Archivos Espanoles De Urologia最新文献

Background: We aimed to investigate the effect of the difference in apnoea severity on the degree of lower urinary tract symptoms (LUTS) and of erectile dysfunction (ED) in patients diagnosed with obstructive sleep apnoea (OSA).

Materials and methods: Between March 2019 and June 2024, 81 patients diagnosed with OSA were included in the study. Polysomnography (PSG) reports were analysed, and patients were divided into three groups according to the apnoea-hypopnea index. PSG parameters were recorded. Patients were evaluated by urologic examination, ultrasonography, uroflowmetry and blood tests. Scales such as the International Prostate Symptom Score (IPSS), quality of life (QoL) related to urinary symptoms and International Index of Erectile Function (IIEF) were used for scoring. Intergroup comparisons were made using the Kruskal-Wallis test and Chi-square test.

Results: Age, smoking, prostate-specific antigen and number of periodic leg movements per hour were not correlated with apnoea severity. Body mass index (BMI), prostate volume, minimum and maximum partial oxygen pressure, uroflowmetry parameters, IPSS, QoL, bladder wall thickness and IIEF score were correlated with OSA severity.

Conclusions: Determining the factors associated with the severity of sleep apnoea could provide insights into mitigating the adverse effects associated with OSA. Increased severity of OSA leads to increased severity of LUTS and ED.

Background: Benign prostate hyperplasia (BPH) is a common health problem amongst men worldwide. It has a multifactorial ethiology, and in some societies, urinating in a standing position is believed to cause BPH. Although the effect of urination position on voiding parameters has been extensively investigated, whether they have a role in the aetiology of BPH is not known.

Material and methods: The patients who had (n = 89) and had not ever used (n = 213) alpha-blockers were included in the study. All patients were divided into four groups in accordance with their past urination habits: Group 1 (I always pee in a standing position), group 2 (I mostly pee in a standing position), group 3 (I mostly pee in a sitting position) and group 4 (I always pee in a sitting position). The current uroflowmetry results, prostate volumes (PVs) and International Prostate Symptom Score (IPSS) of the groups were compared.

Results: The IPSSs of groups 1-4 (total n = 213) who had not used alpha-blockers before were 10 (9-16), 10 (7-14), 10 (7-14) and 10 (8-13) points, respectively; Their median PVs were 40, 35, 40 and 40 mL, respectively; And their average maximum urinary flow rate (Qmax) values were 17 (12.7-20.5), 1.46 (11.1-20), 15 (12.4-18.9) and 15.6 (11.7-19.5) mL/s, respectively. No statistical difference was observed between the groups. Alpha-blockers were started in 104 patients who had not used alpha-blockers before in accordance with their clinical results. When these 104 patients who were started on alpha-blockers for the first time and 89 patients who were started on alpha-blockers before were examined together, the average ages of starting alpha-blockers were 59.9 ± 7.1, 60.5 ± 6.7, 59.6 ± 6.5 and 60.8 ± 6.7 years. No statistical difference was observed between the groups. Patients with and without clinical BPH were compared in terms of past urination habits. In both groups, the rates of patients who always or mostly urinated whilst sitting (60%-61%) and those of patients who always or mostly urinated whilst standing (39%-40%) were similar.

Conclusions: This retrospective study showed that positional urination habits do not have a role in the aetiology of BPH. However, multicentre prospective studies with a larger patient population are needed.

Objective: This meta-analysis evaluates the effect of immune checkpoint inhibitors (ICIs) on advanced prostate cancer, assessing efficacy and safety profiles compared with non-ICI regimens.

Methods: We searched PubMed, Web of Science, Embase and Cochrane Library for pertinent studies, including randomised controlled trials and nonrandomised controlled trials on immunotherapy for prostate cancer. R software was employed for meta-analysis to assess hazard ratios (HRs) for median survival, overall survival (OS), objective response rate (ORR) and serum prostate-specific antigen (PSA) response rate. Egger test, funnel plot analysis and sensitivity analysis were performed to evaluate the results. Heterogeneity sources were explored via meta-regression.

