and FFS, but for M0 patients, only with moderate improvement in FFS. M1 patients < 70 years old, Eastern Cooperative Oncology Group (ECOG) performance status (ECOG PS) 0-1, Gleason score (< 8), or visceral metastases could realize better survival benefit from either combination therapy. In indirect comparisons among M1 patients with younger age (< 70 years), ECOG PS 0-1 or aggressive Gleason score (GS ≥ 8), upfront Abi showed superiority to Doc in prolonging FFS. The incidence of severe adverse events (AEs ≥ 3) was comparable between these two therapeutic regimens. In conclusion, upfront Doc or Abi plus ADT should be considered a standard of care in selected patients with mCNPC. For a subset of populations, Abi may be the first choice for men who start treatment for the first time.

To systematically evaluate the different efficacy among generally used drugs for stent-related symptoms (SRS) with the method of network meta-analysis. A systematic search was performed in the US National Library of Medicine’s life science database (Medline), Embase, the Cochrane Central Register of Controlled Trials, and the Cochrane Database for Systematic Reviews before December 2017. Analysis was performed under multivariate random-effects network model and effects of drugs were ranked with surface under the cumulative ranking (SUCRA) probabilities. 19 trials with 2036 patients investigating 4 different intervention including tamsulosin (Tam), alfuzosin (Alfu), solifenacin (Soli) and combination of Tam and Solif were finally included in our analysis. Tam plus Soli had the highest SUCRA on all aspects of ureteral stent symptom questionnaire: urinary symptoms (86.2%), body pain (85.0%), general health (80.5%), work performance (72.0%) and sexual performance (84.4%). Except for pain relief, Soli showed higher SUCRA than Tam or Alfu in rest respects. Tam and Alfu showed similar SUCRA on urinary symptoms (53.0 vs 48.7%) and body pain relief (61.9 vs 62.9%). Tam plus Soli might be the most effective intervention for SRSs. As for monotherapy, Soli showed advantages in most respects except for pain relief compared to Tam or Alfu. Tam and Alfu showed similar efficacy on urinary symptoms and body pain relief.

Objectives To explore the risk factors for mesh erosion after female pelvic floor reconstructive surgery based on published literature. Materials and Methods A systematic literature search of the PubMed, Embase, Cochrane Library, Chinese Biomedical Literature (CBM), China National Knowledge Infrastructure (CNKI) and Chinese Science and Technology Periodical (VIP) databases was performed to identify studies related to the risk factors for mesh erosion after female pelvic floor reconstruction published before December 2014. Summary unadjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the strength of associations between the factors and mesh erosion. Results In all, 25 studies containing 7 084 patients were included in our systematic review and meta-analysis. Statistically significant differences in mesh erosion after female pelvic floor reconstruction were found in older vs younger patients (OR 0.96, 95% CI 0.94–0.98), more parities vs less parities (OR 1.27, 95% CI 1.07–1.51), the presence of premenopausal/oestrogen replacement therapy (ERT) (OR 1.36, 95% CI 1.03–1.79), diabetes mellitus (OR 1.87, 95% CI 1.35–2.57), smoking (OR 2.35, 95% CI 1.80–3.08), concomitant pelvic organ prolapse (POP) surgery (OR 0.37, 95% CI 0.16–0.84), concomitant hysterectomy (OR 1.46, 95% CI 1.03–2.07), preservation of the uterus at surgery (OR 0.22, 95% CI 0.08–0.63), and surgery performed by senior vs junior surgeons (OR 0.42, 95% CI 0.30–0.58). Conclusion Our study indicates that younger age, more parities, premenopausal/ERT, diabetes mellitus, smoking, concomitant hysterectomy, and surgery performed by a junior surgeon were significant risk factors for mesh erosion after female pelvic floor reconstructive surgery. Moreover, concomitant POP surgery and preservation of the uterus may be the potential protective factors for mesh erosion.

