Archivos Espanoles De Urologia最新文献

Background: Testicular torsion (TT) is a critical condition caused by spermatic cord twisting, which can result in irreversible testicular damage without timely intervention. In Chile, centralised healthcare and significant geographic barriers can delay treatment for TT, which potentially worsens outcomes. This study evaluates the impact of referral status on orchiectomy rates among paediatric TT cases treated at two hospitals in Southern Chile.

Methods: A cross-sectional analysis was conducted on TT cases in patients under 15 years. These patients were treated at Hospital Guillermo Grant Benavente and Hospital Las Higueras between January 2018 and January 2024. Data on demographics, symptom duration, referral status and treatment timelines were analysed using Wilcoxon rank-sum and Pearson's Chi-squared tests, with significance set at p < 0.05.

Results: Among 144 patients, 71% were referred from other facilities. Orchiectomy was performed in 44 cases, with a median symptom duration of 48 h, which was significantly longer than that of non-orchiectomy cases (5 h, p < 0.001). Referred patients showed a higher crude orchiectomy rate (35% vs. 20%; p = 0.064). However, in the multivariable analysis with adjusted age, hospital and symptom onset time, referral emerged as an independent predictor of orchiectomy (odds ratio (OR) = 3.68; 95% confidence interval (CI): 1.15-13.1; p = 0.035).

Conclusions: Referral delays in TT management correlate with increased orchiectomy rates. Enhancing specialist access and referral protocols is crucial to reducing treatment delays and improving outcomes in regions with dispersed healthcare services.

Background: Haemorrhoidectomy, although an important intervention for the management of haemorrhoids, is associated with a risk of postoperative urinary retention in some patients, impacting prognosis and quality of life. This single-centre retrospective study evaluates the efficacy of acupoint moxibustion in the management of post-haemorrhoidectomy urinary retention.

Methods: Patients who developed urinary retention following haemorrhoidectomy were enrolled and allocated into either a traditional hot compress treatment group or an acupoint moxibustion combined treatment group, according to their postoperative management. The traditional hot compress group received hot compress therapy alone, whereas the combined group received additional moxibustion at Qihai (CV6), Guanyuan (CV4) and Shenque (CV8) acupoints alongside conventional hot compress therapy. Baseline clinical characteristics, improvement in urinary retention and duration of postoperative indwelling catheterisation were compared between the groups. Changes in pelvic floor muscle strength, severity of lower abdominal pain, incidence of adverse reactions and patient comfort (assessed by the General Comfort Questionnaire (GCQ)) were also evaluated.

Results: At one and two weeks post-treatment, the combined treatment group demonstrated a higher overall efficacy rate in improving urinary retention, shorter duration of postoperative indwelling catheterisation, greater recovery of pelvic floor muscle strength, more substantial reductions in Visual Analogue Scale (VAS) pain scores and significantly higher GCQ scores (all p values < 0.05) compared with the traditional hot compress group. Both groups showed improvements in pelvic floor muscle strength, reductions in VAS scores and increases in GCQ scores at one and two weeks post-treatment relative to baseline. The incidence of adverse reactions was 6.00% (3/50) in the traditional group and 2.00% (1/50) in the combined group, with no statistically significant difference (p > 0.05).

Conclusions: Acupoint moxibustion combined with traditional hot compress therapy appears to be an effective and safe approach for managing post-haemorrhoidectomy urinary retention. It significantly improves urinary function, reduces the duration of catheterisation, enhances pelvic floor muscle recovery, alleviates lower abdominal pain and increases patient satisfaction and comfort, with a favourable safety profile.

Background: Adrenocortical carcinoma (ACC) is a rare and fatal adrenal cortex cancer with a poor prognosis and high mortality rate. Although surgical resection is the primary treatment for ACC, recurrence is still common. p21-activated kinase 4 (PAK4) is linked to tumour development and progression, being overexpressed in various cancers. However, the role of PAK4 in ACC remains unclear.

Methods: In this study, PAK4 expression in ACC was analysed using sequencing data from the Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA) databases, assessing its clinical relevance with Kaplan-Meier, Cox regression, receiver operating characteristic (ROC) curve and prognostic nomogram models. Functional enrichment of PAK4-related genes was explored using protein-protein interaction (PPI) networks, Gene Ontology (GO)/Kyoto Encyclopedia of Genes and Genomes (KEGG) and gene set enrichment analysis (GSEA). The association between PAK4 messenger RNA (mRNA) expression and immune infiltration was examined via Tumor Immune System Interaction Database (TISIDB). Finally, immunohistochemistry was used for tissue validation.

Results: In the GEO and TCGA databases, PAK4 expression was significantly higher in ACC tissues than in normal samples (p < 0.05). High PAK4 levels were associated with poor prognosis, including shorter overall survival, disease-specific survival and progression-free interval (p < 0.05). Elevated PAK4 expression correlated with advanced T, N and M stages (p < 0.05), indicating increased malignancy in ACC. A PPI network predicted associations between PAK4 and its targets, whereas GSEA linked PAK4 to the Hedgehog signalling pathway and cell proliferation (p < 0.05). The upregulation of PAK4 was also connected to immune regulation and tumour-infiltrating immune cells such as T cells, B cells and mast cells (p < 0.05). Immunohistochemistry confirmed high PAK4 expression in ACC (p < 0.001).

