Publications by authors named "Massimo Madonia"

32 Publications

The role of surgery in platinum-resistant ovarian cancer: A call to the scientific community.

Semin Cancer Biol 2021 Feb 16. Epub 2021 Feb 16.

Department of Gynecologic Oncology, University of Palermo, Palermo, Italy.

In the last decade, a growing attention has been focused on identifying effective therapeutic strategies also in the orphan clinical setting of women with platinum-resistant disease. In this context, secondary cytoreductive surgery (SCS) remains a potential approach only in women with platinum sensitive relapse, but experimental data have been published supporting the role of SCS also in patients with platinum-resistant recurrence. In particular, surgery is emerging as a potential option in specific subgroups of women, such as those patients with low-grade serous histology, or low-volume relapse with disease located in the so-called pharmacological sanctuaries. Furthermore, contrasting evidences have suggested a potential role in this clinical setting of SCS combined with intraperitoneal hyperthermic chemotherapy. In this complex scenario we review here the available evidences regarding the role surgery in ovarian cancer patients with platinum resistant disease, trying also to understand which patients may benefit from this challenging, experimental approach.
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http://dx.doi.org/10.1016/j.semcancer.2021.02.009DOI Listing
February 2021

A preliminary study procedure for detection of polyamines in plasma samples as a potential diagnostic tool in prostate cancer.

J Chromatogr B Analyt Technol Biomed Life Sci 2021 Jan 30;1162:122468. Epub 2020 Nov 30.

Department of Biomedical Sciences, University of Sassari, Sassari, Italy. Electronic address:

Background: Many scientific contributions recognize polyamines as important biomarkers for the diagnosis and treatment of cancer. Several authors have suggested the use of LC/MS instruments as an elective method for their measurement, providing good detection limits and specificity; however, many of these procedures suffer from long chromatographic run times, high detection limits and lengthy and expensive sample pre-treatment steps.

Methods: UHPLC coupled with high-resolution Orbitrap mass spectrometry (UHPLC/Orbitrap) was set up for the identification and separation ofpolyamines, together with some of their metabolites and catabolites, in the plasma of healthy and prostate cancer human patients. Thirteen metabolites were measured in deproteinized plasma samples through a new analytical approach known as the parallel reaction monitoring (PRM) for targeted quantitative analysis.

Results: The calibration curves were linear and R2 ranged from 0.9913 to 0.9995 for all analytes. LOQ values are between 0.382 and 25 ng mL and LOD values are between 0.109 and 7.421 ng mL. The method shows an accuracy and precision for intra-day and inter-day < 15% RSD and R.E.% for all the QC samples. The matrix effect calculated at different concentration levels did not exceed 15%.

Conclusions: The method developed provides rapid, easy and robust identification and measurement of a wide range of polyamines, and some of their metabolites that can be evaluated as biomarkers to predict the clinical features of prostate cancer patients, avoiding invasive diagnostic procedures.
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http://dx.doi.org/10.1016/j.jchromb.2020.122468DOI Listing
January 2021

How Can the COVID-19 Pandemic Lead to Positive Changes in Urology Residency?

Front Surg 2020 24;7:563006. Epub 2020 Nov 24.

Department of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy.

The COVID-19 outbreak, in a few weeks, overloaded Italian hospitals, and the majority of medical procedures were postponed. During the pandemic, with hospital reorganization, clinical and learning activities performed by residents suffered a forced remodulation. The objective of this study is to investigate how urology training in Italy has been affected during the COVID-19 era. In this multi-academic study, we compared residents' training during the highest outbreak level with their previous activity. Overall 387 (67.1%) of the 577 Italian Urology residents participated in a 72-h anonymous online survey with 36 items sent via email. The main outcomes were clinical/surgical activities, social distancing, distance learning, and telemedicine. Clinical and learning activity was significantly reduced for the overall group, and after categorizing residents as those working only in COVID hospitals, both "junior" and "senior" residents, and those working in any of three geographical areas created (Italian regions were clustered in three major zones according to the prevalence of COVID-19). A significant decrease in outpatient activity, invasive diagnostic procedures, and endoscopic and major surgeries was reported. Through multivariate analysis, the specific year of residency has been found to be an independent predictor for all response modification. Being in zone 3 and zone 2 and having "senior" resident status were independent predictors associated with a lower reduction of the clinical and learning activity. Working in a COVID hospital and having "senior" resident status were independent predictors associated with higher reduction of the outpatient activity. Working in zone 3 and having "senior" resident status were independent predictors of lower and higher outpatient surgical activity, respectively. Working in a COVID hospital was an independent predictor associated with robotic surgical activity. The majority of residents reported that distance teaching and multidisciplinary virtual meetings are still not used, and 44.8% reported that their relationships with colleagues decreased. The COVID-19 pandemic presents an unprecedented challenge, including changes in the training and education of urology residents. The COVID era can offer an opportunity to balance and implement innovative solutions that can bridge the educational gap and can be part of future urology training.
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http://dx.doi.org/10.3389/fsurg.2020.563006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732553PMC
November 2020

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

Serenoa repens + selenium + lycopene vs tadalafil 5 mg for the treatment of lower urinary tract symptoms secondary to benign prostatic obstruction: a Phase IV, non-inferiority, open-label, clinical study (SPRITE study).

BJU Int 2018 08 16;122(2):317-325. Epub 2018 Apr 16.

