Archivos Espanoles De Urologia最新文献

Objectives: Urinary stones composed of uric acid can be treated with medicine. Computed tomography (CT) can diagnose urinary stone disease, but it is difficult to predict the type of uric stones. This study aims to develop a method to distinguish pure uric acid (UA) stones from non-uric acid (non-UA) stones by describing quantitative CT parameters of single-energy slices of urinary stones related to chemical stone types.

Methods: Clinical data, CT images, and stone composition analysis results of patients with urinary stones clinically diagnosed at The Department of Urology, Affiliated Hospital of Qingdao University between 1 January 2018 and 31 December 2020 were collected and retrospectively analyzed. The above data were preprocessed and fed into a convolutional neural network to perform deep learning (DL) of the model, and the dataset was validated at a ratio of 4:1. The area under the curve (AUC) value of the receiver operating characteristic (ROC) curve and the confusion matrix were utilized to evaluate the predictive effect of the model.

Results: A retrospective analysis of 918 non-enhanced thin-slice single-energy CT images of known chemical stone types (124 with UA stones and 794 with non-UA stones) was conducted using a DL model. Compared with the results of ex vivo analysis by infrared spectroscopy, the prediction model obtained an AUC of 0.83 for the dichotomous classification of UA stones and non-UA stones. The accuracy of the model was 97.01%, with an F1 score of 89.04%, sensitivity of 84.62%, and specificity of 82.28%.

Conclusions: This DL model constructed based on convolutional neural network analysis of thin-slice single-energy CT images is highly accurate in predicting the composition of pure UA and non-UA stones, providing a simple and rapid diagnosis method.

Background: Overactive bladder (OAB) is an issue in the field of urology that is known for causing symptoms like urges to urinate frequently during the day and even at night (known as nocturia). Nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) play a vital role in the growth and operation of nerve cells in the body. New studies are indicating a connection between these neurotrophins and OAB; As such this research project was undertaken to explore how levels of NGT and BDNF in urine might be related to the presence of OAB in individuals.

Methods: This investigation employed a case-control design, enrolling 44 individuals with a confirmed diagnosis of OAB and an equal number of healthy participants as the control group. Urine samples were collected from all participants, and levels of NGF and BDNF were quantified. To account for fluctuations in urine concentration, NGF/creatinine (Cr) and BDNF/Cr ratios were also determined.

Results: Our research findings revealed that individuals experiencing bladder (OAB) showed increased urinary NGF levels (statistically significant, at p < 0.001). This disparity remained consistent after adjusting for creatinine levels; There were higher NGF/Cr (statistically significant, at p = 0.001) and BDNF/Cr (statistically significant, at p < 0.001) ratios in the OAB group compared to the control group. Additionally we noted a relationship between urine NGF/Cr levels and the presence of OAB (statistically significant, at p < 0.001; Correlation coefficient: +0.686). Urine BDNF/Cr levels showed a correlation with OAB (correlation coefficient of +0.461; p value < 0.001). In OAB prediction, the NGF/Cr cutoff value was found to be 0.87, the NGF cutoff value was 180.02 pg/mL, and the BDNF/Cr ratio was 0.19.

Conclusions: Elevated urinary NGF and BDNF levels are associated with OAB, suggesting a potential role for these neurotrophic factors in the pathogenesis of the condition. Further research is warranted to explore their potential as diagnostic or prognostic biomarkers and to elucidate the underlying molecular mechanisms.

Background: The objectives of this work were the search for novel prognostic biomarkers for the diagnosis of prostate cancer (PCa) and the improvement of therapy outcomes in cases with a poor prognosis and the failure of immunotherapy.

Methods: The GTEx (Genotypic Tissue Expression Project) and TCGA (The Cancer Genome Atlas) databases were used to find out the co-expressed long non-coding RNAs (lncRNAs) associated with necrosis status based on statistics and univariate Cox regression tests. IncRNA associated with necrosis was screened by least absolute shrinkage and selection operator (Lasso) analysis, and the predictive model was further verified by Kaplan-Meier analysis, Receiver Operating Characteristic (ROC) curve analysis, Cox regression, nomogram and calibration curve. Also, immune analysis, principle component analysis, gene set enrichment analysis and prediction of semi-maximum inhibitory concentration in risk groups were conducted.

