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Manfredi C, Franco A, Ditonno F, Mathur R, Franco G, Lombardo R, Russo GI, DE Cillis S, Fiori C, Arcaniolo D, Antonelli A, Autorino R, DE Sio M, DE Nunzio C. Treatment preferences of patients with erectile dysfunction: a systematic review of randomized controlled trials. Minerva Urol Nephrol 2024; 76:42-51. [PMID: 38426421 DOI: 10.23736/s2724-6051.23.05552-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Patients' treatment preferences (PTP) depend on the complex interaction of numerous patient- and treatment-related factors; their assessment can guide therapy and promote compliance of patients with erectile dysfunction (ED). We aimed to systematically describe the literature evaluating the treatment preferences of patients with ED, published in the last 25 years. EVIDENCE ACQUISITION A comprehensive bibliographic search of multiple databases was conducted in June, 2023. The literature search was limited to the articles published since 1998. Articles were deemed eligible if they described male patients with ED (P) undergoing treatment for this condition (I) compared with other treatments, placebo or sham therapy (C), and reported PTP (O). Only randomized controlled trials (RCTs) and post-hoc analyses of RCTs were selected (S). The data were presented in a narrative fashion. The risk of bias (RoB) was evaluated using the RoB 2 tool and the Mulhall-Montorsi model. EVIDENCE SYNTHESIS A total 14 RCTs evaluating 6,841 patients and 4 post-hoc analyses of RCTs were included. All RCTs were considered to be at high RoB. No validated tool was used to investigate PTP. Sildenafil was the most frequently evaluated ED treatment (9 RCTs). Sildenafil was chosen over placebo by 78-100% of subjects and over ICI in 70% of patients due to its easier route of administration. No significant difference in patient preference was recorded between Sildenafil tablets and orodispersible (53% vs. 47%, P>0.05). Tadalafil was preferred over Sildenafil by 66-73% of patients (P<0.05), mainly because it allowed an erection long after taking the drug (55-67%). Tadalafil as-needed was chosen over Tadalafil 3 times/week by 57-59% of the patients (P<0.05). CONCLUSIONS The available RCTs support the preference of ED patients for Sildenafil over ICI, Tadalafil over Sildenafil, and Tadalafil as-needed over Tadalafil 3 times/week. However, these findings should be considered at high RoB.
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Affiliation(s)
- Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, Chicago, IL, USA -
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Raman Mathur
- Medical School, Midwestern University, Downers Grove, IL, USA
| | - Giorgio Franco
- Department of Urology, Policlinico Umberto I Hospital, Sapienza University, Rome, Italy
| | - Riccardo Lombardo
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Giorgio I Russo
- Section of Urology, Department of Surgery, University of Catania, Catania, Italy
| | - Sabrina DE Cillis
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Davide Arcaniolo
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Marco DE Sio
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Cosimo DE Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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Anceschi U, Amparore D, Prata F, Tedesco F, Cacciatore L, Checcucci E, Bove AM, DE Cillis S, Iannuzzi A, Quarà A, Ragusa A, Ortenzi M, Flammia RS, Zampa A, Misuraca L, Tuderti G, Brassetti A, Ferriero M, Mastroianni R, Tufano A, Fiori C, Porpiglia F, Gallucci M, Simone G. Predictors of mid-term functional outcomes for robot-assisted Madigan simple prostatectomy: results of a multicentric series according to the BPH-6 achievement. Minerva Urol Nephrol 2023; 75:607-615. [PMID: 37728496 DOI: 10.23736/s2724-6051.23.05373-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND BPH-6 achievement remains an objective far to be evaluated for every technique currently available for the surgical management of bladder outlet obstruction (BOO) with the goal of preserving