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Rubilotta E, Chiarulli EF, Ammirati E, Bevacqua MC, Manodoro S, Chierchia S, Fragalà E, Masiello G, Li Marzi V, Giammò A, Musco S, Savoca F, Balzarro M, De Nunzio C, De Rienzo G, Fusco F, Lamberti G, Soligo M, De Palma L, Fasano M, Carretta A, Tumietto F, Finazzi-Agrò E, Russo E, Antonelli A, Gubbiotti M, Sampogna G, Spinelli M, Carone R, Martino L, Mancini V. Antibiotic prophylaxis in invasive urodynamics, a Delphi consensus of the Italian Society of Urodynamics (SIUD). Neurourol Urodyn 2024. [PMID: 38587242 DOI: 10.1002/nau.25463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/23/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Although antibiotic prophylaxis (AB) demonstrated a statistically significant reduction in bacteriuria after invasive urodynamics (UDS), no significant decrease in the incidence of urinary tract infections (UTI) has been confirmed. No absolute recommendations on the use of AB in case of relevant potential risk of UTI have been reported, though some categories of patients at increased infective probability after UDS have been recognized. The aim of this study is to report the experts' consensus on the best practice for the use of AB before UDS in the main categories of patients at potential risk of developing UTI. MATERIALS AND METHODS A systematic literature review was performed on AB before UDS in males and females. A panel of experts from the Italian Society of Urodynamics, Continence, Neuro-Urology, and Pelvic Floor (SIUD) assessed the review data and decided by a modified Delphi method on 16 statements proposed and discussed by the panel. The cut-off percentage for the consensus was a ≥70% of positive responses to the survey. The study was a Delphi consensus with experts' opinions, not a clinical trial involving directly patients. RESULTS The panel group was composed of 57 experts in functional urology and UDS, mainly urologists, likewise gynaecologists, physiatrists, infectivologists, pediatric urologists, and nurses. A positive consensus was achieved on 9/16 (56.25%) of the statements, especially on the need for performing AB before UD in patients with neurogenic bladder and immunosuppression. Urine analysis and urine culture before UDS are mandatory, and in the event of their positivity, UDS should be postponed. A consensus was reached on avoiding AB in menopausal status, diabetes, age, gender, bladder outlet obstruction, high postvoid residual, chronic catheterization, previous urological surgery, lack of urological abnormalities, pelvic organ prolapse, and negative urine analysis. CONCLUSIONS Antibiotic prophylaxis is not recommended for patients without notable risk factors and with a negative urine test due to the potential morbidities that may result from antibiotic administration. However, AB can be used for risk categories such as neurogenic bladder and immunosuppression. The evaluation of urine analysis and urine culture and postponing UDS in cases of positive tests were considered good practices, as well as performing AB in the neurogenic bladder and immunosuppression.
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Affiliation(s)
- Emanuele Rubilotta
- Department of Urology, Azienda Ospedaliera Universitaria Verona, Verona, Italy
| | | | - Enrico Ammirati
- Neuro-Urologia, CTO Unità spinale unipolare, Città della Salute e della Scienza, Torino, Italy
| | - Marianna C Bevacqua
- UOC Urologia Abilitata al Trapianto, Grande Ospedale Metropolitano di Reggio Calabria, Milano, Italy
| | - Stefano Manodoro
- UO Ostetricia e Ginecologia Ospedale San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Stefania Chierchia
- Neuro-Urologia, CTO Unità spinale unipolare, Città della Salute e della Scienza, Torino, Italy
| | - Eugenia Fragalà
- UO Urologia Ospedale G.B. Morgagni - L. Pierantoni, AUSL Romagna, Forlì, Italy
| | | | - Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Firenze, Italy
| | | | - Stefania Musco
- Unit of Neuro-Urology, Azienda Ospedaliera Careggi, Firenze, Italy
| | | | - Matteo Balzarro
- Department of Urology, Azienda Ospedaliera Universitaria Verona, Verona, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sapienza University, Ospedale Sant'Andrea, Roma, Italy
| | - Gaetano De Rienzo
- Urology and Andrology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | | | - Marco Soligo
- Unit of Obstetrics and Gynecology, Ospedale Maggiore, Lodi, Italy
| | - Luisa De Palma
- UOC Medicina Fisica e Riabilitazione, Policlinico di Bari, Italy
| | - Massimo Fasano
- UO Malattie Infettive, Ospedale Perinei, Altamura, Bari, Italy
| | - Anna Carretta
- UOC Malattie Infettive, Policlinico di Foggia, Foggia, Italy
| | | | - Enrico Finazzi-Agrò
- Department of Surgical Sciences, Urology Unit, University of Rome Tor Vergata, Roma, Italy
| | - Eleonora Russo
- UO Ginecologia e Ostetricia Universitaria I Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | | | - Gianluca Sampogna
- Unipolar Spinal Unit and Neurourology Service, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Michele Spinelli
- Unipolar Spinal Unit and Neurourology Service, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Leonardo Martino
- Urology Unit and Renal Transplantation, Policlinico di Foggia, Università di Foggia, Foggia, Italy
