Publications by authors named "Giovanni Enrico Cacciamani"

10 Publications

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Applicability of COVID-19 Pandemic Recommendations for Urology Practice: Data from Three Major Italian Hot Spots (BreBeMi).

Eur Urol Open Sci 2021 Apr 29;26:1-9. Epub 2021 Jan 29.

Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.

Background: Lombardy has been the first and one of the most affected European regions during the first and second waves of the novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]).

Objective: To evaluate the impact of coronavirus disease 2019 (COVID-19) on all urologic activities over a 17-wk period in the three largest public hospitals in Lombardy located in the worst hit area in Italy, and to assess the applicability of the authorities' recommendations provided for reorganising urology practice.

Design Setting And Participants: A retrospective analysis of all urologic activities performed at three major public hospitals in Lombardy (Brescia, Bergamo, and Milan), from January 1 to April 28, 2020, was performed.

Outcome Measurements And Statistical Analysis: Join-point regression was used to identify significant changes in trends for all urologic activities. Average weekly percentage changes (AWPCs) were estimated to summarise linear trends. Uro-oncologic surgeries performed during the pandemic were tabulated and stratified according to the first preliminary recommendations by Stensland et al (Stensland KD, Morgan TM, Moinzadeh A, et al. Considerations in the triage of urologic surgeries during the COVID-19 pandemic. Eur Urol 2020;77:663-6) and according to the level of priority recommended by European Association of Urology guidelines.

Results And Limitations: The trend for 2020 urologic activities decreased constantly from weeks 8-9 up to weeks 11-13 (AWPC range -41%, -29.9%;  < 0.001). One-third of uro-oncologic surgeries performed were treatments that could have been postponed, according to the preliminary urologic recommendations. High applicability to recommendations was observed for non-muscle-invasive bladder cancer (NMIBC) patients with intermediate/emergency level of priority, penile and testicular cancer patients, and upper tract urothelial cell carcinoma (UTUC) and renal cell carcinoma (RCC) patients with intermediate level of priority. Low applicability was observed for NMIBC patients with low/high level of priority, UTUC patients with high level of priority, prostate cancer patients with intermediate/high level of priority, and RCC patients with low level of priority.

Conclusions: During COVID-19, we found a reduction in all urologic activities. High-priority surgeries and timing of treatment recommended by the authorities require adaptation according to hospital resources and local incidence.

Patient Summary: We assessed the urologic surgeries that were privileged during the first wave of coronavirus disease 2019 (COVID-19) in the three largest public hospitals in Lombardy, worst hit by the pandemic, to evaluate whether high-priority surgeries and timing of treatment recommended by the authorities are applicable. Pandemic recommendations provided by experts should be tailored according to hospital capacity and different levels of the pandemic.
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http://dx.doi.org/10.1016/j.euros.2021.01.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846227PMC
April 2021

Impact of Smoking Habit on Perioperative Morbidity in Patients Treated with Radical Cystectomy for Urothelial Bladder Cancer: A Systematic Review and Meta-analysis.

Eur Urol Oncol 2021 Aug 5;4(4):580-593. Epub 2020 Nov 5.

Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland. Electronic address:

Context: Smoking habit at the time of surgery is associated with higher perioperative complications and mortality across different types of surgeries. In recent years, several studies have attempted to explore the influence of smoking on perioperative outcomes following radical cystectomy (RC) for urothelial bladder cancer (UBC) with contradictory results.

Objective: To systematically investigate and meta-analyze the association between smoking habit and perioperative morbidity and mortality in UBC patients treated with RC.

Evidence Acquisition: A systematic review of the literature published between January 2000 and January 2020 investigating the impact of smoking habit on perioperative outcomes of patients treated with RC for UBC was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and the Cochrane Handbook for Systematic Reviews of Interventions.

Evidence Synthesis: Overall, 27 articles involving 27 854 patients were included in the systematic review, and of these, 11 studies were included in the meta-analysis. The studies included showed a moderate to high risk of bias. Smoking status (smokers vs nonsmokers) was significantly associated with the onset of major postoperative complications (hazard ratio [HR] 1.87, 95% confidence interval [CI] 1.51-2.32; I = 0%), infections (HR 1.34, 95% CI 1.02-1.72; I = 66.2%), and mortality (HR 1.84, 95% CI 1.14-2.98; I = 4.9%).

Conclusions: Smoking status at the time of RC is associated with increased risk for major postoperative complications, infections, and mortality. These results suggest the need for strict postoperative monitoring in smokers due to the increased risk of experiencing adverse events and underline the need for intensive smoking cessation interventions in the preoperative setting.

