Hevia-Palacios V, Pérez Fentes D, Vilaseca Cabo A
… +12 more, Jalón Monzón A, Rivero Belenchón I, Tolosa Eizaguirre E, Morales Pinto SF, Vázquez Martul D, Arrabal Polo MÁ, Gómez Dos Santos V, Cogorno Wasylkowski L, Ortiz de Urbina PI, Ballestero Diego R, Testa Sklofsky I, Fernández-Pello S
INTRODUCTION AND OBJECTIVES: The management of stage T1 renal cell carcinoma (RCC) has shifted toward nephron-sparing surgery (NSS) and minimally invasive surgery (MIS), but contemporary, country-level data from Spain ar...INTRODUCTION AND OBJECTIVES: The management of stage T1 renal cell carcinoma (RCC) has shifted toward nephron-sparing surgery (NSS) and minimally invasive surgery (MIS), but contemporary, country-level data from Spain are scarce. We sought to describe real-world treatment patterns for T1 RCC across Spanish centres. MATERIAL AND METHODS: Multicentre retrospective descriptive study using the Spanish National Registry of Localized Renal Cancer during 2024. Adults with clinical stage T1 renal masses treated with surgery, ablation or active surveillance (AS) were included. Descriptive statistics were applied. Primary outcomes were management strategy, surgical approach, type of procedure and pathological results; secondary outcomes included intraoperative details. RESULTS: A total of 1121 patients were analysed (71.5% cT1a). Management consisted of surgery in 82.6%, ablation in 9.5% and AS in 7.3%. Among operated patients, partial nephrectomy (PN) accounted for 65.0% overall (74.5% in cT1a; 46.7% in cT1b). MIS predominated (92.3%: 58.4% laparoscopic, 33.9% robotic). The leading reason to perform radical nephrectomy (RN) was technical infeasibility (56.8%). Median warm ischaemia time was 16 min (IQR 0-23). Histology showed clear cell RCC 61.1% and benign lesions 12.4%. Final pathology was pT1a 66.1%, pT1b 25.2%; upstaging occurred in 8.6% (mainly pT3a), more frequently in cT1b. CONCLUSIONS: In Spain, most T1 RCCs are treated surgically with a high adoption of PN for cT1a and widespread MIS. RN remains common in cT1b primarily for anatomical/technical reasons, suggesting variability in access to robotic platforms and subspecialised teams. These data provide a national benchmark and support initiatives to optimise NSS access, resource allocation, and referral pathways.
Sanguedolce F, Baboudjian M, Redondo Ríos A
… +15 more, Leni R, Oderda M, Peyrottes A, Kesch C, Al-Nader M, Uleri A, Long-Depaquit T, Dariane C, Baud H, Olivier J, Benard V, Windisch O, Valerio M, Gandaglia G, Ploussard G
INTRODUCTION: To report the results of confirmatory MRI/biopsy in a European cohort of MRI-selected patients with Gleason Grade Group (GG) 2 prostate cancer (PCa) in active surveillance (AS). METHODS: Multicenter study e...INTRODUCTION: To report the results of confirmatory MRI/biopsy in a European cohort of MRI-selected patients with Gleason Grade Group (GG) 2 prostate cancer (PCa) in active surveillance (AS). METHODS: Multicenter study enrolled patients with GG2 PCa managed by AS between 2016-2024. Serial MRI scans were interpreted according to PRECISE recommendations. Diagnostic accuracy of PRECISE score to predict upgrading on confirmatory biopsy was assessed by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with 95% Confident Intervals (CIs). RESULTS: A total of 77 patients with GG2 PCa was included, with a PI-RADS 4-5 in 48 patients (63%). On confirmatory MRI, 32 cases were classified as PRECISE 4-5 (42%). On confirmatory biopsy, 39 patients (51%) were downgraded to GG0-1, 27 patients (35%) were GG 2 and upgrading occurred in 11 cases (14%). Sensitivity, specificity, NPV and PPV of the PRECISE score 4-5 to detect upgrading was 63.6% (95%CI 31-89), 62.1% (95%CI, 49-74), 91.1% (95%CI, 82-96) and 21.8% (95%CI, 14-32), respectively. In multivariable Cox hazards regression analysis, downgrading at confirmatory biopsy was significantly associated with a reduced risk of subsequent GG3 reclassification (HR 0.125, 95%CI, 0.277-0.560, p = 0.002) and definitive treatment (HR 0.409, 95%CI, 0.199-0.839, p = 0.015). CONCLUSION: MRI selection of patients with GG2 PCa in AS allows better initial characterization of the disease. The absence of progression on MRI indicates a very low risk of grade reclassification, but signs of imaging progression are not always predictive of progression and should not be considered alone for prompting active treatment.