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

Objective: To compare in a randomised, open-label, non-inferiority clinical study, the efficacy and tolerability of Serenoa repens (SeR) + selenium (Se) + lycopene (Ly) (SeR-Se-Ly) therapy vs tadalafil 5 mg in men with lower urinary tract symptoms (LUTS).

Patients And Methods: From May 2015 to January 2017, 427 patients were enrolled in 21 different centres (International Standard Randomised Controlled Trial Number Register [ISRCTN] 73316039). Inclusion criteria included: age between 50 and 80 years, International Prostate Symptom Score (IPSS) ≥12, maximum urinary flow rate (Q ) ≤ 15 mL/s, and post-void residual (PVR) <100 mL. Patients were randomised into two groups in a 2:1 ratio: Group A (SeR-Se-Ly, 1 tablet daily for 6 months) and Group B (tadalafil 5 mg, 1 tablet daily for 6 months). The primary endpoint of the study was the non-inferior variation in the IPSS and Q in Group A vs Group B after 6 months of treatment.

Results: In all, 404 patients completed the full protocol. When comparing both therapies, Group A was statistically not inferior to Group B considering the median change in IPSS (-3.0 vs -3.0; P < 0.01), IPSS quality of life (-2.0 vs -2.0; P < 0.05), and Q (2.0 vs 2.0 mL/s; P < 0.01). We found statistically significant differences in the increase of at least 3 points in Q (38.2% vs 28.1%; P = 0.04) and of at least 30% of Q (39.2% vs 27.3%; P < 0.01) in Group A compared to Group B. The percentage of patients with an increase of at least 3 points in the IPSS and a decrease of at least 25% of the IPSS was not statistically different between the two groups. For adverse events, four patients in Group A (1.44%) and 10 in Group B (7.81%) (P < 0.05) reported side-effects.

Conclusion: We have shown that treatment with SeR-Se-Ly was not inferior to tadalafil 5 mg for improving IPSS and Q in men with LUTS.
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http://dx.doi.org/10.1111/bju.14209DOI Listing
August 2018

Management of female stress urinary incontinence: A care pathway and update.

Maturitas 2018 Mar 9;109:32-38. Epub 2017 Dec 9.

Gynecologic and Obstetric Clinic, Dep. of Clinical and Experimental Medicine, University of Sassari.

Stress urinary incontinence (SUI) is a condition characterized by an involuntary loss of urine occurring as result of an increase in intra-abdominal pressure due to effort or exertion or on sneezing or coughing. Estimates of its prevalence in the female population range from 10% to 40%. A literature search of the Medline, Cochrane library, EMBASE, NLH, ClinicalTrials.gov and Google Scholar databases was done up to July 2017, restricted to English-language articles, using terms related to SUI, medical therapy, surgical therapy and treatment options. The search terms included female stress urinary incontinence, mid-urethral sling, tension-free vaginal tape (TVT) and transobturator tape (TOT, TVT-O). Original articles, reviews and meta-analyses were included. Surgical therapy should be considered only after conservative therapies (e.g. an exercise programme or topical estrogens) have failed. Synthetic mid-urethral slings are the gold standard for the surgical treatment of SUI according to the 2016 guidelines of the European Society of Urology (ESU) and the 2017 position statement of the European Urogynaecological Association (EUA). The therapeutic options are numerous but further research into new therapeutic strategies is needed to achieve a better balance between efficacy and adverse events.
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http://dx.doi.org/10.1016/j.maturitas.2017.12.008DOI Listing
March 2018

Reply to Dr Wael Agur.

Maturitas 2018 04 13;110:125. Epub 2018 Jan 13.

Gynecologic and Obstetric Clinic, Dep. of Clinical and Experimental Medicine, University of Sassari, Italy; Urologic Clinic, Dep. of Clinical and Experimental Medicine, University of Sassari, Italy; Chronic Pelvic Pain Centre, Dep. of Obstetrics and Gynaecology, Ospedale S. Maria Della Speranza, Battipaglia, Italy.

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http://dx.doi.org/10.1016/j.maturitas.2018.01.010DOI Listing
April 2018

Dietary Consumption of Phenolic Acids and Prostate Cancer: A Case-Control Study in Sicily, Southern Italy.

Molecules 2017 Dec 5;22(12). Epub 2017 Dec 5.

Urology Section, University of Catania, 95124 Catania, Italy.

Dietary polyphenols gained the interest of the scientific community due to their wide content in a variety of plant-derived foods and beverages commonly consumed, such as fruits, vegetables, coffee, tea, and cocoa We aimed to investigate whether there was an association between dietary phenolic acid consumption and prostate cancer (PCa) in South Italy. We conducted a population-based case-control study from January 2015 to December 2016 in a single institution of the municipality of Catania, southern Italy (Registration number: 41/2015). Patients with elevated PSA and/or suspicious PCa underwent transperineal prostate biopsy. A total of 118 histopathological-verified PCa cases were collected and a total of 222 controls were selected from a sample of 2044 individuals. Dietary data were collected by using two food frequency questionnaires and data on the phenolic acids content in foods was obtained from the Phenol-Explorer database (www.phenol-explorer.eu). Association between dietary intake of phenolic acids and PCa was calculated through logistic regression analysis. We found lower levels of caffeic acid (2.28 mg/day vs. 2.76 mg/day; < 0.05) and ferulic acid (2.80 mg/day vs. 4.04 mg/day; < 0.01) in PCa when compared to controls. The multivariate logistic regression showed that both caffeic acid (OR = 0.32; < 0.05) and ferulic acid (OR = 0.30; < 0.05) were associated with reduced risk of PCa. Higher intake of hydroxybenzoic acids and caffeic acids were associated with lower risk of advanced PCa. High intake of caffeic acid and ferulic acid may be associated with reduced risk of PCa.
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http://dx.doi.org/10.3390/molecules22122159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6149996PMC
December 2017

Association between dietary phytoestrogens intakes and prostate cancer risk in Sicily.

