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Santucci D, Vertulli D, Esperto F, Eolo Trodella L, Ramella S, Papalia R, Scarpa RM, de Felice C, Francesco Grasso R, Beomonte Zobel B, Faiella E. Role of psa levels and pathological stadiation before radiation therapy in predicting mp-MRI results in patients with prostate cancer recurrence after radical prostatectomy. Actas Urol Esp 2024; 48:140-149. [PMID: 37981171 DOI: 10.1016/j.acuroe.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/28/2022] [Indexed: 11/21/2023]
Abstract
OBJECTIVE To evaluate PSA value in mp-MRI results prediction, analyzing patients with high (GS≥8, pT≥3, pN1) and low grade (GS<8, pT<3, pN0) Prostate Cancer (PCa). MATERIALS AND METHODS One hundred eighty-eight patients underwent 1.5-Tmp-MRI after Radical Prostatectomy (RP) and before Radiotherapy (RT). They were divided into 2 groups: A and B, for patients with biochemical recurrence (BCR) and without BCR but with high local recurrence risk. Considering Gleason Score (GS), pT and pN as independent grouping variables, ROC analyses of PSA levels at primary PCa diagnosis and PSA before RT were performed in order to identify the optimal cut-off to predict mp-MRI result. RESULTS Group A and B showed higher AUC for PSA before RT than PSA at PCa diagnosis, in low and high grade tumors. For low grade tumors the best AUC was 0.646 and 0.685 in group A and B; for high grade the best AUC was 0.705 and 1 in group A and B, respectively. For low grade tumors the best PSA cut-off was 0.565-0.58ng/mL in group A (sensitivity, specificity: 70.5%, 66%), and 0.11-0.13ng/mL in B (sensitivity, specificity: 62.5%, 84.6%). For high grade tumors, the best PSA cut-off obtained was 0.265-0.305ng/mL in group A (sensitivity, specificity: 95%, 42.1%), and 0.13-0.15ng/mL in B (sensitivity, specificity: 100%). CONCLUSION Mp-MRI should be performed as added diagnostic tool always when a BCR is detected, especially in high grade PCa. In patients without BCR, mp-MRI results, although poorly related to pathological stadiation, still have a good diagnostic performance, mostly when PSA>0.1-0.15ng/mL.
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Affiliation(s)
- D Santucci
- Departamento de Radiología, Universidad Campus Bio-Medico, Roma, Italy
| | - D Vertulli
- Departamento de Radiología, Universidad Campus Bio-Medico, Roma, Italy
| | - F Esperto
- Departamento de Urología, Universidad Campus Bio-Medico, Roma, Italy
| | - L Eolo Trodella
- Departamento de Radioterapia, Universidad Campus Bio-Medico, Roma, Italy
| | - S Ramella
- Departamento de Radioterapia, Universidad Campus Bio-Medico, Roma, Italy
| | - R Papalia
- Departamento de Urología, Universidad Campus Bio-Medico, Roma, Italy
| | - R M Scarpa
- Departamento de Urología, Universidad Campus Bio-Medico, Roma, Italy
| | - C de Felice
- Departamento de Radiología, Universidad de Sapienza, Roma, Italy
| | | | - B Beomonte Zobel
- Departamento de Radiología, Universidad Campus Bio-Medico, Roma, Italy
| | - E Faiella
- Departamento de Radiología, Universidad Campus Bio-Medico, Roma, Italy.
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Prata F, Ragusa A, Civitella A, Tuzzolo P, Tedesco F, Cacciatore L, Iannuzzi A, Callè P, Raso G, Fantozzi M, Pira M, Ricci M, Pino M, Minore A, Basile S, Testa A, Crimi VG, Deanesi N, Travino A, D'Addurno G, Scarpa RM, Papalia R. Robot-assisted partial nephrectomy using the novel Hugo™ RAS system: Feasibility, setting and perioperative outcomes of the first off-clamp series. Urologia 2024:3915603231220109. [PMID: 38174713 DOI: 10.1177/03915603231220109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Hugo Robot-Assisted Surgery (RAS) System has been conceived with enhanced modularity but its role for nephron-sparing surgery setting still remains poorly explored. We aimed to describe our experience in robot-assisted partial nephrectomy (RAPN) with a three-arms setting for the first off-clamp series using the new Hugo RAS System. METHODS Patients were placed on an extended flank position at the margin of the surgical bed with a slightly flexion (45°). The first 11 mm robotic trocar (camera port) was placed along the pararectal line 14 ± 2 cm far from the umbilicus. The pneumoperitoneum was then induced through the AirSeal system (SurgiQuest, Milford, Connecticut, USA©). Two more 8 mm operative robotic ports were placed under direct vision, either 8 ± 1 cm far from optic's port. Two 12 mm laparoscopic ports for bed-assistant were placed between robotic ports. Monopolar curved shears, fenestrated grasper, and large needle driver were used in a three-instruments configuration. RESULTS Off-clamp RAPN was successfully performed in seven patients with cT1 renal masses using a trans-peritoneal route. Median port placement and docking time was 6 min (IQR, 4-8 min). Hemostasis was achieved through renorraphy using a single transfix stitch with sliding clips technique. There was no need for additional ports placement. No intraoperative complications occurred, no clashing of robotic instruments or between the robotic arms was observed. No technical failures of the system occurred. Median console time was 83 min (IQR, 68-115 min). Median estimated blood loss were 200 ml (IQR, 50-400 ml). All patients were discharged between post-operative day 2 and 3, without the need of hospital readmission. No complications were recorded within the first 30 post-operative days. CONCLUSIONS We performed the first series of off-clamp RAPN using the novel HUGO RAS System. This novel robotic platform showed an easy-friendly docking system, providing excellent perioperative outcomes with a simple three-arms configuration.
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Affiliation(s)
- F Prata
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - A Ragusa
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - A Civitella
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - P Tuzzolo
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - F Tedesco
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - L Cacciatore
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - A Iannuzzi
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - P Callè
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - G Raso
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - M Fantozzi
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - M Pira
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - M Ricci
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - M Pino
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - A Minore
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - S Basile
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - A Testa
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - V G Crimi
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - N Deanesi
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - A Travino
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - G D'Addurno
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - R M Scarpa
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - R Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
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Scarpa RM, Usai P. Urs E. Studer: a master of surgery. Minerva Urol Nephrol 2023; 75:793. [PMID: 38126296 DOI: 10.23736/s2724-6051.23.05668-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Roberto M Scarpa
- Urological Division and Residency Program Urology, Campus Bio-Medico University, Rome, Italy -
| | - Paolo Usai
- Portes de Provence Hospital Group, Montélimar, France
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Esperto F, Pietropaolo A, Emiliani E, DE Coninck V, Tailly T, Keller EX, Talso M, Tonyali S, Sener ET, Zeesha Nhameed BM, Tzelves L, Ventimiglia E, Juliebø-Jones P, Faiella E, Mykoniatis I, Tsaturyan A, Scarpa RM. Unveiling the impact of stone disease: enhancing quality of life through comprehensive care. Minerva Urol Nephrol 2023; 75:658-660. [PMID: 37728501 DOI: 10.23736/s2724-6051.23.05537-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Esteban Emiliani
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Thomas Tailly
- Department of Urology, Gent University Hospital, Gent, Belgium
| | - Etienne X Keller
- Department of Urology, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Michele Talso
- Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Senol Tonyali
- Department of Urology, Istanbul School of Medicine, Istanbul University, Istanbul, Türkiye
| | - Emre T Sener
- Department of Urology, Marmara University School of Medicine, Istanbul, Türkiye
| | | | - Lazaros Tzelves
- Department of Urology, University College of London Hospital, London, UK
| | - Eugenio Ventimiglia
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS, San Raffaele Hospital, Milan, Italy
| | | | - Eliodoro Faiella
- Department of Radiology, Campus Bio-Medico University, Rome, Italy
| | | | - Arman Tsaturyan
- Department of Urology, Erebouni Medical Center, Yerevan, Armenia
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
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Prata F, Ragusa A, Tempesta C, Iannuzzi A, Tedesco F, Cacciatore L, Raso G, Civitella A, Tuzzolo P, Callè P, Pira M, Pino M, Ricci M, Fantozzi M, Prata SM, Anceschi U, Simone G, Scarpa RM, Papalia R. State of the Art in Robotic Surgery with Hugo RAS System: Feasibility, Safety and Clinical Applications. J Pers Med 2023; 13:1233. [PMID: 37623483 PMCID: PMC10456103 DOI: 10.3390/jpm13081233] [Citation(s) in RCA: 2] [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] [Received: 07/05/2023] [Revised: 08/01/2023] [Accepted: 08/05/2023] [Indexed: 08/26/2023] Open
Abstract
Since its introduction in the early 2000s, robotic surgery has represented a significative innovation within a minimally invasive surgery approach. A variety of robotic platforms have been made available throughout the years, and the outcomes related to those platforms have been described in the literature for many types of surgeries. Medtronic's HugoTM RAS system is one of the newest robotic generations launched, but because of its recent placing on the field, comprehensive clinical data are still lacking. The aim of the present state of the art is to address the current literature concerning the use of the HugoTM RAS robot in order to report its feasibility, safety and clinical applications in different surgical branches. Two reviewers independently conducted a search on the "PubMed" electronic database, using the keywords "Hugo" and "Hugo RAS". After the initial screening of 35 results, a total of 15 articles concerning the Hugo RAS system were selected for the review, including both oncological and benign surgery. Patients' demographic and baseline data were compared including, when available, docking system times, complications and oncological outcomes in the fields of urologic, gynecologic and general surgery. With reference to urological procedures, a total of 156 robot-assisted radical prostatectomies, 10 robot-assisted partial nephrectomies, and 5 robot-assisted adrenalectomies were performed, involving a total of 171 patients. The surgical branch in which the Hugo system found its major application was urology, which was followed by gynecology and general surgery. The Hugo RAS system by Medtronic represents an innovative and safe surgical platform, with excellent perspective for the future and different clinical applications in many surgical branches. More studies are needed to validate the safety and results from this new robotic platform.
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Affiliation(s)
- Francesco Prata
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.R.); (A.I.); (F.T.); (L.C.); (G.R.); (A.C.); (P.T.); (P.C.); (M.P.); (M.P.); (M.R.); (M.F.); (R.M.S.); (R.P.)
| | - Alberto Ragusa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.R.); (A.I.); (F.T.); (L.C.); (G.R.); (A.C.); (P.T.); (P.C.); (M.P.); (M.P.); (M.R.); (M.F.); (R.M.S.); (R.P.)
| | - Claudia Tempesta
- Department of General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy;
| | - Andrea Iannuzzi
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.R.); (A.I.); (F.T.); (L.C.); (G.R.); (A.C.); (P.T.); (P.C.); (M.P.); (M.P.); (M.R.); (M.F.); (R.M.S.); (R.P.)
| | - Francesco Tedesco
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.R.); (A.I.); (F.T.); (L.C.); (G.R.); (A.C.); (P.T.); (P.C.); (M.P.); (M.P.); (M.R.); (M.F.); (R.M.S.); (R.P.)
| | - Loris Cacciatore
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.R.); (A.I.); (F.T.); (L.C.); (G.R.); (A.C.); (P.T.); (P.C.); (M.P.); (M.P.); (M.R.); (M.F.); (R.M.S.); (R.P.)
| | - Gianluigi Raso
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.R.); (A.I.); (F.T.); (L.C.); (G.R.); (A.C.); (P.T.); (P.C.); (M.P.); (M.P.); (M.R.); (M.F.); (R.M.S.); (R.P.)
| | - Angelo Civitella
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.R.); (A.I.); (F.T.); (L.C.); (G.R.); (A.C.); (P.T.); (P.C.); (M.P.); (M.P.); (M.R.); (M.F.); (R.M.S.); (R.P.)
| | - Piergiorgio Tuzzolo
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.R.); (A.I.); (F.T.); (L.C.); (G.R.); (A.C.); (P.T.); (P.C.); (M.P.); (M.P.); (M.R.); (M.F.); (R.M.S.); (R.P.)
| | - Pasquale Callè
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.R.); (A.I.); (F.T.); (L.C.); (G.R.); (A.C.); (P.T.); (P.C.); (M.P.); (M.P.); (M.R.); (M.F.); (R.M.S.); (R.P.)
| | - Matteo Pira
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.R.); (A.I.); (F.T.); (L.C.); (G.R.); (A.C.); (P.T.); (P.C.); (M.P.); (M.P.); (M.R.); (M.F.); (R.M.S.); (R.P.)
| | - Matteo Pino
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.R.); (A.I.); (F.T.); (L.C.); (G.R.); (A.C.); (P.T.); (P.C.); (M.P.); (M.P.); (M.R.); (M.F.); (R.M.S.); (R.P.)
| | - Marco Ricci
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.R.); (A.I.); (F.T.); (L.C.); (G.R.); (A.C.); (P.T.); (P.C.); (M.P.); (M.P.); (M.R.); (M.F.); (R.M.S.); (R.P.)
| | - Marco Fantozzi
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.R.); (A.I.); (F.T.); (L.C.); (G.R.); (A.C.); (P.T.); (P.C.); (M.P.); (M.P.); (M.R.); (M.F.); (R.M.S.); (R.P.)
| | - Salvatore M. Prata
- Simple Operating Unit of Lower Urinary Tract Surgery, SS. Trinità Hospital, Sora, 03039 Frosinone, Italy;
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (U.A.); (G.S.)
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (U.A.); (G.S.)
| | - Roberto M. Scarpa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.R.); (A.I.); (F.T.); (L.C.); (G.R.); (A.C.); (P.T.); (P.C.); (M.P.); (M.P.); (M.R.); (M.F.); (R.M.S.); (R.P.)
| | - Rocco Papalia
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.R.); (A.I.); (F.T.); (L.C.); (G.R.); (A.C.); (P.T.); (P.C.); (M.P.); (M.P.); (M.R.); (M.F.); (R.M.S.); (R.P.)