INTRODUCTION AND OBJECTIVES: Local recurrence after radiotherapy for prostate cancer poses a significant clinical challenge, and the lack of robust comparative evidence limits clear therapeutic guidance. This study aimed...INTRODUCTION AND OBJECTIVES: Local recurrence after radiotherapy for prostate cancer poses a significant clinical challenge, and the lack of robust comparative evidence limits clear therapeutic guidance. This study aimed to assess oncological outcomes of salvage radical prostatectomy (SRP) versus salvage cryoablation (SCA) in patients with localized radio-recurrent disease. MATERIALS AND METHODS: A retrospective, single-centre cohort study was conducted including hormone-sensitive prostate cancer patients with local recurrence after external beam radiotherapy or brachytherapy, treated between 2007 and 2024. The primary endpoint was biochemical recurrence-free survival (BCR-FS) at 3 and 5 years. Secondary endpoints included additional treatment-free survival (AT-FS), metastasis-free survival (MFS), and recurrence predictors. Kaplan-Meier and multivariate logistic regression analyses were performed. RESULTS: A total of 56 patients were included: 32 treated with SRP and 24 with SCA. Median follow-up was significantly longer in the SCA group (8.2 vs. 3.8 years, P < .05). BCR-FS at 3 and 5 years was 47% and 37% in the SCA group and 43% and 32% in the SRP group (P > .05). Five-year AT-FS was 40% (SCA) vs. 55% (SRP; P = .32), and MFS was 85% (SCA) vs. 83% (SRP; P = .92). A Gleason score ≥ 8 at recurrence was independently associated with higher risk of recurrence (OR 7.7; 95% CI: 1.3-47; P = .02). CONCLUSIONS: SRP and SCA showed similar oncological outcomes. Gleason ≥ 8 was the only factor related to poor outcomes. Given the low chance of cure after salvage therapies, SCA may be an adequate option in these patients.
INTRODUCTION: Prostate cancer (PCa) is the most common malignancy among men and currently ranks as the second leading cancer worldwide in terms of incidence. In 2021, a total of 35,764 new cases were diagnosed. The devel...INTRODUCTION: Prostate cancer (PCa) is the most common malignancy among men and currently ranks as the second leading cancer worldwide in terms of incidence. In 2021, a total of 35,764 new cases were diagnosed. The development of new imaging tools such as multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen positron emission tomography (PET-PSMA) has enabled the exploration of less invasive diagnostic strategies in clinically significant prostate cancer. However, performing radical prostatectomy without a prior biopsy remains an exceptional practice, scarcely documented and highly controversial. OBJECTIVE: To report a series of Mexican cases undergoing radical prostatectomy without prior biopsy, using PET-PSMA and mpMRI as the main diagnostic tools, and to propose a preliminary risk stratification model based on SUVmax values: the "M&M's PSMA SCORE SUVmax". MATERIALS AND METHODS: Retrospective, observational, multicenter study of 18 patients treated between 2021 and 2024. Clinical variables, imaging findings, and histopathological results were analyzed. Sensitivity, positive predictive value (PPV), and correlation between SUVmax and ISUP grade were calculated. RESULTS: All cases confirmed clinically significant adenocarcinoma. PET-PSMA showed 100% sensitivity and PPV; mpMRI showed 93.3% sensitivity and 100% PPV. A positive correlation was found between SUVmax and ISUP grade (r = 0.84; P = .038). A preliminary classification based on SUVmax cut-off points was proposed. CONCLUSIONS: This series suggests that, in selected contexts, PET-PSMA and mpMRI could support surgical decision-making even without prior biopsy. However, prospective studies are needed to validate both this strategy and the proposed stratification system.
INTRODUCTION: In 1997, the WHO established the role of genital tract infections in human infertility, currently responsible for 15% of the causes of infertility in men. The WHO classifies urethritis, prostatitis, vesicul...INTRODUCTION: In 1997, the WHO established the role of genital tract infections in human infertility, currently responsible for 15% of the causes of infertility in men. The WHO classifies urethritis, prostatitis, vesiculitis, orchitis, and epididymitis as infections of the male accessory gland. This paper represents the state of the art on inflammation and infection of seminal tract. Objective of the study is to revise literature and to discuss regarding association to fertility. METHODS: A literature search was performed on PubMed database (http://www.pubmed.gov) for peer-reviewed journal articles relating to STD, UTI, Diagnosis and Treatment and Fertility. We carefully evaluated the most representative reports published in literature and all papers results were supported by European and American guidelines results on theme. RESULTS: Seminal tract infections may cause infertility by different mechanisms. Traditionally, the most common infectious causes of male infertility were sexually transmitted infections, especially Neisseria gonorrhoeae. However, the most frequent causes of infection of the seminal tract are Chlamydia trachomatis, Microplasma spp., especially Ureaplasma urealyticum and the gram-negative bacteria typical of urogenital infections. When classifying seminal tract infections, it must be considered whether or not these are sexually transmitted, and treat both partners for Sexual Transmitted Diesase if necessary (STI). There is evidence that treating STIs leads to improved semen parameters. Although antibiotics can improve sperm quality and reduce DNA fragmentation values, there is no evidence that they increase the probability of natural conception. CONCLUSIONS: Taking into account the highly prevalence of infective or inflammatory affections of the male genital tract, its clearly stablished association with infertility and that a remarkable percentage of sexual transmitted infections (STI) are asymptomatic, we believe that these infections must be ruled out during the initial andrological evaluation in couples seeking fertility.
