Archivos Espanoles De Urologia最新文献

Objective: To evaluate the therapeutic effect of low-intensity pulsed ultrasound (LIPUS) on erectile dysfunction (ED), follow up on its continued effects, and analyze the effects of age, body mass index (BMI), smoking, drinking, diabetes, and hypertension on it.

Methods: A retrospective analysis was conducted on patients with ED who initially received LIPUS treatment at our hospital between October 2020 and October 2021. The patients' ED was evaluated according to the International Index of Erectile Function (IIEF-EF) and Erection Hardness Score (EHS), and the included patients were statistically analyzed to uncover the treatment efficacy, continued effects, and factors influencing the therapeutic efficacy of LIPUS.

Results: Among 56 patients with ED, the IIEF-EF and EHS scores before LIPUS treatment were 9.61 ± 6.41 and 1.24 ± 0.99 points, respectively. At 6.41 ± 4.14 months after LIPUS treatment, the IIEF-EF and EHS scores improved to 16.00 ± 7.88 and 2.29 ± 1.12 points, respectively, both showing significant improvement (p < 0.05). Of the included patients, 21 were followed for up to 12.57 ± 3.10 months after their initial treatment, with no observed reduction in the therapeutic effect of LIPUS (p > 0.05). Binary logistic analysis revealed that none of the factors of interest, including age, obesity/overweight, smoking, drinking, diabetes, and hypertension, had a significant impact on the therapeutic effect of LIPUS (p > 0.05).

Conclusions: LIPUS demonstrated a good therapeutic effect on ED, with no significant decrease in efficacy after about 12 months of follow-up and without variations attributable to age, obesity/overweight, smoking, drinking, diabetes, or hypertension.

Background: Patients undergoing intravesical chemotherapy following transurethral resection of bladder tumour (TURBT) frequently face challenges including insufficient disease-related knowledge, inadequate self-management skills during chemotherapy intervals and discontinuity in routine postoperative care. This study aimed to investigate the effects of continuity of care patterns on cancer-related fatigue, self-care ability, fear of recurrence and risk of complications.

Methods: This retrospective study included 105 patients who received intravesical chemotherapy after TURBT in our hospital between January 2022 and December 2024. The patients were divided into a study group (receiving continuity of care, n = 44) and a control group (not receiving continuity of care, n = 61) according to whether they received continuity of care. Their baseline characteristics and clinical data were retrospectively analysed, and their Piper Fatigue Scale-Revised (PFS-R), Exercise of Self-Care Agency Scale (ESCA) and Fear of Cancer Recurrence Inventory Scale (FCRI) scores were collected before and 6 months after intervention.

Results: After the intervention, the behavioural fatigue, emotional fatigue and somatosensory fatigue dimension scores and PFSR total points of the study group were significantly lower than those of the control group (p < 0.05). The scores in the dimensions of sense of responsibility, self-concept, self-care skills and health knowledge level and ESCA total points of the study group were significantly higher than those of the control group (p < 0.05). The severity, coping strategies, psychological distress, insight, reassurance dimension scores and FCRI total points of the study group were significantly lower than those of the control group (p < 0.05). During the follow-up period, the incidence of urinary tract infection (UTI) and urethral pain in the study group was significantly lower than that in the control group (p < 0.05).

Conclusions: Continuity of care was associated with reduced cancer-related fatigue, improved self-care ability, low fear of recurrence and few complications such as UTI and urethral pain in patients receiving intravesical chemotherapy after TURBT. This study describes an evidence-based care protocol designed to improve transitional healthcare management for this patient population.

Background: Epithelial cells (ECs) are key drivers of prostate cancer (PCa) initiation and progression. Our study aimed to identify EC-related immune genes as prognostic biomarkers and explore their clinical significance to guide therapy.

Methods: Single-cell RNA sequencing data from prostate adenocarcinoma samples were analysed to identify EC-specific markers. Prognosis-related immune genes were screened using univariate Cox regression analysis, and a predictive gene signature model was established by employing least absolute shrinkage and selection operator regression analysis. Kaplan-Meier survival analysis and receiver operating characteristic (ROC) curves were used to assess the performance of the gene signature model. Immunohistochemical staining of clinical specimens was conducted to validate key findings.

