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Beloborodov V, Vorobev V, Hovalyg T, Seminskiy I, Sokolova S, Lapteva E, Mankov A. Fast Track Surgery as the Latest Multimodal Strategy of Enhanced Recovery after Urethroplasty. Adv Urol 2023; 2023:2205306. [PMID: 37214228 PMCID: PMC10195176 DOI: 10.1155/2023/2205306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/08/2023] [Accepted: 04/09/2023] [Indexed: 05/24/2023] Open
Abstract
Fast track surgery (FTS), as well as ERAS (enhanced recovery after surgery/rapid recovery programs), is the latest multimodal treatment strategy, designed to reduce the disability period and improve the medical care quality. The study aims to analyze the enhanced recovery protocol effectiveness in a comparative study of elective urethral stricture surgery. A prospective study included 54 patients with an established diagnosis of urethral stricture in 2019-2020 in the urological hospital of the Irkutsk City Clinical Hospital No. 1. All 54 patients have completed the study. There were two groups of patients FTS-group (group II, n = 25) and standard group (group I, n = 29). In terms of preoperative parameters, the comparison groups have statistical homogeneity. The comparative intergroup efficacy analysis of the treatment based on the criteria established in the study demonstrated good treatment results for 5 (17.2%) patients of group I and 20 (80%) patients of group II (p=0.004). The overall efficacy of urethroplasty surgeries, regardless of the treatment protocol, was comparable (86.2% vs 92%; p=0.870), as well as the likelihood of relapse within two years (p=0.512). The predictors of recurrence were technical complications and urethral suture failure (OR 4.36; 95% CI 1.6; 7.11; p=0.002). The FTS protocol reduced the treatment period (p < 0.001) and decreased the severity of postoperative pain (p < 0.001). The use of the "fast track surgery" protocol in urethroplasty with generally similar treatment results makes it possible to achieve a better functional and objective condition of patients in the postoperative period due to less pain, shorter catheterization, and hospitalization.
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Affiliation(s)
- Vladimir Beloborodov
- Department of General Surgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Vladimir Vorobev
- Department of General Surgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Temirlan Hovalyg
- Department of General Surgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Igor Seminskiy
- Department of Phatology, Irkutsk State Medical University, Irkutsk, Russia
| | - Svetlana Sokolova
- Department of General Surgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Ekaterina Lapteva
- Department of Geriatrics, Propaedeutics and Management in Nursing, North-Western State Medical University Named after I.I. Mechnikov, Saint Petersburg, Russia
| | - Aleksandr Mankov
- Department of Anesthesiology-Resuscitation, Irkutsk State Medical University, Irkutsk, Russia
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Lim Joon D, Berlangieri A, Harris B, Tacey M, O'Meara R, Pitt B, Viotto A, Brown K, Schneider M, Lawrentschuk N, Sengupta S, Berry C, Jenkins T, Chao M, Wada M, Foroudi F, Khoo V. Exploratory models comparing ethiodized oil-glue and gold fiducials for bladder radiotherapy image-guidance. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 17:77-83. [PMID: 33898783 PMCID: PMC8058020 DOI: 10.1016/j.phro.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/23/2021] [Accepted: 01/28/2021] [Indexed: 11/27/2022]
Abstract
Background and purpose Image-guidance with fiducials has been shown to improve pelvic radiotherapy outcome. However, bladder fiducials using ethiodized oil (EO) alone can disperse widely, and gold causes Computed Tomography scan (CT) metal artifacts. The study's purpose was to investigate the ability to deliver EO-tissue glue fiducials and compare them to gold for bladder radiotherapy image guidance. Materials and methods A fluid-filled porcine bladder model was used to assess the ability to cystoscopically inject visible EO glue fiducials into the submucosa. We then transferred the bladders into a porcine pelvis for imaging and compared them to gold fiducials using CT, Cone Beam CT (CBCT), and kilovoltage (KV) planar views. A tissue-equivalent phantom was utilized to analyze the CT number Hounsfield Unit (HU) characteristics and artifacts of the glue and gold fiducials. Percentile ranges and normal tissue voxel percentages of the subsequent CT number voxel histogram from a 2 cm sphere surrounding the fiducial was used to characterize the artifact. Results We successfully delivered all EO glue fiducials into the porcine bladders as discrete fiducials. They were well seen on CT, CBCT, and KV imaging. The glue fiducials had lower CT number values, but less CT number spread of the voxel percentile ranges consistent with the diminished contrast and less artifact than gold. The glue fiducial types had similar CT number characteristics. Conclusion This study has shown that EO glue fiducials can be delivered with online visualization qualities comparable to gold fiducials without metal-related artifacts.
