Pub Date : 2025-12-01Epub Date: 2025-10-11DOI: 10.1016/j.acuroe.2025.501865
N. Kulchenko , G. Demyashkin , A. Mansur , A. Strachuk , E. Korovyakova , R. Frantsev , K. Neklyudov , A. Mirontsev , V. Rostovskaya , K. Silakov
Introduction
Paraurethral cysts are rare in females and are often incidental findings during routine medical examinations. To date, no standardized approach exists for the surgical management of large cysts, which tend to cause the most discomfort to patients.
Objective
To evaluate the effectiveness of surgical treatment for large paraurethral cysts through excision and laser vaporization.
Methods
The study included 49 female patients diagnosed with paraurethral cysts larger than 4 cm in diameter. The patients were divided into two groups: Group 1 (n = 26) underwent excision of the paraurethral cyst, and Group 2 (n = 23) underwent laser vaporization. All patients were monitored throughout their hospitalization. The parameters assessed included operation time, the number and type of intraoperative complications, the duration of bladder catheterization, and the length of hospital stay.
Results
Laser vaporization was, on average, 8.6 min shorter than excision (p < 0.05), with a strong correlation between the surgical method and operation time (r = 0.70). Intraoperative complications (bleeding, urethral injury, cyst rupture) occurred 2.8 times less frequently in Group 2 compared to Group 1. The length of hospital stay was 1.3 days shorter following laser vaporization. The correlation between hospital stay duration and surgical method was moderate (r = 0.31).
Conclusion
Laser vaporization offers significant advantages for the treatment of large paraurethral cysts, including shorter operation time, fewer intraoperative complications, and a faster recovery period. Therefore, laser vaporization should be considered the treatment of choice for large paraurethral cysts.
{"title":"Outcomes of surgical treatment of large paraurethral cysts","authors":"N. Kulchenko , G. Demyashkin , A. Mansur , A. Strachuk , E. Korovyakova , R. Frantsev , K. Neklyudov , A. Mirontsev , V. Rostovskaya , K. Silakov","doi":"10.1016/j.acuroe.2025.501865","DOIUrl":"10.1016/j.acuroe.2025.501865","url":null,"abstract":"<div><h3>Introduction</h3><div>Paraurethral cysts are rare in females and are often incidental findings during routine medical examinations. To date, no standardized approach exists for the surgical management of large cysts, which tend to cause the most discomfort to patients.</div></div><div><h3>Objective</h3><div>To evaluate the effectiveness of surgical treatment for large paraurethral cysts through excision and laser vaporization.</div></div><div><h3>Methods</h3><div>The study included 49 female patients diagnosed with paraurethral cysts larger than 4 cm in diameter. The patients were divided into two groups: Group 1 (<em>n</em> = 26) underwent excision of the paraurethral cyst, and Group 2 (<em>n</em> = 23) underwent laser vaporization. All patients were monitored throughout their hospitalization. The parameters assessed included operation time, the number and type of intraoperative complications, the duration of bladder catheterization, and the length of hospital stay.</div></div><div><h3>Results</h3><div>Laser vaporization was, on average, 8.6 min shorter than excision (<em>p</em> < 0.05), with a strong correlation between the surgical method and operation time (<em>r</em> = 0.70). Intraoperative complications (bleeding, urethral injury, cyst rupture) occurred 2.8 times less frequently in Group 2 compared to Group 1. The length of hospital stay was 1.3 days shorter following laser vaporization. The correlation between hospital stay duration and surgical method was moderate (<em>r</em> = 0.31).</div></div><div><h3>Conclusion</h3><div>Laser vaporization offers significant advantages for the treatment of large paraurethral cysts, including shorter operation time, fewer intraoperative complications, and a faster recovery period. Therefore, laser vaporization should be considered the treatment of choice for large paraurethral cysts.</div></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":"49 10","pages":"Article 501865"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288047","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}
Pub Date : 2025-12-01Epub Date: 2025-10-22DOI: 10.1016/j.acuroe.2025.501869
K. Eskandar
Introduction
Focal therapy offers a middle-ground approach for localized prostate cancer, preserving the prostate while avoiding the morbidity of radical treatment. High-Intensity Focused Ultrasound (HIFU) is the most studied focal modality, with FocalONE representing the most widely adopted modern platform enabling precise image-guided ablation.
