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Checcucci E, De Cillis S, Alladio E, Piramide F, Volpi G, Granato S, Zamengo D, Bignante G, Amparore D, Piana A, Manfredi M, Vallariello E, Stura I, Di Dio M, Autorino R, Porpiglia F, Fiori C. Ten-year functional and oncological outcomes of a prospective randomized controlled trial comparing laparoscopic versus robot-assisted radical prostatectomy. Prostate 2024; 84:832-841. [PMID: 38572570 DOI: 10.1002/pros.24702] [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: 10/23/2023] [Revised: 01/28/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Among prostate cancer (PCa) treatment options, mini-invasive surgical approaches have gained a wide diffusion in the last decades. The aim of this study was to present oncological, functional, and quality of life data after 10 years of follow-up of a prospective randomized controlled trial (RCT) (ISRCTN11552140) comparing robot-assisted radical prostatectomy (RARP) versus laparoscopic radical prostatectomy (LRP) for the treatment of PCa. METHODS Patients with localized PCa were randomized to undergo LRP or RARP between January 2010 and January 2011. Functional (continence and potency) and oncological (prostate-specific antigen, biochemical recurrence [BCR] and BCR-free survival [BCRFS]) variables were evaluated. BCRFS curves were estimated by the Kaplan-Meier method and compared using the log-rank test. Machine learning partial least square-discriminant analysis (PLS-DA) was used to identify the variables characterizing more the patients who underwent RARP or LRP. RESULTS Seventy-five of the originally enrolled 120 patients remained on follow-up for 10 years; 40 (53%) underwent RARP and 35 (47%) LRP. Continence and potency recovery rates did not show significant differences (p = 0.068 and p = 0.56, respectively), despite a Δ12% for continence and Δ8% for potency in favor of the robotic approach. However, the quality of continence (in terms of International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] score) and erection (in terms of International Index of Erectile Function-5 [IIEF-5] score) was significantly better after 10 years in the robotic group (p = 0.02 and p < 0.001). PLS-DA revealed that LRP was characterized by the worst functional-related outcomes analyzing the entire follow-up period. Four (10%) and six (17%) patients experienced BCR in RARP and LRP groups, respectively (p = 0.36), with an overall 10-year BCR-free survival of 88% and 78% (p = 0.16). CONCLUSIONS Comparable continence and potency rates were observed between RARP and LRP after a 10-year follow-up. However, the RARP group exhibited superior totally dry rate and erection quality. No difference in terms of oncological outcomes was found.
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Affiliation(s)
- Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Sabrina De Cillis
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Federico Piramide
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Gabriele Volpi
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Stefano Granato
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Davide Zamengo
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Gabriele Bignante
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Alberto Piana
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Matteo Manfredi
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Ilaria Stura
- Department of Public Health and Pediatric Sciences, School of Medicine, University of Turin, Turin, Italy
| | - Michele Di Dio
- Division of Urology, Department of Surgery, SS Annunziata Hospital, Cosenza, Italy
| | | | - Francesco Porpiglia
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
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Checcucci E, Piana A, Volpi G, Piazzolla P, Amparore D, De Cillis S, Piramide F, Gatti C, Stura I, Bollito E, Massa F, Di Dio M, Fiori C, Porpiglia F. Three-dimensional automatic artificial intelligence driven augmented-reality selective biopsy during nerve-sparing robot-assisted radical prostatectomy: A feasibility and accuracy study. Asian J Urol 2023; 10:407-415. [PMID: 38024433 PMCID: PMC10659972 DOI: 10.1016/j.ajur.2023.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/21/2023] [Accepted: 07/06/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To evaluate the accuracy of our new three-dimensional (3D) automatic augmented reality (AAR) system guided by artificial intelligence in the identification of tumour's location at the level of the preserved neurovascular bundle (NVB) at the end of the extirpative phase of nerve-sparing robot-assisted radical prostatectomy. Methods In this prospective study, we enrolled patients with prostate cancer (clinical stages cT1c-3, cN0, and cM0) with a positive index lesion at target biopsy, suspicious for capsular contact or extracapsular extension at preoperative multiparametric magnetic resonance imaging. Patients underwent robot-assisted radical prostatectomy at San Luigi Gonzaga Hospital (Orbassano, Turin, Italy), from December 2020 to December 2021. At the end of extirpative phase, thanks to our new AAR artificial intelligence driven system, the virtual prostate 3D model allowed to identify the tumour's location at the level of the preserved NVB and to perform a selective excisional biopsy, sparing the remaining portion of the bundle. Perioperative and postoperative data were evaluated, especially focusing on the positive surgical margin (PSM) rates, potency, continence recovery, and biochemical recurrence. Results Thirty-four patients were enrolled. In 15 (44.1%) cases, the target lesion was in contact with the prostatic capsule at multiparametric magnetic resonance imaging (Wheeler grade L2) while in 19 (55.9%) cases extracapsular extension was detected (Wheeler grade L3). 3D AAR guided biopsies were negative in all pathological tumour stage 2 (pT2) patients while they revealed the presence of cancer in 14 cases in the pT3 cohort (14/16; 87.5%). PSM rates were 0% and 7.1% in the pathological stages pT2 and pT3 (<3 mm, Gleason score 3), respectively. Conclusion With the proposed 3D AAR system, it is possible to correctly identify the lesion's location on the NVB in 87.5% of pT3 patients and perform a 3D-guided tailored nerve-sparing even in locally advanced diseases, without compromising the oncological safety in terms of PSM rates.
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Affiliation(s)
- Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Alberto Piana
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, To, Italy
| | - Gabriele Volpi
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Pietro Piazzolla
- Department of Mechanical Engineering, Politecnico di Milano, Milan, Italy
| | - Daniele Amparore
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, To, Italy
| | - Sabrina De Cillis
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, To, Italy
| | - Federico Piramide
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, To, Italy
| | - Cecilia Gatti
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, To, Italy
| | - Ilaria Stura
- Department of Public Health and Pediatric Sciences, School of Medicine, University of Turin, Italy
| | - Enrico Bollito
- Department of Pathology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Federica Massa
- Department of Pathology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Michele Di Dio
- SS Annunziata Hospital, Department of Surgery, Division of Urology, Cosenza, Italy
| | - Cristian Fiori
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, To, Italy
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, To, Italy
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Porpiglia F, Checcucci E, DE Cillis S, Piramide F, Amparore D, Piana A, Volpi G, Granato S, Zamengo D, Stura I, Alladio E, Migliaretti G, DE Luca S, Bollito E, Gned D, DI Dio M, Autorino R, Manfredi M, Fiori C. A prospective randomized controlled trial comparing target prostate biopsy alone approach vs. target plus standard in naïve patients with positive mpMRI. Minerva Urol Nephrol 2023; 75:31-41. [PMID: 36626117 DOI: 10.23736/s2724-6051.22.05189-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND In the era of mpMRI guided target fusion biopsy (FB), the role of concomitant standard biopsy (SB) in naïve patients still remains under scrutiny. The aim of this study was to compare the detection rate (DR) of clinically significant prostate cancer (csPCa) in biopsy naïve patients with positive mpMRI who underwent FB alone (Arm A) vs FB+SB (Arm B). Secondary objectives were to compare the incidence of complications, the overall PCa DR and the biopsy results with final pathological findings after robotic prostatectomy (RARP). METHODS This is a single center prospective non-inferiority parallel two arms (1:1) randomized control trial (ISRCTN registry number ISRCTN60263108) which took place at San Luigi Gonzaga University Hospital, Orbassano (Turin, Italy) from 4/2019 to 10/2021. Eligible participants were all adults aged<75 years old, biopsy naïve, with serum PSA<15 ng/mL and positive mpMRI (Pi-Rads V.2>3). FB was performed under ultrasound guidance using the BioJet fusion system; four to six target samples were obtained for each index lesion. SB was performed in accordance with the protocol by Rodríguez-Covarrubias. RARP with total anatomical reconstruction was carried out when indicated. DR of PCa and csPCA (Gleason Score >7) were evaluated. Post-biopsy complications according to Clavien-Dindo were recorded. Concordance between biopsy and RARP pathological findings was evaluated. Fisher's Exact test and Mann-Whitney test were applied; furthermore, Logistic Principal Component Analysis (LogPCA) and Pearson's correlation method, in terms of correlation funnel plots, were performed to explore data in a multivariate way. RESULTS 201 and 193 patients were enrolled in Arm A and B, respectively. csPCa DR was 60.2% vs. 60.6% in Arm A and B respectively (Δ 0.4%; P=0.93); whilst overall PCa DR was 63.7% vs. 71.0% (Δ 7.3%; P=0.12). However, in a target only setting, the addition of SB homolaterally to the index lesion reaching a non-inferior performance compared to the combined sampling (Δ PCa DR 3%). Although the differences of 7.3% in PCa DR, during RARP were registered similar nerve sparing rate (P=0.89), positive surgical margins (P=0.67) and rate of significant upgrading (P=0.12). LogPCA model showed no distinction between the two cohorts; and Pearson's correlation values turned to be between -0.5 and +0.5. In Arm B, the lesion diameter <10 mm is the only predictive variable of positive SB only for PCa (P=0.04), with an additional value +3% for PCa DR. CONCLUSIONS In biopsy naïve patients, FB alone is not inferior to FB+SB in detecting csPCa (Δ csPCa DR 0.4%). Δ 7.3% in overall PCa DR was registered between the two Arms, however the addition of further standard samples homolaterally to mp-MRI index lesion improved the overall PCa DR of FB only sampling (Δ PCa DR 3%). The omission of SB did not influence the post-surgical outcomes in terms of NS approach, PSMr and upgrading/downgrading.
