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Christofidis K, Moulavasilis N, Fragkiadis E, Goutas D, Lazaris AC, Mitropoulos D, Mikou P. Diagnosis of Low-Grade Urothelial Neoplasm in the Era of the Second Edition of the Paris System for Reporting Urinary Cytology. Diagnostics (Basel) 2023; 13:2625. [PMID: 37627884 PMCID: PMC10453841 DOI: 10.3390/diagnostics13162625] [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: 07/10/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The Paris System for Reporting Urinary Cytology (TPS) is considered the gold standard when it comes to diagnostic classifications of urine specimens. Its second edition brought some important changes, including the abolition of the diagnostic category of "low-grade urothelial neoplasm (LGUN)", acknowledging the inability of cytology to reliably discern low-grade urothelial lesions. METHODS In this retrospective study, we assessed the validity of this change, studying the cytological diagnoses of histologically diagnosed low-grade urothelial carcinomas during a three-year period. Moreover, we correlated the sum of the urinary cytology diagnoses of this period with the histological diagnoses, whenever available. RESULTS Although all the cytological diagnoses of LGUN were concordant with the histological diagnoses, most low-grade urothelial carcinomas were misdiagnosed cytologically. Subsequently, the positive predictive value (PPV) of urinary cytology for the diagnosis of LGUN was 100%, while the sensitivity was only 21.7%. Following the cyto-histopathological correlation of the sum of the urinary cytology cases, the sensitivity of urinary cytology for the diagnosis of high-grade urothelial carcinoma (HGUC) was demonstrated to be 90.1%, the specificity 70.8%, the positive predictive value (PPV) 60.3%, the negative predictive value (NPV) 93.6% and the overall accuracy 77.2%, while for LGUN, the values were 21.7%, 97.2%, 87.5%, 58.6% and 61.9%, respectively. Risk of high-grade malignancy was 0% for the non-diagnostic (ND), 4.8% for the non-high-grade urothelial carcinoma (NHGUC), 33.3% for the atypical urothelial cells (AUCs), 65% for the suspicious for high-grade urothelial carcinoma (SHGUC), 100% for the HGUC and 12.5% for the LGUN diagnostic categories. CONCLUSIONS This study validates the incorporation of the LGUN in the NHGUC diagnostic category in the second edition of TPS. Moreover, it proves the ability of urinary cytology to safely diagnose HGUC and stresses the pivotal role of its diagnosis.
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Affiliation(s)
| | - Napoleon Moulavasilis
- 1st Urology Department, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece; (N.M.); (E.F.); (D.M.)
| | - Evangelos Fragkiadis
- 1st Urology Department, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece; (N.M.); (E.F.); (D.M.)
| | - Dimitrios Goutas
- 1st Laboratory of Pathology, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece; (D.G.); (A.C.L.)
| | - Andreas C. Lazaris
- 1st Laboratory of Pathology, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece; (D.G.); (A.C.L.)
| | - Dionisios Mitropoulos
- 1st Urology Department, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece; (N.M.); (E.F.); (D.M.)
| | - Panagiota Mikou
- Cytopathology Department, Laiko General Hospital, 11527 Athens, Greece;
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Kratiras Z, Kotronopoulos G, Kaltsas A, Fragkiadis E, Stravodimos K. A Giant Oncocytoma in an Elderly Female Patient: A Case Report. Cureus 2023; 15:e41612. [PMID: 37565124 PMCID: PMC10410099 DOI: 10.7759/cureus.41612] [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] [Accepted: 07/09/2023] [Indexed: 08/12/2023] Open
Abstract
Renal oncocytomas are rare, benign tumors that can be difficult to distinguish from malignant renal cell carcinomas. This case report presents an 84-year-old woman with a sizeable renal oncocytoma and discusses this rare entity's diagnostic challenges and management.
