Actas Urol Esp [JOURNAL]
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200 papers
Comparative outcomes of Mini-PCNL and suction-assisted flexible ureteroscopy in patients with renal stones ≥2 cm.
Durak HM, Sancı A, Hepşen E … +4 more , Karadağ OB, Yığman M, Sarıkaya K, Sağnak AL
Actas Urol Esp (Engl Ed) · 2026 Jun · PMID 42264218 · Publisher ↗
INTRODUCTION: To compare the efficacy and perioperative outcomes of miniaturized percutaneous nephrolithotomy (mini-PCNL) and flexible ureteroscopy with flexible and navigable suction ureteral access sheath (FANS-UAS) in...
INTRODUCTION: To compare the efficacy and perioperative outcomes of miniaturized percutaneous nephrolithotomy (mini-PCNL) and flexible ureteroscopy with flexible and navigable suction ureteral access sheath (FANS-UAS) in the management of renal stones larger than 2 cm. MATERIAL AND METHOD: This retrospective comparative study evaluated 252 adults with renal stones ≥2 cm treated between May 2024 and December 2025. Mini-PCNL was performed in 142 patients and FANS-UAS-assisted flexible ureteroscopy in 110. Preoperative non-contrast CT was used to characterize stones, and postoperative CT determined stone-free status as the primary endpoint. Operative time, hemoglobin drop, length of stay, Clavien-Dindo complications, and auxiliary intervention rates were analyzed as secondary outcomes. RESULTS: Stone-free rates did not differ significantly between mini-PCNL and FANS-UAS-assisted flexible ureteroscopy (83.1% vs. 76.4%, p = 0.242). Mini-PCNL provided shorter operative times but resulted in greater hemoglobin decline, longer hospitalization, and more minor complications, while major complications were similar. Although mini-PCNL yielded higher stone-free rates in lower pole stones, this was not statistically significant. FANS-UAS was more frequently applied in older, comorbid patients and maintained satisfactory efficacy with a favorable perioperative profile. CONCLUSIONS: Both mini-PCNL and FANS-UAS-assisted flexible ureteroscopy achieved effective stone clearance for renal stones >2 cm. Mini-PCNL was faster, whereas FANS-UAS was associated with lower perioperative morbidity, despite lower adjusted odds of stone-free status compared with mini-PCNL. These results support an individualized approach to procedure selection in large renal stones, with stone burden, lower pole involvement, and patient comorbidity considered together in treatment planning.
Morphometric changes in pelvic floor structure following non-invasive rehabilitation and neuromodulation assessed by ultrasound imaging.
Maiti Bera S, Palma P, Santos Flores JM … +1 more , Rodríguez Vidales EP
Actas Urol Esp (Engl Ed) · 2026 Jun · PMID 42264217 · Publisher ↗
INTRODUCTION AND OBJECTIVE: Pelvic floor disorders represent a common problem in female urology practice and significantly affect quality of life. Objective evidence regarding structural changes induced by non-invasive n...
INTRODUCTION AND OBJECTIVE: Pelvic floor disorders represent a common problem in female urology practice and significantly affect quality of life. Objective evidence regarding structural changes induced by non-invasive neuromodulation remains limited. The aim of this study was to evaluate, using pelvic floor ultrasound (PFUS), the morphometric changes occurring in the pelvic floor following neuromodulation with high intensity focused electromagnetic energy (HIFEM). MATERIALS AND METHODS: This was an analytical, quasi-experimental, prospective observational study with pre- and post-intervention assessment. The study included women with pelvic floor dysfunction treated with transperineal neuromodulation using HIFEM. Urinary symptoms, quality of life, and morphometric parameters were assessed using PFUS. RESULTS: Forty-six women with a mean age of 60.4 ± 12.6 years were analyzed. Significant improvements were observed in urinary frequency, ICIQ-SF, ICIQ-OAB, Sandvik Severity Index, and King's Health Questionnaire scores (p < 0.001). Ultrasound findings demonstrated reduced detrusor thickness, improved bladder emptying, enhanced pelvic floor dynamic activity, and improved pelvic support. CONCLUSIONS: HIFEM neuromodulation was associated with improvements in clinical outcomes and quality of life, as well as morphometric changes in the pelvic floor objectively demonstrated by transperineal ultrasound.
Improving long-term monitoring in NMIBC: Digital Uromonitor® (dUM) as a complementary tool to cystoscopy for two-year recurrence risk stratification.
Rubio-Briones J, Guerrero Ramos F, Mercadé Sánchez A … +21 more , Bezana Abadía I, Martín Rodríguez R, Alcaraz A, Miqueleiz Legaz M, Lozano F, Arrabal Martín M, Cardo AL, Gonzalo Rodríguez V, Caño Velasco J, Serrano Liesa M, Ferreiro Pareja C, Espílez Ortiz R, González-Valcárcel de Torres I, Sánchez Zalabardo D, Guijarro A, Mengual L, Borque-Fernando A, Mariano Esteban Escaño L, Palou Redorta J, Witjes F, Martínez Piñeiro L
Actas Urol Esp (Engl Ed) · 2026 May · PMID 42191068 · Publisher ↗
OBJECTIVE: Non-muscle-invasive bladder cancer (NMIBC) has a high risk of recurrence and requires intensive long-term surveillance. Existing clinical risk models offer limited prognostic accuracy. Molecular urine-based as...
