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  • Review
    Bin Jia, Zhenghao Li, Danfeng Zhao, Qiang Fu
    Archivos Españoles de Urología. 2023, 76(10): 746-754. https://doi.org/10.56434/j.arch.esp.urol.20237610.90
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    Erectile dysfunction (ED) is a common sexual dysfunction in men that can occur with the onset of sexual activity or even earlier, and the development of ED involves a variety of pathophysiologic mechanisms. Organic erectile dysfunction refers to a type of erectile dysfunction that is primarily caused by physical or organic factors rather than psychological or emotional factors. Worldwide, the incidence and prevalence of ED are high. Currently, the mainstay of ED treatment is the use of medications such as phosphodiesterase type 5 inhibitors (PDE5Is). However, these medications cause adverse effects such as flushing, indigestion and headaches and are not effective for some ED patients. Therefore, there is an urgent need to explore new targets of action for the treatment of ED. Ferroptosis is a type of iron-dependent regulated cell death initiated by lipid peroxidation and is a novel form of programmed cell death associated with the pathogenesis of various diseases. Prior research has provided evidence that the ferroptosis pathway plays a pivotal role in the modulation of ED, establishing this pathway as a significant foundation for the development of potential therapeutic interventions for ED. Experiments have shown that the inhibition of ferroptosis can improve ED. This article systematically introduces the role and influence of ferroptosis in various types of organic erectile dysfunction and describes the molecular mechanism, related pathways, and potential targets, providing a theoretical basis for the clinical diagnosis and treatment of ED.

  • Review
    Yoichiro Okubo, Shinya Sato, Hideyuki Terao, Yayoi Yamamoto, Atsuto Suzuki, Chie Hasegawa, Emi Yoshioka, Kyoko Ono, Kota Washimi, Tomoyuki Yokose, Noboru Nakaigawa, Takeshi Kishida, Yohei Miyagi
    Archivos Españoles de Urología. 2023, 76(9): 633-642. https://doi.org/10.56434/j.arch.esp.urol.20237609.78
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    Prostate cancer remains a significant global health challenge. Traditionally anchored by the Gleason score/Grade Group (GS/GG), the landscape of prostate cancer diagnosis is undergoing transformative steps, particularly in the domain of biopsy procedures. GS/GG continues to be pivotal in malignancy grading, but recent technological strides have augmented the diagnostic relevance of biopsies. Integral to this progression is the adoption of advanced imaging techniques, especially magnetic resonance imaging, which has refined biopsy accuracy and efficiency. A deep understanding of prostate cancer pathology reveals a cribriform pattern and intraductal carcinoma of the prostate as independent forms of malignancy, suggesting a potentially aggressive disease course. Furthermore, the distinct behaviour of ductal adenocarcinoma and small cell carcinoma of the prostate, compared with acinar adenocarcinoma, necessitates their accurate differentiation during biopsy. The genomic era ushers in a renewed emphasis on tissue samples obtained from prostate biopsies, especially as mutations in genes, such as BRCA1/2, and paves the way for precision medicine. This review encapsulates the evolving dynamics of prostate biopsy, from technological advancements to the profound implications on prostate cancer management and therapy.

  • Article
    Temidayo S. Omolaoye, Paula A. Velilla, Juan Sebastián Moncada López, Stefan S du Plessis, Walter D. Cardona Maya
    Archivos Españoles de Urología. 2022, 75(10): 831-843. https://doi.org/10.56434/j.arch.esp.urol.20227510.121
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    Objective: Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epitomizes the best preventative SARS-CoV-2 infection strategy to counteract the severe consequences of infection. However, concerns have been raised that the vaccines could have an adverse effect on sperm function and overall reproductive health. This combined systematic review and meta-analysis aimed to investigate the effects of different available SARS-CoV-2 vaccines on semen parameters.

    Methods: A systematic PubMed, Scopus, Google Scholar, ScienceDirect, LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud), and Scilit database literature search until mid-June 2022 was conducted. Prospective and retrospective studies were eligible. No limitation was placed on language. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were thereafter obtained.

