Publications by authors named "Vito Mancini"

39 Publications

Preserving ejaculatory function in young patients with lower urinary tract symptoms: medium- to long-term follow-up of prostatic urethral lift at a single center.

Ther Adv Urol 2021 Jan-Dec;13:17562872211037109. Epub 2021 Jul 31.

Department of Urology and Organ Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy.

Background And Aims: Prostatic urethral lift (Urolift™) is a minimally invasive technique to treat male lower urinary tract symptoms (LUTSs) due to benign prostatic hyperplasia (BPH). The aim of the present study was to assess safety and medium- to long-term outcomes in the relief of urinary symptoms.

Methods: We included 35 men, affected by severe symptomatic BPH evaluated by International Prostate Symptom Score (IPSS), with normal erectile function (EF) and ejaculatory function (EjF) evaluated by the International Index of Erectile Dysfunction (IIEF-5) and Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD-SF). Exclusion criteria were prostate larger than 70 cm, bladder neck sclerosis, concomitant third prostatic lobe, and/or other cervical urethral obstruction or cancer. All patients, preoperatively, performed uroflowmetry (UFM) with peak flow (Q-max) and post void residual volume (PVR), digital rectal exam, transrectal prostate ultrasound to measure prostate volume, PSA, and cystoscopy. Follow-up was scheduled at 1-3-6 months, then yearly, evaluating UFM, IPSS, IIEF-5, and MSHQ-EjD-SF.

Results: All procedures were performed by a single senior surgeon and follow-up was 33.8 ± 12 months. Preoperative PSA was 0.82 ± 0.4 ng/ml and mean operative time was 19.6 ± 10 min and 3 (2-4) implants per patient were used. Parameters reported at last follow-up schedule were: Q-max increase of 68% ( = 0.001), PVR reduction 68% ( = 0.005), and IPSS reduction 55% ( < 0.0001). EF and EjF were similarly preserved, and no patients presented retrograde ejaculation. A total of 88.6% of patients were satisfied with LUTSs improvement and 100% satisfied with EjF.

Conclusion: Urolift can improve urinary disorders secondary to BPH, preserving EjF and EF. It is a safe and easy method, reproducible, and with low incidence of complications. Careful selection of patients is mandatory. The main reason for dissatisfaction is the higher expectation of better BPH symptoms relief although patients with high bladder neck and/or prostate volume >45 cm were aware of the possible failure.
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http://dx.doi.org/10.1177/17562872211037109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8326815PMC
July 2021

Translabial ultrasound: a non-invasive technique for assessing "technical errors" after TOT failure.

Int Urogynecol J 2021 Jun 30. Epub 2021 Jun 30.

Department of Surgical and Biomedical Science, Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Viale Tristano di Joannuccio, 05100, City Terni, TR, Italy.

Introduction And Hypothesis: The aims of this study were to evaluate by transperineal ultrasound if there were ultrasound-detectable changes over time in the dynamic behavior of the sling in patients who underwent transobturator tape (TOT), and to evaluate if dynamic translabial ultrasonography recognized factors that may be associated with failed surgery.

Methods: This was a single-center prospective study. We included women who underwent "out-in" TOT for stress urinary incontinence (SUI). A dynamic translabial ultrasound was performed 6 months post-surgery and again at the last visit. The objective cure for SUI was defined as the absence of urine leakage during the stress test. We evaluated the bladder neck mobility at rest and during Valsalva; the position of the mesh along the urethra; the concordance of urethral movement with the sling during Valsalva; the symmetry of the lateral arms of the sling during straining; and the presence or absence of bladder neck funneling.

Results: From December 2012 to February 2016, 80 consecutive patients were included. Six months after surgery, incontinent women compared with continent women had the sling in a proximal or distal position, that moved discordantly with the urethra (p < 0.0001), with asymmetry arm and bladder neck funneling (p < 0.0001). Continent patients had a significant improvement of urethrocele grade both at rest (p = 0.036) and during Valsalva (p = 0.045).

Conclusions: Technical and positioning errors can lead to the failure of anti-incontinence surgical treatment. Translabial ultrasound allows the correct positioning of the sling to be evaluated and any errors that need to be analyzed in order to then solve the failure.
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http://dx.doi.org/10.1007/s00192-021-04897-6DOI Listing
June 2021

PSA Density Help to Identify Patients With Elevated PSA Due to Prostate Cancer Rather Than Intraprostatic Inflammation: A Prospective Single Center Study.

Front Oncol 2021 20;11:693684. Epub 2021 May 20.

Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.

The association between PSA density, prostate cancer (PCa) and BPH is well established. The aim of the present study was to establish whether PSA density can be used as a reliable parameter to predict csPCa and to determine its optimal cutoff to exclude increased PSA levels due to intraprostatic inflammation. This is a large prospective single-center, observational study evaluating the role of PSA density in the discrimination between intraprostatic inflammation and clinically significant PCa (csPCa). Patients with PSA ≥ 4 ng/ml and/or positive digito-rectal examination (DRE) and scheduled for prostate biopsy were enrolled. Prostatic inflammation (PI) was assessed and graded using the Irani Scores. Multivariable binary logistic regression analysis was used to assess if PSA density was associated with clinically significant PCa (csPCa) rather than prostatic inflammation. A total of 1988 patients met the inclusion criteria. Any PCa and csPCa rates were 47% and 24% respectively. In the group without csPCa, patients with prostatic inflammation had a higher PSA (6.0 vs 5.0 ng/ml; p=0.0003), higher prostate volume (58 vs 52 cc; p<0.0001), were more likely to have a previous negative biopsy (29% vs 21%; p=0.0005) and a negative DRE (70% vs 65%; p=0.023) but no difference in PSA density (0.1 vs 0.11; p=0.2). Conversely in the group with csPCa, patients with prostatic inflammation had a higher prostate volume (43 vs 40 cc; p=0.007) but no difference in the other clinical parameters. At multivariable analysis adjusting for age, biopsy history, DRE and prostate volume, PSA density emerged as a strong predictor of csPCA but was not associated with prostatic inflammation. The optimal cutoffs of PSA density to diagnose csPCa and rule out the presence of prostatic inflammation in patients with an elevated PSA (>4 ng/ml) were 0.10 ng/ml in biopsy naïve patients and 0.15 ng/ml in patients with a previous negative biopsy. PSA density rather than PSA, should be used to evaluate patients at risk of prostate cancer who may need additional testing or prostate biopsy. This readily available parameter can potentially identify men who do not have PCa but have an elevated PSA secondary to benign conditions.
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http://dx.doi.org/10.3389/fonc.2021.693684DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173030PMC
May 2021

The Impact of Lockdown on Couples' Sex Lives.

