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Introduction: Patients' decisions on prostate cancer (PCa) opportunistic screening may vary. This study aimed to assess how demographic and health-related characteristics may influence knowledge and decisions regarding PCa screening. Methods: A cross-sectional survey was conducted among men aged over 40, randomly sampled from the Spanish population, 2022. The survey underwent development and content validation using a modified Delphi method and was administered via telephone. Binomial logistic regression was used to explore the relationship between respondents' characteristics and participants' knowledge and practices concerning PCa and the PSA test. Results: Out of 1,334 men, 1,067 (80%) respondents were interviewed with a mean age of 58.6 years (sd 11.9). Most had secondary or university studies (787, 73.8%) and 61 (5.7%) self-reported their health status as bad or very bad. Most of the respondents (1,018, 95.4%) had knowledge regarding PCa with nearly 70% expressed significant concern about its potential development (720, 70.8%), particularly among those under 64 years (p = 0.001). Out of 847 respondents, 573 (67.7%) reported that they have knowledge regarding the PSA test: 374 (65.4%) reported receiving information from a clinicians, 324 (86.6%) information about the benefits of the test and 189 (49,5%) about its risks, with differences based on educational background. In a multivariable analysis (adjusted for age, educational level and previous prostate problems), respondents with higher levels of education were more likely to have higher knowledge regarding the PSA test (OR 1.75, 95%CI 1.24–2.50, p<0.001). Conclusions: Although most of the patients reported to have knowledge regarding PCa, half of the interviewed men reported knowledge about PSA test. Differences in knowledge prostate cancer screening and undesirable consequences highlight the need to develop and provide tailored information for patients. [ABSTRACT FROM AUTHOR]

Simple Summary: Controversy exists regarding prostate cancer (PC) screening using the prostate-specific antigen (PSA) test. It may reduce PC mortality risk but is associated with false-positive results. We aimed to evaluate the incidence of false-positive and false-negative results in a general clinical setting and the associated variables. We found a high rate of false-positive results (46.6%), resulting in a positive predictive value of 12.7%. Patients also showed a low rate of false-negative results (3.7%) with a negative predictive value of 99.5%. Age, alcohol intake, and having a urinary tract infection were associated with a higher probability of false-positive results; having diabetes mellitus type II was associated with a lower rate of false-positive results. This study showed a higher rate of false-positive results in clinical practice than in previous clinical trials, mainly in patients over 60 years. (1) Background: There are no real-world data evaluating the incidence of false-positive results. We analyzed the clinical and analytical factors associated with the presence of false-positive results in PSA determinations in practice. (2) Methods: A prospective cohort study of patients with a PSA test was performed in clinical practice. We followed the patients by reviewing their medical records for 2 years or until the diagnosis of PCa was reached, whichever came first. (3) Results: False-positive PSA rate was 46.8% (95% CI 44.2–49.2%) and false-negative PSA rate was 2.8% (95% CI 2–3.5%). Patients aged 61–70 years and those over 70 years were more likely to have a false-positive result than those under 45 years (aOR 2.83, 95% CI 1.06–7.55, p = 0.038, and aOR 4.62, 95% CI 1.75–12.22, p = 0.002, respectively). Patients with urinary tract infection were more likely to have a false-positive result (aOR 8.42, 95% CI 2.42–29.34, p = 0.001). Patients with diabetes mellitus were less likely to have a false-positive result (aOR 0.63, 95% CI 0.41–0.98, p = 0.038); (4) Conclusions: This study has generated relevant information that could be very useful for shared decision making in clinical practice. [ABSTRACT FROM AUTHOR]

