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Gacci M, Greco I, Artibani W, Bassi P, Bertoni F, Bracarda S, Briganti A, Carmignani G, Carmignani L, Conti G, Corvò R, De Nunzio C, Fusco F, Graziotti P, Maggi S, Magrini SM, Mirone V, Montironi R, Muto G, Noale M, Pecoraro S, Porreca A, Ricardi U, Russi E, Salonia A, Simonato A, Serni S, Tubaro A, Zagonel V, Crepaldi G. The waiting time for prostate cancer treatment in Italy: analysis from the Pros-IT CNR study. Minerva Urol Nefrol 2020. [PMID: 33200896 DOI: 10.23736/s0393-2249.20.03925-9] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Prostate cancer (PCa) is the second most common neoplasm in male patients. To date, there's no certain indication about the maximum waiting time (WT) acceptable for treatment beginning and the impact on oncological and functional outcomes has not been well established. METHODS Data from the National Research Council PCa monitoring multicenter project in Italy (Pros-IT CNR) were prospectively collected and analyzed. WT was defined as the time from the bioptical diagnosis of PCa to the first treatment received. Patients were divided in two groups, using a time frame of 90 days. Quality of life was measured through the Italian version of the University of California Los Angeles-Prostate Cancer Index (UCLA-PCI) and of the Short-Form Health Survey (SF-12). The occurrence of upgrading, upstaging, presence of lymph node metastasis and positive surgical margins at the final histopathological diagnosis, and PSA at 12 months follow-up were evaluated. RESULTS The overall median WT was 93 days. The logistic multivariable model confirmed that age, being resident in Southern regions of Italy and T staging at diagnosis were significantly associated with a WT >90 days. At 6 months from diagnosis the mean SF-12 score for the emotionalpsychological component was significantly lower in WT ≥ 90 days group (p=0.0428). Among patients treated with surgical approach, no significant differences in oncological outcomes were found in the two groups. CONCLUSIONS In our study age, clinical T stage and provenance from Southern regions of Italy are associated with a WT > 90 days. WT might have no impact on functional and oncological outcome.
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Affiliation(s)
- Mauro Gacci
- Department of Urology, University of Florence, Florence, Italy -
| | - Isabella Greco
- Department of Urology, University of Florence, Florence, Italy
| | - Walter Artibani
- Urologic Clinic, Department of Oncological and Surgical Sciences, AOU Integrata and University of Verona, Verona, Italy
| | | | | | | | - Alberto Briganti
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Luca Carmignani
- Department of Urology, San Donato Policlinic Hospital, Milan, Italy
| | - Giario Conti
- Department of Urology, St. Anna Hospital, Como, Italy
| | - Renzo Corvò
- Department of Radiation Oncology, IRCCS Ospedale Policlinico San Martino - and University, Genoa, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | | | - Stefania Maggi
- National Research Council (CNR), Neuroscience Institute, Aging Branch, Padua, Italy
| | - Stefano M Magrini
- Radiation Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Vincenzo Mirone
- Department of Urology, University Federico II, Naples, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, Ancona, Italy
| | - Giovanni Muto
- Department of Urology, Humanitas, Hospital Gradenigo, Torino, Italy
| | - Marianna Noale
- National Research Council (CNR), Neuroscience Institute, Aging Branch, Padua, Italy
| | | | - Angelo Porreca
- Department of Urology, Abano Terme General Hospital, Padua, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Elvio Russi
- Radiation Unit, San Croce e Carle Hospital, Cuneo, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Stomatological Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | - Sergio Serni
- Department of Urology, University of Florence, Florence, Italy
| | - Andrea Tubaro
- Department of Urology, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Vittorina Zagonel
- 4Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Gaetano Crepaldi
- National Research Council (CNR), Neuroscience Institute, Aging Branch, Padua, Italy
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Fusco F, Uebing A, Scognamiglio G, Guarguagli S, Kempny A, Diller G, Gatzoulis M, Babu-Narayan S, Li W. Long-term follow-up after percutaneous pulmonary valve implantation: sustained clinical benefit with evidence of persistent biventricular reverse remodeling and improved global performance. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with native or post-surgical right ventricular outflow tract (RVOT) dysfunction often require several re-interventions. Percutaneous pulmonary valve implantation (PPVI) has recently been proposed as an attractive alternative to surgery, but there is still lack of data on long-term results.
Aim
To determine the long-term outcome after PPVI and to investigate whether clinical benefit and cardiac performance improvement is achieved after the procedure.
Methods and results
Seventy-eight patients (mean age 31.75±11.7) undergoing PPVI between April 2007 and July 2017 at Royal Brompton Hospital were retrospectively included in the study. The median follow-up was 6.1 years (2.1–11.2). Overall survival was 90.8%±4.1 at 6 years and 85%±5.9 at 11 years with freedom from valve failure (defined as either severe stenosis or regurgitation) of 87.6%±5 at 6 years of follow-up. Annual reintervention rate was 3.2% (95% CI 1.6–5.5). Infective endocarditis was a major concern with annual incidence rate of 1.6% (95% CI 0.5–3.4) and 50% of adverse outcome. Male sex (HR 3.2, 95% CI 1.3–7.9, p=0.013), age at procedure>50 years (HR 4.7, 95% CI 1.5–15.1, p=0.01) and residual mean gradient>25 mmHg at immediate postprocedural echo (HR 4.6, 95% CI 1.6–13.5%, p=0.006) were independently associated to the composite endpoint (including death, re-intervention, valve failure and arrhythmia). At latest follow-up, significant NYHA class (Pre Vs 6.1yrs Post p<0.0001) and cardiopulmonary test results improvement (peakVO2 p=0.01) and arrhythmic burden reduction (p=0.002) were found. Both cardiovascular magnetic resonance (CMR) and serial echocardiograms showed biventricular reverse remodeling (Pre Vs 1.3yrs Post CMR: RVEDVi p=0.0002, RVESVi p=0.0012, LVEDVi p=0.028). Furthermore, speckle tracking assessments demonstrated significant improvement of RV free wall GLS (Pre Vs 6.4yrs Post p=0.03) and LV GLS (p=0.01) at long-term. Moreover, concomitant improvement of RV relaxation properties was suggested by echo evidence of right atrial (RA) reverse remodeling (Pre Vs 6.4yrs Post RA area p=0.0001), increased RA strain (p=0.0005) and reduction of the patients with restrictive RV physiology (p<0.0001).
Conclusion
PPVI is a reliable alternative to surgery with long-lasting favourable clinical effects associated with significant and persistent structural biventricular reverse remodeling and global systolic and diastolic functional improvement. Valve failure and infective endocarditis remain major complications during follow-up. Older and male patients and those with residual transvalvular gradients immediately post procedure are at higher risk of adverse clinical events, thus suggesting that re-intervention should be anticipated and that complete relief of RVOT obstruction should be pursued.
Kaplan-Meier curves for survival free from VF
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- F Fusco
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - A Uebing
- Royal Brompton and Harefield Hospital, London, United Kingdom
| | | | - S Guarguagli
- Royal Brompton and Harefield Hospital, London, United Kingdom
| | - A Kempny
- Royal Brompton and Harefield Hospital, London, United Kingdom
| | - G.P Diller
- Royal Brompton and Harefield Hospital, London, United Kingdom
| | - M.A Gatzoulis
- Royal Brompton and Harefield Hospital, London, United Kingdom
| | | | - W Li
- Royal Brompton and Harefield Hospital, London, United Kingdom
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Ruvolo C, Nocera L, Califano G, La Rocca R, Spena G, Creta M, Capece M, Celentano G, Crocetto F, Mangiapia F, Verze P, Fusco F, Palmieri A, Longo N, Imbimbo C, Brigamti A, Mirone V, Karakiewicz P. Higher cancer mortality in rural upper urinary tract urothelial carcinoma patients. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35607-x] [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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Fusco F, Creta M, Trama F, Esposito F, Crocetto F, Aveta A, Mangiapia F, Imbimbo C, Capece M, La Rocca R, Mirone V, Longo N. Tamsulosin plus a new complementary and alternative medicine in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: Results from a retrospective comparative study. ACTA ACUST UNITED AC 2020; 92. [PMID: 33016038 DOI: 10.4081/aiua.2020.3.173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/12/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND We aimed to compare the efficacy of tamsulosin 0.4 mg once a day alone and the combination therapy involving tamsulosin 0.4 mg once a day plus the complementary and alternative medicine consisting of vitamins (C and D), herbal products (Cucurbita maxima, Capsicum annum, Polygonum capsicatum) and amino acid L-Glutamine bid in patients with lower urinary tract symptoms related to benign prostatic hyperplasia (LUTS/BPH). METHODS We performed a retrospective matched paired comparison. The clinical records of LUTS/BPH patients who underwent medical therapy with tamsulosin 0.4 mg/day plus the complementary and alternative medicine consisting of vitamins (C and D), herbal products (Cucurbita maxima, Capsicum annum, Polygonum capsicatum) and amino acid L-Glutamine bid between January 2019 to September 2019 were reviewed (Group 1). These patients were compared in a 1:1 fashion with LUTS/BPH patients who underwent therapy with tamsulosin 0.4 mg/day alone (Group 2). Total, storage, voiding and Quality of Life (QoL) international prostate symptom (IPSS) score, as well as overactive bladder (OAB)-v8 score and treatment- related adverse events recorded at 40 days follow-up in both groups were compared. RESULTS At 40 days follow-up mean total, storage, voiding and QoL IPSS sub-scores as well as OAB-v8 score significantly improved in both groups. Intergroup comparison showed statistically significant lower mean total IPSS score (11.6 vs 12.4, p = 0.04) mean storage IPSS sub-score (6.5 vs 7.5, p = 0.01), and mean OAB v8 score (16.7 vs 18.8, p = 0.03) in patients in the Group 1. CONCLUSIONS The combination of tamsulosin 0.4 mg/die plus the complementary and alternative medicine consisting of vitamins (C and D), herbal products (Cucurbita maxima, Capsicum annum, Polygonum capsicatum) and amino acid LGlutamine bid provides statistically significant advantages in terms of storage LUTS improvements in patients with LUTS/BPH compared to tamsulosin 0.4 mg/day alone. These findings are preliminary and further prospective studies on a greater number of patients are needed to confirm it.
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Affiliation(s)
- Ferdinando Fusco
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II. Naples.
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De Luca L, Creta M, Barone B, Crocetto F, Cieri M, Campanino MR, Insabato L, Mangiapia F, Fusco F, Imbimbo C, Mirone V, Longo N. A case of incidentally discovered solitary fibrous tumor of the kidney: A case study. Mol Clin Oncol 2020; 13:39. [PMID: 32832082 PMCID: PMC7439114 DOI: 10.3892/mco.2020.2109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/25/2020] [Indexed: 01/21/2023] Open
Abstract
Solitary fibrous tumor (SFT) is a rare neoplasm of mesenchymal origin. The kidney represents an unusual location for SFT and the diagnosis and treatment of renal SFT remains challenging. The present study reports the case of a right kidney SFT incidentally discovered in a 52-year old woman. Radiological findings from computed tomography and magnetic resonance imaging were not specific but highly suspect for a malignant neoplasm. The definitive diagnosis relied on histological examination and immunohistochemical staining for CD34 and signal transducer and activator of transcription 6.