ejaculatory function. The aim of this study was to evaluate predictors of BPH-6 achievement of urethral-sparing robot assisted simple prostatectomy (us-RASP) on a large series performed at two tertiary-care centers. METHODS Two institutional us-RASP datasets were merged, considering eligible all patients with a follow-up >12 months. Baseline, perioperative and functional data according to BPH-6 endpoint were assessed. Descriptive analysis was used. Frequencies and proportions were reported for categorical variables while medians and interquartile ranges (IQRs) were reported for continuously coded variables. A logistic regression model was built to identify predictors of BPH-6 achievement. For all statistical analyses, a two-sided P<0.05 was considered significant. RESULTS Study cohort consisted of 94 eligible patients. The median follow-up was 40.7 months (IQR 31.3-54.2). Overall BPH-6 achievement was 54.7%. Compared to baseline, reduction of ≥30% in IPSS was observed in 93.6% of patients, reduction of <6 points for SHIM in 95.7% and response to MSHQ-EjD question 3 indicating emission of semen in 72.6%, respectively. On multivariable analysis, prostate volume between 110-180 mL (OR 0.09; 95% CI 0.01-0.92; P=0.043) and higher preoperative SHIM score (OR 1.18; 95% CI 1.05-1.32; P<0.01) were independent predictors of BPH-6 metric achievement. CONCLUSIONS us-RASP may provide a complete resolution of BOO and preservation of ejaculatory function in sexually active men with a prostate volume ranging 110-180 mL.
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Affiliation(s)
- Umberto Anceschi
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy -
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Prata
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico of Rome, Rome, Italy
| | - Francesco Tedesco
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico of Rome, Rome, Italy
| | - Loris Cacciatore
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico of Rome, Rome, Italy
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute FPO-IRCCS, Candiolo, Turin, Italy
| | - Alfredo M Bove
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Sabrina DE Cillis
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Andrea Iannuzzi
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico of Rome, Rome, Italy
| | - Alberto Quarà
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Alberto Ragusa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico of Rome, Rome, Italy
| | - Michele Ortenzi
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Rocco S Flammia
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Ashanti Zampa
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Aldo Brassetti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | | | - Riccardo Mastroianni
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Antonio Tufano
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Michele Gallucci
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
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DE Cillis S, Phé V, Osman N. New technologies in the surgical treatment of stress urinary incontinence: which is the path to pursue? Minerva Urol Nephrol 2023; 75:661-662. [PMID: 37728502 DOI: 10.23736/s2724-6051.23.05542-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
- Sabrina DE Cillis
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Véronique Phé
- Department of Urology, Tenon Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
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Geretto P, DE Cillis S, Karsenty G, Candela L, Phé V. Totally intracorporeal robot-assisted supratrigonal cystectomy and ileal augmentation cystoplasty with periprostatic artificial urinary sphincter implantation for male neurogenic mixed urinary incontinence. Minerva Urol Nephrol 2023; 75:272-274. [PMID: 37221825 DOI: 10.23736/s2724-6051.23.05314-4] [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: 05/25/2023]
Affiliation(s)
- Paolo Geretto
- Department of Urology, Tenon Academic Hospital, Assistance-Publique - Hôpitaux de Paris, Sorbonne University, Paris, France -
