Actas urologicas espanolas最新文献_第5页

Técnicas de uretero-ureterostomía en la duplicación ureteral: una revisión narrativa de la literatura 尿道复制中的尿道造口术：文献叙述综述

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2025-10-01 DOI: 10.1016/j.acuro.2025.501817

M. Keleş , A. Harun Kinik , M. Selçuk Silay

Introduction

The aim of this narrative review is to evaluate the uretero-ureteral anastomosis (UUA) methods applied as a surgical option in duplicated renal systems.

Material and methods

Studies evaluating pediatric patients under 18 years of age who underwent any type of uretero-ureteral anastomosis due to double collecting system were included in the review. The other surgical methods to treat duplex systems such as heminephrectomy, ureteral reimplantation and ureteral clipping were excluded. The studies found by searching the keywords «double collecting system ureter ureteral anastomosis», «double collecting system ureteroureterostomy», «duplex kidney ureter ureteral anastomosis», «duplex kidney ureteroureterostomy» in PubMed. Study design, operative measures, technique of surgery, follow-up time, key results and complications were recorded.

Results

A total of 29 studies from 1967 to 2024 (including 2024) were included in the review. When the studies were analysed, there were no studies comparing the three main UUA procedures (open, laparoscopic and robot-assisted laparoscopic). In studies comparing open and robot-assisted UUA, and laparoscopic versus open techniques, minimally invasive approaches demonstrated shorter hospital stays and comparable outcomes, while operation times were similar across groups.

Discussion

According to the available literature, all of the operative approaches are feasible with high success and low complication rates. However, it is not sufficient to determine the superiority of open, laparoscopic and robot-assisted laparoscopic UUA methods. Prospective comparative studies are required to elucidate the effectivity of different methods to treat duplex systems in children.

本综述的目的是评价输尿管-输尿管吻合术（UUA）方法在重复肾系统中的应用。材料和方法评价18岁以下因双收集系统行输尿管-输尿管吻合术的儿童患者的研究纳入本综述。排除了其他治疗双系统的手术方法，如半肾切除术、输尿管再植术和输尿管夹持术。在PubMed检索关键词“双收集系统输尿管输尿管吻合术”、“双收集系统输尿管输尿管吻合术”、“双肾输尿管输尿管吻合术”、“双肾输尿管输尿管输尿管吻合术”发现的研究。记录研究设计、手术措施、手术技术、随访时间、主要结果及并发症。结果1967 - 2024年（含2024年）共纳入29项研究。当研究被分析时，没有研究比较三种主要的UUA手术（开放、腹腔镜和机器人辅助腹腔镜）。在比较开放式和机器人辅助的UUA，以及腹腔镜与开放式技术的研究中，微创方法显示出更短的住院时间和可比较的结果，而两组之间的手术时间相似。根据现有文献，所有手术入路均可行，成功率高，并发症发生率低。然而，尚不足以确定开放、腹腔镜和机器人辅助腹腔镜UUA方法的优越性。需要前瞻性的比较研究来阐明治疗儿童双相系统的不同方法的有效性。

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引用次数: 0

Toxicidad aguda de la SBRT en cáncer de próstata localizado: estudio multicéntrico español SBRT在局部前列腺癌中的急性毒性：西班牙多中心研究

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2025-10-01 DOI: 10.1016/j.acuro.2025.501798

S.E. Romero Zoghbi , F. López Campos , D. Sanz-Rosa , J. Fernández Ibiza , I.J. Thuissard-Vasallo , C. Andreu-Vázquez , C. Laria , J. Andreescu Yagüe , E. Krumina , A. Ocanto , M. Mateos , L.A. Glaría , J.A. García Cuesta , D. Gonsalves , C. Fernández , D. Esteban , J. Begara de la Fuente , D. Rivas , E. López Ramírez , L. Aakki , F. Couñago

Introduction

Stereotactic body radiation therapy (SBRT) has emerged as an effective option for the treatment of localized prostate cancer; however, data from real-world clinical practice remain limited.

Material and Methods

Between January 2020 and December 2023, 251 patients with localized prostate cancer treated with SBRT were included in 12 centers in Spain. The treatment volume included prostate + /- seminal vesicles, without prophylactic pelvic radiotherapy. A dose of 35-40 Gy was prescribed in 5 fractions, every other day. Acute genitourinary (GU), gastrointestinal (GI) and sexual toxicity was assessed up to 6 months post-treatment using the Common Terminology Criteria for Adverse Events (CTCAE) v5.0.

Results

A total of 251 patients were classified based on the National Comprehensive Cancer Network (NCCN®) classification. Four percent of patients had very low-risk disease, 26.3% low-risk, and 66.5% intermediate-risk (27.1% favorable intermediate and 39.4% unfavorable intermediate). Additionally, 2.8% were classified as high-risk and 0.4% as very high-risk. The median patient age was 72 years (range: 65–76), and the baseline PSA was 6.7 ng/mL (range: 5.3–8.7). The median SBRT dose was 40 Gy (range: 35–40 Gy). Grade 2 acute GU toxicity occurred in 6.4% of patients, and grade 3 in 0.4%. Grade 2 GI toxicity was observed in 0.8%, with no cases of grade 3 GI toxicity. Regarding sexual toxicity, 11.2% of patients experienced grade 2, and 1.2% grade 3 toxicity.

Conclusions

Five-fraction SBRT is a feasible and safe treatment with a low incidence of acute toxicity.