Results: The model successfully identified 16 necrosis-related lncRNA models, demonstrating good consistency among the calibration map and prognosis expectation. The ROC curve's area under the curve (AUC) for 1-year overall survival was 0.726, 0.763 and 0.770. The risk groups identified by the model could guide systematic treatment due to significant differences in semi-inhibitory concentrations. The study also demonstrated that the model could differentiate amongst hot and cold tumours and provide accurate mediation, with cluster 2 recognised as a hot tumour and likely to benefit from immunotherapy drugs.

Conclusions: In conclusion, the given study supports the potential of necrosis-related lncRNAs as a biomarker for predicting the prognosis and personalised treatment for PCa.

Objective: Isolated adrenal myelolipoma (IAM) is an uncommon, nonfunctioning tumour of the adrenal gland, primarily composed of adipose tissue and hematopoietic trilinear cells. The etiopathogenesis and clinical relevance of this neoplasm remain poorly understood. However, similar myelolipomatous alterations can also occur within adrenocortical adenomas. This report presents our findings on IAM and adrenocortical adenomas with a myelolipomatous component (AMC), focusing on comparing these cases' clinical, demographic, and pathological characteristics.

Methods: Data from twenty patients were retrospectively analyzed, including twelve diagnosed with IAM and eight with AMC, all of whom underwent adrenalectomy. In the IAM cohort, surgical intervention was primarily indicated based on tumour size and/or related symptoms, while in AMC cases, the indication was often driven by hormonal activity.

Results: Patients with IAM had an average age of 52.5 years, with a predominance of female patients (75%). A significant proportion of this group was obese, with concomitant hypertension (HT) and/or type 2 diabetes mellitus (DM). The tumours were predominantly right-sided, with a median size of 69.0 ± 40.0 mm. Notably, 58% of patients with IAM presented with flank or abdominal pain attributed to the mass effect. None of the IAM cases exhibited hormonal activity. Conversely, the AMC group had a younger average age of 46 years, with a high prevalence also in female patients (63%). The tumours were generally smaller, with a median size of 40.0 ± 16.0 mm, and were mostly left-sided. All patients in this group had a history of HT and/or DM, with six exhibiting hormonally active tumours, which manifested as various clinical syndromes, including Cushing syndrome, pheochromocytoma, and Conn syndrome.

Conclusions: While IAM and AMC share several common features, they also demonstrate distinct differences. The presence of endocrinological syndromes was more frequent in AMC cases, whereas IAM cases rarely showed hormonal activity. The most pronounced difference between the two groups was the tumour size at diagnosis, which contributed to the varying clinical presentations upon hospital admission. Furthermore, the high prevalence of obesity, HT, and DM in both groups suggests that these comorbidities may play a role in the development of myelolipomatous patterns observed in these tumours.

Background: Choosing the appropriate anaesthesia for retrograde intrarenal surgery (RIRS) is crucial due to its potential impact on surgical outcomes, postoperative recovery, and renal function. This retrospective study aimed to compare surgical outcomes and renal function impacts between general anaesthesia and continuous epidural anaesthesia for RIRS.

Methods: Clinical data from patients who underwent RIRS for renal stones at our hospital from January 2023 to December 2023 were retrospectively analysed. Patients were categorised into two groups: Those receiving general anaesthesia and those receiving continuous epidural anaesthesia. General patient information, surgical outcomes, renal function parameters, and postoperative pain scores were evaluated.

Results: The study included 110 patients: 51 in the general anaesthesia group and 59 in the continuous epidural anaesthesia group. Operation duration and stone clearance rates were similar across both groups. However, the epidural group had a significantly shorter hospital stay (1.28 ± 0.39 days vs 1.73 ± 0.42 days) and required less analgesia (25.86 ± 5.26 mg vs 29.56 ± 5.63 mg) (p < 0.001). Although the epidural group had higher preoperative creatinine levels, these levels significantly decreased postoperatively (0.99 ± 0.12 mg/dL vs 1.07 ± 0.11 mg/dL, p < 0.001). Pain scores at 2 hours (3.95 ± 1.28 vs 3.18 ± 1.42, p = 0.004) and 24 hours (3.75 ± 1.67 vs 3.08 ± 1.45, p = 0.027) were lower in the epidural group.

Conclusions: Continuous epidural anaesthesia may offer advantages over general anaesthesia for RIRS, including reduced hospital stays, lower analgesic requirements, potential renoprotection, and improved early postoperative pain management.

