Pub Date : 2024-03-01DOI: 10.1016/j.acuro.2023.07.001
O. Rajmil , J. Moreno-Sepulveda
Objective
This systematic review aims to evaluate the optimal treatment for male infertility resulting from Anabolic Androgenic Steroids (AAS) abuse.
Methods
A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies that compared different protocols for the recovery of spermatogenesis in patients after AAS use were included.
Results
13 studies investigating different protocols to restore spermatogenesis in patients with AAS abuse met the inclusion criteria. The available agents that showed restoration of spermatogenesis include injectable gonadotropins, selective estrogen receptor modulators, and aromatase inhibitors, but their use is still poorly described in the literature.
Conclusions
Clinicians need to be aware of the detrimental effects of AAS on spermatogenesis. AAS-associated infertility may be reversible, but sperm production may take over a year to normalize. Both conservative and aggressive treatment can boost spermatogenesis with positive results. Further understanding of male reproductive endocrinology and high-quality data on the field of restoration of spermatogenesis after AAS abuse are warranted.
{"title":"Recuperación de la espermatogénesis tras el abuso de esteroides anabólicos androgénicos en varones. Revisión sistemática de la literatura","authors":"O. Rajmil , J. Moreno-Sepulveda","doi":"10.1016/j.acuro.2023.07.001","DOIUrl":"10.1016/j.acuro.2023.07.001","url":null,"abstract":"<div><h3>Objective</h3><p>This systematic review aims to evaluate the optimal treatment for male infertility resulting from Anabolic Androgenic Steroids (AAS) abuse.</p></div><div><h3>Methods</h3><p>A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies that compared different protocols for the recovery of spermatogenesis in patients after AAS use were included.</p></div><div><h3>Results</h3><p>13 studies investigating different protocols to restore spermatogenesis in patients with AAS abuse met the inclusion criteria. The available agents that showed restoration of spermatogenesis include injectable gonadotropins, selective estrogen receptor modulators, and aromatase inhibitors, but their use is still poorly described in the literature.</p></div><div><h3>Conclusions</h3><p>Clinicians need to be aware of the detrimental effects of AAS on spermatogenesis. AAS-associated infertility may be reversible, but sperm production may take over a year to normalize. Both conservative and aggressive treatment can boost spermatogenesis with positive results. Further understanding of male reproductive endocrinology and high-quality data on the field of restoration of spermatogenesis after AAS abuse are warranted.</p></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"48 2","pages":"Pages 116-124"},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"53918857","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 : 2024-03-01DOI: 10.1016/j.acuro.2023.07.002
R. Bultó Gonzalvo, M. Bernardello Ureta, J. Cervera Alcaide, M. Sanchez Rodriguez, M. Franco, R. Freixa Sala, J. Areal Calama, F. Agreda Castañeda
Introduction and aim
Patients treated with HoLEP are frequently treated with previous treatments, including 5-alpha-reductase inhibitors (5-ARIs). We investigated the impact of pretreatment with 5-ARIs on perioperative and immediate postoperative parameters in patients treated with HoLEP.
Material and Methods
A retrospective study was performed using a prospectively collected database including all patients treated with HoLEP at our center between January 2017 and January 2023. The resected tissue weight, enucleation and morcellation efficiency (enucleation weight/time and morcellation weight/ time), postoperative complications, hospital stay and hemoglobin drop have been analyzed.
Results
A total of 327 patients were included. Of these, 173 (52.9%) were treated with 5-ARIs. No differences were found among the perioperative parameters investigated to determine efficiency. No differences were observed in peri- or postoperative complications, hospital stay or hemoglobin drop.
Conclusions
Therapy with 5-ARIs had no impact on the immediate postoperative outcomes of patients treated with HoLEP. In our cohort, we observed that the use of 5-ARIs did not affect surgical efficiency, enucleation or morcellation. Further multicenter studies will be necessary to validate these findings.
