Publications by authors named "Giuseppe Morgia"

155 Publications

Mechanical and Ablative Minimally Invasive Techniques for Male LUTS due to Benign Prostatic Obstruction: A Systematic Review according to BPH-6 Evaluation.

Urol Int 2021 Apr 13:1-11. Epub 2021 Apr 13.

Department of Urology, University of Catania, Catania, Italy.

The treatment of male lower urinary tract symptoms (LUTS) due to benign prostatic obstruction represents one of the major interesting aspects in urological clinical practice. Although transurethral resection of the prostate is still considered the surgical gold standard for treatment of benign prostatic hyperplasia with prostate volume <80 mL, various minimally invasive surgical treatments (MITs) have been developed to overcome the limitations of the "conventional" surgery. To date, there are no validated tools to evaluate the surgical outcomes of MITs; however, in the past, BPH-6 has been used for this purpose. In this systematic review, we evaluated the efficacy and safety of MITs according to BPH-6 score system. We focused our attention on MITs based on mechanical devices (prostatic urethral lift and the temporary implantable nitinol device) and techniques for prostate ablation (image guided robotic waterjet ablation and convective water vapor energy ablation). Evidence shows that MITs are capable of leading to an improvement in LUTS without having an overwhelming impact on complications and are a valid alternative to other treatments in patients who wish to preserve their sexual function or in case of inapplicability of conventional surgery. However, comparative studies between these techniques are still missing.
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http://dx.doi.org/10.1159/000514438DOI Listing
April 2021

Systemic combining inflammatory score (SCIS): a new score for prediction of oncologic outcomes in patients with high-risk non-muscle-invasive urothelial bladder cancer.

Transl Androl Urol 2021 Feb;10(2):626-635

Urology Section, Department of Surgery, University of Catania, Catania, Italy.

Background: An accurate and early diagnosis of bladder cancer (BC) is essential to offer patients the most appropriate treatment and the highest cure rate. For this reason, patients need to be best stratified by class and risk factors. We aimed to develop a score able to better predict cancer outcomes, using serum variables of inflammation.

Methods: A total of 1,510 high-risk non-muscle invasive bladder cancer (NMIBC) patients were included in this retrospective observational study. Patients with pathologically proven T1 HG/G3 at first TURBT were included. Systemic combined inflammatory score (SCIS) was calculated according to systemic inflammatory markers (SIM), modified Glasgow prognostic score (mGPS), and prognostic nutritional index (PNI) dichotomized (final score from 0 to 3).

Results: After 48 months of follow-up (IQR 40.0-73.0), 727 patients recurred (48.1%), 485 progressed (32.1%), 81 died for cancer (7.0%), and 163 died for overall causes (10.8%). Overall, 231 (15.3%) patients had concomitant Cis, 669 (44.3%) patients had multifocal pathology, 967 (64.1%) patients had tumor size >3 cm. Overall, 357 (23.6%) patients received immediate-intravesical therapy, 1,356 (89.8%) received adjuvant intravesical therapy, of which 1,382 (91.5%) received BCG, 266 (17.6%) patients received mitomycin C, 4 (0.5%) patients received others intravesical therapy. Higher SCIS was independently predictive of recurrence (hazard ratio HR 1.5, 1.3 and 2.2) and cancer specific mortality for SCIS 0 and 3 (HR: 1.61 and 2.3), and overall mortality for SCIS 0 and 3 (HR: 2.4 and 3.2). Conversely, SCIS was not associated with a higher probability of progression.

Conclusions: The inclusion of the SCIS in clinical practice is simple to apply and can help improve the prediction of cancer outcomes. It can identify patients with high-grade BC who are more likely to experience disease mortality.
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http://dx.doi.org/10.21037/tau-20-1272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947442PMC
February 2021

The Investigative Role of Statins in Ameliorating Lower Urinary Tract Symptoms (LUTS): A Systematic Review.

J Clin Med 2021 Jan 22;10(3). Epub 2021 Jan 22.

Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, 50100 Florence, Italy.

Previous data have shown that patients with metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE) could be refractory to the medical treatment. In this context, the evidence suggests a role for statin use in LUTS/BPE patients. The present systematic review aimed to evaluate the impact of statins on the treatment of men with LUTS/BPE. This review has been registered on PROSPERO (CRD42019120729). A systematic review of English-language literature was performed up to January 2020 in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement) criteria. Retrieved studies had to include adults with LUTS connected to BPE treated with statins drugs for metabolic syndrome. After removing duplicates, a total of 381 studies were identified by the literature search and independently screened. Of these articles, 10 fit the inclusion criteria and were further assessed for eligibility. Data from our systematic review suggest that a long-term therapy with statins, at least 6 months, is required to achieve significant impacts on prostate tissue and LUTS. Moreover, besides statins' direct activity, the risk reduction of LUTS might be connected to the improvement of hypercholesterolemia and MetS. The role of statins for the treatment of LUTS/BPE may be beneficial; however, evidence from robust studies is not enough, and more clinical trial are required.
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http://dx.doi.org/10.3390/jcm10030416DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7865704PMC
January 2021

Analysis of Arterial Stiffness and Sexual Function after Adding on PCSK9 Inhibitor Treatment in Male Patients with Familial Hypercholesterolemia: A Single Lipid Center Real-World Experience.

J Clin Med 2020 Nov 8;9(11). Epub 2020 Nov 8.

Department of Clinical and Experimental Medicine, University of Catania, 95100 Catania, Italy.

Familial hypercholesterolemia (FH) subjects have high low-density lipoprotein cholesterol (LDL-C) and may be at high risk of erectile dysfunction and atherosclerotic cardiovascular diseases. We evaluated the effect of PCSK9-i on sexual function evaluated by the Male Sexual Health Questionnaire (MSHQ) and the International Index of Erectile Function (IIEF-5) questionnaire and on pulse wave velocity (PWV) in FH male subjects. In this prospective observational study, we evaluated 30 FH male patients on high-intensity statins plus ezetimibe and with an LDL-C off-target. All patients added PCSK9-i treatment and obtained clinical assessment at baseline and after six months of PCSK9-i. As expected, LDL-C significantly decreased after adding-on PCSK9-i (-48.73%, < 0.001). MSHQ and PWV significantly improved after adding-on PCSK9-i (for MSHQ 93.63 ± 6.28 vs. 105.41 ± 5.86, < 0.05; for PWV 9.86 ± 1.51 vs. 7.7 ± 1.42, < 0.05); no significant change of IIEF-5 was found. Finally, a simple regression showed that ∆ MSHQ was significantly associated with ∆ LDL-C and ∆ PWV ( value for both <0.05). In conclusion, PCSK9-i therapy significantly improves lipid profile, PWV, and sexual function in FH male patients; our results support the favorable function of PCSK9-i on these parameters.
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http://dx.doi.org/10.3390/jcm9113597DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695132PMC
November 2020

Problems in defining sexual dysfunction in prostate cancer patients.

Int J Impot Res 2020 Aug 28. Epub 2020 Aug 28.

Urology Section, University of Catania, Catania, Italy.

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http://dx.doi.org/10.1038/s41443-020-00350-2DOI Listing
August 2020

How radical prostatectomy procedures have changed over the last 10 years in Italy: a comparative analysis based on more than 1500 patients participating in the MIRROR-SIU/LUNA and the Pros-IT CNR study.

World J Urol 2020 Aug 1. Epub 2020 Aug 1.

Aging Branch, National Research Council (CNR), Neuroscience Institute, Padua, Italy.

Purpose: Therapeutic strategies for prostate cancer (PCa) have been evolving dramatically worldwide. The current article reports on the evolution of surgical management strategies for PCa in Italy.

