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Napolitano L, Maggi M, Sampogna G, Bianco M, Campetella M, Carilli M, Lucci Chiarissi M, Civitella A, DE Vita F, DI Maida F, DI Mauro M, Ercolino A, Fasulo V, Felici G, Gheza A, Guzzardo C, Loizzo D, Mazzone E, Parodi S, Piramide F, Rabito S, Rizzetto R, Romantini F, Scarcella S, Tedde M, Checcucci E, Esperto F, Claps F, Falagario U. A survey on preferences, attitudes, and perspectives of Italian urology trainees: implications of the novel national residency matching program. Minerva Urol Nephrol 2023; 75:718-728. [PMID: 37350584 DOI: 10.23736/s2724-6051.23.05257-6] [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: 06/24/2023]
Abstract
BACKGROUND Since 2014, a new residency program selection process has been established with a national examination. The aim of this study was to assess characteristics, career goals, and practice preferences of current Italian urology residents. METHODS A web-based survey of 25 items performed from May 2021 to September 2021 was sent to 585 Italian urology residents. Descriptive analyses were conducted to describe the surveys' domains: demographics characteristics, studies, plans for fellowship training, interest in the urology field, and career expectations. RESULTS Four hundred and one residents completed the online survey (response rate 68.5%). Most residents were male (70.3%), with a median of 29 (IQR 28-31) years. Urology was the first chosen School in 325 (81.0%) cases, and 174 (43.4%) trainees have chosen to remain in the same University. Uro-oncology was the main field, and endourology the main subspeciality of interest, respectively. More than 40.0% of residents expressed a good level of satisfaction for the training urological course. 232 (57.2%) residents were strongly interested in seeking a hospital career, followed by private career (43.4%) and academic career (20%). CONCLUSIONS After the introduction of the novel national residency matching program the Italian Urology trainees showed a good satisfaction level. Further improvements of the Italian residency programs should be focused on the training network within and outside the main School of Urology.
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Affiliation(s)
- Luigi Napolitano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Martina Maggi
- Department of Urology, Sapienza University, Rome, Italy -
| | - Gianluca Sampogna
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Bianco
- Department of Urology, University of Padua, Padua, Italy
| | | | - Marco Carilli
- Unit of Urology, Tor Vergata Polyclinic Foundation, Rome, Italy
| | | | - Angelo Civitella
- Department of Medicine and Surgery, Campus Bio-Medico University, Rome, Italy
| | | | - Fabrizio DI Maida
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Marina DI Mauro
- Section of Urology, Department of Surgery, University of Catania, Catania, Italy
| | | | - Vittorio Fasulo
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Graziano Felici
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Alberto Gheza
- Department of Urology, University of Brescia, Brescia, Italy
| | | | - Davide Loizzo
- Unit of Transplantation, Department of Urology, Andrology and Kidney, University of Bari, Bari, Italy
| | - Elio Mazzone
- Unit of Urology, Division of Oncology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Parodi
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genoa, Genoa, Italy
| | - Federico Piramide
- Division of Urology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Salvatore Rabito
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Rizzetto
- Department of Urology, AOUI Verona, University of Verona, Verona, Italy
| | - Federico Romantini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Matteo Tedde
- Department of Clinical and Experimental Medicine, Urologic Clinic, University of Sassari, Sassari, Italy
| | - Enrico Checcucci
- Division of Urology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Esperto
- Department of Medicine and Surgery, Campus Bio-Medico University, Rome, Italy
| | - Francesco Claps
- Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Ugo Falagario
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
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Rizzuti M, Sali L, Melzi V, Scarcella S, Costamagna G, Ottoboni L, Quetti L, Brambilla L, Papadimitriou D, Verde F, Ratti A, Ticozzi N, Comi GP, Corti S, Gagliardi D. Genomic and transcriptomic advances in amyotrophic lateral sclerosis. Ageing Res Rev 2023; 92:102126. [PMID: 37972860 DOI: 10.1016/j.arr.2023.102126] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder and the most common motor neuron disease. ALS shows substantial clinical and molecular heterogeneity. In vitro and in vivo models coupled with multiomic techniques have provided important contributions to unraveling the pathomechanisms underlying ALS. To date, despite promising results and accumulating knowledge, an effective treatment is still lacking. Here, we provide an overview of the literature on the use of genomics, epigenomics, transcriptomics and microRNAs to deeply investigate the molecular mechanisms developing and sustaining ALS. We report the most relevant genes implicated in ALS pathogenesis, discussing the use of different high-throughput sequencing techniques and the role of epigenomic modifications. Furthermore, we present transcriptomic studies discussing the most recent advances, from microarrays to bulk and single-cell RNA sequencing. Finally, we discuss the use of microRNAs as potential biomarkers and promising tools for molecular intervention. The integration of data from multiple omic approaches may provide new insights into pathogenic pathways in ALS by shedding light on diagnostic and prognostic biomarkers, helping to stratify patients into clinically relevant subgroups, revealing novel therapeutic targets and supporting the development of new effective therapies.
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Affiliation(s)
- Mafalda Rizzuti
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Sali
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Melzi
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simone Scarcella
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, Università degli Studi di Milano, Milan, Italy
| | - Gianluca Costamagna
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, Università degli Studi di Milano, Milan, Italy
| | - Linda Ottoboni
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, Università degli Studi di Milano, Milan, Italy
| | - Lorenzo Quetti
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Brambilla
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Federico Verde
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, Università degli Studi di Milano, Milan, Italy; Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Antonia Ratti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Nicola Ticozzi
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, Università degli Studi di Milano, Milan, Italy; Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giacomo Pietro Comi
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Dino Ferrari Center, Università degli Studi di Milano, Milan, Italy; Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Corti
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Dino Ferrari Center, Università degli Studi di Milano, Milan, Italy.
| | - Delia Gagliardi
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, Università degli Studi di Milano, Milan, Italy.
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Bravi CA, Dell'Oglio P, Piazza P, Scarcella S, Bianchi L, Falagario U, Turri F, Andras I, Di Maida F, De Groote R, Piramide F, Moschovas MC, Suardi N, Terrone C, Carrieri G, Patel V, Autorino R, Porpiglia F, Vickers A, Briganti A, Montorsi F, Mottrie A, Larcher A. Positive Surgical Margins After Anterior Robot-assisted Radical Prostatectomy: Assessing the Learning Curve in a Multi-institutional Collaboration. Eur Urol Oncol 2023:S2588-9311(23)00251-1. [PMID: 38036328 DOI: 10.1016/j.euo.2023.11.006] [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: 08/19/2023] [Revised: 10/08/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The learning curve for robot-assisted radical prostatectomy (RARP) remains controversial, with prior studies showing that, in contrast with evidence on open and laparoscopic radical prostatectomy, biochemical recurrence rates of experienced versus inexperienced surgeons did not differ. OBJECTIVE To characterize the learning curve for positive surgical margins (PSMs) after RARP. DESIGN, SETTING, AND PARTICIPANTS We analyzed the data of 13 090 patients with prostate cancer undergoing RARP by one of 74 surgeons from ten institutions in Europe and North America between 2003 and 2022. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable models were used to assess the association between surgeon experience at the time of each patient's operation and PSMs after surgery, with adjustment for preoperative prostate-specific antigen level, grade, stage, and year of surgery. Surgeon experience was coded as the number of robotic radical prostatectomies done by the surgeon before the index patient's operation. RESULTS AND LIMITATIONS Overall, 2838 (22%) men had PSMs on final pathology. After adjusting for case mix, we found a significant, nonlinear association between surgical experience and probability of PSMs after surgery, with a lower risk of PSMs for greater surgeon experience (p < 0.0001). The probabilities of PSMs for a patient treated by a surgeon with ten, 250, 500, and 2000 prior robotic procedures were 26%, 21%, 18%, and 14%, respectively (absolute risk difference between ten and 2000 procedures: 11%; 95% confidence interval: 9%, 14%). Similar results were found after stratifying patients according to extracapsular extension at final pathology. Results were also unaltered after excluding surgeons who had moved between institutions. CONCLUSIONS While we characterized the learning curve for PSMs after RARP, the relative contribution of surgical learning to the achievement of optimal outcomes remains controversial. Future investigations should focus on what experienced surgeons do to avoid positive margins and should explore the relationship between learning, margin rate, and biochemical recurrence. Understanding what margins affect recurrence and whether these margins are trainable or a result of other factors may shed light on where to focus future efforts in surgical education. PATIENT SUMMARY In patients receiving robotic radical prostatectomy for prostate cancer, we characterized the learning curve for positive margins. The risk of surgical margins decreased progressively with increasing experience, and plateaued around the 500th procedure. Understanding what margins affect recurrence and whether these margins are trainable or a result of other factors has implications for surgeons and patients, and it may shed light on where to focus future efforts in surgical education.
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Affiliation(s)
- Carlo A Bravi
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK; Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium.
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Urology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Simone Scarcella
- Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche, Italy; Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ugo Falagario
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Filippo Turri
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Iulia Andras
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
| | - Federico Piramide
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | - Nazareno Suardi
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Urology, Ospedali Civili of Brescia, Brescia, Italy
| | - Carlo Terrone
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Vipul Patel
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | | | - Francesco Porpiglia
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
| | - Alessandro Larcher
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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Bravi CA, Dell'Oglio P, Mazzone E, Moschovas MC, Falagario U, Piazza P, Scarcella S, Bednarz C, Sarchi L, Tappero S, Knipper S, De Groote R, Sjoberg D, Schiavina R, Suardi N, Terrone C, Autorino R, Carrieri G, Galosi A, Galfano A, Briganti A, Montorsi F, Patel V, Vickers A, Mottrie A. The Surgical Learning Curve for Biochemical Recurrence After Robot-assisted Radical Prostatectomy. Eur Urol Oncol 2023; 6:414-421. [PMID: 35850976 PMCID: PMC10795739 DOI: 10.1016/j.euo.2022.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/13/2022] [Accepted: 06/30/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Improved cancer control with increasing surgical experience-the learning curve-was demonstrated for open and laparoscopic prostatectomy. In a prior single-center study, we found that this might not be the case for robot-assisted radical prostatectomy (RARP). OBJECTIVE To investigate the relationship between prior experience of a surgeon and biochemical recurrence (BCR) after RARP. DESIGN, SETTING, AND PARTICIPANTS We retrospectively analyzed the data of 8101 patients with prostate cancer treated with RARP by 46 surgeons at nine institutions between 2003 and 2021. Surgical experience was coded as the total number of robotic prostatectomies performed by the surgeon before the patient operation. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We evaluated the relationship of prior surgeon experience with the probability of BCR adjusting for preoperative prostate-specific antigen, pathologic stage, grade, lymph-node involvement, and year of surgery. RESULTS AND LIMITATIONS Overall, 1047 patients had BCR. The median follow-up for patients without BCR was 33 mo (interquartile range: 14, 61). After adjusting for case mix, the relationship between surgical experience and the risk of BCR after surgery was not statistically significant (p = 0.2). The 5-yr BCR-free survival rates for a patient treated by a surgeon with prior 10, 250, and 1000 procedures performed were, respectively, 82.0%, 82.7%, and 84.8% (absolute difference between 10 and 1000 prior procedures: 1.6% [95% confidence interval: 0.4%, 3.3%). Results were robust to a number of sensitivity analyses. CONCLUSIONS These findings suggest that, as opposed to open and laparoscopic radical prostatectomy, surgeons performing RARP achieve adequate cancer control in the early phase of their career. Further research should explore why the learning curve for robotic surgery differs from prior findings for open and laparoscopic radical prostatectomy. We hypothesize that surgical education, including simulation training and the adoption of objective performance metrics, is an important mechanism for flattening the learning curve. PATIENT SUMMARY We investigated the relationship between biochemical recurrence after robot-assisted radical prostatectomy and surgeon's experience. Surgeons at an early stage of their career had similar outcomes to those of more experienced surgeons, and we hypothesized that surgical education in robotics might be an important determinant of such a finding.
