INTRODUCTION: Burnout syndrome is a significant occupational phenomenon among healthcare professionals, characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. Urologists...INTRODUCTION: Burnout syndrome is a significant occupational phenomenon among healthcare professionals, characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. Urologists, due to the demands of their specialty, are particularly vulnerable. This study aims to assess the prevalence and risk factors for burnout syndrome among urologists in Spain. METHOD: A cross-sectional survey was conducted among 257 practicing urologists in Spain. Data were collected using the Maslach Burnout Inventory and additional demographic and occupational questions. Burnout was defined based on high emotional exhaustion combined with either high depersonalization or low personal accomplishment. Statistical analyses included univariate and multivariate logistic regression to identify significant predictors. RESULTS: In the study, the prevalence of burnout among Spanish urologists was 54.9%. Fewer years of experience and female gender were associated with higher burnout rates. Significant stressors included workload and work schedule. Despite the high prevalence, only one third of affected professionals sought psychological support. CONCLUSIONS: Burnout is highly prevalent among Spanish urologists and poses serious risks to both healthcare professionals and patients. Its impact on patient care includes increased likelihood of medical errors, reduced quality of care and patient satisfaction. Targeted interventions and psychological support are urgently needed to address this issue.
INTRODUCTION AND OBJECTIVE: Urethritis is the most common sexually transmitted infection in men. Haemophilus influenzae and Haemophilus parainfluenzae, commensal microorganisms of the respiratory and oral tract, have bee...INTRODUCTION AND OBJECTIVE: Urethritis is the most common sexually transmitted infection in men. Haemophilus influenzae and Haemophilus parainfluenzae, commensal microorganisms of the respiratory and oral tract, have been proposed as potential etiological agents of non-gonococcal urethritis (NGU). This study aimed to determine the prevalence of these species in urine samples from men with urethritis and analyze their clinical correlation. METHODS: A total of 200 urinary DNA samples from patients diagnosed with urethritis were analyzed. Microorganisms were identified through multiplex PCR, amplifying the P6 and 16S rRNA genes. Associations between risk factors and infection were evaluated by calculating odds ratios (OR) and 95% confidence intervals (CI) using OpenEpi 3.03a. RESULTS: The mean age of the population was 55 years (range 20-95). Among the participants, 32.5% had received prior sexual education, and 75% reported not using contraceptive methods. H. influenzae was not detected in any sample, whereas H. parainfluenzae was present in 9.5% (n = 19) of cases. Significant associations were identified with the absence of formal education, a history of more than ten sexual partners, masturbation, and sexual intercourse under the influence of alcohol and/or drugs. CONCLUSIONS: Although H. influenzae and H. parainfluenzae have been rarely identified in urethritis, their high transmissibility and clinical relevance suggest the need for their detection in high-risk populations. Their identification may contribute to improving diagnosis and the implementation of therapeutic strategies.
INTRODUCTION AND OBJECTIVES: Nephrolithiasis is one of the most prevalent urological pathologies worldwide, with an increasing incidence and multifactorial etiology, particularly influenced by diet. Surgical intervention...INTRODUCTION AND OBJECTIVES: Nephrolithiasis is one of the most prevalent urological pathologies worldwide, with an increasing incidence and multifactorial etiology, particularly influenced by diet. Surgical interventions or extracorporeal shock wave lithotripsy (ESWL) are the cornerstone treatments. However, as emphasized by the EAU and AUA guidelines, post-surgical medical management is recommended to reduce recurrence risk. Phyllanthus niruri (PN), widely used in traditional medicine, has been extensively researched, yielding mixed results and presenting an opportunity to explore its role further. This review aims to evaluate PN's potential in enhancing treatment efficacy and reducing stone recurrence. MATERIALS AND METHODS: A systematic literature review was conducted, encompassing articles published from January 1994 to September 2022 in English and Spanish. The review included studies on humans and rats accessible through the authors' institutional affiliations. Titles and abstracts were screened, and relevant studies were selected for in-depth analysis. RESULTS: Out of the 16 selected studies, various mechanisms of action for PN were identified, such as promoting glycosaminoglycan (GAG) aggregation, inhibiting nucleation processes, and altering stone density to favor a stone-free state (SFR). Evidence consistently supports PN's long-term safety, confirmed by serial measurements of serum electrolytes and liver function. Novel applications, such as PN as an adjuvant to ESWL, show benefits for lower renal pole stones. CONCLUSIONS: Growing evidence suggests that PN, when used alongside traditional interventions, is safe, without significant adverse effects, and may improve SFR outcomes after ESWL.
