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Sex-specific bladder cancer incidence trends and generational effects in Spain 西班牙性别特异性膀胱癌发病率趋势和代际影响。
Pub Date : 2025-12-01 DOI: 10.1016/j.acuroe.2025.501863
L. Cayuela , V. Achaval , S. Cabrera Fernández , M. Ortega Calvo , A. Cayuela

Introduction

This study aimed to assess long-term trends in bladder cancer incidence in Spain from 1992 to 2021, using Age-Period-Cohort (A-P-C) modelling to disentangle the contributions of age, period, and cohort effects.

Methods

An ecological trend study was conducted using data from the Global Burden of Disease (GBD) 2021 Study via the Global Health Data Exchange. Age- and sex-specific incidence counts for Spain (1992–2021) were analyzed. Joinpoint regression estimated annual percent changes (APCs) and average annual percent changes (AAPCs). A-P-C modelling assessed net and local drifts, as well as cohort and period rate ratios using 5-year age groups and calendar periods.

Results

From 1992 to 2021, 377,430 male and 66,191 female BC cases were estimated. In men, age-adjusted incidence declined (AAPC = –0.6 %), driven by favourable birth cohort and period effects. In women, a modest decline (AAPC = –0.3%) masked a mid-century cohort effect, with increased risk in those born between 1957 and 1967—consistent with a delayed tobacco epidemic. Incidence rose with age in both sexes, though male-to-female incidence ratios narrowed in older groups.

Conclusion

BC incidence in Spain reflects complex, sex-specific temporal dynamics. While male incidence is decreasing, women show persistent cohort-specific increases. These trends underscore the importance of sex-sensitive public health strategies targeting modifiable risk factors, particularly tobacco use.
本研究旨在评估1992年至2021年西班牙膀胱癌发病率的长期趋势,使用年龄-时期-队列(A-P-C)模型来解开年龄、时期和队列效应的贡献。方法:通过全球健康数据交换,使用全球疾病负担(GBD) 2021研究的数据进行生态趋势研究。分析了西班牙(1992-2021)的年龄和性别特异性发病率。接合点回归估计年变化百分比(APCs)和平均年变化百分比(AAPCs)。A-P-C模型利用5年年龄组和历法期间评估了净漂和局部漂,以及同期和期间的比率。结果:从1992年到2021年,估计有377,430例男性和66191例女性BC病例。在男性中,由于有利的出生队列和时期效应,年龄调整后的发病率下降(AAPC = -0.6%)。在女性中,AAPC的适度下降(-0.3%)掩盖了本世纪中叶的队列效应,1957年至1967年出生的女性风险增加,这与烟草流行的延迟一致。随着年龄的增长,男女发病率均有所上升,但在老年人群中,男女发病率比有所缩小。结论:西班牙的BC发病率反映了复杂的、性别特异性的时间动态。虽然男性发病率正在下降,但女性的发病率却持续上升。这些趋势强调了针对可改变的风险因素,特别是烟草使用,制定对性别敏感的公共卫生战略的重要性。
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引用次数: 0
Cisplatin-induced AKI risk stratification and safety of dose reduction in urothelial carcinoma patients with renal impairment 顺铂诱导肾损害尿路上皮癌患者AKI风险分层及减药安全性。
Pub Date : 2025-12-01 DOI: 10.1016/j.acuroe.2025.501864
S. Yamamoto, K. Higa, K. Kurokawa, H. Bamba, S. Kanaoka, K. Nakamura

Introduction and objectives

Cisplatin is essential for treating urothelial carcinoma but poses a high risk of AKI. Previous studies on CP-AKI risk factors had limitations. Gupta et al. (2020) proposed a simplified risk score linked to CP-AKI and 90-day survival, though validated only in patients with eGFR ≥50 mL/min.

Materials and methods

This single-center retrospective study analyzed 70 patients with urothelial carcinoma treated with cisplatin. Patients with eGFR ≥50 mL/min received full-dose cisplatin (n = 47); those with eGFR 30–49 mL/min received a 75% reduced dose (n = 23), per Japanese guidelines. All received intravenous magnesium. AKI was defined as a ≥ twofold rise in serum creatinine or initiation of renal replacement therapy. The study also evaluated the Gupta score’s association with 90-day survival in metastatic cases.

Results

AKI occurred in 9.3% of the full-dose group and 4.5% of the reduced-dose group (p = 1.000). Higher Gupta scores were significantly associated with lower 90-day survival (p = 0.003).

Conclusion

A 75% cisplatin dose reduction in patients with moderate renal impairment appears safe and maintains efficacy without increasing AKI risk. These findings support personalized dosing and highlight the need to refine clinical guidelines. Further prospective studies are warranted.
简介和目的:顺铂是治疗尿路上皮癌的必要药物,但有较高的AKI风险。以往对CP-AKI危险因素的研究存在局限性。Gupta等人(2020)提出了与CP-AKI和90天生存率相关的简化风险评分,尽管仅在eGFR≥50 mL/min的患者中得到验证。材料和方法:本单中心回顾性研究分析了70例顺铂治疗的尿路上皮癌患者。eGFR≥50 mL/min的患者接受全剂量顺铂治疗(n = 47);根据日本指南,eGFR为30-49 mL/min的患者接受75%的剂量减少(n = 23)。所有人都接受了镁静脉注射。AKI定义为血清肌酐升高≥两倍或开始肾脏替代治疗。该研究还评估了Gupta评分与转移病例90天生存率的关系。结果:全剂量组AKI发生率为9.3%,减剂量组为4.5% (p = 1.000)。较高的Gupta评分与较低的90天生存率显著相关(p = 0.003)。结论:中度肾功能损害患者减少75%的顺铂剂量是安全的,并且在不增加AKI风险的情况下保持疗效。这些发现支持个性化给药,并强调需要完善临床指南。进一步的前瞻性研究是必要的。
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引用次数: 0
Management of incontinence after classic bladder exstrophy closure 典型膀胱外翻闭合术后尿失禁的处理。
Pub Date : 2025-12-01 DOI: 10.1016/j.acuroe.2025.501818
K. Godlewski, M. Davis, D. Weiss, A. Shukla

