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Table 1 Results of systematic review detailing salient manuscript, patient, and leech information

From: Systematic review of medicinal leech therapy in urology

Manuscript details

Patient details

Leech details

Author(s), year, PMID

CARE

score

Demographics

Indications

Treatment

Outcomes

Species

Post-treatment leech details

Age

Years or as noted

Sex

Country

reason for therapy

Prior treatment history

leech Therapy details

Hematology

Medications

Favorable outcome?

Infection following therapy?

Additional information

Mousa et al. 20227, 35263644

25

1 month

M

Canada

Penile replantation

Heparin soaked gauze over penile replant

Leeches were placed on penile glans a total of 4 times and allowed to feed until engorged POD 4–5

Following therapy patient developed hypovolemic shock with hgb 6.7g/dL requiring IV crystalloid resuscitation and blood products

Tetanus immunoglobulin, fluconazole, cefazolin, ciprofloxacin

Yes

No

POD 9 ischemia of foreskin developed, however glans well perfused

Hirudo medicinalis

Not discussed

Asgari et al. 201717, 28845411

19

26

M

Iran

Priapism

No other treatment before or after leech therapy, No penile prosthesis insertion due to financial restraints

2 leeches on each side of penile shaft until engorged, 1 hour break and repeated

Initial CBC and BMP, Anticoagulation panel followed during therapy

IV Ceftriaxone 1.5 grams, antihistamines 7 days

Yes

No

Priapism presented at 80 h. Cavernosal swelling decreased but present post-therapy day 2, resolved at 1 month

Hirudo medicinalis

Not discussed

Wagenheim et al. 20159, 26433079

23

2 week

M

USA

Glans penis congestion after bladder exstrophy repair

No other treatment before or after for indication

1 leech to glans every hour with willing detachment, therapy stopped after venous congestion improved after 24 h of treatment

Hgb and Hct monitored q6 h, blood transfusions given if Hct <30%, 4 transfusion given PRBC 15 cc\kg

Ceftazidime

Yes

No

Not discussed

Hirudo medicinalis

Placed in alcohol after and never reused

Banihani et al. 201418, 24928459

21

1 week

M

USA

Penile replantation

1/4 baby aspirin given daily in solution through NG to prevent platelet sludging but leech therapy first line for venous congestion

1–2 leeches applied then willingly detached every 15min–1hr continuously through POD 3 and used for relief prn of glans/corporal engorgement for 1 week, 2 x sutures placed to leech sites bleeding refractory to pressure

Several blood, FFP, and platelet transfusions given throughout treatment to maintain INR < or equal to 1.5, Platelets 50k–100k

Cefazolin 50mg/kg/day and bacitracin ointment TID, then cefepime 50 mg/kg/day, then PO amoxicillin BID

Yes

No

The first case of penile replantation for complete penile amputation with arterial microvascular anastomosis and the use of postoperative leech therapy for venous congestion.

Not discussed

Placed in alcohol after and never reused

Roche et al. 201219, 22399258

22

28

M

Belgium

Penile replantation

Prophylactic low molecular weight heparin given before post-operative but prior to therapy

Leech therapy started post-operative day 1 every 6–8 h for 4 days

Not discussed

Not discussed

Yes

No

3 days after leech therapy, moderate wound margin necrosis presented on ventral side of penis; POD 21- urethral fistula [suprapubic catheter Tx for 4 weeks]; normal functioning/sensation by 18 months

Not discussed

Not discussed

Mineo et al. 200420, 15134999

23

32

M

USA

Penile replantation

no prior treatment

6 treatments of 3 leeches over 20 h, spontaneous detachment q3–4 h

Hematocrit monitored stable throughout

Cefazolin and bacitracin ointment

Yes

No

Edema resolved at day 10, necrosis req some debridement, non-microsurgical

Hirudo medicinalis

Not discussed

Philip et al. 200321, 12656920

18

(case series) 69, 70, 74

M

UK

Penoscrotal edema

no prior treatment

Area cleaned with soap and water, placed and normally released after engorgement (15–40 min), puncture sites continued to drain the next 6–10 h. Repeated daily for 6, 11, and 15 days

Hgb monitored stable throughout no dec >5%

Not discussed

Yes

No

Primary benefit was drainage from puncture

Hirudo medicinalis

Not discussed

Goessl et al. 199722, 9224347

20

56

M

Germany

Scrotal hematoma

No prior treatment w/puncture or surgery due to diffuse tissue layer spread of hematoma

12 days, 70 total leeches, 5–7 daily

No significant decrease in Hgb throughout treatment

Not discussed

Yes

No

1.5L scrotal hematoma

Not discussed

Not discussed

Pantuck et al. 19961, 8973688

23

37

M

USA

Penile replantation

Post-operative aspirin but leech therapy first line for venous congestion

1–2 leeches added daily to distal third until sated (20–45 min) no signs of venous congestion at 5 days and treatment stopped

4 g/dL drop in Hgb but no transfusion required

IV antibiotics unspecified

Yes

No

Swelling improved, required debridement

Hirudo medicinalis

Discarded in 70% alcohol as medical waste

Lafolla, 19955, 7595772

24

18 h

M

USA

Glans penis congestion after bladder extrophy repair with penile lengthening and pelvic osteotomy

Prior to leech therapy, venous engorgement by bilateral incisions after dilute injection of heparin to glans was unsuccessful

Leech therapy started post-operative day 2, 6 leeches over 5-h period, stored in physiologic saline, attachment facilitated by nick with 22-gauge needle. oozing of blood from sites occurred up to 24 h after therapy

Hematocrit 40% before and 26% after procedure. 10ml/kg pRBC given during procedure and again 10 mL/kg pRBC given after. 20ml/kg was given over 48 h after procedure, raising Hct to 38%. Normal coag studies prior, after PTT was 85 sec and corrected with post-op 10ml/kg FFP

Cefazolin and gentamicin given for 72 h after procedure

Yes

No

Failed initial tx bilateral incisions after injection of dilute heparin solution into glans penis; given total of 40 mg/kg packed RBCs to control Hg levels; given 10 mg/kg FFP due to increased PTT

Hirudo medicinalis

Engorged leeches were killed with immersion in isopropyl alcohol and discarded as biohazard waste

Isgar and Turner, 198923, 2611633

16

81

M

UK

Scrotal hematoma s/p bilateral hydroceles/epididymal cysts

Intraoperative 200 ml blood evacuated from scrotum, tissue remained tense

Applied to scrotum until engorged with blood (approx. 20 min), Process was repeated 6 days daily with 6 leeches per day

Not discussed

Not discussed

Yes

No

Not discussed

Not discussed

Leeches were placed in 6% solution for 2min, where blood was regurgitated, and placed in individual tanks containing rainwater.