Pub Date : 2025-12-01DOI: 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 : 2025-11-01DOI: 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}
Pub Date : 2025-11-01DOI: 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.
{"title":"Prenatal ultrasonographic evaluation and management of renal and urogenital anomalies: A comprehensive review based on experience in a tertiary care center and literature analysis","authors":"K. Weller , G.M. Eggenhuizen , K. Zandbergen , L.A. 't Hoen , J. Mulder , A.T.J.I. Go","doi":"10.1016/j.acuroe.2025.501816","DOIUrl":"10.1016/j.acuroe.2025.501816","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Objective</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":"49 9","pages":"Article 501816"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602746","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 : 2025-11-01DOI: 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.
{"title":"Does preoperative alpha-blocker use affect the results of flexible ureterorenoscopy?","authors":"A. Akinci , A. Sanci , M. Babayigit , C. Gogus","doi":"10.1016/j.acuroe.2025.501836","DOIUrl":"10.1016/j.acuroe.2025.501836","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effect of alpha-blocker therapy during flexible ureterorenoscopy (F-URS) on the treatment of upper urinary tract stones.</div></div><div><h3>Methods</h3><div>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%).</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":"49 9","pages":"Article 501836"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056514","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 : 2025-11-01DOI: 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 , P. Moscatiello , I. Hernández , T. Jerez , C. Grañen , M. Toledo , 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 < 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}
Pub Date : 2025-11-01DOI: 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 , J. Huguet , G. Basile, L. Diéguez, P. Izquierdo, R. Sánchez, P. Gavrilov, A. Gallioli, O. Rodríguez Faba, J.M. Gaya, J. Palou, 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}
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.
{"title":"Total quantification of circulating microRNAs and smallRNAs in plasma and urine as prognostic biomarkers in prostate cancer","authors":"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","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 < 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}
Pub Date : 2025-11-01DOI: 10.1016/j.acuroe.2025.501832
Y. Quiroz Madarriaga , M.İ. Dönmez , R.J.M. Lammers , B. Bañuelos Marco , N. Baydilli , E. Bindi , S. Sforza , I. Selvi , L.A. Hoen
Paediatric urolithiasis is increasing globally, with metabolic abnormalities as a key contributing factor. However, standardized protocols for metabolic evaluation in children are lacking. This study assessed current practices and knowledge among paediatric urologists worldwide. An international survey was distributed in Spanish and English, gathering data on clinician demographics and metabolic evaluation strategies. A total of 194 clinicians from 49 countries responded. Only 11% routinely performed metabolic evaluations, and while 78% requested stone analysis, just 46% ordered 24-h urine studies. In 84% of cases, paediatric nephrologists were responsible for evaluations, with urologists involved in fewer than 25%. Knowledge of spot urine indices varied, and only 55% recognized crystalluria as a lithogenic risk factor. Fewer than one-third felt confident interpreting metabolic results or initiating treatment. These findings highlight inconsistent practices and limited involvement of paediatric urologists, underscoring the need for clearer guidelines and targeted education to enhance metabolic assessment in stone disease.
{"title":"Metabolic evaluation in paediatric urolithiasis: Is a key component being overlooked? An international survey by the YAU-PU Working Group","authors":"Y. Quiroz Madarriaga , M.İ. Dönmez , R.J.M. Lammers , B. Bañuelos Marco , N. Baydilli , E. Bindi , S. Sforza , I. Selvi , L.A. Hoen","doi":"10.1016/j.acuroe.2025.501832","DOIUrl":"10.1016/j.acuroe.2025.501832","url":null,"abstract":"<div><div>Paediatric urolithiasis is increasing globally, with metabolic abnormalities as a key contributing factor. However, standardized protocols for metabolic evaluation in children are lacking. This study assessed current practices and knowledge among paediatric urologists worldwide. An international survey was distributed in Spanish and English, gathering data on clinician demographics and metabolic evaluation strategies. A total of 194 clinicians from 49 countries responded. Only 11% routinely performed metabolic evaluations, and while 78% requested stone analysis, just 46% ordered 24-h urine studies. In 84% of cases, paediatric nephrologists were responsible for evaluations, with urologists involved in fewer than 25%. Knowledge of spot urine indices varied, and only 55% recognized crystalluria as a lithogenic risk factor. Fewer than one-third felt confident interpreting metabolic results or initiating treatment. These findings highlight inconsistent practices and limited involvement of paediatric urologists, underscoring the need for clearer guidelines and targeted education to enhance metabolic assessment in stone disease.</div></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":"49 9","pages":"Article 501832"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777479","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 : 2025-11-01DOI: 10.1016/j.acuroe.2025.501841
G. Lendínez-Cano , C. Roldán Cumbreras , C.B. Congregado Ruíz , R.A. Medina López
Introduction
Palliative care is a fundamental component of the comprehensive management of patients with advanced cancer, significantly improving quality of life. Since most patients with metastatic renal cell carcinoma (mRCC) ultimately die from disease progression, end-of-life care represents a key element of quality cancer care. This area can be assessed through specific indicators derived from administrative data.
