Actas urologicas espanolas最新文献

Objective

This study aimed to assess the influence of age, period, and cohort (A-P-C) factors on kidney cancer (KC) incidence trends in Spain from 1990 to 2019.

Methods

Employing data from the Global Burden of Disease Study 2019, we employed joinpoint analysis to determine long-term patterns and A-P-C modelling to quantify net drift, local drift, longitudinal age curves, and rate ratios (RRs) of period and cohort effects.

Results

Over the period 1990–2019, an estimated 142,811 cases of KC were diagnosed in Spain. A consistent upward trend in KC incidence was observed for both men and women, with the male-to-female ratio remaining stable at 2.6. Joinpoint analysis identified three distinct periods for men: An initial period (1990–1995) characterised by a significant increase in rates, a subsequent period (1995–2016) characterised by a slowdown in the rate of increase, and a final period (2016–2019) in which rates have plateaued. In women, 2 time periods were observed: an initial period (1990–2007) in which rates increased significantly, followed by a period of stabilization (2007–2019).

Men born in the early-mid 20th century had a rising KC risk, peaking in the 1960s. Women’s risk rose steadily, peaking in the late 1990s.

Conclusion

A-P-C analysis reveals steady KC incidence increase in both genders over three decades. This highlights the need for targeted public health policies and effective prevention strategies.

Introduction

Stress urinary incontinence (SUI) is frequently associated with pelvic organ prolapse (POP) and may occur after its surgical treatment.

Aim

To determine the incidence, risk factors and management of SUI during and after POP surgery through a review of the available literature.

Materials and Method

Narrative literature review on the incidence and management of SUI after POP surgery after search of relevant manuscripts indexed in PubMed, EMBASE and Scielo published in Spanish and English between 2013 and 2023.

Results

Occult SUI is defined as visible urine leakage when prolapse is reduced in patients without SUI symptoms. De novo SUI develops after prolapse surgery without having previously existed. In continent patients, the number needed to treat (NNT) to prevent one case of de novo SUI is estimated to be 9 patients and about 17 to avoid repeat incontinence surgery. In patients with occult UI, the NNT to avoid repeat incontinence surgery is around 7. Patients with POP and concomitant SUI are the group most likely to benefit from combined surgery with a more favorable NNT (NNT 2).

Conclusion

Quality studies on combined surgery for treatment SUI and POP repair are lacking. Continent patients with prolapse should be warned of the risk of de novo SUI, although concomitant incontinence treatment is not currently recommended. Incontinence surgery should be considered on an individual basis in patients with prolapse and SUI.

Introduction

The improved image resolution of IMAGE1 S technology will increase tumor detection, achieve a greater number of complete resections, and would probably have an impact on the reduction of recurrences.

Aim

The primary objective was to compare the recurrence rates of IMAGE1 S vs. white light during transurethral resection of the bladder (TUR); the secondary objective was to compare the complication rates according to Clavien-Dindo (CD) at 12 months of follow-up.

Methods

Prospective, randomized 1:1, blinded clinical trial. Recurrence and complication rates according to CD were analyzed using chi-square/U Mann-Whitney tests and recurrence-free survival (RFS) using Kaplan-Meier curves. The European Association of Urology (EAU) 2021 scoring model was used.

Results

The analysis included 103 participants; 49 were assigned to the IMAGE1 S group and 54 to the white light group. Recurrence rates were 12.2% and 25.9%, respectively (P = .080). The low and intermediate risk group had a lower recurrence rate with IMAGE1 S (7.7% vs. 30.8%, P = .003) and a higher RFS with IMAGE1 S (85.2% vs. 62.8% Log Rank: 0.021), with a Hazard Ratio of 0.215 (95% CI: 0.046−0.925). No differences were observed in the high and very high-risk groups. Complications were mostly grade I and rates were similar between both groups (IMAGE1 S 20.4% vs. white light 7.4% P = .083).

Conclusions

There were no differences in the recurrence rates between groups. However, the low and intermediate risk group had a lower recurrence rate with IMAGE1 S. In addition, perioperative complication rates were not higher.