In this paper I present an account of the many professional opportunities that today’s society offers to philologists and linguists. Based on real stories –including mine– of people dedicated to linguistics and philology (some of them authentic influencers), I show how language has become a fundamental tool for digital media and technologies, and how its good use and analysis have become essential in many areas of both the business world and research, but also as part of the image of society in general. Among the many professional channels available to philologists of these times, it is possible to highlight the following: proofreader, linguistic advisor, content creator, community manager, forensic linguist or philologist 2.0 (that is, the one dedicated to all issues related to new technologies), not forgetting that of the teacher, a crucial position to train the people of the future. In all cases, the revolutionary possibilities offered by the new media allow professions to be exercised in a completely renewed and modernized manner. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to assess the effectiveness, safety, and reproducibility of the microureteroscopy (m-URS) in the treatment of distal ureteral stones in women. Materials and Methods: A multicenter, prospective observational study was designed and conducted between March and December 2015. We included women having at least one stone in the distal ureter and being a candidate for surgical treatment using the 4.85F sheath of MicroPerc®. Patients with clinical criteria and/or laboratory analysis indicating sepsis or coagulation alteration were excluded. Results: Thirty-nine women were operated in eight hospitals. The profile of the patients was fairly homogeneous among hospitals. Only differences were found in age, preoperative stent, and the result of the previous urine culture. Immediate stone-free status was achieved in 88.2% and 100% 7 days after the procedure. 97.4% of patients did not present any complication in the postoperative period, with only one case with complication Clavien II. Postureteroscopic Lesion Scale (PULS) in 76.9% of patients did not show any injury, 20.5% had lesions grade 1, and grade 2 lesions 2.6%. As for the reproducibility of m-URS between hospitals, statistical analysis of the results showed differences between all the centers participating in the study. Conclusions: m-URS is an effective, safe, and reproducible technique that minimizes surgical aggression to the ureteral anatomy. Satisfactory and comparable results to ''conventional'' ureteroscopy were obtained in the treatment of distal ureteral stones in women, although clinical trials are needed. The reduction of the ureteral damage may reduce secondary procedures and increase the cost-effectiveness of the procedure. [ABSTRACT FROM AUTHOR]

Scientific societies have provided guidelines to reduce PSA-specific harms. We studied the potential non-compliance of PSA testing with current guidelines in general practice. A cross-sectional study of a random sample of 1291 patients with a PSA test was performed between January and April 2018 in primary health care. Patients with a previous prostate cancer diagnosis or those who were being followed-up for previous high PSA values were excluded. Two independent researchers classified whether each test was potentially non-compliant with recommendations. We estimated frequencies of potentially non-compliant PSA determinations and calculated prevalence ratios (PR) to assess their relationship with possible explanatory variables. A total of 66% (95% CI: 62–69%) of PSA requests in asymptomatic patients were potentially non-compliant with the current guideline. This was associated with having a previous diagnosis of neoplasm (PR adjusted by age and life expectancy: 1.18; 95% CI: 1.02–1.37) as well as being a current consumer of tobacco, alcohol, or other drugs (PR: 0.80; 95% CI: 0.67–0.97). Real world data shows that patients are still frequently exposed to overdiagnosis risk with a PSA potentially non-compliant with recommendations. Patients diagnosed with another neoplasm or non-consumers of toxic substances were more exposed, probably due to increased contact with doctors or health-seeking behaviour. [ABSTRACT FROM AUTHOR]

AbstractTechnologic advances in endourologic surgical material have led to improved image quality, power sources, and auxiliary material (probes, nitinol baskets, etc.). Nevertheless, this material is more expensive, especially the flexible endoscopic material—ureterorenoscopes and nephroscopes. We present a method to expand (average) mean life of flexible nephroscopes: An efficient and cheap protective cover. [ABSTRACT FROM AUTHOR]

