Actas urologicas espanolas最新文献

{"title":"Imaging modalities in advanced prostate cancer: Interim analysis of the Spanish cohort of the RING registry.","authors":"D Chernysheva, E Gómez Gómez, J Burgos Revilla, G Fernández Conejo, S García Barreras, E Linares Espinós, A Gómez Villanueva, M Domínguez Esteban, A Mera Errasti, A Breda, S Fanti, A Bjartell, A R Padhani, F Sanguedolce","doi":"10.1016/j.acuroe.2026.502057","DOIUrl":"10.1016/j.acuroe.2026.502057","url":null,"abstract":"<p><strong>Introduction and objective: </strong>Despite superior accuracy of next-generation imaging (NGI) over conventional imaging (CI), its integration into prostate cancer management remains heterogeneous. We describe real-world imaging strategies for primary staging and restaging at biochemical recurrence (BCR) in the Spanish cohort of the RING registry, and identify clinical factors associated with NGI use and stage reclassification.</p><p><strong>Materials and methods: </strong>RING is a prospective, non-interventional, multicentre registry. This analysis included 213 men from six Spanish centres (January 2025-January 2026) undergoing imaging for primary staging (n = 156) or BCR restaging (n = 57). Logistic regression evaluated predictors of NGI use and escalation to NGI after CI.</p><p><strong>Results: </strong>Overall, 63/213 (29.6%) underwent CI only, 114/213 (53.5%) NGI only, and 36/213 (16.9%) both modalities. Among treatment-naïve patients, ISUP ≥ 4 independently predicted NGI use (adjusted OR 3.86, 95% CI 1.35-12.2; p = 0.015). In the BCR cohort, NGI predominated (89.5%). In the both-imaging subgroup (n = 36), CI-to-NGI escalation occurred in 33/36 (91.7%), with stage migration in 16/33 (48.5%): 7 upgrades (43.8%) and 9 downgrades (56.2%). Predictors of escalation were ISUP ≥ 4 (adjusted OR 7.3, 95% CI 1.81-37.5; p = 0.009), higher PSA (OR 1.9 per log2 doubling; p = 0.047), and younger age (OR 0.89/year; p = 0.017).</p><p><strong>Conclusions: </strong>NGI was the dominant strategy at BCR and in high-grade primary disease. When added after indeterminate CI, NGI reclassified staging in nearly half of patients, with both upgrades and downgrades observed. Further registry follow-up will determine whether imaging pathway influences treatment decisions and long-term patient outcomes.</p>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"502057"},"PeriodicalIF":0.0,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687353","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":"External validation of six scoring systems for predicting retrograde intrarenal surgery outcomes in obese patients.","authors":"Ergun Alma, Adem Altunkol, Hakan Anıl, Umit Uysal, Okan Arslan, Gökay Çetinkökü, Mahmut Eşsizoğlu, Ediz Vuruşkan, Mehmet Reşit Gören","doi":"10.1016/j.acuroe.2026.502058","DOIUrl":"10.1016/j.acuroe.2026.502058","url":null,"abstract":"<p><strong>Objectives: </strong>To determine which scoring systems are most effective in predicting stone-free rates after retrograde intrarenal surgery in our own obese patient group and the factors that may influence this rate.</p><p><strong>Methods: </strong>a total of 251 patients were included in the study. Patients were divided into two groups, stone-free and nonstone-free, on the basis of the presence of residual stones. Patient characteristics such as age, sex, body mass index, e-GFR, and stone laterality were recorded. The characteristics of the stone and the operated kidney included stone diameter, laterality, volume, location, opacity, hounsfield unit, operative time, multiple stones, the presence of multiple calyceal stones, the infundibulopelvic angle, and the renal infundibular length.</p><p><strong>Results: </strong>210 patients (83.7%) were stone free postoperatively, whereas 41 patients (16.3%) had residual fragments. patients with residual stones had significantly larger median stone diameters (20 mm vs. 13 mm, p < 0.001) and greater stone volumes (1560 mm³ vs. 758 mm³, p < 0.001). Multiple stones (60% vs. 19.4%, p < 0.001) and multiple calyceal involvement (57.5% vs. 16.6%, p < 0.001) were also more frequently observed in patients with residual fragments. All five stone scoring systems, R.I.R.S., RUSS, ITO, STONE and T.O.HO presented significantly higher median scores in the residual group than in the stone-free group. TOHO score exhibited the strongest discriminatory performance.</p><p><strong>Conclusion: </strong>All scoring systems except the modified S-ReSC system were found to be effective in predicting the SFR, with stone diameter, multiple stones, and TOHO scoring system playing a leading role in this predictive accuracy.