OBJECTIVE: Non-muscle-invasive bladder cancer (NMIBC) has a high risk of recurrence and requires intensive long-term surveillance. Existing clinical risk models offer limited prognostic accuracy. Molecular urine-based assays may improve prognostic assessment accuracy of future recurrence. This study evaluated whether Digital Uromonitor® (dUM), detecting TERT and FGFR3 mutations via ddPCR, enhances prognostic assessment of two-year recurrence beyond cystoscopy and cytology in a prospective multicenter cohort. METHODS: This prospective, multicenter observational study (EVALUATION-CUETO; NCT05864599) enrolled consecutive NMIBC patients from 26 institutions. Eligible participants had an index tumor diagnosed 3 months-2 years before recruitment and completed two years of follow-up with sufficient DNA for dUM analysis. Clinical, pathological, and biomarker variables (cystoscopy, cytology, dUM) were collected. Recurrence rate was defined as events per year and classified as high (R > 0.5) or low (R ≤ 0.5). RESULTS: Of 201 included patients, 75 (37%) were dUM-positive; TERT promoter mutations accounted for 88% of these cases. dUM showed prognostic value, correctly identifying 59% of recurrences over two years of standardized FU, outperforming cystoscopy alone (42%), with specificity of 74% and NPV of 78%. Combining dUM with cystoscopy increased sensitivity to 71%. Patients negative for both cystoscopy and TERT had the lowest recurrence risk (14%), whereas dual-positive patients exceeded 80%. High baseline recurrence rate consistently increased risk across all biomarker categories. CONCLUSIONS: dUM provides robust, reproducible prognostic information and significantly improves molecular risk stratification in NMIBC. These findings support its potential integration into risk-adapted surveillance strategies, pending validation in larger populations.
i-PCNL: a novel ureteral-catheter application for continuous unidirectional high-flow irrigation during Percutaneous Nephrolithotomy. Technique description and preliminary outcomes.
Servera Ruiz de Velasco A, Ballesta Martínez B, Barrera Rodríguez C … +1 more , Benejam Gual J
Actas Urol Esp (Engl Ed) · 2026 · PMID 42191067 · Publisher ↗
INTRODUCTION: Percutaneous nephrolithotomy (PCNL) remains the technique of choice for the treatment of complex renal stones. Despite technical advances, limitations remain in terms of visibility, fragment migration, and...
INTRODUCTION: Percutaneous nephrolithotomy (PCNL) remains the technique of choice for the treatment of complex renal stones. Despite technical advances, limitations remain in terms of visibility, fragment migration, and effective evacuation of the material. Optimizing irrigation is the key to improve the efficiency and safety of the procedure. MATERIALS AND METHODS: A prospective observational study was done at one referral center, including 14 patients undergoing supine PCNL. A continuous retrograde irrigation technique directed at the upper renal pole was evaluated by adapting commercially available ureteral devices of a specific caliber. Irrigation was performed using a passive system based on hydrostatic pressure dependent on the height of the irrigation bags. Demographic variables, stone characteristics, operative and postoperative parameters, complications, stone-free rate (SFR), and a subjective evaluation of the system using a Likert scale were analyzed. RESULTS: The technique was performed in all cases without incident. No migration of fragments to the upper pole was observed. The mean effective lithotripsy time was 10.07 min. No relevant complications were recorded, except for one case of postoperative anemia. The SFR was 100% in the tomographic control at 4 weeks. The subjective assessment showed high scores for irrigation efficacy, vision quality, and fragment evacuation. CONCLUSIONS: Continuous retrograde irrigation during PCNL is a simple and reproducible technique that, in this preliminary series, showed favorable results, making it a promising option.
Reconstructing the reconstructed: Outcomes of redo-urethroplasty for recurrent urethral strictures.
Uğur R, Keskin ET, Savun M … +1 more , Aktaş E
Actas Urol Esp (Engl Ed) · 2026 May · PMID 42191066 · Publisher ↗
INTRODUCTION: In this study, we aimed to evaluate the results of redo-urethroplasty and to determine the risk factors contributing to the recurrence of stricture. METHODS: Male patients with a history of urethroplasty wh...
