Pub Date : 2025-12-01DOI: 10.1016/j.acuro.2025.501863
L. Cayuela , V. Achaval , S. Cabrera Fernández , M. Ortega Calvo , A. Cayuela
Introduction
This study aimed to assess long-term trends in bladder cancer incidence in Spain from 1992 to 2021, using Age-Period-Cohort (A-P-C) modelling to disentangle the contributions of age, period, and cohort effects.
Methods
An ecological trend study was conducted using data from the Global Burden of Disease (GBD) 2021 Study via the Global Health Data Exchange. Age- and sex-specific incidence counts for Spain (1992-2021) were analyzed. Joinpoint regression estimated annual percent changes (APCs) and average annual percent changes (AAPCs). A-P-C modelling assessed net and local drifts, as well as cohort and period rate ratios using 5-year age groups and calendar periods.
Results
From 1992 to 2021, 377,430 male and 66,191 female bladder cancer cases were estimated. In men, age-adjusted incidence declined (AAPC = −0.6%), driven by favourable birth cohort and period effects. In women, a modest decline (AAPC = −0.3%) masked a mid-century cohort effect, with increased risk in those born between 1957 and 1967 — consistent with a delayed tobacco epidemic. Incidence rose with age in both sexes, though male-to-female incidence ratios narrowed in older groups.
Conclusion
Bladder cancer incidence in Spain reflects complex, sex-specific temporal dynamics. While male incidence is decreasing, women show persistent cohort-specific increases. These trends underscore the importance of sex-sensitive public health strategies targeting modifiable risk factors, particularly tobacco use.
{"title":"Tendencias en la incidencia de cáncer de vejiga por sexo y efectos generacionales en España","authors":"L. Cayuela , V. Achaval , S. Cabrera Fernández , M. Ortega Calvo , A. Cayuela","doi":"10.1016/j.acuro.2025.501863","DOIUrl":"10.1016/j.acuro.2025.501863","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to assess long-term trends in bladder cancer incidence in Spain from 1992 to 2021, using Age-Period-Cohort (A-P-C) modelling to disentangle the contributions of age, period, and cohort effects.</div></div><div><h3>Methods</h3><div>An ecological trend study was conducted using data from the Global Burden of Disease (GBD) 2021 Study via the Global Health Data Exchange. Age- and sex-specific incidence counts for Spain (1992-2021) were analyzed. Joinpoint regression estimated annual percent changes (APCs) and average annual percent changes (AAPCs). A-P-C modelling assessed net and local drifts, as well as cohort and period rate ratios using 5-year age groups and calendar periods.</div></div><div><h3>Results</h3><div>From 1992 to 2021, 377,430 male and 66,191 female bladder cancer cases were estimated. In men, age-adjusted incidence declined (AAPC<!--> <!-->=<!--> <!-->−0.6%), driven by favourable birth cohort and period effects. In women, a modest decline (AAPC<!--> <!-->=<!--> <!-->−0.3%) masked a mid-century cohort effect, with increased risk in those born between 1957 and 1967 — consistent with a delayed tobacco epidemic. Incidence rose with age in both sexes, though male-to-female incidence ratios narrowed in older groups.</div></div><div><h3>Conclusion</h3><div>Bladder cancer incidence in Spain reflects complex, sex-specific temporal dynamics. While male incidence is decreasing, women show persistent cohort-specific increases. These trends underscore the importance of sex-sensitive public health strategies targeting modifiable risk factors, particularly tobacco use.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 10","pages":"Article 501863"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623421","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 : 2025-12-01DOI: 10.1016/j.acuro.2025.501864
S. Yamamoto, K. Higa, K. Kurokawa, H. Bamba, S. Kanaoka, K. Nakamura
Introduction and objectives
Cisplatin is essential for treating urothelial carcinoma but poses a high risk of AKI. Previous studies on CP-AKI risk factors had limitations. Gupta et al. (2024) proposed a simplified risk score linked to CP-AKI and 90-day survival, though validated only in patients with eGFR ≥ 50 mL/min.
Materials and methods
This single-center retrospective study analyzed 70 patients with urothelial carcinoma treated with cisplatin. Patients with eGFR ≥ 50 mL/min received full-dose cisplatin (n = 47); those with eGFR 30–49 mL/min received a 75% reduced dose (n = 23), per Japanese guidelines. All received intravenous magnesium. AKI was defined as a ≥ twofold rise in serum creatinine or initiation of renal replacement therapy. The study also evaluated the Gupta score's association with 90-day survival in metastatic cases.
Results
AKI occurred in 9.3% of the full-dose group and 4.5% of the reduced-dose group (p = 1.000). Higher Gupta scores were significantly associated with lower 90-day survival (p = 0.003).
Conclusion
A 75% cisplatin dose reduction in patients with moderate renal impairment appears safe and maintains efficacy without increasing AKI risk. These findings support personalized dosing and highlight the need to refine clinical guidelines. Further prospective studies are warranted.
