28 February 2023, Volume 76 Issue 1

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  • Review
    Joaquin Carballido
    Archivos Españoles de Urología. 2023, 76(1): 1-28. https://doi.org/10.56434/j.arch.esp.urol.20237601.1
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    The relationship of sex hormones with prostate glandular activity and the evidence of the favourable impact of bilateral orchiectomy in 21 patients with locally advanced or metastatic prostate cancer (PCa), ratified by Huggins C.B. and cols. in 1941, is one of the pillars for the acceptance of androgen deprivation therapy (ADT). Its clinical relevance has withstood the passage of time and remains valid, fundamentally, in advanced PCa. ADT has expanded its use over the years and, after extensive clinical experience, substantial modifications have been incorporated into its indications and options, both of which are increasingly precise. The objective of this review is to update the therapeutic positioning of primary ADT, genetic-molecular advances and future of the developing treatments of PCa.

  • Review
    Paula Diz-Teixeira, Alejandra Alonso-Calvete, Lorenzo A. Justo-Cousiño, Yoana González-González, Iria Da Cuña-Carrera
    Archivos Españoles de Urología. 2023, 76(1): 29-39. https://doi.org/10.56434/j.arch.esp.urol.20237601.2
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    Background: Urinary incontinence in the postpartum period is related to biomechanical and hormonal changes that occur during the obstetric period and also related to perineal trauma during childbirth. Physiotherapy is currently presented as one of the conservative options for the treatment of urinary incontinence at this stage, so this review aims to go over scientific literature to assess the effect of physiotherapy on postpartum urinary incontinence.

    Material and Methods: In February 2022, a bibliographic search was carried out in PubMed, Scopus, Medline, PeDRO and Sport Discuss databases. Studies published within the last 10 years and randomized clinical trials that used physiotherapy techniques for the treatment of postpartum urinary incontinence were identified, but those articles that differ from the objective of the work and those that were duplicated in the databases were excluded.

    Results: Out of the 51 articles identified, 8 were finally included that fit the criteria and the subject of the study. Regarding the intervention, we have found that all the articles refer to pelvic floor muscle training. In addition to urinary incontinence, these studies evaluated other variables such as strength, resistance, quality of life and sexual function, obtaining significant results in 6 out of all the studies consulted.

    Conclusions: Pelvic floor muscle training is beneficial for the treatment of urinary incontinence in the postpartum period, then supervised and controlled exercise combined with a home training routine is recommended. It is not clear whether the benefits are maintained over time.

  • Article
    Yuanshan Cui, Qimei Ma, Yong Zhang, Guangzhu Wei, Zhongbao Zhou
    Archivos Españoles de Urología. 2023, 76(1): 40-49. https://doi.org/10.56434/j.arch.esp.urol.20237601.3
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    Purpose: To verify the efficacy and safety of acupuncture in treating stress urinary incontinence (SUI) in women in a single treatment cycle lasting at least 6 weeks.

    Methods: A preferred reporting items for systematic reviews and meta-analyses (PRISMA) summary was followed correctly. Through the use of EMBASE, Cochrane Library databases, and PubMed (until July 2021), we looked for randomized controlled trials. In addition, the included articles’ original references were looked up as well.

    Results: Totally, we analyzed four studies including 690 patients. Compared with the sham acupuncture group, this analysis verified that acupuncture was critically better result in decreasing mean urine leakage (p = 0.04), 1-hour pad test (p = 0.04), 72-hour incontinence episodes (p < 0.00001), International Consultation on Incontinence Questionnaire-Short Form scores (p = 0.0005) and improving patient self-evaluation (All p < 0.05). However, two groups had no statistical significance in improving pelvic floor muscle strength. In the matter of safety, mainly adverse events, especially with respect to pain, both groups showed no statistical difference.

    Conclusions: Acupuncture is more beneficial to patients with stress urinary incontinence in women with no critical difference in the incidence of advent events than sham acupuncture.

  • Article
    Yongjiang XIONG, Jiaji LIU, Tao ZHAO
    Archivos Españoles de Urología. 2023, 76(1): 50-55. https://doi.org/10.56434/j.arch.esp.urol.20237601.4
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    Objective: By comparing with rigid ureteroscopy (r-URS), we explored the application value of flexible holmium laser sheath combined with r-URS in treating impacted upper ureteral stones. We also verified its effectiveness, safety and economy and investigated its application prospects at community or primary hospitals.