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Affiliation(s)
- Carlo A Bravi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Urology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Elio Mazzone
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Ugo Falagario
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Pietro Piazza
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Simone Scarcella
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche, Italy
| | | | - Luca Sarchi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Stefano Tappero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Sophie Knipper
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
| | - Daniel Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Nazareno Suardi
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Andrea Galosi
- Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche, Italy
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vipul Patel
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
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Van der Jeugt J, Umari P, Mottaran A, Ribeiro L, Lambert E, Vollemaere J, Develtere D, Veys R, Goossens M, Scarcella S, Pauwaert K, Van Praet C, Pauwels E, De Groote R, Dhondt F, Naeyer G, Mottrie A, Schatteman P. Holmium Laser Enucleation of the Prostate versus Robotic Assisted Simple Prostatectomy for lower urinary tract symptoms in patients with extremely large prostates ≧200 ml: A comparative analysis. J Endourol 2023. [PMID: 37335047 DOI: 10.1089/end.2022.0851] [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: 06/21/2023] Open
Abstract
Introduction and objectives Robot-Assisted Simple Prostatectomy (RASP) and Holmium Laser Enucleation of the prostate (HoLEP) are both well-established, minimally-invasive surgical treatment options for lower urinary tract symptoms caused by benign prostatic enlargement. We have reported the first comparative analysis of both techniques in patients with prostates of 200ml. Materials & methods Between 2009 and 2020 a total of 53 patients with a prostate volume of 200ml were surgically treated at OLV Hospital Aalst (Belgium): 31 underwent RASP and 22 underwent HoLEP. Preoperative and postoperative assessments included uroflowmetry with maximum urinary flow rate (Qmax) and post-void residual volume (PVR), as well as the International Prostate Symptom Score (IPSS) and quality of life (IPSS-QoL). The complication rates were evaluated according to the Clavien-Dindo Classification. Results Patients treated with RASP had significantly larger prostate volumes compared to HoLEP (median 226 vs. 204.5 ml, p=0.004). After a median follow-up of 14 months, both groups showed a significant improvement in the maximum flow rate (+10.60 vs. +10.70 ml/s, p=0.724) and a reduction of the IPSS score (-12.50 vs. -9, p=0.246) as well as improvement of the QoL (-3 vs. -3, p=0.880). Median operative time was similar in both groups (150 vs. 132.5 min, p=0.665). The amount of resected tissue was lower in the RASP group (134.5 vs. 180 g, p=0.029) and there was no significant difference in postoperative PSA (1.2 vs. 0.8 ng/ml, p=0,112). Despite a similar median catheterization time (3 vs. 2 days, p=0.748), the median hospitalization time was shorter in the HoLEP group (4 vs. 3 days, p=0.052). Complication rates were similar in both groups (32% vs. 36%, p=0.987). Conclusion Our results suggest similar outcomes for RASP and HoLEP in patients with very large prostates 200ml. These findings will require external validation at other high-volume centers.
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Affiliation(s)
| | - Paolo Umari
- St. George's University Hospital, Department of Urology, London, United Kingdom of Great Britain and Northern Ireland
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | - Angelo Mottaran
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, 18508, Department of Urology, Bologna, Emilia-Romagna, Italy
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | - Luis Ribeiro
- St. George's University Hospital, urology, London, United Kingdom of Great Britain and Northern Ireland;
| | - Edward Lambert
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | | | - Dries Develtere
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | - Ralf Veys
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | - Marijn Goossens
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | - Simone Scarcella
- Polytechnic University of Marche Region, Department of Urology, Ancona, Italy
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | - Kim Pauwaert
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | - Charles Van Praet
- University Hospital Ghent, 60200, urology, Gent, Oost-Vlaanderen, Belgium;
| | | | - Ruben De Groote
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | | | - Geert Naeyer
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | - Alex Mottrie
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
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Scarcella S, Dell'Arti L, Gagliardi D, Magri F, Govoni A, Velardo D, Mainetti C, Minorini V, Ronchi D, Piga D, Comi GP, Corti S, Meneri M. Ischemic optic neuropathy as first presentation in patient with m.3243 A > G MELAS classic mutation. BMC Neurol 2023; 23:165. [PMID: 37095452 PMCID: PMC10123965 DOI: 10.1186/s12883-023-03198-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/22/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a systemic disorder in which multi-organ dysfunction may occur from mitochondrial metabolism failure. Maternally inherited mutations in the MT-TL1 gene are the most frequent causes for this disorder. Clinical manifestations may include stroke-like episodes, epilepsy, dementia, headache and myopathy. Among these, acute visual failure, usually in association with cortical blindness, can occur because of stroke-like episodes affecting the occipital cortex or the visual pathways. Vision loss due to optic neuropathy is otherwise considered a typical manifestation of other mitochondrial diseases such as Leber hereditary optic neuropathy (LHON). CASE PRESENTATION Here we describe a 55-year-old woman, sister of a previously described patient with MELAS harbouring the m.3243A > G (p.0, MT-TL1) mutation, with otherwise unremarkable medical history, that presented with subacute, painful visual impairment of one eye, accompanied by proximal muscular pain and headache. Over the next weeks, she developed severe and progressive vision loss limited to one eye. Ocular examination confirmed unilateral swelling of the optic nerve head; fluorescein angiography showed segmental perfusion delay in the optic disc and papillary leakage. Neuroimaging, blood and CSF examination and temporal artery biopsy ruled out neuroinflammatory disorders and giant cell arteritis (GCA). Mitochondrial sequencing analysis confirmed the m.3243A > G transition, and excluded the three most common LHON mutations, as well as the m.3376G > A LHON/MELAS overlap syndrome mutation. Based on the constellation of clinical symptoms and signs presented in our patient, including the muscular involvement, and the results of the investigations, the diagnosis of optic neuropathy as a stroke-like event affecting the optic disc was performed. L-arginine and ubidecarenone therapies were started with the aim to improve stroke-like episode symptoms and prevention. The visual defect remained stable with no further progression or outbreak of new symptoms. CONCLUSIONS Atypical clinical presentations must be always considered in mitochondrial disorders, even in well-described phenotypes and when mutational load in peripheral tissue is low. Mitotic segregation of mitochondrial DNA (mtDNA) does not allow to know the exact degree of heteroplasmy existent within different tissue, such as retina and optic nerve. Important therapeutic implications arise from a correct diagnosis of atypical presentation of mitochondrial disorders.
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Affiliation(s)
- Simone Scarcella
- Neuroscience Section, Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
- Neurology Unit, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Dell'Arti
- Ophthalmological Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Delia Gagliardi
- Neuroscience Section, Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
- Neurology Unit, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Magri
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Alessandra Govoni
- Neuroscience Section, Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Daniele Velardo
- Neuroscience Section, Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Claudia Mainetti
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Valeria Minorini
- Ophthalmological Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Ronchi
- Neuroscience Section, Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Daniela Piga
- Neurology Unit, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Pietro Comi
- Neuroscience Section, Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Stefania Corti
- Neuroscience Section, Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
- Neurology Unit, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Megi Meneri
- Neuroscience Section, Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy.
- Neurology Unit, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Bravi C, Dall’Oglio P, Mazzone E, De Groote R, Falagario U, Schiavina R, Piazza P, Borghesi M, Scarcella S, Moschovas M, Turri F, Andras I, Di Maida F, Carrieri G, Terrone C, Autorino R, Patel V, Porpiglia F, Bocciardi A, Minervini A, Montorsi F, Rha K, Mottrie A. The surgical learning curve for positive surgical margins after robot-assisted radical prostatectomy: Results from a multi-institutional collaboration. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Beatrici E, Scarcella S, Del Prete C, Giglioni G, Cappuccelli S, Pitoni L, Gabrielloni G, Lacetera V, Beatrici V. Virtue sub-urethral sling for stress urinary incontinence after radical prostatectomy: A single-center experience. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00822-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Scarcella S, Law YXT, Bravi CA, Piazza P, Heldwein FL, Ronchi P, Lacetera V, Beatrici V, Gauhar V, Castellani D. Does using a laser improve outcomes of conventional circumcision in adult and children populations? Results from a systematic review and meta-analysis. Andrology 2023; 11:54-64. [PMID: 36251782 DOI: 10.1111/andr.13321] [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: 08/08/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Male circumcision is a well-known old surgery, and several recently developed techniques have been scaled up, including the introduction of laser technology, as alternative approaches to overcome morbidity of conventional surgery scalpel/suture method OBJECTIVES: We aimed to perform a systematic review and meta-analysis of studies comparing laser circumcision versus conventional circumcision technique in terms of perioperative outcomes and efficacy (complications, unacceptable appearance, reoperation rate) both in children and adults. MATERIALS AND METHODS This review was performed following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Continuous variables were analyzed using the inverse variance of the mean difference with a random effect, 95% confidence interval (CI), and p-value. The incidence of complications, unacceptable appearance, and reoperation rate were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as odds ratio (OR), 95% CI, and p-value. Significance was set at p-value ≤0.05 and 95%CI. RESULTS Seven studies were included. In comparison to the conventional circumcision, laser circumcision shoved lower visual analogue score at 24-h, and 7 days after surgery, a lower rate of overall complication rate (OR 0.33, 95% CI 0.24-0.47, p < 0.001), scarring (OR 0.09, 95% CI 0.02, 0.41, p = 0.002), and unacceptable appearance (OR 0.09, 95% CI 0.05, 0.15, p < 0.001). We found no statistically significant difference in surgical time, and incidence of bleeding, infection, wound dehiscence, and reoperation rate. DISCUSSION AND CONCLUSION Our review infers that laser-assisted circumcision is certainly a safe and strong contender as the procedure of choice in both children and adult populations.
