Actas urologicas espanolas最新文献_第7页

Pharmacological interventions in primary or secondary male anorgasmia: A systematic review 原发性或继发性男性性高潮障碍的药物干预：系统综述。

Actas urologicas espanolas

Pub Date : 2025-11-01 DOI: 10.1016/j.acuroe.2025.501835

M.P. Gómez-Bueno , A.M. Diaz-Hung , H.A. García-Perdomo

Objective

To determine the effectiveness and safety of pharmacological therapy in men older than 18 years with primary or secondary anorgasmia in terms of induced orgasm, improvement of the International Index of Erectile Function (IIEF), or Arizona Sexual Experience Scale (ASEX).

Methods

we conducted this systematic review according to the recommendations of the Cochrane Collaboration and following the PRISMA Statement. We designed a search strategy in MEDLINE (OVID), EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to the present. We assessed the risk of bias based on the STROBE statement for observational studies and the Rob 2.0 tool for clinical trials.

Results

234 patients were included, and 232 were treated with pharmacological therapy in seven studies. Some pathologies reported were a history of prostatectomy, hypogonadism, psychiatric disorders, and use of antidepressants.

Cabergoline was the most frequently administered treatment, followed by yohimbine and bupropion. The cabergoline improved orgasm in 66% of the population and yohimbine in 55%. The change in IIEF orgasmic function improved significantly with cabergoline and bupropion (P = <0.001 and P = 0.002). The ASEX improved with pycnogenol and was maintained in months 2,3 and 4 (p ≤ 0.05). The side effects reported were mild in three studies. Amantadine required discontinuation due to depression.

Conclusion

Pharmacological therapy with cabergoline, yohimbine, bupropion, and pycnogenol can have a positive effect on the orgasmic function of patients with primary or secondary anorgasmia.

目的：从诱导性高潮、改善国际勃起功能指数（IIEF）或亚利桑那性体验量表（ASEX）的角度，确定药物治疗对18岁以上原发性或继发性性高潮障碍男性的有效性和安全性。方法：我们根据Cochrane协作网的建议并遵循PRISMA声明进行系统评价。我们在MEDLINE （OVID）、EMBASE、LILACS和Cochrane Central Register of Controlled Trials （Central）中设计了一个从开始到现在的搜索策略。我们根据观察性研究的STROBE声明和临床试验的Rob 2.0工具评估偏倚风险。结果：纳入234例患者，7项研究中有232例患者接受了药物治疗。一些病理报告是前列腺切除术，性腺功能减退，精神疾病和使用抗抑郁药的历史。卡麦角林是最常用的治疗方法，其次是育亨宾和安非他酮。卡麦角林提高了66%的人的性高潮，育亨宾提高了55%。结论：卡麦角林、育亨宾、安非他酮、碧诺酚等药物治疗对原发性或继发性性高潮障碍患者的性高潮功能均有积极影响。

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引用次数: 0

Main pharmacological differences between mirabegron and vibegron for the treatment of overactive bladder. mirabegron与vibegron治疗膀胱过动症的主要药理差异。

Actas urologicas espanolas

Pub Date : 2025-10-17 DOI: 10.1016/j.acuroe.2025.501868

A Alcántara Montero

引用次数: 0

Reply to comment on "Clinical profile and risk factors identified in patients with renal cancer in Mexican population". Author's reply. 回复“墨西哥人群肾癌患者的临床特征和危险因素”评论。作者的回答。

Actas urologicas espanolas

Pub Date : 2025-10-11 DOI: 10.1016/j.acuroe.2025.501867

G Sánchez-Villaseñor, J P Gómez-Sierra, A González-Ojeda, C Fuentes-Orozco

引用次数: 0

Factors associated with pregnancy related complications in women with a history of vesicoureteral reflux: A systematic review by the EAU-YAU Paediatric Urology Working Group 有膀胱输尿管反流史的妇女妊娠相关并发症的相关因素：EAU-YAU儿科泌尿外科工作组的系统综述