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Affiliation(s)
- Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy - .,Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Sabrina DE Cillis
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Federico Piramide
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Alberto Piana
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Gabriele Volpi
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Stefano Granato
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Davide Zamengo
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Ilaria Stura
- Department of Public Health and Pediatric Sciences, School of Medicine, University of Turin, Turin, Italy
| | | | | | - Stefano DE Luca
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Enrico Bollito
- Department of Pathology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Dario Gned
- Department of Radiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Michele DI Dio
- Division of Urology, Department of Surgery, SS Annunziata Hospital, Cosenza, Italy
| | | | - Matteo Manfredi
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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Sarchi L, De Groote R, Mottrie A. Re: Walter Artibani, Giovanni Cacciamani. Is the Choice Between Clips and No Clips or Cautery and No Cautery Still a Dilemma in Robot-assisted Radical Prostatectomy? Eur Urol Open Sci 2022;44:76–7. EUR UROL SUPPL 2022; 46:147-148. [PMID: 36420114 PMCID: PMC9676145 DOI: 10.1016/j.euros.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/18/2022] Open
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The Impact of intra-abdominal Pressure on Perioperative Outcomes in Robotic-Assisted Radical Prostatectomy: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. JOURNAL OF ONCOLOGY 2022; 2022:4974027. [DOI: 10.1155/2022/4974027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/23/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
Objective. The aim of the study is to analyze the impact of intra-abdominal pressure (IAP) on perioperative outcomes in robotic-assisted radical prostatectomy (RARP). Methods. We searched the PubMed, Cochrane Library, Science, Embase, and CNKI databases systematically, and the retrieval date was from the inception of the databases to April 2022. Randomized controlled trials on high intraabdominal pressure (HIAP) and low intraabdominal pressure (LIAP) in RARP were included. The meta-analysis was performed using Review Manager software (version 5.3). Results. Six studies involving 2,271 patients were included in the meta-analysis. Compared with patients who experienced HIAP, those who experienced LIAP had a lower incidence of postoperative ileus (POI) (risk ratio (RR): 0.42; 95% confidence interval (CI): 0.24 to 0.72;
). However, there were no significant differences in hematoma (RR 2.22; 95% CI, 0.61 to 8.15;
), positive margin rate (RR, 1.06; 95% CI, 0.84 to 1.32;
), urinary retention (RR, 0.99; 95% CI, 0.51 to 1.94;
), operative time (mean difference (MD), −0.36; 95% CI, −12.24 to 6.12;
), or intraoperative blood loss (MD, −21.80; 95% CI, −55.28 to 11.68;
) among patients undergoing LIAP and HIAP. Conclusion. Our study of published trials indicates that using LIAP during RARP may reduce the incidence of POI, and there were no differences in terms of hematoma, positive margin rate, urinary retention, operative time, or intraoperative blood loss.
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Ju G, Wang Z, Shi J, Xu W, Zhang Z, Yin L, Xu D, Ren S. Extraperitoneal tissue retraction technique: An effective assistant of extraperitoneal pure single-port robotic-assisted radical prostatectomy with the da Vinci Si surgical system. Front Surg 2022; 9:941104. [DOI: 10.3389/fsurg.2022.941104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
ObjectiveThe limitations of tissue retraction and the amount of surgical working space have a great impact on extraperitoneal single-port robotic-assisted radical prostatectomy (sp-RARP) with the multiport robotic surgical system. We used an extraperitoneal tissue retraction technique to achieve tissue exposure and working space expansion. This study evaluated the safety, feasibility, and efficacy of the extraperitoneal tissue retraction technique in extraperitoneal pure sp-RARP with the da Vinci Si surgical system.MethodsData from 42 patients were analyzed retrospectively from December 2018 to February 2020. The extraperitoneal tissue retraction technique was not used in 20 patients (group I) and was used in 22 patients (group II). Preoperative, intraoperative, and postoperative data were collected. The oncological and functional data during late follow-up were recorded.ResultsAll patients successfully underwent extraperitoneal pure sp-RARP. No patients required conversion to a multiport surgery or placement of additional assistant ports. The two groups were similar regarding baseline features. The median operation time in group I was significantly longer than that in group II (P < 0.001). The estimated blood loss volume in group I was significantly higher than that in group II (P < 0.001). There were no serious complications in either group. There were four cases of peritoneal tears in group I and none in group II (P = 0.043). The surgical margin and lymph nodes were negative in both groups. The oncological and functional outcomes were similar between the two groups 6 months after the procedure.ConclusionsThe extraperitoneal tissue retraction technique is safe and feasible. The technique promotes tissue exposure and expands the surgical working space, which is important for achieving extraperitoneal pure sp-RARP with the da Vinci Si surgical system, especially for beginners. The short-term oncological and functional outcomes were within acceptable ranges. The long-term effects of this technique need further evaluation.
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The impact of 3D models on positive surgical margins after robot-assisted radical prostatectomy. World J Urol 2022; 40:2221-2229. [PMID: 35790535 DOI: 10.1007/s00345-022-04038-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/03/2022] [Indexed: 10/17/2022] Open
Abstract
PURPOSE To evaluate the role of 3D models on positive surgical margin rate (PSM) rate in patients who underwent robot-assisted radical prostatectomy (RARP) compared to a no-3D control group. Secondarily, we evaluated the postoperative functional and oncological outcomes. METHODS Prospective study enrolling patients with localized prostate cancer (PCa) undergoing RARP with mp-MRI-based 3D model reconstruction, displayed in a cognitive or augmented-reality fashion, at our Centre from 01/2016 to 01/2020. A control no-3D group was extracted from the last two years of our Institutional RARP database. PSMr between the two groups was evaluated and multivariable linear regression (MLR) models were applied. Finally, Kaplan-Meier estimator was used to calculate biochemical recurrence at 12 months after the intervention. RESULTS 160 patients were enrolled in the 3D Group, while 640 were selected for the Control Group. A more conservative NS approach was registered in the 3D Group (full NS 20.6% vs 12.7%; intermediate NS 38.1% vs 38.0%; standard NS 41.2% vs 49.2%; p = 0.02). 3D Group patients had lower PSM rates (25 vs. 35.1%, p = 0.01). At MLR models, the availability of 3D technology (p = 0.005) and the absence of extracapsular extension (ECE, p = 0.004) at mp-MRI were independent predictors of lower PSMr. Moreover, 3D model represented a significant protective factor for PSM in patients with ECE or pT3 disease. CONCLUSION The availability of 3D models during the intervention allows to modulate the NS approach, limiting the occurrence of PSM, especially in patients with ECE at mp-MRI or pT3 PCa.