OBJECTIVE: This study aims to investigate the predictive role of intravesical Bacillus Calmette-Guérin (BCG) therapy on urethral stricture development in male patients undergoing bladder tumor surveillance, while also as...OBJECTIVE: This study aims to investigate the predictive role of intravesical Bacillus Calmette-Guérin (BCG) therapy on urethral stricture development in male patients undergoing bladder tumor surveillance, while also assessing the impact of repeated urethral instrumentation on stricture risk. METHODS: This retrospective study included male patients aged 18-90 with non-muscle invasive bladder tumors followed between 2018 and 2024. Demographics, cystoscopy and TUR procedures, intravesical treatments (BCG and chemotherapy), and urethral stricture diagnosis were recorded. Urethral stricture was confirmed by uroflowmetry, cystoscopy, and urethrography. Patients with prior urethral stricture or incomplete records were excluded. Statistical analyses included logistic regression to identify predictors of stricture development, adjusting for age and comorbidities. Sample size was calculated to ensure adequate power to detect a 15% difference in stricture incidence related to BCG therapy. RESULTS: A total of 187 male patients were analyzed, with a 12.3% urethral stricture incidence. BCG therapy was administered to 32.6% of patients and significantly increased stricture risk (OR: 4.11, P = .015). Each additional dose was associated with an increased risk (OR: 2.11, P = .001). TURP (OR: 2.95, P = .045) and the number of cystoscopies (OR: 1.42 per procedure, P = .040) were also significant predictors. Tumor size ≥3 cm was associated with higher risk (OR: 1.88, P = .037). Spearman analysis showed positive correlations between stricture severity and both BCG doses and cystoscopy number. CONCLUSION: Intravesical BCG therapy, repeated cystoscopies, and TURP increase urethral stricture risk in bladder tumor patients. Preventive measures and careful monitoring are essential to reduce urethral complications.
INTRODUCTION AND OBJECTIVES: Holmium Laser Enucleation of the Prostate (HoLEP) is an effective treatment for benign prostatic obstruction; however, data on its outcomes in patients with acute urinary retention (AUR), par...INTRODUCTION AND OBJECTIVES: Holmium Laser Enucleation of the Prostate (HoLEP) is an effective treatment for benign prostatic obstruction; however, data on its outcomes in patients with acute urinary retention (AUR), particularly those who remained catheter-dependent until surgery, remain limited. This study compared HoLEP outcomes in patients with and without AUR. METHODS: Data from 140 male patients aged 50-80 who underwent HoLEP were retrospectively and exploratorily analyzed. Patients were grouped as catheter-dependent AUR (Group-1) and non-AUR (Group-2). The primary comparison was Qmax at 6 months, while secondary comparisons included functional outcomes and perioperative/postoperative complications. RESULTS: Thirty-four patients (24.3%) had catheter-dependent AUR. They were older (68.9 ± 6.9 vs. 66.2 ± 6.5 years) and had worse baseline IPSS (25[22-29] vs. 22[17-25]), quality of life (QoL; 5 [4-6] vs. 4 [3-5]), Qmax (0 vs. 8[5.6-10] mL/s), and PVR (400[197-560] vs. 100[60-150] mL) (p < 0.05). Perioperative parameters and complication rates were not significantly different between the groups. Following HoLEP, AUR patients showed greater improvements in Qmax (Δ16[14-20.3] vs. 10 [7-15] mL/s), IPSS (Δ16.5[10.8-22.3] vs. 11.5[6-17.3]), QoL (Δ4 [3-5] vs. 3[1-3.3]), and PVR (Δ326[128-502] vs. 62.5[26-120] mL) (p < 0.05). Although patients with catheter-dependent AUR demonstrated more pronounced improvements in functional outcomes, this was largely attributable to worse baseline parameters. No statistically significant differences were observed in postoperative outcomes between the groups. Notably, subjective measures (IPSS and QoL) improved more markedly in Group-1. CONCLUSIONS: HoLEP is an effective treatment option for catheter-dependent AUR patients, providing significant functional improvement. Preoperative catheterization until surgery does not negatively affect surgical efficacy or postoperative outcomes.