Actas urologicas espanolas

Pub Date : 2025-10-01 DOI: 10.1016/j.acuroe.2025.501821

Ismail Selvi , M. İrfan Dönmez , Numan Baydilli , Yesica Quirroz Madarriaga , Rianne J.M. Lammers , Edoardo Bindi , Simone Sforza , Fardod O'Kelly , Bernhard Haid , Beatriz Banuelos Marco , Lisette A. t' Hoen

Introduction

Vesicoureteral reflux (VUR) may have long lasting effects on affected individuals, especially in females. Its intertwined relationship with urinary tract infection (UTI) has been well documented and there is a further risk during pregnancy where UTIs are more problematic.

Objective

To analyze existing data within the literature to identify factors associated with pregnancy-related complications in women with a history of VUR in childhood.

Methods

PubMed, MEDLINE, Embase, and the Cochrane Library databases were searched to identify all published reports of pregnancy outcomes in women with a history of VUR in childhood up to January 2024 (PROSPERO Registration ID: CRD42024550470). Selection criteria included all English-language original articles reporting pregnancy outcomes (maternal and fetal morbidities) in pregnant patients with a history of VUR in childhood. After screening and eligibility assessment, 17 articles met the PICO inclusion criteria.

Results

The search yielded 1060 papers, of which 17 remained after exclusions, and assessed 2349 women with a history of VUR in childhood,1167 pregnant women and a total of 2206 pregnancies. Compared with the general obstetric population, the results showed an increased rate of pregnancy-related complications (particularly febrile urinary tract infection, gestational hypertension, pre-eclampsia) in the presence of renal scarring, even if the women had undergone anti-reflux surgery in childhood, but not persistent low-grade VUR.

Conclusion

Despite the lack of larger prospective randomized controlled trials with long-term follow-up, based on the findings of this systematic review, we conclude that close monitoring during pregnancy should be recommended in the presence of persistent high-grade VUR or in women with renal scarring, even if VUR has resolved.

膀胱输尿管反流（VUR）可能对受影响的个体，特别是女性有长期的影响。它与尿路感染（UTI）的关系错综复杂，在怀孕期间存在进一步的风险，因为尿路感染更成问题。目的：分析文献中的现有数据，以确定儿童期有VUR病史的妇女妊娠相关并发症的相关因素。方法：检索PubMed， MEDLINE， Embase和Cochrane图书馆数据库，以确定截至2024年1月（PROSPERO注册ID: CRD42024550470）的所有已发表的关于儿童期有VUR病史的妇女妊娠结局的报告。选择标准包括所有报道儿童期有VUR病史的孕妇妊娠结局（母体和胎儿发病率）的英文原创文章。经过筛选和资格评估，17篇文章符合PICO纳入标准。结果：共纳入文献1060篇，排除后保留17篇，共纳入儿童期有VUR病史的妇女2349例，孕妇1167例，共2206例妊娠。与一般产科人群相比，结果显示存在肾瘢痕的妊娠相关并发症（特别是发热性尿路感染、妊娠期高血压、先兆子痫）的发生率增加，即使妇女在儿童时期接受过抗反流手术，但没有持续的低级别VUR。结论：尽管缺乏长期随访的大型前瞻性随机对照试验，但基于本系统综述的发现，我们得出结论，即使VUR已经消退，也应建议在妊娠期间密切监测持续存在的高级别VUR或有肾瘢痕的妇女。

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引用次数: 0

Comparison of prognosis between primary and progressive muscle-invasive bladder carcinoma: A prospective analysis of long-term outcomes after radical cystectomy 原发性和进行性肌肉浸润性膀胱癌的预后比较：根治性膀胱切除术后远期预后的前瞻性分析。

Actas urologicas espanolas

Pub Date : 2025-10-01 DOI: 10.1016/j.acuroe.2025.501815

S. Juste-Alvarez, C. García-Rayo Encina, C. Gómez del Cañizo, M. Hernandez-Arroyo, N.R. Miranda-Utrera, A. Rodriguez-Antolin, F. Guerrero-Ramos Félix

Introduction

Up to 15% of muscle-invasive bladder cancers (MIBC) arise from the progression of a non-muscle-invasive neoplasm. Despite sharing similar treatment strategies, the literature reports differences in survival rates between these two groups. This study aims to identify differences in recurrence and survival that may influence individualized treatment approaches.

