Actas urologicas espanolas最新文献_第7页

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 Epub Date: 2025-04-03 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。

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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 Epub Date: 2025-07-05 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。

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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 Epub Date: 2025-07-05 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。

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引用次数: 0

Perfil clínico y factores de riesgo identificados en pacientes con cáncer renal en población mexicana 墨西哥人口中肾癌患者的临床概况和确定的危险因素

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2025-09-01 Epub Date: 2025-06-16 DOI: 10.1016/j.acuro.2025.501814

G. Sánchez-Villaseñor , E.A. Pérez-Du Pond , I. Jasso-García , S.J. Vázquez-Sánchez , R.C. García-Romero , J.P. Gómez-Sierra , M.G. Castillo Cardiel , A.S. Álvarez-Villaseñor , G. Cervantes-Guevara , E. Cervantes-Pérez , S. Ramírez-Ochoa , A. González-Ojeda , C. Fuentes-Orozco

Introduction

Renal cell carcinoma, ranked 14th in global incidence, is more common in men. Its incidence rates increase with age, peaking in individuals older than 75 years. The classic triad is present in only 17% of cases. Surgical management involves total or partial nephrectomy, both associated with potential complications.

Objective

To identify the clinical profile and risk factors in patients with renal cell carcinoma.

Methodology

An observational, cross-sectional, and analytical study was conducted on patients with renal cell carcinoma treated surgically in the Urology Department from January 2020 to June 2023. Demographic and clinical characteristics were analyzed in relation to TNM staging, histologic subtype, and morbidity and mortality.

Results

Among 83 patients, 48 (57%) were men, with a mean age of 59.2 years (SD 10.5). Hypertension (HTN) and obesity were the most frequent comorbidities, each affecting 37 patients (44.6%). Flank pain (37 patients, 44.6%) and hematuria (23 patients, 27.7%) were the most common manifestations. Age > 50 years was associated with advanced stages (P = .003, OR: 5.744, 95% CI: 1.698-19.424), while obesity was associated with a lower risk of advanced stages (P = .0042, OR: 0.220, 95% CI: 0.075-0.648). Complications of open nephrectomy included bleeding in 26 patients (38.8%) and organ injury in 2 patients (2.9%). Mortality was reported in 1 patient.

Conclusion

Age > 50 years is a risk factor for advanced stages, while obesity is associated with a lower risk. Hematuria and flank pain were common, whereas abdominal mass was rarely reported.

肾细胞癌在全球发病率中排名第14位，多见于男性。其发病率随着年龄的增长而增加，在75岁以上的人群中达到高峰。典型的三联征只出现在17%的病例中。手术治疗包括全部或部分肾切除术，两者都有潜在的并发症。目的探讨肾细胞癌的临床特点及危险因素。方法对2020年1月至2023年6月泌尿外科肾细胞癌手术患者进行观察性、横断面性和分析性研究。分析人口统计学和临床特征与TNM分期、组织学亚型、发病率和死亡率的关系。结果83例患者中，男性48例（57%），平均年龄59.2岁（SD 10.5）。高血压（HTN）和肥胖是最常见的合并症，各影响37例（44.6%）。腹部疼痛（37例，44.6%）和血尿（23例，27.7%）是最常见的表现。年龄50岁与晚期相关（P = 0.003, OR: 5.744, 95% CI: 1.698-19.424），而肥胖与晚期风险较低相关（P = 0.0042, OR: 0.220, 95% CI: 0.075-0.648）。开放性肾切除术并发症为出血26例（38.8%），脏器损伤2例（2.9%）。死亡1例。结论50岁是晚期糖尿病的危险因素，而肥胖的风险较低。血尿和腹部疼痛是常见的，而腹部肿块很少报道。

