167 results on '"Guazzoni, Giorgio"'
Search Results
2. Interim analyses from the PROSPET-BX trial: [ G8 Ga]PSMA PET/CT vs. mpMRI in patients with suspicion of prostate cancer and previous negative biopsy.
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Lopci, Egesta, Lazzeri, Massimo, Disconzi, Luca, Colombo, Piergiuseppe, Saita, Alberto, Peschechera, Roberto, Fasulo, Vittorio, Maffei, Davide, Zanca, Roberta, Casale, Paolo, Rodari, Marcello, Guazzoni, Giorgio Ferruccio, Balzarini, Luca, Buffi, Nicolo', and Lughezzani, Giovanni
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- 2024
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3. MP74-08 [68GA]PSMA PET/CT VS. MPMRI IN PATIENTS WITH SUSPICION OF PROSTATE CANCER AND PREVIOUS NEGATIVE BIOPSY: RESULTS OF THE PROSPET-BX TRIAL.
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Fasulo, Vittorio, Maffei, Davide, Arena, Paola, Avolio, Pier Paolo, Disconzi, Luca, Colombo, Piergiuseppe, Saita, Alberto Rosario, Hurle, Rodolfo Fausto, Guazzoni, Giorgio Ferruccio, Balzarini, Luca, Rodari, Marcello, Casale, Paolo, Buffi, Nicolò Maria, Lazzeri, Massimo, Lopci, Egesta, and Lughezzani, Giovanni
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PROSTATE cancer patients ,PROSTATE cancer ,BIOPSY ,DIGITAL rectal examination - Published
- 2024
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4. MP67-03 IMPACT OF NUMBER OF INNER AND OUTER RENORRAPHY STITCHES ON FUNCTIONAL OUTCOMES AFTER ROBOTIC ASSISTED PARTIAL NEPHRECTOMY.
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Garofano, Giuseppe, Saitta, Cesare, Paciotti, Marco, Diana, Pietro, Fasulo, Vittorio, Meagher, Margaret F., Uleri, Alessandro, Beatrici, Edoardo, Piccolini, Andrea, Mancon, Stefano, De Carne, Fabio, Sordelli, Federica, Arena, Paola, Gobbo, Andrea, Yuen, Kit, Saita, Alberto, Lazzeri, Massimo, Hurle, Rodolfo, Guazzoni, Giorgio F., and Lughezzani, Giovanni
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NEPHRECTOMY ,FUNCTIONAL status - Published
- 2024
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5. MP49-15 EVALUATING THE ROLE OF PRI-MUS PROTOCOL IN IDENTIFYING CLINICALLY SIGNIFICANT PROSTATE CANCER: A HIGH-VOLUME EXPERIENCE ON MICROULTRASOUND.
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Maffei, Davide, Avolio, Pier Paolo, Moretto, Stefano, Piccolini, Andrea, Aljoulani, Muhannad, Dagnino, Filippo, De Carne, Fabio, Fasulo, Vittorio, Marco, Paciotti, Saita, Alberto Rosario, Hurle, Rodolfo Fausto, Guazzoni, Giorgio Ferruccio, Casale, Paolo, Buffi, Nicolò Maria, Lazzeri, Massimo, and Lughezzani, Giovanni
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PROSTATE cancer ,PROSTATE biopsy ,WATCHFUL waiting - Published
- 2024
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6. MP35-10 LONG TERM FOLLOW UP AND RISK OF HIGH-GRADE RECURRENCE IN LOW-GRADE PTA BLADDER CANCER PATIENTS.
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Finocchiaro, Alessio, Contieri, Roberto, Casale, Paolo, Saita, Alberto, Buffi, Nicolò Maria, Lughezzani, Giovanni, Frego, Nicola, Gobbo, Andrea, Guazzoni, Giorgio, and Hurle, Rodolfo
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BLADDER cancer ,CANCER patients - Published
- 2024
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7. MP31-03 DECODING CLINICALLY SIGNIFICANT PROSTATE CANCER IN BIOPSY NAIVE PATIENTS: A MACHINE LEARNING APPROACH FROM A TERTIARY REFERRAL CENTER.
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Saitta, Cesare, Dagnino, Filippo, Fasulo, Vittorio, Avolio, Pierpaolo, Paciotti, Marco, Frego, Nicola, Maffei, Davide, Arena, Paola, Beatrici, Edoardo, Decarne, Fabio, Casale, Paolo, Lazzeri, Massimo, Saita, Alberto, Hurle, Rodolfo, Guazzoni, Giorgio, Buffi, Nicolò, and Lughezzani, Giovanni
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PROSTATE biopsy ,MACHINE learning ,DIGITAL rectal examination - Published
- 2024
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8. PD13-12 DIAGNOSTIC PERFORMANCE OF MICROULTRASOUND AT CONFIRMATORY RECLASSIFICATION BIOPSY IN PATIENTS UNDER ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER.
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Dagnino, Filippo, Maffei, Davide, Fasulo, Vittorio, Avolio, Pier Paolo, Moretto, Stefano, Piccolini, Andrea, Aljoulani, Muhannad, De Carne, Fabio, Saitta, Cesare, Beatrici, Edoardo, Pasini, Luisa, Zandegiacomo, Silvia, Paciotti, Marco, Lazzeri, Massimo, Saita, Alberto, Hurle, Rodolfo, Guazzoni, Giorgio, Casale, Paolo, Buffi, Nicolò Maria, and Lughezzani, Giovanni
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WATCHFUL waiting ,PROSTATE cancer ,BIOPSY ,ENDORECTAL ultrasonography - Published
- 2024
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9. MP16-01 REPLACING RETUR WITH CYSTOSCOPY IN HIGH-GRADE T1 NMIBC PATIENTS: CONFIRMATORY RESULTS FROM THE HUNIRE TRIAL.
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Finocchiaro, Alessio, Contieri, Roberto, Casale, Paolo, Buffi, Nicolò Maria, Saita, Alberto, Lughezzani, Giovanni, Paciotti, Marco, Fasulo, Vittorio, Lazzeri, Massimo, Guazzoni, Giorgio, Piccolini, Andrea, and Hurle, Rodolfo
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BLADDER cancer ,CYSTOSCOPY ,NON-muscle invasive bladder cancer - Published
- 2024
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10. Combination of AST to ALT and neutrophils to lymphocytes ratios as predictors of locally advanced disease in patients with bladder cancer subjected to radical cystectomy: Results from a single-institutional series
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Uleri, Alessandro, Hurle, Rodolfo, Contieri, Roberto, Diana, Pietro, Buffi, Nicolòmaria, Lazzeri, Massimo, Saita, Alberto, Casale, Paolo, Guazzoni, Giorgio, and Lughezzani, Giovanni
- Abstract
Background: Bladder cancer (BC) staging is challenging. There is an important need for available and affordable predictors to assess, in combination with imaging, the presence of locally-advanced disease.Objective: To determine the role of the De Ritis ratio (DRR) and neutrophils to lymphocytes ratio (NLR) in the prediction of locally-advanced disease defined as the presence of extravescical extension (pT ⩾ 3) and/or lymph node metastases (LNM) in patients with BC treated with radical cystectomy (RC).Methods: We retrospectively analyzed clinical and pathological data of 139 consecutive patients who underwent RC at our institution. Logistic regression models (LRMs) were fitted to test the above-mentioned outcomes.Results: A total of 139 consecutive patients underwent RC at our institution. Eighty-six (61.9%) patients had a locally-advanced disease. NLR (2.53 and 3.07; p= 0.005) and DRR (1 and 1.17; p= 0.01) were significantly higher in patients with locally-advanced disease as compared to organ-confined disease. In multivariable LRMs, an increasing DRR was an independent predictor of locally-advanced disease (OR = 3.91; 95% CI: 1.282–11.916; p= 0.017). Similarly, an increasing NLR was independently related to presence of locally-advanced disease (OR = 1.28; 95% CI: 1.027–1.591; p= 0.028). In univariate LRMs, patients with DRR > 1.21 had a higher risk of locally advanced disease (OR = 2.83; 95% CI: 1.312–6.128; p= 0.008). Similarly, in patients with NLR > 3.47 there was an increased risk of locally advanced disease (OR = 3.02; 95% CI: 1.374–6.651; p= 0.006). In multivariable LRMs, a DRR > 1.21 was an independent predictor of locally advanced disease (OR = 2.66; 95% CI: 1.12–6.35; p= 0.027). Similarly, an NLR > 3.47 was independently related to presence of locally advanced disease (OR = 2.24; 95% CI: 0.95–5.25; p= 0.065). No other covariates such as gender, BMI, neoadjuvant chemotherapy or diabetes reached statistical significance. The AUC of the multivariate LRM to assess the risk of locally advanced disease was 0.707 (95% CI: 0.623–0.795). Limitations include the retrospective nature of the study and the relatively small sample size.
