Archivos Espanoles De Urologia最新文献

Background: Cancer stem cells (CSCs) contribute to bladder cancer (BCa) progression and treatment resistance. Ferroptosis, an iron-dependent cell death, influences CSC maintenance, but its post-translational regulation remains unclear. This study investigated how the deubiquitinase OTUB1 regulated ferroptosis and CSC-like traits in BCa through interaction with SLC7A11.

Methods: OTUB1 expression was assessed in clinical BCa tissue pairs (tumour vs adjacent normal) collected from patients undergoing surgical resection and in cell lines. Gain- and loss-of-function models were established in BCa cells. Cell viability, stemness capacity and ferroptosis markers were evaluated using Cell Counting Kit-8 (CCK-8) assay, Western blot, sphere formation assay, quantitative real-time polymerase chain reaction (qRT-PCR), immunofluorescence, reactive oxygen species (ROS) detection, enzyme-linked immunosorbent assay (ELISA) and co-immunoprecipitation.

Results: OTUB1 was significantly upregulated in BCa cells and tissues relative to normal controls (p < 0.01). OTUB1 overexpression significantly enhanced BCa cell viability, self-renewal capacity and stemness marker expression but reduced ferroptosisassociated indicators (ROS, malondialdehyde (MDA) and ferrous iron (Fe²⁺)) (p < 0.01). Conversely, OTUB1 knockdown impaired stem-like traits (p < 0.01) and triggered ferroptosis (p < 0.01). Mechanistically, OTUB1 directly interacted with SLC7A11, decreased its ubiquitination and stabilised its protein expression (p < 0.01). Notably, ectopic SLC7A11 expression rescued the impaired stemness and ferroptosis induction caused by OTUB1 knockdown (p < 0.01).

Conclusions: OTUB1 inhibits ferroptosis and sustains CSC-like features in BCa by deubiquitinating and stabilising SLC7A11. The OTUB1-SLC7A11 axis represents a novel regulatory mechanism of CSC maintenance and may serve as an intervention point in BCa.

Background: Radical prostatectomy is a common treatment option for patients with prostate cancer (PCa). In patients with a high-risk disease, the association of pelvic lymphadenectomy is recommended. This review aimed to address the main aspects of performing pelvic lymphadenectomy, including extension and anatomical aspects, number of lymph nodes (LNs) dissected, staging and presurgical planning, nomograms, benefits, and complications, in patients with high-risk PCa.

Methods: We conducted a narrative review using English articles from the MEDLINE/PubMed database. The articles were selected because of their high level of evidence and importance, and we utilized the following expressions and combinations of terms: "high-risk prostate cancer", "pelvic lymph node dissection", "lymphadenectomy" and "radical prostatectomy".

Results: LN involvement in patients with PCa is an independent risk factor for poor prognosis, and this procedure increases the risk of perioperative morbidity. Extended pelvic LN dissection is indicated in high-risk patients, and nomograms are useful in determining whether LN dissection should be performed because of the risk of LN involvement. Determining whether the rate of complications increases during the procedure is important.

Conclusions: In high-risk PCa, extended pelvic LN dissection promotes local staging better than that achieved through limited pelvic LN dissection and new imaging methods at the expense of increased risk of complications.

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been popular surgical treatment approaches for peritoneal carcinomatosis over the past three decades. In addition to metastases due to intra-abdominal malignancies, retroperitoneal renal metastases may occur. This study aimed to evaluate the safety and feasibility of performing nephrectomy in selected patients who underwent CRS for peritoneal carcinomatosis, without increasing morbidity and mortality, and to determine its effect on overall survival (OS).

Methods: In this single-centre retrospective observational study, 11 cases that required partial/total nephrectomy were reviewed amongst patients who underwent CRS and HIPEC for peritoneal carcinomatosis between 2017 and 2024. The effects of the surgical procedure on postoperative OS, mortality and morbidity were evaluated.

Results: The average age of the patients was 54 years (range: 23-83 years). Peritoneal carcinomatosis was caused by colon carcinoma in four cases, sarcomatosis in two cases, renal cell cancer in two cases, ovarian carcinoma in one case, mesothelioma in one case and teratomatosis in one case. Right nephrectomy was performed in six cases, right partial nephrectomy in three cases, left nephrectomy in one case and bilateral nephrectomy in one case. The average Peritoneal Cancer Index was 22.2, and complete cytoreduction was achieved in 90.9% of the patients. No 30-day mortality was observed. The average OS was 14 months (range: 2-53 months). The 1-year survival rate was 45.4%, the 2-year survival rate was 18% and the 3-year survival rate was 9%.

Conclusions: In cases of peritoneal carcinomatosis that require nephrectomy, CRS combined with HIPEC can be performed to achieve complete cytoreduction without increasing morbidity and mortality.

