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Context: The use of scrotal ultrasonography (SUS) has increased the detection rate of indeterminate testicular masses. Defining radiological characteristics that identify malignancy may reduce the number of men undergoing unnecessary radical orchidectomy. Objective: To define which SUS or scrotal magnetic resonance imaging (MRI) characteristics can predict benign or malignant disease in pre‐ or post‐pubertal males with indeterminate testicular masses. Evidence Acquisition This systematic review was conducted in accordance with Cochrane Collaboration guidance. Medline, Embase, Cochrane controlled trials and systematic reviews databases were searched from (1970 to 26 March 2021). Benign and malignant masses were classified using the reported reference test: i.e., histopathology, or 12 months progression‐free radiological surveillance. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies‐2 tool (QUADAS‐2). Evidence Synthesis: A total of 32 studies were identified, including 1692 masses of which 28 studies and 1550 masses reported SUS features, four studies and 142 masses reported MRI features. Meta‐analysis of different SUS (B‐mode) values in post‐pubertal men demonstrated that a size of ≤0.5 cm had a significantly lower odds ratio (OR) of malignancy compared to masses of >0.5 cm (P < 0.001). Comparison of masses of 0.6–1.0 cm and masses of >1.5 cm also demonstrated a significantly lower OR of malignancy (P = 0.04). There was no significant difference between masses of 0.6–1.0 and 1.1–1.5 cm. SUS in post‐pubertal men also had a statistically significantly lower OR of malignancy for heterogenous masses vs homogenous masses (P = 0.04), hyperechogenic vs hypoechogenic masses (P < 0.01), normal vs increased enhancement (P < 0.01), and peripheral vs central vascularity (P < 0.01), respectively. There were limited data on pre‐pubertal SUS, pre‐pubertal MRI and post‐pubertal MRI. Conclusions: This meta‐analysis identifies radiological characteristics that have a lower OR of malignancy and may be of value in the management of the indeterminate testis mass. [ABSTRACT FROM AUTHOR]

Objective: To assess the comparative effectiveness and ranking of minimally invasive treatments (MITs) for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Materials and Methods: We searched multiple databases up to 24 February 2021. We included randomized controlled trials assessing the following treatments: convective radiofrequency water vapour thermal therapy (WVTT; or Rezūm); prostatic arterial embolization (PAE); prostatic urethral lift (PUL; or Urolift); temporary implantable nitinol device (TIND); and transurethral microwave thermotherapy (TUMT) compared to transurethral resection of the prostate (TURP) or sham surgery. We performed a frequentist network meta‐analysis. Results: We included 27 trials involving 3017 men. The overall certainty of the evidence of most outcomes according to GRADE was low to very low. Compared to TURP, we found that PUL and PAE may result in little to no difference in urological symptoms, while WVTT, TUMT and TIND may result in worse urological symptoms. MITs may result in little to no difference in quality of life, compared to TURP. MITs may result in a large reduction in major adverse events compared to TURP. We were uncertain about the effects of PAE and PUL on retreatment compared to TURP, however, TUMT may result in higher retreatment rates. We were very uncertain of the effects of MITs on erectile function and ejaculatory function. Among MITs, PUL and PAE had the highest likelihood of being the most efficacious for urinary symptoms and quality of life, TUMT for major adverse events, WVTT and TIND for erectile function and PUL for ejaculatory function. Excluding WVTT and TIND, for which there were only studies with short‐term (3‐month) follow‐up, PUL had the highest likelihood of being the most efficacious for retreatment. Conclusions: Minimally invasive treatments may result in similar or worse effects concerning urinary symptoms and quality of life compared to TURP at short‐term follow‐up. [ABSTRACT FROM AUTHOR]

To compare monopolar and bipolar transurethral resection of the prostate ( TURP) for clinical effectiveness and adverse events., We conducted an electronic search of MEDLINE, Embase, CENTRAL, Science Citation Index, and also searched reference lists of articles and abstracts from conference proceedings for randomised controlled trials ( RCTs) comparing monopolar and bipolar TURP., Two reviewers independently undertook data extraction and assessed the risk of bias in the included trials using the tool recommended by the Cochrane Collaboration., The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation ( GRADE) approach., From the 949 abstracts that were identified, 94 full texts were assessed for eligibility and a total of 24 trials were included in the review., No statistically significant differences were found in terms of International Prostate Symptom Score ( IPSS) or health-related quality of life ( HRQL) score., Results for maximum urinary flow rate were significant at 3, 6 and 12 months (all P < 0.001), but no clinically significant differences were found and the meta-analysis showed evidence of heterogeneity, Bipolar TURP was associated with fewer adverse events including transurethral resection syndrome (risk ratio [ RR] 0.12, 95% confidence interval [ CI] 0.05-0.31, P < 0.001), clot retention ( RR 0.48, 95% CI 0.30-0.77, P = 0.002) and blood transfusion ( RR 0.53, 95% CI 0.35-0.82, P = 0.004), Several major methodological limitations were identified in the included trials; 22/24 trials had a short follow-up of ≤1 year, there was no evidence of a sample size calculation in 20/24 trials and the application of GRADE showed the evidence for most of the assessed outcomes to be of moderate quality, including all those in which statistical differences were found., Whilst there is no overall difference between monopolar and bipolar TURP for clinical effectiveness, bipolar TURP is associated with fewer adverse events and therefore has a superior safety profile., Various methodological limitations were highlighted in the included trials and as such the results of this review should be interpreted with caution., There is a need for further well-conducted, multicentre RCTs with long-term follow-up data. [ABSTRACT FROM AUTHOR]