28 September 2022, Volume 75 Issue 7

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  • Review
    Pedro Romero Pérez
    Archivos Españoles de Urología. 2022, 75(7): 584-611. https://doi.org/10.56434/j.arch.esp.urol.20227507.87
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    Introduction and Objectives: Multiple chemical sensitivity (MCS) is a complex disease with multiorgan manifestations, some of which are still poorly understood, such as genitourinary manifestations. The objective of this article is to review these genitourinary manifestations.

    Material and Methods: A retrospective descriptive study on the genitourinary manifestations described in patients with multiple chemical sensitivity is performed, based on a systematic review of the literature between February 1956 and December 2020, consulting the Medline/PubMed database and the Google search engine. Descriptive statistics of the variables studied were performed with frequency and percentage for qualitative variables and median and range (minimum-maximum value) for quantitative variables.

    Results: We reviewed the originals or abstracts of 3450 articles on MCS, including 461 on symptoms (13.3%) and selecting 40 (1.1%) that referred to genitourinary pathologies or symptoms and corresponded to 19 reviews, 14 articles on case reports (11 clinical cases and 3 series), 5 books with case reports, 1 consensus document and 1 update. The number of patients with MCS studied in these 40 articles was 4556 of whom 303 presented genitourinary symptoms (6.6%), and corresponded to 277 women (91.4%) and 27 men (8.6%) with a mean age of 39.4 years, range (7-82 years). There were 119 different genitourinary symptoms or pathologies with 170 citations which in frequency were 77 for gynecological symptoms (45.3%) in 28 publications (70%), 62 for urological symptoms (36.5%) in 29 publications (72.5%), 18 for sexological symptoms (10.6%) in 8 publications (20%) and 13 for andrological symptoms (7.6%) in 5 publications (12.5%).

    Conclusions: Genitourinary manifestations of MCS are rare and predominantly in women. They constitute a genitourinary syndrome including gynecological, urological, sexological and andrological symptoms. Until today there has been no study of these symptoms in the medical literature.

  • Article
    Iris Coello, Ana Isabel Martínez, Maria Peraire, Laura Aizpiri, Camila Andrea Vega, Miquel Amer, Ricardo José Guldris, Jose Luis Bauza, Enrique C. Pieras
    Archivos Españoles de Urología. 2022, 75(7): 612-617. https://doi.org/10.56434/j.arch.esp.urol.20227507.88
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    Objective: Expansion of the donor pool has been enabled by the use of donation after circulatory death (DCD). The aim of this study is to identify what donation features are able to predict kidney transplant (KT) outcomes from DCD.

    Materials and Methods: A prospective analysis of all DCD KT from June 2016 to November 2019 was conducted. Association between donor and recipient features, and ischemia times with delayed graft function (DGF) and serum creatinine (Cr) at discharge, and at three and twelve months were analysed.

    Results: A total of 86 KT were performed. The results revealed a relationship between donor age (p = 0.014) and receptors on haemodialysis (p = 0.001) with DGF. There was no association between different ischemia times and DGF. Residual urine output greater than 500mL/day and being on peritoneal dialysis were found to be protective factors for DGF. Correlation analysis illustrated a significant correlation between donor age and Cr at discharge and at 3 months.

    Conclusion: Higher donor age and being on haemodialysis were risk factors for DGF. Likewise, donor age did not show a significant association with 12-month serum Cr. These results demonstrate that donor age is a risk factor for DGF but does not affect long term graft function.

  • Article
    Dan Tan, Fanghao Wu, Wenqian Huo
    Archivos Españoles de Urología. 2022, 75(7): 618-623. https://doi.org/10.56434/j.arch.esp.urol.20227507.89
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    Objectives: Flexible ureteroscopic lithotripsy (FURL), as a common method for treating upper urinary tract calculi, has the risks of complications such as infection and bleeding. Especially, systemic inflammatory response syndrome (SIRS) after FURL may induce multiple organ dysfunction threatening the lives of patients. We aimed to investigate the clinical characteristics and risk factors of SIRS after FURL.

    Methods: A total of 157 upper urinary tract calculus patients treated with FURL from January 2018 to December 2019 were enrolled, and clinical outcomes and complications were analyzed. Patients were divided into SIRS group (n = 31) and non-SIRS group (n = 126) according to the presence or absence of SIRS after FURL. Their clinical data were compared by univariate analysis, and the factors with statistically significant difference were incorporated into LASSO logistic regression analysis. The model was visualized using a nomogram, and model discrimination and accuracy were verified.

