Archivos Espanoles De Urologia最新文献

Background: This study aims to compare the efficacy and safety of retrograde intrarenal surgery (RIRS) between patients aged 65 years and older and younger patients.

Methods: In this retrospective study, we analysed the medical records of patients who underwent RIRS for the management of the proximal ureter and renal stones between September 2022 and December 2023. The patients were divided into two age-based groups. We compared demographic and clinical data including stone-free rates (SFRs), complication rates and the necessity for secondary procedures between the two cohorts. Postoperative complications were categorised using the Clavien-Dindo classification system.

Results: A total of 258 patients were included in the study. Group 1 comprised 193 patients (74.8%) aged younger than 65 years, with an average age of 47 ± 12.3 years. Group 2 included 65 patients (25.2%) aged 65 years and older, with an average age of 68 ± 6.5 years (p-value = 0.0001). The older group had higher prevalence of comorbidities and scores based on American Society of Anaesthesiologists (ASA) guidelines compared with the younger group (p = 0.0001). Despite these differences, no statistically significant difference was observed between the two groups regarding SFR (p = 0.543) and Clavien-Dindo complication rates (p = 0.659). Both groups demonstrated similar rates of postoperative complications and required secondary procedures at similar rates.

Conclusions: RIRS provides similar efficacy and safety in patients aged 65 years and older compared with younger patients. Further studies with larger cohorts and longer follow-up periods are recommended to validate these findings.

Background: This study aimed to investigate the risk factors for urinary tract infections (UTIs) in patients with cervical cancer (CC) following radical surgery, and analyse the etiological distribution and prognostic implications of these infections.

Methods: A retrospective analysis was conducted on the clinical data of 168 patients with CC who underwent radical surgery at our hospital between January 2021 and December 2023. Postoperative UTI incidence and associated risk factors were analysed. Postoperative urine samples were collected under sterile conditions for pathogen culture to analyse pathogen distribution. Patients were classified into poor and good prognosis groups based on their health status within one month of treatment. The relationship between pathogen distribution and prognosis in patients with CC and postoperative UTIs was analysed.

Results: The incidence of postoperative UTIs was 35.12% (59 cases). Among these patients, 84 pathogen strains were detected in urine samples, including 54 of gram-negative bacteria, 26 of gram-positive bacteria, and four of fungi. The single-factor analysis identified age, diabetic status, menopausal status, tumour diameter, surgical duration, intraoperative blood loss volume, duration of ureteral catheterisation, and postoperative urinary retention as potential risk factors. The multifactorial analysis confirmed age, diabetic status, operation duration, intraoperative blood loss volume, duration of ureteral catheterisation, and postoperative urinary retention as independent risk factors. The distribution of Klebsiella pneumoniae (K. pneumoniae) significantly differed between the study groups, while other pathogens showed no significant difference.

Conclusions: UTIs in patients with CC post-radical surgery are primarily caused by gram-negative bacteria, mainly Escherichia coli and K. pneumoniae. K. pneumoniae is predominant in patients with a poor prognosis, while Enterococcus spp. is the most common gram-positive bacterium observed.

Background: The increasing frequency of health checkups has led to an increasing diagnosis of renal stones. There exist various treatments for renal stones, but the less invasive ultra-mini percutaneous nephrolithotomy (UMP) treatment is gaining wide attention. The present study aimed to confirm the characteristics of renal stones that help achieve a high stone-free rate through UMP regardless of the complications.

Methods: A retrospective study was conducted on 100 consecutive patients from May 2016 to February 2021. The study used a 7.5 Fr nephroscope and an irrigation pump. Renal stones were pulverised into as small particles as possible using a holmium laser discharged through an 11/12 Fr operating sheath. Kidneys, ureters, and bladder (KUB) and stone computed tomography (CT) scans were performed four weeks after surgery to confirm the stone-free state in patients.

