Publications by authors named "Federico Piramide"

22 Publications

  • Page 1 of 1

Robot-assisted-radical-cystectomy with total intracorporeal Y neobladder: Analysis of postoperative complications and functional outcomes with urodynamics findings.

Eur J Surg Oncol 2021 Dec 16. Epub 2021 Dec 16.

Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy.

Objectives: To describe our robotic Y intracorporeal neobladder (ICNB) technique and to report its post-operative complications and urodynamics (UD) findings.

Subjects: and Methods: In this prospective study we enrolled patients affected by MIBC (T1-T4N0-N1M0) from 01/2017 to 06/2021 at our Centers. All the patients underwent robotic radical cystectomy (RARC) with Y-ICNB reconfiguration. Early and late complications were collected and classified according to Clavien-Dindo. Continence and potency at 1, 3, 6 and 12 months were evaluated. At the 3rd month of follow-up patients underwent UD. Finally, in a retrospective match paired analysis the functional outcomes of Y RARC patients were compared with a cohort of open Y radical cystectomy.

Results: 45 patients were enrolled. Overall 30-day complications were observed in 25 (55,5%) patients and 30 to 90-days complications in 4 (8,9%). 9 patients (20%) had Clavien ≥3 complications. UDs revealed median neobladder capacity of 268 cc, with a median compliance of 13 ml/cm H20; the voiding phase showed a voiding volume and a post void residual (PVR) of 154 cc and 105 cc respectively. At 12 months of follow-up 4.4%, 15.5% and 4.4% of the patients experienced urge, stress and mix urinary incontinence respectively. The comparison between Y RARC and Y open RC revealed a higher neobladder capacity with open approach (p = 0.049) with subsequent better findings during the voiding phase in terms of maximum flow (p = 0.002), voiding volume (p = 0.001) and PVR (p = 0.01). Focusing on continence recovery, a slight trend in favor of RARC was shown without reaching the statistical significance.

Conclusions: Robotic Y-ICNB is feasible and safe as shown by the low rate of postoperative complications. Satisfying UD functional outcomes are achievable, both during filling and voiding phase.
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http://dx.doi.org/10.1016/j.ejso.2021.12.014DOI Listing
December 2021

Percutaneous Kidney Puncture with Three-dimensional Mixed-reality Hologram Guidance: From Preoperative Planning to Intraoperative Navigation.

Eur Urol 2021 Nov 16. Epub 2021 Nov 16.

Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy.

Background: Despite technical and technological innovations, percutaneous puncture still represents the most challenging step when performing percutaneous nephrolithotomy. This maneuver is characterized by the steepest learning curve and a risk of injuring surrounding organs and kidney damage.

Objective: To evaluate the feasibility of three-dimensional mixed reality (3D MR) holograms in establishing the access point and guiding the needle during percutaneous kidney puncture.

Design, Setting, And Participants: This prospective study included ten patients who underwent 3D MR endoscopic combined intrarenal surgery (ECIRS) for kidney stones from July 2019 to January 2020. A retrospective series of patients who underwent a standard procedure were selected for matched pair analysis.

Surgical Procedure: For patients who underwent 3D MR ECIRS, holograms were overlapped on the real anatomy to guide the surgeon during percutaneous puncture. In the standard group, the procedures were only guided by ultrasound and fluoroscopy.

Measurements: Differences in preoperative and postoperative patient characteristics between the groups were tested using a χ test and a Kruskal-Wallis test for categorical and continuous variables, respectively. Results are reported as the median and interquartile range for continuous variables and as the frequency and percentage for categorical variables.

Results And Limitations: Ten patients underwent 3D MR ECIRS. In all cases, the inferior calyx was punctured correctly, as planned using the overlapping hologram. The median puncture and radiation exposure times were 27 min and 120 s, respectively. No intraoperative or major postoperative complications occurred. Matched pair analysis with the standard ECIRS group revealed a significantly shorter radiation exposure time for the 3D MR group (p < 0.001) even though the puncture time was longer in comparison to the standard group (p < 0.001). Finally, use of 3D MR led to a higher success rate for renal puncture at the first attempt (100% vs 50%; p = 0.032). The main limitations of the study are the small sample size and manual overlapping of the rigid hologram models.

Conclusions: Our experience demonstrates that 3D MR guidance for renal puncture is feasible and safe. The procedure proved to be effective, with the inferior calyx correctly punctured in all cases, and was associated with a low intraoperative radiation exposure time because of the MR guidance.

Patient Summary: Three-dimensional virtual models visualized as holograms and intraoperatively overlapped on the patient's real anatomy seem to be a valid new tool for guiding puncture of the kidney through the skin for minimally invasive treatment.
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http://dx.doi.org/10.1016/j.eururo.2021.10.023DOI Listing
November 2021

New Ultra-minimally Invasive Surgical Treatment for Benign Prostatic Hyperplasia: A Systematic Review and Analysis of Comparative Outcomes.

Eur Urol Open Sci 2021 Nov 22;33:28-41. Epub 2021 Sep 22.

Department of Oncology, Division of Urology, University of Turin, Turin, Italy.

Context: Benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS) is diagnosed in up to 80% of men during their lifetime. Several novel ultra-minimally invasive surgical treatments (uMISTs) for BPH/benign prostatic obstruction (BPO) have become available over the past 5 yr.