Aim: To present state of the art on the management of urinary stones from a panel of globally recognized urolithiasis experts who met during the Experts in Stone Disease Congress in Valencia in January 2024. Options of treatment: The surgical treatment modalities of renal and ureteral stones are well defined by the guidelines of international societies, although for some index cases more alternative options are possible. For 1.5 cm renal stones, both m-PCNL and RIRS have proven to be valid treatment alternatives with comparable stone-free rates. The m-PCNL has proven to be more cost effective and requires a shorter operative time, while the RIRS has demonstrated lower morbidity in terms of blood loss and shorter recovery times. SWL has proven to be less effective at least for lower calyceal stones but has the highest safety profile. For a 6mm obstructing stone of the pelviureteric junction (PUJ) stone, SWL should be the first choice for a stone less than 1 cm, due to less invasiveness and lower risk of complications although it has a lower stone free-rate. RIRS has advantages in certain conditions such as anticoagulant treatment, obesity, or body deformity. Technical issues of the surgical procedures for stone removal: In patients receiving antithrombotic therapy, SWL, PCN and open surgery are at elevated risk of hemorrhage or perinephric hematoma. URS, is associated with less morbidity in these cases. An individualized combined evaluation of risks of bleeding and thromboembolism should determine the perioperative thromboprophylactic strategy. Pre-interventional urine culture and antibiotic therapy are mandatory although UTI treatment is becoming more challenging due to increasing resistance to routinely applied antibiotics. The use of an intrarenal urine culture and stone culture is recommended to adapt antibiotic therapy in case of postoperative infectious complications. Measurements of temperature and pressure during RIRS are vital for ensuring patient safety and optimizing surgical outcomes although techniques of measurements and methods for data analysis are still to be refined. Ureteral stents were improved by the development of new biomaterials, new coatings, and new stent designs. Topics of current research are the development of drug eluting and bioresorbable stents. Complications of endoscopic treatment: PCNL is considered the most invasive surgical option. Fever and sepsis were observed in 11 and 0.5% and need for transfusion and embolization for bleeding in 7 and 0.4%. Major complications, as colonic, splenic, liver, gall bladder and bowel injuries are quite rare but are associated with significant morbidity. Ureteroscopy causes less complications, although some of them can be severe. They depend on high pressure in the urinary tract (sepsis or renal bleeding) or application of excessive force to the urinary tract (ureteral avulsion or stricture). Diagnostic work up:  Genetic testing consents the diagnosis of monogenetic conditions causing stones. It should be carried out in children and in selected adults. In adults, monogenetic diseases can be diagnosed by systematic genetic testing in no more than 4%, when cystinuria, APRT deficiency, and xanthinuria are excluded. A reliable stone analysis by infrared spectroscopy or X-ray diffraction is mandatory and should be associated to examination of the stone under a stereomicroscope. The analysis of digital images of stones by deep convolutional neural networks in dry laboratory or during endoscopic examination could allow the classification of stones based on their color and texture. Scanning electron microscopy (SEM) in association with energy dispersive spectrometry (EDS) is another fundamental research tool for the study of kidney stones. The combination of metagenomic analysis using Next Generation Sequencing (NGS) techniques and the enhanced quantitative urine culture (EQUC) protocol can be used to evaluate the urobiome of renal stone formers. Twenty-four hour urine analysis has a place during patient evaluation together with repeated measurements of urinary pH with a digital pH meter. Urinary supersaturation is the most comprehensive physicochemical risk factor employed in urolithiasis research. Urinary macromolecules can act as both promoters or inhibitors of stone formation depending on the chemical composition of urine in which they are operating. At the moment, there are no clinical applications of macromolecules in stone management or prophylaxis. Patients should be evaluated for the association with systemic pathologies., Prophylaxis: Personalized medicine and public health interventions are complementary to prevent stone recurrence. Personalized medicine addresses a small part of stone patients with a high risk of recurrence and systemic complications requiring specific dietary and pharmacological treatment to prevent stone recurrence and complications of associated systemic diseases. The more numerous subjects who form one or a few stones during their entire lifespan should be treated by modifications of diet and lifestyle. Primary prevention by public health interventions is advisable to reduce prevalence of stones in the general population. Renal stone formers at "high-risk" for recurrence need early diagnosis to start specific treatment. Stone analysis allows the identification of most "high-risk" patients forming non-calcium stones: infection stones (struvite), uric acid and urates, cystine and other rare stones (dihydroxyadenine, xanthine). Patients at "high-risk" forming calcium stones require a more difficult diagnosis by clinical and laboratory evaluation. Particularly, patients with cystinuria and primary hyperoxaluria should be actively searched., Future Research: Application of Artificial Intelligence are promising for automated identification of ureteral stones on CT imaging, prediction of stone composition and 24-hour urinary risk factors by demographics and clinical parameters, assessment of stone composition by evaluation of endoscopic images and prediction of outcomes of stone treatments. The synergy between urologists, nephrologists, and scientists in basic kidney stone research will enhance the depth and breadth of investigations, leading to a more comprehensive understanding of kidney stone formation.