- Division of Neuro-Urology, Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy -
| | - Sabrina DE Cillis
- Department of Urology, Tenon Academic Hospital, Assistance-Publique - Hôpitaux de Paris, Sorbonne University, Paris, France
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Gilles Karsenty
- Department of Urology and Kidney Transplantation, La Conception Hospital, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Luigi Candela
- Department of Urology, Tenon Academic Hospital, Assistance-Publique - Hôpitaux de Paris, Sorbonne University, Paris, France
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Véronique Phé
- Department of Urology, Tenon Academic Hospital, Assistance-Publique - Hôpitaux de Paris, Sorbonne University, Paris, France
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Alessio P, DE Cillis S, Volpi G, Piramide F, Piana A, Gatti C, Amparore D, Fiori C, Checcucci E. Comment on: "Long-term follow-up of two-sided dorsal plus ventral oral graft bulbar urethroplasty: single-center experience on 216 patients". Minerva Urol Nephrol 2023; 75:258-259. [PMID: 36999844 DOI: 10.23736/s2724-6051.23.05320-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Affiliation(s)
- Paolo Alessio
- Department of Surgery, Candiolo Cancer Institute FPO-IRCCS, Turin, Italy -
| | - Sabrina DE Cillis
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Gabriele Volpi
- Department of Surgery, Candiolo Cancer Institute FPO-IRCCS, Turin, Italy
| | - Federico Piramide
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Alberto Piana
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cecilia Gatti
- Department of Surgery, Candiolo Cancer Institute FPO-IRCCS, Turin, Italy
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute FPO-IRCCS, Turin, Italy
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DE Luca S, Checcucci E, Piramide F, Russo F, Alessio P, Garrou D, Peretti D, Sica M, Volpi G, Piana A, DE Cillis S, Amparore D, Manfredi M, Fiori C, Porpiglia F. MRI/real-time ultrasound image fusion guided high-intensity focused ultrasound: a prospective comparative and functional analysis of different ablative techniques. Minerva Urol Nephrol 2023; 75:172-179. [PMID: 36286396 DOI: 10.23736/s2724-6051.22.04853-4] [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] [Indexed: 04/01/2023]
Abstract
BACKGROUND The aim of this paper was to compare safety and functional outcomes of total, hemi and focal ablation by the latest focal high-intensity focused ultrasound (HIFU) device. METHODS This is a prospective study including patients with low to intermediate-risk PCa treated with HIFU by Focal One® device from 11/2018 to 3/2020. Before the treatment all patients underwent mp-magnetic resonance imaging (MRI) and subsequent MRI/transrectal ultrasound (TRUS) fusion and standard biopsy. Patients were stratified according to the type of ablation: total, hemi- or focal ablation. Functional data (IPSS, Quality of Life [QoL], IIEF-5, maximum flow [Qmax] and post void residual [PVR] at flowmetry) were assessed preoperatively and at 1, 3, 6 and 12 months after treatment. Moreover, the urinary symptoms reported by patients at IPSS questionnaire were divided in "irritative" and "obstructive" and compared. RESULTS One hundred patients were enrolled. Median prostate volume and lesion diameter were 46 (IQR 25-75) mL and 10 (IQR 6-13) mm. 15, 50 and 35 patients underwent total, hemi- and focal ablation, respectively. No differences were found between them except for operative time (lower in the focal group, P<0.01). Significant lower incidence of irritative symptoms was identified in the focal group compared to the others (P<0.05 at 1 and 3 months of follow-up). No differences were found among the baseline status and the postoperative assessment in terms of obstructive IPSS items, IIEF-5, QoL, Qmax and PVR (all P value>0.05). CONCLUSIONS Our study suggests that patients' specific HIFU tailoring with the MRI/real-time TRUS Guidance by Focal One® device is able to minimize the side effects of treatment.
