Archivos Espanoles De Urologia最新文献

{"title":"Minipercutaneous Nephrolithotomy as an Alternative to Standard PCNL for Selected Renal Stones ≤ 2 cm: Real-World Retrospective Study.","authors":"Chaofei Zhao, Dongshan Liu, Houyou Ding","doi":"10.56434/j.arch.esp.urol.20267904.73","DOIUrl":"10.56434/j.arch.esp.urol.20267904.73","url":null,"abstract":"<p><strong>Background: </strong>The comparative efficacy and safety of minipercutaneous nephrolithotomy (mPCNL) versus standard percutaneous nephrolithotomy (PCNL) in selected patients with renal stones ≤ 2 cm remain insufficiently defined.</p><p><strong>Methods: </strong>This retrospective cohort study included 146 adult patients with single renal stones ≤ 2 cm who underwent PCNL between May 2023 and May 2025. The patients were assigned to the mPCNL group (≤14 Fr, n = 72) or standard PCNL group (22-24 Fr, n = 74). All procedures were performed using holmium: Yttrium aluminum garnet (YAG) laser lithotripsy. The primary outcome was the single-session stone-free rate assessed by noncontrast computed tomography (CT) within 3 days postoperatively. Secondary outcomes included perioperative parameters,renal function indices (serum creatinine and cystatin C), inflammatory biomarkers (interleukin-6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP)) and postoperative complications.</p><p><strong>Results: </strong>The single-session stone-free rates were comparable between the mPCNL and standard PCNL groups (94.4% vs. 89.2%, <i>p</i> = 0.248). The mPCNL group showed significantly lower intraoperative blood loss, earlier ambulation and shorter hospital stay (all <i>p</i> < 0.001). Although inflammatory markers increased after surgery in both groups,the magnitude of increase in PCT and CRP was significantly lower in the mPCNL group (all <i>p</i> < 0.001). The overall complication rates were low and comparable between the groups (6.94% vs. 12.16%, <i>p</i> = 0.284).</p><p><strong>Conclusions: </strong>In selected patients with renal stones ≤ 2 cm requiring percutaneous intervention,mPCNL provides similar stone clearance and short-term renal safety compared with standard PCNL whilst offering the advantages of reduced surgical trauma, attenuated postoperative inflammatory response and faster recovery.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 4","pages":"625-631"},"PeriodicalIF":0.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213041","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":"External Validation of A Decision Tree Model for Predicting Cancer-Specific Mortality After Radical Cystectomy: A Multi-Center Study in South-East Spain.","authors":"Pau Sarrio-Sanz, Jose Vicente Segura-Heras, Miriam Artés-Artés, Marina Belda-Ferre, Natalia Vidal-Crespo, Pedro Martinez-Meneu, Laura Martínez-Cayuelas, Helena Pérez-Seoane Ballester, Vicente Francisco Gil-Guillen, Luis Gómez-Perez, Manuel Angel Ortiz-Gorraiz","doi":"10.56434/j.arch.esp.urol.20267904.66","DOIUrl":"10.56434/j.arch.esp.urol.20267904.66","url":null,"abstract":"<p><strong>Background: </strong>Accurate prognostic tools are essential for guiding therapeutic decisions and follow-up strategies in patients with urothelial bladder cancer undergoing radical cystectomy. Although decision tree models have shown promise in predicting cancer-specific outcomes, their clinical utility depends on external validation across diverse populations. This study aimed to externally validate a previously published decision tree model for predicting cancer-specific mortality using an independent multi-centre cohort from south-east Spain.</p><p><strong>Methods: </strong>A multi-centre retrospective cohort study was conducted across five university hospitals in south-east Spain. A total of 553 patients with histologically confirmed urothelial bladder cancer who underwent standard radical cystectomy between 2004 and 2025 were included. A decision tree model originally developed using the Surveillance, Epidemiology, and End Results (SEER) database to predict cancer-specific survival was externally validated. The development and validation cohorts were comparatively analysed using chi-square tests and analysis of variance. Model discrimination was assessed using the concordance index (C-index) and calibration plots. Clinical utility was evaluated using decision curve analysis (DCA).