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Kanakaraj J, Chang J, Hampton LJ, Smith SC. The New WHO Category of "Molecularly Defined Renal Carcinomas": Clinical and Diagnostic Features and Management Implications. Urol Oncol 2024:S1078-1439(24)00333-8. [PMID: 38519377 DOI: 10.1016/j.urolonc.2024.02.003] [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: 08/22/2023] [Revised: 01/27/2024] [Accepted: 02/12/2024] [Indexed: 03/24/2024]
Abstract
The evolution of classification of renal tumors has been impacted since the turn of the millennium by rapid progress in histopathology, immunohistochemistry, and molecular genetics. Together, these features have enabled firm recognition of specific, classic types of renal cell carcinomas, such as clear cell renal cell carcinoma, that in current practice trigger histologic-type specific management and treatment protocols. Now, the fifth Edition World Health Classification's new category of "Molecularly defined renal carcinomas" changes the paradigm, defining a total of seven entities based specifically on their fundamental molecular underpinnings. These tumors, which include TFE3-rearranged, TFEB-altered, ELOC-mutated, fumarate hydratase-deficient, succinate dehydrogenase-deficient, ALK-rearranged, and SMARCB1-deficient renal medullary carcinoma, encompass a wide clinical and histopathologic phenotypic spectrum of tumors. Already, important management aspects are apparent for several of these entities, while emerging therapeutic angles are coming into view. A brief, clinically-oriented introduction of the entities in this new category, focusing on relevant diagnostic, molecular, and management aspects, is the subject of this review.
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Affiliation(s)
- Jonathan Kanakaraj
- Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Justin Chang
- Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Lance J Hampton
- Division of Urology, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA; Department of Pathology, Richmond Veterans Affairs Medical Center, Richmond, VA; VCU Massey Comprehensive Cancer Center, Richmond, VA
| | - Steven Christopher Smith
- Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA; Division of Urology, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA; Department of Pathology, Richmond Veterans Affairs Medical Center, Richmond, VA; VCU Massey Comprehensive Cancer Center, Richmond, VA.
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Pham NH, Hoang VT, Bui CLK, Nguyen VQA, Truong VC, Hampton LJ. The Outcome of the Miniaturized Percutaneous Nephrolithotomy in Lateral Position with Guidance of Non-Rotational C-Arm. Res Rep Urol 2024; 16:45-56. [PMID: 38410528 PMCID: PMC10895988 DOI: 10.2147/rru.s442145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/20/2024] [Indexed: 02/28/2024] Open
Abstract
Objective Evaluation of the outcome of the miniaturized percutaneous nephrolithotomy in the treatment of nephrolithiasis with a lateral position based on the principle of a right triangle under the guidance of a C-Arm without contrast fluid. Materials and Methods Sixty-nine cases of Mini-PCNL with the assistance of a vacuum-assisted sheath in the lateral position were performed at Central Hospital from March 2021 to August 2022. Percutaneous renal access was under the guidance of a non-rotational C-arm without contrast medium, and we determined the puncture location and depth of the needle based on the principle of right triangles. Results The median age was 51.6 ± 12.5 years, and males accounted for 68.1% of the cases. 60.9% of all patients had normal weight. The median stone surface area was 361.1mm2, and 59.4% of all cases were graded as 2 regarding Guy's stone score. The successful renal access rate was 100%. The tunnel access from the middle and lower calyx accounted for 94.2%. The median access duration, fluoroscopy duration, and hospital length of stay were 271.7 seconds, 14.79 seconds, and 6.3 days, respectively. The complete stone clearance rate was 78.3%. Bleeding complications occurred in 2 patients without mortality. Three patients required an additional procedure. Conclusion The puncture technique into the renal calyxes based on the principle of the right triangle under the guidance of a non-rotational C-Arm without contrast medium in PCNL is a fast, exact, and safe technique.
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Affiliation(s)
- Ngoc Hung Pham
- Department of Urology, Hue Central Hospital, Hue, Vietnam
| | | | | | | | - Van Can Truong
- Department of Urology, Hue Central Hospital, Hue, Vietnam
| | - Lance J Hampton
- Division of Urology, Massey Cancer Center, VCU Health, Richmond, VA, USA
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Pandolfo SD, Beksac AT, Derweesh I, Celia A, Schiavina R, Bianchi L, Costa G, Carbonara U, Loizzo D, Lucarelli G, Cerrato C, Imbimbo C, Mirone V, Elbich J, Basile G, Hampton LJ, Kim FJ, Capitanio U, Kaouk J, Autorino R. Percutaneous Ablation vs Robot-Assisted Partial Nephrectomy for Completely Endophytic Renal Masses: A Multicenter Trifecta Analysis with a Minimum 3-Year Follow-Up. J Endourol 2023; 37:279-285. [PMID: 36367175 DOI: 10.1089/end.2022.0478] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [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: 11/13/2022] Open
Abstract
Purpose: To compare outcomes of robot-assisted partial nephrectomy (RAPN) and percutaneous tumor ablation (PTA) for completely endophytic renal masses. Methods: Data of patients who underwent RAPN or PTA for treatment of completely endophytic (three points for "E" domain of R.E.N.A.L. score) were collected from seven high-volume U.S. and European centers. PTA included cryoablation, radiofrequency, or microwave ablation. Baseline characteristics, clinical, surgical, and postoperative outcomes were compared. Recurrence-free survival (RFS) was calculated with Kaplan-Meier analysis. Trifecta was used as arbitrary combined outcome parameter as proxy for treatment "quality." Multivariable logistic regression model assessed predictors of trifecta failure. Results: One hundred fifty-two patients (RAPN, n = 60; PTA, n = 92) were included in the analysis. RAPN group was younger (p < 0.001), had lower American Society of Anesthesiologists score (p = 0.002), and higher baseline estimated glomerular filtration rate (p < 0.001). There was no difference in clinical tumor size, clinical T stage, and tumor complexity scores. PTA had significantly lower rate of overall (p < 0.001) and minor (p < 0.001) complications. ΔeGFR at 1 year was statistically higher for RAPN (-15.5 mL/min vs -3.1 mL/min; p = 0.005), no difference in ΔeGFR at last follow-up (p = 0.22) was observed. No difference in recurrences (RAPN, n = 2; PTA, n = 6) and RFS was found (p = 0.154). Trifecta achievement was higher for RAPN but not statistically different (65.3% vs 58.8%; p = 0.477). R.E.N.A.L. Nephrometry Score resulted predictive of trifecta failure (odds ratio = 1.47; confidence interval = 1.13-1.90; p = 0.004). Conclusions: PTA confirms to be an effective treatment for completely endophytic renal masses, offering low complications and good mid-term functional and oncologic outcomes. These outcomes compare favorably with those of RAPN, which seem to be the preferred option for younger and less comorbid patients.
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Affiliation(s)
- Savio Domenico Pandolfo
- Division of Urology, Massey Cancer Center, VCU Health, Richmond, Virginia, USA.,Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II," Napoli, Italy
| | - Alp T Beksac
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ithaar Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano Del Grappa, Italy
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giovanni Costa
- Department of Urology, San Bassiano Hospital, Bassano Del Grappa, Italy
| | - Umberto Carbonara
- Division of Urology, Massey Cancer Center, VCU Health, Richmond, Virginia, USA
| | - Davide Loizzo
- Division of Urology, Massey Cancer Center, VCU Health, Richmond, Virginia, USA.,Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Clara Cerrato
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II," Napoli, Italy
| | - Vicenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II," Napoli, Italy
| | - Jeffrey Elbich
- Department of Radiology, Vascular Interventional Radiology, VCU Health, Richmond, Virginia, USA
| | - Giuseppe Basile
- Department of Urology, San Raffaele Scientific Institute, Milan, Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Lance J Hampton
- Division of Urology, Massey Cancer Center, VCU Health, Richmond, Virginia, USA
| | - Fernando J Kim
- Division of Urology, Denver Health Medical Center, Denver, Colorado, USA
| | - Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Riccardo Autorino
- Division of Urology, Massey Cancer Center, VCU Health, Richmond, Virginia, USA
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Pandolfo SD, Carbonara U, Beksac AT, Derweesh I, Celia A, Schiavina R, Elbich J, Basile G, Hampton LJ, Cerrato C, Costa G, Bianchi L, Lucarelli G, Mirone V, Imbimbo C, Kim FJ, Del Giudice F, Capitanio U, Kaouk J, Autorino R. Microwave versus cryoablation and radiofrequency ablation for small renal mass: a multicenter comparative analysis. Minerva Urol Nephrol 2023; 75:66-72. [PMID: 36286402 DOI: 10.23736/s2724-6051.22.05092-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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
BACKGROUND Ablative techniques emerged as effective alternative to nephron-sparing surgery for treatment of small renal masses. Radiofrequency ablation (RFA) and cryoablation (CRYO) are the two guidelines-recommended techniques. Microwave ablation (MWA) represents a newer technology, less described. The aim of the study was to compare outcomes of MWA to those of CRYO and RFA. METHODS Retrospective investigation of patients who underwent MWA, CRYO, or RFA from seven high-volume US and European centers was performed. The first group included patients who underwent CRYO or RFA; the second MWA. We collected baseline characteristics, clinical, intraoperative, and postoperative data. Oncological data included technical success, local recurrence, and progression to metastasis. Multivariate analysis was performed to find predictors for postoperative complications. A composite outcome of "trifecta" was used to assess surgical, functional, and oncological outcomes. RESULTS 739 patients underwent CRYO or RFA and 50 MWA. CRYO/RFA group had significantly longer operative time (P<0.001), but no difference in LOS, postprocedural Hb mean, intraprocedural complications (P=0.180), overall postprocedural complication rates (P=0.126), and in the 30-day re-admission rate (P=0.853) were detected. No predictive parameter of postprocedural complications was found. Concerning functional outcome, no differences were detected in terms of eGFR at 1 year (P=0.182), ΔeGFR at 1 year (P=0.825) and eGFR at latest follow-up (P=0.070). "Technical success" was achieved in 98.6% of the cases (MWA=100%, CRYO/RFA=98.5%; P=0.775), and there was no significant difference in terms of 2-year recurrence rate (P=0.114) and metastatic progression (P=0.203). Trifecta was achieved in 73.0% of CRYO/RFA vs. 69.6% of MWA cases (P=0.719). CONCLUSIONS MWA is a safe and effective treatment option for small renal masses. Compared with CRYO/RFA, it seems to offer low complication rates, shorter operation time, and equivalent surgical and functional outcomes.