Objective: To evaluate the perioperative and functional outcomes of recently introduced uMISTs for BPH/BPO, including Urolift, Rezūm, temporary implantable nitinol device, prostatic artery embolization (PAE), and intraprostatic injection.

Evidence Acquisition: A systematic literature search was conducted in December 2020 using Medline (via PubMed), Embase (via Ovid), Scopus, and Web of Science (registered on PROSPERO as CRD42021225014). The search strategy used PICO criteria and article selection was conducted in accordance with the PRISMA guidelines. The risk of bias and the quality of the articles included were assessed. A dedicated data extraction form was used to collect the data of interest. Pooled and cumulative analyses were performed to compare perioperative and functional outcomes between study groups. A random-effects model using the DerSimonian and Laird method was used to evaluate heterogeneity. Stata version 15.0 software was used for all statistical analyses.

Evidence Synthesis: The initial electronic search identified 3978 papers, of which 48 ultimately met the inclusion criteria and were included in the analysis. Pooled analysis revealed a uMIST benefit in terms of International Prostate Symptom Score (IPSS; -9.81 points, 95% confidence interval [CI] -11.37 to -8.25 at 1 mo; -13.13 points, 95% CI -14.98 to -11.64 at 12 mo), maximum flow rate (from +3.66 ml/s, 95% CI 2.8-4.5 to +4.14 ml/s, 95% CI 0.72-7.56 at 12 mo), and postvoid residual volume (-10.10 ml, 95% CI -27.90 to 7.71 at 12 mo). No negative impact was observed on scores for the International Index of Erectile Function-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction bother and function scales (overall postintervention change in pooled median score of 1.88, 95% CI 1.34-2.42 at the start of follow-up; and 1.04, 95% CI 0.28-1.8 after 1 yr), or the IPSS-Quality of Life questionnaire.

Conclusions: Novel uMISTs can yield fast and effective relief of LUTS without affecting patient quality of life. Only Rezūm, UroLift, and PAE had a minimal impact on patients' sexual function with respect to baseline, especially regarding preservation of ejaculation.

Patient Summary: We reviewed outcomes for recently introduced ultra-minimally invasive surgical treatments for patients with lower urinary tract symptoms caused by benign prostate enlargement or obstruction. The evidence suggests that these novel techniques are beneficial in terms of controlling symptoms while preserving sexual function.

Take Home  Message: Novel ultra-minimally invasive treatments can yield fast and effective relief of lower urinary tract symptoms without affecting a patient's quality of life.
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http://dx.doi.org/10.1016/j.euros.2021.08.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8473553PMC
November 2021

Beyond the Learning Curve of Prostate MRI/TRUS Target Fusion Biopsy after More than 1000 Procedures.

Urology 2021 09 2;155:39-45. Epub 2021 Jul 2.

Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043.

Objective: To evaluate the learning curve (LC) of two urology residents in the execution of fusion biopsy (FB) in terms of overall prostate cancer (PCa) and clinically significant (cs) PCa detection rate (DR) and according to different characteristics of the lesions on MRI MATERIAL AND METHODS: We analyzed data from our prospective maintained FB database between January 2015 and December 2019. FB was performed using the BioJet fusion system (D&K Technologies, Barum, Germany) with a transrectal or transperineal approach. An ANOVA test was used to evaluate the homogeneity of our cohort. Multivariable linear and logistic regression analysis were used to evaluate the relationship between operator experience and DR for PCa and csPCa. Then, the postprocedural complication rate trend was evaluated.

Results: 1005 patients were included. The overall DR of PCa was 61.2% (615/1005) [IC 0.58 - 0.64]; whilst DR for csPCA was 54.6% (549/1005) [IC 0.51 - 0.57]. Operator experience does not seem to influence the DR of overall PCa and csPCa; whilst for lesions <8 mm in diameter, PCa and csPCa DR increased significantly with operator experience (P = 0.048 and P = 0.038, respectively). Postprocedural complications remained stable during the whole study period (P = 0.75).

Conclusion: A standardized FB approach turned out to be feasible, safe, and effective since the beginning of the residents' LC. PCa and csPCa DR remained stable, at 60% and 55% respectively, after more than 1,000 biopsies. However, for lesions smaller than 8 mm, at least 100 FB of experience is needed to correctly sample the area.
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http://dx.doi.org/10.1016/j.urology.2021.06.021DOI Listing
September 2021

The real-time intraoperative guidance of the new HIFU Focal-One platform allows to minimize the perioperative adverse events in salvage setting.

J Ultrasound 2021 May 24. Epub 2021 May 24.

Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.

Purpose: To assess the use of the new Focal-One HIFU platform in salvage setting to evaluate the occurrence of postoperative complications.

Methods: Patients who underwent salvage HIFU (sHIFU) with Focal-One platform were enrolled prospectively (Candiolo cancer institute-FPO IRCCS; registry number: 258/2018). Perioperative and postoperative outcomes (in terms of oncological and functional ones) were recorded during the first year of follow-up. In particular postoperative complications were classified according to Clavien-Dindo system.

