BACKGROUND:Non-mosaic 47,XXY (Klinefelter syndrome, KS) males rarely retain preserved spermatogenesis. Here, we describe a 43-year-old man with intact fertility (prior natural conception, normal semen parameters), challenging conventional phenotypic paradigms. OBJECTIVES:To report an exceptional non-mosaic 47,XXY case with preserved fertility and normozoospermia, redefining classic phenotyping norms. MATERIALS AND METHODS:We conducted an observational study of a couple (male, non-mosaic 47,XXY; female, normal karyotype) undergoing two PGT-A cycles. Data included semen analyses, reproductive system ultrasonography, endocrine profiles, and embryo genetic diagnostics. RESULTS:Two PGT-A cycles using fresh/thawed sperm yielded three blastocysts: two aneuploid blastocysts in the first cycle (3BC; 6BC) and one untested blastocyst in the second cycle (4BC). Due to cost constraints, the patient declined euploidy testing in the second cycle. A thawed embryo transfer (FET) was performed with the untested blastocyst, resulting in no pregnancy. CONCLUSION:This study presents a paradigm-shifting case of successful assisted reproduction in a couple where the male partner has non-mosaic KS with preserved fertility potential. Our findings challenge conventional assumptions about natural conception in KS patients and underscore the need for: (1) comprehensive evaluation of reproductive endocrine function, (2) molecular characterization of the testicular microenvironment, and (3) longitudinal assessment of fertility potential in atypical KS presentations.

The aim of this meta-analysis was to quantify the available data concerning sperm retrieval rate (SRR) subsequent to testicular sperm extraction (TESE) and the clinical pregnancy rate (CPR) and live birth rate (LBR) subsequent to TESE and intracytoplasmic sperm injection (ICSI) in patients with non-obstructive azoospermia with cryptorchidism treated by orchidopexy. Furthermore, the aim was to explore the potential predictors of SRR, CPR and LBR within this population. Extensive searches were conducted in PubMed, Embase, Cochrane and Web of Science databases, and 23 articles were included in the study, with 1496 patients. The overall SRR per TESE cycle in the total evaluated trials was 60.9% (55.7-66.2%). Factors such as age at TESE, age at orchidopexy, testicular volume, and FSH, LH and testosterone levels did not affect final SRR. Meta-analyses were conducted on 13 studies each for CPR and LBR, including 913 and 799 ICSI cycles, respectively. The overall CPR per ICSI cycle was 37.6% (29.1-46.1%), and the overall LBR per ICSI cycle was 32.6% (24.9-40.4%). Factors as mentioned above, and the age of women undergoing ICSI, did not affect CPR or LBR per ICSI cycle. Although this meta-analysis extensively investigated outcomes of TESE and potential predictors of SRR, CPR and LBR for patients with non-obstructive azoospermia with cryptorchidism treated by orchidopexy, no effective predictors of outcomes were identified.

BackgroundThe PWWP domain-containing proteins are involved in chromatin-associated biological processes, including transcriptional regulation and DNA repair, and most of them are significant for gametogenesis and early embryonic development in mammals. PWWP3A, one of the PWWP domain proteins, is a reader of H3K36me2/H3K36me3 and a response factor to DNA damage. However, the physiological role of PWWP3A in spermatogenesis and fertility remains unclear.ObjectiveThe goal of this study was to explore the function and mechanism of PWWP3A in the process of spermatogenesis.Materials and methodsWe generated V5-Pwwp3a KI mice and PWWP3A polyclonal antibody to observe the localization of PWWP3A in vivo. Meanwhile, Pwwp3a KO mice was used to explore the function in spermatogenesis.ResultsWe reported that PWWP3A is a predominant expression in the testis of mice. During spermatogenesis, PWWP3A exhibits the temporal expression from early-pachytene to the round spermatids. The results of spermatocyte spreading and immunostaining showed that PWWP3A aggregated on the XY body, which then diffused as the XY chromosome separated at late-diplotene. Although the depletion of PWWP3A had no obvious reproductive defects in young male mice, there were observed morphological abnormalities in sperm heads. Immunoprecipitation demonstrated the interaction of PWWP3A with DNA repair proteins SMC5/6; however, PWWP3A deficiency did not result in any meiotic defects. Notably, the testes of aged male Pwwp3a KO mice displayed pronounced degeneration, and were characterized by the presence of vacuolated seminiferous tubules. Furthermore, RNA-seq analysis revealed an upregulation in the expression of genes which may be involving in immunoregulatory and inflammatory response pathways in aged Pwwp3a KO mice with testicular degeneration.ConclusionsOur study showed that PWWP3A was highly enriched in the mouse testis, and the Pwwp3a KO mice were fertile. However, the aged Pwwp3a KO male mice displayed testicular atrophy that may be due to changes in the immune micro-environment or abnormal repair of DNA damage.

