García Rodríguez J, López Tello A, González Ruiz de León C
… +5 more, Sacristán González R, Hevia Suárez M, Fuentes Pastor J, Pérez Vera I, Fernández Gómez JM
INTRODUCTION: Real-world analyses reflect routine clinical practice. We reviewed treatment response and quality of life in metastatic hormone-sensitive prostate cancer (mHSPC) patients treated with androgen receptor inhi...INTRODUCTION: Real-world analyses reflect routine clinical practice. We reviewed treatment response and quality of life in metastatic hormone-sensitive prostate cancer (mHSPC) patients treated with androgen receptor inhibitors. METHODS: We analyzed 89 patients with mHSPC from a descriptive observational cohort. The median follow-up was 16.1 months, with quarterly assessments. We evaluated PSA response, disease progression, and quality-of-life data. RESULTS: Among the patients, 37% had high-volume disease and 63% low-volume; 60% had synchronous metastases. Using apalutamide, we observed PSA reductions of 90%, PSA < 0.2 ng/ml, and ultra-low PSA (<0.02 ng/ml) at 3 and 6 months in 63%, 65%, and 34% and in 65%, 71%, and 53% of patients, respectively. Radiographic progression-free survival (rPFS) was 88% at 15 months. When PET-PSMA was used for imaging, 94% and 92% of patients remained free of radiographic progression at 12 and 24 months, respectively. Regarding quality of life, the FACT-P score remained stable, and pain on the visual analog scale improved, with the proportion of patients scoring >1 decreasing from 35% to 22% over 6 months. CONCLUSION: Real-world analyses using androgen receptor inhibitors in mHSPC reproduce clinical trial results in terms of treatment response. Profound PSA declines and observed progression-free survival outcomes reflect treatment effectiveness without a negative impact on quality of life.
INTRODUCTION: Palliative care is a fundamental component of the comprehensive management of patients with advanced cancer, significantly improving quality of life. Since most patients with metastatic renal cell carcinoma...INTRODUCTION: Palliative care is a fundamental component of the comprehensive management of patients with advanced cancer, significantly improving quality of life. Since most patients with metastatic renal cell carcinoma (mRCC) ultimately die from disease progression, end-of-life care represents a key element of quality cancer care. This area can be assessed through specific indicators derived from administrative data. MATERIALS AND METHODS: We conducted a retrospective analysis of patients diagnosed with mRCC who initiated treatment at our center between September 2012 and September 2019, evaluating quality indicators related to end-of-life care. RESULTS: Of the 71 patients identified, 57 had died at the time of analysis (81.6%). A total of 59.6% (95% CI 46.8-72.3) died in hospital, 64% of these in palliative care units. In the last 30 days of life, 22.8% (95% CI 12-33.5) visited the emergency room more than once, while only 1.8% (95% CI 0-5.1) were admitted to the ICU. Contact with palliative care services was documented in 49% (95% CI 36.1-62) of patients, although only 5.3% (95% CI 0-11.1) received early referral (more than 90 days before death). CONCLUSIONS: Palliative care in mRCC is underutilized and predominantly offered as end-of-life care, with early referral being exceptional. Multidisciplinary strategies are needed to optimize these services.
OBJECTIVE: To evaluate the effect of alpha-blocker therapy during flexible ureterorenoscopy (F-URS) on the treatment of upper urinary tract stones. METHODS: A retrospective analysis was conducted on 476 patients who unde...OBJECTIVE: To evaluate the effect of alpha-blocker therapy during flexible ureterorenoscopy (F-URS) on the treatment of upper urinary tract stones. METHODS: A retrospective analysis was conducted on 476 patients who underwent F-URS at the Department of Urology between January 2010 and January 2017. Data collected included alpha-blocker use, stone size, stone location, patient age and gender, success or failure of ureteral access sheath (UAS) placement, ability to reach the stone during the procedure, postoperative stone-free status, and complication rates. Patients were divided into two groups: alpha-blocker users (n = 90, 18.9%) and non-users (n = 386, 81.1%). RESULTS: No significant differences were observed in gender distribution (P = 0.86) or stone size (P = 0.21) between the two groups. Alpha-blocker users had a lower complication rate (P = 0.022), a higher rate of successful stone access during the procedure (P = 0.007), and a higher postoperative stone-free rate (P = 0.01) compared to non-users. Among alpha-blocker users, tamsulosin and silodosin were associated with higher stone clearance rates (P = 0.046 and P = 0.037, respectively). CONCLUSIONS: Alpha-blocker therapy during F-URS for upper urinary tract stones is associated with improved outcomes, including higher stone access rates, reduced complications, and increased stone-free rates. These findings suggest that alpha-blockers, particularly tamsulosin and silodosin, may enhance the efficacy and safety of F-URS.
