Archivos Espanoles De Urologia最新文献

{"title":"Diagnostic Value of Conventional Ultrasound Combined With Contrast-Enhanced Ultrasound for Differentiating Small Clear Cell and Non-Clear Cell Renal Cell Carcinomas.","authors":"Jiaofeng Zhao, Yongsheng Xia","doi":"10.56434/j.arch.esp.urol.aeu028","DOIUrl":"https://doi.org/10.56434/j.arch.esp.urol.aeu028","url":null,"abstract":"<p><strong>Background: </strong>Renal cell carcinoma (RCC) is the most common malignant tumor of the kidney and accounts for the majority of renal malignancies. The detection of small RCCs has increased in recent years, largely owing to advances in imaging techniques. To date, few studies have investigated the diagnostic value of contrast-enhanced ultrasound (CEUS) in differentiating clear cell renal cell carcinomas (ccRCCs) from non-clear cell renal cell carcinomas (non-ccRCCs) when smaller than 4cm. In this study, we aimed to retrospectively explore the value of conventional ultrasound combined with CEUS in differentiating the two main RCC subtypes.</p><p><strong>Methods: </strong>Altogether, 84 RCC cases were included, comprising 62 ccRCCs and 22 non-ccRCCs. All patients underwent conventional ultrasound and CEUS before surgery. To determine the independent predictors of small ccRCC, we conducted univariate and multivariate logistic regression analyses on the clinical data and ultrasound imaging features of the patients. Receiver operating characteristic (ROC) curve analysis was performed to assess diagnostic performance.</p><p><strong>Results: </strong>Multivariate logistic regression identified cystic change (odds ratio (OR) = 5.959; <i>p</i> = 0.017), parenchymal phase isoenhancement (reference: hypo-enhancement; OR = 6.411; <i>p</i> = 0.007), and hyperenhancement (reference: hypo-enhancement; OR = 15.770; <i>p</i> < 0.001) as independent predictors for distinguishing between small ccRCC and non-ccRCC. Routine ultrasound combined with CEUS demonstrated good evaluation efficacy, with an area under the curve (AUC) of 0.823 (95% confidence interval: 0.733-0.914).</p><p><strong>Conclusions: </strong>This study provides preliminary evidence supporting the use of conventional ultrasound with CEUS for differentiating ccRCCs from non-ccRCCs <4 cm. These findings require confirmation by independent large-scale studies.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 8","pages":"1373-1380"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Relinqing Granules plus Levofloxacin With Postoperative Outcomes After Percutaneous Nephrolithotomy for Infected Kidney Stones: A Retrospective Cohort Study.","authors":"Zhiwei Li, Qiqi Zhu, Junjie Li, Zhiyang Xiao, Dong Li, Yufeng Xu","doi":"10.56434/j.arch.esp.urol.aeu033","DOIUrl":"https://doi.org/10.56434/j.arch.esp.urol.aeu033","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between Relinqing Granules combined with levofloxacin and early postoperative outcomes in patients with infected kidney stones undergoing percutaneous nephrolithotomy (PCNL).</p><p><strong>Methods: </strong>This single-centre retrospective cohort study included 198 patients with infected kidney stones who underwent PCNL between October 2023 and October 2025. All patients received standardised preoperative antimicrobial therapy, and surgery was performed after initial clinical stabilisation. Patients were retrospectively classified into a control group (levofloxacin, n = 98) or a study group (levofloxacin plus Relinqing Granules, n = 100) according to postoperative medication records. Propensity score matching was performed to control confounding bias, with 92 cases in each group matched in a 1:1 ratio. The primary outcomes included bacterial clearance rate and inflammatory markers (blood white blood cell count (WBC), urinary leukocyte count, high-sensitivity C-reactive protein, procalcitonin, and interleukin-6) at 2 weeks after surgery. Secondary outcomes included postoperative renal function parameters at 2 weeks and the stone-free rate (SFR) at 3 months after surgery. The safety outcome was evaluated 2 weeks after surgery based on the incidence of adverse events.</p><p><strong>Results: </strong>Baseline characteristics were comparable between groups (all <i>p</i> > 0.05). At 2 weeks postoperatively, inflammatory markers decreased significantly from baseline in both groups and were lower in the study group than in the control group (all <i>p</i> < 0.05). The bacterial clearance rate was significantly higher in the study group than in the control group at the same time point (92.31% vs 78.79%, <i>p</i> = 0.028). The SFR at 3 months after surgery was also significantly higher in the study group (92.39% vs 82.61%, <i>p</i> = 0.045). The incidence of adverse events was similar between the two groups.</p><p><strong>Conclusions: </strong>The combination of Relinqing Granules and levofloxacin was associated with better early infection control and a higher 3-month SFR after PCNL. Further prospective studies are required to confirm these findings.