Pub Date : 2025-04-01DOI: 10.1016/j.acuro.2025.501686
A. Rosino Sánchez , E. García Torralba , E. Girela Baena , J.A. Macías Cerrolaza , J. Tudela Pallares , M. Zafra Povés , I. Barceló Bayonas , V. Muñoz Guillermo , T. Fernández Aparicio
Introduction
Men with mutations in DNA damage response (DDR) pathways have a higher risk of developing prostate neoplasia compared to the general population. The best studied alterations are mutations in BRCA1/2, ATM and MMR-Lynch s.
Material and methods
A review of the clinical and prognostic implications of mutations in DDR pathways, as well as an evaluation of the different screening strategies available for affected patients.
Objective
To propose an early diagnostic strategy for men with mutations in DDR pathways.
Results
Current guidelines do not provide clear, specific recommendations for this subgroup of men. Among mutations in the MMR pathway, the germline MSH2 mutation is most strongly associated with prostate cancer. Men with germline mutations in BRCA1/2, ATM, and MSH2 have a higher incidence of prostate neoplasia, tend to develop the disease at a younger age, and are more likely to have aggressive forms of the disease. Furthermore, men with BRCA1/2 mutations have a lower cancer-specific survival rate compared to the general population. In these patients, PSA levels have important limitations in detecting prostate cancer. Multiparametric MRI of the prostate may be more effective than periodic PSA testing.
Conclusions
Patients with mutations in DDR pathways are at increased risk for aggressive prostate neoplasms and require earlier and more intensive screening. PSA-based screening has notable limitations. A screening strategy incorporating multiparametric MRI could offer a more effective strategy for this patient group.
{"title":"Diagnóstico precoz del cáncer de próstata en los varones sanos portadores de mutaciones germinales en las vías de respuesta al daño del ADN (vías DNA Damage Response [DDR]). Revisión de la literatura y propuesta de protocolo","authors":"A. Rosino Sánchez , E. García Torralba , E. Girela Baena , J.A. Macías Cerrolaza , J. Tudela Pallares , M. Zafra Povés , I. Barceló Bayonas , V. Muñoz Guillermo , T. Fernández Aparicio","doi":"10.1016/j.acuro.2025.501686","DOIUrl":"10.1016/j.acuro.2025.501686","url":null,"abstract":"<div><h3>Introduction</h3><div>Men with mutations in DNA damage response (DDR) pathways have a higher risk of developing prostate neoplasia compared to the general population. The best studied alterations are mutations in BRCA1/2, ATM and MMR-Lynch s.</div></div><div><h3>Material and methods</h3><div>A review of the clinical and prognostic implications of mutations in DDR pathways, as well as an evaluation of the different screening strategies available for affected patients.</div></div><div><h3>Objective</h3><div>To propose an early diagnostic strategy for men with mutations in DDR pathways.</div></div><div><h3>Results</h3><div>Current guidelines do not provide clear, specific recommendations for this subgroup of men. Among mutations in the MMR pathway, the germline MSH2 mutation is most strongly associated with prostate cancer. Men with germline mutations in BRCA1/2, ATM, and MSH2 have a higher incidence of prostate neoplasia, tend to develop the disease at a younger age, and are more likely to have aggressive forms of the disease. Furthermore, men with BRCA1/2 mutations have a lower cancer-specific survival rate compared to the general population. In these patients, PSA levels have important limitations in detecting prostate cancer. Multiparametric MRI of the prostate may be more effective than periodic PSA testing.</div></div><div><h3>Conclusions</h3><div>Patients with mutations in DDR pathways are at increased risk for aggressive prostate neoplasms and require earlier and more intensive screening. PSA-based screening has notable limitations. A screening strategy incorporating multiparametric MRI could offer a more effective strategy for this patient group.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 3","pages":"Article 501686"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.acuro.2025.501683
G. Basile , G. Fallara , M. Bandini , W. Cazzaniga , F. Negri , L. Dieguez , F. Montorsi , A. Salonia , A. Breda , C. Fankhauser , A. Territo
Introduction
Kidney transplant (KT) recipients are at an elevated risk of developing de novo cancers. However, penile (PeCa) and testis cancers have received limited attention in this setting.
Objective
To summarize the epidemiology, treatment options, and oncological outcomes of penile and testis cancer in KT recipients.
