Prioritising Data Quality Governance for AI in Prostate Cancer: A Methodological Proof-of-Concept Study Using Neural Networks for Risk Stratification Vanessa Talavera-Cobo, Jose Enrique Robles-Garcia, Francisco Guillen-Grima, Andres Calva-Lopez, Mario Tapia-Tapia, et al. Diagnostics, 2026 Background: An accurate D’Amico risk stratification is mandatory for prostate cancer (PCa) management. The purpose of this proof-of-concept study was to establish a methodological framework for integrating validated clinical nomograms with strict data-quality governance in order to generate reliable artificial neural networks (ANNs), even when the sample is small. Methods: We performed a retrospective analysis of a curated cohort of 49 patients from one centre. A multilayer perceptron (MLP) was trained using 11 variables, including the ISUP biopsy grade and Briganti nomogram. Model development was guided by a proactive data-quality protocol based on FAIR principles—the DQG-AI framework (data quality governance for AI-readiness, developed at Clínica Universidad de Navarra)—with stringent checks for accuracy, consistency and validity to ensure data were “AI-ready”. A sensitivity analysis was conducted on three data partitioning scenarios (20/80, 34/66 and 39/61). Results: From a starting pool of 76 patients, the DQG-AI framework was applied to create a highly selected cohort of 49 patients. A multilayer perceptron (MLP) trained on this “AI-ready” dataset achieved, on the 20/80 configuration, mathematically perfect discrimination (AUC 1.000; 100% accuracy) for High vs. Intermediate risk groups on a very small refined internal test set (N = 9), a figure we interpret as a methodological artefact of the curated dataset and validation constraints rather than as an indicator of true model performance. This complete accuracy is not, however, presented as evidence of generalizable clinical utility: it is a best-case figure obtained on a single, very small test subset (N = 9) after necessary validation-related exclusions, and the wide confidence interval (66.4–100%), together with the software-driven removal of test cases carrying factor levels absent from the training set (detailed in the Methods section), explicitly preclude any inference about real-world performance. Accordingly, the deliverable of this proof-of-concept study is the DQG-AI framework itself, not the model’s reported accuracy. Conclusions: The main contribution of this proof-of-concept study is the effective illustration of the DQG-AI framework as a strict, repeatable approach for producing “AI-ready” urological datasets. Although the MLP demonstrated a robust internal signal for risk discrimination, its flawless accuracy is an ideal, non-generalizable situation. The most important deliverable that needs external validation is the DQG-AI framework, not the model’s performance metrics. A pre-specified three-phase multi-institutional validation roadmap (single-centre cohort expansion → within-system between-site validation → Spanish multi-centre external validation), with a minimum target of ~220 evaluable patients derived from a 10-events-per-predictor floor, is provided to operationalise this external validation.
