28 May 2022, Volume 75 Issue 4

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  • Article
    Meftun Culpan, Ayberk Iplikci, Huseyin Ozgur Kazan, Gokhan Atis, Asif Yildirim
    Archivos Españoles de Urología. 2022, 75(4): 310-317. https://doi.org/10.56434/j.arch.esp.urol.20227504.44
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    Objectives: We aimed to evaluate oncologic outcomes of pT3a renal cell carcinoma (RCC) patients that treated with radical or partial nephrectomy and identify clinical or pathological factors that predict local recurrence or metastasis.

    Methods: In this single center, retrospective study, we evaluated medical records of 856 patients who underwent radical or partial nephrectomy for RCC. Patients who had pT3aN0M0 RCC in final pathology and at least 6 months of follow-up included in the study. Patients’ demographic characteristics, laboratory parameters, tumor characteristics and oncological outcomes were recorded. Cancer specific and overall survivals were our primary outcomes. Multivariate analysis was performed to identify factors affecting oncologic outcomes.

    Results: A total of 86 pT3aN0M0 RCC patients were included final analysis of our study. During the mean 60.75 months follow up, 3 patients (3.5%) had experienced local recurrence and 19 patients (22.1%) had experienced metastasis. Total of 24 patients (27.9%) had died during the follow up. In this population 10-year OS was 70.8%, 10-year PFS was 61.3% and 10-year CSS was 78.4%. In multivariate analysis, chronic renal failure (CRF) was an independent worse prognostic factor for overall survival (p=0.03). Besides this sarcomatoid differentiation was an independent prognostic factor for PFS, CSS and OS (p=<0.001).

    Conclusions: Our study investigated the predictive factors for worse oncologic outcomes in pT3aN0M0 RCC patients. Although many factors have predictive value in univariate analysis, only sarcomatoid differentiation have independent predictive value for worse CSS, PFS and OS. Besides sarcomatoid differentiation, CRF is an independent prognostic factor for poor OS.

  • Article
    Adrià Costa-Roig, José Antonio March-Villalba, Irene Diéguez, Ignacio Miró, Lucía Rodríguez, María Ángeles Conca, Alba Polo, Agustín Serrano
    Archivos Españoles de Urología. 2022, 75(4): 318-324. https://doi.org/10.56434/j.arch.esp.urol.20227504.45
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    OBJECTIVE: To analyse the clinical evolution, the therapeutic strategies and the characteristics of the patients presenting enuresis attended at our outpatient clinic.

    MATERIAL AND METHODS: Retrospective study of patients <14 years old(yo) diagnosed of enuresis attended at our outpatient clinic (2011-2019) and completed their follow-up (remission or aged 15). Urotherapy was offered to all patients as initial management. The therapeutic strategies were classified as: first line (desmopressin or clock alarm), second line (desmo-pressin+alarm) and third line(anticholinergics). The remission rate during follow-up, the number of consultations needed until remission and the treatments used were calculated. Statistical tests used:Kaplan-Meier, actuarial survival. Multivariate analysis:Cox regression.Statistical significance:p<0.05.

    RESULTS: Data were collected from 125 patients (mean age: 8.6±2.45yo). Family history of enuresis was present in 38.9%. The mean follow-up was 2.37±1.55yo and the average number of consultations was 7.54±5.06. The remission rate (RE) was 84%(n=105), with a median remission interval:2.66 years (2.34-2.991[95%CI]). The average number of treatments required for remission was 2.74±1.27. RE with urotherapy alone was 20%(n=25); RE with first line:19.3%(n=17) and second line:16.7(n=11). In the remaining patients, a RE of 78.18%(n=43) was achieved by adding an anticholinergic. Patients aged > 8.7 years at the beginning of the follow-up required less time to achieve remission (p=.025). These patients had a higher RE (hazard ratio 1.15 (1.05-1.25))(p=.004). No other variables were significant.

    CONCLUSION: Staged therapeutic strategies are necessary to achieve remission. Only 25% remitted with urotherapy as single treatment. RE are higher when patients are >8.7 yo once they initiate their follow up.

