1
|
Bertolo R, Pecoraro A, Carbonara U, Amparore D, Diana P, Muselaers S, Marchioni M, Mir MC, Antonelli A, Badani K, Breda A, Challacombe B, Kaouk J, Mottrie A, Porpiglia F, Porter J, Minervini A, Campi R. Resection Techniques During Robotic Partial Nephrectomy: A Systematic Review. EUR UROL SUPPL 2023; 52:7-21. [PMID: 37182118 PMCID: PMC10172691 DOI: 10.1016/j.euros.2023.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 05/16/2023] Open
Abstract
Context The resection technique used to excise tumor during robotic partial nephrectomy (RPN) is of paramount importance in achieving optimal clinical outcomes. Objective To provide an overview of the different resection techniques used during RPN, and a pooled analysis of comparative studies. Evidence acquisition The systematic review was conducted according to established principles (PROSPERO: CRD42022371640) on November 7, 2022. A population (P: adult patients undergoing RPN), intervention (I: enucleation), comparator (C: enucleoresection or wedge resection), outcome (O: outcome measurements of interest), and study design (S) framework was prespecified to assess study eligibility. Studies reporting a detailed description of resection techniques and/or evaluating the impact of resection technique on outcomes of surgery were included. Evidence synthesis Resection techniques used during RPN can be broadly classified as resection (non-anatomic) or enucleation (anatomic). A standardized definition for these is lacking. Out of 20 studies retrieved, nine compared "standard" resection versus enucleation. A pooled analysis did not reveal significant differences in terms of operative time, ischemia time, blood loss, transfusions, or positive margins. Significant differences favoring enucleation were found for clamping management (odds ratio [OR] for renal artery clamping 3.51, 95% confidence interval [CI] 1.13-10.88; p = 0.03), overall complications (OR for occurrence 0.55, 95% CI 0.34-0.87; p = 0.01) major complications (OR for occurrence 0.39, 95% CI 0.19-0.79; p = 0.009), length of stay (weighted mean difference [WMD] -0.72 d, 95% CI -0.99 to -0.45; p < 0.001), and decrease in estimated glomerular filtration rate (WMD -2.64 ml/min, 95% CI -5.15 to -0.12; p = 0.04). Conclusions There is heterogeneity in the reporting of resection techniques used during RPN. The urological community must improve the quality of reporting and research produced accordingly. Positive margins are not specifically related to the resection technique. Focusing on studies comparing standard resection versus enucleation, advantages with tumor enucleation in terms of avoidance of artery clamping, overall/major complications, length of stay, and renal function were found. These data should be considered when planning the RPN resection strategy. Patient summary We reviewed studies on robotic surgery for partial kidney removal using different techniques to cut away the kidney tumor. We found that a technique called "enucleation" was associated with similar cancer control outcomes in comparison to the standard technique and had fewer complications, better kidney function after surgery, and a shorter hospital stay.
Collapse
Affiliation(s)
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Umberto Carbonara
- Department of Emergency and Organ Transplantation-Urology, Unit of Andrology and Kidney Transplantation, University of Bari, Bari, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Pietro Diana
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Stijn Muselaers
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, G. D’Annunzio Chieti-Pescara University, Chieti, Italy
- Department of Urology, SS Annunziata Hospital, G. D’Annunzio Chieti-Pescara University, Chieti, Italy
| | - Maria Carmen Mir
- Servicio de Urología, Fundación Investigación Hospital IMED Valencia, Valencia, Spain
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Ketan Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Ben Challacombe
- Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Jihad Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alexandre Mottrie
- Orsi Academy, Melle, Belgium
- Department of Urology, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Jim Porter
- Swedish Urology Group, Swedish Medical Center, Seattle, WA, USA
| | - Andrea Minervini
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| |
Collapse
|
2
|
Desai S, Rac G, Patel HD, Gupta GN. Imaging Features of Renal Masses to Select Optimal Candidates for Tumor Enucleation Partial Nephrectomy. Curr Urol Rep 2022; 23:345-353. [PMID: 36350529 DOI: 10.1007/s11934-022-01121-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE OF REVIEW The goal of this paper was to critically evaluate preoperative findings that optimally select candidates for renal tumor enucleation partial nephrectomy. RECENT FINDINGS Tumor enucleation has been widely accepted as a management option for patients with chronic kidney disease, hereditary renal cell carcinoma, or multifocal disease. Recent evidence suggests safety and efficacy in the management of routine small renal masses. With recent advances in imaging, the literature for ruling out aggressive renal cell carcinoma and selection for tumor enucleation is robust. As the incidence of renal cell carcinoma rises, partial nephrectomy continues to be the mainstay of treatment for localized renal cell carcinoma. Tumor enucleation maximizes preservation of renal parenchyma without hindering oncologic outcomes. It is important to recognize key tumor radiologic findings which urologists may use to optimize patient selection for tumor enucleation.