Aging Male 2018 Mar 17;21(1):48-54. Epub 2017 Aug 17.

a Urology Section , University of Catania , Catania , Italy.

Objective: In this study we aimed to investigate the association between dietary phytoestrogen consumption and prostate cancer in a sample of southern Italian individuals.

Methods: A population-based case-control study on the association between prostate cancer and dietary factors was conducted from January 2015 to December 2016 in a single institution of the municipality of Catania, southern Italy (Registration number: 41/2015). A total of 118 histopathological-verified prostate cancer (PCa) cases and a total of 222 controls were collected. Dietary data was collected by using two food frequency questionnaires.

Results: Patients with PCa consumed significantly higher levels of phytoestrogens. Multivariate logistic regression showed that lignans (Q[quartile]4 vs. Q1, OR [odds ratio] = 4.72; p < .05) and specifically, lariciresinol (Q4 vs. Q1, OR = 4.60; p < .05), pinoresinol (Q4 vs. Q1, OR = 5.62; p < .05), matairesinol (Q4 vs. Q1, OR = 3.63; p < .05), secoisolariciresinol (Q4 vs. Q1, OR = 4.10; p < .05) were associated with increased risk of PCa. Furthermore, we found that isoflavones (Q3 vs. Q1, OR = 0.28; p < .05) and specifically, genistein (Q4 vs. Q1, OR = 0.40; p < .05) were associated with reduced risk of PCa.

Conclusion: We found of an inverse association between dietary isoflavone intake and PCa, while a positive association was found with lignans intake.
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http://dx.doi.org/10.1080/13685538.2017.1365834DOI Listing
March 2018

[Preliminary study on the expression of Toll-like receptors 7 and 8 in bladder urothelial tumors].

Urologia 2015 Oct-Dec;82(4):226-8. Epub 2015 Jul 11.

Clinica Urologica, Dipartimento di Scienze Chirurgiche, Microchirurgiche e Mediche, Università degli Studi di Sassari, Sassari - Italy.

The aim of the study was to demonstrate the expression of Toll-like receptor (TLR)-8 and to confirm the expression of TLR-7 on bladder transitional cell carcinomas (TCCs) analyzing the changes in expression between low-grade (LG) and high-grade (HG) and between non-muscle invasive (NMIBC) and muscle-invasive (MIBC) bladder cancers. In our study, 25 patients who underwent transurethral resection (TURB) for bladder TCC have been selected. Thirteen of those had an LG form,while the other cases were classified as HG; the lesions were NMIBC in 18 patients and MIBC in the others seven. The analysis of TLRs expression has been performed by immuno histochemistry. TRL-8 expression seems to be higher in MIBC (85%) than in NMIBC (78%), but it is associated with a reduced percentage of immuno reactive cells and with a lower intensity. The expression had a large nuclear localization in NMIBC (80%), althoughit was mainly cytoplasmic in MIBC (72%). TLR-7 was expressed in all NMIBC samples (where the localization was mainly nucleo-cytoplasmic) and in the 71% of MIBC samples (mainly in the nucleus). A higher expression of TRL-8 in HG TCC had been observed, while TRL-7 seems to be more expressed in LG forms. Our study allowed to document the immunohistochemical expression of TLR-8 in TCCs, confirm the immunohistochemical expression of TLR-7, and suggest an increased expression of TLR-7 in LG TCC and NMIBC, and a prevalent expression of TLR-8 in HG TCC and MIBC.
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http://dx.doi.org/10.5301/uro.5000121DOI Listing
April 2017

Oxidative stress and body composition in prostate cancer and benign prostatic hyperplasia patients.

Anticancer Res 2014 Sep;34(9):5051-6

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

Objective: To investigate the role of body composition and oxidative stress measured by total thiol groups (TTG) levels in prostate specimens of patients affected by benign prostatic hyperplasia (BPH) or prostate cancer (PCa).

Patients And Methods: From January 2011 to January 2013, a cohort of 150 consecutive male patients who underwent first prostate biopsy were enrolled. Twelve-core needle biopsy was performed as standard procedure, while twelve more needle tissue cores matched with the previous group were also collected for glutathione determination. After definitive diagnosis, measurement of glutathione was performed in the correspondent one matched prostatic sample where PCa or BPH were identified. A day after the prostatic biopsy, body composition was estimated by air plethysmography (BOD POD®).

Results: A significant difference of TTG was observed in BPH and PCa patients; 34 nanomole (nmol) reagent sulfihydrylc (RSH)/ mg protein vs. 1.1 nmol RSH/ mg protein respectively (p<0.05). In BPH patients, a negative correlation was found between TTG and age (r=-0.46; p<0.05), while, in PCa patients, a positive correlation was observed between TTG and fat mass (FM) (r=0.76; p<0.01) and waist circumference (WC) (r=0.49; p<0.05). Multivariate linear regression analysis showed TTG to be negatively associated with age (β-coefficient=-0.4; p<0.05) in BPH patients and positively with FM (β-coefficient=3.4; p<0.01) and WC (β-coefficient=2.7; p<0.05) in PCa patients.