</p>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"502058"},"PeriodicalIF":0.0,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681864","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":"Urinary incontinence after treatment for localized prostate cancer: A systematic review and meta-analysis.","authors":"A P Amaris Vanegas, D C Cabrera Díaz, J D Salgar Prada, J V Sánchez Moreno, D P Gómez Rodríguez","doi":"10.1016/j.acuroe.2026.502060","DOIUrl":"10.1016/j.acuroe.2026.502060","url":null,"abstract":"<p><strong>Introduction: </strong>Urinary incontinence is one of the most common functional complications following curative treatment for localized prostate cancer, with incidence varying across treatment modalities.</p><p><strong>Objective: </strong>To compare the incidence of urinary incontinence following radical prostatectomy versus radiotherapy or brachytherapy.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 statement. A literature search was performed in MEDLINE (via PubMed), Embase, and LILACS from database inception through February 2026. Randomized controlled trials and observational studies evaluating urinary incontinence in patients with localized prostate cancer treated with curative intent were included. Risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects model (DerSimonian-Laird method). The protocol was registered in PROSPERO (CRD420261345996).</p><p><strong>Results: </strong>Eighteen studies were included in the qualitative synthesis, and nine comparative studies comprising 10,208 participants were included in the meta-analysis. Radical prostatectomy was associated with a higher risk of urinary incontinence compared with radiotherapy or brachytherapy (RR = 2.74; 95% CI: 2.03-3.68; P < .001). Substantial heterogeneity was observed across studies (I² = 80.3%). Sensitivity analyses showed consistent results, and no evidence of publication bias was identified.</p><p><strong>Conclusions: </strong>Radical prostatectomy is associated with a higher risk of urinary incontinence compared with radiotherapy modalities in patients with localized prostate cancer. These findings highlight the importance of incorporating functional outcomes into shared decision-making.</p>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"502060"},"PeriodicalIF":0.0,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687360","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":"Real-world treatment of oligometastatic hormone-sensitive prostate cancer: impact of androgen receptor pathway inhibitors, metastasis-directed therapy and primary tumor radiotherapy on survival.","authors":"P M Samper Ots, D González Santos, E González Del Portillo, A Valcárcel Díaz, O Engel, E Amaya Escobar, M Sánchez Encinas, H Gimbernat Diaz, C Blázquez Vallejo, A Husillos Alonso, D Ramírez Martín, E Useros Rodríguez","doi":"10.1016/j.acuroe.2026.502033","DOIUrl":"10.1016/j.acuroe.2026.502033","url":null,"abstract":"<p><strong>Introduction: </strong>The management of oligometastatic hormone-sensitive prostate cancer (omHSPC) has evolved with the introduction of androgen receptor pathway inhibitors (ARPi) and the increasing use of local therapies. However, evidence on the combined impact of systemic intensification and local treatment strategies in real-world settings remains limited.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study including patients with histologically confirmed omHSPC (≤5 metastatic lesions) treated between 2014 and 2023. Treatments included androgen deprivation therapy (ADT) alone or combined with ARPi, prostate radiotherapy (RTp) in de novo metastatic disease, and metastasis-directed therapy (MDT) using stereotactic body radiotherapy. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier methods.</p><p><strong>Results: </strong>Eighty-three patients were included; 28.9% presented with synchronous and 71.1% with metachronous disease. Treatment with ADT plus ARPi was associated with significantly longer PFS and OS compared with ADT alone. These differences persisted after excluding patients with pelvic nodal oligorecurrence. MDT alone was not associated with improved survival outcomes; however, the combination of MDT and ARPi was associated with longer PFS and OS compared with MDT without ARPi. In patients with de novo disease, RTp did not independently improve survival but was associated with longer OS when combined with ARPi. Treatment-related toxicity was low, with no unexpected adverse events.</p><p><strong>Conclusions: </strong>In this real-world series of omHSPC, systemic intensification with ARPi was associated with improved clinical outcomes. The combination of ARPi with local therapies such as RTp or MDT may provide additional benefit; however, these findings should be interpreted with caution and warrant prospective validation.</p>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"502033"},"PeriodicalIF":0.