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 8","pages":"1345-1354"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Postoperative Testicular Volume Ratio Is Associated With Long-Term Growth Failure After Unilateral Redo Orchiopexy in Children.","authors":"Yusuf Atakan Baltrak, Selcan Turker Çolak, Kamuran Tutus, Şeref Selçuk Kılıç, Önder Özden, Murat Alkan, Recep Tuncer","doi":"10.56434/j.arch.esp.urol.aeu039","DOIUrl":"https://doi.org/10.56434/j.arch.esp.urol.aeu039","url":null,"abstract":"<p><strong>Background: </strong>Redo orchiopexy is usually evaluated based on the position of the scrotum after surgery, but satisfactory scrotal placement may not necessarily reflect preserved long-term testicular growth. In this study, we evaluated whether the early postoperative testicular volume ratio (TVR) is associated with long-term growth failure after unilateral redo orchiopexy in children.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included children who underwent unilateral redo orchiopexy between January 2013 and January 2023. Early postoperative ultrasonography was performed 6-12 months after surgery, and subsequent follow-up ultrasonography was performed at ≥24 months. TVR was calculated as the operated testicular volume divided by the contralateral testicular volume × 100. Long-term growth failure was defined as long-term TVR <50% and/or the absence of an interval increase in operated testicular volume beyond expected ultrasonographic measurement variability. The discriminative ability of early TVR was assessed using receiver operating characteristic (ROC) analysis. The ROC-derived cutoff was considered exploratory because it was derived and evaluated in the same cohort.</p><p><strong>Results: </strong>Sixty-eight children met the inclusion criteria. The mean age at redo orchiopexy was 7.8 ± 2.9 years, and the median follow-up was 36 months. Long-term growth failure occurred in 20 patients (29.4%). Children with growth failure had significantly lower early TVR than those with preserved growth (48.6 ± 13.2% vs. 80.4 ± 16.8%, <i>p</i> < 0.001). Early TVR showed good apparent discrimination, with an area under the curve (AUC) of 0.84 (95% confidence interval [CI], 0.72-0.96). In the exploratory multivariable model, each 10-percentage-point increase in early TVR was associated with a lower odds of growth failure (odds ratio [OR] 0.56; 95% bootstrap CI 0.36-0.84). The apparent model AUC was 0.86, and the optimism-corrected AUC after 1000 bootstrap resamples was 0.81. The exploratory 55% cutoff yielded 82% sensitivity, 78% specificity, 69% positive predictive value, and 88% negative predictive value.</p><p><strong>Conclusions: </strong>Early postoperative TVR is associated with long-term testicular growth failure after unilateral redo orchiopexy. A TVR of approximately 55% may help identify children who require closer ultrasonographic surveillance, but this threshold is hypothesis-generating and requires external validation before clinical implementation. TVR should be interpreted as an imaging-based risk stratification marker rather than a direct measure of endocrine, fertility, or histologic testicular function.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 8","pages":"1311-1320"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Delayed Consultation Among Women With Urinary Incontinence in a Urology Outpatient Setting: A Cross-Sectional Study.","authors":"Salim Zengin, Ahmet Olgun, Caglar Boyaci, Abdulbaki Kalkan, Onur Kutluay, Abdullah Gul","doi":"10.56434/j.arch.esp.urol.aeu032","DOIUrl":"https://doi.org/10.56434/j.arch.esp.urol.aeu032","url":null,"abstract":"<p><strong>Background: </strong>To determine the duration of delay in healthcare-seeking among women with urinary incontinence (UI), compare the sociodemographic and clinical characteristics of early and delayed consulters, and investigate sociocultural determinants associated with delayed healthcare-seeking behavior.</p><p><strong>Methods: </strong>This cross-sectional study included 154 women presenting with UI to the Urology Outpatient Clinic of Bursa Yuksek Ihtisas Training and Research Hospital between March and June 2026. UI severity was assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), quality of life using the Incontinence Quality of Life Questionnaire (I-QOL), and sociocultural determinants using the Urinary Incontinence Help-Seeking Scale (UI-HSS), developed by the researchers. Participants were categorized into early consultation (≤1 year) and delayed consultation (>1 year) groups. Factors associated with delayed consultation were evaluated using logistic regression analysis.