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Esperto F, Pietropaolo A, Emiliani E, De Coninck V, Tailly T, Keller EX, Talso M, Tonyali S, Sener ET, Zeeshan Hameed BM, Tzelves L, Ventimiglia E, Juliebø-Jones P, Faiella E, Mykoniatis I, Tsaturyan A, Scarpa RM. Quality of life of patients with stone disease: timing, planning, strategies, and prevention of a systemic pathology. Minerva Urol Nephrol 2023; 75:422-424. [PMID: 37314814 DOI: 10.23736/s2724-6051.23.05435-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy -
| | - Amelia Pietropaolo
- Department of Urology, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Esteban Emiliani
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Thomas Tailly
- Department of Urology, University Hospital of Ghent, Ghent, Belgium
| | - Etienne X Keller
- Department of Urology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Michele Talso
- Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Senol Tonyali
- Department of Urology, Istanbul School of Medicine, University of Istanbul, Istanbul, Türkiye
| | - Emre T Sener
- Department of Urology, Marmara University School of Medicine, Istanbul, Türkiye
| | | | - Lazaros Tzelves
- Department of Urology, University College of London Hospital, London, UK
| | - Eugenio Ventimiglia
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Norway University, Bergen, Norway
| | - Eliodoro Faiella
- Department of Radiology, Campus Biomedico University of Rome, Rome, Italy
| | - Ioannis Mykoniatis
- Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Arman Tsaturyan
- Department of Urology, Erebouni Medical Center, Yerevan, Armenia
| | - Roberto M Scarpa
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
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Prata F, Lucarini G, Menciassi A, Ricotti L, Mazzocchi T, Marziale L, Gruppioni E, Scarpa RM, Papalia R. A magnetic endourethral sphincter against stress urinary incontinence: preliminary pilot study in humans. Minerva Urol Nephrol 2023; 75:514-520. [PMID: 37166131 DOI: 10.23736/s2724-6051.23.05190-x] [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: 05/12/2023]
Abstract
BACKGROUND Urinary incontinence (UI) is a common and frustrating condition that affects patients' quality of life as well as the Healthcare systems. Currently, the most severe cases of UI are treated using implanted, invasive artificial sphincters. We propose an innovative, minimally invasive magnetic endourethral sphincter for the treatment of stress UI (SUI) in patients for whom previous medical and surgical treatments have failed. METHODS Six patients with severe SUI were enrolled at a single center and underwent cystoscopic sphincter implantation. After 10 days, correct device position was confirmed by ultrasonography. The sphincter was explanted after 28 days. RESULTS In all patients, the sphincter was successfully implanted using an endoscopic approach. One patient reached the end of the pilot test (28 days) with the sphincter correctly placed. Patients' responses on the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form questionnaire improved from a score of 18 out of 21 at the screening visit (UI without reasons) to a score of 3 out of 21 (almost perfect continence). No major pain and discomfort were reported. CONCLUSIONS This study showed the feasibility of sphincter implantation, explantation, and overall tolerability, although a redesign of the sphincter distal part is needed.
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Affiliation(s)
- Francesco Prata
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Gioia Lucarini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy -
| | | | - Leonardo Ricotti
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | | | | | - Roberto M Scarpa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rocco Papalia
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Mantica G, Carrion DM, Antón-Juanilla M, Pang KH, Parodi S, Tappero S, Rodriguez-Serrano A, Crespo-Atín V, Cansino R, Scarpa RM, Nikles S, Balzarini F, Terrone C, Gomez Rivas J, Esperto F. Impact of a delayed presentation to the emergency department for acute renal colic on biochemical and clinical outcomes. Actas Urol Esp 2023; 47:41-46. [PMID: 36503815 DOI: 10.1016/j.acuroe.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND OBJECTIVE To verify the impact of delay on biochemical and clinical outcomes for patients presenting to the emergency department (ED) with acute renal colic. MATERIALS AND METHODS Data were retrospectively collected from three institutions of two European countries between 01 January and 30 April 2020. Patients who presented to the ED with unilateral or bilateral renal colic caused by urolithiasis confirmed by imaging tests during the study period were included. A presentation after 24 h since the onset of symptoms was considered a delay. Patients presenting before 24 h from the symptom onset were included in Group A, while the patients presenting after 24 h in Group B. Clinical and biochemical parameters and management were compared. RESULTS A total of 397 patients who presented to ED with confirmed urolithiasis were analyzed (Group A, n = 199; Group B, n = 198. The median (IQR) delay in presentation was 2 days (1,5-4). At presentation, no statistically significant differences were found amongst the two groups of patients regarding presenting symptoms such as fever and flank pain, and the median serum levels of creatinine, C reactive protein and white blood cells. No differences were found in terms of conservative or operative management. CONCLUSION Delay in consultation >24 h is not associated with worsening biochemical parameters and clinical outcomes. Most patients with acute loin pain do not necessarily need urgent attendance to the ED and may be managed in the outpatients.
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Affiliation(s)
- G Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy; European Society of Residents in Urology (ESRU), Arnhem, The Netherlands
| | - D M Carrion
- European Society of Residents in Urology (ESRU), Arnhem, The Netherlands; Department of Urology, La Paz University Hospital, Madrid, Autonomous University of Madrid, Madrid, Spain
| | - M Antón-Juanilla
- Department of Urology, Cruces University Hospital, Barakaldo, Vizcaya, Spain
| | - K H Pang
- European Society of Residents in Urology (ESRU), Arnhem, The Netherlands; Department of Oncology and Metabolism, Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - S Parodi
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - S Tappero
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - A Rodriguez-Serrano
- Department of Urology, La Paz University Hospital, Madrid, Autonomous University of Madrid, Madrid, Spain
| | - V Crespo-Atín
- Department of Urology, Cruces University Hospital, Barakaldo, Vizcaya, Spain
| | - R Cansino
- Department of Urology, La Paz University Hospital, Madrid, Autonomous University of Madrid, Madrid, Spain
| | - R M Scarpa
- Department of Urology, Campus Biomedico, University of Rome, Italy
| | - S Nikles
- European Society of Residents in Urology (ESRU), Arnhem, The Netherlands; Department of Urology, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia
| | - F Balzarini
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy.
| | - C Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - J Gomez Rivas
- European Society of Residents in Urology (ESRU), Arnhem, The Netherlands; Department of Urology, Hospital Clinico San Carlos, Madrid, Spain
| | - F Esperto
- European Society of Residents in Urology (ESRU), Arnhem, The Netherlands; Department of Urology, Campus Biomedico, University of Rome, Italy
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9
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Artibani W, Carmignani L, Carrieri G, Castagnetti M, Cretì G, De Gennaro M, Manzoni G, Masieri L, Porpiglia F, Scarpa RM. The Discipline of Pediatric Urology: Prerogatives and Necessities. Arch Ital Urol Androl 2022; 94:515-518. [PMID: 36576478 DOI: 10.4081/aiua.2022.4.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
To the Editor, The aim of this "position paper" is to describe the discipline of Pediatric Urology with its clinical and cultural competencies, represent the reasons for legitimizing its existence, and reinforce its importance in the "scenario" of the National Italian Healthcare System. The requisites and the educational requirements were defined by both the Italian Ministry of Health with the State-Regions Conference, and the European Union [...].
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Affiliation(s)
| | - Luca Carmignani
- Comitato Esecutivo SIU 2018-2021, Responsabile Ufficio Ricerca.
| | - Giuseppe Carrieri
- Comitato Esecutivo SIU 2018-2021, Responsabile Ufficio Educazionale.
| | - Marco Castagnetti
- GdL SIU Urologia Pediatrica 2018-2021 e Consiglio Direttivo SIUP 2020-21.
| | | | | | | | - Lorenzo Masieri
- GdL SIU Urologia Pediatrica 2018-2021 e Consiglio Direttivo SIUP 2020-21.
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10
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Esperto F, Juliebø-Jones P, Keller EX, Tailly T, Mykoniatis I, DE Coninck V, Pietropaolo A, Talso M, Sener ET, Tonyali S, Zeeshan Hameed BM, Ventimiglia E, Tzelves L, Tsaturyan A, Emiliani E, Papalia R, Scarpa RM. Urolithiasis in anomalous kidneys: RIRS or PCNL, this is the question. May ECIRS be the answer? Minerva Urol Nephrol 2022; 74:802-804. [PMID: 36629810 DOI: 10.23736/s2724-6051.22.05208-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Francesco Esperto
- Department of Urology, Campus Bio-Medico University, Rome, Italy - .,Unit of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy -
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Etienne X Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Tailly
- Department of Urology, University Hospitals Ghent, Ghent, Belgium
| | - Ioannis Mykoniatis
- School of Medicine, Department of Urology, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Michele Talso
- Department of Urology, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Emre T Sener
- School of Medicine, Department of Urology, Marmara University, Istanbul, Turkey
| | - Senol Tonyali
- Istanbul School of Medicine, Department of Urology, Istanbul University, Istanbul, Turkey
| | | | - Eugenio Ventimiglia
- Unit of Urology, Division of Experimental Oncology, URI-Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Lazaros Tzelves
- Second Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Esteban Emiliani
- Department of Urology, Puigvert Foudation, Autonomous University of Barcelona, Barcelona, Spain
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
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11
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Faiella E, Santucci D, Vertulli D, Esperto F, Messina L, Castiello G, Papalia R, Flammia G, Scarpa RM, Fiore M, Trodella LE, Ramella S, Grasso RF, Beomonte Zobel B. The role of multiparametric mri in the diagnosis of local recurrence after radical prostatectomy and before salvage radiotherapy. Actas Urol Esp 2022; 46:397-406. [PMID: 35778338 DOI: 10.1016/j.acuroe.2021.12.011] [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: 08/11/2021] [Accepted: 12/11/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Assess multiparametric-MRI (mp-MRI) diagnostic accuracy in the detection of local recurrence of Prostate Cancer (PCa) after Radical Prostatectomy (PR) and before Radiation Therapy (RT). MATERIALS AND METHODS A total of 188 patients underwent 1.5-T mp-MRI after RP before RT. Patients were divided into two groups: with biochemical recurrence (group A) and without but with high risk of local recurrence (group B). Continuous variables were compared between two groups using T-Student; categoric variables were analyzed using Pearson chi-square. ROC analysis was performed considering PSA before RT, ISUP, pT and pN as grouping variables. RESULTS PCa recurrence (reduction of PSA levels after RT) was 89.8% in the group A and 80.3% in the group B. Comparing patients with and without PCa recurrence, there was a significant difference in PSA values before RT for group A and for PSA values before RT and after RT for group B. In group A, there was a significant correlation between PSA before RT and diameter of recurrence and between PSA before RT and time spent before recurrence. The mp-MRI diagnostic accuracy in detecting PCa local recurrence after RP is of 62.2% in group A and 38% in group B. DWI is the most specific MRI-sequence and DCE the most sensitive. For PSA = 0.5 ng/ml, the AUC decreases while sensitivity and accuracy increase for each MRI-sequence. For PSA = 0.9 ng/ml, DCE-AUC increases significantly. CONCLUSION mp-MRI should always be performed before RT when a recurrence is suspected. New scenarios can be opened considering the role of DWI for PSA ≤ 0.5 ng/ml.
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Affiliation(s)
- E Faiella
- Department of Radiology, University of Rome Campus Bio-medico, Rome, Italy.
| | - D Santucci
- Department of Radiology, University of Rome Campus Bio-medico, Rome, Italy
| | - D Vertulli
- Department of Radiology, University of Rome Campus Bio-medico, Rome, Italy
| | - F Esperto
- Department of Urology, University of Rome Campus Bio-medico, Rome, Italy
| | - L Messina
- Department of Radiology, University of Rome Campus Bio-medico, Rome, Italy
| | - G Castiello
- Department of Radiology, University of Rome Campus Bio-medico, Rome, Italy
| | - R Papalia
- Department of Urology, University of Rome Campus Bio-medico, Rome, Italy
| | - G Flammia
- Department of Urology, University of Rome Campus Bio-medico, Rome, Italy
| | - R M Scarpa
- Department of Urology, University of Rome Campus Bio-medico, Rome, Italy
| | - M Fiore
- Department of Radiotherapy, University of Rome Campus Bio-medico, Rome, Italy
| | - L Eolo Trodella
- Department of Radiotherapy, University of Rome Campus Bio-medico, Rome, Italy
| | - S Ramella
- Department of Radiotherapy, University of Rome Campus Bio-medico, Rome, Italy
| | - R F Grasso
- Department of Radiology, University of Rome Campus Bio-medico, Rome, Italy
| | - B Beomonte Zobel
- Department of Radiology, University of Rome Campus Bio-medico, Rome, Italy
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12
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Esperto F, Juliebø-Jones P, Keller EX, Tailly T, Mykoniatis I, DE Coninck V, Pietropaolo A, Talso M, Sener ET, Tonyali S, Zeeshan Hameed BM, Faiella E, Damiano R, Papalia R, Scarpa RM. Future perspectives to improve outcomes associated with percutaneous nephrolithotomy for anterior calyceal stones: does ECIRS hold the answers? Minerva Urol Nephrol 2022; 73:866-867. [PMID: 35144374 DOI: 10.23736/s2724-6051.21.04815-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Francesco Esperto
- Department of Urology, Campus Bio-Medico University, Rome, Italy - .,Unit of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy -
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Etienne X Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Tailly
- Department of Urology, University Hospitals Ghent, Ghent, Belgium
| | - Ioannis Mykoniatis
- School of Medicine, Department of Urology, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Michele Talso
- Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Emre T Sener
- School of Medicine, Department of Urology, Marmara University, Istanbul, Turkey
| | - Senol Tonyali
- Istanbul School of Medicine, Department of Urology, Istanbul University, Istanbul, Turkey
| | | | - Eliodoro Faiella
- Unit of Diagnostic Imaging, Campus Bio-Medico University, Rome, Italy
| | - Rocco Damiano
- Unit of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
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13
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Mantica G, Balzarini F, Chierigo F, Keller EX, Talso M, Emiliani E, Pietropaolo A, Papalia R, Scarpa RM, Terrone C, Esperto F. The fight between PCNL, laparoscopic and robotic pyelolithotomy: do we have a winner? A systematic review and meta-analysis. Minerva Urol Nephrol 2022; 74:169-177. [PMID: 35147384 DOI: 10.23736/s2724-6051.21.04587-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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
INTRODUCTION The aim of this systematic review and meta-analysis is to provide an updated comparison between the currently available minimally invasive approaches (PCNL, laparoscopic [LP] and robotic pyelolithotomy [RP]) for the management of large renal stones. EVIDENCE ACQUISITION An electronic search of the current literature was conducted through the Medline and NCBI PubMed, Embase, Scopus and Cochrane Collaboration Central Register of Controlled Clinical Trials databases in March 2021. Studies about minimally-invasive treatment for kidney stones were considered. Inclusion criteria were: studies evaluating patients with large renal calculi (≥2 cm); the comparison of at least two of the three approaches (PCNL, LP, RP), reporting data suitable for meta-analysis evaluation. Patients with concomitant management for ureteropelvic junction obstruction (UPJ-O) were excluded. EVIDENCE SYNTHESIS Overall, 17 reports were considered for qualitative and quantitative synthesis, for a total cohort of 1079 patients, of which 534 with PCNL, 525 treated with LP, and 20 with RP. Of those, 16 compared PCNL with LP, while only 1 study compared LP with RP. PCNL mean operative time was statistically significantly shorter than LP and RP while mean estimated blood loss was statistically significantly higher for PNCL. No statistically significant differences were recorded among the three surgical approaches. Finally, PCNL demonstrated slightly, albeit statistically significant lower stone free rate when compared with LP. CONCLUSIONS PCNL, LP and RP may be safely and efficiently used to manage large renal stones. All three procedures showed reasonably low rate of complications with a satisfactory stone clearance rate.
