28 November 2024, Volume 77 Issue 9
    

  • Select all
    |
  • Article
    Clara García-Fuentes, Virginia Hernández, Estíbaliz Jiménez-Alcaide, Enrique de la Peña, Ana Guijarro, Elia Pérez-Fernández, Carlos Llorente
    Archivos Españoles de Urología. 2024, 77(9): 940-947. https://doi.org/10.56434/j.arch.esp.urol.20247709.134
    Download PDF ( )   Knowledge map   Save

    Background: The advantages of active surveillance (AS) in low-risk prostate cancer (PC) have already been widely demonstrated. The 15-year results of the Prostate Testing for Cancer and Treatment (ProtecT) trial were published recently, reflecting worse oncological outcomes of their active monitoring programme (AMP) compared with radical prostatectomy (RP) or radiotherapy (RDT). Our objective was to analyse the survival of patients with International Society of Urological Pathology (ISUP) grade I PC depending on the treatment received and point out the differences between an AS protocol and the AMP established in the ProtecT trial.

    Methods: A retrospective study of patients with ISUP grade I PC managed by AS, RP or RDT was conducted. A comparative intention-to-treat survival analysis was performed. Our AS protocol included routine 18-core surveillance biopsies of all patients. On the basis of this assumption, the patients included in AS were divided into two groups: Those who met the rebiopsy criteria of the ProtecT trial and those who should not have been biopsied in accordance with this trial.

    Results: Of the total 2865 patients, 981 met the selection criteria with a median follow-up of 7.7 years: 448 (45.7%) in AS, 399 (40.7%) in RP and 134 (13.7%) in RDT. The median age at diagnosis was 66.9, 63.2 and 69.2 years, respectively. The AS and RP groups were comparable in all the variables. The overall and cancer-specific survival results were similar, but the AS group had better metastasis-free survival. The RDT group presented worse clinical features in prostate-specific antigen and stage and worse survival outcomes compared with the other groups (p < 0.005). Out of the 448 patients included in AS, 100 met some of the criteria for rebiopsy of the ProtecT trial. Amongst the 348 patients who did not meet any criteria, 138 (39.6%) ended up receiving active treatment due to Gleason progression, increasing number of positive cores or both in the majority of cases (94.4%).

    Conclusions: Surveillance biopsy is a major factor that contributes to achieving good oncological results in AS. Active monitoring is not comparable with an AS protocol, and thus, the results of the ProtecT trial are poorly assessable.

  • Article
    Hyun Cheol Jeong, Han Kyu Chae, Ji-Yeon Han, Dae Yul Yang, Kyungtae Ko
    Archivos Españoles de Urología. 2024, 77(9): 948-954. https://doi.org/10.56434/j.arch.esp.urol.20247709.135
    Download PDF ( )   Knowledge map   Save

    Background: The increasing frequency of health checkups has led to an increasing diagnosis of renal stones. There exist various treatments for renal stones, but the less invasive ultra-mini percutaneous nephrolithotomy (UMP) treatment is gaining wide attention. The present study aimed to confirm the characteristics of renal stones that help achieve a high stone-free rate through UMP regardless of the complications.

    Methods: A retrospective study was conducted on 100 consecutive patients from May 2016 to February 2021. The study used a 7.5 Fr nephroscope and an irrigation pump. Renal stones were pulverised into as small particles as possible using a holmium laser discharged through an 11/12 Fr operating sheath. Kidneys, ureters, and bladder (KUB) and stone computed tomography (CT) scans were performed four weeks after surgery to confirm the stone-free state in patients.

    Results: The present study enrolled 72 men and 28 women who underwent UMP. The mean age of the patients was 61.5 years. The average size of the stones was 2.7 ± 1.1 cm. The average operation time was 74.7 ± 38.5 minutes. Three collecting system injuries occurred; However, no damage to other organs or bleeding was observed. At the one-month follow-up, the overall stone-free rate of UMP was 66%, lower than the target stone-free rate of 87%. The multivariate logistic regression analysis revealed that a high surgical success rate could be predicted in the cases of a single calcium oxalate or uric acid stone with a stone size <3 cm.

    Conclusions: UMP can be considered the first treatment option for single renal calcium oxalate or uric acid stones with a size <3 cm.

  • Article
    Serhat ÇETIN, Kadir Şerefhan ERTEN, Metin ONARAN, İlker ŞEN, Mustafa Özgür TAN, İpek Işık GÖNÜL, Ethem Turgay CERİT, Tevfik Sinan SÖZEN
    Archivos Españoles de Urología. 2024, 77(9): 955-964. https://doi.org/10.56434/j.arch.esp.urol.20247709.136
    Download PDF ( )   Knowledge map   Save

    Objective: Isolated adrenal myelolipoma (IAM) is an uncommon, nonfunctioning tumour of the adrenal gland, primarily composed of adipose tissue and hematopoietic trilinear cells. The etiopathogenesis and clinical relevance of this neoplasm remain poorly understood. However, similar myelolipomatous alterations can also occur within adrenocortical adenomas. This report presents our findings on IAM and adrenocortical adenomas with a myelolipomatous component (AMC), focusing on comparing these cases’ clinical, demographic, and pathological characteristics.