Evidence acquisition
We conducted a systematic review of prospective, retrospective and national transplant registries studies published up to December 2023. Data on the incidence of penile and testis cancers among KT recipients, diagnostic protocols, screening recommendations, and therapeutic strategies tailored for KT recipients were collected. The risk of bias (RoB) of included studies was determined using the Newcastle and Ottawa scale.
Evidence synthesis
Overall, 21 studies involving 67924 KT male recipients were included. PeCa was diagnosed in 33 patients, yielding an incidence ranging from 0.04% to 0.3%. Additionally, 67 cases of testicular cancer were recorded, with an incidence ranging from 0.03% to 0.55%. Most tumors were localized, and histology variants were uncommon. While the surgical treatment of the primary tumor remains consistent with that of the general population, the use of radiotherapy and cytotoxic treatments are less frequently reported in this setting. These therapies should be considered on an individualized basis to minimize the risk of graft injury.
Conclusions
Penile and testis cancers are relatively uncommon among KT recipients. General screening protocols and deviation from current treatment guidelines are not recommended in localized diseases. Given the risk of graft damage, any non-cytotoxic option should be preferred in locally advanced cases.
{"title":"Cáncer de pene y testículo en receptores de trasplante renal: revisión sistemática sobre la epidemiología, las opciones de tratamiento y los resultados oncológicos realizada por el grupo de trabajo de cáncer de pene y testículo de la Asociación Europea de Urología (EAU-YAU)","authors":"G. Basile , G. Fallara , M. Bandini , W. Cazzaniga , F. Negri , L. Dieguez , F. Montorsi , A. Salonia , A. Breda , C. Fankhauser , A. Territo","doi":"10.1016/j.acuro.2025.501683","DOIUrl":"10.1016/j.acuro.2025.501683","url":null,"abstract":"<div><h3>Introduction</h3><div>Kidney transplant (KT) recipients are at an elevated risk of developing de novo cancers. However, penile (PeCa) and testis cancers have received limited attention in this setting.</div></div><div><h3>Objective</h3><div>To summarize the epidemiology, treatment options, and oncological outcomes of penile and testis cancer in KT recipients.</div></div><div><h3>Evidence acquisition</h3><div>We conducted a systematic review of prospective, retrospective and national transplant registries studies published up to December 2023. Data on the incidence of penile and testis cancers among KT recipients, diagnostic protocols, screening recommendations, and therapeutic strategies tailored for KT recipients were collected. The risk of bias (RoB) of included studies was determined using the Newcastle and Ottawa scale.</div></div><div><h3>Evidence synthesis</h3><div>Overall, 21 studies involving 67924 KT male recipients were included. PeCa was diagnosed in 33 patients, yielding an incidence ranging from 0.04% to 0.3%. Additionally, 67 cases of testicular cancer were recorded, with an incidence ranging from 0.03% to 0.55%. Most tumors were localized, and histology variants were uncommon. While the surgical treatment of the primary tumor remains consistent with that of the general population, the use of radiotherapy and cytotoxic treatments are less frequently reported in this setting. These therapies should be considered on an individualized basis to minimize the risk of graft injury.</div></div><div><h3>Conclusions</h3><div>Penile and testis cancers are relatively uncommon among KT recipients. General screening protocols and deviation from current treatment guidelines are not recommended in localized diseases. Given the risk of graft damage, any non-cytotoxic option should be preferred in locally advanced cases.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 3","pages":"Article 501683"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.acuro.2025.501699
N. Pyrgidis , J. Hermans , P. Keller, D. Karatas, B. Ebner, G. Schulz, C. Stief, Y. Volz
Objectives
To evaluate health-related quality of life (HRQOL) six years post-radical cystectomy in patients with muscle-invasive bladder cancer, comparing orthotopic ileal neobladder (ONB) and ileal conduit (IC). Therefore, the study aims to analyze the under-investigated long-term impact of standard bladder cancer treatments on HRQOL and provide insights into the HRQOL differences associated with these two common urinary diversion methods.