Objective
To systematically assess the oncologic control, functional outcomes, safety, and technological advancements of focal and hemiablation HIFU with an emphasis on the FocalONE platform.
Methodology
This systematic review followed PRISMA guidelines and was registered in PROSPERO. A comprehensive search of PubMed, Embase, and Cochrane databases identified prospective studies using FocalONE or earlier-generation transrectal HIFU devices for focal or hemiablation in localized prostate cancer. Key outcomes included biopsy negativity, salvage-free survival, urinary continence, erectile function, and complications. Study quality was appraised using the JBI tool.
Results
Five prospective studies involving 701 patients were included. Biopsy negativity ranged from 84% to 95%, with salvage-free survival reaching up to 92% at mid-term follow-up. Urinary continence was preserved in 96–100% of patients, and erectile function in 74–95%, with the most favorable functional outcomes consistently observed in FocalONE-based cohorts. Most adverse events were minor (grade I–II), with few serious complications. Compared to focal cryotherapy and irreversible electroporation, HIFU showed comparable cancer control and better or similar functional preservation. PSA density and MRI-visible lesions were strong predictors of success.
Conclusion
FocalONE-based focal HIFU provides effective cancer control with excellent functional preservation in selected patients. While evidence from earlier-generation devices supports these trends, generalizability across all HIFU platforms remains to be validated. Its precision and safety profile make it a promising alternative between active surveillance and radical therapies, especially in favorable intermediate-risk cases.
{"title":"FocalONE high-intensity focused ultrasound for localized prostate cancer: A systematic review of oncologic outcomes, functional preservation, and technological evolution","authors":"K. Eskandar","doi":"10.1016/j.acuroe.2025.501869","DOIUrl":"10.1016/j.acuroe.2025.501869","url":null,"abstract":"<div><h3>Introduction</h3><div>Focal therapy offers a middle-ground approach for localized prostate cancer, preserving the prostate while avoiding the morbidity of radical treatment. High-Intensity Focused Ultrasound (HIFU) is the most studied focal modality, with FocalONE representing the most widely adopted modern platform enabling precise image-guided ablation.</div></div><div><h3>Objective</h3><div>To systematically assess the oncologic control, functional outcomes, safety, and technological advancements of focal and hemiablation HIFU with an emphasis on the FocalONE platform.</div></div><div><h3>Methodology</h3><div>This systematic review followed PRISMA guidelines and was registered in PROSPERO. A comprehensive search of PubMed, Embase, and Cochrane databases identified prospective studies using FocalONE or earlier-generation transrectal HIFU devices for focal or hemiablation in localized prostate cancer. Key outcomes included biopsy negativity, salvage-free survival, urinary continence, erectile function, and complications. Study quality was appraised using the JBI tool.</div></div><div><h3>Results</h3><div>Five prospective studies involving 701 patients were included. Biopsy negativity ranged from 84% to 95%, with salvage-free survival reaching up to 92% at mid-term follow-up. Urinary continence was preserved in 96–100% of patients, and erectile function in 74–95%, with the most favorable functional outcomes consistently observed in FocalONE-based cohorts. Most adverse events were minor (grade I–II), with few serious complications. Compared to focal cryotherapy and irreversible electroporation, HIFU showed comparable cancer control and better or similar functional preservation. PSA density and MRI-visible lesions were strong predictors of success.</div></div><div><h3>Conclusion</h3><div>FocalONE-based focal HIFU provides effective cancer control with excellent functional preservation in selected patients. While evidence from earlier-generation devices supports these trends, generalizability across all HIFU platforms remains to be validated. Its precision and safety profile make it a promising alternative between active surveillance and radical therapies, especially in favorable intermediate-risk cases.</div></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":"49 10","pages":"Article 501869"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369404","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}
Pub Date : 2025-12-01Epub Date: 2025-09-12DOI: 10.1016/j.acuroe.2025.501838
J. García Rodríguez, A. López Tello, C. González Ruiz de león, R. Sacristán González, M. Hevia Suárez, J. Fuentes Pastor, I. Pérez Vera, J.M. Fernández Gómez
Introduction
Real-world analyses reflect routine clinical practice. We reviewed treatment response and quality of life in metastatic hormone-sensitive prostate cancer (mHSPC) patients treated with androgen receptor inhibitors.