| | - Vito Mancini
- Urology Unit and Renal Transplantation, Policlinico di Foggia, Università di Foggia, Foggia, Italy
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Cocci A, Pezzoli M, Bianco F, Blefari F, Bove P, Cornud F, De Rienzo G, Destefanis P, Di Trapani D, Giacobbe A, Giovanessi L, Laganà A, Lughezzani G, Manenti G, Muto G, Patelli G, Pinzi N, Regusci S, Russo GI, Salamanca JI, Salvi M, Silvestri L, Verweij F, Walser E, Bertolo RG, Iacovelli V, Bertaccini A, Marchiori D, Davila H, Ditonno P, Gontero P, Iapicca G, M De Reijke T, Ricapito V, Pellegrini P, Minervini A, Serni S, Sessa F. Transperineal laser ablation of the prostate as a treatment for benign prostatic hyperplasia and prostate cancer: The results of a Delphi consensus project. Asian J Urol 2024; 11:271-279. [PMID: 38680587 PMCID: PMC11053328 DOI: 10.1016/j.ajur.2023.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/06/2023] [Indexed: 05/01/2024] Open
Abstract
Objective To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus method. Methods Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and finalized. Results Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from <40 mL (80%) to >80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading to statements and recommendations. Conclusion Echolaser® TPLA is a safe and effective procedure that treats BPH and localized PCa with satisfactory functional and sexual outcomes.
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Affiliation(s)
- Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marta Pezzoli
- Urology Section, University of Florence, Florence, Italy
| | | | | | - Pierluigi Bove
- Torvergata Oncoscience Research Centre of Excellence, TOR, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - Francois Cornud
- Department of Radiology, Hôpital Cochin, Paris Descartes University, Paris, France
| | - Gaetano De Rienzo
- Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Paolo Destefanis
- Unit of Urology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Danilo Di Trapani
- Urology Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | | | - Luca Giovanessi
- Urology Unit, Surgical Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Antonino Laganà
- Departement of Urology, “S.Giovanni Evangelista” Hospital, Tivoli, Italy
| | - Giovanni Lughezzani
- Humanitas Clinical and Research Center–IRCCS, Department of Urology, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Guglielmo Manenti
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome “Tor Vergata”, Rome, Italy
| | - Gianluca Muto
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Gianluigi Patelli
- Department of Interventional Radiology, Pesenti-Fenaroli Hospital-ASST Bergamo Est, Alzano Lombardo, Italy
| | - Novello Pinzi
- Department of Urology, University of Siena, Siena, Italy
| | - Stefano Regusci
- Swiss International Prostate Center, Geneva, Switzerland
- Clinique Générale Beaulieu, Geneva, Switzerland
| | | | - Juan I.M. Salamanca
- Department of Urology, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain
- Lyx Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain
| | - Matteo Salvi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Luigi Silvestri
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Faculty of Pharmacy and Medicine, Urology Unit ICOT, Latina, Italy
| | - Fabrizio Verweij
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Eric Walser
- Department of Radiology, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Riccardo G. Bertolo
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Alessandro Bertaccini
- Department of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Debora Marchiori
- Department of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Hugo Davila
- Florida Healthcare Specialist, Urology and Minimally Invasive Surgery, Florida Cancer Specialist and Research Institute, Vero Beach, FL, USA
- Department of Surgery, Division of Urology and Gynecology, Sebastian River Medical Center, Sebastian, FL, USA
| | - Pasquale Ditonno
- Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Paolo Gontero
- Department of Urology, Molinette Hospital, University of Torino School of Medicine, Turin, Italy
| | | | - Theo M De Reijke
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
| | - Vito Ricapito
- Department of Urology, Policlinico di Bari, Bari, Italy
| | - Pierluca Pellegrini
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Faculty of Pharmacy and Medicine, Urology Unit ICOT, Latina, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Sessa
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
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Carbonara U, Minafra P, Papapicco G, De Rienzo G, Pagliarulo V, Lucarelli G, Vitarelli A, Ditonno P. Xi Nerve-sparing Robotic Radical Perineal Prostatectomy: European Single-center Technique and Outcomes. EUR UROL SUPPL 2022; 41:55-62. [PMID: 35633830 PMCID: PMC9133767 DOI: 10.1016/j.euros.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 12/01/2022] Open
Abstract