Berberine (BBR) is used to treat diarrhea clinically, its reproductive toxicity, however, is poorly documented. This study aims to investigate the impact of BBR on the male reproductive system. Gradient doses of BBR were administered orally to experimental mice for consecutive 14 days. The gut microbiota, sperm concentration of cauda epididymis, and serum testosterone levels were measured after the last dose for assessing the effects of BBR. Moreover, the metabolome and transcriptome of the mice and microbiota were also investigated. Intragastric BBR administration resulted in a significant decrease in serum testosterone levels and epididymal sperm concentration in mice, which was attributed to a dramatic decrease of Muribaculaceae abundance in the gut microbiota of mice. Both fecal microbiota transplantation (FMT) and polyethylene glycol (PEG) treatment experiments also demonstrated that Muribaculaceae is necessary for spermatogenesis. Metabolomic analysis revealed that BBR affected the arginine and proline metabolism pathways, of which ornithine levels were downregulated after BBR administration. Intragastric administration of M.intestinale and its metabolite ornithine to BBR-treated mice achieved a recovery of sperm concentration and testosterone levels. RNA sequencing of testes showed the genes related to the LDLR-mediated cholesterol-synthesis testosterone pathway were downregulated after BBR administration. The levels of testosterone increased and Ldlr gene became more transcriptionally active in TM3 cells cultured in media supplemented with ornithine. This study for the first time revealed an association between BBR-induced gut Muribaculaceae dysbiosis and defects in spermatogenesis via ornithine metabolism, which provided a candidate and strategy for the treatment of infertility caused by a decreased serum testosterone level-induced by gut microbiota dysbiosis.

Background: This paper reports two cases of anatomic urethroplasty (AU) using everted saphenous vein graft (eSVG) with long penile urethral strictures. The preliminary feasibility and safety of the operation are also analyzed. Methods: Two men with penile urethral strictures (5.5 cm and 5.0 cm) were treated with AU using eSVG. The highlight of this novel surgical technique was the anatomical repair of the layer of the narrowed urethral wall without affecting the continuity of the layer of corpus spongiosum. Moreover, the pre- and postoperative Urodynamics and Night Penis Tumescence and Rigidity test results were compared. Results: Complications, such as hematoma, urinary fistula, or urethral strictures, were not observed at 2 weeks postoperatively. At 6 months postoperatively, the urination status and urodynamic indexes of the patients had significantly improved compared with that preoperatively. There was no significant change in erection function before and after the operation. Conclusions: Repairing long penile urethral strictures with AU using eSVG is safe and feasible and can be used as an alternative treatment method.