Patients and methods
This prospective study included 39 patients with urothelial carcinoma treated with ONB or IC at our center between 03/2013 and 01/2023. Patients with variant histology, metastasis, neoadjuvant chemotherapy, or benign indications for cystectomy were excluded. HRQOL was assessed using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire preoperatively, at four and six years postoperatively. Statistical analyses included Chi-square tests, T-tests, and logistic regression models.
Results
Of the patients, 64% (25/39) underwent ONB, and 76.9% (30/39) were male, with an average age of 69 years. No significant differences in overall good HRQOL (GHS >70) were observed between ONB and IC at six years (IC: 60 ± 22; ONB: 69 ± 23, p = 0.2). Patients with IC reported higher insomnia at both follow-ups (4 years: p = 0.01; 6 years: p = 0.03). Emotional function remained stable in ONB patients but declined in IC patients from the fourth to sixth years (p = 0.04).
Conclusions
Long-term HRQOL did not significantly differ between ONB and IC up to six years post-radical cystectomy. Both urinary diversion methods can be offered to patients, with tailored discussions in terms of HRQOL.
{"title":"Derivación urinaria y calidad de vida: 6 años de seguimiento después de la cirugía para el cáncer de vejiga","authors":"N. Pyrgidis , J. Hermans , P. Keller, D. Karatas, B. Ebner, G. Schulz, C. Stief, Y. Volz","doi":"10.1016/j.acuro.2025.501699","DOIUrl":"10.1016/j.acuro.2025.501699","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate health-related quality of life (HRQOL) six years post-radical cystectomy in patients with muscle-invasive bladder cancer, comparing orthotopic ileal neobladder (ONB) and ileal conduit (IC). Therefore, the study aims to analyze the under-investigated long-term impact of standard bladder cancer treatments on HRQOL and provide insights into the HRQOL differences associated with these two common urinary diversion methods.</div></div><div><h3>Patients and methods</h3><div>This prospective study included 39 patients with urothelial carcinoma treated with ONB or IC at our center between 03/2013 and 01/2023. Patients with variant histology, metastasis, neoadjuvant chemotherapy, or benign indications for cystectomy were excluded. HRQOL was assessed using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire preoperatively, at four and six years postoperatively. Statistical analyses included Chi-square tests, T-tests, and logistic regression models.</div></div><div><h3>Results</h3><div>Of the patients, 64% (25/39) underwent ONB, and 76.9% (30/39) were male, with an average age of 69 years. No significant differences in overall good HRQOL (GHS<!--> <!-->>70) were observed between ONB and IC at six years (IC: 60<!--> <!-->±<!--> <!-->22; ONB: 69<!--> <!-->±<!--> <!-->23, p<!--> <!-->=<!--> <!-->0.2). Patients with IC reported higher insomnia at both follow-ups (4 years: p<!--> <!-->=<!--> <!-->0.01; 6 years: p<!--> <!-->=<!--> <!-->0.03). Emotional function remained stable in ONB patients but declined in IC patients from the fourth to sixth years (p<!--> <!-->=<!--> <!-->0.04).</div></div><div><h3>Conclusions</h3><div>Long-term HRQOL did not significantly differ between ONB and IC up to six years post-radical cystectomy. Both urinary diversion methods can be offered to patients, with tailored discussions in terms of HRQOL.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 3","pages":"Article 501699"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.acuro.2025.501702
C. García-Sánchez , I. García-Obrero , C. Muñoz-Calahorro , A.J. Rodríguez-Pérez , R.A. Medina-López
Introduction and objective
Radical prostatectomy has a great impact on urinary continence, although it is a multifactorial aspect. The aim of the study was to evaluate the effect of guided Pelvic Floor Exercises (PFE) versus written information prior to robotic radical prostatectomy (RRP) on the rate of urinary incontinence, and their effect on patients’ quality of life.
Material and method
62 patients were randomized to an experimental (physiotherapist-guided exercises) or control (written information) group. The primary outcome was incontinence rate (measured by pad test). Secondary outcomes were incontinence severity, quality of life (measured by the 36-Item Short Form Survey Instrument (SF-36) and the King's Health Questionnaire (KHQ)), voiding dynamics, correlation between incontinence and quality of life, and other incontinence-related factors.
