Archivos Espanoles De Urologia最新文献

Background: Salvage cystectomy (SC) following failed bladder-preserving therapy shows an association with exceptionally high perioperative morbidity and mortality. Reliable preoperative biomarkers that can predict short-term outcomes are urgently needed. We investigated whether the systemic immune-inflammation index (SII) and De Ritis ratio (aspartate aminotransferase/alanine aminotransferase) can serve as predictors of 90-day postoperative survival following SC.

Methods: Of the 139 patients with advanced bladder cancer (cT3b-cT4) who underwent cystectomy between 2010 and 2025 at a tertiary referral centre, we identified 70 individuals who underwent SC. We then aimed to create a matched control group from a pool of primary radical cystectomy (RC) patients. With the use of a nearest-neighbour matching approach based on age, sex and clinical stage, a suitable match was found for 69 of the 70 SC patients. Therefore, the final study cohort consisted of 70 SC patients and 69 primary RC patients. The groups were well-balanced for the matching variables. Preoperative clinical, pathological and laboratory variables-including SII and De Ritis ratio-were assessed. The primary endpoint was 90-day all-cause mortality, and statistical significance was defined as p < 0.05.

Results: The 90-day mortality rate reached 49.6%. Nonsurvivors had significantly higher preoperative SII (979.9 vs. 521.5, p < 0.001) and De Ritis ratios (1.52 vs. 1.24, p < 0.001) compared with the survivors. Multivariate analyses confirmed SII (p < 0.001) and De Ritis ratio (p = 0.018) as independent predictors of early mortality. Receiver operating characteristic analysis demonstrated good discrimination with SII (area under the curve (AUC): 0.79) and De Ritis ratio (AUC: 0.68). The combined model demonstrated the highest predictive performance (AUC: 0.80; Sensitivity 69.6%; Specificity 80.0%).

Conclusions: Elevated preoperative SII and De Ritis ratio can independently predict 90-day mortality following SC. Their combined use may improve prognostic accuracy and offer a cost-effective and readily available tool for preoperative risk stratification in this high-risk population.

Background: Prune belly syndrome (PBS) is a rare congenital disorder defined by deficient abdominal musculature, urinary tract anomalies and cryptorchidism. Clinical presentation is variable, and extrarenal malformations are common.

Materials and methods: A retrospective descriptive study of seven patients diagnosed with PBS between 1990 and 2024 in a tertiary-care hospital was carried out. Clinical, biochemical, radiological, auxological and surgical data were reviewed.

Results: All patients had megacystis and abdominal muscle hypoplasia. Megalourethra was observed in three (43%), cryptorchidism in six (86%), hydronephrosis in all cases and renal dysplasia in four (57%). Extrarenal anomalies included congenital heart disease in three patients (43%), musculoskeletal defects in three (43%) and other malformations in two (28%). Mean serum creatinine level was 0.83 mg/dL at birth and 1.30 mg/dL at the last follow-up. Two patients (28%) required clean intermittent catheterisation, and one (14%) underwent renal transplantation at 14 years. Surgical procedures included orchidopexy in five patients (71%), vesicostomy in four (57%) and Mitrofanoff appendicovesicostomy in one patient.

Conclusions: PBS is a rare disorder with a heterogeneous clinical spectrum. This cohort revealed a high prevalence of cardiac anomalies. Renal dysplasia, recurrent urinary tract infections and delayed surgical intervention were associated with progressive renal impairment. Management in centres with multidisciplinary teams is essential.

Background and aims: To explore the factors influencing the clinical efficacy of emergency extracorporeal shock wave lithotripsy (ESWL) in patients with upper urinary tract calculi, construct a nomogram model for predicting stone expulsion outcomes and validate its performance.

Methods: A retrospective analysis was conducted on the clinical data of 502 patients with upper urinary tract calculi who underwent emergency ESWL at The First Affiliated Hospital of Henan University of Science and Technology from January 2022 to December 2024. All patients were divided into the effective and ineffective groups based on the complete elimination of calculi within 4 weeks after surgery. Differences in general clinical data, urinalysis, liver and renal function indicators, calculus-related characteristics and treatment-related characteristics between the two groups were compared. Multivariate logistic regression was used to identify independent predictors of ESWL efficacy and construct a nomogram model. The model was evaluated using the receiver operating characteristic curve, calibration curve and decision curve analysis.

