28 November 2022, Volume 75 Issue 9

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  • Article
    José Antonio Ortiz-Rey, Alejandro Bellas-Pereira, Pilar San Miguel-Fraile, Raquel Morellón-Baquera, Patricia Domínguez-Arístegui, Joaquín González-Carreró Fojón
    Archivos Españoles de Urología. 2022, 75(9): 738-745. https://doi.org/10.56434/j.arch.esp.urol.20227509.108
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    Objectives: Intraductal carcinoma of the prostate (IDC-P) is usually associated with high grade, aggresive acinar adenocarcinomas. IDC-P is supposed to result from the spread of the adenocarcinoma along the prostatic ducts. IDC-P rarely occurs without invasive carcinoma or with a coexistent low grade adenocarcinoma.

    Material and Methods: We report two patients, 66 and 75 year-old, who presented IDC-P and low-grade acinar adenocarcinoma foci in their radical prostatectomy surgical specimens.

    Results: Acinar adenocarcinomas were grade group 1, PTEN+, pT2. In the first case, the invasive adenocarcinoma was adjacent but nor intermingled with the IDC-P, and a discordance in the immunophenotype between them was outstanding (positivity for ERG in the acinar carcinoma being negative in the IDC-P). In the second case, the foci of adenocarcinoma were distant from the IDC-P. The first patient had not biochemical recurrence after a 34 month follow-up period.

    Conclusions: This kind of cases supports the existence of an infrequent subtype of IDC-P that could be considered as an in situ neoplasia.

  • Article
    Fangqin Zou, Xianhu Tang, Xianghong Lei, Feng Cao, Juan Luo, Shufeng Liu
    Archivos Españoles de Urología. 2022, 75(9): 746-752. https://doi.org/10.56434/j.arch.esp.urol.20227509.109
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    Introduction: The aim of this study is to compare the treatment efficacy between continuous renal replacement therapy (CRRT) and conventional intermittent hemodialysis (IHD) in patients with sepsis (SIRS) combined with acute kidney injury (AKI) and its impact on inflammatory mediators and coagulation function.

    Method: 122 patients (25–60 years) with SIRS combined with AKI were enrolled in the sudy. The study group (SG) comprised 62 patients who received CRRT (8–10 h/day) + routine treatment, whereas the control group (CG) comprised 60 patients who received conventional IHD (4 h/day, 3 times per week) + routine treatment. inflammatory mediators and coagulation function measures were assessed and compared in each group.

    Results: C-reactive protein, blood creatinine, blood urea nitrogen, blood lactic acid, oxygenation index, central venous oxygen saturation, SOFA (Sequential Organ Failure Assessment) score, interleukin 6, interleukin 8, hypersensitive C-reactive protein, tumor necrosis factor-α, prothrombin time, activated partial thromboplastin time, FIB, and platelet count were better in the SG than in the CG (p < 0.05). The 12- and 24-month survival rates were significantly higher in the SG than in the CG (p < 0.05).

    Conclusions: CRRT can effectively improve clinical symptoms, remove inflammatory factors, and maintain blood coagulation function in patients with SIRS combined with AKI. It is more efficient than IHD treatment and is worthy of clinical promotion.

  • Article
    Cristóbal Ramírez Sevilla, Esther Gómez Lanza, Juan Llopis Manzanera, Alfredo Cetina Herrando, Josep Miquel Puyol Pallàs
    Archivos Españoles de Urología. 2022, 75(9): 753-757. https://doi.org/10.56434/j.arch.esp.urol.20227509.110
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    Background: The objective of this article was to assess the long-term efficacy and safety of the MV140 vaccine to prevent recurrent urinary tract infections (UTIs).

    Methods: This is a prospective, descriptive, comparative and multicenter study of 1003 patients with 3 or more urinary infections for 12 months, treated with the MV140 vaccine from 2011 to 2021. Variables: Age, gender, urinary infections at 3, 6 and 12 months, distribution according to age and months of the year, smoking, use of MV140 vaccines and autovaccines.