Results
We found no differences in the incontinence rate between groups in the months of follow-up (82.61% vs 84.62%, month 1; 61.54% vs 75.86%, month 3; 50% vs 53.33%, month 6; 30.77% vs 40%, month 12) nor in the severity of incontinence between groups. There were significant differences in the quality of life related to “emotional problems” and “personal relationships”, in favor of the control group. We found correlations between incontinence severity and age, severity and quality of life, urgency/frequency and quality of life.
Conclusions
Guided exercises prior to RRP do not seem to offer benefits over written information in either the rate or severity of incontinence. Urinary incontinence correlates with age and quality of life. Quality of life correlates with urgency and voiding frequency.
前言与目的前列腺根治术对尿失禁有很大的影响，尽管这是一个多因素的方面。该研究的目的是评估引导盆底运动（PFE）与机器人根治性前列腺切除术（RRP）前书面信息对尿失禁率的影响，以及它们对患者生活质量的影响。材料与方法将62例患者随机分为实验组（物理治疗师指导的练习）和对照组（书面信息）。主要观察指标为尿失禁率（尿垫试验测定）。次要结果为尿失禁严重程度、生活质量（通过36项简短问卷调查工具（SF-36）和国王健康问卷（KHQ）测量）、排尿动态、尿失禁与生活质量的相关性以及其他与尿失禁相关的因素。结果随访1个月内，两组患者尿失禁率差异无统计学意义(82.61% vs 84.62%，第1个月；61.54% vs 75.86%，第3个月；50% vs 53.33%，第6个月；30.77% vs 40%，第12个月)，组间尿失禁的严重程度也不相同。与“情绪问题”和“人际关系”相关的生活质量有显著差异，有利于对照组。我们发现尿失禁严重程度与年龄、严重程度与生活质量、急迫性/频率与生活质量之间存在相关性。结论：在失禁率和严重程度上，RRP前的指导练习似乎没有书面信息提供的好处。尿失禁与年龄和生活质量有关。生活质量与尿急和尿频相关。
{"title":"Eficacia de los ejercicios de suelo pélvico guiados pre-prostatectomía radical robótica en la incontinencia urinaria y calidad de vida","authors":"C. García-Sánchez , I. García-Obrero , C. Muñoz-Calahorro , A.J. Rodríguez-Pérez , R.A. Medina-López","doi":"10.1016/j.acuro.2025.501702","DOIUrl":"10.1016/j.acuro.2025.501702","url":null,"abstract":"<div><h3>Introduction and objective</h3><div>Radical prostatectomy has a great impact on urinary continence, although it is a multifactorial aspect. The aim of the study was to evaluate the effect of guided Pelvic Floor Exercises (PFE) versus written information prior to robotic radical prostatectomy (RRP) on the rate of urinary incontinence, and their effect on patients’ quality of life.</div></div><div><h3>Material and method</h3><div>62 patients were randomized to an experimental (physiotherapist-guided exercises) or control (written information) group. The primary outcome was incontinence rate (measured by pad test). Secondary outcomes were incontinence severity, quality of life (measured by the 36-Item Short Form Survey Instrument (SF-36) and the King's Health Questionnaire (KHQ)), voiding dynamics, correlation between incontinence and quality of life, and other incontinence-related factors.</div></div><div><h3>Results</h3><div>We found no differences in the incontinence rate between groups in the months of follow-up (82.61% vs 84.62%, month 1; 61.54% vs 75.86%, month 3; 50% vs 53.33%, month 6; 30.77% vs 40%, month 12) nor in the severity of incontinence between groups. There were significant differences in the quality of life related to “emotional problems” and “personal relationships”, in favor of the control group. We found correlations between incontinence severity and age, severity and quality of life, urgency/frequency and quality of life.</div></div><div><h3>Conclusions</h3><div>Guided exercises prior to RRP do not seem to offer benefits over written information in either the rate or severity of incontinence. Urinary incontinence correlates with age and quality of life. Quality of life correlates with urgency and voiding frequency.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 3","pages":"Article 501702"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.acuro.2025.501715
Y. Sun, F. Xu, Z. Xiao, Y. An, H. Zhao
Objective
This study sought to identify risk factors and develop predictive models for kidney stone disease in the U.S. population using data from the National Health and Nutrition Examination Survey (NHANES).
Methods
In a propensity score–matched cohort study, we examined the association of serum α-Klotho, hemoglobin levels, serum creatinine, and the urinary albumin-to-creatinine ratio (uACR) with kidney stone disease.