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Fiori C, Checcucci E, Stura I, Amparore D, De Cillis S, Piana A, Granato S, Volpi G, Sica M, Piramide F, Verri P, Manfredi M, De Luca S, Autorino R, Migliaretti G, Porpiglia F. Development of a novel nomogram to identify the candidate to extended pelvic lymph node dissection in patients who underwent mpMRI and target biopsy only. Prostate Cancer Prostatic Dis 2022:10.1038/s41391-022-00565-y. [PMID: 35750851 DOI: 10.1038/s41391-022-00565-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/16/2022] [Accepted: 06/10/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nowadays a tool able to predict the risk of lymph-node invasion (LNI) in patients underwent target biopsy (TB) only before radical prostatectomy (RP) is still lacking. Our aim is to develop a model based on mp-MRI and target biopsy (TB) alone able to predict the risk of LNI. METHODS We retrospectively extracted data of patients with preoperative positive mp-MRI and TB only who underwent RARP with ePLND from April 2014 to March 2020. A logistic regression model was performed to evaluate the impact of pre- and intra-operative factors on the risk of LNI. Model discrimination was assessed using an area under (AUC) the ROC curve. A nomogram, and its calibration plot, to predict the risk of LNI were generated based on the logistic model. A validation of the model was done using a similar cohort. RESULTS 461 patients were included, of which 52 (11.27) had LNI. After logistic regression analysis and multivariable model DRE, PI-RADS, seminal vesicle invasion, PSA and worst GS at I and II target lesions were significant predictors of LNI. The AUC was 0.74 [0.67-0.81] 95% CI. The calibration plot shows that our model is very close to the ideal one which is in the 95% CI. After the creation of a visual nomogram, the cut-off to discriminate between the risk or not of LNI was set with Youden index at 60 points that correspond to a risk of LNI of 7%. The model applied on a similar cohort shown a LH+ of 2.58 [2.17-2.98] 95% CI. CONCLUSIONS Our nomogram for patients undergoing MRI-TB only takes into account clinical stage, SVI at MRI, biopsy Gleason pattern and PSA and it is able to identify patients with risk of LNI when a score higher than 7% is achieved.
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Affiliation(s)
- Cristian Fiori
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Enrico Checcucci
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy. .,Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy.
| | - Ilaria Stura
- Department of Public Health and Pediatric Sciences, School of Medicine, University of Turin, Turin, Italy
| | - Daniele Amparore
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Sabrina De Cillis
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Alberto Piana
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Stefano Granato
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Gabriele Volpi
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Michele Sica
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Federico Piramide
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Paolo Verri
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Matteo Manfredi
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Stefano De Luca
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | | | - Giuseppe Migliaretti
- Department of Public Health and Pediatric Sciences, School of Medicine, University of Turin, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
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Amparore D, Pecoraro A, Piramide F, Verri P, Checcucci E, De Cillis S, Piana A, Burgio M, Di Dio M, Manfredi M, Fiori C, Porpiglia F. Three-dimensional imaging reconstruction of the kidney's anatomy for a tailored minimal invasive partial nephrectomy: A pilot study. Asian J Urol 2022; 9:263-271. [PMID: 36035345 PMCID: PMC9399544 DOI: 10.1016/j.ajur.2022.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective Methods Results Conclusion
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Affiliation(s)
- Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands
- Corresponding author. Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Angela Pecoraro
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands
| | - Federico Piramide
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Paolo Verri
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Enrico Checcucci
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
- European Association of Urology (EAU) Young Academic Urologists (YAU) Uro-technology and SoMe Working Group, Arnhem, Netherlands
| | - Sabrina De Cillis
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Alberto Piana
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Mariano Burgio
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Michele Di Dio
- Division of Urology, Department of Surgery, SS Annunziata Hospital, Cosenza, Italy
| | - Matteo Manfredi
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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10
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Wen J, Tang T, Ji Y, Zhang Y. PI-RADS v2.1 Combined With Prostate-Specific Antigen Density for Detection of Prostate Cancer in Peripheral Zone. Front Oncol 2022; 12:861928. [PMID: 35463349 PMCID: PMC9024291 DOI: 10.3389/fonc.2022.861928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To evaluate the diagnostic performance of combining the Prostate Imaging Reporting and Data System (PI-RADS) scoring system v2.1 with prostate-specific antigen density (PSAD) to detect prostate cancer (PCa). Methods A total of 266 participants with suspicion of PCa underwent multiparametric magnetic resonance imaging (mpMRI) in our hospital, after at least 4 weeks all patients underwent subsequent systematic transrectal ultrasound (TRUS)-guided biopsy or MRI-TRUS fusion targeted biopsy. All mpMRI images were scored in accordance with the PI-RADS v2.1, and univariate and multivariate logistic regression analyses were performed to determine significant predictors of PCa. Results A total of 119 patients were diagnosed with PCa in the biopsy, of them 101 patients were diagnosed with clinically significant PCa. The multivariate analysis revealed that PI-RADS v2.1 and PSAD were independent predictors for PCa. For peripheral zone (PZ), the area under the ROC curve (AUC) for the combination of PI-RADS score and PSAD was 0.90 (95% CI 0.83-0.96), which is significantly superior to using PI-RADS score (0.85, 95% CI 0.78-0.93, P=0.031) and PSAD alone (0.83, 95% CI 0.75-0.90, P=0.037). For transition zone (TZ), however, the combination model was not significantly superior to PI-RADS alone, with AUC of 0.94 (95% CI 0.89-0.99) vs. 0.93 (95% CI 0.88-0.97, P=0.186). Conclusion The combination of PI-RADS v2.1 with PSAD could significantly improve the diagnostic performance of PCa in PZ. Nevertheless, no significant improvement was observed regarding PCa in TZ.
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Affiliation(s)
- Jing Wen
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Tingting Tang
- Department of Radiology, Yancheng First Peoples' Hospital, Yancheng, China
| | - Yugang Ji
- Department of Radiology, Yancheng First Peoples' Hospital, Yancheng, China
| | - Yilan Zhang
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
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11
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Aycock KN, Campelo SN, Davalos RV. A Comparative Modeling Study of Thermal Mitigation Strategies in Irreversible Electroporation Treatments. JOURNAL OF HEAT TRANSFER 2022; 144:031206. [PMID: 35833151 PMCID: PMC8823459 DOI: 10.1115/1.4053199] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/03/2021] [Indexed: 05/09/2023]
Abstract
Irreversible electroporation (IRE), also referred to as nonthermal pulsed field ablation (PFA), is an attractive focal ablation modality for solid tumors and cardiac tissue due to its ability to destroy aberrant cells with limited disruption of the underlying tissue architecture. Despite its nonthermal cell death mechanism, application of electrical energy results in Joule heating that, if ignored, can cause undesired thermal injury. Engineered thermal mitigation (TM) technologies including phase change materials (PCMs) and active cooling (AC) have been reported and tested as a potential means to limit thermal damage. However, several variables affect TM performance including the pulsing paradigm, electrode geometry, PCM composition, and chosen active cooling parameters, meaning direct comparisons between approaches are lacking. In this study, we developed a computational model of conventional bipolar and monopolar probes with solid, PCM-filled, or actively cooled cores to simulate clinical IRE treatments in pancreatic tissue. This approach reveals that probes with integrated PCM cores can be tuned to drastically limit thermal damage compared to existing solid probes. Furthermore, actively cooled probes provide additional control over thermal effects within the probe vicinity and can altogether abrogate thermal damage. In practice, such differences in performance must be weighed against the increased time, expense, and effort required for modified probes compared to existing solid probes.
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Affiliation(s)
- Kenneth N. Aycock
- Bioelectromechanical Systems Lab, Virginia Tech—Wake Forest School of Biomedical Engineering and Sciences, Virginia Tech Department of Biomedical Engineering and Mechanics, 320 Kelly Hall, 325 Stanger Street, Blacksburg, VA 24061
- Corresponding author. e-mail:
| | - Sabrina N. Campelo
- Bioelectromechanical Systems Lab, Virginia Tech—Wake Forest School of Biomedical Engineering and Sciences, Virginia Tech Department of Biomedical Engineering and Mechanics, 320 Kelly Hall, 325 Stanger Street, Blacksburg, VA 24061
- e-mail:
| | - Rafael V. Davalos
- Bioelectromechanical Systems Lab, Virginia Tech—Wake Forest School of Biomedical Engineering and Sciences, Virginia Tech Department of Biomedical Engineering and Mechanics, 320 Kelly Hall, 325 Stanger Street, Blacksburg, VA 24061
- e-mail:
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12
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Liu J, Zhang J, Yang Z, Liu Q, Zhang W, Qing Z, Wang D. Comparison of Retzius-sparing and conventional robot-assisted laparoscopic radical prostatectomy regarding continence and sexual function: an updated meta-analysis. Prostate Cancer Prostatic Dis 2022; 25:47-54. [PMID: 34697432 DOI: 10.1038/s41391-021-00459-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/24/2021] [Accepted: 09/09/2021] [Indexed: 02/04/2023]
Abstract
ABSTACT BACKGROUND: Studies comparing C-RARP and RS-RARP have reported different results and the choice between the two operation methods remains controversia. METHODS We present the meta-analysis on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The meta-analysis was carried out using Review Manager 5.3 (Cochrane Collaboration, Oxford, United Kingdom) and Stata SE 14.0. The mean difference (MD) with 95% confidence intervals (CI) were used to describe the results of continuous data; odds ratio (OR) with 95% CI were used to describe dichotomous data. Statistical significance was set at P < 0.05. RESULTS The meta-analysis revealed that RS-RARP had a statistically significant advantage in terms of continence recovery immediately after operation (OR: 0.40, 95% CI: 0.20-0.77; P = 0.007) (Fig. 2a), after 1 month (OR: 0.17, 95% CI: 0.10-0.29; P < 0.00001) (Fig. 2b), after 3 months (OR: 0.18, 95% CI: 0.09-0.36; P < 0.00001) (Fig. 2c), after 6 months (OR: 0.26, 95% CI: 0.15-0.46; P < 0.00001) (Fig. 2d) and after 12 months (OR: 0.50, 95% CI: 0.28-0.89; P = 0.02) (Fig. 2e). CONCLUSIONS This meta-analysis found that RS-RARP had better postoperative continence recovery than C-RARP, while sexual function recovery rates were not significantly different. There were also no significant differences in operation time, intraoperative blood loss, length of stay, positive margin rate and complications.
