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Totaro A, Scarciglia E, Marino F, Campetella M, Gandi C, Ragonese M, Bientinesi R, Palermo G, Bizzarri FP, Cretì A, Presutti S, Russo A, Aceto P, Bassi P, Pierconti F, Racioppi M, Sacco E. Robot-Assisted Radical Prostatectomy Performed with the Novel Surgical Robotic Platform Hugo™ RAS: Monocentric First Series of 132 Cases Reporting Surgical, and Early Functional and Oncological Outcomes at a Tertiary Referral Robotic Center. Cancers (Basel) 2024; 16:1602. [PMID: 38672683 PMCID: PMC11049006 DOI: 10.3390/cancers16081602] [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: 03/13/2024] [Revised: 04/07/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Robotic-assisted surgery is the gold standard for performing radical prostatectomy (RARP), with new robotic devices such as HugoTM RAS gaining prominence worldwide. OBJECTIVE We report the surgical, perioperative, and early postoperative outcomes of RARP using HugoTM RAS. DESIGN, SETTING, AND PARTICIPANTS Between April 2022 and October 2023, we performed 132 procedures using the Montsouris technique with a four-robotic-arm configuration in patients with biopsy-proven prostate cancer (PCa). OUTCOME MEASURES We collected intraoperative and perioperative data during hospitalization, along with follow-up data at predefined postoperative intervals of 3 and 6 months. RESULTS AND LIMITATIONS Lymphadenectomy was performed in 25 procedures, with a bilateral nerve-sparing technique in 33 and a monolateral nerve-sparing technique in 33 cases. The mean total surgery time was 242 (±57) min, the mean console time was 124 (±48) min, and the mean docking time was 10 (±2) min. We identified 17 system errors related to robotic arm failures, 9 robotic instrument breakdowns, and 8 significant conflicts between robotic arms. One post-operative complication was classified as Clavien-Dindo 3b. None of the adverse events, whether singular or combined, increased the operative time. Positive margins (pR1) were found in 54 (40.9%) histological specimens, 37 (28.0%) of which were clinically significant. At 3 and 6 months post-surgery, the PSA levels were undetectable in 94.6% and 92.1% of patients, respectively. Social urinary continence was regained in 86% after 6 months. Limitations of our study include its observational monocentric case-series design and the short follow-up data for functional and oncological outcomes. CONCLUSIONS Our initial experience highlights the reliability of the HugoTM RAS system in performing RARP. Additionally, we also list problems and solutions found in our daily work.
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Affiliation(s)
- Angelo Totaro
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Eros Scarciglia
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Filippo Marino
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Marco Campetella
- Department of Urology, Isola Tiberina—Gemelli Isola Hospital, Catholic University Medical School, 00167 Rome, Italy
| | - Carlo Gandi
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Mauro Ragonese
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Riccardo Bientinesi
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Giuseppe Palermo
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Francesco Pio Bizzarri
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Antonio Cretì
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Simona Presutti
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Andrea Russo
- Department of Anesthesia, Emergency and Intensive Care Medicine, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Paola Aceto
- Department of Anesthesia, Emergency and Intensive Care Medicine, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Pierfrancesco Bassi
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Francesco Pierconti
- Department of Pathological Anatomy, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Marco Racioppi
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Emilio Sacco
- Department of Urology, Isola Tiberina—Gemelli Isola Hospital, Catholic University Medical School, 00167 Rome, Italy
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Ferro M, Chiujdea S, Vartolomei MD, Bove P, Porreca A, Busetto GM, Del Giudice F, Antonelli A, Foschi N, Racioppi M, Autorino R, Chiancone F, Longo N, Barone B, Crocetto F, Musi G, Luzzago S, Piccinelli ML, Mistretta FA, de Cobelli O, Tataru OS, Hurle R, Liguori G, Borghesi M, Veccia A, Greco F, Schips L, Marchioni M, Lucarelli G, Dutto D, Colucci F, Russo GI, Giudice AL, Montanari E, Boeri L, Simone G, Rosazza M, Livoti S, Gontero P, Soria F. Advanced Age Impacts Survival After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma. Clin Genitourin Cancer 2024; 22:27-37. [PMID: 37661507 DOI: 10.1016/j.clgc.2023.08.001] [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: 03/23/2023] [Revised: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION Upper tract urothelial carcinoma is rare but has a poor prognosis. Prognostic factors have been extensively studied in order to provide the best possible management for patients. We have aimed to investigate commonly available factors predictive of recurrence and survival in this patient population at high risk of death and recurrence, with an emphasis on the effects of age (using a cutoff of 70 years) on survival outcomes. PATIENTS AND METHODS From 1387 patients with clinically nonmetastatic upper tract urothelial carcinoma treated with radical nephroureterectomy at 21 academic hospital centers between 2005 and 2021, 776 patients were eligible and included in the study. Univariable and multivariable Cox regression models were built to evaluate the independent prognosticators for intravesical and extravesical recurrence, overall survival, and cancer-specific survival according to age groups. A P value of <.05 was considered statistically significant. RESULTS We did not find an association between groups aged <70 and >70 years old and preoperatively clinical or histopathological characteristics. Kaplan-Meier analysis was found no statistical significance between the 2 age groups in terms of intravesical or extravesical recurrence (P = .09 and P = .57). Overall survival (P = .0001) and cancer-specific survival (P = .0001) have been found to be statistically significantly associated with age as independent predictors (confounding factors: gender, tumor size, tumor side, clinical T stage, localization, preoperative hydronephrosis, tumor localization, type of surgery, multifocality of the tumor, pathological grade, lymphovascular invasion, concomitant CIS, lymph node status, necrosis, or history of previous bladder cancer). CONCLUSION This research confirms that patients aged 70 and above who undergo radical nephroureterectomy may have worse outcomes compared to younger patients, older patients needing an improved care and management of UTUC to improve their outcomes in the setting of an increase in this aged population group.
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Affiliation(s)
- Matteo Ferro
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy.
| | - Sever Chiujdea
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Urology, Medical University of Vienna, Wien, Austria; The Institution Organizing University Doctoral Studies (I.O.S.U.D.), George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, Târgu Mureș, Romania
| | - Mihai Dorin Vartolomei
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Urology, Medical University of Vienna, Wien, Austria; The Institution Organizing University Doctoral Studies (I.O.S.U.D.), George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, Târgu Mureș, Romania
| | - Pierluigi Bove
- San Carlo di Nancy Hospital, Rome, Italy; Department of Experimental Medicine, Tor vergata Oncoscience Research Centre of Excellence, TOR, University of Rome Tor Vergata, Rome, Italy
| | - Angelo Porreca
- Oncological Urology, Veneto Institute of Oncology (IOV), IRCCS, Padua, Italy
| | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Nazario Foschi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Nicola Longo
- Urology Unit, Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Biagio Barone
- Urology Unit, Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Felice Crocetto
- Urology Unit, Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Stefano Luzzago
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | | | | | - Ottavio de Cobelli
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Octavian Sabin Tataru
- The Institution Organizing University Doctoral Studies (I.O.S.U.D.), George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, Târgu Mureș, Romania; Department of Simulation Applied in Medicine, George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, Târgu Mureș, Romania
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Giovanni Liguori
- Urology Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Marco Borghesi
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Integrated Sciences (DISC), Urology Section, University of Genova, Genova, Italy
| | - Alessandro Veccia
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Francesco Greco
- Department of Urology, IRCCS Humanitas Gavazzeni, Bergamo, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio, University of Chieti, Chieti, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio, University of Chieti, Chieti, Italy
| | - Giuseppe Lucarelli
- Urology, Andrology and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Daniele Dutto
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Fulvia Colucci
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Giorgio Ivan Russo
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - Arturo Lo Giudice
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - Emanuele Montanari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Boeri
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Matteo Rosazza
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Simone Livoti
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
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Gavi F, Foschi N, Fettucciari D, Russo P, Giannarelli D, Ragonese M, Gandi C, Balocchi G, Francocci A, Bizzarri FP, Marino F, Filomena GB, Palermo G, Totaro A, Racioppi M, Bientinesi R, Sacco E. Assessing Trifecta and Pentafecta Success Rates between Robot-Assisted vs. Open Radical Cystectomy: A Propensity Score-Matched Analysis. Cancers (Basel) 2024; 16:1270. [PMID: 38610948 PMCID: PMC11011078 DOI: 10.3390/cancers16071270] [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: 02/06/2024] [Revised: 03/13/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the surgical and oncological outcomes of robot-assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) using trifecta and pentafecta parameters. METHODS The clinical data of 41 patients who underwent RARC between 2018 and 2022 were prospectively collected and retrospectively compared to those of 330 patients undergoing ORC using 1:1 propensity score matching. Trifecta was defined as simultaneous negative surgical margins (SMs), a lymph node (LN) yield ≥ 16, and the absence of major complications (Clavien-Dindo grade III-V) within 90 days postoperatively. Pentafecta additionally included a 12-month recurrence-free rate and a time between the transurethral resection of a bladder tumor (TURBT) and radical cystectomy (RC) ≤ 3 months. The continuous variables were compared using the Mann-Whitney U test, and the categorical variables were analyzed using the chi-squared test. RESULTS No statistically significant differences in trifecta and pentafecta success rates were observed between the RARC and ORC cohorts after propensity score matching. However, the RARC group exhibited significantly reduced blood loss (RARC: 317 mL vs. ORC: 525 mL, p = 0.01). CONCLUSIONS RARC offers distinct advantages over ORC in terms of reduced blood loss, while trifecta and pentafecta success rates do not differ significantly between the two surgical approaches.
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Affiliation(s)
- Filippo Gavi
- Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.)
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Nazario Foschi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Daniele Fettucciari
- Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.)
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Pierluigi Russo
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Diana Giannarelli
- Facility of Epidemiology and Biostatistics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy
| | - Mauro Ragonese
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Carlo Gandi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Giovanni Balocchi
- Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.)
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Alessandra Francocci
- Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.)
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Francesco Pio Bizzarri
- Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.)
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Filippo Marino
- Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.)
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Giovanni Battista Filomena
- Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.)
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Giuseppe Palermo
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Angelo Totaro
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Marco Racioppi
- Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.)
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Riccardo Bientinesi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
| | - Emilio Sacco
- Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.)
- Urology Department, Isola Tiberina Gemelli Isola Hospital, Catholic University Medical School, 00168 Rome, Italy
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Gavi F, Ragonese M, Fettucciari D, Bientinesi R, Gandi C, Campetella M, Marino F, Racioppi M, Sacco E, Foschi N. Efficacy of transurethral botulinum toxin A injections for bladder outlet obstruction: A systematic review and meta-analysis. Urologia 2024:3915603241228166. [PMID: 38372240 DOI: 10.1177/03915603241228166] [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: 02/20/2024]
Abstract
INTRODUCTION Botulinum toxin A (BoNT-A) injections in the prostate gland have been used as a minimally invasive option for treating bladder outlet obstruction (BOO). However, the efficacy of transurethral BoNT-A injections for BOO is not well established in the literature. The aim of this study is to collect evidence on the efficacy of transurethral BoNT-A injections for the treatment of BOO. MATERIALS AND METHODS This systematic review and meta-analyses was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. A systematic literature search was performed till December 2022. The study population consisted of adult patients diagnosed with BOO, who underwent transurethral injections of BoNT-A for the treatment of BOO. EVIDENCE SYNTHESIS Out of 883 records, we identified seven studies enrolling 232 participants, of which only one nonrandomized controlled trial was found. Four prospective studies and two retrospective studies. Three studies included patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) and were included in the meta-analysis. Three studies included patients with urethral sphincter hyperactivity. One study included patients with primary bladder neck disease (PBND). All studies showed significant improvements from baseline in maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual (PVR) at 3 and 6 months. The adverse events were mild in all studies. Hematuria, UTI, and urinary retention were reported across all studies. CONCLUSION In conclusion, transurethral BoNT-A injections have been shown to improve LUTS, QoL, and urodynamic parameters of individuals with BOO at 3 and 6 months after injections, and no serious adverse effects have been reported. However, data on the long-term benefits of this treatment are scarce, and more prospective, randomized studies with larger samples examining various injection techniques, dosages, and extended follow-up of recurrent injections are needed.
