SUMMARYThe aim of this study was to synthesize and present the latest available evidence regarding the use of oestrogen antagonists as empiric medical therapy for idiopathic male infertility with oligo and/or asthenoteratozoospermia through meta-analysis of randomized controlled trials (RCTs). Systematic literature acquisition was done for English and other foreign language biomedical databases up to March, 2013. RCTs relevant to the topic were identified and critically appraised independently by two physician reviewers. Dichotomous data of pregnancy rate and adverse events were extracted for calculation of odds ratio (OR) and 95% confidence interval (CI). Effect estimates were pooled using Peto method with fixed effect model. The continuous data of semen and endocrine parameters were calculated for the mean difference between pre-and post-treatment effects, the weighted mean difference (WMD) and SD between the control and intervention group were determined and pooled using the random effects model. Inter-study heterogeneity and publication bias were assessed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline for meta-analysis reporting was followed. Eleven RCTs of good methodological quality were included for meta-analysis. The pooled effect estimates showed that oestrogen antagonists use was associated with a statistically significant increased pregnancy rate compared with controls (pooled OR 2.42; 95% CI 1.47-3.94; p = 0.0004). Significant increase in sperm concentration (WMD 5.24; 95% CI 2.12, 88.37; p = 0.001) and per cent sperm motility (WMD 4.55; 95% CI 0.73, 8.37; p = 0.03) were also noted. While significant elevation of serum follicle stimulating hormone (WMD 4.19 95% CI 2.05, 6.34; p = 0.0001) and testosterone (WMD 54.59; 95% CI 15.92, 93.27; p = 0.006) was associated with its use. No significant difference in adverse event was noted between oestrogen antagonists-treated group and controls. The evidence suggests that oestrogen antagonists as empiric medical therapy for idiopathic male infertility with low non-serious adverse event associated, may increase spontaneous pregnancy rate, improve sperm concentration and per cent sperm motility.

Objective. To determine the relationship between dietary omega-3 fatty acids (n-3 PUFA) and omega-6 fatty acids (n-6 PUFA) with prostate cancer risk from meta-analysis of prospective studies. Design. The literature retrieved from electronic biomedical databases up to June 2011 was critically appraised. General variance-based method was used to pool the effect estimates at 95% confidence interval. Heterogeneity was assessed by Chi2 and quantified by I 2. Results. Eight cohort studies were included for meta-analysis. n-3 PUFA, n-6 PUFA, and their derivatives were not significantly associated with risk of prostate cancer in general. A significant negative association between high dietary intake of alpha-linolenic acid (ALA) and prostate cancer risk (pooled RR: 0.915; 95% CI: 0.849, 0.985; P = 0.019) was noted. Likewise, a slightly positive association was noted on dietary long-chain n-3 PUFA, composed of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) with prostate cancer risk (pooled RR: 1.135; 95% CI: 1.008, 1.278; P = 0.036); however, when two other cohort studies with data of EPA and DHA, both analyzed separately, were included into the pool, the association became not significant (RR: 1.034; 95% CI: 0.973, 1.096; P = 0.2780). Conclusion. Intake of n-3 PUFA and n-6 PUFA does not significantly affect risk of prostate cancer. High intake of ALA may reduce risk of prostate cancer, while intake of long-chain omega-3 fatty acids does not have a significant effect.

This document serves as the position statement from ICCS, based on literature review and expert opinion providing our current understanding of BBD in children with UTI.

Objective:Our objective was to systematically analyze the evidence for an association between serum level long chain omega-3 polyunsaturated fatty acid (n-3 PUFA) and prostate cancer risk from human epidemiological studies. Study Procedures: We searched biomedical literature databases up to November 2011 and included epidemiological studies with description of long chain n-3 PUFA and incidence of prostate cancer in humans. Critical appraisal was done by two independent reviewers. Data were pooled using the general variance-based method with random-effects model; effect estimates were expressed as risk ratio with 95% confidence interval (CI). Heterogeneity was assessed by Chi 2 and quantified by I 2 , publication bias was also determined. Results: In total, 12 studies were included. Significant negative association was noted between high serum level of n-3 PUFA docosapentaenoic acid (DPA) and total prostate cancer risk (RR:0.756; 95% CI 0.599, 0.955; p = 0.019). Likewise, a positive association between high blood level of fish oil contents, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and high-grade prostate tumour incidence (RR:1.381; 95% CI 1.050, 1.817; p = 0.021) was noted; however, this finding was evident only after adjustment was done on interstudy variability through the removal of a lower quality study from the pool. Conclusions: High serum levels of long chain n-3 PUFA DPA is associated with reduced total prostate cancer risk. While high blood level of EPA and DHA is possibly associated with increased high-grade prostate tumour risk.

