28 October 2023, Volume 76 Issue 8

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  • Article
    Yajun Wang, Pei Liu, Meili Duan
    Archivos Españoles de Urología. 2023, 76(8): 548-554. https://doi.org/10.56434/j.arch.esp.urol.20237608.68
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    Background: Knowledge about acute kidney injury (AKI) in paediatric patients after liver transplantation is limited. This study focused on the prevalence and contributing factors of AKI and its impact on the postoperative outcomes of paediatric recipients.

    Methods: The data of 211 paediatric patients (<12 years old) who, from December 2018 to November 2020, received first-time liver transplantation for end-stage liver disease or advanced hepatic failure in our hospital were processed for retrospective analysis. According to the criteria of the Kidney Disease Improving Global Outcomes, all patients were dichotomised into AKI and non-AKI groups. The preoperative characteristics of the patients, laboratory test results, donor type and intraoperative parameters between the two groups were compared. The effects of AKI on the postoperative outcomes of paediatric recipients were analysed. The risk factors for AKI after liver transplantation were analysed by multivariate logistic regression.

    Results: The incidence of AKI within the first seven days after paediatric liver transplantation was 34.1%. AKI at stages I, II and III accounted for 69.4%, 22.2% and 8.3%, respectively. Compared with non-AKI patients, AKI patients had a higher proportion of hepatic cirrhosis (p = 0.039) and ascites (p = 0.003); Worse hepatic function (prolonged prothrombin time, activated partial thromboplastin time, decreased level of serum albumin and increased international normalised ratio and total bilirubin level); Higher paediatric end-stage liver disease (PELD) score (p = 0.008); And larger amount of intraoperative blood loss (p < 0.001), fluid positive balance (p = 0.035), red blood cells (RBCs) (p < 0.001) and fresh frozen plasma transfusion (p < 0.001). The multivariate logistic regression analysis demonstrated that ascites (odds ratio (OR): 2.273, p = 0.040), PELD (OR: 1.027, p = 0.013) and RBCs transfusion (OR: 1.033, p < 0.001) were independent contributing factors to AKI in paediatric patients who received liver transplantation. AKI contributed to prolonged hospital stays but did not increase hospital mortality.

    Conclusions: The onset of AKI can markedly prolong the hospital stay, and is common in paediatric patients undergoing liver transplantation. Poor hepatic function and large RBC transfusion contribute to AKI after liver transplantation.

  • Article
    Guanan Zhao, Zhoumin Pan, Peng Wang
    Archivos Españoles de Urología. 2023, 76(8): 555-562. https://doi.org/10.56434/j.arch.esp.urol.20237608.69
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    Objective: To explore the prognostic value of combined detection of serum prostate specific antigen (PSA), lung cancer metastasis-associated transcript 1 (MALAT1), transmembrane serine protease 2 (TMPRSS2), and erythropoietin-specific transforming gene variant 1 (ETV1) in prostate cancer.

    Methods: Ninety patients with prostate cancer who were treated in hospital were divided into two groups according to tumor node metastasis stage: Stage I−II group (n = 34) and stage III−IV group (n = 56). The serum levels of PSA, MALAT1, and TMPRSS2-ETV1 were detected in both groups and correlated with prostate cancer status to determine their value as indicators of disease progression and prognosis.

    Results: Age, body mass index (BMI), and Gleason score differed significantly between the study group and the control group (p < 0.05). The expression levels of serum PSA and MALAT1 were higher in group III–IV than in group I–II, and the positive expression rate of TMPRSS2-ETV1 was significantly higher in group III–IV than in the control group (p < 0.05). Pearson’s correlation analysis showed that serum PSA, MALAT1, and TMPRSS2-ETV1 were significantly correlated with prostate cancer (p < 0.05). Differences in PSA levels correlated with differences in age, BMI, type of pathology, and Gleason score, whereas differences in serum MALAT1 levels correlated with differences in age, BMI, and type of pathology. Gleason scores differed significantly between patients with positive and negative TMPRSS2-ETV1 indicators (p < 0.05). Multivariate logistic regression analysis showed that serum PSA, MALAT1, and TMPRSS2-ETV1 were independent risk factors affecting the prognosis of prostate cancer (p < 0.05). The areas under the curve (AUCs) of serum PSA, MALAT1, and TMPRSS2-ETV1 as prognostic predictors in prostate cancer were 0.692, 0.731, and 0.709, respectively, whereas the AUC of the combination was 0.819. Assessment of disease progression using the combination of indicators had a significantly higher prognostic value than single indicators (p < 0.05).

