The use of local therapy in preventing urethral strictures: A systematic review.

<h4>Background</h4>Urethral stricture disease is a common problem amongst men in Western countries often leading to a decreased quality of life. Current endoscopic treatment procedure shows an unsatisfying stricture recurrence rate which could be improved by addition of local therapies.&...

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Autores principales:	Marleen E Jacobs, Vincent F de Kemp, Maarten Albersen, Laetitia M O de Kort, Petra de Graaf
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/e44eed2bebdb4caab7470b3cf27aae18
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spelling	oai:doaj.org-article:e44eed2bebdb4caab7470b3cf27aae182021-12-02T20:17:15ZThe use of local therapy in preventing urethral strictures: A systematic review.1932-620310.1371/journal.pone.0258256https://doaj.org/article/e44eed2bebdb4caab7470b3cf27aae182021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0258256https://doaj.org/toc/1932-6203<h4>Background</h4>Urethral stricture disease is a common problem amongst men in Western countries often leading to a decreased quality of life. Current endoscopic treatment procedure shows an unsatisfying stricture recurrence rate which could be improved by addition of local therapies.<h4>Objectives</h4>To provide an overview of both preclinical and clinical studies in order to investigate current level of evidence on the addition of local therapy to improve urethral stricture recurrence rates after endoscopic procedures.<h4>Methods</h4>We performed a literature search in December 2020 and August 2021 using Cochrane, Embase, PubMed, Scopus and Web of Science and identified articles through combinations of search terms for 'urethral stricture disease', 'stricture formation' and 'local interventions'. We used the SYRCLE, RoB-2 and ROBINS-I tools to assess risk of bias across included studies. We did not perform a meta-analysis due to methodological differences between studies.<h4>Results</h4>We included 32 articles in the qualitative analysis, 20 of which were preclinical studies and 12 clinical studies. Regarding preclinical articles using an animal model, nearly all interventions showed to have a positive effect on either urethral fibrosis, urethral stricture formation and/or fibrotic protein expression levels. Here, immunosuppressants and chemotherapeutics seemed most promising for possible clinical purposes. Regarding clinical studies, mitomycin-C and hyaluronic acid and carboxymethylcellulose showed positive effects on urethral stricture recurrence rates with low to intermediate risk of bias across studies. However, the positive clinical effects of mitomycin-C and steroids seemed to decrease in studies with a longer follow-up time.<h4>Conclusion</h4>Although local adjuvant use of mitomycin-C or hyaluronic acid and carboxymethylcellulose may carry clinical potential to improve urethral structure recurrence rates after endoscopic procedures, we believe that a large, well-designed RCT with a yearlong follow-up time is necessary to identify the true clinical value.Marleen E JacobsVincent F de KempMaarten AlbersenLaetitia M O de KortPetra de GraafPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 10, p e0258256 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Marleen E Jacobs Vincent F de Kemp Maarten Albersen Laetitia M O de Kort Petra de Graaf The use of local therapy in preventing urethral strictures: A systematic review.
description	<h4>Background</h4>Urethral stricture disease is a common problem amongst men in Western countries often leading to a decreased quality of life. Current endoscopic treatment procedure shows an unsatisfying stricture recurrence rate which could be improved by addition of local therapies.<h4>Objectives</h4>To provide an overview of both preclinical and clinical studies in order to investigate current level of evidence on the addition of local therapy to improve urethral stricture recurrence rates after endoscopic procedures.<h4>Methods</h4>We performed a literature search in December 2020 and August 2021 using Cochrane, Embase, PubMed, Scopus and Web of Science and identified articles through combinations of search terms for 'urethral stricture disease', 'stricture formation' and 'local interventions'. We used the SYRCLE, RoB-2 and ROBINS-I tools to assess risk of bias across included studies. We did not perform a meta-analysis due to methodological differences between studies.<h4>Results</h4>We included 32 articles in the qualitative analysis, 20 of which were preclinical studies and 12 clinical studies. Regarding preclinical articles using an animal model, nearly all interventions showed to have a positive effect on either urethral fibrosis, urethral stricture formation and/or fibrotic protein expression levels. Here, immunosuppressants and chemotherapeutics seemed most promising for possible clinical purposes. Regarding clinical studies, mitomycin-C and hyaluronic acid and carboxymethylcellulose showed positive effects on urethral stricture recurrence rates with low to intermediate risk of bias across studies. However, the positive clinical effects of mitomycin-C and steroids seemed to decrease in studies with a longer follow-up time.<h4>Conclusion</h4>Although local adjuvant use of mitomycin-C or hyaluronic acid and carboxymethylcellulose may carry clinical potential to improve urethral structure recurrence rates after endoscopic procedures, we believe that a large, well-designed RCT with a yearlong follow-up time is necessary to identify the true clinical value.
format	article
author	Marleen E Jacobs Vincent F de Kemp Maarten Albersen Laetitia M O de Kort Petra de Graaf
author_facet	Marleen E Jacobs Vincent F de Kemp Maarten Albersen Laetitia M O de Kort Petra de Graaf
author_sort	Marleen E Jacobs
title	The use of local therapy in preventing urethral strictures: A systematic review.
title_short	The use of local therapy in preventing urethral strictures: A systematic review.
title_full	The use of local therapy in preventing urethral strictures: A systematic review.
title_fullStr	The use of local therapy in preventing urethral strictures: A systematic review.
title_full_unstemmed	The use of local therapy in preventing urethral strictures: A systematic review.
title_sort	use of local therapy in preventing urethral strictures: a systematic review.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/e44eed2bebdb4caab7470b3cf27aae18
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The use of local therapy in preventing urethral strictures: A systematic review.

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