Objective: To identify barriers and facilitators of the implementation of shared decision-making (SDM) on PSA testing in primary care., Design: Systematic review of articles., Data Sources: PubMed, Scopus, Embase and Web of Science., Eligibility Criteria: Original studies published in English or Spanish that assessed the barriers to and facilitators of SDM before PSA testing in primary care were included. No time restrictions were applied., Data Extraction and Synthesis: Two review authors screened the titles, abstracts and full texts for inclusion, and assessed the quality of the included studies. A thematic synthesis of the results were performed and developed a framework. Quality assessment of the studies was based on three checklists: STROBE for quantitative cross-sectional studies, GUIDED for intervention studies and SRQR for qualitative studies., Results: The search returned 431 articles, of which we included 13: five cross-sectional studies, two intervention studies, five qualitative studies and one mixed methods study. The identified barriers included lack of time (healthcare professionals), lack of knowledge (healthcare professionals and patients), and preestablished beliefs (patients). The identified facilitators included decision-making training for professionals, education for patients and healthcare professionals, and dissemination of information., Conclusions: SDM implementation in primary care seems to be a recent field. Many of the barriers identified are modifiable, and the facilitators can be leveraged to strengthen the implementation of SDM., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

(1) Background: There are no real-world data evaluating the incidence of false-positive results. We analyzed the clinical and analytical factors associated with the presence of false-positive results in PSA determinations in practice. (2) Methods: A prospective cohort study of patients with a PSA test was performed in clinical practice. We followed the patients by reviewing their medical records for 2 years or until the diagnosis of PCa was reached, whichever came first. (3) Results: False-positive PSA rate was 46.8% (95% CI 44.2-49.2%) and false-negative PSA rate was 2.8% (95% CI 2-3.5%). Patients aged 61-70 years and those over 70 years were more likely to have a false-positive result than those under 45 years (aOR 2.83, 95% CI 1.06-7.55, p = 0.038, and aOR 4.62, 95% CI 1.75-12.22, p = 0.002, respectively). Patients with urinary tract infection were more likely to have a false-positive result (aOR 8.42, 95% CI 2.42-29.34, p = 0.001). Patients with diabetes mellitus were less likely to have a false-positive result (aOR 0.63, 95% CI 0.41-0.98, p = 0.038); (4) Conclusions: This study has generated relevant information that could be very useful for shared decision making in clinical practice.

Introduction: Medical Expulsive Treatment (MET) for ureteral stones has been questioned for the last few years., Objectives: The main goal of our study is to define the indications of MET, the different drugs that are used and their effectiveness and to propose a follow-up strategy. Secondary objectives include the effectiveness of MET in some special subgroups such as pregnant women and children and to assess aspects of MET cost-effectiveness compared with other options for ureteral lithiasis treatment (ureterorenoscopy or extracorporeal shock wave lithotripsy)., Material and Methods: We have reviewed the most relevant clinical trials and meta-analysis evaluating the impact of the different drugs available for MET. For the research we used some keywords like "medical expulsive treatment/therapy", "ureteral lithiasis", "urolithiasis", "effectiveness", "alpha-blockers" and "calcium-antagonists". MEDLINE database was used for there search (using the portal web Pubmed)., Results: Highest quality studies currently availables how significant methodological limitations leading to heterogeneous and restricted evidence, which is only applicable to patients and lithiasis with specific conditions. Nevertheless, in general terms, it seems that MET can play a certain role in the expulsion of lithiasis ≥ 5mm y ≤ 10 mm located in the distal ureter, although it has not been possible to demonstrate that any of the drugs used may have special superiority in terms of effectiveness. In pregnancy and children, the recommendations of MET are also irregular. Finally, MET seemsto be an alternative cost-effective compared to active options of treatment., Conclusions: Higher quality clinical trials are needed to reliably advice MET. With the current evidence, it appears that MET can improve the expulsion of distal ureteral lithiasis ≥ 5 mm and ≤ 10 mm, even though we have not found differences between the drugs that are available for MET.

