Penile cancer is a rare but debilitating condition, which often requires aggressive treatment. Partial penectomy is considered as a treatment option when a sufficient portion of the penile shaft can be maintained to preserve functionality. This systematic review, which followed the PRIMSA guidelines, aimed to evaluate the effects of partial penectomy for penile cancer on sexual function—the maintenance of which is often a priority in patient groups—and to identify potential factors which may moderate these effects. A systematic search of PubMed, The Cochrane Library, and Open Grey as well as MEDLINE, CINAHL and Open Dissertations via EBSCOhost was conducted from inception through to 24th March, 2022. Studies were required to include adults aged ≥18 years who had undergone partial penectomy for the treatment of penile cancer, with a quantitative measure of sexual function available pre- and post-surgery. Four eligible articles were identified for inclusion in this review, three of which reported a decrease in sexual function pre- to post-surgery across all domains of the International Index of Erectile Function (IIEF) questionnaire (erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction). Conversely, one study reported an increase in sexual function across IIEF domains, except for orgasmic function, which decreased, pre- to post-surgery. Greater penile length was associated with higher post-operative sexual function, whilst increasing age and higher anxiety levels were associated with lower post-operative sexual function levels in one study. Despite the overall drop in sexual function, many patients were still able to maintain satisfactory sex lives following partial penectomy. Given the limited research in this area and small sample sizes across studies, additional well-controlled investigations are warranted to provide further evidence on the effects of partial penectomy for penile cancer on sexual function.

Nutrition plays a key role in training for, and competing in, competitive sport, and is essential for reducing risk of injury and illness, recovering and adapting between bouts of activity, and enhancing performance. Consumption of a Mediterranean diet (MedDiet) has been demonstrated to reduce risk of various non-communicable diseases and increase longevity. Following the key principles of a MedDiet could also represent a useful framework for good nutrition in competitive athletes under most circumstances, with potential benefits for health and performance parameters. In this review, we discuss the potential effects of a MedDiet, or individual foods and compounds readily available in this dietary pattern, on oxidative stress and inflammation, injury and illness risk, vascular and cognitive function, and exercise performance in competitive athletes. We also highlight potential modifications which could be made to the MedDiet (whilst otherwise adhering to the key principles of this dietary pattern) in accordance with contemporary sports nutrition practices, to maximise health and performance effects. In addition, we discuss potential directions for future research.

INTRODUCTION AND OBJECTIVE: Ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) are usually performed under fluoroscopic guidance for the treatment of urolithiasis, with high stone-free rates (SFR) and infrequent complications. Fluoroless techniques are being developed due to concerns regarding radiation exposure during fluoroscopy and its risks. The purpose of this systematic review is to assess the efficacy and safety of fluoroscopy-free URS and RIRS.METHODS: We performed a systematic review based on the PRISMA statement and searched Pubmed and Scopus databases for eligible articles until 31 March, 2020. Studies providing data on SFR, complications or retreatment rate for fluoroscopy-free URS or RIRS were included. We assessed the quality of evidence and risk of bias using the Critical Appraisal Skills Programme or the Institute of Health Economics Appraisal Checklist, depending on the study type.RESULTS: 17 publications were included with a total of 2957 patients. The process of study selection is explained in Figure 1. None of the comparative studies found significative differences in results between fluoroscopy-free or conventional fluoroscopic guided procedures in terms of SFR, complications, or retreatment rate. Most case series reported SFR >85% and low complication rates. Detailed results are described in Table 1. Most studies had moderate quality and 3 were high-quality studies.CONCLUSIONS: The analysis of the collected data in this systematic review suggests URS and RIRS remain effective without fluoroscopy, having no negative impact on the management of kidney stones disease while preserving the health of patients and workers. However, large prospective studies are needed for higher quality evidence.