立体定向放射治疗（SBRT）已成为治疗局限性前列腺癌的有效选择；然而，来自真实世界临床实践的数据仍然有限。材料和方法在2020年1月至2023年12月期间，251名接受SBRT治疗的局限性前列腺癌患者被纳入西班牙12个中心。治疗容积包括前列腺+ /-精囊，无盆腔预防性放疗。35- 40gy的剂量分为5份，每隔一天服用一次。使用不良事件通用术语标准（CTCAE） v5.0对治疗后6个月的急性泌尿生殖系统（GU）、胃肠道（GI）和性毒性进行评估。结果251例患者按照国家综合癌症网络（NCCN®）分类。4%的患者为极低风险，26.3%为低风险，66.5%为中风险（27.1%为有利的中间风险，39.4%为不利的中间风险）。此外，2.8%的人被列为高危人群，0.4%的人被列为高危人群。患者中位年龄为72岁（范围：65-76），基线PSA为6.7 ng/mL（范围：5.3-8.7）。SBRT的中位剂量为40 Gy（范围：35-40 Gy）。6.4%的患者发生2级急性GU毒性，0.4%的患者发生3级急性GU毒性。2级胃肠道毒性为0.8%，没有3级胃肠道毒性病例。关于性毒性，11.2%的患者出现2级毒性，1.2%出现3级毒性。结论五段式SBRT是一种安全可行、急性毒性低的治疗方法。

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引用次数: 0

Análisis de la composición de cálculos urinarios mediante espectroscopia infrarroja 使用红外光谱分析尿路结石成分

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2025-09-01 DOI: 10.1016/j.acuro.2025.501810

X. Han , Z. Zhang , P. Yao , X. Yang

Objective

To assess the composition of urinary stones in Lanzhou area and provide a reference basis for its clinical prevention and treatment.

Methods

A total of 1284 patients with urinary stones were included in the study. The differences in the distribution of stone components among different genders and ages were then analyzed.

Results

The overall male-to-female ratio of the cases was 3.2:1. The average age of the patients was 45.1 ± 14.0 years old. The ratio between upper and lower urinary tract stones was 7.13:1. Mixed stone composition accounted for the majority, 79.0% (1014/1284), with calcium oxalate monohydrate + calcium oxalate dihydrate + carbonate apatite being the most prevalent at 35% (449/1284), and calcium oxalate monohydrate stones being the most prevalent of the single components at 17.8% (228/1284). Apatite carbonate 62.2% (191/307) and magnesium ammonium phosphate hexahydrate 9.8% (30/307) were significantly higher in female patients compared to apatite carbonate 55.2% (539/977) and 2.8% (27/977) in male patients. Calcium oxalate was significantly more prevalent in patients aged 18-60 years than in patients < 18 and ≥ 60 years. The proportion of patients over the age of 60 with urinary stones (10.4%) was significantly higher than patients in other age groups.

Conclusion

Urological stones in Lanzhou area are mainly of mixed type, calcium oxalate monohydrate + calcium oxalate dihydrate + carbonate apatite is the most; with the increase of patient's age, the proportion of uric acid stones increases; the distribution of urinary stone components has significant differences with different genders of patients and different age groups, which is of great significance for clinical prevention and treatment.

目的了解兰州地区泌尿系结石的组成，为其临床防治提供参考依据。方法共纳入1284例泌尿系结石患者。然后分析了不同性别和年龄的石质成分分布的差异。结果全部病例的男女比例为3.2:1。患者平均年龄45.1±14.0岁。上、下尿路结石的比例为7.13:1。混合结石成分占多数，为79.0%(1014/1284)，其中一水草酸钙+二水草酸钙+碳酸盐磷灰石最多，为35%(449/1284)，一水草酸钙结石以单一成分最多，为17.8%（228/1284）。女性患者碳酸磷灰石阳性率62.2%（191/307）、六水磷酸铵镁阳性率9.8%（30/307）显著高于男性患者碳酸磷灰石阳性率55.2%（539/977）、2.8%（27/977）。草酸钙在18-60岁患者中的患病率明显高于18岁和≥60岁患者。60岁以上患者发生尿路结石的比例（10.4%）明显高于其他年龄组。结论兰州地区泌尿系结石以混合型为主，以一水草酸钙+二水草酸钙+碳酸钙磷灰石居多；随着患者年龄的增加，尿酸结石的比例增加；尿石成分的分布在不同性别、不同年龄段的患者中存在显著差异，对临床防治具有重要意义。

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引用次数: 0

¿Es necesario el estado 100% libre de litiasis en los casos de cálculos coraliformes? 珊瑚结石需要100%无石屑状态吗？

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2025-09-01 DOI: 10.1016/j.acuro.2025.501812

G. Freschi , D.P. Resuto , R.H. Astolfi , W.R. Molina , A. Meller

Introduction and objectives

To evaluate long-term outcomes in staghorn stone patients with residual fragments following surgical treatment.

Materials and methods

A retrospective study of patients who underwent percutaneous nephrolithotripsy for staghorn stones and long term follow up were divided into two groups: residual stones versus non-residual stones. The occurrence of new stones or fragment growth, infectious events, and renal function were evaluated. Patients with a follow-up period of less than one year were excluded.

Results

A total of 87 patients (75.9% female) were included in the study. Of these, 21.8% were stone-free, while 78.2% exhibited residual fragments with a median size of 7 mm (3.5-11.5 mm). The average follow-up period was 27 months (21-36 months). Only 24.1% experienced recurrence or growth of residual fragments, with a median growth of 10 mm (6-12 mm). Additionally, 14.9% of patients developed urinary infections during the follow-up period. No significant differences were observed between stone-free patients and those with residual fragments in terms of recurrence, residual fragments growth, infectious events, or deterioration in renal function. Similarly, no differences were noted when comparing patients with positive or negative cultures.