Conclusions: PAK4 is significantly overexpressed in ACC, and it may play a carcinogenic role, showing great application potential as a potential therapeutic target and an independent prognostic biomarker of ACC.

Background: Prostate adenocarcinoma (PRAD) is the most prevalent malignancy in men and frequently evades early detection. However, the role of genes containing adenylate uridylate- (AU-) rich elements (AREGs) in PRAD remains largely uncharacterized.

Methods: Publicly available PRAD datasets were analyzed through weighted gene co-expression network analysis (WGCNA) to identify co-expressed gene modules. Unsupervised clustering defined AREG-associated molecular subtypes. Prognostic genes were selected via univariate/multivariate Cox proportional hazards regression (Cox) regression and least absolute shrinkage and selection operator (LASSO) regularization. Tumor immune infiltration was profiled using CIBERSORT and other bioinformatic tools, with functional enrichment revealing associated mechanisms. Single-cell transcriptomics (TISCH2) and drug sensitivity predictions (CellMiner) were integrated. Finally, quantitative reverse transcription polymerase chain reaction (qRT-PCR) validated hub gene expression in PRAD.

Results: We identified three AU-rich element-related prognostic genes: ACSM3, ACTG2, and DES. The low-risk group exhibited enhanced immune pathway activity and elevated tumor-infiltrating immune cell levels compared to high-risk patients. Functional analyses linked high-risk scores to pathways such as glycosylation and proteasome regulation. Single-cell transcriptomics revealed widespread expression of ACSM3, while ACTG2 and DES were fibroblast-enriched. Drug sensitivity predictions suggested Docetaxel as a potential therapeutic agent for high-risk PRAD patients.

Conclusions: In this study, we propose that an AREG-based signature comprising ACSM3, ACTG2, and DES effectively predicts prognosis and reflects immune microenvironment characteristics in PRAD. Through systematic analysis, we established a prognostic model utilizing these three AREGs, which demonstrates strong potential as a clinical predictor for PRAD patient outcomes.

Objective: This study aims to evaluate the predictive utility of multi-slice spiral computed tomography (MSCT) in assessing the response to neoadjuvant chemotherapy (NAC) in patients with muscle-invasive bladder cancer (MIBC).

Methods: The clinical data of patients with MIBC who received treatment at our institution between January 2022 and January 2024 were retrospectively analysed. The patients were assigned to an observation group or a control group according to whether pathological downstaging was achieved following NAC with a gemcitabine and cisplatin regimen. A multivariate logistic regression analysis was conducted to develop a clinical prediction model, and a receiver operating characteristic (ROC) curve was generated to assess its diagnostic performance. For the evaluation of the model's stability, all patients were randomly assigned to either a training set or a validation set in a 7:3 ratio.

Results: A total of 86 patients were included in the study, among whom 46 achieved pathological downstaging with a downstaging rate of 53.49%. Multivariate logistic regression analysis identified blood flow (BF; odds ratio (OR), 95% confidence interval (CI): 0.63 (0.48-0.81)) and blood volume (BV; OR, 95% CI: 0.04 (0.00-0.46)) measured by MSCT as independent predictors of NAC efficacy (p < 0.05). In the training set, the area under the ROC curve (AUC) was 0.94 (95% CI: 0.89-0.99), with a specificity of 0.86 and a sensitivity of 0.87. In the validation set, the AUC was 0.98 (95% CI: 0.93-1.00), with a specificity of 0.84 and a sensitivity of 0.88. The Hosmer-Lemeshow goodness-of-fit test indicated good calibration, with p-values of 0.504 and 0.915 in the training and validation sets, respectively. The calibration curve demonstrated strong concordance with the ideal 45° reference line, indicating close alignment between predicted and observed probabilities. Decision curve analysis further confirmed the clinical utility of the nomogram, showing a favourable net benefit across a wide range of threshold probabilities.

Conclusions: Pre-chemotherapy BF and BV parameters measured by MSCT were identified as significant predictors of NAC efficacy in patients with MIBC. The predictive model constructed using these parameters demonstrated strong performance in forecasting pathological downstaging following NAC.

Introduction: Bladder cancer (BC) is a common urological malignancy. Radical cystectomy (RC) is the standard therapeutic intervention for muscle-invasive BC (MIBC) and selected cases of non-MIBC, frequently necessitating subsequent urinary diversion. Orthotopic neobladder reconstruction is a commonly used option designed to preserve urinary continence. Delayed complications may manifest following RC and neobladder creation. This work presents a rare case of inguinoscrotal herniation involving an orthotopic neobladder, occurring 10 years after RC. To the best of our knowledge, this work is the first reported case of this complication managed through conservative treatment.

