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Galletta M, De Pasquale M, Buttitta A, Viganò S, Mucciardi G, Giannarini G, Ficarra V. Combined spinal and epidural anaesthesia for open radical cystectomy: A controlled study. BJUI Compass 2024; 5:101-108. [PMID: 38179016 PMCID: PMC10764166 DOI: 10.1002/bco2.221] [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: 11/04/2022] [Revised: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2024] Open
Abstract
Objectives To evaluate the feasibility of loco-regional anaesthesia and to compare perioperative outcomes between loco-regional and standard general anaesthesia in patients with bladder cancer undergoing open radical cystectomy (ORC). Patients and Methods A single-surgeon cohort of 60 consecutive patients with bladder cancer undergoing ORC with an enhanced recovery after surgery protocol between May 2020 and December 2021 was analysed. A study group of 15 patients operated on under combined spinal and epidural anaesthesia was compared with a control group of 45 patients receiving standard general anaesthesia. Intraoperative outcomes were haemodynamic stability, estimated blood loss, intraoperative red blood cell transfusion rate, and anaesthesia time. Postoperative outcomes were pain assessment 24 h after surgery, time to mobilisation, return to oral diet, time to bowel function recovery, length of stay and rate of 90-day complications. Results No patients required conversion from loco-regional to general anaesthesia. All patients in both groups were haemodynamically stable. No significant differences between groups were observed for all other intraoperative outcomes, except for a shorter anaesthesia time in the study versus control group (250 vs. 290 min, p = 0.01). Pain visual score 24 h after surgery was significantly lower in the study versus control group (0 vs. 2, p < 0.001). No significant differences were observed for all other postoperative outcomes, with a comparable time to bowel function recovery (5 days in each group for stool passage), and 90-day complication rate (46.6% vs. 42.2% for the study vs. control group, p = 0.76). Conclusion Our exploratory, controlled study confirmed the feasibility, safety and effectiveness of a pure loco-regional anaesthesia in patients with bladder cancer undergoing ORC. No significant differences were observed in intra- and postoperative outcomes between loco-regional and general anaesthesia, except for a significantly shorter anaesthesia time and greater pain reduction in the early postoperative period for the former.
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Affiliation(s)
- Maria Galletta
- Gaetano Barresi Department of Human and Paediatric Pathology, Anaesthesiology SectionUniversity of MessinaMessinaItaly
| | - Maria De Pasquale
- Gaetano Barresi Department of Human and Paediatric Pathology, Anaesthesiology SectionUniversity of MessinaMessinaItaly
| | - Alessandro Buttitta
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology SectionUniversity of MessinaMessinaItaly
| | - Silvia Viganò
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology SectionUniversity of MessinaMessinaItaly
| | - Giuseppe Mucciardi
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology SectionUniversity of MessinaMessinaItaly
| | | | - Vincenzo Ficarra
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology SectionUniversity of MessinaMessinaItaly
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Falagario UG, Lantz A, Jambor I, Busetto GM, Bettocchi C, Finati M, Ricapito A, Luzzago S, Ferro M, Musi G, Totaro A, Racioppi M, Carbonara U, Checcucci E, Manfredi M, D'Aietti D, Porcaro AB, Nordström T, Björnebo L, Oderda M, Soria F, Taimen P, Aronen HJ, Perez IM, Ettala O, Marchioni M, Simone G, Ferriero M, Brassetti A, Napolitano L, Carmignani L, Signorini C, Conti A, Ludovico G, Scarcia M, Trombetta C, Claps F, Traunero F, Montanari E, Boeri L, Maggi M, Del Giudice F, Bove P, Forte V, Ficarra V, Rossanese M, Mucciardi G, Pagliarulo V, Tafuri A, Mirone V, Schips L, Antonelli A, Gontero P, Cormio L, Sciarra A, Porpiglia F, Bassi P, Ditonno P, Boström PJ, Messina E, Panebianco V, De Cobelli O, Carrieri G. Diagnosis of prostate cancer with magnetic resonance imaging in men treated with 5-alpha-reductase inhibitors. World J Urol 2023; 41:2967-2974. [PMID: 37787941 PMCID: PMC10632288 DOI: 10.1007/s00345-023-04634-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
PURPOSE The primary aim of this study was to evaluate if exposure to 5-alpha-reductase inhibitors (5-ARIs) modifies the effect of MRI for the diagnosis of clinically significant Prostate Cancer (csPCa) (ISUP Gleason grade ≥ 2). METHODS This study is a multicenter cohort study including patients undergoing prostate biopsy and MRI at 24 institutions between 2013 and 2022. Multivariable analysis predicting csPCa with an interaction term between 5-ARIs and PIRADS score was performed. Sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values of MRI were compared in treated and untreated patients. RESULTS 705 patients (9%) were treated with 5-ARIs [median age 69 years, Interquartile range (IQR): 65, 73; median PSA 6.3 ng/ml, IQR 4.0, 9.0; median prostate volume 53 ml, IQR 40, 72] and 6913 were 5-ARIs naïve (age 66 years, IQR 60, 71; PSA 6.5 ng/ml, IQR 4.8, 9.0; prostate volume 50 ml, IQR 37, 65). MRI showed PIRADS 1-2, 3, 4, and 5 lesions in 141 (20%), 158 (22%), 258 (37%), and 148 (21%) patients treated with 5-ARIs, and 878 (13%), 1764 (25%), 2948 (43%), and 1323 (19%) of untreated patients (p < 0.0001). No difference was found in csPCa detection rates, but diagnosis of high-grade PCa (ISUP GG ≥ 3) was higher in treated patients (23% vs 19%, p = 0.013). We did not find any evidence of interaction between PIRADS score and 5-ARIs exposure in predicting csPCa. Sensitivity, specificity, PPV, and NPV of PIRADS ≥ 3 were 94%, 29%, 46%, and 88% in treated patients and 96%, 18%, 43%, and 88% in untreated patients, respectively. CONCLUSIONS Exposure to 5-ARIs does not affect the association of PIRADS score with csPCa. Higher rates of high-grade PCa were detected in treated patients, but most were clearly visible on MRI as PIRADS 4 and 5 lesions. TRIAL REGISTRATION The present study was registered at ClinicalTrials.gov number: NCT05078359.