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Affiliation(s)
- Stefano DE Luca
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Federico Piramide
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Filippo Russo
- Department of Radiology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Paolo Alessio
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Diletta Garrou
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Dario Peretti
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Michele Sica
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Gabriele Volpi
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Alberto Piana
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Sabrina DE Cillis
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Matteo Manfredi
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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Geretto P, DE Cillis S, Phé V. Voiding patterns following radical cystectomy and orthotopic neobladder: is intermittent self-catheterization worth the hype? Minerva Urol Nephrol 2023; 75:246-247. [PMID: 36999840 DOI: 10.23736/s2724-6051.23.05316-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Affiliation(s)
- Paolo Geretto
- Division of Neuro-Urology, Department of Surgical Sciences, CTO Hospital, Città della Salute e della Scienza, Turin, Italy -
| | - Sabrina DE Cillis
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Veronique Phé
- Department of Urology, Tenon Academic Hospital, Assistance Publique-Hopitaux de Paris, Sorbonne University, Paris, France
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Porpiglia F, Checcucci E, DE Cillis S, Piramide F, Amparore D, Piana A, Volpi G, Granato S, Zamengo D, Stura I, Alladio E, Migliaretti G, DE Luca S, Bollito E, Gned D, DI Dio M, Autorino R, Manfredi M, Fiori C. A prospective randomized controlled trial comparing target prostate biopsy alone approach vs. target plus standard in naïve patients with positive mpMRI. Minerva Urol Nephrol 2023; 75:31-41. [PMID: 36626117 DOI: 10.23736/s2724-6051.22.05189-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND In the era of mpMRI guided target fusion biopsy (FB), the role of concomitant standard biopsy (SB) in naïve patients still remains under scrutiny. The aim of this study was to compare the detection rate (DR) of clinically significant prostate cancer (csPCa) in biopsy naïve patients with positive mpMRI who underwent FB alone (Arm A) vs FB+SB (Arm B). Secondary objectives were to compare the incidence of complications, the overall PCa DR and the biopsy results with final pathological findings after robotic prostatectomy (RARP). METHODS This is a single center prospective non-inferiority parallel two arms (1:1) randomized control trial (ISRCTN registry number ISRCTN60263108) which took place at San Luigi Gonzaga University Hospital, Orbassano (Turin, Italy) from 4/2019 to 10/2021. Eligible participants were all adults aged<75 years old, biopsy naïve, with serum PSA<15 ng/mL and positive mpMRI (Pi-Rads V.2>3). FB was performed under ultrasound guidance using the BioJet fusion system; four to six target samples were obtained for each index lesion. SB was performed in accordance with the protocol by Rodríguez-Covarrubias. RARP with total anatomical reconstruction was carried out when indicated. DR of PCa and csPCA (Gleason Score >7) were evaluated. Post-biopsy complications according to Clavien-Dindo were recorded. Concordance between biopsy and RARP pathological findings was evaluated. Fisher's Exact test and Mann-Whitney test were applied; furthermore, Logistic Principal Component Analysis (LogPCA) and Pearson's correlation method, in terms of correlation funnel plots, were performed to explore data in a multivariate way. RESULTS 201 and 193 patients were enrolled in Arm A and B, respectively. csPCa DR was 60.2% vs. 60.6% in Arm A and B respectively (Δ 0.4%; P=0.93); whilst overall PCa DR was 63.7% vs. 71.0% (Δ 7.3%; P=0.12). However, in a target only setting, the addition of SB homolaterally to the index lesion reaching a non-inferior performance compared to the combined sampling (Δ PCa DR 3%). Although the differences of 7.3% in PCa DR, during RARP were registered similar nerve sparing rate (P=0.89), positive surgical margins (P=0.67) and rate of significant upgrading (P=0.12). LogPCA model showed no distinction between the two cohorts; and Pearson's correlation values turned to be between -0.5 and +0.5. In Arm B, the lesion diameter <10 mm is the only predictive variable of positive SB only for PCa (P=0.04), with an additional value +3% for PCa DR. CONCLUSIONS In biopsy naïve patients, FB alone is not inferior to FB+SB in detecting csPCa (Δ csPCa DR 0.4%). Δ 7.3% in overall PCa DR was registered between the two Arms, however the addition of further standard samples homolaterally to mp-MRI index lesion improved the overall PCa DR of FB only sampling (Δ PCa DR 3%). The omission of SB did not influence the post-surgical outcomes in terms of NS approach, PSMr and upgrading/downgrading.