Material and methods

Prospective study of cystectomies performed for MIBC between 2011 and 2023, collecting demographic, diagnostic, treatment, and recurrence data (local, urothelial, or distant). A comparative and multivariate analysis was conducted.

Results

We did not observe significant differences in recurrence rates between primary and progressive MIBC. However, the group with progression showed better overall survival (OS) rates at 2, 5 and 10 years (100%, 90%, 55%) compared to the primary (80%, 55%, 35%; p = 0.012), as well as better cancer-specific survival (CSS) (100%, 100%, 95% vs. 85%, 77%, 65%; p = 0.033). Independent risk factors for recurrence include pN+ (OR: 3.72) and lymphovascular invasion (LVI) (OR: 5.53). Predictors of lower OS include age, nodal involvement, LVI and relapse at any level. For CSS, predictors include nodal involvement, LVI and relapse at any level.

Conclusions

In our series, patients with progressive MIBC have better OS and CSS. For both groups, pN + and LVI are independent risk factors for recurrence. Nodal involvement, LVI and relapse at any level are predictors of poorer OS and CSS.

高达15%的肌肉浸润性膀胱癌（MIBC）是由非肌肉浸润性肿瘤的进展引起的。尽管采用了相似的治疗策略，但文献报道了这两组患者存活率的差异。本研究旨在确定复发率和生存率的差异可能影响个体化治疗方法。材料和方法：对2011年至2023年间膀胱切除术的MIBC患者进行前瞻性研究，收集人口统计学、诊断、治疗和复发数据（局部、尿路上皮或远处）。进行了比较和多变量分析。结果：我们没有观察到原发性和进展性MIBC的复发率有显著差异。然而，进展组在2年、5年和10年的总生存率（OS）（100%、90%、55%）高于原发性组(80%、55%、35%；p = 0.012)，以及更好的癌症特异性生存率（CSS） (100%, 100%, 95% vs. 85%, 77%, 65%；p = 0.033)。复发的独立危险因素包括pN+ (OR: 3.72)和淋巴血管侵犯（LVI）（OR: 5.53）。低OS的预测因素包括年龄、淋巴结累及、LVI和任何程度的复发。对于CSS，预测因子包括淋巴结累及、LVI和任何程度的复发。结论：在我们的研究中，进行性MIBC患者有更好的OS和CSS。在两组中，pN +和LVI是复发的独立危险因素。淋巴结累及、LVI和任何级别的复发是较差的OS和CSS的预测因子。

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引用次数: 0

Comparison of short versus long stent duration on outcomes after pediatric kidney transplantation: a systematic review by the Young Academic Urologists Pediatric Urology and Kidney Transplantation Working Groups 儿科肾移植后支架时间长短的比较：一项由青年学术泌尿科医师儿科泌尿科和肾移植工作组进行的系统综述。

Actas urologicas espanolas

Pub Date : 2025-10-01 DOI: 10.1016/j.acuroe.2025.501825

I.B. de Angst , M. Reichert , M.I. Dönmez , Y. Quiroz , F. O’Kelly , S. Sforza , W.M. Bramer , B. Bañuelos , E. Bindi , I. Selvi , F. Brandt , E. Starink , J. Stufken , A. Territo , A. López-Abad , R.J.M. Lammers , L.A. 't Hoen

Introduction and objectives

Urological complications are common after kidney transplantation (KTx), mostly in the form of ureterovesical obstruction or leakage. Routine ureteral stenting was previously shown to reduce these complications on the expense of other complications such as urinary tract infections (UTI). There is no consensus on optimal duration of stents, and relevant literature on this topic is lacking. The aim of this systematic review is to summarize and compare the incidences of stent-related complications using short (<2 weeks; SD) and long (≥2 weeks; LD) stent duration after pediatric KTx.