Collapse
Affiliation(s)
- Shalin Desai
- Department of Urology, Loyola University Medical Center, 2160 S. First Avenue, Fahey Center, Room 241, Maywood, IL, 60153, USA.
| | - Goran Rac
- Department of Urology, Loyola University Medical Center, 2160 S. First Avenue, Fahey Center, Room 241, Maywood, IL, 60153, USA
| | - Hiten D Patel
- Department of Urology, Loyola University Medical Center, 2160 S. First Avenue, Fahey Center, Room 241, Maywood, IL, 60153, USA
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center, 2160 S. First Avenue, Fahey Center, Room 241, Maywood, IL, 60153, USA
| |
Collapse
|
3
|
Di Maida F, Campi R, Lane BR, De Cobelli O, Sanguedolce F, Hatzichristodoulou G, Antonelli A, Grosso AA, Noyes S, Rodriguez-Faba O, Keeley FX, Langenhuijsen J, Musi G, Klatte T, Roscigno M, Akdogan B, Furlan M, Simeone C, Karakoyunlu N, Marszalek M, Capitanio U, Volpe A, Brookman-May S, Gschwend JE, Smaldone MC, Uzzo RG, Kutikov A, Minervini A. Predictors of Positive Surgical Margins after Robot-Assisted Partial Nephrectomy for Localized Renal Tumors: Insights from a Large Multicenter International Prospective Observational Project (The Surface-Intermediate-Base Margin Score Consortium). J Clin Med 2022; 11:jcm11071765. [PMID: 35407375 PMCID: PMC8999836 DOI: 10.3390/jcm11071765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/12/2022] [Accepted: 03/19/2022] [Indexed: 12/30/2022] Open
Abstract
Background: To explore predictors of positive surgical margins (PSM) after robotic partial nephrectomy (PN) in a large multicenter international observational project, harnessing the Surface-Intermediate-Base (SIB) margin score to report the resection technique after PN in a standardized way. Methods: Data from consecutive patients with cT1-2N0M0 renal masses treated with PN from September 2014 to March 2015 at 16 tertiary referral centers and included in the SIB margin score International Consortium were prospectively collected. For the present study, only patients treated with robotic PN were included. Uni- and multivariable analysis were fitted to explore clinical and surgical predictors of PSMs after PN. Results: Overall, 289 patients were enrolled. Median (IQR) preoperative tumor size was 3.0 (2.3−4.2) cm and median (IQR) PADUA score was 8 (7−9). SIB scores of 0−2 (enucleation), 3−4 (enucleoresection) and 5 (resection) were reported in 53.3%, 27.3% and 19.4% of cases, respectively. A PSM was recorded in 18 (6.2%) patients. PSM rate was 4.5%, 11.4% and 3.6% in case of enucleation, enucleoresection and resection, respectively. Patients with PSMs had tumors with a higher rate of contact with the urinary collecting system (55.6% vs. 27.3%; p < 0.001) and a longer median warm ischemia time (22 vs. 16 min; p = 0.02) compared with patients with negative surgical margins, while no differences emerged between the two groups in terms of other tumor features (i.e., pathological diameter, PADUA score). In multivariable analysis, only enucleoresection (SIB score 3−4) versus enucleation (SIB score 0−2) was found to be an independent predictor of PSM at final pathology (HR: 2.68; 95% CI: 1.25−7.63; p = 0.04), while resection (SIB score 5) was not. Conclusions: In our experience, enucleoresection led to a higher risk of PSMs as compared to enucleation. Further studies are needed to assess the differential impacts of resection technique and surgeon’s experience on margin status after robotic PN.
Collapse
Affiliation(s)
- Fabrizio Di Maida
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, 50134 Florence, Italy; (F.D.M.); (A.A.G.)
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, 50134 Florence, Italy;
| | - Brian R. Lane
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI 49508, USA; (B.R.L.); (S.N.)
| | - Ottavio De Cobelli
- Department of Urology, European Institute of Oncology (IEO), University of Milan, 20141 Milan, Italy; (O.D.C.); (G.M.)
| | - Francesco Sanguedolce
- Bristol Urological Institute, Southmead Hospital, Bristol BS10 5NB, UK; (F.S.); (F.X.K.)