{"title":"¿Tiene el tratamiento previo con inhibidores de la 5-alfa reductasa repercusión en la enucleación prostática con láser holmium? Resultados de un estudio prospectivo observacional y revisión de la literatura","authors":"R. Bultó Gonzalvo, M. Bernardello Ureta, J. Cervera Alcaide, M. Sanchez Rodriguez, M. Franco, R. Freixa Sala, J. Areal Calama, F. Agreda Castañeda","doi":"10.1016/j.acuro.2023.07.002","DOIUrl":"10.1016/j.acuro.2023.07.002","url":null,"abstract":"<div><h3>Introduction and aim</h3><p>Patients treated with HoLEP are frequently treated with previous treatments, including 5-alpha-reductase inhibitors (5-ARIs). We investigated the impact of pretreatment with 5-ARIs on perioperative and immediate postoperative parameters in patients treated with HoLEP.</p></div><div><h3>Material and Methods</h3><p>A retrospective study was performed using a prospectively collected database including all patients treated with HoLEP at our center between January 2017 and January 2023. The resected tissue weight, enucleation and morcellation efficiency (enucleation weight/time and morcellation weight/ time), postoperative complications, hospital stay and hemoglobin drop have been analyzed.</p></div><div><h3>Results</h3><p>A total of 327 patients were included. Of these, 173 (52.9%) were treated with 5-ARIs. No differences were found among the perioperative parameters investigated to determine efficiency. No differences were observed in peri- or postoperative complications, hospital stay or hemoglobin drop.</p></div><div><h3>Conclusions</h3><p>Therapy with 5-ARIs had no impact on the immediate postoperative outcomes of patients treated with HoLEP. In our cohort, we observed that the use of 5-ARIs did not affect surgical efficiency, enucleation or morcellation. Further multicenter studies will be necessary to validate these findings.</p></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"48 2","pages":"Pages 150-154"},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47546517","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 : 2024-03-01DOI: 10.1016/j.acuro.2023.08.003
A. Abu-Suboh Abadia , A. Abu-Suboh Abadia , L. Mosquera Seoane , P. Gómez Martínez , M.A. Trillo Lista , P. Portela Pereira , M.J. Martínez Barcina , J. Palou Redorta , O. Rodríguez Faba
Introduction
Due to their increasing prevalence and complex management, renal tumors are challenging for health professionals. The study aims to evaluate the usefulness of R.E.N.A.L. and PADUA nephrometry scores in the prediction of complications after percutaneous cryoablation.
Material and methods
The study prospectively analyzed 90 patients with 101 stage T1a renal cell carcinoma (RCC) tumors treated with cryoablation.
Results
Ninety patients with 101 small renal tumors who received cryoablative therapy were investigated. The mean age of the patients was 68 years and 74.4% were male. Most tumors were smaller than 4 cm (89.1%) and the mean PADUA and R.E.N.A.L. scores were 8.65 and 7.35, respectively. Complications were observed in 12 cases. PADUA and R.E.N.A.L. scores demonstrated moderate predictive power (AUC = 0.58 and AUC = 0.63, respectively) for post-cryoablation complications.
Conclusions
Percutaneous cryoablation is a safe and effective treatment for small renal tumors. The R.E.N.A.L. and PADUA renal nephrometry scores have moderate predictive power for complications associated with percutaneous cryoablation of renal tumors.
{"title":"Impacto de los sistemas de nefrometría renal en la valoración de las complicaciones en el tratamiento percutáneo guiado por imagen de las masas renales de pequeño tamaño","authors":"A. Abu-Suboh Abadia , A. Abu-Suboh Abadia , L. Mosquera Seoane , P. Gómez Martínez , M.A. Trillo Lista , P. Portela Pereira , M.J. Martínez Barcina , J. Palou Redorta , O. Rodríguez Faba","doi":"10.1016/j.acuro.2023.08.003","DOIUrl":"10.1016/j.acuro.2023.08.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Due to their increasing prevalence and complex management, renal tumors are challenging for health professionals. The study aims to evaluate the usefulness of R.E.N.A.L. and PADUA nephrometry scores in the prediction of complications after percutaneous cryoablation.</p></div><div><h3>Material and methods</h3><p>The study prospectively analyzed 90 patients with 101 stage T1a renal cell carcinoma (RCC) tumors treated with cryoablation.</p></div><div><h3>Results</h3><p>Ninety patients with 101 small renal tumors who received cryoablative therapy were investigated. The mean age of the patients was 68 years and 74.4% were male. Most tumors were smaller than 4 cm (89.1%) and the mean PADUA and R.E.N.A.L. scores were 8.65 and 7.35, respectively. Complications were observed in 12 cases. PADUA and R.E.N.A.L. scores demonstrated moderate predictive power (AUC = 0.58 and AUC = 0.63, respectively) for post-cryoablation complications.</p></div><div><h3>Conclusions</h3><p>Percutaneous cryoablation is a safe and effective treatment for small renal tumors. The R.E.N.A.L. and PADUA renal nephrometry scores have moderate predictive power for complications associated with percutaneous cryoablation of renal tumors.</p></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"48 2","pages":"Pages 155-161"},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135389816","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 : 2024-03-01DOI: 10.1016/j.acuro.2023.09.002
R. Uğur, A. Şimşek
Introduction
The aim of this study is to evaluate and compare erection function (EF) after excision and primary anastomosis urethroplasty (EPAU) and buccal mucosal graft urethroplasty (BMGU) in bulbar urethral stricture.