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- 2022
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11. Head-to-Head Comparison between High-Resolution Microultrasound Imaging and Multiparametric MRI in Detecting and Local Staging of Bladder Cancer: The BUS-MISS Protocol
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Diana, Pietro, Lughezzani, Giovanni, Saita, Alberto, Uleri, Alessandro, Frego, Nicola, Contieri, Roberto, Buffi, Nicolomaria, Balzarini, Luca, D’Orazio, Federico, Piergiuseppe, Colombo, Elefante, Maria Grazia, Lazzeri, Massimo, Guazzoni, Giorgio, Casale, Paolo, and Hurle, Rodolfo
- Abstract
MRI has been proposed as a new staging tool for bladder cancer (BC), but use is limited by its high costs and low availability. 29-MHz high-resolution micro-ultrasound (mUS) technology has been suggested as an alternative to detect BC and distinguish between muscle-invasive and non-muscle invasive BC. The aim was to compare the diagnostic accuracy of mUS vs. magnetic resonance imaging (MRI) in differentiating NMIBC and MIBC at definitive pathological examination. This is a prospective study of patients with a primary diagnosis of BC with either positive urine cytology (UC) or negative UC and a tumor size > 25 mm from a tertiary care high volume center. mUS, with the ExactVu system with an EV29L 29 MHz side-fire transducer, and a 3-Tesla MRI were performed before transurethral resection of bladder tumor (TURBT) in every patient before undergoing TURBT. We compared the imaging results with pathological reports. The analyzed population consisted of 58 individuals. The reported mUS and MRI sensitivity, specificity, positive, and negative predictive values were 85.0%, 76.3%, 65.4%, and 90.6%, versus 85.0%, 50.0%, 47.2%, and 86.4%, respectively. In accuracy analysis, the AUC for mUS and MRI were respectively 0.807 and 0.675. In our population mUS seems to have a better performance in distinguishing NMIBC from MIBC. The main limitation of mUS is the probe shape that makes its use problematic in cases with a large prostate and inadequate rectal preparation. Further studies with a larger population are ongoing to compare and validate these techniques in this setting.
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- 2022
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12. Multiparametric magnetic resonance imaging and clinical variables: Which is the best combination to predict reclassification in active surveillance patients?
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Roscigno, Marco, Stabile, Armando, Lughezzani, Giovanni, Pepe, Pietro, Dell’Atti, Lucio, Naselli, Angelo, Naspro, Richard, Nicolai, Maria, La Croce, Giovanni, Muhannad, Aljoulani, Perugini, Giovanna, Guazzoni, Giorgio, Montorsi, Francesco, Balzarini, Luca, Sironi, Sandro, and Da Pozzo, Luigi F.
- Abstract
We tested the role of multiparametric magnetic resonance imaging (mpMRI) in disease reclassification and whether the combination of mpMRI and clinicopathological variables could represent the most accurate approach to predict the risk of reclassification during active surveillance.
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- 2020
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13. The Use of Multiparametric Magnetic Resonance Imaging for Follow-up of Patients Included in Active Surveillance Protocol. Can PSA Density Discriminate Patients at Different Risk of Reclassification?
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Roscigno, Marco, Stabile, Armando, Lughezzani, Giovanni, Pepe, Pietro, Galosi, Andrea Benedetto, Naselli, Angelo, Naspro, Richard, Nicolai, Maria, La Croce, Giovanni, Aljoulani, Muhannad, Perugini, Giovanna, Guazzoni, Giorgio, Montorsi, Francesco, Balzarini, Luca, Sironi, Sandro, and Da Pozzo, Luigi Filippo
- Abstract
The objective of this study was to test Prostate Imaging Reporting and Data System (PI-RADS) classification on multiparametric magnetic resonance imaging (mpMRI) and MRI-derived prostate-specific antigen density (PSAD) in predicting the risk of reclassification in men in active surveillance (AS), who underwent confirmatory or per-protocol follow-up biopsy.
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- 2020
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14. Stereotactic Body Radiation Therapy for Intermediate-risk Prostate Cancer With VMAT and Real-time Electromagnetic Tracking
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D’Agostino, Giuseppe R., Mancosu, Pietro, Di Brina, Lucia, Franzese, Ciro, Pasini, Luisa, Iftode, Cristina, Comito, Tiziana, De Rose, Fiorenza, Guazzoni, Giorgio F., and Scorsetti, Marta
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- 2020
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15. 68Ga-PSMA Positron Emission Tomography/Computerized Tomography for Primary Diagnosis of Prostate Cancer in Men with Contraindications to or Negative Multiparametric Magnetic Resonance Imaging: A Prospective Observational Study.
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Lopci, Egesta, Saita, Alberto, Lazzeri, Massimo, Lughezzani, Giovanni, Colombo, Piergiuseppe, Buffi, Nicolò Maria, Hurle, Rodolfo, Marzo, Katia, Peschechera, Roberto, Benetti, Alessio, Zandegiacomo, Silvia, Pasini, Luisa, Lista, Giuliana, Cardone, Pasquale, Castello, Angelo, Maffei, Davide, Balzarini, Luca, Chiti, Arturo, Guazzoni, Giorgio, and Casale, Paolo
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POSITRON emission tomography ,PROSTATE cancer ,DIAGNOSIS ,PROSTATE-specific antigen ,DIGITAL rectal examination ,MAGNETIC resonance imaging - Abstract
Purpose 68 Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography may represent the most promising imaging modality to identify and risk stratify prostate cancer in patients with contraindications to or negative multiparametric magnetic resonance imaging. Materials and Methods In this prospective observational study we analyzed 68 Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography in a select group of patients with persistently elevated prostate specific antigen and/or Prostate Health Index suspicious for prostate cancer, negative digital rectal examination and at least 1 negative biopsy. The cohort comprised men with equivocal multiparametric magnetic resonance imaging (Prostate Imaging-Reporting and Data System, version 2 score of 2 or less), or an absolute or relative contraindication to multiparametric magnetic resonance imaging. Sensitivity, specificity and CIs were calculated compared to histopathology findings. ROC analysis was applied to determine the optimal cutoff values of 68 Ga labeled prostate specific membrane antigen uptake to identify clinically significant prostate cancer (Gleason score 7 or greater). Results A total of 45 patients with a median age of 64 years were referred for 68 Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography between January and August 2017. The 25 patients (55.5%) considered to have positive positron emission tomography results underwent software assisted fusion biopsy. We determined the uptake values of regions of interest, including a median maximum standardized uptake value of 5.34 (range 2.25 to 30.41) and a maximum-to-background standardized uptake value ratio of 1.99 (range 1.06 to 14.42). Mean and median uptake values on 68 Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography (ie the maximum standardized uptake value or the maximum-to-background standardized uptake value ratio) were significantly higher for Gleason score 7 lesions than for Gleason score 6 or benign lesions (p <0.001). On ROC analysis a maximum standardized uptake value of 5.4 and a maximum-to-background standardized uptake value ratio of 2 discriminated clinically relevant prostate cancer with 100% overall sensitivity in each case, and 76% and 88% specificity, respectively. Conclusions Our findings support the use of 68 Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography for primary detection of prostate cancer in a specific subset of men. [ABSTRACT FROM AUTHOR]
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- 2018
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16. Active Surveillance for Low Risk Nonmuscle Invasive Bladder Cancer: A Confirmatory and Resource Consumption Study from the BIAS Project.