Patient Summary: In this study, we reviewed the impact of smoking habit on perioperative outcomes following radical cystectomy (RC). Based on the available data, the impact of smoking on morbidity and mortality after RC is significant and relevant; as such, every effort should be made in the preoperative setting to encourage smoking cessation.
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http://dx.doi.org/10.1016/j.euo.2020.10.006DOI Listing
August 2021

Re: Oncological outcome according to attainment of pentafecta after robot-assisted radical cystectomy in patients with bladder cancer in the multicentre KORARC database. BJU Int 2020 July 18. DOI: 10.1111/ bju.15178.

BJU Int 2020 11 18;126(5):644-645. Epub 2020 Sep 18.

Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine/Norris Cancer Center, University of Southern California, Los Angeles, CA, USA.

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http://dx.doi.org/10.1111/bju.15222DOI Listing
November 2020

Impact of Covid-19 on the urology service in United States: perspectives and strategies to face a Pandemic.

Int Braz J Urol 2020 07;46(suppl.1):207-214

Department of Urology, Catherine & Joseph Aresty, USC Institute of Urology, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, Los Angeles, CA, US.

Over the course of several weeks following the first diagnosed case of COVID-19 in the U.S., the virus rapidly spread across our communities. It became evident that the pandemic was going to place a severe strain on all components of the U.S. healthcare system, and we needed to adapt our daily practices, training and education. In the present paper we discuss four pillars to face a pandemic: surgical and outpatients service, tele-medicine and tele-education. In the face of unprecedented risks in providing adequate health care to our patients during this current, evolving public health crisis of COVID-19, alternative patient management tools such as telemedicine services, allow clinicians to maintain necessary patient rapport with their healthcare provider when required. As a subspecialty, urology should take full advantage of telehealth and tele-education at this juncture. As tele-urology and tele-education can obviate the potential drawbacks of "social distancing" as it pertains to healthcare, the platform can also reduce the risk of COVID-19 spread, without compromising quality urological care and educational efforts. Telehealth can bring urologists and their patients together, perhaps closer than ever.
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http://dx.doi.org/10.1590/S1677-5538.IBJU.2020.S126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7720000PMC
July 2020

Perioperative Mortality and Long-Term Survival after Radical Cystectomy: A Population-Based Study in a Southern European Country on 4,389 Patients.

Urol Int 2020 9;104(7-8):559-566. Epub 2020 Apr 9.

Department of Urology, University of Verona, Verona, Italy,

Purpose: Population-based data on survival after radical cystectomy (RC) are lacking from Southern Europe. The aim of this study was to assess trends and determinants of perioperative mortality and long-term survival in the Veneto region (Northeastern Italy).

Methods: All patients submitted to RC for bladder cancer from January 2004 to December 2016 were identified from the regional archive of hospital discharge records. Age at surgery, gender, comorbidities, hospital volume, calendar period of surgery, and type of urinary diversion were retrieved; vital status and cause of death were obtained by linkage with mortality records. Determinants of 90-day mortality were assessed by multilevel logistic regression; long-term survival was investigated by the Kaplan-Meier method and Cox regression.

Results: Among 4,389 included patients, an increase in the share of patients aged ≥80 years (from 13% in 2004-2008 to 24% in 2013-2016, p < 0.001) and a decline in performing continent diversion (from 34.9 to 23.4%, p < 0.001) were observed across the study period. Ninety-day mortality did not change over time and was 4% for patients aged <70 years and 13.7% for those aged ≥80 years. Age- and comorbidities-adjusted mortality was significantly lower in hospitals performing >30 RCs/year (odds ratio 0.67, 95% confidence interval 0.48-0.93). At a median follow-up of 67 months, overall survival at 1 year and 5 years was 72 and 40%, respectively, with a higher rate among younger patients treated in high-volume hospitals.

Conclusion: The population of patients treated with RC is rapidly ageing, with a high risk of perioperative and long-term mortality; this changing epidemiological scenario and better outcomes observed in high-volume hospitals support regionalization of the procedure.
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http://dx.doi.org/10.1159/000506240DOI Listing
April 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

Prostate volume index and prostatic chronic inflammation predicted low tumor load in 945 patients at baseline prostate biopsy.

World J Urol 2020 Apr 1;38(4):957-964. Epub 2019 Jun 1.

Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.

Purpose: To assess associations of prostate volume index (PVI), defined as the ratio of the volume of the central transition zone to the volume of the peripheral zone of the prostate and prostatic chronic inflammation (PCI) as predictors of tumor load by number of positive cores (PC) in patients undergoing baseline random biopsies.

Methods: Parameters evaluated included age, PSA, total prostate volume, PSA density, digital rectal exam, PVI, and PCI. All patients underwent standard transperineal random biopsies. Tumor load was evaluated as absent (no PC), limited (1-3 PC), and extensive (more than 3 PC). The association of factors with the risk of tumor load was evaluated by the multinomial logistic regression model.