Methods
Patients who underwent urethroplasty were identified retrospectively. The criteria for inclusion in the study were determined as being over 18 years old and under 70 years old, being sexually active. Exclusion criteria are: preoperative severe erectile dysfunction, stricture outside the bulbar urethra, psychosocial incompatibility, urethral stricture related to pelvic fracture, follow-up time less than a year. As the primary endpoint, the International Index of Erectile Function-5 (IIEF-5) was determined as a comparison of EF in the preoperative and 3rd, 6th and 12th months after surgery. The secondary endpoint was the evaluation of the effects of demographic data, stricture and treatment characteristics on EF.
Results
Fifty patients were identified considering the inclusion/exclusion criteria. It was observed that there were 30 patients who underwent EPAU and 20 patients who underwent BMGU. At the third month after surgery, EF showed a statistically significant decrease in the EPAU group. In both patient groups, it was observed that the early negative effects after the operation in EF started to improve in the 6th month and returned to the baseline level by the first year.
Conclusion
EPAU and BMGU techniques have a similar effect on EF in the medium and long term. Both methods can be used safely and effectively in the appropriate patient group.
引言 本研究的目的是评估和比较球部尿道狭窄患者接受切除和原位吻合尿道成形术（EPAU）和颊粘膜移植尿道成形术（BMGU）后的勃起功能（EF）。纳入研究的标准是年龄在 18 岁以上、70 岁以下，性生活活跃。排除标准为：术前有严重勃起功能障碍、球部尿道外狭窄、心理社会不相容、尿道狭窄与骨盆骨折有关、随访时间少于一年。国际勃起功能指数-5（International Index of Erectile Function-5，IIEF-5）作为主要终点，用于比较术前、术后第3、第6和第12个月的勃起功能。次要终点是评估人口统计学数据、狭窄和治疗特点对 EF 的影响。据观察，30 名患者接受了 EPAU，20 名患者接受了 BMGU。术后第三个月，EPAU 组的 EF 出现了统计学意义上的显著下降。据观察，两组患者术后早期EF的负面影响在术后第6个月开始改善，并在术后第一年恢复到基线水平。结论EPAU 和 BMGU 技术在中长期对心房颤动率的影响相似，两种方法都可以安全有效地用于合适的患者群体。
{"title":"Preservación de la función eréctil tras la uretroplastia: ¿escisión y anastomosis primaria o injerto de mucosa oral?","authors":"R. Uğur, A. Şimşek","doi":"10.1016/j.acuro.2023.09.002","DOIUrl":"10.1016/j.acuro.2023.09.002","url":null,"abstract":"<div><h3>Introduction</h3><p>The aim of this study is to evaluate and compare erection function (EF) after excision and primary anastomosis urethroplasty (EPAU) and buccal mucosal graft urethroplasty (BMGU) in bulbar urethral stricture.</p></div><div><h3>Methods</h3><p>Patients who underwent urethroplasty were identified retrospectively. The criteria for inclusion in the study were determined as being over 18 years old and under 70 years old, being sexually active. Exclusion criteria are: preoperative severe erectile dysfunction, stricture outside the bulbar urethra, psychosocial incompatibility, urethral stricture related to pelvic fracture, follow-up time less than a year. As the primary endpoint, the International Index of Erectile Function-5 (IIEF-5) was determined as a comparison of EF in the preoperative and 3rd, 6th and 12th months after surgery. The secondary endpoint was the evaluation of the effects of demographic data, stricture and treatment characteristics on EF.</p></div><div><h3>Results</h3><p>Fifty patients were identified considering the inclusion/exclusion criteria. It was observed that there were 30 patients who underwent EPAU and 20 patients who underwent BMGU. At the third month after surgery, EF showed a statistically significant decrease in the EPAU group. In both patient groups, it was observed that the early negative effects after the operation in EF started to improve in the 6th month and returned to the baseline level by the first year.</p></div><div><h3>Conclusion</h3><p>EPAU and BMGU techniques have a similar effect on EF in the medium and long term. Both methods can be used safely and effectively in the appropriate patient group.</p></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"48 2","pages":"Pages 170-176"},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135706062","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 : 2024-03-01DOI: 10.1016/j.acuro.2023.08.004
R. Polo , À. Canós-Nebot , J.P. Caballero-Romeu , P. Caballero , J.A. Galán-Llopis , F. Soria , J.E. de la Cruz-Conty , J. Tuells
Objective
To analyze the level of agreement of the Post-Ureteroscopic Lesion Scale (PULS) and the consequences on its application in clinical practice with more reliable statistical data than the one used in the original work.