INTRODUCTION: In this study, we aimed to evaluate the results of redo-urethroplasty and to determine the risk factors contributing to the recurrence of stricture. METHODS: Male patients with a history of urethroplasty who underwent redo-urethroplasty were retrospectively evaluated and included in the study. Classifications were made according to patient characteristics, features of the stricture, and the surgical procedure performed. Success criteria was defined as anatomical success, which was determined by the resistance-free passage of a 16-Fr flexible cystoscope through the reconstructed urethral lumen. After identifying the influencing factors, univariate and multivariable logistic regression analyses were conducted to determine the predictors for recurrence. RESULTS: A total of 396 male patients who underwent urethroplasty were evaluated, with 76 patients meeting the established criteria for inclusion. The mean age was 42.3 (10-81) years, and the average follow-up period was 44 (13-78) months. The majority of patients (54%) had bulbar strictures, and the average stricture length was 4.8 ± 2.4 (1.3-12) cm. Treatment success was achieved in 72.4% of patients. In univariate analyses, factors statistically significantly (P < .05) associated with recurrence included smoking, diabetes mellitus, stricture length, etiology, and the presence of complications. In the multivariable logistic regression analysis, presence of complications remained statistically significant (P < .05) as an independent predictor of recurrence. CONCLUSIONS: Smoking, diabetes mellitus, stricture length, etiology, and postoperative complications were significantly associated with stricture recurrence. These results suggest that patient-related, stricture-related, and perioperative factors influence recurrence risk after redo-urethroplasty.
Functional outcomes of pyeloplasty in children with reduced preoperative renal function: A multicenter study.
Tobía González S, Bujons-Tur A, Corbetta JP … +9 more , Fadil-Iturralde JL, Smith-Harrison LI, Tobía-González I, Ruiz J, Quiroz Y, Maiolo A, Contardi JC, Weller S, Rosito T
Actas Urol Esp (Engl Ed) · 2026 · PMID 42191065 · Publisher ↗
OBJECTIVE: To evaluate functional outcomes after dismembered pyeloplasty in children with unilateral ureteropelvic junction obstruction (UPJO) and preoperative differential renal function (DRF) ≤40%. MATERIALS AND METHOD...
OBJECTIVE: To evaluate functional outcomes after dismembered pyeloplasty in children with unilateral ureteropelvic junction obstruction (UPJO) and preoperative differential renal function (DRF) ≤40%. MATERIALS AND METHODS: Retrospective multicenter review (2003-2022) including 74 children with primary unilateral UPJO and DRF ≤ 40%. EXCLUSIONS: bilateral UPJO, solitary kidney, secondary causes, prior surgery, and <1-year follow-up. Group 1: DRF < 20%; Group 2: 20-40%. RESULTS: Median age 9 years; 50% right-sided obstruction; 20.3% prenatal hydronephrosis. DRF improved from median 26% preoperatively to 36.9% postoperatively (p < 0.001). Functional improvement >5% occurred in 58.1% overall (73.9% G1 vs. 51.0% G2, p = 0.06). DRF was stable or improved in 93.2%. Prenatal hydronephrosis predicted postoperative deterioration (OR 7.12, 95% CI 1.7-47.3). The median follow-up duration was 48 months (IQR 13-64). CONCLUSIONS: Pyeloplasty was associated with stabilization or improvement of renal function in children with UPJO and reduced preoperative DRF, including those with DRF < 20%. Prenatal hydronephrosis identifies a subgroup at higher risk of postoperative decline.
Urinary pH and oncologic outcomes after bacillus calmette-guérin in non-muscle invasive bladder cancer: a retrospective cohort study.
Kayar K, Kayar R, Ozdemir BB … +4 more , Karabay E, Tosun C, Ozturk MI, Yucebas OE
Actas Urol Esp (Engl Ed) · 2026 · PMID 42191064 · Publisher ↗
INTRODUCTION: Urinary pH may influence intravesical Bacillus Calmette-Guérin (BCG) efficacy by modulating the local immune microenvironment. We evaluated baseline urinary pH as a continuous variable and its association w...
INTRODUCTION: Urinary pH may influence intravesical Bacillus Calmette-Guérin (BCG) efficacy by modulating the local immune microenvironment. We evaluated baseline urinary pH as a continuous variable and its association with oncologic outcomes in BCG-treated non-muscle invasive bladder cancer (NMIBC). METHODS: In this retrospective cohort, 248 NMIBC patients receiving adequate BCG therapy were analyzed. Recurrence-free survival (RFS) and progression-free survival (PFS) were assessed using Cox proportional hazards models. Given limited progression events, ridge (L2-penalized) multivariable regression was applied. Urinary pH was modeled per 1-unit increase and age per 10-year increment. Model discrimination was evaluated using Harrell's concordance index. RESULTS: During follow-up, 43 patients (17.3%) developed recurrence and 28 (11.3%) experienced progression. In multivariable analysis, urinary pH was independently associated with improved RFS (HR 0.53, 95% CI 0.29-0.96, p = 0.035). For PFS, urinary pH showed a similar inverse direction but borderline significance after ridge adjustment (HR 0.69, 95% CI 0.48-1.00, p = 0.052). Concomitant carcinoma in situ and tumor stage remained independent predictors of progression. Model discrimination was good for RFS (C-index 0.713) and strong for PFS (C-index 0.841). CONCLUSIONS: Baseline urinary pH demonstrated an independent association with recurrence and a consistent directional association with progression in BCG-treated NMIBC. While dominant pathological features primarily determine progression risk, urinary pH may represent an accessible microenvironmental modifier of BCG responsiveness. Prospective validation is warranted.
Position paper of the Spanish Society of Radiotherapeutic Oncology (SEOR) and its genitourinary tumors group (URONCOR) on the prescription of parp inhibitors in advanced prostate cancer.