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Affiliation(s)
- Luigi De Luca
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, I-80123 Naples, Italy
| | - Massimiliano Creta
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, I-80123 Naples, Italy
| | - Biagio Barone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, I-80123 Naples, Italy
| | - Felice Crocetto
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, I-80123 Naples, Italy
| | - Miriam Cieri
- Department of Advanced Biomedical Sciences, University of Naples Federico II, I-80123 Naples, Italy
| | - Maria Raffaela Campanino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, I-80123 Naples, Italy
| | - Luigi Insabato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, I-80123 Naples, Italy
| | - Francesco Mangiapia
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, I-80123 Naples, Italy
| | - Ferdinando Fusco
- Department of Woman, Child and General and Specialized Surgery, Urology Unit, University of Campania 'Luigi Vanvitelli', I-80123 Naples, Italy
| | - Ciro Imbimbo
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, I-80123 Naples, Italy
| | - Vincenzo Mirone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, I-80123 Naples, Italy
| | - Nicola Longo
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, I-80123 Naples, Italy
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Creta M, Fusco F, La Rocca R, Capece M, Celentano G, Imbimbo C, Imperatore V, Russo L, Mangiapia F, Mirone V, Russo D, Longo N. Short- and Long-Term Evaluation of Renal Function after Radical Cystectomy and Cutaneous Ureterostomy in High-Risk Patients. J Clin Med 2020; 9:E2191. [PMID: 32664517 PMCID: PMC7408808 DOI: 10.3390/jcm9072191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/30/2020] [Accepted: 07/08/2020] [Indexed: 12/04/2022] Open
Abstract
Deterioration of renal function has been reported after radical cystectomy (RC) with urinary diversion. We investigated renal function changes in elderly bladder cancer (BCa) patients who underwent RC with cutaneous ureterostomy (CU) urinary diversion. We performed a retrospective, observational study. BCa patients aged ≥75 with an American Society of Anesthesiologists (ASA) class greater than II were included. Glomerular filtration rate (GFR) was the main outcome measure. GFR values were recorded preoperatively, at discharge, at 6-month follow-up, and yearly up to 60 months. A total of 70 patients with a median age of 78.0 years were identified. Median preoperative GFR was 74.3 mL/min/1.73 m2 and declined significantly to 54.6 mL/min/1.73 m2 after 6 months (p < 0.001). A gradual GFR decline was observed thereafter, reaching a median value of 46.2 after 60 months. Preoperative GFR and acute kidney injury were significant predictors of fast deterioration of GFR and of 25% deterioration of GFR after 12 months. Elderly BCa patients with high comorbidity rates undergoing RC with CU should be carefully informed about the risk of GFR deterioration and the need for adequate monitoring.
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Affiliation(s)
- Massimiliano Creta
- Urologic Section, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (R.L.R.); (M.C.); (G.C.); (C.I.); (F.M.); (V.M.); (N.L.)
| | - Ferdinando Fusco
- Department of Urology, Luigi Vanvitelli University of Naples, 80131 Naples, Italy;
| | - Roberto La Rocca
- Urologic Section, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (R.L.R.); (M.C.); (G.C.); (C.I.); (F.M.); (V.M.); (N.L.)
| | - Marco Capece
- Urologic Section, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (R.L.R.); (M.C.); (G.C.); (C.I.); (F.M.); (V.M.); (N.L.)
| | - Giuseppe Celentano
- Urologic Section, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (R.L.R.); (M.C.); (G.C.); (C.I.); (F.M.); (V.M.); (N.L.)
| | - Ciro Imbimbo
- Urologic Section, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (R.L.R.); (M.C.); (G.C.); (C.I.); (F.M.); (V.M.); (N.L.)
| | - Vittorio Imperatore
- Urology Unit, Buon Consiglio Fatebenefratelli Hospital, 80123 Naples, Italy;
| | - Luigi Russo
- Nephrology Unit, Ospedale del Mare; 80131 Naples, Italy;
| | - Francesco Mangiapia
- Urologic Section, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (R.L.R.); (M.C.); (G.C.); (C.I.); (F.M.); (V.M.); (N.L.)
| | - Vincenzo Mirone
- Urologic Section, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (R.L.R.); (M.C.); (G.C.); (C.I.); (F.M.); (V.M.); (N.L.)
| | - Domenico Russo
- Nephrology Unit, Department of Public Health; University of Naples Federico II, 80131 Naples, Italy;
| | - Nicola Longo
- Urologic Section, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (R.L.R.); (M.C.); (G.C.); (C.I.); (F.M.); (V.M.); (N.L.)
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Fusco F, Creta M, Mangiapia F, Cirigliano L, Trama F, Pandolfo SD, Imbimbo C, Longo N, Mirone V. Perceptions, Expectations, Preferences, and Attitudes Toward Premature Ejaculation, Its Diagnosis and Topical Treatment with Fortacin™ Spray: Results from an Expert Panel Discussion. Res Rep Urol 2020; 12:211-216. [PMID: 32670915 PMCID: PMC7337443 DOI: 10.2147/rru.s250301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/18/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Premature ejaculation (PE) represents the most prevalent male sexual issue. Before beginning treatment, it is essential to discuss the patient's expectations thoroughly. METHODS Herein, we report the results of an expert panel discussion about perceptions, expectations, preferences, and attitudes towards PE, its diagnosis and treatment. The panel took place in October 2019 and involved 30 Italian urologists experienced in the management of male sexual dysfunction. It aimed at investigating physicians' points of view about selected aspects of PE management which emerged during the counselling of PE patients over the previous two years. Treatment-related questions were mainly focused on topical treatment with Fortacin™. RESULTS Overall, 83.3% of those interviewed declared that most of their patients perceive PE as a bother rather than a disease. The percentage of urologists interviewed perceived that improved subjective control over ejaculation and prolonged intravaginal ejaculatory latency time (IELT) as the main benefit expected by the majority of their patients was 56.5% and 10%, respectively. Eighty percent of urologists reported on-demand regimen as the dosage modality preferred by the majority of their patients and half of them reported the topical route to be the way of administration preferred in most cases. Moreover, 73.3% of urologists reported that adherence to treatment was higher in patients undergoing topical treatment. Finally, 80% of urologists perceived Fortacin to be efficacious in patients with acquired PE and 70% of them perceived its efficacy to be independent from IELT. DISCUSSION Most patients perceive PE as a bother rather than a disease and mainly advocate an improved control over ejaculation. Fortacin is perceived as efficacious in patients with acquired PE, and independent from IELT.
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Affiliation(s)
- Ferdinando Fusco
- Department of Urology, Luigi Vanvitelli University of Naples, Naples, Italy
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Francesco Mangiapia
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Lorenzo Cirigliano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Francesco Trama
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Savio Domenico Pandolfo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
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Lombardo R, Tema G, Cornu JN, Fusco F, McVary K, Tubaro A, De Nunzio C. The urothelium, the urinary microbioma and men LUTS: a systematic review. MINERVA UROL NEFROL 2020; 72:712-722. [PMID: 32550631 DOI: 10.23736/s0393-2249.20.03762-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The pathophysiology and management of male patients with lower urinary tract symptoms (LUTS) is still a matter of debate. In the past few years, the urothelium and the urinary microbiota represented important areas of research to improve the understanding and management of these patients. Aim of the present review was to summarize the available data on the urothelium and the microbiota related to male LUTS. EVIDENCE ACQUISITION A National Center for Biotechnology Information (NCBI) PubMed search for relevant articles published between January 2000 and December 2019 was performed using the medical subjects heading "urothelium," "microbioma," "microbiota," "urobioma," "urobiota," "benign prostatic hyperplasia," "benign prostatic enlargement," "lower urinary tract symptoms," "lower urinary tract dysfunction," "men," "male," "overactive bladder," "receptors." Exclusion criteria included: animal studies and studies on muscarinic and adrenergic pathways. EVIDENCE SYNTHESIS The urothelium has been recently evaluated in humans to evaluate new possible markers and pathways. New possible targets for the treatment of male LUTS include the neural growth factor, the cannabinoid, the vanilloid and the ATP pathways. However, studies in humans are still needed to elucidate the exact role of these pathways in the management of male patients with LUTS. The available evidence on the urinary microbioma in male is poor. Standing to the available, urinary microbioma is evident in healthy urine in males. Moreover, the urinary microbioma varies depending on the method of collection, sexually transmitted disease status, inflammation and urinary symptoms. A possible role of probiotics in the management of LUTS in women has been proposed and may have a role in male patients as well. CONCLUSIONS The urothelium and the urinary microbiota are still poorly studied in men with LUTS. Most of the evidence and the hypothesis on the relationship between urothelium/urinary microbiota and LUTS comes from animal/in-vitro evidence while clinical trials are lacking. These pathways seem interesting even in LUTS pathogenesis in men but their possible role as a new therapeutic target is still an open debate.
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Affiliation(s)
- Riccardo Lombardo
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy -
| | - Giorgia Tema
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Jean N Cornu
- Charles Nicolle University Hospital, Rouen Cedex, France
| | - Ferdinando Fusco
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples, Naples, Italy
| | - Kevin McVary
- Department of Urology, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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Sangiorgi G, Pizzuto A, Diehm N, Greco F, Fusco F, Chiricolo G, Vismara A, Altieri VM, Cereda A, Bongo S. Endovascular therapy for erectile dysfunction: current knowledge and future perspectives. Minerva Cardiol Angiol 2020; 69:579-595. [PMID: 32492987 DOI: 10.23736/s2724-5683.20.05136-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Erectile dysfunction (ED) is defined as the inability to attain or maintain penile erection sufficient for successful sexual intercourse. ED carries a notable influence on quality of life, with significant implications for family and social relationships. Because atherosclerosis of penile arteries represents one of the most frequent causes of ED, patients presenting with it should always be investigated for potential coexistent coronary or peripheral disease. Up to 75% of patients with ED have a stenosis of the iliac-pudendal-penile arteries, supplying perfusion of the male genital organ. Recently the potential treatment of this pathological condition by percutaneous approaches has emerged with good angiographic results and with a significant improvement in symptoms and quality of life. This review will focus on the normal anatomy and physiology of erection, the pathophysiology of ED, the relation between ED and cardiovascular diseases and, lastly, on new treatment modalities aimed at restoration of normal erectile function.
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Affiliation(s)
- Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy -
| | - Alessandra Pizzuto
- Division of Cardiology, Department of Systemic Medicine, Tor Vergata University, Rome, Italy
| | - Nicolas Diehm
- Vascular Institute Central Switzerland, Aarau, Switzerland
| | | | - Ferdinando Fusco
- Department of Urology, Luigi Vanvitelli University, Caserta, Italy
| | - Gaetano Chiricolo
- Division of Cardiology, Department of Systemic Medicine, Tor Vergata University, Rome, Italy
| | - Alberto Vismara
- Department of Urology, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | | | - Alberto Cereda
- Division of Cardiology, San Gaudenzio Clinic, Novara, Italy
| | - Sante Bongo
- Division of Cardiology, San Gaudenzio Clinic, Novara, Italy
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60
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Sangiorgi G, Pizzuto A, Diehm N, Greco F, Fusco F, Chiricolo G, Vismara A, Altieri V, Cereda A, Bongo S. Endovascular therapy for erectile dysfunction: a state of the art review. Minerva Cardioangiol 2020. [PMID: 32492987 DOI: 10.23736/s0026-4725.20.05136-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Erectile dysfunction (ED) is defined as the inability to attain or maintain penile erection sufficient for successful sexual intercourse. ED carries a notable influence on quality of life, with significant implications for family and social relationships. Because atherosclerosis of penile arteries represents one of the most frequent causes of ED, patients presenting with it should always be investigated for potential coexistent coronary or peripheral disease. Up to 75% of patients with ED have a stenosis of the iliac-pudendal-penile arteries, supplying perfusion of the male genital organ. Recently the potential treatment of this pathological condition by percutaneous approaches has emerged with good angiographic results and with a significant improvement in symptoms and quality of life. This review will focus on the normal anatomy and physiology of erection, the pathophysiology of ED, the relation between ED and cardiovascular diseases and, lastly, on new treatment modalities aimed at restoration of normal erectile function.