Methods
14 URS and 14 micro-URS were performed in 14 female porcine model. All the procedures were video recorded and an anatomopathological analysis was performed in each ureter. Sixteen urologists (9 endourologists and 7 general urologists) and 4 residents evaluated the ureteral lesions according to the PULS, with degrees 0, 1 and ≥2. The agreement was calculated with percentages, Kendall's W coefficient and the indicators Fleiss’ Kappa and Krippendorff's Alpha, while the inter-rater agreement was calculated with Spearman's correlation and Cohen's Kappa.
Results
The percent of agreement was 11.1%. The coefficients were likewise classified as low or very low, with the greatest agreement found among the inexperienced. Also, 50% of the raters did not agree with the rest.
Conclusions
The low inter-rater agreement, the specificity of the PULS and the clinical-pathological correlation suggests that this scale is not simple, and probably has a long learning curve.
{"title":"Post-Ureteroscopic Lesion Scale: limitaciones en su aplicabilidad clínica","authors":"R. Polo , À. Canós-Nebot , J.P. Caballero-Romeu , P. Caballero , J.A. Galán-Llopis , F. Soria , J.E. de la Cruz-Conty , J. Tuells","doi":"10.1016/j.acuro.2023.08.004","DOIUrl":"10.1016/j.acuro.2023.08.004","url":null,"abstract":"<div><h3>Objective</h3><p>To analyze the level of agreement of the Post-Ureteroscopic Lesion Scale (PULS) and the consequences on its application in clinical practice with more reliable statistical data than the one used in the original work.</p></div><div><h3>Methods</h3><p>14 URS and 14 micro-URS were performed in 14 female porcine model. All the procedures were video recorded and an anatomopathological analysis was performed in each ureter. Sixteen urologists (9 endourologists and 7 general urologists) and 4 residents evaluated the ureteral lesions according to the PULS, with degrees 0, 1 and ≥2. The agreement was calculated with percentages, Kendall's W coefficient and the indicators Fleiss’ Kappa and Krippendorff's Alpha, while the inter-rater agreement was calculated with Spearman's correlation and Cohen's Kappa.</p></div><div><h3>Results</h3><p>The percent of agreement was 11.1%. The coefficients were likewise classified as low or very low, with the greatest agreement found among the inexperienced. Also, 50% of the raters did not agree with the rest.</p></div><div><h3>Conclusions</h3><p>The low inter-rater agreement, the specificity of the PULS and the clinical-pathological correlation suggests that this scale is not simple, and probably has a long learning curve.</p></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"48 2","pages":"Pages 162-169"},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0210480623001304/pdfft?md5=3a4d955136fdf1c5e3986990e8f01ea9&pid=1-s2.0-S0210480623001304-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135389303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1016/j.acuro.2023.07.004
L. Caamiña , A. Pietropaolo , G. Basile , M.I. Dönmez , A. Uleri , A. Territo , P. Fraile-Gómez
Introduction
Kidney transplantation is the treatment of choice for patients with stage 5 chronic kidney disease (CKD). About 60% of CKD patients are overweight or obese at the time of kidney transplantation, and post-transplant obesity occurs in 50% of patients, with a weight gain of 10% in the first year and high risk of cardiovascular mortality. Obesity is associated with an increased risk of delayed graft function (DGF), acute rejection, surgical complications, graft loss and mortality. The aim of this study is to assess the clinical evolution of obese and overweight patients that have received a kidney transplant, based on short- and long-term complications associated with a higher BMI.