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Affiliation(s)
- Junyan Liu
- Chongqing Medical University, Chongqing, 400016, China
| | - Jindong Zhang
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zongke Yang
- Department of Urology, Dianjiang People's Hospital of Chongqing, Chongqing, 408399, China
| | - Qingyuan Liu
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Weiyang Zhang
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zizhen Qing
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Delin Wang
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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13
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Fan X, Xie N, Chen J, Li T, Cao R, Yu H, He M, Wang Z, Wang Y, Liu H, Wang H, Yin X. Multiparametric MRI and Machine Learning Based Radiomic Models for Preoperative Prediction of Multiple Biological Characteristics in Prostate Cancer. Front Oncol 2022; 12:839621. [PMID: 35198452 PMCID: PMC8859464 DOI: 10.3389/fonc.2022.839621] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/11/2022] [Indexed: 01/18/2023] Open
Abstract
Objectives This study aims to develop and evaluate multiparametric MRI (MP-MRI)-based radiomic models as a noninvasive diagnostic method to predict several biological characteristics of prostate cancer. Methods A total of 252 patients were retrospectively included who underwent radical prostatectomy and MP-MRI examinations. The prediction characteristics of this study were as follows: Ki67, S100, extracapsular extension (ECE), perineural invasion (PNI), and surgical margin (SM). Patients were divided into training cohorts and validation cohorts in the ratio of 4:1 for each group. After lesion segmentation manually, radiomic features were extracted from MP-MRI images and some clinical factors were also included. Max relevance min redundancy (mRMR) and recursive feature elimination (RFE) based on random forest (RF) were adopted to select features. Six classifiers were included (SVM, KNN, RF, decision tree, logistic regression, XGBOOST) to find the best diagnostic performance among them. The diagnostic efficiency of the construction models was evaluated by ROC curves and quantified by AUC. Results RF performed best among the six classifiers for the four groups according to AUC values (Ki67 = 0.87, S100 = 0.80, ECE = 0.85, PNI = 0.82). The performance of SVM was relatively the best for SM (AUC = 0.77). The number and importance of DCE features ranked first in the models of each group. The combined models of MP-MRI and clinical characteristics showed no significant difference compared with MP-MRI models according to Delong’s tests. Conclusions Radiomics models based on MP-MRI have the potential to predict biological characteristics and are expected to be a noninvasive method to evaluate the risk stratification of prostate cancer.
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Affiliation(s)
- Xuhui Fan
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ni Xie
- Institution for Clinical Research, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingwen Chen
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tiewen Li
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Cao
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongwei Yu
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meijuan He
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zilin Wang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yihui Wang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Liu
- Department of Research and Development, Yizhun Medical AI Technology Co. Ltd., Beijing, China
| | - Han Wang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Institution for Clinical Research, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Radiology, Jiading Branch of Shanghai General Hospital, Shanghai, China
| | - Xiaorui Yin
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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14
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Chen Z, Qu M, Shen X, Jiang S, Zhang W, Ji J, Wang Y, Zhang J, Chen Z, Lin L, Li M, Wu C, Gao X. Establishment of an Individualized Predictive Model to Reduce the Core Number for Systematic Prostate Biopsy: A Dual Center Study Based on Stratification of the Disease Risk Score. Front Oncol 2022; 11:831603. [PMID: 35237503 PMCID: PMC8882832 DOI: 10.3389/fonc.2021.831603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To establish an individualized prostate biopsy model that reduces unnecessary biopsy cores based on multiparameter MRI (mpMRI). Materials and Methods This retrospective, non-inferiority dual-center study retrospectively included 609 patients from the Changhai Hospital from June 2017 to November 2020 and 431 patients from the Fujian Union Hospital between 2014 and 2019. Clinical, radiological, and pathological data were analyzed. Data from the Changhai Hospital were used for modeling by calculating the patients’ disease risk scores. Data from the Fujian Union Hospital were used for external verification. Results Based on the data of 609 patients from the Changhai Hospital, we divided the patients evenly into five layers according to the disease risk score. The area under the receiver operating characteristic (ROC) curve (AUC) with 95% confidence intervals (CI) was analyzed. Twelve-core systemic biopsy (12-SBx) was used as the reference standard. The SBx cores from each layer were reduced to 9, 6, 5, 4, and 4. The data of 279 patients with benign pathological results from the Fujian Union Hospital were incorporated into the model. No patients were in the first layer. The accuracies of the models for the other layers were 88, 96.43, 94.87, and 94.59%. The accuracy of each layer would be increased to 96, 100, 100, and 97.30% if the diagnosis of non-clinically significant prostate cancer was excluded. Conclusions In this study, we established an individualized biopsy model using data from a dual center. The results showed great accuracy of the model, indicating its future clinical application.
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Affiliation(s)
- Zeyu Chen
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Min Qu
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xianqi Shen
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Shaoqin Jiang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
- Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, China
| | - Wenhui Zhang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jin Ji
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yan Wang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jili Zhang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhenlin Chen
- Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, China
| | - Lu Lin
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Mengqiang Li
- Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, China
| | - Cheng Wu
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Xu Gao
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
- *Correspondence: Xu Gao,
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15
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Artificial intelligence for target prostate biopsy outcomes prediction the potential application of fuzzy logic. Prostate Cancer Prostatic Dis 2022; 25:359-362. [PMID: 34480083 PMCID: PMC8413110 DOI: 10.1038/s41391-021-00441-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/27/2021] [Accepted: 08/09/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND In current precision prostate cancer (PCa) surgery era the identification of the best patients candidate for prostate biopsy still remains an open issue. The aim of this study was to evaluate if the prostate target biopsy (TB) outcomes could be predicted by using artificial intelligence approach based on a set of clinical pre-biopsy. METHODS Pre-biopsy characteristics in terms of PSA, PSA density, digital rectal examination (DRE), previous prostate biopsies, number of suspicious lesions at mp-MRI, lesion volume, lesion location, and Pi-Rads score were extracted from our prospectively maintained TB database from March 2014 to December 2019. Our approach is based on Fuzzy logic and associative rules mining, with the aim to predict TB outcomes. RESULTS A total of 1448 patients were included. Using the Frequent-Pattern growth algorithm we extracted 875 rules and used to build the fuzzy classifier. 963 subjects were classified whereas for the remaining 484 subjects were not classified since no rules matched with their input variables. Analyzing the classified subjects we obtained a specificity of 59.2% and sensitivity of 90.8% with a negative and the positive predictive values of 81.3% and 76.6%, respectively. In particular, focusing on ISUP ≥ 3 PCa, our model is able to correctly predict the biopsy outcomes in 98.1% of the cases. CONCLUSIONS In this study we demonstrated that the possibility to look at several pre-biopsy variables simultaneously with artificial intelligence algorithms can improve the prediction of TB outcomes, outclassing the performance of PSA, its derivates and MRI alone.