BACKGROUND:Augmentative phalloplasty is a controversial issue. A safe, stable, and efficient surgical method for penile girth enlargement has not been available. This article introduces a novel autologous scrotal flap-turning procedure, the scrotal dartos flap method, for men with small penis syndrome and addresses its efficacy and safety.METHODS:A single-center, prospective study was conducted at the Zhongnan Hospital of Wuhan University, where 29 patients were treated with the scrotal dartos flap method. The key procedure for this technique is fully turning the scrotal dartos flap to the loose plane just between the superficial penile fascia and the Buck fascia to increase the circumference of the penis. Penile girth improvement and adverse events were recorded.RESULTS:Complete follow-up data were collected for 27 of 29 patients (93.1 percent). It yielded a girth improvement of 3.59 ± 0.80 cm (50.8 percent). This enlargement surpassed that of most previous published surgical procedures. In addition, there were no serious adverse events (e.g., penile fibrosis, flap infection, sclerosis, or removal) during the 6-month follow-up. Wound infection ( n = 1), hematoma ( n = 2), and folding ( n = 1) were all slight.CONCLUSIONS:This novel autologous flap-turning procedure performed better than the majority of previously published penile girth enlargement methods and was accompanied by only slight and acceptable adverse events. The scrotal dartos flap method appears to be a viable method for the penile girth enlargement treatment of small penis syndrome.CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, IV.

目的 探讨术中放置可吸收医用膜对精索静脉曲张术后疼痛等并发症的影响.方法 选取2016年1月至2019年1月武汉大学中南医院收治的138例精索静脉曲张患者作为研究对象,对其临床资料进行回顾性分析.根据术中是否应用可吸收医用膜覆盖精索动脉及精索分为研究组(应用,n=86)和对照组(未应用,n=52).观察并比较两组术后疼痛、阴囊水肿、复发及精液质量.结果 术后1个月,两组疼痛评分、疼痛情况比较,差异具有统计学意义(P<0.05).两组术后阴囊水肿发生率、复发率及术后3个月精液质量比较,差异无统计学意义(P>0.05).结论 在精索静脉曲张患者术中使用可吸收医用膜,可减轻术后1个月的阴囊疼痛程度,但对术后阴囊水肿、复发和精液质量无影响.

BACKGROUND With continuous advancement of industrial society, environmental pollution has become more and more serious. There has been an increase in infertility caused by environmental factors. Nonylphenol (NP) is a stable degradation product widely used in daily life and production and has been proven to affect male fertility. However, the underlying mechanisms therein are unclear. Thus, it is necessary to study the effect and mechanism of NP on spermatogonial stem cells (SSCs). AIM To investigate the cytotoxic effect of NP on SSCs via the phosphatidylinositol-3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/AKT/mTOR) pathway. METHODS SSCs were treated with NP at 0, 10, 20 or 30 µmol. MTT assay was performed to evaluate the effect of NP on the proliferation of SSCs. Flow cytometry was conducted to measure SSC apoptosis. The expression of Bad, Bcl-2, cytochrome-c, pro-Caspase 9, SOX-2, OCT-4, Nanog, Nanos3, Stra8, Scp3, GFRα1, CD90, VASA, Nanos2, KIT, PLZF and PI3K/AKT/mTOR-related proteins was observed by western blot, and the mRNA expression of SOX-2, OCT-4 and Nanog was detected by quantitative reverse transcription polymerase chain reaction. RESULTS Compared with untreated cells (0 μmol NP), SSCs treated with NP at all concentrations showed a decrease in cell proliferation and expression of Bcl-2, Nanog, OCT-4, SOX-2, Nanos3, Stra8, Scp3, GFRα1, CD90, VASA, Nanos2, KIT, and PLZF (P < 0.05), whereas the expression of Bad, cytochrome-c, and pro-Caspase 9 increased significantly (P < 0.05). We further examined the PI3K/AKT/mTOR pathway and found that the phosphorylation of PI3K, AKT, mTORC1, and S6K was significantly decreased by NP at all concentrations compared to that in untreated SSCs (P < 0.05). NP exerted the greatest effect at 30 μmol among all NP concentrations. CONCLUSION NP attenuated the proliferation, differentiation and stemness maintenance of SSCs while promoting apoptosis and oxidative stress. The associated mechanism may be related to the PI3K/AKT/mTOR pathway.

Penile cancer represents a rare pathology whose natural history of treatment is poorly understood.

