Archivos Espanoles De Urologia最新文献

Background: The World Health Organization (WHO) classification system for bladder cancer (BC) advocates for the substaging of pT1 disease, which may improve the prediction of cancer recurrence and progression. This study aims to evaluate the application and prognostic significance of a micrometric substaging system, utilising a 1 mm cut-off depth of invasion in patients with pT1 BC.

Methods: We retrospectively reviewed all patients diagnosed with pT1 High-Grade Non-Muscle Invasive Bladder Cancer (NMIBC) at our institution. Lamina propria infiltration was categorised using a 1 mm cut-off to differentiate between Focal (<1 mm) or Extended (≥1 mm) disease, dividing the patients into Focal and Extended groups.

Results: The study included 114 patients, with a median (Interquartile Range (IQR)) age of 78 (71-87) and a Charlson Comorbidity Index (CCI) of 6 (5-7). The median follow-up was 33 (20-53) months. Of these, 56 patients (49.0%) were classified as having focal invasive, while 58 (51.0%) had Extended invasion. Demographic and pathological characteristics were evenly distributed between the two groups without significant differences (p > 0.05). However, Extended disease was more prevalent at initial diagnosis (Odds Ratio (OR) 5.44, p = 0.003). Multivariate analysis identified a first diagnosis of BC, pathological Grade 3 (G3), presence of Carcinoma in situ (CIS) and residual tumour at second resection as independent predictors of Extended pT1. Recurrence rates, progression rates and cancer-specific mortality were 41.2%, 5.3% and 1.8%, respectively. There were no statistically significant differences between the Focal and Extended groups in 3-year recurrence-free (58.9% vs 63.8%, p = 0.654), progression-free (92.9% vs 96.5%, p = 0.270) and cancer-specific survival (100% vs 98.3%, p = 0.425) rates.

Conclusions: In this retrospective, single-centre study, substaging by depth of invasion did not predict recurrence, progression or cancer-specific mortality in patients with pT1 NMIBC. The initial diagnosis of pT1 BC, presence of G3, CIS and residual tumour at the second resection were identified as independent predictors of Extended pT1.

Background: Ferroptosis is an iron-dependent cell death mode. Ferroptosis resistance is related to prostate cancer (PCa) invasion; However, there is vague understanding with regard to the underlying mechanism. This study was undertaken to clarify the role and mechanism of upstream stimulatory factor 1 (USF1) in ferroptosis resistance in invasive PCa.

Methods: USF1 was silenced in the human PCa cell lines C4-2B and PC-3. After these cells were treated with a ferroptosis inhibitor, cell viability and invasion and the expression of glutathione peroxidase 4 (GPX4) were evaluated. Chromatin immunoprecipitation and Dual-luciferase reporter assay suggested an interaction between USF1 and brain-expressed X-linked protein 1 (BEX1). Consequently, BEX1 was overexpressed in USF1-silenced C4-2B and PC-3 cells and its effects on cell viability and invasion and GPX4 expression were examined.

Results: USF1 silencing mitigated PCa cell viability and invasion. Treatment with a ferroptosis inhibitor counteracted the inhibitory roles of USF1 silencing in cell invasion and GPX4 expression. Additionally, USF1 silencing decreased BEX1 expression and USF1 was found to bind to the BEX1 promoter. BEX1 overexpression reversed the influences of USF1 silencing on the viability, BEX1 protein expression, invasive ability and ferroptosis of PCa cells.

Conclusions: USF1 activates the transcription of BEX1, preventing PCa cell ferroptosis and promoting cell invasion. Therefore, USF1 silencing may inhibit the progression of PCa by reducing ferroptosis resistance.

Background: Paediatric circumcision is a standard surgical procedure that frequently induces anxiety, fear, and pain in young patients. Child-friendly nursing has shown potential in alleviating psychosocial distress in paediatric care settings. However, its specific impact on patients undergoing circumcision remains underexplored. This study aimed to evaluate the effectiveness of child-friendly nursing in reducing patients' anxiety, fear and pain in patients undergoing paediatric circumcision.

