1
|
Maiolino G, Boni A, Del Zingaro M, Russo M, Mearini E. Acute uropathogen-related cowperitis with sepsis: case report and literature review. Urol Case Rep 2023; 51:102566. [PMID: 38024513 PMCID: PMC10652140 DOI: 10.1016/j.eucr.2023.102566] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/12/2023] [Indexed: 12/01/2023] Open
Abstract
Acute cowperitis, which was previously known as a common complication of sexually transmitted infections (STIs), is now commonly associated with bacterial urinary tract infections, particularly Escherichia coli. Patients often have a history of STIs, and the symptoms resemble other male accessory gland infections (MAGIs). Recent cases associated with sepsis have been managed with percutaneous drainage and/or surgery. We present a case of acute cowperitis with sepsis and an abscess in the right small gland. The diagnosis was made using transperineal ultrasound, and the patient was successfully treated only with a long-term antibiotic therapy.
Collapse
Affiliation(s)
- Giuseppe Maiolino
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Andrea Boni
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Miriam Russo
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| |
Collapse
|
2
|
Cochetti G, Paladini A, Del Zingaro M, Ciarletti S, Pastore F, Massa G, De Angelis L, Mearini E. Robot-assisted radical cystectomy with intracorporeal reconstruction of urinary diversion by mechanical stapler: prospective evaluation of early and late complications. Front Surg 2023; 10:1157684. [PMID: 37383384 PMCID: PMC10293791 DOI: 10.3389/fsurg.2023.1157684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/22/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction Radical cystectomy with pelvic lymph node dissection is the gold standard treatment for non-metastatic muscle-invasive bladder cancer and high-risk non-muscle-invasive bladder cancer. For years, the traditional open surgery approach was the only viable option. The widespread of robotic surgery led to its employment also in radical cystectomy to reduce complication rates and improve functional outcomes. Regardless of the type of approach, radical cystectomy is a procedure with high morbidity and not negligible mortality. Data available in the literature show how the use of staplers can offer valid functional outcomes, with an acceptable rate of complications shortening the operative time. The aim of our study was to describe the perioperative outcomes and complications associated with robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) using a mechanical stapler. Material and methods From January 2015 to May 2021, we enrolled patients who underwent RARC with pelvic node dissection and stapled ICUD (ileal conduit or ileal Y-shaped neobladder according to the Perugia ileal neobladder) in our high-volume center. Demographic features, perioperative outcomes and early (≤30 days) and late (>90 days) post-operative complications according to the Clavien-Dindo classification, were recorded for each patient. We also analyzed the potential linear correlation between demographic, pre-operative as well as operative features and the risk of post-operative complications. Results Overall, 112 patients who underwent RARC with ICUD were included with a minimum follow-up of 12 months. Intracorporeal Perugia ileal neobladder was performed in 74.1% of cases while ileal conduit was performed in 25.9%. The mean operative time, estimated intraoperative blood loss, and LOS were 289.1 ± 59.7 min, 390.6 ± 186.2 ml, and 17.5 ± 9.8 days, respectively. Early minor and major complications accounted for 26.7% and 10.8%, respectively. Overall late complications were 40.2%. The late most common complications were hydronephrosis (11.6%) and urinary tract infections (20.5%). Stone reservoir formation occurred in 2.7% of patients. Major complications occurred in 5.4%. In the sub-analysis, the mean operative time and the estimated blood loss improved significantly from the first 56 procedures to the last ones. Conclusion RARC with ICUD performed by mechanical stapler is a safe and effective technique. Stapled Y-shaped neobladder did not increase the complication rate.
Collapse
|
3
|
Paladini A, Cochetti G, Felici G, Russo M, Saqer E, Cari L, Bordini S, Mearini E. Complications of extraperitoneal robot-assisted radical prostatectomy in high-risk prostate cancer: A single high-volume center experience. Front Surg 2023; 10:1157528. [PMID: 37066016 PMCID: PMC10098012 DOI: 10.3389/fsurg.2023.1157528] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/28/2023] [Indexed: 03/31/2023] Open
Abstract
IntroductionThe role of robot-assisted radical prostatectomy (RARP) in high-risk prostate cancer (PCa) has been debated over the years, but it appears safe and effective in selected patients. While the outcomes of transperitoneal RARP for high-risk PCa have been already widely investigated, data on the extraperitoneal approach are scarcely available. The primary aim of this study is to evaluate intra- and postoperative complications in a series of patients with high-risk PCa treated by extraperitoneal RARP (eRARP) and pelvic lymph node dissection. The secondary aim is to report oncological and functional outcomes.MethodsData of patients who underwent eRARP for high-risk PCa were prospectively collected from January 2013 to September 2021. Intraoperative and postoperative complications were recorded, as also perioperative, functional, and oncological outcomes. Intraoperative and postoperative complications were classified by employing Intraoperative Adverse Incident Classification by the European Association of Urology and the Clavien–Dindo classification, respectively. Univariate and multivariate analyses were performed to evaluate a potential association between clinical and pathological features and the risk of complications.ResultsA total of 108 patients were included. The mean operative time and estimated blood loss were 183.5 ± 44 min and 115.2 ± 72.4 mL, respectively. Only two intraoperative complications were recorded, both grade 3. Early complications were recorded in 15 patients, of which 14 were of minor grade, and 1 was grade IIIa. Late complications were diagnosed in four patients, all of grade III. Body mass index (BMI) > 30 kg/m2, Prostate-Specific Antigen (PSA) > 20 ng/mL, PSA density >0.15 ng/mL2, and pN1 significantly correlated with a higher rate of overall postoperative complications. Moreover, BMI >30 kg/m2, PSA >20 ng/mL, and pN1 significantly correlated with a higher rate of early complications, while PSA >20 ng/mL, prostate volume <30 mL, and pT3 were significantly associated with a higher risk of late complications. In multivariate regression analysis, PSA >20 ng/mL significantly correlated with overall postoperative complications, while PSA > 20 and pN1 correlated with early complications. Urinary continence and sexual potency were restored in 49.1%, 66.7%, and 79.6% of patients and in 19.1%, 29.9%, and 36.2% of patients at 3, 6, and 12 months, respectively.ConclusionseRARP with pelvic lymph node dissection in patients with high-risk PCa is a feasible and safe technique, resulting in only a few intra- and postoperative complications, mostly of low grade.
Collapse
Affiliation(s)
- Alessio Paladini
- Urology Clinic, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giovanni Cochetti
- Urology Clinic, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Graziano Felici
- Urology Clinic, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Correspondence: Graziano Felici
| | - Miriam Russo
- Urology Clinic, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Eleonora Saqer
- Urology Clinic, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Luigi Cari
- Section of Pharmacology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Stefano Bordini
- Urology Clinic, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Ettore Mearini
- Urology Clinic, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| |
Collapse
|
4
|
Boni A, Gervasoni F, Lomauro A, Del Zingaro M, Maiolino G, Galletti C, Ricci V, Mearini E. Urologic latency time during uroflow stop test with electromyography: an incontinence detector in rehabilitation after robotic radical prostatectomy. Eur J Phys Rehabil Med 2023; 59:94-102. [PMID: 36305651 PMCID: PMC10035442 DOI: 10.23736/s1973-9087.22.07365-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Stress urinary incontinence (UI) is the most common presentation following robot-assisted radical prostatectomy (RARP), but a postoperative non-invasive and objective test is still lacking. To assess pelvic floor integrity after RARP, we recently proposed Uroflow Stop Test (UST) with surface electromyography (EMG). AIM Here we provide two new clinical parameters: the neurologic latency time (NLT) and the urologic latency time (ULT) derived from UST-EMG Test. Principal outcome was to evaluate their variation during one year follow-up and ULT ability to predict post-RARP UI. DESIGN Observational and longitudinal study. SETTING Interdivisional Urology Clinic (Perugia-Terni, Italy). POPULATION Patients with prostate cancer treated with a full nerve-sparing RARP who underwent postoperative pelvic floor muscles training (PFMT): a diurnal functional home program and a weekly hospital program with the use of biofeedback, between 1 and 3 months postoperatively. METHODS All patients consecutively performed a UST-EMG test at one, three, six, and twelve months after surgery. At each follow-up visit we collected NLT values, ULT values, 5-item 26-Expanded Prostate Cancer Index (EPIC), Incontinence Developed on Incontinence Questionnaire (ICIQ-UI) Short Form and International Prostate Symptom Score (IPSS). We analysed statistically significant differences in NLT and ULT between continent and incontinent patients and we evaluate the diagnostic ability of 1-month post-surgery ULT value to diagnose the presence of postoperative UI. RESULTS Sixty patients were enrolled. The mean time to PFMT was 31.08 (range: 30-35) days. Overall IPSS, NLT and ULT had similar trends: progressive decrease until the six months after surgery (1-month vs. 3 months vs. 6 months, P<0.05) to plateau thereafter. When considering the two group of patients, IPSS and NLT were significantly higher in the incontinent group only one month after surgery, while ULT became similar between the two groups at 6 months after surgery. The best cut-off of 1-month ULT values that maximized the Youden function at 12-months resulted 3.13 second. CONCLUSIONS NLT and ULT may respectively account for the nerve and the urethral closure system integrity post-RARP. In the first month after RARP, both NLT and ULT differs between incontinent vs. continent patients. NLT become similar between two group after one month, confirming the recovery from neuropraxia, but ULT remains statistically significant different until 3 months postoperatively. The value of 1-month ULT resulted a valid tool to predict incontinence status at 12 months. CLINICAL REHABILITATION IMPACT ULT and NLT may be also useful tools to monitor the continence progressive recovery after RARP and they may help rehabilitation specialists to evaluate the ongoing results during postoperative follow-up.