Material and methods
A descriptive, observational, cross-sectional study was conducted with 104 kidney or pancreas-kidney transplant patients between March 2017 and December 2020, with a follow-up until April 2021. For comparative analysis, patients were grouped according to BMI.
Results
Mean age was of 56.65 years, 60.6% male and 39.4% female. Overweight patients experienced prolonged surgeries, more surgical wound dehiscence, delayed graft function, hernias, proteinuria and more indications for renal biopsies. Additionally, obese patients displayed more DGF, indications for renal biopsies, proteinuria, development of diabetes mellitus, atrial fibrillation and needed prolonged hospital stays.
Conclusions
Despite a high prevalence of comorbidity in the overweight and/or obese population, we found no reduction in patient and/or graft survival. However, longer follow-up is needed.
{"title":"Evaluación del impacto de la obesidad en los resultados del trasplante renal","authors":"L. Caamiña , A. Pietropaolo , G. Basile , M.I. Dönmez , A. Uleri , A. Territo , P. Fraile-Gómez","doi":"10.1016/j.acuro.2023.07.004","DOIUrl":"10.1016/j.acuro.2023.07.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Kidney transplantation is the treatment of choice for patients with stage 5 chronic kidney disease (CKD). About 60% of CKD patients are overweight or obese at the time of kidney transplantation, and post-transplant obesity occurs in 50% of patients, with a weight gain of 10% in the first year and high risk of cardiovascular mortality. Obesity is associated with an increased risk of delayed graft function (DGF), acute rejection, surgical complications, graft loss and mortality. The aim of this study is to assess the clinical evolution of obese and overweight patients that have received a kidney transplant, based on short- and long-term complications associated with a higher BMI.</p></div><div><h3>Material and methods</h3><p>A descriptive, observational, cross-sectional study was conducted with 104 kidney or pancreas-kidney transplant patients between March 2017 and December 2020, with a follow-up until April 2021. For comparative analysis, patients were grouped according to BMI.</p></div><div><h3>Results</h3><p>Mean age was of 56.65 years, 60.6% male and 39.4% female. Overweight patients experienced prolonged surgeries, more surgical wound dehiscence, delayed graft function, hernias, proteinuria and more indications for renal biopsies. Additionally, obese patients displayed more DGF, indications for renal biopsies, proteinuria, development of diabetes mellitus, atrial fibrillation and needed prolonged hospital stays.</p></div><div><h3>Conclusions</h3><p>Despite a high prevalence of comorbidity in the overweight and/or obese population, we found no reduction in patient and/or graft survival. However, longer follow-up is needed.</p></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"48 2","pages":"Pages 125-133"},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74964772","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 : 2024-03-01DOI: 10.1016/j.acuro.2023.07.009
D. Santucci , D. Vertulli , F. Esperto , L. Eolo Trodella , S. Ramella , R. Papalia , R.M. Scarpa , C. de Felice , R. Francesco Grasso , B. Beomonte Zobel , E. Faiella
Objective
To evaluate prostate-specific antigen (PSA) value in multiparametric magnetic resonance imagin (mp-MRI) results prediction, analyzing patients with high (Gleason Score ≥ 8, pT ≥ 3, pN1) and low grade (Gleason Score < 8, pT < 3, pN0) prostate cancer (PCa).
Materials and methods
One hundred eighty-eight patients underwent 1.5-T mp-MRI after radical prostatectomy and before radiotherapy. They were divided into 2 groups: A and B, for patients with biochemical recurrence (BCR) and without BCR but with high local recurrence risk. Considering Gleason Score, pT and pN as independent grouping variables, ROC analyses of PSA levels at primary PCa diagnosis and PSA before radiotherapy were performed in order to identify the optimal cut-off to predict mp-MRI result.
Results
Group A and B showed higher area under the curve for PSA before radiotherapy than PSA at PCa diagnosis, in low and high grade tumors. For low grade tumors the best area under the curve was 0.646 and 0.685 in group A and B; for high grade the best area under the curve was 0.705 and 1 in group A and B, respectively. For low grade tumors the best PSA cut-off was 0.565-0.58 ng/ml in group A (sensitivity, specificity: 70.5%, 66%), and 0.11-0.13 ng/ml in B (sensitivity, specificity: 62.5%, 84.6%). For high grade tumors, the best PSA cut-off obtained was 0.265-0.305 ng/ml in group A (sensitivity, specificity: 95%, 42.1%), and 0.13-0.15 ng/ml in B (sensitivity, specificity: 100%).