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671745","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":"Do aspiration-assisted access sheaths improve outcomes in miniaturized percutaneous nephrolithotomy? A systematic review and meta-analysis.","authors":"M E Martínez-Corral, C Fernández-Baltar, R Martínez-Corral, D A Pérez-Fentes","doi":"10.1016/j.acuroe.2026.502031","DOIUrl":"10.1016/j.acuroe.2026.502031","url":null,"abstract":"<p><strong>Objective: </strong>To compare vacuum-assisted and conventional percutaneous access sheaths used during miniaturized percutaneous nephrolithotomy (mini-PCNL), evaluating their efficacy and safety.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and prospectively registered in PROSPERO (CRD420251272303). PubMed, Web of Science, and Scopus were searched to identify randomized controlled trials and comparative observational studies evaluating vacuum-assisted (vm-PCNL) versus conventional mini-PCNL (cm-PCNL). Primary outcomes were stone-free rate and overall postoperative complications. Secondary outcomes included operative time, length of hospital stay, and the need for ancillary procedures. Quantitative synthesis was performed using random-effects models with Review Manager version 5.4.</p><p><strong>Results: </strong>Nineteen studies comprising 4079 patients were included. Stone-free rate was significantly higher in the vm-PCNL group compared with cm-PCNL (RR = 1.09; p = 0.0001). Vacuum-assisted techniques were associated with significantly lower rates of overall complications (RR = 0.56, p < 0.00001), infectious complications (RR = 0.50, p < 0.00001), and hemorrhagic complications (RR = 0.61, p = 0.03). Operative time was significantly shorter with vm-PCNL, with a mean reduction of 17.5 min (p < 0.00001). No statistically significant difference was observed in length of hospital stay (p = 0.06). In addition, vm-PCNL was associated with a lower need for ancillary procedures (RR = 0.59, p = 0.002).</p><p><strong>Conclusions: </strong>Vacuum-assisted percutaneous access sheaths are associated with improved efficacy and safety outcomes during mini-PCNL compared with conventional sheaths. The available evidence supports their role in enhancing stone clearance, reducing postoperative morbidity, and improving operative efficiency, and suggests that suction-assisted access sheaths should be strongly considered in contemporary mini-PCNL practice, particularly in settings where effective intrarenal pressure control and efficient fragment evacuation are critical.</p>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"502031"},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537995","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":"Association between postoperative JJ stent duration and stone-free rates after retrograde intrarenal surgery: a large retrospective cohort study.","authors":"M F Şahin, Ç Doğan, F B Tuncer, H S Dayısoylu, M S Köroğlu, O Orbeği, E Öztürk, R Özcan, C M Yazici","doi":"10.1016/j.acuroe.2026.502034","DOIUrl":"10.1016/j.acuroe.2026.502034","url":null,"abstract":"<p><strong>Objective: </strong>Routine JJ stenting after retrograde intrarenal surgery (RIRS) is common, however the optimal postoperative stent dwelling period to maximize stone-free rate (SFR) remains unclear. This study evaluated the effect of different postoperative JJ stent durations on SFR after RIRS.</p><p><strong>Methods: </strong>In this single-center retrospective cohort study, 665 patients who underwent RIRS between August 2022 and May 2025 were analyzed. All patients received a postoperative JJ stent and were categorized by stent duration: Group 1 (0-30 days), Group 2 (31-60 days), Group 3 (61-90 days), and Group 4 (>90 days). Demographics, stone characteristics, perioperative variables, and SFR-assessed by non-contrast computed tomography one week after stent removal-were compared. Residual fragments >4 mm were considered unsuccessful; outcomes were further stratified into three groups as: no residual fragment, 0-2 mm, and 2.1-4 mm residual fragments. ROC and Youden index analyses were used to explore whether a postoperative stent-duration interval was associated with higher observed SFR.</p><p><strong>Results: </strong>Groups included 286, 178, 85, and 116 patients, respectively. Baseline characteristics were comparable. The SFR was statistically significantly higher in Group 1 (75.2%) compared to the other groups (p = 0.006). Postoperative complications, hospitalization time, and operation duration were also similar (all p > 0.05). ROC analysis revealed a 26-27-day interval associated with the highest SFR, although discriminatory performance was modest (AUC: 0.595, p < 0.001) indicating that this finding should be interpreted as exploratory rather than a validated clinical threshold. Multivariate analysis revealed no additional factors other than stent duration affecting SFR.</p><p><strong>Conclusion: </strong>. Earlier postoperative JJ stent removal within the first month was associated with higher SFR in this cohort; however, this association should be interpreted cautiously given the modest discriminatory performance observed in ROC analysis. Prolonged stenting beyond approximately 4 weeks does not improve SFR or reduce complications. Prospective randomized trials are needed to validate these findings.