Archivos Espanoles De Urologia最新文献

Introduction: Emerging studies have indicated that obstructive sleep apnea (OSA) is an independent risk factor for erectile dysfunction (ED). However, the results are inconsistent. By leveraging aggregated statistical data from genome-wide association studies (GWAS), we performed a bidirectional mendelian randomization (MR) analysis to further investigate the potential causal link between OSA and ED.

Materials and methods: We chose single nucleotide polymorphisms (SNPs) as instrumental variables based on rigorous criteria. Our research adopted five advanced two-sample MR analysis approaches, specifically encompassing inverse-variance weighting (IVW), MR-Egger, weighted median, simple mode, and weighted mode. Additionally, we conducted several sensitivity analyses to evaluate heterogeneity, horizontal pleiotropy, and stability, including Cochrane's Q test, MR-Egger intercept test, MR-pleiotropy residual sum and outlier (MR-PRESSO) global test, and leave-one-out analysis.

Results: The study included one dataset related to ED (Bovijn et al.) and two datasets related to OSA (Finngen and Sakaue et al.). The MR study results using the IVW method showed no significant causal association between OSA and ED in two datasets related to OSA. (IVW, odds ratio (OR): 1.01, 95% confidence interval (CI): 0.82-1.24, p = 0.954; 1.07, 0.87-1.30, p = 0.532, respectively). The results of other four MR analysis methods were consistent with IVW. In the reverse MR analyses, there was no causal effect of ED on OSA according to IVW method (IVW, OR: 1.01, 95% CI: 0.96 to 1.06, p = 0.708; 0.95, 0.87-1.05, p = 0.319, respectively). Moreover, sensitivity analysis showed that the study results remain highly consistent, with no indication of multi-collinearity or heterogeneity.

Conclusions: Our MR analysis revealed no clear bidirectional causal link between OSA and ED.

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been popular surgical treatment approaches for peritoneal carcinomatosis over the past three decades. In addition to metastases due to intra-abdominal malignancies, retroperitoneal renal metastases may occur. This study aimed to evaluate the safety and feasibility of performing nephrectomy in selected patients who underwent CRS for peritoneal carcinomatosis, without increasing morbidity and mortality, and to determine its effect on overall survival (OS).

Methods: In this single-centre retrospective observational study, 11 cases that required partial/total nephrectomy were reviewed amongst patients who underwent CRS and HIPEC for peritoneal carcinomatosis between 2017 and 2024. The effects of the surgical procedure on postoperative OS, mortality and morbidity were evaluated.

Results: The average age of the patients was 54 years (range: 23-83 years). Peritoneal carcinomatosis was caused by colon carcinoma in four cases, sarcomatosis in two cases, renal cell cancer in two cases, ovarian carcinoma in one case, mesothelioma in one case and teratomatosis in one case. Right nephrectomy was performed in six cases, right partial nephrectomy in three cases, left nephrectomy in one case and bilateral nephrectomy in one case. The average Peritoneal Cancer Index was 22.2, and complete cytoreduction was achieved in 90.9% of the patients. No 30-day mortality was observed. The average OS was 14 months (range: 2-53 months). The 1-year survival rate was 45.4%, the 2-year survival rate was 18% and the 3-year survival rate was 9%.

Conclusions: In cases of peritoneal carcinomatosis that require nephrectomy, CRS combined with HIPEC can be performed to achieve complete cytoreduction without increasing morbidity and mortality.

Purpose: This study aimed to evaluate perioperative outcomes and postoperative complications following minimally invasive radical cystectomy with ileal conduit (RCIC) performed under an enhanced recovery after surgery (ERAS) protocol, using the Clavien-Dindo classification (CDC) and the comprehensive complication index (CCI).

Methods: An ambispective study (2018-2022) was conducted, collecting demographic, perioperative and postoperative data, with a focus on complications among patients treated during and outside the COVID-19 period. Results were compared between surgeries conducted during the COVID-19 pandemic, including the first wave, and those performed in a non-COVID period.

Results: Among these 90 patients, 49 underwent surgery during the complete COVID-19 period, compared with 41 patients in the pre- and post-pandemic control period. Additionally, 15 of the cases occurred during the first wave of the pandemic. The COVID-19 group showed a higher rate of pN0 staging (87.8% vs 67.5%, p = 0.021) and fewer pN1 cases (2% vs 20%, p = 0.005) than the control group. The most common complications were genitourinary (71, 78.9%), infectious (59, 65.6%) and gastrointestinal (54, 60%). Median CCI increased significantly with each ascending CDC (r = 0.934, p < 0.001). Notably, 20.3% of patients in CDC ≤3a were reclassified to severe morbidity (CCI ≥33.7), with elevated rates during COVID-19 periods (46.7% and 42.9% vs 34.1%). CCI showed a more consistent correlation with length of stay than CDC (r = 0.551, p < 0.001 vs r = 0.460, p < 0.001).