BACKGROUND:Tacrolimus was used as a rinse solution against ischaemia-reperfusion injury (IRI) in liver transplantation for years but its protective effects remain controversies. METHODS:We conducted literature retrieval in electronic databases including MEDLINE, EMBASE and Cochrane Central to identify relevant randomized controlled trials (RCTs) investigating the effects of tacrolimus as a rinse solution in liver transplantation. Postoperative liver function, including alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBIL), at postoperative day (POD) 1, 2 and 7 was extracted for pooled estimation. Forest plots were generated to calculate the differences between the groups. The I2 index statistic was used to assess heterogeneity. Publication bias was evaluated using funnel plots and Egger's test. RESULTS:Three RCTs including 70 liver transplants were evaluated in this study. Pooled estimation revealed that rinse with tacrolimus in liver transplantation did not provide hepatic protection with respect to postoperative ALT (Test Z = 1.36; P = .175), AST (Test Z = 1.70; P = .090) or TBIL (Test Z = 0.69; P = .490). Sensitivity analysis by excluding extended donor criteria (EDC) livers showed similar results. Funnel plots and Egger's test demonstrated that there was no substantial bias. CONCLUSION:We may tentatively conclude that tacrolimus is ineffective for amelioration of postoperative liver function as a rinse solution in liver transplantation. Nevertheless, there is great space for future research in this area, and the potential clinical value of tacrolimus needs to be further addressed. We are expecting more evidence to support our speculations.

INTRODUCTION:The buried penis, if not treated before adolescence, will lead to psychological and physical disorders in adulthood. Therefore, early surgical intervention is necessary. At present, the common surgical methods include the penile corpus fixation, the Johnson's operation, the Devine's method, the modified Devine's method, Shiraki's method, etc. However, we found that these traditional surgeries showed various postoperative complications, such as long-term prepuce edema, avascular necrosis of skin flaps, stenotic prepuce, scarring, and poor appearance. This video shows the main technical steps of our innovative surgical procedure "Six Stitch" (SS) method for the buried penis. MATERIALS AND METHODS:The designation of the so-called SS method was based on the total knots made (six knots were made for the SS procedure). After the crura penis was fully exposed via a longitudinal incision at the penoscrotal junction, at the 2 o'clock position (around the penis), the superficial layer of albuginea of the crura penis was sutured to the prepubic ligament with 2-0 non-absorbable sutures to prevent the retraction of the penis (the 1st knot). The same procedure was used for the 10 o'clock position (the 2nd knot); At the 2 o'clock position, the skin and subcutaneous tissue at the pubic mound were sutured to the prepubic ligament to reconstruct the appearance of dorsum penis (the 3rd knot). The same procedures were used for the 10 o'clock position (the 4th knot). At the 5 o'clock position, the ventral albuginea was sutured to the tunica dartos and subcutaneous tissue at the penoscrotal junction to reconstruct the penoscrotal angle (the 5th knot). The same procedures were used for the 4 o'clock position (the 6th knot). Finally, the gloved prepuce was reset and circumcision was conducted if the redundant prepuce existed. RESULTS:We have done a total of 64 cases of SS procedures for concealed penis; mean length improvement was 3.8 ± 0.5 cm, with a satisfying 95 percent (61 / 64), which was much longer than the outcome of the above-mentioned methods. Mean operative time was 62.3 ± 12.1 minutes, and there was no serious intraoperative or postoperative complication (only 2 presented scar hyperplasia at the incision site). CONCLUSIONS:In conclusion, after the SS procedure, patients with buried penis can acquire an almost 4 cm improvement of penile length and covert incision at the midline of the scrotum, with an acceptable and low incidence of adverse events. This safe and effective procedure may be a viable option for the surgical management of pediatric and adult buried penis.