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Affiliation(s)
- Daryl Lim Joon
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia.,Monash University, Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Wellington Rd, Clayton, Victoria 3800, Australia
| | - Alexandra Berlangieri
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Benjamin Harris
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Mark Tacey
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Rachel O'Meara
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Brent Pitt
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Angela Viotto
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Kerryn Brown
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Michal Schneider
- Monash University, Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Wellington Rd, Clayton, Victoria 3800, Australia
| | - Nathan Lawrentschuk
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Shomik Sengupta
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Colleen Berry
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Trish Jenkins
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Michael Chao
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Morikatsu Wada
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Farshad Foroudi
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Vincent Khoo
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia.,Monash University, Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Wellington Rd, Clayton, Victoria 3800, Australia.,Royal Marsden NHS Foundation Trust, 203 Fulham Rd, Chelsea, London SW3 6JJ, United Kingdom
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Degheili JA, Malhas H, Yoo TK. Unorthodox cause of urinary leak post radical prostatectomy: Catheter balloon within a bladder diverticulum - Case report and highlights on various methods to overcome leaks. Int J Surg Case Rep 2020; 67:196-199. [PMID: 32062506 PMCID: PMC7025078 DOI: 10.1016/j.ijscr.2020.02.015] [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: 11/16/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Radical prostatectomy for prostate cancer has been increasingly adopted, especially for localized disease. Nevertheless, this has not been without any morbidities. Complications, such as urine leak, related to malpositioned or malfunctional indwelling catheters, are rarely reported. PRESENTATION OF CASE A 75-year-old male underwent an open radical prostatectomy for prostate cancer. Soon after surgery, he witnessed urine leak and extravasation. Imaging including a plain CT scan with a retrograde cystography, showed the tip of the indwelling catheter within a diverticular pouch of the bladder; itself possessing two anterior diverticular pouches, giving the shape of a "Mickey-Mouse" like bladder. The balloon was deflated, and the Foley catheter was repositioned within the bladder, under fluoroscopy. The urine leak from the surgical wound and through the urethra, completely vanished. DISCUSSION Urinary leak due to indwelling catheter malfunction or malposition, post radical prostatectomy, is very rare. Only one similar case has been reported so far. Vesicourethral anastomotic leak post prostatectomy is commonly seen, and mostly due to disruption in the posterior anastomosis. Risk factors for such leaks are various and may include: large prostate, previous transurethral resections, techniques adopted for anastomosis and bladder neck reconstruction, among others. Most leakage cases resolve spontaneously or using conservative measures. Those requiring more aggressive interventions are a minority. CONCLUSION Urethrovesical anastomotic leaks are commonly seen after radical prostatectomy. Although most cases are self-limited; others can be managed by various minimally-invasive procedures, diverting urine away from the anastomosis, giving it a chance to properly heal.
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Affiliation(s)
- Jad A Degheili
- Division of Urology, Department of Surgery, American University of Beirut - Medical Center, Riad El-Solh 1107 2020, Beirut, Lebanon.
| | - Haya Malhas
- Department of Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait city, Al Asimah, Kuwait.
| | - Tag Keun Yoo
- Department of Urology, Nowon Eulji Medical Center, Eulji University School of Medicine, 68, Hangeulbiseok-ro, Nowon-gu, Seoul, South Korea.
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Successful body flossing via indwelling nephrostomy allowing for primary realignment of bladder rupture and placement of a foley catheter into the urinary bladder. Radiol Case Rep 2019; 15:49-53. [PMID: 31737146 PMCID: PMC6849421 DOI: 10.1016/j.radcr.2019.10.016] [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: 06/11/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 11/22/2022] Open
Abstract
Vesicourethral anastomosis leaks are one of the most common short-term complications following radical prostatectomy. We present a case of a 67-year-old Caucasian male who presented to our Emergency Department (ED) with abdominal pain and urinary incontinence 10 days after a robotic-assisted laparoscopic prostatectomy. Interventional radiology initially performed successful nephrostomy placement for bilateral hydronephrosis. Vesicourethral disruption was managed via a multidisciplinary approach with urology and interventional radiology in which a novel approach to realign a bladder rupture and appropriately place a foley catheter in the bladder. Vesicourethral leaks are often managed conservatively. In a few cases, such as this one, mini-invasive intervention is often required to repair the disruption.
