Mini Review Open Access
Volume 4 | Issue 2 | DOI: https://doi.org/10.33696/Signaling.4.093

A Study on the Usage of Probiotics as a Safer Antipyretic

  • 1MPH Scholar, School of Public Health, JSS Medical College, Mysore - 570015, India
+ Affiliations - Affiliations

*Corresponding Author

Shantanu Shrivastava, shri.shantanu20@gmail.com

Received Date: March 01, 2023

Accepted Date: May 08, 2023


Most medicines and supplements which include probiotics have both expected clinical outcomes and unwanted side effects, which plays a major role when considering them as a mode of treatment. This review is an update about the advantages and disadvantages associated with the use of probiotics as part of a safe therapeutic armamentarium in health and other diseases. The advantages of probiotics run across multiple tissue systems in the body and a has a wide age spectrum. Probiotics also promote cardiovascular health, accelerate recovery from the condition of antibiotic-associated diarrhoea, decrease the effect of necrotizing enterocolitis with reduced inflammation, and accelerate the healing of the wound. Probiotics also contribute in treating chronic diseases for patients with type 2 diabetes as well as patients with HIV/AIDS. Moreover, probiotics play an important role in the treatment and/or prevention of cancers, especially those of the colon and bladder. On the other hand, probiotics also mimic serious threats to immunocompromised, genetically predisposed bodies, children, and newborns. Using probiotics may lead to bacteremia, fungemia, or septicemia when consumed more. Also, probiotics are found as a causative agent for pneumonia and abdominal abscesses, increase platelet aggregation, and promote antibiotic resistance among others. A huge number of microorganisms inhabit the human gut and consequently cause a compound network of the interactions of those organisms with each other and within the host cells, which stresses the requirement of extra caution in the use of probiotics as treatment therapy.


Probiotics, Prebiotics, Carcinoma, Bacteremia, Lactobacillus, Pathogens


‘Probiotic’ is a derived Greek word which means ‘for life.’ It is considered the opposite of the term antibiotics and has had different meanings over time. The Probiotic was first introduced in mid 1950s’ by scientist Werner Kollath and was first used by Lilley and Stillwell in the year 1965 describing probiotics as a substance that are secreted by one microorganism mainly Lacto bacillus which stimulates the growth of another microorganism [1-3]. However in 1971, there was a different description of the word probiotics; as the tissue extracts which stimulates microbial growth and in 1974, scientist Parker defined Probiotics as “Organisms and substances which contribute to intestinal microbial balance” [4]. Probiotics is a field of study that is growing. A Medline search for the term "probiotics" turned up almost 1,000 publications, compared to 85 during the previous 25 years, indicating a huge increase in research in this area during the last 5 years [5]. This demonstrates the potential significance of this nascent field, but much work has to be done to clarify what a probiotic is and which strains satisfy the criteria for true probiotic bacteria. Despite mounting clinical evidence of the probiotics' true benefits, the commercial front has not yet caught up. Unfortunately, many products labelled as "probiotic" aren't actually "probiotic" because they haven't been sufficiently identified, documented, made using appropriate manufacturing techniques, or clinically validated [6]. Nevertheless, many companies make claims that lead consumers to believe they are using reliable goods. To guarantee the validity and effectiveness of probiotic products, creating guidelines and norms is an essential first step. These recently developed standards and recommendations will be covered later [7].


For papers without a language constraint, PubMed, Medline, Google Scholar, Scopus, and UpToDate databases were searched from 2010 to 2018. Reference lists, authors, reviews, comments, linked disorders, books, and meeting abstracts were also searched manually and in secondary. Probiotics AND bacteremia, cancer, Lactobacillus, opportunistic infections, microbiome, pregnancy, history, digestive system, oral health, side effects, inflammatory bowel disorders, irritable bowel syndrome, and colorectal cancer were the search phrases used to find this review paper. Initial search tactics were wide, followed by a focus on the relevant ailment. Using these search parameters, 150 articles were located, and 56 of them fit our review criteria. Each article was mined for data on research methodology, design, interventions, results, side effects, and treatments.

