Publications by authors named "Guglielmo Mantica"

85 Publications

Simultaneous robotic partial nephrectomy for bilateral renal masses.

World J Urol 2022 Jan 9. Epub 2022 Jan 9.

Department of Urology, Careggi University Hospital, Florence, Italy.

Purpose: There is currently no consensus regarding the optimal treatment strategy for patients presenting with synchronous bilateral renal masses. The decision to perform bilateral procedures on the same intervention or in staged procedures is debated. The aim of this manuscript is to analyse the outcomes of simultaneous robot-assisted partial nephrectomy (RAPN) in a series of patients with bilateral renal masses treated at five Italian robotic institutions.

Methods: Data from a prospectively maintained multi-institutional database on patients subjected to simultaneous RAPN between November 2011 and July 2019 were reviewed. RAPNs were performed with da Vinci Si or Xi surgical system by expert robotic surgeons. Baseline demographics and clinical features, peri- and post-operative data were collected.

Results: Overall, 27 patients underwent simultaneous bilateral RAPN, and 54 RAPNs were performed without need of conversion; median operative time was 250 minutes, median estimated blood loss was 200 mL. Renal artery clamping was needed for 27 (50%) RAPNs with a median warm ischemia time of 15 minutes and no case of acute kidney injury. Complications were reported in 7 (25.9%) patients, mainly represented by Clavien 2 events (6 blood transfusions). Positive surgical margins were assessed in 2 (3.7%) of the renal cell carcinoma. At the median follow-up of 30 months, recurrence-free survival was 100%.

Conclusion: Our data showed that, in selected patients and expert hands, simultaneous bilateral RAPNs could be a safe and feasible procedure with promising results for the treatment of bilateral synchronous renal masses.
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http://dx.doi.org/10.1007/s00345-021-03919-8DOI Listing
January 2022

Ectopic adrenal tissue in the kidney: A systematic review.

Arch Ital Urol Androl 2021 Dec 21;93(4):481-488. Epub 2021 Dec 21.

Department of Urology, San Raffaele Hospital, Milan.

Introduction: Ectopic adrenal tissue in the kidney, including "Ectopic adrenal tissue" and "Adrenal-renal fusion", is a rare event with a specific behavior which may be difficult to distinguish clinically from renal neoplasms. We performed a systematic review on ectopic adrenal tissue variants reported in the literature underlining its clinical aspects.

Methods: Manuscripts which presented a case report or case series of ectopic adrenal tissue in the kidney were included even if published in original articles, reviews, or letters to the editor. A specific search on SCOPUS®, PubMed®, and Web of Science® database was performed. Only English language papers published in a period ranging between August 1991 and April 2020 were considered. Additionally, a case we had at our institution is described, and its characteristics are included. Data on clinical presentation, type of adrenal anomaly, location, anatomopathological and immune-histotype characteristics were collected.

Results: We identified 888 manuscripts. Among these 29 were included in this systematic review. Overall, 39 patients with renal adrenal fusion or adrenal ectopia were considered. In most cases, the diagnosis was made incidentally, or following investigation for flank pain, abdominal pain, or endocrinological disorders. CT scan frequently identified a solid vascularized lesion that was difficult to distinguish from renal neoplasm. Adrenal fusion was mostly located at the level of the upper pole. Adrenal rest was found in the renal parenchyma, renal hilum, or retroperitoneum in close proximity to the renal peduncle. Often these ectopic adrenal tissue lesions follow a benign behavior and can be classified as functioning or non-functioning adenomas. Rarely, they may experience neoplastic degeneration. The most frequently positive markers were inhibin, vimentin, melan-A, synaptophysin and anti-p450 scc.

Conclusions: Ectopic adrenal tissue in the kidney is a rare event with specific clinical characteristics that need to be identified in order to arrive at a correct diagnosis and carry out appropriate treatment management.
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http://dx.doi.org/10.4081/aiua.2021.4.481DOI Listing
December 2021

Genitourinary Tuberculosis: A Comprehensive Review of a Neglected Manifestation in Low-Endemic Countries.

Antibiotics (Basel) 2021 Nov 14;10(11). Epub 2021 Nov 14.

Alta uro AG, Merian Iselin Klinik, Center of Biomechanics & Calorimetry, University of Basel, 4123 Basel, Switzerland.

Genitourinary tuberculosis (GUTB) represents a disease often underestimated by urological specialists, particularly in settings such as the European one, where the pathology is less frequent. Similar to other uncommon diseases at these latitudes, GUTB is a neglected clinical problem. In this light, the aim of this review is to give a comprehensive overview of GUTB in order to provide a useful tool for urologists who seldomly manage this disease. A non-systematic review of genitourinary tuberculosis was performed on relevant articles published from January 1990 to July 2021 using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. GUTB represents up to a quarter of extrapulmonary tuberculosis (EPTB) cases. Diagnostic, therapeutic and surgical work-up have been deeply reviewed and summarized. The mass migration of refugees to Europe as well as the ease of international travel is gradually leading to an upsurge in urological diseases such as GUTB, which were previously only rarely encountered in some European countries. The poor TB knowledge of European urologists should be improved through medical education courses, webinars or telematic means.
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http://dx.doi.org/10.3390/antibiotics10111399DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8614939PMC
November 2021

External validation of the Palacios' equation: a simple and accurate tool to estimate the new baseline renal function after renal cancer surgery.