    Results: Upon search completion, 122 studies were identified and retrieved and 110 were excluded, while the remaining 12 independent studies evaluating the effects of coronavirus disease 2019 (COVID-19) vaccines on semen parameters were included in this review. The total number of men included was 1551, aged 22.4–48 years. Following meta-analysis, the SMD summary measure with 95% CI for each semen parameter included a concentration of 0.22 (0–0.22); Total sperm count of 0.11 (0.18–0.24); Total motility of 0.02 (0.05–0.09); Volume of 0.02 (–0.1–0.14); Vitality of 0.55 (–0.19–0.29), progressive motility of –0.43 (–0.54 to –0.32); Total motile sperm count of –0.38 (–0.44 to –0.31); And normal morphology of 0.42 (–0.54 to –0.3). In brief, the total sperm count was slightly increased post-vaccination, while progressive motility, total motile sperm count, and normal morphology were marginally reduced post-vaccination, according to the meta-analysis.

    Conclusions: No effects were observed regarding sperm viability and semen volume since the results of all the studies crossed the line of no effect. All seminal parameters analyzed showed a negligible or small change in relation to the vaccination effect. Furthermore, the parameters remained within the normal World Health Organization reference ranges, making the clinical significance unclear. Therefore, based on these results, it appears that vaccination does not have negative effects on semen quality. The individual study findings suggested that COVID-19 vaccines are not associated with decreased semen parameters.

  • Case Report
    Jesús Machuca-Aguado, Enrique Rodríguez-Zarco, Belen Carrero-García, Francisco José Vázquez-Ramírez
    Archivos Españoles de Urología. 2022, 75(10): 873-877. https://doi.org/10.56434/j.arch.esp.urol.20227510.127
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    Objective: Secondary urinary bladder tumors account for 2% of neoplasms in this location. Melanoma is the neoplasm that most frequently produces distant metastases in the bladder. Despite its low prevalence, it should be a possible diagnosis to consider facing urological symptoms, due to the existence of targeted therapies.

    Method: We present two cases of uveal melanoma metastasis in the bladder, their characteristics, and a review of the literature.

    Result: In this paper we present the histological characteristics and complementary techniques for the diagnosis of bladder metastases of melanoma and propose their inclusion among the possible differential diagnoses for bladder neoplasms.

    Conclusions: Given that there are currently targeted therapies against melanoma, the relevance of their inclusion in the differential diagnosis of bladder tumors stands out.

  • Article
    Kayhan Yılmaz, Mahmut Taha Ölçücü, Özgür Arı, Kaan Karamik, Yasin Aktaş, Murat Savaş, Mutlu Ateş
    Archivos Españoles de Urología. 2022, 75(5): 447-452. https://doi.org/10.56434/j.arch.esp.urol.20227505.65
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    Introduction: To evlauate role of peritoneal re-approximation methods in the prevention of symphtomatic lymphocele formation in patients underwent transperitoneal robot-assisted laparoscopic prostatectomy (tRALP) and extendeded pelvic lympadenoctomy (ePLND).

    Materials and Methods: Between January 2016 and April 2020, 120 consecutive patients who were administered anterior t-RALP and ePLND were analyzed retrospectively. In group 1 (n = 40), peritoneal approximation was not performed after t-RALP and ePLND application, peritoneal half re-approximation was performed in group 2 (n=40), and peritoneal full re-approximation was performed in group 3 (n=40). Operative parameters and symptomatic lymphocele rates were compared between the groups.

    Results: There was no statistically significant difference between the groups in terms of mean age, body mass index and prostatespecific antigen levels, Gleason score on biopsy, D'amico risk groups, the mean number of lymph nodes removed, Clavien-Dindo complication grade and mean duration of the surgery. Patients with symptomatic lymphocele in Group 1, Group 2, and Group 3 were found to be 2 (5%), 3 (7.5%) and 5 (12.5%), respectively. There was no statistically significant difference between the groups in terms of symptomatic lymphocele formation.

    Conclusion: Half or full closure of the peritoneum does not affect the symptomatic lymphocele formation in patients who underwent tRALP and ePLND.