Material and methods

A systematic search in Embase, MEDLINE, Cochrane, and clinicaltrial.gov was performed. Studies reporting on children (0–18 years) undergoing KTx with intraoperative ureteral stenting with at least one month follow up were included. Data on surgical and outcome characteristics were extracted.

Results

From a total of 322 articles, 14 studies were included, reporting on 971 pediatric KTx of whom 411 were female (42%). Sample sizes ranged from 32 to 146 patients. Mean or median age at time of transplantation ranged from 3.36 to 14.7 years. A systematic synthesis approach was used to summarize results. Of the four comparative studies, only one showed significantly more post-transplant UTIs in the LD group, without a significant difference in other urological complications.

Conclusions

Due to lack of good quality studies, it remains uncertain whether a short stent duration is safer and more feasible for reducing the incidence of stent-related complications in pediatric KTx, while also preventing stenosis or leakage at the ureterovesical anastomosis.

简介和目的：肾移植术后泌尿系统并发症很常见，主要表现为输尿管梗阻或渗漏。常规输尿管支架置入术在减少其他并发症如尿路感染（UTI）的基础上减少了这些并发症。关于支架的最佳持续时间尚无共识，且缺乏相关文献。本系统综述的目的是总结和比较使用简短材料和方法的支架相关并发症的发生率：在Embase、MEDLINE、Cochrane和clinicaltrial.gov进行系统检索。研究报告的儿童（0-18岁）接受KTx术中输尿管支架置入至少一个月的随访。提取手术和结局特征的数据。结果：从322篇文章中，纳入了14项研究，报告了971例儿科KTx，其中411例为女性（42%）。样本量从32例到146例不等。移植时的平均或中位年龄为3.36至14.7岁。采用系统综合的方法对结果进行总结。在四项比较研究中，只有一项研究显示LD组移植后尿路感染明显增加，其他泌尿系统并发症无显著差异。结论：由于缺乏高质量的研究，对于减少小儿KTx支架相关并发症的发生率，同时防止输尿管膀胱吻合口狭窄或渗漏，短支架时间是否更安全、更可行尚不确定。

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引用次数: 0

Acute toxicity of SBRT in localized prostate cancer: A Spanish multicenter study SBRT治疗局限性前列腺癌的急性毒性：一项西班牙多中心研究。

Actas urologicas espanolas

Pub Date : 2025-10-01 DOI: 10.1016/j.acuroe.2025.501798

S.E. Romero Zoghbi , F. López Campos , D. Sanz-Rosa , J. Fernández Ibiza , I.J. Thuissard-Vasallo , C. Andreu-Vázquez , C. Laria , J. Andreescu Yagüe , E. Krumina , A. Ocanto , M. Mateos , L.A. Glaría , J.A. García Cuesta , D. Gonsalves , C. Fernández , D. Esteban , J. Begara de la Fuente , D. Rivas , E. López Ramírez , L. Aakki , F. Couñago

Introduction

Stereotactic body radiation therapy (SBRT) has emerged as an effective option for the treatment of localized prostate cancer; however, data from real-world clinical practice remain limited.

Material and methods

Between January 2020 and December 2023, 251 patients with localized prostate cancer treated with SBRT were included in 12 centers in Spain. The treatment volume included prostate ± seminal vesicles, without prophylactic pelvic radiotherapy. A dose of 35−40 Gy was prescribed in 5 fractions, every other day. Acute genitourinary (GU), gastrointestinal (GI) and sexual toxicity was assessed up to 6 months post-treatment using the Common Terminology Criteria for Adverse Events (CTCAE) v5.0.

