Archivos Espanoles De Urologia最新文献

Purpose: This study aimed to assess the efficacy and safety of same-day flexible ureteroscopic lithotripsy (FURL) and compare clinical outcomes between different ureteral access sheaths.

Methods: A retrospective review was conducted on 182 patients who underwent FURL at our day surgery centre between March and December 2024. The patients were grouped according to the type of ureteral access sheath used: Suction group (navigable suction sheath) and convention group (conventional ureteral sheath). Perioperative outcomes, including operative time, stone-free rate, postoperative parameters and accessory device usage, were compared between the groups.

Results: All the patients successfully completed FURL and were discharged on the same day. The mean stone size was 13.93 ± 6.49 mm, and the mean operative time was 36.70 ± 15.69 min. The overall stone-free rate was 89.56% (163/182). The average postoperative haemoglobin drop was 12.17 ± 7.40 g/L, with a mean procalcitonin level of 0.04 ± 0.02 ng/mL. The pain score prior to discharge was 0.39 ± 0.76, and the mean length of stay was 10.41 ± 2.10 h. The suction group demonstrated significantly reduced use of stone retrieval baskets compared with the convention group. No significant differences in operative time or complication rates were observed.

Conclusions: Same-day FURL is safe and effective in appropriately selected patients. The navigable suction ureteral access sheath offers a clinically advantageous alternative by reducing accessory device use without compromising surgical outcomes.

Background: While enzalutamide has demonstrated reliable therapeutic efficacy in the management of prostate cancer (PC), a substantial proportion of patients eventually develop resistance to this medication after prolonged therapy. Despite this, the identification of biomarkers to effectively predict clinical outcomes in PC patients who exhibit resistance to enzalutamide remains uncertain. The aim of this study was to identify a specific gene associated with acquired resistance to enzalutamide in PC and to investigate the potential prognostic value of this gene.

Methods: The GSE183100, GSE147541, and GSE16560 datasets were obtained from the Gene Expression Omnibus database. Differential gene expression analysis was conducted using the DESeq2 R package and Wilcoxon's rank-sum test. Subsequently, biological process enrichment analysis and gene set variation analysis were performed to identify a promising candidate gene. Additionally, the correlation between the proportions of immune cell infiltration and the expression of candidate genes was evaluated. Finally, the potential implications of these candidate genes on survival outcomes were investigated.

Results: A comprehensive analysis identified a total of 975 differentially expressed genes, predominantly involved in biological processes related to angiogenesis, inflammatory response, positive regulation of cell division, and membrane potential. Notably, secreted frizzled-related protein 1 (SFRP1) expression demonstrated strong, favorable correlations with both angiogenesis and the infiltration of Regulatory T cells. Moreover, the overexpression of SFRP1 was found to be closely associated with improved prognosis in patients with PC.

Conclusions: In conclusion, the downregulation of SFRP1 in enzalutamide-resistance PC is associated with angiogenesis and cellular infiltration. This study identified SFRP1 as a diagnostic biomarker for patients with PC who have developed acquired enzalutamide resistance. These findings provide an important theoretical foundation for the development of novel and complementary therapeutic approaches for PC management.

Background: Shrinking, soft glans penis is contemporarily unavoidable in patients with penile implantation, the final solution to intractable erectile dysfunction (ED). This condition poses a challenge in primary impotence.

Case presentation: We present a case of a 43-year-old patient with primary impotence who underwent six penile prosthesis procedures, alternating between inflatable and malleable prostheses. His sixth implantation involving a malleable cylinder enabled him to engage in dozens of intercourse episodes between the ages of 42 and 43 years. However, this action led to an impending prosthesis extrusion. The patient reported that his partner had firstly raised concerns regarding his shrinking, soft glans. Although prosthesis extrusion is avoidable and soft glans is treatable, persistent surgeon ignorance has led to missed management opportunities. Anatomical understanding is crucial for surgical success. Therefore, we present this unusual case to highlight strategies for treating soft glans in patients with penile implantation.

Conclusions: Although the proactive implementation of preventive measures against prosthesis extrusion was firstly recommended 3 decades ago and a novel strategy for glans enhancement was introduced a decade ago, inadvertent ignorance persists in modern surgical practice. In this case study, we highlight the importance of proper cylinder positioning and the need for innovative glans enhancement techniques.

Background: The study aimed to analyse the comparative effect of low-intensity extracorporeal shockwave therapy (Li-ESWT), platelet-rich plasma (PRP), and their combination for treating arteriogenic erectile dysfunction (ED).