Introduction

The prevalence of endometriosis is estimated to be about 10% among women of reproductive age. In about 5–10% of these patients, involvement of urological structures will be developed due to deep endometriosis. Urologists should be familiar with the management of these patients, who will require multidisciplinary care with medical and surgical treatment.

Material and Methods

Retrospective study of patients diagnosed with deep endometriosis involving urological structures who underwent surgery performed jointly with gynecology and colorectal surgery departments from June 2012 until June 2021 (60 cases). Urologic symptoms were grouped into 3 groupers for subsequent analysis (storage symptoms, voiding symptoms, and low back pain).

Results

Storage symptoms (frequency and urgency) are the most frequent urologic symptoms. Patients with storage symptoms and low back pain showed improvement after surgery. In contrast, patients with voiding symptoms did not improve with surgical treatment.

Conclusions

The prevalence of endometriosis and the likelihood of involving urologic structures require the urologic community to be aware of the pathology.

Patients with storage symptoms will improve following excision of the endometriotic nodules. The need for Partial cystectomies with ureteral reimplantation can be safely performed by laparoscopic or robotic approach, even in previously operated patients, without compromising long-term function.

Introduction

Renal trauma is the most common of urological trauma and accounts for up to 5% of all. The AAST scale is the most widely used to assess renal trauma. This study focuses on high-grade trauma, whose treatment has evolved towards a conservative approach, with techniques such as angioembolization. The aim is to describe the evolution in the management of high-grade renal trauma in all patients treated at La Paz University Hospital from 2001 to 2022.

Methods

A descriptive retrospective study was conducted on patients treated at the hospital. The study was divided into two periods (2001–2010 and 2011–2022). A total of 285 patients with renal trauma were collected, of which 54 were high grade. The main variable is the type of management, conservative (embolization) or interventional through nephrectomy.

Results

In the completed series, there was a decrease in radical nephrectomy in high-grade renal trauma from 50% to 13.8% over time, with an increase in embolization from 23,1% to 44,8%. In patients with isolated renal trauma, those treated with embolization increased from 28.6% to 69.2%, while those undergoing radical/partial nephrectomy decreased from 42.8% to 7.69%.

Conclusion

The management of renal trauma has evolved over the years in our center. The number of patients treated by embolization has increased, while the number of complications and nephrectomies has decreased.

Introduction and objectives

The increasing number of robotic urological procedures observed in recent years highlights the need to expand training opportunities in robotic surgery. Our objective is to investigate the state of robotic training during urology residency in Spain in order to identify significant deficiencies.

Materials and methods

A 20-item online survey was conducted among urology residents in Spain who were registered in the database of the Residents and Young Urologists Group of the Spanish Association of Urology. The survey assessed subjective opinions, institutional aspects, training resources, and experience regarding robotic surgery. A total of 455 email invitations were sent throughout the year 2021. Descriptive analysis of the responses was performed.

Results

The participation rate reached 30%, with a total of 135 residents. 52% of respondents lacked access to a robotic system in their institution, of which only 48% could compensate for this deficiency through external rotations. Among those with access to a robotic system, 25% and 23% reported having access to theoretical and practical training, respectively. The existence of a formal training program was low (13%). 85% of the respondents considered robotic surgery training in Spain to be deficient.

Conclusions

Training for Spanish residents in robotic urological surgery is perceived as inadequate, emphasizing the crucial need for improvement in training programs in this field.

Introduction

Prostate cancer (PCa) ranks second among prevalent cancers in men, necessitating effective screening tools such as multiparametric magnetic resonance imaging (mpMRI) with the prostate imaging reporting and data system (PI-RADS) classification. This study explores the impact of lesion volume on clinically significant prostate cancer (csPCa) detection rates in PI-RADS 3–5 lesions, aiming to contribute insights into the underexplored relationship between lesion size and csPCa detection.

Materials and methods

A retrospective analysis was conducted on data from 754 patients undergoing mpMRI-guided transrectal ultrasound (TRUS) prostate biopsy between January 2016 and 2023. Patients with PI-RADS 3, 4, and 5 lesions were included. Lesion size and PI-RADS categories were assessed through mpMRI, followed by MR fusion biopsy.