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Affiliation(s)
- Savio D Pandolfo
- Division of Urology, Virginia Commonwealth University (VCU) Health, Richmond, VA, USA - .,Unit of Urology, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy -
| | - Umberto Carbonara
- Division of Urology, Virginia Commonwealth University (VCU) Health, Richmond, VA, USA.,Unit of Andrology and Kidney Transplantation, Department of Emergency and Organ Transplantation-Urology, University of Bari, Bari, Italy
| | - Alp T Beksac
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ithaar Derweesh
- School of Medicine, Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano Del Grappa, Vicenza, Italy
| | | | - Jeffrey Elbich
- Division of Interventional Radiology, Department of Radiology, Virginia Commonwealth University (VCU) Health, Richmond, VA, USA
| | - Giuseppe Basile
- Unit of Urology, Division of Experimental Oncology, Department of Urology, URI, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Lance J Hampton
- Division of Urology, Virginia Commonwealth University (VCU) Health, Richmond, VA, USA
| | - Clara Cerrato
- School of Medicine, Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Giovanni Costa
- Department of Urology, San Bassiano Hospital, Bassano Del Grappa, Vicenza, Italy
| | - Lorenzo Bianchi
- Department of Urology, University of Bologna, Bologna, Italy
| | - Giuseppe Lucarelli
- Unit of Andrology and Kidney Transplantation, Department of Emergency and Organ Transplantation-Urology, University of Bari, Bari, Italy
| | - Vincenzo Mirone
- Unit of Urology, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Ciro Imbimbo
- Unit of Urology, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | | | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, Policlinico Umberto I Hospital, Sapienza University, Rome, Italy
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Department of Urology, URI, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Jihad Kaouk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University (VCU) Health, Richmond, VA, USA
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Pandolfo SD, Loizzo D, Beksac AT, Derweesh I, Celia A, Bianchi L, Elbich J, Costa G, Carbonara U, Lucarelli G, Cerrato C, Meagher M, Ditonno P, Hampton LJ, Basile G, Kim FJ, Schiavina R, Capitanio U, Kaouk J, Autorino R. Percutaneous thermal ablation for cT1 renal mass in solitary kidney: A multicenter trifecta comparative analysis versus robot-assisted partial nephrectomy. Eur J Surg Oncol 2023; 49:486-490. [PMID: 36216659 DOI: 10.1016/j.ejso.2022.09.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [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: 07/04/2022] [Revised: 09/20/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Renal cell carcinoma (RCC) in solitary kidney (SK) represents a challenging scenario. We sought to compare outcomes of robot-assisted partial nephrectomy (RAPN) versus percutaneous thermal ablation (PTA) in SK patients with renal tumors cT1. MATERIALS AND METHODS We performed a multicenter retrospective analysis of SK patients treated for RCC. The PTA group included cryoablation or radiofrequency ablation. We collected baseline characteristics, intraoperative, pathological, and post-operative data. We applied an arbitrary composite "trifecta" to assess surgical, functional, and oncological outcomes, only for malignant histology. RFS analysis was performed using the Kaplan-Meier method. Multivariable regression analysis was performed to determine independent predictors of "trifecta" achievement. RESULTS We included 198 SK patients (RAPN, n = 50; PTA n = 119). Mean clinical tumor size was not significantly different while R.E.N.A.L. score was higher for RAPN (p < 0.001). No differences in intra and major post-procedural complications. Recurrence rate was higher in PTA group but not statistically significant (p < 0.328). No difference in metastasis rate was found (p = 0.435). RFS was 96.1% in RAPN and 86.8% in PTA cohort (p = 0.003) while no difference in PFS was detected (p = 0.1). Trifecta was achieved in 72.5% of RAPN vs 77.3% of PTA (p = 0.481). Multivariable analysis has not detected predictors for Trifecta achievement. CONCLUSION PTA offers good outcomes in the management of SK patients with RCC. Compared with RAPN, it might carry a higher risk of recurrence; on the other hand, re-treatment is possible. Overall, PTA can be safely offered to treat SK patients presenting RCC. In general, it should be preferred in more frail patients to minimize the risk of complications.
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Affiliation(s)
- Savio Domenico Pandolfo
- Division of Urology & Massey Cancer Center, VCU Health, Richmond, VA, USA; Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy.
| | - Davide Loizzo
- Division of Urology & Massey Cancer Center, VCU Health, Richmond, VA, USA; Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Alp T Beksac
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ithaar Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Antonio Celia
- Department of Urology, San Bassano Hospital, Bassano Del Grappa, Italy
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jeffrey Elbich
- Department of Radiology, Vascular Interventional Radiology, VCU Health, Richmond, VA, USA
| | - Giovanni Costa
- Department of Urology, San Bassano Hospital, Bassano Del Grappa, Italy
| | - Umberto Carbonara
- Division of Urology & Massey Cancer Center, VCU Health, Richmond, VA, USA
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Clara Cerrato
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Margaret Meagher
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Lance J Hampton
- Division of Urology & Massey Cancer Center, VCU Health, Richmond, VA, USA
| | - Giuseppe Basile
- Department of Urology, San Raffaele Scientific Institute, Milan, Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Riccardo Autorino
- Division of Urology & Massey Cancer Center, VCU Health, Richmond, VA, USA
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Crocerossa F, Fiori C, Capitanio U, Minervini A, Carbonara U, Pandolfo SD, Loizzo D, Eun DD, Larcher A, Mari A, Grosso AA, Di Maida F, Hampton LJ, Cantiello F, Damiano R, Porpiglia F, Autorino R. Estimated Glomerular Filtration Rate Decline at 1 Year After Minimally Invasive Partial Nephrectomy: A Multimodel Comparison of Predictors. EUR UROL SUPPL 2022; 38:52-59. [PMID: 35495283 PMCID: PMC9051959 DOI: 10.1016/j.euros.2022.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 02/11/2022] [Indexed: 12/12/2022] Open
Abstract
Background Long-term renal function after partial nephrectomy (PN) is difficult to predict as it is influenced by several modifiable and nonmodifiable variables, often intertwined in complex relations. Objective To identify variables influencing long-term renal function after PN and to assess their relative weight. Design, setting, and participants A total of 457 patients who underwent either robotic (n = 412) or laparoscopic PN (n = 45) were identified from a multicenter international database. Outcome measurements and statistical analysis The 1-yr estimated glomerular filtration rate (eGFR) percentage loss (1YPL), defined as the eGFR percentage change from baseline at 1 yr after surgery, was the outcome endpoint. Predictors evaluated included demographic data, tumor features, and operative and postoperative variables. Bayesian multimodel analysis of covariance was used to build all possible models and compare the fit of each model to the data via model Bayes factors. Bayesian model averaging was used to quantify the support for each predictor via the inclusion Bayes factor (BFincl). High-dimensional undirected graph estimation was used for network analysis of conditional independence between predictors. Results and limitations Several models were found to be plausible for estimation of 1YPL. The best model, comprising postoperative eGFR percentage loss (PPL), sex, ischemia technique, and preoperative eGFR, was 207 times more likely than all the other models regarding relative predictive performance. Its components were part of the top 44 models and were the predictors with the highest BFincl. The role of cold ischemia, solitary kidney status, surgeon experience, and type of renorraphy was not assessed. Conclusions Preoperative eGFR, sex, ischemia technique, and PPL are the best predictors of eGFR percentage loss at 1 yr after minimally invasive PN. Other predictors seem to be irrelevant, as their influence is insignificant or already nested in the effect of these four parameters. Patient summary Kidney function at 1 year after partial removal of a kidney depends on sex, the technique used to halt blood flow to the kidney during surgery, and kidney function at baseline and in the early postoperative period.
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Affiliation(s)
- Fabio Crocerossa
- Division of Urology, VCU Health, Richmond, VA, USA
- Department of Urology, Magna Graecia University, Catanzaro, Italy
| | - Cristian Fiori
- Division of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Umberto Carbonara
- Division of Urology, VCU Health, Richmond, VA, USA
- Department of Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | | | | | - Daniel D. Eun
- Department of Urology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Alessandro Larcher
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Antonio Andrea Grosso
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Fabrizio Di Maida
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, University of Florence, Florence, Italy
| | | | | | - Rocco Damiano
- Department of Urology, Magna Graecia University, Catanzaro, Italy
| | - Francesco Porpiglia
- Division of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Riccardo Autorino
- Division of Urology, VCU Health, Richmond, VA, USA
- Corresponding author. Division of Urology, VCU Health, West Hospital, 1200 East Broad Street, Richmond, VA 23298, USA. Tel. +1 804 8273099; Fax: +1 804 8282157.
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Crocerossa F, Carbonara U, Parekh J, Urdaneta A, Weprin S, Damiano R, Grob MB, Hampton LJ, Paul A, Autorino R, Cantiello F. PSA and PSA Kinetics as Predictors for 18F-Fluciclovine PET/CT Positivity in Biochemically Recurrent Prostate Cancer. Urol Int 2021; 106:920-927. [PMID: 34933313 DOI: 10.1159/000520684] [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] [Received: 07/13/2021] [Accepted: 10/24/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION 18F-Fluciclovine PET/CT is one of the imaging techniques currently employed to restage prostate cancer (PCa). Due to the conflicting results reported in the literature, it is not yet known at what PSA threshold 18F-fluciclovine PET/CT could reliably demonstrate the presence of recurring disease. We explored the association between 18F-fluciclovine PET/CT positivity and prescan PSA, PSA doubling time, and PSA velocity in patients with biochemical recurrence (BCR) of PCa after curative-intent treatment. METHODS Data from 59 patients who underwent 18F-fluciclovine PET/CT for BCR after radical prostatectomy or radiotherapy were retrieved from a single institution database. Patients already undergone salvage treatments at the time of PET/CT, with newly diagnosed PCa or with initial diagnosis of metastatic PCa were excluded. A 2-sided independent samples Bayesian t test and Bayesian Mann-Whitney U test were used to assess the association between PET/CT and prescan PSA, PSA doubling time, and PSA velocity. RESULTS Evidence for no difference between PET/CT-positive and -negative patients for log-transformed PSA was found (BF01 3.61, % error: 0.01). Robustness check and sequential analysis showed stability across a wide range of prior distribution specifications. The hypothesis of no difference in terms of PSA-dt and for PSA-vel between groups was found to be more likely compared to the alternative hypothesis (BF01 of 3.44 and 3.48, respectively). CONCLUSION PSA and PSA kinetics are unlikely to be associated with 18F-fluciclovine PET/CT positivity in patients with BCR, and none of these serum biomarkers might be used as single predictors of PET/CT detection. Larger studies might be needed to evaluate the role of different predictors.
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Affiliation(s)
- Fabio Crocerossa
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Umberto Carbonara
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Jayashree Parekh
- Department of Radiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Alfredo Urdaneta
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Samuel Weprin
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Rocco Damiano
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Mayer B Grob
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lance J Hampton
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Asit Paul
- Division of Hematology, Department of Internal Medicine, Oncology & Palliative Care, Richmond, Virginia, USA
| | - Riccardo Autorino
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Francesco Cantiello
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
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8
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Pham NH, Visser WR, Phan-Huu QV, Hampton LJ. Renal Autotransplantation for the Treatment of Complete Ureteral Loss: A Case Report. Res Rep Urol 2021; 13:733-737. [PMID: 34611523 PMCID: PMC8487276 DOI: 10.2147/rru.s328832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/11/2021] [Indexed: 11/24/2022] Open
Abstract
We present an exceptional case of a patient with complete ureteral loss. The injury of the patient’s right ureter resulted as a complication of prior ureteroscopic and laparoscopic. For the treatment of complete ureteral loss, the right kidney was removed and placed into the left iliac fossa. Revascularization of the kidney was performed by anastomosis of the renal vasculatures to the external iliac vasculature. Ureteral reconstruction was performed through a Boari bladder flap. At the six-month follow-up visit, the resistive indices of the transplanted kidney proved to be in the normal range.
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Affiliation(s)
- Ngoc Hung Pham
- Urology Department, Hue Central Hospital, Hue City, Vietnam
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9
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Crocerossa F, Carbonara U, Cantiello F, Marchioni M, Ditonno P, Mir MC, Porpiglia F, Derweesh I, Hampton LJ, Damiano R, Autorino R. Robot-assisted Radical Nephrectomy: A Systematic Review and Meta-analysis of Comparative Studies. Eur Urol 2021; 80:428-439. [DOI: 10.1016/j.eururo.2020.10.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/23/2020] [Indexed: 12/21/2022]
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10
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Carbonara U, Branche B, Cisu T, Crocerossa F, Guruli G, Grob MB, Roseman T, Hampton LJ, Autorino R. ROBOT-ASSISTED URETERAL REIMPLANTATION: A SINGLE CENTER COMPARATIVE STUDY. J Endourol 2021; 35:1504-1511. [PMID: 34098751 DOI: 10.1089/end.2021.0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To report a single-center experience with robot-assisted ureteral reimplantation (RAUR) and to compare its outcomes with those of open ureteral reimplantation (OUR). MATERIALS AND METHODS Patients who underwent RAUR or OUR for ureteral disease between 2016 and 2020 were identified. Data collected included baseline, pathological, perioperative and postoperative features. The RAUR outcomes were compared with those of OUR. RESULTS Overall, twenty-one (42.8%) patients underwent RAUR, and 28 (57.2%) underwent OUR. The two groups were similar in terms of baseline and pathological characteristics. There was a statistically significant difference in favor of RAUR for median operative time (216 vs. 317min, p=0.01) and median blood loss (35 vs. 175ml, p=0.001). No difference was observed in overall complication rate (33.3 vs. 46.4%, p=0.9), as well as major complications (Clavien-Dindo≥III grade) rate between RAUR and OUR groups. Median LOS was shorter for RAUR (2 vs. 6 days; p=0.001), as well as median catheterization time (16 vs. 28 days; p=0.005). CONCLUSIONS RAUR is a safe and effective minimally invasive surgical procedure for the management of mid to distal ureteral strictures. It can recapitulate the success rate of the gold standard OUR while offering a benefit in terms of lower surgical morbidity and faster postoperative recovery.
