Actas urologicas espanolas最新文献

英文中文

Manejo actual del carcinoma de células renales en estadio T1 en España: resultados de un registro nacional multicéntrico 西班牙T1期肾细胞癌的当前管理：多中心全国登记的结果

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2026-03-01 Epub Date: 2026-01-02 DOI: 10.1016/j.acuro.2025.501922

V. Hevia-Palacios , D. Pérez Fentes , A. Vilaseca Cabo , A. Jalón Monzón , I. Rivero Belenchón , E. Tolosa Eizaguirre , S.F. Morales Pinto , D. Vázquez Martul , M.Á. Arrabal Polo , V. Gómez dos Santos , L. Cogorno Wasylkowski , P.I. Ortiz de Urbina , R. Ballestero Diego , I. Testa Sklofsky , S. Fernández-Pello

Introduction and objectives

The management of stage T1 renal cell carcinoma (RCC) has shifted toward nephron-sparing surgery (NSS) and minimally invasive surgery (MIS), but contemporary, country-level data from Spain are scarce. We sought to describe real-world treatment patterns for T1 RCC across Spanish centres.

Material and methods

Multicentre retrospective descriptive study using the Spanish National Registry of Localized Renal Cancer during 2024. Adults with clinical stage T1 renal masses treated with surgery, ablation or active surveillance (AS) were included. Descriptive statistics were applied. Primary outcomes were management strategy, surgical approach, type of procedure and pathological results; secondary outcomes included intraoperative details.

Results

A total of 1,121 patients were analysed (71.5% cT1a). Management consisted of surgery in 82.6%, ablation in 9.5% and AS in 7.3%. Among operated patients, partial nephrectomy (PN) accounted for 65.0% overall (74.5% in cT1a; 46.7% in cT1b). MIS predominated (92.3%: 58.4% laparoscopic, 33.9% robotic). The leading reason to perform radical nephrectomy (RN) was technical infeasibility (56.8%). Median warm ischaemia time was 16 min (IQR 0-23). Histology showed clear cell RCC 61.1% and benign lesions 12.4%. Final pathology was pT1a 66.1%, pT1b 25.2%; upstaging occurred in 8.6% (mainly pT3a), more frequently in cT1b.

Conclusions

In Spain, most T1 RCCs are treated surgically with a high adoption of PN for cT1a and widespread MIS. RN remains common in cT1b primarily for anatomical/technical reasons, suggesting variability in access to robotic platforms and subspecialised teams. These data provide a national benchmark and support initiatives to optimise NSS access, resource allocation, and referral pathways.

介绍和目的：T1期肾细胞癌（RCC）的治疗已转向保留肾单元的手术（NSS）和微创手术（MIS），但西班牙目前的国家级数据很少。我们试图描述西班牙各中心T1期RCC的真实治疗模式。材料和方法采用西班牙国家肾癌登记处2024年的多中心回顾性描述性研究。临床T1期肾肿块接受手术、消融或主动监测（AS）治疗的成人纳入研究。采用描述性统计。主要结局包括治疗策略、手术入路、手术类型和病理结果；次要结果包括术中细节。结果共分析1121例患者（71.5%为cT1a）。治疗包括82.6%的手术，9.5%的消融和7.3%的AS。在手术患者中，部分肾切除术（PN）占65.0% （cT1a为74.5%，cT1b为46.7%）。MIS占主导地位（92.3%：腹腔镜58.4%，机器人33.9%）。行根治性肾切除术（RN）的主要原因是技术上不可行（56.8%）。中位热缺血时间16 min （IQR 0 ~ 23）。组织学表现为透明细胞型RCC 61.1%，良性病变12.4%。最终病理为pT1a 66.1%, pT1b 25.2%；占优发生率为8.6%（主要为pT3a），在cT1b中更为常见。结论在西班牙，大多数T1期rcc采用手术治疗，cT1a和广泛的MIS采用PN治疗。RN在cT1b中仍然很常见，主要是由于解剖学/技术原因，这表明机器人平台和亚专业团队的使用存在差异。这些数据提供了国家基准，并支持优化NSS访问、资源分配和转诊途径的举措。

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引用次数: 0

Comentario sobre «Perfil clínico y factores de riesgo identificados en pacientes con cáncer renal en población mexicana». Respuesta de los autores 关于“墨西哥人口中肾癌患者的临床概况和确定的危险因素”的评论。提交人的答复

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2026-03-01 Epub Date: 2025-09-22 DOI: 10.1016/j.acuro.2025.501867

