Archivos Espanoles De Urologia最新文献

Objective: To explore the impact of Tripterygium wilfordii glycosides (TWG) on glomerulosclerosis within a rat model of chronic kidney disease (CKD), as well as the role of the transforming growth factor-β1 (TGF-β1)/Smad signaling pathway in this mechanism.

Methods: Twenty-four clean Sprague-Dawley rats were divided into Sham group (n = 8), model group (n = 8) and TWG group (n = 8). Adriamycin nephropathy (ADRN) rat model was established by jugular vein injection of adriamycin (ADR). TWG rats were given TWG 50 mg/kg intragastrically once a day for 6 weeks. After 10 weeks, the ratio of total cell number to glomerulus, extracellular matrix (ECM) and collagen (Coll) deposition, a-smooth muscle actin (a-SMA), type I collagen (Col1) expression, TGF-β1, p-Smad2/3mRNA expression and TGF-β1, p-Smad2/3 protein expression were compared in each group.

Results: Masson staining revealed that in the model group, there was an increase in glomerular fibrosis, a heightened deposition of collagen fibers, and an expansion of interstitial spaces; Conversely, in the electroacupuncture group, the deposition of glomerular collagen fibers diminished. The intensity of a-SMA and ColI immunofluorescence staining in the kidney tissue of rats from the model group was markedly higher than that observed in the Sham group (p < 0.0001, < 0.0001 respectively). In contrast, the a-SMA and ColI immunofluorescence staining intensity in the TWG group was reduced compared to the model group (p = 0.009, 0.016 respectively). Furthermore, the expression levels of TGF-β1 and Smad3 messenger RNA (mRNA) in the kidney tissue of rats in the TWG group were lower than those in the model group (p = 0.013, 0.008, respectively), while the Smad7 mRNA was elevated compared to the model group (p = 0.019, 0.011, respectively). Additionally, the protein expression levels of TGF-β1 and p-Smad2/3 in the kidney tissue of rats in the TWG group were diminished compared to those in the model group (p < 0.0001, 0.006 respectively).

Conclusions: TWG can improve glomerulosclerosis and delay its progression, which may be achieved by down-regulating TGF-β1/Smad signal pathway.

The literature on the exact incidence of equipment failure during urological surgery is rather heterogeneous. Although failure rates are unacceptably high in other surgical disciplines, more compelling evidence is needed in urology. The present study provides case examples to illustrate several instances of urological instrument malfunction encountered in daily surgical practice, from the field of endourology to the newer robotic systems. Five cases of endourological device failures involving a resectoscope, a semi-rigid ureteroscope and alligator forceps and one case involving monopolar scissors of the Hugo RAS robotic system are presented, without any resultant complications to patients. Urologists and surgical personnel need to become acquainted with various equipment utilised in their field. Initiatives aimed at improvement of handling, inspection and prompt replacement of defective devices, rigorous adherence to manufacturers' guidelines, implementation of evaluative checklists for quality control and the adoption of incident-specific reporting forms are commendable actions toward enhancing operational efficiency. In the context of robotic surgery, a team of technical experts possessing sufficient knowledge of the equipment should offer continuous assistance in accordance with troubleshooting protocols. By implementing a standardised problem-solving strategy, they could diagnose and rectify emerging errors promptly and efficiently. Overall, failure in the theatre demands collective understanding and prompt management. Urologists need to communicate such events and collaborate to improve overall surgical efficiency.

Background: Ureteroscopic lithotripsy using a semi-rigid ureteroscope is the standard treatment for urinary stones. Doxazosin-an alpha-1 adrenergic receptor blocker-relaxes ureteral smooth muscles, reducing peristalsis and contraction frequency. This study aimed to evaluate the efficacy and safety of adjunctive doxazosin before semi-rigid ureteroscopy and retrograde intrarenal surgery (RIRS) for urinary stones.

Methods: We analyzed the data of patients who underwent semi-rigid ureteroscopy and RIRS between January 1, 2022 and December 31, 2022. The patients were divided into four groups: Patients who underwent semi-rigid ureteroscopy with or without doxazosin preoperatively and patients who underwent RIRS with or without doxazosin preoperatively. We assessed the patient's age and sex; Stone laterality, location, and maximum diameter; Successful access rate; And surgical complications. Pearson's chi-square, Fisher's exact, and Student's t-tests were used for the statistical analyses.