</p>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"502034"},"PeriodicalIF":0.0,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148498615","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":"Beyond age: Outcomes and predictors of complications after endoscopic lithotripsy in patients ≥ 85 years old.","authors":"A Bravo-Balado, L Diéguez, A K Kanashiro, A Farré, P Verri, P Diana, L Fila, P Izquierdo, F Millán, F Sánchez-Martín, E Emiliani, O Angerri","doi":"10.1016/j.acuroe.2026.502002","DOIUrl":"10.1016/j.acuroe.2026.502002","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to evaluate the effectiveness and safety of endoscopic lithotripsy in patients aged ≥85 years in a high-volume tertiary center.</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted on patients aged ≥85 years who underwent endoscopic lithotripsy between 2009-2025. Preoperative, intraoperative, and postoperative variables were analyzed. Multivariate logistic regression was used to identify factors associated with complications.</p><p><strong>Results: </strong>Sixty-five patients were included; the median age was 87 years, with a median age-adjusted Charlson Comorbidity Index (aCCI) of 5, and 75.4% had ASA ≥ 3. The median stone size was 11.5 mm. Procedures performed included ureteroscopy (URS) (55.4%), retrograde intrarenal surgery (RIRS) (36.9%), percutaneous nephrolithotomy (PCNL) (4.6%), endoscopic combined intrarenal surgery (ECIRS) (1.5%), and antegrade URS (1.5%). The median operative time and hospital stay were 93.5 min and 2 days, respectively. Postoperative complications occurred in 47.7% of patients, most commonly fever (n = 16) and sepsis (n = 12). Three patients experienced Clavien-Dindo IVa complications, and two died due to septic shock. The stone-free rate (SFR) was 75.4%. Longer operative time (OR = 1.034, p = 0.001) and higher aCCI (OR = 1.716, p = 0.027) were significantly associated with complications. ROC analysis showed operative time ≥73 min and aCCI ≥5 were optimal cut-off points for developing complications, yielding high sensitivity (86.7% and 90.0%) but modest specificity (47.1% and 29.4%).</p><p><strong>Conclusions: </strong>Endoscopic lithotripsy in patients aged ≥85 years is feasible and achieves satisfactory SFR; however, it carries substantial risk of postoperative complications, including potentially life-threatening events. Patient selection based on comorbidity burden is essential. Operative time was associated with complications; although it may reflect procedural complexity, efforts to optimize surgical efficiency may help reduce postoperative complications in this vulnerable population.</p>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"502002"},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407549","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":"Incremental value of binary PSMA PET nodal status when added to Briganti-2019 and MSKCC models for predicting pathologic lymph node metastasis in prostate cancer.","authors":"S Cetin, S Sozen, B Sahin, E Suer, S Yazici, G Aslan, A Bugra Senturk, L Turkeri","doi":"10.1016/j.acuroe.2026.502004","DOIUrl":"10.1016/j.acuroe.2026.502004","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether adding PSMA PET-detected lymph node involvement to established nomograms (Briganti-2019 and MSKCC) improves prediction of pathologic lymph node metastasis(LNM) in prostate cancer.</p><p><strong>Materials and methods: </strong>Retrospective, registry-based, multi-center cohort coordinated by the Turkish Urooncology Association, with data from 10 centers. We included 301 men undergoing radical prostatectomy with extended pelvic lymph node dissection (ePLND) and preoperative 68Ga-PSMA PET/CT. For each nomogram, we fitted a baseline model and a model with the addition of PSMA PET nodal involvement (positive/negative). Discrimination (AUC) was compared using the DeLong test; model fit with the likelihood-ratio (LR) test; clinical utility with decision curve analysis (DCA).</p><p><strong>Results: </strong>For Briganti-2019, AUC numerically increased from 0.744 to 0.828 (ΔAUC +0.084; DeLong P = .342), with improved fit (Δ-2LL 12.633; P < .001). For MSKCC, AUC numerically increased from 0.813 to 0.830 (ΔAUC +0.017; DeLong P = .620), with better fit (Δ-2LL 9.306; P = .002). DCA showed a consistent net-benefit gain for Briganti-2019 with PSMA PET across 5%-20% thresholds (largest around 15%), whereas gains for MSKCC were modest and confined to higher thresholds.</p><p><strong>Conclusion: </strong>Adding PSMA PET/CT nodal status improved model fit and suggested potential incremental clinical utility, particularly for Briganti-2019; however, statistically significant improvement in discrimination was not demonstrated by DeLong testing. PSMA PET/CT and clinical nomograms may be considered complementary tools for selecting candidates for ePLND.