Conclusions

The incidence of recurrence, growth of residual fragments, infectious events, and deterioration of renal function was comparable between patients with and without residual stones. Furthermore, the presence of positive preoperative or intraoperative cultures did not influence these outcomes.

前言和目的评价鹿角石术后残留碎片患者的长期预后。材料与方法回顾性研究经皮肾镜碎石术治疗鹿角结石的患者并进行长期随访，分为残留结石组和非残留结石组。评估新结石或碎片生长情况、感染事件和肾功能。随访期少于一年的患者被排除在外。结果共纳入87例患者，其中女性占75.9%。其中，21.8%无结石，78.2%残留碎片，中位尺寸为7 mm （3.5-11.5 mm）。平均随访27个月（21 ~ 36个月）。仅有24.1%复发或残存碎片生长，中位生长10 mm （6-12 mm）。此外，14.9%的患者在随访期间发生尿路感染。无结石患者与残留碎片患者在复发、残留碎片生长、感染事件或肾功能恶化方面无显著差异。同样，当比较阳性或阴性培养的患者时，也没有发现差异。结论有无残留结石患者的复发、残留碎片生长、感染事件和肾功能恶化的发生率相当。此外，术前或术中培养阳性并不影响这些结果。

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引用次数: 0

Manejo de la corrección fallida de hipospadias: revisión exhaustiva de estrategias y resultados 管理不成功的足下矫正：全面审查战略和结果

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2025-09-01 DOI: 10.1016/j.acuro.2025.501809

L.E. Jesus , J.L. Pippi-Salle

Introduction

Hypospadias surgery has a failure rate ranging from 10% for distal cases to over 30% for proximal cases. However, real-world outcomes may be worse, as some complications emerge late in puberty or are underreported. The expectations for surgical success have evolved, shifting from basic urinary and sexual functionality to achieving a normal penile appearance. Bias in research favors retrospective studies with short follow-ups, and qualitative research remains scarce. This review describes complications following hypospadias surgery, their management, and prognosis.

Method

A non-systematic critical review of existing literature on hypospadias complications and surgical management was conducted.

Results

Common complications include urethrocutaneous fistulae (UCF), glans dehiscence (GD), urethral stenosis (US), urethral diverticulae (UD), urine spraying, and recurrent curvature (RC). UCF is the most frequently reported complication, treated through multilayer closure with vascularized flap coverage. GD occurs more frequently in proximal hypospadias, requiring glans reformatting and tissue augmentation. US often manifests as meatal stenosis or neourethral strictures, requiring meatoplasty or staged urethroplasty. UD arises from loose urethral segments subjected to high urinary flow resistance and is managed via excision or remodeling. Urine spraying is linked to insufficient glans fusion or meatal irregularities, sometimes requiring surgical correction. RC is a significant complication impacting sexual function, requiring individualized correction through dorsal plication or ventral lengthening.

Conclusions

Hypospadias complications require individualized assessment and surgical planning. Late complications, often underrecognized, should be considered in long-term follow-up. Proper surgical technique selection and postoperative evaluation help mitigate recurrence and improve patient outcomes.

尿道下裂手术失败率远端为10%，近端为30%以上。然而，现实世界的结果可能更糟，因为一些并发症出现在青春期后期或被低估。对手术成功的期望已经发生了变化，从基本的泌尿和性功能转移到实现正常的阴茎外观。研究偏向于短期随访的回顾性研究，而定性研究仍然很少。本文综述了尿道下裂手术后的并发症、处理方法和预后。方法对现有关于尿道下裂并发症及手术治疗的文献进行非系统的批判性回顾。结果常见并发症包括尿道瘘（UCF）、龟头裂（GD）、尿道狭窄（US）、尿道憩室（UD）、尿喷、复发曲度（RC）等。UCF是最常见的并发症，通过带血管瓣覆盖的多层闭合治疗。GD多发生在尿道下裂近端，需要龟头重构和组织增大。美国经常表现为金属狭窄或神经尿道狭窄，需要肉成形术或分期尿道成形术。尿路障碍是由于尿道段松动引起的，尿道段受到高尿流阻力，通过切除或重塑来治疗。尿喷与龟头融合不足或金属不规则有关，有时需要手术矫正。RC是影响性功能的重要并发症，需要通过背侧延伸或腹侧延长进行个体化矫正。结论尿道下裂并发症需要个体化评估和手术计划。晚期并发症常被忽视，应在长期随访中予以考虑。正确的手术技术选择和术后评估有助于减轻复发和改善患者预后。

