Pineda-Murillo J, Hernández-León O, Cuellar Del Río JS
… +6 more, Arellano-Cuadros JR, Martínez-Carrillo G, Quintero-Cortés GA, De la Paz-Martínez SP, Avalos-Ramón JC, Lugo-García JA
INTRODUCTION AND OBJECTIVES: Benign prostatic enlargement has a prevalence of approximately 60% in 60-year-old men. En bloc enucleation and its variants, which emerged in 2010, are methods to enucleate the three lobes of...INTRODUCTION AND OBJECTIVES: Benign prostatic enlargement has a prevalence of approximately 60% in 60-year-old men. En bloc enucleation and its variants, which emerged in 2010, are methods to enucleate the three lobes of the prostatic capsule completely, maintaining the capsular plane and the urethral sphincter while removing the prostate. The aim of the present study is to analyze the implementation of the surgical technique, considering the learning curve and the experience accumulated in a group of patients before and after its development. MATERIAL AND METHODS: Retrospective study from July 2022 to November 2024, in which 136 patients with lower urinary tract symptoms due to prostate growth with indication for surgical treatment were included. Bleeding, surgical time, hospital stay, enucleated prostate volume, as well as enucleation, morcellation, time and laser energy efficiencies were analyzed. RESULTS: The efficacy of the procedure was higher in the post-curve group with a p < 0.0001 compared to the pre-curve group with a coefficient of determination R = 0.8091. Enucleation efficiencies, laser time and energy showed a statistically significant difference (p < 0.05) in favor of the post-curve group. CONCLUSIONS: Holmium laser enucleation of the prostate has proven to be an effective and safe surgical treatment, even during the learning curve. The turning point of the procedure depends on proper mentoring and the appropriate selection of cases during the training process.
OBJECTIVE: To investigate the diagnostic value of serum metabolic markers such as HCY, sdLDL-C, Crea, inflammatory factor IL-6 and prostate-specific antigen in elderly patients with prostatic hyperplasia (BPH). METHODS:...OBJECTIVE: To investigate the diagnostic value of serum metabolic markers such as HCY, sdLDL-C, Crea, inflammatory factor IL-6 and prostate-specific antigen in elderly patients with prostatic hyperplasia (BPH). METHODS: 150 senile patients with hyperplasia of prostate were selected as observation group and 169 healthy senile patients were selected as control group. The tPSA, fPSA, fPSA/t PSA and prostate size data of the two groups were collected, and serum samples of the subjects were collected for the detection of HCY, sdLDL, Crea, IL-6 and other indicators. Univariate analysis, correlation analysis and Logistic regression analysis were conducted to analyze the relationship between each index and senility prostatic hyperplasia. The diagnostic efficiency of each serum metabolite was analyzed by receiver operating characteristic curve (ROC). RESULTS: Serum levels of tPSA, fPSA, Crea, HCY, sdLDL-C and IL-6 were significantly increased, fPSA/tPSA ratio and HDL were significantly decreased, and TCHO, TG and LDL had no statistical significance. Serum tPSA and fPSA levels were positively correlated with prostate size, serum IL-6, Crea and HCY levels were positively correlated with tPSA and fPSA levels, and serum sdLDL-C levels were negatively correlated with fPSA levels. Logistic regression analysis showed that tPSA, fPSA, prostate size, HCY, Crea and IL-6 were risk factors for prostate hyperplasia. HDL and fPSA/tPSA are protective factors for benign prostatic hyperplasia. ROC curve analysis showed that the sensitivity and specificity of fPSA/tPSA and IL-6 were 82.7% and 72%, 83.4% and 80.5%, and the area under ROC curve were 0.840 and 0.825, respectively. tPSA and fPSA combined with HCY, IL-6 and Crea had the best diagnostic efficiency, with the area under ROC curve reaching 0.881, specificity and sensitivity reaching 84% and 77.3%, respectively. CONCLUSION: The combined detection of prostate-specific antigen, HCY, Crea and IL-6 can significantly improve the diagnostic efficiency of senile prostatic hyperplasia, and optimize the diagnosis and treatment scheme can even be used as a major screening index to evaluate and predict the incidence of BPH in senile prostatic hyperplasia.
