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Perri D, Pacchetti A, Morini E, Besana U, Mazzoleni F, Verzotti E, Maltagliati M, Romero-Otero J, Pastore AL, Broggini P, Rocco B, Gozen AS, Kallidonis P, Bozzini G. Evaluation of the learning curve for Thulium laser enucleation of the prostate in a contemporary cohort. World J Urol 2024; 42:246. [PMID: 38643250 DOI: 10.1007/s00345-024-04958-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/25/2024] [Indexed: 04/22/2024] Open
Abstract
PURPOSE To assess the learning curve of Thulium laser enucleation of the prostate (ThuLEP) of a single surgeon. METHODS Hundred patients suffering from benign prostatic hyperplasia were treated by the same surgeon. In all cases, a well-trained urologist was present in the operating room. Patients urinary function was assessed preoperatively using the International Prostate Symptoms Score (IPSS), maximum flow rate and Post-Void Residual volume. Preoperative prostate volume was recorded. Enucleation and morcellation efficiency and complication rate were evaluated. Patients were divided into 5 cohorts of 20 consecutive cases to assess changes in outcomes through time. RESULTS Mean age of patients was 73.1 years (SD 17.5) and mean prostate volume was 89.7 ml (SD 55.1). Overall, mean enucleation and morcellation efficiency were 1.7 (SD 2.9) and 5.1 (SD 2.7) g/min. A statistically significant increase in enucleation efficiency was observed when comparing cohort 1 vs 2 (0.9 vs 1.3 g/min, p = 0.03) and cohort 2 vs 3 (1.3 vs 1.7 g/min, p = 0.02). A statistically significant increase in morcellation efficiency was observed when comparing cohort 1 vs 2 (2.8 vs 3.7 g/min, p = 0.02) and cohort 2 vs 3 (3.7 vs 4.9 g/min, p = 0.03). In both cases, no significant differences were observed when comparing the following cohorts. Complication rate showed no significant differences throughout the caseload. CONCLUSIONS In our single-surgeon experience, we observed a learning curve of nearly 60 cases for the ThuLEP procedure in presence of a well-trained surgeon. Complication rate was low from the beginning of surgical experience.
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Affiliation(s)
- D Perri
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy.
| | - A Pacchetti
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
| | - E Morini
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
| | - U Besana
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
| | - F Mazzoleni
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
| | - E Verzotti
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
| | - M Maltagliati
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
| | - J Romero-Otero
- Department of Urology, Hospital Universitario, 12 De Octubre, Madrid, Spain
| | - A L Pastore
- Department of Urology, Sapienza University, Rome, Italy
| | - P Broggini
- Sant'Anna Clinic, Lugano, Swiss, Switzerland
| | - B Rocco
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
| | - A S Gozen
- Department of Urology, SLK-Kliniken Heilbronn, Heilbronn, Germany
| | - P Kallidonis
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - G Bozzini
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
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Perri D, Besana U, Mazzoleni F, Pacchetti A, Morini E, Verzotti E, Maltagliati M, Romero-Otero J, Pastore AL, Gozen AS, Kallidonis P, Pushkar D, Govorov A, Bozzini G. A comparison between vapor tunnel and virtual basket for the treatment of proximal ureteral stones using holmium:YAG laser (Cyber Ho): which is the best tool to reduce retropulsion? World J Urol 2024; 42:244. [PMID: 38642145 DOI: 10.1007/s00345-024-04961-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/25/2024] [Indexed: 04/22/2024] Open
Abstract
PURPOSE To compare vapor tunnel (VT) and virtual basket (VB) tools to reduce retropulsion in the treatment of proximal ureteral stones. METHODS Patients with a single proximal ureteral stone were randomly assigned to holmium laser lithotripsy with the use of VT (Group A) or VB (Group B) tool. The 150W holmium:YAG cyber Ho generator was used. We compared operative time, dusting time, need for flexible ureteroscopy due to stone push-up and occurrence of ureteral lesions. The stone-free rate (SFR) and the occurrence of postoperative ureteral strictures were assessed. RESULTS 186 patients were treated, of which 92 with the VT (49.5%, Group A) and 94 with the VB (50.5%, Group B). Mean stone size was 0.92 vs. 0.91 cm in Groups A vs. B (p = 0.32). Mean total operative time and dusting time were comparable between groups. 7 (7.6%) vs. 6 (6.4%) patients in Groups A vs. B required a flexible ureteroscope because of stone push-up (p = 0.12). Ureteral mucosa lesions were observed in 15 (16.3%) vs. 18 (19.1%) cases in the VT vs. VB group (p = 0.09). 1-Month SFR was comparable (97.8% vs. 95.7%, p = 0.41). We observed one case (1.1%) of postoperative ureteral stricture in the VT group vs. two cases (2.1%) in the VB group (p = 0.19). CONCLUSIONS VT and VB are equally safe and effective tools in reducing retropulsion of ureteral stones. Operative time, dusting time and SFR were comparable. They also equally avoided stone push-up and prevented ureteral lesions, which may later occur in ureteral strictures.
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Affiliation(s)
- Davide Perri
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo Della Battaglia, Italy.
| | - U Besana
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo Della Battaglia, Italy
| | - F Mazzoleni
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo Della Battaglia, Italy
| | - A Pacchetti
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo Della Battaglia, Italy
| | - E Morini
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo Della Battaglia, Italy
| | - E Verzotti
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo Della Battaglia, Italy
| | - M Maltagliati
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo Della Battaglia, Italy
| | - J Romero-Otero
- Department of Urology, Hospital Universitario, 12 De Octubre, Madrid, Spain
| | - A L Pastore
- Department of Urology, Sapienza University, Rome, Italy
| | - A S Gozen
- Department of Urology, SLK-Kliniken Heilbronn, Heilbronn, Germany
| | - P Kallidonis
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - D Pushkar
- Department of Urology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | - A Govorov
- Department of Urology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | - G Bozzini
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo Della Battaglia, Italy
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Valenzi FM, Fuschi A, Al Salhi Y, Sequi MB, Suraci PP, Pacini M, Scalzo S, Rera OA, Antonioni A, Graziani D, Martino G, Candita G, Gianfrancesco F, Zucchi A, Lombardo R, De Nunzio C, Cicione A, Bozzini G, Rengo M, Capodiferro P, Sciarra A, Petrozza V, Carbone A, Pastore AL. Is early continence recovery related to the length of spared urethra? A prospective multicenter study comparing preoperative MRI and histologic specimen measurements after robotic radical prostatectomy. Eur J Surg Oncol 2024; 50:108319. [PMID: 38603868 DOI: 10.1016/j.ejso.2024.108319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/18/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Urinary incontinence (UI) is a common complication after radical prostatectomy, significantly affecting patients' quality of life. This study aimed to correlate the length of preserved urethra in robotic radical prostatectomy (RALP) patients with short-term urinary continence rates within 90 days post-surgery. METHODS A prospective multicentric study enrolled 190 prostate adenocarcinoma patients undergoing RALP. Using preoperative magnetic resonance imaging (mpMRI), urethral length was measured from the external urethral sphincter to the bladder neck. After surgery, histological measurements of the removed urethra were compared to the preoperative mpMRI data. Patients were categorized into two groups at the three-month follow-up based on urinary continence assessed through Urodynamic Study (UDS): Group A (94 patients without UI) and Group B (96 patients with UI). RESULTS Results revealed a significant difference in mean UI recovery time (Group A: 12.35 days, SD: 3.09 vs. Group B: 93.86 days, SD: 34.8, p < 0.0001). A ROC curve identified a 16.5% cut-off value (p < 0.000, sensitivity 87.5%, specificity 91.8%). Both groups showed a significant negative correlation between preserved urethral percentage and UI recovery time (Group A: r -0.655, p < 0.0001; Group B: r -0.340, p: 0.017). Group A had an average of 21.52% preserved urethra, while Group B had 13.86% (p < 0.0001). At one-year follow-up, 93.2% overall patients reported urinary continence without pads. CONCLUSIONS This study emphasizes the positive correlation between preserved urethra percentage in RALP and early urinary continence recovery, highlighting its surgical significance.
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Affiliation(s)
- Fabio Maria Valenzi
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 04100, Latina, Italy
| | - Andrea Fuschi
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 04100, Latina, Italy
| | - Yazan Al Salhi
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 04100, Latina, Italy
| | - Manfredi Bruno Sequi
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 04100, Latina, Italy
| | - Paolo Pietro Suraci
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 04100, Latina, Italy
| | - Matteo Pacini
- Department of Urology, University of Pisa, 56121, Pisa, Italy
| | - Silvio Scalzo
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 04100, Latina, Italy
| | - Onofrio Antonio Rera
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 04100, Latina, Italy
| | - Alice Antonioni
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 04100, Latina, Italy
| | - Damiano Graziani
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 04100, Latina, Italy
| | - Giorgio Martino
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 04100, Latina, Italy
| | - Giuseppe Candita
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 04100, Latina, Italy
| | - Filippo Gianfrancesco
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 04100, Latina, Italy
| | | | - Riccardo Lombardo
- Department of Urology, Faculty of Medicine and Psychiatry, Sant'Andrea Hospital, 00189, Rome, Italy
| | - Cosimo De Nunzio
- Department of Urology, Faculty of Medicine and Psychiatry, Sant'Andrea Hospital, 00189, Rome, Italy
| | - Antonio Cicione
- Department of Urology, Faculty of Medicine and Psychiatry, Sant'Andrea Hospital, 00189, Rome, Italy
| | - Giorgio Bozzini
- Department of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy
| | - Marco Rengo
- University of Rome Sapienza, Department of Radiological, Oncological and Pathological Sciences, Academic Diagnostic, Imaging Division - I.C.O.T. Hospital, Via F. Faggiana 1668, 04100, Latina, Italy
| | - Paola Capodiferro
- University of Rome Sapienza, Department of Radiological, Oncological and Pathological Sciences, Academic Diagnostic, Imaging Division - I.C.O.T. Hospital, Via F. Faggiana 1668, 04100, Latina, Italy
| | - Alessandro Sciarra
- Policlinico Umberto I, Department of Urology, Sapienza University of Rome, 00161, Rome, Italy
| | - Vincenzo Petrozza
- Faculty of Pharmacy and Medicine Dept. of Medico-Surgical Sciences and Biotechnologies Histopathology Unit, ICOT, Latina, Italy
| | - Antonio Carbone
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 04100, Latina, Italy
| | - Antonio Luigi Pastore
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 04100, Latina, Italy.
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Perri D, Mazzoleni F, Besana U, Pacchetti A, Morini E, Calandriello M, Pastore AL, Romero-Otero J, Bruyere F, Sighinolfi MC, Rocco B, Micali S, Gozen AS, Liatsikos E, Roche JB, Bozzini G. A proposed mathematical model to help preoperative planning between RIRS and MiniPerc for renal stones between 10 and 20 mm using holmium:Yag laser (Cyber Ho): the stone management according to size-hardness (SMASH) score. Urolithiasis 2024; 52:58. [PMID: 38565776 DOI: 10.1007/s00240-024-01536-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/22/2024] [Indexed: 04/04/2024]
Abstract
To evaluate the performance of a mathematical model to drive preoperative planning between RIRS and MiniPerc (MP) for the treatment of renal stones between 10 and 20 mm. Patients with a renal stone between 10 and 20 mm were enrolled. A mathematical model named Stone Management According to Size-Hardness (SMASH) score was calculated: hounsfield units (HU) χ stone maximum size (cm)/100. Patients were divided into 4 groups: RIRS with score < 15 (Group A), RIRS with score ≥ 15 (Group B), MP with score < 15 (Group C), MP with score ≥ 15 (Group D). Cyber Ho device was always used. Stone free rate (SFR) was assessed after 3 months. Complication rate and need for auxiliary procedures were evaluated. Between January 2019 and December 2021, 350 patients were enrolled (87, 88, 82 and 93 in Groups A, B, C and D). Mean stone size was 13.1 vs 13.3 mm in Group A vs B (p = 0.18) and 16.2 vs 18.1 mm in Group C vs D (p = 0.12). SFR was 82%, 61%, 75% and 85% for Groups A, B, C and D. SFR was comparable between Groups C and D (p = 0.32) and Groups A and C (p = 0.22). SFR was significantly higher in Group A over B (p = 0.03) and in Group D over B (p = 0.02). Complication rate was 2.2%, 3.4%, 12.1%, 12.9% for Groups A, B, C, D. RIRS and MP are both safe and effective. The mathematical model with the proposed cut-off allowed a proper allocation of patients between endoscopic and percutaneous approaches.Registration number of the study ISRCTN55546280.
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Affiliation(s)
- D Perri
- Department of Urology, Azienda Socio Sanitaria Territoriale Lariana, Como, Italy.
- Department of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy.
| | - F Mazzoleni
- Department of Urology, Azienda Socio Sanitaria Territoriale Lariana, Como, Italy
| | - U Besana
- Department of Urology, Azienda Socio Sanitaria Territoriale Lariana, Como, Italy
| | - A Pacchetti
- Department of Urology, Azienda Socio Sanitaria Territoriale Lariana, Como, Italy
| | - E Morini
- Department of Urology, Azienda Socio Sanitaria Territoriale Lariana, Como, Italy
| | - M Calandriello
- Department of Urology, Azienda Socio Sanitaria Territoriale Lariana, Como, Italy
| | - A L Pastore
- Department of Urology, Sapienza University, Rome, Italy
| | - J Romero-Otero
- Department of Urology, Hospital Universitario, 12 De Octubre, Madrid, Spain
| | - F Bruyere
- Department of Urology, Bretonneau Hospital, Tours, France
| | | | - B Rocco
- Department of Urology, Ospedale San Paolo, Milan, Italy
| | - S Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - A S Gozen
- Department of Urology, SLK-Kliniken Heilbronn, Heilbronn, Germany
| | - E Liatsikos
- Department of Urology, University of Patras, Patras, Greece
| | - J B Roche
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - G Bozzini
- Department of Urology, Azienda Socio Sanitaria Territoriale Lariana, Como, Italy
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Lombardo R, Ghezzo N, Sarcinelli L, Turchi B, Zammitti F, Franco A, Nacchia A, Cicione A, Tema G, Pastore AL, Guarnotta G, Fuschi A, Al Salhi Y, Tubaro A, De Nunzio C. Post-Voided Residual Ratio Does Not Predict Trifecta Outcome after Transurethral Resection of Prostate. Life (Basel) 2024; 14:445. [PMID: 38672716 PMCID: PMC11051523 DOI: 10.3390/life14040445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
The purpose of this study was to assess the importance of the post-void residual (PVR) ratio (PVR ratio) in achieving a favorable trifecta outcome for patients suffering from lower urinary tract symptoms and benign prostatic enlargement (LUTS-BPE) who undergo transurethral resection of the prostate (TURP). Starting from 2015, a series of patients with LUTS-BPE who underwent TURP were included in a forward-looking study. These patients were assessed using the international prostate symptom score (IPSS) screening tool, uroflowmetry, and a transrectal ultrasound to measure prostate volume (TRUS). Both the PVR urine volume and the PVR ratio (PVR-R), which is the PVR as a percentage of total bladder volume (voided volume + PVR), were measured. The assessment of outcomes was based on the trifecta favorable outcome, defined as meeting all of the following criteria: (1) absence of perioperative complications, (2) a postoperative IPSS of less than eight, and (3) a postoperative maximum urinary flow rate (Qmax) greater than 15 mL/s. A total of 143 patients were included, with a median age of 70 years (interquartile range 65-73). Of these, 58% (83/143) achieved a positive trifecta outcome. Upon conducting a multivariate analysis, both IPSS and Qmax were identified as predictors of a positive trifecta outcome, whereas the PVR-R did not prove to be an independent predictor. In summary, it was found that preoperative IPSS and Qmax are indicative of a trifecta outcome following TURP, whereas PVR-R is not.
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Affiliation(s)
- Riccardo Lombardo
- Department of Urology, Sapienza University of Rome, 00185 Rome, Italy; (N.G.); (L.S.); (B.T.); (F.Z.); (A.F.); (A.N.); (A.C.); (G.T.); (A.L.P.); (G.G.); (A.F.); (Y.A.S.); (A.T.); (C.D.N.)
