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Perri D, Rocco B, Sighinolfi MC, Bove P, Pastore AL, Volpe A, Minervini A, Antonelli A, Zaramella S, Galfano A, Cacciamani GE, Celia A, Dalpiaz O, Crivellaro S, Greco F, Pini G, Porreca A, Pacchetti A, Calcagnile T, Berti L, Buizza C, Mazzoleni F, Bozzini G. Open versus Robot-Assisted Radical Cystectomy for the Treatment of pT4a Bladder Cancer: Comparison of Perioperative Outcomes. Cancers (Basel) 2024; 16:1329. [PMID: 38611006 PMCID: PMC11011112 DOI: 10.3390/cancers16071329] [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: 02/24/2024] [Revised: 03/17/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
We compared the perioperative outcomes of open (ORC) vs. robot-assisted (RARC) radical cystectomy in the treatment of pT4a MIBC. In total, 212 patients underwent ORC (102 patients, Group A) vs. RARC (110 patients, Group B) for pT4a bladder cancer. Patients were prospectively followed and retrospectively reviewed. We assessed operative time, estimated blood loss (EBL), intraoperative and postoperative complications, length of stay, transfusion rate, and oncological outcomes. Preoperative features were comparable. The mean operative time was 232.8 vs. 189.2 min (p = 0.04), and mean EBL was 832.8 vs. 523.7 mL in Group A vs. B (p = 0.04). An intraoperative transfusion was performed in 32 (31.4%) vs. 11 (10.0%) cases during ORC vs. RARC (p = 0.03). The intraoperative complications rate was comparable. The mean length of stay was shorter after RARC (12.6 vs. 7.2 days, p = 0.02). Postoperative transfusions were performed in 36 (35.3%) vs. 13 (11.8%) cases (p = 0.03), and postoperative complications occurred in 37 (36.3%) vs. 29 (26.4%) patients in Groups A vs. B (p = 0.05). The positive surgical margin (PSM) rate was lower after RARC. No differences were recorded according to the oncological outcomes. ORC and RARC are feasible treatments for the management of pT4a bladder tumors. Minimally invasive surgery provides shorter operative time, bleeding, transfusion rate, postoperative complications, length of stay, and PSM rate.
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Affiliation(s)
- Davide Perri
- Department of Urology, ASST Lariana, 22100 Como, Italy (G.B.)
| | - Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | | | - Pierluigi Bove
- Department of Urology, Ospedale San Carlo di Nancy, 00165 Rome, Italy
| | | | - Alessandro Volpe
- Department of Urology, Ospedale Maggiore della Carità, 28100 Novara, Italy
| | - Andrea Minervini
- Department of Urology, Azienda Ospedaliero Universitaria Careggi, 50134 Florence, Italy
| | | | | | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | | | - Antonio Celia
- Department of Urology, Ospedale San Bassiano, 36061 Bassano del Grappa, Italy
| | - Orietta Dalpiaz
- Department of Urology, Medical University of Graz, 8010 Graz, Austria
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Francesco Greco
- Department of Urology, Humanitas Gavazzeni, 24125 Bergamo, Italy
| | | | - Angelo Porreca
- Department of Urology, Policlinico Abano Terme, Abano Terme, 35031 Padova, Italy
| | | | | | - Lorenzo Berti
- Department of Urology, Ospedale di Busto Arsizio, 21052 Busto Arsizio, Italy
| | - Carlo Buizza
- Department of Urology, Ospedale di Busto Arsizio, 21052 Busto Arsizio, Italy
| | | | - Giorgio Bozzini
- Department of Urology, ASST Lariana, 22100 Como, Italy (G.B.)
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Perri D, Mazzoleni F, Pacchetti A, Rossini M, Morini E, Berti L, Buizza C, Besana U, Bozzini G. Pathological report and prognostic meaning of Bosniak IV cysts: results from a contemporary cohort. Cent European J Urol 2023; 76:186-189. [PMID: 38045787 PMCID: PMC10690387 DOI: 10.5173/ceju.2023.083r] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/02/2023] [Accepted: 07/23/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Surgery is the recommended treatment for Bosniak IV renal cysts. We performed a retrospective analysis of Bosniak IV lesions surgically removed to increase evidence on their prognostic meaning. Material and methods Patients with a Bosniak IV cyst were considered. A contrast-enhanced computed tomography (CT) scan or magnetic resonance imaging (MRI) detected a solid component with contrast enhancement. In no case a percutaneous biopsy was performed. A radical (9, 21.4%) or partial (33, 78.6%) nephrectomy was performed with laparoscopic (14, 33.3%) or robot-assisted (28, 66.7%) approach. Analysis of the final pathology was performed, and recurrence rate was assessed. Results 42 patients were included. Median lesion size was 54.7 mm (IQR 20.0-81.2). A solid tumour was detected in 40 patients (95.2%), whereas in 2 cases (4.8%) a benign cyst without neoplastic component was diagnosed. Final pathology revealed a low-grade clear cell renal cell carcinoma (ccRCC) in 16 cases (38.0%), a multilocular cystic renal neoplasm of low malignant potential in 6 cases (14.3%), a low-grade papillary RCC (pRCC) type I in 4 cases (9.5%), a clear cell papillary RCC (ccpRCC) in 10 cases (23.8%) and an oncocytoma in 2 cases (4.8%). A high-grade ccRCC was detected in 2 cases (4.8%), whereas no patients had a pRCC type II. In all cases surgical margins were negative. Median follow-up was 24 months and no recurrence occurred. Conclusions Our results increase evidence on the favourable pathology and good prognosis of Bosniak IV renal cysts, supporting the role of surgery as a definitive treatment and suggesting the need for a low-intensity follow-up.
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Affiliation(s)
- Davide Perri
- Division of Urology, Sant’Anna Hospital, San Fermo della Battaglia, Italy
| | - Federica Mazzoleni
- Division of Urology, Sant’Anna Hospital, San Fermo della Battaglia, Italy
| | - Andrea Pacchetti
- Division of Urology, Sant’Anna Hospital, San Fermo della Battaglia, Italy
| | - Mattia Rossini
- Division of Urology, Sant’Anna Hospital, San Fermo della Battaglia, Italy
| | - Elena Morini
- 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
| | - Carlo Buizza
- 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
| | - Giorgio Bozzini
- Division of Urology, Sant’Anna Hospital, San Fermo della Battaglia, Italy
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Bozzini G, Berti L, Maltagliati M, Besana U, Micali S, Roche JB, Romero-Otero J, Pacchetti A, Perri D, Morini E, Saredi G, Mazzoleni F, Sighinolfi MC, Buizza C, Rocco B. Thulium: YAG vs continuous-wave thulium fiber laser enucleation of the prostate: do potential advantages of thulium fiber lasers translate into relevant clinical differences? World J Urol 2023; 41:143-150. [PMID: 36357602 DOI: 10.1007/s00345-022-04201-1] [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: 03/13/2022] [Accepted: 10/25/2022] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To compare endoscopic enucleation of the prostate using a thulium: yttrium-aluminum-garnet (Tm:YAG) laser and a super-pulsed thulium fiber laser set in continuous-wave (CW) mode, and to evaluate whether theoretical advantages of thulium fiber lasers, related to their shorter wavelength, translate into relevant clinical differences. METHODS In total, 110 patients suffering from lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia were randomized to undergo either thulium:YAG laser enucleation of the prostate (ThuLEP) or CW thulium fiber laser enucleation of the prostate (CW-ThuFLEP). Intraoperative and postoperative variables and complications were compared. Micturition improvement was assessed at 3-month follow-up using the International Prostate Symptom Score (IPSS), post-void residual urine (PVR) and maximum flow rate (Qmax). Erectile function was evaluated using the International Index of Erectile Function-5 (IIEF-5). RESULTS No significant differences between the ThuLEP and CW-ThuFLEP groups were found in terms of operative time (70.69 vs 72.41 min), enucleation time (50.23 vs 53.33 min), enucleated tissue weight (40.2 vs 41.9 g), enucleation efficiency (0.80 vs 0.79 g/min), catheterization time (2.45 vs 2.57 days), hospital stay (2.82 vs 2.95 days) and hemoglobin drop (1.05 vs 1.27 g/dl). At 3-month follow-up, no significant differences were found in IPSS (5.09 vs 5.81), Qmax (26.51 vs 27.13 ml/s), PVR (25.22 vs 23.81 ml) and IIEF-5 (14.01 vs 14.54). CONCLUSION ThuLEP and CW-ThuFLEP were equivalent in relieving patients from LUTS and improving micturition. Theoretical advantages of the TFL, such as shallower penetration depth and improved vaporization capacity, did not translate into relevant perioperative outcomes or clinical differences.