Diagnostic Accuracy of PSMA-PET/CT vs. mpMRI in Primary Staging of Intermediate- and High-Risk Prostate Cancer Vanessa Talavera Cobo, Carlos Andres Yánez Ruiz, Mario Daniel Tapia Tapia, Andres Calva Lopez, Carmina Alejandra Muñoz Bastidas, et al. Medical Sciences, 2026 Background: Prostate-specific membrane antigen (PSMA) is markedly overexpressed in prostate cancer (PCa), and there is growing evidence to support its usefulness in initial diagnostic assessments. This study compares the diagnostic performance of PSMA positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (mpMRI) in evaluating seminal vesicle invasion (SVI), extraprostatic extension (EPE), and pelvic lymph node involvement before radical prostatectomy. Methods: A retrospective, single-institution analysis was performed. From a cohort of 325 patients who underwent radical prostatectomy between June 2022 to November 2024, 85 had undergone preoperative PSMA PET/CT for intermediate- and high-risk disease at biopsy, forming our study group. Two blinded specialists, one in radiology and one in nuclear medicine, independently interpreted the scans, using histopathological results as the reference standard. The primary outcome was diagnostic accuracy for T- and N-stage classification, while the secondary outcomes included the correct identification of the index lesion and comparative performance for each modality. Results: The study cohort comprised patients with intermediate-to-high-risk prostate cancer (median age: 66 years; median PSA level: 11.6 ng/mL; median PSA density: 0.3 ng/mL/cm3). Forty-eight patients presented with an ISUP grade of 3 or higher on biopsy. PSMA PET/CT was more sensitive than MRI for detecting EPE (72.2% vs. 46.9%) and nodal metastases (91.7% vs. 8.3%). Furthermore, PSMA PET/CT demonstrated significantly higher concordance with histopathological findings in index tumor localization (76.5% vs. 67.9%, p < 0.001). An exploratory analysis revealed a potential age-dependent pattern, but this requires confirmation in larger studies. Conclusions: In this select cohort, PSMA PET/CT demonstrated greater accuracy than MRI for locoregional staging in patients with intermediate-to-high-risk prostate cancer (PCa). However, the generalizability of these findings is limited by the retrospective design and potential selection bias. These results suggest that PSMA PET/CT may have a valuable role in the initial staging workflow, but this needs to be confirmed in larger, prospective studies. An exploratory analysis suggested a potential age-dependent pattern, but this requires confirmation in larger studies.
Intracavernosal Botulinum Toxin Injection for Erectile Dysfunction: A Comprehensive Systematic Review Vanessa Talavera Cobo, Carlos Andres Yanez Ruiz, Mario Daniel Tapia Tapia, Andres Calva Lopez, Carmina Alejandra Muñoz Bastidas, et al. Life, 2025 Background: Erectile dysfunction (ED) affects approximately 20% of men worldwide, significantly affecting their quality of life. While phosphodiesterase type 5 inhibitors (PDE5-Is) are the standard first-line treatment, a substantial number of patients are non-responders. Second-line treatments, such as intracavernosal alprostadil, are effective but often limited by their invasive nature and the need for frequent injections. Intracavernosal onabotulinumtoxinA (BoNT-A) offers a promising new option. By inhibiting acetylcholine release and norepinephrine, as well as other neurotransmitters involved in detumescence, it facilitates cavernosal smooth muscle relaxation and enhances penile blood flow. Its effects may persist for up to six months following a single injection, potentially reducing treatment burden and improving adherence among men with refractory ED. Methods: A systematic review was performed in accordance with the PRISMA guidelines. Literature searches were conducted in PubMed, Embase, Cochrane Library, Scopus, and Clinicaltrials.gov from inception until August 2025 using a combination of keywords and MeSH terms related to ‘erectile dysfunction’ and ‘botulinum toxin’. After screening, 51 studies met the inclusion criteria. Due to significant heterogeneity in interventions (e.g., BoNT-A dosage, co-therapies), patient populations, and reported outcomes, the data were not suitable for meta-analysis. Consequently, a narrative synthesis was performed to summarize the findings. Results: Among the included studies, intracavernosal BoNT-A was associated with improvements in validated erectile function scores. Reported response rates, variably defined across studies, ranged from 40% to 77.5%. Several studies suggested that efficacy was higher in patients with mild-to-moderate ED and with repeated administration of 100 U doses. The treatment exhibited a favorable safety profile. The most common adverse event was mild, transient penile pain (reported incidence 1.5–6%). No studies reported serious systemic adverse events. The overall strength of the evidence was limited by significant heterogeneity among the included studies and their generally small sample sizes. Conclusions: Based on this systematic review, intracavernosal onabotulinumtoxinA (BoNT-A) may be a beneficial therapeutic option for patients with refractory ED, offering potential improvements in sexual function while reducing the need for invasive therapies. Future large-scale, placebo-controlled studies are essential to confirm these benefits and standardize their clinical application.