Introduction

Classic bladder exstrophy presents a unique challenge for reconstructive surgeons given the significant alternations it has on normal pelvic anatomy. The ultimate goal of surgery, whether in one stage or more, is simple; close the bladder, reconstruct the bladder neck and urethra, and place the unit into a more orthotopic position deep in the pelvis, and establish normal genitalia. Despite significant improvements with the success of bladder exstrophy closure, a patient’s ability to volitionally void and achieve urinary continence after initial closure remain an elusive «holy grail» for bladder exstrophy surgeons. After closure many patients will endure persistent urinary incontinence post exstrophy closure. In this review, we will discuss the conservative strategies and surgical options to facilitate continence in our bladder exstrophy patients. Regardless of surgical approach or initial outcome, all patients with bladder exstrophy require lifelong urologic follow-up.

Methods

A comprehensive search of electronic databases (MEDLINE, PubMed, Embase, PsycINFO and CINAHL), and citation tracking platforms (Google Scholar and Web of Science) was performed. Keywords included Classic Bladder Exstrophy, Incontinence, behavioral therapy, urotherapy, biofeedback, bulking agents, artificial urinary sphincter, bladder neck reconstruction, bladder neck closure, urinary diversion.

Results

Conservative measures such as behavioral therapy, physical therapy and uropsychological counseling should be first line for the treatment of urinary incontinence after exstrophy closure. These interventions along with maturation of the child and bladder growth can improve incontinence without surgery. Patients should be counseled on the limited success of bulking agents and significant risk of erosion with sphincters. Although success after bladder neck reconstruction or bladder neck closure with or without augmentation and catheterizable channel can be variable, these surgical options can be offered to patients that have exhausted conservative treatment strategies.

Conclusions

A patient’s ability to volitionally void and achieve urinary continence remain an elusive goal for bladder exstrophy surgeons with many experiencing persistent urinary incontinence following exstrophy closure. Behavioral therapy, physical therapy and pyschological support should be provided to all bladder exstrophy patients and families. Giving children time to grow and mature can potentially facilitate continence without surgical intervention. If surgical intervention is pursued lifelong follow-up and monitoring is critical.
经典膀胱外翻对重建外科医生提出了一个独特的挑战,因为它对正常骨盆解剖结构有重要的改变。手术的最终目的,无论是一个阶段还是多个阶段,都很简单;关闭膀胱,重建膀胱颈和尿道,并将单元置于骨盆深处更正位的位置,并建立正常的生殖器。尽管膀胱外翻闭合术的成功取得了显著的进步,但对于膀胱外翻外科医生来说,患者在初次闭合后自愿排空并实现尿失禁的能力仍然是一个难以实现的“圣杯”。闭锁后,许多患者在闭锁后会出现持续性尿失禁。在这篇综述中,我们将讨论保守策略和手术选择,以促进膀胱外翻患者的自制。无论采用何种手术方式或初始结果,所有膀胱外翻患者都需要终身泌尿外科随访。方法:综合检索电子数据库(MEDLINE、PubMed、Embase、PsycINFO和CINAHL)和引文跟踪平台(谷歌Scholar和Web of Science)。关键词:经典膀胱外翻,尿失禁,行为治疗,泌尿治疗,生物反馈,膨胀剂,人工尿括约肌,膀胱颈重建,膀胱颈闭合,尿分流。结果:行为治疗、物理治疗、泌尿心理咨询等保守措施是治疗外翻术后尿失禁的首选方法。随着儿童的成熟和膀胱的生长,这些干预措施可以改善失禁而无需手术。应告知患者膨胀剂的有限成功和括约肌糜烂的重大风险。尽管膀胱颈重建术或膀胱颈闭合术的成功与否有不同,但这些手术选择可以提供给已经用尽保守治疗策略的患者。结论:对于膀胱外翻外科医生来说,患者自愿排尿和实现尿失禁的能力仍然是一个难以实现的目标,许多患者在膀胱外翻闭合后经历了持续的尿失禁。对膀胱外翻患者及其家属应给予行为治疗、物理治疗和心理支持。给孩子时间成长和成熟可以潜在地促进失禁,而无需手术干预。如果进行手术干预,终身随访和监测是至关重要的。
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引用次数: 0
The unit volume biopsy length in prostate biopsy: Does it matter? 前列腺活检单位体积活检长度:重要吗?
Pub Date : 2025-12-01 DOI: 10.1016/j.acuroe.2025.501862
J. Tang , T. Wu , K. Zhang , Z. Wen

Introduction

Prostate cancer is a significant global health issue. Prostate biopsy remains the gold standard for diagnosis. However, the impact of biopsy tissue length on diagnostic performance remains controversial. This study investigates the relationship between biopsy tissue length and diagnostic efficacy, introducing a new parameter, "unit volume biopsy length," to optimize clinical practice.

