Archivos Espanoles De Urologia最新文献

Background: This study aimed to compare the efficacy of various injection therapy agents used in combination with internal urethrotomy in preventing fibrosis and stricture recurrence.

Materials and methods: Patients who underwent direct vision internal urethrotomy (DVIU) in our clinic between 2017 and 2022 were retrospectively screened. The patients were divided into four groups: DVIU + intralesional platelet-rich plasma (DVIU + PRP group, n = 21), DVIU + intralesional mitomycin-C (DVIU + MMC group, n = 21), DVIU + intralesional prednisolone (DVIU + prednisolone group, n = 21), and DVIU alone (control group, n = 21). The length (mm) and diameter (mm) of the recurrent urethral strictures and maximum urinary flow rate (Q_max) on uroflowmetry evaluation were measured at 1, 3, and 6 months postoperatively and compared between the four groups.

Results: Urethral stenosis recurred in two (9.5%) patients in the DVIU + PRP group, three (14.3%) in the DVIU + MMC group, seven (33.3%) in the DVIU + prednisolone group, and nine (42.9%) in the control group. The reduction in stenosis recurrence significantly differed between the four groups (p = 0.040). A significant group difference in stenosis length (p = 0.047) but not in stenosis diameter (p = 0.385) was observed in patients with recurrent stenosis. Furthermore, no significant difference in Q_max was found between the groups at 1, 3, and 6 months postoperatively (p = 0.588, p = 0.047, p = 0.067, respectively).

Conclusions: Different intralesional treatments combined with internal urethrotomy demonstrate varying efficacy in reducing urethral stricture recurrence. Considering its high success rate, low cost, and reduced side effects, PRP may be the preferred intralesional treatment option in combination with DVIU.

Purpose: This study aimed to establish a comprehensive evaluation and assessment system for urology specialists based on entrustable professional activities (EPAs).

Methods: A research group was formed to develop a preliminary index system for the evaluation and assessment of urology specialists through an extensive literature review and group discussions. The Delphi method was employed to design a questionnaire, and two rounds of expert consultations were conducted to finalize the index system and design a corresponding assessment method.

Results: A total of 24 experts participated in the two rounds of consultations, with authority coefficients of 0.885 and 0.894, and agreement levels of 0.270 and 0.256, respectively, indicating a high level of expertise and strong consensus among the participants. Based on the expert feedback, 16 key indicators were identified: Recognizing and admitting urological patients, selecting and interpreting specialized tests, diagnosing and differentiating diseases, making therapeutic decisions, documenting medical information, delivering oral clinical case reports, identifying and managing primary care and speciality medical problems, managing critical illness, handling patient transfers and departmental handovers, communicating informed medical decisions, performing basic and specialized surgical operations, providing health guidance, responding to public health emergencies, and engaging in clinical teaching. All indicators scored above 3.5 in importance, with coefficients of variation below 0.25, signifying their appropriateness. The expected confidence levels for each indicator at various stages were determined, and a comprehensive assessment method encompassing "process evaluation, peer impression review, and endpoint assessment" was developed.

Conclusions: This research successfully established an initial EPAs-based evaluation and assessment index system for urology specialists, defined the expected confidence levels for each indicator across different time points, and devised a specific assessment methodology, thereby providing a scientific foundation for the training and evaluation of urology specialists.

Background: This study aims to investigate centrosomal protein 70 (CEP70) in prostate cancer and its effects on angiogenesis and tumour metastasis and elucidate its molecular mechanisms.

Methods: We evaluated CEP70 and Vascular Endothelial Growth Factor Receptor 2 (VEGFR2) in tissue samples from patients with prostate cancer by immunohistochemistry. In vitro experiments included overexpressing CEP70 through transfection and assessing its impact on human umbilical vein endothelial cells (HUVECs). Intervention experiments with an NF-κB pathway inhibitor were conducted to verify the mechanism. Finally, the effects of CEP70 on tumour growth, angiogenesis and metastasis were examined in a nude mouse model.

Results: CEP70 was significantly overexpressed in prostate cancer tissues compared with that in adjacent normal tissues (p < 0.001). In vitro experiments demonstrated that CEP70 overexpression promoted HUVEC migration (p < 0.001), invasion (p < 0.001) and tube formation (p < 0.05). CEP70 significantly upregulated VEGFA expression in prostate cancer cells at messenger RNA (mRNA) (p < 0.001) and protein levels (p < 0.05). VEGFA knockdown experiments confirmed CEP70 as an essential cytokine for CEP70-induced angiogenesis (p < 0.01). Mechanistically, CEP70 promoted VEGFA expression by activating the NF-κB signalling pathway, as evidenced by the reversal of CEP70-induced effects upon treatment with the NF-κB inhibitor BAY11-7082 (p < 0.01).