Probiotics As a Safer Antipyretic

Probiotics are non-pathogenic living microorganisms that comprise certain mutualistic bacteria that, when given to the host in the proper amount, can bestow health-promoting and disease-preventing qualities [8]. Probiotics must be accurately defined, refined to remain viable during their shelf life in a formulation, and have at least one successful human study to demonstrate their effectiveness and safety [9]. Lactic acid bacteria, comprising several strains of Lactobacillus, Bifidobacterium, Streptococcus, and Enterococcus, make up the majority of probiotics [10]. Of these, Lactobacillus and Bifidobacterium may be found in various fermented milk products as well as being sold commercially as nutraceuticals or functional foods. L. acidophilus LA14, a probiotic lactic acid bacterium, increases the beneficial bacteria in the gut, reduces opportunistic infections there, breaks down oxalates, produces bacteriocin, and improves immunological response [11-13]. Because they are popular nutraceuticals that are often regarded as safe and well-tolerated, probiotic dietary supplements may be a cutting-edge treatment approach for treating acetaminophen (APAP) toxicity. L. acidophilus LA14 has been demonstrated to have hepatoprotective properties in rats with an acute APAP overdose [14]. A drop in IL-1 levels in sera was another indication of how the probiotic reduced the hepatic inflammation brought on by APAP [15]. Furthermore, L. acidophilus LA14 treatment significantly decreased nuclear shrinkage in hepatocytes, inflammatory cell infiltration, and hepatic hemorrhage caused by APAP, according to liver sections [16].

Infection Control

The mechanisms by which probiotics function are still poorly understood and there are still many open research concerns. Probiotics do, however, play a part in modifying gut pH, preventing infections by producing antimicrobial compounds, competing for nutrients, growth factors, and pathogen binding and receptor sites, activating immunomodulatory cells, and producing lactase [17]. The most important characteristic of probiotics is that they have been demonstrated to be affordable, safe, and effective at preventing microbial diseases [18]. According to the World Health Organization in 1994, probiotics are thought to be the second-most important immune defense mechanism when commonly prescribed antibiotics stop working owing to antibiotic resistance. "Microbial interference therapy" refers to the use of probiotics to address antibiotic resistance [19].

How Probiotics Reduce the Duration of Diarrhea

There have been several proposed mechanisms for how Lactobacilli reduce rotavirus diarrhea, but none of them have been shown, and they all have drawbacks [20]. Initially, Lactobacilli link to receptors and prevent the virus from sticking and invading by connecting to them through competitive inhibition of receptor sites [21]. This theory may hold water if there was evidence of specialized receptor competition. Patients normally experience diarrhea for at least 12 hours by the time a probiotic is administered [21]. Mature enterocytes have already been infected by the virus in the middle and upper regions of the small intestinal villi. Fluid and glucose absorption is decreased when the virus and/or its enterotoxin, NSP4, interfere with the transfer of fluid and electrolytes [22]. The secretory reflexes may have been set off by the toxin, resulting in fluid loss from secretory epithelia and diarrhea. It is uncertain if such suppression would reduce diarrhea; at most, the viral attachment might benefit from competitive exclusion afterward [23]. If Lactobacilli competed in any manner with the toxin or peptides produced by villous endocrine cells, the chain of events that causes diarrhea may be prevented [24].

Table 1. Claimed health benefits of probiotic microorganisms.



Health benefits


L. rhamnosus

Viral-associated pulmonary damage reduction [25] 

L. plantarum

Antifungal activities and reduction in irritable bowel movements [26]

L. reuteri

Reduction in diarrhea associated episodes in children [27]


B. longum

Effective in gastrointestinal disease treatment [28] and allergic sensitization [29]


L. lactis subsp. Lactis

Adhesion of epithelial cells [30], antimicrobial activity against C. difficile sp. [31]


E. durans

Antibiotic and antioxidant activity [32], Anti-inflammatory activity [33]


S. thermophilus

Reduction in enterocolitis in preterm infants [34,35]


B. coagulans

Prevention of caries [36], treatment of bacterial vaginosis [37]


E. coli Nissle 1917

Treatment of constipation [37], prevention of ocular disease [38], reduction in intestinal colonization [39]

