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Xu MY, Song ZY, Liang CZ. Robot-assisted repair of ureteral stricture. J Robot Surg 2024; 18:354. [PMID: 39340614 PMCID: PMC11438720 DOI: 10.1007/s11701-024-01993-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/23/2024] [Indexed: 09/30/2024]
Abstract
As robot-assisted laparoscopic techniques continue to advance, becoming increasingly complex and refined, there has been significant progress in the minimally invasive treatment of ureteral strictures. This abstract aims to provide an overview and description of various surgical techniques that utilize robots for repairing ureteral strictures. We have summarized the progression of these surgical methods and highlighted the latest advancements in the procedures. When compared to open surgery, robot-assisted reconstruction techniques demonstrate superior functional outcomes, fewer postoperative complications, and a faster recovery in the treatment of ureteral strictures. This abstract aims to provide an overview and description of various surgical techniques utilizing robots to repair ureteral strictures. Robotic ureteral stricture correction has emerged as a valuable therapeutic option, particularly when endoscopic procedures are not feasible. Compared to traditional open surgery, robotic methods exhibit superior therapeutic effectiveness, fewer postoperative complications, and accelerated recovery. Reconstructive procedures such as reimplantation, psoas hitch, Boari flap, ureter-to-ureter anastomosis, appendix graft, buccal mucosa graft (BMG), ileal transplantation, or kidney autotransplantation can be performed depending on the extent and location of the stricture. Robotic surgical techniques also offer advantages, such as an expanded field of vision and the incorporation of supplementary technologies such as FireflyTM, indocyanine green (ICG), and near-infrared fluorescence (NIRF) imaging. However, further long-term, multicenter investigations are necessary to validate the positive findings reported in existing case series. Compared with open surgery, robot-assisted reconstruction techniques yield superior functional outcomes, fewer postoperative complications, and accelerated recovery for the treatment of ureteral strictures.
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Affiliation(s)
- Mu-Yang Xu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, People's Republic of China
- Institute of Urology, Anhui Medical University, Hefei, Anhui, People's Republic of China
- Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Zheng-Yao Song
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, People's Republic of China
- Institute of Urology, Anhui Medical University, Hefei, Anhui, People's Republic of China
- Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Chao-Zhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, People's Republic of China.
- Institute of Urology, Anhui Medical University, Hefei, Anhui, People's Republic of China.
- Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Hefei, Anhui, People's Republic of China.
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Chen S, Huang C, Li Z, Li X, Li Z, Wang X, Yang K, Zhang P, Zhu H, Li X. The modified Whitaker test in evaluating the surgical effect after ileal ureter replacement. World J Urol 2024; 42:533. [PMID: 39302474 DOI: 10.1007/s00345-024-05209-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 08/05/2024] [Indexed: 09/22/2024] Open
Abstract
PURPOSE To develop a novel adaptation of the Whitaker test for assessing the surgical effects of ileal ureter replacement (IUR), and to evaluate its feasibility and effect in the postoperative evaluation. PATIENTS AND METHODS From November 2021 to September 2023, patients undergoing the modified Whitaker test following IUR were prospectively enrolled. The relative pressure was defined as the pelvis pressure minus the bladder pressure. Successful nephrostomy removal was defined as absence of symptoms and improved or stable hydronephrosis. RESULTS The 51 ureters from 39 patients underwent the modified Whitaker test after IUR. The modified Whitaker test was performed successfully on all patients without any reported discomfort. The relative pressure of 47 ureters kept steady (< 15 cmH2O) throughout the examination with well ileal ureter peristalsis and was classified into type I. The relative pressure of 2 ureters increased with perfusion reaching a range of 15-22 cmH2O, with well ileal ureteral peristalsis observed (type II). The relative pressure of 2 ureters increased along with perfusion, with weakening of ileal ureter peristalsis or a leakage of contrast medium, and the relative pressure surpassed 22 cmH2O (type III). Nephrostomy tubes were promptly removed for type I and type II ureters, while removal for type III ureters occurred after a 2-month period. None of the 39 patients required additional interventions for recurrent obstruction. CONCLUSION The modified Whitaker test was a safe and effective approach for the evaluation of surgical effects of IUR, offering additional evidence to assess the safety of nephrostomy tube removal.
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Affiliation(s)
- Silu Chen
- Department of Urology, Institute of Urology, Peking University First Hospital, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Chen Huang
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Zhenyu Li
- Department of Urology, Institute of Urology, Peking University First Hospital, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Xinfei Li
- Department of Urology, Institute of Urology, Peking University First Hospital, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Zhihua Li
- Department of Urology, Institute of Urology, Peking University First Hospital, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Xiang Wang
- Department of Urology, Institute of Urology, Peking University First Hospital, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Kunlin Yang
- Department of Urology, Institute of Urology, Peking University First Hospital, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China.
| | - Xuesong Li
- Department of Urology, Institute of Urology, Peking University First Hospital, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China.