Introduction: Renoureteral colic (CRU) is the most common urological emergency, with a wide spectrum of severity that generates high morbidity and high health costs. However, there is no homogeneous scheme of pharmacological treatment in its acutephase., Aims: The main objective of our work is to evaluate the effectiveness and safety profile of the different drugs used in the treatment of CCR and to propose a practical treatment scheme. The secondary objectives are to evaluate the role of fluid therapy in CRU and the treatment of CRU in pregnant women. MATERIAL AND METHODS: We have carried out a literature search on PubMed using the MeSH terms "renalcolic", "treatment", "anti-inflammatory drugs", "antiemeticdrugs", "fluid therapy" and "pregnant". The most relevant clinical trials, meta-analyses and systematic reviews published from 1 January 2005 to 15 September 2020 in Spanish, English and French were reviewed., Results: In the different studies reviewed, non-steroidalanti-inflammatory drugs (NSAIDs) show better pain control, with lower rescue doses and fewer side effects than treatment with opioids. However, fluid therapy has failed to demonstrate an impact on the treatment of CRU., Conclusions: The initial treatment for CRU is NSAIDs, reserving opioids for successive treatment lines. The control of vegetative cortex can be accomplished with Ondansetron as first choice.

Miniaturization of ureteroscopy materials is intended to decrease tissue damage. However, tissue hypoxia and the gross and microscopic effects on tissue have not been adequately assessed. We compared the gross and microscopic effects of micro-ureteroscopy (m-URS) and conventional ureteroscopy (URS) on the urinary tract. We employed 14 pigs of the Large White race. URS was performed in one of the ureters with an 8/9.8 F ureteroscope, while a 4.85 F m-URS sheath was used in the contralateral ureter. Gross assessment of ureteral wall damage and ureteral orifice damage was performed. For microscopic assessment hematoxylin-eosin staining and immunohistochemistry for detection of tissue hypoxia were conducted. Regarding the macroscopic assessment of ureteral damage, substantial and significant differences were recorded using URS (C = 0.8), but not with m-URS. Microscopic assessment after staining with hematoxylin-eosin revealed greater epithelial desquamation in the URS group (p < 0.05). Pimonidazole staining revealed greater hypoxia in the epithelial cells than in the remainder of the ureteral layers. We conclude that m-URS causes less damage to the ureteral orifice than URS. Histopathological findings show m-URS reduces ureteral epithelial damage compared with conventional ureteroscopy. Both URS and m-URS cause cellular hypoxia.

Micro-ureteroscopy is a novel technique derived from the need to reduce the morbidity associated with conventional ureteroscopy. Reducing morbidity, we will be able to improve quality of life of patients, for example, by shortening the times to elimination of the stones. In this article the authors intend to expose the different applications of micro ureteroscopy as well as the incipient scientific evidence on the topic.

Objective: To improve the knowledge about complications of renal transplantation and, in particular, graft rupture., Methods: Case report and literature review., Outcome: We present the case of a 37 year-old patient receiving a second renal transplant. In the third postoperative day, he suffered an abrupt change from the correct evolution, with intense pain in the left iliac fossa (the side of the implant) and hemodynamic instability. Imaging tests suggested retroperitoneal collection and adjacent to the implant. In this situation we decided reoperation, we found a ruptured renal unit and transplant nephrectomy was carried out. The pathologic study confirmed that the cause of this rupture was acute rejection of the implant., Conclusion: The rupture of the graft is one of the most serious complications in renal transplantation. Rapid diagnosis and surgical treatment are required. Conservative management is the treatment of choice for possible preservation of the renal unit, but there are some situations in which it is dangerous and removal of the graft must be carried out.