</p><p><strong>Results: </strong>The C-index was 0.733 in the Spanish validation cohort, indicating good discriminative performance. DCA demonstrated a net benefit of using the model over a \"treat-all\" strategy at threshold probabilities >25%. Despite demographic and staging differences between the validation and original cohorts, the model maintained its predictive accuracy.</p><p><strong>Conclusions: </strong>This study provides formal external validation of a decision tree model for predicting cancer-specific mortality after radical cystectomy, demonstrating robust performance and supporting its use in clinical settings in south-east Spain.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 4","pages":"567-575"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213066","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":"Proton Beam Therapy in Prostate Cancer: Clinical Evidence, Controversies and Future Directions.","authors":"Elías Gomis-Sellés, María González de Dueñas, Gerard Meca, Marta García-Marqueta, Sara Moreno-López, Javier Albendea Roch, María Isabel Garrido Botella, Begoña Caballero, Juan Gómez Rivas, Mohamed Shelan, Fernando López Campos, Felipe Couñago","doi":"10.56434/j.arch.esp.urol.20267904.63","DOIUrl":"10.56434/j.arch.esp.urol.20267904.63","url":null,"abstract":"<p><p>Proton beam therapy (PBT) offers a unique dosimetric advantage over photon-based external beam radiotherapy by concentrating dose at a certain depth (the Bragg peak) and markedly reducing the exit dose to surrounding normal tissues. This narrative review summarises and evaluates the clinical, dosimetric and radiobiological evidence for PBT in localised and locally advanced prostate cancer (PCa), focusing on treatment-related toxicity, oncological outcomes and emerging research directions. Comparative dosimetric studies consistently demonstrate reductions in low-intermediate dose exposure to the bladder and rectum with protons, whereas prospective and large retrospective cohorts report low rates of severe (≥ G3) genitourinary (GU) and gastrointestinal (GI) toxicity, alongside preserved long-term patient-reported quality of life. Meta-analyses reported modest reductions in acute GI events, whilst reporting similar 5-year biochemical control in pooled, heterogeneous series; however, observational and claims-based analyses often fail to demonstrate clear clinical advantages compared with modern intensity-modulated radiation therapy/volumetric modulated arc therapy (IMRT/VMAT). Key radiobiological uncertainties, notably the variable relative biological effectiveness and linear energy transfer (LET) heterogeneity near distal dose fall-off regions, complicate the analysis of toxicity patterns and highlight the need for comprehensive reporting. Limitations of the existing literature include the prevalence of non-randomised designs, heterogeneity in fractionation schedules, inconsistent endpoint definitions and limited use of standardised patient-reported outcomes. The preliminary results of the PARTIQoL randomised clinical trial did not demonstrate significant differences in quality-of-life outcomes between PBT and IMRT/VMAT. Ongoing randomised phase III trials (e.g., Prostate Advanced Radiation Technologies Investigating Quality of Life, Proton Therapy for Postoperative Prostate Cancer Trial and PROton PROstate Trial 1) and advances in adaptive planning, AI-assisted workflows and FLASH (ultra-high dose-rate radiotherapy) dose-rate research are expected to further refine patient selection and treatment delivery. Currently, the routine use of PBT for all patients with localised PCa remains under evaluation; careful patient selection and robust randomised evidence are essential to justify broad clinical implementation.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 4","pages":"537-549"},"PeriodicalIF":0.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213050","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":"Long-Term Outcomes After Laparoscopy-Assisted Cryoablation for Renal Cell Carcinoma-Results From a Single-Center Series.","authors":"Denis Mesinovic, Peter Elfving, Violeta Karadzic, Bianca Scholtz, Pernilla Sundqvist, Fredrik Liedberg","doi":"10.56434/j.arch.esp.urol.20267904.69","DOIUrl":"10.56434/j.arch.esp.urol.20267904.69","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic-assisted renal cryoablation (LRC) is a treatment option for small renal masses (SRMs), offering a nephron-sparing alternative to partial nephrectomy. This study evaluated long-term oncologic outcomes and perioperative complications after LRC in a single-center cohort.