Introduction: Emerging studies have indicated that obstructive sleep apnea (OSA) is an independent risk factor for erectile dysfunction (ED). However, the results are inconsistent. By leveraging aggregated statistical data from genome-wide association studies (GWAS), we performed a bidirectional mendelian randomization (MR) analysis to further investigate the potential causal link between OSA and ED.

Materials and methods: We chose single nucleotide polymorphisms (SNPs) as instrumental variables based on rigorous criteria. Our research adopted five advanced two-sample MR analysis approaches, specifically encompassing inverse-variance weighting (IVW), MR-Egger, weighted median, simple mode, and weighted mode. Additionally, we conducted several sensitivity analyses to evaluate heterogeneity, horizontal pleiotropy, and stability, including Cochrane's Q test, MR-Egger intercept test, MR-pleiotropy residual sum and outlier (MR-PRESSO) global test, and leave-one-out analysis.

Results: The study included one dataset related to ED (Bovijn et al.) and two datasets related to OSA (Finngen and Sakaue et al.). The MR study results using the IVW method showed no significant causal association between OSA and ED in two datasets related to OSA. (IVW, odds ratio (OR): 1.01, 95% confidence interval (CI): 0.82-1.24, p = 0.954; 1.07, 0.87-1.30, p = 0.532, respectively). The results of other four MR analysis methods were consistent with IVW. In the reverse MR analyses, there was no causal effect of ED on OSA according to IVW method (IVW, OR: 1.01, 95% CI: 0.96 to 1.06, p = 0.708; 0.95, 0.87-1.05, p = 0.319, respectively). Moreover, sensitivity analysis showed that the study results remain highly consistent, with no indication of multi-collinearity or heterogeneity.

Conclusions: Our MR analysis revealed no clear bidirectional causal link between OSA and ED.

Purpose: This study aimed to evaluate perioperative outcomes and postoperative complications following minimally invasive radical cystectomy with ileal conduit (RCIC) performed under an enhanced recovery after surgery (ERAS) protocol, using the Clavien-Dindo classification (CDC) and the comprehensive complication index (CCI).

Methods: An ambispective study (2018-2022) was conducted, collecting demographic, perioperative and postoperative data, with a focus on complications among patients treated during and outside the COVID-19 period. Results were compared between surgeries conducted during the COVID-19 pandemic, including the first wave, and those performed in a non-COVID period.

Results: Among these 90 patients, 49 underwent surgery during the complete COVID-19 period, compared with 41 patients in the pre- and post-pandemic control period. Additionally, 15 of the cases occurred during the first wave of the pandemic. The COVID-19 group showed a higher rate of pN0 staging (87.8% vs 67.5%, p = 0.021) and fewer pN1 cases (2% vs 20%, p = 0.005) than the control group. The most common complications were genitourinary (71, 78.9%), infectious (59, 65.6%) and gastrointestinal (54, 60%). Median CCI increased significantly with each ascending CDC (r = 0.934, p < 0.001). Notably, 20.3% of patients in CDC ≤3a were reclassified to severe morbidity (CCI ≥33.7), with elevated rates during COVID-19 periods (46.7% and 42.9% vs 34.1%). CCI showed a more consistent correlation with length of stay than CDC (r = 0.551, p < 0.001 vs r = 0.460, p < 0.001).

Conclusions: Minimally invasive RCIC during the COVID-19 pandemic was associated with increased postoperative morbidity. Compared with RCIC, the CCI provides a more accurate estimation of morbidity burden and should be incorporated into standard surgical outcome reporting.

Background: This study aims to investigate the potential use of qualitative interferon-γ release assay, specifically T-spot testing focusing on culture filtrate protein 10 (CFP-10) positivity, in predicting the response of patients with high-risk non-muscle invasive bladder cancer (NMIBC) to intracavitary Bacillus Calmette-Guerin (BCG) vaccine instillation.

Methods: Patients diagnosed with high-risk NMIBC were retrospectively identified from an institutional database and subsequently underwent prospective T-spot testing. Following the completion of an adequate course of BCG instillation, patients who were unresponsive to BCG were assigned to the study group. By contrast, those who remained recurrence free for at least one year post-treatment were assigned to the control group.

Results: In this cohort of 42 patients with high-risk NMIBC, the median age was 67, and 40.0% were unresponsive to BCG. The distribution comprised 50.0% pTa and 81% high-grade cases. Over a median follow-up of 18 months, the positive BCG response varied between pTa (81%) and pT1 (38%; p = 0.005), and T-spot testing revealed positivity in 75.0% of the control group and 92% in BCG-unresponsive patients (p = 0.235). Notably, CFP-10 positivity was significantly more prevalent in the BCG-unresponsive group, observed in 91.7% of the patients, in contrast to 35.7% in the control group (p = 0.004).