</p><p><strong>Results: </strong>Overall, 40.3% of participants delayed seeking medical care for more than one year after symptom onset. Women with delayed consultation had lower educational attainment, higher ICIQ-SF scores, and lower I-QOL total scores (all <i>p</i> < 0.001). Scores for illness perception, embarrassment and consultation barriers, normalization beliefs, lack of social support, and fatalism were also significantly higher among delayed consulters (all <i>p</i> < 0.05). Increasing consultation delay was associated with greater symptom severity and poorer quality of life. In multivariable analysis, higher educational level (odds ratio [OR] = 0.57, <i>p</i> = 0.001) and higher I-QOL total score (OR = 0.93, <i>p</i> = 0.005) were associated with lower odds of delayed consultation. Prior use of alternative treatments was also associated with lower odds of delayed consultation (OR = 0.43, <i>p</i> = 0.036).</p><p><strong>Conclusions: </strong>Delayed healthcare-seeking is common among women with UI and cannot be explained solely by symptom severity. Educational level, quality of life, and sociocultural factors were associated with healthcare-seeking behavior. Addressing these factors may facilitate earlier diagnosis and treatment.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 8","pages":"1333-1344"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Injury Mechanism and Diagnostic Pathway on Reconstructive Outcomes Following Iatrogenic Ureteral Injury.","authors":"Eser Ördek, Ahmet Beyazıt, Eren Günsay, Duran Kuru, Sadık Görür","doi":"10.56434/j.arch.esp.urol.aeu042","DOIUrl":"https://doi.org/10.56434/j.arch.esp.urol.aeu042","url":null,"abstract":"<p><strong>Background: </strong>Iatrogenic ureteral injury (IUI) is a rare but serious complication of abdominal and pelvic surgery, often leading to substantial morbidity and additional surgical interventions. This study aimed to evaluate the association of the diagnostic pathway (intraoperative diagnosis with immediate repair versus postoperative diagnosis with delayed repair) with perioperative and functional outcomes.</p><p><strong>Methods: </strong>In this study, 92 patients who underwent reconstructive surgery for IUI between 2015 and 2025 were retrospectively analyzed. The patients were stratified into early and delayed repair groups, and injuries were classified as thermal full-thickness injury, thermal ischemic injury, or non-thermal full-thickness injury. Perioperative, postoperative, and functional outcomes were compared.</p><p><strong>Results: </strong>Of the 92 patients, 62 (67.4%) underwent early repair and 30 (32.6%) delayed repair. Delayed repair was associated with a longer hospital stay [9 (7-12.5) vs. 7 (5-7) days; <i>p</i> = 0.004], higher rates of percutaneous nephrostomy (83.3% vs. 0%; <i>p</i> < 0.001), and reoperation (16.7% vs. 0%; <i>p</i> = 0.003). Overall complication, nephrectomy, hydronephrosis, and long-term renal functional loss rates were comparable between groups. Thermal ischemic injury was associated with significantly higher postoperative complication rates than thermal full-thickness and non-thermal full-thickness injuries (53.3% vs. 25.0% vs. 23.1%, respectively; <i>p</i> = 0.021).</p><p><strong>Conclusions: </strong>A delayed diagnostic pathway, resulting in delayed reconstruction, was associated with prolonged hospitalization, greater need for urinary diversion, and higher reoperation rates. Thermal ischemic strictures represented a distinct subgroup with an increased risk of postoperative complications. These findings highlight the importance of early recognition and appropriate reconstructive management in patients with IUI.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 8","pages":"1291-1301"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic Syndrome and Bladder Cancer Risk: A Meta-Analysis of Cohort Studies.","authors":"Haoyang Teng, Jie Chen, Jiren Qian, Liyang Chen, Yudi Zhu, Tianyu Tang, Ping Wang, Xin Xu","doi":"10.56434/j.arch.esp.urol.aeu035","DOIUrl":"10.56434/j.arch.esp.urol.aeu035","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to systematically assess the relationship between metabolic syndrome (MetS) and the incidence of bladder cancer.</p><p><strong>Methods: </strong>We performed a comprehensive search of the PubMed, EMBASE, Cochrane CENTRAL, Web of Science, and Scopus databases to retrieve eligible cohort studies. Pooled relative risk (RR) and corresponding 95% confidence interval (CI) were estimated using a random-effects model. Robustness was checked via a leave-one-out sensitivity analysis. Publication bias was assessed both graphically (funnel plots) and statistically (Begg's and Egger's tests).</p><p><strong>Results: </strong>The final meta-analysis incorporated six studies, encompassing a total population of over 13 million individuals and 22,000 newly diagnosed cases. The aggregated data revealed that MetS was associated with a statistically significant 12% elevation in bladder cancer risk (RR = 1.12; 95% CI: 1.03-1.22). Sensitivity analysis demonstrated the stability of these results, and no evidence of significant publication bias was observed. Substantial heterogeneity was observed across studies (<i>I</i>² = 62.4%, <i>p</i> = 0.009). Sensitivity analysis demonstrated the robustness of the pooled estimate. Exclusion of any single study did not materially alter the overall conclusion. Begg's test produced a <i>p</i>-value of 0.711, while Egger's test showed a <i>p</i>-value of 0.062.