22 results on '"Bianchi, Giampaolo"'
Search Results
2. Positive surgical margin during radical prostatectomy: overview of sampling methods for frozen sections and techniques for the secondary resection of the neurovascular bundles.
- Author
-
Sighinolfi MC, Eissa A, Spandri V, Puliatti S, Micali S, Reggiani Bonetti L, Bertoni L, Bianchi G, and Rocco B
- Subjects
- Humans, Image-Guided Biopsy methods, Intraoperative Period, Male, Prostate surgery, Prostatic Neoplasms pathology, Reoperation, Margins of Excision, Neoplasm Staging, Prostate pathology, Prostatectomy methods, Prostatic Neoplasms surgery
- Abstract
Objective: The aim of the paper is to provide an overview of intraoperative sampling methods for frozen section (FS) analysis and of surgical techniques for a secondary neurovascular bundle (NVB) resection, as the method of surgical margin (SM) sampling and the management of a positive SM (PSM) at the nerve-sparing (NS) area are under evaluated issues. FS analysis during radical prostatectomy (RP) can help to tailor the plane of dissection based on cancer extension and thus extend the indications for NS surgery., Evidence Acquisition: We performed a PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science, Cochrane Library, and Elton B. Stephens Co. (EBSCO)host search to include articles published in the last decade, evaluating FS analysis in the NS area and surgical attempts to convert a PSM to a negative status., Evidence Synthesis: Overall, 19 papers met our inclusion criteria. The ways to collect samples for FS analysis included: systematic (analysing the whole posterolateral aspect of the prostate specimen, i.e., neurovascular structure-adjacent frozen-section examination [NeuroSAFE]); magnetic resonance imaging (MRI)-guided (biopsies from MRI-suspicious areas, retrieved by the surgeon in a cognitive way); and random biopsies from the soft periprostatic tissues. Techniques to address a PSM in the NS area included: full resection of the spared NVB, from its caudal to cranial aspect, often including the rectolateral part of the Denonvilliers' fascia; partial resection of the NVB, in cases where sampling attempts to localise a PSM; incremental approach, meaning a partial or full resection that extends until no prostate tissue is found in the soft periprostatic environment., Conclusions: There is no homogeneity in prostate sampling for FS analysis, although most recent evidence is moving toward a systematic sampling of the entire NS area. The management of a PSM is variable and can be affected by the sampling strategy (difficult localisation of the persisting tumour at the NVB). The difficult identification of the exact soft tissue location contiguous to a PSM could be considered as the critical point of FS analysis and of spared-NVB management., (© 2020 The Authors BJU International © 2020 BJU International Published by John Wiley & Sons Ltd.)
- Published
- 2020
- Full Text
- View/download PDF
3. Real-time assessment of surgical margins during radical prostatectomy: a novel approach that uses fluorescence confocal microscopy for the evaluation of peri-prostatic soft tissue.
- Author
-
Rocco B, Sighinolfi MC, Bertoni L, Spandri V, Puliatti S, Eissa A, Reggiani Bonetti L, Azzoni P, Sandri M, De Carne C, Turri F, Cimadamore A, Montironi R, Maiorana A, Micali S, Bianchi G, and Pellacani G
- Subjects
- Computer Systems, Humans, Male, Prospective Studies, Prostate drug effects, Prostatic Neoplasms diagnostic imaging, Fluorescence, Intraoperative Care methods, Margins of Excision, Microscopy, Confocal methods, Prostate pathology, Prostate surgery, Prostatectomy methods, Prostatic Neoplasms pathology, Prostatic Neoplasms surgery
- Published
- 2020
- Full Text
- View/download PDF
4. "Real-time" Assessment of Surgical Margins During Radical Prostatectomy: State-of-the-Art.
- Author
-
Eissa A, Zoeir A, Sighinolfi MC, Puliatti S, Bevilacqua L, Del Prete C, Bertoni L, Azzoni P, Reggiani Bonetti L, Micali S, Bianchi G, and Rocco B
- Subjects
- Augmented Reality, Frozen Sections, Humans, Male, Margins of Excision, Microscopy, Confocal methods, Microscopy, Fluorescence, Multiphoton methods, Prostate surgery, Prostatic Neoplasms diagnosis, Prostatic Neoplasms pathology, Review Literature as Topic, Tomography, Optical Coherence methods, Intraoperative Care methods, Prostate pathology, Prostatectomy methods, Prostatic Neoplasms surgery
- Abstract
Histopathologic examination of the pathologic specimens using hematoxylin & eosin stains represents the backbone of the modern pathology. It is time-consuming; thus, "real-time" assessment of prostatic and periprostatic tissue has gained special interest in the diagnosis and management of prostate cancer. The current study focuses on the review of the different available techniques for "real-time" evaluation of surgical margins during radical prostatectomy (RP). We performed a comprehensive search of the Medline database to identify all the articles discussing "real-time" or intraoperative assessment of surgical margins during RP. Several filters were applied to the search to include only English articles performed on human subjects and published between January 2000 and March 2019. The search revealed several options for pathologic assessment of surgical margins including intraoperative frozen sections, confocal laser endomicroscopy, optical spectroscopy, photodynamic diagnosis, optical coherence tomography, multiphoton microscopy, structured illumination microscopy, 3D augmented reality, and ex vivo fluorescence confocal microscope. Frozen section represents the gold standard technique for real-time pathologic examinations of surgical margins during RP; however, several other options showed promising results in the initial clinical trials, and considering the rapid development in the field of molecular and cellular imaging, some of these options may serve as an alternative to frozen section., (Copyright © 2019. Published by Elsevier Inc.)
