RESUMEN
BACKGROUND: Male infertility is a prevalent and worldwide problem with various difficulties in treatment. Clomiphene citrate is a selective estrogen receptor modulator and may improve semen quality by stimulating hormone synthesis and spermatogenesis. There is lack of evidence on the efficacy of clomiphene citrate as therapy for male infertility. OBJECTIVES: Therefore, a systematic review and meta-analysis was performed to assess the efficacy of clomiphene citrate on sperm quality in infertile men. METHODS: A search was conducted in the PubMed, EMBASE and Cochrane databases for effectiveness in infertile males treated with clomiphene citrate. Both intervention and observational studies were included. Primary outcome measures were semen parameters (concentration, motility and morphology). Secondary outcomes included hormonal evaluation, pregnancy rate and side effects. Studies were included for meta-analysis if they provided absolute numbers for outcomes before and during treatment with appropriate SD or SE. RESULTS: Total 1799 studies were identified during the search, 18 studies remained for qualitative analysis (n = 731) and 15 studies for meta-analysis (n = 566). Study populations ranged between 11 and 140 participants. Sperm concentration was higher during treatment, with a mean difference 8.38 × 106 /ml (95% confidence interval: 5.17-11.59; p < 0.00001; I2 = 87%). Total sperm motility was higher during treatment, with a mean difference of 8.14% (95% confidence interval: 3.83-12.45; p < 0.00001; I2 = 76%). There was no difference in sperm morphology before and during treatment. Total testosterone, follicle-stimulating hormone, luteinizing hormone and estradiol were higher during clomiphene citrate treatment. During follow-up, no serious adverse effects occurred. In 10 studies, pregnancy rate was reported and yielded a mean of 17% during clomiphene citrate treatment (range: 0%-40%). CONCLUSIONS: Clomiphene citrate increased sperm concentration and motility and could be considered as a safe therapy for improving sperm parameters in infertile males.
Asunto(s)
Infertilidad Masculina , Análisis de Semen , Embarazo , Femenino , Masculino , Humanos , Motilidad Espermática , Semen , Clomifeno/efectos adversos , Infertilidad Masculina/tratamiento farmacológico , Infertilidad Masculina/inducido químicamente , Testosterona/uso terapéuticoRESUMEN
PURPOSE: The aim of this study was to demonstrate features predictive of treatment response for patient-tailored overactive bladder (OAB) intervention with an implantable tibial neurostimulator using patient and technical prediction factors. MATERIALS AND METHODS: This study was designed as a follow-up study based on parameter settings and patients' preferences during the pilot and extended study of the implantable tibial nerve stimulator (RENOVA™ iStim system). For this study, we compared all treatment parameters (stimulation amplitude, frequency, and pulse width) and usage data (duration of treatment) during the different follow-up visits. RESULTS: We obtained usage data from a total of 32 patients who were implanted with the system between February and September 2015. Age, sex, body mass index (BMI) and previous experience with percutaneous tibial nerve stimulation (PTNS) treatment were considered as possible prediction factors for treatment success. However, only BMI was considered a statistically significant prediction factor (p = 0.042). A statistically significant increase in mean treatment level was seen in the responder group during the 3 month follow-up visit (mean: 6.7 mA, SD 0.416) as compared with the initial system activation visit (mean: 5.8 mA, SD 0.400) (p = 0.049). No other visits demonstrated statistically significant changes in both groups (responders and nonresponders) during the defined timepoints. CONCLUSION: This data underscores the need to use patient-tailored OAB treatment. BMI was found to be a negative predictive factor for treatment success. However, it was not possible to develop a specific responder model. A model predicting response to treatment could be useful for implementing shared decision making.
Asunto(s)
Estimulación Eléctrica Transcutánea del Nervio , Vejiga Urinaria Hiperactiva , Estudios de Seguimiento , Humanos , Prioridad del Paciente , Nervio Tibial , Resultado del Tratamiento , Vejiga Urinaria Hiperactiva/terapiaRESUMEN
BACKGROUND: Overactive bladder is a chronic condition affecting lower urinary tract function that has a significant negative impact on QoL. OBJECTIVE: Evaluation of the BlueWind implantable tibial nerve system performance and safety in refractory OAB. DESIGN, SETTING, AND PARTICIPANTS INTERVENTION: A 6-month multi-center prospective intervention study. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Objective assessment was done by voiding diary parameters including voids/day, volume voided/day, urgency assessment, leaking episodes/day, pads used/day, leak severity, and clinical success defined as a ≥50% reduction in the number of leaks/day or number of voids/day or number of episodes with degree of urgency >2 or a return to <8 voids/day on a 3 Day diary. Subjective assessment was based on OAB-q including HRQL and symptom severity score. Safety was evaluated by adverse event (AE) analysis. RESULTS AND LIMITATIONS: Thirty-four of the 36 implanted subjects completed the study. One subject withdrew voluntarily and one developed inflammation necessitating removal of the system. In the remaining subjects, 71% experienced clinical success at 6 months. Leaks/day, leak severity, and pad changes/day decreased significantly over time with 27.6% of urge incontinence subjects that became "dry." Voids/day, degree of urgency, volume/void, pads changed improved significantly. All quality of life aspects (concern, coping, sleep, and social) improved as well as symptom severity scores measured by the OAB-q. Adverse events included: implant site pain (13.9%), suspected infection (22.2%), and procedural wound complications (8.3%). CONCLUSIONS: The BlueWind implantable tibial nerve stimulator is a safe, minimally invasive system that affords OAB patients significant improvements. PATIENT SUMMARY: The performance and safety of the BlueWind RENOVA™ implantable tibial nerve neuromodulator for OAB was tested. Our preliminary results demonstrate that the system has a low risk safety profile and may be considered an effective treatment option for OAB management.
Asunto(s)
Terapia por Estimulación Eléctrica/instrumentación , Neuroestimuladores Implantables , Calidad de Vida , Nervio Tibial/fisiopatología , Vejiga Urinaria Hiperactiva/terapia , Incontinencia Urinaria de Urgencia/terapia , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Vejiga Urinaria Hiperactiva/fisiopatología , Incontinencia Urinaria de Urgencia/fisiopatología , Micción/fisiologíaRESUMEN
AIM: Over the past few years, we have been doing an increasing number of revisions for artificial urinary sphincters (AUS) at our center. The study aims to investigate reason for this change in our practice. METHODS: Demographics and surgical outcomes of patients who received AUS in 2003-2014 at our center were retrospectively evaluated, and patients were contacted to check the current status of their AUS. The outcomes of the study were: percentage of revisions and explanation, survival, and the risk factors associated with these events. RESULTS: A total of 102 patients (72 years (30-87)) underwent 214 procedures: 99 primary implants, 11 secondary implants, 84 revisions, and 20 explantations-median follow-up was 54 months (5-146). The 5-years and 10-years revision-free survival for AUS were 47% and 23%, respectively. The 5 and 10 years explantation-free survival were 77% and 72%, respectively. The median time to revision for AUS implanted in 2010-2014 was shorter than in AUS implanted in 2003-2009 (6 vs. 13.5 months, P = 0.08). The percentage of AUS that were preceded by urethral surgery for incontinence was significantly higher in AUS implanted in 2010-2014 than in those implanted in 2003-2009 (19% vs. 63%, P = 0.001). The percentage of patients with AUS who received radiotherapy in the past 5 years was higher than in 2003-2009 (53% vs. 30%, P = 0.09). CONCLUSIONS: In modern urological practice, more exposure to RT and previous surgeries for incontinence are associated with increased risk for revision with decline in AUS survival.