{"title":"Perfil clínico y factores de riesgo identificados en pacientes con cáncer renal en población mexicana","authors":"G. Sánchez-Villaseñor , E.A. Pérez-Du Pond , I. Jasso-García , S.J. Vázquez-Sánchez , R.C. García-Romero , J.P. Gómez-Sierra , M.G. Castillo Cardiel , A.S. Álvarez-Villaseñor , G. Cervantes-Guevara , E. Cervantes-Pérez , S. Ramírez-Ochoa , A. González-Ojeda , C. Fuentes-Orozco","doi":"10.1016/j.acuro.2025.501814","DOIUrl":"10.1016/j.acuro.2025.501814","url":null,"abstract":"<div><h3>Introduction</h3><div>Renal cell carcinoma, ranked 14th in global incidence, is more common in men. Its incidence rates increase with age, peaking in individuals older than 75years. The classic triad is present in only 17% of cases. Surgical management involves total or partial nephrectomy, both associated with potential complications.</div></div><div><h3>Objective</h3><div>To identify the clinical profile and risk factors in patients with renal cell carcinoma.</div></div><div><h3>Methodology</h3><div>An observational, cross-sectional, and analytical study was conducted on patients with renal cell carcinoma treated surgically in the Urology Department from January 2020 to June 2023. Demographic and clinical characteristics were analyzed in relation to TNM staging, histologic subtype, and morbidity and mortality.</div></div><div><h3>Results</h3><div>Among 83 patients, 48 (57%) were men, with a mean age of 59.2 years (SD 10.5). Hypertension (HTN) and obesity were the most frequent comorbidities, each affecting 37 patients (44.6%). Flank pain (37 patients, 44.6%) and hematuria (23 patients, 27.7%) were the most common manifestations. Age >50years was associated with advanced stages (<em>P</em>   =.0042, OR: 0.220, 95%CI: 0.075-0.648). Complications of open nephrectomy included bleeding in 26 patients (38.8%) and organ injury in 2 patients (2.9%). Mortality was reported in 1 patient.</div></div><div><h3>Conclusion</h3><div>Age >50years is a risk factor for advanced stages, while obesity is associated with a lower risk. Hematuria and flank pain were common, whereas abdominal mass was rarely reported.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 7","pages":"Article 501814"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144922084","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

Comparación del P-score de Prostatype® y los modelos de riesgo tradicionales para predecir los resultados del cáncer de próstata en España 在西班牙，Prostatype®的p分数与传统风险模型预测前列腺癌结果的比较

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2025-07-01 Epub Date: 2025-05-06 DOI: 10.1016/j.acuro.2025.501788

P. González-Peramato , M. Álvarez-Maestro , V. Heredia-Soto , M. Mendiola Sabio , E. Linares , Á. Serrano , J.L. Álvarez-Ossorio , E. López Alcina , L. Prieto , F. Vázquez Alonso , M. Aller Rodríguez , E. Berglund

Introduction

Prostate cancer (PCa) shows varied aggressiveness, complicating personalised treatment decisions. Traditional risk stratification systems rely on clinical parameters but may miss crucial genetic insights. The Prostatype® score (P-score) integrates gene expression with clinical data to improve PCa risk assessment precision.

Objectives

To validate the P-score's predictive performance for prostate cancer-specific mortality (PCSM) and metastasis in a Spanish cohort, comparing it with NCCN, D’Amico, and EAU systems.

Materials and Methods

This study was multicentre, retrospective and included seven Spanish hospitals. Of 154 core needle biopsies, 93 met RNA criteria, and for those, P-score was calculated based on IGFBP3, VGLL3, and F3 genes expression and clinical data.

The primary endpoint was PCa-specific mortality (PCSM), with secondary endpoints being development of metastasis, adverse pathology (AP), and International Society of Urological Pathology (ISUP) grading.

Results

The P-score demonstrated superior accuracy in predicting 10-year PCSM, with an AUC of 0.81 and a C-index of 0.75, outperforming NCCN (AUC 0.77, C-index 0.69) and D’Amico/EAU (AUC 0.70, C-index 0.62). For metastasis prediction, the P-score achieved a C-index of 0.77, significantly higher than NCCN, D’Amico, and EAU (0.58). Kaplan-Meier analysis underscored the P-score's ability to better stratify patients by risk, especially high-risk groups. Additionally, the P-score correlated with tumour burden, showing significant associations with positive biopsy cores (p = 0.017) and ISUP grade at radical prostatectomy (p = 0.0028).

Conclusions

In this Spanish cohort, the P-score outperformed traditional clinicopathological systems in predicting PCSM, development of metastasis, and pathological markers, supporting its clinical utility for more personalised PCa management.

