Archivos Espanoles De Urologia最新文献

Background: The endoscopic treatment of complete ureteral transections has been reported. However, records on the use of metallic ureteral stents for this purpose are lacking. We present a case of complete ureteral transection successfully treated with ureteral realignment using an Allium ureteral stent.

Case presentation: A 70-year-old man underwent abdominoperineal amputation due to rectal cancer. Postoperatively, he was diagnosed with a complete right ureteral transection and subsequent urinary leakage. Pyelography revealed that the two ureteral ends of the injured area were not contiguous. A ureteral guidewire was passed through the injured area using a combined antegrade and retrograde approach. Given the severity of the injury, realignment with an Allium ureteral stent was attempted. Following successful placement, the urinary leak resolved, and the affected renal unit remained free of hydronephrosis. The short-term follow-up (2 weeks) does not allow assessment of long-term outcomes, which represents a major limitation of this report.

Conclusions: To the best of our knowledge, this study is among the very few reported cases utilising an Allium stent for the endoscopic realignment of complete ureteral transection. We believe that this stent may be useful in the endoscopic resolution of complete ureteral transections because of its larger diameter and ability to isolate the affected area compared with other catheters such as the double-J stent.

Objective: This study aimed to evaluate the safety and efficacy of a novel transurethral cystolithotripsy device designed to manage bladder calculi.

Methods: Consecutive patients with bladder calculi who underwent transurethral cystolithotripsy at our medical center performed by the same surgical team between January 2014 and July 2019 were included. Patients' medical records data were evaluated retrospectively. Patients were divided into three groups based on the cystolithotripsy approach used: Conventional transurethral discontinuous flow cystoscope (Group 1); Ureteroscope inserted into a 26 Fr resectoscope sheath (Group 2); And Group 3 received treatment using our redesigned resectoscope incorporating an Fr5 guide catheter replacing the conventional electricity loop (Group 3).

Results: In total, 69 patients were included. Postoperative ultrasonography confirmed complete stone clearance in all groups. The median lithotripsy operation time was significantly shorter in Group 3 (20.00 min, Q1-Q3: 15.00-25.00) compared to Group 1 (40.00 min, Q1-Q3: 40.00-60.00) and Group 2 (27.50 min, Q1-Q3: 15.00-36.25) (p < 0.0001). Group 3 also required the least irrigation fluid (12.00 L, Q1-Q3: 6.00-20.25), compared to Group 1 (33.00 L, Q1-Q3: 27.00-36.00) and Group 2 (39.00 L, Q1-Q3: 29.25-45.75) (p < 0.0001). No vesical perforation occurred in Group 3, while one case occurred in Groups 1 and 2. Postoperative fever was observed in three patients from Group 1 and two from Group 3. No other intraoperative or postoperative complications were noted.

Conclusions: Our redesigned continuous-flow resectoscope is a safe and highly effective modality for treating bladder calculi, reducing operative time and irrigation volume significantly compared to conventional methods, while maintaining a low complication rate. Study findings suggest that this novel approach may serve as a cost-effective and efficient alternative for transurethral cystolithotripsy.

Background: Percutaneous nephrolithotomy (PCNL) is the preferred technique for kidney stones larger than 20 mm in maximum diameter. The objective of this study is to evaluate the effect of the nephrostomy tube technique vs. that of the tubeless technique in patients undergoing supine PCNL, focusing on postoperative complications and hospital stay duration.

Methods: This retrospective observational study was conducted from January 2018 to June 2024. A total of 243 patients underwent supine PCNL. Clinical, surgical and postoperative variables were compared between patients with and without nephrostomy tubes. Complications were classified into clinically relevant categories: Infectious (fever ≥38 °C), haemorrhagic (postoperative haemoglobin drop >1 g/dL within 48 h or the requirement for blood transfusion) and severe (including nephrectomy and mortality). A binary logistic regression model was used to identify independent predictors of complications. Stone-free status was assessed by noncontrast computed tomography (CT) at six weeks. All analyses were performed with IBM SPSS Statistics 26.0.

Results: In 50% of patients, a nephrostomy tube was placed at the end of the procedure. The overall complication rate was 14.4% and was significantly higher in patients with nephrostomy tubes (22.9% vs. 6.7%; p < 0.001) than in those without. Hospital stay was longer in patients with nephrostomy tubes (median 3 days (interquartile range (IQR) 2-4) vs. 1 day (IQR 1-2); p < 0.001) than in those without. Stone-free rate was comparable between groups (80.9% vs. 77.8%; p = 0.529). In multivariate analysis, nephrostomy remained independently associated with complications (odds ratio 4.15; 95% confidence interval 1.72-10.02; p = 0.001).