目的 介绍中南医院泌尿外科开展的经阴囊入路反向脱套固定治疗隐匿性阴茎的术式,并评估其临床疗效和安全性.方法 回顾性分析中南医院泌尿外科2014年12月至2017年12月采用经阴囊入路隐匿性阴茎矫正术(以下简称“三针法”)治疗的48例隐匿性阴茎患者的临床资料,统计患者手术时间、出血量、术后恢复及并发症等方面数据.结果 所有患者均手术成功,平均住院时间(7.00±1.03)d;平均手术时间为(67.4±10.8)min;出血量(10.00±1.03)mL.术后随访半年,未发生严重并发症,仅1例复发;术后感染0例、狭窄2例、疤痕赘生7例;术后外形满意度高(93.7％).结论 经阴囊入路反向脱套法治疗隐匿性阴茎安全有效,并发症较低,值得进一步研究和推广.

目的 探讨宁泌泰胶囊对慢性前列腺炎伴男性不育症患者精液质量的影响.方法 选取男性不育症伴慢性前列腺炎患者63例,给予口服宁泌泰胶囊(4粒/次,3次/天)治疗4周,观察治疗前后,精浆弹性蛋白酶浓度的变化以及主要精液常规指标的变化,评价疗效.结果 本研究纳入患者63例,平均年龄为(31.4±0.9)岁,治疗后,受试者精浆弹性蛋白酶浓度显著降低由2035.80 ng/mL降为634.00 ng/mL(P＜0.05),前向运动精子比例显著性升高(P＜0.05),而精子密度无显著性变化.结论 宁泌泰胶囊能有效降低精浆弹性蛋白酶的浓度,提高前向运动精子的比例,因此,我们认为宁泌泰胶囊是改善精液质量的有效药物.

This paper was aimed to introduce and compare outcomes of a novel “Su-Wang (S-W) technique” for endoscopic treatment of adult hydrocele with conventional open hydrocelectomy with “Jaboulay’s (JA) procedure” regarding adverse events (AEs) and patient satisfaction. In the randomized controlled trial, adult males with primary hydroceles were prospectively assigned into S-W or JA group. We recorded perioperative data and postoperative AEs (incision length, recurrence, hematoma, wound infection and edema vanished time). Finally, a total of 42 adult patients underwent the S-W (n = 22) or JA (n = 20) procedure. Procedures were successfully completed for all 42 patients. No significant differences were found between the two groups regarding age, symptom duration, body mass index, and size of the hydrocele. The incision length was significantly shorter in the S-W group (1.00 ± 0.24 cm) than in the JA group (6.10 ± 1.46 cm). After 6 months’ follow-up, complete data of 90.5% (38/42) were obtained. Severe AEs did not occur in any patient. Recurrence, hematoma, wound infection, edema vanished time values, and satisfaction in the S-W group were superior to those in the JA group. All patients in the S-W group were satisfied with this novel procedure, particularly due to the minimally invasive incision. In conclusion, the novel “S-W technique” for hydrocelectomy provided satisfactory cosmetic results with a 1-cm scrotal incision only. With the near-complete excision of the parietal TV, it resulted in no recurrence, fewer AEs, and rapid postoperative rehabilitation in comparison to the traditional “JA procedure.” The endoscopic “S-W technique” may be a viable alternative for the surgical treatment of adult primary vaginal hydrocele.

Background Management of chronic idiopathic testicular pain may be difficult because of problems identifying the causes. We evaluated “AUTOKLAV”, a novel endourological nephrolithotomy device to diagnose and treat chronic idiopathic testicular pain. Methods We divided 103 patients to either scrotoscopy group (SG, n = 64) or open exploration group (OEG, n = 39) between September 2014 and March 2017 at Zhongnan Hospital. Perioperative information, like operating time, length of incision, and wound infections, was carefully recorded during in hospital. Follow-up data, like pain scores improvement, satisfaction with penis appearance, and adverse event, were collected at one month postoperatively. Results Finally, both the operating time and length of incision showed better performance for SG (43.6 ± 4.7 versus 51.5 ± 9.0 min; 0.7 ± 0.2 versus 4.1 ± 0.8 cm; both P <0.01). Though the pain improvement had no significant differences between the two groups (2.92 ± 0.99 and 2.14 ± 1.02, p>0.05), SG showed obvious advantages in incidence of wound infections and satisfaction with wound/scrotum appearance (0% versus 2.9%; 96.4% versus 85.3%, both P<0.05). Conclusions In conclusion, scrotoscopy using the novel AUTOKLAV device is feasible, has an acceptable complication rate, and can be effective and safe in men with idiopathic chronic testicular pain. Etiologically, secondary inflammatory changes caused by the complete or incomplete torsion of testicular or epididymis appendices or by the existence of stones in the tunica sac might be responsible for the pain.