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Chen S, Fan S, Yang K, Li Z, Gao W, Wang X, Li Z, Wang B, Huang C, Zhu H, Gu Y, Li X. Robotic appendiceal ureteric interposition or replacement: the surgical technique. BJU Int 2024. [PMID: 39225148 DOI: 10.1111/bju.16523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Affiliation(s)
- Silu Chen
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
| | - Shubo Fan
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
| | - Kunlin Yang
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
| | - Zhihua Li
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
| | - Wenzhi Gao
- Department of Urology, Peking University First Hospital - Miyun Hospital, Beijing, China
| | - Xiang Wang
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
| | - Zhenyu Li
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
| | - Bing Wang
- Department of Urology, Peking University First Hospital - Miyun Hospital, Beijing, China
| | - Chen Huang
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Yaming Gu
- Department of Urology, Peking University First Hospital - Miyun Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, Beijing, China
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Chen S, Wang X, Li Z, Li X, Han G, Tao Z, Li Z, Zhang P, Zhu H, Yang K, Li X. Minimally invasive versus open ileal ureter with ileocystoplasty: comparative outcomes and 5-year experience. BMC Urol 2024; 24:118. [PMID: 38858691 PMCID: PMC11163719 DOI: 10.1186/s12894-024-01509-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024] Open
Abstract
PURPOSE To present the experience of ileal ureter with ileocystoplasty (IUC), and compare the outcomes of IUC in minimally invasive procedures to open procedures. PATIENTS AND METHODS From December 2017 to April 2023, twenty patients underwent IUC in open or minimally invasive (including laparoscopic and robotic) procedures. The baseline characteristics, perioperative data and follow-up outcomes were collected. Success was defined as relief of clinical symptoms, stable postoperative serum creatine and absence of radiographic obstruction. The perioperative and follow-up outcomes of open procedures and minimally invasive procedures were compared. RESULTS The etiology included pelvic irradiation (14/20), urinary tuberculosis (3/20) and surgical injury (3/20). Bilateral ureter strictures were repaired in 15 cases. The surgeries conducted consisted of open procedures in 9 patients and minimally invasive procedures in 11 patients. Compared to open procedures, minimally invasive surgeries had less median estimated blood loss (EBL) (100 ml vs. 300 min, p = 0.010) and shorter postoperative hospitalization (27 d vs. 13 d, p = 0.004). Two patients in the open group experienced grade 3 complications (sigmoid fistula and acute cholecystitis in one patient, and pulmonary embolism in another patient). Over a median follow-up period of 20.1 months, the median bladder functional capacity was 300 ml, with a 100% success rate of IUC. CONCLUSION IUC is feasible in both open and minimally invasive procedures, with acceptable complications and a high success rate. Minimally invasive procedures can have less EBL and shorter postoperative hospitalization than open procedure. However, prospective studies with larger groups and longer follow-up are needed.
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Affiliation(s)
- Silu Chen
- Department of Urology, Institute of Urology, Peking University First Hospital, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Xiang Wang
- Department of Urology, Institute of Urology, Peking University First Hospital, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Zhihua Li
- Department of Urology, Institute of Urology, Peking University First Hospital, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Xinfei Li
- Department of Urology, Institute of Urology, Peking University First Hospital, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Guanpeng Han
- Department of Urology, Institute of Urology, Peking University First Hospital, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Zihao Tao
- Department of Urology, Institute of Urology, Peking University First Hospital, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Zhenyu Li
- Department of Urology, Institute of Urology, Peking University First Hospital, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Kunlin Yang
- Department of Urology, Institute of Urology, Peking University First Hospital, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China.
| | - Xuesong Li
- Department of Urology, Institute of Urology, Peking University First Hospital, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China.
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Wang X, Zhang Y, Zhang J, Li Z, Han G, Zhang L, Li X, Yang K, Wang B, Zhang P, Huang C, Liu J, Zhu H, Zhou L, Zhang K, Li X. Minimal-invasive ileal ureter replacement for the management of multiple ureteral polyps: the initial experience. Int Urol Nephrol 2024; 56:1919-1926. [PMID: 38200364 DOI: 10.1007/s11255-023-03850-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/09/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE To present our initial experience in the management of multiple ureteral polyps with robotic or laparoscopic ileal ureter replacement (IUR). METHODS Eight consecutive patients diagnosed with multiple ureteral polyps underwent robotic or laparoscopic IUR between July 2019 and November 2022. Unilateral IUR was performed in 5 patients with polyps in the left (n = 3) or right (n = 2) side, and 3 patients with bilateral multiple polyps underwent bilateral IUR. Demographic characteristics, perioperative data and follow-up outcomes were prospectively collected. RESULTS A cohort of 5 male and 3 female patients (11 ureters) with a mean age of 32.8 ± 11.3 years were included. Among these patients, 5 presented with recurrent flank pain, 1 had hematuria, and 2 were asymptomatic. Four patients experienced prior failed surgical interventions. The mean length of diseased ureter was 11.9 ± 4.7 cm, with more than 10 cm in eight sides. All procedures were performed successfully. The mean operation time was 319 ± 87.6 min with 3 patients who simultaneously underwent intraoperative ureteroscopy. The mean length of ileal graft was 23.8 ± 5.8 cm. During the mean follow-up of 20.4 ± 12.8 months, one major complication, specifically incision infection, and four minor complications, including urinary infection (n = 3) and metabolic acidosis (n = 1), were observed. All patients presented symptom-free, with improved/stabilized hydronephrosis and no signs of restenosis. CONCLUSION Robotic or laparoscopic IUR is a feasible, safe, and effective surgical option for patients with long ureteral defects caused by multiple polyps.