- Published
- 2020
- Full Text
- View/download PDF
5. Ex vivo fluorescence confocal microscopy: the first application for real-time pathological examination of prostatic tissue.
- Author
-
Puliatti S, Bertoni L, Pirola GM, Azzoni P, Bevilacqua L, Eissa A, Elsherbiny A, Sighinolfi MC, Chester J, Kaleci S, Rocco B, Micali S, Bagni I, Bonetti LR, Maiorana A, Malvehy J, Longo C, Montironi R, Bianchi G, and Pellacani G
- Subjects
- Aged, Biopsy, Humans, Intraoperative Care, Male, Middle Aged, Prospective Studies, ROC Curve, Robotic Surgical Procedures methods, Microscopy, Confocal methods, Microscopy, Fluorescence methods, Prostate diagnostic imaging, Prostate pathology, Prostate surgery, Prostatectomy methods, Prostatic Neoplasms diagnostic imaging, Prostatic Neoplasms pathology, Prostatic Neoplasms surgery
- Abstract
Objective: To report the first application of ex vivo fluorescence confocal microscopy (FCM) - a novel optical technology that is capable of providing fast microscopic imaging of unfixed tissue specimens- in the urological field assessing its diagnostic accuracy for non neoplastic and cancerous prostate tissue (prostatic adenocarcinoma) compared to the 'gold standard' histopathological diagnoses., Patients and Methods: In all, 89 specimens from 13 patients with clinically localised prostate cancer were enrolled into the study. All patients underwent robot-assisted laparoscopic radical prostatectomy with fresh prostatic tissue biopsies taken at the end of each intervention using an 18-G biopsy punch. Specimens were randomly assigned to the three collaborating pathologists for evaluation. Intra- and inter-observer agreement was tested by the means of Cohen's κ. The diagnostic performance was evaluated on receiver operating characteristic curve analysis., Results: The overall diagnostic agreement between FCM and histopathological diagnoses was substantial with a 91% correct diagnosis (κ = 0.75) and an area under the curve of 0.884 (95% confidence interval 0.840-0.920), 83.33% sensitivity, and 93.53% specificity., Conclusion: FCM seems to be a promising tool for enhanced specimens' reporting performance, given its simple application and very rapid microscopic image generation (<5 min/specimen). This technique may potentially be used for intraoperative pathological specimens' analysis., (© 2019 The Authors BJU International © 2019 BJU International Published by John Wiley & Sons Ltd.)
- Published
- 2019
- Full Text
- View/download PDF
6. Effect of puboprostatic ligament reconstruction on continence recovery after robot-assisted laparoscopic prostatectomy: our initial experience.
- Author
-
Puliatti S, Elsherbiny A, Eissa A, Pirola G, Morini E, Squecco D, Inzillo R, Zoeir A, Iseppi A, Sighinolfi MC, Micali S, Rocco B, and Bianchi G
- Subjects
- Aged, Aged, 80 and over, Humans, Male, Middle Aged, Prostatic Neoplasms surgery, Quality of Life, Plastic Surgery Procedures, Retrospective Studies, Treatment Outcome, Laparoscopy adverse effects, Ligaments surgery, Postoperative Complications surgery, Prostate surgery, Prostatectomy adverse effects, Robotic Surgical Procedures adverse effects, Urinary Incontinence etiology, Urinary Incontinence surgery
- Abstract
Background: Prostate cancer represents a serious health problem worldwide. Radical prostatectomy is the gold standard for management of localized prostate cancer. Urinary incontinence is among the most common complications affecting robot-assisted laparoscopic prostatectomy (RALP) patients' postoperative quality of life. Several surgical modifications were introduced to overcome this problem including the puboprostatic ligament reconstruction. In this study, we discuss our technique of anterior reconstruction of the puboprostatic ligament during RALP and its effect on the continence outcome postoperatively., Methods: In this retrospective study, the data of 95 consecutive patients were analyzed and the patients were divided in two groups; the control group "group A" (47 patients) and the anterior reconstruction group "group B" (48 patients). The primary endpoint of this study was to compare both groups as regards the postoperative continence rates., Results: Complete continence (no pads) rates were reported at time of catheter removal (T0), 1 month (T1), 4 months (T4), 6 months (T6) and 12 months (T12) postoperatively. Moreover, the social continence (0-1 security pad) was reported at 12 months postoperatively. Complete continence was significantly different between both groups at T0 and T6 (P=0.022, and P=0.035 respectively). The social continence was not significantly different between both groups (85.1% vs. 89.6% in group A vs. group B)., Conclusions: Despite anterior reconstruction of the puboprostatic ligament showed no significant effect on the overall continence, it showed earlier return to continence up to 6 months, which supports the theory that anterior puboprostatic reconstruction may provide better immediate continence and shorten the time to continence for RALP patients. However, most of the published literature showed better continence rates with the total anatomical reconstruction (combined anterior and posterior). Therefore, we started to offer patients in our center total anatomical reconstruction during RALP.
- Published
- 2019
- Full Text
- View/download PDF
7. Supra-pubic versus urethral catheter after robot-assisted radical prostatectomy: systematic review of current evidence.