Cimadamore A, Moschini M, Teoh J
… +16 more, Albisinni S, Adwin Z, Shen Ta W, Mori K, Wroclawski M, Soria F, Aziz A, Laukhtina E, Monsalve DC, Krajewski W, Karavitakis M, Abufaraj M, Uleri A, Gallioli A, Pradere B, en representación del Grupo de Trabajo de Carcinoma Urotelial de la Sección de Jóvenes Urólogos Académicos - Asociación Europea de Urología (EAU-YAU)
INTRODUCTION: Collaboration between pathologists and urologists is crucial for accurate diagnostic reporting and patient management, particularly in urology. This study aims to evaluate international practices regarding...INTRODUCTION: Collaboration between pathologists and urologists is crucial for accurate diagnostic reporting and patient management, particularly in urology. This study aims to evaluate international practices regarding pathology reporting of bladder specimens to identify areas for improvement. MATERIALS AND METHODS: A web-based survey with 32 questions was developed in collaboration with the EAU Young Academic Urologists Urothelial Cancer Working Party. It was sent to urologists with more than five years of experience across different institutions globally. Descriptive statistics were used to evaluate the responses. RESULTS: A total of 157 responses were received from urologists, representing a response rate of 65%. Most respondents (64.3%) found pathological reports comprehensive, although 36% reported unclear reports in some cases. Pathologists were contacted for clarification in less than 20% of cases. Notably, the reporting of pathological subtypes and depth of invasion was inconsistent among institutions. CONCLUSION: The survey highlights variability in pathology report quality across centers. Standardized reporting, increased pathologist involvement in multidisciplinary teams, and adherence to international guidelines are necessary to improve the accuracy and clarity of pathology reports in urology.
Mancon S, Matsukawa A, Cadenar A
… +20 more, Tsuboi I, Miszczyk M, Parizi MK, Fazekas T, Schulz RJ, Cormio A, Laukhtina E, Gallioli A, Diana P, Contieri R, Soria F, Pradere B, Lughezzani G, Kimura T, Territo A, Breda A, Buffi NM, Hurle R, Shariat SF, D'Andrea D
INTRODUCTION: Opium is used recreationally and for pain relief in certain regions and has been classified as a human carcinogen by the IARC. While its use is rare in Europe and Oceania, it remains a major public health i...INTRODUCTION: Opium is used recreationally and for pain relief in certain regions and has been classified as a human carcinogen by the IARC. While its use is rare in Europe and Oceania, it remains a major public health issue in other parts of the world. This study evaluates the risk of bladder cancer (BCa) among opium users compared to non-users. METHODS: A comprehensive search of MEDLINE, Scopus, and Web of Science was conducted up to July 2024 to identify studies examining the link between opium use and BCa. A meta-analysis was performed to calculate the pooled risk ratio (RR) with 95% confidence intervals (CIs) (PROSPERO: CRD42024562623). RESULTS: A total of 15 studies (n=60,149) were included. The analysis showed that opium users had a significantly higher risk of developing BCa than non-users (RR: 2.36; 95% CI: 1.92-2.90; P<.001). The risk increased with the amount of opium consumed, regardless of type or method of use. CONCLUSIONS: Opium consumption increase the risk of developing BCa by more than twofold among users. Awareness of its carcinogenic potential and public health implications is crucial. Our findings underscore the need for global prevention strategies and further research into opium-related BCa risks.
Hassi Roman M, Mate K, de Pablos-RodrIguez P
… +22 more, Zamora Horcajada Á, Guijarro Cascales A, Sanchís Bonet Á, Vilaseca A, Vázquez-Martul Pazos D, Linares Espinós E, Muñoz Rodríguez J, de la Morena Gallego JM, Alemán JR, Gómez Rivas J, Formisano L, Juan Fita MJ, Costa Planells M, Domínguez Esteban M, Pérez Márquez M, García Sanz M, García Expósito N, Picola N, Servian Vives P, Sopeña Sutil R, Climent Durán MA, Ramírez Backhaus M
INTRODUCTION: Apalutamide has shown significantly increases in radiographic progression-free survival (rPFS) and overall survival (OS) in metastatic hormone-sensitive prostate cancer (mHSPC) patients diagnosed by convent...INTRODUCTION: Apalutamide has shown significantly increases in radiographic progression-free survival (rPFS) and overall survival (OS) in metastatic hormone-sensitive prostate cancer (mHSPC) patients diagnosed by conventional imaging (CI). However, there is scarce knowledge on the use of apalutamide in mHSPC population diagnosed by NGI. METHODS: Retrospective multicenter study of mHSPC patients treated with apalutamide from May 2018 to September 2023 registered in the Real-World Evidence APA (RWE-APA). CI and NGI group were defined, according to the diagnostic tool of metastatic disease. Primary objective was rPFS at 24 mo in CI vs NGI group. Secondary objectives were OS in CI vs NGI group and rPFS in synchronic/metachronic, low volume (LV)/high volume (HV) in CI and NGI groups and risk of developing new metastasis according to the imaging technique, metastasis volume and location of the metastasis. RESULTS: 772 mHSPC patients were included. 47% (359) of patients were diagnosed with CI and 53% (413) of patients with NGI. rPFS at 24 mo was 80% in the CI group vs 84% in the NGI group (Hazard ratio (HR): 0.57 (0.35-0.92) 95% Confidence Interval [CI], p = 0.023). OS at 24 mo was 89.5% in the CI group and 95.8% in the NGI group (HR 0.35; 95% CI, 0.16-0.75, p = 0.007). In the multivariable analysis, only HV was significantly associated with metastatic progression (HR 0.33 (0.18-0.59) 95% CI; p < 0.001). CONCLUSION: mHSPC patients treated with apalutamide and NGI-diagnosed exhibited superior rPFS and OS in comparison with CI-diagnosed patients.