Results
Initially, 216,560 participants were screened; following propensity matching, 28,370 adults aged 40 to 79 years were included in the final analysis. Serum α-Klotho levels were inversely associated with kidney stone disease, particularly among individuals with chronic kidney disease and those who consumed alcohol. Hemoglobin levels demonstrated an inverse association with kidney stone disease risk, whereas serum creatinine levels exhibited a U-shaped relationship. No significant trend was observed for uACR overall. Low hemoglobin and α-Klotho levels, as well as elevated serum creatinine and uACR, were significantly associated with increased all-cause mortality.
Conclusion
Our findings underscore the significance of serum α-Klotho, hemoglobin, serum creatinine, and uACR levels in assessing the risk of kidney stone disease and all-cause mortality, suggesting these markers as potential targets for prevention and management strategies. Further research is warranted to clarify the mechanisms underlying these associations.
{"title":"Factores de riesgo y modelos predictivos de litiasis renal en la población estadounidense: estudio de cohortes emparejadas mediante puntuación de propensión","authors":"Y. Sun, F. Xu, Z. Xiao, Y. An, H. Zhao","doi":"10.1016/j.acuro.2025.501715","DOIUrl":"10.1016/j.acuro.2025.501715","url":null,"abstract":"<div><h3>Objective</h3><div>This study sought to identify risk factors and develop predictive models for kidney stone disease in the U.S. population using data from the National Health and Nutrition Examination Survey (NHANES).</div></div><div><h3>Methods</h3><div>In a propensity score–matched cohort study, we examined the association of serum α-Klotho, hemoglobin levels, serum creatinine, and the urinary albumin-to-creatinine ratio (uACR) with kidney stone disease.</div></div><div><h3>Results</h3><div>Initially, 216,560 participants were screened; following propensity matching, 28,370 adults aged 40 to 79 years were included in the final analysis. Serum α-Klotho levels were inversely associated with kidney stone disease, particularly among individuals with chronic kidney disease and those who consumed alcohol. Hemoglobin levels demonstrated an inverse association with kidney stone disease risk, whereas serum creatinine levels exhibited a U-shaped relationship. No significant trend was observed for uACR overall. Low hemoglobin and α-Klotho levels, as well as elevated serum creatinine and uACR, were significantly associated with increased all-cause mortality.</div></div><div><h3>Conclusion</h3><div>Our findings underscore the significance of serum α-Klotho, hemoglobin, serum creatinine, and uACR levels in assessing the risk of kidney stone disease and all-cause mortality, suggesting these markers as potential targets for prevention and management strategies. Further research is warranted to clarify the mechanisms underlying these associations.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 3","pages":"Article 501715"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.acuro.2025.501705
L.E. Ortega Polledo , E. García Rico , A. Sánchez Pellejero , G.F.J. Bianchini Hernández , A. Sanchís Bonet , J. Gómez Rivas , I. Galante Romo , J. Moreno Sierra , B. Miñana , S. Ahyai , S. Alonso y Gregorio
Objective
The objective is to evaluate the effectiveness and safety of a surgeon's learning curve for holmium laser enucleation of the prostate in 125 consecutive cases.
Materials and methods
Preoperative baseline characteristics, functional outcomes, surgical times, and complications of the first 125 patients treated by holmium laser enucleation of the prostate were recorded. The sample was divided into quintiles (25 cases/group), and statistical analysis was carried out using the ANOVA test, Kruskal-Wallis H test, Chi-squared test, and likelihood-ratio test.
Results
Surgical time decreased progressively: 92 min (Q1), 65 min (Q2), 54 min (Q3), 45 min (Q4) and 50 min (Q5) (p < 0.001). Enucleation rate gradually increased: 1.08 g/min (Q1), 1.65 g/min (Q2), 1.82 g/min (Q3), 1.96 g/min (Q4) and 2.74 g/min (Q5) (p < 0.001). There were no differences in enucleated weight (Q1: 51 g, Q2: 57 g, Q3: 51 g, Q4: 53 g, Q5: 65 g) (p = 0.21), length of hospital stay (median 1.12 days), bladder catheterization (mean 1.51 days), intra- and postoperative complications or urethral stricture (5.6%) (p > 0.05). Time to continence recovery was similar in quintiles 1 to 4 (23, 27, 21 and 20 days, respectively) and shorter in quintile 5 (3.5 days) (p < 0.001).