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Affiliation(s)
- Umberto Carbonara
- Virginia Commonwealth University Health System, 6887, Department of Urology, 11200 E BROAD ST, RICHMOND, Richmond, Virginia, United States, 23233.,Università degli Studi di Bari Aldo Moro, 9295, Department of Urology, Bari, Puglia, Italy;
| | | | - Theodore Cisu
- VCU Health, 6887, Richmond, Virginia, United States;
| | - Fabio Crocerossa
- Virginia Commonwealth University Health System, 6887, Department of Urology, 1200 E Broad St., Richmond, Virginia, United States, 23298;
| | - Georgi Guruli
- VCU Health, 6887, Richmond, Virginia, United States;
| | - Mayer B Grob
- VCU Health, 6887, Richmond, Virginia, United States;
| | - Tyler Roseman
- VCU Health, 6887, Richmond, Virginia, United States;
| | | | - Riccardo Autorino
- Virginia Commonwealth University Health System, 6887, Surgery (Urology), 1200 East Broad st, Richmond, Virginia, United States, 23298;
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11
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Carbonara U, Eun D, Derweesh I, Capitanio U, Celia A, Fiori C, Checcucci E, Amparore D, Lee J, Larcher A, Patel D, Meagher M, Crocerossa F, Veccia A, Hampton LJ, Montorsi F, Porpiglia F, Autorino R. Retroperitoneal versus transepritoneal robot-assisted partial nephrectomy for postero-lateral renal masses: an international multicenter analysis. World J Urol 2021; 39:4175-4182. [PMID: 34050813 DOI: 10.1007/s00345-021-03741-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/20/2021] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To assess the outcomes of retroperitoneal robot-assisted partial nephrectomy (r-RAPN) in a large cohort of patients with postero-lateral renal masses comparing to those of transperitoneal RAPN (t-RAPN). METHODS Patients with posterior (R.E.N.A.L. score grading P) or lateral (grading X) renal mass who underwent RAPN in six high-volume US and European centers were identified and stratified into two groups according to surgical approach: r-RAPN ("study group") and t-RAPN ("control group"). Baseline characteristics, intraoperative, and postoperative data were collected and compared. RESULTS Overall, 447 patients were identified for the analysis. 231 (51.7%) and 216 (48.3%) patients underwent r-RAPN and t-RAPN, respectively. Baseline characteristics were not statistically significantly different between the groups. r-RAPN group reported lower median operative time (140 vs. 170 min, p < 0.001). No difference was found in ischemia time, estimated blood loss, and intraoperative complications. Overall, 47 and 54 postoperative complications were observed in r-RAPN and t-RAPN groups, respectively (20.3 vs. 25.1%, p = 0.9). 1 and 2 patients reported major complications (Clavien-Dindo ≥ III grade) in the retroperitoneal and transperitoneal groups (0.4 vs. 0.9%, p = 0.9). There was no difference in hospital re-admission rate, median length of stay, and PSM rate. Trifecta criteria were achieved in 90.3 and 89.2% of r-RAPN and t-RAPN, respectively (p = 0.7). CONCLUSION r-RAPN and t-RAPN offer similar postoperative, functional, and oncological outcomes for patients with postero-lateral renal tumors. Our analysis suggests an advantage for r-RAPN in terms of shorter operative time, whereas it does not confirm a difference in terms of length of stay, as suggested by previous reports.
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Affiliation(s)
- Umberto Carbonara
- Division of Urology, VCU Health, Richmond, VA, 23298-0118, USA.,Department of Urology, University of Bari, Bari, Italy
| | - Daniel Eun
- Department of Urology, Temple University, Philadelphia, PA, USA
| | | | - Umberto Capitanio
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Enrico Checcucci
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Jennifer Lee
- Department of Urology, Temple University, Philadelphia, PA, USA
| | - Alessandro Larcher
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Devin Patel
- Department of Urology, UCSD, San Diego, CA, USA
| | | | | | | | - Lance J Hampton
- Division of Urology, VCU Health, Richmond, VA, 23298-0118, USA
| | - Francesco Montorsi
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
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12
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Carbonara U, Simone G, Minervini A, Sundaram CP, Larcher A, Lee J, Checcucci E, Fiori C, Patel D, Meagher M, Crocerossa F, Veccia A, Hampton LJ, Ditonno P, Battaglia M, Brassetti A, Bove A, Mari A, Campi R, Carini M, Sulek J, Montorsi F, Capitanio U, Eun D, Porpiglia F, Derweesh I, Autorino R. Outcomes of robot-assisted partial nephrectomy for completely endophytic renal tumors: A multicenter analysis. Eur J Surg Oncol 2021; 47:1179-1186. [DOI: 10.1016/j.ejso.2020.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/30/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022] Open
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13
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Veccia A, Carbonara U, Derweesh I, Mehrazin R, Porter J, Abdollah F, Mazzone E, Sundaram CP, Gonzalgo M, Mastroianni R, Ghoreifi A, Cacciamani GE, Patel D, Marcus J, Danno A, Steward J, Bhattu AS, Asghar A, Reese AC, Wu Z, Uzzo RG, Minervini A, Rha KH, Ferro M, Margulis V, Hampton LJ, Simone G, Eun DD, Djaladat H, Mottrie A, Autorino R. Single stage Xi® robotic radical nephroureterectomy for upper tract urothelial carcinoma: surgical technique and outcomes. Minerva Urol Nephrol 2021; 74:233-241. [PMID: 33781022 DOI: 10.23736/s2724-6051.21.04247-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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 Radical nephroureterectomy (RNU) represents the standard of care for high grade upper tract urothelial carcinoma (UTUC). Open and laparoscopic approaches are well-established treatments, but evidence regarding robotic RANU is growing. The introduction of the Xi® system facilitates the implementation of this multi-quadrant procedure. The aim of this video-article is to describe the surgical steps and the outcomes of Xi® robotic RNU. METHODS Single stage Xi® robotic RNU without patients repositioning and robot re-docking were done between 2015 and 2019 and collected in a large worldwide multi-institutional study, the ROBotic surgery for Upper tract Urothelial cancer STudy (ROBUUST). Institutional review board approval and data share agreement were obtained at each center. Surgical technique is described in detail in the accompanying video. Descriptive statistics of baseline characteristics and surgical, pathological, and oncological outcomes were analyzed. RESULTSː Overall, 148 patients were included in the analysis; 14% had an ECOG >1 and 68.2% ASA ≥3. Median tumor dimension was 3.0 (IQR:2.0-4.2) cm and 34.5% showed hydronephrosis at diagnosis. Forty-eight% were cT1 tumors. Bladder cuff excision and lymph node dissection were performed in 96% and 38.1% of the procedures, respectively. Median operative time and estimated blood loss were 215.5 (IQR:160.5-290.0) minutes and 100.0 (IQR: 50.0-150.0) mL, respectively. Approximately 56% of patients took opioids during hospital stay for a total morphine equivalent dose of 22.9 (IQR:16.0-60.0) milligrams equivalent. Postoperative complications were 26 (17.7%), with 4 major (15.4%). Seven patients underwent adjuvant chemotherapy, with median number of cycles of 4.0 (IQR:3.0-6.0). CONCLUSIONS Single stage Xi® RNU is a reproducible and safe minimally invasive procedure for treatment of UTUC. Additional potential advantages of the robot might be a wider implementation of LND with a minimally invasive approach.
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Affiliation(s)
| | | | - Ithaar Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Elio Mazzone
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Chandru P Sundaram
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Alireza Ghoreifi
- Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Devin Patel
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Jamil Marcus
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Alyssa Danno
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - James Steward
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Amit S Bhattu
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aeen Asghar
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Adam C Reese
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Zhenjie Wu
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Robert G Uzzo
- Department of Urological Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA, USA
| | | | - Koon H Rha
- Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Daniel D Eun
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Hooman Djaladat
- Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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14
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Branche B, Crocerossa F, Carbonara U, Klausner AP, Roseman JT, Hampton LJ, Autorino R. Management of Bladder Neck Contracture in the Age of Robotic Prostatectomy: An Evidence-based Guide. Eur Urol Focus 2021; 8:297-301. [PMID: 33531288 DOI: 10.1016/j.euf.2021.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/08/2020] [Revised: 11/16/2020] [Accepted: 01/08/2021] [Indexed: 11/30/2022]
Abstract
The incidence of bladder neck contracture (BNC), or postprostatectomy vesicourethral anastomosis, has declined since the advent of robotic surgery. However, men with peripheral vascular comorbidities, among other factors, still have a high risk of developing this complication after any surgery that involves manipulation of the prostate. The best strategy for BNC management remains uncertain because of inconsistency in success for different approaches across studies. We reviewed the available evidence on BNC, including the results for endoscopic treatments, scar modulation therapies, and open and robotic bladder neck reconstruction. On the basis of these data, we propose a management flowchart. Patient baseline status and subjective goals and preferences remain crucial in management choices. PATIENT SUMMARY: Contracture of the bladder neck can occur as a complication after surgery to the prostate. We reviewed the evidence for various treatment approaches and propose a flowchart for management of this condition.
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Affiliation(s)
- Brandee Branche
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Fabio Crocerossa
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA; Division of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Umberto Carbonara
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA; Department of Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Adam P Klausner
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - John T Roseman
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Lance J Hampton
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Riccardo Autorino
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA.
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15
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Abstract
PURPOSE OF REVIEW The aim of this study was to provide an updated review of robotic-assisted kidney transplant (RAKT) with an emphasis on advantages over the open kidney transplant (OKT), utility in special populations and resources available to overcome the learning curve of robotic surgery. RECENT FINDINGS The majority of the reported studies showed that RAKT and OKT have similar functional outcomes including similar ischemia times and time to postoperative normalization of creatinine. However, RAKT results in fewer wound complications, decreased estimated blood loss and pain. Given these benefits, RAKT is a promising approach for obese patient across BMI subtypes and several studies showed decreased wound complications in this population compared with the open approach. Moreover, new 3D-print techniques are promising resources for robotic simulation, which may decrease the learning curve of robotic surgery. SUMMARY Overall, RAKT is a feasible approach especially in obese patients. However, more data with long-term follow-up are needed to fully elucidate the advantages over OKT before universal implementation of this approach is possible.
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Affiliation(s)
| | | | | | - Chandra S Bhati
- Department of Transplant Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
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16
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Carbonara U, Lee J, Crocerossa F, Veccia A, Hampton LJ, Eun D, Autorino R. Single overnight stay after robot-assisted partial nephrectomy: a bi-center experience. Minerva Urol Nephrol 2020; 73:773-780. [PMID: 33200901 DOI: 10.23736/s2724-6051.20.04054-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite hospital length of stay (LOS) being shorter for robot-assisted partial nephrectomy (RAPN) compared to its open counterpart, several series in the literature report on average a LOS of 2-3 days or more. We aimed to assess factors predicting a prolonged length of stay (beyond a single overnight stay) in patients undergoing RAPN. METHODS Patients who underwent RAPN between 2010 and 2019 at two USA Centers were included and divided into two groups according to LOS: the study group included all patients who were discharged on POD1, whereas the control group included patients with LOS ≥2 days. Demographics, surgical and perioperative outcomes were compared between the groups. Multivariable logistic regression analyses were used to identify independent predictors of LOS ≥2. RESULTS Overall, 173 (60.5%) patients discharged on POD1, and 113 (39.5%) discharged on POD≥2. Patients in the study group presented a lower mean BMI (29 vs. 32, P=0.02). Retroperitoneal approach was performed in 13.3% patients with shorter LOS (P<0.001). There was a statistically significant difference in median OT (144 vs. 168 min, P=0.005) and WIT (19 vs. 23 min, P=0.001). We observed six postoperative complications (3.6%) in patients discharged on POD1 and 35 (30.5%) in control group (P<0.001). Major complications (Clavien-Dindo grade ≥III) were observed in three of POD1 patients (1.8 vs. 6.1%, P<0.001). There was no difference in hospital readmission rate. On logistic regression analysis, independent predictors of prolonged LOS were OT (OR=1.01, 95% CI: 1.0-1.2, P=0.001), and occurrence of a postoperative complication (OR=2.2, 95% CI: 2.0-2.5, P<0.001). CONCLUSIONS Our findings confirm that a single overnight stay after RAPN is feasible and safe. In our experience, and within the limitations of the present analysis, prolonged operative time and occurrence of immediate postoperative complications translate into higher risk of prolonged hospital stay. Besides adopting a minimally invasive approach, surgeons should also implement perioperative care pathways facilitating early discharge without increasing the risk of readmission.