OBJECTIVE: To evaluate the relationship between treatment response and radiological progression-free survival (rPFS) in patients with metastatic castration-sensitive prostate cancer (mCSPC) assessed by PSMA-PET/CT using...OBJECTIVE: To evaluate the relationship between treatment response and radiological progression-free survival (rPFS) in patients with metastatic castration-sensitive prostate cancer (mCSPC) assessed by PSMA-PET/CT using Response Evaluation Criteria on PSMA (RECIP 1.0) criteria. METHODS: In this study, 116 patients were analyzed retrospectively. At the beginning of the treatment and week 12 were PSMA PET/CT images evaluated for changes in total tumor volüme and new lesions. Patients were divided into four groups according to RECIP criteria; complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). The primary outcome was the correlation of RECIP criteria with rPFS. RESULTS: Mean age of the patients was 67 years [IQR: 62-72]. Total of 116 patients; 65 (56%) hadPR, 17 (14,6%) SD, 19 (16,3%) PD, and 15 (12%) CR. rPFS was found to be statistically significantly different among these four groups (p < 0.001). RECIP PD was found to be significantly shorter rPFS compared with non-PD (p < 0.001), with an rPFS of 7 months (95% CI: 3.45-10.56). PSA values were measured at nadir in 40 patients and no patient in this group was evaluated as having PD. CONCLUSION: RECIP criteria have been shown to have prognostic significance in terms of evaluating treatment response and rPFS in mCSPC patients.
OBJECTIVE: To determine the effectiveness and safety of pharmacological therapy in men older than 18 years with primary or secondary anorgasmia in terms of induced orgasm, improvement of the International Index of Erecti...OBJECTIVE: To determine the effectiveness and safety of pharmacological therapy in men older than 18 years with primary or secondary anorgasmia in terms of induced orgasm, improvement of the International Index of Erectile Function (IIEF), or Arizona Sexual Experience Scale (ASEX). METHODS: we conducted this systematic review according to the recommendations of the Cochrane Collaboration and following the PRISMA Statement. We designed a search strategy in MEDLINE (OVID), EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to the present. We assessed the risk of bias based on the STROBE statement for observational studies and the Rob 2.0 tool for clinical trials. RESULTS: 234 patients were included, and 232 were treated with pharmacological therapy in seven studies. Some pathologies reported were a history of prostatectomy, hypogonadism, psychiatric disorders, and use of antidepressants. Cabergoline was the most frequently administered treatment, followed by yohimbine and bupropion. The cabergoline improved orgasm in 66% of the population and yohimbine in 55%. The change in IIEF orgasmic function improved significantly with cabergoline and bupropion (P = <0.001 and P = 0.002). The ASEX improved with pycnogenol and was maintained in months 2,3 and 4 (p ≤ 0.05). The side effects reported were mild in three studies. Amantadine required discontinuation due to depression. CONCLUSION: Pharmacological therapy with cabergoline, yohimbine, bupropion, and pycnogenol can have a positive effect on the orgasmic function of patients with primary or secondary anorgasmia.