González-Peramato P, Álvarez-Maestro M, Heredia-Soto V
… +9 more, Mendiola Sabio M, Linares E, Serrano Á, Álvarez-Ossorio JL, López Alcina E, Prieto L, Vázquez Alonso F, Aller Rodríguez M, Berglund E
INTRODUCTION: Prostate cancer (PCa) shows varied aggressiveness, complicating personalised treatment decisions. Traditional risk stratification systems rely on clinical parameters but may miss crucial genetic insights. T...INTRODUCTION: Prostate cancer (PCa) shows varied aggressiveness, complicating personalised treatment decisions. Traditional risk stratification systems rely on clinical parameters but may miss crucial genetic insights. The Prostatype® score (P-score) integrates gene expression with clinical data to improve PCa risk assessment precision. OBJECTIVES: To validate the P-score's predictive performance for prostate cancer-specific mortality (PCSM) and metastasis in a Spanish cohort, comparing it with NCCN, D'Amico, and EAU systems. MATERIALS AND METHODS: This study was multicentre, retrospective and included seven Spanish hospitals. Of 154 core needle biopsies, 93 met RNA criteria, and for those, P-score was calculated based on IGFBP3, VGLL3, and F3 genes expression and clinical data. The primary endpoint was PCa-specific mortality (PCSM), with secondary endpoints being development of metastasis, adverse pathology (AP), and International Society of Urological Pathology (ISUP) grading. RESULTS: The P-score demonstrated superior accuracy in predicting 10-year PCSM, with an AUC of 0.81 and a C-index of 0.75, outperforming NCCN (AUC 0.77, C-index 0.69) and D'Amico/EAU (AUC 0.70, C-index 0.62). For metastasis prediction, the P-score achieved a C-index of 0.77, significantly higher than NCCN, D'Amico, and EAU (0.58). Kaplan-Meier analysis underscored the P-score's ability to better stratify patients by risk, especially high-risk groups. Additionally, the P-score correlated with tumour burden, showing significant associations with positive biopsy cores (p = 0.017) and ISUP grade at radical prostatectomy (p = 0.0028). CONCLUSIONS: In this Spanish cohort, the P-score outperformed traditional clinicopathological systems in predicting PCSM, development of metastasis, and pathological markers, supporting its clinical utility for more personalised PCa management.
INTRODUCTION: Stress urinary incontinence (SUI) affects between 2.5% and 40% of patients after radical prostatectomy. Although the implantation of an artificial urinary sphincter (AUS) offers continence rates of 70%-80%,...INTRODUCTION: Stress urinary incontinence (SUI) affects between 2.5% and 40% of patients after radical prostatectomy. Although the implantation of an artificial urinary sphincter (AUS) offers continence rates of 70%-80%, its failure rate reaches 25% in some series. This single-center retrospective study analyzed the survival of AUS and the factors associated with its failure. MATERIALS AND METHODS: A total of 145 patients treated with the AMS 800 device (Boston Scientific®) between 2010 and 2023 were included. Kaplan-Meier analysis and the Cox proportional hazards model were used to evaluate device survival and identify predictive factors for failure. RESULTS: The mean age was 68.6 years; 28% of patients were smokers, 43.7% had diabetes, and 26.2% had undergone prior radiation therapy. Radical prostatectomy was the main cause of SUI (86.9%). In the majority of cases (91.5%), the artificial urinary sphincter was implanted around the bulbar urethra. During follow-up, 25.5% of patients required revision surgery. The probability of functional sphincter survival was 89% at 1 year, 78% at 2 years, 64% at 5 years, and 51% at 10 years. On multivariate analysis, prior radiation therapy [HR 2.06; P = .029] and diabetes [HR 2.24; P = .04] were associated with poorer device survival. CONCLUSIONS: The AUS is an effective and safe treatment for severe SUI, although radiotherapy and diabetes may adversely affect its durability.
