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Breeden-Guilhot H, Boltri M, Dicembre M, Melchior JC, Duquesnoy M, Hanachi M. Vitamin D Status And Associated Factors In Extremely Malnourished Adult Patients With Anorexia Nervosa. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.150] [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: 03/29/2023]
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Boltri M, Sapuppo W, Kayser N, Yeganyan A, Duquesnoy M, Dicembre M, Leboyer M, Hanachi M. Assessment Of Autism Spectrum Symptoms In A Population Of Extremely Malnourished Patients With Anorexia Nervosa: A Pilot Study. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.095] [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: 03/28/2023]
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Claps F, Mir MC, van Rhijn BWG, Mazzon G, Soria F, D'Andrea D, Marra G, Boltri M, Traunero F, Massanova M, Liguori G, Dominguez-Escrig JL, Celia A, Gontero P, Shariat SF, Trombetta C, Pavan N. Impact of the controlling nutritional status (CONUT) score on perioperative morbidity and oncological outcomes in patients with bladder cancer treated with radical cystectomy. Urol Oncol 2023; 41:49.e13-49.e22. [PMID: 36274030 DOI: 10.1016/j.urolonc.2022.09.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 06/14/2022] [Revised: 09/04/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the impact of the Controlling Nutritional Status (CONUT) score on perioperative morbidity and oncological outcomes of bladder cancer (BC) patients treated with radical cystectomy (RC). MATERIALS AND METHODS We retrospectively analyzed a multi-institutional cohort of 347 patients treated with RC for clinical-localized BC between 2005 and 2019. The CONUT-score was defined as an algorithm including serum albumin, total lymphocyte count, and cholesterol. Multivariable logistic regression analyses were performed to evaluate the ability of the CONUT-score to predict any-grade complications, major complications and 30 days readmission. Multivariable Cox' regression models were performed to evaluate the prognostic effect of the CONUT-score on recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS). RESULTS A cut-off value to discriminate between low and high CONUT-score was determined by calculating the receiver operating characteristic (ROC) curve. The area under the curve was 0.72 hence high CONUT-score was defined as ≥3 points. Overall, 112 (32.3%) patients had a high CONUT. At multivariable logistic regression analyses, high CONUT was associated with any-grade complications (OR 3.58, P = 0.001), major complications (OR 2.56, P = 0.003) and 30 days readmission (OR 2.39, P = 0.01). On multivariable Cox' regression analyses, high CONUT remained associated with worse RFS (HR 2.57, P < 0.001), OS (HR 2.37, P < 0.001) and CSS (HR 3.52, P < 0.001). CONCLUSIONS Poor nutritional status measured by the CONUT-score is independently associated with a poorer postoperative course after RC and is predictive of worse RFS, OS, and CSS. This simple index could serve as a comprehensive personalized risk-stratification tool identifying patients who may benefit from an intensified regimen of supportive cares.
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Affiliation(s)
- Francesco Claps
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain.
| | - Maria Carmen Mir
- Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Bas W G van Rhijn
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Francesco Soria
- Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Surgical Sciences, University of Torino School of Medicine, Turin, Italy
| | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, University of Torino School of Medicine, Turin, Italy
| | - Matteo Boltri
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Fabio Traunero
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Matteo Massanova
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Giovanni Liguori
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, University of Torino School of Medicine, Turin, Italy
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical center, Dallas, TX; Department of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Carlo Trombetta
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Nicola Pavan
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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Khadhouri S, Gallagher KM, MacKenzie KR, Shah TT, Gao C, Moore S, Zimmermann EF, Edison E, Jefferies M, Nambiar A, Anbarasan T, Mannas MP, Lee T, Marra G, Gómez Rivas J, Marcq G, Assmus MA, Uçar T, Claps F, Boltri M, La Montagna G, Burnhope T, Nkwam N, Austin T, Boxall NE, Downey AP, Sukhu TA, Antón-Juanilla M, Rai S, Chin YF, Moore M, Drake T, Green JSA, Goulao B, MacLennan G, Nielsen M, McGrath JS, Kasivisvanathan V. Developing a Diagnostic Multivariable Prediction Model for Urinary Tract Cancer in Patients Referred with Haematuria: Results from the IDENTIFY Collaborative Study. Eur Urol Focus 2022; 8:1673-1682. [PMID: 35760722 DOI: 10.1016/j.euf.2022.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/05/2022] [Accepted: 06/04/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patient factors associated with urinary tract cancer can be used to risk stratify patients referred with haematuria, prioritising those with a higher risk of cancer for prompt investigation. OBJECTIVE To develop a prediction model for urinary tract cancer in patients referred with haematuria. DESIGN, SETTING, AND PARTICIPANTS A prospective observational study was conducted in 10 282 patients from 110 hospitals across 26 countries, aged ≥16 yr and referred to secondary care with haematuria. Patients with a known or previous urological malignancy were excluded. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcomes were the presence or absence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC], and renal cancer). Mixed-effect multivariable logistic regression was performed with site and country as random effects and clinically important patient-level candidate predictors, chosen a priori, as fixed effects. Predictors were selected primarily using clinical reasoning, in addition to backward stepwise selection. Calibration and discrimination were calculated, and bootstrap validation was performed to calculate optimism. RESULTS AND LIMITATIONS The unadjusted prevalence was 17.2% (n = 1763) for bladder cancer, 1.20% (n = 123) for UTUC, and 1.00% (n = 103) for renal cancer. The final model included predictors of increased risk (visible haematuria, age, smoking history, male sex, and family history) and reduced risk (previous haematuria investigations, urinary tract infection, dysuria/suprapubic pain, anticoagulation, catheter use, and previous pelvic radiotherapy). The area under the receiver operating characteristic curve of the final model was 0.86 (95% confidence interval 0.85-0.87). The model is limited to patients without previous urological malignancy. CONCLUSIONS This cancer prediction model is the first to consider established and novel urinary tract cancer diagnostic markers. It can be used in secondary care for risk stratifying patients and aid the clinician's decision-making process in prioritising patients for investigation. PATIENT SUMMARY We have developed a tool that uses a person's characteristics to determine the risk of cancer if that person develops blood in the urine (haematuria). This can be used to help prioritise patients for further investigation.
