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Chen Z, Cruciani L, Lievore E, Fontana M, De Cobelli O, Musi G, Ferrigno G, De Momi E. Spatio-temporal layers based intra-operative stereo depth estimation network via hierarchical prediction and progressive training. Comput Methods Programs Biomed 2024; 244:107937. [PMID: 38006707 DOI: 10.1016/j.cmpb.2023.107937] [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] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/18/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND AND OBJECTIVE Safety of robotic surgery can be enhanced through augmented vision or artificial constraints to the robotl motion, and intra-operative depth estimation is the cornerstone of these applications because it provides precise position information of surgical scenes in 3D space. High-quality depth estimation of endoscopic scenes has been a valuable issue, and the development of deep learning provides more possibility and potential to address this issue. METHODS In this paper, a deep learning-based approach is proposed to recover 3D information of intra-operative scenes. To this aim, a fully 3D encoder-decoder network integrating spatio-temporal layers is designed, and it adopts hierarchical prediction and progressive learning to enhance prediction accuracy and shorten training time. RESULTS Our network gets the depth estimation accuracy of MAE 2.55±1.51 (mm) and RMSE 5.23±1.40 (mm) using 8 surgical videos with a resolution of 1280×1024, which performs better compared with six other state-of-the-art methods that were trained on the same data. CONCLUSIONS Our network can implement a promising depth estimation performance in intra-operative scenes using stereo images, allowing the integration in robot-assisted surgery to enhance safety.
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Affiliation(s)
- Ziyang Chen
- Politecnico di Milano, Department of Electronics, Information and Bioengineering, Milano, 20133, Italy.
| | - Laura Cruciani
- Politecnico di Milano, Department of Electronics, Information and Bioengineering, Milano, 20133, Italy
| | - Elena Lievore
- European Institute of Oncology, Department of Urology, IRCCS, Milan, 20141, Italy
| | - Matteo Fontana
- European Institute of Oncology, Department of Urology, IRCCS, Milan, 20141, Italy
| | - Ottavio De Cobelli
- European Institute of Oncology, Department of Urology, IRCCS, Milan, 20141, Italy; University of Milan, Department of Oncology and Onco-haematology, Faculty of Medicine and Surgery, Milan, Italy
| | - Gennaro Musi
- European Institute of Oncology, Department of Urology, IRCCS, Milan, 20141, Italy; University of Milan, Department of Oncology and Onco-haematology, Faculty of Medicine and Surgery, Milan, Italy
| | - Giancarlo Ferrigno
- Politecnico di Milano, Department of Electronics, Information and Bioengineering, Milano, 20133, Italy
| | - Elena De Momi
- Politecnico di Milano, Department of Electronics, Information and Bioengineering, Milano, 20133, Italy; European Institute of Oncology, Department of Urology, IRCCS, Milan, 20141, Italy
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Mjaess G, Peltier A, Roche JB, Lievore E, Lacetera V, Chiacchio G, Beatrici V, Mastroianni R, Simone G, Windisch O, Benamran D, Fourcade A, Nguyen TA, Fournier G, Fiard G, Ploussard G, Roumeguère T, Albisinni S, Diamand R. A Novel Nomogram to Identify Candidates for Focal Therapy Among Patients with Localized Prostate Cancer Diagnosed via Magnetic Resonance Imaging-Targeted and Systematic Biopsies: A European Multicenter Study. Eur Urol Focus 2023; 9:992-999. [PMID: 37147167 DOI: 10.1016/j.euf.2023.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/12/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Suitable selection criteria for focal therapy (FT) are crucial to achieve success in localized prostate cancer (PCa). OBJECTIVE To develop a multivariable model that better delineates eligibility for FT and reduces undertreatment by predicting unfavorable disease at radical prostatectomy (RP). DESIGN, SETTING, AND PARTICIPANTS Data were retrospectively collected from a prospective European multicenter cohort of 767 patients who underwent magnetic resonance imaging (MRI)-targeted and systematic biopsies followed by RP in eight referral centers between 2016 and 2021. The Imperial College of London eligibility criteria for FT were applied: (1) unifocal MRI lesion with Prostate Imaging-Reporting and Data System score of 3-5; (2) prostate-specific antigen (PSA) ≤20 ng/ml; (3) cT2-3a stage on MRI; and (4) International Society of Urological Pathology grade group (GG) 1 and ≥6 mm or GG 2-3. A total of 334 patients were included in the final analysis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was unfavorable disease at RP, defined as GG ≥4, and/or lymph node invasion, and/or seminal vesicle invasion, and/or contralateral clinically significant PCa. Logistic regression was used to assess predictors of unfavorable disease. The performance of the models including clinical, MRI, and biopsy information was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis. A coefficient-based nomogram was developed and internally validated. RESULTS AND LIMITATIONS Overall, 43 patients (13%) had unfavorable disease on RP pathology. The model including PSA, clinical stage on digital rectal examination, and maximum lesion diameter on MRI had an AUC of 73% on internal validation and formed the basis of the nomogram. Addition of other MRI or biopsy information did not significantly improve the model performance. Using a cutoff of 25%, the proportion of patients eligible for FT was 89% at the cost of missing 30 patients (10%) with unfavorable disease. External validation is required before the nomogram can be used in clinical practice. CONCLUSIONS We report the first nomogram that improves selection criteria for FT and limits the risk of undertreatment. PATIENT SUMMARY We conducted a study to develop a better way of selecting patients for focal therapy for localized prostate cancer. A novel predictive tool was developed using the prostate-specific antigen (PSA) level measured before biopsy, tumor stage assessed via digital rectal examination, and lesion size on magnetic resonance imaging (MRI) scans. This tool improves the prediction of unfavorable disease and may reduce the risk of undertreatment of localized prostate cancer when using focal therapy.