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Nacchia A, Franco A, Cicione A, Riolo S, Santoro G, Romagnoli M, Sarcinelli L, Fiasconaro D, Ghezzo N, Gallo G, Tema G, Pastore AL, Salhi YA, Fuschi A, Carbone A, Franco G, Lombardo R, Tubaro A, De Nunzio C. Medications Mostly Associated With Ejaculatory Disorders: Assessment of the Eudra-Vigilance and Food and Drug Administration Pharmacovigilance Databases Entries. Urology 2024; 185:59-64. [PMID: 38331221 DOI: 10.1016/j.urology.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/08/2023] [Accepted: 12/26/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To identify which medications are mostly associated with ejaculatory disorders through a disproportionality analysis. METHODS The Food and Drug Administration Adverse Event Reporting System (FDA-FAERS) and the Eudra-Vigilance (EV) database were queried to identify medications more commonly associated to ejaculatory disorders from September 10, 2012 to June 1, 2023. Proportional Reported Ratios (PRRs) were computed for all the selected drugs. RESULTS Overall, 7404 reports of ejaculatory disorders reports were identified, and of these, 6854 cases (92.6%) were attributed to ten specific medications. On FDA-FAERS and EV databases, Paroxetine and Tamsulosin were the main responsible of delayed ejaculation (103/448 events, 23.0%) and retrograde ejaculation (366/1033 events, 35.4%), respectively. Finasteride was mostly related to painful ejaculation and ejaculation failure, with 150 events (7.8%) and 735 events (38.4%) respectively. Within the group of high-risk medications, Sildenafil presented higher risk of ejaculatory disorders than Tadalafil (PRR=5.85 (95%CI 5.09-6.78), P < .01). CONCLUSION Ten drugs were recognized to display significant reporting levels of ejaculatory disorders. Among them, Finasteride and Sildenafil were responsible for the most reports in FDA-FAERS and in EV databases, respectively. Physicians should thoroughly counsel patients treated with these drugs about the risk of ejaculatory disorders. Further integration into clinical trials is needed to enhance the applicability and significance of these results.
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Affiliation(s)
- Antonio Nacchia
- 'Sapienza' University of Rome, Department of Urology, Rome, Italy
| | - Antonio Franco
- 'Sapienza' University of Rome, Department of Urology, Rome, Italy
| | - Antonio Cicione
- 'Sapienza' University of Rome, Department of Urology, Rome, Italy
| | - Sara Riolo
- 'Sapienza' University of Rome, Department of Urology, Rome, Italy
| | - Giuseppe Santoro
- 'Sapienza' University of Rome, Department of Urology, Rome, Italy
| | - Matteo Romagnoli
- 'Sapienza' University of Rome, Department of Urology, Rome, Italy
| | - Luca Sarcinelli
- 'Sapienza' University of Rome, Department of Urology, Rome, Italy
| | | | - Nicola Ghezzo
- 'Sapienza' University of Rome, Department of Urology, Rome, Italy
| | - Giacomo Gallo
- 'Sapienza' University of Rome, Department of Urology, Rome, Italy
| | - Giorgia Tema
- 'Sapienza' University of Rome, Department of Urology, Rome, Italy
| | | | - Yazan Al Salhi
- 'Sapienza' University of Rome, Department of Urology, Rome, Italy
| | - Andrea Fuschi
- 'Sapienza' University of Rome, Department of Urology, Rome, Italy
| | - Antonio Carbone
- 'Sapienza' University of Rome, Department of Urology, Rome, Italy
| | - Giorgio Franco
- 'Sapienza' University of Rome, Department of Urology, Rome, Italy
| | | | - Andrea Tubaro
- 'Sapienza' University of Rome, Department of Urology, Rome, Italy
| | - Cosimo De Nunzio
- 'Sapienza' University of Rome, Department of Urology, Rome, Italy.
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7
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Turchi B, Lombardo R, Franco A, Tema G, Nacchia A, Cicione A, Pastore AL, Carbone A, Fuschi A, Franco G, Tubaro A, De Nunzio C. Residents and Consultants Have Equal Outcomes When Performing Transrectal Fusion Biopsies: A Randomized Clinical Trial. Curr Oncol 2024; 31:747-758. [PMID: 38392049 PMCID: PMC10887997 DOI: 10.3390/curroncol31020055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
The aim of our study was to compare the performance of residents vs. consultants in transrectal fusion prostate biopsies (FUS-PBs), as well as patient-reported comfort. Between January 2021 and October 2022, a consecutive series of patients undergoing FUS-PBs were randomized into two groups: (A) FUS-PBs performed by a consultant; (B) FUS-PBs performed by trained residents (>50 procedures). All patients underwent FUS-PBs with 12 systematic cores and 3/6 target cores. The detection rate and number of positive cores in the target lesion were compared between groups, and the patient's discomfort after the procedure was evaluated using the VAS scale. Overall, 140 patients with a median age of 72 years were enrolled. Overall, 69/140 (49.3%) presented prostate cancer and 53/69 (76.8%) presented a clinically significant cancer (Grade Group ≥ 2). Consultants presented a detection rate of 37/70 (52.9%) and residents a detection rate of 32/70 (45.7%) (p > 0.2); the mean number of positive cores in the index lesion was similar in both groups (1.5 vs. 1.1; p > 0.10). In terms of the patients' experiences, the procedure was well tolerated, with a median VAS score of 2 in both groups, with no statistically significant differences. Residents showed satisfactory outcomes in terms of detection rate, procedural time, and patient comfort when performing prostate biopsies. Residents, after adequate training, can safely perform prostate biopsies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Cosimo De Nunzio
- Department of Urology, Sapienza University of Rome, 00100 Rome, Italy; (B.T.); (R.L.); (A.F.); (G.T.); (A.N.); (A.C.); (A.L.P.); (A.C.); (A.F.); (G.F.); (A.T.)
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Perri D, Mazzoleni F, Besana U, Pacchetti A, Morini E, Berti L, Calandriello M, Pastore AL, Romero-Otero J, Bruyere F, Sighinolfi MC, Rocco B, Micali S, Gozen AS, Liatsikos E, Roche JB, Bozzini G. Pulsed-wave vs Continuous-wave Thulium Fiber Laser Enucleation of the Prostate (ThuFLEP): A Comparison of Perioperative Outcomes. Urology 2023; 178:120-124. [PMID: 37257589 DOI: 10.1016/j.urology.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/07/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To compare intra and early postoperative outcomes between pulsed-wave and continuous-wave Thulium Fiber Laser Enucleation of the Prostate (PW-ThuFLEP vs CW-ThuFLEP) for the treatment of benign prostatic hyperplasia. METHODS 238 patients with lower urinary tract symptoms due to benign prostatic hyperplasia underwent PW-ThuFLEP (118 patients) vs CW-ThuFLEP (120 patients). Preoperative prostate volume, adenoma volume, prostate-specific antigen (PSA), and hemoglobin values were recorded. International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), post-void residual volume, and International Index of Erectile Function-5 score (IIEF-5) were assessed. Operative time, enucleation time, enucleation efficiency, catheterization time, irrigation volume, hospital stay, hemoglobin drop, and postoperative complications were recorded. Micturition improvements and sexual outcomes were evaluated 3months after surgery. RESULTS CW-ThuFLEP showed shorter operative time (61.5 vs 67.4 minutes, P = .04). Enucleation time (50.2 vs 53.3 minutes, P = .12), enucleation efficiency (0.8 vs 0.7 g/min, P = .38), catheterization time (2.2 vs 2.1days, P = .29), irrigation volume (32.9 vs 32.8L, P = .71), hospital stay (2.8 vs 2.6days, P = .29) and hemoglobin drop (0.38 vs 0.39 g/dL, P = .53) were comparable. No significant difference in complication rate was observed. At 3-month follow-up, the procedures did not show any significant difference in IPSS, Qmax, post-void residual volume, IIEF-5, and PSA value. CONCLUSION PW-ThuFLEP and CW-ThuFLEP both relieve lower urinary tract symptoms equally, with high efficacy and safety. Operative time was significantly shorter with CW-ThuFLEP, but with a small difference with low clinical impact. Enucleation time, enucleation efficiency, catheterization time, irrigation volume, hospital stay, hemoglobin and PSA drop, complication rate, and sexual outcomes showed no differences.
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Affiliation(s)
- D Perri
- Department of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy.
| | - F Mazzoleni
- Department of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
| | - U Besana
- Department of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
| | - A Pacchetti
- Department of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
| | - E Morini
- Department of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
| | - L Berti
- Department of Urology, ASST Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - M Calandriello
- Department of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
| | - A L Pastore
- Department of Urology, Sapienza University of Rome, Latina, Italy
| | - J Romero-Otero
- Department of Urology, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - F Bruyere
- Department of Urology, CHRU Bretonneau, Tours, France
| | - M C Sighinolfi
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - B Rocco
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - S Micali
- Department of Urology, Modena and Reggio Emilia University, Modena, Italy
| | - A S Gozen
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - E Liatsikos
- Department of Urology, University of Patras, Patras, Greece
| | - J B Roche
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - G Bozzini
- Department of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
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9
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Martoccia A, Al Salhi Y, Fuschi A, Rera OA, Suraci PP, Scalzo S, Antonioni A, Valenzi FM, Sequi MB, De Nunzio C, Lombardo R, Sciarra A, Di Pierro G, Bozzini G, Asimakopoulos AD, Finazzi Agrò E, Zucchi A, Gubiotti M, Cervigni M, Carbone A, Pastore AL. Robot-Assisted Sacrocolpopexy versus Trans-Vaginal Multicompartment Prolapse Repair: Impact on Lower Bowel Tract Function. Biomedicines 2023; 11:2105. [PMID: 37626605 PMCID: PMC10452351 DOI: 10.3390/biomedicines11082105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/05/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND This study evaluated the effectiveness, safety, and possible changes in bowel symptoms after multicompartment prolapse surgery by comparing two different surgical approaches, transvaginal mesh surgery with levatorplasty (TVMLP) and robot-assisted sacrocolpopexy (RSC). METHODS All patients underwent pelvic (POP-Q staging system) and rectal examination to evaluate anal sphincter tone in the lithotomy position with the appropriate Valsalva test. The preoperative evaluation included urodynamics and pelvic magnetic resonance defecography. Patient Global Impression of Improvement (PGI-I) at follow-up measured subjective improvement. All patients completed Agachan-Wexner's questionnaire at 0 and 12 months of follow-up to evaluate bowel symptoms. RESULTS A total of 73 cases were randomized into the RSC group (36 cases) and TVMLP group (37 cases). After surgery, the main POP-Q stage in both groups was stage I (RCS 80.5% vs. TVMLP 82%). There was a significant difference (p < 0.05) in postoperative anal sphincter tone: 35%. The TVMLP group experienced a hypertonic anal sphincter, while none of the RSC group did. Regarding subjective improvement, the median PGI-I was 1 in both groups. At 12 months of follow-up, both groups exhibited a significant improvement in bowel symptoms. CONCLUSIONS RSC and TVMLP successfully corrected multicompartment POP. RSC showed a greater improvement in the total Agachan-Wexner score and lower bowel symptoms.
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Affiliation(s)
- Alessia Martoccia
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Yazan Al Salhi
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Andrea Fuschi
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Onofrio Antonio Rera
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Paolo Pietro Suraci
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Silvio Scalzo
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Alice Antonioni
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Fabio Maria Valenzi
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Manfredi Bruno Sequi
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Cosimo De Nunzio
- Department of Urology, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (C.D.N.); (R.L.)
| | - Riccardo Lombardo
- Department of Urology, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (C.D.N.); (R.L.)
| | - Alessandro Sciarra
- Policlinico Umberto I, Department of Urology, Sapienza University of Rome, 00161 Rome, Italy; (A.S.); (G.D.P.)
| | - Giovanni Di Pierro
- Policlinico Umberto I, Department of Urology, Sapienza University of Rome, 00161 Rome, Italy; (A.S.); (G.D.P.)
| | - Giorgio Bozzini
- Department of Urology, ASST Lariana-Sant’Anna Hospital, 22100 Como, Italy;
| | - Anastasios D. Asimakopoulos
- Urology Unit, Fondazione PTV Policlinico Tor Vergata University Hospital, 00133 Rome, Italy; (A.D.A.); (E.F.A.)
| | - Enrico Finazzi Agrò
- Urology Unit, Fondazione PTV Policlinico Tor Vergata University Hospital, 00133 Rome, Italy; (A.D.A.); (E.F.A.)
| | | | | | - Mauro Cervigni
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Antonio Carbone
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Antonio Luigi Pastore
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
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Al Salhi Y, Sequi MB, Valenzi FM, Fuschi A, Martoccia A, Suraci PP, Carbone A, Tema G, Lombardo R, Cicione A, Pastore AL, De Nunzio C. Cancer Stem Cells and Prostate Cancer: A Narrative Review. Int J Mol Sci 2023; 24:ijms24097746. [PMID: 37175453 PMCID: PMC10178135 DOI: 10.3390/ijms24097746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Cancer stem cells (CSCs) are a small and elusive subpopulation of self-renewing cancer cells with the remarkable ability to initiate, propagate, and spread malignant disease. In the past years, several authors have focused on the possible role of CSCs in PCa development and progression. PCa CSCs typically originate from a luminal prostate cell. Three main pathways are involved in the CSC development, including the Wnt, Sonic Hedgehog, and Notch signaling pathways. Studies have observed an important role for epithelial mesenchymal transition in this process as well as for some specific miRNA. These studies led to the development of studies targeting these specific pathways to improve the management of PCa development and progression. CSCs in prostate cancer represent an actual and promising field of research.
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Affiliation(s)
- Yazan Al Salhi
- Urology Unit, Department of Medico-Surgical Sciences & Biotechnologies, Faculty of Pharmacy & Medicine, Sapienza University of Rome, 04100 Latina, Italy
| | - Manfredi Bruno Sequi
- Urology Unit, Department of Medico-Surgical Sciences & Biotechnologies, Faculty of Pharmacy & Medicine, Sapienza University of Rome, 04100 Latina, Italy
| | - Fabio Maria Valenzi
- Urology Unit, Department of Medico-Surgical Sciences & Biotechnologies, Faculty of Pharmacy & Medicine, Sapienza University of Rome, 04100 Latina, Italy
| | - Andrea Fuschi
- Urology Unit, Department of Medico-Surgical Sciences & Biotechnologies, Faculty of Pharmacy & Medicine, Sapienza University of Rome, 04100 Latina, Italy
| | - Alessia Martoccia
- Urology Unit, Department of Medico-Surgical Sciences & Biotechnologies, Faculty of Pharmacy & Medicine, Sapienza University of Rome, 04100 Latina, Italy
| | - Paolo Pietro Suraci
- Urology Unit, Department of Medico-Surgical Sciences & Biotechnologies, Faculty of Pharmacy & Medicine, Sapienza University of Rome, 04100 Latina, Italy
| | - Antonio Carbone
- Urology Unit, Department of Medico-Surgical Sciences & Biotechnologies, Faculty of Pharmacy & Medicine, Sapienza University of Rome, 04100 Latina, Italy
| | - Giorgia Tema
- Urology Unit, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Riccardo Lombardo
- Urology Unit, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Antonio Cicione
- Urology Unit, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Antonio Luigi Pastore
- Urology Unit, Department of Medico-Surgical Sciences & Biotechnologies, Faculty of Pharmacy & Medicine, Sapienza University of Rome, 04100 Latina, Italy
| | - Cosimo De Nunzio
- Urology Unit, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
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11
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Fuschi A, Pastore AL, Al Salhi Y, Martoccia A, De Nunzio C, Tema G, Rera OA, Carbone F, Asimakopoulos AD, Sequi MB, Valenzi FM, Suraci PP, Scalzo S, Del Giudice F, Nardecchia S, Bozzini G, Corsini A, Sciarra A, Carbone A. The impact of radical prostatectomy on global climate: a prospective multicentre study comparing laparoscopic versus robotic surgery. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00672-4. [PMID: 37085603 DOI: 10.1038/s41391-023-00672-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/26/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND More than 4% of the global greenhouse gas emissions are generated by healthcare system. Focusing on the environmental impact of minimally invasive surgery, we assessed and compared the CO2 emissions between Robot-assisted (RALP) and Laparoscopic Radical Prostatectomy (LRP). METHODS In patients prospectively enrolled, we evaluated the age, surgical and anesthesiologic time, postoperative intensive care unit and hospital stay, blood transfusion, pre- and postoperative hemoglobin and Gleason score, open conversion need, and complications (Clavien-Dindo classification). We assessed the life cycle to estimate the energy consumption for surgical procedures and hospital stays. We reported the materials, CO2 produced, and fluid quantity infused and dispersed. Disposable and reusable materials and instruments were weighed and divided into metal, plastic, and composite fibers. The CO2 consumption for disposal and decontamination was also evaluated. RESULTS Of the 223 patients investigated, 119 and 104 patients underwent RALP and LRP, respectively. The two groups were comparable as regards age and preoperative Gleason score. The laparoscopic and robotic instruments weighed 1733 g and 1737 g, respectively. The CO2 emissions due to instrumentation were higher in the laparoscopic group, with the majority coming from plastic and composite fiber components. The CO2 emissions for metal components were higher in the robotic group. The robot functioned at 3.5 kW/h, producing 4 kg/h of CO2. The laparoscopic column operated at 600 W/h, emitting ~1 kg/h of CO2. The operating room operated at 3,0 kW/h. The operating time was longer in the laparoscopic group, resulting in higher CO2 emissions. CO2 emissions from hospital room energy consumption were lower in the robot-assisted group. The total CO2 emissions were ~47 kg and ~60 kg per procedure in the robot-assisted and laparoscopic groups, respectively. CONCLUSIONS RALP generates substantially less CO2 than LRP owing to the use of more reusable surgical supplies, shorter operative time and hospital stay.