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Affiliation(s)
- Umberto Carbonara
- Division of Urology, VCU Health, Richmond, VA, USA.,Department of Urology, University of Bari, Bari, Italy
| | - Jennifer Lee
- Department of Urology, Temple University, Philadelphia, PA, USA
| | - Fabio Crocerossa
- Division of Urology, VCU Health, Richmond, VA, USA.,Department of Urology, Magna Graecia University, Catanzaro, Italy
| | | | | | - Daniel Eun
- Department of Urology, Temple University, Philadelphia, PA, USA
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17
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Carbonara U, Simone G, Capitanio U, Minervini A, Fiori C, Larcher A, Checcucci E, Amparore D, Crocerossa F, Veccia A, Weprin S, Ditonno P, Brassetti A, Bove A, Mari A, Grosso AA, Carini M, Montorsi F, Hampton LJ, Gallucci M, Porpiglia F, Autorino R. Robot-assisted partial nephrectomy: 7-year outcomes. Minerva Urol Nephrol 2020; 73:540-543. [PMID: 33200907 DOI: 10.23736/s2724-6051.20.04151-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [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 The role of robot-assisted partial nephrectomy (RAPN) in the management of renal masses has exponentially grown over the past 10 years. Nevertheless, data on long term outcomes of the procedure remains limited. Herein we report oncological and functional outcomes of patients who underwent RAPN for a malignant mass with a median follow-up of 7 years, the longest follow-up to date. METHODS A retrospective analysis of an international multicenter database was performed. All consecutive patients undergoing surgery between 2009 and 2013 with a minimum of 3-year follow-up and complete data on renal function were included. Demographics, surgical and perioperative outcomes were analyzed. Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analysis. RESULTS Overall, our study cohort was composed of eighty-five patients with a median follow-up of 88 months. Median clinical tumor size was 3 cm, with mostly (74.1%) clinical stage T1a, and median RENAL score 6. Final histopathologic analysis revealed clear cell RCC in 76.5% of cases. PSM was present in seven patients (8.2%). Eleven overall deaths (12.9%) occurred in the cohort during the follow-up period. Two of these (2.33%) were attributed to metastatic RCC. The OS, CSS, and DFS rates were 91.7%, 97.7%, and 91.7% at 84 months, respectively. Regarding the renal functional outcomes, seventeen patients (20.1%) presented a CKD upstaging in our cohort. CONCLUSIONS Our findings show excellent 7-year oncologic and functional outcomes of the procedure, which duplicate those achieved in historical series of open and laparoscopic surgery.
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Affiliation(s)
- Umberto Carbonara
- Division of Urology, VCU Health, Richmond, VA, USA.,Department of Urology, University of Bari, Bari, Italy
| | | | - Umberto Capitanio
- Unit of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Alessandro Larcher
- Unit of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | - Enrico Checcucci
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | | | | | - Pasquale Ditonno
- Department of Urology, University of Bari, Bari, Italy.,Unit of Urology, Giovanni Paolo II National Cancer Institute IRCCS, Bari, Italy
| | - Aldo Brassetti
- Department of Urology, Regina Elena Institute, Rome, Italy
| | - Alfredo Bove
- Department of Urology, Regina Elena Institute, Rome, Italy
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Montorsi
- Unit of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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18
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Carbonara U, Simone G, Capitanio U, Minervini A, Fiori C, Larcher A, Checcucci E, Amparore D, Crocerossa F, Veccia A, Weprin S, Ditonno P, Brassetti A, Bove A, Mari A, Grosso AA, Carini M, Montorsi F, Hampton LJ, Gallucci M, Porpiglia F, Autorino R. Robot-assisted partial nephrectomy: 7-year outcomes. Minerva Urol Nephrol 2020. [PMID: 33200907 DOI: 10.23736/s0393-2249.20.04151-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The role of robot-assisted partial nephrectomy (RAPN) in the management of renal masses has exponentially grown over the past 10 years. Nevertheless, data on long term outcomes of the procedure remains limited. Herein we report oncological and functional outcomes of patients who underwent RAPN for a malignant mass with a median follow-up of 7 years, the longest follow-up to date. METHODS A retrospective analysis of an international multicenter database was performed. All consecutive patients undergoing surgery between 2009 and 2013 with a minimum of 3-year follow-up and complete data on renal function were included. Demographics, surgical and perioperative outcomes were analyzed. Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analysis. RESULTS Overall, our study cohort was composed of eighty-five patients with a median follow-up of 88 months. Median clinical tumor size was 3 cm, with mostly (74.1%) clinical stage T1a, and median RENAL score 6. Final histopathologic analysis revealed clear cell RCC in 76.5% of cases. PSM was present in seven patients (8.2%). Eleven overall deaths (12.9%) occurred in the cohort during the follow-up period. Two of these (2.33%) were attributed to metastatic RCC. The OS, CSS, and DFS rates were 91.7%, 97.7%, and 91.7% at 84 months, respectively. Regarding the renal functional outcomes, seventeen patients (20.1%) presented a CKD upstaging in our cohort. CONCLUSIONS Our findings show excellent 7-year oncologic and functional outcomes of the procedure, which duplicate those achieved in historical series of open and laparoscopic surgery.
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Affiliation(s)
- Umberto Carbonara
- Division of Urology, VCU Health, Richmond, VA, USA.,Department of Urology, University of Bari, Bari, Italy
| | | | - Umberto Capitanio
- Unit of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Alessandro Larcher
- Unit of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | - Enrico Checcucci
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | | | | | - Pasquale Ditonno
- Department of Urology, University of Bari, Bari, Italy.,Unit of Urology, Giovanni Paolo II National Cancer Institute IRCCS, Bari, Italy
| | - Aldo Brassetti
- Department of Urology, Regina Elena Institute, Rome, Italy
| | - Alfredo Bove
- Department of Urology, Regina Elena Institute, Rome, Italy
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Montorsi
- Unit of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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Gayhart MG, Johnson N, Paul A, Quillin JM, Hampton LJ, Idowu MO, Smith SC. Universal Mismatch Repair Protein Screening in Upper Tract Urothelial Carcinoma. Am J Clin Pathol 2020; 154:792-801. [PMID: 32789450 DOI: 10.1093/ajcp/aqaa100] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Universal screening of upper tract urothelial carcinoma (UTUC) for Lynch syndrome by mismatch repair (MMR) protein immunohistochemistry (IHC) has been recommended by some investigators. Herein, we assess this recommendation retrospectively by simulating its performance on a retrospective, unselected cohort of UTUCs, with comparison to the established setting of colorectal and endometrial adenocarcinoma. METHODS We assessed for complete loss of MMR protein (MLH1, MSH2, MSH6, and PMS2) IHC in 74 consecutive cases of UTUC and then tabulated clinical and pathologic factors. MMR findings from same-institution colorectal and endometrial adenocarcinomas were tabulated for comparison. RESULTS We observed loss of at least one MMR protein in 12% in our UTUC cohort (three MSH2/MSH6, three MSH6 only, one MLH1/PMS2, and two PMS2 only). Of these nine cases (seven males, two females, median age 67 years, five associated with colorectal adenocarcinoma), at least three (4% of the overall cohort) proved to be Lynch syndrome. Overall, MMR loss in UTUC was comparable to colorectal (11%; 50 of 471 cases) and endometrial (12%; 12 of 101 cases) adenocarcinomas. CONCLUSIONS The rate of MMR loss observed in UTUC was comparable to that in the established setting of colorectal and endometrial adenocarcinomas, supporting universal UTUC screening at our institution and others.
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Affiliation(s)
| | - Nicole Johnson
- Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond
| | - Asit Paul
- Division of Hematology, Oncology, and Palliative Care, Department of Medicine, Virginia Commonwealth University School of Medicine, Richmond
| | - John M Quillin
- Department of Human and Molecular Genetics, Virginia Commonwealth University School of Medicine, Richmond
| | - Lance J Hampton
- Division of Urology, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond
| | - Michael O Idowu
- Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond
| | - Steven Christopher Smith
- Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond
- Division of Urology, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond
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20
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Larcher A, Wallis CJ, Pavan N, Porpiglia F, Takagi T, Tanabe K, Rha KH, Raheem AA, Yang B, Zang C, Perdonà S, Quarto G, Maurer T, Amiel T, Schips L, Castellucci R, Crivellaro S, Dobbs R, Baiamonte G, Celia A, De Concilio B, Furlan M, Lima E, Linares E, Micali S, Amparore D, De Naeyer G, Trombetta C, Hampton LJ, Tracey A, Bindayi A, Antonelli A, Derweesh I, Mir C, Montorsi F, Mottrie A, Autorino R, Capitanio U. Outcomes of minimally invasive partial nephrectomy among very elderly patients: report from the RESURGE collaborative international database. Cent European J Urol 2020; 73:273-279. [PMID: 33133653 PMCID: PMC7587491 DOI: 10.5173/ceju.2020.0179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 01/20/2023] Open
Abstract
The aim of the study was to perform a comprehensive investigation of clinical outcomes of robot-assisted partial nephrectomy (RAPN) or laparoscopic partial nephrectomy (LPN) in elderly patients presenting with a renal mass. The REnal SURGery in Elderly (RESURGE) collaborative database was queried to identify patients aged 75 or older diagnosed with cT1-2 renal mass and treated with RAPN or LPN. Study outcomes were: overall complications (OC); warm ischemia time (WIT) and 6-month estimated glomerular filtration rate (eGFR); positive surgical margins (PSM), disease recurrence (REC), cancer-specific mortality (CSM) and other-cause mortality (OCM). Descriptive statistics, Kaplan-Meier, smoothed Poisson plots and logistic and linear regression models (MVA) were used. Overall, 216 patients were included in this analysis. OC rate was 34%, most of them being of low Clavien grade. Median WIT was 17 minutes and median 6-month eGFR was 54 ml/min/1.73 m2. PSM rate was 5%. After a median follow-up of 20 months, the 5-year rates of REC, CSM and OCM were 4, 4 and 5%, respectively. At MVA predicting perioperative morbidity, RAPN relative to LPN (odds ratio [OR] 0.33; p <0.0001) was associated with lower OC rate. At MVA predicting functional outcomes, RAPN relative to LPN was associated with shorter WIT (estimate [EST] -4.09; p <0.0001), and with higher 6-month eGFR (EST 6.03; p = 0.01). In appropriately selected patients with small renal masses, minimally-invasive PN is associated with acceptable perioperative outcomes. The use of a robotic approach over a standard laparoscopic approach can be advantageous with respect to clinically relevant outcomes, and it should be preferred when available.