Methods
We analyzed 89 patients with mHSPC from a descriptive observational cohort. The median follow-up was 16.1 months, with quarterly assessments. We evaluated PSA response, disease progression, and quality-of-life data.
Results
Among the patients, 37% had high-volume disease and 63% low-volume; 60% had synchronous metastases. Using apalutamide, we observed PSA reductions of 90%, PSA < 0.2 ng/ml, and ultra-low PSA (<0.02 ng/ml) at 3 and 6 months in 63%, 65%, and 34% and in 65%, 71%, and 53% of patients, respectively. Radiographic progression-free survival (rPFS) was 88% at 15 months. When PET-PSMA was used for imaging, 94% and 92% of patients remained free of radiographic progression at 12 and 24 months, respectively. Regarding quality of life, the FACT-P score remained stable, and pain on the visual analog scale improved, with the proportion of patients scoring >1 decreasing from 35% to 22% over 6 months.
Conclusion
Real-world analyses using androgen receptor inhibitors in mHSPC reproduce clinical trial results in terms of treatment response. Profound PSA declines and observed progression-free survival outcomes reflect treatment effectiveness without a negative impact on quality of life.
{"title":"Real-world data from a single-center cohort of patients with metastatic hormone-sensitive prostate cancer in Spain: Analysis of response, progression, and quality of life","authors":"J. García Rodríguez, A. López Tello, C. González Ruiz de león, R. Sacristán González, M. Hevia Suárez, J. Fuentes Pastor, I. Pérez Vera, J.M. Fernández Gómez","doi":"10.1016/j.acuroe.2025.501838","DOIUrl":"10.1016/j.acuroe.2025.501838","url":null,"abstract":"<div><h3>Introduction</h3><div>Real-world analyses reflect routine clinical practice. We reviewed treatment response and quality of life in metastatic hormone-sensitive prostate cancer (mHSPC) patients treated with androgen receptor inhibitors.</div></div><div><h3>Methods</h3><div>We analyzed 89 patients with mHSPC from a descriptive observational cohort. The median follow-up was 16.1 months, with quarterly assessments. We evaluated PSA response, disease progression, and quality-of-life data.</div></div><div><h3>Results</h3><div>Among the patients, 37% had high-volume disease and 63% low-volume; 60% had synchronous metastases. Using apalutamide, we observed PSA reductions of 90%, PSA < 0.2 ng/ml, and ultra-low PSA (<0.02 ng/ml) at 3 and 6 months in 63%, 65%, and 34% and in 65%, 71%, and 53% of patients, respectively. Radiographic progression-free survival (rPFS) was 88% at 15 months. When PET-PSMA was used for imaging, 94% and 92% of patients remained free of radiographic progression at 12 and 24 months, respectively. Regarding quality of life, the FACT-P score remained stable, and pain on the visual analog scale improved, with the proportion of patients scoring >1 decreasing from 35% to 22% over 6 months.</div></div><div><h3>Conclusion</h3><div>Real-world analyses using androgen receptor inhibitors in mHSPC reproduce clinical trial results in terms of treatment response. Profound PSA declines and observed progression-free survival outcomes reflect treatment effectiveness without a negative impact on quality of life.</div></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":"49 10","pages":"Article 501838"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067078","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}
Pub Date : 2025-12-01Epub Date: 2025-08-05DOI: 10.1016/j.acuroe.2025.501820
R.J.M. Lammers , L.A. 't Hoen , F. O’Kelly , I. Selvi , Y. Quiroz Madarriaga , N. Baydilli , B. Bañuelos Marco , M.I. Dönmez , S. Sforza , E. Bindi , B. Haid , en representación del Grupo de Trabajo de Urología Pediátrica de la Sección de Jóvenes Urólogos Académicos (YAU) - Asociación Europea de Urología (EAU)
The objective of this study was provide an overview of current practices on hormonal therapy (HT) in children with undescended testes (UDT).