Results: A five-gene prognostic signature (opioid receptor κ1 (OPRK1), early growth response 1 (EGR1), arrestin β2 (ARRB2), high mobility group box 2 (HMGB2), and tripartite motif-containing 27 (TRIM27)) model was derived from the differential expression profiles of EC-associated immune genes in PCa. Patients with PCa placed in the high-risk group exhibited significantly poorer survival outcomes. Our prognostic gene signature model demonstrated strong predictive accuracy and clinical applicability. Patients in the high-risk group showed a higher infiltration of regulatory T cells (Tregs) and M2 macrophages, whereas resting memory cluster of differentiation 4 (CD4+) T cells were more abundant in the low-risk group. Among the signature genes, OPRK1 was markedly overexpressed in PCa tumour tissues, and its expression was positively associated with a favourable prognosis.

Conclusions: This study highlights the prognostic value of EC-derived immune genes in PCa and establishes a reliable gene signature model for PCa risk stratification. Notably, OPRK1 may serve as a novel therapeutic target, offering new insights into precision oncology and improving outcome prediction for patients with PCa.

In primary hyperoxaluria (PH), clinical manifestations can initiate during early childhood. Given the high prevalence of urinary lithiasis and chronic kidney disease (CKD) among adult population, in which clinical manifestations of PH after childhood, diagnosis becomes more difficult. This guide was developed to improve the diagnostic and therapeutic fields of PH in adult patients for clinicians. PH can cause (i) kidney stones and (ii) calcium oxalate crystal deposition within the kidney tissue (oxalate nephropathy). Clinical criteria for suspected PH in adults include the following: (i) Recurrent stone disease (in children, however, it should be suspected in the first episode); (ii) Nephrocalcinosis that is particularly associated with decreased glomerular filtration rate (GFR); (iii) Presence of oxalate crystals (calcium oxalate monohydrate and whewellite) in any biological fluid or tissue. To the above, the following can be added: (iv) Hyperoxaluria without clear cause of secondary hyperoxaluria; (v) Oxalate urinary excretion >1.0 mmol/1.73 m² body surface area in two samples; (vi) Kidney transplant recipients with previous CKD of unknown aetiology or previous history of recurrent urolithiasis and presenting graft nephrocalcinosis and GFR drop with no other clear cause. Routine PH screening of all adult patients with hyperoxaluria is costly strategy and therefore not recommended. Suspected PH in adults should be guided in accordance with clinical criteria. In patients with a confirmed PH diagnosis, all efforts should be directed towards adequate genetic and biochemical characterisation given that each patient can benefit from various therapeutic strategies.

Recent advances in paediatric vesicoureteral reflux (VUR) have focused on risk-stratification models to better identify patients at risk for complications such as renal scarring, persistent VUR, or breakthrough urinary tract infections (UTIs). By addressing critical clinical questions-such as predicting VUR presence, assessing the likelihood of spontaneous resolution, and determining the risk of breakthrough UTIs despite antibiotic prophylaxis-these tools enhance decision-making. Predictive models like the VURx score and ureteral diameter ratio integrate clinical, demographic, and imaging data to provide personalised risk assessments. Additionally, machine-learning techniques have advanced predictive accuracy by analysing complex interactions among risk factors, enabling tailored treatment plans. These stratification methods help clinicians minimise unnecessary procedures whilst ensuring early intervention for high-risk patients. In terms of management, continuous antibiotic prophylaxis (CAP) remains a common strategy for preventing UTIs in children with VUR. Guidelines from the American Urological Association (AUA) and European Society for Paediatric Urology (ESPU) emphasise a risk-based approach, recommending CAP primarily for high-risk patients. Alternatives to CAP include behavioural interventions, such as managing constipation and encouraging regular voiding, to reduce UTI recurrence. They should be considered as the initial step for all patients with suspected VUR. For patients with persistent reflux or recurrent UTIs despite conservative measures, surgical options, including endoscopic injection or ureteral reimplantation, offer effective solutions to mitigate long-term complications.