J Clin Med 2021 Apr 1;10(7). Epub 2021 Apr 1.

Department of Surgical and Biomedical Science, Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, 05100 Terni, Italy.

Background: the aim of this study was to perform an Italian telematics survey analysis on the changes in couples' sex lives during the coronavirus disease 2019 (COVID-19) lockdown.

Methods: a multicenter cross sectional study was conducted on people sexually active and in stable relationships for at least 6 months. To evaluate male and female sexual dysfunctions, we used the international index of erectile function (IIEF-15) and the female sexual function index (FSFI), respectively; marital quality and stability were evaluated by the marital adjustment test (items 10-15); to evaluate the severity of anxiety symptoms, we used the Hamilton Anxiety Rating Scale. The effects of the quarantine on couples' relationships was assessed with questions created in-house.

Results: we included 2149 participants. The sex lives improved for 49% of participants, particularly those in cohabitation; for 29% it deteriorated, while for 22% of participants it did not change. Women who responded that their sex lives deteriorated had no sexual dysfunction, but they had anxiety, tension, fear, and insomnia. Contrarily, men who reported deteriorating sex lives had erectile dysfunctions and orgasmic disorders. In both genders, being unemployed or smart working, or having sons were risk factors for worsening the couples' sex lives.

Conclusion: this study should encourage evaluation of the long-term effects of COVID-19 on the sex lives of couples.
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http://dx.doi.org/10.3390/jcm10071414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037775PMC
April 2021

Non-Muscle Invasive Bladder Cancer with Variant Histology: Biological Features and Clinical Implications.

Oncology 2021 18;99(6):345-358. Epub 2021 Mar 18.

Urology Unit, University of Foggia, Bonomo Teaching Hospital, Foggia, Italy.

Background: The most common bladder cancer (BC) histotype is pure urothelial carcinoma (UC), which may undergo divergent differentiation in some cases. Variant histology (VH) presents along variable morphologies, either single or combined between them or with pure UC. From a clinical standpoint, the vast majority of BC is diagnosed at non-invasive or minimally invasive stages, namely as non-muscle invasive BC (NMIBC). There is a wide range of therapeutic options for patients with NMIBC, according to their clinical and pathological features. However, current risk stratification models do not show optimal effectiveness. Evidence from the literature suggests that VH has peculiar biological features, and may be associated with poorer survival outcomes compared to pure UC.

Summary: In order to describe the biological features and prognostic/predictive role of VH in NMIBC, and to discuss current treatment options, we performed a systematic literature search through multiple databases (PubMed/Medline, Google Scholar) for relevant articles according to the following terms, single and/or in combination: "non-muscle invasive bladder cancer," "variant histology," "micropapillary variant," "glandular differentiation," "squamous differentiation," "nested variant," "plasmacytoid variant," and "sarcomatoid variant." We extracted 99 studies including original articles, reviews, and systematic reviews, and subsequently analyzed data from 16 studies reporting on the outcome of NMIBC with VH. We found that the relative rarity of these forms as well as the heterogeneity in study populations and therapeutic protocols results in conflicting findings overall. Key Messages: The presence of VH should be taken into account when counseling a patient with NMIBC, since it may upgrade the disease to high-risk tumor and thus warrant a more aggressive treatment.
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http://dx.doi.org/10.1159/000514759DOI Listing
June 2021

Peyronie's disease may negatively impact the sexual experience of a couple and female sexual function: a single center study.

Transl Androl Urol 2021 Feb;10(2):555-562

Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy.

Background: Peyonie's disease (PD) mostly affects males in the fifth decade of life, with a prevalence in the general population ranging between 0.5% and 20.3%. The pathology of PD is characterized by fibrosis of the tunic albuginea of the cavernous bodies of the penis, with the presence of pain in the erection and penile deformity. This is associated with decreased sexual function for both participants. The objective of the study was to investigate the influence of PD pathology on both male patients' and their female partners' sexual spheres, and analyze changes in sexual function and perception following penile correction surgery.

Methods: Prospective study, we included male patients with PD and their female partner sexually active. Patients underwent corporoplasty with multiple plications. The male and female sexuality was evaluated before surgery and three months after male treatment by the Female sexual Function Index (FSFI); International Index of Erectile Function (IIEF); Visual Analogical Scale (VAS).

Results: From January 2018 to November 2019 we included 35 couple. The female subjects before partner's surgery presented dyspareunia, loss of sexual desire, inability to achieve orgasm, and sexual dissatisfaction. At three months after surgical treatment there was an improvement of sexual function in both male patients and female partners (desire P<0.0001, arousal P<0.0001, lubrification P<0.0001, orgasm P<0.0001, satisfaction P<0.0001, pain P<0.0001). As regarding male patients the pain decreased significantly (VAS score from 6 to 2.5), while there was no statistically significant improvement in erectile function (P=0.05).

Conclusions: Our findings suggest that a viable approach to treatment of PD patients that involves their partners could lead to better functional and psychological results.
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http://dx.doi.org/10.21037/tau-20-1067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947445PMC
February 2021

A misdiagnosis of mesh extrusion treated as a psychiatric female pelvic pain.

Urologia 2020 Nov 27:391560320974890. Epub 2020 Nov 27.

Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy.

Introduction: Complications due to prosthetic surgery with mesh implantation may be misunderstood due to the insidious clinical presentation and inexperience of many surgeons if not adequately trained for the purpose.

Case Report: A 45-year-old female underwent a trans obturator tape procedure to correct severe stress urinary incontinence 3 months after surgery she developed urethral pain. The sling was partially removed, but the pain persisted. No residue sling was visualized by cystoscopies after surgery, and the pain was attributed to a psychiatric problem. She was treated with opioids, pregabalin without improvement of pain, until an extrusion of the sling into the urethra has been diagnosed by a careful urethrocystoscopy.

Conclusion: It has been treated in our department by the removal of the residual sling, plus urethroplasty. The patient was followed up at 6 months with resolution of the painful symptoms.
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http://dx.doi.org/10.1177/0391560320974890DOI Listing
November 2020

Early and Late Efficacy on Wound Healing of Silver Nanoparticle Gel in Males after Circumcision.

J Clin Med 2020 Jun 11;9(6). Epub 2020 Jun 11.

Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy.