- Uro-Oncology Unit, Fundacio Puigvert, 08025 Barcelona, Spain;
| | - Georgios Hatzichristodoulou
- Department of Urology, Rechts der Isar University Hospital, Technical University of Munich, 81675 Munich, Germany; (G.H.); (J.E.G.)
- Department of Urology, Martha-Maria Hospital Nuremberg, 90491 Nurnberg, Germany
| | - Alessandro Antonelli
- Department of Urology, University of Brescia, 25121 Brescia, Italy; (A.A.); (M.F.); (C.S.)
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy
| | - Antonio Andrea Grosso
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, 50134 Florence, Italy; (F.D.M.); (A.A.G.)
| | - Sabrina Noyes
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI 49508, USA; (B.R.L.); (S.N.)
| | | | - Frank X. Keeley
- Bristol Urological Institute, Southmead Hospital, Bristol BS10 5NB, UK; (F.S.); (F.X.K.)
| | - Johan Langenhuijsen
- Department of Urology, Radboud University Nijmegen Medical Centre, 6525 GA Nijmegen, The Netherlands;
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology (IEO), University of Milan, 20141 Milan, Italy; (O.D.C.); (G.M.)
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Bournemouth BH7 7DW, UK;
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
| | - Marco Roscigno
- Department of Urology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Bulent Akdogan
- Department of Urology, School of Medicine, Hacettepe University, Ankara 06800, Turkey;
| | - Maria Furlan
- Department of Urology, University of Brescia, 25121 Brescia, Italy; (A.A.); (M.F.); (C.S.)
| | - Claudio Simeone
- Department of Urology, University of Brescia, 25121 Brescia, Italy; (A.A.); (M.F.); (C.S.)
| | - Nihat Karakoyunlu
- Department of Urology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara 06145, Turkey;
| | - Martin Marszalek
- Department of Urology and Andrology, Sozialmedizinishes Zentrum Ost-Donauspital, 1220 Vienna, Austria;
- Department of Urology, Graz Medical University, 8036 Graz, Austria
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, 20132 Milan, Italy;
| | - Alessandro Volpe
- Department of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, 28100 Novara, Italy;
| | - Sabine Brookman-May
- Department of Urology, Campus Grosshadern, Ludwig-Maximilians University (LMU), 80539 Munich, Germany;
- Janssen Pharma Research and Development, San Diego, CA 92121, USA
| | - Jürgen E. Gschwend
- Department of Urology, Rechts der Isar University Hospital, Technical University of Munich, 81675 Munich, Germany; (G.H.); (J.E.G.)
| | - Marc C. Smaldone
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (M.C.S.); (R.G.U.); (A.K.)
| | - Robert G. Uzzo
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (M.C.S.); (R.G.U.); (A.K.)
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (M.C.S.); (R.G.U.); (A.K.)
| | - Andrea Minervini
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, 50134 Florence, Italy; (F.D.M.); (A.A.G.)
- Correspondence:
| | | |
Collapse
|
4
|
Liu Q, Gao M, Lin TX, Liao B, Wang YH, Wu SX, Xu SZ, Pan JX, Xu ZX, Huang J, Dong W. Parenchymal Mass Loss During Partial Nephrectomy: Role of Devascularized Parenchymal Mass and Excised Parenchymal Mass and Impact on Functional Preservation. Clin Genitourin Cancer 2021; 20:e199-e204. [PMID: 35000877 DOI: 10.1016/j.clgc.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 11/19/2022]
Abstract
This study included 93 patients with renal masses who underwent standard partial nephrectomy or tumor enucleation. After surgery, parenchymal mass loss caused by devascularization resulted in more damage to renal function than excised parenchymal mass loss. Surgeons should seek better techniques to decrease devascularization during reconstruction. INTRODUCTION To evaluate the importance of devascularized parenchymal mass(DPM) and excised parenchymal mass(EPM) in functional preservation after standard partial nephrectomy(SPN). PATIENTS AND METHODS Forty-one patients who underwent pure tumor enucleation(TE) and 52 patients who underwent SPN with necessary data were included. As no EPM was lost in TE, the TE samples were used to estimate the degree of volume shrinkage that occurred when the measurements were performed in vivo with blood flow versus ex vivo without, and the shrinkage ratio was calculated as specimen volume divided by tumor volume in vivo. In SPN, the specimen volume comprised tumor volume plus EPM. The EPM was calculated as specimen volume divided by shrinkage ratio minus tumor volume in vivo. The DPM was defined as total ipsilateral parenchymal mass loss minus EPM. T tests, χ2 test, and Mann-Whitney U tests were employed to compare clinical characteristics. Multivariate analysis was used to identify variables that correlated with glomerular filtration rate(GFR) preservation. RESULTS The mean sizes of devascularized and excised parenchymal masses were 13.6 cm3 and 5.2 cm3 (P = .01), which accounted for 7.8% and 3.4% of preoperative ipsilateral parenchymal mass (P = .03) in SPN, respectively. The shrinkage ratio was 0.71 and correlation coefficient was 0.965. After stepwise regression, DPM, and preoperative GFR were significantly associated with global GFR preservation. CONCLUSION The DPM comprises most of parenchymal mass loss after SPN and plays a more important role than EPM on functional outcomes. Surgeons should pay more attention to reducing devascularization during partial nephrectomy.