{"title":"Estratificación de riesgo de insuficiencia renal aguda por cisplatino y seguridad de la reducción de dosis en pacientes con carcinoma urotelial y deterioro de la función renal","authors":"S. Yamamoto, K. Higa, K. Kurokawa, H. Bamba, S. Kanaoka, K. Nakamura","doi":"10.1016/j.acuro.2025.501864","DOIUrl":"10.1016/j.acuro.2025.501864","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Cisplatin is essential for treating urothelial carcinoma but poses a high risk of AKI. Previous studies on CP-AKI risk factors had limitations. Gupta et al. (2024) proposed a simplified risk score linked to CP-AKI and 90-day survival, though validated only in patients with eGFR ≥ 50<!--> <!-->mL/min.</div></div><div><h3>Materials and methods</h3><div>This single-center retrospective study analyzed 70 patients with urothelial carcinoma treated with cisplatin. Patients with eGFR ≥ 50<!--> <!-->mL/min received full-dose cisplatin (n<!--> <!-->=<!--> <!-->47); those with eGFR 30–49<!--> <!-->mL/min received a 75% reduced dose (n<!--> <!-->=<!--> <!-->23), per Japanese guidelines. All received intravenous magnesium. AKI was defined as a ≥ twofold rise in serum creatinine or initiation of renal replacement therapy. The study also evaluated the Gupta score's association with 90-day survival in metastatic cases.</div></div><div><h3>Results</h3><div>AKI occurred in 9.3% of the full-dose group and 4.5% of the reduced-dose group (p<!--> <!-->=<!--> <!-->1.000). Higher Gupta scores were significantly associated with lower 90-day survival (p<!--> <!-->=<!--> <!-->0.003).</div></div><div><h3>Conclusion</h3><div>A 75% cisplatin dose reduction in patients with moderate renal impairment appears safe and maintains efficacy without increasing AKI risk. These findings support personalized dosing and highlight the need to refine clinical guidelines. Further prospective studies are warranted.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 10","pages":"Article 501864"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623422","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 : 2025-12-01DOI: 10.1016/j.acuro.2025.501838
J. García Rodríguez, A. López Tello, C. González Ruiz de león, R. Sacristán González, M. Hevia Suárez, J. Fuentes Pastor, I. Pérez Vera, J.M. Fernández Gómez
Introduction
Real-world analyses reflect routine clinical practice. We reviewed treatment response and quality of life in metastatic hormone-sensitive prostate cancer (mHSPC) patients treated with androgen receptor inhibitors.
Methods
We analyzed 89 patients with mHSPC from a descriptive observational cohort. The median follow-up was 16.1 months, with quarterly assessments. We evaluated PSA response, disease progression, and quality-of-life data.
Results
Among the patients, 37% had high-volume disease and 63% low-volume; 60% had synchronous metastases. Using apalutamide, we observed PSA reductions of 90%, PSA < 0.2 ng/ml, and ultra-low PSA (< 0.02 ng/ml) at 3 and 6 months in 63%, 65%, and 34% and in 65%, 71%, and 53% of patients, respectively. Radiographic progression-free survival (rPFS) was 88% at 15 months. When PET-PSMA was used for imaging, 94% and 92% of patients remained free of radiographic progression at 12 and 24 months, respectively. Regarding quality of life, the FACT-P score remained stable, and pain on the visual analog scale improved, with the proportion of patients scoring > 1 decreasing from 35% to 22% over 6 months.
Conclusion
Real-world analyses using androgen receptor inhibitors in mHSPC reproduce clinical trial results in terms of treatment response. Profound PSA declines and observed progression-free survival outcomes reflect treatment effectiveness without a negative impact on quality of life.
{"title":"Datos de vida real sobre una serie de pacientes con cáncer de próstata metastásico hormono sensible de un único centro en España. Análisis de respuesta, progresión y calidad de vida","authors":"J. García Rodríguez, A. López Tello, C. González Ruiz de león, R. Sacristán González, M. Hevia Suárez, J. Fuentes Pastor, I. Pérez Vera, J.M. Fernández Gómez","doi":"10.1016/j.acuro.2025.501838","DOIUrl":"10.1016/j.acuro.2025.501838","url":null,"abstract":"<div><h3>Introduction</h3><div>Real-world analyses reflect routine clinical practice. We reviewed treatment response and quality of life in metastatic hormone-sensitive prostate cancer (mHSPC) patients treated with androgen receptor inhibitors.</div></div><div><h3>Methods</h3><div>We analyzed 89 patients with mHSPC from a descriptive observational cohort. The median follow-up was 16.1 months, with quarterly assessments. We evaluated PSA response, disease progression, and quality-of-life data.</div></div><div><h3>Results</h3><div>Among the patients, 37% had high-volume disease and 63% low-volume; 60% had synchronous metastases. Using apalutamide, we observed PSA reductions of 90%, PSA<!--> <!--><<!--> <!-->0.2 ng/ml, and ultra-low PSA (<<!--> <!-->0.02 ng/ml) at 3 and 6 months in 63%, 65%, and 34% and in 65%, 71%, and 53% of patients, respectively. Radiographic progression-free survival (rPFS) was 88% at 15 months. When PET-PSMA was used for imaging, 94% and 92% of patients remained free of radiographic progression at 12 and 24 months, respectively. Regarding quality of life, the FACT-P score remained stable, and pain on the visual analog scale improved, with the proportion of patients scoring ><!--> <!-->1 decreasing from 35% to 22% over 6 months.</div></div><div><h3>Conclusion</h3><div>Real-world analyses using androgen receptor inhibitors in mHSPC reproduce clinical trial results in terms of treatment response. Profound PSA declines and observed progression-free survival outcomes reflect treatment effectiveness without a negative impact on quality of life.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 10","pages":"Article 501838"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623406","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 : 2025-11-01DOI: 10.1016/j.acuro.2025.501861
M.V. Lorenzo-Sánchez , M. Granada Picazo-Martínez , J.M. Giménez-Bachs , M.J. Donate-Moreno , S. Navarro-Jiménez , M.A. Tárraga-Honrubia , A.S. Salinas-Sánchez
Introduction
Circulating RNAs (cfRNAs) have emerged as promising biomarkers in liquid biopsy for prostate cancer (PCa). However, the lack of standardization in their analysis and the heterogeneity across available studies limit clinical application.