INTRODUCTION AND OBJECTIVES: Uroflowmetry and postvoid residual urine volume measurement remain essential in evaluating patients with lower urinary tract dysfunction. The objective was to identify patients with a high ri...INTRODUCTION AND OBJECTIVES: Uroflowmetry and postvoid residual urine volume measurement remain essential in evaluating patients with lower urinary tract dysfunction. The objective was to identify patients with a high risk of infection or renal damage based on the lower urinary tract parameters. MATERIALS AND METHODS: Over a one-year period we investigated patients who had an indication for uroflowmetry and postvoid residual urine volume measurement between 5-18 years of age. All parameters were prospectively recorded. After the initial evaluation, patients were divided into increased/normal postvoid residual urine volume groups. Lower urinary tract parameters, urinary tract infection and hydronephrosis status were analyzed. RESULTS: A total of 176 girls and 140 boys with an age of 9 (5-16) were assessed. When increased (n = 135)/normal postvoid residual urine volume (n = 181) groups of patients were analyzed, patients with a diagnosis of dysfunctional voiding, staccato and interrupted-shaped flow pattern, decreased Qavg, increased micrution duration, decreased daytime voiding frequency, and constipation were found to be prone to increased postvoid residual urine volume. A diagnosis of overactive bladder or dysfunctional voiding and high postvoid residual urine volume were both found to be related to infections. CONCLUSIONS: We contributed to the literature by evaluating different types of lower urinary tract conditions and their clinical parameters to better understand the predisposing factors to detect patients at risk of infections or renal damage such as dysfunctional voiding, staccato and interrupted-shaped flow pattern, constipation, decreased Qavg, prolonged duration of micturition and decreased daytime voiding frequency regardless of age and gender status.
Artero Fullana S, Caño Velasco J, Lafuente Puentedura A
… +29 more, Polanco Pujol L, Bataller Monfort V, Moralejo Gárate M, Subiela JD, Gallioli A, Moschini M, Pichler R, Del Giudice F, Marcq G, Teoh J, Soria F, Mertens L, Krajewski W, Laukhtina E, Mori K, Pradere B, Afferi L, Tully KH, Albisinni S, Abu Ghanem Y, d'Andrea D, Mari A, Albers Acosta E, Contieri R, Cimadamore A, Grobet-Jeandin E, Gómez Rivas J, Hernández Fernández C, en representación del Grupo de Trabajo de Carcinoma Urotelial de la Sección de Jóvenes Urólogos Académicos - Asociación Europea de Urología (EAU-YAU)
INTRODUCTION AND OBJECTIVE: Current upper tract urothelial carcinoma (UTUC) diagnosis and disease management rely on the combination of CT Urography (CTU), cytology and ureteroscopy (URS). The limited accuracy and compli...INTRODUCTION AND OBJECTIVE: Current upper tract urothelial carcinoma (UTUC) diagnosis and disease management rely on the combination of CT Urography (CTU), cytology and ureteroscopy (URS). The limited accuracy and complications associated with these tools have led to the search for non-invasive and reliable biomarkers. Our aim was to review and analyse the existing data on the use of Bladder EpiCheck® to assess its performance as a diagnostic tool for UTUC. MATERIAL AND METHODS: A literature search on the diagnostic value of Bladder EpiCheck® as a urinary biomarker in UTUC was conducted through PubMed, Web of Science and Scopus until February 2024. Pooled sensitivity (Se), specificity (Sp), negative predictive value (NPV) and positive predictive value (PPV) of the biomarker were calculated. Diagnostic performance was assessed through the area under the curve (AUC). RESULTS: Four studies, including 334 patients, were included in the quantitative analysis. Bladder EpiCheck® showed promising pooled diagnostic values with Se of 0.85 (95% CI 0.55-0.96), Sp of 0.93 (95% CI 0.56-0.99), PPV of 0.74 (95% CI 0.54-0.87) and NPV of 0.84 (95% CI 0.77-0.89). The exact AUC obtained was 0.912. CONCLUSIONS: Bladder EpiCheck® is an effective diagnostic tool in UTUC, showing a promising diagnostic accuracy, with a Se and NPV of 85% and 84%, respectively. Its use in UTUC diagnosis and follow-up could reduce or postpone the need for more invasive procedures, such as URS, thereby reducing the procedure-associated risks and improving patients' quality of life. Although further research and large prospective studies are needed, the current results indicate that Bladder EpiCheck® is a promising tool in UTUC diagnosis, treatment decision-making, and follow-up.