Methods: The data from two independent Italian multicenter projects, the MIRROR-SIU/LUNA (started in 2007, holding data of 890 patients) and the Pros-IT-CNR project (started in 2014, with data of 692 patients), were compared. Differences in patients' characteristics were evaluated. Multivariable logistic regression models were used to identify characteristics associated with robot-assisted (RA) procedure, nerve sparing (NS) approach, and lymph node dissection (LND).

Results: The two cohorts did not differ in terms of age and prostate-specific antigen (PSA) levels at biopsy. Patients enrolled in the Pros-IT-CNR project more frequently were submitted to RA (58.8% vs 27.6%, p < 0.001) and NS prostatectomy (58.4% vs. 52.9%, p = 0.04), but received LND less frequently (47.7% vs. 76.7%, p < 0.001), as compared to the MIRROR-SIU/LUNA patients. At multivariate logistic models, Lower Gleason Scores (GS) and PSA levels were significantly associated with RA prostatectomy in both cohorts. As for the MIRROR-SIU/LUNA data, clinical T-stage was a predictor for NS (OR = 0.07 for T3, T4) and LND (OR = 2.41 for T2) procedures. As for Pros-IT CNR data, GS ≥ (4 + 3) and positive cancer cores ≥ 50% were decisive factors both for NS (OR 0.29 and 0.30) and LND (OR 7.53 and 2.31) strategies.

Conclusions: PCa management has changed over the last decade in Italian centers: RA and NS procedures without LND have become the methods of choice to treat newly medium-high risk diagnosed PCa.
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http://dx.doi.org/10.1007/s00345-020-03350-5DOI Listing
August 2020

Evaluation of the "Teaching Guide for Basic Laparoscopic Skills" as a stand-alone educational tool for hands-on training sessions: a pilot study.

World J Urol 2021 Jan 21;39(1):281-287. Epub 2020 Mar 21.

Department of Urology and Kidney Transplant, Grande Ospedale Metropolitano, Reggio Calabria, Italy.

Introduction And Objectives: Standardization of hands-on training (HoT) has profoundly impacted the educational field in the last decade. To provide quality training sessions on a global scale, the European School of Urology Training group developed a teaching guide for tutors in 2015. Our study aims to understand whether this guide alone can provide information enough to match the performance improvement guaranteed by an expert tutor.

Material And Methods: 4 randomized groups of participants underwent HoT sessions with different teaching modalities: an expert surgeon (group 1), an expert E-BLUS tutor (group 2), E-BLUS guide alone (group 3), no tutor (group 4). Groups 1 and 2 were respectively provided with two different tutors to avoid biases related to personal tutor ability. Along the training session, each participant could perform five trials on two E-BLUS tasks: Peg transfer and Knot tying. During trials 1 and 5, completion time and number of errors were recorded for analysis with Pi-score algorithm. The average per-group Pi-scores were then compared to measure different performance improvement results.

Results: 60 participants from Italy were enrolled and randomized into four groups of 15. Pi-scores recorded on Peg transfer task were 24,6 (group 1), 26,4 (group 2), 42,2 (group 3), 11,7 (group 4). Pi-scores recorded on Knot tying task were 33,2 (group 1), 31,3 (group 2), 37,5 (group 3), 18,6 (group 4).

Conclusion: Compared to a human tutor, standardized teaching with the EBLUS guide may produce similar performance improvement. This evidence opens doors to automated teaching and to several novelties in hands-on training.
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http://dx.doi.org/10.1007/s00345-020-03161-8DOI Listing
January 2021

Implant of ATOMS® system for the treatment of postoperative male stress urinary incontinence: an Italian multicentric study.

Minerva Urol Nefrol 2020 Dec 4;72(6):770-777. Epub 2019 Nov 4.

CTO/Unipolar Spinal Cord Unit, Department of Neuro-Urology, Città della Salute e della Scienza, Turin, Italy.

Background: The aim of this study was to evaluate efficacy and safety of the ATOMS system for the treatment of postoperative stress urinary incontinence (SUI).

Methods: We included all consecutive male patients referring for postoperative SUI and treated with ATOMS system from June 2013 to July 2017. Patients received anamnesis, 24 h Pad Test, Pad count, physical examination, urodynamic evaluation, ICIQ-UI SF questionnaire. We excluded patients with low bladder capacity and compliance, uncontrolled detrusor overactivity.

Results: We treated 98 patients with median age of 70.21±10.02 years. The most common cause of SUI was open radical prostatectomy in 79 patients. Ten patients had undergone urethrotomy, 7 bladder neck incision, 14 adjuvant radiotherapy. Thirty-nine patients suffered of mild incontinence (24 h Pad Test <200 g), 49 moderate incontinence (200-400 g), 10 severe incontinence (≥400 g). Thirty-one patients underwent previous incontinence surgery: 29 ProACT, 3 artificial urinary sphincters (in 2 cases both devices), 1 bulking agents and subsequent male sling. Median follow-up was 21.5 months. We had a significant reduction of mean 24 h Pads Test, pad count and ICIQ-UI SF questionnaire (P<0.01). At last follow-up 47.96% of patients were dry and 79.59% reached social continence. A high incontinence grade, adjuvant radiotherapy, previous urethral surgery and incontinence surgery have been associated with lower continence results. We had complications in 33 patients (33.7%). The device was removed in 4 cases due to scrotal port erosion and in one case due to persistent pain.

Conclusions: The ATOMS system seems to be an effective and safe surgical treatment for postoperative male SUI.
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http://dx.doi.org/10.23736/S0393-2249.19.03457-XDOI Listing
December 2020

"Aquabeam® System" for benign prostatic hyperplasia and LUTS: birth of a new era. A systematic review of functional and sexual outcome and adverse events of the technique.

Int J Impot Res 2019 Nov 7;31(6):392-399. Epub 2019 Jun 7.

Department of Surgery, Urology Section, University of Catania, Catania, Italy.

Purpose: Aim of this systematic review is to evaluate functional outcomes (Qmax, QoL, IPSS, PVR), sexual outcome (erectile dysfunction and anejaculation rate), and adverse events evaluated according to the Clavien-Dindo classification.

Methods: The bibliographic search with the included terms (prostate, benign prostatic hyperplasia, benign prostatic enlargement, lower urinary tract symptoms, water jet dissection, aquablation, Aquabeam®) produced a literature of 32 articles altogether. After removing papers of not interest or articles which the outcomes could not be deduced, nine studies were examined for a total of 664 patients screened.

Results: The functional outcomes, evaluated after water jet dissection, have shown improvement with respect to the baseline in all the selected articles. In the comparison papers with the TURP, the Aquablation has been statistically not inferior regarding functional outcomes. The sexual outcomes have highlighted a better ejaculation rate for water jet dissection than TURP. Regarding the adverse events, water jet dissection documented low rates of adverse events and, in comparison studies, were not statistically superior than TURP.

Conclusions: In our systematic review, the Aquabeam® System for the treatment of LUTS/BPH has proven to be a safe technique that provides functional outcomes comparable to TURP. About sexual outcomes, the most important data is certainly the low rate of retrograde ejaculation. However, other multicenter randomized trials with larger cohorts and longer follow-up are still needed.
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http://dx.doi.org/10.1038/s41443-019-0158-3DOI Listing
November 2019

Systemic Inflammatory Markers and Oncologic Outcomes in Patients with High-risk Non-muscle-invasive Urothelial Bladder Cancer.

Eur Urol Oncol 2018 10 13;1(5):403-410. Epub 2018 Jul 13.

Division of Urology, European Institute of Oncology, Milan, Italy.

Background: Serum levels of neutrophils, platelets, and lymphocytes have been recognized as factors related to poor prognosis for many solid tumors, including bladder cancer (BC).

