28 October 2022, Volume 75 Issue 8

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  • Review
    Yaiza María Yáñez-Castillo, Miguel Ángel Arrabal-Polo
    Archivos Españoles de Urología. 2022, 75(8): 669-683. https://doi.org/10.56434/j.arch.esp.urol.20227508.98
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    Introduction: Platelet rich plasma is a product obtained from vein whole blood sample, with a high concentration of growth factors, which have been reported to be beneficial for tissue regeneration. In the last few years, several assays that pretend to demonstrate the efficacy of platelet rich plasma in many disciplines, including urology, have been published.

    Aim and Methods: The aim of this assay is to develop a bibliographic review of the publications available about platelet rich plasma and urology. The search was based on PubMed database.

    Conclusions: Platelet rich plasma has demonstrated to be a safe and easy to obtain product, and it has also shown promising results in terms of efficacy in urology. However, it is necessary to conduct large, placebo-controlled, studies that can confirm or deny the effectiveness of platelet rich plasma before it can be used on urological conditions.

  • Article
    Raquel Sopeña Sutil, Adolfo Gómez Grande, Alejandro González Díaz, Julio Téigel Tobar, María Ángeles Cabeza Rodríguez, Enrique González Billalabeitia, Alfredo Rodríguez Antolín
    Archivos Españoles de Urología. 2022, 75(8): 684-692. https://doi.org/10.56434/j.arch.esp.urol.20227508.99
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    Objective: To assess the diagnostic accuracy of 18F-Choline PET/CT in the initial staging of high-risk prostate cancer (PC), and to compare it with conventional imaging techniques and to assess the changes in therapeutic attitude derived from its results.

    Secondary Objectives: To assess the concordance between 18F-Choline PET/CT and conventional study and to find related prognostic factors.

    Material and Methods: Retrospective observational study of 78 patients with high-risk PC undergoing 18F-Choline PET/CT after conventional initial staging (CT + BS). Sensitivity, specificity and predictive values of 18F-Choline PET/CT and CT + BS were calculated. The golden standard was histological result or follow-up. Tumor characteristics were collected and univariate and multivariate analyzes were performed.

    Results: The median age was 67 years old and mean PSA was 42.39 ng/mL. The sensitivity, specificity and NPV in global initial staging for PET/CT 18F-Choline and conventional imaging were: 92.9% vs 38.5%, 83.3% vs 42.3%, and 90.9% vs 40.7%, respectively. Lymph node staging: sensitivity 96.3% vs 61.5% and specificity 80% vs 76%, respectively. Bone staging: sensitivity 91.7% vs 21.4% and specificity 97.4% vs 83.8%, respectively. There was agreement in 25 patients (32%) (p = 0.004), Kappa index 0.134 (p = 0.011). The treatment was modified in 47.4% patients. PSA, PSADT% positive cores and cT were related to PET results. PSA level <8.9 ng/mL was considered an independent protective factor for positive PET (OR 0.03) (95% CI: 0.002-0.435, p 0.010).

    Conclusions: 18F-Choline PET/CT seems to be superior to CT + BS for initial staging in high-risk PC. It could be considered because its results can change the treatment decision in almost half of the patients.

  • Article
    Irene Diéguez, José Antonio March, Adrià Costa-Roig, Ignacio Miró, Cinta Sangüesa, Lucía Rodríguez, Alba Polo, María Ángeles Conca, Carsten Driller, Agustín Serrano
    Archivos Españoles de Urología. 2022, 75(8): 693-699. https://doi.org/10.56434/j.arch.esp.urol.20227508.100
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    Introduction: Voiding urosonography (VUS) is a dynamic imaging technique which evaluates the lower urinary tract by introducing sonographic contrast into the bladder, preferably used in the diagnosis of vesicoureteral reflux (VUR). Our goals were to describe the clinical indications for performing a VUS for VUR’s diagnosis and analyse its diagnostic reliability.