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Affiliation(s)
- Giuseppe Sangiorgi
- Division of Cardiology, Department of Systemic Medicine, University of Tor Vergata, Rome, Italy -
| | - Alessandra Pizzuto
- Division of Cardiology, Department of Systemic Medicine, University of Tor Vergata, Rome, Italy
| | - Nicholas Diehm
- Vascular Institute Central Switzerland, Aarau, Switzerland
| | | | - Ferdinando Fusco
- Department of Urology, University "Luigi Vanvitelli", Caserta, Italy
| | - Gaetano Chiricolo
- Division of Cardiology, Department of Systemic Medicine, University of Tor Vergata, Rome, Italy
| | | | | | - Alberto Cereda
- Division of Cardiology, Clinica San Gaudenzio, Novara, Italy
| | - Sante Bongo
- Division of Cardiology, Clinica San Gaudenzio, Novara, Italy
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Corona G, Minhas S, Giwercman A, Bettocchi C, Dinkelman-Smit M, Dohle G, Fusco F, Kadioglou A, Kliesch S, Kopa Z, Krausz C, Pelliccione F, Pizzocaro A, Rassweiler J, Verze P, Vignozzi L, Weidner W, Maggi M, Sofikitis N. Sperm recovery and ICSI outcomes in men with non-obstructive azoospermia: a systematic review and meta-analysis. Hum Reprod Update 2020; 25:733-757. [PMID: 31665451 DOI: 10.1093/humupd/dmz028] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/18/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Factor affecting sperm retrieval rate (SRR) or pregnancy rates (PR) after testicular sperm extraction (TESE) in patients with non-obstructive azoospermia (NOA) have not been systematically evaluated. In addition, although micro-TESE (mTESE) has been advocated as the gold standard for sperm retrieval in men with NOA, its superiority over conventional TESE (cTESE) remains conflicting. OBJECTIVE AND RATIONALE The objective was to perform a meta-analysis of the currently available studies comparing the techniques of sperm retrieval and to identify clinical and biochemical factors predicting SRR in men with NOA. In addition, PRs and live birth rates (LBRs), as derived from subjects with NOA post-ICSI, were also analysed as secondary outcomes. SEARCH METHODS An extensive Medline, Embase and Cochrane search was performed. All trials reporting SRR derived from cTESE or mTESE in patients with NOA and their specific determinants were included. Data derived from genetic causes of NOA or testicular sperm aspiration were excluded. OUTCOMES Out of 1236 studies, 117 studies met the inclusion criteria for this study, enrolling 21 404 patients with a mean age (± SD) of 35.0 ± 2.7 years. cTESE and mTESE were used in 56 and 43 studies, respectively. In addition, 10 studies used a mixed approach and 8 studies compared cTESE with mTESE approach. Overall, a SRR per TESE procedure of 47[45;49]% (mean percentage [95% CI]) was found. No differences were observed when mTESE was compared to cTESE (46[43;49]% for cTESE versus 46[42;49]% for mTESE). Meta-regression analysis demonstrated that SRR per cycle was independent of age and hormonal parameters at enrolment. However, the SRR increased as a function of testis volume. In particular, by applying ROC curve analysis, a mean testis volume higher than 12.5 ml predicted SRR >60% with an accuracy of 86.2% ± 0.01. In addition, SRR decreased as a function of the number of Klinefelter's syndrome cases included (S = -0.02[-0.04;-0.01]; P < 0.01. I = 0.12[-0.05;0.29]; P = 0.16). Information on fertility outcomes after ICSI was available in 42 studies. Overall, a total of 1096 biochemical pregnancies were reported (cumulative PR = 29[25;32]% per ICSI cycle). A similar rate was observed when LBR was analysed (569 live births with a cumulative LBR = 24[20;28]% per ICSI cycle). No influence of male and female age, mean testis volume or hormonal parameters on both PR and LBR per ICSI cycle was observed. Finally, a higher PR per ICSI cycle was observed when the use of fresh sperm was compared to cryopreserved sperm (PR = 35[30;40]%, versus 20[13;29]% respectively): however, this result was not confirmed when cumulative LBR per ICSI cycle was analysed (LBR = 30[20;41]% for fresh versus 20[12;31]% for cryopreserved sperm). WIDER IMPLICATIONS This analysis shows that cTESE/mTESE in subjects with NOA results in SRRs of up to 50%, with no differences when cTESE was compared to mTESE. Retrieved sperms resulted in a LBR of up to 28% ICSI cycle. Although no difference between techniques was found, to conclusively clarify if one technique is superior to the other, there is a need for a sufficiently powered and well-designed randomized controlled trial to compare mTESE to cTESE in men with NOA.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Endocrinology Unit, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, Italy
| | - Suks Minhas
- Department of Urology, Imperial College NHS Healthcare, London, UK
| | - Aleksander Giwercman
- Molecular Reproductive Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Carlo Bettocchi
- Department of Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | - Gert Dohle
- Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Ferdinando Fusco
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Ates Kadioglou
- Department of Urology, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| | - Sabine Kliesch
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology (CeRA), Münster University Hospital (UKM), Münster, Germany
| | - Zsolt Kopa
- Andrology Centre, Department of Urology Semmelweis University, Budapest, Hungary
| | - Csilla Krausz
- Andrology, Women's Endocrinology and Gender Inconguence Unit, Department of Experimental and Clinical Biomedical Sciences, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Fiore Pelliccione
- Diabetes and Metabolism Unit, Department of Internal Medicine, Azienda ASL 02 Chieti-Lanciano-Vasto, F. Renzetti Hospital, Lanciano, Italy
| | - Alessandro Pizzocaro
- Endocrinology Unit, Department of Biomedical Sciences, Humanitas University and Humanitas Research Center IRCCS, Rozzano, Milan, Italy
| | - Jens Rassweiler
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heilbronn, Germany
| | - Paolo Verze
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Inconguence Unit, Department of Experimental and Clinical Biomedical Sciences, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Wolfgang Weidner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Germany
| | - Mario Maggi
- Diabetes and Metabolism Unit, Department of Internal Medicine, Azienda ASL 02 Chieti-Lanciano-Vasto, F. Renzetti Hospital, Lanciano, Italy
| | - Nikolaos Sofikitis
- Department of Urology, Ioannina University School of Medicine, Ioannina, Greece
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Capece M, Spirito L, La Rocca R, Napolitano L, Buonopane R, Di Meo S, Sodo M, Bracale U, Longo N, Palmieri A, Fusco F, Verze P, Califano G, Crocetto F, Imbimbo C, Mirone V, Imperatore V, Creta M. Hexaminolevulinate blue light cystoscopy (Hal) assisted transurethral resection of the bladder tumour vs white light transurethral resection of the bladder tumour in non-muscle invasive bladder cancer (NMIBC) : a retrospective analysis. ACTA ACUST UNITED AC 2020; 92:17-20. [PMID: 32255316 DOI: 10.4081/aiua.2020.1.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/19/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Bladder cancer is the eleventh most commonly diagnosed cancer worldwide. The recurrence rate of this cancer can be very high, up to 45%. Photodynamic diagnosis (PDD) is more sensitive than standard procedures for the detection of malignant tumours. The aim of the study was to evaluate oncological outcomes in white light TURB (WL-TURB) and hexaminolevuninate blue light TURB (Hal-TURB). PATIENTS AND METHODS This was a retrospective longitudinal single-center study. In the period between January 2016 and October 2016 WL-TURB was the only therapeutic option available. From November 2016 until April 2017 all TURBs were fluorescence-guided (Hal-TURB). Kaplan-Meier curves have been used to estimate recurrence free survival rates. RESULTS One hundred and eleven patients underwent Hal- TURB and 137 underwent WL-TURB. Recurrence rate after 12 months was 19.8% (22 out of 111 patients) and 37.2% (51 out of 137 patients) in HAL-group and WL-group respectively (p < 0.01). The recurrence-free period was longer in HAL-group rather than WL-group (8.9 months vs 7.3 months, p < 0.05). Moreover, the recurrence rate during the first 6 months was 3.7% in patients who underwent HAL-TURB and 16% in those who received WL-TURB (p < 0.01). CONCLUSION The results of the study show that recurrence-free survival was longer in patients undergoing HAL-TURB compared to the patients who received standard WL-TURB.
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Affiliation(s)
- Marco Capece
- Madonna del Buon Consiglio, "Fatebenefratelli" Hospital, Naples.
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Creta M, Longo N, Arcaniolo D, Giannella R, Cai T, Cicalese A, De Nunzio C, Grimaldi G, Cicalese V, De Sio M, Autorino R, Lima E, Fedelini P, Marmo M, Capece M, La Rocca R, Tubaro A, Imbimbo C, Mirone V, Fusco F. Hyperbaric oxygen therapy reduces mortality in patients with Fournier's Gangrene. Results from a multi-institutional observational study. MINERVA UROL NEFROL 2020; 72:223-228. [PMID: 32083420 DOI: 10.23736/s0393-2249.20.03696-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Massimiliano Creta
- Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Nicola Longo
- Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Davide Arcaniolo
- Unit of Urology, Luigi Vanvitelli University of Campania, Naples, Italy
| | | | - Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
| | | | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Giovanni Grimaldi
- Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS, G. Pascale Foundation, Naples, Italy
| | | | - Marco De Sio
- Unit of Urology, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Riccardo Autorino
- Unit of Urology, Luigi Vanvitelli University of Campania, Naples, Italy
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, USA
- Division of Urology, McGuire VA Medical Center, Richmond, VA, USA
| | - Estevao Lima
- Department of Urology, Braga Hospital, Braga, Portugal
| | - Paolo Fedelini
- Department of Urology, A. Cardarelli Hospital, Naples, Italy
| | - Mariano Marmo
- Department of Anesthesia, Intensive Care and HBOT Unit, A. Cardarelli Hospital, Naples, Italy
| | - Marco Capece
- Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Roberto La Rocca
- Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Andrea Tubaro
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Ferdinando Fusco
- Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy -
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Creta M, Cornu JN, Roehrborn CG, Finazzi Agrò E, Montorsi F, Longo N, Imperatore V, De Sio M, Arcaniolo D, Mirone V, Fusco F. Clinical Efficacy of Silodosin in Patients with Severe Lower Urinary Tract Symptoms Related to Benign Prostatic Obstruction: A Pooled Analysis of Phase 3 and 4 Trials. Eur Urol Focus 2020; 7:440-443. [PMID: 32057739 DOI: 10.1016/j.euf.2020.01.014] [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: 11/11/2019] [Revised: 01/16/2020] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
Abstract
We performed a post hoc analysis of data from phase 3 and 4 studies to evaluate the efficacy of silodosin 8mg in patients with severe lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). The presence of two or more of the following criteria was adopted to define severity: total International Prostate Symptom Score (IPSS) 20-35, quality of life (QoL) score 5-6, maximum urinary flow <5ml/s or postvoid residual volume ≥100ml, and prostate volume ≥50ml. Mean improvements in total (8.1 vs 4.7), storage (3.1 vs 2.0), voiding (5.0 vs 2.7), and QoL (1.3 vs 0.7) IPSS scores were significantly greater for patients receiving silodosin compared to placebo (all p< 0.0001). Mean improvements in total, storage, voiding, and QoL IPSS scores were similar for the severe and not severe LUTS cohorts. In conclusion, silodosin significantly improves symptoms and QoL in all LUTS/BPO patients, including those with severe symptoms. PATIENT SUMMARY: Silodosin improves symptoms and quality of life for patients with severe lower urinary tract symptoms related to benign prostatic obstruction.
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Affiliation(s)
- Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Jean-Nicolas Cornu
- Department of Urology, Charles-Nicolle University Hospital, Rouen Cedex, France
| | - Claus G Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Enrico Finazzi Agrò
- Department of Surgery, Chair of Urology, Tor Vergata University, Tor Vergata University Hospital, Rome, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | | | - Marco De Sio
- Department of Urology, Luigi Vanvitelli University of Naples, Naples, Italy
| | - Davide Arcaniolo
- Department of Urology, Luigi Vanvitelli University of Naples, Naples, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Ferdinando Fusco
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy.
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Creta M, Collà Ruvolo C, Longo N, Mangiapia F, Arcaniolo D, DE Sio M, DE Nunzio C, Imbimbo C, Mirone V, Fusco F. Detrusor overactivity and underactivity: implication for lower urinary tract symptoms related to benign prostate hyperplasia diagnosis and treatment. Minerva Urol Nephrol 2020; 73:59-71. [PMID: 32026666 DOI: 10.23736/s2724-6051.20.03678-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Detrusor underactivity (DUA) and detrusor overactivity (DO) have potential impact on the outcomes of surgery for lower urinary tract symptoms related to benign prostate hyperplasia (LUTS/BPH). EVIDENCE ACQUISITION We performed a literature search including studies on humans enrolling patients with preoperative urodynamic evidence of DO and/or DUA undergoing LUTS/BPH surgery. Factors that may influence the outcomes of surgery in these patients were evaluated. EVIDENCE SYNTHESIS In patients with DUA mean bladder contractility index improved from +4 to +44.6, mean total International Prostate Symptom Score (IPSS) improved from -3 to -19.5 points, mean maximum urinary flow (Q<inf>max</inf>) improved from +1.4 to +11.7 mL/s, and mean postvoid residual volume (PVR) improved from -16.5 to -736 mL. Older age, lack of obstruction, concomitant DO, lower detrusor contractility and use of transurethral resection of the prostate (TURP) or photovaporization (PV) instead of Holmium laser enucleation of the prostate (HoLEP) were associated with worse outcomes. In patients with DO, the percentage of DO resolution ranged from 57.1% to 83.3%. Mean total IPSS, Q<inf>max</inf>, and PVR variations ranged from +0.9 to -15.7 points, from -0.2 mL/s to +14 mL/s, and from -19.6 to -202.5 mL, respectively. Older age, lack of obstruction, terminal DO, low maximum cystometric capacity, early and high amplitude DO, and use of transurethral prostate incision instead of TURP or open adenomectomy were associated with worse outcomes. CONCLUSIONS In patients with DUA or DO, surgery for LUTS/BPH provides overall good results. However, a number of factors can affect these outcomes.