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Affiliation(s)
- Andrea Fuschi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Antonio Luigi Pastore
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy.
| | - Yazan Al Salhi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Alessia Martoccia
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giorgia Tema
- Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Onofrio Antonio Rera
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Flavia Carbone
- Uroresearch, Non-profit Association for Research in Urology, Latina, Italy
| | | | - Manfredi Bruno Sequi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Fabio Maria Valenzi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Paolo Pietro Suraci
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Silvio Scalzo
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Francesco Del Giudice
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Stefano Nardecchia
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, Rome, Italy
| | - Giorgio Bozzini
- Department of Urology, ASST Lariana-Sant'Anna Hospital, Como, Italy
| | - Alessandro Corsini
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, Rome, Italy
| | - Alessandro Sciarra
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Antonio Carbone
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
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12
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Giannese D, Moriconi D, Cupisti A, Zucchi A, Pastore AL, Simonato A, Mogorovich A, Claps F, Bartoletti R. Idiopathic Retroperitoneal Fibrosis: What Is the Optimal Clinical Approach for Long-Term Preservation of Renal Function? Urol Int 2023; 107:134-147. [PMID: 36273441 DOI: 10.1159/000526114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/04/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to investigate the long-term effects of ureteral stenting and the exact timing of stent removal in favor of surgery in patients with idiopathic retroperitoneal fibrosis (IRF). SUMMARY Medline research terms of "idiopathic retroperitoneal fibrosis" AND " medical therapy" OR "ureteral stenting" OR "surgical treatment" were done. Systematic reviews and observational and clinical studies were analyzed to obtain indication regarding the objective of the study for a narrative review. Ninety-two papers were analyzed. The treatment of IRF includes the monitoring of retroperitoneal fibrotic process spread and the prevention of abdominal organs entrapment. Treatment of ureteral obstruction includes medical therapy and ureteral stenting (US) or percutaneous nephrostomy (PNS) to overcome the worsening of renal function. Up to now, the timing of US or PNS removal is not yet clear, both for the complexity of evaluating the efficacy of the medical therapy and demonstrating the resolution of obstructive nephropathy. Moreover, it is not yet clear if the long-term ureteral stent placement or PNS is able to maintain an efficient renal function. Ureterolysis with a laparoscopic robot-assisted approach is now considered as an ultimate treatment for ureteral obstruction, limiting the progression of kidney impairment and improving the quality of life of patients, although nephrologists are generally abdicant regarding the potential switch toward the surgical approach. KEY MESSAGES Prospective studies regarding the long-term effects of US on the renal function impairment in patients with IRF should be structured to obtain adequate information on the exact timing for the surgical approach.
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Affiliation(s)
- Domenico Giannese
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Diego Moriconi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Zucchi
- Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Antonio Luigi Pastore
- Department of Urology, ICOT Latina, Polo Pontino, La Sapienza University of Rome, Latina, Italy
| | | | - Andrea Mogorovich
- Urology Unit, Azienda Sanitaria Toscana Nord Ovest, Viareggio, Italy
| | - Francesco Claps
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
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13
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Perri D, Berti L, Pacchetti A, Morini E, Maltagliati M, Besana U, Pastore AL, Romero-Otero J, Saredi G, Centrella D, Sighinolfi MC, Rocco B, Micali S, Broggini P, Boldini M, Mazzoleni F, Bozzini G. A comparison among RIRS and MiniPerc for renal stones between 10 and 20 mm using thulium fiber laser (Fiber Dust): a randomized controlled trial. World J Urol 2022; 40:2555-2560. [PMID: 36029330 DOI: 10.1007/s00345-022-04133-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE We performed a prospective randomized comparison among Retrograde IntraRenal Surgery (RIRS) and MiniPerc (MP) for stones between 10 and 20 mm to evaluate outcomes with the same laser device: Fiber Dust. METHODS Patients with a single renal stone between 10 and 20 mm were randomized to RIRS (Group A) versus MP (Group B). Exclusion criteria were age < 18 or > 75, presence of acute infection, coagulation impairments, cardiovascular or pulmonary comorbidities. In both groups, the Fiber Dust laser was used. A CT scan after 3 months was performed. A negative CT scan or asymptomatic patients with stone fragments < 3 mm and a negative urinary culture were the criteria to assess the stone-free status. A statistical analysis was carried out to assess success, complication and retreatment rates and need for auxiliary treatments. RESULTS Between January 2021 and January 2022, 186 patients were enrolled (90 in Group A and 96 in Group B). Mean stone size was 15.8 mm and 14.9 mm in Group A and B, respectively (p = 0.23). The overall stone-free rate (SFR) was 73.3% for Group A and 84.4% for Group B. A higher SFR was reached for upper calyceal stones in Group A (90.4%) lower calyceal stones in Group B (91.6%). Retreatment rate (p = 0.31) and auxiliary procedure rate (p = 0.18) were comparable. Complication rate was 5.5% and 5.2% for Groups A and B, respectively. CONCLUSIONS RIRS and MP are both effective to obtain a postoperative SFR with Fiber Dust. According to the stone position one treatment is superior to the other one.
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Affiliation(s)
- Davide Perri
- Division of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy.
| | - Lorenzo Berti
- Division of Urology, ASST Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Andrea Pacchetti
- Division of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
| | - Elena Morini
- Division of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
| | - Matteo Maltagliati
- Division of Urology, ASST Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Umberto Besana
- Division of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
| | - Antonio Luigi Pastore
- Division of Urology, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | | | - Giovanni Saredi
- Division of Urology, ASST Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy
| | | | | | | | - Salvatore Micali
- Division of Urology, Modena and Reggio Emilia University, Modena, Italy
| | - Paolo Broggini
- Division of Urology, Clinica Sant'Anna, Lugano, Switzerland
| | - Marco Boldini
- Division of Urology, Clinica Sant'Anna, Lugano, Switzerland
| | - Federica Mazzoleni
- Division of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
| | - Giorgio Bozzini
- Division of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
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14
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Asimakopoulos AD, Colalillo G, Miano R, Finazzi Agrò E, Farullo G, Fuschi A, Pastore AL, Germani S. Double-J stent placement during laparoscopic ureterolithotomy: the "seagull" technique. BJU Int 2022; 130:839-843. [PMID: 35934989 DOI: 10.1111/bju.15866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Gaia Colalillo
- Unit of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
| | - Roberto Miano
- Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Enrico Finazzi Agrò
- Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Farullo
- Unit of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
| | | | | | - Stefano Germani
- Unit of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
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15
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Bartoletti R, Pastore AL, Fabris FM, Di Vico T, Morganti R, Mogorovich A, Morelli G, Peroni D, Al Salhi Y, Zucchi A. 16 years follow-up evaluation of immediate vs delayed vs. combined hormonal therapy on fertility of patients with cryptorchidism: results of a longitudinal cohort study. Reprod Biol Endocrinol 2022; 20:102. [PMID: 35836180 PMCID: PMC9281152 DOI: 10.1186/s12958-022-00975-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To investigate in a longitudinal cohort study, the best treatment to preserve fertility in cryptorchid subjects. Patients treated with immediate hormonal vs. delayed vs. combined (hormone plus surgery) therapy consecutively enrolled during the period 1987-1997, were evaluated. METHODS Two hundred fifty-five subjects were enrolled and 192 patients completed the follow-upt. One hundred fifty-six patients and 36 out 192 had monolateral and bilateral cryptorchidism, respectively. Twenty-nine out of 192 were previously treated by surgery alone (Group A), 93/192 by hormone therapy alone (Group B), 51/192 received sequential combined hormone therapy plus surgery (Group C) whilst 19/192 refused any type of treatment (Group D). The other 63 patients were considered lost to follow-up. All the patients underwent medical consultation, scrotal ultrasound scan, sperm analysis and Inhibin B, Follicular Stimulating Hormone (FSH) and Testosterone (T) serum level determination. RESULTS Testicular volume was found decreased in the Group D patients whilst hormone serum levels were comparable in all groups. Statistically significant differences for sperm characteristics were found in patients treated with hormonal therapy alone or combined with surgery (Groups B and C). These two groups reported better semen quality than patients who received surgery alone or no treatment. No differences were observed between monolateral and bilateral cryptorchidism patients. CONCLUSIONS Early prolonged hormonal therapy is advisable in all patients with cryptorchidism independently from the surgical option of promoting testicular descent to the scrotum. Hormonal therapy provides in our study better chance to obtain adequate sperm quality in adult life.
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Affiliation(s)
- Riccardo Bartoletti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Antonio Luigi Pastore
- Urology Department, Sapienza University of Rome, ICOT Latina, Faculty of Pharmacy and Medicine, Corso della Repubblica 79, 04100, Latina, Italy.
| | | | - Tommaso Di Vico
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Riccardo Morganti
- Department of Bio Statistics, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Andrea Mogorovich
- Urology Unit, Versilia Hospital, AO-Toscana Nord Ovest, Viareggio, Italy
| | - Girolamo Morelli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Diego Peroni
- Department of Experimental and Clinical Medicine, University of Pisa, Pisa, Italy
| | - Yazan Al Salhi
- Urology Department, Sapienza University of Rome, ICOT Latina, Faculty of Pharmacy and Medicine, Corso della Repubblica 79, 04100, Latina, Italy
| | - Alessandro Zucchi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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16
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Al Demour SH, Abuhamad M, Santarisi AN, Al-Zubi M, Al-Rawashdah SF, Halalsheh O, Carbone A, Pastore AL, Ahmad MM. The Effect of Transurethral Resection of the Prostate on Erectile and Ejaculatory Functions in Patients with Benign Prostatic Hyperplasia. Urol Int 2022; 106:997-1004. [PMID: 35654017 PMCID: PMC9393792 DOI: 10.1159/000524957] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/05/2022] [Indexed: 12/02/2022]
Abstract
Introduction The aim of this study was to investigate the effect of TURP on erectile function (EF) and ejaculatory function (EJF). Methods A total of 91 patients who underwent TURP were retrospectively assessed. Patients were divided into two groups based on International Index of Erectile Function (IIEF-5): group A included 41 patients with normal EF, and group B included 50 patients with erectile dysfunction (ED). All patients were evaluated for EF and EJF at baseline, 1, 3, and 6 months after TURP by using IIEF-5, Ejaculatory Domain-Male Sexual-Health Inventory (Ej-MSHQ). Results In group A, there were no significant statistical differences in mean IIEF-5 at baseline and after TURP 22.88 ± 0.81 versus 22.63 ± 2.63 (p = 0.065). However, in group B, there was significant improvement in IIEF-5 after TURP all over the follow-up time points in comparison to the baseline (p = <0.001). The loss of EJF was significant among patients in group A. There was significant improvement of IPSS and Qmax in group A after surgery compared to group B. Conclusion The results confirmed that TURP has no significant negative influence on EF, and patients with preexisting ED were improved after TURP. On the contrary, the loss of EJF was significant.
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Affiliation(s)
- Saddam H Al Demour
- Department of Special Surgery, Division of Urology, School of Medicine, The University of Jordan, Amman, Jordan.,Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Mohannad Abuhamad
- Department of Special Surgery, Division of Urology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Abdallah Nader Santarisi
- Department of Special Surgery, Division of Urology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad Al-Zubi
- Department of Urology, School of Medicine, Yarmouk University, Irbid, Jordan
| | - Samer Fathi Al-Rawashdah
- Department of Special Surgery, Urology Unit, School of Medicine, Mutah University, Karak, Jordan
| | - Omar Halalsheh
- Department of Surgery and Urology, School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Antonio Carbone
- Unit of Urology, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Antonio Luigi Pastore
- Unit of Urology, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Muayyad M Ahmad
- Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
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17
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Al Salhi Y, Fuschi A, Martoccia A, Velotti G, Suraci PP, Scalzo S, Rera OA, Antonioni A, Valenzi FM, Bozzini G, Carbone A, Pastore AL. Laparoscopic radical nephroureterectomy with only three trocars: Results of a prospective single centre study. Arch Ital Urol Androl 2022; 94:7-11. [PMID: 35352517 DOI: 10.4081/aiua.2022.1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Radical nephroureterectomy (RNU) with full bladder cuff excision is the gold standard for treatment of non-metastatic upper tract urothelial cancer (UTUC). We describe our technique of laparoscopic nephroureterectomy (LNU) with bladder cuff excision technique with modified port placement, reporting our long-term follow-up outcomes. METHODS Patients affected by UTUC were prospectively enrolled and undergone to LNU. Perioperative outcomes, oncological data at 6, 12, 24 and 36 months after surgery, and all the surgical complications according to Clavien-Dindo classification were evaluated in all subjects. RESULTS A total of 50 patients with UTUC underwent LNU, using this new technique without patient and port repositioning. The mean operative time was 168 minutes, estimated blood loss was 75 mL, mean length of hospital stay was 3 days. There were no intraoperative complications while four late complications occurred (two grade IIIb and two grade II according to Clavien-Dindo classification, incisional hernias and fever, respectively). Postoperative pathology was T1 in 12 patients, T2 in 17 patients, and T3 in 21 patients. Tumor grade was low in 12 patients and high in 38 patients. CONCLUSIONS In our study the described LNU technique was related to a significant reduction in terms of operative time and length of hospital stay, with a faster patients' recovery and no peri and postoperative complications. The long-term oncological outcomes were similar to data reported in literature.
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Affiliation(s)
- Yazan Al Salhi
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina; ICOT-Surgery, Orthopedics, Traumatology Institute, Latina.
| | - Andrea Fuschi
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina; ICOT-Surgery, Orthopedics, Traumatology Institute, Latina.
| | - Alessia Martoccia
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina.
| | - Gennaro Velotti
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina.
| | - Paolo Pietro Suraci
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina.
| | - Silvio Scalzo
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina.
| | - Onofrio Antonio Rera
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina.
| | - Alice Antonioni
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina.
| | - Fabio Maria Valenzi
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina.
| | | | - Antonio Carbone
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina.
| | - Antonio Luigi Pastore
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina.
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Fuschi A, Martoccia A, Al Salhi Y, Maggi M, Capone L, Suraci PP, Antonioni A, Bozzini G, Illiano E, Costantini E, Zucchi A, Cervigni M, Carbone A, Pastore AL. Sexual and functional outcomes after prolapse surgery: a randomized prospective comparison of trocarless transvaginal mesh and pelvic organ prolapse suspension. Langenbecks Arch Surg 2022; 407:1693-1700. [PMID: 35113228 DOI: 10.1007/s00423-022-02458-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/28/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Stress urinary incontinence (SUI) related to pelvic organ prolapse represents a common condition that negatively impacts female sexual activity. Laparoscopic pelvic organ prolapse surgery (POPs) and the anterior repair with a trocar-less trans-vaginal mesh (TTMs) represent two different surgical techniques to treat SUI secondary to POP. This study aimed to report the results of these techniques comparing the sexual and functional outcome improvement. MATERIALS AND METHODS Fifty-nine sexually active female patients, complaining of urodynamic stress incontinence, were enrolled in this prospective study, and simply randomized in two groups: 29 POPs and 30 TTMs. All patients were studied at baseline and 6 months after surgery. Preoperative evaluation included medical history, urodynamic test, Female Sexual Function Index (FSFI), and pelvic magnetic resonance defecography. Six months after surgery, all patients completed the FSFI and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and were investigated with a uroflowmetry test with post-void residual volume (PVR). RESULTS At 6 months after surgery, 87% of POPs patients and 79% of TTMs subjects resulted dry. No statistically significant results were obtained in terms of urinary outcomes between the two surgical groups. Regarding sexual function, POPs group exhibited a significant greater improvement of global FSFI (mean: 27.4; SD: 4.31) compared to TTMs group (mean FSFI: 23.56; SD: 2.28; p-value ≤ 0.0001). CONCLUSIONS Our results indicated that POPs and TTMs lead to satisfactory and safe functional outcomes with a good recovery of urinary continence. Furthermore, POPs, when compared to TTMs, led to a greater improvement of sexual function.
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Affiliation(s)
- Andrea Fuschi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
- ICOT - Surgery, Orthopedy, Traumatology Institute, Latina, Italy
| | - Alessia Martoccia
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Yazan Al Salhi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
- ICOT - Surgery, Orthopedy, Traumatology Institute, Latina, Italy
| | - Martina Maggi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Lorenzo Capone
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Paolo Pietro Suraci
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Alice Antonioni
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Ester Illiano
- Department of Surgical and Biomedical Science, Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, TR, Italy
| | - Elisabetta Costantini
- Department of Surgical and Biomedical Science, Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, TR, Italy
| | - Alessandro Zucchi
- Department of Translationals Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Mauro Cervigni
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
- ICOT - Surgery, Orthopedy, Traumatology Institute, Latina, Italy
| | - Antonio Carbone
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy
| | - Antonio Luigi Pastore
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy.
