Actas urologicas espanolas最新文献

{"title":"Un nuevo modelo machine learning para predecir los resultados de la Novel Trifecta y la validación de su pronóstico en una gran serie unicéntrica de nefrectomías parciales mínimamente invasivas","authors":"A. Farré ,&nbsp;A. Uleri ,&nbsp;A. Gallioli ,&nbsp;M. Baboudjian ,&nbsp;I. Sanz ,&nbsp;M. Casadevall ,&nbsp;P. Hernández ,&nbsp;A. Territo ,&nbsp;P. Gavrilov ,&nbsp;O. Rodríguez Faba ,&nbsp;J. Huguet ,&nbsp;J.M. Gaya ,&nbsp;J. Palou ,&nbsp;A. Breda","doi":"10.1016/j.acuro.2025.501900","DOIUrl":"10.1016/j.acuro.2025.501900","url":null,"abstract":"<div><h3>Introduction</h3><div>Novel trifecta has been proposed to define surgical success in patients undergoing partial nephrectomy (PN). This study aimed to evaluate its role in predicting survival outcomes and to identify the predictors of trifecta achievement via a machine-learning based model.</div></div><div><h3>Methods</h3><div>Data from consecutive patients who underwent minimally invasive PN between 2003 and 2022 were retrospectively analysed. Surgical success was defined through the achievement of novel trifecta (No Clavien-Dindo ≥<!--> <!-->3 postoperative complications, negative surgical margins and &lt;<!--> <!-->30% reduction in postoperative eGFR). Kaplan-Meier curves were used to assess the impact of trifecta achievement on survival. Automated chi-squared interaction detection (CHAID), a recursive machine-learning algorithm, was applied to predict trifecta achievement.</div></div><div><h3>Results</h3><div>A total of 465 patients were included, with a median follow-up of 72 (IQR: 38-108) months. The trifecta was achieved in 73% of cases and was associated with significantly improved overall survival (85% vs. 69.8%; <em>P</em> <!-->=<!--> <!-->.04). Solitary kidney status, patient age, and surgical experience were the most relevant predictors, allowing classification into three clusters. Trifecta rates were 43.6% in cluster #1 (solitary kidney), 71.2% in cluster #2 (non-solitary kidney with surgical experience ≤<!--> <!-->80<!--> <!-->cases or &gt;<!--> <!-->80<!--> <!-->cases and patients-age ≥<!--> <!-->65), and 88.5% in cluster #3 (non-solitary kidney, patients-age &lt;<!--> <!-->65, surgicall experience &gt;<!--> <!-->80<!--> <!-->cases).</div></div><div><h3>Conclusions</h3><div>Novel trifecta achievement after PN correlates with overall survival but not with other oncological outcomes. A predictive model was developed, highlighting surgical experience as the only modifiable factor. Tailored perioperative strategies and advanced surgical training may improve trifecta achievement.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"50 5","pages":"Article 501900"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148060282","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":"Desarrollo de cáncer vesical y rectal en los pacientes con cáncer de próstata tratados mediante cirugía o radioterapia: estudio poblacional","authors":"P. Martínez Rodríguez,&nbsp;A. Poza Fernández,&nbsp;G. García Fadrique,&nbsp;J. Acedo González,&nbsp;O. Montero Adriá,&nbsp;N. Mateo Cárcel,&nbsp;L. Marzullo Zucchet,&nbsp;F. Gómez Palomo,&nbsp;C. Reig Ruiz","doi":"10.1016/j.acuro.2026.501928","DOIUrl":"10.1016/j.acuro.2026.501928","url":null,"abstract":"<div><h3>Introduction</h3><div>Radical prostatectomy (RP) and radiotherapy (RT) are the main treatment options for localized and locally advanced (LA) prostate cancer (PCa). While erectile dysfunction and urinary incontinence have been widely studied, there is limited evidence regarding pelvic malignancies and radiation-induced rectal or urinary toxicity.</div></div><div><h3>Materials and methods</h3><div>This retrospective study involved patients with localized and LA PCa treated exclusively with RP or RT between 2010 and 2019 in our Health Department. A total of 356 patients were included: 138 treated with RP and 218 with RT. Rectal and bladder tumors, as well as urinary and gastrointestinal toxicity variables, were compared using the Chi-square test (Fisher's exact test when expected frequencies were &lt;<!--> <!-->5). Multivariate analysis was performed using logistic regression adjusted for clinical variables. Statistical significance was set at <em>P</em>&lt;.05.