Methods

A retrospective analysis was conducted on the clinical data of 301 patients who underwent prostate biopsy. The biopsy tissue length and unit volume biopsy length were compared between patients with positive and negative results, and their impact on the detection rate of prostate cancer was analyzed to obtain the optimal threshold for unit volume biopsy length.

Results

Among the 301 patients, 130 (43.19%) had positive results, while 171 had negative results. The median unit volume biopsy length in the positive group was 0.39 cm/mL, which was significantly higher than that in the negative group (0.28 cm/mL; P < 0.05). When the unit volume biopsy length exceeded 0.39 cm/mL, the detection rate of prostate cancer significantly increased (OR 2.879, 95% CI 1.728–4.796), with positive rates of 58.58% and 32.94% in the groups above and below the threshold, respectively (P < 0.05).

Conclusion

Unit volume biopsy length significantly affects the detection rate of prostate cancer. It is recommended that at least 0.39 cm of biopsy tissue be obtained per milliliter of prostate tissue to ensure adequate screening.
前列腺癌是一个重要的全球健康问题。前列腺活检仍然是诊断的金标准。然而,活检组织长度对诊断性能的影响仍然存在争议。本研究探讨了活检组织长度与诊断效果之间的关系,并引入了一个新的参数“单位体积活检长度”,以优化临床实践。方法:对301例前列腺活检患者的临床资料进行回顾性分析。比较阳性和阴性患者的活检组织长度和单位体积活检长度,分析其对前列腺癌检出率的影响,得出单位体积活检长度的最佳阈值。结果:301例患者中,阳性130例(43.19%),阴性171例。阳性组单位体积活检长度中位数为0.39 cm/ml,显著高于阴性组(0.28 cm/ml, P<0.05)。当单位体积活检长度超过0.39 cm/ml时,前列腺癌的检出率显著升高(OR 2.879, 95% CI 1.728-4.796),高于阈值组阳性率为58.58%,低于阈值组阳性率为32.94% (P<0.05)。结论:单位体积活检长度对前列腺癌的检出率有显著影响。建议每毫升前列腺组织至少有0.39厘米的活检组织,以确保充分的筛查。
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引用次数: 0
Diagnostic value of structured anamnesis for phenotype identification in chronic pelvic pain syndrome: A practice-oriented retrospective study 结构记忆对慢性盆腔疼痛综合征表型鉴定的诊断价值:一项以实践为导向的回顾性研究。
Pub Date : 2025-11-01 DOI: 10.1016/j.acuroe.2025.501858
E. Vicente Palacio , P. Bosch Knape , S. Tarragón Gabarro , C. Centeno Álvarez , L. de Verdonces Román , A. Sanchez i Puy , B. Juaneda Castell , S. Cuadrench Solorzano , E. Sotelo Burillo , L.M. Marco Pérez , L. Sabiote Rubio , D. Salinas Duffo , J.A. Peña González

Objective

To assess whether chronic pelvic pain presents specific qualitative traits, as described by patients, that can guide identification of its underlying clinical phenotype.

Materials and methods

A retrospective study including 157 patients (81 men, 76 women), interviewed systematically by a single evaluator using a structured 10-item table aimed at identifying three possible phenotypes. The correlation between the predicted phenotype (based solely on anamnesis) and the final phenotype (established through physical examination, treatment response, and clinical evolution) was analyzed. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) were calculated by phenotype and sex. The diagnostic relevance of each question was assessed, and statistical significance was tested using the Chi-square test.

Results

In women, the proportion of predicted phenotypes confirmed as final was: 64.5% bladder, 19.7% myofascial, 30.2% neuropathic. In men: 8.6% bladder, 81.5% myofascial, 23.5% neuropathic. Women-bladder: Se 0.92, Sp 0.74, PPV 0.90, NPV 0.72, AUC 0.82. Myofascial: Se 0.44, Sp 0.93, PPV 0.79, NPV 0.75, AUC 0.76. Neuropathic: Se 0.36, Sp 0.98, PPV 0.89, NPV 0.79, AUC 0.51. Men-bladder: Se 0.57, Sp 0.83, PPV 0.21, NPV 0.96, AUC 0.81. Myofascial: Se 0.75, Sp 0.75, PPV 0.93, NPV 0.41, AUC 0.75. Neuropathic: Se 0.29, Sp 1.00, PPV 1.00, NPV 0.80, AUC 0.64.