    Methods: Data from twenty patients were retrospectively analyzed, including twelve diagnosed with IAM and eight with AMC, all of whom underwent adrenalectomy. In the IAM cohort, surgical intervention was primarily indicated based on tumour size and/or related symptoms, while in AMC cases, the indication was often driven by hormonal activity.

    Results: Patients with IAM had an average age of 52.5 years, with a predominance of female patients (75%). A significant proportion of this group was obese, with concomitant hypertension (HT) and/or type 2 diabetes mellitus (DM). The tumours were predominantly right-sided, with a median size of 69.0 ± 40.0 mm. Notably, 58% of patients with IAM presented with flank or abdominal pain attributed to the mass effect. None of the IAM cases exhibited hormonal activity. Conversely, the AMC group had a younger average age of 46 years, with a high prevalence also in female patients (63%). The tumours were generally smaller, with a median size of 40.0 ± 16.0 mm, and were mostly left-sided. All patients in this group had a history of HT and/or DM, with six exhibiting hormonally active tumours, which manifested as various clinical syndromes, including Cushing syndrome, pheochromocytoma, and Conn syndrome.

    Conclusions: While IAM and AMC share several common features, they also demonstrate distinct differences. The presence of endocrinological syndromes was more frequent in AMC cases, whereas IAM cases rarely showed hormonal activity. The most pronounced difference between the two groups was the tumour size at diagnosis, which contributed to the varying clinical presentations upon hospital admission. Furthermore, the high prevalence of obesity, HT, and DM in both groups suggests that these comorbidities may play a role in the development of myelolipomatous patterns observed in these tumours.

  • Article
    Adem Sancı, Hüseyin Mert Durak, Berk Yasin Ekenci, Emre Hepşen, Metin Yığman, Kubilay Sarıkaya, Azmi Levent Sağnak, Ahmet Nihat Karakoyunlu
    Archivos Españoles de Urología. 2024, 77(9): 965-970. https://doi.org/10.56434/j.arch.esp.urol.20247709.137
    Download PDF ( )   Knowledge map   Save

    Background: This study aims to compare the efficacy and safety of retrograde intrarenal surgery (RIRS) between patients aged 65 years and older and younger patients.

    Methods: In this retrospective study, we analysed the medical records of patients who underwent RIRS for the management of the proximal ureter and renal stones between September 2022 and December 2023. The patients were divided into two age-based groups. We compared demographic and clinical data including stone-free rates (SFRs), complication rates and the necessity for secondary procedures between the two cohorts. Postoperative complications were categorised using the Clavien–Dindo classification system.

    Results: A total of 258 patients were included in the study. Group 1 comprised 193 patients (74.8%) aged younger than 65 years, with an average age of 47 ± 12.3 years. Group 2 included 65 patients (25.2%) aged 65 years and older, with an average age of 68 ± 6.5 years (p-value = 0.0001). The older group had higher prevalence of comorbidities and scores based on American Society of Anaesthesiologists (ASA) guidelines compared with the younger group (p = 0.0001). Despite these differences, no statistically significant difference was observed between the two groups regarding SFR (p = 0.543) and Clavien–Dindo complication rates (p = 0.659). Both groups demonstrated similar rates of postoperative complications and required secondary procedures at similar rates.

    Conclusions: RIRS provides similar efficacy and safety in patients aged 65 years and older compared with younger patients. Further studies with larger cohorts and longer follow-up periods are recommended to validate these findings.

  • Article
    Ozgur Ekici, Murat Gunay, Abdullah Gul, Ozlem Admıs, Ali Seydi Bozkurt, Ercument Keskin
    Archivos Españoles de Urología. 2024, 77(9): 971-977. https://doi.org/10.56434/j.arch.esp.urol.20247709.138
    Download PDF ( )   Knowledge map   Save

    Background: Overactive bladder (OAB) is an issue in the field of urology that is known for causing symptoms like urges to urinate frequently during the day and even at night (known as nocturia). Nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) play a vital role in the growth and operation of nerve cells in the body. New studies are indicating a connection between these neurotrophins and OAB; As such this research project was undertaken to explore how levels of NGT and BDNF in urine might be related to the presence of OAB in individuals.

    Methods: This investigation employed a case-control design, enrolling 44 individuals with a confirmed diagnosis of OAB and an equal number of healthy participants as the control group. Urine samples were collected from all participants, and levels of NGF and BDNF were quantified. To account for fluctuations in urine concentration, NGF/creatinine (Cr) and BDNF/Cr ratios were also determined.

    Results: Our research findings revealed that individuals experiencing bladder (OAB) showed increased urinary NGF levels (statistically significant, at p < 0.001). This disparity remained consistent after adjusting for creatinine levels; There were higher NGF/Cr (statistically significant, at p = 0.001) and BDNF/Cr (statistically significant, at p < 0.001) ratios in the OAB group compared to the control group. Additionally we noted a relationship between urine NGF/Cr levels and the presence of OAB (statistically significant, at p < 0.001; Correlation coefficient: +0.686). Urine BDNF/Cr levels showed a correlation with OAB (correlation coefficient of +0.461; p value < 0.001). In OAB prediction, the NGF/Cr cutoff value was found to be 0.87, the NGF cutoff value was 180.02 pg/mL, and the BDNF/Cr ratio was 0.19.