Collapse
Affiliation(s)
- Andrea Boni
- Department of Surgical and Biomedical Sciences, Interdivisional Urology Clinic (Perugia-Terni), University Hospital of Perugia, Perugia, Italy
| | - Fabrizio Gervasoni
- Unit of Rehabilitation, Luigi Sacco University Hospital, A.S.S.T. Fatebenefratelli-Sacco, Milan, Italy
| | - Antonella Lomauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy -
| | - Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, Interdivisional Urology Clinic (Perugia-Terni), University Hospital of Perugia, Perugia, Italy
| | - Giuseppe Maiolino
- Department of Surgical and Biomedical Sciences, Interdivisional Urology Clinic (Perugia-Terni), University Hospital of Perugia, Perugia, Italy
| | - Chiara Galletti
- Department of Psychiatry, Santa Maria University Hospital, Terni, Italy
| | - Vincenzo Ricci
- Unit of Rehabilitation, Luigi Sacco University Hospital, A.S.S.T. Fatebenefratelli-Sacco, Milan, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Interdivisional Urology Clinic (Perugia-Terni), University Hospital of Perugia, Perugia, Italy
| |
Collapse
|
5
|
Cochetti G, Roupret M, Paladini A, Seisen T, Vaessen C, Pinar U, Ciarletti S, Tancredi A, Guadagni L, Saqer E, Chartier-Kastler E, Mearini E. Peri-operative and short-term functional outcomes comparison between HoLEP and robotic simple prostatectomy for large prostate. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01176-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
6
|
Mearini E, Paladini A, Cellini V, Mearini M, Felici G, Vitale A, Cochetti G. Ureteroiliac fistula after oncological surgery: Case report and review of the literature. Open Med (Wars) 2022; 17:2013-2020. [PMID: 36568516 PMCID: PMC9746699 DOI: 10.1515/med-2022-0588] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 10/02/2022] [Accepted: 10/28/2022] [Indexed: 12/15/2022] Open
Abstract
Fistulas arising between ureters and iliac arteries (UAF) are rare pathological events and frequently require emergency treatment, as they are associated with massive haematuria and haemorrhagic shock. The medical history plays a key role in the diagnostic and therapeutic process, as it allows to include UAF among the differential diagnoses of gross haematuria. The emergency treatments of fistulas arising between the urinary system and the vascular system include the open repairing surgery or the endovascular grafting, the latter generally better tolerated by patients suffering from multiple comorbidities or not eligible for traditional surgery. Nephrostomy or ureteral stent can be used to drain the affected upper urinary tract temporarily or permanently. Herein, we reported two cases of oncological patients affected by UAF and treated successfully by endovascular procedures. Furthermore, we performed a narrative review of the literature concerning UAF and its diagnostic and therapeutic management. Although our study did not allow us to state definitive conclusion about the diagnostic and therapeutic management of UAF due to small sample size, our findings support previous experiences in favour of the treatment of fistulas with an endovascular approach.
Collapse
Affiliation(s)
- Ettore Mearini
- Department of Medicine and Surgery, Division of Urology, University of Perugia, Perugia, 06129, Italy
| | - Alessio Paladini
- Department of Medicine and Surgery, Division of Urology, University of Perugia, Perugia, 06129, Italy
| | - Valerio Cellini
- Department of Medicine and Surgery, Division of Urology, University of Perugia, Perugia, 06129, Italy
| | - Matteo Mearini
- Department of Medicine and Surgery, Division of Urology, University of Perugia, Perugia, 06129, Italy
| | - Graziano Felici
- Department of Medicine and Surgery, Division of Urology, University of Perugia, Perugia, 06129, Italy
| | - Andrea Vitale
- Department of Medicine and Surgery, Division of Urology, University of Perugia, Perugia, 06129, Italy
| | - Giovanni Cochetti
- Department of Medicine and Surgery, Division of Urology, University of Perugia, Perugia, 06129, Italy
| |
Collapse
|
7
|
Porreca A, Di Gianfrancesco L, Artibani W, Busetto G, Carrieri G, Antonelli A, Bianchi L, Brunocilla E, Bocciardi A, Carini M, Celia A, Cochetti G, Gallina A, Mearini E, Minervini A, Schiavina R, Serni S, D’Agostino D, Corsi P, Crestani A. Robot-assisted, laparoscopic, and open radical cystectomy: Surgical data of 1400 patients from The Italian Radical Cystectomy Registry (RIC) on intraoperative outcomes. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02576-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
8
|
Maiolino G, Del Zingaro M, Manfredini G, Graziano F, Tancredi A, Boni A, Mearini E. Peak systolic velocity at basal penile ultrasound and individual 10-year risk of cardiovascular disease. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
9
|
Siracusano S, Zaka A, Bassi P, Gontero P, Mearini E, Imbimbo C, Simonato A, Dal Moro F, Giannarini G, Valotto C, Montorsi F, Colombo R, Porpiglia F, Bartoletti R, Vella M, Minervini A, Rossanese M, Porcaro B, Romantini F, Vicentini C, Talamini R, Ficarra V, Racioppi M, Lonardi C. Short-term effects of bowel function on global health quality of life after radical cystectomy. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01118-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
10
|
Maiolino G, Ciarletti S, Manfredini G, Paladini A, Mearini E. Acceleration parameters at uroflowmetry to predict urodynamic study findings. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01076-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
11
|
Tancredi A, Cochetti G, Maiolino G, Manfredini G, Vitale A, Guadagni L, Marsico M, Paladini A, Del Zingaro M, Mearini E. Evaluation of peri-operative and functional outcomes of cap holep technique. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01163-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
12
|
Paladini A, Cochetti G, Tancredi A, Mearini M, Vitale A, Pastore F, Mangione P, Mearini E. Management of Fournier's gangrene during the Covid-19 pandemic era: make a virtue out of necessity. Basic Clin Androl 2022; 32:12. [PMID: 35850577 PMCID: PMC9294754 DOI: 10.1186/s12610-022-00162-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
Background Fournier’s gangrene (FG) is a necrotizing fasciitis caused by aerobic and anaerobic bacterial infection that involves genitalia and perineum. Males, in their 60 s, are more affected with 1.6 new cases/100.000/year. Main risk factors are diabetes, malignancy, inflammatory bowel disease. FG is a potentially lethal disease with a rapid and progressive involvement of subcutaneous and fascial plane. A multimodal approach with surgical debridement, antibiotic therapy, intensive support care, and hyperbaric oxygen therapy (HBOT) is often needed. We present the inpatient management of an FG case during the Covid-19 pandemic period. A narrative review of the Literature searching “Fournier’s gangrene”, “necrotizing fasciitis” on PubMed and Scopus was performed. Case presentation A 60 years old man affected by diabetes mellitus, with ileostomy after colectomy for ulcerative colitis, was admitted to our Emergency Department with fever and acute pain, edema, dyschromia of right hemiscrotum, penis, and perineal region. Computed tomography revealed air-gas content and fluid-edematous thickening of these regions. Fournier’s Gangrene Severity Index was 9. A prompt broad-spectrum antibiotic therapy with Piperacillin/Tazobactam, Imipenem and Daptomycin, surgical debridement of genitalia and perineal region with vital tissue exposure, were performed. Bedside daily surgical wound medications with fibrine debridement, normal saline and povidone-iodine solutions irrigation, iodoform and fatty gauze application, were performed until discharge on the 40th postoperative day. Every 3 days office-based medication with silver dressing, after normal saline and povidone-iodine irrigation and fibrinous tissue debridement, was performed until complete re-epithelialization of the scrotum on the 60th postoperative day. Conclusions FG is burdened by a high mortality rate, up to 30%. In the literature, HBOT could improve wound restoration and disease-specific survival. Unfortunately, in our center, we do not have HBOT. Moreover, one of the pandemic period problems was the patient’s displacement and outpatient hospital management. For all these reasons we decided for a conservative inpatient management. Daily cleaning of the surgical wound allowed to obtain its complete restoration avoiding surgical graft and hyperbaric oxygen chamber therapy, without foregoing optimal outcomes.
Collapse
Affiliation(s)
- Alessio Paladini
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Giovanni Cochetti
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy.
| | - Angelica Tancredi
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Matteo Mearini
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Andrea Vitale
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Francesca Pastore
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Paolo Mangione
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Ettore Mearini
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| |
Collapse
|
13
|
Siracusano S, Zaka A, Bassi P, Gontero P, Mearini E, Imbimbo C, Simonato A, Dal Moro F, Giannarini G, Valotto C, Montorsi F, Colombo R, Porpiglia F, Bartoletti R, Vella M, Minervini A, Porcaro AB, Romantini F, Vicentini C, Talamini R, Ficarra V, Lonardi C. Quality-of-Life Outcomes in Female Patients With Ileal Conduit or Orthotopic Neobladder Urinary Diversion: 6-Month Results of a Multicenter Prospective Study. Front Oncol 2022; 12:855546. [PMID: 35515136 PMCID: PMC9067240 DOI: 10.3389/fonc.2022.855546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Radical cystectomy (RC) often affects patients’ life as this surgery is a traumatic and invasive event for the patients, with drawbacks on their daily, social, working, and sex life. Such changes in the quality of life (QoL) of patients are commonly studied through retrospective clinical evaluations and rarely with longitudinal studies. To date, studies focusing on functional outcomes, sexual function, and health-related QoL for female patients are lacking. We evaluated 37 patients using EORTC QLQ-C30 (QLQ-30) and Short-Form 36 (SF-36) questionnaires, before and after surgery, at 3 and 6 months of follow-up. The mean values for the emotional functioning in QLQ-C30 as well as the mental health in SF-36 were significantly higher in the ONB group compared to the IC group at 3 months of follow-up. These differences were not significant at 6 months of follow-up. At 6 months of follow-up, the ONB group showed a higher mean score in the physical and role functioning than the IC group. Although there was a statistically significant age difference at baseline of the two groups, none of the results are correlated with age, as demonstrated by Spearman’s analysis. The ONB seems to represent the most advantageous solution compared to the IC in terms of QOL at the 6-month follow-up.
Collapse
Affiliation(s)
- Salvatore Siracusano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Agustina Zaka
- Department of Surgery, Dentistry, Pediatrics and Gynaecology, University of Verona, Verona, Italy
| | | | - Paolo Gontero
- Department of Surgical Science, Turin University, Turin, Italy
| | - Ettore Mearini
- Department of Medicine and Surgery, Perugia University, Perugia, Italy
| | - Ciro Imbimbo
- Department of Urology, Federico II Naples University, Naples, Italy
| | | | | | | | | | - Francesco Montorsi
- Department of Urology, San Raffaele Hospital, Vita e Salute University, Milan, Italy
| | - Renzo Colombo
- Department of Urology, San Raffaele Hospital, Vita e Salute University, Milan, Italy
| | | | | | - Marco Vella
- Department of Urology, Palermo University, Palermo, Italy
| | | | | | - Federico Romantini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carlo Vicentini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Renato Talamini
- Department of Epidemiology, Aviano Oncology Center, Aviano, Italy
| | | | | |
Collapse
|
14
|
Busetto GM, D’Agostino D, Colicchia M, Palmer K, Artibani W, Antonelli A, Bianchi L, Bocciardi A, Brunocilla E, Carini M, Carrieri G, Cormio L, Falagario UG, De Berardinis E, Sciarra A, Leonardo C, Del Giudice F, Maggi M, de Cobelli O, Ferro M, Musi G, Ercolino A, Di Maida F, Gallina A, Introini C, Mearini E, Cochetti G, Minervini A, Montorsi F, Schiavina R, Serni S, Simeone C, Parma P, Serao A, Mangano MS, Pomara G, Ditonno P, Simonato A, Romagnoli D, Crestani A, Porreca A. Robot-Assisted, Laparoscopic, and Open Radical Cystectomy: Pre-Operative Data of 1400 Patients From The Italian Radical Cystectomy Registry. Front Oncol 2022; 12:895460. [PMID: 35600337 PMCID: PMC9117739 DOI: 10.3389/fonc.2022.895460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/06/2022] [Indexed: 12/16/2022] Open
Abstract
Introduction The Italian Radical Cystectomy Registry (RIC) is an observational prospective study aiming to understand clinical variables and patient characteristics associated with short- and long-term outcomes among bladder cancer (BC) patients undergoing radical cystectomy (RC). Moreover, it compares the effectiveness of three RC techniques - open, robotic, and laparoscopic. Methods From 2017 to 2020, 1400 patients were enrolled at one of the 28 centers across Italy. Patient characteristics, as well as preoperative, postoperative, and follow-up (3, 6, 12, and 24 months) clinical variables and outcomes were collected. Results Preoperatively, it was found that patients undergoing robotic procedures were younger (p<.001) and more likely to have undergone preoperative neoadjuvant chemotherapy (p<.001) and BCG instillation (p<.001). Hypertension was the most common comorbidity among all patients (55%), and overall, patients undergoing open and laparoscopic RC had a higher Charlson Comorbidities Index (CCI) compared to robotic RC (p<.001). Finally, laparoscopic patients had a lower G-stage classification (p=.003) and open patients had a higher ASA score (p<.001). Conclusion The present study summarizes the characteristic of patients included in the RIC. Future results will provide invaluable information about outcomes among BC patients undergoing RC. This will inform physicians about the best techniques and course of care based on patient clinical factors and characteristics.