Introduction Medical conferences are integral to academic medicine, with academic posters being a well-established medium for presenting research. However, conferences carry an ecological footprint due to greenhouse gas emissions. Furthermore, traditional conference formats have recently not been possible due to the COVID-19 pandemic. Herein we examine the carbon footprint associated with travel by presenting delegates to the Fall SPU conferences from 2013 to 2019, and the 2015 ESPU conference. Methods Online programs for the targeted SPU Fall meetings and the 2015 ESPU Annual Meeting were retrospectively reviewed. Variables collected included meeting location and presenter home base. Distance traveled by the presenter, and likely CO 2 e of this return trip were estimated using online calculators. Analysis was performed using the Kruskal-Wallis-H test with pairwise comparisons to detect differences in round trip distances and CO 2 e between meeting locations. Results Six Fall SPU conferences and one ESPU conference were reviewed. The majority of presenters were from the region (North America and Europe, respectively), for both SPU and ESPU. The median round trip distance was 2596.34 miles (IQR 1420.96–4438.30), and the median CO 2 e 0.61 metric tons (IQR 0.36–1.02). We found that the distances traveled to conferences in the Western USA and Europe were slightly further than those to conferences in Central Canada and the Southern US. The difference in CO 2 e between these locations did not achieve statistical significance. Conclusion Presenter travel to and from pediatric urological conferences generates an important carbon footprint and may not be possible in the medium-term future due to a global pandemic. We should explore strategies to allow meetings and knowledge exchange to continue whilst reducing the need for travel and the ecological burden of conferences. Level of Evidence Level III: Most comparative level of evidence.

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Background Lower urinary tract obstruction (LUTO) is a rare but critical fetal diagnosis. Different ultrasound markers have been reported with varying sensitivity and specificity. Aims The objective of this systematic review and meta‐analysis was to identify the diagnostic accuracy of ultrasound markers for LUTO. Materials and Methods We performed a systematic literature review of studies reporting on fetuses with hydronephrosis or a prenatally suspected and/or postnatally confirmed diagnosis of LUTO. Bayesian bivariate random effects meta‐analytic models were fitted, and we calculated posterior means and 95% credible intervals for the pooled diagnostic odds ratio (DOR). Results A total of 36,189 studies were identified; 636 studies were available for full text review and a total of 42 studies were included in the Bayesian meta‐analysis. Among the ultrasound signs assessed, megacystis (DOR 49.15, [15.28, 177.44]), bilateral hydroureteronephrosis (DOR 41.33, [13.36,164.83]), bladder thickening (DOR 13.73, [1.23, 115.20]), bilateral hydronephrosis (DOR 8.36 [3.17, 21.91]), male sex (DOR 8.08 [3.05, 22.82]), oligo‐ or anhydramnios (DOR 7.75 [4.23, 14.46]), and urinoma (DOR 7.47 [1.14, 33.18]) were found to be predictive of LUTO (Table 1). The predictive sensitivities and specificities however are low and wide study heterogeneity existed. Discussion Classically, LUTO is suspected in the presence of prenatally detected megacystis with a dilated posterior urethra (i.e., the keyhole sign), and bilateral hydroureteronephrosis. However, keyhole sign has been found to have modest diagnostic performance in predicting the presence of LUTO in the literature which we confirmed in our analysis. The surprisingly low specificity may be influenced by several factors, including the degree of obstruction, and the diligence of the sonographer at searching for and documenting it during the scan. As a result, providers should consider this when establishing the differential for a fetus with hydronephrosis as the presence or absence of keyhole sign does not reliably rule in or rule out LUTO. Conclusions Megacystis, bilateral hydroureteronephrosis and bladder wall thickening are the most accurate predictors of LUTO. Given the significant consequences of a missed LUTO diagnosis, clinicians providing counselling for prenatal hydronephrosis should maintain a low threshold for considering LUTO as part of the differential diagnosis.