Conclusion: Aging determines a progressive reduction of TTG in BPH patients, while in PCa subjects glutathione concentrations are significantly lower and FM and WC are associated with an unbalance of its levels.
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September 2014

Tailored treatment including radical prostatectomy and radiation therapy + androgen deprivation therapy versus exclusive radical prostatectomy in high-risk prostate cancer patients: results from a prospective study.

Int Braz J Urol 2014 May-Jun;40(3):322-9

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

Purpose: To evaluate outcomes of patients with high risk prostate cancer (PCa) who underwent radical prostatectomy (RP) in a context of a multidisciplinary approach including adjuvant radiation (RT) + androgen deprivation therapy (ADT).

Matherials And Methods: 244 consecutive patients with high risk localized PCa underwent RP and bilateral extended pelvic lymph node dissection at our institution. Adjuvant RT + 24 months ADT was carried out in subjects with pathological stage ≥ T3N0 and/or positive surgical margins or in patients with local relapse.

Results: After a median follow-up was 54.17 months (range 5.4-117.16), 13 (5.3%) subjects had biochemical progression, 21 (8.6%) had clinical progression, 7 (2.9%) died due to prostate cancer and 15 (6.1%) died due to other causes. 136 (55.7%) patients did not receive any adjuvant treatment while 108 (44.3%) received respectively adjuvant or salvage RT+ADT. Multivariate Cox proportional hazard analysis showed that pre-operative PSA value at diagnosis is a significant predictive factor for BCR (HR: 1.04, p < 0.05) and that Gleason Score 8-10 (HR: 2.4; p < 0.05) and PSMs (HR: 2.01; p < 0.01) were significant predictors for clinical progression. Radical prostatectomy group was associated with BPFS, CPFS, CSS and OS at 5-years of 97%, 90%, 95% and 86% respectively, while adjuvant radiation + androgen deprivation therapy group was associated with a BPFS, CPFS and CSS at 5-years of 91%, 83%, 95% and 88%, without any statistical difference.

Conclusions: Multimodality tailored treatment based on RP and adjuvant therapy with RT+ADT achieve similar results in terms of OS after 5-years of follow-up.
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http://dx.doi.org/10.1590/S1677-5538.IBJU.2014.03.05DOI Listing
February 2015

Prevalence of intratubular germ cell neoplasia and multifocality in testicular germ cell tumors ≤ 2 cm: relationship with other pathological features.

Clin Genitourin Cancer 2015 Feb 11;13(1):e31-5. Epub 2014 Jun 11.

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

Introduction: The aim of this study was to determine the prevalence of TIN and multifocality in men undergoing radical orchiectomy for testicular germ cell tumor (TGCT), and among those with a main tumor size ≤ 2 cm, potentially eligible for testis-sparing surgery.

Patients And Methods: Orchiectomy specimens from 126 consecutive patients treated for TGCT tumor between 2003 and 2012 were included. Multifocality was defined as a distinct tumor focus with a diameter ≥ 1 mm separable from the main tumor mass. Uni- and multivariate logistic regression was performed to identify the association between pathological variables and multifocality and to identify variables for predicting clinical stage II to III and pathological stage ≥ pT2.

Results: Of the 126 patients, 103 (82.0%) had clinical stage I cancer at presentation and 23 (18.0%) had clinical stage II to III. The median size of the primary tumor mass was 3.7 cm (range, 0.5-12 cm) in multifocality and 3.0 cm (range, 0.6-8.0 cm) in monofocality, respectively (P < .05). The prevalence of multifocality and TIN was lower in the presence of a smaller main tumor mass (≤ 1 cm) compared with tumors 1.1 to 2.0 cm (P < .05), and increased when the index mass tumor diameter was ≥ 2 cm (P trend < .05). No association was found between tumor histology and multifocality (P = .95) or TIN (P = .54) using the χ(2) test.

Conclusion: The prevalence of multifocality and TIN was decreased in smaller tumors (≤ 1 cm) and increased when the index mass tumor diameter was ≥ 1.1 cm.
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http://dx.doi.org/10.1016/j.clgc.2014.06.009DOI Listing
February 2015

Erectile function in men with failed hypospadias repair.

Arch Esp Urol 2014 Jan-Feb;67(1):152-6

Department of Experimental Medicine and Surgery. University of Tor Vergata. Rome.Italy.

Objectives: While efforts have been made to study erectile function in patients with urethral stricture, very few prior investigations have specifically assessed erectile function in men with failed hypospadias surgery. We set forth to assess the baseline erectile function of men with hypospadias failure presenting for urethroplasty as adults.

Methods: Retrospective data was analyzed on 163 adult patients with prior failed hypospadias repair who presented for urethroplasty from 2002-2007 at two sites in the United States and Italy. All patients had completed the International Index of Erectile Function (IIEF) pre-operatively. Standard IIEF-6 categories were used to assess baseline level of erectile dysfunction (ED) defined as none (≥ 26), minimal (18-25) ,moderate (11-17), and severe (≤ 10). A subset of 13 hypospadias patients prospectively completed the IIEF questionnaire pre and post- operatively.