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Affiliation(s)
- Sinan Khadhouri
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK; Aberdeen Royal Infirmary, Aberdeen, UK; British Urology Researchers in Surgical Training (BURST) Collaborative, UK.
| | - Kevin M Gallagher
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Western General Hospital, Edinburgh, UK; Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Kenneth R MacKenzie
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Freeman Hospital, Newcastle Upon Tyne, UK
| | - Taimur T Shah
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Department of Surgery and Cancer, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Chuanyu Gao
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Addenbrookes Hospital, Cambridge, UK
| | - Sacha Moore
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Wrexham Maelor Hospital, Wrexham, UK
| | - Eleanor F Zimmermann
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Torbay and South Devon NHS Foundation Trust, Torbay, UK
| | - Eric Edison
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, UK
| | - Matthew Jefferies
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Morriston Hospital, Swansea, UK; Swansea University, Swansea, UK
| | - Arjun Nambiar
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Freeman Hospital, Newcastle Upon Tyne, UK
| | - Thineskrishna Anbarasan
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Western General Hospital, Edinburgh, UK
| | - Miles P Mannas
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Taeweon Lee
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Giancarlo Marra
- Department of Surgical Sciences, Città della Salute e della Scienza, Turin, Italy; University of Turin, Turin, Italy
| | - Juan Gómez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Gautier Marcq
- Urology Department, Claude Huriez Hospital, CHU Lille, Lille, France; CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, University Lille, Lille, France
| | - Mark A Assmus
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Taha Uçar
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Francesco Claps
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Matteo Boltri
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Giuseppe La Montagna
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Tara Burnhope
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Nkwam Nkwam
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Tomas Austin
- Department of Urology, Queen Alexandra Hospital, Portsmouth, UK
| | | | | | - Troy A Sukhu
- University of North Carolina Hospitals, Chapel Hill, NC, USA
| | | | - Sonpreet Rai
- St James University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | | | - Madeline Moore
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | - James S A Green
- Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, UK; Healthcare and Population Research, Kings College, London, UK
| | - Beatriz Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Matthew Nielsen
- University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - John S McGrath
- University of Exeter Medical School, Exeter, UK; Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Veeru Kasivisvanathan
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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Castellani D, Di Rosa M, Saredi G, Pacchetti A, Banchero R, Ambrosini F, Meroni P, Guano G, Boltri M, Bucci S, Simonetti E, Maestroni U, Ferretti S, Terrone C, Dellabella M. Change in postoperative storage symptoms and de novo urge-incontinence after Thulium: YAG laser enucleation of the prostate: results from a prospective, multicenter study. J Endourol 2022; 36:1223-1230. [PMID: 35414264 DOI: 10.1089/end.2022.0118] [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: 11/12/2022] Open
Abstract
OBJECTIVES To assess the change of storage symptoms and their impact on quality of life in men undergoing Thulium: YAG laser enucleation of the prostate (ThuLEP) for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS BPH patients requiring surgery were prospectively evaluated (April 2019-October 2020). INCLUSION CRITERIA International Prostate Symptom Score (IPSS) ≥8, maximum urinary flow rate ≤15 ml/s, and urinary retention. EXCLUSION CRITERIA previous urethral/prostatic surgery, pelvic irradiation, bladder/prostate cancer, neurogenic bladder, concomitant transurethral surgery, and active urinary tract infection. IPSS, International Continence Society-Overactive Bladder (ICIQ-OAB) and International Continence Society-Overactive Bladder Quality of Life (ICIQ-OABq) scores were gathered before surgery and 1,3,6 and 12 months after surgery. RESULTS 117 men were included. Mean age was 68.0±7.7 years. Mean prostate volume was 86.6±34 cc. Mean IPSS subscore was 8.7±3.1 and 11.7±4.7 for storage and voiding symptoms, respectively. Mean ICIQ-OAB was 29.1±16.8. Mean ICIQ-OABq was 80.3±30.6. Voiding IPSS decreased 72.8% at 1-month, whereas the reduction of storage IPSS was 38.0%. ICIQ-OAB decreased 49.6% at 1-month. ICIQ-OABq showed a 30.0% reduction. One year after surgery, the reduction of voiding IPSS was 94.8%, ICIQ-OAB 85.5%, storage IPSS 76.7%, and ICIQ-OABq 60.5%. Urge-incontinence was present in 26.5% of men at 1-month, 15.4% at 3-month and 4.3% at 6-month. 4(3.4%) patients complained of urge-incontinence 12 months after surgery. CONCLUSION Both storage and voiding LUTS significantly decreased after ThuLEP but storage symptoms showed less reduction with a significant impact on patients' quality of life, particularly during the first 3 months.