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Hurle, Rodolfo, Lazzeri, Massimo, Vanni, Elena, Lughezzani, Giovanni, Buffi, NicolòMaria, Casale, Paolo, Saita, Alberto, Morenghi, Emanuela, Forni, Giovanni, Cardone, Pasquale, Lista, Giuliana, Colombo, Piergiuseppe, Peschechera, Roberto, Pasini, Luisa, Zandegiacomo, Silvia, Benetti, Alessio, Maffei, Davide, Vavassori, Ivano, and Guazzoni, Giorgio
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WATCHFUL waiting ,BLADDER cancer treatment ,NONMUSCLE actin ,TRANSURETHRAL prostatectomy ,CONFIRMATORY factor analysis ,SCIENTIFIC observation - Abstract
Purpose We investigated predictive factors of failure and performed a resource consumption analysis in patients who underwent active surveillance for nonmuscle invasive bladder cancer. Materials and Methods This prospective observational study monitored patients with a history of pathologically confirmed stage pTa (grade 1-2) or pT1a (grade 2) nonmuscle invasive bladder cancer, and recurrent small size and number of tumors without hematuria and positive urine cytology. The primary end point was the failure rate of active surveillance. Assessment of failure predictive variables and per year direct hospital resource consumption analysis were secondary outcomes. Descriptive statistical analysis and Cox regression with univariable and multivariable analysis were done. Results Of 625 patients with nonmuscle invasive bladder cancer 122 with a total of 146 active surveillance events were included in the protocol. Of the events 59 (40.4%) were deemed to require treatment after entering active surveillance. Median time on active surveillance was 11 months (IQR 5–26). Currently 76 patients (62.3%) remain under observation. On univariable analysis only time from the first transurethral resection to the start of active surveillance seemed to be inversely associated with recurrence-free survival (HR 0.99, 95% CI 0.98–1.00, p = 0.027). Multivariable analysis also revealed an association with age at active surveillance start (HR 0.97, 95% CI 0.94–1.00, p = 0.031) and the size of the lesion at the first transurethral resection (HR 1.55, 95% CI 1.06–2.27, p = 0.025). The average specific annual resource consumption savings for each avoided transurethral bladder tumor resection was €1,378 for each intervention avoided. Conclusions Active surveillance might be a reasonable clinical and cost-effective strategy in patients who present with small, low grade pTa/pT1a recurrent papillary bladder tumors. [ABSTRACT FROM AUTHOR]
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- 2018
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17. Validation of Neutrophil-to-lymphocyte Ratio in a Multi-institutional Cohort of Patients With T1G3 Non–muscle-invasive Bladder Cancer
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Vartolomei, Mihai Dorin, Ferro, Matteo, Cantiello, Francesco, Lucarelli, Giuseppe, Di Stasi, Savino, Hurle, Rodolfo, Guazzoni, Giorgio, Busetto, Gian Maria, De Berardinis, Ettore, Damiano, Rocco, Perdona, Sisto, Verze, Paolo, La Rocca, Roberto, Borghesi, Marco, Schiavina, Riccardo, Brunocilla, Eugenio, Almeida, Gilberto L., Bove, Pierluigi, Lima, Estevao, Grimaldi, Giovanni, Autorino, Riccardo, Crisan, Nicolae, Abu Farhan, Abdal Rahman, Battaglia, Michele, Serretta, Vincenzo, Russo, Giorgio Ivan, Morgia, Giuseppe, Terracciano, Daniela, Musi, Gennaro, de Cobelli, Ottavio, Mirone, Vincenzo, and Shariat, Shahrokh F.
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Neutrophil-to-lymphocyte ratio was found associated with worse disease recurrence and progression in patients with T1 non–muscle-invasive bladder cancer in some single-center studies. We validated high pretreatment neutrophil-to-lymphocyte ratio (cutoff, 3) as an independent predictor of disease recurrence, progression, and cancer-specific survival in patients with primary T1 HG/G3 non–muscle-invasive bladder cancer treated with intravesical bacillus Calmette-Guérin therapy.
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- 2018
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18. Systemic Inflammatory Markers and Oncologic Outcomes in Patients with High-risk Non–muscle-invasive Urothelial Bladder Cancer
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Cantiello, Francesco, Russo, Giorgio I., Vartolomei, Mihai Dorin, Farhan, Abdal Rahman Abu, Terracciano, Daniela, Musi, Gennaro, Lucarelli, Giuseppe, Di Stasi, Savino M., Hurle, Rodolfo, Serretta, Vincenzo, Busetto, Gian Maria, Scafuro, Chiara, Perdonà, Sisto, Borghesi, Marco, Schiavina, Riccardo, Cioffi, Antonio, De Berardinis, Ettore, Almeida, Gilberto L., Bove, Pierluigi, Lima, Estevao, Ucciero, Giuseppe, Matei, Deliu Victor, Crisan, Nicolae, Verze, Paolo, Battaglia, Michele, Guazzoni, Giorgio, Autorino, Riccardo, Morgia, Giuseppe, Damiano, Rocco, de Cobelli, Ottavio, Mirone, Vincenzo, Shariat, Shahrokh F., and Ferro, Matteo
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Serum levels of neutrophils, platelets, and lymphocytes have been recognized as factors related to poor prognosis for many solid tumors, including bladder cancer (BC).
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- 2018
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19. Pathological Outcomes for Patients Who Failed To Remain Under Active Surveillance for Low-risk Non–muscle-invasive Bladder Cancer: Update and Results from the Bladder Cancer Italian Active Surveillance Project
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Hurle, Rodolfo, Colombo, Piergiuseppe, Lazzeri, Massimo, Lughezzani, Giovanni, Buffi, Nicolò Maria, Saita, Alberto, Elefante, Grazia Maria, Morenghi, Emanuela, Forni, Giovanni, Cardone, Pasquale, Lista, Giuliana, Maffei, Davide, Guazzoni, Giorgio, and Casale, Paolo
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It has been shown that active surveillance (AS) is feasible and effective in a subset of patients with recurrent low-grade (LG) non–muscle-invasive bladder cancer (NMIBC).
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- 2018
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20. Randomized phase III clinical trial of neoadjuvant intravesical mitomycin C (MMC) treatment in patients with primary treatment-naïve non-muscle invasive bladder cancer (NMIBC).
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Lazzeri, Massimo, Rescigno, Maria, Guazzoni, Giorgio Ferruccio, Casale, Paolo, Buffi, NicolòMaria, Lughezzani, Giovanni, Mancon, Stefano, Fasulo, Vittorio, Saita, Alberto, and Hurle, Rodolfo
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- 2023
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21. Awareness of genetic risk for prostate cancer (PCa) in men from families with germline mutations in DNA-repair genes.
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Lazzeri, Massimo, Fasulo, Vittorio, Buffi, NicolòMaria, Lughezzani, Giovanni, Casale, Paolo, Benetti, Alessio, Saita, Alberto, Hurle, Rodolfo, Guazzoni, Giorgio Ferruccio, Chiarelli, Giuseppe, Asselta, Rosanna, and Soldà, Giulia
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- 2023
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22. Is Robot-assisted Surgery Contraindicated in the Case of Partial Nephrectomy for Complex Tumours or Relevant Comorbidities? A Comparative Analysis of Morbidity, Renal Function, and Oncologic Outcomes
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Larcher, Alessandro, Capitanio, Umberto, De Naeyer, Geert, Fossati, Nicola, D’Hondt, Frederiek, Muttin, Fabio, De Groote, Ruben, Guazzoni, Giorgio, Salonia, Andrea, Briganti, Alberto, Montorsi, Francesco, and Mottrie, Alexandre
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Available comparisons between open partial nephrectomy (OPN) and robot-assisted partial nephrectomy (RAPN) are scarce, incomplete, and affected by non-negligible risk of bias.
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- 2018
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23. Long-Term Followup and Deterioration Rate of Anterior Substitution Urethroplasty.