Results: The mean age at presentation for urethroplasty was 39.7 years. Based on IIEF-6 scores, 54% of patients presented with some degree of ED with 22.1%, 3.7%, and 28.2% reporting severe, moderate and mild ED respectively. While the oldest patient population (>50) had the highest incidence of severe ED (38.9%), the youngest age group (=30) had a 60% rate of ED with 18% classified as severe (Table I). Subset analysis of 13 failed hypospadias patients following urethroplasty revealed that 11 (85%) patients had the same or improved erectile function following surgery.

Conclusions: Patients presenting for repair after hypospadias failure often require complex penile reconstruction impacting both urinary as well as sexual quality of life. Among these patients there appears to be a high baseline prevalence of ED. Older patients had a higher incidence of more severe ED; however, the majority of younger patients still presented with some form of ED and a significant number with severe ED. Urethroplasty does not appear to negatively impact erectile function in men with previous hypospadias failure; however a disease specific questionnaire is needed to fully address this issue.
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March 2016

Pneumatic lithotripsy versus holmium:YAG laser lithotripsy for the treatment of single ureteral stones: a prospective, single-blinded study.

Urol Int 2014 28;92(4):468-72. Epub 2014 Jan 28.

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

Objective: The aim of this prospective single-blinded study was to analyze the stone-free (SF) rates between pneumatic lithotripsy (PL) and laser lithotripsy (LL) for the treatment of single and primary ureteral stones and to evaluate potentially predictive factors of a SF status.

Material And Methods: From January 2010 to January 2011, 133 consecutive patients with single and primary ureteral stones were prospectively enrolled. Uni- and multivariate logistic regression were performed to estimate predictive factors of a SF status.

Results: The SF rate in the PL group was 80.7 and 86.1% in the LL group (p = 0.002). Success rates with regard of stone position were not significantly different between groups. At univariate logistic regression, middle ureteral stone (OR 3.33, p = 0.04), distal ureteral stone (OR 4.4, p = 0.02), LL (OR 3.05, p = 0.04) and Hounsfield units (HUs) (OR 1.07, p = 0.03) were significantly predictive factors of a SF status. At a multivariate logistic regression, middle ureteral stone (OR 5.58, p = 0.01), distal ureteral stone (OR 7.87, p < 0.01), LL (OR 2.4, p = 0.02) and HUs ≥1,200 (OR 1.15, p = 0.02) were significantly associated with a SF status.

Conclusions: LL significantly influences the SF status after ureteroscopy, allowing a higher SF rate when compared to PL. HUs may significantly influence this success rate.
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http://dx.doi.org/10.1159/000355828DOI Listing
February 2015

A case of gross haematuria due to an ureteric-iliac artery fistula.

Ann Ital Chir 2013 Dec 23;84(ePub). Epub 2013 Dec 23.

A case of gross haematuria due to an ureteric-iliac artery fistula We report a case of a 75-year-old man presented with gross haematuria and left hydronephrosis due to an ureteric iliac- artery fistula . Medical history included a previous positioning of aorto-bisiliac graft and an iliac artery stent placed to exclude an hypogastric aneurysm. A retrograde pyelography revealed a compression of the middle ureter and an extravasation of contrast at that level, for this reason a double J stent was inserted. Contrast-enhanced computed tomography showed the presence of a fistula between the left ureter and the internal iliac. The patient underwent endovascular treatment using a stent-graft with the subsequent patient's recovery. Ureteric iliac-artery fistula is a rare condition and it generally manifests with life threatening gross bleeding. We suggest a multidisciplinary clinical approach in order to achieve the best results for the patient and to avoid severe complications. Endovascular techniques have been demonstrated to be effective and rapid in the treatment of this emergency condition; ureteral stenting is also recommended.
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December 2013

The role of the heme oxygenase system in the metabolic syndrome.

Curr Pharm Des 2014 ;20(31):4970-4

Department of Drug Sciences, University of Catania, Viale Andrea Doria, 6, 95125 Catania (Italy).

Molecular chaperones and the heat shock response play a major role in the maintenance of cellular homeostasis under various pathological conditions. In particular, their role is to regulate protein conformation, protect proteins from misfolding and aggregation, and maintain signalling and organellarnetworks. Among variousheat shock proteins, Hsp32 also known as heme oxygenase-1 (HO-1), has demonstrated an important role in metabolic syndrome. In particular, the HO system seems to play a major role in the complex pathophysiological cascade involved in insulin resistance mechanisms, and adipocyte functions as measured by the release of important adipokynes. The aim of the present review is to point out the role of HO-1 in metabolic syndrome, and how to exploit its beneficial effects as a therapeutic strategy to prevent complicationsof andto improve insulin sensitivity.
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http://dx.doi.org/10.2174/1381612819666131206103824DOI Listing
May 2016

Multifocality in testicular germ cell tumor (TGCT): what is the significance of this finding?

Int Urol Nephrol 2014 Jun 7;46(6):1131-5. Epub 2013 Dec 7.

Department of Urology, School of Medicine Policlinico Hospital, University of Catania, Catania, Italy.

Purpose: The aim of the study is to determine the association between multifocality and the pathological features of testicular germ cell tumors and its clinical implication.

Methods: Orchiectomy specimens from 254 consecutive patients with testis cancer between 2003 and 2013 were included. Multifocality was defined as a distinct tumor focus of cluster of malignant cells > 0.5 mm and separable from the main tumor mass. Univariate logistic regression analysis was performed to evaluate the association between multifocality and other pathological features. Multivariate logistic regression analyses were carried out to identify potential predictive factors of multifocality for clinical stages II-III and the pathological stage ≥ pT2.