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Affiliation(s)
- Daniele Castellani
- AOU Ospedali Riuniti di Ancona, 18494, via conca 71, Ancona, Italy, 60126;
| | | | - Giovanni Saredi
- Ospedale di Circolo e Fondazione Macchi, Urology, Varese, Italy;
| | - Andrea Pacchetti
- Ospedale di Circolo e Fondazione Macchi, Urology, via Tagliamento 14, Induno Olona, Italy, 21056;
| | | | | | - Paola Meroni
- Ospedale di Circolo e Fondazione Macchi, Urology, Varese, Italy;
| | - Giovanni Guano
- University of Genoa, 9302, Urology, Genova, Liguria, Italy;
| | - Matteo Boltri
- Hospital of Cattinara, 415994, Trieste, Friuli-Venezia Giulia, Italy;
| | | | - Elisa Simonetti
- Azienda Ospedaliero-Universitaria di Parma, 18630, Parma, Emilia-Romagna, Italy;
| | - Umberto Maestroni
- Hospital and University of Parma, Urology OU, Surgical Department, Parma, Italy;
| | - Stefania Ferretti
- Hospital and University of Parma, O.U. Urology, Via Gramsci, n° 14, Parma, Italy, 43100;
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Ongaro L, Boltri M, Claps F, Vianello F, Lenardon O, Visalli F, Buttazzi L, Maruzzi D, Migliozzi F, Pavan N, Liguori G, Trombetta C. The adding value of COntrolling NUTritional status (CONUT) score to pre-operative counselling on significant early loss of renal function after radical nephrectomy for cancer. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01194-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Khadhouri S, Gallagher KM, MacKenzie KR, Shah TT, Gao C, Moore S, Zimmermann EF, Edison E, Jefferies M, Nambiar A, Mannas MP, Lee T, Marra G, Lillaz B, Gómez Rivas J, Olivier J, Assmus MA, Uçar T, Claps F, Boltri M, Burnhope T, Nkwam N, Tanasescu G, Boxall NE, Downey AP, Lal AA, Antón-Juanilla M, Clarke H, Lau DHW, Gillams K, Crockett M, Nielsen M, Takwoingi Y, Chuchu N, O'Rourke J, MacLennan G, McGrath JS, Kasivisvanathan V. The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study. BJU Int 2021; 128:440-450. [PMID: 33991045 DOI: 10.1111/bju.15483] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. PATIENTS AND METHODS This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. RESULTS Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3-34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1-30.2), UTUC (n = 128) 1.14% (95% CI 0.77-1.52), renal cancer (n = 107) 1.05% (95% CI 0.80-1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32-2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03-1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90-4.15; P < 0.001), male sex 1.30 (95% CI 1.14-1.50; P < 0.001), and smoking 2.70 (95% CI 2.30-3.18; P < 0.001). CONCLUSIONS A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer.
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Affiliation(s)
- Sinan Khadhouri
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.,Aberdeen Royal Infirmary, Aberdeen, UK.,British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK
| | - Kevin M Gallagher
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Department of Clinical Surgery, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - Kenneth R MacKenzie
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Freeman Hospital, Newcastle Upon Tyne, UK
| | - Taimur T Shah
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Dept. of Surgery and Cancer, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Chuanyu Gao
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sacha Moore
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Wrexham Maelor Hospital, Wrexham, UK
| | - Eleanor F Zimmermann
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Torbay and South Devon NHS Foundation Trust, Torbay, UK
| | - Eric Edison
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, UK
| | - Matthew Jefferies
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Morriston Hospital, Swansea, UK
| | - Arjun Nambiar
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Freeman Hospital, Newcastle Upon Tyne, UK
| | - Miles P Mannas
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Taeweon Lee
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Giancarlo Marra
- Department of Surgical Sciences, Città della Salute e della Scienza, Turin, Italy.,University of Turin, Turin, Italy
| | | | - Juan Gómez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Jonathan Olivier
- Urology Department, Claude Huriez Hospital, CHU Lille, Lille, France
| | - Mark A Assmus
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Taha Uçar
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Francesco Claps
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Matteo Boltri
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Tara Burnhope
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Nkwam Nkwam
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | | | | | - Asim A Lal
- University of North Carolina Hospitals, Chapel Hill, NC, USA
| | | | - Holly Clarke
- Bradford Teaching Hospitals, NHS Foundation Trust, Bradford, UK
| | | | | | - Matthew Crockett
- Frimley Renal Cancer Centre, Frimley Hospitals NHS Foundation Trust, Camberley, UK
| | - Matthew Nielsen
- University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Naomi Chuchu
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - John O'Rourke
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John S McGrath
- University of Exeter Medical School, Exeter, UK.,Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Veeru Kasivisvanathan
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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Khadhouri S, Gallagher K, MacKenzie K, Shah T, Gao C, Moore S, Zimmermann E, Edison E, Jefferies M, Nambiar A, Mannas M, Lee T, Marra G, Gomez Rivas J, Marcq G, Assmus M, Ucar T, Claps F, Boltri M, Montagna GL, Burnhope T, Nkwam N, Austin T, Boxall N, Downey A, Sukhu T, Anton-Juanilla M, Rai S, Chin YF, Moore M, Drake T, Green J, Nielsen M, Takwoingi Y, McGrath J, Kasivisvanathan V. 92 Reshaping the Diagnostic Pathways for Investigation of Haematuria During and After The COVID-19 Pandemic: Diagnostic Accuracy of Strategies for Detection of Bladder Cancer from The IDENTIFY Cohort Study. Br J Surg 2021. [PMCID: PMC8135806 DOI: 10.1093/bjs/znab135.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Diagnostic haematuria services have been reduced due to the COVID-19 pandemic, compromising patient care, and necessitating a more pragmatic pathway.
Method
The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of haematuria. Using this data, we developed strategies using combinations of imaging and cytology as triage tests to maximise cancer detection within a pragmatic pathway.
Results
8112 patients (74·4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70·7%) patients had visible haematuria (VH) and 2375 (29·3%) had non-visible haematuria (NVH). Diagnostic test performance was used to determine optimal age cut-offs for four proposed strategies. We recommended proceeding directly to transurethral resection of bladder tumour for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients to capture high risk bladder cancer.
Conclusions
We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.