Objective: To evaluate the prognostic role of the combination of the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR) in patients with high-risk non-muscle-invasive urothelial BC (NIMBC).

Design, Setting, And Participants: A total of 1151 NMIBC patients who underwent first transurethral resection of the bladder tumor (TURBT) at 13 academic institutions between January 1, 2002 and December 31, 2012 were included in this analysis. The median follow-up was 48 mo.

Intervention: TURBT with intravesical chemotherapy or immunotherapy.

Outcome Measurements And Statistical Analysis: Multivariable Cox regression analysis was performed to identify factors predictive of recurrence, progression, cancer-specific mortality, and overall mortality. A systemic inflammatory marker (SIM) score was calculated based on cutoffs for NLR, PLR, and LMR.

Results And Limitations: The 48-mo recurrence-free survival was 80.8%, 47.35%, 20.67%, and 17.06% for patients with an SIM score of 0, 1, 2, and 3, respectively (p<0.01, log-rank test) while the corresponding 48-mo progression free-survival was 92.0%, 75.67%, 72.85%, and 63.1% (p<0.01, log-rank test). SIM scores of 1, 2, and 3 were associated with recurrence (hazard ratio [HR] 3.73, 7.06, and 7.88) and progression (HR 3.15, 4.41, and 5.83). Limitations include the lack of external validation and comparison to other clinical risk models.

Conclusions: Patients with high-grade T1 stage NMIBC with high SIM scores have worse oncologic outcomes in terms of recurrence and progression. Further studies should be conducted to stratify patients according to SIM scores to identify individuals who might benefit from early cystectomy.

Patient Summary: In this study, we defined a risk score (the SIM score) based on the measurement of routine systemic inflammatory markers. This score can identify patients with high-grade bladder cancer not invading the muscular layer who are more likely to suffer from tumor recurrence and progression. Therefore, the score could be used to select patients who might benefit from early bladder removal.
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http://dx.doi.org/10.1016/j.euo.2018.06.006DOI Listing
October 2018

The use of laser as a therapeutic modality as compared to TURP for the small prostate ≤40 mL: a collaborative review.

Minerva Urol Nefrol 2019 Dec 5;71(6):569-575. Epub 2019 Apr 5.

Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospital, Sheffield, UK.

Introduction: In the last decade therapeutic options for patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE) have constantly increased. Although transurethral resection of the prostate (TURP) is still considered the surgical gold standard, different lasers and advanced techniques have been introduced as alternatives to TURP.

Evidence Acquisition: A non-systematic Medline/Pubmed literature search was performed with different combination of terms including: "BPH," "M-TURP," "B-TURP" "bladder outlet obstruction," "YAG laser," "Diode laser," "Potassium titanyl phosphate," "KTP," "bladder outlet obstruction" (BOO), "BOO in small prostate". Only studies reporting prostate volume ≤40 cc were considered for this review.

Evidence Syntesis: Current evidence on the use of laser as a therapeutic modality as compared to TURP reported similar functional results of bipolar-TURP, Thulium laser and Greenlight. For prostate gland ≤40 cc, HoLEP can be technically more difficult while Holmium-TUIP seems to be a valid option but with a higher rate of retrograde ejaculation which is considerably higher than the rate in electrocautery series. The diode laser showed excellent intra-operatively haemostasis with clear endoscopic vision and durable improvements in functional results, but may produce greater passive thermal energy conduction that can cause scrotal edema and anal pain. However, conclusions need to be drawn after median to long term evaluation of patients and consideration of the economic implications, coupled with the potential for reducing morbidity.

Conclusions: Evidence acquisition from the literature showed that mini-invasive surgeries, including Greenlight laser and Holmium laser incision represent valid alternatives to TURP in prostate ≤40 g. We reported effective results of laser therapy as therapeutic modalities as compared to TURP for the small prostate ≤40 mL, both for enucleation and excision or cauterization, however cost effective of laser in the current literature are still scarce and it should be implemented.
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http://dx.doi.org/10.23736/S0393-2249.19.03350-2DOI Listing
December 2019

Comparative Effectiveness of Intralesional Therapy for Peyronie's Disease in Controlled Clinical Studies: A Systematic Review and Network Meta-Analysis.

J Sex Med 2019 Feb 26;16(2):289-299. Epub 2019 Jan 26.

Department of Neurosciences, Reproductive Sciences, Odontostomatology, Urology Unit, University of Naples, Naples, Italy.

Introduction: Medical treatment of Peyronie's disease (PD) in terms of intralesional therapy is still a matter of debate.

Aim: To compare the efficacy of different classes of intralesional therapy with a network meta-analysis (NMA) method.

Methods: The search was conducted using documents published in PubMed, Scopus, and Web of Science databases until September 30, 2017. We included randomized controlled trials comparing at least 1 intralesional therapy with a placebo therapy or with another drug for the treatment of PD. All intralesional therapies have been considered: collagenase Clostridium histolyticum (CCH), hyaluronic acid, verapamil, and interferon α-2b.

Main Outcome Measure: Outcomes of the study are the mean change in penile curvature (PC) and in erectile function (EF) assessed with the International Index of Erectile Function questionnaire.

Results: In total, 8 comparisons matched with the inclusion criteria, which includes 1,050 patients. With regard to PC (degree) improvement, hyaluronic acid and verapamil showed worse outcomes when compared with CCH (-6.66 and -2.30) and interferon α-2b (-6.75 and -2.38). When considering improvement in EF, hyaluronic acid, verapamil and interferon α-2b showed a slight increase in mean change when compared with CCH (+2.39, +1.77, and +0.65). Moreover, verapamil and interferon α-2b showed slightly worse mean change in comparison to hyaluronic acid (+0.62 and +1.74), whereas interferon α-2b was worse than verapamil (-1.12).

Clinical Implications: Based on this NMA, empirical therapy for PD should be avoided to offer the patients the best treatment in terms of level of evidence.

Strengths & Limitations: In this NMA, we have provided, for the first time, evidence of the efficacy between different intralesional therapies for the treatment of PD. We were not able to compare all specific outcomes (ie, pain, plaque size, patient satisfaction) of PD, because of the lack of homogeneity across relevant studies. Moreover, because of the few included studies, a meta-regression analysis of predictive factors of treatment response was not calculated.

Conclusion: This is the first meta-analysis comparing all available intralesional treatments for PD. CCH and interferon α-2b showed the best outcome in terms of PC, whereas hyaluronic acid was most efficient in relation to EF. Russo GI, Cacciamani G, Cocci A, et al. Comparative Effectiveness of Intralesional Therapy for Peyronie's Disease in Controlled Clinical Studies: A Systematic Review and Network Meta-Analysis. J Sex Med 2019;16:289-299.
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http://dx.doi.org/10.1016/j.jsxm.2018.12.011DOI Listing
February 2019

Multidisciplinary approach to prostatitis.

Arch Ital Urol Androl 2019 Jan 18;90(4):227-248. Epub 2019 Jan 18.

ASST Nord Milano.