Objective
To evaluate the diagnostic and prognostic utility of the total concentration of cell-free circulating small RNA (cf-sRNA) and microRNA (cf-miRNA) in plasma and urine from PCa patients using accessible techniques, without identifying specific miRNAs.
Materials and methods
Prospective, longitudinal study including 143 men (111 with PCa and 32 healthy controls). Plasma and urine cf-sRNA and cf-miRNA levels were quantified with an Agilent 2100 Bioanalyzer. Levels were correlated with clinical features, tumor stage, and progression to metastatic castration-resistant PCa (mCRPC). A longitudinal follow-up was conducted in a metastatic subgroup.
Results
Plasma and urine levels of cf-miRNA and cf-sRNA were significantly higher in patients with advanced PCa, particularly in those who progressed to mCRPC (p< 0.05). During follow-up, a significant increase in plasma cf-miRNA was observed after treatment (p = 0.031), as well as an increase in the relative percentage of cf-miRNA in urine (p = 0.012).
Conclusions
Total quantification of cf-miRNA in plasma and urine is an accessible strategy with potential value as a dynamic biomarker for PCa monitoring and prognosis. Its use could complement current diagnostic tools, although further studies are required to validate its utility in clinical practice.
{"title":"Cuantificación total de microRNA y smallRNA circulantes en plasma y orina como biomarcadores pronósticos en el cáncer de próstata","authors":"M.V. Lorenzo-Sánchez , M. Granada Picazo-Martínez , J.M. Giménez-Bachs , M.J. Donate-Moreno , S. Navarro-Jiménez , M.A. Tárraga-Honrubia , A.S. Salinas-Sánchez","doi":"10.1016/j.acuro.2025.501861","DOIUrl":"10.1016/j.acuro.2025.501861","url":null,"abstract":"<div><h3>Introduction</h3><div>Circulating RNAs (cfRNAs) have emerged as promising biomarkers in liquid biopsy for prostate cancer (PCa). However, the lack of standardization in their analysis and the heterogeneity across available studies limit clinical application.</div></div><div><h3>Objective</h3><div>To evaluate the diagnostic and prognostic utility of the total concentration of cell-free circulating small RNA (cf-sRNA) and microRNA (cf-miRNA) in plasma and urine from PCa patients using accessible techniques, without identifying specific miRNAs.</div></div><div><h3>Materials and methods</h3><div>Prospective, longitudinal study including 143 men (111 with PCa and 32 healthy controls). Plasma and urine cf-sRNA and cf-miRNA levels were quantified with an Agilent 2100 Bioanalyzer. Levels were correlated with clinical features, tumor stage, and progression to metastatic castration-resistant PCa (mCRPC). A longitudinal follow-up was conducted in a metastatic subgroup.</div></div><div><h3>Results</h3><div>Plasma and urine levels of cf-miRNA and cf-sRNA were significantly higher in patients with advanced PCa, particularly in those who progressed to mCRPC (p<<!--> <!-->0.05). During follow-up, a significant increase in plasma cf-miRNA was observed after treatment (p<!--> <!-->=<!--> <!-->0.031), as well as an increase in the relative percentage of cf-miRNA in urine (p<!--> <!-->=<!--> <!-->0.012).</div></div><div><h3>Conclusions</h3><div>Total quantification of cf-miRNA in plasma and urine is an accessible strategy with potential value as a dynamic biomarker for PCa monitoring and prognosis. Its use could complement current diagnostic tools, although further studies are required to validate its utility in clinical practice.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 9","pages":"Article 501861"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425553","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 : 2025-11-01DOI: 10.1016/j.acuro.2025.501836
A. Akinci , A. Sanci , M. Babayigit , C. Gogus
Objective
To evaluate the effect of alpha-blocker therapy during flexible ureterorenoscopy (F-URS) on the treatment of upper urinary tract stones.