Background Radical prostatectomy (RP) represents the standard of care for the treatment of patients with organ-confined prostatic cancer. Historically, perineal RP has been described as the first surgical approach for the complete removal of the prostatic gland. In the past years, robotic techniques provided some technical advantages that allow resuming alternative approaches, such as robotic radical perineal prostatectomy (r-RPP). Objective To present in detail the technique of Xi nerve-sparing r-RPP and to report perioperative, oncological, and functional outcomes from a European tertiary center. Design setting and participants Patients with low- or intermediate-risk prostatic cancer not suitable for active surveillance and prostate volume up to 60 ml who underwent r-RPP between November 2018 and December 2020 were identified. Surgical procedure All patients underwent Xi nerve-sparing r-RPP. Measurements Baseline characteristics and intraoperative, pathological, and postoperative data were collected and analyzed. The complications were reported according to the standardized methodology to report complications proposed by European Association of Urology guidelines. Results and limitations Overall, our series included 26 patients who underwent r-RPP. Patients' median age was 62.5 yr. Thirteen (50%) and eight (30.7%) patients showed a body mass index (BMI) of 25-30 and >30, respectively. A history of past surgical procedures was present in seven (26.8%) patients. The median prostate volume was 40 (interquartile range [IQR]: 28-52) ml. The median operative time and blood lost were 246 (IQR: 230-268) min and 275 (IQR: 200-400) ml, respectively. Overall, four (15.4%) patients reported intraoperative complications and five (19.2%) reported postoperative complications, with one (3.8%) reporting major complications (Clavien-Dindo ≥3). No patient with biochemical recurrence (BCR) was reported at 1 yr of follow-up. Continence rates were 73.0%, 84.6%, and 92.3%, respectively, at 3, 6, and 12 mo after surgery. Erectile potency recovery rates were 57.1%, 66.6%, and 80.9% at 3, 6, and 12 mo of follow-up, respectively. Conclusions Xi r-RPP is a challenging but safe minimally invasive approach for selected patients. No patient reported BCR at 12 mo. The choice of the surgical approach for RP is likely to be based on the patient's characteristics as well as the surgeon's preferences. Patient summary Our study suggests that Xi radical perineal prostatectomy is a safe minimally invasive approach for patients with low- or intermediate-risk prostatic cancer, and complex abdominal surgical history or comorbidities.
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Affiliation(s)
- Umberto Carbonara
- Corresponding author. Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy. Tel. +39 342 755 2215; Fax: +39 080 559 5236.
| | | | - Giuseppe Papapicco
- Department of Emergency and Organ Transplantation – Urology Unit, Aldo Moro University, Bari, Italy
| | - Gaetano De Rienzo
- Department of Emergency and Organ Transplantation – Urology Unit, Aldo Moro University, Bari, Italy
| | - Vincenzo Pagliarulo
- Department of Emergency and Organ Transplantation – Urology Unit, Aldo Moro University, Bari, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation – Urology Unit, Aldo Moro University, Bari, Italy
| | - Antonio Vitarelli
- Department of Emergency and Organ Transplantation – Urology Unit, Aldo Moro University, Bari, Italy
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation – Urology Unit, Aldo Moro University, Bari, Italy
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De Rienzo G, Minafra P, Ditonno P. Reply to Davide Rosati, Riccardo Lombardo, Cosimo De Nunzio, Constantino Leonardo, and Andrea Tubaro's Words of Wisdom re: Transperineal Interstitial Laser Ablation of the Prostate, A Novel Option for Minimally Invasive Treatment of Benign Prostatic Obstruction. Eur Urol 2021;80:673-4. Eur Urol 2022; 81:e100-e101. [PMID: 35101305 DOI: 10.1016/j.eururo.2021.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Gaetano De Rienzo
- Urology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
| | - Paolo Minafra
- Urology Unit, S.S. Annunziata Hospital, Taranto, Italy
| | - Pasquale Ditonno
- Urology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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De Rienzo G, Minafra P, Finazzi Agrò E, Ditonno P. Re: Can we say that detrusor contractility didn't change in: "Evaluation"evaluation of the effect of 100 U of onabotulinum toxin A on detrusor contractility in women with idiopathic OAB: A multicentre prospective study"? Neurourol Urodyn 2022; 41:687-688. [PMID: 35005806 DOI: 10.1002/nau.24862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Gaetano De Rienzo
- Department of Emergency and Organ Transplantation-Urology, Andrology, and Kidney Transplantation Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Paolo Minafra
- Urology Unit, SS. Annunziata Hospital, Taranto, Italy
| | | | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation-Urology, Andrology, and Kidney Transplantation Unit, University of Bari "Aldo Moro", Bari, Italy.,Urology Unit, National Cancer Institute IRCCS "Giovanni Paolo II", Bari, Italy
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De Rienzo G, Minafra P, Iliano E, Agrò EF, Serati M, Giammò A, Bianchi FP, Costantini E, Ditonno P. Evaluation of the effect of 100U of Onabotulinum toxin A on detrusor contractility in women with idiopathic OAB: A multicentre prospective study. Neurourol Urodyn 2021; 41:306-312. [PMID: 34664738 PMCID: PMC9297902 DOI: 10.1002/nau.24820] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 01/22/2023]