Results: The final analysis included 266 patients. Patient's age and sex and stone laterality, location, and maximal diameter were similar between the groups. In the semi-rigid ureteroscopic lithotripsy group, the successful access rate was higher in patients who received doxazosin (95%) compared with those who did not (79.69%) (p = 0.023). In the RIRS group, the successful access rate was higher in patients who received doxazosin (84.09%) compared with those who did not (57.41%) (p = 0.040). In the RIRS group, the duration of postoperative double-J stent placement in patients who received doxazosin was significantly shorter than that in those who did not (p = 0.010). Notably, no serious drug-related adverse events were observed.

Conclusions: Doxazosin can be safely and effectively used before semi-rigid and flexible ureteroscopy.

Objective: This study aimed to investigate the risk factors for catheter-associated urinary tract infection (CAUTI) in patients with ischaemic stroke and provide a scientific basis for developing targeted preventive and nursing measures.

Methods: A retrospective cohort study was conducted to study patients with ischaemic stroke and indwelling catheterisation admitted to the Emergency Department of Beijing Tiantan Hospital, Capital Medical University from December 2023 to February 2025. During hospitalisation, quality control was carried out in strict accordance with the consistent nursing operation of the patient's urethral catheter insertion and daily maintenance of the urinary catheter. According to the occurrence of urinary tract infection recorded by the medical record system, the patients were divided into infected group and non-infected group. Univariate and multivariate logistic regression analyses were conducted to examine the general information and relevant risk factors of the two patient groups.

Results: A total of 998 patients with ischaemic stroke were hospitalised and received indwelling urinary catheter care. Among them, 87 patients developed CAUTI, yielding an incidence rate of 8.72%. A total of 376 pathogenic bacteria were identified from the 87 patients with ischaemic stroke who developed CAUTI. The patients were divided into an infected group (n = 87) and a non-infected group (n = 911) according to the occurrence of CAUTI. Logistic regression analysis revealed that age ≥60 years (odds ratio (OR) = 0.525, 95% confidence interval (CI) = 0.314-0.877), body mass index (BMI) ≥28.1 kg/m² (OR = 3.219, 95% CI = 1.446-5.630), diabetes (OR = 2.901, 95% CI = 2.238-3.386), parenteral nutrition support (OR = 2.943, 95% CI = 2.113-3.223), indwelling urinary catheter time ≥6 days (OR = 0.689, 95% CI = 0.193-0.985), number of catheter intubations ≥2 times (OR = 1.733, 95% CI = 0.345-3.513) and time to use antimicrobials ≥7 days (OR = 0.756, 95% CI = 0.418-1.356) were all risk factors for the development of CAUTI in patients with ischaemic stroke (p < 0.05).

Conclusions: Age, BMI, diabetes mellitus, parenteral nutrition support, time of indwelling urinary catheter, number of catheter intubations and time of antimicrobial use are the risk factors for CAUTI in patients with ischaemic stroke. Preventive measures and care strategies considering these risk factors can be taken to reduce the risk of infection.

Background: A plethora of studies have demonstrated that the level of uric acid (UA) and gout are the risk factors for erectile dysfunction (ED). However, the causal effect of UA level and gout on ED is still unclear. This Mendelian randomization (MR) study aims to examine the bidirectional causality between ED and UA levels as well as gout.

Methods: We performed a bidirectional MR analysis using summary statistics from genome-wide association studies (GWAS) to investigate the causal association between ED and UA levels as well as gout. We meticulously selected single nucleotide polymorphisms (SNPs) based on rigorous criteria as instrumental variables. Four two-sample MR analysis methods, including inverse-variance weighted (IVW), MR-Egger, weighted median, and weighted mode, were applied in our study. Furthermore, several sensitivity analyses including Cochrane's Q-test, MR-Egger intercept test, the Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) global test, and leave-one-out analysis were performed to assess heterogeneity, horizontal pleiotropy, and stability.