Does Oxygen Work? Evidence for Oxygenation During Kidney Graft Preservation: A Review Andres Calva Lopez, Jose Enrique Robles Garcia, Carlos Andres Yanez Ruiz, Mario Daniel Tapia Tapia, Vanessa Talavera Cobo, et al. Journal of Clinical Medicine, 2025 Kidney transplantation (KT) is the gold-standard treatment of end-stage kidney disease (ESKD). Traditional preservation methods, such as static cold storage (SCS), have been replaced by modern and more effective preservation methods, especially hypothermic machine perfusion (HMP). Regardless of improved preservation, ischemia-reperfusion injury (IRI) is inevitable, limiting graft functionality through delayed graft function (DGF) and graft survival. Supplementing the ischemic kidney graft with oxygen during hypothermic preservation has been used in different methods as an attempt to counteract IRI and its effects on graft function and survival. Various oxygenation methods have been studied, from adaptations of classic and well-known preservation strategies, like the addition of oxygen carriers to SCS, or more innovative preservation methods, like hyperbaric oxygenation or retrograde oxygen persufflation. In this review, we will attempt to provide a summary of the available evidence on oxygen carriers, hyperbaric oxygenation, the two-layer method, retrograde oxygen persufflation, and hypothermic oxygenated machine perfusion (HOPE) and discuss the effect these strategies have on kidney graft functionality.
The Evolution of Kidney Graft Preservation Through the Years Andres Calva Lopez, Jose Enrique Robles Garcia, Carlos Andres Yanez Ruiz, Mario Daniel Tapia Tapia, Vanessa Talavera Cobo, et al. Life, 2024 Chronic kidney disease (CKD) is a prevalent disease affecting almost 10% of the world’s population, with many cases progressing to end-stage kidney disease (ESKD). Kidney transplantation (KT) is the gold-standard treatment for ESKD. Due to growing KT waitlists, the deceased kidney donor (DKDs) criteria have expanded to increase the number of available kidney grafts. Kidney graft preservation ensures optimal graft function after KT. Static cold storage (SCS) as a preservation method is still widely used. Hypothermic machine perfusion (HMP) has proven to decrease delayed graft function (DGF) and increase graft survival. Most recent studies advocate for the use of HMP regardless of donor type. However, emerging technologies, such as hypothermic oxygenated machine perfusion (HOPE) and normothermic machine perfusion (NMP), have shown promising results in specific scenarios. This review aims to provide a summary of the well-established kidney graft preservation methods and their outcomes, as well as novel technological advances that allow for newer preservation strategies.
Graft survival and delayed graft function with normothermic regional perfusion and rapid recovery after circulatory death in kidney transplantation: a propensity score matching study Joseba SALGUERO, Laura CHAMORRO, Enrique GÓMEZ-GÓMEZ, José E. ROBLES, Juan P. CAMPOS Minerva Urology and Nephrology, 2024 BACKGROUND A shortage of kidney grafts has led to the implementation of various strategies, including donations after circulatory death. The in situ normothermic regional perfusion technique has been introduced to improve graft quality by reducing warm ischemia times. However, there is limited evidence available on its mid- and long-term outcomes. Therefore, this study aimed to compare the incidence of delayed graft function, graft function, and survival at three years among three groups: brain death donors, rapid recovery, and normothermic regional perfusion. METHODS A retrospective analysis of a cohort of kidney transplantations was conducted at a single referral center between January 1, 2015, and December 31, 2019. Univariate and multivariate regression models and propensity score matching analysis were performed to compare recipient-related, transplantation procedure-related, donor-related, and kidney function variables. RESULTS A total of 327 patients were included, with 256 kidneys from brain death donors, 52 kidneys from rapid recovery, and 19 patients from normothermic regional perfusion. After propensity score matching, univariate and multivariate analyses showed a higher incidence of delayed graft function in the rapid recovery group compared to the others (OR: 2.39 CI95%: 1.19, 4.77) with a longer hospital stay (median 11, 15 and 10 days, respectively). However, no differences in 1- and 3-year graft function and survival were found. CONCLUSIONS Normothermic regional perfusion offers advantages over rapid recovery, with a reduced incidence of delayed graft function and a shorter hospital stay. However, no differences in mid-term graft function and survival were found.
