Archivos Espanoles De Urologia最新文献

Objective: Urinary tract infection (UTI) frequently occurs in patients with ureteral calculi and metabolic syndrome (MetS). Timely recognition of patients at elevated risk remains a clinical challenge. This study aimed to construct and internally validate a nomogram for assessing the risk of UTI in this population.

Materials and methods: We retrospectively reviewed the data of 254 patients diagnosed with ureteral calculi and MetS who were hospitalised between January 2022 and March 2025. Baseline patient characteristics, clinical parameters, laboratory test results and imaging findings were systematically collected. Factors showing significant differences (p < 0.05) between patients with and without UTI were examined for multicollinearity and then entered into a multivariable regression framework to determine independent predictors. A risk-prediction nomogram based on these key determinants was subsequently constructed. The model's performance was assessed through the area under the receiver operating characteristic curve (AUC), calibration plot, Hosmer-Lemeshow goodness-of-fit test, Brier score and decision curve analysis (DCA). Internal validation was conducted using bootstrap resampling.

Results: Multivariate analysis identified periureteral fat stranding, tissue rim sign, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and positive urine nitrite as independent predictors of UTI. The constructed nomogram exhibited robust discriminative ability (AUC = 0.783; 95% confidence interval (CI): 0.702-0.863) and satisfactory calibration (χ²= 6.867, p= 0.551; Brier score = 0.118). Bootstrap validation confirmed model stability (AUC = 0.783). DCA indicated that the nomogram yielded a superior net clinical benefit compared with strategies of treating all or none with a probability threshold of 0.1-0.85.

Conclusions: The proposed nomogram accurately predicts the risk of UTI in patients with ureteral calculi and MetS. The integration of imaging features, haematologic inflammatory markers and urinalysis results enables individualised risk assessment,facilitating the early detection of high-risk patients and informing timely preventive and therapeutic interventions.

Background: Vesicourethral anastomotic stenosis (VUAS) is a rare but complex complication following radical prostatectomy (RP), with an incidence ranging from 0.5% to 33% depending on surgical approach, surgeon experience and prior radiotherapy. Risk factors include intraoperative bleeding, urinary leakage, infection and adjuvant treatments. Despite advances in minimally invasive and robotic surgery, VUAS remains a significant cause of morbidity, often compromising urinary function and quality of life. Our objective is to evaluate the surgical and functional outcomes of perineal vesicourethral re-anastomosis in patients with recurrent VUAS after radical prostatectomy.

Methods: We retrospectively reviewed 12 patients with recurrent VUAS treated between 2017 and 2024 by a single surgeon, with a minimum follow-up period of 6 months. All had at least one failed endoscopic treatment and preoperative incontinence. Anatomic success was assessed by urethrogram or urethroscopy. Descriptive analysis was conducted on demographic, surgical and outcome data.

Results: The mean patient age was 71 years, with a median interval of 42-4 months (interquartile range (IQR) 9.5-86.1) from RP to stenosis diagnosis. Minor postoperative complications (Clavien I-II) occurred in three patients. Anatomical success, defined as the atraumatic passage of a 16 Fr cystoscope and/or absence of radiological stenosis, was achieved in 83.3% of cases with a mean follow-up of 39.5 months (standard deviation (SD) 24.7). At follow-up, urinary incontinence persisted in the majority of patients, and seven underwent artificial urinary sphincter implantation with satisfactory functional outcomes. One patient developed a urosymphyseal fistula complicated with pubic osteitis, ultimately requiring cystectomy and pubectomy.

Conclusions: Perineal vesicourethral re-anastomosis represents an effective salvage strategy for recurrent VUAS after RP, providing high rates of urethral patency. However, it carries a substantial risk of postoperative incontinence, frequently necessitating subsequent continence surgery. Management should be centralised in reconstructive referral centres to optimise anatomical and functional outcomes.

Background: Artificial intelligence (AI) and big data are transforming urological oncology by enhancing diagnostic precision, prognostic assessment and treatment personalisation for prostate, bladder and kidney cancer.

Methods: We searched PubMed and MEDLINE up to September 2025 for English-language, peer-reviewed human studies using terms including "artificial intelligence", "deep learning", "radiomics", "real-world evidence" and "urological oncology".

Results: AI-driven radiomics and deep learning models have demonstrated high accuracy in detecting and characterising urological malignancies by using magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET) and histopathology. In prostate, bladder and kidney cancers, AI-driven radiomics and deep learning models have demonstrated high diagnostic performance, with reported area under the curves (AUCs) typically ranging from 0.80 to 0.95 for lesion detection, staging and risk stratification. Sensitivities and specificities in cystoscopic image analysis often exceed 90%, but radiogenomic models for renal cancer achieve mutation prediction accuracies of 85%-95%.

Conclusions: AI and big data are reshaping urological oncology by integrating diagnostic imaging, pathology and real-world practice. Their continued integration promises a precise, equitable and adaptive model of cancer care. Despite these robust results, most studies rely on retrospective or single-centre datasets with limited external validation, raising concerns about generalisability. Future progress will depend on multicentre standardisation, federated learning frameworks and incorporation of multimodal real-world data to facilitate clinically robust and implementable AI systems.