Results: Our study included 19 studies with 3661 participants. Findings indicated no significant improvement in OS (HR = 1.04, 95% confidence interval (CI) = 0.9-1.18), progression-free survival (HR = 0.95, 95% CI = 0.83-1.09) or response rates (PSA = 0.12, 95% CI = 0.08-0.18; ORR = 0.12, 95% CI = 0.08-0.18), with substantial variation in outcomes (I² ≥60%). The rates of adverse events (AEs) varied, with notable incidences of Grade ≥3 reactions. The incidence rates for immune-related AEs were Grade ≥3 AEs, and all-grade AEs 0.37 (95% CI = 0.12-0.72, I² = 96%, p < 0.01), 0.90 (95% CI = 0.83-0.94, I² = 92%, p < 0.01) and 0.38 (95% CI = 0.28-0.49, I² = 94%, p < 0.01). In the meta-regression analysis of confounding factors, only therapy was determined to be significant in PSA response rate.

Conclusions: ICI therapy exhibits potential efficacy in some patients with prostate cancer. However, its widespread application is limited by its uncertain efficacy and potential adverse reactions. Future research should focus on optimising patient selection through biomarkers and improving ICI treatment strategies to enhance efficacy and safety.

Background: Prostate cancer (PCa) is the most commonly diagnosed cancer in men worldwide. Prostate-specific antigen (PSA) is widely used in PCa suspicion but lacks specificity. Additional markers, such as PSA density, free:total PSA ratio and multiparametric prostate magnetic resonance imaging (MRI), are employed. This study evaluated the role of hypothalamo-pituitary axis hormones and adrenal-derived androgens in predicting PCa and clinically significant PCa (csPCa).

Patients and methods: This prospective cohort study included 464 male patients scheduled for transrectal prostate biopsy due to elevated PSA or abnormal digital rectal examination findings. Patients were divided into two groups on the basis of biopsy results: Group 1 (benign) and Group 2 (PCa). Prebiopsy levels of PSA, total testosterone (TTE), luteinising hormone (LH), follicle-stimulating hormone (FSH), oestradiol (EST), prolactin (PRL), testosterone density (TTEd), PSA density (PSAd) and dehydroepiandrosterone sulphate (DHEAS) were examined. Patients were also categorised into three groups to assess csPCa: Group A (no malignancy or clinically insignificant PCa), Group B (csPCa) and Group C (clinically insignificant PCa).

Results: Group 2 had significantly lower DHEAS levels (p = 0.03) and higher TTEd (p < 0.05) and PSAd (p < 0.05) levels than Group 1. No significant differences were found in FSH, LH, EST, TTE and PRL levels between groups (p > 0.05). The comparison of patients with csPCa (Group B) with patients in other groups revealed that DHEAS (p < 0.05) levels were significantly lower and PSAd (p < 0.05) was significantly higher in Group B than in other groups. DHEAS levels showed a negative correlation with age (r = -0.387, p < 0.05). In patients over 65 years of age, low DHEAS levels were significantly associated with csPCa (p < 0.05).

Conclusions: Serum PSA alone is insufficient for PCa diagnosis. DHEAS and TTEd are useful in predicting PCa and csPCa. The decrease in DHEAS levels is associated with an increased risk of PCa and csPCa, suggesting its potential role as a marker in patient management. Further large-scale studies are needed to confirm these findings.

Objective: This study explored an infection control management mode effect that prevents catheter-associated urinary tract infection (CAUTI) in an intensive care unit (ICU).

Methods: A retrospective cohort study was conducted on patients who received indwelling catheters from February 2020 to February 2022 in the ICU ward. Patients were categorised into two groups, including the study (implemented the infection control management model) and reference groups (received the usual clinical management protocols), based on different clinical management protocols. The CAUTI results at different moments of the patients' lives were examined, and the groups were compared in terms of CAUTI incidence, catheter retention time, Family Satisfaction with Care in the Intensive Care Unit-24 (FS-ICU-24) and Acute Physiology and Chronic Health Evaluation II (APACHE-II).

Results: A total of 102 patients were included in this study, with 48 and 54 allotted to the study and reference groups, respectively. No significant difference in the CAUTI control rate was found between the groups at 2 and 5 days (p > 0.05), whereas the CAUTI control rate at 7 days in the study group was significantly lower than that in the reference group (p < 0.05). The FS-ICU-24 score of the study group was significantly higher than that of the reference group, whereas the APACHE-II score was significantly lower (p < 0.001). The study group's catheter retention and ICU treatment times were significantly lower than those of the reference group (p < 0.001).

