Archivos Espanoles De Urologia最新文献

Aim: This study aimed to assess the relationship between serum adropin levels and the severity of erectile dysfunction (ED) and to investigate serum adropin levels as a potential biomarker of ED severity.

Material and methods: This prospective case-control study was conducted amongst patients who applied to our outpatient clinic. Patients' medical histories were obtained, and comprehensive systemic examinations were conducted. Fasting glucose levels, lipid profiles, total testosterone levels, adropin levels and International Index of Erectile Function (IIEF) scores were measured and analysed through logistic regression and receiver-operating characteristic curve analysis.

Results: Of the 89 patients, 45 complained of ED and matched with 44 patients without ED. Adropin levels were significantly lower in the ED group (p = 0.001; p < 0.05). Using a cut-off value of 2.1 for adropin, the sensitivity was 91.11%, and the specificity was 45.45% with a positive predictive value of 63.08%, negative predictive value of 83.33% and accuracy of 68.54%. The area under curve was 0.711. Logistic regression analysis revealed that adropin values below 2.1 were associated with a 6.31-fold increased risk of developing ED. Furthermore, a significant relationship was observed between serum adropin levels and IIEF scores.

Conclusions: Adropin levels below 2.1 may serve as an independent risk factor of developing ED. This finding may contribute to the development of possible predictive models for individualising andrological patient management.

Background: Although rare, testicular adenomatoid tumours are the most common benign neoplasms of the paratesticular region, particularly affecting the epididymis and spermatic cord. These benign mesothelial-derived tumours rarely undergo malignant transformation and are typically managed with surgical excision. However, their clinical presentation may mimic the tumours arising from the testis, either benign or malignant, leading to grave consequences.

Case presentation: We report the challenging case of a 49-year-old man who presented with a painful mass in the left scrotal lower pole. Owing to the suspicious imaging features, malignancy was initially considered. Histopathological examination revealed an infarcted adenomatoid tumour. This finding is rare and emphasises the importance of accurate diagnosis to avoid overtreatment. This case report describes the microscopic and macroscopic aspects of an infarcted adenomatoid tumour of the paratesticular area, focusing on the diagnostic and therapeutic approaches.

Conclusions: This case underscores the necessity for the careful clinical and imaging evaluation of paratesticular masses. In settings where intraoperative frozen-section analysis or advanced imaging modalities are available, the application of a conservative, testis-sparing approach may be feasible. Awareness of this rare presentation can help avoid overtreatment and guide tailored surgical decision-making. Multidisciplinary collaboration is essential to balance oncological safety with the preservation of testicular function in benign conditions that mimic malignant diseases.

Background: Bladder cancer has a high recurrence rate and presents postoperative challenges that impact patient recovery. Enhanced recovery after surgery (ERAS) programs, which incorporate nutritional and psychological strategies, have demonstrated benefits in perioperative care. This study evaluates the effect of a novel nutritional-psychological dual-wheel-driven ERAS protocol on postoperative outcomes in patients undergoing bladder cancer surgery.

Methods: A retrospective cohort study was conducted on patients with bladder cancer treated between January 2021 and June 2024. Participants were divided into a routine ERAS group and an enhanced support group receiving enhanced nutritional and psychological support. Perioperative outcomes, including postoperative recovery time, anxiety, nutritional status, complications and patient satisfaction were assessed between groups.

Results: The enhanced support group (n = 121) demonstrated significant improvements in postoperative recovery metrics compared with the routine group (n = 124), that is, they had reduced intensive care unit stay, faster nasogastric tube removal and earlier time to flatus, defecation and full oral diet (p < 0.05). Repeated-measures analysis of variance (ANOVA) revealed a significant interaction effect of time and group on Nutritional Risk Screening (NRS) 2002 scores (p = 0.010). The main effects of time and group were significant for NRS 2002, Self-Rating Anxiety Scale (SAS) and visual analogue scale (VAS) scores (all p < 0.05). Simple effects analysis showed lower NRS 2002 and SAS scores in the enhanced support group than in the routine group at 24 hours before surgery and 1 day after surgery (p < 0.05) but higher VAS scores (p < 0.05). Fewer wound leakage complications occurred in the enhanced support group (p = 0.031), and patient satisfaction rates were significantly higher (p = 0.003).