Background Intraductal carcinoma of prostate (IDC-P) is always underestimated pathological pattern in prostate cancer and its role is still unclear in castration resistant prostate cancer (CRPC). This study was conducted to investigate the presence and the roles of IDC-P in patients with metastatic CRPC. Methods 45 patients with initially diagnosed metastatic prostate cancer and then progressed to CRPC, were included. All of them were received twice transperineal biopsies at the time of initial diagnosis and the time of CRPC. All samples were retrieved to detect the presence of IDC-P. PSA doubling time (PSADT) was considered as a parameter presenting the progression of CRPC. The relationships between IDC-P and other clinicopathological variables were analyzed. Results IDC-P was found only in 20% (9/45) cases at initial diagnosis, whereas, it increased to 62.5% (28/45) at the time of CRPC (χ2= 16.568, P = 0.000). Compared to acinar adenocarcinoma components in tumor tissues, IDC-P components, especially solid subtype, had obviously poor/no response to androgen deprivation therapy (ADT). In addition, among patients treated with docetaxel-based chemotherapy (n = 24), patients with IDC-P also showed more unfavorable response than those without IDC-P (20% vs. 66.7%, P = 0.022). The presence of IDC-P and serum testosterone at the time of CRPC, were significantly associated with rapid disease progression. 13/28 (46.4%) CRPC with IDC-P had PSADT less than 30 days, while, only 1/17 (5.9%) patient without IDC-P had a less than 30 days PSADT (χ2 = 8.114, P = 0.004). Limitations included the relative short follow-up time and a relative small cohort. Conclusions The presence of IDC-P was significantly associated with rapid progression of CRPC. And its presence could suggest the poor response to initial ADT and sequential docetaxel-based chemotherapy. Detection of IDC-P should be of importance in CRPC, and re-biopsy at the time of CRPC might be one of practical solutions. The mechanism of the ADT and docetaxel resistance to IDC-P needed to be further investigated. Prostate 75:1247–1254, 2015. © 2015 Wiley Periodicals, Inc.

We applied a newly introduced method, network meta-analysis, to re-evaluate the expulsion effect of drugs including tamsulosin, doxazosin, nifedipine, terazosin and rowatinex after extracorporeal shock wave lithotripsy (ESWL) as described in the literature. A systematic search was performed in Medline, Embase and Cochrane Library for articles published before March 2016. Twenty-six studies with 2775 patients were included. The primary outcome was the number of patients with successful stone expulsion. The data were subdivided into three groups according to duration of follow-up. A standard network model was established in each subgroup. In 15-day follow-up results, SUCRA outcome showed the ranking of effects was: doxazosin > tamsulosin > rowatinex > nifedipine > terazosin (88.6, 77.4, 58.6, 32.2 and 30.4, respectively). In 45-day follow-up results, SUCRA ranking was: tamsulosin > nifedipine > rowatinex (69.4, 67.2 and 62.6, respectively). In 90-day follow-up results, SUCRA ranking was: doxazosin > rowatinex > tamsulosin (84.1, 68.1 and 49.1, respectively). In conclusion, doxazosin and tamsulosin have potential to be the first choice for pharmacological therapy to promote the expulsion of urinary stone fragments after ESWL, with this doxazosin can improve the SFR in the long term, while tamsulosin may result more in accelerating the process of expulsion.

To compare postoperative outcomes between the perineal inverted-U and the vertical midline incision approaches of the urethroplasty and clarify them via gross anatomy. A total of 461 male patients, from Jan. 2006 to Jun. 2014, who underwent the urethroplasty via perineal midline vertical or inverted-U incision approach were recruited retrospectively. By match pairing for etiology and stricture length, 410 patients from two groups (205 for each group) were selected. Anatomy experiments were also performed. Outcome measurements and statistical analysis: the Chi-square, Student’s t and binary logistic regression analyses were performed to compare the operative and postoperative data on the two groups. With regard to patients with bulbar urethral stricture, the rate of surgical site infection (SSI) in perineal inverted-U group was 18.6% while 1.9% in the midline vertical group (p

