Archivos Espanoles De Urologia最新文献

Objective: This study aimed to evaluate the postoperative recovery of urinary continence, complications, metabolic changes and urodynamic parameters in patients with bladder cancer undergoing radical cystectomy combined with orthotopic ileocaecal neobladder reconstruction and to explore the safety and functional feasibility of this surgical approach.

Methods: A retrospective analysis was performed on 45 bladder cancer patients who underwent radical cystectomy with orthotopic ileocaecal neobladder reconstruction at our hospital between January 2020 and January 2025. All patients received standardised postoperative follow-up, including urodynamic evaluations at 6 and 12 months, and rehabilitation training such as pelvic floor exercises, abdominal pressure-assisted voiding, and bladder sensation training. Clinical outcomes were assessed by comparing urinary continence, complications, biochemical parameters, and urodynamic indices at different postoperative time points.

Results: At 3 months postoperatively, urinary incontinence (daytime and nighttime) was higher than at 6 months, indicating gradual improvement over time (p < 0.05). Early complications, mainly urine leakage and infections, were relatively common within 3 months but decreased thereafter, with few patients experiencing enterocutaneous fistula, urinary fistula, or urinary stones (p > 0.05). Postoperative haemoglobin and serum chloride decreased significantly (p < 0.05), while other biochemical parameters remained largely unchanged, except for an increase in blood urea nitrogen. Urodynamic assessments showed that by 12 months, neobladder maximum capacity and urinary flow rate increased significantly (p < 0.05), storage-phase bladder pressure decreased below urethral closure pressure (p < 0.05), voiding-phase pressures were unchanged (p > 0.05), and post-void residual volume was reduced (p < 0.05).

Conclusions: Orthotopic ileocaecal neobladder reconstruction after radical cystectomy is a safe and feasible urinary diversion. With standardised rehabilitation and follow-up, patients achieve satisfactory continence and stable metabolic and bladder function. However, long-term outcomes require validation in larger studies.

Background: Renal cell carcinoma (RCC) is a radiation-resistant tumor. Eg5, a spindle motor protein, plays a crucial role in centrosome separation and bipolar spindle formation during mitosis. We explored whether Eg5 is an important therapeutic target for treating RCC.

Methods: We selected radiation-resistant 786-O renal carcinoma cells and divided them into four groups: Control, 10 Gy irradiation, Eg5 inhibitor, and 10 Gy + Eg5 inhibitor. The proliferative ability of the tumor cells was assessed using the cell counting kit-8 assay; A transwell assay was employed to evaluate their invasive capacity. A clonogenic assay was performed to assess clonogenic survival. We divided the 786-O renal carcinoma cells into 10 Gy irradiation and 10 Gy + Eg5 inhibitor groups. Flow cytometry, cell cycle analysis, polymerase chain reaction (PCR), and western blotting were conducted to compare radiosensitivity between the two groups and to investigate potential underlying mechanisms.

Results: The levels of cell proliferation, clonogenic survival, and migration in the 10 Gy + Eg5 inhibitor group (0.395 ± 0.007, 119.3 ± 7.513, 24.33 ± 2.333, respectively) were significantly lower than those in the control (0.772 ± 0.005, 294.3 ± 10.710, 83.00 ± 3.786, respectively) and 10 Gy groups (0.667 ± 0.006, 211.7 ± 9.528, 54.33 ± 2.728, respectively) (p < 0.05). Flow cytometry showed that the level of apoptosis in the 10 Gy + Eg5 inhibitor group (16.87 ± 2.476, 17.0%) was significantly higher than in the 10 Gy group (6.319 ± 0.380, 6.0%) (p < 0.05). Flow cytometry analysis further revealed that the proportion of cells in the G1 phase in the 10 Gy + Eg5 inhibitor group (10.037 ± 1.434) was lower than in the 10 Gy group (24.327 ± 2.252) (p < 0.05). PCR results showed that the messenger ribonucleic acid (mRNA) levels of H2AX, TP53BP1, XRCC1, and CDKN1A in the 10 Gy + Eg5 inhibitor group were significantly higher than those in the 10 Gy group (p < 0.05).

Conclusions: Eg5 inhibitors specifically bind to the Eg5 protein and disrupt mitosis, thereby improving the radiosensitivity of RCC by regulating the cell cycle. An Eg5 inhibitor combined with radiotherapy may represent an effective adjuvant therapy for RCC.