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Diagnosis of urine leakage after bladder repair: a prospective comparative study of ultra-low-dose CT cystography and conventional retrograde cystography. Radiol Med 2019; 124:812-818. [PMID: 31087214 DOI: 10.1007/s11547-019-01041-9] [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: 07/24/2018] [Accepted: 04/28/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE We performed this prospective cohort study to compare the accuracy and technical characteristics of ultra-low-dose CT cystography with those of conventional retrograde cystography. MATERIALS AND METHODS A cohort of 31 patients referred for cystography after bladder repair were enrolled. To detect urine leakage, we initially performed conventional cystography after retrograde distention of the bladder with dilute iodinated contrast material, followed by ultra-low-dose CT cystography. The diagnostic accuracy of these two modalities was compared, and the technical characteristics of ultra-low-dose CT cystography were examined. RESULTS All 31 referred patients were included in this study. Of the 31 patients, 27 (87.1%) underwent bladder repair after radical prostatectomy, 3 (9.7%) after radical cystectomy, and 1 (3.2%) after bladder diverticulectomy. Four of the 31 patients were diagnosed with urine leakage by conventional cystography. These four patients were confirmed to have urine leakage by ultra-low-dose CT cystography. Another five patients who did not have urine leakage according to conventional cystography were diagnosed with urine leakage by ultra-low-dose CT cystography. Moreover, performing ultra-low-dose CT cystography enabled us to identify the precise location and amount of urine leakage in all nine patients. Based on these findings, we were able to establish a proper treatment plan. CONCLUSIONS Ultra-low-dose CT cystography is an accurate method for evaluating urine leakage after bladder repair, and this technique may help determine the most appropriate treatment strategy for patients with urine leakage after bladder repair.
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Duncan C, Joon DL, Lawrentschuk N, Jenkins T, Schneider M, Khoo V, Chao M, Lawlor M, O'Meara R, Berry C, Viotto A, Brown K, Wada M, Foroudi F, Sengupta S. Fiducial markers: can the urologist do better? World J Urol 2018; 37:1281-1287. [PMID: 30288597 DOI: 10.1007/s00345-018-2515-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 09/29/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Radiotherapy to the bladder has a risk of toxicity to pelvic structures, which can be reduced by using fiducial markers for targeting. Injectable contrast offers an alternative marker to gold seeds, which may fall out or exacerbate scarring. Combining contrast agents with tissue glue can minimize dispersion through tissue, enhancing its utility. We evaluated combinations of contrast agents and tissue glue using porcine bladder, for feasibility and utility as fiducial markers to aid image-guided radiotherapy. METHODS Different contrast agents (Lipiodol ultra or Urografin) were combined with different tissue glues (Histoacryl, Tisseal or Glubran2). The mixtures were endoscopically injected into porcine bladder submucosa to identify the area of interest with multiple fiducial markers. The porcine bladders were imaged within a phantom porcine pelvis using standard radiation therapy imaging modalities. The feasibility as an injectable fiducial marker and visibility of each fiducial marker on imaging were scored as binary outcomes by two proceduralists and two radiation therapists, respectively. RESULTS Lipiodol-glue combinations were successfully administered as multiple fiducials that were evident on CT and CBCT. Lipiodol with Histoacryl or Glubran2 was visible on kV imaging. The Lipiodol Glubran2 combination was deemed subjectively easiest to use at delivery, and a better fiducial on KV imaging. CONCLUSION This study demonstrates the feasibility of mixing contrast medium Lipiodol with Histoacryl or Glubran2 tissue glue, which, injected endoscopically, provides discrete and visible fiducial markers to aid image-guided radiotherapy. Although promising, further study is required to assess the durability of these markers through a course of radiotherapy.