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Affiliation(s)
- Giorgio Bozzini
- Department of Urology, ASST-Lariana, Ospedale Sant'Anna, San Fermo della Battaglia, CO, Italy.
| | - Lorenzo Berti
- Department of Urology, ASST-Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio, VA, Italy.,Department of Urology, Università degli Studi di Modena e Reggio Emilia, Modena, MO, Italy
| | - Matteo Maltagliati
- Department of Urology, ASST-Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio, VA, Italy.,Department of Urology, Università degli Studi di Modena e Reggio Emilia, Modena, MO, Italy
| | - Umberto Besana
- Department of Urology, ASST-Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio, VA, Italy
| | - Salvatore Micali
- Department of Urology, Università degli Studi di Modena e Reggio Emilia, Modena, MO, Italy
| | | | | | - Andrea Pacchetti
- Department of Urology, ASST-Lariana, Ospedale Sant'Anna, San Fermo della Battaglia, CO, Italy
| | - Davide Perri
- Department of Urology, ASST-Lariana, Ospedale Sant'Anna, San Fermo della Battaglia, CO, Italy
| | - Elena Morini
- Department of Urology, ASST-Lariana, Ospedale Sant'Anna, San Fermo della Battaglia, CO, Italy
| | - Giovanni Saredi
- Department of Urology, ASST-Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio, VA, Italy
| | - Federica Mazzoleni
- Department of Urology, ASST-Lariana, Ospedale Sant'Anna, San Fermo della Battaglia, CO, Italy
| | | | - Carlo Buizza
- Department of Urology, ASST-Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio, VA, Italy
| | - Bernardo Rocco
- Department of Urology, ASST-Santi Paolo e Carlo, Milan, MI, Italy
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Pacchetti A, Maltagliati M, Berti L, Morini E, Perri D, Besana U, Buizza C, Micali S, Rocco B, Sighinolfi M, Roche J, Bozzini G. Pulsed vs continuous tFLEP: a multi-institution trial to compare intra and early postoperative outcomes. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01080-1] [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: 11/07/2022] Open
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Bozzini G, Berti L, Maltagliati M, Sciorio C, Sighinolfi MC, Micali S, Otero JR, Buizza C, Rocco B. Current evidence of ThuLEP for BPH: A review of literature. Turk J Urol 2022; 47:461-469. [PMID: 35118964 DOI: 10.5152/tud.2021.21170] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Endoscopic enucleation of the prostate (EEP) techniques for the treatment of benign prostatic hyperplasia (BPH) have become increasingly popular among urologists over the past 23 years. Despite the energy source employed, the aim of all these procedures is to endoscopically remove the prostatic lobes by enucleating them from the prostate surgical capsule. The reasons for which EEP has gained popularity among urologists are the reduction in complications and hospital stay compared to endoscopic gold standard Transurethral Resection of the Prostate (TURP), but especially the possibility to treat large prostates, allowing to abandon open simple prostatectomy (OP) and to avoid the burden related to open surgery. Holmium laser enucleation of the prostate (HoLEP) sets the basic principles of all EEP techniques in 1998 and has become the treatment of reference for BPH. Since then, various lasers have been developed and applied to prostatic enucleation. The thulium laser has a slightly shorter wavelength compared to the holmium laser and a continuous wave output, which increase vaporization and reduce penetration depth. These features make it ideal for prostatic enucleation. A vapoenucleating technique called Thulium Laser Vapoenucleation of the Prostate was presented in 2009, followed by a blunt enucleating technique called Thulium Laser Enucleation of the Prostate in 2010. These techniques have become alternatives to HoLEP and TURP; however, the amount of literature and randomized controlled trials available are inferior compared to HoLEP. The aim of th describe, and discuss current evidence on thulium enucleating techniques.
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Affiliation(s)
- Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio VA, Italy
| | - Lorenzo Berti
- Department of Urology, ASST Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio VA, Italy; Department of Urology, Universita? Degli Studi di Modena e Reggio Emilia, Modena MO, Italy
| | - Matteo Maltagliati
- Department of Urology, ASST Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio VA, Italy; Department of Urology, Universita? Degli Studi di Modena e Reggio Emilia, Modena MO, Italy
| | - Carmine Sciorio
- Department of Urology, ASST Lecco, Ospedale Alessandro Manzoni, Lecco LC, Italy
| | | | - Salvatore Micali
- Department of Urology, Universita? Degli Studi di Modena e Reggio Emilia, Modena MO, Italy
| | | | - Carlo Buizza
- Department of Urology, ASST Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio VA, Italy
| | - Bernardo Rocco
- Department of Urology, Universita? Degli Studi di Modena e Reggio Emilia, Modena MO, Italy
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Maltagliati M, Berti L, Besana U, Buizza C, Perri D, Micali S, Rocco B, Sighinolfi M, Sciorio C, Pastore A, Pushkar D, Govorov A, Romero Otero J, Bozzini G. Treatment of ureteral stone with LithoEvo device and Vapor Tunnel tool. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01258-1] [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: 11/16/2022]
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Maltagliati M, Berti L, Perri D, Besana U, Buizza C, Gozen A, Sighinolfi M, Rocco B, Micali S, Bozzini G. Preliminary RCC embolization before laparoscopic partial nephrectomy. Outcomes on surgical procedure. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00436-5] [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: 11/26/2022]
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8
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Berti L, Maltagliati M, Besana U, Buizza C, Pacchetti A, Micali S, Sighinolfi M, Rocco B, Bozzini G. A comparison among RIRS and miniPERC for renal stones between 1 and 2 cm using fiber dust: A RCT. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01085-5] [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: 11/28/2022]
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9
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Bozzini G, Bevilacqua L, Besana U, Calori A, Pastore A, Romero Otero J, Macchi A, Broggini P, Breda A, Gozen A, Inzillo R, Puliatti S, Sighinolfi MC, Rocco B, Liatsikos E, Muller A, Buizza C. Ureteral access sheath-related injuries vs. post-operative infections. Is sheath insertion always needed? A prospective randomized study to understand the lights and shadows of this practice. Actas Urol Esp 2021; 45:576-581. [PMID: 34697008 DOI: 10.1016/j.acuroe.2020.11.010] [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: 04/25/2020] [Accepted: 11/25/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare intraoperative ureteral injuries in RIRS with UAS insertion with the rate of postoperative infections after RIRS without UAS insertion. PATIENTS AND METHODS In this randomized trial, patients who received an indication for RIRS between January 2017 and December 2017 were divided into two groups. Group A had no UAS insertion and Group B had UAS insertion. Post-Ureteroscopic Lesion Scale (PULS) grading was performed after UAS or flexible ureteroscope removal. Proximal, middle and distal ureteral lesions were evaluated and compared according to the PULS scale. Additionally, patients in both groups were followed postoperatively to assess any infective complication. RESULTS The evaluation comprised 181 patients, 89 for group A and 92 for group B. Overall stone-free rate, clinically insignificant residual fragments, and final stone-free rate were 41.4%, 53.5%, and 95%, respectively. There were 33 (37.1%) patients with ureteral lesions in group A while 42 (45.6%) patients had ureteral lesions in group B, with no significant difference. On the other hand, the overall presence of postoperative infection rate was much higher for Group A (37.1% vs 16.3% P = 0.03). CONCLUSIONS UAS insertion does not result in a higher number of ureteral injuries. UAS insertion during RIRS allows a lower rate of postoperative infections. CLINICAL TRIAL REGISTRATION NUMBER (ISRCTN REGISTRY NUMBER) 55546280.