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Affiliation(s)
- Filippo Gavi
- Postgraduate School of Urology, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mauro Ragonese
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Daniele Fettucciari
- Postgraduate School of Urology, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Riccardo Bientinesi
- Department of Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, University of Sacred Heart, Rome, Italy
| | - Carlo Gandi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Campetella
- Urology Department, Isola Tiberina-Gemelli Isola Hospital, Catholic University Medical School, Rome, Italy
| | - Filippo Marino
- Postgraduate School of Urology, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Racioppi
- Department of Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, University of Sacred Heart, Rome, Italy
| | - Emilio Sacco
- Urology Department, Isola Tiberina-Gemelli Isola Hospital, Catholic University Medical School, Rome, Italy
| | - Nazario Foschi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Russo P, Palermo G, Iacovelli R, Ragonese M, Ciccarese C, Maioriello G, Fantasia F, Bizzarri FP, Marino F, Moosavi K, Nigro D, Filomena GB, Gavi F, Rossi F, Pinto F, Racioppi M, Foschi N. Comparison of PIV and Other Immune Inflammation Markers of Oncological and Survival Outcomes in Patients Undergoing Radical Cystectomy. Cancers (Basel) 2024; 16:651. [PMID: 38339402 PMCID: PMC10854772 DOI: 10.3390/cancers16030651] [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: 12/29/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Inflammation is widely acknowledged as a significant characteristic of cancer, playing a substantial function in both the initiation and advancement of cancers. In this research, we planned to compare pan-immune inflammation markers and other well-known markers (systemic immune inflammation index and neutrophil to lymphocyte ratio) to predict prognosis in individuals treated with radical cystectomy for bladder cancer. METHODS In this retrospective analysis, we focused on preoperative PIV, systemic immune inflammation index (SII), and neutrophil-lymphocyte ratio (NLR) in 193 individuals managed with radical cystectomy for bladder cancer between January 2016 and November 2022. Multivariable logistic regression assessments were performed to assess the predictive capabilities of PIV, SII, and NLR for infiltration of lymph nodes (N), aggressive tumor stage (pT3/pT4), and any non-organ limited disease at the time of RC. Multivariable Cox regression analyses were conducted to assess the predictive impact of PIV on Relapse-free survival (RFS), Cancer-specific survival (CSS), and Overall survival (OS). RESULTS Our individuals were divided into high PIV and low PIV cohorts using the optimal cut-off value (340.96 × 109/L) based on receiver operating characteristic curve analysis for relapse-free survival. In multivariable preoperative logistic regression models, only SII and PIV correlated with the infiltration of lymph nodes, aggressive disease, and any non-organ confined disease. In multivariable Cox regression models considering presurgical clinicopathological variables, a higher PIV was associated with diminished RFS (p = 0.017) and OS (p = 0.029). In addition, in multivariable Cox regression models for postoperative outcomes, a high PIV correlated with both RFS (p = 0.034) and OS (p = 0.048). CONCLUSIONS Our study suggests that PIV and SII are two very similar markers that may serve as independent and significant predictors of aggressive disease and worse survival impacts on individuals undergoing radical cystectomy for bladder neoplasm.
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Affiliation(s)
- Pierluigi Russo
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy; (P.R.); (M.R.); (G.M.); (F.F.); (F.P.B.); (F.M.); (K.M.); (D.N.); (G.B.F.); (F.G.); (F.R.); (F.P.); (M.R.); (N.F.)
| | - Giuseppe Palermo
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy; (P.R.); (M.R.); (G.M.); (F.F.); (F.P.B.); (F.M.); (K.M.); (D.N.); (G.B.F.); (F.G.); (F.R.); (F.P.); (M.R.); (N.F.)
| | - Roberto Iacovelli
- Department of Oncology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy; (R.I.); (C.C.)
| | - Mauro Ragonese
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy; (P.R.); (M.R.); (G.M.); (F.F.); (F.P.B.); (F.M.); (K.M.); (D.N.); (G.B.F.); (F.G.); (F.R.); (F.P.); (M.R.); (N.F.)
| | - Chiara Ciccarese
- Department of Oncology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy; (R.I.); (C.C.)
| | - Giuseppe Maioriello
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy; (P.R.); (M.R.); (G.M.); (F.F.); (F.P.B.); (F.M.); (K.M.); (D.N.); (G.B.F.); (F.G.); (F.R.); (F.P.); (M.R.); (N.F.)
| | - Fabrizio Fantasia
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy; (P.R.); (M.R.); (G.M.); (F.F.); (F.P.B.); (F.M.); (K.M.); (D.N.); (G.B.F.); (F.G.); (F.R.); (F.P.); (M.R.); (N.F.)
| | - Francesco Pio Bizzarri
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy; (P.R.); (M.R.); (G.M.); (F.F.); (F.P.B.); (F.M.); (K.M.); (D.N.); (G.B.F.); (F.G.); (F.R.); (F.P.); (M.R.); (N.F.)
| | - Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy; (P.R.); (M.R.); (G.M.); (F.F.); (F.P.B.); (F.M.); (K.M.); (D.N.); (G.B.F.); (F.G.); (F.R.); (F.P.); (M.R.); (N.F.)
| | - Koosha Moosavi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy; (P.R.); (M.R.); (G.M.); (F.F.); (F.P.B.); (F.M.); (K.M.); (D.N.); (G.B.F.); (F.G.); (F.R.); (F.P.); (M.R.); (N.F.)
| | - Domenico Nigro
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy; (P.R.); (M.R.); (G.M.); (F.F.); (F.P.B.); (F.M.); (K.M.); (D.N.); (G.B.F.); (F.G.); (F.R.); (F.P.); (M.R.); (N.F.)
| | - Giovanni Battista Filomena
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy; (P.R.); (M.R.); (G.M.); (F.F.); (F.P.B.); (F.M.); (K.M.); (D.N.); (G.B.F.); (F.G.); (F.R.); (F.P.); (M.R.); (N.F.)
| | - Filippo Gavi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy; (P.R.); (M.R.); (G.M.); (F.F.); (F.P.B.); (F.M.); (K.M.); (D.N.); (G.B.F.); (F.G.); (F.R.); (F.P.); (M.R.); (N.F.)
| | - Francesco Rossi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy; (P.R.); (M.R.); (G.M.); (F.F.); (F.P.B.); (F.M.); (K.M.); (D.N.); (G.B.F.); (F.G.); (F.R.); (F.P.); (M.R.); (N.F.)
| | - Francesco Pinto
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy; (P.R.); (M.R.); (G.M.); (F.F.); (F.P.B.); (F.M.); (K.M.); (D.N.); (G.B.F.); (F.G.); (F.R.); (F.P.); (M.R.); (N.F.)
| | - Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy; (P.R.); (M.R.); (G.M.); (F.F.); (F.P.B.); (F.M.); (K.M.); (D.N.); (G.B.F.); (F.G.); (F.R.); (F.P.); (M.R.); (N.F.)
| | - Nazario Foschi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy; (P.R.); (M.R.); (G.M.); (F.F.); (F.P.B.); (F.M.); (K.M.); (D.N.); (G.B.F.); (F.G.); (F.R.); (F.P.); (M.R.); (N.F.)
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Campetella M, Filomena GB, Marino F, Fantasia F, Russo P, Gavi F, Rossi F, Gandi C, Ragonese M, Foschi N, Totaro A, Sacco E, Racioppi M, Bientinesi R. Etiology, presentation and management of urinary tract infections in multiple sclerosis patients: A review of the current literature. Urologia 2024:3915603231224511. [PMID: 38279809 DOI: 10.1177/03915603231224511] [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: 01/29/2024]
Abstract
Urinary tract infections (UTIs) present a formidable challenge in the care of individuals affected by multiple sclerosis (MS). Lower urinary tract dysfunction is a prevalent issue among MS patients, predisposing them to an elevated risk of UTIs. When left untreated, UTIs can further exacerbate the already compromised quality of life in individuals with MS. The diagnosis and management of UTIs in MS patients necessitate a careful clinical evaluation. The objective of this review is to delineate preventive strategies and current and developing therapeutic approaches for preventing and treating UTIs associated with urinary dysfunction, catheterization, and upper urinary tract infections in patients with MS. Effectively addressing UTIs and urinary tract dysfunction in individuals with multiple sclerosis calls for a comprehensive, interdisciplinary approach.
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Affiliation(s)
- Marco Campetella
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - G B Filomena
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Marino
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Fantasia
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Russo
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Gavi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Rossi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Gandi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Ragonese
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - N Foschi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Totaro
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Sacco
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Racioppi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Bientinesi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
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Filomena GB, Marino F, Scarciglia E, Russo P, Fantasia F, Bientinesi R, Ragonese M, Foschi N, Gulino G, Sacco E, Racioppi M. Simultaneous surgical management of renal cancer with atrial thrombotic extension and severe chronic coronary artery disease: a case report. J Med Case Rep 2023; 17:543. [PMID: 38087378 PMCID: PMC10717298 DOI: 10.1186/s13256-023-04292-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Renal cell carcinoma accounts for 2-3% of all malignant cancers in adults and is characterized by the potential development of venous tumor thrombus. CASE PRESENTATION We present a rare case of a 62-year-old Caucasian man who arrived in the emergency department for monosymptomatic hematuria. Further investigation revealed a right renal cell carcinoma with 16 cm intravascular extension through the renal vein into the inferior vena cava and right atrium associated with significant coronary artery disease based on the computed tomography scan and coronary angiography. To the best of our knowledge, after an extensive literature review, only one similar case has been reported with involvement of the contralateral kidney. Therefore, there are no applicable management recommendations. After performing coronary artery bypass graft surgery, we proceeded with an open right radical nephrectomy and inferior vena cava and right atrium thrombectomy under cardiopulmonary bypass and while the patient's heart was still beating. The postoperative course went without complications, and the patient was discharged from the hospital on the 10th postoperative day. CONCLUSIONS Radical nephrectomy and thrombectomy with reconstruction of the inferior vena cava combined with coronary artery bypass graft can be performed safely and effectively in selected patients with renal cell carcinoma and significant coronary artery disease. Multidisciplinary teamwork and careful patient selection are essential for optimal outcomes.
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Affiliation(s)
- Giovanni Battista Filomena
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eros Scarciglia
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pierluigi Russo
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabrizio Fantasia
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Bientinesi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mauro Ragonese
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nazario Foschi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gaetano Gulino
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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8
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Falagario UG, Lantz A, Jambor I, Busetto GM, Bettocchi C, Finati M, Ricapito A, Luzzago S, Ferro M, Musi G, Totaro A, Racioppi M, Carbonara U, Checcucci E, Manfredi M, D'Aietti D, Porcaro AB, Nordström T, Björnebo L, Oderda M, Soria F, Taimen P, Aronen HJ, Perez IM, Ettala O, Marchioni M, Simone G, Ferriero M, Brassetti A, Napolitano L, Carmignani L, Signorini C, Conti A, Ludovico G, Scarcia M, Trombetta C, Claps F, Traunero F, Montanari E, Boeri L, Maggi M, Del Giudice F, Bove P, Forte V, Ficarra V, Rossanese M, Mucciardi G, Pagliarulo V, Tafuri A, Mirone V, Schips L, Antonelli A, Gontero P, Cormio L, Sciarra A, Porpiglia F, Bassi P, Ditonno P, Boström PJ, Messina E, Panebianco V, De Cobelli O, Carrieri G. Diagnosis of prostate cancer with magnetic resonance imaging in men treated with 5-alpha-reductase inhibitors. World J Urol 2023; 41:2967-2974. [PMID: 37787941 PMCID: PMC10632288 DOI: 10.1007/s00345-023-04634-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
PURPOSE The primary aim of this study was to evaluate if exposure to 5-alpha-reductase inhibitors (5-ARIs) modifies the effect of MRI for the diagnosis of clinically significant Prostate Cancer (csPCa) (ISUP Gleason grade ≥ 2). METHODS This study is a multicenter cohort study including patients undergoing prostate biopsy and MRI at 24 institutions between 2013 and 2022. Multivariable analysis predicting csPCa with an interaction term between 5-ARIs and PIRADS score was performed. Sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values of MRI were compared in treated and untreated patients. RESULTS 705 patients (9%) were treated with 5-ARIs [median age 69 years, Interquartile range (IQR): 65, 73; median PSA 6.3 ng/ml, IQR 4.0, 9.0; median prostate volume 53 ml, IQR 40, 72] and 6913 were 5-ARIs naïve (age 66 years, IQR 60, 71; PSA 6.5 ng/ml, IQR 4.8, 9.0; prostate volume 50 ml, IQR 37, 65). MRI showed PIRADS 1-2, 3, 4, and 5 lesions in 141 (20%), 158 (22%), 258 (37%), and 148 (21%) patients treated with 5-ARIs, and 878 (13%), 1764 (25%), 2948 (43%), and 1323 (19%) of untreated patients (p < 0.0001). No difference was found in csPCa detection rates, but diagnosis of high-grade PCa (ISUP GG ≥ 3) was higher in treated patients (23% vs 19%, p = 0.013). We did not find any evidence of interaction between PIRADS score and 5-ARIs exposure in predicting csPCa. Sensitivity, specificity, PPV, and NPV of PIRADS ≥ 3 were 94%, 29%, 46%, and 88% in treated patients and 96%, 18%, 43%, and 88% in untreated patients, respectively. CONCLUSIONS Exposure to 5-ARIs does not affect the association of PIRADS score with csPCa. Higher rates of high-grade PCa were detected in treated patients, but most were clearly visible on MRI as PIRADS 4 and 5 lesions. TRIAL REGISTRATION The present study was registered at ClinicalTrials.gov number: NCT05078359.
