Publications by authors named "Massimiliano Poggio"

18 Publications

  • Page 1 of 1

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

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

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

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

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

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

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

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

Eur Urol 2021 Nov 16. Epub 2021 Nov 16.

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

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

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

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

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

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

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

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

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

Prostate cancer management at an Italian tertiary referral center: does multidisciplinary team meeting influence diagnostic and therapeutic decision-making process? A snapshot of the everyday clinical practice.

Minerva Urol Nefrol 2019 Dec 4;71(6):576-582. Epub 2019 Sep 4.

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

Background: Multidisciplinary team (MDT) management decision-making process appears as an interesting tool to answer most aspects of prostate cancer (PCa) diagnosis and treatment, allowing a fairer choice of therapies. The aim of this study to prospectively investigate the impact on prostate cancer clinical management of the uro-oncology MDT meeting at an Italian tertiary referral center.

Methods: All cases discussed over an 18-months period at San Luigi Hospital uro-oncology MDT were prospectively evaluated for the impact of the MDT discussion on PCa clinical decision-making. Dilemma and management plan in the monodisciplinary visit before and/or after primary treatment were recorded. Subsequently, the MDT discussed the case and reached a consensus decision, which was also recorded. Changes in diagnostic assessment and patient management from pre- to post-MDT meeting were evaluated by a consultant urologist.

Results: Overall, 201 patients, of which 99, 81 and 21 with local, advanced and metastatic disease respectively, were selected for MDT evaluation. The most frequent reasons for MDT approach after either PCa diagnosis or primary treatment were metastatic disease or locally advanced disease/positive surgical margins/biochemical recurrence, respectively. Patients with local, advanced and metastatic disease had a significative change of diagnostic/therapeutic management in 23.2%, 46.9% and 33.4%, respectively (P<0.001). Multimodal treatment was recommended in 25.3%.

Conclusions: The uro-oncology MDT meeting alters management plans in at least one-quarter of patients reaching almost 50% of cases in locally advanced disease.
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http://dx.doi.org/10.23736/S0393-2249.19.03231-4DOI Listing
December 2019

[Ureteroscopy: is it the best?].

Urologia 2014 Apr-Jun;81(2):99-107. Epub 2014 Jun 10.

Divisione di Urologia, Dipartimento di Oncologia, Ospedale San Luigi Gonzaga, Orbassano (TO) - Italy.

Over the last 40 years the treatment of urolithiasis passed from open surgical therapies to minimally invasive approaches. From the introduction of the first ureteroscopes in '80s many technological improvements allowed to reduce endourological instruments' size, ensuring in the meanwhile an increasingly high success rate in the resolution of the urolithiasis. The purpose of the study is to review the current role of the ureteroscopy(URS) in the treatment of urinary stones. A non-systematic review was performed considering the most recent Guidelines and results from Literature. The results confirm that, considering ureteral calculi, the stone-free rate (SFR) for URS is significantly higher than for ESWL in the treatment of distal ureteral stones <10 mm and >10 mm. Endoscopy has a first-line role also in the treatment of proximal ureteral stones >10 mm, together with ESWL. Retreatment rate and ancillary procedures are also lower in patients treated with URS, despite it is more invasive if compared with ESWL. Recent data are available in Literature about the treatment of nephrolithiasis with Retrograde Intra-Renal Surgery (RIRS). RIRS is the first-line treatment, together with ESWL, for stones <20 mm, and second choice for stones >20 mm. However, for large renal stones the role of RIRS is still being discussed. In conclusion, the majority of urinary stones can be treated by rigid or flexible URS. Further studies are required to clarify the role of endoscopy in the treatment of large stones, especially if compared to percutaneous approaches.
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http://dx.doi.org/10.5301/uro.5000076DOI Listing
September 2015

Effects of serum testosterone levels after 6 months of androgen deprivation therapy on the outcome of patients with prostate cancer.

Clin Genitourin Cancer 2013 Sep 23;11(3):325-330.e1. Epub 2013 Mar 23.

Medical Oncology, Department of Oncology, Università degli Studi di Torino, Turin, Italy.

Background: Controversy exists about whether testosterone serum levels at a cutoff point of < 50 ng/dL during luteinizing hormone-releasing hormone analogue (LHRHA) treatment are related to the outcome of patients with prostate cancer. We assessed the relationship between serum testosterone levels after 6 months of LHRHA therapy and disease outcome in a consecutive series of patients with prostate cancer.