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Affiliation(s)
- Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy - .,Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Sabrina DE Cillis
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Federico Piramide
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Alberto Piana
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Gabriele Volpi
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Stefano Granato
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Davide Zamengo
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Ilaria Stura
- Department of Public Health and Pediatric Sciences, School of Medicine, University of Turin, Turin, Italy
| | | | | | - Stefano DE Luca
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Enrico Bollito
- Department of Pathology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Dario Gned
- Department of Radiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Michele DI Dio
- Division of Urology, Department of Surgery, SS Annunziata Hospital, Cosenza, Italy
| | | | - Matteo Manfredi
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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DE Cillis S, Geretto P, Cancrini F, Phé V. Uncomplicated overactive bladder: do we need urodynamics testing for better etiologic evaluation? Minerva Urol Nephrol 2022; 73:868-869. [PMID: 35144375 DOI: 10.23736/s2724-6051.21.04823-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sabrina DE Cillis
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy -
| | - Paolo Geretto
- Division of Neuro-Urology, Department of Surgical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Fabiana Cancrini
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Véronique Phé
- Division of Urology, Tenon Hospital, Sorbonne University, Paris, France
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Amparore D, DE Cillis S, Checcucci E, Fiori C. Functional and sexual outcomes recovery after simple prostatectomy: the past, the present, the future of the surgical technique. Minerva Urol Nephrol 2021; 73:554-556. [PMID: 34494418 DOI: 10.23736/s2724-6051.21.04633-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Daniele Amparore
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Sabrina DE Cillis
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Enrico Checcucci
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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Amparore D, Pecoraro A, Piramide F, Checcucci E, DE Cillis S, Volpi G, Piana A, Verri P, Granato S, Sica M, Manfredi M, Fiori C, Porpiglia F. Comparison between minimally-invasive partial and radical nephrectomy for the treatment of clinical T2 renal masses: results of a 10-year study in a tertiary care center. Minerva Urol Nephrol 2021; 73:509-517. [PMID: 33887896 DOI: 10.23736/s2724-6051.21.04390-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Even if partial nephrectomy (PN) is nowadays considered the standard for managing cT1 renal masses, its role in the management of cT2 kidney tumors is controversial. We aimed to compare oncologic and functional outcomes of minimally invasive radical nephrectomy (RN) and PN in cT2 renal masses. METHODS Patients with cT2 renal masses underwent minimally-invasive PN or RN performed by a highly experienced single surgeon from 2009 to 2019 were considered. Demographic, perioperative and functional variables were compared. Cumulative incidence plot and competing risks regression (CRR) models were used to test differences in 5-year cancer-specific mortality (CSM) and 5-year other-cause mortality (OCM) rates. Kaplan-Meier and Cox regression model was used to test differences in 5-year progression free survival (PFS) rates. RESULTS Overall, 52 PN vs. 64 RN patients were identified. Relative to RN, PN patients recorded higher rates of complications (25% vs. 7.8%, P=0.02) but lower upstaging rate (≥pT3a 64.1% vs. 19.2%, P<0.0001). Functional outcomes were in favor of PN (all P<0.001). No differences were recorded between 5-year CSM and OCM according to nephrectomy type. At CRR models, older age and upstaging were independent predictors of 5-year OCM and CSM, respectively (all P<0.01). Finally, only upstaging, high grade tumors and presence of positive surgical margins were identified as independent predictors of 5-year PFS (all P<0.01). CONCLUSIONS In experienced hands the treatment of cT2 renal neoplasms with minimally-invasive PN is feasible, providing perioperative and oncological safety profiles comparable to RN, with advantages in terms of functional outcomes.