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Barbagli, Guido, Kulkarni, Sanjay B., Fossati, Nicola, Larcher, Alessandro, Sansalone, Salvatore, Guazzoni, Giorgio, Romano, Giuseppe, Pankaj, Joshi M., Dell'Acqua, Vincenzo, and Lazzeri, Massimo
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URETHROPLASTY ,RETROSPECTIVE studies ,FOLLOW-up studies (Medicine) ,HEALTH outcome assessment ,CLINICAL trials ,ORAL mucosa - Abstract
Purpose We investigated deterioration of the success rate of penile and bulbar substitution urethroplasty. Materials and Methods We performed a retrospective descriptive analysis of patients who underwent substitution urethroplasty between July 1994 and September 2007. Inclusion criteria included 1-stage anterior urethroplasty using penile skin or oral mucosa with a minimum of 6 years followup. Patients with posterior urethral stricture, failed hypospadias or incomplete clinical records were excluded from analysis. The primary study outcome was postoperative failure-free survival and the secondary outcome was to identify significant predictors of treatment failure. The clinical outcome was considered a failure when any postoperative instrumentation was needed. Descriptive statistical analysis was done as well as Kaplan-Meier analysis, and univariable and multivariable Cox regression analysis. Results A total of 359 patients were included in study. Median followup was 118 months. Of the procedures 265 (73.8%) were successful and 94 (26.2%) failed, including 91 (96.8%) within the first 5 years. Substitute tissue type (oral mucosa vs skin) was the only significant predictor on univariable analysis (HR 1.86, p = 0.005). This result was confirmed by multivariable analysis adjusting for age at surgery, stricture length and etiology, urethroplasty type and previous treatments (HR 2.26, p = 0.001). Conclusions Deterioration after anterior 1-stage substitution urethroplasty seems to develop within the first 5 years. Oral mucosa showed greater failure-free survival than penile skin and 1-stage penile urethroplasty showed the same success rate as bulbar urethroplasty. [ABSTRACT FROM AUTHOR]
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- 2014
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24. Prediction of Early and Late Complications after Oral Mucosal Graft Harvesting: Multivariable Analysis from a Cohort of 553 Consecutive Patients.
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Barbagli, Guido, Fossati, Nicola, Sansalone, Salvatore, Larcher, Alessandro, Romano, Giuseppe, Dell'Acqua, Vincenzo, Guazzoni, Giorgio, and Lazzeri, Massimo
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COMPARATIVE studies ,THERAPEUTIC complications ,ORAL mucosa diseases ,COHORT analysis ,URETHROPLASTY ,QUESTIONNAIRES -- Data processing ,HEMORRHAGE ,PATIENT satisfaction ,THERAPEUTICS - Abstract
Purpose: We investigated the early and late complications after oral mucosal graft harvesting, and reported the independent predictors of outcome via multivariable analysis. Materials and Methods: We performed a retrospective descriptive study of 553 patients from whom an oral mucosa graft was harvested for urethroplasty from single or bilateral cheeks. Patients who underwent oral mucosa harvesting from the lip, the tongue or from the cheek and lip at the same time were excluded from analysis. The oral graft was harvested in an ovoid shape with closure of the wound. Postoperative early and late complications were investigated using a self-administered, nonvalidated, semiquantitative questionnaire. There were 6 questions on early complications, and 13 questions investigated late complications and patient satisfaction. Results: Descriptive statistics of categorical variables focused on frequencies and proportions. Univariable and multivariable analyses were used to predict early and late dissatisfaction of patients. Bleeding was reported in 3.4% of patients. Overall 53.2% of patients did not report any pain and 36.3% reported no swelling. Late complications analysis showed that 95.5% of patients declared that the surgical closure of the wound did not cause any difficulty in opening the mouth or problems with smiling (98.2%) and/or dry mouth (95.8%). Overall 98.2% of patients were satisfied with the procedure. Univariable and multivariable analyses revealed that bilateral graft harvesting was the only significant predictor of patient dissatisfaction (OR 2.85, p = 0.01 and OR 2.72, p = 0.02; respectively). Conclusions: Harvesting the oral mucosa ovoid graft from a single cheek with closure of the wound is a safe procedure with high rates of patient satisfaction. [ABSTRACT FROM AUTHOR]
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- 2014
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25. Head-to-Head Comparison of Prostate Health Index and Urinary PCA3 for Predicting Cancer at Initial or Repeat Biopsy.
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Scattoni, Vincenzo, Lazzeri, Massimo, Lughezzani, Giovanni, De Luca, Stefano, Passera, Roberto, Bollito, Enrico, Randone, Donato, Abdollah, Firas, Capitanio, Umberto, Larcher, Alessandro, Lista, Giuliana, Gadda, Giulio Maria, Bini, Vittorio, Montorsi, Francesco, Guazzoni, Giorgio, Diaz, Mireya, and MarksL, Leonard S.
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BIOPSY ,DIAGNOSIS ,PROSTATE cancer ,LOGISTIC regression analysis ,PERFORMANCE evaluation ,CLINICAL trials ,COMPARATIVE studies - Abstract
Purpose: We performed a head-to-head comparison of the PHI (Prostate Health Index) and PCA3. Materials and Methods: We evaluated PHI and PCA3 performance in 211 patients undergoing initial (116) or repeat (95) prostate biopsy. Multivariable logistic regression analysis was done using the AUC to test the accuracy of PHI and PCA3 for predicting prostate cancer in the overall population and in each setting. Decision curve analysis was used to compare the clinical benefit of different models. Results: Overall, the AUC of the PHI (0.70) was significantly higher than the AUC of PCA3 (0.59), total prostate specific antigen (0.56) and free-to-total prostate specific antigen (0.60) (p = 0.043, 0.002 and 0.037, respectively). PHI was more accurate than PCA3 for predicting prostate cancer in the initial setting (AUC 0.69 vs 0.57) and in the repeat setting (AUC 0.72 vs 0.63), although no statistically significant difference was observed. Including PCA3 in the base multivariable model (prostate specific antigen plus free-to-total prostate specific antigen plus prostate volume) did not increase predictive accuracy in either setting (AUC 0.79 vs 0.80 and 0.75 vs 0.76, respectively). Conversely, including PHI in the base multivariable model improved predictive accuracy by 5% (AUC 0.79 to 0.84) and 6% (AUC 0.75 to 0.81) in the initial and repeat prostate biopsy settings, respectively. On decision curve analysis the highest net benefit was observed when PHI was added to the base multivariable model. Conclusions: PHI and PCA3 provide a significant increase in sensitivity and specificity compared to all other examined markers and they may help guide biopsy decisions. PCA3 does not increase the accuracy of predicting prostate cancer when PHI is assessed. [ABSTRACT FROM AUTHOR]
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- 2013
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26. Development and Internal Validation of a Prostate Health Index Based Nomogram for Predicting Prostate Cancer at Extended Biopsy.
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Lughezzani, Giovanni, Lazzeri, Massimo, Larcher, Alessandro, Lista, Giuliana, Scattoni, Vincenzo, Cestari, Andrea, Buffi, Nicoló Maria, Bini, Vittorio, and Guazzoni, Giorgio
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PROSTATE cancer ,DIAGNOSIS ,DIGITAL rectal examination ,BIOPSY ,PROSTATE-specific antigen ,LOGISTIC regression analysis ,HEALTH outcome assessment ,DECISION making in clinical medicine - Abstract
Purpose: We developed and validated a Prostate Health Index (Beckman Coulter, Brea, California) based nomogram to predict prostate cancer at extended prostate biopsy. Materials and Methods: The study population consisted of 729 patients who were scheduled for prostate biopsy following suspicious digital rectal examination and/or increased prostate specific antigen. Total and free prostate specific antigen, percent free-to-total prostate specific antigen, [–2]proPSA and the prostate health index [([–2]proPSA/free prostate specific antigen) × √total prostate specific antigen)] were determined. Logistic regression models were fitted to test prostate cancer predictors. Predictive accuracy estimates of biopsy outcome predictions were quantified. Regression coefficients were used to create a decision making tool to predict prostate cancer. A calibration plot was used to evaluate the extent of overestimating or underestimating the observed prostate cancer rate. Decision curve analysis provided an estimate of the net benefit obtained using the prostate health index based nomogram. Results: Overall 280 of 729 patients (38.4%) were diagnosed with prostate cancer at extended prostate biopsy. On accuracy analyses prostate health index emerged as the most informative predictor of prostate cancer (AUC 0.70) compared to established predictors, such as total prostate specific antigen (0.51) and percent free-to-total prostate specific antigen (0.62). Including the prostate health index in a multivariable logistic regression model based on patient age, prostate volume, digital rectal examination and biopsy history significantly increased predictive accuracy by 7% from 0.73 to 0.80 (p <0.001). Nomogram calibration was good. Decision curve analysis showed that using the prostate health index based nomogram resulted in the highest net benefit. Conclusions: The prostate health index based nomogram can assist clinicians in the decision to perform biopsy by providing an accurate estimation of an individual risk of prostate cancer. [Copyright &y& Elsevier]
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- 2012
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27. Serum Index Test %[-2]proPSA and Prostate Health Index are More Accurate than Prostate Specific Antigen and %fPSA in Predicting a Positive Repeat Prostate Biopsy.