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Affiliation(s)
- Alessandro Larcher
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Urology, OLV Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | | | - Nicola Pavan
- Department of Urology, University of Trieste, Trieste, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Toshio Takagi
- Department of Urology, Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Women's Medical University, Tokyo, Japan
| | - Koon H. Rha
- Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ali Abdel Raheem
- Department of Urology, Tanta University, Tanta, Egypt; Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Bo Yang
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Chao Zang
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Sisto Perdonà
- Division of Urology, IRCCS Fondazione G.Pascale, Naples, Italy
| | - Giuseppe Quarto
- Division of Urology, IRCCS Fondazione G.Pascale, Naples, Italy
| | - Tobias Maurer
- Department of Urology, Technical University, Munich, Germany
| | - Thomas Amiel
- Department of Urology, Technical University, Munich, Germany
| | - Luigi Schips
- Department Of Urology, Annunziata Hospital, G. D’Annunzio University, Chieti, Italy
| | - Roberto Castellucci
- Department Of Urology, Annunziata Hospital, G. D’Annunzio University, Chieti, Italy
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Ryan Dobbs
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Gianfranco Baiamonte
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | | | - Maria Furlan
- Department of Urology, Spedali Civili Hospital University of Brescia, Brescia, Italy
| | - Estevão Lima
- Department of CUF Urology and Service of Urology, Hospital of Braga, Braga, Portugal
| | | | - Salvatore Micali
- University of Modena and Reggio Emilia, Department of Urology, Modena, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | | | - Carlo Trombetta
- Department of Urology, University of Trieste, Trieste, Italy
| | | | | | - Ahmet Bindayi
- Department of Urology, UCSD Health System, La Jolla, CA, USA
| | - Alessandro Antonelli
- Department of Urology, Spedali Civili Hospital University of Brescia, Brescia, Italy
| | - Ithaar Derweesh
- Department of Urology, UCSD Health System, La Jolla, CA, USA
| | - Carme Mir
- Instituto Valenciano de Oncologia Foundation, Valencia, Spain
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alexandre Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | | | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
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Falagario U, Veccia A, Weprin S, Albuquerque EV, Nahas WC, Carrieri G, Pansadoro V, Hampton LJ, Porpiglia F, Autorino R. Robotic-assisted surgery for the treatment of urologic cancers: recent advances. Expert Rev Med Devices 2020; 17:579-590. [PMID: 32342705 DOI: 10.1080/17434440.2020.1762487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION As the medical field is moving toward personalized and tailored approaches, we entered the era of precision surgery for the management of genitourinary cancers1. This is facilitated by the implementation of new technologies, among which robotic surgery stands out for the significant impact in the surgical field over the last two decades. AREAS COVERED This article reviews the latest evidence on robotic surgery for the treatment of urologic cancers, including prostate, kidney, bladder, testis, and penile cancer. Functional and oncologic outcomes, new surgical techniques, new imaging modalities, and new robotic platforms are discussed. EXPERT OPINION Robotic surgery had a growing role in the management of genitourinary cancers over the past 10 years. Despite a lack of high-quality evidence comparing the effectiveness of robotic to open surgery, the robotic approach allowed a larger adoption of a minimally invasive surgical approach, translating into lower surgical morbidity and shorter hospital stay. New robotic platforms might allow to explore novel surgical approaches, and new technologies might facilitate surgical navigation and intraoperative identification of anatomical structures, allowing a more tailored and precise surgery. It is an exciting time for robotic surgery, and upcoming technological advances will offer better outcomes to urologic cancer patients.
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Affiliation(s)
- Ugo Falagario
- Division of Urology, VCU Health System , Richmond, Virginia, USA.,Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia , Foggia, Italy
| | - Alessandro Veccia
- Division of Urology, VCU Health System , Richmond, Virginia, USA.,Urology Unit, ASST Spedali Civili Hospital , Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia , Italy
| | - Samuel Weprin
- Division of Urology, VCU Health System , Richmond, Virginia, USA
| | - Emanuel V Albuquerque
- Divisão De Urologia, Faculdade De Medicina Da Universidade De São Paulo, Instituto Do Câncer De Estado De São Paulo , São Paulo, Brazil
| | - William C Nahas
- Divisão De Urologia, Faculdade De Medicina Da Universidade De São Paulo, Instituto Do Câncer De Estado De São Paulo , São Paulo, Brazil
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia , Foggia, Italy
| | - Vito Pansadoro
- Department of Urology, Vincenzo Pansadoro Foundation , Rome, Italy
| | - Lance J Hampton
- Division of Urology, VCU Health System , Richmond, Virginia, USA
| | - Francesco Porpiglia
- Division of Urology, University of Turin, San Luigi Gonzaga Hospital , Orbassano, Italy
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Nandanan N, Veccia A, Antonelli A, Derweesh I, Mottrie A, Minervini A, Aron M, Simone G, Capitanio U, Simeone C, Eun D, Perdonà S, Porter J, Sundaram C, Zhang C, Uzzo R, Challacombe B, Hampton LJ, Kaouk J, Porpiglia F, Autorino R. Outcomes and predictors of benign histology in patients undergoing robotic partial or radical nephrectomy for renal masses: a multicenter study. Cent European J Urol 2020; 73:33-38. [PMID: 32395320 PMCID: PMC7203778 DOI: 10.5173/ceju.2020.0019] [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: 02/03/2020] [Revised: 02/09/2020] [Accepted: 03/01/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction Theaim of this study was to assess preoperative factors associated with benign histology in patients undergoing surgical removal of a renal mass and to analyze outcomes of robotic partial nephrectomy (PN) and radical nephrectomy (RN) for these masses. Material and methods Overall, 2,944 cases (543 benign and 2,401 malignant) who underwent robotic PN and RN between 2003–2018 at 10 institutions worldwide were included. The assessment of the predictors of benign histology was made at the final surgical pathology report. Descriptive statistics, Mann-Whitney U, Pearson’s χ2, and logistic regression analysis were used. Results Patients in the benign group were mostly female (61 vs. 33%; p <0.001), with lower body mass index (BMI) (26.0 vs. 27.1 kg/m2; p <0.001). The benign group presented smaller tumor size (2.8 vs. 3.5 cm; p <0.001), R.E.N.A.L. score (6.0 vs. 7.0; p <0.001). There was a lower rate of hilar (11 vs.18%; p = 0.001), cT≥3 (1 vs. 4.5%; p <0.001) tumors in the benign group. There was a statistically significant higher rate of PN in the benign group (97 vs. 86%; p <0.001) as well as a statistically significant lower 30-day re-admission rate (2 vs. 5%; p = 0.081). Multivariable analysis showed male gender (OR: 0.52; p <0.001), BMI (OR: 0.95; p <0.001), and cT3a (OR: 0.22; p = 0.005) to be inversely associated to benign histology. Conclusions In 18% of cases, a benign histologic type was found. Only 3% of these tumors were treated with RN. Female gender, lower BMI, and higher T staging showed to be independent predictors of benign histology.
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Affiliation(s)
- Naveen Nandanan
- Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA.,equal contributions
| | - Alessandro Veccia
- Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA.,Urology Unit, ASST SpedaliCivili Hospital, Brescia, Italy, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Italy.,equal contributions
| | - Alessandro Antonelli
- Urology Unit, ASST SpedaliCivili Hospital, Brescia, Italy, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Italy
| | - Ithaar Derweesh
- Department of Urology, UCSD Health System, La Jolla, CA, USA
| | | | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Firenze, Italy
| | - Monish Aron
- Center for Robotic Simulation and Education, USC Institute of Urology, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Giuseppe Simone
- Department of Urology, 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Claudio Simeone
- Urology Unit, ASST SpedaliCivili Hospital, Brescia, Italy, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Italy
| | - Daniel Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Sisto Perdonà
- Urology Unit, G. Pascale Foundation IRCS, Naples, Italy
| | | | - Chandru Sundaram
- Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Chao Zhang
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Robert Uzzo
- Division of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - Lance J Hampton
- Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Jihad Kaouk
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Francesco Porpiglia
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA
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Veccia A, Weprin S, Balthazar A, Hampton LJ, Autorino R. Simplified transvesical robot-assisted simple prostatectomy: Technical nuances. Urology Video Journal 2020. [DOI: 10.1016/j.urolvj.2019.100025] [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: 10/25/2022] Open
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Veccia A, Dell'oglio P, Antonelli A, Minervini A, Simone G, Challacombe B, Perdonà S, Porter J, Zhang C, Capitanio U, Sundaram CP, Cacciamani G, Aron M, Anele U, Hampton LJ, Simeone C, De Naeyer G, Bradshawh A, Mari A, Campi R, Carini M, Fiori C, Gallucci M, Jacobsohn K, Eun D, Lau C, Kaouk J, Derweesh I, Porpiglia F, Mottrie A, Autorino R. Robotic partial nephrectomy versus radical nephrectomy in elderly patients with large renal masses. MINERVA UROL NEFROL 2020; 72. [DOI: 10.23736/s0393-2249.19.03583-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Antonelli A, Veccia A, Francavilla S, Bertolo R, Bove P, Hampton LJ, Mari A, Palumbo C, Simeone C, Minervini A, Autorino R. On-clamp versus off-clamp robotic partial nephrectomy: A systematic review and meta-analysis. Urologia 2019; 86:52-62. [PMID: 31179885 DOI: 10.1177/0391560319847847] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The debate on the pros and cons of robot-assisted partial nephrectomy performed with (on-clamp) or without (off-clamp) renal artery clamping is ongoing. The aim of this meta-analysis is to summarize the available evidence on the comparative studies assessing the outcomes of these two approaches. MATERIAL AND METHODS A systematic review of the literature on PubMed, ScienceDirect®, and Embase® was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA). Only comparative and case-control studies were submitted to full-text assessment and meta-analysis. RevMan 5.3 software was used. RESULTS From the initial retrieval of 1937 studies, 15 fulfilling inclusion criteria were selected and provided 2075 patients for analysis (702 off-clamp, 1373 on-clamp). Baseline tumor's features showed a significant difference in size (weighted mean difference: -0.58 cm; 95% confidence interval: [-1.06, -0.10]; p = 0.02) and R.E.N.A.L. score (weighted mean difference: -0.53; 95% confidence interval: [-0.81, -0.25]; p = 0.0002), but not in the exophytic property, the location, and the PADUA score. Pooled analysis revealed shorter operative time (p = 0.02) and higher estimated blood loss (p = 0.0002) for the off-clamp group. Overall complication and transfusion rates were similar, while higher major complication rate was observed in the on-clamp approach (5.6% vs 1.9%, p = 0.03). No differences in oncological outcomes were found. Finally, functional outcomes (assessed by estimated glomerular filtration rate at early postoperative, 3 month, 6 month, and last available follow-up) were not statistically different. CONCLUSION This meta-analysis shows that off-clamp robot-assisted partial nephrectomy is reserved to smaller renal masses. Under such conditions, no differences with the on-clamp approach emerged.
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Affiliation(s)
- Alessandro Antonelli
- 1 Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy.,2 Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Alessandro Veccia
- 1 Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy.,2 Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,3 Division of Urology, VCU Health System, Richmond, VA, USA
| | - Simone Francavilla
- 1 Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy.,2 Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Pierluigi Bove
- 4 Urology Department, San Carlo di Nancy Hospital, Rome, Italy
| | | | - Andrea Mari
- 5 Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Carlotta Palumbo
- 1 Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy.,2 Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Claudio Simeone
- 1 Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy.,2 Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Minervini
- 5 Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
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Veccia A, Antonelli A, Francavilla S, Simeone C, Guruli G, Zargar H, Perdoná S, Ferro M, Carrieri G, Hampton LJ, Porpiglia F, Autorino R. Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases. World J Urol 2019; 38:845-852. [PMID: 31773242 DOI: 10.1007/s00345-019-03020-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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: 06/09/2019] [Accepted: 11/10/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To perform a systematic review and meta-analysis of the literature inherent robotic nephroureterectomy (RNU) and to compare its outcomes with those of other nephroureterectomy (NU) techniques. METHODS A systematic literature search was performed up to April 2019 using PubMed, Embase®, and Web of Science. The Preferred Reporting Items for Systematic Review and Meta-analysis Statement was followed for study selection. The following data were extracted for each study: baseline features, surgical outcomes, oncological outcomes, and survival outcomes. Stata® 15.0 was used for statistical analysis. RESULTS Literature search identified 80 studies eligible for the meta-analysis and overall 87,291 patients were included in the analysis: open NU (ONU; n = 45,601), hand-assisted laparoscopic NU (HALNU; n = 442), laparoscopic NU (LNU n = 31,093), and RNU (n = 10,155). RNU was more likely to be performed in those patients with multifocal tumor location (proportion: 0.19; 95% CI 0.14, 0.24) and high-grade disease (proportion: 0.70; 95% CI 0.53, 0.68). The lowest EBL was recorded in the RNU group (weighted mean (WM) 163.31 mL; 95% CI 88.94, 237.68), whereas the highest was in the ONU group (414.99 mL; 95% CI 378.52, 451.46). Operative time was shorter for ONU (224.98 mL; 95% CI 212.26, 237.69). RNU had lower rate of intraoperative complications (0.02; 95% CI 0.01, 0.05). ONU showed higher odds of transfusions (0.20; 95% CI 0.15, 0.25). LOS was statistically significantly shorter for the RNU group (5.35 days; 95% CI 4.97, 5.82). HALNU seemed to present lower risk of PSM (0.02; 95% CI - 0.01, 0.05), and lower risk of recurrence (0.22; 95% CI 0.15, 0.30), metastasis (0.07; 95% CI 0.05, 0.10), and cancer-related death (0.03; 95% CI 0.01, 0.06). ONU showed the lowest 5 years cancer specific survival (proportion: 0.77; 95% CI 0.74, 0.80). No correlation was found between the surgical technique and recurrence-free and cancer-specific survival. CONCLUSIONS Evidence regarding RNU for the treatment of UTUC is increasing but it remains quite sparse and of low quality. Despite this, RNU seems to be safe, and to offer the advantages of a minimally invasive approach without impairing the oncological outcomes. Nevertheless, ONU, HALNU, and LNU still represent a valid, and commonly used surgical treatment option. As RNU becomes more popular, and concerns related to its use remain, the best surgical technique for NU remains to be determined.