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Affiliation(s)
- Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy - .,Renal Cancer Working Group of the Young Academic Urologists (YAU) Working Party of the European Association of Urology (EAU), Arnhem, the Netherlands -
| | - Angela Pecoraro
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.,Renal Cancer Working Group of the Young Academic Urologists (YAU) Working Party of the European Association of Urology (EAU), Arnhem, the Netherlands
| | - Federico Piramide
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.,Uro-technology and SoMe Working Group of the Young Academic Urologists (YAU) Working Party of the European Association of Urology (EAU), Arnhem, the Netherlands
| | - Sabrina DE Cillis
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Gabriele Volpi
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Alberto Piana
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Paolo Verri
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Stefano Granato
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Michele Sica
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Matteo Manfredi
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
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12
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Amparore D, Pecoraro A, Checcucci E, DE Cillis S, Piramide F, Volpi G, Piana A, Verri P, Granato S, Sica M, Manfredi M, Fiori C, Autorino R, Porpiglia F. 3D imaging technologies in minimally-invasive kidney and prostate cancer surgery: which is the urologists' perception? Minerva Urol Nephrol 2021; 74:178-185. [PMID: 33769019 DOI: 10.23736/s2724-6051.21.04131-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many specific 3D imaging technologies are currently available for the practising urologists. Aim of the study was to assess their perception about different 3D imaging tools in the field of prostate and kidney cancer surgery. METHODS All the attendees of the 8th Techno-Urology-Meeting were asked to fill a questionnaire regarding the role of 3D virtual reconstruction PDFs, 3D printing models, Augmented-Reality (AR) and mixed reality technology in the setting of surgical planning, patient counselling, intraoperative guidance and training for kidney and prostate cancer surgery; Moreover the different materials used for 3D printing were compared to assess the most suitable in reproducing the organ and tumor features, as well as their estimated cost and production time. RESULTS The population consisted of 180 attendees. Overall, AR was the preferred option for intraoperative guidance and training, in both prostate (55% and 38.3%) and kidney cancer surgery (58.3% and 40%). HoloLens was perceived as the best imaging technology for the surgical planning (50% for prostate and 60% for kidney), whereas printed models for patients counselling (66.7% for prostate and 61.7% for kidney). Fused deposition models were deemed as the best printing technology in representing kidney anatomy and renal tumor location (40%), while silicon (46.7%) and Polyjet (36.7%) models for prostate anatomy and cancer location. Finally, attendees demonstrated poor knowledge of 3D printing costs and production times. CONCLUSIONS Our study shows the perceptions of a heterogeneous surrogate of practising urologists about the role and potential applications of 3D imaging technologies in daily surgical practice.
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Affiliation(s)
- Daniele Amparore
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy -
| | - Angela Pecoraro
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Enrico Checcucci
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy.,Uro-technology and SoMe Working Group of the Young Academic Urologists (YAU) Working Party of the European Association of Urology (EAU), Arnhem, The Netherlands
| | - Sabrina DE Cillis
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Federico Piramide
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Gabriele Volpi
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Alberto Piana
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Paolo Verri
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Stefano Granato
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Michele Sica
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Matteo Manfredi
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | | | - Francesco Porpiglia
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
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Checcucci E, Pecoraro A, DE Cillis S, Manfredi M, Amparore D, Aimar R, Piramide F, Granato S, Volpi G, Autorino R, Fiori C, Porpiglia F. The importance of anatomical reconstruction for continence recovery after robot assisted radical prostatectomy: a systematic review and pooled analysis from referral centers. Minerva Urol Nephrol 2020; 73:165-177. [PMID: 33200906 DOI: 10.23736/s2724-6051.20.04146-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Urinary incontinence is one of the most scared sequelae of robot assisted radical prostatectomy (RARP). Therefore, different surgical modifications, aimed to restore the original anatomy, were proposed to overcome this issue. The purpose of this study is to assess which is the best reconstruction technique (posterior only: PR; anterior only: AR; total: TR) compared to the standard approach for continence recovery after RARP in a tertiary care center. EVIDENCE ACQUISITION After establishing an a priori protocol, a systematic electronic literature search was conducted in May 2019. The article selection proceeded in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and was registered (PROSPERO registry number 131667). The risk of bias and the quality assessment of the included studies were performed. Simple pooled analysis was performed for continence rates according to the definition of continence (0 pad vs. 0-1 pad) and the different types of reconstruction at 1, 4, 12, 24, 52 weeks after RARP. Complication rate, operative and console time and estimated blood loss were pooled. Two-side test of proportion and T-test were used to compare rates and mean, respectively. EVIDENCE SYNTHESIS Six studies meeting the inclusion criteria were found and included in the analysis. All the included studies were of "poor" or "good" quality. A high or moderate risk of bias was recorded. TR showed higher continence recovery rates, compared to their anterior reconstruction counterpart at 1, 4, 12, 24, 52 weeks (P<0.001 at all time-points). At 12 weeks TR showed the highest continence rates (P<0.001), followed by AR and PR. No statistically significant differences were recorded regarding anastomosis-related complication rates (anastomosis stricture P=0.08; urine leakage P=0.1). CONCLUSIONS In patients undergoing RARP, TR facilitates a faster and higher continence recovery compared to standard approach or PR or AR only.