Materials and methods
We conducted a retrospective analysis of patients diagnosed with mRCC who initiated treatment at our center between September 2012 and September 2019, evaluating quality indicators related to end-of-life care.
Results
Of the 71 patients identified, 57 had died at the time of analysis (81.6%).
A total of 59.6% (95% CI 46.8–72.3) died in hospital, 64% of these in palliative care units. In the last 30 days of life, 22.8% (95% CI 12–33.5) visited the emergency room more than once, while only 1.8% (95% CI 0–5.1) were admitted to the ICU. Contact with palliative care services was documented in 49% (95% CI 36.1–62) of patients, although only 5.3% (95% CI 0–11.1) received early referral (more than 90 days before death).
Conclusions
Palliative care in mRCC is underutilized and predominantly offered as end-of-life care, with early referral being exceptional. Multidisciplinary strategies are needed to optimize these services.
导读：姑息治疗是晚期癌症患者综合管理的基本组成部分，可显著提高患者的生活质量。由于大多数转移性肾细胞癌（mRCC）患者最终死于疾病进展，临终关怀是高质量癌症护理的关键要素。可以通过从行政数据中得出的具体指标来评估这一领域。材料与方法：回顾性分析2012年9月至2019年9月在本中心开始治疗的mRCC患者，评估与临终关怀相关的质量指标。结果：71例患者中，57例在分析时死亡（81.6%）。共有59.6% （95% CI 46.8-72.3）死于医院，其中64%死于姑息治疗病房。在生命的最后30天，22.8% （95% CI 12-33.5）的患者不止一次去急诊室，而只有1.8% （95% CI 0-5.1）的患者住进了ICU。49% （95% CI 36.1-62）的患者接触过姑息治疗服务，尽管只有5.3% （95% CI 0-11.1）的患者接受了早期转诊（死亡前90天以上）。结论：姑息治疗在mRCC中未得到充分利用，主要作为临终关怀提供，早期转诊是例外。需要多学科战略来优化这些服务。
{"title":"End-of-life and palliative care in patients with metastatic renal cancer","authors":"G. Lendínez-Cano , C. Roldán Cumbreras , C.B. Congregado Ruíz , R.A. Medina López","doi":"10.1016/j.acuroe.2025.501841","DOIUrl":"10.1016/j.acuroe.2025.501841","url":null,"abstract":"<div><h3>Introduction</h3><div>Palliative care is a fundamental component of the comprehensive management of patients with advanced cancer, significantly improving quality of life. Since most patients with metastatic renal cell carcinoma (mRCC) ultimately die from disease progression, end-of-life care represents a key element of quality cancer care. This area can be assessed through specific indicators derived from administrative data.</div></div><div><h3>Materials and methods</h3><div>We conducted a retrospective analysis of patients diagnosed with mRCC who initiated treatment at our center between September 2012 and September 2019, evaluating quality indicators related to end-of-life care.</div></div><div><h3>Results</h3><div>Of the 71 patients identified, 57 had died at the time of analysis (81.6%).</div><div>A total of 59.6% (95% CI 46.8–72.3) died in hospital, 64% of these in palliative care units. In the last 30 days of life, 22.8% (95% CI 12–33.5) visited the emergency room more than once, while only 1.8% (95% CI 0–5.1) were admitted to the ICU. Contact with palliative care services was documented in 49% (95% CI 36.1–62) of patients, although only 5.3% (95% CI 0–11.1) received early referral (more than 90 days before death).</div></div><div><h3>Conclusions</h3><div>Palliative care in mRCC is underutilized and predominantly offered as end-of-life care, with early referral being exceptional. Multidisciplinary strategies are needed to optimize these services.</div></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":"49 9","pages":"Article 501841"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056488","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 : 2025-11-01DOI: 10.1016/j.acuroe.2025.501859
E. Venegas-Vázquez , C. Beas-Ruiz Velasco , R. Martínez de Pinillos-Valverde , J.P. Gómez-Sierra , C.E. Capetillo-Texson , V.T. Hernández-Ramírez , A.R. Villaseñor-Rodríguez , J.M. Guzmán-Díaz , X. Monteón-Aspeitia , A. González-Ojeda , G. Cervantes-Guevara , E. Cervantes-Pérez , S. Ramírez-Ochoa , M.G. Castillo-Cardiel , C. Fuentes-Orozco
Introduction
Renal transplantation is the renal replacement therapy of choice in patients with end-stage chronic kidney disease. Major urological complications such as urinary leakage, ureteral stricture and urinary tract infection, usually occur in the first three months post-transplantation and lead to a higher morbidity and mortality and lower graft function.
Objective
To evaluate the impact of double J catheter colocation on major urological complications in extravesical ureteroneocystostomy in renal recipients.
Methods
Open clinical trial. The study included renal transplant recipients who underwent extravesical ureteroneocystostomy with trans-surgical placement of double J catheter compared to extravesical ureteroneocystostomy without trans-surgical catheter placement. The study variables were urinary leakage, ureteral stricture, urinary tract infection, surgical complications and graft function.