Background: This study aimed to evaluate the diagnostic value of serum matrix metalloproteinase-9 (MMP-9) and nuclear matrix protein 22 (NMP22) in patients with bladder cancer.

Methods: Patients pathologically diagnosed with bladder cancer between January 2023 and January 2024 were included as the experimental group, while healthy individuals undergoing routine physical examinations during the same period comprised the control group. Serum MMP-9 and NMP22 levels were measured via enzyme-linked immunosorbent assay. Diagnostic performance was assessed using receiver operating characteristic curves, and multivariate logistic regression was performed to determine their ability to independently predict tumor-node-metastasis (TNM) stage.

Results: Serum MMP-9 and NMP22 levels were significantly higher in bladder cancer patients compared to healthy controls (p < 0.001). Patients at the T stage showed significantly elevated levels compared to those at the N and M stages (p < 0.001). The areas under the curves for MMP-9, NMP22, and their combination were 0.786 (95% confidence interval (CI): 0.714-0.857), 0.785 (95% CI: 0.714-0.857), and 0.793 (95% CI: 0.725-0.862), respectively, with corresponding sensitivities of 70.00%, 72.00%, and 75.00%, and specificities of 80.00%, 78.00%, and 85.00%. Hematuria (odds ratio (OR): 3.42, 95% CI: 1.89-6.18), frequent urination (OR: 2.44, 95% CI: 1.41-4.22), urinary urgency (OR: 2.18, 95% CI: 1.19-3.99), MMP-9 (OR: 1.01, 95% CI: 1.004-1.016), and NMP22 (OR: 0.98, 95% CI: 0.97-0.99) were identified as independent predictors of TNM stage (p < 0.05). The Cancer Genome Atlas (TCGA) data further confirmed elevated MMP-9 messenger RNA (mRNA) expression in tumor tissues versus adjacent normal tissues (p < 0.001).

Conclusions: Serum MMP-9 and NMP22 levels are significantly elevated in bladder cancer and correlate with TNM stage. Combined detection may improve diagnostic accuracy and clinical utility in bladder cancer diagnosis.

Background: Cisplatin (CP) is an effective chemotherapeutic agent. However, its clinical application is limited by its notable gonadotoxic and systemic side effects. Apilarnil, a biologically active product of drone larva, possesses antioxidant, anti-inflammatory and androgenic properties, which suggests its potential protective effects against chemotherapy-induced toxicity. This study aimed to investigate the protective and therapeutic effects of different doses of apilarnil on CP-induced gonadal toxicity and systemic biochemical changes in a rat model.

Methods: A total of 64 adult male Wistar rats were randomly assigned to eight experimental groups, including the control, CP-treated, apilarnil-treated (50 and 100 mg/kg) and combined CP-apilarnil treatment groups. Treatments were administered via orogastric gavage or intraperitoneal injection. Testicular and epididymal weights, epididymal sperm concentration and motility, haematological and biochemical parameters and histopathological changes were evaluated.

Results: CP administration considerably decreased testis and epididymis weights, sperm concentration and motility while altering haematological indices (mean corpuscular volume, lymphocytes and neutrophils), elevating serum glucose, triglycerides, cholesterol, liver enzyme levels and reducing testosterone levels. Apilarnil treatment, particularly when administered prior to CP exposure, ameliorated these adverse effects by improving sperm parameters, normalising blood indices, modulating biochemical markers and enhancing histological preservation of seminiferous tubules.

Conclusions: Apilarnil exhibits promising protective effects against CP-induced gonadal toxicity and systemic damage. These findings support further investigation of apilarnil as an adjunctive agent to mitigate chemotherapy-associated side effects.

Background: In this study, biomarkers that can predict prostate cancer with a Gleason grade of 8 or higher were explored through nuclear magnetic resonance (NMR).

Methods: Patients scheduled for transrectal prostate biopsy were enrolled, and urine samples were collected after prostate massage. Patients with cancer were categorised as having Gleason grades of 6-7 or ≥8. All spectra were acquired using a Bruker Avance III DRX 600 spectrometer. For statistical analysis, univariate and multivariate analyses were conducted using metabolites and clinical variables, and the presence of tumours with Gleason grades of ≥8 was predicted.