Patients And Methods: Serum testosterone levels were measured prospectively in a cohort of patients given LHRHA for 6 months. End points were time to progression (TTP) and overall survival (OS).

Results: The study population was 153 patients: 54 with metastatic disease and 99 with biochemical failure. In multivariate analysis, adjustment for age, baseline serum prostatic specific antigen (PSA) levels, Gleason score, and disease stage, testosterone levels < 50 ng/dL failed to be associated with TTP and OS. A cutoff of < 20 ng/dL was associated with a nonsignificant lower risk of progression (adjusted hazard ratio [HR] 0.58; 95% confidence interval [CI] 0.30-1.15; P = .12) and a significant lower risk of death (adjusted HR, 0.19; 95% CI, 0.04-0.76; P = .02). Only 25 patients attained serum testosterone levels < 20 ng/dL. Using a receiver operating characteristic curve (ROC), we found that a testosterone value of 30 ng/dL offered the best overall sensitivity and specificity for prediction of death. Serum testosterone levels < 30 ng/mL were associated with a significantly lower risk of death (adjusted HR, 0.45; 95% CI, 0.22-0.94; P = .034.

Conclusions: Serum testosterone levels lower than the currently adopted cutoff of 50 ng/dL have a prognostic role in patients with prostate cancer receiving LHRHA and are a promising surrogate parameter of LHRHA efficacy.
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http://dx.doi.org/10.1016/j.clgc.2013.01.002DOI Listing
September 2013

Randomised controlled trial comparing laparoscopic and robot-assisted radical prostatectomy.

Eur Urol 2013 Apr 20;63(4):606-14. Epub 2012 Jul 20.

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

Background: The advantages of robot-assisted radical prostatectomy (RARP) over laparoscopic radical prostatectomy (LRP) have rarely been investigated in randomised controlled trials.

Objective: To compare RARP and LRP in terms of the functional, perioperative, and oncologic outcomes. The main end point of the study was changes in continence 3 mo after surgery.

Design, Setting, And Participants: From January 2010 to January 2011, 120 patients with organ-confined prostate cancer were enrolled and randomly assigned (using a randomisation plan) to one of two groups based on surgical approach: the RARP group and the LRP group.

Intervention: All RARP and LRP interventions were performed with the same technique by the same single surgeon.

Outcome Measurements And Statistical Analysis: The demographic, perioperative, and pathologic results, such as the complications and prostate-specific antigen (PSA) measurements, were recorded and compared. Continence was evaluated at the time of catheter removal and 48 h later, and continence and potency were evaluated after 1, 3, 6, and 12 mo. The student t test, Mann-Whitney test, χ(2) test, Pearson χ(2) test, and multiple regression analysis were used for statistics.

Results And Limitations: The two groups (RARP: n=60; LRP: n=60) were comparable in terms of demographic data. No differences were recorded in terms of perioperative and pathologic results, complication rate, or PSA measurements. The continence rate was higher in the RARP group at every time point: Continence after 3 mo was 80% in the RARP group and 61.6% in the LRP group (p=0.044), and after 1 yr, the continence rate was 95.0% and 83.3%, respectively (p=0.042). Among preoperative potent patients treated with nerve-sparing techniques, the rate of erection recovery was 80.0% and 54.2%, respectively (p=0.020). The limitations included the small number of patients.

Conclusions: RARP provided better functional results in terms of the recovery of continence and potency. Further studies are needed to confirm our results.
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http://dx.doi.org/10.1016/j.eururo.2012.07.007DOI Listing
April 2013

Surgical margin status of specimen and oncological outcomes after laparoscopic radical prostatectomy: experience after 400 procedures.

World J Urol 2012 Apr 23;30(2):245-50. Epub 2011 Jun 23.

Division of Urology, Department of Clinical and Biological Sciences, University of Turin, "San Luigi" Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy.

Purpose: To analyse the surgical margins status of prostatic glands, resected by laparoscopic radical prostatectomy (LRP) for prostate cancer, and to correlate it with biochemical free survival rate (BFSR).

Methods: Data were collected prospectively from 405 patients undergoing LRP from 2000 to 2009 at a single institution. Patients undergoing neoadjuvant and/or adjuvant therapy were excluded from the study. Three hundred patients matched all the criteria: 232 of these had negative surgical margins (NSM) and 68 positive surgical margins (PSM). The median follow-up was 62 months. PSM were classified based on the following: (a) the number of margins, monofocal and multifocal, (b) the location, apical or non-apical and (c) the extension, ≤2.8 mm or >2.8 mm. These data were then entered into a multivariate analysis.