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Affiliation(s)
- Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy.,European Society of Residents in Urology (ESRU)
| | - Federica Balzarini
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy -
| | - Francesco Chierigo
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Etienne X Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Young Academic Urologists (YAU) Urolithiasis & Endourology working party
| | - Michele Talso
- Young Academic Urologists (YAU) Urolithiasis & Endourology working party.,Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Esteban Emiliani
- Young Academic Urologists (YAU) Urolithiasis & Endourology working party.,Department of Urology, Endourology and Urolithiasis Unit, Fundacion Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Amelia Pietropaolo
- Young Academic Urologists (YAU) Urolithiasis & Endourology working party.,Department of Urology, University Hospital Southampton, Tremona Road, Southampton, UK
| | - Rocco Papalia
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Francesco Esperto
- European Society of Residents in Urology (ESRU).,Young Academic Urologists (YAU) Urolithiasis & Endourology working party.,Department of Urology, Campus Biomedico University of Rome, Rome, Italy
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14
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Esperto F, Pietropaolo A, Emiliani E, DE Conninck V, Tailly T, Keller EX, Talso M, Tonyali S, Sener ET, Zeeshan Hameed BM, Usai P, DI Paola V, Papalia R, Scarpa RM. From the Hippocratic oath to the stone center: how to deal with stone disease. Minerva Urol Nephrol 2021; 73:561-563. [PMID: 34847649 DOI: 10.23736/s2724-6051.21.04722-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy -
| | | | - Esteban Emiliani
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Etienne X Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michele Talso
- Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Senol Tonyali
- Department of Urology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Emre T Sener
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Paolo Usai
- Service of Urology, Portes de Provence Hospitals, Montelimar, France.,University of Cagliari, Cagliari, Italy
| | - Valerio DI Paola
- Department of Radiology, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Rocco Papalia
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
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15
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Marchioni M, DE Francesco P, Campi R, Carbonara U, Ferro M, Schips L, Gomez Rivas J, Papalia R, Scarpa RM, Esperto F. Current management of radiation cystitis after pelvic radiotherapy: a systematic review. Minerva Urol Nephrol 2021; 74:281-291. [PMID: 34714035 DOI: 10.23736/s2724-6051.21.04539-0] [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
INTRODUCTION We aimed to summarize current literature about radiation cystitis treatments, providing physician of a summary of current management options. EVIDENCE ACQUISITION A systematic literature review searching on PubMed (Medline), Scopus, and Web of Science databases was performed in March 2021. PRISMA guidelines were followed. Population consisted of patients with a diagnosis of radiation cystitis after pelvic radiotherapy (P). We focused our attention on different treatments, such as conservative or surgical one (I). Single or multiple arms studies were deemed eligible with no mandatory comparison (C). Main outcomes of interest were symptoms control and adverse events rates (O). EVIDENCE SYNTHESIS The search identified 1,194 records. Of all, four studies focused on the use of hyperbaric oxygen therapy showing complete response rates ranging from 52 to 87% approximately. Oral administration of cranberry compounds was investigated in one study showing no superiority to placebo. Intravesical instillation of different compounds were investigated in five studies showing the highest complete response rates after alum (60%) and formalin administration (75%). Endoscopic conservative surgical treatments (fibrin glue or vaporization) also showed 75% complete response rates. In patients who did not respond to conservative treatments robotic cystectomy is feasible with overall complication rates of about 59.3% at 90 days. CONCLUSIONS Radiotherapy induced cystitis is an under-reported condition after pelvic radiotherapy. Several treatments have been proposed, but in up to 10% of cases salvage cystectomy is necessary. A stepwise approach, with progressive treatment aggressiveness is recommended.
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Affiliation(s)
- Michele Marchioni
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. d'Annunzio University, Chieti, Italy -
| | - Piergustavo DE Francesco
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. d'Annunzio University, Chieti, Italy
| | - Riccardo Campi
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Umberto Carbonara
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Matteo Ferro
- Department of Urology, IRCSS European Institute of Oncology (IEO), Milan, Italy
| | - Luigi Schips
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. d'Annunzio University, Chieti, Italy
| | - Juan Gomez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
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16
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Fasanella D, Antonaci A, Esperto F, Scarpa RM, Ferro M, Schips L, Marchioni M. Potential prognostic value of miRNAs as biomarker for progression and recurrence after nephrectomy in renal cell carcinoma: a literature review. Diagnosis (Berl) 2021; 9:157-165. [PMID: 34674417 DOI: 10.1515/dx-2021-0080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/06/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES We provide a systematic literature review on tissue miRNAs in patients with RCC to evaluate and summarize their usefulness as prognostic markers. We undertook a systematic search for articles in English using the PubMed-Medline database from January 2010 to December 2020. Studies were identified and selected according to the PRISMA criteria and the PICO methodology. The population consisted of RCC patients undergoing nephrectomy and the main outcome of interest was recurrence-free survival (RFS). Only studies providing hazard ratios (HRs) from multivariate or univariate analyzes with corresponding 95% confidence intervals (CI) and/or area under the curve (AUC) were considered. CONTENT All nine included studies (1,541 patients) analyzed the relationship between tissue miRNA expression levels (up or downregulated) and RFS. Some of these found that the methylation status of miR-9-1, miR-9-3 and miR-124 was associated with a high risk of relapse. Moreover, miR-200b overexpression was associated with OS. MiR-210 overexpression indicated a shorter OS than those who were miR-210 negative. Finally, patients with high miR-125b expression had shorter CSS than those with low expression; similarly, patients with low miR-126 expression also had shorter CSS time. SUMMARY AND OUTLOOK Several studies tested the usefulness of specific miRNAs to predict RCC recurrence. Some of them showed a fair accuracy and strong relationship between specific miRNA over or under-expression and survival outcomes. However, results from these studies are preliminary and miRNAs use in routine clinical practice is still far to come.
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Affiliation(s)
- Daniela Fasanella
- Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio University of Chieti, Urology Unit, SS Annunziata Hospital, Chieti, Italy
| | - Alessio Antonaci
- Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio University of Chieti, Urology Unit, SS Annunziata Hospital, Chieti, Italy
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology-IRCCS, Milan, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio University of Chieti, Urology Unit, SS Annunziata Hospital, Chieti, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio University of Chieti, Urology Unit, SS Annunziata Hospital, Chieti, Italy
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17
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Ferro M, Del Giudice F, Carrieri G, Busetto GM, Cormio L, Hurle R, Contieri R, Arcaniolo D, Sciarra A, Maggi M, Porpiglia F, Manfredi M, Fiori C, Antonelli A, Tafuri A, Bove P, Terrone C, Borghesi M, Costantini E, Iliano E, Montanari E, Boeri L, Russo GI, Madonia M, Tedde A, Veccia A, Simeone C, Liguori G, Trombetta C, Brunocilla E, Schiavina R, Dal Moro F, Racioppi M, Vartolomei MD, Longo N, Spirito L, Crocetto F, Cantiello F, Damiano R, Di Stasi SM, Marchioni M, Schips L, Parma P, Carmignani L, Conti A, Soria F, Gontero P, Barone B, Deho F, Zaffuto E, Papalia R, Scarpa RM, Pagliarulo V, Lucarelli G, Ditonno P, Botticelli FMG, Musi G, Catellani M, de Cobelli O. The Impact of SARS-CoV-2 Pandemic on Time to Primary, Secondary Resection and Adjuvant Intravesical Therapy in Patients with High-Risk Non-Muscle Invasive Bladder Cancer: A Retrospective Multi-Institutional Cohort Analysis. Cancers (Basel) 2021; 13:cancers13215276. [PMID: 34771440 PMCID: PMC8582553 DOI: 10.3390/cancers13215276] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary The worldwide COVID-19 emergency has had an important impact on healthcare systems with the need to assist infected patients and also treat non-deferrable oncological conditions. In urology, the main concern has been for patients with bladder cancer, the tenth most common malignancy, where the quality and the alacrity of treatment has a clear well-demonstrated impact on the survivor. The aim of our Italian multi-institutional retrospective study was to assess the impact of the COVID-19 outbreak on diagnosis and treatment of non-muscle invasive bladder cancer. We observed a significant delay between diagnosis and surgical treatment, with a lower adherence to the standard therapeutic scheme such as BCG intravesical instillation and urological guidelines. We also recorded a different attitude in treatment depending on the patients’ location in Italy. Further investigation could show the impact of the pandemic on the survival of these patients. Abstract Background: To investigate the impact of COVID-19 outbreak on the diagnosis and treatment of non-muscle invasive bladder cancer (NMIBC). Methods: A retrospective analysis was performed using an Italian multi-institutional database of TURBT patients with high-risk urothelial NMIBC between January 2019 and February 2021, followed by Re-TURBT and/or adjuvant intravesical BCG. Results: A total of 2591 patients from 27 institutions with primary TURBT were included. Of these, 1534 (59.2%) and 1056 (40.8%) underwent TURBT before and during the COVID-19 outbreak, respectively. Time between diagnosis and TURBT was significantly longer during the COVID-19 period (65 vs. 52 days, p = 0.002). One thousand and sixty-six patients (41.1%) received Re-TURBT, 604 (56.7%) during the pre-COVID-19. The median time to secondary resection was significantly longer during the COVID-19 period (55 vs. 48 days, p < 0.0001). A total of 977 patients underwent adjuvant intravesical therapy after primary or secondary resection, with a similar distribution across the two groups (n = 453, 86% vs. n = 388, 86.2%). However, the proportion of the patients who underwent maintenance significantly differed (79.5% vs. 60.4%, p < 0.0001). Conclusions: The COVID-19 pandemic represented an unprecedented challenge to our health system. Our study did not show significant differences in TURBT quality. However, a delay in treatment schedule and disease management was observed. Investigation of the oncological impacts of those differences should be advocated.
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Affiliation(s)
- Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
- Correspondence:
| | - Francesco Del Giudice
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (F.D.G.); (A.S.); (M.M.)
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (G.C.); (G.M.B.); (L.C.)
| | - Gian Maria Busetto
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (G.C.); (G.M.B.); (L.C.)
| | - Luigi Cormio
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (G.C.); (G.M.B.); (L.C.)
| | - Rodolfo Hurle
- Department of Urology, Humanitas Research Hospital, IRCCS, 20089 Milan, Italy; (R.H.); (R.C.)
| | - Roberto Contieri
- Department of Urology, Humanitas Research Hospital, IRCCS, 20089 Milan, Italy; (R.H.); (R.C.)
| | - Davide Arcaniolo
- Unit of Urology, Luigi Vanvitelli University of Campania, 80138 Naples, Italy;
| | - Alessandro Sciarra
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (F.D.G.); (A.S.); (M.M.)
| | - Martina Maggi
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (F.D.G.); (A.S.); (M.M.)
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, 10043 Turin, Italy; (F.P.); (M.M.); (C.F.)
| | - Matteo Manfredi
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, 10043 Turin, Italy; (F.P.); (M.M.); (C.F.)
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, 10043 Turin, Italy; (F.P.); (M.M.); (C.F.)
| | - Alessandro Antonelli
- Department of Urology, Ospedale Civile Maggiore, Polo Chirurgico Confortini, University of Verona, 37126 Verona, Italy; (A.A.); (A.T.)
- Urology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Alessandro Tafuri
- Department of Urology, Ospedale Civile Maggiore, Polo Chirurgico Confortini, University of Verona, 37126 Verona, Italy; (A.A.); (A.T.)
- Urology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Pierluigi Bove
- Department of Urology, San Carlo di Nancy Hospital, Via Aurelia 275, 00165 Rome, Italy;
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, 16132 Genova, Italy; (C.T.); (M.B.)
| | - Marco Borghesi
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, 16132 Genova, Italy; (C.T.); (M.B.)
| | - Elisabetta Costantini
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, 05100 Terni, Italy; (E.C.); (E.I.)
| | - Ester Iliano
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, 05100 Terni, Italy; (E.C.); (E.I.)
| | - Emanuele Montanari
- Urology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (E.M.); (L.B.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Luca Boeri
- Urology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (E.M.); (L.B.)
| | | | - Massimo Madonia
- Urologic Clinic, Department of Clinical and Experimental Medicine, University of Sassari, 07100 Sassari, Italy; (M.M.); (A.T.)
| | - Alessandro Tedde
- Urologic Clinic, Department of Clinical and Experimental Medicine, University of Sassari, 07100 Sassari, Italy; (M.M.); (A.T.)
| | - Alessandro Veccia
- Division of Urology, VCU Health System, Richmond, VA 23298, USA;
- Urology Unit, ASST Spedali Civili Hospital, 25133 Brescia, Italy
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, 25121 Brescia, Italy;
| | - Claudio Simeone
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, 25121 Brescia, Italy;
| | - Giovanni Liguori
- Department of Urology, ASUITS, University of Trieste, 34149 Trieste, Italy; (G.L.); (C.T.)
| | - Carlo Trombetta
- Department of Urology, ASUITS, University of Trieste, 34149 Trieste, Italy; (G.L.); (C.T.)