Case presentation: A 58-year-old male with a history of RC and orthotopic neobladder substitution performed 10 years prior presented to the Emergency Department with pyrexia. Physical examination revealed a right-sided inguinoscrotal swelling. Diagnostic investigations confirmed a urinary tract infection. Ultrasonography identified the orthotopic neobladder within the hernia sac and determined a post-void residual volume of 400 cc. The patient was admitted for intravenous antibiotic therapy and correction of metabolic derangements. Planned surgical repair was deferred due to patient-specific factors and comorbidities. Manual hernia reduction was performed instead, followed by a regimen of four to six daily self-intermittent catheterisations, alongside lifestyle modifications and the prescription of a hernia truss. The patient has remained free of complications at 24 months of follow-up.

Conclusions: Inguinoscrotal herniation of an orthotopic neobladder is an uncommon delayed complication following RC. Although previous reports describe surgical correction, this work indicates that conservative management-encompassing clean intermittent catheterisation, behavioural modifications and external support-may constitute a viable alternative for selected patients unsuitable for or declining surgical intervention. Comprehensive patient education and diligent long-term surveillance are imperative for successful conservative management.

Background: Prostatic extra-gastrointestinal stromal tumors (EGISTs) are notably uncommon, and the effectiveness of radical prostatectomy in managing these tumors has not been definitively established.

Case summary: A male patient, aged 71, with a history of two previous bowel resections, reported to the Department of Urology exhibiting symptoms of frequent urination, urgency, and difficulty in defecation persisting for three years. A digital rectal examination indicated the prostate was considerably enlarged, smooth, and firm. The concentrations of total serum total prostate-specific antigen (PSA) and free PSA were recorded at 0.15 ng/mL and 0.04 ng/mL, respectively. A transrectal ultrasound (TRUS) revealed a hypoechoic mass within the prostate, measuring 14.1 × 11.9 × 11.1 cm. Subsequent magnetic resonance imaging (MRI) showed a large, distinct lesion characterized by aggressive growth that compressed the adjacent rectum and bladder, initially suggesting a prostate sarcoma originating from the interlobular tissues. Guided by TRUS, a prostate biopsy indicated the presence of either a benign mesenchymal tumor or a solitary fibrous tumor (SFT). The patient was treated with radical prostatectomy, cystectomy, urinary diversion, and colostomy, leading to the final diagnosis of an EGIST. Throughout a follow-up of seven years, there was no sign of tumor recurrence.

Conclusion: Prostatic EGISTs, while exceedingly rare, require differentiation from other neoplasms such as sarcomas and SFTs. Radical prostatectomy has demonstrated efficacy as a treatment option for these resectable tumors.

Objective: This study aims to explore the correlation of serum inhibin B, endothelin (ET) and human epididymal secretory protein 4 (HE4) with sperm quality in patients with varicocele (VC) to provide new insights for diagnosis, treatment and prognosis.

Methods: From May 2022 to February 2025, 64 patients with VC (all underwent varicocelectomy) and 64 healthy controls with matched age and body mass index (BMI) were recruited. Fasting blood and semen samples were collected early in the morning for enzyme-linked immunosorbent assay (ELISA) quantification of serum inhibin B and ET as well as seminal plasma HE4 levels. Standard semen analysis was performed to evaluate sperm concentration, motility and morphology. Correlations between biomarkers and sperm quality and VC severity were assessed using Pearson/Spearman tests. Pre- and post-operative changes were analysed using paired t-test.

Results: Patients with VC showed significantly reduced inhibin B (p < 0.05) and elevated ET and HE4 compared with the controls (p < 0.05). The combined detection using inhibin B + ET + HE4 showed sensitivity and specificity values of 89.06% and 65.63% for VC, respectively. Inhibin B exhibited a positive correlation with sperm density, total motility and progressive motility (p < 0.01), whereas ET and HE4 exhibited inverse relationships (p < 0.05). Postoperative follow-up at 3 months showed that inhibin B levels in patients with VC increased compared with the preoperative levels (p < 0.05), while the levels of ET and HE4 decreased (p < 0.05).

Conclusions: Inhibin B, ET and HE4 are closely related to sperm quality, with reduced inhibin B and statistically elevated ET and HE4 levels observed in patients with VC.

Objective: By analyzing penile measurement values, this study explored the changes in the degree of penile concealment in infants under 12 months of age, to reflect whether surgical treatment is necessary.

Methods: The flaccid penile length, stretched penile length (SPL), and penile index (PI) were measured at birth and 12 months of age. Paired t-tests were conducted to compare the PI differences in infants in the concealed penis group at birth and 12 months, with p < 0.05 considered statistically significant. An independent samples t-test was used to compare the SPL differences between the two groups at birth and 12 months, with p < 0.05 indicating statistical significance.

Results: A total of 161 newborns born between August 2019 and June 2023 were divided into two groups: The concealed penis (n = 81) and the normal infant group (n = 80). The PI of infants in the concealed penis group at 12 months was 0.38; When compared to the initial PI of 0.35 at birth, the difference was not statistically significant. At 12 months, the SPL for the normal infant group was 2.59 cm, slightly longer than the SPL of 2.48 cm in the concealed penis group; However, the difference was not statistically significant.

Conclusions: In infants with a concealed penis, the concealed state does not significantly worsen during birth to 12 months, nor does it notably impact penile development. Surgical intervention may therefore be deferred for patients under 12 months of age for further observation.