We evaluate the early and late safety and efficacy of silver nanoparticle (AgNPs) in wound healing after circumcision. This multicenter prospective comparative non-randomized observational study compares wound dressing with AgNPs (group A) vs. gentamicin cream (group B). Follow-up included objective evaluation at 10 and 30 days by the Southampton Scoring System (SSS) and Stony Brook Scar Evaluation Scale (SBSES). We enrolled 392 males: 194 in group A, and 198 in group B. At 10 days follow-up, in group A, the SSS scale was grade 1 in 49.5% and grade 2 in the remaining; meanwhile, in group B, grade 1 was in 58%, grade 2 in 34.3%, and grade 4 in 7.6%. At 30 days follow-up, grade 1 healing was 97.4% and 98.4% in group A and B, respectively. At 10 days follow-up, the mean SBSES score was 3.58 and 3.69 in group A and B, respectively; while at 30 days follow-up, 4.81 and 4.76 in group A and B, respectively. Only in group B did 7.6% of males have antibiotic therapy due to pus discharge. No patients needed surgical wound revision. AgNPs led to a late but safer healing, they were non-inferior to the antibiotic cream wound dressing efficacy, and they avoided pus discharge and the need for oral antibiotics due to their polymer material.
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http://dx.doi.org/10.3390/jcm9061822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356923PMC
June 2020

PTX3 modulates the immunoflogosis in tumor microenvironment and is a prognostic factor for patients with clear cell renal cell carcinoma.

Aging (Albany NY) 2020 04 28;12(8):7585-7602. Epub 2020 Apr 28.

Clinical Pathology Unit and Center of Molecular Medicine, Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 71122, Foggia, Italy.

Pentraxin-3 (PTX3) belongs to the pentraxine family, innate immune regulators involved in angiogenesis, proliferation and immune escape in cancer. Here, we evaluated PTX3 tissue expression and serum levels as biomarkers of clear cell renal cell carcinoma (ccRCC) and analyzed the possible role of complement system activation on tumor site. A 10-year retrospective cohort study including patients undergoing nephrectomy for ccRCC was also performed. PTX3 expression was elevated in both neoplastic renal cell lines and tissues, while it was absent in both normal renal proximal tubular cells (HK2) and normal renal tissues. Analysis of complement system activation on tumor tissues showed the co-expression of PTX3 with C1q, C3aR, C5R1 and CD59, but not with C5b-9 terminal complex. RCC patients showed higher serum PTX3 levels as compared to non-neoplastic patients (p<0.0001). Higher PTX3 serum levels were observed in patients with higher Fuhrman grade (p<0.01), lymph node (p<0.0001), and visceral metastases (p<0.001). Patients with higher PTX3 levels also showed significantly lower survival rates (p=0.002). Our results suggest that expression of PTX3 can affect the immunoflogosis in the ccRCC microenvironment, by activating the classical pathway of CS (C1q) and releasing pro-angiogenic factors (C3a, C5a). The up-regulation of CD59 also inhibits the complement-mediated cellular lysis.
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http://dx.doi.org/10.18632/aging.103169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202504PMC
April 2020

Is coexistent overactive-underactive bladder (with or without detrusor overactivity and underactivity) a real clinical syndrome? ICI-RS 2019.

Neurourol Urodyn 2020 07 7;39 Suppl 3:S50-S59. Epub 2020 Feb 7.

Bristol Urological Institute, University of Bristol, Bristol, United Kingdom.

Aims: Lower urinary tract symptoms (LUTS) can be classified into symptom syndromes based on which symptoms are predominant. Overactive bladder (OAB) syndrome, a storage dysfunction, and underactive bladder (UAB) syndrome, a voiding dysfunction, are common syndromes, which urodynamic tests may show to be caused by detrusor overactivity (DO) and detrusor underactivity (DU), but can also be associated with other urethro-vesical dysfunctions. Sometimes OAB and UAB can coexist in the same patient and, if so, need a specific approach beyond treatment of the single and apparently opposing syndromes.

Methods: During its 2019 meeting in Bristol, the International Consultation on Incontinence Research Society held a literature review and expert consensus discussion focused on the emerging awareness of the coexisting overactive-underactive bladder (COUB).

Results: The consensus considered whether COUB is the combination of OAB and UAB syndromes, or a real unique clinical syndrome in the same patient, possibly with a common etiology. Definitions, pathophysiology, diagnosis, and treatment were discussed, and high-priority research questions were identified.

Conclusions: COUB (with or without urodynamic evidence of DO and DU) may be considered a real clinical syndrome, because it differs from single OAB and UAB, and may not be the combination of both syndromes. Urodynamic tests may be necessary in unclear cases or in cases not responding to initial treatment of the most troublesome symptoms. It is pivotal to define the evolution of the syndrome and the characteristic population, and to recognize predictive or phenotyping factors to develop a specific approach and adequate outcome measures.
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http://dx.doi.org/10.1002/nau.24311DOI Listing
July 2020

Urethral bulking agents for the treatment of female stress urinary incontinence.

Int Urogynecol J 2020 08;31(8):1493-1494

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

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http://dx.doi.org/10.1007/s00192-019-04221-3DOI Listing
August 2020

How can we better manage drug-resistant OAB/DO? ICI-RS 2018.

Neurourol Urodyn 2019 12;38 Suppl 5:S46-S55

Department of Urology, Guy's Hospital & King's College School of Medicine, London, United Kingdom.

Aims: Botulinum toxin A (BTX-A), sacral nerve stimulation (SNM), and posterior tibial nerve stimulation (PTNS) are established treatments for idiopathic overactive bladder (OAB) refractory to oral drug therapy. At the ICI-RS meeting in Bristol in 2018 a think tank was convened to address the question of how to better manage drug-resistant OAB/DO (detrusor overactivity).

Methods: The think tank conducted a literature review and an expert consensus meeting focusing on the evidence for predicting response and adverse events (AEs) with the current therapies for drug-resistant idiopathic OAB.

Results: Several factors have been associated with poor outcomes using BTX-A including increasing age, body mass index, male sex, and frailty. Voiding dysfunction with BTX-A also appears to be more prevalent in those with increasing age, male sex, higher baseline postvoid residual and with poorer contractility as assessed by urodynamic parameters. SNM full implantation appears to be higher with the first stage tined lead placement procedure compared to percutaneous nerve evaluation. Urodynamics do not appear to predict outcomes with SNM. Patients with psychiatric comorbidity are more likely to experience AEs with SNM. Outcomes related to lead positioning and the number of active electrodes are mixed in predicting long term success. Patients with increased daytime frequency and lower first sensation of bladder filling were independent factors associated with success with PTNS.

Conclusions: Further research is required to optimize these procedures and to better understand which patients will benefit from the various options available in managing refractory OAB.
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http://dx.doi.org/10.1002/nau.24055DOI Listing
December 2019

A Prospective Comparative Study of the Feasibility and Reliability of Telephone Follow-Up in Female Urology: The Patient Home Office Novel Evaluation (PHONE) Study.

Urology 2020 Feb 11;136:82-87. Epub 2019 Nov 11.

Dept. of Urology Azienda Ospedaliera Universitaria Integrata, Verona, Italy.