前列腺癌（PCa）表现出多种侵袭性，使个性化治疗决策复杂化。传统的风险分层系统依赖于临床参数，但可能错过关键的遗传见解。前列腺类型评分（P-score）将基因表达与临床数据相结合，以提高前列腺癌风险评估的准确性。目的在西班牙队列中验证p评分对前列腺癌特异性死亡率（PCSM）和转移的预测性能，并将其与NCCN、D 'Amico和EAU系统进行比较。材料与方法本研究为多中心、回顾性研究，纳入7家西班牙医院。154例核心穿刺活检中，93例符合RNA标准，根据IGFBP3、VGLL3和F3基因表达及临床数据计算p评分。主要终点是前列腺癌特异性死亡率（PCSM），次要终点是转移的发生、不良病理（AP）和国际泌尿病理学会（ISUP）分级。结果p -评分预测10年PCSM的准确率较高，AUC为0.81，c -指数为0.75，优于NCCN （AUC 0.77， c -指数0.69）和D 'Amico /EAU （AUC 0.70， c -指数0.62）。对于转移预测，p -评分的c指数为0.77，显著高于NCCN、D 'Amico和EAU（0.58）。Kaplan-Meier分析强调了P-score能够更好地根据风险对患者进行分层，尤其是高危人群。此外，p评分与肿瘤负荷相关，与活检阳性（p = 0.017）和根治性前列腺切除术时的ISUP分级（p = 0.0028）有显著相关性。在这个西班牙队列中，p -评分在预测PCSM、转移发展和病理标志物方面优于传统的临床病理系统，支持其在更个性化的PCa治疗中的临床应用。

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引用次数: 0

La influencia de la invasión linfovascular en la recurrencia y progresión del cáncer vesical no músculo invasivo tratado con bacilo de Calmette-Guérin 淋巴管侵袭对用Calmette- Guerin杆菌治疗的侵袭性非肌肉膀胱癌复发和进展的影响

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2025-07-01 Epub Date: 2025-04-11 DOI: 10.1016/j.acuro.2025.501785

U. Aydin , S. Cetin , M. Yavuz Koparal , C. Coskun , I.I. Gonul , S. Yesil , T.S. Sozen

Introduction and objectives

To investigate whether lymphovascular invasion (LVI) could be a factor in predicting recurrence and progression in patients with high and very high-risk non-muscle-invasive bladder cancer (NMIBC) who received Bacillus Calmette-Guérin (BCG) treatment.

Methods

Ninety-three patients with high and very high-risk NMIBC, diagnosed initially in our clinic, were treated with at least 1 year of BCG therapy, and they were followed up to assess recurrence and progression, comparing those with and without LVI at the time of diagnosis.

Results

In the entire cohort, LVI was present in 33 (35.5%) patients while absent in 60 (64.5%) patients. Among patients with LVI, 17 (51.5%) showed recurrence, and 11 (33.3%) showed progression. Statistically significant differences were observed in both recurrence and progression in patients with LVI compared to those without LVI (P < .001 and .04, respectively). Additionally, univariate and multivariate regression analysis revealed that the presence of LVI was an independent factor predicting recurrence (P = .001).

Conclusion

In our study, we demonstrated the importance of being cautious regarding recurrence and progression in patients with high and very high-risk NMIBC who also have LVI despite receiving standard treatment. We found that approximately one-third of these patients may experience recurrence within one year.

前言和目的探讨淋巴血管侵袭（LVI）是否可能是预测高、高危非肌肉浸润性膀胱癌（NMIBC）患者接受卡介苗治疗后复发和进展的一个因素。方法93例首次确诊的高、高危NMIBC患者，接受至少1年BCG治疗，随访评估复发和进展情况，比较诊断时有无LVI的患者。结果在整个队列中，33例（35.5%）患者存在LVI， 60例（64.5%）患者不存在LVI。LVI患者中，17例（51.5%）出现复发，11例（33.3%）出现进展。与无LVI患者相比，LVI患者的复发和进展均有统计学差异(P <；分别为0.001和0.04)。此外，单因素和多因素回归分析显示LVI的存在是预测复发的独立因素（P = .001）。结论：在我们的研究中，我们证明了尽管接受了标准治疗，但对患有LVI的高风险和高危NMIBC患者的复发和进展保持谨慎的重要性。我们发现大约三分之一的患者可能在一年内复发。