Diezhandino P, Couñago F, Ocanto A … +5 more , Gómez de Iturriaga A, Conde A, Maldonado X, Serrano J, López-Campos F
Actas Urol Esp (Engl Ed) · 2026 · PMID 42178023 · Publisher ↗
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When evidence is not interchangeable: The limits of therapeutic equivalence in high-risk biochemical recurrence of prostate cancer.
Pérez Fentes D, Gómez Iturriaga A, Ramírez Backhaus M … +2 more , Gómez Rivas J, López Campos F
Actas Urol Esp (Engl Ed) · 2026 May · PMID 42178022 · Publisher ↗
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Incidence, risk factors and prognostic impact of pyelonephritis in cancer patients with percutaneous nephrostomy for malignant ureteral obstruction.
Selman Mert M, Murat Ipek O
Actas Urol Esp (Engl Ed) · 2026 May · PMID 42176952 · Publisher ↗
INTRODUCTION AND OBJECTIVES: Percutaneous nephrostomy (PCN) is commonly used for malignant ureteral obstruction but carries significant infection risk in immunocompromised cancer patients. Data on pyelonephritis incidenc...
INTRODUCTION AND OBJECTIVES: Percutaneous nephrostomy (PCN) is commonly used for malignant ureteral obstruction but carries significant infection risk in immunocompromised cancer patients. Data on pyelonephritis incidence, risk factors, and prognostic impact in this population remain limited. This study aimed to determine the incidence, risk factors, and prognostic impact of nephrostomy-related pyelonephritis and identify modifiable targets for infection prevention. MATERIALS AND METHODS: In this prospective observational study, 115 adult patients with malignancy-associated grade ≥2 hydronephrosis who underwent primary PCN were followed for two years. Demographic, oncological and procedural data, handwashing education status and laboratory parameters were recorded. Serial urine, renal pelvis, skin and catheter tip cultures were obtained. Pyelonephritis was defined by fever, flank pain and inflammatory markers with a positive urine culture. Pyelonephritis-free survival and overall survival were analyzed using Kaplan-Meier and Cox regression models. RESULTS: During follow-up, pyelonephritis occurred in 65 patients (56.5%), with a mean pyelonephritis-free survival of 82.7 days. Female sex, prior colectomy, catheter dislocation, higher baseline WBC and higher C-reactive protein levels were independently associated with pyelonephritis. Two-year overall survival was 66.1% and baseline levels of albumin (low), WBC (high) and pyelonephritis presence independently predicted mortality. Handwashing education was strongly associated with a lower incidence of pyelonephritis and shorter hospital stay. CONCLUSIONS: In patients with malignant ureteral obstruction requiring PCN, pyelonephritis is a common complication with prognostic implications. Hand hygiene education, better catheter care, early detection/treatment, and follow-up of routine laboratory markers may reduce infection burden and improve survival in this highly vulnerable population.
Prospective randomized evaluation of patient- and physician-reported pain concordance in flexible cystoscopy: impact of experience and anxiety.
Ozgur G, Ozdemiroglu C, Kars M … +2 more , Senoglu Y, Cam HK
Actas Urol Esp (Engl Ed) · 2026 May · PMID 42176951 · Publisher ↗
INTRODUCTION: Flexible cystoscopy is commonly performed under local anesthesia. This study explores the effects of pre-procedural anxiety, depression, and physician experience on both patient pain and the physician's per...
INTRODUCTION: Flexible cystoscopy is commonly performed under local anesthesia. This study explores the effects of pre-procedural anxiety, depression, and physician experience on both patient pain and the physician's perception of it. METHODS: This prospective, randomized study included 120 male patients (≥18 years), scheduled for flexible cystoscopy under intraurethral 2% lidocaine. Patients were randomly assigned to four groups based on the experience level of the physician. Pain perception was assessed using the Visual Analog Scale (VAS), while pre-procedural anxiety and depression were measured with the Hospital Anxiety and Depression (HAD) scale. RESULTS: Postoperative VAS-pain scores were slightly higher than preoperative values (2 vs. 1.5; p < 0.001), but this difference was considered clinically negligible due to the overall low pain levels observed. Although doctors tended to underestimate patients' pain, a correlation was observed between patient- and physician-reported postoperative VAS-pain (r = 0.487, p < 0.01). Physician experience did not significantly affect pain perception (p = 0.585). Interestingly, although the differences in VAS-scores are not clinically important, the correlation analysis revealed that less experienced physicians -residents- demonstrated a stronger concordance between their perception of patient pain and the patients' self-reported pain (r = 0.798 and r = 0.633). HADS-anxiety scores correlated positively with both preoperative and postoperative pain and anxiety levels (r = 0.194-0.404, p < 0.05), while HADS-depression showed no association. CONCLUSION: Flexible cystoscopy performed under local anesthesia is a well-tolerated procedure, irrespective of the physician's level of experience. The correlation between patient and physician pain scores suggests that physicians can reliably assess patient discomfort. Managing preoperative anxiety is essential to enhance patient comfort during the procedure.