The modern clinical research on prostatitis started with the work of Stamey and coworkers who developed the basic principles we are still using. They established the segmented culture technique for localizing the infections in the males to the urethra, the bladder, or the prostate and to differentiate the main categories of prostatitis. Such categories with slight modifications are still used according to the NIH classification: acute bacterial prostatitis, chronic bacterial prostatitis, Chronic Pelvic Pain Syndrome (CPPS) and asymptomatic prostatitis. Prostatic inflammation is considered an important factor in influencing both prostatic growth and progression of symptoms of benign prostatic hyperplasia and prostatitis. Chronic inflammation/neuroinflammation is a result of a deregulated acute phase response of the innate immune system affecting surrounding neural tissue at molecular, structural and functional levels. Clinical observations suggest that chronic inflammation correlates with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and benign prostatic hyperplasia (BPH) and an history of clinical chronic prostatitis significantly increases the odds for prostate cancer. The NIHNIDDK classification based on the use of the microbiological 4- glasses localization test or simplified 2-glasses test, is currently accepted worldwide. The UPOINT system identifies groups of clinicians with homogeneous clinical presentation and is used to recognize phenotypes to be submitted to specific treatments. The UPOINTS algorithm implemented the original UPOINT adding to the urinary domains (U), psycho-social (P), organspecific (O), infection (I), neurological (N), muscle tension and tenderness (T) a further domain related to sexuality (S). In fact sexual dysfunction (erectile, ejaculatory, libido loss) has been described in 46-92% of cases with a high impact on the quality of life of patients with CP/CPPS. Prostatic ultrasound represents the most popular imaging test in the work-up of either acute and chronic prostatitis although no specific hypo-hyperechoic pattern has been clearly associated with chronic bacterial prostatitis and CPPS. Use of a digital-processing software to calculate the extension of prostatic calcification area at ultrasound demonstrated a higher percentage of prostatic calcification in patients with chronic bacterial prostatitis. Multiparametric Magnetic Resonance Imaging (mpMRI) is the current state-of-the art imaging modality in the assessment of patients with prostate cancer although a variety of benign conditions, including inflammation, may mimic prostate cancer and act as confounding factors in the discrimination between neoplastic and non-neoplastic lesions. Bacteria can infect prostate gland by: ascending the urethra, reflux of urine into the prostatic ducts, direct inoculation of bacteria through inserted biopsy needles or hematogenous seeding. Enterobacteriaceae are the predominant pathogens in acute and chronic bacterial prostatitis, but an increasing role of Enterococci has been reported. Many strains of these uropathogens exhibit the ability to form biofilm and multidrug- resistance. Sexually Transmitted Infections (STI) agents, in particular Chlamydia trachomatis and Mycoplasma genitalium, have been also considered as causative pathogens of chronic bacterial prostatitis. On the contrary the effective role in genital diseases of other "genital mycoplasmas" is still a much debated issue. Sexually Transmitted Infections agents should be investigated by molecular methods in both patient and sexual partner. "Next generation" investigations, such as cytokine analysis, cytological typing of immune cells could help stratifying the immune response. Epigenetic dysregulation of inflammatory factors should be investigated according to systemic and compartment-specific signals. The search for biomarkers should also include evaluation of hormonal pathways, as measurement of estrogen levels in semen. Antimicrobials are the first line agents for the treatment of bacterial prostatitis. The success of antimicrobial treatment depends on the antibacterial activity and the pharmacokinetic characteristics of the drug which must reach high concentrations in prostate secretion and prostate tissue. Acute bacterial prostatitis can be a serious infection with a potential risk for urosepsis For iInitial treatment of severely ill patients, intravenous administration of high doses of bactericidal antimicrobials, such as broad-spectrum penicillins, third-generation cephalosporins or fluoroquinolones, is recommended in combination with an aminoglycoside. Use of piperacillin-tazobactam and meropenem is justified in presence of multiresistant gramnegative pathogens. The antibiotic treatment of chronic prostatitis is currently based on the use of fluoroquinolones that, given for 2 to 4 weeks, cured about 70% of men with chronic bacterial prostatitis. For the treatment of Chlamydial prostatitis macrolides were shown to be more effective than fluoroquinolones, whereas no differences were observed in microbiological and clinical efficacy between macrolides and tetracyclines for the treatment of infections caused by intracellular pathogens. Aminoglycosides and fosfomycin could be considered as a therapeutic alternative for the treatment of quinolone resistant prostatitis. Use of alpha-blockers in CP/CPPS patients with urinary symptoms and analgesics +/- non steroidal anti-inflammatory drugs (NSAID), in presence of pain demonstrated a reduction of symptoms reduction and an improvement of quality of life, although long term use of NSAID is limited by side effect profile. However, the multimodal therapeutic regimen by contemporary use of alphablockers, antibiotics and anti-inflammatory showed a better control of prostatitis symptoms than single drug treatment. Novel therapeutic substances for the treatment of pain, such as the cannabinoid anandamide would be highly interesting to test. An alternative for the treatment of chronic prostatitis/chronic pelvic pain syndrome is phytotherapy, as primary therapy or in association with other drugs. Quercetin, pollen extract, extract of Serenoa repens and other mixtures of herbal extracts showed a positive effect on symptoms and quality of life without side effects. The association of CP/CPPS with alterations of intestinal function has been described. Diet has its effects on inflammation by regulation of the composition of intestinal flora and direct action on the intestinal cells (sterile inflammation). Intestinal bacteria (microbiota) interacts with food influencing the metabolic, immune and inflammatory response of the organism. The intestinal microbiota has protective function against pathogenic bacteria, metabolic function by synthesis of vitamins, decomposition of bile acids and production of trophic factors (butyrate), and modulation of the intestinal immune system. The alteration of the microbiota is called "dysbiosis" causing invasive intestinal diseases pathologies (leaky gut syndrome and food intolerances, irritable bowel syndrome or chronic inflammatory bowel diseases) and correlating with numerous systemic diseases including acute and chronic prostatitis. Administration of live probiotics bacteria can be used to regulate the balance if intestinal flora. Sessions of hydrocolontherapy can represent an integration to this therapeutic approach. Finally, microbiological examination of sexual partners can offer supplementary information for treatment.
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http://dx.doi.org/10.4081/aiua.2018.4.227DOI Listing
January 2019

Effects of Varicocele Treatment on Sperm Conventional Parameters: Surgical Varicocelectomy Versus Sclerotherapy.

Cardiovasc Intervent Radiol 2019 Mar 5;42(3):396-404. Epub 2018 Dec 5.

Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy.

Introduction: Varicocele is often associated with impaired sperm parameters. Different procedures have been developed for varicocele treatment. The aim of this study was to evaluate the effects of varicocele treatment on conventional sperm parameters.

Materials And Methods: We compared two different techniques of intervention: surgical varicocelectomy and sclerotherapy. We also evaluated the number of varicocele recurrences and the pregnancy rate. We included 102 patients (mean age 29.8 ± 0.8 years) with ultrasound diagnosis of varicocele. We excluded patients whose ultrasound evaluation and/or sperm parameters were not known before and after varicocele correction. We divided the patients (excluding 8 with azoospermia) into two subgroups: surgical varicocelectomy (n = 44) and sclerotherapy (n = 50). For each patient, we compared conventional sperm parameters before and after varicocele correction.

Results: After varicocele correction, we found a significant improvement in sperm concentration, total count and total motility. Considering the two subgroups, baseline sperm parameters did not differ significantly. Sperm concentration and total count increased significantly after varicocele correction by varicocelectomy. Varicocele correction by sclerotherapy resulted in a significant increase in sperm concentration, progressive and total motility. We found varicocele recurrence in 32% of patients who underwent varicocelectomy and in 19.7% of patients undergoing sclerotherapy. The pregnancy rate was higher after sclerotherapy (28%) than after surgical varicocelectomy (13%).

Conclusion: Varicocele treatment must be recommended when other causes of infertility have been treated. Our results suggest the use of sclerotherapy for varicocele repair.

Level Of Evidence: 2 b.
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http://dx.doi.org/10.1007/s00270-018-2136-4DOI Listing
March 2019

Predictors of Residual T1 High Grade on Re-Transurethral Resection in a Large Multi-Institutional Cohort of Patients with Primary T1 High-Grade/Grade 3 Bladder Cancer.