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Affiliation(s)
- Ugo G Falagario
- Unit of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy.
| | - Anna Lantz
- Unit of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ivan Jambor
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Gian Maria Busetto
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Carlo Bettocchi
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Marco Finati
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Anna Ricapito
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Angelo Totaro
- Department of Urology, Catholic University Medical School "A. Gemelli" Hospital, Rome, Italy
| | - Marco Racioppi
- Department of Urology, Catholic University Medical School "A. Gemelli" Hospital, Rome, Italy
| | - Umberto Carbonara
- Department of Urology, Andrology and Kidney Transplantation, University of Bari, Bari, Italy
| | - Enrico Checcucci
- Department of Urology, Azienda Ospedaliera Universitaria "San Luigi Gonzaga", University of Turin, Turin, Italy
| | - Matteo Manfredi
- Department of Urology, Azienda Ospedaliera Universitaria "San Luigi Gonzaga", University of Turin, Turin, Italy
| | - Damiano D'Aietti
- UOC Urologia, Azienda Ospedaliera Universitaria Integrata Di Verona, Verona, Italy
| | | | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Björnebo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marco Oderda
- Department of Surgical Sciences, Città Della Salute E Della Scienza Di Torino, Molinette Hospital, Turin, Italy
| | - Francesco Soria
- Department of Surgical Sciences, Città Della Salute E Della Scienza Di Torino, Molinette Hospital, Turin, Italy
| | - Pekka Taimen
- Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Ileana Montoya Perez
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Otto Ettala
- Department of Urology, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | - Michele Marchioni
- Department of Urology, Università "G.d'Annunzio", Chieti-Pescara, Italy
| | - Giuseppe Simone
- Department of Oncologic Urology, IRCCS "Regina Elena" National Cancer Institute of Rome, Rome, Italy
| | - Mariaconsiglia Ferriero
- Department of Oncologic Urology, IRCCS "Regina Elena" National Cancer Institute of Rome, Rome, Italy
| | - Aldo Brassetti
- Department of Oncologic Urology, IRCCS "Regina Elena" National Cancer Institute of Rome, Rome, Italy
| | - Luigi Napolitano
- Department of Urology, University of Naples Federico II, Naples, Italy
| | | | | | | | - Giuseppe Ludovico
- Department of Urology, Ente Ecclesiastico Miulli, Acquaviva Delle Fonti, Italy
| | - Marcello Scarcia
- Department of Urology, Ente Ecclesiastico Miulli, Acquaviva Delle Fonti, Italy
| | | | | | | | - Emanuele Montanari
- Department of Urology, IRCCS Foundation Ca' Granda-Maggiore Policlinico Hospital, Milan, Italy
| | - Luca Boeri
- Department of Urology, IRCCS Foundation Ca' Granda-Maggiore Policlinico Hospital, Milan, Italy
| | - Martina Maggi
- Department of Maternal Infant and Urological Sciences, Sapienza Rome University, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urological Sciences, Sapienza Rome University, Rome, Italy
| | - Pierluigi Bove
- Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy
| | - Valerio Forte
- Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy
| | | | - Marta Rossanese
- Department of Urology, University of Messina, Messina, Italy
| | | | | | | | - Vincenzo Mirone
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Luigi Schips
- Department of Urology, Università "G.d'Annunzio", Chieti-Pescara, Italy
| | - Alessandro Antonelli
- UOC Urologia, Azienda Ospedaliera Universitaria Integrata Di Verona, Verona, Italy
| | - Paolo Gontero
- Department of Surgical Sciences, Città Della Salute E Della Scienza Di Torino, Molinette Hospital, Turin, Italy
| | - Luigi Cormio
- Unit of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Ospedale L. Bonomo, Andria, Italy
| | - Alessandro Sciarra
- Department of Maternal Infant and Urological Sciences, Sapienza Rome University, Rome, Italy
| | - Francesco Porpiglia
- Department of Urology, Azienda Ospedaliera Universitaria "San Luigi Gonzaga", University of Turin, Turin, Italy
| | - PierFrancesco Bassi
- Department of Urology, Catholic University Medical School "A. Gemelli" Hospital, Rome, Italy
| | - Pasquale Ditonno
- Department of Urology, Andrology and Kidney Transplantation, University of Bari, Bari, Italy
| | - Peter J Boström
- Department of Urology, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | - Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Ottavio De Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
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Ficarra V, Rossanese M, Gilante M, Foti M, Macchione L, Mucciardi G, Martini M, Giannarini G. Retzius-sparing vs. standard robot-assisted radical prostatectomy for clinically localised prostate cancer: a comparative study. Prostate Cancer Prostatic Dis 2023; 26:568-574. [PMID: 36443438 DOI: 10.1038/s41391-022-00625-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Retzius-sparing robot-assisted radical prostatectomy (RARP) is not yet universally accepted due to still limited functional data and some concerns on oncological safety compared to the standard one. We assessed perioperative, pathological and early functional outcomes in patients with clinically localised prostate cancer treated with Retzius-sparing versus standard RARP. METHODS A single-surgeon cohort of 207 consecutive patients undergoing RARP was analysed. A later study group of 102 patients receiving the Retzius-sparing approach was compared with an earlier control group of 105 patients receiving the standard one. Urinary continence recovery 1 week after catheter removal was the primary study outcome. Urinary continence recovery 1, 2, 3 and 6 months after catheter removal, potency recovery 6 months postoperatively, rate of perioperative complications and positive surgical margins were secondary study outcomes. RESULTS Patients in the study group reported significantly higher urinary continence recovery rates 1 week (91.2% vs. 54.3%, p < 0.001), 1 month (92.2% vs. 66.7%, p < 0.001), 2 months (95.1% vs. 74.3%, p < 0.001), 3 months (96.1% vs. 83.8%, p = 0.01), but not 6 months (97% vs 90.5%, p = 0.09) after catheter removal compared to controls. Potency recovery rates 6 months after catheter removal were significantly higher in the study than the control group (68.2% vs 51.6%, p = 0.03). On multivariable analyses, the Retzius-sparing approach was an independent predictor of 1-week urinary continence recovery, but not of 6-month potency recovery. There were significant differences neither in perioperative complication rate (9.8% in the study vs. 14.3% in the control group, p = 0.28) nor in positive surgical margin rate (9.8% in the study vs. 8.6% in the control group, p = 0.75). CONCLUSIONS In a comparative study, we observed a significant improvement in immediate urinary continence, but not in early potency recovery, using the Retzius-sparing compared to the standard approach for RARP, with no increase in perioperative complication and positive surgical margin rate.