Results

A total of 251 patients were classified based on the National Comprehensive Cancer Network (NCCN®) classification. Four percent of patients had very low-risk disease, 26.3% low-risk, and 66.5% intermediate-risk (27.1% favorable intermediate and 39.4% unfavorable intermediate). Additionally, 2.8% were classified as high-risk and 0.4% as very high-risk. The median patient age was 72 years (range: 65–76), and the baseline PSA was 6.7 ng/ml (range: 5.3–8.7). The median SBRT dose was 40 Gy (range: 35–40 Gy). Grade 2 acute GU toxicity occurred in 6.4% of patients, and grade 3 in 0.4%. Grade 2 GI toxicity was observed in 0.8%, with no cases of grade 3 GI toxicity. Regarding sexual toxicity, 11.2% of patients experienced grade 2, and 1.2% grade 3 toxicity.

Conclusions

Five-fraction SBRT is a feasible and safe treatment with a low incidence of acute toxicity.

立体定向放射治疗（SBRT）已成为治疗局限性前列腺癌的有效选择；然而，来自真实世界临床实践的数据仍然有限。材料和方法：2020年1月至2023年12月，西班牙12个中心纳入251例接受SBRT治疗的局限性前列腺癌患者。治疗容积包括前列腺+/-精囊，无盆腔预防性放疗。35- 40gy的剂量分为5份，每隔一天服用一次。使用不良事件通用术语标准（CTCAE） v5.0对治疗后6个月的急性泌尿生殖系统（GU）、胃肠道（GI）和性毒性进行评估。结果：251例患者根据国家综合癌症网络（NCCN®）分类。4%的患者为极低风险，26.3%为低风险，66.5%为中风险（27.1%为有利的中间风险，39.4%为不利的中间风险）。此外，2.8%的人被列为高危人群，0.4%的人被列为高危人群。患者中位年龄为72岁（范围：65-76），基线PSA为6.7 ng/mL（范围：5.3-8.7）。SBRT的中位剂量为40 Gy（范围：35-40 Gy）。6.4%的患者发生2级急性GU毒性，0.4%的患者发生3级急性GU毒性。2级胃肠道毒性为0.8%，没有3级胃肠道毒性病例。关于性毒性，11.2%的患者出现2级毒性，1.2%出现3级毒性。结论：五段式SBRT是一种安全可行的治疗方法，急性毒性发生率低。

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引用次数: 0

Comparison of thulium fiber laser and holmium:YAG laser lithotripsy in retrograde intrarenal surgery for kidney Stone treatment: A randomized prospective study 铥光纤激光与钬激光碎石在肾结石逆行肾内手术中的比较：一项随机前瞻性研究。

Actas urologicas espanolas

Pub Date : 2025-10-01 DOI: 10.1016/j.acuroe.2025.501808

B. Kozubaev , S. Oguz Demirdogen , T. Aksakalli , F. Ozkaya , S. Adanur

Objective

This study compares the clinical outcomes of Holmium:YAG (Ho:YAG) laser lithotripsy and Thulium Fiber Laser (TFL) lithotripsy in retrograde intrarenal surgery (RIRS) for kidney stones <20 mm.

Materials and methods

Patients who underwent RIRS for renal stones <20 mm between September 2022 and November 2023 were prospectively analyzed. They were randomly assigned to either the TFL or Ho:YAG laser group using a sealed-envelope method. Preoperative demographics, stone characteristics, kidney-ureter-bladder x-ray (KUB), ultrasound and noncontrast computer tomography (NCCT) scan findings were recorded. Operative time, laser usage time, postoperative stone-free rate (SFR), and complications were assessed and statistically analyzed.