Conclusion
Mp-MRI should be performed as added diagnostic tool always when a BCR is detected, especially in high grade PCa. In patients without BCR, mp-MRI results, although poorly related to pathological stadiation, still have a good diagnostic performance, mostly when PSA > 0.1-0.15 ng/ml.
{"title":"El papel del antígeno prostático específico (PSA) y el estadio patológico antes de la radioterapia en la predicción de los resultados de la resonancia magnética multiparamétrica (RMmp) en pacientes con recidiva del cancer de próstata tras prostatectomía radical","authors":"D. Santucci , D. Vertulli , F. Esperto , L. Eolo Trodella , S. Ramella , R. Papalia , R.M. Scarpa , C. de Felice , R. Francesco Grasso , B. Beomonte Zobel , E. Faiella","doi":"10.1016/j.acuro.2023.07.009","DOIUrl":"10.1016/j.acuro.2023.07.009","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate prostate-specific antigen (PSA) value in multiparametric magnetic resonance imagin (mp-MRI) results prediction, analyzing patients with high (Gleason Score <!--> <!-->≥<!--> <!-->8, pT<!--> <!-->≥<!--> <!-->3, pN1) and low grade (Gleason Score <!--> <!--><<!--> <!-->8, pT<!--> <!--><<!--> <!-->3, pN0) prostate cancer (PCa).</p></div><div><h3>Materials and methods</h3><p>One hundred eighty-eight patients underwent 1.5-T mp-MRI after radical prostatectomy and before radiotherapy. They were divided into 2 groups: A and B, for patients with biochemical recurrence (BCR) and without BCR but with high local recurrence risk. Considering Gleason Score, pT and pN as independent grouping variables, ROC analyses of PSA levels at primary PCa diagnosis and PSA before radiotherapy were performed in order to identify the optimal cut-off to predict mp-MRI result.</p></div><div><h3>Results</h3><p>Group A and B showed higher area under the curve for PSA before radiotherapy than PSA at PCa diagnosis, in low and high grade tumors. For low grade tumors the best area under the curve was 0.646 and 0.685 in group A and B; for high grade the best area under the curve was 0.705 and 1 in group A and B, respectively. For low grade tumors the best PSA cut-off was 0.565-0.58<!--> <!-->ng/ml in group A (sensitivity, specificity: 70.5%, 66%), and 0.11-0.13<!--> <!-->ng/ml in B (sensitivity, specificity: 62.5%, 84.6%). For high grade tumors, the best PSA cut-off obtained was 0.265-0.305<!--> <!-->ng/ml in group A (sensitivity, specificity: 95%, 42.1%), and 0.13-0.15<!--> <!-->ng/ml in B (sensitivity, specificity: 100%).</p></div><div><h3>Conclusion</h3><p>Mp-MRI should be performed as added diagnostic tool always when a BCR is detected, especially in high grade PCa. In patients without BCR, mp-MRI results, although poorly related to pathological stadiation, still have a good diagnostic performance, mostly when PSA<!--> <!-->><!--> <!-->0.1-0.15<!--> <!-->ng/ml.</p></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"48 2","pages":"Pages 140-149"},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135606582","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 : 2024-03-01DOI: 10.1016/j.acuro.2023.07.006
C. Mínguez Ojeda, I. Laso García, D. López Curtis, G. Duque Ruiz, M. Mata Alcaraz, M. Santiago González, A. Artiles Medina, M. Hevia Palacios, F. Arias Fúnez, F.J. Burgos Revilla
Objective
To evaluate the efficacy and complications of extracorporeal lithotripsy (SWL) as a first-line treatment for renal and ureteral stones.
Methods
Retrospective and observational study of all the patients treated with lithotripsy in a third level center between January 2014 and January 2021; characteristics of the patients, the stones, complications and results of SWL is recollected. Multivariate logistic regression of the factors associated with stone size reduction was performed. A statistical analysis of the factors associated with additional treatment after SWL and factors associated with complications is also executed.