Results: Median patient age was 33 years (range 19-70). Multifocality was identified in 58 (22.83 %) orchiectomy specimens. Subjects with multifocality had larger primary tumor lesions (3.7 vs. 3.0 cm; p < 0.05). No association was found between histology and multifocality (p = 0.95). On univariate logistic regression analysis, multifocality was not significantly associated with all pathological features. On multivariate logistic regression analysis, multifocality was not demonstrated to be an adverse pathological feature of clinical stages II-III (p = 0.23) or pathological stage ≥ pT2 (p = 0.30) when included in a model with tumor size ≥ 4 cm and rete testis invasion in seminoma tumor and neither of clinical stages II-III (p = 0.36) or pathological stage ≥ pT2 (p = 0.20) when included in a model with lymphovascular invasion and percentage of embrional cancer ≥ 50 % in non-seminoma ones.

Conclusion: Multifocality should not be considered an adverse pathological feature in patients with testis cancer, independently to histological subtypes.
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http://dx.doi.org/10.1007/s11255-013-0617-6DOI Listing
June 2014

Percentage of cancer involvement in positive cores can predict unfavorable disease in men with low-risk prostate cancer but eligible for the prostate cancer international: active surveillance criteria.

Urol Oncol 2014 Apr 1;32(3):291-6. Epub 2013 Nov 1.

Department of Urology, University of Catania, Italy.

Objectives: To identify predictive factors of unfavorable disease and of biochemical failure in patients treated with radical prostatectomy but eligible for active surveillance (AS) according to Prostate Cancer Research International: Active Surveillance (PRIAS) criteria. We aimed to introduce and validate the percentage of cancer involvement in positive cores (CIPC) as potential worse predictive factor.

Methods: From January 2002 to December 2007, 750 consecutive subjects underwent radical prostatectomy at a single institution. We identified 147 (19.05%) patients who were eligible for AS based on PRIAS criteria: clinical stage T1c or T2 disease, prostate-specific antigen level of ≤ 10 ng/ml, Gleason score ≤ 6, prostate-specific antigen-D of<0.2 ng/ml(2), and fewer than 3 positive biopsy cores. CIPC was included in the analysis.

Results: Of the 147 patients, 95 (66.43%) patients had favorable disease, whereas 48 (33.57%) had unfavorable disease. In multivariate logistic regression, maximum cancer length (odds ratio 12.52, P<0.01) and CIPC (odds ratio 1.70, P<0.01) represented independent predictors of unfavorable prostate cancer. The area under the receiver operating characteristics curve analysis revealed significantly higher performance after including CIPC to the PRIAS criteria (0.61 vs. 0.94, P<0.01). A cutoff of 0.4mm of CIPC was set to predict unfavorable disease with 93% specificity, 76% sensibility, and 87% accuracy based on the receiver operating characteristics curve analysis. Finally, the 3- and 5-years biochemical recurrence (BCR)-free survival were significantly lower in subjects with CIPC ≥ 0.4mm, 88.4 % and 81.0% vs. 97.8% and 95.7%, respectively (P< 0.01).

Conclusions: Our findings suggest that the inclusion of CIPC to the prostate biopsy features could be helpful to avoid misclassification in patients eligible for AS according to the PRIAS criteria.
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http://dx.doi.org/10.1016/j.urolonc.2013.07.004DOI Listing
April 2014

Efficacy and 9 years' follow-up of posterior intravaginal slingplasty for genital prolapse.

J Obstet Gynaecol Res 2014 Jan 19;40(1):219-23. Epub 2013 Sep 19.

Department of Surgical, Microsurgical and Medical Sciences, Gynecologic and Obstetric Clinic, University of Sassari, Sassari, Italy.

Aim: The aim of this study was to assess the long-term efficacy and complication rates of posterior intravaginal slingplasty (IVS) in women suffering from genital prolapse.

Material And Methods: Posterior IVS or infracoccygeal sacropexy is a minimally invasive procedure for suspension of the vagina with the goal of creating new uterosacral ligaments through the insertion of a polypropylene tape. Forty-four patients were enrolled: 25 patients, affected by uterovaginal prolapse, were subjected to vaginal hysterectomy and posterior IVS; and 19 patients, diagnosed with vaginal vault prolapse, were subjected to posterior IVS alone. The primary outcome for posterior IVS was 12-month, 24-month and annual 9-year postoperative efficacy that is based on a Pelvic Organ Prolapse Quantitative score of -5 at point C, which describes the vaginal apex.

Results: Of the 44 patients who underwent posterior IVS, none required blood transfusions with an average reduction of perioperative hemoglobin of 1.2 ± 0.4 g/dl, and the average time of hospitalization was 4.3 ± 0.6 days. The rate of success was 93.18% (41/44) at 9 years' follow-up. We had only one case of extrusion (2.27%) and three cases of recurrence (6.82%), such as two cases of cystocele and of rectocele.

Conclusions: Most patients interviewed confirmed that their quality of life improved after surgery, 86.36% of the operated patients reported that their sexual performance improved and that they would recommend this surgery for their friends. Posterior IVS was a minimally invasive surgical procedure with a high success rate for genital prolapse.
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http://dx.doi.org/10.1111/jog.12162DOI Listing
January 2014

Basal cell carcinoma of the nipple-areola complex: report of a case and literature review.

