28 March 2023, Volume 76 Issue 2

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  • Review
    Paula Gayarre Abril, Benjamín Blasco Beltrán, Daniel Hijazo Gascón, Jorge Subirá Ríos, Victoria Capapé Póves, Carlos Blanco Chamorro, Maria Rut Sieso Gracia, Francisco Xavier Elizalde Benito, Gonzalo Abril Baquero, Patricia Carrera Lasfuentes, Jorge Rioja Zuazu
    Archivos Españoles de Urología. 2023, 76(2): 107-113. https://doi.org/10.56434/j.arch.esp.urol.20237602.11
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    Purpose: Kidney stone disease affects 5% of the population and is associated with non-negligible morbidity. Retrograde intrarenal surgery and percutaneous nephrolithotomy are the treatments of choice. We analyzed the results from our patients who underwent retrograde intrarenal surgery at controlled pressure.

    Materials and Methods: We conducted an observational, descriptive, retrospective study of 403 patients who underwent retrograde intrarenal surgery at the Hospital Clínico Universitario Lozano Blesa (Zaragoza, Spain) between January 2013 and December 2019.

    Results: The mean surgical time was 111.1 minutes, with a mean stone volume of 3.5 cm3 (maximum volume, 38.3 cm3). A total of 70 patients (17.3%) developed postoperative Clavien-Dindo complications—64 minor (91.4%) and 6 major (8.6%). In addition, 28 patients (6.9%) presented with an early complication (<3 months), with urinary tract infection and pyelonephritis being the most common. The stone-free rate was 69.0%, with a retreatment rate of 4.7%.

    Conclusions: Sex was statistically significantly related to the onset of minor Clavien postoperative complications (p = 0.001). Similarly, corticosteroid use was associated with the onset of major Clavien complications (p = 0.030). Neither surgical time nor stone volume was found to be statistically significantly related to the onset of Clavien postoperative complications or early complications.

  • Article
    Pablo Sánchez Verdes, Sergio Fernández-Pello Montes, Iván González Rodríguez, Pelayo José Suárez Sal, Lidia Martín Gómez, Luis Rodríguez Villamil
    Archivos Españoles de Urología. 2023, 76(2): 114-122. https://doi.org/10.56434/j.arch.esp.urol.20237602.12
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    Background and Objective: One-stop clinics have emerged as a tool to optimize the therapeutic management of cancer patients. The main purpose of this study was to assess the role of the one-stop hematuria clinic (OSHC), as compared to a conventional clinic (CC), on the overall and disease-free survival of patients with bladder cancer.

    Methods: A five-year follow-up retrospective and single-center study was conducted in patients with primary bladder tumor diagnosed between 2006 and 2015. The primary outcomes were five-year overall survival and one-year relapse rate.

    Results: A total of 394 patients (160 in OSHC and 234 in CC) were included. No differences were observed in terms of age, sex, smoking habit or risk group between the OSHC and CC groups. The average times from first symptom to diagnosis (24.9 ± 29.1 vs. 100.7 ± 93.6 days) and from first symptom to treatment (70.2 ± 34.0 vs. 155.0 ± 102.9 days) were significantly lower in the OSHC group than in the CC group (p < 0.001 each). There was no significant difference in the five-year survival rate between OSHC and CC (103/160 vs. 150/234, respectively; p = 0.951), although the proportion of relapses during the first year was significantly lower in the OSHC group (35/139, 25.2%) than in the CC one (74/195, 38.0%; p = 0.02).

    Conclusions: OSHC significantly reduced the diagnosis and treatment times. The early-relapse rate was significantly lower in the OSHC group, although the five-year survival rate was similar.

  • Article
    Yao Cao, Chaoban Wang, Liqun Dong
    Archivos Españoles de Urología. 2023, 76(2): 123-131. https://doi.org/10.56434/j.arch.esp.urol.20237602.13
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    Introduction: Lupus nephritis (LN) is still a great burden for patients with systemic lupus erythematosus, and also one of the most severe complications of SLE. Radix Paeoniae Alba (white peony, WP) is proved with potential efficacy in treating LN. This study was to explore the effective ingredients, potential targets, and pathways of WP in treating LN based on network pharmacology and molecular docking.