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Affiliation(s)
- Ugo G Falagario
- Unit of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy.
| | - Anna Lantz
- Unit of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ivan Jambor
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Gian Maria Busetto
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Carlo Bettocchi
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Marco Finati
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Anna Ricapito
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Angelo Totaro
- Department of Urology, Catholic University Medical School "A. Gemelli" Hospital, Rome, Italy
| | - Marco Racioppi
- Department of Urology, Catholic University Medical School "A. Gemelli" Hospital, Rome, Italy
| | - Umberto Carbonara
- Department of Urology, Andrology and Kidney Transplantation, University of Bari, Bari, Italy
| | - Enrico Checcucci
- Department of Urology, Azienda Ospedaliera Universitaria "San Luigi Gonzaga", University of Turin, Turin, Italy
| | - Matteo Manfredi
- Department of Urology, Azienda Ospedaliera Universitaria "San Luigi Gonzaga", University of Turin, Turin, Italy
| | - Damiano D'Aietti
- UOC Urologia, Azienda Ospedaliera Universitaria Integrata Di Verona, Verona, Italy
| | | | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Björnebo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marco Oderda
- Department of Surgical Sciences, Città Della Salute E Della Scienza Di Torino, Molinette Hospital, Turin, Italy
| | - Francesco Soria
- Department of Surgical Sciences, Città Della Salute E Della Scienza Di Torino, Molinette Hospital, Turin, Italy
| | - Pekka Taimen
- Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Ileana Montoya Perez
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Otto Ettala
- Department of Urology, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | - Michele Marchioni
- Department of Urology, Università "G.d'Annunzio", Chieti-Pescara, Italy
| | - Giuseppe Simone
- Department of Oncologic Urology, IRCCS "Regina Elena" National Cancer Institute of Rome, Rome, Italy
| | - Mariaconsiglia Ferriero
- Department of Oncologic Urology, IRCCS "Regina Elena" National Cancer Institute of Rome, Rome, Italy
| | - Aldo Brassetti
- Department of Oncologic Urology, IRCCS "Regina Elena" National Cancer Institute of Rome, Rome, Italy
| | - Luigi Napolitano
- Department of Urology, University of Naples Federico II, Naples, Italy
| | | | | | | | - Giuseppe Ludovico
- Department of Urology, Ente Ecclesiastico Miulli, Acquaviva Delle Fonti, Italy
| | - Marcello Scarcia
- Department of Urology, Ente Ecclesiastico Miulli, Acquaviva Delle Fonti, Italy
| | | | | | | | - Emanuele Montanari
- Department of Urology, IRCCS Foundation Ca' Granda-Maggiore Policlinico Hospital, Milan, Italy
| | - Luca Boeri
- Department of Urology, IRCCS Foundation Ca' Granda-Maggiore Policlinico Hospital, Milan, Italy
| | - Martina Maggi
- Department of Maternal Infant and Urological Sciences, Sapienza Rome University, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urological Sciences, Sapienza Rome University, Rome, Italy
| | - Pierluigi Bove
- Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy
| | - Valerio Forte
- Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy
| | | | - Marta Rossanese
- Department of Urology, University of Messina, Messina, Italy
| | | | | | | | - Vincenzo Mirone
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Luigi Schips
- Department of Urology, Università "G.d'Annunzio", Chieti-Pescara, Italy
| | - Alessandro Antonelli
- UOC Urologia, Azienda Ospedaliera Universitaria Integrata Di Verona, Verona, Italy
| | - Paolo Gontero
- Department of Surgical Sciences, Città Della Salute E Della Scienza Di Torino, Molinette Hospital, Turin, Italy
| | - Luigi Cormio
- Unit of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Ospedale L. Bonomo, Andria, Italy
| | - Alessandro Sciarra
- Department of Maternal Infant and Urological Sciences, Sapienza Rome University, Rome, Italy
| | - Francesco Porpiglia
- Department of Urology, Azienda Ospedaliera Universitaria "San Luigi Gonzaga", University of Turin, Turin, Italy
| | - PierFrancesco Bassi
- Department of Urology, Catholic University Medical School "A. Gemelli" Hospital, Rome, Italy
| | - Pasquale Ditonno
- Department of Urology, Andrology and Kidney Transplantation, University of Bari, Bari, Italy
| | - Peter J Boström
- Department of Urology, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | - Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Ottavio De Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
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Campetella M, Marino F, Gavi F, Gandi C, Ragonese M, Coluzzi S, Racioppi M, Sacco E, Bientinesi R. Classification and management of sexual dysfunctions in multiple sclerosis patients: A review of current literature. Urologia 2023; 90:605-610. [PMID: 37387303 DOI: 10.1177/03915603231183751] [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] [Indexed: 07/01/2023]
Abstract
Multiple sclerosis (MS) is the most frequent neurological disease in young adults, with the greatest incidence between age of 30 and 35 years. Sexual dysfunctions (SDs) are frequent, but are often underestimated in patients with MS, and can have a significantly high impact on patient's quality of life. Aim of this review is to summarize sexual dysfunctions in male and female MS patients and to illustrate current and emerging therapeutic options for treatment.
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Affiliation(s)
- Marco Campetella
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Filippo Gavi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Carlo Gandi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Mauro Ragonese
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Simone Coluzzi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Riccardo Bientinesi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
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10
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Gandi C, Cosenza L, Campetella M, Marino F, Ragonese M, Bientinesi R, Totaro A, Racioppi M, Sacco E. What can the metaverse do for urology? Urologia 2023:3915603231175940. [PMID: 37265169 DOI: 10.1177/03915603231175940] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Everyone talks about the metaverse but few know what it really is. Augmented reality, virtual reality, internet of things (IoT), 5G, blockchain: these are just some of the technologies underlying the structure of the metaverse, a sort of parallel dimension in which the physical and virtual worlds merge together enabling users to interact by emerging technologies in order to enhance their actions and decisions. The healthcare scientific community is already looking at the metaverse as a new research frontier, a tool to improve medical knowledge and patient care. We reviewed the metaverse applications and services, looking for those that could best be developed in the urological field. Urology, due to its technological nature, is a privileged laboratory for experimenting and exploiting the applications of the metaverse both inside and outside the operating room. The revolution of the metaverse is already happening, which is why it is necessary that urologists face it as protagonists in order to lead it in the right direction.
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Affiliation(s)
- Carlo Gandi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Cosenza
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Campetella
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mauro Ragonese
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Bientinesi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Totaro
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
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Sacco E, Marino F, Gandi C, Bientinesi R, Totaro A, Moretto S, Gavi F, Campetella M, Racioppi M. Transalbugineal Artificial Urinary Sphincter: A Refined Implantation Technique to Improve Surgical Outcomes. J Clin Med 2023; 12:jcm12083021. [PMID: 37109357 PMCID: PMC10141998 DOI: 10.3390/jcm12083021] [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: 02/26/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
The artificial urinary sphincter (AUS) implantation is an effective treatment of post-prostatectomy urinary incontinence (PPI). Still, it may result in troublesome complications such as intraoperative urethral lesion and postoperative erosion. Based on the multilayered structure of the tunica albuginea of the corpora cavernosa, we evaluated an alternative transalbugineal surgical technique of AUS cuff placement with the aim to decrease perioperative morbidity while preserving the integrity of the corpora cavernosa. A retrospective study was conducted in a tertiary referral center from September 2012 to October 2021, including 47 consecutive patients undergoing AUS (AMS800®) transalbugineal implantation. At a median (IQR) follow-up of 60 (24-84) months, no intraoperative urethral injury and only one noniatrogenic erosion occurred. The actuarial 12 mo and 5 yr overall erosion-free rates were 95.74% (95% CI: 84.04-98.92) and 91.76% (95% CI: 75.23-97.43), respectively. In preoperatively potent patients, the IIEF-5 score remained unchanged. The social continence (0-1 pads per day) rate was 82.98% (CI 95%: 68.83-91.10) at 12 mos and 76.81% (CI 95%: 60.56-87.04) at 5 yrs follow-up. Our technically refined approach to AUS implantation may help to avoid intraoperative urethral lesions and lower the risk of subsequent erosion without compromising sexual function in potent patients. Prospective and adequately powered studies are necessary to achieve more compelling evidence.
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Affiliation(s)
- Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Carlo Gandi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Riccardo Bientinesi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Angelo Totaro
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Stefano Moretto
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Filippo Gavi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marco Campetella
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Ciccarese C, Strusi A, Arduini D, Russo P, Palermo G, Foschi N, Racioppi M, Tortora G, Iacovelli R. Post nephrectomy management of localized renal cell carcinoma. From risk stratification to therapeutic evidence in an evolving clinical scenario. Cancer Treat Rev 2023; 115:102528. [PMID: 36905896 DOI: 10.1016/j.ctrv.2023.102528] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/13/2023]
Abstract
Standard treatment for localized non-metastatic renal cell carcinoma (RCC) is radical or partial nephrectomy. However, after radical surgery, patients with stage II-III have a substantial risk of relapse (around 35%). To date a unique standardized classification for the risk of disease recurrence still lack. Moreover, in the last years great attention has been focused in developing systemic therapies with the aim of improving the disease-free survival (DFS) of high-risk patients, with negative results from adjuvant VEGFR-TKIs. Therefore, there is still a need for developing effective treatments for radically resected RCC patients who are at intermediate/high risk of relapse. Recently, interesting results came from immune-checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 pathway, with a significant benefit in terms of disease-free survival from adjuvant pembrolizumab. However, the conflicting results of diverse clinical trials investigating different ICI-based regimens in the adjuvant setting, together with the still immature data on the overall survival advantage of immunotherapy, requires careful considerations. Furthermore, several questions remain unanswered, primarily regarding the selection of patients who could benefit the most from immunotherapy. In this review, we have summarized the main clinical trials investigating adjuvant therapy in RCC, with a particular focus on immunotherapy. Moreover, we have analyzed the crucial issue of patients' stratification according to the risk of disease recurrence, and we have described the possible future prospective and novel agents under evaluation for perioperative and adjuvant therapies.
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Affiliation(s)
- Chiara Ciccarese
- Medical Oncology Unit, Fondazione Policlinico A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Alessandro Strusi
- Medical Oncology Unit, Fondazione Policlinico A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Daniela Arduini
- Medical Oncology Unit, Fondazione Policlinico A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Pierluigi Russo
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; Urology Unit, Fondazione Policlinico A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Giuseppe Palermo
- Urology Unit, Fondazione Policlinico A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Nazario Foschi
- Urology Unit, Fondazione Policlinico A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Marco Racioppi
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; Urology Unit, Fondazione Policlinico A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Giampaolo Tortora
- Medical Oncology Unit, Fondazione Policlinico A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Roberto Iacovelli
- Medical Oncology Unit, Fondazione Policlinico A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy.
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Iacovelli R, Cicala CM, Ciccarese C, Sacco E, Racioppi M, Bassi PF, Tortora G. Management of metastatic urothelial carcinoma: Current approach, emerging agents, and future perspectives. Urologia 2022; 90:3-10. [PMID: 36537831 DOI: 10.1177/03915603221139907] [Citation(s) in RCA: 1] [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: 12/24/2022]
Abstract
Metastatic urothelial carcinoma (mUC) is a lethal disease for which platinum-based chemotherapy represents the standard of care; however, long-term survival is achieved only in a minority of patients. Recently, along with important advances in the comprehension of the biology of this disease, the treatment paradigm of mUC has undergone a rapid expansion with the approval of several immune-checkpoint inhibitors (ICIs) and targeted agents in both first- and second-line settings. Cisplatin-based chemotherapy remains the backbone of first-therapy for mUC; nevertheless, for those patients who do not progress after the full course of first-line chemotherapy, maintenance treatment with the anti-PD-L1 avelumab showed to prolong overall survival compared observation alone. Moreover, the disappointing results of chemotherapy in pre-treated patients have led to the investigation and the subsequent approval of the anti-PD-1 pembrolizumab, which showed an unprecedented survival benefit when compared to second-line chemotherapy. Recently, target therapy with the antibody-drug conjugate (ADC) enfortumab vedotin, directed against Nectin-4, showed outstanding results in patients treated with both chemotherapy and immunotherapy. The FGFR inhibitor erdafitinib and sacituzumab govitecan, an ADC targeting Trop-2, demonstrated encouraging activity in phase II studies and are currently under investigation in randomized phase III trials. ICIs and targeted therapies also demonstrated promising results as first-line treatment of cisplatin-ineligible patients; randomized trials of ICIs alone or in combination with targeted agents are ongoing and may broaden the therapeutic armamentarium for this category of patients. In this review, we describe the current state of art for the treatment of mUC; in addition, we present the latest evidences from the most recent literature and congress presentations. Finally, we illustrate the key ongoing clinical trials, focusing on ICIs and target therapies.
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Affiliation(s)
- Roberto Iacovelli
- Medical Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Chiara Ciccarese
- Medical Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Racioppi
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pier Francesco Bassi
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giampaolo Tortora
- Medical Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Gandi C, Totaro A, Bientinesi R, Marino F, Pierconti F, Russo A, Racioppi M, Bassi P, Sacco E. Purely Off-Clamp Partial Nephrectomy: Robotic Approach Better than Open Using a Pentafecta Outcome with Propensity Score Matching. J Clin Med 2022; 11:jcm11216241. [PMID: 36362469 PMCID: PMC9655173 DOI: 10.3390/jcm11216241] [Citation(s) in RCA: 2] [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: 08/31/2022] [Revised: 10/05/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Partial nephrectomy (PN) is the gold standard treatment for localized renal masses. Robot-assisted PN (RAPN) has overcome laparoscopy’s technical limitations, greatly expanding the indications of minimally invasive PN, which is dominated by renal artery clamping in almost all published series. We compared off-clamp RAPN (OFFC-RAPN) with the open approach (OFFC-OPN) using propensity score (PS) matching. A favourable pentafecta outcome was defined as a combination of no positive surgical margins (PSM), no complications of Clavien−Dindo (CD) grade ≥ 3, post-operative eGFR loss <10%, length of hospital stay (LOS) ≤ 5 days and estimated blood loss (EBL) < 200 mL. A total of 340 consecutive patients were included. The PS-matched cohort included 142 patients: 71 matched pairs well-balanced for all covariates. The OFFC-RAPN group showed significantly shorter operative time (149.8 vs. 173.9 min, p = 0.003), lower EBL (182.1 vs. 329.3 mL, p = 0.001), and shorter LOS (5.8 vs. 6.9 days, p = 0.02), with a higher proportion of patients with LOS ≤ 5 days (57.7% vs. 23.9%, p < 0.001). No significant differences were found for PSM rate (2.8% vs. 8.4%, p = 0.27), CD > 2 complication rate (4.2% vs. 2.8%, p = 1.00) and mean ± SD eGFR change (−0.06 ± 0.3 vs. −0.8 ± 0.3, p = 0.5). Pentafecta was achieved in 56.3% and 21.1% in the OFFC-RAPN and OFFC-OPN series, respectively (p < 0.0001). On multivariable analysis, surgical approach and BMI proved to be independent predictors of achieving pentafecta. After adjusting for potential treatment selection bias, OFFC-RAPN outperformed OFFC-OPN for important peri-operative outcomes, without compromising oncological and functional safety.
