28 November 2023, Volume 76 Issue 9

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  • Review
    Yoichiro Okubo, Shinya Sato, Hideyuki Terao, Yayoi Yamamoto, Atsuto Suzuki, Chie Hasegawa, Emi Yoshioka, Kyoko Ono, Kota Washimi, Tomoyuki Yokose, Noboru Nakaigawa, Takeshi Kishida, Yohei Miyagi
    Archivos Españoles de Urología. 2023, 76(9): 633-642. https://doi.org/10.56434/j.arch.esp.urol.20237609.78
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    Prostate cancer remains a significant global health challenge. Traditionally anchored by the Gleason score/Grade Group (GS/GG), the landscape of prostate cancer diagnosis is undergoing transformative steps, particularly in the domain of biopsy procedures. GS/GG continues to be pivotal in malignancy grading, but recent technological strides have augmented the diagnostic relevance of biopsies. Integral to this progression is the adoption of advanced imaging techniques, especially magnetic resonance imaging, which has refined biopsy accuracy and efficiency. A deep understanding of prostate cancer pathology reveals a cribriform pattern and intraductal carcinoma of the prostate as independent forms of malignancy, suggesting a potentially aggressive disease course. Furthermore, the distinct behaviour of ductal adenocarcinoma and small cell carcinoma of the prostate, compared with acinar adenocarcinoma, necessitates their accurate differentiation during biopsy. The genomic era ushers in a renewed emphasis on tissue samples obtained from prostate biopsies, especially as mutations in genes, such as BRCA1/2, and paves the way for precision medicine. This review encapsulates the evolving dynamics of prostate biopsy, from technological advancements to the profound implications on prostate cancer management and therapy.

  • Review
    Mohamed A.A.A. Hegazi, Gianluigi Taverna, Fabio Grizzi
    Archivos Españoles de Urología. 2023, 76(9): 643-656. https://doi.org/10.56434/j.arch.esp.urol.20237609.79
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    Benign prostatic hyperplasia (BPH) is a prevalent condition among older men that is characterized by the enlargement of the prostate gland and compression of the urethra, which often results in lower urinary tract symptoms, such as frequent urination, difficulty in starting urination, and incomplete bladder emptying. The development of BPH is thought to be primarily due to an imbalance between cell proliferation and apoptosis, underlying inflammation, epithelial-to-mesenchymal transition, and local paracrine and autocrine growth factors, although the exact molecular mechanisms are not yet fully understood. Anatomical structures considered natural and benign observations can occasionally present multi-parametric magnetic resonance imaging appearances that resemble prostate cancer (PCa), posing a risk of misinterpretation and generating false-positive outcomes and subsequently, unnecessary interventions. To aid in the diagnosis of BPH, distinguish it from PCa, and assist with treatment and outcome prediction, various Artificial Intelligence (AI)-based algorithms have been proposed to assist clinicians in the medical practice. Here, we explore the results of these new technological advances and discuss their potential to enhance clinicians’ cognitive abilities and expertise. There is no doubt that AI holds extensive medical potential, but the cornerstone for secure, efficient, and ethical integration into diverse medical fields still remains well-structured clinical trials.

  • Article
    Xuena Dong, Yuhan Wang, Shuhui Wang, Cong Li, Min Zhang, Fanglin Hou
    Archivos Españoles de Urología. 2023, 76(9): 657-665. https://doi.org/10.56434/j.arch.esp.urol.20237609.80
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    Objective: To observe the clinical effect of the combination of compound Kushen injection (CKI) and gemcitabine on postoperative patients with non-muscular invasive bladder cancer (NMIBC) and its influence on serum-related factors.

    Methods: A total of 150 patients with NMIBC were randomly divided into two groups. The patients in the control group (n = 75) received gemcitabine therapy; They were given 0.2 g gemcitabine once a week for 8 weeks after surgery and then changed to once every 2 weeks for eight times. The patients in the observation group (n = 75) were given CKI treatment on the basis of the control group for 10 days. The treatment was continued for three courses. After continuous follow-up for 2 years, the blood biochemistry, serum-related factors and immune T cell subsets and the safety and immune function changes, total effective rate, recurrence rate and occurrence of adverse reactions were evaluated.

    Results: The interferon-γ, interleukin (IL)-2, clusters of differentiation (CD)8+, serum cell adhesion molecules (CAMs), hepatocyte CAM and cysteine proteinase-8 levels in the two groups after treatment significantly increased compared with those before treatment (p < 0.05), with the observation group showing more increase (p < 0.05). However, the tumour necrosis factor-α, C-reactive protein (CRP), IL-6, CD3+, CD4+, matrix metalloproteinase (MMP)-9, MMP-2, epithelial-specific CAM, soluble CAM-1, liver CAM, E-cadherin, vascular endothelial growth factor and fibroblast growth factor levels decreased significantly after treatment (p < 0.05), with the observation group exhibiting more decrease (p < 0.05). The adverse reactions and recurrence rate in the observation group obviously decreased in comparison to those in the control group (p < 0.05).

