Eight-year follow-up on postoperative improvement protocol in extensive metoidioplasty transgenders:A case series

Background:This study aimed to evaluate the long-term penile size among patients who underwent extensive metoidioplasty.Methods:An evaluation was conducted on 7 out of 14 patients(mean age:29.71±13.76 years)who participated in a 2015 study that introduced a postoperative protocol to improve penile size after extensive metoidioplasty.Five transsexual females(46XX karyotype)and two patients with 5-alpha reductase deficiency were retrospectively followed up in 2023 to assess the long-term efficacy of the protocol at a specialized clinic in a general hospital in Tehran,Iran.All participants were informed about the study and consented to participate.Results:Five patients achieved increased penile size from their 2015 measurements(mean,29.00±13.34 mm).Five patients requested a larger sized penile traction device to continue the protocol.Conclusion:The long-term implementation of this protocol can result in increased penile size.We advise highly motivated patients to continue practicing the protocol to achieve better results.

Comparing the Efficacy and Safety of Treating Chronic Hepatitis B Infection during Pregnancy with Lamivudine,Telbivudine,and Tenofovir:A Meta-analysis

Background and Aims:The perinatal transmission of hepatitis B virus(HBV)remains an important global health problem.Here,a systematic review and meta-analysis were conducted to evaluate the evidence regarding the efficacy and maternal/fetal safety of treating pregnant women with lamivudine,telbivudine(LdT),and tenofovir(TDF).Methods:A PubMed and Scopus search resulted in 1,076 records,which were reduced to 36,containing 7,717 pregnant women with chronic HBV infection and 7467 infants meeting the inclusion criteria.The latest search was in August 2019.Results:Treatment with LdT,but not lamivudine and TDF,could significantly reduce the hepatitis B virus surface antigen-positive rate(odds ratio(OR)=0.37)in infants;it also led to higher rates of hepatitis B e antigen loss(OR=12.14),hepatitis B e antigen seroconversion(OR=8.93),and alanine aminotransferase normalization in mothers(OR=1.49).Each of these treatments was able to significantly reduce HBV DNA positivity at birth(total OR=0.19)and mother-to-child-transmission of HBV(total OR=0.15),and to cause higher rates of HBV DNA suppression in mothers(total OR=25.53).However,nucleos(t)ide analogues might also be involved in creatine kinase elevation(total OR=7.48).In contrast,no significant association was found between nucleos(t)ide analogue therapy and preterm/premature births,congenital malformation,low birth weight,and abortion or fetal/infant death.The results suggested LdT's high capability of preventing mother-to-childtransmission.However,TDF failed to show significant associations to a reduced risk of mother-to-child-transmission,probably due to the low number of patients included.Conclusions:Although using either lamivudine,LdT,orTDF could lead to more favorable maternal/fetal outcomes,LdT seemed to show more potential in resolving certain infant-and maternal-related outcomes.More studies on the safety profile of such treatments are required.