Methods: Clinical data of paediatric patients who underwent circumcision at Taizhou Hospital of Zhejiang Province from January 2022 to November 2023 were retrospectively analysed. Patients were divided into the traditional nursing (January 2022 to December 2022) and child-friendly nursing (January 2023 to November 2023) groups. Psychosocial parameters, including anxiety, depression, pain, and fear, were assessed using the Children's Anxiety Meter-State (CAM-S), Children's Depression Inventory (CDI), Wong-Baker FACES Pain Rating Scale (WBFPRS), and Children's Fear Scale (CFS), respectively.

Results: No significant differences were found in CAM-S, CDI, WBFPRS, and CFS scores between the two groups before intervention (p > 0.05). However, post-intervention scores for all parameters in the child-friendly nursing group were significantly lower than those in the traditional nursing group (p < 0.001). The results suggest that child-friendly nursing effectively reduces anxiety, depression, fear and pain in children undergoing circumcision.

Conclusions: This study provides compelling evidence supporting the effectiveness of child-friendly nursing in enhancing surgical experiences and improving psychosocial outcomes for paediatric patients undergoing circumcision.

Background: Transferring the intricate laparoscopic radical prostatectomy (LRP) technique poses a considerable challenge for novice surgeons. Fellowship programs, typically lasting three to twelve months, remain the primary avenue for acquiring laparoscopic skills. This study proposes that residency-based laparoscopy training confers distinct advantages over fellowship programs during the initial stages of LRP.

Methods: The study analyzed retrospectively collected data and operation videos from the first and second sets of fifty operations (Group 1 and Group 2) out of a total of 553 performed by the "fellow" surgeon between August 2009 and December 2022, and the first fifty operations by the "resident" surgeon from January 2022 to June 2023. Parameters examined included patient demographics, preoperative prostate-specific antigen (PSA) levels, grades, stages, operation durations, complications, postoperative outcomes, and short-term (6-month) oncological and functional results.

Results: No statistically significant differences were observed in prostate volume, age, body mass index, or PSA levels between Groups 2 and 3 or 1 and 3 (p > 0.05). Nevertheless, Group 3 exhibited significantly more International Society of Urological Pathology grade 3 and 4 cases than Group 1 (p = 0.004) and Group 2 (p = 0.006). Additionally, Group 3 had a shorter anastomosis time (AT) (25 min vs. 35 min, p < 0.001) and reduced estimated blood loss (EBL) (275 mL vs. 385 mL, p = 0.008) compared to Group 1. No significant differences were found among the groups regarding intraoperative complications, nerve sparing, or lymph node dissection rates. While Group 2's anastomosis time was comparable to that of Group 3 (24 min vs. 25 min, p = 0.144), it demonstrated a significantly shorter insufflation duration (150 min vs. 170 min, p < 0.001). Functional outcomes, including continence and erectile function at six months, showed no significant differences across the groups.

Conclusions: This study underscores the potential benefits of integrating LRP training into a surgeon's residency, particularly in the early stages of their learning curve (LC), by reducing anastomosis and operation times and EBL in the first fifty cases. Initial findings suggest that implementing modular training in residency programs could enhance LRP proficiency, benefiting both surgeons and patients.

Background: Febrile urinary tract infections in children are typically treated with a standard 10-day course of antibiotics. However, prolonged antibiotic use can lead to increased bacterial resistance, underscoring the need to explore shorter treatment regimens. This study aimed to compare the short-term therapeutic effects of amoxicillin-clavulanic acid and ceftriaxone sodium in children under five years old with febrile urinary tract infections.

Methods: Clinical data from 109 children under five years old diagnosed with febrile urinary tract infections between August 2022 and December 2023 were retrospectively analyzed. Among them, 52 children received ceftriaxone sodium (group A), and 48 children received amoxicillin-clavulanic acid (group B). Clinical symptoms, laboratory indicators, clinical efficacy, and adverse reactions were compared between the two groups.

