Review Suggested citationMontes Cardona CE, García-Perdomo HA. Incidence of penile cancer worldwide: systematic review and meta-analysis. Rev Panam Salud Publica. 2017;41:e117. doi: 10.26633/RPSP.2017.117. Penile cancer is a rare malignancy, especially in developed countries, in which the annual incidence is below 1 case per 100 000 men. This incidence represents less than 1% of malignancies in this gender; however, in certain Asian, African, and South American countries, the occurrence may represent up to 10% of cases (1). One of the countries with the highest incidence of penile cancer in the world is India, with rates up to 3.32 per 100 000 men in some regions. In contrast, rates among Jewish men born in Israel are reportedly very close to zero (2).Penile cancer typically affects older men, and its incidence rate consistently increases with age (3). The age group most commonly affected by penile cancer is between 50 and 70 years, with a mean age of 67 years in the United States of America (4), although the disease has also been observed in patients under 40 years (3). The vast majority of patients have an apparently localized disease at diagnosis, with high-risk characteristics for nodal involvement but without clinical evidence of such involvement. This suggests that the morbidity and mortality among these patients is underestimated (5).The risk factors associated with a greater likelihood of developing the disease, as well as the factors associated with higher incidence rates, are clearly known (6). Nevertheless, neither the global impact of penile cancer nor the variations according to different geographic areas or the changing trends in different time intervals are precisely known. The objective of this systematic review was to determine the incidence of penile cancer in the global population. METHODSWe conducted a meta-analysis of observational studies, following the Metaanalysis of Observational Studies in Epidemiology (MOOSE) (7) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) ABSTRACTObjective.
PurposeTo determine the efficacy of phosphodiesterase type 5 inhibitors (PDE5i) as medical expulsive therapy (MET) for the treatment of distal ureteral calculi.Materials and MethodsA 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 Searches were also conducted in other databases and unpublished literature.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.ResultsFour 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.ConclusionsCompared with a placebo, PDE5i could be effective as MET for the treatment of distal ureter calculi.
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