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Affiliation(s)
- Massimiliano Creta
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Claudia Collà Ruvolo
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Nicola Longo
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Francesco Mangiapia
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Davide Arcaniolo
- Unit of Urology, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Marco DE Sio
- Unit of Urology, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Cosimo DE Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Ciro Imbimbo
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Vincenzo Mirone
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Ferdinando Fusco
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy -
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Creta M, Collà Ruvolo C, Longo N, Mangiapia F, Arcaniolo D, DE Sio M, DE Nunzio C, Imbimbo C, Mirone V, Fusco F. Detrusor overactivity and underactivity: implication for lower urinary tract symptoms related to benign prostate hyperplasia diagnosis and treatment. Minerva Urol Nephrol 2020. [PMID: 32026666 DOI: 10.23736/s0393-2249.20.03678-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Detrusor underactivity (DUA) and detrusor overactivity (DO) have potential impact on the outcomes of surgery for lower urinary tract symptoms related to benign prostate hyperplasia (LUTS/BPH). EVIDENCE ACQUISITION We performed a literature search including studies on humans enrolling patients with preoperative urodynamic evidence of DO and/or DUA undergoing LUTS/BPH surgery. Factors that may influence the outcomes of surgery in these patients were evaluated. EVIDENCE SYNTHESIS In patients with DUA mean bladder contractility index improved from +4 to +44.6, mean total International Prostate Symptom Score (IPSS) improved from -3 to -19.5 points, mean maximum urinary flow (Q<inf>max</inf>) improved from +1.4 to +11.7 mL/s, and mean postvoid residual volume (PVR) improved from -16.5 to -736 mL. Older age, lack of obstruction, concomitant DO, lower detrusor contractility and use of transurethral resection of the prostate (TURP) or photovaporization (PV) instead of Holmium laser enucleation of the prostate (HoLEP) were associated with worse outcomes. In patients with DO, the percentage of DO resolution ranged from 57.1% to 83.3%. Mean total IPSS, Q<inf>max</inf>, and PVR variations ranged from +0.9 to -15.7 points, from -0.2 mL/s to +14 mL/s, and from -19.6 to -202.5 mL, respectively. Older age, lack of obstruction, terminal DO, low maximum cystometric capacity, early and high amplitude DO, and use of transurethral prostate incision instead of TURP or open adenomectomy were associated with worse outcomes. CONCLUSIONS In patients with DUA or DO, surgery for LUTS/BPH provides overall good results. However, a number of factors can affect these outcomes.
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Affiliation(s)
- Massimiliano Creta
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Claudia Collà Ruvolo
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Nicola Longo
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Francesco Mangiapia
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Davide Arcaniolo
- Unit of Urology, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Marco DE Sio
- Unit of Urology, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Cosimo DE Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Ciro Imbimbo
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Vincenzo Mirone
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Ferdinando Fusco
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy -
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Capece M, Arcaniolo D, Manfredi C, Palmieri A, De Sio M, Verze P, Fusco F, Longo N, Mirone V. Second cycle of intralesional Collagenase Clostridium histolyticum for Peyronie's disease using the modified shortened protocol: Results from a retrospective analysis. Andrologia 2020; 52:e13527. [PMID: 32003061 DOI: 10.1111/and.13527] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/16/2019] [Accepted: 12/31/2019] [Indexed: 01/30/2023] Open
Abstract
The purpose of this study was to evaluate the effectiveness and safety of the second cycle of Collagenase Clostridium histolyticum injections using the modified shortened protocol. We performed a retrospective analysis on patients who had already undergone the first cycle of injections using the modified shortened protocol and requested more injections to improve the remaining curvature. The International Index of Erectile Function, the Peyronie's Disease Questionnaire and the Global Assessment of Peyronie's Disease questionnaire were self-administered to all patients. All the parameters were recorded at baseline, after the first cycle and after the second cycle of injections. All adverse events were recorded. Seventeen patients completed two cycles of injections. All patients had a reduction of the initial curvature after the first cycle, with a mean improvement of 17.4° (27.4%). After the second cycle, the reduction of the curvature was 7.9° (17.1%), and 29.4% of patients had no further improvement. No severe side effect was recorded. The results of the present study confirm the effectiveness and safety of the modified shortened protocol of Collagenase C. histolyticum injections for Peyronie's disease. However, the second cycle of three injections may be less effective, and patients may not be completely satisfied.
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Affiliation(s)
- Marco Capece
- Urology Unit, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Davide Arcaniolo
- Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Celeste Manfredi
- Urology Unit, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples "Federico II", Naples, Italy.,Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Palmieri
- Urology Unit, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Marco De Sio
- Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Verze
- Urology Unit, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Ferdinando Fusco
- Urology Unit, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Nicola Longo
- Urology Unit, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Vincenzo Mirone
- Urology Unit, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples "Federico II", Naples, Italy
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Ostenfeld E, Ricci P, Fusco F, Flick C, West C, Gatzoulis MA, Babu-Narayan SV, Li W. P989 Speckle tracking echocardiography for assessment of baseline myocardial dysfunction and remodelling following tricuspid valve surgery in adults with Ebsteins anomaly. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Swedish Heart-Lung Foundation, Swedish Society of Medicine, Swedish Heart Association, Skåne University Hospital, Region Skåne, and Lund University
Background
Ebstein’s anomaly (EA) is due to failure of tricuspid valve (TV) delamination and often associated with RV myopathy. Conventional echocardiographic measurements of systolic ventricular function such as LV EF, and tricuspid annular plane systolic excursion/fractional area change (TAPSE/FAC) are load dependent and may therefore not reflect true myocardial function. Speckle tracking echocardiography (STE) evaluates more subtle myocardial deformation globally and on a regional level. Due to being load independent STE may be the most appropriate way to determine myocardial effects of EA intervention for which data in adults are limited.
Purpose
We aimed to study biventricular myocardial function before and after tricuspid valve repair/replacement (TVR) in adults with EA with both STE-derived peak systolic global and regional longitudinal strain (GLS; RLS) and conventional echocardiography.
Methods
A retrospective study of 18 EA patients (55.6% women), who underwent surgical TV repair/replacement (3/15; age at operation: 39 ± 12y) between 2005-2017 was performed. 2D longitudinal strain and conventional assessment of LV and RV function were assessed pre-TVR, and at 1- and 2-years post-TVR. LV and right ventricular (RV) segments were graded for STE assessment feasibility (0-3: no visualisation-optimal). Segments scored 0 were excluded from the strain analysis. Biventricular GLS and RLS were measured by semi-automated tracking.
Results
Compared to pre-TVR, LVEF improved after TVR at 1 year (Table 1, p = 0.03), but this was not sustained and returned to baseline after 2 years. TAPSE declined 1-year post-TVR with no further change after 2 years (Table 1). RVFAC did not differ pre- and post-TVR. LV GLS and RLS were low pre-TVR without amelioration at 1 or 2 years after TVR (Table 1). RV GLS deteriorated from pre-TVR to 1-year post-TVR with only minor amelioration after 2 years (p = 0.03). RV RLS showed a decrease at basal and mid free wall 1-year post-TVR, and at basal free wall, the mid free wall and the mid septum after 2 years (Table 1). Only, one segment improved in RLS from 1 to 2-year post-TVR (p = 0.03). Least feasible segments were LV apical lateral (both pre- and post-TVR), RV mid (pre-TVR and 1y post-TVR) and apical free wall (pre-TVR, 1y and 2y post-TVR) (all, median score 1).
Conclusions
In adult patients with EA, LV GLS was reduced before and unchanged after surgery despite preserved EF, and LVEF initially improved but returned to baseline values with time. Although TV surgery reduced the degree of TV regurgitation and RV size, it might have unmasked a potential RV myocardial disease. Both RV longitudinal strain and TAPSE were reduced 1 and 2 years post-TVR with limited recovery of RV longitudinal strain, but not of TAPSE, between 1 and 2 years post-TVR. Speckle tracking echocardiography (STE) is a feasible and a sensitive, load independent method in detecting biventricular myocardial dysfunction and time course of remodelling after surgery.
Abstract P989 Table 1
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Affiliation(s)
- E Ostenfeld
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, and Skane University Hospital, Lund, Sweden
| | - P Ricci
- Royal Brompton and Harefield NHS Foundation Trust, Adult Congenital Heart Centre and Imperial College School of Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - F Fusco
- Royal Brompton and Harefield NHS Foundation Trust, NIHR Cardiovascula Research Unit, and Imperial College School of Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - C Flick
- Royal Brompton and Harefield NHS Foundation Trust, Adult Congenital Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - C West
- Royal Brompton and Harefield NHS Foundation Trust, Adult Congenital Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - M A Gatzoulis
- Royal Brompton and Harefield NHS Foundation Trust, Adult Congenital Heart Centre and Imperial College School of Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - S V Babu-Narayan
- Royal Brompton and Harefield NHS Foundation Trust, Adult Congenital Heart Centre and Imperial College School of Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - W Li
- Royal Brompton and Harefield NHS Foundation Trust, Adult Congenital Heart Centre and Imperial College School of Medicine, London, United Kingdom of Great Britain & Northern Ireland
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Fusco F, Castro M, Rigby M, Shore D, Scognamiglio G, Gatzoulis M, Li W. P1598 Ruptured Sinus of Valsalva: clinical and echocardiographic features at presentation and long-term results after surgical and percutaneous repair. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Rupture of Sinus of Valsalva (rSOV) is a rare and potentially life-threatening condition often misdiagnosed. Percutaneous device closure has been replacing surgical repair as a treatment of choice. However, long-term outcome is poorly documented.
Methods
Echo database (2001-2019) was searched for patients >16y with rSOV. Clinical data were collected from ACHD database. Marfan Syndrome patients were excluded.
Results
Fifteen patients (42.2y, 10M) were diagnosed with rSOVbetween 1979 and 2019. HF symptoms at initial presentation were reported in 50%. All cases were diagnosed by TTE with finding of high velocity continuous flow from SOV to right heart. Two were initially misdiagnosed as VSD. Digital imaging recordings of 10/15 were available. The aortic root was dilated in 8/10. Four had asymmetrical SOV dilatation. LV and LA were dilated in 7/10 and 9/10. Significant aortic regurgitation was in 4. Two had RVOTO. RVSP was always raised. Echo findings are summarised in the Table.
Mean FU after repair was 10,7y (0,9-39). Ten patients had surgical repair and 5 device closure. Seven had repair of concomitant lesions (4 VSD closure and 3 AVR) at the time of the procedure. One redo device closure was performed. During FU 1 died from Cardiomyopathy. At the latest FU significant improvement in functional class, LV and LA size and RVSP was found.