World J Urol 2021 Nov 26. Epub 2021 Nov 26.

Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Aristide Stefani 1, 37126, Verona, Italy.

Purpose: To externally validate the Palacios' equation estimating the new baseline glomerular filtration rate (NB-GFR) after partial or radical-nephrectomy (PN, RN) for Renal cancer carcinoma (RCC).

Materials And Methods: Our research group recently published two studies that investigated the association between renal function and cancer-specific survival in RCC. The first one included 3457 patients undergone RN or PN for a cT1-2 RCC coming from five high-volume centers; the second one considered 1767 patients undergone RN or PN for a cT1-4 RCC in a single high-volume center. From such datasets, available complete patients' data were used to calculate the predicted NB-GFR through the Palacios' equation: predicted NB-GFR = 35.03 + 0.65 ∙ preoperative GFR - 18.19 ∙ (if radical nephrectomy) - 0.25 ∙ age + 2.83 ∙ (if tumor size > 7 cm) - 2.09 ∙ (if diabetes). The observed NB-GFR was calculated by the CKD-EPI equation on serum creatinine at 3-12 months after surgery. Concordance between observed and predicted NB-GFR was evaluated by Lin's concordance correlation coefficient and Bland-Altman analysis.

Results: 2419 patients were included (1210, cohort #1; 1219, cohort #2). The median observed NB-GFR value in cohorts #1 and #2 was 73.0 ml/min/1.73 m (IQR 56.1-90.1) and 64.2 ml/min/1.73 m (IQR 49.6-83); the median predicted NB-GFR was 71.1 ml/min/1.73 m (IQR 58-81.5) and 62.6 ml/min/1.73m (IQR 47.9-75.9). The concordance line showed a slope of 0.80 and 0.86, and an intercept at 11.02 and 5.41 ml/min/1.73 m in the cohort#1 and #2, respectively. The Palacio's equation moderately over-estimated and under-estimated NB-GFR, for values below and above the cut-off of 50 ml/min/1.73 m and 35 ml/min/1.73m in cohort#1 and #2. The Lin's concordance correlation coefficient was 0.79 (95% CI 0.77-0.81) and 0.83 (95% CI 0.82-0.85).

Conclusions: We confirm the predictive performances of Palacios' equation, supporting its utilization in clinical practice.
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http://dx.doi.org/10.1007/s00345-021-03887-zDOI Listing
November 2021

Survival after radical prostatectomy vs. radiation therapy in ductal carcinoma of the prostate.

Int Urol Nephrol 2022 Jan 19;54(1):89-95. Epub 2021 Nov 19.

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.

Aim: To compare cancer-specific mortality (CSM) rates between radical prostatectomy (RP) vs. external beam radiotherapy (RT) in patients with ductal carcinoma (DC) of the prostate.

Materials And Methods: Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2016), we identified 369 DC patients, of whom 303 (82%) vs. 66 (18%) were treated with RP vs. RT, respectively. Kaplan-Meier plots and uni- and stepwise multivariate Cox regression models addressed CSM in the unmatched population. After propensity score matching (PSM) and inverse probability of treatment weighting (IPTW), Kaplan-Meier curve and Cox regression models tested the effect of RP vs RT on CSM.

Results: Overall, RT patients were older, harbored higher PSA values, higher clinical T and higher Gleason grade groups. 5-year CSM rates were respectively 4.2 vs. 10% for RP vs. RT (HR 0.40, 95% CI 0.16-0.99, p = 0.048, favoring RP). At step-by-step multivariate Cox regression, after adding possible confounders, the central tendency of the HR for RP vs. RT approached 1. PSM resulted into 124 vs. 53 patients treated respectively with RP vs. RT. After PSM, as well as after IPTW, the protective effect of RP was no longer present (HR 1.16, 95% CI 0.23-5.73, p = 0.9 and 0.97, 95% CI 0.35-2.66, p = 0.9, respectively).

Conclusions: Although CSM rate of ductal carcinoma RP patients is lower of that of RT patients, this apparent benefit disappears after statistical adjustment for population differences.
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http://dx.doi.org/10.1007/s11255-021-03070-8DOI Listing
January 2022

Bladder cancer histological variants: which parameters could predict the concordance between transurethral resection of bladder tumor and radical cystectomy specimens?

Cent European J Urol 2021 9;74(3):355-361. Epub 2021 Sep 9.

Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy.

Introduction: The concordance rate of bladder cancer (BCa) histological variants (HV) between transurethral resection of bladder tumor (TURBT) and radical cystectomy (RC) is sub-optimal and is unclear which factors may influence it. The aim of this study was to identify factors that may be correlated to a higher TURBT-RC concordance rate.