Results: The present study enrolled 72 men and 28 women who underwent UMP. The mean age of the patients was 61.5 years. The average size of the stones was 2.7 ± 1.1 cm. The average operation time was 74.7 ± 38.5 minutes. Three collecting system injuries occurred; However, no damage to other organs or bleeding was observed. At the one-month follow-up, the overall stone-free rate of UMP was 66%, lower than the target stone-free rate of 87%. The multivariate logistic regression analysis revealed that a high surgical success rate could be predicted in the cases of a single calcium oxalate or uric acid stone with a stone size <3 cm.

Conclusions: UMP can be considered the first treatment option for single renal calcium oxalate or uric acid stones with a size <3 cm.

Background: Renal cell carcinoma (RCC) is a reclusive tumor, usually discovered incidentally on imaging examinations of other abdominal diseases. Although prognosis models based on pathology are more accurate, it is crucial to evaluate tumor prognosis before invasive operations to support the choice of active surveillance and ablation therapy. Thus, non-invasive methods are essential for determining appropriate treatment strategies in patients.

Methods: Data from 106 patients under non-metastatic clear cell RCC (ccRCC) who went through partial/radical nephrectomy from January 2016 to October 2023 were retrospectively evaluated. Basic demographic information, preoperative hematological indicators, pathological data, and computed tomography (CT) measurements of perinephric adipose tissue (PAT) were collected for each patient. The CT assessments of PAT, including thickness, radiodensity, and Mayo adhesive probability (MAP) score, were performed by a radiologist. Univariate and multivariate logistic regression analysis was applied to clarify risk factors of Fuhrman grade, tumor size, and the Stage Size Grade Necrosis (SSIGN) score. The receiver operating characteristic (ROC) curve of SSIGN was then constructed in order to determine discriminatory ability and optimal cut-off values of these risk factors.

Results: The radiodensity of PAT on the tumor side was significantly higher (p < 0.001) compared to the contralateral side. RCCs with higher maximum radiodensity of PAT and elevated C-reactive protein-to-albumin ratio (CAR) were related to a higher Fuhrman grade, larger tumor size, and increased Stage Size Grade Necrosis (SSIGN) scores (all p < 0.05). The area under curve (AUC) of maximum radiodensity of PAT and CAR for higher SSIGN scores was 0.816 (p = 0.003) and 0.811 (p = 0.004) each. The optimal cut-off values of PAT and CAR for higher SSIGN scores were -69.685 and 0.0452, respectively.

Conclusions: The study corroborates that PAT and CAR's maximum radiodensity are independent markers for predicting Fuhrman grade, tumor size and SSIGN. These non-invasive methods are likely to improve traditional prognostic prediction and possibly effect new therapeutic strategies for patients with non-metastatic ccRCC.

Background: This study aimed to compare the efficacy of various injection therapy agents used in combination with internal urethrotomy in preventing fibrosis and stricture recurrence.

Materials and methods: Patients who underwent direct vision internal urethrotomy (DVIU) in our clinic between 2017 and 2022 were retrospectively screened. The patients were divided into four groups: DVIU + intralesional platelet-rich plasma (DVIU + PRP group, n = 21), DVIU + intralesional mitomycin-C (DVIU + MMC group, n = 21), DVIU + intralesional prednisolone (DVIU + prednisolone group, n = 21), and DVIU alone (control group, n = 21). The length (mm) and diameter (mm) of the recurrent urethral strictures and maximum urinary flow rate (Q_max) on uroflowmetry evaluation were measured at 1, 3, and 6 months postoperatively and compared between the four groups.

Results: Urethral stenosis recurred in two (9.5%) patients in the DVIU + PRP group, three (14.3%) in the DVIU + MMC group, seven (33.3%) in the DVIU + prednisolone group, and nine (42.9%) in the control group. The reduction in stenosis recurrence significantly differed between the four groups (p = 0.040). A significant group difference in stenosis length (p = 0.047) but not in stenosis diameter (p = 0.385) was observed in patients with recurrent stenosis. Furthermore, no significant difference in Q_max was found between the groups at 1, 3, and 6 months postoperatively (p = 0.588, p = 0.047, p = 0.067, respectively).

