Scolaris Content Display Scolaris Content Display

PRISMA study flow diagram
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Figure 1

PRISMA study flow diagram

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 ISD versus no treatment, Outcome 1 Recurrent urethral stricture.
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Analysis 1.1

Comparison 1 ISD versus no treatment, Outcome 1 Recurrent urethral stricture.

Comparison 1 ISD versus no treatment, Outcome 2 Adverse events.
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Analysis 1.2

Comparison 1 ISD versus no treatment, Outcome 2 Adverse events.

Comparison 2 One programme of ISD versus another, Outcome 1 Recurrent urethral stricture.
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Analysis 2.1

Comparison 2 One programme of ISD versus another, Outcome 1 Recurrent urethral stricture.

Comparison 3 One device for ISD versus another, Outcome 1 Recurrent urethral stricture (type of catheter).
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Analysis 3.1

Comparison 3 One device for ISD versus another, Outcome 1 Recurrent urethral stricture (type of catheter).

Comparison 3 One device for ISD versus another, Outcome 2 Recurrent urethral stricture (catheter lubrication).
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Analysis 3.2

Comparison 3 One device for ISD versus another, Outcome 2 Recurrent urethral stricture (catheter lubrication).

Comparison 3 One device for ISD versus another, Outcome 3 Adverse events.
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Analysis 3.3

Comparison 3 One device for ISD versus another, Outcome 3 Adverse events.

Summary of findings for the main comparison. Intermittent self‐dilatation compared to no treatment for males after urethral stricture surgery

Intermittent self‐dilatation compared to no treatment for males after urethral stricture surgery

Population: males after urethral stricture surgery
Intervention: intermittent self‐dilatation
Comparison: no treatment

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

No treatment

Intermittent self‐dilatation

Recurrent urethral stricture
Follow‐up: 8‐24 months

618 per 1000

433 per 1000
(297 to 618)

RR 0.7
(0.48 to 1)

404
(6 studies)

⊕⊝⊝⊝
very low1,2,3

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Downgraded by two for risk of bias: all six trials comprising the quantitative synthesis were judged high risk of bias in two or more domains.
2 Downgraded by two for inconsistency: the point estimates of the effect size vary widely; the statistical test for heterogeneity is highly significant (P = 0.003), and the I2 is large (72%).
3 Downgraded by two for imprecision: the total number of events was less than 300 and the 95% confidence interval of the effect size is 0.48 to 1.00 (> 50% and includes the line of no effect).

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Summary of findings for the main comparison. Intermittent self‐dilatation compared to no treatment for males after urethral stricture surgery
Comparison 1. ISD versus no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Recurrent urethral stricture Show forest plot

6

404

Risk Ratio (M‐H, Random, 95% CI)

0.70 [0.48, 1.00]

2 Adverse events Show forest plot

2

91

Risk Ratio (M‐H, Random, 95% CI)

0.60 [0.11, 3.26]

2.1 Urinary tract infection/bacteriuria

2

91

Risk Ratio (M‐H, Random, 95% CI)

0.60 [0.11, 3.26]

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Comparison 1. ISD versus no treatment
Comparison 2. One programme of ISD versus another

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Recurrent urethral stricture Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

1.1 Short duration versus long duration of treatment

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

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Comparison 2. One programme of ISD versus another
Comparison 3. One device for ISD versus another

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Recurrent urethral stricture (type of catheter) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

1.1 LoFric vs PVC

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Recurrent urethral stricture (catheter lubrication) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2.1 Triamcinolone gel versus water‐based lubricant

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Adverse events Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

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Comparison 3. One device for ISD versus another