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Affiliation(s)
- Carlo Gandi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-3015-8542
| | - Angelo Totaro
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Riccardo Bientinesi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Pierconti
- Department of Anatomic Pathology and Histology, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Russo
- Department of Anesthesiology and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Pierfrancesco Bassi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Siracusano S, Zaka A, Bassi P, Gontero P, Mearini E, Imbimbo C, Simonato A, Dal Moro F, Giannarini G, Valotto C, Montorsi F, Colombo R, Porpiglia F, Bartoletti R, Vella M, Minervini A, Rossanese M, Porcaro B, Romantini F, Vicentini C, Talamini R, Ficarra V, Racioppi M, Lonardi C. Short-term effects of bowel function on global health quality of life after radical cystectomy. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01118-1] [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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16
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Ragonese M, Bizzarri F, Foti M, Palermo G, Racioppi M, Bassi P. The role of methylation test in prediction of delayed BCG failure in high risk non muscle invasive bladder cancer. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00229-4] [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: 10/18/2022] Open
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17
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Gandi C, Totaro A, Bientinesi R, Marino F, Pierconti F, Martini M, Russo A, Racioppi M, Bassi P, Sacco E. A multi-surgeon learning curve analysis of overall and site-specific positive surgical margins after RARP and implications for training. J Robot Surg 2022; 16:1451-1461. [PMID: 35226289 DOI: 10.1007/s11701-022-01378-w] [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: 10/27/2021] [Accepted: 01/29/2022] [Indexed: 11/27/2022]
Abstract
Robot-assisted radical prostatectomy (RARP) is the most adopted treatment for localized prostate cancer. The aim of this study was to explore the learning curves (LC) for overall and site-specific positive surgical margins (PSM) occurrence after RARP of multiple surgeons within a step-structured mentor-initiated training program. The study included consecutive patients undergoing RARP between January 2013 and March 2020, by three surgeons: a mentor and his two trainees. Prospectively collected patients' data were retrospectively analyzed. The cumulative summation (CUSUM) method was used to generate the LCs, with turning points indicating the number of cases to reach proficiency levels. Furthermore, the association between PSM and surgical experience was evaluated, adjusting for case mix. A total of 761 consecutive patients were included, 370 treated by the Mentor surgeon, 247 and 144 treated, respectively, by the two Trainees. Mentor and Trainees had similar PSM rates (31.6% vs 28.0% vs 31.3%, p = 0.6). CUSUM charts showed different LC shapes for different PSM locations (postero-lateral, bladder neck, apex, and multifocal/> 3 mm). Surgical experience was significantly associated with overall, postero-lateral, and multifocal/> 3 mm PSMs, in the Mentor series only. Trainees reached their turning points after far fewer cases then the Mentor, both for overall (12 and 31 vs 153), postero-lateral (24 and 30 vs 120), and multifocal/> 3 mm PSMs (9 and 31 vs 153). The achievement of stable SM proficiency takes involved different LCs depending on the prostatic location being considered. Monitoring site-specific LC can indicate the surgical steps for which there may be still room for further technical refinements, even when an apparent proficiency status seems achieved.
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Affiliation(s)
- Carlo Gandi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Angelo Totaro
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Bientinesi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Pierconti
- Department of Anatomic Pathology and Histology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Martini
- Department of Anatomic Pathology and Histology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Russo
- Department of Anesthesiology and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - PierFrancesco Bassi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
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Sacco E, Bientinesi R, Gandi C, Marino F, Gavi F, Moretto S, Totaro A, Racioppi M, Bassi P. Bulbospongiosus muscle-sparing male sling implantation for postprostatectomy incontinence: Evaluation of safety and efficacy outcomes. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00662-5] [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: 11/27/2022]
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19
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Gandi C, Bientinesi R, Totaro A, Marino F, Moretto S, Gavi F, Pierconti F, Racioppi M, Bassi P, Sacco E. Clamp-less partial nephrectomy: A propensity score-matched analysis comparing robot-assisted with open approach. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00424-9] [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: 11/04/2022]
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Sacco E, Gandi C, Bientinesi R, Marino F, Moretto S, Ragonese M, Totaro A, Pierconti F, Racioppi M, Bassi P. Male sling placement for post-prostatectomy incontinence can involve a lengthy learning curve: A multi-outcome assessment via cumulative sum failure analysis. Urologia 2022; 89:521-528. [PMID: 35073794 DOI: 10.1177/03915603211072844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSES Little research exists on potential learning curve for male sling procedures. We aimed to perform a learning curve analysis of a single surgeon's experience of sling placement evaluating multiple outcomes and using the cumulative sum failure methodology. METHODS The study included 65 consecutive patients that underwent implantation of a fixed transobturator sling (TiLOOP Male) for post-radical prostatectomy stress incontinence at our institution from January 2013 to December 2018. Dichotomous outcomes evaluated with cumulative sum failure analysis included 12-months continence defined based on Patient Global Impression of Improvement (PGI-I) questionnaire (primary outcome), 24 h pad test and, 24 h pad use, operative time (⩽/>60 min), and complications (yes/no). Univariate and multivariate logistic regression analyses were performed to evaluate the association of the procedures' chronological sequence number with the outcomes. RESULTS Cumulative sum failure curves revealed a clear and lengthy learning curve effect for most of subjective and quantitative continence outcomes and for operative time. For the primary outcome (at least much improved at PGI-I), 62 procedures were required to overcome the learning curve. Accordingly, multivariate analyses showed that the sequence number was statistically significant for predicting failures based on PGI-I (adjusted OR 0.95; 95% CI: 0.91-0.99; p = 0.02), objective outcomes, and operative time. CONCLUSIONS An evident and lengthy learning curve was observed in our series of male sling placement to achieve the end level of proficiency, independently from case-mix. Individualized structured training on male sling surgery will benefit patients treated in the initial surgeon's experience. Surgical experience should be considered when reporting studies on male slings.
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Affiliation(s)
- Emilio Sacco
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Gandi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Bientinesi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Marino
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Moretto
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mauro Ragonese
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Totaro
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Pierconti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Racioppi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pierfrancesco Bassi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Racioppi M. Advances in Management of Bladder Cancer. J Clin Med 2021; 11:jcm11010203. [PMID: 35011943 PMCID: PMC8746062 DOI: 10.3390/jcm11010203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
Bladder cancer (BC) is a complex disease with the following presentations, which are completely different from one another: non-muscle-infiltrating bladder cancer (NMIBC) and muscle-infiltrating bladder cancer (MIBC) [...].
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Affiliation(s)
- Marco Racioppi
- Clinica Urologica, Policlinico "Agostino Gemelli" Foundation, Catholic University of Sacred Hearth, IRCSS, 00168 Rome, Italy
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22
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Pierconti F, Martini M, Cenci T, Fiorentino V, Gianfrancesco LD, Ragonese M, Bientinesi R, Rossi E, Larocca LM, Racioppi M, Bassi PF. The bladder epicheck test and cytology in the follow-up of patients with non-muscle-invasive high grade bladder carcinoma. Urol Oncol 2021; 40:108.e19-108.e25. [PMID: 34903453 DOI: 10.1016/j.urolonc.2021.11.013] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/19/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The management of non-muscle invasive bladder carcinoma (NMIBC) after transurethral resection of a bladder tumor consists of adjuvant intravesical therapy and strict and long surveillance with urine cytology and cystoscopy. The Bladder EpiCheck test (Nucleix Ltd) (BE) is a newly developed urinary markers based on DNA methylation changes in a panel of 15 genomic biomarkers, with a promising performance in term of non-invasive NMIBC detection. METHODS In this study we prospectively enrolled 151 consecutive patients with high grade NMIBC, treated with intravesical BCG and mitomycin C therapy and evaluated during the follow-up by voided urine cytology and white-light cystoscopy, according to the European Association of Urology Guidelines. The Bladder EpiCheck test was performed at the same time of urine cytology in voided specimen. In all cases with positive cytology the diagnosis was confirmed by histology and a diagnosis was made according to the 2017 tumor, node, metastasis (TNM) classification and graded using both the 1973 and the 2004 World Health Organization (WHO) classifications. RESULTS At three months of follow-up, we reported similar overall specificity rates for BE and urine cytology (85,1% vs 86,3%). In the group of patients with carcinoma in situ (CIS), we found the same specificity for BE and urine cytology (81,4%), while in the groups of patients with papillary high grade NMIBC, the specificity of BE was higher compared to cytology (96,3% vs 90,4%). The sensitivity of BE was always higher compared to cytology during all the follow-up both for papillary NMIBC and CIS. CONCLUSION In the early follow-up of NMIBC the EpiCheck test might replace urinary cytology.
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Affiliation(s)
- Francesco Pierconti
- Insititute of Pathology, Università Cattolica del S. Cuore- Fondazione Policlinico A. Gemelli, L.go A. Gemelli, Rome, Italy.
| | - Maurizio Martini
- Insititute of Pathology, Università Cattolica del S. Cuore- Fondazione Policlinico A. Gemelli, L.go A. Gemelli, Rome, Italy
| | - Tonia Cenci
- Insititute of Pathology, Università Cattolica del S. Cuore- Fondazione Policlinico A. Gemelli, L.go A. Gemelli, Rome, Italy
| | - Vincenzo Fiorentino
- Insititute of Pathology, Università Cattolica del S. Cuore- Fondazione Policlinico A. Gemelli, L.go A. Gemelli, Rome, Italy
| | - Luca Di Gianfrancesco
- Insititute of Pathology, Università Cattolica del S. Cuore- Fondazione Policlinico A. Gemelli, L.go A. Gemelli, Rome, Italy
| | - Mauro Ragonese
- Insititute of Pathology, Università Cattolica del S. Cuore- Fondazione Policlinico A. Gemelli, L.go A. Gemelli, Rome, Italy
| | - Riccardo Bientinesi
- Insititute of Pathology, Università Cattolica del S. Cuore- Fondazione Policlinico A. Gemelli, L.go A. Gemelli, Rome, Italy
| | - Ernesto Rossi
- Insititute of Pathology, Università Cattolica del S. Cuore- Fondazione Policlinico A. Gemelli, L.go A. Gemelli, Rome, Italy
| | - Luigi M Larocca
- Insititute of Pathology, Università Cattolica del S. Cuore- Fondazione Policlinico A. Gemelli, L.go A. Gemelli, Rome, Italy
| | - Marco Racioppi
- Insititute of Pathology, Università Cattolica del S. Cuore- Fondazione Policlinico A. Gemelli, L.go A. Gemelli, Rome, Italy
| | - Pier Francesco Bassi
- Insititute of Pathology, Università Cattolica del S. Cuore- Fondazione Policlinico A. Gemelli, L.go A. Gemelli, Rome, Italy
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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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Di Gianfrancesco L, Foti M, Ragonese M, Palermo G, Sacco E, Pinto F, Totaro A, Marino F, Akhundov A, Bassi P, Racioppi M. A large pilot study on the diagnostic performance of electronic nose in detecting Bladder Cancer. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)01227-1] [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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25
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Pierconti F, Martini M, Fiorentino V, Cenci T, Racioppi M, Foschi N, Di Gianfrancesco L, Sacco E, Rossi E, Larocca LM, Bassi PF. Upper urothelial tract high-grade carcinoma: comparison of urine cytology and DNA methylation analysis in urinary samples. Hum Pathol 2021; 118:42-48. [PMID: 34582934 DOI: 10.1016/j.humpath.2021.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
Numerous studies showed that bladder urothelial carcinoma and upper urothelial tract carcinoma (UTUC) display clinical and genomic similarities. In order to analyze that the same panel of biomarkers used in the diagnosis of bladder urothelial carcinoma could be suitable for early detection of UTUC, we performed a retrospective study in which we analyzed Bladder EpiCheck scores in the urinary samples obtained by selective ureteral catheterization in a high-grade UTUC cohort, correlating the results with urinary cytology and diagnostic urethral biopsies. The present study represents a retrospective analysis of 82 patients with clinically localized high-grade UTUC (60 renal pelvis UTUC, 22 ureter UTUC) who had undergone a radical nephroureterectomy (RNU) at our Urology department from June 2018 to November 2020. Before any surgical procedure, one sample of urine, obtained by selective ureteral catheterization, was collected for each patient for cytological examination, and the remaining material was stored for the Bladder EpiCheck test. Our results showed that the sensitivity of the methylation test for high-grade UTUC was about 97.4%, significantly higher than the sensitivity of urinary cytology either considering the HGUC cytological diagnosis or including in the positive cases the SHGUC cytological diagnosis (97.4% versus 59% or 70.5%). The methylation analysis of urinary samples may represent a valid tool in the diagnostic process of patients with suspected UTUC. In cases with a difficult clinical decision after upper urinary tract biopsy and cytology, the methylation test could assist in the clinical management of UTUC patients.