Results

A total of 126 patients (mean age: 49.16 ± 15.18 years; 64.3% male, 35.7% female) were included. The TFL group (n = 64, 50.8%) had significantly shorter operative and laser usage times than the Ho:YAG laser group (n = 62, 49.2%) (operative time: 45.77 ± 15.67 min vs. 52.79 ± 18.11 min, p = 0.031; laser usage: 29.84 ± 13.32 min vs. 36.39 ± 15.75 min, p = 0.024). No significant SFR difference was found between groups (TFL group: n = 57, 91.8% vs. Ho:YAG laser group: n = 60, 93.8% ; p = 0.488).

Conclusion

In the treatment of kidney stones smaller than 20 mm using laser lithotripsy, both TFL and Ho:YAG laser are effective, safe, and associated with low complication rates. However, the use of TFL significantly reduces operative time and lithotripsy time, potentially improving surgical efficiency. Further studies with larger patient cohorts are necessary to validate these findings and provide additional insights into the advantages and limitations of each laser type.

目的：比较钬激光碎石术（Ho:YAG）和铥光纤激光碎石术（TFL）在肾结石逆行肾内手术（RIRS）中的临床效果。材料和方法：行RIRS治疗肾结石患者结果：共126例患者(平均年龄：49.16±15.18岁；男性64.3%，女性35.7%)。TFL组（n = 64, 50.8%）的手术时间和激光使用时间均显著短于Ho:YAG激光组（n = 62, 49.2%）(手术时间：45.77±15.67 min vs 52.79±18.11 min, p = 0.031；激光用法:29.84±13.32分钟和36.39±15.75分钟,p = 0.024)。两组间SFR差异无统计学意义(TFL组：n = 57, 91.8% vs Ho:YAG激光组：n = 60, 93.8%；p = 0.488)。结论：激光碎石治疗小于20mm肾结石，TFL和Ho:YAG激光均有效、安全，并发症发生率低。然而，TFL的使用显著减少了手术时间和碎石时间，潜在地提高了手术效率。有必要对更大的患者群体进行进一步的研究，以验证这些发现，并进一步了解每种激光类型的优点和局限性。

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引用次数: 0

Efficacy of dietary interventions targeting calcium and oxalate intake in the prevention of calcium oxalate stones: An integrative review 针对钙和草酸盐摄入的饮食干预在预防草酸钙结石中的效果：一项综合综述。

Actas urologicas espanolas

Pub Date : 2025-10-01 DOI: 10.1016/j.acuroe.2025.501826

P. Vázquez Carral

Introduction

Calcium oxalate kidney stones—the most common type of renal calculi—are closely associated with dietary and metabolic factors. An appropriate dietary approach can help prevent their formation and reduce the risk of recurrence.

Objective

To evaluate the efficacy of dietary interventions involving adequate calcium intake combined with oxalate control in preventing the formation of calcium oxalate kidney stones.

Evidence acquisition

An integrative review was conducted in PubMed, Scopus, Medline, and Dialnet (2014–2024), following PRISMA guidelines, focusing on calcium and oxalate dietary management in kidney stone disease.

Evidence synthesis and conclusions

The reviewed evidence indicates that an adequate calcium intake (800–1,200 mg/day) reduces intestinal oxalate absorption and, consequently, urinary oxalate excretion. Additionally, hydration, sodium restriction, and urine alkalinization with citrate are complementary dietary strategies. Recent studies also suggest that urinary microbiota and genetic predisposition may influence individual responses to dietary interventions. Overall, a personalized dietary approach may constitute an effective and accessible strategy for the prevention of calcium oxalate kidney stones. However, the current body of evidence is limited by methodological constraints and heterogeneity across studies.

