434 results on '"Eugenio Brunocilla"'
Search Results
2. 43 - Complete urodynamic study in Robot-assisted Radical Cystectomy (RARC) with intracorporeal orthotopic neobladder (ICON): Prospective comparison of Y and modified Y Bordeaux reconfigurations
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Marco Salvador, Valerio Vagnoni, Lorenzo Bianchi, Francesco Chessa, Chiara Madeddu, Mariateresa Pugliese, Riccardo Schiavina, and Eugenio Brunocilla
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Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2024
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3. Immunohistochemistry analysis of PSMA expression at prostatic biopsy in high-risk prostate cancer: potential implications for PSMA-PET patient selection
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Matteo Droghetti, Lorenzo Bianchi, Massimiliano Presutti, Luigia Vetrone, Andrea Farolfi, Riccardo Mei, Francesca Giunchi, Alessio Degiovanni, Angelo Mottaran, Pietro Piazza, Danilo Cangemi, Paolo Castellucci, Antonietta D’Errico, Riccardo Schiavina, Eugenio Brunocilla, and Stefano Fanti
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PSMA PET ,immunohistochemistry ,prostate cancer ,biopsy ,radical prostatectomy ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
IntroductionProstate-specific membrane antigen (PSMA) is a transmembrane protein expressed by normal prostatic tissue. Therefore, molecular imaging targeting PSMA (PSMA-PET) has gained particular interest and diffusion for PCa staging and restaging. Several factors may affect PSMA-PET results, and many tools have been proposed to improve patient selection. Furthermore, PSMA expression is not homogeneous among different tissues and within the prostate itself. The aims of this study were to evaluate immunohistochemistry (IHC) features of prostate biopsy samples and to assess their correlation with whole-mount specimens and PSMA-PET parameters.MethodsWe included consecutive high-risk PCa patients who underwent PSMA-PET for staging proposal at our institution from January 2022 to December 2022. The PET parameters selected were SUVmax, total volume (TV), and total lesion activity (TL). Each patient underwent multiparametric MRI (mpMRI) and fusion-targeted prostate biopsy prior to surgery. IHC analyses were performed on the index lesion cores. IHC visual score (VS) (1, 2, 3) and visual pattern (VP) (membranous, cytoplasmic, and combined) and the percentage of PSMA-negative tumor areas (PSMA%neg) within biopsy cores were evaluated.ResultsForty-three patients who underwent robotic radical prostatectomy after PSMA-PET were available for analyses. Concordance between VS and VP at biopsy and final pathology showed a Cohen’s kappa coefficient of 0.39 and 0.38, respectively. Patients with PSMA%neg 20% on biopsy cores in terms of SUVmax, PSMA-TL, and PSMA-TV (p = 0.5, p = 0.5, and p = 0.9 respectively).ConclusionsWe found a correlation between IHC VS and VP on targeted biopsy cores and SUVmax at PSMA-PET. However, the correlation between the IHC parameters of biopsy cores and final pathology was not as high as expected. Nevertheless, the presence of PSMA%neg
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- 2024
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4. Efficacy of a Novel Prophylactic Scheme of Fosfomycin Trometamol in Patients Undergoing Endoscopic Surgery for Benign Prostatic Hyperplasia: Findings from a Prospective Monocentric Single-Arm Study
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Pasquale Maria Berrino, Milo Gatti, Valeria Rotaru, Lorenzo Bianchi, Fabio Tumietto, Elena Sora, Riccardo Schiavina, Eugenio Brunocilla, Pierluigi Viale, and Federico Pea
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fosfomycin ,antibiotic prophylaxis ,urological procedures ,benign prostatic hyperplasia ,clinical efficacy ,Therapeutics. Pharmacology ,RM1-950 - Abstract
This study aimed to assess the efficacy of a novel prophylactic scheme of fosfomycin trometamol in patients undergoing elective HoLEP (holmium laser enucleation of the prostate) or TURP (transurethral resection of the prostate) procedures for treating benign prostatic hyperplasia. Patients affected by benign prostatic hyperplasia and undergoing elective HoLEP or TURP procedures during the period February 2022–June 2023 were prospectively enrolled. Two 3 g oral fosfomycin trometamol doses 12 h apart were administered at 8.00 p.m. on day −1 (i.e., the day before HoLEP or TURP procedure) and at 8.00 a.m. on day 0 (i.e., the day of the surgical procedure). The following outcomes were assessed: prevalence of fever occurring in the first 48 h after surgical procedure; prevalence of urological complications occurring after the surgical procedure; prevalence of proven urinary tract infections (UTIs) and/or bloodstream infections (BSIs) at 14 days post-procedure; and prevalence of emergency department admission for UTI-related sepsis at 14 days post-procedure. Univariate analysis comparing patients with and without proven UTI, BSI, or emergency department admission at 14 days post-procedure was carried out. Overall, 96 patients (median age 70 years) undergoing HoLEP (82.3%) or TURP (17.7%) were prospectively included. Median (IQR) time of surgical procedure after the morning fosfomycin dose was 226.5 min (range 88.5–393.75 min). Fever in the post-surgical 48 h occurred in 3/96 patients (3.1%). Prevalence of proven UTI at 14 days was as low as 1.0% (1/96), whereas no patient had proven BSI or UTI-related sepsis requiring emergency department admission at 14 days. Our findings support the contention that a prophylactic scheme based on two doses of fosfomycin trometamol 12 h apart before surgical intervention may represent a valuable strategy for preventing infectious complications in urologic patients undergoing HoLEP or TURP. Larger definitive confirmatory studies are warranted.
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- 2024
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5. Unraveling the safety of adjuvant radiotherapy in prostate cancer: impact of older age and hypofractionated regimens on acute and late toxicity - a multicenter comprehensive analysis
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Milly Buwenge, Gabriella Macchia, Letizia Cavallini, Annalisa Cortesi, Claudio Malizia, Lorenzo Bianchi, Maria Ntreta, Alessandra Arcelli, Ilaria Capocaccia, Elena Natoli, Savino Cilla, Francesco Cellini, Luca Tagliaferri, Lidia Strigari, Silvia Cammelli, Riccardo Schiavina, Eugenio Brunocilla, Alessio Giuseppe Morganti, and Francesco Deodato
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prostate neoplasms ,observational study ,toxicity ,predictive factors ,radiotherapy ,adjuvant therapy ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
BackgroundThe objective of this study was to assess the impact of age and other patient and treatment characteristics on toxicity in prostate cancer patients receiving adjuvant radiotherapy (RT).Materials and methodsThis observational study (ICAROS-1) evaluated both acute (RTOG) and late (RTOG/EORTC) toxicity. Patient- (age; Charlson’s comorbidity index) and treatment-related characteristics (nodal irradiation; previous TURP; use, type, and duration of ADT, RT fractionation and technique, image-guidance systems, EQD2 delivered to the prostate bed and pelvic nodes) were recorded and analyzed.ResultsA total of 381 patients were enrolled. The median EQD2 to the prostate bed (α/β=1.5) was 71.4 Gy. The majority of patients (75.4%) were treated with intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT). Acute G3 gastrointestinal (GI) and genitourinary (GU) toxicity rates were 0.5% and 1.3%, respectively. No patients experienced >G3 acute toxicity. The multivariable analysis of acute toxicity (binomial logistic regression) showed a statistically significant association between older age (> 65) and decreased odds of G≥2 GI acute toxicity (OR: 0.569; 95%CI: 0.329-0.973; p: 0.040) and decreased odds of G≥2 GU acute toxicity (OR: 0.956; 95%CI: 0.918-0.996; p: 0.031). The 5-year late toxicity-free survival rates for G≥3 GI and GU toxicity were 98.1% and 94.5%, respectively. The only significant correlation found (Cox’s regression model) was a reduced risk of late GI toxicity in patients undergoing hypofractionation (HR: 0.38; 95% CI: 0.18-0.78; p: 0.008).ConclusionsThe unexpected results of this analysis could be explained by a “response shift bias” concerning the protective effect of older age and by treatment in later periods (using IMRT/VMAT) concerning the favorable effect of hypofractionation. However, overall, the study suggests that age should not be a reason to avoid adjuvant RT and that the latter is well-tolerated even with moderately hypofractionated regimens.
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- 2023
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6. A Planned Multidisciplinary Surgical Approach to Treat Primary Pelvic Malignancies
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Andrea Sambri, Michele Fiore, Matteo Rottoli, Giuseppe Bianchi, Marco Pignatti, Marta Bortoli, Amelio Ercolino, Stefano Ancetti, Anna Myriam Perrone, Pierandrea De Iaco, Riccardo Cipriani, Eugenio Brunocilla, Davide Maria Donati, Mauro Gargiulo, Gilberto Poggioli, and Massimiliano De Paolis
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sarcoma ,pelvis ,multidisciplinary ,orthopedic ,vascular ,plastic ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
The pelvic anatomy poses great challenges to orthopedic surgeons. Sarcomas are often large in size and typically enclosed in the narrow confines of the pelvis with the close proximity of vital structures. The aim of this study is to report a systematic planned multidisciplinary surgical approach to treat pelvic sarcomas. Seventeen patients affected by bone and soft tissue sarcomas of the pelvis, treated using a planned multidisciplinary surgical approach, combining the expertise of orthopedic oncology and other surgeons (colleagues from urology, vascular surgery, abdominal surgery, gynecology and plastic surgery), were included. Seven patients were treated with hindquarter amputation; 10 patients underwent excision of the tumor. Reconstruction of bone defects was conducted in six patients with a custom-made 3D-printed pelvic prosthesis. Thirteen patients experienced at least one complication. Well-organized multidisciplinary collaborations between each subspecialty are the cornerstone for the management of patients affected by pelvic sarcomas, which should be conducted in specialized centers. A multidisciplinary surgical approach is of paramount importance in order to obtain the best successful surgical results and adequate margins for achieving acceptable outcomes.
