Archivos Espanoles De Urologia最新文献

{"title":"Proprioceptive Trunk-Based Physiotherapy for Stress Urinary Incontinence: Case Report in a Rhythmic Gymnast.","authors":"Gabriela Martínez-Roig, Irene Sandoval-Hernández, Marta María Córdoba-Peláez, Anna Rutkowska, Borja Rodríguez-Sanjuán, Guadalupe Molina-Torres","doi":"10.56434/j.arch.esp.urol.20267903.62","DOIUrl":"https://doi.org/10.56434/j.arch.esp.urol.20267903.62","url":null,"abstract":"<p><strong>Background: </strong>Pelvic floor dysfunction (PFD) encompasses the set of clinical alterations characterised by a loss of muscular control or an incoordination in the activity of the muscles that make up this region. In the female population, the prevalence of urinary incontinence (UI) is between 24% and 45%, making it the most common PFD. Stress urinary incontinence (SUI) occurs when there is an increase in intra- abdominal pressure, such as when coughing, sneezing or lifting heavy objects, causing involuntary urine leakage. It is common for elite gymnasts to experience an increase in intra-abdominal pressure, exacerbating the onset of SUI.</p><p><strong>Case description: </strong>25-year-old patient who started practising rhythmic gymnastics at the age of 9. In the anamnesis, the patient reported that for about 8 years she had been experiencing SUI during training and competitions. The patient refers that factors such as fatigue or stressful situations influence her presentation.</p><p><strong>Objective: </strong>The main objective of this clinical case is the improvement of UI symptomatology during sports practice, through the use of the proprioceptive trunk.</p><p><strong>Intervention: </strong>The physiotherapy intervention was carried out over six weeks with a frequency of three sessions per week and was structured under an active, guided treatment approach. The sessions lasted approximately 30 minutes. In the first phase of the intervention the aim was to improve the patient's proprioception and pelvic floor activation; in the second phase, the aim was to strengthen the core musculature and the scapulohumeral region, while ensuring the maintenance of proper body posture; finally, the final phase consisted of the application of the intervention to functionality within the sporting context.</p><p><strong>Conclusions: </strong>In this patient with SUI, an improvement has been observed in the symptomatology that she presented at the beginning of the intervention, achieving significant advances both at an objective level, with the self-reported questionnaires and the voiding diary, and at a subjective level in her sensations when practising sport.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 3","pages":"531-536"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857432","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":"Hyperrealistic 3D Models for the Simulation of Surgical Procedures in Peyronie's Disease.","authors":"Jaime García-Herrero, Felix Campos-Juanatey, Juan Pedraja Vidal, Paola Calleja-Hermosa, Raquel Varea Malo, Eneko Alonso Mediavilla, Néstor García Formoso, José Luis Gutiérrez Baños","doi":"10.56434/j.arch.esp.urol.20267903.45","DOIUrl":"https://doi.org/10.56434/j.arch.esp.urol.20267903.45","url":null,"abstract":"<p><strong>Background: </strong>Penile curvature correction surgeries for Peyronie's disease require a learning curve to acquire confidence and precision in optimally performing the procedures for the patient. Given that these interventions are not frequent in daily practice, surgical simulation with hyperrealistic models can be a tool for correctly and safely acquiring technical skills.</p><p><strong>Materials and methods: </strong>We developed hyperrealistic models with different curvature degrees that allow the complete simulation of Peyronie's disease correction surgeries. These models were evaluated and validated by specialist clinicians and residents in training using a specific questionnaire for this measurement.</p><p><strong>Results: </strong>The penile models have different curvature degrees and are anatomically accurate, mimicking corpora cavernosa, urethra, Buck's fascia, neurovascular structures and skin layer. They were designed with different degrees of consistency and hardness to simulate any of the surgical techniques used to correct penile curvatures. In an initial simulation, the overall model accuracy was 3.8 (standard deviation (SD) 1.1) out of 6, improving to 4.8 (SD 0.9) out of 6 in the second simulation performed after the models had been developed and the materials improved. The model was recommended by participants for training in penile curvature correction procedures, with a score of 4.5 (SD 1.3) out of 6.</p><p><strong>Conclusions: </strong>Hyperrealistic penile curvature models developed using additive printing may be an alternative for acquiring experience in performing penile curvature correction procedures and improving the outcomes and safety in real patient surgeries.