Objective: This study aims to analyse factors influencing maternal postpartum stress urinary incontinence (SUI) and construct a prediction model using a nomogram.

Methods: A retrospective analysis of clinical data was conducted on 500 women who delivered at our hospital between June 2021 and June 2024, of whom 147 developed postpartum SUI. The participants were randomly assigned to the modelling (n = 354) or validation groups (n = 146) in a 7:3 ratio. The modelling group was further subdivided on the basis of postpartum SUI occurrence: SUI (n = 106) and non-SUI groups (n = 248). Relevant factors were identified through logistic regression analysis, and a nomogram was constructed using R software. The nomogram was evaluated through receiver operating characteristic, calibration and decision curves.

Results: Significant differences existed between the SUI and non-SUI groups in maternal educational attainment, newborn weight, current address, natural birth and gestation period (p < 0.05). Educational attainment (junior high school and below), increase in newborn weight, rural residence, natural birth and parity (≥ 2) were identified as risk factors for postpartum SUI (p < 0.05). The nomogram showed good predictive performance with area under the curve (AUC) values of 0.778 and 0.754 for the modelling and validation groups, respectively (p < 0.05).

Conclusions: Maternal educational attainment, newborn weight, current address, natural birth and gestation period are risk factors for postpartum SUI. Based on these factors, the proposed nomogram model is a potentially reliable tool for predicting postpartum SUI risk.

Introduction: The treatment for severe male stress urinary incontinence (SUI) following surgery refers to the implantation of an artificial urinary sphincter (AUS). Traditionally, the procedure requires two incisions: Perineal and inguinal.

Objective: To present a series of patients treated with the Zephyr 375 AUS implanted via a single perineal incision.

Materials and methods: We report 14 male patients with SUI following transurethral resection of the prostate (1) and radical prostatectomy (13). Preoperative assessment included a pad test and cystoscopy. Under epidural anaesthesia, bulbar urethra was exposed through a vertical perineal incision via dissection and division of the bulbospongiosus muscle. After catheter removal, the cuff was placed around the urethra and tested to ensure appropriate pressure and then deactivated. The pump-reservoir was positioned by digitally creating a scrotal dartos pouch from the perineum and secured with a 3/0 Vicryl. The perineum was closed, and a urinary catheter was installed.

Results: The mean age was 65 years (55-74), and the average operative time was 64 minutes (50-85). All patients were discharged the following day without a catheter. Each one of them can palpate the pump-reservoir in the scrotum. After activation, all patients achieved continence, with five requiring a safety pad. During follow-up, four patients required pressure adjustment due to diminished continence with desirable outcomes. Patient satisfaction was notably high.

Conclusions: After a mean follow-up of 19 months, the Zephyr 375 AUS demonstrated good functional outcomes for the treatment of severe male SUI. The system allowed for effective pressure adjustments when efficacy diminished. Implantation via a single perineal approach simplifies the procedure and reduces morbidity associated with dual-incision techniques.

Background: Bladder cancer (BC) represents the most prevalent malignancy within the urinary system. Mounting evidence underscores the critical involvement of ferroptosis in cancer pathogenesis; Consequently, this study delves into its molecular underpinnings and therapeutic potential specifically in BC.

Methods: We analyzed gene expression profiles from The Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus (GEO) repositories. Ferroptosis-related genes (FRGs) were selected from the FerrDb database. Utilizing systematic bioinformatics analyses, we identify differentially expressed and prognostic FRGs and construct an FRGs prognostic model. Combined with protein-protein interaction (PPI) analysis, solute carrier family 3 member 2 (SLC3A2) was selected for further study. Following targeted small interfering RNA (siRNA)-mediated knockdown of SLC3A2 in BC cell lines, we conducted comprehensive functional assays to evaluate its effect on malignant phenotypes, ferroptosis, and cisplatin sensitivity.

Results: SLC3A2 expression was significantly elevated in BC cells ( p < 0.001). Its knockdown inhibited the proliferation, migration, and invasion abilities and promoted erastin-induced ferroptosis, as evidenced by increased reactive oxygen species (ROS), lipid peroxidation, and iron accumulation (all p < 0.05). SLC3A2 depletion also enhanced cisplatin sensitivity.

Conclusions: Collectively, these findings establish SLC3A2 as playing a vital oncogenic role in BC tumorigenesis and progression. Its function in inhibiting ferroptosis-especially during cisplatin-based chemotherapy-makes it a promising therapeutic target.

Background: Bone metastasis (BM) is a common complication associated with advanced prostate cancer (PCa). The multiparametric features of transrectal ultrasound (TRUS) in PCa patients with BM remain poorly characterized. This study examined the presence of TRUS in patients with BM and developed a clinical nomogram for risk assessment.