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Affiliation(s)
- Zisis Kratiras
- Department of Urology, Attikon University Hospital, Athens, GRC
| | | | - Aris Kaltsas
- Department of Urology, University of Loannina, Loannina, GRC
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Fragkoulis C, Fragkiadis E, Sakellakis M, Pinitas A, Tzannis K, Gavalas N, Stamatakos P, Leventi A, Papadopoulos G, Stathouros G, Kostopoulou A, Makrydaki D, Giannopoulou E, Marialena D, Stravodimos K, Choreftaki T, Bamias A, Ntoumas K, Papatsoris A. Intravesical administration of durvalumab to patients with high risk non muscle invasive bladder cancer after BCG failure. A phase II trial by the Hellenic GU Cancer Group. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00467-0] [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: 02/12/2023]
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Fragkiadis E, Alamanis C, Constantinides CA, Mitropoulos D. Prediction of post radical nephrectomy complications based on patient comorbidity preoperatively. Arch Ital Urol Androl 2021; 93:251-254. [PMID: 34839625 DOI: 10.4081/aiua.2021.3.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/22/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Comorbidity along with tumor and patient characteristics is taken into account when deciding for the surgical treatment of renal cell carcinoma (RCC). Comorbidity has also been used as an independent predictive factor for postoperative complications of several major urological procedures including radical nephrectomy for RCC. The aim of the present study was to objectively evaluate the association between comorbidity and postoperative complications after radical nephrectomy for RCC, using standardized systems to grade both comorbidity and severity of postoperative complications. MATERIALS AND METHODS Clinicopathological data of 171 patients undergoing open radical nephrectomy for lesions suspected of RCC were prospectively recorded for a period of 3 years. Comorbidity was scored using the Charlson Comorbidity Index (CCI) while postoperative complications were graded according to the Clavien-Dindo system. RESULTS Patients were predominantly males (59.1%); their age ranged from 35 to 88 years (mean ± SD: 63.6 ± 11.9 yrs) with 50.8% of them being ≤ 65 yrs. CCI ranged from 0 to 8 with the majority (85.3%) scoring ≤ 2. The procedure was uncomplicated in 57.3% cases; 10 patients suffered major (grade III/IV) complications and 4 patients died within the 40 days postoperative period. CCI correlated with the manifestation of any postoperative complication, Clavien ≥ 1, OR (95% CI): 1.47 (1.09-1.96), p = 0.011 and the occurrence of severe complications, Clavien > 2. OR (95% CI): 1.29 (1.01-1.63), p = 0.038. CONCLUSIONS The present prospective study showed that considerable complications occur in patients with major comorbidities. CCI is easily calculated and should be incorporated in preoperative consultation especially in cases of elder patients with severe comorbidity and favorable tumor characteristics where less invasive interventions or even active surveillance could be applied.
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Giannakodimos I, Giannakodimos A, Fragkiadis E, Schizas D, Mastoraki A. Modifications regarding diagnostic approach and therapeutic management of urinary stones' disorders during COVID-19 pandemic. Urolithiasis 2020; 49:183-184. [PMID: 33206230 PMCID: PMC7672405 DOI: 10.1007/s00240-020-01230-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ilias Giannakodimos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Street, Athens, Greece
| | - Alexios Giannakodimos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Street, Athens, Greece
| | - Evangelos Fragkiadis
- First Department of Urology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Street, Athens, Greece
| | - Aikaterini Mastoraki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Street, Athens, Greece.
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Papatsoris A, Fragkoulis C, Fragkiadis E, Pinitas A, Tzannis K, Gavalas N, Stravodimos K, Ntoumas K, Mitropoulos D, Constantinides K, Giannopoulou E, Bamias A, Deliveliotis C. A run-in phase clinical study for intravesical administration of durvalumab in patients with high-risk, non-muscle-invasive bladder cancer (NMIBC). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33374-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Tselos A, Moris D, Tsilimigras DI, Fragkiadis E, Mpaili E, Sakarellos P, Vailas M, Shah KN, Papalampros A. Robot-Assisted Retroperitoneal Lymphadenectomy in Testicular Cancer Treatment: A Systematic Review. J Laparoendosc Adv Surg Tech A 2018; 28:682-689. [PMID: 29474141 DOI: 10.1089/lap.2017.0672] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Retroperitoneal lymph node dissection (RPLND) in testicular cancer is a documented treatment along with active surveillance and chemotherapy. This study aims to summarize the current evidence on the use of Robot-assisted RPLND (RARPLND) in comparison with the laparoscopic and open approach. MATERIALS AND METHODS A search was conducted in the existing literature focusing on reports with outcomes of RARPLND for stage I-IIB testicular tumor. RESULTS Eleven studies complied with the inclusion criteria, including 116 patients. The average follow-up of 21.2 months showed no retroperitoneal recurrence. The median lymph node yield was 22.3 and the overall positive rate was 26%. Complications were encountered in 8% of the patients. The robotic approach showed similar results to the laparoscopic approach and outperformed the open procedure in perioperative parameters. CONCLUSIONS Relapse-free survival, nodal yield, and complication rates during RARPLND for clinical stage I-IIB are acceptable. Further studies are required to establish these findings and determine benefit from the use of robotic approach.