Other Miscellaneous Advantages of Probiotics

Probiotic usage in human and animal health has also been reported to offer other benefits. According to in vivo data, the probiotic Lactobacillus rhamnoses GG (LGG) has specific effects on mucosal physiology that speed up wound healing [40]. These effects are brought on by the previously established secretion of the proteins P40 and P75, which regulate epidermal growth factor receptor signaling. Moreover, the anti-infective and anti-inflammatory properties of probiotics can reduce the risk of infection while speeding up the healing of wounds. Probiotics have a specific place in the local management of chronic wounds in diabetes patients [41]. Probiotics begin to treat diabetic wounds by entering the dermis through the intercellular lipid matrix. They trigger the type 1 transmembrane protein toll-like receptors (TLRs), which have been discovered to be key signaling receptors for pathogen-associated molecular patterns, inside the dermis (PAMPs) [42]. The mouth, nasal cavity, keratinocytes, and Langerhans cells are only a few epithelia that have TLRs. Via the TLRs, probiotic-derived bioactivities (PDBs) promote the production of beta-defensin proteins (β-defensins) [43].

The β-defensins antibacterial and anti-inflammatory properties boost the skin's immune system. Moreover, TLRs are essential for the upregulation of collagen and elastin, a rise in cellular respiration, and an enhancement of the skin's clarity, texture, and overall appearance [44]. Gram-positive pathogens like Staphylococcus aureus and Enterococcus as well as Gram-negative bacteria like E. coli are prominent sources of bacterial infection in diabetic foot ulcers [45]. Lipoteichoic acid (LTA), produced by these bacteria, has been discovered to be a TLR 2 ligand. The inflammatory response of the bacterial membrane lipoproteins is mediated by TLR 2 [46]. The host recognizes PAMPs, or bacteria's components, and regulates cellular processes. Hence, it has been established that TLR 2 is crucial for the host's defenses against the microbes [47].

Probiotics and pathogens compete for attachment sites on the host cell's surface [48]. This binding may cause the host cells to produce anti-inflammatory cytokines, reducing inflammation at the tissue's surface. Probiotics can also secrete several antimicrobials that can either inhibit the spread of illnesses or eradicate them [49]. Probiotics can immunomodulate, which increases overall body immunity. During the same process, probiotics reacts with APC (Antigen Presenting cells) (macrophages and dendritic cells), which are essential for healing wounds and developing scars [50]. A 90% decrease in the size of chronic leg ulcers was observed in 43% of individuals with diabetes and 50% of non-diabetic patients after the 30 days of topical treatment with L plantarum. A significant decrease in colony-forming units was also observed after 5 days [51].

Several types of research have shown that strains of Lactobacilli are very effective in preventing antibiotic-associated diarrhea [52]. Lactobacilli species are easily available in the form of probiotics because of their crucial properties such as higher tolerance to hydrochloric acid and bile juice along with having the capability to adhere to the surfaces of the intestine and can also tolerate low pH [53,54]. Results show that Lactobacillus rhamnosus CRL1505 has been effective in reducing pulmonary damage due to viral infections by blocking the protein chains [25]. In a recently published meta-analysis, it has shown that probiotic stains were safe and effective in reducing urinary tract infections in adult women [55].

Conclusion and Future Research

In conclusion, because bacteria make up a significant physical portion of the gastrointestinal tract and other places, it is crucial that professionals recognize their existence and deliberately evaluate what role they may play in health and disease. Probiotics must be well documented to be used as therapeutic or health maintenance treatments. This includes the strain(s), product formulation, and mechanisms of action. The vast array of microbial species found in the gut must be further understood to employ probiotic strains in a way that makes sense given their interactions with host cells and one another. It's only that people are just now realizing how important microbes have always been to the human body.


This paper and the research behind it would not have been possible without the exceptional support of my co-author, Dr. Nimisha Bhatu. Her enthusiasm, knowledge, and exacting attention to detail have been an inspiration and kept my work on track to the final draft of this paper. The generosity and expertise of one and all have improved this study in innumerable ways and saved me from many errors; those that inevitably remain are entirely my responsibility.


1. Adams MR, Marteau P. On the safety of lactic acid bacteria from food. Int J Food Microbiol. 1995;27:263-4.

2. Aiba Y, Suzuki N, Kabir AM, Takagi A, Koga Y. Lactic acid-mediated suppression of Helicobacter pylori by the oral administration of Lactobacillus salivarius as a probiotic in a gnotobiotic murine model. Am J Gastroenterol. 1998;93:2097-101.