- Author
-
Bertolo R, Tracey A, Dasgupta P, Rocco B, Micali S, Bianchi G, Hampton L, Tewari AK, Porpiglia F, and Autorino R
- Subjects
- Adult, Humans, Male, Pain, Procedural etiology, Prospective Studies, Prostatic Neoplasms, Randomized Controlled Trials as Topic statistics & numerical data, Retrospective Studies, Urinary Catheterization adverse effects, Urinary Catheterization statistics & numerical data, Urinary Catheters, Prostatectomy, Robotic Surgical Procedures, Urethra, Urinary Catheterization methods
- Abstract
Purpose: To provide latest evidence on the use of suprapubic catheter (SPC) versus urethral catheter (UC) after robot-assisted laparoscopic radical prostatectomy (RARP)., Materials and Methods: A systematic revision of literature was performed up to September 2017 using different search engines (Pubmed, Ovid, Scopus) to identified studies comparing the use of SPC versus standard UC after RARP. Identification and selection of the studies were conducted according to the preferred reporting items for systematic reviews and meta-analysis criteria. For continuous outcomes, the weighted mean difference (WMD) was used as a summary measure, whereas the odds ratio (OR) or risk ratio (RR) with 95% confidence interval (CI) was calculated for binary variables. RR was preferred in cases of a high number of events to avoid overestimation. Pooled estimates were calculated using the random-effect model to account for clinical heterogeneity. All statistical analyses were performed using Review manager 5 (Cochrane Collaboration, Oxford, UK)., Results: Eight studies were identified and included in this systematic review, namely 3 RCTs, 4 non-randomized prospective studies, and one retrospective study. A total of 966 RARP cases were collected for the cumulative analysis. Among them, 492 patients received standard UC and 474 SPC placement after RARP. UC patients had higher baseline PSA (WMD 0.44 ng/ml; p = 0.02). Visual Analog Scale (VAS) score was found to be significantly lower in patients with SPC at postoperative day 7 (WMD 0.53; 95% CI 0.13-0.93; p = 0.009). Regarding penile pain, a significant difference in favor of the SPC group was found at postoperative day 7 assessment (WMD 1.2; 95% CI 0.82-1.6; p < 0.001). More patients in the SPC group reported "not at all" or "minimal pain" at this time point (OR 0.17, 95% CI 0.06, 0.44; p < 0.001). No significant differences were found in terms of continence recovery rate at 6-12 weeks between the groups (UC 78.7%, 88.2%; RR 0.92, 95% CI 0.84, 1.01; p = 0.09). Similarly, no differences were found in terms of catheter-related issues (p = 0.17). However, UC patients had lower likelihood of overall complications (OR 0.44, 95% CI 0.21-0.89, p = 0.02)., Conclusions: Available evidence suggests that the use of SPC can be a viable option for postoperative urine drainage after RARP, as it can translate into decreased postoperative pain without carrying a significant higher risk of catheter-related complications. Further investigation seems to be warranted, ideally within the framework of a multicentre randomized study with standardized analysis of outcomes.
- Published
- 2018
- Full Text
- View/download PDF
8. A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy.
- Author
-
Patel VR, Sandri M, Grasso AAC, De Lorenzis E, Palmisano F, Albo G, Coelho RF, Mottrie A, Harvey T, Kameh D, Palayapalayam H, Wiklund P, Bosari S, Puliatti S, Zuccolotto P, Bianchi G, and Rocco B
- Subjects
- Aged, Computer Graphics, Humans, Logistic Models, Male, Middle Aged, Neoplasm Invasiveness, Organ Sparing Treatments, Predictive Value of Tests, ROC Curve, Algorithms, Peripheral Nerves surgery, Prostate pathology, Prostatectomy methods, Prostatic Neoplasms pathology, Prostatic Neoplasms surgery
- Abstract
Objectives: To create a statistical tool for the estimation of extracapsular extension (ECE) level of prostate cancer and determine the nerve-sparing (NS) approach that can be safely performed during radical prostatectomy (RP)., Patients and Methods: A total of 11 794 lobes, from 6 360 patients who underwent robot-assisted RP between 2008 and 2016 were evaluated. Clinicopathological features were included in a statistical algorithm for the prediction of the maximum ECE width. Five multivariable logistic models were estimated for: presence of ECE and ECE width of >1, >2, >3, and >4 mm. A five-zone decision rule based on a lower and upper threshold is proposed. Using a graphical interface, surgeons can view patient's pre-treatment characteristics and a curve showing the estimated probabilities for ECE amount together with the areas identified by the decision rule., Results: Of the 6 360 patients, 1 803 (28.4%) were affected by non-organ-confined disease. ECE was present in 1 351 lobes (11.4%) and extended beyond the capsule for >1, >2, >3, and >4 mm in 498 (4.2%), 261 (2.2%), 148 (1.3%), 99 (0.8%) cases, respectively. ECE width was up to 15 mm (interquartile range 1.00-2.00). The five logistic models showed good predictive performance, the area under the receiver operating characteristic curve was: 0.81 for ECE, and 0.84, 0.85, 0.88, and 0.90 for ECE width of >1, >2, >3, and >4 mm, respectively., Conclusion: This novel tool predicts with good accuracy the presence and amount of ECE. Furthermore, the graphical interface available at www.prece.it can support surgeons in patient counselling and preoperative planning., (© 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.)
- Published
- 2018
- Full Text
- View/download PDF
9. Re: Critical Analysis of Early Recurrence after Laparoscopic Radical Cystectomy in a Large Cohort by the ESUT: S. Albisinni, L. Fossion, M. Oderda, O. M. Aboumarzouk, F. Aoun, T. Tokas, V. Varca, R. Sanchez-Salas, X. Cathelineau, P. Chlosta, F. Gaboardi, U. Nagele, T. Piechaud, J. Rassweiler, P. Rimington, L. Salomon and R. van Velthoven J Urol 2016;195:1710-1717.