Introduction: Stab wounds of the kidney have traditionally been managed by open surgery. Nowadays the conservative management of stab wounds injuries is extended in order to avoid unnecessaries nephrectomies and laparotomies without increasing morbidity and mortality. Although there is no a strong evidence to recommend when to operate or what sort of follow up we must do., Material and Methods: We present two new cases of stab wounds injuries managed conservatively. We performed a systematic review of the literature., Results: Both patients evolved favorably although one of them presented hematuria 7 days after the traumatism and we performed an embolization of an arteriovenous fistula. Most of the articles are based on series of cases or retrosprospective studies., Conclusions: The diagnosis and staging of stab wounds of the kidney must be done with clinic and CT scan. Conservative management is required when the patient is not hemodinamically unstable and injuries do not require inmediate repair. These patients require a long-term follow up to prevent the appearance of complications. Randomized prospective multicenter trials are needed to support the optimum management for each kidney injury degree.

Aim: Adenocarcinomas of the upper urinary tract are very rare malignancies often related to primary genitourinary and extraurinary tumours. Primary adenocarcinomas are even rarer. There are no clinical guidelines for the management of primary ureteral adenocarcinoma. Our objective is to propose a management algoritm of this sort of tumours., Methods: We report a case of adenocarcinoma affecting a ureteral stump in a patient who previously underwent a nephrectomy. A review of literature is performed., Results: After the ureterectomy the pathologist diagnosed a ureteral adenocarcinoma. We performed an extension study in order to discard an extraurinary origin., Conclusions: Adenocarcinoma of the ureteral stump is a very rare malignancy. About the clinic and pathologic characterization, there is no an established reference due to the short number of previous reports. Clinical presentation may include previous nephrectomy, flank pain, dysuria, urgency and/or gross hematuria. It seem necessary the complete resection of the urinary tract when a nephrectomy is performed. Adjuvant chemotherapy can be employed with uncertain results.

Objectives: This work tries to analyze the urodynamic studies performed in patients over the age of 65 years in the Department 19 of HCAV with the aim of reviewing our activity in this population segment between January 2001 and September 2006, and to perform a clinical-urodynamic correlation which will help to find a diagnosis avoiding the need to repeat urodynamic tests., Methods: We perform a descriptive transversal study with retrospective analysis of data from patients older than 65 years who underwent urodynamic tests. Total population in this age range in our health-care department (HCD) (HCD 19) is 35.260 inhabitants (12% of total population) (Valencia health care agency. Healthcare Management HCD 19. Alicante General University Hospital. May 2005). In this population 41% are males (14.620 people) and 59% females (20.637 people)., Results: Among males, the most frequent urodynamic finding is infravesical obstruction in almost half of the cases (48%), followed by bladder hyperactivity in 197%, and idiopathic bladder hyperactivity and urgency incontinence with 10%, respectively. No reproducibilily of the symptoms reaches 9% of the cases. On the other hand, in females the most frequent finding is mixed urinary incontinence in 25% of the cases, followed by bladder hyperactivity 17%, urgency incontinence 14% and stress urinary incontinence 13%. No reproducibility of the symptoms reached 11%. In the opposite extreme are intravesical obstruction and sphincter/detrusor dyssynergia without any case., Conclusions: We find that people between 70 and 75 years old are the population group undergoing a greater number of urodynamic tests in our area. The most frequent urodynamic tests performed at our department was pressure/flow study with evaluation of post void residual. Urethra profile was reserved for recurrent stress urinary incontinence after surgery. Obstructive symptoms in males and mixed urinary incontinence in females were the most frequent causes for the indication of urodynamic tests. Our symptom no-reproduceability rates were below 10% of the cases.