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Affiliation(s)
- Vincenzo Ficarra
- Gaetano Barresi Department of Human and Paediatric Pathology, Urologic Section, University of Messina, Messina, Italy
| | - Marta Rossanese
- Gaetano Barresi Department of Human and Paediatric Pathology, Urologic Section, University of Messina, Messina, Italy
| | - Manuel Gilante
- Gaetano Barresi Department of Human and Paediatric Pathology, Urologic Section, University of Messina, Messina, Italy
| | - Mauro Foti
- Gaetano Barresi Department of Human and Paediatric Pathology, Urologic Section, University of Messina, Messina, Italy
| | - Luciano Macchione
- Gaetano Barresi Department of Human and Paediatric Pathology, Urologic Section, University of Messina, Messina, Italy
| | - Giuseppe Mucciardi
- Gaetano Barresi Department of Human and Paediatric Pathology, Urologic Section, University of Messina, Messina, Italy
| | - Maurizio Martini
- Gaetano Barresi Department of Human and Paediatric Pathology, Pathology Section, University of Messina, Messina, Italy
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy.
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Romito I, Giannarini G, Rossanese M, Mucciardi G, Simonato A, Ficarra V. Incidence of Rectal Injury After Radical Prostatectomy: A Systematic Review and Meta-analysis. EUR UROL SUPPL 2023; 52:85-99. [PMID: 37213241 PMCID: PMC10192923 DOI: 10.1016/j.euros.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 05/23/2023] Open
Abstract
Context Rectal injury (RI) is a dreaded complication after radical prostatectomy (RP), increasing the risk of early postoperative complications, such as bleeding and severe infection/sepsis, and late sequelae, such as a rectourethral fistula (RUF). Considering its traditionally low incidence, uncertainty remains as to predisposing risk factors and management. Objective To examine the incidence of RI after RP in contemporary series and to propose a pragmatic algorithm for its management. Evidence acquisition A systematic literature search was performed using the Medline and Scopus databases. Studies reporting data on RI incidence were selected. Subgroup analyses were conducted to assess the differential incidence by age, surgical approach, salvage RP after radiation therapy, and previous benign prostatic hyperplasia (BPH)-related surgery. Evidence synthesis Eighty-eight, mostly retrospective noncomparative, studies were selected. The meta-analysis obtained a pooled RI incidence of 0.58% (95% confidence interval [CI] 0.46-0.73) in contemporary series with significant across-study heterogeneity (I2 = 100%, p < 0.00001). The highest RI incidence was found in patients undergoing open RP (1.25%; 95% CI 0.66-2.38) and laparoscopic RP (1.25%; 95% CI 0.75-2.08) followed by perineal RP (0.19%; 95% CI 0-276.95) and robotic RP (0.08%; 95% CI 0.02-0.31). Age ≥60 yr (0.56%; 95% CI 0.37-06) and salvage RP after radiation therapy (6.01%; 95% CI 3.99-9.05), but not previous BPH-related surgery (4.08%, 95% CI 0.92-18.20), were also associated with an increased RI incidence. Intraoperative versus postoperative RI detection was associated with a significantly decreased risk of severe postoperative complications (such as sepsis and bleeding) and subsequent formation of a RUF. Conclusions RI is a rare, but potentially devastating, complication following RP. RI incidence was higher in patients ≥60 yr of age, and in those who underwent open/laparoscopic approach or salvage RP after radiation therapy. Intraoperative RI detection and repair apparently constitute the single most critical step to significantly decrease the risk of major postoperative complications and subsequent RUF formation. Conversely, intraoperatively undetected RI can lead more often to severe infective complications and RUF, the management of which remains poorly standardised and requires complex procedures. Patient summary Accidental rectum tear is a rare, but potentially devastating, complication in men undergoing prostate removal for cancer. It occurs more often in patients aged 60 yr or older as well as in those who underwent prostate removal via an open/laparoscopic approach and/or prostate removal after radiation therapy for recurrent disease. Prompt identification and repair of this condition during the initial operation are the key to reduce further complications such as the formation of an abnormal opening between the rectum and the urinary tract.
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Affiliation(s)
- Ilaria Romito
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Marta Rossanese
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
| | - Giuseppe Mucciardi
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Oral Sciences, Urology Section, University of Palermo, Palermo, Italy
| | - Vincenzo Ficarra
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
- Corresponding author. Gaetano Barresi Department of Human and Paediatric Pathology, Urologic Section, University of Messina, Azienda Ospedaliera Universitaria Policlinico “Gaetano Martino”, Via Consolare Valeria 1, IT-98125 Messina, Italy. Tel. +390902217027.
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Mucciardi G, Buttitta A, Rossanese M, Macchione L, Anastasi G, Giannarini G, Ficarra V. Probability of detecting significant and aggressive prostate cancer by MRI-identified lesions in a series of biopsy naïve-men. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00350-0] [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: 02/12/2023]
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Giannarini G, Rossanese M, Macchione L, Mucciardi G, Crestani A, Ficarra V. Robot-assisted Bladder Diverticulectomy Using a Transperitoneal Extravesical Approach. EUR UROL SUPPL 2022; 44:162-168. [PMID: 36110902 PMCID: PMC9468349 DOI: 10.1016/j.euros.2022.08.016] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/15/2022] Open
Abstract
Background Objective Design, setting, and participants Surgical procedure Outcome measurements and statistical analysis Results and limitations Conclusions Patient summary
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Affiliation(s)
- Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Marta Rossanese
- Urology Section, Gaetano Barresi Department of Human and Paediatric Pathology, University of Messina, Messina, Italy
| | - Luciano Macchione
- Urology Section, Gaetano Barresi Department of Human and Paediatric Pathology, University of Messina, Messina, Italy
| | - Giuseppe Mucciardi
- Urology Section, Gaetano Barresi Department of Human and Paediatric Pathology, University of Messina, Messina, Italy
| | - Alessandro Crestani
- Oncological Urology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Vincenzo Ficarra
- Urology Section, Gaetano Barresi Department of Human and Paediatric Pathology, University of Messina, Messina, Italy
- Corresponding author. Urology Section, Gaetano Barresi Department of Human and Paediatric Pathology, University of Messina, Policlinico Universitario G. Martino, Via Consolare Valeria 1, Messina, Italy.