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- 2023
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7. Multiparametric magnetic resonance imaging for the differential diagnosis between granulomatous prostatitis and prostate cancer: a literature review to an intriguing diagnostic challenge
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Caterina Gaudiano, Benedetta Renzetti, Cristina De Fino, Beniamino Corcioni, Federica Ciccarese, Lorenzo Bianchi, Riccardo Schiavina, Matteo Droghetti, Francesca Giunchi, Eugenio Brunocilla, and Michelangelo Fiorentino
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prostate cancer ,granulomatous prostatitis ,non-specific granulomatous prostatitis ,granulomatous prostatitis induced by BCG ,multiparametric magnetic resonance imaging ,PI-RADS score ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Multiparametric magnetic resonance imaging (mpMRI) is currently the most effective diagnostic tool for detecting prostate cancer (PCa) and evaluating adenocarcinoma-mimicking lesions of the prostate gland, among which granulomatous prostatitis (GP) represents the most interesting diagnostic challenge. GP consists of a heterogeneous group of chronic inflammatory lesions that can be differentiated into four types: idiopathic, infective, iatrogenic, and associated with systemic granulomatous disease. The incidence of GP is growing due to the increase in endourological surgical interventions and the adoption of intravesical instillation of Bacillus Calmette-Guerin in patients with non-muscle invasive bladder cancer; therefore, the difficulty lies in identifying specific features of GP on mpMRI to avoid the use of transrectal prostate biopsy as much as possible.
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- 2023
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8. Transverse prostate maximum sectional area can predict clinically significant prostate cancer in PI-RADS 3 lesions at multiparametric magnetic resonance imaging
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Caterina Gaudiano, Lorenzo Braccischi, Makoto Taninokuchi Tomassoni, Alexandro Paccapelo, Lorenzo Bianchi, Beniamino Corcioni, Federica Ciccarese, Riccardo Schiavina, Matteo Droghetti, Francesca Giunchi, Michelangelo Fiorentino, Eugenio Brunocilla, and Rita Golfieri
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multiparametric magnetic resonance imaging ,prostate cancer ,PI-RADS 3 lesions ,transverse prostate maximum sectional area ,PIRADS 3 ,urological imaging ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
BackgroundTo evaluate multiparametric magnetic resonance imaging (mpMRI) parameters, such as TransPA (transverse prostate maximum sectional area), TransCGA (transverse central gland sectional area), TransPZA (transverse peripheral zone sectional area), and TransPAI (TransPZA/TransCGA ratio) in predicting prostate cancer (PCa) in prostate imaging reporting and data system (PI-RADS) 3 lesions.MethodsSensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), the area under the receiver operating characteristic curve (AUC), and the best cut-off, were calculated. Univariate and multivariate analyses were carried out to evaluate the capability to predict PCa.ResultsOut of 120 PI-RADS 3 lesions, 54 (45.0%) were PCa with 34 (28.3%) csPCas. Median TransPA, TransCGA, TransPZA and TransPAI were 15.4cm2, 9.1cm2, 5.5cm2 and 0.57, respectively. At multivariate analysis, location in the transition zone (OR=7.92, 95% CI: 2.70-23.29, P
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- 2023
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9. Pharmacokinetic/Pharmacodynamic Target Attainment of Continuous Infusion Piperacillin–Tazobactam or Meropenem and Microbiological Outcome among Urologic Patients with Documented Gram-Negative Infections
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Pasquale Maria Berrino, Milo Gatti, Matteo Rinaldi, Eugenio Brunocilla, Pierluigi Viale, and Federico Pea
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piperacillin–tazobactam ,meropenem ,urology ,Gram-negative infections ,PK/PD target attainment ,microbiological outcome ,Therapeutics. Pharmacology ,RM1-950 - Abstract
(1) Objectives: To describe the relationship between pharmacokinetic/pharmacodynamic (PK/PD) target attainment of continuous infusion (CI) piperacillin–tazobactam or meropenem monotherapy and microbiological outcome in a case series of urological patients with documented Gram-negative infections. (2) Methods: Patients admitted to the urology ward who were treated with CI piperacillin–tazobactam or meropenem monotherapy for documented Gram-negative infections and underwent real-time therapeutic drug monitoring (TDM)-guided expert clinical pharmacological advice (ECPA) program from June 2021 to May 2023 were retrospectively retrieved. Average steady-state (Css) piperacillin–tazobactam and meropenem concentrations were determined, and the free fractions (fCss) were calculated. Optimal PK/PD target attainments were defined as an fCss/MIC ratio >4 for CI meropenem and an fCss/MIC ratio of piperacillin >4 coupled with an fCss/CT ratio for tazobactam >1 for piperacillin–tazobactam (joint PK/PD target). The relationship between beta-lactam PK/PD targets and microbiological outcome was explored. (3) Results: Sixteen urologic patients with documented Gram-negative infections (62.5% complicated urinary tract infections (cUTI)) had 30 TDM-guided ECPAs. At first TDM assessment, beta-lactam dosing adjustments were recommended in 11 out of 16 cases (68.75%, of which 62.5% decreases and 6.25% increases). Overall, beta-lactam dosing adjustments were recommended in 14 out of 30 ECPAs (46.6%). Beta-lactam PK/PD target attainments were optimal in 100.0% of cases. Microbiological failure occurred in two patients, both developing beta-lactam resistance. (4) Conclusion: A TDM-guided ECPA program may allow for optimizing beta-lactam treatment in urologic patients with documented Gram-negative infections, ensuring microbiological eradication in most cases.
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- 2023
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10. 3D renal model for surgical planning of partial nephrectomy: A way to improve surgical outcomes
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Lorenzo Bianchi, Laura Cercenelli, Barbara Bortolani, Pietro Piazza, Matteo Droghetti, Sara Boschi, Caterina Gaudiano, Giulia Carpani, Francesco Chessa, Simone Lodi, Lorenzo Tartarini, Alessandro Bertaccini, Rita Golfieri, Emanuela Marcelli, Riccardo Schiavina, and Eugenio Brunocilla
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3D model ,surgical planning ,surgical outcomes ,renal cancer ,partial nephrectomy ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Objectiveto evaluate the impact of 3D model for a comprehensive assessment of surgical planning and quality of partial nephrectomy (PN).Materials and methods195 patients with cT1-T2 renal mass scheduled for PN were enrolled in two groups: Study Group (n= 100), including patients referred to PN with revision of both 2D computed tomography (CT) imaging and 3D model; Control group (n= 95), including patients referred to PN with revision of 2D CT imaging. Overall, 20 individuals were switched to radical nephrectomy (RN). The primary outcome was the impact of 3D models-based surgical planning on Trifecta achievement (defined as the contemporary absence of positive surgical margin, major complications and ≤30% postoperative eGFR reduction). The secondary outcome was the impact of 3D models on surgical planning of PN. Multivariate logistic regressions were used to identify predictors of selective clamping and Trifecta’s achievement in patients treated with PN (n=175).ResultsOverall, 73 (80.2%) patients in Study group and 53 (63.1%) patients in Control group achieved the Trifecta (p=0.01). The preoperative plan of arterial clamping was recorded as clampless, main artery and selective in 22 (24.2%), 22 (24.2%) and 47 (51.6%) cases in Study group vs. 31 (36.9%), 46 (54.8%) and 7 (8.3%) cases in Control group, respectively (p
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- 2022
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11. Dynamic FDG PET/CT on bladder paraganglioma: A case report
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Makoto Taninokuchi Tomassoni, Arrigo Cattabriga, Caterina Gaudiano, Federica Ciccarese, Beniamino Corcioni, Lorenzo Bianchi, Riccardo Schiavina, Eugenio Brunocilla, and Rita Golfieri
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bladder paraganglioma ,bladder cancer ,FDG PET/CT ,nuclear medicine ,radiology ,Medicine (General) ,R5-920 - Abstract
Paraganglioma (PGL) is characterized by equivocal clinical manifestations and arriving to a suspicion might be challenging. Nevertheless, diagnostic imaging and nuclear medicine are a fundamental part of the diagnosis and management of this particular neuroendocrine tumor (NET). We herein report a rare case of bladder paraganglioma with unusual onset and typical PET/CT characteristics that led to its recognition.
