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Su J, Wang N, Zhu Q, Yuan L, Zhang Y, Deng Z. Initial experience of transurethral-assisted laparoendoscopic single-site nephroureterectomy. Asian J Surg 2023; 46:380-384. [PMID: 35525697 DOI: 10.1016/j.asjsur.2022.04.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/30/2022] [Accepted: 04/21/2022] [Indexed: 12/16/2022] Open
Abstract
PURPOSE We describe a new transurethral technique for distal ureter management and the improvement of intraoperative exposure during LESS-NU. METHODS A total of 20 transurethral assisted LESS-NU were performed between May 2018 and December 2020 in our institution. The access route for the operation was via a single-port, with four channels placed through a transumbilical incision. After the lower ureter was separated from the bladder wall, a 1470 laser working channel was placed through the urethra to precisely cut the ureteral orifice. Following this, a self-made urethra auxiliary port was inserted through the bladder cuff opening to facilitate a resection of the ureter and kidney. The peri-operative and postoperative data were then retrospectively collected and analysed. RESULTS All procedures were completed successfully and one patient needed an additional port. The mean operative time was 196.8 ± 45.8 min and the mean estimated blood loss was 58.9 ± 32.0 ml. The days required for the surgical drain removal and the hospital stay were 4.6 ± 4.6 and 11.1 ± 6.4 days, respectively. One patient developed a fever following surgery but there were no major complications. During the average follow-up period, which lasted 25.5 months, one patient developed spinal cord metastasis and died 8 months after surgery. No obvious abnormalities were found in any of the other patients. CONCLUSION The tansurethral approach of the distal ureter for LESS-NU is deemed safe and efficient. The technique used offers accurate control of the distal ureter and good exposure of LESS.
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Affiliation(s)
- Jian Su
- Department of Urology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing 210029, China.
| | - Ninghong Wang
- Department of Urology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing 210029, China
| | - Qingyi Zhu
- Department of Urology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing 210029, China
| | - Lin Yuan
- Department of Urology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing 210029, China
| | - Yang Zhang
- Department of Urology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing 210029, China
| | - Zhonglei Deng
- Department of Urology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing 210029, China
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Rodríguez-Serrano A, Carrión DM, Gómez Rivas J, Álvarez-Maestro M, Sánchez S, Rodríguez de Bethencourt F, Aguilera Bazán A, Martínez-Piñeiro L. Prognostic value of urinary cytology for detecting urothelial carcinoma recurrence after radical cystectomy. Actas Urol Esp 2021; 45:466-472. [PMID: 34148845 DOI: 10.1016/j.acuroe.2021.06.001] [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: 08/26/2020] [Accepted: 11/03/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Urethral or upper urinary tract (UUT) recurrence of urothelial carcinoma (UC) after radical cystectomy (RC) are rare (4-6%), and their diagnosis usually occurs within the first two years. Although it is known that its early detection offers benefit in terms of survival, currently there are no clear recommendations for the detection of recurrence in the remnant urothelium (RU). Our aim is to determine the diagnostic value of urinary cytology for the detection of recurrences in the RU and to estimate its impact as an early diagnostic method on survival. MATERIAL AND METHODS Retrospective review of patients who underwent RC for urothelial carcinoma between 2008-2016, with a follow-up of at least 24 months. RESULTS The study included 142 patients. In a median follow-up of 68.5 months, nine patients (6.3%) presented recurrences in the RU (urethra: four, UUT: four, synchronous: one). The sensitivity and specificity of urinary cytology for the diagnosis of UUT recurrences were 20% and 96%, respectively. No significant differences were found between overall survival and cancer-specific survival among patients according to the urinary cytology results. CONCLUSION Recurrences in the RU after RC are infrequent; our study has shown that urinary cytology offers a low sensitivity for their diagnoses. For these reasons, we do not consider that urinary cytology provides useful information for surveillance of these patients.