</p><p><strong>Methods: </strong>We conducted a retrospective single-center review of 52 patients who underwent LRC for SRMs ≤4 cm between 2006 and 2015. Primary outcomes included local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS). Secondary outcomes included 90-day postoperative complications graded by the Clavien-Dindo system.</p><p><strong>Results: </strong>The 5- and 10-year LRFS were 90% (95% Confidence Interval (CI) 86-94%) and 90% (95% CI 86-94%), and MFS were 94% (95% CI 92-97%) and 94% (95% CI 92-97%), respectively. OS for patients with malignant histology was 87% (CI 82-91%). Approximately 30% of patients had benign tumors. The overall complication rate was 21%. No perioperative mortality occurred.</p><p><strong>Conclusions: </strong>LRC provided effective long-term local tumor control with acceptable complication rates in patients with SRMs. However, the lack of preprocedural biopsy led to overtreatment of benign tumors. The findings highlight the importance of histologic confirmation prior to ablation.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 4","pages":"591-597"},"PeriodicalIF":0.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213043","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 Fibrosis-Related Gene Expression Profiles in Benign Ureteral Stricture Tissue With Restenosis After Ureteroplasty.","authors":"Yuhao Chen, Wei Liu, Changjie Shi, Zhe Liu, Xiaodong Zhao, Wenquan Zhou, Le Qu, Wen Cheng, Dian Fu","doi":"10.56434/j.arch.esp.urol.20267904.79","DOIUrl":"10.56434/j.arch.esp.urol.20267904.79","url":null,"abstract":"<p><strong>Background: </strong>To investigate fibrosis-related gene expression profiles in benign ureteral strictures and their association with restenosis after ureteroplasty and to develop a predictive risk score model.</p><p><strong>Methods: </strong>A total of 100 patients with benign strictures who underwent ureteroplasty were included.Stenotic tissues were collected intraoperatively, and the expression levels of 15 fibrosis-related genes were determined by quantitative real-time PCR. According to whether restenosis occurred at 12 months postoperatively, the patients were assigned to stenotic group (n = 39) and non-stenotic group (n = 61). Independent predictors were identified using logistic regression, a risk score model was constructed and model performance was assessed using receiver operating characteristic curve, calibration curves and decision curve analysis (DCA). The restenosis-free rates of the risk groups were compared through Kaplan-Meier survival analysis, and internal validation was performed through Bootstrap resampling.</p><p><strong>Results: </strong>High expression levels of type I collagen α1 chain (<i>COL1A1</i>), transforming growth factor-β1 (<i>TGFB1</i>), Snail family member 1 (<i>SNAI1</i>), SMAD family member 3 (<i>SMAD3</i>) and thrombospondin 2 (<i>THBS2</i>) genes were identified as independent risk factors for postoperative restenosis (all <i>p</i> < 0.05). Kaplan-Meier analysis revealed that the restenosis-free rate at 12 months was significantly lower in the high-risk group than in the low-risk group (51.02% vs. 70.59%, log-rank <i>p</i> = 0.007). The area under the curve (AUC) of the risk scoring model was 0.854 [95% confidence interval (CI): 0.772-0.973], with a sensitivity of 87.12% and specificity of 84.55%. Bootstrap internal validation yielded a corrected AUC of 0.848 (95% CI: 0.812-0.891), confirming the model's stability. The calibration curve demonstrated good agreement between predicted probabilities and observed outcomes (Hosmer-Lemeshow test, <i>p</i> > 0.05). DCA showed that the model provided a net clinical benefit across a wide range of threshold probabilities. Further analysis showed that the expression levels of the above five genes were significantly positively correlated with the pathological fibrosis grade of stenotic tissues (all <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The high expression levels of <i>COL1A1</i>, <i>TGFB1</i>, <i>SNAI1</i>, <i>SMAD3</i> and <i>THBS2</i> in benign ureteral strictures is closely related to the degree of tissue fibrosis and postoperative restenosis. The risk scoring model based on these genes showed good predictive performance and can thus serve as useful tool for clinical individualised treatment and prognostic assessment.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 4","pages":"676-684"},"PeriodicalIF":0.