Archivos Espanoles De Urologia最新文献

Background: Benign prostatic hyperplasia (BPH) is a common condition, particularly among high-risk patients who are unsuitable for surgical intervention due to comorbidities or anticoagulant use. Bipolar radiofrequency ablation is a minimally invasive technique that has been studied for its potential safety and efficacy. This study aimed to investigate the effectiveness of bipolar radiofrequency ablation in treating BPH and to identify the factors influencing the procedural success in high-risk patients.

Methods: Forty-six patients who underwent radiofrequency ablation treatment for prostate between 2018 and 2022 were included in this study. Pre-procedure prostate volume, International Prostate Symptom Score (IPSS), post-voiding residual urine volume (PVR), maximum urine flow rate (Qmax) on uroflowmetric examination, quality of life (QoL) due to urinary symptoms, metabolic syndrome status and bladder wall thickness on ultrasonographic examination were measured and compared with the values at the 3rd month of follow-up.

Results: The mean age of the patients was 75.34 ± 10.67 years (55-94 years). Qmax, PVR, QoL and IPSS improved in all the patients after the procedure (p < 0.001). High pre-procedure PVR, low pre-procedure Qmax and prostate volume less than 70 g were found to be statistically significant factors affecting the success of the procedure (p = 0.03, 0.03, 0.04) (odds ratio (OR) = 1.15, 0.75, 1.30).

Conclusions: Bipolar radiofrequency ablation for prostate is a safe option with a low incidence of side effects and complications for patients who are at high anaesthetic risk due to comorbidities or anticoagulant/antiplatelet therapy and unsuitable or hesitant to undergo for surgery because of potential surgical complications and side effects.

Background: Urinary stone treatment is of interest from a health-economic point of view because of competing technical approaches, high incidence and high recurrence rates. In France, since the release of the activity-based funding called T2A (for Tarification A l'Activité), concerns about possibly induced overactivity have been increasing. A flat-sum-based payment per stone episode has even been proposed. This study aims to describe different parameters, such as reintervention rates.

Methods: Using the linkage between different stays of one patient, we studied multiple stays and procedures in the extensive reimbursement database of a group of nationwide private clinics. Patients were identified in 2020, and their procedures and stays were studied in 2019, 2020 and 2021. Demographic data, number of stays and interventions, number of multiple interventions, number of ureteral stentings without other procedures and the rate of outpatient stays were collected.

Results: We obtained 50,295 stays from 31,209 patients (0.52 female/male). The median age of the patients was 54 years. The average number of stays was 1.6. No intervention was performed in 16% of the patients. Shockwave lithotripsy (SWL) and ureteroscopy (URS) were performed in 24.7% and 63.3% of the patients, respectively. After one primary URS, 3.2% of the patients were treated with 1.3 SWL on the average, and 24.2% were treated with 1.3 URS on the average. Percutaneous nephrolithotomy with first intent was marginal in the sample, and local disparities were rare.

Conclusions: In this representative sample, despite true limitations, repeated procedures were less frequent than expected.

Objective: Conventional penile venous surgery for erection restoration and surgery for penile augmentation have been controversial. Based on de novo penile fibrovascular assembly, we report innovative penile venous stripping (PVS) and factual penile girth enhancement (FPGE).

Methods: From 2013 to 2023, refractory impotence and dysmorphia prompted 31 patients to seek PVS and FPGE, and all of them were confirmed with veno-occlusive dysfunction. PVS involves stripping erection-related veins, primarily one deep dorsal vein and two cavernosal veins, after the ligation of each emissary vein closest to the outer tunica albuginea using 6-0 nylon. FPGE was performed bilaterally along the tunica albuginea. Then, two tunic defects were fashioned with a 70.0 × 30.0 mm² venous stripe and covered with either autologous venous walls (AVW) or Surgiform (SF). Penile girth was measured, and radio-opaque contrast was used to compare intracorporeal retention. Patients resorted to follow-up if there was no surgery. The abridged 5-item version of the International Index of Erectile Function (IIEF-5) score and Erection Hardness Scale (EHS) were used yearly during follow-up via the Internet.

