Actas urologicas espanolas最新文献

Introduction: Prostate cancer (PCa) screening based on prostate-specific antigen (PSA) testing has represented a major milestone in early detection; however, it has also prompted considerable debate due to the risks of overdiagnosis and overtreatment. This review examines the evolution of PCa screening, highlighting its main challenges and emerging approaches aimed at achieving more accurate and individualized detection.

Methods: A narrative review of the literature was conducted using databases such as PubMed and Google Scholar, applying MeSH terms related to screening, overdiagnosis, and prostate cancer. Clinical studies, systematic reviews, and recent guidelines pertinent to the topic were included.

Results: The PLCO, ERSPC, and Göteborg trials provide complementary insights into the impact of PSA-based screening, with outcomes ranging from limited benefit to significant reductions in PCa-specific mortality. Based on these this findings, a paradigm shift toward risk-stratified screening strategies has been advocated. The incorporation of new tools such as magnetic resonance imaging, blood and urine biomarkers, risk calculators, and artificial intelligence-based algorithms has improved diagnostic accuracy. These strategies reduce unnecessary biopsies and focus on the detection of clinically significant disease. Current guidelines recommend individualized assessment based on factors such as age, baseline PSA levels, family history, and comorbidities.

Conclusion: The future of PCa screening resides in personalized medicine, in which the integration of clinical, imaging, and molecular parameters will enable a more efficient approach, minimizing unnecessary interventions and improving overall patient outcomes.

Introduction and objectives: Whole-body bone mineral content (BMC) and bone mineral density (BMD) can provide comprehensive information about the health of the whole body. This study aimed to assess whether BMC and BMD are potentially associated with self-reported kidney stones.

Materials and methods: Multiple logistic regression analysis was used to investigate the potential association between BMC/BMD and kidney stones. Subgroup analysis and interaction tests were used to examine the stability of the relationship. Restricted cubic spline plots were used to examine the dose-response relationship. Saturation effect and threshold effect analyses were used to assess inflection points in the dose-response relationship.

Results: The study population consisted of 8030 adults. Compared with those with low BMD levels, the prevalence of kidney stones was lower in those with high BMD levels (6.55% vs. 10.87%, P = 0.0001). After adjusting for all covariates, there was a negative association between whole-body BMC and kidney stones (OR = 0.06, 95% CI = 0.02-0.25; P < 0.0001), and between whole-body BMD and kidney stones (OR = 0.19, 95% CI = 0.08-0.45; P = 0.0002). Subgroup analyses and interaction tests identified diabetes and smoking as significant influences. In the non-smoking population, a non-linear relationship was shown between BMD and kidney stones (non-linear P value = 0.039).

Conclusions: BMC and BMD were inversely associated with the prevalence of kidney stones in U.S. adults. Although causality cannot be established, these findings suggest that bone health assessment may help identify individuals at higher risk of kidney stones, especially among smokers and patients with diabetes.

Introduction: Advances in natural language processing (NLP) technologies have gained prominence for extracting relevant clinical information. Savana is a platform capable of analyzing free-text data and interpreting the content of electronic health records (EHRs).

Objective: To validate the results obtained through NLP by Savana from data of patients with prostate cancer (PC) included in active surveillance (AS), compare them with our database, and assess their reliability.

Methods: Observational and retrospective study of patients with PC in AS between 2014 and 2022. The results from our database were blinded to Savana. Information from the EHRs was transformed by Savana into analysis-ready data. After an initial evaluation, it was necessary to refine the preliminary results and readjust the variables and terminology to eliminate discrepancies.

Results: Of the 2865 patients included in our database, 306 met the selection criteria. Savana detected 366 patients with the terms "PC," "Gleason," and "AS." The results were similar regarding Gleason score at diagnosis: 93.4% Gleason 6 in our series vs. 92% in Savana. Likewise, the proportion of patients who received treatment with curative intent, and the type of treatment were comparable: 33.3% in our series (RP: 56.9%; RT: 42.1%) vs. 32.5% in Savana (RP: 59.7%; RT: 40.3%). However, only 24.8% showed Gleason progression in our series vs. 31% in Savana. The mortality rate was 3.2% in our series vs. 7.4% in Savana.

Conclusions: NLP represents a promising tool in clinical research, but its implementation should be approached with caution.

Introduction and objectives: Holmium Laser Enucleation of the Prostate (HoLEP) is an effective treatment for benign prostatic obstruction; however, data on its outcomes in patients with acute urinary retention (AUR), particularly those who remained catheter-dependent until surgery, remain limited. This study compared HoLEP outcomes in patients with and without AUR.

Methods: Data from 140 male patients aged 50-80 who underwent HoLEP were retrospectively and exploratorily analyzed. Patients were grouped as catheter-dependent AUR (Group-1) and non-AUR (Group-2). The primary comparison was Qmax at 6 months, while secondary comparisons included functional outcomes and perioperative/postoperative complications.

