{"title":"Management of incontinence after classic bladder exstrophy closure.","authors":"K Godlewski, M Davis, D Weiss, A Shukla","doi":"10.1016/j.acuroe.2025.501818","DOIUrl":"10.1016/j.acuroe.2025.501818","url":null,"abstract":"<p><strong>Introduction: </strong>Classic bladder exstrophy presents a unique challenge for reconstructive surgeons given the significant alternations it has on normal pelvic anatomy. The ultimate goal of surgery, whether in one stage or more, is simple; close the bladder, reconstruct the bladder neck and urethra, and place the unit into a more orthotopic position deep in the pelvis, and establish normal genitalia. Despite significant improvements with the success of bladder exstrophy closure, a patient's ability to volitionally void and achieve urinary continence after initial closure remain an elusive «holy grail» for bladder exstrophy surgeons. After closure many patients will endure persistent urinary incontinence post exstrophy closure. In this review, we will discuss the conservative strategies and surgical options to facilitate continence in our bladder exstrophy patients. Regardless of surgical approach or initial outcome, all patients with bladder exstrophy require lifelong urologic follow-up.</p><p><strong>Methods: </strong>A comprehensive search of electronic databases (MEDLINE, PubMed, Embase, PsycINFO and CINAHL), and citation tracking platforms (Google Scholar and Web of Science) was performed. Keywords included Classic Bladder Exstrophy, Incontinence, behavioral therapy, urotherapy, biofeedback, bulking agents, artificial urinary sphincter, bladder neck reconstruction, bladder neck closure, urinary diversion.</p><p><strong>Results: </strong>Conservative measures such as behavioral therapy, physical therapy and uropsychological counseling should be first line for the treatment of urinary incontinence after exstrophy closure. These interventions along with maturation of the child and bladder growth can improve incontinence without surgery. Patients should be counseled on the limited success of bulking agents and significant risk of erosion with sphincters. Although success after bladder neck reconstruction or bladder neck closure with or without augmentation and catheterizable channel can be variable, these surgical options can be offered to patients that have exhausted conservative treatment strategies.</p><p><strong>Conclusions: </strong>A patient's ability to volitionally void and achieve urinary continence remain an elusive goal for bladder exstrophy surgeons with many experiencing persistent urinary incontinence following exstrophy closure. Behavioral therapy, physical therapy and pyschological support should be provided to all bladder exstrophy patients and families. Giving children time to grow and mature can potentially facilitate continence without surgical intervention. If surgical intervention is pursued lifelong follow-up and monitoring is critical.</p>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"501818"},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Uretero-ureterostomy methods in ureteral duplication: Narrative review of the literature.","authors":"M Keleş, A Harun Kinik, M Selçuk Silay","doi":"10.1016/j.acuroe.2025.501817","DOIUrl":"10.1016/j.acuroe.2025.501817","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this narrative review is to evaluate the uretero-ureteral anastomosis (UUA) methods applied as a surgical option in duplicated renal systems.</p><p><strong>Material and methods: </strong>Studies evaluating pediatric patients under 18 years of age who underwent any type of uretero-ureteral anastomosis due to double collecting system were included in the review. The other surgical methods to treat duplex systems such as heminephrectomy, ureteral reimplantation and ureteral clipping were excluded. The studies found by searching the keywords «double collecting system ureter ureteral anastomosis», «double collecting system ureteroureterostomy», «duplex kidney ureter ureteral anastomosis», «duplex kidney ureteroureterostomy» in PubMed. Study design, operative measures, technique of surgery, follow-up time, key results and complications were recorded.</p><p><strong>Results: </strong>A total of 29 studies from 1967 to 2024 (including 2024) were included in the review. When the studies were analysed, there were no studies comparing the three main UUA procedures (open, laparoscopic and robot-assisted laparoscopic). In studies comparing open and robot-assisted UUA, and laparoscopic versus open techniques, minimally invasive approaches demonstrated shorter hospital stays and comparable outcomes, while operation times were similar across groups.</p><p><strong>Discussion: </strong>According to the available literature, all of the operative approaches are feasible with high success and low complication rates. However, it is not sufficient to determine the superiority of open, laparoscopic and robot-assisted laparoscopic UUA methods. Prospective comparative studies are required to elucidate the effectivity of different methods to treat duplex systems in children.</p>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"501817"},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I Selvi, M I Dönmez, N Baydilli, Y Quirroz Madarriaga, R Lammers, E Bindi, S Sforza, F O'Kelly, B Haid, B Banuelos Marco, L A T' Hoen