Objective: To determinate the feasibility, reliability, and patient satisfaction of telephonic follow-up in women treated for stress urinary incontinence (SUI) or pelvic organ prolapse (POP): Patient-Home-Office-Novel-Evaluation (PHONE) study.

Methods: This is a prospective comparative study in women following surgery for SUI underwent middle urethral sling (MUS) (Group A), or symptomatic anterior vaginal wall (AVW) defect underwent AVW repair (fascial/mesh/biomesh) (Group B). The 1-year follow-up included a telephonic interview using a checklist and validated questionnaires followed by a standard outpatient clinic visit 7-12 days later including: an interview, validated questionnaires, objective examination, and score satisfaction with the telephone follow-up.

Results: We enrolled 420 pts: 215 for SUI in Group A, and 205 for POP in Group B. SUI recurrence was 19.1% and 11.6% at the telephone and office follow-up, respectively. De-novo urgency urinary incontinence rate was 7.5%. Telephone follow-up was able to detect POP recurrence and related symptoms. Tape and mesh extrusions were detected only at the objective evaluation: 1.9% and 4.4% respectively. No difference was found at the questionnaires. Satisfaction with the telephone follow-up was high.

Conclusion: Due to the wrongly interpretation of de-novo urge urinary incontinence as a recurrence of SUI, a telephone interview may lose reliability in case of reported incontinence. Thus, telephone follow-up was feasible and reliable in women not reporting incontinence. In patients treated for POP the phone interview was a valid tool only in case of no-prosthetic surgery due to the absence of extrusion in these cases.
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http://dx.doi.org/10.1016/j.urology.2019.10.021DOI Listing
February 2020

The impact of age on intravesical instillation of Bacille Calmette-Guerin treatment in patients with high-grade T1 bladder cancer.

Medicine (Baltimore) 2019 Aug;98(31):e16223

Department of Urology and Renal Transplantation.

Intravesical instillation of Bacille Calmette-Guèrin (BCG) is the standard adjuvant treatment for high-risk non muscle invasive bladder cancer (NMIBC). Since its mechanism of action is supposed to be linked to the immune system efficiency and senescence could negatively affect this efficiency, BCG efficacy in the elderly has been questioned. This study aimed to assess the impact of age on BCG efficacy and safety in patients with high-grade T1 bladder cancer (BC).Among 123 patients with high-grade T1 BCG scheduled for BCG treatment, 82 were <75 year-old (group A) and 41 were ≥75 year-old (group B). Follow-up: urine cytology and cystoscopy every 3 months for the first 2 years, every 6 months for the third year, and then yearly. Tumor recurrence was defined as pathological evidence of disease at the bladder biopsy; tumor progression was defined as pathological shift to muscle invasive disease at the bladder biopsy or the imaging techniques showing recurrent BC and distant metastasis likely related to it.The median follow-up was 65 months (range 11-152). Recurrence occurred in 35 patients, 19 (23.2%) in the group A and 16 (39%) in the group B. Progression occurred in 18 patients, 12 (14.6%) in the group A and 6 (14.6%) in the group B. Recurrence free rate was similar in both groups up to 2 years. The 5 years progression rate was almost the same in both groups A and B (85.9% vs 84.7%), whereas the 5 years cancer-specific survival (CSS) was 92.6% in the group A and 85.4% in the group B. Of the 18 patients with progression, 11 underwent cystectomy; 12 patients died because of their BC. Kaplan-Meier plots pointed out no difference in recurrence-free, progression-free, and CSS between the 2 groups. Adverse events were similar in the 2 groups. Only 4 (3.3%) patients, 2 (2.4%) in the group A and 2 (4.8%) in the group B, experienced mild adverse reactions compatible with treatment.Elderly patients with high-grade T1 BC are not poorer candidates to BCG treatment, as they had similar benefit and adverse reactions than those aging ≥75 years.
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http://dx.doi.org/10.1097/MD.0000000000016223DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708772PMC
August 2019

Impact of Overactive Bladder-Wet Syndrome on Female Sexual Function: A Systematic Review and Meta-Analysis.

Sex Med Rev 2019 10 17;7(4):565-574. Epub 2019 Jul 17.

Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.

Introduction: Overactive bladder (OAB) is subtyped into OAB-wet and OAB-dry, based on the presence or absence, respectively, of urgency incontinence. Although women with OAB frequently have a higher risk for sexual dysfunction, a systematic review on the impact of OAB-wet on female sexuality is lacking. This may be evaluated by measuring the effect of the bladder condition on sexuality per se, or by the effect of OAB treatment on female sexual dysfunction.

Aim: To assess the role of OAB-wet on female sexual function.

Methods: A systematic review of the literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Research on PubMed, EMBASE, and SCOPUS was performed and concluded on October 15, 2018. A systematic computerized search was conducted on published literature from January 1, 2000-2018. Meta-analysis was performed with a meta-analysis program.

Main Outcomes Measures: The following search terms were used: ((("female sexual function") OR ("female sexual dysfunction") OR ("female sexuality") OR ("dyspareunia")) AND (("overactive bladder") OR ("coital incontinence") OR ("detrusor instability") OR ("detrusor overactivity") OR ("urge urinary incontinence") OR (onabotulinumtoxinA) OR ("botulinum") OR ("sacral neuromodulation") OR (SNM) OR (PTNS) OR ("stoller afferent neuro-stimulation") OR ("SANS") OR ("antimuscarinic drugs") OR ("anticholinergic") OR ("peripheral neuromodulation") OR (beta-agonist))).

Results: 1,033 references were reviewed for inclusion and exclusion criteria. Final analysis identified 12 articles for systematic review. OAB-wet was reported as the most affecting factor on sexuality. OAB treatments showed improvement of both the OAB-wet and the sexual function. Results of the meta-analysis suggested that OAB therapies improving OAB-wet significantly reduced female sexual dysfunction (odds ratio 0.19; 95% CI 0.26-0.45).

Conclusion: OAB-wet represents a risk for sexual dysfunction; however, data available show low-quality evidence of the impact of OAB-wet on sexual dysfunction. Balzarro M, Rubilotta E, Mancini V, et al. Impact of Overactive Bladder-Wet Syndrome on Female Sexual Function: A Systematic Review and Meta-Analysis. Sex Med Rev 2019;7:565-574.
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http://dx.doi.org/10.1016/j.sxmr.2019.05.002DOI Listing
October 2019

Prognostic and therapeutic role of HER2 expression in micropapillary carcinoma of the bladder.

Mol Clin Oncol 2019 Feb 7;10(2):205-213. Epub 2018 Dec 7.

Department of Urology and Renal Transplantation, University Hospital, I-71121 Foggia, Italy.