Results: Overall BFSR rate was 67.6% in PSM group and 88.8% in NSM group (P < 0.001). We registered a HR of 3.78 in multivariate analysis (P < 0.001). In terms of the extension, BFSR in univariate survival analysis was 77.8% in ≤2.8 mm PSM and 38.9% in >2.8 mm PSM (P = 0.003), with a HR of 5.68 (P = 0.011) in multivariate analysis. BFSR was 59% for apical margins and 77% for non-apical margins (P = 0.038). In monofocal margins, BFSR was 73%, while 53% in multifocal (P = 0.014).

Conclusions: We recommend careful evaluation of patients with PSM following LRP, especially if they are more than 2.8 mm, and in these cases, adjuvant therapy should be considered after radical surgery.
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http://dx.doi.org/10.1007/s00345-011-0711-2DOI Listing
April 2012

Endoscopic combined intrarenal surgery for high burden renal stones.

Arch Ital Urol Androl 2010 Mar;82(1):41-2

Department of Urology, San Luigi University Hospital, Orbassano, Torino, Italy.

"High burden stones" include single or multiple large calculi (altogether surface area > 300 mm 2, or largest diameter > 20 mm), and staghorn calculi (any branched stone occupying more than one portion of the renal collecting system, i.e. pelvis with one or more calyceal extensions). Since clinically threatening, their active removal is mandatory. All updated guidelines recommend four modalities as potential treatment for large/staghorn urolithiasis, including PNL monotherapy, ESWL monotherapy, combinations of PNL and ESWL, and open surgery. The technical enhancement and increasing spread of PNL, ESWL and ureteroscopy in the past twenty years has led to displacement of the surgical therapy of renoureteral calculi in the daily urological practice (nowadays 1-5.4% of cases in developed countries and in well-equipped, dedicated centres), but open or laparoscopic management of urolithiasis is still a viable option that should be considered in few, highly selected circumstances. Currently, PNL is the preferred first-line, minimally invasive treatment for complete one-step removal of high burden urolithiasis. It has been suggested that two or more access sites may be required for complete clearance, yet implying greater blood loss. The use of single-tract PNL with adjuvant procedures such as flexible ureteroscopy/nephroscopy may decrease the disadvantages of the multiple-tract PNL without compromising on stone-free rates. ECIRS (= endoscopic combined intrarenal surgery) is a new, versatile approach for the treatment of large and/or complex urolithiasis. Combining the anterograde and retrograde approach to the renal cavities, ECIRS allows the combined use of all the rigid and flexible endourological armamentarium, and optimal endovision percutaneous renal puncture, preliminary evaluation of renal stones features, negligible need of multiple percutaneous accesses, immediate treatment of concomitant ureteral calculi or ureteropyelic junction stenoses; final visual control of the stone-free status. ECIRS is usually performed in the Galdakao-modified supine Valdivia position, the only patient position supporting this comprehensive attitude of the urologist towards upper urinary tract pathologies. Optimal planning of a safe and effective ECIRS procedure also benefits from an accurate preliminary three-dimensional study by means of tomography urography of the pelvicalyceal anatomy (which is complex and often highly variable) and of the stone features (site, number, size).
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March 2010

The patient position for PNL: does it matter?

Arch Ital Urol Androl 2010 Mar;82(1):30-1

Department of Urology, San Luigi University Hospital, Orbassano, Torino, Italy.