AKT1, also known as v-akt murine thymoma viral oncogene homolog 1, is involved in the regulation of cell-survival and anti-apoptotic activities, which may affect the pathogenesis of various cancers. However, the association between genetic variants of AKT1 and the risk of developing prostate cancer has not been investigated before. This study investigated the associations between three polymorphisms (rs1130214, rs3730358, and rs2494732) in AKT1 and the risk of development of prostate cancer in the Chinese Han population. Sequenom MassARRAY & iPLEX technology were used to genotype these polymorphisms in 493 Chinese Han patients with prostate cancer and 309 age-matched healthy individuals. Compared to the CC genotype of the rs3730358 polymorphism, the CT genotype of the same polymorphism was strongly associated with a decreased risk of prostate cancer (OR = 0.617, 95%CI = 0.390-0.976, P = 0.037). However, there was no significant difference between the allele frequency of the rs3730358 polymorphism and those of the other two polymorphisms (P > 0.05). Moreover, no significant difference was found in the haplotype analysis (P > 0.05). Our study found that the variant genotype CT of rs3730358 of AKT1 was associated with a decreased risk of prostate cancer, which suggested that this polymorphism could play an important role in the development of the disease.

BACKGROUND Intraductal carcinoma of prostate (IDC-P) was usually found to be co-exist with conventional aggressive prostate adenocarcinoma. The presence of IDC-P was considered as an adverse pathological factor, which was associated with high Gleason score, large prostate volume and accelerated disease progression. However, no any information is available on the presence of IDC-P diagnosed by needle biopsy in patients with metastatic prostate cancer. We investigated the incidence and prognostic value of intraductal carcinoma of prostate (IDC-P) in initial diagnosed metastatic prostate cancer. METHODS We included 278 patients with initial diagnosed metastatic prostate cancer treated between 2008 and 2011, all the pathological diagnosis were from ultrasonic-guided transperineal needle biopsy. IDC-P was strictly defined according to Epstein's criteria. Analyzed factors included age, Eastern Cooperative Oncology Group (ECOG) score, clinical T staging, Gleason scores, baseline prostate specific antigen (PSA), alkaline phosphatase (ALP), hemoglobin (HGB), PSA normalization, and the presence of IDC-P. RESULTS Totally, IDC-P was found in 57/278 (20.5%) cases. Univariate analysis showed that, compared with cases without IDC-P, cases with IDC-P was definitely associated with much shorter CRPC-free survival (CFS) time (46.05 ± 1.39 vs. 22.98 ± 1.80 months, P = 0.000) and OS time (50.38 ± 1.18 vs. 36.43 ± 2.10 months, P = 0.000). Multivariate analysis showed that the presence of IDC-P was the only independent prognostic factor associated with poor CFS (HR = 4.886, P = 0.011) and OS (HR = 1.945, P = 0.020). Further sub-analysis showed, even among patients with higher Gleason score (≥8) (n = 158), IDC-P was still significantly and inversely associated with CFS and OS (the median CFS time: 40 versus 22 months; P = 0.000; the median OS time: 54 vs. 36 months, P = 0.000). Again, Cox's regression model confirmed that only the presence of IDC-P was still not only an independent prognostic factor predicting shorter time of CRPC (HR = 4.031, P = 0.035), but also for poorer OS (HR = 2.499, P = 0.006). CONCLUSIONS The presence of IDC-P in initial diagnosed metastatic prostate cancer, even among patients with more aggressive pattern, was firstly found to be significantly and independently associated with earlier occurrence of CRPC and poorer OS. We recommended the presence of IDC-P should be a routine record in pathological report of clinical diagnosis and other potential therapeutic regimen might be added to intervene in the integrated therapy as early as possible. Prostate 75:225–232, 2015. © 2014 Wiley Periodicals, Inc.