Conclusions: Minimally invasive RCIC during the COVID-19 pandemic was associated with increased postoperative morbidity. Compared with RCIC, the CCI provides a more accurate estimation of morbidity burden and should be incorporated into standard surgical outcome reporting.

Background: This study aims to investigate the potential use of qualitative interferon-γ release assay, specifically T-spot testing focusing on culture filtrate protein 10 (CFP-10) positivity, in predicting the response of patients with high-risk non-muscle invasive bladder cancer (NMIBC) to intracavitary Bacillus Calmette-Guerin (BCG) vaccine instillation.

Methods: Patients diagnosed with high-risk NMIBC were retrospectively identified from an institutional database and subsequently underwent prospective T-spot testing. Following the completion of an adequate course of BCG instillation, patients who were unresponsive to BCG were assigned to the study group. By contrast, those who remained recurrence free for at least one year post-treatment were assigned to the control group.

Results: In this cohort of 42 patients with high-risk NMIBC, the median age was 67, and 40.0% were unresponsive to BCG. The distribution comprised 50.0% pTa and 81% high-grade cases. Over a median follow-up of 18 months, the positive BCG response varied between pTa (81%) and pT1 (38%; p = 0.005), and T-spot testing revealed positivity in 75.0% of the control group and 92% in BCG-unresponsive patients (p = 0.235). Notably, CFP-10 positivity was significantly more prevalent in the BCG-unresponsive group, observed in 91.7% of the patients, in contrast to 35.7% in the control group (p = 0.004).

Conclusions: T-spot test or more specifically CFP-10 positivity is a potential marker for predicting response to BCG instillation in patients with NMIBC.

Background: Delayed graft function is a common situation that leads to increased long-term rates of graft rejection and loss. It is seen increasingly more often, as the use of kidneys from donors after controlled cardiac death has become more widespread. This study aimed to identify factors contributing to its onset and determine how these factors may influence graft survival.

Methods: This study analysed kidney transplants with grafts from donors after controlled cardiac death performed at our hospital since the start of program in March 2013 until December 2023. Data on delayed graft function presence, graft survival, and variables related to donor, recipient, harvesting technique, ischemia time and surgical complications were collected.

Results: Recipients (male sex, 69%; Mean age, 57.9 years) received replacement renal therapy (haemodialysis in 47.6%) for a mean of 1.8 years. Amongst the donors, 73% presented expanded criteria. Ultrarapid technique was used in 61.1%, with a total warm ischemia time of 22.3 min. In all, 49 (38.9%) patients experienced delayed graft function. According to a multivariate analysis, this finding was associated with time on dialysis treatment (odds ratio (OR), 2.3; p = 0.02), donor history of diabetes mellitus (OR, 11.0; p = 0.03), score ≥3 on renal graft biopsy (OR, 4.9; p = 0.02), use of ultrarapid techniques compared with abdominal normothermic regional perfusion with extracorporeal membrane oxygenation (OR, 55.0; p = 0.03) and longer warm ischemia time (OR, 1.1; p = 0.02). Graft function was lost by 16 (12.7%) patients after a mean follow-up of 4.1 years (standard deviation (SD), 2.8). The likelihood of graft survival was 93% at 5 years. The presence of delayed graft function did not increase the rate of graft loss (p = 0.127); However, when only late losses were considered, 16.7% of kidneys with delayed graft function were lost vs. 4.1% without delayed graft function (p = 0.022).

Conclusions: In kidney transplants from donation after cardiac death, delayed graft function is associated with reduced graft survival. The incidence can be lowered by factors such as perfusion with extracorporeal membrane oxygenation, harvest techniques and shorter warm ischemia times.

Background: In recent years, claims of medical malpractice have increased. Doctors from the surgical branch frequently appear in medical malpractice reports. However, research in the national medical literature regarding the examination of court cases reflected in the higher judiciary in the field of urology appears to be lacking. This study aims to identify situations that give rise to malpractice claims in urology, specify errors and professionally risky situations and aid in the elimination of these deficiencies.

Methods: We examined the Supreme Court appeal decisions related to urology malpractice cases resolved between 2012 and 2022, using the keywords "urology" and "urologist" on the official website of the Republic of Turkey Supreme Court.

Results: We examined 37 Supreme Court decisions. We discovered that 12 cases involved negligent homicide, 9 cases involved negligent injury, 8 cases involved incorrect procedures, 4 cases involved lack of due care, 2 cases involved misuse of authority and 2 cases did not specify the type of fault.

Conclusions: We shed light on the instances in which urology specialists face allegations of malpractice. To avoid and minimise medical errors that may result in death or disability, specialists must be prepared for every situation before surgery and follow up the patients appropriately.