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Rossanese M, Lombardo D, Pollicino T, Mucciardi G, Raimondo G, Ficarra V. The occult hepatitis b infection (OBI) plays an important role in the pathogenesis of parenchymal renal cell carcinoma (RCC). EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01306-4] [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: 11/06/2022] Open
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Mucciardi G, Favilla V, Gilante M, Foti M, Rossanese M, Isgrò A, Ficarra V. Bipolar transurethral resection of the prostate (TURP) for large (>80 CC) benign prostatic enlargement (BPE). EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01075-8] [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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Ficarra V, Giannarini G, Alario G, Tulone G, Rossanese M, Mucciardi G, Valotto C, Simonato A. The novel urethral fixation technique improves urinary continence recovery in men undergoing open radical cystectomy and ileal orthotopic neobladder. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00985-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] Open
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Giannarini G, Rossanese M, Crestani A, Alario G, Mucciardi G, Isgrò A, Ficarra V. The novel urethral fixation technique versus standard vesico-urethral anastomosis improves early urinary continence recovery after robot-assisted radical prostatectomy: a prospective comparative study. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)01017-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: 11/16/2022] Open
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Ficarra V, Giannarini G, Alario G, Tulone G, Rossanese M, Mucciardi G, Valotto C, Simonato A. Urethral fixation technique improves urinary continence recovery in male patients undergoing open radical cystectomy and ileal orthotopic neobladder. Minerva Urol Nephrol 2021; 74:313-320. [PMID: 34156199 DOI: 10.23736/s2724-6051.21.04354-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We assessed urinary continence recovery and perioperative complications in patients operated on with the novel urethral fixation technique during open radical cystectomy (RC) with ileal orthotopic neobladder (IONB). METHODS A retrospective cohort of 82 consecutive male patients undergoing open RC with IONB between 07/2013 and 06/2020 was analyzed. A study group of 48 patients operated on with the urethral fixation technique was compared with a control group of 34 patients receiving standard neovesico-urethral anastomosis. In the study group, the urethral stump was fixed to the dorsal median raphe posteriorly and to the medial portion of levator ani muscle postero-laterally in order to avoid urethral retraction/deviation. Urinary continence recovery and perioperative complications were assessed and compared between the two groups. RESULTS The two groups were comparable with regard to demographic, clinical and pathological variables. At the median follow-up of 36 months, 42 (87.5%) patients in the study, and 22 (64.7%) in the control group during daytime, and 32 (66.7%) patients in the study, and 15 (44.1%) patients in the control group during nighttime used no pads or a safety pad (p=0.01 and p=0.04, respectively). Ninety-day postoperative complications were observed in 14 (29.2%) patients in the study, and in 10 (29.4%) cases in the control group (p=0.77). CONCLUSIONS In our exploratory case-control study of male patients undergoing open RC with IONB, we observed a significant improvement in daytime and nighttime urinary continence recovery with no increase in perioperative complications using the novel urethral fixation technique compared to the standard neovesical-urethral anastomosis.
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Affiliation(s)
- Vincenzo Ficarra
- Urologic Section, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy -
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Giuseppe Alario
- Urologic Section, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy
| | - Gabriele Tulone
- Urology Section, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Marta Rossanese
- Urologic Section, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy
| | - Giuseppe Mucciardi
- Urologic Section, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy
| | - Claudio Valotto
- Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Alchiede Simonato
- Urology Section, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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Giannarini G, Crestani A, Rossanese M, Alario G, Mucciardi G, Valotto C, Ficarra V. Retrosigmoid ileal conduit without transposition of the left ureter after open radical cystectomy: Results of a prospective two-centre study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00738-7] [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: 11/29/2022]
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Ficarra V, Crestani A, Rossanese M, Alario G, Mucciardi G, Giannarini G, Valotto C. Retrosigmoid ileal conduit without transposition of the left ureter after open radical cystectomy for bladder cancer. BJU Int 2021; 129:48-53. [PMID: 33751788 DOI: 10.1111/bju.15375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess perioperative outcomes, complications, and rate of uretero-ileal anastomotic stricture (UAS) in patients undergoing retrosigmoid ileal conduit after radical cystectomy (RC). PATIENTS AND METHODS Clinical records of consecutive patients receiving retrosigmoid ileal conduit after open RC for bladder cancer between March 2016 and June 2020 at two academic centres were prospectively collected. Two expert surgeons performed all cases. Operating room (OR) time, estimated blood loss (EBL), transfusion rate, and 90-day postoperative complications classified according to the Clavien-Dindo system, were assessed. In particular, rate of UAS, defined as upper urinary tract dilatation requiring endourological or surgical management, was evaluated. RESULTS A total of 97 patients were analysed. The median (interquartile range [IQR]) OR time was 245 (215-290) min, median (IQR) EBL was 350 (300-500) mL, and blood transfusions were given to 15 (15.5%) cases. There were no intraoperative complications. There were 90-day postoperative complications in 33 patients (34%), being major (Grade III-V) in 19 (19.6%). Two patients died from early postoperative complications. At a median (IQR) follow-up of 25 (14-40) months, there was only one case (1%) of UAS, involving the right ureter and requiring an open uretero-ileal re-implantation. CONCLUSION The retrosigmoid ileal conduit is a safe and valid option for non-continent urinary diversion after RC, ensuring a very low risk of UAS at an intermediate-term follow-up.