Results: Overall, among 31 patients, 18 underwent PVS and FPGE, and they were allocated to the surgery group; The remaining 13 were categorised as the control group. The follow-up period was 0.2-10.0 (5.5 ± 1.6) years. In the surgery group, the radiopacity of the postoperative cavernosogram was consistently enhanced. Although indifference was observed in IIEF-5 and EHS (p ≥ 0.95; 20.8 ± 2.3 vs. 20.7 ± 2.1; 3.1 ± 0.2 vs. 3.3 ± 0.2) between AVW and SF, a significant improvement was detected after surgery (both p ≤ 0.01 in IIEF-5 and EHS scores (9.7 ± 2.8 vs. 20.8 ± 2.3; 1.7 ± 0.6 vs. 3.2 ± 0.2, respectively)). In addition, the diameters of the glans and penile shaft were significantly increased (both p ≤ 0.01; 28.0 ± 2.3 and 28.2 ± 2.1 mm vs. 35.3 ± 2.2 and 36.3 ± 2.1 mm, respectively). The satisfaction rate was 81.3% (13/16) when two inconsistent data were excluded in the AVW subgroup.

Conclusions: Although this retrospective study encountered limitations, the combined PVS and FPGE surgery shows promise. Further validation requires a larger sample size and more extended surveillance.

Objective: Stress urinary incontinence (SUI) is a common postpartum complication in women. This study aims to evaluate the clinical efficacy of pelvic floor muscle training (PFMT) combined with biofeedback stimulation (BS) in the treatment of postpartum SUI.

Methods: A total of patients with postpartum SUI admitted to our hospital from January 2023 to January 2024 were enrolled in the study. Based on the treatment method, the patients were divided into the following two groups: PFMT + BS group and PFMT group. Both groups received treatment for three months. Pelvic floor muscle strength and pelvic floor ultrasound indices were evaluated at T0 (before treatment) and T2 (three months after treatment). The 1-h pad test, Incontinence Urinary Incontinence Questionnaire Short Form (ICI-Q-SF) and Incontinence Quality of Life Questionnaire (I-QOL) were assessed at T0, T1 (one month after treatment) and T2. Data were analysed using repeated measures analysis of variance (ANOVA).

Results: A total of 105 patients were included in the study, with 58 patients in the PFMT + BS group and 47 patients in the PFMT group. After treatment, the PFMT + BS group demonstrated significantly better pelvic floor muscle strength and ultrasound compared to the PFMT group (p < 0.05). Repeated measures ANOVA revealed significant interaction effects between time and group on the 1-h pad test, ICI-Q-SF and I-QOL (p < 0.05), along with significant main effects for time and group (p < 0.001). Simple effects analysis showed no significant differences between groups at T0 (p > 0.05). However, at T1 and T2, the PFMT + BS group had significantly lower 1-h pad test and ICI-Q-SF scores (p < 0.05) and significantly higher I-QOL score (p < 0.05) compared to the PFMT group.

Conclusions: PFMT combined with BS is more effective than PFMT alone in treating postpartum SUI and thus warrants clinical implementation.

Androgen deprivation therapy (ADT) has been a pillar in the management of prostate cancer (PCa) since the 1940s and remains a standard of care across different clinical scenarios of PCa. Gonadotropin-releasing hormone (GnRH) agonists are the most commonly used form of ADT because they have consistently proven to be effective. The arrival of GnRH antagonists, such as degarelix and relugolix, has introduced an alternative to agonists while offering distinct advantages. Antagonists achieve the rapid suppression of testosterone without the initial flare effect observed with agonists. Relugolix, an oral antagonist, has been reported to result in the rapid recovery of normal testosterone levels after treatment discontinuation and may be associated with a potentially lower cardiovascular (CV) risk than agonists. Moreover, antagonists provide an additional therapeutic option that enables an individualised treatment approach, aligning with the growing emphasis on personalised medicine. However, evidence regarding the superiority of antagonists over agonists in terms of clinical outcomes or side effects remains limited and, in some cases, contradictory. The effectiveness of antagonists, particularly in sustaining long-term testosterone suppression, and their safety profile, especially in relation to CV risks, remain debated. Although early studies indicate potential advantages, current clinical evidence is still evolving and requires further validation. This narrative review of the literature aims to provide a comprehensive update on the role of antagonists in PCa management, highlighting their potential benefits and limitations while addressing existing controversies. Despite the apparent advantages of antagonists, long-term prospective studies must be conducted to confirm their efficacy and safety, particularly when combined with other therapies, and to define their role across different disease stages.