Results: The study included one dataset related to UA levels (GWAS meta-analysis conducted by Tin et al.), two datasets related to gout (ukb-b-12765 and finn-R9-M13_GOUT), and one dataset related to ED (GWAS meta-analysis conducted by Bovijn et al.). MR results of the IVW method indicated that UA levels and gout were not causally associated with ED in three UA levels/gout-related datasets (IVW, odds ratios (OR): 0.99, 95% confidence interval (CI): 0.92-1.07, p = 0.834; 3.20, 0.17-61.69, 0.441; 1.03, 0.97-1.09, 0.372, respectively). The reverse MR revealed no evidence of a causal effect of ED on UA levels or gout according to the IVW method (OR: 0.99, 95% CI: 0.96-1.02, p: 0.568; 1.00, 1.00-1.00, 0.555; 0.97, 0.89-1.05, 0.425, respectively). The results of other MR analysis methods were consistent with IVW. Furthermore, sensitivity analysis suggested that the results were robust, with no pleiotropy or heterogeneity detected.

Conclusions: Our MR study supports no bidirectional causal effect of UA level or gout on ED.

Ureteropelvic junction obstruction (UPJO), characterised by prenatal or postnatal renal pelvis dilation, represents the primary cause of congenital paediatric hydronephrosis. UPJO may lead to impaired renal function in paediatric patients. Its pathogenesis includes genetic predisposition and anatomical abnormalities. While spontaneous resolution may occur in some infants, progressive hydronephrosis can lead to renal impairment without intervention. The assessment of the degree of hydronephrosis, renal dysfunction and surgical indications in paediatric patients before surgery is beneficial for providing doctors with surgical decisions. Pyeloplasty remains the gold-standard surgical intervention. Surgical approach selection, such as minimally invasive or open surgery and drainage method during surgery, directly affects outcomes. Many factors can affect postoperative complications and reoperation. Postoperative prognostic evaluation and renal function prediction remain key clinical focuses. Long-term follow-up data can provide significant clinical value. The application of neural network prediction models in this field still needs to be explored. This review aims to explore the update progress on risk prediction models of UPJO for children mainly over the past decade. We analysed various risk factors before, during and after surgery, intending to construct risk prediction models that cover the entire disease cycle in diagnosis and treatment. This review could provide a practical basis for surgeons to make clinical decisions.

Background: This study aimed to evaluate the correlation of Hounsfield unit (HU) to the success rate of medical expulsive therapy (MET) for distal ureteric calculus of size 4-10 mm.

Methods: All recruited patients were divided into two groups: Group A, who successfully passed the stone, and group B, who failed to expel the stone. All patients were prescribed with silodosin for a maximum period of 4 weeks. The stone expulsion rate, mean stone area, mean HU, stone expulsion time, number of pain episodes, grades of hydronephrosis (HDN) and laterality of stone were studied.

Results: Out of 87 patients, eight patients were excluded from the study: Four patients had adverse drug reactions, and other four patients were lost to follow up. Hence, 79 patients were finalised for the study. Group A comprised 57 patients, and group B comprised 22 patients. No statistical difference was found between the two groups in terms of mean age, gender, stone density (HU) and side or grade of HDN (p > 0.05). The mean stone area (p = 0.001) and number of pain episodes per day (p = 0.0004) were significantly less in patients who successfully passed stone. The HU was lower in the MET success group (816.04) than in the failure group (900.86), but the difference was not statistically significant (p = 0.123). Receiver operating characteristic analysis showed that the cut off values for stone area and stone density were ≤38 mm² and ≤992 HU, respectively.

Conclusions: MET is undoubtedly a treatment modality for lower ureteric stones of size 10 mm. On computed tomography (CT) scan, stone area can be used as an effective parameter, but stone density (HU) cannot determine MET success. Further studies that include more patients and an evaluation of stone composition are required.

Background: We conducted a meta-analysis to compare the efficacy and drug-related adverse events (AEs) of the combination of tamsulosin and dutasteride versus tamsulosin monotherapy for the treatment of benign prostatic hyperplasia (BPH).

Methods: Relevant articles published in PubMed, Embase and Cochrane from 2004 to 2024 were searched and downloaded. These studies were screened following pre-established inclusion criteria, and data were extracted. Review Manager software was used for methodological quality assessment of randomised controlled trials and statistical analysis.