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213069","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":"Assessing the Effectiveness of \"Onabotulinumtoxin A\" (Botox®) Intradetrusor Injection for Overactive Bladder (OAB) Patients After Medical Therapy Failure.","authors":"Giuseppe Saitta, Benedetto Calabrese, Vincenzo Striano, Giuseppe Di Paola, Andrea Simone Ceresoli, Franco Anacleto Mantovani, Attilio Luigi Meazza, Mauro Seveso","doi":"10.56434/j.arch.esp.urol.20267904.70","DOIUrl":"10.56434/j.arch.esp.urol.20267904.70","url":null,"abstract":"<p><strong>Background: </strong>Urge urinary incontinence (UUI) is a persistent and disabling condition that occurs in Overactive Bladder (OAB) patients without evidence of urinary tract infection (UTI). At our institution, intradetrusor injections of onabotulinumtoxinA (BTX-A) are implemented as a second-line therapy for patients in whom pharmacological management has failed.</p><p><strong>Methods: </strong>Between January 2020 and March 2023, 62 patients (38 women, 24 men) with prior treatment using antimuscarinic agents and/or β3-adrenoceptor agonists were evaluated. Of these, 14 had significant comorbidities, including 8 patients with neurological disorders. Those with neurological involvement received 200 U of onabotulinumtoxinA, whereas the remaining 54 received 100 U (Botox®, Allergan, Irvine, CA, USA). Follow-up assessments at 3, 6, 12 and 24 months included urinary leakage (Pad test), the need for clean intermittent catheterisation (CIC), completion of the OAB questionnaire and monitoring of adverse events.</p><p><strong>Results: </strong>The treatment resulted in significant reductions in urinary leakage (UL) at 3 and 6 months compared with baseline, along with a marked decrease in detrusor pressure at 6 months (<i>p</i> < 0.05). Both the 100 U and 200 U regimens maintained clinical efficacy for up to one year postprocedure. The incidence of adverse events was comparable to that observed with oral pharmacotherapy.</p><p><strong>Conclusions: </strong>Intradetrusor BTX-A is a safe and effective therapeutic option for OAB patients who are unresponsive to other therapeutic options. The major benefits observed were lowered detrusor pressure and reduced UL at 6 months, as well as reduced CIC at 6 and 12 months. A 100 U dose appears adequate for most cases, although its benefit tends to diminish after 12 months. Thus, we propose to repeat the procedure after about one year. However, no clinically relevant differences were observed between the 100 U and 200 U doses.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 4","pages":"598-605"},"PeriodicalIF":0.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212978","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":"Preoperative Drainage Strategy in Robot-Assisted Adult Pyeloplasty.","authors":"Mahmoud Farzat, Florian M Wagenlehner","doi":"10.56434/j.arch.esp.urol.20267904.68","DOIUrl":"10.56434/j.arch.esp.urol.20267904.68","url":null,"abstract":"<p><strong>Background: </strong>The optimal preoperative drainage strategy for ureteropelvic junction obstruction remains controversial. This study compares the outcomes between different preoperative urinary drainage methods in robot-assisted pyeloplasty (RAPY).</p><p><strong>Methods: </strong>This retrospective study was conducted on 45 patients who underwent RAPY from 2020 to 2024 and categorised by clinical presentation: flank pain with hydronephrosis requiring preoperative urinary drainage double-J ureter catheter (DJ) or percutaneous nephrostomy (PCN) or renal function deterioration (no-drain) scheduled for pyeloplasty. The patients were divided into three groups: DJ (n = 10), PCN (n = 10) and no preoperative catheter (n = 25). Primary endpoint was the occurrence of complications within 90 days after surgery. Secondary endpoints included console time, hospitalisation rates, improvement in glomerular filtration rate (GFR) (compared between baseline GFR and GFR at discharge) and readmission rates.</p><p><strong>Results: </strong>The immediate GFR improvement after surgery was 2.57 mL/min/1.73 m² (<i>p</i> = 0.62). Complications were observed in 30% of the PCN group, 32% of the no-drain group (<i>p</i> = 0.18) and none in the DJ group (0%). Five major complications occurred, four of them in the no-drain group. One was incisional hernia, and one was subcutaneous hematoma. In three patients, the intraoperatively inserted DJ catheter had to be replaced postoperatively. All replacements took place in the no-drain group. Six patients were readmitted within 90 days postoperatively (three each in the PCN and no preoperative catheter groups).