Conclusions: The implementation of infection control management mode can effectively reduce the incidence of CAUTI in ICU patients, improve clinical satisfaction and shorten catheter retention time, and thus, it exhibits a certain clinical application value.

Background: This study aimed to investigate the impact of Watson's Caring Model in Nursing (WCMN) on self-esteem, depression, resilience, quality of life, and patient satisfaction as well as determine potential outcome differences between patients receiving this personalised nursing care model and those provided with standard nursing care.

Methods: This retrospective study included 113 patients who underwent radical prostatectomy at our hospital from January 2023 to June 2023. According to the type of care received, the patients were categorised into a traditional nursing group (n = 67) and a WCMN group (n = 46). Data collected from the patients included demographic information and the measurements of self-esteem (Self-Esteem Scale), depression (Hamilton Depression Rating Scale), resilience (Connor-Davidson Resilience Scale), and quality of life (Short Form 12) at baseline and 1 week post-surgery.

Results: The WCMN group showed a significant increase in follow-up self-esteem scores compared to those in the traditional nursing group (t = 2.547, p = 0.012). Additionally, the WCMN group exhibited significantly lower follow-up depression scores (t = 2.035, p = 0.044) and higher resilience scores (t = 2.046, p = 0.044) and quality of life scores (t = 2.100, p = 0.038) than the traditional nursing group. Lastly, patient satisfaction scores, including overall satisfaction, nursing care satisfaction, information satisfaction, emotional support satisfaction, and involvement satisfaction scores, were significantly higher in the WCMN group than in the traditional nursing group (p < 0.05).

Conclusions: WCMN has a beneficial effect on self-esteem, depression, resilience, quality of life, and patient satisfaction in patients who undergo radical prostatectomy for prostate cancer.

Background: Lower urinary tract symptoms are observed in individuals with pathologies affecting the lower urinary system. This survey aimed to evaluate the prevalence of lower urinary tract symptoms and the contributing factors amongst medical students, a young population undergoing a stressful educational process.

Methods: A 43-question survey was prepared for the first to sixth year medical students, incorporating the constipation scoring system to evaluate constipation, the generalized anxiety disorder 7-item scale to assess anxiety levels, and the core lower urinary tract symptom score to explore the lower urinary tract symptoms. The survey collected data on dietary habits, smoking status, consumption of alcoholic and caffeinated drinks, living conditions, age, gender, body mass index and educational level of the participants.

Results: The sample included 222 participants, with a median age of 22 years. The participants consisted of male (46.4%) and female (53.6%) students. The prevalence of lower urinary tract symptoms was 83.78%. Amongst storage symptoms, urgency was the most frequent, affecting 59.0% of participants. Additionally, 58.10% of individuals experienced at least one voiding symptom, with the feeling of incomplete bladder emptying being the most common. In multivariate analyses, constipation (p < 0.001), gender (p = 0.016), anxiety (p = 0.027) and smoking (p = 0.014) were risk factors for storage symptoms, and increased body mass index (p = 0.048) and constipation (p < 0.001) were risk factors for voiding symptoms.

Conclusions: This study highlights the high prevalence of lower urinary tract symptoms amongst medical students and identifies various contributing factors. The findings underscore the need for awareness and interventions to address lower urinary tract symptoms in this population, particularly considering its effect on quality of life.

Background/purpose: Addressing perioperative anxiety, pain and restlessness and promoting family involvement through the family-centred care (FCC) model and video education may lead to improved postoperative outcomes. This study aimed to evaluate the effect of combining the FCC model with video education on the postoperative recovery of paediatric patients who underwent urological surgery.

Methods: This prospective randomised controlled study enrolled 200 paediatric patients who were undergoing general anaesthesia and recovery in the post-anaesthesia care unit at The First Affiliated Hospital of Sun Yat-sen University from January to April 2024. They were randomly assigned to Group A (routine care), Group B (routine care + video education), Group C (routine care + FCC model) and Group D (routine care + video education + FCC model), with 50 cases in each group. Various indicators, including recovery trajectory, agitation and pain scores, psychological states and treatment compliance, were assessed and compared amongst the groups.