Micropapillary carcinoma of the bladder (MPBC) is a variant type of infiltrating urothelial carcinoma, which portends a poor biological behavior in terms of disease stage at first diagnosis and clinical outcome; its peculiar morphology raises issues concerning the ability of tumor detection by imaging techniques and proper biopsy procedure, and the appropriate treatment for non-muscle infiltrating and muscle-infiltrating MPBC remains a matter of debate. On the basis of its established prognostic and therapeutic role in breast and gastro-esophageal cancer in the first instance, the human epidermal growth factor receptor-2 (HER2) has been investigated in selected case series of MPBC over the last 10 years. The aim of the present review was to summarize the existing evidence on HER2 status in MPBC, and to discuss its present and future utility in risk assessment and treatment choice of this uncommon, yet aggressive, disease.
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http://dx.doi.org/10.3892/mco.2018.1786DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327213PMC
February 2019

Combined Plaque Incision, Buccal Mucosa Grafting, and Additional Tunica Albuginea Plication for Peyronie's Disease.

Sex Med 2019 Mar 11;7(1):48-53. Epub 2018 Dec 11.

Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.

Introduction: Surgery remains the gold standard for treatment in stable patients with penile deformity associated to Peyronie's disease (PD).

Aim: To evaluate the long-term results of plaque incision and buccal mucosa grafting (BMG), with or without additional tunica albuginea plication (TAP), in the correction of severe penile curvatures secondary to PD.

Methods: 72 patients with severe curvature caused by PD, normal erections, and stable disease entered this prospective study. Preoperatively, they underwent penile duplex ultrasounds with measurement of curvature and length of affected side. All procedures were carried out by 1 surgeon. Patients were seen at 1, 3, 6, and 12 months postoperatively, then yearly. Subjective outcome was assessed by the Sexual Encounter Profile (SEP) questionnaire, and objective outcome was assessed by an intracavernous injection (ICI) test performed within the first year for evaluating penile rigidity, straightness, and length.

Main Outcome Measure: Long-term outcomes include penile straightening, penile shortening, and sexual satisfaction.

Results: Mean curvature was 71.32 ± 17.6° (range 40-110); 33 (45.8%) patients had a 2-sided curvature with a mean second curvature of 33.79 ± 12.2° (range 10-60). Additional TAP was needed in 60% of patients for complete straightening or graft stretching. All patients resumed unassisted intercourse 1 month after surgery; 4 (5.5%) refused follow-up, claiming excessive penile shortening. In the remaining 68, the ICI test showed no recurvature, shortening, or de novo erectile dysfunction. At mean follow-up of 62.01 ± 34.3 months (range 12-135), all were able to obtain an erection (SEP-1), 97.1% to penetrate (SEP-2), and 89.7% to successfully complete intercourse (SEP-3); 80.9% of them were satisfied with erection hardness (SEP-4) and 86.8% were overall satisfied (SEP-5), with the main reason for dissatisfaction being expectation of better length and rigidity.

Conclusion: BMG, with or without TAP, provides excellent long-term results and is safe and reproducible, representing a valuable treatment option for PD, but great care should be taken in patient counseling to avoid unrealistic expectations. Cormio L, Mancini V, Massenio P. Combined Plaque Incision, Buccal Mucosa Grafting, and Additional Tunica Albuginea Plication for Peyronie's Disease. Sex Med 2019;7:48-53.
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http://dx.doi.org/10.1016/j.esxm.2018.11.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6377369PMC
March 2019

Morphological and Immunohistochemical Biomarkers in Distinguishing Prostate Carcinoma and Urothelial Carcinoma: A Comprehensive Review.

Int J Surg Pathol 2019 Apr 3;27(2):120-133. Epub 2018 Dec 3.

1 University Hospital, Foggia, Italy.

The differential diagnosis between high-grade prostate carcinoma and infiltrating urothelial carcinoma (UC) in transurethral resection prostate specimens as well as cystoprostatectomy specimens may often be challenging due to morphologic and clinical overlap of the 2 entities. Such distinction has critical therapeutic and staging consequences, yet it is hampered by both issues in morphology and by the low accuracy rates of single immunohistochemical markers, as reported in literature. This review aims to provide a comprehensive analysis of the available morphological and immunohistochemical parameters, which may allow to discriminate between prostate carcinoma and urothelial carcinoma in the proper clinical context and to discuss their diagnostic applications in daily practice.
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http://dx.doi.org/10.1177/1066896918814198DOI Listing
April 2019

Human Epidermal Growth Factor Receptor 2 in Non-Muscle Invasive Bladder Cancer: Issues in Assessment Methods and Its Role as Prognostic/Predictive Marker and Putative Therapeutic Target: A Comprehensive Review.

Urol Int 2019 21;102(3):249-261. Epub 2018 Nov 21.

Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.

Although human epidermal growth factor receptor 2 (HER2) plays a prognostic and predictive role in breast and gastric cancer, its function in bladder cancer (BC) is still controversial. A comprehensive review of the literature has been carried out. An electronic search of databases from PubMed, Scopus, Google Scholar was implemented. The search terms were: "BC," "bladder carcinoma," "bladder neoplasm," "human epidermal growth factor 2," "HER2," "HER-2," "c-erbB-2," "c-erbB2," "erbB-2," "erbB2," "neu," "marker," "biomarker," and "prognosis". Results of the review consented to (a) summarize the available data on HER2 a predictor of recurrence and/or progression free survival on univariate and multivariate analysis, (b) explore the related issues in assessing HER2 status on these tumor samples, since they may severely impair its predictive function, and (c) report the state-of-the art of HER2 as a putative therapeutic target in BC and especially non-muscle invasive BC. HER2 stands out for being a prognostic factor as well as a therapeutic target in various cancers. Data from the literature concerning its use in BC provide conflicting results, probably due to the inherent complexity of BC biology. Efforts should be made to establish a suitable tumor-specific scoring system, and to assess single drugs' efficacy in well-designed clinical trials.
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http://dx.doi.org/10.1159/000494359DOI Listing
December 2019

Development and Internal Validation of Novel Nomograms Based on Benign Prostatic Obstruction-Related Parameters to Predict the Risk of Prostate Cancer at First Prostate Biopsy.

Front Oncol 2018 16;8:438. Epub 2018 Oct 16.

Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.