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Affiliation(s)
- Francesco Pierconti
- Department of Pathology, Insitute of Pathology, Università Cattolica Del S. Cuore, Fondazione Policlinico "A. Gemelli", Rome, 00138, Italy.
| | - Maurizio Martini
- Department of Pathology, Insitute of Pathology, Università Cattolica Del S. Cuore, Fondazione Policlinico "A. Gemelli", Rome, 00138, Italy
| | - Vincenzo Fiorentino
- Department of Pathology, Insitute of Pathology, Università Cattolica Del S. Cuore, Fondazione Policlinico "A. Gemelli", Rome, 00138, Italy
| | - Tonia Cenci
- Department of Pathology, Insitute of Pathology, Università Cattolica Del S. Cuore, Fondazione Policlinico "A. Gemelli", Rome, 00138, Italy
| | - Marco Racioppi
- Department of Urology, Insitute of Urology, Università Cattolica Del S. Cuore, Fondazione Policlinico "A. Gemelli", Rome, 00138, Italy
| | - Nazario Foschi
- Department of Urology, Insitute of Urology, Università Cattolica Del S. Cuore, Fondazione Policlinico "A. Gemelli", Rome, 00138, Italy
| | - Luca Di Gianfrancesco
- Department of Urology, Insitute of Urology, Università Cattolica Del S. Cuore, Fondazione Policlinico "A. Gemelli", Rome, 00138, Italy
| | - Emilio Sacco
- Department of Urology, Insitute of Urology, Università Cattolica Del S. Cuore, Fondazione Policlinico "A. Gemelli", Rome, 00138, Italy
| | - Ernesto Rossi
- Department of Oncology, Università Cattolica Del S. Cuore, Fondazione Policlinico "A. Gemelli", Rome, 00138, Italy
| | - Luigi M Larocca
- Department of Pathology, Insitute of Pathology, Università Cattolica Del S. Cuore, Fondazione Policlinico "A. Gemelli", Rome, 00138, Italy
| | - Pier Francesco Bassi
- Department of Urology, Insitute of Urology, Università Cattolica Del S. Cuore, Fondazione Policlinico "A. Gemelli", Rome, 00138, Italy
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26
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Santoro AA, Di Gianfrancesco L, Racioppi M, Pinto F, Palermo G, Sacco E, Campetella M, Scarciglia E, Bientinesi R, Di Paola V, Totaro A. Multiparametric magnetic resonance imaging of the prostate: Lights and shadows. Urologia 2021; 88:280-286. [PMID: 34075837 DOI: 10.1177/03915603211019982] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prostate cancer is the second most commonly diagnosed cancer in man. Since the first MRI was performed, enormous progress has been made in diagnosis, treatment, and follow up of PCa, mainly due to multiparametric prostatic MRI (mpMRI). Although mpMRI has become the best imaging tool for identifying PCa, some limitations still exist. Prostate imaging with mpMRI is, to date, the best way to locate suspicious lesions to trigger prostate biopsy, plan active surveillance, or definitive treatment. In case of relapse, mpMRI can help detect local disease and provide specific management. It is well known that there is a subset of patients in whom mpMRI fails to depict csPCa. These missed significant cancers demand great attention. Prostate mpMRI quality depends on several factors related to equipment (including equipment vendor, magnet field and gradient strength, coil set used, software and hardware levels, sequence parameter choices), patient (medications, body habitus, motion, metal implants, rectal gas), and most importantly the radiologic interpretation of images (learning curve effects, subjectivity of observations, interobserver variations, and reporting styles). Inter-reader variability represents a huge current limitation of this method. Therefore, mpMRI remains the best imaging tool available to detect PCa, guiding diagnosis, treatment, and follow up while inter-reader variability represents the best limitation. Radiomics can help identifying imaging biomarkers to help radiologist in detecting significant PCa, reducing examination times, and costs.
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Affiliation(s)
- Agostino Antonio Santoro
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Luca Di Gianfrancesco
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Marco Racioppi
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Francesco Pinto
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Giuseppe Palermo
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Emilio Sacco
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Marco Campetella
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Eros Scarciglia
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Riccardo Bientinesi
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Valerio Di Paola
- Department of Radiology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Angelo Totaro
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
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Gandi C, Totaro A, Bientinesi R, Di Gianfrancesco L, Pierconti F, Martini M, Russo A, Racioppi M, Bassi PF, Sacco E. A multi-surgeon learning curve analysis of overall and site-specific positive surgical margins after RARP. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01466-4] [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: 11/30/2022]
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Totaro A, Di Gianfrancesco L, Pinto F, Racioppi M, Palermo G, Campetella M, Santoro AA, Arbia G, Sacco E. Rate of clinically significant prostate cancer on repeat saturation biopsy after a diagnosis of atypical small acinar proliferation. Urologia 2021; 88:194-199. [PMID: 33579180 DOI: 10.1177/0391560321993595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Atypical small acinar proliferation (ASAP) occurs in approximately 5% of prostate biopsies. Approximately 30%-40% of these patients may develop prostate cancer (PCa) within a 5-year period, often not clinically significant. Current guidelines recommend a repeat biopsy within 3-6 months after the initial diagnosis, but it seem not to be the best strategy. METHODS Objectives-evaluating the natural history of ASAP, stratifying the risk of csPCa after ASAP, identifying predictive factors of PCa after atypical diagnosis. Materials and methods-retrospective single-institutional study on patients undergoing prostate biopsy for suspicious PCa (2005-2016). We evaluated the incidence of overall PCa, intermediate-high risk of PCa and csPCa in case of ASAP, according to D'Amico classification and Epstein modified criteria. RESULTS Out of 4.567 patients undergoing prostate biopsy, ASAP was detected in 2.6% of cases. All patients with ASAP underwent repeat saturation biopsy within 6 months and PCa was diagnosed in 34.5%. According to D'Amico classification, 26%, 5.9%, and 2.5% had low, intermediate, and high-risk disease, respectively. According modified Epstein criteria, the incidence of csPCa was 12.6%. LRT showed that the overall probability to develop PCa doubled when PSA density (PSAD) moved from values lower than 0.13 ng/ml/cc to class 0.13-0.30 ng/ml/cc, and it tripled when PSAD was higher than 0.30 ng/ml/cc. CONCLUSIONS The rate of csPCa in patients with an initial diagnosis of ASAP who had repeat biopsy was 12.6%. The overall PCa rate was 34.5%. Among patient undergoing RP, an upgrading from ncsPCa to csPCa was reported in 35% of cases. PSAD is the only predictive factor directly associated to the risk of developing PCa on repeat biopsy. These findings suggest that immediate repeat biopsy remains the correct strategy in absence of novel predictor factors and non-invasive diagnostic evaluations.
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Affiliation(s)
- Angelo Totaro
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Luca Di Gianfrancesco
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Francesco Pinto
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Marco Racioppi
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Giuseppe Palermo
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Marco Campetella
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Agostino Antonio Santoro
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Giuseppe Arbia
- Department of Statistical Science, Faculty of Economics, Catholic University of the Sacred Heart, Rome, Italy
| | - Emilio Sacco
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
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Gandi C, Vaccarella L, Bientinesi R, Racioppi M, Pierconti F, Sacco E. Bladder cancer in the time of machine learning: Intelligent tools for diagnosis and management. Urologia 2021; 88:94-102. [PMID: 33402061 DOI: 10.1177/0391560320987169] [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] [Indexed: 12/16/2022]
Abstract
Machine learning (ML) is the subfield of artificial intelligence (AI), born from the marriage between statistics and computer science, with the unique purpose of building prediction algorithms able to improve their performances by automatically learning from massive data sets. The availability of ever-growing computational power and highly evolved pattern recognition software has led to the spread of ML-based systems able to perform complex tasks in bioinformatics, medical imaging, and diagnostics. These intelligent tools could be the answer to the unmet need for non-invasive and patient-tailored instruments for the diagnosis and management of bladder cancer (BC), which are still based on old technologies and unchanged nomograms. We reviewed the most significant evidence on ML in the diagnosis, prognosis, and management of bladder cancer, to find out if these intelligent technologies are ready to be introduced into the daily clinical practice of the urologist.
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Affiliation(s)
- Carlo Gandi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Vaccarella
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Bientinesi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Pierconti
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Aceto P, Bassi P, Sollazzi L, Racioppi M, Fortunato G, Di Gianfrancesco L, Marusco I, Ragonese M, Cataldo A, Palermo G. Implementation of frailty preoperative assessment to predict outcome in patients undergoing urological surgery: a systematic review and meta-analysis. BJU Int 2020; 127:507-517. [PMID: 33259147 DOI: 10.1111/bju.15314] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND A common limit of the widely used risk scores for preoperative assessment is the lack of information about aspects linked to frailty that may affect outcome, especially in the setting of elderly patients undergoing urological surgery. Frailty has recently been introduced as an additional characteristic to be assessed for better identifying patients at risk of negative outcomes. OBJECTIVE To examine the evidence for recent advances in preoperative assessment in patients undergoing urological surgery focussing on the detrimental effect of frailty on outcome, including major (mPCs) and total postoperative complications (tPCs), discharge to a facility, and mortality. The secondary aim was to establish which cut-off scores of the modified Frailty Index (mFI, 11 items) and/or simplified FI (sFI, five items) predicted PCs. METHODS We searched PubMed, the Excerpta Medica database (EMBASE), Cochrane Library and clinicaltrial.gov from inception to 31 May 2020. Studies reporting relationships between the investigated outcomes and patients' frailty were included. We estimated odds ratios (ORs) through a random effect model by using Revman 5.4. RESULTS Frailty, assessed by different tools, was associated with a significantly higher rate of 30-day (OR 1.73, 95% confidence interval [CI] 1.58-1.89) and 90-day (OR 2.09, 95% CI 1.14-3.82) mPCs and 30-day tPCs (OR 2.10, 95% CI 1.76-2.52). A mFI of ≥2 was associated with a higher rate of 30-day mPCs (OR 1.79, 95% CI 1.69-1.89) and greater 30-day mortality (OR 3.46, 95% CI 2.10-5.49). A pre-planned post hoc analysis also revealed that a sFI of ≥3 was predictive of mPCs (OR 3.30, 95% CI 2.12-5.12). CONCLUSIONS Frailty assessment may help to predict PCs and mortality in patients undergoing major urological surgery. Either a mFi of ≥2 or sFI of ≥3 should be considered potential 'red flags' for preoperative risk assessment and decision-making. There is not enough evidence to confirm the necessity to perform frailty assessment in minor urological surgery.
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Affiliation(s)
- Paola Aceto
- Dipartimento di Scienze Dell'Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Pierfrancesco Bassi
- Università Cattolica del Sacro Cuore, Roma, Italia.,Dipartimento di Scienze Mediche e Chirurgiche, Clinica Urologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Liliana Sollazzi
- Dipartimento di Scienze Dell'Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Marco Racioppi
- Università Cattolica del Sacro Cuore, Roma, Italia.,Dipartimento di Scienze Mediche e Chirurgiche, Clinica Urologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Giusy Fortunato
- Dipartimento di Scienze Dell'Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Luca Di Gianfrancesco
- Dipartimento di Scienze Mediche e Chirurgiche, Clinica Urologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Irene Marusco
- Dipartimento di Scienze Dell'Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Mauro Ragonese
- Dipartimento di Scienze Mediche e Chirurgiche, Clinica Urologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Andrea Cataldo
- Dipartimento di Scienze Dell'Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Giuseppe Palermo
- Dipartimento di Scienze Mediche e Chirurgiche, Clinica Urologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
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Busetto GM, Del Giudice F, Mari A, Sperduti I, Longo N, Antonelli A, Cerruto MA, Costantini E, Carini M, Minervini A, Rocco B, Artibani W, Porreca A, Porpiglia F, Damiano R, De Sio M, Arcaniolo D, Cimino S, Russo GI, Lucarelli G, Di Tonno P, Gontero P, Soria F, Trombetta C, Liguori G, Scarpa RM, Papalia R, Terrone C, Borghesi M, Verze P, Madonia M, De Lisa A, Bove P, Guazzoni G, Lughezzani G, Racioppi M, Di Gianfrancesco L, Brunocilla E, Schiavina R, Simeone C, Veccia A, Montorsi F, Briganti A, Dal Moro F, Pavone C, Serretta V, Di Stasi SM, Galosi AB, Schips L, Marchioni M, Montanari E, Carrieri G, Cormio L, Greco F, Musi G, Maggi M, Conti SL, Tubaro A, De Berardinis E, Sciarra A, Gallucci M, Mirone V, de Cobelli O, Ferro M. How Can the COVID-19 Pandemic Lead to Positive Changes in Urology Residency? Front Surg 2020; 7:563006. [PMID: 33330604 PMCID: PMC7732553 DOI: 10.3389/fsurg.2020.563006] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/15/2020] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 outbreak, in a few weeks, overloaded Italian hospitals, and the majority of medical procedures were postponed. During the pandemic, with hospital reorganization, clinical and learning activities performed by residents suffered a forced remodulation. The objective of this study is to investigate how urology training in Italy has been affected during the COVID-19 era. In this multi-academic study, we compared residents' training during the highest outbreak level with their previous activity. Overall 387 (67.1%) of the 577 Italian Urology residents participated in a 72-h anonymous online survey with 36 items sent via email. The main outcomes were clinical/surgical activities, social distancing, distance learning, and telemedicine. Clinical and learning activity was significantly reduced for the overall group, and after categorizing residents as those working only in COVID hospitals, both "junior" and "senior" residents, and those working in any of three geographical areas created (Italian regions were clustered in three major zones according to the prevalence of COVID-19). A significant decrease in outpatient activity, invasive diagnostic procedures, and endoscopic and major surgeries was reported. Through multivariate analysis, the specific year of residency has been found to be an independent predictor for all response modification. Being in zone 3 and zone 2 and having "senior" resident status were independent predictors associated with a lower reduction of the clinical and learning activity. Working in a COVID hospital and having "senior" resident status were independent predictors associated with higher reduction of the outpatient activity. Working in zone 3 and having "senior" resident status were independent predictors of lower and higher outpatient surgical activity, respectively. Working in a COVID hospital was an independent predictor associated with robotic surgical activity. The majority of residents reported that distance teaching and multidisciplinary virtual meetings are still not used, and 44.8% reported that their relationships with colleagues decreased. The COVID-19 pandemic presents an unprecedented challenge, including changes in the training and education of urology residents. The COVID era can offer an opportunity to balance and implement innovative solutions that can bridge the educational gap and can be part of future urology training.