{"title":"Manejo de la corrección fallida de hipospadias: revisión exhaustiva de estrategias y resultados","authors":"L.E. Jesus , J.L. Pippi-Salle","doi":"10.1016/j.acuro.2025.501809","DOIUrl":"10.1016/j.acuro.2025.501809","url":null,"abstract":"<div><h3>Introduction</h3><div>Hypospadias surgery has a failure rate ranging from 10% for distal cases to over 30% for proximal cases. However, real-world outcomes may be worse, as some complications emerge late in puberty or are underreported. The expectations for surgical success have evolved, shifting from basic urinary and sexual functionality to achieving a normal penile appearance. Bias in research favors retrospective studies with short follow-ups, and qualitative research remains scarce. This review describes complications following hypospadias surgery, their management, and prognosis.</div></div><div><h3>Method</h3><div>A non-systematic critical review of existing literature on hypospadias complications and surgical management was conducted.</div></div><div><h3>Results</h3><div>Common complications include urethrocutaneous fistulae (UCF), glans dehiscence (GD), urethral stenosis (US), urethral diverticulae (UD), urine spraying, and recurrent curvature (RC). UCF is the most frequently reported complication, treated through multilayer closure with vascularized flap coverage. GD occurs more frequently in proximal hypospadias, requiring glans reformatting and tissue augmentation. US often manifests as meatal stenosis or neourethral strictures, requiring meatoplasty or staged urethroplasty. UD arises from loose urethral segments subjected to high urinary flow resistance and is managed via excision or remodeling. Urine spraying is linked to insufficient glans fusion or meatal irregularities, sometimes requiring surgical correction. RC is a significant complication impacting sexual function, requiring individualized correction through dorsal plication or ventral lengthening.</div></div><div><h3>Conclusions</h3><div>Hypospadias complications require individualized assessment and surgical planning. Late complications, often underrecognized, should be considered in long-term follow-up. Proper surgical technique selection and postoperative evaluation help mitigate recurrence and improve patient outcomes.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 7","pages":"Article 501809"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144922157","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

Mapeo de las disparidades regionales en la mortalidad por cáncer de testículo en España (2004-2023) 西班牙睾丸癌死亡率区域差异图（2004-2023年）

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2025-09-01 DOI: 10.1016/j.acuro.2025.501800

L. Cayuela , S. Cabrera Fernández , R. Roldán Testillano , M. Ortega Calvo , A. Cayuela

Introduction

This study investigates testicular cancer (TC) mortality trends and spatial patterns in Spain, utilizing provincial-level spatial analysis to identify high-risk clusters.

Methods

An ecological study was conducted using TC mortality data (ICD-10 code C62) from the Spanish National Institute of Statistics (2004-2023). Age-standardized mortality rates were calculated using the direct method. Temporal trends were analyzed with Joinpoint regression. Spatial patterns were assessed using standardized mortality ratios, smoothed relative risk, and posterior probabilities through Bayesian hierarchical models. Spatial clustering was examined with Tango's test and Kulldorff's likelihood ratio test.

Results

A total of 909 TC deaths were recorded, with age-standardized mortality rates ranging from 0.14 to 0.26 per 1,000,000 inhabitants. No significant temporal trends were observed. Age-specific mortality showed a bimodal distribution, peaking at ages 35-39 and 85+. The highest standardized mortality ratios were found in Zamora (2.58), Segovia (2.64), and Soria (2.39), while the lowest were in Madrid (0.66) and Barcelona (0.55). Bayesian spatial analysis identified elevated relative risk in Badajoz (1.6), Huelva (1.47), and Sevilla (1.4). Kulldorff's analysis revealed a high-mortality cluster in southwestern Spain (Huelva, Sevilla, Badajoz), with a secondary cluster extending to neighbouring provinces.

Conclusions

While TC mortality in Spain remained stable, significant regional disparities exist. High-risk provinces and mortality clusters highlight potential inequalities in healthcare access, socioeconomic conditions, and environmental exposures.

本研究调查了西班牙睾丸癌（TC）死亡率趋势和空间模式，利用省级空间分析来确定高危集群。方法采用西班牙国家统计局2004-2023年TC死亡率数据（ICD-10代码C62）进行生态学研究。采用直接法计算年龄标准化死亡率。用关节点回归分析时间趋势。通过贝叶斯层次模型，使用标准化死亡率、平滑相对风险和后验概率来评估空间格局。空间聚类分析采用Tango检验和Kulldorff似然比检验。结果共有909例TC死亡，年龄标准化死亡率为0.14 ~ 0.26 / 100万居民。没有观察到明显的时间趋势。按年龄划分的死亡率呈双峰分布，在35-39岁和85岁以上达到高峰。标准化死亡率最高的是萨莫拉（2.58）、塞戈维亚（2.64）和索里亚（2.39），最低的是马德里（0.66）和巴塞罗那（0.55）。贝叶斯空间分析发现巴达霍斯（1.6）、韦尔瓦（1.47）和塞维利亚（1.4）的相对危险度较高。Kulldorff的分析显示，西班牙西南部（韦尔瓦、塞维利亚、巴达霍斯）有一个高死亡率聚集群，第二个聚集群延伸到邻近省份。结论西班牙TC死亡率保持稳定，但存在显著的地区差异。高风险省份和死亡率集群突出了医疗保健获取、社会经济条件和环境暴露方面的潜在不平等。