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Affiliation(s)
- A Rodríguez-Serrano
- Servicio de Urología, Hospital Universitario La Paz, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain.
| | - D M Carrión
- Servicio de Urología, Hospital Universitario La Paz, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain
| | - J Gómez Rivas
- Servicio de Urología, Hospital Universitario La Paz, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Investigación IdiPAZ, Hospital Universitario La Paz, Madrid, Spain
| | - M Álvarez-Maestro
- Servicio de Urología, Hospital Universitario La Paz, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Investigación IdiPAZ, Hospital Universitario La Paz, Madrid, Spain
| | - S Sánchez
- Universidad Autónoma de Madrid, Madrid, Spain; Servicio de Traumatología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - F Rodríguez de Bethencourt
- Servicio de Urología, Hospital Universitario La Paz, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Investigación IdiPAZ, Hospital Universitario La Paz, Madrid, Spain
| | - A Aguilera Bazán
- Servicio de Urología, Hospital Universitario La Paz, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Investigación IdiPAZ, Hospital Universitario La Paz, Madrid, Spain
| | - L Martínez-Piñeiro
- Servicio de Urología, Hospital Universitario La Paz, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Investigación IdiPAZ, Hospital Universitario La Paz, Madrid, Spain
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Veccia A, Carbonara U, Derweesh I, Mehrazin R, Porter J, Abdollah F, Mazzone E, Sundaram CP, Gonzalgo M, Mastroianni R, Ghoreifi A, Cacciamani GE, Patel D, Marcus J, Danno A, Steward J, Bhattu AS, Asghar A, Reese AC, Wu Z, Uzzo RG, Minervini A, Rha KH, Ferro M, Margulis V, Hampton LJ, Simone G, Eun DD, Djaladat H, Mottrie A, Autorino R. Single stage Xi® robotic radical nephroureterectomy for upper tract urothelial carcinoma: surgical technique and outcomes. Minerva Urol Nephrol 2021; 74:233-241. [PMID: 33781022 DOI: 10.23736/s2724-6051.21.04247-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Radical nephroureterectomy (RNU) represents the standard of care for high grade upper tract urothelial carcinoma (UTUC). Open and laparoscopic approaches are well-established treatments, but evidence regarding robotic RANU is growing. The introduction of the Xi® system facilitates the implementation of this multi-quadrant procedure. The aim of this video-article is to describe the surgical steps and the outcomes of Xi® robotic RNU. METHODS Single stage Xi® robotic RNU without patients repositioning and robot re-docking were done between 2015 and 2019 and collected in a large worldwide multi-institutional study, the ROBotic surgery for Upper tract Urothelial cancer STudy (ROBUUST). Institutional review board approval and data share agreement were obtained at each center. Surgical technique is described in detail in the accompanying video. Descriptive statistics of baseline characteristics and surgical, pathological, and oncological outcomes were analyzed. RESULTSː Overall, 148 patients were included in the analysis; 14% had an ECOG >1 and 68.2% ASA ≥3. Median tumor dimension was 3.0 (IQR:2.0-4.2) cm and 34.5% showed hydronephrosis at diagnosis. Forty-eight% were cT1 tumors. Bladder cuff excision and lymph node dissection were performed in 96% and 38.1% of the procedures, respectively. Median operative time and estimated blood loss were 215.5 (IQR:160.5-290.0) minutes and 100.0 (IQR: 50.0-150.0) mL, respectively. Approximately 56% of patients took opioids during hospital stay for a total morphine equivalent dose of 22.9 (IQR:16.0-60.0) milligrams equivalent. Postoperative complications were 26 (17.7%), with 4 major (15.4%). Seven patients underwent adjuvant chemotherapy, with median number of cycles of 4.0 (IQR:3.0-6.0). CONCLUSIONS Single stage Xi® RNU is a reproducible and safe minimally invasive procedure for treatment of UTUC. Additional potential advantages of the robot might be a wider implementation of LND with a minimally invasive approach.