Results: Thirty-four patients (24.3%) had catheter-dependent AUR. They were older (68.9 ± 6.9 vs. 66.2 ± 6.5 years) and had worse baseline IPSS (25[22-29] vs. 22[17-25]), quality of life (QoL; 5 [4-6] vs. 4 [3-5]), Qmax (0 vs. 8[5.6-10] mL/s), and PVR (400[197-560] vs. 100[60-150] mL) (p < 0.05). Perioperative parameters and complication rates were not significantly different between the groups. Following HoLEP, AUR patients showed greater improvements in Qmax (Δ16[14-20.3] vs. 10 [7-15] mL/s), IPSS (Δ16.5[10.8-22.3] vs. 11.5[6-17.3]), QoL (Δ4 [3-5] vs. 3[1-3.3]), and PVR (Δ326[128-502] vs. 62.5[26-120] mL) (p < 0.05). Although patients with catheter-dependent AUR demonstrated more pronounced improvements in functional outcomes, this was largely attributable to worse baseline parameters. No statistically significant differences were observed in postoperative outcomes between the groups. Notably, subjective measures (IPSS and QoL) improved more markedly in Group-1.

Conclusions: HoLEP is an effective treatment option for catheter-dependent AUR patients, providing significant functional improvement. Preoperative catheterization until surgery does not negatively affect surgical efficacy or postoperative outcomes.

Introduction: Urinary tract infections (UTIs) are common among women, and approximately 20-30% experience recurrent episodes (rUTIs). The increasing prevalence of antimicrobial resistance highlights the need for non-antibiotic preventive strategies. d-mannose and proanthocyanidins (PAC) have shown potential in reducing rUTIs. The aim of this study was to evaluate the efficacy of a combination of d-mannose and PAC in preventing postcoital UTIs over a 6-month period.

Materials and methods: We conducted a prospective, single-center pilot study including 26 women aged 18-45 years with a history of recurrent postcoital UTIs. Participants received a daily prolonged-release formulation containing d-mannose (2000 mg) and PAC (140 mg) for 6 months. The primary outcome was the incidence of postcoital UTI episodes. Secondary outcomes included treatment adherence, episode severity, microbiological findings, safety, quality of life, and patient-reported improvement. Analyses were performed on both the intention-to-treat (ITT) and per-protocol (PP) populations.

Results: At 6 months, 53.6% of participants had no new UTI episodes. A total of 24 episodes were recorded in 12 women, with more than two-thirds concentrated in a small subgroup. Overall, UTI incidence decreased significantly (p = 0.01), and 76.2% of participants remained infection-free at the final visit. Adherence was high (90.9% at 3 months and 85.7% at 6 months). Positive urine cultures most frequently identified Klebsiella aerogenes and Escherichia coli. Sexual function remained stable, and 80.9% of women reported subjective improvement. Only one withdrawal occurred due to vaginal dryness.

Conclusions: The combination of d-mannose and PAC in a prolonged-release formulation appears to be a promising, safe, and well-tolerated strategy for the prevention of postcoital rUTIs in young women. Larger randomized controlled trials are warranted to confirm these preliminary findings.

Introduction: The soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) is a cytokine that modulates inflammatory and atherogenic reactions. In our study, we aimed to determine whether sTWEAK could be a biomarker of erectile dysfunction (ED).

Methods: Ninety patients diagnosed with ED and 90 healthy participants were prospectively enrolled during the period of September 2021-September 2023. Participants were divided into three groups according to International Index of Erectile Function (IIEF) Erectile Function Domain scores; severe disease (1-10), moderate-mild disease (11-21) and healthy control (22-30). All participants filled out Beck Depression Inventory (BDI). Blood samples were collected for complete blood count, biochemical analysis and hormonal assessment.

Results: sTWEAK levels were higher in patients and increased with the severity of the disease as well. Healthy participants had lower BDI score (P = .001) and erythrocyte sedimentation rate (P = .001). Analysis with ROC curve demonstrated good area under curve value for sTWEAK (0.776, P = .001) in predicting ED. Optimal threshold level was determined as 5,41 ng/mL (71.1% sensitivity and 71.1% specificity).

Conclusions: We revealed that there is a significant association between sTWEAK levels and severity of disease, therefore we belive that sTWEAK pathway has a role in the pathogenesis of atherosclerosis in patients with ED.

Objective: This study aimed to assess whether adding voided urine cytology to the European Organisation for Research and Treatment of Cancer (EORTC) score improves the indication for a single instillation of mitomycin C following transurethral resection of the bladder and whether this approach improves mitomycin C instillation rate.