To introduce the detailed procedures of two innovative surgical options for pediatric buried penis and prospectively compare their efficacy and safety.

Obejctive To evaluate the clinical efficacy of Ningmitai capsule in the treatment of typeⅢ prostatitis. Methods Fifty patients with type Ⅲ prostatitis in Zhongnan Hospital of Wuhan University were given oral Ningmitai Capsule (4 capsules/time, 3 times a day). The changes of NIH-CPSI score and seminal neutrophil elastase concentrations were observed before and after treatment to assess the efficacy. Results After 1 months of treatment, the total score of NIH-CPSI decreased significantly from 21.34±3.44 to 16.30±4.08, and the pain or discomfort symptom score, micturition symptom score and quality of life score were significantly lower than those before treatment (P<0.05). The concentration of seminal neutrophil elastase in patients decreased from 1666.42 ng/mL before treatment to 920.25 ng/mL, after treatment (P<0.05). Conclusion Ningmitai capsule can effectively alleviate the symptoms of prostatitis and it is an effective method for the treatment of type III prostatitis.

Introduction: Standard hydrocelectomy for adult primary vaginal hydrocele may cause postoperative discomfort, limited mobility, and complications, such as hematoma, infection, persistent swelling, chronic pain, and decreased fertility.1–3 To decrease the complications, we described a novel endoscopic “Su-Wang technique” for adult primary vaginal hydrocele with the aid of a scrotoscope. Materials and Methods: A 56-year-old man with fall bilge feeling of the right scrotum for 12 months was found to have primary vaginal hydrocele by the B-mode ultrasound. First, a transverse incision about 1 cm long is made at the anterior superior part of the right scrotum. Then, we cut the skin, dartos, and superficial fascia of the scrotum layer-by-layer, until the parietal layer of the tunica vaginalis was exposed. We made a length of about 0.5 cm incision, and then a self-made working sheath was passed through the incision into the vaginal cavity, steadily fixed at the parietal layer. Through the self-made working sheath, we inserted the scrotoscope into the vaginal cavity. Using a plasma cylindrical electrode, we burned a circle at the parietal layer of the tunica vaginalis as a marker. The distance between the burned place and the testis or epididymis was 1 to 2 cm. Along the circular mark, the parietal layer of the tunica vaginalis was burned with a plasma cylindrical electrode. The burning depth penetrates only the parietal layer of the tunica vaginalis, but does not reach the deep fascial layer of the scrotal wall. After checking the depth of the burn site, the scrotoscope was pulled out. Then, the parietal layer of the tunica vaginalis was peeled away from the deep fascial layer of the scrotal wall. After that, the parietal layer of the tunica vaginalis could be easily stripped from the scrotum. Results: We have completed 15 cases of primary vaginal hydrocele in adults with the “Su-Wang technique,” the average size of hydrocele was 7.8 cm, the average operation time was 43 minutes, the average volume of drainage after operation was 7 mL, the average drain removal time was 2 days postoperatively, and the length of stay was 4 day. Postoperative hematoma or wound infection did not occur. Mild scrotal edema usually dissipated within 2 days after surgery. Patients were able to resume normal daily activity an average of 4 days after surgery (range 2–5). All 15 cases were cured and followed up for 1 year without recurrence. Conclusions: Our “Su-Wang technique” allows the surgeon to remove large hydrocele through a 1-cm incision and to almost completely resect the parietal tunica vaginalis, resulting in no recurrence, minimal complications, and early recovery. This procedure may be a viable option for surgical treatment of adult primary vaginal hydrocele. No competing financial interests exist. Runtime of video: 7 mins 12 secs