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Affiliation(s)
| | | | - Ithaar Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Elio Mazzone
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Chandru P Sundaram
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Alireza Ghoreifi
- Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Devin Patel
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Jamil Marcus
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Alyssa Danno
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - James Steward
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Amit S Bhattu
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aeen Asghar
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Adam C Reese
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Zhenjie Wu
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Robert G Uzzo
- Department of Urological Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA, USA
| | | | - Koon H Rha
- Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Daniel D Eun
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Hooman Djaladat
- Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Rodríguez-Serrano A, Carrión D, Gómez Rivas J, Álvarez-Maestro M, Sánchez S, Rodríguez de Bethencourt F, Aguilera Bazán A, Martínez-Piñeiro L. Prognostic value of urinary cytology for detecting urothelial carcinoma recurrence after radical cystectomy. Actas Urol Esp 2021. [PMID: 33509614 DOI: 10.1016/j.acuro.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Urethral or upper urinary tract (UUT) recurrence of urothelial carcinoma (UC) after radical cystectomy (RC) are rare (4-6%), and their diagnosis usually occurs within the first two years. Although it is known that its early detection offers benefit in terms of survival, currently there are no clear recommendations for the detection of recurrence in the remnant urothelium (RU). Our aim is to determine the diagnostic value of urinary cytology for the detection of recurrences in the RU and to estimate its impact as an early diagnostic method on survival. MATERIAL AND METHODS Retrospective review of patients who underwent RC for urothelial carcinoma between 2008-2016, with a follow-up of at least 24 months. RESULTS The study included 142 patients. In a median follow-up of 68.5 months, nine patients (6.3%) presented recurrences in the RU (urethra: four, UUT: four, synchronous: one). The sensitivity and specificity of urinary cytology for the diagnosis of UUT recurrences were 20% and 96%, respectively. No significant differences were found between overall survival and cancer-specific survival among patients according to the urinary cytology results. CONCLUSION Recurrences in the RU after RC are infrequent; our study has shown that urinary cytology offers a low sensitivity for their diagnoses. For these reasons, we do not consider that urinary cytology provides useful information for surveillance of these patients.
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Carrion DM, Rodríguez-Socarrás ME, Mantica G, Pang KH, Esperto F, Mattigk A, Duijvesz D, Vásquez JL, Díez Sebastián J, Scarpa RM, Papalia R, Palou J, Gómez Rivas J. Interest and involvement of European urology residents in academic and research activities. An ESRU-ESU-ESUT collaborative study. MINERVA UROL NEFROL 2020; 72:384-387. [DOI: 10.23736/s0393-2249.20.03734-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Esperto F, Papalia R, Pang KH, Cataldo R, Scarpa RM. What is the role of residents during a pandemic? MINERVA UROL NEFROL 2020; 72:387-388. [PMID: 32580536 DOI: 10.23736/s0393-2249.20.03903-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Francesco Esperto
- Department of Urology, Campus Bio-Medico, University of Rome, Rome, Italy -
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Karl H Pang
- Unit of Academic Urology, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Rita Cataldo
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico, University of Rome, Rome, Italy
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7
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Amparore D, Campi R, Checcucci E, Sessa F, Pecoraro A, Minervini A, Fiori C, Ficarra V, Novara G, Serni S, Porpiglia F. Forecasting the Future of Urology Practice: A Comprehensive Review of the Recommendations by International and European Associations on Priority Procedures During the COVID-19 Pandemic. Eur Urol Focus 2020; 6:1032-1048. [PMID: 32553544 PMCID: PMC7261455 DOI: 10.1016/j.euf.2020.05.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/24/2020] [Indexed: 01/17/2023]
Abstract
Context The unprecedented health care scenario caused by the coronavirus disease 2019 (COVID-19) pandemic has revolutionized urology practice worldwide. Objective To review the recommendations by the international and European national urological associations/societies (UASs) on prioritization strategies for both oncological and nononcological procedures released during the current emergency scenario. Evidence acquisition Each UAS official website was searched between April 8 and 18, 2020, to retrieve any document, publication, or position paper on prioritization strategies regarding both diagnostic and therapeutic urological procedures, and any recommendations on the use of telemedicine and minimally invasive surgery. We collected detailed information on all urological procedures, stratified by disease, priority (higher vs lower), and