The present study aimed to determine the ability of novel nomograms based onto readily-available clinical parameters, like those related to benign prostatic obstruction (BPO), in predicting the outcome of first prostate biopsy (PBx). To do so, we analyzed our Internal Review Board-approved prospectively-maintained PBx database. Patients with PSA>20 ng/ml were excluded because of their high risk of harboring prostate cancer (PCa). A total of 2577 were found to be eligible for study analyses. The ability of age, PSA, digital rectal examination (DRE), prostate volume (PVol), post-void residual urinary volume (PVR), and peak flow rate (PFR) in predicting PCa and clinically-significant PCa (CSPCa)was tested by univariable and multivariable logistic regression analysis. The predictive accuracy of the multivariate models was assessed using receiver operator characteristic curves analysis, calibration plot, and decision-curve analyses (DCA). Nomograms predicting PCa and CSPCa were built using the coefficients of the logit function. Multivariable logistic regression analysis showed that all variables but PFR significantly predicted PCA and CSPCa. The addition of the BPO-related variables PVol and PVR to a model based on age, PSA and DRE findings increased the model predictive accuracy from 0.664 to 0.768 for PCa and from 0.7365 to 0.8002 for CSPCa. Calibration plot demonstrated excellent models' concordance. DCA demonstrated that the model predicting PCa is of value between ~15 and ~80% threshold probabilities, whereas the one predicting CSPCa is of value between ~10 and ~60% threshold probabilities. In conclusion, our novel nomograms including PVR and PVol significantly increased the accuracy of the model based on age, PSA and DRE in predicting PCa and CSPCa at first PBx. Being based onto parameters commonly assessed in the initial evaluation of men "prostate health," these novel nomograms could represent a valuable and easy-to-use tool for physicians to help patients to understand their risk of harboring PCa and CSPCa.
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http://dx.doi.org/10.3389/fonc.2018.00438DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198078PMC
October 2018

Retrograde Intrarenal Surgery for Symptomatic Renal Sinus Cysts: Long-Term Results and Literature Review.

Urol Int 2018 2;101(2):150-155. Epub 2018 May 2.

Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.

Introduction: To report the long-term multicenter experience with retrograde intrarenal holmium-laser incision (RIR-HoLI) in the management of symptomatic renal sinus cysts (RSCs). In the literature, RIR-HoLI has been shown to be a safe and effective treatment, but there are only a few reports regarding long-term results and reproducibility of this procedure.

Material And Methods: From June 2010 to June 2015, 14 patients with symptomatic RSCs underwent RIR-HoLI. The mean age was 52.1 ± 11.28 years (range 28-77) and the mean cyst size was 53.2 ± 14.23 mm (range 35-90). In all cases, contrast-enhanced computer tomography (CT) showed compression of the renal pelvis by the cyst (no malignancy). Surgical outcome was assessed in terms of symptoms improvement (measured by Visual Analogue Scale [VAS] for pain) and renal ultrasound findings at 3-6-12 months postoperatively and then yearly. CT scan was carried out at 12 months follow-up.

Results: RIR-HoLI was successful in all patients. The mean operative time was 47.8 ± 13.54 min (range 30-80) and mean hospital stay was 3.5 days (range 2-5). There were 2 Clavien grade II complications (flank pain and urgency delaying discharge). After surgery, all patients -became asymptomatic (VAS score change, p = 0.0001). One patient had persistence of a small cyst (10 mm). Mean follow-up is 44 ± 17.24 months (range 24-84); all patients remained asymptomatic, with no signs of recurrence.

Conclusions: RIR-HoLI proved to be a safe and effective treatment for symptomatic RSCs. In our experience, it provided excellent long-term results and was reproducible at 4 different -institutions.
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http://dx.doi.org/10.1159/000488685DOI Listing
December 2018

Asymptomatic solitary bladder plasmocytoma: A case report and literature review.

Medicine (Baltimore) 2017 Dec;96(50):e9347

Department of Urology and Renal Transplantation Department of Pathology, University of Foggia, Foggia, Italy.

Rationale: Solitary extramedullary plasmocytoma may arise in any organ, either as a primary tumor or as part of a systemic myeloma; if it rarely affects bladder, it presents with urinary symptoms. We describe the first case of asymptomatic BP occasionally diagnosed in a patient with ascites.

Patient Concerns: A 74-year-old woman with hepatitis C virus (HCV)-related liver cirrhosis presented with ascites and no urinary or other symptoms.

Diagnoses: Routine blood tests were within normal ranges, except for mild elevation of transaminases due to chronic hepatitis. Abdominal ultrasound and computed tomography (CT) scanning showed multiple liver nodules suspected for carcinomas and, incidentally, a 18 mm solid lesion of right bladder wall.

Outcomes: She underwent transurethral resection of the bladder tumor and percutaneous liver biopsies; final diagnosis was solitary bladder plasmocytoma (BP) and hepatocellular carcinoma (HCC), respectively. She was given chemoembolization of the main HCC nodule but no adjuvant treatment for BP. At 3-month follow-up, total-body CT showed no signs of bladder disease nor distant metastases; unfortunately, she died one month later due to liver failure.

Lessons: This is the first reported case of asymptomatic BP. This rare neoplasm may pose difficulties in differential diagnosis with both bladder metastases and the plasmocytoid variant of bladder transitional cell carcinoma. We also highlighted lack of factors predicting disease outcome as well as response to potential adjuvant treatments.
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http://dx.doi.org/10.1097/MD.0000000000009347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815820PMC
December 2017

Evolving concepts and use of immunohistochemical biomarkers in flat non-neoplastic urothelial lesions: WHO 2016 classification update with diagnostic algorithm.

Biomarkers 2018 May - Jun;23(4):305-314. Epub 2018 Jan 25.

d Department of Urology and Renal Transplantation , University of Foggia , Foggia , Italy.

Context: The classification of flat non-neoplastic urothelial lesions has been evolved through the years in the attempt to better define a spectrum of morphologic entities with somewhat overlapping features. Differentiating these lesions is important because of differences in patient management and clinical outcome. Materials and methods and objective: A systematic review of the literature has been carried out in order to (1) assess the most striking clinical features of each lesion and (2) identify those morphological traits and immunophenotypical markers which may aid in the differential diagnosis.

Results And Conclusion: Our results point out the importance of a proper definition of flat non-neoplastic urothelial lesions in order to predict clinical behaviour and allow tailored patient management; therefore, we attempted to construct a novel and "easy to use" algorithm for a clear, standardized and evidence-based pathological diagnosis.
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http://dx.doi.org/10.1080/1354750X.2018.1428360DOI Listing
September 2018

Surgical management of female pelvic organ prolapse with and without urinary incontinence: A single center experience.

Medicine (Baltimore) 2017 Sep;96(39):e7914

Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.