Material And Methods: Consecutive patients who had undergone RC between 2000 and 2019 at a single Institution with pathological evidence of HV were included. Patients with diagnosis of HV both at RC and at the previous TURBT were enlisted in the TURBT-RC Concordance Group (CG), whereas patients with only evidence of HV at RC in the TURBT-RC Non-Concordance Group (NCG). Surgical factors evaluated were the source of energy (mono- vs bipolar), surgeon's experience (
Results: A total of 81 patients were included, 49 (60.5%) in the CG and 32 (39.5%) in the NCG. Among the surgical factors, maximal core length (MCL) was significantly higher in the CG (12.5 vs 10 mm, p = 0.014) (Table 1). At uni- and multivariable analyses, MCL>10 mm represented an independent predictor of concordance [OR 2.95; CI (1.01-8.61); p = 0.048]. Tumor recurrence, focality and dimension, source of energy, surgeon's experience, performance of re-TURBT and total number of specimens at TURBT did not significantly predict the concordance.

Conclusions: Longer specimens at TURBT yield a higher chance to detect HV before RC. In this light, improving the quality of bladder resection means improving the management of BCa.
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http://dx.doi.org/10.5173/ceju.2021.140.R1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552936PMC
September 2021

Survival after Radical Prostatectomy versus Radiation Therapy in High-Risk and Very High-Risk Prostate Cancer.

J Urol 2022 02 24;207(2):375-384. Epub 2021 Sep 24.

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.

Purpose: Our goal was to compare cancer-specific mortality (CSM) rates between radical prostatectomy (RP) vs external beam radiotherapy (EBRT) in National Comprehensive Cancer Network© (NCCN©) high risk (HR) patients, as well as in Johns Hopkins University (JH) HR and very high risk (VHR) subgroups.

Materials And Methods: Within the Surveillance, Epidemiology, and End Results database (2010-2016), we identified 24,407 NCCN HR patients, of whom 10,300 (42%) vs 14,107 (58%) patients qualified for JH HR vs VHR, respectively. Overall, 9,823 (40%) underwent RP vs 14,584 (60%) EBRT. Cumulative incidence plots and competing-risks regression addressed CSM after 1:1 propensity score matching (according to age, prostate specific antigen, clinical T and N stages, and biopsy Gleason score) between RP and EBRT patients. All analyses addressed the combined NCCN HR cohort, as well as in JH HR and JH VHR subgroups.

Results: In the combined NCCN HR cohort 5-year CSM rates were 2.3% for RP vs 4.1% for EBRT and yielded a multivariate hazard ratio of 0.68 (95% CI 0.54-0.86, p <0.001) favoring RP. In VHR patients 5-year CSM rates were 3.5% for RP vs 6.0% for EBRT, yielding a multivariate hazard ratio of 0.58 (95% CI 0.44-0.77, p <0.001) favoring RP. Conversely, in HR patients no significant difference was recorded between RP vs EBRT (HR 0.7, 95% CI 0.39-1.25, p=0.2).

Conclusions: Our data suggest that RP holds a CSM advantage over EBRT in the combined NCCN HR cohort, and in its subgroup of JH VHR patients.
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http://dx.doi.org/10.1097/JU.0000000000002250DOI Listing
February 2022

The Tomato Model.

Urology 2021 Nov 10;157:280-281. Epub 2021 Aug 10.

Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy.

Objectives: Percutaneous renal access (PCA) is one of the most difficult intervention in endourology. Hands-on training is a useful tool for a good understanding of the puncturing technique, reducing the learning curve, and lowering risks of complications during first procedures. The ideal surgical simulator should efficiently improve trainees' skills, be easily accessible, low-cost, and realistic. We aim to present novel fluoroscopy-guided PCA simulator named TOMATO model.

Materials And Methods: The model can be easily built in few minutes using low-cost items: yoga mat, cotton wool, forceps, needle-driver, scalpel, 0 silk suture, chiba needle, small pebble (1 cm ca) and a few kidney-shaped tomatoes. The yoga mat is fold in half, sutured with silk, placed on the operating table, and thanks to the friction created between the mat and sheet underneath there is no need for other fixating methods. Once placed inside the yoga mat, the tomato is held still in the position by the cotton wool, which is placed around the vegetable. The tomato imitates the real renal structure. Therefore is ideal for this use, and there is no need for liquid-contrast enhancement. The goal is achieved when the operator manages to move the pebble with chiba needle during pulsed fluoroscopy. The model was tested 3 times by 3 endourologists and by 10 residents in training with no experience as first operators. A 7-items questionnaire (1-10 rating scale) was administered to the participants in order to evaluate the utility of the model. Trainees' kidney access time (KAT) and radiation time (RT) were assessed at the first use and after 1 hour of training (circa 15 attempts to reach the target per resident).

Results: The model allowed residents' significant reduction of the KAT and RT. KAT passed from 114 (144.25-89) to 72.5 (97.25-49.5) seconds (P = .04) while RAT passed from 82 (89.75-56) to 51.5 (60.25-35.75) seconds (P < .001). The residents particularly appreciated the high-fidelity reproduction of the anatomy that the model offers, and its' usefulness for learning the puncturing technique, giving it 8.5 and 10 points, while the same items were rated 7.7, and 9.3 by the experts, respectively. Trainees felt that their skills could be improved by using this model. The main issue was finding the materials mimicking the real-life tissues and their different characteristics.