Collapse
Affiliation(s)
- Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
- *Correspondence: Gian Maria Busetto,
| | | | | | - Katie Palmer
- Department of Internal Medicine and Geriatrics, University Cattolica del Sacro Cuore, Rome, Italy
| | - Walter Artibani
- Department of Urology, Policlinico Abano Terme, Abano Terme, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy
| | - Lorenzo Bianchi
- Department of Urology, University of Bologna, Bologna, Italy
| | | | | | - Marco Carini
- Department of Urology, University of Florence, Florence, Italy
| | | | - Luigi Cormio
- Department of Urology, Villa Salus Clinic, Mestre, Italy
| | | | - Ettore De Berardinis
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Costantino Leonardo
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Martina Maggi
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Ottavio de Cobelli
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Amelio Ercolino
- Department of Urology, University of Bologna, Bologna, Italy
| | | | - Andrea Gallina
- Department of Urology, San Raffaele Hospital and Scientific Institute, Milan, Italy
| | | | - Ettore Mearini
- Department of Urology, University of Perugia, Perugia, Italy
| | | | | | - Francesco Montorsi
- Department of Urology, San Raffaele Hospital and Scientific Institute, Milan, Italy
| | | | - Sergio Serni
- Department of Urology, University of Florence, Florence, Italy
| | - Claudio Simeone
- Department of Urology, University of Brescia, Brescia, Italy
| | - Paolo Parma
- Department of Urology, Azienda Socio Sanitaria Territoriale (ASST) Mantova, Mantova, Italy
| | - Armando Serao
- Department of Urology, Azienda Ospedaliera di Alessandria, Alessandria, Italy
| | | | - Giorgio Pomara
- Department of Urology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | | | - Alessandro Crestani
- Oncological Urology, Veneto Institute of Oncology (IOV) – Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Angelo Porreca
- Oncological Urology, Veneto Institute of Oncology (IOV) – Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| |
Collapse
|
15
|
Del Zingaro M, Maiolino G, Ceccarelli S, Branca A, Rosati F, Cochetti G, Mearini E. Post‐void residual volume after uroflowmetry measured using both ultrasound and bladder scanner by urologic nurses. Int J of Uro Nursing 2022. [DOI: 10.1111/ijun.12286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Giuseppe Maiolino
- Medicine and Surgery, Urology Clinic University of Perugia Perugia Italy
| | - Silvia Ceccarelli
- Medicine and Surgery, Urology Clinic University of Perugia Perugia Italy
| | - Angela Branca
- Medicine and Surgery, Urology Clinic University of Perugia Perugia Italy
| | - Francesca Rosati
- Nursing Degree Course of Foligno University of Perugia Foligno Italy
| | - Giovanni Cochetti
- Medicine and Surgery, Urology Clinic University of Perugia Perugia Italy
| | - Ettore Mearini
- Medicine and Surgery, Urology Clinic University of Perugia Perugia Italy
| |
Collapse
|
16
|
Mearini E, Rossi De Vermandois J, Cellini V, Soli I, Saqer E, Cochetti G. Robot-assisted “Y”-shaped orthotopic ileal neobladder by stapler: Surgical technique and report of perioperative and functional outcomes. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01334-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
17
|
Porreca A, Di Gianfrancesco L, Artibani W, Busetto GM, Carrieri G, Antonelli A, Bianchi L, Brunocilla E, Bocciardi AM, Carini M, Celia A, Cochetti G, Gallina A, Mearini E, Minervini A, Schiavina R, Serni S, D'Agostino D, Debbi E, Corsi P, Crestani A. Robotic-assisted, laparoscopic, and open radical cystectomy: surgical data of 1400 patients from The Italian Radical Cystectomy Registry on intraoperative outcomes. Cent European J Urol 2022; 75:135-144. [PMID: 35937656 PMCID: PMC9326698 DOI: 10.5173/ceju.2022.0284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/27/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The Italian Radical Cystectomy Registry (Registro Italiano Cistectomie – RIC) aimed to analyse outcomes of a multicenter series of patients treated with radical cystectomy (RC) for bladder cancer. Material and methods An observational, prospective, multicenter, cohort study was performed to collect data from RC and urinary diversion via open (ORC), laparoscopic (LRC), or robotic-assisted (RARC) techniques performed in 28 Italian Urological Departments. The enrolment was planned from January 2017 to June 2020 (goal: 1000 patients), with a total of 1425 patients included. Chi-square and t-tests were used for categorical and continuous variables. All tests were 2-sided, with a significance level set at p <0.05. Results Overall median operative-time was longer in RARCs (390 minutes, IQR 335–465) than ORCs (250, 217–309) and LRCs (292, 228–350) (p <0.001). Lymph node dissection (LND) was performed more frequently in RARCs (97.1%) and LRCs (93.5%) than ORCs (85.6%) (p <0.001), with extended-LND performed 2-fold more frequently in RARCs (61.6%) (p <0.001). The neobladder rate was significantly higher (more than one-half) in RARCs. The median estimated blood loss (EBL) rate was lower in RARCs (250 ml, 165–400) than LRCs (330, 200–600) and ORCs (400, 250–600) (p <0.001), with intraoperative blood transfusion rates of 11.4%, 21.7% and 35.6%, respectively (p <0.001). The conversion to open rate was slightly higher in RARCs (6.8%) than LRCs (4.3%). Intraoperative complications occurred in 1.3% of cases without statistically significant differences among the approaches. Conclusions Data from the RIC confirmed the need to collect as much data as possible in a multicenter manner. RARCs proves to be feasible with perioperative complication rates that do not differ from the other approaches.
Collapse
Affiliation(s)
- Angelo Porreca
- Oncological Urology, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | | | - Walter Artibani
- Department of Urology, Policlinico Abano Terme, Abano Terme, Italy
| | - Gian Maria Busetto
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Lorenzo Bianchi
- Department of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Department of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Aldo Massimo Bocciardi
- Struttura Complessa Urologia, ASST, Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Marco Carini
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Firenze, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano Del Grappa, Italy
| | | | - Andrea Gallina
- Department of Urology and Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, URI, Urological Research Institute, Milano, Italy
| | - Ettore Mearini
- Department of Urology, University of Perugia, Perugia, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Firenze, Italy
| | - Riccardo Schiavina
- Department of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Sergio Serni
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Firenze, Italy
| | | | - Erica Debbi
- Oncological Urology, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Paolo Corsi
- Oncological Urology, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | | |
Collapse
|
18
|
Cochetti G, Rossi de Vermandois JA, Maulà V, Cari L, Cagnani R, Suvieri C, Balducci PM, Paladini A, Del Zingaro M, Nocentini G, Mearini E. Diagnostic performance of the Bladder EpiCheck methylation test and photodynamic diagnosis-guided cystoscopy in the surveillance of high-risk non-muscle invasive bladder cancer: A single centre, prospective, blinded clinical trial. Urol Oncol 2021; 40:105.e11-105.e18. [PMID: 34911649 DOI: 10.1016/j.urolonc.2021.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/04/2021] [Accepted: 11/01/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE Currently, bladder cancer (BC) surveillance consists of periodic white light cystoscopy and urinary cytology (UC). However, both diagnostic tools have limitations. Therefore, to improve the management of recurrent BC, novel, innovative diagnostic tests are needed. The primary aim of this study was to determine the diagnostic performance of Bladder EpiCheck (BE) and photodynamic diagnosis (PDD) guided cystoscopy in the surveillance of high-risk BC. A secondary aim was to compare Bladder EpiCheck (BE) and PDD-guided cystoscopy findings with whose of UC to design a diagnostic algorithm that facilitates clinical decision making. PATIENTS AND METHODS: This was a prospective, blinded, single-arm, single-visit cohort study. All patients were under surveillance for high-risk non-muscle-invasive bladder cancer, and underwent cystoscopy with PDD and a BE test. Those who received a histological diagnosis were used as a reference population. Receiver operating characteristic curve analysis was performed to evaluate the diagnostic performance of BE, PDD-guided cystoscopy, and UC for identifying biopsy-confirmed BC lesions. The diagnostic power of the test was assessed by determining the area under the curve (AUC). RESULTS Forty patients were enrolled. For BE, the AUC was 0.95, and BC recurrence was detected at a sensitivity of 100% and specificity of 90.9%. For PDD, the AUC was 0.51, with a sensitivity and specificity of 61% and 41%, respectively. BE was combined with UC to create a decision-making algorithm capable of reducing the number of follow-up cystoscopies needed. CONCLUSION BE is a very accurate diagnostic tool that has the potential to be useful in the surveillance of high-risk BC patients. Especially when combined with UC, it may be used to reduce the number of cystoscopies needed throughout follow-up. Conversely, the use of PDD as a diagnostic tool in such patients should be reconsidered. However, due to the small sample size of this study, a larger prospective clinical trial should be performed to confirm findings.