  • Article
    Sedat YAHŞİ, Cavit CEYLAN, Yalçın KIZILKAN, Samet ŞENEL, Kazım CEVİZ
    Archivos Españoles de Urología. 2022, 75(4): 325-329. https://doi.org/10.56434/j.arch.esp.urol.20227504.46
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    Objective: Studies have reported that the cribriform morphology observed in prostate biopsy is associated with increased up-staging, upgrading, positive surgical margins and aggressive prognosis after radical prostatectomy. In our study, we aimed to evaluate the relationship between cribriform morphology and biochemical recurrence in patients with moderate-risk localized PCa with a Gleason score of 3+4 (ISUP grade 2) after radical prostatectomy.

    Methods: Datas of 177 patients in the moderate-risk group who were evaluated as ISUP grade 2 after radical prostatectomy were retrospectively evaluated. Patients were divided into 2 groups as without (Group 1) and with biochemical recurrence (Group 2). Age, preoperative PSA level, T stage, follow-up time and presence of cribriform morphology in both groups were evaluated and compared.

    Results: The mean preoperative serum total PSA level (group 1: 8.2 ± 3.9 and group 2: 11.9 ± 4.7) and presence of cribriform morphology (group 1: 25 (16%) and group 2: 9 (42%)) was significantly higher in group 2 (p = 0.001 and p = 0.007, respectively). According to the results of univariate and multivariate logistic regression analysis, preoperative serum total PSA level and pres-ence of cribriform morphology were found to be independent risk factors for biochemical recurrence (OR: 4,4; %95 Cl: 1,6-11,7; p=0.003 and OR: 4,7; %95 Cl: 1,7-13,1; p=0,003, respectively).

    Conclusion: Cribriform morphology of PCa is a risk factor for biochemical recurrence in patients with moderate risk and GS 3+4. In this respect, individualizing PCa cases accompanied by cribriform morphology from other Gleason Score 3+4 cases seems to be an appropriate approach.

  • Article
    Miguel Ángel Rodríguez Cabello, Santiago Méndez Rubio, Álvaro Moraga Sanz, Juan Luis Sanz Miguelañez, David Vázquez Alba, Carolina Aulló González, Arturo Platas Sancho
    Archivos Españoles de Urología. 2022, 75(4): 330-338. https://doi.org/10.56434/j.arch.esp.urol.20227504.47
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    Introduction: The 3-Tesla multiparametric MRI (mpMRI) system represents a diagnostic advance for prostate cancer. Our aim is to demonstrate that the results in 1.5-Tesla mpMRI are not inferior compared to the 3-Tesla for the correct diagnosis of prostate cancer.

    Material and methods: Non-inferiority comparative cross-sectional study between fusion-guided prostate biopsy results. 344 patients with clinical suspicion of prostate cancer (elevated PSA and/or suspicious DRE) and mpMRI interpreted and verified by the same radiologists in all cases, 270 in 1.5-Tesla and 74 in 3-Tesla, with at least one lesion PIRADSv2≥ 3. Exclusion criteria were positive biopsy or previous prostate treatment. We consider malignancy as ISUP≥ 1 and significant tumor as ISUP≥ 2. We used Wilcoxon and t-student test (central tendency measures), diagnostic test (gold standard: ISUP of targeted biopsy), Chi2 test and Z-test (comparison of prevalences and 95%CI malignancy and significant tumor according to mpMRI).

    Results: Median prostate volume 50cc(IQR:33.5) and PSA 6.11ng/ml(IQR:3.39). Mean age 67.4±8.1years. Number of suspi-cious lesions/patient: mpMRI 1.3 (1.5-Tesla) and 1.5 (3-Tesla). No differences were found between mpMRI (homogeneous and comparable samples). 57% (1.5-Tesla) vs 66% (3-Tesla) of targeted biopsies were malignant, and 34%vs38% were significant tumor, with no significant differences. Se, Sp, PPV and NPV for malignancy (1.5-Tesla vs 3-Tesla) were 96%vs90%, 38%vs44%, 67%vs76%, and 86%vs69%, with no significant differences.

    Conclusions: There are no significant differences between 1.5-Tesla vs 3-Tesla mpMRI regarding targeted biopsy results. Not to have 3-Tesla mpMRI may not be a limitation to use 1.5-Tesla as a diagnostic test for the better diagnosis of prostate cancer.