    Results: The results of univariate analysis indicated that there were significant differences in gender, average stone size, preoperative urinary white blood cell count, surgery time and postoperative stone bacterial culture between the two groups. The results of LASSO logistic regression analysis showed that the above factors were independent risk factors for patients with SIRS. The C-index of the SIRS risk prediction model was 0.992. The area under the ROC curve of this model was 0.944 (95% CI: 0.913-0.997), the sensitivity was 97.9%, and the specificity was 95.8%. The average absolute error between actual and predicted risk probabilities was 0.028. The model for predicting the risk of SIRS had good discrimination and high consistency with the actual observed value.

    Conclusions: Females, larger stones, higher preoperative urinary white blood cell count, longer surgery time and postoperative positive stone bacterial culture are independent risk factors of SIRS after FURL for upper urinary tract calculi.

  • Article
    Gonzalo Bueno-Serrano, María Pilar Alcoba-García, Juan Tabares-Jiménez, Raquel González-López, Lucía Llanos-Jiménez, Ignacio Mahillo-Fernández, Carmen González-Enguita
    Archivos Españoles de Urología. 2022, 75(7): 624-629. https://doi.org/10.56434/j.arch.esp.urol.20227507.90
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    Objectives: To compare the efficacy of 4 different analgesic regimens that include music and nitrous oxide during the treatment of renal lithiasis with ambulatory extracorporeal shock wave lithotripsy (ESWL).

    Materials and Methods: A single-centre, longitudinal, prospective, randomized, open and parallel group study was conducted. Patients with renal lithiasis were included and were randomized to Group A (basal analgesia: midazolam (1 mg), fentanyl (0.05 mg) and dexketoprofen (50 mg)), Group B (basal analgesia and nitrous oxide), Group C (basal analgesia and music) and Group D (basal analgesia, nitrous oxide and music). For the measurement of pain, a visual analogue scale ranging from 0 (no pain) to 100 (maximum pain imaginable) was used. Patient satisfaction was assessed using a Likert questionnaire. The epidemiological data of the patients in terms of lithiasis, previous clinical and ESWL sessions, and pain measured with the VAS before, during (maximum) at the end of the session and at discharge were recorded. Data on complications were also collected, as was the patients’ subjective evaluation of the treatment and their satisfaction. The ESWL procedure was performed with a Storz Modulith SLX-F2® lithotripter. A maximum of 4000 waves were applied at a frequency of 1.5 Hz.

    Results: Eighty patients were included (20 per group). None of the analgesia guidelines proved to be superior to the others for pain control during the ESWL session. Patients younger than 50 years had significantly higher values for the maximum VAS. Only 13.75% of patients required rescue analgesia. A total of 77.5% described their experience as good, very good or excellent, regardless of the assigned group.

    Conclusions: The addition of nitrous oxide and/or music did not result in a statistically significant improvement over the basal analgesia regimen of midazolam, fentanyl and dexketoprofen; however, the degree of patient satisfaction was very high.

  • Article
    Javier San Bartolomé Gutiérrez, Antonio Santamaría Abad, Feliciano Sánchez Domínguez, María Dolores Ludeña de la Cruz, Juan Jesús Cruz Hernández
    Archivos Españoles de Urología. 2022, 75(7): 630-637. https://doi.org/10.56434/j.arch.esp.urol.20227507.91
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    Objectives: Knowing the incidence of prostate cancer in Salamanca and its evolution, as well as the age at diagnosis and its evolution. In addition, analyzing the mortality from prostate cancer in the province of Salamanca.

    Methods: Descriptive and analytical, longitudinal and retrospective observational study. From the collection of data from the Pathological Anatomy service and the Clinical Documentation service of the Hospital Complex of Salamanca a database was developed for the calculation of incidence rates. The information collected on mortality was obtained through the National Institute of Statistics. For regression analysis, segmented “jointpoint” models were developed.

    Results: 2676 males diagnosed with prostate cancer were recorded in the province of Salamanca (period 2006-2015). The risk of prostate cancer up to age 74 in 2006 was 6.23%, almost double in 2010. The evolution of mortality rates adjusted to the European population in the province of Salamanca during the period 2006-2015 showed a slight decrease.

    Conclusions: In general, Prostate cancer incidence rates increased progressively over the years studied, similar to Spain’s overall rates. These rates increased as age progressed. In general, our incidence rates were lower than those reported by the provinces of northern Spain (except Vizcaya) and higher than those recorded by the provinces of southern Spain. In Europe, our rate was surpassed by countries in northern and western Europe and lower than countries in southern and eastern Europe, and part of central Europe. Countries like U.S.A had rates higher than ours, while Canada accounted for a similar rate. On the other hand, mortality rates remained stable during the middle of the study period, suffering from then on a non-statistically significant anual decrease.