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Salciccia S, Rosati D, Viscuso P, Canale V, Scarrone E, Frisenda M, Catuzzi R, Moriconi M, Asero V, Signore S, De Dominicis M, Emiliozzi P, Carbone A, Pastore AL, Fuschi A, Di Pierro GB, Gentilucci A, Cattarino S, Mariotti G, Busetto GM, Ferro M, De Berardinis E, Ricciuti GP, Panebianco V, Magliocca FM, Del Giudice F, Maggi M, Sciarra A. Influence of operative time and blood loss on surgical margins and functional outcomes for laparoscopic versus robotic-assisted radical prostatectomy: a prospective analysis. Cent European J Urol 2022; 74:503-515. [PMID: 35083069 PMCID: PMC8771133 DOI: 10.5173/ceju.2021.0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/22/2021] [Accepted: 11/06/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction The aim of this article was to analyze whether operative time and blood loss during radical prostatectomy (RP) can significantly influence surgical margins (SM) status and post-operative functional outcomes. Material and methods We prospectively analyzed prostate cancer (PC) patients undergoing RP, using robot-assisted (RARP) or laparoscopic (LRP) procedures. Blood loss was defined using the variation in hemoglobin (Hb, g/dl) values from the day before surgery and no later than 4 hours after surgery. Results From a whole population of 413 cases considered for RP, 67% underwent LRP and 33.0% RARP. Positive SM (SM+) were found in 33.9% of cases. Mean surgical operative time was 172.3 ±76 min (range 49–485), whereas blood loss was 2.3 ±1.2 g/dl (range 0.3–7.6). Operative time and blood loss at RP were not significantly correlated (r = -0.028275; p = 0.684). SM+ rates significantly (p = 0.002) varied by operative time; a higher SM+ rate was found in cases with an operative time <120 min (41.2%) and >240 min (53.4%). The risk of SM+ significantly increased 1.70 and 1.94 times in cases with an operative time <120 min and >240 min, respectively, independently to the surgical approach. The rate of erectile disfunction (ED) varied from 22.4% to 60.3% between <120 min and >240 min procedures (p = 0.001). According to blood loss, SM+ rates slightly but significantly (p = 0.032) varied; a higher rate of SM+ was found in cases with a Hb variation between 2–4 g/dl (35.9%). Conclusions Independently to the surgical approach, operative time, more than blood loss at RP, represents a significant variable able to influence SM status and post-operative ED.
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Affiliation(s)
- Stefano Salciccia
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Davide Rosati
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Pietro Viscuso
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Vittorio Canale
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Emiliano Scarrone
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Marco Frisenda
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Roberta Catuzzi
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Martina Moriconi
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Vincenzo Asero
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Stefano Signore
- Department of Urology, S. Eugenio Hospital, ASL Rome 2, Rome, Italy
| | | | - Paolo Emiliozzi
- Department of Urology, San Camillo Forlanini Hospital, Rome, Italy
| | - Antonio Carbone
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza Rome University, Polo Pontino, Latina, Italy
| | - Antonio Luigi Pastore
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza Rome University, Polo Pontino, Latina, Italy
| | - Andrea Fuschi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza Rome University, Polo Pontino, Latina, Italy
| | - Giovanni Battista Di Pierro
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | | | | | - Gianna Mariotti
- Department of Urology, University Sapienza Rome, Rome, Italy
| | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Ettore De Berardinis
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Gian Piero Ricciuti
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Fabio Massimo Magliocca
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Martina Maggi
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
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Bozzini G, Maltagliati M, Berti L, Vismara R, Sanguedolce F, Crisci A, Fiore GB, Redaelli A, Pastore AL, Gozen A, Breda A, Scoffone C, Ahmed K, Mueller A, Gidaro S, Liatsikos E. Development and Validation of a Novel Skills Training Model for PCNL, an ESUT project. Acta Biomed 2022; 93:e2022254. [PMID: 36043983 PMCID: PMC9534240 DOI: 10.23750/abm.v93i4.11821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 06/21/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND AND AIM The aim of this study is to validate a totally non biologic training model that combines the use of ultrasound and X ray to train Urologists and Residents in Urology in PerCutaneous NephroLithotripsy (PCNL). METHODS The training pathway was divided into three modules: Module 1, related to the acquisition of basic UltraSound (US) skill on the kidney; Module 2, consisting of correct Nephrostomy placement; and Module 3, in which a complete PCNL was performed on the model. Trainees practiced on the model first on Module 1, than in 2 and in 3. The pathway was repeated at least three times. Afterward, they rated the performance of the model and the improvement gained using a global rating score questionnaire. RESULTS A total of 150 Urologists took part in this study. Questionnaire outcomes on this training model showed a mean 4.21 (range 1-5) of positive outcome overall. Individual constructive validity showed statistical significance between the first and the last time that trainees practiced on the PCNL model among the three different modules. Statistical significance was also found between residents, fellows and experts scores. Trainees increased their skills during the training modules. CONCLUSION This PCNL training model allows for the acquisition of technical knowledge and skills as US basic skill, Nephrostomy placement and entire PCNL procedure. Its structured use could allow a better and safer training pathway to increase the skill in performing a PCNL.
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Affiliation(s)
- Giorgio Bozzini
- ESUT, European section for UroTechnology EAU, Urology Department, ASST Lariana, Sant’Anna Hospital Como, Italy
| | | | - Lorenzo Berti
- Urology Department, ASST Lariana, Sant’Anna Hospital Como, Italy
| | | | - Francesco Sanguedolce
- ESUT, European section for UroTechnology EAU, Urology Department, Fundacio Puigvert, Barcelona, Spain
| | | | | | | | | | - Ali Gozen
- ESUT, European section for UroTechnology EAU, Urology Department, University of Heidelberg, Heilbronn, Germany
| | - Alberto Breda
- ESUT, European section for UroTechnology EAU, Urology Department, Fundacio Puigvert, Barcelona, Spain
| | - Cesare Scoffone
- ESUT, European section for UroTechnology EAU, Urology Department, Cottolengo Hospital, Torino, Italy
| | - Kamran Ahmed
- ESUT, European section for UroTechnology EAU, Urology Department, MRC Centre for Transplantation, Kings College London, Guys Hospital, London, UK
| | | | - Stefano Gidaro
- School of Medicine, Nazarbayev University, Dept. of Medicine; Nur-Sultan 010000, Kazakhstan
| | - Evangelos Liatsikos
- ESUT, European section for UroTechnology EAU, Urology Department, University of Patras, Greece
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21
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Asimakopoulos AD, Colalillo G, Telesca R, Mauriello A, Miano R, Di Stasi SM, Germani S, Finazzi Agrò E, Petrozza V, Caruso G, Carbone A, Pastore AL, Fuschi A. T1 Bladder Cancer: Comparison of the Prognostic Impact of Two Substaging Systems on Disease Recurrence and Progression and Suggestion of a Novel Nomogram. Front Surg 2021; 8:704902. [PMID: 34497827 PMCID: PMC8419324 DOI: 10.3389/fsurg.2021.704902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The T1 substaging of bladder cancer (BCa) potentially impacts disease progression. The objective of the study was to compare the prognostic accuracy of two substaging systems on the recurrence and progression of primary pathologic T1 (pT1) BCa and to test a nomogram based on pT1 substaging for predicting recurrence-free survival (RFS) and progression-free survival (PFS). Methods: The medical records of 204 patients affected by pT1 BCa were retrospectively reviewed. Substaging was defined according to the depth of lamina propria invasion in T1a-c and the extension of the lamina propria invasion to T1-microinvasive (T1m) or T1-extensive (T1e). Uni- and multivariable Cox regression models evaluated the independent variables correlated with recurrence and progression. The predictive accuracies of the two substaging systems were compared by Harrell's C index. Multivariate Cox regression models for the RFS and PFS were also depicted by a nomogram. Results: The 5-year RFS was 47.5% with a significant difference between T1c and T1a (p = 0.02) and between T1e and T1m (p < 0.001). The 5-year PFS was 75.9% with a significant difference between T1c and T1a (p = 0.011) and between T1e and T1m (p < 0.001). Model T1m-e showed a higher predictive power than T1a-c for predicting RFS and PFS. In the univariate and multivariate model subcategory T1e, the diameter, location, and number of tumors were confirmed as factors influencing recurrence and progression after adjusting for the other variables. The nomogram incorporating the T1m-e model showed a satisfactory agreement between model predictions at 5 years and actual observations. Conclusions: Substaging is significantly associated with RFS and PFS for patients affected by T1 BCa and should be included in innovative prognostic nomograms.
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Affiliation(s)
| | - Gaia Colalillo
- Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Rossana Telesca
- Pathology, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Mauriello
- Pathology, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Miano
- Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Savino Mauro Di Stasi
- Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Germani
- Division of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
| | - Enrico Finazzi Agrò
- Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Vincenzo Petrozza
- Pathology, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Gianluca Caruso
- Pathology, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Antonio Carbone
- Urology Unit ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Antonio Luigi Pastore
- Urology Unit ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Andrea Fuschi
- Urology Unit ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
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Abreu D, Carvalhal G, Gueglio G, Tobia I, Garcia P, Zuñiga A, Meza L, Bengió R, Scorticati C, Castillejos R, Rodriguez F, Autran AM, Gonzales C, Gadu J, Nolazco A, Ameri C, Zampolli H, Langenhin R, Muguruza D, Machado MT, Mingote P, Yandian J, Clavijo J, Nogueira L, Clark O, Secin F, Rovegno A, Vilas A, Barrios E, Decia R, Guimarães G, Glina S, Pal SK, Rodriguez O, Palou J, Spiess P, Lara PN, Linehan WM, Pastore AL, Zequi SC. Prognostic Factors in De Novo Metastatic Renal Cell Carcinoma: A Report From the Latin American Renal Cancer Group. JCO Glob Oncol 2021; 7:671-685. [PMID: 33974442 PMCID: PMC8162501 DOI: 10.1200/go.20.00621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the effect of clinical and pathological variables on cancer-specific and overall survival (OS) in de novo metastatic patients from a collaborative of primarily Latin American countries. PATIENTS AND METHODS Of 4,060 patients with renal cell carcinoma diagnosed between 1990 and 2015, a total of 530 (14.5%) had metastasis at clinical presentation. Relationships between clinical and pathological parameters and treatment-related outcomes were analyzed by Cox regression and the log-rank method. RESULTS Of 530 patients, 184 (90.6%) had died of renal cell carcinoma. The median OS of the entire cohort was 24 months. American Society of Anesthesiology classification 3-4 (hazard ratio [HR]: 1.64), perirenal fat invasion (HR: 2.02), and ≥ 2 metastatic organ sites (HR: 2.19) were independent prognostic factors for 5-year OS in multivariable analyses. We created a risk group stratification with these variables: no adverse risk factors (favorable group), median OS not reached; one adverse factor (intermediate group), median OS 33 months (HR: 2.04); and two or three adverse factors (poor risk group), median OS 14 months (HR: 3.58). CONCLUSION Our study defines novel prognostic factors that are relevant to a Latin American cohort. With external validation, these easily discerned clinical variables can be used to offer prognostic information across low- and middle-income countries.
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Affiliation(s)
- Diego Abreu
- Servicio de Urología, Hospital Pasteur, Montevideo, Uruguay
| | | | | | | | | | | | - Luis Meza
- Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
| | | | | | - Ricardo Castillejos
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCNSZ), Ciudad de México, Mexico
| | - Francisco Rodriguez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCNSZ), Ciudad de México, Mexico
| | | | | | - Jose Gadu
- Hospital Militar, Ciudad de México, Mexico
| | | | | | | | - Raúl Langenhin
- Coperativa Médica de Paysandú (COMEPA), Paysandú, Uruguay
| | - Diego Muguruza
- Coperativa Médica de Paysandú (COMEPA), Paysandú, Uruguay
| | | | | | | | | | | | | | - Fernando Secin
- Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Agustín Rovegno
- Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Ana Vilas
- Departamento de Patología, Hospital Pasteur, Montevideo, Uruguay
| | - Enrique Barrios
- Departamento de Métodos Cuantitativos, Facultad de Medicina, Montevideo, Uruguay
| | - Ricardo Decia
- Servicio de Urología, Hospital Pasteur, Montevideo, Uruguay
| | | | | | | | | | | | | | - Primo N Lara
- The University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | | | - Antonio Luigi Pastore
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
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23
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Illiano E, Trama F, Crocetto F, Califano G, Aveta A, Motta G, Pastore AL, Brancorsini S, Fabi C, Costantini E. Prolapse Surgery: What Kind of Antibiotic Prophylaxis Is Necessary? Urol Int 2021; 105:771-776. [PMID: 34333491 DOI: 10.1159/000517788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/06/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to assess whether antibiotic prophylaxis or therapy is sufficient for laparoscopic or vaginal prolapse surgery with mesh. METHODS This is a single-center prospective study. The study was divided into 3 groups. Protocol A: metronidazole (15 mg/kg) and piperacillin-tazobactam (2 g) 1 h before surgery and, for postoperative treatment, gentamycin (160 mg) 1 h before surgery in a single dose. Metronidazole and piperacillin-tazobactam were administered until hospital discharge. Protocol B: gentamycin and piperacillin-tazobactam in the same manner as group A. Protocol C: clindamycin (600 mg) and gentamicin (160 mg) 1 h before surgery in a single dose. RESULTS We included 87 consecutive patients who underwent prolapse surgery involving mesh prostheses: 57 by the laparoscopic approach and 30 by the vaginal route. Of these, 30 patients were included in protocol A, 30 in protocol B, and 27 in protocol C. There were no statistically significant differences among the 3 protocols regarding any postoperative complications, except for urinary tract infections that were more in the vaginal approach than in the laparoscopic route, in protocol A (p = 0.002). CONCLUSIONS One-shot prophylaxis can be successfully used in prolapse surgery regardless of the surgical approach.
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Affiliation(s)
- Ester Illiano
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy
| | - Francesco Trama
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy
| | - Felice Crocetto
- Department of General and Specializes surgery, Renal Transplantation, Nephrology, Intensive Care and Pain Management, University Federico II of Naples, Naples, Italy
| | - Gianluigi Califano
- Department of General and Specializes surgery, Renal Transplantation, Nephrology, Intensive Care and Pain Management, University Federico II of Naples, Naples, Italy
| | - Achille Aveta
- Department of General and Specializes surgery, Renal Transplantation, Nephrology, Intensive Care and Pain Management, University Federico II of Naples, Naples, Italy
| | | | - Antonio Luigi Pastore
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit Sapienza University of Rome, Faculty of Pharmacy and Medicine, Rome, Italy
| | - Stefano Brancorsini
- Department of Experimental Medicine-Section of Terni, University of Perugia, Terni, Italy
| | - Consuelo Fabi
- Department of Experimental Medicine-Section of Terni, University of Perugia, Terni, Italy
| | - Elisabetta Costantini
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy
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24
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Cipriani C, Iacovelli V, Sandri M, Bertolo R, Maiorino F, Antonucci F, Micali S, Rocco B, Puliatti S, Ferrarese P, Benedetto G, Minervini A, Cocci A, Pastore AL, Al Salhi Y, Antonelli A, Morena T, Volpe A, Poletti F, Celia A, Zeccolini G, Leonardo C, Proietti F, Finazzi Agrò E, Bove P. The microbiological profile of patients with Fournier's gangrene: A retrospective multi-institutional cohort study. Urologia 2021; 89:437-443. [PMID: 34024222 DOI: 10.1177/03915603211018441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the role of the microbiological profile and of disease-related factors in the management of patients affected with Fournier's gangrene (FG). PATIENTS AND METHODS Data regarding patients admitted for FG at nine Italian Hospitals (March 2007-June 2018) were collected. Patients were stratified according to the number of microorganisms documented: Group A - one microorganism; Group B - two microorganisms; Group C - more than three microorganisms. Baseline blood tests, dedicated scoring systems, predisposing risk factors, disease's features, management and post-operative course were analyzed. UpSet technique for visualizing set intersections in a matrix layout and Cuzick's nonparametric test for trend across ordered groups were used. RESULTS Eighty-one patients were available for the analysis: 18 included in Group A, 32 in Group B, 31 in Group C. The most common microorganism isolated was Escherichia coli. In Group B-C, Escherichia coli was often associated to Enterococcus faecalis, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Statistically significant positive association was highlighted among the number of pathogens (Group A vs B vs C) and serum C-reactive Protein (p < 0.001), procalcitonin (p = 0.02) and creatinine (p = 0.03). Scoring systems were associated with the number of microorganisms detected (p < 0.02). A significant association between the number of microorganisms and the use of VAC therapy and need of a fecal diversion was found (p < 0.02). The number of microorganisms was positively associated with the length of stay (LOS) (p = 0.02). Ten weeks after initial debridement, wound closure was achieved in 11 (91.7%), 22 (84.6%) and 20 (80%) patients in Group A, B, and C, respectively, with no differences in overall survival. CONCLUSION Polymicrobial infections in FG are positively associated with inflammatory scores, the need for fecal diversion and the LOS. This results may help the counseling and the clinical management of this rare niche of patients.