INTRODUCTION: Testicular cancer accounts for 5% of urological tumors, with an incidence of 5.6 cases per 100,000 men per year in Europe (1). Salvage retroperitoneal lymphadenectomy is the standard surgery for persistent...INTRODUCTION: Testicular cancer accounts for 5% of urological tumors, with an incidence of 5.6 cases per 100,000 men per year in Europe (1). Salvage retroperitoneal lymphadenectomy is the standard surgery for persistent retroperitoneal masses after chemotherapy. The advent of minimally invasive surgery is changing the therapeutic approach. The objective is to present our initial experience with the transmesocolic robotic approach for the surgical management of these masses. METHODS: We report the perioperative and oncological outcomes of four patients affected by non-seminomatous germ cell tumors who were treated with transmesocolic robotic left para-aortic retroperitoneal lymphadenectomy. RESULTS: The surgical time for the first case was 220 min, and the average surgical time for the remaining cases was 120 min (SD: 15). Estimated blood loss was 82.5 mL (SD: 79.3). No intraoperative or postoperative complications were observed. Pathological anatomy revealed post-pubertal teratoma (30%) and necrosis (70%) in case 1, necrosis with reactive adenitis in case 2, extensive fibrosis in case 3 and post-pubertal teratoma in case 4. Currently, all patients are disease-free. CONCLUSIONS: Robotic retroperitoneal lymphadenectomy is a safe and precise technique that offers favorable oncological and functional outcomes. The transmesocolic approach represents a feasible option in selected cases, ensuring rapid retroperitoneal access and reduced surgical time.
Pichler R, van Creij NCH, Subiela JD
… +16 more, Cimadamore A, Caño-Velasco J, Tully KH, Mori K, Contieri R, Afferi L, Mari A, Soria F, Del Giudice F, D'Elia C, Mayr R, Mertens LS, Pyrgidis N, Moschini M, Gallioli A, Asociación Europea de Urología-Jóvenes Urólogos Académicos (EAU-YAU): Grupo de Trabajo de Carcinoma Urotelial
FGFR3 mutations are among the most frequent genomic alterations in urothelial cancer (UC) being mainly associated with the luminal papillary (LumP) subtype. With the establishment of fibroblast growth factor receptor (FG...FGFR3 mutations are among the most frequent genomic alterations in urothelial cancer (UC) being mainly associated with the luminal papillary (LumP) subtype. With the establishment of fibroblast growth factor receptor (FGFR) inhibitors, the treatment of UC is now shifting more and more towards personalized medicine. A systematic review using Medline and scientific meeting records was carried out according to the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines to assess the potential role of FGFR inhibitors in combination with additional therapies for the management of UC. Ongoing trials were identified via a systematic search on ClinicalTrials.gov. A total of eleven full-text papers, ten congress abstracts, and 5 trials on ClinicalTrials.gov were identified. Following the BLC2001 and THOR study, erdafitinib is the only approved FGFR1-4 inhibitor for metastatic UC with susceptible FGFR2/3 alterations following platinum-based chemotherapy. According to the THOR data of cohort 2, erdafitinib should not be recommended in patients who are eligible for and have not received prior immune checkpoint inhibitors (ICIs). One phase 3 trial is currently evaluating the intravesical device system (TAR210) in FGFR-altered intermediate non-muscle invasive bladder cancer (MoonRISe-1). Preclinical evidence suggests that combination-based approaches could be considered to improve the efficacy of FGFR inhibitors in patients with UC. Nine phase 1b/2 trials are focusing on the combination of FGFR inhibitors with ICIs, chemotherapy, or enfortumab vedotin. In metastatic disease, some preliminary analyses have reported promising results from these combinations (e.g. NORSE and FORT-2 trial). However, no phase 3 trial is terminated, so there is currently no level 1 evidence with long-term outcomes to support the combination of FGFR inhibitors with ICIs, chemotherapy, or targeted therapies. A better understanding of the different mechanisms of action to inhibit FGFR signaling pathways, optimal patient selection and treatment approaches is still needed.