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Affiliation(s)
- Georges Mjaess
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
| | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Elena Lievore
- Department of Urology, Clinique Saint-Augustin, Bordeaux, France; Department of Urology, IRCCS Istituto Europeo di Oncologia, Milan, Italy
| | - Vito Lacetera
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Giuseppe Chiacchio
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Valerio Beatrici
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Olivier Windisch
- Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Daniel Benamran
- Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Alexandre Fourcade
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Truong An Nguyen
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Georges Fournier
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, Grenoble, France
| | | | - Thierry Roumeguère
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Romain Diamand
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
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Musi G, Molinari F, Mistretta FA, Piccinelli ML, Guzzo S, Tozzi M, Lievore E, Blezien O, Fontana M, Cioffi A, Cullurà D, Verri E, Cossu Rocca M, Nolè F, Ferro M, de Cobelli O, Luzzago S. Penile-Sparing Surgery for Tumour Recurrence after Previous Glansectomy/Partial Penectomy: Treatment Feasibility and Oncological Outcomes. Cancers (Basel) 2023; 15:4807. [PMID: 37835501 PMCID: PMC10571586 DOI: 10.3390/cancers15194807] [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: 08/08/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023] Open
Abstract
We tested the feasibility and oncological outcomes after penile-sparing surgery (PSS) for local recurrent penile cancer after a previous glansectomy/partial penectomy. We retrospectively analysed 13 patients (1997-2022) with local recurrence of penile cancer after a previous glansectomy or partial penectomy. All patients underwent PSS: circumcision, excision, or laser ablation. First, technical feasibility, treatment setting, and complications (Clavien-Dindo) were recorded. Second, Kaplan-Meier plots depicted overall and local recurrences over time. Overall, 11 (84.5%) vs. 2 (15.5%) patients were previously treated with glansectomy vs. partial penectomy. The median (IQR) time to disease recurrence was 56 (13-88) months. Six (46%) vs. two (15.5%) vs. five (38.5%) patients were treated with, respectively, local excision vs. local excision + circumcision vs. laser ablation. All procedures, except one, were performed in an outpatient setting. Only one Clavien-Dindo 2 complication was recorded. The median follow-up time was 41 months. Overall, three (23%) vs. four (30.5%) patients experienced local vs. overall recurrence, respectively. All local recurrences were safely treated with salvage surgery. In conclusion, we reported the results of a preliminary analysis testing safety, feasibility, and early oncological outcomes of PSS procedures for patients with local recurrence after previous glansectomy or partial penectomy. Stronger oncological outcomes should be tested in other series to optimise patient selection.
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Affiliation(s)
- Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (G.M.); (F.M.); (F.A.M.); (M.L.P.); (S.G.); (M.T.); (E.L.); (O.B.); (M.F.); (A.C.); (M.F.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Filippo Molinari
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (G.M.); (F.M.); (F.A.M.); (M.L.P.); (S.G.); (M.T.); (E.L.); (O.B.); (M.F.); (A.C.); (M.F.); (O.d.C.)
| | - Francesco A. Mistretta
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (G.M.); (F.M.); (F.A.M.); (M.L.P.); (S.G.); (M.T.); (E.L.); (O.B.); (M.F.); (A.C.); (M.F.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Mattia Luca Piccinelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (G.M.); (F.M.); (F.A.M.); (M.L.P.); (S.G.); (M.T.); (E.L.); (O.B.); (M.F.); (A.C.); (M.F.); (O.d.C.)
| | - Sonia Guzzo
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (G.M.); (F.M.); (F.A.M.); (M.L.P.); (S.G.); (M.T.); (E.L.); (O.B.); (M.F.); (A.C.); (M.F.); (O.d.C.)
| | - Marco Tozzi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (G.M.); (F.M.); (F.A.M.); (M.L.P.); (S.G.); (M.T.); (E.L.); (O.B.); (M.F.); (A.C.); (M.F.); (O.d.C.)
| | - Elena Lievore
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (G.M.); (F.M.); (F.A.M.); (M.L.P.); (S.G.); (M.T.); (E.L.); (O.B.); (M.F.); (A.C.); (M.F.); (O.d.C.)
| | - Oskar Blezien
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (G.M.); (F.M.); (F.A.M.); (M.L.P.); (S.G.); (M.T.); (E.L.); (O.B.); (M.F.); (A.C.); (M.F.); (O.d.C.)
| | - Matteo Fontana
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (G.M.); (F.M.); (F.A.M.); (M.L.P.); (S.G.); (M.T.); (E.L.); (O.B.); (M.F.); (A.C.); (M.F.); (O.d.C.)
| | - Antonio Cioffi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (G.M.); (F.M.); (F.A.M.); (M.L.P.); (S.G.); (M.T.); (E.L.); (O.B.); (M.F.); (A.C.); (M.F.); (O.d.C.)
| | - Daniela Cullurà
- Department of Medical Oncology, Division of Urogenital and Head and Neck Tumours, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (D.C.); (E.V.); (M.C.R.); (F.N.)
| | - Elena Verri
- Department of Medical Oncology, Division of Urogenital and Head and Neck Tumours, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (D.C.); (E.V.); (M.C.R.); (F.N.)
| | - Maria Cossu Rocca
- Department of Medical Oncology, Division of Urogenital and Head and Neck Tumours, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (D.C.); (E.V.); (M.C.R.); (F.N.)
| | - Franco Nolè
- Department of Medical Oncology, Division of Urogenital and Head and Neck Tumours, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (D.C.); (E.V.); (M.C.R.); (F.N.)
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (G.M.); (F.M.); (F.A.M.); (M.L.P.); (S.G.); (M.T.); (E.L.); (O.B.); (M.F.); (A.C.); (M.F.); (O.d.C.)
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (G.M.); (F.M.); (F.A.M.); (M.L.P.); (S.G.); (M.T.); (E.L.); (O.B.); (M.F.); (A.C.); (M.F.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (G.M.); (F.M.); (F.A.M.); (M.L.P.); (S.G.); (M.T.); (E.L.); (O.B.); (M.F.); (A.C.); (M.F.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
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Chen Z, Marzullo A, Alberti D, Lievore E, Fontana M, De Cobelli O, Musi G, Ferrigno G, De Momi E. FRSR: Framework for real-time scene reconstruction in robot-assisted minimally invasive surgery. Comput Biol Med 2023; 163:107121. [PMID: 37311383 DOI: 10.1016/j.compbiomed.2023.107121] [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: 02/14/2023] [Revised: 05/12/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023]
Abstract
3D reconstruction of the intra-operative scenes provides precise position information which is the foundation of various safety related applications in robot-assisted surgery, such as augmented reality. Herein, a framework integrated into a known surgical system is proposed to enhance the safety of robotic surgery. In this paper, we present a scene reconstruction framework to restore the 3D information of the surgical site in real time. In particular, a lightweight encoder-decoder network is designed to perform disparity estimation, which is the key component of the scene reconstruction framework. The stereo endoscope of da Vinci Research Kit (dVRK) is adopted to explore the feasibility of the proposed approach, and it provides the possibility for the migration to other Robot Operating System (ROS) based robot platforms due to the strong independence on hardware. The framework is evaluated using three different scenarios, including a public dataset (3018 pairs of endoscopic images), the scene from the dVRK endoscope in our lab as well as a self-made clinical dataset captured from an oncology hospital. Experimental results show that the proposed framework can reconstruct 3D surgical scenes in real time (25 FPS), and achieve high accuracy (2.69 ± 1.48 mm in MAE, 5.47 ± 1.34 mm in RMSE and 0.41 ± 0.23 in SRE, respectively). It demonstrates that our framework can reconstruct intra-operative scenes with high reliability of both accuracy and speed, and the validation of clinical data also shows its potential in surgery. This work enhances the state of art in 3D intra-operative scene reconstruction based on medical robot platforms. The clinical dataset has been released to promote the development of scene reconstruction in the medical image community.