</div></div><div><h3>Results</h3><div>Both groups were homogeneous in terms of tumor stage and smoking status. Statistically significant differences were observed between groups in the incidence of pelvic tumors (<em>P</em>=.032), bladder tumors (<em>P</em>=.033), and urinary and gastrointestinal toxicity (<em>P</em>&lt;.001). Patients treated with radiotherapy had an almost 11-fold increased risk of bladder tumors (OR: 10.61; 95% CI: 1.42-224.98).</div></div><div><h3>Conclusions</h3><div>In our series, patients with localized and LA PCa treated with RT presented a higher incidence of pelvic tumors and urinary/rectal toxicity compared with those treated with RP.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"50 5","pages":"Article 501928"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148060286","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":"Comentario sobre «Análisis de la supervivencia del dispositivo y los factores predictivos de la misma en una cohorte de pacientes intervenidos de esfínter urinario artificial masculino»","authors":"R. Sah ,&nbsp;A. Mathur","doi":"10.1016/j.acuro.2025.501811","DOIUrl":"10.1016/j.acuro.2025.501811","url":null,"abstract":"","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"50 5","pages":"Article 501811"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148060227","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":"Relación de la densidad y contenido mineral óseo total con la presencia de litiasis renal en adultos estadounidenses: un estudio nacional transversal","authors":"L. Chen ,&nbsp;L. Lv ,&nbsp;Z. Zhang ,&nbsp;S. Jiang","doi":"10.1016/j.acuro.2025.501901","DOIUrl":"10.1016/j.acuro.2025.501901","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Whole-body bone mineral content (BMC) and bone mineral density (BMD) can provide comprehensive information about the health of the whole body. This study aimed to assess whether BMC and BMD are potentially associated with self-reported kidney stones.</div></div><div><h3>Materials and methods</h3><div>Multiple logistic regression analysis was used to investigate the potential association between BMC/BMD and kidney stones. Subgroup analysis and interaction tests were used to examine the stability of the relationship. Restricted cubic spline plots were used to examine the dose-response relationship. Saturation effect and threshold effect analyses were used to assess inflection points in the dose-response relationship.</div></div><div><h3>Results</h3><div>The study population consisted of 8030 adults. Compared with those with low BMD levels, the prevalence of kidney stones was lower in those with high BMD levels (6.55% vs. 10.87%, <em>P</em> <!-->=<!--> <!-->.0001). After adjusting for all covariates, there was a negative association between whole-body BMC and kidney stones (OR<!--> <!-->=<!--> <!-->0.06; 95%<!--> <!-->CI: 0.02-0.25; <em>P</em> <!-->&lt;<!--> <!-->.0001), and between whole-body BMD and kidney stones (OR<!--> <!-->=<!--> <!-->0.19; 95%<!--> <!-->CI: 0.08-0.45; <em>P</em> <!-->=<!--> <!-->.0002). Subgroup analyses and interaction tests identified diabetes and smoking as significant influences. In the non-smoking population, a non-linear relationship was shown between BMD and kidney stones (non-linear <em>P</em> value<!--> <!-->=<!--> <!-->.039).</div></div><div><h3>Conclusions</h3><div>BMC and BMD were inversely associated with the prevalence of kidney stones in U.S. adults. Although causality cannot be established, these findings suggest that bone health assessment may help identify individuals at higher risk of kidney stones, especially among smokers and patients with diabetes.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"50 5","pages":"Article 501901"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148060283","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":"¿Es el Índice de Fragilidad Modificado-5 un predictor fiable de la morbilidad posoperatoria en pacientes ancianos sometidos a cistectomía radical? Un estudio comparativo con el CCI y el G8","authors":"A. Ayten,&nbsp;H. Ceylan,&nbsp;A.H. Kınık,&nbsp;M. Gelmis,&nbsp;S. Kardas","doi":"10.1016/j.acuro.2025.501902","DOIUrl":"10.1016/j.acuro.2025.501902","url":null,"abstract":"<div><h3>Objective</h3><div>In this study, the success of the Modified Frailty Index-5 (mFI-5) score in predicting postoperative morbidity in elderly patients who underwent radical cystectomy (RC) for bladder cancer was evaluated, and this score was compared with the widely used Charlson Comorbidity Index (CCI) and Geriatric 8 (G8) screening tools.