Results

Of the patients, 33.7%, 52.3%, and 14.1% had PI-RADS 3, 4, and 5 lesions, respectively. Lesion sizes correlated significantly with csPCa detection in PI-RADS 4 and 5 categories. For PI-RADS 3 lesions, no significant differences in csPCa rates were observed based on lesion size. However, in PI-RADS 4 and 5 groups, larger lesions showed higher csPCa rates.

Conclusion

This study suggests that subgroup categorizations based on lesion volume could predict clinically significant PCa with high accuracy, potentially reducing unnecessary biopsies and associated overtreatment. Future research should further explore the relationship between lesion size and csPCa, clarifying discussions regarding the inclusion of systematic biopsies in diagnostic protocols.

Introduction

Stress Urinary Incontinence is a condition that impairs the quality of life in women and randomized controlled trials of electroacupuncture for stress urinary incontinence have been conducted.

Objective

The aim of this systematic review and meta-analysis was to examine the effect of electroacupuncture on the severity and symptoms of urinary incontinence in women with stress urinary incontinence.

Methods

Literature searches were conducted in PubMed, CINAHL, Scopus and Science Citation Index until November 2023. This study was based on the recommendations of the Cochrane guidelines. Data were analyzed using the Review Manager computer program (Version 5.4). The methodological quality of the studies was assessed using the RoB-2 tool.

Results

The analysis included 888 women with stress urinary incontinence and three studies. In women with stress urinary incontinence, electroacupuncture intervention improved urinary incontinence severity and quality of life (MD: −2.37, 95% CI: −3.29 to 1.45, Z = 5.07, p < 0.001), urinary leakage (SMD: −0.79, 95% CI: −1.02 to −0.55, Z = 6.60, p = 0.001) and incontinence episode frequency (SMD: −2.24, 95% CI: −4.17 to −0.32, Z = 2.29, p < 0.02).

Conclusion

In women with stress urinary incontinence, electroacupuncture intervention decreased the severity of urinary incontinence and improved the quality of life. Symptoms related to urinary incontinence were found to decrease urinary leakage and incontinence episode frequency. The studies included in the analysis were determined to be low-risk studies in quality assessment.

Background

Bladder cancer (BC) is the seventh most common cancer worldwide. Not every infection ends as cancer, although the HPV-induced carcinogenesis is a complex process consequence of inflammation. To determine the association between human papillomavirus (HPV) and the diagnosis of bladder cancer.

Methods

We carried out a systematic review according to Cochrane and PRISMA recommendations. We searched in EMBASE, Medline (Ovid), and The Cochrane Central Register of Controlled Trials (CENTRAL), from inception to nowadays. We included case-control studies. The risk of bias assessment was performed based on QUADAS2. We performed a random effect Meta-analysis.

Results

We included 14 studies in qualitative and quantitative analysis. There was mainly a low risk of bias. We finally found a strong association between the presence of HPV and bladder cancer diagnosis (OR 4.18 95%CI 2.63–6.66; I2 = 40%).

Conclusions

HPV is currently associated with the diagnosis of bladder cancer.

Introduction and objective

Pudendal neuralgia is a severely intense, painful, neuropathic condition, involving the dermatome of the pudendal nerve (S2, S3, S4). The diagnosis is complex and usually takes many years to be made. Techniques that use electrical current have been shown to decrease pain and improve quality of life in patients with this condition. The aim of this review was to analyze the existing literature on the effects of electrical current in the treatment of patients with pudendal neuralgia.

Material and methods

A literature search was carried out in PubMed, Cinahl, Medline, Cochrane Library, ENFISPO, PEDro, Scopus and Web of Science databases, using the search terms “Electric Stimulation Therapy”, “pudendal neuralgia” and “pudendal nerve entrapment”.

Results

The most frequently repeated intervention is pulsed radiofrequency. Other techniques used are transcutaneous electrical nerve stimulation, pulsed electromagnetic field therapy and neuromodulation. All studies show significant improvement in pain, analgesic intake, depression-anxiety or quality of life.

Conclusions

The application of electrical current seems to be effective in the management of pudendal neuralgia. The scientific evidence is scarce, of poor methodological quality, and its use is based on the efficacy demonstrated in other indications of chronic pain.