{"title":"Mapeo de las disparidades regionales en la mortalidad por cáncer de testículo en España (2004-2023)","authors":"L. Cayuela , S. Cabrera Fernández , R. Roldán Testillano , M. Ortega Calvo , A. Cayuela","doi":"10.1016/j.acuro.2025.501800","DOIUrl":"10.1016/j.acuro.2025.501800","url":null,"abstract":"<div><h3>Introduction</h3><div>This study investigates testicular cancer (TC) mortality trends and spatial patterns in Spain, utilizing provincial-level spatial analysis to identify high-risk clusters.</div></div><div><h3>Methods</h3><div>An ecological study was conducted using TC mortality data (ICD-10 code C62) from the Spanish National Institute of Statistics (2004-2023). Age-standardized mortality rates were calculated using the direct method. Temporal trends were analyzed with Joinpoint regression. Spatial patterns were assessed using standardized mortality ratios, smoothed relative risk, and posterior probabilities through Bayesian hierarchical models. Spatial clustering was examined with Tango's test and Kulldorff's likelihood ratio test.</div></div><div><h3>Results</h3><div>A total of 909 TC deaths were recorded, with age-standardized mortality rates ranging from 0.14 to 0.26 per 1,000,000 inhabitants. No significant temporal trends were observed. Age-specific mortality showed a bimodal distribution, peaking at ages 35-39 and 85+. The highest standardized mortality ratios were found in Zamora (2.58), Segovia (2.64), and Soria (2.39), while the lowest were in Madrid (0.66) and Barcelona (0.55). Bayesian spatial analysis identified elevated relative risk in Badajoz (1.6), Huelva (1.47), and Sevilla (1.4). Kulldorff's analysis revealed a high-mortality cluster in southwestern Spain (Huelva, Sevilla, Badajoz), with a secondary cluster extending to neighbouring provinces.</div></div><div><h3>Conclusions</h3><div>While TC mortality in Spain remained stable, significant regional disparities exist. High-risk provinces and mortality clusters highlight potential inequalities in healthcare access, socioeconomic conditions, and environmental exposures.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 7","pages":"Article 501800"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144922085","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

Competencias quirúrgicas en urología: concordancia entre la percepción de residentes y profesionales en ejercicio en un país latinoamericano 泌尿科的外科手术技能：拉丁美洲国家居民与执业专业人员之间的一致性

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2025-09-01 DOI: 10.1016/j.acuro.2025.501794

J. Scherñuk, M.G. Dorsemaine, J.K. Toapanta Ortega, D. Zimmermann, I.P. Tobia, D. Santillán

Introduction

Consensus remains lacking on which surgeries should be deemed essential for general urologists and which should be reserved for subspecialists. This study aims to compare the perceptions of urology trainees (Trainees) and practicing urologists (PractUrol) regarding the relevance of surgeries for independent practice and subspecialist training.

Methods

Cross-sectional comparative study on Trainees and PractUrol from a Latin-American country. Participants completed a Google Forms® questionnaire on 56 urological surgeries in September-October 2023, categorizing each as Essential Index (E-index), Supervised Index (Sup-index), or Subspecialty (Subspec). Statistical comparisons were performed using Chi-square or Fisher's exact tests with Bonferroni correction.

Results

Among 138 participants (109 PractUrol, 29 Trainees), 78.6% (44/56) of surgeries showed agreement between groups, with 13 surgeries achieving over 75% concordance. Disagreements were noted for 21.4% (12/56) of surgeries: (1) Microvaricocelectomy, penectomy, DVIU, ureteral reimplantation, and vesicovaginal fístula repair were more often classified as Subspec by Trainees but as E-index by PractUrol. (2) Radical cystectomy with orthotopic diversion and Boari Flap were classified as Subspec by Trainees but as Sup-index by PractUrol. (3) Partial cystectomy, pelvic, and inguinal lymphadenectomy were more frequently deemed Subspec by Trainees. (4) Flexible ureteroscopy was considered E-index by Trainees but Sup-index by PractUrol. (5) Artificial urinary sphincter placement was more often classified as Sup-index by PractUrol.

Conclusion

There is substantial agreement on the relevance of urological surgeries between PractUrol and Trainees, including 13 surgeries deemed essential by over 75% of participants. However, differing opinions on 12 surgeries highlight areas for further discussion.

对于哪些手术对于普通泌尿科医生来说是必要的，哪些手术应该留给专科医生，共识仍然缺乏。本研究旨在比较泌尿外科培训生（受训者）和执业泌尿科医生（PractUrol）对独立执业和专科培训手术相关性的看法。方法对来自拉美某国的研修生和实业生进行横断面比较研究。参与者于2023年9月至10月完成了56例泌尿外科手术的谷歌Forms®问卷调查，并将其分类为基本指数（E-index）、监督指数（Sup-index）或亚专科（Subspec）。统计学比较采用卡方检验或Fisher精确检验，并进行Bonferroni校正。结果138例患者（PractUrol 109例，实习生29例）中，78.6%（44/56）例手术组间吻合，其中13例手术组间吻合率达75%以上。21.4%（12/56）的手术存在分歧：(1)微精索静脉曲张切除术、阴茎切除术、DVIU、输尿管再植和膀胱阴道fístula修复被练习者更多地归类为Subspec，而PractUrol则将其归类为e指数。(2)根治性膀胱切除术伴原位转流和Boari皮瓣被学员归为Subspec， PractUrol归为Sup-index。(3)部分膀胱切除术、盆腔和腹股沟淋巴结切除术更常被学员视为亚规范。(4)柔性输尿管镜被学员认为是E-index，而PractUrol认为是Sup-index。(5) PractUrol多将人工尿道括约肌置入术分类为supi -index。结论PractUrol和受训者对泌尿外科手术的相关性有实质性的共识，包括75%以上的参与者认为必要的13种手术。然而，对12种手术的不同意见突出了进一步讨论的领域。

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引用次数: 0

Nuevas perspectivas y estrategias emergentes de preservación vesical para el tumor vesical músculo invasivo 侵袭性肌肉膀胱肿瘤膀胱保存的新前景和新出现的策略

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2025-09-01 DOI: 10.1016/j.acuro.2025.501758

J.D. Subiela , F. Guerrero-Ramos , Ó. Rodríguez-Faba , J. Aumatell , P. Gajate , F. López-Campos , E. Sevillano , M. Hernández-Arroyo , E. García-Rojo , A. Artiles Medina , D. Sáenz-Calzada , C. Gómez-Cañizo , J. Romero-Otero , F. Couñago

Introduction and objective

Muscle-invasive bladder cancer (MIBC) poses significant challenges, traditionally treated with radical cystectomy, a procedure with considerable morbidity and impact on quality of life. Bladder-sparing approaches aim to preserve the bladder while maintaining oncological efficacy. This review explores emerging perspectives in bladder-sparing strategies for MIBC, focusing on patient selection criteria, molecular characterization, non-invasive treatment response assessment, systemic therapies, radiation techniques, and the role of intravesical devices.