  • Article
    Huaping Chen, Xiaolong Wu, Zhi Wen, Yifeng Zhu, Liuhui Liao, Jie Yang
    Archivos Españoles de Urología. 2022, 75(5): 467-471. https://doi.org/10.56434/j.arch.esp.urol.20227505.68
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    Background: The clinicopathological and prognostic relevance of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and monocyte/lymphocyte ratio (MLR) in non-muscular invasive bladder cancer (NMIBC) was investigated.

    Methods: All patients who underwent transurethral resection of bladder tumor (TURBT) and postoperative intravesical chemotherapy had their peripheral blood levels of NLR, PLR, and MLR quantified. The preoperative peripheral blood levels of NLR, PLR, and MLR were analyzed in patients with G1, G2, and G3 NMIBC. A total of 208 patients was divided into poor prognosis (PP, with recurrence, n=51) and good prognosis (GP, no recurrence, n=157) groups, according to whether the recurrence of NMIBC was observed at 1-year follow-up after treatment. Univariate and multivariate logistic regression analyses were performed to evaluate the prognostic factors in NMIBC. In addition, receiver operating characteristic (ROC) curves were used to analyze the prognostic performance of NLR, PLR, and MLR in NMIBC.

    Results: The preoperative peripheral blood level of PLR was significantly increased in patients with G3 NMIBC compared with that in patients with G1 (p < 0.05) and G2 NMIBC (p < 0.05). The results of univariate and multivariate logistic regression analyses showed that the tumor diameter, differentiation grade, and preoperative peripheral blood levels of NLR, PLR, and MLR were independent prognostic factors for NMIBC recurrence (p < 0.05). Compared with the NMIBC patients without recurrence, 3.490%, 177.575% and 3.175% were determined as the optimum prognostic cutoffs for NLR, PLR, and MLR, respectively. ROC curve was used to evaluate the sensitivity, specificity, and area under the curve (AUC) of NLR, PLR, MLR, and combinations. In contrast to NLR, PLR, or MLR, the combination of NLR, PLR, and MLR (AUC 0.758, sensitivity 66.70%, specificity 89.80%,Youden index 0.565) improved the prognostic performance in the discrimination of NMIBC patients with recurrence from thosewithout recurrence.

    Conclusions: The preoperative peripheral blood levels of NLR, PLR, and MLR, which were closely related to the grade and recurrence of NMIBC, were easy to detect and inexpensive. Moreover, these three factors showed the potential for auxiliary prognostic evaluation of NMIBC, wherein the combination than individual values exhibited better prognostic performance.

  • Article
    Lei Yonghua, Jiao Dian, Yao Zhen, Wang Lei, Zhao Zhiguang
    Archivos Españoles de Urología. 2022, 75(3): 287-294. https://doi.org/10.37554/en-j.arch.esp.urol-20210411-3505-25
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    Objective: To study the prognosticvalues of preoperative neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) for patients with muscle-invasive bladder cancer (MIBC) undergoing radicalcystectomy. Methods: The clinical data of 186 MIBC patientsreceiving radical cystectomy from January 2013 toOctober 2015 were collected. Receiver operating characteristic(ROC) curves were plotted based on preoperativeNLR, PLR and LMR as well as survival of patientswithin 5 years after surgery. The NLR, PLR and LMRvalues of patients with different clinicopathologicalcharacteristics were described by frequencies.Recurrence-free survival curve was plotted using theKaplan-Meier method, and survival curves were comparedby the log-rank test. Independent risk factorsfor recurrence were explored by multivariate logistic regression analysis. NLR, PLR and LMR were utilizedto establish the recurrence risk scoring model, and theaccuracy for predicting recurrence was assessed byROC curves. Results: NLR groups had significantly differentpathological grade, T stage, lymph node metastasisand tumor number. The differences in age,pathological grade, T stage, lymph node metastasisand tumor number were significant between PLRgroups. Gender, pathological grade, T stage, lymphnode metastasis, tumor number and tumor sizehad significant differences between LMR groups(Pfree survival rate between NLR≥2.45 andNLRand PLRLMR≥3.72 and LMR33.61%) (Ptumor number, lymph node metastasis, NLR, PLRand LMR were independent risk factors for MIBCpatients. After these factors were included into therecurrence risk scoring model, the area under ROCcurve was 0.821. Conclusions: Preoperative NLR, PLR and LMRare potential biomarkers for determining the prognosisof MIBC patients, and the combination of independent risk factors may work better for prognosticevaluation.