Results: In the analysis of recovery trajectories, no significant differences were found amongst the groups in terms of time to resume breathing and extubation duration (p > 0.05). However, a notable distinction was observed in the recovery time of anaesthesia across the groups (p < 0.001). Compared with Groups B and C, Group D exhibited significant improvement in agitation and pain scores (p < 0.05). In addition, Group D had significantly lower anxiety level and higher treatment compliance than Groups B and C (p < 0.05).

Conclusions: The combined approach of the FCC model and video education may improve postoperative recovery outcomes in paediatric patients who underwent urological surgery. Hence, this approach is worth promoting and applying in clinical practice.

Background: Bladder cancer is a common malignancy that arises from the urothelium. Treatment options for advanced bladder cancer remain limited, particularly in patients who have progressed after first-line therapy. Immunotherapy with programmed death-ligand 1 (PD-L1) inhibitors, such as durvalumab, has shown promise in improving outcomes in these patients. Radiotherapy (RT) is another modality that can be integrated to enhance local tumour control. This study explored the efficacy and safety of combining durvalumab with RT as a second-line treatment for patients with advanced bladder cancer, aiming to provide insights into its potential therapeutic benefits. Bladder cancer is a type of malignant tumour that arises from the epithelial lining of the bladder and commonly manifests as haematuria and frequent urination.

Methods: A total of 58 patients who were diagnosed with advanced bladder cancer and treated at our hospital between January 2020 and June 2022 were retrospectively analysed. Patients were divided into two groups: A control group (n = 33) receiving durvalumab monotherapy and an observation group (n = 25) receiving durvalumab combined with RT. The remission rates, two-year survival rates, median survival times, serum tumour marker levels and adverse events of the two groups were compared.

Results: Before treatment, the differences in the serum tumour marker levels between the two groups (p > 0.05) were not significant. Compared with the control group, the observation group presented significantly lower serum tumour marker levels (p < 0.05). Furthermore, compared with the control group, the observation group had a higher overall clinical objective response rate (96.00% vs. 75.76%) and a better two-year survival rate (40.00% vs. 15.15%). Additionally, progression-free survival (PFS) was longer in the observation group (18 months vs. 16 months, p = 0.001).

Conclusions: Durvalumab combined with RT as a second-line treatment for advanced bladder cancer effectively reduces the expression of tumour markers and improves two-year survival and PFS, offering valuable clinical insights.

Objective: Approximately one-third of individuals diagnosed with prostate cancer (PCa) experience biochemical recurrence (BCR) following their initial curative therapy. BCR significantly increases the risk of distant metastases and is associated with higher mortality rates, particularly in patients with poor prognostic indicators. This study aims to investigate the strong correlation between positive surgical margins (PSMs) and BCR after radical prostatectomy, offering foundational insights and guidance for predicting patient survival and optimising postoperative intervention strategies.

Methods: A retrospective analysis was conducted on the clinical data of 498 patients who underwent laparoscopic radical prostatectomy between January 2015 and January 2021 at Ningbo Yinzhou No.2 Hospital. Pathological specimens and medical records were reviewed. Of these, 127 patients with PSMs and 279 patients with negative surgical margins (NSMs) were included in the statistical analysis. The analysis incorporated clinical and pathological parameters, including primary tumour characteristics, PSMs, pathological tumour staging, surgical margin status, Gleason grade group, and other relevant factors, with BCR-free survival as the primary endpoint.

Results: During the follow-up period of this study, 129 cases of BCR were identified among the 406 patients. Of these, 34 cases occurred in patients with PSMs, accounting for approximately 26.8% (34/127), and 95 cases occurred in patients with NSMs, accounting for approximately 34.1% (95/279). The difference in recurrence between the two groups was statistically significant (p < 0.001). The median time to BCR was 19.2 months for patients with PSMs, compared to 28.2 months for patients with NSMs, with this difference also reaching statistical significance (p < 0.001). The Gleason grading group in patients with PSMs was a stronger predictor of recurrence than the primary tumour characteristics.

Conclusions: The presence of PSMs is a significant independent predictor of BCR in patients undergoing radical prostatectomy for PCa. Early detection and timely intervention for patients with PSMs are crucial for improving postoperative outcomes.