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Affiliation(s)
- G Bozzini
- ESUT, European Section for UroTechnology EAU, Arnhem, The Netherlands; Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italy.
| | - L Bevilacqua
- Urology Department, Baggiovara Hospital, Módena, Italy
| | - U Besana
- Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italy
| | - A Calori
- Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italy
| | - A Pastore
- Urology Department, Università La Sapienza, Latina, Italy
| | - J Romero Otero
- Urology Department, Hospital 12 de Octubre, Madrid, Spain
| | - A Macchi
- Urology Department, INT, Milán, Italy
| | - P Broggini
- Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italy
| | - A Breda
- ESUT, European Section for UroTechnology EAU, Arnhem, The Netherlands; Urology Department, Fundacio Puigvert, Barcelona, Spain
| | - A Gozen
- ESUT, European Section for UroTechnology EAU, Arnhem, The Netherlands; Urology Department, University of Heidelberg, Heilbronn, Germany
| | - R Inzillo
- Urology Department, Baggiovara Hospital, Módena, Italy
| | - S Puliatti
- Urology Department, Baggiovara Hospital, Módena, Italy
| | | | - B Rocco
- ESUT, European Section for UroTechnology EAU, Arnhem, The Netherlands; Urology Department, Baggiovara Hospital, Módena, Italy
| | - E Liatsikos
- ESUT, European Section for UroTechnology EAU, Arnhem, The Netherlands; Urology Department, University of Patras, Patras, Greece
| | - A Muller
- Urology Department, Limattal Hospital, Schilieren, Switzerland
| | - C Buizza
- Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italy
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Bozzini G, Berti L, Maltagliati M, Besana U, Calori A, Filippi B, Sighinolfi M, Micali S, Buizza C, Rocco B. Laparoscopic partial nephrectomy with thulium laser enucleation of the tumor: perioperative and functional outcomes. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00948-4] [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: 11/24/2022] Open
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Bozzini G, Maltagliati M, Berti L, Besana U, Calori A, Cassani A, Filippi B, Sighinolfi M, Buizza C, Micali S, Rocco B. Xray and US free calix puncture before PCNL (XUF PCNL): a comparison with standard Xray/US guided puncture. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00777-1] [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: 11/29/2022] Open
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12
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Bozzini G, Bevilacqua L, Besana U, Calori A, Pastore A, Romero Otero J, Macchi A, Broggini P, Breda A, Gozen A, Inzillo R, Puliatti S, Sighinolfi MC, Rocco B, Liatsikos E, Muller A, Buizza C. Ureteral access sheath-related injuries vs. post-operative infections. Is sheath insertion always needed? A prospective randomized study to understand the lights and shadows of this practice. Actas Urol Esp 2021; 45:S0210-4806(21)00125-X. [PMID: 34344583 DOI: 10.1016/j.acuro.2020.11.010] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 10/28/2020] [Accepted: 11/25/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare intraoperative ureteral injuries in RIRS with UAS insertion with the rate of postoperative infections after RIRS without UAS insertion. PATIENTS AND METHODS In this randomized trial, patients who received an indication for RIRS between January 2017 and December 2017 were divided into two groups. Group A had no UAS insertion and Group B had UAS insertion. Post-Ureteroscopic Lesion Scale (PULS) grading was performed after UAS or flexible ureteroscope removal. Proximal, middle and distal ureteral lesions were evaluated and compared according to the PULS scale. Additionally, patients in both groups were followed postoperatively to assess any infective complication. RESULTS The evaluation comprised 181 patients, 89 for group A and 92 for group B. Overall stone-free rate, clinically insignificant residual fragments, and final stone-free rate were 41.4%, 53.5%, and 95%, respectively. There were 33 (37.1%) patients with ureteral lesions in group A while 42 (45.6%) patients had ureteral lesions in group B, with no significant difference. On the other hand, the overall presence of postoperative infection rate was much higher for Group A (37.1% vs 16.3% P=.03). CONCLUSIONS UAS insertion does not result in a higher number of ureteral injuries. UAS insertion during RIRS allows a lower rate of postoperative infections. Clinical Trial Registration Number (ISRCTN registry number): 55546280.
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Affiliation(s)
- G Bozzini
- ESUT, European section for UroTechnology EAU, Arnhem, Países Bajos; Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italia.
| | - L Bevilacqua
- Urology Department, Baggiovara Hospital, Módena, Italia
| | - U Besana
- Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italia
| | - A Calori
- Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italia
| | - A Pastore
- Urology Department, Università La Sapienza, Latina, Italia
| | - J Romero Otero
- Urology Department, Hospital 12 de Octubre, Madrid, España
| | - A Macchi
- Urology Department, INT, Milán, Italia
| | - P Broggini
- Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italia
| | - A Breda
- ESUT, European section for UroTechnology EAU, Arnhem, Países Bajos; Urology Department, Fundacio Puigvert, Barcelona, España
| | - A Gozen
- ESUT, European section for UroTechnology EAU, Arnhem, Países Bajos; Urology Department, University of Heidelberg, Heilbronn, Alemania
| | - R Inzillo
- Urology Department, Baggiovara Hospital, Módena, Italia
| | - S Puliatti
- Urology Department, Baggiovara Hospital, Módena, Italia
| | | | - B Rocco
- ESUT, European section for UroTechnology EAU, Arnhem, Países Bajos; Urology Department, Baggiovara Hospital, Módena, Italia
| | - E Liatsikos
- ESUT, European section for UroTechnology EAU, Arnhem, Países Bajos; Urology Department, University of Patras, Patras, Grecia
| | - A Muller
- Urology Department, Limattal Hospital, Schilieren, Suiza
| | - C Buizza
- Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italia
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Berti L, Maltagliati M, Buizza C, Besana U, Calori A, Antonelli D, Justich M, Marcangeli P, Micali S, Sighinolfi M, Rocco B, Bozzini G. A comparison among RIRS and MiniPerc for renal stones between 1-2 cm: A randomized controlled trial. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00659-x] [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: 10/20/2022]
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Maltagliati M, Berti L, Besana U, Calori A, Buizza C, Rivolta L, Gastaldi C, Autieri G, Sighinolfi M, Micali S, Rocco B, Bozzini G. Holmium laser enucleation of the prostate with virtual basket tool: Faster and better control on bleeding. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00460-7] [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: 10/20/2022]
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Maltagliati M, Berti L, Buizza C, Besana U, Rivolta L, Gastaldi C, Calori A, Malvestiti G, Sighinolfi M, Micali S, Rocco B, Bozzini G. Xray and US free calix puncture before PCNL (XUF PCNL). Comparison with standard Xray/US guided puncture. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00663-1] [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: 10/20/2022]
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Maltagliati M, Berti L, Buizza C, Rivolta L, Gastaldi C, Pedaci G, Malvestiti G, Autieri G, Sighinolfi M, Micali S, Rocco B, Bozzini G. Post-enucleation morcellation procedure: Lights and shadows. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00461-9] [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: 10/20/2022]
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Bozzini G, Maltagliati M, Berti L, Besana U, Calori A, Pastore AL, Gozen A, Govorov A, Liatsikos E, Micali S, Rocco B, Tunc L, Buizza C. "VirtualBasket" ureteroscopic holmium laser lithotripsy: intraoperative and early postoperative outcomes. Minerva Urol Nephrol 2021; 74:344-350. [PMID: 33769013 DOI: 10.23736/s2724-6051.21.04025-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The "VirtualBasket" technology is the result of pulse modulation during holmium laser emission: the laser emits part of the energy to create an initial bubble, and a second pulse is emitted when the vapor bubble is at its maximum expansion, so that it can pass through the previously created vapor channel. The aim of this study is to outline the outcomes of the "VirtualBasket" technology in ureteral and renal stones. METHODS 160 Patients were randomly assigned to holmium laser lithotripsy with or without the "VirtualBasket" technology in ureteric or renal cases (40 per 4 groups). All procedures were performed by four experienced urologists. The Quanta System Cyber Ho 100W laser generator with 365 μm fibers was used for all of the ureteral cases, whereas, 272 μm fibers were used for all of the cases in the renal pelvis. Demographic data, stone parameters, perioperative complications and success rates were compared. A statistical analysis was carried out to assess patients data and outcomes. All of the reported p-values were obtained with the two-sided exact method at the conventional 5% significance level. The degree of stone retropulsion was graded on a Likert scale from zero (no retropulsion) to 3 (maximum retropulsion). RESULTS All groups were comparable in terms of age, and pre-operative stone size (ureter stone size: 1.2 vs. 1.1 cm; renal pelvis stone size: 1.55 vs. 1.62 cm). Compared to the regular mode, the "VirtualBasket" technology was associated with significantly lower fragmentation time (mean time for ureteral stones: 20.4 vs. 16.1 minutes, p<0.05; mean time for renal stones: 28.7 vs. 19.8 minutes, p<0.05) and total procedural time (mean time for ureteral stones 49 vs. 35.7 minutes; mean time for renal stones 67.1 vs. 52.4 minutes). There were no significant differences in terms of energy delivered to the stones, intraoperative complications and success rate at 1 month. The "VirtualBasket" technology was associated with significantly lower retropulsion. CONCLUSIONS The "VirtualBasket" technology is associated with significantly lower fragmentation and procedural times. The reduced fragmentation time is a result of the significantly lower retropulsion of the stones during laser lithotripsy, which improves stone fragmentation efficiency.