Results: 20 patients were enrolled. No grade 3 complications were recorded. Referring to grade 2 complications, eight patients reported urgency after 3 months of follow-up, and in 4 cases, a low urinary tract infection occurred. Evaluating the impact of sHIFU on patients' sexual potency, micturition and quality of life, no significant deterioration was recorded during the follow-up as proven using the ANOVA analysis for repeated measurements. Only two patient had a biochemical failure after 12 months of follow-up.

Conclusions: The real-time intraoperative guidance with Focal-One platform, allows a continuous monitoring and tailoring of the treatment, with a minimization of the adverse events even in a salvage setting.
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http://dx.doi.org/10.1007/s40477-021-00594-8DOI Listing
May 2021

Three-dimensional Virtual Models' Assistance During Minimally Invasive Partial Nephrectomy Minimizes the Impairment of Kidney Function.

Eur Urol Oncol 2021 Apr 23. Epub 2021 Apr 23.

Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano (Turin), Italy.

Three-dimensional virtual models (3DVMs) are nowadays under scrutiny to improve partial nephrectomy (PN) outcomes. This report aims to analyze their impact on renal function preservation after minimally invasive PN. A total of 100 patients treated with minimally invasive PN with contrast-enhanced computed tomography from which a 3DVM was obtained, and having undergone baseline and 3rd month postoperative renal scans were prospectively enrolled and compared with a control group of 251 patients without 3DVMs. Weighted differential of pre- and postoperative renal scan-based effective renal plasmatic flow (b-WD ERPF) was calculated, according to the availability of 3DVMs and PADUA risk category. Multivariable logistic regression (MLR) models predicting a significant loss of renal function (LORF; ERPF drop >20%) were performed, overall and according to PADUA risk categories. The b-WD ERPF of the 3DVM group showed significantly lower LORF (-10%) than that of the control group (-19.6%, p =  0.02). In MLR, the availability of a 3DVM was found to be the only protective factor against a significant LORF (odds ratio [OR] = 0.3, p =  0.002). Moreover, after stratification as per tumor surgical complexity, this protective role was observed in both PADUA 8-9 and ≥10 category risk patients (OR = 0.3, p =  0.03 and OR = 0.1, p =  0.01). PATIENT SUMMARY: The drop in operated kidney function was significantly lower in surgeries assisted by three-dimensional virtual models (3VDMs), indicating that the availability of a 3VDM is the only protective factor against a significant functional damage.
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http://dx.doi.org/10.1016/j.euo.2021.04.001DOI Listing
April 2021

Comparison between minimally-invasive partial and radical nephrectomy for the treatment of clinical T2 renal masses: results of a 10-year study in a tertiary care center.

Minerva Urol Nephrol 2021 Aug 22;73(4):509-517. Epub 2021 Apr 22.

Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.

Background: Even if partial nephrectomy (PN) is nowadays considered the standard for managing cT1 renal masses, its role in the management of cT2 kidney tumors is controversial. We aimed to compare oncologic and functional outcomes of minimally invasive radical nephrectomy (RN) and PN in cT2 renal masses.

Methods: Patients with cT2 renal masses underwent minimally-invasive PN or RN performed by a highly experienced single surgeon from 2009 to 2019 were considered. Demographic, perioperative and functional variables were compared. Cumulative incidence plot and competing risks regression (CRR) models were used to test differences in 5-year cancer-specific mortality (CSM) and 5-year other-cause mortality (OCM) rates. Kaplan-Meier and Cox regression model was used to test differences in 5-year progression free survival (PFS) rates.

Results: Overall, 52 PN vs. 64 RN patients were identified. Relative to RN, PN patients recorded higher rates of complications (25% vs. 7.8%, P=0.02) but lower upstaging rate (≥pT3a 64.1% vs. 19.2%, P<0.0001). Functional outcomes were in favor of PN (all P<0.001). No differences were recorded between 5-year CSM and OCM according to nephrectomy type. At CRR models, older age and upstaging were independent predictors of 5-year OCM and CSM, respectively (all P<0.01). Finally, only upstaging, high grade tumors and presence of positive surgical margins were identified as independent predictors of 5-year PFS (all P<0.01).

Conclusions: In experienced hands the treatment of cT2 renal neoplasms with minimally-invasive PN is feasible, providing perioperative and oncological safety profiles comparable to RN, with advantages in terms of functional outcomes.
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http://dx.doi.org/10.23736/S2724-6051.21.04390-1DOI Listing
August 2021

3D imaging technologies in minimally-invasive kidney and prostate cancer surgery: which is the urologists' perception?

Minerva Urol Nephrol 2021 Mar 26. Epub 2021 Mar 26.

Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy.

Background: Many specific 3D imaging technologies are currently available for the practising urologists. Aim of the study was to assess their perception about different 3D imaging tools in the field of prostate and kidney cancer surgery.

Methods: All the attendees of the 8th Techno-Urology-Meeting were asked to fill a questionnaire regarding the role of 3D virtual reconstruction PDFs, 3D printing models, Augmented-Reality (AR) and mixed reality technology in the setting of surgical planning, patient counselling, intraoperative guidance and training for kidney and prostate cancer surgery; Moreover the different materials used for 3D printing were compared to assess the most suitable in reproducing the organ and tumor features, as well as their estimated cost and production time.