INTRODUCTION: Calcium oxalate kidney stones-the most common type of renal calculi-are closely associated with dietary and metabolic factors. An appropriate dietary approach can help prevent their formation and reduce the...INTRODUCTION: Calcium oxalate kidney stones-the most common type of renal calculi-are closely associated with dietary and metabolic factors. An appropriate dietary approach can help prevent their formation and reduce the risk of recurrence. OBJECTIVE: To evaluate the efficacy of dietary interventions involving adequate calcium intake combined with oxalate control in preventing the formation of calcium oxalate kidney stones. EVIDENCE ACQUISITION: An integrative review was conducted in PubMed, Scopus, Medline, and Dialnet (2014-2024), following PRISMA guidelines, focusing on calcium and oxalate dietary management in kidney stone disease. EVIDENCE SYNTHESIS AND CONCLUSIONS: The reviewed evidence indicates that an adequate calcium intake (800-1,200 mg/day) reduces intestinal oxalate absorption and, consequently, urinary oxalate excretion. Additionally, hydration, sodium restriction, and urine alkalinization with citrate are complementary dietary strategies. Recent studies also suggest that urinary microbiota and genetic predisposition may influence individual responses to dietary interventions. Overall, a personalized dietary approach may constitute an effective and accessible strategy for the prevention of calcium oxalate kidney stones. However, the current body of evidence is limited by methodological constraints and heterogeneity across studies.
Lammers RJM, 't Hoen LA, O'Kelly F
… +9 more, Selvi I, Quiroz Madarriaga Y, Baydilli N, Bañuelos Marco B, Dönmez MI, Sforza S, Bindi E, Haid B, en representación del Grupo de Trabajo de Urología Pediátrica de la Sección de Jóvenes Urólogos Académicos (YAU) - Asociación Europea de Urología (EAU)
The objective of this study was provide an overview of current practices on hormonal therapy (HT) in children with undescended testes (UDT). An online questionnaire about HT, referral patterns, and orchidopexy was spread...The objective of this study was provide an overview of current practices on hormonal therapy (HT) in children with undescended testes (UDT). An online questionnaire about HT, referral patterns, and orchidopexy was spread via several (social media) networks involved in pediatric urology. A total of 283 individuals responded, with 54 countries sampled. The majority (84%) did not prescribe HT for UDT, predominantly due to a paucity of scientific evidence (76%). Among those who use HT, main reason was bilateral UDT (62%). There was no clear preference in administration type (50% intramuscular injection, 50% nasal spray). GnRH was slightly more favoured over HCG (50% vs. 32%). No standardized schedule was used. Most respondents (67%) felt all forms of UDT should be treated by either a pediatric urologist or -surgeon. Eighty-seven percent follow the current guidelines and perform orchidopexy between 6-18 months of age.
Baydilli N, Dönmez MI, Quiroz Madarriaga Y
… +7 more, Banuelos Marco B, Selvi I, Bindi E, Lammers R, Sforza S, 't Hoen LA, en representación del Grupo de Trabajo de Urología Pediátrica de la Sección de Jóvenes Urólogos – Asociación Europea de Urología (EAU-YAU)
OBJECTIVE: This study assessed global diagnostic and therapeutic approaches to nocturnal enuresis (NE), highlighting current practices and variations. MATERIALS AND METHODS: An 18-question survey by the European Associat...OBJECTIVE: This study assessed global diagnostic and therapeutic approaches to nocturnal enuresis (NE), highlighting current practices and variations. MATERIALS AND METHODS: An 18-question survey by the European Association of Urology (EAU) Young Academic Urologist (YAU) Paediatric Urology Working Group targeted clinicians managing NE. Distributed online, it reached Urologists, Pediatric Urologists, Pediatricians, Nephrologists, and Urotherapists. The survey collected demographic data and details on diagnostic and treatment practices. Responses were analyzed using descriptive statistics. RESULTS: Most respondents worked in university or government hospitals, with pediatric urologists forming the largest group (43.6%). A significant portion had 11-20 years of NE management experience. Initial treatment favored behavioral strategies and urotherapy (84.5%), with desmopressin as a common first-line medication (23.8%). Most clinicians initiated treatment at ages 5-6. Bladder diaries were widely used (82.0%), while airway assessments were inconsistent (52.1%). Diagnostic test usage varied, with urinary tract ultrasonography (53.65%) and urinalysis (51.5%) employed to identify underlying abnormalities. Psychological referrals were common for secondary enuresis (58.9%). CONCLUSION: NE management varies globally due to regional practices, clinician experience, and specialty focus. The findings emphasize the need for standardized guidelines and education on comprehensive assessments, including sleep-related factors. International collaboration and guideline development could enhance consistency and improve patient outcomes.