{"title":"La influencia de la invasión linfovascular en la recurrencia y progresión del cáncer vesical no músculo invasivo tratado con bacilo de Calmette-Guérin","authors":"U. Aydin , S. Cetin , M. Yavuz Koparal , C. Coskun , I.I. Gonul , S. Yesil , T.S. Sozen","doi":"10.1016/j.acuro.2025.501785","DOIUrl":"10.1016/j.acuro.2025.501785","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>To investigate whether lymphovascular invasion (LVI) could be a factor in predicting recurrence and progression in patients with high and very high-risk non-muscle-invasive bladder cancer (NMIBC) who received Bacillus Calmette-Guérin (BCG) treatment.</div></div><div><h3>Methods</h3><div>Ninety-three patients with high and very high-risk NMIBC, diagnosed initially in our clinic, were treated with at least 1 year of BCG therapy, and they were followed up to assess recurrence and progression, comparing those with and without LVI at the time of diagnosis.</div></div><div><h3>Results</h3><div>In the entire cohort, LVI was present in 33 (35.5%) patients while absent in 60 (64.5%) patients. Among patients with LVI, 17 (51.5%) showed recurrence, and 11 (33.3%) showed progression. Statistically significant differences were observed in both recurrence and progression in patients with LVI compared to those without LVI (<em>P</em>  =.001).</div></div><div><h3>Conclusion</h3><div>In our study, we demonstrated the importance of being cautious regarding recurrence and progression in patients with high and very high-risk NMIBC who also have LVI despite receiving standard treatment. We found that approximately one-third of these patients may experience recurrence within one year.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 6","pages":"Article 501785"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517662","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

El síndrome de burnout en urólogos españoles: prevalencia, factores de riesgo e implicaciones para la salud mental 西班牙泌尿科医生的倦怠综合症：流行率、危险因素和对精神健康的影响

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2025-07-01 Epub Date: 2025-05-18 DOI: 10.1016/j.acuro.2025.501793

B. Nakdali Kassab , J.V. Segura Heras , M. Gómez Garberí , J.J. Pacheco Bru , M.A. Ortiz Gorraiz , J.J. Mira Solves

Introduction

Burnout syndrome is a significant occupational phenomenon among healthcare professionals, characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. Urologists, due to the demands of their specialty, are particularly vulnerable. This study aims to assess the prevalence and risk factors for burnout syndrome among urologists in Spain.

Method

A cross-sectional survey was conducted among 257 practicing urologists in Spain. Data were collected using the Maslach Burnout Inventory and additional demographic and occupational questions. Burnout was defined based on high emotional exhaustion combined with either high depersonalization or low personal accomplishment. Statistical analyses included univariate and multivariate logistic regression to identify significant predictors.

Results

In the study, the prevalence of burnout among Spanish urologists was 54.9%. Fewer years of experience and female gender were associated with higher burnout rates. Significant stressors included workload and work schedule. Despite the high prevalence, only one third of affected professionals sought psychological support.

Conclusions

Burnout is highly prevalent among Spanish urologists and poses serious risks to both healthcare professionals and patients. Its impact on patient care includes increased likelihood of medical errors, reduced quality of care and patient satisfaction. Targeted interventions and psychological support are urgently needed to address this issue.

职业倦怠综合征是一种重要的职业现象，主要表现为情绪耗竭、人格解体和个人成就感降低。泌尿科医生，由于他们的专业需求，是特别脆弱的。本研究旨在评估西班牙泌尿科医生中职业倦怠综合征的患病率和危险因素。方法对西班牙257名执业泌尿科医师进行横断面调查。数据收集使用马斯拉克职业倦怠量表和额外的人口统计和职业问题。倦怠的定义是基于高度情绪耗竭并伴有高度去人格化或低个人成就感。统计分析包括单变量和多变量逻辑回归，以确定显著的预测因子。结果西班牙泌尿科医师职业倦怠率为54.9%。经验年数较少和女性与较高的倦怠率相关。重要的压力源包括工作量和工作安排。尽管患病率很高，但只有三分之一的受影响专业人员寻求心理支持。结论职业倦怠在西班牙泌尿科医生中非常普遍，给医护人员和患者都带来了严重的风险。它对患者护理的影响包括增加医疗差错的可能性，降低护理质量和患者满意度。迫切需要有针对性的干预措施和心理支持来解决这个问题。

