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      Strategies for Reducing the Impact of Cycling on the Perineum in Healthy Males: Systematic Review and Meta-analysis

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          Abstract

          Introduction

          Perineal pressure associated with bicycle riding is the cause of several genitourinary pathologies, most notably Alcock’s syndrome and subsequent perineal numbness. The possible link between cycling-induced perineal numbness and erectile dysfunction makes the development of strategies for perineal protection in bicycle users critical.

          Objective

          To assess the effectiveness of strategies for reducing the impact of cycling on the perineum in healthy males.

          Methods

          We have conducted a systematic review and a meta-analysis of studies examining various means of reducing the impact of cycling on the perineum under the PRISMA guidelines.

          Results

          Out of 2217 screened studies, 22 met our inclusion criteria, and 6 qualified for meta-analysis. The strategies included various designs of saddles, changes in the cycling position, seat shock absorber, shorts with different padding, using the recumbent bike. Using the no-nose saddle and recumbent bike resulted in a significant reduction of perineal pressure and higher penile oxygen pressure compared with a standard saddle. Indirect evidence supports the protective effect of standing on the pedals every few minutes during cycling. More evidence is needed to support—or dismiss—other strategies.

          Conclusions

          Current evidence supports the use of no-nose saddles as a mean to reduce the negative impact of cycling on the perineum in healthy males at the cost of worse stability and increase of posterior seat pressure. Standing on the pedals every ten minutes might be an effective and potentially widely applicable strategy. The use of a recumbent bike appears to protect the perineum, but several concerns prevent its widespread use.

          Electronic supplementary material

          The online version of this article (10.1007/s40279-020-01363-z) contains supplementary material, which is available to authorized users.

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          Most cited references42

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          RoB 2: a revised tool for assessing risk of bias in randomised trials

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            ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions

            Non-randomised studies of the effects of interventions are critical to many areas of healthcare evaluation, but their results may be biased. It is therefore important to understand and appraise their strengths and weaknesses. We developed ROBINS-I (“Risk Of Bias In Non-randomised Studies - of Interventions”), a new tool for evaluating risk of bias in estimates of the comparative effectiveness (harm or benefit) of interventions from studies that did not use randomisation to allocate units (individuals or clusters of individuals) to comparison groups. The tool will be particularly useful to those undertaking systematic reviews that include non-randomised studies.
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              The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration

              Systematic reviews and meta-analyses are essential to summarise evidence relating to efficacy and safety of healthcare interventions accurately and reliably. The clarity and transparency of these reports, however, are not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (quality of reporting of meta-analysis) statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realising these issues, an international group that included experienced authors and methodologists developed PRISMA (preferred reporting items for systematic reviews and meta-analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this explanation and elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA statement, this document, and the associated website (www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
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                Author and article information

                Contributors
                kamil.litwinowicz@student.umed.wroc.pl
                Journal
                Sports Med
                Sports Med
                Sports Medicine (Auckland, N.z.)
                Springer International Publishing (Cham )
                0112-1642
                1179-2035
                19 October 2020
                19 October 2020
                2021
                : 51
                : 2
                : 275-287
                Affiliations
                [1 ]GRID grid.4495.c, ISNI 0000 0001 1090 049X, Department of Medical Biochemistry, , Wroclaw Medical University, ; ul. Chalubińskiego 10, 50-368 Wroclaw, Poland
                [2 ]GRID grid.4495.c, ISNI 0000 0001 1090 049X, Department of Microbiology, , Wroclaw Medical University, ; ul. Chalubińskiego 4, 50-368 Wroclaw, Poland
                [3 ]GRID grid.4495.c, ISNI 0000 0001 1090 049X, Department of Psychiatry, , Wroclaw Medical University, ; Wybrzeze L. Pasteura 10, 50-367 Wroclaw, Poland
                Author information
                http://orcid.org/0000-0002-1856-7246
                http://orcid.org/0000-0002-0252-7944
                http://orcid.org/0000-0001-7336-1876
                Article
                1363
                10.1007/s40279-020-01363-z
                7846539
                33074460
                d19cce0e-759d-4aef-bb62-3b60499a5569
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Funding
                Funded by: Wroclaw Medical University
                Categories
                Systematic Review
                Custom metadata
                © Springer Nature Switzerland AG 2021

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