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Affiliation(s)
- Vincenzo Ficarra
- Department of Human and Paediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy
| | | | - Marta Rossanese
- Department of Human and Paediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy
| | - Giuseppe Alario
- Department of Human and Paediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy
| | - Giuseppe Mucciardi
- Department of Human and Paediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy
| | - Gianluca Giannarini
- Urology Unit, "Santa Maria della Misericordia" University Hospital, Udine, Italy
| | - Claudio Valotto
- Urology Unit, "Santa Maria della Misericordia" University Hospital, Udine, Italy
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Rossanese M, Caloggero S, Alario G, Mucciardi G, Novara G, Giannarini G, Ficarra V. Relative position of bladder neck to pubic symphysis on cystogram is a strong and reproducible predictor of early urinary continence recovery following radical prostatectomy. Urologia 2020; 88:115-121. [PMID: 33234060 DOI: 10.1177/0391560320974891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess whether bladder neck angle and position on cystogram predict early urinary continence in patients scheduled for early catheter removal after radical prostatectomy (RP). METHODS A total of 103 patients undergoing open or robot-assisted RP by one expert surgeon between January and December 2019 were retrospectively analyzed. A cystogram was performed on postoperative day 3 or 4 to evaluate anastomotic leakage, and, if none or minimal, the catheter was removed. Urinary continence was evaluated with a validated questionnaire at 1 week, 1 month, and 3 months after RP. Four investigators of different experience assigned bladder neck angle and relative position of bladder neck to pubic symphysis on archived cystogram images. Association between these two parameters and urinary continence rates at different follow-up times was assessed with logistic regression analysis adjusting for patient and tumor characteristics, and surgical technique. Interobserver agreement in assigning the two parameters was measured with k statistic. RESULTS Catheter was removed immediately after cystogram in 101 (98%) patients. On multivariable analysis, only relative position of bladder neck to pubic symphysis was an independent predictor of 1-week (odds ratio [OR] 30. 95% confidence intervals [CIs] 6-138, p < 0.001), 1-month (OR 11. 95%CIs 3.8-32, p < 0.001), and 3-month (OR 19. 95%CIs 3.6-98, p < 0.001) urinary continence. Interobserver agreement for bladder neck and relative position of bladder neck to pubic symphysis was fair to moderate, and substantial to almost perfect, respectively. CONCLUSIONS Relative position of bladder neck to pubic symphysis on cystogram is a strong and reproducible predictor of early urinary continence after RP.
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Affiliation(s)
- Marta Rossanese
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Italy
| | | | - Giuseppe Alario
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Italy
| | - Giuseppe Mucciardi
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Italy
| | - Giacomo Novara
- Department of Surgery, Oncology and Gastroenterology, Urology Unit, University of Padua, Italy
| | - Gianluca Giannarini
- Academic Medical Centre "Santa Maria della Misericordia", Urology Unit, Udine, Italy
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Italy
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Ficarra V, Mucciardi G, Giannarini G. Re: Riccardo Campi, Daniele Amparore, Umberto Capitanio, et al. Assessing the burden of nondeferrable major uro-oncologic surgery to guide prioritisation strategies during the COVID-19 pandemic: insights from three Italian high-volume referral centres. Eur Urol 2020;78:11-15. Eur Urol 2020; 78:e16-e17. [PMID: 32360048 PMCID: PMC7180347 DOI: 10.1016/j.eururo.2020.04.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Vincenzo Ficarra
- Urologic Section, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy.
| | - Giuseppe Mucciardi
- Urologic Section, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia Academic Medical Center, Udine, Italy
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Sofia C, Magno C, Silipigni S, Cantisani V, Mucciardi G, Sottile F, Inferrera A, Mazziotti S, Ascenti G. Value of three-dimensional volume rendering images in the assessment of the centrality index for preoperative planning in patients with renal masses. Clin Radiol 2017; 72:33-40. [DOI: 10.1016/j.crad.2016.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 08/10/2016] [Accepted: 09/09/2016] [Indexed: 01/20/2023]
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17
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Butticè S, Laganà AS, Mucciardi G, Marson F, Tefik T, Netsch C, Vitale SG, Sener E, Pappalardo R, Magno C. Different patterns of pelvic ureteral endometriosis. What is the best treatment? Results of a retrospective analysis. ACTA ACUST UNITED AC 2016; 88:266-269. [PMID: 28073190 DOI: 10.4081/aiua.2016.4.266] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 05/22/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Endometriosis is an estrogendependent disease. The incidence of urinary tract endometriosis (UE) increased during the last few years and, nowadays, it ranges from 0.3 to 12% of all women affected by the disease. The ureter is the second most common site affected. The ureteral endometriosis is classified in extrinsic and intrinsic. The aim of this study is to individuate the best treatments for each subset of ureteral endometriosis. MATERIALS AND METHODS 32 patients diagnosed with surgically treated UE were retrospectively reviewed. The patients were divided into 3 subsets (intrinsic UE, extrinsic UE with and without obstruction). The patients with intrinsic UE (n = 10) were treated with laser endoureterotomy. The patients with extrinsic UE (n = 22) were divided in two subsets with (n = 16) and without (n = 6) hydronephrosis. All the patients underwent ureteral stenting, and resection and reimplantation was performed in the first group, and when the mass was > 2.5 cm (n = 3) Boari flap was performed. Laparoscopic ureterolysis (shaving) was performed in the second group. RESULTS In the extrinsic subset of UE, we obtained an high therapeutic success (84%). Conversely, in the intrinsic subset there was a recurrence rate of the disease in 6/10 of the patients (60%). CONCLUSIONS Ureterolysis seems to be a good treatment in extrinsic UE without obstruction. Resection and reimplantation allows excellent results in the extrinsic UE with obstruction. In the intrinsic subset, the endoureterotomy approach is inadequate.
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Affiliation(s)
- Salvatore Butticè
- Department of Human Phatology, Section of Urology, University of Messina, Messina.
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Mucciardi G, Galì A, D'Amico C, Muscarà G, Barresi V, Magno C. Transitional Cell Carcinoma of the Renal Pelvis With Synchronous Ipsilateral Papillary Renal Cell Carcinoma: Case Report and Review. Urol Case Rep 2016; 3:93-5. [PMID: 26793514 PMCID: PMC4672672 DOI: 10.1016/j.eucr.2015.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 02/13/2015] [Revised: 02/27/2015] [Accepted: 03/02/2015] [Indexed: 12/27/2022] Open
Abstract
Diagnosis of synchronous primary genitourinary tumors are uncommon. Thus far, about 50 cases of synchronous renal tumors have been reported in the literature. We present for the first time a case of a 83-year-old man presenting in the same kidney two separate primary malignancies, a TCC of the renal pelvis and a papillary renal cell carcinoma Type 1. Considered the increased incidence of genitourinary tumors, in presence of a small renal tumor with hematuria, in our opinion, is necessary to pay attention to the diagnostic phase for the chance to highlight an urothelial cancer.