Collapse
Affiliation(s)
- Giovanni Cochetti
- Division of Urology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | | | - Vincenza Maulà
- Biotechnology Laboratory in Urology, Division of Urology Clinic, Department of Surgical and Biomedical Sciences, University Hospital of Perugia, Perugia, Italy
| | - Luigi Cari
- Department of Medicine, Section of Pharmacology, University of Perugia, Perugia, Italy
| | - Rosy Cagnani
- Biotechnology Laboratory in Urology, Division of Urology Clinic, Department of Surgical and Biomedical Sciences, University Hospital of Perugia, Perugia, Italy
| | - Chiara Suvieri
- Biotechnology Laboratory in Urology, Division of Urology Clinic, Department of Surgical and Biomedical Sciences, University Hospital of Perugia, Perugia, Italy
| | | | - Alessio Paladini
- Division of Urology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy.
| | - Michele Del Zingaro
- Division of Urology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Giuseppe Nocentini
- Department of Medicine, Section of Pharmacology, University of Perugia, Perugia, Italy
| | - Ettore Mearini
- Division of Urology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| |
Collapse
|
19
|
Morelli MB, Amantini C, Rossi de Vermandois JA, Gubbiotti M, Giannantoni A, Mearini E, Maggi F, Nabissi M, Marinelli O, Santoni M, Cimadamore A, Montironi R, Santoni G. Correlation between High PD-L1 and EMT/Invasive Genes Expression and Reduced Recurrence-Free Survival in Blood-Circulating Tumor Cells from Patients with Non-Muscle-Invasive Bladder Cancer. Cancers (Basel) 2021; 13:cancers13235989. [PMID: 34885101 PMCID: PMC8656875 DOI: 10.3390/cancers13235989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND PD-L1 represents a crucial immune checkpoint molecule in the tumor microenvironment, identified as a key target for cancer immunotherapy. A correlation between PD-L1 and EMT-related genes expression in various human cancers has been suggested. METHODS By ScreenCell filtration, digital droplet PCR and confocal microscopy analysis, we aimed to investigate the expression of PD-L1 and EMT/invasive genes (TWIST1, ZEB1, VIMENTIN, TIMP2) in circulating tumor cells (CTCs) collected from the blood of non-muscle-invasive bladder cancer (NMIBC) patients, assessing the prognostic value of these biomarkers in the disease. Welchs' test and Mann-Whitney U test, correlation index, Kaplan-Meier, Univariate and Multivariate Cox hazard proportional analysis were used. RESULTS Higher PD-L1, TIMP2 and VIM mRNA levels were found in pT1 compared to pTa NMIBC. As evaluated by Kaplan-Meier and Univariate and Multivariate Cox analysis, enhancement of PD-L1, TWIST1 and TIMP2 expression reduces the recurrent free survival in NMIBC patients. CONCLUSIONS High PD-L1, TWIST1 and TIMP2 mRNAs mark the recurrent-NMIBC patients and by reducing the RFS represent negative prognostic biomarkers in these patients.
Collapse
Affiliation(s)
- Maria Beatrice Morelli
- School of Pharmacy, Section of Experimental Medicine, University of Camerino, 62032 Camerino, Italy; (F.M.); (M.N.); (O.M.)
- Correspondence: (M.B.M.); (G.S.); Tel.: +39-0737403312 (M.B.M.); +39-0737403319 (G.S.)
| | - Consuelo Amantini
- School of Biosciences and Veterinary Medicine, University of Camerino, 62032 Camerino, Italy;
| | | | | | - Antonella Giannantoni
- Department of Medical and Surgical Sciences, University of Siena, 53100 Siena, Italy;
- Neurosciences, Functional and Surgical Urology Unit, Santa Maria alle Scotte Hospital, 53100 Siena, Italy
| | - Ettore Mearini
- Urologic and Andrologic Clinics, University of Perugia, 05100 Perugia, Italy; (J.A.R.d.V.); (E.M.)
| | - Federica Maggi
- School of Pharmacy, Section of Experimental Medicine, University of Camerino, 62032 Camerino, Italy; (F.M.); (M.N.); (O.M.)
- Department of Molecular Medicine, University Sapienza, 00185 Rome, Italy
| | - Massimo Nabissi
- School of Pharmacy, Section of Experimental Medicine, University of Camerino, 62032 Camerino, Italy; (F.M.); (M.N.); (O.M.)
| | - Oliviero Marinelli
- School of Pharmacy, Section of Experimental Medicine, University of Camerino, 62032 Camerino, Italy; (F.M.); (M.N.); (O.M.)
| | - Matteo Santoni
- Oncology Unit, Macerata Hospital, 62100 Macerata, Italy;
| | - Alessia Cimadamore
- Section of Pathological Anatomy, Department of Biomedical Sciences and Public Health School of Medicine, Polytechnic University of Marche Region, Umberto I Hospitals, 60121 Ancona, Italy;
| | - Rodolfo Montironi
- Molecular Medicine and Cell Therapy Foundation, Department of Clinical and Molecular Sciences, Polytechnic University of Marche Region, 60126 Ancona, Italy;
| | - Giorgio Santoni
- School of Pharmacy, Section of Experimental Medicine, University of Camerino, 62032 Camerino, Italy; (F.M.); (M.N.); (O.M.)
- Correspondence: (M.B.M.); (G.S.); Tel.: +39-0737403312 (M.B.M.); +39-0737403319 (G.S.)
| |
Collapse
|
20
|
Del Zingaro M, Cochetti G, Zucchi A, Paladini A, Rossi De Vermandois JA, Ciarletti S, Felici G, Maiolino G, Renzetti R, Gaudio G, Mearini E. Holmium:YAG Laser for the Treatment of Genital and urethral Warts: Multicentre Prospective Evaluation of Safety and Efficacy. J Lasers Med Sci 2021; 12:e34. [PMID: 34733757 DOI: 10.34172/jlms.2021.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/06/2021] [Indexed: 01/30/2023]
Abstract
Introduction: Genital condylomatosis is a highly contagious disease caused by the human papilloma virus (HPV). The aim of this prospective multicentre study was to evaluate the safety and efficacy of the Holmium:YAG (yttrium-aluminium-garnet) laser in the treatment of genital and intra-urethral warts; the secondary aim was to assess the patients' postoperative satisfaction and cosmetic results. Methods: From December 2016 to March 2019, patients with genital warts were prospectively enrolled in three hospitals. The inclusion criteria were male gender, age over 18 years-old and treatment-naïve. External and urethral genitalia warts were treated by the Holmium YAG laser. The follow-up analysis consisted of physical examination, flexible urethro-cystoscopy in case of meatal lesions, and administration of Dermatology Quality of Life Index (DLQI) and Patient Global Impression of Improvement (PGI-I) questionnaires at 1, 3, 6 and 12 months after surgery and subsequently yearly. Results: Sixty patients were enrolled. The single treatment was effective in 57/60 patients (95%). At a mean follow-up of 26 months, recurrences occurred in 8 patients (13.3%). No peri- or post-operative complication occurred. An improvement in pre-operative condition was highlighted with PGI-I and DLQI questionnaires. Conclusion: Our prospective multicentre study showed that holmium laser surgery seems to be a safe and effective treatment for external genital and urethral warts. Good dermatological outcomes aid to further improve patient satisfaction.
Collapse
Affiliation(s)
- Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, Italy
| | - Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, Italy
| | | | - Alessio Paladini
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, Italy
| | | | - Sara Ciarletti
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, Italy
| | - Graziano Felici
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, Italy
| | - Giuseppe Maiolino
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, Italy
| | - Roberto Renzetti
- Department of Surgeries, Urology, Presidio Ospedaliero Pescara, Pescara, Italy
| | - Gianluca Gaudio
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, Italy
| |
Collapse
|
21
|
Mearini E, Del Zingaro M, Maiolino G, Manfredini G, Paladini A, Ciarletti S, Guiggi P, Cochetti G. Robotic tumor enucleation in high complexity cT2 renal mass with involvement of collecting system. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02293-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
22
|
Cochetti G, Cellini V, Rossi De Vermandois J, Paladini A, Ciarletti S, Mearini E. Robot-assisted radical cystectomy and intracorporeal urinary diversion by mechanical stapler: The experience from a High Volume Center. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02254-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
23
|
Mearini E, Rossi De Vermandois J, Cellini V, Soli I, Saqer E, Cochetti G. Robotic reconstruction of “Y”-shaped orthotopic ileal neobladder by stapler: Step-by-step technique and evaluation of perioperative and functional outcomes. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02299-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
24
|
Cochetti G, Felici G, Vitale A, Paladini A, La Mura R, Mearini E. Robot-assisted enucleation as treatment for synchronous ipsilateral renal tumors. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02292-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
25
|
Cochetti G, de Vermandois JR, Maulà V, Cari L, Cagnani R, Paladini A, Tancredi A, Manfredini G, Stivalini D, Ciarletti S, Nocentini G, Mearini E. Diagnostic performance of the bladder epichecktm methylation test and photodynamic diagnosis guided cystoscopy in surveillance of high risk non-muscle invasive bladder cancer: results of a single center, prospective, blinded clinical trial. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00879-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
26
|
Cochetti G, Del Zingaro M, Panciarola M, Paladini A, Guiggi P, Ciarletti S, Nogara A, Turco M, Felici G, Maiolino G, Gaudio G, Mearini E. HoLEP Cap: step-by-step technique. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00713-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
27
|
Soli I, Turco M, Guiggi P, Marsico M, Manfredini G, Maiolino G, de Vermandois JR, Cochetti G, Mearini E. Should we reconsider SWL for ureteral stones >10 mm? EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00740-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
28
|
Del Zingaro M, Cochetti G, Maiolino G, Stivalini D, Manfredini G, Tancredi A, Felici G, Ciarletti S, Gaudio G, Rossi de Vermandois JA, Mearini E. Influence of COVID-19 pandemic on stress levels of urologic patients. Open Med (Wars) 2021; 16:1198-1205. [PMID: 34514166 PMCID: PMC8389503 DOI: 10.1515/med-2021-0289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/22/2021] [Accepted: 04/12/2021] [Indexed: 01/23/2023] Open
Abstract
Introduction Several studies have shown the consequences of COVID-19 pandemic on perceived stress of different populations, but none of them analyzed urological patients who underwent elective surgery. Methods We enrolled prospectively patients who underwent elective surgery between March and October 2020. A survey on COVID-19 and the 4-item Perceived Stress Scale (PPS-4) questionnaire were administered at hospital admission. Demographic and medical history data were also collected. Uni- and multivariate analyses were performed to identify independent predictors of higher PSS-4 values (≥7). Results A total of 200 patients were enrolled. Mean PSS-4 value resulted 6.04. Patients with PSS-4 value ≥7 resulted 43.5% (87/200). In multivariate analysis, PSS-4 value ≥7 was independently associated (p < 0.05) with female gender (OR 6.42), oncological disease (OR 2.87), high (>5 in a range between 0 and 10) fear of intrahospital transmission of SARS-CoV-2 infection (OR 4.75), history of bladder instillation (OR 0.26), and current smokers (OR 0.27) Conclusion High PSS-4 values at hospital admission in urologic surgical patients are positively correlated with female gender, fear of intrahospital transmission of SARS-CoV-2 infection, and oncological disease. PSS-4 questionnaire could be useful to select patients for whom a preadmission counselling is necessary to improve the management of their high stress level.
Collapse
Affiliation(s)
- Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Giuseppe Maiolino
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Piazzale Giorgio Menghini 1, Perugia, 06129, Italy
| | - Davide Stivalini
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Giulia Manfredini
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Angelica Tancredi
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Graziano Felici
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Sara Ciarletti
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Gianluca Gaudio
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | | | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| |
Collapse
|
29
|
Mearini E, Del Zingaro M, Ciarletti S, Paladini A, Felici G, Gaudio G, Cochetti G. Full neurovascular sparing extraperitoneal robotic radical prostatectomy: A single center experience with PERUSIA technique. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01535-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
30
|
Boni A, Maiolino G, Del Zingaro M, Cochetti G, Turco M, Paladini A, Mearini E. Positive uroflow stop test with EMG may predict potency recovery after RARP. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00860-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
31
|
Cochetti G, Paladini A, de Vermandois JAR, Fatigoni S, Zanelli M, Ascani S, Mearini E. Metastatic renal Ewing's sarcoma in adult woman: Case report and review of the literature. Open Med (Wars) 2021; 16:397-409. [PMID: 33748424 PMCID: PMC7957192 DOI: 10.1515/med-2021-0207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 11/22/2020] [Accepted: 12/09/2020] [Indexed: 01/18/2023] Open
Abstract
Primary renal extra-skeletal Ewing sarcoma is a rare neoplasm, often metastatic at diagnosis, and with a poor outcome. A multimodal approach is often the treatment of choice in this aggressive neoplasm. We present a case of primary renal extra-skeletal sarcoma in a 45-year-old woman who underwent tumor resection without clear margins. After no response to the first cycle of chemotherapy, we documented an early onset of local recurrence. The patient refused any other treatment and died four months after surgery.