Results: The population consisted of 180 attendees. Overall, AR was the preferred option for intraoperative guidance and training, in both prostate (55% and 38.3%) and kidney cancer surgery (58.3% and 40%). HoloLens was perceived as the best imaging technology for the surgical planning (50% for prostate and 60% for kidney), whereas printed models for patients counselling (66.7% for prostate and 61.7% for kidney). Fused deposition models were deemed as the best printing technology in representing kidney anatomy and renal tumor location (40%), while silicon (46.7%) and Polyjet (36.7%) models for prostate anatomy and cancer location. Finally, attendees demonstrated poor knowledge of 3D printing costs and production times.

Conclusions: Our study shows the perceptions of a heterogeneous surrogate of practising urologists about the role and potential applications of 3D imaging technologies in daily surgical practice.
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http://dx.doi.org/10.23736/S2724-6051.21.04131-XDOI Listing
March 2021

Anastomosis quality score during robot-assisted radical prostatectomy: a new simple tool to maximize postoperative management.

World J Urol 2021 Aug 3;39(8):2921-2928. Epub 2021 Jan 3.

Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy.

Purpose: The urethro-vesical anastomosis represents one of the most challenging steps of robotic prostatectomy (RARP). To maximize postoperative management, we specifically designed our anastomosis quality score (AQS), based on the intraoperative characteristics of the urethra and bladder neck.

Methods: This is a prospective study, conducted from April 2019 to March 2020. All the patients were classified into three different AQS categories (low, intermediate, high) based on the quality of the anastomosis. The postoperative management was modulated accordingly.

Results: We enrolled 333 patients. According to AQS, no differences were recorded in intraoperative complications (p = 0.9). Median hospital stay and catheterization time were longer in AQS 1 group (p < 0.001). Additionally, the occurrence of postoperative complication was higher in AQS 1 category (p = 0.002) but, when focusing on the complications related to the quality of the anastomosis, no differences were found neither for acute urinary retention (p = 0.12) nor urine leakage (p = 0.11). Finally, concerning the continence recovery, no significant differences were found among the three groups for each time point. The highest potency recovery rate at one month of follow-up was recorded in AQS 3 category (p = 0. 03).

Conclusion: The AQS proposed revealed to be a valid too to intraoperatively categorize patients who underwent RARP on the basis of the urethral and bladder neck features. The modulated postoperative management for each specific score category allowed to limit the occurrence of complications and to maximize the functional outcomes.
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http://dx.doi.org/10.1007/s00345-020-03549-6DOI Listing
August 2021

Implementing telemedicine for the management of benign urologic conditions: a single centre experience in Italy.

World J Urol 2021 Aug 1;39(8):3109-3115. Epub 2021 Jan 1.

Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Turin, Italy.

Purpose: To assess the use of telemedicine with phone-call visits as a practical tool to follow-up with patients affected by urological benign diseases, whose clinic visits had been cancelled during the acute phase of the COVID-19 pandemic.

Methods: Patients were contacted via phone-call and a specific questionnaire was administered to evaluate the health status of these patients and to identify those who needed an "in-person" ambulatory visit due to the worsening of their condition. Secondarily, the patients' perception of a potential shift towards a "telemedicine" approach to the management of their condition and to indirectly evaluate their desire to return to "in-person" clinic visits.

Results: 607 were contacted by phone-call. 87.5% (531/607) of the cases showed stability of the symptoms so no clinic in-person or emergency visits were needed. 81.5% (495/607) of patients were more concerned about the risk of contagion than their urological condition. The median score for phone visit comprehensibility and ease of communication of exams was 5/5; whilst patients' perception of phone visits' usefulness was scored 4/5. 53% (322/607) of the interviewees didn't own the basic supports required to be able to perform a real telemedicine consult according to the required standards.

Conclusion: Telemedicine approach limits the number of unnecessary accesses to medical facilities and represents an important tool for the limitation of the risk of transmission of infectious diseases, such as COVID-19. However, infrastructures, health workers and patients should reach out to a computerization process to allow a wider diffusion of more advanced forms of telemedicine, such as televisit.
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http://dx.doi.org/10.1007/s00345-020-03536-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775638PMC
August 2021

The importance of anatomical reconstruction for continence recovery after robot assisted radical prostatectomy: a systematic review and pooled analysis from referral centers.

Minerva Urol Nephrol 2021 04 17;73(2):165-177. Epub 2020 Nov 17.

Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.

Introduction: Urinary incontinence is one of the most scared sequelae of robot assisted radical prostatectomy (RARP). Therefore, different surgical modifications, aimed to restore the original anatomy, were proposed to overcome this issue. The purpose of this study is to assess which is the best reconstruction technique (posterior only: PR; anterior only: AR; total: TR) compared to the standard approach for continence recovery after RARP in a tertiary care center.

Evidence Acquisition: After establishing an a priori protocol, a systematic electronic literature search was conducted in May 2019. The article selection proceeded in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and was registered (PROSPERO registry number 131667). The risk of bias and the quality assessment of the included studies were performed. Simple pooled analysis was performed for continence rates according to the definition of continence (0 pad vs. 0-1 pad) and the different types of reconstruction at 1, 4, 12, 24, 52 weeks after RARP. Complication rate, operative and console time and estimated blood loss were pooled. Two-side test of proportion and T-test were used to compare rates and mean, respectively.