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- 2022
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12. Robot-Assisted, Laparoscopic, and Open Radical Cystectomy: Pre-Operative Data of 1400 Patients From The Italian Radical Cystectomy Registry
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Gian Maria Busetto, Daniele D’Agostino, Michele Colicchia, Katie Palmer, Walter Artibani, Alessandro Antonelli, Lorenzo Bianchi, Aldo Bocciardi, Eugenio Brunocilla, Marco Carini, Giuseppe Carrieri, Luigi Cormio, Ugo Giovanni Falagario, Ettore De Berardinis, Alessandro Sciarra, Costantino Leonardo, Francesco Del Giudice, Martina Maggi, Ottavio de Cobelli, Matteo Ferro, Gennaro Musi, Amelio Ercolino, Fabrizio Di Maida, Andrea Gallina, Carlo Introini, Ettore Mearini, Giovanni Cochetti, Andrea Minervini, Francesco Montorsi, Riccardo Schiavina, Sergio Serni, Claudio Simeone, Paolo Parma, Armando Serao, Mario Salvatore Mangano, Giorgio Pomara, Pasquale Ditonno, Alchiede Simonato, Daniele Romagnoli, Alessandro Crestani, and Angelo Porreca
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urinary bladder neoplasms ,radical cystectomy ,multicenter ,Italy ,RIC ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
IntroductionThe Italian Radical Cystectomy Registry (RIC) is an observational prospective study aiming to understand clinical variables and patient characteristics associated with short- and long-term outcomes among bladder cancer (BC) patients undergoing radical cystectomy (RC). Moreover, it compares the effectiveness of three RC techniques - open, robotic, and laparoscopic.MethodsFrom 2017 to 2020, 1400 patients were enrolled at one of the 28 centers across Italy. Patient characteristics, as well as preoperative, postoperative, and follow-up (3, 6, 12, and 24 months) clinical variables and outcomes were collected.ResultsPreoperatively, it was found that patients undergoing robotic procedures were younger (p
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- 2022
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13. Protocol of the Italian Radical Cystectomy Registry (RIC): a non-randomized, 24-month, multicenter study comparing robotic-assisted, laparoscopic, and open surgery for radical cystectomy in bladder cancer
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Angelo Porreca, Katie Palmer, Walter Artibani, Alessandro Antonelli, Lorenzo Bianchi, Eugenio Brunocilla, Aldo Massimo Bocciardi, Maurizio Brausi, Gian Maria Busetto, Marco Carini, Giuseppe Carrieri, Antonio Celia, Luca Cindolo, Giovanni Cochetti, Renzo Colombo, Ettore De Berardinis, Ottavio De Cobelli, Fabrizio Di Maida, Amelio Ercolino, Franco Gaboardi, Antonio Galfano, Andrea Gallina, Michele Gallucci, Carlo Introini, Ettore Mearini, Andrea Minervini, Francesco Montorsi, Gennaro Musi, Giovannalberto Pini, Riccardo Schiavina, Silvia Secco, Sergio Serni, Claudio Simeone, Giovanni Tasso, and Daniele D’Agostino
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Cancer ,Neoplasm ,bladder ,Urinary ,Robotic ,Surgery ,Bladder reconstruction ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Bladder cancer is the ninth most common type of cancer worldwide. In the past, radical cystectomy via open surgery has been considered the gold-standard treatment for muscle invasive bladder cancer. However, in recent years there has been a progressive increase in the use of robot-assisted laparoscopic radical cystectomy. The aim of the current project is to investigate the surgical, oncological, and functional outcomes of patients with bladder cancer who undergo radical cystectomy comparing three different surgical techniques (robotic-assisted, laparoscopic, and open surgery). Pre-, peri- and post-operative factors will be examined, and participants will be followed for a period of up to 24 months to identify risks of mortality, oncological outcomes, hospital readmission, sexual performance, and continence. Methods We describe a protocol for an observational, prospective, multicenter, cohort study to assess patients affected by bladder neoplasms undergoing radical cystectomy and urinary diversion. The Italian Radical Cystectomy Registry is an electronic registry to prospectively collect the data of patients undergoing radical cystectomy conducted with any technique (open, laparoscopic, robotic-assisted). Twenty-eight urology departments across Italy will provide data for the study, with the recruitment phase between 1st January 2017-31st October 2020. Information is collected from the patients at the moment of surgical intervention and during follow-up (3, 6, 12, and 24 months after radical cystectomy). Peri-operative variables include surgery time, type of urinary diversion, conversion to open surgery, bleeding, nerve sparing and lymphadenectomy. Follow-up data collection includes histological information (e.g., post-op staging, grading, and tumor histology), short- and long-term outcomes (e.g., mortality, post-op complications, hospital readmission, sexual potency, continence etc). Discussion The current protocol aims to contribute additional data to the field concerning the short- and long-term outcomes of three different radical cystectomy surgical techniques for patients with bladder cancer, including open, laparoscopic, and robot-assisted. This is a comparative-effectiveness trial that takes into account a complex range of factors and decision making by both physicians and patients that affect their choice of surgical technique. Trial registration ClinicalTrials.gov , NCT04228198 . Registered 14th January 2020- Retrospectively registered.
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- 2021
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14. The role of MRI in the detection of local recurrence: Added value of multiparametric approach and Signal Intensity/Time Curve analysis
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Caterina Gaudiano, Federica Ciccarese, Lorenzo Bianchi, Beniamino Corcioni, Antonio De Cinque, Francesca Giunchi, Riccardo Schiavina, Michelangelo Fiorentino, Eugenio Brunocilla, and Rita Golfieri
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Multiparametric magnetic resonance imaging ,Prostate cancer ,Radical prostatectomy ,Prostate cancer recurrence ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Objective: The aim of the study was to evaluate the accuracy of multiparametric Magnetic Resonance Imaging (mpMRI) in the detection of local recurrence of prostate cancer (PCa) with the evaluation of the added value of signal Intensity/Time (I/T) curves. Materials and methods: A retrospective analysis of 22 patients undergoing mpMRI from 2015 to 2020 was carried out, with the following inclusion criteria: performing transrectal ultrasound guided biopsy within 3 months in the case of positive or doubtful findings and undergoing biopsy and/or clinical follow-up for 24 months in the case of negative results. The images were reviewed, and the lesions were catalogued according to morphological, diffusion-weighted imaging (DWI) and dynamic contrast- enhanced (DCE) features. Results: The presence of local recurrence was detected in 11/22 patients (50%). Greater diameter, hyperintensity on DWI, positive contrast enhancement and type 2/3 signal I/T curves were more frequently observed in patients with local recurrence (all p < 0.05). Of all the sequences, DCE was the most accurate; however, the combination of DCE and DWI showed the best results, with a sensitivity of 100%, a specificity of 82%, a negative predictive value of 100% and a positive predictive value of 85%. Conclusions: The utility of MRI in the detection of local recurrence is tied to the multiparametric approach, with all sequences providing useful information. A combination of DCE and DWI is particularly effective. Moreover, specificity could be additionally improved using analysis of the signal I/T curves.
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- 2022
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15. Twenty Years’ Experience in Retroperitoneal Lymph Node Dissection for Testicular Cancer in a Tertiary Referral Center
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Angelo Mottaran, Amelio Ercolino, Lorenzo Bianchi, Pietro Piazza, Francesco Manes, Sasan Amirhassankhani, Marco Salvador, Francesco Chessa, Beniamino Corcioni, Alessandro Bertaccini, Riccardo Schiavina, and Eugenio Brunocilla
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retroperitoneal lymph node dissection ,open approach ,testicular cancer ,primary setting ,secondary setting ,RPLND ,Medicine (General) ,R5-920 - Abstract
Background and Objectives: The aim of this article is to present a single-surgeon, open retroperitoneal lymph node dissection (RPLND) series for testicular cancer in a high-volume center. Materials and Methods: We reviewed data from patients who underwent RPLND performed by an experienced surgeon at our institution between 2000 and 2019. We evaluated surgical and perioperative outcomes, complications, Recurrence-Free Survival (RFS), Overall Survival (OS), and Cancer-Specific Survival (CSS). Results: RPLND was performed in primary and secondary settings in 21 (32%) and 44 (68%) patients, respectively. Median operative time was 180 min. Median hospital stay was 6 days. Complications occurred in 23 (35%) patients, with 9 (14%) events reported as Clavien grade ≥ 3. Patients in the primary RPLND group were significantly younger, more likely to have NSGCT, had higher clinical N0 and M0, and had higher nerve-sparing RPLND (all p ≤ 0.04) compared to those in the secondary RPLND group. In the median follow-up of 120 (56–180) months, 10 (15%) patients experienced recurrence. Finally, 20-year OS, CSS, and RFS were 89%, 92%, and 85%, respectively, with no significant difference in survival rates between primary vs. secondary RPLND subgroups (p = 0.64, p = 0.7, and p = 0.31, respectively). Conclusions: Open RPLND performed by an experienced high-volume surgeon achieves excellent oncological and functional outcomes supporting the centralization of these complex procedures.
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- 2023
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16. Diagnostic accuracy of the Novel 29 MHz micro-ultrasound 'ExactVuTM' for the detection of clinically significant prostate cancer: A prospective single institutional study. A step forward in the diagnosis of prostate cancer
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Francesco Chessa, Riccardo Schiavina, Amelio Ercolino, Caterina Gaudiano, Davide Giusti, Lorenzo Bianchi, Cristian Pultrone, Emanuela Marcelli, Concetta Distefano, Luca Lodigiani, and Eugenio Brunocilla
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Prostate Cancer ,Imaging ,Detection rate ,Microultrasound ,PRI-MUS score ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Introduction and Objective: ExactVuTM is a real-time micro-ultrasound system which provides, according to the Prostate Risk Identification Using Micro-Ultrasound protocol (PRI-MUS), a 300% higher resolution compared to conventional transrectal ultrasound. To evaluate the performance of ExactVuTM in the detection of Clinically significant Prostate Cancer (CsPCa). Materials and methods: Patients with Prostate Cancer diagnosed at fusion biopsy were imaged with ExactVuTM. CsPCa was defined as any Gleason Score ≥ 3+4. ExactVuTM examination was considered as positive when PRI-MUS score was ≥ 3. PRI-MUS scoring system was considered as correct when the fusion biopsy was positive for CsPCa. A transrectal fusion biopsy- proven CsPCa was considered as a gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operator characteristic (ROC) curve (AUC) were calculated. Results: 57 patients out of 68 (84%) had a csPCa. PRI-MUS score was correctly assessed in 68% of cases. Regarding the detection of CsPCa, ExactVuTM ’s sensitivity, specificity, PPV, and NPV was 68%, 73%, 93%, and 31%, respectively and the AUC was 0.7 (95% CI 0.5-0-8). For detecting CsPCa in the transition/ anterior zone the sensitivity, specificity, PPV, and NPV was 45%, 66%, 83% and 25% respectively ant the AUC was 0.5 (95% CI 0.2-0.9). Accounting only the CsPCa located in the peripheral zone, sensitivity, specificity, PPV, and NPV raised up to 74%, 75%, 94%, 33%, respectively with AUC 0.75 (95% CI 0.5-0-9). Conclusions: ExactVuTM provides high resolution of the prostatic peripheral zone and could represent a step forward in the detection of CsPCa as a triage tool. Further studies are needed to confirm these promising results.
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- 2021
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17. How Can the COVID-19 Pandemic Lead to Positive Changes in Urology Residency?