Conclusion
Patients with rSOV may present with acute HF. High velocity continuous flow from SOV to right heart on TTE is characteristic feature for diagnosis. Percutaneous closure is an attractive alternative to surgery in patients with isolated lesion. Significant haemodynamic improvement can be achieved with good long-term haemodynamic results
Tot = 15 Initial findings Latest FU NYHA class 4 class I 2 class II 2 class III 4 class IV 3 unknown 11 class I 2 class II 1 class III 0 class IV* SOV (mm) 38.2 (33-44) STJ (mm) 36.2 (26-42 Asc Ao (mm) 30.3 (25-34) rupture site 8 RC sinus, 2 NC sinus Shunt to 8 RVOT, 1 RA, 1 RVOT + RA LVEDV (ml) 169.7 (114-330) 120 (67-230)* LVESV (ml) 66(42-130) 46 (28-80)* LAVi (ml/m2) 53.1 (30-129) 35 (24-53)* LV EF% 61.2 (57-65) 60.4 (50-70) RVSP (mmHg) 53.2 (37-130) 24.06 (15-32)** Pre VS post procedure p-value: * P < 0,05 **P < 0,01
Abstract P1598 Figure. PLAX in patient with ruptured RC sinus
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Affiliation(s)
- F Fusco
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Castro
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Rigby
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - D Shore
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | | | - M Gatzoulis
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - W Li
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
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Fusco F, Scognamiglio G, Colonna D, Palma M, Granata G, Russo MG, Sarubbi B. 1107 An unusual vegetation on a prosthetic pulmonary valve. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Patient presentation
During a routine check up, a 47yo man with Tetralogy of Fallot and congenital absence of left pulmonary branch was found to have a vegetation on his prosthetic pulmonary valve. His surgical history included TOF repair with left pulmonary branch bypass aged 4 years and a redo surgery for pulmonary valve replacement 3 years earlier. Before last surgery, CMR showed severe pulmonary regurgitation, dilated RV with mildly impaired systolic function (EF 40%) and absent flow in left pulmonary branch due to bypass occlusion.
Diagnostic work-up
The patient reported increasing shortness of breath (NYHA class III) over the last months. He reported one single fever peak two months before.He was on Apixaban and Amiodarone for previous history of AF. He was afebrile and an ejective systolic 4/6 murmur was heard. He was in sinus rhythm at 70 bpm. The TTE showed dilated RV with severely reduced systolic function (FAC 12%), severe pulmonary stenosis (peak gradient of 70 mmHg) with mild regurgitation, and a mobile and echogenic vegetation of 10 X 9 mm was seen on the prosthetic pulmonary valve. His blood tests at the admission demostrated raised WBC (9.460/uL) and PCR 11.7 mg/dl (n.v. < 3.0). The PCR remained stable during the following days. Serial blood samples for cultures were obtained, but all resulted negative. Uncommom causes of negative blood culteres infective endocarditis were investigated with specific serological tests for research of fastious agents, but all resulted negative. Antinuclear and antiphospholipid antibodies were also tested. A total-body CT was performed and it showed several liver formations. A FDG PET-CT was requested and it demostrated active marked glucose uptake by a mediastinic node, as well as by liver, brain and prosthetic pulmonary valve.
Diagnosis and outcome
After a careful review of all the clinical and imaging data, our opinion was that the most probable diagnosis was non infective thrombotic endocarditis in patient with metastatic cancer. In this situation, the valvular glucose uptake was likely due active thrombus formation rathen then being a sign of inflammatory response. Unfortunately, the patient died suddenly two weeks after the PET-CT and it was impossible to confirm the diagnosis with biopsy.
Conclusion
Differential diagnosis of cardiac vegetations is a challenging process including microbological tests, multi modality imaging and clinical reasoning. It is always necessary to consider alternative diagnosis, even when traditional imaging tests seem to suggest infective endocarditis.
Non infective thrombotic endocarditis are a rare form of negative blood culteres endocarditis related to systemic hypercoagulable state (i.e. antiphospholipid syndrome, systemic lupus, behcet syndrome, cancer). Malignancies can be considered an unusual cause of cardiac vegetation and they must be taken into account on differential diagnosis.
Abstract 1107 Figure. FDG uptake in pulmonary position
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Affiliation(s)
- F Fusco
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | | | - D Colonna
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - M Palma
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - G Granata
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - M G Russo
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - B Sarubbi
- AO dei Colli-Monaldi Hospital, Naples, Italy
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Fusco F, Scognamiglio G, Vitiello F, Gilli M, Piantedosi F, Colonna D, Palma M, Granata G, Sarubbi B. P781 Role of serum biomarkers combined with two-dimensional speckle tracking echocardiography for screening of immunotherapy-induced cardiotoxicity. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Immune checkpoint inhibitors (ICIs) are a novel class of antineoplastic drugs which have dramatically changed the management of non-small cell lung cancer. ICI-associated cardiotoxicity is rare, but potentially fatal, presenting in most of cases as autoimmune acute myocarditis during the first phase of treatment. However, since an extensive cardiac monitoring is not routinely performed in most immunotherapy trials, the true incidence of ICIs related cardiac effects is largely unknown.
Aim
Aim of our study is to ascertain a possible subclinical cardiac involvement in patients with non-small cell lung cancer treated with ICIs.
Methods
We prospectively recruited 40 patients (13 males; mean age 64.3 ± 8.3 years) starting immunotherapy with PD-1/PDL-1 inhibitors for non-small lung cancer between January and August 2018. Demographic and clinical data were recorded and all patients underwent a standard 12-lead ECG and a transthoracic echocardiogram with assessment of left ventricular global longitudinal strain (LV GLS). Furthermore, blood samples for pro BNP-nt and high sensitivity Troponin T (hsTnT) measurements were collected. Serial assessments were performed before and 1 and 3 months after initiation of immunotherapy.
Results
A history of previous coronary artery disease was documented in eight cases (20%). At follow-up no cardiovascular events were recorded. Compared with baseline, echocardiographic parameters of ventricular function did not significantly changed at 1 and 3 months (LVEF 61 ± 6% at baseline, 61 ± 5% at 1 month, 60,2 ± 5% at 3 months, p =0.1; E/E’at baseline 9.2 ± 3, 9.2 ± 2.8 at 1 month, 9.1 ±3,5 at 3 months, p = 0.2;TAPSE 20 ± 3.4 mm at baseline, 21.3 ± 2.8 mm at 1 month, 20 ± 3.8 mm at 3 months, p =0.1; LV GLS -20.3 ± 3.6% at baseline, -20.8 ± 2.3% at 1 month, -20.6 ± 3% at 3 months; p = 0.4). Analogously, no significant increase in circulating levels of cardiac biomarkers was found with hsTnT <0.015 ng/ml in all patients at baseline, 1 month and 3 months and median proBNP-nt 118 pg/ml (IQR 47-200) at baseline, 171 pg/ml (IQR 91-520) at 1 month, and 182 pg/ml (IQR 78-470) at 3 months, p = 0.9.
Conclusions
In our study no significant clinical or subclinical evidence of myocardial involvement was detected during treatment with ICIs in patients with non-small cell lung cancer, thus suggesting the potential cardiovascular safety of this promising class of antineoplastic drugs.
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Affiliation(s)
- F Fusco
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | | | - F Vitiello
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - M Gilli
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | | | - D Colonna
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - M Palma
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - G Granata
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - B Sarubbi
- AO dei Colli-Monaldi Hospital, Naples, Italy
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Antropoli M, Fusco F, Brillantino A, Lanza M, Monte G, Cricrì AM, Scardi F, Ciorra FR, Marra E, Castriconi M. Treatment of acute diverticulitis with open abdomen technique. Ann Ital Chir 2020; 91:705-708. [PMID: 33554945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM The aim of this study is to highlight our experience about the use of open Abdomen's technique as strategy for the management of complicated colon diverticulitis with a delayed anastomosis or colostomy. MATERIALS AND METHODS Thirty patients, with III and IV Hinchey stage, have been undertaken to a surgical procedure with Open Abdomen technique and application of Ab-thera device. A second surgical look was made after 48-72 hours in order to evaluate the possibility to do an anastomosis or colostomy. RESULTS No deaths in patients with anastomosis were reported, but one case of leakage at the 8th day and one case of micro pulmonary embolism had been displayed. Elderly patients were discharged between the 15TH /18th day. One patient affected by lymphoma was sent in haematology department for other treatment. DISCUSSION Today trend is to treat the diverticular disease with colic and paracolic abscess by a medical therapy and percutaneous drainage under CT scan or ultrasound view. With III and IV of Hinchey scale we perform the resection with anastomosis or colostomy. The open abdomen technique allows the surgeons to make the decision of colostomy or anastomosis in the second surgical look at 48-72 hours after the first treatment with irrigation and aspiration during AB-Thera. CONCLUSION The Open Abdomen technique is a valid therapeutic alternative approach for patients with acute diverticulitis disease in III and IV Hinchey grade. This therapeutic approach gives important advantages in patients with delayed colostomy. KEY WORDS Diverticulitis, Damage Control Surgery, Open Abdomen.
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73
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Gentile I, Fusco F, Buonomo AR, Scotto R, Zappulo E, Pinchera B, Persico F, Califano G, Borgia G, Longo N. Prevalence and risk factors of erectile dysfunction in patients with hepatitis B virus or hepatitis C virus or chronic liver disease: results from a prospective study. Sex Health 2019; 15:408-412. [PMID: 30045807 DOI: 10.1071/sh17168] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 05/22/2018] [Indexed: 01/23/2023]
Abstract
Background Approximately 300million people are affected by hepatitis B virus (HBV) or hepatitis C virus (HCV) infection worldwide. Erectile dysfunction (ED) is a frequent condition that impairs the quality of life and can be associated with several chronic disorders (type 2 diabetes mellitus, atherosclerosis, depression). Few studies have evaluated the prevalence of ED in patients with HBV and HCV chronic infection. The aim of this study was to evaluate the prevalence and the risk factors of ED in a cohort of patients with HBV or HCV-related chronic liver diseases. METHODS Consecutive patients with HCV and HBV chronic infection were enrolled. RESULTS In total, 89 out (49 with cirrhosis, 21 with HBV and 68 with HCV infection) were included in this study. ED was diagnosed in 76.4% of patients. The use of phosphodiesterase type 5 inhibitors was reported by 21.3% of patients. Patients with ED were older and had a higher rate of cirrhosis and diabetes mellitus compared with patients without ED. At multivariate analysis, diabetes mellitus and stage of liver disease (cirrhosis vs chronic hepatitis) were the only independent predictors of ED. CONCLUSION Due to the high rate of ED in outpatients with viral-related liver disease and the underuse of phosphodiesterase type 5 inhibitors, a larger study focussed on these patients is needed.
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Affiliation(s)
- Ivan Gentile
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples Federico II, Naples 80131, Italy
| | - Ferdinando Fusco
- Urology Unit, Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples 80131, Italy
| | - Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples Federico II, Naples 80131, Italy
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples Federico II, Naples 80131, Italy
| | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples Federico II, Naples 80131, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples Federico II, Naples 80131, Italy
| | - Francesco Persico
- Urology Unit, Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples 80131, Italy
| | - Gianluigi Califano
- Urology Unit, Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples 80131, Italy
| | - Guglielmo Borgia
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples Federico II, Naples 80131, Italy
| | - Nicola Longo
- Urology Unit, Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples 80131, Italy
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Stanzione A, Cuocolo R, Cocozza S, Romeo V, Persico F, Fusco F, Longo N, Brunetti A, Imbriaco M. Detection of Extraprostatic Extension of Cancer on Biparametric MRI Combining Texture Analysis and Machine Learning: Preliminary Results. Acad Radiol 2019; 26:1338-1344. [PMID: 30655050 DOI: 10.1016/j.acra.2018.12.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/18/2018] [Accepted: 12/28/2018] [Indexed: 02/08/2023]
Abstract
RATIONALE AND OBJECTIVES Extraprostatic extension of disease (EPE) has a major role in risk stratification of prostate cancer patients. Currently, pretreatment local staging is performed with MRI, while the gold standard is represented by histopathological analysis after radical prostatectomy. Texture analysis (TA) is a quantitative postprocessing method for data extraction, while machine learning (ML) employs artificial intelligence algorithms for data classification. Purpose of this study was to assess whether ML algorithms could predict histopathological EPE using TA features extracted from unenhanced MR images. MATERIALS AND METHODS Index lesions from biparametric MRI examinations of 39 patients with prostate cancer who underwent radical prostatectomy were manually segmented on both T2-weighted images and ADC maps for TA data extraction. Combinations of different feature selection methods and ML classifiers were tested, and their performance was compared to a baseline accuracy reference. RESULTS The classifier showing the best performance was the Bayesian Network, using the dataset obtained by the Subset Evaluator feature selection method. It showed a percentage of correctly classified instances of 82%, an area under the curve of 0.88, a weighted true positive rate of 0.82 and a weighted true negative rate of 0.80. CONCLUSION A combined ML and TA approach appears as a feasible tool to predict histopathological EPE on biparametric MR images.