J Cancer 2018 20;9(22):4250-4254. Epub 2018 Oct 20.

Division of Urology, European Institute of Oncology, Milan, Italy.

The aim of this multi-institutional study was to identify predictors of residual high-grade (HG) disease at re-transurethral resection (reTUR) in a large cohort of primary T1 HG/Grade 3 (G3) bladder cancer patients. A total of 1155 patients with primary T1 HG/G3 bladder cancer from 13 academic institutions that underwent a reTUR within 6 weeks after first TUR were evaluated. Logistic regression analysis was performed to assess the association of predictive factors with residual HG at reTUR. Residual HG cancer was found in 288 (24.9%) of patients at reTUR. Patients presenting residual HG cancer were more likely to have carcinoma in situ (CIS) at first resection (p<0.001), multiple tumors (p=0.02), and tumor size larger than 3 cm (p=0.02). Residual HG disease at reTUR was associated with increased preoperative neutrophil-to-lymphocytes ratio (NLR) (p=0.006) and body mass index (BMI)>=25 kg/m. On multivariable analysis, independent predictors for HG residual disease at reTUR were tumor size >3cm (OR = 1.37; 95% CI: 1.02-1.84, p=0.03), concomitant CIS (OR 1.92; 95% CI: 1.32-2.78, p=0.001), being overweight (OR= 2.08; 95% CI: 1.44-3.01, p<0.001) and obesity (OR 2.48; 95% CI: 1.64-3.77, p<0.001). A reTUR in high grade T1 bladder cancer is mandatory as about 25% of patients, presents residual high grade disease. Independent predictors to identify patients at risk of residual high grade disease after a complete TUR include tumor size, presence of carcinoma in situ, and BMI >=25 kg/m.
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http://dx.doi.org/10.7150/jca.26129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6277616PMC
October 2018

Role of multiparametric magnetic resonance imaging for patients under active surveillance for prostate cancer: a systematic review with diagnostic meta-analysis.

Prostate Cancer Prostatic Dis 2019 05 28;22(2):206-220. Epub 2018 Nov 28.

Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany.

Background: The use of multiparametric magnetic resonance imaging (mpMRI) in the setting of patients under active surveillance (AS) is promising. In this systematic-review we aimed to analyse the role of mpMRI in patients under AS.

Methods: A comprehensive literature research for English-language original and review articles, recently published, was carried out using Medline, Scopus and Web of sciences databases until 30 October 2017. The following MeSH terms were used: 'active surveillance', 'prostate cancer', 'multiparametric magnetic resonance imaging'. A diagnostic meta-analysis was performed for 3.0 T mpMRI in predicting disease re-classification.

Results: In total, 226 studies were selected after research and after removal of duplicates. After analysis on inclusion criteria, 43 studies were identified as eligible for this systematic review with a total of 6,605 patients. The timing of MRI during follow-up of AS differed from all studies like criteria for inclusion in the AS protocol. Overall, there was a low risk of bias across all studies. The diagnostic meta-analysis for 1.5 tesla showed a sensitivity of 0.60, negative predictive value (NPV) of 0.75 and a hierarchical summary receiving operating curve (HSROC) of 0.74 while for 3.0 tesla mpMRI a sensitivity of 0.81, a NPV of 0.78 and a HSROC of 0.83.

Conclusions: Overall, the available evidence suggests that both 1.5 or 3.0 Tesla mpMRI are a valid tool to monitor progression during AS follow-up, showing good accuracy capabilities in detecting PCa re-classification. However, the modality to better define what means 'disease progression' on mpMRI must be further evaluated.
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http://dx.doi.org/10.1038/s41391-018-0113-2DOI Listing
May 2019

High-throughput detection of low abundance sialylated glycoproteins in human serum by TiO enrichment and targeted LC-MS/MS analysis: application to a prostate cancer sample set.

Anal Bioanal Chem 2019 Jan 28;411(3):755-763. Epub 2018 Nov 28.

Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Campus "S. Venuta", Viale Europa, Loc. Germaneto, 88100, Catanzaro, Italy.

Glycopeptide enrichment can be a strategy to allow the detection of peptides belonging to low abundance proteins in complex matrixes such as blood serum or plasma. Though several glycopeptide enrichment protocols have shown excellent sensitivities in this respect, few reports have demonstrated the applicability of these methods to relatively large sample cohorts. In this work, a fast protocol based on TiO enrichment and highly sensitive mass spectrometric analysis by Selected Reaction Monitoring (SRM) has been applied to a cohort of serum samples from prostate cancer and benign prostatic hyperplasia patients in order to detect low abundance proteins in a single LC-MS/MS analysis in nanoscale format, without immunodepletion or peptide fractionation. A peptide library of over 700 formerly N-glycosylated peptides was created by data dependent analysis. Then, 16 medium to low abundance proteins were selected for detection by single injection LC-MS/MS based on selected-reaction monitoring. Results demonstrated the consistent detection of the low-level proteins under investigation. Following label-free quantification, four proteins (Adipocyte plasma membrane-associated protein, Periostin, Cathepsin D and Lysosome-associated membrane glycoprotein 2) were found significantly increased in prostate cancer sera compared to the control group. Graphical abstract ᅟ.
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http://dx.doi.org/10.1007/s00216-018-1497-5DOI Listing
January 2019

Mobile phone apps for the prediction of prostate cancer: External validation of the Coral and Rotterdam apps.

Eur J Surg Oncol 2019 03 16;45(3):471-476. Epub 2018 Oct 16.

Department of Urology, Ospedale Sant' Andrea, Rome, Italy. Electronic address:

Objective: To analyze the performance of two mobile phone apps-the Rotterdam prostate cancer risk app and the Coral app-in a cohort of patients undergoing prostate biopsies.

Methods: A consecutive series of men undergoing prostate biopsies were enrolled in two centers. Indications for prostate biopsy included abnormal prostate-specific antigen levels (PSA >4 ng/mL) and/or an abnormal digital rectal examination (DRE). Prostate cancer risk and high-grade prostate cancer risk were assessed using the Rotterdam prostate cancer risk app (iOS) and the Coral app (iOS). The usability of the apps was also assessed and compared using the Post-Study System Usability Questionnaire (PSSUQ) developed by IBM.

Results: Overall, 1682 patients with a median age of 68 (62-73) years were enrolled. The Rotterdam app outperformed the Coral app in the prediction of prostate cancer (AUC: 0.70 versus 0.631, p = 0.001) and of high-grade prostate cancer (0.75 versus 0.69, p = 0.001) (Fig. 1). PSSUQ data revealed that both Rotterdam and Coral applications were comparable in terms of usefulness (87% versus 83%, p = 0.708), information quality (74% versus 72%, p = 0.349), interface quality (79% versus 74%, p = 0.216) and satisfaction (76% versus 76%, p = 0.935), respectively. In terms of preferences, 26/50 (54%) preferred the Rotterdam app, while 24/50 (46%) preferred the Coral app.

Conclusion: In our experience the Rotterdam App outperformed the Coral App for the prediction of prostate cancer or high-grade cancer diagnosis. In particular we confirmed, using the Rotterdam app, that only one out of ten patients with a low Rotterdam score will harbor high-grade prostate cancer on biopsy.
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http://dx.doi.org/10.1016/j.ejso.2018.09.018DOI Listing
March 2019

Adherence to Mediterranean diet and prostate cancer risk in Sicily: population-based case-control study.

Int J Impot Res 2019 Jul 18;31(4):269-275. Epub 2018 Oct 18.

Urology Section, University of Catania, Catania, Italy.

