Archivos Espanoles De Urologia最新文献

Background: Prostate cancer commonly affects older men. There is increasing interest in minimally invasive treatment options such as high-intensity focused ultrasound, which provides oncologic control with reduced side effects and functional preservation. We evaluated the oncologic and functional outcomes of whole-gland high-intensity focused ultrasound therapy for localized prostate cancer at a single tertiary center in Taiwan.

Methods: This retrospective study included 63 patients with primary localized prostate cancer with tumor stage ≤T2 and Grade Group 1-3 who were treated with whole-gland high-intensity focused ultrasound between July 2019 and October 2024. Outcomes included biochemical disease-free survival, prostate-specific antigen kinetics, and complication rates. Biochemical recurrence was defined using the American Society for Therapeutic Radiology and Oncology Phoenix criteria (nadir prostate-specific antigen level + 2 ng/mL). A contemporaneous group of patients that underwent robotic-assisted radical prostatectomy (RaRP) served as control.

Results: The median preoperative prostate-specific antigen level was 8.58 ng/mL. Nadir prostate-specific antigen levels averaged 0.43 ng/mL and were reached after 2.90 months. At a median follow-up of 14.73 months, 20.63% of the patients had experienced disease progression. Higher initial prostate-specific antigen levels, prostate-specific antigen levels at the procedure, and older age were significantly associated with recurrence (p < 0.05). The overall complication rate was 30.16%, without a high Clavien-Dindo grade (4/5). Six patients (9.09%) required high-intensity focused ultrasound twice due to persistent or recurrent disease.

Conclusions: Whole-gland high-intensity focused ultrasound showed comparable short-term oncological outcomes with an acceptable rate of complications in selected patients with localized prostate cancer. Despite positive preliminary results, the lack of standardized surveillance protocols and the variability in outcome definitions require further prospective randomized studies.

Introduction: Testicular prosthesis placement enhances body image and satisfaction in pediatric patients after orchiectomy due to testicular torsion. However, no standardized guidelines exist for the optimal surgical approach with minimal complications. Our aim is to describe a simple and reliable technique of testicular prostheses in pediatric patients, avoiding the inguinal approach.

Methods: A retrospective multicenter study was conducted on patients under 18 years who underwent prosthesis placement following orchiectomy for testicular torsion between 2016 and 2022 in four hospitals. Prostheses were inserted through a supracrescrotal incision at the penile base, creating a subcutaneous pocket via blunt dissection towards the scrotum. No drains were placed.

Results: A total of 21 patients were included (median age of 14.9 years; interquartile range (IQR) 13.4-15.8 years) with a median time between torsion and prosthesis placement of 14 months (IQR 10-17 months). Regarding the size, 14 prostheses of size 42 × 32 mm and 7 of 37 × 28 mm were placed. Median operative duration was 15 minutes (IQR 12-18 minutes), with no intraoperative complications. All patients were discharged the same day of surgery. After a median follow-up of 41 months (IQR 26-54), no infections, prosthesis extrusions, or complications were reported. Patients experienced no pain or discomfort, and all reported satisfactory outcomes. No prosthesis exchanges were required.

Conclusions: Suprascrotal testicular prosthesis placement appears to be a straightforward and safe procedure for adolescents after testicular torsion, providing excellent cosmetic and satisfaction outcomes with low morbidity in the medium term. Larger prospective studies are needed to confirm these findings.

Background: Benign prostatic hyperplasia (BPH) is highly prevalent in the aging male population. Transurethral resection of the prostate (TURP), the current gold standard treatment, demonstrates significant efficacy but is associated with complications and high retreatment rates. Extraperitoneal laparoscopic urethra-preserving prostatectomy has emerged as a promising minimally invasive surgical alternative. This study aimed to compare the efficacy and safety of modified extraperitoneal laparoscopic surgery with conventional TURP for BPH treatment.

Methods: Ninety-two patients with BPH who underwent surgical treatment between May 2022 and July 2023 were included in this retrospective study and divided into two groups with 46 each: Transurethral resection of the prostate (TURP) group and extraperitoneal laparoscopic surgery (ELS) group. Preoperative International Prostate Symptom Score (IPSS), maximum urine flow rate (MFR), residual urine volume (RUV) and quality of life (QOL) scores were recorded and compared with those at the 3-month follow-up. Patient age, body mass index (BMI), prostate-specific antigen (PSA), prostate size and complications were also documented and compared between the groups.