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Affiliation(s)
- Alessandro Veccia
- Division of Urology, VCU Health System, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA.,Urology Unit, ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Alessandro Antonelli
- Urology Unit, ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Simone Francavilla
- Urology Unit, ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Georgi Guruli
- Division of Urology, VCU Health System, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA
| | - Homayoun Zargar
- Department of Surgery, Department of Urology, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - Sisto Perdoná
- Uro-Gynecological Department, Fondazione "G. Pascale" IRCCS, Naples, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Lance J Hampton
- Division of Urology, VCU Health System, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA
| | | | - Riccardo Autorino
- Division of Urology, VCU Health System, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA.
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Veccia A, Antonelli A, Uzzo RG, Novara G, Kutikov A, Ficarra V, Simeone C, Mirone V, Hampton LJ, Derweesh I, Porpiglia F, Autorino R. Predictive Value of Nephrometry Scores in Nephron-sparing Surgery: A Systematic Review and Meta-analysis. Eur Urol Focus 2019; 6:490-504. [PMID: 31776071 DOI: 10.1016/j.euf.2019.11.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/17/2019] [Accepted: 11/03/2019] [Indexed: 01/20/2023]
Abstract
CONTEXT Over the last decade, several nephrometry scores (NSs) have been introduced with the aim of facilitating preoperative decision making, planning, and counseling in the field of nephron-sparing surgery. However, their predictive role remains controversial. OBJECTIVE To describe currently available nephrometry scores and to determine their predictive role for different outcomes by performing a systematic review and meta-analysis of the literature. EVIDENCE ACQUISITION PubMed, Embase®, and Web of Science were screened to identify eligible studies. Identification and selection of the reports were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). A pooled analysis of NS predictive role of intraoperative, postoperative, oncological, and functional outcomes was performed. Odds ratio was considered the effect size. All the analyses were performed using Stata 15.0, and statistical significance was set at p≤ 0.05. EVIDENCE SYNTHESIS Overall, 51 studies meeting our inclusion criteria were identified and considered for the analysis. Except for one prospective randomized trial, all the studies were retrospective. All the studies were found to be of intermediate quality, except for one of high quality. Most studies assessed the predictive role of the Radius-Exophytic/Endophytic-Nearness-Anterior/Posterior-Location (RENAL) and Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) scores, mostly regarding complications after nephron-sparing surgery. RENAL was an independent predictor of an on-clamp procedure (p< 0.001). Mayo Adhesive Probability score was related to adhesive perinephric fat (p= 0.005). Continuous and high-complexity RENAL scores were predictors of warm ischemia time (WIT; p= 0.006 and p< 0.001, respectively). Continuous (p< 0.001) and high-complexity (p< 0.001) PADUA scores were related to WIT. Continuous and high-complexity RENAL scores were predictors of overall complications (p= 0.002 and p< 0.001, respectively). PADUA score was related to complications both as continuous (p< 0.001) and as a categorical value (p< 0.002). The RENAL scores R=3 (p= 0.008), E=2 (p= 0.039), and hilar location (p= 0.006) were predictors of histological malignancy. Continuous and categorical RENAL scores were independent predictors of an estimated glomerular filtration rate (eGFR) increase (p= 0.006 and p< 0.001, respectively). The Diameter-Axial-Polar score (p= 0.018) and Peritumoral Artery Scoring System (PASS; p= 0.02) were also independent predictors. CONCLUSIONS The literature regarding nephrometry scoring systems is sparse, and mostly focused on RENAL and PADUA, which are easy to calculate and have a good correlation with most outcomes. Renal Pelvic Score is the best predictor of pelvicalyceal entry/repair and urine leak, whereas Surgical Approach Renal Ranking and PASS strongly predict surgical approach and renal function variation, respectively. Other nephrometry scores based on mathematical models are limited by their complexity, and they lack evidence supporting their predictive value. PATIENT SUMMARY We reviewed the medical literature regarding the use and value of so-called "nephrometry scores," which are scoring systems based on radiological imaging and made to grade the complexity of a renal tumor. We analyzed whether these scoring systems can predict some of the outcomes of patients undergoing surgical removal of renal tumors.
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Affiliation(s)
- Alessandro Veccia
- Division of Urology, VCU Health System, Richmond, VA, USA; Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy and Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Italy
| | - Alessandro Antonelli
- Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy and Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Italy
| | - Robert G Uzzo
- Division of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Giacomo Novara
- Department of Oncologic, Surgical and Gastrointestinal Sciences, Urologic Unit, University of Padua, Italy
| | | | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Italy
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy and Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Italy
| | - Vincenzo Mirone
- Department of Urology, Federico II University, Naples, Italy
| | | | - Ithaar Derweesh
- Department of Urology, UCSD Health System, La Jolla, CA, USA
| | - Francesco Porpiglia
- Division of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
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Antonelli A, Veccia A, Pavan N, Mir C, Breda A, Takagi T, Rha KH, Maurer T, Zhang C, Long JA, De Nunzio C, Lima E, Ferro M, Micali S, Quarto G, Linares E, Celia A, Schips L, Bove P, Larcher A, Fiori C, Mottrie A, Bindayi A, Trombetta C, Silvestri T, Palou J, Faba OR, Tanabe K, Yang B, Fiard G, Tubaro A, Torres JN, De Cobelli O, Bevilacqua L, Castellucci R, Tracey A, Hampton LJ, Montorsi F, Perdonà S, Simeone C, Palumbo C, Capitanio U, Derweesh I, Porpiglia F, Autorino R. Outcomes of Partial and Radical Nephrectomy in Octogenarians – A Multicenter International Study (Resurge). Urology 2019; 129:139-145. [DOI: 10.1016/j.urology.2019.03.009] [Citation(s) in RCA: 6] [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: 01/23/2019] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 01/26/2023]
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Zattoni F, Artibani W, Patel V, Montorsi F, Porpiglia F, Hampton LJ, Rocco B, Dasgupta P, Hemal AK, Mottrie A, Tewari A, Dal Moro F. Technical innovations to optimize continence recovery after robotic assisted radical prostatectomy. MINERVA UROL NEFROL 2019; 71:324-338. [DOI: 10.23736/s0393-2249.19.03395-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Lim K, Autorino R, Veccia A, Zukovksi EB, Levy M, Hampton LJ. Robot assisted laparoscopic prostatectomy in liver transplant recipient. MINERVA UROL NEFROL 2019; 71:185-188. [PMID: 30895766 DOI: 10.23736/s0393-2249.19.03334-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Robotic assisted laparoscopic prostatectomy (RALP) in liver transplant recipients (LTRs) is not well documented. We present two cases of RALP in LTRs with localized prostate cancer (PCa). In both cases, a transperitoneal approach was used, and they were successfully completed without perioperative complications. Thus, RALP seems to be a feasible, safe and effective treatment for PCa in LTRs. Significant modifications to the surgical technique do not seem to be required, and patient optimization in preparation for surgery remains the key factor. History of liver transplant should not discourage embarking in a RALP in Centers with adequate robotic expertise.
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Affiliation(s)
- Kenneth Lim
- Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA -
| | - Alessandro Veccia
- Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Eduardo B Zukovksi
- Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Marlon Levy
- Division of Transplant Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Lance J Hampton
- Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA
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Anele UA, Marchioni M, Yang B, Simone G, Uzzo RG, Lau C, Mir MC, Capitanio U, Porter J, Jacobsohn K, de Luyk N, Mari A, Chang K, Fiori C, Sulek J, Mottrie A, White W, Perdona S, Quarto G, Bindayi A, Ashrafi A, Schips L, Berardinelli F, Zhang C, Gallucci M, Ramirez-Backhaus M, Larcher A, Kilday P, Liao M, Langenstroer P, Dasgupta P, Challacombe B, Kutikov A, Minervini A, Rha KH, Sundaram CP, Hampton LJ, Porpiglia F, Aron M, Derweesh I, Autorino R. Robotic versus laparoscopic radical nephrectomy: a large multi-institutional analysis (ROSULA Collaborative Group). World J Urol 2019; 37:2439-2450. [DOI: 10.1007/s00345-019-02657-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/28/2019] [Indexed: 12/14/2022] Open
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Swavely NR, Anele UA, Porpiglia F, Mir MC, Hampton LJ, Autorino R. Optimization of renal function preservation during robotic partial nephrectomy. Ther Adv Urol 2019; 11:1756287218815819. [PMID: 30671138 PMCID: PMC6329014 DOI: 10.1177/1756287218815819] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/06/2018] [Indexed: 01/20/2023] Open
Abstract
Over the past few years, the role of robotic-assisted partial nephrectomy (RPN) has exponentially grown. Multiple recognized factors contribute to postoperative renal function in patients undergoing RPN. The aim of this review is to identify these potential factors, and to evaluate strategies that may help optimize the goal of renal function preservation. A nonsystematic literature review was performed to retrieve the most recent evidence on factors contributing to renal function post-RPN. Analyzed elements include baseline factors (tumor complexity and patient characteristics), intraoperative (surgical) factors (control of the renal hilum and type of ischemia, resection technique, renorrhaphy technique), and pharmacotherapeutics. In conclusion, the advantages of robotic surgery in the setting of partial nephrectomy (PN) are becoming well established. Maximal preservation of renal function remains a priority goal of the procedure, and it is influenced by a plethora of factors. Adequate patient selection using radiomics, control of comorbidities, utilization of evidence-based intraoperative techniques/strategies, and postoperative care are key components of postoperative preservation of renal function. Further investigations regarding these factors and their effects on long-term renal function are necessary and will continue to aid in guiding appropriate patient care.