</p><p><strong>Conclusions: </strong>MetS is linked to a moderately higher risk of developing bladder cancer. These results underscore the importance of maintaining metabolic health as a potential strategy for bladder cancer prevention.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 8","pages":"1419-1428"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Stroke Neurogenic Bladder With Its Secondary Fibrosis: Pathophysiology and Management Challenges.","authors":"Shuangfeng Huang, Zhongbao Zhou","doi":"10.56434/j.arch.esp.urol.aeu041","DOIUrl":"https://doi.org/10.56434/j.arch.esp.urol.aeu041","url":null,"abstract":"","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 8","pages":"1480-1482"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Same-Day Discharge With Early Telehealth Follow-Up After Minimally Invasive Benign Gynecologic and Urogynecologic Surgery: Healthcare Utilization, Safety, and Direct Costs.","authors":"Ümran Karabulut Doğan, Erhan Hüseyin Cömert, Erol Karakaş, Kübra Bağcı, Pınar Kadiroğulları, Ozan Doğan","doi":"10.56434/j.arch.esp.urol.aeu024","DOIUrl":"https://doi.org/10.56434/j.arch.esp.urol.aeu024","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Same-day discharge and early telehealth follow-up are increasingly combined after minimally invasive benign gynecologic and urogynecologic surgery, but pathway-level evidence is limited. We evaluated the observed combination of same-day discharge and a completed telehealth contact within 48-72 hours in relation to 30-day healthcare utilization, direct institutional cost, recovery, and adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective single-center cohort included 289 consecutive patients treated between January 2023 and April 2026. The comparative cohort comprised 212 patients eligible for same-day discharge; 211 had complete covariate data. Four observed pathways were defined by discharge status and telehealth completion. The primary analysis used generalized propensity-score overlap weighting. Pairwise doubly robust estimators, conventional adjustment, a binary pathway-completion analysis, and a full-cohort model served as supportive or sensitivity analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The combined pathway was completed by 142 of 212 eligible patients (67.0%). In the primary weighted comparison with no same-day discharge/no telehealth, it was not associated with lower 30-day healthcare utilization (risk ratio 0.72, 95% confidence interval 0.47-1.09; &lt;i&gt;p&lt;/i&gt; = 0.122). A binary comparison with all other pathways was also null (risk ratio 1.00, 95% confidence interval 0.68-1.48; &lt;i&gt;p&lt;/i&gt; = 0.987). Pairwise augmented inverse probability weighting and targeted maximum likelihood estimation both yielded a risk ratio of 0.61 (95% confidence interval 0.41-0.81; &lt;i&gt;p&lt;/i&gt; &lt; 0.001), but residual imbalance remained, estimates varied by method, and these pairwise estimates are susceptible to exposure-timing bias and are not interpreted as causal. Mean nominal direct cost was 56,601 versus 69,882 Turkish lira (cost ratio 0.87, 95% confidence interval 0.83-0.91; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Because the ratio compares contemporaneous groups, it was robust to inflation across the study period. Median time to return to normal activity was 13.25 versus 16.4 days and was descriptive only. Any 30-day safety event occurred in 15.5% versus 28.9% (penalized odds ratio 0.45, 95% confidence interval 0.19-1.02; &lt;i&gt;p&lt;/i&gt; = 0.057).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The observed same-day-discharge-plus-telehealth pathway was consistently associated with lower direct institutional cost across analytic approaches, whereas evidence for a reduction in 30-day healthcare utilization was not robust across methods. Given the observational design, potential exposure-timing bias, limited effective sample size, and residual confounding, these associations should not be interpreted as causal effects of the pathway on healthcare utilization or clinical outcomes. No clear excess of short-term adverse events was identified, although safety equivalence was not established. Prospective multicenter studies should account explicitly for the timing","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 8","pages":"1321-1332"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synchronous Bilateral Clear Cell Renal Cell Carcinoma With Multifocal Recurrence and Prolonged Disease Control Under Sequential Multimodal Therapy: A Case Report.","authors":"Otto José Guillermo Chacón-Medina, Sara Custodio-Cabello, Magda Palka-Kotlowska, Adriana Rosero-Rodriguez, Claudia García-Ruíz, Sheherezade Gallego-Nieto, Beatriz Chacón-Ovejero, Luis Cabezón-Gutiérrez","doi":"10.56434/j.arch.esp.urol.aeu031","DOIUrl":"https://doi.org/10.56434/j.arch.esp.urol.aeu031","url":null,"abstract":"<p><strong>Background: </strong>Synchronous bilateral renal cell carcinoma (RCC) is an uncommon clinical presentation that raises important diagnostic, surgical, and oncological management challenges. Colonic serosal metastases from RCC represent a particularly rare site of spread.