- Author
-
Mynbaev OA, Micali S, Zordani A, and Bianchi G
- Subjects
- Cohort Studies, Humans, Laparoscopy, Urinary Bladder, Cystectomy, Prostatectomy
- Published
- 2016
- Full Text
- View/download PDF
10. A Retrospective Analysis of the Hemostatic Effect of FloSeal in Patients Undergoing Robot-Assisted Laparoscopic Radical Prostatectomy.
- Author
-
Martorana E, Ghaith A, Micali S, Pirola GM, De Carne C, Fidanza F, and Bianchi G
- Subjects
- Aged, Blood Loss, Surgical, Blood Transfusion, Hemoglobins analysis, Hemorrhage drug therapy, Hemostasis, Humans, Intraoperative Period, Length of Stay, Male, Middle Aged, Postoperative Period, Retrospective Studies, Surgical Procedures, Operative, Treatment Outcome, Hemostatics therapeutic use, Laparoscopy methods, Prostatectomy methods, Prostatic Neoplasms surgery, Robotic Surgical Procedures methods
- Abstract
Background: Perioperative bleeding is a potential complication of robot-assisted laparoscopic radical prostatectomy (RALP) that may worsen outcomes. The role of local hemostatic materials in RALP has not been adequately assessed. We evaluated the hemostatic impact of FloSeal (Baxter International Inc., Fremont, Calif., USA) in RALP., Methods: A retrospective analysis was performed of 392 consecutive patients with prostate cancer who underwent RALP at our institution between February 2008 and July 2014. The patients were divided into 2 consecutive homogenous groups based on the use of FloSeal. Group A included 200 patients who underwent RALP between February 2008 and May 2011, with hemostasis performed using only traditional techniques. Group B included the remaining 192 patients, who underwent RALP between June 2011 and July 2014 and received FloSeal 5 ml after traditional hemostatic methods. We compared the blood transfusion rate, the differences between immediate postoperative hemoglobin (Hb) and mean postoperative day 1 (POD1) Hb levels, difference between POD1 and least Hb levels and difference between immediate postoperative Hb and least Hb levels., Results: The intraoperative use of FloSeal significantly decreased the blood transfusions rate, from 8.5 to 2.1% (p = 0.004). FloSeal was also associated with significant improvements in the difference between the immediate postoperative Hb and POD1 Hb levels (p = 0.03), mean POD1 Hb and least Hb (p = 0.01) and mean immediate postoperative Hb and least Hb levels (p = 0.034)., Conclusions: In this study, the use of FloSeal improves hemostatic outcomes in patients undergoing RALP compared with traditional hemostatic techniques, without increase of cost., (© 2016 S. Karger AG, Basel.)
- Published
- 2016
- Full Text
- View/download PDF
11. Potential effectiveness of pelvic floor rehabilitation treatment for postradical prostatectomy incontinence, climacturia, and erectile dysfunction: a case series.
- Author
-
Sighinolfi MC, Rivalta M, Mofferdin A, Micali S, De Stefani S, and Bianchi G
- Subjects
- Aged, Erectile Dysfunction diagnosis, Humans, Male, Middle Aged, Prostatic Neoplasms surgery, Severity of Illness Index, Surveys and Questionnaires, Erectile Dysfunction etiology, Erectile Dysfunction surgery, Pelvic Floor physiopathology, Pelvic Floor surgery, Postoperative Complications, Prostatectomy methods, Urinary Incontinence etiology, Urinary Incontinence physiopathology, Urinary Incontinence surgery
- Abstract
Introduction: Radical prostatectomy is the treatment of choice for prostate cancer; although novel techniques have significantly reduced its side effects, the procedure can provoke urinary incontinence of various degrees and/or erectile dysfunction., Aim: We evaluate the effect of a complete pelvic floor rehabilitation program on both incontinence and erectile dysfunction, including climacturia, in a preliminary case series., Main Outcomes Measures: Pad usage and International Index of Erectile Function (IIEF-15) Questionnaire., Methods: Three male patients, previously submitted to nerve and bladder neck sparing radical prostatectomy, presented with urinary incontinence, climacturia and erectile dysfunction of new onset. We decided to manage those subjects with a pelvic-floor rehabilitation program consisting of active pelvic-floor muscle exercises, electromyography biofeedback for strength and endurance, electrical stimulation. The whole program lasted 4 months, with weekly sessions, including general advices on lifestyle changes. Pad usage for incontinence and IIEF-15 were used to assess symptoms before and after the procedure., Results: Before a complete rehabilitation program, pad usage was 1 per day in all the subjects, and the score for erectile function was set at 17 (range 15-20). After the procedure, all the patients experienced a satisfying urinary continence and an improvement in erectile function (mean IIEF score: 22, range 19-24). Similarly, climacturia seems to be subjectively reduced in all the subjects., Conclusion: Pelvic floor muscles exercises seem to result in an improved urinary continence and erectile function after radical prostatectomy. Since this is the first clinical case series dealing with this topic, our outcomes are encouraging and suggest the potential usefulness of such noninvasive treatment modality.