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Affiliation(s)
- Simone Scarcella
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro-Fano, Italy
| | - Yu Xi Terence Law
- Department of Urology, National University Hospital, Singapore, Singapore
| | - Carlo Andrea Bravi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Flavio L Heldwein
- Department of Urology, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Piero Ronchi
- Department of Urology, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Polytechnic University of the Marche Region, Ancona, Italy
| | - Vito Lacetera
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro-Fano, Italy
| | - Valerio Beatrici
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro-Fano, Italy
| | - Vineet Gauhar
- Department of Urology Ng Teng Fong General Hospital (NUHS), Singapore, Singapore
| | - Daniele Castellani
- Department of Urology, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Polytechnic University of the Marche Region, Ancona, Italy.,Faculty of Medicine, School of Urology, Polytechnic University of Le Marche, Ancona, Italy
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Scarcella S, Bravi C, Piazza P, Mottaran A, Sarchi L, Paciotti M, Nocera L, Martini A, Piro A, Puliatti S, Beatrici V, De Groote R, Briganti A, Montorsi F, Mottrie A. Validating the comprehensive complication index for assessing cumulative morbidity after robot-assisted radical cystectomy: results from a high-volume institution. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01130-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Ronchi P, Scarcella S, Manno S, Beatrici V, Dell’Atti L. Dual laser circumcision: a novel technique to improve traditional surgery. Laser Ther 2022. [DOI: 10.4081/ltj.2022.295] [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: 12/24/2022]
Abstract
Circumcision represents one of the oldest and routinely performed urological surgery. It implies the exeresis of the prepuce due to ethnic, religious and medical reasons. Different authors reported straightforward advantages of this procedure including increased penile hygiene, reduction of penile cancer risks and lower rates of urinary tract infections. Circumcision can be easily performed and reproduced according to different techniques. Nowadays, different types of lasers have been developed and this technology is gaining consensus in the urological community. Aim of this article is to describe our surgical technique for laser circumcision with the Lasemar Eufuton 1500, clarifying the surgical steps and the benefits of this technology.
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Gauhar V, Traxer O, García Rojo E, Scarcella S, Pavia MP, Chan VWS, Pretore E, Wroclawski ML, Corrales M, Tiong HY, Lim EJ, Teoh JYC, Heng CT, de la Rosette J, Somani BK, Castellani D. Complications and outcomes of tubeless versus nephrostomy tube in percutaneous nephrolithotomy: a systematic review and meta-analysis of randomized clinical trials. Urolithiasis 2022; 50:511-522. [PMID: 35674819 PMCID: PMC9468100 DOI: 10.1007/s00240-022-01337-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/23/2022] [Indexed: 10/26/2022]
Abstract
We aimed to perform a systematic review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy (PCNL) (ureteral stent/catheter, no nephrostomy) compared to Standard PCNL (nephrostomy, with/without ureteral stent/catheter) to evaluate if the tubeless approach is better. The inverse variance of the mean difference with a random effect, 95% Confidence Interval (CI), and p values was used for continuous variables. Categorical variables were assessed using Cochran-Mantel-Haenszel method with the random effect model, and reported as Risk Ratio (RR), 95% CI, and p values. Statistical significance was set at p < 0.05 and a 95% CI. 26 studies were included. Mean operative time was significantly shorter in the Tubeless group (MD-5.18 min, 95% CI - 6.56, - 3.80, p < 0.00001). Mean postoperative length of stay was also significantly shorter in the Tubeless group (MD-1.10 day, 95% CI - 1.48, - 0.71, p < 0.00001). Incidence of blood transfusion, angioembolization for bleeding control, pain score at the first postoperative day, the number of patients requiring postoperative pain medication, fever, urinary infections, sepsis, perirenal fluid collection, pleural breach, hospital readmission, and SFR did not differ between the two groups. Incidence of postoperative urinary fistula was significantly lower in the Tubeless group (RR 0.18, 95% CI 0.07, 0.47, p = 0.0005). This systematic review shows that tubeless PCNL can be safely performed and the standout benefits are shorter operative time and hospital stay, and a lower rate of postoperative urinary fistula.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Olivier Traxer
- Department of Urology Hôpital Tenon, Sorbonne University, Paris, France
| | - Esther García Rojo
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain
| | - Simone Scarcella
- Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Maria Pia Pavia
- Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Eugenio Pretore
- Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, BP-a Beneficência Portuguesa de São Paulo, Sao Paulo, SP, Brazil.,Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Mariela Corrales
- Department of Urology Hôpital Tenon, Sorbonne University, Paris, France
| | - Ho Yee Tiong
- Department of Urology, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, S.H. Ho Urology Centre, Hong Kong, China
| | - Chin-Tiong Heng
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Jean de la Rosette
- Department of Urology, Medipol Mega University Hospital, Istanbul Medipol University, Istanbul, Turkey
| | | | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy.
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Puliatti S, Eissa A, Checcucci E, Piazza P, Amato M, Scarcella S, Rivas JG, Taratkin M, Marenco J, Rivero IB, Kowalewski KF, Cacciamani G, El-Sherbiny A, Zoeir A, El-Bahnasy AM, De Groote R, Mottrie A, Micali S. New imaging technologies for robotic kidney cancer surgery. Asian J Urol 2022; 9:253-262. [PMID: 36035346 PMCID: PMC9399539 DOI: 10.1016/j.ajur.2022.03.008] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/19/2022] [Accepted: 03/16/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Kidney cancers account for approximately 2% of all newly diagnosed cancer in 2020. Among the primary treatment options for kidney cancer, urologist may choose between radical or partial nephrectomy, or ablative therapies. Nowadays, robotic-assisted partial nephrectomy (RAPN) for the management of renal cancers has gained popularity, up to being considered the gold standard. However, RAPN is a challenging procedure with a steep learning curve. Methods In this narrative review, different imaging technologies used to guide and aid RAPN are discussed. Results Three-dimensional visualization technology has been extensively discussed in RAPN, showing its value in enhancing robotic-surgery training, patient counseling, surgical planning, and intraoperative guidance. Intraoperative imaging technologies such as intracorporeal ultrasound, near-infrared fluorescent imaging, and intraoperative pathological examination can also be used to improve the outcomes following RAPN. Finally, artificial intelligence may play a role in the field of RAPN soon. Conclusion RAPN is a complex surgery; however, many imaging technologies may play an important role in facilitating it.
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Gauhar V, Pirola GM, Scarcella S, Angelis MVD, Giulioni C, Rubilotta E, Gubbiotti M, Lim EJ, Law YXT, Wroclawski ML, Tiong HY, Castellani D. Nephrostomy tube versus double J ureteral stent in patients with malignant ureteric obstruction. A systematic review and meta-analysis of comparative studies. Int Braz J Urol 2022; 48:903-914. [PMID: 36037256 PMCID: PMC9747026 DOI: 10.1590/s1677-5538.ibju.2022.0225] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/31/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE We aimed to perform a systematic review to assess perioperative outcomes, complications, and survival in studies comparing ureteral stent and percutaneous nephrostomy in malignant ureteral obstruction. MATERIALS AND METHODS This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Meta-analyses were performed on procedural data; outcomes; complications (device-related, accidental dislodgement, febrile episodes, unplanned device replacement), dislodgment, and overall survival. Continuous variables were pooled using the inverse variance of the mean difference (MD) with a fixed effect, and 95% confidence interval (CI). The incidences of complications were pooled using the Cochran-Mantel-Haenszel method with the random effect model and reported as Odds Ratio (OR), and 95% CI. Statistical significance was set two-tail p-value < 0.05 Results: Ten studies were included. Procedure time (MD -10.26 minutes 95%CI -12.40-8.02, p< 0.00001), hospital stay (MD -1.30 days 95%CI -1.69 - -0.92, p< 0.0001), number of accidental tube dislodgments (OR 0.25 95% CI 0.13 - 0.48, p< 0.0001) were significantly lower in the stent group. No difference was found in mean fluoroscopy time, decrease in creatinine level post procedure, overall number of complications, interval time between the change of tubes, number of febrile episodes after diversion, unplanned device substitution, and overall survival. CONCLUSION Our meta-analysis favors stents as the preferred choice as these are easier to maintain and ureteral stent placement should be recommended whenever feasible. If the malignant obstruction precludes a stent placement, then PCN is a safe alternative.
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Affiliation(s)
- Vineet Gauhar
- Ng Teng Fong General HospitalDepartment of UrologySingaporeSingaporeDepartment of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Giacomo Maria Pirola
- San Donato HospitalDepartment of UrologyArezzoItalyDepartment of Urology, San Donato Hospital, Arezzo, Italy
| | - Simone Scarcella
- Le Marche Polytechnic UniversityFaculty of MedicineSchool of UrologyAnconaItalyFaculty of Medicine, School of Urology, Le Marche Polytechnic University, Ancona, Italy
| | - Maria Vittoria De Angelis
- Le Marche Polytechnic UniversityFaculty of MedicineSchool of UrologyAnconaItalyFaculty of Medicine, School of Urology, Le Marche Polytechnic University, Ancona, Italy
| | - Carlo Giulioni
- Le Marche Polytechnic UniversityFaculty of MedicineSchool of UrologyAnconaItalyFaculty of Medicine, School of Urology, Le Marche Polytechnic University, Ancona, Italy
| | - Emanuele Rubilotta
- University of VeronaAzienda Ospedaliero Universitaria of VeronaDepartment of UrologyVeronaItalyDepartment of Urology, Azienda Ospedaliero Universitaria of Verona, University of Verona, Verona, Italy
| | - Marilena Gubbiotti
- San Donato HospitalDepartment of UrologyArezzoItalyDepartment of Urology, San Donato Hospital, Arezzo, Italy
| | - Ee Jean Lim
- Singapore General HospitalDepartment of UrologySingaporeSingaporeDepartment of Urology, Singapore General Hospital, Singapore, Singapore
| | - Yu Xi Terence Law
- National University HospitalDepartment of UrologySingaporeSingaporeDepartment of Urology, National University Hospital, Singapore, Singapore
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP, Brasil,Faculdade de Medicina do ABCSanto AndréSPBrasilFaculdade de Medicina do ABC - FMABC, Santo André, SP, Brasil,BP – A Beneficência Portuguesa de São PauloSão PauloSPBrasilBP – A Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
| | - Ho Yee Tiong
- University Surgical ClusterNational University HospitalDepartment of UrologySingaporeSingaporeDepartment of Urology, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Daniele Castellani
- Azienda Ospedaliero Universitaria Ospedali Riuniti di AnconaUrology UnitAnconaItalyUrology Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona, Italy,Correspondence address: Daniele Castellani, MD Faculty of Medicine, School of Urology, Le Marche Polytechnic University, Via Conca 71, 60126, Ancona, Italy. Fax: + 39715963367 E-mail:
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Giulioni C, Scarcella S, Di Biase M, Marconi A, Sortino G, Diambrini M, Giannubilo W, Castellani D, Ferrara V. The Role of Intraoperative Ultrasonography Associated with Clampless Technique in Three-Dimensional Retroperitoneoscopic Laparoscopic Enucleation of Completely Endophytic Renal Tumors. J Laparoendosc Adv Surg Tech A 2022; 32:987-991. [PMID: 35442780 DOI: 10.1089/lap.2022.0033] [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] [Indexed: 11/12/2022] Open
Abstract
Objectives: To evaluate perioperative and functional outcomes of clampless laparoscopic tumor enucleation for completely endophytic renal tumors with the guide of intraoperative ultrasonography. Methods: We analyzed patients with clinically completely endophytic tumors, renal tumors, who underwent clampless three-dimensional (3D) retroperitoneoscopic laparoscopic tumor enucleation between January 2012 and January 2021. Patients with exophytic tumors were excluded. Intraoperative ultrasonography was used to map out the mass in all surgeries. Results: Overall, 57 patients underwent clampless 3D retroperitoneoscopic laparoscopic tumor enucleation. Mean surgical time was 131 minutes, and mean estimated blood loss was 202 mL. Mean hospital stay was 4.7 days. Major and minor postoperative complications occurred, respectively, in 3 and 10 cases. Only a patient had a positive surgical margin. One-year renal function did not differ from baseline. Conclusion: Our study showed that clampless laparoscopic enucleation guided by laparoscopic ultrasonography ensured satisfactory outcomes for completely intrarenal tumors, with excellent renal function preservation 1 year after surgery.