    Conclusions: Elevated urinary NGF and BDNF levels are associated with OAB, suggesting a potential role for these neurotrophic factors in the pathogenesis of the condition. Further research is warranted to explore their potential as diagnostic or prognostic biomarkers and to elucidate the underlying molecular mechanisms.

  • Article
    Nihat Türkmen, Kerem Bursalı
    Archivos Españoles de Urología. 2024, 77(9): 978-983. https://doi.org/10.56434/j.arch.esp.urol.20247709.139
    Download PDF ( )   Knowledge map   Save

    Background: This study aimed to compare the efficacy of various injection therapy agents used in combination with internal urethrotomy in preventing fibrosis and stricture recurrence.

    Materials and Methods: Patients who underwent direct vision internal urethrotomy (DVIU) in our clinic between 2017 and 2022 were retrospectively screened. The patients were divided into four groups: DVIU + intralesional platelet-rich plasma (DVIU + PRP group, n = 21), DVIU + intralesional mitomycin-C (DVIU + MMC group, n = 21), DVIU + intralesional prednisolone (DVIU + prednisolone group, n = 21), and DVIU alone (control group, n = 21). The length (mm) and diameter (mm) of the recurrent urethral strictures and maximum urinary flow rate (Qmax) on uroflowmetry evaluation were measured at 1, 3, and 6 months postoperatively and compared between the four groups.

    Results: Urethral stenosis recurred in two (9.5%) patients in the DVIU + PRP group, three (14.3%) in the DVIU + MMC group, seven (33.3%) in the DVIU + prednisolone group, and nine (42.9%) in the control group. The reduction in stenosis recurrence significantly differed between the four groups (p = 0.040). A significant group difference in stenosis length (p = 0.047) but not in stenosis diameter (p = 0.385) was observed in patients with recurrent stenosis. Furthermore, no significant difference in Qmax was found between the groups at 1, 3, and 6 months postoperatively (p = 0.588, p = 0.047, p = 0.067, respectively).

    Conclusions: Different intralesional treatments combined with internal urethrotomy demonstrate varying efficacy in reducing urethral stricture recurrence. Considering its high success rate, low cost, and reduced side effects, PRP may be the preferred intralesional treatment option in combination with DVIU.

  • Article
    Salih Manav, Anil Erdik, Haci Ibrahim Cimen, Yavuz Tarik Atik, Deniz Gul, Hasan Salih Kose, Hasan Salih Saglam
    Archivos Españoles de Urología. 2024, 77(9): 984-991. https://doi.org/10.56434/j.arch.esp.urol.20247709.140
    Download PDF ( )   Knowledge map   Save

    Background: To determine the predictive value of patient’s preoperative characteristics and laboratory values for positive surgical margin (PSM) after radical retropubic prostatectomy (RRP).

    Methods: This study included 278 patients who underwent RRP between January 2011 and October 2022 due to prostate cancer (PCa) with no prior radiotherapy or hormonal treatment. The patients’ preoperative characteristics and laboratory findings were recorded, and the patients were divided into two groups based on their surgical margin status. Multivariate logistic regression was performed to assess the impact of the patients’ preoperative characteristics and laboratory results on PSM status.

    Results: The PSM group exhibited significantly higher body mass index (BMI), number of biopsy positive cores, percentage of tumours in positive cores, and neutrophil-to-lymphocyte ratio (NLR) than the negative surgical margin (NSM) group (p < 0.001, p = 0.004, p < 0.001, and p = 0.035, respectively). Conversely, the aspartate transaminase/alanine transaminase (AST/ALT) ratio was significantly lower in the PSM group than in the NSM group (p = 0.031). Compared to the NSM group, the PSM group had a significantly higher proportion of patients with a preoperative Gleason score (GS) of ≥8 and an elevated D’Amico risk (p < 0.001 and p = 0.046, respectively). Furthermore, BMI, preoperative prostate-specific antigen (PSA) level, percentage of tumours in positive cores, NLR, GS ≥8, and high D’Amico risk were significant independent predictors of PSM. The NLR cut-off value of ≥1.96 was found to be appropriate, leading to a sensitivity of 69%, specificity of 46%, positive predictive value of 13%, and negative predictive value of 93%. Lastly, the area under the receiver operating characteristic curve of the NLR for PSM was 0.581 (95% confidence interval: 0.52–0.64, p = 0.035).

    Conclusions: Our study results reveal that NLR, BMI, percentage of tumours in positive cores, preoperative PSA level, high-risk PCa, and GS ≥8 are predictive factors for PSM. Preoperative NLR may serve as an independent predictor of PSM following RRP.