Methods: From December 2021 to September 2023, 114 consecutive patients with pathologically confirmed PCa were enrolled in this study. Based on the bone scan results, the patients were classified into BM (n = 56) and non-BM (n = 58) groups. Clinical, baseline TRUS, and transrectal contrast-enhanced ultrasound (TR-CEUS) data were recorded. Predictors of BM were identified using univariate and multivariate logistic regression. A nomogram was developed and internally validated via bootstrap resampling (1000 repetitions). The performance of the model was assessed using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).

Results: The results of the multivariate analysis revealed three independent predictors of BM, which included elevated total prostate-specific antigen (T-PSA) (odds ratio (OR) = 4.745, 95% CI: 2.177-10.344, p = 0.018), higher Gleason score (GS) (OR = 1.844, 95% CI: 1.144-2.970, p = 0.012), and TR-CEUS wash-in presence (OR = 3.268, 95% CI: 1.014-10.538, p = 0.047). The nomogram that incorporated these predictors showed strong discrimination, with an area under the curve (AUC) of 0.899 (95% CI: 0.841-0.96) in the development cohort and 0.859 (95% CI: 0.765-0.968) upon internal validation. Calibration was satisfactory, and the model offered significant net clinical benefits.

Conclusions: We found that TR-CEUS wash-in is an independent predictor of BM in PCa patients. Based on the clinical parameters T-PSA, GS, and TR-CEUS, a nomogram might provide a clinical reference for accurately assessing BM.

Clinical trial registration: This study was registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn) (Registration No. ChiCTR 2400082813).

Objective: This study aims to evaluate the characteristics of patients with urinary stone disease before and during the pandemic and to assess the impact of the pandemic on diagnosis-to-treatment intervals and treatment outcomes.

Materials and methods: Medical records, laboratory values and radiological images of patients who underwent ureterolithotripsy, retrograde intrarenal surgery and percutaneous nephrolithotomy for ureteral and renal stones before and during the pandemic were retrospectively analysed. Pregnant women and patients under the age of 18 were excluded from the study. The patients' demographic data, number of stones, stone size, stone location, hydronephrosis, impacted stones, creatinine levels, duration of surgery, stone-free rates, hospital stay, complication rates and diagnosis-to-treatment intervals before and during the pandemic were compared.

Results: A total of 162 patients with ureteral stones and 129 patients with kidney stones were included in the study. During the pandemic, complication rates and diagnosis-to-treatment intervals were considerably higher in patients with kidney and ureteral stones. Furthermore, the presence of impacted stones for ureteral stones and the presence of hydronephrosis for kidney stones emerged as predictors of complications.

Conclusions: During the pandemic, delays were observed in the diagnosis and treatment of patients with both renal and ureteral stones. This delay negatively affected the patients' clinical characteristics at presentation (hydronephrosis) and surgical outcomes (complication rates). Therefore, patients with urolithiasis should be prioritised in exceptional situations, such as pandemics.

Objective: To investigate the risk factors of urinary tract infection (UTI) after the ureteroscopic treatment of renal calculi and analyse the correlation amongst serum inflammatory markers, perioperative factors and infection occurrence.

Methods: A retrospective analysis was conducted on patients who underwent ureteroscopic lithotripsy and stone extraction at the authors' hospital. On the basis of postoperative diagnostic criteria, patients were categorised into the infection (n = 60) and noninfection (n = 150) groups. The serum levels of C-reactive protein (CRP), procalcitonin (PCT), lipopolysaccharide (LPS), endotoxin (ET) and interleukin-8 (IL-8) were measured preoperatively and postoperatively in both groups. In addition, the maximum stone diameter, operative time and postoperative catheterisation duration were recorded. The correlations amongst serum markers, perioperative factors and UTI were analysed, and univariate and multivariate logistic regression analyses were performed to identify independent risk factors.

Results: No significant differences in baseline characteristics or preoperative serum markers were found between the two groups (p > 0.05). The postoperative serum levels of CRP, PCT, LPS, ET and IL-8 were significantly higher in the infection group than in the noninfection group (p < 0.05). Maximum stone diameter did not differ significantly between groups (p > 0.05). However, operative time and postoperative catheterisation duration were markedly longer in the infection group (p < 0.05) than in the noninfection group. Postoperative UTI showed a positive correlation with CRP, PCT, LPS, ET, IL-8, operative time and catheterisation duration (p < 0.001). Multivariate logistic regression analysis identified PCT, IL-8 and postoperative catheterisation duration as independent risk factors for infection (p < 0.05). Although CRP, ET and operative time did not reach statistical significance, all had odds ratio > 1, suggesting a potential association with increased infection risk.

Conclusions: Postoperative UTI following ureteroscopic lithotripsy is closely associated with elevated serum inflammatory markers and perioperative factors. Increased PCT and IL-8 levels, as well as prolonged postoperative catheterisation, were identified as independent risk factors. Monitoring perioperative inflammatory indicators and optimising surgical and catheter management may reduce the incidence of postoperative UTI and provide a basis for individualised preventive strategies in clinical practice.