Objectives Capsular invasion is frequently detected in localized renal cell carcinoma (RCCs) samples. Whether patients with localized RCCs and capsular invasion will suffer poorer clinical outcome than those without this pathologic finding is still at issue. Materials and methods We performed a systematic literature research of Central, Medline, Embase, and Chinese database CNKI and VIP. Cohort studies comparing the prognosis in patients with localized RCCs and with or without capsular invasion were included. Incidence of capsular invasion in different Fuhrman grade, primary TNM stage, and clinical outcome were analyzed. Results Six cohort studies with 2,295 eligible patients were identified. Capsular invasion was presented in 500 specimens (21.79%). Lower grade (Fuhrman I/II vs. Fuhrman III/IV) and stage (pT1 vs. pT2) diseases were associated with lower incidence of capsular invasion, with OR = 0.56, 95% CI[0.37–0.85] and OR = 0.35, 95% CI[0.25–0.49], respectively. Our pooled analysis showed patients with capsular invasive had 1.80 times the risk of tumor recurrence than patients without these findings (HR = 1.8, 95% CI [1.21, 2.68]), and patients with localized RCCs and capsular invasion were detected at 4.93 times risk in developing cancer related death than those without its presence during follow up (HR = 4.93, 95% CI [2.14, 11.35]). Conclusion Patients with localized RCCs and capsular invasion are of poorer prognosis than those without this finding. Capsular invasion may serve as an additional factor in stratifying patient with localized RCCs.

Background Controversy remains on the superiority of combination therapy over monotherapy on ureteral stent-related symptoms (SRSs). We tend to explore if there is a necessity of combination therapy. Methods One hundred cases of unilateral upper urinary tract calculi with stent insertion (pre and post flexible ureteroscopy) were randomized into 4 groups, given non-treatment, solifenacin, tamsulosin or combination respectively. Eight times of follow-ups were given after each insertion. Results SRSs released spontaneously within 4 days after insertion (p = 0.017) but then stay with no further improvement. Benefit of solifenacin on flank pain started showing after day4 (p = 0.002), which was comparable to that of tamsulosin and combination (p = 0.914 vs 0.195). Combination therapy showed superiority over both monotherapy before day4, but after then solifenacin and tamsulosin showed similar effectiveness with the combination therapy on both bladder pain (p = 0.229 vs 0.394) and urgency (p = 0.813 vs 0.974). No improvement on hematuria or frequency was observed in each group. Conclusions Combination therapy takes effect faster but shows no supervisory after the first few days compared with monotherapy. Trial registration The study protocol was registered on Chinese Clinical Trial Register on April 17th, 2013 (registration number: ChiCTR-TRC-13003148). Electronic supplementary material The online version of this article (doi:10.1186/s12894-016-0186-y) contains supplementary material, which is available to authorized users.

Reason for Withdrawal The protocol is out of date and does not meet the current methodological standards of The Cochrane Collaboration. To view the published versions of this article, please click the 'Other versions' tab.

Means of total scores of quality of life on each follow-up day. No significant difference existed from day1 to day14 (p = 0.674). Figure S2. Means of Symptom scores of pre- and post-lithotripsy cases. Generally pre- and post-lithotripsy cases had no significant differences in total scores of all symptoms (p = 0.066) but subsection analysis showed significant difference existed before day4 (p = 0.001) (a). Subgroup analysis demonstrated difference in scores of bladder area pain (p = 0.036), kidney area pain (p = 0.005) and hematuria (p = 0.001) (b, c, d). No obvious difference showed up on frequency (p = 0.232) and urgency (p = 0.825) from the beginning to the end. (e, f). Figure S3. Solifenacin, tamsulosin and combination group showed no superiority over the control group on hematuria (p = 0.736 vs 0.924 vs 1.000) (a). Solifenacin, tamsulosin and combination therapy didn’t effectively release the level of frequency (p = 0.073 vs 0.860 vs 0.092) (b). Figure S4. Mean of scores of quality of life. Significant difference existed among the 4 groups (p = 0.046) but combination therapy wasn’t superior to either single drug group (solifenacin and tamsulosin, p = 0.107 vs 0.670). (DOCX 807 kb)