</div></div><div><h3>Methods</h3><div>Between January 2017 and April 2025, 102 patients aged ≥65 years who underwent open RS for T2–T4a N0M0 bladder cancer were retrospectively reviewed. mFI-5, CCI, and G8 scores were calculated from preoperative data. Patients were divided into two groups based on mFI-5 scores: &lt;<!--> <!-->2 (Group 1, non-frail) and ≥2 (Group 2, frail). Major complications were defined as Clavien–Dindo (CD) ≥3. Clinical data, complication rates, hospital stay duration, and readmission rates after discharge were compared.</div></div><div><h3>Results</h3><div>Of the patients, 40 (39.2%) were in Group 1 and 62 (60.8%) were in Group 2. The rates of any complications and CD≥3 complications were higher in Group 2 (p<!--> <!-->=<!--> <!-->0.006 and p<!--> <!-->=<!--> <!-->0.018, respectively). In multivariate analysis, mFI-5 ≥2 approximately tripled the risk of CD≥3 complications (OR<!--> <!-->=<!--> <!-->3.036; 95% CI 0.966–9.546; p<!--> <!-->=<!--> <!-->0.043). In ROC analysis, the AUC value of mFI-5 for CD≥3 complications was 0.718 (95% CI: 0.613–0.822), which was higher than that of CCI and G8. The AUC value of mFI-5 for predicting readmission was 0.704 (95% CI: 0.599–0.810).</div></div><div><h3>Conclusion</h3><div>mFI-5 is a practical frailty assessment tool that predicts postoperative morbidity in elderly RS patients with higher accuracy than CCI and G8.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"50 5","pages":"Article 501902"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148060225","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":"Transferencia de competencias de los videojuegos a la cirugía robótica y laparoscópica: ¿es posible en la sociedad actual?","authors":"G. Fernández-Conejo","doi":"10.1016/j.acuro.2025.501813","DOIUrl":"10.1016/j.acuro.2025.501813","url":null,"abstract":"","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"50 5","pages":"Article 501813"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148060284","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":"¿Cirugía o radioterapia?: factores determinantes en la decisión terapéutica del cáncer de próstata localizado en España","authors":"J. Perez-Ardavin ,&nbsp;C.D. Vera-Donoso ,&nbsp;J.M. Alapont ,&nbsp;M. Martinez-Sarmiento ,&nbsp;J.J. Monserrat ,&nbsp;J.L. Ruíz Cerdá ,&nbsp;A.J. Conde ,&nbsp;A. Budía Alba","doi":"10.1016/j.acuro.2026.501929","DOIUrl":"10.1016/j.acuro.2026.501929","url":null,"abstract":"<div><h3>Introduction</h3><div>The choice between radical prostatectomy (RP) and radiotherapy (RT) for localized prostate cancer depends on multiple factors. The aim of this study was to describe how urologists and radiation oncologists weigh these variables when recommending primary treatment, and to develop clinical decision support algorithms.</div></div><div><h3>Methods</h3><div>An online cross-sectional survey was designed for specialists in Urology and Radiation Oncology in Spain. The questionnaire was developed ad hoc and reviewed by an expert panel. Demographic data and treatment preferences were collected using a Likert scale (1-2 RP; 3 neutral; 4-5 RT) across hypothetical clinical scenarios. Clinical consensus was defined as agreement ≥<!--> <!-->75%.</div></div><div><h3>Result</h3><div>The mean age of respondents was 41.3<!--> <!-->years (SD: 10.3), with 68.5% urologists and 31.5% radiation oncologists. Overall, in young patients (&lt;<!--> <!-->50<!--> <!-->years) with high IPSS (≥<!--> <!-->20), intravesical prostatic protrusion, Qmax &lt;<!--> <!-->10<!--> <!-->mL/s, and elevated post-void residual (PVR), the preference for surgery was high (&gt;<!--> <!-->75%) (<em>P</em> <!-->&lt;<!--> <!-->.001). In contrast, in patients older than 70<!--> <!