Abstract
Aims Intradetrusor injection of Onabotulinum Toxin A (BTX‐A) is a third‐line treatment for overactive bladder (OAB). Voiding dysfunction and the need for intermittent catheterization are potential complications, consequent to bladder contractility (BC) decrement. Primary aim: to evaluate BC variation after BTX‐A detrusor injection in women with idiopathic OAB. Methods A prospective multi‐institutional observational study was conducted. Medical history, bladder diary, 24‐h pad test, and invasive urodynamic parameters were recorded before and 4–6 weeks after BTX‐A 100U administration. BC was measured as Modified Projected Isovolumetric Pressure (PIP1), that is, maximum flow rate (Qmax) + detrusor pressure at Qmax (PdetQmax). Continuous variables were expressed as median and interquartile range. We compared continuous variables using Wilcoxon test and proportions between two times with Fisher exact test. Results No changes in PIP1 were observed (p > 0.05) in 45 women enrolled between January 2018 and September 2019. Median age was 54.6 years. At baseline, 91.1% had urge urinary incontinence, with 4.9 ± 2.6 daily pads used and a 24‐h pad test of 205.4 ± 70.8 g. Baseline detrusor contractility was normal in all the patients. Postoperatively, an improvement in the 24‐h pad test (p < 0.01), daily voids (p < 0.01), and nocturia (p < 0.01) occurred. Urodynamics pointed out a significant reduction of detrusor overactivity rate (p < 0.01) and an increase of median maximum cystometric capacity (p < 0.01). No difference was observed in median Qmax (p > 0.05), PdetQmax (p > 0.05), and PVR (p > 0.05). No patient needed postoperative catheterization. Conclusions The current series provides evidence that detrusor injection of botulinum toxin is an effective option for treating OAB, without causing voiding dysfunction and BC impairment.
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Affiliation(s)
- Gaetano De Rienzo
- Urology, Andrology, and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Paolo Minafra
- Urology Unit, SS. Annunziata Hospital, Taranto, Italy
| | - Ester Iliano
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy
| | | | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Alessandro Giammò
- CTO-Spinal Cord Unit, Department of Neurourology, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Paolo Bianchi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Elisabetta Costantini
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy
| | - Pasquale Ditonno
- Urology, Andrology, and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy.,Urology Unit, National Cancer Institute IRCCS "Giovanni Paolo II", Bari, Italy
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Campobasso D, Acampora A, De Nunzio C, Greco F, Marchioni M, Destefanis P, Altieri V, Bergamaschi F, Fasolis G, Varvello F, Voce S, Palmieri F, Divan C, Malossini G, Oriti R, Ruggera L, Tuccio A, Tubaro A, Delicato G, Laganà A, Dadone C, Pucci L, Carrino M, Montefiore F, Germani S, Miano R, Rabito S, De Rienzo G, Frattini A, Ferrari G, Cindolo L. Post-Operative Acute Urinary Retention After Greenlight Laser. Analysis of Risk Factors from A Multicentric Database. Urol J 2021; 18:693-698. [PMID: 34346047 DOI: 10.22037/uj.v18i.6489] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE Greenlight laser is a mini-invasive technique used to treat Benign Prostatic Obstruction (BPO). Some of the advantages of GreenLight photoselective vaporization (PVP) are shorter catheterization time and hospital stay compared to TURP. Post-operative acute urinary retention (pAUR) leads to patients' discomfort, prolonged hospital stay and increased health care costs. We analyzed risk factors for urinary retention after GreenLight laser PVP. MATERIALS AND METHODS In a multicenter experience, we retrospectively analyzed the onset of early and late post-operative acute urinary retention in patients undergoing standard or anatomical PVP. The pre-, intra- and post-operative characteristics were compared betweene patients who started to void and the patients who developed post-operative urinary retention. RESULTS The study included 434 patients suitable for the study. Post-operative acute urinary retention occurred in 39 (9%). Patients with a lower prostate volume (P < .001), an adenoma volume lower than 40 mL (P < .001), and lower lasing time (P = .013) had a higher probability to develop pAUR at the univariate analysis. The multivariate logistic regression confirmed that lower lasing time (95% CI: 0.86-0.99, OR = 0.93, P = .046) and adenoma volume (95% CI: 0.89-0.98, OR = 0.94, P = .006) are correlated to pAUR. Furthermore IPSS ≥ 19 (95% CI: 1.19- 10.75, OR = 2.27, P = .023) and treatment with 5-ARI (95% CI: 1.05-15.03, OR = 3.98, P = .042) are risk factors for pAUR. CONCLUSION In our series, post-operative acute urinary retention was related to low adenoma volume and lasing time, pre-operative IPSS ≥ 19 and 5-ARI intake. These data should be considered in deciding the best timing for urethral catheters removal.