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Arcaniolo D, Manfredi C, Veccia A, Herrmann TRW, Lima E, Mirone V, Fusco F, Fiori C, Antonelli A, Rassweiler J, Liatsikos E, Porpiglia F, De Sio M, Autorino R. Bipolar endoscopic enucleation versus bipolar transurethral resection of the prostate: an ESUT systematic review and cumulative analysis. World J Urol 2019; 38:1177-1186. [PMID: 31346761 DOI: 10.1007/s00345-019-02890-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 05/15/2019] [Accepted: 07/23/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To perform a cumulative analysis of the current evidence on the surgical and functional outcomes of bipolar endoscopic enucleation of the prostate (b-EEP) versus bipolar transurethral resection of the prostate (b-TURP). METHODS A systematic review of the literature was performed on PubMed, Ovid®, and Scopus® according to Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA Statement). The meta-analysis was conducted using the Review Manager 5.3 software. Parameters of interest were surgical and functional outcomes. Weighted mean difference, and odds ratio with 95% confidence interval were calculated for continuous and binary variables, respectively. Pooled estimates were calculated using the random-effect model. RESULTS Fourteen comparative studies were included. No statistically significant difference in terms of overall baseline characteristics was found. b-EEP had higher amount of resected tissue (p < 0.0001), shorter catheter time (p = 0.006), lower Hb drop (p = 0.03), and shorter length of stay (p < 0.0001). Equally, overall post-operative complications were lower (p = 0.01) as well as short (p = 0.04), and long-term complication rate (p = 0.04). There was higher re-intervention rate in the b-TURP group (p = 0.02) whereas b-EEP group had smaller residual prostate volume (p = 0.03), and lower post-operative PSA values (p < 0.00001). At long term, b-EEP presented lower IPSS (p = 0.04), higher Qmax (p = 0.002), and lower PVR (p < 0.00001). CONCLUSIONS b-EEP is an effective and safe surgical treatment for BPO. This procedure might offer several advantages over standard b-TURP, including the resection of a larger amount of tissue within the same operative time, shorter hospitalization, lower risk of complications, and lower re-intervention rate. This was submitted to PROSPERO registry: CRD42019126748.
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Affiliation(s)
| | | | - Alessandro Veccia
- Division of Urology, Department of Surgery, VCU Health, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA
- Urology Unit and Department of Medical and Surgical Specialties, Radiological Science, and Public Health, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Thomas R W Herrmann
- Department of Urology, Kantonsspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Estevão Lima
- Department of Urology, Braga Hospital, Braga, Portugal
| | - Vincenzo Mirone
- Department of Urology, Federico II University, Naples, Italy
| | | | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Alessandro Antonelli
- Urology Unit and Department of Medical and Surgical Specialties, Radiological Science, and Public Health, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Jens Rassweiler
- Department of Urology, University of Heidelberg, SLK Kliniken, Heilbronn, Germany
| | | | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Marco De Sio
- Urology Unit, Luigi Vanvitelli University, Naples, Italy
| | - Riccardo Autorino
- Urology Unit, Luigi Vanvitelli University, Naples, Italy.
- Division of Urology, Department of Surgery, VCU Health, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA.
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Rossi A, Fusco F. <p>Wine Index of Salubrity and Health (WISH): an evidence-based instrument to evaluate the impact of good wine on well-being</p>. IJWR 2019. [DOI: 10.2147/ijwr.s177394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Brillantino A, Andreano M, Lanza M, D'Ambrosio V, Fusco F, Antropoli M, Lucia A, Zito ES, Forner A, Ambrosino F, Monte G, Cricrì AM, Robustelli U, De Masi A, Calce R, Ciardiello G, Renzi A, Castriconi M. Advantages of Damage Control Strategy With Abdominal Negative Pressure and Instillation in Patients With Diffuse Peritonitis From Perforated Diverticular Disease. Surg Innov 2019; 26:656-661. [PMID: 31221028 DOI: 10.1177/1553350619857561] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 01/12/2023]
Abstract
Purpose. To evaluate the results of Damage Control Strategy (DCS) in the treatment of generalized peritonitis from perforated diverticular disease in patients with preoperative severe systemic diseases. Methods. All the patients with diffuse peritonitis (Hinchey 3 and 4) and the American Society of Anesthesiologists (ASA) score ≥3 were included and underwent DCS consisting of a 2-step procedure. The first was peritoneal lavage, perforated colon-stapled resection, and temporary abdominal closure with negative pressure wound therapy combined with instillation. The second step, 48 hours later, included the possibility of restoring intestinal continuity basing on local and general patients' conditions. Results. Thirty patients (18 [60%] women and 12 [40%] men, median age 68.5 [range = 35-84] years) were included (18 [60%] ASA III, 11 [36.7%] ASA IV, and 1 [0.03%] ASA V). Seven patients (23.3%) showed sepsis and 1 (3.33%) septic shock. At second surgery, 24 patients (80%) received a colorectal anastomosis and 6 patients (20%) underwent a Hartmann's procedure. Median hospital stay was 18 days (range = 12-62). Postoperative morbidity rate was 23.3% (7/30) and included 1 anastomotic leak treated with Hartmann's procedure. Consequently, at discharge from hospital, 23 patients (76.6%) were free of stoma. Primary fascial closure was possible in all patients. Conclusions. DCS with temporary abdominal closure by negative pressure wound therapy combined with instillation in patients with diffuse peritonitis from complicated diverticulitis could represent a feasible surgical option both in hemodynamically stable and no stable patients, showing encouraging results including a low stoma rate and an acceptable morbidity rate.
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Sturiale A, Fabiani B, Menconi C, Cafaro D, Fusco F, Bellio G, Schiano di Visconte M, Naldini G. Correction to: Long-term results after stapled hemorrhoidopexy: a survey study with mean follow-up of 12 years. Tech Coloproctol 2018; 22:733. [DOI: 10.1007/s10151-018-1866-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Carrino M, Pucci L, Chiancone F, Fusco F, Mirone V, Fedelini P. 596 Can the testicular parenchyma fibrosis be a predictor of testicular failure in the patients with varicocele? J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.04.502] [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: 11/25/2022]
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80
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Cuocolo R, Stanzione A, Rusconi G, Petretta M, Ponsiglione A, Fusco F, Longo N, Persico F, Cocozza S, Brunetti A, Imbriaco M. PSA-density does not improve bi-parametric prostate MR detection of prostate cancer in a biopsy naïve patient population. Eur J Radiol 2018; 104:64-70. [DOI: 10.1016/j.ejrad.2018.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 04/30/2018] [Accepted: 05/03/2018] [Indexed: 11/29/2022]
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Fusco F, Creta M, De Nunzio C, Gacci M, Li Marzi V, Finazzi Agrò E. Alpha-1 adrenergic antagonists, 5-alpha reductase inhibitors, phosphodiesterase type 5 inhibitors, and phytotherapic compounds in men with lower urinary tract symptoms suggestive of benign prostatic obstruction: A systematic review and meta-analysis of ur. Neurourol Urodyn 2018; 37:1865-1874. [DOI: 10.1002/nau.23554] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/13/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Ferdinando Fusco
- Department of Neurosciences; Human Reproduction and Odontostomatology; University of Naples; Naples Italy
- Italian Society of Urodynamics Publication Group; Naples Italy
| | - Massimiliano Creta
- Department of Neurosciences; Human Reproduction and Odontostomatology; University of Naples; Naples Italy
| | - Cosimo De Nunzio
- Italian Society of Urodynamics Publication Group; Naples Italy
- Department of Urology; “Sapienza” University of Rome; Sant'Andrea Hospital; Rome Italy
| | - Mauro Gacci
- Italian Society of Urodynamics Publication Group; Naples Italy
- Department of Urology; University of Florence; Careggi Hospital; Florence Italy
| | - Vincenzo Li Marzi
- Italian Society of Urodynamics Publication Group; Naples Italy
- Department of Urology; University of Florence; Careggi Hospital; Florence Italy
| | - Enrico Finazzi Agrò
- Italian Society of Urodynamics Publication Group; Naples Italy
- Department of Experimental and Surgical Medicine; Urology Clinic; University “Tor Vergata”; Roma Italy
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Imperatore V, Creta M, Di Meo S, Buonopane R, Longo N, Fusco F, Spirito L, Imbimbo C, Mirone V. Intravesical administration of combined hyaluronic acid and chondroitin sulfate can improve symptoms in patients with refractory bacillus Calmette-Guerin-induced chemical cystitis: Preliminary experience with one-year follow-up. ACTA ACUST UNITED AC 2018; 90:11-14. [PMID: 29633792 DOI: 10.4081/aiua.2018.1.11] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/21/2017] [Accepted: 10/23/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We investigated the efficacy of intravesical instillations of combined hyaluronic acid (HA) and chondroitin sulphate (CS) in patients with bacillus Calmette-Guérin (BCG)-induced chemical cystitis unresponsive to first-line therapies. PATIENTS AND METHODS We retrospectively reviewed the clinical records of patients with grade 2 BCG-induced chemical cystitis unresponsive to first line therapeutic options performed according to the International Bladder Cancer Group guidelines who underwent intravesical instillations of HA/CS. Bladder pain, urinary urgency, voiding volume and number of voids/24 hours recorded prior to treatment, at the end of the treatment, at six months and at one-year follow-up were recorded and analyzed. RESULTS The records of 20 patients were identified. All patients underwent eight weekly instillations of HA/CS. Mean baseline visual analogue scale (VAS) scores ± Standard Deviation (SD) for urinary urgency and bladder pain were 7.8 ± 0.5 and 7.2 ± 1.0, respectively. Mean number of voids/24 hours ± SD was 15.4 ± 2.3 and mean urine volume per void ± SD was 85.8 ± 21.0 mL. At the end of the treatment, mean VAS scores ± SD for urgency and pain significantly decreased to 4.7 ± 1.1 and 4.2 ± 0.9, respectively (p < 0.05 in both cases). Mean number of voids/24 hours ± SD decreased to 9.6 ± 1.4 (p < 0.05) and mean urine volume per void ± SD significantly increased to 194.1 ± 59.5 mL (p < 0.05). At six months and one-year followup, all outcome measures remained stable. CONCLUSIONS Bladder instillations of HA/CS provide significant and durable improvement of bladder pain, urinary urgency, urinary volume per void and urinary frequency in patients with refractory BCG-induced chemical cystitis.
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Affiliation(s)
- Vittorio Imperatore
- Unità Operativa di Urologia, Ospedale Buon Consiglio - Fatebenefratelli, Napoli.
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Fusco F, Creta M. Sexual function in patients undergoing combination treatment with α1-adrenoceptor antagonists and 5α-reductase inhibitors: a step forward in a still-open debate. BJU Int 2018; 121:491-492. [DOI: 10.1111/bju.14176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Ferdinando Fusco
- Department of Neurosciences, Human Reproduction and Odontostomatology; University of Naples Federico II; Naples Italy
| | - Massimiliano Creta
- Department of Neurosciences, Human Reproduction and Odontostomatology; University of Naples Federico II; Naples Italy
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Fusco F, Creta M, De Nunzio C, Iacovelli V, Mangiapia F, Li Marzi V, Finazzi Agrò E. Progressive bladder remodeling due to bladder outlet obstruction: a systematic review of morphological and molecular evidences in humans. BMC Urol 2018; 18:15. [PMID: 29519236 PMCID: PMC5844070 DOI: 10.1186/s12894-018-0329-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/28/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Bladder outlet obstruction is a common urological condition. We aimed to summarize available evidences about bladder outlet obstruction-induced molecular and morphological alterations occurring in human bladder. METHODS We performed a literature search up to December 2017 including clinical and preclinical basic research studies on humans. The following search terms were combined: angiogenesis, apoptosis, bladder outlet obstruction, collagen, electron microscopy, extracellular matrix, fibrosis, hypoxia, histology, inflammation, innervation, ischemia, pressure, proliferation, remodeling, suburothelium, smooth muscle cells, stretch, urothelium. RESULTS We identified 36 relevant studies. A three-stages model of bladder wall remodeling can be hypothesized involving an initial hypertrophy phase, a subsequent compensation phase and a later decompensation. Histological and molecular alterations occur in the following compartments: urothelium, suburothelium, detrusor smooth muscle cells, detrusor extracellular matrix, nerves. Cyclic stretch, increased hydrostatic and cyclic hydrodynamic pressure and hypoxia are stimuli capable of modulating multiple signaling pathways involved in this remodeling process. CONCLUSIONS Bladder outlet obstruction leads to progressive bladder tissue remodeling in humans. Multiple signaling pathways are involved.