Evidence Synthesis: Six studies meeting the inclusion criteria were found and included in the analysis. All the included studies were of "poor" or "good" quality. A high or moderate risk of bias was recorded. TR showed higher continence recovery rates, compared to their anterior reconstruction counterpart at 1, 4, 12, 24, 52 weeks (P<0.001 at all time-points). At 12 weeks TR showed the highest continence rates (P<0.001), followed by AR and PR. No statistically significant differences were recorded regarding anastomosis-related complication rates (anastomosis stricture P=0.08; urine leakage P=0.1).

Conclusions: In patients undergoing RARP, TR facilitates a faster and higher continence recovery compared to standard approach or PR or AR only.
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http://dx.doi.org/10.23736/S2724-6051.20.04146-6DOI Listing
April 2021

Urethral-sparing Robot-assisted Simple Prostatectomy: An Innovative Technique to Preserve Ejaculatory Function Overcoming the Limitation of the Standard Millin Approach.

Eur Urol 2021 08 5;80(2):222-233. Epub 2020 Oct 5.

Department of Urology, "San Luigi Gonzaga" Hospital, University of Turin, Orbassano (Turin), Italy.

Background: Despite recent technical innovations in the treatment of benign prostatic hyperplasia (BPH), retrograde ejaculation is still one of the most frequent adverse effects, with a major impact on patients' quality of life.

Objective: To evaluate the efficacy of our technique of urethral-sparing robotic-assisted simple prostatectomy (usRASP) in obtaining effective deobstruction and maintaining anterograde ejaculation, and secondarily, to compare these outcomes with those of a control group of patients who underwent standard robotic adenomectomy according to the Millin technique.

Design, Setting, And Participants: We prospectively enrolled patients between August 2017 and July 2019 with large BPH (prostate volume >80 ml) affected by significant BPH-related lower urinary tract symptoms (LUTS) who underwent usRASP. Then, a retrospective control group treated with standard Millin robotic-assisted simple prostatectomy (RASP) was selected.

Surgical Procedure: The innovative aspect of our technique is the pivotal role of enucleation of the adenoma from all the anatomical structures, especially from the urethra. On the basis of the final results, the patients were divided into three groups (full, partial, or failed urethral sparing). Control group patients underwent standard Millin.

Measurements: All perioperative and follow-up data were collected, and descriptive, univariate, and multivariate analyses were performed.

Results And Limitations: Ninety-two patients were enrolled. Full urethral-sparing adenomectomy was performed in 56 cases (60.86%). Urethral-sparing adenomectomy with minimal urethral infraction occurred in 21 cases (22.82%). In 15 patients (16.48%), the procedure was converted to standard RASP. Clavien grade ≥3 complications occurred in two patients (2%). Among the 70 patients with preoperative ejaculation, 57 (81%) maintained anterograde ejaculation at the 12th postoperative month. The maximum flow rate increased (17 m/s from baseline, p =  0.034), and International Prostate Symptom Score decreased rapidly (from 20 to 5 points; p <  0.001). With respect to the technique of the control group patients, usRASP allows the same perioperative and urinary functional outcomes, but with an improvement in terms of sexual function, especially for the ejaculation (p <  0.001 at every time point). A small sample size and short follow-up time are the major limitations of this study.

Conclusions: Urethral-sparing RASP has been found to be a safe and effective procedure that allows resolution of LUTS in large BPH and maintaining of ejaculatory function in a high percentage of patients.

Patient Summary: Based on our findings, this technique should be considered as an option when counseling patients with large benign prostatic hyperplasia who are motivated to preserve antegrade ejaculation.
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http://dx.doi.org/10.1016/j.eururo.2020.09.028DOI Listing
August 2021

The role of additional standard biopsy in the MRI-targeted biopsy era.

Minerva Urol Nefrol 2020 10 2;72(5):637-639. Epub 2020 Jun 2.

Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.

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http://dx.doi.org/10.23736/S0393-2249.20.03958-2DOI Listing
October 2020

The vaccine journey for COVID-19: a comprehensive systematic review of current clinical trials in humans.

Panminerva Med 2020 May 26. Epub 2020 May 26.

Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy.

Introduction: Since December 2019, there has been an outbreak of a novel beta-coronavirus (SARS-CoV-2) in Wuhan, China. On March the 11th the World Health Organization (WHO) declared COVID-19 as a pandemic, with over 118,000 cases in more than 110 countries around the world. In response to the global coronavirus disease 2019 (COVID-19) emergency, clinical trial research assessing the efficacy and safety of experimental vaccines to prevent COVID-19 are emerging at an unprecedented rate. The aim of this systematic review is to summarize the preliminary experiences and ongoing clinical trials of the major candidates and challenges of the vaccine strategies in humans.

Evidence Acquisition: After a priori protocol registration with PROSPERO (181483), a systematic research of the published literature was conducted on 24 April 2020 using Medline (via PubMed), Embase (via Ovid), and WHO databases. Moreover, to explore the more recent literature we also searched the preprint server medRxiv. Finally, we scrutinized the Cochrane COVID-19 study register and the COVID-19 section of ClinicalTrials.gov database for identifying relevant ongoing clinical trials. Thereafter we selected the articles according to the PRISMA guidelines. Animal or in-vitro experimental studies were excluded. Moreover editorials, commentaries, abstracts, reviews, book chapters, and articles not in English were not included.