Kidney Survival Impact of Delayed Graft Function Depends on Kidney Donor Risk Index: A Single-Center Cohort Study Joseba Salguero, Laura Chamorro, Enrique Gómez-Gómez, Patricia de Benito, Jose E. Robles, et al. Journal of Clinical Medicine, 2023 Background: Delayed graft function (DGF) is a significant challenge in renal transplantation, particularly with deceased donors, necessitating early postoperative dialysis. The prolonged effects of medium- and long-term DGF remain uncertain, marked by contradictory graft survival outcomes. This incongruity might arise from the inherent graft resilience and regenerative capacity during transplantation. This study investigates DGF’s impact on graft survival, focusing on grafts displaying favorable (KDRI < 1) and unfavorable outcomes (KDRI ≥ 1). Methods: In this retrospective cohort study (January 2015–December 2019), we assessed kidney transplants at our center, excluding multiorgan simultaneous cases, primary non-functioning grafts, and surgical complications causing graft loss. Patients were categorized into DGF presence or absence groups. Univariate and multivariate analyses, alongside propensity score matching (PSM), were performed. Results: The study encompassed 322 deceased donor kidneys, with 83 encountering DGF. Grafts with higher KDRI indices (KDRI ≥ 1) and DGF exhibited a notably increased graft loss risk (HR: 4.17, 95% CI: 1.93–9.01). However, lower-KDRI donor grafts displayed no significant disparities between the DGF and non-DGF groups. Conclusions: Delayed graft function (DGF) development significantly contributes to graft loss in kidney transplants, particularly in grafts with KDRI ≥ 1.
Diseño y validación de un cuestionario de salud en pacientes con urolitiasis tratados mediante litotricia extracorpórea por ondas de choque (LEOC) Archivos Espanoles De Urologia, 2019
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Gene sequence analysis of suppressor oncogene p53 in bladder carcinoma Actas Urologicas Espanolas, 1998
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Therapeutic alternatives in benign prostatic hyperplasia Medicina Clinica, 1993
Clinico-pathologic correlation in patients undergoing surgical staging and radical prostatectomy for prostatic cancer Actas Urologicas Espanolas, 1993
Inhibitory effect of high energy shock waves and radiotherapy in vitro. Journal of Stone Disease, 1993
Shockwave cytotoxicity on neoplastic and non-neoplastic cells Actas Urologicas Espanolas, 1993
Diagnosis of cancer of the prostate by determining the blood levels of specific prostatic antigen, rectal examination, and transrectal echography Actas Urologicas Espanolas, 1993
Prediction value of tissue expression of human chorionic gonadotrophin (β-HCG) in the infiltrant transitional carcinoma of the bladder Actas Urologicas Espanolas, 1993
Inhibition of tumor cell growth by the action of high-energy sources Actas Urologicas Espanolas, 1993
Multivariate analysis of local response to preoperative treatment in patients with infiltrating carcinoma of the bladder Actas Urologicas Espanolas, 1993
Urachal cyst: an unusual cause of intestinal obstruction Actas Urologicas Espanolas, 1993
Leiomyosarcoma of the vena cava: presentation of 2 clinical cases Actas Urologicas Espanolas, 1993
Extracorporeal shock wave lithotripsy of ureteral stones: clinical experience using a second generation lithotripter. Journal of Stone Disease, 1992
Kidney pelvis tumor in ectopic kidney. Report of a case Actas Urologicas Espanolas, 1992
Secondary vesical melanoma, contribution of one case Actas Urologicas Espanolas, 1992
Retroperitoneal ganglioneuroma: an infrequent tumor Actas Urologicas Espanolas, 1992