Objective: This study aimed to investigate the efficacy of electroacupuncture (EA) combined with supervised pelvic floor muscle training (PFMT) in improving post-radical prostatectomy urinary incontinence (PRPUI).

Methods: The clinical data and treatment methods of patients with PRPUI admitted to the Third Affiliated Hospital of Zhejiang Chinese Medicine University from January 2023 to December 2023 were retrospectively collected, and they were divided into the PFMT group and PFMT + EA group according to the postoperative treatment methods. The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF) and Incontinence Quality of Life Questionnaire (I-QOL) of patients before treatment (T0), 6 weeks of treatment (T1) and 12 weeks of treatment (T2) were collected and compared. Pelvic floor electromyography assessment values (maximum systolic electromyography (EMG) value, mean EMG value during isometric contraction and mean EMG value during endurance contraction) in patients at T0 and T2 were collected and compared.

Results: A total of 226 patients with PRPUI were included in the study: PFMT group (n = 112) and PFMT + EA group (n = 114). The results from repeated measures Analysis of Variance (ANOVA) indicated a significant interaction between time and group for ICIQ-UI-SF and I-QOL (p < 0.001), as well as a significant main effect for time and group (p < 0.001). The ICIQ-UI-SF in the PFMT + EA group was lower than that in the PFMT group at T1 and T2, but the I-QOL was higher in the PFMT + EA group than in the PFMT group, and there was a significant difference between the two groups (p < 0.001). At the T2 time point, the maximum systolic EMG value, mean isometric contraction EMG value and mean endurance contraction EMG value in the PFMT + EA group were significantly higher than those in the PFMT group (p < 0.05).

Conclusions: EA combined with supervised PFMT can be used as an effective non-surgical treatment for the treatment of PRPUI.

Background: Lung adenocarcinoma (LUAD) and bladder cancer (BLCA) are two major cancers that have high incidence and mortality worldwide and are particularly exacerbated by smoking, which is a primary risk factor that influences cancer progression through genetic and immune pathways. Temozolomide (TMZ), a chemotherapeutic agent, is often used to treat various cancers, including brain tumours, and is known to induce DNA damage via methylation. This study aims to identify key smoking-related genes, particularly TNFAIP6, and explore their mechanisms in LUAD and BLCA, focusing on their prognostic value, role in cancer progression, immune regulation, and response to TMZ.

Methods: Bayesian colocalisation and pan-cancer differential analyses identified 14 key genes, including TNFAIP6. Pan-cancer survival and clinical stage analyses were performed using The Cancer Genome Atlas (TCGA) data. TNFAIP6's functional role in cancer stages, smoking status, immune infiltration and its effect on TMZ resistance was analysed through statistical tests, gene set enrichment analysis (GSEA) and gene set variation analysis (GSVA). Laboratory experiments were conducted to assess TNFAIP6's influence on cell proliferation, apoptosis, epithelial-mesenchymal transition (EMT) markers, oxidative stress and TMZ-induced post-translational modifications (PTMs).

Results: TNFAIP6 was significantly upregulated in LUAD and BLCA and linked to poorer prognosis, especially in smokers. High TNFAIP6 expression was associated with pro-inflammatory pathways and immune suppression in the tumour microenvironment. Moreover, TMZ treatment induced considerable PTMs in TNFAIP6, promoting resistance to the drug, which was confirmed by functional assays showing increased cell viability and migration in TNFAIP6-overexpressing cells.

Conclusions: TNFAIP6 is a key biomarker of poor prognosis in smoking-related cancers. Interestingly, silencing TNFAIP6 both inhibits TMZ's anticancer effects and underscores its potential role in immune regulation, highlighting the paradoxical value of TNFAIP6 in developing novel therapeutic strategies, including combination therapies.

Objective: To investigate the predictors of postoperative erectile dysfunction (ED) in patients who underwent bilateral nerve-sparing laparoscopic radical prostatectomy (BNLRP).

Materials and methods: Patients with preoperative ED were excluded. Postoperative erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) at 6 months postoperatively, with a cutoff score of ≤12 to define ED. The diagnostic value of associated factors was assessed using odds ratios (ORs) with 95% confidence intervals (CIs) based on univariate and multivariate logistic regression analyses. Only variables with p < 0.05 in univariate analysis were included in the multivariate model to avoid multicollinearity and overfitting.