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Affiliation(s)
- Aggelos Tselos
- 1 1st Department of Surgery, Laikon General Hospital, University of Athens , Athens, Greece
| | - Demetrios Moris
- 2 Department of Surgery, Duke University Medical Center , Durham, North Carolina
| | | | - Evangelos Fragkiadis
- 3 1st Department of Urology, Laikon General Hospital, University of Athens , Athens, Greece
| | - Eustratia Mpaili
- 1 1st Department of Surgery, Laikon General Hospital, University of Athens , Athens, Greece
| | - Panagiotis Sakarellos
- 1 1st Department of Surgery, Laikon General Hospital, University of Athens , Athens, Greece
| | - Michail Vailas
- 1 1st Department of Surgery, Laikon General Hospital, University of Athens , Athens, Greece
| | - Kevin N Shah
- 2 Department of Surgery, Duke University Medical Center , Durham, North Carolina
| | - Alexandros Papalampros
- 1 1st Department of Surgery, Laikon General Hospital, University of Athens , Athens, Greece
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Collins J, Mottrie A, Hosseini A, Challacombe B, Adding C, Dasgupta P, Artibani W, Gaston R, Piechaud T, Sooriakumaran P, Pini G, Nilsson A, Fragkiadis E, Tewari A, Badani K, Gill I, Desai M, Patel V, Ahlawat R, Murphy D, Coelho R, Rha K, Gandaglia G, Verhagen H, Wiklund P. MP11-12 LIVE STREAMING OF ROBOTIC SURGERY FROM LEADING EDUCATIONAL CENTRES ENABLES A GLOBAL APPROACH TO SURGICAL TEACHING. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2383] [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: 10/22/2022]
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Adamakis I, Fragkiadis E, Katafigiotis I, Kousournas G, Stravodimos K, Constantinides CA. A two staged treatment procedure for the difficult to treat bladder neck contractures with concomitant incontinence. In the search of a solution to a complex problem. Arch Ital Urol Androl 2015; 87:233-7. [PMID: 26428647 DOI: 10.4081/aiua.2015.3.233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 09/29/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine the efficacy of a two staged treating strategy with the use of a non-permanent urethral ALLIUM(®) stent for the management of recurrent bladder neck stenosis and subsequently the use of an artificial sphincter AUS800(®) by AMS for the management of the incontinence. MATERIALS AND METHODS We progressively identified patients eligible for the study creating a population of cases with recurrent bladder neck stenosis and concomitant incontinence occurring after the last intervention for the stenosis. Efficacy for the treatment of the stenosis was defined as no recurrence both prior and post to the sphincter placement and efficacy for the treatment of the incontinence was defined as continence (0-1pads) after the sphincter placement. RESULTS AND LIMITATIONS 14 white males with a mean age of 66.21, ranging from 59 to 73 years consisted the population of the study. All patients had severe stress incontinence following the last transurethral resection. The efficacy of the treatment of the bladder neck stenosis was 93% (13/14) while the efficacy for the treatment of the incontinence was 100%. A single patient had a recurrent bladder neck stenosis after the artificial sphincter placement and was treated with transurethral resection using a long pediatric 13 F resectoscope at 12 months. Our limitations is the absence of a control group and the small number of patients enrolled, with a relatively short time of follow up. CONCLUSIONS In our series we propose the use of a non-permanent urethral ALLIUM(®) stent for 6 months in order to control the growth of fibrotic scar tissue, a further 6 months follow up for recurrence, and then placement of an artificial sphincter. The results are very promising both on stabilizing the vesicourethral stenosis, and on patient safety and tolerability.