  • Article
    Gastón López-Fontana, Juan Manuel Guglielmi, Rodrigo López-Fontana, Mariana Lis Hinojosa-Jury, Constanza López-Fontana, José Daniel López-Laur
    Archivos Españoles de Urología. 2022, 75(7): 638-641. https://doi.org/10.56434/j.arch.esp.urol.20227507.92
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    Objective: To analyze the perioperatory and short-oncological outcomes in 5 cases with CRPC M0 developed after pRT that underwent salvage laparoscopic RP (sLRP) and review the current evidence.

    Material and Methods: Perioperatory and oncological outcomes were prospectively analyzed. Inclusion criteria were patients that had received pRT and posteriorly presented with CRPC M0 in standard imagines and positron emission tomography MRI coline. Evidence was reviewed in PUBMED database.

    Results: No surgical complications and blood transfusion were reported. Two patients required an endoscopic urethrotomy due to bladder neck contracture (Clavien IIIb). Final pathological findings were T3 or more, multifocal with 3 positive surgical margins. Four patients reach undetectable PSA after surgery except one that continuous under ADT without disease progression. After 12 months follow-up, 4 patients persist with undetectable PSA and one with stable disease under ADT. Current evidence demonstrated that CRPC M0 treated with open, laparoscopic or robotic RP a biochemical recurrence of 68.7% as a hormone-sensitive PC; however, 17.4% were disease-free after 4 years of follow-up.

    Conclusion: Our serie, 4 cases are disease free after 12 months follow-up. Current evidence is a retrospective and multicenter experience with few cases and intermediate oncological follow-up. More cases with longer follow-up and better evidence are required to opt for this treatment as a first line.

  • Article
    Mercedes Ubetagoyena, Ramon Areses, Jone Mendia, Marisol Perez
    Archivos Españoles de Urología. 2022, 75(7): 642-646. https://doi.org/10.56434/j.arch.esp.urol.20227507.93
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    Introduction: In lithogenesis, for a stone to form it is necessary that the urine is supersaturated with respect to the salt that will constitute the future stone. The objective was to analyze the urinary saturations of Calcium Oxalate (CaOxa), brushite (calcium phosphate), struvite (ammonium-magnesium phosphate) and uric acid (UA) in children with and without lithiasis. Correlate them with the different parameters involved in the lithiasic process. And compare saturations in children with or without overweight.

    Material and Methods: We examined 108 healthy children and 53 patients diagnosed with lithiasis. In 24-h urine, the different biochemical parameters involved in lithiasis and the saturation levels of CaOxa, brushite, struvite and UA.

    Results: We studied 108 healthy children with a mean age of 9.5 ± 3.9 years. Renal lithiasis was diagnosed in 53 patients with an average age of 10.5 ± 5.8 years. Children with lithiasis had higher saturation values of CaOxa (4.86 ± 2.71 vs. 3.15 ± 1.99, p < 0.01) and brushite (1.58 ± 1.23 vs. 0.86 ± 0.81, p < 0.001) compared to non-lithiasic children. UA saturation was higher in children with body mass index greater than 22 (5.25 ± 3.52 vs. 3.84 ± 3.5, p < 0.04). Finally, urinary pH, ammonium concentration and uricosuria influenced UA saturation. that the urinary pH regression coefficient in the uric acid saturation regression analysis was –4.5.

    Conclusions: The mean values of calcium oxalate and brushite saturations were higher in children with lithiasis. Uric acid saturation was elevated in overweight children. Finally, urinary pH greatly influenced uric acid saturation.

  • Article
    Luis Enrique Pérez-Moreno, Victor Ernesto González-Velazquez, Lissi Lisbeth Rodríguez-Rodríguez, Elys María Pedraza-Rodríguez, Yuliet Díaz-Legon, Eligio Barreto-Fiu
    Archivos Españoles de Urología. 2022, 75(7): 647-654. https://doi.org/10.56434/j.arch.esp.urol.20227507.94
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    Objective: To assess the prognostic value of mortality of a new system for quantifying the lesion length circumscribed to the genitals and adjacent anatomical areas in patients with Fournier’s gangrene.

    Methods: An observational, analytical and prospective study in the Urology service of the Arnaldo Milián Castro University Hospital, between January 2007 and December 2019. The sample consisted of 60 patients diagnosed with Fournier’s gangrene. To determine the lesion length, a new quantification system was designed by the authors. Its predictive capacity was determined by binary logistic regression analysis and its discriminatory capacity by the area under the ROC curve.