{"title":"Factors associated with pregnancy related complications in women with a history of vesicoureteral reflux: A systematic review by the EAU-YAU Paediatric Urology Working Group.","authors":"I Selvi, M I Dönmez, N Baydilli, Y Quirroz Madarriaga, R Lammers, E Bindi, S Sforza, F O'Kelly, B Haid, B Banuelos Marco, L A T' Hoen","doi":"10.1016/j.acuroe.2025.501821","DOIUrl":"10.1016/j.acuroe.2025.501821","url":null,"abstract":"<p><strong>Introduction: </strong>Vesicoureteral reflux (VUR) may have long lasting effects on affected individuals, especially in females. Its intertwined relationship with urinary tract infection (UTI) has been well documented and there is a further risk during pregnancy where UTIs are more problematic.</p><p><strong>Objective: </strong>To analyze existing data within the literature to identify factors associated with pregnancy-related complications in women with a history of VUR in childhood.</p><p><strong>Methods: </strong>PubMed, MEDLINE, Embase, and the Cochrane Library databases were searched to identify all published reports of pregnancy outcomes in women with a history of VUR in childhood up to January 2024 (PROSPERO Registration ID: CRD42024550470). Selection criteria included all English-language original articles reporting pregnancy outcomes (maternal and fetal morbidities) in pregnant patients with a history of VUR in childhood. After screening and eligibility assessment, 17 articles met the PICO inclusion criteria.</p><p><strong>Results: </strong>The search yielded 1060 papers, of which 17 remained after exclusions, and assessed 2349 women with a history of VUR in childhood,1167 pregnant women and a total of 2206 pregnancies. Compared with the general obstetric population, the results showed an increased rate of pregnancy-related complications (particularly febrile urinary tract infection, gestational hypertension, pre-eclampsia) in the presence of renal scarring, even if the women had undergone anti-reflux surgery in childhood, but not persistent low-grade VUR.</p><p><strong>Conclusion: </strong>Despite the lack of larger prospective randomized controlled trials with long-term follow-up, based on the findings of this systematic review, we conclude that close monitoring during pregnancy should be recommended in the presence of persistent high-grade VUR or in women with renal scarring, even if VUR has resolved.</p>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"501821"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144628483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J A Mainez, J A Galán, J M López, B Isern-Amengual, P Sanchís-Cortés
{"title":"User profile and engagement with a digital health application for urolithiasis management: A descriptive study of the first 699 users.","authors":"J A Mainez, J A Galán, J M López, B Isern-Amengual, P Sanchís-Cortés","doi":"10.1016/j.acuroe.2025.501819","DOIUrl":"10.1016/j.acuroe.2025.501819","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Urolithiasis is a prevalent urological condition that requires continuous monitoring and management to prevent recurrence. The myLit-Control® App is a digital health tool designed to support self-management by tracking urinary pH, water intake, and medication adherence. This study aimed to describe the demographic and clinical characteristics of myLit-Control® App users in Spain, analyze their engagement patterns, and evaluate adherence to health goals.</p><p><strong>Patients and methods: </strong>This retrospective observational study included users who downloaded the app between May 2022 and June 2024. Data on demographics, urinary pH tracking, water intake, and medication adherence were extracted and analyzed to explore correlations, group comparisons, and identify factors influencing adherence and outcomes.</p><p><strong>Results: </strong>The study included 699 users, with a median age of 50 years (IQR 40-59) and 57.1% male. A total of 217 users (31.0%) were taking urolithiasis-specific treatment. Urine pH monitoring was used by 52.9% of participants, with a rate of 53% (± 37) within target pH levels. Water intake tracking was the most frequently used feature, yet adherence to hydration goals remained low (15±30%). A negative correlation was observed between age and treatment adherence (r=-0.456, p<0.001).</p><p><strong>Conclusions: </strong>The myLit-Control® App facilitates urinary pH monitoring and medication adherence, supporting self-management in urolithiasis patients. However, engagement with key features, particularly water intake tracking, remains suboptimal. Future research should explore long-term outcomes and strategies to enhance patient adherence, ensuring effective integration of mHealth tools in routine clinical practice.</p>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"501819"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144628484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S Juste Álvarez, C García-Rayo Encina, C Gómez Del Cañizo, M Hernández Arroyo, A Rodríguez Antolín, F Guerrero-Ramos Félix