    Results: Mean age was 78 and 82.7% were women. At baseline, 84.1% had 3 to 5 infections. According to age, 68.6% had >70 years. There were more consultations in March (12.3%) and fewer in August (4.4%). Smokers represented 24.6% and 21.8% follow autovaccines. Results at 3 months: 0 UTI 45%, 1 UTI 31.3%, 2 UTI 19.2%. 6 months: 0 UTI 29.3%, 1 UTI 33.2%, 2 UTI 24.3%. 12 months: 0 UTI 9%, 1 UTI 28.2%, 2 UTI 17.5%. Smokers: 0–1 UTI 80.2% (3 months), 65.5% (6 months), 53.9% (12 months). Non-smokers: 0–1 UTI 85.8% (3 months), 66.8% (6 months), 20% (12 months). p = 0.41, 0.27 and 0.21 respectively. Vaccines: 0–1 UTI 74.5% (3 months), 61% (6 months), 38.8% (12 months). Autovaccines: 0–1 UTI 82.7% (3 months), 68 % (6 months), 28.2% (12 months). p = 0.04, 0.25 and 0.63 respectively.

    Conclusions: MV140 reduced the number of UTI to 0–2 in 95.5% at 3 months, 86.8% at 6 months and 54.7% at 12 months. Smoking did not worsen the response of MV140. Autovaccines achieved better results than vaccines only at 3 months. Adverse effects represented 1.49%, but no patient had to abandon treatment.

  • Article
    Hyun Cheol Jeong, Su Jin Kim, Dae Yul Yang, Kyungtae Ko
    Archivos Españoles de Urología. 2022, 75(9): 758-763. https://doi.org/10.56434/j.arch.esp.urol.20227509.111
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    Background: Ultra-mini PCNL (UMP) is a device that removes stones by using 7.5 Fr. nephroscope and 11/12 Fr. working sheath. The stone free rate (SFR) does not lag behind the convetional PCNL, but due to the diameter of the small device, UMP has many disadvantages; Irrigation pressure increases easily during surgery and post operative febrile urinary tract infection (UTI) is relative common. The purpose of this study is to present the surgical results of UMP with strict irrigation pressure control using a pressure control irrigator.

    Methods: 70 consecutive patients who underwent UMP surgery for kidney stones were enrolled retrospectively. All surgeries proceeded with the shoulder rotated supine position. Of these, initial 35 patients underwent surgery using 100 mmHg irrigation power previously and later 35 patients underwent surgery below 40 mmHg irrigation power.

    Results: The stone size of the UMP 100 mmHg group was 2.52 ± 1.05 and that of the UMP 40 mmHg group was 2.79 ± 1.32 respectively. Operative time was also slightly shorter in the UMP 40 mmHg group, but there was no statistical difference between the two groups. There was no statistical difference in stone free rate, but UMP 100 mmHg group showed 37.1% of post operative febrile urinary tract infection rate and 11.4 % in UMP 40 mmHg group and they are significantly different (p = 0.039).

    Conclusions: Strict irrigation pressure control below 40 mm during UMP can reduce post operative febrile UTI without affecting SFR.

  • Article
    Ahmet Yüce, Erdal Benli, Abdullah Çırakoğlu, İbrahim Yazıcı, İsmail Nalbant
    Archivos Españoles de Urología. 2022, 75(9): 764-770. https://doi.org/10.56434/j.arch.esp.urol.20227509.112
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    Background: Storage symptoms are pathology with increasing frequency and importance among elderly men. The efficacy and advantages of the new bipolar radiofrequency prostate thermotherapy method were investigated for storage symptoms in elderly.

    Methods: The outcomes for 150 elderly patients with significant storage symptoms accompanying voiding symptoms were investigated. The patients’ Qmax (maximum urinary flow rate), prostate volumes, OAB-V8 (overactivebladder-Validated 8) and quality of life scores were questioned before the procedure and 1st month and 6th month.

    Results: OAB-V8 total score had mean value of 26.3, with values identified as 16.2 (p < 0.001) at the end of the 1st month and 13.9 (p = 0.001) at the end of the 6th month. There were significant reductions in daytime frequent urination, uncomfortable urgency and sudden feeling of urgency complaints (p < 0.001). Thirty-five patients had significant fall in urgency with incontinence (p = 0.016).

    Conclusions: The bipolar radiofrequency thermotherapy method provides significant improvement of storage symptoms in elderly men. It is thought that this method has advantages in terms of its effects on storage and voiding symptoms in the elderly.

