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Martini A, Wever L, Soeterik TFW, Rakauskas A, Fankhauser CD, Grogg JB, Checcucci E, Amparore D, Haiquel L, Rodriguez-Sanchez L, Ploussard G, Qiang P, Affentranger A, Marquis A, Marra G, Ettala O, Zattoni F, Falagario UG, De Angelis M, Kesch C, Apfelbeck M, Al-Hammouri T, Kretschmer A, Kasivisvanathan V, Preisser F, Lefebvre E, Olivier J, Radtke JP, Carrieri G, Moro FD, Boström P, Jambor I, Gontero P, Chiu PK, John H, Macek P, Porpiglia F, Hermanns T, van den Bergh RCN, van Basten JPA, Gandaglia G, Valerio M. An updated model for predicting side-specific extraprostatic extension in the era of MRI-targeted biopsy. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-023-00776-x. [PMID: 38182804 DOI: 10.1038/s41391-023-00776-x] [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: 09/03/2023] [Revised: 11/26/2023] [Accepted: 12/01/2023] [Indexed: 01/07/2024]
Abstract
PURPOSE Accurate prediction of extraprostatic extension (EPE) is pivotal for surgical planning. Herein, we aimed to provide an updated model for predicting EPE among patients diagnosed with MRI-targeted biopsy. MATERIALS AND METHODS We analyzed a multi-institutional dataset of men with clinically localized prostate cancer diagnosed by MRI-targeted biopsy and subsequently underwent prostatectomy. To develop a side-specific predictive model, we considered the prostatic lobes separately. A multivariable logistic regression analysis was fitted to predict side-specific EPE. The decision curve analysis was used to evaluate the net clinical benefit. Finally, a regression tree was employed to identify three risk categories to assist urologists in selecting candidates for nerve-sparing, incremental nerve sparing and non-nerve-sparing surgery. RESULTS Overall, data from 3169 hemi-prostates were considered, after the exclusion of prostatic lobes with no biopsy-documented tumor. EPE was present on final pathology in 1,094 (34%) cases. Among these, MRI was able to predict EPE correctly in 568 (52%) cases. A model including PSA, maximum diameter of the index lesion, presence of EPE on MRI, highest ISUP grade in the ipsilateral hemi-prostate, and percentage of positive cores in the ipsilateral hemi-prostate achieved an AUC of 81% after internal validation. Overall, 566, 577, and 2,026 observations fell in the low-, intermediate- and high-risk groups for EPE, as identified by the regression tree. The EPE rate across the groups was: 5.1%, 14.9%, and 48% for the low-, intermediate- and high-risk group, respectively. CONCLUSION In this study we present an update of the first side-specific MRI-based nomogram for the prediction of extraprostatic extension together with updated risk categories to help clinicians in deciding on the best approach to nerve-preservation.
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Affiliation(s)
- Alberto Martini
- Department of Urology, La Croix du Sud Hospital, Toulouse, France.
| | - Lieke Wever
- St. Antonius ziekenhuis, Nieuwegein, the Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Arnas Rakauskas
- Department of Urology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Josias Bastian Grogg
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | - Luciano Haiquel
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | | | - Peng Qiang
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Alessandro Marquis
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Otto Ettala
- Department of Urology, Turku University, Turku, Finland
| | - Fabio Zattoni
- Urology Unit, Academical Medical Centre Hospital, Udine, Italy
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | | | - Mario De Angelis
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | | | - Tarek Al-Hammouri
- Department of Urology, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Veeru Kasivisvanathan
- Department of Urology, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | | | | | - Jan Philipp Radtke
- Department of Urology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | | | - Fabrizio Dal Moro
- Urology Unit, Academical Medical Centre Hospital, Udine, Italy
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | - Peter Boström
- Department of Urology, Turku University, Turku, Finland
| | - Ivan Jambor
- Department of Urology, Turku University, Turku, Finland
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Peter K Chiu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Hubert John
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Jean-Paul A van Basten
- St. Antonius ziekenhuis, Nieuwegein, the Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Massimo Valerio
- Department of Urology, Geneva University Hospital, Geneva, Switzerland.
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Rodriguez-Sanchez L, Martini A, Zhuang J, Guo H, Rajwa P, Mandoorah Q, Haiquel L, Shariat SF, Gandaglia G, Valerio M, Marra G. External validation of an algorithm to personalize nerve sparing approaches during robot-assisted radical prostatectomy in men with unilateral high-risk prostate cancer. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-023-00779-8. [PMID: 38177256 DOI: 10.1038/s41391-023-00779-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/19/2023] [Accepted: 12/13/2023] [Indexed: 01/06/2024]
Abstract
Limited evidence exists about preserving neurovascular bundles during radical prostatectomy (RP) for high-risk prostate cancer (HRPCa) patients. Hence, we validated an existing algorithm predicting contralateral extraprostatic extension (cEPE) risk in unilateral high-risk cases. This algorithm aims to assist in determining the suitability of unilateral nerve-sparing RP. Among 264 patients, 48 (18%) had cEPE. The risk of cECE varied: 8%, 17.2%, and 30.8% for the low, intermediate, and high-risk groups, respectively. Despite a higher risk of cECE among individuals classified as low-risk in the development group compared to the validation group, our algorithm's superiority over always/never nerve-sparing RP was reaffirmed by decision curve analysis. Therefore, we conclude that bilateral excision may not always be justified in men with unilateral HRPCa. Instead, decisions can be based on our suggested nomogram.