Conclusions: Different intralesional treatments combined with internal urethrotomy demonstrate varying efficacy in reducing urethral stricture recurrence. Considering its high success rate, low cost, and reduced side effects, PRP may be the preferred intralesional treatment option in combination with DVIU.

Purpose: This study aimed to establish a comprehensive evaluation and assessment system for urology specialists based on entrustable professional activities (EPAs).

Methods: A research group was formed to develop a preliminary index system for the evaluation and assessment of urology specialists through an extensive literature review and group discussions. The Delphi method was employed to design a questionnaire, and two rounds of expert consultations were conducted to finalize the index system and design a corresponding assessment method.

Results: A total of 24 experts participated in the two rounds of consultations, with authority coefficients of 0.885 and 0.894, and agreement levels of 0.270 and 0.256, respectively, indicating a high level of expertise and strong consensus among the participants. Based on the expert feedback, 16 key indicators were identified: Recognizing and admitting urological patients, selecting and interpreting specialized tests, diagnosing and differentiating diseases, making therapeutic decisions, documenting medical information, delivering oral clinical case reports, identifying and managing primary care and speciality medical problems, managing critical illness, handling patient transfers and departmental handovers, communicating informed medical decisions, performing basic and specialized surgical operations, providing health guidance, responding to public health emergencies, and engaging in clinical teaching. All indicators scored above 3.5 in importance, with coefficients of variation below 0.25, signifying their appropriateness. The expected confidence levels for each indicator at various stages were determined, and a comprehensive assessment method encompassing "process evaluation, peer impression review, and endpoint assessment" was developed.

Conclusions: This research successfully established an initial EPAs-based evaluation and assessment index system for urology specialists, defined the expected confidence levels for each indicator across different time points, and devised a specific assessment methodology, thereby providing a scientific foundation for the training and evaluation of urology specialists.

Background: This study aims to investigate centrosomal protein 70 (CEP70) in prostate cancer and its effects on angiogenesis and tumour metastasis and elucidate its molecular mechanisms.

Methods: We evaluated CEP70 and Vascular Endothelial Growth Factor Receptor 2 (VEGFR2) in tissue samples from patients with prostate cancer by immunohistochemistry. In vitro experiments included overexpressing CEP70 through transfection and assessing its impact on human umbilical vein endothelial cells (HUVECs). Intervention experiments with an NF-κB pathway inhibitor were conducted to verify the mechanism. Finally, the effects of CEP70 on tumour growth, angiogenesis and metastasis were examined in a nude mouse model.

Results: CEP70 was significantly overexpressed in prostate cancer tissues compared with that in adjacent normal tissues (p < 0.001). In vitro experiments demonstrated that CEP70 overexpression promoted HUVEC migration (p < 0.001), invasion (p < 0.001) and tube formation (p < 0.05). CEP70 significantly upregulated VEGFA expression in prostate cancer cells at messenger RNA (mRNA) (p < 0.001) and protein levels (p < 0.05). VEGFA knockdown experiments confirmed CEP70 as an essential cytokine for CEP70-induced angiogenesis (p < 0.01). Mechanistically, CEP70 promoted VEGFA expression by activating the NF-κB signalling pathway, as evidenced by the reversal of CEP70-induced effects upon treatment with the NF-κB inhibitor BAY11-7082 (p < 0.01).

Conclusions: CEP70 promotes tumour angiogenesis and metastasis by upregulating VEGFA through NF-κB pathway activation.

Background: Traditional diagnostic methods have limitations in accurately identifying and characterising prostate apex cancer. Therefore, exploring innovative approaches such as magnetic resonance imaging (MRI) radiomics, biomarker assessments and clinical pathological features is essential to improve diagnostic accuracy.