An online questionnaire about HT, referral patterns, and orchidopexy was spread via several (social media) networks involved in pediatric urology.
A total of 283 individuals responded, with 54 countries sampled. The majority (84%) did not prescribe HT for UDT, predominantly due to a paucity of scientific evidence (76%). Among those who use HT, main reason was bilateral UDT (62%). There was no clear preference in administration type (50% intramuscular injection, 50% nasal spray). GnRH was slightly more favoured over HCG (50% vs. 32%). No standardized schedule was used. Most respondents (67%) felt all forms of UDT should be treated by either a pediatric urologist or -surgeon. Eighty-seven percent follow the current guidelines and perform orchidopexy between 6–18 months of age.
{"title":"Use of hormonal therapy for undescended testis? Results of a worldwide questionnaire","authors":"R.J.M. Lammers , L.A. 't Hoen , F. O’Kelly , I. Selvi , Y. Quiroz Madarriaga , N. Baydilli , B. Bañuelos Marco , M.I. Dönmez , S. Sforza , E. Bindi , B. Haid , en representación del Grupo de Trabajo de Urología Pediátrica de la Sección de Jóvenes Urólogos Académicos (YAU) - Asociación Europea de Urología (EAU)","doi":"10.1016/j.acuroe.2025.501820","DOIUrl":"10.1016/j.acuroe.2025.501820","url":null,"abstract":"<div><div>The objective of this study was provide an overview of current practices on hormonal therapy (HT) in children with undescended testes (UDT).</div><div>An online questionnaire about HT, referral patterns, and orchidopexy was spread via several (social media) networks involved in pediatric urology.</div><div>A total of 283 individuals responded, with 54 countries sampled. The majority (84%) did not prescribe HT for UDT, predominantly due to a paucity of scientific evidence (76%). Among those who use HT, main reason was bilateral UDT (62%). There was no clear preference in administration type (50% intramuscular injection, 50% nasal spray). GnRH was slightly more favoured over HCG (50% vs. 32%). No standardized schedule was used. Most respondents (67%) felt all forms of UDT should be treated by either a pediatric urologist or -surgeon. Eighty-seven percent follow the current guidelines and perform orchidopexy between 6–18 months of age.</div></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":"49 10","pages":"Article 501820"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777480","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}
Pub Date : 2025-12-01Epub Date: 2025-09-12DOI: 10.1016/j.acuroe.2025.501839
Ö. Faruk Akgün , A. Altunkol , E. Alma , Ü. Uysal , B. Aksay , Y.E. Kök
Objectives
To compare the diagnostic performance of cognitive fusion biopsy and/or standard systematic biopsy performed following multiparametric magnetic resonance imaging (mpMRI) in the detection of prostate cancer (PCa), and to assess the standalone diagnostic value of mpMRI.
Materials and methods
Initially, 1153 patients undergoing PBx from 2017 to 2022 were chosen. Patients were divided into three groups: those with standard PBx without mpMRI (1st group), those with standard PBx after mpMRI (2nd group) and those with standard and cognitive fusion PBx after mpMRI (3rd group). The correlations of general PCa and clinically significant PCa (csPCa) detection rates and Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) scores were evaluated.
Results
The overall PCa detection rate was highest in group 2 (47%). Additionally, the malignancy rate in group 3 was significantly higher compared to group 1 (P < .05). Though the csPCa rate was higher in the third group (40%) compared to the other groups, no significant difference was identified. As the PI-RADS score increased, the malignancy rates appeared to increase. The rate of high-risk patients in the group with cognitive fusion biopsy performed (11, 17%) was higher compared to the second group (P < .05).
Conclusions
Multiparametric MRI is valuable in prostate cancer diagnosis, particularly for lesion detection and biopsy guidance in patients with high PI-RADS scores. However, in our study, the addition of cognitive fusion biopsy did not significantly increase the detection rate of csPCa. Further prospective randomized studies are needed to clarify its diagnostic value.