  • Review
    Gómez Gómez Enrique, Puche Sanz Ignacio, Valero Rosa J, Carrasco Valiente Julia, Campos Hernandez Juan Pablo, Anglada Curado Francisco José
    Archivos Españoles de Urología. 2022, 75(2): 156-164.
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    PSA is the most widely used diagnosticand prognostic biomarker in prostate cancer (PCa).However, its lack of specificity has generated the needto search for new complementary markers. In thisscenario, blood plasma constitutes one of the sourcesof search for new markers, which have been tried tobe combined with PSA and other clinical variables inorder to develop tests that increase their diagnosticspecificity.This narrative review of the literature provides anoverview of commercially available plasma biomarkers and tests for use in different clinical settingsfor PCa. The most studied markers to help select theappropriate patients for initial and / or repeat biopsyhave been: PHI, 4K, STHLM3. These markers havebeen oriented towards the diagnosis of the so-calledclinically signifi cant PCa, trying to validate and calibratetheir algorithms in different populations. Giventhe development and evolution in the diagnosis of PCa,there is still a lack of evidence of the impact of magneticresonance imaging (MRI) when used in combinationwith these new markers, as well as its possiblerole in the screening of the disease and not only in theearly diagnosis process. Furthermore, there are only asmall number of studies that have directly comparedthese tests with each other and with PSA, so there isnot enough evidence to know which test has the bestproperties in each clinical scenario. In order to clarifythe true diagnostic role of these new biomarkers, newprospective, comparative studies in different populationsare absolutely necessary to evaluate their clinicalutility in combination with MRI and fusion biopsy.

  • Article
    López Juan Manuel, Mainez Juan Antonio, Mora Christian Jorge, Gil Jesús, Garganta Rosendo
    Archivos Españoles de Urología. 2022, 75(1): 60-68.
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    Original article: Usefulness and Acceptability of a Smart pH Meter and Mobile Medical App as a Monitoring Tool in Patients with Urolithiasis: Short-term Prospective Study. Objective: An accurate strategy for regularly measuring urine pH is the use of portable electronic pH meters. This study evaluated the usefulness and acceptability of the smart Lit-Control® pH Meter connected with a companion mobile medical application (myLit-Control(R) App) used by patients with urolithiasis for home monitoring of urine pH. We also examined adherence and compliance rates, and users´ satisfaction levels. MATERIALS AND METHODS: This was a multicenter, prospective study conducted in 10 centers from Spain. Adult patients with a history of urolithiasis were recruited and instructed to carry out a pH measurement with the pH meter three times per day for two weeks. User tasks included turning on the device, registration and on boarding processes in the App, sync the device and the App, and data dumping. At the end of the trial, we evaluated the level of adherence and usage compliance. Participants' perceptions about the usefulness, acceptability, and satisfaction with the device/App were collected through the Computer System Usability Questionnaire (CSUQ) and subjective surveys. RESULTS: Participants were 27 men and 10 women. The mean age of participants was 48.7 (SD = 10.4) years, ranging from 25 to 66. The predominant type of stone was calcium oxalate. The mean pH of all readings was 5.83 (SD = 0.41). Seventy-three (73%) patients met the "good adherence" criterion (not being more than 2 days without recording any pH value). The compliance (actual vs. theoretical readings) was 87.6%. Participants rated the usability of the App 5.4 and above (on a 7-point scale) in all the items of CSUQ. Satisfaction was high, as indicated by the mean score of 6.0 in item 16. In the subjective questionnaire (0 to 3 scale), nearly all mean values were above 2. Patients scored their probability to recommend the App with an average of 8.2 on a 0 to 10 scale. Conclusion: The new smart Lit-Control® pH Meter and the accompanying medical App were deemed useful and acceptable by urolithiasis patients as a portable tool for urine pH monitoring at home. The usage compliance rates were high and the satisfaction with the products was good.