    Methods: From December 2018 to November 2021, 158 patients with impacted upper ureteral stones were selected from Yongchuan Hospital of Chongqing Medical University. Seventy-five patients in the control group were treated with r-URS, and 83 patients in the experimental group were treated with r-URS combined with a flexible holmium laser sheath if necessary. The operation time, postoperative hospital stay, hospitalization expenses, stone clearance rate after r-URS, auxiliary extracorporeal shock wave lithotripsy (ESWL) ratio, auxiliary flexible ureteroscope, the incidence of postoperative complications and the stone clearance rate after one month were observed.

    Results: The postoperative hospital stay, stone clearance rate after r-URS, the ratio of auxiliary ESWL, the ratio of the auxiliary flexible ureteroscope, and total hospitalization expenses in the experimental group were significantly less than those in the control group (p < 0.05). There was no significant difference in operation time, postoperative complications, and stone clearance rate after one month between the two groups (p > 0.05).

    Conclusions: r-URS combined with flexible holmium laser sheath in treating impacted upper ureteral stones can improve the stone clearance rate and reduce hospitalization expenses. Therefore, it has a certain application value in community or primary hospitals.

  • Article
    Li Guo, Chen Ma, Meiyu Wang, Yuefeng Du
    Archivos Españoles de Urología. 2023, 76(1): 56-64. https://doi.org/10.56434/j.arch.esp.urol.20237601.5
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    Objective: The main pathological changes of hemorrhagic cystitis (HC) are bladder inflammation, bladder epithelial damage and mast cell infiltration. Tropisetron has been corroborate to conduct a protective role in HC, but its specific etiology remains unclear. The objective of this research was to estimate the mechanism of action of Tropisetron in haemorrhagic cystitis tissue.

    Methods: Cyclophosphamide (CTX) was utilized to induce the construction of HC rat model, and rats were handled with different doses of Tropisetron. The impact of Tropisetron on the expression of inflammatory factors and oxidative stress factors in the rats with cystitis were measured by western blot, as well as the related proteins of toll-like receptor 4/nuclear transcription factor-κB (TLR-4/NF-κB) and januskinase 1/signal transducer and activator of transcription 3 (JAK1/STAT3) pathways.

    Results: CTX-induced cystitis in rats was accompanied by notable pathological tissue damage and increased bladder wet weight ratio, elevated mast cell numbers and collagen fibrosis compared to controls. Tropisetron ameliorated CTX-induced injury in a concentration-dependent manner. Futhermore, CTX induced oxidative stress and inflammatory damage, while Tropisetron can alleviate these injuries. Besides, Tropisetron ameliorated CTX-induced cystitis by restraining TLR-4/NF-κB and JAK1/STAT3 signalling pathways.

    Conclusions: Taken together, Tropisetron ameliorates cyclophosphamide-induced haemorrhagic cystitis via modulating TLR-4/NF-κB and JAK1/STAT3 signalling pathways. These findings carry important implication for the study of the molecular mechanisms of pharmacological treatment of hemorrhagic cystitis.

  • Article
    Jorge Panach-Navarrete, Marcos Antonio Lloret-Durà, Silvia Sánchez-Gimeno, Esther Murcia-Díez, José María Martínez-Jabaloyas
    Archivos Españoles de Urología. 2023, 76(1): 65-69. https://doi.org/10.56434/j.arch.esp.urol.20237601.6
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    Introduction: The aim of this study was to compare the IsirisTM cystoscope with a common reusable flexible cystoscope in terms of patient perceived pain and endoscopy time in the ureteral stent removal setting.

    Materials and Methods: A non-randomized prospective study comparing the IsirisTM single-use cystoscope with a reusable flexible cystoscope. A visual analogue scale (VAS) was used for pain assessment and endoscopy time was recorded in seconds. Univariate and multivariate analyses were performed to assess the correlation between endoscope type and clinical variables with VAS score and endoscopy time.

    Results: A total of 85 patients were included in the study: 53 in the disposable cystoscope group and 32 in the reusable cystoscope group. Ureteral stent extraction was successful in all cases. The mean VAS score was similar between groups (single-use group was 2.09 +/– 2.53 vs 2.53 +/– 2.14 in the reusable cystoscope group) (p = 0.13). Same was observed endoscopy time (74.92 +/– 74.45 s. in the single-use group vs 98.87 +/– 153.33 s. in the reusable group) (p = 0.07). Age (coefficient β = –0.36, p < 0.04) and body mass index (BMI) (coefficient β = –0.22, p < 0.02) were inversely correlated with perceived pain during ureteral stent removal, measured by VAS score.