Collapse
Affiliation(s)
- Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Urology Clinic, University of Perugia, Perugia, Italy
| | - Alessio Paladini
- Department of Surgical and Biomedical Sciences, Urology Clinic, University of Perugia, Perugia, Italy
| | | | - Sonia Fatigoni
- Department of Surgical and Biomedical Sciences, Medical Oncology, University of Perugia, Perugia, Italy
| | - Magda Zanelli
- Department of Oncology and Advanced Technologies, Pathology Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Ascani
- Department of Experimental Medicine, Institute of Pathologic Anatomy, “Santa Maria” Hospital, Terni, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Urology Clinic, University of Perugia, Perugia, Italy
| |
Collapse
|
32
|
Jordakieva G, Bianchini R, Reichhold D, Piehslinger J, Groschopf A, Jensen SA, Mearini E, Nocentini G, Crevenna R, Zlabinger GJ, Karagiannis SN, Klaus A, Jensen-Jarolim E. IgG4 induces tolerogenic M2-like macrophages and correlates with disease progression in colon cancer. Oncoimmunology 2021; 10:1880687. [PMID: 33628623 PMCID: PMC7889146 DOI: 10.1080/2162402x.2021.1880687] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 12/16/2022] Open
Abstract
IgG4 subclass antibodies are expressed in alternative Th2 environments featuring high IL-10 expression, including several solid tumors such as melanoma. To induce tolerance, allergen immunotherapy mediates antibody class switching from pro-inflammatory IgE to anti-inflammatory IgG4. We previously reported that IgG4 drives allergic M2 macrophages toward tolerogenic states. Here we assessed the roles of IgG4 and macrophage activation in colorectal cancer (CRC). In this observer-blinded, case-control study, we analyzed total circulating serum IgE, IgG1 and IgG4 levels in CRC (n = 38) patients with (n = 13, TxNxM1) or without (n = 25, TxNxM0) metastasis, and in healthy donors (n = 21). Primary cultures of circulating monocyte-derived macrophages from healthy controls and CRC patients were further evaluated in their responses to stimulation with IgG1 or IgG4. We found higher absolute serum levels of IgG4 in patients with CRC. IgG4 enabled polarization of macrophages derived from CRC patients and healthy controls into alternatively-activated tolerogenic M2b phenotypes. IgG4-stimulated M2 macrophages were characterized by lower surface CD206, CD163, CD14, and CD11b expression and higher CCL-1, IL-10, and IL-6 production. IgG4 was less potent that IgG1 in triggering antibody-dependent cell-mediated phagocytosis (ADCP) of cancer cells. Further, higher z-normalized IgG4/-IgE sera level ratios correlated with the presence of metastasis (p = .0247 and p = .0009, respectively) in CRC patients. High IgG4 in CRC synergizes with macrophages in shaping an immunosuppressive microenvironment and impairs anti-cancer effector cell functions. The shift of serum IgG4/IgE ratios toward enhanced tolerance induction in metastatic disease indicates a role for high IgG4 in disease progression and poor prognostic outcome.
Collapse
Affiliation(s)
- Galateja Jordakieva
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Vienna, Austria
| | - Rodolfo Bianchini
- The Interuniversity Messerli Research Institute of the University of Veterinary Medicine, the Medical University of Vienna and the University of Vienna, Unit of Comparative Medicine, Vienna, Austria
- Institute Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Division of Comparative Immunology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Daniel Reichhold
- Department of General Surgery, Barmherzige Schwestern Krankenhaus Wien, Vienna, Austria
| | - Jakob Piehslinger
- Department of General Surgery, Barmherzige Schwestern Krankenhaus Wien, Vienna, Austria
| | - Alina Groschopf
- The Interuniversity Messerli Research Institute of the University of Veterinary Medicine, the Medical University of Vienna and the University of Vienna, Unit of Comparative Medicine, Vienna, Austria
- Institute Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Division of Comparative Immunology and Oncology, Medical University of Vienna, Vienna, Austria
- FH Campus Wien, Department of Health Science, Section of Biomedical Analytics, University of Applied Sciences, Vienna, Austria
| | - Sebastian A. Jensen
- Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Urology Clinic of Perugia, University of Perugia, Perugia, Italy
| | - Giuseppe Nocentini
- Section of Pharmacology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Vienna, Austria
| | - Gerhard J. Zlabinger
- Division of Clinical and Experimental Immunology, Institute of Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Sophia N. Karagiannis
- St. John’s Institute of Dermatology, School of Basic & Medical Biosciences, King’s College London, London, UK
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Cancer Centre, London, UK
| | - Alexander Klaus
- Department of General Surgery, Barmherzige Schwestern Krankenhaus Wien, Vienna, Austria
| | - Erika Jensen-Jarolim
- The Interuniversity Messerli Research Institute of the University of Veterinary Medicine, the Medical University of Vienna and the University of Vienna, Unit of Comparative Medicine, Vienna, Austria
- Institute Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Division of Comparative Immunology and Oncology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
33
|
Cochetti G, Del Zingaro M, Ciarletti S, Paladini A, Felici G, Stivalini D, Cellini V, Mearini E. New Evolution of Robotic Radical Prostatectomy: A Single Center Experience with PERUSIA Technique. Applied Sciences 2021; 11:1513. [DOI: 10.3390/app11041513] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Radical prostatectomy (RP) is the standard surgical treatment of organ-confined prostate cancer in patients with a life expectancy of at least 10 years. In a recent prospective study, we described the PERUSIA (Posterior, Extraperitoneal, Robotic, Under Santorini, Intrafascial, Anterograde) technique, which is an extraperitoneal full nerve sparing robotic RP, showing its feasibility and safety. The aim of this retrospective study was to evaluate the peri-operative, oncologic, and functional outcomes of the PERUSIA technique. We retrospectively analyzed the data of 454 robotic-assisted radical prostatectomies (RARP) performed using the PERUSIA technique from January 2012 to October 2019. We evaluated perioperative outcomes (operative time, estimated blood loss, catheterization time, complication rate, length of stay), oncological (positive surgical margins and biochemical recurrence), and functional outcomes in terms of urinary continence and sexual potency. The overall complication rate was 16%, positive surgical margins were 8.1%, and biochemical recurrence occurred in 8.6% at median follow-up of 47 months. Urinary continence was achieved in 69% of cases the day after the removal of the catheter, in 92% at 3 months, and in 97% at 12 months after surgery. The average rate of sexual potency was 72% and 82% respectively 3 and 12 months after surgery. Our findings show that the PERUSIA technique is a safe extraperitoneal approach to perform a full nerve sparing technique providing exciting functional outcomes.
Collapse
|
34
|
Porreca A, Palmer K, Artibani W, Antonelli A, Bianchi L, Brunocilla E, Bocciardi AM, Brausi M, Busetto GM, Carini M, Carrieri G, Celia A, Cindolo L, Cochetti G, Colombo R, De Berardinis E, De Cobelli O, Di Maida F, Ercolino A, Gaboardi F, Galfano A, Gallina A, Gallucci M, Introini C, Mearini E, Minervini A, Montorsi F, Musi G, Pini G, Schiavina R, Secco S, Serni S, Simeone C, Tasso G, D'Agostino D. Protocol of the Italian Radical Cystectomy Registry (RIC): a non-randomized, 24-month, multicenter study comparing robotic-assisted, laparoscopic, and open surgery for radical cystectomy in bladder cancer. BMC Cancer 2021; 21:51. [PMID: 33430820 PMCID: PMC7802145 DOI: 10.1186/s12885-020-07748-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022] Open
Abstract
Background Bladder cancer is the ninth most common type of cancer worldwide. In the past, radical cystectomy via open surgery has been considered the gold-standard treatment for muscle invasive bladder cancer. However, in recent years there has been a progressive increase in the use of robot-assisted laparoscopic radical cystectomy. The aim of the current project is to investigate the surgical, oncological, and functional outcomes of patients with bladder cancer who undergo radical cystectomy comparing three different surgical techniques (robotic-assisted, laparoscopic, and open surgery). Pre-, peri- and post-operative factors will be examined, and participants will be followed for a period of up to 24 months to identify risks of mortality, oncological outcomes, hospital readmission, sexual performance, and continence. Methods We describe a protocol for an observational, prospective, multicenter, cohort study to assess patients affected by bladder neoplasms undergoing radical cystectomy and urinary diversion. The Italian Radical Cystectomy Registry is an electronic registry to prospectively collect the data of patients undergoing radical cystectomy conducted with any technique (open, laparoscopic, robotic-assisted). Twenty-eight urology departments across Italy will provide data for the study, with the recruitment phase between 1st January 2017-31st October 2020. Information is collected from the patients at the moment of surgical intervention and during follow-up (3, 6, 12, and 24 months after radical cystectomy). Peri-operative variables include surgery time, type of urinary diversion, conversion to open surgery, bleeding, nerve sparing and lymphadenectomy. Follow-up data collection includes histological information (e.g., post-op staging, grading, and tumor histology), short- and long-term outcomes (e.g., mortality, post-op complications, hospital readmission, sexual potency, continence etc). Discussion The current protocol aims to contribute additional data to the field concerning the short- and long-term outcomes of three different radical cystectomy surgical techniques for patients with bladder cancer, including open, laparoscopic, and robot-assisted. This is a comparative-effectiveness trial that takes into account a complex range of factors and decision making by both physicians and patients that affect their choice of surgical technique. Trial registration ClinicalTrials.gov, NCT04228198. Registered 14th January 2020- Retrospectively registered.