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Affiliation(s)
- Ferdinando Fusco
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università Degli Studi Di Napoli Federico II, Via Pansini, 5, 80131 Naples, Italy
| | - Massimiliano Creta
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università Degli Studi Di Napoli Federico II, Via Pansini, 5, 80131 Naples, Italy
| | - Cosimo De Nunzio
- Dipartimento di Urologia, Ospedale Sant’Andrea, Università Degli Studi di Roma “La Sapienza”, Rota, Italy
| | - Valerio Iacovelli
- Dipartimento di Medicina Sperimentale e Chirurgia, Università Degli Studi di Roma “Tor Vergata”, Roma, Italy
| | - Francesco Mangiapia
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università Degli Studi Di Napoli Federico II, Via Pansini, 5, 80131 Naples, Italy
| | - Vincenzo Li Marzi
- Dipartimento di Urologia, Ospedale Careggi, Università Degli Studi di Firenze, Firenze, Italy
| | - Enrico Finazzi Agrò
- Dipartimento di Medicina Sperimentale e Chirurgia, Università Degli Studi di Roma “Tor Vergata”, Roma, Italy
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Fusco F, Creta M, Longo N, Persico F, Franco M, Mirone V. Silodosin 8 mg improves benign prostatic obstruction in Caucasian patients with lower urinary tract symptoms suggestive of benign prostatic enlargement: results from an explorative clinical study. BMC Urol 2018; 18:12. [PMID: 29502524 PMCID: PMC5836453 DOI: 10.1186/s12894-018-0326-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 12/03/2017] [Accepted: 02/22/2018] [Indexed: 01/15/2023] Open
Abstract
Background To preliminary investigate the effects of silodosin 8 mg once daily on obstruction urodynamic parameters and subjective symptoms in Caucasian patients with lower urinary tract symptoms suggestive of benign prostatic enlargement. Methods We performed a single-center, open-label, single-arm, post-marketing interventional clinical trial. Inclusion criteria were: Caucasian subjects aged ≥50 years waiting to undergo surgery for lower urinary tract symptoms suggestive of benign prostatic enlargement, international prostate symptom total score ≥ 13, international prostate symptom-quality of life score ≥ 3, prostate volume ≥ 30 ml, maximum urine flow rate ≤ 15 mL/s, bladder outlet obstruction index > 40. Eligible subjects received one capsule of silodosin 8 mg once daily for 8 weeks. Invasive urodynamic evaluations were performed at baseline and at 8-weeks follow-up. International prostate symptom questionnaire was administered at baseline, after 4-weeks and 8-weeks of treatment. Results Overall, 34 subjects were included. Mean bladder outlet obstruction index significantly decreased from 70.6 to 39.2 and bladder outlet obstruction index class improved in 16 patients (53.3%). Statistically significant improvements of mean total international prostate symptom score, mean storage sub-score, mean voiding sub-score and mean quality of life sub-score were evident after 4-weeks of treatment with further improvements after 8-weeks. At the end of the treatment, all patients declared that their condition improved enough to spare or delay surgery. Conclusions Silodosin 8 mg once daily significantly improves benign prostatic obstruction in Caucasian patients with lower urinary tract symptoms suggestive of benign prostatic enlargement waiting for surgery. Trial registration EudraCT n. 2015-002277-38 Date of registration: 15th December 2017.
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Affiliation(s)
- Ferdinando Fusco
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples, Federico II - Via Pansini 5, 80131, Naples, Italy.
| | - Massimiliano Creta
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples, Federico II - Via Pansini 5, 80131, Naples, Italy
| | - Nicola Longo
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples, Federico II - Via Pansini 5, 80131, Naples, Italy
| | - Francesco Persico
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples, Federico II - Via Pansini 5, 80131, Naples, Italy
| | - Marco Franco
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples, Federico II - Via Pansini 5, 80131, Naples, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples, Federico II - Via Pansini 5, 80131, Naples, Italy
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Creta M, Longo N, Imbimbo C, Imperatore V, Mirone V, Fusco F. Health-related quality of life in bladder cancer patients undergoing radical cystectomy and urinary stoma: still many gaps. Transl Androl Urol 2018; 7:S111-S113. [PMID: 29648553 PMCID: PMC5881212 DOI: 10.21037/tau.2017.12.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Nicola Longo
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | | | - Vincenzo Mirone
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Ferdinando Fusco
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
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Fusco F, Lembo A, Ludovico G, Farina FP, Montorsi F, Fabris GM, Soli M, Scarpa RM, Gentile V, Motta M, Spera E, Casarico A, Sicuteri R, Rossi A, Mirone V. Tadalafil versus sildenafil citrate in the treatment of ED: Italian patients’ preferences and explanatory notes. Urologia 2018. [DOI: 10.1177/039156030807500105] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This is an open, multicentre, randomized, crossover study having the aim to evaluate the preference for sildenafil citrate or tadalafil in a population of Italian patients affected by ED, and to compare the efficacy and safety of these two drugs. Material and Methods. From October 2003 to November 2004, thirteen Italian centers enrolled ED patients (age >18) being in steady and naïve relation to ED treatment, both through PDE5 inhibitors and any other treatment option. These patients were randomized to sildenafil or tadalafil for 12 weeks, after which they were switched to the alternative treatment for a further 12 weeks. The preference was evaluated through the Treatment Preference Question (TPQ): “During this clinical trial you have taken tadalafil and sildenafil for the treatment of erectile dysfunction. Which medication do you prefer to take for the next 8 weeks of treatment?”. Moreover, patients were asked to express their preference as “strong” or “moderate” and to answer some questions to clarify the reasons behind their preference. SEP and IIEF-EF questionnaires were used for a comparison of efficacy. Results. 167 patients were enrolled, 144 of whom completed both treatment periods. On being asked the TPQ, 75% of patients (n=108) decided to continue treatment with tadalafil, in particular because it made it possible to have an erection many hours after taking the medication (first or second preference reason for 64.8% of patients), while 25% (n=36) preferred sildenafil (p=0.001). Both drugs improved the IIEF-EF and SEP scores compared to baseline, with a slightly but significantly greater improvement with tadalafil for both parameters. Conclusions. Tadalafil and sildenafil are both effective and well tolerated. Most of the patients prefer tadalafil thanks to the possibility of having sexual intercourse many hours after taking the medication.
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Affiliation(s)
- F. Fusco
- Clinica Urologica, Università Federico II, Napoli
| | - A. Lembo
- USC Urologia, Ospedali Riuniti di Bergamo
| | - G.M. Ludovico
- Unità di Urologia Operativa, Ospedale Civile, Monopoli (BA)
| | | | - F. Montorsi
- Reparto di Urologia, Ospedale S. Raffaele Milano
| | | | - M. Soli
- Dipartimento di Andrologia, AO e Policlinico S. Orsola Malpighi, Bologna
| | | | - V. Gentile
- Dipartimento di Urologia U. Bracci, Università La Sapienza, Roma
| | - M. Motta
- Urologia Clinica II, Ospedale V. Emanuele, Catania
| | - E. Spera
- Urologia, Università Tor Vergata, Roma
| | | | | | | | - V. Mirone
- Clinica Urologica, Università Federico II, Napoli
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Imperatore V, Creta M, Di Meo S, Buonopane R, Spirito L, Fusco F, Longo N, Forte NR, Mirone V. Incidentally discovered pelvic paraganglioma: A case report. Arch Ital Urol Androl 2017; 89:319-320. [DOI: 10.4081/aiua.2017.4.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/16/2017] [Indexed: 11/22/2022] Open
Abstract
Paragangliomas (PGL) are rare neuroendocrine tumors of the autonomic nervous system originating from paraganglia. Although PGL may arise at any site where physiologic paraganglionic tissue exists, the localization in the small pelvis is extremely rare. PGL may be hormonally active and release surplus catecholamines into the blood or inactive. The asymptomatic cases pose a diagnostic dilemma. We describe the case of an asymptomatic PGL arising in the small pelvis sidewall presenting as an incidentally discovered asymptomatic mass in a male subject.
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89
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Fusco F, Novara G. Reply to Wael Agur and Jawad Freites' Letter to the Editor re: Ferdinando Fusco, Mohamed Abdel-Fattah, Christopher R. Chapple, et al. Updated Systematic Review and Meta-analysis of the Comparative Data on Colposuspensions, Pubovaginal Slings, and Midurethral Tapes in the Surgical Treatment of Female Stress Urinary Incontinence. Eur Urol 2017;72:567-91. Eur Urol 2017; 73:e56-e57. [PMID: 28967555 DOI: 10.1016/j.eururo.2017.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/05/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Ferdinando Fusco
- Urology Unit, Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy.
| | - Giacomo Novara
- Urology Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Via Giustiniani 2, Padua, 35100, Italy.
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d'Emmanuele di Villa Bianca R, Fusco F, Mirone V, Cirino G, Sorrentino R. The Role of the Hydrogen Sulfide Pathway in Male and Female Urogenital System in Health and Disease. Antioxid Redox Signal 2017; 27:654-668. [PMID: 28398118 DOI: 10.1089/ars.2017.7079] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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] [Indexed: 12/24/2022]
Abstract
SIGNIFICANCE The endogenous hydrogen sulfide (H2S) pathway produces an array of biological effects that vary depending on the bodily region. In addition, the H2S pathway's relevance often changes depending on a healthy or disease state. There is abundant evidence pointing to a key role for this pathway in male and female genito-urinary diseases, suggesting it as a possible target for new therapeutic approaches. Recent Advances: The tissue-specific localization of the H2S enzymes in the genito-urinary tract has allowed for a better understanding of its role in the body's pathophysiology. Indeed, in humans, cystathionine-γ-lyase (CSE) plays a major role in corpus cavernosum whereas cystathionine-β-synthase (CBS) plays a role in bladder functioning. The prostate epithelium expresses CBS and CSE, but stromal CSE only. In the uterus, up- or downregulation of CBS and CSE varies strongly depending on the female's hormonal cycle or pregnancy. CRITICAL ISSUES There is still the need to better define the male and female's sexual hormonal roles in regulating the H2S pathway, particularly in human pathological conditions. The lack of a correlation between human and animal data should be carefully considered when planning preclinical studies. The unmet need for selective enzymatic inhibitors and the different methodologies for H2S measurements still represent a critical issue in this research field. FUTURE DIRECTIONS It is feasible that the L-cysteine/H2S pathway can represent an alternative therapeutic target in genito-urinary tract disorders. The research should focus on erectile dysfunction and preeclampsia, characterized by vascular defect, as well as on bladder disorders where the urothelium is compromised. Antioxid. Redox Signal. 27, 654-668.
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Affiliation(s)
- Roberta d'Emmanuele di Villa Bianca
- 1 Department of Pharmacy, School of Medicine, University of Naples Federico II , Naples, Italy .,2 Interdepartmental Centre for Sexual Medicine, School of Medicine, University of Naples Federico II , Naples, Italy
| | - Ferdinando Fusco
- 2 Interdepartmental Centre for Sexual Medicine, School of Medicine, University of Naples Federico II , Naples, Italy .,3 Department of Neurosciences, Human Reproduction and Odontostomatology, School of Medicine, University of Naples Federico II , Naples, Italy
| | - Vincenzo Mirone
- 2 Interdepartmental Centre for Sexual Medicine, School of Medicine, University of Naples Federico II , Naples, Italy .,3 Department of Neurosciences, Human Reproduction and Odontostomatology, School of Medicine, University of Naples Federico II , Naples, Italy
| | - Giuseppe Cirino
- 1 Department of Pharmacy, School of Medicine, University of Naples Federico II , Naples, Italy .,2 Interdepartmental Centre for Sexual Medicine, School of Medicine, University of Naples Federico II , Naples, Italy
| | - Raffaella Sorrentino
- 1 Department of Pharmacy, School of Medicine, University of Naples Federico II , Naples, Italy .,2 Interdepartmental Centre for Sexual Medicine, School of Medicine, University of Naples Federico II , Naples, Italy
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Gray A, Wolstenholme J, Fusco F, Chau I, Dunham L, Love S, Roberts A, Moschandreas J, Virdee P, Lewington V, Wilson G, Tait P, Khan N, Berry D, Wotherspoon A, Morgan B, Wasan H, Van Hazel G, Gibbs P, Sharma R. Quality of life in patients with liver metastases from colorectal cancer treated with first-line selective internal radiotherapy (SIRT): Results from the FOXFIRE prospective randomized studies. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.117] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
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Creta M, Mirone V, Di Meo S, Buonopane R, Longo N, Fusco F, Forte NR, Imperatore V. A rare case of male pelvic squamous cell carcinoma of unknown primary origin presenting as perineal abscess and urethral stenosis. ACTA ACUST UNITED AC 2017; 89:154-155. [PMID: 28679191 DOI: 10.4081/aiua.2017.2.154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 02/18/2017] [Indexed: 11/23/2022]
Abstract
Carcinomas of unknown primary origin (CUP) represent a diagnostic and therapeutic challenge. Squamous cell CUP located in the male pelvis are very rare. We describe a case of a locally advanced squamous cell CUP occurring in the male pelvis presenting as perineal abscess and urethral stenosis and diagnosed by means of transperineal needle biopsy.
