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Cochrane Database of Systematic Reviews

Intermittent self‐dilatation for urethral stricture disease in males

Información

DOI:
https://doi.org/10.1002/14651858.CD010258.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 19 diciembre 2014see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Incontinencia

Copyright:
  1. Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Matthew J Jackson

    Correspondencia a: Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

    [email protected]

  • Rajan Veeratterapillay

    Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

  • Chris K Harding

    Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

  • Trevor J Dorkin

    Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

Contributions of authors

Matthew Jackson (MJ), Rajan Veeratterapillay (RV), Chris Harding (CH) and Trevor Dorkin (TD) were responsible for the conception of the protocol. MJ and CH were responsible for screening search results, screening retrieved papers against the inclusion criteria and appraising the quality of papers. MJ, RV and TD were responsible for extracting data. MJ and TD were responsible for checking the data for inter‐observer agreement. MJ was responsible for entering data into Review Manager. MJ and RV were responsible for assessing risk of bias. MJ was responsible for carrying out the analysis. MJ and RV were responsible for interpreting the analysis. MJ, RV and CH were responsible for drafting the review. MJ, RV, CH and TD were responsible for reviewing the final manuscript.

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • NIHR, UK.

    The Cochrane Incontinence Group is supported by NIHR funding

Declarations of interest

Matthew J Jackson: nil

Rajan Veeraterapillay: nil

Christopher K Harding: speaker at meetings for Astellas, GSK, Lilly, Allergan and B Braun
Advisory Board for AMS

Trevor J Dorkin: speaker at meetings for Lilly, Pfizer and Astellas

Acknowledgements

We thank Sheila Wallace for undertaking the systematic literature search.

Version history

Published

Title

Stage

Authors

Version

2014 Dec 19

Intermittent self‐dilatation for urethral stricture disease in males

Review

Matthew J Jackson, Rajan Veeratterapillay, Chris K Harding, Trevor J Dorkin

https://doi.org/10.1002/14651858.CD010258.pub2

2012 Dec 12

Intermittent self‐dilatation for urethral stricture disease in men

Protocol

Matthew J Jackson, Rajan Veeratterapillay, Chris Harding, Trevor Dorkin

https://doi.org/10.1002/14651858.CD010258

Differences between protocol and review

Use of the GRADE methodology was not specified in the protocol but was adopted for the review to assess the quality of the evidence pertaining to the effect of intermittent self‐dilatation on risk of recurrent urethral stricture.

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

PRISMA study flow diagram
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
Analysis 1.1

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

Comparison 1 ISD versus no treatment, Outcome 2 Adverse events.
Figuras y tablas -
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.
Figuras y tablas -
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).
Figuras y tablas -
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).
Figuras y tablas -
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.
Figuras y tablas -
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).

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
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

Figuras y tablas -
Comparison 3. One device for ISD versus another