Collapse
Affiliation(s)
| | - Katie Palmer
- Department of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, 00136, Rome, Italy.
| | - Walter Artibani
- Department of Urology, Policlinico Abano Terme, Abano Terme, PD, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy
| | - Lorenzo Bianchi
- Department of Urology, University of Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, Bologna, Italy.,Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Aldo Massimo Bocciardi
- Struttura Complessa Urologia, ASST, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Gian Maria Busetto
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano Del Grappa, Italy
| | - Luca Cindolo
- Department of Urology, "Villa Stuart" Private Hospital, Rome, Italy
| | | | - Renzo Colombo
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ettore De Berardinis
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Ottavio De Cobelli
- IEO European Institute of Oncology, IRCCS, Milan, Italy.,Department of Hematology and Hemato-Oncology, Universty of Milan, Milan, Italy
| | - Fabrizio Di Maida
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Amelio Ercolino
- Department of Urology, University of Bologna, Bologna, Italy
| | - Franco Gaboardi
- Department of Urology, San Raffaele Turro Hospital, Milano, Italy
| | | | - Andrea Gallina
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele Gallucci
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Carlo Introini
- Department of Urology, E.O. Ospedali Galliera, Genova, Italy
| | - Ettore Mearini
- Department of Urology, University of Perugia, Perugia, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gennaro Musi
- IEO European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Riccardo Schiavina
- Department of Urology, University of Bologna, Bologna, Italy.,Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvia Secco
- Struttura Complessa Urologia, ASST, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Claudio Simeone
- Department of Urology, University of Brescia, Brescia, Italy
| | - Giovanni Tasso
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | | |
Collapse
|
35
|
Cochetti G, Cari L, Nocentini G, Maulà V, Suvieri C, Cagnani R, Rossi De Vermandois JA, Mearini E. Detection of urinary miRNAs for diagnosis of clear cell renal cell carcinoma. Sci Rep 2020; 10:21290. [PMID: 33277569 PMCID: PMC7718885 DOI: 10.1038/s41598-020-77774-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 11/10/2020] [Indexed: 12/16/2022] Open
Abstract
The lack of symptoms at the early stages of clear cell renal cell carcinoma (ccRCC) allows the tumour to metastasize, leading to a dramatic reduction in patient survival. Therefore, we studied and set up a method based on urinary microRNAs (miRNAs) for the diagnosis of ccRCC. First, miRNA expression in ccRCC specimens and kidney tissues from healthy subjects (HSs) was investigated through analysis of data banks and validated by comparing expression of miRNAs in ccRCC and adjacent non-cancerous kidney tissue specimens by RT-qPCR. Subsequently, we developed an algorithm to establish which miRNAs are more likely to be found in the urine of ccRCC patients that indicated miR-122, miR-1271, and miR-15b as potential interesting markers. The evaluation of their levels and three internal controls in the urine of 13 patients and 14 HSs resulted in the development of a score (7p-urinary score) to evaluate the presence of ccRCC in patients. The resulting area under the Receiver Operating Characteristic (ROC) curve, sensitivity, and specificity were equal to 0.96, 100% (95% CI 75–100%), and 86% (95% CI 57–98%), respectively. In conclusion, our study provides a proof of concept that combining the expression values of some urinary miRNAs might be useful in the diagnosis of ccRCC.
Collapse
Affiliation(s)
- Giovanni Cochetti
- Urology Clinic, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Luigi Cari
- Pharmacology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giuseppe Nocentini
- Pharmacology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
| | - Vincenza Maulà
- Urology Clinic, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Chiara Suvieri
- Urology Clinic, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Rosy Cagnani
- Urology Clinic, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - Ettore Mearini
- Urology Clinic, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| |
Collapse
|
36
|
Del Zingaro M, Gaudio G, Cochetti G, Felici G, Tiezzi A, de Vermandois JR, Paladini A, Panciarola M, Mearini E. Laparoscopic and robotic treatment of colo-vesical fistula without bowel resection: evaluation of surgical outcomes from a case series at long term. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35608-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
37
|
Turco M, Guiggi P, Tiezzi A, Boni A, Paladini A, Mearini E, Cochetti G. Endoscopic Combined Intrarenal Surgery for Stone Formation After Previous Laparoscopic and Open Renal Surgery. J Endourol Case Rep 2020; 6:60-63. [PMID: 32775678 DOI: 10.1089/cren.2019.0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Nonabsorbable sutures used during renal surgery represent a known substratum for stone growth. We hereby describe two cases of nephrolithiasis secondary to permanent suture material, originally placed during conservative renal surgical procedures and afterward migrated into the caliceal system, managed with endoscopic combined intrarenal surgery (ECIRS) with subsequent complete renal clearance. Case Presentation: Case 1. A 54-year-old male, with history of laparoscopic excision of a left parapelvic cyst, presenting with left inferior caliceal stone. Case 2. A 79-year-old female, who underwent open enucleation of a left renal pelvis tumor 15 years before. She presented with bilateral lithiasis, including a staghorn stone in the left renal pelvis. Both patients underwent left ECIRS by two surgeons, revealing the presence of suture devices, which were completely removed. Abdominal CT at 1 month after surgery did not show residual lithiasic fragments in both cases. Conclusion: To prevent the risk of stone formation, it is mandatory to use nonabsorbable suture agents sparingly during conservative renal surgery and furthermore to remove all foreign material from the collecting system because they have the potential for calculi growth. In this sense, ECIRS technique may also avoid further open or minimally invasive surgery and the use of suture instruments.
Collapse
Affiliation(s)
- Morena Turco
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, Perugia, Italy
| | - Paolo Guiggi
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, Perugia, Italy
| | - Alberto Tiezzi
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, Perugia, Italy
| | - Andrea Boni
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, Perugia, Italy
| | - Alessio Paladini
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, Perugia, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, Perugia, Italy
| | - Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, Perugia, Italy
| |
Collapse
|
38
|
Cochetti G, Paladini A, Del Zingaro M, Rossi De Vermandois J, Marsico M, Gaudio G, Tiezzi A, Mearini E. Comparative efficacy between laparoscopic and robotic adrenalectomy for adrenal mass: A multicentre prospective study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33191-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
39
|
Cochetti G, Cocca D, Maddonni S, Paladini A, Sarti E, Stivalini D, Mearini E. Combined Robotic Surgery for Double Renal Masses and Prostate Cancer: Myth or Reality? Medicina (Kaunas) 2020; 56:E318. [PMID: 32604918 PMCID: PMC7353895 DOI: 10.3390/medicina56060318] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 12/24/2022]
Abstract
With the widespread use of imaging modalities performed for the staging of prostate cancer, the incidental detection of synchronous tumors is increasing in frequency. Robotic surgery represents a technical evolution in the treatment of solid tumors of the urinary tract, and it can be a valid option in the case of multi-organ involvement. We reported a case of synchronous prostate cancer and bifocal renal carcinoma in a 66-year-old male. We performed the first case of a combined upper- and lower-tract robotic surgery for a double-left-partial nephrectomy associated with radical prostatectomy by the transperitoneal approach. A comprehensive literature review in this field has also been carried out. Total operative time was 265 min. Renal hypotension time was 25 min. Blood loss was 250 mL. The patient had an uneventful postoperative course. No recurrence occurred after 12 months. In the literature, 10 cases of robotic, radical, or partial nephrectomy and simultaneous radical prostatectomy have been described. Robotic surgery provides less invasiveness than open surgery with comparable oncological efficacy, overcoming the limitations of the traditional laparoscopy. During robotic combined surgery for synchronous tumors, the planning of the trocars' positioning is crucial to obtain good surgical results, reducing the abdominal trauma, the convalescence, and the length of hospitalization with a consequent cost reduction. Rare complications can be related to prolonged pneumoperitoneum. Simultaneous robotic prostatectomy and partial nephrectomy appears to be a safe and feasible surgical option in patients with synchronous prostate cancer and renal cell carcinoma.
Collapse
Affiliation(s)
| | - Diego Cocca
- Department of Surgical and Biomedical Sciences, Urology Clinic of Perugia, Perugia University, 06100 Perugia, Italy; (G.C.); (S.M.); (A.P.); (E.S.); (D.S.); (E.M.)
| | | | | | | | | | | |
Collapse
|
40
|
Cochetti G, Abraha I, Randolph J, Montedori A, Boni A, Arezzo A, Mazza E, Rossi De Vermandois JA, Cirocchi R, Mearini E. Surgical wound closure by staples or sutures?: Systematic review. Medicine (Baltimore) 2020; 99:e20573. [PMID: 32569183 PMCID: PMC7310845 DOI: 10.1097/md.0000000000020573] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
AIM To compare the effects of sutures and staples for skin closure of surgical wounds. MATERIAL AND METHODS We included published and unpublished randomized controlled trials (RCTs) and cluster-randomized trials comparing staples with sutures. Patients were adults (aged 18 years or over) who had undergone any type of surgery. The primary outcomes were risk of overall and severe wound infection. Secondary outcomes included length of hospital stay, readmission rate, adverse events, patient satisfaction with cosmetic results, postoperative pain. RESULTS Forty-two very low to low quality RCTs with a total of 11,067 patients were included. Sutures resulted in slightly fewer overall wound infections (4.90%) compared to staples (6.75%) but it is uncertain whether there is a difference between the groups (risk ratio [RR] 1.20, 95% confidence intervals [CI] 0.80-1.79; patients = 9864; studies = 34; I = 70%). The evidence was also insufficient to state a difference in terms of severe wound infection (staples 1.4% vs sutures 1.3%; RR 1.08, 95% CI 0.61-1.89; patients = 3036; studies = 17; I = 0%), grade of satisfaction (RR 0.99, 95% CI 0.91-1.07; patients = 3243; studies = 14; I = 67%) and hospital stay. Staples may increase the risk of adverse events (7.3% for staples vs 3.5% for sutures; RR 2.00, 95% CI 1.44-2.79; patients = 6246; studies = 21; I = 33%), readmission rate (RR 1.28, 95% CI 0.18-9.05; patients = 2466; studies = 5; I = 66%) and postoperative pain (standardized mean difference [SMD] 0.41,95%CI -0.35 to 1.16; I = 88%, patients = 390 patients, studies = 5). CONCLUSIONS Due to the lack of high quality evidence, we could not state if sutures are better than staples in terms of wound infection, readmission rate, adverse events, and postoperative pain. With a low quality of evidence, sutures reduce postoperative pain and improve grade of satisfaction with the cosmetic outcome.
Collapse
Affiliation(s)
- Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, University of Perugia
| | - Iosief Abraha
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Justus Randolph
- Tift College of Education, Mercer University, Atlanta, GA, USA
| | | | - Andrea Boni
- Department of Surgical and Biomedical Sciences, University of Perugia
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin
| | - Elena Mazza
- Department of Surgical Sciences, University of Torino, Turin
| | | | - Roberto Cirocchi
- Department of General Surgery, University of Perugia, Terni, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, University of Perugia
| |
Collapse
|
41
|
Castiglione M, Conti C, Frondizi D, Cottini E, Cochetti G, Ciampini A, Cellini V, Mearini E. A Combined One-Staged Robot-Assisted Sacral Chordoma Resection. World Neurosurg 2020; 141:210-214. [PMID: 32553601 DOI: 10.1016/j.wneu.2020.06.056] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The robotic surgery is an advanced modern minimally invasive technology, widely used in urologic oncology, and it has become useful in particular conditions. Over time, different surgical specialties made use of the robotic properties to minimize complications for high-risk procedures. A combined 1-staged robot-assisted multidisciplinary surgery with intraoperative neurophysiological monitoring can be a safe procedure to remove a sacral chordoma with low morbidity rates. CASE DESCRIPTION A 64-year-old woman complained of a few months of drug-resistant low back and abdominal pain. The subsequent development of constipation brought the patient to undergo an abdominal computed tomography scan and magnetic resonance imaging. Radiologic investigations revealed a large size sacral mass associated with a partial destruction of the sacrum and posterior compression of the rectum. The tumor was en bloc removed by a combined 1-staged anterior laparoscopic robot-assisted and posterior open lumbosacral approach with continue intraoperative neurophysiological monitoring of sacral and pudendal plexuses. The histological diagnosis was of chordoma. After surgery, the patient reported pain relief and the total recovery of bowel dysfunction with good 11-month follow-up outcome. CONCLUSIONS This combined technique represents a promising treatment option in selected cases. The robotic technology combined with the experience of highly qualified staff can improve the surgical result by minimizing complications. However, longer follow-up is necessary to confirm the long-term effects in terms of recurrence and survival.