    Conclusions: Serum levels of PSA, MALAT1, and TMPRSS2-ETV1 were abnormal in patients with prostate cancer, and the combined detection of these factors provided a reference for assessing disease progression and predicting the prognosis of prostate cancer.

  • Article
    Jianghua Xue, Ning Liu, Chen Su
    Archivos Españoles de Urología. 2023, 76(8): 563-569. https://doi.org/10.56434/j.arch.esp.urol.20237608.70
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    Objective: This study aimed to explore the effect of terazosin hydrochloride combined with interventional embolisation on prostate volume and quality of life (QOL) of elderly patients with prostatic hyperplasia (PH).

    Methods: The clinical data of 175 elderly patients with PH admitted to Central Hospital Affiliated to Shandong First Medical University from July 2020 to July 2022 were selected for retrospective analysis. Based on different treatment regimens, 89 patients who received interventional embolisation alone were included in the control group (CG), and 86 patients undergoing interventional embolisation combined with terazosin hydrochloride were included in the study group (SG). The prostate volume, serum indicators, adverse reactions and QOL of the two groups before and after treatment were compared between the two groups.

    Results: Before treatment, no significant difference in 36-item short-form health survey (SF-36) scores, serum tumour necrosis factor-α (TNF-α) and prostate-specific antigen (PSA) was observed in both groups (p > 0.05). After treatment, the SF-36 score in the SG was 78.20 ± 6.84 points, which was significantly higher than that in the CG (72.67 ± 5.94 points). In addition, the SG had remarkably lower residual urine volume and prostate volume, higher maximum flow rate and lower TNF-α and PSA levels compared with the CG (p < 0.05). The adverse reaction rate of the SG was only 4.65%, which was significantly lower than that of the CG (14.61%, p < 0.05).

    Conclusions: Terazosin hydrochloride combined with interventional embolisation overtly reduces the prostate volume and improves the clinical symptoms of patients with fewer side effects, which has a certain clinical application value.

  • Article
    Hui Guo, Jie Li, Xianfeng Lu
    Archivos Españoles de Urología. 2023, 76(8): 570-578. https://doi.org/10.56434/j.arch.esp.urol.20237608.71
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    Objective: The diagnostic value of multi-slice helical computed tomography (MSCT) reconstruction parameters combined with 3.0 T magnetic resonance (MR) in clear cell renal cell carcinoma (CCRCC) was analysed.

    Methods: A total of 158 patients with renal tumours were selected in First Hospital in Zibo city from February 2018 to March 2023 for the retrospective study and divided into CCRCC and non-CCRCCs groups according to the final results of pathological diagnosis. MSCT detection and 3.0 T MR detection were performed in both groups for imaging manifestation analysis. The receiver operating characteristic (ROC) curve was used in analysing the clinical efficacy of each single and combined diagnosis.

    Results: The results of pathological diagnosis showed 115 patients with CCRCC and 43 non-CCRCC patients, accounting for 72.78% and 27.22%, respectively. Patients with CCRCC had higher proportions of calcification, necrosis, cystic degeneration and more pseudocapsules than non-CCRCC patients (p < 0.05). Patients with CCRCC mainly showed peripheral and heterogeneous enhancement, whereas non-CCRCC patients mainly showed homogeneous enhancement, and the difference was significant (p < 0.05). The cortical phase, parenchymal phase and excretion stage had higher computed tomography (CT) values in the CCRCC group (p < 0.001), and no significant difference in the CT value of plain scan phase was found between the groups (p > 0.05). The CCRCC group had obviously higher apparent diffusion coefficient value and incidence of necrosis and cystic degeneration (p < 0.001), lower incidence of haemorrhage (p < 0.05) and distinctly higher cortical enhancement indexes in the cortical phase, parenchymal phase and delay period (p < 0.001). The ROC analysis showed that the area under the curve, specificity, sensitivity and 95% CI of combined detection were higher than those of each single detection.

    Conclusions: The combination of MSCT reconstruction parameters and 3.0 T MR has a certain diagnostic value for CCRCC. The combined diagnosis has higher area under the curve, specificity, sensitivity and 95% CI, which can provide effective reference for clinical diagnosis and treatment, with a certain clinical application value.