Conclusions
The initiation of a holmium laser enucleation of the prostate program following the completion of training demonstrates a low morbidity rate and highly favorable functional outcomes. The efficiency of the technique demonstrates a linear and consistent increase from the outset of the learning curve, with significantly reduced surgical times achieved after 25 cases.
目的评价外科医生学习曲线在连续125例钬激光前列腺摘除手术中的有效性和安全性。材料与方法记录125例钬激光前列腺摘除患者的术前基线特征、功能结局、手术时间及并发症。将样本分成五分位数（25例/组），采用方差分析、Kruskal-Wallis H检验、卡方检验和似然比检验进行统计分析。结果手术时间依次缩短：92 min （Q1）、65 min （Q2）、54 min （Q3）、45 min （Q4）、50 min (Q5) (p <；0.001)。去核速率逐渐增加：1.08 g/min (Q1), 1.65 g/min (Q2), 1.82 g/min (Q3), 1.96 g/min （Q4）和2.74 g/min (Q5) (p <；0.001)。在去核重量（Q1: 51 g, Q2: 57 g, Q3: 51 g, Q4: 53 g, Q5: 65 g） （p = 0.21），住院时间（中位1.12天），膀胱导尿（平均1.51天），手术内和术后并发症或尿道狭窄（5.6%）(p >；0.05)。1至4分位数（分别为23、27、21和20天）的失禁恢复时间相似，而5分位数（3.5天）的失禁恢复时间较短(p <；0.001)。结论：在训练结束后开始钬激光前列腺摘除术具有低发病率和良好的功能预后。从学习曲线开始，该技术的效率就呈现出线性和一致的增长，在25例手术后显著减少了手术时间。
{"title":"Análisis prospectivo de la curva de aprendizaje en enucleación prostática con láser de holmio: serie de 125 casos","authors":"L.E. Ortega Polledo , E. García Rico , A. Sánchez Pellejero , G.F.J. Bianchini Hernández , A. Sanchís Bonet , J. Gómez Rivas , I. Galante Romo , J. Moreno Sierra , B. Miñana , S. Ahyai , S. Alonso y Gregorio","doi":"10.1016/j.acuro.2025.501705","DOIUrl":"10.1016/j.acuro.2025.501705","url":null,"abstract":"<div><h3>Objective</h3><div>The objective is to evaluate the effectiveness and safety of a surgeon's learning curve for holmium laser enucleation of the prostate in 125 consecutive cases.</div></div><div><h3>Materials and methods</h3><div>Preoperative baseline characteristics, functional outcomes, surgical times, and complications of the first 125 patients treated by holmium laser enucleation of the prostate were recorded. The sample was divided into quintiles (25 cases/group), and statistical analysis was carried out using the ANOVA test, Kruskal-Wallis H test, Chi-squared test, and likelihood-ratio test.</div></div><div><h3>Results</h3><div>Surgical time decreased progressively: 92<!--> <!-->min (Q1), 65<!--> <!-->min (Q2), 54<!--> <!-->min (Q3), 45<!--> <!-->min (Q4) and 50<!--> <!-->min (Q5) (p<!--> <!--><<!--> <!-->0.001). Enucleation rate gradually increased: 1.08<!--> <!-->g/min (Q1), 1.65<!--> <!-->g/min (Q2), 1.82<!--> <!-->g/min (Q3), 1.96<!--> <!-->g/min (Q4) and 2.74<!--> <!-->g/min (Q5) (p<!--> <!--><<!--> <!-->0.001). There were no differences in enucleated weight (Q1: 51<!--> <!-->g, Q2: 57<!--> <!-->g, Q3: 51<!--> <!-->g, Q4: 53<!--> <!-->g, Q5: 65<!--> <!-->g) (p<!--> <!-->=<!--> <!-->0.21), length of hospital stay (median 1.12 days), bladder catheterization (mean 1.51 days), intra- and postoperative complications or urethral stricture (5.6%) (p<!--> <!-->><!--> <!-->0.05). Time to continence recovery was similar in quintiles 1 to 4 (23, 27, 21 and 20 days, respectively) and shorter in quintile 5 (3.5 days) (p<!--> <!--><<!--> <!-->0.001).</div></div><div><h3>Conclusions</h3><div>The initiation of a holmium laser enucleation of the prostate program following the completion of training demonstrates a low morbidity rate and highly favorable functional outcomes. The efficiency of the technique demonstrates a linear and consistent increase from the outset of the learning curve, with significantly reduced surgical times achieved after 25 cases.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 3","pages":"Article 501705"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.acuro.2025.501706
B. Kati , E. Ordek , I. Demir , E. Sabri Pelit
Introduction
Varicocele, defined as abnormal convoluted enlargement of the pampiniform plexus veins, is the most common cause of correctable male infertility. This study aimed to investigate the effect of blood drainage in varicose veins on spermiogram parameters, postoperative pain, cosmetic appearance, and patient satisfaction in patients undergoing subinguinal microscopic varicocelectomy.