{"title":"El síndrome de burnout en urólogos españoles: prevalencia, factores de riesgo e implicaciones para la salud mental","authors":"B. Nakdali Kassab , J.V. Segura Heras , M. Gómez Garberí , J.J. Pacheco Bru , M.A. Ortiz Gorraiz , J.J. Mira Solves","doi":"10.1016/j.acuro.2025.501793","DOIUrl":"10.1016/j.acuro.2025.501793","url":null,"abstract":"<div><h3>Introduction</h3><div>Burnout syndrome is a significant occupational phenomenon among healthcare professionals, characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. Urologists, due to the demands of their specialty, are particularly vulnerable. This study aims to assess the prevalence and risk factors for burnout syndrome among urologists in Spain.</div></div><div><h3>Method</h3><div>A cross-sectional survey was conducted among 257 practicing urologists in Spain. Data were collected using the Maslach Burnout Inventory and additional demographic and occupational questions. Burnout was defined based on high emotional exhaustion combined with either high depersonalization or low personal accomplishment. Statistical analyses included univariate and multivariate logistic regression to identify significant predictors.</div></div><div><h3>Results</h3><div>In the study, the prevalence of burnout among Spanish urologists was 54.9%. Fewer years of experience and female gender were associated with higher burnout rates. Significant stressors included workload and work schedule. Despite the high prevalence, only one third of affected professionals sought psychological support.</div></div><div><h3>Conclusions</h3><div>Burnout is highly prevalent among Spanish urologists and poses serious risks to both healthcare professionals and patients. Its impact on patient care includes increased likelihood of medical errors, reduced quality of care and patient satisfaction. Targeted interventions and psychological support are urgently needed to address this issue.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 6","pages":"Article 501793"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517904","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

Detección molecular y relevancia clínica de Haemophilus spp. en uretritis masculina: prevalencia y factores asociados 男性尿道炎中嗜血友病的分子检测和临床相关性：流行率和相关因素

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2025-07-01 Epub Date: 2025-05-15 DOI: 10.1016/j.acuro.2025.501790

O. Mar-Herrera, J. Llaca-Díaz, A. Flores-Aréchiga, N. Casillas-Vega

Introduction and objective

Urethritis is the most common sexually transmitted infection in men. Haemophilus influenzae and Haemophilus parainfluenzae, commensal microorganisms of the respiratory and oral tract, have been proposed as potential etiological agents of non-gonococcal urethritis (NGU). This study aimed to determine the prevalence of these species in urine samples from men with urethritis and analyze their clinical correlation.

Methods

A total of 200 urinary DNA samples from patients diagnosed with urethritis were analyzed. Microorganisms were identified through multiplex PCR, amplifying the P6 and 16S rRNA genes. Associations between risk factors and infection were evaluated by calculating odds ratios (OR) and 95% confidence intervals (CI) using OpenEpi 3.03a.

Results

The mean age of the population was 55 years (range 20-95). Among the participants, 32.5% had received prior sexual education, and 75% reported not using contraceptive methods. H. influenzae was not detected in any sample, whereas H. parainfluenzae was present in 9.5% (n = 19) of cases. Significant associations were identified with the absence of formal education, a history of more than ten sexual partners, masturbation, and sexual intercourse under the influence of alcohol and/or drugs.

Conclusions

Although H. influenzae and H. parainfluenzae have been rarely identified in urethritis, their high transmissibility and clinical relevance suggest the need for their detection in high-risk populations. Their identification may contribute to improving diagnosis and the implementation of therapeutic strategies.

前言与目的尿道炎是男性最常见的性传播感染。流感嗜血杆菌和副流感嗜血杆菌是呼吸道和口腔的共生微生物，已被认为是非淋球菌性尿道炎（NGU）的潜在病原。本研究旨在确定这些物种在尿道炎男性尿液样本中的患病率，并分析其临床相关性。方法对200例诊断为尿道炎患者的尿液DNA样本进行分析。通过多重PCR扩增P6和16S rRNA基因鉴定微生物。使用OpenEpi 3.03a软件计算优势比（OR）和95%置信区间（CI），评估危险因素与感染之间的关联。结果患者平均年龄55岁，年龄范围20 ~ 95岁。在参与者中，32.5%的人接受过性教育，75%的人没有使用避孕方法。在任何样本中未检测到流感嗜血杆菌，而在9.5% （n = 19）的病例中存在副流感嗜血杆菌。研究发现，缺乏正规教育、有10名以上的性伴侣、手淫以及在酒精和/或毒品的影响下发生性行为，与性行为有显著关联。结论虽然流感嗜血杆菌和副流感嗜血杆菌在尿道炎中很少被发现，但它们的高传播性和临床相关性提示有必要在高危人群中进行检测。它们的识别可能有助于提高诊断和治疗策略的实施。