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Affiliation(s)
- Ziyang Chen
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, 20133, Italy.
| | - Aldo Marzullo
- Department of Mathematics and Computer Science, University of Calabria, Rende, 87036, Italy
| | - Davide Alberti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, 20133, Italy
| | - Elena Lievore
- Department of Urology, European Institute of Oncology, IRCCS, Milan, 20141, Italy
| | - Matteo Fontana
- Department of Urology, European Institute of Oncology, IRCCS, Milan, 20141, Italy
| | - Ottavio De Cobelli
- Department of Urology, European Institute of Oncology, IRCCS, Milan, 20141, Italy; Department of Oncology and Onco-haematology, Faculty of Medicine and Surgery, University of Milan, Milan, 20122, Italy
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, IRCCS, Milan, 20141, Italy; Department of Oncology and Onco-haematology, Faculty of Medicine and Surgery, University of Milan, Milan, 20122, Italy
| | - Giancarlo Ferrigno
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, 20133, Italy
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, 20133, Italy; Department of Urology, European Institute of Oncology, IRCCS, Milan, 20141, Italy
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Diamand R, Peltier A, Roche JB, Lievore E, Lacetera V, Chiacchio G, Beatrici V, Mastroianni R, Simone G, Windisch O, Benamran D, Fourcade A, Nguyen TA, Fournier G, Fiard G, Ploussard G, Roumeguère T, Albisinni S. Risk stratification for early biochemical recurrence of prostate cancer in the era of multiparametric magnetic resonance imagining-targeted biopsy. Prostate 2023; 83:572-579. [PMID: 36705314 DOI: 10.1002/pros.24490] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/23/2022] [Accepted: 01/06/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (MRI) and MRI-targeted biopsy are nowadays recommended in the prostate cancer (PCa) diagnostic pathway. Ploussard and Mazzone have integrated these tools into novel risk classification systems predicting the risk of early biochemical recurrence (eBCR) in PCa patients who underwent radical prostatectomy (RP). We aimed to assess available risk classification systems and to define the best-performing. METHODS Data on 1371 patients diagnosed by MRI-targeted biopsy and treated by RP between 2014 and 2022 at eight European tertiary referral centers were analyzed. Risk classifications systems included were the European Association of Urology (EAU) and National Comprehensive Cancer Network (NCCN) risk groups, the Cancer of the Prostate Risk Assessment (CAPRA) score, the International Staging Collaboration for Cancer of the Prostate (STAR-CAP) classification, the Ploussard and Mazzone models, and ISUP grade group. Kaplan-Meier analyses were used to compare eBCR among risk classification systems. Performance was assessed in terms of discrimination quantified using Harrell's c-index, calibration, and decision curve analysis (DCA). RESULTS Overall, 152 (11%) patients had eBCR at a median follow-up of 31 months (interquartile range: 19-45). The 3-year eBCR-free survival rate was 91% (95% confidence interval [CI]: 89-93). For each risk classification system, a significant difference among survival probabilities was observed (log-rank test p < 0.05) except for NCCN classification (p = 0.06). The highest discrimination was obtained with the STAR-CAP classification (c-index 66%) compared to CAPRA score (63% vs. 66%, p = 0.2), ISUP grade group (62% vs. 66, p = 0.07), Ploussard (61% vs. 66%, p = 0.003) and Mazzone models (59% vs. 66%, p = 0.02), and EAU (57% vs. 66%, p < 0.001) and NCCN (57% vs. 66%, p < 0.001) risk groups. Risk classification systems demonstrated good calibration characteristics. At DCA, the CAPRA score showed the highest net benefit at a probability threshold of 9%-15%. CONCLUSIONS The performance of risk classification systems using MRI and MRI-targeted information was less optimistic when tested in a contemporary set of patients. CAPRA score and STAR-CAP classification were the best-performing and should be preferred for treatment decision-making.
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Affiliation(s)
- Romain Diamand
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Elena Lievore
- Department of Urology, Clinique Saint-Augustin, Bordeaux, France
- Department of Urology, IRCCS IEO Istituto Europeo di Oncologia, Milan, Italy
| | - Vito Lacetera
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Giuseppe Chiacchio
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Valerio Beatrici
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Olivier Windisch
- Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Daniel Benamran
- Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Alexandre Fourcade
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Truong A Nguyen
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Georges Fournier
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC, Grenoble, France
| | | | - Thierry Roumeguère
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
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Di Trapani E, Guzzo S, Lievore E, Terrone C, Krajewski W, Xylinas E, Peroni A, Galfano A, Kelly J, Hurle R, Albisinni S, Shariat S, Teoh J, Hendricksen K, Antonelli A, Roumiguié M, Sanchez Salas R, Mir C, Soria F, Simone G, Montorsi F, Simeone C, Musi G, De Cobelli O. Evaluating the impact of complications on survival outcomes in patients treated with radical cystectomy for bladder cancer. Results from a European multi-institutional collaboration (YAU Urothelial Cancer Group). Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00200-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Law K, Piccinelli M, Tappero S, Panunzio A, Cano Garcia C, Barletta F, Incesu RB, Vaccaro C, Nardini S, Guzzo S, Lievore E, Tian Z, Karakiewicz P. Demographics and clinical characteristics of solitary fibrous tumours: A contemporary population-based analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01131-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Diamand R, Peltier A, Roche JB, Lievore E, Lacetera V, Chiacchio G, Beatrici V, Mastroianni R, Simone G, Windisch O, Benamran D, Fourcade A, Nguyen TA, Fournier G, Fiard G, Ploussard G, Roumeguère T, Albisinni S. Optimizing multiparametric magnetic resonance imaging-targeted biopsy and prostate cancer grading accuracy. World J Urol 2023; 41:77-84. [PMID: 36509932 DOI: 10.1007/s00345-022-04244-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To assess the most efficient biopsy method to improve International Society of Urological Pathology (ISUP) grade group accuracy with final pathology of the radical prostatectomy (RP) specimen in the era of magnetic resonance imaging (MRI)-driven pathway. METHODS A total of 753 patients diagnosed by transrectal MRI-targeted and systematic biopsies (namely "standard method"), treated by RP, between 2016 and 2021 were evaluated. Biopsy methods included MRI-targeted biopsy, side-specific systematic biopsies relative to index MRI lesion and combination of both. Number of MRI-targeted biopsy cores and positive cores needed per index MRI lesion were assessed. Multivariable analysis was performed to analyze predictive factors of upgrading using MRI targeted and ipsilateral systematic biopsies method. RESULTS Overall, ISUP grade group accuracy varied among biopsy methods with upgrading rate of 35%, 49%, 27%, and 24% for MRI targeted, systematic, MRI targeted and ipsilateral systematic biopsies and standard methods, respectively (p < 0.001). A minimum of two positive MRI-targeted biopsies cores per index MRI lesion were required when testing MRI targeted and ipsilateral systematic biopsies method to reach equivalent accuracy compared to standard method. Omitting contralateral systematic biopsies spared an average of 5.9 cores per patient. At multivariable analysis, only the number of positive MRI-targeted biopsy cores per index MRI lesion was predictive of upgrading. CONCLUSION MRI targeted and ipsilateral systematic biopsies allowed an accurate definition of ISUP grade group and appears to be an interesting alternative when compared with standard method, reducing total number of biopsy cores needed.