  • Article
    Fengping Lai, Hui Liu, Huihua Wang
    Archivos Españoles de Urología. 2024, 77(9): 992-998. https://doi.org/10.56434/j.arch.esp.urol.20247709.141
    Download PDF ( )   Knowledge map   Save

    Background: Hysterectomy is associated with stress urinary incontinence (SUI), pelvic floor muscle weakness and sexual dysfunction. Pelvic floor exercises have emerged as a potential intervention for addressing these challenges, with remote guided programs offering personalised care. This retrospective study aimed to assess the effect of a nurse-led remote guided pelvic floor exercise program on in patients after total hysterectomy.

    Methods: A retrospective analysis was conducted on 81 patients who underwent pelvic floor exercises after total hysterectomy. The patients were divided into regular pelvic floor exercise group (n = 40) and nurse-led remote guided pelvic floor exercise group (n = 41). The severity of SUI in patients was assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). The strength and endurance of pelvic floor muscles were assessed using a pressure sensor before and after treatment, and sexual function was evaluated using the Female Sexual Function Index (FSFI) questionnaire.

    Results: The baseline characteristics showed no significant differences between the two groups. The nurse-led remote guided pelvic floor exercise group had a significantly greater reduction in urinary incontinence severity (65.00% vs. 85.37%, χ2 = 4.516, p = 0.034) and a lower post-treatment SUI frequency (1.76 ± 0.75 vs. 2.15 ± 0.95, t = 2.059, p = 0.043). Additionally, this group showed better improvements in muscle strength and endurance (25.61 ± 5.69 vs. 23.19 ± 5.02, t = 2.036, p = 0.045) and FSFI score (29.67 ± 4.05 vs. 27.91 ± 3.83, t = 2.011, p = 0.048).

    Conclusions: The study demonstrates that a nurse-led remote guided pelvic floor exercise program is associated with significant improvements in SUI, pelvic floor muscle function and sexual well-being in patients after total hysterectomy.

  • Article
    Ben Xu, Jiaen Zhang, Lin Ye, Changwei Yuan
    Archivos Españoles de Urología. 2024, 77(9): 999-1006. https://doi.org/10.56434/j.arch.esp.urol.20247709.142
    Download PDF ( )   Knowledge map   Save

    Purpose: This study aimed to establish a comprehensive evaluation and assessment system for urology specialists based on entrustable professional activities (EPAs).

    Methods: A research group was formed to develop a preliminary index system for the evaluation and assessment of urology specialists through an extensive literature review and group discussions. The Delphi method was employed to design a questionnaire, and two rounds of expert consultations were conducted to finalize the index system and design a corresponding assessment method.

    Results: A total of 24 experts participated in the two rounds of consultations, with authority coefficients of 0.885 and 0.894, and agreement levels of 0.270 and 0.256, respectively, indicating a high level of expertise and strong consensus among the participants. Based on the expert feedback, 16 key indicators were identified: Recognizing and admitting urological patients, selecting and interpreting specialized tests, diagnosing and differentiating diseases, making therapeutic decisions, documenting medical information, delivering oral clinical case reports, identifying and managing primary care and speciality medical problems, managing critical illness, handling patient transfers and departmental handovers, communicating informed medical decisions, performing basic and specialized surgical operations, providing health guidance, responding to public health emergencies, and engaging in clinical teaching. All indicators scored above 3.5 in importance, with coefficients of variation below 0.25, signifying their appropriateness. The expected confidence levels for each indicator at various stages were determined, and a comprehensive assessment method encompassing “process evaluation, peer impression review, and endpoint assessment” was developed.

    Conclusions: This research successfully established an initial EPAs-based evaluation and assessment index system for urology specialists, defined the expected confidence levels for each indicator across different time points, and devised a specific assessment methodology, thereby providing a scientific foundation for the training and evaluation of urology specialists.

  • Article
    Chuhan Wang, Wei Wei, Zhiying Ye, Danli Ma, Huimin Yu, Fei Zheng
    Archivos Españoles de Urología. 2024, 77(9): 1007-1016. https://doi.org/10.56434/j.arch.esp.urol.20247709.143
    Download PDF ( )   Knowledge map   Save

    Background: This study aimed to evaluate the mid- to long-term efficacy of tension-free vaginal tape (TVT) and trans-obturator transvaginal tape (TVT-O) by using evidence-based medicine meta-analysis methods to provide a reference for choosing a sling to treat female stress urinary incontinence (SUI).

    Methods: A computer search was performed on PubMed, Embase, Web of Science, ProQuest PsycINFO, CINAHL and Cochrane Library for randomised controlled trials on TVT and TVT-O in the treatment of female SUI. The search time limit was from the establishment of the database to March 2024, and the literature was screened and quality assessed. Meta-analysis was used to appraise the subjective cure rate, objective cure rate and postoperative complication rates and intraoperative of the two surgical methods for SUI.