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, S-Orsola-Malpighi Hospital, 40138 Bologna, Italy; (E.B.); (R.S.)
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, S-Orsola-Malpighi Hospital, 40138 Bologna, Italy; (E.B.); (R.S.)
| | - Fabrizio Dal Moro
- Urology Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, 35128 Padua, Italy;
| | - Marco Racioppi
- Urology Clinic, A. Gemelli Hospital Foundation, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy;
| | - Mihai Dorin Vartolomei
- Urology Department, Medical University of Vienna, A-1090 Vienna, Austria;
- IOSUD, Universitatea de Medicina Farmacie Stiinte si Tehnologie “George Emil Palade” din Targu Mures, 540142 Mureș, Romania
| | - Nicola Longo
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Lorenzo Spirito
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Felice Crocetto
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Francesco Cantiello
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Rocco Damiano
- Department of Urology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Savino M. Di Stasi
- Department of Surgery and Experimental Medicine, Tor Vergata University, 00133 Rome, Italy;
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, Urology Unit, “SS. Annunziata” Hospital, G. d’Annunzio University of Chieti, 66100 Chieti, Italy; (M.M.); (L.S.)
- Department of Urology, ASL Abruzzo 2, 65017 Chieti, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, Urology Unit, “SS. Annunziata” Hospital, G. d’Annunzio University of Chieti, 66100 Chieti, Italy; (M.M.); (L.S.)
- Department of Urology, ASL Abruzzo 2, 65017 Chieti, Italy
| | - Paolo Parma
- Urology Unit, Ospedale San Carlo Poma, 46100 Mantova, Italy;
| | - Luca Carmignani
- Department of Urology, San Donato Policlinic Hospital, 20094 Milan, Italy; (L.C.); (A.C.)
| | - Andrea Conti
- Department of Urology, San Donato Policlinic Hospital, 20094 Milan, Italy; (L.C.); (A.C.)
| | - Francesco Soria
- Department of Surgical Sciences, Division of Urology, San Giovanni Battista Hospital, University of Studies of Torino, 10121 Turin, Italy; (F.S.); (P.G.)
| | - Paolo Gontero
- Department of Surgical Sciences, Division of Urology, San Giovanni Battista Hospital, University of Studies of Torino, 10121 Turin, Italy; (F.S.); (P.G.)
| | - Biagio Barone
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Federico Deho
- Unit of Urology, ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, 21100 Varese, Italy; (F.D.); (E.Z.)
| | - Emanuele Zaffuto
- Unit of Urology, ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, 21100 Varese, Italy; (F.D.); (E.Z.)
| | - Rocco Papalia
- Department of Urology, Campus Biomedico University Hospital, 00198 Rome, Italy; (R.P.); (R.M.S.)
| | - Roberto M. Scarpa
- Department of Urology, Campus Biomedico University Hospital, 00198 Rome, Italy; (R.P.); (R.M.S.)
| | | | - Giuseppe Lucarelli
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (P.D.)
| | - Pasquale Ditonno
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (P.D.)
| | - Francesco Maria Gerardo Botticelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Michele Catellani
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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18
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Esperto F, Prata F, Antonelli A, Alloni R, Campanozzi L, Cataldo R, Civitella A, Fiori C, Ghilardi G, Guglielmelli E, Minervini A, Muto G, Rocco B, Sighinolfi C, Pang KH, Simone G, Tambone V, Tuzzolo P, Scarpa RM, Papalia R. Bioethical implications of robotic surgery in urology: a narrative review. Minerva Urol Nephrol 2021; 73:700-710. [PMID: 34308607 DOI: 10.23736/s2724-6051.21.04240-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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 Robotic technologies are being increasingly implemented in healthcare, including urology, holding promises for improving medicine worldwide. However, these new approaches raise ethical concerns for professionals, patients, researchers and institutions that need to be addressed. The aim of this review is to investigate the existing literature related to bioethical issues associated with robotic surgery in urology, in order to identify current challenges and make preliminary suggestions to ensure an ethical implementation of these technologies. METHODS We performed a narrative review of the pertaining literature through a systematic search of two databases (PubMed and Web of Science) in August 2020. RESULTS Our search yielded 76 articles for full-text evaluation and 48 articles were included in the narrative review. Several bioethical issues were identified and can be categorized into five main subjects: 1) robotic surgery accessibility; 2) safety; 3) gender gap; 4) costs and 5) learning curve. 1) Robotic surgery is expensive, and in some health systems may lead to inequality in healthcare access. In more affluent countries the national distribution of several robotic platforms may influence the centralization of robotic surgery, therefore potentially affecting oncological and functional outcomes in low-volume centers. 2) There is a considerable gap between surgical skills and patients' perception of competence, leading to ethical consequences on modern healthcare. Published incidence of adverse events during robotic surgery in large series is between 2% and 15%, which does not significantly differ amongst open or laparoscopic approaches. 3) No data about gap differences in accessibility to robotic platforms were retrieved from our search. 4) Robotic platforms are expensive but a key reason why hospitals are willing to absorb the high upfront costs is patient demand. It is possible to achieve cost-equivalence between open and robotic prostatectomy if the volume of centers is higher than 10 cases per week. 5) A validated, structured curriculum and accreditation has been created for robotic surgery. This allows acquisition and development of basic and complex robotic skills focusing on patient safety and short learning curve. CONCLUSIONS Tech-medicine is rapidly moving forward. Robotic approach to urology seems to be accessible in more affluent countries, safe, economically sustainable, and easy to learn with an appropriate learning curve for both sex. It is mandatory to keep maintaining a critical rational approach with constant control of the available evidence regarding efficacy, efficiency and safety.
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Affiliation(s)
- Francesco Esperto
- Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy -
| | - Francesco Prata
- Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy
| | | | - Rossana Alloni
- Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Laura Campanozzi
- Institute of Philosophy of Scientific and Technological Practice, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rita Cataldo
- Anesthesia and Intensive Care Section, Department of Anesthesia, Intensive Care and Pain Therapy, Campus Bio-Medico University of Rome, Rome, Italy
| | - Angelo Civitella
- Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Giampaolo Ghilardi
- Institute of Philosophy of Scientific and Technological Practice, Campus Bio-Medico University of Rome, Rome, Italy
| | - Eugenio Guglielmelli
- Laboratory of Biomedical Robotics and Biomicrosystems, Campus Bio-Medico University of Rome, Rome, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Giovanni Muto
- Department of Urology, Humanitas Gradenigo University, Turin, Italy
| | - Bernardo Rocco
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Sighinolfi
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Karl H Pang
- Academic Urology Unit, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy
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19
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Lonati C, Esperto F, Scarpa RM, Papalia R, Gómez Rivas J, Alvarez-Maestro M, Afferi L, Fankhauser CD, Mattei A, Colombo R, Montorsi F, Briganti A, Krajewski W, Carando R, Laukhtina E, Teoh JY, Zamboni S, Simeone C, Moschini M. Bladder perforation during transurethral resection of the bladder: a comprehensive algorithm for diagnosis, management and follow up. Minerva Urol Nephrol 2021; 74:570-580. [PMID: 34263743 DOI: 10.23736/s2724-6051.21.04436-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Despite bladder perforation (BP) is a frequent complication during transurethral resection of bladder (TURB) for bladder cancer (BCa), literature lacks systematic reviews focusing on this issue. We aimed to investigate incidence, diagnosis, therapy, and prognosis after BP during TURB for BCa; therapy was distinguished between conservative (without the need for bladder repair) and surgical management (requiring bladder wall closure). EVIDENCE ACQUISITION A systematic search was conducted up to April 2021 using PubMed, Scopus, Cochrane Database of Systematic Reviews, and Web of Science to identify articles focusing on incidence, detection, management, or survival outcomes after iatrogenic BP. The selection of articles followed the Preferred Reporting Items for Systematic Review and Meta-Analyses process. EVIDENCE SYNTHESIS We included 41 studies, involving 21,174 patients. Overall, 521 patients experienced BP during TURB for BCa, with a mean incidence of 2.4%, up to 58.3% when post-operative cystography is routinely performed after all TURB procedures. Risk factors were low body mass index (BMI) (p=0.01), resection depth (p=0.006 and p=0.03), and low surgical experience (p=0.006). Extraperitoneal BP (68.5%) were treated conservatively in 97.5% of patients; intraperitoneal BP were managed with surgical bladder closure in 56% of cases. Overall, three immediate BP-related deaths were recorded due to septic complications. Extravesical tumour seeding was observed after 6 intraperitoneal and 1 extraperitoneal BP (median time: 6.2 months). Intraperitoneal BP (p=0.0003) and bladder closure (p<0.001) were found as independent predictors of extravesical tumour recurrence. CONCLUSIONS BP is more frequent than expected when proper diagnosis is routinely performed after all TURB procedures. Risk factors include low BMI, resection depth, and unexperienced surgeon. The risk of sepsis after BP suggests empirical antibiotic prophylaxis after BP.
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Affiliation(s)
- Chiara Lonati
- Department of Urology, Spedali Civili of Brescia, Brescia, Italy - .,Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland -
| | - Francesco Esperto
- Department of Urology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Juan Gómez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | | | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Renzo Colombo
- Department of Urology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Department of Urology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Roberto Carando
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.,Clinica Luganese Moncucco, Lugano, Switzerland.,Clinica S.Anna, Swiss Medical Group, Sorengo, Switzerland.,Clinica Santa Chiara, Locarno, Switzerland
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Jeremy Y Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Stefania Zamboni
- Department of Urology, Spedali Civili of Brescia, Brescia, Italy
| | - Claudio Simeone
- Department of Urology, Spedali Civili of Brescia, Brescia, Italy
| | - Marco Moschini
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.,Department of Urology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
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20
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Campi R, Amparore D, Checcucci E, Claps F, Teoh JYC, Serni S, Scarpa RM, Porpiglia F, Carrion DM, Rivas JG, Loeb S, Cacciamani GE, Esperto F. Exploring the Residents' Perspective on Smart learning Modalities and Contents for Virtual Urology Education: Lesson Learned During the COVID-19 Pandemic. Actas Urol Esp 2021; 45:39-48. [PMID: 33168176 PMCID: PMC7486033 DOI: 10.1016/j.acuro.2020.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/22/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE The COVID-19 outbreak has substantially altered residents' training activities. While several new virtual learning programs have been recently implemented, the perspective of urology trainees regarding their usefulness still needs to be investigated. METHODS A cross-sectional, 30-item, web-based Survey was conducted through Twitter from April 4th, 2020 to April 18th, 2020, aiming to evaluate the urology residents' perspective on smart learning (SL) modalities (pre-recorded videos, webinars, podcasts, and social media [SoMe]), and contents (frontal lessons, clinical case discussions, updates on Guidelines and on clinical trials, surgical videos, Journal Clubs, and seminars on leadership and non-technical skills). RESULTS Overall, 501 urology residents from 58 countries completed the survey. Of these, 78.4, 78.2, 56.9 and 51.9% of them considered pre-recorded videos, interactive webinars, podcasts and SoMe highly useful modalities of smart learning, respectively. The contents considered as highly useful by the greatest proportion of residents were updates on guidelines (84.8%) and surgical videos (81.0%). In addition, 58.9 and 56.5% of responders deemed seminars on leadership and on non-technical skills highly useful smart learning contents. The three preferred combinations of smart learning modality and content were: pre-recorded surgical videos, interactive webinars on clinical cases, and pre-recorded videos on guidelines. CONCLUSION Our study provides the first global «big picture» of the smart learning modalities and contents that should be prioritized to optimize virtual Urology education. While this survey was conducted during the COVID-19 outbreak, our findings might have even more impact in the future.
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Affiliation(s)
- R Campi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; European Society of Residents in Urology (ESRU), Arnhem, the Netherlands.
| | - D Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - E Checcucci
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands; Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - F Claps
- Urological Clinic Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - J Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - S Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - R M Scarpa
- Department of Urology, Campus Biomedico, University of Rome, Rome, Italy
| | - F Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - D M Carrion
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands; Autonomous University of Madrid, Madrid, Spain; Department of Urology, La Paz University Hospital, Madrid, Spain
| | - J Gomez Rivas
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands; Department of Urology, La Paz University Hospital, Madrid, Spain
| | - S Loeb
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - G E Cacciamani
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - F Esperto
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands; Department of Urology, Campus Biomedico, University of Rome, Rome, Italy
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21
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Campi R, Sessa F, Corti F, Carrion DM, Mari A, Amparore D, Mir MC, Fiori C, Papalia R, Kutikov A, Volpe A, Capitanio U, Pierorazio PM, Scarpa RM, Porpiglia F, Minervini A, Serni S, Esperto F. Triggers for delayed intervention in patients with small renal masses undergoing active surveillance: a systematic review. MINERVA UROL NEFROL 2021; 72:389-407. [PMID: 32734748 DOI: 10.23736/s0393-2249.20.03870-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Patients with small renal masses (SRM) can be exposed to overdiagnosis and overtreatment. As such, active surveillance (AS) is recommended by all Guidelines for selected patients. However, it remains underutilized. One key reason is the lack of consensus on the factors prompting delayed intervention (DI). Herein we provide an updated overview of the triggers for DI in patients with SRMs initially undergoing AS. EVIDENCE ACQUISITION A systematic review of the English-language literature was performed according to the PRISMA statement recommendations using the MEDLINE, Cochrane Central Register of Controlled Trials and Web of Science databases. EVIDENCE SYNTHESIS Overall, 10 prospective studies including 1870 patients were included. Median patient age ranged between 64 and 75 years, while median tumor size between 1.7 cm to 2.3 cm. The proportion of cystic SRMs ranged from 0% to 30%. Baseline renal tumor biopsy was performed in 7-45.2% of patients. Among these, malignant histology was found in 28.5%-83.3% of cases. Overall, the median growth rate of SRMs ranged between 0.10 and 0.27 cm/year. The proportion of patients undergoing DI ranged between 7% and 44%, after a median AS period of 12-27 months. The most commonly performed type of DI was surgery. Of resected SRMs, 0% to 30% were benign. The actual triggers for DI were either tumor-related (renal mass growth, stage progression, development of local complications/symptoms) or patient-related (patient preference, improved medical conditions, or qualification for other surgical procedures). At a median follow-up of 21.7 - 57-6 months, the proportion of patients experiencing metastatic disease, cancer-specific and other-cause mortality was 0-3.1%, 0-4% and 0-45.6%, respectively. CONCLUSIONS The available evidence shows that both tumor-related and patient-related factors are ultimate triggers for DI in patients with SRMs undergoing AS. However, the level of evidence is still low and further research is needed to individualize AS strategies according to both tumor biology and patient-related characteristics and values.