González Enguita C, Pérez Fentes D, Budía Alba A
… +6 more, Lorenzo Gómez MF, Gómez Rivas J, Manso Aparicio C, Fernández Aparicio T, Alvárez-Ossorio Fernández JL, en representación de la Junta Directiva AEU (Asociación Española de Urología), del GUO (Grupo de Urología Oncológica) y del Patronato Rector de la FIU (Fundación para la Investigación en Urología)
In recent months, restrictions have been proposed on the prescription of PARP inhibitors (iPARP) by urologists in metastatic castration-resistant prostate cancer (mCRPC). The Spanish Association of Urology (AEU), its Uro...In recent months, restrictions have been proposed on the prescription of PARP inhibitors (iPARP) by urologists in metastatic castration-resistant prostate cancer (mCRPC). The Spanish Association of Urology (AEU), its Uro-Oncology Group (GUO), and the presidents of the Regional Urology Associations consider these limitations unjustified from clinical, organizational, legal, or professional perspectives. They unduly restrict the exercise of competencies recognized in the interdisciplinary management of prostate cancer, in line with the training, experience, and current regulations of the specialty. This document argues, from scientific, clinical, and legal standpoints, that urologists are qualified and legally authorized to prescribe and administer iPARP according to current legislation and the official training program. It also advocates a collaborative model centred on the patient's care pathway and based on mutual respect among specialties, ensuring professional autonomy, continuity of care, and equitable access to therapeutic innovation.
Ortega Polledo LE, Sánchez Pellejero A, Bianchini Hernández GFJ
… +11 more, García Rico E, Redondo González E, Subiela Henríquez JD, Mata Deniz P, Marugán Álvarez MJ, Gómez Rivas J, Galante Romo I, Moreno Sierra J, Ahyai S, Miñana B, Alonso Y Gregorio S
OBJECTIVE: To evaluate the rate of stress urinary incontinence, time to continence recovery, and incidence of urethral stricture in a series of patients who underwent holmium laser enucleation of the prostate (HoLEP) fro...OBJECTIVE: To evaluate the rate of stress urinary incontinence, time to continence recovery, and incidence of urethral stricture in a series of patients who underwent holmium laser enucleation of the prostate (HoLEP) from the beginning of the learning curve of a single surgeon. MATERIALS AND METHODS: Prospective study of 254 patients consecutively operated on by one surgeon between December 2022 and December 2024. Continence was defined as the use of 0 pads. Survival analysis (Kaplan-Meier) was performed to estimate time to continence recovery. Results were stratified according to surgical technique (2- or 3-lobe vs. en bloc), prostate volume, and BMI. Overall and de novo urethral stricture rates were analyzed according to operative time, ultrasound volume, and enucleated weight. RESULTS: The median time to continence was 20 days. The continence rates at 1 month, 2 months, and 4 months were 80.7%, 91.2%, and 98.5%, respectively. Although incontinence decreased progressively, urgency was more frequent in persistent cases. No significant differences were observed in the time to continence according to surgical technique, prostate volume, or BMI. The overall rate of urethral stricture was 3.9%, with 3.65% de novo cases. No associated risk factors were identified. CONCLUSIONS: HoLEP showed a low rate of transient incontinence and urethral stricture, and no correlation with surgical technique or patient clinical characteristics.
Urachal adenocarcinoma is an extremely rare malignancy, accounting for less than 1% of all bladder tumors. Diagnosis is often delayed due to nonspecific symptoms and low clinical suspicion. We report the case of a 52-yea...Urachal adenocarcinoma is an extremely rare malignancy, accounting for less than 1% of all bladder tumors. Diagnosis is often delayed due to nonspecific symptoms and low clinical suspicion. We report the case of a 52-year-old male with no relevant medical history who presented with lower urinary tract symptoms. Cystoscopy revealed a cystic lesion at the bladder dome. Transurethral resection confirmed mucinous urachal adenocarcinoma. CT imaging showed no locoregional or distant spread, and tumor markers were within normal limits. The patient underwent laparoscopic partial cystectomy with en bloc excision of the urachus and umbilicus plus bilateral pelvic lymphadenectomy. Final pathology confirmed a Sheldon stage IIIA mucinous cystadenocarcinoma. At 25 months of follow-up, the patient remains free of disease recurrence. Given its low prevalence and aggressive nature, accurate diagnosis and appropriate surgical management are critical. While surgery remains the cornerstone in localized disease, the role of systemic therapy remains unclear. Immunotherapy and targeted therapies are emerging as promising options in advanced stages. This case illustrates the diagnostic challenges and emphasizes the importance of surgical planning and long-term surveillance in the absence of standardized treatment guidelines. Midline bladder lesions should prompt suspicion of urachal adenocarcinoma. Complete surgical excision is essential, with lymphadenectomy and systemic therapy considered on a case-by-case basis. Long-term follow-up is necessary due to the high risk of recurrence.