    Conclusions: Ureteral catheter removal with a flexible cystoscope is a well-tolerated procedure in patients. Older age and high BMI are associated with better intervention tolerance. Use of a single-use flexible cystoscope is comparable to that of a common flexible cystoscope in terms of pain and endoscopy time.

  • Article
    Xueneng Zhang, Huan Liu, Junchao Zhang, Zhen Wang, Shu Yang, Daoquan Liu, Jianmin Liu, Yan Li, Xun Fu, Xinhua Zhang
    Archivos Españoles de Urología. 2023, 76(1): 70-83. https://doi.org/10.56434/j.arch.esp.urol.20237601.7
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    Background: Muscle-invasive bladder cancer (MIBC) is characterized as bladder tumors that infiltrate into the muscle layer, along with multiple metastasis and poor prognosis. Numerous research studies have been performed to identify the underlying clinical and pathological alterations that occur. However, few studies have revealed the molecular mechanism of its progression based upon the immunotherapy response. Our present study was designed to identify biomarkers which may predict the immunotherapy response by investigating the tumor microenvironment (TME) in MIBC.

    Methods: The transcriptome and clinical data of MIBC patients were obtained and analyzed with R version 4.0.3 (POSIT Software, Boston, MA, USA) ESTIMATE package. Differentially expressed immune-related genes (DEIRGs) were identified and further analyzed via the protein-protein interaction network (PPI). Meanwhile, univariate Cox analysis was utilized to screen out the prognostic DEIRGs (PDEIRGs). Then, the PPI core gene was matched with PDEIRGs to obtain the target gene-fibronectin-1 (FN1). Human MIBC and control tissues were collected and FN1 was measured with Quantitative Reverse Transcription PCR (qRT-PCR) and Western-Blot. Finally, the relationship between FN1 expression level and MIBC was validated through survival, univariate Cox, multivariate Cox, Gene Set Enrichment Analysis (GSEA) and correlation analysis of tumor infiltrating immune cells.

    Results: TME DEIRGs were identified and the target gene FN1 was obtained. The higher expression of FN1 was confirmed in MIBC tissues via bioinformatics analysis, qRT-PCR and Western-Blot. Moreover, higher FN1 expression correlated with reduced survival time and FN1 expression was further favorably correlated with clinic-pathological features (grade, TNM stage, invasion, lymphatic and distant metastasis). Additionally, the genes in the high FN1 expression group were mainly enriched in immune-related activities and macrophage M2, T cell CD4, T cell CD8 and T cell follicular helper cells were correlated with FN1. Finally, it was observed that FN1 was closely related to key immune checkpoints.

    Conclusions: FN1 was identified as a novel and independent prognostic factor for MIBC. Our data also suggests FN1 can predict MIBC patients’ response to immune checkpoints inhibitors.

  • Article
    Jun Zhang, Xianen Gu
    Archivos Españoles de Urología. 2023, 76(1): 84-89. https://doi.org/10.56434/j.arch.esp.urol.20237601.8
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    Background: Percutaneous nephrolithotomy (PCNL) has been widely used in the clinical practice of urinary calculi. The prone positioning for PCNL is generally adopted, while it is associated with a certain risk when repositioning the patient into the prone position after anesthesia. This approach is more difficult for obese or elderly patients with respiratory diseases. The application of PCNL combined with B-mode ultrasound-guided renal access in the lateral decubitus flank position for complex renal calculi has been poorly investigated. This study aimed to evaluate the efficacy and safety of PCNL combined with B-mode ultrasound-guided renal access in the lateral decubitus flank position for complex renal calculi.

    Methods: From June 2012 to August 2020, 660 patients with renal stones (>20 mm) were enrolled. All patients were diagnosed by ultrasonography, kidney-ureter-bladder (KUB) plain X-ray imaging, intravenous urography (IVU), or computed tomographic urography (CTU). All the enrolled subjects underwent PCNL combined with B-mode ultrasound-guided renal access in the lateral decubitus flank position.