    Methods: The active ingredients and potential protein targets of WP were gathered on Traditional Chinese Medicine Systematic Pharmacology Database and predicted by Swiss Target Prediction. LN-related therapeutic targets were acquired from multiple databases including Genecards, DisGeNET, OMIM, Drugbank, and PharmGKB. The intersection targets of WP and LN were acquired through Veeny 2.1.0. Protein-Protein Interaction (PPI) network was established by STRING. The results were then visualized by Cytoscape version 3.7.1. to study the mechanisms of WP on LN, gene ontology and functional enrichment analysis were carried out. Finally, molecular docking presented with the binding ability of key targets and major active components.

    Results: We acquired a total of 13 active ingredients and 260 potential targets of WP. Among them, the intersection with targets of LN were 82 proteins. These targets were regarded as potential therapeutic targets. Through PPI network, we found that the top three proteins were RAC-alpha serine/threonine protein kinase (AKT1), vascular endothelial growth factor A (VEGFA), and transcription factor Jun (JUN), and their corresponding components were kaempferol, paeoniflorin, lactiflorin, paeoniflorgenone, etc. The results of enrichment analysis suggested that WP treatment for LN mainly involves in signaling pathways in cancer, lipid and atherosclerosis, advanced glycation end product (AGE)-receptor of AGE (RAGE) pathways, C-type lectin receptor and nuclear factor (NF)-kappa B signaling pathways. Molecular docking predicted that the above components have excellent affinity to AKT1, VEGFA, and JUN.

    Conclusions: This study gave an insight into the key target proteins and potential underlying pharmacological mechanism of WP in treating LN, which provided evidence for further researches on the mechanism of WP on LN.

  • Article
    Emrah Okucu, Ugur Yucetas, Nejdet Karsiyakali, Hikmet Koseoglu, Esma Yucetas, Erkan Erkan, Mustafa Kadihasanoglu, Mahmut Gokhan Toktas
    Archivos Españoles de Urología. 2023, 76(2): 132-138. https://doi.org/10.56434/j.arch.esp.urol.20237602.14
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    Aim: To compare serum endothelial-specific molecule-1 (ESM-1 or endocan) levels between individuals with primary bladder cancer (BC) who have various pathological features of BC and healthy volunteers.

    Materials and Methods: 154 consecutive patients with primary BC (Group-1) and 52 healthy volunteers (Group-2) were accepted into this prospective, non-randomized, observational research between January 2017 and December 2018. Peripheral blood samples were obtained from each participant to measure serum ESM-1/endocan levels. Group-1 was further divided into subgroups as Group-1A (pTa), Group-1B (pT1) and Group-1C (pT2) based on the transurethral resection of bladder tumour (TURBT) histopathological results. In addition Group-1 was divided into other subgroups based on pathological features of BC including tumor grade, tumor volume and muscle-invasive status. Groups were compared statistically regarding ESM-1/endocan levels.

    Results: Median age of the individuals was 63 (22) years in Group-1 and 66 (11) years in Group-2 (p = 0.051). There were 140 (90.9%) males and 14 (9.1%) females in Group-1 and 30 (57.7%) males and 22 (42.3%) females in Group-2 (p < 0.001). The serum ESM-1/endocan measurements were lower in Group-2 than in Group-1 (p = 0.018). Of the patients in Group-1, 62 (40.3%) had low-grade tumors and 92 (59.7%) had high-grade tumors. When Group-1 was further divided into other subgroups according to different pathological features of BC such as tumor stage, grade, muscle-invasive status and tumor volume it was detected that there was a statistically meaningful difference between all subgroups of Group-1 and Group-2 in terms of serum ESM-1/endocan levels (p < 0.05 for each). The serum ESM-1/endocan cut-off value (3.472 ng/mL) had a specificity of 57.7%, sensitivity of 59.1%, NPV (negative predictive value) of 32.3% and PPV (positive predictive value) of 80.5% for predicting the presence of BC with an AUC (Area Under the Curve) of 0.609 (95% confidence interval (CI) 0.524–0.694; p = 0.018).

    Conclusions: The serum ESM-1/endocan levels can be considered a potentially useful predictor for BC. Higher serum ESM-1/endocan levels are related with poor pathological outcomes in BC.