  • Article
    Youjun Xu, Lianxin Luo, Lina Han, Fangfang Zhou, Qun Luo
    Archivos Españoles de Urología. 2022, 75(9): 771-778. https://doi.org/10.56434/j.arch.esp.urol.20227509.113
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    Background: To evaluate the incidence, risk factors, and outcomes of acute kidney injury (AKI) in patients with decompensated cirrhosis based on the Kidney Disease: Improving Global Outcomes Clinical Practice Guideline.

    Methods: For this retrospective analysis, 923 inpatients were recruited between January 2013 and December 2017. The patients’ baseline demographics and clinical information were collected and analyzed. Univariate and multiple logistic regression analyses were conducted to determine the independent risk factors for AKI and in-hospital mortality. Kaplan–Meier survival analyses were used to analyze the between-group differences in mortality.

    Results: Of the 923 patients, 262 (28.39%) developed AKI. According to the multivariate analysis, an age ≥65 years (odds ratio [OR]: 1.776, 95% confidence interval [CI]: 1.288–2.449, p < 0.001), infection (OR: 1.386, 95% CI: 1.024–1.875, p = 0.034), hypotension (OR: 1.709, 95% CI: 1.091–2.679, p = 0.019), white blood cell count >10 × 109 /L (OR: 4.054, 95% CI: 2.006–8.193, p < 0.001), albumin concentration <35 g/L (OR: 1.931, 95% CI: 1.392–2.680, p < 0.001), baseline serum creatinine concentration >88.4 µmol/L (OR: 2.136, 95% CI: 1.511–3.021, p < 0.001), estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 (OR: 2.384, 95% CI: 1.372–4.145, p = 0.002), and serum sodium concentration <135 mmol/L (OR: 1.686, 95% CI: 1.155–2.459, p = 0.007) were independent risk factors for AKI. Moreover, AKI was significantly associated with in-hospital mortality (OR: 6.934, 95% CI: 1.333–11.052, p = 0.021). Kaplan–Meier survival analysis confirmed that patients with AKI had higher in-hospital mortality than those without AKI.

    Conclusions: The incidence of AKI was high among patients with decompensated cirrhosis. Infection, an elevated baseline serum creatinine concentration, and decreased eGFR were independent risk factors for both AKI and in-hospital mortality. AKI was an independent risk factor for in-hospital mortality. Based on the risk factors identified, AKI prediction models and treatment approaches care bundles can be used for the early identification and modification of potential predisposing factors and for improving outcomes in these patients in the future.

  • Article
    Siqi Jiang, Jianhong Ma, Sheng Wei, Pengfei Ren, Jianmin Liu, Yongying Zhou, Daoquan Liu, Xinhua Zhang
    Archivos Españoles de Urología. 2022, 75(9): 779-790. https://doi.org/10.56434/j.arch.esp.urol.20227509.114
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    Background: Bladder cancer (BLCA) is an extremely common carcinoma of the urinary system that has a high incidence of relapse. Although intensive studies have investigated its pathology in the past decades, there are significant knowledge gaps regarding the characterization of the molecular processes underlying the progression of disease and consequently its prognosis. The purpose of current research was to identify significant genes that could serve as prognostic and progression biomarkers.

    Methods: Gene expression profiles were downloaded from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) database. Differential gene expression analysis (DGEA) and weighted gene co-expression network analysis (WGCNA) were conducted to recognize differential co-expression genes. Gene Ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were performed to explore gene function. Moreover, protein-protein interactions (PPI) network, overall survival (OS) and disease-free survival (DFS) were used to identify survival-related hub genes. Additionally, associations between these gene’s expression and clinical parameters were determined. Finally, the Human Protein Atlas (HPA) database and qRT-PCR were used to validate gene’s expression.

    Results: About 124 differential co-expression genes were identified. These genes were mainly enriched in muscle system process and muscle contraction (biological process, BP), contractile fiber, myofibril, sarcomere, focal adhesion and cell-substrate junction (cellular component, CC) and actin binding (molecular function, MF) in GO enrichment analysis, while enriched in vascular smooth muscle contraction, focal adhesion, cardiac muscle contraction, hypertrophic cardiomyopathy, dilated cardiomyopathy and regulation of actin cytoskeleton in KEGG analysis. Furthermore, five survival-related hub genes (MYH11, ACTA2, CALD1, TPM1, MYLK) were identified via OS and DFS. In addition, these survival-related gene’s expression was correlated with grade, stage and TNM stage. Finally, all survival-related hub genes were determined to be down-regulated in BLCA tissues by qRT-PCR and HPA databases.