patient setting (outpatient vs inpatient). Then, we critically discussed the implications of such recommendations for urology practice in both the forthcoming “adaptive” and the future “chronic” phase of the COVID-19 pandemic. Evidence synthesis Overall, we analyzed the recommendations from 13 UASs, of which four were international (American Urological Association, Confederation Americana de Urologia, European Association of Urology, and Urological Society of Australia and New Zealand) and nine national (from Belgium, France, Germany, Italy, Poland, Portugal, The Netherlands, and the UK). In the outpatient setting, the procedures that are likely to impact the future burden of urologists’ workload most are prostate biopsies and elective procedures for benign conditions. In the inpatient setting, the most relevant contributors to this burden are represented by elective surgeries for lower-risk prostate and renal cancers, nonobstructing stone disease, and benign prostatic hyperplasia. Finally, some UASs recommended special precautions to perform minimally invasive surgery, while others outlined the potential role of telemedicine to optimize resources in the current and future scenarios. Conclusions The expected changes will put significant strain on urological units worldwide regarding the overall workload of urologists, internal logistics, inflow of surgical patients, and waiting lists. In light of these predictions, urologists should strive to leverage this emergency period to reshape their role in the future. Patient summary Overall, there was a large consensus among different urological associations/societies regarding the prioritization of most urological procedures, including those in the outpatient setting, urological emergencies, and many inpatient surgeries for both oncological and nononcological conditions. On the contrary, some differences were found regarding specific cancer surgeries (ie, radical cystectomy for higher-risk bladder cancer and nephrectomy for larger organ-confined renal masses), potentially due to different prioritization criteria and/or health care contexts. In the future, the outpatient procedures that are likely to impact the burden of urologists’ workload most are prostate biopsies and elective procedures for benign conditions. In the inpatient setting, the most relevant contributors to this burden are represented by elective surgeries for lower-risk prostate and renal cancers, nonobstructing stone disease, and benign prostatic hyperplasia.
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Affiliation(s)
- Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Riccardo Campi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Sessa
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Angela Pecoraro
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urology Section, University of Messina, Messina, Italy
| | - Giacomo Novara
- Urologic Unit, Department of Oncologic, Surgical and Gastrointestinal Sciences, University of Padua, Padua, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy.
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8
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Wu Z, Li M, Wang J, Veccia A, Xu Y, Zhang C, Ren J, Yin L, Chen M, Wang J, Xu D, Zhang Z, Liu B, Yang B, Xie L, Qu L, Wang L. Pure retroperitoneoscopic extravesical standardized seeable (PRESS) excision of distal ureter and bladder cuff in radical nephroureterectomy: step-by-step technique. Minerva Urol Nephrol 2020; 73:392-400. [PMID: 32284528 DOI: 10.23736/s2724-6051.20.03711-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Concerns have been raised regarding the management of bladder cuff with these minimally invasive approaches. The aim of this study was to describe a modified radical nephroureterectomy (RNU) with pure retroperitoneoscopic extravesical standardized seeable (PRESS) bladder cuff excision (BCE) and to assess its outcomes based on a novel concept of intraoperative "trifecta." METHODS Twenty-four patients with upper urinary tract urothelial carcinoma underwent retroperitoneoscopic RNU from August 2017 to August 2019. A modified RNU with PRESS BCE and lymph node dissection (LND) was performed. Descriptive analysis of patients' characteristics, surgical technique, perioperative outcomes, and follow-up data was performed. BCE trifecta was defined as en-bloc excision, mucosa-to-mucosa reliable closure and no urine spillage. RESULTS In 23 out of 24 cases (95.8%) the procedure was successfully completed. One patient was converted to open distal ureterectomy with a Gibson incision due to peritoneum rupture during dissection of the distal ureter. BCE trifecta was achieved in 95.7% (22/23) cases of all patients finished with PRESS technique. Median OT was 260 min (IQR: 220-305) with median EBL of 100 mL (IQR: 100-250). Median OT for distal ureterectomy was 52 min (IQR: 40-69). No positive surgical margin occurred. Median postoperative hospital stay was 6 d (IQR: 5-7). Median follow-up time was 7 mo (IQR: 5-17). One patient (4.3%) experienced bladder recurrence and no patient developed distant metastasis or died of the disease. CONCLUSIONS Herein, we demonstrate a standardized retroperitoneoscopic RNU technique that is safe and reproducible, enabling the visual confirmation of complete BCE and facilitating LND. BCE trifecta should be a routine goal in minimally invasive RNU. Prospective comparison with the standard open surgical technique is warranted.