microRNAs (miRNA) silence target genes through Watson-Crick based binding to the 3'untranslated regions (3'UTR). Thus, polymorphisms in the miRNA-binding sites may disrupt this process and play a potential role in cancer pathogenesis. Integrins have been implicated in the genesis and development of many tumors. This study was designed to evaluate the association between five SNP loci in predicted miRNA-binding sites in five integrin genes and prostate cancer occurrence and prognosis to provide data for screening high-risk Chinese Han individuals. These five polymorphisms were genotyped by using the high-resolution melting method (HRM) in 347 Chinese Han prostate cancer patients with long-time follow-up together with 367 age-matched healthy controls. GC carriers of rs11902171 in ITGAv were associated with a decreased risk of prostate cancer (OR 0.57, 95% CI 0.35-0.93). However, no significant difference was detected in genotype distributions of the five SNP loci in the progression-free survival time of prostate cancer. The ITGAv gene SNP rs11902171 may be potentially associated with the risk of prostate cancer.

To evaluate the feasibility and limitation of single-incision laparoscopic cholecystectomy (SILC), we performed a systematic literature search and 11 studies were included. SILC was successfully performed in 91.9% participants and conventional instruments were used mostly. Although longer operative time was required for this novel procedure than the conventional laparoscopic cholecystectomy, mean difference was 18.54 minutes (P=0.0001) and a learning curve was noted. There was no significant discrepancy in overall complications and severe complications (P=0.51 and 0.82, respectively). No difference in the length of hospital stay between the 2 groups was detected (P=0.09). No consensus has reached on the postoperative pain score between the 2 techniques. SILC with conventional instruments was a feasible and safe approach. It may be offered as an alternative for cholecystectomy in carefully selected patients.

Single-nucleotide polymorphisms located in the microRNA biogenesis pathway could alter the risk for developing prostate cancer. The present study was intended to identify common genetic variants responsible for prostate cancer susceptibility in the GEMIN4 gene. The high-resolution melting method was used to genotype seven polymorphisms (rs7813, rs4968104, rs3744741, rs2740348, rs1062923, rs910925, and rs910924) in the GEMIN4 gene in 300 prostate cancer patients and 244 matched controls. The encouraging discovery in this study was in the rs2740348. Patients carrying the variant heterozygote GC genotype in the rs2740348 were at a 36% decreased risk of prostate cancer (odds ratio [OR] = 0.64; 95% confidence interval [CI] = 0.42, 0.99). Similarly, this variant allele carrier showed significant risk for prostate cancer (OR = 0.64). In addition, subjects carrying the homozygote TT genotype in the rs7813 had a significantly increased risk of prostate cancer (OR = 2.53, 95% CI = 1.07, 6.28). Two common haplotypes were found to be associated with decreased risk of prostate cancer. In the subgroup analysis, higher risk of more severity of prostate cancer (clinical stage III and IV) was observed in individuals with the rs7813 TT genotype (OR = 2.64, 95% CI = 1.02, 7.64), while lower risk of more severity of prostate cancer was observed in individuals with the rs3744741 T allele (OR = 0.69, 95% CI = 0.50, 0.96). Overall, our study provides substantial support for the association between the GEMIN4 gene and the risk of prostate cancer.

The Arg194Trp polymorphism in the X-ray repair cross-complementing group 1 (XRCC1) gene has been proved to be in association with cancer risk in Chinese Mainland population, but a large number of studies have reported inconclusive results. A more comprehensive and precise estimation of the relationship is needed to clear the way towards future studies. Thus, we performed a meta-analysis to analysis these associations. A total of 34 case-control studies in 34 articles were included in this meta-analysis. The results showed that the 194Trp/Trp homozygote had a 31% increased risk of cancer than 194Trp/Arg and 194Arg/Arg genotypes, OR was 1.31 and 95%CI was 1.13 to 1.53. In the subgroup analysis by cancer sites, the Arg194Trp polymorphism was associated with increased risks of lung cancer (OR = 1.27 and 95%CI: 1.07-1.50 for Trp/Trp versus Arg/Arg + Arg/Trp) and esophageal cancer (OR = 1.68 and 95%CI: 1.33-2.13 for Trp/Trp versus Arg/Arg + Arg/Trp). This meta-analysis suggested that the Arg194Trp polymorphism of the XRCC1 gene is a cancer susceptible factor among Chinese Mainland population. More intensive and deeper studies are needed to further reveal the mechanism between Arg194Trp polymorphisms of XRCC1 gene and cancer risks in Chinese Mainland population.

