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Pedraza AM, Gupta R, Musheyev D, Pino T, Shah A, Brody R, Wagaskar V, Kaufmann B, Gorin MA, Menon M, Tewari A. Microultrasound in the detection of the index lesion in prostate cancer. Prostate 2024; 84:79-86. [PMID: 37828815 DOI: 10.1002/pros.24628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/20/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION AND OBJECTIVE The natural progression of prostate cancer is primarily driven by an index lesion (IL). Studies have shown that different metastases within the same patient arise from a single precursor cell. Therefore, our aim is to assess the effectiveness of transrectal microultrasound (MUS) in comparison to multiparametric magnetic resonance imaging (mpMRI) for detecting the IL in prostate cancer. We used quarter-mount pathological results as the reference standard for this evaluation. MATERIALS AND METHODS Three hundred and sixty-three patients who underwent Robot-Assisted Radical Prostatectomy (RARP) from June 2021 to August 2022 were included. All received mpMRI and MUS before RARP. MUS was performed by experienced operators blinded to mpMRI and biopsy results. The IL in the radical prostatectomy specimen was defined as the lesion with extraprostatic extension, the highest Grade Group (GG), or the largest tumor volume if the GG was the same. The correlation between imaging and final pathology findings was performed. A descriptive statistical analysis is presented. RESULTS The patients' prostates were analyzed in 12 regions (anterior/posterior, right/left, apex/mid/base). A total of 4308 regions were identified. Of these, 935 were involved by the ILs. Compared with final pathology, MUS demonstrated a sensitivity, specificity, PPV, and NPV of 68.7%, 96.3%, 80.8%, and 93.1%, respectively, while mpMRI showed a sensitivity, specificity, PPV, and NPV of 68.6%, 97.2%, 86.1%, and 92.5%, respectively, for the detection of the IL. Most of the lesions missed by MUS were located in the anterior zone (62%). CONCLUSION MUS exhibits a diagnostic performance similar to mpMRI when it comes to detecting the IL in prostate cancer. MUS is a cost-effective option, offers real-time evaluation, and has no delay in the acquisition process.
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Affiliation(s)
- Adriana M Pedraza
- Department of Urologic Surgery, The Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
| | - Raghav Gupta
- Department of Urologic Surgery, The Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
| | - David Musheyev
- Department of Urologic Surgery, The Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
| | - Tanisha Pino
- Department of Urologic Surgery, The Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
| | - Akash Shah
- Department of Uro-oncologic Surgery, Kokilaben Dhirubhai Ambani Hospital, Four Bungalows, Mumbai, India
| | - Rachel Brody
- Department of Pathology, The Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
| | - Vinayak Wagaskar
- Department of Urologic Surgery, The Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
| | - Basil Kaufmann
- Department of Urologic Surgery, The Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
| | - Michael A Gorin
- Department of Urologic Surgery, The Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
| | - Mani Menon
- Department of Urologic Surgery, The Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
| | - Ashutosh Tewari
- Department of Urologic Surgery, The Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
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Dias AB, Ghai S. Prostate Cancer Diagnosis with Micro-ultrasound: What We Know now and New Horizons. Radiol Clin North Am 2024; 62:189-197. [PMID: 37973243 DOI: 10.1016/j.rcl.2023.06.014] [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] [Indexed: 11/19/2023]
Abstract
Prostate cancer (PCa) is the most common non-cutaneous cancer diagnosed in males. Multiparametric Magnetic Resonance Imaging (mpMRI) with targeted biopsy can detect PCa and is currently the recommended initial test in men at risk for PCa. Micro-Ultrasound (MicroUS) is a novel high-resolution 29-MHz ultrasound with ∼three times greater resolution of conventional transrectal ultrasound (TRUS) resolution. Preliminary data suggest improved accuracy of ultrasound for targeted prostate biopsy. A growing body of evidence has become available supporting MicroUS as a potentially time and cost saving modality for PCa detection, with early results suggesting comparable accuracy to mpMRI. Additionally, microUS allows real-time visualization for accurate targeted biopsy. It is not yet clear whether MicroUS should be used on its own or in combination with mpMRI for prostate cancer detection. The ongoing OPTIMUM randomized controlled trial will help to establish the role of MicroUS in the diagnostic algorithm for the detection of clinically significant (cs)-PCa. Early data also indicate this imaging modality may have a role in local staging (eg, extracapsular extension prediction) and active surveillance of PCa. MicroUS has also the potential to add value to biparametric (bp) MRI, and may represent a promising tool for guidance of focal therapy in the near future.
