Archivos Espanoles De Urologia最新文献

Objective: Urology patients are often placed with a catheter following surgery. Hence, a high-quality and appropriate management and removal programme can considerably reduce catheter-associated complications such as urinary tract infections and improve patient comfort. This retrospective study investigated the impact of a collaborative medical-nursing catheter removal protocol on reducing the incidence of urinary tract infections in urological surgery patients.

Methods: Patients who underwent partial nephrectomy at our hospital between January 2021 and December 2022 were enrolled and allocated to a control and an observation group based on the method of urinary catheter removal. A physician was solely responsible for monitoring, evaluating, and removing the catheter in the control group, whereas a physician and nurses performed these catheter management activities in the observation group. The two groups were compared in terms of urinary tract infections, urinary tract irritation and hematuria signs, pain levels, and catheter retention time.

Results: A total of 178 patients were included, among which 88 were divided into the control group and 90 into the observation group according to their corresponding urinary catheter removal method entered into the medical records system. The general characteristics of the two groups were similar (p > 0.05). However, the rates of urinary tract infections and urinary tract irritation and hematuria signs in the observation group were lower than those in the control group (1.11% vs. 9.09%, χ² = 5.902, p = 0.037; 5.55% vs. 15.91%, χ² = 4.159, p = 0.041, respectively). The observation group also exhibited lower levels of urinary pain within 1 h post-catheter removal and shorter total catheter retention time than the control group (t = 2.497, p = 0.013; t = 2.316, p = 0.022, respectively).

Conclusions: Collaborative medical-nursing catheter removal protocols for patients undergoing partial nephrectomy may effectively alleviate urinary pain, decrease the incidence of urinary tract infections and irritation and hematuria signs, and shorten catheter retention time, underscoring the clinical significance of its implementation in this specific population.

Background: Urosepsis represents a complication of upper urinary tract stones (UUTSs) in patients with type 2 diabetes mellitus (T2DM), thus necessitating a comprehensive understanding of risk factors. This single-centre retrospective study aimed to analyse the risk factors for urosepsis in this patient population.

Methods: Clinical data of patients with UUTS and T2DM admitted from January 2015 to January 2024 were collected and retrospectively analysed. Laboratory parameters, including white blood cell (WBC) count, serum creatinine, urine culture, C-reactive protein and imaging findings were assessed. Stepwise backward selection and logistic regression analysis was used to explore the risk factors of urosepsis.

Results: A total of 108 patients, including 56 patients complicated with urosepsis and 52 without urosepsis, were included. The urosepsis group exhibited significantly increased white blood cell count (15.75 ± 2.58 vs. 14.63 ± 2.76, p = 0.031), colony-forming units per millilitre in urine culture (5000.46 ± 1200.56 vs. 4570.13 ± 1000.24, p = 0.045), serum C-reactive protein levels (43.02 ± 12.36 vs. 38.54 ± 10.75, p = 0.047), presence of hydronephrosis (82.14% vs. 63.46%, p = 0.049) , ureteral stricture (46.43% vs. 25.00%, p = 0.034), prevalence of Gram-negative bacteria (85.71% vs. 67.31%, p = 0.042), antibiotic resistance (37.50% vs. 17.31%, p = 0.034), and empirical antibiotic use (62.50% vs. 40.38%, p = 0.035) compared with the non-urosepsis group. Gram-negative bacteria (odds ratio (OR) = 2.914, p = 0.027), antibiotic resistance (OR = 2.867, p = 0.022), renal hydronephrosis (OR = 2.648, p = 0.031), urethral stricture (OR = 2.600, p = 0.022) and antibiotic usage history (OR = 2.460, p = 0.023) exhibited significant OR values, whereas white blood cell (WBC) count demonstrated a moderate OR value (OR = 1.175, p = 0.034). These findings further underscore their potential to be reasonably predictive risk factors for urosepsis.

Conclusions: This study identified various risk factors associated with urosepsis in patients with T2DM and UUTS. Laboratory parameters, imaging findings and urinary tract infection characteristics were found to be significant contributors to the development of urosepsis in this patient population.

Background: Prostate cancer is a remarkable global health concern, necessitating accurate risk stratification for optimal treatment and outcome prediction. By highlighting the potential of imaging-based approaches to improve risk assessment in prostate cancer, this research aims to evaluate the diagnostic efficacy of the Prostate Imaging Reporting and Data System (PI-RADS) v2.1 combined with apparent diffusion coefficient (ADC) values to gain increased context within the broad landscape of clinical needs and advancements in prostate cancer management.