336 Background: Treatments for de novo metastatic prostate cancer (mPCa) are evolving. However predictive models for this subset of the population are still lacking. The aim of this study is to develop nomograms to predict the incidence of castration resistant PCa (CRPC) and overall survival (OS) for de novo mPCa patients. Methods: Data from 449 de novo mPCa patients were retrospectively analyzed. Patients were randomly divided into either the training or the validation cohort. Predictive factors were selected by Cox-proportional model and further used for building predictive models. The outcomes were incidence of CRPC and OS. Results: Predictive parameters included: Gleason Score (GS), intraductal carcinoma of the prostate (IDC-P), ECOG status, alkaline phosphatase (ALP), hemoglobin (HGB) and prostate specific antigen (PSA). IDC-P and GS were the strongest prognosticators for both the incidence of CRPC and OS. Nomograms for predicting CRPC and OS had an internal validated C-index of 0.762 and 0.723, respectively. Based on the beta-coefficients of the final model, risk classification systems were constructed. For those with favorable-, intermediate- and poor-prognosis, the median time to CRPC was 62.6, 28.0 and 13.0 months (P

Phosphodiesterase type 5 (PDE5) inhibitors are recommended for patients with erectile dysfunction by American Urological Association and European Association Urology guidelines. However, recent researches have shown that PDE5 inhibitors may lead to increased melanoma risk. Thus, we aimed to explore whether PDE5 inhibitors are associated with increased melanoma risk based on published literatures.We conducted a systematic online search on PubMed, EMBASE, Cochrane Library, Chinese Biochemical Literature, China National Knowledge Infrastructure, and Chinese Science and Technology Periodical databases to identify the related studies. Odds ratios (ORs), risk ratios, and hazard ratios with 95% confidence intervals (CIs) were extracted and calculated to assess the strength of associations between PDE5 inhibitors and melanoma risk. We also extracted the basal cell carcinoma (BCC) to validate the association in this study.We included 5 studies containing 100,932 participants in our systematic review and meta-analysis. The calculated results suggested positive results of PDE5 inhibitors on melanoma risk (OR: 1.13; 95%CI: 1.04-1.23). For localized and nonlocalized melanoma, the results were different (OR: 1.22; 95%CI: 1.04-1.43 for localized melanoma) (OR: 0.62; 95%CI: 0.39-0.98 for nonlocalized melanoma). It also showed that PDE5 inhibitors were associated with increased BCC risk (OR: 1.18; 95%CI: 1.11-1.27).The association between PDE5 inhibitors and melanoma might not be causal due to potential bias (patient selection, and so on) and limitations.

Intraductal carcinoma of prostate (IDC-P) is always underestimated pathological pattern in prostate cancer and its role is still unclear in castration resistant prostate cancer (CRPC). This study was conducted to investigate the presence and the roles of IDC-P in patients with metastatic CRPC.45 patients with initially diagnosed metastatic prostate cancer and then progressed to CRPC, were included. All of them were received twice transperineal biopsies at the time of initial diagnosis and the time of CRPC. All samples were retrieved to detect the presence of IDC-P. PSA doubling time (PSADT) was considered as a parameter presenting the progression of CRPC. The relationships between IDC-P and other clinicopathological variables were analyzed.IDC-P was found only in 20% (9/45) cases at initial diagnosis, whereas, it increased to 62.5% (28/45) at the time of CRPC (χ(2) = 16.568, P = 0.000). Compared to acinar adenocarcinoma components in tumor tissues, IDC-P components, especially solid subtype, had obviously poor/no response to androgen deprivation therapy (ADT). In addition, among patients treated with docetaxel-based chemotherapy (n = 24), patients with IDC-P also showed more unfavorable response than those without IDC-P (20% vs. 66.7%, P = 0.022). The presence of IDC-P and serum testosterone at the time of CRPC, were significantly associated with rapid disease progression. 13/28 (46.4%) CRPC with IDC-P had PSADT less than 30 days, while, only 1/17 (5.9%) patient without IDC-P had a less than 30 days PSADT (χ(2) = 8.114, P = 0.004). Limitations included the relative short follow-up time and a relative small cohort.The presence of IDC-P was significantly associated with rapid progression of CRPC. And its presence could suggest the poor response to initial ADT and sequential docetaxel-based chemotherapy. Detection of IDC-P should be of importance in CRPC, and re-biopsy at the time of CRPC might be one of practical solutions. The mechanism of the ADT and docetaxel resistance to IDC-P needed to be further investigated.