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Stravodimos K, Katafigiotis I, Fragkiadis E, Tyritzis S, Constantinides CA. Correcting and sharing our complications. Misplacement of pigtail catheter, during a Robot Assisted Pyeloplasty. Clinical findings, diagnosis, possible causes and endoscopic treatment. ACTA ACUST UNITED AC 2015; 87:165-6. [PMID: 26150038 DOI: 10.4081/aiua.2015.2.165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/06/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Robotic assisted pyeloplasty (RAP) is rapidly adopted by surgeons around the world. We present a unique complication of the technique, consisting of pigtail misplacement, which was endoscopically resolved. We discuss the clinical findings, differential diagnosis and principles of endoscopic treatment. MATERIALS AND METHODS A 41 years old female patients underwent transperitoneal right side RAP with the Hynes-Anderson technique for ureteropelvic junction obstruction. Pigtail was placed intraoperatively in an antegrade fashion. Post operative course appeared normal but Kidney-Ureterer-Bladder(KUB) X-ray, revealed a misplaced pigtail. Patient underwent a semirigid ureterorenoscopy demonstrating that the pigtail was exiting the collecting system in the rear line of suturing between continuous sutures. Pigtail was retrieved with a stone retrieval forceps with short upward motions in the renal pelvis under fluoroscopy and then removed from patient, in order to avoid stressing the anastomosis. No leakage was noted in fluoroscopy, a pigtail was correctly placed and patient recovery was uneventful. RESULTS Retrograde pyelography was the key to accurate diagnosis and endoscopic treatment, because the exact point of exit and anastomosis integrity were established. Retrieval of the pigtail was the most challenging part. Lack of proper visualization and mobilization of the rear part of the anastomosis during surgery, combined with lack of tactile feedback, because of robotic instrumentation, were of critical importance in the manifestation of such a mishap. Endoscopy facilitated case resolve, but proper handling is required to protect the anastomosis. CONCLUSIONS The introduction of novel techniques can carry the burden of novel complications. A surgeon must always keep in mind the complications inherent to the technique and at the same time the limitations of the equipment used, especially the lack of tactile feedback in robotic instrumentation.
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Deligiannis D, Anastasiou I, Mygdalis V, Fragkiadis E, Stravodimos K. Change of practice patterns in urology with the introduction of the Da Vinci surgical system: the Greek NHS experience in debt crisis era. Arch Ital Urol Androl 2015; 87:56-61. [PMID: 25847898 DOI: 10.4081/aiua.2015.1.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/01/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the attitudinal change for urologic surgery in Greece since the introduction of the da Vinci Surgical System (DVS). We describe contemporary trends at public hospital level, the initial Greek experience, while at the same time Greece is in economic crisis and funding is under austerity measures. MATERIALS AND METHODS We retrospectively analyzed annualized case log data on urologic procedures, between 2008 (installation of the DVS) and 2013, from "Laiko'' Hospital in Athens. We evaluated, using summary statistics, trends and institutional status regarding robot-assisted surgery (RAS). We also analyzed the relationship between the introduction of RAS and change in total volume of procedures performed. RESULTS 1578 of the urological procedures performed at "Laiko'' Hospital were pooled, 1342 (85%) being open and 236 RAS (15%). We observed a 6-fold increase in the number of RAS performed, from 7% of the total procedural volume (14/212) in 2008 to 30% (96/331) in 2013. For radical prostatectomy, in 2008 2% were robot-assisted and 98% open while in 2013, 46% and 54% respectively. Pyeloplasty was performed more often using the robot-assisted method since 2010. RAS-dedicated surgeons increased both RAS and the total number of procedures they performed. From 86 in 2008 to 145 in 2013, with 57% of them being RAS in 2013 as compared to 13 % in 2008. CONCLUSIONS Robot-assisted surgery has integrated into the armamentarium for urologic surgery in Greece at public hospital level. Surgical robot acquisition is also associated with increased volume of procedures, especially prostatectomy, despite the ongoing debate over cost-effectiveness, during economic crisis and International Monetary Fund (IFN) era.
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Affiliation(s)
- Dimitros Deligiannis
- 1st Department of Urology, University of Athens, Medical School "Laiko" Hospital, Athens.
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Katafigiotis I, Fragkiadis E, Pournaras C, Nonni A, Stravodimos KG. A rare case of a 39 year old male with a parasite called Dioctophyma renale mimicking renal cancer at the computed tomography of the right kidney. A case report. Parasitol Int 2013; 62:459-60. [PMID: 23811203 DOI: 10.1016/j.parint.2013.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/22/2013] [Accepted: 06/14/2013] [Indexed: 10/26/2022]
Abstract
We present a very rare case of a 39 year old patient with Dioctophyma renale depicted as a Bosniak cyst IV of the right kidney who was finally subjected to a robotic assisted radical nephrectomy.
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Affiliation(s)
- Ioannis Katafigiotis
- 1st University Urology Clinic Laiko Hospital, University of Athens, Athens, Greece.
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