3. Gill HS, Rutherfurd KJ, Prasad J, Gopal PK. Enhancement of natural and acquired immunity by Lactobacillus rhamnosus (HN001), Lactobacillus acidophilus (HN017) and Bifidobacterium lactis (HN019). Br J Nutr. 2000;83:167-76.

4. Gionchetti P, Rizzello F, Venturi A, Brigidi P, Matteuzzi D, Bazzocchi G, et al. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Gastroenterology. 2000 Aug;119:305-309.

5. Glass RI, Lew JF, Gangarosa RE, LeBaron CW, Ho MS. Estimates of morbidity and mortality rates for diarrheal diseases in American children. J Pediatr. 1991 Apr;118(4 Pt 2):S27-33.

6. Gopal PK, Prasad J, Smart J, Gill HS. In vitro adherence properties of Lactobacillus rhamnosus DR20 and Bifidobacterium lactis DR10 strains and their antagonistic activity against an enterotoxigenic Escherichia coli. Int J Food Microbiol. 2001 Aug 5;67(3):207-16.

7. Gorbach SL. Probiotics and gastrointestinal health. Am J Gastroenterol. 2000;95:S2-4.

8. Guandalini S. Use of Lactobacillus-GG in paediatric Crohns disease. Dig Liver Dis. 2002;34(Suppl. 2):S63-S65.

9. Reid G, Charbonneau D, Erb J, Kochanowski B, Beuerman D, Poehner R, et al. Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women. FEMS Immunol Med Microbiol. 2003 Mar 20;35(2):131-4.

10. Reid, G., D. Charbonneau, S. Gonzalez, G. Gardiner, J. Erb, and A. W. Bruce. 2002. Ability of Lactobacillus GR-1 and RC-14 to stimulate host defences and reduce gut translocation and infectivity of Salmonella typhimurium. Nutraceut. Food 7:168-173.

11. Reid G, Cook RL, Bruce AW. Examination of strains of lactobacilli for properties that may influence bacterial interference in the urinary tract. J Urol. 1987 Aug;138(2):330-5.

12. Reid G, McGroarty JA, Tomeczek L, Bruce AW. Identification and plasmid profiles of Lactobacillus species from the vagina of 100 healthy women. FEMS Immunol Med Microbiol. 1996 Aug;15(1):23-6.

13. Reid G, Millsap K, Bruce AW. Implantation of Lactobacillus casei var rhamnosus into vagina. Lancet. 1994 Oct 29;344(8931):1229.

14. Reid G, Zalai C, Gardiner G. Urogenital lactobacilli probiotics, reliability and regulatory issues. J Dairy Sci. 2001;84:E164-E169.

15. Reveneau N, Geoffroy MC, Locht C, Chagnaud P, Mercenier A. Comparison of the immune responses induced by local immunizations with recombinant Lactobacillus plantarum producing tetanus toxin fragment C in different cellular locations. Vaccine. 2002 Mar 15;20(13-14):1769-77.

16. Saavedra JM, Bauman NA, Oung I, Perman JA, Yolken RH. Feeding of Bifidobacterium bifidum and Streptococcus thermophilus to infants in hospital for prevention of diarrhoea and shedding of rotavirus. Lancet. 1994 Oct 15;344(8929):1046-9.

17. Sanders ME, Morelli L, Bush S. “Lactobacillus sporogenes” is not a Lactobacillus probiotic. ASM News. 2001;67:385-6.

18. Scientific Committee on Animal Nutrition. 2001. Report of the Scientific Committee on Animal Nutrition on the criteria for assessing the safety of microorganisms resistant to antibiotics of human clinical and veterinary importance. European Commission Health and Consumer Protection Directorate-General.

19. Schwebke JR, Richey CM, Weiss HL. Correlation of behaviors with microbiological changes in vaginal flora. J Infect Dis. 1999;180:1632-6.

20. Sen S, Mullan MM, Parker TJ, Woolner JT, Tarry SA, Hunter JO. Effect of Lactobacillus plantarum 299v on colonic fermentation and symptoms of irritable bowel syndrome. Dig Dis Sci. 2002 Nov;47(11):2615-20.