Conclusions: TOMATO model might be a helpful and creative way to start learning the steps of kidney puncturing using low-cost materials and we believe its' strength is being easily reproducible in all urology units.
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http://dx.doi.org/10.1016/j.urology.2021.07.025DOI Listing
November 2021

The possible impact of SARS-COV-2 on neglected tropical diseases in Europe: the out of spotlights emerging of schistosomiasis.

J Prev Med Hyg 2021 Mar 29;62(1):E3-E4. Epub 2021 Apr 29.

Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.

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http://dx.doi.org/10.15167/2421-4248/jpmh2021.62.1.1867DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283622PMC
March 2021

The role of the multi-disciplinary team and multi-disciplinary therapeutic protocol in the management of the chronic pelvic pain: There is strenght in numbers!

Arch Ital Urol Androl 2021 Jun 28;93(2):211-214. Epub 2021 Jun 28.

Department of Urology, San Raffaele Hospital, Milan.

Introduction: The aim of the study is to evaluate the effectiveness of a Multi-disciplinary team (MDT) and multi-disciplinary approach in the treatment of Chronic Pelvic Pain (CPP).

Methods: The data of all consecutive patients referred for a CPP from 11/2016 to 2/2019 has been prospectively collected. The sample was divided in two groups: Group A, made by patients managed after the institution of our MDT, and Group B, made of patients managed before this date. The MDT is composed by three urogynecologists, a psychologist and a physiotherapist. All Group A patients underwent a weekly bladder instillation with dimethyl sulfoxide (DMSO), kinesiotherapy for trigger points and Percutaneous Tibial Nerve Stimulation for 10 consecutive weeks. Patients were asked to perform a self-treatment following the Stanford Protocol and to adhere to a specific diet. All Group B patients were managed only with DMSO instillations and a strict diet.

Results: The Group A was made of 41 females and 6 males while the Group B was made of 38 females and 5 males. The Group A patients showed a statistically significant improvement in the Pelvic Pain Urgency Frequency, in the frequency times reported at the 6 months voiding diary, and a better Patient Global Impression of Improvement.

Conclusions: Our data support the efficacy of the MDT in the management of CPP. The multimodal approach might represent an effective and reproducible non-invasive option to manage successfully CPP.
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http://dx.doi.org/10.4081/aiua.2021.2.211DOI Listing
June 2021

Spinal versus general anesthesia during retrograde intra-renal surgery: A propensity score matching analysis.

Curr Urol 2021 Jun 26;15(2):106-110. Epub 2021 Apr 26.

Department of Surgical and Integrated Diagnostics, University of Genova, Genova, Italy.

Background: The indications for retrograde intra-renal surgery (RIRS) have greatly increased, however, there is still no consensus on the use of spinal anesthesia (SA) during this procedure. The aim of this study was to evaluate the comparability of surgical conditions and outcomes with RIRS performed under SA versus general anesthesia (GA) for renal stones.

Materials And Methods: This was a prospective, observational study in patients scheduled for RIRS in a single teaching hospital in Italy. Inclusion criteria were age >18 years and the presence of single or multiple renal stones. We recorded information concerning the site of lithiasis, the number of calculi, total stone burden, and the presence of concomitant ureteral stones or hydronephrosis. A propensity score-matched analysis was performed to evaluate the results in terms of surgical outcome, intraoperative and postoperative complications, and analgesia demand balanced for confounding factors. Patients were followed-up until day 90 from discharge.

Results: We included 120 patients, the propensity score-matched cohort included 40 patients in the SA and 40 in the GA groups. The stone-free rate was 67.5% in the GA group and 70.0% in the SA group ( = 0.81). The use of auxiliary procedures within 90 days did not differ between groups (25.0% vs. 22.5%,  = 0.79). No cases of conversion from SA to GA were recorded. We did not find any differences in intraoperative bleedings, perforations, and abortions. Complication rates were similar in the 2 groups (10.0% in GA vs. 5.0% in SA,  = 0.64).

Conclusions: In our cohort, RIRS performed under SA and GA was equivalent in terms of surgical results and complications.
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http://dx.doi.org/10.1097/CU9.0000000000000014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8221011PMC
June 2021

Rotterdam mobile phone app including MRI data for the prediction of prostate cancer: A multicenter external validation.

Eur J Surg Oncol 2021 10 30;47(10):2640-2645. Epub 2021 Apr 30.

Department of Urology, Ospedale Sant'Andrea-Università di Roma "Sapienza", Rome, Italy.

Objectives: The Rotterdam Prostate Cancer Risk calculator (RPCRC) has been validated in the past years. Recently a new version including multiparametric magnetic resonance imaging (mpMRI) data has been released. The aim of our study was to analyze the performance of the mpMRI RPCRC app.

Methods: A series of men undergoing prostate biopsies were enrolled in eleven Italian centers. Indications for prostate biopsy included: abnormal Prostate specific antigen levels (PSA>4 ng/ml), abnormal DRE and abnormal mpMRI. Patients' characteristics were recorded. Prostate cancer (PCa) risk and high-grade PCa risk were assessed using the RPCRC app. The performance of the mpMRI RPCRC in the prediction of cancer and high-grade PCa was evaluated using receiver operator characteristics, calibration plots and decision curve analysis.