Evidence Synthesis: Our search identified 1359 published papers, 478 pre-print articles and 367 ongoing clinical trials. Finally, only ten ongoing clinical trials met the inclusion criteria. Specifically, seven developed vaccines for the S protein of SARS-CoV-2 and three clinical trials assessed the protective role of BCG vaccine against COVID-19. The first group included phase I/II trials with different types of molecules (DNA or mRNA vaccine, bacterial plasmid or viral vectors), the latter were phase III/IV trials designed on the basis of a heterologous lymphocyte activation by the BCG vaccine.

Conclusions: This new disease is pushing the scientific community to develop swiftly a safe and effective vaccine. Notwithstanding the limitations of our analysis, given by the absence of available results, we try to provide a comprehensive view of the ongoing clinical trials in humans. Our analysis reveals a worldwide effort of both scientists and enterprises to achieve one of the most challenging goals of our century.
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http://dx.doi.org/10.23736/S0031-0808.20.03958-0DOI Listing
May 2020

Subtotal ureteral substitution with ileum for patients with multiple ureteral stenosis.

Transl Androl Urol 2020 Apr;9(2):971-976

Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA.

The use of small bowel for ureteral substitution in patients with ureteral stenosis can, nowadays, be safely performed with a laparoscopic or robotic mini-invasive approach. To date, this technique required a complete substitution of the ureter with ileum. In this work we present our robotic intracorporeal sub-total ureteral substitution preserving the distal part of the ureter with the aim to reduce the risk of vescico-ureteral reflux. We report the case of a 65-years old male with a "functional" right single kidney and multiple recurrent stenosis. Our technique seems to be feasible and safe, no intra or postoperative complication were recorded. At 3 months of follow-up the trans-nephrostomic enhanced CT showed a completely opacification of ileal ureter, thus the nephrostomic tube was removed. At 6 and 12 months the patient was asymptomatic and with a level of serum creatinine 1.9 and 1.6 mg/dL, respectively. In conclusion the sub-total ureteral substitution with ileum can be a safety and effective procedure for patients who require a mandatory preservation of homolateral renal function.
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http://dx.doi.org/10.21037/tau.2019.12.32DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215022PMC
April 2020

Single-port robot-assisted radical prostatectomy: a systematic review and pooled analysis of the preliminary experiences.

BJU Int 2020 07 1;126(1):55-64. Epub 2020 May 1.

Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy.

Objective: To summarize the clinical experiences with single-port (SP) robot-assisted radical prostatectomy (RARP) reported in the literature and to describe the peri-operative and short-term outcomes of this procedure.

Material And Methods: A systematic review of the literature was performed in December 2019 using Medline (via PubMed), Embase (via Ovid), Cochrane databases, Scopus and Web of Science (PROSPERO registry number 164129). All studies that reported intra- and peri-operative data on SP-RARP were included. Cadaveric series and perineal or partial prostatectomy series were excluded.

Results: The pooled mean operating time, estimated blood loss, length of hospital stay and catheterization time were 190.55 min, 198.4 mL, 1.86 days and 8.21 days, respectively. The pooled mean number of lymph nodes removed was 8.33, and the pooled rate of positive surgical margins was 33%. The pooled minor complication rate was 15%. Only one urinary leakage and one major complication (transient ischaemic attack) were recorded. Regarding functional outcomes, pooled continence and potency rates at 12 weeks were 55% and 42%, respectively.

Conclusions: The present analysis confirms that SP-RARP is safe and feasible. This novel robotic platform resulted in similar intra-operative and peri-operative outcomes to those obtained with the standard multiport da Vinci system. The advantages of single incision can be translated into a preservation of the patient's body image and self-esteem and cosmesis, which have a great impact on a patient's quality of life.
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http://dx.doi.org/10.1111/bju.15069DOI Listing
July 2020

Three-dimensional Augmented Reality Robot-assisted Partial Nephrectomy in Case of Complex Tumours (PADUA ≥10): A New Intraoperative Tool Overcoming the Ultrasound Guidance.

Eur Urol 2020 08 30;78(2):229-238. Epub 2019 Dec 30.

Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Robotic Surgery Institute Academy, Melle, Belgium.

Background: Despite technical improvements introduced with robotic surgery, management of complex tumours (PADUA score ≥10) is still a matter of debate within the field of transperitoneal robot-assisted partial nephrectomy (RAPN).

Objective: To evaluate the accuracy of our three-dimensional (3D) static and elastic augmented reality (AR) systems based on hyperaccuracy models (HA3D) in identifying tumours and intrarenal structures during transperitoneal RAPN (AR-RAPN), compared with standard ultrasound (US).

Design, Setting, And Participants: A retrospective study was conducted, including 91 patients who underwent RAPN for complex renal tumours, 48 with 3D AR guidance and 43 with 2D US guidance, from July 2017 to May 2019.

Surgical Procedure: In patients who underwent 3D AR-RAPN, virtual image overlapping guided the surgeon during resection and suture phases. In the 2D US group, interventions were driven by US only.