</p>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"502004"},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407587","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":"Flexible ureteroscopy using the novel 6.3 flexible ureteroscope. Does it affect the intrarenal fluid temperature? An in vivo experimental study.","authors":"A Peteinaris, V Tatanis, A Vagionis, T Spinos, B Ballesta Martinez, A Tsaturyan, V Tsekoura, P Katsakiori, E Liatsikos, T Vrettos, P Kallidonis","doi":"10.1016/j.acuroe.2026.502006","DOIUrl":"10.1016/j.acuroe.2026.502006","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate intrarenal fluid temperature (IFT) changes during high-power Holmium:YAG (Ho: YAG) laser activation using a 6.3 Fr single-use ureteroscope in an in vivo porcine model replicating human anatomy.</p><p><strong>Methods: </strong>Three female pigs underwent flexible ureteroscopy with and without ureteral access sheath (UAS), and with or without artificial stone presence. A 150 W Ho:YAG laser was applied at varying energy settings (10 W to 60 W) using a 200 μm fiber. IFT was recorded continuously for 30 s per condition using a thermocouple. A total of 192 measurements were analyzed, with 43 °C set as the thermal injury threshold.</p><p><strong>Results: </strong>Across all configurations, IFT remained below 43 °C. Higher laser settings (40 W and 60 W) were associated with statistically significant IFT increases (P < .01), but without surpassing cytotoxic thresholds. The use of UAS consistently reduced IFT compared to conditions without a ureteral access sheath. The presence of stone slightly attenuated the temperature rise, potentially due to partial laser energy absorption. The 6.3 Fr ureteroscope demonstrated favorable safety across scenarios.</p><p><strong>Conclusion: </strong>In this in vivo model simulating renal anatomy, high-power Ho:YAG lithotripsy with the 6.3 Fr single-use ureteroscope did not result in thermal injury. UAS use and proper irrigation remain essential to controlling IFT. Findings suggest that device miniaturization combined with procedural awareness can enhance safety during high-power lithotripsy. Further clinical validation is warranted.</p>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"502006"},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407598","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":"Comparison of different encrustation severity scores for residual stone fragments after encrusted double J stent removal.","authors":"Serdar Basboga, Ahmet Burak Yilmaz, Kamal Karimzada, Ali Yasin Ozercan, Tanju Keten, Ozer Guzel, Altug Tuncel","doi":"10.1016/j.acuroe.2026.502003","DOIUrl":"10.1016/j.acuroe.2026.502003","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between commonly used encrustation severity scoring systems and residual stone fragments following encrusted double-J stent removal.</p><p><strong>Materials and methods: </strong>Between January 2019 and January 2023, 1572 patients who underwent surgery for urolithiasis were retrospectively reviewed. Fifty-eight patients (3.6%) with encrusted double-J stents met the inclusion criteria. Patients were categorized into two groups based on non-contrast computed tomography findings four to six weeks after double-J stent removal: residual stone fragments (>3 mm) (n = 7) and stone-free status (n = 51). Encrustation severity was assessed using the Forgotten-Encrusted-Calcified (FECal) classification, Kidney-Ureter-Bladder (KUB) score, Visual Grading for Ureteral Encrusted Stent (V-GUES) system, and Encrustation Burden Score (EBS). Clinical variables and operative outcomes were compared, and predictors of residual fragments were analyzed using logistic regression analyses.</p><p><strong>Results: </strong>Baseline demographic and clinical characteristics were comparable between groups (all p > 0.05). Patients with residual fragments had significantly higher encrustation burden (p = 0.022) and longer operative duration (p = 0.034). V-GUES and EBS were significantly higher in the residual group (p < 0.001 and p = 0.022, respectively), whereas FECal and KUB scores did not differ significantly between groups. In univariate analysis, both V-GUES score (OR: 3.299, p = 0.019) and EBS (OR: 1.006, p = 0.032) were associated with residual stone fragments. However, no variable remained statistically significant in multivariate analysis, likely due to the limited number of residual stone events.</p><p><strong>Conclusion: </strong>V-GUES score and EBS differed significantly between groups. Although both were associated with residual fragments in univariate analyses, these associations did not remain in multivariate models.</p>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":" ","pages":"502003"},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407572","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}