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Lazzeri, Massimo, Briganti, Alberto, Scattoni, Vincenzo, Lughezzani, Giovanni, Larcher, Alessandro, Gadda, Giulio Maria, Lista, Giuliana, Cestari, Andrea, Buffi, Nicolòmaria, Bini, Vittorio, Freschi, Massimo, Rigatti, Patrizio, Montorsi, Francesco, and Guazzoni, Giorgio
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PROSTATE-specific antigen ,DIAGNOSIS ,PROSTATE cancer ,SERUM ,BIOPSY ,SCIENTIFIC observation ,LONGITUDINAL method ,LOGISTIC regression analysis - Abstract
Purpose: We tested the hypothesis that serum isoform [-2]proPSA derivatives %p2PSA and Prostate Health Index are accurate predictors of prostate cancer in men scheduled for repeat biopsy. Materials and Methods: The study was an observational prospective evaluation of a clinical cohort of men with 1 or 2 previous negative prostate biopsies, with persistent suspicion of prostate cancer. They were enrolled in the study to determine the diagnostic accuracy of %p2PSA using the formula, (p2PSA pg/ml)/(free prostate specific antigen ng/ml × 1,000)]× 100, and Beckman-Coulter Prostate Health Index using the formula, (p2PSA/free prostate specific antigen) × √total prostate specific antigen), and to compare it with the accuracy of established prostate cancer serum tests (total prostate specific antigen, free prostate specific antigen and percent free prostate specific antigen). Multivariable logistic regression models were complemented by predictive accuracy analysis and decision curve analysis. Results: Prostate cancer was found in 71 of 222 (31.9%) subjects. %p2PSA and Prostate Health Index were the most accurate predictors of disease. %p2PSA significantly outperformed total prostate specific antigen, free prostate specific antigen, percent free prostate specific antigen and p2PSA in the prediction of prostate cancer (p ≤0.01), but not Prostate Health Index (p = 0.094). Prostate Health Index significantly outperformed total prostate specific antigen and p2PSA (p ≤0.001) but not free prostate specific antigen (p = 0.109) and free/total prostate specific antigen (p = 0.136). In multivariable logistic regression models %p2PSA and Prostate Health Index achieved independent predictor status, and significantly increased the accuracy of multivariable models including prostate specific antigen and prostate volume with or without percent free prostate specific antigen and prostate specific antigen density by 8% to 11% (p ≤0.034). At a %p2PSA cutoff of 1.23, 153 (68.9%) biopsies could have been avoided, missing prostate cancer in 6 patients. At a Prostate Health Index cutoff of 28.8, 116 (52.25%) biopsies could have been avoided, missing prostate cancer in 6 patients. Conclusions: Serum %p2PSA and Prostate Health Index are more accurate than standard reference tests in predicting repeat prostate biopsy outcome, and could avoid unnecessary repeat biopsies. [Copyright &y& Elsevier]
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- 2012
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28. Preoperative Erectile Function Represents a Significant Predictor of Postoperative Urinary Continence Recovery in Patients Treated With Bilateral Nerve Sparing Radical Prostatectomy.
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Gandaglia, Giorgio, Suardi, Nazareno, Gallina, Andrea, Capitanio, Umberto, Abdollah, Firas, Salonia, Andrea, Nava, Luciano, Colombo, Renzo, Guazzoni, Giorgio, Rigatti, Patrizio, Montorsi, Francesco, and Briganti, Alberto
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PROSTATECTOMY complications ,IMPOTENCE ,PROSTATE cancer treatment ,BODY mass index ,SYMPTOMS ,PROSTATE-specific antigen ,RETROPUBIC prostatectomy ,MULTIVARIATE analysis - Abstract
Purpose: The association between baseline functional status and urinary continence recovery after radical prostatectomy remains controversial. We tested the hypothesis that baseline erectile and urinary function predicts urinary continence recovery after bilateral nerve sparing radical prostatectomy. Materials and Methods: The study included 752 patients with prostate cancer treated with bilateral nerve sparing radical prostatectomy between 2003 and 2009. All patients had preoperative functional and oncological data available, including age at surgery, body mass index, prostate specific antigen, and erectile and urinary function. Preoperatively erectile and urinary function was assessed by the erectile function domain of the International Index of Erectile Function and the International Prostatic Symptoms Score. Urinary continence was defined as wearing no pads. Univariate and multivariate Cox regression models were used to test the association between predictors and urinary continence recovery after surgery. Results: At a mean postoperative followup of 30.7 months (median 29, range 1 to 80) 611 patients (81.3%) had recovered urinary continence. Overall the urinary continence recovery rate at 1 and 3 years was 73.9% and 82.2%, respectively. On univariate Cox regression analysis patient age and the preoperative score on the erectile function domain of the International Index of Erectile Function were significantly associated with urinary continence recovery (each p ≤0.04). On multivariate analysis age at surgery and the preoperative erectile function domain of the International Index of Erectile Function were the only independent predictors of urinary continence recovery after bilateral nerve sparing radical prostatectomy (each p ≤0.04). Conclusions: Age and preoperative erectile function should be considered for urinary continence predictions after bilateral nerve sparing radical prostatectomy and for accurate patient counseling before surgery. Preoperative erectile function might be a marker of pelvic vascular disease, which may affect the status of the external urinary sphincter. [ABSTRACT FROM AUTHOR]
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- 2012
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29. Is Sperm Banking of Interest to Patients With Nongerm Cell Urological Cancer Before Potentially Fertility Damaging Treatments?
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Salonia, Andrea, Gallina, Andrea, Matloob, Rayan, Rocchini, Lorenzo, Saccà, Antonino, Abdollah, Firas, Colombo, Renzo, Suardi, Nazareno, Briganti, Alberto, Guazzoni, Giorgio, Rigatti, Patrizio, and Montorsi, Francesco
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SPERM banks ,URINARY organ cancer ,CANCER patients ,PATIENT psychology ,GENITAL diseases ,HUMAN fertility ,GERM cells ,THERAPEUTICS - Abstract
Purpose: We assessed the opinions of patients with nongerm cell urological cancer on sperm banking before undergoing surgical or nonsurgical therapy that could potentially endanger subsequent fertility. Materials and Methods: Between April 2007 and July 2008, 753 patients visited a urological office and were invited to complete a brief self-administered questionnaire to assess opinions on sperm banking before undergoing any eventual therapy potentially dangerous for male fertility. Logistic regression models tested the association between predictors (age, educational level, relationship status, previous fatherhood and benign disorder vs nongerm cell urological cancer) and patient wishes for sperm banking. Results: Median patient age was 65 years (mean 61.6, range 18 to 76). Overall 522 patients (69.3%) had nongerm cell urological cancer and only 242 (32.1%) were in favor of pretreatment sperm banking. On univariate analysis age (OR 0.961, p <0.001), a stable relationship (OR 0.486, p <0.001) and previous fatherhood (OR 0.390, p <0.001) were inversely associated with the wish for sperm banking, whereas having cancer and educational status were not significantly correlated. Multivariate analysis indicated that aging (OR 0.966, p = 0.001) and previous fatherhood (OR 0.587, p = 0.029) maintained inverse associations. Having urological cancer was positively (OR 1.494, p = 0.045) associated with the wish for sperm banking. Conclusions: In urological patients there is a low rate of willingness to bank sperm before any potential fertility damaging therapeutic approach. Having nongerm cell urological cancer is an independent predictor that is positively associated with the wish to bank sperm. It is vitally important to provide comprehensive information about pretreatment sperm banking to young adults with nongerm cell urological cancer. [Copyright &y& Elsevier]
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- 2009
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30. Renal Sinus Fat Invasion in pT3a Clear Cell Renal Cell Carcinoma Affects Outcomes of Patients Without Nodal Involvement or Distant Metastases.