INTRODUCTION: Abdominal wall closure defects (AWCD) represent a cause of morbidity and mortality in patients undergoing laparotomy. OBJECTIVE: The aim of this study was to determine the risk factors contributing to the a...INTRODUCTION: Abdominal wall closure defects (AWCD) represent a cause of morbidity and mortality in patients undergoing laparotomy. OBJECTIVE: The aim of this study was to determine the risk factors contributing to the appearance of AWCD in open radical cystectomy. METHODS: A retrospective, analytical, observational, descriptive study and multivariate analysis was conducted including patients who underwent open radical cystectomy for bladder cancer at the General University Hospital of Castellón between January 2018 and December 2021. RESULTS: A total of 80 patients were included. The mean age was 70 years, with 86.3% being men. Sixteen presented with an evisceration (20%). Risk factors in the multivariate analysis were age, history of vascular or coronary disease, preoperative albumin, hemodynamic instability, and surgical time. Eight patients presented with an eventration (10%). A higher body mass index and a lower preoperative hemoglobin level were associated with eventration. CONCLUSION: The risk factors associated with abdominal wall closure defects are identifiable and preventable.
INTRODUCTION: Clean intermittent catheterization (CIC) is a technique used for bladder emptying in patients with neurogenic or non-neurogenic lower urinary tract dysfunction. CIC is considered the best option for most pa...INTRODUCTION: Clean intermittent catheterization (CIC) is a technique used for bladder emptying in patients with neurogenic or non-neurogenic lower urinary tract dysfunction. CIC is considered the best option for most patients with dysfunctional voiding, as it improves their quality of life with a low complication rate. However, there is considerable variability in the management of CIC across regions and countries, as well as a lack of standardized guidelines. This study aims to determine the patient profile, associated complications and resource utilization related to the procedure. METHODS: This descriptive, multicenter, cross-sectional study was conducted in the functional urology and urodynamics units of 23 hospitals across Spain between April 2019 and April 2021. Patient characteristics were collected and stored in the Multicenter Studies Research Platform of the Spanish Urology Association. RESULTS: This study included 573 CIC users, with a mean age of 54.1 years (SD: 19.1). Of the participants, 78.6% lived in urban areas, and 53.9% had additional comorbidities. The primary indication for CIC was spinal cord injury (29.5%), followed by hypocontractile neurogenic bladder (20.8%). Most patients performed one clean intermittent catheterization per day (87.3%), with a median of three. The most common complication observed was urinary tract infection (51.8%). Additionally, 95.3% of patients attended at least one urology consultation in the past year. CONCLUSIONS: CIC is mostly indicated for neurological pathologies, and urinary tract infection is the most common associated complication. CIC is a fundamental procedure in functional urology units and is linked to significant healthcare resource consumption. Knowledge on the patient profile and the characteristics associated with CIC is crucial for comprehensive patient management, as it helps reduce and prevent potential complications while also informing healthcare strategies for more efficient resource management.
INTRODUCTION AND OBJECTIVES: Gut microbiota (GM) comprises a diverse community of bacteria associated with a wide range of diseases. Emerging research indicates that GM dysbiosis may affect the progression of prostate ca...INTRODUCTION AND OBJECTIVES: Gut microbiota (GM) comprises a diverse community of bacteria associated with a wide range of diseases. Emerging research indicates that GM dysbiosis may affect the progression of prostate cancer (PC) and its response to treatment. This study aimed to describe GM in patients with PC at various disease stages. MATERIALS AND METHODS: A cross-sectional study was conducted at Complejo Hospitalario Universitario de Vigo between 2023 and 2024. 49 patientes were classified into three groups: active surveillance (AS), disease-free post-treatment (DF) and advanced disease (AD). Faecal samples were obtained for GM analysis and DNA was used for 16S rRNA sequencing. The structure of the microbial community was examined via alpha and beta diversity analysis, and differential abundance was measured using the LinDA model. RESULTS: Alpha diversity analysis revealed diminished taxon richness in patients under AS and in those treated with androgen receptor pathway in hibitors (ARPI). Beta diversity analysis indicated substantial changes attributable to the treatment group, radiation, hormone therapy, and ARPI. The AD group had a diminished number of potentially advantageous bacteria (Methanobrevibacter, Paraprevotella, Colidextribacter) and an elevated abundance of Terrisporobacter and Streptococcus compared to the DF group. The AS group showed reduction in Intestinibacter, Adlercreutzia, Subdoligranulum, and Methanobrevibacter, along with an increase in Fusicatenibacter, Lachnospiraceae, and Lachnoclostridium. CONCLUSIONS: Patients who remain disease-free after therapy have restored microbiota abundant in potential beneficial bacteria, in contrast to individuals with severe disease or those under active monitoring. This study indicates that gut microbiome characteristics could assist in risk assessment and act as possible treatment targets for prostate cancer.
