Archivos Espanoles De Urologia最新文献

Background: Transperineal (TP) biopsy is increasingly used as an alternative to standard transrectal (TR) biopsy for prostate cancer detection to reduce infection risks. However, evidence on comparative diagnostic accuracy remains inconclusive. The aim of this study was to perform an updated systematic review and meta-analysis of studies comparing prostate cancer detection rates between TP and TR ultrasound biopsies.

Methods: PubMed, EMBASE, Web of Science and other databases were searched for relevant studies up to December 2023. Randomised trials and observational studies comparing TP and TR biopsies were included. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random effects models. Heterogeneity was assessed, and subgroup analyses were conducted.

Results: Nine studies comprising four randomised controlled trials (RCTs) and five observational studies were analysed, including 2763 patients (1376 TP, 1387 TR). No significant difference was found in overall cancer detection rates between TP and TR biopsies (RR = 0.9762, 95% CI = 0.8225-1.1586 for random effects model). However, subgroup analysis found that the RCTs showed no difference (RR = 0.9681, 95% CI = 0.8491-1.1038), whereas the observational studies varied (RR = 0.9416, 95% CI = 0.8073-1.0983). Significant heterogeneity was present across studies (I² = 64.3%, p = 0.0156). Details on the prostate specific antigen (PSA) levels in the included studies were provided, and no significant differences were found between TP and TR biopsies regardless of whether a PSA threshold of >10 ng/mL or <10 ng/mL was used.

Conclusions: In summary, this updated meta-analysis found no significant difference between TP and TR biopsies in overall prostate cancer detection rates. The subgroup analysis highlighted that results from RCTs specifically indicated equivalence in diagnostic accuracy. TP biopsy may be considered an appropriate alternative to TR biopsy for patients requiring prostate biopsy.

Background: Paediatric hydronephrosis frequently necessitates surgical intervention. However, postoperative urinary tract infections (UTIs) are common and challenging. This retrospective cohort study aimed to identify UTI risk factors following an operation for paediatric hydronephrosis.

Methods: Paediatric patients with hydronephrosis who underwent operation from January to December 2023 were studied. Patients were categorised into no UTI and UTI groups. Demographics, surgical history, pre/postoperative factors, imaging, and lab values were compared.

Results: A total of 111 patients were enrolled, with 98 in the no-UTI group and 13 in the UTI group. The UTI group had significantly more previous surgeries and longer surgical duration (p < 0.05). Preoperative factors associated with UTI occurrence included higher hydronephrosis grade, absence of antibiotic prophylaxis, presence of vesicoureteral reflux (VUR), abnormal preoperative urine cultures, and ureteral stent placement (p < 0.05). The UTI group exhibited more extended hospital stays, higher rates of postoperative fever, reoperation, and readmission within 30 days (p < 0.05). Postoperative imaging and laboratory findings were also significantly different (p < 0.05). The UTI group had elevated white blood cell count, C-reactive protein levels, serum creatinine, and urine white blood cell count (p < 0.05). Other potential risk factors included constipation, family history of UTI, bladder dysfunction, history of recurrent UTI, and use of prophylactic antibiotics. Multivariate logistic regression analysis indicated that while antibiotic prophylaxis and preoperative urine culture results negatively correlated with UTI occurrence, other factors were positively correlated, with the number of previous surgeries having the most significant impact on UTI occurrence (odds ratio (OR) = 20.617; 95% confidence interval (CI): [0.718, 0.802]; p < 0.001).

Conclusions: Multiple factors contribute to the risk of postoperative UTI for paediatric hydronephrosis, highlighting the need for tailored interventions to mitigate risks and improve outcomes.

Background: The advantages of active surveillance (AS) in low-risk prostate cancer (PC) have already been widely demonstrated. The 15-year results of the Prostate Testing for Cancer and Treatment (ProtecT) trial were published recently, reflecting worse oncological outcomes of their active monitoring programme (AMP) compared with radical prostatectomy (RP) or radiotherapy (RDT). Our objective was to analyse the survival of patients with International Society of Urological Pathology (ISUP) grade I PC depending on the treatment received and point out the differences between an AS protocol and the AMP established in the ProtecT trial.

Methods: A retrospective study of patients with ISUP grade I PC managed by AS, RP or RDT was conducted. A comparative intention-to-treat survival analysis was performed. Our AS protocol included routine 18-core surveillance biopsies of all patients. On the basis of this assumption, the patients included in AS were divided into two groups: Those who met the rebiopsy criteria of the ProtecT trial and those who should not have been biopsied in accordance with this trial.