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16
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Sciarra A, Maggi M. Comment on: "Prognostic value of preoperative albumin to globulin ratio in patients treated with salvage radical prostatectomy for radiation recurrent prostate cancer". Minerva Urol Nephrol 2021; 73:683-685. [PMID: 34847653 DOI: 10.23736/s2724-6051.21.04725-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alessandro Sciarra
- Department of Maternal-Infant and Urological Sciences, Sapienza University, Umberto I Hospital, Rome, Italy
| | - Martina Maggi
- Department of Maternal-Infant and Urological Sciences, Sapienza University, Umberto I Hospital, Rome, Italy -
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17
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Puliatti S, Piazza P, Cacciamani GE, Gómez Rivas J, Taratkin M, Marenco JL, Rivero Belenchon I, Kowalewski KF, Checcucci E. Comment on: "Predictive factors for opioid-free management after robotic radical prostatectomy: the value of a single-port robotic platform". Minerva Urol Nephrol 2021; 73:677-679. [PMID: 34847651 DOI: 10.23736/s2724-6051.21.04724-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.,Orsi Academy, Ghent, Belgium
| | - Pietro Piazza
- Orsi Academy, Ghent, Belgium.,Department of Urology, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Juan Gómez Rivas
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - José L Marenco
- Department of Urology, Valencian Institute of Oncology Foundation, Valencia, Spain
| | - Ines Rivero Belenchon
- Department of Urology and Nephrology, Virgen del Rocío University Hospital, Seville, Spain
| | - Karl-Friedrich Kowalewski
- Department of Urology and Urological Surgery, Mannheim University Medical Center, Heidelberg University, Mannheim, Germany
| | - Enrico Checcucci
- Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy - .,Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
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18
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Sholklapper T, Checcucci E, Puliatti S, Taratkin M, Marenco J, Kowalewski KF, Gomez Rivas J, Rivero I, Lebastchi A, Abreu A, Cacciamani GE. Comment on: "Fusion US/MRI prostate biopsy using a computer aided diagnostic (CAD) system". Minerva Urol Nephrol 2021; 73:686-688. [PMID: 34847654 DOI: 10.23736/s2724-6051.21.04743-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tamir Sholklapper
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.,Department of Urology, OLV, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - José Marenco
- Department of Urology, Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - Juan Gomez Rivas
- Department of Urology, Clinico San Carlos University Hospital, Madrid, Spain
| | - Ines Rivero
- Department of Urology and Nephrology, Virgen del Rocío University Hospital, Seville, Spain
| | - Amir Lebastchi
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andre Abreu
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA -
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Rai BP, Mayerhofer C, Somani BK, Kallidonis P, Nagele U, Tokas T. Magnetic Resonance Imaging/Ultrasound Fusion-guided Transperineal Versus Magnetic Resonance Imaging/Ultrasound Fusion-guided Transrectal Prostate Biopsy-A Systematic Review. Eur Urol Oncol 2021; 4:904-913. [PMID: 33478936 DOI: 10.1016/j.euo.2020.12.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/25/2020] [Accepted: 12/20/2020] [Indexed: 11/23/2022]
Abstract
CONTEXT Magnetic resonance imaging (MRI)-targeted biopsies have changed the dogma in prostate cancer diagnosis. Biopsies can be performed either transrectally (MRI-guided and transrectal ultrasound fusion transrectal biopsy [MRI-TRUSB]) or transperineally (MRI-guided and transrectal ultrasound fusion transperineal biopsy [MRI-TPB]). OBJECTIVE To evaluate the detection and complication rates of MRI-TRUSB and MRI-TPB. EVIDENCE ACQUISITION We performed a literature search in PubMed, Scopus, EMBASE, and CENTRAL, and selected randomized controlled trials (RCTs) and observational studies comparing MRI-TRUSB versus MRI-TPB. EVIDENCE SYNTHESIS Our search identified 3608 studies; we included five in the qualitative and two in the quantitative synthesis. On per-patient pooled analysis for clinically significant prostate cancer (csPCa), MRI-TPB detection rates were significantly higher (relative risk 1.28 [95% confidence interval {CI} 1.03-1.60], p = 0.03). On a per-lesion analysis, MRI-TPB anterior csPCa detection rates were statistically significantly higher (relative risk 2.46 [95% CI 1.22-4.98], p = 0.01). On a per-lesion analysis, MRI-TPB and MRI-TRUSB overall cancer detection rates were 75% and 81.6% (p= 0.53), and csPCa detection rates were 65.7% and 75.5% (p = 0.40), respectively. MRI-TPB had lower complication rates (odds ratio 2.56 [95% CI 1.14-5.56, p < 0.05]). On Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evaluation, we rated all outcomes as "very low" certainty of the evidence for all outcome measures. CONCLUSIONS This review highlights the paucity of good-quality evidence comparing MRI-TPB and MRI-TRUSB. MRI-TPB achieves better detection for csPCa, anterior tumors, and lower infective complications. While RCTs are the highest quality of evidence that can address existing evidence limitations, there are concerns regarding infective complications associated with the MRI-TRUSB. Therefore, the authors propose that researchers and clinicians adopt a pragmatic approach by maintaining prospective databases, internal auditing of the MRI-TPB approach, and comparing these data with historical MRI-TRUSB cohorts. PATIENT SUMMARY We looked at the outcomes by comparing magnetic resonance imaging (MRI)-guided and transrectal ultrasound fusion transrectal biopsy with MRI-guided and transrectal ultrasound fusion transperineal biopsy (TPB). The analysis suggests, based on very low certainty evidence, that MRI-TPB has better detection for clinically significant prostate cancer, anterior tumors, and lower complications.
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Affiliation(s)
| | - Christoph Mayerhofer
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria; Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria; Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group
| | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria; Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group.
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Karakose A, Yitgin Y. Penile rehabilitation with low-intensity extracorporeal shock wave therapy in patients after prostate cancer surgery. Early physiological changes and postoperative follow-up outcomes. Int J Clin Pract 2021; 75:e14804. [PMID: 34487369 DOI: 10.1111/ijcp.14804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION To investigate the efficacy, safety and postoperative outcomes of using tadalafil and low-intensity extracorporeal shock wave therapy (Li-ESWT) on penile rehabilitation and preventing urinary incontinence after radical prostatectomy. METHODS In total, we included 66 patients who used only tadalafil (n = 32) in group 1 and used tadalafil and treated by Li-ESWT (n = 34) in group 2. We noted International Index of Erectile Function (IIEF) 5, daily incontinence pad measurements at preoperative, postoperative 3rd, 6th and 12th months respectively. We also evaluated penis blood flow and neovascularisation by penile doppler ultrasonography at postoperative 3rd and 12th months for all patients. Statistical analyses were performed with SPSS version 18. A P-value < .05 was considered significant. RESULTS Preoperative demographic characteristics were similar in the two groups. There was a statistically significant improvement in IIEF-5, which started at the 6th month and continued increasingly at the 12th month in group 2 compared with group 1. Also, there was a significant decrease in incontinence rate in group 2 compared with group 1 in the sixth month. CONCLUSIONS Combined use of tadalafil and Li-ESWT is highly effective and safe for the treatment of erectile dysfunction and for the prevention of urinary incontinence after prostate cancer surgery.
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Affiliation(s)
- Ayhan Karakose
- Depatment of Urology, Istinye Universtiy Faculty of Medicine, Esenyurt/Istanbul, Turkey
| | - Yasin Yitgin
- Depatment of Urology, Istinye Universtiy Faculty of Medicine, Esenyurt/Istanbul, Turkey
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21
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Esperto F, Prata F, Antonelli A, Alloni R, Campanozzi L, Cataldo R, Civitella A, Fiori C, Ghilardi G, Guglielmelli E, Minervini A, Muto G, Rocco B, Sighinolfi C, Pang KH, Simone G, Tambone V, Tuzzolo P, Scarpa RM, Papalia R. Bioethical implications of robotic surgery in urology: a narrative review. Minerva Urol Nephrol 2021; 73:700-710. [PMID: 34308607 DOI: 10.23736/s2724-6051.21.04240-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Robotic technologies are being increasingly implemented in healthcare, including urology, holding promises for improving medicine worldwide. However, these new approaches raise ethical concerns for professionals, patients, researchers and institutions that need to be addressed. The aim of this review is to investigate the existing literature related to bioethical issues associated with robotic surgery in urology, in order to identify current challenges and make preliminary suggestions to ensure an ethical implementation of these technologies. METHODS We performed a narrative review of the pertaining literature through a systematic search of two databases (PubMed and Web of Science) in August 2020. RESULTS Our search yielded 76 articles for full-text evaluation and 48 articles were included in the narrative review. Several bioethical issues were identified and can be categorized into five main subjects: 1) robotic surgery accessibility; 2) safety; 3) gender gap; 4) costs and 5) learning curve. 1) Robotic surgery is expensive, and in some health systems may lead to inequality in healthcare access. In more affluent countries the national distribution of several robotic platforms may influence the centralization of robotic surgery, therefore potentially affecting oncological and functional outcomes in low-volume centers. 2) There is a considerable gap between surgical skills and patients' perception of competence, leading to ethical consequences on modern healthcare. Published incidence of adverse events during robotic surgery in large series is between 2% and 15%, which does not significantly differ amongst open or laparoscopic approaches. 3) No data about gap differences in accessibility to robotic platforms were retrieved from our search. 4) Robotic platforms are expensive but a key reason why hospitals are willing to absorb the high upfront costs is patient demand. It is possible to achieve cost-equivalence between open and robotic prostatectomy if the volume of centers is higher than 10 cases per week. 5) A validated, structured curriculum and accreditation has been created for robotic surgery. This allows acquisition and development of basic and complex robotic skills focusing on patient safety and short learning curve. CONCLUSIONS Tech-medicine is rapidly moving forward. Robotic approach to urology seems to be accessible in more affluent countries, safe, economically sustainable, and easy to learn with an appropriate learning curve for both sex. It is mandatory to keep maintaining a critical rational approach with constant control of the available evidence regarding efficacy, efficiency and safety.