Results: Overall, 580 patients were enrolled: 404/580 (70%) presented PCa and out of them 224/404 (55%) presented high-grade PCa. In the prediction of cancer, the RC presented good discrimination (AUC = 0.74), poor calibration (p = 0.01) and a clinical net benefit in the range of probabilities between 50 and 90% for the prediction of PCa (Fig. 1). In the prediction of high-grade PCa, the RC presented good discrimination (AUC = 0.79), good calibration (p = 0.48) and a clinical net benefit in the range of probabilities between 20 and 80% (Fig. 1).

Conclusions: The Rotterdam prostate cancer risk App accurately predicts the risk of PCa and particularly high-grade cancer. The clinical net benefit is wide for high-grade cancer and therefore its implementation in clinical practice should be encouraged. Further studies should assess its definitive role in clinical practice.
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http://dx.doi.org/10.1016/j.ejso.2021.04.033DOI Listing
October 2021

Prostate cancer testicular metastasis: Are they underestimated? Case report and analysis of the literature.

Urologia 2021 Apr 8:3915603211009118. Epub 2021 Apr 8.

Department of Urology, San Raffaele Turro Hospital, San Raffaele University, Milan, Italy.

Introduction: We aim to present a rare case of a patient who developed a late testicular metastasis of PCa after radical prostatectomy.

Case Description: A 78 years old man presenting for left testicular swelling slowly increasing of size over the last 2 months. He underwent a retropubic radical prostatectomy and extended bilateral lymphadenectomy in 2007 for prostatic adenocarcinoma. At the time of the presentation the last PSA was 0.91 ng/mL. The patient underwent a standard left orchifunicolectomy in April 2019 without intra- or perioperative complications. The pathological analysis showed a testicular metastasis of acinar adenocarcinoma.

Conclusions: In conclusion, testicular metastasis from PCa are uncommon conditions. PSA evaluation and physical examination of all sites of metastasis and accurate evaluation of all signs/symptoms during the clinical visit remains crucial to the diagnosis of recurrence.
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http://dx.doi.org/10.1177/03915603211009118DOI Listing
April 2021

Age above 70 years and Charlson Comorbidity Index higher than 3 are associated with reduced survival probabilities after radical cystectomy for bladder cancer. Data from a contemporary series of 334 consecutive patients.

Arch Ital Urol Androl 2021 Mar 18;93(1):15-20. Epub 2021 Mar 18.

Department of Urology, IRCCS Policlinico San Martino, University of Genova.

Objective: To assess the joint effect of age and comorbidities on clinical outcomes of radical cystectomy (RC).

Methods: 334 consecutive patients undergoing open RC for bladder cancer (BC) during the years 2005-2015 were analyzed. Pre-, peri- and post-operative parameters, including age at RC (ARC) and Charlson Comorbidity Index (CCI), were evaluated. Overall and cancer-specific survivals (OS, CSS) were assessed by univariate and multivariate modelling. Furthermore, a three-knot restricted cubic spline (RCS) was fitted to survival data to detect dependency between death-rate ratio (HR) and ARC.

Results: Median follow-up time was 3.8 years (IQR = 1.3-7.5) while median OS was 5.9 years (95%CL = 3.8-9.1). Globally, 180 patients died in our cohort (53.8%), 112 of which (62.2%) from BC and 68 patients (37.8%) for unrelated causes. After adjusting for preoperative, pathological and perioperative parameters, patients with CCI > 3 showed significantly higher death rates (HR = 1.61; p = 0.022). The highest death rate was recorded in ARC = 71-76 years (HR = 2.25; p = 0.034). After fitting an RCS to both OS and CSS rates, two overlapping nonlinear trends, with common highest risk values included in ARC = 70-75 years, were observed.

Conclusions: Age over 70 years and CCI > 3 were significant factors limiting the survival of RC and should both be considered when comparing current RC outcomes.
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http://dx.doi.org/10.4081/aiua.2021.1.15DOI Listing
March 2021

Renal infarction in a COVID-19 patient.

Pan Afr Med J 2020 27;37:182. Epub 2020 Oct 27.

Department of Urology, Policlinico San Martino Hospital, University of Genova, Genoa, Italy.

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http://dx.doi.org/10.11604/pamj.2020.37.182.26187DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7778167PMC
October 2020

Sexuality during COVID lockdown: a cross-sectional Italian study among hospital workers and their relatives.

Int J Impot Res 2021 Jan 5;33(1):131-136. Epub 2021 Jan 5.

Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy.