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Affiliation(s)
- Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy.,ESUT, European Section for UroTechnology
| | - Matteo Maltagliati
- Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy - .,Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Berti
- Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy.,Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, 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
| | - Antonio L Pastore
- Department of Urology, ICOT Latina, Università la Sapienza, Roma, Italy
| | - Ali Gozen
- ESUT, European Section for UroTechnology.,Department of Urology, SLK Heilbronn Hospital, Heilbronn, Germany
| | - Alexander Govorov
- ESUT, European Section for UroTechnology.,Department of Urology, Moscow University, Moscow, Russia
| | - Evangelos Liatsikos
- ESUT, European Section for UroTechnology.,Department of Urology, Patras University, Patras, Greece
| | - Salvatore Micali
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- ESUT, European Section for UroTechnology.,Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Lütfi Tunc
- ESUT, European Section for UroTechnology.,Department of Urology, Gazi University, Ankara, Turkey
| | - Carlo Buizza
- Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy
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Bozzini G, Maltagliati M, Besana U, Berti L, Calori A, Sighinolfi MC, Micali S, Roche JB, Gozen A, Mueller A, Pushkar D, Liatsikos E, Boldini M, Buizza C, Rocco B. Holmium laser enucleation of the prostate with Virtual Basket mode: faster and better control on bleeding. BMC Urol 2021; 21:28. [PMID: 33622326 PMCID: PMC7903737 DOI: 10.1186/s12894-021-00797-5] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To compare clinical intra and early postoperative outcomes between conventional Holmium laser enucleation of the prostate (HoLEP) and Holmium laser enucleation of the prostate using the Virtual Basket tool (VB-HoLEP) to treat benign prostatic hyperplasia (BPH). METHODS This prospective randomized study enrolled consecutive patients with BPH, who were assigned to undergo either HoLEP (n = 100), or VB-HoLEP (n = 100). All patients were evaluated preoperatively and postoperatively, with particular attention to catheterization time, operative time, blood loss, irrigation volume and hospital stay. We also evaluated the patients at 3 and 6 months after surgery and assessed maximum flow rate (Qmax), postvoid residual urine volume (PVR), the International Prostate Symptom Score (IPSS) and the Quality of Life score (QOLS). RESULTS No significant differences in preoperative parameters between patients in each study arm were found. Compared to HoLEP, VB-HoLEP resulted in less hemoglobin decrease (2.54 vs. 1.12 g/dl, P = 0.03) and reduced operative time (57.33 ± 29.71 vs. 42.99 ± 18.51 min, P = 0.04). HoLEP and VB-HoLEP detrmined similar catheterization time (2.2 vs. 1.9 days, P = 0.45), irrigation volume (33.3 vs. 31.7 l, P = 0.69), and hospital stay (2.8 vs. 2.7 days, P = 0.21). During the 6-month follow-up no significant differences in IPSS, Qmax, PVR, and QOLS were demonstrated. CONCLUSIONS HoLEP and VB-HoLEP are both efficient and safe procedures for relieving lower urinary tract symptoms. VB-HoLEP was statistically superior to HoLEP in blood loss and operative time. However, procedures did not differ significantly in catheterization time, hospital stay, and irrigation volume. No significant differences were demonstrated in QOLS, IPSS, Qmax and PVR throughout the 6-month follow-up. TRIAL REGISTRATION Current Controlled Trials ISRCTN72879639; date of registration: June 25th, 2015. Retrospectively registred.
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Affiliation(s)
- Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Via Arnaldo da Brescia, 21052, Busto Arsizio, VA, Italy.
- ESUT, European Section for UroTechnology, Arnhem, Italy.
| | - Matteo Maltagliati
- Department of Urology, ASST Valle Olona, Via Arnaldo da Brescia, 21052, Busto Arsizio, VA, Italy
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Umberto Besana
- Department of Urology, ASST Valle Olona, Via Arnaldo da Brescia, 21052, Busto Arsizio, VA, Italy
| | - Lorenzo Berti
- Department of Urology, ASST Valle Olona, Via Arnaldo da Brescia, 21052, Busto Arsizio, VA, Italy
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Albert Calori
- Department of Urology, ASST Valle Olona, Via Arnaldo da Brescia, 21052, Busto Arsizio, VA, Italy
| | - Maria Chiara Sighinolfi
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- ESUT, European Section for UroTechnology, Arnhem, Italy
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Ali Gozen
- Department of Urology, SLK Kliniken, Heilbron, Germany
| | | | - Dimitry Pushkar
- Department of Urology, Moscow State University, Moscow, Russia
| | | | - Marco Boldini
- Department of Urology, Clinica Sant'Anna, Lugano, Switzerland
| | - Carlo Buizza
- Department of Urology, ASST Valle Olona, Via Arnaldo da Brescia, 21052, Busto Arsizio, VA, Italy
| | - Bernardo Rocco
- ESUT, European Section for UroTechnology, Arnhem, Italy
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
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Bozzini G, Filippi B, Alriyalat S, Calori A, Besana U, Mueller A, Pushkar D, Romero-Otero J, Pastore A, Sighinolfi MC, Micali S, Buizza C, Rocco B. Disposable versus Reusable Ureteroscopes: A Prospective Multicenter Randomized Comparison. Res Rep Urol 2021; 13:63-71. [PMID: 33604311 PMCID: PMC7882796 DOI: 10.2147/rru.s277049] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/12/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose To compare reusable and disposable flexible ureteroscopes in terms of efficacy and safety for patients undergoing Retrograde Intrarenal Surgery (RIRS). Patients and Methods Patients with a renal stone eligible for RIRS were enrolled in this multicenter, randomized, clinical trial study. Patients were randomized into two groups: group A (90 patients) underwent RIRS with a reusable flexible ureteroscope and group B (90 patients) were treated with a disposable one. Results The patients’ demographics, stone features and pre-operative urine cultures were comparable between the groups. The Stone Free Rates (SFRs) were not significantly different (86.6% and 90.0% for group A and group B, respectively, p=0.11) and the mean cost for each procedure was comparable (2321 € in group A vs 2543 € in group B, p=0.09). However, the days of hospitalization and of antibiotic therapy were higher in group A (p ≤ 0.05). The overall complication rate in group A was 8.8% whilst in group B it was 3.3% (p ≤ 0.05); in particular, group A exhibited a greater number of major complications (Clavien score IIIa-V). The overall postoperative infection rate was 16.6% in group A and 3.3% in group B (p ≤ 0.05). Furthermore, none of the patients in group B developed urosepsis or had a positive blood culture, while 3 patients in group A did (p<0.05). Conclusion The use of disposable ureteroscopes is characterized by significantly lower post-operative complications and infection rates, while having comparable costs and SFRs vis à vis reusable ureteroscopes. Clinical Trial Registration Number: ISRCTN92289221.