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Affiliation(s)
- Romain Diamand
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Rue Meylemeersch 90, 1070, Brussels, Belgium.
| | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Rue Meylemeersch 90, 1070, Brussels, Belgium
| | | | - Elena Lievore
- Department of Urology, Clinique Saint-Augustin, Bordeaux, France.,Department of Urology, IRCCS IEO Istituto Europeo di Oncologia, Mila, Italy
| | - Vito Lacetera
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Giuseppe Chiacchio
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Valerio Beatrici
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Olivier Windisch
- Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Daniel Benamran
- Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Alexandre Fourcade
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Truong An Nguyen
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Georges Fournier
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC, Grenoble, France
| | | | - Thierry Roumeguère
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Rue Meylemeersch 90, 1070, Brussels, Belgium
| | - Simone Albisinni
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Rue Meylemeersch 90, 1070, Brussels, Belgium
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9
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Blezien O, Mistretta F, Luzzago S, Molinari F, Lievore E, Fontana M, Cozzi G, Bianchi R, Brescia A, Cordima G, Mauri G, Orsi F, Ferro M, Musi G, De Cobelli O. Effect of body mass index and obesity on perioperative and oncological outcomes in patients treated with thermal ablation for T1 renal cell tumors. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01187-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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10
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Guzzo S, Lievore E, Di Trapani E, Mistretta F, Luzzago S, Rouprêt M, Terrone C, Laukhtina E, Simeone C, Roumiguié M, Soria F, Kelly J, Shariat S, Albisinni S, Krajewski W, Antonelli A, Ploussard G, Teoh J, Oscar RB, Montorsi F, Hurle R, Maestro MA, Xylinas E, Salas RS, Simone G, Carme M, Galfano A, Hendricksen K, Peroni A, Musi G, De Cobelli O. Evaluating the impact of complications on survival outcomes in patients treated with radical cystectomy for bladder cancer. Results from an european multi-institutional collaboration (YAU urothelial cancer group). EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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11
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Diamand R, Roche JB, Lievore E, Lacetera V, Chiacchio G, Beatrici V, Mastroianni R, Simone G, Windisch O, Benamran D, Favre MM, Fourcade A, Nguyen TA, Fournier G, Fiard G, Ploussard G, Roumeguère T, Peltier A, Albisinni S. External Validation of Models for Prediction of Side-specific Extracapsular Extension in Prostate Cancer Patients Undergoing Radical Prostatectomy. Eur Urol Focus 2022; 9:309-316. [PMID: 36153227 DOI: 10.1016/j.euf.2022.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 06/22/2022] [Revised: 07/29/2022] [Accepted: 09/08/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Predicting the risk of side-specific extracapsular extension (ECE) is essential for planning nerve-sparing radical prostatectomy (RP) in patients with prostate cancer (PCa). OBJECTIVE To externally validate available models for prediction of ECE. DESIGN, SETTING, AND PARTICIPANTS Sixteen models were assessed in a cohort of 737 consecutive PCa patients diagnosed via multiparametric magnetic resonance imaging (MRI)-targeted and systematic biopsies and treated with RP between January 2016 and November 2021 at eight referral centers. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Model performance was evaluated in terms of discrimination using area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA). RESULTS AND LIMITATIONS Overall, ECE was identified in 308/1474 (21%) prostatic lobes. Prostatic lobes with ECE had higher side-specific clinical stage on digital rectal examination and MRI, number of positive biopsy cores, and International Society of Urological Pathology grade group in comparison to those without ECE (all p < 0.0001). Less optimistic performance was observed in comparison to previous published studies, although the models described by Pak, Patel, Martini, and Soeterik achieved the highest accuracy (AUC ranging from 0.73 to 0.77), adequate calibration for a probability threshold <40%, and the highest net benefit for a probability threshold >8% on DCA. Inclusion of MRI-targeted biopsy data and MRI information in models improved patient selection and clinical usefulness. Using model-derived cutoffs suggested by their authors, approximately 15% of positive surgical margins could have been avoided. Some available models were not included because of missing data, which constitutes a limitation of the study. CONCLUSIONS We report an external validation of models predicting ECE and identified the four with the best performance. These models should be applied for preoperative planning and patient counseling. PATIENT SUMMARY We validated several tools for predicting extension of prostate cancer outside the prostate gland. These tools can improve patient selection for surgery that spares nerves affecting recovery of sexual potency after removal of the prostate. They could potentially reduce the risk of finding cancer cells at the edge of specimens taken for pathology, a finding that suggests that not all of the cancer has been removed.
