28 June 2023, Volume 76 Issue 4

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  • Article
    Chang Xu, Bixin Chen, Jianneng Pan, Xiaoyang Zhou, Zhaojun Xu, Hua Wang
    Archivos Españoles de Urología. 2023, 76(4): 245-254. https://doi.org/10.56434/j.arch.esp.urol.20237604.28
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    Background: Acute kidney injury (AKI) is frequently caused by sepsis. Recently, the Acute Disease Quality Initiative (ADQI) workgroup further classified AKI as transient or persistent. Oliguria and increased serum creatinine represent two different kinds of renal impairment. The aim of the study was to assess mortality and cumulative AKI score associated with transient and persistent AKI in septic patients.

    Methods: Septic patients were stratified according to the presence and AKI development (considered persistent when remaining >48 h) were included. An adjusted logistic regression model was used to determine hospital mortality. In addition, we calculated an AKI score by combining both Kidney Disease: Improving Global Outcomes (KDIGO) criteria of urine output and creatinine AKI stages. The relationship between the cumulative AKI score and persistent AKI was further examined using the logistic regression model and receiver operating characteristic (ROC) curve analysis.

    Results: 12928 septic patients were enrolled in the study. AKI occurred in 73.7% of septic patients, in 39.5% was transient and in 60.5% was persistent. Patients with persistent AKI had higher severity scores and more severe renal dysfunction upon admission. Persistent AKI, but not transient AKI, was associated with increased intensive care units (ICUs) and hospital mortality. Then we found that the cumulative AKI score was associated with an increased risk of persistent AKI. This association was consistent across three original KDIGO severity stages and subgroup analyses.

    Conclusions: It was found that persistent AKI was independently associated with mortality in septic patients. Furthermore, serum creatinine and urine output criteria had cumulative effects on KDIGO AKI staging and provided more information about the relationship between AKI and outcomes.

  • Article
    Xinyu Shen, Qianqing Pan, Yuhua Huang, Jianan You, Yunyi Chen, Xiang Ding
    Archivos Españoles de Urología. 2023, 76(4): 255-263. https://doi.org/10.56434/j.arch.esp.urol.20237604.29
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    Background: Accurately identifying uric acid stones is pivotal in determining the appropriate treatment strategy for patients. This study aimed to design an innovative nomogram to predict the occurrence of uric acid stones in the upper urinary tract.

    Methods: This retrospective study examined 680 patients with urinary stones from October 2019 to September 2022. Risk factors were identified through univariate and multivariate logistic regression, leading to the development of a nomogram. This model’s validity was then assessed internally using receiver operating characteristic (ROC) curves, the area under the curve (AUC), calibration curves, and decision curve analysis (DCA).

    Results: Our findings revealed that metabolic syndrome (odds ratio (OR) = 4.347, 95% confidence interval (CI) 1.306–14.466, p = 0.017), serum urea levels (OR = 1.004, 95% CI 1.143–2.002, p = 0.004), urinary pH (OR = 0.185, 95% CI 0.059–0.583, p = 0.004), urinary potassium (OR = 0.926, 95% CI 0.875–0.981, p = 0.009), and urinary calcium (OR = 0.693, 95% CI 0.492–0.977, p = 0.037) are independent factors for upper urinary tract uric acid stones. Utilizing the five variables, we developed a predictive nomogram. The AUC of the training cohort and the validation cohort were 0.917 (95% CI 0.871–0.963) and 0.914 (95% CI 0.850–0.978), respectively. Calibration curves indicated strong consistency in both cohorts, and the DCA revealed the model’s clinical utility.

    Conclusions: We devised a reliable and user-friendly nomogram to predict uric acid stones in the upper urinary tract. It is based on metabolic syndrome, serum biochemical markers, and 24-hour urinary parameters. Key determinants include metabolic syndrome, serum urea, urinary pH, urinary potassium and urinary calcium.

  • Article
    Xuehua Zhu, Zenan Liu, Jide He, Ziang Li, Yi Huang, Jian Lu
    Archivos Españoles de Urología. 2023, 76(4): 264-269. https://doi.org/10.56434/j.arch.esp.urol.20237604.30
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    Objective: We aimed to investigate the predictive value of imaging features derived from magnetic resonance imaging (MRI) and develop a radiomics model predicting the biochemical recurrence-free survival (BFS) in prostate cancer (PCa) patients treated with seed brachytherapy (seed-BT).

    Methods: The data of 272 patients with PCa treated with seed-BT at Peking University Third Hospital from 2007 to 2019 was retrospectively investigated. Based on the eligibility criteria, 83 patients were finally included in our study. The cohort was divided into two groups in a ratio of 8:2 (training set: n = 67, test set: n = 16). The Cox survival model combined with the least absolute shrinkage and selection operator (LASSO) algorithm was applied to select the radiomics features from T2WI of pretreatment MRI. A radiomics model with selected features was established to predict the BFS.