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Affiliation(s)
- Xiang Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Yiming Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Jilong Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
- Department of Nursing, Peking University First Hospital, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Guanpeng Han
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Lianghao Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Bing Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, No. 29 Xibahenanli St, Chaoyang District, Beijing, 100020, China
| | - Chen Huang
- Department of Urology, Beijing Jiangong Hospital, No. 6 Rufuli St, Xicheng District, Beijing, 100034, China
| | - Jing Liu
- Department of Urology, Beijing Jiangong Hospital, No. 6 Rufuli St, Xicheng District, Beijing, 100034, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, No. 6 Rufuli St, Xicheng District, Beijing, 100034, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Kai Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
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Hamamoto S, Taguchi K, Kawase K, Unno R, Isogai M, Torii K, Iwatsuki S, Etani T, Naiki T, Okada A, Yasui T. Efficacy of Robot-Assisted Ureteroureterostomy in Patients with Complex Ureteral Stricture after Ureteroscopic Lithotripsy. J Clin Med 2023; 12:7726. [PMID: 38137795 PMCID: PMC10743600 DOI: 10.3390/jcm12247726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Ureteral stricture (US) postureteroscopic lithotripsy (URSL) has emerged as a severe complication with the widespread use of laser technology. Furthermore, managing a complex US is challenging. Therefore, this study evaluated the efficacy of robot-assisted ureteroureterostomy (RAUU) in addressing US post-URSL and analyzed the pathology of transected ureteral tissues to identify the risk factors for US. METHODS we conducted a prospective cohort study on patients who underwent RAUU for URSL-induced US from April 2021 to May 2023. RESULTS A total of 14 patients with a mean age of 49.8 years were included in this study. The mean stricture length on radiography was 22.66 ± 7.38 mm. Nine (64.2%) patients had experienced failure with previous interventions. The overall success rate was 92.9%, both clinically and radiographically, without major complications, at a mean follow-up of 12.8 months. The pathological findings revealed microcalcifications and a loss of ureteral mucosa in 57.1% and 28.6% of patients, respectively. CONCLUSIONS The RAUU technique shows promise as a viable option for US post-URSL in appropriately selected patients despite severe pathological changes in the ureter. Therefore, the migration of microcalcifications to the site of ureteral perforation may be a significant factor contributing to US development.
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Affiliation(s)
- Shuzo Hamamoto
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya 4678601, Japan; (K.T.); (K.K.); (R.U.); (M.I.); (K.T.); (S.I.); (T.E.); (T.N.); (A.O.); (T.Y.)
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Franco A, Ditonno F, Manfredi C, Johnson AD, Mamgain A, Feldman-Schultz O, Feng CL, Pellegrino AA, Mir MC, Porpiglia F, Crivellaro S, De Nunzio C, Chow AK, Autorino R. Robot-assisted Surgery in the Field of Urology: The Most Pioneering Approaches 2015-2023. Res Rep Urol 2023; 15:453-470. [PMID: 37842031 PMCID: PMC10575039 DOI: 10.2147/rru.s386025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/30/2023] [Indexed: 10/17/2023] Open
Abstract
Robot-assisted surgery has emerged as a transformative technology, revolutionizing surgical approaches and techniques that decades ago could barely be imagined. The field of urology has taken charge in pioneering a new era of minimally invasive surgery with the ascent of robotic systems which offer enhanced visualization, precision, dexterity, and enabling surgeons to perform intricate maneuvers with improved accuracy. This has led to improved surgical outcomes, including reduced blood loss, lower complication rates, and faster patient recovery. The aim of our review is to present an evidence-based critical analysis on the most pioneering robotic urologic approaches described over the last eight years (2015-2023).
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Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, University of Verona, Verona, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL, USA
- Urology Unit, “Luigi Vanvitelli” University, Naples, Italy
| | | | | | | | - Carol L Feng
- Department of Urology, Rush University, Chicago, IL, USA
| | - Antony A Pellegrino
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
- Unit of Urology/Division of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Carmen Mir
- Department of Urology, Hospital Universitario La Ribera, Valencia, Spain
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Cosimo De Nunzio
- Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy
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