Computed tomography-based prediction of ureteroscopic failure in impacted ureteral stones: A focus on stone volume and ureteral anatomy.
Dinckal M, Ergun KE, Akyol A … +4 more , Kalemci MS, Simsir A, Altay AB, Kizilay F
Actas Urol Esp (Engl Ed) · 2026 · PMID 42176950 · Publisher ↗
INTRODUCTION: Impacted ureteral stones are associated with lower ureteroscopic success and increased procedural complexity. Although ureteroscopy is the standard treatment, reliable preoperative predictors of failure are...
INTRODUCTION: Impacted ureteral stones are associated with lower ureteroscopic success and increased procedural complexity. Although ureteroscopy is the standard treatment, reliable preoperative predictors of failure are limited, and decision-making often depends on intraoperative findings. This study evaluated the association between preoperative CT-based stone and ureteral anatomical parameters and ureteroscopic failure among patients with endoscopically confirmed impacted ureteral calculi. METHODS: This retrospective study analyzed 123 patients with impacted ureteral calculi who underwent URS. Preoperative non-contrast computed tomography images were evaluated for stone characteristics, ureteral wall thickness (UWT), and ureteral anatomical features, including kinking. URS success was defined as stone-free status after the initial procedure, and the predictive value of CT parameters was assessed using receiver operating characteristic analysis and univariate and multivariate logistic regression models. RESULTS: The overall URS success rate was 68.3%. In univariate analysis, stone volume, proximal kink width, and proximal kink length were significantly larger in the failed group. Multivariate logistic regression analysis identified stone volume as the sole independent predictor of URS failure (OR: 3.05; 95% CI: 1.06-8.78; P = .039). A stone volume ≥ 451.28 mm³ demonstrated modest predictive power (AUC = 0.615). Although proximal kink parameters showed promising results in univariate analysis and ROC curves, these associations were not independent of other factors. UWT showed no significant differences between the groups. CONCLUSIONS: Stone volume is the only independent predictor of ureteroscopic failure in impacted ureteral stones, while ureteral anatomy may provide complementary information regarding procedural complexity.
Factors associated with urinary incontinence after endoscopic prostate enucleation: A scoping review.
Rodríguez Caicedo N, López Ramos HE, Huertas JM … +2 more , Vivas Ramírez N, González-Nieto J
Actas Urol Esp (Engl Ed) · 2026 · PMID 42019920 · Publisher ↗
INTRODUCTION AND OBJECTIVE: Endoscopic enucleation of the prostate is an established treatment for benign prostatic obstruction, providing substantial improvement in lower urinary tract symptoms and urinary flow. However...
INTRODUCTION AND OBJECTIVE: Endoscopic enucleation of the prostate is an established treatment for benign prostatic obstruction, providing substantial improvement in lower urinary tract symptoms and urinary flow. However, postoperative urinary incontinence (UI), typically transient, remains a relevant concern. Evidence regarding factors associated with postoperative UI remains heterogeneous. This scoping review aimed to synthesize available literature describing variables associated with urinary incontinence following endoscopic prostate enucleation. MATERIALS AND METHODS: A scoping review was conducted using PubMed and Embase. The search identified 490 records; after duplicate removal and screening by three independent reviewers, 52 studies were included. Most were retrospective cohort studies with heterogeneous designs, follow-up intervals, and definitions of UI. Data analyzed descriptively in accordance with PRISMA-ScR guidelines. RESULTS: Reporting of postoperative UI varied across studies, including differences in subtype classification and outcome measurement methods. Early postoperative UI was commonly reported (15-35%), with most cases resolving within 6 months and persistent incontinence generally below 3% at one year. Advanced age, diabetes mellitus, obesity, larger prostate volume, greater resected tissue weight, and elevated preoperative post-void residual were described as associated with early UI. However, variability in outcome definitions and inconsistent multivariable adjustment limited identification of definitive independent predictors. CONCLUSIONS: Postoperative urinary incontinence after endoscopic prostate enucleation is transient and resolves over time. Although several patient and surgical factors are repeatedly linked to early UI, heterogeneity of existing evidence precludes firm conclusions regarding independent predictors. Standardized outcome definitions and prospective studies are needed to improve risk stratification and guide perioperative counseling.
Clinical and tumor-related determinants of early morbidity and prolonged hospital stay after TUR-BT.
Aydın YM, Ozdel O, Mungan NA
Actas Urol Esp (Engl Ed) · 2026 Apr · PMID 42019919 · Publisher ↗
INTRODUCTION AND OBJECTIVES: Transurethral resection of bladder tumor (TUR-BT) morbidity rates vary widely in the literature (4.3%-43.5%), and differences across studies reflect differences in patient populations and def...