INTRODUCCTION AND OBJECTIVE: Muscle-invasive bladder cancer (MIBC) poses significant challenges, traditionally treated with radical cystectomy, a procedure with considerable morbidity and impact on quality of life. Bladd...INTRODUCCTION AND OBJECTIVE: Muscle-invasive bladder cancer (MIBC) poses significant challenges, traditionally treated with radical cystectomy, a procedure with considerable morbidity and impact on quality of life. Bladder-sparing approaches aim to preserve the bladder while maintaining oncological efficacy. This review explores emerging perspectives in bladder-sparing strategies for MIBC, focusing on patient selection criteria, molecular characterization, non-invasive treatment response assessment, systemic therapies, radiation techniques, and the role of intravesical devices. METHODS: A comprehensive narrative review provides insights into novel perspectives in bladder-sparing strategies for treating MIBC. RESULTS: Patient selection criteria for bladder preservation remain challenging. While the traditional approach focuses on selecting candidates with MIBC with fewer clinicopathological risk characteristics, some studies suggest that histological variants and the presence of hydronephrosis may not be absolute exclusion criteria. Molecular classification data shows promise but lacks sufficient evidence, while immune cell infiltration may provide insights into potential treatment response. MRI and radiomics offer the potential for non-invasive treatment response assessment. Ongoing trials investigate new systemic therapies, radiation therapy approaches, and the role of intravesical devices in bladder preservation, with some preliminary data appearing promising. CONCLUSION: Bladder-sparing strategies for MIBC are currently experiencing substantial evolution. Achieving optimal patient selection may entail the integration of clinical, radiological, histopathological, and molecular data. It is likely that shortly, multimodal approaches incorporating neoadjuvant systemic therapy, radiotherapy, intravesical devices, and possibly maintenance or adjuvant regimens guided by biomarker-driven strategies will become standard practice.
INTRODUCTION AND OBJECTIVES: To investigate whether lymphovascular invasion (LVI) could be a factor in predicting recurrence and progression in patients with high and very high-risk non-muscle-invasive bladder cancer (NM...INTRODUCTION AND OBJECTIVES: To investigate whether lymphovascular invasion (LVI) could be a factor in predicting recurrence and progression in patients with high and very high-risk non-muscle-invasive bladder cancer (NMIBC) who received Bacillus Calmette-Guérin (BCG) treatment. METHODS: Ninety-three patients with high and very high-risk NMIBC, diagnosed initially in our clinic, were treated with at least 1 year of BCG therapy, and they were followed up to assess recurrence and progression, comparing those with and without lymphovascular invasion (LVI) at the time of diagnosis. RESULTS: In the entire cohort, LVI was present in 33 (35.5%) patients while absent in 60 (64.5%) patients. Among patients with LVI, 17 (51.5%) showed recurrence, and 11 (33.3%) showed progression. Statistically significant differences were observed in both recurrence and progression in patients with LVI compared to those without LVI (p < 0.001 and 0.04, respectively). Additionally, univariate and multivariate regression analysis revealed that the presence of LVI was an independent factor predicting recurrence (p = 0.001). CONCLUSION: In our study, we demonstrated the importance of being cautious regarding recurrence and progression in patients with high and very high-risk NMIBC who also have LVI despite receiving standard treatment. We found that approximately one-third of these patients may experience recurrence within one year.