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 3","pages":"381-388"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857423","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":"Current Evidence on the Use of Cystoscopy in the Follow-up of Non-Muscle-Invasive Bladder Cancer: Are We Overusing It? Systematic Review of the Literature.","authors":"Javier Baudet León, Jorge Caño Velasco, Lucia Polanco Pujol, Silvia Artero Fullana, Beatriz Pastor Rodenas, Jose Daniel Subiela Henriquez, Luis Alberto García Martín, Carlos Hernández Fernández, Alejandro Bielsa Carrillo","doi":"10.56434/j.arch.esp.urol.20267903.43","DOIUrl":"https://doi.org/10.56434/j.arch.esp.urol.20267903.43","url":null,"abstract":"<p><strong>Background: </strong>Non-muscle-invasive bladder cancer (NMIBC) accounts for the majority of bladder cancers. Its follow-up entails high costs and significant impact on quality of life. Cystoscopy is the standard method, although uncertainties remain regarding the optimal frequency and duration. The aim was to review the available evidence on surveillance schedules and their impact on recurrence and progression.</p><p><strong>Methods: </strong>A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta- Analyses). Searches in PubMed, Web of Science and Scopus included clinical and observational studies published between 2004 and 2024. After applying inclusion criteria and assessment with QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies), 8 articles were selected out of a total of 3679.</p><p><strong>Results: </strong>The studies included a total of 30,600 patients. With regard to the first cystoscopy, performing it within 3-4 months after transurethral resection of the bladder showed better outcomes, whereas excessively early or delayed procedures increased the risk of recurrence and progression. In low-risk patients, some studies support discontinuing surveillance after 5 years without recurrence, while others recommend prolonging it in patients with risk factors such as smoking or multiple tumours. In high-risk patients, across the different surveillance schedules analysed, no differences were found in terms of mortality or progression. No conclusive studies were identified for the intermediate-risk group.</p><p><strong>Conclusions: </strong>The first cystoscopy should be performed within 3-4 months after the initial surgery. Although risk-stratified recommendations exist, current evidence is limited and sometimes contradictory. Prospective and long-term studies are required to define optimal surveillance schedules, with the aim of optimising resources and reducing the burden on patients.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 3","pages":"362-370"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857473","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":"Comparative Analysis of Greenlight Laser Photovaporization and Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia Surgery.","authors":"Eduardo García Rico, Luis Enrique Ortega Polledo, Alejandro Sánchez Pellejero, Geo Bianchini Hernández, Juan Gómez Rivas, Angeles Sanchis Bonet, Isabel Galante Romo, Jesús Moreno Sierra, Sergio Alonso Y Gregorio","doi":"10.56434/j.arch.esp.urol.20267903.46","DOIUrl":"https://doi.org/10.56434/j.arch.esp.urol.20267903.46","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to compare efficacy and safety between photoselective vaporization of the prostate (PVP) with Green- Light laser and Holmium laser enucleation of the prostate (HoLEP).</p><p><strong>Materials and methods: </strong>A total of 220 patients who underwent endoscopic disobstruction surgery of the prostate were included; Of which, 110 had PVP and 110 had HoLEP (prospective cohort). Preoperative, intraoperative and postoperative variables were recorded, including hospital stay, catheterisation duration, adverse effects, transfusion rate, maximum urinary flow (Qmax) at 12 months, reduction of prostate-specific antigen (PSA) at 6 months, urgency, urinary continence and urethral stricture. Statistical analysis was performed with Fisher's exact, Student's t and Mann-Whitney U tests, with a significance level of <i>p</i> < 0.05.</p><p><strong>Results: </strong>Both groups presented comparable preoperative characteristics. No significant differences were observed in the days of admission, days of catheterisation, adverse effects, transfusion rate or readmission rate. However, the HoLEP group showed a significantly higher Qmax (31.31 mL/s vs. 24.48 mL/s, <i>p</i> = 0.014) and a greater reduction in PSA (94.54% vs. 47.11%, <i>p</i> = 0.008). Urgency was lower in the HoLEP group (0.9% vs. 11.8%, <i>p</i> = 0.001), and the rate of urinary continence was identical in both groups (99.09%). Urethral stricture was higher in the HoLEP group (4.5% vs. 0.9%, <i>p</i> = 0.219), although the difference was not statistically significant (<i>p</i> > 0.05).</p><p><strong>Conclusions: </strong>Overall, PVP and HoLEP present a low morbidity rate and present similar long-term urinary continence rates. Moreover, HoLEP offers a greater improvement in urinary flow and a greater reduction in PSA but leads to a higher rate of urethral stricture than PVP.