Radiation-induced intracranial vasculopathy after radiotherapy (laser surgery) for craniopharyngioma: a study case report

Brain irradiation is commonly used for many primary brain malignancies. After radiotherapy, the potential for the development of radiation-induced vasculopathy exists and should be kept in mind. Craniopharyngioma is one rare slowly developing, usually benign tumor. In the majority of cases, such tumors grow above the anterior upper lip of pituitary gland and are located mainly on Sella Turcica or on side sella areas. Macroscopically, they seem like big globe tumors with the white or red-blooded surface. Histologically, have ascertained two types, adamantinomatous and papillary type (though they have ascertained and mixed types). However, independently of their main type, they usually have cystic form. The size of craniopharyngioma is between 2 to 4 cm. Strike 0,12-2/100.000 people a year, 30 to 50% of all cases presenting during childhood and adolescence and they constitute the 2-5% of all brain tumors. The peak incidence rates have been shown in children of ages 5 to 14 years and adults of ages 50 to 74 years.  The study below presents one case of post-radiation vasculopathy of the brain arteries of the patient who received radiation therapy to the brain as part of his craniopharingioma management. It will be underscored the significance of this patient condition and also will be described possible routes to prevent the occurrence of vasculopathy.

Efficacy and Safety of Platelet-Rich Plasma Injections for the Treatment of Female Sexual Dysfunction and Stress Urinary Incontinence: A Systematic Review

Introduction: There is no clear evidence in the literature that platelet-rich plasma (PRP) injections improve female sexual dysfunction (FSD) and female stress urinary incontinence (SUI). Objectives: A systematic review was performed to study the efficacy and safety of PRP injections in women with the above pathologies, as well as to explore the optimal dosing, frequency and area of injections, and duration of treatment. Methods: A systematic search on PubMed, Embase and the Cochrane Library database was performed, as well as sources of grey literature from the date of database or source creation to January 2023. After title/abstract and full-text screening, clinical studies on humans evaluating the efficacy of PRP in gynecological disorders using standardized tools were included. Risk of bias was undertaken with RoB-2 for randomized-controlled trials (RCT) and the Newcastle-Ottawa Scale (NOS) for observational studies. Results: Four prospective and one retrospective study explored FSD, while six prospective and one RCT evaluated female SUI. A total of 327 women with a mean age of 51 ± 12 years were included. For FSD, PRP significantly improved the Female Sexual Function Index (FSFI), the Vaginal Health Index (VHI) and the Female Sexual Distress score (FSDS). For SUI, PRP led to a significant improvement in the International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF) and the Urogenital Distress Inventory (UDI-6). The identified RCT reported a significantly higher mean score of ICIQ-SF (p < 0.05) and UDI-6 (p < 0.01) in the midurethral sling group compared to the PRP injections group. Regarding the risk of bias, the RCT was characterized by high risk, whereas the observational studies were of moderate risk. The protocol for PRP injections for FSD is the injection of 2 mL of PRP into the distal anterior vaginal wall once a month for 3 months. For female SUI, 5–6 mL of PRP should be injected into the periurethral area once a month for 3 months. Conclusions: Despite the promising initial results of PRP injections, the level of current evidence is low due to methodological issues in the available studies. It becomes clear that there is an emerging need for high-quality research examining PRP injections for the treatment of FSD and female SUI

Efficacy and Safety of Platelet-Rich Plasma Injections for the Treatment of Female Sexual Dysfunction and Stress Urinary Incontinence: A Systematic Review