Giulioni C, Singh A, Yuen SK
… +11 more, Nedbal C, De Stefano V, Lim EJ, Wroclawski ML, Chai CA, Maggi M, Cafarelli A, Castellani D, Tp R, Satapathy A, Gauhar V
OBJECTIVE: To systematically review the outcomes of percutaneous nephrolithotomy (PCNL) performed in local (LA) or regional anesthesia (RA) as compared to general anesthesia (GA). METHODS: Literature search was conducted...OBJECTIVE: To systematically review the outcomes of percutaneous nephrolithotomy (PCNL) performed in local (LA) or regional anesthesia (RA) as compared to general anesthesia (GA). METHODS: Literature search was conducted on 12th April 2024 including PubMed, Medline, Embase, and Scopus database. Complications were assessed using the Cochran-Mantel-Haenszel Method with the random effect model and reported as odds ratio (OR), 95% confidence interval (CI), and p-values. Analyses were two-tailed and the significance was set at p < 0.05 and a 95% CI. Continuous variables were pooled using the inverse variance of the mean difference with a random effect, 95% CI, and p-values. RESULTS: Fourteen studies were included. Overall, there were 1413 patients, with 703 patients in the LA/RA group and 710 in the GA group. There was no difference in Clavien grade III and ≥III complications, postoperative pain, postoperative headache, operative time, postoperative stay, stone-free rate, and intraoperative mean heart rate between LA/RA and GA. Meta-analysis shows that the nausea and vomiting rate favors the LA/RA group (OR 0.10), blood transfusion rate is lower in LA/RA group (OR 0.40), intraoperative blood loss is lower in LA/RA group (MD -59.63 ml) and intraoperative mean arterial pressure is lower in LA/RA group (MD -10.80 mmHg). CONCLUSIONS: This meta-analysis shows no difference in stone-free and complication rates or hospital stay if PCNL is done under GA or LA/RA. LA/RA offers advantages for better intraoperative hemodynamic stability with lesser post-operative nausea and vomiting. PCNL under RA adoption in clinical practice is perhaps limited to centers where specialist anesthetist services can support this procedure.
INTRODUCTION: Penile cancer lymph node (LN) metastases are critical prognostic factors. The European Association of Urology (EAU) guidelines recommend dynamic sentinel node biopsy (DSNB) as a less invasive alternative fo...INTRODUCTION: Penile cancer lymph node (LN) metastases are critical prognostic factors. The European Association of Urology (EAU) guidelines recommend dynamic sentinel node biopsy (DSNB) as a less invasive alternative for cN0 patients with intermediate- to high-risk tumors. Due to the rarity of penile cancer, lymph node staging tends to be underutilized, and few centers have a significant number of patients to develop the DSNB technique and observe its evolution over time. Previously, our series reported a sensitivity of 66%, and our aim is to contribute to the available evidence, based on 25 years of real-world experience. MATERIALS AND METHODS: Retrospective single-center study involving 95 groins of 51 patients with intermediate or high-risk penile squamous carcinoma, who underwent DSNB between November 1999 and July 2024. Clinical data, including histology, surgical treatment, and complications, were analyzed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Complications were registered using the Clavien-Dindo system. RESULTS: The median age of patients was 60 (range 30-84) years. 10/51 patients (21%) had metastatic sentinel node. DSNB successfully identified sentinel nodes in 95.7% for right and 89.5% for left groins. The false-negative rate was 8.1%, with a sensitivity of 77%, specificity of 100%, PPV of 100%, and NPV of 92%. 18% (9/51) of patients suffered complications being most of them minor (6/9), 3 patients experimented major complications. DISCUSSION AND CONCLUSION: The updated DSNB outcomes show improved diagnostic accuracy compared to previous reports, reflecting enhanced techniques and learning curves. The study highlights the accuracy and the low morbidity of DSNB.