  • Article
    Michele Antonucci, Daniele Castellani, Giorgia Tema, Angelo Territo, Mauro De Dominicis, Lorenzo Defidio
    Archivos Españoles de Urología. 2022, 75(4): 339-345. https://doi.org/10.56434/j.arch.esp.urol.20227504.48
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    Objectives: We aimed to evaluate the prevalence and predictive factors of postoperative infections after a standardized low-pressure RIRS technique. The secondary outcome was comparing surgeons’ experience in terms of infective complication and stone-free rate.

    Methods: A single-center retrospective analysis was conducted on all patients who underwent RIRS for kidney stones between January 2018 and February 2019. Inclusion criteria: adults, stone ≤ 20 mm (unless percutaneous nephrolithotomy contraindica-tions). Concomitant ureteral lithotripsy was allowed. Exclusion criteria: bilateral surgery, active urinary tract infections (UTI), pregnancy, fever at surgery. Low-pressure RIRS and ureteroscopy was achieved with gravity irrigation, a 5 Ch open-ended urethral catheter (ureteral lithotripsy), intravenous furosemide (20 mg), and ureteral access sheath above the ureteral-pelvic junction (RIRS).

    Results: 236 patients were included in the analysis. Mean age was 55.89±13.96 years. Mean stone diameter was 14.28±5.81mm. 43 (18.2%) patients underwent concomitant ureteral lithotripsy. Mean operative time was 61.10 ± 31.36 minutes. Infective complications occurred in 13 (5.5%) patients. Sepsis occurred in 10 (4.2%) patients and septic shock occurred in 1 (0.4%). One patient (0.4%) required stent substitution. Multivariate logistic regression analysis showed that history of UTI predicted for higher risk of postoperative infections (OR 8.434, CI 95% 2.36–29.46). Outcomes comparison of surgical expertise did not statistically differ in terms of stone-free rate and infective complications.

    Conclusion: Our standardized RIRS technique achieved a low postoperative infective complication rate. History of UTI was the strongest predictor of postoperative infections.

  • Article
    Shuzhen Liu, Yuling Zhao, Yubin Zhao, Xiaochun Tang
    Archivos Españoles de Urología. 2022, 75(4): 346-353. https://doi.org/10.56434/j.arch.esp.urol.20227504.49
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    Objectives: Clear cell renal cell carcinoma (ccRCC) is a type of kidney cancer that has a poor prognosis. microRNA-487a (miR-487a) plays a role in the prognosis of gastric cancer, liver cancer, and other cancers. The purpose of this study is to explore the role of miR-487a in the generation and progression of ccRCC.

    Materials and Methods: The RT-qPCR technology was used to detect the expression levels of miR-487a in ccRCC tissues and cell lines. The association between miR-487a and clinical-pathological characteristics of patients was analyzed using the chi-square test. Kaplan-Meier survival analysis and Cox regression analysis were used to analyze the prognostic significance of miR-487a in ccRCC. CCK-8 and Transwell assays were used to analyze the influences of miR-487a on cell proliferation, migration, and invasion.

    Results: miR-487a was significantly up-regulated in ccRCC tissues and cell lines. The high expression of miR-487a is related to lymph node metastasis and TNM staging and may be used as an independent prognostic factor related to lower overall survival and disease-free survival rate. Increased expression of miR-487a accelerated the proliferation, migration, and invasion of ccRCC cells.

    Conclusion: The enhanced expression of miR-487a was related to the prognosis of ccRCC, and it also facilitated cell proliferation, migration, and invasion.

  • Article
    Pau Sarrió-Sanz, Laura Sanchez-Caballero, Laura Martinez-Cayuelas, Carlos Francisco Gori, Juan José Pacheco-Bru, Baraa Nakdali-Kassab, Miguel Gómez-Garberí, Pablo Caballero-Perez, Luis Gomez-Perez, Manuel Angel Ortiz-Gorraiz
    Archivos Españoles de Urología. 2022, 75(4): 354-360. https://doi.org/10.56434/j.arch.esp.urol.20227504.50
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    Objectives: The aim was to study the efficacy and tolerance in patients with haemorrhagic radiation-induced cystitis (HRC) treated with hyperbaric oxygen therapy (HOT) and analyze which factors were related to the response to the treatment.