The purpose of the study was to evaluate the association between shock wave lithotripsy (SWL) for urinary stone and new-onset diabetes mellitus (DM). A comprehensive data collection was performed in the Pubmed database, Embase database, Chinese Biomedical database, Chinese National Knowledge Infrastructure database and VIP database. Difference in incidence of new-onset DM after SWL between cases and controls was evaluated by odds ratio (OR) with its 95 % confidence interval (CI). And summary adjusted risk ratios (RRs) and 95 % CIs were calculated to assess the strength of association between SWL and new-onset DM, and then subgroup analyses were conducted. Five studies were included in this meta-analysis. The incidence of new-onset DM after SWL is not higher than that in the population who do not receive SWL [OR = 1.59, 95 % CI (0.92, 2.74), P = 0.10]. And statistical association between SWL and new-onset DM could not be found significantly [RR = 1.33, 95 % CI (0.83, 2.13), P = 0.24], either. However, body mass index (BMI) [RR = 1.09, 95 % CI (1.04, 1.14), P < 0.001] and family history of DM (FHx DM) [RR = 0.35, 95 % CI (0.15, 0.80), P = 0.013] were found significantly associated with the development of DM in subgroup analyses. Our data suggests that there is no association between SWL for urinary stone and new-onset DM.

Intraductal carcinoma of prostate (IDC-P) was usually found to be co-exist with conventional aggressive prostate adenocarcinoma. The presence of IDC-P was considered as an adverse pathological factor, which was associated with high Gleason score, large prostate volume and accelerated disease progression. However, no any information is available on the presence of IDC-P diagnosed by needle biopsy in patients with metastatic prostate cancer. We investigated the incidence and prognostic value of intraductal carcinoma of prostate (IDC-P) in initial diagnosed metastatic prostate cancer.We included 278 patients with initial diagnosed metastatic prostate cancer treated between 2008 and 2011, all the pathological diagnosis were from ultrasonic-guided transperineal needle biopsy. IDC-P was strictly defined according to Epstein's criteria. Analyzed factors included age, Eastern Cooperative Oncology Group (ECOG) score, clinical T staging, Gleason scores, baseline prostate specific antigen (PSA), alkaline phosphatase (ALP), hemoglobin (HGB), PSA normalization, and the presence of IDC-P.Totally, IDC-P was found in 57/278 (20.5%) cases. Univariate analysis showed that, compared with cases without IDC-P, cases with IDC-P was definitely associated with much shorter CRPC-free survival (CFS) time (46.05 ± 1.39 vs. 22.98 ± 1.80 months, P = 0.000) and OS time (50.38 ± 1.18 vs. 36.43 ± 2.10 months, P = 0.000). Multivariate analysis showed that the presence of IDC-P was the only independent prognostic factor associated with poor CFS (HR = 4.886, P = 0.011) and OS (HR = 1.945, P = 0.020). Further sub-analysis showed, even among patients with higher Gleason score (≥8) (n = 158), IDC-P was still significantly and inversely associated with CFS and OS (the median CFS time: 40 versus 22 months; P = 0.000; the median OS time: 54 vs. 36 months, P = 0.000). Again, Cox's regression model confirmed that only the presence of IDC-P was still not only an independent prognostic factor predicting shorter time of CRPC (HR = 4.031, P = 0.035), but also for poorer OS (HR = 2.499, P = 0.006).The presence of IDC-P in initial diagnosed metastatic prostate cancer, even among patients with more aggressive pattern, was firstly found to be significantly and independently associated with earlier occurrence of CRPC and poorer OS. We recommended the presence of IDC-P should be a routine record in pathological report of clinical diagnosis and other potential therapeutic regimen might be added to intervene in the integrated therapy as early as possible. Prostate 75:225-232, 2015. © 2014 Wiley Periodicals, Inc.