In March 2020, the Italian Government introduced measures to reduce the spread of COVID-19 infection. Between 8th April and 2nd May 2020 we investigated levels and correlates of sexual activity and depression during COVID-19 lockdown in a sample of hospital workers and their acquaintances by an online survey on SurveyMonkey. Socio-demographic data, International Index of Erectile Function, Female Sexual Function Index, and Beck Depression Inventory were recorded. Multivariable logistic regression analysis (MLRA) was used to test predictors of depressive symptoms and low sexual desire and satisfaction. A statistically significant difference in age, change in working habit, sexual satisfaction, sexual desire, and depressive symptoms was found between males and females. A statistically significant higher proportion of health care workers had low sexual desire (65.3% vs 56.8%, p = 0.042). At MLRA, age, being female, being a health care worker, having children at home, living with the partner, and having low sexual satisfaction were predictors of low level of sexual desire. To our knowledge, this is one of the few studies using validated questionnaires for both males and females to assess sexual well-being and psychometric alterations during COVID quarantine.
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http://dx.doi.org/10.1038/s41443-020-00393-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7782561PMC
January 2021

Outcomes and costs analysis of Externalized PyeloUreteral versus internal Double-J ureteral stents after paediatric laparoscopic Anderson-Hynes pyeloplasty.

J Pediatr Urol 2021 04 8;17(2):232.e1-232.e7. Epub 2020 Dec 8.

Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom; Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health. Electronic address:

Background: The gold standard treatment for Uretero-Pelvic Junction Obstruction (UPJO) is laparoscopic dismembered pyeloplasty according to the Anderson-Hynes technique. The internal Double-J ureteral (DJ) and the Externalized PyeloUreteral (EPU) stents are usually the drainage of choice. Only a few articles have compared the clinical impact of the different drainage techniques on the perioperative morbidity and none presented a cost analysis of the incurred hospital stay.

Objective: To present the clinical outcome and financial analysis of a cohort of children who underwent a laparoscopic pyeloplasty comparing the use of the DJ versus EPU stent.

Study Design: Retrospective study of consecutives children who underwent laparoscopic Anderson-Hynes pyeloplasty in a single tertiary paediatric referral centre from January 2017 to March 2020. Patients were grouped according to the type of stent used: DJ stent vs EPU stent.

Results: Fifty-three laparoscopic pyeloplasties were performed on 51 patients: 27 (50.9%) had an EPU stent and 26 (49.1%) a DJ stent. There was no statistically significant difference between the two patient groups with regards to surgical time, hospital stay, stent-related complications or the need for re-do surgery. All the EPU stents were removed with an outpatient admission 8.1 days ± 3.1 after surgery while the DJ stents were removed with a cystoscopy 61.6 days ± 30.2 after surgery (p value < 0.001). On a financial analysis (Figure), the hospital costs for stent removal were significantly lower for the EPU stent group (£ 686.7 ± 263.4 vs £ 1425 ± 299.5, p value < 0.01).

Discussion: Both drainage methods have some disadvantages. Possible complications associated with DJ stents include migration and artificial vesicoureteral reflux which may lead to higher incidence of Urinary Tract Infections. Possible disadvantages of the EPU stent insertion are related to the damage of the renal parenchyma and to the risk of developing skin site infections and urinary leaks. However, in our series the EPU stent has not been associated with a higher incidence of bleeding, leakage or discomfort. In addition to clinical considerations, there is a financial implication to be considered. With this regard, the EPU stent was associated with a significant reduction in the incurred hospital costs.

Conclusions: The use of DJ and EPU stents is equivalent in regards of overall complications and success rates. DJ and EPU stents provided comparable success and complication rates, however the latter avoids the need of an additional general anaesthesia and reduces the overall incurred hospital costs.
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http://dx.doi.org/10.1016/j.jpurol.2020.12.006DOI Listing
April 2021

Complications of endourological procedures and their treatment.

Arch Ital Urol Androl 2020 Dec 18;92(4). Epub 2020 Dec 18.

Department of Urology, Policlinico San Martino Hospital, University of Genova.

Endourological treatment for urinary stones and other obstructive urinary tract diseases is minimally invasive but in some cases it involves serious complications. This collection of cases describes some complications of endourological procedures and how they were treated. Case 1: A case of right ultrasound-guided percutaneous nephrostomy found to be misplaced in the inferior vena cava. The case was safely managed, but it showed that ultrasound guidance alone may be insufficient so it is recommended that percutaneous nephrostomy should be always placed under fluoroscopic control, either alone or in combination with ultrasound guidance. Case 2: A case of renal subcapsular hematoma occurring on retrograde intrarenal surgery at high perfusion pressure. The hematoma was drained under combined ultrasonic and radiological guidance. Post treatment recovery was uneventful. Large stone size, severe ipsilateral hydronephrosis, long operation time, higher hydrostatic pressure of the irrigating solution and low ureteral wall compliance are supposed to be risks factors associated with renal subcapsular formation. Management strategy should be tailored to patient's clinical conditions. In hemodynamically stable patients, large hematoma drainage is recommended to prevent further complications and favours early recovery. Case 3: A case of double J stent fracture discovered one month after the insertion to relieve obstruction from a 1 cm stone in the right proximal ureter. The distal fragment of the stent was removed by cystoscopy while the proximal fragment was removed by semirigid ureteroscopy in two sessions due to fever and extensive calcification. Case 4: A mini-invasive technique for transurethral replacement of completely encrusted urinary stents in female patients. This technique allows the interventional radiologist to replace obstructed urinary stents by avoiding more invasive and traumatic urological procedures with sedation.
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http://dx.doi.org/10.4081/aiua.2020.4.321DOI Listing
December 2020

Non-COVID-19 admissions to the emergency department during the pandemic second wave in Italy: What is changed from the first wave?