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Affiliation(s)
- Riccardo Campi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy - .,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy - .,European Society of Residents in Urology (ESRU), Arnhem, the Netherlands -
| | - Francesco Sessa
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Corti
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Diego M Carrion
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands.,Department of Urology, La Paz University Hospital, Autonomous University of Madrid, Madrid, Spain
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Maria C Mir
- Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Alexander Kutikov
- Division of Urology and Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Umberto Capitanio
- Division of Experimental Oncology, Unit of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Phillip M Pierorazio
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Esperto
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands.,Department of Urology, Campus Bio-Medico University, Rome, Italy
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22
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Greco F, Marchioni M, Esperto F, Papalia R, Schips L, Scarpa RM. How Targeted Therapy Influence Renal Surgery for Renal Cell Carcinoma. Curr Drug Targets 2020; 21:1550-1557. [PMID: 32621715 DOI: 10.2174/1389450121666200704150933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/11/2020] [Accepted: 05/18/2020] [Indexed: 11/22/2022]
Abstract
Between the end of 2005 and the beginning of 2006, several new target therapies have been introduced for the treatment of renal cell carcinoma. In this review, we aimed to explore and summarize the main findings of the use of systemic treatment and its effect on surgery in patients with renal cell carcinoma. We identified three different settings: neoadjuvant and adjuvant settings as well as the association of systemic therapy with surgery in the metastatic renal cell carcinoma patients. Neoadjuvant target therapy with tyrosine kinase inhibitor may facilitate the tumor resection and reduce the overall tumor diameter and its complexity. However, most of the evidence is from small phase I or II clinical trials and results are often conflicting without determining a relevant change in the main parameters investigated, such as tumor complexity. In the adjuvant setting, results from pivotal trials investigating the use of tyrosine kinase inhibitors for patients with non-metastatic RCC treated with surgery discourage this practice. Indeed, most of the evidence from single clinical trials and pooled results from meta-analysis failed to find a survival advantage with the use of adjuvant systemic treatment. To date, an improvement of clinical outcomes after systemic targeted therapies could be only found in the setting of cytoreductive nephrectomy. However, the CARMENA and SURTIME trials recently confirmed the evidence against a surgical treatment in patients with mRCC and poor prognosis. In the near future, significant changes may be introduced by the use of immunotherapies.
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Affiliation(s)
- Francesco Greco
- Department of Urology, Humanitas Gavazzeni, Bergamo, Italy,School of Medicine and Surgery, Humanitas University, Milan, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University of Chieti, "SS. Annunziata" Hospital, Urology Unit, Chieti, Italy
| | - Francesco Esperto
- Department of Urology, Campus Biomedico, University of Rome, Rome, Italy
| | - Rocco Papalia
- Department of Urology, Campus Biomedico, University of Rome, Rome, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University of Chieti, "SS. Annunziata" Hospital, Urology Unit, Chieti, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Biomedico, University of Rome, Rome, Italy
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23
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Porpiglia F, Amparore D, Checcucci E, Fiori C, Artibani W, Scarpa RM. The revolution of congress meetings and scientific events: how to navigate among their heterogeneous modalities? Minerva Urol Nephrol 2020; 73:3-5. [PMID: 33034431 DOI: 10.23736/s2724-6051.20.04177-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.,Uro-technology and SoMe Working Group of the Young Academic Urologists (YAU), Working Party of the European Association of Urology (EAU), Arnhem, the Netherlands
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Walter Artibani
- Department of Urology, Polyclinic of Abano Terme, Abano Terme, Padua, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University Hospital, Rome, Italy
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24
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Porpiglia F, Amparore D, Checcucci E, Fiori C, Artibani W, Scarpa RM. The revolution of congress meetings and scientific events: how to navigate among their heterogeneous modalities? Minerva Urol Nephrol 2020. [PMID: 33034431 DOI: 10.23736/s0393-2249.20.04177-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.,Uro-technology and SoMe Working Group of the Young Academic Urologists (YAU), Working Party of the European Association of Urology (EAU), Arnhem, the Netherlands
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Walter Artibani
- Department of Urology, Polyclinic of Abano Terme, Abano Terme, Padua, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University Hospital, Rome, Italy
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25
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Keller EX, DE Coninck V, Proietti S, Talso M, Emiliani E, Ploumidis A, Mantica G, Somani B, Traxer O, Scarpa RM, Esperto F. Prone versus supine percutaneous nephrolithotomy: a systematic review and meta-analysis of current literature. Minerva Urol Nephrol 2020; 73:50-58. [PMID: 33016031 DOI: 10.23736/s2724-6051.20.03960-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PNL) can be performed either in prone or supine position. This study aimed at gathering together randomized controlled trials (RCTs) comparing efficacy and safety between prone and supine PNL. EVIDENCE ACQUISITION Systematic review of literature was conducted using the Scopus, Medline and Web of Science databases. Study selection, data extraction and quality assessment were independently assessed by two authors. Meta-analysis was performed with Review Manager 5.3. Sensitivity analyses were performed to exclude studies with high risk of bias. EVIDENCE SYNTHESIS Pooled data from 12 studies including 1290 patients were available for analysis. Only one study was found to have overall low risk of bias. Significantly shorter operative time was found in favor of supine PNL (mean difference 13 minutes, 95% confidence interval [CI]: 3.4-22.7; P<0.01). Stone-free rate (SFR)≥14 days after surgery was significantly higher in prone PNL (odds ratio [OR]=2.15, 95% CI: 1.07-4.34; P=0.03). Significantly higher fever rate was found in prone PNL (OR=1.60, 95% CI: 1.03-2.47; P=0.04). Overall SFR, hospital stay length, complications rate, transfusions rate and blood loss, as well as non-lower calyx puncture rate, puncture attempts and tubeless intervention rate did not differ between prone and supine PNL (P>0.05). CONCLUSIONS Efficacy of PNL seems balanced between prone and supine position, with comparable overall SFR and shorter operative time in favor of supine PNL. Safety of PNL appears in favor of supine PNL, with lower fever rate. Because of study heterogeneity and possible risks of outcome bias, results from this study should be interpreted with caution. Altogether, both prone and supine PNL account for appropriate therapy options.
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Affiliation(s)
- Etienne X Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland -
| | | | - Silvia Proietti
- Department of Urology, Ville Turro Division, European Training Center for Endourology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michele Talso
- Department of Urology, Hospital of Vimercate, Vimercate, Monza-Brianza, Italy
| | - Esteban Emiliani
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Guglielmo Mantica
- Department of Urology, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Bhaskar Somani
- University Hospital Southampton NHS Trust, University of Southampton, Southampton, UK
| | - Olivier Traxer
- Department of Urology, Sorbonne University, GRC N. 20 Lithiase Urinaire, Hospital Tenon AP-HP, Paris, France
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
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26
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Keller EX, DE Coninck V, Proietti S, Talso M, Emiliani E, Ploumidis A, Mantica G, Somani B, Traxer O, Scarpa RM, Esperto F. Prone versus supine percutaneous nephrolithotomy: a systematic review and meta-analysis of current literature. Minerva Urol Nephrol 2020. [PMID: 33016031 DOI: 10.23736/s0393-2249.20.03960-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PNL) can be performed either in prone or supine position. This study aimed at gathering together randomized controlled trials (RCTs) comparing efficacy and safety between prone and supine PNL. EVIDENCE ACQUISITION Systematic review of literature was conducted using the Scopus, Medline and Web of Science databases. Study selection, data extraction and quality assessment were independently assessed by two authors. Meta-analysis was performed with Review Manager 5.3. Sensitivity analyses were performed to exclude studies with high risk of bias. EVIDENCE SYNTHESIS Pooled data from 12 studies including 1290 patients were available for analysis. Only one study was found to have overall low risk of bias. Significantly shorter operative time was found in favor of supine PNL (mean difference 13 minutes, 95% confidence interval [CI]: 3.4-22.7; P<0.01). Stone-free rate (SFR)≥14 days after surgery was significantly higher in prone PNL (odds ratio [OR]=2.15, 95% CI: 1.07-4.34; P=0.03). Significantly higher fever rate was found in prone PNL (OR=1.60, 95% CI: 1.03-2.47; P=0.04). Overall SFR, hospital stay length, complications rate, transfusions rate and blood loss, as well as non-lower calyx puncture rate, puncture attempts and tubeless intervention rate did not differ between prone and supine PNL (P>0.05). CONCLUSIONS Efficacy of PNL seems balanced between prone and supine position, with comparable overall SFR and shorter operative time in favor of supine PNL. Safety of PNL appears in favor of supine PNL, with lower fever rate. Because of study heterogeneity and possible risks of outcome bias, results from this study should be interpreted with caution. Altogether, both prone and supine PNL account for appropriate therapy options.
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Affiliation(s)
- Etienne X Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland -
| | | | - Silvia Proietti
- Department of Urology, Ville Turro Division, European Training Center for Endourology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michele Talso
- Department of Urology, Hospital of Vimercate, Vimercate, Monza-Brianza, Italy
| | - Esteban Emiliani
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Guglielmo Mantica
- Department of Urology, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Bhaskar Somani
- University Hospital Southampton NHS Trust, University of Southampton, Southampton, UK
| | - Olivier Traxer
- Department of Urology, Sorbonne University, GRC N. 20 Lithiase Urinaire, Hospital Tenon AP-HP, Paris, France
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
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27
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Miura N, Pradere B, Mori K, Mostafaei H, Quhal F, Misrai V, D'Andrea D, Albisinni S, Papalia R, Saika T, Scarpa RM, Shariat SF, Esperto F. Metastasis-directed therapy and prostate-targeted therapy in oligometastatic prostate cancer: a systematic review. MINERVA UROL NEFROL 2020; 72:531-542. [PMID: 32550632 DOI: 10.23736/s0393-2249.20.03779-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The aim of this review was to summarize the available evidence on the role of metastasis-directed therapy (MDT) and/or prostate-targeted therapy (PTT) in the setting of oligometastatic prostate cancer (PCa). EVIDENCE ACQUISITION We searched PubMed, the Web of Science, and the Cochrane Library databases. The following keywords were used: ("prostate cancer" OR "prostate carcinoma" OR "prostate neoplasm" OR "prostate tumor") AND ("oligometastatic" OR "oligometastasis" OR "PSMA") AND ("surgery" OR "prostatectomy" OR "radical prostatectomy" OR "cytoreductive" OR "local treatment" OR "radiotherapy" OR "stereotactic" OR "stereotaxic") AND ("survival" OR "mortality"). EVIDENCE SYNTHESIS After evaluating the selection criteria, 81 studies were evaluated for our endpoints. We included 22 studies for PTT of synchronous mPCa. There have been no randomized studies on cytoreductive prostatectomy (cRP). Four prospective studies showed that cRP was feasible but did not contribute to a positive effect on overall survival (OS). Regarding PTT-radiotherapy, two randomized controlled phase 3 trials showed that OS was improved in men with a low metastatic burden. Regarding MDT of metachronous lymph node recurrence, we included 29 retrospective studies. For MDT of oligometastases, we included 30 studies. One randomized phase 2 trial showed that androgen deprivation therapy-free survival improved with stereotactic body radiation therapy compared to that with surveillance; however, benefits on OS remain unclear. CONCLUSIONS We performed a comprehensive overview of the current literature on MDT and PTT. The feasibility of MDT and PTT is supported by several retrospective studies. Nevertheless, there remains a lack of high-quality trials to prove its survival benefits. Results from ongoing prospective trials data are awaited.
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Affiliation(s)
- Noriyoshi Miura
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria -
- Department of Urology, Ehime University Graduate School of Medicine, Ehime, Japan -
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University Hospital of Tours, Tours, France
- EAU Young Urologist Office (YOU), Arnhem, the Netherlands
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Simone Albisinni
- Department of Urology, Erasme Hospital, University Clinics of Brussels, University of Brussels, Brussels, Belgium
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Takashi Saika
- Department of Urology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Urology, University of Jordan, Amman, Jordan
- European Association of Urology Research Foundation, Arnhem, the Netherlands
| | - Francesco Esperto
- EAU Young Urologist Office (YOU), Arnhem, the Netherlands
- Department of Urology, Campus Bio-Medico University, Rome, Italy
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands
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28
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Marchioni M, De Francesco P, Castellucci R, Papalia R, Sarikaya S, Gomez Rivas J, Schips L, Scarpa RM, Esperto F. Management of erectile dysfunction following robot-assisted radical prostatectomy: a systematic review. MINERVA UROL NEFROL 2020; 72:543-554. [PMID: 32748616 DOI: 10.23736/s0393-2249.20.03780-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION We aimed to summarize evidences about the efficacy of available treatments for erectile disfunction after robotic assisted radical prostatectomy (RARP). EVIDENCE ACQUISITION A systematic literature review searching on PubMed (Medline), Scopus, and Web of Science databases was performed in December 2019. PRISMA guidelines were followed. Population consisted of patients with erectile disfunction after RARP (P), conservative and surgical intervention were considered of interest (I). No comparator was considered mandatory (C). Outcomes of interest were the recovery of erectile function after conservative treatments and sexual function after surgical treatments (O). EVIDENCE SYNTHESIS Eleven studies were included. Seven studies focused on the use of phosphodiesterase-5 inhibitors (PDE5i) alone (five studies) or associated with other treatments (two studies). All the studies confirmed the efficacy of PDE5i, while the most promising association is with vacuum pump erectile devices. Two studies investigated topical treatments, namely low intensity extracorporeal shock wave therapy and alprostadil. Low intensity extracorporeal shock wave therapy may be a promising option in patients in whom nerve-sparing surgery was performed. The use of alprostadil could be an effective alternative to intracorporeal injection in those who underwent non-nerve-sparing surgery. One study focused and confirmed the efficacy of penile implants. Furthermore, one study reported the efficacy of a multi-modal treatment with preoperative medication, showing the benefits of a multimodal approach. CONCLUSIONS Penile rehabilitation with PDE5i is effective after nerve sparing RARP. The association of PDE5i with vacuum devices could led to a faster recovery. A multimodal approach with preoperative specific care seems to be effective to fasten erectile function recovery.