Methods

A comprehensive narrative review provides insights into novel perspectives in bladder-sparing strategies for treating MIBC.

Results

Patient selection criteria for bladder preservation remain challenging. While the traditional approach focuses on selecting candidates with MIBC with fewer clinicopathological risk characteristics, some studies suggest that histological variants and the presence of hydronephrosis may not be absolute exclusion criteria. Molecular classification data shows promise but lacks sufficient evidence, while immune cell infiltration may provide insights into potential treatment response. MRI and radiomics offer the potential for non-invasive treatment response assessment. Ongoing trials investigate new systemic therapies, radiation therapy approaches, and the role of intravesical devices in bladder preservation, with some preliminary data appearing promising.

Conclusion

Bladder-sparing strategies for MIBC are currently experiencing substantial evolution. Achieving optimal patient selection may entail the integration of clinical, radiological, histopathological, and molecular data. It is likely that shortly, multimodal approaches incorporating neoadjuvant systemic therapy, radiotherapy, intravesical devices, and possibly maintenance or adjuvant regimens guided by biomarker-driven strategies will become standard practice.

简介与目的肌肉浸润性膀胱癌（MIBC）面临着巨大的挑战，传统上采用根治性膀胱切除术治疗，这一手术具有相当高的发病率和对生活质量的影响。保留膀胱入路的目的是在保持肿瘤疗效的同时保护膀胱。本综述探讨了MIBC保膀胱策略的新兴观点，重点关注患者选择标准、分子特征、非侵入性治疗反应评估、全身治疗、放射技术和膀胱内装置的作用。方法通过综合叙述综述，从新的角度探讨保膀胱治疗MIBC的策略。结果膀胱保留患者的选择标准仍然具有挑战性。虽然传统的方法侧重于选择具有较少临床病理风险特征的MIBC候选人，但一些研究表明，组织学变异和肾积水的存在可能不是绝对的排除标准。分子分类数据显示有希望，但缺乏足够的证据，而免疫细胞浸润可能提供潜在治疗反应的见解。MRI和放射组学为非侵入性治疗反应评估提供了可能。正在进行的试验研究了新的全身治疗方法、放射治疗方法和膀胱内装置在膀胱保存中的作用，一些初步数据看起来很有希望。结论：膀胱保留策略目前正经历着实质性的演变。实现最佳的患者选择可能需要整合临床、放射学、组织病理学和分子数据。可能在不久的将来，结合新辅助全身治疗、放疗、膀胱内装置以及可能由生物标志物驱动的策略指导的维持或辅助方案的多模式方法将成为标准做法。

{"title":"Nuevas perspectivas y estrategias emergentes de preservación vesical para el tumor vesical músculo invasivo","authors":"J.D. Subiela , F. Guerrero-Ramos , Ó. Rodríguez-Faba , J. Aumatell , P. Gajate , F. López-Campos , E. Sevillano , M. Hernández-Arroyo , E. García-Rojo , A. Artiles Medina , D. Sáenz-Calzada , C. Gómez-Cañizo , J. Romero-Otero , F. Couñago","doi":"10.1016/j.acuro.2025.501758","DOIUrl":"10.1016/j.acuro.2025.501758","url":null,"abstract":"<div><h3>Introduction and objective</h3><div>Muscle-invasive bladder cancer (MIBC) poses significant challenges, traditionally treated with radical cystectomy, a procedure with considerable morbidity and impact on quality of life. Bladder-sparing approaches aim to preserve the bladder while maintaining oncological efficacy. This review explores emerging perspectives in bladder-sparing strategies for MIBC, focusing on patient selection criteria, molecular characterization, non-invasive treatment response assessment, systemic therapies, radiation techniques, and the role of intravesical devices.</div></div><div><h3>Methods</h3><div>A comprehensive narrative review provides insights into novel perspectives in bladder-sparing strategies for treating MIBC.</div></div><div><h3>Results</h3><div>Patient selection criteria for bladder preservation remain challenging. While the traditional approach focuses on selecting candidates with MIBC with fewer clinicopathological risk characteristics, some studies suggest that histological variants and the presence of hydronephrosis may not be absolute exclusion criteria. Molecular classification data shows promise but lacks sufficient evidence, while immune cell infiltration may provide insights into potential treatment response. MRI and radiomics offer the potential for non-invasive treatment response assessment. Ongoing trials investigate new systemic therapies, radiation therapy approaches, and the role of intravesical devices in bladder preservation, with some preliminary data appearing promising.</div></div><div><h3>Conclusion</h3><div>Bladder-sparing strategies for MIBC are currently experiencing substantial evolution. Achieving optimal patient selection may entail the integration of clinical, radiological, histopathological, and molecular data. It is likely that shortly, multimodal approaches incorporating neoadjuvant systemic therapy, radiotherapy, intravesical devices, and possibly maintenance or adjuvant regimens guided by biomarker-driven strategies will become standard practice.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 7","pages":"Article 501758"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144922081","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