Results: The study evaluated 945 patients. Cancer PC were detected in 477 (507%) cases of whom 207 (43.4%) had limited tumor load and 270 (56.6%) had extensive tumor load. Among other factors, comparing patients with limited tumor load with negative cases, PVI [odds ratio, OR = 0.521, 95% confidence interval (CI) 0.330-0.824; p < 0.005] and PCI (OR = 0.289, 95% CI 0.180-0.466; p < 0.0001) were inversely associated with the PCA risk. Comparing patients with extensive tumor load with negative patients, PVI (OR = 0.579, 95% CI 0.356-0.944; p = 0.028), and PCI (OR = 0.150, 95% CI 0.085-0.265; p < 0.0001), predicted PCA risk. Comparing extensive tumor load with limited tumor load patients, PVI and PCI did not show any association with the tumor load.

Conclusions: Increased PVI and the presence of PCI decreased the risk of increased tumor load and associated with less aggressive prostate cancer biology in patients at baseline random biopsies.
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http://dx.doi.org/10.1007/s00345-019-02830-7DOI Listing
April 2020

Radical prostatectomy for high-risk prostate cancer | Opinion: NO.

Int Braz J Urol 2019 May-Jun;45(3):428-434

USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA.

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http://dx.doi.org/10.1590/S1677-5538.IBJU.2019.03.03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6786100PMC
July 2019

Impact of Combination of Local Anesthetic Wounds Infiltration and Ultrasound Transversus Abdominal Plane Block in Patients Undergoing Robot-Assisted Radical Prostatectomy: Perioperative Results of a Double-Blind Randomized Controlled Trial.

J Endourol 2019 04 31;33(4):295-301. Epub 2019 Jan 31.

1 Departments of Urology, Italy.

Objective: To determinate benefits of the combination of local anesthetic wounds infiltration and ultrasound transversus abdominal plane (US-TAP) block with ropivacaine on postoperative pain, early recovery, and hospital stay in patients undergoing robot-assisted radical prostatectomy (RARP).

Methods: The study is double-blinded randomized controlled trial. Our hypothesis was that the combination of wound infiltration and US-TAP block with ropivacaine would decrease immediate postoperative pain and opioids use. Primary outcomes included postoperative pain and opioids demand during the hospital stay. Secondary outcomes were nausea/vomiting rate, stool passing time, use of prokinetics, length of hospital stay (LOS), and 30-days readmission to the hospital for pain or other US-TAP block-related complications.

Results: A total of 100 patients who underwent RARP were eligible for the analysis; 57 received the US-TAP block with 20 mL of 0.35% ropivacaine (US-TAP block group) and 43 did not receive US-TAP block (no-US-TAP group). All the patients received the local wound anesthetic infiltration with 20 mL of 0.35% ropivacaine. US-TAP block group showed a decreased mean Numerical Rating Scale (NRS) within 12 hours after surgery (1.6 vs 2.6; p = 0.02) and mean NRS (1.8 vs 2.7; p = 0.04) with lesser number of patients who used opioid (3.5% vs 18.6%; p = 0.01) during the first 24 hours. Moreover, we found a shorter mean LOS (4.27 vs 4.72, days; p = 0.04) with a lower requirement of prokinetics administration during the hospital stay (21% vs 72%; p < 0.001). No US-TAP block-related complications were reported.

Conclusion: Combination of anesthetic wound infiltration and US-TAP block with ropivacaine as part of a multimodal analgesic regimen can be safely offered to patients undergoing RARP and extended pelvic lymph node dissection. It improves the immediate postoperative pain control, reducing opioids administration and is associated to a decreased use of prokinetics and shorter hospital stay.
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http://dx.doi.org/10.1089/end.2018.0761DOI Listing
April 2019

Future of Urology training.

Arch Esp Urol 2018 Jan;71(1):158-163

Department of Urology. La Paz University Hospital. Madrid. Spain. European Association of Urology/Young Academics Urologists. Uro-Technology and communications working party. (ESUT-YAUwp). Arnhem. The Netherlands.

Urology has become more complex through the years, as it comprises increasingly sophisticated medical and surgical technologies such as advanced medical tumour therapies, and endourological, laparoscopicand robotic surgical techniques. Training in urology starts during medical school and once a medical student chooses to specialize on it, becomes life-long. Becoming a good urologist requires a highly qualified education and sufficient experience. To devise a training programme of high proficiency, several important factors must be considered. There are many studies in the literature revealing the thoughts of urology residents towards their training, needs and the realities. The aim of this chapter is to review the new technologies in urology training and show the new pathway of the future of training in urology.
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January 2018
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