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Affiliation(s)
- Giorgio Bozzini
- Urology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | | | | | - Alberto Calori
- Urology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Umberto Besana
- Urology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Alexander Mueller
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Dmitri Pushkar
- Urology Department First Moscow State Medical University, Moscow, Russia
| | | | | | | | | | - Carlo Buizza
- Urology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Bernardo Rocco
- Urology Department, Policlinico of Modena, Modena, Italy
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Bozzini G, Filippi B, Alriyalat S, Calori A, Besana U, Mueller A, Pushkar D, Otero J, Pastore A, Sighinolfi M, Micali S, Buizza C, Rocco B. Disposable versus reusable ureteroscopes: A prospective multicenter randomized comparison. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35417-3] [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: 11/27/2022] Open
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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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Bozzini G, Maltagliati M, Besana U, Calori A, Gastaldi C, Chisena S, Sighinolfi C, Rocco B, Buizza C. A comparison among RIRS, miniperc and ultraminiperc for lower calyceal stones between 1 and 2 cm: A randomised controlled trial. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33861-1] [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: 10/23/2022] Open
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Bozzini G, Berti L, Besana U, Calori A, Antonelli D, Malvestiti G, Sighinolfi C, Rocco B, Buizza C. Prognostic factors predicting late bleeding after ThuLEP. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34067-2] [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: 11/28/2022] Open
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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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Bozzini G, Mueller A, Berti L, Maltagliati M, Buizza C. RE: Lasers versus bipolar technology in the transurethral treatment of benign prostatic enlargement: a systematic review and meta-analysis of comparative studies. World J Urol 2020; 39:1657-1658. [PMID: 32363452 DOI: 10.1007/s00345-020-03231-x] [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] [Received: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Giorgio Bozzini
- Department Of Urology, ASST Valle Olona, Busto Arsizio, VA, Italy.
| | - Alex Mueller
- Urologische Klinik, Spital Limmattal, Schlieren, Switzerland
| | - Lorenzo Berti
- Department Of Urology, ASST Valle Olona, Busto Arsizio, VA, Italy
| | | | - Carlo Buizza
- Department Of Urology, ASST Valle Olona, Busto Arsizio, VA, Italy
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Morini* E, Sighinolfi MC, Beaptiste Roche J, Bozzini G, Romero Otero J, Inzillo R, Berti L, Amato M, Bevilacqua L, Umberto B, Rocco B, Buizza C. MP69-01 “VAPORTUNNEL” URETEROSCOPIC HOLMIUM LASER LITHOTRIPSY: INTRAOPERATIVE AND EARLY POSTOPERATIVE OUTCOMES. J Urol 2020. [DOI: 10.1097/ju.0000000000000949.01] [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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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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Bozzini G, Gastaldi C, Besana U, Calori A, Casellato S, Parma P, Pastore A, Macchi A, Breda A, Gozen A, Skolarikos A, Herrmann T, Scoffone C, Eissa A, Sighinolfi MC, Rocco B, Buizza C, Liatsikos E. Thulium-laser retrograde intra renal ablation of upper urinary tract transitional cell carcinoma: an ESUT Study. Minerva Urol Nephrol 2020; 73:114-121. [PMID: 32026668 DOI: 10.23736/s2724-6051.20.03689-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Radical nephroureterectomy (RNU) is the gold standard treatment for upper urinary tract urothelial carcinoma (UTUC); however, patients presenting with small low-grade UTUC have been treated by flexible ureteroscopic laser ablation with good outcomes. Different types of laser have been discussed in the literature including Holmium and Neodymium lasers. We aimed to assess the safety and efficacy of Thulium laser (Tm:YAG) in the ureteroscopic ablation of UTUC. METHODS A retrospective observational multicentre study of patients diagnosed with papillary UTUC between January 2015 and December 2016 was carried out. All patients underwent ureteroscopic biopsy of the UTUC followed by Tm:YAG ablation. Based on the histopathological grade of the tumor, patients were counseled to undergo either RNU (high- grade tumors) or conservative management and follow-up (low-grade tumor). RESULTS RNU was performed in 31 patients, while the remaining 47 patients (undergone Tm:YAG ablation only) were followed up for a mean of 11.7 months with only 19.2% of patients showing upper tract recurrence and no patients showed postoperative ureteral strictures. Limitations include the short follow-up and retrospective nature of the study. CONCLUSIONS On the short term, thulium Laser ablation of UTUC is safe and feasible especially in low-grade UTUC.
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Affiliation(s)
- Giorgio Bozzini
- ESUT (European section for UroTechnology), Arnehm, the Netherlands - .,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
| | - Stefano Casellato
- Department of Urology, Istituti Clinici Zucchi, Monza, Monza-Brianza, Italy
| | - Paolo Parma
- Department of Urology, Poma Hospital, Mantua, Italy
| | | | - Alberto Macchi
- Department of Urology, IRCCS Istituto Nazionale Tumori Foundation, Milan, Italy
| | - Alberto Breda
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, Puigvert Foundation, Barcelona, Spain
| | - Ali Gozen
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, University of Heidelberg, Heilbronn, Germany
| | - Andreas Skolarikos
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, Athens Univerity, Athens, Greece
| | - Thomas Herrmann
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Frauenfeld, Switzerland
| | - Cesare Scoffone
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, Cottolengo Hospital, Turin, Italy
| | - Ahmed Eissa
- Department of Urology, Baggiovara Hospital, Modena, Italy.,Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Bernardo Rocco
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, Baggiovara Hospital, Modena, Italy
| | - Carlo Buizza
- Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Evangelos Liatsikos
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, University of Patras, Patras, Greece
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Bozzini G, Gastaldi C, Besana U, Calori A, Casellato S, Parma P, Pastore A, Macchi A, Breda A, Gozen A, Skolarikos A, Herrmann T, Scoffone C, Eissa A, Sighinolfi MC, Rocco B, Buizza C, Liatsikos E. Thulium-laser retrograde intra renal ablation of upper urinary tract transitional cell carcinoma: an ESUT Study. Minerva Urol Nephrol 2020. [PMID: 32026668 DOI: 10.23736/s0393-2249.20.03689-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Radical nephroureterectomy (RNU) is the gold standard treatment for upper urinary tract urothelial carcinoma (UTUC); however, patients presenting with small low-grade UTUC have been treated by flexible ureteroscopic laser ablation with good outcomes. Different types of laser have been discussed in the literature including Holmium and Neodymium lasers. We aimed to assess the safety and efficacy of Thulium laser (Tm:YAG) in the ureteroscopic ablation of UTUC. METHODS A retrospective observational multicentre study of patients diagnosed with papillary UTUC between January 2015 and December 2016 was carried out. All patients underwent ureteroscopic biopsy of the UTUC followed by Tm:YAG ablation. Based on the histopathological grade of the tumor, patients were counseled to undergo either RNU (high- grade tumors) or conservative management and follow-up (low-grade tumor). RESULTS RNU was performed in 31 patients, while the remaining 47 patients (undergone Tm:YAG ablation only) were followed up for a mean of 11.7 months with only 19.2% of patients showing upper tract recurrence and no patients showed postoperative ureteral strictures. Limitations include the short follow-up and retrospective nature of the study. CONCLUSIONS On the short term, thulium Laser ablation of UTUC is safe and feasible especially in low-grade UTUC.
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Affiliation(s)
- Giorgio Bozzini
- ESUT (European section for UroTechnology), Arnehm, the Netherlands - .,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
| | - Stefano Casellato
- Department of Urology, Istituti Clinici Zucchi, Monza, Monza-Brianza, Italy
| | - Paolo Parma
- Department of Urology, Poma Hospital, Mantua, Italy
| | | | - Alberto Macchi
- Department of Urology, IRCCS Istituto Nazionale Tumori Foundation, Milan, Italy
| | - Alberto Breda
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, Puigvert Foundation, Barcelona, Spain
| | - Ali Gozen
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, University of Heidelberg, Heilbronn, Germany
| | - Andreas Skolarikos
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, Athens Univerity, Athens, Greece
| | - Thomas Herrmann
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Frauenfeld, Switzerland
| | - Cesare Scoffone
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, Cottolengo Hospital, Turin, Italy
| | - Ahmed Eissa
- Department of Urology, Baggiovara Hospital, Modena, Italy.,Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Bernardo Rocco
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, Baggiovara Hospital, Modena, Italy
| | - Carlo Buizza
- Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Evangelos Liatsikos
- ESUT (European section for UroTechnology), Arnehm, the Netherlands.,Department of Urology, University of Patras, Patras, Greece
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Puliatti S, Eissa A, Bevilacqua L, Morini E, Del Prete C, Ciarlariello S, Sighinolfi M, Spandri V, Azzoni P, Bertoni L, Reggiani Bonetti L, Bozzini G, Buizza C, Rocco B, Pellacani G, Bianchi G. Ex vivo fluorescence confocal microscopy in the assessment of urothelial carcinoma grading in bladder and ureter: Our preliminary experience. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)30071-9] [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: 11/28/2022] Open
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31
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Gastaldi C, Bozzini G, Besana U, Broggini P, Bono P, Pedaci G, Puliatti S, Bevilacqua L, Ciarlariello S, Aydogan T, Sighinolfi M, Micali S, Rocco B, Buizza C. Stone related preoperative factors affecting postoperative PCNL Stone Free Rate (SFR). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)30023-9] [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: 11/26/2022] Open
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32
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Bozzini G, Seveso M, Otero JR, Osmolorskij B, Garcia Cruz E, Margreiter M, Verze P, Besana U, Buizza C. Is there a clinical role for frozen section analysis during partial nephrectomy? A multicenter experience over 10 years. MINERVA UROL NEFROL 2019; 72:332-338. [PMID: 31833332 DOI: 10.23736/s0393-2249.19.03110-2] [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] [Indexed: 11/08/2022]
Abstract
BACKGROUND Frozen section analysis (FSA) is frequently performed during partial nephrectomy (PN). We investigate the utility of intraoperative FSA by evaluating its impact on final surgical margin (SM) status. METHODS Between January 1995 and December 2005, a series of patients who were treated with open PN for renal cell carcinoma was prospectively analyzed. During PN, each patient underwent a FSA on renal parenchyma distal margin. If FSA was positive for infiltration a deeper excision was performed till obtaining a negative FSA. SM outcome of the FSA was compared with the final pathology report. Recurrence-free survival (RFS) and cost analysis on the FSA performed were analyzed. RESULTS A total number of 373 patients were enrolled. FSA was performed in all the patients considered for PN. Fifteen patients had a conversion to radical nephrectomy. Positive SMs at the definitive pathological outcome were found in 36 patients (9.6%). FSA was positive in eight patients (2.1%). In that eight cases after a deeper excision the definitive pathological outcome on SM was still positive in two cases. FSA revealed just 14.3% of the positive SM. Patients with positive SM had a worse follow up considering RFS (P<0.05). Kaplan-Meier analysis revealed that FSA did not considerably contribute to prevent recurrence (P=0.35). 1438 euros was the mean cost of performing a FSA during PN. CONCLUSIONS FSA during PN does not reduce the risk of positive SMs. The use of FSA has also a higher cost related to the procedure.