INTRODUCTION: Focal therapy (FT) has emerged as an intermediate therapeutic strategy between active surveillance (AS) and radical treatments for the management of localized prostate cancer (PCa) in patients with clinical...INTRODUCTION: Focal therapy (FT) has emerged as an intermediate therapeutic strategy between active surveillance (AS) and radical treatments for the management of localized prostate cancer (PCa) in patients with clinically significant disease and a well-defined index lesion (IL). The development of ablative and imaging techniques has enabled the selective treatment of the IL, preserving healthy tissue and reducing adverse effects. OBJECTIVES: o review the current evidence on FT in localized PCa, including technological modalities, selection criteria, diagnostic tools, post-treatment surveillance strategies, and barriers to its clinical implementation in the Spanish healthcare setting. MATERIALS AND METHODS: A structured narrative review was conducted through a search in PubMed, Scopus, and Web of Science, including studies published up to April 2025. Original articles, reviews, clinical guidelines, and meta-analyses focusing on FT for localized PCa were selected. Prospective and comparative studies addressing oncological and functional outcomes, as well as associated technologies such as fusion biopsy, multiparametric magnetic resonance imaging (mpMRI), prostate-specific membrane antigen positron emission tomography (PSMA-PET), and artificial intelligence (AI), were prioritized. RESULTS: FT offers encouraging short- and medium-term oncological outcomes, with notable functional preservation. Modalities such as high-intensity focused ultrasound (HIFU) and cryotherapy are currently the most widely used and have the longest clinical trajectory, while irreversible electroporation (IRE) stands out among emerging techniques with results. Surveillance after FT should be multifactorial and include serial PSA monitoring, systematic and targeted biopsies, as well as imaging techniques such as mpMRI. Specific tools such as PI-FAB (Prostate Imaging after Focal Ablation) and TARGET (Transatlantic Recommendations for MRI Evaluation after Focal Therapy) systems allow for standardized interpretation of mpMRI after FT. In Spain, its adoption remains limited, reinforcing the need for specific guidelines and multicenter registries.
INTRODUCTION: Advances in natural language processing (NLP) technologies have gained prominence for extracting relevant clinical information. Savana is a platform capable of analyzing free-text data and interpreting the...INTRODUCTION: Advances in natural language processing (NLP) technologies have gained prominence for extracting relevant clinical information. Savana is a platform capable of analyzing free-text data and interpreting the content of electronic health records (EHRs). OBJECTIVE: To validate the results obtained through NLP by Savana from data of patients with prostate cancer (PC) included in active surveillance (AS), compare them with our database, and assess their reliability. METHODS: Observational and retrospective study of patients with PC in AS between 2014 and 2022. The results from our database were blinded to Savana. Information from the EHRs was transformed by Savana into analysis-ready data. After an initial evaluation, it was necessary to refine the preliminary results and readjust the variables and terminology to eliminate discrepancies. RESULTS: Of the 2865 patients included in our database, 306 met the selection criteria. Savana detected 366 patients with the terms "PC," "Gleason," and "AS." The results were similar regarding Gleason score at diagnosis: 93.4% Gleason 6 in our series vs. 92% in Savana. Likewise, the proportion of patients who received treatment with curative intent, and the type of treatment were comparable: 33.3% in our series (RP: 56.9%; RT: 42.1%) vs. 32.5% in Savana (RP: 59.7%; RT: 40.3%). However, only 24.8% showed Gleason progression in our series vs. 31% in Savana. The mortality rate was 3.2% in our series vs. 7.4% in Savana. CONCLUSIONS: NLP represents a promising tool in clinical research, but its implementation should be approached with caution.