Conclusions

A structured anamnesis may help identify the clinical phenotype underlying chronic pelvic pain (bladder, myofascial, or neuropathic).
目的:评估慢性盆腔疼痛是否表现出特定的定性特征,如患者所述,可以指导识别其潜在的临床表型。材料和方法:一项回顾性研究,包括157名患者(81名男性,76名女性),由一名评估者使用结构化的10项表进行系统访谈,旨在确定三种可能的表型。分析预测表型(仅基于记忆)与最终表型(通过体格检查、治疗反应和临床进展建立)之间的相关性。根据表型和性别计算敏感性(Se)、特异性(Sp)、阳性预测值(PPV)、阴性预测值(NPV)和曲线下面积(AUC)。评估每个问题的诊断相关性,并使用卡方检验进行统计学显著性检验。结果:在女性中,最终确定的预测表型比例为:64.5%为膀胱型,19.7%为肌筋膜型,30.2%为神经性。男性:8.6%膀胱,81.5%肌筋膜,23.5%神经性病变。女性膀胱:Se 0.92, Sp 0.74, PPV 0.90, NPV 0.72, AUC 0.82。肌筋膜:Se 0.44, Sp 0.93, PPV 0.79, NPV 0.75, AUC 0.76。神经性:Se 0.36, Sp 0.98, PPV 0.89, NPV 0.79, AUC 0.51。男性膀胱:Se 0.57, Sp 0.83, PPV 0.21, NPV 0.96, AUC 0.81。肌筋膜:Se 0.75, Sp 0.75, PPV 0.93, NPV 0.41, AUC 0.75。神经性:Se 0.29, Sp 1.00, PPV 1.00, NPV 0.80, AUC 0.64。结论:结构化记忆可能有助于确定慢性盆腔疼痛(膀胱、肌筋膜或神经性)的临床表型。
{"title":"Diagnostic value of structured anamnesis for phenotype identification in chronic pelvic pain syndrome: A practice-oriented retrospective study","authors":"E. Vicente Palacio ,&nbsp;P. Bosch Knape ,&nbsp;S. Tarragón Gabarro ,&nbsp;C. Centeno Álvarez ,&nbsp;L. de Verdonces Román ,&nbsp;A. Sanchez i Puy ,&nbsp;B. Juaneda Castell ,&nbsp;S. Cuadrench Solorzano ,&nbsp;E. Sotelo Burillo ,&nbsp;L.M. Marco Pérez ,&nbsp;L. Sabiote Rubio ,&nbsp;D. Salinas Duffo ,&nbsp;J.A. Peña González","doi":"10.1016/j.acuroe.2025.501858","DOIUrl":"10.1016/j.acuroe.2025.501858","url":null,"abstract":"<div><h3>Objective</h3><div>To assess whether chronic pelvic pain presents specific qualitative traits, as described by patients, that can guide identification of its underlying clinical phenotype.</div></div><div><h3>Materials and methods</h3><div>A retrospective study including 157 patients (81 men, 76 women), interviewed systematically by a single evaluator using a structured 10-item table aimed at identifying three possible phenotypes. The correlation between the predicted phenotype (based solely on anamnesis) and the final phenotype (established through physical examination, treatment response, and clinical evolution) was analyzed. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) were calculated by phenotype and sex. The diagnostic relevance of each question was assessed, and statistical significance was tested using the Chi-square test.</div></div><div><h3>Results</h3><div>In women, the proportion of predicted phenotypes confirmed as final was: 64.5% bladder, 19.7% myofascial, 30.2% neuropathic. In men: 8.6% bladder, 81.5% myofascial, 23.5% neuropathic. Women-bladder: Se 0.92, Sp 0.74, PPV 0.90, NPV 0.72, AUC 0.82. Myofascial: Se 0.44, Sp 0.93, PPV 0.79, NPV 0.75, AUC 0.76. Neuropathic: Se 0.36, Sp 0.98, PPV 0.89, NPV 0.79, AUC 0.51. Men-bladder: Se 0.57, Sp 0.83, PPV 0.21, NPV 0.96, AUC 0.81. Myofascial: Se 0.75, Sp 0.75, PPV 0.93, NPV 0.41, AUC 0.75. Neuropathic: Se 0.29, Sp 1.00, PPV 1.00, NPV 0.80, AUC 0.64.</div></div><div><h3>Conclusions</h3><div>A structured anamnesis may help identify the clinical phenotype underlying chronic pelvic pain (bladder, myofascial, or neuropathic).</div></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":"49 9","pages":"Article 501858"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prenatal ultrasonographic evaluation and management of renal and urogenital anomalies: A comprehensive review based on experience in a tertiary care center and literature analysis 产前超声评估和处理肾脏和泌尿生殖异常:基于三级保健中心的经验和文献分析的综合回顾。
Pub Date : 2025-11-01 DOI: 10.1016/j.acuroe.2025.501816
K. Weller , G.M. Eggenhuizen , K. Zandbergen , L.A. 't Hoen , J. Mulder , A.T.J.I. Go

Introduction

Congenital renal and urogenital anomalies represent a major part of all congenital anomalies. These range from mild, transient conditions to severe forms leading to irreversible organ damage or perinatal mortality. Timely prenatal identification is crucial for expecting parents and their healthcare providers to decide about the continuation of a pregnancy or for careful planning of perinatal and postnatal care.

Objective

To describe the most common indications for referral of fetal renal and urogenital malformations, the process of narrowing the differential diagnosis based on prenatal ultrasonography and the coordination between prenatal and postnatal care in a tertiary care center in the Netherlands.

Results

The most common indications for referral of fetal renal and urogenital malformations are (1) Abnormal Renal Parenchyma, (2) Urinary Tract Dilatation, (3) Abnormal Bladder Appearance, and (4) Atypical Genitalia. In the differential diagnosis, ultrasonographic evaluation is crucial to determine the specific region of the urogenital system affected, its onset during pregnancy, and its progression throughout gestation. Integrated prenatal and postnatal care for these types of malformations relies on a multidisciplinary approach to guide parental decision-making in continuation of the pregnancy and optimize outcomes. Some cases only require routine perinatal care in secondary care centers, while complex malformations benefit from specialized planning at tertiary centers to improve outcomes.