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Affiliation(s)
- Romain Diamand
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
| | | | - Elena Lievore
- Department of Urology, Clinique Saint-Augustin, Bordeaux, France; Department of Urology, IRCCS IEO Istituto Europeo di Oncologia, Milan, Italy
| | - Vito Lacetera
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Giuseppe Chiacchio
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Valerio Beatrici
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Olivier Windisch
- Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Daniel Benamran
- Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Alexandre Fourcade
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Truong An Nguyen
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Georges Fournier
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC, Grenoble, France
| | | | - Thierry Roumeguère
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
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12
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Gallioli A, De Lorenzis E, Lievore E, Boeri L, Colombo L, Fontana M, Breda A, Montanari E, Albo G. The effect of CO2 pressure and flow variation on carbon particles spread during pneumoperitoneum: an experimental study. J Endourol 2021; 36:807-813. [PMID: 34779236 DOI: 10.1089/end.2021.0336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A correlation between atypical recurrences and minimally-invasive surgery has been suggested in case of urothelial cancer; however, very few data are available on the role of pneumo peritoneum in terms of gas flow and intra-abdominal pressure. The objective of the study is to analyze the impact of CO2 pneumoperitoneum variation on an inert material as surrogate of neoplastic cells. MATERIAL AND METHODS We designed an experimental model mimicking pneumoperitoneum in three settings: sealed flow (no leakage), pulsatile flow (alternating efflux and influx) and continuous flow (AirSeal® insufflator). Each experiment was characterized by a pre-determined gas flow and pressure, trocar distance and position from the particles. Hounsfield density (HD) variation in the areas of interest was measured as index of graphite powder dispersion. A Linear regression model was employed to measure the correlation between modifiable variables and HD. RESULTS HD was lower in the pulsatile compared to both the sealed and continuous flows (p < 0.03). On multivariate analysis for sealed setting, flow and total gas liters delivered (i.e. gas leakage) were inversely and independently related to HD (all p <0.03). In pulsatile setting, trocar position, trocar distance and gas flow independently predicted HD (all p <0.03). In continuous setting, gas pressure was directly and independently related to HD (p = 0.004) due to decreased pneumoperitoneum stability and increased CO2 liters delivered. In case of in-flow trocar positioned laterally to the particles, low flow (1 L/min) or low pressure (8 mmHg), HD values recorded in the three settings were all overlapping (all p > 0.05). CONCLUSIONS Flow and pressure setting, in-flow trocar distance and contiguity from the tumor, and pneumoperitoneum stability may be all crucial component in minimally invasive surgery. In vivo, these variables should be considered as potential risk factors for tumor cells spread within the abdominal cavity.
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Affiliation(s)
- Andrea Gallioli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy.,Fundacio Puigvert, 16444, Urology, Barcelona, Catalunya, Spain;
| | - Elisa De Lorenzis
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy.,Università degli Studi di Milano, 9304, Department of Clinical Sciences and Community Health, Milano, Lombardia, Italy;
| | - Elena Lievore
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy;
| | - Luca Boeri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy.,Università degli Studi di Milano, 9304, Department of Clinical Sciences and Community Health, Milano, Lombardia, Italy;
| | - Lorenzo Colombo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy;
| | - Matteo Fontana
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy;
| | - Alberto Breda
- Fundació Puigvert, 16444, Urology, Barcelona, Catalunya, Spain;
| | - Emanuele Montanari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy.,Università degli Studi di Milano, 9304, Department of Clinical Sciences and Community Health, Milano, Lombardia, Italy;
| | - Giancarlo Albo
- La Fondazione IRCCS Ospedale Maggiore Policlinico, 9339, Urology, Milano, Milano, Italy.,Università degli Studi di Milano, 9304, Department of Clinical Sciences and Community Health, Milano, Lombardia, Italy;
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13
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Bebi C, Fulgheri I, Spinelli MG, Turetti M, Lievore E, Ripa F, Rocchini L, De Lorenzis E, Albo G, D'Amico M, Salonia A, Carrafiello G, Montanari E, Boeri L. Development of a novel clinical and radiological risk score to predict septic complications after urinary decompression in patients with obstructive uropathy. J Endourol 2021; 36:360-368. [PMID: 34693753 DOI: 10.1089/end.2021.0148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Well-defined clinical predictors of sepsis after upper tract drainage for obstructive uropathy are lacking. The study aim is to develop a data driven score to predict risk of sepsis after decompression of the upper urinary tract. MATERIALS AND METHODS Complete clinical and radiological data from 271 patients entering the emergency department for obstructive uropathy and submitted to stent/nephrostomy tube decompression were evaluated. The Charlson Comorbidity Index (CCI) was used to score comorbidities. The definition of sepsis was an increase in ≥2 SOFA points (or postoperative persistently elevated score +1 additional increase) and documented blood or urine cultures. Descriptive statistics and stepwise multivariable logistic regression modelling with ROC analysis were performed in order to obtain a composite risk score to predict the risk of sepsis after surgery. RESULTS Fifty-five (20.3%) patients developed sepsis. At multivariable analysis, CCI ≥2 (OR 3.10; 95%CI 1.36-7.04), max body temperature ≥38°C (OR 4.35; 95%CI 1.89-9.44), grade III-IV hydronephrosis (OR 2.37; 95%CI 1.10-4.98), Hounsfield units of the dilated collecting system ≥7.0 (OR 4.47; 95%CI 2.03-9.81), WBC ≥15x103/mmc (OR 2.77; 95%CI 1.24-6.19) and C-reactive protein ≥10 (OR 3.27; 95%CI 1.41-7.56) were independently associated with sepsis. The PPV of a true sepsis increased incrementally as a function of number of positive variables, ranging from 1.6% to 100.0% among patients with 1 and 6 positive variables, respectively. CONCLUSION Our risk score identifies accurately patients with an increased risk of sepsis after urinary decompression for obstructive uropathy, hence improving clinical management.