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Affiliation(s)
- Chiara Cipriani
- Urology Unit, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy
| | - Valerio Iacovelli
- Urology Unit, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy.,Department of Surgical Sciences, University Tor Vergata, Roma, Italy
| | - Marco Sandri
- Big and Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, Brescia, Italy
| | - Riccardo Bertolo
- Urology Unit, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy
| | - Francesco Maiorino
- Urology Unit, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy
| | | | - Salvatore Micali
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Cocci
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | | | | | - Alessandro Antonelli
- University Hospital of Verona, Department of Surgery, Dentistry, Paediatrics and Gynaecology, Urology Unit, Verona and Confortini - Borgo General Hospital, Trento, Italy
| | - Tonino Morena
- Department of Urology, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Filippo Poletti
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | | | | | - Flavia Proietti
- Department of Urology, La Sapienza University of Rome, Rome, Italy
| | | | - Pierluigi Bove
- Urology Unit, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy.,Department of Surgical Sciences, University Tor Vergata, Roma, Italy
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25
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Minervini A, Di Maida F, Mari A, Porreca A, Rocco B, Celia A, Bove P, Umari P, Volpe A, Galfano A, Pastore AL, Annino F, Parma P, Greco F, Nucciotti R, Schiavina R, Esposito F, Romagnoli D, Leonardo C, Falabella R, Gallo F, Amenta M, Sciorio C, Verze P, Tafuri A, Pucci L, Varca V, Zaramella S, Pagliarulo V, Bozzini G, Ceruti C, Falsaperla M, Cafarelli A, Antonelli A. Perioperative outcomes of patients undergoing urological elective surgery during the COVID-19 pandemic: a national overview across 28 Italian institutions. Cent European J Urol 2021; 74:259-268. [PMID: 34336248 PMCID: PMC8318031 DOI: 10.5173/ceju.2021.0374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/02/2021] [Accepted: 04/08/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction The aim of this study was to assess the safety of elective urological surgery performed during the pandemic by estimating the prevalence of COVID-19-like symptoms in the postoperative period and its correlation with perioperative and clinical factors. Material and methods In this multicenter, observational study we recorded clinical, surgical and postoperative data of consecutive patients undergoing elective urological surgery in 28 different institutions across Italy during initial stage of the COVID-19 pandemic (between February 24 and March 30, 2020, inclusive). Results A total of 1943 patients were enrolled. In 12%, 7.1%, 21.3%, 56.7% and 2.6% of cases an open, laparoscopic, robotic, endoscopic or percutaneous surgical approach was performed, respectively. Overall, 166 (8.5%) postoperative complications were registered, 77 (3.9%) surgical and 89 (4.6%) medical. Twenty-eight (1.4%) patients were readmitted to hospital after discharge and 13 (0.7%) died. In the 30 days following discharge, fever and respiratory symptoms were recorded in 101 (5.2%) and 60 (3.1%) patients. At multivariable analysis, not performing nasopharyngeal swab at hospital admission (HR 2.3; CI 95% 1.01–5.19; p = 0.04) was independently associated with risk of developing postoperative medical complications. Number of patients in the facility was confirmed as an independent predictor of experiencing postoperative respiratory symptoms (p = 0.047, HR:1.12; CI95% 1.00–1.05), while COVID-19-free type of hospitalization facility was a strong independent protective factor (p = 0.02, HR:0.23, CI95% 0.07–0.79). Conclusions Performing elective surgery during the COVID-19 pandemic does not seem to affect perioperative outcomes as long as proper preventive measures are adopted, including nasopharyngeal swab before hospital admission and hospitalization in dedicated COVID-19-free facilities.
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Affiliation(s)
- Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Fabrizio Di Maida
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Angelo Porreca
- Department of Oncological Urology - Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy
| | - Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo Dipartimento di Scienze della Salute - Università degli Studi di Milano, Milano, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Pierluigi Bove
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - Paolo Umari
- Division of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Alessandro Volpe
- Division of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | | | - Antonio Luigi Pastore
- Department of Medical-Surgical Sciences and Biotechnologies, 'Sapienza' University of Rome, Urology Unit ICOT, Latina, Italy
| | | | - Paolo Parma
- Urology Department, Ospedale Poma, Mantova, Italy
| | | | | | | | - Fabio Esposito
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Daniele Romagnoli
- Department of Oncological Urology - Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy
| | | | - Roberto Falabella
- Department of Urology, Azienda Ospedaliera Regionale di Potenza, Potenza, Italy
| | - Fabrizio Gallo
- Department of Urology, San Paolo Hospital, Savona, Italy
| | | | | | - Paolo Verze
- Department of Urology, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Alessandro Tafuri
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Italy
| | - Luigi Pucci
- Department of Urology, AORN A. Cardarelli, Naples, Italy
| | - Virginia Varca
- Hospital G. Salvini, ASST Rhodense Garbagnate Milanese, Milan, Italy
| | | | | | - Giorgio Bozzini
- Urology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Carlo Ceruti
- SCDU Urologia, Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Italy
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26
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Fuschi A, Capone L, Abuorouq S, Al Salhi Y, Velotti G, Aversa S, Carbone F, Maceroni P, Petrozza V, Carbone A, Pastore AL, Porta N. Shear wave elastography in varicocele patients: Prospective study to investigate correlation with semen parameters and histological findings. Int J Clin Pract 2021; 75:e13699. [PMID: 32910514 DOI: 10.1111/ijcp.13699] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/02/2020] [Indexed: 02/01/2023] Open
Abstract
AIMS Shear wave elastosonography (SWE) is a non-invasive ultrasound imaging modality used to assess the mechanical properties of tissues such as rigidity and elasticity. In this prospective study, we investigated the effect of laparoscopic varicocelectomy on the elasticity, degree of fibrosis and function of the testes through SWE and we evaluated the correlation with semen parameters and histology findings. METHODS Male patients with monolateral left varicocele and progressive alteration of the semen quality were enrolled prospectively. Patients were evaluated before varicocelectomy, 3 and 6 months after surgery with semen analysis, ecocolordoppler US and SWE. In all patients, a left testicular biopsy was performed at the time of varicocelectomy and it was repeated after 6 months in 55% of patients in order to investigate the histological findings and to correlate with SWE results. RESULTS The study was conducted on 82 patients. SWE showed a statistically significant difference between left and right testicles. Three months after surgery the mean left testicular volume increased, mean left SWE features decreased, and sperm count increased (P values < .0001). The SWE parameters, testicular volume and semen analysis values showed a statistically significant positive correlation between the pre and postoperative results (P value < .0001). The histological alterations were significantly changed 6 months postoperative with a complete morphology recovery in accordance with SWE results. CONCLUSIONS SWE showed a statistically significant positive correlation with testicular volume, semen analysis and histological findings. This study represents the first investigation that correlates the varicocele, the testis volume, the quality of the seminal fluid ant the histological findings with the ultrasound and SWE values.
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Affiliation(s)
- Andrea Fuschi
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
- ICOT - Surgery, Orthopedy, Traumatology Institute, Latina, Italy
| | - Lorenzo Capone
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Saleh Abuorouq
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Yazan Al Salhi
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
- ICOT - Surgery, Orthopedy, Traumatology Institute, Latina, Italy
| | - Gennaro Velotti
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Sara Aversa
- Histology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Flavia Carbone
- Uroresearch, Non-profit Association for Research in Urology, Latina, Italy
| | - Piero Maceroni
- ICOT - Surgery, Orthopedy, Traumatology Institute, Latina, Italy
| | - Vincenzo Petrozza
- Histology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Antonio Carbone
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
- Uroresearch, Non-profit Association for Research in Urology, Latina, Italy
| | - Antonio Luigi Pastore
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
- Uroresearch, Non-profit Association for Research in Urology, Latina, Italy
| | - Natale Porta
- Histology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
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27
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Iacovelli V, Cipriani C, Sandri M, Filippone R, Ferracci A, Micali S, Rocco B, Puliatti S, Ferrarese P, Benedetto G, Minervini A, Cocci A, Pastore AL, Al Salhi Y, Antonelli A, Morena T, Volpe A, Poletti F, Celia A, Zeccolini G, Leonardo C, Proietti F, Finazzi Agrò E, Bove P. The role of vacuum-assisted closure (VAC) therapy in the management of FOURNIER'S gangrene: a retrospective multi-institutional cohort study. World J Urol 2021; 39:121-128. [PMID: 32236663 PMCID: PMC7223519 DOI: 10.1007/s00345-020-03170-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/14/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To explore the role of vacuum assisted closure (VAC) therapy versus conventional dressings in the Fournier's gangrene wound therapy. PATIENTS AND METHODS This is a retrospective multi-institutional cohort study. Data of 92 patients from nine centers between 2007 and 2018 were retrospectively analyzed. After surgery, patient having a local or a disseminated FG were managed with VAC therapy or with conventional dressings. The 10-weeks wound closure cumulative rate and OS were analyzed. RESULTS Of the 92 patients, 62 (67.4%) showed local and 30 (32.6%) a disseminated FG. After surgery, 19 patients (20.7%) with local and 14 (15.2%) with disseminated FG underwent to VAC therapy; 43 (46.7%) with local and 16 (17.4%) with disseminated FG were treated using conventional dressings. The multivariable logistic regression analysis demonstrated that the VAC in patients with disseminated FG led to a higher cumulative rate of wound closure than patients treated with no-VAC (OR = 6.5; 95% CI 1.1-37.4, p = 0.036). The Kaplan-Meier survival curves for the OS showed a significant difference between no-VAC patients with local and disseminated FG (OS rate at 90 days 0.90, 95% CI 0.71-0.97 vs 0.55, 95% CI 0.24-0.78, respectively; p = 0.039). Cox regression confirmed that no-VAC patients with disseminated FG showed the lowest OS (hazard ratio adjusted for sex and age HR = 3.4, 95% CI 1.1-10.4; p = 0.033). CONCLUSIONS In this large cohort study, VAC therapy in patients with disseminated FG may offer an advantage in terms of 10-weeks wound closure cumulative rate and OS at 90 days after initial surgery.
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Affiliation(s)
- Valerio Iacovelli
- Urology Unit, San Carlo Di Nancy Hospital, GVM Care and Research, Via Aurelia 275, 00100, Rome, Italy.
- Department of Surgical Sciences, University Tor Vergata, Roma, Italy.
| | - Chiara Cipriani
- Urology Unit, San Carlo Di Nancy Hospital, GVM Care and Research, Via Aurelia 275, 00100, Rome, Italy
| | - Marco Sandri
- Data Methods and System Statistical Laboratory, University of Brescia, Brescia, Italy
| | - Roberta Filippone
- Department of Surgical Sciences, University Tor Vergata, Roma, Italy
| | | | - Salvatore Micali
- Department of Urology, Ospedale Policlinico E Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, Ospedale Policlinico E Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, Ospedale Policlinico E Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Cocci
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | | | | | - Alessandro Antonelli
- Urology Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University Hospital of Verona, Verona and Confortini, Borgo General Hospital, Trento, Italy
| | - Tonino Morena
- Urology Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University Hospital of Verona, Verona and Confortini, Borgo General Hospital, Trento, Italy
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy
| | - Filippo Poletti
- Department of Urology, University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | | | | | - Flavia Proietti
- Department of Urology, La Sapienza University of Rome, Rome, Italy
| | | | - Pierluigi Bove
- Urology Unit, San Carlo Di Nancy Hospital, GVM Care and Research, Via Aurelia 275, 00100, Rome, Italy
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Al-Rawashdah S, Mansi H, Pastore AL, Carbone A. Adrenal cavernous Hemangioma;A rare diagnosis of adrenal incidentaloma:A case report, and literature review. Urol Case Rep 2020; 34:101477. [PMID: 33204642 PMCID: PMC7653277 DOI: 10.1016/j.eucr.2020.101477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 10/30/2020] [Indexed: 10/26/2022] Open
Abstract
Adrenal cavernous hemangioma is an extremely rare benign tumor. To date, less than 70 cases have been reported in the literature. In most of the cases, the tumor is hormonally silent, discovered incidentally and the diagnosis is made postoperatively. Pre-operative differentiation between this benign tumor and other malignant adrenal tumors is challenging. In this article we present a case of a non-functioning adrenal incidentaloma that was managed by laparoscopic adrenalectomy. The post-operative histological diagnosis was adrenal cavernous hemangioma.
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Affiliation(s)
- Samer Al-Rawashdah
- Department of Special Surgery, Urology Unit, Faculty of Medicine, Mutah University, Karak, Jordan
| | - Hammam Mansi
- Department of Special Surgery, Urology Unit, Faculty of Medicine, Mutah University, Karak, Jordan
| | - Antonio Luigi Pastore
- Department of Medico-Surgical Sciences and Biotechnologies/Urology Unit, Sapienza University - Polo Pontino - ICOT Hospital, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Antonio Carbone
- Department of Medico-Surgical Sciences and Biotechnologies/Urology Unit, Sapienza University - Polo Pontino - ICOT Hospital, Via Franco Faggiana, 1668, 04100, Latina, Italy
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Al Salhi Y, Fuschi A, Velotti G, Capone L, Aversa S, de Nunzio C, Porta N, Petrozza V, Carbone A, Pastore AL. Robot-assisted retroperitoneal lymphadenectomy in patient with type I papillary renal cancer recurrence after 5 years of follow-up. J Surg Case Rep 2020; 2020:rjaa336. [PMID: 33072251 PMCID: PMC7546679 DOI: 10.1093/jscr/rjaa336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/29/2020] [Indexed: 11/12/2022] Open
Abstract
Papillary renal cell carcinoma (PRCC) is a rare cancer and is the second most frequent histologic type among all renal cell carcinoma, accounting for up to 15%. A 72-year-old man underwent a right radical nephrectomy 7 years ago with final histopathology diagnosis of type 1 PRCC with negative surgical margins. Five years after surgery, computed tomography scan imaging showed the presence of multiple masses suspicious for node recurrences disease localized in the renal lodge, in the inter-aorto-caval space, at the iliac vessels bifurcation and right common iliac vessels. Patient underwent a robotic retroperitoneal lymphadenectomy. The histopathological examination confirmed the recurrence of type I papillary renal cancer in all the specimens. No further recurrences have been observed at 24-month follow-up after surgery. This report is the first describing a robot-assisted minimally invasive surgical excision for type I papillary renal cancer nodal and renal fossa recurrences.
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Affiliation(s)
- Yazan Al Salhi
- Department of Medico-Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Urology Unit ICOT, Latina, Italy
| | - Andrea Fuschi
- Department of Medico-Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Urology Unit ICOT, Latina, Italy
| | - Gennaro Velotti
- Department of Medico-Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Urology Unit ICOT, Latina, Italy
| | - Lorenzo Capone
- Department of Medico-Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Urology Unit ICOT, Latina, Italy
| | - Sara Aversa
- Department of Medico-Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Pathology Unit ICOT, Latina, Italy
| | - Cosimo de Nunzio
- Department of Urology, La Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Natale Porta
- Department of Medico-Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Pathology Unit ICOT, Latina, Italy
| | - Vincenzo Petrozza
- Department of Medico-Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Pathology Unit ICOT, Latina, Italy
| | - Antonio Carbone
- Department of Medico-Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Urology Unit ICOT, Latina, Italy
| | - Antonio Luigi Pastore
- Department of Medico-Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Urology Unit ICOT, Latina, Italy
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Bozzini G, Berti L, Maltagliati M, Besana U, Calori A, Müller A, Sighinolfi MC, Micali S, Pastore AL, Ledezma R, Broggini P, Rocco B, Buizza C. Ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP): outcomes on a large cohort. World J Urol 2020; 39:2029-2035. [PMID: 32929626 DOI: 10.1007/s00345-020-03442-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/05/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the effects of a new ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP) technique on sexual functions and micturition, in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) and to evaluate how the surgical technique of ES-ThuLEP can lead to ejaculation preservation. METHODS A prospective study was carried out between January 2015 and January 2018 on patients with surgical indication for BPH, who wished to preserve ejaculation. The patients were treated with ES-ThuLEP and were evaluated before and 3 and 6 months after surgery. Three validated questionnaires (ICIQ-MLUTSsex, IIEF-5 and IPSS) were used to assess changes in ejaculation, erectile function and urinary symptoms. Uroflowmetry (Qmax and Qavg), post-void residual volume and voided volume were also evaluated, to assess micturition improvement. Patients with moderate to severe erectile dysfunction were excluded. Statistical analysis was performed with the Student's t test, Chi-square test and logistic regression analysis. RESULTS Two hundred and eighty three patients were enrolled. Ejaculation was spared in 203 and 219 patients at 3 and 6 months after surgery. No significant differences were observed between erectile function before and after surgery: baseline IIEF-5 = 16.2 ± 4.47 vs 16.7 ± 2.9 (p = 0.419) and 17.7 ± 3.2 (p = 0.410) at 3 and 6 months. Significant improvement in urinary symptoms was achieved: baseline IPSS = 19.4 ± 7.24 vs 5.8 ± 4.3 (p = 0.032) and 3.9 ± 4.1 (p = 0.029) at 3 and 6 months. CONCLUSION ES-ThuLEP effectively preserved ejaculation in over two thirds of the patients without compromising micturition improvement or erectile function. ES-ThuLEP could be a valid treatment option for BPH in young and sexually active men.