de Angst IB, Reichert M, Dönmez MI
… +14 more, Quiroz Y, O'Kelly F, Sforza S, Bramer WM, Bañuelos B, Bindi E, Selvi I, Brandt F, Starink E, Stufken J, Territo A, López-Abad A, Lammers RJM, 't Hoen LA
INTRODUCTION AND OBJECTIVES: Urological complications are common after kidney transplantation (KTx), mostly in the form of ureterovesical obstruction or leakage. Routine ureteral stenting was previously shown to reduce t...INTRODUCTION AND OBJECTIVES: Urological complications are common after kidney transplantation (KTx), mostly in the form of ureterovesical obstruction or leakage. Routine ureteral stenting was previously shown to reduce these complications on the expense of other complications such as urinary tract infections (UTI). There is no consensus on optimal duration of stents, and relevant literature on this topic is lacking. The aim of this systematic review is to summarize and compare the incidences of stent-related complications using short (<2 weeks; SD) and long (≥2 weeks; LD) stent duration after pediatric KTx. MATERIAL AND METHODS: A systematic search in Embase, MEDLINE, Cochrane, and clinicaltrial.gov was performed. Studies reporting on children (0-18 years) undergoing KTx with intraoperative ureteral stenting with at least one month follow up were included. Data on surgical and outcome characteristics were extracted. RESULTS: From a total of 322 articles, 14 studies were included, reporting on 971 pediatric KTx of whom 411 were female (42%). Sample sizes ranged from 32 to 146 patients. Mean or median age at time of transplantation ranged from 3.36 to 14.7 years. A systematic synthesis approach was used to summarize results. Of the four comparative studies, only one showed significantly more post-transplant UTIs in the LD group, without a significant difference in other urological complications. CONCLUSIONS: Due to lack of good quality studies, it remains uncertain whether a short stent duration is safer and more feasible for reducing the incidence of stent-related complications in pediatric KTx, while also preventing stenosis or leakage at the ureterovesical anastomosis.
Diana P, Gallioli A, Uleri A
… +11 more, Mas L, Pujol R, Territo A, Rodriguez-Faba O, Gaya JM, Sanguedolce F, Huguet J, Parada R, Algaba F, Palou J, Breda A
INTRODUCTION AND OBJECTIVES: Urology residents training programs across Europe are uneven and often unsatisfactory. The significance of resident mentoring should not be overstated and trainees should be mentored by train...INTRODUCTION AND OBJECTIVES: Urology residents training programs across Europe are uneven and often unsatisfactory. The significance of resident mentoring should not be overstated and trainees should be mentored by training-trained attending urologist even in case of common procedures such transurethral resection of bladder tumor (TURBT). The goal of this study is to demonstrate the comparability in TURBT performance between supervised urology residents and attendings. MATERIALS AND METHODS: This study is a subanalysis of a prospective, randomized trial enrolling patients diagnosed with BC and undergoing endoscopic intervention. The trial (NCT04712201) was approved by the Institutional Review Board (2017/09c). Surgeons were either urology attendings or supervised residents of the 3rd-5th year. Primary outcome was to compare surgical and post-operative outcomes in both groups. RESULTS: From 04/2018 to 06/2021, 300 patients met inclusion criteria and 248 (83%) of these underwent the assigned intervention. 200 (80.6%) patients were males and median (SD) age was 72.2 (11.2). No statistical differences were found in terms of intra and post-operative outcomes (all P > .05). Linear and logistic regression analysis resulted comparable for all variables (all P > .05). CONCLUSION: Supervised urology residents do not put the patient at an increased risk of complications neither perform a suboptimal procedure. Resident mentoring is fundamental in order to reach comparable results in surgical outcomes and pathological diagnosis. A structured standardized program with trained trainers and proficiency evaluations are warranted to gain and maintain these outcomes across Europe.