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Affiliation(s)
- Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy -
| | - Mauro Seveso
- Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | | | | | | | | | - Paolo Verze
- Department of Urology, Vienna General Hospital, Vienna, Austria
| | - Umberto Besana
- Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Carlo Buizza
- Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy
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Borghesi M, Schiavina R, Antonelli A, Buizza C, Celia A, Parma P, De Concilio B, Mengoni F, Romagnoli D, Saraceni G, Brunocilla E, Porreca A. Peri-Operative Outcomes after Open and Robot-Assisted Radical Cystectomy by Using an Advanced Bipolar Seal and Cut Technology (Caiman®): A Prospective, Comparative, and Multi-Institutional Study. Curr Urol 2019; 12:64-69. [PMID: 31114462 DOI: 10.1159/000489421] [Citation(s) in RCA: 5] [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] [Received: 09/06/2017] [Accepted: 11/28/2017] [Indexed: 11/19/2022] Open
Abstract
Objective To report and compare the peri-operative outcomes of patients undergoing open (ORC) and robotic-assisted radical cystectomy (RARC) for bladder cancer performed with a radiofrequency seal and cut device (Caiman®). Materials and Methods Data of patients undergoing ORC or RARC between January 2015 and March 2016 at 6 Italian institutions were prospectively recorded and analyzed. Thirty-and 90-day complications were stratified according to the Martin's criteria and graded according to the Clavien-Dindo classification. Data on operative time, blood loss, transfusion rate, complications, and length of stay were evaluated and compared between the ORC and RARC groups. Results Thirty-three (66%) and 17 (34%) patients were treated with ORC and RARC, respectively. The median age was 72 (64-78) years. Overall operative time was longer in RARC compared to ORC (389 ± 80.1 vs. 242 ± 62.2 min, p < 0.001), while the estimated blood loss during cystectomy was higher after ORC (370 ± 126.8 vs. 243.3 ± 201.6 ml, p = 0.03). The transfusion rate was significantly higher in the ORC compared to RARC (24.2 vs. 5.9%, p = 0.04). Eight (19%) and 7 (16.7%) patients experienced 30- and 90-day post-operative complications, with no significant difference between ORC and RARC. Length of stay was significantly shorter in RARC group (median 7 vs. 14 days, p < 0.001). Conclusion Open and robot-assisted procedures were safely performed by using a new advanced bipolar seal and cut technology (Caiman®). RARC demonstrated to be superior to ORC in terms of bleeding, transfusion rates and length of hospital stay, despite longer operative time.
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Affiliation(s)
- Marco Borghesi
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna
| | | | - Carlo Buizza
- Department of Urology, Ospedale di Circolo, Busto Arsizio
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa
| | - Paolo Parma
- Department of Urology, Carlo Poma Hospital, Mantova
| | | | - Francesco Mengoni
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna
| | - Daniele Romagnoli
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna
| | - Giacomo Saraceni
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna
| | - Angelo Porreca
- Department of Urology, Policlinino Abano Terme, Abano Terme, Italy
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de Girolamo G, Candini V, Buizza C, Ferrari C, Boero ME, Giobbio GM, Goldschmidt N, Greppo S, Iozzino L, Maggi P, Melegari A, Pasqualetti P, Rossi G. Is psychiatric residential facility discharge possible and predictable? A multivariate analytical approach applied to a prospective study in Italy. Soc Psychiatry Psychiatr Epidemiol 2014; 49:157-67. [PMID: 23712514 DOI: 10.1007/s00127-013-0705-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 05/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND A growing number of severely ill patients require long-term care in non-hospital residential facilities (RFs). Despite the magnitude of this development, longitudinal studies surveying fairly large resident samples and yielding important information on this population have been very few. AIMS The aims of the study were (1) to describe the socio-demographic, clinical, and treatment-related characteristics of RF patients during an index period in 2010; (2) to identify predictors and characteristics associated with discharge at the 1-year follow-up; (3) to evaluate clinicians' predictions about each patient's likelihood of home discharge (HD). METHODS A prospective observational cohort study was conducted involving all patients staying in 23 medium-long-term RFs of the St John of God Order with a primary psychiatric diagnosis. A comprehensive set of socio-demographic, clinical, and treatment-related information was gathered and standardized assessments (BPRS, HONOS, PSP, PHI, SLOF, RBANS) were administered to each participant. Logistic regression analyses were run to identify independent discharge predictors. RESULTS The study involved 403 patients (66.7% male), with a mean age of 49 years (SD = 10). The participants' average illness duration was 23 years; median value for length of stay in the RF was 2.2 years. The most frequent diagnosis was schizophrenia (67.5%). 104 (25.8%) were discharged: 13.6% to home, 8.2% to other RFs, 2.2% to supported housing, and 1.5% to prison. Clinicians' predictions about HD were generally erroneous. CONCLUSIONS Very few patients were discharged to independent accommodations after 1 year. The main variables associated with a higher HD likelihood were: illness duration of <15 years and effective social support during the previous year. Lower severity of psychopathology and higher working skill levels were also associated with a significantly greater HD likelihood.
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Affiliation(s)
- G de Girolamo
- IRCCS St John of God Fatebenefratelli, Via Pilastroni, 4, 25125, Brescia, Italy,
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35
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Lanfredi M, de Girolamo G, Candini V, Buizza C, Ferrari C, Boero M, Giobbio G, Goldschmidt N, Greppo S, Iozzino L, Maggi P, Melegari A, Pasqualetti P, Rossi G. 1039 – Predictors of quality of life in a sample of inpatients with schizophrenia in 23 residential facilities in northern italy. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)76163-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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36
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Candini V, Buizza C, de Girolamo G, Ferrari C, Caldera M, Nobili G, Pioli R, Sacchetti E, Saviotti F, Seggioli G, Zanini A. 1040 – A study of effectiveness of structured group psychoeducation for bipolar patients. A controlled trial in italy. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)76164-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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37
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de Girolamo G, Candini V, Buizza C, Giobbio G, Maggi P, Greppo S, Boero M, Melegari A, Goldschmidt N. 1044 – A prospective comparison between formerly and never violent patients living in psychiatric residential facilities. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)76167-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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38
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de Girolamo G, Candini V, Buizza C, Ferrari C, Boero M, Giobbio G, Goldschmidt N, Greppo S, Iozzino L, Maggi P, Melegari A, Pasqualetti P, Rossi G. 1036 – Characteristics of patients and factors associated to discharge from residential facilities: a prospective cohort study in italy. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)76161-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Mandressi A, Buizza C, Antonelli D, Belloni M, Chisena S, Zaroli A, Bernasconi S. Retro-extraperitoneal laparoscopic approach to excise retroperitoneal organs: Kidney and adrenal gland. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/13645709309152957] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
The stigmatisation of the psychiatric patient is still a strong barrier to the integration process of these subjects in our society. Therefore, it is necessary to identify what types of prejudices exist and the types of variables with which they are linked, in order to plan strategies to reduce them. In this exploratory study we administered a semi-structured interview to 303 subjects in order to examine the relationships between social attitudes towards mental disorders and some social demographic variables, the information about mental disorders and the previous 'contacts' with psychiatric patients. The data analysis shows that there is a relationship between knowledge of psychiatric patients and a more positive attitude towards them (i.e., less fear, more integration and work opportunities). This study is to be considered preliminary as far as people's attitudes towards psychiatric patients are concerned. This result encourages the planning and implementation of sensitisation and information programs concerning mental disorders, in the sense that increasing the knowledge of mental disorders could lead to significant achievements in the important fight against the stigma surrounding psychiatric patients.