G. Sánchez-Villaseñor , J.P. Gómez-Sierra , A. González-Ojeda , C. Fuentes-Orozco

引用次数: 0

Eficacia y seguridad de la vigilancia activa y la quimioablación en el tratamiento del cáncer de vejiga no musculoinvasivo (CVNMI): revisión sistemática y análisis conjunto del Grupo de trabajo de carcinoma urotelial de la Sección de jóvenes urólogos académicos-Asociación Europea de Urología (YAU-EAU) 积极监测和化疗治疗非肌肉侵入性膀胱癌（CVNMI）的有效性和安全性：青年泌尿科-欧洲泌尿学协会（YAU-EAU）泌尿癌工作组的系统综述和联合分析

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2026-03-01 Epub Date: 2025-12-18 DOI: 10.1016/j.acuro.2025.501917

A. Saouli , R. Contieri , F. Quhal , R. Hurle , M. Guenouni , G. Ploussard , K. Mori , T. Yanagisawa , B. Pradere , E. Laukhtina , P. Rajwa , S. Albisinni , W. Krajewski , A. Cimadamore , F. del Giudice , J. Gómez Rivas , F. Soria , S.F. Shariat , P. Gontero , L.S. Mertens , M. Moschini

Objective

To evaluate the oncological outcomes and safety of chemoablation and Active Surveillance for non-muscle invasive bladder cancer.

Methods

A systematic review was performed by accessing the following bibliographic databases: PubMed, Scopus, Embase and the Cochrane central register of controlled trials were searched.

Results

A total of 29 studies (1847 patients) met the inclusion criteria. The vast majority of patients included had Active Surveillance (n = 7, 582) and chemoablation (n = 21, 1265).

Regarding chemoablation, Mitomycine C (MMC) was used in 14 studies, Epirubicin in 2 studies, Bacillus Calmette-Guerin (BCG) in one study and Gemcitabine in 5 studies (weekly or single dose).

Follow-up ranged from 2 weeks to 39 months (Mean 16.8 months). The mean timing of initial assessment was 4.2 (range: 1 day to 27 weeks), and the pooled complete response (CR) rate was 52.3%.

For the AS protocol, the pathological findings before observation were Ta (n = 583, 86%), low (n = 462, 60.1%) and high grade (n = 138, 42.1%). Mean follow up was 47 months ranged from 25 to 72 months, the mean duration of AS was 13.4 months. The mean AS failure rate was 64%. Grade progression, stage progression and progression to muscle-invasive bladder cancer (MIBC) were 68 (16.5%), 35 (8.5%) and 5 (1%) of cases, respectively.

Conclusions

Patients with selected inclusion criteria based on the review can be referred for active Surveillance or chemoablation protocol, with a minimal risk of progression in either grade or stage for AS and a good complete response for chemoablation.

目的评价非肌源性浸润性膀胱癌化疗消融与主动监测的预后及安全性。方法通过检索PubMed、Scopus、Embase和Cochrane中央对照试验数据库进行系统评价。结果29项研究（1847例患者）符合纳入标准。绝大多数纳入的患者进行了主动监测（n = 7,582）和化疗（n = 21,1265）。化疗消融方面，14项研究使用丝裂霉素C (MMC)， 2项研究使用表柔比星，1项研究使用卡介苗（BCG）， 5项研究使用吉西他滨（每周或单次给药）。随访2周~ 39个月，平均16.8个月。初始评估的平均时间为4.2（范围：1天至27周），合并完全缓解（CR）率为52.3%。AS方案观察前病理表现为Ta （n = 583,86%）、低（n = 462,60.1%）和高（n = 138, 42.1%）。平均随访47个月，25 ~ 72个月，平均AS病程13.4个月。AS的平均失败率为64%。分级进展68例（16.5%），分期进展35例（8.5%），进展为肌肉浸润性膀胱癌5例（1%）。结论：根据综述选择纳入标准的患者可以参考主动监测或化疗消融方案，无论是分级还是分期，AS进展的风险都很小，并且化疗消融有良好的完全缓解。

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引用次数: 0

A propósito de un caso: tumor mixto epitelial y estromal del riñón con evolución sarcomatosa 以一例为例：伴有肉瘤的上皮和骨髓混合肾肿瘤

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2026-01-01 Epub Date: 2025-01-28 DOI: 10.1016/j.acuro.2025.501692

A.C. Jiménez Domínguez , A.J.G. Álvarez Lucena , P. Vila Braña , F. Vázquez Alonso