    Conclusions: The combination of CKI and gemcitabine can improve the inflammatory response, relieve the clinical symptoms of patients and reduce adverse clinical symptoms during gemcitabine infusion chemotherapy, with high safety.

  • Article
    Yifu Chen, Jianjun Hu, Liucheng Peng, Yaowang Zhao
    Archivos Españoles de Urología. 2023, 76(9): 666-673. https://doi.org/10.56434/j.arch.esp.urol.20237609.81
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    Objective: This study aimed to explore the incidence of postoperative urethral stricture in children after hypospadias surgery, analyse its risk factors, and construct a prediction model.

    Methods: We retrospectively analysed the clinical data of 402 children with hypospadias surgery in Hunan Children’s Hospital from January 2022 to January 2023. To explore the risk factors of urethral stricture after hypospadias surgery in children, the incidence of postoperative urethral stricture in children was statistically analysed, and univariate and multivariate logistic regression analyses were adopted. A prediction model was established, and the prediction efficiency of the model was examined using a receiver operating characteristic curve.

    Results: The incidence of postoperative urethral stricture in children after hypospadias surgery was 9.20% (37/402). On this basis, the children were divided into stricture group (SG, n = 37) and normal group (NG, n = 365). Both groups had overt differences in disease classification, urinary tract infection, indwelling-catheter time, and surgical methods (p < 0.05). Logistic regression analysis showed that urinary tract infection, surgical methods, and long indwelling-catheter time were the risk factors (p < 0.001). The prediction model constructed based on the above results had certain prediction efficiency.

    Conclusions: More attention should be paid to children with urinary tract infection, high-risk surgery, and long indwelling-catheter time after hypospadias surgery. Our prediction model can serve as an effective reference for evaluating the occurrence of postoperative urethral stricture.

  • Article
    Junxiu Dong, Xianhui Zhao, Yan Wang, Min Zhang, Weiling Wang, Yun Liu
    Archivos Españoles de Urología. 2023, 76(9): 674-679. https://doi.org/10.56434/j.arch.esp.urol.20237609.82
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    Objective: To explore the clinical diagnostic value of ultrasound elastography (UE) combined with serum testosterone (T) detection in prostate cancer (PCa).

    Method: A total of 155 patients with suspected PCa admitted to Affiliated Qingdao Third People’s Hospital from January 2020 to January 2022 were included in this study. All the patients underwent UE detection and serum T examination and were divided into positive and negative groups based on histopathological examination results. The detection rates of UE detection, serum T detection and combined detection of the two were compared. T test, nonparametric test and binary logistic regression were used for statistical analysis. The diagnostic efficiencies of single and combined detection were analysed using the receiver operating characteristic (ROC) curve.

    Result: After the pathological confirmation, 71 cases were classified under the positive group and 84 cases in the negative group. The positive group had significantly higher elastic strain ratio and elastic-image compression index level and a significantly lower serum T level than the negative group (p < 0.05). Elastic strain ratio, elastic image compression index and serum T level were all risk factors for PCa (p < 0.05). ROC analysis showed that the sensitivity of combined detection was significantly higher than that of single detection.

    Conclusions: Offering a certain clinical application value, the application of combined UE and serum T detection in the clinical diagnosis of PCa can compensate for the shortcomings of single diagnosis, improve diagnostic sensitivity and accuracy and provide a new direction for the clinical diagnosis of PCa.

  • Article
    Ting Wu, Zhiqin Zhang, Haowen Huang, Xiaoyan Wu
    Archivos Españoles de Urología. 2023, 76(9): 680-689. https://doi.org/10.56434/j.arch.esp.urol.20237609.83
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    Objective: We conducted bioinformatics analysis of the gene chip data of empagliflozin for diabetic nephropathy (DN). The differentially expressed genes (DEGs) between DN and control mice and between DN and DN treated with empagliflozin (DNE) mice were screened to explore the related metabolic pathogenesis and predict the potential competing endogenous RNA (ceRNA)-related networks’ metabolic mechanism of the empagliflozin effect on DN.

    Methods: The intersection of DEGs in mice between the control and DN groups and between the DN and DNE groups was selected. GO (Gene Ontology) and KEGG (Kyoto Encyclopedia of Genes and Genomes) analyses were performed, and the metabolic items involving the most genes in the coregulation were considered. A protein-interaction network was constructed with the STRING website. Cytoscape software and its plug-ins were utilised to analyse the hotspot differential genes. The noncoding RNAs in which the differential genes may play a role were obtained from the miRanda, miRDB, and TargetScan databases to establish network diagrams.