  • Article
    François Peinado Ibarra, Borja García Gómez, Saturnino Luján Marco, Ana María Segura Paños
    Archivos Españoles de Urología. 2023, 76(2): 139-144. https://doi.org/10.56434/j.arch.esp.urol.20237602.15
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    Objective: To describe the profile of patients with erectile dysfunction (ED), attending to consultation and satisfaction using sildenafil oral suspension, from the specialist’s perception.

    Materials and methods: This is a nationwide multicenter, epidemiological, descriptive and observational study, with the studied population as the unit of study. Thirty urologists and/or andrologists completed a questionnaire with questions about ED patients’ profile attending to their practice, sildenafil oral suspension perception of effectiveness and safeness, and their opinion about patients’ satisfaction after sildenafil oral suspension treatment. Aggregate data were collected for the last 6 patients treated or on treatment with sildenafil oral suspension.

    Results: Overall, 40.9% and 24.9% of patients had moderate or severe ED, respectively. Among the patients, 73.6% were older than 50 years. The disease progression was approximately one year (11.8 months). ED etiology was mostly organic (38.1%) and mixed (31.8%). Cardiovascular comorbidities were present in 57.4%, mental health problems in 16.4% and hormonal disorders in 10.2% of the patients. The main reason for choosing sildenafil oral suspension was the ease of dose adjustment. The specialists considered that 73.4% of the patients responded satisfactorily to treatment. They also rated the perceived effectiveness and safeness of the product as very good or good.

    Conclusions: Urologists and andrologists consider that most patients with ED achieve a high degree of satisfaction with sildenafil oral suspension. The main advantage of the treatment is the possibility of adjusting the dose according to patient’s needs and circumstances.

  • Article
    Ali Akbar Firasi, Mohammad Ayodhia Soebadi, Budi Himawan, Wienta Diarsvitri
    Archivos Españoles de Urología. 2023, 76(2): 145-151. https://doi.org/10.56434/j.arch.esp.urol.20237602.16
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    Background: The formation of bladder calculi is a complex multifactorial process. Our objective was to identify predictors of bladder calculi in men.

    Methods: This cross-sectional study was conducted at a regional public hospital. We used medical records from 2017 to 2019 for men diagnosed with urinary calculi or benign prostatic hyperplasia (BPH). The diagnosis of urinary calculi was based on urinalysis, plain x-ray, and ultrasonography (USG). The diagnosis of BPH was based on digital rectal examination (DRE), USG, and American Urological Association (AUA) Symptom Index to assess the severity of BPH. The data were analyzed using Kruskal-Wallis, Mann-Whitney U, Chi-square tests, and binary logistic regression.

    Results: Of 2010 study participants, 66.0% were men with urinary calculi, 39.7% had BPH, 21.0% were aged 70 years or more, 12.5% lived in limestone mountain areas, and 24.6% had occupations that were mainly outdoors. Urinary calculi in men with BPH were found in the urethra (3.0%), bladder (27.6%), ureter (2.2%), and kidney (1.1%). Of all men with urinary calculi, the odds of having bladder calculi in men aged 70 years or more was 13.484, 95% confidence interval (95% CI): 8.336–21.811; In men with BPH was 11.182, 95% CI: 6.440–19.416; In men who lived in limestone mountain area was 1.894, 95% CI: 1.242–2.887; In men whose occupation is mainly outdoor was 3.240, 95% CI: 1.954–5.375, compared to reference groups.

    Conclusions: Age, BPH, geography of residence, and occupation were predictors of bladder calculi in men.

  • Article
    Qingchao Li, Liangliang Qing, Wenbo Xu, Yongjin Yang, Chengyu You, Yongfeng Lao, Zhilong Dong
    Archivos Españoles de Urología. 2023, 76(2): 152-160. https://doi.org/10.56434/j.arch.esp.urol.20237602.17
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    Objective: To assess the anticancer effect, target, and mechanism of berberine on bladder cancer.

    Methods: Bladder cancer T24 and 5637 cells were treated with different concentrations of berberine. Then, cell proliferation was assessed by cell counting kit-8 (CCK8) measure, cell migration and invasion were assessed by transwell method, cell cycle and apoptosis were assessed by flow cytometry, and the expression of human epidermal growth factor receptor-2/PhosphoInositide-3 Kinase/AKT Serine/Threonine Kinase (HER2/PI3K/AKT) proteins were assessed by Western blot. Berberine molecular docking and HER2 target were performed using the AutoDock Tools 1.5.6. Finally, HER2 inhibitors CP-724714 and berberine were used independently or in combination to detect AKT and P-AKT protein downstream changes by Western blot.