Currently, PNL is the treatment of choice for large and/or otherwise complex urolithiasis. PNL was initially performed with the patient in a supine-oblique position, but later on the prone position became the conventional one for habit and handiness. The prone position provides a larger area for percutaneous renal access, a wider space for instrument manipulation, and a claimed lower risk of splanchnic injury. Nonetheless, it implies important anaesthesiological risks, including circulatory, haemodynamic, and ventilatory difficulties; need of several nurses to be present for intraoperative changes of the decubitus in case of simultaneous retrograde instrumentation of the ureter, implying evident risks related to pressure points; an increased radiological hazard to the urologist's hands; patient discomfort. To overcome these drawbacks, various safe and effective changes in patient positioning for PNL have been proposed over the years, including the reverse lithotomy position, the prone split-leg position, the lateral decubitus, the supine position, and the Galdakao-modified supine Valdivia (GMSV) position. Among these, the GMSV position is safe and effective, and seems profitable and ergonomic. It allows optimal cardiopulmonary control during general anaesthesia; an easy puncture of the kidney; a reduced risk of colonic injury; simultaneous antero-retrograde approach to the renal cavities (PNL and retrograde ureteroscopy = ECIRS, Endoscopic Combined IntraRenal Surgery), with no need of intraoperative repositioning of the anaesthetized patient, less need for nurses in the operating room, less occupational risk due to shifting of heavy loads, less risk of pressure injuries related to inaccurate repositioning, and reduced duration of the procedure; facilitated spontaneous evacuation of stone fragments; a comfortable sitting position and a restrained X-ray exposure of the hands for the urologist. But, first of all, GMSV position fully supports a new comprehensive attitude of the urologist towards a variety of upper urinary tract pathologies, facing them with a rich armamentarium of rigid and flexible endoscopes and a versatile antero-retrograde approach. Prone position may still be useful in case of important vertebral malformations, specifically hindering the supine position, or for simultaneous bilateral PNL, without having to move the patient intraoperatively, so is still present in the complementary techniques of a skilled endourologist.
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March 2010

Prognostic role of neuroendocrine differentiation in prostate cancer, putting together the pieces of the puzzle.

Open Access J Urol 2010 Jul 23;2:109-24. Epub 2010 Jul 23.

Oncologia Medica, Università di Torino, Azienda Ospedaliero Universitaria San Luigi, Orbassano, Italy.

Neuroendocrine (NE) differentiation is a common feature in prostate cancer (PC). The clinical significance of this phenomenon is controversial; however preclinical and clinical data are in favor of an association with poor prognosis and early onset of a castrate resistant status. NE PC cells do not proliferate, but they can stimulate the proliferation of the exocrine component through the production of paracrine growth factors. The same paracrine signals may favor the outgrowth of castrate adapted tumors through androgen receptor dependent or independent mechanisms. Noteworthy, NE differentiation in PC is not a stable phenotype, being stimulated by several agents including androgen deprivation therapy, radiation therapy, and chemotherapy. The proportion of NE positive PC, therefore, is destined to increase during the natural history of the disease. This may complicate the assessment of the prognostic significance of this phenomenon. The majority of clinical studies have shown a significant correlation between NE differentiation and disease prognosis, confirming the preclinical rationale. In conclusion the NE phenotype is a prognostic parameter in PC. Whether this phenomenon is a pure prognostic factor or whether it can influence the prognosis by favoring the onset of a castrate resistance status is a matter of future research.
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http://dx.doi.org/10.2147/rru.s6573DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3818883PMC
July 2010

Treatment of the pyelocalyceal tumors with laser.

Arch Esp Urol 2008 Nov;61(9):1080-7

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

Transitional cell carcinoma of the upper urinary tract (UUT-TCC) is relatively uncommon, accounting for 2-5% of all urothelial tumors. Its incidence appears to be increasing as a result of progress in imaging, endoscopy, and improved survival from bladder cancer. Renal pelvis tumors represent 10% of all renal cancers. Pyelic neoplasms occur at a rate twice to four times the incidence of tumors in the ureter, where the common site is the distal tract (about 70%). One third of UUT-TCC ore multifocal, and about 1% are simultaneous and bilateral. The introduction of lasers represented a big step in the diagnosis and endoscopic treatment of upper urinary tract tumors. A successful laser treatment is defined by the careful selection of the patients affected by urinary tract lesions. Usually, only patients affected by low grade and papillary lesion should be treated endoscopically with laser. Patients with high grade and invasive lesions should rather be submitted to surgical procedure. Actually, the urologist has a wide choice in laser technology (Holmium laser, Thulium laser). For a correct and safe treatment of ureteral and pyelic lesions with lasers it is mandatory to respect some technical advises. First of all, an adequate access for a good vision of ureter and renal pelvis is imperative. In fact, the urologist should always work in safety, with an optimal control of the instrumentation. Then, it is important to define the laser type and its energy level. The development in laser technology (i.e. small and flexible laser fibers) allows also a radical, safe and minimally invasive treatment of urothelial lesions using flexible ureteroscopes. Of course it is mandatory to evaluate the grade and stage of the tumors by means of the ureteroscopic biopsies: invasive tumors must be treated by immediate nephroureterectomy while the endoscopic treatment should be reserved to those patients with a solitary kidney, renal failure, bilateral tumors, severe comorbities or affected by a solitary tumors with <15 mm in diameter and of low-grade/stage.
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http://dx.doi.org/10.4321/s0004-06142008000900018DOI Listing
November 2008

Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy?