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Affiliation(s)
- Zhenjie Wu
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Mingmin Li
- Department of Radiology, Changhai Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Jianchao Wang
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Alessandro Veccia
- Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA.,Unit of Urology, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili Hospital, University of Brescia, Italy
| | - Yifan Xu
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Chao Zhang
- Department of Urology, Changhai Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Jizhong Ren
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Lei Yin
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Ming Chen
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Junkai Wang
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Dongliang Xu
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Zongqin Zhang
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Bing Liu
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Bo Yang
- Department of Urology, Changhai Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Liping Xie
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China -
| | - Le Qu
- Department of Urology, East Region Military Command General Hospital (Jinling Hospital), Clinical School of Medical College, Nanjing University, Nanjing, China
| | - Linhui Wang
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
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9
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Proietti S, Marchioni M, Eisner BH, Lucianò R, Saitta G, Rodríguez-Socarrás ME, D'Orta C, Bellinzoni P, Schips L, Gaboardi F, Giusti G. Conservative treatment of upper urinary tract carcinoma in patients with imperative indications. Minerva Urol Nephrol 2020; 73:245-252. [PMID: 32083422 DOI: 10.23736/s2724-6051.20.03710-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To report our experience for endoscopic treatment of upper urinary tract carcinoma (UTUC) in patients with imperative indications for management. METHODS Retrospective data were collected for all patients who underwent endoscopic management of UTUC for imperative situations, from September 2013 to January 2019. Comorbidity was determined by using the age-adjusted Charlson Comorbidity Index (CCI). The primary endpoint of the study was overall survival (OS). Secondary outcomes were recurrence-free survival (RFS) rates, complication rates and global renal function. RESULTS A total of 29 patients were enrolled in the study. The median age was 69.0 (IQR 63.0-79.0) years and the median CCI was 6 (IQR 4-8). Overall, 137 endoscopic procedures were performed; 117 (85.4%) had no complication. Clavien-Dindo grade III and IV complications were 3 (2.2%) and 1 (0.7%) respectively. The median follow-up of 23 months (IQR 14-35). During the follow-up, 2 (6.9%) patients died for cause not related to cancer. Recurrence of UTUC occurred in 18 patients (61.1%). The 24-month OS was 96.4±3.5% and the 24-month RFS was 31.7±9.4%. Lower RFS rates were found in high grade tumor patients (22.2±13.9%) compared to low grade tumor patients (35.6±12.3%) (P=0.237). There was statistical difference in creatinine and eGFR values when comparing baseline to last follow-up (P=0.018 and P=0.005, respectively). CONCLUSIONS Endoscopic management of UTUC in patients with imperative indications appears to be a reasonable alternative to nephroureterectomy. However, stringent endoscopic follow-up is necessary due to the high risk of disease recurrence.