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Affiliation(s)
- Michele Marchioni
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. d'Annunzio University, Chieti, Italy - .,Department of Urology, ASL Abruzzo 2, Chieti, Italy - .,European Associations of Urology-European Society of Residents in Urology (EAU-ESRU) -
| | | | | | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Selçuk Sarikaya
- European Associations of Urology-European Society of Residents in Urology (EAU-ESRU).,Department of Urology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Juan Gomez Rivas
- European Associations of Urology-European Society of Residents in Urology (EAU-ESRU).,Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Luigi Schips
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. d'Annunzio University, Chieti, Italy.,Department of Urology, ASL Abruzzo 2, Chieti, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Francesco Esperto
- European Associations of Urology-European Society of Residents in Urology (EAU-ESRU).,Department of Urology, Campus Bio-Medico University, Rome, Italy
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Abstract
The COVID-19 pandemic has impacted our lives, our habits and our healthcare system. Italy is one of the countries affected first and more aggressively from the outbreak. Our rapidity has been guide for other healthcare systems from around the World. We describe the impact of COVID-19 on Urology, how the Urological scientific community responded to the emergency and our experience in a high-volume Roman University hospital. The aim of our work is to share our experience providing suggestions for other global hospitals on how to manage the COVID-19 emergency.
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Affiliation(s)
- Francesco Esperto
- University of RomeCampus Bio-medicoDepartment of UrologyRomeItalyDepartment of Urology, Campus Bio-medico, University of Rome, Rome, Italy
| | - Rocco Papalia
- University of RomeCampus Bio-medicoDepartment of UrologyRomeItalyDepartment of Urology, Campus Bio-medico, University of Rome, Rome, Italy
| | - Ana María Autrán-Gómez
- University Hospital Fundación Jiménez DíazDepartment of UrologyMadridSpainDepartment of Urology University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Roberto M. Scarpa
- University of RomeCampus Bio-medicoDepartment of UrologyRomeItalyDepartment of Urology, Campus Bio-medico, University of Rome, Rome, Italy
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30
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Abstract
The COVID-19 outbreak has led to the deferral of a great number of surgeries in an attempt to reduce transmission of infection, free up hospital beds, intensive care and anaesthetists, and limit aerosol-generating procedures. Guidelines and suggestions have been provided to categorize Urological diseases into risk groups and recommendations are available on procedures that can be or cannot be deferred. We aim to summarise updates on diagnosis, treatment and follow up of bladder cancer during the COVID-19 outbreaks.
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Affiliation(s)
- Francesco Esperto
- Campus Bio-Medico University of RomeDepartment of UrologyRomeItalyDepartment of Urology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Karl H. Pang
- University of SheffieldAcademic Urology UnitSheffieldUnited Kingdom, UKAcademic Urology Unit, University of Sheffield, Sheffield, United Kingdom, UK
| | - Simone Albisinni
- Université Libre de BruxellesUniversity Clinics of BrusselsDepartment of UrologyBrusselsBelgiumDepartment of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Rocco Papalia
- Campus Bio-Medico University of RomeDepartment of UrologyRomeItalyDepartment of Urology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Roberto M. Scarpa
- Campus Bio-Medico University of RomeDepartment of UrologyRomeItalyDepartment of Urology, Campus Bio-Medico University of Rome, Rome, Italy
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31
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Esperto F, Prata F, Civitella A, Pang KH, Marchioni M, Tuzzolo P, Scarpa RM, Papalia R. Implementation and strategies to ensure adequate coordination within a Urology Department during the COVID-19 pandemic. Int Braz J Urol 2020; 46:170-180. [PMID: 32649082 PMCID: PMC7719985 DOI: 10.1590/s1677-5538.ibju.2020.s122] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/10/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE to provide an update on the management of a Urology Department during the COVID-19 outbreak, suggesting strategies to optimize assistance to the patients, to implement telemedicine and triage protocols, to define pathways for hospital access, to reduce risk of contagious inside the hospital and to determine the role of residents during the pandemic. MATERIALS AND METHODS In May the 6th 2020 we performed a review of the literature through online search engines (PubMed, Web of Science and Science Direct). We looked at recommendations provided by the EAU and ERUS regarding the management of urological patients during the COVID-19 pandemic. The main aspects of interest were: the definition of deferrable and non-deferrable procedures, Personal Protective Equipment (PPE) and hospital protocols for health care providers, triage, hospitalization and surgery, post-operative care training and residents' activity. A narrative summary of guidelines and current literature for each point of interest was performed. CONCLUSION In the actual Covid-19 scenario, while the number of positive patients globally keep on rising, it is fundamental to embrace a new way to deliver healthcare and to overcome challenges of physical distancing and self-isolation. The use of appropriate PPE, definite pathways to access the hospital, the implementation of telemedicine protocols can represent effective strategies to carry on delivering healthcare.
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Affiliation(s)
- Francesco Esperto
- Campus Bio-Medico University of RomeDepartment of UrologyRomeItalyDepartment of Urology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Francesco Prata
- Campus Bio-Medico University of RomeDepartment of UrologyRomeItalyDepartment of Urology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Angelo Civitella
- Campus Bio-Medico University of RomeDepartment of UrologyRomeItalyDepartment of Urology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Karl H. Pang
- University of SheffieldDepartment of OncologySheffieldUnited Kingdom, UKDepartment of Oncology University of Sheffield, Sheffield, United Kingdom, UK
- University of SheffieldDepartment of MetabolismSheffieldUnited Kingdom, UKDepartment of Metabolism, University of Sheffield, Sheffield, United Kingdom, UK
| | - Michele Marchioni
- University of ChietiDepartment of Medical Oral and Biotechnological Sciences “G D'Annunzio”ItalyDepartment of Medical Oral and Biotechnological Sciences “G D'Annunzio” University of Chieti. Urology Unit SS Annunziata Hospital Chieti, Italy
| | - Piergiorgio Tuzzolo
- Campus Bio-Medico University of RomeDepartment of UrologyRomeItalyDepartment of Urology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Roberto M. Scarpa
- Campus Bio-Medico University of RomeDepartment of UrologyRomeItalyDepartment of Urology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rocco Papalia
- Campus Bio-Medico University of RomeDepartment of UrologyRomeItalyDepartment of Urology, Campus Bio-Medico University of Rome, Rome, Italy
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32
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Papalia R, Cataldo R, Alloni R, Pang KH, Alcini A, Flammia G, Salerno A, Notarangelo MG, Angeletti S, Venditti A, Sommella L, Scarpa RM, Esperto F. Urologic surgery in a safe hospital during the COVID-19 pandemic scenario. Minerva Urol Nephrol 2020; 73:384-391. [PMID: 32573174 DOI: 10.23736/s2724-6051.20.03923-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The COVID-19 pandemic induced a global emergency that overwhelmed most hospitals around the world. Access to hospitals has been restricted to selective oncological and urgent patients to minimize surgeries requiring Intensive Care Unit care. All other kind of non-urgent and benign surgeries have been rescheduled. The burden of oncological and urgent cases on the healthcare system has increased. METHODS We have been asked to become the referral center for major oncological and urgent urological surgeries, increasing our surgical volume. Through meticulous hospital protocols on PPE, use of nasopharyngeal swabs, controlled hospital access and the prompt management of suspected/positive cases, we were able to perform 31% more urological surgical procedures during the COVID-19 pandemic compared to the same period in 2019. RESULTS We observed a 72% increase in oncological surgical procedures and 150% in urgent procedures. CONCLUSIONS Our experience shows how the management of oncological and urgent cases can be maintained during unexpected, global emergencies, such as COVID-19.
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Affiliation(s)
- Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Rita Cataldo
- Unit of Anesthesiology, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Rossana Alloni
- Clinical Direction, Campus Bio-Medico University, Rome, Italy
| | - Karl H Pang
- Unit of Academic Urology, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Antonio Alcini
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Gerardo Flammia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | | | | | - Silvia Angeletti
- Unit of Clinical Laboratory Science, Campus Bio-Medico University, Rome, Italy
| | | | | | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
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Papalia R, Cataldo R, Alloni R, Pang KH, Alcini A, Flammia G, Salerno A, Notarangelo MG, Angeletti S, Venditti A, Sommella L, Scarpa RM, Esperto F. Urologic surgery in a safe hospital during the COVID-19 pandemic scenario. Minerva Urol Nephrol 2020. [PMID: 32573174 DOI: 10.23736/s0393-2249.20.03923-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The COVID-19 pandemic induced a global emergency that overwhelmed most hospitals around the world. Access to hospitals has been restricted to selective oncological and urgent patients to minimize surgeries requiring Intensive Care Unit care. All other kind of non-urgent and benign surgeries have been rescheduled. The burden of oncological and urgent cases on the healthcare system has increased. METHODS We have been asked to become the referral center for major oncological and urgent urological surgeries, increasing our surgical volume. Through meticulous hospital protocols on PPE, use of nasopharyngeal swabs, controlled hospital access and the prompt management of suspected/positive cases, we were able to perform 31% more urological surgical procedures during the COVID-19 pandemic compared to the same period in 2019. RESULTS We observed a 72% increase in oncological surgical procedures and 150% in urgent procedures. CONCLUSIONS Our experience shows how the management of oncological and urgent cases can be maintained during unexpected, global emergencies, such as COVID-19.
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Affiliation(s)
- Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Rita Cataldo
- Unit of Anesthesiology, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Rossana Alloni
- Clinical Direction, Campus Bio-Medico University, Rome, Italy
| | - Karl H Pang
- Unit of Academic Urology, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Antonio Alcini
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Gerardo Flammia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | | | | | - Silvia Angeletti
- Unit of Clinical Laboratory Science, Campus Bio-Medico University, Rome, Italy
| | | | | | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
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Carrion DM, Rodríguez-Socarrás ME, Mantica G, Pang KH, Esperto F, Mattigk A, Duijvesz D, Vásquez JL, Díez Sebastián J, Scarpa RM, Papalia R, Palou J, Gómez Rivas J. Interest and involvement of European urology residents in academic and research activities. An ESRU-ESU-ESUT collaborative study. MINERVA UROL NEFROL 2020; 72:384-387. [DOI: 10.23736/s0393-2249.20.03734-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Affiliation(s)
- Francesco Esperto
- Department of Urology, Campus Bio-Medico, University of Rome, Rome, Italy -
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Karl H Pang
- Unit of Academic Urology, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Rita Cataldo
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico, University of Rome, Rome, Italy
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Marchioni M, Primiceri G, Castellan P, Schips L, Mantica G, Chapple C, Papalia R, Porpiglia F, Scarpa RM, Esperto F. Conservative management of urinary incontinence following robot-assisted radical prostatectomy. MINERVA UROL NEFROL 2020; 72:555-562. [PMID: 32432436 DOI: 10.23736/s0393-2249.20.03782-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Robotic assisted radical prostatectomy (RARP) is getting more and more popular becoming the most common radical prostatectomy technique. Unfortunately, a not negligible proportion of patients in whom RARP is performed experience urinary incontinence. We aimed to systematically review the current literature evidence on urinary incontinence conservative treatment after RARP. EDIDENCE AQUISITION A systematic literature review search using PubMed (Medline), Scopus, and Web of Science databases was performed in December 2019. PRISMA guidelines have been adopted. Population consisted of patients with urinary incontinence after RARP (P), conservative intervention was considered of interest (I). No comparator was considered mandatory (C). Outcomes of interest were the recovery of continence and quality of life (O). EVIDEDENCE SYNTHESIS Six studies were included. Four of them investigated the use of pelvic floor muscle training (PFMT). PFMT improved pelvic muscle strength. Continence recovery was faster when guided PFMT was adopted. Moreover, two studies tested the effect of solifenacin on urinary incontinence. One of them, a randomized clinical trial, failed to show shorter time to continence in solifenacin group compared to placebo. CONCLUSIONS The use of pads is associated with a detrimental effect on quality of life thus active treatments for UI post-RARP are warranted. PFMT has the main advantage to shorten the time for recovery. The use of solifenacin seems to not offer striking advantages in UI following RARP. Future studies should focus on testing the efficacy of these treatments when used after robotic vs. open radical prostatectomy.