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Affiliation(s)
- Adriano Basso Dias
- Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, 585 University Avenue, 1PMB-298, Toronto, ON M5G 2N2, Canada
| | - Sangeet Ghai
- Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, 585 University Avenue, 1PMB-298, Toronto, ON M5G 2N2, Canada.
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Avolio PP, Lughezzani G, Anidjar M, Hassan T, Rompré-Brodeur A, Buffi NM, Lazzeri M, Sanchez-Salas R. The diagnostic accuracy of micro-ultrasound for prostate cancer diagnosis: a review. World J Urol 2023; 41:3267-3276. [PMID: 37555985 DOI: 10.1007/s00345-023-04521-w] [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: 03/30/2023] [Accepted: 07/02/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE Micro-UltraSound (microUS) is a new imaging modality capable of identifying and targeting suspicious areas, which might further increase the diagnostic yield of prostate biopsy (PBx). Aim of this review is to provide insights into the usefulness of microUS for the sub-stratification of prostate cancer (PCa), clinically significant PCa (i.e., any Gleason score ≥ 7 PCa; csPCa) along with non-organ-confined disease in patients undergoing PBx. METHODS A PubMed literature search was performed using keywords: prostate cancer diagnosis, prostate cancer diagnosis surveillance, systematic biopsy, target biopsy, micro-ultrasound, and prostate risk identification using micro-ultrasound. RESULTS MicroUS could significantly improve multiparametric magnetic resonance imaging (mpMRI) findings by adding valuable anatomical and pathological information provided by real-time examination. Furthermore, microUS target biopsy could replace systematic biopsy in clinical practice by reducing the detection of clinically insignificant (ciPCa) and increasing that of csPCa. Finally, microUS may be useful in predicting the presence of non-organ confined PCa before radical prostatectomy and it could also be an effective add-on tool for patient monitoring within the active surveillance program. CONCLUSION MicroUS may represent an attractive step forward for the management of csPCa as a complementary or alternative tool to mpMRI. Nevertheless, further longitudinal studies are warranted, and the strength of the evidence is still suboptimal to provide clear recommendations for daily clinical practice.
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Affiliation(s)
- Pier Paolo Avolio
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Maurice Anidjar
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Toufic Hassan
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Alexis Rompré-Brodeur
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Nicolò Maria Buffi
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Rafael Sanchez-Salas
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada.
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Vassallo R, Aleef TA, Zeng Q, Wodlinger B, Black PC, Salcudean SE. Robotically controlled three-dimensional micro-ultrasound for prostate biopsy guidance. Int J Comput Assist Radiol Surg 2023:10.1007/s11548-023-02869-3. [PMID: 36995513 DOI: 10.1007/s11548-023-02869-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE Prostate imaging to guide biopsy remains unsatisfactory, with current solutions suffering from high complexity and poor accuracy and reliability. One novel entrant into this field is micro-ultrasound (microUS), which uses a high-frequency imaging probe to achieve very high spatial resolution, and achieves prostate cancer detection rates equivalent to multiparametric magnetic resonance imaging (mpMRI). However, the ExactVu transrectal microUS probe has a unique geometry that makes it challenging to acquire controlled, repeatable three-dimensional (3D) transrectal ultrasound (TRUS) volumes. We describe the design, fabrication, and validation of a 3D acquisition system that allows for the accurate use of the ExactVu microUS device for volumetric prostate imaging. METHODS The design uses a motorized, computer-controlled brachytherapy stepper to rotate the ExactVu transducer about its axis. We perform geometric validation using a phantom with known dimensions and compare performance with magnetic resonance imaging (MRI) using a commercial quality assurance anthropomorphic prostate phantom. RESULTS Our geometric validation shows accuracy of 1 mm or less in all three directions, and images of an anthropomorphic phantom qualitatively match those acquired using MRI and show good agreement quantitatively. CONCLUSION We describe the first system to acquire robotically controlled 3D microUS images using the ExactVu microUS system. The reconstructed 3D microUS images are accurate, which will allow for future applications of the ExactVu microUS system in prostate specimen and in vivo imaging.