Conclusion

Dedicated ultrasonographic evaluation of fetal renal and urogenital anomalies in a tertiary care center enables accurate diagnosis and individualized care planning, particularly in complex cases. This approach provides parents with timely information, supports decision-making, and guides individualized perinatal care.
简介:先天性肾脏和泌尿生殖器异常是所有先天性异常的主要部分。这些疾病的范围从轻微的、短暂的状况到导致不可逆器官损害或围产期死亡的严重形式。及时的产前鉴定对于准父母及其医疗保健提供者决定是否继续妊娠或仔细规划围产期和产后护理至关重要。目的:描述最常见的指征转介胎儿肾脏和泌尿生殖系统畸形,缩小基于产前超声鉴别诊断的过程和产前和产后护理之间的协调在荷兰三级保健中心。结果:胎儿肾脏和泌尿生殖系统畸形转诊最常见的指征是(1)肾实质异常,(2)尿路扩张,(3)膀胱外观异常,(4)非典型生殖器。在鉴别诊断中,超声评估对于确定泌尿生殖系统受影响的特定区域,其在妊娠期间的发病以及整个妊娠期间的进展至关重要。这些类型的畸形的综合产前和产后护理依赖于多学科的方法来指导父母在继续妊娠和优化结果的决策。有些病例只需要在二级护理中心进行常规围产期护理,而复杂的畸形则可以在三级护理中心进行专门规划,以改善结果。结论:在三级医疗中心对胎儿肾脏和泌尿生殖器异常进行专门的超声评估,可以准确诊断和个性化护理计划,特别是在复杂的病例中。这种方法为父母提供及时的信息,支持决策,并指导个性化的围产期护理。
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引用次数: 0
Does preoperative alpha-blocker use affect the results of flexible ureterorenoscopy? 术前使用α -阻滞剂会影响输尿管镜检查结果吗?
Pub Date : 2025-11-01 DOI: 10.1016/j.acuroe.2025.501836
A. Akinci , A. Sanci , M. Babayigit , C. Gogus

Objective

To evaluate the effect of alpha-blocker therapy during flexible ureterorenoscopy (F-URS) on the treatment of upper urinary tract stones.

Methods

A retrospective analysis was conducted on 476 patients who underwent F-URS at the Department of Urology between January 2010 and January 2017. Data collected included alpha-blocker use, stone size, stone location, patient age and gender, success or failure of ureteral access sheath (UAS) placement, ability to reach the stone during the procedure, postoperative stone-free status, and complication rates. Patients were divided into two groups: alpha-blocker users (n = 90, 18.9%) and non-users (n = 386, 81.1%).

Results

No significant differences were observed in gender distribution (P = 0.86) or stone size (P = 0.21) between the two groups. Alpha-blocker users had a lower complication rate (P = 0.022), a higher rate of successful stone access during the procedure (P = 0.007), and a higher postoperative stone-free rate (P = 0.01) compared to non-users. Among alpha-blocker users, tamsulosin and silodosin were associated with higher stone clearance rates (P = 0.046 and P = 0.037, respectively).

Conclusions

Alpha-blocker therapy during F-URS for upper urinary tract stones is associated with improved outcomes, including higher stone access rates, reduced complications, and increased stone-free rates. These findings suggest that alpha-blockers, particularly tamsulosin and silodosin, may enhance the efficacy and safety of F-URS.
目的:探讨柔性输尿管镜下应用α -阻滞剂治疗上尿路结石的效果。方法:回顾性分析2010年1月至2017年1月在泌尿外科接受F-URS治疗的476例患者。收集的数据包括α -阻滞剂的使用、结石大小、结石位置、患者年龄和性别、输尿管鞘(UAS)放置的成功或失败、手术过程中到达结石的能力、术后无结石状态和并发症发生率。患者分为两组:α受体阻滞剂使用者(n = 90, 18.9%)和非使用者(n = 386, 81.1%)。结果:两组患者在性别分布(p = 0.86)和结石大小(p = 0.21)方面均无显著差异。与未使用α受体阻滞剂的患者相比,使用α受体阻滞剂的患者并发症发生率较低(p = 0.022),手术过程中结石进入成功率较高(p = 0.007),术后结石清除率较高(p = 0.01)。在α受体阻滞剂使用者中,坦索罗辛和西洛多辛与较高的结石清除率相关(p = 0.046和p = 0.037分别)。结论:在F-URS治疗上尿路结石期间,α受体阻滞剂治疗与改善预后相关,包括更高的结石通路率、更少的并发症和更高的结石清除率。这些发现表明,α受体阻滞剂,特别是坦索罗辛和西洛多辛,可能会提高F-URS的疗效和安全性。
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引用次数: 0
The mesh fixation dilemma in robotic sacrocolpopexy: Absorbable or non-absorbable sutures? Insights from a high-volume observational cohort 机器人骶髋固定术中的网片固定困境:可吸收缝线还是不可吸收缝线?来自大量观察队列的见解。
Pub Date : 2025-11-01 DOI: 10.1016/j.acuroe.2025.501866
D. Carracedo , P. Moscatiello , I. Hernández , T. Jerez , C. Grañen , M. Toledo , M.A. Sanchez-Encinas

Introduction

Limited evidence has been reported on the results of robot-assisted sacrocolpopexy (RASC) related to the type of sutures used.

Objective

The objective of this study is to analyze the results comparing absorbable with non-absorbable sutures. The primary outcome was mesh related complications and secondary outcomes were anatomical success, early complications and patient satisfaction.

