28 December 2022, Volume 75 Issue 10

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  • Article
    Lan Bu, Fang Nie, Yan Li, Ting Wang, Xiaoyu Yang, Dan Yang
    Archivos Españoles de Urología. 2022, 75(10): 807-812. https://doi.org/10.56434/j.arch.esp.urol.20227510.118
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    Background: The objective of our study was to share the experience of the ectopic ureter and to characterize associated clinical features, medical images, and management.

    Methods: A retrospective analysis was performed on 13 cases of ectopic ureter confirmed by surgery. The gender, age, abnormal urinary leakage, the site of the ectopic ureter, renal dysplasia, and surgical methods of the patients were compared and analyzed.

    Results: Eleven females and 2 males with ectopic ureters were analyzed. Eight cases had the clinical symptom of persistent or intermittent urine leakage since birth. One case was with complete persistent urine leakage, and 4 cases with no urine leakage. The site of the ectopic ureters was mostly unilateral. Ectopic ureters were located in the vagina in 6 cases, urethra in 4 cases, prostate in 1, and uncertain in 2 cases. There were 3 cases with ectopic kidney and renal atrophy, 3 cases had “Y” ureter, and 8 cases had repeated ureters with duplex kidneys. Twelve cases were treated with surgery, and 1 case underwent bilateral ureteral stent implantation. Three cases were complicated with ureteral stump syndrome after surgery.

    Conclusions: The classic symptom of the ectopic ureter is continuous wetting with intermittent normal micturition in most young girl patients. Ectopic ureter is often associated with duplex kidneys, ectopic kidneys and atrophic kidneys. The surgical approach should be personalized. The aim of the surgery is to make the patient without urine leakage and preserve kidney function.

  • Article
    Sihui Wu, Xiaoming Sun, Xiaoyang Liu, Jiawei Li, Xingyu Yang, Yuanyuan Bao, Hongchuan Yu
    Archivos Españoles de Urología. 2022, 75(10): 813-818. https://doi.org/10.56434/j.arch.esp.urol.20227510.119
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    Purpose: To investigate the clinical efficacy of percutaneous tibial nerve stimulation combines sacral nerve root magnetic stimulation in the treatment of chronic pelvic pain syndrome and chronic prostatitis.

    Methods: 60 male patients diagnosed with chronic pelvic pain syndrome or chronic prostatitis were analyzed in this study. Patients in the experimental group were treated with percutaneous tibial nerve stimulation (7 Hz) combined with sacral nerve root magnetic stimulation (5 Hz) whilst patients in the control group receiving treatment with only percutaneous tibial nerve stimulation. The National Institutes of Health-Chronic Prostatitis Symptom Index was used to evaluate prostatitis in the 2 groups before and at 4 weeks after treatment.

    Results: All patients showed improvements in scores before and after treatment in the two groups (p < 0.05). Further comparison between the two groups showed that patients in the experimental experienced more significant improvements in each of the indicators compare that to the control group patients (p < 0.05).

    Conclusions: Both percutaneous tibial nerve stimulation and percutaneous tibial nerve stimulation combined with magnetic stimulation of the sacral nerve roots have benefits for patients, but the benefits are more excellent when used together than when used alone.

  • Article
    Rijin Song, Chengjian Ji, Rong Cong, Jiaochen Luan, Liangyu Yao, Ninghong Song, Xianghu Meng
    Archivos Españoles de Urología. 2022, 75(10): 819-830. https://doi.org/10.56434/j.arch.esp.urol.20227510.120
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    Purpose: Percutaneous nephrolithotomy (PCNL) requires perforating the kidney, which may damage part of the patient’s nephron. Further, compared with single-channel PCNL (S-PCNL), the safety of multi-channel PCNL (M-PCNL) and whether it affects the renal function of patients has been debated. The meta-analysis aimed to comprehensively evaluate the safety of M-PCNL.

    Methods: We carefully searched the Pubmed, Embass, and Web of Science databases for relevant research reported before October 30, 2021, and analyzed the included literature using the Stata software. Changes in the serum creatinine levels, split renal function and the incidence of postoperative complications were used to evaluate the safety of M-PCNL.

    Results: Overall, 11 articles were included in this meta-analysis. The results showed that there was no statistically significant difference between S-PCNL and M-PCNL in terms of changes in serum creatinine levels (pooled Mean Difference (MD) = –0.015, 95% CI: –0.047–0.018, I2 = 0.0%, p = 0.92). Further, a sensitivity analysis showed that our conclusions were stable. With the p-values in both Egger’s and Begg’s tests being greater than 0.05, there was no significant publication bias in the included literature. A subgroup analysis based on patient ethnicity yielded consistent results. Our meta-analysis yielded similar results in terms of changes in split renal function (pooled MD = 0.008, 95% CI: –0.013–0.030, I2 = 96%, p < 0.01). There was no significant difference in the incidence of postoperative renal perforation between M-PCNL and S-PCNL (pooled Odds Ratio (OR) = 1.686, 95% CI: 0.677–4.193, I2 = 0.0%, p = 0.66). However, M-PCNL was found to cause more postoperative blood transfusion, postoperative infection, and pleural damage than S-PCNL (pooled OR = 3.104, 95% CI: 2.277–4.232, I2 = 46%, p = 0.03, pooled OR = 1.862, 95% CI: 1.165–2.974, I2 = 0%, p = 0.46, and pooled OR = 3.446, 95% CI: 1.168–10.171, I2 = 0%, p = 1.00 respectively).