Conclusions: CEP70 promotes tumour angiogenesis and metastasis by upregulating VEGFA through NF-κB pathway activation.

Background: Traditional diagnostic methods have limitations in accurately identifying and characterising prostate apex cancer. Therefore, exploring innovative approaches such as magnetic resonance imaging (MRI) radiomics, biomarker assessments and clinical pathological features is essential to improve diagnostic accuracy.

Methods: This retrospective study evaluated diagnostic data from 52 patients with prostate apex cancer and 52 healthy individuals. MRI radiomics features-including grey-level non-uniformity, co-occurrence homogeneity, first order skewness, grey level co-occurrence matrix (GLCM) correlation, wavelet-low-high-low (wavelet-LHL) energy and prostate apparent diffusion coefficient (ADC) values-were compared between the groups. Biomarker levels, including Free Prostate-Specific Antigen (fPSA), Prostate-Specific Antigen (PSA), Ratio of Free to Total Prostate-Specific Antigen (f/tPSA), Prostate Volume (PV) and Prostate-Specific Antigen Density (PSAD), were also measured and analysed. Statistical analyses included t-tests, chi-square tests, correlation analyses and receiver operating characteristic (ROC) analyses.

Results: Significant differences were observed between the healthy and cancer groups in several MRI radiomics features: Grey-level non-uniformity (57.23 ± 7.31 vs. 69.54 ± 9.84, p < 0.001), co-occurrence homogeneity (0.29 ± 0.05 vs. 0.21 ± 0.07, p < 0.001), first order skewness (2.91 ± 0.61 vs. 3.85 ± 0.71, p < 0.001), GLCM correlation (0.72 ± 0.06 vs. 0.62 ± 0.07, p < 0.001), wavelet-LHL energy (264.14 ± 30.12 vs. 311.24 ± 42.13, p < 0.001) and prostate ADC value (1.29 ± 0.25 vs. 0.98 ± 0.15 × 10^-3 mm²/s, p < 0.001). Biomarker levels also differed significantly: fPSA (0.93 ± 0.50 vs. 1.97 ± 1.69 ng/mL^-1, p = 0.032), PSA (6.69 ± 2.55 vs. 17.45 ± 7.85 ng/mL^-1, p = 0.048), f/tPSA (0.14 ± 0.07 vs. 0.11 ± 0.07 ng/mL^-1, p = 0.020), PV (42.16 ± 8.32 vs. 38.43 ± 8.92 mL, p = 0.030) and PSAD (0.17 ± 0.08 vs. 0.49 ± 0.29 µg/L/mL^-1, p = 0.040). The combined model of these parameters achieved a sensitivity of 0.865, a specificity of 0.962 and an area under the curve of 0.913.

Conclusions: The integration of MRI radiomics, biomarker assessments and clinical pathological features presents a promising approach for diagnosing prostate apex cancer.

Background: To determine the predictive value of patient's preoperative characteristics and laboratory values for positive surgical margin (PSM) after radical retropubic prostatectomy (RRP).

Methods: This study included 278 patients who underwent RRP between January 2011 and October 2022 due to prostate cancer (PCa) with no prior radiotherapy or hormonal treatment. The patients' preoperative characteristics and laboratory findings were recorded, and the patients were divided into two groups based on their surgical margin status. Multivariate logistic regression was performed to assess the impact of the patients' preoperative characteristics and laboratory results on PSM status.

Results: The PSM group exhibited significantly higher body mass index (BMI), number of biopsy positive cores, percentage of tumours in positive cores, and neutrophil-to-lymphocyte ratio (NLR) than the negative surgical margin (NSM) group (p < 0.001, p = 0.004, p < 0.001, and p = 0.035, respectively). Conversely, the aspartate transaminase/alanine transaminase (AST/ALT) ratio was significantly lower in the PSM group than in the NSM group (p = 0.031). Compared to the NSM group, the PSM group had a significantly higher proportion of patients with a preoperative Gleason score (GS) of ≥8 and an elevated D'Amico risk (p < 0.001 and p = 0.046, respectively). Furthermore, BMI, preoperative prostate-specific antigen (PSA) level, percentage of tumours in positive cores, NLR, GS ≥8, and high D'Amico risk were significant independent predictors of PSM. The NLR cut-off value of ≥1.96 was found to be appropriate, leading to a sensitivity of 69%, specificity of 46%, positive predictive value of 13%, and negative predictive value of 93%. Lastly, the area under the receiver operating characteristic curve of the NLR for PSM was 0.581 (95% confidence interval: 0.52-0.64, p = 0.035).

Conclusions: Our study results reveal that NLR, BMI, percentage of tumours in positive cores, preoperative PSA level, high-risk PCa, and GS ≥8 are predictive factors for PSM. Preoperative NLR may serve as an independent predictor of PSM following RRP.

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.