Transperitoneal Versus Extraperitoneal Laparoscopic Radical Prostatectomy For Patients With Localized Prostate Cancer:A Meta-Analysis And Metabolic Syndrome And Risk Of Erectile Dysfunction:A Meta-Analysis

Chapter one:transperitoneal versus extraperitoneal laparoscopic radicalprostatectomy for patients with localized prostate cancer:a meta analysisBackground:Laparoscopic radical prostatectomy (LRP) is currently employed by an increasing number of institutions for the management of localized prostate cancer. Preliminary data published so far suggest that laparoscopic radical prostatectomy has the same outcome as the open procedure in terms of continence and cancer control. Laparoscopic radical prostatectomy can be performed by either a transperitoneal approach, dissecting seminal vesicles at the beginning of the intervention, or by a completely extraperitoneal approach. The extraperitoneal approach is similar to the retropubic open intervention, which is familiar to all urologists. It also avoids the complications related to entering the peritoneal cavity It has already been shown by several authors that, regarding results, transperitoneal laparoscopic radical prostatectomy is comparable to the retropubic procedure. we decided to evaluate the effectiveness and safety of transperitoneal laparoscopic radical prostatectomy(TLRP) and extraperitoneal laparoscopic radical prostatectomy (ELRP) in the treatment of localized prostate cancer. Methods:We searched Medline, Cochrane Library, Chinese Journal Full-text Database, wanfang and CBM, extracted comparable data from eligible studies and performed for meta-analysis to evaluate the primary outcomes using Stata12.0.Results:Nine clinical controlled trials were included in this analysis. These studies included a total of942patients:492treated with TLRP and450treated with ELRP. Meta-analysis showed that,the differences in operative time [SMD=0.60,95%CI (-0.06,1.26)], operative blood loss [SMD=0.01,95%CI(-0.35,0.36)], catheterization time [SMD=0.10,95%CI(-0.21,0.40)] and hospital stay [SMD=0.45,95%CI (-0.01,0.91)] were not statistically significant between the TLRP and ELRP. but in the ELRP group,intestinal function recovery time [SMD=1.18,95%CI(0.26,2.10)] was significantly shorter than in the TLRP group.Conclusion:our results suggest that,for the treatment of localized prostate cancer,ELRP is similar to TLRP with respect to operative time,operative blood loss,catheterization time,and hospital stay,but shorter intestinal function recovery time.However,more high-quality randomized controlled trials (RCTs) with larger sample sizes and extended follow-ups should be required to analysis.Chapter two: Metabolic Syndrome and Risk of Erectile Dysfunction: A Meta-AnalysisBackground:Erectile dysfunction (ED) is a kind of common disease of Andrology, the increase of age and basic diseases increased significantly higher risk of ED. Although ED is not life threatening, it can result in withdrawal from sexual intimacy, impairing the quality of life of both the patient with ED and his partner decreased working productivity and increased healthcare use. The etiology of ED is often multifactorial, with lifestyle, neurologic, hormonal, vascular, and psychological factors playing a role. Studies have suggested an association of ED with a number of risk factors, including age, education level, obesity, hypertension, unfavorable lipid levels, alcohol abuse, cigarette smoking, physical activity.Metabolic syndrome (MS) is a cluster of abnormal metabolic conditions that increases the risk of cardiovascular disease and type2diabetes mellitus. Typically, it includes abdominal obesity, dyslipidemia, hyperglycemia, and elevated blood pressure. Epidemiologic studies have demonstrated that the prevalence of MS has dramatically increased worldwide. In particular, in China, the prevalence of MS has increased dramatically owing to alterations in lifestyle and dietary habits in recent decades.The association between MS and ED has gained substantial attention during the previous few years, MS is associated with a twofold increase of5-to10-year risk of cardiovascular disease (CVD). The relationship between MS and CVD has been established as well as the relationship between CVD and ED. however, few studies has investigated the association between MS and ED. Additionally, evidence is limited because majority of these studies are case-control studies or cross-sectional studies. During the previous few years, some cohort studies in different countries and populations that demonstrated the association between MS and ED had been published. But whether MS is an independent risk factor or merely a silent marker of ED remain unclear. With accumulating evidence worldwide, we therefore performed a meta-analysis of studies that evaluated the association between MS and ED.Methods:The PubMed, Embase, and Cochrane Library were searched to identify relevant studies eligible for the meta-analysis before August1,2013. The following search terms were used:"metabolic syndrome","erectile dysfunction""sexual dysfunction" and "impotence", and reference lists of selected articles were also manually examined to find relevant studies not discovered in the databases. If more than one article were published using the same data or the same author, the article with largest sample size only was included. this search strategy was performed iteratively until no new relevant article was found. The language was limited to English.The following information was extracted independently by two investigators (liu luhao and zhang tao),and any disagreements were resolved through discussion to come to a consensus:(1) name of the first author;(2) year of publication;(3) country of origin;(4) age of study population;(5) number of participants;(6) MS criteria;(7) definition or measurement. The association of MS and ED was estimated by calculating pooled RR and95%CI. The significance of pooled RR was determined by Z test (P<0.05was considered statistically significant). Homogeneity was tested by the Q statistic (significance level at P<0.10) and the I2statistic (significance level at I2>50%). The combined risk estimates were computed using either fixed-effects models or random-effects models in the presence of heterogeneity. We conducted subgroup analyses to explore heterogeneity, across studies and the difference between subgroups was tested by meta-regression analysis. Potential publication bias was assessed by visual inspection of the Begg’s funnel plots in which the log RRs were plotted against their SEs. We also performed the Begg’s and Egger’s tests to evaluate the presence of publication bias11,12. All analyses were performed using STATA12.0(Stata Corporation, College Station,TX, USA).Results:A total of10studies involving4092participants were included in the meta-analysis. MS was associated with an increased incidence of ED (RR=1.60,95%CI=1.27-2.02, p<0.001), with significant evidence of heterogeneity among these studies (p for heterogeneity <0.001,I2=92.9%). The subgroup and sensitivity analysis confirmed the stability of the results and no publication bias was detected. The present meta-analysis suggests that MS is significantly associated with risk of ED. Large-scale and well-design prospective studies are required to further investigate the association between MS and risk of ED.Conclusion:To the best of our knowledge, the present study represents the first meta-analysis quantitatively the association between MS and risk of ED. Our study included two perspective cohort studies, five case-control studies and four cross-sectional study involving4434participants. The present meta-analysis suggests that MS is significantly associated with risk of ED. Large-scale and well-design prospective studies are required to further investigate the association between MS and risk of ED.