Results
84 patients were included, 42 patients in the study group and 42 in the control group, who had a mean follow-up of 10.7 months. Of the urological complications presented: 4 (4.8%) patients with urinary leakage, all in the non-catheter group (RR 0.475 95% CI 0.377−0.598, p = 0.04); 2 (2.4%) patients with ureteral stricture, one in each group (RR 1 95% CI 0. 246−4.066, p = 1.0); and 20 (23.8%) patients with urinary tract infection, being 9 (21.4%) patients in the control group and 11 (26.2%) in the study group (RR 1.135 CI 95% 0.710–1.817, p = 0.608). No differences regarding graft function were observed.
Conclusion
Our study showed a significant reduction in the incidence of urinary leakage with prophylactic ureteral catheter use, although no significant association was observed with other complications such as ureteral stricture or surgical complications. Furthermore, its use was not significantly associated with urinary tract infections or graft dysfunction.
肾移植是终末期慢性肾病患者肾替代治疗的选择。主要的泌尿系统并发症，如尿漏、输尿管狭窄和尿路感染，通常发生在移植后的前三个月，导致较高的发病率和死亡率，移植物功能下降。目的：探讨双J管配置对肾术后输尿管外膀胱造瘘主要泌尿系统并发症的影响。方法：开放式临床试验。该研究包括肾移植受者行经手术放置双J导管的体外输尿管膀胱造口术与不放置导管的体外输尿管膀胱造口术。研究变量为尿漏、输尿管狭窄、尿路感染、手术并发症和移植物功能。结果：共纳入84例患者，研究组42例，对照组42例，平均随访10.7个月。泌尿系统并发症中出现：4例（4.8%）患者出现尿漏，均为非置管组（RR 0.475 95% CI 0.377 ~ 0.598, p = 0.04）；输尿管狭窄2例（2.4%），每组1例(RR 1, 95% CI 0。246 - 4.066, p = 1.0)；尿路感染20例（23.8%），对照组9例（21.4%），研究组11例（26.2%）（RR 1.135, CI 95% 0.710 ~ 1.817, p = 0.608）。在移植物功能方面没有观察到差异。结论：我们的研究显示，预防性输尿管导管的使用显著降低了尿漏的发生率，尽管与输尿管狭窄或手术并发症等其他并发症没有明显的关联。此外，它的使用与尿路感染或移植物功能障碍没有显著相关性。
{"title":"Prophylactic Double J Stent and Major Urological Complications during Extravesical Ureteroneocystostomy in Kidney Transplant Recipients","authors":"E. Venegas-Vázquez , C. Beas-Ruiz Velasco , R. Martínez de Pinillos-Valverde , J.P. Gómez-Sierra , C.E. Capetillo-Texson , V.T. Hernández-Ramírez , A.R. Villaseñor-Rodríguez , J.M. Guzmán-Díaz , X. Monteón-Aspeitia , A. González-Ojeda , G. Cervantes-Guevara , E. Cervantes-Pérez , S. Ramírez-Ochoa , M.G. Castillo-Cardiel , C. Fuentes-Orozco","doi":"10.1016/j.acuroe.2025.501859","DOIUrl":"10.1016/j.acuroe.2025.501859","url":null,"abstract":"<div><h3>Introduction</h3><div>Renal transplantation is the renal replacement therapy of choice in patients with end-stage chronic kidney disease. Major urological complications such as urinary leakage, ureteral stricture and urinary tract infection, usually occur in the first three months post-transplantation and lead to a higher morbidity and mortality and lower graft function.</div></div><div><h3>Objective</h3><div>To evaluate the impact of double J catheter colocation on major urological complications in extravesical ureteroneocystostomy in renal recipients.</div></div><div><h3>Methods</h3><div>Open clinical trial. The study included renal transplant recipients who underwent extravesical ureteroneocystostomy with trans-surgical placement of double J catheter compared to extravesical ureteroneocystostomy without trans-surgical catheter placement. The study variables were urinary leakage, ureteral stricture, urinary tract infection, surgical complications and graft function.</div></div><div><h3>Results</h3><div>84 patients were included, 42 patients in the study group and 42 in the control group, who had a mean follow-up of 10.7 months. Of the urological complications presented: 4 (4.8%) patients with urinary leakage, all in the non-catheter group (RR 0.475 95% CI 0.377−0.598, p = 0.04); 2 (2.4%) patients with ureteral stricture, one in each group (RR 1 95% CI 0. 246−4.066, p = 1.0); and 20 (23.8%) patients with urinary tract infection, being 9 (21.4%) patients in the control group and 11 (26.2%) in the study group (RR 1.135 CI 95% 0.710–1.817, p = 0.608). No differences regarding graft function were observed.</div></div><div><h3>Conclusion</h3><div>Our study showed a significant reduction in the incidence of urinary leakage with prophylactic ureteral catheter use, although no significant association was observed with other complications such as ureteral stricture or surgical complications. Furthermore, its use was not significantly associated with urinary tract infections or graft dysfunction.</div></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":"49 9","pages":"Article 501859"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194224","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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