Paediatric urolithiasis is increasing globally, with metabolic abnormalities as a key contributing factor. However, standardized protocols for metabolic evaluation in children are lacking. This study assessed current pra...Paediatric urolithiasis is increasing globally, with metabolic abnormalities as a key contributing factor. However, standardized protocols for metabolic evaluation in children are lacking. This study assessed current practices and knowledge among paediatric urologists worldwide. An international survey was distributed in Spanish and English, gathering data on clinician demographics and metabolic evaluation strategies. A total of 194 clinicians from 49 countries responded. Only 11% routinely performed metabolic evaluations, and while 78% requested stone analysis, just 46% ordered 24-h urine studies. In 84% of cases, paediatric nephrologists were responsible for evaluations, with urologists involved in fewer than 25%. Knowledge of spot urine indices varied, and only 55% recognized crystalluria as a lithogenic risk factor. Fewer than one-third felt confident interpreting metabolic results or initiating treatment. These findings highlight inconsistent practices and limited involvement of paediatric urologists, underscoring the need for clearer guidelines and targeted education to enhance metabolic assessment in stone disease.
Schwartzmann I, Secco S, Farré A
… +10 more, García-Barreras S, Fernández E, D'Anna M, Cindolo L, Parejo V, Tornero JI, Ferrari G, Varvello F, Ponce de León J, Povo I
INTRODUCTION: Water Vapor Thermal Therapy (WVTT) has emerged as a minimally invasive surgical therapy (MIST) for benign prostatic obstruction. However, the optimal number of intraprostatic injections remains debated. Thi...INTRODUCTION: Water Vapor Thermal Therapy (WVTT) has emerged as a minimally invasive surgical therapy (MIST) for benign prostatic obstruction. However, the optimal number of intraprostatic injections remains debated. This study introduces injection density (ID), defined as the number of injections per 10 cc of prostate volume, to assess its impact on treatment failure after WVTT. METHODS: Multicentric retrospective study across 11 European centers, analysing patients who underwent WVTT between March 2019 and March 2024. Baseline, surgical, and postoperative data were collected during a 24 months follow-up. The primary outcome was treatment failure, defined as the need for medical or surgical intervention 12 months post-WVTT. Secondary outcomes included sexual function and postoperative complications. Logistic regression was performed across ID cut-off points from 0.75 to 2.5 injections per 10 cc. RESULTS: A total of 722 patients underwent WVTT with a mean age of 64 years and a mean prostate volume of 60 cc. Baseline Qmax was 8.0±3.6mL/s. Intermediate ID cut-off points (1.25-1.75) suggested a protective effect against treatment failure, with 1.75 being the first to reach statistical significance (P=.028). Higher ID cut-off points (2.00-2.50) maintained a protective effect, but only 2.25 reached significance (P=.024). No significant relationship was found between ID and complications. Sexual function remained stable across ID thresholds. CONCLUSIONS: Optimizing ID during WVTT may improve success rates without increasing complications or negatively impacting sexual function. These findings support a volumetric approach over the traditional linear injection technique to enhance WVTT outcomes.