INTRODUCTION AND OBJECTIVES: Transurethral resection of bladder tumor (TUR-BT) morbidity rates vary widely in the literature (4.3%-43.5%), and differences across studies reflect differences in patient populations and definitions of adverse events. We aimed to identify independent risk factors for postoperative complications and prolonged length of hospital stay (LOS) following TUR-BT. MATERIALS AND METHODS: We analyzed data from 803 patients who underwent bipolar TUR-BT between 01/2012 and 10/2024. Demographic, clinical, and pathological variables were evaluated, including age, sex, ASA score, tumor size, number, morphology, grade, stage, resection status, intravesical treatment, history of prior TUR-BT, and reTUR-BT. Complications occurring within 30 days were classified according to the Clavien-Dindo system. A hospital stay exceeding the study's median LOS (>3 days) was defined as prolonged. Logistic regression models were used to identify independent predictors of complications and prolonged LOS. RESULTS: Postoperative complications occurred in 10.6% of cases, most of which were low-grade (Clavien-Dindo I-II, 82.3%). Hematuria and urinary tract infections were the most common events. Independent predictors of complications included higher ASA scores (3-4) (OR = 2.075, p = 0.016), tumor multiplicity (OR = 1.878, p = 0.021), incomplete resection (OR = 2.247, p = 0.018), pT2 stage (OR = 3.188, p = 0.002), and CIS (OR = 3.476, p = 0.017). Prolonged LOS was independently associated with larger tumor size (OR = 1.009, p = 0.005), non-papillary morphology (OR = 1.903, p = 0.001), incomplete resection (OR = 1.904, p = 0.035), reTUR-BT (OR = 1.926, p = 0.001), and the presence of complications (OR = 4.777, p < 0.001). CONCLUSIONS: TUR-BT is generally safe; however, early morbidity and prolonged hospitalization are influenced by tumor characteristics, operative factors, and patient comorbidity, informing perioperative risk stratification.
Effectiveness of email reminders to reduce outpatient non-attendance: A quasi-experimental study in a urology department.
Santillan D, Giunta DH
Actas Urol Esp (Engl Ed) · 2026 · PMID 42019918 · Publisher ↗
INTRODUCTION: Non-attendance at scheduled medical appointments implies negative consequences for both healthcare systems and individual patient health. An email reminder system that includes a link to easily cancel appoi...
INTRODUCTION: Non-attendance at scheduled medical appointments implies negative consequences for both healthcare systems and individual patient health. An email reminder system that includes a link to easily cancel appointments was implemented. The objective of this study is to evaluate the effectiveness of this tool to reduce non-attendance. METHODS: We conducted a retrospective, quasi-experimental before-and-after study using two complementary analytical approaches: an individual-level analysis of scheduled appointments and an aggregated interrupted time series (ITS) analysis by epidemiological weeks. All consecutive adult urology appointments from twelve months before the implementation (July 2021) to twelve months after (March 2024) were included. Appointments scheduled before the intervention were considered unexposed, while those scheduled afterward were considered exposed. We used logistic regression for individual-level and segmented Poisson regression for aggregated ITS analysis. RESULTS: A total of 272,331 appointments corresponding to 73,387 individuals were analyzed over 144 epidemiological weeks. In the main individual-level analysis, the non-attendance percentage was nearly 3% lower in the exposed group. The adjusted odds ratio for the effect of the reminder on non-attendance was 0.76 (95% CI 0.73-0.81). In the ITS analysis, segmented regression confirmed an immediate 13% drop at intervention (Relative Risk 0.868, RR), and a post-intervention decline of 0.4% per week (RR 0.996). Sensitivity and subgroup analyses yielded similar results. CONCLUSIONS: We observed a consistent association between the reminders and the reduction in non-attendance percentages for urology appointments, both in the individual-level and aggregated analyses.
Antibiotic prophylaxis in urodynamics: A systematic review of secondary studies.
Castillo Carvajal L, Zapata CA, Corrales Acosta E … +6 more , Errando Smet C, Przydacz M, De Cillis S, Tantay CG, Geretto P, Caceres AL
Actas Urol Esp (Engl Ed) · 2026 Apr · PMID 42002142 · Publisher ↗
Urodynamics is the functional study of the urinary tract and an invasive diagnostic test that involves inserting a catheter into the bladder to assess bladder-related symptoms. One major risk is the development of urinar...
Urodynamics is the functional study of the urinary tract and an invasive diagnostic test that involves inserting a catheter into the bladder to assess bladder-related symptoms. One major risk is the development of urinary tract infections (UTI) following the procedure. Currently, there is no global consensus on the use of antibiotic prophylaxis. This study aims to identify key recommendations regarding prophylactic antibiotic therapy associated with urodynamic procedures. A systematic review of clinical practice guidelines (CPG), systematic reviews, and meta-analyses was conducted with subsequent quality evaluation. Out of 320 references, four clinical practice guidelines, one meta-analysis, and one systematic review were selected. Three clinical practice guidelines had acceptable global quality, and one was a "Best Practice Statement". All guidelines agree that antibiotic prophylaxis is not recommended for low-risk patients but should be used in those at high risk of postoperative infection. The meta-analysis concluded that prophylactic antibiotics could reduce the risk of asymptomatic bacteriuria and symptomatic UTI post-urodynamics without increasing the incidence of adverse events. For high-risk patients, the recommended antimicrobials include trimethoprim-sulfamethoxazole or fluoroquinolones, considering the institution's resistance profile. These recommendations are based on expert panel opinions following a systematic literature review. Current evidence indicates that routine antibiotic prophylaxis prior to urodynamic studies is not warranted, as its primary benefit lies in reducing asymptomatic bacteriuria without significantly decreasing the incidence of symptomatic urinary tract infections. Prophylactic antibiotics should be reserved for patients at high risk of infection, with antimicrobial selection guided by local resistance patterns and an individualized assessment of risk and benefit.