The study reports a single center experience with surgical management of female pelvic organ prolapse (POP) with and without urinary incontinence.Between January 2006 and July 2016, 93 consecutive patients with anterior and/or apical symptomatic POP underwent abdominal sacrocolpopexy (ASC) or laparoscopic sacrocolpopexy (LSC) or pubovaginal cystocele sling (PCS); 25 patients had concomitant stress urinary incontinence (SUI). Subjective outcome was assessed by the Pelvic Floor Impact Questionnaire (short form) (PFIQ-7) investigating bladder, bowel and vaginal functions, sexual activity, and daily life. Objective outcomes included the POP anatomic correction by Baden Walker HWS classification, urinary tract infection (UTI) rates, urge urinary incontinence (UUI), and SUI rates. Data were prospectively collected.Forty-three patients underwent PCS, 29 ASC, and 21 LSC. Mean follow-up was 54.88 ± 33.1, 28.89 ± 23.5, and 16.8 ± 11.3 months for PCS, ASC, and LSC, respectively. POP recurrence occurred in 10.5%, 7.5%, and 0% while de novo (ie, in untreated compartment/s) POP occurred in 15.8%, 7.4%, and 4.8% of patients who have undergone PCS, ASC, and LSC, respectively. Kaplan-Meier estimates of POP-free survival showed no difference among the 3 procedures. All procedures significantly reduced PFIQ-7 scores improving quality of life and the rates of recurrent UTIs and concomitant UUI. PCS cured all cases with concomitant SUI; de novo SUI occurred only in 7.4% and 4.8% of patients who have undergone ASC and LSC, respectively. Mean surgical time was significantly shorter for PCS compared to ASC and LSC (P = .0001), and for ASC compared to LSC (P = .004); there was no difference in postoperative pain and hospital stay. Compared to ASC/LSC, PCS involved a higher rate (27.9% vs 6%; P = .01) of minor complications, mainly transient urinary retention, and a lower rate (0% vs 8%; P = .06) of complications requiring surgery.In this single center experience, PCS was not only provided similar subjective and objective results than ASC and LSC but also able to correct concomitant SUI without causing de novo SUI and was safer than other 2 techniques, in female POP repair.
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http://dx.doi.org/10.1097/MD.0000000000007914DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5626256PMC
September 2017

Prognostic Factors for Anastomotic Urinary Leakage Following Retropubic Radical Prostatectomy and Correlation With Voiding Outcomes.

Medicine (Baltimore) 2016 Apr;95(16):e3475

From the Department of Urology and Renal Transplantation (LC, GDF, VM, NR, OS, GC), University of Foggia, Foggia, Italy; Department of Radiology (CS, DM), San Carlo Hospital, Potenza, Italy; Department of Pathology (FS), University of Foggia, Foggia, Italy; Department of Internal Medicine (FB), University of Foggia, Foggia, Italy; and Department of Emergency and Organ Transplantation (GL), University of Bari, Bari, Italy.

This study aimed to determine the occurrence and grade of cystographically detected urinary leakage (UL) in a contemporary series of open retropubic radical prostatectomy (RP), whether patients' clinical variables predict occurrence of UL, and whether occurrence of UL correlates with patients' voiding outcomes in terms of urinary continence and anastomotic stricture (AS). Enrolled patients underwent cystography 7 days after retropubic RP; in case of UL, the catheter was left in situ and cystography repeated at 7 days intervals until demonstrating absence of UL. Leakage was classified as grade I = extraperitoneal leak <6 cm, grade II = extraperitoneal leak >6 cm, grade III = leak freely extending in the small pelvis. Voiding was evaluated at 3, 6, and 12 months after RP using the 24-hour pad test and uroflowmetry; in cases of maximum flow rate <10 mL/s, urethrocystoscopy was carried out to determine presence and location of an AS. The first postoperative cystogram showed UL in 52.6% of patients (grade I in 48.1%, grade II in 21.5%, and grade III in 30.4% of the cases). Multivariate analysis demonstrated that patients with UL had significantly greater prostate volume (64.5 vs 34.8 cc, P < 0.001), loss of serum hemoglobin (4.77 vs 4.19 g/dL, P < 0.001), lower postoperative serum total proteins (4.85 vs 5.4 g/dL, P < 0.001), and higher rate of AS (20.6% vs. 2.8%, p < 0.001) than those without UL. Continence rate at 3, 6, and 12 months postoperatively was 34.2%, 76%, and 90%, respectively, in patients with UL compared with 77.5%, 80.3%, and 93% in patients without UL; such difference was statistically significant (P < 0.001) only at 3 months follow-up. ROC curve analysis showed that prostate volume and postoperative serum total proteins had the best AUC (0.821 and 0.822, respectively) and when combined, their positive and negative predictive values for UL were 90% and 93%, respectively. In conclusion, half of the patients undergoing open retropubic RP may present, 7 days postoperatively, some degree of cystographically detected UL; prostate volume, loss of serum hemoglobin, and postoperative serum total proteins could be used to predict it. UL delayed return to urinary continence without affecting long-term results, but led to a significantly higher rate of AS.
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http://dx.doi.org/10.1097/MD.0000000000003475DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845855PMC
April 2016

Absence of Bladder Outlet Obstruction Is an Independent Risk Factor for Prostate Cancer in Men Undergoing Prostate Biopsy.

Medicine (Baltimore) 2016 Feb;95(7):e2551

From the Department of Urology (LC, GL, OS, GDF, VM, PM, FT, GC) and Renal Transplantation, University of Foggia, Foggia, Italy; Department of Emergency and Organ Transplantation (GL), University of Bari, Bari, Italy; and Department of Pathology (FS, PB), University of Foggia, Foggia, Italy.

The purpose of this study was to investigate the relationship between bladder outlet obstruction (BOO) and the risk of being diagnosed with prostate cancer (PCa).Study population consisted of 2673 patients scheduled for the first prostate biopsy (PBx). All patients underwent uroflowmetry before PBx; those with a peak flow rate (PFR) <10 mL/s were considered to have BOO.The incidence of PCa was 41.3% (1104/2673) in the overall population and 34.1% (659/1905) in patients with serum prostate-specific antigen (PSA) ≤ 10 ng/mL. Univariate and multivariate logistic regression analyses showed that patients with BOO had a significantly (P < 0.0001) lower risk than those without BOO of being diagnosed with PCa (33.1% vs 66.9% in the overall population; 30% vs 70% in patients with PSA ≤ 10 ng/mL). As the presence of BOO was significantly correlated to a large prostate volume, another independent predictor of PBx outcome, we tested whether these parameters could be used to identify, in the subset of patients with PSA≤10 ng/mL, those who could potentially be spared from a PBx. If we would have not biopsied patients with BOO and prostate volume ≥60 mL, 14.5% of biopsies could have been avoided while missing only 6% of tumors. Only 10% of the tumors that would have been missed were high-risk cancers.In conclusion, in men undergoing PBx, the absence of BOO, as determined by a PFR ≥10 mL/s, is an independent risk factor for PCa. Our study provides ground for this simple, noninvasive, objective parameter being used, alone or in combination with prostate volume, in the decision-making process of men potentially facing a PBx.
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http://dx.doi.org/10.1097/MD.0000000000002551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998598PMC
February 2016

Cystocele Repair by Autologous Rectus Fascia Graft: the Pubovaginal Cystocele Sling.