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Affiliation(s)
- Silvia Proietti
- Department of Urology, IRCCS San Raffaele Hospital, Ville Turro Division, Milan, Italy -
| | - Michele Marchioni
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti, Italy
| | - Brian H Eisner
- Department of Urology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Roberta Lucianò
- Unit of Pathology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giuseppe Saitta
- Department of Urology, IRCCS San Raffaele Hospital, Ville Turro Division, Milan, Italy
| | | | - Carlo D'Orta
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti, Italy
| | - Piera Bellinzoni
- Department of Urology, IRCCS San Raffaele Hospital, Ville Turro Division, Milan, Italy
| | - Luigi Schips
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti, Italy
| | - Franco Gaboardi
- Department of Urology, IRCCS San Raffaele Hospital, Ville Turro Division, Milan, Italy
| | - Guido Giusti
- Department of Urology, IRCCS San Raffaele Hospital, Ville Turro Division, Milan, Italy
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Veccia A, Antonelli A, Francavilla S, Simeone C, Guruli G, Zargar H, Perdoná S, Ferro M, Carrieri G, Hampton LJ, Porpiglia F, Autorino R. Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases. World J Urol 2019; 38:845-852. [PMID: 31773242 DOI: 10.1007/s00345-019-03020-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 11/10/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To perform a systematic review and meta-analysis of the literature inherent robotic nephroureterectomy (RNU) and to compare its outcomes with those of other nephroureterectomy (NU) techniques. METHODS A systematic literature search was performed up to April 2019 using PubMed, Embase®, and Web of Science. The Preferred Reporting Items for Systematic Review and Meta-analysis Statement was followed for study selection. The following data were extracted for each study: baseline features, surgical outcomes, oncological outcomes, and survival outcomes. Stata® 15.0 was used for statistical analysis. RESULTS Literature search identified 80 studies eligible for the meta-analysis and overall 87,291 patients were included in the analysis: open NU (ONU; n = 45,601), hand-assisted laparoscopic NU (HALNU; n = 442), laparoscopic NU (LNU n = 31,093), and RNU (n = 10,155). RNU was more likely to be performed in those patients with multifocal tumor location (proportion: 0.19; 95% CI 0.14, 0.24) and high-grade disease (proportion: 0.70; 95% CI 0.53, 0.68). The lowest EBL was recorded in the RNU group (weighted mean (WM) 163.31 mL; 95% CI 88.94, 237.68), whereas the highest was in the ONU group (414.99 mL; 95% CI 378.52, 451.46). Operative time was shorter for ONU (224.98 mL; 95% CI 212.26, 237.69). RNU had lower rate of intraoperative complications (0.02; 95% CI 0.01, 0.05). ONU showed higher odds of transfusions (0.20; 95% CI 0.15, 0.25). LOS was statistically significantly shorter for the RNU group (5.35 days; 95% CI 4.97, 5.82). HALNU seemed to present lower risk of PSM (0.02; 95% CI - 0.01, 0.05), and lower risk of recurrence (0.22; 95% CI 0.15, 0.30), metastasis (0.07; 95% CI 0.05, 0.10), and cancer-related death (0.03; 95% CI 0.01, 0.06). ONU showed the lowest 5 years cancer specific survival (proportion: 0.77; 95% CI 0.74, 0.80). No correlation was found between the surgical technique and recurrence-free and cancer-specific survival. CONCLUSIONS Evidence regarding RNU for the treatment of UTUC is increasing but it remains quite sparse and of low quality. Despite this, RNU seems to be safe, and to offer the advantages of a minimally invasive approach without impairing the oncological outcomes. Nevertheless, ONU, HALNU, and LNU still represent a valid, and commonly used surgical treatment option. As RNU becomes more popular, and concerns related to its use remain, the best surgical technique for NU remains to be determined.
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Affiliation(s)
- Alessandro Veccia
- Division of Urology, VCU Health System, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA.,Urology Unit, ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Alessandro Antonelli
- Urology Unit, ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Simone Francavilla
- Urology Unit, ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Georgi Guruli
- Division of Urology, VCU Health System, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA
| | - Homayoun Zargar
- Department of Surgery, Department of Urology, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - Sisto Perdoná
- Uro-Gynecological Department, Fondazione "G. Pascale" IRCCS, Naples, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Lance J Hampton
- Division of Urology, VCU Health System, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA
| | | | - Riccardo Autorino
- Division of Urology, VCU Health System, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA.
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