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Bertini, Roberto, Roscigno, Marco, Freschi, Massimo, Strada, Elena, Petralia, Giovanni, Pasta, Alessandra, Matloob, Rayan, Sozzi, Francesco, Da Pozzo, Luigi, Colombo, Renzo, Guazzoni, Giorgio, Doglioni, Claudio, Montorsi, Francesco, and Rigatti, Patrizio
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CANCER invasiveness ,FAT cells ,RENAL cell carcinoma ,KIDNEY surgery ,CANCER patients ,RETROSPECTIVE studies ,REGRESSION analysis - Abstract
Purpose: According to the 2002 American Joint Committee on Cancer TNM classification, perinephric and renal sinus fat invasion are classified as pT3a renal cell carcinoma. However, only a few studies have assessed the impact of sinus fat invasion on patient survival and with controversial results. We analyzed the impact of sinus fat invasion on cancer specific survival in a cohort of patients with pT3a clear cell renal cell carcinoma. Materials and Methods: We retrospectively analyzed data on 115 consecutive patients treated with open radical nephrectomy for unilateral, sporadic pT3a clear cell renal cell carcinoma at our department from 1989 to 2006. All pathological specimens were rereviewed by a single uropathologist. The prognostic role of sinus fat invasion in cancer specific survival was assessed by Cox proportional hazards regression models. Results: Ten patients had direct ipsilateral adrenal invasion and were excluded from analysis. A total of 105 patients with clear cell renal cell carcinoma were evaluated. Median followup was 38 months. In the overall population sinus fat invasion did not reach independent predictive status in terms of cancer specific survival on multivariate Cox regression analysis after adjusting for age, performance status, tumor dimension, tumor grade, synchronous metastases, nodal involvement, sarcomatoid differentiation and coagulative necrosis. In the subset of patients with pNx/pN0 M0 (83) the actuarial 5-year cancer specific survival was 71.9% and 45.5% for those with perinephric fat invasion only and sinus fat invasion, respectively (p = 0.025). Sinus fat invasion achieved an independent predictive role on multivariable Cox regression analysis (p = 0.048, HR 2.06). Conclusions: Sinus fat invasion in clear cell renal cell carcinoma significantly affects cancer specific survival in patients without nodal or distant metastases. However, sinus fat invasion is not associated with worse cancer specific survival in cases of metastatic disease. [Copyright &y& Elsevier]
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- 2009
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31. Initial Extended Transrectal Prostate Biopsy—Are More Prostate Cancers Detected With 18 Cores Than With 12 Cores?
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Scattoni, Vincenzo, Roscigno, Marco, Raber, Marco, Dehò, Federico, Maga, Tommaso, Zanoni, Matteo, Riva, Matteo, Sangalli, Mattia, Nava, Luciano, Mazzoccoli, Bruno, Freschi, Massimo, Guazzoni, Giorgio, Rigatti, Patrizio, and Montorsi, Francesco
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PROSTATE cancer ,BIOPSY ,CANCER patients ,MEDICAL imaging systems - Abstract
Purpose: We retrospectively investigated the detection rates of prostate cancer, high grade prostatic intraepithelial neoplasia and atypical glands suggestive of carcinoma by initial 18 and 12-core prostate biopsy. Materials and Methods: A total of 3,460 consecutive patients with prostate specific antigen between 2.5 and 15 ng/ml underwent 12 (1,684) or 18 (1,776) core prostate biopsy under local anesthesia at 2 departments that adopted the same indications for performing biopsy. Biopsies were evenly distributed throughout the prostate in 6 sectors. In the 12-core prostate biopsy group 2 samples were obtained from each sector and in the 18-core prostate biopsy group 1 additional core was taken from each sector. Results: The cancer detection rate in patients who underwent 18-core prostate biopsy was not different from the rate in those who underwent 12-core prostate biopsy (39.9% and 38.4%, p = 0.37), nor did the detection of atypical glands suggestive of carcinoma differ significantly between the 2 groups (2.9% and 3.3%, respectively, p = 0.33). However, 18-core prostate biopsy detected a significantly higher percent of cases of high grade prostatic intraepithelial neoplasia (20.0% vs 12.9%, p = 0.001). The cancer detection rate was higher with 18 than with 12-core prostate biopsy in patients with a prostate volume of 55 cc or greater (31.5% vs 24.8%, p = 0.01) but not in those with a prostate volume of less than 55 cc (54.3% and 53.0%, respectively, p = 0.7). Moreover, we determined that patients with positive digital rectal examination findings do not need 18-core prostate biopsy as opposed to 12-core prostate biopsy. Conclusions: Compared with 12-core prostate biopsy, 18-core prostate biopsy detects significantly more cases of high grade prostatic intraepithelial neoplasia. However, 18-core prostate biopsy detects a significantly higher number of cancer only in patients with a prostate volume of 55 cc or greater. [Copyright &y& Elsevier]
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- 2008
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32. Anastomotic Fibrous Ring as Cause of Stricture Recurrence After Bulbar Onlay Graft Urethroplasty.
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Barbagli, Guido, Guazzoni, Giorgio, Palminteri, Enzo, and Lazzeri, Massimo
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URINARY organ surgery ,MUCOUS membranes ,URINARY organs ,OPERATIVE surgery - Abstract
Purpose: We retrospectively reviewed patterns of failure after bulbar substitution urethroplasty. In particular we investigated the prevalence and location of anastomotic fibrous ring strictures occurring at the apical anastomoses between the graft and urethral plate after 3 types of onlay graft techniques. Materials and Methods: We reviewed the records of 107 patients who underwent bulbar urethroplasty between 1994 and 2004. Mean patient age was 44 years. Patients with lichen sclerosus, failed hypospadias repair or urethroplasty and panurethral strictures were excluded. A total of 45 patients underwent dorsal onlay skin graft urethroplasty, 50 underwent buccal mucosa onlay graft urethroplasty and 12 underwent augmented end-to-end urethroplasty. The clinical outcome was considered a success or failure at the time that any postoperative procedure was needed, including dilation. Mean followup was 74 months (range 12 to 130). Results: Of 107 cases 85 (80%) were successful and 22 (20%) failed. Failure in 12 patients (11%) involved the whole grafted area and in 10 (9%) it involved the anastomotic site, which was distal and proximal in 5 each. Urethrography, urethral ultrasound and urethroscopy were fundamental for determining the difference between full-length and focal extension of re-stricture. Failures were treated with multistage urethroplasty in 12 cases, urethrotomy in 7 and 1-stage urethroplasty in 3. Of the patients 16 had a satisfactory final outcome and 6 underwent definitive perineal urinary diversion. Conclusions: The prevalence and location of anastomotic ring strictures after bulbar urethroplasty were uniformly distributed in after 3 surgical techniques using skin or buccal mucosa. Further studies are necessary to clarify the etiology of these fibrous ring strictures. [Copyright &y& Elsevier]
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- 2006
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33. Focal Therapy and Prostate Cancer
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Lazzeri, Massimo, Losa, Andrea, Buffi, Nicolòmaria, Lughezzani, Giovanni, Fossati, Nicola, Abrate, Alberto, Larcher, Alessandro, Lista, Giuliana, Mistretta, Alessandro, and Guazzoni, Giorgio
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The International Task Force on Prostate Cancer defines focal therapy (FT) for prostate cancer (PCa) as the therapy that “selectively ablates known disease and preserves existing functions, with the overall objective of minimizing lifetime morbidity without compromising life expectancy”. FT for the treatment of PCa has been called the “male lumpectomy”, an analogue to women's breast lumpectomy for the treatment of breast cancer. Radical prostatectomy continues to be the most frequently performed treatment for localized PCa, as anatomic knowledge and several technical advances, i.e. the introduction of robotic assisted surgery, have led to successful oncological outcome and lower rates of post-treatment morbidity. However, a proportion of patients still experiences a no negligible sexual, urinary, and bowel morbidity. Although the rationale of active surveillance for low-risk PCa (PSA <10 ng/mL, Gleason grade 6 or less, and clinical stage T1c-T2a) is sound, only few of newly diagnosed patients elect this approach. Thus, in the recent years the concept of a “subtotal therapy” gained the interest of some urological schools. The aim of this paper is to review the existing literature in order to provide the status of art on FT for PCa. The manuscript will focus on the characteristics of the target population, on the pre-operative evaluation to localise disease, as well as on perioperative, functional, and disease-control following focal therapy.L'International Task Force on Prostate Cancer definisce la terapia focale (TF) per il carcinoma prostatico (CP) una terapia che selettivamente distrugge la neoplasia precedentemente individuata e preserva le funzioni dell'organo, con l'obiettivo di minimizzare la morbilità senza compromettere la radicalità oncologica. La TF per il CP è stata paragonata alla quadrantectomia per il tumore della mammella. Sebbene, grazie ad una maggiore conoscenza anatomica e all'innovazione tecnologica, rappresentata in primis all'introduzione della piattaforma robotica, la prostatectomia radicale continua ad essere il trattamento radicale più diffuso per la cura del CP localizzato, l'impatto delle complicazioni urinarie, sessuali ed intestinali sulla qualità di vita non è trascurabile. La sorveglianza attiva è stata considerata un'alternativa ai trattamenti radicali per pazienti con basso rischio (PSA <10 ng/mL, Gleason score 6, stadio clinico T1c-T2a). Sfortunatamente una significativa percentuale di pazienti in sorveglianza attiva viene successivamente avviata a terapia radicale sia per riclassificazione bioptica o per motivi psicologici. Negli ultimi anni ha quindi preso campo la possibilità di una terapia sub totale o focale. L'obiettivo di questo lavoro è quello di rivedere la letteratura recente sul tema cercando di identificare quali siano le caratteristiche del paziente candidabile, gli strumenti impiegati per l'esatta localizzazione della neoplasia, le principali tecniche usate e le strategie di follow-up.