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Affiliation(s)
- S Khadhouri
- University of Aberdeen, Aberdeen, United Kingdom
- BURST, London, United Kingdom
| | - K Gallagher
- Western General Hospital, Edinburgh, United Kingdom
- BURST, London, United Kingdom
| | - K MacKenzie
- Freeman Hospital, Newcastle, United Kingdom
- BURST, London, United Kingdom
| | - T Shah
- Charing Cross Hospital, London, United Kingdom
- BURST, London, United Kingdom
| | - C Gao
- Addenbrookes Hospital, Cambridge, United Kingdom
- BURST, London, United Kingdom
| | - S Moore
- Wrexham Maelor Hospital, Wrexham, United Kingdom
- BURST, London, United Kingdom
| | - E Zimmermann
- Torbay and South Devon NHS Foundation Trust, Torbay, United Kingdom
- BURST, London, United Kingdom
| | - E Edison
- Whipps Cross Hospital, London, United Kingdom
- BURST, London, United Kingdom
| | - M Jefferies
- Morriston Hospital, Swansea, United Kingdom
- BURST, London, United Kingdom
| | - A Nambiar
- Freeman Hospital, Newcastle, United Kingdom
- BURST, London, United Kingdom
| | - M Mannas
- University of British Columbia, Vancouver, Canada
| | - T Lee
- University of British Columbia, Vancouver, Canada
| | - G Marra
- University of Turin, Turin, Italy
| | | | - G Marcq
- University of Lille, Lille, France
| | - M Assmus
- University of Alberta, Edmonton, Canada
| | - T Ucar
- Istanbul Medeniyet University, Istanbul, Turkey
| | - F Claps
- University of Trieste, Trieste, Italy
| | - M Boltri
- University of Trieste, Trieste, Italy
| | | | - T Burnhope
- University of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - N Nkwam
- University of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - T Austin
- Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - N Boxall
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - A Downey
- Doncaster Royal Infirmary, Doncaster, United Kingdom
| | - T Sukhu
- University of North Carolina Hospitals, Chapel Hill, USA
| | | | - S Rai
- St James University Hospital, Leeds, United Kingdom
| | - Y F Chin
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - M Moore
- University of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - T Drake
- The Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - J Green
- Whipps Cross Hospital, London, United Kingdom
| | - M Nielsen
- University of North Carolina Hospitals, Chapel Hill, USA
| | - Y Takwoingi
- University of Birmingham, Birmingham, United Kingdom
| | - J McGrath
- University of Exeter Medical School, Exeter, United Kingdom
| | - V Kasivisvanathan
- University College London, London, United Kingdom
- BURST, London, United Kingdom
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9
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Rizzo M, Ongaro L, Claps F, Ghassempour D, Verzotti E, Migliozzi F, Boltri M, Pavan N, Garaffa G, Bucci S, Umari P, Trombetta C, Liguori G. Analysis of clinical utility of abdominopelvic computed tomography in the follow-up of Stage I seminoma: a single center evaluation. Minerva Urol Nephrol 2021; 73:84-89. [PMID: 31833335 DOI: 10.23736/s2724-6051.19.03562-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Abdominopelvic computed tomography (CT) is widely used in the follow-up of seminoma patients after radical orchidectomy. The aim of this study was to evaluate the clinical utility of abdominopelvic computed tomography in the follow-up of patients with Stage I seminoma. METHODS The pathological reports of all patients that have undergone radical orchidectomy in our tertiary referral center between January 2002 and January 2018 have been retrospectively reviewed. All patients with Stage I seminoma and negative serum tumor markers after radical orchidectomy were included. Patients with follow-up shorter than 12 months were excluded. Surveillance records of every patient were reviewed with regard to abdominopelvic imaging. RESULTS Of the 133 patients who have undergone radical orchidectomy in our center, 55 had Stage I pure seminoma with normal levels of serum tumor markers after surgery. Two patients were excluded as the follow-up was inadequate. Mean follow-up was 63.2 months (IQR: 30-73). The results of 211 abdominopelvic CTs performed as part of the follow-up were reviewed. Two (3,7%) patients developed recurrence; one consisted of a scrotal lump and was diagnosed with ultrasonography (US) while the second appeared as paraaortic nodal metastasis and was diagnosed with abdominopelvic CT. The recurrence was successfully treated in both patients. A single abdominopelvic CT was useful for the detection of recurrent disease in our entire study population. No cancer specific death has been reported in the study population. CONCLUSIONS Follow-up schedules for Stage I seminoma expose patients to potential risks of radiation-induced tumors, emotional distress and represent a significant burden for the healthcare system. The current series suggests that a better risk adapted patient-tailored follow-up program is needed in order to avoid unnecessary investigations.
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Affiliation(s)
- Michele Rizzo
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy -
| | - Luca Ongaro
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Francesco Claps
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Dario Ghassempour
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Enrica Verzotti
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Francesca Migliozzi
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Matteo Boltri
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Nicola Pavan
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Giulio Garaffa
- The Institute of Urology, University College London Hospitals, London, UK
| | - Stefano Bucci
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Paolo Umari
- Department of Surgery, Clinic of Urology, University of Eastern Piedmont, Novara, Italy
| | - Carlo Trombetta
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Giovanni Liguori
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
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Claps F, Pavan N, Maresma MM, Mazzon G, Rizzo M, Ramirez-Backhaus M, Boltri M, Soria F, Massanova M, D’Andrea D, Traunero F, Marra G, Liguori G, Gontero P, Shariat S, Rubio-Briones J, Celia A, Trombetta C. Impact of preoperative Controlling nutritional status (CONUT) score on perioperative morbidity and survival outcomes in patients with bladder cancer treated with radical cystectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35599-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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11
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Liguori G, Papa G, Boltri M, Stocco C, De Grazia A, Rizzo M, Pavan N, Ramella V, Trombetta C, Arnež ZM. Reconstruction of penile skin loss using a combined therapy of negative pressure wound therapy, dermal regeneration template, and split-thickness skin graft application. Int J Impot Res 2020; 33:854-859. [PMID: 32801347 DOI: 10.1038/s41443-020-00343-1] [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] [Received: 04/28/2020] [Revised: 07/24/2020] [Accepted: 08/07/2020] [Indexed: 11/09/2022]
Abstract
This study evaluates the use of acellular dermal matrix (ADM) in conjunction with negative pressure wound therapy (NPWT) and delayed split-thickness skin graft (STSG) application as an alternative to free tissue transfer for defect coverage of the penile shaft. Five patients with genital lymphedema and one with penile skin deficiency underwent penile shaft reconstruction with a two-stage surgical procedure. The first procedure aimed to the correction of skin defect and to neodermis regeneration through the use of an ADM (Integra®, Integra Lifesciences Corp., Plainsboro, NJ, USA) and NPWT. The second procedure 3 weeks later aimed to the covering of the skin defect with an unmeshed STSG. Both the Integra and skin graft showed completely taking at 7 days postop. No major complications occurred. At 6 months grafts gained sufficient elasticity to allow the sliding of the epidermis over the dermal layer, similarly the physiological penile shaft skin. Our results suggest that combined therapy might be an alternative to free tissue transfer for defect coverage of the penile shaft, leading to a good esthetic result, an optimal shaft coverage and providing adequate extensibility during erections. For best results we advise that in these cases urologists should collaborate with plastic surgeons.