Results: Children from group B showed significantly shorter improvement times for fever, dysuria, and urinary frequency compared to those in group A (p < 0.05). Initially, there were no significant differences in the levels of white blood cell counts, squamous epithelial cells, bacteria, interleukin-6, interleukin-8, and neutrophil gelatinase-associated lipocalin between the two groups (p > 0.05). However, after treatment, group B exhibited significantly lower levels of white blood cell counts, squamous epithelial cells, bacteria, interleukin-6, interleukin-8, and neutrophil gelatinase-associated lipocalin compared to group A (p < 0.05). Moreover, the total effective rate was significantly higher in group B (95.83%) than in group A (80.77%) (p < 0.05). There was no significant difference in the incidence of adverse reactions between groups B (10.42%) and A (13.45%) (p > 0.05).

Conclusions: Amoxicillin-clavulanic acid demonstrated superior short-term therapeutic efficacy for febrile urinary tract infections in children under five years old compared to ceftriaxone sodium. It effectively reduced cure times, mitigated inflammatory responses, and improved treatment outcomes, suggesting its potential for broader clinical application and adoption.

Objective: Spinal cord injury (SCI) severely affects motor, sensory, reflex, and other functions, impacting 250,000 to 500,000 individuals globally each year. Bladder voiding dysfunction, a prevalent and serious complication of SCI, results in significant morbidity and reduced quality of life. This study examines the impact of nurse-led clean intermittent catheterization combined with synchronous health education for family members on improving compliance in patients with SCI and bladder voiding dysfunction.

Methods: Eighty-four patients with urinary dysfunction post-SCI treated in our hospital from January 2023 to January 2024 were selected. Family members were assigned to a control group (n = 40) or an observation group (n = 44) based on their participation in nurse-led health education. Urinary tract management proficiency, satisfaction, compliance, and complications were observed and statistically analyzed in both groups on the 30th day after self-initiated intermittent catheterization.

Results: By the 30th day, the observation group exhibited significantly higher cognitive scores in urinary tract management than the control group (p < 0.001). Additionally, the observation group showed greater compliance in daily water intake (p = 0.018), proper timing (p = 0.018), and correct bladder function training (p = 0.004). The incidence of urinary tract infections was lower in the observation group (p = 0.018). Patient satisfaction in the observation group also exceeded that of the control group in all measured aspects and total scores (p < 0.001).

Conclusions: Nurse-led synchronous health education for family members during clean intermittent catheterization significantly enhances patient compliance, reduces complications, and improves patient satisfaction.

Background: Urinary incontinence is a common complication following a stroke. No specific drugs are available in Western medicine, and surgical treatment is highly traumatic, limiting its clinical application. This study aimed to observe the clinical efficacy of electroacupuncture at the "Sacral Four Points" combined with moxibustion at the "Abdominal Three Points" on post-stroke urinary incontinence, exploring its impact on urodynamics and quality of life.

Methods: Patients with post-stroke urinary incontinence treated at our Hospital from January 2021 to December 2023 were recruited. The study included 117 patients: 57 in the electroacupuncture group and 60 in the combined group. Urodynamic parameters were measured, and scores from the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the Incontinence Quality of Life Questionnaire (I-QOL) were recorded before, and after the first and third courses of treatment. Clinical efficacy and adverse reactions were evaluated post-treatment.

Results: The study found no significant differences in clinical characteristics between the groups (p > 0.05), providing a baseline for comparison. Both groups showed substantial decreases in leakage volume after one course of treatment (p < 0.05), with a reduction in the ICIQ-UI SF score (p < 0.05) and an increase in the I-QOL score (p < 0.05). After three courses of treatment, the leakage volume of patients in both groups significantly decreased (p < 0.05), the ICIQ-UI SF score decreased (p < 0.05), and the I-QOL score increased (p < 0.05). The combined group showed a lower leakage volume compared to the electroacupuncture group (p < 0.05), with lower ICIQ-UI SF scores (p = 0.027) and higher I-QOL scores (p = 0.048). Importantly, the total effective rate was significantly higher in the combined group (88.33% vs 64.91%, p = 0.037), demonstrating the safety and efficacy of the treatment.