{"title":"Comparison of prognosis between primary and progressive muscle-invasive bladder carcinoma: A prospective analysis of long-term outcomes after radical cystectomy.","authors":"S Juste Álvarez, C García-Rayo Encina, C Gómez Del Cañizo, M Hernández Arroyo, A Rodríguez Antolín, F Guerrero-Ramos Félix","doi":"10.1016/j.acuroe.2025.501815","DOIUrl":"10.1016/j.acuroe.2025.501815","url":null,"abstract":"<p><strong>Introduction: </strong>Up to 15% of muscle-invasive bladder cancers (MIBC) arise from the progression of a non-muscle-invasive neoplasm. Despite sharing similar treatment strategies, the literature reports differences in survival rates between these two groups. This study aims to identify differences in recurrence and survival that may influence individualized treatment approaches.</p><p><strong>Material and methods: </strong>Prospective study of cystectomies performed for MIBC between 2011 and 2023, collecting demographic, diagnostic, treatment, and recurrence data (local, urothelial, or distant). A comparative and multivariate analysis was conducted.</p><p><strong>Results: </strong>We did not observe significant differences in recurrence rates between primary and progressive MIBC. However, the group with progression showed better overall survival (OS) rates at 2, 5 and 10 years (100%, 90%, 55%) compared to the primary (80%, 55%, 35%; p = 0.012), as well as better cancer-specific survival (CSS) (100%, 100%, 95% vs. 85%, 77%, 65%; p = 0.033). Independent risk factors for recurrence include pN+ (OR: 3.72) and lymphovascular invasion (LVI) (OR: 5.53). Predictors of lower OS include age, nodal involvement, LVI and relapse at any level. For CSS, predictors include nodal involvement, LVI and relapse at any level.</p><p><strong>Conclusions: </strong>In our series, patients with progressive MIBC have better OS and CSS. For both groups, pN + and LVI are independent risk factors for recurrence. Nodal involvement, LVI and relapse at any level are predictors of poorer OS and CSS.</p>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"501815"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K Weller, G M Eggenhuizen, K Zandbergen, L A 't Hoen, J Mulder, A T J I Go
{"title":"Prenatal ultrasonographic evaluation and management of renal and urogenital anomalies: A comprehensive review based on experience in a tertiary care center and literature analysis.","authors":"K Weller, G M Eggenhuizen, K Zandbergen, L A 't Hoen, J Mulder, A T J I Go","doi":"10.1016/j.acuroe.2025.501816","DOIUrl":"10.1016/j.acuroe.2025.501816","url":null,"abstract":"<p><strong>Introduction: </strong>Congenital renal and urogenital anomalies represent a major part of all congenital anomalies. These range from mild, transient conditions to severe forms leading to irreversible organ damage or perinatal mortality. Timely prenatal identification is crucial for expecting parents and their healthcare providers to decide about the continuation of a pregnancy or for careful planning of perinatal and postnatal care.</p><p><strong>Objective: </strong>To describe the most common indications for referral of fetal renal and urogenital malformations, the process of narrowing the differential diagnosis based on prenatal ultrasonography and the coordination between prenatal and postnatal care in a tertiary care center in the Netherlands.</p><p><strong>Results: </strong>The most common indications for referral of fetal renal and urogenital malformations are (1) Abnormal Renal Parenchyma, (2) Urinary Tract Dilatation, (3) Abnormal Bladder Appearance, and (4) Atypical Genitalia. In the differential diagnosis, ultrasonographic evaluation is crucial to determine the specific region of the urogenital system affected, its onset during pregnancy, and its progression throughout gestation. Integrated prenatal and postnatal care for these types of malformations relies on a multidisciplinary approach to guide parental decision-making in continuation of the pregnancy and optimize outcomes. Some cases only require routine perinatal care in secondary care centers, while complex malformations benefit from specialized planning at tertiary centers to improve outcomes.</p><p><strong>Conclusion: </strong>Dedicated ultrasonographic evaluation of fetal renal and urogenital anomalies in a tertiary care center enables accurate diagnosis and individualized care planning, particularly in complex cases. This approach provides parents with timely information, supports decision-making, and guides individualized perinatal care.</p>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"501816"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comment on \"Analysis of device survival and predictive factors in a cohort of patients undergoing male artificial urinary sphincter implantation\".","authors":"R Sah, A Mathur","doi":"10.1016/j.acuroe.2025.501811","DOIUrl":"10.1016/j.acuroe.2025.501811","url":null,"abstract":"","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"501811"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G Sánchez-Villaseñor, E A Pérez-Du Pond, I Jasso-García, S J Vázquez-Sánchez, R C García-Romero, J P Gómez-Sierra, M G Castillo-Cardiel, A S Álvarez-Villaseñor, G Cervantes-Guevara, E Cervantes-Pérez, S Ramírez-Ochoa, A González-Ojeda, C Fuentes-Orozco