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Affiliation(s)
| | - Giovanni Papa
- Department of Plastic Surgery, University of Trieste, Trieste, Italy
| | - Matteo Boltri
- Department of Urology, University of Trieste, Trieste, Italy
| | - Chiara Stocco
- Department of Plastic Surgery, University of Trieste, Trieste, Italy
| | - Alessia De Grazia
- Department of Plastic Surgery, University of Trieste, Trieste, Italy
| | - Michele Rizzo
- Department of Urology, University of Trieste, Trieste, Italy
| | - Nicola Pavan
- Department of Urology, University of Trieste, Trieste, Italy
| | - Vittorio Ramella
- Department of Plastic Surgery, University of Trieste, Trieste, Italy
| | - Carlo Trombetta
- Department of Urology, University of Trieste, Trieste, Italy
| | - Zoran Marij Arnež
- Department of Plastic Surgery, University of Trieste, Trieste, Italy
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Rizzo M, Cabas P, Pavan N, Umari P, Verzotti E, Boltri M, Stacul F, Bertolotto M, Liguori G, Trombetta C. Needle tract seeding after percutaneous cryoablation of small renal masses; a case series and literature review. Scand J Urol 2020; 54:122-127. [PMID: 32153242 DOI: 10.1080/21681805.2020.1736149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neoplastic cell seeding due to needle tumor manipulation during renal mass biopsy (RMB) or thermal ablative treatment is a rare but potentially serious event that can turn an organ-confined and curable tumor in a nonorgan-confined and non-curable disease. Despite the widespread use of percutaneous thermal ablative treatment for small renal masses (SRMs), this complication has been described in few case reports and small case series and has never been reported after ablative treatment alone. We report a series of two patients that underwent cryoablation for SRMs and developed recurrence along the needle tract. Available knowledge on the controversial topic of tumor seeding following needle manipulation are poor. So far, reporting cases of tumor cell seeding due to needle manipulation is useful to permit a better understanding of this complication.
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Affiliation(s)
- Michele Rizzo
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Paolo Cabas
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Nicola Pavan
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Paolo Umari
- Division of Urology, Maggiore della Carita' Hospital, University of Eastern Piedmont, Novara, Italy
| | - Enrica Verzotti
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Matteo Boltri
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Fulvio Stacul
- Department of Radiology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Michele Bertolotto
- Department of Radiology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Giovanni Liguori
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Carlo Trombetta
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
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13
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Rizzo M, Ongaro L, Claps F, Ghassempour D, Verzotti E, Migliozzi F, Boltri M, Pavan N, Garaffa G, Bucci S, Umari P, Trombetta C, Liguori G. Analysis of clinical utility of abdominopelvic computed tomography in the follow-up of Stage I seminoma: a single center evaluation. Minerva Urol Nephrol 2019. [PMID: 31833335 DOI: 10.23736/s0393-2249.19.03562-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 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 Abdominopelvic computed tomography (CT) is widely used in the follow-up of seminoma patients after radical orchidectomy. The aim of this study was to evaluate the clinical utility of abdominopelvic computed tomography in the follow-up of patients with Stage I seminoma. METHODS The pathological reports of all patients that have undergone radical orchidectomy in our tertiary referral center between January 2002 and January 2018 have been retrospectively reviewed. All patients with Stage I seminoma and negative serum tumor markers after radical orchidectomy were included. Patients with follow-up shorter than 12 months were excluded. Surveillance records of every patient were reviewed with regard to abdominopelvic imaging. RESULTS Of the 133 patients who have undergone radical orchidectomy in our center, 55 had Stage I pure seminoma with normal levels of serum tumor markers after surgery. Two patients were excluded as the follow-up was inadequate. Mean follow-up was 63.2 months (IQR: 30-73). The results of 211 abdominopelvic CTs performed as part of the follow-up were reviewed. Two (3,7%) patients developed recurrence; one consisted of a scrotal lump and was diagnosed with ultrasonography (US) while the second appeared as paraaortic nodal metastasis and was diagnosed with abdominopelvic CT. The recurrence was successfully treated in both patients. A single abdominopelvic CT was useful for the detection of recurrent disease in our entire study population. No cancer specific death has been reported in the study population. CONCLUSIONS Follow-up schedules for Stage I seminoma expose patients to potential risks of radiation-induced tumors, emotional distress and represent a significant burden for the healthcare system. The current series suggests that a better risk adapted patient-tailored follow-up program is needed in order to avoid unnecessary investigations.