Results: A total of 140 (27.9%) patients had ineffective treatment. Independent risk factors for failure included long emergency visit-to-ESWL time, high urinary white-blood-cell count, elevated serum creatinine/serum uric acid, large maximum stone diameter, high stone density and severe hydronephrosis; ESWL energy and the number of shocks were mediated associated factors; High estimated glomerular filtration rate and ureteral calculi were protective factors (all p < 0.05). The nomogram showed a good predictive performance (area under the curve = 0.862, 95% confidence interval: 0.793-0.931) with good calibration and net benefit.

Conclusions: A validated nomogram based on independent predictors and mediated factors was constructed to provide a reliable tool for emergency ESWL decision-making.

Background: To evaluate the antineoplastic effects of Ankaferd Blood Stopper (ABS) compared with standard immunotherapeutic and chemotherapeutic agents in primary bladder cancer cell cultures.

Methods: Tumour tissues taken from patients who underwent transurethral bladder tumour resection due to primary bladder tumour were grown in primary cell culture (PCC). Each patient was divided into six different groups. Ankaferd Blood Stopper, Bacillus Calmette-Guérin (BCG), gemcitabine (GCB), ABS + BCG and ABS + GCB combinations were applied to the groups. A 24-h viability assay was performed for all groups.

Results: Amongst the 24 patients diagnosed with bladder cancer, 4 were excluded due to the detection of muscle invasive bladder cancer on pathological evaluation. Consequently, 20 patients with confirmed non-muscle invasive bladder cancer (NMIBC) were included in the study. Patients treated with BCG, ABS and GCB were compared with the control group, and the average cell viability rates were 39.20%, 32.30% and 42.00%, respectively (p < 0.001). Furthermore, combination treatments (ABS + BCG and ABS + GCB) resulted in significant reductions in viability (p < 0.001). Despite similarities in stages, histological types and grades, the viability outcomes following drug treatment varied.

Conclusions: ABS negatively impacted the survival outcomes of bladder cancer cells. Upon examination of the results for each bladder tumour, despite identical stages and grades, the viability responses still varied. These findings support further investigation of personalised treatment and ABS as a potential adjunct in bladder cancer therapy.

Objective: This study aimed to describe the aetiology and risk factors of urinary tract infection in patients with type 2 diabetes mellitus (T2DM).

Methods: The clinical data of patients with T2DM treated in our hospital from January 2023 to January 2025 were retrospectively analysed. The patients were divided into the infection group and control group based on the occurrence of urinary tract infection (UTI). The incidence and risk factors of T2DM associated with UTI were analysed. Multivariate logistic regression analysis was conducted to establish a risk prediction model, and a receiver operating characteristic (ROC) curve was drawn. All patients were randomly divided into a training set and a validation set at a ratio of 7:3 to evaluate the stability of the prediction model.

Results: This study comprised 269 patients with T2DM, of whom 50 had UTI, resulting in an incidence rate of 18.59%. Multivariate logistic regression analysis showed that the duration of diabetes and levels of glycosylated haemoglobin (HbA1c), sodium-dependent glucose transporter 2 (SGLT2) inhibitor and albumin (ALB) were independent risk factors for T2DM complicated by UTI (p < 0.05). The area under the ROC curve for the training set was 0.806 (95% CI 0.723-0.888), the specificity was 0.845 and the sensitivity was 0.833. In the validation set, the area under the ROC curve was 0.877 (95% CI 0.793-0.960), the specificity was 0.829 and the sensitivity was 0.882. The calibration curve indicated that the prediction curve fit well with the ideal curve (45-degree diagonal). This suggested a strong correlation between the predicted and actual probabilities, indicating a good model.

Conclusions: Duration of diabetes and levels of HbA1c, SGLT2 inhibitor and ALB may be independent risk factors for UTI in patients with T2DM. These indicators should be monitored in clinical practice to prevent UTIs.

Background: Retroperitoneal lymph node dissection (RPLND) is an effective treatment option for testicular cancer with retroperitoneal lymph node metastasis. The accurate prediction of surgical and oncological outcomes after RPLND is essential. In the present study, we aim to evaluate the effect of central sarcopenia on surgical and oncological outcomes in patients undergoing RPLND.