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Affiliation(s)
- Carlo Giulioni
- Department of Urology, "Ospedali Riuniti" University Hospital, Ancona, Italy
| | - Simone Scarcella
- Department of Urology, "Ospedali Riuniti" University Hospital, Ancona, Italy
| | | | - Andrea Marconi
- Department of Urology, Hospital "Carlo Urbani," Jesi, Italy
| | | | | | | | - Daniele Castellani
- Department of Urology, "Ospedali Riuniti" University Hospital, Ancona, Italy
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Scarcella S, Mottaran A, Bravi C, Van Der Jeugt J, Piazza P, Sarchi L, Paciotti M, Puliatti S, Umari P, Giuloni C, Milanese G, Dell'Atti L, Castellani D, Galosi A, De Groote R, Schatteman P, Mottrie A. Peri-operative outcomes of open versus robot-assisted simple prostatectomy: Results from two high-volume centres. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00961-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Piazza P, Bravi CA, Puliatti S, Cacciamani GE, Knipper S, Amato M, Dell'Oglio P, Mazzone E, Rosiello G, Farinha R, Sarchi L, Scarcella S, Wisz P, Schiavina R, Develtere D, De Backer P, De Groote R, D'Hondt F, Mottrie A. Assessing pentafecta achievement after robot-assisted radical cystectomy and its association with surgical experience: Results from a high-volume institution. Urol Oncol 2022; 40:272.e11-272.e20. [PMID: 35094932 DOI: 10.1016/j.urolonc.2022.01.001] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/25/2021] [Accepted: 01/01/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Radical cystectomy (RC) represents the gold standard treatment for high-risk bladder cancer. Despite evidence suggesting that surgical experience correlates with perioperative and oncologic outcomes of robot-assisted RC (RARC), validated tools to assess its quality objectively are lacking. We aimed to evaluate the impact of RC-Pentafecta (absence of early major complications, absence of urinary diversion related sequelae at ≤12 months, absence of soft tissue surgical margins, ≥16 lymph nodes at final pathology and absence of clinical recurrence at ≤12 months) on oncological outcomes and the role of surgical experience on its achievement. MATERIALS AND METHODS We retrospectively evaluated 366 patients undergoing RARC with intracorporeal urinary diversion in a single tertiary centre with a minimum of 1 year follow-up. Surgeries were performed using the DaVinci Xi system according to a previously described technique. Kaplan-Meier curves were used to investigate 5-years overall survival and cancer specific mortality-free survival (CSS) according to RC-Pentafecta achievement. Multivariable Cox's regressions were performed to evaluate the impact of RC-Pentafecta on overall mortality. Multivariable logistic regressions were performed to explore the effect of surgical experience on RC-pentafecta achievement. Locally weighted scatterplot smoother function was used to graphically explore this relationship. RESULTS Patients achieving RC-Pentafecta showed higher 5-year overall survival (71.8% vs. 59.6%, P < 0.001) and CSS (84% vs. 71%, P < 0.001) when compared with patients not achieving it. At multivariable Cox's regression, RC-Pentafecta achievement (HR 0.57, P = 0.03), positive surgical margins (HR 2.48, P = 0.002), pN+ (HR 2.23, P = 0.002), pT≥3 (HR 1.71, P = 0.04) and current smoking status (HR 2.4, P = 0.006) were significant predictors of overall mortality. At multivariable logistic regression surgical experience (OR 1.2, P < 0.001), age (OR 0.93, P = 0.04), previous prostate surgery (OR 0.7, P = 0.02) and pT≥3 (OR 0.8, P = 0.03) were independent predictors of RC-Pentafecta achievement. A linear relationship between surgical experience and RC-Pentafecta achievement, without reaching a plateau, was observed. CONCLUSIONS RC-Pentafecta is a valuable tool to assess surgical quality of RARC and the experience of the center where the surgery is performed and may be used to identify "referral" centers for treatment of high-risk bladder cancer.
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Affiliation(s)
- Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium.
| | - Carlo Andrea Bravi
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Puliatti
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Sophie Knipper
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Martini-Klinik Prostate Cancer Center, Hamburg, Germany
| | - Marco Amato
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elio Mazzone
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Rosiello
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Luca Sarchi
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Simone Scarcella
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, Polytechnic University of Marche Region, Ancona, Italy
| | | | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; University of Bologna, Bologna, Italy
| | - Dries Develtere
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Pieter De Backer
- ORSI Academy, Melle, Belgium; Department of Urology, University of Ghent, Ghent, Belgium
| | - Ruben De Groote
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Frederiek D'Hondt
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Alexandre Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
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18
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Law Y, Teoh J, Castellani D, Lim E, Chan E, Wroclawski M, Pirola G, Giulioni C, Rubilotta E, Gubbioti M, Scarcella S, Chew B, Traxer O, Somani B, Gauhar V. Role of pre-operative ureteral stent on outcomes of Retrograde Intra Renal Surgery (RIRS): Systematic review and meta-analysis of 3219 patients and comparison of Asian and non-Asian cohorts. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00267-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Law YXT, Teoh JYC, Castellani D, Lim EJ, Chan EOT, Wroclawski M, Pirola GM, Giulioni C, Rubilotta E, Gubbioti M, Scarcella S, Chew BH, Traxer O, Somani BK, Gauhar V. Role of pre-operative ureteral stent on outcomes of retrograde intra-renal surgery (RIRS): systematic review and meta-analysis of 3831 patients and comparison of Asian and non-Asian cohorts. World J Urol 2022; 40:1377-1389. [PMID: 35072738 DOI: 10.1007/s00345-022-03935-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/13/2021] [Accepted: 01/07/2022] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate the outcomes of pre-stented (PS) versus non-pre-stented (NPS) patients who have undergone retrograde intrarenal surgery (RIRS) for renal calculi with subgroup analysis of Asian and non-Asian cohorts. METHODS Protocol is registered in PROSPERO, CRD42021261123. Eligible studies identified from four electronic databases. Meta-analysis was done to enumerate the outcomes of RIRS in between PS and NPS. Secondary sub-analysis was done to look for differences in outcomes in Asian and non-Asian cohorts. RESULTS Fourteen studies involving 3831 patients (4 prospective, 10 retrospective studies) were included. PS patients experienced higher success rates of ureteral access sheath (UAS) insertion than NPS (RR 1.09, 95% CI 1.05-1.13, p < 0.00001). PS patients had lower risk of ureteral injuries from UAS placement (RR 0.69, 95% CI 0.50-0.96, p = 0.03). No significant differences in intra- and postoperative complications between two groups were found. Stone-free rate (SFR) outcomes for residual fragment (RF) cut-off of < 1 mm and < 4 mm favoured the PS patients (RR 1.10, 95% CI 1.04-1.17, p = 0.002 for < 4 mm, RR1.10, 95% CI 1.02-1.19, p = 0.02 for < 1 mm). In the subgroup analysis, PS Asian patients had similar SFR as NPS patients for SFR(< 4 mm) but non-Asian population showed better outcomes in the PS patients for SFR(< 4 mm) (RR 1.31, 95% CI 1.13-1.52, p = 0.0005). CONCLUSIONS This meta-analysis suggests that pre-stenting results in a higher success for UAS placement, minimising intraoperative ureteric injury, with higher overall SFR for any RF cut-off in PS cohorts. In non-Asian cohort, significant differences occurred at SFR < 4 mm but not for SFR < 1 mm. No difference was seen in our Asian cohort for any SFR cut-off in both PS and NPS patients.
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Affiliation(s)
- Y X T Law
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore.
| | - J Y C Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - D Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - E J Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - E O T Chan
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - M Wroclawski
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil.,BP-a Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - G M Pirola
- Department of Urology, San Donato Hospital, Arezzo, Italy
| | - C Giulioni
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - E Rubilotta
- Department of Urology, A.O.U.I. Verona University, Verona, Italy
| | - M Gubbioti
- Department of Urology, San Donato Hospital, Arezzo, Italy
| | - S Scarcella
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - B H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - O Traxer
- Service d'Urologie, Sorbonne Université, Paris, France.,Service d'Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - V Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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Amato M, Piazza P, Deruyver Y, Del Favero L, Van den Broeck T, Sarchi L, Scarcella S, Bravi CA, Puliatti S, Micali S, Van Haute C, Van Cleynenbreugel B. Laparoscopic assisted mini-ECIRS for ectopic kidney lithiasis: A case report and literature review. CEN Case Rep 2022; 11:295-301. [PMID: 34982417 DOI: 10.1007/s13730-021-00683-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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/26/2021] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Ectopic kidney is a rare anatomic variant with an incidence of about 1 in 900. Renal stones can pose a challenge when a standard approach is not possible. Laparoscopic-assisted endourologic procedure can be a feasible and safe choice. CASE REPORT AND LITERATURE REVIEW We present a case of 32 years old man with spastic quadriplegia, megacolon and pelvic kidney undergoing intervention of laparoscopic-assisted Mini ECIRS for staghorn stone of the left pelvic kidney. To the best of our knowledge, only 59 cases are reported in the literature concerning laparoscopically assisted encdourologic treatment which seems a feasible, safe and adaptable technique in selected complex cases. CONCLUSION Laparoscopic-assisted mini ECIRS is a viable option for the treatment of ectopic kidney stones. This technique should be considered when anatomical anomalies are encountered, to avoid puncture-related complications.
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Affiliation(s)
- Marco Amato
- Department of Urology, University Hospitals Leuven, Leuven, Belgium. .,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy. .,ORSI Academy, Melle, Belgium.
| | - Pietro Piazza
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium.,Department of Urology, Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italy
| | - Yves Deruyver
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Lina Del Favero
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Luca Sarchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.,ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
| | - Simone Scarcella
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
| | - Carlo Andrea Bravi
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.,ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Carl Van Haute
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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21
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Scarcella S, Castellani D, Piazza P, Giulioni C, Sarchi L, Amato M, Bravi CA, Lores MP, Farinha R, Knipper S, Palagonia E, Skrobot SA, Develtere D, Berquin C, Sinatti C, Van Puyvelde H, De Groote R, Umari P, De Naeyer G, Dell'Atti L, Milanese G, Puliatti S, Teoh JYC, B Galosi A, Mottrie A. Concomitant robot-assisted laparoscopic surgeries for upper and lower urinary tract malignancies: a comprehensive literature review. J Robot Surg 2021; 16:991-1005. [PMID: 34748165 DOI: 10.1007/s11701-021-01317-1] [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: 08/25/2021] [Accepted: 10/03/2021] [Indexed: 12/24/2022]
Abstract
Worldwide, we have witnessed an expansion of robot-assisted laparoscopic surgery (RALS) and thanks to the global adoption of high-resolution diagnostic imaging technologies, an increased incidence of newly diagnosed prostatic, renal and bladder cancers has been recorded with concurrent second primary urological cancer diagnoses increasing by 1.5%. Diverse authors have reported their findings concerning synchronous multi-visceral malignances robotic treatment within the scientific literature. The aim of this study is to comprehensively review all reported articles describing concurrent upper and lower RALS using a singular robotic port scheme within the same intervention for renal malignances and concomitant prostatic or bladder cancers. To the best of our knowledge and vigorous literature search, this is the first study that comprehensively evaluates and reports all combined upper and lower urinary tract surgeries published so far. In carefully selected patients, thanks to multidisciplinary preoperative assessment and surgical planning a combined robotic approach can reduce the morbidity, complications, hospital admissions and the overall length of hospitalization.