INTRODUCTION: Improving the quality of care is a fundamental issue in medicine. The analysis of routine practice and its adequacy to the available evidence can detect areas for improvement. We have decided to apply these...INTRODUCTION: Improving the quality of care is a fundamental issue in medicine. The analysis of routine practice and its adequacy to the available evidence can detect areas for improvement. We have decided to apply these principles to the surgical treatment of phimosis in pediatric age. The aim of this study is to analyze the situation of phimosis surgery for children up to 18 years of age in our environment and its compliance with current recommendations. MATERIAL AND METHODS: Retrospective descriptive observational study including surgeries performed for phimosis in children and adolescents up to 18 years of age in 2022 and 2023. Data were compared with the recommendations of the European and British Pediatric Urology Associations. RESULTS: A total of 222 medical records were included. All surgeries were performed on an outpatient basis and with loco-regional anesthesia. The percentage of pathological phimosis was 11%. Among physiological phimosis, 47% were asymptomatic (70% between 3 and 7 years of age). DISCUSSION: According to current European recommendations, phimosis surgery is reserved for cases of symptomatic pathological or physiological phimosis or with increased risk of urinary tract infection. In pediatric patients in our environment, all aspects of phimosis surgery are performed according to current recommendations, but the percentage of asymptomatic phimosis operated on in young children is high. Based on the possibility of spontaneous resolution, the indication and optimal age of intervention in this group of patients should be reviewed.
OBJECTIVE: To analyze our series of radical nephrectomies and laparoscopic nephroureterectomies in elderly patients. MATERIALS AND METHODS: A retrospective review of patients aged 85 years and older who underwent major l...OBJECTIVE: To analyze our series of radical nephrectomies and laparoscopic nephroureterectomies in elderly patients. MATERIALS AND METHODS: A retrospective review of patients aged 85 years and older who underwent major laparoscopic surgery for renal tumors at our center between April 2005 and March 2022 was conducted. Clinical-pathological characteristics, complications, and postoperative outcomes were analyzed. RESULTS: Forty-seven patients were included, with a median age of 87 years. Fifteen nephrectomies for renal tumors (Group 1), and 32 nephroureterectomies for urinary tract tumors, (Group 2) were performed. In Group 1, four postoperative complications were observed: two Clavien 1, one Clavien 2, and one Clavien 4a. The most common histology was clear cell carcinoma. Nine patients had locally advanced tumors (TNM ≥ T3) at diagnosis. Five-year cancer-specific survival and overall survival rates were 73% and 40%, respectively. In Group 2, 14 postoperative complications occurred: six (18.8%) Clavien 1, four (12.5%) Clavien 2, and five (15.6%) Clavien 5. All patients had urothelial carcinoma in their pathology reports. Twenty (62.5%) had invasive tumors (TNM ≥ T2) at diagnosis. Five-year cancer-specific survival and overall survival rates were 45% and 30%, respectively. CONCLUSION: Laparoscopic renal oncologic surgery in elderly patients is feasible, although it is associated with a high morbimortality rate, particularly in those with urinary tract tumors. It is essential to provide this patient group with adequate information regarding the elevated surgical risks associated with the procedure.
INTRODUCTION: Kidney transplant (KT) recipients are at an elevated risk of developing de novo cancers. However, penile (PeCa) and testis cancers have received limited attention in this setting. OBJECTIVE: To summarize th...INTRODUCTION: Kidney transplant (KT) recipients are at an elevated risk of developing de novo cancers. However, penile (PeCa) and testis cancers have received limited attention in this setting. OBJECTIVE: To summarize the epidemiology, treatment options, and oncological outcomes of penile and testis cancer in KT recipients. EVIDENCE ACQUISITION: We conducted a systematic review of prospective, retrospective and national transplant registries studies published up to December 2023. Data on the incidence of penile and testis cancers among KT recipients, diagnostic protocols, screening recommendations, and therapeutic strategies tailored for KT recipients were collected. The risk of bias (RoB) of included studies was determined using the Newcastle and Ottawa scale. EVIDENCE SYNTHESIS: Overall, 21 studies involving 67924 KT male recipients were included. PeCa was diagnosed in 33 patients, yielding an incidence ranging from 0.04% to 0.3%. Additionally, 67 cases of testicular cancer were recorded, with an incidence ranging from 0.03% to 0.55%. Most tumors were localized, and histology variants were uncommon. While the surgical treatment of the primary tumor remains consistent with that of the general population, the use of radiotherapy and cytotoxic treatments are less frequently reported in this setting. These therapies should be considered on an individualized basis to minimize the risk of graft injury. CONCLUSIONS: Penile and testis cancers are relatively uncommon among KT recipients. General screening protocols and deviation from current treatment guidelines are not recommended in localized diseases. Given the risk of graft damage, any non-cytotoxic option should be preferred in locally advanced cases.