Methods: The clinical data of 145 patients diagnosed with prostate cancer were retrospectively analysed. The patients were divided into low-moderate- and high-risk groups on the basis of Gleason scores. PI-RADS v2.1 scores were assessed by senior radiologists and ADC values were calculated by using diffusion-weighted imaging. Statistical, univariate logistic regression, and receiver operating characteristic curve analyses were employed to evaluate the diagnostic efficacy of each index and combined PI-RADS v2.1 scores and ADC values.

Results: This study found significant differences in PI-RADS v2.1 scores and ADC values between the low-moderate- and high-risk groups (p < 0.001). Logistic regression analysis revealed associations of various clinical indicators, PI-RADS score and ADC values with Gleason risk classification. Amongst indices, mean ADC demonstrated the highest sensitivity (0.912) and area under curve (AUC) value (0.962) and the combination of PI-RADS v2.1 with mean ADC showed high predictive value for the Gleason risk grading of prostate cancer with a high AUC value (0.966).

Conclusions: This study provides valuable evidence for the potential utility of imaging-based approaches, specifically PI-RADS v2.1 combined with ADC values, in enhancing the accuracy of risk stratification in prostate cancer.

Background: Stress urinary incontinence (SUI) is a common postoperative complication that significantly affects the quality of life in women who have undergone radical hysterectomy for cervical cancer. This study evaluates the incidence and risk factors associated with SUI in women after cervical cancer surgery.

Methods: This case-control study included women diagnosed with cervical cancer who underwent radical hysterectomy at our hospital between May 2020 and May 2023. Participants were divided into two groups based on the presence of postoperative SUI, namely the SUI group and the SUI-free group. Inclusion criteria required the absence of preoperative urinary incontinence and stable vital signs. Data were collected on demographic characteristics, tumour histology and staging, urodynamic parameters, and intraoperative and postoperative factors.

Results: Ninety-seven patients with cervical cancer who underwent radical hysterectomy were divided into two groups: The SUI group (n = 27) and the SUI-free group (n = 70), with an SUI incidence of 27.8% in the study population. Significant differences between the SUI and SUI-free groups were observed in menopausal status (p = 0.026), chronic constipation (p = 0.011), and tumour diameter (p < 0.001). Urodynamic assessments revealed a higher maximum urinary flow rate (Qmax) in the SUI group compared to the SUI-free group (21.36 ± 6.41 vs. 17.38 ± 5.18 mL/s; p = 0.002). Logistic regression analysis identified menopause (odds ratio (OR) = 7.700, 95% confidence interval (CI) = 1.256-47.192), chronic constipation (OR = 9.918, 95% CI = 1.387-70.911), Qmax (OR = 1.302, 95% CI = 1.061-1.598), and surgery duration (OR = 1.040, 95% CI = 1.001-1.081) as independent protective factors.

Conclusions: SUI is a significant postoperative complication in women undergoing cervical cancer surgery. Menopause, chronic constipation, tumour diameter, Qmax, and surgery duration were independent risk factors.

Background: Kidney stone disease (KSD) is a prevalent and significant global urological issue, and ureteroscopic holmium laser lithotripsy (UHLL) is a primary treatment option. This study aimed to assess the impact of stone computed tomography (CT) value on the outcomes of UHLL in treating KSD.

Methods: A retrospective analysis was conducted on the clinical data of 101 patients who underwent UHLL at our hospital between September 2022 and December 2023. Patients were categorised into two groups based on stone CT values. Demographic characteristics, intraoperative factors, stone clearance, and complications were evaluated and compared between the low- and high-CT groups.

Results: The high-CT group had significantly longer intraoperative durations than the low-CT group (p < 0.001). Fragmentation time was considerably higher in the high-CT group (p < 0.001). Stone clearance rates after three postoperative months were substantially higher in the low-CT group (98.04%) than in the high-CT group (84.00%) (χ² = 4.523, p = 0.033). Although the low-CT group had a lower complication rate, the difference was insignificant (p = 0.356). CT values showed a positive correlation with durations of operation and fragmentation (p < 0.01), and a negative correlation with stone clearance (p < 0.05).

Conclusions: Stone CT values are key factors influencing the procedural outcomes and postoperative complications of UHLL.