    Results: Analysis of the diabetes and control groups showed that 424 genes were upregulated and 354 were downregulated. In the analysis of DEGs between the DN and diabetic groups, the comparison between the diabetic and empagliflozin groups showed that 430 genes were upregulated and 84 were downregulated. The co-downregulated enrichment results were primarily reflected in various metabolic disorders, including glucose metabolism, lipid metabolism, amino acid metabolism, and others. The co-upregulated genes were associated with the inflammatory response, apoptosis, and cell senescence. This finding indicated that empagliflozin may inhibit the progression of diabetic nephropathy by inhibiting inflammation, apoptosis, and senescence. The key genes and related mechanisms of noncoding RNA were determined through Cytoscape analysis and the prediction of common DEGs in metabolic items.

    Conclusions: The analysis of DEGs and key core genes in this study enhanced our understanding of the effect of empagliflozin on the pathogenesis of DN and provided more potential gene targets and application ideas for DN treatment.

  • Article
    Xiaofeng Wang, Tianqi Wang, Gang Wu, Zhunan Xu, Fengze Sun, Chu Liu, Jitao Wu
    Archivos Españoles de Urología. 2023, 76(9): 690-695. https://doi.org/10.56434/j.arch.esp.urol.20237609.84
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    Background: To investigate the correlation between temperature and testicular torsion in Jiaodong Peninsula which has temperate continental monsoon climate and is represented by Yantai and its surrounding areas.

    Methods: A retrospective analysis was conducted by reviewing clinical data of 292 patients who were admitted and surgically confirmed to have testicular torsion in the Yantai Yuhuangding hospital medical complex between January 1, 2009, and August 31, 2022. Male patients who underwent circumcision (foreskin) were allocated to the control group. Temperature data were obtained from the China Meteorological Data Service Center. Chi-squared test or Fisher’s exact test and one-way analysis of variance were employed to compare patient characteristics and climatic variables among the different groups. Pearson’s correlation analysis was used to analyze the association between monthly average ambient temperature and monthly cumulative number of cases. Moreover, a logistic regression model was utilized to identify the independent factors of testicular torsion.

    Results: The mean age of patients with testicular torsion was 16.8 years. The number of cases was the highest in autumn. The temperature was the highest in summer and the lowest in winter (p < 0.01). Furthermore, the temperature difference (TD) in autumn was the highest in the four seasons groups (p < 0.01). The patients were divided into the high TD and low TD groups according to the mean TD (7.62 C) on the admission day. The high TD group had a higher number of patients than the low TD group, and the temperature was lower in the former group than in the latter group (p < 0.01). A roughly negative correlation was observed between ambient temperature and the number of cases (Pearson’s r = −0.228, 95% confidence interval (CI): −0.366 to −0.079, p = 0.003). Logistic regression analysis revealed that the independent risk factor for testicular torsion was TD on admission day (odds ratio, 1.82; 95% CI, 1.28–2.59; p < 0.001).

    Conclusions: To some extent, external temperature can affect the body surface temperature of patients and then induce testicular torsion. We concluded that testicular torsion easily occurs in the season in which the temperature drops and the TD is high.

  • Article
    Yifeng Gu, Yongchang Chen, Yan Zhao, Ge Zhang, Ke Lu, Jun Hu, Zhenyu Fu
    Archivos Españoles de Urología. 2023, 76(9): 696-702. https://doi.org/10.56434/j.arch.esp.urol.20237609.85
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    Background: Percutaneous nephrolithotomy (PCNL) is a proven and efficient treatment method; Nevertheless, it is essential to note that there is still a risk of significant bleeding. The purpose of this paper is to explore the risk factors for massive hemorrhage after PCNL in the oblique supine position and provide a basis for the development of measures to prevent massive hemorrhage.

    Methods: The clinical data of 97 patients who underwent PCNL in the oblique supine position at Changshu No. 2 People’s Hospital from January 2019 to December 2020 were retrospectively analyzed. Patients were placed in the massive hemorrhage group if their hemoglobin levels decreased by ≥20 g/L 24 h after the operation, and the other patients were placed in the nonmassive hemorrhage group. Differences in sex, age, body mass index (BMI), hypertension, diabetes, surgical side, perirenal fat stranding (PFS), calculus long diameter, surgical access, and operation time were compared between the two groups to determine the risk factors for massive bleeding. Multivariable logistic regression analysis was used to determine the risk factors for massive hemorrhage after PCNL.