Introduction: There is no clear evidence in the literature that platelet-rich plasma (PRP) injections improve female sexual dysfunction (FSD) and female stress urinary incontinence (SUI). Objectives: A systematic review was performed to study the efficacy and safety of PRP injections in women with the above pathologies, as well as to explore the optimal dosing, frequency and area of injections, and duration of treatment. Methods: A systematic search on PubMed, Embase and the Cochrane Library database was performed, as well as sources of grey literature from the date of database or source creation to January 2023. After title/abstract and full-text screening, clinical studies on humans evaluating the efficacy of PRP in gynecological disorders using standardized tools were included. Risk of bias was undertaken with RoB-2 for randomized-controlled trials (RCT) and the Newcastle-Ottawa Scale (NOS) for observational studies. Results: Four prospective and one retrospective study explored FSD, while six prospective and one RCT evaluated female SUI. A total of 327 women with a mean age of 51 ± 12 years were included. For FSD, PRP significantly improved the Female Sexual Function Index (FSFI), the Vaginal Health Index (VHI) and the Female Sexual Distress score (FSDS). For SUI, PRP led to a significant improvement in the International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF) and the Urogenital Distress Inventory (UDI-6). The identified RCT reported a significantly higher mean score of ICIQ-SF (p p Conclusions: Despite the promising initial results of PRP injections, the level of current evidence is low due to methodological issues in the available studies. It becomes clear that there is an emerging need for high-quality research examining PRP injections for the treatment of FSD and female SUI

Mini percutaneous nephrolithotomy versus standard percutaneous nephrolithotomy for the management of renal stones over 2 cm: a systematic review and meta-analysis of randomized controlled trials

INTRODUCTION Standard percutaneous nephrolithotomy (sPCNL) is recommended for renal stones over 2 cm. Mini percutaneous nephrolithotomy (mPCNL) has also emerged as a promising technique in this setting. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the safety and efficacy of sPCNL to mPCNL for the management of renal stones over 2cm. EVIDENCE ACQUISITION We systematically searched PubMed, Cochrane Library and Scopus databases until April 2021 and sources of grey literature for relevant RCTs. We performed a meta-analysis of odds ratios (ORs) to compare bleeding or other complications and stone-free rate (SFR) between sPCNL and mPCNL. Similarly, we undertook a meta-analysis of weighted mean differences for the mean operative and hospitalization time between the two techniques (PROSPERO: CRD42021241860). EVIDENCE SYNTHESIS Pooled data from 8 RCTs (2535 patients) were available for analysis. sPCNL was associated with a higher hemoglobin drop (0.59 g/dL, 95%CI: 0.4-0.77, I$^{2}$=93%), higher likelihood of postoperative blood transfusion (OR: 2.58, 95%CI: 1.03-6.45, I$^{2}$=30%) and longer hospital stay (0.75 days, 95%CI: 0.45-1.05, I$^{2}$=73%) compared to mPCNL. No significant differences were demonstrated in SFR (OR: 0.92, 95%CI: 0.74-1.16, I$^{2}$=0%) and mean operative time (4.05 minutes, 95%CI: -9.45-1.37, I$^{2}$=91%) after sPCNL versus mPCNL. Similarly, no significant differences were observed for postoperative fever, pain and Clavien-Dindo complications. CONCLUSIONS mPCNL represents a safe and effective technique and may be also recommended as a first-line treatment modality for well-selected patients with renal stones over 2cm. Still, further high-quality RCTs on the field are mandatory since the overall level of evidence is low

The Effect of Antioxidant Supplementation on Operated or Non-Operated Varicocele-Associated Infertility: A Systematic Review and Meta-Analysis

In patients with varicocele-associated infertility, the effect of antioxidant supplementation on fertility is unknown. We performed a systematic review and meta-analysis to explore their role in patients with operated or non-operated varicocele. We searched major databases and sources of grey literature until May 2021 (PROSPERO: CRD42021248195). We included 14 studies (980 individuals) in the systematic review. Of the 14 studies, 2 explored the effect of antioxidant supplementation in patients with non-operated varicocele, 1 compared antioxidants versus surgical repair of varicocele, while 11 explored antioxidants after surgical repair of varicocele and were also included in the meta-analysis. Regarding pregnancy rates, no significant differences were demonstrated after treatment with antioxidants versus no treatment at three (OR: 2.28, 95% CI: 0.7–7.48) and six months (OR: 1.88, 95% CI: 0.62–5.72). Accordingly, contradictory findings were reported in sperm concentration, morphology, and motility, as well as DNA fragmentation. Our findings indicate that antioxidant supplementation does not improve pregnancy rates and semen parameters in patients with varicocele-associated infertility, in the absence of previous screening for oxidative stress. Based on the previous notion, most included studies also raised methodological concerns. Therefore, definitive conclusions about the efficacy of antioxidant supplementation in this setting cannot be drawn and further research on the field is mandatory