Background: Percutaneous nephrolithotomy (PCNL) is the standard procedure for treating upper urinary tract calculi and complex kidney calculi >2 cm in diameter, though it has a high incidence of postoperative complications. This study aimed to investigate the effect of Orem's management model on patients undergoing PCNL.

Methods: This retrospective study included 465 patients who underwent PCNL from February 2022 to February 2023 from two tertiary hospitals. After excluding 16 patients based on exclusion criteria, 449 patients remained. The observation group (n = 227) received Orem's management model, while the control group (n = 222) underwent conventional surgical management. Primary outcomes included postoperative recovery time and the incidence of postoperative complications, while secondary outcomes such as postoperative pain levels (measured via a numerical rating scale) and self-care ability assessed through the exercise of self-care agency were obtained through medical records and physical examinations.

Results: Compared to the control group, the observation group achieved faster outcomes for the first anal exsufflation, first ambulation, and discharge, and a lower incidence of postoperative complications (p < 0.05). Post-management, the observation group had lower numerical rating scale scores and higher exercise of self-care agency scores (p < 0.001).

Conclusions: Orem's management model accelerates postoperative recovery, alleviates pain, and reduces postoperative complications in patients undergoing PCNL. Moreover, this model enhances self-care ability, though its effectiveness is limited to patients with non-recurrent renal calculi and normal renal function. Further exploration of its broader application is needed.

Introduction: Partial nephrectomy is the preferred treatment for renal tumors <7 cm. Robot-assisted laparoscopic approach is a minimally invasive method that offers advantages for resecting complex tumors. Here, we conducted a descriptive retrospective analysis of the first robotic partial nephrectomies (RPNs) performed at our center.

Materials and methods: A retrospective cohort of 94 patients who consecutively underwent RPN at our center between November 2012 and December 2022 was investigated. Baseline patient data, tumor characteristics, intraoperative variables, pathological tumor analysis, and postoperative complications at 30 days were analyzed.

Results: The patients were followed up for a median of 25.3 months. Baseline values included a median age of 63 years and a median body mass index (BMI) of 28.1. Intraoperative variables comprised a median surgical time of 150 min and a median warm ischemia time of 16 min. The mean postoperative creatinine level was 1 mg/dL. The median tumor size was 41.9 mm, with a median PADUA score of 8 and a median RENAL score of 8. Resected tumors were predominantly cT1a (58.5%) and cT1b (39.3%), while the positive margin rate was 21.3%. A total of 19.2% of the patients experienced Clavien-Dindo complications, of which 11% were Clavien-Dindo I; 66.7%, Clavien-Dindo II; And 22.2%, Clavien-Dindo IIIb. However, no Clavien-Dindo IIIa or IV complications were reported.

Conclusions: RPN is an effective and safe technique for treating solid renal masses, demonstrating a low complication rate and adequate oncologic control locally and distally.

Purpose: To examine the impact of driving pressure-guided positive end-expiratory pressure ventilation on cerebral blood flow and pulmonary function in patients undergoing laparoscopic radical prostatectomy.

Methods: A retrospective analysis was conducted on clinical data from patients who underwent laparoscopic radical prostatectomy at our hospital between June 2022 and June 2023. The patients were divided into two groups, namely the conventional ventilation group and the driving pressure-guided positive end-expiratory pressure ventilation group. Measurements and analyses were performed on cerebral blood flow, neurological status, and pulmonary function parameters.

Results: A total of 105 patients were included in this single-centre retrospective study, with 51 patients in the conventional ventilation group and 54 patients in the driving pressure-guided positive end-expiratory pressure ventilation group. The driving pressure-guided positive end-expiratory pressure ventilation group demonstrated significantly higher cerebral blood flow, cerebral autoregulation index, cerebrovascular resistance, and cerebral oxygen saturation compared to the conventional ventilation group (p < 0.05). Additionally, patients in the driving pressure-guided positive end-expiratory pressure ventilation group exhibited improved neurological outcomes, a higher partial pressure of oxygen/fraction of inspired oxygen ratio, increased lung compliance, decreased peak expiratory flow, elevated respiratory rate, and a lower lung injury score compared to the conventional ventilation group (p < 0.05).

Conclusions: The findings suggest that driving pressure-guided positive end-expiratory pressure ventilation might positively influence cerebral blood flow and pulmonary function parameters in patients undergoing laparoscopic radical prostatectomy.