{"title":"Detección molecular y relevancia clínica de Haemophilus spp. en uretritis masculina: prevalencia y factores asociados","authors":"O. Mar-Herrera, J. Llaca-Díaz, A. Flores-Aréchiga, N. Casillas-Vega","doi":"10.1016/j.acuro.2025.501790","DOIUrl":"10.1016/j.acuro.2025.501790","url":null,"abstract":"<div><h3>Introduction and objective</h3><div>Urethritis is the most common sexually transmitted infection in men. <em>Haemophilus influenzae</em> and <em>Haemophilus parainfluenzae</em>, commensal microorganisms of the respiratory and oral tract, have been proposed as potential etiological agents of non-gonococcal urethritis (NGU). This study aimed to determine the prevalence of these species in urine samples from men with urethritis and analyze their clinical correlation.</div></div><div><h3>Methods</h3><div>A total of 200 urinary DNA samples from patients diagnosed with urethritis were analyzed. Microorganisms were identified through multiplex PCR, amplifying the <em>P6</em> and <em>16S rRNA</em> genes. Associations between risk factors and infection were evaluated by calculating odds ratios (OR) and 95% confidence intervals (CI) using OpenEpi 3.03a.</div></div><div><h3>Results</h3><div>The mean age of the population was 55 years (range 20-95). Among the participants, 32.5% had received prior sexual education, and 75% reported not using contraceptive methods. <em>H. influenzae</em> was not detected in any sample, whereas <em>H. parainfluenzae</em> was present in 9.5% (n=19) of cases. Significant associations were identified with the absence of formal education, a history of more than ten sexual partners, masturbation, and sexual intercourse under the influence of alcohol and/or drugs.</div></div><div><h3>Conclusions</h3><div>Although <em>H. influenzae</em> and <em>H. parainfluenzae</em> have been rarely identified in urethritis, their high transmissibility and clinical relevance suggest the need for their detection in high-risk populations. Their identification may contribute to improving diagnosis and the implementation of therapeutic strategies.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 6","pages":"Article 501790"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517659","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

Análisis de la supervivencia del dispositivo y los factores predictivos de la misma en una cohorte de pacientes intervenidos de esfínter urinario artificial masculino 男性人工尿道括面肌组患者存活率和预测因素分析

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2025-07-01 Epub Date: 2025-05-06 DOI: 10.1016/j.acuro.2025.501786

C. Mínguez Ojeda, A. Artiles Medina, A. Fraile Poblador, Á. Sánchez González, J.D. Subiela Henríquez, J. Brasero Burgos, I. de la Parra Sánchez, D. López Curtis, P. del Olmo Durán, A. Fernández-Mardomingo Díaz, M.Á. Jiménez Cidre, V. Gómez Dos Santos, F.J. Burgos Revilla

Introduction

Stress urinary incontinence (SUI) affects between 2.5% and 40% of patients after radical prostatectomy. Although the implantation of an artificial urinary sphincter (AUS) offers continence rates of 70-80%, its failure rate reaches 25% in some series. This single-center retrospective study analyzed the survival of AUS and the factors associated with its failure.

Materials and methods

A total of 145 patients treated with the AMS 800® device (Boston Scientific) between 2010 and 2023 were included. Kaplan-Meier analysis and the Cox proportional hazards model were used to evaluate device survival and identify predictive factors for failure.

Results

The mean age was 68.6 years; 28% of patients were smokers, 43.7% had diabetes, and 26.2% had undergone prior radiation therapy. Radical prostatectomy was the main cause of SUI (86.9%). In the majority of cases (91.5%), the artificial urinary sphincter was implanted around the bulbar urethra. During follow-up, 25.5% of patients required revision surgery. The probability of functional sphincter survival was 89% at 1 year, 78% at 2 years, 64% at 5 years, and 51% at 10 years. On multivariate analysis, prior radiation therapy (HR: 2.06; P=.029) and diabetes (HR: 2.24; P=.04]) were associated with poorer device survival.

Conclusions

The AUS is an effective and safe treatment for severe SUI, although radiotherapy and diabetes may adversely affect its durability.