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Gian Maria Busetto, Francesco Del Giudice, Andrea Mari, Isabella Sperduti, Nicola Longo, Alessandro Antonelli, Maria Angela Cerruto, Elisabetta Costantini, Marco Carini, Andrea Minervini, Bernardo Rocco, Walter Artibani, Angelo Porreca, Francesco Porpiglia, Rocco Damiano, Marco De Sio, Davide Arcaniolo, Sebastiano Cimino, Giorgio Ivan Russo, Giuseppe Lucarelli, Pasquale Di Tonno, Paolo Gontero, Francesco Soria, Carlo Trombetta, Giovanni Liguori, Roberto Mario Scarpa, Rocco Papalia, Carlo Terrone, Marco Borghesi, Paolo Verze, Massimo Madonia, Antonello De Lisa, Pierluigi Bove, Giorgio Guazzoni, Giovanni Lughezzani, Marco Racioppi, Luca Di Gianfrancesco, Eugenio Brunocilla, Riccardo Schiavina, Claudio Simeone, Alessandro Veccia, Francesco Montorsi, Alberto Briganti, Fabrizio Dal Moro, Carlo Pavone, Vincenzo Serretta, Savino Mauro Di Stasi, Andrea Benedetto Galosi, Luigi Schips, Michele Marchioni, Emanuele Montanari, Giuseppe Carrieri, Luigi Cormio, Francesco Greco, Gennaro Musi, Martina Maggi, Simon L. Conti, Andrea Tubaro, Ettore De Berardinis, Alessandro Sciarra, Michele Gallucci, Vincenzo Mirone, Ottavio de Cobelli, and Matteo Ferro
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urology ,residency ,residents ,pandemic ,COVID-19 ,Surgery ,RD1-811 - Abstract
The COVID-19 outbreak, in a few weeks, overloaded Italian hospitals, and the majority of medical procedures were postponed. During the pandemic, with hospital reorganization, clinical and learning activities performed by residents suffered a forced remodulation. The objective of this study is to investigate how urology training in Italy has been affected during the COVID-19 era. In this multi-academic study, we compared residents' training during the highest outbreak level with their previous activity. Overall 387 (67.1%) of the 577 Italian Urology residents participated in a 72-h anonymous online survey with 36 items sent via email. The main outcomes were clinical/surgical activities, social distancing, distance learning, and telemedicine. Clinical and learning activity was significantly reduced for the overall group, and after categorizing residents as those working only in COVID hospitals, both “junior” and “senior” residents, and those working in any of three geographical areas created (Italian regions were clustered in three major zones according to the prevalence of COVID-19). A significant decrease in outpatient activity, invasive diagnostic procedures, and endoscopic and major surgeries was reported. Through multivariate analysis, the specific year of residency has been found to be an independent predictor for all response modification. Being in zone 3 and zone 2 and having “senior” resident status were independent predictors associated with a lower reduction of the clinical and learning activity. Working in a COVID hospital and having “senior” resident status were independent predictors associated with higher reduction of the outpatient activity. Working in zone 3 and having “senior” resident status were independent predictors of lower and higher outpatient surgical activity, respectively. Working in a COVID hospital was an independent predictor associated with robotic surgical activity. The majority of residents reported that distance teaching and multidisciplinary virtual meetings are still not used, and 44.8% reported that their relationships with colleagues decreased. The COVID-19 pandemic presents an unprecedented challenge, including changes in the training and education of urology residents. The COVID era can offer an opportunity to balance and implement innovative solutions that can bridge the educational gap and can be part of future urology training.
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- 2020
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18. Penile-scrotal flap vaginoplasty versus inverted penile skin flap expanded with spatulated urethra: A multidisciplinary single-centre analysis
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Giorgio Gentile, Ardigò Martino, Daniela Nadalin, Martina Masetti, Brigida Lilia Marta, Franco Palmisano, Alessandro Franceschelli, Patrizia Stella, Anna Paola Sanfelici, Eugenio Brunocilla, and Fulvio Colombo
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Transgender ,Penile inversion ,Vaginoplasty ,Techniques ,Outcomes, Sexologist ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
This study is aimed to compare outcomes of penile-scrotal flap vaginoplasty to inverted penile skin flap expanded with spatulated urethra as a singlecentre experience. Data regarding vaginoplasty performed between May 2003 and January 2014 were reviewed. Subjects were divided into two groups according to the surgical technique performed: perineal- scrotal flap vaginoplasty (Group A), and inverted penile skin flap expanded with spatulated urethra vaginoplasty (Group B). All patients underwent to psychological analysis before surgery. Functional follow-up was based on a modified validated Female Sexual Function Index. Overall, 67 patients with a mean (SD) age of 34 (±9.38) years underwent to surgery. 41 patients were included into the Group A and 26 into the Group B. Mean operative time among Groups A and B was 316 (±101.65) and 594 (±89.06) minutes, respectively (p
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- 2020
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19. Holmium laser prostatectomy in a tertiary Italian center: A prospective cost analysis in comparison with bipolar TURP and open prostatectomy
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Riccardo Schiavina, Lorenzo Bianchi, Marco Giampaoli, Marco Borghesi, Hussam Dababneh, Francesco Chessa, Cristian Pultrone, Andrea Angiolini, Umberto Barbaresi, Matteo Cevenini, Fabio Manferrari, Alessandro Bertaccini, Angelo Porreca, and Eugenio Brunocilla
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HoLEP ,Xost analysis ,TURP ,Open prostatectomy ,Prostatic enlargement ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Objective: To assess the economic impact of Holmium laser enucleation of prostate (HoLEP) in comparison with transurethral resection of prostate (TURP) and open prostatectomy (OP). Methods: Between January 2017 and January 2018, we prospectively enrolled 151 men who underwent HoLEP, TURP or OP at tertiary Italian center, due to bladder outflow obstruction symptoms. Patients with prostate volume ≤ 70 cc and those with prostate volume > 70 cc were scheduled for TURP or HoLEP and OP or HoLEP, respectively. Intraoperative and early post-operative functional outcomes were recorded up to 6 months follow up. Cost analysis was carried out considering direct costs (operating room [OR] utilization costs, nurse, surgeons and anesthesiologists’ costs, OR disposable products costs and OR products sterilization costs), indirect costs (hospital stay costs and diagnostics costs) and global costs as sum of both direct and indirect plus general costs related to hospitalization. Cost analysis was performed comparing patients referred to TURP and HoLEP with prostate volume ≤ 70 cc and men underwent OP and HoLEP with prostate volume > 70 cc respectively. Results: Overall, 53 (35.1%), 51 (33.7%) and 47 (31.1%) were scheduled to HoLEP, TURP and OP, respectively. Both TURP, HoLEP and OP proved to effectively improve urinary symptoms related to BPE. Considering patients with prostate volume ≤ 70 cc, median global cost of HoLEP was similar to median global cost of TURP (2151.69 € vs. 2185.61 €, respectively; p = 0.61). Considering patients with prostate volume > 70 cc, median global cost of HoLEP was found to be significantly lower than median global cost of OP (2174.15 € vs. 4064.97 €, respectively; p ≤ 0.001). Conclusions: Global costs of HoLEP are comparable to those of TURP, offering a cost saving of only 11.4 € in favor of HoLEP. Conversely, HoLEP proved to be a strong competitor of OP because of significant global cost sparing amounting to 1890.82 € in favor of HoLEP.
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- 2020
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20. Not fatal venous air embolism after holmium laser enucleation of the prostate: Case report and review of literature
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Daniele Romagnoli, Mobin Ghaemian, Daniele D'Agostino, Paolo Corsi, Marco Giampaoli, Alessandro Del Rosso, Matteo Cevenini, Riccardo Schiavina, Eugenio Brunocilla, Giorgio Davià, Walter Artibani, and Angelo Porreca
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Holmium Laser enucleation of the prostate ,Nitrogen embolus ,Transurethral resection of the prostate ,Urethral disobstruction ,Venous embolism ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Objective: Holmium laser has demonstrated high efficacy in urethral disobstruction. Venous air embolism (VAE) is a rare complication of prostate surgery. Only two cases of venous air embolism (VAE) in patients submitted to HoLEP, have been described. In this paper we show a third case of not fatal VAE after HoLEP. Materials and methods: A case of VAE occurred in holmium laser enucleation (HoLEP) due to obstructive lower urinary tract symptoms (LUTS) in a 70 years old patient. After the procedure, patient’s end tidal carbon dioxide (ETCO2) levels dramatically decreased at 17 mmHg, with pressure airway (PAW)16 mmHg; oxygen saturation level was at 75%, without any loss in the ventilation circuit and with arterial blood pressure of 94/54 mmHg. Due to the negativity for other suspicions, the suspect of VAE was postulated. Result: The immediate switching from laryngeal mask to Oro Tracheal Intubation increased the oxygen level. A cardiac transthoracic ultrasound was negative for air bubbles inside cardiac cavities, without any alteration in the cardiac kinetics. Arterial blood sample turned negative for any alteration compatible with VAE and catheter continuous vesical irrigation was started to obtain clear washing fluid without blood cloths. The extubated patient showed no neurological defects. Conclusions: An invasive monitoring system is the key to rapidly and correctly identify any embolic episode during this kind of surgery.