Methods: This retrospective study evaluated diagnostic data from 52 patients with prostate apex cancer and 52 healthy individuals. MRI radiomics features-including grey-level non-uniformity, co-occurrence homogeneity, first order skewness, grey level co-occurrence matrix (GLCM) correlation, wavelet-low-high-low (wavelet-LHL) energy and prostate apparent diffusion coefficient (ADC) values-were compared between the groups. Biomarker levels, including Free Prostate-Specific Antigen (fPSA), Prostate-Specific Antigen (PSA), Ratio of Free to Total Prostate-Specific Antigen (f/tPSA), Prostate Volume (PV) and Prostate-Specific Antigen Density (PSAD), were also measured and analysed. Statistical analyses included t-tests, chi-square tests, correlation analyses and receiver operating characteristic (ROC) analyses.

Results: Significant differences were observed between the healthy and cancer groups in several MRI radiomics features: Grey-level non-uniformity (57.23 ± 7.31 vs. 69.54 ± 9.84, p < 0.001), co-occurrence homogeneity (0.29 ± 0.05 vs. 0.21 ± 0.07, p < 0.001), first order skewness (2.91 ± 0.61 vs. 3.85 ± 0.71, p < 0.001), GLCM correlation (0.72 ± 0.06 vs. 0.62 ± 0.07, p < 0.001), wavelet-LHL energy (264.14 ± 30.12 vs. 311.24 ± 42.13, p < 0.001) and prostate ADC value (1.29 ± 0.25 vs. 0.98 ± 0.15 × 10^-3 mm²/s, p < 0.001). Biomarker levels also differed significantly: fPSA (0.93 ± 0.50 vs. 1.97 ± 1.69 ng/mL^-1, p = 0.032), PSA (6.69 ± 2.55 vs. 17.45 ± 7.85 ng/mL^-1, p = 0.048), f/tPSA (0.14 ± 0.07 vs. 0.11 ± 0.07 ng/mL^-1, p = 0.020), PV (42.16 ± 8.32 vs. 38.43 ± 8.92 mL, p = 0.030) and PSAD (0.17 ± 0.08 vs. 0.49 ± 0.29 µg/L/mL^-1, p = 0.040). The combined model of these parameters achieved a sensitivity of 0.865, a specificity of 0.962 and an area under the curve of 0.913.

Conclusions: The integration of MRI radiomics, biomarker assessments and clinical pathological features presents a promising approach for diagnosing prostate apex cancer.

Background: To determine the predictive value of patient's preoperative characteristics and laboratory values for positive surgical margin (PSM) after radical retropubic prostatectomy (RRP).

Methods: This study included 278 patients who underwent RRP between January 2011 and October 2022 due to prostate cancer (PCa) with no prior radiotherapy or hormonal treatment. The patients' preoperative characteristics and laboratory findings were recorded, and the patients were divided into two groups based on their surgical margin status. Multivariate logistic regression was performed to assess the impact of the patients' preoperative characteristics and laboratory results on PSM status.

Results: The PSM group exhibited significantly higher body mass index (BMI), number of biopsy positive cores, percentage of tumours in positive cores, and neutrophil-to-lymphocyte ratio (NLR) than the negative surgical margin (NSM) group (p < 0.001, p = 0.004, p < 0.001, and p = 0.035, respectively). Conversely, the aspartate transaminase/alanine transaminase (AST/ALT) ratio was significantly lower in the PSM group than in the NSM group (p = 0.031). Compared to the NSM group, the PSM group had a significantly higher proportion of patients with a preoperative Gleason score (GS) of ≥8 and an elevated D'Amico risk (p < 0.001 and p = 0.046, respectively). Furthermore, BMI, preoperative prostate-specific antigen (PSA) level, percentage of tumours in positive cores, NLR, GS ≥8, and high D'Amico risk were significant independent predictors of PSM. The NLR cut-off value of ≥1.96 was found to be appropriate, leading to a sensitivity of 69%, specificity of 46%, positive predictive value of 13%, and negative predictive value of 93%. Lastly, the area under the receiver operating characteristic curve of the NLR for PSM was 0.581 (95% confidence interval: 0.52-0.64, p = 0.035).

Conclusions: Our study results reveal that NLR, BMI, percentage of tumours in positive cores, preoperative PSA level, high-risk PCa, and GS ≥8 are predictive factors for PSM. Preoperative NLR may serve as an independent predictor of PSM following RRP.