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Affiliation(s)
- Davide Campobasso
- Dept. of Urology, Ospedale Civile di Guastalla ed Ospedale Ercole Franchini di Montecchio Emilia, Azienda USL-IRCCS di Reggio Emilia, Italy .
| | - Anna Acampora
- Department of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Cosimo De Nunzio
- Dept of Urology, "Sant'Andrea" Hospital, Sapienza University, Roma, Italy .
| | | | - Michele Marchioni
- Dept. of Medical, Oral and Biotechnological Sciences,"G. D'Annunzio" University of Chieti, Chieti, Italy.
| | - Paolo Destefanis
- Dept. of Urology, Azienda Ospedaliera Città della Salute e della Scienza di Torino - Sede Molinette, Torino, Italy.
| | | | - Franco Bergamaschi
- Dept. of Urology, "Arcispedale Santa Maria Nuova", Reggio Emilia, Italy.
| | | | | | - Salvatore Voce
- Dept. of Urology, "Santa Maria delle Croci Hospital", Ravenna, Italy .
| | - Fabiano Palmieri
- Dept. of Urology, "Santa Maria delle Croci Hospital", Ravenna, Italy .
| | - Claudio Divan
- Dept. of Urology, "Rovereto Hospital", Rovereto, Italy.
| | | | - Rino Oriti
- Dept. of Urology, "Ulivella e Glicini Clinic", Florence, Italy.
| | - Lorenzo Ruggera
- Dept. of Urology, Clinica urologica azienda ospedaliera - University of Padova, Padova, Italy.
| | - Agostino Tuccio
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy. .
| | - Andrea Tubaro
- Dept of urology, "Sant'Andrea" Hospital, Sapienza University, Roma, Italy .
| | | | - Antonino Laganà
- Dept. of Urology, "S.Giovanni Evangelista" Hospital, Tivoli, Italy .
| | - Claudio Dadone
- Dept. of Urology, "Santa Croce e Carle" Hospital, Cuneo, Italy.
| | - Luigi Pucci
- Dept. of Urology, AORN "Antonio Cardarelli", Naples, Italy.
| | | | | | - Stefano Germani
- UOSD Urologia, Fondazione Policlinico Tor Vergata, Rome, Italy.
| | - Roberto Miano
- UOSD Urologia, Fondazione Policlinico Tor Vergata, Rome, Italy.
| | | | - Gaetano De Rienzo
- Dept. of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari, Bari, Italy .
| | - Antonio Frattini
- Dept. of Urology, Ospedale Civile di Guastalla ed Ospedale Ercole Franchini di Montecchio Emilia, Azienda USL-IRCCS di Reggio Emilia, Italy .
| | | | - Luca Cindolo
- Dept. of Urology, "Villa Stuart" Private Hospital, Rome, Italy .
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8
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Prontera PP, Rinaldi M, Prontera PP, Saverio Grossi F, Spilotros M, Lucarelli G, Rienzo GD, Ditonno P, Battaglia M. “Non-Parasitic” and “Non-Iatrogenic” Chyluria: Its Diagnosis and Treatment. Surg Case Rep 2021. [DOI: 10.31487/j.scr.2021.03.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Chyluria occurs in all its forms with milky urine, recurrent episodes of acute urinary retention, left renal colic and proteinuria. In non-parasitic or iatrogenic diseases, it is secondary to communicate between the cisterna system of the chyli and the lymphatics of the calyx system of the left urinary tract with a retrograde passage of a kilo and its appearance in the urine which therefore take on a milky appearance [1, 2]. Sometimes, episodically, especially after the ingestion of a high-fat meal, the quantity of kilo is so abundant that it can cause obstruction of the upper urinary tract and of the bladder, resulting in renal colic or acute urinary retention that may require their unblocking with double J stent or bladder catheter [3, 4]. After conservative attempts with a fat-free diet or with the parenteral diet, in case of their failure, surgery must be performed by performing a para-aortic and renal hilum lymphadenectomy and, in severe cases, with intraperitonealization of the kidney and left ureter. This is the case of the patient reported below and successfully treated recently with an innovative “open” surgical technique.