Calzas Montalvo C, Alonso Isa M, Lo Re M
… +8 more, Caro González MP, Juste Álvarez S, de la Calle Moreno A, García-Rayo Encina C, González Ginel I, Romero Otero J, Rodríguez Antolín A, García Gómez B
INTRODUCTION & OBJECTIVES: There is limited evidence regarding sexual satisfaction among female partners of patients with penile prosthesis (PP) and factors influencing it. MATERIALS & METHODS: Single-center, retrospecti...INTRODUCTION & OBJECTIVES: There is limited evidence regarding sexual satisfaction among female partners of patients with penile prosthesis (PP) and factors influencing it. MATERIALS & METHODS: Single-center, retrospective, observational study including all patients aged ≥18 years who underwent PP implantation (inflatable and malleable types) between October 2007-December 2022 at Hospital 12 de Octubre, Madrid, Spain. 73 female partners completed the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire (5-item partner version). Each question was scored from 0 (lowest satisfaction) to 4 (highest satisfaction), resulting in an overall EDITS score ranging from 0 to 100. Variables collected: time since surgery, monthly intercourse frequency, type and brand of PP, initial placement rationale, new versus replacement surgery, total and inflatable PP part length. RESULTS: Average (standard deviation) scores were: 3.3 (0.9), 3.19 (0.9), 2.42 (0.8), 3.45 (0.9), and 3.67 (0.8). The overall average satisfaction score was 80 (12.4). Statistical analysis revealed no significant correlations between female partners' satisfaction and their age (r = -0.128), actual age of the patient (r = -0.041), time since surgery (r = -0.072), monthly intercourse frequency (r = 0.164), type of PP (p = 0.521), brand of inflatable PP (p = 0.582), causes of erectile dysfunction (p = 0.174), number of replacements (p = 0.705), total (r = 0.167) or inflatable PP part length (r = 0.134). CONCLUSIONS: Sexual satisfaction among female partners in our cohort is high but we did not demonstrate any predictors of couple satisfaction.
Grosso AA, Cadenar A, Pillozzi S
… +21 more, Carli G, Lipparini F, Di Maida F, Pichler R, Krajewski W, Albisinni S, Laukhtina E, Mancon S, Del Giudice F, Mir MC, Soria F, Moschini M, Shariat SF, Roupret M, Yuen-Chun Teoh J, Antonuzzo L, Breda A, Minervini A, Gallioli A, Mari A, en representación del Grupo de Trabajo de Carcinoma Urotelial de la Sección de Jóvenes Urólogos Académicos - Asociación Europea de Urología (EAU-YAU)
OBJECTIVES: To evaluate the role of circulating tumor DNA (ctDNA) as a prognostic and predictive biomarker in the perioperative management of muscle-invasive bladder cancer (MIBC). METHODS: We conducted a systematic lite...OBJECTIVES: To evaluate the role of circulating tumor DNA (ctDNA) as a prognostic and predictive biomarker in the perioperative management of muscle-invasive bladder cancer (MIBC). METHODS: We conducted a systematic literature review using PubMed, MEDLINE, and Embase, following PRISMA guidelines. Studies from January 2013 to March 2024 were included if they examined ctDNA in MIBC patients undergoing radical cystectomy (RC) and perioperative chemotherapy or immunotherapy. RESULTS: Eight studies were included. ctDNA detected before RC was associated with poor recurrence-free survival and higher risk of nodal and locally advanced disease. Postoperative ctDNA levels correlated with shorter disease-free survival and higher recurrence rates. ctDNA clearance during neoadjuvant chemotherapy was predictive of treatment response. ctDNA status post-neoadjuvant immunotherapy correlated with pathological outcomes and recurrence rates. CONCLUSIONS: ctDNA is a promising biomarker for predicting oncological outcomes in MIBC, with potential to guide perioperative treatment decisions. Further randomized controlled trials are needed to validate these findings.