Background: Percutaneous nephrolithotomy (PNL) is a gold-standard procedure for managing complex kidney stones. It is traditionally performed in the prone position. Supine PNL offers benefits, such as enhanced ergonomics and simultaneous retrograde surgery. This study evaluates the outcomes and learning curve of a single novice surgeon transitioning from 119 prone to 118 supine cases.

Methods: This retrospective analysis included 237 patients (119 prone and 118 supine) treated between 2017 and 2024. All procedures involved general anaesthesia, fluoroscopy-guided renal puncture and standard or mini-PNL operations. Outcomes, such as operation time, fluoroscopy time, stone-free rate, complication and hospital stay, were analysed.

Results: Patients in the supine group had more comorbidities and required more complex procedures (e.g., multi-tract access and mini-PNL) but exhibited significantly shorter operative times (98 versus 123 minutes, p < 0.001) and fewer complications (6.8% versus 19.3%, p = 0.009) than those in the prone group. First-month stone-free rates were comparable (75.2% supine versus 76.5% prone, p = 0.132), and the supine group had higher stone-free rates after additional intervention (88.9% versus 78.2%, p = 0.047). Transitioning to supine PNL demonstrated a smooth learning curve without increased fluoroscopy times or adverse events.

Conclusions: Transitioning from prone PNL to supine PNL is feasible. The process shortens the operative time and produce comparable stone-free rates. Future studies should explore learning curves for different approaches.

Objective: To explore the impact of Tripterygium wilfordii glycosides (TWG) on glomerulosclerosis within a rat model of chronic kidney disease (CKD), as well as the role of the transforming growth factor-β1 (TGF-β1)/Smad signaling pathway in this mechanism.

Methods: Twenty-four clean Sprague-Dawley rats were divided into Sham group (n = 8), model group (n = 8) and TWG group (n = 8). Adriamycin nephropathy (ADRN) rat model was established by jugular vein injection of adriamycin (ADR). TWG rats were given TWG 50 mg/kg intragastrically once a day for 6 weeks. After 10 weeks, the ratio of total cell number to glomerulus, extracellular matrix (ECM) and collagen (Coll) deposition, a-smooth muscle actin (a-SMA), type I collagen (Col1) expression, TGF-β1, p-Smad2/3mRNA expression and TGF-β1, p-Smad2/3 protein expression were compared in each group.

Results: Masson staining revealed that in the model group, there was an increase in glomerular fibrosis, a heightened deposition of collagen fibers, and an expansion of interstitial spaces; Conversely, in the electroacupuncture group, the deposition of glomerular collagen fibers diminished. The intensity of a-SMA and ColI immunofluorescence staining in the kidney tissue of rats from the model group was markedly higher than that observed in the Sham group (p < 0.0001, < 0.0001 respectively). In contrast, the a-SMA and ColI immunofluorescence staining intensity in the TWG group was reduced compared to the model group (p = 0.009, 0.016 respectively). Furthermore, the expression levels of TGF-β1 and Smad3 messenger RNA (mRNA) in the kidney tissue of rats in the TWG group were lower than those in the model group (p = 0.013, 0.008, respectively), while the Smad7 mRNA was elevated compared to the model group (p = 0.019, 0.011, respectively). Additionally, the protein expression levels of TGF-β1 and p-Smad2/3 in the kidney tissue of rats in the TWG group were diminished compared to those in the model group (p < 0.0001, 0.006 respectively).

Conclusions: TWG can improve glomerulosclerosis and delay its progression, which may be achieved by down-regulating TGF-β1/Smad signal pathway.

The literature on the exact incidence of equipment failure during urological surgery is rather heterogeneous. Although failure rates are unacceptably high in other surgical disciplines, more compelling evidence is needed in urology. The present study provides case examples to illustrate several instances of urological instrument malfunction encountered in daily surgical practice, from the field of endourology to the newer robotic systems. Five cases of endourological device failures involving a resectoscope, a semi-rigid ureteroscope and alligator forceps and one case involving monopolar scissors of the Hugo RAS robotic system are presented, without any resultant complications to patients. Urologists and surgical personnel need to become acquainted with various equipment utilised in their field. Initiatives aimed at improvement of handling, inspection and prompt replacement of defective devices, rigorous adherence to manufacturers' guidelines, implementation of evaluative checklists for quality control and the adoption of incident-specific reporting forms are commendable actions toward enhancing operational efficiency. In the context of robotic surgery, a team of technical experts possessing sufficient knowledge of the equipment should offer continuous assistance in accordance with troubleshooting protocols. By implementing a standardised problem-solving strategy, they could diagnose and rectify emerging errors promptly and efficiently. Overall, failure in the theatre demands collective understanding and prompt management. Urologists need to communicate such events and collaborate to improve overall surgical efficiency.