Background: Robotic surgery has made significant technological advances, with robotic single-port surgery emerging as an innovative approach. However, this technique requires a reassessment of surgical training because its learning curve (LC) may differ from that of standard robotic procedures. In this comprehensive review, the LC of single-port and standard robotic surgeries in different urological procedures is evaluated and compared.

Methods: A non-systematic review of robotic surgeries and LCs was performed in September 2024 using relevant articles from PubMed, Scopus and the Cochrane Central Register of Controlled Trials. The review focused on the LCs and structured programmes for robotic procedures. Articles were selected based on their relevance to urological practice and the availability of objective or subjective metrics for assessing the LC. Studies describing institutional protocols, simulation training and modular curricula were also included.

Results: Robotic radical prostatectomy, cystectomy, kidney transplantation, nephrectomy (radical and partial), pyeloplasty and single-port procedures were evaluated in relation to the LCs and structured programmes. Key findings highlight significant variability in LC duration depending on the procedure, surgeon's experience, and type of robotic platform.

Conclusions: Future research should aim to standardise LC metrics, capture surgeons' baseline experiences and explore innovative training methods, such as simulation-based learning, to ensure the safe and efficient mastery of robotic urological surgery. Collaborative efforts between academic centres and robotic training platforms may facilitate more consistent and reproducible surgical education pathways.

Background: Alpha blockers (ARBs) are important agents in treating benign prostatic hyperplasia (BPH). Although multiple ARBs are available, comparative data on their early and mid-term effects are limited. This study aimed to evaluate and compare the early clinical efficacy of three ARBs (alfuzosin, tamsulosin and silodosin) in patients with lower urinary tract symptoms due to BPH.

Methods: This retrospective study was conducted using a 1:1:1 matched design on the basis of age, prostate-specific antigen level and prostate volume. Eligible patients were subsequently grouped for comparison. Patients received 10 mg of alfuzosin, 0.4 mg of tamsulosin or 8 mg of silodosin once daily for 3 months. Uroflowmetry parameters, including maximum urinary flow rate (Qmax), average urinary flow rate (Qave) and post-void residual volume (PVR), were assessed at baseline, 6 h after the first dose and at the first and third months. The International Prostate Symptom Score (IPSS) and quality of life (QoL) scores were evaluated at baseline and the first and third months. Repeated-measure analysis of variance (ANOVA) and Bonferroni post-hoc tests were applied.

Results: A total of 117 patients were included in the final analysis, with 38 in the alfuzosin group, 40 in the tamsulosin group and 39 in the silodosin group. Repeated-measure ANOVA revealed that all groups showed significant improvements over time in Qmax, IPSS and QoL scores (p < 0.001). Silodosin provided a significantly greater increase in Qmax at 6 h than alfuzosin (p = 0.013) and tamsulosin (p = 0.044), though no statistically significant differences were observed between groups at the first or third month (p = 1.000). PVR values decreased in all groups over time, but intergroup differences were not statistically significant (p > 0.05).

Conclusions: Silodosin provided the most rapid symptomatic improvement following initial administration, likely due to its high α1A-receptor selectivity. However, by the third month, all three agents showed similar clinical efficacy, supporting their use as viable treatment options tailored to patient-specific needs.

Background: Fragile patients with indwelling bladder catheter (IBC) represent a category at high risk of morbidity and overall quality of life decline. The goal for these patients is to remove the bladder catheter and avoid surgical stress, complications and long hospitalisation. Prostatic artery embolisation (PAE) has been developed as a minimally invasive procedure for the treatment of benign prostatic obstruction (BPO)-related lower urinary tract symptoms. We evaluated the results of PAE in patients unfit for surgery with IBC.

Methods: We retrospectively reviewed data on fragile patients unfit for surgery due to comorbidities with IBC secondary to BPO who underwent PAE in three centres. Our objective was to remove urinary catheter and maintain patients free from bladder catheter. We divided patients into two groups: Those with successful (Group A) or unsuccessful (Group B) procedure after 1 year.