Materials and methods: A retrospective observational study was conducted on 272 bladder cancer patients treated at a tertiary center from March 2020 to March 2022. After applying the exclusion criteria, 123 patients were included in the analysis. Voided urine cytology results and EORTC scores, with and without pathological data, were compared to the full EORTC 2006 score (gold standard) to evaluate the need for mitomycin C. Statistical analyses included sensitivity, specificity, receiver operating characteristic curves, and the Kappa index to measure test concordance. The method's application in our center was also compared with existing literature.

Results: Combining urine cytology with the EORTC score without pathological data improved the accuracy of mitomycin C indications, increasing the area under the curve from 0.62 to 0.79. This approach reduced unnecessary mitomycin C administration in 53 patients, with only 6 patients missing beneficial treatment, none of whom were low-risk. Only 6 cases lacked documented reasons for not receiving the instillation, a better rate than reported in the literature.

Conclusions: Adding urine cytology to the EORTC score enhances the accuracy of mitomycin C indications, reducing unnecessary treatments while ensuring appropriate therapy for low-risk patients. Further studies are needed to validate these findings across different populations.

Objective: To evaluate the rate of stress urinary incontinence, time to continence recovery, and incidence of urethral stricture in a series of patients who underwent holmium laser enucleation of the prostate (HoLEP) from the beginning of the learning curve of a single surgeon.

Materials and methods: Prospective study of 254 patients consecutively operated on by one surgeon between December 2022 and December 2024. Continence was defined as the use of 0 pads. Survival analysis (Kaplan-Meier) was performed to estimate time to continence recovery. Results were stratified according to surgical technique (2- or 3-lobe vs. en bloc), prostate volume, and BMI. Overall and de novo urethral stricture rates were analyzed according to operative time, ultrasound volume, and enucleated weight.

Results: The median time to continence was 20 days. The continence rates at 1 month, 2 months, and 4 months were 80.7%, 91.2%, and 98.5%, respectively. Although incontinence decreased progressively, urgency was more frequent in persistent cases. No significant differences were observed in the time to continence according to surgical technique, prostate volume, or BMI. The overall rate of urethral stricture was 3.9%, with 3.65% de novo cases. No associated risk factors were identified.

Conclusions: HoLEP showed a low rate of transient incontinence and urethral stricture, and no correlation with surgical technique or patient clinical characteristics.

In recent months, restrictions have been proposed on the prescription of PARP inhibitors (iPARP) by urologists in metastatic castration-resistant prostate cancer (mCRPC). The Spanish Association of Urology (AEU), its Uro-Oncology Group (GUO), and the presidents of the Regional Urology Associations consider these limitations unjustified from clinical, organizational, legal, or professional perspectives. They unduly restrict the exercise of competencies recognized in the interdisciplinary management of prostate cancer, in line with the training, experience, and current regulations of the specialty. This document argues, from scientific, clinical, and legal standpoints, that urologists are qualified and legally authorized to prescribe and administer iPARP according to current legislation and the official training program. It also advocates a collaborative model centred on the patient's care pathway and based on mutual respect among specialties, ensuring professional autonomy, continuity of care, and equitable access to therapeutic innovation.

Introduction: In 1997, the WHO established the role of genital tract infections in human infertility, currently responsible for 15% of the causes of infertility in men. The WHO classifies urethritis, prostatitis, vesiculitis, orchitis, and epididymitis as infections of the male accessory gland. This paper represents the state of the art on inflammation and infection of seminal tract. Objective of the study is to revise literature and to discuss regarding association to fertility.

Methods: A literature search was performed on PubMed database (http://www.pubmed.gov) for peer-reviewed journal articles relating to STD, UTI, Diagnosis and Treatment and Fertility. We carefully evaluated the most representative reports published in literature and all papers results were supported by European and American guidelines results on theme.

Results: Seminal tract infections may cause infertility by different mechanisms. Traditionally, the most common infectious causes of male infertility were sexually transmitted infections, especially Neisseria gonorrhoeae. However, the most frequent causes of infection of the seminal tract are Chlamydia trachomatis, Microplasma spp., especially Ureaplasma urealyticum and the gram-negative bacteria typical of urogenital infections. When classifying seminal tract infections, it must be considered whether or not these are sexually transmitted, and treat both partners for Sexual Transmitted Diesase if necessary (STI). There is evidence that treating STIs leads to improved semen parameters. Although antibiotics can improve sperm quality and reduce DNA fragmentation values, there is no evidence that they increase the probability of natural conception.

Conclusions: Taking into account the highly prevalence of infective or inflammatory affections of the male genital tract, its clearly stablished association with infertility and that a remarkable percentage of sexual transmitted infections (STI) are asymptomatic, we believe that these infections must be ruled out during the initial andrological evaluation in couples seeking fertility.