    Results: Nineteen patients experienced biochemical recurrence (BCR) during a median follow-up period of 46 months. Three features with non-zero coefficients were selected from 1598 features and used to construct a radiomics model for BCR prediction. The model accurately predicted the BCR in both the training and test groups, for which the concordance index (C-index) were 0.83 and 0.78, respectively. Receiver operating characteristic (ROC) analysis of the test set was conducted to assess the prediction accuracy. The model achieved a high area under the operator curve (AUC) performance for BCR prediction in the test cohort.

    Conclusions: Our study revealed the considerable potential of a radiomics model based on MRI-derived imaging features in BCR prediction of PCa patients after seed-BT. Radiomics provides a new perspective to clinicians assessing the outcome of radiotherapy, facilitating accurate prognostic evaluation and preoperative consultation for PCa patients followed by seed-BT.

  • Article
    Ke Yang, Bin Hu, Guohua Zhu, Dongbo Yuan, Wei Wang, Hao Su, Heng Liu, Jianguo Zhu
    Archivos Españoles de Urología. 2023, 76(4): 270-282. https://doi.org/10.56434/j.arch.esp.urol.20237604.31
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    Background: Prostaglandin E2 receptor 3 (PTGER3, EP3) is essential for many malignancies growth and metastasis. The role of PTGER3 in kidney renal clear cell carcinoma (KIRC) was assessed in terms of its prognosis and its association with immune infiltration.

    Methods: Transcriptomic expression profiles of PTGER3 were acquired from The Cancer Genome Atlas (TCGA) database. Comparative analysis was performed to evaluate the disparity in PTGER3 expression between KIRC and normal tissues. The discriminative potential of PTGER3 as a distinguishing determinant was assessed through receiver operating characteristic (ROC) curves. Prognostic factors were evaluated employing COX regression and logistic models. Furthermore, the impact of PTGER3 on survival was ascertained utilizing the Kaplan–Meier method. A protein-protein interaction (PPI) network was constructed utilizing the STRING database. To investigate the correlation between immune infiltration levels and PTGER3 expression, a single-sample Gene Set Enrichment Analysis (GSEA) method was employed, employing the Gene Set Variation Analysis (GSVA) package and the Tumor Immune Estimation Resource (TIMER) database.

    Results: Bioinformatics analysis unveiled a significant downregulation of PTGER3 expression in KIRC tissues compared to paraneoplastic tissues (p < 0.001). Furthermore, quantitative reverse transcription polymerase chain reaction (qRT-PCR) experiments demonstrated a reduction in PTGER3 expression in 786-O cells in contrast to paraneoplastic tissues (p < 0.01). The ROC curve, employing PTGER3 as a potential diagnostic biomarker, exhibited a substantial area under the curve (AUC) value of 0.929. According to the Kaplan–Meier survival analysis, reduced PTGER3 expression increased the chance of negative overall survival (OS) (p = 0.019). A PPI network was constructed, elucidating the interaction patterns between PTGER3 and the top 10 co-expressed genes. An examination of gene enrichment and immune infiltration levels found a link between PTGER3 transcription and immune infiltration levels. Notably, high B cell counts and low Mast cell counts were connected to a poor prognosis in KIRC patients.

    Conclusions: The expression of PTGER3 was found to be diminished in KIRC in comparison to paracancerous tissue. This observation exhibited a correlation with both prognosis and immune cell infiltration. As a result, our findings suggest that PTGER3 could be considered a promising biomarker to forecast KIRC prognosis and as a possible target for immunotherapy.

  • Article
    Xiaohong Ji, Jianfang Zhang, Yuanyuan Li, Lin Hu
    Archivos Españoles de Urología. 2023, 76(4): 283-289. https://doi.org/10.56434/j.arch.esp.urol.20237604.32
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    Objective: This study aimed to explore the influencing factors of quality of life (QOL) and establish a prediction model in patients with primary nephrotic syndrome (PNS).

    Methods: A single-centre retrospective study was conducted on 245 patients with PNS admitted to Zibo Central Hospital from August 2020 to August 2022. According to the 36-Item Short-Form Health Survey (SF-36) for QOL evaluation, the patients were divided into the good QOL group (the total score ≥50 points) and poor QOL group (the total score <50 points). Univariate analysis was conducted by collecting clinical data from patients, and multiple logistic regression analysis was carried out on single factors with statistically significant differences to construct a clinical prediction model. The diagnostic efficacy of the prediction model was evaluated using the receiver operating characteristic (ROC) curve.

    Results: A total of 245 questionnaires were distributed, and 243 valid questionnaires were recovered, in which 143 cases had good QOL, with an average score of (71.86 ± 10.83) points, and 100 cases had poor QOL, with an average score of (40.03 ± 5.95) points. Statistical differences were observed in age, education level, monthly family average income, payment methods of medical expenses, albumin, 24-hour urinary protein quantification (24 h UPro) and serum uric acid (SUA) in both groups (p < 0.05), whereas no statistical difference was found in gender, body mass index (BMI) and marital status (p > 0.05). The multiple logistic regression analysis showed that age (X1), monthly family average income (X2), payment methods of medical expenses (X3), albumin (X4), 24 h UPro (X5) and SUA (X6) were risk factors for the QOL of patients with PNS, with Y = –12.105 + 0.130X1 + 0.457X2 + 0.448X3 + –0.161X4 + 0.823X5 + 0.025X6 as the regression prediction model. The results of ROC curve showed that the area under the curve (AUC) was 0.987 with standard error of 0.005 (p < 0.001), and 95% CI was 0.976–0.998.