Methods
A retrospective analysis was conducted on 476 patients who underwent F-URS at the Department of Urology between January 2010 and January 2017. Data collected included alpha-blocker use, stone size, stone location, patient age and gender, success or failure of ureteral access sheath (UAS) placement, ability to reach the stone during the procedure, postoperative stone-free status, and complication rates. Patients were divided into two groups: alpha-blocker users (n = 90, 18.9%) and non-users (n = 386, 81.1%).
Results
No significant differences were observed in gender distribution (p = 0.86) or stone size (p = 0.21) between the two groups. Alpha-blocker users had a lower complication rate (p = 0.022), a higher rate of successful stone access during the procedure (p = 0.007), and a higher postoperative stone-free rate (p = 0.01) compared to non-users. Among alpha-blocker users, tamsulosin and silodosin were associated with higher stone clearance rates (p = 0.046 and p = 0.037, respectively).
Conclusions
Alpha-blocker therapy during F-URS for upper urinary tract stones is associated with improved outcomes, including higher stone access rates, reduced complications, and increased stone-free rates. These findings suggest that alpha-blockers, particularly tamsulosin and silodosin, may enhance the efficacy and safety of F-URS.
{"title":"¿El uso preoperatorio de bloqueadores alfa afecta los resultados de la ureterorrenoscopia flexible?","authors":"A. Akinci , A. Sanci , M. Babayigit , C. Gogus","doi":"10.1016/j.acuro.2025.501836","DOIUrl":"10.1016/j.acuro.2025.501836","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effect of alpha-blocker therapy during flexible ureterorenoscopy (F-URS) on the treatment of upper urinary tract stones.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 476 patients who underwent F-URS at the Department of Urology between January 2010 and January 2017. Data collected included alpha-blocker use, stone size, stone location, patient age and gender, success or failure of ureteral access sheath (UAS) placement, ability to reach the stone during the procedure, postoperative stone-free status, and complication rates. Patients were divided into two groups: alpha-blocker users (n<!--> <!-->=<!--> <!-->90, 18.9%) and non-users (n<!--> <!-->=<!--> <!-->386, 81.1%).</div></div><div><h3>Results</h3><div>No significant differences were observed in gender distribution (p<!--> <!-->=<!--> <!-->0.86) or stone size (p<!--> <!-->=<!--> <!-->0.21) between the two groups. Alpha-blocker users had a lower complication rate (p<!--> <!-->=<!--> <!-->0.022), a higher rate of successful stone access during the procedure (p<!--> <!-->=<!--> <!-->0.007), and a higher postoperative stone-free rate (p<!--> <!-->=<!--> <!-->0.01) compared to non-users. Among alpha-blocker users, tamsulosin and silodosin were associated with higher stone clearance rates (p<!--> <!-->=<!--> <!-->0.046 and p<!--> <!-->=<!--> <!-->0.037, respectively).</div></div><div><h3>Conclusions</h3><div>Alpha-blocker therapy during F-URS for upper urinary tract stones is associated with improved outcomes, including higher stone access rates, reduced complications, and increased stone-free rates. These findings suggest that alpha-blockers, particularly tamsulosin and silodosin, may enhance the efficacy and safety of F-URS.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 9","pages":"Article 501836"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425434","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 : 2025-11-01DOI: 10.1016/j.acuro.2025.501832
Y. Quiroz Madarriaga , M.İ. Dönmez , R.J.M. Lammers , B. Bañuelos Marco , N. Baydilli , E. Bindi , S. Sforza , I. Selvi , L.A. Hoen
Paediatric urolithiasis is increasing globally, with metabolic abnormalities as a key contributing factor. However, standardized protocols for metabolic evaluation in children are lacking. This study assessed current practices and knowledge among paediatric urologists worldwide. An international survey was distributed in Spanish and English, gathering data on clinician demographics and metabolic evaluation strategies. A total of 194 clinicians from 49 countries responded. Only 11% routinely performed metabolic evaluations, and while 78% requested stone analysis, just 46% ordered 24-hour urine studies. In 84% of cases, paediatric nephrologists were responsible for evaluations, with urologists involved in fewer than 25%. Knowledge of spot urine indices varied, and only 55% recognized crystalluria as a lithogenic risk factor. Fewer than one-third felt confident interpreting metabolic results or initiating treatment. These findings highlight inconsistent practices and limited involvement of paediatric urologists, underscoring the need for clearer guidelines and targeted education to enhance metabolic assessment in stone disease.