OBJECTIVE: To evaluate the effect of suturing the bladderneck in benign prostatic hyperplasia surgery on bleeding parameter sand surgical outcomes. METHODS: The age, comorbidities, preoperative findings, surgical treatme...OBJECTIVE: To evaluate the effect of suturing the bladderneck in benign prostatic hyperplasia surgery on bleeding parameter sand surgical outcomes. METHODS: The age, comorbidities, preoperative findings, surgical treatment techniques, peroperative and postoperative bleedingrates, blood transfusion rates, complication rates, surgery note sand postoperative patient follow-ups of the patients operated on for benign prostatic hyperplasia were taken from the patient files. Patients who were sutured to the bladder neck and those who were not were divided into two group sand compared in terms of bleeding and surgical results. RESULTS: A total of 170 patients were included in the study, 106 patients whounder went bladder neck suturing and 64 patients who did not undergo bladder neck suturing. While the mean operation time in hemostatic suture applied group 84.2 ± 7.8 min, this time was 61.4 ± 6.3 min hemostatic suture not applied group (p < 0.001). The mean decrease in hemoglobin levels at the 2nd postoperative hour in the suturing group was observed to be greater than in the non-suturing group (2.1 g/dl, 2 g/dl, respectively). There was no statistical difference in postoperative blood transfusion rates (15.1%, 15.6%, respectively, p = 0.137). Postoperative complications and follow-updata were similar for bothgroup. Bladder neck contracture was higher rate (7.5% vs. 3.1%) in hemostatic suture applied group but ıt was not statistically significant. CONCLUSION: Application of hemostatic suture prolongs the operation time of open prostatectomy without affecting bleeding parameter sand postoperative results. For this reason, open prostatectomy surgery is a surgical method that can be performed safely without applying sutures.
INTRODUCTION: Aimed to investigate the feasibility and availability of fluoroless retrograde intrarenal surgery (fRIRS) in a large patient population. METHODS: Patients who underwent fRIRS for ureteral or renal calculi i...INTRODUCTION: Aimed to investigate the feasibility and availability of fluoroless retrograde intrarenal surgery (fRIRS) in a large patient population. METHODS: Patients who underwent fRIRS for ureteral or renal calculi in our center between June 2019 and June 2024 were reviewed. Demographic data, stone characteristics, operation time, perioperative-postoperative complications, perioperative complications, and stone-free rates of patients who underwent fRIRS for ureteral or renal calculi were evaluated. Claven-Dindo classification was used for complications. All procedures were performed under spinal or general anesthesia. RESULTS: 1079 patients were included in the study. Of the 1079 patients, 352 (32.6%) were female and 727 (67.4%) were male. The mean age was 47.33 ± 14.31 years. The mean size of the stones was 13.1 ± 6.33 mm. Of the patients, 208 (19.27%) received general anesthesia and 871 (80.73%) received spinal anesthesia. The mean operation time was 37.14 ± 17.65 min. All patients received a Double J (DJ) stent postoperatively. The rate of complications was 8% overall. The complications observed in general were minor; postoperative colic pain and hematuria were observed in 36 (3.3%) patients and 26 (2.4%) patients, respectively. Stone-free rate was 86.4%. CONCLUSION: The fRIRS is a safe and feasible method for the treatment of uncomplicated ureteral and renal calculi. In uncomplicated patients, it has similar complication and success rates to conventional methods and eliminates radiation exposure.
OBJECTIVE: This study sought to identify risk factors and develop predictive models for kidney stone disease in the U.S. population using data from the National Health and Nutrition Examination Survey (NHANES). METHODS:...OBJECTIVE: This study sought to identify risk factors and develop predictive models for kidney stone disease in the U.S. population using data from the National Health and Nutrition Examination Survey (NHANES). METHODS: In a propensity score-matched cohort study, we examined the association of serum α-Klotho, hemoglobin levels, serum creatinine, and the urinary albumin-to-creatinine ratio (uACR) with kidney stone disease. RESULTS: Initially, 216,560 participants were screened; following propensity matching, 28,370 adults aged 40-79 years were included in the final analysis. Serum α-Klotho levels were inversely associated with kidney stone disease, particularly among individuals with chronic kidney disease and those who consumed alcohol. Hemoglobin levels demonstrated an inverse association with kidney stone disease risk, whereas serum creatinine levels exhibited a U-shaped relationship. No significant trend was observed for uACR overall. Low hemoglobin and α-Klotho levels, as well as elevated serum creatinine and uACR, were significantly associated with increased all-cause mortality. CONCLUSION: Our findings underscore the significance of serum α-Klotho, hemoglobin, serum creatinine, and uACR levels in assessing the risk of kidney stone disease and all-cause mortality, suggesting these markers as potential targets for prevention and management strategies. Further research is warranted to clarify the mechanisms underlying these associations.
