Overactive bladder management within the Spanish healthcare system faces significant challenges, including suboptimal therapeutic adherence. This consensus proposes recommendations to improve the care process (both clinical and organizational) from an adherence perspective. A Multidisciplinary Working Group of 14 members critically reviewed and discussed the literature (individually and in joint sessions) and formulated recommendations around five pillars: (1) strategic planning, with a realistic medium-term horizon and progress toward common protocols; (2) technological innovation and digitalization, enabling bidirectional communication among professionals, follow-up, clinical decision-making, and interoperability; (3) coordination and collaboration, across levels of care, healthcare professionals, and patients; (4) a focus on health outcomes and quality of life, with personalized treatments and continuous monitoring; and (5) social awareness and patient empowerment, increasing disease visibility, raising awareness among the public and patients, and fostering active patient participation.
INTRODUCTION AND OBJECTIVE: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. MATERIALS AND METHODS: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. RESULTS: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). CONCLUSIONS: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.
OBJECTIVES: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. METHODS: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. RESULTS: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. CONCLUSION: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.
OBJECTIVE:To investigate the impact of stone composition on peroperative and postoperative outcomes in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS:We retrospectively analyzed data from 152 patients who underwent PCNL at our institution between January 2020 and August 2024. Patients were divided into subgroups based on stone composition: calcium oxalate, calcium phosphate, uric acid, cystine, and struvite. We compared peroperative and postoperative outcomes, including stone-free rates, complications, and the need for auxiliary procedures, between the groups. RESULTS:The overall stone-free rate was 63.8%. When complications were grouped as minor and major according to Clavien, no statistically significant difference was found between the groups in terms of patient characteristics, stone characteristics and perioperative techniques. When patient characteristics, stone characteristics and perioperative data were compared between stone compositions, statistically significant differences were found between the groups in terms of age, gender, comorbidity, The American Society of Anesthesiologists (ASA) score, stone size and stone density. Stone-free rates varied significantly based on stone composition (p = 0.024). There was a statistically significant association between stone composition and postoperative sepsis (p < 0.001). CONCLUSION:Stone composition can significantly impact stone-free rates and postoperative complications in patients undergoing PCNL. These results underscore the importance of considering stone composition when planning PCNL and tailoring treatment strategies.