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 3","pages":"389-393"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857416","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":"Risk Stratification of Suspected Clinically Localized Prostate Cancer Using Multi-Indicator Functional Differentiation: A Predictive Model With fPSA/tPSA, PHI, PCA3, and MRI.","authors":"Liuying Li, Yijing Xu, Mingjing Chen","doi":"10.56434/j.arch.esp.urol.20267903.60","DOIUrl":"https://doi.org/10.56434/j.arch.esp.urol.20267903.60","url":null,"abstract":"<p><strong>Background: </strong>Accurate risk stratification is crucial for managing men with suspected clinically localized prostate cancer, particularly those with total prostate-specific antigen (tPSA) in the diagnostic grey zone (4-10 ng/mL). This study aimed to develop and validate a predictive model integrating multi-dimensional indicators to distinguish clinically insignificant prostate cancer from significant disease.</p><p><strong>Methods: </strong>This retrospective cohort study analysed 242 patients with suspected clinically localized prostate cancer who underwent biopsy from January 2020-December 2021. Patients were stratified into low-risk (n = 118) and high-risk (n = 124) groups based on biopsy pathology. Key biomarkers including free prostate-specific antigen (fPSA)/tPSA ratio, Prostate Health Index (PHI), and Prostate Cancer Antigen 3 (PCA3) score were measured before biopsy. Multiparametric magnetic resonance imaging (mp-MRI) parameters were also assessed.</p><p><strong>Results: </strong>The high-risk group had significantly lower percentage of free to total prostate‑specific antigen (%fPSA) and prostate volume, but higher PHI, PCA3 scores, and positive Prostate Imaging-Reporting and Data System (PI-RADS) findings (all <i>p</i> < 0.05). Multivariate analysis identified %fPSA, PHI, PCA3 score, prostate volume, PI-RADS score ≥ 4, and index lesion diameter as independent predictors. A nomogram incorporating these factors demonstrated excellent discrimination, with an area under the curve (AUC) of 0.885 in the development cohort, remaining robust upon 10-fold cross-validation (AUC = 0.871). Temporal validation in an independent cohort (n = 80) yielded an AUC of 0.863.</p><p><strong>Conclusions: </strong>The developed nomogram, integrating initial fPSA/tPSA screening, PHI risk quantification, PCA3 molecular confirmation, and magnetic resonance imaging (MRI) features, provides an effective tool for personalized risk stratification, with direct comparative analyses confirming its advantage over single-modality approaches.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 3","pages":"513-523"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857412","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":"Robotic-assisted Urological Minimally Invasive Cancer Surgeries using the MicroHand S Surgical Robot System.","authors":"Hang Yuan, Yaozhong Wang, Yuzhi Ji","doi":"10.56434/j.arch.esp.urol.20267903.57","DOIUrl":"https://doi.org/10.56434/j.arch.esp.urol.20267903.57","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the safety and feasibility of the enhanced MicroHand S surgical robot system in urological minimally invasive cancer surgeries, in alignment with the IDEAL-D Framework Stage 2a.</p><p><strong>Methods: </strong>Procedures were performed by an experienced urologist from the Affiliated Hospital of Qingdao University using the MicroHand S surgical robot system. Patients requiring radical cystectomy, partial nephrectomy, or radical prostatectomy were enrolled. The primary endpoint was the rate of unplanned conversion from robot-assisted surgery to conventional laparoscopic or open surgery. An independent Clinical Expert Committee reviewed the study to adjudicate the occurrence of adverse events (AEs) and serious adverse events (SAEs). All patients were followed for 1 year postoperatively.</p><p><strong>Results: </strong>These procedures included 12 radical cystectomies, 8 radical prostatectomies, and 3 partial nephrectomies. All procedures were completed successfully without the need for conversion to conventional laparoscopic or open surgery. No robotic devices or surgical instruments related AEs were recorded during the procedure. All patients had a postoperative Clavien-Dindo classification of grade Ⅰ before discharge (100%). No patients returned to the operating room within 24 hours of surgery. At 1- year follow-up none patient presented a tumor recurrence.</p><p><strong>Conclusions: </strong>The MicroHand S system is safe and feasible for complex urological MICS, supporting further clinical trial recruitment.</p><p><strong>Clinical trial registration: </strong>The study was registered at Clinicaltrials.gov (https://trialsearch.who.int/Trial2.aspx?TrialID=NCT05462392), registration number: NCT05462392.