    Results: All 13 included studies were of high quality. The subjective cure rate (Risk Ratio (RR) [1.00] and 95% CI [0.96; 1.05]) and objective cure rate (RR [1.03] and 95% CI [1.00; 1.06]) of TVT and TVT-O were similar. The incidence of hematoma during TVT surgery was significantly higher than that of TVT-O (RR [2.62] and 95% CI [0.84; 8.13]), and the incidence of medial thigh/groin pain after TVT was lower than that of TVT-O (RR [0.25] and 95% CI [0.13; 0.49]). Minimal differences were observed in the incidence of bladder perforation, band erosion and dysuria/urinary retention.

    Conclusions: The mid- and long-term effects of TVT and TVT-O surgical methods in the treatment of female SUI were similar and effective. In terms of complications, TVT had a higher incidence of hematoma than TVT-O, and TVT had a lower incidence of pain in the inner thigh/groin area than TVT-O.

  • Article
    Yuanchao Cao, Hang Yuan, Yang Guo, Bin Li, Xinning Wang, Xinsheng Wang, Yanjiang Li, Wei Jiao
    Archivos Españoles de Urología. 2024, 77(9): 1017-1025. https://doi.org/10.56434/j.arch.esp.urol.20247709.144
    Download PDF ( )   Knowledge map   Save

    Objectives: Urinary stones composed of uric acid can be treated with medicine. Computed tomography (CT) can diagnose urinary stone disease, but it is difficult to predict the type of uric stones. This study aims to develop a method to distinguish pure uric acid (UA) stones from non-uric acid (non-UA) stones by describing quantitative CT parameters of single-energy slices of urinary stones related to chemical stone types.

    Methods: Clinical data, CT images, and stone composition analysis results of patients with urinary stones clinically diagnosed at The Department of Urology, Affiliated Hospital of Qingdao University between 1 January 2018 and 31 December 2020 were collected and retrospectively analyzed. The above data were preprocessed and fed into a convolutional neural network to perform deep learning (DL) of the model, and the dataset was validated at a ratio of 4:1. The area under the curve (AUC) value of the receiver operating characteristic (ROC) curve and the confusion matrix were utilized to evaluate the predictive effect of the model.

    Results: A retrospective analysis of 918 non-enhanced thin-slice single-energy CT images of known chemical stone types (124 with UA stones and 794 with non-UA stones) was conducted using a DL model. Compared with the results of ex vivo analysis by infrared spectroscopy, the prediction model obtained an AUC of 0.83 for the dichotomous classification of UA stones and non-UA stones. The accuracy of the model was 97.01%, with an F1 score of 89.04%, sensitivity of 84.62%, and specificity of 82.28%.

    Conclusions: This DL model constructed based on convolutional neural network analysis of thin-slice single-energy CT images is highly accurate in predicting the composition of pure UA and non-UA stones, providing a simple and rapid diagnosis method.

  • Article
    Xianfeng Qu, Yingchao Geng, Zhiyun Wang, Weihong Hua
    Archivos Españoles de Urología. 2024, 77(9): 1026-1034. https://doi.org/10.56434/j.arch.esp.urol.20247709.145
    Download PDF ( )   Knowledge map   Save

    Background: Paediatric hydronephrosis frequently necessitates surgical intervention. However, postoperative urinary tract infections (UTIs) are common and challenging. This retrospective cohort study aimed to identify UTI risk factors following an operation for paediatric hydronephrosis.

    Methods: Paediatric patients with hydronephrosis who underwent operation from January to December 2023 were studied. Patients were categorised into no UTI and UTI groups. Demographics, surgical history, pre/postoperative factors, imaging, and lab values were compared.

    Results: A total of 111 patients were enrolled, with 98 in the no-UTI group and 13 in the UTI group. The UTI group had significantly more previous surgeries and longer surgical duration (p < 0.05). Preoperative factors associated with UTI occurrence included higher hydronephrosis grade, absence of antibiotic prophylaxis, presence of vesicoureteral reflux (VUR), abnormal preoperative urine cultures, and ureteral stent placement (p < 0.05). The UTI group exhibited more extended hospital stays, higher rates of postoperative fever, reoperation, and readmission within 30 days (p < 0.05). Postoperative imaging and laboratory findings were also significantly different (p < 0.05). The UTI group had elevated white blood cell count, C-reactive protein levels, serum creatinine, and urine white blood cell count (p < 0.05). Other potential risk factors included constipation, family history of UTI, bladder dysfunction, history of recurrent UTI, and use of prophylactic antibiotics. Multivariate logistic regression analysis indicated that while antibiotic prophylaxis and preoperative urine culture results negatively correlated with UTI occurrence, other factors were positively correlated, with the number of previous surgeries having the most significant impact on UTI occurrence (odds ratio (OR) = 20.617; 95% confidence interval (CI): [0.718, 0.802]; p < 0.001).

    Conclusions: Multiple factors contribute to the risk of postoperative UTI for paediatric hydronephrosis, highlighting the need for tailored interventions to mitigate risks and improve outcomes.

  • Article
    Qiannan Song, Lijia Zhang, Xue Lei, Songjiang Liu
    Archivos Españoles de Urología. 2024, 77(9): 1035-1046. https://doi.org/10.56434/j.arch.esp.urol.20247709.146
    Download PDF ( )   Knowledge map   Save

    Background: This study aims to investigate centrosomal protein 70 (CEP70) in prostate cancer and its effects on angiogenesis and tumour metastasis and elucidate its molecular mechanisms.