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- 2020
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21. Is Fast Track protocol a safe tool to reduce hospitalization time after radical cystectomy with ileal urinary diversion? Initial results from a single high-volume centre
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Daniele Romagnoli, Riccardo Schiavina, Lorenzo Bianchi, Marco Borghesi, Francesco Chessa, Federico Mineo Bianchi, Andrea Angiolini, Carlo Casablanca, Marco Giampaoli, Paolo Corsi, Daniele D'Agostino, Eugenio Brunocilla, and Angelo Porreca
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Radical Cystectomy ,Fast Track ,Enhanced Recovery After Surgery ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Introduction and aim: Radical Cystectomy (RC) with ileal urinary diversion is one of the most complex urological surgical procedure, and many Fast Track (FT) protocols have been described to reduce hospitalization, without increasing postoperatory complications. We present the one-year results of a dedicated protocol developed at a high volume centre. Materials and methods: The FT protocol was designed after a review of the literature and a multidisciplinary collegiate discussion, and it was applied to patients scheduled to open RC with intestinal urinary diversion. To validate its feasibility, we compared its results with data collected from a 1:1 matched population of patients who had undergone the same surgical procedure, without the implementation of the FT protocol. Results: We enrolled in the FT group 11 (55%) patients scheduled to RC with ileal conduit diversion, and 9 patients (45%) scheduled to orthotopic neobladder (Studer) substitution, while a numerically equivalent population was enrolled in the control group, matched according to age at surgery, BMI, gender, ASA score, CCI, preoperative stage and type of urinary diversion. No statistically significant difference was found in terms of pre-operatory and intra-operatory domains. Median overall age was 71 years (Inter Quartile Range - IQR: 63-76) and mean operatory time was 276 ± 57 minutes. Hospitalization time was significantly reduced in the FT group, considering oralization and canalization items we found a significant advantage in the FT group. No statistically significant difference was found in the control of the post-operatory pain. We found no difference, in terms of both early and late complications ratio, among the two populations. Complications graded Clavien ≥ 3 were found in 4 patients of the control group (20%), while in only one patient (5%) in the Fast Track group, though this difference was not statistically significant. Conclusions: The Fast Track protocol developed in this study has proven to be effective in significantly reducing hospitalization time in patients submitted to RC with intestinal urinary diversion, without increasing post-operatory complications ratio.
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- 2020
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22. 'In-bore' MRI prostate biopsy is a safe preoperative clinical tool to exclude significant prostate cancer in symptomatic patients with benign prostatic obstruction before transurethral laser enucleation
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Angelo Porreca, Daniele D'Agostino, Mario Vigo, Paolo Corsi, Daniele Romagnoli, Alessandro Del Rosso, Riccardo Schiavina, Eugenio Brunocilla, Walter Artibani, and Marco Giampaoli
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magnetic resonance imaging ,Holmium laser enucleation of the prostate ,prostate biopsy ,prostatic enlargement ,prostate cancer ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Introduction: Purpose of our study was to investigate the role of a negative in-bore MRI-guided biopsy (MRI-GB) in comparison to a negative multiparametric prostate MRI (mpMRI) and a contextual negative transrectal ultrasound guided biopsy of the prostate with regard to incidental prostate cancer findings in the surgical specimen of men who underwent to Holmium Laser enucleation of prostate (HoLEP) with a preoperative suspicion of prostate cancer. Materials and methods: Data of 117 of symptomatic patients for bladder outflow obstruction who subsequently underwent to HoLEP was retrospectively analyzed form a multicentric database. All patients had a raised serum PSA and/or an abnormal digital rectal examination (DRE) with a pre-interventional mpMRI. Prostate cancer was excluded either with an en-bore MRI-GB (group "IN-BORE MRI-GB" n = 57) in case of a suspect area at the mpMRI or with a standard biopsy (group "mpMRI + TRUS-GB" n = 60) in case of a negative mpMRI. Preoperative characteristic surgical and histological outcomes were analyzed. Univariate and multivariate logistic regression model was performed to investigate independent predictors of incidental Prostate Cancer (iPCa). Results: Both groups presented moderate to severe lower tract urinary symptoms: median IPSS was 19 (IQR: 17.0-22.0) in the IN-BORE MRI-GB group and 20 (IQR: 17.5-22.0) in the mpMRI + TRUS-GB (p = 0.71). No statistically significant difference was found between the two groups besides total prostate volume with 68 cc (IQR: 58.0-97.0) in the IN-BORE MRI-GB group and 84 cc (IQR: 70.0-115.0) in the mpMRI + TRU-GB group (p = 0.01) No differences were registered in surgical time, removed tissue, catheterization time, hospital stay and complications rate. No different rates (p = 0.50) of iPCa were found in the IN-BORE MRI-GB group (14%) in comparison with mpMRI + TRUS-GB group (10 %); pT stage and ISUP Grade Group in iPCa stratification were comparable between the two groups. In multivariate analysis a statistically significant correlation with age as an independent predictive factor of iPCa was found (OR 1.14; 95% CI: 1.02-1.27; p = 0.02) while no correlations were revealed with PSA (OR 1.12; 95% CI: 0.99-1.28; p = 0.08) and a negative in-bore MRI-GB (OR 1.72; 95% CI: 0.51-5.77; p = 0.37). Conclusions: Including a mpMRI and an eventual in-bore MRIGB represents a novel clinical approach before surgery in patients with symptomatic obstruction with a concomitant suspicion of PCa, leading to low rate of iPCa and avoiding unnecessary standard TRUS-GB biopsies
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- 2020
23. MRI/TRUS FUSION guided biopsy as first approach in ambulatory setting: Feasibility and performance of a new fusion device
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Daniele D'Agostino, Federico Mineo Bianchi, Daniele Romagnoli, Marco Giampaoli, Paolo Corsi, Alessandro Del Rosso, Riccardo Schiavina, Eugenio Brunocilla, and Angelo Porreca
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Prostate cancer ,Magnetic Resonance ,Prostate biopsy ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Purpose: To evaluate the detection rate of Magnetic Resonance Imaging/Transrectal Ultrasound (MRI/TRUS) Fusion Biopsy performed in a series of patients with suspicious prostate cancer in an ambulatory setting. Materials and methods: Between March 2018 and January 2019 a series of 155 patients undergoing MRI/TRUS fusionguided biopsy were prospectively enrolled. All patients presented a suspected diagnosis for prostate cancer because of raised Prostate Specific Antigen (PSA) serum level and/or abnormal physical examination (digital rectal examination), and showed at least one suspicious area at the multiparametric Magnetic Resonance Imaging (mpMRI). Results: Of 155 patients, 58 (37.4%) were biopsy-naïve, 97 (62.6%) had at least 1 previous negative TRUS-guided biopsy. The median age of the patient cohort was 66 years (IQR, 61- 69); the median prebiopsy PSA value was 7.1 ng/ml (IQR, 5- 8.9). Overall, the Fusion-TB findings were positive in 94 of 155 patients with a detection rate (DR) of 60%; a significantly high DR was obtained in terms of clinically significant prostate cancer (csPCa) by Fusion-TB (61 pts; 41.9%). The overall DR in the 121 biopsy-naive patients was 60.6%. In the subgroup of the 34 patients with at least 1 previous set of TRUS-GB, overall DR was 39.3% (35/50). Conclusions: The targeted MRI/TRUS fusion-guided biopsy represents a safe and accurate approach for diagnosis of csPCa, especially in patient with previous TRUS guided biopsy negative and suspicious prostate cancer.
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- 2020
24. Management of self-inflicted orchiectomy in psychiatric patient. Case report and non-systematic review of the literature
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Marco Garofalo, Alessandro Colella, Paolo Sadini, Lorenzo Bianchi, Giacomo Saraceni, Eugenio Brunocilla, Giorgio Gentile, and Fulvio Colombo
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self orchiectomy ,genital mutilation ,self castration ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Introduction: Self-inflicted orchidectomy and auto-castration, also known as “Eshmun complex” is a rare phenomenon. The aim of our study it to present the management of a patient who performed a self orchiectomy and propose a non-systematic review of literature about self-orchiectomy. Material and method: A 27-years old male Patient with psychiatric disorder was admitted to our ward to have been cutted his scrotum with scissors and cut away his left testicle causing active bleeding from the left spermatic artery. The patient underwent emergency surgery with clamping of the spermatic cord and hemostasis of the wound. Results: After surgery the clinical condition of the patient remained good during whole hospitalization. Urgent psychiatric evaluation was performed in order to administer proper therapy for acute management. To best of our knowledge, only 11 cases of self-orchidectomy are reported in literature and all of them except 1 case, underwent surgical exploration. Conclusions: Self-orchidectomy is an extremely rare phenomenon, often associated with psychiatric disorders, compounded by the use of drugs. In our opinion, emergency surgery should be the first choice of treatment, offering diagnostic and hemostatic purpose in a single act, aimed to prevent acute and postacute complications.
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- 2018
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25. The impact of a structured intensive modular training in the learning curve of robot assisted radical prostatectomy
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Riccardo Schiavina, Marco Borghesi, Hussam Dababneh, Martina Sofia Rossi, Cristian Vincenzo Pultrone, Valerio Vagnoni, Francesco Chessa, Lorenzo Bianchi, Angelo Porreca, Alexandre Mottrie, and Eugenio Brunocilla
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Training ,Robot assisted radical prostatectomy ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Aim: The success of Robot Assisted Laparoscopic Prostatectomy (RALP) is mainly due to his relatively short learning curve. Twenty cases are needed to reach a “4 hours-proficiency”. However, to achieve optimal functional outcomes such as urinary continence and potency recovery may require more experience. We aim to report the perioperative and early functional outcomes of patients undergoing RALP, after a structured modular training program. Methods: A surgeon with no previous laparoscopic or robotic experience attained a 3 month modular training including: a) e-learning; b) assistance and training to the operating table; c) dry console training; d) step by step in vivo modular training performing 40 surgical steps in increasing difficulty, under the supervision of an experienced mentor. Demographics, intraoperative and postoperative functional outcomes were recorded after his first 120 procedures, considering four groups of 30 cases. Results: All procedures were completed successfully without conversion to open approach. Overall 19 (15%) post operative complications were observed and 84% were graded as minor (Clavien I-II). Overall operative time and console time gradually decreased during the learning curve, with statistical significance in favour of Group 4. The overall continence rate at 1 and 3 months was 74% and 87% respectively with a significant improvement in continence rate throughout the four groups (p = 0.04). Considering those patients submitted to nerve-sparing procedure we found a significant increase in potency recovery over the four groups (p = 0.04) with the higher potency recovery rate up to 80% in the last 30 cases. Conclusions: Optimal perioperative and functional outcomes have been attained since early phase of the learning curve after an intensive structured modular training and less than 100 consecutive procedures seem needed in order to achieve optimal urinary continence and erectile function recovery.