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 3","pages":"484-494"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857463","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":"Predictors of BCG Therapy Complications in Non-Muscle-Invasive Bladder Cancer: A Clavien-Dindo-Based Study.","authors":"Turgay Turan, Ozgur Efiloglu, Ilkin Hamidzada, Javid Ahmadzada, Salih Polat, Asif Yildirim","doi":"10.56434/j.arch.esp.urol.20267903.58","DOIUrl":"https://doi.org/10.56434/j.arch.esp.urol.20267903.58","url":null,"abstract":"<p><strong>Background: </strong>Intravesical Bacillus Calmette-Guérin (BCG) therapy is the standard adjuvant treatment for non-muscle-invasive bladder cancer (NMIBC), particularly in patients with carcinoma in situ, following transurethral tumor resection. Despite its proven oncological benefits, BCG therapy may be associated with a wide range of local and systemic adverse events. This study aimed to evaluate the clinical significance of BCG-related complications across the full severity spectrum and to assess their impact on treatment continuation using the Clavien-Dindo classification system.</p><p><strong>Methods: </strong>This retrospective study included 694 patients with bladder cancer who received intravesical BCG therapy between 2004 and 2024. Ethical approval was obtained prior to data collection. Patient demographics, comorbidities, tumor characteristics, and treatment details were recorded. Freeze-dried BCG (12.5 mg) was administered intravesically according to induction and maintenance protocols. Adverse events occurring during therapy were systematically classified using the Clavien-Dindo system. The primary outcome was the occurrence of any BCG-related complication. The median follow-up duration was 34 months.</p><p><strong>Results: </strong>The study cohort comprised 580 men (83.6%) and 114 women (16.4%), with a mean age of 65.1±7.5. Maintenance BCG therapy was administered to 295 patients (42.5%). A total of 122 patients (17.6%) experienced BCG-related complications, the majority of which were low-grade (Clavien-Dindo grade ≤2). Severe complications were rare. In multivariate logistic regression analysis, increasing age (odds ratio [OR]: 1.055; 95% confidence interval [CI]: 1.033-1.078; <i>p</i> < 0.001) and high tumor grade (OR: 2.473; 95% CI: 1.379-4.436; <i>p</i> = 0.002) were identified as independent predictors of complications.</p><p><strong>Conclusions: </strong>Intravesical BCG therapy is generally safe and well tolerated. However, advanced age and high tumor grade are associated with an increased risk of treatment-related adverse events. These findings highlight the importance of careful patient selection, close monitoring, and individualized management strategies, particularly in elderly patients undergoing BCG therapy.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 3","pages":"495-503"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857500","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":"Ankaferd versus Immunotherapeutics and Chemotherapeutics in Bladder Cancer.","authors":"Xiaodi Feng, Dan Sun, Lingfu Xu, Changming Zhu, Wentao Gai, Qian Liu","doi":"10.56434/j.arch.esp.urol.20267903.59","DOIUrl":"https://doi.org/10.56434/j.arch.esp.urol.20267903.59","url":null,"abstract":"<p><strong>Background: </strong>Accurate prognostic tools for cystitis remain limited. This study aimed to develop and validate a nomogram-based prediction model and explore the prognostic value of serum amyloid A (SAA), advanced oxidation protein products (AOPP) and endothelial nitric oxide synthase (eNOS).</p><p><strong>Methods: </strong>A total of 234 patients diagnosed with cystitis from March 2022 to December 2024 were assigned to a training cohort (n = 164) and a validation cohort (n = 70) in a 7:3 ratio. In the training cohort, independent prognostic risk factors were identified through univariate and subsequent multivariate logistic regression. These factors were then incorporated into a prognostic nomogram. The model's performance was assessed using receiver operating characteristic (ROC) curve analysis, calibration plots and decision curve analysis (DCA). An internal validation was subsequently performed using an independent validation set.</p><p><strong>Results: </strong>In the training cohort, 52 patients (31.71%) experienced a poor prognosis, compared with 22 patients (31.4%) in the validation cohort. No significant differences were observed in baseline characteristics or the incidence of poor prognosis between the two cohorts (<i>p</i> > 0.05). Multivariate analysis identified the following independent risk factors for a poor prognosis: elevated SAA levels, increased AOPP levels, decreased eNOS levels, comorbid diabetes mellitus, age of 60 years or older and a disease duration exceeding 3 months (all <i>p</i> < 0.05). The nomogram demonstrated favourable discriminatory ability, with an area under the ROC curve of 0.838 (95% confidence interval (CI): 0.757-0.919) in the training set and 0.735 (95% CI: 0.588-0.902) in the validation set.</p><p><strong>Conclusions: </strong>The nomogram incorporating SAA, AOPP, eNOS and clinical factors demonstrates promising prognostic performance for patients with cystitis, serving as a potential tool for the early identification of high-risk individuals and supporting optimised treatment strategies.