Background Current evidence regarding the efficacy of ethanol locks in preventing catheter-related bloodstream infection (CRBI) is inconclusive. Methods Electronic databases, including PubMed, Web of Science, Embase, and the Cochrane Library (until April 2018),were systematically searched for relevant studies. Two reviewers independently screened the retrieved records and identified RCTs that met the inclusion criteria. Relevant data were extracted for pooled analyses using Review Manager 5.3 software. Subgroup analysis was performed according to the study quality, duration of the ethanol lock, disease type and CRBI definition. Eggs’ method was applied to detect publication bias. Sensitivity analysis was conducted to check the stability of the meta-analysis results. Results Ten RCTs involving 2760 patients were included in the analysis. The overall pooled result indicated that ethanol locks significantly reduced the incidence of CRBI (RR 0.66, 95% CI 0.51–0.86). Subgroup analysis suggested that an ethanol lock significantly decreased the incidence of CRBI in patients with hematological diseases (RR 0.50, 95% CI 0.31–0.80). An ethanol lock significantly reduced the incidence of CRBI in a2-hour ethanol lock group (RR 0.49, 95% CI 0.33–0.73). The meta-analysis showed that an ethanol lock significantly reduced the incidence of CRBI according to analysis of high-(RR 0.66, 95% CI 0.47–0.94) or low-(RR 0.66, 95% CI 0.46–0.95) quality studies. Meta-analysis of studies with a strict CRBI definition showed that an ethanol lock can significantly prevent CRBI (RR 0.61, 95% CI 0.42–0.89). The results of sensitivity analysis suggested that the pooled result was stable. Meta-analysis of adverse events showed that an ethanol lock did not increase the incidence of thrombosis (RR 1.05, 95% CI 0.51–2.18) or mortality (RR 0.99, 95% CI 0.90–1.08) but did result in increased nausea (RR 1.54, 95% CI 1.01–2.35), dizziness (RR 4.21, 95% CI 2.40–7.39),elevated blushing rates (RR 3.27, 95% CI 2.05–5.22) and altered taste rates (RR 2.61, 95% CI 1.93–3.54). Conclusions An ethanol lock may play a role in the prevention of CRBI, especially in immunocompromised patients with hematological diseases.

In this work, we aim to further analyze the association of statins use with biochemical recurrence (BCR) of prostate cancer (PCa) and PCa-specific mortality after definitive therapy. A systematic literature search of PubMed, MEDLINE and EMBASE through Jul 2015 was conducted. Pooled Hazard ratio (HR) estimates with corresponding 95% confidence intervals (CIs) were calculated using random-effects model. STATA version 10 (Stata corporation, college station, TX) was employed to conduct all statistical analyses. A total of 22 and 8 studies contributed to the biochemical recurrence analysis and PCa-specific mortality, respectively. 13 trials were included for BCR-free survival analysis. The combined result showed statins users had lowered 12% BCR risk of PCa compared with non-users (HR = 0.88, 95%CI: 0.765–0.998) (p < 0.05). The association was null among the men who underwent radical prostatectomy as primary therapy (HR = 0.96, 95%CI: 0.83–1.09), while the improved outcomes had be seen among patients who received radiation therapy (HR = 0.67, 95%CI: 0.48–0.86). After excluding the patients undergoing ADT, participants did not benefit from statins use (HR = 0.94, 95%CI: 0.77–1.11). Meanwhile, long-term statins using did not alter recurrence risk. A lower risk of prostate cancer-specific mortality was observed among statins users (HR = 0.68, 95%CI: 0.56–0.80). There was a plausible trend towards increasing the BCR-free survival rate among statins users.