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- 2018
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26. 3D Reconstruction and physical renal model to improve percutaneous punture during PNL
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Lorenzo Bianchi, Riccardo Schiavina, Umberto Barbaresi, Andrea Angiolini, Cristian V. Pultrone, Fabio Manferrari, Barbara Bortolani, Laura Cercenelli, Marco Borghesi, Francesco Chessa, Elisa Sessagesimi, Caterina Gaudiano, Emanuela Marcelli, and Eugenio Brunocilla
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Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
ABSTRACT Introduction and Objectives: We aim to present the use of 3D digital and physical renal model (1–5) to guide the percutaneous access during percutaneous nephrolithotripsy (PNL). Materials and Methods: We present the clinical case of a 30 years old man with left renal stone (25x15 mm). A virtual 3D reconstruction of the anatomical model including the stone, the renal parenchyma, the urinary collecting system (UCS) and the skeletal landmarks (lumbar spine and ribs) was elaborated. Finally, a physical 3D model was created with a 3D printer including the renal parenchyma, UCS and the stone. The surgeon evaluated the 3D virtual reconstruction and manipulated the printed model before surgery to improve the anatomical knowledge and to facilitate the percutaneous access. In prone position, combining ultrasound and fluoroscopy implemented by the preoperative anatomical planning based on the 3D virtual and printed model, an easy and safe access of the inferior calyx was achieved. Then, the patient underwent PNL using a 30 Fr Amplatz sheet with semi-rigid nephroscope and ultrasound energy to achieve a complete lithotripsy of the pelvic stone. Results: The procedure was safely completed with 1 single percutaneous puncture (time of puncture 2 minutes). Overall surgical time was 90 min. No intra and postoperative complications were reported. The CT scan performed before discharge confirmed a complete stone free state. Conclusion: The 3D-guided approach to PNL facilitates the preoperative planning of the puncture with better knowledge of the renal anatomy and may be helpful to reduce operative time and improve the learning curve.
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- 2019
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27. Mini-invasive robotic assisted pyelolithotomy: Comparison between the transperitoneal and retroperitoneal approach
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Daniele D'Agostino, Paolo Corsi, Marco Giampaoli, Federico Mineo Bianchi, Daniele Romagnoli, Simone Crivellaro, Giacomo Saraceni, Marco Garofalo, Riccardo Schiavina, Eugenio Brunocilla, Walter Artibani, and Angelo Porreca
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Transperitoneal pyelolithotomy ,Retroperitoneal pyelolithotomy ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Objective: To compare the retroperitoneal with the transperitoneal approach in a series of patients underwent to robotic-assisted pyelolithotomy (RP). Materials and methods: From January 2015 to December 2018 we evaluated 20 patients subjected to robotic pyelolithotomy; 11 patients were treated with retroperitoneal approach (RRP) and 9 with transperitoneal approach (TRP). For each patient intra and perioperative data were recorded: operative time (OT), blood loss (BL), length of hospital stay (LOS), stone clearance, post-operative complications and time to remove the drain. The presence of stone fragments < 4 mm was considered as stone free rate. Results: The principal stone burden was greater in the TRP group than in the RRP group (48 ± 10 mm vs 32 ± 14 mm, p = 0.12). Preoperative hydronephrosis was present in 7 (64%) patients in RRP group and a mild hydronephrosis in 3 of TRP group (p = 0.04). The average operative time was higher in the RRP group than in the TRP group (203 ± 45 min vs 137 ± 31 min, p = 0.002). The average blood loss was 305 ± 175 ml in the RRP group versus 94 ± 104 ml in the TRP group (p = 0.005). The stone free rate was similar between the two groups, 36% (4 patients) in the RRP group and 44% (4 patients) in the TRP (p = 0.966). Conclusions: RP appears to be a safe and effective minimally invasive treatment for some patients with renal staghorn calculi or urinary tract malformations. The TRP may give lower operative time and better results in terms of blood loss and length of hospital stay.
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- 2019
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28. Comparison between 'In-bore' MRI guided prostate biopsy and standard ultrasound guided biopsy in the patient with suspicious prostate cancer: Preliminary results
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Daniele D’Agostino, Federico Mineo Bianchi, Daniele Romagnoli, Paolo Corsi, Marco Giampaoli, Riccardo Schiavina, Eugenio Brunocilla, Walter Artibani, and Angelo Porreca
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Prostate cancer ,MRI guided biopsy ,Ultrasound guided biopsy ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Objectives: To evaluate the detection rate of prostate cancer (PCa) in patients who underwent to “in bore” Magnetic Resonance Imaging -guided prostate (MRI-GB) biopsy compared to the standard transrectal ultrasound guided prostate biopsy (TRUS-GB). Materials and methods: Between January 2017 and March 2015 a cohort of 39 consecutive patients was prospectively enrolled. All the patients underwent an "in-bore" guided MRI prostatic biopsy and subsequently ultrasound-guided standard prostate biopsy. Results: Median age of patients was 65.5 years (SD ± 6.6), median total PSA serum level was 6.6 ng/ml (SD ± 4.1), median prostate total volume was 51.1 cc (SD ± 26.7). Thirty of 39 (76.9%) were biopsy-naïve patients while 7/39 (17.9%) had at least one previous negative random TRUS-GB; 2/39 (5.1%) patients were already diagnosed as PCa and were on active surveillance. In 18/39 (53.8%) men Pca was diagnosed; as regards the MRI-GB results related to the PI-RADS score, biopsies of PIRADS 3 lesions were positive in 5/18 cases (27.8%), while the number of positive cases of PI-RADS 4 and 5 lesions was 7/11 (63.6%) and 6/10 (60%)respectively. At the histological examination, 4/39 (10.3%) had a PCa ISUP grade group 1, 11/39 (28.2%) had a ISUP 2, 6/39(15.4%) had a ISUP grade group 3 and 2/39 (5.1%) had a ISUP 4-5. Conclusions: MRI-GB represents a promising technique that may offer some of advantages compared to standard systematic TRUSGB. Our preliminary experience in MRI-GB resulted safe and feasible and represents a viable procedure for the diagnosis and characterization of PCa.
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- 2019
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29. Posterior muscle-fascial reconstruction and knotless urethro-neo bladder anastomosis during robot-assisted radical cystectomy: Description of the technique and its impact on urinary continence
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Federico Mineo Bianchi, Daniele Romagnoli, Daniele D'Agostino, Antonio Salvaggio, Marco Giampaoli, Paolo Corsi, Lorenzo Bianchi, Marco Borghesi, Riccardo Schiavina, Eugenio Brunocilla, Peter Wiklund, and Angelo Porreca
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robotic radical cystectomy ,orthotopic neobladder ,posterior muscolkofascial reconstruction ,radical cystectomy ,robotic surgery ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Objective: The aim of our study is to describe the use of posterior muscle-fascial reconstruction during urethro-ileal anastomosis in bladder cancer (BC) patients submitted to robot-assisted radical cystectomy (RC) with orthotopic neobladder (ON) and its role in facilitating day- and night-time continence recovery during a 12-month follow up. Materials and methods: We prospectively collected data from 42 consecutive patients who underwent RARC with totally intracorporeal ON and extended pelvic lymph node dissection (PLND) at our Institution from June 2014 to October 2017. Prior to the urethro-neobladder anastomosis we reconstructed the Denonvilliers Fascia (DF) as previously described for radical prostatectomy using a bidirectional barbed suture. Day and night-time recovery rates were reported at 3, 6 and 12 months after surgery, with continent patients being those using either no urinary pads or 1 safety pads. Results: Median age at surgery was 63 yrs, 41 (97.6%) patients were male. 28 (66.7%) patients presented a clinical T2 disease. Median operative time and median ON reconstruction time were 450 minutes and 180 minutes respectively. 13 (31%) individuals had non-organ confined disease, with 11 (26.2%) patients with positive lymph nodes (median 3 positive lymph nodes) and 2 (4.8%) with non-urothelial cancer at final pathologic examination. Median hospital stay and median catheterization time were 7 (IQR 7-8) and 21 (IQR 19-22). During first 30 post-operative days we recorded 7 (16.7%) low-grade Clavien and 2 (4.8%) IIIa Clavien complications, whereas between 30 and 90 postoperative days we recorded 4 (9.5%) low-grade, 4 (9.5) IIIa and 1 (2.4%) IIIb complications. Day-time and night-time continence rates were 61.9% vs 52.4%, 73.8% vs 64.3% and 90.5% vs 73.8% at three, six and twelve months follow up. Day-time continence was significantly superior in the younger group (97% vs 57%, p 0.01); night-time continence rates were also superior among < 70 yrs patients, despite not reaching statistical significance (77% vs 57%, p 0.3). Conclusions: Posterior muscle-fascial reconstruction aids continence recovery in BC patients undergoing RARC with ON, with younger and fitter patients most benefitting from ON reconstruction.
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- 2019
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30. Pubis bone osteomyelitys after robotic radical cystectomy with continent intracorporeal urinary diversion: Multidisciplinary approach to a complex situation
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Daniele Romagnoli, Federico Mineo Bianchi, Paolo Sadini, Andrea Angiolini, Daniele D'Agostino, Marco Giampaoli, Sergio Candiotto, Riccardo Schiavina, Eugenio Brunocilla, and Angelo Porreca
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Osteomyelitis ,Cystectomy ,Urinary Fistula ,Robotic ,Multidisciplinary ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Pubic bone osteomyelitis is a rare infectious condition which is characterized by a complex diagnostic and therapeutic workup, due to its various clinical manifestations. Among the many causes of this condition, urinary fistula is the most common in case of previous urological procedures. In order to solve this complication, it is crucial to treat both the fistula and (moreover) the infectious locus arising from it, because treating the fistula alone does not provide any control on the infectious noxa. We present the first case of pubic bone osteomyelitis arising from a urinary fistula after a robotic radical cystectomy with intra corporeal continent neobladder, which has been successfully treated through a multidisciplinary approach.