Methods
Patients diagnosed with clinical varicocele and admitted to our urology outpatient clinic between January 2020 and January 2024 were evaluated. Those with a venous vessel diameter ≥ 2.5 mm underwent subinguinal microscopic varicocelectomy. In 75 patients, a small incision was made in the thickest varicose vein, and the veins were ligated after venous blood was drained by hand patting. In another 75 patients, vessels were cut and ligated by the classical method without venous blood drainage. Exclusion criteria included patients younger than 18, those with secondary varicocelectomy history, undescended testis, testicular trauma or tumors, and prior infertility treatment. Preoperative and postoperative spermiogram values, pain scores, cosmetic appearance, and patient satisfaction were recorded and compared.
Results
The pain rate was significantly lower (p < 0.05) in the blood-milking varicocelectomy group during postoperative controls (7-10 days) compared to the classical method group. The blood-milking group also showed significantly higher (p < 0.05) sperm count and motility at the 3rd postoperative month. Cosmetic satisfaction was significantly higher (p < 0.05) in the blood-milking group.
Conclusions
Blood drainage during subinguinal microscopic varicocelectomy significantly reduces postoperative pain and enhances sperm values, cosmetic outcomes, and patient satisfaction. These findings reveal that vein-milking techniques during varicocelectomy can optimize postoperative outcomes.
{"title":"El drenaje de las venas varicosas (vein milking) durante la varicocelectomía microscópica subinguinal: efectos sobre el dolor, el resultado estético y el espermiograma","authors":"B. Kati , E. Ordek , I. Demir , E. Sabri Pelit","doi":"10.1016/j.acuro.2025.501706","DOIUrl":"10.1016/j.acuro.2025.501706","url":null,"abstract":"<div><h3>Introduction</h3><div>Varicocele, defined as abnormal convoluted enlargement of the pampiniform plexus veins, is the most common cause of correctable male infertility. This study aimed to investigate the effect of blood drainage in varicose veins on spermiogram parameters, postoperative pain, cosmetic appearance, and patient satisfaction in patients undergoing subinguinal microscopic varicocelectomy.</div></div><div><h3>Methods</h3><div>Patients diagnosed with clinical varicocele and admitted to our urology outpatient clinic between January 2020 and January 2024 were evaluated. Those with a venous vessel diameter<!--> <!-->≥<!--> <!-->2.5<!--> <!-->mm underwent subinguinal microscopic varicocelectomy. In 75 patients, a small incision was made in the thickest varicose vein, and the veins were ligated after venous blood was drained by hand patting. In another 75 patients, vessels were cut and ligated by the classical method without venous blood drainage. Exclusion criteria included patients younger than 18, those with secondary varicocelectomy history, undescended testis, testicular trauma or tumors, and prior infertility treatment. Preoperative and postoperative spermiogram values, pain scores, cosmetic appearance, and patient satisfaction were recorded and compared.</div></div><div><h3>Results</h3><div>The pain rate was significantly lower (p<!--> <!--><<!--> <!-->0.05) in the blood-milking varicocelectomy group during postoperative controls (7-10 days) compared to the classical method group. The blood-milking group also showed significantly higher (p<!--> <!--><<!--> <!-->0.05) sperm count and motility at the 3rd postoperative month. Cosmetic satisfaction was significantly higher (p<!--> <!--><<!--> <!-->0.05) in the blood-milking group.</div></div><div><h3>Conclusions</h3><div>Blood drainage during subinguinal microscopic varicocelectomy significantly reduces postoperative pain and enhances sperm values, cosmetic outcomes, and patient satisfaction. These findings reveal that vein-milking techniques during varicocelectomy can optimize postoperative outcomes.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 3","pages":"Article 501706"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.acuro.2025.501685
M.Á. Arrabal-Polo , L. Gómez-Morón , F. Gutiérrez-Tejero , A. Zambudio-Munuera , I. Millán-Ramos , M. Arrabal-Martín
Introduction
Given the lack of comparative studies on adjuvant treatment for clear cell renal cell carcinoma, we present an updated systematic review, exploring the various options for adjuvant therapy. This review is conducted in accordance with the PRISMA guidelines.