Methods: This prospective observational study involved men diagnosed with arteriogenic ED over six months. Four hundred men aged 35-65 with ED, diagnosed using the International Index of Erectile Function (IIEF-5) and penile colour Doppler ultrasonography (USG), joined the research. The participants were divided into four groups: Li-ESWT, PRP, Li-ESWT + PRP, and Control. Outcomes were assessed at baseline and at one, three and six months post-treatment, focusing on changes in IIEF-5 scores and penile haemodynamics, including peak systolic velocity (PSV) and end-diastolic velocity (EDV).

Results: Li-ESWT significantly improved IIEF-5 scores from baseline to three months (p = 0.001), with sustained but reduced effects at six months (p = 0.001). PRP alone showed mild improvement at one month (p = 0.028), with no significant effect persisting at six months (p = 0.119). Combination therapy demonstrated the most pronounced and sustained improvement in IIEF-5 scores, particularly at three and six months (p = 0.001). Haemodynamic analysis revealed a significant increase in PSV at three months in the Li-ESWT and combination groups (p = 0.001) with mild regression at six months (p = 0.003). EDV changes were negligible across all groups and time points (p > 0.05).

Conclusions: Combining Li-ESWT and PRP provided the most substantial and sustained improvement in erectile function and arterial haemodynamics. While Li-ESWT demonstrated notable efficacy, PRP alone showed limited and transient benefits.

Background: Benign prostatic hyperplasia (BPH) is a condition prevalent in men over 50 years old and characterised by benign prostatic obstruction and lower urinary tract symptoms. The Rezum^TM system, a minimally invasive technique based on thermal ablation using water vapor, aims to provide an effective treatment with reduced surgical effect and preserved quality of life.

Methods: A bibliographic review was conducted on publications indexed in PUBMED and SCOPUS from 2015 to 2023. Sixteen studies, including clinical trials and multicentre experiences, on the adverse effects (AEs) and tolerance to Rezum^TM treatment were selected. Data were organised in accordance with Clavien-Dindo criteria and compared with bipolar transurethral resection of the prostate (TURP).

Results: The main AEs associated with Rezum^TM include haematuria (1.7%-71.7%), dysuria (1.79%-64.5%), frequency/urgency (3.2%-50%), acute urinary retention (4.4%-33.8%) and urinary tract infection (2%-20%). These events are generally mild to moderate (Clavien-Dindo I-II) and tend to resolve spontaneously or with symptomatic treatment. Erectile dysfunction was reported in less than 5.56% of all reviewed studies, highlighting its limited impact on sexual function. Re-treatment rates were within the range of 4.4%-8.33%, associated with the conservative therapeutic strategy.

Conclusions: The Rezum^TM system demonstrates a favourable safety profile with mild/moderate and manageable AEs and high tolerability (100% across reviewed studies). It is an effective and minimally invasive alternative for managing BPH, particularly for patients seeking to minimise surgical risk and preserve sexual function.

Background: Pulmonary embolism (PE) secondary to lymphocyst formation after robotic-assisted laparoscopic radical prostatectomy (RALRP) is a rare but serious complication. Although most patients with pelvic lymphocysts receive effective conservative treatment, there is no consensus on treatment strategies for patients who do not respond to conservative treatment. This case report highlights the clinical features, diagnostic challenges, and treatment approaches for managing this condition.

Case presentation: A 61-year-old male with prostate cancer (pT3N0M0) underwent RALRP. One week after discharge, he developed swelling and pain in his right lower limb, with localised warmth and worsening symptoms upon activity. A pelvic lymphocyst was suspected and the patient was initially managed symptomatically prior to discharge. However, three weeks later, he returned with persistent right lower limb edema and new-onset dyspnea. Further evaluation confirmed a secondary PE due to the lymphocyst. The patient showed significant improvement after a comprehensive treatment strategy, including anticoagulation, thrombolysis, and inferior vena cava filter placement. Concurrently, the lymphocyst was successfully managed with computed tomography (CT)-guided percutaneous drainage and sclerotherapy, leading to complete resolution. The patient was discharged without complications, and follow-up showed no recurrence.

Conclusions: PE secondary to lymphocyst formation is an uncommon but serious complication after radical prostatectomy. Early detection and intervention in high-risk patients are essential to improve patient outcomes.