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Affiliation(s)
- Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Angela Pecoraro
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Sabrina DE Cillis
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Matteo Manfredi
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Roberta Aimar
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Federico Piramide
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Stefano Granato
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Gabriele Volpi
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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Checcucci E, Pecoraro A, DE Cillis S, Manfredi M, Amparore D, Aimar R, Piramide F, Granato S, Volpi G, Autorino R, Fiori C, Porpiglia F. The importance of anatomical reconstruction for continence recovery after robot assisted radical prostatectomy: a systematic review and pooled analysis from referral centers. Minerva Urol Nephrol 2020. [PMID: 33200906 DOI: 10.23736/s0393-2249.20.04146-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Urinary incontinence is one of the most scared sequelae of robot assisted radical prostatectomy (RARP). Therefore, different surgical modifications, aimed to restore the original anatomy, were proposed to overcome this issue. The purpose of this study is to assess which is the best reconstruction technique (posterior only: PR; anterior only: AR; total: TR) compared to the standard approach for continence recovery after RARP in a tertiary care center. EVIDENCE ACQUISITION After establishing an a priori protocol, a systematic electronic literature search was conducted in May 2019. The article selection proceeded in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and was registered (PROSPERO registry number 131667). The risk of bias and the quality assessment of the included studies were performed. Simple pooled analysis was performed for continence rates according to the definition of continence (0 pad vs. 0-1 pad) and the different types of reconstruction at 1, 4, 12, 24, 52 weeks after RARP. Complication rate, operative and console time and estimated blood loss were pooled. Two-side test of proportion and T-test were used to compare rates and mean, respectively. EVIDENCE SYNTHESIS Six studies meeting the inclusion criteria were found and included in the analysis. All the included studies were of "poor" or "good" quality. A high or moderate risk of bias was recorded. TR showed higher continence recovery rates, compared to their anterior reconstruction counterpart at 1, 4, 12, 24, 52 weeks (P<0.001 at all time-points). At 12 weeks TR showed the highest continence rates (P<0.001), followed by AR and PR. No statistically significant differences were recorded regarding anastomosis-related complication rates (anastomosis stricture P=0.08; urine leakage P=0.1). CONCLUSIONS In patients undergoing RARP, TR facilitates a faster and higher continence recovery compared to standard approach or PR or AR only.
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Affiliation(s)
- Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Angela Pecoraro
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Sabrina DE Cillis
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Matteo Manfredi
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Roberta Aimar
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Federico Piramide
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Stefano Granato
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Gabriele Volpi
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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Checcucci E, Amparore D, Pecoraro A, Peretti D, Aimar R, DE Cillis S, Piramide F, Volpi G, Piazzolla P, Manfrin D, Manfredi M, Fiori C, Porpiglia F. 3D mixed reality holograms for preoperative surgical planning of nephron-sparing surgery: evaluation of surgeons' perception. Minerva Urol Nephrol 2019; 73:367-375. [PMID: 31486325 DOI: 10.23736/s2724-6051.19.03610-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND 3D reconstructions are gaining a wide diffusion in nephron-sparing surgery (NSS) planning. They have usually been studied on common 2D flat supports, with limitations regarding real depth comprehension and interaction. Nowadays, it is possible to visualize kidney 3D reconstructions as holograms in a "mixed reality" (MR) setting. The aim of this study was to test the face and content validity of this technology, and to assess the role of 3D holograms in aiding preoperative planning for highly complex renal tumors amenable by NSS. METHODS We evaluated surgeons' perception of mixed reality for partial nephrectomy during a urological international meeting organized at our Institution in January 2019. Thanks to the images of preoperative CT, hyper-accuracy 3D (HA3DTM) reconstructions were performed. Then, a virtual environment was created, and it interacted with the models in mixed reality setting by using HoloLens. We submitted to all the attendees a questionnaire, expressed by the Likert scale (1-10), about their opinion over the use and application of the MR. Moreover, the attendees had the chance to perform a first-hand MR experience; then, they were asked to choose their clamping and resection approach. RESULTS Overall 172 questionnaires were collected. The scores obtained regarding both surgical planning (scored 8/10) and anatomical accuracy (9/10) were very positive. High satisfaction toward the potential role of this technology in surgical planning and understanding of surgical complexity (both scored 9/10) were expressed. After a first-hand experience with HoloLens and MR, 64.4% and 44.4% of the surgeons changed their clamping and resection approach, respectively - compared to CT image visualization only - choosing a more selective one. CONCLUSIONS Our study suggests that surgeons perceive holograms and MR as a useful and interesting tool for the preoperative setting before partial nephrectomy, in the direction of an ever more precise surgery.