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- 2013
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34. Consolidation Radiotherapy for a Rare Case of Extranodal Mucosa-Associated Lymphoid Tissue Non-Hodgkin's Lymphoma Synchronous with Prostate Adenocarcinoma
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Alongi, Filippo, Aniko, Maria Deli, Ferreri, Andrés José Maria, Rosso, Alberto, Cozzarini, Cesare, Fallanca, Federico, Berardi, Genoveffa, Schipani, Stefano, Gianolli, Luigi, Guazzoni, Giorgio, and Di Muzio, Nadia
- Abstract
Nongastric primary extranodal mucosa-associated lymphoid tissue (MALT) lymphomas are uncommon, with around 0.1% occurring in the prostate. Even less frequent is the presence of MALT lymphoma synchronous with another type of neoplasm in the same organ, especially the prostate. Only a single case of concurrent adenocarcinoma and MALT lymphoma of the prostate has been reported in the literature. We report a rare case of primary extranodal marginal zone MALT lymphoma incidentally diagnosed during radical prostatectomy for an adenocarcinoma of the prostate in a 53-year-old patient. Fourteen months later a recurrence of the MALT lymphoma involving both sides of the diaphragm was found and was treated with chemoimmunotherapy. High-dose radiotherapy was delivered to residual bulky disease in the pelvic region. At 18 months from the end of radiation treatment the patient was without signs of relapse of MALT lymphoma. This preliminary result confirms that rare cases of MALT lymphoma of the prostate should be discussed and treated under the collaborative supervision of hematologists and medical and radiation oncologists. In fact, at an advanced stage of the disease, a chemotherapy regimen with additional consolidation radiotherapy could be an effective strategy, as in all other lymphomas.
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- 2010
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35. Holmium laser enucleation of the prostate and holmium laser ablation of the prostate indications and outcome
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Suardi, Nazareno, Gallina, Andrea, Salonia, Andrea, Briganti, Alberto, Dehò, Federico, Zanni, Giuseppe, Abdollah, Firas, Naspro, Richard, Cestari, Andrea, Guazzoni, Giorgio, Rigatti, Patrizio, and Montorsi, Francesco
- Abstract
Holmium laser enucleation of the prostate (HoLEP) has been proposed as an alternative to transurethral resection of the prostate and to open prostatectomy for patients with lower urinary tract symptoms because of large benign prostatic enlargement. The aim of this review is to critically analyze currently available evidence-based reports regarding HoLEP, with particular interest in long-term follow-up results.
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- 2009
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36. Cost Containment in Laparoscopic Radical Nephrectomy: Feasibility and Advantages over Open Radical Nephrectomy
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Guazzoni, Giorgio, Cestari, Andrea, Naspro, Richard, Riva, Matteo, and Rigatti, Patrizio
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Purpose: To highlight the impact of the laparoscopic experience of the surgical team on achievement of satisfactory results with cost containment in performing laparoscopic radical nephrectomy (LRN).Patients and Methods: We compared the cost components of 15 consecutive uncomplicated LRNs performed in 2001 (LRN01) with 15 consecutive uncomplicated laparoscopic radical nephrectomies performed in 2003 (LRN03) and with 15 consecutive uncomplicated procedures performed at our institution by the same surgical team in the year 1999 matched for patient age, tumor size, and disease stage. The groups were comparable in demographics.Results: The operative times were 250, 225, and 195 minutes in the LRN01, LRN03, and open-surgery groups, respectively, while the lengths of postoperative stay were 3.8, 3.1, and 6.5 days. Operating room costs, excluding the disposable instruments, were 11.00 /min for the open surgery and 10.00 /min for laparoscopic nephrectomy, and the cost of the postoperative stay was 300 to 310 per day. The cost of disposable instruments was 952.18 for LRN01 and 146.37 for LRN03. The overall costs were 4155.00 for the open-surgery group, 4672.00 for LRN01, and 3336.37 for LRN03.Conclusions: Cost containment in laparoscopic nephrectomy is possible. A proper team learning curve and the employment of reliable reusable instruments is the key to reducing costs, making this procedure as economically advantageous as the equivalent open procedure.
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- 2006
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37. Laparoscopic adrenalectomy and adrenal-preserving surgery
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Cestari, Andrea, Naspro, Richard, Rigatti, Patrizio, and Guazzoni, Giorgio
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The aim of this paper is to define the current role of laparoscopy in the management of surgical adrenal diseases evaluating the surgical aspects, the indications and contraindications of laparoscopic adrenalectomy, focusing also on the most innovative tendencies in the laparoscopic adrenal-preserving surgery.
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- 2005
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38. Update of the minimally invasive therapies for benign prostatic hyperplasia
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Naspro, Richard, Salonia, Andrea, Colombo, Renzo, Cestari, Andrea, Guazzoni, Giorgio, Rigatti, Patrizio, and Montorsi, Francesco
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The elevated impact benign prostatic hyperplasia has on patient quality of life has determined continuous research into the development of minimally invasive therapies aimed at restoring or preserving a good quality of life. The purpose of this review is to highlight recent developments in the field of minimally invasive treatment of benign prostatic hyperplasia, and to determine their possible impact on everyday clinical practice.
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- 2005
39. LAPAROSCOPIC CRYOABLATION OF SOLID RENAL MASSES: INTERMEDIATE TERM FOLLOWUP
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CESTARI, ANDREA, GUAZZONI, GIORGIO, DELL'ACQUA, VINCENZO, NAVA, LUCIANO, CARDONE, GIAMPIERO, BALCONI, GIUSEPPE, NASPRO, RICHARD, MONTORSI, FRANCESCO, and RIGATTI, PATRIZIO
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We report our experience with laparoscopic renal cryoablation (LRC) in select cases of small renal neoplasms. We evaluated the oncological results with the advantages of minimally invasive surgery.
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- 2004
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40. Holmium Laser Enucleation Versus Transurethral Resection of the Prostate. Are Histological Findings Comparable?
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NASPRO, RICHARD, FRESCHI, MASSIMO, SALONIA, ANDREA, GUAZZONI, GIORGIO, Di GIROLAMO, VALERIO, SCATTONI, RENZO COLOMBO VINCENZO, RIGATTI, PATRIZIO, and MONTORSI, FRANCESCO
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We investigated if an adequate histological diagnosis can be made from tissue after holmium laser enucleation of the prostate (HoLEP) and whether it is comparable to transurethral prostate resection (TURP) tissue findings in patients with benign prostatic hyperplasia.
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- 2004
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41. A Prospective Study Comparing Paroxetine Alone Versus Paroxetine Plus Sildenafil in Patients With Premature Ejaculation
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SALONIA, ANDREA, MAGA, TOMMASO, COLOMBO, RENZO, SCATTONI, VINCENZO, BRIGANTI, ALBERTO, CESTARI, ANDREA, GUAZZONI, GIORGIO, RIGATTI, PATRIZIO, and MONTORSI, FRANCESCO
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We compared the efficacy of paroxetine alone and combined with sildenafil in patients complaining of premature ejaculation.
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- 2002
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42. RECONFIGURATION OF THE SEVERELY FIBROTIC PENIS WITH A PENILE IMPLANT
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MONTORSI, FRANCESCO, SALONIA, ANDREA, MAGA, TOMMASO, COLOMBO, RENZO, CESTARI, ANDREA, GUAZZONI, GIORGIO, and RIGATTI, PATRIZIO
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Using evidence based methods we prospectively evaluated the impact of a new surgical procedure on penile deformity caused by severe cavernous fibrosis.