Background: Transperineal (TP) biopsy is increasingly used as an alternative to standard transrectal (TR) biopsy for prostate cancer detection to reduce infection risks. However, evidence on comparative diagnostic accuracy remains inconclusive. The aim of this study was to perform an updated systematic review and meta-analysis of studies comparing prostate cancer detection rates between TP and TR ultrasound biopsies.

Methods: PubMed, EMBASE, Web of Science and other databases were searched for relevant studies up to December 2023. Randomised trials and observational studies comparing TP and TR biopsies were included. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random effects models. Heterogeneity was assessed, and subgroup analyses were conducted.

Results: Nine studies comprising four randomised controlled trials (RCTs) and five observational studies were analysed, including 2763 patients (1376 TP, 1387 TR). No significant difference was found in overall cancer detection rates between TP and TR biopsies (RR = 0.9762, 95% CI = 0.8225-1.1586 for random effects model). However, subgroup analysis found that the RCTs showed no difference (RR = 0.9681, 95% CI = 0.8491-1.1038), whereas the observational studies varied (RR = 0.9416, 95% CI = 0.8073-1.0983). Significant heterogeneity was present across studies (I² = 64.3%, p = 0.0156). Details on the prostate specific antigen (PSA) levels in the included studies were provided, and no significant differences were found between TP and TR biopsies regardless of whether a PSA threshold of >10 ng/mL or <10 ng/mL was used.

Conclusions: In summary, this updated meta-analysis found no significant difference between TP and TR biopsies in overall prostate cancer detection rates. The subgroup analysis highlighted that results from RCTs specifically indicated equivalence in diagnostic accuracy. TP biopsy may be considered an appropriate alternative to TR biopsy for patients requiring prostate biopsy.

Background: This study aimed to evaluate the mid- to long-term efficacy of tension-free vaginal tape (TVT) and trans-obturator transvaginal tape (TVT-O) by using evidence-based medicine meta-analysis methods to provide a reference for choosing a sling to treat female stress urinary incontinence (SUI).

Methods: A computer search was performed on PubMed, Embase, Web of Science, ProQuest PsycINFO, CINAHL and Cochrane Library for randomised controlled trials on TVT and TVT-O in the treatment of female SUI. The search time limit was from the establishment of the database to March 2024, and the literature was screened and quality assessed. Meta-analysis was used to appraise the subjective cure rate, objective cure rate and postoperative complication rates and intraoperative of the two surgical methods for SUI.

Results: All 13 included studies were of high quality. The subjective cure rate (Risk Ratio (RR) [1.00] and 95% CI [0.96; 1.05]) and objective cure rate (RR [1.03] and 95% CI [1.00; 1.06]) of TVT and TVT-O were similar. The incidence of hematoma during TVT surgery was significantly higher than that of TVT-O (RR [2.62] and 95% CI [0.84; 8.13]), and the incidence of medial thigh/groin pain after TVT was lower than that of TVT-O (RR [0.25] and 95% CI [0.13; 0.49]). Minimal differences were observed in the incidence of bladder perforation, band erosion and dysuria/urinary retention.

Conclusions: The mid- and long-term effects of TVT and TVT-O surgical methods in the treatment of female SUI were similar and effective. In terms of complications, TVT had a higher incidence of hematoma than TVT-O, and TVT had a lower incidence of pain in the inner thigh/groin area than TVT-O.

Background: The advantages of active surveillance (AS) in low-risk prostate cancer (PC) have already been widely demonstrated. The 15-year results of the Prostate Testing for Cancer and Treatment (ProtecT) trial were published recently, reflecting worse oncological outcomes of their active monitoring programme (AMP) compared with radical prostatectomy (RP) or radiotherapy (RDT). Our objective was to analyse the survival of patients with International Society of Urological Pathology (ISUP) grade I PC depending on the treatment received and point out the differences between an AS protocol and the AMP established in the ProtecT trial.

Methods: A retrospective study of patients with ISUP grade I PC managed by AS, RP or RDT was conducted. A comparative intention-to-treat survival analysis was performed. Our AS protocol included routine 18-core surveillance biopsies of all patients. On the basis of this assumption, the patients included in AS were divided into two groups: Those who met the rebiopsy criteria of the ProtecT trial and those who should not have been biopsied in accordance with this trial.