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Affiliation(s)
- Michele Marchioni
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. d'Annunzio University, Chieti, Italy - .,Department of Urology, ASL Abruzzo 2, Chieti, Italy - .,European Association of Urology - European Society of Residents in Urology (EAU-ESRU) -
| | - Giulia Primiceri
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. d'Annunzio University, Chieti, Italy
| | | | - Luigi Schips
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. d'Annunzio University, Chieti, Italy.,Department of Urology, ASL Abruzzo 2, Chieti, Italy
| | - Guglielmo Mantica
- European Association of Urology - European Society of Residents in Urology (EAU-ESRU).,Department of Urology, San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy
| | - Christopher Chapple
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Francesco Esperto
- European Association of Urology - European Society of Residents in Urology (EAU-ESRU).,Department of Urology, Campus Bio-Medico University, Rome, Italy
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Afferi L, Moschini M, Cumberbatch MG, Catto JW, Scarpa RM, Porpiglia F, Mattei A, Sanchez-Salas R, Esperto F. Biomarkers predicting oncological outcomes of high-risk non-muscle-invasive bladder cancer. MINERVA UROL NEFROL 2020; 72:265-278. [PMID: 32298067 DOI: 10.23736/s0393-2249.20.03786-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The European Organization for Research and Treatment of Cancer (EORTC) and the Spanish Urological Club for Oncological Treatment (CUETO) scoring systems show limited accuracy for the prediction of disease recurrence and progression of non-muscle-invasive bladder cancer (NMIBC). This aspect is even more relevant in the category of HR NMIBC. Biomarkers might potentially help to further categorize the outcomes of these patients. Therefore, we sought to review the evidence available on tissue-based, urinary, and serum biomarkers for the prediction of recurrence, progression, and survival in HR NMIBC. EVIDENCE ACQUISITION A systematic literature review without time restrictions was performed using PubMed/EMBASE, Web of Science, SCOPUS, and the Cochrane Libraries. The search was filtered for articles in the English, Italian, German, French, and Spanish languages, involving patients with more than 18 years of age. Relevant papers on tissue-based, serum and urinary biomarkers related to the prediction of oncological outcomes for high-risk bladder cancer patients were included in the analyses. EVIDENCE SYNTHESIS Overall, 71 studies were eligible for inclusion in this review. The majority of the investigations performed so far focused on immunohistochemical analyses on tumoral tissue. Overall, p53 was the most studied biomarker, but results regarding its prognostic and predictive role were contradictory. Ki67 seems to be a promising biomarker in the prediction of recurrence. Recently, PD-L1 has been associated with the prediction of recurrence free survival and of treatment-refractory disease. Markers developed un urine samples are focused on commercially available kits, which currently do not unequivocally show strongly superior levels of accuracy to cytology. However, they have demonstrated to be potentially helpful in the prediction of recurrence. Blood-based biomarkers represent an emerging reality with promising future applications. CONCLUSIONS Despite a long history of attempts to discover accurate biomarkers predicting oncological outcomes for HR NMIBC, contradictory or uncertain findings render the adoption of this ancillary techniques in clinical practice still unlikely. Future attempts should be directed to the development of prospective trials and the definition of standardized cut-off levels to render findings worthy of comparison.
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Affiliation(s)
- Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Marco Moschini
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland - .,Department of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - James W Catto
- Unit of Academic Urology, University of Sheffield, Sheffield, UK
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Francesco Porpiglia
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris and Universitè Paris Descartes, Paris, France
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Ficarra V, Novara G, Abrate A, Bartoletti R, Crestani A, De Nunzio C, Giannarini G, Gregori A, Liguori G, Mirone V, Pavan N, Scarpa RM, Simonato A, Trombetta C, Tubaro A, Porpiglia F. Urology practice during the COVID-19 pandemic. MINERVA UROL NEFROL 2020; 72:369-375. [PMID: 32202401 DOI: 10.23736/s0393-2249.20.03846-1] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 and the disease it causes, coronavirus disease 2019 (COVID-19) is generating a rapid and tragic health emergency in Italy due to the need to provide assistance to an overwhelming number of infected patients and, at the same time, treat all the non-deferrable oncological and benign conditions. A panel of Italian urologists has agreed on possible strategies for the reorganization of urological routine practice and on a set of recommendations that should facilitate the process of rescheduling both surgical and outpatient activities during the COVID-19 pandemic and in the subsequent phases. This document could be a valid tool to be used in routine clinical practice and, possibly, a cornerstone for further discussion on the topic also considering the further evolution of the COVID-19 pandemic. It also may provide useful recommendations for national and international urological societies in a condition of emergency.
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Affiliation(s)
- Vincenzo Ficarra
- Section of Urology, Department of Human and Pediatric Pathology Gaetano Barresi, University of Messina, Messina, Italy -
| | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | - Alberto Abrate
- Section of Urology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Riccardo Bartoletti
- Unit of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | | | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Gianluca Giannarini
- Unit of Urology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy
| | - Andrea Gregori
- Unit of Urology, ASST Fatebenefratelli-Sacco, Sacco Hospital, Milan, Italy
| | - Giovanni Liguori
- Department of Urology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Vincenzo Mirone
- Department of Urology, Federico II University of Naples, Naples, Italy
| | - Nicola Pavan
- Department of Urology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Alchiede Simonato
- Section of Urology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.,Urology Unit, Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
| | - Carlo Trombetta
- Department of Urology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
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DE Luca S, Amante E, Fiori C, Alleva G, Alladio E, Marini F, Garrou D, Manfredi M, Amparore D, Checcucci E, Pruner S, Salomone A, Scarpa RM, Vincenti M, Porpiglia F. Prospective evaluation of urinary steroids and prostate carcinoma-induced deviation: preliminary results. Minerva Urol Nephrol 2019; 73:98-106. [PMID: 31833333 DOI: 10.23736/s2724-6051.19.03529-x] [Citation(s) in RCA: 4] [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: 11/08/2022]
Abstract
BACKGROUND The serum prostate-specific antigen is the most widespread biomarker for prostate disease. Its low specificity for prostatic malignancies is a matter of concern and the reason why new biomarkers for screening purposes are needed. The correlation between altered production of the main steroids and prostate carcinoma (PCa) occurrence is historically known. The purpose of this study is to evaluate the modifications of a comprehensive urinary endogenous steroidal profile (USP) induced by PCa, by multivariate statistical methods. METHODS A total of 283 Italian subjects were included in the study, 139 controls and 144 PCa-affected patients. The USP, including 17 steroids and five urinary steroidal ratios, was quantitatively evaluated using gas chromatography coupled with single quadrupole mass spectrometry (GC-MS). The data were interpreted using a chemometric, multivariate approach (intrinsically more sensible to alterations with respect to traditional statistics) and a model for the discrimination of cancer-affected profiles was built. RESULTS Two multivariate classification models were calculated, the former including three steroids with the highest statistical significance (e.g. testosterone, etiocholanolone and 7β-OH-DHEA) and PSA values, the latter considering the three steroids' levels only. Both models yielded high sensitivity and specificity scores near to 70%, resulting significantly higher than PSA alone. CONCLUSIONS Three USP steroids resulted significantly altered in our PCa population. These preliminary results, combined with the simplicity and low-cost of the analysis, open to further investigation of the potential role of this restricted USP in PCa diagnosis.
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Affiliation(s)
- Stefano DE Luca
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Eleonora Amante
- Department of Chemistry, University of Turin, Turin, Italy - .,A. Bertinaria Anti-Doping Center, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Giorgio Alleva
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | | | - Diletta Garrou
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Matteo Manfredi
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Daniele Amparore
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Enrico Checcucci
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Serena Pruner
- Department of Chemistry, University of Turin, Turin, Italy
| | - Alberto Salomone
- Department of Chemistry, University of Turin, Turin, Italy.,A. Bertinaria Anti-Doping Center, Orbassano, Turin, Italy
| | - Roberto M Scarpa
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Marco Vincenti
- Department of Chemistry, University of Turin, Turin, Italy.,A. Bertinaria Anti-Doping Center, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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Scarpa RM, Papalia R. EDITORIAL COMMENT. Urology 2019; 134:197-198. [PMID: 31789179 DOI: 10.1016/j.urology.2019.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/09/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Roberto M Scarpa
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Rocco Papalia
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
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Manfredi M, Fiori C, Peretti D, Piramide F, Checcucci E, Garrou D, Amparore D, De Luca S, Di Dio M, Scarpa RM, Porpiglia F. Laparoscopic simple prostatectomy: complications and functional results after five years of follow-up. MINERVA UROL NEFROL 2019; 72:498-504. [PMID: 31619032 DOI: 10.23736/s0393-2249.19.03526-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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 aim of this study was to investigate complications and functional results in a cohort of patients who underwent extraperitoneoscopic transcapsular laparoscopic simple prostatectomy (LSP) for large prostate adenomas with a minimum follow-up of 5 years. METHODS We retrospectively reviewed data obtained from our prospectively maintained database of patients treated with LSP at our institution between January 2004 and June 2012, with at least 5 years of reported follow-up data. Demographics, perioperative results, early and late complications, and functional results were evaluated. The various impacts of the independent variables on the development of complications was evaluated performing logistic regression models. Follow-up was planned at 1, 3, 6 and 12 months, then yearly up to a minimum of 5 years. RESULTS One-hundred patients were included in our analysis. Median follow-up was 135 (IQR 24) months (11 years and 3 months). Grade III complications were recorded in 2 cases. Five cases of late postoperative complications were recorded. Logistic regression models showed a statistically significant correlation between the adenoma volume and the risk of developing early postoperative complications (OR 1.014). International Prostate Symptom Score (I-PSS), I-PSS quality of life (QoL) index, and maximum urine flow (Qmax) significantly improved when comparing preoperative and postoperative results. No significant differences were recorded in the I-PSS and I-PSS QoL index during follow-up. A low but significant worsening in Qmax was observed starting the 48th month after surgery. CONCLUSIONS The present findings confirm that LSP carries a low rate of early and late complications, and it offers good functional outcomes at 5 years.
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Affiliation(s)
- Matteo Manfredi
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Dario Peretti
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Federico Piramide
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Enrico Checcucci
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Diletta Garrou
- 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
| | - Stefano De Luca
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Michele Di Dio
- Division of Urology, Department of Surgery, SS Annunziata Hospital, Cosenza, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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Scarpa RM, Papalia R. Re: Giusti et al., Editorial Comment on: Supracostal Upper Pole Endoscopic-Guided Prone Tubeless "Maxi-Percutaneous Nephrolithotomy": A Contemporary Evaluation of Complications by Altschuler et al. (From: Giusti G, Proietti S, and Rodríguez-Socarrás, ME. J Endourol 2019;33:279-280; DOI: 10.1089/end.2018.0856). J Endourol 2019; 33:281-282. [PMID: 30760023 DOI: 10.1089/end.2019.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Rocco Papalia
- Department of Urology Campus Bio-Medico University, Rome, Italy
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43
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Fiori C, Bertolo R, Manfredi M, Mele F, Amparore D, Cattaneo G, Morra I, Scarpa RM, Porpiglia F. Robot-assisted laparoendoscopic single-site versus mini-laparoscopic pyeloplasty: a comparison of perioperative, functional and cosmetic results. Minerva Urol Nephrol 2017; 69:604-612. [PMID: 28429925 DOI: 10.23736/s0393-2249.17.02833-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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 New approaches have been developed to further reduce the invasiveness of laparoscopic pyeloplasty (P) as treatment for uretero-pelvic junction obstruction (UPJO). Aim of the study was to compare perioperative, functional and cosmetic results of mini-laparoscopic (mL-P) versus robot-assisted laparoendoscopic single-site P (rLESS-P). METHODS Since April 2009 to June 2010, 12 adult patients with primary UPJO, BMI<25 and no previous abdominal surgeries were enrolled undergoing mLP (3-mm instruments only). With the same indications since February 2012 to October 2013, 15 patients underwent rLESS-P with "single site"® platform (Intuitive Surgery Inc, Sunnyvale, CA, USA). Success of surgeries was determined by clinical parameters and renal scan (success if T 1/2<20 min) at 12 months postoperatively. Demographics and perioperative results were analyzed. Cosmetic results were assessed by using the Patient Scar Assessment Questionnaire (PSAQ). RESULTS Groups were comparable at baseline. No differences were found in perioperative variables except for a longer operative time in rLESS-P group (128 vs. 190, P<0.001). Postoperative complications rate, analgesic consumption, pain visual analogue scale scores, hospital stay and success rate of surgeries were not significantly different between the groups. PSAQ revealed that in both the groups patients were satisfied with the cosmetic result. At one-year follow-up no recurrences were observed. Semiquantitative analysis of costs revealed an extra-cost for rLESS-P of € 3410 per procedure. CONCLUSIONS In our experience, both mLP and rLESS-P appeared to be feasible and safe in the treatment of UPJO and allowed for excellent cosmetic results. r-LESS required longer operative times and higher costs.
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Affiliation(s)
- Cristian Fiori
- Division of Urology, Department of Oncology-University of Turin, "San Luigi Gonzaga" Hospital, Orbassano, Turin, Italia -
| | - Riccardo Bertolo
- Division of Urology, Department of Oncology-University of Turin, "San Luigi Gonzaga" Hospital, Orbassano, Turin, Italia
| | - Matteo Manfredi
- Division of Urology, Department of Oncology-University of Turin, "San Luigi Gonzaga" Hospital, Orbassano, Turin, Italia
| | - Fabrizio Mele
- Division of Urology, Department of Oncology-University of Turin, "San Luigi Gonzaga" Hospital, Orbassano, Turin, Italia
| | - Daniele Amparore
- Division of Urology, Department of Oncology-University of Turin, "San Luigi Gonzaga" Hospital, Orbassano, Turin, Italia
| | - Giovanni Cattaneo
- Division of Urology, Department of Oncology-University of Turin, "San Luigi Gonzaga" Hospital, Orbassano, Turin, Italia
| | - Ivano Morra
- Division of Urology, Department of Oncology-University of Turin, "San Luigi Gonzaga" Hospital, Orbassano, Turin, Italia
| | - Roberto M Scarpa
- Division of Urology, Department of Oncology-University of Turin, "San Luigi Gonzaga" Hospital, Orbassano, Turin, Italia
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology-University of Turin, "San Luigi Gonzaga" Hospital, Orbassano, Turin, Italia
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Legemate JD, Wijnstok NJ, Matsuda T, Strijbos W, Erdogru T, Roth B, Kinoshita H, Palacios-Ramos J, Scarpa RM, de la Rosette JJ. Characteristics and outcomes of ureteroscopic treatment in 2650 patients with impacted ureteral stones. World J Urol 2017; 35:1497-1506. [PMID: 28321499 PMCID: PMC5613106 DOI: 10.1007/s00345-017-2028-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 02/18/2017] [Indexed: 12/23/2022] Open
Abstract
Purpose To describe stone-free rates and complications of ureteroscopic treatment for impacted compared with non-impacted ureteral stones and evaluate predictive variables for impaction. Methods The Clinical Research Office of the Endourological Society prospectively collected 1 consecutive year of data from 114 centers worldwide. Patients eligible for inclusion were patients treated with ureteroscopy for ureteral stones. Patient characteristics, treatment details, and outcomes were compared with regard to stone impaction. Logistic regression analyses were conducted to explore predictive variables for ureteral stone impaction and to analyse the effect of impaction on outcomes. Results Of the 8543 treated patients, 2650 (31%) had impacted and 5893 (69%) non-impacted stones. The stone-free rate was 87.1% for impacted stones, which is lower compared with 92.7% for non-impacted stones (p < 0.001). Intra-operative complication rates were higher for impacted stones (7.9 versus 3.0%, p < 0.001). Significantly higher ureteral perforation- and avulsion rates were reported in the impacted stone group compared with the non-impacted stone group. No association between stone impaction and post-operative complications could be shown. Female gender, ASA-score >1, prior stone treatment, positive pre-operative urine culture, and larger stones showed to be predictive variables for stone impaction. Conclusions Ureteroscopic treatment for impacted stones is associated with lower stone-free rates and higher intra-operative complication rates compared with treatment for non-impacted stones. The predictive variables for the presence of stone impaction may contribute to the identification of stone impaction during the diagnostic process. Moreover, identification of stone impaction may aid the selection of the optimal treatment modality. Electronic supplementary material The online version of this article (doi:10.1007/s00345-017-2028-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jaap D Legemate
- Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands.