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9
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Reale G, Marchioni M, Altieri V, Greco F, De Nunzio C, Destefanis P, Ricciardulli S, Bergamaschi F, Fasolis G, Varvello F, Voce S, Palmieri F, Divan C, Malossini G, Oriti R, Tuccio A, Ruggera L, Tubaro A, Delicato G, Laganà A, Dadone C, De Rienzo G, Ditonno A, Frattini A, Pucci L, Carrino M, Montefiore F, Germani S, Miano R, Schips L, Rabito S, Ferrari G, Cindolo L. Operative profile, safety and functional outcomes after GreenLight laser prostate surgery: results from a 12 months follow-up multicenter Italian cohort analyses. MINERVA UROL NEFROL 2020; 72:622-628. [PMID: 32284526 DOI: 10.23736/s0393-2249.20.03597-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Over the two past decades, GreenLight laser therapy has been considered a valid alternative for the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia/benign prostatic obstruction (BPH/BPO). However, the debate on the effectiveness of laser therapy compared to conventional techniques is still open. The aim of our study is to analyze and describe the use of GreenLight laser prostate surgery in Italy, with regard to the surgical techniques performed and the surgical and functional outcomes at mid-term follow-up. METHODS From March 2012 to July 2018, patients who underwent GreenLight laser prostate surgery for LUTS due to BPH/BPO from 19 Italian centers were included. The following parameters were evaluated in the population: age, prostate volume, prostate adenoma volume, PSA tot, Q<inf>max</inf> at uroflowmetry (UFM), International Prostatic Symptoms Score (IPSS), previous therapy for LUTS, use of anticoagulants and antiplatelet drugs. We recorded also the kind of anesthesia, mean laser time (min), mean irradiation time (min), TURP conversion/completion rate, postoperative day of catheter removal, postoperative acute urinary retention (AUR), hospital stay, variation of hematocrit (Ht) and hemoglobin levels (Hb). Early complications were classified according to the Clavien-Dindo classification, the re-operation rate within 30 days and after 30 days, the late complications and the Patient Global Impression of Improvement were also collected. Changes over time in terms of blood loss and functional outcomes (IPSS and Q<inf>max</inf> at the UFM at 6 and 12 months) were tested with Student's test for paired samples. We assumed P≤0.05 as level of statistical significance. RESULTS Overall, 1077 were enrolled in the study, 554 (56.4%) were treated with standard vaporization and 523 (48.6%) with anatomical vaporization. Student's t-test for paired samples showed no statistically significant differences in terms of reduction of Ht preoperative vs. Ht postoperative (42.80±3.91 vs. 39.93±5.35 95% CI P=0.3) and preintervention and postintervention Hb levels (14.28±1.46 vs. 13.72 P=0.35). Compared with the preoperative Q<inf>max</inf> (8.60±2.64), the 6- and 12-month UFM showed a significant improvement [19.56±6.29, P<0.01 and 19.99±5.92 P<0.01]. In terms of IPSS variation, compared to the baseline level (22±5.51) the 6- and 12-month follow-up confirmed a significant reduction (8.01±4.41 P<0.01 and 5.81±4.12 P<0.01 respectively). Postoperative complications were CD0, CD1, CD2, CD3, CD4 in 33.0%,35.3%, 2.9%, 0.3%, and 0.6%. CONCLUSIONS To the best of our knowledge, this is one of the most numerous surgical series of GreenLight laser vaporization and with the longest follow-up. This technique should be considered as a safe and effective alternative in the treatment of secondary LUTS to BPH.