Eur Urol 2008 Dec 8;54(6):1393-403. Epub 2008 Aug 8.

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

Background: Percutaneous nephrolithotomy (PCNL), the gold standard for the management of large and/or complex urolithiasis, is conventionally performed with the patient in the prone position, which has several drawbacks. Of the various changes in patient positioning proposed over the years, the Galdakao-modified supine Valdivia (GMSV) position seems the most beneficial. It allows simultaneous performance of PCNL and retrograde ureteroscopy (ECIRS, Endoscopic Combined Intra-Renal Surgery) and has unquestionable anaesthesiological advantages.

Objective: To prospectively analyse the safety and efficacy of endoscopic combined intrarenal surgery (ECIRS) in GMSV position for the treatment of large and/or complex urolithiasis.

Design, Setting, And Participants: From April 2004 to December 2007, 127 consecutive patients who were followed in our department for large and/or complex urolithiasis were selected for surgery (American Society of Anesthesiologists [ASA] score 1-3, no active urinary tract infection [UTI], any body mass index [BMI]).

Intervention: All the patients underwent ECIRS in GMSV position. Technical choices about percutaneous access, endoscopic instruments and accessories, and postoperative renal and ureteral drainage are detailed.

Measurements: Patients' mean age plus or minus standard deviation (+/- SD) was 53.1 yr+/-14.2. Of the 127 patients, 5.5% had congenital renal abnormalities, 3.9% had solitary kidneys, and 60.6% were symptomatic for renal colics, haematuria, and recurrent UTI. Mean stone size+/-SD was 23.8mm+/-7.3 (range: 11-40); 33.8% of the calculi were calyceal, 33.1% were pelvic, 33.1% were multiple or staghorn, and 4.7% were also ureteral.

Results And Limitations: Mean operative time+/-SD was 70min+/-28, including patient positioning. Stone-free rate was 81.9% after the first treatment and was 87.4% after a second early treatment using the same percutaneous access during the same hospital stay (mean+/-SD: 5.1 d+/-2.9). We registered overall complications at 38.6% with no splanchnic injuries or deaths and no perioperative anaesthesiological problems.

Conclusions: ECIRS performed in GMSV position seems to be a safe, effective, and versatile procedure with a high one-step stone-free rate, unquestionable anaesthesiological advantages, and no additional procedure-related complications.
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http://dx.doi.org/10.1016/j.eururo.2008.07.073DOI Listing
December 2008

Changes in prostate cancer at radical prostatectomy during the prostate specific antigen era: an Italian experience.

Anal Quant Cytol Histol 2008 Jun;30(3):152-9

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

Objective: To assess changes in prostate cancer clinical and pathologic features by review of 15 years' experience with radical prostatectomy.

Study Design: A total of 596 consecutive patients who underwent open or laparoscopic radical prostatectomy (RP) between 1991 and 2006 were included. All had clinically localized prostate cancer. Surgical specimens were analyzed or blindly reviewed by a uropathologist, and whole-mount sections were prepared. Statistical analysis evaluated whether significant changes in clinical and pathologic variables occurred over time.

Results: Median prostate specific antigen (PSA) values at diagnosis significantly decreased over time. Definite stage migration was observed, with significant increase of organ-confined tumors. Incidence of seminal vesicle and lymph node involvement declined steadily. Median tumor volume decreased significantly over time (p<0.001). Incidence of nonsignificant cancers at RP increased significantly, reaching 25.6% in 2006. PSA value has progressively lost correlation with prostate cancer volume and today correlates only with prostate gland volume.

Conclusion: Prostate cancer stage and volume at diagnosis have steadily decreased in the last 15 years, likely reflecting increasing use of PSA testing. In early prostate cancer, PSA level no longer correlates with tumor volume.
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June 2008

Feasibility of 21-day continuous infusion of epirubicin in hormone-refractory prostate cancer patients.