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Affiliation(s)
- Simone Scarcella
- Department of Urology, Polytechnic University of Marche Region, Umberto I Hospital "Ospedali Riuniti", 71 Conca Street, 60126, Ancona, Italy.
| | - Daniele Castellani
- Department of Urology, Polytechnic University of Marche Region, Umberto I Hospital "Ospedali Riuniti", 71 Conca Street, 60126, Ancona, Italy
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlo Giulioni
- Department of Urology, Polytechnic University of Marche Region, Umberto I Hospital "Ospedali Riuniti", 71 Conca Street, 60126, Ancona, Italy
| | - Luca Sarchi
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Amato
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Andrea Bravi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Division of Oncology/Unit of Urology; URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Maria Peraire Lores
- Department of Urology, Son Espases University Hospital, Palma de Mallorca, Spain
| | | | - Sophie Knipper
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Erika Palagonia
- Department of Urology, Polytechnic University of Marche Region, Umberto I Hospital "Ospedali Riuniti", 71 Conca Street, 60126, Ancona, Italy
| | | | - Dries Develtere
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Camille Berquin
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Céline Sinatti
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | | | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Paolo Umari
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Geert De Naeyer
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Lucio Dell'Atti
- Department of Urology, Polytechnic University of Marche Region, Umberto I Hospital "Ospedali Riuniti", 71 Conca Street, 60126, Ancona, Italy
| | - Giulio Milanese
- Department of Urology, Polytechnic University of Marche Region, Umberto I Hospital "Ospedali Riuniti", 71 Conca Street, 60126, Ancona, Italy
| | - Stefano Puliatti
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Jeremy Yuen-Chun Teoh
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Andrea B Galosi
- Department of Urology, Polytechnic University of Marche Region, Umberto I Hospital "Ospedali Riuniti", 71 Conca Street, 60126, Ancona, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium.,ORSI Academy, Melle, Belgium
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22
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Piazza P, Bravi C, Puliatti S, Cacciamani G, Knipper S, Amato M, Dell’Oglio P, Mazzone E, Rosiello G, Mottaran A, Sarchi L, Paciotti M, Farinha R, Scarcella S, Wisz P, Schiavina R, Brunocilla E, Bianchi L, Develtere D, Sinatti C, Berquin C, De Groote R, De Backer P, D’Hondt F, Mottrie A. External validation of radical cystectomy pentafecta, achievement assessment and its association with surgical experience. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02259-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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23
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Scarcella S, Castellani D, Gauhar V, Teoh JYC, Giulioni C, Piazza P, Bravi CA, De Groote R, De Naeyer G, Puliatti S, Galosi AB, Mottrie A. Robotic-assisted versus open simple prostatectomy: Results from a systematic review and meta-analysis of comparative studies. Investig Clin Urol 2021; 62:631-640. [PMID: 34729963 PMCID: PMC8566792 DOI: 10.4111/icu.20210297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/14/2021] [Accepted: 09/12/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To review safety and efficacy of robotic-assisted simple prostatectomy (RASP) compared to open simple prostatectomy (OP). MATERIALS AND METHODS A comprehensive literature search was performed to assess the differences in perioperative course and functional outcomes in patients with benign prostatic hyperplasia and surgical indication. The incidences of complications were pooled using the Cochran-Mantel-Haenszel Method and expressed as odds ratio (OR), 95% confidence interval (CI), and p-values. Perioperative course and functional outcomes were pooled using the inverse variance of the mean difference (MD), 95% CI, and p-values. Analyses were two-tailed and the significance was set at p<0.05. RESULTS Eight studies were accepted. Meta-analysis showed significantly longer surgical time (MD, 43.72; 95% CI, 30.57-56.88; p<0.00001) with a significantly lower estimated blood loss (MD, -563.20; 95% CI, -739.95 to -386.46; p<0.00001) and shorter postoperative stay (MD, -2.85; 95% CI, -3.72 to -1.99; p<0.00001) in RASP. Catheterization time did not differ (MD, 0.65; 95% CI, -2.17 to 3.48; p=0.65). The risk of blood transfusion was significantly higher in OP (OR, 0.23; 95% CI, 0.17-0.33; p<0.00001). The risk of recatheterization (OR, 1.96; 95% CI, 0.32-11.93; p=0.47), postoperative urinary infections (OR, 0.89; 95% CI, 0.23-3.51; p=0.87) and 30-day readmission rate (OR, 0.96; 95% CI, 0.61-1.51; p=0.86) did not differ. At 3-month follow-up, functional outcomes were similar. CONCLUSIONS RASP demonstrated a better perioperative outcome and equal early functional outcomes as compared to OP. These findings should be balanced against the longer operative time and higher cost of robotic surgery.
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Affiliation(s)
- Simone Scarcella
- Urology Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti di Ancona", Università Politecnica delle Marche, Ancona, Italy
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti di Ancona", Università Politecnica delle Marche, Ancona, Italy.
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, NUHS, Jurong East, Singapore
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Carlo Giulioni
- Urology Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti di Ancona", Università Politecnica delle Marche, Ancona, Italy
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlo Andrea Bravi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
- ORSI Academy, Melle, Belgium
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Geert De Naeyer
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti di Ancona", Università Politecnica delle Marche, Ancona, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
- ORSI Academy, Melle, Belgium
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Amato M, Puliatti S, Farinha R, Piazza P, Sarchi L, Mazzone E, Rosiello G, Bravi C, Scarcella S, Knipper A, De Groote R, Van Cleynenbreugel B, Rocco B, Bianchi G, Micali S, Mottrie A, Gallagher A. Proficiency based progression (PBP): A scientific approach to training (robotic) surgical skills. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02310-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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De Stefano V, Giulioni C, Scarcella S, Stramucci S, Milanese G, Castellani D, Galosi A. Preoperative ureteral stent insertion within 2 months from retrograde intra-renal surgery: a useful tool to prevent postoperative infection? EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00744-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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26
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Giulioni C, Maurizi V, Scarcella S, Di Biase M, Iacovelli V, Galosi AB, Castellani D. Do environmental and occupational exposure to pyrethroids and organophosphates affect human semen parameters? Results of a systematic review and meta-analysis. Andrologia 2021; 53:e14215. [PMID: 34410018 DOI: 10.1111/and.14215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/25/2021] [Accepted: 07/29/2021] [Indexed: 11/30/2022] Open
Abstract
Our purpose was to review and analyse the impact of pyrethroids and organophosphates exposure on human semen parameters. A comprehensive literature search was performed through MEDLINE via PubMed, Scopus and Webscience. Only cohort studies examining semen parameters in workers or general populations exposed to pyrethroids or organophosphates were included. Ejaculate volume, sperm count, concentration, motility, viability, normal morphology and seminal pH alterations were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and expressed as weighted mean difference, risk ratios, 95% confidence intervals and p-values. Seven cross-sectional studies regarding pyrethroids were included. Four of them were eligible for meta-analysis. The only parameter affected by pyrethroid exposure was normal sperm morphology (WMD-7,61%, 95%CI -11,92 to -3,30;p = 0,0,005). Nine studies were selected to evaluate the impact of organophosphates on semen parameters with six of them eligible for meta-analysis. A significant reduction was detected for the following: ejaculate volume (WMD -0,47ml, 95%CI -0,69 to -0,25; p < 0,0001), sperm count (WMD-40,03, 95%CI -66,81 to -13,25;p = 0,003), concentration (WMD-13,69 x10⁶/mL, 95%CI -23, 27 to-4,12;p = 0,005) and motility (WMD -5,70%, 95%CI -12,89 to 1,50;p = 0,12). Despite the increase in sperm abnormality, it has been shown that pyrethroids are unrelated to reduced sperm quality. However, the negative association of organophosphates with spermatogenesis is noteworthy.
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Affiliation(s)
- Carlo Giulioni
- Department of Urology, Ospedali Riuniti" University Hospital, Ancona, Italy
| | - Valentina Maurizi
- Department of Clinical and Molecular Sciences, "Polytechnic University of Marche Region, Ospedali Riuniti" University Hospital, Ancona, Italy
| | - Simone Scarcella
- Department of Urology, Ospedali Riuniti" University Hospital, Ancona, Italy
| | | | - Valerio Iacovelli
- Urology Unit, "San Carlo di Nancy" General Hospital - GVM Care and Research, Rome, Italy
| | | | - Daniele Castellani
- Department of Urology, Ospedali Riuniti" University Hospital, Ancona, Italy
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Castellani D, Pirola GM, Rubilotta E, Gubbiotti M, Scarcella S, Maggi M, Gauhar V, Teoh JYC, Galosi AB. GreenLight Laser™ Photovaporization versus Transurethral Resection of the Prostate: A Systematic Review and Meta-Analysis. Res Rep Urol 2021; 13:263-271. [PMID: 34295844 PMCID: PMC8290851 DOI: 10.2147/rru.s277482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/05/2021] [Indexed: 11/23/2022] Open
Abstract
GreenLight laser™ photovaporization of the prostate (GLL-PVP) has become a valid alternative to traditional transurethral resection of the prostate (TURP) in men requiring surgery for benign prostatic hyperplasia. We aimed to review systematically the safety and efficacy of studies comparing GLL PVP and TURP in the medium-term. A comprehensive literature search was performed. Twelve studies were identified for meta-analysis. Meta-analyses showed a longer postoperative catheterization time (risk ratio (RR): 1.12, 95% CI:1.09–1.14, p<0.00001) and length of stay (RR: 1.16, 95% CI:1.12–1.19, p<0.00001) in the TURP group; higher risk of transfusion in the TURP group (RR: 6.51, 95% CI: 2,90–14,64 p<0.00001); no difference in the risk of urinary tract infections (RR: 0.83, 95% CI: 0.58–1.18, p=0.30) and transient re-catheterization (RR: 1.11, 95% CI: 0.76–1.60, p=0.60). Regarding reoperation rate, no difference was found in term of postoperative urethral stricture (RR: 1.13, 95% CI: 0.73–1.75, p=0.59) and bladder neck contracture (RR: 0.66, 95% CI: 0.31–1.40, p=0.28). A significantly higher incidence in reoperation for persistent/regrowth adenoma was present in the GLLL-PVP (RR: 0.64, 95% CI: 0.41–0.99, p=0.05). Data at 2-year follow-up showed significant better post-voiding residual (PVR) (MD: -1.42, 95% CI: -2.01, -0.82, p<0.00001) and International Prostate Symptom Score (IPSS) (MD: -0.35, 95% CI: -0.50, -0.20, p<0.00001) after TURP. No difference was found in the mean PVR at 2 years after TURP, in the mean maximum flow rate (Qmax) (MD: 0.30, 95% CI: -0.02–0.61, p=0.06) and quality of life QoL score (MD: 0.05, 95% CI: -0.02–0.42, p=0.13). At 5-year follow-up, data showed better IPSS (MD: -1.70, 95% CI: -2.45,-0.95, p<0.00001), QoL scores (MD: -0.35, 95% CI: -0.69, -0.02, p=0.04) and Qmax (MD: 3.29, 95% CI: 0.19–6.38, p=0.04) after TURP. Data of PVR showed no significant difference (MD: -11.54, 95% CI: -29.55–6.46, p=0.21). In conclusion, our analysis shows that GLL-PVP is a safer and more efficacious procedure than standard TURP in the early and medium-term. However, in the long term period GLL-PVP showed a higher incidence of reoperation rate due to incomplete vaporization/regrowth of prostatic adenoma.