Methods

A prospective, comparative study for the first 123 RASC surgeries performed between December 2016 and June 2022. All patients who underwent robotic sacrocolpopexy were included. No exclusion criteria were established. The procedures were performed by surgeon “A” who used non-absorbable sutures and surgeon “B” who used absorbable sutures. Patient data was collected at baseline, intraoperatively, as well as reporting early complications and mesh-related complications. Anatomic recurrence was defined as patients with POP ≥ 2 on the Baden-Walker scale while the sensation of vaginal bulge determined subjective failure.

Results

Non-absorbable sutures were used in 55.3% of the patients while absorbable sutures were used in 44.7% of the patients. The mean follow-up was longer in the absorbable suture group (21.5 vs. 35.3 p < 0.01).
No statistically significant differences were found in mesh-complication rate (4.4% vs. 0%, p = 0.16) and in anatomical recurrence and subjective (4.4% vs. 9.1%, p = 0.24).
The main limitation of our study was the absence of randomization.

Conclusions

The type of suture used for mesh fixation in RASC does not influence the anatomical outcomes, early complications or mesh-related complications.
机器人辅助骶colpop固定术(RASC)的结果与所使用的缝合线类型相关的证据有限。目的:分析可吸收缝线与不可吸收缝线的临床效果。主要结果是补片相关并发症,次要结果是解剖成功、早期并发症和患者满意度。方法:对2016年12月至2022年6月期间进行的首批123例RASC手术进行前瞻性比较研究。所有接受机器人骶骶固定术的患者均被纳入研究。未建立排除标准。手术由使用不可吸收缝合线的外科医生A和使用可吸收缝合线的外科医生B进行。在基线、术中收集患者数据,并报告早期并发症和网状物相关并发症。解剖性复发定义为巴登-沃克评分(Baden-Walker scale)的POP≥2,阴道隆起感为主观失败。结果:55.3%的患者使用不可吸收缝线,44.7%的患者使用可吸收缝线。可吸收缝线组的平均随访时间较长(21.5 P vs. 35.3 P)。结论:用于RASC补片固定的缝线类型不影响解剖结果、早期并发症或补片相关并发症。
{"title":"The mesh fixation dilemma in robotic sacrocolpopexy: Absorbable or non-absorbable sutures? Insights from a high-volume observational cohort","authors":"D. Carracedo ,&nbsp;P. Moscatiello ,&nbsp;I. Hernández ,&nbsp;T. Jerez ,&nbsp;C. Grañen ,&nbsp;M. Toledo ,&nbsp;M.A. Sanchez-Encinas","doi":"10.1016/j.acuroe.2025.501866","DOIUrl":"10.1016/j.acuroe.2025.501866","url":null,"abstract":"<div><h3>Introduction</h3><div>Limited evidence has been reported on the results of robot-assisted sacrocolpopexy (RASC) related to the type of sutures used.</div></div><div><h3>Objective</h3><div>The objective of this study is to analyze the results comparing absorbable with non-absorbable sutures. The primary outcome was mesh related complications and secondary outcomes were anatomical success, early complications and patient satisfaction.</div></div><div><h3>Methods</h3><div>A prospective, comparative study for the first 123 RASC surgeries performed between December 2016 and June 2022. All patients who underwent robotic sacrocolpopexy were included. No exclusion criteria were established. The procedures were performed by surgeon “A” who used non-absorbable sutures and surgeon “B” who used absorbable sutures. Patient data was collected at baseline, intraoperatively, as well as reporting early complications and mesh-related complications. Anatomic recurrence was defined as patients with POP ≥ 2 on the Baden-Walker scale while the sensation of vaginal bulge determined subjective failure.</div></div><div><h3>Results</h3><div>Non-absorbable sutures were used in 55.3% of the patients while absorbable sutures were used in 44.7% of the patients. The mean follow-up was longer in the absorbable suture group (21.5 vs. 35.3 p &lt; 0.01).</div><div>No statistically significant differences were found in mesh-complication rate (4.4% vs. 0%, p = 0.16) and in anatomical recurrence and subjective (4.4% vs. 9.1%, p = 0.24).</div><div>The main limitation of our study was the absence of randomization.</div></div><div><h3>Conclusions</h3><div>The type of suture used for mesh fixation in RASC does not influence the anatomical outcomes, early complications or mesh-related complications.</div></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":"49 9","pages":"Article 501866"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Oncological outcomes for patients with European Association of Urology definitions of BCG failure treated with radical cystectomy 欧洲泌尿外科协会定义卡介苗失败行根治性膀胱切除术患者的肿瘤预后。
Pub Date : 2025-11-01 DOI: 10.1016/j.acuroe.2025.501834
A. Farré , J. Huguet , G. Basile, L. Diéguez, P. Izquierdo, R. Sánchez, P. Gavrilov, A. Gallioli, O. Rodríguez Faba, J.M. Gaya, J. Palou, A. Breda

Introduction

The management of non-muscle invasive bladder cancer (NMIBC) failing Bacillus Calmette-Guérin (BCG) therapy remains challenging. The European Association of Urology (EAU) has standardized definitions of BCG failure. We aim to evaluate oncological outcomes in patients undergoing radical cystectomy (RC) for NMIBC following BCG failure, as defined by the EAU.