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Affiliation(s)
- Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Angela Pecoraro
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Dario Peretti
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Roberta Aimar
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Sabrina DE Cillis
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Federico Piramide
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Gabriele Volpi
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Pietro Piazzolla
- Department of Management and Production Engineer, Polytechnic University of Turin, Turin, Italy
| | - Diego Manfrin
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Matteo Manfredi
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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Checcucci E, Amparore D, Pecoraro A, Peretti D, Aimar R, DE Cillis S, Piramide F, Volpi G, Piazzolla P, Manfrin D, Manfredi M, Fiori C, Porpiglia F. 3D mixed reality holograms for preoperative surgical planning of nephron-sparing surgery: evaluation of surgeons' perception. Minerva Urol Nephrol 2019. [PMID: 31486325 DOI: 10.23736/s0393-2249.19.03610-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND 3D reconstructions are gaining a wide diffusion in nephron-sparing surgery (NSS) planning. They have usually been studied on common 2D flat supports, with limitations regarding real depth comprehension and interaction. Nowadays, it is possible to visualize kidney 3D reconstructions as holograms in a "mixed reality" (MR) setting. The aim of this study was to test the face and content validity of this technology, and to assess the role of 3D holograms in aiding preoperative planning for highly complex renal tumors amenable by NSS. METHODS We evaluated surgeons' perception of mixed reality for partial nephrectomy during a urological international meeting organized at our Institution in January 2019. Thanks to the images of preoperative CT, hyper-accuracy 3D (HA3DTM) reconstructions were performed. Then, a virtual environment was created, and it interacted with the models in mixed reality setting by using HoloLens. We submitted to all the attendees a questionnaire, expressed by the Likert scale (1-10), about their opinion over the use and application of the MR. Moreover, the attendees had the chance to perform a first-hand MR experience; then, they were asked to choose their clamping and resection approach. RESULTS Overall 172 questionnaires were collected. The scores obtained regarding both surgical planning (scored 8/10) and anatomical accuracy (9/10) were very positive. High satisfaction toward the potential role of this technology in surgical planning and understanding of surgical complexity (both scored 9/10) were expressed. After a first-hand experience with HoloLens and MR, 64.4% and 44.4% of the surgeons changed their clamping and resection approach, respectively - compared to CT image visualization only - choosing a more selective one. CONCLUSIONS Our study suggests that surgeons perceive holograms and MR as a useful and interesting tool for the preoperative setting before partial nephrectomy, in the direction of an ever more precise surgery.
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Affiliation(s)
- Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Angela Pecoraro
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Dario Peretti
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Roberta Aimar
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Sabrina DE Cillis
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Federico Piramide
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Gabriele Volpi
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Pietro Piazzolla
- Department of Management and Production Engineer, Polytechnic University of Turin, Turin, Italy
| | - Diego Manfrin
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Matteo Manfredi
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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