    Results: There were no significant differences in sex, BMI, hypertension, diabetes, surgical side, or calculus long diameter between the two groups (p > 0.05), and there were statistically significant differences in age, PFS, surgical access, and operation time (p < 0.05). Multivariate logistic regression analysis indicated that PFS and extensive surgical access were independent risk factors (p < 0.05).

    Conclusions: PFS and extensive surgical access were independent risk factors. Carefully reading computed tomography (CT) films before surgery and reducing the size of the surgical access area are important measures for reducing the risk of massive hemorrhages.

  • Article
    Ruimei Yu, Jingwu Ge, Yu Lei
    Archivos Españoles de Urología. 2023, 76(9): 703-710. https://doi.org/10.56434/j.arch.esp.urol.20237609.86
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    Background: This study aimed to explore the effects of different nursing modes on immune function and renal function in patients with renal calculus and on percutaneous nephrolithotomy (PCNL).

    Methods: A total of 160 patients with kidney stone who were admitted to our hospital from January 2017 to January 2023 were retrospectively selected and equally divided into routine and comprehensive nursing groups. Both groups were treated with percutaneous nephrolithotomy, but the patients in the routine nursing group were treated with usual care, whereas the patients in the comprehensive nursing group were treated with comprehensive nursing. The levels of serum T lymphocyte subsets were detected by flow cytometry, the levels of serum immune indicators and renal function indicators in the two groups were measured and the incidence of postoperative complications and nursing satisfaction were recorded.

    Results: The levels of serum blood urea nitrogen, creatinine, kidney injury molecule and CD8+ cell subsets in the comprehensive nursing group were lower than those in the routine nursing group (p < 0.05), whereas the CD4+ cell subsets, CD4+:CD8+ ratio, and immunoglobulins (Ig)A, IgG and IgM levels were significantly higher than those in the routine nursing group (p < 0.05). The incidence of postoperative complications in the comprehensive nursing group was 2.50% (2/80), which was significantly lower than that in the routine nursing group (13.75%, 11/80), and the difference was statistically significant (χ2 = 6.782, p = 0.009). Nursing satisfaction in the comprehensive nursing group was 96.25% (77/80), which was significantly higher than that in the routine nursing group (85.00%, 68/80; χ2 = 5.959, p = 0.015).

    Conclusions: The comprehensive nursing mode can effectively reduce the influence of PCNL on T cell subsets, immunoglobulin levels in patients with renal calculus, damage to renal function and complications; Can improve patients’ satisfaction with nursing; And promote postoperative recovery.

  • Case Report
    Xia Wang, Hao Wang, Ziyu Wan, Qiqi Fu, Zhangjie Zhen, Tao Liu, Feng Tang, Jianping Peng
    Archivos Españoles de Urología. 2023, 76(9): 711-717. https://doi.org/10.56434/j.arch.esp.urol.20237609.87
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    Background: Solitary fibrous tumors (SFTs) manifest in various anatomical locations but are seldom encountered in the prostate. Despite their rare occurrence in this region, SFTs demonstrate a marked propensity for recurrence. This study elucidates a case of recurrent prostate SFT, previously misdiagnosed, and delineates the salient features and diagnostic criteria pertaining for SFTs.

    Methods: Through a meticulous analysis of the patient’s antecedent medical records and corroborative diagnostic evaluations, we hypothesized that the presenting pathology was indicative of a prostate SFT. In order to substantiate this supposition, we re-examined archival pathological specimens from the patient. The ensuing pathological assessment validated our conjecture. To address the recurrence, we conducted an open surgical procedure to excise the tumor. Subsequent postoperative pathological evaluations further corroborated the diagnosis of prostate SFT.

    Results: Upon re-evaluation of the patient’s earlier pathological specimens, we discerned that what had been previously classified as a “seminal vesicle tumor” was, in fact, a prostate SFT. During the surgical intervention, it was observed that the prostatic tumor had invaded the bladder, yet there was no seminal vesicle involvement. The tumor dimensions were approximately 7 × 5 × 4 cm, and the margin between the tumor and the surgical resection edge was less than 0.1 cm. The postoperative histological analysis confirmed the diagnosis of recurrent prostate SFT, substantiating our designation of the patient’s condition as such. A year-long follow-up revealed no conspicuous signs of tumor recurrence.

    Conclusions: Therapeutic intervention for prostate SFT is predominantly surgical. However, given the tumor’s marked predisposition for recurrence, the specific mechanisms underlying its etiology and pathogenesis remain enigmatic. Hence, a comprehensive understanding of its pathogenic and recurrent characteristics, coupled with regular postoperative surveillance, is imperative for efficacious treatment and prevention of prostate SFT.