| | - Nienke J Wijnstok
- Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Willem Strijbos
- Department of Urology, Zuyderland Medisch Centrum Parkstad, Heerlen, The Netherlands
| | - Tibet Erdogru
- Department of Urology, Memorial Istanbul Atasehir Hospital, Istanbul, Turkey
| | - Beat Roth
- Department of Urology, University Hospital Bern, Bern, Switzerland
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | | | | | - Jean J de la Rosette
- Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands
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Cracco CM, Knoll T, Liatsikos EN, Osther PJ, Smith AD, Scarpa RM, Scoffone CM. Rigid-only versus combined rigid and flexible percutaneous nephrolithotomy: a systematic review. Minerva Urol Nephrol 2017; 69:330-341. [PMID: 28124870 DOI: 10.23736/s0393-2249.17.02841-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PNL) is usually performed worldwide with a rigid-only antegrade approach. Daily practice suggests that adding flexible nephroscopy and/or ureteroscopy to conventional rigid PNL might improve its efficacy and safety, but available evidence is weak. Appraisal of reliable outcomes of such PNL techniques would better guide intraoperative choices and optimize surgical results. Therefore, our objective was to systematically review relevant literature comparing the outcomes of rigid-only PNL and combined flexible PNLs (adding flexible nephroscopy and/or flexible ureteroscopy) for the treatment of large and/or complex upper urinary tract calculi, with regard to efficacy and safety. EVIDENCE ACQUISITION Ovid MedLine, PubMed, Scopus and Web of Science databases were searched in August 2016 to identify relevant studies. Article selection was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis criteria. EVIDENCE SYNTHESIS Six articles reporting on 666 patients were included: two randomized controlled trials, two retrospective comparative studies and two case series ≥50 patients (one prospective and one retrospective). A narrative synthesis of minor evidences was also prepared. The adjunct of flexible nephroscopy and/or ureteroscopy provided better stone-free rates (range 86.7-96.97%), through a single percutaneous access most of the times and in any position, reducing the need for second-look procedures. Safety of the combined flexible procedures was improved to a variable degree, with a consensual reduction of the mean hospital stay (range 5.1-7 days). CONCLUSIONS The current evidence suggests that patients with large and/or complex urolithiasis might benefit from the adjunct of flexible nephroscopy and/or ureteroscopy to rigid PNL.
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Affiliation(s)
| | - Thomas Knoll
- Department of Urology, Klinikum Sindelfingen-Böblingen, University of Tübingen, Sindelfingen, Germany
| | | | - Palle J Osther
- Urological Research Center, Department of Urology, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark
| | - Arthur D Smith
- The Arthur DM Smith Institute for Urology, North Shore-LIJ Health System, New York, NY, USA
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Doria C, Mosele GR, Solla F, Maestretti G, Balsano M, Scarpa RM. Treatment of osteoporosis secondary to hypogonadism in prostate cancer patients: a prospective randomized multicenter international study with denosumab vs. alendronate. Minerva Urol Nephrol 2016; 69:271-277. [PMID: 27813398 DOI: 10.23736/s0393-2249.16.02808-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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 Osteoporosis is a complication of androgen deprivation therapy (ADT) in men with prostate carcinoma. This is a multicenter, randomized, double-blind prospective study on use of denosumab versus alendronate in the therapy of secondary osteoporosis related to ADT. METHODS A total of 234 patients with diagnosis of osteoporosis underwent ADT for prostate cancer were enrolled. Patients were randomly assigned 1:1 to receive denosumab 60 mg subcutaneously every 6 months or alendronate (70 mg/week) for 2 years. All patient received supplemental vitamin D (600 IU/day) and supplemental calcium to maintain a calcium intake of 1200 mg per day. Effectiveness of therapy in both groups (denosumab group and alendronate group) was assessed by changes in bone turnover markers (BTMs), bone mineral density, fracture incidence, Visual Analogue Scale score for back pain, and Short Form-8 health survey score for health-related quality of life. RESULTS In the denosumab study group, level of BTMs for bone formation were significantly increased from baseline at all time points during the study (P<0.001); in the alendronate study group level of BTMs for bone formation were increased too (P>0.05). Mean changes in BMD at final follow-up differed significantly between two groups. BMD changes at the lumbar spine at 24 months were 5.6% with denosumab vs. -1.1% with alendronate (P<0.001). CONCLUSIONS Denosumab and alendronate showed similar clinical efficacy in the therapy of ADT-related osteoporosis in men with prostate carcinoma; both drugs provided significant improvements in back pain and general health conditions. Denosumab showed significant increase of BTMs and BMD than alendronate with lower rate of new vertebral fractures.
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Affiliation(s)
- Carlo Doria
- Department of Orthopedics, University of Sassari, Sassari, Italy
| | - Giulia R Mosele
- Department of Orthopedics, University of Sassari, Sassari, Italy -
| | - Federico Solla
- Department of Orthopedics, Pediatric Hospital of Nice, Lenval University Hospital, Nice, France
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Abstract
BACKGROUND Renal cell carcinoma (RCC) is among the ten most common cancers in both men and women. It comprises 2-3% of all malignancies. The most common site for metastasis from RCC is the lung (50% of patients), followed by the skeleton (20% to 50% of patients). METHODS We retrospectively reviewed our consecutive series of 63 patients surgically treated for spinal metastases from RCC. The surgical treatment for spinal metastases varied in each patient. Factors influencing the choice of surgery included age, disease status, symptoms, morbidity of the patient, the location, the number of repetitive lesions and the existence of extra-osseous metastases. For 42 patients (66.66%) the treatment included radiation two weeks after the surgical procedure. RESULTS A total of 68 surgical procedures were performed in 63 patients. For all patients we collected data about type of RCC, locations of metastasis, type of spine metastasis, type of surgery and complications. In this way we had an exahustive vision of the natural history of this kind of patients. CONCLUSIONS Spine metastatic RCC has a poor prognosis. The favorable prognostic factor is solitary spinal metastasis without involvement of visceral organs where the gold standard treatment is corpectomy en bloc. The negative prognostic factors are the presence of one or more pathological fractures and neurological deficits. Bisphosphonate as zoledronic acid reduce significantly skeletal morbidity and significantly prolong time to bone lesion progression in patients with spine metastases from renal cell carcinoma.
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Affiliation(s)
- Giulia R Mosele
- Orthopaedic Department, University of Sassari, Sassari, Italy -
| | | | | | - Carlo Doria
- Orthopaedic Department, University of Sassari, Sassari, Italy
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Porpiglia F, Fiori C, Daffara FC, Zaggia B, Ardito A, Scarpa RM, Papotti M, Berruti A, Scagliotti GV, Terzolo M. Does nephrectomy during radical adrenalectomy for stage II adrenocortical cancer affect patient outcome? J Endocrinol Invest 2016; 39:465-71. [PMID: 26694705 DOI: 10.1007/s40618-015-0422-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate if including nephrectomy in the standard surgical approach to stage II adrenocortical cancer (i.e., adrenalectomy) might modify oncologic outcome of patients. METHODS We performed a retrospective analysis involving 41 patients with stage II adrenocortical cancer (ACC) who had undergone radical surgery. Patients were divided into two groups according to the surgical procedure: group A = radical adrenalectomy alone, group AN = radical adrenalectomy + radical nephrectomy. Oncologic effectiveness of the procedures was tested comparing the recurrence-free and overall survival of patients of A vs AN groups. RESULTS The group A consisted of 25 patients and group AN of 16 patients. No differences were noted between the two groups in terms of demographic data and ACC characteristics. During follow-up, 15/25 (60 %) patients of group A vs 14/16 (87.5 %) patients of group AN experienced a recurrence, after a median of 36 months in group A and 10 months in group AN (p = 0.06); a significant impairment of renal function was recorded in patients of AN group with respect to those of group A. Finally, 13/25 (52 %) patients of group A and 10/16 (62.5 %) patients of group AN died due to ACC-related causes. No differences in survival times were noted (p = 0.3). CONCLUSION Our study suggests that adjunctive nephrectomy does not modify the oncologic results of adrenalectomy in the treatment of stage II ACC in terms of recurrence-free and overall survival. Thus, when there are no signs of ACC local invasion, surgeon should make every effort to preserve the kidney.
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Affiliation(s)
- F Porpiglia
- Division of Urology, Department of Oncology, "San Luigi" Hospital-Orbassano, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy.
| | - C Fiori
- Division of Urology, Department of Oncology, "San Luigi" Hospital-Orbassano, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy
| | - F C Daffara
- Division of Internal Medicine, Department of Oncology, "San Luigi" Hospital-Orbassano, University of Turin, Orbassano, TO, Italy
| | - B Zaggia
- Division of Internal Medicine, Department of Oncology, "San Luigi" Hospital-Orbassano, University of Turin, Orbassano, TO, Italy
| | - A Ardito
- Division of Internal Medicine, Department of Oncology, "San Luigi" Hospital-Orbassano, University of Turin, Orbassano, TO, Italy
| | - R M Scarpa
- Division of Urology, Department of Oncology, "San Luigi" Hospital-Orbassano, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy
| | - M Papotti
- Division of Pathology, Department of Oncology, "San Luigi" Hospital-Orbassano, University of Turin, Orbassano, TO, Italy
| | - A Berruti
- Medical Oncology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia at Spedali Civili Hospital, Brescia, Italy
| | - G V Scagliotti
- Division of Oncology, Department of Oncology, "San Luigi" Hospital-Orbassano, University of Turin, Orbassano, TO, Italy
| | - M Terzolo
- Division of Internal Medicine, Department of Oncology, "San Luigi" Hospital-Orbassano, University of Turin, Orbassano, TO, Italy
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De Luca S, Passera R, Sottile A, Fiori C, Scarpa RM, Porpiglia F. [-2]proPSA versus ultrasensitive PSA fluctuations over time in the first year from radical prostatectomy, in an high-risk prostate cancer population: A first report. BMC Urol 2016; 16:14. [PMID: 27013515 PMCID: PMC4806444 DOI: 10.1186/s12894-016-0131-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/16/2016] [Indexed: 11/10/2022] Open
Abstract
Background [−2]proPSA and its derivatives have an higher diagnostic accuracy than PSA in predicting prostate cancer (PCa). In alternative to PSA, ultrasensitive PSA (uPSA) and [−2]proPSA could be potentially useful in recurrent disease detection. This research focused on [−2]proPSA and uPSA fluctuations over time and their possible clinical and pathological determinants, in the first year after RP. Methods A cohort of 106 consecutive patients, undergoing RP for high-risk prostate cancer (pT3/pT4 and/or positive margins), was enrolled. No patient received either preoperative/postoperative androgen deprivation therapy or immediate adjuvant RT, this latter for patient choice. [−2]proPSA and uPSA were measured at 1, 3, 6, 9, 12 months after RP; their trends over time were estimated by the mixed-effects linear model. The uPSA relapse was defined either as 3 rising uPSA values after nadir or 2 consecutive uPSA >0.2 ng/ml after RP. Results The biochemical recurrence (BCR) rate at 1 year after RP was either 38.6 % (in case of 3 rising uPSA values) or 34.9 % (in case of PSA >0.2 ng/ml after nadir), respectively. The main risk factors for uPSA fluctuations over time were PSA at diagnosis >8 ng/ml (p = 0.014), pT (p = 0.038) and pN staging (p = 0.001). In turn, PSA at diagnosis >8 ng/ml (p = 0.012) and pN (p < 0.001) were the main determinants for [−2]proPSA trend over time. In a 39 patients subgroup, uPSA decreased from month 1 to 3, while [−2]proPSA increased in 90 % of them; subsequently, both uPSA and [−2]proPSA increased in almost all cases. The [−2]proPSA trend over time was independent from BCR status either in the whole cohort as well in the 39 men subgroup. Conclusions Both uPSA and [−2]proPSA had independent significant fluctuations over time. PSA at diagnosis >8 ng/ml and pathological staging significantly modified both these trends over time. Since BCR was not confirmed as determinant of [−2]proPSA fluctuations, its use as marker of early biochemical relapse may not be actually recommended, in an high-risk prostate cancer patients population.
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Affiliation(s)
- S De Luca
- Division of Urology, San Luigi Gonzaga Hospital and University of Torino, Orbassano, Italy
| | - R Passera
- Division of Nuclear Medicine, San Giovanni Battista Hospital and University of Torino, Corso AM Dogliotti 14, 10126, Torino, Italy.
| | - A Sottile
- Division of Laboratory Medicine, Candiolo Cancer Institute, Candiolo, Italy
| | - C Fiori
- Division of Urology, San Luigi Gonzaga Hospital and University of Torino, Orbassano, Italy
| | - R M Scarpa
- Division of Urology, San Luigi Gonzaga Hospital and University of Torino, Orbassano, Italy
| | - F Porpiglia
- Division of Urology, San Luigi Gonzaga Hospital and University of Torino, Orbassano, Italy
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