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Affiliation(s)
- Reid Vassallo
- School of Biomedical Engineering, The University of British Columbia, 251-2222 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Tajwar Abrar Aleef
- School of Biomedical Engineering, The University of British Columbia, 251-2222 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Qi Zeng
- Department of Electrical and Computer Engineering, The University of British Columbia, 5500-2332 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Brian Wodlinger
- Exact Imaging, 15-7676 Woodbine Avenue, Markham, ON, L3R 2N2, Canada
| | - Peter C Black
- Department of Urologic Sciences, The University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Septimiu E Salcudean
- School of Biomedical Engineering, The University of British Columbia, 251-2222 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
- Department of Electrical and Computer Engineering, The University of British Columbia, 5500-2332 Main Mall, Vancouver, BC, V6T 1Z4, Canada
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Basso Dias A, Ghai S. Micro-Ultrasound: Current Role in Prostate Cancer Diagnosis and Future Possibilities. Cancers (Basel) 2023; 15:cancers15041280. [PMID: 36831622 PMCID: PMC9954149 DOI: 10.3390/cancers15041280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023] Open
Abstract
Prostate Cancer (PCa) is the second most common cancer in men. Population screening using prostate specific antigen (PSA) blood test and digital rectal exam (DRE) is recommended by the NCCN, EAU and other prominent clinical guidelines. While MRI is the recommended initial test in men at risk for PCa, micro-Ultrasound (MicroUS) is a novel high resolution ultrasound technology that has shown promise in PCa detection. This article provides a narrative review of the studies to date which have been conducted to evaluate the functionality and efficacy of MicroUS within the patient care pathway for prostate cancer. A total of 13 relevant publications comparing detection of csPCa between MicroUS and mpMRI were selected. An amount of 4 publications referring to use of MicroUS for other indications were found. Each publication was evaluated for risk of bias and applicability using the Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool. The studies reviewed conclude that MicroUS detection rates for clinically significant prostate cancer diagnosis are comparable to the detection rates of mpMRI guided biopsy procedures. While the existing literature indicates that MicroUS should replace conventional TRUS for prostate imaging and biopsy, it is not yet clear whether MicroUS should be used on its own or in conjunction with mpMRI for augmenting prostate cancer detection. The ongoing OPTIMUM trial will provide evidence on how best to utilize this new technology. Early data also suggest this flexible new imaging modality has a place in local staging and active surveillance of prostate cancer as well as in bladder cancer staging.
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Calace FP, Napolitano L, Arcaniolo D, Stizzo M, Barone B, Crocetto F, Olivetta M, Amicuzi U, Cirillo L, Rubinacci A, Lecce A, Pandolfo SD, Langella NA, Persico F, Trama F, Quattrone C, Bottone F, Spirito L, De Sio M, Manfredi C. Micro-Ultrasound in the Diagnosis and Staging of Prostate and Bladder Cancer: A Comprehensive Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1624. [PMID: 36363581 PMCID: PMC9695797 DOI: 10.3390/medicina58111624] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 08/07/2023]
Abstract
Background and Objectives: Multiparametric magnetic resonance imaging (mpMRI) of the prostate and prostate-specific membrane antigen positron emission tomography (PSMA PET) are some examples of how the advancement of imaging techniques have revolutionized the diagnosis, staging, and consequently management of patients with prostate cancer (PCa). Although with less striking results, novel radiological modalities have also been proposed for bladder cancer (BCa) in recent years. Micro-ultrasound (MUS) is an imaging examination characterized by high real-time spatial resolution, recently introduced in the urological field. This article aimed to describe the current evidence regarding the application of MUS for the diagnosis and staging of PCa and BCa. Materials and Methods: We designed a narrative review. A comprehensive search in the MEDLINE, Scopus, and Cochrane Library databases was performed. Articles in English-language and published until July 2022 were deemed eligible. Retrospective and prospective primary clinical studies, as well as meta-analyses, were included. Results: MUS-guided prostate biopsy showed high sensitivity (0.91, 95% CI, 0.79-0.97) in the diagnosis of clinically significant PCa (csPCa). It was associated with a higher detection rate of csPCa than a systematic biopsy (1.18, 95% CI 0.83-1.68). No significant difference was found between MUS and mpMRI-guided biopsy in the total detection of PCa (p = 0.89) and in the detection of Grade Groups ≥ 2 (p = 0.92). The use of MUS to distinguish between non-muscle-invasive and muscle-invasive BCa was described, highlighting an up-staging with MUS only in a minority of cases (28.6%). Conclusions: Promising findings have emerged regarding the feasibility and accuracy of MUS in the diagnosis and staging of PCa and BCa. However, the available evidence is limited and should be considered preliminary.
