BACKGROUNDOnabotulinumtoxinA is widely used in treating neurogenic detrusor overactivity (NDO). We carried out a systematic review and meta-analysis to assess the efficacy and safety of the drug for treating NDO.

METHODSWe searched the following databases: Medline, EMBASE, and the Cochrane Controlled Trials Register. All published randomized double-blind, placebo-controlled trials of onabotulinumtoxinA for the treatment of NDO were identified in the analysis. The reference lists of the retrieved studies were also investigated.

RESULTSFour publications involving a total of 807 patients were identified in the analysis, which compared onabotulinumtoxinA with placebo. The changes of the mean number of urinary incontinence per week (the standardized mean difference [SMD] = -10.91, 95% confidence intervals [CIs] = -14.18--7.63, P < 0.0001); maximum cystometric capacity (SMD = 146.09, 95% CI = 126.19-165.99, P < 0.0001) and maximum detrusor pressure (SMD = -32.65, 95% CI = -37.83--27.48, P < 0.0001) indicated that onabotulinumtoxinA was more effective than the placebo, despite the doses of onabotulinumtoxinA. Safety assessments primarily localized to the urinary tract indicated onabotulinumtoxinA were often associated with more complications. Urinary tract infections (relative risk [RR] =1.48, 95% CI = 1.20-1.81, P = 0.0002); hematuria (RR = 1.81, 95% CI = 1.00-3.24, P = 0.05) and urinary retention (RR = 5.87, 95% CI = 3.61-9.56, P < 0.0001).

CONCLUSIONSThis meta-analysis indicates that onabotulinumtoxinA to be an effective treatment for NDO with side effects primarily localized to urinary tract.

Botulinum Toxins, Type A ; adverse effects ; therapeutic use ; Humans ; Urinary Bladder, Overactive ; drug therapy

OBJECTIVETo compare the impacts of transurethral resection of the prostate (TURP), transurethral electrovaporization of the prostate (TUEVP) and holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) on male sexual function.

METHODSWe identified randomized controlled trials on the influence of TURP, TUEVP and HoLEP on the sexual function of BPH patients, and performed meta-analysis on the included data using Revman 5.0.25.

RESULTSNine randomized controlled trials involving 1 050 BPH patients were included in the meta-analysis. The baseline of the study was comparable. TURP affected erectile function less than TUEVP (P = 0.04), but the two had no significant difference in their influence on ejaculatory function. Nor was any significant difference found between HoLEP and TURP in their influence on either erectile or ejaculatory function at 12 and 24 months after surgery.

CONCLUSIONTUEVP induces a higher incidence of erectile dysfunction than TURP, but its influence on ejaculatory function is not significantly different from the latter. HoLEP and TURP have no significant difference in their influence on erectile function and ejaculatory function.

Erectile Dysfunction ; etiology ; Humans ; Male ; Prostatic Hyperplasia ; surgery ; Randomized Controlled Trials as Topic ; Transurethral Resection of Prostate ; adverse effects ; methods

Adult ; Clavicle ; injuries ; Female ; Fractures, Bone ; surgery ; Humans ; Male ; Scapula ; injuries ; Shoulder Joint ; surgery ; Young Adult