Ann Ital Chir 2013 Sep 12;84(ePub). Epub 2013 Sep 12.

Basal cell carcinoma of the nipple areola complex in female patients is an extremely rare tumor with a malignant clinical behavior. The Authors present the case of a Basal cell carcinoma of the nipple areola complex in a Caucasian woman, evaluated by clinical and histological findings. Our clinical experience suggests that Basal cell carcinoma of the nipple areola complex has a local aggressive behavior with an higher metastatic potentiality compared to basal cell carcinoma of common sites. However, an accurate tissue sparing excision may be successful in the long term.
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September 2013

Potential efficacy of some african plants in benign prostatic hyperplasia and prostate cancer.

Mini Rev Med Chem 2013 Oct;13(11):1564-71

School of Medicine Policlinico Hospital, University of Catania, Italy.

Traditional medicine is very popular in Africa and it is considered as an alternative form of health care. Plants and vegetables used in folk and traditional medicine have gained wide acceptance as one of the main sources of prophylactic and chemopreventive drug discovery and this is due to the evidence of particular biological and biochemical characteristics of each plants extracts. The role of these compounds in urological field may be explained by the antiinflammatory effect through interference with prostaglandin metabolism, alteration of lipid peroxidation, direct inhibition of prostate growth and moreover through an antiandrogenic or antiestrogenic effect and a decrease of the availability of sex hormone-binding globulin. Since Benign Prostatic Hyperplasia and Prostate Cancer are two of the most diffuse diseases of aging male and considering that standard medical therapy is accompanied with different side effects, the emerging use of African plants may be justified. This review takes a look at some African plants extracts properties and their relative urological application. Different biomolecular mechanisms of action are promising, suggesting a real application in reducing prostate cells proliferation.
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http://dx.doi.org/10.2174/13895575113139990008DOI Listing
October 2013

Unusual presentation of tuberous sclerosis complex.

Urology 2012 Oct 15;80(4):e39-40. Epub 2012 Aug 15.

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

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http://dx.doi.org/10.1016/j.urology.2012.06.016DOI Listing
October 2012

Polyphenols: key issues involved in chemoprevention of prostate cancer.

Oxid Med Cell Longev 2012 28;2012:632959. Epub 2012 May 28.

Department of Urology, University of Catania, 95125 Catania, Italy.

Prostate cancer is is the most common solid neoplasm and it is now recognized as one of the most important medical problems facing the male population. Due to its long latency and its identifiable preneoplastic lesions, prostate cancer is an ideal target tumor for chemoprevention. Different compounds are available and certainly polyphenols represent those with efficacy against prostate cancer. This review take a look at activity and properties of major polyphenolic substances, such as epigallocatechin-3-gallate, curcumin, resveratrol and the flavonoids quercetin and genistein. Although the current studies are limited, mechanisms of action of polyphenols added with the lack of side effects show a a start for future strategies in prostate chemoprevention.
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http://dx.doi.org/10.1155/2012/632959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3368543PMC
October 2012

[The relationship between oxidative stress and obesity in prostate disease].

Urologia 2012 Apr-Jun;79(2):156-8

Clinica Urologica, Università degli Studi di Catania, Catania, Italy.

Recent data suggest that chronic increment of reactive oxygen species (ROS) may be involved in the development and progression of chronic prostatic disease, such as BPH and PCa; adipose tissue produces bioactive substances called adipokines, also involved in the production of ROS. Our study aims to evaluate the relationship between obesity and oxidative stress in prostate disease.
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http://dx.doi.org/10.5301/RU.2012.9206DOI Listing
October 2012

[Current role of prostatic transrectal ultrasound in the diagnosis of CaP].

Urologia 2012 Apr-Jun;79(2):130-4

Azienda Ospedaliero-Universitaria, Aou Sassari, Italy.

Introduction: Cancer of the prostate (PCa) is now recognized as one of the most important medical problems facing the male population. In Europe, PCa is the most common solid neoplasm, with an incidence rate of 214 cases per 1000 men, outnumbering lung and colorectal cancer (1). According to the EAU guidelines, the main diagnostic tools to obtain evidence of PCa include DRE, serum concentration of PSA and transrectal ultrasonography (TRUS). But, does TRUS affect the diagnostic process?

Material And Methods: Between March 2007 and March 2011 we performed 441 prostate biopsies to compare the results with clinical, laboratory and ultrasonographic features of every patient. We investigated sensitivity, specificity, accuracy, positive and negative predictive value and likelihood ratio about every diagnostic tool (PSA, DRE and TRUS).

Results: The transrectal ultrasonography has a low diagnostic accuracy for prostate cancer because it shows: Low sensitivity and specificity (higher incidence of false positives than true positives); Variability of ultrasound situations within which the tumor occurs.

Conclusions: In our opinion TRUS may be considered only a complement to PSA and DRE.
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http://dx.doi.org/10.5301/RU.2012.9109DOI Listing
October 2012

Dietary patterns and prostatic diseases.

Front Biosci (Elite Ed) 2012 Jan 1;4:195-204. Epub 2012 Jan 1.