    Methods: We evaluated CEP70 and Vascular Endothelial Growth Factor Receptor 2 (VEGFR2) in tissue samples from patients with prostate cancer by immunohistochemistry. In vitro experiments included overexpressing CEP70 through transfection and assessing its impact on human umbilical vein endothelial cells (HUVECs). Intervention experiments with an NF-κB pathway inhibitor were conducted to verify the mechanism. Finally, the effects of CEP70 on tumour growth, angiogenesis and metastasis were examined in a nude mouse model.

    Results: CEP70 was significantly overexpressed in prostate cancer tissues compared with that in adjacent normal tissues (p < 0.001). In vitro experiments demonstrated that CEP70 overexpression promoted HUVEC migration (p < 0.001), invasion (p < 0.001) and tube formation (p < 0.05). CEP70 significantly upregulated VEGFA expression in prostate cancer cells at messenger RNA (mRNA) (p < 0.001) and protein levels (p < 0.05). VEGFA knockdown experiments confirmed CEP70 as an essential cytokine for CEP70-induced angiogenesis (p < 0.01). Mechanistically, CEP70 promoted VEGFA expression by activating the NF-κB signalling pathway, as evidenced by the reversal of CEP70-induced effects upon treatment with the NF-κB inhibitor BAY11-7082 (p < 0.01).

    Conclusions: CEP70 promotes tumour angiogenesis and metastasis by upregulating VEGFA through NF-κB pathway activation.

  • Article
    Ying Chen, Li Yang, Yin Huang, Huaxin Lu
    Archivos Españoles de Urología. 2024, 77(9): 1047-1053. https://doi.org/10.56434/j.arch.esp.urol.20247709.147
    Download PDF ( )   Knowledge map   Save

    Background: Choosing the appropriate anaesthesia for retrograde intrarenal surgery (RIRS) is crucial due to its potential impact on surgical outcomes, postoperative recovery, and renal function. This retrospective study aimed to compare surgical outcomes and renal function impacts between general anaesthesia and continuous epidural anaesthesia for RIRS.

    Methods: Clinical data from patients who underwent RIRS for renal stones at our hospital from January 2023 to December 2023 were retrospectively analysed. Patients were categorised into two groups: Those receiving general anaesthesia and those receiving continuous epidural anaesthesia. General patient information, surgical outcomes, renal function parameters, and postoperative pain scores were evaluated.

    Results: The study included 110 patients: 51 in the general anaesthesia group and 59 in the continuous epidural anaesthesia group. Operation duration and stone clearance rates were similar across both groups. However, the epidural group had a significantly shorter hospital stay (1.28 ± 0.39 days vs 1.73 ± 0.42 days) and required less analgesia (25.86 ± 5.26 mg vs 29.56 ± 5.63 mg) (p < 0.001). Although the epidural group had higher preoperative creatinine levels, these levels significantly decreased postoperatively (0.99 ± 0.12 mg/dL vs 1.07 ± 0.11 mg/dL, p < 0.001). Pain scores at 2 hours (3.95 ± 1.28 vs 3.18 ± 1.42, p = 0.004) and 24 hours (3.75 ± 1.67 vs 3.08 ± 1.45, p = 0.027) were lower in the epidural group.

    Conclusions: Continuous epidural anaesthesia may offer advantages over general anaesthesia for RIRS, including reduced hospital stays, lower analgesic requirements, potential renoprotection, and improved early postoperative pain management.

  • Article
    Bing Liu, Zhiming Cui, Shenhao Xu, Cheng Zhang
    Archivos Españoles de Urología. 2024, 77(9): 1054-1061. https://doi.org/10.56434/j.arch.esp.urol.20247709.148
    Download PDF ( )   Knowledge map   Save

    Background: Renal cell carcinoma (RCC) is a reclusive tumor, usually discovered incidentally on imaging examinations of other abdominal diseases. Although prognosis models based on pathology are more accurate, it is crucial to evaluate tumor prognosis before invasive operations to support the choice of active surveillance and ablation therapy. Thus, non-invasive methods are essential for determining appropriate treatment strategies in patients.

    Methods: Data from 106 patients under non-metastatic clear cell RCC (ccRCC) who went through partial/radical nephrectomy from January 2016 to October 2023 were retrospectively evaluated. Basic demographic information, preoperative hematological indicators, pathological data, and computed tomography (CT) measurements of perinephric adipose tissue (PAT) were collected for each patient. The CT assessments of PAT, including thickness, radiodensity, and Mayo adhesive probability (MAP) score, were performed by a radiologist. Univariate and multivariate logistic regression analysis was applied to clarify risk factors of Fuhrman grade, tumor size, and the Stage Size Grade Necrosis (SSIGN) score. The receiver operating characteristic (ROC) curve of SSIGN was then constructed in order to determine discriminatory ability and optimal cut-off values of these risk factors.