    Conclusions: Compared with S-PCNL, M-PCNL showed no significant differences in terms of changes in serum creatinine levels in patients. However, M-PCNL showed a greater probability of resulting in postoperative blood transfusion, postoperative infection, and pleural damage.

  • 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.

  • Article
    Daocheng Fang, Yi Yang, Hui Li, Congzhen Shi, Zufu Zhang, Yuanyuan Hu
    Archivos Españoles de Urología. 2022, 75(10): 844-848. https://doi.org/10.56434/j.arch.esp.urol.20227510.122
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    Introduction: The aim of this study was to explore the clinical effect of transurethral columnar balloon dilation of the prostate (TUCBDP), in the treatment of benign prostatic hyperplasia in men over the age of 60 years old.

    Methods: This was a retrospective multi-center study follow-up of patients with benign prostatic hyperplasia (BPH) who underwent TUCBDP. The international prostate symptom score (IPSS), quality of life score (QoL), residual urine volume (PVR), and maximum urine flow rate (Qmax) were evaluated one and six months after the procedure.

    Results: All 68 patients had the operation from January 2019 to December 2021. Their postoperative IPSS, QoL, PVR, and Qmax of the patients significantly improved, in comparison to before procedure (p < 0.05). The improvement rate of IPSS and QoL in the small volume BPH group was significantly higher than that in the non-small volume BPH group (p < 0.05), but had little effect on the improvement rate of PVR and Qmax.

    Conclusions: TUCBDP can significantly improve IPSS, QoL, PVR, and Qmax in elderly men with BPH up to six months after the procedure, with the advantages of shorter operation time and less blood loss. The postoperative improvement effect of patients with small volume BPH was more obvious than that of patients with non-small volume BPH.

  • Article
    Rui Zhou, Yue Ma, Zhiyong Liu, Chaoqin Kang, Qiang Wang
    Archivos Españoles de Urología. 2022, 75(10): 849-853. https://doi.org/10.56434/j.arch.esp.urol.20227510.123
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    Purpose: To assess the efficacy of flexible ureteroscopy (F-URS) in treating single kidney stones and the role of Neutrophil Gelatinase-Associated Lipocalin (NGAL) in detecting early renal function abnormalities in patients with solitary kidney stones.

    Materials and Methods: We retrospectively analyzed 23 patients with solitary kidney nephrolithiasis who underwent F-URS at the Sichuan Science City Hospital between January 2017 and November 2020. We collected data on the following variables: Age, gender, stone size, surgery time, perioperative outcomes, and complications; Stone-free rates (SFRs) were calculated using computed tomography (CT). Serum creatinine (SCr) and NGAL levels were tested before surgery and at one-day and one-month postoperatively.

    Results: The average size of the stones was 1.53 ± 0.57 cm. The average operating time was 59.28 ± 21.25 minutes. For urethral stricture, three patients (13.0%) required second-stage F-URS. The SFRs were 91.3% following the first and second treatments. The mean NGAL levels were significantly increased at one-day postoperatively compared to baseline (768.91 ± 514.50 ng/mL vs. 173.39 ± 147.94 ng/mL, respectively, p < 0.001). Minor complications, including gross hematuria (n = 5) and mild fever (n = 3), occurred in 34.8% of cases (n = 8), who recovered quickly.

    Conclusions: F-URS is a safe and efficient therapeutic approach for patients with solitary kidney nephrolithiasis, and NGAL has huge prospects as an indicator of early-stage renal injury in this patient population.

  • Article
    Batuhan ERGANİ, Hayal BOYACIOĞLU, Özcan KILIÇ
    Archivos Españoles de Urología. 2022, 75(10): 854-861. https://doi.org/10.56434/j.arch.esp.urol.20227510.124
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    Background: Sexual function is an excellent marker of psychological, systemic, and specifically vascular performance. Endothelial dysfunction is the main determinant of coronavirus disease 2019 (COVID-19) symptoms. Considering the adverse effects of the COVID-19 pandemic on psychological and sexual functions, we hypothesized potential differences and underlying factors if there is any erectile function and premature ejaculation status of male patients with COVID-19 by comparing both with the control group.