    Conclusions: Our current study verified five new key genes in BLCA, which may participate in the prognosis and progression and serve as novel biomarkers of BLCA.

  • Article
    María Romo Rosado, Adoración Granados Molina, Almudena Lagares Velasco, Gloria Caro Chinchilla, Paula Vidal Lana, Enrique La Orden Izquierdo, Llanos Salar Vidal
    Archivos Españoles de Urología. 2022, 75(9): 791-797. https://doi.org/10.56434/j.arch.esp.urol.20227509.115
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    Introduction: Resistance to antibiotics is a growing problem with repercussions on the choice of first-line treatment in urinary tract infection (UTI) in childhood.

    Objectives: To know the current pattern of antibiotic susceptibility/resistance of the most frequent germs that cause UTI in our healthcare area. Secondary objective is to know the evolution of these patterns over time.

    Patients and Methods: A cross-sectional retrospective study of UTI episodes in a first-level hospital in two periods: 1st January 2008-31th December 2010 and 1st January 2017-31th December 2019 through a review of medical records, recording the following variables: Age, sex, fever, hospital admission, uropathy/bladder dysfunction, antibiotic prophylaxis.

    Results: First period: 174 UTI episodes (156 patients); Second period: 266 UTI episodes (218 patients). The most frequently isolated germ was E. coli, but in patients with uropathy or bladder dysfunction, the percentage of different germs is greater. A significant increase in resistance to amoxicillin/clavulanate (from 12.2 to 24%) is observed between both periods, it remains stable and in an acceptable range for gentamicin, cotrimoxazole and slightly increases to first-generation cephalosporins. In patients with uropathy/bladder dysfunction, resistance to all these antibiotics is significantly increased.

    Conclusions: The increased resistance of the most frequent uropathogens in the UTI of the pediatric population of our healthcare area to amoxicillin/clavulanate makes it unsuitable as empirical therapy. First-generation cephalosporins are an adequate alternative in patients without risk factors.

  • Case Report
    Estefanía Ruiz Guerrero, Ana Victoria Ojeda Claro, María José Ledo Cepero, José Luis Álvarez-Ossorio Fernández
    Archivos Españoles de Urología. 2022, 75(9): 798-802. https://doi.org/10.56434/j.arch.esp.urol.20227509.116
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    Introduction: Immunotherapy is recommended as category 1 in first-line treatment in metastatic renal cancer (mRC), however the evidence on the management of toxicities in patients with chronic renal failure is limited.

    Description of the Cases: Case 1: Patient with mRC and renal failure on hemodialysis. After 25 months of treatment with Nivolumab, he presented a partial response, without toxicities. Case 2: Patient with mRC undergoing treatment with Nivolumab-Ipilimumab, who after 6 cycles was admitted for acute renal failure, compatible with grade 4 nephrotoxicity, requiring definitive suspension of treatment, corticosteroid therapy and hemodialysis.

    Conclusions: Nivolumab is a safe and effective therapy in hemodialysis patients, not increasing adverse events, nor requiring dose adjustment. Immunotherapy nephrotoxicity must be adequately managed in daily clinical practice in an interdisciplinary way with the nephrologist.

  • Case Report
    Jorge Panach-Navarrete, Lorena Valls-González, Rocío Gil-Viana, José María Martínez-Jabaloyas
    Archivos Españoles de Urología. 2022, 75(9): 803-806. https://doi.org/10.56434/j.arch.esp.urol.20227509.117
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    Introduction: In this work, we present two cases of heminephrectomies with postoperative findings of cystic lesions in the bed of the excised renal segment.

    Material and Methods: Description of the clinical cases, therapeutic management and description of the ultrasound findings. A review of the published cases was carried out.

    Results: We present a case of open heminephrectomy due to atrophy of the upper hemirrenal in a case of ureterocele, and another case with bilateral lower heminephrectomy in a case of vesicoureteral reflux disease. In the first case, the cystic lesion disappeared during follow-up, while in the second, the cysts remained stable. In none of the cases published in the literature was it necessary to perform any intervention to resolve the cysts.

    Conclusions: The appearance of cystic lesions in the heminephrectomy bed in pediatric patients is a radiological finding that occurs frequently. Due to its favorable evolution, without the need for additional procedures for its resolution, we do not consider the presence of these lesions as a complication after heminephrectomy.