Collapse
Affiliation(s)
- Melina Castiglione
- Department of Neuroscience, Neurosurgery, Saint Maria University of Terni, Terni, Italy.
| | - Carlo Conti
- Department of Neuroscience, Neurosurgery, Saint Maria University of Terni, Terni, Italy
| | - Domenico Frondizi
- Department of Neuroscience, Neurosurgery, Saint Maria University of Terni, Terni, Italy
| | - Emanuele Cottini
- Department of Surgical and Biomedical Sciences, Urology Clinic Perugia-Terni, University of Perugia, Santa Maria della Misericordia Hospital Piazzale Menghini, Perugia, Italy
| | - Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Urology Clinic Perugia-Terni, University of Perugia, Santa Maria della Misericordia Hospital Piazzale Menghini, Perugia, Italy
| | - Alessandro Ciampini
- Department of Neuroscience, Neurosurgery, Saint Maria University of Terni, Terni, Italy
| | - Valerio Cellini
- Department of Surgical and Biomedical Sciences, Urology Clinic Perugia-Terni, University of Perugia, Santa Maria della Misericordia Hospital Piazzale Menghini, Perugia, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Urology Clinic Perugia-Terni, University of Perugia, Santa Maria della Misericordia Hospital Piazzale Menghini, Perugia, Italy
| |
Collapse
|
42
|
Cochetti G, Rossi de Vermandois JA, Maulà V, Giulietti M, Cecati M, Del Zingaro M, Cagnani R, Suvieri C, Paladini A, Mearini E. Role of miRNAs in prostate cancer: Do we really know everything? Urol Oncol 2020; 38:623-635. [PMID: 32284256 DOI: 10.1016/j.urolonc.2020.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 12/16/2022]
Abstract
Many different genetic alterations, as well as complex epigenetic interactions, are the basis of the genesis and progression of prostate cancer (CaP). This is the reason why until now the molecular pathways related to development of this cancer were only partly known, and even less those that determine aggressive or indolent tumour behaviour. MicroRNAs (miRNAs) represent a class of about 22 nucleotides long, small non-coding RNAs, which are involved in gene expression regulation at the post-transcriptional level. MiRNAs play a crucial role in regulating several biological functions and preserving homeostasis, as they carry out a wide modulatory activity on various molecular signalling pathways. MiRNA genes are placed in cancer-related genomic regions or in fragile sites, and they have been proven to be involved in the main steps of carcinogenesis as oncogenes or oncosuppressors in many types of cancer, including CaP. We performed a narrative review to describe the relationship between miRNAs and the crucial steps of development and progression of CaP. The aims of this study were to improve the knowledge regarding the mechanisms underlying miRNA expression and their target genes, and to contribute to understanding the relationship between miRNA expression profiles and CaP.
Collapse
Affiliation(s)
- Giovanni Cochetti
- Division of Urology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | | | - Vincenza Maulà
- Biotechnology Laboratory in Urology, Division of Urology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Matteo Giulietti
- Department of Specialistic Clinical and Odontostomatological Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Monia Cecati
- Department of Specialistic Clinical and Odontostomatological Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Michele Del Zingaro
- Division of Urology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Rosy Cagnani
- Biotechnology Laboratory in Urology, Division of Urology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Chiara Suvieri
- Biotechnology Laboratory in Urology, Division of Urology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Alessio Paladini
- Division of Urology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy.
| | - Ettore Mearini
- Division of Urology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| |
Collapse
|
43
|
Del Zingaro M, Cochetti G, Gaudio G, Tiezzi A, Paladini A, de Vermandois JAR, Mearini E. Robotic conservative treatment for prostatourethrorectal fistula: original technique step by step. Int Braz J Urol 2020; 46:481-482. [PMID: 32167725 PMCID: PMC7088482 DOI: 10.1590/s1677-5538.ibju.2018.0584] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 08/16/2019] [Indexed: 11/22/2022] Open
Abstract
Purpose: Prostatourethrorectal fistula (PURF) is an uncommon complication resulting from surgery, radiation or trauma (1). The most common therapeutic management is transperineal surgery (1). Transabdominal approach is less used and limited to large fistulae needing cystectomy and rectal resection (1). The aim of this study was to show an original robotic technique of conservative treatment for PURF. Materials and Methods: A 75 years old man referred recurrent UTI, pneumaturia and urinary loss from rectum due to PURF arising after TURP performed after transvesical prostate adenomectomy. Cystogram, cystoscopy and MRI confirmed PURF. We used a robotic approach performing isolation, resection and suture of the fistulous tract on rectal and urethral side. Leak test was negative. We carried out an omental flap, positioned between rectum and prostatic urethra, and a temporary ileostomy without any bowel resection or urinary diversion. Results: Operative time was 210 minutes, estimated blood loss 50ml. Oral feeding was restored at 48 hours. Bladder catheter was removed on the 15th post-operative day. Post-operative cystogram was negative. Post-operative complications were ileus and urinary tract infection. Hospital stay was 10 days. At 6 months follow-up, before temporary ileostomy closure, cystoscopy showed a totally re-epithelised fovea, and cystogram and CT enterography were negative. Conclusions: Robotic conservative treatment of PURF seems to be safe and feasible (2, 3). Robotic approach allows accurate surgical dissection, through easier access to the rectal-prostatic plane, reducing the need for resection. To our knowledge, this is the first robotic conservative treatment for PURF reproducing the same steps of laparotomic approach with the advantages of minimally invasive technique (4).
Collapse
Affiliation(s)
- Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, Urology Clinic, University of Perugia, Santa Maria della Misericordia Hospital Piazzale Menghini, Perugia, Italy
| | - Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Urology Clinic, University of Perugia, Santa Maria della Misericordia Hospital Piazzale Menghini, Perugia, Italy
| | - Gianluca Gaudio
- Department of Surgical and Biomedical Sciences, Urology Clinic, University of Perugia, Santa Maria della Misericordia Hospital Piazzale Menghini, Perugia, Italy
| | - Alberto Tiezzi
- Department of Surgical and Biomedical Sciences, Urology Clinic, University of Perugia, Santa Maria della Misericordia Hospital Piazzale Menghini, Perugia, Italy
| | - Alessio Paladini
- Department of Surgical and Biomedical Sciences, Urology Clinic, University of Perugia, Santa Maria della Misericordia Hospital Piazzale Menghini, Perugia, Italy
| | - Jacopo Adolfo Rossi de Vermandois
- Department of Surgical and Biomedical Sciences, Urology Clinic, University of Perugia, Santa Maria della Misericordia Hospital Piazzale Menghini, Perugia, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Urology Clinic, University of Perugia, Santa Maria della Misericordia Hospital Piazzale Menghini, Perugia, Italy
| |
Collapse
|
44
|
Zingaro MD, Boni A, Vermandois JARD, Paladini A, Lepri E, Ursi P, Cirocchi R, Turco M, Gaudio G, Nogara A, Mearini E. Fournier's Gangrene and Intravenous Drug Abuse: an Unusual Case Report and Review of The Literature. Open Med (Wars) 2019; 14:694-710. [PMID: 31934634 PMCID: PMC6947763 DOI: 10.1515/med-2019-0114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 07/09/2019] [Indexed: 12/29/2022] Open
Abstract
Fournier's gangrene is a potentially fatal emergency condition characterized by necrotizing fasciitis and supported by an infection of the external genital, perineal and perianal region, with a rapid and progressive spread from subcutaneous fat tissue to fascial planes. In this case report, a 52-year-old man, with a history of hepatitis C-virus (HCV)-related chronic liver disease and cocaine use disorder for which he was receiving methadone maintenance therapy, was admitted to the Emergency Department with necrotic tissue involving the external genitalia. Fournier's gangrene is usually due to compromised host immunity, without a precise cause of bacterial infection; here it is linked to a loco-regional intravenous injection of cocaine. A multimodal approach, including a wide surgical debridement and a postponed skin graft, was needed. Here we report this case, with a narrative review of the literature.
Collapse
Affiliation(s)
- Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Andrea Boni
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | | | - Alessio Paladini
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Emanuele Lepri
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Pietro Ursi
- Department of General Surgery and Surgical Specialties “Paride Stefanini”;, Sapienza University of Rome, Rome, Italy
| | - Roberto Cirocchi
- Division of General Surgery, Department of Surgical and Biochemical Sciences, University of Perugia, Perugia, Italy
| | - Morena Turco
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Gianluca Gaudio
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Andrea Nogara
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| |
Collapse
|
45
|
Cochetti G, Zingaro MD, Boni A, Allegritti M, de Vermandois JAR, Paladini A, Egidi MG, Poli G, Ursi P, Cirocchi R, Mearini E. Renal Artery Embolization Before Radical Nephrectomy for Complex Renal Tumour: Which are the True Advantages? Open Med (Wars) 2019; 14:797-804. [PMID: 31737784 PMCID: PMC6843490 DOI: 10.1515/med-2019-0095] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/15/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction Renal artery embolization is performed before radical nephrectomy (RN) for renal mass in order to induce preoperative infarction and to facilitate surgical intervention through decrease of intraoperative bleeding. Moreover, in metastatic renal cancer it seems to stimulate tumour-specific antibodies, even if no established benefits in clinical response or survival have been reported. The role of preoperative renal artery embolization (PRAE) in management of renal masses has been often debated and its real benefits are still unclear. Nevertheless, in huge and complex renal masses, which are often characterized by a high and anarchic blood supply and rapid local invasion, radical nephrectomy can be challenging even for skilled surgeons. The aim of this prospective randomized study was to evaluate the effectiveness and safety of PRAE in complex masses by comparing perioperative outcomes of RN with and without PRAE. Materials and methods From December 2015 to May 2018 we enrolled prospectively 64 patients who underwent RN for localized (T2a-b) or locally advanced (T3 and T4) or advanced (N+, M+) renal cancers. Patients were divided in two groups. The first group included 30 patients who underwent PRAE; in the second group we enrolled 34 patients who did not undergo RN without PRAE. Perioperative outcomes in terms of operative time, blood loss, transfusion rate and length of hospitalization were evaluated. Statistical analysis was performed using GraphPad Prism 6.0 software. Results Median blood loss was 250 ml (50-500) and 400 ml (50-1000) in the first and second group, respectively, with a statistically significant difference (p=0.0066). Median surgical time was 200 min (90-390) and 240 min (130-390) in PRAE and No-PRAE group (p=0.06), respectively. No major complications occurred after embolization. Overall complication rate in Group 1 and 2 was 46.7% (14/30) and 50% (17/34), respectively (p=0.34). No major complications occurred in both groups. The mean follow up was 21,5 months. Conclusions Our results prove PRAE to be a safe procedure with low complications rate. To our experience, PRAE seems to be a useful tool in surgical management of a large mass and advanced disease.