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Affiliation(s)
- Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Ospedale di Busto Arsizio (VA), Busto Arsizio, Italy.
| | - Lorenzo Berti
- Department of Urology, ASST Valle Olona, Ospedale di Busto Arsizio (VA), Busto Arsizio, Italy
- Department of Urology, Università degli Studi di Modena e Reggio Emilia (MO), Modena, Italy
| | - Matteo Maltagliati
- Department of Urology, ASST Valle Olona, Ospedale di Busto Arsizio (VA), Busto Arsizio, Italy
- Department of Urology, Università degli Studi di Modena e Reggio Emilia (MO), Modena, Italy
| | - Umberto Besana
- Department of Urology, ASST Valle Olona, Ospedale di Busto Arsizio (VA), Busto Arsizio, Italy
| | - Alberto Calori
- Department of Urology, ASST Valle Olona, Ospedale di Busto Arsizio (VA), Busto Arsizio, Italy
| | | | | | - Salvatore Micali
- Department of Urology, Università degli Studi di Modena e Reggio Emilia (MO), Modena, Italy
| | | | - Rodrigo Ledezma
- Department of Urology, Hospital Clìnico Universidad de Chile, Santiago, Chile
| | - Paolo Broggini
- Department of Urology, Clinica Sant'Anna, Lugano, Switzerland
| | - Bernardo Rocco
- Department of Urology, Università degli Studi di Modena e Reggio Emilia (MO), Modena, Italy
| | - Carlo Buizza
- Department of Urology, ASST Valle Olona, Ospedale di Busto Arsizio (VA), Busto Arsizio, Italy
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Coluzzi F, Caputi FF, Billeci D, Pastore AL, Candeletti S, Rocco M, Romualdi P. Safe Use of Opioids in Chronic Kidney Disease and Hemodialysis Patients: Tips and Tricks for Non-Pain Specialists. Ther Clin Risk Manag 2020; 16:821-837. [PMID: 32982255 PMCID: PMC7490082 DOI: 10.2147/tcrm.s262843] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022] Open
Abstract
In patients suffering from moderate-to-severe chronic kidney disease (CKD) or end-stage renal disease (ESRD), subjected to hemodialysis (HD), pain is very common, but often underestimated. Opioids are still the mainstay of severe chronic pain management; however, their prescription in CKD and HD patients is still significantly low and pain is often under-treated. Altered pharmacokinetics and the lack of clinical trials on the use of opioids in patients with renal impairment increase physicians' concerns in this specific population. This narrative review focused on the correct and safe use of opioids in patients with CKD and HD. Morphine and codeine are not recommended, because the accumulation of their metabolites may cause neurotoxic symptoms. Oxycodone and hydromorphone can be safely used, but adequate dosage adjustments are required in CKD. In dialyzed patients, these opioids should be considered as second-line agents and patients should be carefully monitored. According to different studies, buprenorphine and fentanyl could be considered first-line opioids in the management of pain in CKD; however, fentanyl is not appropriate in patients undergoing HD. Tapentadol does not need dosage adjustment in mild-to-moderate renal impairment conditions; however, no data are available on its use in ESRD. Opioid-related side effects may be exacerbated by common comorbidities in CKD patients. Opioid-induced constipation can be managed with peripherally-acting-μ-opioid-receptor-antagonists (PAMORA). Unlike the other PAMORA, naldemedine does not require any dose adjustment in CKD and HD patients. Accurate pain diagnosis, opioid titration and tailoring are mandatory to minimize the risks and to improve the outcome of the analgesic therapy.
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Affiliation(s)
- Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Latina, Italy
- Unit of Anesthesia, Intensive Care and Pain Medicine, Sant’Andrea University Hospital, Rome, Italy
| | | | - Domenico Billeci
- Division of Neurosurgery, Ca’Foncello Hospital, ASL Marca Trevigiana, University of Padova, Treviso, Italy
| | - Antonio Luigi Pastore
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Latina, Italy
- Unit of Urology, Sapienza c/o I.C.O.T, Polo Pontino, Latina, Italy
| | - Sanzio Candeletti
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum University, Bologna, Italy
| | - Monica Rocco
- Unit of Anesthesia, Intensive Care and Pain Medicine, Sant’Andrea University Hospital, Rome, Italy
- Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Patrizia Romualdi
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum University, Bologna, Italy
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Mastroianni R, Brassetti A, Krajewski W, Zdrojowy R, Salhi YA, Anceschi U, Bove AM, Carbone A, De Nunzio C, Fuschi A, Ferriero M, Nacchia A, Pastore AL, Tema G, Tuderti G, Gallucci M, Simone G. Assessing the Impact of the Absence of Detrusor Muscle in Ta Low-grade Urothelial Carcinoma of the Bladder on Recurrence-free Survival. Eur Urol Focus 2020; 7:1324-1331. [PMID: 32900676 DOI: 10.1016/j.euf.2020.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/27/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Obtaining detrusor muscle (DM) in transurethral resection of bladder tumor (TURBt) specimen is considered a surrogate marker of resection quality. However, evidence was principally investigated in high-risk tumors. Therefore, DM sampling for low-grade (LG) urothelial carcinoma (UC) remains poorly investigated and certainly requires further investigation. OBJECTIVE To assess whether the absence of DM in TURBt specimen has a negative impact on recurrence-free survival (RFS) in patients with a Ta LG UC. DESIGN, SETTING, AND PARTICIPANTS A multicenter TURBt database was queried for "LG, Ta, UC of the bladder." All patients treated between 1996 and 2018 with tumor grade assessed according to both 1973 World Health Organization and 2004 WHO/International Society of Urological Pathology grading classifications and with a minimum follow-up of 1 yr were included. Patients with a previous history of high-grade UC, upper urinary tract UC, or bladder tumor differentiations other than UC were excluded. INTERVENTION TURBt. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Baseline demographic, clinical, and pathologic data were analyzed. The European Organization for Research and Treatment of Cancer (EORTC) risk group was recorded. Kaplan-Meier analysis was performed to assess the predictive role of clinical and pathologic data for RFS. Univariable and multivariable Cox regression analyses were performed to identify the predictors of recurrence. RESULTS AND LIMITATIONS Overall, 521 patients were included. At Kaplan-Meier analysis, the low-risk cohort displayed significantly higher RFS than the intermediate-risk cohort (1-yr RFS 87% vs 79%; log-rank p = 0.007). At univariable Cox regression analysis, only gender, multiple tumors, tumor diameter ≥3 cm, and EORTC risk group were significant predictors of recurrence. Absence of DM had no impact on RFS. Multivariable Cox regression analysis confirmed gender and EORTC risk group as independent predictors of recurrence. CONCLUSIONS Absence of DM in TURBt specimen has negligible role in RFS of patients with Ta LG tumors of the bladder. PATIENT SUMMARY In this study, we assessed the role that detrusor muscle (DM) in transurethral resection of bladder tumor specimen has in recurrence-free survival, in patients with a Ta low-grade urothelial carcinoma of the bladder. Absence of DM has no impact on tumor recurrence; therefore, it does not require additional attention.
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Affiliation(s)
- Riccardo Mastroianni
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy; Department of Urology, "Sapienza" University, Rome, Italy.
| | - Ado Brassetti
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Wojciech Krajewski
- Department of Urology and Urological Oncology, Wrocław Medical University, Wrocław, Poland
| | - Romuald Zdrojowy
- Department of Urology and Urological Oncology, Wrocław Medical University, Wrocław, Poland
| | - Yazan Al Salhi
- Department of Medico Surgical Sciences and Biotechnologies-Urology Unit, "Sapienza" University-I.C.O.T., Latina, Italy
| | - Umberto Anceschi
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Alfredo Maria Bove
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Antonio Carbone
- Department of Medico Surgical Sciences and Biotechnologies-Urology Unit, "Sapienza" University-I.C.O.T., Latina, Italy
| | | | - Andrea Fuschi
- Department of Medico Surgical Sciences and Biotechnologies-Urology Unit, "Sapienza" University-I.C.O.T., Latina, Italy
| | | | | | - Antonio Luigi Pastore
- Department of Medico Surgical Sciences and Biotechnologies-Urology Unit, "Sapienza" University-I.C.O.T., Latina, Italy
| | - Giorgia Tema
- Department of Urology, "Sant'Andrea" Hospital, Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | | | - Giuseppe Simone
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
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Petrozza V, Costantini M, Tito C, Giammusso LM, Sorrentino V, Cacciotti J, Porta N, Iaiza A, Pastore AL, Di Carlo A, Simone G, Carbone A, Gallucci M, Fazi F. Emerging role of secreted miR-210-3p as potential biomarker for clear cell Renal Cell Carcinoma metastasis. Cancer Biomark 2020; 27:181-188. [PMID: 31771042 DOI: 10.3233/cbm-190242] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND MicroRNAs (miRNAs) are emerging as promising molecules in the diagnosis, prognosis and treatment of urological tumours. Recently, our group performed two independent studies highlighting that miR-210-3p may be a useful biomarker not only for diagnosis but also for post-surgery clear cell Renal Cell Carcinoma (ccRCC) management. OBJECTIVE The aim of this study is to further explore the effectiveness of miRNA as non-invasive biomarker for clinical outcomes and ccRCC response to the treatment. METHODS We analyzed miR-210-3p levels in neoplastic and healthy tissue and in urine specimens collected at surgery and during follow-up of 21 ccRCC patients by RTqPCR. RESULTS Firstly, we confirmed that the expression of miR-210-3p was upregulated in tumor tissues and in urine samples of analyzed cohort. Of note is that miR-210-3p expression was significantly reduced in urine samples from disease-free patients during follow-up (from 3 to 12 months) compared to the baseline levels observed at the time of surgery. In a small subgroup of patients presenting metastatic progression (such as bone, intestinal or lung metastasis), the urine levels of miR-210-3p correlated with responsiveness to the therapy. CONCLUSIONS This pilot study highlights the relevance of secreted miR-210-3p as powerful non-invasive prognostic and predictive biomarker for the evaluation of clinical outcomes and treatment response during ccRCC follow up.
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Affiliation(s)
- Vincenzo Petrozza
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Pathology Unit ICOT, Latina, Italy.,Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Pathology Unit ICOT, Latina, Italy
| | - Manuela Costantini
- Department of Urology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy.,Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Pathology Unit ICOT, Latina, Italy
| | - Claudia Tito
- Department of Medico Surgical Sciences and Biotechnologies, Sapienza University of Rome, Urology Unit ICOT, Latina, Italy.,Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Pathology Unit ICOT, Latina, Italy
| | - Laura Maria Giammusso
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Section of Histology and Medical Embryology, Laboratory Affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University of Rome, Rome, Italy
| | - Veronica Sorrentino
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Pathology Unit ICOT, Latina, Italy
| | - Jessica Cacciotti
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Pathology Unit ICOT, Latina, Italy
| | - Natale Porta
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Pathology Unit ICOT, Latina, Italy
| | - Alessia Iaiza
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Section of Histology and Medical Embryology, Laboratory Affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University of Rome, Rome, Italy
| | - Antonio Luigi Pastore
- Department of Medico Surgical Sciences and Biotechnologies, Sapienza University of Rome, Urology Unit ICOT, Latina, Italy
| | - Angelina Di Carlo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Carbone
- Department of Medico Surgical Sciences and Biotechnologies, Sapienza University of Rome, Urology Unit ICOT, Latina, Italy.,Department of Urology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Michele Gallucci
- Department of Urology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy.,Department of Urology, Sapienza University of Rome, Rome, Italy.,Department of Urology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Fazi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Section of Histology and Medical Embryology, Laboratory Affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University of Rome, Rome, Italy.,Department of Urology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
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Balzarro M, Rubilotta E, Trabacchin N, Soldano A, Cerrato C, Migliorini F, Mancini V, Pastore AL, Carbone A, Cormio L, Carrieri G, Antonelli A. Early and Late Efficacy on Wound Healing of Silver Nanoparticle Gel in Males after Circumcision. J Clin Med 2020; 9:jcm9061822. [PMID: 32545258 PMCID: PMC7356923 DOI: 10.3390/jcm9061822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/28/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022] Open
Abstract
We evaluate the early and late safety and efficacy of silver nanoparticle (AgNPs) in wound healing after circumcision. This multicenter prospective comparative non-randomized observational study compares wound dressing with AgNPs (group A) vs. gentamicin cream (group B). Follow-up included objective evaluation at 10 and 30 days by the Southampton Scoring System (SSS) and Stony Brook Scar Evaluation Scale (SBSES). We enrolled 392 males: 194 in group A, and 198 in group B. At 10 days follow-up, in group A, the SSS scale was grade 1 in 49.5% and grade 2 in the remaining; meanwhile, in group B, grade 1 was in 58%, grade 2 in 34.3%, and grade 4 in 7.6%. At 30 days follow-up, grade 1 healing was 97.4% and 98.4% in group A and B, respectively. At 10 days follow-up, the mean SBSES score was 3.58 and 3.69 in group A and B, respectively; while at 30 days follow-up, 4.81 and 4.76 in group A and B, respectively. Only in group B did 7.6% of males have antibiotic therapy due to pus discharge. No patients needed surgical wound revision. AgNPs led to a late but safer healing, they were non-inferior to the antibiotic cream wound dressing efficacy, and they avoided pus discharge and the need for oral antibiotics due to their polymer material.
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Affiliation(s)
- Matteo Balzarro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy; (E.R.); (N.T.); (A.S.); (C.C.); (F.M.); (A.A.)
- Correspondence:
| | - Emanuele Rubilotta
- Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy; (E.R.); (N.T.); (A.S.); (C.C.); (F.M.); (A.A.)
| | - Nicolò Trabacchin
- Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy; (E.R.); (N.T.); (A.S.); (C.C.); (F.M.); (A.A.)
| | - Antonio Soldano
- Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy; (E.R.); (N.T.); (A.S.); (C.C.); (F.M.); (A.A.)
| | - Clara Cerrato
- Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy; (E.R.); (N.T.); (A.S.); (C.C.); (F.M.); (A.A.)
| | - Filippo Migliorini
- Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy; (E.R.); (N.T.); (A.S.); (C.C.); (F.M.); (A.A.)
| | - Vito Mancini
- Department of Urology and Renal Transplantation, University of Foggia, 71122 Foggia, Italy; (V.M.); (L.C.); (G.C.)
| | - Antonio Luigi Pastore
- Department of Medic-Surgical Sciences and Biotechnologies Urology Unit, Sapienza University of Rome, 00185 Latina, Italy; (A.L.P.); (A.C.)
| | - Antonio Carbone
- Department of Medic-Surgical Sciences and Biotechnologies Urology Unit, Sapienza University of Rome, 00185 Latina, Italy; (A.L.P.); (A.C.)
| | - Luigi Cormio
- Department of Urology and Renal Transplantation, University of Foggia, 71122 Foggia, Italy; (V.M.); (L.C.); (G.C.)
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University of Foggia, 71122 Foggia, Italy; (V.M.); (L.C.); (G.C.)
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy; (E.R.); (N.T.); (A.S.); (C.C.); (F.M.); (A.A.)