- Published
- 2009
- Full Text
- View/download PDF
12. Re: A Novel Tool for Predicting Extracapsular Extension During Graded Partial Nerve Sparing in Radical Prostatectomy
- Author
-
Patel, Vipul, Sandri, Marco, Grasso, Angelica Anna Chiara, Lorenzis, De, Elisa, Palmisano, Franco, Albo, Giancarlo, Coelho, Rafael Ferreira, Mottrie, Alexander, Tadzia, Harvey, Kameh, Darian, Palayapalayam, Hariharan, Wiklund, Peter, Bosari, Silvano, Puliatti, Stefano, Zuccolotto, Paola, Bianchi, Giampaolo, Rocco, Bernardo, Montironi, Rodolfo, Cheng, Liang, Lopez-Beltran, Antonio, Scarpelli, Marina, and Montorsi, Francesco
- Subjects
Male ,0301 basic medicine ,medicine.medical_specialty ,Nerve sparing ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Predictive Value of Tests ,Computer Graphics ,medicine ,Humans ,In patient ,Neoplasm Invasiveness ,Peripheral Nerves ,Aged ,Prostatectomy ,Preoperative planning ,Receiver operating characteristic ,business.industry ,Prostate ,Seminal Vesicles ,Prostatic Neoplasms ,Extension (predicate logic) ,Nomogram ,Middle Aged ,Surgery ,Logistic Models ,030104 developmental biology ,ROC Curve ,030220 oncology & carcinogenesis ,Nuclear medicine ,business ,Organ Sparing Treatments ,Algorithms ,Statistical algorithm - Abstract
Objectives To create a statistical tool for the estimation of extracapsular extension (ECE) level of prostate cancer and determine the nerve-sparing (NS) approach that can be safely performed during radical prostatectomy (RP). Patients and methods A total of 11 794 lobes, from 6 360 patients who underwent robot-assisted RP between 2008 and 2016 were evaluated. Clinicopathological features were included in a statistical algorithm for the prediction of the maximum ECE width. Five multivariable logistic models were estimated for: presence of ECE and ECE width of >1, >2, >3, and >4 mm. A five-zone decision rule based on a lower and upper threshold is proposed. Using a graphical interface, surgeons can view patient's pre-treatment characteristics and a curve showing the estimated probabilities for ECE amount together with the areas identified by the decision rule. Results Of the 6 360 patients, 1 803 (28.4%) were affected by non-organ-confined disease. ECE was present in 1 351 lobes (11.4%) and extended beyond the capsule for >1, >2, >3, and >4 mm in 498 (4.2%), 261 (2.2%), 148 (1.3%), 99 (0.8%) cases, respectively. ECE width was up to 15 mm (interquartile range 1.00-2.00). The five logistic models showed good predictive performance, the area under the receiver operating characteristic curve was: 0.81 for ECE, and 0.84, 0.85, 0.88, and 0.90 for ECE width of >1, >2, >3, and >4 mm, respectively. Conclusion This novel tool predicts with good accuracy the presence and amount of ECE. Furthermore, the graphical interface available at www.prece.it can support surgeons in patient counselling and preoperative planning.
- Published
- 2018
13. Re: Critical Analysis of Early Recurrence after Laparoscopic Radical Cystectomy in a Large Cohort by the ESUT
- Author
-
Mynbaev, Ospan A., Micali, Salvatore, Zordani, Alessio, and Bianchi, Giampaolo
- Subjects
Cohort Studies ,Prostatectomy ,Urology ,Urinary Bladder ,Humans ,Laparoscopy ,Cystectomy - Published
- 2016
14. Safety and efficacy of abiraterone acetate in chemotherapy-naive patients with metastatic castration-resistant prostate cancer: an Italian multicenter "real life" study.
- Author
-
Cindolo, Luca, Natoli, Clara, De Nunzio, Cosimo, De Tursi, Michele, Valeriani, Maurizio, Giacinti, Silvana, Micali, Salvatore, Rizzo, Mino, Bianchi, Giampaolo, Martorana, Eugenio, Scarcia, Marcello, Ludovico, Giuseppe Mario, Bove, Pierluigi, Laudisi, Anastasia, Selvaggio, Oscar, Carrieri, Giuseppe, Bada, Maida, Castellan, Pietro, Boccasile, Stefano, and Ditonno, Pasquale
- Subjects
ABIRATERONE acetate ,PROSTATE cancer treatment ,PROSTATE cancer patients ,CANCER chemotherapy ,RADIOTHERAPY ,GLEASON grading system ,PATIENT satisfaction ,THERAPEUTICS ,CLINICAL trials ,DRUG side effects ,METASTASIS ,PROGNOSIS ,PROSTATE tumors ,PROSTATECTOMY ,PROSTATE-specific antigen ,TREATMENT effectiveness ,DISEASE progression ,KAPLAN-Meier estimator ,BRIEF Pain Inventory - Abstract
Background: To evaluate the safety and efficacy of abiraterone acetate (AA) in the "real life" clinical practice for men with chemotherapy-naïve metastatic castration-resistant prostate.Methods: A consecutive series of patients with mCRPC in 9 Italian tertiary centres treated with AA was collected. Demographics, clinical parameters, treatment outcomes and toxicity were recorded. The Brief Pain Inventory scale Q3 was tracked and patient treatment satisfaction was evaluated. Survival curves were estimated by the method of Kaplan-Meier and Cox regression and compared by the log-rank test statistic.Results: We included 145 patients (mean age 76.5y). All patients were on androgen deprivation therapy. Patients had prior radiotherapy, radical prostatectomy, both treatments or exclusive androgen deprivation therapy in 17%, 33%, 9% and 40%, respectively. 