    Material and methods: We performed a retrospective cohort study of patients treated with HOT for HRC symptoms in a provincial referral centre from 2010 to 2020. We evaluated clinical response to treatment, number of hospitalizations due to HRC and subjective response using the PGI-I questionnaire.

    Results: We treated 52 patients, with a median of 30 sessions, during 6 months and 40 months (6-68 months) of follow-up. 69.2%of patients responded completely and 21,2% partially. The 53.2% of patients improved before the first 10 sessions. Reduction of hospitalizations/per year due to haematuria from 2.8 to 1.1 (p=0,001). The 73,5% of patients stated that they were “very much better” or “much better” after treatment. During the follow-up, 15.4% of patients had recurrence of HRC. 9.6% of the patients required salvage cystectomy. The patients with a highest RTOG-EORTC scale had more risk to still with symptoms (OR 3.01 (IC95 1.48 – 6.16). All patients were able to complete the proposed treatment plan with good tolerance to HOT.

    Conclusions: These results show the clinical benefit of HOT in the treatment of HRC, with a reduction of the number of hospitalizations and a subjective improvement.

  • Article
    Andrea Benedetto Galosi, Lucio Dell’Atti, Daniele Castellani, Marco Tiroli, Maria Pia Pavia, Eugenio Pretore, Lorenzo Montesi, Mariella Donati, Paolo Cerchiara, Elisabetta Cerutti, Giulio Milanese
    Archivos Españoles de Urología. 2022, 75(4): 361-367. https://doi.org/10.37554/en-j.arch.esp.urol-20210525-3501-21
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    Objectives: Retrograde intrarenal surgery (RIRS) is commonly performed under general anesthesia (GA) because renal mobility during breathing may affect lithotripsy. However, spinal anesthesia (SA) is adopted in clinical practice due to clinical conditions that contraindicate GA. We aimed to compare results of RIRS for stones performed under GA compared to SA regarding stone-free rate (SFR) status and postoperative complications in a consecutive single-center series.

    Methods: We retrospectively reviewed all patients who underwent RIRS for stones between 2017 and 2020. Inclusion criteria: age ≥ 18 years, renal stone burden deemed suitable for RIRS with a stone diameter ≤ 20 mm. Exclusion criteria: stones >20 mm, urinary tract infection, bilateral surgery, second-look procedures, unmodifiable bleeding diathesis, <5mm asymptomatic lower calyx stones. SFR was defined as no residual fragment >3 mm at 6-12 weeks follow-up. The choice of anesthesia was a shared decision between anesthesiologists and patient preference.

    Results: 230 patients were included in the analysis. Mean age was 57.50±13.73 years. 33% of stones were located in the pelvis. 28.7% of patients had multiple stones. Mean cumulative stone diameter was 16.60±6.54 mm. 63% of patients underwent RIRS under SA. There were no significant differences between the two groups in terms of preoperative characteristics, except for comor-bidity, significantly higher in the GA group. Mean time of operating room occupation was longer in the GA group (81.58±35.37 minutes) than in the SA group (72.85±25.91 minutes,p=0.033). Length of stay was shorter in the SA group (mean 2.2±1.66 days vs 3.46±5.88 in GA,p=0.019). Logistic regression showed that multiple stones in the collecting system were associated with residual fragments (HR 0.386, 95%CI 0.151-0.991,p=0.04). There were no statistically significant differences in overall and high-grade complications, and in SFR between SA (75.9%) and GA groups (70.6%,p=0.317).

    Conclusion: SA does not affect SFR and postoperative complications in patients who underwent RIRS in daily practice.

  • Article
    Rabia Burcin GIRGIN, Seyma Ozkanli, Pinar ENGİN-ZERK, Tuce Soylemez, Zeynep Cagla OLGUN, Asif Yildirim, Gozde KIR
    Archivos Españoles de Urología. 2022, 75(4): 368-374. https://doi.org/10.37554/en-j.arch.esp.urol-20210619-3504-24
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    Introduction: The most common type of renal cancers is the clear cell renal cell carcinoma (CCRCC) and 98% of CCRCCs have a loss of sequence in the short arm of chromosome 3 by deletion or translocation. Programmed cell death; another possible mechanism of tumorigenesis, comprises two separate components: apoptosis and autophagy. This study aims to show the rela-tion between the prognostic parameters and survival, and Beclin-1, as the representative marker of autophagy, and Bcl-2 as the representative marker of apoptosis in CCRCC patients. In this study, we aimed to determine if Beclin-1 and Bcl-2 expression levels can provide any prognostic information about CCRCC patients.