Results: Of the total 2865 patients, 981 met the selection criteria with a median follow-up of 7.7 years: 448 (45.7%) in AS, 399 (40.7%) in RP and 134 (13.7%) in RDT. The median age at diagnosis was 66.9, 63.2 and 69.2 years, respectively. The AS and RP groups were comparable in all the variables. The overall and cancer-specific survival results were similar, but the AS group had better metastasis-free survival. The RDT group presented worse clinical features in prostate-specific antigen and stage and worse survival outcomes compared with the other groups (p < 0.005). Out of the 448 patients included in AS, 100 met some of the criteria for rebiopsy of the ProtecT trial. Amongst the 348 patients who did not meet any criteria, 138 (39.6%) ended up receiving active treatment due to Gleason progression, increasing number of positive cores or both in the majority of cases (94.4%).

Conclusions: Surveillance biopsy is a major factor that contributes to achieving good oncological results in AS. Active monitoring is not comparable with an AS protocol, and thus, the results of the ProtecT trial are poorly assessable.

Background: Hysterectomy is associated with stress urinary incontinence (SUI), pelvic floor muscle weakness and sexual dysfunction. Pelvic floor exercises have emerged as a potential intervention for addressing these challenges, with remote guided programs offering personalised care. This retrospective study aimed to assess the effect of a nurse-led remote guided pelvic floor exercise program on in patients after total hysterectomy.

Methods: A retrospective analysis was conducted on 81 patients who underwent pelvic floor exercises after total hysterectomy. The patients were divided into regular pelvic floor exercise group (n = 40) and nurse-led remote guided pelvic floor exercise group (n = 41). The severity of SUI in patients was assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). The strength and endurance of pelvic floor muscles were assessed using a pressure sensor before and after treatment, and sexual function was evaluated using the Female Sexual Function Index (FSFI) questionnaire.

Results: The baseline characteristics showed no significant differences between the two groups. The nurse-led remote guided pelvic floor exercise group had a significantly greater reduction in urinary incontinence severity (65.00% vs. 85.37%, χ² = 4.516, p = 0.034) and a lower post-treatment SUI frequency (1.76 ± 0.75 vs. 2.15 ± 0.95, t = 2.059, p = 0.043). Additionally, this group showed better improvements in muscle strength and endurance (25.61 ± 5.69 vs. 23.19 ± 5.02, t = 2.036, p = 0.045) and FSFI score (29.67 ± 4.05 vs. 27.91 ± 3.83, t = 2.011, p = 0.048).

Conclusions: The study demonstrates that a nurse-led remote guided pelvic floor exercise program is associated with significant improvements in SUI, pelvic floor muscle function and sexual well-being in patients after total hysterectomy.

Background: Paediatric hydronephrosis frequently necessitates surgical intervention. However, postoperative urinary tract infections (UTIs) are common and challenging. This retrospective cohort study aimed to identify UTI risk factors following an operation for paediatric hydronephrosis.

Methods: Paediatric patients with hydronephrosis who underwent operation from January to December 2023 were studied. Patients were categorised into no UTI and UTI groups. Demographics, surgical history, pre/postoperative factors, imaging, and lab values were compared.

Results: A total of 111 patients were enrolled, with 98 in the no-UTI group and 13 in the UTI group. The UTI group had significantly more previous surgeries and longer surgical duration (p < 0.05). Preoperative factors associated with UTI occurrence included higher hydronephrosis grade, absence of antibiotic prophylaxis, presence of vesicoureteral reflux (VUR), abnormal preoperative urine cultures, and ureteral stent placement (p < 0.05). The UTI group exhibited more extended hospital stays, higher rates of postoperative fever, reoperation, and readmission within 30 days (p < 0.05). Postoperative imaging and laboratory findings were also significantly different (p < 0.05). The UTI group had elevated white blood cell count, C-reactive protein levels, serum creatinine, and urine white blood cell count (p < 0.05). Other potential risk factors included constipation, family history of UTI, bladder dysfunction, history of recurrent UTI, and use of prophylactic antibiotics. Multivariate logistic regression analysis indicated that while antibiotic prophylaxis and preoperative urine culture results negatively correlated with UTI occurrence, other factors were positively correlated, with the number of previous surgeries having the most significant impact on UTI occurrence (odds ratio (OR) = 20.617; 95% confidence interval (CI): [0.718, 0.802]; p < 0.001).

Conclusions: Multiple factors contribute to the risk of postoperative UTI for paediatric hydronephrosis, highlighting the need for tailored interventions to mitigate risks and improve outcomes.