Prostate cancer (PCa) is the second most frequently diagnosed cancer and the sixth leading cause of death from cancer worldwide. Countries following a Mediterranean-type dietary pattern, has been reported to have lower PCa incidence and mortality compared with other European regions. A population-based case-control study has been conducted from January 2015 to December 2016 in a single institution of the municipality of Catania, southern Italy. A total of 118 PCa and 238 population-based controls were collected. Controls had significantly higher adherence to the Mediterranean diet, which was evident for several subgroups (including age groups, overweight and obese men, current smokers, alcohol intake, low and medium physical activity levels). PCa cases were found to consume lower amount of vegetables (223 g/d vs. 261 g/d; p = 0.001), legumes (34.26 g/d vs. 53.55 g/d; p = 0.003), and fish (47.75 g/d vs. 58.3 g/d) than controls; other differences emerged were related to alcohol intake (12.37 g/d vs 5.07 g/d; p < 0.01), cereals (254.06 g/d vs.235.94 g/d; p < 0.001), dairy (196 g/d vs. 166 g/d; p < 0.001), and meat consumption (98.09 g/d vs. 70.15 g/d; p < 0.001). However, no statistically significant differences between cases and controls were found regarding fruit, legumes, and olive oil consumption. The Mediterranean diet score was inversely associated with lower likelihood of having PCa in a linear manner (odds ratio [OR]: 0.86 [95% CI 0.77-0.96]). Specifically, individuals in the highest group of adherence had 78% less likelihood of have PCa and 14% less likelihood for each point increase of the score. The model adjusted for total polyphenol intake showed still a significant inverse association between adherence to the Mediterranean diet and PCa, but the relation was no more linear and not significant for one-point increase of the score (OR: 0.88 [95% CI 0.77-1.01]). In our cohorts of Italian men, we observed that high adherence to the Mediterranean diet was inversely associated with likelihood of having PCa cancer.
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http://dx.doi.org/10.1038/s41443-018-0088-5DOI Listing
July 2019

Sildenafil 25 mg ODT + Collagenase Clostridium hystoliticum vs Collagenase Clostridium hystoliticum Alone for the Management of Peyronie's Disease: A Matched-Pair Comparison Analysis.

J Sex Med 2018 10 20;15(10):1472-1477. Epub 2018 Sep 20.

Urology Section, University of Catania, Catania, Italy. Electronic address:

Introduction: The effectiveness of phosphodiesterase type 5 (PDE5) inhibitors over the conservative management of Peyronie's disease (PD) has been widely questioned.

Aim: To determine the role of sildenafil 25 mg film formulation twice a day (S25 b.i.d.) in the improvement of curvature after treatment of collagenase of Clostridium hystoliticum (CCH) in penile curvature owing to PD.

Methods: From April 2017 to April 2018, 161 consecutive patients were treated with S25 b.i.d. + CCH or CCH alone. Adjustment variables consisted of age, penile curvature, and the 15-question International Index of Erectile Function (IIEF-15) questionnaire at baseline using 1:1 propensity-score matching. Overall, 50 patients were considered subdivided into the following: 25 patients who received S25 b.i.d. + CCH (group A) and 25 who received CCH alone (group B). Patients received CCH injection using a shortened protocol and vacuum device in both groups.

Main Outcome Measure: The primary outcome of the study was the change in penile curvature after treatment, and secondary outcomes were the change in sexual function (IIEF-15) and in the Peyronie's Disease Questionnaire (PDQ) and its subscores, PDQ-PS (psychosexual symptoms), PDQ-PP (penile pain), and PDQ-SB (symptom bother).

Results: Overall, mean penile curvature was 47.0° (SD 21.88), the mean IIEF-EF (erectile function) was 23.56 (SD 4.10), and the mean PDQ was 27.06 (SD 13.55). After the treatment, we observed a mean change for penile curvature of 25.6 (SD 9.05) in group A and -25.6 (SD 9.7) in group B (P < .01), for IIEF-EF of 2.28 (SD 2.33) in group A and 1.36 (SD 1.77) in group B (P = .03), for PDQ-PS of -3.04 (SD 2.95) in group A and of -2.12 (SD 2.06) in group B (P = .11), for PDQ-PP of -1.0 (SD 4.48) in group A and of -0.88 (SD 2.04) in group B (P = .60), for PDQ-SB of -5.84 (SD 4.58) in group A and of -4.16 (SD 4.45) in group B (P = .60), and for Female Sexual Function Index of 3.8 (SD 2.45) in group A and of 2.72 (SD 2.28) in group B (P = .14). We found a rate of global satisfaction of 70.83% in group A and of 84.0% in group B (P = .27).

Clinical Implications: Addition of S25 b.i.d. to CCH is superior to CCH alone for improving penile curvature and erectile function.

Strength & Limitations: This is the first study comparing sildenafil + CCH vs CCH alone for the treatment of PD. Lack of randomization and direct verification of appropriate use of penile modeling could be considered limitations.

Conclusion: In this study, combination therapy was superior in terms of penile curvature and erectile dysfunction improvement. Cocci A, Cito G, Urzì D, et al. Sildenafil 25 mg ODT + collagenase Clostridium hystoliticum vs collagenase Clostridium hystoliticum alone for the management of Peyronie's disease: A matched-pair comparison analysis. J Sex Med 2018;15:1472-1477.
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http://dx.doi.org/10.1016/j.jsxm.2018.08.012DOI Listing
October 2018

The occurrence of intraoperative complications during partial nephrectomy and their impact on postoperative outcome: results from the RECORd1 project.

Minerva Urol Nefrol 2019 Feb 10;71(1):47-54. Epub 2018 Sep 10.

Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.

Background: The aim of this study was to analyze the predictive factors of intraoperative complications in patients submitted to PN and the impact of intraoperative complications on postoperative outcomes.

Methods: Data of 1055 patients who underwent PN for cortical renal masses were recorded from a multicenter prospective observational study (RECORd1 project).

Results: Overall, 48 (5%) patients experienced 49 intraoperative complications (four medical, 45 surgical). At multivariable analysis, age (OR=1.02, 95% CI: 1.00-1.08, P=0.03), imperative versus elective surgical indication (OR=2.55, 95% CI: 1.12-5.85, P=0.03), open (OR=5.76, 95% CI: 1.05-9.21, P=0.01) and laparoscopic (OR=2.35, 95% CI: 1.11-4.95, P=0.03) versus robotic approaches resulted independent predictive factors of intraoperative complications. Patients experiencing intraoperative complications had a significantly higher rate of overall postoperative complications (41.6% vs. 17.3%, P<0.0001), surgical postoperative complications (29.2% vs. 12.6%, P<0.0001), Clavien 2 surgical postoperative complications (14.6% vs. 7.2%, P=0.05) and a significantly longer length of stay (8 [6-9] vs. 7 [5-8] days, P<0.0001) than those with an uneventful intraoperative course.

Conclusions: Efforts should be made to minimize the risk of intraoperative complications during PN, and, in that case, patients should be carefully monitored.
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http://dx.doi.org/10.23736/S0393-2249.18.03202-2DOI Listing
February 2019

Mixofibrosarcoma of the kidney: An unusual site for a common soft tissue tumor.

Pathol Res Pract 2018 10 23;214(10):1745-1746. Epub 2018 Jul 23.

Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Anatomic Pathology Section, School of Medicine, University of Catania, 95131, Catania, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.prp.2018.07.012DOI Listing
October 2018

Validation of Neutrophil-to-lymphocyte Ratio in a Multi-institutional Cohort of Patients With T1G3 Non-muscle-invasive Bladder Cancer.

Clin Genitourin Cancer 2018 12 6;16(6):445-452. Epub 2018 Jul 6.

Department of Urology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Weill Cornell Medical College, New York, NY.