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Affiliation(s)
- Francesco Esperto
- Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy -
| | - Francesco Prata
- Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy
| | | | - Rossana Alloni
- Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Laura Campanozzi
- Institute of Philosophy of Scientific and Technological Practice, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rita Cataldo
- Anesthesia and Intensive Care Section, Department of Anesthesia, Intensive Care and Pain Therapy, Campus Bio-Medico University of Rome, Rome, Italy
| | - Angelo Civitella
- Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Giampaolo Ghilardi
- Institute of Philosophy of Scientific and Technological Practice, Campus Bio-Medico University of Rome, Rome, Italy
| | - Eugenio Guglielmelli
- Laboratory of Biomedical Robotics and Biomicrosystems, Campus Bio-Medico University of Rome, Rome, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Giovanni Muto
- Department of Urology, Humanitas Gradenigo University, Turin, Italy
| | - Bernardo Rocco
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Sighinolfi
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Karl H Pang
- Academic Urology Unit, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy
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22
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Checcucci E, De Cillis S, Amparore D, Garrou D, Aimar R, Piana A, Piramide F, Granato S, Cattaneo G, Manfredi M, Fiori C, Bollito E, Stura I, Migliaretti G, Porpiglia F. Naive patients with suspicious prostate cancer and positive multiparametric magnetic resonance imaging (mp-MRI): is it time for fusion target biopsy alone? JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211023713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To determine if standard biopsy still has a role in the detection of prostate cancer or clinically significant prostate cancer in biopsy-naive patients with positive multiparametric magnetic resonance imaging. Materials and methods: We extracted, from our prospective maintained fusion biopsy database, patients from March 2014 to December 2018. The detection rate of prostate cancer and clinically significant prostate cancer and complication rate were analysed in a cohort of patients who underwent fusion biopsy alone (group A) or fusion biopsy plus standard biopsy (group B). The International Society of Urological Pathology grade group determined on prostate biopsy with the grade group determined on final pathology among patients who underwent radical prostatectomy were compared. Results: Prostate cancer was found in 249/389 (64.01%) and 215/337 (63.8%) patients in groups A and B, respectively ( P=0.98), while the clinically significant prostate cancer detection rate was 57.8% and 55.1% ( P=0.52). No significant differences in complications were found. No differences in the upgrading rate between biopsy and final pathology finding after radical prostatectomy were recorded. Conclusions: In biopsy-naive patients, with suspected prostate cancer and positive multiparametric magnetic resonance imaging the addition of standard biopsy to fusion biopsy did not increase significantly the detection rate of prostate cancer or clinically significant prostate cancer. Moreover, the rate of upgrading of the cancer grade group between biopsy and final pathology was not affected by the addition of standard biopsy. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
- Enrico Checcucci
- Department of Urology, San Luigi Gonzaga Hospital, Italy
- Department of Pathology, San Luigi Gonzaga Hospital, Italy
| | | | | | - Diletta Garrou
- Department of Urology, San Luigi Gonzaga Hospital, Italy
| | - Roberta Aimar
- Department of Urology, San Luigi Gonzaga Hospital, Italy
| | - Alberto Piana
- Department of Urology, San Luigi Gonzaga Hospital, Italy
| | | | | | | | | | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, Italy
| | - Enrico Bollito
- Department of Pathology, San Luigi Gonzaga Hospital, Italy
| | - Ilaria Stura
- Department of Public Health and Pediatric Sciences, University of Turin, Italy
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23
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Buckle T, Hensbergen AW, van Willigen DM, Bosse F, Bauwens K, Pelger RCM, van Leeuwen FWB. Intraoperative visualization of nerves using a myelin protein-zero specific fluorescent tracer. EJNMMI Res 2021; 11:50. [PMID: 34052912 PMCID: PMC8164657 DOI: 10.1186/s13550-021-00792-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Surgically induced nerve damage is a common but debilitating side effect in oncological surgery. With the aim to use fluorescence guidance to enable nerve-sparing interventions in future surgery, a fluorescent tracer was developed that specifically targets myelin protein zero (P0). RESULTS Truncated homotypic P0 protein-based peptide sequences were C-terminally functionalized with the far-red cyanine dye Cy5. The lead compound Cy5-P0101-125 was selected after initial solubility, (photo)physical and in vitro evaluation (including P0-blocking experiments). Cy5-P0101-125 (KD = 105 ± 17 nM) allowed in vitro and ex vivo P0-related staining. Furthermore, Cy5-P0101-125 enabled in vivo fluorescence imaging of the Sciatic nerve in mice after local intravenous (i.v.) administration and showed compatibility with a clinical fluorescence laparoscope during evaluation in a porcine model undergoing robot-assisted surgery. Biodistribution data revealed that i.v. administered [111In]In-DTPA-P0101-125 does not enter the central nervous system (CNS). CONCLUSION P0101-125 has proven to be a potent nerve-specific agent that is able to target P0/myelin under in vitro, ex vivo, and in vivo conditions without posing a threat for CNS-related toxicity.
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Affiliation(s)
- Tessa Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
| | - Albertus W Hensbergen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Danny M van Willigen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Frank Bosse
- Neurologische Klinik, Heinrich-Heine University Dusseldorf, Düsseldorf, Germany
| | | | - Rob C M Pelger
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
- ORSI Academy, Melle, Belgium.
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24
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Checcucci E, De Luca S, Piramide F, Garrou D, Mosca A, Galla A, Belli G, Russo F, Rescigno P, Poti C, Amparore D, Verri P, Volpi G, Manfredi M, Fiori C, Porpiglia F. The real-time intraoperative guidance of the new HIFU Focal-One ® platform allows to minimize the perioperative adverse events in salvage setting. J Ultrasound 2021; 25:225-232. [PMID: 34031862 DOI: 10.1007/s40477-021-00594-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/14/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To assess the use of the new Focal-One® HIFU platform in salvage setting to evaluate the occurrence of postoperative complications. METHODS Patients who underwent salvage HIFU (sHIFU) with Focal-One® platform were enrolled prospectively (Candiolo cancer institute-FPO IRCCS; registry number: 258/2018). Perioperative and postoperative outcomes (in terms of oncological and functional ones) were recorded during the first year of follow-up. In particular postoperative complications were classified according to Clavien-Dindo system. RESULTS 20 patients were enrolled. No grade 3 complications were recorded. Referring to grade 2 complications, eight patients reported urgency after 3 months of follow-up, and in 4 cases, a low urinary tract infection occurred. Evaluating the impact of sHIFU on patients' sexual potency, micturition and quality of life, no significant deterioration was recorded during the follow-up as proven using the ANOVA analysis for repeated measurements. Only two patient had a biochemical failure after 12 months of follow-up. CONCLUSIONS The real-time intraoperative guidance with Focal-One® platform, allows a continuous monitoring and tailoring of the treatment, with a minimization of the adverse events even in a salvage setting.