  • Article
    Weiqiang Jiang, Tian Nie, Ping Jin
    Archivos Españoles de Urología. 2023, 76(8): 579-587. https://doi.org/10.56434/j.arch.esp.urol.20237608.72
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    Objectives: The therapeutic effect of acupuncture treatment on chronic kidney disease (CKD) was assessed, and the characteristics of acupoint selection in different CKD types were summarised.

    Methods: A total of 100 patients with CKD were enrolled in this retrospective cohort study, of whom 50 received acupuncture treatment for 12 weeks (acupuncture group) and 50 received routine treatment for 12 weeks (control group). Routine treatment included appropriate rest, low-salt and low-protein diet and correction of the disturbance in water, electrolyte and acid-base balance. Hypertensive patients received antihypertensive treatment, and patients with hyperuricaemia received uric acid lowering treatment. Acupuncture acupoints were selected in accordance with traditional Chinese medicine (TCM) theory. Baseline characteristics, therapeutic effects and adverse events were assessed, and kidney function indexes, urine albumin creatine ratios (UACRs) and estimated glomerular filtration rates (eGFRs) were compared at different time points (before acupuncture treatment, T1; Immediately after acupuncture treatment, T2; After 3 months of follow-up, T3).

    Results: The baseline data were slightly different between the groups (p > 0.05), specifically gender, age, duration time, TCM syndrome, CKD stage, systolic blood pressure (SBP), diastolic blood pressure (DBP), and cholesterol, triglyceride, low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). The acupuncture group presented better therapeutic effects than the control group (82.00% vs. 60.00%, p = 0.015). At T2 or T3, the value of UACR in both groups obviously decreased (p < 0.05), whereas the eGFRs markedly increased (p < 0.05). In addition, at T2 or T3, the UACRs were significantly lower in the acupuncture group than in the control group (p < 0.01), whereas an opposite result was obtained for eGFR (p < 0.05). The adverse event rate barely differed between the groups (8.00% vs. 6.00%, p = 0.695).

    Conclusions: Acupuncture treatment can effectively treat CKD and can improve kidney function. This study provides a theoretical basis for clinical application.

  • Article
    Lili Yu, Hong Sun, Minxia Che, Wentao Gai
    Archivos Españoles de Urología. 2023, 76(8): 588-595. https://doi.org/10.56434/j.arch.esp.urol.20237608.73
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    Purpose: This study reviewed and analysed the serological indexes, clinical efficacy and common clinical indexes of patients with metastatic castration-resistant prostate cancer (mCRPC) treated with combination of abiraterone hydrochloride tablets and endocrine therapy.

    Method: This study is a retrospective analysis. A total of 133 mCRPC patients who were admitted to our hospital from January 2019 to December 2021 were selected as the study subjects. The patients were categorised into the experimental group (n = 51) and control group (n = 82) according to their treatment method. The control group was treated with docetaxel combined with endocrine therapy, whilst the experimental group was treated with combination therapy with abiraterone hydrochloride tablets. Subsequently, the clinical data of the two groups, including serum insulin-like growth factor-1 (IGF-1), human glandular kallikrein 2 (hK2), prostate specific antigen (PSA), vascular endothelial growth factor (VEGF) and serum carcinoembryonic antigen (CEA), were analysed.

    Result: The overall response rate of the experimental group (84.3%) was higher than that of the control group (72.0%). The serum levels of CEA, total prostate specific antigen, free prostate specific antigen, testosterone and androgen receptor splice variant 7 in both groups were lower than those of before treatment, and the values obtained by the experimental group were lower than those of the control group (p < 0.05). After treatment, the levels of CD3+, CD4+ and CD4+/CD8+ in both groups were higher than those before treatment, and the levels of CD8+, IGF-1, hK2, PSA and VEGF in the two groups decreased after treatment (p < 0.05).

    Conclusions: The use of abiraterone hydrochloride tablet combined with endocrine therapy for patients with mCRPC is effective and can improve clinical symptoms and serum cytokine levels.