Cognitive and fusion MRI-Targeted prostate biopsies: A multicenter comparative analysis in 485 patients.
Hepşen E, Çapar F, Ergin İE … +3 more , Doğan AE, Karakoyunlu AN, Kesimal U
Actas Urol Esp (Engl Ed) · 2026 · PMID 41936889 · Publisher ↗
OBJECTIVES: This multicenter study aimed to compare the diagnostic performance of cognitive registration targeted biopsy (Cog-Tb) and MRI-transrectal ultrasound fusion targeted biopsy (Fus-Tb) in men with Prostate Imagin...
OBJECTIVES: This multicenter study aimed to compare the diagnostic performance of cognitive registration targeted biopsy (Cog-Tb) and MRI-transrectal ultrasound fusion targeted biopsy (Fus-Tb) in men with Prostate Imaging Reporting and Data System (PI-RADS) ≥3 lesions. MATERIALS AND METHODS: Men with PSA ≥ 3 ng/mL and/or abnormal digital rectal examination findings who had mpMRI lesions scored as PI-RADS ≥3 were included. This was a retrospective multicenter study, and the Cog-Tb and Fus-Tb groups were obtained from non-contemporary time periods and from different operators (Cog-Tb performed by urologists, Fus-Tb by a dedicated interventional radiologist). Atotal of 267 patients who underwent Cog-Tb and 218 who underwent Fus-Tb were retrospectively analyzed. At least two targeted cores were obtained from each mpMRI-defined lesion, in addition to 10-12 systematic cores. csPCa was defined as International Society of Urological Pathology (ISUP) Grade Group ≥2. Patients were stratified using a PSAd cutoff value of 0.15. In addition, a predefined stratified analysis by PI-RADS category (3 vs. 4-5) was performed, and odds ratios with 95% confidence intervals were calculated to assess independent predictors of csPCa. RESULTS: There was no significant difference between Cog-Tb and Fus-Tb in the detection of ISUP ≥ 2 prostate cancer (p = 0.91). In the PI-RADS 3 subgroup, PSAd values were significantly higher in patients with ISUP ≥ 2 compared with those with benign or ISUP 1 pathology for both Cog-Tb (p = 0.02) and Fus-Tb (p = 0.04). Similarly, in the PI-RADS 4-5 subgroup, PSAd levels were significantly higher in patients with ISUP ≥ 2 disease for both biopsy techniques (p = 0.01). Multivariate logistic regression showed that biopsy modality was not an independent predictor of csPCa (OR 1.4, 95% CI 0.8-2.5). In contrast, both PSAd (OR 5.9, 95% CI 2.6-13.1) and PI-RADS category (OR 6.8, 95% CI 3.4-13.4) were strong independent predictors of csPCa. CONCLUSION: Cog-Tb and Fus-Tb demonstrated comparable effectiveness in detecting csPCa in patients with PI-RADS ≥3 lesions, particularly when PSAd ≥0.15. In settings lacking fusion technology, Cog-Tb performed by experienced clinicians remains a reliable and cost-effective alternative.
Single-port robotic partial nephrectomy with the Da Vinci SP platform: Feasibility and early outcomes from the first Spanish series.
Hevia-Palacios V, Brime-Menéndez R, Cámara-Martínez C … +7 more , Guevara R, Paesano N, García-Rojo E, Barrientos F, Lista-Mateos F, Justo-Quintas J, Romero-Otero J
Actas Urol Esp (Engl Ed) · 2026 Apr · PMID 41935783 · Publisher ↗
INTRODUCTION: Single-port robot-assisted partial nephrectomy (SP-RAPN) is an emerging minimally invasive technique that integrates all instruments through a single multichannel port. Despite its increasing international...
INTRODUCTION: Single-port robot-assisted partial nephrectomy (SP-RAPN) is an emerging minimally invasive technique that integrates all instruments through a single multichannel port. Despite its increasing international use, European experience remains limited and no prior clinical series have been reported in Spain. This study aims to assess the feasibility, perioperative safety, and early outcomes of SP-RAPN in the first Spanish institutional experience. MATERIALS AND METHODS: Prospective observational study including the first eight consecutive patients undergoing SP-RAPN at a high-volume RAPN centre. Surgical approach was selected according to tumour location. Perioperative parameters, postoperative recovery, renal function at 3 months, and pathological outcomes were collected. RESULTS: All procedures were completed successfully without conversion. Mean tumour size was 33 mm and mean RENAL score 7. Access was transperitoneal in 50%, pure retroperitoneal in 25%, and SARA/LAA in 25% of cases. Mean warm ischemia time was 19 min and mean operative time 123 min. Estimated blood loss was low (125 mL), and no transfusions were required. Only one minor complication (Clavien I) occurred. Serum creatinine remained stable postoperatively and at 3 months. Final pathology confirmed renal cell carcinoma in 7 patients, with negative surgical margins in 87.5%. Early recurrence-free survival was 100%. CONCLUSIONS: SP-RAPN is a feasible, reproducible, and safe procedure for localized T1 renal tumours. Perioperative, functional, and oncologic outcomes were favourable and within the ranges reported for RAPN in contemporary series. The versatility of transperitoneal, retroperitoneal, and SARA/LAA approaches may further expand its indications. Future multicentre studies with larger cohorts and long-term follow-up will be essential to confirm the durability and clinical benefits of this promising technique.