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- 2019
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31. Preservation of the smooth muscular internal (vesical) sphincter and of the proximal urethra during retropubic radical prostatectomy: A technical modification to improve the early recovery of continence
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Eugenio Brunocilla, Riccardo Schiavina, Marco Borghesi, Cristian Pultrone, Matteo Cevenini, Valerio Vagnoni, and Giuseppe Martorana
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Radical prostatectomy ,Urinary continence ,Internal sphincter ,Proximal urethra ,Surgical margins ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Objective: We describe our technique for preservation of the smooth muscular internal (vesical) sphincter and proximal urethra during radical retropubic prostatectomy (RRP) and present our preliminary clinical results. Materials and methods: The first steps of the prostatectomy reflect the standard RRP, while for the final phases the procedure continues in an anterograde manner with incision of the fibers of the detrusor muscle at the insertion of the ventral surface of the base of the prostate. At this level, the inner circular muscle of the bladder neck forms a sphincteric ring of smooth muscle that covers the longitudinally oriented smooth muscle component of the urethral musculature that extends distally to the verumontanum. These two proximal structures represent the internal sphincter that envelops and locks the proximal urethra. A blunt dissection is continued until the ring shaped vesical sphincter is separated from the prostate and the longitudinally oriented smooth muscle component of the urethral musculature is identified. The base of the prostate is then gently separated from the urethra and from the bladder until the maximal length of the urethral musculature is isolated and preserved. Results: After 30 initial set-up procedures, 40 consecutive patients with organ confined prostate cancer were submitted to radical retropubic prostatectomy with the preservation of muscular internal sphincter and the proximal urethra and compared to 40 patients submitted to standard procedure who served as control group. The group of patients submitted to our technical modification had a faster recovery of early continence than control group at 3 and 7 days. Conclusions: The described technique is a feasible and safe method for preservation of the internal urethral sphincter and allows improving the early recovery of urinary continence. The technique does not increase the rate of positive margins and the duration of the procedure.
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- 2014
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32. Massive hematuria due to ruptured iatrogenic aortic pseudoaneurysm: A case report
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Valerio Vagnoni, Caterina Gaudiano, Giovanni Passaretti, Riccardo Schiavina, Eugenio Brunocilla, Cristian Vincenzo Pultrone, Marco Borghesi, and Giuseppe Martorana
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Haematuria ,Aortic pseudoaneurysm ,Pelvic surgery ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
We report an interesting case of massive haematuria secondary to a rupture of a pseudoa- neurysm of the abdominal aorta below the renal vessels. A 65-year-old woman present- ed at our institution with a painful massive haematuria and anaemia. Two months before, she undergone a pelvic surgery complicated by an accidental injury of the right ureter sutured with a end-to-end anastomosis. An abdominal computed tomography (CT) scan with intravenous contrast showed a right-sided hydronephrosis with clots in the lumen of the right pelvis with a massive retroperitoneal hematoma due to a rupture of a iatrogenic pseudoaneurysm of the abdominal aorta below the origin of the renal arteries.
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- 2013
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33. Neutrophil gelatinase-associated lipocalin increases HLA-G(+)/FoxP3(+) T-regulatory cell population in an in vitro model of PBMC.
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Gaetano La Manna, Giulia Ghinatti, Pier Luigi Tazzari, Francesco Alviano, Francesca Ricci, Irene Capelli, Vania Cuna, Paola Todeschini, Eugenio Brunocilla, Pasqualepaolo Pagliaro, Laura Bonsi, and Sergio Stefoni
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Medicine ,Science - Abstract
Neutrophil gelatinase-associated lipocalin (NGAL) is emerging as a mediator of various biological and pathological states. However, the specific biological role of this molecule remains unclear, as it serves as a biomarker for many conditions. The high sensitivity of NGAL as a biomarker coupled with relatively low specificity may hide important biological roles. Data point toward an acute compensatory, protective role for NGAL in response to adverse cellular stresses, including inflammatory and oxidative stress. The aim of this study was to understand whether NGAL modulates the T-cell response through regulation of the human leukocyte antigen G (HLA-G) complex, which is a mediator of tolerance.Peripheral blood mononuclear cells (PBMCs) were obtained from eight healthy donors and isolated by centrifugation on a Ficoll gradient. All donors gave informed consent. PBMCs were treated with four different concentrations of NGAL (40-320 ng/ml) in an iron-loaded or iron-free form. Changes in cell phenotype were analyzed by flow cytometry. NGAL stimulated expression of HLA-G on CD4+ T cells in a dose- and iron-dependent manner. Iron deficiency prevented NGAL-mediated effects, such that HLA-G expression was unaltered. Furthermore, NGAL treatment affected stimulation of regulatory T cells and in vitro expansion of CD4(+) CD25(+) FoxP3(+) cells. An NGAL neutralizing antibody limited HLA-G expression and significantly decreased the percentage of CD4(+) CD25(+) FoxP3(+) cells.We provide in vitro evidence that NGAL is involved in cellular immunity. The potential role of NGAL as an immunomodulatory molecule is based on its ability to induce immune tolerance by upregulating HLA-G expression and expansion of T-regulatory cells in healthy donors. Future studies should further evaluate the role of NGAL in immunology and immunomodulation and its possible relationship to immunosuppressive therapy efficacy, tolerance induction in transplant patients, and other immunological disorders.
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- 2014
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34. Sex-related penile fracture with complete urethral rupture: A case report and review of the literature
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Marco Garofalo, Lorenzo Bianchi, Giorgio Gentile, Marco Borghesi, Valerio Vagnoni, Hussam Dababneh, Riccardo Schiavina, Alessandro Franceschelli, Daniele Romagnoli, Fulvio Colombo, Beniamino Corcioni, Rita Golfieri, and Eugenio Brunocilla
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penile fracture, Complete urethral rupture, Surgical repair ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Objective: To present the management of a patient with partial disruption of both cavernosal bodies and complete urethral rupture and to propose a non-systematic review of literature about complete urethral rupture. Material and method - Case report: A 46 years old man presented to our emergency department after a blunt injury of the penis during sexual intercourse. On physical examination there was subcutaneous hematoma extending over the proximal penile shaft with a dorsal-left sided deviation of the penis and urethral bleeding. Ultrasound investigation showed an hematoma in the ventral shaft of the penis with a discontinuity of the tunica albuginea of the right cavernosal corporum. The patient underwent immediate emergency surgery consisted on evacuation of the hematoma, reparation the partial defect of both two cavernosal bodies and end to end suture of the urethra that resulted completely disrupted. Results: The urethral catheter was removed at the 12-th postoperative day without voiding symptoms after a retrograde urethrography. 6 months postoperatively the patients was evaluated with uroflowmetry demonstrating a max flow rate of 22 ml/s and optimal functional outcomes evaluated with validated questionnaires. 8 months after surgery the patients was evaluated by dynamic magnetic resonance (MRI) of the penis showing only a little curvature on the left side of the penile shaft. Conclusion: Penile fracture is an extremely uncommon urologic injury with approximately 1331 reported cases in the literature till the years 2001. To best of our knowledge from 2001 up today, 1839 more cases have been reported, only in 159 of them anterior urethral rupture was associated and in only 22 cases a complete urethral rupture was described. In our opinion, in order to prevent long term complications, in case of clinical suspicion of penile fracture, especially if it is associated to urethral disruption, emergency surgery should be the first choice of treatment.
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- 2015
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35. First case of 18F-FACBC PET/CT-guided salvage radiotherapy for local relapse after radical prostatectomy with negative 11C-Choline PET/CT and multiparametric MRI: New imaging techniques may improve patient selection
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Eugenio Brunocilla, Riccardo Schiavina, Cristina Nanni, Marco Borghesi, Matteo Cevenini, Enrico Molinaroli, Valerio Vagnoni, Paolo Castellucci, Francesco Ceci, Stefano Fanti, Caterina Gaudiano, Rita Golfieri, and Giuseppe Martorana
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Prostate cancer ,PET/CT ,11C-Choline ,18FFACBC ,Salvage radiotherapy ,Biochemical relapse ,Local relapse ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
We present the first case of salvage radiotherapy based on the results of 18F-FACBC PET/CT performed for a PSA relapse after radical prostatectomy. The patients underwent 11CCholine PET/CT and multiparametric MRI that were negative while 18F-FACBC PET/CT visualized a suspected local relapse confirmed by transrectal ultrasound-guided biopsy. No distant relapse was detected. Thus the patient was submitted to salvage radiotherapy in the prostatic fossa. After 20 months of follow-up, the PSA was undetectable and 18F-FACBC PET/CT was negative. Salvage radiotherapy after surgery, provided that it is administered at the earliest evidence of the biochemical relapse, may improve cancer control and favourably influence the course of disease as well as the adjuvant approach. New imaging techniques may increase the efficacy of the salvage radiotherapy thus helping in the selection of the patients. Preliminary clinical reports showed an improvement in the detection rate of 20-40% of 18F-FACBC in comparison with 11C-Choline for the detection of disease relapse after radical prostatecomy, rendering the 18F-FACBC the potential radiotracer of the future for prostate cancer.
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- 2014
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36. First case of bilateral, synchronous anaplastic variant of spermatocytic seminoma treated with radical orchifunicolectomy as single approach: Case report and review of the literature
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Giorgio Gentile, Francesca Giunchi, Riccardo Schiavina, Alessandro Franceschelli, Marco Borghesi, Ziv Zukerman, Matteo Cevenini, Valerio Vagnoni, Daniele Romagnoli, Fulvio Colombo, Giuseppe Martorana, and Eugenio Brunocilla
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Testicular cancer ,Spermatocytic seminoma ,Anaplastic variant ,Bilateral disease ,Radical orchifunicolectomy ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Spermatocytic Seminoma (SS) is less common than the Classic variant, as its incidence ranges between 1.3% and 2.3% of all seminomas. Generally SS is diagnosed in men older than 50 years. The Anaplastic variant of Spermatocytic Seminoma is characterized by an earlier onset when compared to SS, but a benign behavior in spite of its histological patterns similar to Classic Seminoma. We reported the first case of bilateral, largest and synchronous Anaplastic Spermatocytic Seminoma, in a patient treated with radical orchifunicolectomy alone and with long-term follow-up. The currently available data show that Anaplastic SS reveals a clinically benign behavior, and no distant metastases have been reported so far. A close surveillance after surgery could be considered a valid option in the management of this rare testicular neoplasm.