Conclusions: In this retrospective series, tubeless PCNL was associated with significantly reduced overall complication rates, mainly as a result of a low number of bleeding events, and short hospital stay without compromising stone-free rates. These findings support the safety of a tubeless approach in appropriately selected patients.

Background: Neurogenic bladder (NB) is a complex bladder dysfunction that arises subsequent to spinal cord injury (SCI), profoundly affecting the quality of life. This study examined the effects of varying intensities of repetitive transcranial magnetic stimulation on NB treatment outcomes.

Methods: Patients admitted because of SCI-induced NB between March 2022 and March 2024 were enrolled. Patients were divided according to the treatment methods they received: 120% resting motor threshold (RMT) and 80% RMT groups. Baseline data, lower urinary tract symptoms and the Neurogenic Bladder Symptom Score (NBSS), Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD) and World Health Organization Quality of Life-BREF (WHOQOL-BREF) scores were analysed and compared between the groups.

Results: A total of 128 participants successfully completed the study (120% RMT: n = 68; 80% RMT: n = 60). The groups exhibited similar baseline characteristics and yielded equivalent pre-intervention outcomes (all p > 0.05). After the intervention, significant decreases in daily voiding, leakage frequency and residual urine volume (RUV), NBSS, HAMA and HAMD scores were observed (all p < 0.05 compared with pre-intervention values). The 120% RMT group exhibited more pronounced decreases (p < 0.05). Significant increases in maximum flow rate, single void volume and WHOQOL-BREF (all p < 0.05) and more pronounced advancements were observed in the 120% RMT group (p < 0.05).

Conclusions: This study demonstrates that 120% RMT improves the physical symptoms, psychological well-being and overall quality of life for patients with SCI-induced NB.

Background: The use of anticoagulant (AC) and antiaggregant (AG) medications is increasingly common in elderly patients undergoing urologic surgeries. This prospective observational study aimed to evaluate the influence of AC/AG therapy on bleeding-related complications following transurethral resection of the prostate (TURP), transurethral resection of bladder tumour (TURBT) and open prostatectomy (OP).

Methods: Patients who underwent TURP, TURBT or OP between March 2022 and January 2023 were included in this study. Patients were stratified according to AC/AG usage. Perioperative management details, including low-molecular-weight heparin (LMWH) bridging, were recorded. We evaluated parameters including duration of irrigation, length of stay, episodes of clot retention, transfusion rate and re-admission rate due to haematuria.

Results: Among TURP patients, those using AC/AG therapy had significantly higher rates of transfusion (2.27% vs 0%, p = 0.038), postoperative clot retention (7.57% vs 0.53%, p = 0.008), re-catheterisation (9.09% vs 3.72%, p = 0.046) and re-admission due to haematuria (11.36% vs 3.72%, p = 0.008) compared with those not receiving AC/AG therapy. In the TURBT group, AC/AG use was associated with an elevated rate of rehospitalisation (p = 0.026). OP patients on AC/AG therapy experienced increased transfusion rates (p = 0.030), early postoperative clot retention (p = 0.034) and re-operations (p = 0.016). LMWH bridging was associated with further increases in irrigation volume, early clot retention and rehospitalisation, particularly in TURBT and OP patients.

Conclusions: AC/AG therapy significantly influences bleeding outcomes after TURP, TURBT and OP. LMWH bridging may further exacerbate these risks. This study emphasises the need for caution regarding bleeding-related complications in patients receiving AC/AG therapy.

Background: This study aims to evaluate long-term surgical outcomes and identify predictive factors associated with urethroplasty failure in patients with anterior urethral strictures.

Methods: A retrospective study was conducted on 419 patients who underwent urethroplasty between January 2009 and December 2024. Eleven different surgical techniques were performed based on the location, length and aetiology of strictures as well as prior interventions. Clinical data including demographics, surgical history, stricture characteristics and complications were analysed. Surgical success was defined as the absence of any further urethral intervention and maximum voiding flow rate above 15 mL/s months or years after the surgery. Statistical analysis included Cox regression, Chi-square and Kaplan-Meier survival analysis.

Results: The overall surgical success rate was 74.7% (313/419 patients), with a complication rate of 10.2%. Recurrence occurred in 25.3% of cases. Univariate analysis revealed that body mass index (BMI), stricture length, number of previous direct vision internal urethrotomies (DVIUs), prior urethroplasty and panurethral strictures (>10 cm) were significantly associated with surgical failure. Multivariate analysis identified increased BMI and number of previous DVIUs as independent predictors of failure (p < 0.05).

Conclusions: History of prior interventions and BMI are key factors influencing outcomes. Early referral for definitive surgical management is recommended to avoid progression and reduce failure risk.