Conclusions: Electroacupuncture at the "Sacral Four Points" combined with moxibustion at the "Abdominal Three Points" improves the clinical symptoms and enhances the quality of life for patients with post-stroke urinary incontinence, showing superior results compared to electroacupuncture alone.

Objective: This study aimed to provide valuable insights into the comparative efficacy of different surgical approaches for nephron-sparing surgery (NSS) and contribute to the existing literature in this field.

Materials and methods: This study included patients who underwent NSS for small renal masses between January 2016 and March 2024. A total of 97 patients (41 in the open approach group, 56 in the laparoscopic approach group) with demographic, radiological, intraoperative, renal functional, and oncological follow-up data were included. Three different anatomical scoring systems (R.E.N.A.L. nephrometry score, PADUA score and C-index) were utilised to assess tumour location and estimate proximity to the hilum and collecting system.

Results: In the open nephron-sparing surgery (ONSS) and laparoscopic nephron-sparing surgery (LNSS) groups, the mean kidney tumour diameters (SD) were 5.20 ± 2.30 and 4.90 ± 2.10, which were similar in both surgical method groups (p = 0.061). However, tumours treated with ONSS had significantly more adverse morphometric features (p < 0.05). For ONSS and LNSS groups, the mean R.E.N.A.L. nephrometry scores (SD) were 6.15 ± 2.04 and 5.2 ± 1.4 (p = 0.032), respectively; The mean PADUA scores (SD) were 7.46 ± 1.14 and 6.8 ± 1.0 (p = 0.049), respectively; And the mean C-index (SD) scores were 1.39 ± 0.4 and 1.37 ± 0.5 (p = 0.062), respectively. No significant differences were found in the mean tumour diameter (cm) (Inter Quantile Range (IQR)) distribution of both groups (p = 0.058). Despite the slight increase in transfusion rate in the LNSS group, estimated blood loss (EBL), transfusion rates, and length of hospital stay were similar in both groups.

Conclusions: Although LNSS does not appear superior in terms of intraoperative blood loss, length of hospital stay and transfusion rate, it provides comparable long-term outcomes to ONSS. Our study suggests that when matched with nephrometry scores, LNSS can achieve similar outcomes to ONSS.

Backgrounds: F-box protein 45 (FBXO45) has been implicated in the progression of several diseases. Whether FBXO45 is involved in the development of bladder cancer remains unclear. Thus, this study focused on the effect of FBXO45 on the malignant progression of bladder cancer cells.

Methods: FBXO45 small-interference fragment was transfected into RT4 and 5637 cells by liposome-mediated transfection, and the knockdown efficiency of FBXO45 was verified by Western blot assay. The growth rate between FBXO45 knockdown cell lines and control cell lines was compared by counting kit 8 and plate cloning experiments. The motility of bladder cancer cells was observed via the Transwell test and Wound healing test. The effects of FBXO45 silencing on apoptosis and cell division were confirmed by flow cytometry. Western blot assay was performed to determine the function of FBXO45 knockdown on key proteins of cell apoptosis and the ERK/Cyclin D1/CDK4 pathway.

Results: After FBXO45 knockdown, the proliferation of bladder cancer cells was blocked (p < 0.01), and the migration and invasion abilities were reduced (p < 0.01). FBXO45 knockdown reduced the number of S-phase cells (RT4, p < 0.01; 5637, p < 0.05) and enhanced the apoptotic rate (p < 0.01). FBXO45 knockdown decreased the levels of p-ERK1/2, CDK4 and Cyclin D1 (p < 0.01).

Conclusions: This study revealed that FBXO45 plays a carcinogenic role in bladder cancer via the ERK/Cyclin D1/CDK4 pathway, which provides a reference for the clinical treatment of patients with bladder cancer.