Material and method
A systematic review was conducted, and 13 clinical trials were included after applying the pre-specified inclusion criteria. The risk of bias and the level of evidence were assessed. Subsequently, the requisite data were extracted in order to present the findings of the studies.
Results and discussion
The present systematic review establishes that pembrolizumab can be used as adjuvant therapy in patients with advanced renal cancer at high risk after nephrectomy. This is supported by the KEYNOTE-564 study, which concluded that it increased disease-free survival (DFS) and overall survival. The use of sunitinib is discussed, since the study published in NEJM shows a modest benefit in terms of DFS, but only in an independent and blinded central review. According to the PROTECT study, pazopanib has no overall benefit. The EVEREST study showed no significant benefit over everolimus. Further studies are needed to confirm the use of axitinib, as the ATLAS trial showed statistically significant results in DFS in higher-risk population based on investigator assessment, but not based on independent central review. Therapy with 5-FU, α-IFN and IL-2, atezolizumab, sorafenib, thalidomide, nivolumab + ipilimumab should not be used in the adjuvant setting.
{"title":"Tratamiento adyuvante en el cáncer renal de células claras de riesgo intermedio-alto. Revisión sistemática","authors":"M.Á. Arrabal-Polo , L. Gómez-Morón , F. Gutiérrez-Tejero , A. Zambudio-Munuera , I. Millán-Ramos , M. Arrabal-Martín","doi":"10.1016/j.acuro.2025.501685","DOIUrl":"10.1016/j.acuro.2025.501685","url":null,"abstract":"<div><h3>Introduction</h3><div>Given the lack of comparative studies on adjuvant treatment for clear cell renal cell carcinoma, we present an updated systematic review, exploring the various options for adjuvant therapy. This review is conducted in accordance with the PRISMA guidelines.</div></div><div><h3>Material and method</h3><div>A systematic review was conducted, and 13 clinical trials were included after applying the pre-specified inclusion criteria. The risk of bias and the level of evidence were assessed. Subsequently, the requisite data were extracted in order to present the findings of the studies.</div></div><div><h3>Results and discussion</h3><div>The present systematic review establishes that pembrolizumab can be used as adjuvant therapy in patients with advanced renal cancer at high risk after nephrectomy. This is supported by the KEYNOTE-564 study, which concluded that it increased disease-free survival (DFS) and overall survival. The use of sunitinib is discussed, since the study published in NEJM shows a modest benefit in terms of DFS, but only in an independent and blinded central review. According to the PROTECT study, pazopanib has no overall benefit. The EVEREST study showed no significant benefit over everolimus. Further studies are needed to confirm the use of axitinib, as the ATLAS trial showed statistically significant results in DFS in higher-risk population based on investigator assessment, but not based on independent central review. Therapy with 5-FU, α-IFN and IL-2, atezolizumab, sorafenib, thalidomide, nivolumab<!--> <!-->+<!--> <!-->ipilimumab should not be used in the adjuvant setting.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 2","pages":"Article 501685"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143518871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.acuro.2025.501698
C. Vargas-Blasco , J. Arimany-Manso
{"title":"¿Qué saben los varones españoles sobre el cáncer de próstata?","authors":"C. Vargas-Blasco , J. Arimany-Manso","doi":"10.1016/j.acuro.2025.501698","DOIUrl":"10.1016/j.acuro.2025.501698","url":null,"abstract":"","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 2","pages":"Article 501698"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143518870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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