引用次数: 0

Técnicas ablativas para tumores renales en pacientes inoperables: un paso adelante en la SBRT 不可手术肾肿瘤消融技术：SBRT向前迈出的一步

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2026-01-01 Epub Date: 2025-08-08 DOI: 10.1016/j.acuro.2025.501857

A. Ocanto , R. Ciérvide , V. Hevia-Palacios , R. García , V. Gómez , P. Cruz , A. Olavarría , F. Couñago , F. López-Campos

Introduction

The localized renal cell carcinoma (RCC) is the eighth most common tumour in Spain. While surgical resection remains the gold standard for treatment, some elderly and frail patients may not be suitable candidates for this procedure. In selected cases, ablative therapies provide less invasive alternatives. Recent research has highlighted the potential of Stereotactic Body Radiotherapy (SBRT) as a non-invasive, well-tolerated, and effective treatment for RCC. This review aims to examine recent advances in SBRT for localized RCC, focusing on patient selection, treatment modalities and delivery, as well as efficacy and tolerance assessment.

Material and methods

A narrative literature review of English articles using Pubmed, Scopus, Cochrane, Google Scholar and Science Direct databases was performed focusing on prospective and relevant retrospective studies. Search terms included “kidney cancer”, “renal cell carcinoma”, “stereotactic radiotherapy”, “radiofrequency ablation”, “cryoablation”, “microwave ablation”, “SBRT” and “SABR”.

Results

Studies have reported local control rates ranging from 80% to 100% with SBRT. The decline in glomerular filtration rate following SBRT is approximately -10 to -13 mL/min over the years. Common toxicities are rare and are mostly classified as CTCAE grade I.

Conclusion

Based on available evidence, SBRT appears to be a viable option for patients with localized RCC who are not surgical candidates, given its high local control rate and favorable safety profile. Therefore, some indications for its use in clinical practice have been purposed according to the available evidence and recommending a case by case discussion in a uro-oncology multidisciplinary setting to optimize patient selection and treatment planning.

局限性肾细胞癌（RCC）是西班牙第八大常见肿瘤。虽然手术切除仍然是治疗的金标准，但一些老年人和虚弱的患者可能不适合这种手术。在某些情况下，消融治疗提供了侵入性较小的选择。最近的研究强调了立体定向放射治疗（SBRT）作为一种无创、耐受性良好、有效的RCC治疗方法的潜力。本综述旨在探讨SBRT治疗局部RCC的最新进展，重点是患者选择，治疗方式和递送，以及疗效和耐受性评估。材料与方法对Pubmed、Scopus、Cochrane、b谷歌Scholar和Science Direct数据库中的英文文章进行叙述性文献综述，重点进行前瞻性和相关回顾性研究。搜索词包括“肾癌”、“肾细胞癌”、“立体定向放疗”、“射频消融”、“冷冻消融”、“微波消融”、“SBRT”和“SABR”。结果研究报告SBRT的局部控制率从80%到100%不等。多年来，SBRT后肾小球滤过率的下降约为-10至-13 mL/min。结论基于现有证据，SBRT具有较高的局部控制率和良好的安全性，对于不适合手术的局限性RCC患者来说，SBRT似乎是一种可行的选择。因此，在临床实践中，一些适应症的使用是根据现有的证据，并建议在泌尿肿瘤多学科背景下逐个病例讨论，以优化患者选择和治疗计划。

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引用次数: 0

Impacto de los parámetros demográficos y los métodos de drenaje en el pronóstico de la pielonefritis enfisematosa. Estudio unicéntrico retrospectivo de 10 años 人口参数和排水方法对肺泡性肾盂肾炎预后的影响。10年回顾性中心研究

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2026-01-01 Epub Date: 2025-09-11 DOI: 10.1016/j.acuro.2025.501860

E. Gokmen, M.U. Kutukoglu, T. Altuntas, M. Kars, T.E. Sener, Y. Tanidir

Objective

To demonstrate the impact of demographic data on the clinical outcomes of patients with emphysematous pyelonephritis (EPN) treated at our center, and to present the results obtained—particularly through the comparison of drainage methods—in the largest patient group possible.

Materials and methods

This retrospective single-center study included 54 EPN patients treated at a tertiary care hospital. Inclusion required symptoms of upper urinary tract infection and gas in the renal parenchyma, collecting system, or perinephric space on abdominal CT. Data on demographics, urinary tract stones, labs, imaging (Huang and Tseng classification), hospital and intensive care unit (ICU) stay, and mortality were analyzed by initial treatment, drainage method, and platelet count. Patients with at least 6 months of follow-up were assessed for infection recurrence, renal function loss, and delayed nephrectomy.