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Affiliation(s)
- Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of Le Marche, Ancona, Italy
| | | | | | | | - Simone Scarcella
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of Le Marche, Ancona, Italy
| | - Martina Maggi
- Urology Division, La Sapienza University, Rome, Italy
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital (NUHS), Singapore
| | - Jeremy Yuen-Chun Teoh
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Andrea Benedetto Galosi
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of Le Marche, Ancona, Italy
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Palagonia E, Scarcella S, Dell'Atti L, Milanese G, Schatteman P, D'Hondt F, De Naeyer G, Galosi AB, Mottrie A. Robot-assisted segmental ureterectomy with psoas hitch ureteral reimplantation: Oncological, functional and perioperative outcomes of case series of a single centre. ACTA ACUST UNITED AC 2021; 93:101-106. [PMID: 33754620 DOI: 10.4081/aiua.2021.1.101] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/21/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION According to the Urology guidelines, in selected cases of distal upper tract urothelial carcinoma (UTUC) segmental ureterectomy (SU) can be offered. There is no consensus in the surgical technique of preference. Robot-assisted SU could be an option to overcome all the limitations of open and laparoscopic techniques. We describe our first experience of robot assisted SU with psoas hitch ureteral reimplantation (RAPHUR). MATERIALS AND METHODS 11 patients underwent RAPHUR for distal UTUC between 2013 and 2017 in a single centre. Pre-, intra-, and postoperative outcomes were assessed. Conventional imaging was performed after 1, 3, 6 months and 1 year from surgery as follow up protocol. We retrospectively evaluated the technical feasibility, oncological and functional outcomes. RESULTS Median age was 71 years (57-91). The median length of the ureteral defect was 23 mm (10-40). Median preoperative creatinine level was 1.22 mg/dl (0.7-1.85) and median eGFR was 57.5 ml/min/1.73m2 (31-80). Five (45.5%) patients were symptomatic and 7 (63.6%) had hydronephrosis. Median operative time was 185 min (120-240), with a median blood loss of 100 ml (50-300). No case required conversion to open surgery. Overall, only 1 (9%) patient developed Clavien Dindo ≥ 3 postoperative complications. Average hospital stay was 7 (2-9) days. Mean postoperative creatinine was 1.05 mg/dl (0.8-1.85) and mean postoperative eGFR was 72 (36-83). During a median follow up time of 25.5 months (12-53), 4 (36.4%) patients experienced recurrence of urothelial cancer at conventional imaging follow up and 2 (18.2%) died due to its progression. CONCLUSIONS In our initial experience RAPHUR can be proposed to selected cases of distal ureteral carcinoma with optimal perioperative and functional outcomes. However, cancer control may be undermined compared to nephroureterectomy. Thus, further prospective studies are needed to confirm our findings.
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Affiliation(s)
- Erika Palagonia
- Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche, Italy; ORSI Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Moorselbaan, Aalst.
| | - Simone Scarcella
- Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche.
| | - Lucio Dell'Atti
- Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche.
| | - Giulio Milanese
- Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche.
| | - Peter Schatteman
- ORSI Academy, Melle; Department of Urology, Onze Lieve Vrouw Hospital, Moorselbaan, Aalst.
| | - Frederiek D'Hondt
- ORSI Academy, Melle; Department of Urology, Onze Lieve Vrouw Hospital, Moorselbaan, Aalst.
| | - Geert De Naeyer
- ORSI Academy, Melle; Department of Urology, Onze Lieve Vrouw Hospital, Moorselbaan, Aalst.
| | - Andrea B Galosi
- Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche.
| | - Alexander Mottrie
- ORSI Academy, Melle; Department of Urology, Onze Lieve Vrouw Hospital, Moorselbaan, Aalst.
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Galosi AB, Palagonia E, Scarcella S, Cimadamore A, Lacetera V, Delle Fave RF, Antezza A, Dell'Atti L. Detection limits of significant prostate cancer using multiparametric MR and digital rectal examination in men with low serum PSA: Up-date of the Italian Society of Integrated Diagnostic in Urology. ACTA ACUST UNITED AC 2021; 93:92-100. [PMID: 33754619 DOI: 10.4081/aiua.2021.1.92] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 11/22/2022]
Abstract
Reasons why significant prostate cancer is still missed in early stage were investigated at the 22nd National SIEUN (Italian Society of integrated diagnostic in Urology, Andrology, Nephrology) congress took place from 30th November to 1st December 2020, in virtual modality. Even if multiparametric magnetic resonance (MR) has been introduced in the clinical practice several, limitations are emerging in patient with regular digital rectal examination (DRE) and serum prostate specific antigen (PSA) levels approaching the normal limits. The present paper summarizes highlights observed in those cases where significant prostate cancer may be missed by PSA or imaging and DRE. The issue of multidisciplinary interest had been subdivided and deepened under four main topics: biochemical, clinical, pathological and radiological point of view with a focus on PI-RADS 3 lesions.
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Affiliation(s)
- Andrea B Galosi
- Division of Urology, School of Medicine, Università Politecnica delle Marche, Ancona.
| | - Erika Palagonia
- Division of Urology, School of Medicine, Università Politecnica delle Marche, Ancona.
| | - Simone Scarcella
- Division of Urology, School of Medicine, Università Politecnica delle Marche, Ancona.
| | - Alessia Cimadamore
- Division of Pathology, School of Medicine, Università Politecnica delle Marche, Ancona.
| | - Vito Lacetera
- Division of Urology, Azienda Ospedaliera Marche Nord, Pesaro.
| | - Rocco F Delle Fave
- Division of Urology, School of Medicine, Università Politecnica delle Marche, Ancona.
| | - Angelo Antezza
- Division of Urology, School of Medicine, Università Politecnica delle Marche, Ancona.
| | - Lucio Dell'Atti
- Division of Urology, School of Medicine, Università Politecnica delle Marche, Ancona.
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Dell'Atti L, Fabiani A, Palagonia E, Edoardo A, Pavia MP, Scarcella S, Maurelli V, Principi E, Tiroli M, Milanese G, Servi L, Galosi AB. Unusual clinical scenarios in Urology and Andrology. ACTA ACUST UNITED AC 2021; 93:120-126. [PMID: 33754624 DOI: 10.4081/aiua.2021.1.120] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/21/2021] [Indexed: 11/23/2022]
Abstract
This collection includes some unusual cases and how they were diagnosed and treated. Case 1: A case of a patient with primary hyperthyroidism presenting with a submucosal ureteral stone after endoscopic lithotripsy was described. After multiple endoscopic treatment, the stone was successfully removed by open ureterolithotomy recovering ureteral patency and normal renal function. Case 2: A case of burned-out testicular cancer with atypical lymphatic spread (stage II A) was presented. After right orchiectomy and complete remission of tumor markers, due to atypical metastases location and uncertain histology, the patient was treated with systemic therapy based on bleomycin, etoposide and cisplatin (PEB). At re-staging after chemotherapy computed tomography showed reduction of all node metastases and an observation protocol was proposed. Case 3: A patient was readmitted to hospital after 12 days from an uneventful Robot-Assisted Radical Prostatectomy (RARP) for prostate cancer due to lower abdominal pain plus abdominal distension, nausea and constipation not responsive to medical therapy. Computed Tomography showed colon and small bowel dilatation without any evidence of anatomical or mechanical obstruction. Laparoscopic abdominal exploration confirmed bowel distension without evidence of obstructing lesions. Ogilvie's Syndrome or acute colonic pseudo-obstruction (ACPO) was diagnosed. The patient fully recovered and was discharged six days after the procedure. Case 4: A case of recurrent Acute Idiopathic Scrotal Edema (AISE) was diagnosed on clinical signs together with the decisive help of pathognomonic ultrasound findings as the "fountain sign". Case 5: Small bilateral testicular nodules were diagnosed in a 30-years old patient undergoing scrotal ultrasound in follow up of acute lymphoblastic leukemia. Ultrasound guided testis sparing surgery was performed demonstrating Leydig cell tumors.
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Affiliation(s)
- Lucio Dell'Atti
- Division of Urology, University Hospital "Ospedali Riuniti", School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona.
| | - Andrea Fabiani
- Urology Unit, Surgery Department, Macerata Civic Hospital, Area Vasta 3 Asur Marche.
| | - Erika Palagonia
- Division of Urology, University Hospital "Ospedali Riuniti", School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona.
| | - Agostini Edoardo
- Division of Urology, University Hospital "Ospedali Riuniti", School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona.
| | - Maria Pia Pavia
- Urology Unit, Surgery Department, Macerata Civic Hospital, Area Vasta 3 Asur Marche.
| | - Simone Scarcella
- Division of Urology, University Hospital "Ospedali Riuniti", School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona.
| | - Valentina Maurelli
- Urology Unit, Surgery Department, Macerata Civic Hospital, Area Vasta 3 Asur Marche.
| | - Emanuele Principi
- Urology Unit, Surgery Department, Macerata Civic Hospital, Area Vasta 3 Asur Marche.
| | - Marco Tiroli
- Division of Urology, University Hospital "Ospedali Riuniti", School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona.
| | - Giulio Milanese
- Division of Urology, University Hospital "Ospedali Riuniti", School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona.
| | - Lucilla Servi
- Urology Unit, Surgery Department, Macerata Civic Hospital, Area Vasta 3 Asur Marche.
| | - Andrea Benedetto Galosi
- Division of Urology, University Hospital "Ospedali Riuniti", School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona.
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Scarcella S, Tiroli M, Torino G, Mariscoli F, Cobellis G, Galosi AB. Combined treatment of ureteropelvic junction obstruction and renal calculi with robot-assisted laparoscopic pyeloplasty and laser lithotripsy in children: Case report and non-systematic review of the literature. Int J Med Robot 2021; 17:e2246. [PMID: 33626232 DOI: 10.1002/rcs.2246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE(S) The incidence of urinary tract stone disease is steadily increasing in both adult and paediatric populations. This condition develops due to different factors: dietary or metabolic alterations, infection, and congenital anatomic malformations. Standard indications and treatments for children are analogous to the ones indicated for adults. Extracorporeal shock wave lithotripsy, ureterorenoscopy and percutaneous nephrolithotomy (PCNL) should be preferred to more invasive techniques. Moreover, the introduction of laparoscopic and robot-assisted laparoscopic approaches have improved surgical outcomes, lowering the bleeding risk with higher stone-free rates, even in complicated cases. Despite these well-known improvements, there are few reports regarding laparoscopic robot-assisted management for urinary tract stone disease in paediatric patients under the age of 10, especially with concomitant treatment of ureteropelvic junction obstruction and multiple calyceal stones. PATIENT AND METHOD(S) A 4-year-old child was referred for recurrent right abdominal flank pain, macroscopic haematuria and a previous history of urinary tract infections. A computed tomography of the abdomen showed right ureteropelvic junction obstruction associated with multiple unilateral stones located in the renal pelvis and in the interpolar renal calyces. Due to its complexity, we held a multidisciplinary meeting with paediatric surgeons and nephrologists to determine optimal treatment. As a result, a combined robot-assisted laparoscopic pyeloplasty (LP) and renal calculi holmium laser lithotripsy using a digital flexible ureteroscope through an abdominal robotic trocar was performed. No post-surgical complications were recorded, and the patient was discharged within 48 h following surgery. At subsequent regular follow-up examinations over a period of 24 months, no signs of recurrence were detected for both ureteropelvic junction obstruction and stone disease. RESULT(S) Robot-assisted LP with concomitant laser lithotripsy is a reasonable treatment option for designated young paediatric patients with challenging ureteropelvic junction obstruction complicated by urolithiasis, especially in cases where stones are not amenable with standard procedures.