57% of the patients had a Gleason score higher more than 7 at diagnosis. 62% were asymptomatic patients. The median serum total PSA at AA start was 17 ng/mL (range 0,4-2100). The median exposure to AA was 10 months (range 1-35). The proportion of patients achieving a PSA decline ≥50% at 12 weeks was 49%. Distribution of patient satisfaction was 32% "greatly improved", 38% "improved", 24% "not changed", 5.5% "worsened". Grade 3 and 4 toxicity was recorded in 17/145 patients 11.7% (70% cardiovascular events, 30% critical elevation of AST/ALT levels). At the last follow-up, median progression free and overall survival were 17 and 26.5 months, respectively. Both outcomes significantly correlated with the presence of pain, patient satisfaction, PSA baseline and PSA decline.Conclusions: The AA is effective and well tolerated in asymptomatic or slightly symptomatic mCRPC in a "real life" setting. The survival outcomes are influenced by the presence of pain, patient satisfaction, baseline PSA and PSA decline.Trial Registration: The study was retrospectively registered at ISRCTN as DOI: 10.1186/ISRCTN 52513758 in date April the 30th 2016. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
15. Robotic assisted laparoscopic radical prostatectomy: lateral approach to the bladder neck preservation in case of median lobe
- Author
-
Annino, F., Beato, A., De Carne, C., Micali, Salvatore, Sighinolfi, M. C., DE STEFANI, Stefano, and Bianchi, Giampaolo
- Subjects
radical ,prostatectomy ,Robotic ,laparoscopic - Published
- 2010
16. Tension-and energy-free robotic-assisted laparoscopic radical prostatectomy: Application during the learning curve
- Author
-
Annino, F., Beato, A., De Carne, C., Micali, Salvatore, DE STEFANI, Stefano, and Bianchi, Giampaolo
- Subjects
learning curve ,Tension ,robotic-assisted ,prostatectomy ,energy ,laparoscopic - Published
- 2009
17. Management and therapeutic response of a prostate ductal adenocarcinoma: a still unknown tumour?
- Author
-
Martorana, Eugenio, Micali, Salvatore, Pirola, Giacomo Maria, Bonetti, Luca Reggiani, Clò, Vera, Ghaith, Ahmed, and Bianchi, Giampaolo
- Subjects
DUCTAL carcinoma ,PROSTATE cancer treatment ,CANCER treatment ,METASTASIS ,PROSTATECTOMY ,THERAPEUTICS - Abstract
Ductal adenocarcinoma is a rare subtype of prostate cancer with a worse prognosis. Histologically, it is characterized by the presence of tall, pseudostratified columnar epithelium with abundant cytoplasm organized in a papillary or cribriform-papillary pattern. Several clinical differences distinguish this subtype of prostate cancer by the conventional acinar adenocarcinoma: exophytic growth into the prostatic urethra, different clinical presentation, different sites of metastasis and more aggressiveness. The rarity of this tumour forced to base our knowledge on small case series or on individual case reports, and does not help to establish appropriate guidelines. Therefore, the diagnosis of this tumour masks clinical implications that are still not well-understood. We report the case of a 69-year-old Caucasian man with a diagnosis of pure prostate ductal adenocarcinoma that early developed multiple metastases after radical prostatectomy. The patient started hormonal therapy with a fast biochemical and radiologic (positron emission tomography-computed tomography, PET-CT) hormonal escape. Therefore, we took the decision to perform chemotherapy with Taxotere along with prednisolone with a relative stability of prostate-specific antigen (PSA) level, but a new PET-CT scan showed a further progression of the disease. Finally, the patient underwent therapy with Abiraterone acetate that did not stop the cancer progression. No therapeutic options available showed a good control of disease progression. PSA proved to be a poor marker while, on the contrary, PET-CT scan has proved to be particularly useful in the management of the disease progression. More efforts are required to add new knowledge about this tumour and assess what is known until now. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
18. Editorial Comment on: Three-Layer Two-Step Posterior Reconstruction Using Peritoneum During Robot-Assisted Radical Prostatectomy to Improve Recovery of Urinary Continence: A Prospective Comparative Study by Ogawa et al.
- Author
-
Rocco, Bernardo Maria Cesare and Bianchi, Giampaolo
- Subjects
- *
PERITONEUM , *PROSTATECTOMY , *URINARY catheters , *HISTOPATHOLOGY , *SKELETAL muscle - Published
- 2017
- Full Text
- View/download PDF
19. Introduzione.
- Author
-
Bianchi, Giampaolo
- Subjects
- *
ENDOSCOPIC surgery , *UROLOGY , *PROSTATECTOMY , *RANDOMIZED controlled trials , *MAGNETIC resonance imaging , *SURGICAL complications , *OPERATIVE surgery - Published
- 2011
- Full Text
- View/download PDF
20. Digital Frozen Sections with Fluorescence Confocal Microscopy During Robot-assisted Radical Prostatectomy: Surgical Technique.