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

Dietary patterns play a role on prostatic diseases in association with genetic, behavioral, occupational and environmental ones. Data from reviewed literature provide evidences of a possible relationship between dietary habits and the incidence of prostate disorders, even if it is not enough to justify a widespread adoption of new dietary habits. In this review the role of dietary patterns, including the use of supplements, in the prevention and treatment of the most frequent and known prostatic diseases, benign prostatic hyperplasia (BPH) and prostate cancer (PC) was analyzed. A limited number of well designed trials were identified in which diet and dietary supplement intervention appeared to slow disease progression. Although conclusive evidences are limited, the current data suggest that a diet low in total calories and fat, high in vegetables and fruits and that body weight control could be possibly effective in preventing prostatic diseases. On the other hand care must be taken to ensure that over-consumption of dietary supplements does not occur because it may be harmful.
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http://dx.doi.org/10.2741/369DOI Listing
January 2012

Perineal-guided endoscopic extraction of ejaculatory duct stones to treat obstructive azoospermia.

Fertil Steril 2011 Jun 21;95(7):2430.e11-4. Epub 2011 Feb 21.

Department of Urology, Univeristy of Catania, Catania, Italy.

Objective: To report a case of transurethral endoscopic treatment of ejaculatory duct stones with transrectal ultrasound (TRUS)-guided perineal needle implant and ureteroscopic extraction of deferent duct stones in an infertile man.

Design: Case report.

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

Patient(s): A 33-year-old man with azoospermia, low ejaculate volume, perineal discomfort, and unilateral seminal tract dilatation caused by obstructing lithiasis of the ejaculatory and deferent ducts.

Intervention(s): Transurethral endoscopic treatment of ejaculatory duct stones with TRUS-guided perineal needle implant and ureteroscopic extraction of deferent duct stones.

Main Outcome Measure(s): Improvements in symptoms and seminal parameters.

Result(s): The patients had successful relief of symptoms and correction of obstructive azoospermia.

Conclusion(s): This new technique allows a more rapid and targeted identification of ejaculatory duct lithiasis, and the ureteroscope enables management of distal seminal stones through the normal anatomic tract.
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http://dx.doi.org/10.1016/j.fertnstert.2011.01.146DOI Listing
June 2011

Relationship between lower urinary tract symptoms and serum levels of sex hormones in men with symptomatic benign prostatic hyperplasia.

BJU Int 2010 Dec;106(11):1700-3

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

Objectives: To investigate a possible association between the severity of lower urinary tract symptoms (LUTS) and the serum levels of sex hormones in men with symptomatic benign prostatic hyperplasia (BPH) that underwent surgery for severe benign prostatic obstruction.

Patients And Methods: In all, 127 selected men with symptomatic BPH attending our urology clinic were recruited. The clinical conditions of BPH were assessed by digital rectal examination, serum prostate-specific antigen (PSA) determination, International Prostate Symptom Score (IPSS), transrectal ultrasonography and maximum urinary flow rate (Q(max) ) value at uroflussimetry. Before surgery, we measured the serum concentrations of total testosterone (TT) and free testosterone (FT), oestradiol, prolactin, luteinizing hormone and follicle-stimulating hormone. We excluded men with endocrine diseases, those with prostate disease who were receiving antiandrogen therapy and those with psychological diseases. The relationships between the IPSS score and serum sex hormone levels were determined.

Results: The final study population consisted of 122 men (mean age of 70.66 years), as five were excluded (three due to incomplete evaluation and two who were diagnosed with prostate cancer). On statistical analysis, the total IPSS was significantly associated with age (r= 0.405, P < 0.001) and TT (r= 0.298, P= 0.020) but not with FT or the serum levels of the other sex hormones. The serum levels of testosterone and IPSS did not correlate with prostate volume and Q(max) . PSA level and age correlated with prostate volume (r= 0.394, P < 0.001; r = 0.374, P < 0.001, respectively). We distinguished two subgroups of patients: the first group of 40 men with an IPSS of <19 and the second group of 82 with an IPSS of >19, and we evaluated the median levels of TT in each group. There was an increased risk of LUTS in men with a greater serum concentration of TT (P= 0.042), although the mean TT level was in the normal range.

Conclusions: In the present study, the severity of LUTS was associated with age and serum levels of TT but only age correlated with the measures of BPH, especially prostate volume. The potential effects of testosterone on LUTS may well be indirect. Additional large studies are needed to confirm these preliminary results.
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http://dx.doi.org/10.1111/j.1464-410X.2010.09459.xDOI Listing
December 2010

New advances in clinical biomarkers in testis cancer.

Front Biosci (Elite Ed) 2010 Jan 1;2:456-77. Epub 2010 Jan 1.

Department of Urology, University of Messina, Italy.

Diagnostic work-up when a testicular cancer is suspected includes a clinical examination, determination of risk factors, imaging and serum tumours markers. Tumour markers are useful in the diagnosis and staging of disease, for monitor the therapeutic response and to detect tumour recurrence. The alpha- fetoprotein (AFP) and beta-human chorionic gonadotropin (beta-hCG) are well established as serum markers for GCTs of the testis, lactate dehydrogenase (LDH) and placental-like alkaline phosphatase (PLAP) may be alternative serological markers with less specifity. However, these markers are increased in only about 60 per cent of patients with testicular cancer. Therefore, additional tumour markers would facilitate clinical diagnosis and treatment in these patients. In this review we have evaluated the clinical application of several markers of testis cancers in serum, semen and tissue samples. Immunohistochemistry detection of some of these being solid new markers in addition to the routinely used but none have been shown to be superior to the classical markers in serum and semen samples. Further research is need in this context for the detection of new markers.
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http://dx.doi.org/10.2741/e105DOI Listing
January 2010