Aim: Apelin is a regulatory peptide that exerts its effects through the G protein-coupled APJ receptor (APJ-R), expressed across various organs. Studies on apelin in the male reproductive system remain limited. Adenomyomatous hyperplasia (AH) and related lower urinary tract symptoms become more prevalent with age. Similar to other sex organs, the prostate is highly responsive to hormones and growth factors. Dihydrotestosterone influences apoptosis and proliferation through intracellular androgen receptors, whereas 5α reductase inhibitors serve therapeutic and haemostatic purposes. This study aims to determine whether Apelin exerts differential effects on apoptosis and angiogenesis in the prostate tissues of AH and treated AH cases.

Material and methods: Cases diagnosed with adenomyomatous hyperplasia through prostatectomy and/or prostate transurethral resection (TUR) material between 2011 and 2013, either treated with (treatment-G) or without 5α-reduction inhibitor therapy (Adeno-G group), were included in the study. In addition, cases diagnosed in 2023 with benign prostate tissue via tru-cut biopsy (Benign-G) were incorporated. Paraffin-embedded tissue blocks from these cases were stained immunohistochemically using apelin antibody and evaluated under a light microscope.

Results: The study included 132 cases, comprising 69 in the Benign-G group, 33 in the treatment-G group and 30 in the Adeno-G group. Staining results for all tissues (epithelial and stromal) revealed a significant difference in positive/negative ratios amongst the groups (p = 0.006). The Benign and Adeno groups exhibited similar positive/negative distributions (37.0% vs. 63.0% and 33.3% vs. 66.7%, respectively), whereas negative staining predominated in the treatment group (84.8%).

Conclusions: The significant decrease in apelin levels in the treatment group, along with the apparent relationship between 5dihydrotestosterone (HT) levels and apelin, suggests a potential broader relevance beyond benign cases.

Objective: This study aimed to explore the effect of electroacupuncture (EA) stimulation on bladder function improvement, sleep quality and psychological state in patients with neurogenic bladder (NB) after spinal cord injury (SCI).

Methods: Patients with NB after SCI treated in our hospital from January 2020 to January 2025 were retrospectively enrolled and divided into a traditional treatment group and an EA treatment group on the basis of their treatment protocols. Both groups received bladder function training, with the EA group additionally receiving EA. Bladder function was evaluated using maximum bladder capacity (MBC), intravesical pressure (IVP) and residual urine volume (RUV). Micturition frequency (MF), single voided volume (SVV) and maximum voided volume (MVV) were used to assess micturition status. The Pittsburgh Sleep Quality Index (PSQI), the Self-rating Anxiety Scale (SAS) and the Self-rating Depression Scale (SDS) were used to evaluate sleep quality and psychological state.

Results: A total of 118 patients were included (56 in the EA group and 62 in the traditional group). The EA group showed significantly better improvements in bladder function and micturition indices (MBC, RUV, MF, SVV and MVV) than the traditional group (p < 0.05). The PSQI, SAS and SDS scores in the EA group were notably lower, indicating marked improvements in sleep quality and psychological state (p < 0.05). The EA group also had a lower incidence of adverse reactions (p < 0.05).

Conclusions: EA stimulation combined with bladder function training effectively improves bladder function, micturition, sleep quality and psychological state in patients with NB after SCI.

Background: Ureteroscopic lithotripsy for renal or ureteral stones is a standard technique performed by every urologist. Double J (DJ) stents are a part of this surgery. This study investigated how patients' compliance affects the time of DJ stent removal.

Methods: The cases of patients aged 20-80 years old who underwent transurethral ureteroscopic lithotripsy were reviewed. The duration of postoperative DJ stent retention was set as 21-28 days in all cases, and a duration of 14-35 days indicated compliance. Short durations signified intolerance, and long durations were considered negligence. The age, gender, stone side, level and size, and educational level and behaviours regarding stent removal of the patients were compared.

Results: A total of 146 patients were included. The duration of DJ stent retention ranged from two days to 152 days (mean 36.6 days). Amongst the patients, 66 were compliant with the recommended removal time of 28 ± 7 days, whereas 80 were noncompliant. The mean age of the group unable to tolerate stents was significantly lower (p = 0.032) that those of other groups. When the patients were divided into two groups on the basis of educational level (low and high), a significant relationship was observed between compliance with stent removal timing and educational level (p = 0.036).

Conclusions: Postoperative planning is critical for young patients. This study demonstrated that a significant number of patients are unaware of the timing for DJ stent removal. Educational status, in particular, should be taken into consideration. Various measures, such as mobile phone applications, reminder short message service (SMS) messages and record-keeping systems, can help prevent complications caused by forgotten stents.