{"title":"Estudio metabólico en la urolitiasis pediátrica: ¿se está ignorando un componente clave? Encuesta internacional del grupo de trabajo de Urología Pediátrica de la sección de Jóvenes Urólogos Académicos (YAU-PU) de la EAU","authors":"Y. Quiroz Madarriaga , M.İ. Dönmez , R.J.M. Lammers , B. Bañuelos Marco , N. Baydilli , E. Bindi , S. Sforza , I. Selvi , L.A. Hoen","doi":"10.1016/j.acuro.2025.501832","DOIUrl":"10.1016/j.acuro.2025.501832","url":null,"abstract":"<div><div>Paediatric urolithiasis is increasing globally, with metabolic abnormalities as a key contributing factor. However, standardized protocols for metabolic evaluation in children are lacking. This study assessed current practices and knowledge among paediatric urologists worldwide. An international survey was distributed in Spanish and English, gathering data on clinician demographics and metabolic evaluation strategies. A total of 194 clinicians from 49 countries responded. Only 11% routinely performed metabolic evaluations, and while 78% requested stone analysis, just 46% ordered 24-hour urine studies. In 84% of cases, paediatric nephrologists were responsible for evaluations, with urologists involved in fewer than 25%. Knowledge of spot urine indices varied, and only 55% recognized crystalluria as a lithogenic risk factor. Fewer than one-third felt confident interpreting metabolic results or initiating treatment. These findings highlight inconsistent practices and limited involvement of paediatric urologists, underscoring the need for clearer guidelines and targeted education to enhance metabolic assessment in stone disease.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 9","pages":"Article 501832"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425551","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 : 2025-11-01DOI: 10.1016/j.acuro.2025.501859
E. Venegas-Vázquez , C. Beas-Ruiz Velasco , R. Martínez de Pinillos-Valverde , J.P. Gómez-Sierra , C.E. Capetillo-Texson , V.T. Hernández-Ramírez , A.R. Villaseñor-Rodríguez , J.M. Guzmán-Díaz , X. Monteón-Aspeitia , A. González-Ojeda , G. Cervantes-Guevara , E. Cervantes-Pérez , S. Ramírez-Ochoa , M.G. Castillo-Cardiel , C. Fuentes-Orozco
Introduction
Renal transplantation is the renal replacement therapy of choice in patients with end-stage chronic kidney disease. Major urological complications such as urinary leakage, ureteral stricture and urinary tract infection, usually occur in the first 3 months post-transplantation and lead to a higher morbidity and mortality and lower graft function.
Objective
To evaluate the impact of double J catheter colocation on major urological complications in extravesical ureteroneocystostomy in renal recipients.
Materials and Methods
Open clinical trial. The study included renal transplant recipients who underwent extravesical ureteroneocystostomy with trans-surgical placement of double J catheter compared to extravesical ureteroneocystostomy without trans-surgical catheter placement. The study variables were urinary leakage, ureteral stricture, urinary tract infection, surgical complications and graft function.
Results
Eighty-four patients were included, 42 patients in the study group and 42 in the control group, who had a mean follow-up of 10.7 months. The urological complications presented were: 4 (4.8%) patients with urinary leakage, all in the non-catheter group (RR 0.475; 95% CI 0.377-0.598; p = 0.04); 2 (2.4%) patients with ureteral stricture, one in each group (RR 1; 95% CI 0.246-4.066; p = 1.0), and 20 (23.8%) patients with urinary tract infection, being 9 (21.4%) patients in the control group and 11 (26.2%) in the study group (RR 1.135; CI 95% 0.710-1.817; p = 0.608). No differences regarding graft function were observed.
Conclusion
Our study showed a significant reduction in the incidence of urinary leakage with prophylactic ureteral catheter use, although no significant association was observed with other complications such as ureteral stricture or surgical complications. Furthermore, its use was not significantly associated with urinary tract infections or graft dysfunction.
肾移植是终末期慢性肾病患者肾替代治疗的首选方法。主要的泌尿系统并发症如尿漏、输尿管狭窄和尿路感染，通常发生在移植后的前3个月，导致较高的发病率和死亡率，移植物功能下降。目的探讨双J管配置对肾术后输尿管外膀胱造瘘主要泌尿系统并发症的影响。材料与方法开放式临床试验。该研究包括肾移植受者行经手术放置双J导管的体外输尿管膀胱造口术与不放置导管的体外输尿管膀胱造口术。研究变量为尿漏、输尿管狭窄、尿路感染、手术并发症和移植物功能。结果共纳入84例患者，研究组42例，对照组42例，平均随访10.7个月。出现的泌尿系统并发症有：4例（4.8%）患者出现尿漏，均为非置管组（RR 0.475; 95% CI 0.377 ~ 0.598; p = 0.04）；输尿管狭窄2例（2.4%），两组各1例（RR 1; 95% CI 0.246 ~ 4.066; p = 1.0）；尿路感染20例（23.8%），其中对照组9例（21.4%），研究组11例（26.2%）（RR 1.135; CI 95% 0.710 ~ 1.817; p = 0.608）。在移植物功能方面没有观察到差异。结论我们的研究显示，预防性输尿管导管的使用显著降低了尿漏的发生率，但与输尿管狭窄或手术并发症等其他并发症没有明显的关联。此外，它的使用与尿路感染或移植物功能障碍没有显著相关性。