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Affiliation(s)
- Giulio Reale
- Department of Urology, S. Maria delle Croci Hospital, Azienda AUSL Romagna, Ravenna, Italy -
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti, Italy
| | | | | | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Paolo Destefanis
- Departement of Urology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | | | - Franco Bergamaschi
- Department of Urology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | | | - Salvatore Voce
- Department of Urology, S. Maria delle Croci Hospital, Azienda AUSL Romagna, Ravenna, Italy
| | - Fabiano Palmieri
- Department of Urology, S. Maria delle Croci Hospital, Azienda AUSL Romagna, Ravenna, Italy
| | - Claudio Divan
- Department of Urology, Hospital of Rovereto, Rovereto, Milan, Italy
| | - Gianni Malossini
- Department of Urology, Hospital of Rovereto, Rovereto, Milan, Italy
| | - Rino Oriti
- Department of Urology, Ulivella e Glicini Clinic, Florence, Italy
| | - Agostino Tuccio
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Lorenzo Ruggera
- Department of Urology, Urologic Clinic, University of Padua, Padua, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Giampaolo Delicato
- Department of Urology, S.Giovanni Evangelista Hospital, Tivoli, Rome, Italy
| | - Antonino Laganà
- Department of Urology, S.Giovanni Evangelista Hospital, Tivoli, Rome, Italy
| | - Claudio Dadone
- Department of Urology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Gaetano De Rienzo
- Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Andrea Ditonno
- Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Antonio Frattini
- Department of Urology, Ospedale Civile di Guastalla, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Ercole Franchini di Montecchio Emilia Hospital, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Pucci
- Department of Urology, AORN Antonio Cardarelli, Naples, Italy
| | | | - Franco Montefiore
- Department of Urology, San Giacomo Hospital, Novi Ligure, Alessandria, Italy
| | - Stefano Germani
- Unit of Urology, Department of Surgery, Tor Vergata Polyclinic Foundation, Tor Vergata University, Rome, Italy
| | - Roberto Miano
- Unit of Urology, Department of Surgery, Tor Vergata Polyclinic Foundation, Tor Vergata University, Rome, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti, Italy
| | | | | | - Luca Cindolo
- Department of Urology, Villa Stuart Private Hospital, Rome, Italy
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10
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Campobasso D, Marchioni M, Altieri V, Greco F, De Nunzio C, Destefanis P, Ricciardulli S, Bergamaschi F, Fasolis G, Varvello F, Voce S, Palmieri F, Divan C, Malossini G, Oriti R, Tuccio A, Ruggera L, Tubaro A, Delicato G, Laganà A, Dadone C, De Rienzo G, Frattini A, Pucci L, Carrino M, Montefiore F, Germani S, Miano R, Schips L, Rabito S, Ferrari G, Cindolo L. GreenLight Photoselective Vaporization of the Prostate: One Laser for Different Prostate Sizes. J Endourol 2020; 34:54-62. [DOI: 10.1089/end.2019.0478] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Davide Campobasso
- Department of Urology, Ospedale Civile di Guastalla and Ospedale Ercole Franchini di Montecchio Emilia, Azienda USL-IRCCS di Reggio Emilia, Guastalla, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, “G. D'Annunzio” University of Chieti, Chieti, Italy
| | | | | | - Cosimo De Nunzio
- Department of Urology, “Sant'Andrea” Hospital, Sapienza University, Roma, Italy
| | - Paolo Destefanis
- Department of Urology, Azienda Ospedaliera Città della Salute e della Scienza di Torino—Sede Molinette, Torino, Italy
| | | | - Franco Bergamaschi
- Department of Urology, “Arcispedale Santa Maria Nuova,” Reggio Emilia, Italy
| | | | | | - Salvatore Voce
- Department of Urology, “Santa Maria delle Croci Hospital,” Ravenna, Italy
| | - Fabiano Palmieri
- Department of Urology, “Santa Maria delle Croci Hospital,” Ravenna, Italy
| | - Claudio Divan
- Department of Urology, “Rovereto Hospital,” Rovereto, Italy
| | | | - Rino Oriti
- Department of Urology, “Ulivella e Glicini Clinic,” Florence, Italy
| | - Agostino Tuccio
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Lorenzo Ruggera
- Department of Urology, Clinica urologica azienda ospedaliera, University of Padova, Padova, Italy
| | - Andrea Tubaro
- Department of Urology, “Sant'Andrea” Hospital, Sapienza University, Roma, Italy
| | - Giampaolo Delicato
- Department of Urology, “S. Giovanni Evangelista” Hospital, Tivoli, Italy
| | - Antonino Laganà
- Department of Urology, “S. Giovanni Evangelista” Hospital, Tivoli, Italy
| | - Claudio Dadone
- Department of Urology, “Santa Croce e Carle” Hospital, Cuneo, Italy
| | - Gaetano De Rienzo
- Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari, Bari, Italy
| | - Antonio Frattini
- Department of Urology, Ospedale Civile di Guastalla and Ospedale Ercole Franchini di Montecchio Emilia, Azienda USL-IRCCS di Reggio Emilia, Guastalla, Italy
| | - Lugi Pucci
- Department of Urology, AORN “Antonio Cardarelli,” Naples, Italy
| | | | | | - Stefano Germani
- UOSD Urologia, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Roberto Miano
- UOSD Urologia, Dipartimento di Scienze Chirurgiche, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Luigi Schips
- Department of Urology, ASL Abruzzo 2, Chieti, Italy
| | | | | | - Luca Cindolo
- Department of Urology, “Villa Stuart” Private Hospital, Rome, Italy