Pure squamous carcinoma of the ureter. Review of a case Archivos Espanoles De Urologia, 1992
Infiltrant vesical carcinoma with metastatic nodular involvement: Radical treatment and survival Actas Urologicas Espanolas, 1992
Tumor thrombosis in inferior vena cava: diagnostic imaging and therapeutic approximation Actas Urologicas Espanolas, 1992
Monotherapy of ureteral calculi with extracorporeal shockwave lithotripsy Actas Urologicas Espanolas, 1992
Prognostic value of local vascular infiltration in infiltrating transitional carcinoma of the bladder Actas Urologicas Espanolas, 1992
Vascular complications in 237 recipients of renal transplant from cadaver Actas Urologicas Espanolas, 1992
Cadaveric renal transplantation: Multifactorial analysis of possible causes affecting graft outcome in recipients treated with and without cyclosporine Transplantation Proceedings, 1992
Infiltrant vesical carcinoma: Preliminary results of multiple therapy protocols using radiotherapy and co-adjuvant chemotherapy Actas Urologicas Espanolas, 1992
Treatment of urological complications in renal transplant recipients by endourological techniques Trasplante Journal of Organ and Tissue Transplantation, 1991
Uretero-iliac fistula: presentation of a case and review of the literature Actas Urologicas Espanolas, 1991
Survival analysis in renal cell carcinoma with invasion of the vena cava Actas Urologicas Espanolas, 1991
Paratesticular rhabdomyosarcoma with intracaval neoplastic involvement: presentation of a case and review of the literature Actas Urologicas Espanolas, 1991
Urologic complications in 237 recipients of cadaveric kidney transplantation Actas Urologicas Espanolas, 1991
Influence of vascular anastomosis as well as warm and cold ischemia intervals on the survival of corpse renal graft Actas Urologicas Espanolas, 1991
Multivariate analysis of prognostic factors impacting graft survival in cadaveric renal transplantation in the cyclosporine and pre-cyclosporine era Trasplante Journal of Organ and Tissue Transplantation, 1990
Superficial tumors of the bladder: prognostic value of the free of disease period Actas Urologicas Espanolas, 1990
Tumor of the upper urothelium: radical treatment and prognostic factors Actas Urologicas Espanolas, 1990
Urothelial tumor markers: update Revista De Medicina De La Universidad De Navarra, 1990
Neoadjuvant immunotherapy in non-metastatic renal adenocarcinoma Actas Urologicas Espanolas, 1990
Extracorporeal shockwave lithotripsy (ESWL) for the treatment of bladder lithiasis. A new therapeutic option Actas Urologicas Espanolas, 1990
Cardiopulmonary by-pass with cardiac arrest and deep hypothermia for the surgical treatment of tumor thrombi in the vena cava caused by kidney carcinoma Actas Urologicas Espanolas, 1990
Prognostic value of initial function in both graft and patient survival in renal transplants from a corpse donor; impact of cyclosporin A Actas Urologicas Espanolas, 1990
Pelvic lipomatosis: a new case Actas Urologicas Espanolas, 1989
Effect of complementary treatment (radiotherapy, chemotherapy) on the survival of patients with T3 tumors of the bladder treated with radical surgery Actas Urologicas Espanolas, 1989
Value of computerized axial tomography in the diagnosis of idiopathic retroperitoneal fibrosis. Apropos of 2 new cases Archivos Espanoles De Urologia, 1986
A retrospective study of 101 renal transplants. Part I: Global results Actas Urologicas Espanolas, 1985
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Emphysematous cystitis: Two new cases Archivos Espanoles De Urologia, 1985
Intraparenchymatous abscess in a renal graft Actas Urologicas Espanolas, 1985
Genitourinary complications in oncology Archivos Espanoles De Urologia, 1985