Duración de la deprivación androgénica con la radioterapia de rescate en los pacientes con cáncer de próstata con recidiva bioquímica tras cirugía: datos iniciales de reclutamiento en el ensayo fase III URONCOR 06-24 手术后生化复发的前列腺癌患者在进行挽救性放射治疗的同时剥夺雄激素的时间长短：III期试验初步招募数据URONCOR 06-24

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2025-09-01 DOI: 10.1016/j.acuro.2025.501823

C. González San Segundo , F. López-Campos , A. Gómez Iturriaga , M. Santos , A. Ocanto , L. Montezuma , A.M. Boladeras-Inglada , L. Glaria , S. Guardado , A. Rodríguez , I. Henríquez , J. Olivera , V. Duque-Santana , J. Garre , S. Moreno , J. Valero , A.J. Conde , A. Doval , G. Sancho , P. Martín Nieto , F. Couñago

Introduction

URONCOR 06-24 (NCT05781217) is a prospective, multicenter, randomized, open-label, phase III trial evaluating the impact on distant metastasis-free survival (MFS) of short-term (6 months) versus long-term (24 months) androgen deprivation therapy (ADT) in combination with salvage radiotherapy in high- and intermediate-risk patients after biochemical recurrence (BCR).

Material and method

A total of 534 men will be randomized to receive either 6 or 24 months of ADT. Stratification is based on risk group (intermediate vs high) and nodal status (pN0 vs pNx).

Results

From March 2023 to November 2024, 122 patients have been enrolled: 34 (28%) with intermediate risk and 88 (72%) with high risk. Fifty-five patients (45%) are pNx. The mean time from surgery to BCR is 25.4 months, and the PSA at inclusion was 0.55 ng/ml. Restaging was performed in 89 patients, 75 of whom underwent PET/CT (97%, PSMA PET/CT). Hypofractionation was used in 68% of cases, and elective pelvic irradiation in 33%. At the time of analysis, all patients had PSA normalization. No severe ADT-related toxicity has been reported

Conclusion

URONCOR 06-24 is the first clinical trial comparing long- versus short-term ADT in the setting of BCR after prostatectomy, with stratification by risk group. Initial recruitment data show a balanced distribution of prognostic factors between both arms and no serious adverse events related to ADT.

uroncor 06-24 （NCT05781217）是一项前瞻性、多中心、随机、开放标签的III期临床试验，评估短期（6个月）与长期（24个月）雄激素剥夺治疗（ADT）联合补补性放疗对生化复发（BCR）后中高危患者远处无转移生存（MFS）的影响。材料和方法总共534名男性将随机接受6个月或24个月的ADT治疗。分层是基于风险组（中等vs高）和淋巴结状态（pN0 vs pNx）。结果从2023年3月至2024年11月共纳入122例患者，其中中危34例（28%），高危88例（72%）。55例（45%）为pNx。从手术到BCR平均时间为25.4个月，纳入时PSA为0.55 ng/ml。89例患者进行了重新分期，其中75例接受了PET/CT（97%为PSMA PET/CT）。68%的病例采用低分割术，33%的病例采用选择性骨盆照射。分析时，所有患者PSA均恢复正常。结论uroncor 06-24是第一个比较前列腺切除术后BCR患者长期和短期ADT的临床试验，并按风险组分层。最初的招募数据显示两组预后因素分布平衡，没有与ADT相关的严重不良事件。

{"title":"Duración de la deprivación androgénica con la radioterapia de rescate en los pacientes con cáncer de próstata con recidiva bioquímica tras cirugía: datos iniciales de reclutamiento en el ensayo fase III URONCOR 06-24","authors":"C. González San Segundo , F. López-Campos , A. Gómez Iturriaga , M. Santos , A. Ocanto , L. Montezuma , A.M. Boladeras-Inglada , L. Glaria , S. Guardado , A. Rodríguez , I. Henríquez , J. Olivera , V. Duque-Santana , J. Garre , S. Moreno , J. Valero , A.J. Conde , A. Doval , G. Sancho , P. Martín Nieto , F. Couñago","doi":"10.1016/j.acuro.2025.501823","DOIUrl":"10.1016/j.acuro.2025.501823","url":null,"abstract":"<div><h3>Introduction</h3><div>URONCOR 06-24 (NCT05781217) is a prospective, multicenter, randomized, open-label, phase III trial evaluating the impact on distant metastasis-free survival (MFS) of short-term (6 months) versus long-term (24 months) androgen deprivation therapy (ADT) in combination with salvage radiotherapy in high- and intermediate-risk patients after biochemical recurrence (BCR).</div></div><div><h3>Material and method</h3><div>A total of 534 men will be randomized to receive either 6 or 24 months of ADT. Stratification is based on risk group (intermediate vs high) and nodal status (pN0 vs pNx).</div></div><div><h3>Results</h3><div>From March 2023 to November 2024, 122 patients have been enrolled: 34 (28%) with intermediate risk and 88 (72%) with high risk. Fifty-five patients (45%) are pNx. The mean time from surgery to BCR is 25.4 months, and the PSA at inclusion was 0.55 ng/ml. Restaging was performed in 89 patients, 75 of whom underwent PET/CT (97%, PSMA PET/CT). Hypofractionation was used in 68% of cases, and elective pelvic irradiation in 33%. At the time of analysis, all patients had PSA normalization. No severe ADT-related toxicity has been reported</div></div><div><h3>Conclusion</h3><div>URONCOR 06-24 is the first clinical trial comparing long- versus short-term ADT in the setting of BCR after prostatectomy, with stratification by risk group. Initial recruitment data show a balanced distribution of prognostic factors between both arms and no serious adverse events related to ADT.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 7","pages":"Article 501823"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144922082","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

