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PURPOSE: To determine the effectiveness and harms of bladder-preserving trimodal therapy (TMT) as a first-line treatment versus radical cystectomy (RC) plus radical pelvic lymphadenectomy in the treatment of muscle-invasive bladder cancer in terms of overall survival. METHODS: We included parallel clinical trials and prospective and retrospective cohort studies that included patients older than 18 years old, diagnosed with muscle-invasive bladder cancer, who underwent TMT compared with RC. The planned comparison was TMT versus RC plus pelvic lymphadenectomy as first-line treatment. The primary outcome was overall survival (OS) and secondary outcomes were salvage cystectomy and cancer-specific survival and progression-free survival. A search strategy was designed for MEDLINE, CENTRAL, Embase, and LILACS. We saturated information with conference abstracts, in progress clinical trials, literature published in non-indexed journals, and other sources of gray literature. Standardized tools assessed the risk of bias independently. We performed the statistical analysis in R v3.4.1 and effect sizes were reported in terms of hazard ratios (HR) and the corresponding 95% confidence intervals (95%CI). Accordingly, we used a random effect model due to the statistical heterogeneity found in included studies. RESULTS: We found 2682 records with the search strategies and, finally, 11 studies were included in the quantitative analysis. The summary HR for OS was 1.06 95%CI (0.85-1.31) I2 = 77%, showing no statistical difference. Regarding cancer-specific survival, the summary HR was 1.23 95%CI (1.04-1.46) I2 = 14%. On the other side, for the progression-free survival, the summary HR was 1.11 95%CI (0.63-1.95) I2 = 78%. Only one study described HR for adverse events (1.37 95%CI 1.16-1.59). CONCLUSION: We found no differences in overall survival and progression-free survival between these two interventions. Nonetheless, we found that cancer-specific survival favored patients who received radical cystectomy.

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Objective. To determine the global incidence of penile cancer. Methods. A systematic review and meta-analysis of observational studies was performed, with no limits on their language of publication. Analyses were performed using Stata 13 statistical software. A random-effects model was used, according to the heterogeneity found in the studies. The main outcome was expressed in terms of age-standardized incidence. Results. A total of 23 studies were eligible, with 71 156 penile cancer patients in 86 countries. According to the review conducted, the estimated age-standardized incidence of penile cancer worldwide is 0.84 cases per 100 000 person-years (95% confidence interval: 0.79–0.89). Romania reported the highest incidence, 7.26 per 100 000 person-years, between 1983 and 1987; however, some countries in Latin America and Africa reported an incidence of between 2.0 and 5.7 per 100 000. Conclusions. Penile cancer is considered a rare malignancy due to its already-known, particularly low incidence rate. The estimated age-standardized incidence rate by the world standard population today is 0.84 cases per 100 000 person-years. There were no significant differences in the incidence rate of penile cancer with respect to the distribution by continent or the trend over time.

Objetivo. Determinar la incidencia mundial del cáncer de pene. Métodos. Se realizó una revisión sistemática y un metanálisis de estudios de observación, sin ninguna limitación por el idioma de publicación. Para los análisis se usó el software estadístico Stata 13. Se usó un modelo de efectos aleatorios, conforme a la heterogeneidad encontrada en los estudios. El resultado principal se expresó en términos de incidencia ajustada por la edad. Resultados. En total, 23 estudios (con una población total de 71 156 pacientes con cáncer de pene en 86 países) cumplieron con los criterios establecidos. Según esta revisión, se estima que la incidencia ajustada por la edad del cáncer de pene a escala mundial es de 0,84 casos por 100 000 años-persona (intervalo de confianza de 95%: 0,79–0,89). Rumania notificó la incidencia más alta, de 7,26 por 100 000 años-persona, entre 1983 y 1987; sin embargo, algunos países de América Latina y África notificaron una incidencia de entre 2,0 y 5,7 por 100 000. Conclusiones. Se considera que el cáncer de pene es una neoplasia maligna rara debido a que la tasa de incidencia conocida es particularmente baja. Hoy en día, la tasa de incidencia ajustada por la edad estimada para la población estándar mundial es de 0,84 casos por 100 000 años-persona. No se observó ninguna diferencia significativa de la tasa de incidencia del cáncer de pene con respecto a la distribución por continente o la tendencia con el transcurso del tiempo.