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Bozzini G, Aydogan TB, Müller A, Sighinolfi MC, Besana U, Calori A, Lorenzo B, Govorov A, Pushkar DY, Pini G, Pastore AL, Romero-Otero J, Rocco B, Buizza C. A comparison among PCNL, Miniperc and Ultraminiperc for lower calyceal stones between 1 and 2 cm: a prospective, comparative, multicenter and randomised study. BMC Urol 2020; 20:67. [PMID: 32522171 PMCID: PMC7288549 DOI: 10.1186/s12894-020-00636-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Conventional Percutaneous Lithotripsy (PCNL) has been an effective, successful and easy approach for especially > 1 cm sized calyceal stones however risks of complications and nephron loss are inevitable. Our aim is to compare the efficacy and safety of PCNL, MiniPerc (MP) and UltraMiniPerc (UMP) for lower calyceal stones between 1 and 2 cm with a multicenter prospective randomized study. Methods Between January 2015 and June 2018, 132 consecutive patients with single lower calyceal stone were enrolled. Patients were randomized in three groups; A: PCNL; B: MP; C: UMP. 44 patients for the Group A, 47 for Group B and 41 for Group C. Exclusion criterias were the presence of coagulation impairments, age of < 18 or > 75, presence of infection or serious comorbidities. Patients were controlled with computerized tomography scan after 3 months. A negative CT or an asymptomatic patient with stone fragments < 3 mm size were the criteria to assess the stone-free status. Patient characteristics, stone free rates (SFR) s, complications and re-treatment rates were analyzed. Results The mean stone size were 16.38, 16.82 and 15.23 mm respectively in Group A, B and C(p = 0.34). The overall SFR was significantly higher in Group A (86.3%) and B (82.9%) as compared to Group C (78%)(p < 0.05). The re-treatment rate was significantly higher in Group C (12.1%) and complication rates was higher in Group A (13.6%) as compared to others(p < 0.05). The hospitalization was significantly shorter in Group C compared to Group A (p = 0.04). Conclusions PCNL and MP showed higher efficacy than UMP to obtain a better SFR. Auxiliary and re-treatment rates were higher in UMP. On the other hand for such this kind of stones PCNL had more complications. Overall evaluation favors MP as a better indication in stones 1–2 cm size.
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Affiliation(s)
- Giorgio Bozzini
- Department of Urology, ASST Valle Olona Busto Arsizio, Varese, Italy
| | | | | | | | - Umberto Besana
- Department of Urology, ASST Valle Olona Busto Arsizio, Varese, Italy
| | - Alberto Calori
- Department of Urology, ASST Valle Olona Busto Arsizio, Varese, Italy
| | - Berti Lorenzo
- Department of Urology, ASST Valle Olona Busto Arsizio, Varese, Italy
| | - Alexander Govorov
- Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Dmitry Y Pushkar
- Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | | | | | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Buizza
- Department of Urology, ASST Valle Olona Busto Arsizio, Varese, Italy
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Inzillo* R, Bozzini G, Serena M, Pastore AL, Umberto B, Amato M, Bevilacqua L, Parma P, Saredi G, Casellato S, Micali S, Rocco B, Buizza C. MP73-17 THULIUM LASER EN-BLOC RESECTION OF BLADDER TUMOR (THUEB-BT): TIGER (THULIUM ITALIAN GROUP ESTABLISHED ON RESEARCH) STUDY TO COMPARE LASER AND ELECTRICAL EN- BLOC TRANSURETHRAL RESECTION OF BLADDER TUMOR. J Urol 2020. [DOI: 10.1097/ju.0000000000000959.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Al Rawashdah SF, Pastore AL, Velotti G, Fuschi A, Capone L, Suraci PP, Martoccia A, Saltarelli A, Minucci S, Falsaperla M, Al Salhi Y, Illiano E, Costantini E, Carbone A. Sexual and functional outcomes of prostate artery embolisation: A prospective long-term follow-up, large cohort study. Int J Clin Pract 2020; 74:e13454. [PMID: 31769906 DOI: 10.1111/ijcp.13454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/22/2019] [Indexed: 01/28/2023] Open
Abstract
AIM OF THE STUDY Among minimally invasive procedures for treating benign prostate hyperplasia (BPH) prostate artery embolisation (PAE) is described as safe and effective. Aim of this study is to report our results, focusing on sexual outcomes (erectile and ejaculatory functions sparing) of PAE in patients suffering from bladder outlet obstruction (BOO) secondary to BPH. METHODS We prospectively enrolled and submitted to PAE subjects suffering from BOO secondary to BPH. All patients were not suitable for surgery or declined invasive approaches. All subjects were preoperatively and postoperatively (3, 6, 12 and 18 months after) evaluated by urinary flowmetry, post voiding residual volume, prostate volume, serum PSA levels, International Index of Erectile Function, International Prostate Symptom Score and QoL scores. RESULTS PAE was performed in 147 patients (mean age 72.5 y.o.). PAE was technically successful in all patients. The procedure lasted a mean time of 94.3 minutes, with a mean fluoroscopic time of 42.5 minutes. Twelve months follow-up data were available for all patients, while 126 patients (85%) completed the 18 months follow up. At 12 months follow up, the mean IPSS and QoL scores significantly decreased, and all the objective parameters (mean Qmax, PVR and prostate volume) reported a significant improvement. A total of 130 patients (88.5%) at 12 months reported the antegrade ejaculation preserved, and a slight not significant improvement of IIEF scores. The 18 months after PAE outcomes confirmed the significant improvement of all the variables evaluated (even for PSA values and IIEF scores). No major complications occurred. CONCLUSIONS Our results evidence prostate artery embolisation as highly feasible and safe procedure with interesting outcomes. In particular, in our study PAE reported promising results in preserving antegrade ejaculation and erectile function. Our data are in line with the literature, confirming how PAE reduces obstructive symptoms in BPH patients not suitable or refusing standard surgical approaches.
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Affiliation(s)
| | - Antonio Luigi Pastore
- Department of Medico-Surgical Biotechnologies, Department of Urology, Sapienza University of Rome, Latina, Italy
| | - Gennaro Velotti
- Department of Medico-Surgical Biotechnologies, Department of Urology, Sapienza University of Rome, Latina, Italy
| | - Andrea Fuschi
- Department of Medico-Surgical Biotechnologies, Department of Urology, Sapienza University of Rome, Latina, Italy
| | - Lorenzo Capone
- Department of Medico-Surgical Biotechnologies, Department of Urology, Sapienza University of Rome, Latina, Italy
| | - Pietro Paolo Suraci
- Department of Medico-Surgical Biotechnologies, Department of Urology, Sapienza University of Rome, Latina, Italy
| | - Alessia Martoccia
- Department of Medico-Surgical Biotechnologies, Department of Urology, Sapienza University of Rome, Latina, Italy
| | | | - Sergio Minucci
- Radiology Unit, San Carlo di Nancy Hospital, Rome, Italy
| | | | - Yazan Al Salhi
- Department of Medico-Surgical Biotechnologies, Department of Urology, Sapienza University of Rome, Latina, Italy
| | - Ester Illiano
- Department of Urology, AOU Santa Maria Terni, University of Perugia, Terni, Italy
| | | | - Antonio Carbone
- Department of Medico-Surgical Biotechnologies, Department of Urology, Sapienza University of Rome, Latina, Italy
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Marigliano C, Badia S, Bellini D, Rengo M, Caruso D, Tito C, Miglietta S, Palleschi G, Pastore AL, Carbone A, Fazi F, Petrozza V, Laghi A. Radiogenomics in Clear Cell Renal Cell Carcinoma: Correlations Between Advanced CT Imaging (Texture Analysis) and MicroRNAs Expression. Technol Cancer Res Treat 2020; 18:1533033819878458. [PMID: 31564221 PMCID: PMC6767738 DOI: 10.1177/1533033819878458] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE A relevant challenge for the improvement of clear cell renal cell carcinoma management could derive from the identification of novel molecular biomarkers that could greatly improve the diagnosis, prognosis, and treatment choice of these neoplasms. In this study, we investigate whether quantitative parameters obtained from computed tomography texture analysis may correlate with the expression of selected oncogenic microRNAs. METHODS In a retrospective single-center study, multiphasic computed tomography examination (with arterial, portal, and urographic phases) was performed on 20 patients with clear cell renal cell carcinoma and computed tomography texture analysis parameters such as entropy, kurtosis, skewness, mean, and standard deviation of pixel distribution were measured using multiple filter settings. These quantitative data were correlated with the expression of selected microRNAs (miR-21-5p, miR-210-3p, miR-185-5p, miR-221-3p, miR-145-5p). Both the evaluations (microRNAs and computed tomography texture analysis) were performed on matched tumor and normal corticomedullar tissues of the same patients cohort. RESULTS In this pilot study, we evidenced that computed tomography texture analysis has robust parameters (eg, entropy, mean, standard deviation) to distinguish normal from pathological tissues. Moreover, a higher coefficient of determination between entropy and miR-21-5p expression was evidenced in tumor versus normal tissue. Interestingly, entropy and miR-21-5p show promising correlation in clear cell renal cell carcinoma opening to a radiogenomic strategy to improve clear cell renal cell carcinoma management. CONCLUSION In this pilot study, a promising correlation between microRNAs and computed tomography texture analysis has been found in clear cell renal cell carcinoma. A clear cell renal cell carcinoma can benefit from noninvasive evaluation of texture parameters in adjunction to biopsy results. In particular, a promising correlation between entropy and miR-21-5p was found.
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Affiliation(s)
- Chiara Marigliano
- Department of Radiological, Oncological and Pathological Sciences, University of Rome "Sapienza"-Polo Pontino, ICOT Hospital, Latina, Italy
| | - Stefano Badia
- Department of Radiological, Oncological and Pathological Sciences, University of Rome "Sapienza"-Polo Pontino, ICOT Hospital, Latina, Italy
| | - Davide Bellini
- Department of Radiological, Oncological and Pathological Sciences, University of Rome "Sapienza"-Polo Pontino, ICOT Hospital, Latina, Italy
| | - Marco Rengo
- Department of Radiological, Oncological and Pathological Sciences, University of Rome "Sapienza"-Polo Pontino, ICOT Hospital, Latina, Italy
| | - Damiano Caruso
- Department of Radiological, Oncology and Pathology Sciences, "Sapienza" University of Rome, Italy Radiology Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Claudia Tito
- Department of Anatomical, Histological, Forensic & Orthopaedic Sciences, Section of Histology & Medical Embryology, "Sapienza" University of Rome, Laboratory Affiliated With Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Rome, Italy
| | - Selenia Miglietta
- Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, Section of Anatomy, Electron Microscopy Unit, Laboratory "Pietro M. Motta," "Sapienza" University of Rome, Rome, Italy
| | - Giovanni Palleschi
- Department of Medical-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Urology Unit ICOT, Latina, Italy
| | - Antonio Luigi Pastore
- Department of Medical-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Urology Unit ICOT, Latina, Italy
| | - Antonio Carbone
- Department of Medical-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Urology Unit ICOT, Latina, Italy
| | - Francesco Fazi
- Department of Anatomical, Histological, Forensic & Orthopaedic Sciences, Section of Histology & Medical Embryology, "Sapienza" University of Rome, Laboratory Affiliated With Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Rome, Italy
| | - Vincenzo Petrozza
- Department of Medical-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Urology Unit ICOT, Latina, Italy
| | - Andrea Laghi
- Department of Radiological, Oncology and Pathology Sciences, "Sapienza" University of Rome, Italy Radiology Unit, Sant'Andrea University Hospital, Rome, Italy
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Sanguedolce F, Cormio L, Carrieri G, Calò B, Russo D, Menin A, Pastore AL, Greco F, Bozzini G, Galfano A, Pini G, Porreca A, Mugavero F, Falsaperla M, Ceruti C, Cindolo L, Antonelli A, Minervini A. Role of androgen receptor expression in non-muscle-invasive bladder cancer: a systematic review and meta-analysis. Histol Histopathol 2019; 35:423-432. [PMID: 31803932 DOI: 10.14670/hh-18-189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In order to evaluate the potential prognostic/predictive role of androgen receptor (AR) expression in non-muscle-invasive bladder cancer (NMIBC), and whether it may represent a therapeutic target, we conducted a systematic search of the literature using 'androgen receptor or AR', 'testosterone', 'bladder cancer' and 'non-muscle invasive bladder cancer or NMIBC' as keywords. Eleven studies met the inclusion/exclusion criteria. No significant association was found between AR status and patients' gender (p=0.232), tumor size (p=0.975), tumor stage (p=0.237), tumor grade (p=0.444), tumor multicentricity (p=0.397), concomitant CIS (p=0.316) and progression of disease (p=0.397). On the other hand, relative lack of AR expression was significantly correlated to recurrent disease (p=0.001). Evidence for a direct correlation between AR expression and recurrence-free survival of patients with NMIBC indicate ARs as potential markers of BC behavior; moreover, the finding of a role of androgen blockade therapy in improving survival highlights the potential clinical application of this pathway, which deserves to be further explored.
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Affiliation(s)
- Francesca Sanguedolce
- Department of Pathology, University Hospital, Foggia, Italy. .,AGILE Group (Italian Group for Advanced Laparoscopic and Robotic Urologic Surgery), Italy
| | - 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
| | - Beppe Calò
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Davide Russo
- Department of Pathology, University Hospital, Foggia, Italy
| | - Andrea Menin
- Department of Pathology, San Bortolo Hospital, Vicenza, Italy
| | - Antonio Luigi Pastore
- AGILE Group (Italian Group for Advanced Laparoscopic and Robotic Urologic Surgery), Italy.,Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Francesco Greco
- AGILE Group (Italian Group for Advanced Laparoscopic and Robotic Urologic Surgery), Italy.,Department of Urology, Humanitas Gavazzeni, Bergamo, Italy
| | - Giorgio Bozzini
- AGILE Group (Italian Group for Advanced Laparoscopic and Robotic Urologic Surgery), Italy.,Department of Urology, ASST Valle Olona, Busto A. (VA), Italy
| | - Antonio Galfano
- AGILE Group (Italian Group for Advanced Laparoscopic and Robotic Urologic Surgery), Italy.,Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovannalberto Pini
- AGILE Group (Italian Group for Advanced Laparoscopic and Robotic Urologic Surgery), Italy.,Department of Urology, San Raffaele Turro Hospital, San Raffaele University, Milan, Italy
| | - Angelo Porreca
- AGILE Group (Italian Group for Advanced Laparoscopic and Robotic Urologic Surgery), Italy.,Urology Unit, Policlinico of Abano, Abano Terme, Italy
| | - Filippo Mugavero
- AGILE Group (Italian Group for Advanced Laparoscopic and Robotic Urologic Surgery), Italy.,Urology Unit, Ospedale Vittorio Emanuele, Catania, Italy
| | - Mario Falsaperla
- AGILE Group (Italian Group for Advanced Laparoscopic and Robotic Urologic Surgery), Italy.,Urology Unit, Ospedale Vittorio Emanuele, Catania, Italy
| | - Carlo Ceruti
- AGILE Group (Italian Group for Advanced Laparoscopic and Robotic Urologic Surgery), Italy.,Urology Clinic, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Luca Cindolo
- AGILE Group (Italian Group for Advanced Laparoscopic and Robotic Urologic Surgery), Italy.,Department of Urology, ASL02 Abruzzo, Chieti, Italy
| | - Alessandro Antonelli
- AGILE Group (Italian Group for Advanced Laparoscopic and Robotic Urologic Surgery), Italy.,Urology Unit, ASST-Spedali Civili, Brescia, Italy
| | - Andrea Minervini
- AGILE Group (Italian Group for Advanced Laparoscopic and Robotic Urologic Surgery), Italy.,Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
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Pastore AL, Palleschi G, Fuschi A, Al Salhi Y, Zucchi A, Bozzini G, Illiano E, Costantini E, Carbone A. Pelvic muscle floor rehabilitation as a therapeutic option in lifelong premature ejaculation: long-term outcomes. Asian J Androl 2019; 20:572-575. [PMID: 29974885 PMCID: PMC6219291 DOI: 10.4103/aja.aja_30_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The aim of the study was to evaluate the long-term outcomes of pelvic floor muscle (PFM) rehabilitation in males with lifelong premature ejaculation (PE), using intravaginal ejaculatory latency time (IELT) and the self-report Premature Ejaculation Diagnostic Tool (PEDT) as primary outcomes. A total of 154 participants were retrospectively reviewed in this study, with 122 completing the training protocol. At baseline, all participants had an IELT ≤60 s and PEDT score >11. Participants completed a 12-week program of PFM rehabilitation, including physio-kinesiotherapy treatment, electrostimulation, and biofeedback, with three sessions per week, with 20 min for each component completed at each session. The effectiveness of intervention was evaluated by comparing the change in the geometric mean of IELT and PEDT values, from baseline, at 3, 6, and 12 months during the intervention, and at 24 and 36 months postintervention, using a paired sample 2-tailed t-test, including the associated 95% confidence intervals. Of the 122 participants who completed PFM rehabilitation, 111 gained control of their ejaculation reflex, with a mean IELT of 161.6 s and PEDT score of 2.3 at the 12-week endpoint of the intervention, representing an increase from baseline of 40.4 s and 17.0 scores, respectively, for IELT and PEDT (P < 0.0001). Of the 95 participants who completed the 36-month follow-up, 64% and 56% maintained satisfactory ejaculation control at 24 and 36 months postintervention, respectively.