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Affiliation(s)
- R Vezzoli
- Psychiatry Rehabilitation Unit, IRCCS Centro S. Giovanni di Dio Fatebenefratelli, via Pilastroni 4, Brescia, Italy
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41
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Buizza C, Mandressi A. [Urologic laparoscopy in day hospital]. Arch Ital Urol Androl 1998; 70:137-43. [PMID: 9738318] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Thanks to the less invasiveness that is the limitation of the surgical trauma, the utilization of laparoscopic techniques for managing a wide range of urological disorders has vastly expanded over the past five years. The advantages of less postoperative pain, shorter convalescence and decreased analgesic use collide with the high costs and the necessity of a proper training. Few cases are reported in the literature about urological laparoscopic procedures performed on an outpatient basis. This is due to the requirement of the general anesthesia in most cases with prolonged operative and anesthesiological times. Urological laparoscopic procedures are applicable on an outpatient basis only if the length of the surgery is less than two hours and the patients are able to collaborate and without concurrent medical problems. Therefore we think that the urological laparoscopic diagnostic procedures feasible on an outpatient basis could be: pelvic lymphadenectomy, identification of intra-abdominal testis and intersex, renal biopsy. Varicocelectomy, intra-abdominal orchiectomy, renal cyst resection, pelvic lymphocelectomy and bladder neck suspension can be performed as same-day surgery. We emphasize that the appropriate patient selection is critical: the ability of the patient and his family to care for the patient at home following surgery is of paramount importance in the decision to proceed with outpatient surgery. The availability of appropriately trained and experienced doctors and nurses are crucial for the potential postoperative complications.
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Affiliation(s)
- C Buizza
- Unità Operativa di Urologia, Azienda Ospedaliera di Busto Arsizio
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Buizza C, Antonelli D, Chisena S, Bernasconi S, Zaroli A, Belloni M, Mandressi A. [Conservative therapy in renal carcinoma: follow-up]. Arch Ital Urol Androl 1997; 69:93-100. [PMID: 9213499] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Due to the increasing use of sophisticated imaging techniques, up to 30% of diagnosed renal cell carcinoma (RCC) are asymptomatic and diagnosed incidentally. Getting the cue from our personal survey of conservative renal surgery for renal cell carcinoma with a cancer specific survival of 95.5% after a mean follow up of 32.7 months, a review of the literature is illustrated: numerous studies have documented the technical success rate with this approach as well as long term disease free survival, comparable to that obtained by radical nephrectomy, in patients with unilateral, small, low stage tumors and normal opposite kidney. Patient selection is of extreme importance in case of partial resection in the presence of a normal contralateral kidney. The tumor must be < 3-4 cm, solitary, well delineated on CT, without invasion of the perinephric far or pyelocaliceal system (T1 and T2), easily resectable with at least 1 cm of healthy parenchyma. Only well informed patients who agree on a careful follow up after surgery can be candidates for kidney sparing surgery. In case of imperative surgery the follow up must be strict and personified for every single patient. Those patients who underwent a partial nephrectomy in presence of a normal contralateral kidney should be monitored with a conventional follow up monitored in order to detect an eventual local recurrence: 12 monthly ultrasonography and contrast enhanced CT scan alternately every 6 months for the first five years after surgery and then lifelong once a year by echography and/or CT scan.
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Affiliation(s)
- C Buizza
- Unità Operativa di Urologia, Ospedale di Busto Arisizio, VA
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43
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Mandressi A, Bernasconi S, Zaroli A, Buizza C, Belloni M, Antonelli D, Chisena S, Taverna GL. [100 orthotopic neobladders in men after cystectomy: a 5-year experience]. Arch Ital Urol Androl 1996; 68:323-31. [PMID: 9026235] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Urethral bladder substitution is traditionally suggested to good prognosis cystectomized patients. In our series this diversion was chosen for all but the salvage cystectomized men. Between the 1st of February 1991 and the 30th of April 1996, one hundred consecutive men underwent lower urinary tract reconstruction after radical cystoprostatectomy for bladder cancer. An orthotopic ileal neobladder was constructed (in 84 cases according to Kock's technique and in 16 to Studer's technique). Total early complication rate was 29% (29/100), including one perioperative death due to sepsis (mortality rate 1%). 13 patients required surgery (6 retroperitoneal hematomas, 2 wound dehiscences, 1 urinary fistula, 1 lymphocele, 1 rectal-neobladder fistula, 1 rectal-cutaneous fistula, 1 necrosis of the terminal ureter). The late complication rate was 19% (19/100); in 8 cases reparative surgery was required (1 mechanical ileus, 2 bladder neck stenoses, 3 stenoses of the ureteral anastomosis, 2 laparoceles). Four patients were lost at the follow-up; out of the 96 remaining patients only 85 were evaluable for continence: continence during the day was achieved in a period between there to six months in 78 patients (91.7%); night continence was achieved with planned awakenings in 60 patients (70.5%). Eight patients recovered potency, another 7 had successful intercourses after PGE1 intracavernous injection. Renal function based on creatinine value was mildly impaired in 5/78 evaluable patients (6.4%) (peak creatinine 2.8 mg%). In 29 patients tumour progression was observed (29%): 9 pelvic and 20 metastatic. Among the latter 2 urethral recurrences were observed (2%). Twenty-four patients died for metastatic cancer, one for primitive lung cancer, one patient for postoperative septic shock. Adjuvant chemotherapy was administered in 11 patients without complication with an indwelling catheter in the neobladder to avoid drug reabsorption. Four patients showed complete response (2 are alive after a mean of 12 months), 6 were non responders and 1 had a partial response. In our series the ileal neobladder is a feasible method of urinary diversion when urethral cancer involvement is ruled out. Early and late complications are proportionally decreasing with experience and overall continence is satisfactory. The fate of the neobladder depends on both the technique and patient's compliance. Only educated patients can cope successfully with neobladder diversion without major complications. All the patients operated for non salvage cystectomy deserve to be diverted with a continent urethral bladder substitution.
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Affiliation(s)
- A Mandressi
- Unità Operativa di Urologia, Azienda USSL 3, Busto Arsizio (VA)
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Mandressi A, Buizza C, Antonelli D, Chisena S. Is laparoscopy a worthy method to treat varicocele? Comparison between 160 cases of two-port laparoscopic and 120 cases of open inguinal spermatic vein ligation. J Endourol 1996; 10:435-41. [PMID: 8905490 DOI: 10.1089/end.1996.10.435] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Because it is still a puzzling debate whether ligation of a unilateral varicose spermatic vein is worth performing by laparoscopy, even with the two-port technique, we conducted a study in which 280 patients with palpable left varicoceles were treated with spermatic vein ligation either by open surgery (120 patients) or by laparoscopy (160 patients). The inclusion criteria were the same for each group, and the two groups were homogeneous in preoperative clinical features and patient characteristics. The clinical outcomes were compared 6 months after surgery, and the costs of each treatment were analyzed. The procedures showed the same effectiveness and intraoperative safety. Open surgery scored a shorter operating time, whereas hospitalization was significantly shorter in the laparoscopic group. Postoperative complications occurred more frequently in the open surgery than in the laparoscopic group (7.5% and 0.6%, respectively). Of the patients treated, 197 were eligible for seminal analysis: 82 and 115 in the open surgery and laparoscopic groups, respectively. Significant improvement in seminal analysis was recorded in both groups, whereas no difference was found between the groups. Laparoscopy costs about 60% more than open surgery. It can thus be concluded that laparoscopy is not a worthy method to treat unilateral varicocele.