Objetivo. Determinar a incidência mundial de câncer de pênis. Métodos. Um estudo de revisão sistemática e meta-análise de estudos observacionais foi conduzido, sem restrição do idioma da publicação. As análises foram realizadas com o uso do software de estatística Stata 13. Um modelo de efeitos aleatórios foi usado, segundo a heterogeneidade encontrada nos estudos. O desfecho principal foi expresso como taxa de incidência padronizada por idade. Resultados. Vinte e três estudos satisfizeram os critérios, englobando 71.156 pacientes com câncer de pênis em 86 países. De acordo com a revisão conduzida, a taxa de incidência padronizada por idade estimada para o câncer de pênis em todo o mundo é de 0,84 caso por 100.000 pessoas-ano (intervalo de confiança de 95% 0,79–0,89). A Romênia registrou a taxa de incidência mais elevada, 7,26 por 100.000 pessoas-ano, entre 1983 e 1987. Porém, alguns países da América Latina e África registraram taxas de incidência entre 2,0 e 5,7 por 100.000 pessoas-ano. Conclusões. O câncer de pênis é uma neoplasia maligna rara devido à sua conhecida taxa de incidência especialmente baixa. A atual taxa de incidência padronizada por idade estimada para a população mundial padrão é de 0,84 caso por 100.000 pessoas-ano. Não foi encontrada diferença significativa na taxa de incidência do câncer de pênis quanto à distribuição por continente ou tendência temporal.

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PURPOSE: To determine the efficacy of phosphodiesterase type 5 inhibitors (PDE5i) as medical expulsive therapy (MET) for the treatment of distal ureteral calculi. MATERIALS AND METHODS: A search strategy was conducted in the MEDLINE, CENTRAL, and Embase databases. Searches were also conducted in other databases and unpublished literature. Clinical trials were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration's tool. An analysis of random effects due to statistical heterogeneity was conducted. The primary outcome was the expulsion rate of the distal ureteral calculus in 28 days. The secondary outcomes were the time to expulsion, side effects of treatment, and amount (mg) of nonopioid analgesia. The measure of the effect was the risk difference (RD) with a 95% confidence interval (CI). The planned interventions were PDE5i vs. placebo, tadalafil vs. placebo, and tadalafil vs. tamsulosin. RESULTS: Four articles were included in the qualitative and quantitative analysis. Records of 580 patients were found among the four studies. A low risk of bias was shown for the majority of the study items. The calculi expulsion rate had an RD of 0.26 (95% CI, 0.15-0.37) and a less prolonged expulsion as a secondary outcome with a mean difference of -4.39 days (95% CI, -6.69 to -2.09) in favor of PDE5i compared with the placebo. No significant difference was found for these outcomes when comparing tadalafil with tamsulosin. CONCLUSIONS: Compared with a placebo, PDE5i could be effective as MET for the treatment of distal ureter calculi.

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OBJECTIVE: To determine the global incidence of penile cancer. METHODS: A systematic review and meta-analysis of observational studies was performed, with no limits on their language of publication. Analyses were performed using Stata 13 statistical software. A random-effects model was used, according to the heterogeneity found in the studies. The main outcome was expressed in terms of age-standardized incidence. RESULTS: A total of 23 studies were eligible, with 71 156 penile cancer patients in 86 countries. According to the review conducted, the estimated age-standardized incidence of penile cancer worldwide is 0.84 cases per 100 000 person-years (95% confidence interval: 0.79-0.89). Romania reported the highest incidence, 7.26 per 100 000 person-years, between 1983 and 1987; however, some countries in Latin America and Africa reported an incidence of between 2.0 and 5.7 per 100 000. CONCLUSIONS: Penile cancer is considered a rare malignancy due to its already-known, particularly low incidence rate. The estimated age-standardized incidence rate by the world standard population today is 0.84 cases per 100 000 person-years. There were no significant differences in the incidence rate of penile cancer with respect to the distribution by continent or the trend over time.