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Affiliation(s)
- Giuseppe Mucciardi
- Department of Human Pathology, Urologic Unit, Policlinico "G. Martino", University of Messina, Italy
| | - Alessandro Galì
- Department of Human Pathology, Urologic Unit, Policlinico "G. Martino", University of Messina, Italy
| | - Carmela D'Amico
- Department of Human Pathology, Urologic Unit, Policlinico "G. Martino", University of Messina, Italy
| | - Graziella Muscarà
- Department of Human Pathology, Urologic Unit, Policlinico "G. Martino", University of Messina, Italy
| | - Valeria Barresi
- Department of Human Pathology, Urologic Unit, Policlinico "G. Martino", University of Messina, Italy
| | - Carlo Magno
- Department of Human Pathology, Urologic Unit, Policlinico "G. Martino", University of Messina, Italy
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Netsch C, Magno C, Butticè S, Macchione L, Mucciardi G, Herrmann TR, Gross AJ. Thulium Vaporesection of the Prostate and Thulium Vapoenucleation of the Prostate in Patients on Oral Anticoagulants: A Retrospective Three-Centre Matched-Paired Comparison. Urol Int 2015; 96:421-6. [DOI: 10.1159/000441013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/10/2015] [Indexed: 11/19/2022]
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20
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Magno C, Mucciardi G, Galì A, Pappalardo R, Lembo F, Anastasi G, Butticè S, Ascenti G, Lugnani F. Is whole gland salvage cryotherapy effective as palliative treatment of haematuria in patients with locally advanced prostate cancer? Results of a preliminary case series. Ther Adv Urol 2015; 7:235-40. [PMID: 26425138 DOI: 10.1177/1756287215585451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Locally advanced prostate cancer may cause several complications such as haematuria, bladder outlet obstruction, and renal failure due to the ureteral obstruction. Various treatments have been suggested, including radiotherapy, antifibrinolytics, bladder irrigation with alum solution, transurethral surgery and angioembolization, none of which have proven effectiveness. In the last years cryoablation has become a valid therapeutic option for prostate cancer. In our experience we used this 'new' technique as haemostatic therapy. METHODS We selected four patients with gross haematuria affected by locally advanced hormone refractory prostate cancer, who had already been treated with primary radiotherapy. We used third-generation cryotherapy: under ultrasonographic guidance, we inserted six cryoprobes, two in each of the vascular pedicles reaching at least -60°C, and three thermometers. We then induced two freeze-thaw cycles. RESULTS After the operation the haematuria stopped in all patients and at 9-month follow up we observed a mean of four red cells (range three to five) in the urinary sediment with no evidence of bacteriuria. Prostate volume, prostate-specific antigen and postmicturition residue were significantly reduced. Qmax improved significantly too. CONCLUSION Our experience has given us good results with minimal intra- and postoperative complications. We think that haemostatic cryotherapy as a palliative approach for locally advanced prostate cancer could represent a valid treatment option and more consideration could be given to its use.
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Affiliation(s)
- Carlo Magno
- Department of Human Phatology, Unit of Urology, University of Messina, Via C. Valeria 1, 98125 Messina, Italy
| | - Giuseppe Mucciardi
- Department of Human Pathology, Unit of Urology, University of Messina, Messina, Italy
| | - Alessandro Galì
- Department of Human Pathology, Unit of Urology, University of Messina, Messina, Italy
| | - Rosa Pappalardo
- Department of Human Pathology, Unit of Urology, University of Messina, Messina, Italy
| | - Francesco Lembo
- Department of Human Pathology, Unit of Urology, University of Messina, Messina, Italy
| | - Giuseppina Anastasi
- Department of Human Pathology, Unit of Urology, University of Messina, Messina, Italy
| | - Salvatore Butticè
- Department of Human Pathology, Unit of Urology, University of Messina, Messina, Italy
| | - Giorgio Ascenti
- Department of Radiology, University of Messina, Messina, Italy
| | - Franco Lugnani
- Unit of Urology, Kirurski Sanatorij Ljubljana Slovenia, Slovenia
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Mucciardi G, Gali' A, Barresi V, Mucciardi M, Aguennouz M, Inferrera A, Magno C. Telomere instability in papillary bladder urothelial carcinomas: Comparison with grading and risk of recurrence. Indian J Urol 2014; 30:245-51. [PMID: 25097306 PMCID: PMC4120207 DOI: 10.4103/0970-1591.134241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: Shortening of telomere is associated with cellular senescence and cancer. This study aims to investigate the relationship between tumor grade and recurrence in relation to telomere length (TL), telomerase activity (TA) and telomere-binding proteins expression (TBPs) in patients with non-muscle invasive bladder cancer (NMIBC). Materials and Methods: Tumor/healthy tissues were collected from 58 patients (35 with and 23 without NMIBC). Cystoscopy was performed at 3, 6 and 12 months to determine recurrence. Tumor grades and recurrence were correlated with TL, TA and TBPs using the Kruskal–Wallis non-parametric test. Results were considered significant at P < 0.05. Results: Histological evaluation indicated 15 patients (42.9%) with high-grade (HG) and 20 patients (57.1%) with low-grade (LG) NMIBC. TL, TA and TBPs were found to be significantly different in tumors as compared with controls. A significant (P < 0.05) difference in the expression of TBPs was observed in the disease-free mucosa of cancer patients as compared with HG and LG tumors. In the follow-up, a total of 11 tumor recurrences were observed; among these eight recurrences were observed in patients with HG tumors and three in patients with LG tumors. TL, Human telomerase reverse transcriptase (hTERT) (that represents TA) and poly (ADP-ribose) polymerase 1 (PARP-1) in tumor samples and telomeric repeat binding factors TRF1, TRF2 and tankyrase (TANK) in normal mucosa obtained from the tumor group were respectively found to exhibit a positive and negative association with the risk of recurrence. Conclusions: Our study demonstrates that TL, TA and TBPs are altered in tumors and non-cancerous mucosa in patients with papillary urothelial NMIBC. Further studies are warranted to identify their suitability as a potential biomarker.