Measurements: Patient characteristics were tested using the Fisher's exact test for categorical variables and the Mann-Whitney test for continuous ones. Intraoperative, postoperative, and surgical outcomes were collected. All results for continuous variables were expressed as medians (range), and frequencies and proportions were reported as percentages.

Results And Limitations: The use of 3D AR guidance makes it possible to correctly identify the lesion and intraparenchymal structures with a more accurate 3D perception of the location and the nature of the different structures relative to the standard 2D US guidance. This translates to a lower rate of global ischaemia (45.8% in the 3D group vs 69.7% in the US group; p = 0.03), higher rate of enucleation (62.5% vs 37.5% in the 3D and US groups, respectively; p = 0.02), and lower rate of collecting system violation (10.4% vs 45.5%; p = 0.003). Postoperatively, 3D AR guidance use correlates to a low risk of surgery-related complications in 3D AR groups and a lower drop in estimated renal plasma flow at renal scan at 3 mo of follow-up (-12.38 in the 3D group vs -18.14 in the US group; p = 0.01). The main limitations of this study are short follow-up time and small sample size.

Conclusions: HA3D models that overlap in vivo anatomy during AR-RAPN for complex tumours can be useful for identifying the lesion and intraparenchymal structures that are difficult to visualise with US only. This translates to a potential improvement in the quality of the resection phase and a reduction in postoperative complications, with better functional recovery.

Patient Summary: Based on our findings, three-dimensional augmented reality robot-assisted partial nephrectomy seems to help surgeons in the management of complex renal tumours, with potential early postoperative benefits.
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http://dx.doi.org/10.1016/j.eururo.2019.11.024DOI Listing
August 2020

Laparoscopic simple prostatectomy: complications and functional results after five years of follow-up.

Minerva Urol Nefrol 2020 Aug 10;72(4):498-504. Epub 2019 Oct 10.

Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.

Background: The aim of this study was to investigate complications and functional results in a cohort of patients who underwent extraperitoneoscopic transcapsular laparoscopic simple prostatectomy (LSP) for large prostate adenomas with a minimum follow-up of 5 years.

Methods: We retrospectively reviewed data obtained from our prospectively maintained database of patients treated with LSP at our institution between January 2004 and June 2012, with at least 5 years of reported follow-up data. Demographics, perioperative results, early and late complications, and functional results were evaluated. The various impacts of the independent variables on the development of complications was evaluated performing logistic regression models. Follow-up was planned at 1, 3, 6 and 12 months, then yearly up to a minimum of 5 years.

Results: One-hundred patients were included in our analysis. Median follow-up was 135 (IQR 24) months (11 years and 3 months). Grade III complications were recorded in 2 cases. Five cases of late postoperative complications were recorded. Logistic regression models showed a statistically significant correlation between the adenoma volume and the risk of developing early postoperative complications (OR 1.014). International Prostate Symptom Score (I-PSS), I-PSS quality of life (QoL) index, and maximum urine flow (Qmax) significantly improved when comparing preoperative and postoperative results. No significant differences were recorded in the I-PSS and I-PSS QoL index during follow-up. A low but significant worsening in Qmax was observed starting the 48th month after surgery.

Conclusions: The present findings confirm that LSP carries a low rate of early and late complications, and it offers good functional outcomes at 5 years.
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http://dx.doi.org/10.23736/S0393-2249.19.03526-4DOI Listing
August 2020

3D mixed reality holograms for preoperative surgical planning of nephron-sparing surgery: evaluation of surgeons' perception.

Minerva Urol Nephrol 2021 06 5;73(3):367-375. Epub 2019 Sep 5.

Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.

Background: 3D reconstructions are gaining a wide diffusion in nephron-sparing surgery (NSS) planning. They have usually been studied on common 2D flat supports, with limitations regarding real depth comprehension and interaction. Nowadays, it is possible to visualize kidney 3D reconstructions as holograms in a "mixed reality" (MR) setting. The aim of this study was to test the face and content validity of this technology, and to assess the role of 3D holograms in aiding preoperative planning for highly complex renal tumors amenable by NSS.

Methods: We evaluated surgeons' perception of mixed reality for partial nephrectomy during a urological international meeting organized at our Institution in January 2019. Thanks to the images of preoperative CT, hyper-accuracy 3D (HA3D) reconstructions were performed. Then, a virtual environment was created, and it interacted with the models in mixed reality setting by using HoloLens. We submitted to all the attendees a questionnaire, expressed by the Likert scale (1-10), about their opinion over the use and application of the MR. Moreover, the attendees had the chance to perform a first-hand MR experience; then, they were asked to choose their clamping and resection approach.

Results: Overall 172 questionnaires were collected. The scores obtained regarding both surgical planning (scored 8/10) and anatomical accuracy (9/10) were very positive. High satisfaction toward the potential role of this technology in surgical planning and understanding of surgical complexity (both scored 9/10) were expressed. After a first-hand experience with HoloLens and MR, 64.4% and 44.4% of the surgeons changed their clamping and resection approach, respectively - compared to CT image visualization only - choosing a more selective one.

Conclusions: Our study suggests that surgeons perceive holograms and MR as a useful and interesting tool for the preoperative setting before partial nephrectomy, in the direction of an ever more precise surgery.
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http://dx.doi.org/10.23736/S2724-6051.19.03610-5DOI Listing
June 2021

3D imaging applications for robotic urologic surgery: an ESUT YAUWP review.