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- 2001
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43. EIGHT-YEAR EXPERIENCE WITH TRANSPERITONEAL LAPAROSCOPIC ADRENAL SURGERY
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GUAZZONI, GIORGIO, CESTARI, ANDREA, MONTORSI, FRANCESCO, LANZI, ROBERTO, NAVA, LUCIANO, CENTEMERO, ANTONELLA, and RIGATTI, PATRIZIO
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Laparoscopic adrenalectomy is currently the technique of choice for removing benign adrenal lesions. Various laparoscopic techniques and approaches have been reported using the transperitoneal or retroperitoneal approach. We present our 8-year experience with and long-term results of transperitoneal laparoscopic adrenalectomy.
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- 2001
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44. EVIDENCE BASED ASSESSMENT OF LONG-TERM RESULTS OF PLAQUE INCISION AND VEIN GRAFTING FOR PEYRONIE’S DISEASE
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MONTORSI, FRANCESCO, SALONIA, ANDREA, MAGA, TOMMASO, BUA, LINA, GUAZZONI, GIORGIO, BARBIERI, LUIGI, BARBAGLI, GUIDO, CHIESA, ROBERTO, PIZZINI, GIULIANO, and RIGATTI, PATRIZIO
- Abstract
We assessed the long-term outcome of plaque incision and vein grafting in select patients with Peyronie’s disease by extensive preoperative and postoperative subjective and objective analysis.
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- 2000
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45. The Added Value of Robotic Surgery
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Buffi, Nicolò Maria, Lughezzani, Giovanni, Lazzeri, Massimo, Casale, Paolo, Fiorini, Girolamo, Hurle, Rodolfo, Taverna, Gian Luigi, and Guazzoni, Giorgio
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Robotic surgery has recently emerged as a feasible alternative to open and laparoscopic procedures for the treatment of many urological diseases. The use of robotics allows the surgeon to overcome the limitations of standard laparoscopy while maintaining the advantages of a minimally invasive approach. Robotic-assisted radical prostatectomy is the most frequent surgery performed robotically, resulting in better functional outcomes and comparable oncological results with respect to open surgery. Given its advantages, the indications for robotic surgery have progressively extended to different fields, and there is increasing evidence for its effectiveness in high-risk prostate cancer, bladder cancer, kidney cancer, and adrenal disease. Based on the available evidence in the literature, robotic surgery should be considered a viable option for the treatment of many urological conditions, with the final aim of optimizing patients’ outcomes.
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- 2015
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46. The predictive usefulness of age and kind of onset in discriminating psychogenic from organic impotence
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Clerici, Stefano, Orlandini, Alvise, Fossati, Andrea, Montorsi, Francesco, Guazzoni, Giorgio, Rigatti, Patrizio, and Maffei, Cesare
- Abstract
Abstract: It is well known in clinical practice that psychogenic impotence affects younger patients than organic impotence and with a more acute onset. In the present study the authors evaluated the predictive usefulness and discriminating power of the following sociodemographic and clinical variables: age, kind of onset (acute or gradual), civil status, number of partners, duration of illness. The sample was made of 133 patients suffering from erectile dysfunction for at least three months, consecutively admitted to the Multidisciplinary Centre for the Diagnosis and Treatment of Impotence of the Scientific Institute San Raffaele of Milan from May 1992 to April 1993. All patients underwent a thorough clinical and laboratory evaluation: 72 (54.5%) were psychogenic (mean age 42.611.2); 60 (45.5%) organic (mean age 56.39.8). Stepwise logistic regression model identified age and kind of onset as significant predictors of kind of impotence. According to the logistic regression classification table, sensitivity for psychogenic impotence was 778, specificity was. 750, positive predictive power was .789, and negative predictive power was .738. These results indicate that age and kind of onset proved to be significant predictors of psychogenic impotence and to have a good clinical functioning as both inclusion and exclusion criteria. These results suggest that a patient in his forties and with an acute onset of impotence should be firstly assessed from a psychological point of view; and on the opposite, a 50 year old patient with a gradual onset presents a rationale for a thorough clinical evaluation.
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- 1994
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47. Iatrogenic erectile dysfunction
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Montorsi, Francesco, Maga, Tommaso, Guazzoni, Giorgio, and Rigatti, Patrizio
- Abstract
Iatrogenic erectile dysfunction includes abnormalities of erectile function due to any kind of therapeutic modality, that is surgery, radiotherapy, physical therapy and drug therapy. Transurethral prostatectomy does not seem to be significantly related to postoperative erectile dysfunction. When performed with a bilateral nerve-sparing technique and subsequent programmed oxygenation of the corpora cavernosa, radical prostatectomy is also associated with a minor rate of postoperative erectile dysfunction. New techniques of radiotherapy for prostate cancer also show low rates of damage to the erectile function. Finally, drugs such as antihypertensive agents are significantly associated with erectile dysfunction only in the case of thiazide diuretics.
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- 1997
48. Transrectal Microwave Hyperthermia for Advanced Prostate Cancer: Long-Term Clinical Results
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Montorsi, Francesco, Guazzoni, Giorgio, Colombo, Renzo, Galli, Laura, Bergamaschi, Franco, and Rigatti, Patrizio
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Transrectal microwave hyperthermia was applied to 46 stages D1 and D2 prostate cancer patients to treat urinary symptoms and local pain unrelieved by total androgen ablation therapy. Hyperthermia was administered in 10, 60-minute sessions twice a week for 5 weeks. A calculated intraprostatic temperature of 43.5 ± 0.5C was maintained throughout the treatment. At 2 years the mean residual urine volume was significantly decreased (p <0.05), while the mean peak flow rate and maximum flow nomogram were improved but not significantly. The majority of patients reported a notable amelioration of subjective symptoms and quality of life. The only complication was a prostatorectal fistula that was cured by leaving a urethral catheter in place for 4 weeks. Prostatic hyperthermia is a safe and effective palliative procedure for bladder outlet obstruction due to advanced prostate cancer.
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- 1992
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49. Transrectal Microwave Hyperthermia for Benign Prostatic Hyperplasia: Long-Term Clinical, Pathological and Ultrastructural Patterns
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Montorsi, Francesco, Galli, Laura, Guazzoni, Giorgio, Colombo, Renzo, Bulfamante, Gaetano, Barbieri, Luigi, Matozzo, Vincenzo, Grazioli, Vittorio, and Rigatti, Patrizio
- Abstract
Transrectal microwave hyperthermia of the prostate was administered to 191 patients with bladder outlet obstruction due to benign prostatic hyperplasia who were either at poor operative risk or who refused surgery. Patients were divided in 2 groups according to age and they underwent either 5 or 10, 60-minute sessions of hyperthermia, with a calculated intraprostatic temperature of 42.5 plus or minus 0.5C. Light and electron microscopy showed no irreversible damage at the glandular epithelium but did demonstrate a significant increase in neoformed intraprostatic capillary-like vessels. At 1, 12 and 24 months residual urine volume was significantly decreased in the majority of patients but only a minor amelioration of urinary flow rates and subjective symptoms was observed. According to maximum flow nomograms all patients were still obstructed postoperatively. Transrectal hyperthermia cannot be considered a genuine alternative to surgery for patients with bladder outlet obstruction due to benign prostatic hyperplasia.
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- 1992
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50. Open Surgical Revision of Laparoscopic Pelvic Lymphadenectomy for Staging of Prostate Cancer: The Impact of Laparoscopic Learning Curve
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Guazzoni, Giorgio, Montorsi, Francesco, Bergamaschi, Franco, Bellinzoni, Piera, Centemero, Antonella, Consonni, Paolo, and Rigatti, Patrizio
- Abstract
We attempt to clarify the impact of the learning curve on the first 30 laparoscopic pelvic lymphadenectomies performed at our institute. Open surgical revision of the area of laparoscopic dissection was performed at radical retropubic prostatectomy. The mean number of obturator and iliac lymph nodes removed laparoscopically was 8.7 and 8.8 from the right and left sides, respectively. The mean number of residual obturator and iliac lymph nodes removed at open operation was 3.2 and 3 from the right and left sides, respectively. The amount of residual lymph node tissue after laparoscopic lymphadenectomy progressively decreased with time, especially after the first 20 cases. A microscopic pelvic lymph node metastasis was found at open operation in patients 6, 14 and 15, who had false-negative results at laparoscopy. Due to the learning curve effect, the first 30 patients who undergo laparoscopic pelvic lymphadenectomy should be assessed again by an open operation at radical retropubic prostatectomy.
- Published
- 1994
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