Results: Ninety-two patients were included in this study (46 in each group). Baseline characteristics were comparable between the groups. At 3 months, both groups demonstrated significant improvements in IPSS, MFR, RUV and QOL scores (p < 0.001). Compared with the TURP group, the ELS group showed greater improvements in IPSS, MFR, RUV and QOL scores, with fewer postoperative complications (p < 0.001).

Conclusions: Extraperitoneal laparoscopic prostatectomy using the modified urethra-preserving technique was beneficial for restoring urinary continence and improving patients' quality of life. This approach showed favourable perioperative outcomes and low complication rates. Further studies with large sample sizes and extended follow-up periods are required to confirm these findings and determine the long-term efficacy of this strategy.

Background: The identification of reliable biomarkers for prostate cancer remains a pressing need in clinical oncology. Inflammatory and regulatory molecules such as NF-κB p65, apolipoprotein E (ApoE), angiopoietin-1 (Ang-1), forkhead box protein A2 (FOXA2), presenilin enhancer-2 (PEN-2) and β-amyloid precursor protein (β-APP) have been implicated in tumour biology. However, their roles in prostate cancer progression and invasion require further elucidation.

Methods: Serum levels of NF-κB p65, ApoE, Ang-1, FOXA2, PEN-2 and β-APP were measured in five distinct groups: Healthy controls, benign prostatic hyperplasia, non-treated prostate cancer, radical prostatectomy and metastatic prostate cancer. Quantification was performed using validated sandwich enzyme-linked immunosorbent assay (ELISA) kits (Elabscience®, Wuhan, China), with optical density readings at 450 nm. All measurements adhered strictly to manufacturer protocols. Receiver operating characteristic curve was analysed to calculate the area under the curve (AUC) for each biomarker.

Results: ApoE (AUC = 0.83) and Ang-1 (AUC = 0.81) demonstrated the best diagnostic accuracy. PEN-2 (AUC = 0.81), FOXA2 (AUC = 0.79), and β-APP (AUC = 0.79) showed moderate-to-good discrimination, whereas NF-κB p65 (AUC = 0.76) exhibited moderate performance across disease stages.

Conclusions: Ang-1 and ApoE exhibited promising predictive potential in prostate cancer progression, whereas NF-κB p65 and PEN-2 demonstrated modest discriminative performance. FOXA2 showed expression variation across disease stages but lacked sufficient diagnostic value. These results highlight the diverse molecular profiles involved in prostate cancer biology and underline the need for validation in larger cohorts before clinical application.

Background and aims: Elderly patients with renal calculi face elevated surgical risks due to reduced physiological reserve and comorbidities. Retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are the primary treatments for this condition, but their efficacy and safety in this population remain unclear.

Methods: This single-centre retrospective study included 144 patients (≥65 years) with renal calculi, divided into RIRS (n = 75) and PCNL (n = 69) groups. Propensity score matching yielded 65 patients per group, comparing stone clearance rate, secondary surgery rate, perioperative safety indicators, Visual Analogue Scale (VAS) pain scores and 36-Item Short Form Health Survey (SF-36) quality of life scores.

Results: The PCNL group had higher stone clearance rates at 2 weeks (84.62% vs. 69.23%) and 1 month (95.38% vs. 84.62%) than the RIRS group (both p < 0.05), but secondary surgery rates did not differ (p > 0.05). The RIRS group showed less intraoperative blood loss (51.54 ± 13.84 vs. 93.87 ± 26.19 mL), shorter operation time (78.69 ± 12.54 vs. 89.85 ± 15.41 min) and hospital stay (5.77 ± 1.09 vs. 7.02 ± 1.18 days; All p < 0.05), lower postoperative VAS scores and higher 2-week SF-36 scores (p < 0.05).

Conclusions: Although PCNL offers higher stone clearance, RIRS is superior in reducing blood loss, shortening hospital stays, alleviating pain and improving quality of life. RIRS may be more suitable for elderly patients with renal calculi.

Objective: In this retrospective study, 150 cases of prostate cancer were evaluated to explore the ability of combined magnetic resonance imaging (MRI) features and nonspecific serum markers to distinguish clinically significant prostate cancer (csPCa) from nonclinically significant prostate cancer (ncsPCa) in patients with confirmed prostate cancer and to evaluate their application value in risk stratification.

Methods: This retrospective study analysed 150 patients with prostate cancer treated at our institution between May 2022 and May 2025. The patients were divided into csPCa (Gleason score ≥7) and ncsPCa groups (Gleason score = 6) according to Gleason score of pathology. Baseline clinical data and routine haematological and coagulation markers, including neutrophil count (NEU), lymphocyte count (LYM), fibrinogen (FIB), D-dimer and prostate-specific antigen (PSA) were collected. All patients subsequently underwent prostate-specific MRI following enrolment.