microRNAs (miRNA) silence target genes through Watson-Crick based binding to the 3'untranslated regions (3'UTR). Thus, polymorphisms in the miRNA-binding sites may disrupt this process and play a potential role in cancer pathogenesis. Integrins have been implicated in the genesis and development of many tumors. This study was designed to evaluate the association between five SNP loci in predicted miRNA-binding sites in five integrin genes and prostate cancer occurrence and prognosis to provide data for screening high-risk Chinese Han individuals. These five polymorphisms were genotyped by using the high-resolution melting method (HRM) in 347 Chinese Han prostate cancer patients with long-time follow-up together with 367 age-matched healthy controls. GC carriers of rs11902171 in ITGAv were associated with a decreased risk of prostate cancer (OR 0.57, 95% CI 0.35-0.93). However, no significant difference was detected in genotype distributions of the five SNP loci in the progression-free survival time of prostate cancer. The ITGAv gene SNP rs11902171 may be potentially associated with the risk of prostate cancer.

The aim of this study was to evaluate the necessity for stenting after ureteroscopic lithotripsy. We performed a systematic research of Medline, Embase, Cochrane central registration for RCTs concerning the comparison between stented and non-stented post-ureteroscopic procedures for stone removal and reference lists of the included study were also screened. 15 trials were included and data related was extracted and analyzed in meta way. No difference was detected in stone free rate and stricture formation between the two groups (P = 0.69; P = 0.67). Participants with stents had higher risk of being infected than those without, RR = 1.72, but with no difference. Stent related lower urinary symptoms were more frequently experienced by stented patients, dysuria (RR = 5.24, P = 0.003); hematuria (RR = 7.28, P = 0.001); loin voiding pain (RR = 5.24, P = 0.003). Postoperative pain score were also higher in patients with stent in the early period after surgery with mean difference 0.95 (P = 0.002). With additional time needed for the placement of stent, the operative time in stented patients were 3.36 min longer than those without stenting (P = 0.02). The additional cost for longer operative room stay, together with the sent and cystoscopic stent removed conditionally, and made the cost for stented patients much higher. No difference were detected in length of hospital stay between both groups (P = 0.22), the stented patients were even of lower rate pay unplanned hospital visit (RR = 0.81, P = 0.55). Stenting did not improve the outcome of patients who underwent ureteroscopic lithotripsy, but associated with increased complication rate. Routinely stenting after ureteroscopic procedure for stone removal was not necessary; however, it still should be reserved conditionally.

The use of antibiotic prophylaxis in hernia repair is still under debate. The aim of this meta-analysis was to assess the effect of antibiotic prophylaxis in patients undergoing open mesh repair of inguinal hernia with respect to incidence of postoperative surgical site infection (SSI). A literature search was conducted in databases of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials. Study selection, data extraction, quality assessment, and meta-analysis were conducted according to the recommendations by Cochrane collaboration. Nine randomized controlled trials were included. Incidence of surgical site infection was 39/1642 (2.38%) in the antibiotic group and 70/1676 (4.18%) in the control group. Antibiotics showed a protective effect in preventing SSI after mesh inguinal hernia repair (odds ratio: 0.61, 95% confidence interval: 0.40–0.92, I2: 0%). Antibiotic prophylaxis did reduce the incidence of SSI in hernia patients undergoing mesh hernioplasty. The cost effectiveness of antibiotic prophylaxis needs further evaluation.