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Affiliation(s)
- Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142, km 3,95, 10060, Candiolo, Turin, Italy. .,Uro-Technology and SoMe Working Group of the Young Academic Urologists (YAU) Working Party of the European Association of Urology (EAU), Arnhem, The Netherlands. .,Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.
| | - Stefano De Luca
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Federico Piramide
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Diletta Garrou
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142, km 3,95, 10060, Candiolo, Turin, Italy.,Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Alessandra Mosca
- Multidisciplinary Outpatient Oncology Clinic, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Andrea Galla
- Division of Radiation Therapy, Candiolo Cancer Institute, Candiolo, Turin, Italy
| | - Gaetano Belli
- Division of Radiation Therapy, Candiolo Cancer Institute, Candiolo, Turin, Italy
| | - Filippo Russo
- Department of Radiology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Pasquale Rescigno
- Interdisciplinary Group for Translational Research and Clinical Trials (GIRT-Uro), Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Carlo Poti
- Department of Nuclear Medicine, Azienda USL Della Valle d'Aosta, Aosta, Italy
| | - Daniele Amparore
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Paolo Verri
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Gabriele Volpi
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Matteo Manfredi
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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25
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Morozov A, Barret E, Veneziano D, Grigoryan V, Salomon G, Fokin I, Taratkin M, Poddubskaya E, Gomez Rivas J, Puliatti S, Okhunov Z, Cacciamani GE, Checcucci E, Marenco Jiménez JL, Enikeev D. A systematic review of nerve-sparing surgery for high-risk prostate cancer. Minerva Urol Nephrol 2021; 73:283-291. [PMID: 33439578 DOI: 10.23736/s2724-6051.20.04178-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION We provide a systematic analysis of nerve-sparing surgery (NSS) to assess and summarize the risks and benefits of NSS in high-risk prostate cancer (PCa). EVIDENCE ACQUISITION We have undertaken a systematic search of original articles using 3 databases: Medline/PubMed, Scopus, and Web of Science. Original articles in English containing outcomes of nerve-sparing radical prostatectomy (RP) for high-risk PCa were included. The primary outcomes were oncological results: the rate of positive surgical margins and biochemical relapse. The secondary outcomes were functional results: erectile function (EF) and urinary continence. EVIDENCE SYNTHESIS The rate of positive surgical margins differed considerably, from zero to 47%. The majority of authors found no correlation between NSS and a positive surgical margin rate. The rate of biochemical relapse ranged from 9.3% to 61%. Most of the articles lacked data on odds ratio (OR) for positive margin and biochemical relapse. The presented results showed no effect of nerve sparing (NS) on positive margin (OR=0.81, 0.6-1.09) or biochemical relapse (hazard ratio [HR]=0.93, 0.52-1.64). A strong association between NSS and potency rate was observed. Without NSS, between 0% and 42% of patients were potent, with unilateral 79-80%, with bilateral - up to 90-100%. Urinary continence was not strongly associated with NSS and was relatively good in both patients with and without NSS. CONCLUSIONS NSS may provide benefits for patients with urinary continence and significantly improves EF in high-risk patients. Moreover, it is not associated with an increased risk of relapse in short- and middle-term follow-up. However, the advantages of using such a surgical technique are unclear.
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Affiliation(s)
- Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Eric Barret
- Department of Urology, Institute Mutualiste Montsouris, Paris, France
| | - Domenico Veneziano
- Department of Urology and Kidney Transplant, G.O.M. Reggio Calabria, Reggio Calabria, Italy.,Hofstra University, New York, NY, USA
| | - Vagarshak Grigoryan
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Georg Salomon
- Martini Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Igor Fokin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia - .,European Association of Urology (EAU), Arnhem, the Netherlands
| | | | - Juan Gomez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, CA, USA
| | - Giovanni E Cacciamani
- Keck School of Medicine, Department of Urology, Catherine & Joseph Aresty Foundation, USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA, USA.,Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Enrico Checcucci
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | | | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Section of Urotechnology, European Association of Urology (EAU), Arnhem, the Netherlands
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26
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Anastomosis quality score during robot-assisted radical prostatectomy: a new simple tool to maximize postoperative management. World J Urol 2021; 39:2921-2928. [PMID: 33388913 DOI: 10.1007/s00345-020-03549-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The urethro-vesical anastomosis represents one of the most challenging steps of robotic prostatectomy (RARP). To maximize postoperative management, we specifically designed our anastomosis quality score (AQS), based on the intraoperative characteristics of the urethra and bladder neck. METHODS This is a prospective study, conducted from April 2019 to March 2020. All the patients were classified into three different AQS categories (low, intermediate, high) based on the quality of the anastomosis. The postoperative management was modulated accordingly. RESULTS We enrolled 333 patients. According to AQS, no differences were recorded in intraoperative complications (p = 0.9). Median hospital stay and catheterization time were longer in AQS 1 group (p < 0.001). Additionally, the occurrence of postoperative complication was higher in AQS 1 category (p = 0.002) but, when focusing on the complications related to the quality of the anastomosis, no differences were found neither for acute urinary retention (p = 0.12) nor urine leakage (p = 0.11). Finally, concerning the continence recovery, no significant differences were found among the three groups for each time point. The highest potency recovery rate at one month of follow-up was recorded in AQS 3 category (p = 0. 03). CONCLUSION The AQS proposed revealed to be a valid too to intraoperatively categorize patients who underwent RARP on the basis of the urethral and bladder neck features. The modulated postoperative management for each specific score category allowed to limit the occurrence of complications and to maximize the functional outcomes.
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27
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Checcucci E, De Cillis S, Pecoraro A, Peretti D, Volpi G, Amparore D, Piramide F, Piana A, Manfredi M, Fiori C, Autorino R, Dasgupta P, Porpiglia F. Single-port robot-assisted radical prostatectomy: a systematic review and pooled analysis of the preliminary experiences. BJU Int 2020; 126:55-64. [PMID: 32248613 DOI: 10.1111/bju.15069] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To summarize the clinical experiences with single-port (SP) robot-assisted radical prostatectomy (RARP) reported in the literature and to describe the peri-operative and short-term outcomes of this procedure. MATERIAL AND METHODS A systematic review of the literature was performed in December 2019 using Medline (via PubMed), Embase (via Ovid), Cochrane databases, Scopus and Web of Science (PROSPERO registry number 164129). All studies that reported intra- and peri-operative data on SP-RARP were included. Cadaveric series and perineal or partial prostatectomy series were excluded. RESULTS The pooled mean operating time, estimated blood loss, length of hospital stay and catheterization time were 190.55 min, 198.4 mL, 1.86 days and 8.21 days, respectively. The pooled mean number of lymph nodes removed was 8.33, and the pooled rate of positive surgical margins was 33%. The pooled minor complication rate was 15%. Only one urinary leakage and one major complication (transient ischaemic attack) were recorded. Regarding functional outcomes, pooled continence and potency rates at 12 weeks were 55% and 42%, respectively. CONCLUSIONS The present analysis confirms that SP-RARP is safe and feasible. This novel robotic platform resulted in similar intra-operative and peri-operative outcomes to those obtained with the standard multiport da Vinci system. The advantages of single incision can be translated into a preservation of the patient's body image and self-esteem and cosmesis, which have a great impact on a patient's quality of life.
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Affiliation(s)
- Enrico Checcucci
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Sabrina De Cillis
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Angela Pecoraro
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Dario Peretti
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Gabriele Volpi
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Federico Piramide
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Alberto Piana
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Matteo Manfredi
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | | | | | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
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28
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Falagario UG, Jambor I, Ratnani P, Martini A, Treacy PJ, Wajswol E, Lantz A, Papastefanou G, Weil R, Phillip D, Lewis S, Haines K, Cormio L, Carrieri G, Kyprianou N, Wiklund P, Tewari AK. Performance of prostate multiparametric MRI for prediction of prostate cancer extra-prostatic extension according to NCCN risk categories: implication for surgical planning. MINERVA UROL NEFROL 2020; 72:746-754. [PMID: 32182231 DOI: 10.23736/s0393-2249.20.03688-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Prediction of extra-prostatic extension (EPE) in men undergoing radical prostatectomy (RP) is of utmost importance. Great variability in the performance of multiparametric magnetic resonance imaging (mpMRI) has been reported for prediction of EPE. The present study aimed to determine the diagnostic performance of mpMRI for predicting EPE in different National Comprehensive Cancer Network (NCCN) risk categories. METHODS Overall 664 patients who underwent radical prostatectomy with a staging mpMRI were enrolled in this single-center, retrospective study. Patients with mpMRI report non-compliant with PI-RADSv2.0, were excluded. Patients were stratified according to NCCN criteria: very low/low (VLR-LR) to High Risk (HR) in order to assess final pathology EPE rates (focal and established). Sensitivity, specificity, positive and negative predictive values of staging mpMRI were computed in each group. Univariable and multivariable analysis were used to evaluate predictors of positive surgical margins. RESULTS Pathological evaluation demonstrated established and focal EPE in 60 (9%) and 106 (16%) patients, respectively, while mpMRI suspicion for EPE was present in 180 (27%) patients. Age, preoperative PSA, PSA density, number of positive cores, NCCN groups, prostate volume, mpMRI suspicion for EPE, PIRADSv2.0 and lesion size differed significantly between the patients with any EPE and without EPE (all P≤0.05). The sensitivity of mpMRI in detecting any EPE varied from 12% (95% CI: 0.6-53%) in VLR-LR to 83% (66-93%) in HR while the corresponding values for the specificity were 92% (85-96%) and 63% (45-78%), respectively. Patients with false-negative mpMRI EPE prediction were more likely to have positive surgical margins in univariable (OR: 2.14; CI: 1.18, 3.87) as well as multivariable analysis adjusting for NCCN risk categories (OR: 1.97; CI: 1.08, 3.60). CONCLUSIONS The performance of mpMRI for prediction of EPE varies greatly between different NCCN risk categories with a low positive predicting value in patients at low to favorable intermediate risk and a low negative predictive value in patients at Unfavorable intermediate to high risk PCa. Given that mpMRI EPE misdiagnosis could have a negative impact on oncological and functional outcomes, NCCN risk categories should be considered when interpreting mpMRI findings in PCa patients.