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Affiliation(s)
- Massimiliano Creta
- Unità Operativa di Urologia, Ospedale Buon Consiglio - Fatebenefratelli, Napoli.
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Creta M, Mirone V, Di Meo S, Buonopane R, Longo N, Fusco F, Forte NR, Imperatore V. A case of highly aggressive anaplastic seminoma of the testis presenting as fungating scrotal lesion. ACTA ACUST UNITED AC 2017; 89:158-159. [PMID: 28679192 DOI: 10.4081/aiua.2017.2.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/05/2017] [Indexed: 11/23/2022]
Abstract
Anaplastic seminoma (AS) is an uncommon histological variant of classical seminoma of the testis and account for 5%-15% of cases. It is poorly described in the scientific literature. We present the case of a 50-years-old homeless man presenting with fever, marked left scrotal hardness and a fungating left scrotal lesion. He underwent left orchiopexy 40 years before. A computed tomography with contrast media showed a suspect testis cancer with scrotal involvment, extensive intralesional necrosis and multiple systemic metastases. A wide excision of the left hemiscrotum including the testis was performed in order to prevent severe local and systemic infectious complications. Histological examination revealed an AS. General conditions showed a rapid deterioration and the patient died on post operative day 10.
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Affiliation(s)
- Massimiliano Creta
- Unità Operativa di Urologia, Ospedale Buon Consiglio - Fatebenefratelli, Napoli.
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Abstract
Endometriosis is a benign condition described as the presence of endometrial- like tissue found outside the uterine cavity. Hepatic endometriosis is one of the rarest localization of extrapelvic endometriosis, only 22 cases have been reported in the literature. The preoperative diagnosis of hepatic endometriosis is rather difficult because in about the half of the patient affected they had no history of endometriosis. Moreover radiological images reveal no characteristic findings for hepatic endometriosis. It is often described as cystic mass with or without solid component, difficult to distinguish from hepatic abscess, hematoma, cystoadenoma or malignant neoplasia. We report a case of a 27-year-old female with a large cystic mass involving the left lobe of the liver. The patient underwent laparoscopic exploration and converted to laparotomy for resection of giant hepatic endometriosis.
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95
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Fusco F, Arcaniolo D, Restaino A, Lauri I, Franzese C. Prevalence of chronic prostatic inflammation based on clinical diagnostic criteria in a real-practice setting: a nation-wide observational study. Minerva Urol Nephrol 2017; 69:509-518. [PMID: 28114753 DOI: 10.23736/s0393-2249.17.02830-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chronic prostatic inflammation has a key role in the pathogenesis and progression of benign prostatic hyperplasia (BPH). Thus, the identification of patients with chronic inflammation is mandatory for Urologists. This study investigates which clinical, imaging and laboratory findings are used by Urologists in clinical practice to diagnose BPH and chronic prostate inflammation. METHODS This was a multicenter, non-interventional, observational study involving 30 Italian large-volume primary care urology centers. Patients were allocated into four diagnosis group: patients with BPH; patients with BPH and chronic prostate inflammation; patients with chronic prostate inflammation alone; and patients with lower urinary tract symptoms (LUTS) due to other causes. RESULTS In total, 6134 patients were enrolled. BPH diagnosis with or without concomitant prostate inflammation was more frequent in older patients, while inflammation alone was prevalent in younger patients. Predictive factors for diagnosis of inflammation in all patients, regardless of age, were normal urinary flow (OR=2.73) and proved in-fection (OR=5.90), while in older patients (>61 years) diagnosis of chronic prostatic inflammation was specifically predicted by higher PSA values (≥4 ng/mL; OR=2.91), normal prostate volume (OR=10.23), mild symptoms (IPSS <8; OR=1.84), presence of intraprostatic calcifications (OR=4.55), and the combination of both infection and calcifications (OR=10.79). CONCLUSIONS In daily practice, the presence of chronic prostatic inflammation is underestimated. A stricter application of established diagnostic criteria suggested would increase the detection rate of chronic prostatic inflammation and potentially change the therapeutic approach in many patients with LUTS.
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96
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Roehrborn CG, Cruz F, Fusco F. α1-Blockers in Men with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Obstruction: Is Silodosin Different? Adv Ther 2017; 33:2110-2121. [PMID: 27752927 PMCID: PMC5126182 DOI: 10.1007/s12325-016-0423-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Indexed: 12/12/2022]
Abstract
Available α1-blockers (ABs) have different profiles of receptor selectivity. Silodosin exhibits the highest selectivity for the α1A adrenergic receptor. This pharmacological feature couples with a singular urodynamic and clinical profile. The magnitude of bladder outlet obstruction improvement in patients receiving silodosin is higher if compared to other ABs. From a clinical point of view, current evidence suggests an advantage in favor of silodosin in terms of nocturia improvement and cardiovascular safety. The incidence of ejaculatory dysfunction with silodosin is higher compared to other Abs.
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97
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Stanzione A, Imbriaco M, Cocozza S, Fusco F, Rusconi G, Nappi C, Mirone V, Mangiapia F, Brunetti A, Ragozzino A, Longo N. Erratum to "Biparametric 3t magnetic resonance imaging for prostatic cancer detection in a biopsy-naïve patient population: A further improvement of PI-RADS v2? [Eur. J. Radiol. 85 (12) (2016) 2269-2274]". Eur J Radiol 2016; 87:125. [PMID: 28034566 DOI: 10.1016/j.ejrad.2016.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy.
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Ferdinando Fusco
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University "Federico II", Naples, Italy
| | - Giovanni Rusconi
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University "Federico II", Naples, Italy
| | - Francesco Mangiapia
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University "Federico II", Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Alfonso Ragozzino
- Department of Radiology, Ospedale S. Maria delle Grazie, Pozzuoli, Italy
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University "Federico II", Naples, Italy
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98
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Ferro M, Bottero D, D'Elia C, Matei DV, Cioffi A, Cozzi G, Serino A, Cordima G, Bianchi R, Incarbone PG, Brescia A, Musi G, Fusco F, Detti S, Mirone V, de Cobelli O. Virtue male sling for post-prostatectomy stress incontinence: a prospective evaluation and mid-term outcomes. BJU Int 2016; 119:482-488. [PMID: 27696622 DOI: 10.1111/bju.13672] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of the Virtue® male sling (Coloplast, Humlebaek, Denmark) in a cohort of patients affected by post-prostatectomy stress urinary incontinence (SUI). METHODS All 29 consecutive patients treated with a Virtue male sling at our Institution between July 2012 and October 2013 were included in the present prospective, non-randomized study. Patients were evaluated preoperatively and at 1, 3, 6, 12, 24 and 36 months after surgery using a 24-h pad weight test, the International Consultation on Incontinence short-form questionnaire (ICIQ-SF), Urinary Symptom Profile (USP) questionnaire, a bladder diary, uroflowmetry and the Patient Global Impression of Improvement (PGI-I) and Patient Global Impression of Severity questionnaires. RESULTS The mean patient age was 65.5 years. A total of 72.4% of patients had preoperative mild incontinence (1-2 pads/day), while nine patients used 3-5 pads/day. There were a total of 17 complications, which occurred in 29 patients (58.6%); all were Clavien-Dindo grade I. At 12-month follow-up patients showed a significant improvement in 24-h pad test (128.6 vs 2.5 g), number of pads per day (2 vs 0), ICIQ-SF score (14.3 vs 0.9) and USP score for SUI (4 vs 0), and outcomes remained stable at 36 months. At last follow-up, the median score on the PGI-I questionnaire was 1 (very much better). CONCLUSION The Virtue male sling is an effective treatment option for low to moderate post-prostatectomy incontinence.
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Affiliation(s)
- Matteo Ferro
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Danilo Bottero
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Carolina D'Elia
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | | | - Antonio Cioffi
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Gabriele Cozzi
- Department of Urology, European Institute of Oncology, Milan, Italy
| | | | - Giovanni Cordima
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Roberto Bianchi
- Department of Urology, European Institute of Oncology, Milan, Italy
| | | | - Antonio Brescia
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Ferdinando Fusco
- Department of Urology, University Federico II of Naples, Naples, Italy
| | - Serena Detti
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Vincenzo Mirone
- Department of Urology, University Federico II of Naples, Naples, Italy
| | - Ottavio de Cobelli
- Department of Urology, European Institute of Oncology, Milan, Italy.,University of Milan, Milan, Italy.,'Iuliu Hatieganu', University of Medicine and Pharmacy, Cluj-Napoca, Romania
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99
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Stanzione A, Imbriaco M, Cocozza S, Fusco F, Rusconi G, Nappi C, Mirone V, Mangiapia F, Brunetti A, Ragozzino A, Longo N. Biparametric 3T Magnetic Resonance Imaging for prostatic cancer detection in a biopsy-naïve patient population: a further improvement of PI-RADS v2? Eur J Radiol 2016; 85:2269-2274. [PMID: 27842676 DOI: 10.1016/j.ejrad.2016.10.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 10/10/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To prospectively determine the diagnostic accuracy of a biparametric 3T magnetic resonance imaging protocol (BP-MRI) for prostatic cancer detection, compared to a multiparametric MRI protocol (MP-MRI), in a biopsy naïve patient population. METHODS Eighty-two untreated patients (mean age 65±7.6years) with clinical suspicion of prostate cancer and/or altered prostate-specific antigen (PSA) levels underwent a MP-MRI, including T2-weighted imaging, diffusion-weighted imaging (with the correspondent apparent diffusion coefficient maps) and dynamic contrast enhanced sequence, followed by prostate biopsy. Two radiologists reviewed both the BP-MRI and the MP-MRI protocols to establish a radiological diagnosis. Receiver operating characteristics curves were obtained to determine the diagnostic performance of the two protocols. RESULTS The mean PSA level was 8.8±8.1ng/ml. A total of 34 prostatic tumors were identified, with a Gleason score that ranged from 3+3 to 5+4. Of these 34 tumors, 29 were located within the peripheral zone and 5 in the transitional zone. BP-MRI and MP-MRI showed a similar performance in terms of overall diagnostic accuracy, with an area under the curve of 0.91 and 0.93, respectively (p=n.s.). CONCLUSIONS BP-MRI prostate protocol is feasible for prostatic cancer detection compared to a standard MP-MRI protocol, requiring a shorter acquisition and interpretation time, with comparable diagnostic accuracy to the conventional protocol, without the administration of gadolinium-based contrast agent.
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Affiliation(s)
- Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy.
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Ferdinando Fusco
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University "Federico II", Naples, Italy
| | - Giovanni Rusconi
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University "Federico II", Naples, Italy
| | - Francesco Mangiapia
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University "Federico II", Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Alfonso Ragozzino
- Department of Radiology, Ospedale S. Maria delle Grazie, Pozzuoli, Italy
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University "Federico II", Naples, Italy
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100
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Fode M, Fusco F, Lipshultz L, Weidner W. Sexually Transmitted Disease and Male Infertility: A Systematic Review. Eur Urol Focus 2016; 2:383-393. [DOI: 10.1016/j.euf.2016.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/08/2016] [Accepted: 08/04/2016] [Indexed: 12/09/2022]
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