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Affiliation(s)
- Carolina Bebi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy;
| | - Irene Fulgheri
- IRCCS Fondazione Ca' Granda-Ospedale Maggiore Policlinico, Radiology Unit, Milan, Italy, via Sforza 35, 20122, Milan, Italy, Milan, Italy;
| | - Matteo Giulio Spinelli
- IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Urology Milan, IT, Urology, Milan, Italy;
| | - Matteo Turetti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy;
| | - Elena Lievore
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy;
| | - Francesco Ripa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy;
| | - Lorenzo Rocchini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy;
| | - Elisa De Lorenzis
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Medical School University of Milan, Via della Commenda 15, Milan, Italy;
| | - Giancarlo Albo
- IRCCS Fondazione Ca' Granda - Ospedale Maggiore Policlinico, Urology, Milan, Italy;
| | - Mario D'Amico
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Radiology, Milan, Lombardia, Italy;
| | - Andrea Salonia
- San Raffaele Hospital, 9372, Urology, Milano, Lombardia, Italy;
| | - Gianpaolo Carrafiello
- Department of Radiology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy , Milan, Italy;
| | - Emanuele Montanari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy;
| | - Luca Boeri
- IRCCS Fondazione Ca' Granda - Ospedale Maggiore Policlinico, Urology, Milan, Italy;
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14
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Silvani C, De Lorenzis E, Bebi C, Boeri L, Ripa F, Lievore E, Gallioli A, Turetti M, Lucignani G, Lo Baido V, Longo F, Teri A, Dodaro A, Vignati C, Matinato C, Albo G, Colombo R, Montanari E. Real-time PCR-based bacterial detection versus traditional culture of percutaneous nephrolithotomy derived stones: an investigational study. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00933-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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15
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Boeri L, Spinelli M, Lievore E, Lucignani G, Turetti M, Ripa F, Bebi C, Silvani C, Lo Baido V, Biondetti P, Martinelli L, De Lorenzis E, Albo G, Ierardi A, Carrafiello G, Montanari E. External validation and clinical significance of a radiologic classification system for spontaneous upper urinary tract rupture. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00775-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Lievore E, Zanetti S, Fulgheri I, Turetti M, Bebi C, Ripa F, Silvani C, Lucignani G, Lo Baido V, Rocchini L, De Lorenzis E, Albo G, Longo F, Montanari E, Boeri L. Vacuum cleaner effect or vacuum assisted sheath for mini-percutaneous nephrolitotomy: outcomes and cost analysis from a tertiary referral center. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00773-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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17
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Lievore E, Zanetti SP, Fulgheri I, Turetti M, Silvani C, Bebi C, Ripa F, Lucignani G, Pozzi E, Rocchini L, De Lorenzis E, Albo G, Longo F, Salonia A, Montanari E, Boeri L. Cost analysis between mini-percutaneous nephrolithotomy with and without vacuum-assisted access sheath. World J Urol 2021; 40:201-211. [PMID: 34432135 PMCID: PMC8813798 DOI: 10.1007/s00345-021-03811-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To perform a cost analysis between vacuum-assisted percutaneous nephrolithotomy (vmPCNL) and minimally invasive PCNL (MIP) and explore potential predictors of costs associated with the procedures. Methods We analyzed data from 225 patients who underwent vmPCNL or MIP at a single tertiary referral academic center between January 2016 and December 2020. We collected patients’ demographics, peri-and postoperative data and detailed expense records. After propensity score matching, 108 (66.7%) vmPCNL and 54 (33.3%) MIP procedures were analyzed. Descriptive statistics assessed differences in clinical and operative parameters. Univariable and multivariable linear regression models tested the association between clinical variables and costs. Results Operative time (OT) was shorter for vmPCNL, and the use of additional instruments to complete litholapaxy was more frequent in MIP (all p ≤ 0.01). Length of stay (LOS) was longer for MIP patients (p = 0.03) and the stone-free (SF) rate was higher after vmPCNL (p = 0.04). The overall instrumentation cost was higher for vmPCNL (p < 0.001), but total procedural costs were equivalent (p = 0.9). However, the overall cost for the hospitalization was higher for MIP than vmPCNL (p = 0.01). Univariable linear regression revealed that patient’s comorbidities, OT, any postoperative complication and LOS were associated with hospitalization costs (all p < 0.001). Multivariable linear regression analysis revealed that LOS and OT were associated with hospitalization costs (all p < 0.001), after accounting for vmPCNL procedure, patients’ comorbidities, and complications. Conclusion vmPCNL may represent a valid option due to clinical and economic benefits. Shorter OT, the lower need for disposable equipment and the lower complication rate reduced procedural and hospitalization costs. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03811-5.
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Affiliation(s)
- Elena Lievore
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Irene Fulgheri
- Department of Radiology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Turetti
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Carlo Silvani
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Carolina Bebi
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Francesco Ripa
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Gianpaolo Lucignani
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Lorenzo Rocchini
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Fabrizio Longo
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Boeri
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.
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18
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Zanetti SP, Fontana M, Lievore E, Turetti M, Longo F, De Lorenzis E, Albo G, Montanari E. The Matryoshka technique in percutaneous nephrolithotomy. ACTA ACUST UNITED AC 2021; 93:162-166. [PMID: 34286549 DOI: 10.4081/aiua.2021.2.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/16/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Miniaturized percutaneous nephrolithotomy (PCNL) reduces the risk of haemorrhagic complications, but the limited field of work represents a drawback. To obtain the best outcomes, the percutaneous access size should be intraoperatively tailored. Our purpose is to describe the indications and the procedural steps of the Matryoshka technique and to report its clinical outcomes. MATERIALS AND METHODS We performed a retrospective analysis of the data from consecutive Matryoshka PCNL procedures from October 2016 to January 2018. Collected data included patients' history, stone characteristics, intra- and post-operative items, stone clearance and need for retreatment. The main indication to the Matryoshka technique is the inability to securely position a guidewire due to an obstruction or narrowness in the pyelocalyceal system. This technique begins by puncturing the calyx hosting the stone and advancing a hydrophilic guidewire through the needle. If the guidewire cannot proceed beyond the stone, the Matryoshka technique is employed for tract stabilization. The tract is carefully dilated with small-bore instruments and a cautious lithotripsy is performed to create enough space to introduce the guidewire beyond the stone under visual control. Once the access has been stabilized the surgeon can upsize the tract to the optimum to complete the procedure. Additionally, the technique can be employed when an intraoperative reassessment induces the surgeon to further dilate the tract to quicken the procedure. RESULTS Sixteen patients were included, with a median stone volume of 3.49 cm3. Median operative time was 112 minutes. Three Clavien I-II (postoperative fever) and one Clavien IIIB (colon perforation) complications were reported. No blood transfusions were recorded. Three patients underwent scheduled retreatment as part of a multistep procedure. Out of the remaining 13 patients, 10 (76.9%) obtained a complete stone clearance. CONCLUSIONS The Matryoshka technique helps the urologist to obtain a secure percutaneous access and makes PCNL flexible and progressive, potentially minimizing the risk of access-related complications.