    Results: Berberine inhibited the proliferation of T24 and 5637 bladder cancer cells in a concentration-dependent and time-dependent manner. Berberine can significantly inhibit the migration, invasion, and cell cycle progression of T24 and 5637 bladder cancer cells, promote their apoptosis, and down-regulate the expression of HER2/PI3K/AKT proteins. Berberine showed good docking with HER2 molecular target and had a similar and synergistic effect with HER2 inhibitor in T24 and 5637 bladder cancer cells.

    Conclusions: Berberine inhibited the proliferation, migration, invasion, and cell cycle progression of T24 and 5637 bladder cancer cells and promoted their apoptosis by down-regulating HER2/PI3K/AKT signaling pathway.

  • Article
    Xiaonan Mu, Longfei Guo, Zhen Guo, Longyang Zhang, Sijun Wang
    Archivos Españoles de Urología. 2023, 76(2): 161-168. https://doi.org/10.56434/j.arch.esp.urol.20237602.18
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    Objective: To assess the clinical outcome of 1470 nm diode laser enucleation of the prostate (DiLEP) vs. bipolar transurethral enucleation of prostate (TUEP) for benign prostatic hyperplasia (BPH).

    Methods: One hundred and fifty-seven patients were retrospectively involved in this study. Eighty-two patients underwent DiLEP while 75 underwent bipolar TUEP. Seventy-three patients in DiLEP and sixty-nine in bipolar TUEP completed the 3-year follow-up, respectively. The baseline properties, perioperative data, and postsurgical outcomes were evaluated.

    Results: No statistically significant differences were found between DiLEP and bipolar TUEP in preoperative parameters. Significantly shorter operating time was noted in DiLEP group (p = 0.000). No patient suffered dangerous complications, and none in either group required a blood transfusion. No statistically significant differences were found between DiLEP and bipolar TUEP in the decrease in hemoglobin or sodium. During the 3-year postoperative follow-up, ongoing and significant improvements were found in both groups without any difference.

    Conclusions: Both DiLEP and bipolar TUEP can improve low urinary tract symptoms (LUTS) secondary to BPH in a comparable way with high efficacy. Compared with bipolar TUEP, DiLEP with a morcellator required a shorter operative time.

  • Article
    Alejandro Bellas-Pereira, María de los Ángeles Betancor Santos, Alba López Castelló, María Pérez Costas, Milagros Otero-García, Pilar San Miguel-Fraile, Patricia Domínguez-Aristegui, José Antonio Ortiz-Rey
    Archivos Españoles de Urología. 2023, 76(2): 169-174. https://doi.org/10.56434/j.arch.esp.urol.20237602.19
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    Background: Angiomyolipomas (AML) represent less than 10% of renal tumours. They are most often detected incidentally during imaging tests, but there are several histological variants that pose difficulties in the radiological differential diagnosis. Their identification should allow the loss of renal parenchyma due to embolization or radical surgery to be prevented.

    Methods: Retrospective study of patients undergoing kidney surgery with post-surgical pathological diagnosis of AML at the Álvaro Cunqueiro Hospital (2016–2021). Patients with a radiological diagnosis of AML who underwent surgery based on clinical criteria were excluded.

    Results: 18 patients were registered, allowing for the assessment of 18 renal tumours. All of the cases were diagnosed incidentally. Preoperative radiological diagnosis was: 9 lesions suggestive of renal cell carcinoma (RCC) (50%), 7 cases suggestive of RCC vs. AML (38.9%) and 2 lesions suggestive of AML vs. retroperitoneal liposarcoma (11.1%). Histological variants of AML were found in 61.1% of cases (n = 11). The most widely used surgical technique was partial nephrectomy, in 66.67% of cases.

    Conclusions: The radiological differential diagnosis of AML, and particularly its variants, with malignant lesions have important limitations either due to the predominance or scarcity of any of the AML components. Some cases can also pose difficulties at the histological level. This fact highlights the importance of the specialization of uroradiologists and uropathologists and the performance of kidney-sparing therapeutic techniques.