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Affiliation(s)
- Francesco Paolo Calace
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Luigi Napolitano
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Davide Arcaniolo
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Marco Stizzo
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Biagio Barone
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Felice Crocetto
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Michelangelo Olivetta
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Ugo Amicuzi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Luigi Cirillo
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Andrea Rubinacci
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Arturo Lecce
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Savio Domenico Pandolfo
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | | | | | - Francesco Trama
- Department of Surgical and Biomedical Science, Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, 05100 Terni, Italy
| | - Carmelo Quattrone
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Francesco Bottone
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Lorenzo Spirito
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Marco De Sio
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
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Gurwin A, Kowalczyk K, Knecht-Gurwin K, Stelmach P, Nowak Ł, Krajewski W, Szydełko T, Małkiewicz B. Alternatives for MRI in Prostate Cancer Diagnostics-Review of Current Ultrasound-Based Techniques. Cancers (Basel) 2022; 14:cancers14081859. [PMID: 35454767 PMCID: PMC9028694 DOI: 10.3390/cancers14081859] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Prostate cancer (PCa) is the most common solid malignant tumor in men worldwide with various clinical manifestations. Due to overdiagnosis and overtreatment of a clinically insignificant disease, multiparametric magnetic resonance imaging is recommended for every patient before performing prostate biopsy. However, the diagnostic pathway currently has many limitations and is still far from ideal. Therefore, further alternatives need to be investigated. As the novel ultrasound-based techniques, such as shear wave elastography, contrast-enhanced ultrasound or high frequency micro-ultrasound are able to, overcome the limitations of magnetic resonance imaging presenting good performance in recent studies, we have summarized and compared the results of each technique in the detection of PCa. Furthermore, we analyzed the future perspectives for ultrasound modalities that may soon significantly improve their diagnostic value. Abstract The purpose of this review is to present the current role of ultrasound-based techniques in the diagnostic pathway of prostate cancer (PCa). With overdiagnosis and overtreatment of a clinically insignificant PCa over the past years, multiparametric magnetic resonance imaging (mpMRI) started to be recommended for every patient suspected of PCa before performing a biopsy. It enabled targeted sampling of the suspicious prostate regions, improving the accuracy of the traditional systematic biopsy. However, mpMRI is associated with high costs, relatively low availability, long and separate procedure, or exposure to the contrast agent. The novel ultrasound modalities, such as shear wave elastography (SWE), contrast-enhanced ultrasound (CEUS), or high frequency micro-ultrasound (MicroUS), may be capable of maintaining the performance of mpMRI without its limitations. Moreover, the real-time lesion visualization during biopsy would significantly simplify the diagnostic process. Another value of these new techniques is the ability to enhance the performance of mpMRI by creating the image fusion of multiple modalities. Such models might be further analyzed by artificial intelligence to mark the regions of interest for investigators and help to decide about the biopsy indications. The dynamic development and promising results of new ultrasound-based techniques should encourage researchers to thoroughly study their utilization in prostate imaging.
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Affiliation(s)
- Adam Gurwin
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (P.S.); (Ł.N.); (W.K.); (T.S.)
- Correspondence: (A.G.); (B.M.); Tel.: +48-607-728-002 (A.G.); +48-506-158-136 (B.M.)
| | - Kamil Kowalczyk
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (P.S.); (Ł.N.); (W.K.); (T.S.)
| | - Klaudia Knecht-Gurwin
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Paweł Stelmach
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (P.S.); (Ł.N.); (W.K.); (T.S.)
| | - Łukasz Nowak
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (P.S.); (Ł.N.); (W.K.); (T.S.)
| | - Wojciech Krajewski
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (P.S.); (Ł.N.); (W.K.); (T.S.)
| | - Tomasz Szydełko
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (P.S.); (Ł.N.); (W.K.); (T.S.)
| | - Bartosz Małkiewicz
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (P.S.); (Ł.N.); (W.K.); (T.S.)
- Correspondence: (A.G.); (B.M.); Tel.: +48-607-728-002 (A.G.); +48-506-158-136 (B.M.)
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