J Urol 2015 Sep 30;194(3):721-7. Epub 2015 Mar 30.

Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.

Purpose: The autologous rectus fascia pubovaginal sling has been a safe and effective means of correcting stress urinary incontinence. We tested the feasibility of using a larger graft to correct cystocele with or without stress urinary incontinence.

Materials And Methods: Between January 2006 and October 2010, 30 patients with symptomatic cystocele underwent the pubovaginal cystocele sling procedure, including 14 with and 16 without concomitant stress urinary incontinence. The technique is a modification of the standard pubovaginal sling procedure. A large trapezoidal (major base 6 cm, minor base 4 cm and height 5 cm) rectus fascia graft is used with 4 instead of 2 sutures to suspend the graft corners. The 2 sutures at the level of the mid urethra are tied above the rectus muscles in a tension-free manner while the 2 sutures at the level of the cervical fold are tied with tension. Data on anatomical outcomes (Baden-Walker classification), functional outcomes (PFIQ-7), post-void residual urine volume and urinary tract infection were prospectively collected.

Results: At a mean followup of 62.6 months (range 46 to 98) there was no recurrence in the anterior compartment. There was 1 recurrence involving the apical and posterior compartments. All patients reported a statistically significant improvement in PFIQ-7 score. When present preoperatively, post-void residual urine volume, urinary tract infection and stress urinary incontinence ceased in all cases. The only complication was donor site wound dehiscence without fascial involvement.

Conclusions: The autologous pubovaginal cystocele sling seems to be a safe, effective technique to correct cystocele with or without stress urinary incontinence.
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http://dx.doi.org/10.1016/j.juro.2015.03.104DOI Listing
September 2015

Simultaneous radical nephroureterectomy and transurethral distal ureter balloon occlusion and detachment.

World J Surg Oncol 2014 Nov 15;12:345. Epub 2014 Nov 15.

Department of Urology and Renal Transplantation, University of Foggia, Viale L Pinto 1, 71121 Foggia, Italy.

Background: Distal ureter bladder cuff (DUBC) excision is an essential part of radical nephroureterectomy (RNU) but there is no agreement on the ideal surgical technique to achieve it. We describe a novel technique for endoscopic DUBC excision during RNU that complies with the oncological principle of preventing spillage of tumor cells, by occluding the distal ureter before its excision, while shortening surgical time, and by avoiding repositioning the patient.

Methods: Between June 2010 and May 2012, 10 patients underwent simultaneous open RNU and transurethral distal ureter balloon occlusion and detachment using a flexible cystoscope (f-TUDUBOD) in lumbotomy position. After having ruled out the presence of a concomitant bladder tumor, one surgeon used a flexible cystoscope to occlude the affected ureter with a 5Fr Fogarty catheter and circumferentially incised the orifice until detaching it from the bladder with a boogie electrode or a Holmium laser; meanwhile, two other surgeons performed open RNU through a lumbotomic approach. Data were compared with those of patients who had previously undergone open RNU after TUDUBOD.

Results: Mean surgical time for simultaneous open RNU and f-TUDUBOD was 113.4±29.2 minutes, significantly shorter (P<0.01) than that for open RNU after TUDUBOD (154.2±26.4 minutes). There were no complications. Surgical margins were always negative; at mean follow-up of 31.1 months, there was no recurrence in the perivesical space and a 20% (2/10) bladder recurrence rate comparing favorably with that (23.1%) observed at 30-month follow-up in patients who had undergone open RNU after TUDUBOD.

Conclusions: Simultaneous open RNU and f-TUDUBOD proved to be feasible and to represent a safe and effective means of shortening surgical time, with obvious clinical and economical benefits.
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http://dx.doi.org/10.1186/1477-7819-12-345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4289158PMC
November 2014

Emerging urinary markers of renal injury in obstructive nephropathy.

Biomed Res Int 2014 2;2014:303298. Epub 2014 Jul 2.

Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, 70124 Bari, Italy.

The effects of obstruction on renal function are the consequence of many factors that profoundly alter all components of glomerular function. Besides the acute effects on glomerular filtration rate and tubule function, a chronic obstruction induces tubular and interstitial injury that results from the activation of different pathways. The progression of tubulointerstitial injury leads to chronic renal damage characterized by tubular atrophy, inflammatory cell infiltration, and interstitial fibrosis. Obstructive nephropathy is an evolving disease in which the renal damage continues even after relief of the obstruction. In particular, it has been demonstrated that the time of relief is the most important factor in predicting long-term renal function deterioration. In this setting, the EGF/MCP-1 ratio, urinary NGAL, and urinary KIM-1 are useful early biomarkers of progressive renal damage and could have a potential role in predicting the long-term renal outcome. This minireview summarizes the role of these emerging urinary biomarkers of obstructive nephropathy based on the current understanding of the pathophysiology of renal injury.
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http://dx.doi.org/10.1155/2014/303298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4101977PMC
April 2015

Epidermoid cyst of the coronal sulcus mimicking penile cancer: a case report.

J Med Case Rep 2014 Jun 6;8:179. Epub 2014 Jun 6.

Department of Urology and Renal Transplantation, University of Foggia, Viale Luigi Pinto 1, 71121 Foggia, Italy.

Introduction: Epidermoid cysts represent common benign tumors occurring anywhere in the body but very rarely in the penis. Only a few cases of penile localization have been reported in the literature so far, most of them being congenital and/or idiopathic, usually presenting in children as slow-growing, solitary, well-delimited cystic lesions. Here, we describe the case of a patient with a penile epidermoid cyst presenting as an ulcerated lesion of the coronal sulcus, thus mimicking penile cancer.

Case Presentation: A 36-year-old Caucasian man presented with a three-month history of a rapidly growing asymptomatic ulcerated lesion in the ventral portion of the penile coronal sulcus. At surgical exploration, the area under the ulcerated lesion had a well-demarcated cystic shape; following its wide excision, an intraoperative histological examination revealed an epidermoid cyst. No recurrence had occurred at nine years of follow-up.

Conclusions: Rare benign tumors of the penis, like the described epidermoid cyst, may mimic cancer. Nevertheless, penile ulcerated lesions should always be surgically explored as wide excision and intraoperative histological examination remain the only means of obtaining a precise disease definition and, consequently, administering the appropriate treatment.
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http://dx.doi.org/10.1186/1752-1947-8-179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4070339PMC
June 2014
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