    Results: Successful access was achieved in 660 patients (100%). Micro-channel PCNL and PCNL were performed on 503 and 157 patients, respectively. The stone-free rate was 85.30% (563/660). A dual-channel access was required for phase I PCNL in 92 cases, and reconstruction of channel was required for 33 cases for phase II PCNL. The stone-free rate of phase I PCNL was 85.30% (563/660). Totally, 45 patients had stones that were cleared during phase II PCNL, while 5 patients became stone-free after phase III PCNL. Besides, 12 cases became stone-free after undergoing PCNL combined with extracorporeal shock wave lithotripsy. The mean operation time was 66 (range, 38 to 155) min, and the mean length of hospital stay was 16 (range, 8 to 33) days. One case developed heavy bleeding 6 days after the removal of kidney fistula, and one case developed acute left epididymitis during urethral catheter retention. No visceral injuries and other complications occurred.

    Conclusions: PCNL combined with B-mode ultrasound-guided renal access in the lateral decubitus flank position is safe and convenient, preventing the surgical team and patients from exposure to harmful radiations.

  • Article
    Yi Qiao, He Xiao, Zixing Ye, Yang Yu, Xiaohong Fan, Ou Wang, Rongrong Li, Hanqing Luo, Haimin Liu, Shuang Hu, Zhigang Ji
    Archivos Españoles de Urología. 2023, 76(1): 90-97. https://doi.org/10.56434/j.arch.esp.urol.20237601.9
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    Background: This study aimed to investigate the prevalence of urolithiasis and its association with systemic diseases among inpatients in a top hospital of China.

    Methods: This cross-sectional study included all inpatients in Peking Union Medical College Hospital (PUMCH) from 1 January 2017 to 31 December 2017. Patients were divided in two groups, the urolithiasis group and non-urolithiasis group. Subgroup analysis according to payment type (General or VIP ward), hospitalization department (surgical or not) and age was performed with patients in the urolithiasis group. Additionally, Univariable and multivariable regression analyses were performed to determine factors associated with urolithiasis prevalence.

    Results: 69518 hospitalized cases were included in this study. The age was 53.40 ± 15.05 and 48.00 ± 18.12 years, and the male-to-female ratio was 1.7:1 and 0.55:1 in the urolithiasis and non-urolithiasis groups, respectively (p < 0.01). Among all patients, urolithiasis had a prevalence of 1.78%. The rate depending on payment type (5.73% versus 9.05%, p < 0.01) and hospitalization department (56.37% versus 70.91%, p < 0.01) were significantly lower in urolithiasis group compared to the non-urolithiasis. Urolithiasis rate also showed age differences. Female was independent protective factor of urolithiasis, while age, hospitalization in the non-surgical department and payment type of general ward were risk factors of urolithiasis (all p < 0.01).

    Conclusions: Gender, age, hospitalization in the non-surgical department and the socioeconomic status, specifically, the payment type of general ward, are independently associated with urolithiasis.

  • Article
    Aurora Ortiz Núñez, Rodrigo Martins de Almeida, Laura Mateu Arrom, Carlos Rubio Terrés, Darío Rubio Rodríguez, Ana Maria Mora Blázquez
    Archivos Españoles de Urología. 2023, 76(1): 98-106. https://doi.org/10.56434/j.arch.esp.urol.20237601.10
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    Objective: To assess the economic impact associated with overactive bladder (OAB) patients, treated with mirabegron or antimuscarinics (AM) in Spain, over a 12-month period.

    Methods: A probabilistic model (second-order Monte Carlo simulation) was used in a hypothetical cohort of 1000 patients with OAB and a time horizon of 12 months. The use of resources was obtained from the retrospective observational study MIRACAT that included 3330 patients with OAB. The analysis was carried out from the perspective of the National Health System (NHS) including that of society with the indirect cost of abseenteism in a sensitivity analysis. Unit costs were obtained from Spanish public healthcare prices (€ 2021) and from previously published Spanish studies.

    Results: The annual average savings for the NHS for each patient with OAB treated with mirabegron would be € 1135 (95%confidence interval (CI) € 390; 2421) compared with a patient treated with AM. Annual average savings were maintained in all the sensitivity analyses carried out, ranging from a minimum of € 299 to a maximum of € 3381 per patient. The substitution of 25% of the AM treatments (for 81534 patients) to mirabegron would generate, within 1 year, savings for the NHS of € 92 million (95% CI € 31; 197 million).

    Conclusions: According to the present model, the treatment of OAB with mirabegron would generate savings compared with treatment with AM in all scenarios and sensitivity analysis performed, and for the NHS and for society perspectives.