    Methods: Hospitalized male patients diagnosed with COVID-19 pneumonia were evaluated. Male patients who applied to the Urology outpatient clinic were the control group. All participants completed the International Index of Erectile Function Form-15 (IIEF-15) and gave information regarding their premature ejaculation (PE) status if present. COVID-19 patients were called by phone to fill in the IIEF-15. Their PE status was questioned on the 45th and 90th days after discharge. The following parameters were in the data records: Age, comorbidity, length of hospital stay, treatment, oxygen saturation, pulmonary involvement, white blood cell (WBC), C-reactive protein (CRP), ferritin, fibrinogen, D-dimer, and sedimentation values.

    Results: The study had 253 participants, including 168 COVID-19 patients and 85 volunteers as the control group. The number of PE cases was less, whereas erectile dysfunction (ED) cases were more in the COVID-19 patient group in comparison to the control group in the pre-pandemic period (p = 0.00) (p = 0.00). In the post-pandemic period, PE developed in 13 more COVID-19 patients on the 45th and 90th days (p = 0.00). The IIEF-15 scores of COVID-19 patients decreased by 4-point in the short term and by 3-point in the long term (p = 0.002). Age and sedimentation were responsible for the difference in PE status. On the other hand, comorbidity, length of hospital stay, treatment type, WBC, D-dimer, ferritin, CRP levels, and pulmonary infiltration were responsible for the difference in ED.

    Conclusions: Based on our findings, we can say that we have enough evidence to suspect COVID-19 sequelae can affect male sexual health. After the pandemic, male patients with andrological problems should have enough time to feel more comfortable and their organic and psychogenic conditions should be optimized.

  • Article
    Junchao Wu, Shuchen He, Haifeng Wang, Guiming Zhou, Xuede Qiu
    Archivos Españoles de Urología. 2022, 75(10): 862-866. https://doi.org/10.56434/j.arch.esp.urol.20227510.125
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    Objectives: To evaluate the efficacy and cost effectiveness of two-stage percutaneous nephrolithotomy (PCNL) in complex renal calculus disease.

    Methods: The clinical data of 106 patients who underwent two-stage PCNL at the Second Affiliated Hospital of Kunming Medical University from January 2017 to May 2022 were analyzed. In order to select more accurate timing and strategies to reduce costs and surgery risk in two-stage PCNL patients, different parameters were measured—including the preoperative urinary tract infection, intraoperative bleeding, operative time, postoperative stone clearance and treatment costs. Patients were divided into group A and group B according to different timings of two-stage PCNL operation. Group A included patients who underwent two-stage PCNL during their period of hospitalization 5 to 9 days after the one-stage PCNL. Group B comprised patients who were re-hospitalized for two-stage PCNL 29 to 35 days after the one-stage PCNL.

    Results: There were statistically significant differences in the influence of stone diameter and operation time in intraoperative blood loss of PCNL in 106 patients (p < 0.001). Compared with one-stage PCNL, the intraoperative hemoglobin loss and hematocrit loss means of patients with two-stage PCNL were decreased, the stone diameter mean of was smaller, and the mean operative time was diminished (p < 0.001). There were no significant differences in the hemoglobin loss, hematocrit loss and stone clearance rate means between group A and group B (p > 0.05). The urinary tract infection rate in group A was lower than the one in group B, and the average treatment cost was lower than the one in group B (p = 0.006, p < 0.001, respectively).

    Conclusions: Intraoperative bleeding in PCNL is influenced by stone diameter and operative time. Two-stage PCNL displays smaller calculi, shorter operation time and lower intraoperative blood loss than one-stage PCNL. Patients who had no surgical contraindication could undergo two-stage PCNL during the same hospitalization 5 to 9 days after one-stage PCNL to avoid rehospitalization. This approach could reduce the risk of urinary tract infection of indwelling nephrostomy tube and decrease the economic burden of patients.

  • Article
    Lirong Yu, Xiangping Du, Yi Yuan, Li Yang, Yun Hu, Xian Wu
    Archivos Españoles de Urología. 2022, 75(10): 867-872. https://doi.org/10.56434/j.arch.esp.urol.20227510.126
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    Background: To investigate the influencing factors of health-related quality of life (HRQOL) in children and adolescents with congenital adrenal hyperplasia (CAH).

    Methods: Pediatric Quality of Life Inventory 4.0 (PedsQL4.0) and 8-item Morisky medication adherence scale (MMAS-8) were used to survey eighty-seven children and adolescents with CAH (5–18 years), as well as their parents. SPSS 26.0 software was utilized for statistical analysis.

    Results: The scores of social functions, school performance, social psychological function and total scores of CAH girls aged 13–18 years were lower than those of boys (p < 0.05). CAH children with older age, longer course of disease, older than 3 years old at first diagnosis, living in rural areas, lower education level of caregivers and lower family monthly income had lower scores. CAH patients with poor compliance and complications had significantly lower scores in each single domain, social psychological function, and total scores than those with good compliance and no complications (p < 0.05).

    Conclusions: Age, age at initial diagnosis, course of disease, complications, compliance, residence, education level of caregivers and family income were important factors affecting HRQOL of CAH children and adolescents, among which complications and compliance were independent key influencing factors.

  • 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.