Mini-percutaneous nephrolithotomy versus flexible ureteroscopic holmium laser lithotripsy using a negative-pressure ureteral access sheath: a minimally invasive approach for renal calculi.
Chen Q, Liu P, Peng F … +1 more , Zhang Y
Actas Urol Esp (Engl Ed) · 2026 Apr · PMID 41935782 · Publisher ↗
INTRODUCTION: Renal calculi are a common urological condition, and minimally invasive surgical techniques have become the mainstay of treatment. We evaluated and compared the clinical effectiveness of mini-percutaneous n...
INTRODUCTION: Renal calculi are a common urological condition, and minimally invasive surgical techniques have become the mainstay of treatment. We evaluated and compared the clinical effectiveness of mini-percutaneous nephrolithotomy (mini-PCNL) and flexible ureteroscopic holmium laser lithotripsy (FURL) assisted by a negative-pressure ureteral access sheath (NPUAS) in the management of renal calculi. METHODS: A total of 124 patients with renal calculi were assigned to mini-PCNL (n = 62) or NPUAS-FURL (n = 62) groups. Surgical parameters (operative time, blood loss), hospitalization, stone clearance, efficacy, complications, renal function (Scr, BUN, UA), inflammatory markers (IL-6, CRP, PCT), and postoperative pain (VAS at 4/12/24/48 h) were evaluated. RESULTS: Compared with mini-PCNL, the NPUAS-FURL group demonstrated shorter operative and hospitalization times and reduced intraoperative bleeding (P < 0.05). Stone clearance and overall efficacy were higher in the NPUAS-FURL group (95.16% each) than in the mini-PCNL group (77.42% and 80.65%; P < 0.05). The incidence of complications was similar between groups (14.52% vs. 22.58%, P > 0.05). At 24 h postoperatively, Scr, BUN, UA, IL-6, CRP, and PCT increased in both groups but remained significantly lower in the NPUAS-FURL group (P < 0.05). VAS scores progressively decreased over time, with consistently lower values observed in the NPUAS-FURL cohort (P < 0.05). CONCLUSION: NPUAS-assisted FURL outperforms mini-PCNL in renal calculi treatment, offering higher stone clearance, reduced trauma, better renal function preservation, milder inflammation, and less pain, with comparable safety.
Predictive factors for biochemical recurrence after radical prostatectomy in ISUP Grade Group 1 prostate cancer: a retrospective cohort with long-term follow-up.
Diéguez-Álvarez L, Hernández Álvarez AI, Panach-Navarrete J … +3 more , Castelló-Porcar A, Esteban-Igual L, Martínez-Jabaloyas JM
Actas Urol Esp (Engl Ed) · 2026 Apr · PMID 41932388 · Publisher ↗
INTRODUCTION: The clinical relevance of biochemical recurrence (BCR) after radical prostatectomy (RP) in ISUP Grade Group 1 prostate cancer is unclear. We evaluated the incidence of BCR, its pathological predictors, and...
INTRODUCTION: The clinical relevance of biochemical recurrence (BCR) after radical prostatectomy (RP) in ISUP Grade Group 1 prostate cancer is unclear. We evaluated the incidence of BCR, its pathological predictors, and long-term oncologic outcomes in this population. MATERIALS AND METHODS: Retrospective observational study of consecutive patients who underwent RP between 1999 and 2012 with ISUP GG 1 adenocarcinoma in the specimen. BCR was defined as PSA ≥ 0.2 ng/mL in two consecutive measurements after postoperative nadir. BCR-free survival and overall survival were estimated using Kaplan-Meier analysis, and predictors of BCR were identified using Cox regression. Salvage treatments, events of radiologic progression, and mortality were described. RESULTS: A total of 208 patients were included. The median follow-up was 12.1 years. BCR was observed in 45 (21.6%), with a median time to BCR of 5.2 years (IQR 2.3-7.5). Five-year BCR-free survival was 92%, 81% at 10 years, and 78% at 15 years. Positive surgical margins were the only independent predictor of BCR (HR 3.27; 95% CI 1.64-6.53; p < 0.001). Eleven patients with BCR (24.4%) received salvage radiotherapy. Only 3 patients developed radiologic progression (1.4%); 42 deaths (20.2%) were recorded; none of them were cancer-specific deaths. CONCLUSIONS: In ISUP grade group 1 prostate cancer treated with RP, BCR is relatively common but rarely associated with radiologic progression; no cancer-specific deaths were observed during long-term follow-up. Positive margins were associated with a higher risk of BCR.
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