    Results: In the studied sample, Fournier’s gangrene mortality was 26.7%. The logistic regression analysis demonstrated the prognostic value of mortality of the quantification system evaluated, for each point that the extension of the lesion increased, the risk of death increased by approximately five times, thus being superior to the methods previously used to quantify the injury. Results of the calibration of the quantification system by the Hosmer-Lemeshhow test showed that the data were adjusted to the regression equation (p = 0.278). An area under the curve of 0.957 was observed, which reflects a good discriminatory capacity, showing a sensitivity of 93.75% and a specificity of 93.18%.

    Conclusions: The system for quantifying the lesion length in patients with Fournier’s gangrene proposed in the present study showed an excellent prognostic value for mortality. The integration of this new method into others prognostic scores could substantially increase sensibility and specificity on diagnostic, by means of offering a more precise approach of the lesion dimensions.

  • Article
    Cristina de la Encarnación Castellano, Angela Canos Nebot, Pablo Vargas Andreu, Nuria García Carbajosa, Luis Prieto Chaparro, Silvia Chillon Sempere, Juan Antonio Galán Llopis
    Archivos Españoles de Urología. 2022, 75(7): 655-662. https://doi.org/10.56434/j.arch.esp.urol.20227507.95
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    Introduction: Radiotherapeutic treatment of prostate cancer has been validated in terms of efficacy, but its relationship with the occurrence of second pelvic primary malignancy and the relevance of radio-induced toxicity is still under debate. This study analyses the occurrence of second pelvic primary malignancy as well as morbidity secondary to radiotherapy treatment in patients treated for prostate cancer.

    Material and Methods: Retrospective consecutive descriptive study of 317 patients who received radiotherapy treatment for prostate cancer between 2007 and 2017. Predictor variables, side effects and the appearance of second pelvic primary malignancy during a maximum follow-up of 10 years were collected. We analyse whether there is a significant relationship in the appearance of second pelvic primary malignancy and describe the clinical toxicity presented by the patients.

    Results: The median age was 62.27 years and the most commonly employed treatment modality was brachytherapy with IMRT (60%). 17 patients (5.4%) developed a second pelvic primary malignancy, with a median time to onset of 58 and 25 months for bladder and colon tumours, respectively. Local recurrence and mortality rates are 8% and 7%, respectively. Statistically significant association is demonstrated for the occurrence of second pelvic primary malignancy and for chronic radioinduced toxicity according to type of radiotherapy χ2 (4) = 16.34; p = 0.003 and χ2 (1) = 6.47; p = 0.011 respectively.

    Conclusions: In our series, the occurrence of a second pelvic primary malignancy is statistically associated with the modality of radiotherapy administered and occurrence of chronic adverse effects.

  • Case Report
    Rodrigo López-Fontana, Gastón López-Fontana, Juan Manuel Guglielmi, José Daniel López-Laur, Mariana Lis Hinojosa Jury
    Archivos Españoles de Urología. 2022, 75(7): 663-666. https://doi.org/10.56434/j.arch.esp.urol.20227507.96
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    Objective: To report 2 cases of an extremely rare bladder tumor such as Cystitis Glandularis (CG) that were management by different strategies and review the current evidence.

    Material and Methods: Both cases of 43 and 48 years reported the same lower urinary tract symptoms that simulated a malignant bladder tumor. Case 1 presented with an extensive tumor affecting the trigone and the left upper urinary tract; the second case presented a less extensive tumor also at the bladder trigone.

    Results: The first patient required two bladder tumor resection and a laparoscopic uretero-vesical reimplantation with adyuvant steroids. The other patient only required one bladder tumor resection without adyuvant treatment. Finally, after 7 and 6 months, both patients do not present tumor recurrence; respectively.

    Conclusion: Cystitis Glandularis (CG) represent an extremely rare tumor. Usually presentation is in young people with predilection at the bladder trigone. Current evidence ruled out being preneoplastic without standardized treatment. Two cases were analyzed with completely different characteristics, but with satisfactory treatment.

  • Case Report
    Lucía Raposo Rodríguez, Nuria Fernández García, Lorenzo Pastor Hernández, Óscar Fernández Guinea, Ana María Benítez Vázquez
    Archivos Españoles de Urología. 2022, 75(7): 667-668. https://doi.org/10.56434/j.arch.esp.urol.20227507.97
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    Thrombosis of the corpus cavernosum is a rare disease of unknown cause that usually affects young men. We present the case of a 25-year-old man with an unilateral, painful perineal mass and ultrasound scan compatible with this entity. The magnetic resonance and tomography computarised scan images corroborate the diagnosis. Anticoagulants were prescribed which solved the clinical picture.