Introduction: The aim of this multicenter study was to investigate the prognostic role of neutrophil-to-lymphocyte ratio (NLR) and to validate the NLR cutoff of 3 in a large multi-institutional cohort of patients with primary T1 HG/G3 non-muscle-invasive bladder cancer (NMIBC).

Patients And Methods: The study period was from January 2002 through December 2012. A total of 1046 patients with primary T1 HG/G3 who had NMIBC on re-transurethral bladder resection (TURB) who received adjuvant intravesical bacillus Calmette-Guérin therapy with maintenance from 13 academic institutions were included. Endpoints were time to disease, and recurrence-free (RFS), progression-free (PFS), overall (OS), and cancer-specific survival (CSS).

Results: A total of 512 (48.9%) of patients had NLR ≥ 3 prior to TURB. High pretreatment NLR was associated with female gender and residual T1HG/G3 on re-TURB. The 5-year RFS estimates were 9.4% (95% confidence interval [CI], 6.8%-12.4%) in patients with NLR ≥ 3 compared with 58.8% (95% CI, 54%-63.2%) in patients with NLR < 3; the 5-year PFS estimates were 57.1% (95% CI, 51.5%-62.2%) versus 79.2% (95% CI, 74.7%-83%; P < .0001); the 10-year OS estimates were 63.6% (95% CI, 55%-71%) versus 66.5% (95% CI, 56.8%-74.5%; P = .03); the 10-year CSS estimates were 77.4% (95% CI, 68.4%-84.2%) versus 84.3% (95% CI, 76.6%-89.7%; P = .004). NLR was independently associated with disease recurrence (hazard ratio [HR], 3.34; 95% CI, 2.82-3.95; P < .001), progression (HR, 2.18; 95% CI, 1.71-2.78; P < .001) and CSS (HR, 1.65; 95% CI, 1.02-2.66; P = .03). The addition of NLR to a multivariable model that included established features increased its discrimination for predicting of RFS (+6.9%), PFS (+1.8%), and CSS (+1.7%).

Conclusions: Pretreatment NLR ≥ 3 was a strong predictor for RFS, PFS, and CSS in patients with primary T1 HG/G3 NMIBC. It could help in the decision-making regarding intensity of therapy and follow-up.
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http://dx.doi.org/10.1016/j.clgc.2018.07.003DOI Listing
December 2018

Association between dietary flavonoids intake and prostate cancer risk: A case-control study in Sicily.

Complement Ther Med 2018 Aug 15;39:14-18. Epub 2018 May 15.

Urology section - University of Catania, Catania, Italy.

Objectives: The aim of this study is to test the association between dietary flavonoids intake and prostate cancer (PCa) in a sample of southern Italian individuals.

Design: A population-based case-control study on the association between PCa and dietary factors was conducted from January 2015 to December 2016, in a single institution.

Setting: Patients with elevated PSA (Prostate Specific Antigen) and/or suspicion of PCa underwent transperineal prostate biopsy (≥12 cores). A total of 118 histopathological-verified PCa cases were collected and matched with controls, which were selected from a sample of 2044 individuals randomly recruited among the same reference population. Finally, a total of 222 controls were selected.

Main Outcome Measures: Prevalence of PCa.

Results: Consumption of certain groups of flavonoids significantly differed between controls and cases, in particular: flavonols (63.36 vs 37.14 mg/d, P < 0.001), flavanols (107.61 vs. 74.24 mg/d, P = .016), flavanones (40.92 vs. 81.32 mg/d, P < 0.001), catechins (63.36 vs. 36.18 mg/d, P = .006). In the multivariate model, flavanols and flavones were associated with reduced risk of PCa, despite not in the highest quartile of intake. Higher flavonol and catechin intake was consistently associated with reduced risk of PCa (Odds Ratio (OR) = 0.19, 95% CI: 0.06-0.56 and OR = 0.12, 95% CI: 0.04-0.36). In contrast, the highest intake of flavanones was positively associated with PCa.

Conclusion: Flavonols and catechins have proved to be the most promising molecules for a potential protective role against PCa. Nevertheless, further research on flavanones is needed to better establish whether they are associated with PCa.
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http://dx.doi.org/10.1016/j.ctim.2018.05.002DOI Listing
August 2018

Complication Rate After Antibiotic Prophylaxis with Fosfomycin Versus Fluorochinolones or β-lactam Antibiotics in Patients Undergoing Prostate Biopsy: A Propensity Score-adjusted Analysis.

Eur Urol Focus 2020 03 13;6(2):370-375. Epub 2018 Jul 13.

Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy.

Background: Transrectal ultrasound-guided prostate biopsy (TRBx) or transperineal Bx (TPBx) are considered alternative approaches for the diagnosis of prostate cancer (PCa). However, urinary tract infection (UTI) or other complications could be more frequent in the TRBx approach.

Objective: To determine the complication rate following different antimicrobial prophylaxis (AMP; fosfomycin trometamol [FT] vs ß-lactame or fluorochinolones [FQ]) in patients undergoing TRBx or TPBx.

Design, Setting, And Participants: The analyses were based on prospectively collected data of a cohort of patients who underwent TRBx or TPBx for elevated prostate-specific antigen (PSA; ≥4ng/ml) or clinical suspicion of PCa, between September 2016 and March 2017. Patients received a single dose of 3g oral FT (group A) or, alternatively, FQ or ß-lactame (group B).

Intervention: TRBx versus TPBx.

Outcome Measurements And Statistical Analysis: Adjustment variables consisted of age, PSA, biopsy technique (TPBx vs TRBx), and antibiotic prophylaxis (FT vs ß-lactame or FQ) using 1:1 propensity-score matching. Overall, 526 patients were considered, of whom 258 received FT (group A) and the other 258 received ß-lactame or FQ (group B).

Results And Limitations: Overall complications occurred in 390 (75.58%) and major complications in 67/516 (12.98%). Lower prevalence of UTIs was detected in group A (34.1%) compared with that in group B (43.4%; p=0.03), while similar rates of haematuria (54.7% vs 55.4%), haemospermia (39.5% vs 33.0%), and acute urinary retention (11.6% vs 9.3%) were detected in groups A and B. We found that group B (odds ratio [OR]: 1.54; p=0.03), I grade haematuria (OR: 6.17; p<0.01), and II grade haematuria (OR: 5.13; p<0.01) were significantly associated with increased risk of UTIs.

Conclusions: AMP with fluoroquinoles or ß-lactam antibiotics increased the rate of UTIs, when compared with FT, in patients undergoing TRBx or TPBx. The appearance of haematuria or haemospermia is associated with UTIs, suggesting the possibility of tailoring the strategy for prophylaxis in this category of patients.

Patient Summary: In this study, comparing complications after transrectal ultrasound-guided prostate biopsy versus transperineal biopsy, prophylaxis with fluoroquinoles or ß-lactam antibiotics increased the rate of urinary tract infections when compared with fosfomycin trometamol, regardless of the type of biopsy approach.
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http://dx.doi.org/10.1016/j.euf.2018.06.014DOI Listing
March 2020

An increased body mass index is associated with a worse prognosis in patients administered BCG immunotherapy for T1 bladder cancer.

World J Urol 2019 Mar 10;37(3):507-514. Epub 2018 Jul 10.

Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy.

Purpose: The body mass index (BMI) may be associated with an increased incidence and aggressiveness of urological cancers. In this study, we aimed to evaluate the impact of the BMI on survival in patients with T1G3 non-muscle-invasive bladder cancer (NMIBC).

Methods: A total of 1155 T1G3 NMIBC patients from 13 academic institutions were retrospectively reviewed and patients administered adjuvant intravesical Bacillus Calmette-Guérin (BCG) immunotherapy with maintenance were included. Multivariable Cox regression analysis was performed to identify factors predictive of recurrence and progression.