Results: Eight studies containing 8793 patients were included in the meta-analysis. Combined dutasteride and tamsulosin more significantly improved symptoms (mean difference (MD): -1.55; 95% confidence interval (CI): -2.27, -0.84; p < 0.001), increased maximum urine flow (MD: 1.54; 95% CI: 1.18, 1.91; p < 0.001) and decreased prostate volume (MD: -14.42; 95% CI: -20.62, -8.22; p < 0.001) and prostate-specific antigen (MD: -2.32; 95% CI: -3.03, -1.61; p < 0.001) in patients with BPH than tamsulosin monotherapy. The combined drug also reduced the negative effect on patients' living status (MD: -0.68; 95% CI: -1.02, -0.33; p < 0.001), acute urinary retention or BPH-related surgeries (odds ratio (OR): 0.33; 95% CI: 0.25, 0.44; p < 0.001) and clinical progression of BPH (OR: 0.52; 95% CI: 0.44, 0.61; p < 0.001). However, the combination of dutasteride and tamsulosin significantly increased the incidence of drug-related AEs (OR: 2.13; 95% CI: 1.67, 2.73; p < 0.001) in patients with BPH.

Conclusions: In patients with BPH, the combination of dutasteride and tamsulosin is a beneficial treatment option, but the impact on drug-related AEs events needs to be considered on an individual basis.

Objectives: This study aims to assess the efficacy and safety of five categories of intracorporeal lithotripsy devices in percutaneous nephrolithotomy (PCNL): Pneumatic lithotripters, ultrasonic lithotripters, double-probe dual-energy lithotripters, single-probe dual-energy (SPDE) lithotripters and lasers.

Methods: A network meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed, Embase and Cochrane were utilised to search for randomised controlled trials (RCTs) up to 10 August 2024. Surface under cumulative ranking area technique was used to rank interventions. Outcomes of interest included baseline characteristics, stone-free rate (SFR), complications, operative time and fragmentation time.

Results: Fourteen RCTs comprising 1516 procedures were included. No statistically significant difference was found in complications after using the devices. SPDE lithotripters (ratio of ratios (RR) = 1.90, 95% confidence interval (CI) = (1.11 to 3.28)) and lasers (RR = 1.76, 95% CI = 1.09 to 2.84) were associated with significantly higher SFR than pneumatic lithotripters. SPDE lithotripters significantly outperformed in decreasing operation time and fragmentation time. Based on the surface under the cumulative ranking curve (SUCRA) value, lasers and SPDE lithotripters performed better in SFR. In addition, SPDE lithotripters exhibited superior performance in terms of few complications and shortest fragmentation time and operative time.

Conclusions: All five categories of devices were found to be equally safe for PCNL. SPDE lithotripters and lasers had higher efficacy. Moreover, SPDE lithotripters exhibited the shortest fragmentation time and operative time. These findings suggest that SPDE lithotripters have potential to be next-generation efficient lithotripsy devices.

Background: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent urological condition affecting men's health. This study aims to investigate the clinical efficacy of Qianlie Shutong (QLST) capsule in the treatment of CP/CPPS.

Methods: The medical records of patients with CP/CPPS who were admitted to our hospital from January 2023 to January 2024 were retrospectively analysed. They were divided into observation and control groups according to treatment modality received. The control group received levofloxacin (0.5 g, qd) in combination with tamsulosin hydrochloride (0.2 mg, qd). The observation group received an additional supplementation of QLST capsule (0.4 g, tid) alongside the treatment administered to the control group. Both groups underwent treatment for 28 days. Baseline data and clinical outcomes were compared between the groups, including the National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), maximum urine flow rate (Qmax), urine volume (UV), prostate-specific extracellular vesicle protein (PSEP) and International Index of Erectile Function-15 (IIEF-15).

Results: A total of 117 patients were enrolled in this study, comprising 60 in the observation group and 57 in the control group. No significant differences in baseline characteristics were found between the two groups (p > 0.05). Before intervention, no significant differences in NIH-CPSI, Qmax, UV, PSEP and IIEF-15 were found between the two groups (p > 0.05). Following intervention, both groups exhibited significant reductions in NIH-CPSI and PSEP, and the levels in the observation group were lower than those in the control group (p < 0.05). Qmax, UV and IIEF-15 increased in both groups, and the levels in the observation group were higher than those in the control group (p < 0.05).

Conclusions: This study demonstrates that QLST effectively alleviates the clinical symptoms in patients with CP/CPPS, reduces PSEP levels and improves erectile function, supporting its clinical application.