Conclusions: The nutritional-psychological dual-wheel-driven ERAS protocol is associated with improved postoperative recovery, reduced complications and increased patient satisfaction in patients with bladder cancer.

Introduction: Segmental testicular infarction (STI) is a rare, benign condition that often mimics testicular tumours, leading to diagnostic challenges and, at times, unnecessary orchiectomies. The clinical challenge is the lack of a consensus regarding which imaging tools should be used to characterise the testicular lesions and which one is the most reliable.

Case presentation: We report the case of a 34-year-old man presenting at the emergency department with right testicular pain and swelling. Contrast-enhanced ultrasound (CEUS) performed at our hospital revealed a poorly defined, hypoechoic lesion with peripheral rim enhancement, consistent with subacute infarction. Follow-up CEUS 1 month later showed reduction in lesion size and absence of enhancement, supporting a benign evolution. However, surgical exploration was performed because of the impossibility to fully exclude malignancy. Intraoperative frozen-section analysis confirmed haemorrhagic infarction with no signs of malignancy.

Conclusions: CEUS plays a central role in guiding diagnosis and follow-up, offering detailed assessment of testicular perfusion. Compared with conventional ultrasound and magnetic resonance imaging, CEUS is faster, safer, more cost-effective and highly accurate in differentiating infarction from hypovascular tumours. This case study supports the growing use of CEUS as a first-line imaging modality in the evaluation of testicular lesions, promoting conservative management and avoiding overtreatment in appropriate clinical settings.

Background: This study aimed to compare the efficacy and safety of prone and supine percutaneous nephrolithotomy (PCNL) in patients with complex renal stones and anatomical abnormalities.

Methods: This retrospective study analysed the data of patients with complex renal stones and anatomical anomalies who underwent PCNL between December 2022 and June 2024. Inclusion criteria encompassed adult patients with complex renal stones (Guy's score 3 or 4), staghorn calculi, diverticular stone, obesity, kyphoscoliosis and solitary kidney or renal anomalies (horseshoe kidney, autosomal dominance polycystic kidney, malrotated kidney, and pelvic kidney). Patients were divided into prone (group P) and supine (group S) groups on the basis of PCNL positioning. Efficiency was evaluated on the basis of stone-free rates (SFRs), and safety was assessed using the Clavien-Dindo complication classification.

Results: A total of 222 patients were included in the study, with 118 patients in group P and 104 patients in group S. No significant differences were observed in stone burden, Hounsfield unit (HU) density or other demographic parameters. Group S had a shorter operative time (105.78 ± 15.71 min) and time to positioning (14.83 ± 12.44 min, p < 0.001) but a longer scopy time (8.13 ± 2.88 min, p < 0.001). The overall SFRs were 77.11% for group P and 75.00% for group S (p = 0.713). Postoperative complications, assessed using the Clavien-Dindo classification, were similar between the groups, with 4.23% major complications in group P and 5.76% in group S.

Conclusions: Supine and prone PCNL demonstrated similar success rates and complication profiles, with supine PCNL offering the advantage of shorter operative times while effectively managing complex cases.

Introduction: Metastatic renal cell carcinoma (RCC) to the bladder is extremely rare. A total of 1.6% of the patients were found via autopsy reports.