González San Segundo C, López-Campos F, Gómez Iturriaga A
… +29 more, Santos M, Ocanto A, Montezuma L, Boladeras-Inglada AM, Glaria L, Guardado S, Rodríguez A, Henríquez I, Olivera J, Duque-Santana V, Garre J, Moreno S, Valero J, Conde AJ, Doval A, Sancho G, Martin Nieto P, Castaño Cantos A, García N, Fernández Alonso S, García García R, Díaz Gavela A, Buchser D, Maldonado X, Mases J, Hernando Requejo O, Sanmamed N, Martínez Salamanca JI, Couñago F
INTRODUCTION: URONCOR 06-24 (NCT05781217) is a prospective, multicenter, randomized, open-label, phase III trial evaluating the impact on distant metastasis-free survival (MFS) of short-term (6 months) versus long-term (...INTRODUCTION: URONCOR 06-24 (NCT05781217) is a prospective, multicenter, randomized, open-label, phase III trial evaluating the impact on distant metastasis-free survival (MFS) of short-term (6 months) versus long-term (24 months) androgen deprivation therapy (ADT) in combination with salvage radiotherapy in high- and intermediate-risk patients after biochemical recurrence (BCR). MATERIAL AND METHOD: A total of 534 men will be randomized to receive either 6 or 24 months of ADT. Stratification is based on risk group (intermediate vs high) and nodal status (pN0 vs pNx). RESULTS: From March 2023 to November 2024, 122 patients have been enrolled: 34 (28%) with intermediate risk and 88 (72%) with high risk. Fifty-five patients (45%) are pNx. The mean time from surgery to BCR is 25.4 months, and the PSA at inclusion was 0.55 ng/ml. Restaging was performed in 89 patients, 75 of whom underwent PET/CT (97%, PSMA PET/CT). Hypofractionation was used in 68% of cases, and elective pelvic irradiation in 33%. At the time of analysis, all patients had PSA normalization. No severe ADT-related toxicity has been reported. CONCLUSION: URONCOR 06-24 is the first clinical trial comparing long- versus short-term ADT in the setting of BCR after prostatectomy, with stratification by risk group. Initial recruitment data show a balanced distribution of prognostic factors between both arms and no serious adverse events related to ADT.
INTRODUCTION: Classic bladder exstrophy presents a unique challenge for reconstructive surgeons given the significant alternations it has on normal pelvic anatomy. The ultimate goal of surgery, whether in one stage or mo...INTRODUCTION: Classic bladder exstrophy presents a unique challenge for reconstructive surgeons given the significant alternations it has on normal pelvic anatomy. The ultimate goal of surgery, whether in one stage or more, is simple; close the bladder, reconstruct the bladder neck and urethra, and place the unit into a more orthotopic position deep in the pelvis, and establish normal genitalia. Despite significant improvements with the success of bladder exstrophy closure, a patient's ability to volitionally void and achieve urinary continence after initial closure remain an elusive «holy grail» for bladder exstrophy surgeons. After closure many patients will endure persistent urinary incontinence post exstrophy closure. In this review, we will discuss the conservative strategies and surgical options to facilitate continence in our bladder exstrophy patients. Regardless of surgical approach or initial outcome, all patients with bladder exstrophy require lifelong urologic follow-up. METHODS: A comprehensive search of electronic databases (MEDLINE, PubMed, Embase, PsycINFO and CINAHL), and citation tracking platforms (Google Scholar and Web of Science) was performed. Keywords included Classic Bladder Exstrophy, Incontinence, behavioral therapy, urotherapy, biofeedback, bulking agents, artificial urinary sphincter, bladder neck reconstruction, bladder neck closure, urinary diversion. RESULTS: Conservative measures such as behavioral therapy, physical therapy and uropsychological counseling should be first line for the treatment of urinary incontinence after exstrophy closure. These interventions along with maturation of the child and bladder growth can improve incontinence without surgery. Patients should be counseled on the limited success of bulking agents and significant risk of erosion with sphincters. Although success after bladder neck reconstruction or bladder neck closure with or without augmentation and catheterizable channel can be variable, these surgical options can be offered to patients that have exhausted conservative treatment strategies. CONCLUSIONS: A patient's ability to volitionally void and achieve urinary continence remain an elusive goal for bladder exstrophy surgeons with many experiencing persistent urinary incontinence following exstrophy closure. Behavioral therapy, physical therapy and pyschological support should be provided to all bladder exstrophy patients and families. Giving children time to grow and mature can potentially facilitate continence without surgical intervention. If surgical intervention is pursued lifelong follow-up and monitoring is critical.