INTRODUCTION AND OBJECTIVES: Whole-body bone mineral content (BMC) and bone mineral density (BMD) can provide comprehensive information about the health of the whole body. This study aimed to assess whether BMC and BMD a...INTRODUCTION AND OBJECTIVES: Whole-body bone mineral content (BMC) and bone mineral density (BMD) can provide comprehensive information about the health of the whole body. This study aimed to assess whether BMC and BMD are potentially associated with self-reported kidney stones. MATERIALS AND METHODS: Multiple logistic regression analysis was used to investigate the potential association between BMC/BMD and kidney stones. Subgroup analysis and interaction tests were used to examine the stability of the relationship. Restricted cubic spline plots were used to examine the dose-response relationship. Saturation effect and threshold effect analyses were used to assess inflection points in the dose-response relationship. RESULTS: The study population consisted of 8030 adults. Compared with those with low BMD levels, the prevalence of kidney stones was lower in those with high BMD levels (6.55% vs. 10.87%, P = 0.0001). After adjusting for all covariates, there was a negative association between whole-body BMC and kidney stones (OR = 0.06, 95% CI = 0.02-0.25; P < 0.0001), and between whole-body BMD and kidney stones (OR = 0.19, 95% CI = 0.08-0.45; P = 0.0002). Subgroup analyses and interaction tests identified diabetes and smoking as significant influences. In the non-smoking population, a non-linear relationship was shown between BMD and kidney stones (non-linear P value = 0.039). CONCLUSIONS: BMC and BMD were inversely associated with the prevalence of kidney stones in U.S. adults. Although causality cannot be established, these findings suggest that bone health assessment may help identify individuals at higher risk of kidney stones, especially among smokers and patients with diabetes.
López Pérez E, García-Astillero Vallecillo V, Gómez de Vicente JM
… +8 more, Bravo Marín S, Yebes Á, de Castro Guerín C, García-Matres Y Cortés MJ, Maínez Rodríguez JA, Cámara Llorente N, Iglesias García C, Martínez-Piñeiro Lorenzo L
INTRODUCTION: Urinary tract infections (UTIs) are common among women, and approximately 20-30% experience recurrent episodes (rUTIs). The increasing prevalence of antimicrobial resistance highlights the need for non-anti...INTRODUCTION: Urinary tract infections (UTIs) are common among women, and approximately 20-30% experience recurrent episodes (rUTIs). The increasing prevalence of antimicrobial resistance highlights the need for non-antibiotic preventive strategies. d-mannose and proanthocyanidins (PAC) have shown potential in reducing rUTIs. The aim of this study was to evaluate the efficacy of a combination of d-mannose and PAC in preventing postcoital UTIs over a 6-month period. MATERIALS AND METHODS: We conducted a prospective, single-center pilot study including 26 women aged 18-45 years with a history of recurrent postcoital UTIs. Participants received a daily prolonged-release formulation containing d-mannose (2000 mg) and PAC (140 mg) for 6 months. The primary outcome was the incidence of postcoital UTI episodes. Secondary outcomes included treatment adherence, episode severity, microbiological findings, safety, quality of life, and patient-reported improvement. Analyses were performed on both the intention-to-treat (ITT) and per-protocol (PP) populations. RESULTS: At 6 months, 53.6% of participants had no new UTI episodes. A total of 24 episodes were recorded in 12 women, with more than two-thirds concentrated in a small subgroup. Overall, UTI incidence decreased significantly (p = 0.01), and 76.2% of participants remained infection-free at the final visit. Adherence was high (90.9% at 3 months and 85.7% at 6 months). Positive urine cultures most frequently identified Klebsiella aerogenes and Escherichia coli. Sexual function remained stable, and 80.9% of women reported subjective improvement. Only one withdrawal occurred due to vaginal dryness. CONCLUSIONS: The combination of d-mannose and PAC in a prolonged-release formulation appears to be a promising, safe, and well-tolerated strategy for the prevention of postcoital rUTIs in young women. Larger randomized controlled trials are warranted to confirm these preliminary findings.
Saouli A, Contieri R, Quhal F
… +21 more, Hurle R, Guenouni M, Ploussard G, Mori K, Yanagisawa T, Pradere B, Laukhtina E, Rajwa P, Albisinni S, Krajewski W, Cimadamore A, Del Giudice F, Gómez Rivas J, Soria F, Shariat SF, Gontero P, Mertens LS, van Rhijn BWG, AlShammari M, Gallioli A, Moschini M
OBJECTIVE: To evaluate the oncological outcomes and safety of chemoablation and Active Surveillance for non-muscle invasive bladder cancer. METHODS: A systematic review was performed by accessing the following bibliograp...OBJECTIVE: To evaluate the oncological outcomes and safety of chemoablation and Active Surveillance for non-muscle invasive bladder cancer. METHODS: A systematic review was performed by accessing the following bibliographic databases: PubMed, Scopus, Embase and the Cochrane central register of controlled trials were searched. RESULTS: A total of 29 studies (1847 patients) met the inclusion criteria. The vast majority of patients included had Active Surveillance (n = 7, 582) and chemoablation (n = 21, 1265). Regarding chemoablation, Mitomycine C (MMC) was used in 14 studies, Epirubicin in 2 studies, Bacillus Calmette-Guerin (BCG) in one study and Gemcitabine in 5 studies (weekly or single dose). Follow-up ranged from 2 weeks to 39 months (Mean 16.8 months). The mean timing of initial assessment was 4.2 (range: 1 day to 27 weeks), and the pooled complete response (CR) rate was 52.3%. For the AS protocol, the pathological findings before observation were Ta (n = 583, 86%), low (n = 462, 60.1%) and high grade (n = 138, 42.1%). Mean follow up was 47 months ranged from 25 to 72 months, the mean duration of AS was 13.4 months. The mean AS failure rate was 64%. Grade progression, stage progression and progression to muscle-invasive bladder cancer (MIBC) were 68 (16.5%), 35 (8.5%) and 5 (1%) of cases, respectively. CONCLUSIONS: Patients with selected inclusion criteria based on the review can be referred for active Surveillance or chemoablation protocol, with a minimal risk of progression in either grade or stage for AS and a good complete response for chemoablation.