</p><p><strong>Conclusions: </strong>Short-term, preoperative, X-ray-guided DJ catheter placement appears to be a safe approach for adult pyeloplasty preparation to prevent postoperative complications associated with blind DJ insertion. It can also help in avoiding the effects of long-term stenting. Placing a nephrostomy catheter is another reasonable option. Further prospective studies are needed to validate our findings.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 4","pages":"584-590"},"PeriodicalIF":0.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212979","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":"An Individualized Treatment Approach Based on Abscess Size in Renal Abscesses: A Retrospective Study.","authors":"Kursad Donmez, Enis Mert Yorulmaz, Serkan Ozcan, Osman Kose, Sacit Nuri Gorgel, Yigit Akin","doi":"10.56434/j.arch.esp.urol.20267904.67","DOIUrl":"10.56434/j.arch.esp.urol.20267904.67","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to evaluate the impact of the abscess-to-kidney surface area ratio, inflammatory biomarkers, and comorbidities on treatment decisions in renal abscess management, beyond the traditional size-based approach.</p><p><strong>Methods: </strong>This retrospective cohort study included 41 adult patients with radiologically confirmed renal or perirenal abscesses between 2016 and 2025. Patients were categorized into three groups: medical therapy only, minimally invasive drainage, and invasive surgical intervention. Abscess size, contact surface ratio, and laboratory parameters (e.g., neutrophil-to-lymphocyte ratio (NLR), albumin) were analyzed. Multinomial logistic regression and subgroup analyses were performed to identify predictors of treatment modality.</p><p><strong>Results: </strong>The mean abscess diameter was significantly different across treatment groups (<i>p</i> < 0.001), with a higher rate of invasive interventions in abscesses >60% of the kidney surface. Elevated NLR was an independent predictor of invasive treatment in the multivariate model. While lower albumin levels were observed in univariate analysis among patients requiring invasive therapy, this association was not independent in the adjusted model. Diabetes mellitus was significantly more prevalent among patients requiring invasive therapy (<i>p</i> = 0.002). Among patients with 30-60% surface area involvement, NLR was significantly higher in those requiring surgical intervention (<i>p</i> = 0.014). The regression model demonstrated good predictive performance.</p><p><strong>Conclusions: </strong>A multidimensional treatment algorithm that integrates abscess-to-kidney surface area ratio, systemic inflammatory response, and comorbid conditions may guide optimal therapy for renal abscesses. Particularly in intermediate-sized abscesses, laboratory markers such as NLR and albumin may help identify candidates for early intervention, potentially avoiding delayed or insufficient treatment.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 4","pages":"576-583"},"PeriodicalIF":0.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212935","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 Between Functional Multiparametric MRI Features and Tumour Immune Microenvironment Phenotypes in Prostate Cancer: A Retrospective Study.","authors":"Peng Wang, Enhao Wang, Guanghai Ji, Hao Deng, Yuan Yuan, Xiaofang Lin, Kebing Chen, Sheng Xiao, Fei Liu","doi":"10.56434/j.arch.esp.urol.20267904.72","DOIUrl":"10.56434/j.arch.esp.urol.20267904.72","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the association between functional multiparametric magnetic resonance imaging (mpMRI) features and tumour immune microenvironment (TIME) phenotypes (immune-inflamed, immune-excluded and immune-desert) in prostate cancer (PCa) and to develop a multiclass prediction model.</p><p><strong>Methods: </strong>This retrospective study enrolled 228 patients with PCa who underwent mpMRI between January 2023 and October 2025. The patients were categorised into three TIME phenotypes based on immune cell infiltration patterns. Functional mpMRI features (apparent diffusion coefficient (ADC)_mean, ADC_min, Prostate Imaging Reporting and Data System (PI-RADS) score and lesion diameter) and clinicopathological indices were collected. Variables identified through univariate analysis were entered into a multinomial logistic regression model to assess independent factors associated with TIME phenotypes. Model performance was evaluated through 10-fold cross-validation, receiver operating characteristic (ROC) analysis and confusion matrix evaluation.