Am J Emerg Med 2021 07 26;45:625-626. Epub 2020 Nov 26.

Division of Anesthesia and Intensive Care, San Martino Policlinic Hospital, IRCCS for Oncology, Genoa, Italy.

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http://dx.doi.org/10.1016/j.ajem.2020.11.046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690299PMC
July 2021

Bladder Cancer and Associated Risk Factors: The African Panorama.

Eur Urol 2021 05 4;79(5):568-570. Epub 2020 Dec 4.

Department of Urology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa.

The African continent is unique in terms of its epidemiological evidence, causes, and possible future trends for bladder cancer (BCa). Factors include smoking rates and parasitic infection with Schistosoma haematobium. These issues in Africa could be addressed by increasing cultural awareness of BCa causes and symptoms via social media, banning smoking in public places, and ensuring that praziquantel is readily available in areas at high risk of schistosomiasis.
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http://dx.doi.org/10.1016/j.eururo.2020.11.041DOI Listing
May 2021

Comparison of Safety, Efficacy and Outcomes of Robot Assisted Laparoscopic Pyeloplasty vs Conventional Laparoscopy.

Res Rep Urol 2020 10;12:555-562. Epub 2020 Nov 10.

Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy.

Pyeloplasty is considered the gold standard for the management of ureteropelvic junction obstruction in cases of flank pain, recurrent stone formation or infection, and deteriorating renal function. Over the last two decades, minimally invasive techniques such as robotic (RALP) and laparoscopic pyeloplasty (LP) have become increasingly popular and have been moderately replacing the open approach. This paper aims to provide a comprehensive up-to-date review on safety, efficacy and outcomes regarding robotic repair of UPJO compared to the conventional laparoscopic procedure. RALP represents a viable and innovative alternative to conventional LP with a comparable success and complication rate both in adult and in paediatric fields. The robotic approach seems to add further technical advantages when compared to conventional LP but sustains a higher costs. Currently, the choice to adopt one of the different minimally invasive approaches depends on the surgeon's preference or experience, and on institutional availability.
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http://dx.doi.org/10.2147/RRU.S238823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667144PMC
November 2020

Urology apps: overview of current types and use.

Cent European J Urol 2020 7;73(3):369-372. Epub 2020 Aug 7.

Department of Urology, Policlinico San Martino Hospital, University of Genova, Italy.

Introduction: In recent years numerous applications have been developed with different purposes, aimed both at simplifying the lives of doctors and patients also within the urological field.

Material And Methods: In January 2020 we conducted a search in the Apple App Store and Google Play Store.

Results: A total of 521 apps were reviewed, an increase of 8 times as compared to the last complete available review of eight years ago. Most of the urological apps are geared towards the patient and provide information and services to improve the understanding and treatment of different diseases. Some of these apps also get the patient directly in touch with healthcare staff allowing for an improvement in doctor-patient communication.

Conclusions: Although the usefulness of many of these tools is undoubted, the problem of scientific validation, content control and privacy are not yet solved.
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http://dx.doi.org/10.5173/ceju.2020.0090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7587494PMC
August 2020

Prepuce-sparing corporoplasty as a safe alternative for patients with acquired penile curvature.

Arch Ital Urol Androl 2020 Oct 1;92(3). Epub 2020 Oct 1.

Department of Urology, Policlinico San Martino Hospital, University of Genoa.

Objectives: penile curvature is a rare condition, classified as congenital or acquired (Peyronie's disease) (PD). Surgical correction is the standard treatment. It's common practice to associate circumcision with penile de-gloving to prevent complications. In this paper we evaluate the feasibility of penile surgery avoiding circumcision.

Materials And Methods: patients presenting with penile curvature were treated using a modified Nesbit procedure. Patients were divided into group A if they opted for a prepuce-sparing surgery and the others into group B. Patients were evaluated pre and postoperatively and postoperative complications were assessed. The 5-item International Index of Erectile Function (IIEF-5) was administered before and 6 months after surgery and we compared the difference of mean value using T-Test.

Results: Group A and B were made of 53 and 16 patients respectively. Median age was 59 years [interquartile range (IQR) 12] in A and 62 (IQR 9) in B (p = 0.2). Median curvature was 40° (IQR 40°) in A and 40 ° (IQR 30°) in B (p = 0.62). Mean difference between pre- and post-operative IEFF was 1.9 ± 2 in A and 2.6 ± 2.1 in B (p = 0.36).

Conclusions: According to our experience, surgical correction of penile curvature without performing circumcision could be a safe and feasible strategy. We recommend performing circumcision only in patients who present with pre-operative phimosis.
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http://dx.doi.org/10.4081/aiua.2020.3.182DOI Listing
October 2020

Prone versus supine percutaneous nephrolithotomy: a systematic review and meta-analysis of current literature.