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Affiliation(s)
| | - Francesco Del Giudice
- Sapienza Rome University Policlinico Umberto I, Rome, Italy.,Stanford University, Palo Alto, CA, United States
| | | | - Isabella Sperduti
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | - Marco De Sio
- University of Campania "L. Vanvitelli", Caserta, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Martina Maggi
- Sapienza Rome University Policlinico Umberto I, Rome, Italy
| | | | - Andrea Tubaro
- Sapienza Rome University Sant'Andrea Hospital, Rome, Italy
| | | | | | | | | | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Haematology-Oncology, University of Milan, Milan, Italy
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
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Di Gianfrancesco L, Ragonese M, Palermo G, Sacco E, Bassi P, Racioppi M. Second-Line Conservative Device-Assisted Intravesical Treatment in Selected Patients With Recurrent High-Risk Non-Muscle-Invasive Bladder Cancer. Clin Genitourin Cancer 2020; 19:e100-e119. [PMID: 33309565 DOI: 10.1016/j.clgc.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In cases of recurrent high-risk non-muscle-invasive bladder cancer, radical cystectomy (RC) is recommended. We compared oncologic and treatment-related outcomes of second-line conservative device-assisted therapy to RC. PATIENTS AND METHODS In a retrospective cohort study, we analyzed 209 consecutive patients with recurrent bacillus Calmette-Guérin-unresponsive high-risk non-muscle-invasive bladder cancer; 107 subjects refused RC and were offered electromotive drug administration (n = 44) or chemohyperthermia (n = 63) (group A), and 102 patients underwent RC (group B). In group A, patients who did not benefit from device-assisted treatment underwent RC. The endpoints were high-grade disease-free survival, progression-free survival, cancer-specific survival, overall survival, and treatment-related complications. Follow-up was based on international guideline recommendations. Analyses were performed with log-rank and Fisher exact tests. RESULTS The median follow-up was 59 months (SD ± 5.3). When comparing group A to B, overall survival rates were 91.6% and 90.2%, respectively (P > .05); cancer-specific survival was 94.4% and 96.1%, respectively (P > .05); high-grade disease-free survival was 43% and 74.5%, respectively (P < .05); and progression-free survival was 59.8% and 75.5%, respectively (P < .05). Patients with carcinoma-in-situ had worse oncologic outcomes compared to patients with papillary disease. In the multivariate analysis, multifocality, disease recurrence, and progression risk group were independently associated with device treatment failure. The 90-day RC-related overall complications rates were 63.9% in group A and 66.6% in group B (P = .63); grade 3 to 5 complications were 9.8% in group A and 9.8% in group B(P = .99). Complications within group A were comparable (P > .05). CONCLUSION Device-assisted treatment may a represent a valid second-line conservative tool in selected patients with recurrent high-risk non-muscle-invasive bladder cancer.
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Affiliation(s)
- Luca Di Gianfrancesco
- Department of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore di Roma, Rome, Italy.
| | - Mauro Ragonese
- Department of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore di Roma, Rome, Italy
| | - Giuseppe Palermo
- Department of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore di Roma, Rome, Italy
| | - Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore di Roma, Rome, Italy
| | - PierFrancesco Bassi
- Department of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore di Roma, Rome, Italy
| | - Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore di Roma, Rome, Italy
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Lenci N, Francesco P, Scarciglia E, Fiorentino V, Schino M, Palermo G, Racioppi M, Bassi P, Martini M. Metanephric adenoma with BRAF V600K mutation and a doubtful radiological imaging: pitfalls in the diagnostic process. Med Mol Morphol 2020; 54:187-191. [PMID: 33175195 PMCID: PMC8139902 DOI: 10.1007/s00795-020-00269-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/22/2020] [Indexed: 01/15/2023]
Abstract
Metanephric adenoma (MA) is an uncommon benign renal tumor whose histomorphological aspect resembles that of Wilms’ tumor and papillary renal cell carcinoma. From a diagnostic and therapeutic perspective, recognition of this entity is important as it has a more favorable clinical outcome compared with Wilms’ tumor and papillary renal cell carcinoma. MA should not be treated with nephrectomy if the tumor size is small, opting for a conservative treatment. However, the preoperative diagnosis of this disease is extremely challenging. The present study describes a case of this rare disease, showing an ambiguous radiological imaging and that only after a percutaneous biopsy, was defined as a MA and treated with partial nephrectomy. Moreover, the histological diagnosis of this case was partially complicated by the equivocal immunohistochemical analysis showing negativity for BRAF VE1 staining. Only the mutational analysis demonstrated the presence of the BRAF V600K mutation (for the first time described in a case of metanephric adenoma), highlighting the necessity of sequencing in case of MA with negativity for BRAF VE1 clone.
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Affiliation(s)
- Niccolo Lenci
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Pierconti Francesco
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.,Divisione di Anatomia Patologica, Dipartimento di scienze della vita e sanità pubblica, Università Cattolica del Sacro Cuore A. Gemelli, Rome, Italy
| | - Eros Scarciglia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Vincenzo Fiorentino
- Divisione di Anatomia Patologica, Dipartimento di scienze della vita e sanità pubblica, Università Cattolica del Sacro Cuore A. Gemelli, Rome, Italy
| | - Mattia Schino
- Divisione di Anatomia Patologica, Dipartimento di scienze della vita e sanità pubblica, Università Cattolica del Sacro Cuore A. Gemelli, Rome, Italy
| | - Giuseppe Palermo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Marco Racioppi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.,Divisione di Urologia, Dipartimento di medicina e chirurgia traslazionale, Università Cattolica del Sacro Cuore A. Gemelli, Rome, Italy
| | - Pierfrancesco Bassi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.,Divisione di Urologia, Dipartimento di medicina e chirurgia traslazionale, Università Cattolica del Sacro Cuore A. Gemelli, Rome, Italy
| | - Maurizio Martini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy. .,Divisione di Anatomia Patologica, Dipartimento di scienze della vita e sanità pubblica, Università Cattolica del Sacro Cuore A. Gemelli, Rome, Italy.
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Di Gianfrancesco L, Ragonese M, Palermo G, Sacco E, Nigro D, Distante A, Totaro A, Foschi N, Bassi P, Racioppi M. A new prognostic tool for therapy-response in non-muscle invasive bladder cancer patients: The Bladder Outlet-Cancer Score (BOCS). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)36261-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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35
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Di Gianfrancesco L, Ragonese M, Palermo G, Sacco E, Akhundov A, Scarciglia E, Gandi C, Gulino G, Bassi P, Racioppi M. Could the therapeutic response in patients with non-muscle invasive bladder cancer be affected by chronic urinary retention? EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)36262-5] [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: 12/01/2022] Open
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Ragonese M, Foschi N, Pinto F, Di Gianfrancesco L, Bassi P, Racioppi M. Immediate ileal ureter replacement for ureteral avulsion during ureterescopy. IJU Case Rep 2020; 3:241-243. [PMID: 33163914 PMCID: PMC7609185 DOI: 10.1002/iju5.12202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Complete ureteral avulsion represents a rare and fearsome complication of ureteroscopy, reported in less than 1% of cases. In literature there are few reports and different options are presented for its treatment. We present a case of a ureteral avulsion managed with ileal ureter replacement. CASE PRESENTATION A 67-year-old man with a left proximal ureter stone was treated at our department with ureteroscopy. During retrieval of the instrument a complete ureteral avulsion was discovered, with a so-called "scabbard lesion". We decided to proceed with immediate laparotomy and we performed a ileal ureter replacement. CONCLUSION Ureteral avulsion is a rare complication but must be known as a possible complication in high volume center. There is no standard definition regarding its treatment, and in our experience immediate treatment with ileal ureter replacement proved to be safe and effective without any changes in renal function.
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Affiliation(s)
- Mauro Ragonese
- Urology ClinicA. Gemelli HospitalCatholic University of the Sacred HeartRomeItaly
| | - Nazario Foschi
- Urology ClinicA. Gemelli HospitalCatholic University of the Sacred HeartRomeItaly
| | - Francesco Pinto
- Urology ClinicA. Gemelli HospitalCatholic University of the Sacred HeartRomeItaly
| | | | - Pierfrancesco Bassi
- Urology ClinicA. Gemelli HospitalCatholic University of the Sacred HeartRomeItaly
| | - Marco Racioppi
- Urology ClinicA. Gemelli HospitalCatholic University of the Sacred HeartRomeItaly
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Sacco E, Gandi C, Marino F, Totaro A, Di Gianfrancesco L, Palermo G, Pierconti F, Racioppi M, Bassi P. Artificial urinary sphincter significantly better than fixed sling for moderate post-prostatectomy stress urinary incontinence: a propensity score-matched study. BJU Int 2020; 127:229-237. [PMID: 32744793 DOI: 10.1111/bju.15197] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare the efficacy of artificial urinary sphincter (AUS) vs retrourethral transobturator sling (RTS) in men with moderate post-prostatectomy urinary incontinence (PPI) using propensity score-matching analysis to enhance the validity of the comparison (Canadian Task Force classification II-2). PATIENTS AND METHODS Consecutive men with moderate (3-5 pads/day) stress-prevalent PPI were included if implanted with a RTS (TiLOOP® Male; pfm medical, Köln, Germany) or AUS (AMS800® ; Boston Scientific, Boston, MA, USA) since July 2011 to December 2017 and with ≥12 months of follow-up. Preoperative assessment included 24-h pad usage, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), urethrocystoscopy, and urodynamics if indicated. Propensity score-matching analysis was based on age, body mass index, Charlson Comorbidity Index, pad usage, previous radiotherapy, and urethrotomy. The primary outcome was at least 'much improved' response at 12-months according to the Patient Global Impression of Improvement questionnaire, without additional PPI surgery or prosthesis explantation. RESULTS Of 109 included patients, 70 patients were matched and the study groups were well balanced for the baseline matched variables. The median baseline 24-h pad usage was four in both groups (P = 0.10), and median follow-up was 51.2 months for AUS and 47.2 months (P = 0.5) for RTS patients. In the AUS and RTS cohorts, respectively, 33 (94.3%) and 24 (68.6%) patients achieved the primary outcome (P < 0.001), the 0-1 pad/day rates was 94.3% vs 68.6% (P = 0.012) at 12 months, and 91.4% vs 68.6% (P = 0.034) at last follow-up. At the last follow-up, the median 24-h leakage volumes, median ICIQ-SF scores and satisfaction rates were 0 vs 15 mL (P = 0.017), 4 vs 10 (P = 0.001), and 94.3% vs 68.6% (P = 0.012) in the AUS and RTS cohorts, respectively. There were no significant differences in overall rates of complications and re-interventions, although Clavien-Dindo Grade III complications (n = 3) occurred only in the AUS group. At sensitivity analysis, the study was reasonably robust to hidden bias. CONCLUSION We found that AUS implantation significantly outperformed RTS in patients with moderate PPI for both subjective and objective outcomes.