{"title":"Clinical profile and risk factors identified in patients with renal cancer in Mexican population.","authors":"G Sánchez-Villaseñor, E A Pérez-Du Pond, I Jasso-García, S J Vázquez-Sánchez, R C García-Romero, J P Gómez-Sierra, M G Castillo-Cardiel, A S Álvarez-Villaseñor, G Cervantes-Guevara, E Cervantes-Pérez, S Ramírez-Ochoa, A González-Ojeda, C Fuentes-Orozco","doi":"10.1016/j.acuroe.2025.501814","DOIUrl":"10.1016/j.acuroe.2025.501814","url":null,"abstract":"<p><strong>Introduction: </strong>Renal cell carcinoma, ranked 14th in global incidence, is more common in men. Its incidence rates increase with age, peaking in individuals older than 75 years. The classic triad is present in only 17% of cases. Surgical management involves total or partial nephrectomy, both associated with potential complications.</p><p><strong>Objective: </strong>To identify the clinical profile and risk factors in patients with renal cell carcinoma.</p><p><strong>Methodology: </strong>An observational, cross-sectional, and analytical study was conducted on patients with renal cell carcinoma treated surgically in the Urology Department from January 2020 to June 2023. Demographic and clinical characteristics were analyzed in relation to TNM staging, histologic subtype, and morbidity and mortality.</p><p><strong>Results: </strong>Among 83 patients, 48 (57%) were men, with a mean age of 59.2 years (SD 10.5). Hypertension (HTN) and obesity were the most frequent comorbidities, each affecting 37 patients (44.6%). Flank pain (37 patients, 44.6%) and hematuria (23 patients, 27.7%) were the most common manifestations. Age >50 years was associated with advanced stages (p = 0.003, OR 5.744, 95% CI 1.698-19.424), while obesity was associated with a lower risk of advanced stages (p = 0.0042, OR 0.220, 95% CI 0.075-0.648). Complications of open nephrectomy included bleeding in 26 patients (38.8%) and organ injury in 2 patients (2.9%). Mortality was reported in 1 patient.</p><p><strong>Conclusion: </strong>Age >50 years is a risk factor for advanced stages, while obesity is associated with a lower risk. Hematuria and flank pain were common, whereas abdominal mass was rarely reported.</p>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"501814"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Infrared spectroscopic analysis of urinary stone composition.","authors":"X Han, Z Zhang, P Yao, X Yang","doi":"10.1016/j.acuroe.2025.501810","DOIUrl":"10.1016/j.acuroe.2025.501810","url":null,"abstract":"<p><strong>Objective: </strong>To assess the composition of urinary stones in Lanzhou area and provide a reference basis for its clinical prevention and treatment.</p><p><strong>Methods: </strong>A total of 1284 patients with urinary stones were included in the study. The differences in the distribution of stone components among different genders and ages were then analyzed.</p><p><strong>Results: </strong>The overall male-to-female ratio of the cases was 3.2:1. The average age of the patients was 45.1 ± 14.0 years old. The ratio between upper and lower urinary tract stones was 7.13:1. Mixed stone composition accounted for the majority, 79.0% (1014/1284), with calcium oxalate monohydrate + calcium oxalate dihydrate + carbonate apatite being the most prevalent at 35% (449/1284), and calcium oxalate monohydrate stones being the most prevalent of the single components at 17.8% (228/1284). Apatite carbonate 62.2% (191/307) and magnesium ammonium phosphate hexahydrate 9.8% (30/307) were significantly higher in female patients compared to apatite carbonate 55.2% (539/977) and 2.8% (27/977) in male patients. Calcium oxalate was significantly more prevalent in patients aged 18-60 years than in patients <18 and ≥60 years. The proportion of patients over the age of 60 with urinary stones (10.4%) was significantly higher than patients in other age groups.</p><p><strong>Conclusion: </strong>Urological stones in Lanzhou area are mainly of mixed type, calcium oxalate monohydrate + calcium oxalate dihydrate + carbonate apatite is the most; with the increase of patient's age, the proportion of uric acid stones increases; the distribution of urinary stone components has significant differences with different genders of patients and different age groups, which is of great significance for clinical prevention and treatment.</p>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"501810"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Transference of video game skills to robotic and laparoscopic surgery: Feasibility in contemporary practice.","authors":"G Fernández-Conejo","doi":"10.1016/j.acuroe.2025.501813","DOIUrl":"10.1016/j.acuroe.2025.501813","url":null,"abstract":"","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"501813"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}