INTRODUCTION: The soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) is a cytokine that modulates inflammatory and atherogenic reactions. In our study, we aimed to determine whether sTWEAK could be a b...INTRODUCTION: The soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) is a cytokine that modulates inflammatory and atherogenic reactions. In our study, we aimed to determine whether sTWEAK could be a biomarker of erectile dysfunction (ED). METHODS: Ninety patients diagnosed with ED and 90 healthy participants were prospectively enrolled during the period of September 2021-September 2023. Participants were divided into three groups according to International Index of Erectile Function (IIEF) Erectile Function Domain scores; severe disease (1-10), moderate-mild disease (11-21) and healthy control (22-30). All participants filled out Beck Depression Inventory (BDI). Blood samples were collected for complete blood count, biochemical analysis and hormonal assessment. RESULTS: sTWEAK levels were higher in patients and increased with the severity of the disease as well. Healthy participants had lower BDI score (P = .001) and erythrocyte sedimentation rate (P = .001). Analysis with ROC curve demonstrated good area under curve value for sTWEAK (0.776, P = .001) in predicting ED. Optimal threshold level was determined as 5,41 ng/mL (71.1% sensitivity and 71.1% specificity). CONCLUSIONS: We revealed that there is a significant association between sTWEAK levels and severity of disease, therefore we belive that sTWEAK pathway has a role in the pathogenesis of atherosclerosis in patients with ED.
Pereira do Nascimento LA, Mariano da Costa Junior RM, Ramos Machado V
… +6 more, Saab Filho JJ, Bueno Bavaresco MH, Panhoca R, Aparecido França W, Seabra Rios LA, Pinheiro Soares G
INTRODUCTION: The management of metastatic prostate cancer (MPC) is complex and requires timely, coordinated decision-making across multiple specialties. Multidisciplinary team meetings (MDMs) have been increasingly adop...INTRODUCTION: The management of metastatic prostate cancer (MPC) is complex and requires timely, coordinated decision-making across multiple specialties. Multidisciplinary team meetings (MDMs) have been increasingly adopted to optimize treatment planning, yet evidence regarding their impact on objective clinical outcomes in genitourinary cancers remains limited. METHODS: This retrospective, single-center cohort study compared two periods of MPC care: before MDM implementation (2018-2019) and after implementation (2021-2022). Patients were identified through institutional records. Demographic data, treatment timelines, therapeutic choices, and follow-up patterns were collected. Primary outcomes included time to clinical oncology consultation, time to treatment initiation, systemic therapy use, and follow-up adherence. RESULTS: One hundred thirty-nine patients were included, 72 in the 2018-2019 period and 67 in the 2021-2022 period. There was a significant reduction in the time taken to consult clinical oncology (P < .05) and to start treatment (P < .05). Systemic therapy started predominantly in the castration-sensitive setting (70.2% vs 14.3%; P < .001). The MDM promoted a higher quality of treatment, with a greater prescription of docetaxel and novel antiandrogens (95.7% vs 64.3%; P = .001) and zoledronic acid in the castration-resistant phase (92.5% vs 79.2%; P = .047). The MDM discussion optimized follow-up, with loss to follow-up observed in only 7.5% of cases (P < .001). CONCLUSION: The implementation of multidisciplinary team meetings significantly improved the timeliness, quality, and adherence to oncological care for patients with metastatic prostate cancer. MDMs should be incorporated as a standard component of care in institutions managing this population.