- Author
-
Rocco, Bernardo, Sarchi, Luca, Assumma, Simone, Cimadamore, Alessia, Montironi, Rodolfo, Reggiani Bonetti, Luca, Turri, Filippo, De Carne, Cosimo, Puliatti, Stefano, Maiorana, Antonino, Pellacani, Giovanni, Micali, Salvatore, Bianchi, Giampaolo, and Sighinolfi, Maria Chiara
- Subjects
- *
RADICAL prostatectomy , *FLUORESCENCE microscopy , *OPERATIVE surgery , *SURGICAL robots , *SURGICAL margin , *PROSTATECTOMY - Abstract
Robot-assisted radical prostatectomy (RARP) involves a tradeoff between oncological control and functional outcomes. Intraoperative control of surgical margins (SMs) may help in ensuring the safety of the dissection. Fluorescence confocal microscopy (FCM) is an effective method for interpretation of prostate tissue and provides digital images with an appearance similar to hematoxylin-eosin staining. To describe an alternative technique to NeuroSAFE for intraoperative evaluation of neurovascular-adjacent margins shaved from ex vivo specimens using FCM analysis. This was a prospective study of 24 patients undergoing RARP with intraoperative FCM control of margin status. After surgical dissection, SMs are sectioned from the fresh prostate using the Mohs technique (shaving): three slices from the apex and the right and left posterolateral aspects are obtained. Digital images of the shavings are immediately acquired via FCM and shared with a remote pathologist. In the case of a positive SM, a focal secondary resection of the bundle can be performed owing to the ability of FCM to locate a region of interest on the flat sample. The primary outcome measure was the rate of negative margins at neurovascular-adjacent sites. Oncological and functional outcomes for patients with 1 yr of follow-up are also reported. All patients had negative SMs in shavings from neurovascular-adjacent areas at final histopathology; four underwent a secondary resection with final conversion to negative SM status. Nine of ten patients with 1-yr follow-up are free of biochemical recurrence (prostate-specific antigen persistence in one pN1 case), nine are fully continent, and four of the five with preoperative potency have recovered their sexual function. Digital frozen sections with FCM during RARP may represent an alternative to NeuroSAFE for possible optimization of functional outcomes without compromising oncological safety. We developed a technique to ensure complete removal of cancer tissue during surgical removal of the prostate. Tissue specimens are examined via digital microscopy in real time during the operation. This allows the surgeon to remove more tissue if cancer is detected at the margins of a specimen, while avoiding unnecessary removal of healthy tissue. Fluorescence confocal microscopy analysis of areas adjacent to neurovascular bundles in freshly shaved prostate specimens represents a feasible and easy procedure to control surgical margin status during prostatectomy. The ability to create digital images without conventional processing and to allow remote reporting is a major strength. In the future, the technique could be used to guide functional tissue sparing and reduce positive margins at final histopathology. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
21. Supra-pubic versus urethral catheter after robot-assisted radical prostatectomy: systematic review of current evidence
- Author
-
Giampaolo Bianchi, Bernardo Rocco, Francesco Porpiglia, Riccardo Autorino, Riccardo Bertolo, Salvatore Micali, Prokar Dasgupta, Lance J. Hampton, Ash Tewari, Andrew Tracey, Bertolo, Riccardo, Tracey, Andrew, Dasgupta, Prokar, Rocco, Bernardo, Micali, Salvatore, Bianchi, Giampaolo, Hampton, Lance, Tewari, Ash K., Porpiglia, Francesco, and Autorino, Riccardo
- Subjects
Adult ,Male ,medicine.medical_specialty ,Laparoscopic radical prostatectomy ,Procedural ,medicine.medical_treatment ,Urology ,030232 urology & nephrology ,Suprapubic catheter ,Pain ,Prostate cancer ,Robot-assisted radical prostatectomy ,Urethral catheter ,Humans ,Pain, Procedural ,Prospective Studies ,Prostatic Neoplasms ,Randomized Controlled Trials as Topic ,Retrospective Studies ,Urinary Catheterization ,Urinary Catheters ,Prostatectomy ,Robotic Surgical Procedures ,Urethra ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Penile pain ,business.industry ,Retrospective cohort study ,Odds ratio ,Confidence interval ,030220 oncology & carcinogenesis ,Relative risk ,business - Abstract
Purpose: To provide latest evidence on the use of suprapubic catheter (SPC) versus urethral catheter (UC) after robot-assisted laparoscopic radical prostatectomy (RARP). Materials and methods: A systematic revision of literature was performed up to September 2017 using different search engines (Pubmed, Ovid, Scopus) to identified studies comparing the use of SPC versus standard UC after RARP. Identification and selection of the studies were conducted according to the preferred reporting items for systematic reviews and meta-analysis criteria. For continuous outcomes, the weighted mean difference (WMD) was used as a summary measure, whereas the odds ratio (OR) or risk ratio (RR) with 95% confidence interval (CI) was calculated for binary variables. RR was preferred in cases of a high number of events to avoid overestimation. Pooled estimates were calculated using the random-effect model to account for clinical heterogeneity. All statistical analyses were performed using Review manager 5 (Cochrane Collaboration, Oxford, UK). Results: Eight studies were identified and included in this systematic review, namely 3 RCTs, 4 non-randomized prospective studies, and one retrospective study. A total of 966 RARP cases were collected for the cumulative analysis. Among them, 492 patients received standard UC and 474 SPC placement after RARP. UC patients had higher baseline PSA (WMD 0.44 ng/ml; p = 0.02). Visual Analog Scale (VAS) score was found to be significantly lower in patients with SPC at postoperative day 7 (WMD 0.53; 95% CI 0.13–0.93; p = 0.009). Regarding penile pain, a significant difference in favor of the SPC group was found at postoperative day 7 assessment (WMD 1.2; 95% CI 0.82–1.6; p < 0.001). More patients in the SPC group reported “not at all” or “minimal pain” at this time point (OR 0.17, 95% CI 0.06, 0.44; p < 0.001). No significant differences were found in terms of continence recovery rate at 6–12 weeks between the groups (UC 78.7%, 88.2%; RR 0.92, 95% CI 0.84, 1.01; p = 0.09). Similarly, no differences were found in terms of catheter-related issues (p = 0.17). However, UC patients had lower likelihood of overall complications (OR 0.44, 95% CI 0.21–0.89, p = 0.02). Conclusions: Available evidence suggests that the use of SPC can be a viable option for postoperative urine drainage after RARP, as it can translate into decreased postoperative pain without carrying a significant higher risk of catheter-related complications. Further investigation seems to be warranted, ideally within the framework of a multicentre randomized study with standardized analysis of outcomes.