Methods

Retrospective study analyzed 93 patients with NMIBC who underwent RC between 2011 and 2021 after BCG therapy failure. Patients were stratified into 4 groups: clinical NMIBC, clinical progression, subclinical progression (understaged), and pathological NMIBC (pNMIBC) groups. Oncological outcomes included cancer-specific survival (CSS) and overall survival (OS). Kaplan-Meier and logistic regression analyses were used to evaluate outcomes and predictors of disease progression.

Results

Among 93 patients, 64 (68.8%) had clinical NMIBC, and 29 (31.2%) showed clinical progression to muscle-invasive bladder cancer (MIBC) prior to RC. Of those with clinical NMIBC, 46 (71.9%) were confirmed as pNMIBC and 18 (28.1%) had subclinical progression. Patients with pNMIBC had significantly better 5-year CSS (95.5%) and OS (77.6%) compared to those with clinical (CSS 70.4%, OS 50.2%) or subclinical progression (CSS 64.1%, OS 43.8%). cT1 with conco-mitant carcinoma in situ and prostatic urethral involvement were independent predictors of muscle-invasive disease at RC.

Conclusions

Patients treated at an appropriate stage show superior survival outcomes com-pared to those with progression. These findings underscore the importance of timely surgical intervention in BCG-unresponsive NMIBC and support early RC in select high-risk patients to improve long-term prognosis.
简介:卡介苗治疗失败的非肌肉浸润性膀胱癌(NMIBC)的治疗仍然具有挑战性。欧洲泌尿外科协会(EAU)对卡介苗失败有标准化的定义。我们的目的是评估在BCG失败后接受根治性膀胱切除术(RC)的NMIBC患者的肿瘤学结果。方法:回顾性分析2011年至2021年间93例因卡介苗治疗失败而接受RC治疗的NMIBC患者。将患者分为临床NMIBC组、临床进展组、亚临床进展组和病理性NMIBC组(pNMIBC)。肿瘤预后包括癌症特异性生存期(CSS)和总生存期(OS)。Kaplan-Meier和logistic回归分析用于评估结果和疾病进展的预测因素。结果:93例患者中,64例(68.8%)有临床NMIBC, 29例(31.2%)在RC前有临床进展为肌肉浸润性膀胱癌(MIBC)。在临床NMIBC患者中,46例(71.9%)确诊为pNMIBC, 18例(28.1%)为亚临床进展。pNMIBC患者的5年CSS(95.5%)和OS(77.6%)明显优于临床(CSS 70.4%, OS 50.2%)或亚临床进展(CSS 64.1%, OS 43.8%)患者。cT1合并原位癌和前列腺尿道受累是RC肌肉侵袭性疾病的独立预测因子。结论:与进展患者相比,在适当阶段治疗的患者表现出更好的生存结果。这些发现强调了及时手术干预bcg无反应的NMIBC的重要性,并支持早期RC选择高危患者以改善长期预后。
{"title":"Oncological outcomes for patients with European Association of Urology definitions of BCG failure treated with radical cystectomy","authors":"A. Farré ,&nbsp;J. Huguet ,&nbsp;G. Basile,&nbsp;L. Diéguez,&nbsp;P. Izquierdo,&nbsp;R. Sánchez,&nbsp;P. Gavrilov,&nbsp;A. Gallioli,&nbsp;O. Rodríguez Faba,&nbsp;J.M. Gaya,&nbsp;J. Palou,&nbsp;A. Breda","doi":"10.1016/j.acuroe.2025.501834","DOIUrl":"10.1016/j.acuroe.2025.501834","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of non-muscle invasive bladder cancer (NMIBC) failing Bacillus Calmette-Guérin (BCG) therapy remains challenging. The European Association of Urology (EAU) has standardized definitions of BCG failure. We aim to evaluate oncological outcomes in patients undergoing radical cystectomy (RC) for NMIBC following BCG failure, as defined by the EAU.</div></div><div><h3>Methods</h3><div>Retrospective study analyzed 93 patients with NMIBC who underwent RC between 2011 and 2021 after BCG therapy failure. Patients were stratified into 4 groups: clinical NMIBC, clinical progression, subclinical progression (understaged), and pathological NMIBC (pNMIBC) groups. Oncological outcomes included cancer-specific survival (CSS) and overall survival (OS). Kaplan-Meier and logistic regression analyses were used to evaluate outcomes and predictors of disease progression.</div></div><div><h3>Results</h3><div>Among 93 patients, 64 (68.8%) had clinical NMIBC, and 29 (31.2%) showed clinical progression to muscle-invasive bladder cancer (MIBC) prior to RC. Of those with clinical NMIBC, 46 (71.9%) were confirmed as pNMIBC and 18 (28.1%) had subclinical progression. Patients with pNMIBC had significantly better 5-year CSS (95.5%) and OS (77.6%) compared to those with clinical (CSS 70.4%, OS 50.2%) or subclinical progression (CSS 64.1%, OS 43.8%). cT1 with conco-mitant carcinoma in situ and prostatic urethral involvement were independent predictors of muscle-invasive disease at RC.</div></div><div><h3>Conclusions</h3><div>Patients treated at an appropriate stage show superior survival outcomes com-pared to those with progression. These findings underscore the importance of timely surgical intervention in BCG-unresponsive NMIBC and support early RC in select high-risk patients to improve long-term prognosis.</div></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":"49 9","pages":"Article 501834"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Total quantification of circulating microRNAs and smallRNAs in plasma and urine as prognostic biomarkers in prostate cancer 血浆和尿液中循环小rna和小rna的总定量作为前列腺癌预后的生物标志物。
Pub Date : 2025-11-01 DOI: 10.1016/j.acuroe.2025.501861
M.V. Lorenzo-Sánchez , M.G. Picazo-Martínez , J.M. Giménez-Bachs , M.J. Donate-Moreno , S. Navarro Jiménez , M.A. Tárraga-Honrubia , A.S. Salinas-Sánchez

Introduction

Circulating RNAs (cfRNAs) have emerged as promising biomarkers in liquid biopsy for prostate cancer (PCa). However, the lack of standardization in their analysis and the heterogeneity across available studies limit clinical application.