Collapse
Affiliation(s)
- Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Urology Clinic of Perugia, Perugia University, P.le Menghini, 06100, Perugia, Italy
| | - Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, Urology Clinic of Perugia, Perugia University, P.le Menghini, 06100, Perugia, Italy
| | - Andrea Boni
- Department of Surgical and Biomedical Sciences, Urology Clinic of Perugia, Perugia University, P.le Menghini, 06100, Perugia, Italy
| | | | | | - Alessio Paladini
- Department of Surgical and Biomedical Sciences, Urology Clinic of Perugia, Perugia University, P.le Menghini, 06100, Perugia, Italy
| | - Maria Giulia Egidi
- Department of Surgical and Biomedical Sciences, Urology Clinic of Perugia, Perugia University, P.le Menghini, 06100, Perugia, Italy
| | - Giulia Poli
- Department of Surgical and Biomedical Sciences, Urology Clinic of Perugia, Perugia University, P.le Menghini, 06100, Perugia, Italy
| | - Pietro Ursi
- Department of General Surgery Paride Stefanini, Umberto I Policlinico Roma, Italy
| | - Roberto Cirocchi
- Department of Surgical and Biomedical Sciences, Division of Week surgery, S. Maria Hospital, Terni, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Urology Clinic of Perugia, Perugia University, P.le Menghini, 06100, Perugia, Italy
| |
Collapse
|
46
|
Del Zingaro M, Boni A, Paladini A, Rossi De Vermandois JA, Ciarletti S, Felici G, Ursi P, Cirocchi R, Mearini E. Fournier's gangrene secondary to locally advanced prostate cancer: case report and review of the Literature. G Chir 2019; 40:481-496. [PMID: 32007109] [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: 06/10/2023]
Abstract
Fournier's gangrene is a rare and potentially lethal condition. Previously described as an idiopathic process, this necrotising fasciitis is secondary to infection and in 95% of cases the cause arises from ano-rectum (30-50%), uro-genitalia (20-40%) or genital skin (20%). Cancer could lead to a Fournier's gangrene thanks a Romacompromised host immunity condition. In the past the rate of death was high ranging from 20% to 80%, while currently mortality is decreasing to 10%. We report a case of a 76-years-old man with Fournier's Gangrene due to locally advanced prostate cancer. The multimodal therapeutic management included broad-spectrum antibiotic therapy, intravenous fluid resuscitation and surgical debridement that was delayed by the will of the patient. To our knowledge, this is the first case of Fournier's gangrene caused by prostate cancer without common predisposing factors. In order to improve the knowledge about this rare disease, we performed a narrative review of the literature.
Collapse
|
47
|
de Vermandois JAR, Cochetti G, Zingaro MD, Santoro A, Panciarola M, Boni A, Marsico M, Gaudio G, Paladini A, Guiggi P, Cirocchi R, Mearini E. Evaluation of Surgical Site Infection in Mini-invasive Urological Surgery. Open Med (Wars) 2019; 14:711-718. [PMID: 31572804 PMCID: PMC6749724 DOI: 10.1515/med-2019-0081] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 06/24/2019] [Indexed: 01/09/2023] Open
Abstract
Surgical Site Infection (SSI) is the most frequent source of infection in surgical patients and the second most frequent cause of hospital-acquired infection. The primary aim of this prospective study was to compare SSI occurrences between minimally invasive surgery (MIS) and open urological surgery. Secondly, perioperative outcomes were evaluated in two different approaches. A consecutive group of 60 patients undergoing urological surgery were prospectively enrolled in a single high-volume center between May and October 2018. We included procedures that were performed by minimally invasive or traditional techniques. We evaluated and compared the incidence of SSI and perioperative outcomes in terms of intraoperative bleeding, post-operative complications, postoperative pain, patient satisfaction with the analgesic treatment, time to flatus, time of oral intake and mobilization, and length of hospital stay. The two groups were homogeneous with regard to demographic data. Superficial incisional SSIs were diagnosed in 10% of cases (3/30) in the second group and 0% in the first (p<0.05); space/organ SSIs developed in 4 patients, which were diagnosed by ultrasound scan and confirmed by abdominal CT: 1 patient (3.3%) in group 1 showed an infected lymphocele, whereas 1 case of infected lymphocele and 2 cases of pelvic abscess were detected in group 2 (10%, p<0.05). All the perioperative outcomes as well as were overall complication rate favored MIS (p<0.05). The use of minimally invasive techniques in urological surgery reduced the risk of SSI by comparison with a traditional approach. In addition, MIS was associated with better perioperative outcomes and a lower overall complication rate.
Collapse
Affiliation(s)
| | - Giovanni Cochetti
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Michele Del Zingaro
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Alberto Santoro
- Department of General Surgery and Surgical Specialties "Paride Stefanini";, Sapienza University of Rome, Rome, Italy
| | - Mattia Panciarola
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Andrea Boni
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Matteo Marsico
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Gianluca Gaudio
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Alessio Paladini
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Paolo Guiggi
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Roberto Cirocchi
- Department of Digestive Surgery and Liver Unit, University of Perugia, Perugia, Italy
| | - Ettore Mearini
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| |
Collapse
|
48
|
Boni A, Cochetti G, Sidoni A, Bellezza G, Lepri E, Giglio AD, Turco M, Vermandois JARD, Zingaro MD, Cirocchi R, Mearini E. Primary Angiosarcoma of the Kidney: Case Report and Comprehensive Literature Review. Open Med (Wars) 2019; 14:443-455. [PMID: 31410364 PMCID: PMC6689208 DOI: 10.1515/med-2019-0048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/24/2019] [Indexed: 02/01/2023] Open
Abstract
Purpose Angiosarcoma (AS) is an aggressive malignant tumour of endothelial origin, most frequently compelling the skin. The kidney is a rare site of primary occurrence of AS with a quite challenging diagnosis and poor prognosis, mainly due to its raw metastasising power. We described our first case of AS treatment. A comprehensive literature review in this field is also carried out. Patients and methods We report the case of a 56-years-old man with radiological appearance of an 11 cm poor vascularised left renal mass. The pre-operative imaging ruled out distant metastases and inferior vena cava thrombosis. Thus, after radioembolization, we performed a transperitoneal open radical nephrectomy with regional lymphadenectomy with the removal of the middle portion of the ileo-psoas muscle, followed by two lines of adjuvant chemotherapy. We analysed all the papers concerning primary kidney AS until December 2018. Results Estimated intraoperative blood loss was 200 mL with an operative time of 100 minutes. No postoperative complications were recorded, with the patient discharge in the 8th postoperative day. The pathological assessment showed a pT3a N0, M0 tumour compatible with AS of the kidney. An immune-histochemical study showed a vascular positive for CD31, CD34, Fli-1 with a Ki-67/Mib 1 of 50%. One month after surgery the patient began adjuvant chemotherapy with gemcitabine. After 45 days from surgery, a Computed Tomography scan showed lung and liver metastases with disease relapse in the left kidney lodge. The response to the first-line treatment was excellent, unlike the second-line, encountering a chemo-refractory disease. The cancer-specific survival was of 15 months. We included 66 cases in our review. Conclusion This is the first case of treatment of kidney AS performed at our Institute. Our findings added new information about the unclear biology and progression of this subset of tumours, demonstrating an abysmal prognosis.
Collapse
Affiliation(s)
- Andrea Boni
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| | - Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| | - Angelo Sidoni
- Department of Experimental Medicine, Section of Anatomic Pathology and Histology, Perugia Medical School, University of Perugia, Perugia, Italy
| | - Guido Bellezza
- Department of Experimental Medicine, Section of Anatomic Pathology and Histology, Perugia Medical School, University of Perugia, Perugia, Italy
| | - Emanuele Lepri
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| | - Andrea De Giglio
- Department of Experimental Medicine, Section of Oncology, University of Perugia, Perugia, Italy
| | - Morena Turco
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia - S.M. della Misericordia Hospital, P.le Menghini 1, 06132, Perugia, Italy
| | - Jacopo Adolfo Rossi De Vermandois
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| | - Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| | - Roberto Cirocchi
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| |
Collapse
|
49
|
Mearini E, Del Zingaro M, Boni A. The widespread of Robot-Assisted Surgery: the urologist perspective. G Chir 2019; 40:253-256. [PMID: 32011976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
|
50
|
Poli G, Egidi MG, Cochetti G, Brancorsini S, Mearini E. Relationship between cellular and exosomal miRNAs targeting NOD-like receptors in bladder cancer: preliminary results. MINERVA UROL NEFROL 2019; 72:207-213. [PMID: 31144487 DOI: 10.23736/s0393-2249.19.03297-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Exosomes are membrane vesicles secreted by both cancerous and normal cells which play important roles during intercellular communications and oncogenic transformation. Many reports highlight the importance of exosomal microRNAs (miRNAs) as pro-tumorigenic mediators during carcinogenesis, since they regulate all these pathways at the post-transcriptional level. Since bladder cancer cells have a high immunogenic potential, from one hand, and inflammation process is intimately connected to carcinogenesis, from the other, the interest in analyzing inflammasome-related exo-miRNAs is apparent. The modulation of miRNAs targeting NOD-like receptor mRNAs in patients harboring bladder cancer has been assessed in our previous studies. METHODS In the present report, we characterized the previously selected miRNAs in the soluble fraction of the same bladder cancer patient cohort, stratified according to the risk of recurrence and progression. Exosome precipitation and isolation were performed; the expression levels of exosomal miRNAs were compared with their cellular counterparts. RESULTS An up-regulation of exosomal miR-141-3p and miR-19a-3p with respect to urine sediment was reported. Linear regression analysis showed a significant negative correlation for the same miRNAs. Moreover, exosomal miRNAs increased in low risk compared to high risk patients, which was opposite to that observed for urine sediment. CONCLUSIONS Our work demonstrated the inverse correlation between exosomal and cellular miRNAs in patients with bladder cancer. The fact that these miRNAs were higher in exosomal than cellular fraction allowed us to hypothesize their active compartmentalization during cancer progression, suggesting their potential role as cancer messengers.
Collapse
Affiliation(s)
- Giulia Poli
- Department of Experimental Medicine, University of Perugia, Terni, Italy
| | - Maria G Egidi
- Department of Surgical and Biomedical Sciences, Clinic of Urology, University of Perugia, Perugia, Italy
| | - Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Clinic of Urology, University of Perugia, Perugia, Italy -
| | | | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Clinic of Urology, University of Perugia, Perugia, Italy
| |
Collapse
|