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Affiliation(s)
- Natalie R Swavely
- Department of Surgery, VCU Health, Richmond, VA, USA Department of Surgery, McGuire VA Medical Center, Richmond, VA, USA
| | - Uzoma A Anele
- Department of Surgery, VCU Health, Richmond, VA, USA Department of Surgery, McGuire VA Medical Center, Richmond, VA, USA
| | | | - Maria C Mir
- Instituto Valenciano de Oncologia Foundation, Valencia, Spain
| | - Lance J Hampton
- Department of Surgery, VCU Health, Richmond, VA, USA Department of Surgery, McGuire VA Medical Center, Richmond, VA, USA
| | - Riccardo Autorino
- VCU Health and Division of Urology, Department of Surgery, McGuire VA Medical Center, 1200 East Broad St, Richmond, VA 23249, USA
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Autorino R, Mayer Grob B, Guruli G, Hampton LJ. Partial Versus Total Nephrectomy: Indications, Limitations, and Advantages. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_62] [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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Anele UA, Hampton LJ, Grob MB, Autorino R. Prediction of Aggressive Histology: The Ongoing Dilemma of Renal Masses in the “Omics” Era. Eur Urol 2018; 74:498-500. [DOI: 10.1016/j.eururo.2018.06.046] [Citation(s) in RCA: 7] [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: 06/19/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
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Bertolo R, Autorino R, Simone G, Derweesh I, Garisto JD, Minervini A, Eun D, Perdona S, Porter J, Rha KH, Mottrie A, White WM, Schips L, Yang B, Jacobsohn K, Uzzo RG, Challacombe B, Ferro M, Sulek J, Capitanio U, Anele UA, Tuderti G, Costantini M, Ryan S, Bindayi A, Mari A, Carini M, Keehn A, Quarto G, Liao M, Chang K, Larcher A, De Naeyer G, De Cobelli O, Berardinelli F, Zhang C, Langenstroer P, Kutikov A, Chen D, De Luyk N, Sundaram CP, Montorsi F, Stein RJ, Haber GP, Hampton LJ, Dasgupta P, Gallucci M, Kaouk J, Porpiglia F. Outcomes of Robot-assisted Partial Nephrectomy for Clinical T2 Renal Tumors: A Multicenter Analysis (ROSULA Collaborative Group). Eur Urol 2018; 74:226-232. [DOI: 10.1016/j.eururo.2018.05.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 05/03/2018] [Indexed: 12/11/2022]
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Pavan N, Derweesh I, Hampton LJ, White WM, Porter J, Challacombe BJ, Dasgupta P, Bertolo R, Kaouk J, Mirone V, Porpiglia F, Autorino R. Retroperitoneal Robotic Partial Nephrectomy: Systematic Review and Cumulative Analysis of Comparative Outcomes. J Endourol 2018; 32:591-596. [PMID: 29695171 DOI: 10.1089/end.2018.0211] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To compare the outcomes of retroperitoneal vs transperitoneal approach for robot-assisted partial nephrectomy (RAPN). MATERIALS AND METHODS A systematic review of the literature was performed through January 2018 using PubMed, Scopus, and Ovid databases. Article selection proceeded according to the search strategy based on PRISMA criteria. Only studies comparing retroperitoneal to transperitoneal approach for RAPN were deemed eligible for inclusion. RESULTS Seven retrospective case-control studies were identified and included in the analysis, with a total number of 1379 patients (866 for transperitoneal group; 513 for retroperitoneal group). In the retroperitoneal group, tumors were slightly larger [weighted mean difference (WMD): 0.29 cm; 95% confidence interval (CI): 0.04-0.54; p = 0.02], and more frequently located posterior/lateral (odds ratio: 0.61; 95% CI: 0.41-0.90; p = 0.01). In two of the studies only posterior tumors had been included. Both operating time (WMD 20.17 min; 95% CI 6.46-33.88; p = 0.004) and estimated blood loss (WMD 54.57 mL; 95% CI 6.73-102.4; p = 0.03) were significantly lower in the retroperitoneal group. In addition, length of stay was significantly shorter in the retroperitoneal group (WMD 0.46 days; CI 95% 0.15-0.76; p = 0.003). No differences were found regarding overall (p = 0.67) and major (p = 0.82) postoperative complications, warm ischemia time (p = 0.96), and positive surgical margins (p = 0.95). CONCLUSIONS Retroperitoneal RAPN can offer in select patients similar outcomes to those of the most common transperitoneal RAPN. Furthermore, it may be particularly advantageous for posterior upper pole and perihilar tumors and associated with reduction in operative time and hospital stay. Robotic surgeons should be ideally familiar with both approaches to adapt their surgical strategy to confront renal neoplasms from a position of technical advantage and ultimately optimize outcomes.
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Affiliation(s)
- Nicola Pavan
- 1 Urology Clinic, University of Trieste , Trieste, Italy
| | - Ithaar Derweesh
- 2 Department of Urology, UC San Diego Health System , La Jolla, California
| | - Lance J Hampton
- 3 Division of Urology, Virginia Commonwealth University , Richmond, Virginia
| | - Wesley M White
- 4 Department of Urology, The University of Tennessee Medical Center , Knoxville, Tennessee
| | | | - Benjamin J Challacombe
- 6 MRC Centre for Transplantation, NIHR Biomedical Research Centre, Guy's Hospital, King's College London , United Kingdom
| | - Prokar Dasgupta
- 6 MRC Centre for Transplantation, NIHR Biomedical Research Centre, Guy's Hospital, King's College London , United Kingdom
| | - Riccardo Bertolo
- 7 Glickman Urological Institute , Cleveland Clinic, Cleveland, Ohio
| | - Jihad Kaouk
- 7 Glickman Urological Institute , Cleveland Clinic, Cleveland, Ohio
| | - Vincenzo Mirone
- 8 Department of Urology, School of Medicine, University of Naples Federico II , Naples, Italy
| | - Francesco Porpiglia
- 9 Department of Urology, University of Turin-San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Riccardo Autorino
- 3 Division of Urology, Virginia Commonwealth University , Richmond, Virginia
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Deebel NA, Morin JP, Autorino R, Vince R, Grob B, Hampton LJ. Prostate Cancer in Transgender Women: Incidence, Etiopathogenesis, and Management Challenges. Urology 2017; 110:166-171. [DOI: 10.1016/j.urology.2017.08.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 01/14/2023]
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38
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Marchioni M, Primiceri G, Cindolo L, Hampton LJ, Grob MB, Guruli G, Schips L, Shariat SF, Autorino R. Impact of diagnostic ureteroscopy on intravesical recurrence in patients undergoing radical nephroureterectomy for upper tract urothelial cancer: a systematic review and meta-analysis. BJU Int 2017. [PMID: 28621055 DOI: 10.1111/bju.13935] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [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: 12/27/2022]
Abstract
Aim of this study was to analyse the association between the use of diagnostic ureteroscopy (URS) and the development of intravesical recurrence (IVR) in patients undergoing radical nephroureterectomy (RNU) for high-risk upper tract urothelial carcinoma. A systematic review of the published data was performed up to December 2016, using multiple search engines to identify eligible studies. A formal meta-analysis was conducted of studies comparing patients who underwent URS before RNU with those who did not. Hazard ratios (HRs), with their 95% confidence intervals (CIs), from each study were used to calculate pooled HRs. Pooled estimates were calculated using a fixed-effects or random-effects model according to heterogeneity. Statistical analyses were performed using RevMan, version 5. Seven studies were included in the systematic review, but only six of these were deemed fully eligible for meta-analysis. Among the 2 382 patients included in the meta-analysis, 765 underwent diagnostic URS prior to RNU. All examined studies were retrospective, and the majority examined Asian populations. The IVR rate ranged from 39.2% to 60.7% and from 16.7% to 46% in patients with and without prior URS, respectively. In the pooled analysis, a statistically significant association was found between performance of URS prior to RNU and IVR (HR 1.56, 95% CI 1.33-1.88; P < 0.001). There was no heterogeneity in the observed outcomes, according to the I2 statistic of 2% (P = 0.40). Within the intrinsic limitations of this type of analysis, these findings suggest a significant association between the use of diagnostic URS and higher risk of developing IVR after RNU. Further research in this area should be encouraged to further investigate the possible causality behind this association and it potential clinical implications.
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Affiliation(s)
- Michele Marchioni
- Department of Urology, SS Annunziata Hospital, 'G. D'Annunzio' University of Chieti, Chieti, Italy
| | - Giulia Primiceri
- Department of Urology, SS Annunziata Hospital, 'G. D'Annunzio' University of Chieti, Chieti, Italy
| | - Luca Cindolo
- Department of Urology, ASL Abruzzo 2, Chieti, Italy
| | - Lance J Hampton
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA.,Division of Urology, McGuire Veterans Affairs Hospital, Richmond, VA, USA
| | - Mayer B Grob
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA.,Division of Urology, McGuire Veterans Affairs Hospital, Richmond, VA, USA
| | - Georgi Guruli
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA.,Division of Urology, McGuire Veterans Affairs Hospital, Richmond, VA, USA
| | - Luigi Schips
- Department of Urology, ASL Abruzzo 2, Chieti, Italy
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA.,Division of Urology, McGuire Veterans Affairs Hospital, Richmond, VA, USA
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Nabavizadeh R, Nabavizadeh B, Hampton LJ, Nabavizadeh A. Herniation of a urinary bladder diverticulum: diagnosis and management of a fluctuating inguinal mass. BMJ Case Rep 2017; 2017:bcr-2016-217947. [PMID: 28325718 DOI: 10.1136/bcr-2016-217947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Inguinal herniation of a bladder diverticulum is a rare finding. The diagnosis should be suspected if the size of hernia is variable on urination. These patients may also experience obstructive voiding symptoms. Various imaging modalities may clarify the diagnosis. In our patient, intravenous urography precisely showed a bladder diverticulum in the right inguinal area. The patient underwent open simple prostatectomy and herniorrhaphy. He remains symptom-free on follow-up.
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Affiliation(s)
- Reza Nabavizadeh
- Department of Urology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Behnam Nabavizadeh
- Tehran University of Medical Sciences, Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran, Tehran, Iran
| | - Lance J Hampton
- Department of Urology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Aliakbar Nabavizadeh
- Department of Urology, Kerman University of Medical Sciences, Kerman, Kerman, Iran
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Pavan N, Derweesh IH, Mir CM, Novara G, Hampton LJ, Ferro M, Perdonà S, Parekh DJ, Porpiglia F, Autorino R. Outcomes of Laparoscopic and Robotic Partial Nephrectomy for Large (>4 Cm) Kidney Tumors: Systematic Review and Meta-Analysis. Ann Surg Oncol 2017; 24:2420-2428. [DOI: 10.1245/s10434-017-5831-5] [Citation(s) in RCA: 13] [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: 12/28/2016] [Indexed: 01/06/2023]
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Autorino R, Porpiglia F, Dasgupta P, Rassweiler J, Catto JW, Hampton LJ, Lima E, Mirone V, Derweesh IH, Debruyne FMJ. Precision surgery and genitourinary cancers. Eur J Surg Oncol 2017; 43:893-908. [PMID: 28254473 DOI: 10.1016/j.ejso.2017.02.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 02/08/2017] [Indexed: 02/06/2023] Open
Abstract
The landscape of the surgical management of urologic malignancies has dramatically changed over the past 20 years. On one side, better diagnostic and prognostic tools allowed better patient selection and more reliable surgical planning. On the other hand, the implementation of minimally invasive techniques and technologies, such as robot-assisted laparoscopy surgery and image-guided surgery, allowed minimizing surgical morbidity. Ultimately, these advances have translated into a more tailored approach to the management of urologic cancer patients. Following the paradigm of "precision medicine", contemporary urologic surgery has entered a technology-driven era of "precision surgery", which entails a range of surgical procedures tailored to combine maximal treatment efficacy with minimal impact on patient function and health related quality of life. Aim of this non-systematic review is to provide a critical analysis of the most recent advances in the field of surgical uro-oncology, and to define the current and future role of "precision surgery" in the management of genitourinary cancers.
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Affiliation(s)
- R Autorino
- Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA.
| | - F Porpiglia
- Division of Urology, University of Turin, San Luigi Hospital, Orbassano, Italy.
| | - P Dasgupta
- King's College London, Guy's Hospital, London, UK.
| | - J Rassweiler
- Department of Urology, SLK Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany.
| | - J W Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK.
| | - L J Hampton
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA.
| | - E Lima
- Life and Health Sciences Research Institute, The Clinic Academic Center, University of Minho, and Department of CUF Urology, Braga, Portugal.
| | - V Mirone
- Department of Urology, Federico II University, Naples, Italy.
| | - I H Derweesh
- Department of Urology, UC San Diego Health System, La Jolla, CA, USA.
| | - F M J Debruyne
- Andros Men's Health Institutes, Arnhem, The Netherlands.