21. Sewankambo N, Gray RH, Wawer MJ, Paxton L, McNaim D, Wabwire-Mangen F, et al. HIV-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis. Lancet. 1997 Aug 23;350(9077):546-50.

22. Thushara RM, Gangadaran S, Solati Z, Moghadasian MH. Cardiovascular benefits of probiotics: a review of experimental and clinical studies. Food & Function. 2016;7(2):632-42.

23. Kołodziej M, Szajewska H. Lactobacillus reuteri DSM 17938 in the prevention of antibiotic- associated diarrhoea in children: protocol of a randomised controlled trial. BMJ Open. 2017;7(1):e013928.

24. Di Gioia D, Aloisio I, Mazzola G, Biavati B. Bifidobacteria: their impact on gut microbiota composition and their applications as probiotics in infants. Applied Microbiology and Biotechnology. 2014;98(2):563-77.

25. Zelaya H, Tsukida K, Chiba E, Marranzino G, Alvarez S, Kitazawa H, et al. Immunobiotic Lactobacilli reduce viral-associated pulmonary damage through the modulation of inflammation-coagulation interactions. Int Immunopharmacol. 2014;19:161-173.

26. Ortiz L, Ruiz F, Pascual L, Barberis L. Effect of two probiotic strains of Lactobacillus on in vitro adherence of Listeria monocytogenes, Streptococcus agalactiae, and Staphylococcus aureus to vaginal epithelial cells. Curr Microbiol. 2014;68(6):679-84.

27. Szajewska H, Urbańska M, Chmielewska A, Weizman Z, Shamir R. Meta-analysis: Lactobacillus reuteri strain DSM 17938 (and the original strain ATCC 55730) for treating acute gastroenteritis in children. Benef Microbes. 2014 Sep;5(3):285-93.

28. Yu H, Liu L, Chang Z, Wang S, Wen B, Yin P, et al. Genome sequence of the bacterium Bifidobacterium longum strain CMCC P0001, a probiotic strain used for treating gastrointestinal disease. Genome Announc. 2013 Sep 12;1(5):e00716-13.

29. Schwarzer M, Srutkova D, Schabussova I, Hudcovic T, Akgün J, Wiedermann U, et al. Neonatal colonization of germ-free mice with Bifidobacterium longum prevents allergic sensitization to major birch pollen allergen Bet v 1. Vaccine. 2013;31:5405-12.

30. Yang X, Wang Y, Huo G. Complete Genome Sequence of Lactococcus lactis subsp. lactis KLDS4.0325. Genome Announc. 2013 Nov 27;1(6):e00962-13.

31. Lee JS, Chung MJ, Seo JG. In vitro evaluation of antimicrobial activity of lactic acid bacteria against Clostridium difficile. Toxicol Res. 2013;29:99-106.

32. Pieniz S, Andreazza R, Pereira JQ, de Oliveira Camargo FA, Brandelli A. Production of selenium-enriched biomass by Enterococcus durans. Biol Trace Elem Res. 2013;155:447-54.

33. Raz I, Gollop N, Polak-Charcon S, Schwartz B. Isolation and characterisation of new putative probiotic bacteria from human colonic flora. Br J Nutr. 2007;97:725-34.

34. Jacobs SE, Tobin JM, Opie GF, Donath S, Tabrizi SN, Pirotta M, et al. Probiotic effects on late-onset sepsis in very preterm infants: A randomized controlled trial. Pediatrics. 2013 Dec;132(6):1055-62.

35. Li D, Rosito G, Slagle T. Probiotics for the prevention of necrotizing enterocolitis in neonates: An 8-year retrospective cohort study. J Clin Pharm Ther. 2013;38:445-49.

36. Jindal G, Pandey RK, Agarwal J, Singh M. A comparative evaluation of probiotics on salivary mutans Streptococci counts in Indian children. Eur Arch Paediatr Dent. 2011;12:211-15.

37. Chmielewska A, Szajewska H. Systematic review of randomised controlled trials: Probiotics for functional constipation. World J Gastroenterol. 2010;16:69-75.

