Francesco Esperto1, Wesley Verla2, Achilles Ploumidis3, Rachel Barratt4, Roberto La Rocca5, Nicolaas Lumen2, Yuhong Yuan6, Felix Campos-Juanatey7, Tamsin Greenwell4, Francisco Martins8, Nadir Osman9, Silke Riechardt10, Marjan Waterloos2, Konstantinos Dimitropoulos11. 1. Department of Urology, Campus Biomedico University of Rome, Via Álvaro Del Portillo, 200 00128, Rome, Italy. francescoesperto@gmail.com. 2. Division of Urology, Gent University Hospital, Gent, Belgium. 3. Department of Urology, Athens Medical Centre, Athens, Greece. 4. Department of Urology, University College London Hospital, London, UK. 5. Department of Urology, University of Naples Federico II, Naples, Italy. 6. Department of Medicine, Health Science Centre, McMaster University, Hamilton, ON, Canada. 7. Urology Department, Marques de Valdecilla University Hospital, Santander, Spain. 8. Department of Urology, Santa Maria University Hospital, University of Lisbon, School of Medicine, Lisbon, Portugal. 9. Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK. 10. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 11. Department of Urology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK.
Abstract
PURPOSE: The benefits and harms of the available types of surgical management for lichen sclerosus-related (LS) strictures remain unclear and, thus, clear and robust clinical practice recommendations cannot be given. MATERIALS AND METHODS: To assess the role of single-stage OMGU in the management of LS strictures and explore how its benefits and harms compare with the alternative management options. Medline, Embase and Cochrane controlled trial databases (CENTRAL, CDSR) were systematically searched. Randomized (RCTs) and nonrandomized studies (NRCSs) comparing single-stage OMGU with other surgical management options for LS strictures and single-arm studies on single-stage OMGU were included. Risk of bias (RoB) was assessed. RESULTS: Of the 1912 abstracts identified, 15 studies (1 NRCS and 14 single-arm studies) were included, recruiting in total 649 patients. All studies were at high RoB. In the only NRCS available, stricture-free rate (SFR) for single-stage and staged OMGU was 88% vs 60%, respectively (p = 0.05), at a mean follow-up of 66.5 months. SFR range for single-stage OMGU in single-arm studies was 65-100% (mean/median follow-up, 12-59 months). Single-stage OMGU had low complication rates and beneficial impact on LUTS and QoL. CONCLUSIONS: The present SR highlights the methodological limitations of the available literature. In the absence of adverse local tissue conditions, and taking into consideration benefit-harm balance and surgeon's skills and expertise, single-stage OMGU can be justified in patients with LS strictures.
PURPOSE: The benefits and harms of the available types of surgical management for lichen sclerosus-related (LS) strictures remain unclear and, thus, clear and robust clinical practice recommendations cannot be given. MATERIALS AND METHODS: To assess the role of single-stage OMGU in the management of LS strictures and explore how its benefits and harms compare with the alternative management options. Medline, Embase and Cochrane controlled trial databases (CENTRAL, CDSR) were systematically searched. Randomized (RCTs) and nonrandomized studies (NRCSs) comparing single-stage OMGU with other surgical management options for LS strictures and single-arm studies on single-stage OMGU were included. Risk of bias (RoB) was assessed. RESULTS: Of the 1912 abstracts identified, 15 studies (1 NRCS and 14 single-arm studies) were included, recruiting in total 649 patients. All studies were at high RoB. In the only NRCS available, stricture-free rate (SFR) for single-stage and staged OMGU was 88% vs 60%, respectively (p = 0.05), at a mean follow-up of 66.5 months. SFR range for single-stage OMGU in single-arm studies was 65-100% (mean/median follow-up, 12-59 months). Single-stage OMGU had low complication rates and beneficial impact on LUTS and QoL. CONCLUSIONS: The present SR highlights the methodological limitations of the available literature. In the absence of adverse local tissue conditions, and taking into consideration benefit-harm balance and surgeon's skills and expertise, single-stage OMGU can be justified in patients with LS strictures.
Authors: Pierre A Clavien; Jeffrey Barkun; Michelle L de Oliveira; Jean Nicolas Vauthey; Daniel Dindo; Richard D Schulick; Eduardo de Santibañes; Juan Pekolj; Ksenija Slankamenac; Claudio Bassi; Rolf Graf; René Vonlanthen; Robert Padbury; John L Cameron; Masatoshi Makuuchi Journal: Ann Surg Date: 2009-08 Impact factor: 12.969
Authors: Susan S W Wong; Omar M Aboumarzouk; Radhakrishna Narahari; Anna O'Riordan; Robert Pickard Journal: Cochrane Database Syst Rev Date: 2012-12-12
Authors: Felix Campos-Juanatey; Ainara Azueta Etxebarria; Paola Calleja Hermosa; Sara Marcos Gonzalez; Eneko Alonso Mediavilla; Miguel Angel Correas Gomez; Jose Antonio Portillo Martin; Jose Luis Gutierrrez Baños Journal: J Clin Med Date: 2022-04-06 Impact factor: 4.241