- Published
- 2018
22. Safety and efficacy of abiraterone acetate in chemotherapy-naive patients with metastatic castration-resistant prostate cancer: an Italian multicenter 'real life' study
- Author
-
Maida Bada, Eugenio Martorana, Luigi Schips, Silvana Giacinti, Cosimo De Nunzio, Giuseppe Mario Ludovico, Marcello Scarcia, Stefano Boccasile, Giampaolo Bianchi, Maurizio Valeriani, Anastasia Laudisi, Salvatore Micali, Pasquale Ditonno, Mino Rizzo, Clara Natoli, Paolo Verze, Oscar Selvaggio, Michele De Tursi, Luca Cindolo, Vincenzo Mirone, Paolo Chiodini, Pierluigi Bove, Giuseppe Carrieri, Pietro Castellan, Cindolo, Luca, Natoli, Clara, De Nunzio, Cosimo, De Tursi, Michele, Valeriani, Maurizio, Giacinti, Silvana, Micali, Salvatore, Rizzo, Mino, Bianchi, Giampaolo, Martorana, Eugenio, Scarcia, Marcello, Ludovico, Giuseppe Mario, Bove, Pierluigi, Laudisi, Anastasia, Selvaggio, Oscar, Carrieri, Giuseppe, Bada, Maida, Castellan, Pietro, Boccasile, Stefano, Ditonno, Pasquale, Chiodini, Paolo, Verze, Paolo, Mirone, Vincenzo, and Schips, Luigi
- Subjects
Male ,Cancer Research ,medicine.medical_treatment ,030232 urology & nephrology ,Kaplan-Meier Estimate ,Castration-Resistant ,Androgen deprivation therapy ,Prostate cancer ,chemistry.chemical_compound ,0302 clinical medicine ,Risk Factors ,80 and over ,Abiraterone acetate ,Androgen receptor ,Castration-resistant prostate cancer ,Abiraterone Acetate ,Aged ,Aged, 80 and over ,Disease Progression ,Disease-Free Survival ,Drug-Related Side Effects and Adverse Reactions ,Humans ,Middle Aged ,Neoplasm Metastasis ,Prostate-Specific Antigen ,Prostatectomy ,Prostatic Neoplasms, Castration-Resistant ,Treatment Outcome ,Oncology ,Genetics ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Prostate-specific antigen ,030220 oncology & carcinogenesis ,medicine.symptom ,Research Article ,medicine.medical_specialty ,lcsh:RC254-282 ,Asymptomatic ,03 medical and health sciences ,Patient satisfaction ,Genetic ,Internal medicine ,medicine ,Brief Pain Inventory ,abiraterone acetate ,androgen deprivation therapy ,androgen receptor ,castration-resistant prostate cancer ,prostate cancer ,business.industry ,Prostatic Neoplasms ,medicine.disease ,Surgery ,Settore MED/24 ,chemistry ,business - Abstract
Background To evaluate the safety and efficacy of abiraterone acetate (AA) in the “real life” clinical practice for men with chemotherapy-naïve metastatic castration-resistant prostate. Methods A consecutive series of patients with mCRPC in 9 Italian tertiary centres treated with AA was collected. Demographics, clinical parameters, treatment outcomes and toxicity were recorded. The Brief Pain Inventory scale Q3 was tracked and patient treatment satisfaction was evaluated. Survival curves were estimated by the method of Kaplan-Meier and Cox regression and compared by the log-rank test statistic. Results We included 145 patients (mean age 76.5y). All patients were on androgen deprivation therapy. Patients had prior radiotherapy, radical prostatectomy, both treatments or exclusive androgen deprivation therapy in 17%, 33%, 9% and 40%, respectively. 57% of the patients had a Gleason score higher more than 7 at diagnosis. 62% were asymptomatic patients. The median serum total PSA at AA start was 17 ng/mL (range 0,4–2100). The median exposure to AA was 10 months (range 1–35). The proportion of patients achieving a PSA decline ≥50% at 12 weeks was 49%. Distribution of patient satisfaction was 32% “greatly improved”, 38% “improved”, 24% “not changed”, 5.5% “worsened”. Grade 3 and 4 toxicity was recorded in 17/145 patients 11.7% (70% cardiovascular events, 30% critical elevation of AST/ALT levels). At the last follow-up, median progression free and overall survival were 17 and 26.5 months, respectively. Both outcomes significantly correlated with the presence of pain, patient satisfaction, PSA baseline and PSA decline. Conclusions The AA is effective and well tolerated in asymptomatic or slightly symptomatic mCRPC in a “real life” setting. The survival outcomes are influenced by the presence of pain, patient satisfaction, baseline PSA and PSA decline. Trial registration The study was retrospectively registered at ISRCTN as DOI:10.1186/ISRCTN 52513758 in date April the 30th 2016. Electronic supplementary material The online version of this article (10.1186/s12885-017-3755-x) contains supplementary material, which is available to authorized users.
- Published
- 2017
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.