Collapse
Affiliation(s)
- Qi Liu
- Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Urinary Diseases, Guangzhou, China
| | - Ming Gao
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tian X Lin
- Guangdong Provincial Clinical Research Center for Urinary Diseases, Guangzhou, China
| | - Bei Liao
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ya H Wang
- Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shao X Wu
- Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shi Z Xu
- Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Urinary Diseases, Guangzhou, China
| | - Jie X Pan
- Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zi X Xu
- Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Urinary Diseases, Guangzhou, China
| | - Jian Huang
- Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Urinary Diseases, Guangzhou, China
| | - Wen Dong
- Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Urinary Diseases, Guangzhou, China.
| |
Collapse
|
5
|
Amparore D, Pecoraro A, Piramide F, Checcucci E, DE Cillis S, Volpi G, Piana A, Verri P, Granato S, Sica M, Manfredi M, Fiori C, Porpiglia F. Comparison between minimally-invasive partial and radical nephrectomy for the treatment of clinical T2 renal masses: results of a 10-year study in a tertiary care center. Minerva Urol Nephrol 2021; 73:509-517. [PMID: 33887896 DOI: 10.23736/s2724-6051.21.04390-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Even if partial nephrectomy (PN) is nowadays considered the standard for managing cT1 renal masses, its role in the management of cT2 kidney tumors is controversial. We aimed to compare oncologic and functional outcomes of minimally invasive radical nephrectomy (RN) and PN in cT2 renal masses. METHODS Patients with cT2 renal masses underwent minimally-invasive PN or RN performed by a highly experienced single surgeon from 2009 to 2019 were considered. Demographic, perioperative and functional variables were compared. Cumulative incidence plot and competing risks regression (CRR) models were used to test differences in 5-year cancer-specific mortality (CSM) and 5-year other-cause mortality (OCM) rates. Kaplan-Meier and Cox regression model was used to test differences in 5-year progression free survival (PFS) rates. RESULTS Overall, 52 PN vs. 64 RN patients were identified. Relative to RN, PN patients recorded higher rates of complications (25% vs. 7.8%, P=0.02) but lower upstaging rate (≥pT3a 64.1% vs. 19.2%, P<0.0001). Functional outcomes were in favor of PN (all P<0.001). No differences were recorded between 5-year CSM and OCM according to nephrectomy type. At CRR models, older age and upstaging were independent predictors of 5-year OCM and CSM, respectively (all P<0.01). Finally, only upstaging, high grade tumors and presence of positive surgical margins were identified as independent predictors of 5-year PFS (all P<0.01). CONCLUSIONS In experienced hands the treatment of cT2 renal neoplasms with minimally-invasive PN is feasible, providing perioperative and oncological safety profiles comparable to RN, with advantages in terms of functional outcomes.
Collapse
Affiliation(s)
- Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy - .,Renal Cancer Working Group of the Young Academic Urologists (YAU) Working Party of the European Association of Urology (EAU), Arnhem, the Netherlands -
| | - Angela Pecoraro
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.,Renal Cancer Working Group of the Young Academic Urologists (YAU) Working Party of the European Association of Urology (EAU), Arnhem, the Netherlands
| | - Federico Piramide
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, 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
| | - Sabrina DE Cillis
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Gabriele Volpi
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Alberto Piana
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Paolo Verri
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Stefano Granato
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Michele Sica
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Matteo Manfredi
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| |
Collapse
|