{"title":"Comparison of cognitive fusion and standard prostate biopsy after multiparametric prostate magnetic resonance imaging and place of multiparametric prostate magnetic resonance imaging in diagnosis","authors":"Ö. Faruk Akgün , A. Altunkol , E. Alma , Ü. Uysal , B. Aksay , Y.E. Kök","doi":"10.1016/j.acuroe.2025.501839","DOIUrl":"10.1016/j.acuroe.2025.501839","url":null,"abstract":"<div><h3>Objectives</h3><div>To compare the diagnostic performance of cognitive fusion biopsy and/or standard systematic biopsy performed following multiparametric magnetic resonance imaging (mpMRI) in the detection of prostate cancer (PCa), and to assess the standalone diagnostic value of mpMRI.</div></div><div><h3>Materials and methods</h3><div>Initially, 1153 patients undergoing PBx from 2017 to 2022 were chosen. Patients were divided into three groups: those with standard PBx without mpMRI (1st group), those with standard PBx after mpMRI (2nd group) and those with standard and cognitive fusion PBx after mpMRI (3rd group). The correlations of general PCa and clinically significant PCa (csPCa) detection rates and Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) scores were evaluated.</div></div><div><h3>Results</h3><div>The overall PCa detection rate was highest in group 2 (47%). Additionally, the malignancy rate in group 3 was significantly higher compared to group 1 (<em>P</em> < .05). Though the csPCa rate was higher in the third group (40%) compared to the other groups, no significant difference was identified. As the PI-RADS score increased, the malignancy rates appeared to increase. The rate of high-risk patients in the group with cognitive fusion biopsy performed (11, 17%) was higher compared to the second group (<em>P</em> < .05).</div></div><div><h3>Conclusions</h3><div>Multiparametric MRI is valuable in prostate cancer diagnosis, particularly for lesion detection and biopsy guidance in patients with high PI-RADS scores. However, in our study, the addition of cognitive fusion biopsy did not significantly increase the detection rate of csPCa. Further prospective randomized studies are needed to clarify its diagnostic value.</div></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":"49 10","pages":"Article 501839"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067155","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}
Pub Date : 2025-12-01Epub Date: 2025-09-29DOI: 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.
{"title":"Sex-specific bladder cancer incidence trends and generational effects in Spain","authors":"L. Cayuela , V. Achaval , S. Cabrera Fernández , M. Ortega Calvo , A. Cayuela","doi":"10.1016/j.acuroe.2025.501863","DOIUrl":"10.1016/j.acuroe.2025.501863","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":"49 10","pages":"Article 501863"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208949","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}
Pub Date : 2025-12-01Epub Date: 2025-10-11DOI: 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.
{"title":"Cisplatin-induced AKI risk stratification and safety of dose reduction in urothelial carcinoma patients with renal impairment","authors":"S. Yamamoto, K. Higa, K. Kurokawa, H. Bamba, S. Kanaoka, K. Nakamura","doi":"10.1016/j.acuroe.2025.501864","DOIUrl":"10.1016/j.acuroe.2025.501864","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>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.</div></div><div><h3>Materials and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":"49 10","pages":"Article 501864"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288103","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}
Pub Date : 2025-12-01Epub Date: 2025-07-14DOI: 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。
{"title":"Management of incontinence after classic bladder exstrophy closure","authors":"K. Godlewski, M. Davis, D. Weiss, A. Shukla","doi":"10.1016/j.acuroe.2025.501818","DOIUrl":"10.1016/j.acuroe.2025.501818","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":"49 10","pages":"Article 501818"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651710","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}
Pub Date : 2025-12-01Epub Date: 2025-10-01DOI: 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。
{"title":"The unit volume biopsy length in prostate biopsy: Does it matter?","authors":"J. Tang , T. Wu , K. Zhang , Z. Wen","doi":"10.1016/j.acuroe.2025.501862","DOIUrl":"10.1016/j.acuroe.2025.501862","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":"49 10","pages":"Article 501862"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226474","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}
Pub Date : 2025-11-01Epub Date: 2025-09-12DOI: 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).
{"title":"Diagnostic value of structured anamnesis for phenotype identification in chronic pelvic pain syndrome: A practice-oriented retrospective study","authors":"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","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}
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