导读：压力性尿失禁（SUI）在根治性前列腺切除术后的发生率为2.5% - 40%。虽然人工尿道括约肌（AUS）植入术的失禁率为70-80%，但在某些系列中其失败率达到25%。这项单中心回顾性研究分析了AUS的生存率及其失败的相关因素。材料和方法在2010年至2023年期间，共纳入145例使用AMS 800®设备（波士顿科学公司）治疗的患者。Kaplan-Meier分析和Cox比例风险模型用于评估器械存活率和确定失效的预测因素。结果患者平均年龄68.6岁；28%的患者为吸烟者，43.7%的患者患有糖尿病，26.2%的患者既往接受过放疗。根治性前列腺切除术是SUI的主要原因（86.9%）。大多数病例（91.5%）在球尿道周围植入人工尿道括约肌。随访期间，25.5%的患者需要翻修手术。功能性括约肌存活的概率为1年89%，2年78%，5年64%，10年51%。多因素分析显示，既往放射治疗(HR: 2.06；P= 0.029)和糖尿病(HR: 2.24；P=.04])与较差的器械存活率相关。结论AUS是一种安全有效的治疗重度SUI的方法，但放疗和糖尿病可能会影响其耐久性。

{"title":"Análisis de la supervivencia del dispositivo y los factores predictivos de la misma en una cohorte de pacientes intervenidos de esfínter urinario artificial masculino","authors":"C. Mínguez Ojeda, A. Artiles Medina, A. Fraile Poblador, Á. Sánchez González, J.D. Subiela Henríquez, J. Brasero Burgos, I. de la Parra Sánchez, D. López Curtis, P. del Olmo Durán, A. Fernández-Mardomingo Díaz, M.Á. Jiménez Cidre, V. Gómez Dos Santos, F.J. Burgos Revilla","doi":"10.1016/j.acuro.2025.501786","DOIUrl":"10.1016/j.acuro.2025.501786","url":null,"abstract":"<div><h3>Introduction</h3><div>Stress urinary incontinence (SUI) affects between 2.5% and 40% of patients after radical prostatectomy. Although the implantation of an artificial urinary sphincter (AUS) offers continence rates of 70-80%, its failure rate reaches 25% in some series. This single-center retrospective study analyzed the survival of AUS and the factors associated with its failure.</div></div><div><h3>Materials and methods</h3><div>A total of 145 patients treated with the AMS 800® device (Boston Scientific) between 2010 and 2023 were included. Kaplan-Meier analysis and the Cox proportional hazards model were used to evaluate device survival and identify predictive factors for failure.</div></div><div><h3>Results</h3><div>The mean age was 68.6 years; 28% of patients were smokers, 43.7% had diabetes, and 26.2% had undergone prior radiation therapy. Radical prostatectomy was the main cause of SUI (86.9%). In the majority of cases (91.5%), the artificial urinary sphincter was implanted around the bulbar urethra. During follow-up, 25.5% of patients required revision surgery. The probability of functional sphincter survival was 89% at 1 year, 78% at 2 years, 64% at 5 years, and 51% at 10 years. On multivariate analysis, prior radiation therapy (HR: 2.06; <em>P</em>=.029) and diabetes (HR: 2.24; <em>P</em>=.04]) were associated with poorer device survival.</div></div><div><h3>Conclusions</h3><div>The AUS is an effective and safe treatment for severe SUI, although radiotherapy and diabetes may adversely affect its durability.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 6","pages":"Article 501786"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517660","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

Phyllanthus niruri en el manejo de las litiasis urinarias: revisión sistemática de la literatura Phyllanthus niruri在尿路碎石病管理中的作用：系统文献综述

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas

Pub Date : 2025-07-01 Epub Date: 2025-05-18 DOI: 10.1016/j.acuro.2025.501791

J. Iregui-Parra , V. Rojas Ossa , C.M. Arias Salazar , A.D. López Estupiñán , D. Díaz Varela , L.M. Sinisterra Parra , L. Diéguez , E. Emiliani

Introduction and objectives

Nephrolithiasis is one of the most prevalent urological pathologies worldwide, with an increasing incidence and multifactorial etiology, particularly influenced by diet. Surgical interventions or extracorporeal shock wave lithotripsy (ESWL) are the cornerstone treatments. However, as emphasized by the EAU and AUA guidelines, post-surgical medical management is recommended to reduce recurrence risk. Phyllanthus niruri (PN), widely used in traditional medicine, has been extensively researched, yielding mixed results and presenting an opportunity to explore its role further. This review aims to evaluate PN's potential in enhancing treatment efficacy and reducing stone recurrence.