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Affiliation(s)
- Emilio Sacco
- "Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Gandi
- "Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Marino
- "Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Totaro
- "Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Di Gianfrancesco
- "Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Palermo
- "Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Pierconti
- "Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Racioppi
- "Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pierfrancesco Bassi
- "Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
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Racioppi M, Di Gianfrancesco L, Ragonese M, Palermo G, Sacco E, Bassi P. The diagnostic accuracy of Bladder EpiCheck in high-risk population. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33505-9] [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: 10/23/2022] Open
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Bassi P, Di Gianfrancesco L, Ragonese M, Sacco E, Palermo G, Arboretti R, Ceccato R, Salmaso L, Racioppi M. Improved non-invasive diagnosis of Bladder Cancer: A large pilot study with electronic nose. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)30070-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bassi P, Gianfrancesco L, Ragonese M, Palermo G, Pierconti F, Martini M, Racioppi M. Bladder EpiCheck in high risk population. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)30091-4] [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: 11/29/2022] Open
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Racioppi M, Di Gianfrancesco L, Ragonese M, Palermo G, Sacco E, Bassi PF. Can Neutrophil-to-Lymphocyte ratio predict the response to BCG in high-risk non muscle invasive bladder cancer? Int Braz J Urol 2019; 45:315-324. [PMID: 30785697 PMCID: PMC6541147 DOI: 10.1590/s1677-5538.ibju.2018.0249] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 09/29/2018] [Indexed: 12/12/2022] Open
Abstract
Objectives: To evaluate the neutrophil-to-lymphocyte ratio (NLR) as a prognostic factor for response of high risk non muscle invasive bladder cancer (HRNMIBC) treated with BCG therapy. Materials and Methods: Between March 2010 and February 2014 in a tertiary center 100 consecutive patients with newly diagnosed HRNMIBC were retrospectively analyzed. Patients were divided according to NLR value: 46 patients with NLR value less than 3 (NLR < 3 group), and 54 patients with NLR value more than 3 (NLR ≥ 3 group). At the end of follow-up 52 patients were high grade disease free (BCG-responder group) and 48 patients underwent radical cystectomy for high grade recurrence or progression to muscle invasive disease (BCG non-responder group). The average follow-up was 60 months. Intervention: analysis and correlation of preoperative NLR value with response to BCG in terms of recurrence and progression. Results: The optimal cut-off for NLR was ≥ 3 according to the receiver operating characteristics analysis (AUC 0.760, 95% CI, 0.669-0.850). Mean NLR value was 3.65 ± 1.16 in BCG non-responder group and 2.61 ± 0.77 in BCG responder group (p = 0.01). NLR correlated with recurrence (r = 0.55, p = 0.01) and progression risk scores (r = 0.49, p = 0.01). In multivariate analysis, NLR (p = 0.02) and EORTC recurrence risk groups (p = 0.01) were associated to the primary endpoint. The log-rank test showed statistically significant difference between NLR < 3 and NLR ≥ 3 curves (p < 0.05). Conclusions: NLR value preoperatively evaluated could be a useful tool to predict BCG response of HRNMIBC. These results could lead to the development of prospective studies to assess the real prognostic value of NLR in HRNMIBC.
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Affiliation(s)
- Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS - Università Cattolica del Sacro Cuore di Roma
| | - Luca Di Gianfrancesco
- Department of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS - Università Cattolica del Sacro Cuore di Roma
| | - Mauro Ragonese
- Department of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS - Università Cattolica del Sacro Cuore di Roma
| | - Giuseppe Palermo
- Department of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS - Università Cattolica del Sacro Cuore di Roma
| | - Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS - Università Cattolica del Sacro Cuore di Roma
| | - Pier Francesco Bassi
- Department of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS - Università Cattolica del Sacro Cuore di Roma
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Palermo G, Bassi P, Racioppi M, Recupero SM, Sacco E, Campetella M, Canu G, Pinto F. Circulating tumor cells as prognostic biological marker in different stages prostate cancer and the effect of different therapeutic approaches on their expression. MINERVA UROL NEFROL 2019; 72:214-222. [PMID: 31144490 DOI: 10.23736/s0393-2249.19.03377-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Circulating tumor cells (CTCs) represent a prerequisite for the formation of metastases. The aim of the study was to identify the role of CTCs as a biological marker of aggressiveness of prostate cancer and verify the expression of molecular markers predictive of response to different therapeutic approaches. METHODS Prospective, single-arm, non-randomized trial. Twenty-four patients with prostate cancer were enrolled into two groups: group 1 (N.=11) with localized prostate cancer treated with radical prostatectomy; group 2 (N.=13) with metastatic disease. We performed, dosage of blood PSA and testosterone, detection of EGFR, PSMA, PSA and Androgen Receptor (AR) expression on CTC during pre-treatment and follow-up at 1, 3, 9 and 18 months. RESULTS A total of 65 blood samples were evaluated. In group 1, pre-treatment sampling was negative for the expression of markers on CTC in 90% of the patients while group 2 pre-treatment sampling was positive for the expression of at least one biomarker in seven of 13 patients (54%). After treatment, four patients in group 2 experienced a reduced expression of the markers on CTC, however, in one case there was a new increase of PSA and PSMA at 3 months. One patient had a positivity of AR at 3 months. CONCLUSIONS The expression of PSA, PSMA, EGFR and AR on CTCs appears to be absent in the pre-treatment samplings in cases of localized prostate cancer. The same markers are hyper-expressed before treatment mostly in metastatic prostate cancer and can relate with early biochemical relapse.
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Affiliation(s)
- Giuseppe Palermo
- Department of Urology, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy -
| | - Pierfrancesco Bassi
- Department of Urology, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy
| | - Marco Racioppi
- Department of Urology, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy
| | - Salvatore M Recupero
- Department of Urology, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy
| | - Emilio Sacco
- Department of Urology, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy
| | - Marco Campetella
- Department of Urology, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy
| | - Giulia Canu
- Department of Biochemistry, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy
| | - Francesco Pinto
- Department of Urology, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy
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Racioppi M, Di Gianfrancesco L, Ragonese M, Palermo G, Sacco E, Bassi PF. ElectroMotive drug administration (EMDA) of Mitomycin C as first-line salvage therapy in high risk "BCG failure" non muscle invasive bladder cancer: 3 years follow-up outcomes. BMC Cancer 2018; 18:1224. [PMID: 30522445 PMCID: PMC6282335 DOI: 10.1186/s12885-018-5134-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 04/03/2018] [Accepted: 11/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In case of high grade non-muscle invasive bladder cancer (HG-NMIBC), intravesical BCG represents the first-line treatment; despite the "gold" standard therapy, up to 50% of patients relapse, needing radical cystectomy. Hence, alternative therapeutic strategies have been developed. The aim of the study was to evaluate a first-line salvage treatment with EMDA®-MMC in patients with HGNMIBC unresponsive to BCG. METHODS We carried out a prospective, single-center, single-arm Phase II study in order to evaluate the efficacy (in terms of recurrence and progression) and the safety of the EMDA®-MMC treatment in 26 (21 male, 5 female) consecutive patients with "BCG refractory" HGNMIBC on a 3 years follow-up. EMDA®-MMC treatment consisted of 40 mg of MMC diluted in 100 ml of sterile water retained in the bladder for 30 min with 20 mA pulsed electric current. EMDA®-MMC regimen consisted of an induction course of 6 weekly instillations followed by a maintenance course of 6 monthly instillations. Follow-up was performed with systematic mapping biopsies of the bladder (with sampling in the prostatic urethra for men), voiding and washing urinary cytology, radiological study of the upper urinary tract. We performed Survival Kaplan-Meier curves and Log-rank test in order to analyze high grade disease-free survival. RESULTS At the end of follow-up, 16 patients (61.5%) preserved their native bladder; 10 patients (38.4%) underwent radical cystectomy, in 6 patients (23.1%) for recurrent HGNMIBC and in 4 patients (15.4%) for progression to muscle-invasive disease. At the end of follow-up, stratifying patients based on TNM classification (TaG3, T1G3, Cis, TaT1G3 + Cis), disease-free rates were 75, 71.4, 50 and 25%, respectively; survival curves showed statistically significant differences (p value < 0.05). Regarding toxicity, we reported severe adverse systemic event of hypersensitivity to the MMC in 3 patients (11.5%), and local side effects in 6 patients (26.1%). CONCLUSIONS In the field of alternative strategies to radical cystectomy, the EMDA®-MMC could be considered safe and effective in high-risk NMIBC unresponsive to BCG, as a "bladder sparing" therapy in selected patients. Multicenter studies with a larger number of patients and a longer follow-up might confirm our preliminary results. TRIAL REGISTRATION EudraCT2017-002585-43. 17 June 2017 (retrospectively registered).
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Affiliation(s)
- Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario “A. Gemelli” IRCSS, Largo Agostino Gemelli, 8, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, L.go A. Gemelli, 8, 00168 Rome, Italy
| | - Luca Di Gianfrancesco
- Department of Urology, Fondazione Policlinico Universitario “A. Gemelli” IRCSS, Largo Agostino Gemelli, 8, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, L.go A. Gemelli, 8, 00168 Rome, Italy
| | - Mauro Ragonese
- Department of Urology, Fondazione Policlinico Universitario “A. Gemelli” IRCSS, Largo Agostino Gemelli, 8, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, L.go A. Gemelli, 8, 00168 Rome, Italy
| | - Giuseppe Palermo
- Department of Urology, Fondazione Policlinico Universitario “A. Gemelli” IRCSS, Largo Agostino Gemelli, 8, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, L.go A. Gemelli, 8, 00168 Rome, Italy
| | - Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario “A. Gemelli” IRCSS, Largo Agostino Gemelli, 8, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, L.go A. Gemelli, 8, 00168 Rome, Italy
| | - Pier Francesco Bassi
- Department of Urology, Fondazione Policlinico Universitario “A. Gemelli” IRCSS, Largo Agostino Gemelli, 8, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, L.go A. Gemelli, 8, 00168 Rome, Italy
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Siracusano S, D'Elia C, Cerruto MA, Gacci M, Ciciliato S, Simonato A, Porcaro A, De Marco V, Talamini R, Toffoli L, Saleh O, Serni S, Visalli F, Niero M, Lonardi C, Imbimbo C, Verze P, Mirone V, Racioppi M, Iafrate M, Cacciamani G, De Marchi D, Bassi P, Artibani W. Quality of life following urinary diversion: Orthotopic ileal neobladder versus ileal conduit. A multicentre study among long-term, female bladder cancer survivors. Eur J Surg Oncol 2018; 45:477-481. [PMID: 30385155 DOI: 10.1016/j.ejso.2018.10.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 10/08/2018] [Accepted: 10/17/2018] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Women undergoing radical cystectomy (RC) followed by urinary diversion (UD) for bladder cancer experience a substantial reduction in health-related quality of life (HRQOL). At present, studies comparing long-term QOL outcomes for different UD methods, needed to inform evidence-based choices of bladder reconstruction for female patients, are sparse. Our objective was to compare two common UD methods in terms of their HRQOL outcomes in women. MATERIALS AND METHODS We retrospectively analysed HRQOL in 73 consecutive female bladder cancer patients having undergone orthotopic ileal neobladder (IONB, N = 24) or ileal conduit (IC, N = 49) following RC between 2007 and 2013 in six Italian academic urological centres. Patients had no evidence of tumour recurrence and were actively followed up. Validated Italian versions of the European Organisation for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder-cancer-specific (QLQ-BLM30) questionnaires were used to evaluate HRQOL. RESULTS Patients in the IONB group were significantly younger than those in the IC group (median age: 67 and 73 years, respectively, p = 0.02). Barring that, the two groups did not present statistically significant differences in median length of follow-up (43 vs 54 months), pathological stage, grading of the neoplasm, or adjuvant chemo - or radiotherapy. No significant differences in QOL were found between the groups, with the exception of financial difficulties, affecting IONB patients significantly more than IC patients (mean score on a scale of 0-100: 33.3 ± 29.5 vs 18.4 ± 19.3, respectively; p = 0.05). CONCLUSION Financial difficulties was the only HRQOL item to differ between the two UD groups.
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Affiliation(s)
| | | | | | - Mauro Gacci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | | | - Alchiede Simonato
- University of Genoa, Department of Urology, IRCSS San Martino - IST, Genoa, Italy
| | | | | | - Renato Talamini
- IRCCS-CRO, Unit of Epidemiology and Biostatistics, Aviano, Italy
| | - Laura Toffoli
- Trieste University, Urology Department, Trieste, Italy
| | - Omar Saleh
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | | | - Mauro Niero
- University of Verona, Human Sciences Department, Verona, Italy
| | | | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences, Odontostomatology, Urology Unit, University of Naples, Italy
| | - Paolo Verze
- Department of Neurosciences, Reproductive Sciences, Odontostomatology, Urology Unit, University of Naples, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences, Odontostomatology, Urology Unit, University of Naples, Italy
| | - Marco Racioppi
- Catholic University of Rome, Policlinico Gemelli, Urology Department, Rome, Italy
| | | | | | | | - Pierfrancesco Bassi
- Catholic University of Rome, Policlinico Gemelli, Urology Department, Rome, Italy
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Sacco E, Bientinesi R, Gandi C, Di Gianfrancesco L, Pierconti F, Racioppi M, Bassi P. Patient pad count is a poor measure of urinary incontinence compared with 48-h pad test: results of a large-scale multicentre study. BJU Int 2018; 123:E69-E78. [PMID: 30253042 DOI: 10.1111/bju.14566] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine in a large population of community-dwelling incontinent patients the accuracy and determinants of pad count as a measure of urinary incontinence (UI), using data from a multicentre 48-h pad test study. MATERIALS AND METHODS Incontinent patients, who were provided with absorbent products for the period January 2012 to March 2016, volunteered to perform a 48-h home-based pad test and to fill in a diary with information on pad usage. Correlations between UI measures (48-h pad count and pad weight gain, mean pad weight gain per pad) were calculated. Logistic regression analyses were conducted to investigate patient-related and pad usage-related factors influencing pad count. RESULTS A total of 14 493 patients (median age 81 years) were included, with a total of 98 362 continence products used overall during the study period. The 48-h pad count showed a weak correlation with 48-h pad weight gain (R2 = 0.12; 0.19 for men and 0.11 for women) and mean pad weight gain per pad (R2 = -0.03). The weakest correlation was observed among patients using >6 pads/48 h (R2 = 0.02). A statistically significant negative association between pad absorption capacity and pad count was observed. Patients using products with a shaped and rectangular design had 34% and 40% higher propensity to use more pads than those using briefs (P < 0.001), respectively. CONCLUSIONS The results of this very large observational study confirmed that pad count is a poor measure of UI severity. Pad count only measured 12% of the variability of UI volume and was affected by several patient-related and pad usage-related factors. Consequently, pad count should not be used instead of the pad test as an objective measure of UI when an accurate evaluation is required for research or clinical purposes.