Background: This study aimed to compare the outcomes of open partial nephrectomy (OPN) and robot-assisted partial nephrectomy (RAPN) based on preoperative risk assessment using Martini's nomogram and postoperative trifecta and pentafecta criteria.

Methods: We retrospectively reviewed patients who underwent OPN or RAPN between 2017 and 2021. Renal function was assessed pre- and postoperatively using estimated glomerular filtration rate (eGFR) calculated by the Cockcroft-Gault formula. Baseline renal function was defined in accordance with the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The Martini's nomogram was used preoperatively to estimate the risk of >25% postoperative eGFR decline; Surgical outcomes were evaluated in accordance with trifecta and pentafecta criteria.

Results: A total of 103 patients were included (OPN: 63; RAPN: 40). The median follow-up was 77 (65-87) months. Median warm ischemia time was significantly lower in the OPN group (20 vs. 27.5 min, p < 0.001). Trifecta and pentafecta achievement rates were higher in the OPN group (65% vs. 25%, p < 0.001; 30.1% vs. 10%, p < 0.05, respectively). Martini's nomogram showed good discrimination in OPN (area under the curve (AUC) = 0.87) and RAPN (AUC = 0.80). Calibration analyses indicated overestimation in the OPN high-risk stratum, whereas the RAPN high/very-high strata were consistent with predictions.

Conclusions: In this retrospective cohort, OPN was associated with higher trifecta and pentafecta achievement than RAPN. The Martini's nomogram showed good discrimination but procedure-dependent calibration: Strata-level predictions aligned in RAPN, whereas risk was overestimated in the OPN high-risk stratum. These findings support cautious use for risk ranking and underscore the need for procedure-specific recalibration and further external validation, particularly for OPN.

Objective: Catheter-associated urinary tract infection (CAUTI) is a common type of hospital-acquired infection in the emergency intensive care unit (EICU). The aim of this study was to explore effective nursing management programs to reduce the incidence of CAUTI in patients with EICU.

Methods: This retrospective study collected the clinical data of critically ill patients from the Department of Emergency Medicine of Soochow University in China from January 2024 to December 2024. Patients admitted from January to June 2024 were treated in the usual care group, and patients admitted from July to December 2024 were treated in the CAUTI prevention care group. The monthly incidence of CAUTI, the duration of urinary catheter indwelling, the duration of bladder irritation symptoms, the number of days of hospitalisation and the adverse reaction rate of patients in the two time periods were compared.

Results: A total of 833 patients were admitted to the EICU for observation, and they were divided into the usual care group (n = 427) and the CAUTI prevention care group (n = 406). Ninety-seven patients developed CAUTI, with an overall incidence rate of 11.64%. Among them, 64 cases (14.99%) of CAUTI occurred in the conventional nursing group, which was higher than that in the CAUTI prevention care group (33 cases, 8.13%), and the difference was statistically significant (p < 0.05). The duration of urinary catheterisation, duration of bladder irritation, length of hospital stay and incidence of adverse reactions in patients with CAUTI in the CAUTI prevention care group were lower than those in the usual care group (p < 0.05).

Conclusions: Reasonable nursing management program is related to a low incidence of CAUTI in EICU and has a certain effect on its prevention.

Background and aims: Radical prostatectomy is the key for localised prostate cancer, but postoperative urinary incontinence and chronic pain impair outcomes. Enhancing perioperative care improves prognosis. This single-centre retrospective study evaluated a symptom management theory-based nursing model for radical prostatectomy patients.

Methods: A total of 165 patients were divided into the control (routine care, n = 75) and observation (symptom management nursing, n = 90) groups. After propensity score matching (PSM), 67 patients per group were analysed. Outcomes (pain: Visual Analogue Scale (VAS); Urinary incontinence: International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UISF); Negative emotions: Self-Rating Anxiety Scale (SAS)/Self-Rating Depression Scale (SDS); Quality of life: Functional Assessment of Cancer Therapy-Prostate (FACT-P)) were assessed before treatment, end of 2-week treatment and 1 month post-treatment. Three-month postoperative complications were compared.

Results: At end of treatment and 1-month post-treatment, the observation group had lower VAS, ICIQ-UISF, SAS and SDS scores (all p < 0.05), higher FACT-P scores (all dimensions, p < 0.05) and lower urinary incontinence incidence (p < 0.05). The 3-month complication rate was 7.46% (5/67) vs 19.40% (13/67) in the control (p < 0.05).

Conclusions: Symptom management-based nursing alleviates pain, reduces urinary incontinence, relieves negative emotions, improves the quality of life and lowers complications, with clinical value for postoperative rehabilitation.