Case presentation: A 44-year-old male patient presented with left flank pain and hematuria. A 40 mm tumor extending into the pelvis was detected in contrast-enhanced computed tomography (CECT). After benign urine cytology and transurethral-resection (TUR) biopsy from the bladder, left nephroureterectomy and ureteral cuff resection were performed because of a left endophytic renal mass and suspected upper tract urothelial carcinoma. Pathology analysis revealed papillary RCC. In the patient with hematuria, a 16mm mass was detected in the bladder 2 years after nephrectomy. Papillary type RCC was detected after complete TUR of the bladder tumor. Left iliac-lymph-node metastasis was detected via postoperative positron emission tomography-computed tomography (PET-CT). After six months of sunitinib treatment, the metastatic lymphadenopathy was found to regress on PET-CT.

Discussion: Solitary resectable intravesical metastatic RCC is a good prognostic factor. Late-onset systemic metastasis may be observed and should be considered during follow-up. PET-CT scanning should be performed if necessary, and the patient can be treated with sunitinib.

Background: Bladder cancer is a common malignant tumor of the urinary system. Although lymphoepithelial carcinoma can occur in the liver, breast, thymus, lungs, skin, and other organs, its presence in the urinary system is exceptionally rare.

Methods: We report the case of a 50-year-old man who presented to our hospital with hematuria. Urinary tract computed tomography revealed a malignant bladder tumor, with an enhancing nodule measuring 9 mm in the posterior wall of the bladder. The patient received transurethral resection of the bladder tumor, followed by arterial embolization chemotherapy and intravenous chemotherapy combined with immunotherapy successively, and finally underwent cystoscopy follow-up to monitor the condition.

Results: After transurethral resection of the bladder tumor, immunohistochemistry revealed tumor cells appearing as syncytial bodies with unclear boundaries. The nuclei were large and vacuolated, with marked infiltration of lymphoplasmacytes observed both between and within the tumor islands. The markers were as follows: cytokeratin 7 (CK7) (+), CK20 (-), S-100 (-), prostate-specific antigen (PSA) (-), Desmin (-), Melanoma (-), Epstein-Barr virus-encoded RNA (EBER) (-), spalt like transcription factor 4 (SALL4) (-), P63 (-), CKpan (+), GATA binding protein 3 (GATA-3) (-), epithelial membrane antigen (EMA) (+), P40 (-), cluster of differentiation (CD)117 (+), CD20 (-), CD3 (-), CD30 (-), placental alkaline phosphatase (PLAP) (-), CD15 (small weak+), and Ki67 (35%+). The patient was diagnosed with lymphoepithelial carcinoma.

Conclusions: The patient remained recurrence-free at 11 months of follow-up after gemcitabine bladder infusion chemotherapy, arterial drug-infusion embolization, systemic chemotherapy, and immunotherapy.

Objective: This study aimed to determine whether asperuloside (ASP) inhibits the proliferation and invasion of bladder cancer (BLCA) cells and its ability to undergo epithelial-mesenchymal transition (EMT) by downregulating activating transcription factor 6 (ATF6) signalling.

Methods: The expression levels of ATF6 and EMT markers were assessed in tumor and surrounding normal tissues obtained from patients with BLCA. In vitro, T24 BLCA cells were transfected with the ATF6 plasmid or a control vector, treated with different concentrations of ASP (0, 1, 3 and 5 mM) and then treated with 5 mM ASP. We examined cell growth, apoptosis (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL) assay), migration and invasion (Transwell), EMT markers (E-cadherin, N-cadherin and Snail) and inflammatory cytokines (interleukin-6 (IL-6), C-C motif ligand 2 (CCL2) and C-X-C motif chemokine ligand 10 (CXCL10)) using Western blot, quantitative real-time polymerase chain reaction (qRT-PCR) and functional assays.

Results: BLCA tissues had significantly higher levels of ATF6 than nearby normal tissues (p < 0.01). ASP treatment decreased cell invasion and migration in a dose-dependent manner (p < 0.05) and markedly increased apoptosis in T24 cells (p < 0.05). E-cadherin was upregulated and N-cadherin and Snail proteins were downregulated (p < 0.05) as a result of changes in the expression of EMT markers. In addition, ASP decreased inflammatory cytokine levels of IL-6, CCL2 and CXCL10 messenger RNA (mRNA) (p < 0.01 vs. control). ATF6 overexpression partially counteracted these effects, confirming ATF6's function in mediating ASP's biological effects.