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Affiliation(s)
- Michele Rizzo
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy -
| | - Luca Ongaro
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Francesco Claps
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Dario Ghassempour
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Enrica Verzotti
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Francesca Migliozzi
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Matteo Boltri
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Nicola Pavan
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Giulio Garaffa
- The Institute of Urology, University College London Hospitals, London, UK
| | - Stefano Bucci
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Paolo Umari
- Department of Surgery, Clinic of Urology, University of Eastern Piedmont, Novara, Italy
| | - Carlo Trombetta
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Giovanni Liguori
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
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Liguori G, Rizzo M, Boschian R, Cai T, Palmieri A, Bucci S, Pavan N, Claps F, Boltri M, Bertolotto M, Trombetta C. The management of stuttering priapism. MINERVA UROL NEFROL 2019; 72:173-186. [PMID: 30957473 DOI: 10.23736/s0393-2249.19.03323-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Stuttering priapism is a variation of ischemic priapism, generally transient and self-limiting, occurring during sleep and lasting less than 3-4 hours. It may progress to episodes of complete ischemic priapism in approximately one third of cases, necessitating emergent intervention. EVIDENCE ACQUISITION This review aims to provide an up-to-date picture of the pathophysiology and management of stuttering priapism. A search using Medline and EMBASE for relevant publications using the terms "priapism", "stuttering", "diagnosis", "treatment", "fibrosis", was performed. EVIDENCE SYNTHESIS Stuttering priapism shares its etiologies with ischemic priapism and a large number of diseases or clinical situations have risk association for developing the disorder. The most common causes are sickle cell disease or other hematologic and coagulative dyscrasias especially in children. In the adult population, idiopathic priapism occurring without any discernible cause is considered to be the most common form in adults. The medical management of priapism represents a therapeutic challenge to urologists. Unfortunately, although numerous medical treatment options have been reported, the majority are through small trials or anecdotal reports. Understanding the underlying pathophysiology and understanding the current and emerging future agents and therapeutic options are mandatory in order to provide the best solution for each patient. CONCLUSIONS The goal of management of priapism is to achieve detumescence of the persistent erection in order to preserve erectile function. To achieve successful management, urologists should address this emergency clinical condition. In the present article, we review the diagnosis and clinical management of the three types of priapism.
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Affiliation(s)
| | - Michele Rizzo
- Department of Urology, University of Trieste, Trieste, Italy
| | | | - Tommaso Cai
- Department of Urology, Santa Chiara Hospital, Trento, Italy
| | | | - Stefano Bucci
- Department of Urology, University of Trieste, Trieste, Italy
| | - Nicola Pavan
- Department of Urology, University of Trieste, Trieste, Italy
| | - Francesco Claps
- Department of Urology, University of Trieste, Trieste, Italy
| | - Matteo Boltri
- Department of Urology, University of Trieste, Trieste, Italy
| | | | - Carlo Trombetta
- Department of Urology, University of Trieste, Trieste, Italy
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Magri V, Boltri M, Cai T, Colombo R, Cuzzocrea S, De Visschere P, Giuberti R, Granatieri CM, Latino MA, Larganà G, Leli C, Maierna G, Marchese V, Massa E, Matteelli A, Montanari E, Morgia G, Naber KG, Papadouli V, Perletti G, Rekleiti N, Russo GI, Sensini A, Stamatiou K, Trinchieri A, Wagenlehner FME. Multidisciplinary approach to prostatitis. ACTA ACUST UNITED AC 2019; 90:227-248. [PMID: 30655633 DOI: 10.4081/aiua.2018.4.227] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Indexed: 01/01/2023]
Abstract
The modern clinical research on prostatitis started with the work of Stamey and coworkers who developed the basic principles we are still using. They established the segmented culture technique for localizing the infections in the males to the urethra, the bladder, or the prostate and to differentiate the main categories of prostatitis. Such categories with slight modifications are still used according to the NIH classification: acute bacterial prostatitis, chronic bacterial prostatitis, Chronic Pelvic Pain Syndrome (CPPS) and asymptomatic prostatitis. Prostatic inflammation is considered an important factor in influencing both prostatic growth and progression of symptoms of benign prostatic hyperplasia and prostatitis. Chronic inflammation/neuroinflammation is a result of a deregulated acute phase response of the innate immune system affecting surrounding neural tissue at molecular, structural and functional levels. Clinical observations suggest that chronic inflammation correlates with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and benign prostatic hyperplasia (BPH) and an history of clinical chronic prostatitis significantly increases the odds for prostate cancer. The NIHNIDDK classification based on the use of the microbiological 4- glasses localization test or simplified 2-glasses test, is currently accepted worldwide. The UPOINT system identifies groups of clinicians with homogeneous clinical presentation and is used to recognize phenotypes to be submitted to specific treatments. The UPOINTS algorithm implemented the original UPOINT adding to the urinary domains (U), psycho-social (P), organspecific (O), infection (I), neurological (N), muscle tension and tenderness (T) a further domain related to sexuality (S). In fact sexual dysfunction (erectile, ejaculatory, libido loss) has been described in 46-92% of cases with a high impact on the quality of life of patients with CP/CPPS. Prostatic ultrasound represents the most popular imaging test in the work-up of either acute and chronic prostatitis although no specific hypo-hyperechoic pattern has been clearly associated with chronic bacterial prostatitis and CPPS. Use of a digital-processing software to calculate the extension of prostatic calcification area at ultrasound demonstrated a higher percentage of prostatic calcification in patients with chronic bacterial prostatitis. Multiparametric Magnetic Resonance Imaging (mpMRI) is the current state-of-the art imaging modality in the assessment