草酸钙肾结石是最常见的肾结石类型，与饮食和代谢因素密切相关。适当的饮食方法可以帮助预防它们的形成并降低复发的风险。目的：评价饮食干预包括充足的钙摄入和控制草酸盐在预防草酸钙肾结石形成中的作用。证据获取：根据PRISMA指南，在PubMed、Scopus、Medline和Dialnet（2014-2024）中进行了一项综合评价，重点关注肾结石疾病的钙和草酸盐饮食管理。证据综合和结论：所审查的证据表明，足够的钙摄入量（800- 1200mg /天）减少肠道草酸吸收，从而减少尿草酸排泄。此外，水合作用、限钠和用柠檬酸盐碱化尿液是补充的饮食策略。最近的研究还表明，尿微生物群和遗传易感性可能影响个体对饮食干预的反应。总的来说，个性化的饮食方法可能是预防草酸钙肾结石的一种有效和可行的策略。然而，目前的证据受到方法学约束和研究异质性的限制。

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引用次数: 0

Delayed cytoreductive nephrectomy in adults with metastatic renal cell carcinoma and vena cava tumor thrombus treated with immunotherapy-based neoadjuvant therapy: A systematic review 以免疫疗法为基础的新辅助疗法治疗成人转移性肾癌和腔静脉肿瘤血栓的延迟细胞减少性肾切除术：一项系统综述。

Actas urologicas espanolas

Pub Date : 2025-10-01 DOI: 10.1016/j.acuroe.2025.501799

E.S. Cruz Peralta , M. González Domínguez , R.J. Salgueiro Ergueta , M.L. Peralta Pedrero

Introduction

Renal cell carcinoma (RCC) invades the inferior vena cava (IVC) in 4%–10% of cases, increasing the risk of surgical complications that affect oncological outcomes.

Materials and methods

The research question was defined using the PICOST acronym. An exhaustive search, material selection, and data extraction were conducted in duplicate and independently. Original articles were included on patients with metastatic RCC (mRCC) with thrombus in the IVC, treated with immune checkpoint inhibitors with or without tyrosine kinase inhibitors (TKIs) and cytoreductive nephrectomy (CN). Studies involving patients with thrombi localized solely to the renal artery or atrium were excluded.

Results

A total of 17 articles were included: one retrospective cohort, five retrospective case series, and 11 retrospective case reports. In total, 32 patients were analyzed; 10 were excluded due to the absence of metastases. In most cases, the size of the primary tumor decreased. Regarding the thrombus in the IVC, based on the level, out of 22 patients, 7 remained unchanged, 13 showed a reduction (9 by one level, 3 by two levels, and 1 by three levels), and one showed an increase. In another case, the magnitude of the reduction in thrombus size or level was not specified. Tumor thrombus size decreased even in cases where the level remained unchanged.

Conclusions

Patients with mRCC and thrombus in the IVC may benefit from neoadjuvant treatment with immune checkpoint inhibitors, with or without TKIs, and delayed cytoreductive nephrectomy.

导言：肾细胞癌（RCC）侵袭下腔静脉（IVC）的病例占4%至10%，增加了影响肿瘤预后的手术并发症的风险。材料和方法：使用PICOST首字母缩写词定义研究问题。详尽的搜索，材料选择和数据提取进行了两份和独立。原始文章纳入了在IVC中有血栓的转移性肾癌（mRCC）患者，接受免疫检查点抑制剂联合或不联合酪氨酸激酶抑制剂（TKIs）和细胞减减性肾切除术（CN）治疗。排除了血栓仅局限于肾动脉或心房的患者。结果：共纳入17篇文章：1篇回顾性队列，5篇回顾性病例系列，11篇回顾性病例报告。共分析32例患者；10例因无转移而被排除。在大多数病例中，原发肿瘤的大小减小。对于下腔静脉血栓，22例患者中，7例保持不变，13例减少（9例减少一级，3例减少二级，1例减少三级），1例增加。在另一种情况下，血栓大小或水平减少的幅度没有指定。即使在水平保持不变的情况下，肿瘤血栓的大小也会减小。结论：mRCC和IVC血栓患者可能受益于免疫检查点抑制剂的新辅助治疗，有或没有TKIs，以及延迟的细胞减减性肾切除术。

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引用次数: 0