Conclusions: In T24 BLCA cells, ASP inhibits ATF6, which prevents apoptosis resistance and migration and alters the expression of inflammatory genes and EMT markers. According to these findings, ASP is a promising natural substance that targets the endoplasmic reticulum (ER) stress-ATF6 axis in BLCA. It has a unique multi-target capability that allows it to simultaneously control inflammation, tumour proliferation and metastasis, providing a therapeutic advantage over conventional single-target agents.

Objective: This study aimed to investigate the pathogen distribution and drug resistance of sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors in patients with urinary tract infection (UTI) during the treatment of type 2 diabetes mellitus (T2DM).

Methods: A retrospective study was conducted to collect clinical data from patients with T2DM who developed UTI during treatment with SGLT-2 inhibitors. Patients were admitted to the West China Tianfu hospital, Sichuan University between December 2023 and February 2025. Urine samples were used to analyse the distribution of pathogenic bacteria and antibiotic resistance rates.

Results: A total of 233 patients, including 71 males (30.47%) and 162 females (69.53%), who met the inclusion and exclusion criteria were admitted. Sixty-one strains (26.18%) of Gram-positive bacteria and 167 strains (71.67%) of Gram-negative bacteria were detected. Five cases (2.15%) of fungi (Candida albicans) were recorded. The top two Gram-positive bacteria were Enterococcus faecalis (E. faecalis) (34.43%) and Enterococcus faecium (E. faecium) (22.95%), and the top two Gram-negative bacteria were Escherichia coli (E. coli) (79.04%) and Klebsiella pneumoniae (K. pneumoniae) (11.38%). Different pathogens were resistant to different types of antibiotics. The resistance rates of E. faecium to penicillin, gentamicin, ciprofloxacin, clindamycin, erythromycin and cotrimoxazole were significantly different from those of E. faecalis (p < 0.05). The resistance rates of E. coli to piperacillin/tazobactam, ceftriaxone, nitrofurantoin and ciprofloxacin were significantly different from those of K. pneumoniae (p < 0.05).

Conclusions: The distribution of pathogenic bacteria complicated by UTI in patients with T2DM treated with SGLT-2 inhibitors was dominated by Gram-negative bacteria such as E. coli, some Gram-positive bacteria, and a small number of fungi. Antibiotics should be used appropriately in this population because of the pharmacological mechanism of SGLT-2 inhibitors.

Objective: To evaluate the efficacy of supervised and early use of the Epi-No® device in preventing urinary incontinence (UI) and perineal injury six months post-delivery in primigravid women.

Methods: A quasi-experimental matched study was carried out in a low-risk obstetric unit hospital. Gravid women in the study group (SG) underwent 10 sessions (twice weekly for five weeks) using the Epi-No® device from the 34th gestational week onwards. SG was valued prior to the intervention (between the 30th and 32nd gestational weeks) and six months post-delivery. UI was measured using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF).

Results: Thirty-seven participants were included in the SG, conversely 32 participants in the control group (CG) were included in the analysis. The SG demonstrated a higher number of participants with intact perineum or first-degree laceration only, compared with the CG (p < 0.001). Women in the CG had a 9.86% greater likelihood of experiencing second- or third-degree perineal lacerations or undergoing episiotomy, whereas those in the SG had a 96.70% lower likelihood of deep laceration (p < 0.001). In addition, the SG exhibited a significantly greater maximum perineal strength than the CG (p = 0.004). A significant inverse correlation (-0.38) was observed between perineal strength and ICIQ-UI SF score in the SG (p = 0.001).

Conclusions: Assisted use of the Epi-No® device from 34 weeks of pregnancy correlated with less severe deep perineal injuries, better quality of life, and significantly reduced postpartum ICIQ-UI SF scores.