Results
1727 patients are included. Stone mean size was 9,5 mm. 1540 (89.4%) patients presented reduction in stone size. In multivariate analysis, stone size (OR = 1.13; P = 0.00), ureteral location of the lithiasis (OR = 1.15; P = 0.052) and number of waves (P = 0.002; OR = 1.00) used in SWL are the factors associated with reduction of stone size. Additional treatment after lithotripsy was needed in 665 patients (38.5%). The factors associated with the need for retreatment were stone size (OR = 1.131; P = 0.000), number of waves (OR = 1.000; P = 0.000), energy (OR = 1.005; P = 0.000). 153 patients (8.8%) suffered complications after SWL. A statistically significant association was found between the size of the lithiasis (P = 0.024, OR = 1.054) and the previous urinary diversion (P = 0.004, OR = 0.571).
Conclusion
Lithotripsy remains an effective treatment as the first line of therapy for reno-ureteral lithiasis with a low percentage of complications.
{"title":"Validez actual de la litotricia extracorpórea como tratamiento de primera línea de la litiasis","authors":"C. Mínguez Ojeda, I. Laso García, D. López Curtis, G. Duque Ruiz, M. Mata Alcaraz, M. Santiago González, A. Artiles Medina, M. Hevia Palacios, F. Arias Fúnez, F.J. Burgos Revilla","doi":"10.1016/j.acuro.2023.07.006","DOIUrl":"10.1016/j.acuro.2023.07.006","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the efficacy and complications of extracorporeal lithotripsy (SWL) as a first-line treatment for renal and ureteral stones.</p></div><div><h3>Methods</h3><p>Retrospective and observational study of all the patients treated with lithotripsy in a third level center between January 2014 and January 2021; characteristics of the patients, the stones, complications and results of SWL is recollected. Multivariate logistic regression of the factors associated with stone size reduction was performed. A statistical analysis of the factors associated with additional treatment after SWL and factors associated with complications is also executed.</p></div><div><h3>Results</h3><p>1727 patients are included. Stone mean size was 9,5 mm. 1540 (89.4%) patients presented reduction in stone size. In multivariate analysis, stone size (OR<!--> <!-->=<!--> <!-->1.13; <em>P</em> <!-->=<!--> <!-->0.00), ureteral location of the lithiasis (OR<!--> <!-->=<!--> <!-->1.15; <em>P</em> <!-->=<!--> <!-->0.052) and number of waves (<em>P</em> <!-->=<!--> <!-->0.002; OR<!--> <!-->=<!--> <!-->1.00) used in SWL are the factors associated with reduction of stone size. Additional treatment after lithotripsy was needed in 665 patients (38.5%). The factors associated with the need for retreatment were stone size (OR<!--> <!-->=<!--> <!-->1.131; <em>P</em> <!-->=<!--> <!-->0.000), number of waves (OR<!--> <!-->=<!--> <!-->1.000; <em>P</em> <!-->=<!--> <!-->0.000), energy (OR<!--> <!-->=<!--> <!-->1.005; <em>P</em> <!-->=<!--> <!-->0.000). 153 patients (8.8%) suffered complications after SWL. A statistically significant association was found between the size of the lithiasis (<em>P</em> <!-->=<!--> <!-->0.024, OR<!--> <!-->=<!--> <!-->1.054) and the previous urinary diversion (<em>P</em> <!-->=<!--> <!-->0.004, OR<!--> <!-->=<!--> <!-->0.571).</p></div><div><h3>Conclusion</h3><p>Lithotripsy remains an effective treatment as the first line of therapy for reno-ureteral lithiasis with a low percentage of complications.</p></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"48 2","pages":"Pages 134-139"},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"53918901","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 : 2024-03-01DOI: 10.1016/j.acuro.2023.08.007
J.C. Angulo , J. Díaz Goizueta , F.J. Díaz Alférez , J. Szczesniewski
{"title":"Carlos Alférez y la conversión de «Actas de la AEU» en «Actas Urológicas Españolas»","authors":"J.C. Angulo , J. Díaz Goizueta , F.J. Díaz Alférez , J. Szczesniewski","doi":"10.1016/j.acuro.2023.08.007","DOIUrl":"10.1016/j.acuro.2023.08.007","url":null,"abstract":"","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"48 2","pages":"Pages 113-115"},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135588121","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 : 2024-03-01DOI: 10.1016/j.acuro.2023.06.006
C. Calzas Montalvo , J. Medina-Polo , N.R. Miranda Utrera , S. Juste Álvarez , A. de la Calle Moreno , M.P. Caro González , R. Santos Perez de la Blanca , M. Hernández Arroyo , E. Peña Vallejo , J. Teigell Tobar , J.M. Duarte Ojeda , M. Pamplona Casamayor , Á. Tejido Sánchez , L. García González , A. Arrébola Pajares , Á. Sánchez Guerrero , J. Rodríguez de la Calle , A. Rodríguez Antolín
Introduction and objectives
Transplant renal artery stenosis (TRAS) is a vascular complication after kidney transplantation which estimated incidence is 13%. It could cause refractory arterial hypertension, kidney dysfunction and premature death in transplant recipients.