Results: Data were obtained from 107 patients with prostate cancer: 73 (68.2%) with Gleason grades of 6-7 and 34 (31.8%) with Gleason grades of ≥8. A predictive model incorporating the 29 most significant metabolites identified through partial least squares-discriminant analysis was established. Suspicious digital rectal examination (DRE) results were considered. The model predicted a Gleason grade of ≥8, demonstrating an area under the curve of 0.92, sensitivity of 82%, specificity of 92%, positive predictive value of 84% and negative predictive value of 90%. Metabolites associated with amino acid metabolism and glycolysis were prominent in this model.

Conclusions: Our study demonstrates that a model combining urinary metabolites with clinical data, specifically DRE findings, can effectively stratify risk in patients with biopsy-confirmed prostate cancer according to Gleason grade. Metabolites linked to glycolysis and amino acid metabolism were particularly relevant. This minimally invasive approach may assist clinical decision-making, although validation in larger multi-centre cohorts is required to confirm its robustness and generalisability.

Background: The rare metabolic disease, adenine phosphoribosyl transferase (APRT) deficiency, is asymptomatic in many cases until it is discovered in terminal renal failure. The most frequent complication is 2,8-dihydroxyadenine (2,8-DHA) urolithiasis. Stones, which are frequently bilateral and recurrent, appear in childhood in one-third of cases.

Case report: An 8-year-old girl presented with urinary tract infection and coralliform urolithiasis in the right kidney. Initial radiological examination showed emphysematous pyelonephritis stage 1 due to obstructive lithiasis. Stone analysis helped confirm the diagnosis of APRT deficiency.

Discussion: The diagnostic difficulties, clinical manifestations, and the impact of early detection and management on preventing stone recurrence and complication were discussed. The therapeutic strategies available, including dietary modifications and allopurinol therapy, were reviewed.

Conclusions: Early intervention with therapeutic and dietetic measures could preserve the normal renal function of the young patient.

The first description of focal therapy (FT) for prostate cancer was by Gary Onik when he described the use of hemigland cryoablation. Currently, focal therapy is performed using different energy modalities: (1) Cryotherapy, (2) irreversible electroporation, (3) high-intensity focused ultrasound, (4) transurethral ultrasound ablation, (5) focal laser therapy, (6) bipolar radiofrequency ablation and (7) photodynamic therapy. Intermediate-risk prostate cancer with an index lesion seen on prostate magnetic resonance imaging, with negative or low-grade cancer on systematic biopsies is appropriate candidate for focal therapy. Currently, most follow-up protocols include prostate-specific antigen (PSA) measurement every three months during the first year and every six months thereafter, conducting multiparametric magnetic resonance imaging (mpMRI) scans at six months, twelve months, and then annually, as well as performing targeted biopsies of the ablation zone along with systematic biopsies between six to twelve months post-treatment. In general, FT rarely results in significant morbidity and appears to have a minimal effect on quality of life, however long-term oncological outcomes require further assessment. The heterogeneity in technologies, patient selection criteria, follow-up protocols and lack of high-level evidence for focal therapy present the biggest challenges in recommending this treatment modality as a standard management option for selecting patients. The aim of this article is to discuss the challenges surrounding patient selection and to review the different focal therapy modalities and follow-up strategies after treatment.

Background: The body image perception (BIP) of patients may deteriorate after surgery. Our study aims to evaluate the BIP of patients who underwent retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) because of kidney stones.

Methods: A total of 158 patients, including 46 patients who underwent PCNL, 57 patients who underwent RIRS and 55 patients in a healthy control group, were included in this prospective study. The BIP of patients was evaluated by using the Body Dysmorphic Disorder Scale (BDDS) questionnaire. BDDS was administered to patients during the preoperative period and in the first and third postoperative months. The BDDS scores of patients were compared amongst the PCNL, RIRS and control groups. One-way analysis of variance (ANOVA) was employed to compare the means of variables across the three patient groups.