Materials and Methods

A systematic literature review was conducted, encompassing articles published from January 1994 to September 2022 in English and Spanish. The review included studies on humans and rats accessible through the authors’ institutional affiliations. Titles and abstracts were screened, and relevant studies were selected for in-depth analysis.

Results

Out of the 16 selected studies, various mechanisms of action for PN were identified, such as promoting glycosaminoglycan (GAG) aggregation, inhibiting nucleation processes, and altering stone density to favor a stone-free state (SFR). Evidence consistently supports PN's long-term safety, confirmed by serial measurements of serum electrolytes and liver function. Novel applications, such as PN as an adjuvant to ESWL, show benefits for lower renal pole stones.

Conclusions

Growing evidence suggests that PN, when used alongside traditional interventions, is safe, without significant adverse effects, and may improve SFR outcomes after ESWL.

导读和目的肾结石是世界范围内最常见的泌尿系统疾病之一，其发病率不断上升，病因多因素，特别是受饮食的影响。外科手术或体外冲击波碎石（ESWL）是治疗的基础。然而，正如EAU和AUA指南所强调的，建议术后医疗管理以减少复发风险。在传统医学中广泛使用的Phyllanthus niruri （PN）已经得到了广泛的研究，产生了不同的结果，并提供了进一步探索其作用的机会。本综述旨在评价PN在提高治疗效果和减少结石复发方面的潜力。材料和方法对1994年1月至2022年9月以英语和西班牙语发表的文章进行了系统的文献综述。该综述包括通过作者的机构关系可获得的对人类和大鼠的研究。筛选题目和摘要，选择相关研究进行深入分析。结果在16项选定的研究中，确定了PN的各种作用机制，如促进糖胺聚糖（GAG）聚集，抑制成核过程，改变结石密度以促进结石游离状态（SFR）。经血清电解质和肝功能的一系列测量证实，证据一致支持PN的长期安全性。新的应用，如PN作为ESWL的辅助，显示出对肾下极结石的益处。结论：越来越多的证据表明，当与传统干预措施一起使用时，PN是安全的，没有明显的不良反应，并且可能改善ESWL后的SFR结果。

{"title":"Phyllanthus niruri en el manejo de las litiasis urinarias: revisión sistemática de la literatura","authors":"J. Iregui-Parra , V. Rojas Ossa , C.M. Arias Salazar , A.D. López Estupiñán , D. Díaz Varela , L.M. Sinisterra Parra , L. Diéguez , E. Emiliani","doi":"10.1016/j.acuro.2025.501791","DOIUrl":"10.1016/j.acuro.2025.501791","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Nephrolithiasis is one of the most prevalent urological pathologies worldwide, with an increasing incidence and multifactorial etiology, particularly influenced by diet. Surgical interventions or extracorporeal shock wave lithotripsy (ESWL) are the cornerstone treatments. However, as emphasized by the EAU and AUA guidelines, post-surgical medical management is recommended to reduce recurrence risk. Phyllanthus niruri (PN), widely used in traditional medicine, has been extensively researched, yielding mixed results and presenting an opportunity to explore its role further. This review aims to evaluate PN's potential in enhancing treatment efficacy and reducing stone recurrence.</div></div><div><h3>Materials and Methods</h3><div>A systematic literature review was conducted, encompassing articles published from January 1994 to September 2022 in English and Spanish. The review included studies on humans and rats accessible through the authors’ institutional affiliations. Titles and abstracts were screened, and relevant studies were selected for in-depth analysis.</div></div><div><h3>Results</h3><div>Out of the 16 selected studies, various mechanisms of action for PN were identified, such as promoting glycosaminoglycan (GAG) aggregation, inhibiting nucleation processes, and altering stone density to favor a stone-free state (SFR). Evidence consistently supports PN's long-term safety, confirmed by serial measurements of serum electrolytes and liver function. Novel applications, such as PN as an adjuvant to ESWL, show benefits for lower renal pole stones.</div></div><div><h3>Conclusions</h3><div>Growing evidence suggests that PN, when used alongside traditional interventions, is safe, without significant adverse effects, and may improve SFR outcomes after ESWL.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 6","pages":"Article 501791"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517903","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