    Material and Methods: Cross-sectional study carried on patients under 15 years old with a VUS taken between November 2013-2020. Sex, age, indications (lower urinary tract infection—LUTI; dilatated lower urinary tract—DLUT; duplex collecting system—DCS), results (presence/absence of VUR, score and side) and complications were analysed. U Mann-Whitney and Chi-squared tests were used and 2 predictive capacity models for the indications used to detect VUR were employed (logistic binomial regression and multilayer perceptron neural network). Statistical significance p < 0.05.

    Results: 415 VUS were completed correctly (male 51.8%, median age 7.3 (3.1-15.3) months). Indications were: LUTI (67.5%), DLUT (33.5%) and DCS (10.2%); presenting 1, 2 and 3 indications in 86.5%, 12.8% and 0.7% respectively. VUR was diagnosed in 34.7% cases. A tendency towards statistically significance was showed related to male sex (p = 0.052) and the only significative clinical indication for VUR was DCS (p = 0.007). Patients with 2 simultaneous indications had higher probability of VUR (p = 0.012). DCS presence or male sex were the only predictive variables of VUR: DCS = OR 1.89 (1.54-6.52) (p = 0.006) and male sex = OR 1.56 (1.03-2.35) (p = 0.035).

    Conclusions: VUS is a thriving technique, radiation free and with a low complications rate. Presence of DCS, male sex or 2 simultaneous indications for VUS increase the probability of presenting VUR.

  • Article
    Mehmet Serkan Ozkent, Yunus Emre Goger, Ahmet Atici, Muzaffer Tansel Kilinç, Harun Uçmak, Mehmet Giray Sonmez
    Archivos Españoles de Urología. 2022, 75(8): 700-705. https://doi.org/10.56434/j.arch.esp.urol.20227508.101
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    Objectives: To evaluate the relationship between urine pH value and urodynamic parameters in patients with overactive bladder.

    Methods: The patients’ data whose underwent standard urodynamic study at two tertiary centers in our city. The period between January 2015–January 2021 was reviewed retrospectively. The inclusion criteria were the patients with overactive bladder, over 18 years of age, and with urine analysis before urodynamic study. Patients were divided into two groups as those with acidic urine pH (Group 1) and without (Group 2). The detrusor pressures obtained from filling cystometry were compared between the groups. In addition, the correlation between detrusor pressure and urine pH was examined.

    Results: The data from 211 patients (109 females, 102 males) were analyzed during the screening period. Eighty-two patients were in Group 1 and 129 patients in Group 2. The mean age was similar between the groups (p = 0.244). The bladder volume at first sensation of filling and urodynamic maximal bladder capacity was lower in Group 1 than Group 2 (p = 0.004; p < 0.001, respectively). The maximum detrusor pressure was higher in the acidic urine pH group (Group 1, 55.8 ± 20.6) than non-acidic urine pH group (Group 2, 14.5 ± 10.2), and it was statistically significant (p < 0.001). In addition, a significant negative correlation was observed between urine pH level and detrusor pressure (p < 0.001).

    Conclusions: The presence of acidic urinalysis is associated with many urodynamic findings. Significantly, the patients with detrusor overactivity had more acidic urine than without detrusor overactivity. Therefore, for patients with high detrusor pressure, urinalysis should be evaluated carefully.

  • Article
    Inmaculada Díaz de Mera-Sánchez Migallón, Pedro Carrión-López, Pedro Jesús Fernández-Anguita, Laura Herraiz-Raya, Óscar Legido-Gómez, Antonio S. Salinas-Sánchez
    Archivos Españoles de Urología. 2022, 75(8): 706-713. https://doi.org/10.56434/j.arch.esp.urol.20227508.102
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    Introduction: To determine the predictive role of the neutrophil/lymphocyte ratio (NLR) in the prognosis and survival of patients with squamous cell carcinoma of the penis.

    Materials and Methods: A retrospective cohort study of 96 patients with squamous cell carcinoma of the penis (SCCP). Clinical and histological data, bloodwork and disease evolution information were collected. We determined neutrophil/lymphocyte ratios and analyzed their relationship to prognosis and survival.