Objective

To evaluate the diagnostic and prognostic utility of the total concentration of cell-free circulating small RNA (cf-sRNA) and microRNA (cf-miRNA) in plasma and urine from PCa patients using accessible techniques, without identifying specific miRNAs.

Materials and methods

Prospective, longitudinal study including 143 men (111 with PCa and 32 healthy controls). Plasma and urine cf-sRNA and cf-miRNA levels were quantified with an Agilent 2100 Bioanalyzer. Levels were correlated with clinical features, tumor stage, and progression to metastatic castration-resistant PCa (mCRPC). A longitudinal follow-up was conducted in a metastatic subgroup.

Results

Plasma and urine levels of cf-miRNA and cf-sRNA were significantly higher in patients with advanced PCa, particularly in those who progressed to mCRPC (p < 0.05). During follow-up, a significant increase in plasma cf-miRNA was observed after treatment (p = 0.031), as well as an increase in the relative percentage of cf-miRNA in urine (p = 0.012).

Conclusions

Total quantification of cf-miRNA in plasma and urine is an accessible strategy with potential value as a dynamic biomarker for PCa monitoring and prognosis. Its use could complement current diagnostic tools, although further studies are required to validate its utility in clinical practice.
循环rna (cfRNAs)已成为前列腺癌(PCa)液体活检中有前景的生物标志物。然而,他们的分析缺乏标准化和现有研究的异质性限制了临床应用。目的:在不确定特异性mirna的情况下,利用无障碍技术评估PCa患者血浆和尿液中游离循环小RNA (cf-sRNA)和微RNA (cf-miRNA)总浓度的诊断和预后价值。材料和方法:前瞻性、纵向研究,包括143名男性(111名PCa患者和32名健康对照)。使用Agilent 2100生物分析仪定量测定血浆和尿液中cf-sRNA和cf-miRNA水平。水平与临床特征、肿瘤分期和转移性去势抵抗性PCa (mCRPC)的进展相关。在转移亚组中进行纵向随访。结果:晚期PCa患者血浆和尿液中cf-miRNA和cf-sRNA水平显著高于晚期PCa患者,特别是进展为mCRPC的患者(p)。结果:晚期PCa患者血浆和尿液中cf-miRNA和cf-sRNA水平显著高于晚期PCa患者,特别是进展为mCRPC的患者(p)。结论:血浆和尿液中cf-miRNA的总定量是一种可行的策略,作为PCa监测和预后的动态生物标志物具有潜在价值。它的使用可以补充现有的诊断工具,尽管需要进一步的研究来验证其在临床实践中的效用。
{"title":"Total quantification of circulating microRNAs and smallRNAs in plasma and urine as prognostic biomarkers in prostate cancer","authors":"M.V. Lorenzo-Sánchez ,&nbsp;M.G. Picazo-Martínez ,&nbsp;J.M. Giménez-Bachs ,&nbsp;M.J. Donate-Moreno ,&nbsp;S. Navarro Jiménez ,&nbsp;M.A. Tárraga-Honrubia ,&nbsp;A.S. Salinas-Sánchez","doi":"10.1016/j.acuroe.2025.501861","DOIUrl":"10.1016/j.acuroe.2025.501861","url":null,"abstract":"<div><h3>Introduction</h3><div>Circulating RNAs (cfRNAs) have emerged as promising biomarkers in liquid biopsy for prostate cancer (PCa). However, the lack of standardization in their analysis and the heterogeneity across available studies limit clinical application.</div></div><div><h3>Objective</h3><div>To evaluate the diagnostic and prognostic utility of the total concentration of cell-free circulating small RNA (cf-sRNA) and microRNA (cf-miRNA) in plasma and urine from PCa patients using accessible techniques, without identifying specific miRNAs.</div></div><div><h3>Materials and methods</h3><div>Prospective, longitudinal study including 143 men (111 with PCa and 32 healthy controls). Plasma and urine cf-sRNA and cf-miRNA levels were quantified with an Agilent 2100 Bioanalyzer. Levels were correlated with clinical features, tumor stage, and progression to metastatic castration-resistant PCa (mCRPC). A longitudinal follow-up was conducted in a metastatic subgroup.</div></div><div><h3>Results</h3><div>Plasma and urine levels of cf-miRNA and cf-sRNA were significantly higher in patients with advanced PCa, particularly in those who progressed to mCRPC (p &lt; 0.05). During follow-up, a significant increase in plasma cf-miRNA was observed after treatment (p = 0.031), as well as an increase in the relative percentage of cf-miRNA in urine (p = 0.012).</div></div><div><h3>Conclusions</h3><div>Total quantification of cf-miRNA in plasma and urine is an accessible strategy with potential value as a dynamic biomarker for PCa monitoring and prognosis. Its use could complement current diagnostic tools, although further studies are required to validate its utility in clinical practice.</div></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":"49 9","pages":"Article 501861"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Actas urologicas espanolas
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