INTRODUCTION: Adrenal incidentalomas (AI) measuring 4-6 cm present a diagnostic challenge, as size alone inadequately predicts malignancy and creates uncertainty in surgical decisions. OBJECTIVE: To evaluate the Systemic...INTRODUCTION: Adrenal incidentalomas (AI) measuring 4-6 cm present a diagnostic challenge, as size alone inadequately predicts malignancy and creates uncertainty in surgical decisions. OBJECTIVE: To evaluate the Systemic Immune-Inflammation Index (SII) as a predictor of malignancy in adrenal tumors ≥4 cm, with a focus on the 4-6 cm "gray zone." METHODS: Retrospective single-center cohort of 91 adrenalectomy patients with AI ≥ 4 cm (ACC n = 19, ACA n = 72). A predefined subgroup included 46 patients with 4-6 cm tumors (ACC n = 9, ACA n = 37). SII was calculated from preoperative complete blood counts (CBC) as platelets × neutrophils / lymphocytes. Predictive performance was assessed using ROC analysis and logistic regression. RESULTS: In the ≥4 cm cohort, SII was higher in ACC vs. ACA (1107.4 vs. 711.3, p < 0.001). SII independently predicted ACC (per 100-unit increase: OR 0.78, 95% CI 0.67-0.90; p = 0.002). SII showed AUC 0.778 with a cut-off of 811 (sensitivity 78.9%, specificity 73.6%). Tumor size was not predictive (AUC ≈ 0.50). In the 4-6 cm subgroup, SII remained an independent predictor (per 100-unit increase: OR 0.61, 95% CI 0.45-0.82; p = 0.004), with AUC 0.898 at a cut-off of 945 (sensitivity 88.9%, specificity 83.8%). CONCLUSIONS: SII-derived from routine CBC-is a low-cost, adjunctive biomarker that improves preoperative malignancy risk stratification beyond size in AI, particularly in 4-6 cm tumors. External prospective validation is warranted before routine implementation.
INTRODUCTION: Prostate cancer (PCa) screening based on prostate-specific antigen (PSA) testing has represented a major milestone in early detection; however, it has also prompted considerable debate due to the risks of o...INTRODUCTION: Prostate cancer (PCa) screening based on prostate-specific antigen (PSA) testing has represented a major milestone in early detection; however, it has also prompted considerable debate due to the risks of overdiagnosis and overtreatment. This review examines the evolution of PCa screening, highlighting its main challenges and emerging approaches aimed at achieving more accurate and individualized detection. METHODS: A narrative review of the literature was conducted using databases such as PubMed and Google Scholar, applying MeSH terms related to screening, overdiagnosis, and prostate cancer. Clinical studies, systematic reviews, and recent guidelines pertinent to the topic were included. RESULTS: The PLCO, ERSPC, and Göteborg trials provide complementary insights into the impact of PSA-based screening, with outcomes ranging from limited benefit to significant reductions in PCa-specific mortality. Based on these this findings, a paradigm shift toward risk-stratified screening strategies has been advocated. The incorporation of new tools such as magnetic resonance imaging, blood and urine biomarkers, risk calculators, and artificial intelligence-based algorithms has improved diagnostic accuracy. These strategies reduce unnecessary biopsies and focus on the detection of clinically significant disease. Current guidelines recommend individualized assessment based on factors such as age, baseline PSA levels, family history, and comorbidities. CONCLUSION: The future of PCa screening resides in personalized medicine, in which the integration of clinical, imaging, and molecular parameters will enable a more efficient approach, minimizing unnecessary interventions and improving overall patient outcomes.
Gómez Del Cañizo C, Fernández Sánchez N, González Ginel I
… +5 more, Hernández Arroyo M, Martín-Arriscado Arroba C, de la Calle Moreno A, Rodríguez Antolín A, Guerrero Ramos F
OBJECTIVE: This study aimed to assess whether adding voided urine cytology to the European Organisation for Research and Treatment of Cancer (EORTC) score improves the indication for a single instillation of mitomycin C...OBJECTIVE: This study aimed to assess whether adding voided urine cytology to the European Organisation for Research and Treatment of Cancer (EORTC) score improves the indication for a single instillation of mitomycin C following transurethral resection of the bladder and whether this approach improves mitomycin C instillation rate. MATERIALS AND METHODS: A retrospective observational study was conducted on 272 bladder cancer patients treated at a tertiary center from March 2020 to March 2022. After applying the exclusion criteria, 123 patients were included in the analysis. Voided urine cytology results and EORTC scores, with and without pathological data, were compared to the full EORTC 2006 score (gold standard) to evaluate the need for mitomycin C. Statistical analyses included sensitivity, specificity, receiver operating characteristic curves, and the Kappa index to measure test concordance. The method's application in our center was also compared with existing literature. RESULTS: Combining urine cytology with the EORTC score without pathological data improved the accuracy of mitomycin C indications, increasing the area under the curve from 0.62 to 0.79. This approach reduced unnecessary mitomycin C administration in 53 patients, with only 6 patients missing beneficial treatment, none of whom were low-risk. Only 6 cases lacked documented reasons for not receiving the instillation, a better rate than reported in the literature. CONCLUSIONS: Adding urine cytology to the EORTC score enhances the accuracy of mitomycin C indications, reducing unnecessary treatments while ensuring appropriate therapy for low-risk patients. Further studies are needed to validate these findings across different populations.