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Affiliation(s)
- Simone Scarcella
- Department of Urology, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital, Ancona, Italy
| | - Marco Tiroli
- Department of Urology, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital, Ancona, Italy
| | - Giovanni Torino
- Pediatric Surgery Unit, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital and "G. Salesi" Children's Hospital, Ancona, Italy
| | - Francesca Mariscoli
- Pediatric Surgery Unit, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital and "G. Salesi" Children's Hospital, Ancona, Italy
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital and "G. Salesi" Children's Hospital, Ancona, Italy
| | - Andrea Benedetto Galosi
- Department of Urology, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital, Ancona, Italy
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Scarcella S, Dell`Atti L, Agostini E, Giulioni C, Sbrollini G, Giulio M, Pierini L, Agostini A, Floridi C, Giovagnoni A, Galosi A. Who scores the game in nephron-sparing surgery? renal scoring system reproducibility among residents in urology and radiology. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35500-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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33
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Giulioni C, Agostini E, Scarcella S, Dell’Atti L, Sbrollini G, Montesi L, Milanoese G, Galosi A. Resection technique in perioperative and functional outcomes of nephron sparing surgery: experience in open, laparoscopic and robot-assisted surgery. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35503-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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34
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Montesi L, Sabbatini L, Leone L, Palagonia E, Parlavecchio A, Franzese C, Cimadamore A, Dell’atti L, Capretti C, Papaveri A, Scarcella S, Milanese G, Montironi R, Galosi A. Seminal vesicle invasion in pT3bN0cM0 prostate cancer patients treated with radical prostatetectomy: Impact of Ohori patterns of invasion on biochemical recurrence. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33509-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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35
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Capretti C, Milanese G, Cameli A, Sbaraglia F, Mari A, Pierini L, Misericordia M, Scarcella S, Giovagnoni A, Giuseppetti G, Galosi A. Combination of Dual Energy CT scan and Infrared Spectroscopy: Analysis of imaging accuracy in prediction of different stones composition and stiffness. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33392-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Fossati N, Robesti D, Karnes RJ, Soligo M, Boorjian SA, Bossi A, Coraggio G, Di Muzio N, Cozzarini C, Noris Chiorda B, Gandaglia G, Scarcella S, Bartkowiak D, Böhmer D, Shariat S, Goldner G, Battaglia A, Joniau S, Haustermans K, De Meerleer G, Fonteyne V, Ost P, Van Poppel H, Montorsi F, Wiegel T, Briganti A. Assessing the Role and Optimal Duration of Hormonal Treatment in Association with Salvage Radiation Therapy After Radical Prostatectomy: Results from a Multi-Institutional Study. Eur Urol 2019; 76:443-449. [DOI: 10.1016/j.eururo.2019.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
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Dell'Atti L, Scarcella S, Tallè M, Polito M, Galosi AB. Simultaneous curvature correction at the time of the penile fracture repair: surgical and functional outcomes. Res Rep Urol 2019; 11:105-110. [PMID: 31114766 PMCID: PMC6489630 DOI: 10.2147/rru.s191997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/24/2018] [Accepted: 03/25/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: After a penile fracture (PF), an early surgical exploration and defect closure of the lesions are recommended to prevent long-term complications. However, postoperative unsatisfactory penile curvatures are frequent in the literature. In this study, we wished to present surgical outcomes of PF after surgical repair approach with an early intraoperative curvature correction and update our series with postoperative follow-up. Patients and methods: An institutional retrospective review study of 36 patients undergoing surgical treatment for PF was performed. Mean age of patients was 53.2 years. All surgical explorations were performed within 12 hours after the traumatic event. The surgical repair with a contemporary penile plication was then made to straighten the tunica angulations in patients with curvature greater than 30°, using 2– 3 pairs of 2–0 absorbable suture of polydioxanone. Results: The length of the tear ranged from 8 to 20 mm. 77.7% of the patients required a correction of the cavernous body deviation. No early complications occurred in any case. The median patient stays in the hospital was 3.4 days. At a mean follow-up of 20.6 months, all patients were able to insert the penis in the partner’s vagina, and were satisfied overall with sexual intercourse; three patients (10.7%) reported residual pain and discomfort for the knots of the sutures. Conclusions: An early intraoperative curvature correction may be used for a variety of angulation deformities and severe degrees of deviations secondary to a repair after penile trauma, and may be helpful in preventing postoperative morbidity.
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Affiliation(s)
- Lucio Dell'Atti
- Department of Urology, University Hospital "Ospedali Riuniti", Ancona, Italy
| | - Simone Scarcella
- Department of Urology, Polytechnic University of Marche, Ancona, Italy
| | - Matteo Tallè
- Department of Urology, Polytechnic University of Marche, Ancona, Italy
| | - Massimo Polito
- Andrology Unit, University Hospital "Ospedali Riuniti", Ancona, Italy
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Martini A, Gandaglia G, Fossati N, Scuderi S, Bravi CA, Mazzone E, Stabile A, Scarcella S, Robesti D, Barletta F, Cucchiara V, Mirone V, Montorsi F, Briganti A. Defining Clinically Meaningful Positive Surgical Margins in Patients Undergoing Radical Prostatectomy for Localised Prostate Cancer. Eur Urol Oncol 2019; 4:42-48. [PMID: 31411971 DOI: 10.1016/j.euo.2019.03.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/27/2019] [Accepted: 03/12/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND The impact of positive surgical margins (PSMs) on the risk of metastases in prostate cancer (PCa) patients treated with radical prostatectomy (RP) is still debated. OBJECTIVE To identify PSM features associated with recurrence in a stage-by-stage analysis. DESIGN, SETTING, AND PARTICIPANTS A total of 1757 PCa patients treated with RP without neoadjuvant or adjuvant treatments between 2011 and 2017 were identified. Patients were stratified according to the presence of PSM and to margins characteristics in three groups: no versus favourable (single margin <3mm) versus unfavourable (≥3mm or multifocal margin) PSMs. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Predictors of biochemical recurrence (BCR) and clinical recurrence (CR) were assessed using semiparametric Cox proportional hazard models. RESULTS AND LIMITATIONS Overall, 285 (16%) patients had PSMs; 146 (51%) had a unifocal PSM, while 139 (49%) had a multifocal PSM. The median length of a PSM was 1mm. Overall, 120 (42%) versus 165 (58%) patients had favourable versus unfavourable PSMs. In patients with ≤pT3a and pathologic grade group ≤3 disease (n=1351), favourable (hazard ratio [HR]: 2.24; 95% confidence interval [CI]: 1.19-4.22) and unfavourable (HR: 2.68; 95% CI: 1.49-4.84) PSMs significantly increased the risk of BCR (p<0.01). However, they were not associated with CR (all p>0.05). Conversely, in patients with pT3b/4 and/or pathologic grade group 4-5 and/or pN1 (n=406), only an unfavourable PSM was associated with both BCR (HR: 2.96; 95% CI: 1.19-4.22) and CR (HR: 2.60; 95% CI: 1.07-6.30; all p≤0.04). CONCLUSIONS Although the presence of PSMs was associated with an increased risk of BCR in all stages, only men with adverse pathologic characteristics and an unfavourable PSM were at an increased risk of experiencing metastases as compared with their counterparts with no or a single margin shorter than 3mm. PATIENT SUMMARY In this study, we defined a new category of unfavourable positive surgical margins (namely, ≥3mm and/or multifocal), which confers a higher risk of developing metastasis in men with more aggressive pathologic features.
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Affiliation(s)
- Alberto Martini
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Nicola Fossati
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Simone Scuderi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Carlo Andrea Bravi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Elio Mazzone
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Armando Stabile
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Simone Scarcella
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Daniele Robesti
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Barletta
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Vito Cucchiara
- Department of Urology, Università Federico II, Naples, Italy
| | - Vincenzo Mirone
- Department of Urology, Università Federico II, Naples, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Scarcella S, Dell'Atti L, Galosi AB. Renal germ cell metastatic tumour with rupture, bleeding and syncope: an unusual clinical presentation in a young patient. BMJ Case Rep 2018; 2018:bcr-2017-223990. [PMID: 30093464 DOI: 10.1136/bcr-2017-223990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The most common malignancy in young men is a germ cell tumour of the testes. Metastatic renal disease is relatively uncommon and usually manifests in the retroperitoneal lymph nodes. Visceral metastases to the liver, and metastases to the lungs and the brain are more common. Few large studies characterising patients with germ cell tumours and associated renal metastases have yet been published. We report an unusual case of successful management, through demolitive surgery, of a 22-year-old male patient affected by spontaneous intrarenal rupture of metastases secondary to testicular cancer. The patient was admitted to our urology department due to recurrent episodes of haematuria and clinical symptoms of persistent hypotension.
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Affiliation(s)
| | - Lucio Dell'Atti
- Urology, University Hospital "Ospedali Riuniti", Ancona, Italy
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Dell'Atti L, Scarcella S, Manno S, Polito M, Galosi AB. Approach for Renal Tumors With Low Nephrometry Score Through Unclamped Sutureless Laparoscopic Enucleation Technique: Functional and Oncologic Outcomes. Clin Genitourin Cancer 2018; 16:e1251-e1256. [PMID: 30122517 DOI: 10.1016/j.clgc.2018.07.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Revised: 07/16/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE We report an unclamped sutureless laparoscopic simple enucleation (LSE) technique for renal tumors with low nephrometry score and analyze complication rates as well as functional and oncologic outcomes. PATIENTS AND METHODS We reviewed the data of 143 consecutive patients who underwent sutureless laparoscopic tumor enucleation with zero ischemia by a single experienced laparoscopic surgeon. The inclusion criteria for LSE with zero ischemia were tumor size ≤ 5 cm and RENAL nephrometry score of 4 to 6. The following data were collected: age, gender, body mass index, tumor side, renal function, tumor characteristics, American Society of Anesthesiologists score, operative time, positive surgical margins, estimated blood loss, and surgical complications. RESULTS The median RENAL score of patients was 4.7. Median tumor size was 2.7 cm. Conversion to open surgery and hilum vessels clamped were not necessary in any patient. There were no changes in postoperative creatinine values and estimated glomerular filtration rate. The median operation duration time was 78.2 minutes, and median estimated blood loss was 110.2 mL. The median hospital stay was 3.8 days. A total of 2.8% of the patients had positive surgical margins at pathologic examination. Of the 143 patients, 7% developed fever after surgery requiring an adequate antibiotic regimen, 1.4% developed postoperative bleeding requiring blood transfusions, and 0.7% had postoperative urinary leakage from the drainage requiring double-J stent position. CONCLUSION The unclamped sutureless LSE is a rational and safe approach to renal tumors with a low nephrometry score. This surgical technique does not increase the complication rate despite the reduction in parenchymal mass excised and the absence of hilar control.