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Affiliation(s)
| | - Matteo Fontana
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Urology, Milan.
| | - Elena Lievore
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Urology, Milan.
| | - Matteo Turetti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Urology, Milan.
| | - Fabrizio Longo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Urology, Milan.
| | - Elisa De Lorenzis
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Urology, Milan; Department of Clinical Sciences and Community Health, University of Milan, Department of Urology, Milan.
| | - Giancarlo Albo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Urology, Milan; Department of Clinical Sciences and Community Health, University of Milan, Department of Urology, Milan.
| | - Emanuele Montanari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Urology, Milan; Department of Clinical Sciences and Community Health, University of Milan, Department of Urology, Milan.
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Lievore E, Runza L, Ghidini M, Galassi B, Gallioli A, Bebi C, Boeri L, Blundo C, Rossi CF, Longo F, Albo G, Montanari E, DE Lorenzis E. Micropapillary Bladder Cancer Metastatic to the Breast: A Case Report and Brief Literature Review. In Vivo 2021; 35:453-459. [PMID: 33402496 DOI: 10.21873/invivo.12278] [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: 09/24/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Bladder cancer (BC) usually metastasizes to the lymph nodes, bone, lung, liver and peritoneum, but rarely in the breast. CASE REPORT We present a case of a 66-year-old female diagnosed with a massive bladder tumor, who presented a right mammary nodule after neo-adjuvant chemotherapy. A biopsy of the nodule did not permit a definite diagnosis of metastatic spread, which was confirmed by excision of the nodule. In the literature, we found only 7 other similar cases of BC metastasis to the breast. Currently, a non-invasive method for differentiating a breast metastasis from primary cancer is lacking, although there are some clinical and radiological aspects that may help the diagnosis. Histological examination provides diagnostic certainty. CONCLUSION Breast metastases from BC are unusual and consequently difficult to identify without non-invasive tools. Clinical history and histological study play a pivotal role in determining the correct diagnosis.
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Affiliation(s)
- Elena Lievore
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Letterio Runza
- Department of Anatomical Pathology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Ghidini
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Barbara Galassi
- Department of Oncology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Gallioli
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carolina Bebi
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Concetta Blundo
- Department of Breast Surgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Francesca Rossi
- Department of Breast Surgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabrizio Longo
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Elisa DE Lorenzis
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; .,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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20
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Bebi C, Turetti M, Lievore E, Ripa F, Rocchini L, Spinelli MG, De Lorenzis E, Albo G, Longo F, Gadda F, Dell’Orto PG, Salonia A, Montanari E, Boeri L. Bipolar Transurethral Enucleation of the Prostate: Is it a size-independent endoscopic treatment option for symptomatic benign prostatic hyperplasia? PLoS One 2021; 16:e0253083. [PMID: 34106986 PMCID: PMC8189479 DOI: 10.1371/journal.pone.0253083] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/27/2021] [Indexed: 12/23/2022] Open
Abstract
Background Bipolar Transurethral Enucleation of the Prostate (B-TUEP) is recommended as a first-choice treatment for benign prostatic obstruction in prostates >80 ml. Differently, B-TUEP is only considered as an alternative option after TURP for smaller prostates (30–80 ml). The aim of our study is to assess the relation between prostate size and surgical outcomes after B-TUEP. Methods We performed a retrospective analysis of data collected from 172 patients submitted to B-TUEP. Patients were segregated according to tertiles of prostate volume (PV) (≤60 ml, 61–110 ml, >110 ml). For each group we evaluated enucleation efficacy (enucleated weight/enucleation time), complication rates, urinary and sexual function parameters. Functional and sexual parameters were compared between groups at baseline, 1 and 3 months follow up. Descriptive statistics and linear and logistic regression models tested the association between PV and postoperative complications/outcomes. Results Operative time and weight of enucleated adenomas increased along with prostate volumes (all p≤0.01). Enucleation efficacy was higher in men with PV >110 ml compared to other groups (p≤0.001). Length of hospital stay, catheterization time and rates of postoperative complications, such as transfusion and clot evacuation rates and bladder neck/urethral strictures, were comparable between groups. Urinary symptoms improved at 1-and 3-months in each group as compared to baseline evaluation (all p<0.01) but they did not differ according to PV. In each group maximum urinary flow and post-void residual volume significantly improved at 3 months compared to baseline (all p≤0.01), without differences according to PV. Sexual symptoms were similar between groups at each follow up assessment. At multivariable linear and logistic regression analysis, prostate volume was not associated with postoperative functional outcomes and complications. Conversely, patient’s comorbid status and antiplatelet/anticoagulation use were independently associated with postoperative complications. Conclusion According to our findings, B-TUEP should be considered a “size independent procedure” as it can provide symptom relief in men with prostates of all sizes with the same efficacy and safety profile.
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Affiliation(s)
- Carolina Bebi
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Matteo Turetti
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elena Lievore
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Francesco Ripa
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Lorenzo Rocchini
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Matteo Giulio Spinelli
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Fabrizio Longo
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Franco Gadda
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Guido Dell’Orto
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- * E-mail:
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21
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Bebi C, Fulgheri I, Spinelli M, Turetti M, Lievore E, Ripa F, Rocchini L, De Lorenzis E, Albo G, D’Amico M, Carrafiello G, Montanari E, Boeri L. Development of a novel clinical and radiological risk score to predict septic complications in patients with obstructive uropathy. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00532-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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Lievore E, Boeri L, Zanetti SP, Fulgheri I, Fontana M, Turetti M, Bebi C, Botticelli F, Gallioli A, Longo F, Brambilla R, Campoleoni M, De Lorenzis E, Montanari E, Albo G. Clinical Comparison of Mini-Percutaneous Nephrolithotomy with Vacuum Cleaner Effect or with a Vacuum-Assisted Access Sheath: A Single-Center Experience. J Endourol 2021; 35:601-608. [PMID: 33076705 DOI: 10.1089/end.2020.0555] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Indexed: 11/12/2022] Open
Abstract
Purpose: To compare outcomes of two different miniaturized percutaneous nephrolithotomy (PCNL) techniques: minimally invasive PCNL (MIP) with the vacuum cleaner effect and vacuum-assisted mini-PCNL (vmPCNL). Materials and Methods: Data from 104 (66.7%) patients who underwent vmPCNL and 52 (33.3%) patients who underwent MIP at a single tertiary referral academic center between January 2016 and December 2019 were analyzed. Patient demographics and peri- and postoperative data were recorded, and propensity score matching was performed. Descriptive statistics and linear regression models were used to identify variables associated with operative time (OT) and patient effective dose. Logistic regression analyses were used to identify factors associated with infectious complications and stone-free (SF) status. Results: Patient demographics and stone characteristics were comparable between groups. vmPCNL was associated with shorter OT (p < 0.001), fluoroscopy time, and patient effective dose (4.2 mSv vs 7.9 mSv; p < 0.001). A higher rate of infectious complications was found in the MIP group (25.0% vs 7.7%, p < 0.01). Linear regression analysis showed that stone volume, multiple stones, and MIP procedure (all p values ≤0.02) were associated with longer OT. Similarly, OT and the MIP procedure (p ≤ 0.02) were associated with higher patient effective dose. Logistic regression analysis revealed that the stone volume, positive preoperative bladder urine culture, and MIP procedure (all p values ≤0.02) were associated with postoperative infectious complications. vmPCNL was not associated with the SF rate. Conclusions: Mini-PCNL performed with continuous active suction is associated with lower rates of infectious complications, shorter OT, and lower patient effective dose than MIP.