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Affiliation(s)
- Catriona Duncan
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Daryl Lim Joon
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC, Australia.,Olivia Newtown-John Cancer Research Institute, Austin Hospital, Melbourne, VIC, Australia.,The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Trish Jenkins
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia
| | | | | | - Michael Chao
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia
| | - Marita Lawlor
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia
| | - Rachel O'Meara
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia
| | - Colleen Berry
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia
| | - Angela Viotto
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia
| | - Kerryn Brown
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia
| | - Morikatsu Wada
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia.,Olivia Newtown-John Cancer Research Institute, Austin Hospital, Melbourne, VIC, Australia
| | - Farshad Foroudi
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia.,Olivia Newtown-John Cancer Research Institute, Austin Hospital, Melbourne, VIC, Australia
| | - Shomik Sengupta
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC, Australia. .,Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC, 3128, Australia.
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Ayyıldız SN, Ayyıldız A. Cyanoacrylic tissue glues: Biochemical properties and their usage in urology. Turk J Urol 2017; 43:14-24. [PMID: 28270946 DOI: 10.5152/tud.2017.09465] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/10/2016] [Indexed: 11/22/2022]
Abstract
Tissue adhesives are being used in medical and cosmetic industries and first aid for a long time. But their everyday usage has not been widespread. Only case report information is available about their usage. Despite good and meaningful results after they were used, there is lack of standard information that gives idea of about in which cases they could be helpful. Nowadays, cyanoacrylates are used in the surgery more frequently. In this review, we wanted to oversee the biochemical properties and the urological utilisation areas of cyanoacrylates.
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Affiliation(s)
- Sema Nur Ayyıldız
- Clinic of Biochemistry, Ministry of Health, Ankara Education and Training Hospital, Ankara, Turkey
| | - Ali Ayyıldız
- Clinic of Urology, Ministry of Health, Ankara Education and Training Hospital, Ankara, Turkey
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Palm CA, Glaiberman CB, Culp WTN. Treatment of a urethral duplication in a dog using cyanoacrylate and coil embolization. J Vet Intern Med 2015; 29:727-31. [PMID: 25776807 PMCID: PMC4895500 DOI: 10.1111/jvim.12571] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/06/2015] [Accepted: 02/04/2015] [Indexed: 02/05/2023] Open
Affiliation(s)
- C A Palm
- School of Veterinary Medicine, University of California-Davis, Davis, CA
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Selli C, De Maria M, Manica M, Turri FM, Manassero F. Minimally invasive treatment of urinary fistulas using N-butyl-2-cyanoacrylate: a valid first line option. BMC Urol 2013; 13:55. [PMID: 24152605 PMCID: PMC4015743 DOI: 10.1186/1471-2490-13-55] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/11/2013] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND A few single case reports and only one clinical series have been published so far about the use of N-butyl-2-cyanoacrylate in the treatment of urinary fistulas persisting after conventional urinary drainage. CASE PRESENTATION We treated five patients with a mean age of 59.2 years presenting iatrogenic urinary fistulas which persisted following conventional drainage manouvres. There were 3 calyceal fistulas following open, laparoscopic and robotic removal of renal lesions respectively, one pelvic fistula after orthotopic ileal neobladder and a bilateral dehiscence of uretero-sigmoidostomy. We used open-end catheters of different sizes adopting a retrograde endoscopic approach for cyanoacrylate injection in the renal calyces, while a descending percutaneous approach via the pelvic drain tract and bilateral nephrostomies respectively was used for the pelvic fistulas. Fluoroscopic control was always used during the occlusion procedures. The amount of adhesive injected ranged between 2 and 5 cc and in one case the procedure was repeated. With a median follow-up of 11 months we observed clinical and radiological resolution in 4 cases (80%), while a recurrent and infected calyceal fistula after laparoscopic thermal renal damage during tumor enucleoresection required nephrectomy. No significant complications were documented. CONCLUSIONS In an attempt to spare further challenging surgery in patients that had been already operated on recently, minimally invasive occlusion of persistent urinary fistulas with N-butyl-2-cyanoacrylate represents a valid first line treatment, justified in cases when the urinary output is not excessive and there is a favorable ratio between the length and diameter of the fistulous tract.
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Affiliation(s)
- Cesare Selli
- Department of Urology, University of Pisa, Pisa, Italy
- Urologia Universitaria, Edificio 30 C, via Paradisa 2, Pisa, I-56124, Italy
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