Minerva Urol Nephrol 2021 02 5;73(1):50-58. Epub 2020 Oct 5.

Department of Urology, Campus Bio-Medico University, Rome, Italy.

Introduction: Percutaneous nephrolithotomy (PNL) can be performed either in prone or supine position. This study aimed at gathering together randomized controlled trials (RCTs) comparing efficacy and safety between prone and supine PNL.

Evidence Acquisition: Systematic review of literature was conducted using the Scopus, Medline and Web of Science databases. Study selection, data extraction and quality assessment were independently assessed by two authors. Meta-analysis was performed with Review Manager 5.3. Sensitivity analyses were performed to exclude studies with high risk of bias.

Evidence Synthesis: Pooled data from 12 studies including 1290 patients were available for analysis. Only one study was found to have overall low risk of bias. Significantly shorter operative time was found in favor of supine PNL (mean difference 13 minutes, 95% confidence interval [CI]: 3.4-22.7; P<0.01). Stone-free rate (SFR)≥14 days after surgery was significantly higher in prone PNL (odds ratio [OR]=2.15, 95% CI: 1.07-4.34; P=0.03). Significantly higher fever rate was found in prone PNL (OR=1.60, 95% CI: 1.03-2.47; P=0.04). Overall SFR, hospital stay length, complications rate, transfusions rate and blood loss, as well as non-lower calyx puncture rate, puncture attempts and tubeless intervention rate did not differ between prone and supine PNL (P>0.05).

Conclusions: Efficacy of PNL seems balanced between prone and supine position, with comparable overall SFR and shorter operative time in favor of supine PNL. Safety of PNL appears in favor of supine PNL, with lower fever rate. Because of study heterogeneity and possible risks of outcome bias, results from this study should be interpreted with caution. Altogether, both prone and supine PNL account for appropriate therapy options.
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http://dx.doi.org/10.23736/S2724-6051.20.03960-0DOI Listing
February 2021

An invited commentary on "day care surgery versus inpatient percutaneous nephrolithotomy: A systematic review and meta-analysis." (international journal of surgery 2020; epub ahead of print).

Int J Surg 2020 11 25;83:154-155. Epub 2020 Sep 25.

Department of Urology, Policlinico San Martino Hospital, University of Genova, Italy.

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http://dx.doi.org/10.1016/j.ijsu.2020.09.036DOI Listing
November 2020

Knowledge gap across continents: the andrology and male infertility exposure among urology residents in the United States and Europe.

Int J Impot Res 2021 Sep 21;33(6):603-610. Epub 2020 Aug 21.

Department of Urology, University of Illinois at Chicago, Chicago, USA.

It is well established that resident's exposure and training are of primary importance and positively correlated with patient and health quality outcomes. We aimed to compare and contrast urology residents' self-reported perspectives and attitudes toward exposure and education of andrology and male infertility during residency in both the United States and Europe. We performed a cross-sectional design study using a survey that was distributed to a representative sample of American and European urology residents. The survey included questions regarding demographics, and the residents' perception and description of their training in this specific subspecialty. Response data were analyzed using Chi-square tests. Sixty-five percent of European and thirty-five percent American urology residents reported feeling uncomfortable in a new consultation evaluating an infertile patient and interpreting semen analyses. Surprisingly, more than half of responders replied that they would not go to their own training institutions seeking for male fertility care (78% US and 58% Europeans). In the comparative analysis, although no differences were observed in the very low number (18%) of hospitals that offer formal microsurgical training for urology residents between the US and Europe, more US institutions were reported to have an operating microscope for urology (68% vs. 41%), and more US residents replied reported participating in at least one urologic surgery using the microscope (65% vs. 34%). In conclusion, both American and European residents shared the same frustration regarding their education and exposure to andrology and male infertility during residency training. Collaborative efforts between stakeholders are needed to establish a clear and focused curriculum and training objectives to eliminate this educational gap.
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http://dx.doi.org/10.1038/s41443-020-00342-2DOI Listing
September 2021

Simulator Availability Index: a novel easy indicator to track training trends. Is Europe currently at a urological training recession risk?

Cent European J Urol 2020 6;73(2):231-233. Epub 2020 Apr 6.

ESUT-YAU Working Party.

Introduction: To evaluate the European trend regarding the availability of surgical simulators and to propose a novel index to easily track this trend.

Material And Methods: During European Urology Residents Education Program, from 2014 to 2018, residents were asked through an anonymous survey about the availability of specific simulator training boxes at their department. The Simulator Availability Index (SAI) was made by the ratio between the number of departments with at least one box trainer and the total number of departments evaluated.

Results: The SAI decreased in five years from 0.47 to 0.41 for laparoscopic trainers, while the already low initial SAI (0.17) decreased by up to 0.05 in four years for both ureteroscopy (URS) and transurethral resection (TUR) trainers.

Conclusions: A self-analysis may be advisable in order to improve the spread of information and investigate whether any specific reasons may be responsible for this trend. The SAI might be a simple but useful tool to monitor and evaluate this trend in the context of national training plans.
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http://dx.doi.org/10.5173/ceju.2020.0048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7407789PMC
April 2020
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