</p><p><strong>Case summary: </strong>We report the case of a 67-year-old man with synchronous bilateral clear cell RCC (ccRCC) who underwent staged nephrectomies in 2022, followed by early multifocal recurrence necessitating completion left nephrectomy, bilateral adrenalectomy, and segmental colectomy for serosal colonic involvement in October 2023. Pathology confirmed metastatic ccRCC at all resected sites. Adjuvant pembrolizumab was initiated post-resection but failed to prevent rapid systemic progression with bone and pulmonary metastases. Following adjuvant immunotherapy failure, the patient received three sequential lines of targeted therapy in the metastatic setting: sunitinib (first line), everolimus (second line), and cabozantinib (third line). Cabozantinib achieved a durable metabolic response, with complete resolution of nodal disease and partial response of bone and pulmonary lesions, despite prior multiline exposure. Treatment was complicated by medication-related osteonecrosis of the jaw, requiring temporary discontinuation; cabozantinib was reintroduced at a reduced dose (20 mg/day), which was associated with maintained disease control and acceptable tolerance. At the time of reporting, the patient remained on reduced-dose cabozantinib with chronic hemodialysis and hormonal replacement, maintaining an Eastern Cooperative Oncology Group (ECOG) performance status of 0.</p><p><strong>Conclusions: </strong>This case illustrates the biological heterogeneity and unusual metastatic tropism of ccRCC, and underscores the clinical value of individualized multidisciplinary management; combining aggressive metastasectomy, palliative radiotherapy, and sequential targeted systemic therapy, in achieving meaningful long-term disease control while preserving quality of life.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 8","pages":"1474-1479"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Preoperative Inflammatory Markers With Bladder Stone Recurrence After HoLEP Combined With Lithotripsy in Patients With Benign Prostatic Hyperplasia: A Retrospective Cohort Study.","authors":"Juntao Guo, Minjun Jiang, Jianchun Chen, Zheng Ma","doi":"10.56434/j.arch.esp.urol.aeu040","DOIUrl":"https://doi.org/10.56434/j.arch.esp.urol.aeu040","url":null,"abstract":"<p><strong>Objective: </strong>To assess the association of preoperative neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) with postoperative bladder stone recurrence, and to improve risk stratification in patients with benign prostatic hyperplasia (BPH) and bladder stones.</p><p><strong>Methods: </strong>This retrospective cohort included 202 patients who underwent holmium laser enucleation of the prostate combined with bladder lithotripsy between July 2022 and June 2024. The primary Cox model included age, diabetes, recurrent urinary tract infection (UTI), postvoid residual urine volume, NLR, and CRP. A clinical model was compared with a clinical + NLR + CRP model using the C-index, 24-month time-dependent area under the curve (AUC), Brier score, calibration, bootstrap validation, and decision-curve analysis. Matched and restricted-cohort analyses assessed robustness.</p><p><strong>Results: </strong>During 18-42 months of follow-up, 42 patients (20.8%) developed recurrent bladder stones. In the adjusted Cox model, higher NLR (hazard ratio [HR] = 2.06, 95% confidence interval [CI]: 1.39-3.05, <i>p</i> < 0.001) and CRP (HR = 1.07 per 1 mg/L, 95% CI: 1.02-1.12, <i>p</i> = 0.005) were associated with a higher hazard of bladder stone recurrence. Adding NLR and CRP increased the C-index from 0.681 to 0.754 and the 24-month AUC from 0.693 to 0.771, while reducing the Brier score from 0.162 to 0.143. The optimism-corrected C-index was 0.741. Decision-curve analysis indicated an incremental net benefit mainly across threshold probabilities of approximately 12%-35%. Results remained directionally consistent in all sensitivity analyses. With an exploratory NLR cutoff of 2.24, 24-month recurrence-free survival was 91.0% for NLR ≤ 2.24 and 78.5% for NLR > 2.24 (log-rank <i>p</i> = 0.002).</p><p><strong>Conclusions: </strong>Higher preoperative NLR and CRP were associated with bladder stone recurrence and provided incremental value for internal risk stratification beyond selected clinical factors. External validation is required before clinical use.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 8","pages":"1464-1473"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}