of patients with prostate cancer although a variety of benign conditions, including inflammation, may mimic prostate cancer and act as confounding factors in the discrimination between neoplastic and non-neoplastic lesions. Bacteria can infect prostate gland by: ascending the urethra, reflux of urine into the prostatic ducts, direct inoculation of bacteria through inserted biopsy needles or hematogenous seeding. Enterobacteriaceae are the predominant pathogens in acute and chronic bacterial prostatitis, but an increasing role of Enterococci has been reported. Many strains of these uropathogens exhibit the ability to form biofilm and multidrug- resistance. Sexually Transmitted Infections (STI) agents, in particular Chlamydia trachomatis and Mycoplasma genitalium, have been also considered as causative pathogens of chronic bacterial prostatitis. On the contrary the effective role in genital diseases of other "genital mycoplasmas" is still a much debated issue. Sexually Transmitted Infections agents should be investigated by molecular methods in both patient and sexual partner. "Next generation" investigations, such as cytokine analysis, cytological typing of immune cells could help stratifying the immune response. Epigenetic dysregulation of inflammatory factors should be investigated according to systemic and compartment-specific signals. The search for biomarkers should also include evaluation of hormonal pathways, as measurement of estrogen levels in semen. Antimicrobials are the first line agents for the treatment of bacterial prostatitis. The success of antimicrobial treatment depends on the antibacterial activity and the pharmacokinetic characteristics of the drug which must reach high concentrations in prostate secretion and prostate tissue. Acute bacterial prostatitis can be a serious infection with a potential risk for urosepsis For iInitial treatment of severely ill patients, intravenous administration of high doses of bactericidal antimicrobials, such as broad-spectrum penicillins, third-generation cephalosporins or fluoroquinolones, is recommended in combination with an aminoglycoside. Use of piperacillin-tazobactam and meropenem is justified in presence of multiresistant gramnegative pathogens. The antibiotic treatment of chronic prostatitis is currently based on the use of fluoroquinolones that, given for 2 to 4 weeks, cured about 70% of men with chronic bacterial prostatitis. For the treatment of Chlamydial prostatitis macrolides were shown to be more effective than fluoroquinolones, whereas no differences were observed in microbiological and clinical efficacy between macrolides and tetracyclines for the treatment of infections caused by intracellular pathogens. Aminoglycosides and fosfomycin could be considered as a therapeutic alternative for the treatment of quinolone resistant prostatitis. Use of alpha-blockers in CP/CPPS patients with urinary symptoms and analgesics +/- non steroidal anti-inflammatory drugs (NSAID), in presence of pain demonstrated a reduction of symptoms reduction and an improvement of quality of life, although long term use of NSAID is limited by side effect profile. However, the multimodal therapeutic regimen by contemporary use of alphablockers, antibiotics and anti-inflammatory showed a better control of prostatitis symptoms than single drug treatment. Novel therapeutic substances for the treatment of pain, such as the cannabinoid anandamide would be highly interesting to test. An alternative for the treatment of chronic prostatitis/chronic pelvic pain syndrome is phytotherapy, as primary therapy or in association with other drugs. Quercetin, pollen extract, extract of Serenoa repens and other mixtures of herbal extracts showed a positive effect on symptoms and quality of life without side effects. The association of CP/CPPS with alterations of intestinal function has been described. Diet has its effects on inflammation by regulation of the composition of intestinal flora and direct action on the intestinal cells (sterile inflammation). Intestinal bacteria (microbiota) interacts with food influencing the metabolic, immune and inflammatory response of the organism. The intestinal microbiota has protective function against pathogenic bacteria, metabolic function by synthesis of vitamins, decomposition of bile acids and production of trophic factors (butyrate), and modulation of the intestinal immune system. The alteration of the microbiota is called "dysbiosis" causing invasive intestinal diseases pathologies (leaky gut syndrome and food intolerances, irritable bowel syndrome or chronic inflammatory bowel diseases) and correlating with numerous systemic diseases including acute and chronic prostatitis. Administration of live probiotics bacteria can be used to regulate the balance if intestinal flora. Sessions of hydrocolontherapy can represent an integration to this therapeutic approach. Finally, microbiological examination of sexual partners can offer supplementary information for treatment.
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Boltri M, Magri V, Montanari E, Perletti G, Trinchieri A. Computer-Assisted Quantitative Assessment of Prostatic Calcifications in Patients with Chronic Prostatitis. Urol Int 2018; 100:450-455. [PMID: 29698941 DOI: 10.1159/000486346] [Citation(s) in RCA: 1] [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: 11/03/2017] [Accepted: 12/14/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was the development of quantitative assessment of prostatic calcifications at prostatic ultrasound examination by the use of an image analyzer. MATERIALS AND METHODS A group of 82 patients was evaluated by medical history, physical, and transrectal ultrasound examination. Patients had a urethral swab, a 4-specimen study and culture of the seminal fluid. Patients were classified according to National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health. Subjective symptoms were scored by Chronic Prostatitis Symptom Index (CPSI) questionnaire. Ultrasound images were analyzed by the digital processing software Image J to quantitatively assess the presence of calcifications. RESULTS Computer-assessed calcified areas were significantly higher in chronic bacterial prostatitis (n = 18; group II; 6.76 ± 8.09%) than in the chronic pelvic pain syndrome group IIIa (n = 26; 2.07 ± 1.01%) and IIIb (n = 38; 2.31 ± 2.18%). The area of calcification of the prostate was significantly related to the CPSI score for domains of micturition (r = 0.278, p = 0.023), Prostatic Specific Antigen values (r = 0341, p = 0.005), postvoiding residual urine (r = 0.262, p = 0.032), total prostate volume (r = 0.592, p = 0.000), and adenoma volume (r = 0.593; p = 0.000). CONCLUSIONS The presence of calcifications is more frequently observed in patients with chronic bacterial prostatitis and is related to urinary symptoms.