Methods: This retrospective cohort study was approved by the institutional ethics committee. Patients diagnosed with metastatic testicular germ cell cancer treated with three or four cycles of bleomycin, etoposide and platinum chemotherapy followed by RPLND between 2010 and 2023 were enrolled. Demographic factors (age, gender, body mass index, comorbidities and cancer characteristics), RPLND pathology, postoperative complications and survival data were evaluated, and the relationship between the psoas lumbar vertebral index (PLVI) calculated from axial computed tomography images and clinical outcomes was examined.

Results: The median follow-up duration for the 48 patients was 81.5 months (interquartile range (IQR): 32-150). The median age at RPLND was 26 years (IQR: 21-30). The median PLVI was 0.79 (IQR: 0.65-0.91), and low PLVI values were significantly associated with high postoperative complication rates (p = 0.013). Furthermore, low PLVI (p = 0.007) and large tumour size (p = 0.018) were independently associated with short metastasis-free survival (MFS).

Conclusions: Low PLVI is significantly associated with short MFS and an increased risk of postoperative complications. In addition, large tumour size predicts short MFS, and the PLVI is a potentially valuable predictive marker for surgical and oncological outcomes for patients undergoing post-chemotherapy RPLND.

Selective preservation of the testicular lymphatics is the most effective among the strategies for preventing postoperative hydrocele after laparoscopic Palomo varicocelectomy (LPV). Classical methods employ intraoperative dyes, such as isosulfan blue, instead of indocyanine green (ICG), which enables clearer and real-time lymphatic mapping through near-infrared imaging after intratesticular injection. ICG facilitates the precise identification and preservation of lymphatic vessels and reduces hydrocele risk. Notably, LPV is traditionally performed with three trocars, but this technical note describes a two-port ICG-assisted modification based on an illustrative case and discusses its practical implications, highlighting its potential as a tool for advancing single-incision laparoscopic surgery.

Objectives: This study investigated whether the Naples prognostic score (NPS), derived from preoperative immunonutritional markers, can predict biochemical recurrence (BCR) amongst individuals with prostate cancer (PCa) treated surgically with robot-assisted laparoscopic radical prostatectomy (RALP).

Methods: This study involved a retrospective review of information obtained from patients who underwent RALP for PCa between February 2019 and June 2023. The information included patients' laboratory findings, biopsy results and postoperative pathological assessments. Participants were separated into BCR-positive and BCR-negative cohorts. Comparisons across these groups included preoperative laboratory measurements, NPS assessments and histopathological findings from biopsy and surgical specimens. Independent predictors of BCR were determined through Cox regression analysis.

Results: This analysis comprised 321 individuals treated with RALP who had a minimum postoperative follow-up of one year for BCR assessment. Cox regression analysis revealed that high preoperative prostate-specific antigen (PSA) levels (hazard rate (HR) = 1.067; 95% confidence interval (CI) = 1.018-1.109; p < 0.001), postoperative specimen pathology >International Society of Urological Pathology (ISUP) 3 (HR = 2.459; 95% CI = 1.264-4.782; p = 0.008), positive surgical margins (HR = 2.625; 95% CI = 1.253-5.502; p = 0.011) and an NPS of 3 or 4 (HR = 2.692; 95% CI = 1.377-5.261; p = 0.004) were associated with an increased risk of BCR. The NPS-only Cox regression model demonstrated a moderate predictive ability with Harrell's concordance index (C-index) of 0.654 (95% CI = 0.582-0.726), and the combined Cox regression model incorporating preoperative PSA levels, postoperative specimen pathology >ISUP 3, positive surgical margins and an NPS of 3 or 4 showed high discriminative performance with a C-index of 0.819 (95% CI = 0.761-0.877). Kaplan--Meier survival analysis revealed a statistically significant reduction in BCR-free survival amongst patients in the high-risk NPS group (57.9%) relative to those in the low-risk NPS group (81.2%) following RALP (log-rank test, p < 0.001).

Conclusions: A high NPS was found to be associated with an increased risk of BCR in patients with localised PCa. These results suggest that pretreatment NPS may serve as a useful adjunctive prognostic marker. Nevertheless, additional well-designed prospective investigations are required to validate its applicability in clinical practice.

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.