Results: A retrospective review was conducted on 79 patients who underwent BNLRP for localised prostate cancer between April 2020 and March 2023. Postoperative ED was observed in 37 (46.8%) patients. Univariate analysis revealed significant associations between ED and age (p < 0.001), diabetes mellitus (p < 0.001), coronary artery disease (p < 0.001), hypertension (p < 0.001), Gleason score (p < 0.001), operative time (p < 0.001) and intraoperative blood loss (p < 0.001). Multivariate logistic regression identified age (OR: 1.136, p = 0.046), diabetes mellitus (OR: 32.706, p = 0.003), Gleason score (OR: 4.749, p = 0.015), operative time (OR: 1.200, p = 0.001) and blood loss (OR: 1.010, p = 0.039) as independent predictors.

Conclusions: ED after BNLRP is associated with patient-related and surgical factors. Identifying these predictors may improve preoperative counselling and support early postoperative rehabilitation strategies. Prospective multicentre studies are necessary to externally validate these findings.

Background: This study aims to evaluate and compare the transobturator tape and minisling surgical techniques in the treatment of stress urinary incontinence, focusing on their effectiveness and postoperative outcomes.

Methods: This retrospective analysis included 113 patients who underwent midurethral sling surgery for stress urinary incontinence at Islahiye State Hospital between January 2016 and October 2022. The patients were divided into two groups: Those treated with transobturator tape (Group 1, n = 70) and those treated with minisling (Group 2, n = 43). Data were collected from medical records and follow-up interviews. The variables assessed included demographics (age and body mass index), preoperative and postoperative Urinary Incontinence Quality of Life Scale scores, and postoperative pain details. Operative details, such as procedure duration and hospital stay length, were recorded. Patients were also asked about postoperative symptoms, including groin pain and dyspareunia. Additionally, the duration of symptom-free months following surgery was documented. Binary logistic regression analysis was conducted to evaluate the effect of surgical methods on long-term well-being.

Results: The transobturator tape and minisling techniques demonstrated similar improvements in postoperative Urinary Incontinence Quality of Life Scale scores (p = 0.213). However, the minisling procedure had significantly shorter operative time (29.2 min vs. 52.2 min, p < 0.001) and hospital stay (1.33 days vs. 1.96 days, p = 0.003) than transobturator tape. Postoperative complications were notably higher in the transobturator tape group, with significantly more patients reporting groin pain (28.6% vs. 4.7%, p = 0.002) and dyspareunia (20.0% vs. 0.0%, p = 0.002). Logistic regression analysis identified surgical method as the primary predictor of long-term well-being beyond one year (p = 0.040).

Conclusions: While the transobturator tape and minisling surgeries are effective for treating stress urinary incontinence, the minisling method offers advantages, such as shorter operative time, reduced hospital stay, and fewer postoperative complications, over the transobturator tape method. These findings suggest that the minisling approach may provide a more favorable patient experience, particularly due to reduced postoperative pain and quick recovery, than the transobturator tape method.

Background: Kidney stones are common in elderly patients, and their high recurrence rate after surgery is a significant clinical issue. This single-centre retrospective study aimed to assess the impact of the knowledge-attitude-practice (KAP) education model on preventing kidney stone recurrence in elderly patients.

Methods: Elderly patients who underwent kidney stone surgery from January 2022 to January 2023 were divided into an intervention group and a control group based on the KAP education model intervention. The recurrence of stones, renal function, calcium and phosphorus metabolism, and urine indices were compared before and 3 months after treatment in the two groups.

Results: The recurrence rates of kidney stones in the intervention group at 6 months, 1 year and 2 years after the surgery were all lower than the control group (p < 0.05). The levels of serum creatinine, blood urea nitrogen, uric acid and cystatin C in both groups 3 months after the intervention were lower than those before the treatment, and the reduction of each renal function index in the intervention group was more significant (p < 0.05). The total 24-hour urine volume in both groups was higher than before treatment, while urinary calcium, urinary oxalate and urinary uric acid (UA) were lower. The improvement of each urine index was more obvious in the intervention group (p < 0.05).

Conclusions: The KAP education model has a significant effect on preventing the recurrence of kidney stones in elderly patients.