    Results: The mean age of patients was 72,1 years. The average follow-up time for the sample was 3,8 years (CI 95%: 3,0–4,6). Compared to patients with NLR <3, those with NLR >3 presented a higher proportion of cancers in stages cN1 (29.7% vs 6.8%; p = 0,004), stages pT3 and pT4 (24,3% vs 9,5%; p = 0,05), and stages TNM III and IV (32,4% vs 10,2%; p = 0,01); additionally, there were more cases of perineural invasion in the NLR >3 patients (29,7% vs 10,2%; p = 0,03). The mean overall survival (OS) was 7,9 years (CI 95%: 6,2–9,6) and the cancer-specific survival (CSS), 1,3 years (CI 95%: 0,7–1,9). There were no differences in OS, CSS or in progression-free survival (PFS) in patients with NLR >3 compared to those with NLR <3 . However, in the Cox regression analysis, a higher NLR was independently associated (along with metastasis and need for adjuvant treatment) with lower PFS, with an HR: 1,27 (CI 95%: 1,02–1,57; p = 0,02).

    Conclusions: The utilization of NLR in clinical practice can be considered an additional tool to aid in the diagnosis and prognosis of patients with squamous cell carcinoma of the penis.

  • Article
    Xiao Liu, Pan Wu, Huiting Zhang, Ling Li, Hui Xiao
    Archivos Españoles de Urología. 2022, 75(8): 714-719. https://doi.org/10.56434/j.arch.esp.urol.20227508.103
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    Background: Vascular calcification (VC) is a serious pathological manifestation of vascular terminals and is an important pathological basis of cardiovascular diseases in patients with end-stage renal disease (ESRD). This study explored the clinical value of serum microRNA-211-5p (miR-211-5p) in VC in patients with ESRD, this study was designed.

    Methods: The relative expression of miR-211-5p in the serum of the calcified group and the non-calcified group was quantified by quantitative reverse transcription polymerase chain reaction. The clinical biochemical indexes and the expression differences in miR-211-5p expression in the serum of groups were compared by two independent samples t-test or nonparametric test or one-way analysis of variance test. The receiver operating characteristic (ROC), Kaplan-Meier, and Cox regression analysis were carried out to analyze the predictive value of serum miR-211-5p in patients with ESRD.

    Results: The relative quantification of serum miR-211-5p was lessened in calcified group and gradually decreased with the progression of VC. Serum miR-211-5p had a high diagnostic accuracy in the diagnosis of VC progression in ESRD patients. Kaplan-Meier and Cox regression methods revealed that miR-211-5p might be an independent biomarker for prognosis of ESRD patients.

    Conclusions: MiR-211-5p is a potential diagnostic and prognostic marker of VC in patients with ESRD.

  • 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(8): 720-728. https://doi.org/10.56434/j.arch.esp.urol.20227508.104
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    Objective: Complications in donation after circulatory death (DCD) kidney transplants (KT) are barely described, while in some urological complications the cause is unknown. The aim of this study is to describe surgical and urological complications and analyze what donation features could be involved.

    Methods: A prospective, single center study was performed from 2016 to 2019 including all KT from controlled cardiac death donors (cDCD).

    Results: A total of 86 cDCD KT were included in the study. Recipient BMI, residual urine output (RUO) <500 mL/day, delayed graft function (DGF), and wound complication were related to UTI (p = 0.020, p = 0.008, p = 0.016, and p = 0.004, respectively). Features related to early graft nephrectomy were recipient BMI and recipients with diabetes mellitus (DM) (p = 0.025 and p = 0.036, respectively). DM in recipients was significantly associated with hematuria (p = 0.046). Urinary leak (UL) was associated to vascular complication and ureteral stricture (US) (p = 0.029 both). UL and lymphocele were associated to US (p = 0.029 both). Features related to lymphocele were recipient BMI and US (p = 0.028 and p = 0.029, respectively). History of previous transplant, time from cardiac arrest (CA) to cold flush, and DGF, were associated to wound complication (p = 0.040, p = 0.011 and p = 0.016, respectively).