Conclusions: T-spot test or more specifically CFP-10 positivity is a potential marker for predicting response to BCG instillation in patients with NMIBC.

Background: Delayed graft function is a common situation that leads to increased long-term rates of graft rejection and loss. It is seen increasingly more often, as the use of kidneys from donors after controlled cardiac death has become more widespread. This study aimed to identify factors contributing to its onset and determine how these factors may influence graft survival.

Methods: This study analysed kidney transplants with grafts from donors after controlled cardiac death performed at our hospital since the start of program in March 2013 until December 2023. Data on delayed graft function presence, graft survival, and variables related to donor, recipient, harvesting technique, ischemia time and surgical complications were collected.

Results: Recipients (male sex, 69%; Mean age, 57.9 years) received replacement renal therapy (haemodialysis in 47.6%) for a mean of 1.8 years. Amongst the donors, 73% presented expanded criteria. Ultrarapid technique was used in 61.1%, with a total warm ischemia time of 22.3 min. In all, 49 (38.9%) patients experienced delayed graft function. According to a multivariate analysis, this finding was associated with time on dialysis treatment (odds ratio (OR), 2.3; p = 0.02), donor history of diabetes mellitus (OR, 11.0; p = 0.03), score ≥3 on renal graft biopsy (OR, 4.9; p = 0.02), use of ultrarapid techniques compared with abdominal normothermic regional perfusion with extracorporeal membrane oxygenation (OR, 55.0; p = 0.03) and longer warm ischemia time (OR, 1.1; p = 0.02). Graft function was lost by 16 (12.7%) patients after a mean follow-up of 4.1 years (standard deviation (SD), 2.8). The likelihood of graft survival was 93% at 5 years. The presence of delayed graft function did not increase the rate of graft loss (p = 0.127); However, when only late losses were considered, 16.7% of kidneys with delayed graft function were lost vs. 4.1% without delayed graft function (p = 0.022).

Conclusions: In kidney transplants from donation after cardiac death, delayed graft function is associated with reduced graft survival. The incidence can be lowered by factors such as perfusion with extracorporeal membrane oxygenation, harvest techniques and shorter warm ischemia times.

Background: In recent years, claims of medical malpractice have increased. Doctors from the surgical branch frequently appear in medical malpractice reports. However, research in the national medical literature regarding the examination of court cases reflected in the higher judiciary in the field of urology appears to be lacking. This study aims to identify situations that give rise to malpractice claims in urology, specify errors and professionally risky situations and aid in the elimination of these deficiencies.

Methods: We examined the Supreme Court appeal decisions related to urology malpractice cases resolved between 2012 and 2022, using the keywords "urology" and "urologist" on the official website of the Republic of Turkey Supreme Court.

Results: We examined 37 Supreme Court decisions. We discovered that 12 cases involved negligent homicide, 9 cases involved negligent injury, 8 cases involved incorrect procedures, 4 cases involved lack of due care, 2 cases involved misuse of authority and 2 cases did not specify the type of fault.

Conclusions: We shed light on the instances in which urology specialists face allegations of malpractice. To avoid and minimise medical errors that may result in death or disability, specialists must be prepared for every situation before surgery and follow up the patients appropriately.

Background: Percutaneous nephrolithotomy (PNL) is a gold-standard procedure for managing complex kidney stones. It is traditionally performed in the prone position. Supine PNL offers benefits, such as enhanced ergonomics and simultaneous retrograde surgery. This study evaluates the outcomes and learning curve of a single novice surgeon transitioning from 119 prone to 118 supine cases.

Methods: This retrospective analysis included 237 patients (119 prone and 118 supine) treated between 2017 and 2024. All procedures involved general anaesthesia, fluoroscopy-guided renal puncture and standard or mini-PNL operations. Outcomes, such as operation time, fluoroscopy time, stone-free rate, complication and hospital stay, were analysed.

Results: Patients in the supine group had more comorbidities and required more complex procedures (e.g., multi-tract access and mini-PNL) but exhibited significantly shorter operative times (98 versus 123 minutes, p < 0.001) and fewer complications (6.8% versus 19.3%, p = 0.009) than those in the prone group. First-month stone-free rates were comparable (75.2% supine versus 76.5% prone, p = 0.132), and the supine group had higher stone-free rates after additional intervention (88.9% versus 78.2%, p = 0.047). Transitioning to supine PNL demonstrated a smooth learning curve without increased fluoroscopy times or adverse events.

Conclusions: Transitioning from prone PNL to supine PNL is feasible. The process shortens the operative time and produce comparable stone-free rates. Future studies should explore learning curves for different approaches.