Anticancer Res 2005 Nov-Dec;25(6C):4475-9

Gruppo Onco-Urologico Piemontese, Oncologia Medica, Departimento di Scienze Cliniche e Biologiche, Università di Torino, Azienda Ospedaliera San Luigi, Orbassano, Italy.

Background: Epirubicin (EPX) has been found to be active in hormone-refractory prostate cancer (HRPC) patients. Prolonged EPX infusion has never been investigated in this patient subset.

Patients And Methods: A feasibility study was conducted in which EPX was administered in 21-day continuous infusion to 15 patients with HRPC. The EPX dose was 5 mg/m2 daily for 21 consecutive days (one course). One week was allowed before starting the next course.

Results: The patients received 1 to 6 courses (median 3). As a whole, the treatment was well tolerated. Nine patients did not develop any toxicity, while WHO grade 3 and 4 toxicities were recorded in 4 patients. Alopecia (WHO grade 1-2) was presented in 4 cases. Five patients attained >50% decrease in serum prostate-specific antigen (PSA).

Conclusion: Prolonged EPX infusion is feasible and potentially active in the treatment of HRPC patients. Our data suggest caution in administering this treatment in patients bearing rheumatologic disease.
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January 2006

[Asymptomatic prostatitis: a frequent cause of raising PSA].

Recenti Prog Med 2005 Jul-Aug;96(7-8):365-9

The Prostatic Specific Antigen (PSA) is one of the best tumour markers currently available, and it is widely employed in the diagnosis and follow up of prostate cancer. Nevertheless, it is not specific for prostatic carcinoma, and an increase in its serum levels can also be related to benign prostatic hyperplasia, inflammation/infection or traumatic manoeuvres on the prostatic gland. Because of its well-known clinical features acute prostatitis does not require PSA evaluation for diagnosis, but other prostatitis (such as category IV NIH prostatitis) can be responsible of an increase in PSA levels without associated symptoms. Category IV prostatitis has a fairly high prevalence, affecting about one third of the adult males. Recently some studies have showed that approximately half of the patients with PSA levels in the grey zone and without symptoms of prostatitis undergo a decrease in PSA levels after a 2-4-week treatment with antibiotics. Thanks to this approach, 20-30% of the patients obtain PSA normalization and consequently avoid prostatic biopsies. In conclusion, the use of antibiotic treatment allows an increase in PSA specificity and a decrease in the number of unnecessary prostatic biopsies. The cost-benefit ratio of this approach has to be verified by means of prospective randomized trials.
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November 2005

PSA decrease after levofloxacin therapy in patients with histological prostatitis.

Arch Ital Urol Androl 2004 Dec;76(4):154-8

University of Turin, San Luigi Gonzaga Hospital, Urological Clinic, Department of Clinical and Biological Sciences, Italy.

Objective: To evaluate the effect of levofloxacin (LVX) oral therapy on total serum prostate specific antigen (PSA) values in patients with histological prostatitis.

Materials And Methods: All consecutive outpatients with histological evidence of chronic prostatitis, total PSA > 4 ng/ml, normal DRE and urinalysis and treated once daily with LVX 500 mg per os for 20 days were retrospectively evaluated for total serum PSA reduction. A decrease of PSA value > 5% was considered correlated with the antibiotic therapy.

Results: A total of 26 outpatients were evaluated (median age = 65 years). Median total serum PSA concentrations, before and after LVX therapy, were 7.1 ng/ml (range 4.1-15 ng/ml) and 5.8 ng/ml (2-15 ng/ml), respectively (p= n.s). The median reduction of total PSA was 16.6% (range 5.7 - 63.6%). A statistically significant decrease of median total PSA was observed in 15 out of 26 patients (57.6%): 7.2 ng/ml and 4.2 ng/ml before and after LVX therapy, respectively (p=0.002); the marker normalized in 7 out of 15 patients (46.7%). In all the remaining patients prostate biopsy was repeated: prostate cancer (Pca) was detected in 1 out of 8 patients with significant reduction of total PSA and in 4 out of 11 patients with no significant marker decrease. The incidence of Pca in second prostate biopsies raised from 19% (5 cases out of 26) to 26% (5 cases out of 19).

Conclusions: Treatment with LVX significantly reduced PSA values in over half of the patients with asymptomatic prostatitis, elevated total PSA and normal DRE and urinalysis. This approach could be applied in the ambulatory setting in order to increase the specificity of total PSA testing, reducing the number of negative, unnecessary, prostate biopsies.
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December 2004
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