    Conclusions: Surgical and urological complications after KT are an important issue to resolve. Our data revealed an association between RUO <500 mL/day, DGF, and wound complication with urinary infection, as well as between recipient DM and hematuria. Recipient BMI and DM were related to early graft nephrectomy. Vascular complications were associated with urinary leak, and lymphocele with US. Finally, wound complication was related to previous transplant, DGF, and time from CA to cold flush. This data revealed interesting associations between donor and recipient features and cDCD KT complications, providing more information to improve prevention and management.

  • Case Report
    María Medina-González, Jorge Panach-Navarrete, Daniel Mata-Cano, José María Martínez Jabaloyas
    Archivos Españoles de Urología. 2022, 75(8): 729-730. https://doi.org/10.56434/j.arch.esp.urol.20227508.105
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    Introduction: Intravesical immunotherapy with bacillus Calmette-Guerin (BCG) is considered as the standard treatment for non-muscle invasive bladder cancer with high risk of recurrence and progression.

    Objective: To report a case of granulomatous cystitis in a patient receiving BCG intravesical therapy for urothelial carcinoma.

    Material and Methods: A 63-year-old man underwent BCG treatment for a bladder tumor with pathological diagnosis of T1G3 urothelial carcinoma. Five months later, trans urethral resection (TUR) of bladder was performed for an erythematous lesion, with results of post-BCG cystitis. Two years later, the patient presented with hematuria and with suspicious findings in the cystoscopy (extensive fibrin-covered and calcified lesions in the bladder) and a bladder TUR was done.

    Results: The histopathological study showed granulomatous cystitis with necrosis and the presence of BAAR compatible with post-BCG origin. In the mycobacterial culture, M. bovis grew, and treatment was initiated. A cystography was performed on suspicion of a microbladder on CT with secondary vesicoureteral reflux, confirmed in this test. It was decided to perform a radical cystectomy. Histopathology reported post-BCG granulomatous cystitis and prostatitis.

    Conclusions: After BCG treatment, if symptoms or images are suggestive of granulomatous cystitis, a study of mycobacterial infection should be started to avoid the development of complications, such as the microbladder as in the case we present.

  • Case Report
    Patricio Emiliano Modina, Carlos Ignacio David, Fernando Dipatto, Fabricio Cozzutti, Claudio Radolovich, Miguel Angel Bergero
    Archivos Españoles de Urología. 2022, 75(8): 731-735. https://doi.org/10.56434/j.arch.esp.urol.20227508.106
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    Introduction: Psoas abscess is a rare pathological entity being retroperitonescopy an unusual therapeutic modality for its resolution.

    Materials and Methods: The objective is to present and describe five patients with a diagnosis of psoas abscess that were resolved by retroperitoneoscopy in our institution and then carried out a non-systematic review of the literature.

    Results: The mean age was 58.8 years and 80% were male. All patients had back pain and none had therapeutic resolution with conservative treatment. 60% of the patients had a methicillin sensitive Staphyylococus Aureus. In the follow-up with a mean of 10.2 months, no recurrence was observed.

    Conclusions: Early diagnosis of psoas abscess is important for its correct resolution. In our small series of patients, retroperitoneoscopy was an effective treatment.

  • Case Report
    María Negueroles-García, Francisco Pastor-Hernández, José María Martínez-Jabaloyas
    Archivos Españoles de Urología. 2022, 75(8): 736-737. https://doi.org/10.56434/j.arch.esp.urol.20227508.107
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    Introduction: The renal trauma is present in a 5% of all trauma cases. In the most common causes, conservative treatment can be performed. It is reported a case of renal trauma due to metal sick that required surgical management. It is considered that this is a rare clinical case with urgent surgical management that is not usual in this type of trauma. In addition, it is an example of quick decision-making since the patient’s life depends on them.

    Case Report: A 69-year-old man was referred to our institution for polytrauma. In contrast-enhanced computed tomography, renal, intestinal and great vessel were suspected, so an urgent surgical treatment was decided. During surgery, radical nephrectomy was performed due to perforation of the right kidney by a metal stick.

    Conclusions: Although conservative treatment of renal trauma can be performed in most cases, it must be taken into account that radical nephrectomy is a possible option when the kidney cannot be preserved.