Results: Significant difference in Prostate Imaging Reporting and Data System (PI-RADS) V2.1 score distribution was observed between the two groups (p < 0.05). The csPCa group also had higher neutrophil-to-lymphocyte ratio (NLR), FIB, D-dimer and PSA levels than the ncsPCa group (p < 0.05). Multivariate analysis confirmed these indicators as independent predictors of csPCa (p < 0.05). Receiver operating characteristic curve analysis showed the following area under the curve (AUC) values in diagnosing csPCa: 0.677 (95% confidence interval (CI): 0.571-0.784) for PI-RADS V2.1 score, with an optimal cutoff of 3.00; 0.738 (95% CI: 0.638-0.838) for NLR, with an optimal cutoff of 3.67; 0.769 (95% CI: 0.680-0.858) for FIB, with an optimal cutoff of 4.01; And 0.745 (95% CI: 0.639-0.852) for D-dimer, with an optimal cutoff of 0.595. The combined diagnostic model yielded an AUC of 0.839 (95% CI: 0.757-0.920) for identifying csPCa.

Conclusions: The combined use of prostate-specific MRI features and nonspecific serum markers (NLR, FIB and D-dimer) can effectively improve the diagnostic accuracy of csPCa.

Objective: To investigate the application value of an operating room nursing protocol based on the Enhanced Recovery after Surgery (ERAS) concept in patients with prostate cancer undergoing laparoscopic radical prostatectomy (LRP).

Methods: A retrospective collection was conducted on patients who were scheduled to undergo LRP and admitted to the urology department of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2024 to June 2025. The general preoperative, surgical-related and clinical data of the two groups of patients were collected and compared.

Results: A total of 147 patients with LRP were collected during the study. These patients were divided into the traditional nursing (n = 73) and ERAS (n = 74) groups in accordance with different nursing plans. No significant difference was found in the general data of the two groups before surgery (p > 0.05). In the ERAS group, the moments marking the first discharge and exhaust, along with the lengths of time of urinary catheter indwelling and overall hospital stays, were all markedly shorter than those in the group receiving traditional nursing care, with the disparities between the two groups being statistically significant (p < 0.001). Additionally, the patients in the ERAS group exhibited a notably higher average urinary flow rate than their counterparts in the traditional nursing group (p < 0.001). The first voiding time of the patients in the ERAS group was earlier than that of the patients in the traditional nursing group (p < 0.001). At 8, 12, 24 and 48 h after surgery, the Numerical Rating Scale scores of the patients in the ERAS group were lower than those of the patients in the traditional nursing group (p < 0.001). The results of repeated analysis of variance revealed a significant difference in the time-group main effect (p < 0.001). The Incontinence Quality of Life Questionnaire scores of the patients in the ERAS group were higher than those of the patients in the traditional nursing group at three days after surgery and discharge (p < 0.001).

Conclusions: The operating room nursing protocol based on the ERAS concept has clinical value in patients with prostate cancer undergoing LRP.

Objective: The objective of this review was to collate and critically appraise the nascent body of evidence juxtaposing the da Vinci single-port (SP) system with its multiple-port (MP) antecedent, with the goal of ascertaining its surgical efficacy and postoperative outcomes.

Methods: The databases searched included PubMed, Web of Science, and Embase. Two independent reviewers conducted the initial screening for potential inclusion, assessed the quality of the studies via the Newcastle-Ottawa Scale, and extracted relevant data. A third reviewer was responsible for reconciling the data. Random effects models were utilized.

Results: The final meta-analysis included eight studies, encompassing a cohort of 1389 patients, with 502 patients allocated to the SP group and 887 to the multiple-port group. We observed no significant differences in operative duration (WMD: 0.12, 95% confidence interval (CI): -7.44-7.67), blood loss (weighted mean difference (WMD): -11.50, 95% CI: -28.89-5.90), positive surgical margins (odds ratio (OR): 0.80, 95% CI: 0.59-1.08), complications (OR: 1.29, 95% CI: 0.77-2.16), urinary continence (OR: 1.18, 95% CI: 0.86-1.62), or erectile function (OR: 0.84, 95% CI: 0.58-1.24) between the two procedural types. The meta-analysis revealed a mean difference of -0.86 days (95% CI: -1.64 to -0.08), suggesting a tendency toward shorter hospitalization for the SP group.

Conclusions: The da Vinci SP system presents itself as a formidable contender when juxtaposed with its MP counterparts. Notwithstanding the encouraging preliminary data, a more substantial evidence base is needed to ascertain the definitive role of the SP system within the domain of urological surgery.