Densidad de inyección en Rezum®: menos puede no ser más. Un estudio internacional multicéntrico Rezum®的注射密度：少即是多。多中心国际研究

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2025-09-01 DOI: 10.1016/j.acuro.2025.501824

I. Schwartzmann , S. Secco , A. Farré , S. García-Barreras , E. Fernández , M. D’Anna , L. Cindolo , V. Parejo , J.I. Tornero , G. Ferrari , F. Varvello , J. Ponce de León , I. Povo

Introduction

Water vapor thermal therapy (WVTT) has emerged as a minimally invasive surgical therapy (MIST) for benign prostatic obstruction. However, the optimal number of intraprostatic injections remains debated. This study introduces injection density (ID), defined as the number of injections per 10 cc of prostate volume, to assess its impact on treatment failure after WVTT.

Methods

Multicentric retrospective study across 11 European centers, analysing patients who underwent WVTT between March 2019 and March 2024. Baseline, surgical, and postoperative data were collected during a 24 months follow-up. The primary outcome was treatment failure, defined as the need for medical or surgical intervention 12 months post-WVTT. Secondary outcomes included sexual function and postoperative complications. Logistic regression was performed across ID cut-off points from 0.75 to 2.5 injections per 10 cc.

Results

A total of 722 patients underwent WVTT with a mean age of 64 years and a mean prostate volume of 60 cc. Baseline Qmax was 8.0 ± 3.6 ml/s. Intermediate ID cut-off points (1.25-1.75) suggested a protective effect against treatment failure, with 1.75 being the first to reach statistical significance (p = 0.028). Higher ID cut-off points (2.00-2.50) maintained a protective effect, but only 2.25 reached significance (P=.024). No significant relationship was found between ID and complications. Sexual function remained stable across ID thresholds.

Conclusions

Optimizing ID during WVTT may improve success rates without increasing complications or negatively impacting sexual function. These findings support a volumetric approach over the traditional linear injection technique to enhance WVTT outcomes.

水蒸气热疗法（WVTT）已成为一种治疗良性前列腺阻塞的微创手术疗法（MIST）。然而，前列腺内注射的最佳次数仍有争议。本研究引入注射密度（ID），定义为每10cc前列腺体积注射的次数，以评估其对WVTT后治疗失败的影响。方法11个欧洲中心的多中心回顾性研究，分析2019年3月至2024年3月期间接受WVTT治疗的患者。在24个月的随访中收集基线、手术和术后数据。主要结局是治疗失败，定义为wvtt后12个月是否需要药物或手术干预。次要结局包括性功能和术后并发症。结果722例患者接受WVTT治疗，平均年龄64岁，平均前列腺体积60cc，基线Qmax为8.0±3.6 ml/s。中间ID分界点（1.25-1.75）提示对治疗失败有保护作用，1.75首先达到统计学意义（p = 0.028）。较高的ID分界点（2.00-2.50）维持了保护作用，但只有2.25达到显著性（P= 0.024）。ID与并发症无明显关系。性功能在ID阈值范围内保持稳定。结论在不增加并发症和不影响性功能的前提下，优化体外移植术的ID可提高手术成功率。这些发现支持容积法优于传统的线性注入技术，以提高WVTT的效果。

{"title":"Densidad de inyección en Rezum®: menos puede no ser más. Un estudio internacional multicéntrico","authors":"I. Schwartzmann , S. Secco , A. Farré , S. García-Barreras , E. Fernández , M. D’Anna , L. Cindolo , V. Parejo , J.I. Tornero , G. Ferrari , F. Varvello , J. Ponce de León , I. Povo","doi":"10.1016/j.acuro.2025.501824","DOIUrl":"10.1016/j.acuro.2025.501824","url":null,"abstract":"<div><h3>Introduction</h3><div>Water vapor thermal therapy (WVTT) has emerged as a minimally invasive surgical therapy (MIST) for benign prostatic obstruction. However, the optimal number of intraprostatic injections remains debated. This study introduces injection density (ID), defined as the number of injections per 10 cc of prostate volume, to assess its impact on treatment failure after WVTT.</div></div><div><h3>Methods</h3><div>Multicentric retrospective study across 11 European centers, analysing patients who underwent WVTT between March 2019 and March 2024. Baseline, surgical, and postoperative data were collected during a 24 months follow-up. The primary outcome was treatment failure, defined as the need for medical or surgical intervention 12 months post-WVTT. Secondary outcomes included sexual function and postoperative complications. Logistic regression was performed across ID cut-off points from 0.75 to 2.5 injections per 10 cc.</div></div><div><h3>Results</h3><div>A total of 722 patients underwent WVTT with a mean age of 64 years and a mean prostate volume of 60 cc. Baseline Qmax was 8.0±3.6ml/s. Intermediate ID cut-off points (1.25-1.75) suggested a protective effect against treatment failure, with 1.75 being the first to reach statistical significance (p=0.028). Higher ID cut-off points (2.00-2.50) maintained a protective effect, but only 2.25 reached significance (<em>P</em>=.024). No significant relationship was found between ID and complications. Sexual function remained stable across ID thresholds.</div></div><div><h3>Conclusions</h3><div>Optimizing ID during WVTT may improve success rates without increasing complications or negatively impacting sexual function. These findings support a volumetric approach over the traditional linear injection technique to enhance WVTT outcomes.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 7","pages":"Article 501824"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144922083","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