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Affiliation(s)
| | - Alberto Martini
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Junlong Zhuang
- Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, PR China
| | - Hongqiao Guo
- Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, PR China
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Qusay Mandoorah
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Luciano Haiquel
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Valerio
- Department of Urology, Geneva University Hospital, Geneva, Switzerland
| | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
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Martini A, Wever L, Soeterik TFW, Rakauskas A, Fankhauser CD, Grogg JB, Checcucci E, Amparore D, Haiquel L, Rodriguez-Sanchez L, Ploussard G, Qiang P, Affentranger A, Marquis A, Marra G, Ettala O, Zattoni F, Falagario UG, De Angelis M, Kesch C, Apfelbeck M, Al-Hammouri T, Kretschmer A, Kasivisvanathan V, Preisser F, Lefebvre E, Olivier J, Radtke JP, Briganti A, Montorsi F, Carrieri G, Moro FD, Boström P, Jambor I, Gontero P, Chiu PK, John H, Macek P, Porpiglia F, Hermanns T, van den Bergh RCN, van Basten JPA, Gandaglia G, Valerio M. Unilateral Pelvic Lymph Node Dissection in Prostate Cancer Patients Diagnosed in the Era of Magnetic Resonance Imaging-targeted Biopsy: A Study That Challenges the Dogma. J Urol 2023; 210:117-127. [PMID: 37052480 DOI: 10.1097/ju.0000000000003442] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 03/21/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE Bilateral extended pelvic lymph node dissection at the time of radical prostatectomy is the current standard of care if pelvic lymph node dissection is indicated; often, however, pelvic lymph node dissection is performed in pN0 disease. With the more accurate staging achieved with magnetic resonance imaging-targeted biopsies for prostate cancer diagnosis, the indication for bilateral extended pelvic lymph node dissection may be revised. We aimed to assess the feasibility of unilateral extended pelvic lymph node dissection in the era of modern prostate cancer imaging. MATERIALS AND METHODS We analyzed a multi-institutional data set of men with cN0 disease diagnosed by magnetic resonance imaging-targeted biopsy who underwent prostatectomy and bilateral extended pelvic lymph node dissection. The outcome of the study was lymph node invasion contralateral to the prostatic lobe with worse disease features, ie, dominant lobe. Logistic regression to predict lymph node invasion contralateral to the dominant lobe was generated and internally validated. RESULTS Overall, data from 2,253 patients were considered. Lymph node invasion was documented in 302 (13%) patients; 83 (4%) patients had lymph node invasion contralateral to the dominant prostatic lobe. A model including prostate-specific antigen, maximum diameter of the index lesion, seminal vesicle invasion on magnetic resonance imaging, International Society of Urological Pathology grade in the nondominant side, and percentage of positive cores in the nondominant side achieved an area under the curve of 84% after internal validation. With a cutoff of contralateral lymph node invasion of 1%, 602 (27%) contralateral pelvic lymph node dissections would be omitted with only 1 (1.2%) lymph node invasion missed. CONCLUSIONS Pelvic lymph node dissection could be omitted contralateral to the prostate lobe with worse disease features in selected patients. We propose a model that can help avoid contralateral pelvic lymph node dissection in almost one-third of cases.