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Affiliation(s)
- Elena Lievore
- Department of Urology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Irene Fulgheri
- Department of Pharmacy, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Fontana
- Department of Urology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Matteo Turetti
- Department of Urology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Carolina Bebi
- Department of Urology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Francesco Botticelli
- Department of Urology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Andrea Gallioli
- Department of Urology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Fabrizio Longo
- Department of Urology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Roberto Brambilla
- Health Physics Unit, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Mauro Campoleoni
- Health Physics Unit, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Gallioli A, Albo G, Lievore E, Boeri L, Longo F, Spinelli MG, Costantino G, Montanari E, De Lorenzis E. How the COVID-19 Wave Changed Emergency Urology: Results From an Academic Tertiary Referral Hospital in the Epicentre of the Italian Red Zone. Urology 2021; 147:43-49. [PMID: 33010292 PMCID: PMC7527349 DOI: 10.1016/j.urology.2020.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/07/2020] [Accepted: 09/20/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To quantify and characterize the burden of urological patients admitted to emergency department (ED) in Lombardy during Italian COVID-19 outbreak, comparing it to a reference population from 2019. METHODS We retrospectively analysed all consecutive admissions to ED from 1 January to 9 April in both 2019 and 2020. According to the ED discharge ICD-9-CM code, patients were grouped in urological and respiratory patients. We evaluated the type of access (self-presented/ambulance), discharge priority code, ED discharge (hospitalization, home), need for urological consultation or urgent surgery. RESULTS The number of urological diagnoses in ED was inversely associated to COVID-19 diagnoses (95% confidence interval -0.41/-0.19; Beta = -0.8; P < .0001). The average access per day was significantly lower after 10 March 2020 (1.5 ± 1.1 vs 6.5 ± 2.6; P < .0001), compared to reference period. From 11 March 2020, the inappropriate admissions to ED were reduced (10/45 vs 96/195; P = .001). Consequently, the patients admitted were generally more demanding, requiring a higher rate of urgent surgeries (4/45 vs 4/195; P = .02). This reflected in an increase of the hospitalization rate from 12.7% to 17.8% (Beta = 0.88; P < .0001) during 2020. CONCLUSION Urological admissions to ED during lockdown differed from the same period of 2019 both qualitatively and quantitatively. The spectrum of patients seems to be relatively more critical, often requiring an urgent management. These patients may represent a challenge due to the difficult circumstances caused by the pandemic.
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Affiliation(s)
- Andrea Gallioli
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Giancarlo Albo
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Elena Lievore
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Luca Boeri
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Fabrizio Longo
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Giorgio Costantino
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Emergency Department & Emergency Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Montanari
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Elisa De Lorenzis
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
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Bebi C, Turetti M, Lievore E, Ripa F, Bilato M, Rocchini L, Gallioli A, Spinelli MG, De Lorenzis E, Albo G, Longo F, Gadda F, Dell'Orto PG, Montanari E, Boeri L. Sexual and ejaculatory function after holmium laser enucleation of the prostate and bipolar transurethral enucleation of the prostate: a single-center experience. Int J Impot Res 2020; 34:71-80. [PMID: 33082545 DOI: 10.1038/s41443-020-00366-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/29/2020] [Accepted: 10/09/2020] [Indexed: 12/20/2022]
Abstract
Currently available surgical treatments for Lower Urinary Tract Symptoms (LUTS) due to Benign Prostatic Obstruction (BPO) are associated with an increased risk of sexual dysfunction. The aim of our study is to compare sexual and ejaculatory function after Holmium Laser Enucleation of the Prostate (HoLEP) and Bipolar Transurethral Enucleation of the Prostate (B-TUEP). We performed a retrospective analysis of data prospectively collected from 62 (44.9%) and 76 (55.1%) patients who underwent HoLEP and B-TUEP, respectively. Erectile function and ejaculation characteristics were assessed with the International Index of Erectile Function-Erectile Function (IIEF-EF) domain and the Male Sexual Health Questionnaire-Ejaculatory function (MSHQ-EJ) questionnaires. Our study recorded no change in erectile function and no significant difference in rates of preserved antegrade ejaculation after both surgeries. One month after surgery, rates of physical pain/discomfort and perceived decreased physical pleasure during ejaculation were higher in HoLEP than B-TUEP patients (all p < 0.03). Moreover, HoLEP patients were more bothered by their ejaculatory difficulties than B-TUEP men (p = 0.03). At 3- and 12-months follow-up, all ejaculation-related differences disappeared. In conclusion, both procedures are valid alternatives for BPO treatment as they offer comparable urinary and sexual outcomes in the long term. However, in the first month after surgery, HoLEP patients present with more ejaculatory difficulties.
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Affiliation(s)
- Carolina Bebi
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Matteo Turetti
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elena Lievore
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Francesco Ripa
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Marco Bilato
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Lorenzo Rocchini
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Andrea Gallioli
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Matteo Giulio Spinelli
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Fabrizio Longo
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Franco Gadda
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Guido Dell'Orto
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
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Lievore E, Zanetti S, Boeri L, Turetti M, Gallioli A, Fontana M, Longo F, De Lorenzis E, Albo G, Montanari E. Holmium laser lithotripsy enhanced by Moses™ technology in percutaneous nephrolithotomy: preliminary results from a comparative study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35424-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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26
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Zanetti S, Lievore E, Fontana M, Turetti M, Gallioli A, Rocchini L, Longo F, Albo G, De Lorenzis E, Montanari E. Renal pelvic pressure fluctuations during vacuum assisted mini-PCNL: May this technique help reducing infectious complications? EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33274-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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