    Results: The radiodensity of PAT on the tumor side was significantly higher (p < 0.001) compared to the contralateral side. RCCs with higher maximum radiodensity of PAT and elevated C-reactive protein-to-albumin ratio (CAR) were related to a higher Fuhrman grade, larger tumor size, and increased Stage Size Grade Necrosis (SSIGN) scores (all p < 0.05). The area under curve (AUC) of maximum radiodensity of PAT and CAR for higher SSIGN scores was 0.816 (p = 0.003) and 0.811 (p = 0.004) each. The optimal cut-off values of PAT and CAR for higher SSIGN scores were –69.685 and 0.0452, respectively.

    Conclusions: The study corroborates that PAT and CAR’s maximum radiodensity are independent markers for predicting Fuhrman grade, tumor size and SSIGN. These non-invasive methods are likely to improve traditional prognostic prediction and possibly effect new therapeutic strategies for patients with non-metastatic ccRCC.

  • Article
    Yupeng Guo, Yue Liu, Guangqian Jiang, Bing Wan
    Archivos Españoles de Urología. 2024, 77(9): 1062-1069. https://doi.org/10.56434/j.arch.esp.urol.20247709.149
    Download PDF ( )   Knowledge map   Save

    Background: Traditional diagnostic methods have limitations in accurately identifying and characterising prostate apex cancer. Therefore, exploring innovative approaches such as magnetic resonance imaging (MRI) radiomics, biomarker assessments and clinical pathological features is essential to improve diagnostic accuracy.

    Methods: This retrospective study evaluated diagnostic data from 52 patients with prostate apex cancer and 52 healthy individuals. MRI radiomics features—including grey-level non-uniformity, co-occurrence homogeneity, first order skewness, grey level co-occurrence matrix (GLCM) correlation, wavelet-low-high-low (wavelet-LHL) energy and prostate apparent diffusion coefficient (ADC) values—were compared between the groups. Biomarker levels, including Free Prostate-Specific Antigen (fPSA), Prostate-Specific Antigen (PSA), Ratio of Free to Total Prostate-Specific Antigen (f/tPSA), Prostate Volume (PV) and Prostate-Specific Antigen Density (PSAD), were also measured and analysed. Statistical analyses included t-tests, chi-square tests, correlation analyses and receiver operating characteristic (ROC) analyses.

    Results: Significant differences were observed between the healthy and cancer groups in several MRI radiomics features: Grey-level non-uniformity (57.23 ± 7.31 vs. 69.54 ± 9.84, p < 0.001), co-occurrence homogeneity (0.29 ± 0.05 vs. 0.21 ± 0.07, p < 0.001), first order skewness (2.91 ± 0.61 vs. 3.85 ± 0.71, p < 0.001), GLCM correlation (0.72 ± 0.06 vs. 0.62 ± 0.07, p < 0.001), wavelet-LHL energy (264.14 ± 30.12 vs. 311.24 ± 42.13, p < 0.001) and prostate ADC value (1.29 ± 0.25 vs. 0.98 ± 0.15 × 10−3 mm2/s, p < 0.001). Biomarker levels also differed significantly: fPSA (0.93 ± 0.50 vs. 1.97 ± 1.69 ng/mL−1, p = 0.032), PSA (6.69 ± 2.55 vs. 17.45 ± 7.85 ng/mL−1, p = 0.048), f/tPSA (0.14 ± 0.07 vs. 0.11 ± 0.07 ng/mL−1, p = 0.020), PV (42.16 ± 8.32 vs. 38.43 ± 8.92 mL, p = 0.030) and PSAD (0.17 ± 0.08 vs. 0.49 ± 0.29 µg/L/mL−1, p = 0.040). The combined model of these parameters achieved a sensitivity of 0.865, a specificity of 0.962 and an area under the curve of 0.913.

    Conclusions: The integration of MRI radiomics, biomarker assessments and clinical pathological features presents a promising approach for diagnosing prostate apex cancer.

  • Article
    Yun Mao, Qinfen Xu, Jinwei Zhang, Sangsang Chou, Mei Shen, Mengjing Chen
    Archivos Españoles de Urología. 2024, 77(9): 1070-1077. https://doi.org/10.56434/j.arch.esp.urol.20247709.150
    Download PDF ( )   Knowledge map   Save

    Background: This study aimed to investigate the risk factors for urinary tract infections (UTIs) in patients with cervical cancer (CC) following radical surgery, and analyse the etiological distribution and prognostic implications of these infections.

    Methods: A retrospective analysis was conducted on the clinical data of 168 patients with CC who underwent radical surgery at our hospital between January 2021 and December 2023. Postoperative UTI incidence and associated risk factors were analysed. Postoperative urine samples were collected under sterile conditions for pathogen culture to analyse pathogen distribution. Patients were classified into poor and good prognosis groups based on their health status within one month of treatment. The relationship between pathogen distribution and prognosis in patients with CC and postoperative UTIs was analysed.