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Affiliation(s)
- A Mandressi
- Urological Operative Unit, Busto Arsizio Hospital, Italy
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Chisena S, Antonelli D, Bernasconi S, Zaroli A, Buizza C, Belloni M, Mandressi A. [T1G3 of the bladder: our experience]. Arch Ital Urol Androl 1996; 68:51-4. [PMID: 8664923] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
From June 1991 to June 1995 we treated 20 patients affected by T1 G3 TCC of the bladder, 18 men and 2 women, with a mean age of 65.1 years (46-71). In 11 patients the disease was monofocal, with diameter of the tumor under 3.5 cms; in 5 patients monofocal with diameter of the tumor over 3.5 cms; in 1 patient multifocal and in 3 patients complex (mono or multifocal associated with CIS). The 11 patients with monofocal disease under 3.5 cms were treated with TUR-B, the other 9 (all males) were submitted to radical cystectomy with OINB diversion as first choice treatment. The mean follow up (all patients) was 3.2 years (6 months-14 years). Out of the patients of the former group only 3 did not show any relapse, the other 8 showed multiple relapses or metachronous tumors: 5 were treated with TUR-B+BCG, 3 were cystectomized. The patients submitted to cystectomy as first choice treatment did not show any progression of the disease after a mean follow-up of 19.8 months.
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Chisena S, Mandressi A, Zaroli A, Belloni M, Antonelli D, Bernasconi S, Buizza C. [Alpha blockers, TUS-P and TUR-P in the treatment of benign prostatic hypertrophy. A comparison using multivariate statistical analysis]. Arch Ital Urol Androl 1995; 67:41-5. [PMID: 7538387] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
To evaluate the effectiveness of Alpha-blockers, TUI-P and TUR-P in the treatment of obstruction due to BPH, 50 patients, never before treated, were considered. Fifteen were treated with alfuzosin chlorhydrate 7.5 mg/day for four months, 15 were submitted to TUI-P and 20 to TUR-P. In all patients linear purr was carried out before treatment and was repeated from 60 to 90 days after intervention in surgical patients and during the fourth month of treatment in patients treated with alfuzosin. The data obtained were analyzed with the T-test both for dependent and independent samples. The results show that Alpha-blocker contain an increase in maximal flow, without decreasing bladder voiding pressures. On the contrary TUI-P and TUR-P, besides the increase in maximal flow obtain a significant reduction of bladder pressures. The conclusions are the following: maximal flow alone is not a sufficient parameter to evaluate the work of the bladder, the entity of the obstruction and the effectiveness of the therapy. The treatment with Alpha-blockers is unable to reduce the obstruction due to BPH. TUI-P and TUR-P realize an effective deobstruction. Under the same deobstructing effect TUR-P assures a better voiding performance by obtaining higher flow values.
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Affiliation(s)
- S Chisena
- Unità Operativa di Urologia, Ospedale di Busto Arsizio, Va
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Zaroli A, Mandressi A, Belloni M, Antonelli D, Bernasconi S, Buizza C, Chisena S. [Physiopathology of BPH obstruction]. Arch Ital Urol Androl 1995; 67:13-6. [PMID: 7538381] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The underlying BPH related mechanisms of outlet obstruction are outlined (modification of the shape of the bladder neck, failure of funnel formation, geometric variations of the urethra, alpha 1 adrenoceptors mediated sympathetic hyperactivity at the level of the lower genito-urinary tract). Bladder voiding dysfunction in response to prostate obstruction is also discussed and correlated to ultrastructural patterns and clinical symptoms. Finally, a pathogenetic mechanism for detrusor overactivity in obstructed bladder is suggested.
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Affiliation(s)
- A Zaroli
- U.O. di Urologia, U.S.S.L. n. 8, Busto Arsizio
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Mandressi A, Buizza C, Antonelli D, Chisena S, Servadio G. Retroperitoneoscopy. Ann Urol (Paris) 1995; 29:91-96. [PMID: 7646003] [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] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
From October 1992 to June 1994, 12 nephrectomies (all for benign diseases), one nephropexy and 7 adrenalectomies (one pheochromocitoma, three adenomas, one cyst) were performed. In all the cases the retroperitoneal working space was created with direct CO2 insufflation (without balloon) with the patient in prone position. Four 10-12 mm ports were always inserted in the lumbar area. Eighteen procedures were successful (90%), 2 failed (one nephrectomy and one adrenalectomy) and underwent open surgery. Twelve procedures were carried out with the patients in prone position, six (one nephropexy and 5 nephrectomies) were performed with the patients in lateral de cubitus. The removal of organs was managed either through an enlarged port (phi 2 cm.) or by joining vertically the stabs of the two ports lateral to the sarcospinalis muscle. The average operative time was 4.10 hours) range 2.30-5.20). Both CO2 absorption and blood loss were negligible. No major complications were observed. Postoperative pain never required medications. All patients were able to stand on the 1st postoperative day. Mean postoperative hospitalisation was 4 days. Direct retroperitoneal approach provides optimal access for laparoscopic renal, proximal ureteral and adrenal surgery, avoiding extensive dissection and handling of intraperitoneal structures.
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Affiliation(s)
- A Mandressi
- Unitá Operativa di Urologia, Ospedale Generale, Busto Arsizio, VA, Italy
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Mandressi A, Buizza C, Assi A, Solbiati L, Antonelli D, Allaria P, Greco S, Cioffi V. [Familial multiple bilateral carcinoma of the kidney: clinical strategy and surgical approach]. Arch Ital Urol Androl 1993; 65:539-49. [PMID: 8252084] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A case of familiar bilateral multicentric RCC in a young woman is an ideal model to evaluate preoperative and intraoperative diagnostic and surgical tools in order to achieve two distinct goals: the oncologic radicalness and the renal function preserved. Radical bilateral nephrectomy, the renal hypothermia by perfusion of both kidneys, the bench high resolution sonography of parenchyma, the choose of one kidney suitable for conservative surgery, the resection of suspect lesions with intraoperative pathology, the reconstructive bench surgery, the autotransplantation, are the steps accurately performed with particular concern to eradication of all the tumoral lesions present in the kidneys. The results confirm that renal function has been preserved with this method. Radicalness should be appointed by a longlasting follow up. However, as it is discussed, conservative surgery, when accurately performed can give results not different from radical demolitive surgery. In this paper tools to improve diagnostic and therapeutic methods are described in order to increase the diagnostic accuracy and the therapeutic efficacy. The possibility that this multiple RCC can be a part of the abnormalities occurring in the Von Hippel-Lindau syndrome does not change the surgical approach, being the RCC the worst prognostic factor of the syndrome.
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Affiliation(s)
- A Mandressi
- Unità Operativa di Urologia, USSL n. 8, Ospedale di Busto Arsizio, VA
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Mandressi A, Buizza C, Belloni M, Chisena S, Antonelli D, Bernasconi S, Zaroli A. [Retroextraperitoneal laparoscopic nephrectomy]. Arch Ital Urol Androl 1993; 65:251-3. [PMID: 8334447] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The authors describe a new technique of laparoscopic nephrectomy; the retroextraperitoneal approach has been successfully performed in 4 patients with the following indications: 2 non functioning hydronephrotic kidneys, 2 atrophic chronic pyelonephritic kidneys. The patient was put in a proneoblique position after the retrograde placement of a ureteral catheter up to the renal pelvis, through which the contrast medium was injected. The Veress needle is inserted under fluoroscopic guidance into the perirenal fatty space which was insufflated with CO2. One 12 mm and three 10 mm Trocars were inserted into the cavity created by gas in the trapezoid area whose boundaries are: the 12th rib, the iliac crest, the posterior axillary line and the sacrospinalis muscle. The kidney was progressively dissected free with the traditional laparoscopic instruments (forceps and scissors). The artery has always been closed with clips. In two patients the vein has been stapled and cut with EndoGIA. After the section of the clipped ureter the kidney was removed en block by pulling it out through the 20 mm Kleiber Trocar in two cases and in the other two cases by extending to a length of 4 cm the port of one Trocar. The average total operating time was 4.35 hours and blood loss < 200 cc. The patients were all discharged on the fourth postoperative day. The advantages of the retroextraperitoneal approach with respect to open surgery are synthetically the following: a less traumatic and a more accurate dissection almost always bloodless; a shorter hospitalization period; an almost painless postoperative course.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A Mandressi
- Unità Operativa di Urologia, Ospedale di Busto Arsizio U.S.S.L. 8
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