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Affiliation(s)
| | | | | | - Massimo Mucciardi
- Department of Economics Statistics Mathematics and Sociology, University of Messina, Italy
| | - M'Hammemd Aguennouz
- Department of Neuroscience Psychiatrics and Anesthesiology Sciences, University of Messina, Italy
| | | | - Carlo Magno
- Department of Urology, University of Messina, Italy
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Morgia G, Cimino S, Favilla V, Russo GI, Squadrito F, Mucciardi G, Masieri L, Minutoli L, Grosso G, Castelli T. Effects of Serenoa repens, selenium and lycopene (Profluss®) on chronic inflammation associated with benign prostatic hyperplasia: results of "FLOG" (Flogosis and Profluss in Prostatic and Genital Disease), a multicentre Italian study. Int Braz J Urol 2013; 39:214-21. [PMID: 23683667 DOI: 10.1590/s1677-5538.ibju.2013.02.10] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 01/15/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of Profluss® on prostatic chronic inflammation (PCI). MATERIALS AND METHODS We prospectively enrolled 168 subjects affected by LUTS due to bladder outlet obstruction submitted to 12 cores prostatic biopsy for suspected prostate cancer + 2 cores collected for PCI valuation. First group consisted of 108 subjects, with histological diagnosis of PCI associated with BPH and high grade PIN and/or ASAP, randomly assigned to 1:1 ratio to daily Profluss® (group I) for 6 months or to control group (group Ic). Second group consisted of 60 subjects, with histological diagnosis of BPH, randomly assigned to 1:1 ratio to daily Profluss® + a-blockers treatment (group II) for 3 months or to control group (group IIc). After 6 months first group underwent 24 cores prostatic re-biopsy + 2 cores for PCI while after 3 months second group underwent two-cores prostatic for PCI. Specimens were evaluated for changes in inflammation parameters and for density of T-cells (CD3, CD8), B-cells (CD20) and macrophages (CD68). RESULTS At follow-up there were statistical significant reductions of extension and grading of flogosis, mean values of CD20, CD3, CD68 and mean PSA value in group I compared to Ic, while extension and grading of flogosis in group II were inferior to IIc but not statistical significant. A statistically significant reduction in the density of CD20, CD3, CD68, CD8 was demonstrated in group II in respect to control IIc. CONCLUSIONS Serenoa repens+Selenium+Lycopene may have an anti-inflammatory activity that could be of interest in the treatment of PCI in BPH and/or PIN/ASAP patients.
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Affiliation(s)
- Giuseppe Morgia
- Department of Urology and Department of Hygiene and Public Health, University of Catania, Catania, Italy
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Macchione L, Mucciardi G, Gali' A, Di Benedetto A, Butticè S, Magno C. Efficacy and safety of prostate vaporesection using a 120-W 2-μm continuous-wave Tm:YAG laser (RevoLix 2) in patients on continuous oral anticoagulant or antiplatelet therapy. Int Urol Nephrol 2013; 45:1545-51. [PMID: 23892531 DOI: 10.1007/s11255-013-0487-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 06/01/2013] [Indexed: 12/21/2022]
Abstract
The aim of our current study was to demonstrate the efficacy and safety of vaporesection using a 120-W Tm:YAG laser (Revolix Duo) in patients with BPH receiving systemic anticoagulation or antiplatelet therapy. Between April 2010 and November 2011, a total of 76 patients using oral antiplatelet or anticoagulant (OA) agents affected by LUTS for BPH were underwent thulium vaporesection of the prostate (ThuVARP) using a 120-W 2-μm CW Tm:YAG laser and evaluated at 3- and 6-month follow-up. Of these, in 41 patients (group A) was performed vaporesection while receiving OA therapy. In 35 patients (group B), OA agents were discontinued 10 days before surgery. There were no significant differences in average vaporesection times, catheterization time, or hospital stay. There was no significant change in serum sodium level before and immediately after vaporesection in either group. Significant improvements compared to baseline were observed at each postoperative assessment in both groups for Qmax, PVR, IPSS, and QoL. More specifically, the IPSS score improved from 21.7 at baseline to 5.2 at 6 months in group A and from 20.7 to 4.5 in group B. At 6 months, Qmax increased 226 and 190 % for the 2 groups, respectively. The PVR decreased from 119 at baseline to 11 mL at 6 months in group A and from 125 to 11 mL in group B. ThuVARP is a safe and efficient procedure for patients with BPH, refractory to pharmacotherapy, who require active antiplatelet or anticoagulant therapy.
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Affiliation(s)
- Luciano Macchione
- Department of Urology, University of Messina, Via Consolare valeria 1, 98126, Messina, Italy
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Mucciardi G, Galì A, Inferrera A, Di Benedetto A, Macchione L, Mucciardi M, Magno C. Longitudinal observational cohort study about detrusor underactivity as a risk factor for bladder neck contracture after retropubic radical prostatectomy: preliminary results. Int Urol Nephrol 2013; 45:721-6. [DOI: 10.1007/s11255-013-0426-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 03/18/2013] [Indexed: 11/28/2022]
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Di Benedetto A, Arena S, Nicotina PA, Mucciardi G, Galì A, Magno C. Pacemakers in the upper urinary tract. Neurourol Urodyn 2012; 32:349-53. [DOI: 10.1002/nau.22310] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 08/16/2012] [Indexed: 01/15/2023]
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Di Benedetto A, Inferrera A, Mucciardi G, Magno C. Reply by the Authors. Urology 2012. [DOI: 10.1016/j.urology.2012.03.015] [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: 10/28/2022]
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Di Benedetto A, Macchione L, Ciccarello G, Mileto A, Inferrera A, Mucciardi G, Galì A, Ascenti G, Magno C. Isolated Large Hydatid Cyst in the Kidney of an Elderly Man. Urology 2012; 79:e47-8. [DOI: 10.1016/j.urology.2011.08.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 08/25/2011] [Accepted: 08/30/2011] [Indexed: 11/29/2022]
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Morgia G, Castelli T, Cimino S, Favilla V, Fragalà E, Russo M, Carini M, Vespasiani G, Marchese F, Salvia G, Di Trapani D, Gentile M, Forte F, Masala A, Militello A, Mucciardi G, Barresi G. 1978 EFFECTS OF SERENOA REPENS, SELENIUM AND LYCOPENE ON CHRONIC INFLAMMATION ASSOCIATED WITH BPH: RESULTS OF A MULTICENTRE ITALIAN STUDY “FLOG” (FLOGOSIS AND PROFLUSS IN PROSTATIC AND GENITAL DISEASE). J Urol 2011. [DOI: 10.1016/j.juro.2011.02.2203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Morgia G, Mucciardi G, Galì A, Madonia M, Marchese F, Di Benedetto A, Romano G, Bonvissuto G, Castelli T, Macchione L, Magno C. Treatment of chronic prostatitis/chronic pelvic pain syndrome category IIIA with Serenoa repens plus selenium and lycopene (Profluss) versus S. repens alone: an Italian randomized multicenter-controlled study. Urol Int 2010; 84:400-6. [PMID: 20332612 DOI: 10.1159/000302716] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 10/12/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of Serenoa repens + selenium and lycopene (Profluss) versus S. repens alone for the treatment of category IIIa chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). PATIENTS AND METHODS 102 patients with IIIa CP/CPPS were enrolled and randomized into two groups each to receive Profluss or S. repens alone for 8 weeks. Evaluation was based on results of the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), IPSS, maximum peak flow rate (MPFR), and PSA measurements at baseline and at weeks 4, 8 and 8 after the end of treatment. The primary endpoint was a >50% reduction in NIH-CPSI score. Secondary endpoints evaluated were MPFR, IPSS, PSA and white blood cell count. RESULTS No patients withdrew from the study. The mean NIH-CPSI score decreased significantly (p < 0.001) in both groups; we observed a decrease in the total score from 27.45 to 13.27 in group 1 (-51.64%) and from 27.76 to 20.62 in group 2 (-26.06%). IPSS improved significantly (p < 0.001) in both arms, but more in group 1. PSA and white blood cell count decreased significantly (p < 0.007) only in group 1. The MPFR improved more in group 1 (p < 0.005). CONCLUSION Profluss is a triple therapy that is safe and well tolerated. It ameliorates symptoms associated with IIIa CP/CPPS.