World J Urol 2020 Apr 27;38(4):869-881. Epub 2019 Aug 27.

Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Regione Gonzole 10,, 10043, Orbassano, Turin, Italy.

Context: Despite the current era of precision surgery in robotics, an unmet need still remains for optimal surgical planning and navigation for most genitourinary diseases. 3D virtual reconstruction of 2D cross-sectional imaging has been increasingly adopted to help surgeons better understand the surgical anatomy.

Objectives: To provide a short overview of the most recent evidence on current applications of 3D imaging in robotic urologic surgery.

Evidence Acquisition: A non-systematic review of the literature was performed. Medline, PubMed, the Cochrane Database and Embase were screened for studies regarding the use of 3D models in robotic urology.

Evidence Synthesis: 3D reconstruction technology creates 3D virtual and printed models that first appeared in urology to aid surgical planning and intraoperative navigation, especially in the treatment of oncological diseases of the prostate and kidneys. The latest revolution in the field involves models overlapping onto the real anatomy and performing augmented reality procedures.

Conclusion: 3D virtual/printing technology has entered daily practice in some tertiary centres, especially for the management of urological tumours. The 3D models can be virtual or printed, and can help the surgeon in surgical planning, physician education and training, and patient counselling. Moreover, integration of robotic platforms with the 3D models and the possibility of performing augmented reality surgeries increase the surgeon's confidence with the pathology, with potential benefits in precision and tailoring of the procedures.
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http://dx.doi.org/10.1007/s00345-019-02922-4DOI Listing
April 2020

Assessment of the relationship between renal volume and renal function after minimally-invasive partial nephrectomy: the role of computed tomography and nuclear renal scan.

Minerva Urol Nefrol 2018 Oct 14;70(5):509-517. Epub 2018 May 14.

Division of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.

Background: To evaluate the correlation between the loss of renal function as assessed by Tc99MAG-3 renal scan and the loss of renal volume as calculated by volumetric assessment on CT-scan in patients who underwent minimally-invasive partial nephrectomy (PN).

Methods: PN prospectively-maintained database was retrospectively queried for patients who underwent minimally-invasive PN (2012-2017) for renal mass ≤cT2 and had complete data on renal scan and contrast-enhanced CT-scan (both performed in our Institution) both at preoperative assessment and at the third postoperative month follow-up. Tc99MAG-3 renal scan was performed to get renal functional data; renal volume was calculated by dedicated software from CT-scan with a semiautomated method. Statistical analysis aimed to identify relationships between loss of renal volume and loss of renal function and other patients' and surgical variables, particularly regarding lesion complexity (assessed by PADUA Score).

Results: Fifty-seven patients were analyzed. Both at univariate and multivariate analysis, the percentage of loss of renal function was significantly correlated to the loss of renal volume (P<0.001). Warm ischemia significantly correlated with the loss of renal volume (P=0.003). After stratification according to PADUA score categories, higher surgical complexity renal masses had stronger correlation between the loss of renal volume and the loss of renal function.

Conclusions: The use of the semiautomated method for the 3D segmentation of the kidney to get the volumetric assessment could be a valid tool to support the future use of CT-scan as the tool to pair the oncological and the functional follow-up after PN.
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http://dx.doi.org/10.23736/S0393-2249.18.03140-5DOI Listing
October 2018

The preoperative stratification of patients based on renal scan data is unable to predict the functional outcome after partial nephrectomy.

Int Braz J Urol 2018 Jul-Aug;44(4):740-749

Division of Urology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy.

Introduction: eGFR-categories are used to predict functional outcome after partial nephrectomy (PN); no study categorized patients according to preoperative renal scan (RS) data. Aim of the study was to evaluate if stratification of patients according to RS is a reliable method to predict minor/major loss of renal function after PN.

Materials And Methods: We considered patients who underwent PN and RS pre-/post-PN for T1 tumor in our Institution (2007-2017). Demographics, perioperative and specifically functional data were analysed. On the basis of the baseline Split Renal Function (SRF), patients were stratified into risk-categories: 1) baseline operated-kidney SRF range 45-55%; 2) baseline operated-kidney SRF < 45%. Risk categories were analysed with postoperative functional outcome: postoperative operated-kidney SRF decrease below 90% of baseline was considered significant loss of function. Contingency tables and univariate/multivariate regression were analysed looking for independent factors of postoperative functional impairment.

Results: 224 patients were analysed, 125 (55.8%) maintained >90% of their baseline function. Worse probability of maintaining ≥90 baseline renal function was found in patients with Charlson's Comorbidity Index (CCI≥3) (p=0.004) and patients with PADUA score ≥8 (p=0.023). After stratification by baseline renal function, ischemia was the only independent factor: no effect on patients with poorer baseline renal function. Patients with baseline SRF 45-55% who did not experience ischemia had the highest probability to maintain ≥90% baseline SRF (p=0.028). Ischemia >25 minutes was detrimental (p=0.017).

Conclusions: Stratification of patients by SRF before PN is not a reliable predictor of renal functional outcome. Ischemia seems to scarcely influence patients with poorer renal function.
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http://dx.doi.org/10.1590/S1677-5538.IBJU.2017.0636DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092664PMC
July 2018
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