Archivos Espanoles De Urologia最新文献

Background: Kidney stone disease (KSD) is a prevalent and significant global urological issue, and ureteroscopic holmium laser lithotripsy (UHLL) is a primary treatment option. This study aimed to assess the impact of stone computed tomography (CT) value on the outcomes of UHLL in treating KSD.

Methods: A retrospective analysis was conducted on the clinical data of 101 patients who underwent UHLL at our hospital between September 2022 and December 2023. Patients were categorised into two groups based on stone CT values. Demographic characteristics, intraoperative factors, stone clearance, and complications were evaluated and compared between the low- and high-CT groups.

Results: The high-CT group had significantly longer intraoperative durations than the low-CT group (p < 0.001). Fragmentation time was considerably higher in the high-CT group (p < 0.001). Stone clearance rates after three postoperative months were substantially higher in the low-CT group (98.04%) than in the high-CT group (84.00%) (χ² = 4.523, p = 0.033). Although the low-CT group had a lower complication rate, the difference was insignificant (p = 0.356). CT values showed a positive correlation with durations of operation and fragmentation (p < 0.01), and a negative correlation with stone clearance (p < 0.05).

Conclusions: Stone CT values are key factors influencing the procedural outcomes and postoperative complications of UHLL.

Background: Percutaneous nephrolithotomy (PCNL) is the standard procedure for treating upper urinary tract calculi and complex kidney calculi >2 cm in diameter, though it has a high incidence of postoperative complications. This study aimed to investigate the effect of Orem's management model on patients undergoing PCNL.

Methods: This retrospective study included 465 patients who underwent PCNL from February 2022 to February 2023 from two tertiary hospitals. After excluding 16 patients based on exclusion criteria, 449 patients remained. The observation group (n = 227) received Orem's management model, while the control group (n = 222) underwent conventional surgical management. Primary outcomes included postoperative recovery time and the incidence of postoperative complications, while secondary outcomes such as postoperative pain levels (measured via a numerical rating scale) and self-care ability assessed through the exercise of self-care agency were obtained through medical records and physical examinations.

Results: Compared to the control group, the observation group achieved faster outcomes for the first anal exsufflation, first ambulation, and discharge, and a lower incidence of postoperative complications (p < 0.05). Post-management, the observation group had lower numerical rating scale scores and higher exercise of self-care agency scores (p < 0.001).

Conclusions: Orem's management model accelerates postoperative recovery, alleviates pain, and reduces postoperative complications in patients undergoing PCNL. Moreover, this model enhances self-care ability, though its effectiveness is limited to patients with non-recurrent renal calculi and normal renal function. Further exploration of its broader application is needed.

Introduction: Partial nephrectomy is the preferred treatment for renal tumors <7 cm. Robot-assisted laparoscopic approach is a minimally invasive method that offers advantages for resecting complex tumors. Here, we conducted a descriptive retrospective analysis of the first robotic partial nephrectomies (RPNs) performed at our center.

Materials and methods: A retrospective cohort of 94 patients who consecutively underwent RPN at our center between November 2012 and December 2022 was investigated. Baseline patient data, tumor characteristics, intraoperative variables, pathological tumor analysis, and postoperative complications at 30 days were analyzed.

Results: The patients were followed up for a median of 25.3 months. Baseline values included a median age of 63 years and a median body mass index (BMI) of 28.1. Intraoperative variables comprised a median surgical time of 150 min and a median warm ischemia time of 16 min. The mean postoperative creatinine level was 1 mg/dL. The median tumor size was 41.9 mm, with a median PADUA score of 8 and a median RENAL score of 8. Resected tumors were predominantly cT1a (58.5%) and cT1b (39.3%), while the positive margin rate was 21.3%. A total of 19.2% of the patients experienced Clavien-Dindo complications, of which 11% were Clavien-Dindo I; 66.7%, Clavien-Dindo II; And 22.2%, Clavien-Dindo IIIb. However, no Clavien-Dindo IIIa or IV complications were reported.

Conclusions: RPN is an effective and safe technique for treating solid renal masses, demonstrating a low complication rate and adequate oncologic control locally and distally.

Purpose: To examine the impact of driving pressure-guided positive end-expiratory pressure ventilation on cerebral blood flow and pulmonary function in patients undergoing laparoscopic radical prostatectomy.

Methods: A retrospective analysis was conducted on clinical data from patients who underwent laparoscopic radical prostatectomy at our hospital between June 2022 and June 2023. The patients were divided into two groups, namely the conventional ventilation group and the driving pressure-guided positive end-expiratory pressure ventilation group. Measurements and analyses were performed on cerebral blood flow, neurological status, and pulmonary function parameters.

Results: A total of 105 patients were included in this single-centre retrospective study, with 51 patients in the conventional ventilation group and 54 patients in the driving pressure-guided positive end-expiratory pressure ventilation group. The driving pressure-guided positive end-expiratory pressure ventilation group demonstrated significantly higher cerebral blood flow, cerebral autoregulation index, cerebrovascular resistance, and cerebral oxygen saturation compared to the conventional ventilation group (p < 0.05). Additionally, patients in the driving pressure-guided positive end-expiratory pressure ventilation group exhibited improved neurological outcomes, a higher partial pressure of oxygen/fraction of inspired oxygen ratio, increased lung compliance, decreased peak expiratory flow, elevated respiratory rate, and a lower lung injury score compared to the conventional ventilation group (p < 0.05).

Conclusions: The findings suggest that driving pressure-guided positive end-expiratory pressure ventilation might positively influence cerebral blood flow and pulmonary function parameters in patients undergoing laparoscopic radical prostatectomy.

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.