Results

Advanced age was associated with increased ICU need and mortality (respectively p = 0.047, p = 0.039). Diabetes was associated with longer hospital stays compared to those without DM (14 vs. 7.5 days, p = 0.015). Thrombocytopenia was linked to higher rates of non-functioning kidneys (66.7%) and delayed nephrectomy (33.3%). No significant differences in morbidity or mortality were found between drainage methods (percutaneous vs. DJ stent). More male patients had advanced-stage disease, though this did not impact outcomes.

Conclusion

EPN is an emergency urological situation with high rate of mortality. Therefore, early diagnosis and appropriate management are crucial to decrease morbidity and mortality. Patient management approaches can be improved with growing evidence and prospective data with future studies.

目的探讨人口学数据对我院肺气肿性肾盂肾炎（EPN）患者临床预后的影响，并在尽可能大的患者群体中介绍所获得的结果，特别是通过引流方法的比较。材料和方法本回顾性单中心研究纳入了在三级医院治疗的54例EPN患者。纳入需要有上尿路感染的症状，腹部CT显示肾实质、收集系统或肾周间隙有气体。通过初始治疗、引流方法和血小板计数分析人口统计学、尿路结石、实验室、影像学（Huang和Tseng分类）、住院和重症监护病房（ICU）住院时间和死亡率。随访至少6个月的患者评估感染复发、肾功能丧失和延迟肾切除术。结果高龄与ICU需求和死亡率增加相关（p = 0.047, p = 0.039）。与非糖尿病患者相比，糖尿病患者住院时间更长（14天vs. 7.5天，p = 0.015）。血小板减少症与肾功能不全（66.7%）和延迟肾切除术（33.3%）相关。两种引流方法（经皮与DJ支架）的发病率和死亡率无显著差异。更多的男性患者患有晚期疾病，尽管这并不影响结果。结论epn是一种死亡率高的泌尿外科急症。因此，早期诊断和适当的治疗对于降低发病率和死亡率至关重要。随着越来越多的证据和未来研究的前瞻性数据，患者管理方法可以得到改进。

{"title":"Impacto de los parámetros demográficos y los métodos de drenaje en el pronóstico de la pielonefritis enfisematosa. Estudio unicéntrico retrospectivo de 10 años","authors":"E. Gokmen, M.U. Kutukoglu, T. Altuntas, M. Kars, T.E. Sener, Y. Tanidir","doi":"10.1016/j.acuro.2025.501860","DOIUrl":"10.1016/j.acuro.2025.501860","url":null,"abstract":"<div><h3>Objective</h3><div>To demonstrate the impact of demographic data on the clinical outcomes of patients with emphysematous pyelonephritis (EPN) treated at our center, and to present the results obtained—particularly through the comparison of drainage methods—in the largest patient group possible.</div></div><div><h3>Materials and methods</h3><div>This retrospective single-center study included 54 EPN patients treated at a tertiary care hospital. Inclusion required symptoms of upper urinary tract infection and gas in the renal parenchyma, collecting system, or perinephric space on abdominal CT. Data on demographics, urinary tract stones, labs, imaging (Huang and Tseng classification), hospital and intensive care unit (ICU) stay, and mortality were analyzed by initial treatment, drainage method, and platelet count. Patients with at least 6 months of follow-up were assessed for infection recurrence, renal function loss, and delayed nephrectomy.</div></div><div><h3>Results</h3><div>Advanced age was associated with increased ICU need and mortality (respectively p=0.047, p=0.039). Diabetes was associated with longer hospital stays compared to those without DM (14 vs. 7.5 days, p=0.015). Thrombocytopenia was linked to higher rates of non-functioning kidneys (66.7%) and delayed nephrectomy (33.3%). No significant differences in morbidity or mortality were found between drainage methods (percutaneous vs. DJ stent). More male patients had advanced-stage disease, though this did not impact outcomes.</div></div><div><h3>Conclusion</h3><div>EPN is an emergency urological situation with high rate of mortality. Therefore, early diagnosis and appropriate management are crucial to decrease morbidity and mortality. Patient management approaches can be improved with growing evidence and prospective data with future studies.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"50 1","pages":"Article 501860"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145898163","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}

引用次数: 0

Adjuntos frente a residentes supervisados: resultados de la formación en resección transuretral de tumores de vejiga y perspectivas a futuro 助理与受监督的住院医师：经尿道切除膀胱肿瘤培训的结果和未来前景

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2026-01-01 Epub Date: 2025-07-14 DOI: 10.1016/j.acuro.2025.501830

P. Diana , A. Gallioli , A. Uleri , L. Mas , R. Pujol , A. Territo , O. Rodriguez-Faba , J.M. Gaya , F. Sanguedolce , J. Huguet , R. Parada , F. Algaba , J. Palou , A. Breda

Introduction and objectives

Urology residents training programs across Europe are uneven and often unsatisfactory. The significance of resident mentoring should not be overstated and trainees should be mentored by training-trained attending urologist even in case of common procedures such transurethral resection of bladder tumor (TURBT). The goal of this study is to demonstrate the comparability in TURBT performance between supervised urology residents and attendings.