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Affiliation(s)
- Matteo Boltri
- Urology Medical School, University of Trieste, Trieste, Italy
| | | | - Emanuele Montanari
- IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Gianpaolo Perletti
- Department of Basic Medical Sciences, Faculty of Medicine and Medical Sciences, Ghent University, Ghent, Belgium.,Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, Università degli Studi dell'Insubria, Busto Arsizio, Italy
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D’Alonzo M, Fenoglio A, Balocco P, Rondoletto S, Venditti E, Boltri M, Piovano A, Pecchio S, Biglia N. Nipple Sparing Mastectomy: analysis of non-oncological contraindications. 5 years of a single medical center experience. Breast 2017. [DOI: 10.1016/s0960-9776(17)30355-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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18
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Borsetti G, Merlino G, Bergamin F, Cerato C, Boltri M, Borsetti M. A 38 kg skin-reducing bilateral mastectomy: a unique case. J Plast Reconstr Aesthet Surg 2008; 62:133-4. [PMID: 18694661 DOI: 10.1016/j.bjps.2008.03.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 03/25/2008] [Indexed: 11/28/2022]
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Merlino G, Borsetti M, Boltri M. Reverse radial artery bone flap reconstruction of segmental metacarpal losses. J Hand Surg Eur Vol 2007; 32:98-101. [PMID: 17034910 DOI: 10.1016/j.jhsb.2006.08.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Revised: 08/18/2006] [Accepted: 08/22/2006] [Indexed: 02/03/2023]
Abstract
A vascularised bone segment of the distal radius was harvested as a distally based flap to treat segmental metacarpal bone loss in three patients. One reconstruction followed resection of a giant cell tumour excision and the other two were to replace traumatic bone loss. The bone defects were in the second metacarpal in two cases and in the second and third metacarpal in one case and included three shaft and one distal metacarpal reconstruction. The mean length of the metacarpal defects was 6 cm. All of the flaps survived and no complications occurred at the donor site. Clinical and radiological union was established in all cases after an average of 3 months.
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Affiliation(s)
- G Merlino
- Department of Plastic Surgery, Maria Vittoria Hospital, Turin, Italy
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Abstract
We present our experience with augmentation mammaplasty on 14 patients with a thin chest wall and poor subcutaneous tissue. Thanks to Polytech Silimed code 20675, a new anatomical prosthesis filled with "soft" cohesive gel, the lodging in a subglandular position was possible without anomalous salience in the upper pole, and a more natural mammary profile was achieved without capsular contracture, dislocation, or misplacement of the mammary implants.
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Boltri M. [Traditional cutaneous suture and synthesis with Fasterzip. Comparative esthetic results]. MINERVA CHIR 1998; 53:453-6. [PMID: 9780640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
A group of 20 patients underwent plastic surgery for inguinal hernia. In 10 cases the incision was sutured using a traditional technique, whereas in 10 cases the wound was joined using Fasterzip. The cosmetic appearance of the wound in the two groups was compared at 8, 30, 60 and 90 days after surgery. It was found that the use of Fasterzip was significantly better during the initial phase, but as the scarring process progressed, the differences became less evident.
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Affiliation(s)
- M Boltri
- I Divisione di Chirurgia Generale, USL IV, Ospedale G. Bosco, Torino
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Boltri M. [Atraumatic closure of skin wounds with fasterzip. Immediate and long term esthetic results]. MINERVA CHIR 1997; 52:1405-9. [PMID: 9489344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A new mechanical suturing device called Fasterzip was used in three groups of patients of both sexes undergoing surgery for cholelithiasis, inguinal hernia and appendicitis. The use and removal of the device was very fast and easy. Clinical controls were performed 3, 8, 30, 60 and 90 days after surgery. In all cases, the scarring process took places in a physiological manner and resulted in the healing of the skin wound with excellent results from a cosmetic point of view.
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Affiliation(s)
- M Boltri
- I Divisione di Chirurgia Generale, USL IV, Ospedale G. Bosco, Torino
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Boltri F, Moro L, Voghera P, Boltri M, Dal Bo R. [Videolaparoscopic cholecystectomy in the obese patient]. MINERVA CHIR 1995; 50:79-83. [PMID: 7617266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The difficulties which arise when performing VLC in obese patients primarily concern the induction of pneumoperitoneum and the use of normal surgical instruments. This is due to the thickness of the abdominal wall and the scarce anchorage of the cutis and subcutis to the musculo-fascia level. Two technical variations of pneumoperitoneum are proposed in order to overcome the first problem, whereas with regard to the latter the authors suggest moving the trocar insertion points towards the site of the gallbladder.
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Affiliation(s)
- F Boltri
- I Divisione di Chirurgia Generale, Ospedale G. Bosco, Torino
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Boltri F, Boltri M, Coverlizza S, Voghera P, Gentilli S, Mosso L. [Retroperitoneal paragangliomas. Considerations on a internephro-caval case]. MINERVA CHIR 1994; 49:1121-7. [PMID: 7708235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A case of paraganglioma situated between right renal vein, right renal artery and inferior vena cava is here with described. The report constitutes the rise to frame with precision the tumor according with WHO classification. Moreover criteria are to be discussed for nature and seat diagnosis, as well for the choice of the best way of access.
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Affiliation(s)
- F Boltri
- I Divisione di Chirurgia Generale, Ospedale G. Bosco, Torino
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Boltri F, Moro L, Voghera P, Boltri M, Bonello F. ["Prophylactic" video-laparoscopic cholecystectomy]. MINERVA CHIR 1994; 49:987-90. [PMID: 7808676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The authors examine the prophylaxis of infections caused by cholelithiasis in kidney and heart transplant candidates as a new indication for videolaparoscopic cholecystectomy (VLC). The study included 6 patients in dialysis for chronic renal insufficiency and one patient suffering from cyanogenic congenital cardiopathy with asymptomatic gallbladder calculosis. The results obtained show that there are no substantial differences compared to patients without associated pathologies and justifies the inclusion of "prophylactic" VLC in preparatory treatment protocols for kidney and heart transplant in patients suffering from cholelithiasis. The authors emphasise the necessary technical measures to prevent hemorrhage, intraoperative loss of CO2 and postoperative laparoceles.
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Affiliation(s)
- F Boltri
- I Divisione di Chirurgia Generale, Ospedale G. Bosco, Torino
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