OBJECTIVE: This study examines trends and disparities in kidney cancer (KC) mortality in Spain from 1983 to 2022, focusing on gender, birth cohort, and age influences. METHODS: Data from the Spanish National Institute of...OBJECTIVE: This study examines trends and disparities in kidney cancer (KC) mortality in Spain from 1983 to 2022, focusing on gender, birth cohort, and age influences. METHODS: Data from the Spanish National Institute of Statistics were analyzed using age-standardized mortality rates (ASMRs). Joinpoint regression identified temporal trends and annual percentage changes, while Age-Period-Cohort (A-P-C) analysis assessed the impacts of age, calendar period, and birth cohort on mortality. RESULTS: KC mortality increased significantly for both sexes, with men experiencing a steeper rise (1.2% annually) compared to women (0.6% annually). Joinpoint analysis revealed distinct phases: a sharp increase until the mid-1990s, followed by stabilization for men and a slight decline for women. Men aged over 50, particularly those above 80, showed pronounced increases. A-P-C analysis confirmed age as a significant risk factor, with consistently higher mortality rates observed among men across all age groups. Men born from the early 20th century until the 1960s faced increasing mortality risks, while women's risk, after an increase in the early 20th century, stabilized after the 1933 birth cohort. For those born after 1960, both sexes show a potential decline in KC mortality, with a slight upturn in men from the 1980s onwards. The period effect exhibited an increase during the 1980s-1990s, followed by stabilization for men and a continuous decrease for women. CONCLUSION: This study reveals significant disparities in KC mortality trends in Spain across genders, birth cohorts, and age groups. Despite advancements in diagnosis and treatment, substantial public health challenges remain.
Albers Acosta E, Pelari-Mici L, Celada Luis G
… +25 more, Velasco Balanza C, Zapatero A, Romero-Laorden N, Toquero Diez P, Caño-Velasco J, Guerrero-Ramos F, Moschini M, Krajewski W, Del Giudice F, Soria F, Laukhtina E, Mertens L, Pichler R, Mori K, D'Andrea D, Mari A, Marcq G, Teoh J, Afferi L, Albisinni S, Pradere B, Gallioli A, Subiela JD, San José Manso L, en representación del Grupo de Trabajo de Carcinoma Urotelial de la Sección de Jóvenes Urólogos Académicos - Asociación Europea de Urología (EAU-YAU)
INTRODUCTION AND OBJECTIVES: Urothelial carcinoma is a challenging disease that requires a comprehensive approach. Multidisciplinary tumor committees are essential to bring specialists together, optimize treatment, ensur...INTRODUCTION AND OBJECTIVES: Urothelial carcinoma is a challenging disease that requires a comprehensive approach. Multidisciplinary tumor committees are essential to bring specialists together, optimize treatment, ensure individualized care, and promote evidence-based decision making. This study aims to collect evidence and explore the impact of multidisciplinary tumor committees in the management of urothelial carcinoma. MATERIALS AND METHODS: A systematic review was performed following PRISMA guidelines. We searched PubMed/Medline, Embase, Scopus and Cochrane databases for relevant studies on the role of multidisciplinary committees in the management of urothelial carcinoma, including bladder cancer, upper tract urothelial carcinoma and urethral carcinoma. Given the limited and heterogeneous evidence, a systematic review with narrative synthesis was performed. RESULTS: Multidisciplinary tumor committees had a significant impact on the diagnosis and treatment of urothelial neoplasms, especially bladder cancer. Consistent findings showed that these committees produced substantial changes in treatment, improved adherence to clinical guidelines, and demonstrated a potential to improve patient outcomes. In addition, multidisciplinary committees increased the likelihood of curative treatments and were associated with reduced mortality rates, enhanced clinical decision making, and improved patient care, particularly in bladder and upper tract urothelial carcinoma. CONCLUSIONS: This review highlights the essential role of multidisciplinary tumor committees in improving the management of urothelial carcinoma of the bladder and upper urinary tract. However, further research using standardized approaches is needed. The absence of studies on urethral carcinoma underlines the urgent need to investigate the potential benefits of multidisciplinary tumor committees. Future studies should cover a wider range of tumor types and follow standardized methodologies to provide a more complete and generalizable picture.