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Affiliation(s)
- Antonio Luigi Pastore
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ICOT, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, Latina (LT) 04100, Italy.,Uroresearch, Nonprofit Association for Research in Urology, Latina 04100, Italy
| | - Giovanni Palleschi
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ICOT, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, Latina (LT) 04100, Italy.,Uroresearch, Nonprofit Association for Research in Urology, Latina 04100, Italy
| | - Andrea Fuschi
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ICOT, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, Latina (LT) 04100, Italy
| | - Yazan Al Salhi
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ICOT, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, Latina (LT) 04100, Italy
| | - Alessandro Zucchi
- Department of Urology and Andrology, University of Perugia, Perugia 05156, Italy
| | - Giorgio Bozzini
- Department of Urology, MATER DOMINI Humanitas, Castellanza (VA) 21053, Italy
| | - Ester Illiano
- Department of Urology and Andrology, University of Perugia, Perugia 05156, Italy
| | | | - Antonio Carbone
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ICOT, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, Latina (LT) 04100, Italy.,Uroresearch, Nonprofit Association for Research in Urology, Latina 04100, Italy
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De Nunzio C, Pastore AL, Lombardo R, Cancrini F, Carbone A, Fuschi A, Dutto L, Tubaro A, Witt JH. The EORTC quality of life questionnaire predicts early and long-term incontinence in patients treated with robotic assisted radical prostatectomy: Analysis of a large single center cohort. Urol Oncol 2019; 37:1006-1013. [PMID: 31326315 DOI: 10.1016/j.urolonc.2019.06.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/28/2019] [Accepted: 06/24/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of our study is to evaluate the role of preoperative quality of life (QL) as a possible risk factor for post robotic assisted radical prostatectomy (RARP) urinary incontinence. The secondary aim is to evaluate the possible effect of preoperative QL on post RARP lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). METHODS AND MATERIALS Between 2012 and 2017, all patients undergoing RARP for prostate cancer were enrolled. Patient's demographic, clinical, and histological characteristics were recorded. ED, LUTS, urinary incontinence, and QL were evaluated at baseline and postoperatively at 3, 6, and 12 months. Incontinence was evaluated with the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form questionnaire and QL with the EORTC QLQ-C30 global health score (QLQ-GHS). Multivariate logistic regression analysis was used to evaluate the risk of postoperative incontinence, moderate/severe incontinence, LUTS, and moderate/severe ED. RESULTS Overall 4,603 patients were enrolled. Incontinence rates at 3, 6, and 12 months were respectively 17%, 10%, and 8%. On multivariate analysis, QL was an independent predictor of early incontinence (QLQ-GHS:0.71, CI:0.59-0.86; P= 0.001), severe incontinence (QLQ-GHS:0.65, CI:0.49-0.97; P= 0.006), and LUTS (QLQ-GHS:0.48, CI:0.41-0.57; P= 0.001). Single center design may be considered a limitation. CONCLUSIONS In our study a comprehensive evaluation of preoperative patient's QL, assessed by the EORTC QLQ-C30 questionnaire, can predict the early and long-term moderate/severe incontinence risk in RARP treated patients. Further studies should confirm our results.
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Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, "Sant'Andrea" Hospital, "La Sapienza" University, Rome, Italy.
| | | | - Riccardo Lombardo
- Department of Urology, "Sant'Andrea" Hospital, "La Sapienza" University, Rome, Italy
| | - Fabiana Cancrini
- Department of Urology, "Sant'Andrea" Hospital, "La Sapienza" University, Rome, Italy
| | | | - Andrea Fuschi
- Department of Urology, Ospedale di Latina, Latina, Italy
| | - Lorenzo Dutto
- St Antonius Hospital Gronau, Department of Urology, Pediatric Urology and Urological Oncology, Prostate Cancer Northwest, Gronau, Germany
| | - Andrea Tubaro
- Department of Urology, "Sant'Andrea" Hospital, "La Sapienza" University, Rome, Italy
| | - Joern Heinrich Witt
- St Antonius Hospital Gronau, Department of Urology, Pediatric Urology and Urological Oncology, Prostate Cancer Northwest, Gronau, Germany
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Pastore AL, Al Salhi Y, Fuschi A, Martoccia A, Velotti G, Capone L, Bozzini G, Porta N, Petrozza V, Illiano E, Costantini E, Carbone A. Successful treatment with pollen extract of hematospermia in patients with xanthogranolomatous prostatitis. ACTA ACUST UNITED AC 2019; 91:22-24. [PMID: 30932425 DOI: 10.4081/aiua.2019.1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 01/26/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The aim of this study was to report our experience in the management of hematospermia observed in 16 patients suffering from xanthogranulomatous prostatitis. METHODS Recurrent episodes of hematospermia were the onset symptom in all patients, and in 25% of patients it was combined with fever. All patients reported PSA value elevation and the digital rectal examination (DRE) revealed an increase of the gland size and of its consistency in all cases. In all patients, the hematospermia was treated with the oral administration of two tablets of pollen extract in a single (1 g) dose daily for 30 days. RESULTS Sixteen patients were observed between 2008 and 2016, referring hematospermia, progressive lower urinary tract symptoms (LUTS), and serum PSA level increase. To exclude the prostate cancer presence all patients were submitted to transperineal TRUS guided biopsy. In all the patients complete resolution of hematospermia was achieved treatment with pollen extract. All patients were subsequently treated for LUTS (alpha-adrenergic blockers), but none reported any significant improvement of symptoms. Basing on these pieces of evidence, after 90 days of alpha-blockers therapy, all patients underwent bipolar TURP. Histological examination of resected prostatic tissue revealed in all patients the diagnosis of xanthogranulomatous prostatitis. CONCLUSIONS Patients with xanthogranulomatous prostatitis especially experience irritative symptoms, sometimes combined with fever or hematospermia. Hematospermia as the onset symptom has not been reported so far. The administration of the pollen extract for 30 days was associated with a complete resolution of hematospermia.
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Affiliation(s)
- Antonio Luigi Pastore
- Sapienza University of Rome, Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Latina; Uroresearch, no profit Association for Research in Urology, Latina.
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Asimakopoulos AD, Topazio L, De Angelis M, Agrò EF, Pastore AL, Fuschi A, Annino F. Retzius-sparing versus standard robot-assisted radical prostatectomy: a prospective randomized comparison on immediate continence rates. Surg Endosc 2018; 33:2187-2196. [PMID: 30426256 DOI: 10.1007/s00464-018-6499-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Post-prostatectomy urinary incontinence is an adverse event leading to significant distress. Our aim was to evaluate immediate urinary continence (UC) recovery in a single-surgeon prospective randomized comparative study between the traditional robot-assisted laparoscopic radical prostatectomy (TR-RALP) and the Retzius-sparing RALP (RS-RALP), for the treatment of the clinically localized prostate cancer (PCa). METHODS 102 consecutive PCa patients were prospectively randomized to TR-RALP (57) or RS-RALP (45). Postoperative continence was defined as patient-reported absence of leakage or use of 0 pads/day. The immediate continence rate and 95% confidence interval (CI 95%) were calculated for each treatment. Univariable and multivariate logistic regressions were used to assess predictors of immediate continence following RALP. Continence rates from 1 to 6 months were calculated by Kaplan-Meier curves; log-rank test was used for the curve comparison. Two analyses were performed, considering a per-protocol (PP) population regarding all randomized patients that received nerve-sparing RALP and an Intention-To-Treat (ITT) population regarding all randomized patients that received RALP. RESULTS In the PP analysis, the rates of immediate continence were 12/40 (30%) (CI 95% 17-47%) for the TR-RALP and 20/39 (51.3%) (CI 95% 35-68%) for the RS-RALP (p = 0.05). In the ITT analysis, the corresponding rates were 12/57 (21%) (CI 95% 11-34%) for the TR-RALP and 23/45 (51%) (CI 95% 36-66%) for the RS-RALP (p = 0.001). Median time to continence was 21 days for the TR-RALP and 1 day for RS-RALP, respectively (p = 0.02). The relative Kaplan-Meier curves regarding continence resulted statistically different when compared with the log rank test (p = 0.02). In the multivariate analysis, lower age and the Retzius-sparing approach were significantly associated to earlier continence recovery. CONCLUSIONS The Retzius-sparing approach significantly reduces time to continence following RALP. Further studies are required to confirm the reproducibility of our results and investigate the role of the RS-RALP as an additional "protective" factor for postoperative continence in the elderly population.
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Affiliation(s)
- Anastasios D Asimakopoulos
- Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy. .,Department of Experimental Medicine and Surgery, UOC of Urology, University of Rome Tor Vergata, Rome, Italy.
| | - Luca Topazio
- Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy
| | - Michele De Angelis
- Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy
| | - Enrico Finazzi Agrò
- Department of Experimental Medicine and Surgery, UOC of Urology, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Luigi Pastore
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Andrea Fuschi
- Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy.,Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Filippo Annino
- Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy
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Antonelli A, Allinovi M, Cocci A, Russo GI, Schiavina R, Rocco B, Giovannalberto P, Celia A, Galfano A, Varca V, Bozzini G, Ceruti C, Greco F, Verze P, Pastore AL, Porreca A, Minervini A. The Predictive Role of Biomarkers for the Detection of Acute Kidney Injury After Partial or Radical Nephrectomy: A Systematic Review of the Literature. Eur Urol Focus 2018; 6:344-353. [PMID: 30309817 DOI: 10.1016/j.euf.2018.09.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/04/2018] [Accepted: 09/27/2018] [Indexed: 11/28/2022]
Abstract
CONTEXT Postoperative acute kidney injury (AKI) is a serious complication after kidney surgery, associated with prolonged hospital stay, high morbidity, and mortality. Biomarkers represent a tool of increasing importance to identify renal impairment after partial nephrectomy (PN) or radical nephrectomy (RN) in order to optimize and anticipate the diagnosis of AKI. OBJECTIVE The goal of this systematic review is to investigate current insights on the role of biomarkers in predicting renal impairment in patients undergoing PN or RN. EVIDENCE ACQUISITION A systematic review was conducted up to November 30, 2017 through PubMed, Scopus, and Embase databases, to identify eligible studies evaluating the role of biomarkers for the prediction of AKI after PN or RN. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria were applied to select articles. EVIDENCE SYNTHESIS According to the study selection criteria, 10 publications were included with a total number of 728 patients. Incidence of AKI was 26.7% (range: 9-58%). Based on the evidence reviewed, serum cystatin C and urinary neutrophil gelatinase-associated lipocalin (NGAL) showed a significant correlation with serum creatinine rise postoperatively, emerging as potential noninvasive and early biomarkers of AKI in patients undergoing renal surgery. In this setting, serum cystatin C and urinary NGAL have preceded the rise in serum creatinine peak from 3 up to 24h, even in case of mild renal damage. CONCLUSIONS The literature underlines the potential usefulness of biomarkers such as cystatin C and NGAL as promising and early tools to predict AKI after PN or RN. However, no strong evidence in support of their use is available to date and further investigations are awaited. PATIENT SUMMARY We looked at the role of biomarkers in predicting renal injury in patients undergoing partial or radical nephrectomy. Serum cystatin C and urinary neutrophil gelatinase-associated lipocalin have emerged as promising noninvasive, accurate, and early biomarkers.
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Affiliation(s)
- Alessandro Antonelli
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Marco Allinovi
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Andrea Cocci
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
| | | | | | - Bernardo Rocco
- Department of Urology, University of Milan, Milan, Italy
| | | | - Antonio Celia
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Virginia Varca
- Department of Urology, G. Salvini Hospital, Milan, Italy
| | | | - Carlo Ceruti
- Urology Clinic, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Francesco Greco
- Casa di Cura Dottor Pederzoli, Urology and Minimal Invasive Surgery, Peschiera del Garda, Italy
| | - Paolo Verze
- Department of Urology, University of Naples, Naples, Italy
| | | | - Angelo Porreca
- Department of Urology, Abano Terme Hospital, Padua, Italy
| | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
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Palleschi G, Pastore AL, Petrozza V, Calogero A, De Falco E, Carbone A. MP54-10 M2 MUSCARINIC RECEPTORS INHIBIT CELL PROLIFERATION AND MIGRATION IN UROTHELIAL BLADDER CANCER CELLS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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De Nunzio C, Pastore AL, Lombardo R, Cancrini F, Carbone A, Fuschi A, Dutti L, Witt JH, Tubaro A. MP05-15 THE EORTC QLQ-C30 QUESTIONNAIRES PREDICTS EARLY AND LONG-TERM INCONTINENCE IN PATIENTS TREATED WITH ROBOTIC RADICAL PROSTATECTOMY: ANALYSIS OF A LARGE SINGLE CENTER COHORT. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Palleschi G, Pastore AL, Fuschi A, Al Salhi Y, Carbone A. V05-10 TOTALLY INTRACORPOREAL LAPAROSCOPIC RADICAL CYSTECTOMY WITH MODIFIED ILEAL PADUA NEOBLADDER RECOSTRUCTION IN MALE. SURGICAL APPROACH EVOLUTION AND OUTCOMES. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Costantini E, Illiano E, Giannitsas K, Prestipino M, Pastore AL, Carbone A, Palleschi G, Balsamo R, Natale F, Villari D, Bini V, Maruccia S, Filocamo MT, Zucchi A. Urological dysfunction in young women: an inheritance of childhood? BJU Int 2017; 121:453-457. [PMID: 29160004 DOI: 10.1111/bju.14081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the correlation of a history of lower urinary tract symptomatology during childhood with lower urinary tract dysfunction in young adult women. SUBJECTS AND METHODS This was a multicentre, prospective, case-control study conducted between April 2013 and November 2015. A total of 300 women, aged 18-40 years, participated. The case group comprised women attending urogynaecology clinics for various lower urinary tract complaints and the control group was recruited from a healthy population. Exclusion criteria were designed to avoid common causes of lower urinary tract dysfunction and symptoms and included diabetes mellitus, neurological disease and pelvic inflammatory disease. All women completed a self-administered 77-item questionnaire, exploring childhood urological and bowel history, as well as current urological, bowel and sexual symptoms. Statistical analysis was performed using chi-squared and Fisher's exact tests to compare categorical variables. Multivariate logistic regression models were fit for the prediction of the adult outcomes, incorporating as explanatory variables all those that showed a significant P value in bivariate analysis. P values < 0.05 were considered statistically significant. RESULTS Women with childhood urinary voiding and storage symptoms had a higher prevalence of these symptoms in adult life compared with women without such history. Women with urinary tract infections (UTIs) during childhood had a higher incidence of adult UTIs compared with women without this problem in childhood. CONCLUSIONS Lower urinary tract dysfunction in childhood seems to 'persist' in young adult life but the implications of this finding in clinical practice need to be defined in future studies.
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Affiliation(s)
- Elisabetta Costantini
- Department of Surgical and Biomedical Sciences, Urology and Andrology Clinic, University of Perugia, Perugia, Italy
| | - Ester Illiano
- Department of Surgical and Biomedical Sciences, Urology and Andrology Clinic, University of Perugia, Perugia, Italy
| | - Konstantinos Giannitsas
- Department of Urology, University of Patras School of Medicine, Patras University Hospital, Patras, Greece
| | - Marco Prestipino
- Department of Paediatric Surgery, C.U. Paediatric Surgery, University of Perugia, Perugia, Italy
| | - Antonio Luigi Pastore
- Department of Medico Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University, ICOT, Rome, Italy
| | - Antonio Carbone
- Department of Medico Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University, ICOT, Rome, Italy
| | - Giovanni Palleschi
- Department of Medico Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University, ICOT, Rome, Italy
| | - Raffaele Balsamo
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Franca Natale
- Department of Obstetrics and Gynecology, S. Carlo-IDI Hospital, Rome, Italy
| | - Donata Villari
- Department of Urology, University of Florence, Florence, Italy
| | - Vittorio Bini
- Internal Medicine, University of Perugia, Perugia, Italy
| | | | | | - Alessandro Zucchi
- Department of Surgical and Biomedical Sciences, Urology and Andrology Clinic, University of Perugia, Perugia, Italy
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Pastore AL, Mir A, Maruccia S, Palleschi G, Carbone A, Lopez C, Camps N, Palou J. Psychological distress in patients undergoing surgery for urological cancer: A single centre cross-sectional study. Urol Oncol 2017; 35:673.e1-673.e7. [DOI: 10.1016/j.urolonc.2017.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 08/06/2017] [Accepted: 08/08/2017] [Indexed: 11/16/2022]
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Pastore AL, Palleschi G, Carbone A, Maruccia S, Bou AM, Camps Bellnoch N, Palou J. MP86-12 PSYCHOLOGICAL DISTRESS IN PATIENTS UNDERGOING SURGERY FOR UROLOGICAL CANCER: A PROSPECTIVE SINGLE CENTRE CROSS-SECTIONAL STUDY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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