OBJECTIVES: Patients with non-muscle invasive bladder cancer (NMIBC) face a high risk of recurrence and progression after transurethral resection, making adjuvant therapies necessary. Intravesical device-assisted therapi...OBJECTIVES: Patients with non-muscle invasive bladder cancer (NMIBC) face a high risk of recurrence and progression after transurethral resection, making adjuvant therapies necessary. Intravesical device-assisted therapies, such as radiofrequency-induced thermochemotherapy (RITE), have shown promise in enhancing the effectiveness of intravesical chemotherapies. This study aimed to evaluate oncological outcomes in patients with NMIBC treated with RITE in a real-world setting, encompassing those unresponsive to prior Bacillus Calmette-Guérin (BCG) or intravesical chemotherapy, as well as those who declined or were ineligible for BCG or radical cystectomy (RC). METHODS: A retrospective multicenter analysis of patients treated with RITE for NMIBC between 2015 and 2024 was performed. Co-primary endpoints of the study were intravesical recurrence free survival (RFS) and high-grade intravesical recurrence free survival (HG-RFS). Secondary endpoints included radical cystectomy-free survival (RC-FS), overall survival (OS), cancer-specific survival (CSS), and adverse events (AEs). RESULTS: Fifty-nine consecutive patients were included in the final analyses. Overall, 12 (20%) and 45 (76%) patients failed previous intravesical chemotherapy, and immunotherapy with BCG, respectively. The 24-months RFS and HG-RFS following RITE were 68.6% (95% CI: 0.568, 0.828) and 74.8% (95% CI: 0.632, 0.885). RC-FS at 24 months was 93.8% (95% CI: 0.872, 1.000). The OS probability at 24 months was 91%, with a CSS of 97.8%. Most common AEs were dysuria and urgency in 27 (45.7%) patients, treatment limiting bladder spasms in 11 (19%) patients, low bladder compliance in 11 (19%) patients and urethral strictures in 5 (8%) patients. CONCLUSION: In our analyses, RITE resulted in notable antitumor activity and allows for the avoidance of more aggressive and quality-of-life-limiting therapies, such as radical cystectomy. RITE might be considered as a second-line bladder-sparing option in patients failing previous intravesical therapies. Long-term follow-up and larger-scale data are required to validate our findings.
Łaszkiewicz J, Del Giudice F, Li S
… +27 more, Krajewski W, Nowak Ł, Szydełko T, Basran S, De Berardinis E, Carino D, Corvino R, Santerelli V, Ferro M, Rocco B, Sighinolfi MC, Crocetto F, Barone B, Dinacci F, Pichler R, Subiela JD, Pradere B, Moschini M, Mari A, Gallioli A, Mori K, Soria F, Mertens L, Abu-Ghanem Y, Nair R, Khan MS, Chung BI
INTRODUCTION AND OBJECTIVES: Transurethral resection of the bladder tumor (TURBT) is a standard procedure in bladder cancer (BC), which is associated with low risk of venous thrombo-embolism (VTE). The aim of this study...INTRODUCTION AND OBJECTIVES: Transurethral resection of the bladder tumor (TURBT) is a standard procedure in bladder cancer (BC), which is associated with low risk of venous thrombo-embolism (VTE). The aim of this study was to find the predictors of postoperative VTE in patients undergoing TURBT for BC. MATERIALS AND METHODS: In this retrospective cohort analysis, patients aged ≥ 18 years with BC diagnosis undergoing TURBT were identified in the Merative® Marketscan® Research de-identified databases in 2007-2021. Patients with prior VTE events were excluded. Preoperative diagnostic codes and outpatient prescriptions present in at least 1% of the cohort were recorded (205 variables). Then, logistic regressions were performed including each variable separately, all variables together, as well as variables selected by stepwise and Least Absolute Shrinkage and Selection Operator (LASSO) selection methods. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated. RESULTS: In total, 132,425 patients were included in this study, with 1959 (1.5%) individuals diagnosed with postoperative VTE. Various malignant neoplasms diagnosed before BC were significant risk factors of postoperative VTE, with aOR reaching up to 2.26 (95% CI: 1.96-2.61). Another strong predictor of VTE was a diagnosis of nephritis, nephrotic syndrome, and nephrosis (aOR 1.67, 95% CI: 1.48-1.87 stepwise; aOR 1.65, 95% CI: 1.46-1.85 LASSO). Also, patients with diseases of the urinary system, non-specific symptoms, diseases of the respiratory system, anemias, and other cardiovascular diseases were associated with increased VTE risk. Regarding drugs, antidiabetic agents and gastrointestinal drugs reduced the probability of VTE. CONCLUSIONS: Numerous preoperative factors have influence on the risk of VTE after TURBT. These findings might facilitate the clinical decision about the implementation of thromboprophylaxis in the appropriate patients.