</p><p><strong>Results: </strong>Significant differences in prostate-specific antigen (PSA) level, International Society of Urological Pathology (ISUP) grade and mpMRI feature were observed among the three TIME phenotypes (<i>p</i> < 0.05). The immune-inflamed phenotype was associated with higher PSA and lower ADC_mean. The immune-desert phenotype was more common in lesions with low PI-RADS scores. Elevated PSA and reduced ADC_mean were independent factors associated with the immune-inflamed phenotype, whereas a low PI-RADS score was significantly associated with the immune-desert phenotype. ROC analysis showed area under the curve values of 0.654 (95% CI: 0.557-0.691) for immune-inflamed, 0.742 (95% CI: 0.654-0.791) for immune-excluded and 0.802 (95% CI: 0.782-0.852) for immune-desert phenotypes.</p><p><strong>Conclusions: </strong>Functional mpMRI features show significant associations with TIME phenotypes in PCa. Elevated PSA levels and low ADC_mean value may serve as indicators of the immune-inflamed phenotype, whereas a low PI-RADS score may suggest an immune-desert phenotype. These findings highlight the potential of mpMRI as a non-invasive imaging surrogate for assessing TIME phenotypes and inform precision immunotherapy in PCa.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 4","pages":"614-624"},"PeriodicalIF":0.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212955","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":"A Nomogram for Predicting 28-Day Mortality in Critically Ill Patients With Prostate Cancer: A Retrospective Cohort Study Based on the MIMIC-IV Database.","authors":"Yue Yao, Jingjing Dong, Ziwei Wang, Yidie Su","doi":"10.56434/j.arch.esp.urol.20267904.75","DOIUrl":"10.56434/j.arch.esp.urol.20267904.75","url":null,"abstract":"<p><strong>Background: </strong>Despite their clinical complexity,patients with prostate cancer (PCa) requiring intensive care remain an understudied demographic for which precision prognostic instruments are lacking. We sought to establish and verify a robust nomogram tailored to predict the 28-day mortality risk for this specific cohort.</p><p><strong>Methods: </strong>We utilised retrospective data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Patients were randomly assigned to training and validation sets (7:3) by using random seeds. Least Absolute Shrinkage and Selection Operator (LASSO) regression with 20-fold cross-validation and the 1SE rule was employed to select predictors and construct the model. Model performance was evaluated by employing receiver operating characteristic (ROC) curves, calibration plots with Hosmer-Lemeshow tests and decision curve analysis (DCA).</p><p><strong>Results: </strong>The analysis of 529 patients (370 training/159 validation) yielded six decisive predictors. Our proposed nomogram exhibited markedly higher discriminative accuracy than traditional metrics. Specifically, it achieved an area under the receiver operating characteristic curve (AUROC) of 0.814 in the training set,eclipsing Simplified Acute Physiology Score II (SAPS II) (0.737), Sequential Organ Failure Assessment (SOFA) (0.645) and the Charlson Comorbidity Index (CCI) (0.734). These findings were mirrored in the validation phase (AUROC:0.809). On the validation set, we also found that the AUROC of our model was 0.809, whereas those of SAPS II, SOFA and CCI were 0.764, 0.686 and 0.725, respectively.High <i>p</i> values in Hosmer-Lemeshow tests (<i>p</i> > 0.05) reflected strong calibration.Meanwhile, DCA curves underscored our nomogram's superior net clinical benefit over conventional scoring systems.</p><p><strong>Conclusions: </strong>Our established 28-day mortality prediction model for critically ill patients with PCa facilitates early risk stratification and intervention,potentially improving survival outcomes in this high-risk population.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 4","pages":"641-650"},"PeriodicalIF":0.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212937","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}