{"title":"Impacto sobre las complicaciones urológicas mayores con el uso profiláctico de catéter doble J en la ureteroneocistostomía extravesical en receptores de trasplante renal","authors":"E. Venegas-Vázquez , C. Beas-Ruiz Velasco , R. Martínez de Pinillos-Valverde , J.P. Gómez-Sierra , C.E. Capetillo-Texson , V.T. Hernández-Ramírez , A.R. Villaseñor-Rodríguez , J.M. Guzmán-Díaz , X. Monteón-Aspeitia , A. González-Ojeda , G. Cervantes-Guevara , E. Cervantes-Pérez , S. Ramírez-Ochoa , M.G. Castillo-Cardiel , C. Fuentes-Orozco","doi":"10.1016/j.acuro.2025.501859","DOIUrl":"10.1016/j.acuro.2025.501859","url":null,"abstract":"<div><h3>Introduction</h3><div>Renal transplantation is the renal replacement therapy of choice in patients with end-stage chronic kidney disease. Major urological complications such as urinary leakage, ureteral stricture and urinary tract infection, usually occur in the first 3 months post-transplantation and lead to a higher morbidity and mortality and lower graft function.</div></div><div><h3>Objective</h3><div>To evaluate the impact of double J catheter colocation on major urological complications in extravesical ureteroneocystostomy in renal recipients.</div></div><div><h3>Materials and Methods</h3><div>Open clinical trial. The study included renal transplant recipients who underwent extravesical ureteroneocystostomy with trans-surgical placement of double J catheter compared to extravesical ureteroneocystostomy without trans-surgical catheter placement. The study variables were urinary leakage, ureteral stricture, urinary tract infection, surgical complications and graft function.</div></div><div><h3>Results</h3><div>Eighty-four patients were included, 42 patients in the study group and 42 in the control group, who had a mean follow-up of 10.7 months. The urological complications presented were: 4 (4.8%) patients with urinary leakage, all in the non-catheter group (RR 0.475; 95% <span>C</span>I 0.377-0.598; p<!--> <!-->=<!--> <!-->0.04); 2 (2.4%) patients with ureteral stricture, one in each group (RR 1; 95% CI 0.246-4.066; p<!--> <!-->=<!--> <!-->1.0), and 20 (23.8%) patients with urinary tract infection, being 9 (21.4%) patients in the control group and 11 (26.2%) in the study group (RR 1.135; CI 95% 0.710-1.817; p<!--> <!-->=<!--> <!-->0.608). No differences regarding graft function were observed.</div></div><div><h3>Conclusion</h3><div>Our study showed a significant reduction in the incidence of urinary leakage with prophylactic ureteral catheter use, although no significant association was observed with other complications such as ureteral stricture or surgical complications. Furthermore, its use was not significantly associated with urinary tract infections or graft dysfunction.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 9","pages":"Article 501859"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425554","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 : 2025-11-01DOI: 10.1016/j.acuro.2025.501816
K. Weller , G.M. Eggenhuizen , K. Zandbergen , L.A. ’t Hoen , J. Mulder , A.T.J.I. Go
Introduction
Congenital renal and urogenital anomalies represent a major part of all congenital anomalies. These range from mild, transient conditions to severe forms leading to irreversible organ damage or perinatal mortality. Timely prenatal identification is crucial for expecting parents and their healthcare providers to decide about the continuation of a pregnancy or for careful planning of perinatal and postnatal care.
Objective
To describe the most common indications for referral of fetal renal and urogenital malformations, the process of narrowing the differential diagnosis based on prenatal ultrasonography and the coordination between prenatal and postnatal care in a tertiary care center in the Netherlands.
Results
The most common indications for referral of fetal renal and urogenital malformations are: (1) abnormal renal parenchyma; (2) urinary tract dilatation; (3) abnormal bladder appearance, and (4) atypical genitalia. In the differential diagnosis, ultrasonographic evaluation is crucial to determine the specific region of the urogenital system affected, its onset during pregnancy, and its progression throughout gestation. Integrated prenatal and postnatal care for these types of malformations relies on a multidisciplinary approach to guide parental decision-making in continuation of the pregnancy and optimize outcomes. Some cases only require routine perinatal care in secondary care centers, while complex malformations benefit from specialized planning at tertiary centers to improve outcomes.
Conclusion
Dedicated ultrasonographic evaluation of fetal renal and urogenital anomalies in a tertiary care center enables accurate diagnosis and individualized care planning, particularly in complex cases. This approach provides parents with timely information, supports decision-making, and guides individualized perinatal care.