  • Article
    Zhaohui Tian, Jia Liu, Mingyue Zeng, Qingqi Zeng
    Archivos Españoles de Urología. 2023, 76(8): 596-604. https://doi.org/10.56434/j.arch.esp.urol.20237608.74
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    Background: Tong Jing Yi Hao Formula (TJYHF) is a Traditional Chinese medicine used for oligoasthenospermia (OAS) treatment. However, the role of TJYHF against OAS is unclear. This study was an initial attempt to solve this problem.

    Methods: Rats were randomly allocated to normal, ornidazole (Orn), levocarnitine (450 mg/kg), low-dose TJYHF (6.5 g/kg) and high-dose TJYHF (26 g/kg) groups, each consisting of six rats. Oral administration of Orn (400 mg/kg) for 4 weeks was used to induce OAS, followed by oral doses of the respective drugs for an additional 4 weeks. Parameters, including the testicular index, epididymis index, testicular volume, sperm parameters, sex hormone levels, histological changes and markers of oxidative stress, were evaluated to assess the effects of treatment. The potential mechanism involved in the therapeutic effects of TJYHF was studied by evaluating the activity and expression levels of key molecules within the reactive oxygen species (ROS)/mitogen-activated protein kinase (MAPK)/hypoxia-inducible factor 1 (HIF-1) pathway.

    Results: Compared with healthy rats, the Orn-induced rats demonstrated decreases in testicular index, epididymis index, testicular volume, sperm concentration, total sperm count, percentage of forwarding sperm motility, total sperm motility, testosterone, spermatogenic epithelium, reproductive cell, glutathione peroxidase, superoxide dismutase and glutathione and increases in sperm deoxyribonucleic acid fragmentation index, follicle-stimulating hormone, luteinizing hormone and malondialdehyde. In the testicles, an enhancement in the ROS level and phosphorylation levels of extracellular signal-regulated kinase 1/2 (ERK1/2), c-jun N-terminal kinase (JNK) and p38 mitogen-activated protein kinase (p38) was observed after Orn challenge. Moreover, the protein expression levels and immunostaining intensity of p38 and HIF-1α increased, indicating the activation of the ROS/MAPK/HIF-1 pathway. All of the aforementioned changes exhibited statistical significance (p < 0.01). Compared with Orn-induced rats, TJYHF effectively rescued the Orn-induced aforementioned disorders. Mechanistically, TJYHF suppressed the ROS level and ERK1/2, JNK and p38 phosphorylation levels. Besides, it reduced the protein expression levels and immunostaining intensity of p38 and HIF-1α, demonstrating the inactivation of the ROS/MAPK/HIF-1 pathway. Notably, the aforementioned enhancements demonstrated statistical significance (p < 0.01).

    Conclusions: TJYHF exerted a beneficial effect on reproductive function in OAS rats through the inhibition of the ROS/MAPK/HIF-1 pathway.

  • Article
    Cheng Li, Zhengqiang Wan, Qilang Deng, Zhigang Li, Yinglei Wang
    Archivos Españoles de Urología. 2023, 76(8): 605-621. https://doi.org/10.56434/j.arch.esp.urol.20237608.75
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    Background: The aim of this study was to investigate the common gene signatures and potential molecular mechanisms of bladder urothelial carcinoma (BLCA) and metabolic syndrome (MS).

    Methods: Transcriptome data for BLCA and MS were obtained from the Gene Expression Omnibus (GEO) database. Weighted gene co-expression network analysis (WGCNA) was utilized to identify co-expression networks associated with BLCA and MS, and five hub genes were further screened and validated using logistic least absolute shrinkage and selection operator (LASSO) regression models and receiver operating characteristic (ROC) curve, and external dataset for validation. The relationship between the hub genes and the clinicopathological characteristics and prognosis of BLCA patients was explored in the GEO and The Cancer Genome Atlas (TCGA)-BLCA cohorts, respectively. Differences in the immune microenvironment of BLCA and MS were analyzed using the database CIBERSORT and the R package “ssGSEA”, and the correlation between hub genes and tumor microenvironment, immune score and targeted drugs was analyzed with the help of the TCGA-BLCA cohort. Finally, BLCA single-cell RNA (scRNA) data were used to analyze the expression levels of the hub genes in various cell types of BLCA and molecular mechanisms.