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11
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Illiano E, Ditonno P, Giannitsas K, De Rienzo G, Bini V, Costantini E. AUTHOR REPLY. Urology 2019; 134:122-123. [PMID: 31789174 DOI: 10.1016/j.urology.2019.07.047] [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] [Received: 05/11/2019] [Accepted: 07/30/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Ester Illiano
- Andrology and Urogynecology Clinic, Santa Maria Terni, Terni Hospital, Department of Surgical and Biomedical Science, University of Perugia, Italy
| | - Pasquale Ditonno
- Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | - Gaetano De Rienzo
- Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Vittorio Bini
- Internal Medicine, Endocrine and Metabolic Science Section, Department of Medicine, University of Perugia, Italy
| | - Elisabetta Costantini
- Andrology and Urogynecology Clinic, Santa Maria Terni, Terni Hospital, Department of Surgical and Biomedical Science, University of Perugia, Italy
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12
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Illiano E, Ditonno P, Giannitsas K, De Rienzo G, Bini V, Costantini E. Robot-assisted Vs Laparoscopic Sacrocolpopexy for High-stage Pelvic Organ Prolapse: A Prospective, Randomized, Single-center Study. Urology 2019; 134:116-123. [DOI: 10.1016/j.urology.2019.07.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/24/2019] [Accepted: 07/30/2019] [Indexed: 11/25/2022]
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13
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Marchioni M, Schips L, Greco F, Frattini A, Neri F, Ruggera L, Fasolis G, Varvello F, Destefanis P, De Rienzo G, Ditonno P, Ferrari G, Cindolo L. Perioperative major acute cardiovascular events after 180-W GreenLight laser photoselective vaporization of the prostate. Int Urol Nephrol 2018; 50:1955-1962. [PMID: 30141122 DOI: 10.1007/s11255-018-1968-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/16/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Major acute cardiovascular events (MACE) prevalence after 180-W GreenLight (180-W GL) laser photoselective vaporization (PVP) have never been explored. Aim of our study is to evaluate perioperative MACE that occurred concomitantly with 180-W GL PVP. MATERIALS AND METHODS We relied on a multi-institutional database that included 14 centers. Data from 923 patients who underwent 180-W GL PVP were reviewed. We abstracted pre- and perioperative data of patients who experienced perioperative MACE, such as angina pectoris, acute myocardial infarction, other chronic ischemic heart disease, transient ischemic attack, or cerebrovascular accident as well as deep venous thrombosis with or without pulmonary embolism. We relied on a case-series format to report the main findings of our analyses. RESULTS 18 (1.9%) patients reported MACE in 7 centers. Median age was 69.5 (IQR 66.0-79.2) years. Of all, 7 patients underwent standard PVP and 11 anatomical PVP. Eleven patients (61.1%) were not under anticoagulant/antiplatelet treatment, 6 (33.3%) were under low dose aspirin, and 1 (5.6%) was under clopidogrel. Four patients (22.2%) had an instrumental and laboratory diagnosis of myocardial infarction, 7 (38.9%) had an episode of angina pectoris with or without rhythm alteration, 3 (16.7%) reported symptomatic deep venous thrombosis, and 4 (22.2%) had other MACE-like events. CONCLUSIONS Physician should take in consideration the possibility of MACE or MACE-like events. The real MACE rate may be different as only half of included centers reported MACE. Since the main target of laser surgery are high-risk bleeding patients, prospective observational trials focused on detection of these possible complications are warranted.
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Affiliation(s)
| | - Luigi Schips
- Department of Urology, "G. D'Annunzio" University, Chieti, Italy
| | - Francesco Greco
- Department of Urology, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Antonio Frattini
- Department of Urology, "Ercole Franchini" Hospital, Montecchio Emilia and Civital Hospital of Guastalla, AUSL of Reggio Emilia, Reggio Emilia, Italy
| | - Fabio Neri
- Department of Urology, ASL Abruzzo2, Chieti, Italy
| | - Lorenzo Ruggera
- Department of Urology, Clinica urologica azienda ospedaliera - University of Padova, Padua, Italy
| | | | | | - Paolo Destefanis
- Department of Urology, Azienda Ospedaliera Città della Salute e della Scienza di Torino - Sede Molinette, Torino, Italy
| | - Gaetano De Rienzo
- Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari, Bari, Italy
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari, Bari, Italy
| | | | - Luca Cindolo
- Department of Urology, ASL Abruzzo2, Chieti, Italy. .,Urology Department, ASL Abruzzo2, Via S. Camillo de Lellis 1, 66054, Vasto, Italy.
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14
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Cindolo L, De Nunzio C, Greco F, Destefanis P, Bergamaschi F, Ferrari G, Fasolis G, Palmieri F, Divan C, Oriti R, Ruggera L, Tubaro A, Dadone C, De Rienzo G, Frattini A, Mirone V, Schips L. Standard vs. anatomical 180-W GreenLight laser photoselective vaporization of the prostate: a propensity score analysis. World J Urol 2017; 36:91-97. [DOI: 10.1007/s00345-017-2106-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/20/2017] [Indexed: 11/30/2022] Open
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