    Methods: We examined a total of 84 patients who underwent partial or radical nephrectomy and were diagnosed as having CCRCC between January 2008 and December 2015. Immunohistochemical staining was performed, the evaluation was for Beclin-1 and Bcl-2 semi-quantitative, and based on the percentage of positively stained cells (proportion) and staining intensity.

    Results: There was only a statistical significance between Beclin-1 expression and age (r:-0.274; p=0.012; p <0.05). There was a marginal significance between ISUP grade and Beclin-1 (p=0.051). The relation of Bcl-2 expression with the ISUP grade, recurrence, metastasis, and mortality revealed statistical significance (p=0.001, p=0.019, p=0.009, p=0.013, respectively). The ISUP grade and the Bcl-2 expression revealed statistical significance on multivariate analysis ( HR 7.453, 95% CI: 1.935-28.713, p=0.004). The 5-year and 10-year tumor recurrences rates were lower in Bcl-2 positive group, and Bcl-2 positive group experi-enced longer disease free and overall survival.

    Conclusion: There was only marginal correlation between Beclin-1 expression and ISUP grade. No other histopathologic prog-nostic parameters histologic parameters revealed any signigificance. The higher expression of Bcl-2 is correlated with nuclear lower ISUP grade, lower pT stage, and longer disease free and overall survival.

  • Case Report
    Rocío Barrabino-Martín, José Miguel Molina-Hernández, Sergio Ferra-Murcia, José Ignacio Abad Vivas-Pérez
    Archivos Españoles de Urología. 2022, 75(4): 375-376. https://doi.org/10.56434/j.arch.esp.urol.20227504.53
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    Kidney development is a complex process that begins during the fifth to ninth weeks of life. Different types of renal congenital anomalies exist; however, they are rare and usually asymptomatic. Renal ectopia is a rare malformation that affects 0.01-0.05% of patients. Of all the locations, the most frequent is the pelvic (55%). We present a case of a 21-year-old man with bilateral renal ectopia.

  • Case Report
    Javier Arredondo Montero, Mónica Bronte Anaut, Marta Montes, Carlos Bardají Pascual
    Archivos Españoles de Urología. 2022, 75(4): 377-378. https://doi.org/10.56434/j.arch.esp.urol.20227504.54
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    The presence of ectopic adrenal remnants in the inguinal canal is an infrequent finding in pediatric patients. We performed a retrospective review of all pediatric patients diagnosed with ectopic adrenal tissue as an incidental finding during surgery of the inguinal canal at our center between 2000 and 2021. Six patients were included. The mean age was 3.83 ± 2.91 years. 3 (50%) were Arab and 3 (50%) were Caucasian. All patients were male. Five of the patients (83.3%) underwent surgery for testicular maldescent and one patient (16.6%) underwent surgery for a left hydrocele. 4 patients were operated on the right side (66%) and 2 on the left side (33%). Histologically, the presence of ectopic adrenal tissue was confirmed in all patients. All patients are healthy, discharged and under ambulatory follow-up. The existing literature suggests that ectopic adrenal remnants do not appear to have clinical or prognostic implications.

  • Case Report
    Hasan Demirkan, Mehmet Özgür Kuzdan
    Archivos Españoles de Urología. 2022, 75(4): 379-381. https://doi.org/10.56434/j.arch.esp.urol.20227504.55
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    Objectives: Robinow syndrome is a very rare syndrome characterized by short stature, extremity deformities, costovertebral abnormalities, renal/external genital malformations, and fetal facial appearance. It might be inherited by either autosomal dominant or severe recessive form. Diagnosis is generally established by the aid of genetic mutation and phenotypic findings. The urogenital component of the disease frequently presents with microgenitalia such as micropenis and/or cryptorchidism.

    Methods: Herein, a four-year-old boy with Robinow syndrome accompanied by incomplete bladder duplication is discussed.

    Results: The duplication in the bladder was screened by cystoscopy and corrective surgery was performed.

    Conclusions: This rare manifestation is the first for urological findings of Robinow syndrome in literature.