Methods
We carried out a retrospective study including every patient who underwent renal transplantation between 2014 and 2020. They were evaluated with a systematic post-transplant renal Doppler ultrasound. To identify independent risk factors for transplant renal artery stenosis we performed a multivariate analysis.
Results
Seven hundred twenty-four kidney transplants were included, 12% were living donors and 88% were deceased donors. The mean age was 54.8 in recipients and 53 in donors. Transplant renal artery stenosis was diagnosed in 70 (10%) recipients, the majority in the first 6 months after surgery. The 51% of patients with transplant renal artery stenosis were managed conservatively. The multivariate analysis showed diabetes mellitus, graft rejection, arterial resuture and donor body mass index as independent risk factors for transplant renal artery stenosis. Survival of the grafts with transplant renal artery stenosis was 98% at 6 months and 95% at two years.
Conclusions
The systematic performance of Doppler ultrasound in the immediate post-transplant period diagnosed 10% of transplant renal artery stenosis in our cohort. Despite the above risk factors, an adequate monitoring and treatment could avoid the increased risk of graft loss in patients with transplant renal artery stenosis.
{"title":"Estenosis arterial del injerto renal: evaluación de la incidencia mediante ecografía doppler, factores de riesgo y análisis de las complicaciones que pueden afectar a la supervivencia del injerto","authors":"C. Calzas Montalvo , J. Medina-Polo , N.R. Miranda Utrera , S. Juste Álvarez , A. de la Calle Moreno , M.P. Caro González , R. Santos Perez de la Blanca , M. Hernández Arroyo , E. Peña Vallejo , J. Teigell Tobar , J.M. Duarte Ojeda , M. Pamplona Casamayor , Á. Tejido Sánchez , L. García González , A. Arrébola Pajares , Á. Sánchez Guerrero , J. Rodríguez de la Calle , A. Rodríguez Antolín","doi":"10.1016/j.acuro.2023.06.006","DOIUrl":"10.1016/j.acuro.2023.06.006","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>Transplant renal artery stenosis (TRAS) is a vascular complication after kidney transplantation which estimated incidence is 13%. It could cause refractory arterial hypertension, kidney dysfunction and premature death in transplant recipients.</p></div><div><h3>Methods</h3><p>We carried out a retrospective study including every patient who underwent renal transplantation between 2014 and 2020. They were evaluated with a systematic post-transplant renal Doppler ultrasound. To identify independent risk factors for transplant renal artery stenosis we performed a multivariate analysis.</p></div><div><h3>Results</h3><p>Seven hundred twenty-four kidney transplants were included, 12% were living donors and 88% were deceased donors. The mean age was 54.8 in recipients and 53 in donors. Transplant renal artery stenosis was diagnosed in 70 (10%) recipients, the majority in the first 6 months after surgery. The 51% of patients with transplant renal artery stenosis were managed conservatively. The multivariate analysis showed diabetes mellitus, graft rejection, arterial resuture and donor body mass index as independent risk factors for transplant renal artery stenosis. Survival of the grafts with transplant renal artery stenosis was 98% at 6 months and 95% at two years.</p></div><div><h3>Conclusions</h3><p>The systematic performance of Doppler ultrasound in the immediate post-transplant period diagnosed 10% of transplant renal artery stenosis in our cohort. Despite the above risk factors, an adequate monitoring and treatment could avoid the increased risk of graft loss in patients with transplant renal artery stenosis.</p></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"48 2","pages":"Pages 177-183"},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"53918820","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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