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Affiliation(s)
- Ugo G Falagario
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA - .,Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy -
| | - Ivan Jambor
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, University of Turku, Turku, Finland
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ethan Wajswol
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anna Lantz
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - George Papastefanou
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Weil
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deron Phillip
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luigi Cormio
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Natasha Kyprianou
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Simultaneous whole-body PET/MRI with integrated multiparametric MRI for primary staging of high-risk prostate cancer. World J Urol 2020; 38:2513-2521. [PMID: 31907632 DOI: 10.1007/s00345-019-03066-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/21/2019] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Whole-body positron emission tomography/magnetic resonance imaging (wbPET/MRI) is a promising diagnostic tool of recurrent prostate cancer (PC), but its role in primary staging of high-risk PC (hrPC) is not well defined. Thus, the aim was to compare the diagnostic accuracy for T-staging of PET-blinded reading (PBR) and PET/MRI. METHODS In this prospective study, hrPC patients scheduled to radical prostatectomy (RPx) with extended lymphadenectomy (eLND) were staged with wbPET/MRI and either 68Ga-PSMA-11 or 11C-choline including simultaneous multiparametric MRI (mpMRI). Images were assessed in two sessions, first as PBR (mpMRI and wbMRI) and second as wbPET/MRI. Prostate Imaging Reporting and Data System criteria (PIRADS v2) were used for T-staging. Results were correlated with the exact anatomical localization and extension as defined by histopathology. Diagnostic accuracy of cTNM stage according to PBR was compared to pathological pTNM stage as reference standard. RESULTS Thirty-four patients underwent wbPET/MRI of 68Ga-PSMA-11 (n = 17) or 11C-choline (n = 17). Twenty-four patients meeting the inclusion criteria of localized disease ± nodal disease based on imaging results underwent RPx and eLND, whereas ten patients were excluded from analysis due to metastatic disease. T-stage was best defined by mpMRI with underestimation of tumor lesion size by PET for both tracers. N-stage yielded a per patient sensitivity/specificity comparable to PBR. CONCLUSION MpMRI is the primary modality for T-staging in hrPC as PET underestimated T-stage in direct comparison to final pathology. In this selected study, cohort MRI shows no inferiority compared to wbPET/MRI considering N-staging.
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Checcucci E, Autorino R, Cacciamani GE, Amparore D, De Cillis S, Piana A, Piazzolla P, Vezzetti E, Fiori C, Veneziano D, Tewari A, Dasgupta P, Hung A, Gill I, Porpiglia F. Artificial intelligence and neural networks in urology: current clinical applications. MINERVA UROL NEFROL 2019; 72:49-57. [PMID: 31833725 DOI: 10.23736/s0393-2249.19.03613-0] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION As we enter the era of "big data," an increasing amount of complex health-care data will become available. These data are often redundant, "noisy," and characterized by wide variability. In order to offer a precise and transversal view of a clinical scenario the artificial intelligence (AI) with machine learning (ML) algorithms and Artificial neuron networks (ANNs) process were adopted, with a promising wide diffusion in the near future. The present work aims to provide a comprehensive and critical overview of the current and potential applications of AI and ANNs in urology. EVIDENCE ACQUISITION A non-systematic review of the literature was performed by screening Medline, PubMed, the Cochrane Database, and Embase to detect pertinent studies regarding the application of AI and ANN in Urology. EVIDENCE SYNTHESIS The main application of AI in urology is the field of genitourinary cancers. Focusing on prostate cancer, AI was applied for the prediction of prostate biopsy results. For bladder cancer, the prediction of recurrence-free probability and diagnostic evaluation were analysed with ML algorithms. For kidney and testis cancer, anecdotal experiences were reported for staging and prediction of diseases recurrence. More recently, AI has been applied in non-oncological diseases like stones and functional urology. CONCLUSIONS AI technologies are growing their role in health care; but, up to now, their "real-life" implementation remains limited. However, in the near future, the potential of AI-driven era could change the clinical practice in Urology, improving overall patient outcomes.
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Affiliation(s)
- Enrico Checcucci
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | | | | | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Sabrina De Cillis
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Alberto Piana
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Pietro Piazzolla
- Department of Management and Production Engineer, Politechnic University of Turin, Turin, Italy
| | - Enrico Vezzetti
- Department of Management and Production Engineer, Politechnic University of Turin, Turin, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Domenico Veneziano
- Department of Urology and Renal Transplantation, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Ash Tewari
- Icahn School of Medicine of Mount Sinai, New York, NY, USA
| | | | - Andrew Hung
- USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Inderbir Gill
- USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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Comparison of intra- and postoperative analgesia and pain perception in robot-assisted vs. open radical prostatectomy. World J Urol 2019; 38:1451-1457. [DOI: 10.1007/s00345-019-02938-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/28/2019] [Indexed: 02/04/2023] Open
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3D imaging applications for robotic urologic surgery: an ESUT YAUWP review. World J Urol 2019; 38:869-881. [DOI: 10.1007/s00345-019-02922-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/20/2019] [Indexed: 12/15/2022] Open
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Checcucci E, Veccia A, Fiori C, Amparore D, Manfredi M, Di Dio M, Morra I, Galfano A, Autorino R, Bocciardi AM, Dasgupta P, Porpiglia F. Retzius-sparing robot-assisted radical prostatectomy vs the standard approach: a systematic review and analysis of comparative outcomes. BJU Int 2019; 125:8-16. [PMID: 31373142 DOI: 10.1111/bju.14887] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To summarize the current evidence on Retzius-sparing (RS)-robot-assisted radical prostatectomy (RARP) and to compare its oncological, peri-operative and functional outcomes with those of standard retropubic RARP (S-RARP). MATERIALS AND METHODS After establishing an a priori protocol, a systematic electronic literature search was conducted in January 2019 using the Medline (via PubMed), Embase (via Ovid) and Cochrane databases. The search strategy relied on the 'PICO' (Patient Intervention Comparison Outcome) criteria and article selection was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only studies reporting the oncological and functional outcomes of RARP (as determined by type of procedure [RS-RARP vs S-RARP]) were considered for inclusion. Risk of bias and study quality were assessed. Finally, peri-operative and functional outcomes were recorded and analysed. RESULTS A shorter operating time was associated with RS-RARP (weighted mean difference [WMD] 14.7 min, 95% confidence interval [CI] -28.25, 1.16; P = 0.03), whereas no significant difference was found in terms of estimated blood loss (WMD 1.45 mL, 95% CI -31.18, 34.08; P = 0.93). Also, no significant difference between the two groups was observed for overall (odds ratio [OR] 0.86, 95% CI 0.40, 1.85; P = 0.71) and major (Clavien >3; OR 0.88, 95% CI 0.30, 2.57) postoperative complications; however, the likelihood of positive surgical margins (PSMs) was lower for the S-RARP group (rate 15.2% vs 24%; OR 1.71, 95% CI 1.12, 2.60; P = 0.01). The cumulative analysis showed a statistically significant advantage for RS-RARP in terms of continence recovery at 1 month (OR 2.54, 95% CI 1.16, 5.53; P = 0.02), as well as at 3 months (OR 3.86, 95% CI 2.23, 6.68; P < 0.001), 6 months (OR 3.61, 95% CI 1.88, 6.91; P = 0.001), and 12 months (OR 7.29, 95% CI 1.89, 28.13; P = 0.004). CONCLUSION Our analysis confirms that RS-RARP is a safe and feasible alternative to S-RARP. This novel approach may be associated with faster and higher recovery of continence, without increasing the risk of complications. One caveat might be the higher risk of PSMs, and this can be regarded as a current pitfall of the technique, probably related to an expected learning curve.
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Affiliation(s)
- Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano (Turin), Italy
| | - Alessandro Veccia
- Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy.,Division of Urology, VCU Health, Richmond, VA, USA
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano (Turin), Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano (Turin), Italy
| | - Matteo Manfredi
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano (Turin), Italy
| | - Michele Di Dio
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano (Turin), Italy
| | - Ivano Morra
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano (Turin), Italy
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, 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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