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Affiliation(s)
- Lucio Dell'Atti
- Department of Urology, University Hospital "Ospedali Riuniti", Ancona, Italy.
| | - Simone Scarcella
- Department of Urology, University Hospital "Ospedali Riuniti", Ancona, Italy
| | - Stefano Manno
- Department of Urology, University Hospital "Ospedali Riuniti", Ancona, Italy
| | - Massimo Polito
- Department of Urology, University Hospital "Ospedali Riuniti", Ancona, Italy
| | - Andrea B Galosi
- Department of Urology, Polytechnic University of Marche Region, Ancona, Italy
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Dell'Atti L, Scarcella S, Argalia G, Montesi L, Giuseppetti GM, Galosi AB. Rupture of the cavernous body diagnosed by contrast-enhanced ultrasound: Presentation of a clinical case. ACTA ACUST UNITED AC 2018; 90:143-144. [PMID: 29974733 DOI: 10.4081/aiua.2018.2.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/29/2018] [Indexed: 12/17/2022]
Abstract
Penile trauma represents a urological emergency characterized by the breaking of the albuginea tunic. A fast diagnosis and early surgical repair are the best treatments to avoid post-operative sequelae such as curvatures or deformities of the penis. An ultrasound evaluation may not be able to identify the injury in the tunica albuginea due to the edematous swelling of the penis and clots within the tear deteriorate the image contrast and can hide the injury. We here report a case study of successful management via surgical treatment for rupture of the cavernous body diagnosed by contrast-enhanced ultrasound in a young patient with penile trauma.
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Affiliation(s)
- Lucio Dell'Atti
- Department of Urology, Polytechnic University of Marche Region, University Hospital "Ospedali Riuniti", Ancona.
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Dell'Atti L, Leone L, Scarcella S, Montesi L, Galosi AB. PD02-03 PENILE FRACTURE REPAIR WITH AN EARLY INTRAOPERATIVE CURVATURE CORRECTION, IF NEEDED: SURGICAL OUTCOMES OF A CONTEMPORARY APPROACH. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.228] [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: 12/01/2022]
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Scarcella S, Hanna R, Brennan G, Solana H, Fairweather I. Fasciola hepatica: Histological changes in the somatic and reproductive tissues of liver fluke following closantel treatment of experimentally-infected sheep. Vet Parasitol 2016; 215:38-47. [DOI: 10.1016/j.vetpar.2015.10.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 10/28/2015] [Accepted: 10/30/2015] [Indexed: 11/29/2022]
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Scarcella S, Miranda-Miranda E, Solana MV, Solana H. Approach to molecular characterization of different strains of Fasciola hepatica using random amplified polymorphic DNA polymerase chain reaction. Parasitol Res 2015; 114:1341-5. [PMID: 25595655 DOI: 10.1007/s00436-015-4310-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/07/2015] [Indexed: 11/24/2022]
Abstract
The aim of the present study was to genetically characterize Fasciola hepatica strains from diverse ecogeographical regions (America and Europe), susceptible and resistant to Triclabendazole, using the random amplified polymorphic DNA fragments (RAPDs-PCR) technique to elucidate genetic variability between the different isolates. Ten different oligonucleotide primers of 10 bases with GC content varying from 50-70% were used. A polymerase chain reaction (PCR) was carried out in 25 μl of total volume. Duplicate PCR reactions on each individual template DNA were performed to test the reproducibility of the individual DNA bands. The size of the RAPD-PCR fragments was determined by the reciprocal plot between the delay factors (Rf) versus the logarithm of molecular weight ladder. The phenogram obtained showed three main clusters, the major of which contained European Strains (Cullompton and Sligo) showing a genetic distance of 27.2 between them. The American strains (Cedive and Cajamarca) on the other hand formed each their distinctive group but clearly maintaining a closer genetic relationship among them than that to their European counterparts, with which showed a distance of 33.8 and 37.8, respectively. This polymorphism would give this species enhanced adaptability against the host, as well as the environment. The existence of genetically different populations of F. hepatica could allow, against any selection pressure, natural or artificial (for use fasciolicides products and/or control measures), one or more populations of F. hepatica to be able to survive and create resistance or adaptability to such selective pressure.
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Affiliation(s)
- S Scarcella
- Laboratorio de Biología Celular y Molecular, Centro de Investigación Veterinaria de Tandil (CIVETAN), CONICET, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires, Campus Universitario, Campus Universitario, 7000, Tandil, Argentina,
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Ortiz P, Scarcella S, Cerna C, Rosales C, Cabrera M, Guzmán M, Lamenza P, Solana H. Resistance of Fasciola hepatica against Triclabendazole in cattle in Cajamarca (Peru): a clinical trial and an in vivo efficacy test in sheep. Vet Parasitol 2013; 195:118-21. [PMID: 23352107 DOI: 10.1016/j.vetpar.2013.01.001] [Citation(s) in RCA: 72] [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] [Received: 10/17/2012] [Revised: 12/31/2012] [Accepted: 01/02/2013] [Indexed: 11/17/2022]
Abstract
Fasciolosis caused by Fasciola hepatica, is the most prevalent parasitic disease in dairy cattle from the northern region of Cajamarca, Peru. The control of this parasite is based on the use of Triclabendazole (TCBZ), a drug that has been used for more than fifteen years in this area. Recent studies, however, have reported a lack of clinical efficacy after treating dairy cattle. This research was aimed to determine the efficacy of TCBZ in a clinical trial. Eleven dairy cows all positive to F. hepatica identified by presence of eggs in feces, were treated with TCBZ (Fasinex(®) 10%) at 12 mg/kg body weight. Fourteen and thirty days after treatment, the animals were analyzed for F. hepatica eggs in their feces by the fecal egg count reduction test. The results found show an overall efficacy of 31.05% and 13. 63% (14 and 30 days post treatment, respectively). Furthermore, an in vivo efficacy test was conducted in sheep with metacercariae obtained from eggs isolated from a cow clinically resistant to TCBZ. Eleven sheep divided in two groups, a control group with no treatment (n=5) and a treated group (n=6) were all infected with two hundred metacercariae. One hundred and six days after infection all the animals demonstrated F. hepatica eggs in their feces, confirming the presence of adult parasites in their livers. The animals were then treated with TCBZ (Fasinex(®) 10%) at 10mg/kg body weight. Fifteen days later, the animals were sacrificed and the number of F. hepatica in their livers counted. The results of this experiment showed an efficacy of the flukicide of 25.2% confirming the resistance to TCBZ of the F. hepatica isolated from dairy cattle in Cajamarca, Peru.
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Affiliation(s)
- P Ortiz
- Facultad de Ciencias Veterinarias, Universidad Nacional de Cajamarca, Cajamarca, Peru.
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Scarcella S, Miranda-Miranda E, Cossío-Bayúgar R, Ceballos L, Fernandez V, Solana H. Increase of carboxylesterase activity in Fasciola hepatica recovered from triclabendazole treated sheep. Mol Biochem Parasitol 2012; 185:151-3. [PMID: 22814337 DOI: 10.1016/j.molbiopara.2012.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 07/06/2012] [Accepted: 07/07/2012] [Indexed: 11/30/2022]
Abstract
In the present work, we evaluate in vivo the activity of carboxylesterase of Fasciola hepatica exposed to triclabendazole. We observed a statistically significant increase in enzyme activity at 24 and 48 h post treatment (P<0.01 and P<0.001, respectively). The zymogram of cytosolic fractions identified a protein of 170 kDa containing the carboxylesterase activity. The densitograms of the zymograms confirmed the phenomenon of enzyme induction under the experimental conditions of the assay. These results provide not only the understanding of the importance of this metabolic pathway in flukes but carboxylesterase would also be an enzyme that could participate more actively in the development of anthelmintic resistance at TCBZ.
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Affiliation(s)
- S Scarcella
- CIVETAN-CONICET, UNC PBA, 7000 Tandil, Argentina.
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Scarcella S, Lamenza P, Virkel G, Solana H. Expression differential of microsomal and cytosolic glutathione-S-transferases in Fasciola hepatica resistant at triclabendazole. Mol Biochem Parasitol 2012; 181:37-9. [DOI: 10.1016/j.molbiopara.2011.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 09/27/2011] [Accepted: 09/28/2011] [Indexed: 11/17/2022]
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Virkel G, Lifschitz A, Sallovitz J, Ballent M, Scarcella S, Lanusse C. Inhibition of cytochrome P450 activity enhances the systemic availability of triclabendazole metabolites in sheep. J Vet Pharmacol Ther 2009; 32:79-86. [PMID: 19161459 DOI: 10.1111/j.1365-2885.2008.01006.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Understanding the disposition kinetics and the pattern of metabolism is critical to optimise the flukicidal activity of triclabendazole (TCBZ) in ruminants. TCBZ is metabolised by both flavin-monooxygenase (FMO) and cytochrome P450 (P450) in the liver. Interference with these metabolic pathways may be useful to increase the systemic availabilities of TCBZ metabolites, which may improve the efficacy against Fasciola hepatica. The plasma disposition of TCBZ metabolites was evaluated following TCBZ co-administration with FMO [methimazole (MTZ)] and P450 [piperonyl butoxyde (PB) and ketoconazole (KTZ)] inhibitors in sheep. Twenty (20) healthy Corriedale x Merino weaned female lambs were randomly allocated into four experimental groups. Animals of each group were treated as follow: Group A, TCBZ alone (5 mg/kg, IV route); Group B, TCBZ (5 mg/kg, IV) + MTZ (3 mg/kg, IV); Group C, TCBZ (5 mg/kg, IV) + PB (30 mg/kg, IV) and Group D, TCBZ (5 mg/kg, IV) + KTZ (10 mg/kg, orally). Blood samples were taken over 240 h post-treatment and analysed by HPLC. TCBZ sulphoxide and sulphone were the main metabolites recovered in plasma. MTZ did not affect TCBZ disposition kinetics. TCBZ sulphoxide Cmax values were significantly increased (P < 0.05) after the TCBZ + PB (62%) and TCBZ + KTZ (37%) treatments compared to those measured in the TCBZ alone treatment. TCBZ sulphoxide plasma AUCs were higher (P < 0.05) in the presence of both PB (99%) and KTZ (41%). Inhibition of TCBZ P450-mediated oxidation in the liver accounted for the increased systemic availability of its active metabolite TCBZ sulphoxide. This work contributes to the search of different strategies to improve the use of this flukicidal drug in ruminants.
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Affiliation(s)
- G Virkel
- Laboratorio de Farmacología, Dpto. de Fisiopatología, Facultad de Ciencias Veterinarias, UNCPBA, Tandil, Buenos Aires, Argentina.
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Solana H, Scarcella S, Virkel G, Ceriani C, Rodríguez J, Lanusse C. Albendazole enantiomeric metabolism and binding to cytosolic proteins in the liver fluke Fasciola hepatica. Vet Res Commun 2008; 33:163-73. [DOI: 10.1007/s11259-008-9166-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 08/08/2008] [Indexed: 11/30/2022]
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