Results: A total of 74 patients with IBC receiving PAE were included. No PAE failure occurred due to tortuous or atherosclerotic vessels. After 1 year, 49 patients (66.20%) were without bladder catheter. We found no differences in age (75.30 vs 78.70), Charlson comorbidity index (6.00 vs 6.60), prostate volume (94.70 vs 94.70), hospital stay (1.90 vs 3.90 days), catheterisation time after the procedure (17.20 vs 20.80 days) or complication rate (11.20% vs 8.30%) between Groups A and B. One patient developed postembolisation partial penile necrosis, two had penile skin ischemia (conservatively managed), and four developed urinary tract infection following the procedure. The history of IBC was longer in Group B than in Group A (9.70 vs 6.20 months, p = 0.018). Multivariate logistic regression confirmed a significant reduction in the probability of unsuccessful procedure based on an increased postoperative catheterisation time (odds ratio = 0.91; 95% confidence interval: 0.83-0.99).

Conclusions: PAE is a minimally invasive surgical treatment for BPO. This procedure should be considered in elderly and fragile patients, based on its favourable safety profile. In our series, PAE was a safe procedure for patients with IBC affected by BPO. In our experience, the success of this treatment is correlated with postoperative catheterisation. Patient's selection and counselling are key for optimising the results.

Background: We aimed to determine which parameters other than the time until torsion surgery can predict orchiectomy risk in acute testicular torsion (TT).

Methods: The medical records of acute TT who applied to five different health centres in Turkey between 2016 and 2023 were analysed retrospectively. Patients who underwent orchiectomy because blood flow cannot be detected were defined as Group I, and patients with testicles preserved and fixed were defined as Group II. The differences between the two groups and potential predictors of testicular salvage were analysed.

Results: Eighty-three patients with TT were included in the study. Amongst them, 44 (53.01%) were included in Group I and 39 patients (46.99%) in Group II. Time from the onset of pain to surgery and mean platelet volume (MPV) were significantly higher in Group I (p < 0.05). In Group II, the ipsilateral Prehn's sign negativity rates, the rate of normal ipsilateral testicular echogenicity, and the rate of normal volume on ultrasonography were significantly higher than those in Group I (p < 0.05). We created a new scoring system named Time, MPV, Prehn's sign, Echogenicity, and Volume (TMPEV) that can predict the risk of orchiectomy in TT by using the parameters that differed statistically between Groups I and II.

Conclusions: The time until surgery may not be the only factor affecting the possibility of testicular recovery in acute TT. MPV, positivity of Prehn's sign, differentiations in ipsilateral testicular echogenicity and volume changes on ultrasonography, may have significant value in predicting the possibility of orchiectomy after open detorsion surgery. If more comprehensive and clear nomograms similar to our new TMPEV scoring system can be created, more proactive algorithms can also be developed for predicting orchiectomy after TT and managing TT.

Background: Erectile dysfunction (ED) and sarcopenia share common risk factors, particularly advanced age. This study aimed to assess the effect of sarcopenia on ED treatment outcomes.

Materials and methods: A prospective observational study was conducted, involving patients receiving ED treatment from six different centres. Sarcopenia was evaluated using the Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls (SARC-F) questionnaire, the 30-Second Chair Stand Test, and the 4-Meter Walk Test. The International Index of Erectile Function (IIEF) questionnaire was used to assess ED severity. The treatment response in patients regularly using phosphodiesterase type 5 inhibitors (PDE5i) for ED was analysed in relation to sarcopenia.

Results: The study included 137 patients (mean age = 54.91 ± 12.46 years) who regularly used PDE5i. Sarcopenia suspicion was present in 15.33% (n = 21) of patients. Those with suspected sarcopenia were older (mean age = 64.62 ± 5.83 years) and had lower baseline IIEF scores (8.76 ± 3.57) than patients without suspected sarcopenia (p < 0.001 for both). Whilst the IIEF scores significantly increased after PDE5i treatment in patients without suspected sarcopenia (from 11.64 ± 4.82 to 17.28 ± 5.70; p < 0.001), the increase was not significant in those with suspected sarcopenia (from 8.76 ± 3.57 to 9.81 ± 5.14; p = 0.283).

Conclusions: Sarcopenia may contribute to a poor response to ED treatment, particularly in older patients. It could be a significant factor in ED treatment resistance, especially at an advanced age.