    Conclusions: Age, monthly family average income, payment methods of medical expenses, albumin, 24 h UPro and SUA are risk factors that affect the QOL of patients with PNS, and the construction of prediction model has good evaluation value and can provide a reference for clinical practice.

  • Article
    Xiaoyun Liu, Fengjuan Wang, Wen Du, Xiansong Yang
    Archivos Españoles de Urología. 2023, 76(4): 290-297. https://doi.org/10.56434/j.arch.esp.urol.20237604.33
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    Background: Overexpressed endothelial cell specific molecule-1 (ESM-1) has been identified in various human malignancies, but its expression and function in clear cell renal cell carcinoma (ccRCC) progression are still uncovered. This study explored the critical roles as well as molecular mechanism of ESM-1 in ccRCC progression.

    Methods: The ESM-1 expression in ccRCC tissues and cells was measured using Western blot assay. The function of ESM-1 knockdown in ccRCC cell viability, invasion as well as migration was analysed. Changes in specific proteins were also detected by Western blot analysis.

    Results: The ESM-1 expression increased in ccRCC tissue samples and cells, which indicated poor prognosis. Moreover, ESM-1 silencing considerably inhibited ccRCC cell growth, invasion and migration in vitro. ESM-1 partially promoted ccRCC development through wingless-type mouse mammary tumour integration site family/beta-catenin (Wnt/β-catenin signalling).

    Conclusions: ESM-1 acted as an oncogene by influencing the Wnt/β-catenin pathway in ccRCC.

  • Article
    Yubo Su, Jingwen Ai, Min Jia, Genquan Yue, Lingyan Zhao, Hailing Li, Qi Liu, Dongyang Liu, Yuqi Wang, Wenjing Zhang, Yumin Gao, Haisheng Wang
    Archivos Españoles de Urología. 2023, 76(4): 298-308. https://doi.org/10.56434/j.arch.esp.urol.20237604.34
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    Background: We aimed to examine the relationships between the angiotensinogen (AGT) and vascular endothelial growth factor (VEGF) gene single nucleotide polymorphisms and susceptibility to bladder and kidney cancers.

    Methods: A 1:1 paired case-control study was conducted, which included 143 newly diagnosed kidney cancer cases, 182 newly diagnosed bladder cancer cases, and healthy subjects in the same period collected from two hospitals. Medical records and a questionnaire were used to obtain relevant information. Genotypes were determined by improved multiple ligase detection reaction (iMLDR) and VEGF serum expression levels were detected by enzyme-linked immunosorbent assays (ELISAs).

    Results: The VEGF gene/genotype frequencies of rs833061 and rs1570360 were statistically different among various pathological grades of kidney cancer, while the AGT rs699 gene/genotype frequencies were statistically different among various pathological types of bladder cancer. In kidney cancer, rs699 was associated with smoking, drinking, and hair coloring, while in bladder cancer, rs699, rs1570360, rs3025039, and rs833061 were associated with smoking, drinking, hair coloring, exercise, and urine holding.

    Conclusions: This work will help identify biomarkers that can predict the early metastasis and recurrence of kidney or bladder cancer, as well as help improve patient survival rates by predicting their susceptibility.

    Significance: This work will provide reference for the prevention and treatment of kidney and bladder cancers.

  • Case Report
    Qian Chen, Junbing Ye, Xiaobin Li, Rong Chen, Shiping Zeng
    Archivos Españoles de Urología. 2023, 76(4): 309-312. https://doi.org/10.56434/j.arch.esp.urol.20237604.35
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    Background: Among prostate cancer, primary prostate squamous cell carcinoma (SCC) is a rare condition with low incidence, and secondary prostate SCC is rarer with fewer cases reported globally. This report presents an extremely rare case of secondary prostate SCC that metastasised from lung cancer.

    Case Presentation: This study reports the case of a 77-year-old man who presented with acute urinary retention and dysuria and was admitted to our hospital. Physical and digital rectal examinations were conducted and revealed the overfilling of the suprapubic bladder and a slightly enlarged prostate without palpable nodules, respectively. The patient was tested negative for total and free prostate antigens (PSA) and had large masses in the upper lobes of both lungs and an irregularly enlarged prostate in the computed tomography images. The patient was inserted immediately with 18F triple-cavity Foley catheter to drain haematuria with blood clots. The patient was treated with electric coagulation haemostasis and transurethral resection of the prostate and subjected to postoperative histopathological analysis, which revealed the diagnosis of SCC. The patient was advised to undergo further radiation therapy and chemotherapy but rejected all follow-up treatments for lungs and prostate. The patient recovered uneventfully and was discharged 7 days after the operation. The patient remained alive after 6 months of follow-up.

    Conclusions: Secondary prostate SCC is an extremely rare type of tumour. Surgical intervention plays a role in stopping bleeding and relieving urination problems, and timely treatment may led to favourable prognosis.