Results: After re-TURBT, 288 patients (27.53%) showed residual high-grade NMIBC, while 867 (82.89%) were negative. During follow-up, 678 (64.82%) suffered recurrence, and 303 (30%) progression, 150 (14.34%) died of all causes, and 77 (7.36%) died of bladder cancer. At multivariate analysis, tumor size (hazard ratio [HR]:1.3; p = 0.001), and multifocality (HR:1.24; p = 0.004) were significantly associated with recurrence (c-index for the model:55.98). Overweight (HR: 4; p < 0.001) and obesity (HR:5.33 p < 0.001) were significantly associated with an increased risk of recurrence. Addition of the BMI to a model that included standard clinicopathological factors increased the C-index by 9.9. For progression, we found that tumor size (HR:1.63; p < 0.001), multifocality (HR:1.31; p = 0.01) and concomitant CIS (HR: 2.07; p < 0.001) were significant prognostic factors at multivariate analysis (C-index 63.8). Overweight (HR: 2.52; p < 0.001) and obesity (HR: 2.521 p < 0.001) were significantly associated with an increased risk of progression. Addition of the BMI to a model that included standard clinicopathological factors increased the C-index by 1.9.

Conclusions: The BMI could have a relevant role in the clinical management of T1G3 NMIBC, if associated with bladder cancer recurrence and progression. In particular, this anthropometric factor should be taken into account at initial diagnosis and in therapeutic strategy decision making.
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http://dx.doi.org/10.1007/s00345-018-2397-1DOI Listing
March 2019

High-Grade T1 on Re-Transurethral Resection after Initial High-Grade T1 Confers Worse Oncological Outcomes: Results of a Multi-Institutional Study.

Urol Int 2018 4;101(1):7-15. Epub 2018 Jul 4.

Department of Urology, Medical University of Vienna, Vienna, Austria.

Introduction: The aim of this multicenter study was to investigate the prognostic impact of residual T1 high-grade (HG)/G3 tumors at re-transurethral resection (TUR of bladder tumor) in a large multi-institutional cohort of patients with primary T1 HG/G3 bladder cancer (BC).

Patients And Methods: The study period was from January 2002 to -December 2012. A total of 1,046 patients with primary T1 HG/G3 and who had non-muscle invasive BC (NMIBC) on re-TUR followed by adjuvant intravesical Bacillus Calmette-Guerin (BCG) therapy with maintenance were included. Endpoints were time to disease recurrence, progression, and overall and cancer-specific death.

Results: A total of 257 (24.6%) patients had residual T1 HG/G3 tumors. The presence of concomitant carcinoma in situ, multiple and large tumors (> 3 cm) at first TUR were associated with residual T1 HG/G3. Five-year recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS) were 17% (CI 11.8-23); 58.2% (CI 50.7-65); 73.7% (CI 66.3-79.7); and 84.5% (CI 77.8-89.3), respectively, in patients with residual T1 HG/G3, compared to 36.7% (CI 32.8-40.6); 71.4% (CI 67.3-75.2); 89.8% (CI 86.6-92.3); and 95.7% (CI 93.4-97.3), respectively, in patients with NMIBC other than T1 HG/G3 or T0 tumors. Residual T1 HG/G3 was independently associated with RFS, PFS, OS, and CSS in multivariable analyses.

Conclusions: Residual T1 HG/G3 tumor at re-TUR confers worse prognosis in patients with primary T1 HG/G3 treated with maintenance BCG. Patients with residual T1 HG/G3 for primary T1 HG/G3 are very likely to fail BCG therapy alone.
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http://dx.doi.org/10.1159/000490765DOI Listing
January 2019

Comparison Between Cu-PSMA-617 PET/CT and F-Choline PET/CT Imaging in Early Diagnosis of Prostate Cancer Biochemical Recurrence.

Clin Genitourin Cancer 2018 10 4;16(5):385-391. Epub 2018 Jun 4.

Diagnostic Imaging, Nuclear Medicine Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy.

Purpose: To evaluate the diagnostic performance of Cu-PSMA-617 positron emission tomography (PET) with computed tomography (CT) for restaging prostate cancer after biochemical recurrence (BCR) and to compare it with F-choline PET/CT in a per-patient analysis.

Patients And Methods: An observational study was performed of 43 patients with BCR after laparoscopic radical prostatectomy who underwent Cu-PSMA-617 PET/CT and subsequently F-choline PET/CT for restaging. The detection rates (DR) of Cu-PSMA-617 PET/CT and of F-choline PET/CT were calculated by standardized maximum uptake value (SUV) at 4 hours and SUV at 1 hour as reference, respectively. Furthermore, univariate logistic regression analysis was carried out to identify independent predictive factors of positivity with Cu-PSMA-617 PET/CT.

Results: An overall positivity with Cu-PSMA-617 PET/CT was found in 32 patients (74.4%) versus 19 (44.2%) with F-choline PET/CT. Specifically, after stratifying for prostate-specific antigen (PSA) values, we found a good performance of Cu-PSMA-617 PET/CT at low PSA levels compared to F-choline PET/CT, with a DR of 57.1% versus 14.3% for PSA 0.2-0.5 ng/mL (P = .031), and of 60% versus 30% with PSA 0.5-1 ng/mL. At univariate binary logistic regression analysis, PSA level was the only independent predictor of Cu-PSMA-617 PET/CT positivity. No significant difference in terms of DR for both Cu-PSMA-617 PET/CT and F-choline PET/CT was found according to different Gleason score subgroups.

Conclusion: In our study cohort, a better performance was observed for Cu-PSMA-617 PET/CT compared to F-choline PET/CT in restaging after BCR, especially in patients with low PSA values.
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http://dx.doi.org/10.1016/j.clgc.2018.05.014DOI Listing
October 2018

Predictors of treatment success after collagenase Clostridium histolyticum injection for Peyronie's disease: development of a nomogram from a multicentre single-arm, non-placebo controlled clinical study.

BJU Int 2018 10 20;122(4):680-687. Epub 2018 Jun 20.

Department of Urology, Santa Maria Annunciata Hospital, Florence, Italy.

Objective: To build a nomogram able to predict treatment success after collagenase Clostridium histolyticum (CCH) for Peyronie's disease (PD).

Materials And Methods: Between November 2016 and November 2017, we enrolled 135 patients with PD into a multicentre single-arm prospective study. All patients enrolled received CCH treatment. Success of therapy was defined as a decrease in penile curvature (PC) of ≥20° from baseline. Treatment satisfaction was assessed using a scale from 1 to 10, and high satisfaction was arbitrarily defined as a score of ≥8. Calcification level was classified as: absence of calcification; low perilesional calcification; and high calcification.

Results: The median (interquartile range [IQR]) patient age was 56.0 (45.0-65.0) years and the median (IQR) was PC was 30 (30.0-60.0)°. After the treatment protocol, we observed a significant median change in PC of -20.0° (P < 0.01). The median (IQR) PC improvement was 44 (28.0-67.0)%. Overall median (IQR) satisfaction score was 8.0 (7.0-9.0). Treatment efficacy was reported in a total of 77 patients (57.04%). When analysing factors associated with PC improvement after treatment, we found that baseline PC (odds ratio [OR] 1.14; P < 0.01), basal plaque (OR 64.27; P < 0.01), low calcification (OR 0.06; P < 0.01) and high calcification (OR 0.03; P < 0.01) were significant predictors of PC improvement. The c-index for the model was 0.93.

Conclusions: Patients with longer PD duration, greater baseline PC and basal plaque location had a greater chance of treatment success. These results could be applied to clinical practice before external validation of our nomogram.
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http://dx.doi.org/10.1111/bju.14410DOI Listing
October 2018