-->years with multiple comorbidities and body mass index (BMI) &gt;<!--> <!-->35, a preference for radiotherapy (4-5) was observed in more than 75% of cases (<em>P</em> <!-->&lt;<!--> <!-->.001).</div></div><div><h3>Conclusions</h3><div>Treatment preferences for localized PCa depend primarily on age, comorbidity, and urinary symptoms, with consistent differences between specialties. These findings reinforce the need to integrate shared decision-making tools and to develop clinical decision support algorithms.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"50 5","pages":"Article 501929"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148060287","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":"Comentario sobre «Análisis de la supervivencia del dispositivo y los factores predictivos de la misma en una cohorte de pacientes intervenidos de esfínter urinario artificial masculino». Respuesta de los autores","authors":"C. Minguez Ojeda,&nbsp;A. Artiles Medina","doi":"10.1016/j.acuro.2025.501840","DOIUrl":"10.1016/j.acuro.2025.501840","url":null,"abstract":"","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"50 4","pages":"Article 501840"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147801907","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":"Impacto de la lista de espera quirúrgica en los resultados oncológicos de la prostatectomía radical en pacientes con cáncer de próstata de riesgo intermedio y alto","authors":"P. de Pablos-Rodríguez ,&nbsp;P. Guedes Oliva ,&nbsp;Á. Gómez Ferrer ,&nbsp;M. Beamud Cortés ,&nbsp;A. Wong Gutiérrez ,&nbsp;C. Gutiérrez Castañé ,&nbsp;A. Calatrava Fons ,&nbsp;J. Aliaga Patiño ,&nbsp;Á. García Cortés ,&nbsp;J. Agustín López ,&nbsp;A. Collado Serra ,&nbsp;V. Rodríguez Part ,&nbsp;J.L. Casanova Ramón Borja","doi":"10.1016/j.acuro.2025.501910","DOIUrl":"10.1016/j.acuro.2025.501910","url":null,"abstract":"<div><h3>Introduction</h3><div>The prognosis of localized prostate cancer (PCa) following radical treatment is generally favorable, although up to 46% of patients may still experience adverse outcomes. The impact of delayed surgery in intermediate-risk (IR) or high-risk (HR) patients remains under discussion. This study evaluates its association with oncological outcomes.</div></div><div><h3>Materials and methods</h3><div>Retrospective study of 2,296 patients with IR and HR PCa who underwent radical prostatectomy (RP) between 1986 and 2025. Upgrading, upstaging, positive margins, PSA persistence, and lymph node involvement were analyzed. Waiting time was grouped into &lt;<!--> <!-->3, 3–6, and &gt;<!--> <!-->6 months.</div></div><div><h3>Results</h3><div>The median waiting time was 3.5 months. Eighty-five percent of patients were operated on within 6 months. At 5 years, no difference was detected between waiting time and time to biochemical recurrence (BCR) when comparing the &lt;<!--> <!-->3-month group with the 3–6-month group (HR 0.93; 95% <span>C</span>I 0.76–1.13) and the &gt;<!--> <!-->6 months group (HR 0.74; 95% CI 0.53–1.04) among IR patients. In HR patients, no differences were observed either: 3–6 months (HR 0.85; 95% CI 0.71–1.01) and &gt;<!--> <!-->6 months (HR 0.79; 95% CI 0.61–1.03). No increased risk of adverse pathological outcomes was found with longer delays.</div></div><div><h3>Conclusions</h3><div>A waiting time of ≤<!--> <!-->6 months was not associated with worse oncological prognosis, supporting its safety in IR or HR PCa.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"50 4","pages":"Article 501910"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147801971","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":"¿Es factible el abordaje retroperitoneal utilizando la plataforma robótica de puerto único para la nefrectomía nativa tras el trasplante renal?","authors":"H.B. Haberal ,&nbsp;F.M. Valenzi ,&nbsp;V. Santarelli ,&nbsp;S. Crivellaro","doi":"10.1016/j.acuro.2025.501797","DOIUrl":"10.1016/j.acuro.2025.501797","url":null,"abstract":"","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"50 4","pages":"Article 501797"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147801906","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}