38. Stein E, Inic-Kanada A, Belij S, Montanaro J, Bintner N, Schlacher S, et al. In vitro and in vivo uptake study of Escherichia coli Nissle 1917 bacterial ghosts: Cell-based delivery system to target ocular surface diseases. Invest Ophthalmol Vis Sci. 2013;54:6326-33.

39. Deriu E, Liu JZ, Pezeshki M, Edwards RA, Ochoa RJ, Contreras H, et al. Probiotic bacteria reduce Salmonella typhimurium intestinal colonization by competing for iron. Cell Host Microbe. 2013;14:26-37.

40. Ratna Sudha M, Yelikar KA, Deshpande S. Clinical study of Bacillus coagulans unique IS-2 (ATCC PTA-11748) in the treatment of patients with bacterial vaginosis. Indian J Microbiol. 2012;52:396-9.

41. Embleton ND, Zalewski S, Berrington JE. Probiotics for prevention of necrotizing enterocolitis and sepsis in preterm infants. Current Opinion in Infectious Diseases. 2016;29(3):256-61.

42. AlFaleh K, Anabrees J. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Evid Based Child Health. 2014;9:584-671.

43. Hashemi A, Villa CR, Comelli EM. Probiotics in early life: a preventative and treatment approach. Food & Function. 2016;7(4):1752-68.

44. Sheil B, Shanahan F, O'Mahony L. Probiotic effects on inflammatory bowel disease. J Nutr. 2007 Mar;137(3 Suppl 2):819S-24S.

45. Omahony L, Feeney M, Ohalloran S, Murphy L, Kiely B, Fitzgibbon J, et al. Probiotic impact on microbial flora, inflammation and tumour development in IL-10 knockout mice. Alimentary

46. Ciorba M. A Gastroenterologist's Guide to Probiotics. Clin Gastroenterol Hepatol. 2012;10:960-8.

47. Bellavia M, Rappa F, Bello MLO, Brecchia G, Tomasello G, Leone A, et al. Lactobacillus casei and Bifidobacterium lactis supplementation reduces tissue damage of intestinal mucosa and liver after 2,4,6- trinitrobenzenesulfonic acid treatment in mice. J Biol Regul Homeost Agents. 2014;28(2):251-61.

48. Lenoir M, Carmen SD, Cortes-Pere NG, Lozano-Ojalvo D, Muñoz-Provencio D, Chain F, et al. Lactobacillus casei BL23 regulates Treg and Th17 T-cell populations and reduces DMH-associated colorectal cancer. Journal of Gastroenterology. 2016;51(9):862-73.

49. White JS, Hoper M, Parks RW, Clements WD, Diamond T, Bengmark S. The probiotic bacterium Lactobacillus plantarum species 299 reduces intestinal permeability in experimental biliary obstruction. Lett Appl Microbiol. 2006;42:19-23.

50. Whorwell PJ, Altringer L, Morel J, Bond Y, Charbonneau D, O’Mahony L, et al. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol. 2006;101:1581-90.

51. Yamada T, Nagata S, Kondo S, Bian L, Wang C, Asahara T, et al. Effect of continuous probiotic fermented milk intake containing Lactobacillus casei strain Shirota on fever in mass infectious gastroenteritis rest home outbreak. Kansenshogaku Zasshi. 2009;83:31-35.

52. Zhou JS, Pillidge CJ, Gopal PK, Gill HS. Antibiotic susceptibility profiles of new probiotic Lactobacillus and Bifido- bacterium strains. Int J Food Microbiol. 2005;98:211-7.

53. Tulumoglu S, Yuksekdag ZN, Beyatli Y, Simsek O, Cinar B, Yaşar E. Probiotic properties of Lactobacilli species isolated from children's feces. Anaerobe. 2013;24:36-42.

54. Lee SJ, Bose S, Seo JG, Chung WS, Lim CY, Kim H. The effects of co-administration of probiotics with herbal medicine on obesity, metabolic endotoxemia and dysbiosis: A randomized double-blind controlled clinical trial. Clin Nutr. 2014 Dec;33(6):973-81.

55. Grin PM, Kowalewska PM, Alhazzan W, Fox-Robichaud AE. Lactobacillus for preventing recurrent urinary tract infections in women: Meta-analysis. Can J Urol. 2013;20:6607-14.

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