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Affiliation(s)
- Alberto Martini
- Department of Urology, La Croix du Sud Hospital, Toulouse, France
| | - Lieke Wever
- St Antonius Ziekenhuis, Nieuwegein, The Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Arnas Rakauskas
- Department of Urology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Josias Bastian Grogg
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | - Luciano Haiquel
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | | | - Peng Qiang
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | - Alessandro Marquis
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Otto Ettala
- Department of Urology, Turku University, Turku, Finland
| | - Fabio Zattoni
- Urology Unit, Academical Medical Centre Hospital, Udine, Italy
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | | | - Mario De Angelis
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | | | - Tarek Al-Hammouri
- Department of Urology, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Veeru Kasivisvanathan
- Department of Urology, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | | | | | - Jan Philipp Radtke
- Department of Urology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Fabrizio Dal Moro
- Urology Unit, Academical Medical Centre Hospital, Udine, Italy
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | - Peter Boström
- Department of Urology, Turku University, Turku, Finland
| | - Ivan Jambor
- Department of Urology, Turku University, Turku, Finland
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Peter K Chiu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Hubert John
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Jean-Paul A van Basten
- St Antonius Ziekenhuis, Nieuwegein, The Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Massimo Valerio
- Department of Urology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
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Martini A, Wever L, Soeterik TFW, Rakauskas A, Fankhauser CD, Grogg JB, Checcucci E, Amparore D, Haiquel L, Rodriguez-Sanchez L, Ploussard G, Qiang P, Affentranger A, Marquis A, Marra G, Ettala O, Zattoni F, Falagario UG, De Angelis M, Kesch C, Apfelbeck M, Al-Hammouri T, Kretschmer A, Kasivisvanathan V, Preisser F, Lefebvre E, Olivier J, Radtke JP, Briganti A, Montorsi F, Carrieri G, Moro FD, Boström P, Jambor I, Gontero P, Chiu PK, John H, Macek P, Porpiglia F, Hermanns T, van den Bergh RCN, van Basten JPA, Gandaglia G, Valerio M. Reply by Authors. J Urol 2023:101097JU000000000000344202. [PMID: 37052482 DOI: 10.1097/ju.0000000000003442.02] [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: 04/14/2023]
Affiliation(s)
- Alberto Martini
- Department of Urology, La Croix du Sud Hospital, Toulouse, France
| | - Lieke Wever
- St Antonius Ziekenhuis, Nieuwegein, The Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Arnas Rakauskas
- Department of Urology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Josias Bastian Grogg
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | - Luciano Haiquel
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | | | - Peng Qiang
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | - Alessandro Marquis
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Otto Ettala
- Department of Urology, Turku University, Turku, Finland
| | - Fabio Zattoni
- Urology Unit, Academical Medical Centre Hospital, Udine, Italy
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | | | - Mario De Angelis
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | | | - Tarek Al-Hammouri
- Department of Urology, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Veeru Kasivisvanathan
- Department of Urology, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | | | | | - Jan Philipp Radtke
- Department of Urology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Fabrizio Dal Moro
- Urology Unit, Academical Medical Centre Hospital, Udine, Italy
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | - Peter Boström
- Department of Urology, Turku University, Turku, Finland
| | - Ivan Jambor
- Department of Urology, Turku University, Turku, Finland
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Peter K Chiu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Hubert John
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Jean-Paul A van Basten
- St Antonius Ziekenhuis, Nieuwegein, The Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Massimo Valerio
- Department of Urology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
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Abstract
INTRODUCTION The therapeutic role of pelvic lymph node dissection (PLND) in prostate cancer (PCa) is unknown due to absence of randomized trials. OBJECTIVE to present a critical review on the therapeutic benefits of PLND in high risk localized PCa patients. MATERIALS AND METHODS A search of the literature on PLND was performed using PubMed, Cochrane, and Medline database. Articles obtained regarding diagnostic imaging and sentinel lymph node dissection, PLND extension, impact of PLND on survival, PLND in node positive "only" disease and PLND surgical risks were critically reviewed. RESULTS High-risk PCa commonly develops metastases. In these patients, the possibility of presenting lymph node disease is high. Thus, extended PLND during radical prostatectomy may be recommended in selected patients with localized high-risk PCa for both accurate staging and therapeutic intent. Although recent advances in detecting patients with lymph node involvement (LNI) with novel imaging and sentinel node dissection, extended PLND continues to be the most accurate method to stage lymph node disease, which may be related to the number of nodes removed. However, extended PLND increases surgical time, with potential impact on perioperative complications, hospital length of stay, rehospitalization and healthcare costs. Controversy persists on its therapeutic benefit, particularly in patients with high node burden. CONCLUSION The impact of PLND on biochemical recurrence and PCa survival is unclear yet. Selection of patients may benefit from extended PLND but the challenge remains to identify them accurately. Only prospective randomized study would answer the precise role of PLND in high-risk pelvis confined PCa patients.
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Affiliation(s)
- Luciano Haiquel
- Sanatorio Las Lomas de San IsidroDepartment of UrologyBuenos AiresArgentinaDepartment of Urology, Sanatorio Las Lomas de San Isidro, Buenos Aires, Argentina
| | - Xavier Cathelineau
- Université Paris DescartesL’Institut Mutualiste MontsourisDepartment of UrologyParisFranceDepartment of Urology, L’Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Université Paris DescartesL’Institut Mutualiste MontsourisDepartment of UrologyParisFranceDepartment of Urology, L’Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Petr Macek
- Université Paris DescartesL’Institut Mutualiste MontsourisDepartment of UrologyParisFranceDepartment of Urology, L’Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Fernando Secin
- Universidad de Buenos AiresDiscipline of UrologyArgentinaDiscipline of Urology, Universidad de Buenos Aires, Argentina
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