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Abstract
Background: We present an intrarenal adrenocortical adenoma discovered incidentally after robot-assisted partial nephrectomy and total adrenalectomy for a suspicious renal mass. Current literature describes the rare occurrence of an adrenocortical adenoma arising from a renal–adrenal fusion. This case represents an uncommon, benign pathology that should be considered in the differential diagnosis of an enhancing renal mass. Case Presentation: The patient is a 62-year-old female found to have an enhancing mass at the anterolateral aspect of the upper pole of the right kidney concerning for renal-cell carcinoma. CT imaging was performed to work up a cause for hyperparathyroidism. During robot-assisted partial nephrectomy, the lesion was found to be partially adherent to the lateral limb of the right adrenal gland. Microscopic evaluation with Melan-A staining showed the mass to be of adrenal origin with benign features and lack of capsulation, indicating an adrenal adenoma arising from intrarenal ectopic adrenal rests. Conclusion: An intrarenal adrenal adenoma arising from ectopic adrenal tissue is a unique pathology that represents a benign differential diagnosis in the evaluation of an enhancing renal mass. However, it cannot be differentiated from renal-cell carcinoma based on cross-sectional imaging alone and requires postoperative pathologic assessment to confirm the diagnosis.
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Affiliation(s)
- Samay Sappal
- School of Medicine, Virginia Commonwealth University , Richmond, Virginia
| | - Jay Sulek
- Division of Urology, Virginia Commonwealth University , Richmond, Virginia
| | - Steven C Smith
- Department of Pathology, Virginia Commonwealth University , Richmond, Virginia
| | - Lance J Hampton
- Division of Urology, Virginia Commonwealth University , Richmond, Virginia
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Tuong NE, Klausner AP, Hampton LJ. A review of post-stroke urinary incontinence. Can J Urol 2016; 23:8265-8270. [PMID: 27347618] [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: 06/06/2023]
Abstract
INTRODUCTION Cerebrovascular accidents, or strokes, are a common cause of morbidity and mortality in the United States. Urinary incontinence is a prevalent morbidity experienced by post-stroke patients that is associated with long term disability and institutionalization effects on these patients. MATERIALS AND METHODS An extensive literature review was conducted using multiple academic search engines using the keywords: 'stroke,' 'CVA,' 'urinary incontinence,' 'urodynamics,' 'pharmacologic treatments,' and 'conservative treatments.' Articles were reviewed and summarized to explain incidence, assessment, and treatments of urinary incontinence in post-stroke individuals. RESULTS Twenty-eight percent to seventy-nine percent of stroke survivors experience urinary incontinence with detrusor overactivity being the most common type of incontinence assessed by urodynamic studies. There continues to be insufficient data studying the effects and benefits of non-pharmacologic and pharmacologic treatments in post-stroke patients. Similarly, urinary incontinence remains an indicator of increased morbidity, disability, and institutionalization rates in the post-stroke patient. CONCLUSIONS Stroke is a debilitating disease which causes urinary incontinence in many patients. As a result, patients have increased rates of hospitalization and disability compared to post-stroke patients without urinary incontinence. The history and physical exam are key in diagnosing the type of urinary incontinence with urodynamic studies being an adjunctive study. Non-pharmacologic treatment, such as behavioral therapy, and pharmacologic agents including antimuscarinics and beta adrenergic medications, are not well studied in the post-stroke patient. Urinary incontinence in stroke patients needs to be further studied to help decrease morbidity and mortality rates within this population.
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Affiliation(s)
- Nicole E Tuong
- Department of Urology, State University of New York, Upstate Medical University, Syracuse, New York, USA
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Chong JT, Dolat MT, Klausner AP, Dragoescu E, Hampton LJ. The role of cystectomy for non-malignant bladder conditions: a review. Can J Urol 2014; 21:7433-7441. [PMID: 25347367] [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: 06/04/2023]
Abstract
INTRODUCTION Few studies have adequately addressed the indications, efficacy, and quality-of-life for cystectomy performed for non-malignant bladder conditions. Patients with debilitating non-malignant bladder conditions who have failed all previous conservative therapies may undergo various forms of cystectomy, including partial, simple or radical cystectomy. We provide a review of the current literature and recommendations for cystectomy for various non-malignant bladder conditions. MATERIALS AND METHODS A systematic review of MEDLINE was conducted to find prospective and retrospective studies using the keywords "cystectomy", "benign", and `non-malignant`. Articles were reviewed and triaged, background articles were added as supplements, leaving a final review of 67 papers. RESULTS Data from the final review suggests that common benign indications for cystectomy are interstitial cystitis/painful bladder syndrome (IC/PBS), neurogenic bladder, hemorrhagic/radiation cystitis, infectious diseases of the bladder and miscellaneous conditions of the bladder such as endometriosis and total refractory incontinence. The most common perioperative complications include urinary tract and wound infections. Efficacy of cystectomy in patients with IC/PBS is greater than 80%, while efficacy in patients with neurogenic bladder is greater than 90%. Finally, improved urinary quality-of-life has been demonstrated in patients with neurogenic bladder post-cystectomy. CONCLUSION Cystectomy for non-malignant conditions can be considered for patients who have failed previous conservative therapy. The limited data in existence suggests fertility can be adequately preserved after cystectomy in younger males. The data regarding the forms of urinary diversion suggests no significant advantage between any of the major forms of urinary diversion. Finally, while newer pharmacologics and technological advances are widely used in the treatment of various benign urological conditions, their role in preventing or treating refractory benign bladder conditions have not been fully characterized.
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Affiliation(s)
- Julio T Chong
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Moore BW, Dolat MET, McPartlin D, Mayer Grob B, Guruli G, Hampton LJ. Establishment of a new robotic prostatectomy program at a tertiary Veteran's Affairs medical center. J Robot Surg 2012; 7:171-5. [PMID: 27000909 DOI: 10.1007/s11701-012-0364-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 06/11/2012] [Indexed: 11/27/2022]
Abstract
The objective of this study is to report the initial results of a newly established robotic prostatectomy (DVP) program at a Veteran's Affairs (VA) medical center. All patients who underwent a radical prostatectomy during the first 18 months of our robotic surgical program were included in this study. These patients were compared to a control group that included all patients who underwent an open prostatectomy 18 months prior to starting our robotic program. Preoperative, intraoperative and postoperative data was compared between open and robotic prostatectomies. 38 men underwent radical retropubic prostatectomy (RRP) between September 2007 and February 2009. With the introduction of robotic prostatectomy, the total number of prostatectomies increased by 84 % to 70 (9 RRP, 61 DVP). Prostate-specific antigen (PSA), Gleason score and clinical stage were similar for both groups. Average estimated blood loss (EBL) was 1205 mL for RRP and 126 mL for DVP. Mean operative times in minutes were 259 and 254 for RRP and DVP, respectively. Complications included two rectal perforations, a cerebrovascular accident, one death after RRP and one open conversion for failure to progress. Average length of stay was 5.1 for RRP and 1.8 days for DVP. Total positive margins were 24 % for RRP and 15 % for DVP. For T2-specific disease, 16.7 % had positive margins after RRP compared to 4.3 % after DVP. The establishment of a robotic prostatectomy program at a tertiary VA medical center was achieved in a safe and efficient manner with improvement in EBL and length of stay when compared to our open prostatectomies. Oncologic outcomes were equivalent when compared to other initial DVP programs.
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Affiliation(s)
- Blake W Moore
- Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
- McGuire Veterans Affairs Hospital, Richmond, VA, USA
| | - Mary Ellen T Dolat
- Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
- McGuire Veterans Affairs Hospital, Richmond, VA, USA
| | - Daniel McPartlin
- Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
- McGuire Veterans Affairs Hospital, Richmond, VA, USA
| | - B Mayer Grob
- Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
- McGuire Veterans Affairs Hospital, Richmond, VA, USA
| | - Georgi Guruli
- Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
- McGuire Veterans Affairs Hospital, Richmond, VA, USA
| | - Lance J Hampton
- Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA.
- McGuire Veterans Affairs Hospital, Richmond, VA, USA.
- Division of Urology, Department of Surgery, VCU Medical Center, 1200 East Broad Street, Suite 7204, 980118, Richmond, VA, 23298, USA.
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Benabdallah JO, Hampton LJ, Guruli G, Grob BM. Robot-assisted laparoscopic combined nephroureterectomy and cystoprostatectomy: an initial report and review of the literature. J Robot Surg 2011; 6:159-62. [PMID: 27628280 DOI: 10.1007/s11701-011-0273-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 04/20/2011] [Indexed: 10/18/2022]
Abstract
Patients presenting with invasive, high-grade, or recurrent bladder cancer and synchronous upper urinary tract malignancy may be considered for simultaneous nephroureterectomy and radical cystectomy. We present the first known reported case of robot-assisted laparoscopic combined nephroureterectomy and cystoprostatectomy, describing a 62-year-old man with recurrent T1 bladder cancer and concomitant upper urinary tract transitional cell carcinoma. Patient underwent robot-assisted laparoscopic combined nephroureterectomy and radical cystoprostatectomy with extended pelvic lymph node dissection and extracorporeal ileal conduit urinary diversion. Robotic surgery was completed successfully without need for conversion to open procedure. There were no operative or perioperative complications. Blood loss (200 ml) and hospital stay (7 days) were less than prior reported laparoscopic experience with combined surgery. Although indications may be rare, robotic nephroureterectomy with simultaneous radical cystoprostatectomy is a feasible and safe surgical option.
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Affiliation(s)
- Justin O Benabdallah
- Division of Urology, Virginia Commonwealth University Health Systems, West Hospital, 7th Floor, 1200 E. Broad St., P.O. Box 980118, Richmond, VA, 23298-0118, USA.
| | - Lance J Hampton
- Division of Urology, Virginia Commonwealth University Health Systems, West Hospital, 7th Floor, 1200 E. Broad St., P.O. Box 980118, Richmond, VA, 23298-0118, USA.,Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Georgi Guruli
- Division of Urology, Virginia Commonwealth University Health Systems, West Hospital, 7th Floor, 1200 E. Broad St., P.O. Box 980118, Richmond, VA, 23298-0118, USA.,Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - B Mayer Grob
- Division of Urology, Virginia Commonwealth University Health Systems, West Hospital, 7th Floor, 1200 E. Broad St., P.O. Box 980118, Richmond, VA, 23298-0118, USA.,Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
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Abstract
A varicocele is a dilatation of the testicular vein and the pampiniform venous plexus within the spermatic cord. Although rare in pediatric populations, the prevalence of varicoceles markedly increases with pubertal development. Varicoceles are progressive lesions that may hinder testicular growth and function over time and are the most common and correctable cause of male infertility. Approximately 40% of men with primary infertility have a varicocele, and more than half of them experience improvements in semen parameters after varicocelectomy. The decision to treat adolescents with varicocele is a controversial one. The task for pediatricians and urologists is to identify those adolescents who are at greatest risk for infertility in adulthood, in an effort to offer early surgical intervention to those most likely to benefit.
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Affiliation(s)
- Samuel P Robinson
- Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298-0118, USA
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Link BA, Nelson RA, Josephson DY, Hampton LJ, Wilson TG. TRAINING OF UROLOGIC ONCOLOGY FELLOWS DOES NOT ADVERSELY IMPACT OUTCOMES OF ROBOTIC ASSISTED LAPAROSCOPIC PROSTATECTOMY. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61825-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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Hampton LJ, Jacobsohn K, Nelson RA, Crocitto LE, Satterthwaite RW, Wilson TG. PATIENTS WITH PRIOR TURP UNDERGOING ROBOTIC ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY HAVE HIGHER POSITIVE SURGICAL MARGIN RATES. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61776-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Abstract
Ectopic positioning of the kidney is a relatively common event, with the thoracic location of the ectopic kidney the most unusual. At least 140 cases of thoracic kidney have been described, with no consistent anomalies reported in association with the superior location. The vast majority of patients with thoracic kidney are asymptomatic, with the problem discovered incidentally. We report the first documented case of a thoracic kidney presenting with flank pain and demonstrating ureteropelvic junction obstruction on nuclear scintigraphy treated by open dismembered pyeloplasty through a supra-11th rib incision.
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Affiliation(s)
- Lance J Hampton
- Division of Urology, Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131, USA
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