Results: Of the total 2865 patients, 981 met the selection criteria with a median follow-up of 7.7 years: 448 (45.7%) in AS, 399 (40.7%) in RP and 134 (13.7%) in RDT. The median age at diagnosis was 66.9, 63.2 and 69.2 years, respectively. The AS and RP groups were comparable in all the variables. The overall and cancer-specific survival results were similar, but the AS group had better metastasis-free survival. The RDT group presented worse clinical features in prostate-specific antigen and stage and worse survival outcomes compared with the other groups (p < 0.005). Out of the 448 patients included in AS, 100 met some of the criteria for rebiopsy of the ProtecT trial. Amongst the 348 patients who did not meet any criteria, 138 (39.6%) ended up receiving active treatment due to Gleason progression, increasing number of positive cores or both in the majority of cases (94.4%).

Conclusions: Surveillance biopsy is a major factor that contributes to achieving good oncological results in AS. Active monitoring is not comparable with an AS protocol, and thus, the results of the ProtecT trial are poorly assessable.

Background: Hysterectomy is associated with stress urinary incontinence (SUI), pelvic floor muscle weakness and sexual dysfunction. Pelvic floor exercises have emerged as a potential intervention for addressing these challenges, with remote guided programs offering personalised care. This retrospective study aimed to assess the effect of a nurse-led remote guided pelvic floor exercise program on in patients after total hysterectomy.

Methods: A retrospective analysis was conducted on 81 patients who underwent pelvic floor exercises after total hysterectomy. The patients were divided into regular pelvic floor exercise group (n = 40) and nurse-led remote guided pelvic floor exercise group (n = 41). The severity of SUI in patients was assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). The strength and endurance of pelvic floor muscles were assessed using a pressure sensor before and after treatment, and sexual function was evaluated using the Female Sexual Function Index (FSFI) questionnaire.

Results: The baseline characteristics showed no significant differences between the two groups. The nurse-led remote guided pelvic floor exercise group had a significantly greater reduction in urinary incontinence severity (65.00% vs. 85.37%, χ² = 4.516, p = 0.034) and a lower post-treatment SUI frequency (1.76 ± 0.75 vs. 2.15 ± 0.95, t = 2.059, p = 0.043). Additionally, this group showed better improvements in muscle strength and endurance (25.61 ± 5.69 vs. 23.19 ± 5.02, t = 2.036, p = 0.045) and FSFI score (29.67 ± 4.05 vs. 27.91 ± 3.83, t = 2.011, p = 0.048).

Conclusions: The study demonstrates that a nurse-led remote guided pelvic floor exercise program is associated with significant improvements in SUI, pelvic floor muscle function and sexual well-being in patients after total hysterectomy.

Background: This study aimed to evaluate the mid- to long-term efficacy of tension-free vaginal tape (TVT) and trans-obturator transvaginal tape (TVT-O) by using evidence-based medicine meta-analysis methods to provide a reference for choosing a sling to treat female stress urinary incontinence (SUI).

Methods: A computer search was performed on PubMed, Embase, Web of Science, ProQuest PsycINFO, CINAHL and Cochrane Library for randomised controlled trials on TVT and TVT-O in the treatment of female SUI. The search time limit was from the establishment of the database to March 2024, and the literature was screened and quality assessed. Meta-analysis was used to appraise the subjective cure rate, objective cure rate and postoperative complication rates and intraoperative of the two surgical methods for SUI.

Results: All 13 included studies were of high quality. The subjective cure rate (Risk Ratio (RR) [1.00] and 95% CI [0.96; 1.05]) and objective cure rate (RR [1.03] and 95% CI [1.00; 1.06]) of TVT and TVT-O were similar. The incidence of hematoma during TVT surgery was significantly higher than that of TVT-O (RR [2.62] and 95% CI [0.84; 8.13]), and the incidence of medial thigh/groin pain after TVT was lower than that of TVT-O (RR [0.25] and 95% CI [0.13; 0.49]). Minimal differences were observed in the incidence of bladder perforation, band erosion and dysuria/urinary retention.

Conclusions: The mid- and long-term effects of TVT and TVT-O surgical methods in the treatment of female SUI were similar and effective. In terms of complications, TVT had a higher incidence of hematoma than TVT-O, and TVT had a lower incidence of pain in the inner thigh/groin area than TVT-O.

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.