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 3","pages":"504-512"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857254","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":"Nutritional and Inflammatory Biomarkers Predict Postoperative Infectious Complications After Percutaneous Nephrolithotomy: A Retrospective Cohort Study.","authors":"Lichun Duan, Shuang Ai, Xiaomin Yang","doi":"10.56434/j.arch.esp.urol.20267903.52","DOIUrl":"https://doi.org/10.56434/j.arch.esp.urol.20267903.52","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous nephrolithotomy (PCNL) is the primary surgical modality for managing renal calculi, yet the nonnegligible incidence of postoperative infectious complications significantly compromises patient prognosis.</p><p><strong>Objective: </strong>To develop a pre-operative predictive model based on nutritional and inflammatory biomarkers to quantify the risk of infectious complications following PCNL.</p><p><strong>Methods: </strong>From January 2022 to December 2024, 529 consecutive PCNL patients met the inclusion criteria. Pre-operative baseline characteristics, nutritional biomarkers (Prealbumin (PA), Hemoglobin (Hb), Prognostic Nutritional Index (PNI)), and inflammatory biomarkers (C-Reactive Protein (CRP), Procalcitonin (PCT), White Blood Cell Count (WBC), Neutrophil-to- Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Systemic Immune-Inflammation Index (SII)) were collected. The main outcome was the occurrence of any infectious complication within 30 days. Univariable analysis screened candidate predictors; multivariable logistic regression integrated key biomarkers into a risk-prediction model. Receiver Operating Characteristic (ROC) curves were used to evaluate discrimination, providing the Area Under the Curve (AUC) and optimal cut-off values.</p><p><strong>Results: </strong>Among 529 patients who undergoing PCNL, 54 (10.21%) developed postoperative infectious complications. Multivariate logistic regression analysis identified four independent predictors: PNI (Odds Ratio (OR) = 0.386, <i>p</i> < 0.001), PLR (OR = 3.362, <i>p</i> = 0.009), NLR (OR = 2.446, <i>p</i> = 0.017), and SII (OR = 3.300, <i>p</i> < 0.001). The combined prediction model integrating these biomarkers demonstrated superior discriminative ability (AUC = 0.871, 95% Confidence Interval (CI): 0.839-0.898), significantly outperforming individual biomarkers (all <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>A pre-operative model integrating nutritional and inflammatory biomarkers may accurately stratifies patients at high risk for infectious complications after PCNL, enabling early risk assessment and targeted intervention to improve outcomes.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 3","pages":"440-449"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857453","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":"Sperm DNA Fragmentation Testing in the Era of Assisted Reproduction: Clinical Utility, Thresholds, and Management Strategies.","authors":"Xiaodong Zhao, Jianwen Wang, Huabin Wang, Cheng Peng, Lin Liu, Yongwei Shan","doi":"10.56434/j.arch.esp.urol.20267903.44","DOIUrl":"https://doi.org/10.56434/j.arch.esp.urol.20267903.44","url":null,"abstract":"<p><p>Sperm DNA fragmentation (SDF) has emerged as a clinically important biomarker in male infertility evaluation, offering diagnostic information beyond conventional semen analysis. The inclusion of SDF testing into the World Health Organization 6th edition laboratory manual underscores its growing relevance in reproductive medicine. Elevated SDF levels have been associated with reduced fertilization rates, impaired embryo quality, decreased pregnancy rates, and increased miscarriage risk, particularly in couples with otherwise normal semen parameters. This narrative review examines current SDF testing methodologies, focusing on clinical applicability and diagnostic thresholds. We compared four principal testing modalities-terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL), sperm chromatin structure assay (SCSA), sperm chromatin dispersion (SCD) test, and Comet assay, by evaluating their technical characteristics, reproducibility, and predictive value for assisted reproductive technology (ART) outcomes. The evidence demonstrates that, although universal thresholds remain elusive, methodology-specific cut-off values provide meaningful clinical guidance: TUNEL (>16.8-20%), SCSA DNA fragmentation index (>25%), SCD (15-25%), and alkaline Comet assay (>26%). Clinical indications for SDF testing include recurrent pregnancy loss, unexplained infertility, and recurrent ART failure. Evidence-based management strategies encompass varicocelectomy, short ejaculatory abstinence protocols, antioxidant therapy, and testicular sperm extraction for refractory cases. Interpretation should be contextualised by female partner age, oocyte quality, and planned ART modality, as these factors substantially influence the clinical impact of elevated SDF. By integrating findings of recent literature, this review provides a practical, evidence-based framework for the judicious application of SDF testing, including patient selection criteria, methodological considerations, and stepwise therapeutic interventions.</p>","PeriodicalId":48852,"journal":{"name":"Archivos Espanoles De Urologia","volume":"79 3","pages":"371-380"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857471","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}