{"title":"Evaluación ecográfica prenatal y manejo de anomalías renales y urogenitales: una revisión exhaustiva basada en la experiencia en un centro de atención terciaria y análisis de la literatura","authors":"K. Weller , G.M. Eggenhuizen , K. Zandbergen , L.A. ’t Hoen , J. Mulder , A.T.J.I. Go","doi":"10.1016/j.acuro.2025.501816","DOIUrl":"10.1016/j.acuro.2025.501816","url":null,"abstract":"<div><h3>Introduction</h3><div>Congenital renal and urogenital anomalies represent a major part of all congenital anomalies. These range from mild, transient conditions to severe forms leading to irreversible organ damage or perinatal mortality. Timely prenatal identification is crucial for expecting parents and their healthcare providers to decide about the continuation of a pregnancy or for careful planning of perinatal and postnatal care.</div></div><div><h3>Objective</h3><div>To describe the most common indications for referral of fetal renal and urogenital malformations, the process of narrowing the differential diagnosis based on prenatal ultrasonography and the coordination between prenatal and postnatal care in a tertiary care center in the Netherlands.</div></div><div><h3>Results</h3><div>The most common indications for referral of fetal renal and urogenital malformations are: (1)<!--> <!-->abnormal renal parenchyma; (2)<!--> <!-->urinary tract dilatation; (3)<!--> <!-->abnormal bladder appearance, and (4)<!--> <!-->atypical genitalia. In the differential diagnosis, ultrasonographic evaluation is crucial to determine the specific region of the urogenital system affected, its onset during pregnancy, and its progression throughout gestation. Integrated prenatal and postnatal care for these types of malformations relies on a multidisciplinary approach to guide parental decision-making in continuation of the pregnancy and optimize outcomes. Some cases only require routine perinatal care in secondary care centers, while complex malformations benefit from specialized planning at tertiary centers to improve outcomes.</div></div><div><h3>Conclusion</h3><div>Dedicated ultrasonographic evaluation of fetal renal and urogenital anomalies in a tertiary care center enables accurate diagnosis and individualized care planning, particularly in complex cases. This approach provides parents with timely information, supports decision-making, and guides individualized perinatal care.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 9","pages":"Article 501816"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425556","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 : 2025-11-01DOI: 10.1016/j.acuro.2025.501841
G. Lendínez-Cano , C. Roldán Cumbreras , C.B. Congregado Ruíz , R.A. Medina López
Introduction
Palliative care is a fundamental component of the comprehensive management of patients with advanced cancer, significantly improving quality of life. Since most patients with metastatic renal cell carcinoma (mRCC) ultimately die from disease progression, end-of-life care represents a key element of quality cancer care. This area can be assessed through specific indicators derived from administrative data.
Materials and methods
We conducted a retrospective analysis of patients diagnosed with mRCC who initiated treatment at our center between September 2012 and September 2019, evaluating quality indicators related to end-of-life care.
Results
Of the 71 patients identified, 57 had died at the time of analysis (81.6%).
A total of 59.6% (95% CI; 46.8-72.3) died in hospital, 64% of these in palliative care units. In the last 30 days of life, 22.8% (95% CI: 12-33.5) visited the emergency room more than once, while only 1.8% (95% CI: 0-5.1) were admitted to the ICU. Contact with palliative care services was documented in 49% (95% CI: 36.1-62) of patients, although only 5.3% (95% CI: 0-11.1) received early referral (more than 90 days before death).
Conclusions
Palliative care in mRCC is underutilized and predominantly offered as terminal care, with early referral being exceptional. Multidisciplinary strategies are needed to optimize these services.
{"title":"Análisis de la atención al final de la vida y cuidados paliativos en los pacientes con cáncer renal metastásico","authors":"G. Lendínez-Cano , C. Roldán Cumbreras , C.B. Congregado Ruíz , R.A. Medina López","doi":"10.1016/j.acuro.2025.501841","DOIUrl":"10.1016/j.acuro.2025.501841","url":null,"abstract":"<div><h3>Introduction</h3><div>Palliative care is a fundamental component of the comprehensive management of patients with advanced cancer, significantly improving quality of life. Since most patients with metastatic renal cell carcinoma (mRCC) ultimately die from disease progression, end-of-life care represents a key element of quality cancer care. This area can be assessed through specific indicators derived from administrative data.</div></div><div><h3>Materials and methods</h3><div>We conducted a retrospective analysis of patients diagnosed with mRCC who initiated treatment at our center between September 2012 and September 2019, evaluating quality indicators related to end-of-life care.</div></div><div><h3>Results</h3><div>Of the 71 patients identified, 57 had died at the time of analysis (81.6%).</div><div>A total of 59.6% (95% CI; 46.8-72.3) died in hospital, 64% of these in palliative care units. In the last 30 days of life, 22.8% (95% CI: 12-33.5) visited the emergency room more than once, while only 1.8% (95% CI: 0-5.1) were admitted to the ICU. Contact with palliative care services was documented in 49% (95% CI: 36.1-62) of patients, although only 5.3% (95% CI: 0-11.1) received early referral (more than 90 days before death).</div></div><div><h3>Conclusions</h3><div>Palliative care in mRCC is underutilized and predominantly offered as terminal care, with early referral being exceptional. Multidisciplinary strategies are needed to optimize these services.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 9","pages":"Article 501841"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425435","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 : 2025-11-01DOI: 10.1016/j.acuro.2025.501834
A. Farré , J. Huguet , G. Basile, L. Diéguez, P. Izquierdo, R. Sánchez, P. Gavrilov, A. Gallioli, O. Rodríguez Faba, J.M. Gaya, J. Palou, A. Breda
Introduction
The management of non-muscle invasive bladder cancer (NMIBC) failing Bacillus Calmette-Guérin (BCG) therapy remains challenging. The European Association of Urology (EAU) has standardized definitions of BCG failure. We aim to evaluate oncological outcomes in patients undergoing radical cystectomy (RC) for NMIBC following BCG failure, as defined by the EAU.