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Affiliation(s)
- G Morgia
- Departments of Urology, University of Messina, Messina, Italy
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Ciccarello G, Mucciardi G, Morgia G, Spinelli F, Ascenti G, Macchione L, Magno C. A Case of Renal Capsular Liposarcoma with Intracaval Fat Thrombus. Eur Urol 2010; 57:350-3. [DOI: 10.1016/j.eururo.2009.07.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 07/15/2009] [Indexed: 11/16/2022]
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Cuccia G, Mucciardi G, Morgia G, Stagno d'Alcontres F, Galì A, Cotrufo S, Romeo M, Magno C. Vacuum-assisted closure for the treatment of Fournier's gangrene. Urol Int 2009; 82:426-31. [PMID: 19506410 DOI: 10.1159/000218532] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 03/31/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fournier's gangrene (FG) is a very aggressive necrotizing fasciitis involving subcutaneous fat and skin of scrotal and perineal regions. Vacuum-assisted closure (VAC) is a well-known method used to treat complex wounds. The authors for the first time enhance a multimodal strategy to treat the FG using VAC, reducing the number of surgical debridements, allowing a one-step surgical reconstruction with locoregional fasciocutaneous flap. METHODS Six patients with the diagnosis of FG were reviewed retrospectively at our institution. All patients were affected by very extensive FG. The FG Severity Index (FGSI) was used to evaluate the prognosis of the case at admission. Following the acute phase (24-48 h), VAC was used to achieve wound cleaning and prepare the area to a single-stage reconstruction with superomedial thigh flap. Hyperbaric oxygen therapy was also used before final reconstruction. RESULTS The average FGSI was 10.5, ranging from 8 to 12. All patients survived and were completely healed at the mean follow-up time of 9 months (range 3-30 months). CONCLUSIONS VAC therapy is effective to clean and prepare the wounds, cutting off the fasciitis process and reducing the hospital stay and patient discomfort. Multidisciplinary treatment is mandatory during this devastating infection.
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Magno C, Mucciardi G, Galì A, Anastasi G, Inferrera A, Morgia G. Transurethral ethanol ablation of the prostate (TEAP): an effective minimally invasive treatment alternative to traditional surgery for symptomatic benign prostatic hyperplasia (BPH) in high-risk comorbidity patients. Int Urol Nephrol 2008; 40:941-6. [DOI: 10.1007/s11255-008-9394-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 04/16/2008] [Indexed: 11/30/2022]
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Morgia G, Mucciardi G, Madonia M, Castelli T, Favilla V, Magno C. TREATMENT OF CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME (CP/CPPS) WITH SERENOA REPENS PLUS SELENIO AND LICOPENE (PROFLUSS®): A RANDOMIZED MULTICENTER PLACEBO-CONTROLLED STUDY. J Urol 2008. [DOI: 10.1016/s0022-5347(08)60097-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: 10/22/2022]
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Magno C, Melloni D, Galì A, Mucciardi G, Nicocia G, Morandi B, Melioli G, Ferlazzo G. The anti-tumor activity of bacillus Calmette-Guerin in bladder cancer is associated with an increase in the circulating level of interleukin-2. Immunol Lett 2002; 81:235-8. [PMID: 11947931 DOI: 10.1016/s0165-2478(02)00040-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [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: 11/21/2022]
Abstract
Bacillus Calmette-Guerin (BCG) is currently employed in the treatment of superficial bladder cancer but, despite its recognized effectiveness in preventing recurrences and progression, the immune mechanisms behind its antitumor activity remain to be delineated. In this study we provide evidence that a prolonged increase in the plasma levels of IL-2, but not IL-1beta, IL-4, IL-10, IL-2R or TNF-alpha occured in patients affected by bladder cancer following effective BCG treatment. Conversely, a drop in circulating IL-2 was consistently associated with tumor relapse. The level of IL-2 was elevated even further 15 days after the last BCG administration in patients who did not experience tumor recurrence, suggesting a prolonged T cell-mediated response against antigens other than BCG. Our results indicate that a specific type 1 immune response plays a major role in the anti-cancer activity of BCG. In addition, monitoring IL-2 plasma levels may offer a useful tool for predicting tumor recurrences.
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Affiliation(s)
- Carlo Magno
- Unità di Urologia, Universita' degli Studi di Messina, Messina, Italy
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Anastasi G, Buemi M, Mucciardi G, Crea G, Sanfilippo G, Magno C. [Usefulness of ultrasonography in the diagnosis of acute scrotal edema]. Arch Ital Urol Androl 2000; 72:238-40. [PMID: 11221045] [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: 02/19/2023] Open
Abstract
Ultrasonography has gained an important role for the diagnosis of acute and chronic scrotal lesions. We report our experience on 6 cases of acute scrotal edema. The etiology of edema was congestive cardiopathy (two patients), glomerulonephrosis (three patients) and lumboaortic lymphnode metastases from bladder transitional cell carcinoma (one patient). Ultrasound scan scrotal appearances were similar in all examined patients, and the only pathologic findings observed were "onion" like appearance and a thickened scrotal wall. Therefore, to define acute scrotal edema etiology, it isn't enough an ultrasound examination, but it's necessary to extend the ultrasound scan assessment to other organs.
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Affiliation(s)
- G Anastasi
- Divisione di Urologia, Azienda Policlinico Universitario, Università degli Studi di Messina
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