    Results: The incidence of postoperative UTIs was 35.12% (59 cases). Among these patients, 84 pathogen strains were detected in urine samples, including 54 of gram-negative bacteria, 26 of gram-positive bacteria, and four of fungi. The single-factor analysis identified age, diabetic status, menopausal status, tumour diameter, surgical duration, intraoperative blood loss volume, duration of ureteral catheterisation, and postoperative urinary retention as potential risk factors. The multifactorial analysis confirmed age, diabetic status, operation duration, intraoperative blood loss volume, duration of ureteral catheterisation, and postoperative urinary retention as independent risk factors. The distribution of Klebsiella pneumoniae (K. pneumoniae) significantly differed between the study groups, while other pathogens showed no significant difference.

    Conclusions: UTIs in patients with CC post-radical surgery are primarily caused by gram-negative bacteria, mainly Escherichia coli and K. pneumoniae. K. pneumoniae is predominant in patients with a poor prognosis, while Enterococcus spp. is the most common gram-positive bacterium observed.

  • Article
    Kai Li, Kaiyu Lu, Fei Wang, Chunchun Zhao, Hua Shen, Caibin Fan
    Archivos Españoles de Urología. 2024, 77(9): 1078-1088. https://doi.org/10.56434/j.arch.esp.urol.20247709.151
    Download PDF ( )   Knowledge map   Save

    Background: The objectives of this work were the search for novel prognostic biomarkers for the diagnosis of prostate cancer (PCa) and the improvement of therapy outcomes in cases with a poor prognosis and the failure of immunotherapy.

    Methods: The GTEx (Genotypic Tissue Expression Project) and TCGA (The Cancer Genome Atlas) databases were used to find out the co-expressed long non-coding RNAs (lncRNAs) associated with necrosis status based on statistics and univariate Cox regression tests. IncRNA associated with necrosis was screened by least absolute shrinkage and selection operator (Lasso) analysis, and the predictive model was further verified by Kaplan–Meier analysis, Receiver Operating Characteristic (ROC) curve analysis, Cox regression, nomogram and calibration curve. Also, immune analysis, principle component analysis, gene set enrichment analysis and prediction of semi-maximum inhibitory concentration in risk groups were conducted.

    Results: The model successfully identified 16 necrosis-related lncRNA models, demonstrating good consistency among the calibration map and prognosis expectation. The ROC curve’s area under the curve (AUC) for 1-year overall survival was 0.726, 0.763 and 0.770. The risk groups identified by the model could guide systematic treatment due to significant differences in semi-inhibitory concentrations. The study also demonstrated that the model could differentiate amongst hot and cold tumours and provide accurate mediation, with cluster 2 recognised as a hot tumour and likely to benefit from immunotherapy drugs.

    Conclusions: In conclusion, the given study supports the potential of necrosis-related lncRNAs as a biomarker for predicting the prognosis and personalised treatment for PCa.

  • Article
    Yanchun Fang, Linv Xia, Haiyan Lu, Hailing He
    Archivos Españoles de Urología. 2024, 77(9): 1089-1099. https://doi.org/10.56434/j.arch.esp.urol.20247709.152
    Download PDF ( )   Knowledge map   Save

    Background: Transperineal (TP) biopsy is increasingly used as an alternative to standard transrectal (TR) biopsy for prostate cancer detection to reduce infection risks. However, evidence on comparative diagnostic accuracy remains inconclusive. The aim of this study was to perform an updated systematic review and meta-analysis of studies comparing prostate cancer detection rates between TP and TR ultrasound biopsies.

    Methods: PubMed, EMBASE, Web of Science and other databases were searched for relevant studies up to December 2023. Randomised trials and observational studies comparing TP and TR biopsies were included. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random effects models. Heterogeneity was assessed, and subgroup analyses were conducted.

    Results: Nine studies comprising four randomised controlled trials (RCTs) and five observational studies were analysed, including 2763 patients (1376 TP, 1387 TR). No significant difference was found in overall cancer detection rates between TP and TR biopsies (RR = 0.9762, 95% CI = 0.8225–1.1586 for random effects model). However, subgroup analysis found that the RCTs showed no difference (RR = 0.9681, 95% CI = 0.8491–1.1038), whereas the observational studies varied (RR = 0.9416, 95% CI = 0.8073–1.0983). Significant heterogeneity was present across studies (I2 = 64.3%, p = 0.0156). Details on the prostate specific antigen (PSA) levels in the included studies were provided, and no significant differences were found between TP and TR biopsies regardless of whether a PSA threshold of >10 ng/mL or <10 ng/mL was used.

    Conclusions: In summary, this updated meta-analysis found no significant difference between TP and TR biopsies in overall prostate cancer detection rates. The subgroup analysis highlighted that results from RCTs specifically indicated equivalence in diagnostic accuracy. TP biopsy may be considered an appropriate alternative to TR biopsy for patients requiring prostate biopsy.

  • Letter
    Wei Li, Yulan Li, Yi Zhao, Yu Zhao, Di Han
    Archivos Españoles de Urología. 2024, 77(9): 1100-1101. https://doi.org/10.56434/j.arch.esp.urol.20247709.153
    Download PDF ( )   Knowledge map   Save