Materials and methods

This study is a subanalysis of a prospective, randomized trial enrolling patients diagnosed with BC and undergoing endoscopic intervention. The trial (NCT04712201) was approved by the Institutional Review Board (2017/09c). Surgeons were either urology attendings or supervised residents of the 3rd-5th year. Primary outcome was to compare surgical and post-operative outcomes in both groups.

Results

From 04/2018 to 06/2021, 300 patients met inclusion criteria and 248 (83%) of these underwent the assigned intervention. 200 (80.6%) patients were males and median (SD) age was 72.2 (11.2). No statistical differences were found in terms of intra and post-operative outcomes (all P > .05). Linear and logistic regression analysis resulted comparable for all variables (all P > .05).

Conclusion

Supervised urology residents do not put the patient at an increased risk of complications neither perform a suboptimal procedure. Resident mentoring is fundamental in order to reach comparable results in surgical outcomes and pathological diagnosis. A structured standardized program with trained trainers and proficiency evaluations are warranted to gain and maintain these outcomes across Europe.

欧洲泌尿外科住院医师培训项目参差不齐，往往令人不满意。住院医师指导的重要性不应被夸大，即使是经尿道膀胱肿瘤切除术（turt）等常见手术，也应由受过培训的主治泌尿科医师指导。本研究的目的是为了证明在泌尿外科住院医师和主治医师之间turt表现的可比性。材料和方法本研究是一项前瞻性随机试验的亚分析，纳入诊断为BC并接受内镜干预的患者。该试验（NCT04712201）已获得机构审查委员会（2017/09c）的批准。外科医生要么是泌尿科主治医师，要么是第3 -5年的住院医师。主要结果是比较两组的手术和术后结果。结果2018年4月至2021年6月，300例患者符合纳入标准，其中248例（83%）接受了指定的干预。200例（80.6%）患者为男性，中位（SD）年龄为72.2岁（11.2岁）。两组患者术中、术后预后差异无统计学意义（P > 0.05）。线性和逻辑回归分析结果显示所有变量具有可比性（均P >； 0.05）。结论受监督的泌尿外科住院医师不会增加患者并发症的风险，也不会执行次优手术。为了在手术结果和病理诊断方面达到可比较的结果，住院指导是基本的。一个有训练有素的培训师和熟练程度评估的结构化标准化项目保证在整个欧洲获得和保持这些成果。

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引用次数: 0

Comentario sobre «Nuevos factores de riesgo de tromboembolismo venoso (TEV) después de la resección transuretral de tumor vesical (RTU): modelos de regresión multivariable escalonada y LASSO basados en datos de reclamaciones de seguros de EE.UU.» 关于“经尿道膀胱肿瘤切除后静脉血栓栓塞的新危险因素：基于美国保险索赔数据的分级多变量回归模型和LASSO”的评论

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2026-01-01 Epub Date: 2025-05-06 DOI: 10.1016/j.acuro.2025.501787

S. Kumar , R. Mehta , R. Sah

引用次数: 0

Comentario sobre «Comparación del P-score de Prostatype® y los modelos de riesgo tradicionales para predecir los resultados del cáncer de próstata en España» 关于“西班牙前列腺癌预后中Prostatype®的p分数与传统风险模型的比较”的评论

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2026-01-01 Epub Date: 2025-07-11 DOI: 10.1016/j.acuro.2025.501827

S. Kumar , R. Sah

引用次数: 0

Comentario sobre «Comparación del P-score de Prostatype® y los modelos de riesgo tradicionales para predecir los resultados del cáncer de próstata en España». Respuesta de los autores 关于“Prostatype®的p分数与传统风险模型预测西班牙前列腺癌结果的比较”的评论。提交人的答复

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2026-01-01 Epub Date: 2025-07-11 DOI: 10.1016/j.acuro.2025.501828

P. González-Peramato , E. Berglund

引用次数: 0

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