Methods
Retrospective study analyzed 93 patients with NMIBC who underwent RC between 2011 and 2021 after BCG therapy failure. Patients were stratified into 4 groups: clinical NMIBC, clinical progression, subclinical progression (understaged), and pathological NMIBC (pNMIBC) groups. Oncological outcomes included cancer-specific survival (CSS) and overall survival (OS). Kaplan-Meier and logistic regression analyses were used to evaluate outcomes and predictors of disease progression.
Results
Among 93 patients, 64 (68.8%) had clinical NMIBC, and 29 (31.2%) showed clinical progression to muscle-invasive bladder cancer (MIBC) prior to RC. Of those with clinical NMIBC, 46 (71.9%) were confirmed as pNMIBC and 18 (28.1%) had subclinical progression. Patients with pNMIBC had significantly better 5-year CSS (95.5%) and OS (77.6%) compared to those with clinical (CSS 70.4%, OS 50.2%) or subclinical progression (CSS 64.1%, OS 43.8%). cT1 with concomitant carcinoma in situ and prostatic urethral involvement were independent predictors of muscle-invasive disease at RC.
Conclusions
Patients treated at an appropriate stage show superior survival outcomes compared to those with progression. These findings underscore the importance of timely surgical intervention in BCG-unresponsive NMIBC and support early RC in select high-risk patients to improve long-term prognosis.
卡介苗治疗失败的非肌肉浸润性膀胱癌（NMIBC）的治疗仍然具有挑战性。欧洲泌尿外科协会（EAU）对卡介苗失败有标准化的定义。我们的目的是评估在BCG失败后接受根治性膀胱切除术（RC）的NMIBC患者的肿瘤学结果。方法回顾性分析2011年至2021年间93例卡介苗治疗失败后接受RC治疗的NMIBC患者。将患者分为临床NMIBC组、临床进展组、亚临床进展组和病理性NMIBC组（pNMIBC）。肿瘤预后包括癌症特异性生存期（CSS）和总生存期（OS）。Kaplan-Meier和logistic回归分析用于评估结果和疾病进展的预测因素。结果93例患者中，64例（68.8%）有临床NMIBC， 29例（31.2%）在RC前有临床进展为肌肉浸润性膀胱癌（MIBC）。在临床NMIBC患者中，46例（71.9%）确诊为pNMIBC， 18例（28.1%）为亚临床进展。pNMIBC患者的5年CSS（95.5%）和OS（77.6%）明显优于临床（CSS 70.4%, OS 50.2%）或亚临床进展（CSS 64.1%, OS 43.8%）患者。cT1合并原位癌和前列腺尿道受累是RC肌肉侵袭性疾病的独立预测因子。结论：与进展期患者相比，在适当阶段治疗的患者具有更好的生存结果。这些发现强调了及时手术干预bcg无反应的NMIBC的重要性，并支持早期RC选择高危患者以改善长期预后。
{"title":"Resultados oncológicos en los pacientes con tumor vesical no músculo invasivo sometidos a cistectomía radical tras el fracaso a BCG según las definiciones propuestas por la Asociación Europea de Urología","authors":"A. Farré , J. Huguet , G. Basile, L. Diéguez, P. Izquierdo, R. Sánchez, P. Gavrilov, A. Gallioli, O. Rodríguez Faba, J.M. Gaya, J. Palou, A. Breda","doi":"10.1016/j.acuro.2025.501834","DOIUrl":"10.1016/j.acuro.2025.501834","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of non-muscle invasive bladder cancer (NMIBC) failing Bacillus Calmette-Guérin (BCG) therapy remains challenging. The European Association of Urology (EAU) has standardized definitions of BCG failure. We aim to evaluate oncological outcomes in patients undergoing radical cystectomy (RC) for NMIBC following BCG failure, as defined by the EAU.</div></div><div><h3>Methods</h3><div>Retrospective study analyzed 93 patients with NMIBC who underwent RC between 2011 and 2021 after BCG therapy failure. Patients were stratified into 4 groups: clinical NMIBC, clinical progression, subclinical progression (understaged), and pathological NMIBC (pNMIBC) groups. Oncological outcomes included cancer-specific survival (CSS) and overall survival (OS). Kaplan-Meier and logistic regression analyses were used to evaluate outcomes and predictors of disease progression.</div></div><div><h3>Results</h3><div>Among 93 patients, 64 (68.8%) had clinical NMIBC, and 29 (31.2%) showed clinical progression to muscle-invasive bladder cancer (MIBC) prior to RC. Of those with clinical NMIBC, 46 (71.9%) were confirmed as pNMIBC and 18 (28.1%) had subclinical progression. Patients with pNMIBC had significantly better 5-year CSS (95.5%) and OS (77.6%) compared to those with clinical (CSS 70.4%, OS 50.2%) or subclinical progression (CSS 64.1%, OS 43.8%). cT1 with concomitant carcinoma in situ and prostatic urethral involvement were independent predictors of muscle-invasive disease at RC.</div></div><div><h3>Conclusions</h3><div>Patients treated at an appropriate stage show superior survival outcomes compared to those with progression. These findings underscore the importance of timely surgical intervention in BCG-unresponsive NMIBC and support early RC in select high-risk patients to improve long-term prognosis.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 9","pages":"Article 501834"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425555","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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