Results: The mean BDDS score in the PCNL group (n = 46) was significantly higher than that in the RIRS (n = 57) and control groups (n = 55) in the first postoperative month (p = 0.008 and 0.008). No significant difference was found between the mean BDDS scores of patients in the RIRS and control groups in the first postoperative month (p = 1.000). No significant difference was found amongst the mean BDDS scores of patients in the PCNL, RIRS and control groups in the third postoperative month (p = 0.725). A positive correlation was found between the educational levels and BDDS scores of patients (p = 0.000, r = 0.529), whereas a negative correlation was found between age and BDDS score (p = 0.030, r = -0.320).

Conclusions: No deterioration in BIP was found in patients who underwent RIRS. In patients who underwent PCNL, negative BIP was observed in the first postoperative month and improved by the third postoperative month, reaching levels similar to those in the control and RIRS groups. RIRS and PCNL are reliable surgical methods in terms of postoperative BIP.

Background: Human papillomavirus (HPV) is a prevalent viral infection that poses considerable health risks to males, including genital warts and various cancers. The epidemiology of HPV in the male population requires novel approaches for effective patient education. This study investigated the efficacy of Chat Generative Pre-trained Transformer-4 (ChatGPT-4), a sophisticated artificial intelligence model, in disseminating accurate information about HPV-induced genital warts in men.

Methods: A meticulously designed questionnaire comprising 240 items, spanning multiple-choice and true/false formats, was administered to ChatGPT-4 from October 2024 to January 2025. The questionnaire covered HPV transmission, clinical manifestations, diagnostic approaches, treatment options and preventive strategies. The responses were evaluated for accuracy and completeness using Likert scales, with repeated questioning sessions to assess the potential for response improvement over time.

Results: ChatGPT-4 initially provided accurate and/or highly rated responses for 191 out of 240 questions. Subsequent rounds of questioning for inaccurately answered or low-scoring questions showed a progressive improvement, with 14 and 15 questions answered correctly or receiving higher accuracy scores in the second and third rounds, respectively. The overall accuracy rate was 79.60%, with specific subgroup analyses revealing strengths in general information and protection but challenges in questions about HPV-induced genital warts in men.

Conclusions: ChatGPT-4 demonstrates preliminary medical value and potential for patient education in urology. However, variable subgroup accuracy suggests that further optimisation and validation are needed before clinical deployment. Its ability to accurately address a wide range of queries, combined with the potential for an improvement in response accuracy over time, highlights its value in enhancing health communication.

Background: Retrograde intrarenal surgery (RIRS) is minimally invasive with rapid recovery, whereas tamsulosin hydrochloride promotes stone expulsion and reduces pain. Whether their combination has a synergistic effect on treating renal calculi ≤2 cm remains unclear. This study aims to explore the efficacy and safety of RIRS combined with tamsulosin in such patients using single-centre data.

Methods: The clinical data of patients with renal calculi ≤2 cm treated in The First Hospital of Fangshan District, China from January 2021 to January 2024 were retrospectively collected. The patients were divided into a combination therapy group (RIRS + oral tamsulosin) and a control group (RIRS alone). Clinical efficacy, stone-free rate and adverse event incidence were compared between the groups. Renal function changes, pain intensity and quality of life before and after treatment were evaluated.

Results: After propensity score matching, 53 patients were included in the combination therapy group and 53 in the control group. The total effective rate in the combination therapy group was 96.22% (51/53), which was higher than that (81.13%, 43/53) in the control group (χ² = 6.014, p = 0.014). The stone-free rate in the combination therapy group was also significantly higher than that in the control group (94.34% vs. 79.25%, χ² = 5.267, p = 0.022), whereas the scores of expulsive pain, first stone expulsion time and complete stone expulsion time were significantly lower (t = 2.165, 7.142, 4.538; All p < 0.05). After treatment, the levels of serum creatinine, blood urea nitrogen, uric acid, β2-microglobulin, interleukin-6, tumour necrosis factor-α and C-reactive protein decreased in both groups. The glomerular filtration rate and scores of physical function, psychological status, social function and symptoms/discomfort improved. The enhancements in the combination therapy group were more significant than those in the control group (all p < 0.05). No difference in the incidence of postoperative complications was found between the two groups (13.21% vs. 11.32%, χ² = 0.088, p = 0.767).

Conclusions: RIRS combined with tamsulosin demonstrates remarkable short-term clinical efficacy, stone clearance and renal function protection in patients with renal calculi ≤2 cm, showing promising clinical application.