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Affiliation(s)
- Emilio Sacco
- "Agostino Gemelli" Academic Hospital Foundation-IRCCS, Catholic University School of Medicine, Rome, Italy
| | - Riccardo Bientinesi
- "Agostino Gemelli" Academic Hospital Foundation-IRCCS, Catholic University School of Medicine, Rome, Italy
| | - Carlo Gandi
- "Agostino Gemelli" Academic Hospital Foundation-IRCCS, Catholic University School of Medicine, Rome, Italy
| | - Luca Di Gianfrancesco
- "Agostino Gemelli" Academic Hospital Foundation-IRCCS, Catholic University School of Medicine, Rome, Italy
| | - Francesco Pierconti
- "Agostino Gemelli" Academic Hospital Foundation-IRCCS, Catholic University School of Medicine, Rome, Italy
| | - Marco Racioppi
- "Agostino Gemelli" Academic Hospital Foundation-IRCCS, Catholic University School of Medicine, Rome, Italy
| | - Pierfrancesco Bassi
- "Agostino Gemelli" Academic Hospital Foundation-IRCCS, Catholic University School of Medicine, Rome, Italy
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Racioppi M, Di Gianfrancesco L, Ragonese M, Palermo G, Sacco E, Bassi P. Chemoablation with Intensive Intravesical Mitomycin C Treatment: A New Approach for Non-muscle-invasive Bladder Cancer. Eur Urol Oncol 2018; 2:576-583. [PMID: 31411974 DOI: 10.1016/j.euo.2018.08.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Received: 07/02/2018] [Revised: 08/21/2018] [Accepted: 08/28/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Mitomycin C (MMC) is widely used, but the optimal dose and schedule have not been established. OBJECTIVE To evaluate the ablative power and patient safety of a short-term intensive schedule of intravesical MMC in patients with recurrent non-muscle-invasive bladder cancer (NMIBC). DESIGN, SETTING, AND PARTICIPANTS This was a prospective, single-center, nonrandomized study that compared 47 patients (group 1) with a history of low- to intermediate-risk NMIBC with long free-recurrence intervals, recurrence of ≤1cm in maximum diameter, and negative cytology to 47 consecutive patients with the same baseline characteristics (group 2). INTERVENTION Intravesical MMC three times per week for 2 wk for group 1. Transurethral resection of bladder tumor (TUR-BT) and early instillation and a weekly schedule of intravesical MMC for group 2. All cancer-free patients underwent monthly MMC maintenance. Follow-up included bladder mapping, voiding and washing urinary cytology, TUR of suspected area, TUR of previous tumor location, and ultrasound or computed tomography/magnetic resonance imaging. OUTCOME MEASUREMENT AND STATISTICAL ANALYSIS We used χ2 and Student's t test for comparison of categorical and continuous variables, respectively. Kaplan-Meier curves were plotted to estimate cancer-free survival. The significance level was set to p<0.05. RESULTS AND LIMITATIONS The complete response rate at 39 mo was 61.7% in group 1 and 70.2% in group 2 (p=0.38). Kaplan-Mayer analysis revealed no difference in cancer-free survival rates overall (log-rank <3.84), according to tumor size in each group (log-rank <3.84), or between the groups (log-rank <7.82). No cases of systemic toxicity were observed. Local toxicities did not differ between the groups (p=0.32) and resolved on treatment of symptoms, and no patient discontinued their treatment. Limitations include the small number of patients, selection bias because of the single tertiary center, and short follow-up. CONCLUSIONS The proposed MMC schedule had good ablative power that can be explained by better concordance between the scheduled timing and the tumor cell duplication rate. The short-term intensive schedule could be considered as a therapeutic strategy to replace TUR-BT in selected NMIBC patients. PATIENT SUMMARY We report our experience of a tailored intravesical therapy schedule for bladder cancer. This schedule could be considered a therapeutic strategy to replace surgery for selected patients.
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Affiliation(s)
- Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore di Roma, Rome, Italy
| | - Luca Di Gianfrancesco
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore di Roma, Rome, Italy.
| | - Mauro Ragonese
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore di Roma, Rome, Italy
| | - Giuseppe Palermo
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore di Roma, Rome, Italy
| | - Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore di Roma, Rome, Italy
| | - PierFrancesco Bassi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore di Roma, Rome, Italy
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Siracusano S, D'Elia C, Cerruto MA, Saleh O, Serni S, Gacci M, Ciciliato S, Simonato A, Porcaro A, DE Marco V, Talamini R, Toffoli L, Visalli F, Niero M, Lonardi C, Imbimbo C, Verze P, Mirone V, Racioppi M, Iafrate M, Cacciamani G, DE Marchi D, Bassi P, Artibani W. Quality of Life in Patients with Bladder Cancer Undergoing Ileal Conduit: A Comparison of Women Versus Men. ACTA ACUST UNITED AC 2018; 32:139-143. [PMID: 29275311 DOI: 10.21873/invivo.11216] [Citation(s) in RCA: 6] [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: 10/16/2017] [Revised: 11/19/2017] [Accepted: 11/29/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND/AIM Studies comparing health-related quality of life (HR-QoL) between patients who underwent radical cystectomy (RC) and those who underwent a different form of urinary diversion has not reached yet univocal and reliable conclusions. The aim of our study was to evaluate bladder-specific long-term HR-QoL after radical cystectomy and ileal conduit. PATIENTS AND METHODS A multicenter study was carried out on 145 consecutive patients (112 males and 33 females) undergoing RC and ileal conduit (IC). HR-QoL assessment was conducted using Italian versions of European Organisation for Research and Treatment of Cancer QLQ-C30 and EORTC BLM-30 questionnaires. RESULTS Our data showed that women who underwent IC presented greater problems than men in cognitive functioning (mean score±SD: 77.3±27.9 vs. 87.8±18.6) as well in future perspective (score: 42.4±34.4 vs. 21.9±24.6). Nevertheless, men undergoing IC had more problems in sexual functioning than women (score: 23.3±24.5 vs. 7.0±20.3) (all p<0.05). CONCLUSION In our series, female patients presented a greater burden than male patients in cognitive functioning as well in future perspective, but lower concerns with regard to sexual function.
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Affiliation(s)
| | - Carolina D'Elia
- Urology Department, Bolzano General Hospital, Bolzano, Italy
| | | | - Omar Saleh
- Urology Department, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Urology Department, Careggi Hospital, University of Florence, Florence, Italy
| | - Mauro Gacci
- Urology Department, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Alchiede Simonato
- Department of Urology, IRCSS San Martino - IST, University of Genoa, Genoa, Italy
| | | | | | - Renato Talamini
- Unit of Epidemiology and Biostatistics, IRCCS_CRO, Aviano, Italy
| | - Laura Toffoli
- Urology Department, Trieste University, Trieste, Italy
| | | | - Mauro Niero
- TESIS Department, University of Verona, Verona, Italy
| | | | - Ciro Imbimbo
- Urology Department, University of Naples, Federico II, Naples, Italy
| | - Paolo Verze
- Urology Department, University of Naples, Federico II, Naples, Italy
| | - Vincenzo Mirone
- Urology Department, University of Naples, Federico II, Naples, Italy
| | - Marco Racioppi
- Urology Department, Foudazione Policlinico Gemelli, Catholic University of Rome, Rome, Italy
| | | | | | | | - Pierfrancesco Bassi
- Urology Department, Foudazione Policlinico Gemelli, Catholic University of Rome, Rome, Italy
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Sacco E, Gandi C, Vaccarella L, Recupero S, Racioppi M, Pinto F, Totaro A, Foschi N, Palermo G, Pierconti F, Bassi P. Titanized Transobturator Sling Placement for Male Stress Urinary Incontinence Using an Inside-out Single-incision Technique: Minimum 12-Months Follow-up Study. Urology 2018; 115:144-150. [DOI: 10.1016/j.urology.2018.02.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/14/2018] [Accepted: 02/17/2018] [Indexed: 11/16/2022]
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Racioppi M, Di Gianfrancesco L, Ragonese M, Palermo G, Sacco E, Bassi P. The challenges of Bacillus of Calmette-Guerin (BCG) therapy for high risk non muscle invasive bladder cancer treatment in older patients. J Geriatr Oncol 2018; 9:507-512. [PMID: 29673806 DOI: 10.1016/j.jgo.2018.03.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 02/14/2018] [Accepted: 03/28/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To evaluate the efficacy and safety of a tailored endovesical immunotherapy protocol with biweekly BCG for elderly Patients with high risk non muscle invasive bladder cancer (HG-NMIBC). MATERIALS AND METHODS We retrospectively evaluated data from 200 patients older than 80 years newly diagnosed with HG-NMIBC: 100 (group 1) with multiple comorbidities (WHO PS 2-3, ASA score ≥3, Charlson Comorbidity index ≥3, GFR<60 mL/min) were treated with BCG induction course administered biweekly; 100 (group 2) with statistically significant better conditions were treated with standard weekly BCG therapy. After the induction treatment disease-free patients underwent to at least one year of BCG maintenance therapy. Endpoints were: initial response to BCG, cancer-free survival and rate of progression at 2 years, rate of complications. RESULTS No statistically significant differences were found in terms of initial response to BCG (69% in Group 1 vs 71% in Group 2, P = 0.75), cancer free survival (57% vs 55% respectively, P = 0.77) and rate of progression (20% vs 14% respectively, P = 0.26) at 2 years. The difference in the rate of overall complications was statistically significant (15% in Group 1 vs 27% in Group 2, P = 0.03), in the rate of severe complications was not statistically significant (5% in Group 1 vs 7% in Group 2, P = 0.61). CONCLUSION A tailored regimen of BCG administration is possible and safe in frail elderly patients, limiting side effects and risk of undertreatment but maintaining oncological outcomes. Preliminary results in a small patients group are promising but larger randomized studies are needed to confirm our data.
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Affiliation(s)
- Marco Racioppi
- Department of Urology, "Agostino Gemelli" Academic Hospital Foundation, IRCCS, Catholic University School of Medicine, Rome, Italy
| | - Luca Di Gianfrancesco
- Department of Urology, "Agostino Gemelli" Academic Hospital Foundation, IRCCS, Catholic University School of Medicine, Rome, Italy.
| | - Mauro Ragonese
- Department of Urology, "Agostino Gemelli" Academic Hospital Foundation, IRCCS, Catholic University School of Medicine, Rome, Italy
| | - Giuseppe Palermo
- Department of Urology, "Agostino Gemelli" Academic Hospital Foundation, IRCCS, Catholic University School of Medicine, Rome, Italy
| | - Emilio Sacco
- Department of Urology, "Agostino Gemelli" Academic Hospital Foundation, IRCCS, Catholic University School of Medicine, Rome, Italy
| | - PierFrancesco Bassi
- Department of Urology, "Agostino Gemelli" Academic Hospital Foundation, IRCCS, Catholic University School of Medicine, Rome, Italy
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50
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Cellini N, Luzi S, Morganti AG, Mantini G, Valentini V, Racioppi M, Leone M, Mattiucci GC, Di Gesù C, Giustacchini M, Destito A, Smaniotto D, Alcini E. Hormono-Radiotherapy in Prostatic Carcinoma: Prognostic Factors and Implications for Combined Modality Treatment. Tumori 2018; 88:495-9. [PMID: 12597145 DOI: 10.1177/030089160208800612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to evaluate the prognostic role of several clinical variables in a patient population undergoing neoadjuvant hormonotherapy (NHT) with external beam radiotherapy (ERT) to identify subsets of patients with an unfavorable prognosis who require intensified therapy. Eighty-four patients (mean age, 68.2 +/– 6.1 years; range, 52–81 years) underwent ERT (45 Gy to pelvic volume; 65 Gy mean dose to prostate volume) and NHT (oral flutamide: 250 mg three times daily for 30 days; LH-RH analogue: one vial every 28 days starting two months before radiotherapy and for its entire duration). The distribution according to clinical stage was T2: 46.4%, T3: 50.0%, T4: 3.6%. The distribution according to the Gleason score was grade 2–4: 17.9%; grade 5–7: 53.6%; grade 8–10: 28.5%. The distribution according to pretreatment PSA levels (in ng/mL) was 0–4: 5.9%; 4–10: 26.2%; 10–20: 16.7%; ≥20: 51.2%. With a median follow-up of 36 months, 3.6% of patients died; hematogenous metastases and local disease progression were found in 16.7% and 6% of patients, respectively. Overall, the incidence of disease progression was 17.9%. 32.9% of patients showed biochemical failure during follow-up. Overall, metastasis-free, local progression-free and biochemical failure-free actuarial survival at five years was 89.2%, 66.5%, 85.0% and 41.9%, respectively. At univariate analysis (log-rank) clinical stage (cT) was shown to be significantly correlated with the incidence of metastasis (P = 0.0004), local progression (P <0.0001) and disease-free survival (P = 0.0005). At multivariate analysis (Cox) the correlations between clinical stage and metastasis (P = 0.0175), local progression (P = 0.0200) and disease-free survival (P = 0.0175) were confirmed. Gleason score and pretreatment PSA levels did not show any significant correlation with these endpoints. These results confirm the indications of the recent literature, which, in prostate carcinoma at higher clinical stages, suggest the use of prolonged hormonal therapy after radiotherapy.
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Affiliation(s)
- Numa Cellini
- Istituto di Radiologia, Cattedra di Radioterapia, Universitá Cattolica del Sacro Cuore, Policlinico a Gemelli, Rome, Italy
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