    Results: Five hub genes were screened by WGCNA and LASSO regression analysis, namely AP2-associated protein kinase 1 (AAK1), ATP-binding cassette subfamily F member 2 (ABCF2), Mitochondrial ribosomal protein L42 (MRPL42), La-related protein 3 (SSB) and TATA-box binding protein-associated factor 10 (TAF10). Analyzed in the GEO and TCGA-BLCA cohorts, we found that the hub genes (TAF10 and ABCF2) were closely associated with the clinicopathological characteristics and prognosis of BLCA patients. In CIBERSORT, we discovered that the hub genes are closely linked to the immune microenvironment, immune score, and especially with dendritic cells (DCs). In the single-cell RNA sequencing (scRNA-seq) analysis of BLCA, we identified that SSB was significantly differentially expressed in BLCA and normal bladder tissues and that it plays an important role in the development of BLCA.

    Conclusions: The interaction of BLCA with MS may be associated with several cancer pathways being activated and identified TAF10 and ABCF2 as potential biomarkers and therapeutic targets for patients with BLCA and MS.

  • Case Report
    Tianxi Yu, Xin Cui, Ning Liang, Shuang Wu, Chunhua Lin
    Archivos Españoles de Urología. 2023, 76(8): 622-626. https://doi.org/10.56434/j.arch.esp.urol.20237608.76
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    Background: Penile metastases are extremely rare events, originating primarily from primary pelvic tumours of the prostate, bladder, and gastrointestinal tract. The underlying mechanism of bladder cancer metastasis to the penis remains unclear. Metastasis to the penis is usually considered a late manifestation of systemic spread. Therefore, the prognosis of patients with penile metastasis remains poor and their survival period is short. Therefore, reporting this rare case will help to better understand the characteristics, diagnosis, and treatment processes of the disease, with the aim of improving the accuracy and efficiency of diagnosis and treatment.

    Case Description: A 65-year-old male received transurethral resection of a bladder tumor. One year later, he underwent radical cystectomy because of the recurrence and progression of bladder cancer. Postoperative pathology demonstrated that the stage of bladder cancer was T3N0M0. One year later, he discovered a penile mass that gradually grew and became hard, accompanied by urinary retention, but without other clinical symptoms. The patient underwent a complete penectomy. Histopathology and immunohistochemistry results demonstrated the tumour’s origin as a bladder urothelial carcinoma. The patient received systemic chemotherapy after surgery, but died 7 months later.

    Conclusions: Although penile metastasis of bladder cancer typically indicates an advanced stage of the malignant tumour and poor prognosis, we recommend that male patients with a history of bladder cancer should undergo a regular clinical examination of the penis to rapidly detect the disease and receive early treatment. In this case, despite treatment measures such as systemic chemotherapy and penectomy, the patient’s prognosis remained poor.

  • Case Report
    Haiping Yang, Pingjiang Wang
    Archivos Españoles de Urología. 2023, 76(8): 627-632. https://doi.org/10.56434/j.arch.esp.urol.20237608.77
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    Background: Non-Hodgkin’s lymphoma (NHL) seldom involves the kidney, and it is even more uncommon for the kidney to be the primary renal non-Hodgkin’s lymphoma (PRNHL). Due to its rarity, PRNHL is often confused with renal cell carcinoma (RCC). Tumor collision refers to the simultaneous development of two histologically distinct malignancies in the same organ or space. Collision kidney tumors have already been described but only in a few cases. Here, we report an extremely unusual case involving a collision tumor between PRNHL and RCC.

    Case Presentation: During a routine physical examination, a 61-year-old male was diagnosed with a tumor in his left kidney. The patient underwent a laparoscopic left partial nephrectomy. A 3.2 cm renal mass was seen on gross examination of the nephrectomy specimen, and the final pathology showed two different tumor types. The first type was a typical clear cell renal cell carcinoma (ccRCC), which made up the majority of the overall tumor. The second was composed of small- to medium-sized lymphoid monomorphic cells with uneven nuclei. Immunohistochemistry confirmed the diagnosis of a collision tumor consisting of PRNHC and ccRCC. After surgery, the patient received five courses of cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) therapy. With the gradual deterioration of all aspects of his physical function, the patient finally died of respiratory failure 15 months later.

    Conclusions: We present a rare case of a collision tumor consisting of renal cell carcinoma and primary renal non-Hodgkin’s lymphoma. Despite their rarity, it is essential to report such cases to further understand the behavior of these tumors and develop evidence-based treatment strategies.