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- 2014
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37. Site-specific concordance of targeted and systematic biopsy cores at the index lesion on multiparametric magnetic resonance: can we spare the double-tap?
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Matteo Droghetti, Lorenzo Bianchi, Carlo Beretta, Eleonora Balestrazzi, Francesco Costa, Alberto Feruzzi, Pietro Piazza, Carlo Roveroni, Caterina Gaudiano, Beniamino Corcioni, Francesca Giunchi, Michelangelo Fiorentino, Rita Golfieri, Riccardo Schiavina, and Eugenio Brunocilla
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Urology - Abstract
To define the impact of systematic biopsy (SB) cores directed in the same area of index lesion in patients undergoing targeted biopsy (TB) and SB for prostate cancer (PCa) suspicion.We retrospectively analyzed data of biopsy-naïve patients with one single suspicious lesion at mpMRI who underwent TB plus SB at our institution between January 2015 and September 2021. A convenient sample of 336 patients was available for our analyses. The primary outcome was to evaluate the impact of overlapping SB cores directed to the index lesion at mpMRI. The secondary outcome was to evaluate the SB cores concordance in terms of highest Gleason Score Detection with TB cores.56% of patients were found to have site-specific concordance. SB cores determined disease upgrade in 22.1% patients. Thirty-one (16.4%) site-concordant patients experienced upgrade through overlapping SB cores, while 149 (79.3%) had no benefit by SB cores, and 8 (4.3%) patients had the worst ISUP at TB cores. 50% of the patients with negative-TB were upgraded to insignificant PCa, and 17.5% was upgraded from negative to unfavorable-intermediate- or high-risk PCa. Overall, 14 (19.4%) patients were also upgraded from ISUP 1 on TB to csPCa, with 28.5% of these harboring high-risk PCa. In csPCas at TB, 9 (12.5%) patients were upgraded from intermediate- to high-risk disease by SB.TB alone consents to identify worst ISUP PCa in vast majority of patients scheduled for biopsy. A non-negligible number of patients are upgraded via-SB cores, including also index lesion overlapping cores. Omitting these cores might lead to a suboptimal patient management.
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- 2022
38. Prediction of significant renal function decline after open, laparoscopic, and robotic partial nephrectomy: External validation of the Martini’s nomogram on the RECORD2 project cohort
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Alessandro Antonelli, Andrea Mari, Alessandro Tafuri, Riccardo Tellini, Umberto Capitanio, Paolo Gontero, Antonio Andrea Grosso, Vincenzo Li Marzi, Nicola Longo, Francesco Porpiglia, Angelo Porreca, Bernardo Rocco, Claudio Simeone, Riccardo Schiavina, Luigi Schips, Salvatore Siracusano, Carlo Terrone, Vincenzo Ficarra, Marco Carini, Andrea Minervini, Vincenzo Altieri, Daniele Amparore, Walter Artibani, Fabrizio Di Maida, Francesco Berardinelli, Pierluigi Bove, Carlo Andrea Bravi, Eugenio Brunocilla, Anna Cadenar, Antonio Celia, Elisabetta Costantini, Luigi Da Pozzo, Alberto Diminutto, Mario Falsaperla, Gaetano Grosso, Luca Lambertini, Alessandro Larcher, Francesco Maiorino, Giancarlo Marra, Francesco Montorsi, Andrea Polara, Riccardo Rizzetto, Marco Roscigno, Alchiede Simonato, Carlo Trombetta, Antonelli, Alessandro, Mari, Andrea, Tafuri, Alessandro, Tellini, Riccardo, Capitanio, Umberto, Gontero, Paolo, Andrea Grosso, Antonio, Li Marzi, Vincenzo, Longo, Nicola, Porpiglia, Francesco, Porreca, Angelo, Rocco, Bernardo, Simeone, Claudio, Schiavina, Riccardo, Schips, Luigi, Siracusano, Salvatore, Terrone, Carlo, Ficarra, Vincenzo, Carini, Marco, Minervini, Andrea, Berardinelli, Francesco, Bove, Pierluigi, Andrea Bravi, Carlo, Brunocilla, Eugenio, Cadenar, Anna, Celia, Antonio, Costantini, Elisabetta, Da Pozzo, Luigi, Diminutto, Alberto, Falsaperla, Mario, Grosso, Gaetano, Lambertini, Luca, Larcher, Alessandro, Maiorino, Francesco, Marra, Giancarlo, Montorsi, Francesco, Polara, Andrea, Rizzetto, Riccardo, Roscigno, Marco, Simonato, Alchiede, Trombetta, Carlo, and Alessandro Antonelli, Andrea Mari, Alessandro Tafuri, Riccardo Tellini, Umberto Capitanio, Paolo Gontero, Antonio Andrea Grosso, Vincenzo Li Marzi, Nicola Longo, Francesco Porpiglia, Angelo Porreca, Bernardo Rocco, Claudio Simeone, Riccardo Schiavina, Luigi Schips, Salvatore Siracusano, Carlo Terrone, Vincenzo Ficarra, Marco Carini, Andrea Minervini, Vincenzo Altieri, Daniele Amparore, Walter Artibani, Fabrizio Di Maida, Francesco Berardinelli, Pierluigi Bove, Carlo Andrea Bravi, Eugenio Brunocilla, Anna Cadenar, Antonio Celia, Elisabetta Costantini, Luigi Da Pozzo, Alberto Diminutto, Mario Falsaperla, Gaetano Grosso, Luca Lambertini, Alessandro Larcher, Francesco Maiorino, Giancarlo Marra, Francesco Montorsi, Andrea Polara, Riccardo Rizzetto, Marco Roscigno, Luigi Schips, Alchiede Simonato, Carlo Trombetta
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laparoscopy ,nephron-sparing surgery ,renal cell carcinoma ,renal function ,robotics ,Humans ,Kidney ,Nephrectomy ,Nomograms ,Kidney Neoplasms ,Laparoscopy ,Robotic Surgical Procedures ,Robotics ,Urology - Abstract
Objectives: Martini et al. developed a nomogram to predict significant (>25%) renal function loss after robot-assisted partial nephrectomy and identified four risk categories. We aimed to externally validate Martini’s nomogram on a large, national, multi-institutional data set including open, laparoscopic, and robot-assisted partial nephrectomy. Methods: Data of 2584 patients treated with partial nephrectomy for renal masses at 26 urological Italian centers (RECORD2 project) were collected. Renal function was assessed at baseline, on third postoperative day, and then at 6, 12, 24, and 48 months postoperatively. Multivariable models accounting for variables included in the Martini’s nomogram were applied to each approach predicting renal function loss at all the specific timeframes. Results: Multivariable models showed high area under the curve for robot-assisted partial nephrectomy at 6- and 12-month (87.3% and 83.6%) and for laparoscopic partial nephrectomy (83.2% and 75.4%), whereas area under the curves were lower in open partial nephrectomy (78.4% and 75.2%). The predictive ability of the model decreased in all the surgical approaches at 48 months from surgery. Each Martini risk group showed an increasing percentage of patients developing a significant renal function reduction in the open, laparoscopic and robot-assisted partial nephrectomy group, as well as an increased probability to develop a significant estimated glomerular filtration rate reduction in the considered time cutoffs, although the predictive ability of the classes was
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- 2022
39. A case report of myoid gonadal stromal tumor treated with testis sparing surgery
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Amelio Ercolino, Francesco Manes, Francesco Vasuri, Lorenzo Bianchi, Marco Garofalo, Pietro Piazza, Beniamino Corcioni, Riccardo Schiavina, Rita Golfieri, Michelangelo Fiorentino, Maurizio Colecchia, Eugenio Brunocilla, Ercolino, Amelio, Manes, Francesco, Vasuri, Francesco, Bianchi, Lorenzo, Garofalo, Marco, Piazza, Pietro, Corcioni, Beniamino, Schiavina, Riccardo, Golfieri, Rita, Fiorentino, Michelangelo, Colecchia, Maurizio, and Brunocilla, Eugenio
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Stromal testicular tumor ,Reproductive Medicine ,testis sparing approach ,diagnostic imaging evaluation ,Urology ,case report - Abstract
Background: Myoid gonadal stromal tumors (MGST) of the testis represent a very rare finding. They are an emerging clinicopathological entity with specific features and identity. Nowadays, pathological recognition and diagnosis of MGSTs still represents a difficult challenge in most cases and there are no data of specific radiological features of these tumors expect for what seen by ultrasound; besides a conservative surgical approach was never performed to treat these lesions.Case Description: We present the case of a 20-year-old young man patient with symptoms suspicious for left varicocele, who was incidentally diagnosed with right testicular nodule via scrotal doppler ultrasound powered with contrast enhancement infusion and subsequent multiparametric magnetic resonance imaging. Then, lesion was treated through a testis sparing surgical approach. Histopathology, which included an external revision by an experienced Center, revealed a MGST with benign features, so that no further treatment was considered. 3 and 12 months after surgery a contrast enhancement ultrasound was performed with no evidence of recurrence.Conclusions: Previous reported cases of MGST were all difficult to characterize as a specific pathological entity; treatment usually applied was radical orchiectomy and a subsequent total Body CT was performed for staging purpose. No metastatic spreading nor recurrence were ever reported. Considering the favorable behavior of this pathologic entity, testis-sparing surgery with no radiation exposure during follow-up is a safe and effective strategy.
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- 2022
40. Novel Volumetric and Morphological Parameters Derived from Three-dimensional Virtual Modeling to Improve Comprehension of Tumor’s Anatomy in Patients with Renal Cancer
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Lorenzo Bianchi, Giulia Carpani, Francesco Chessa, Alessandro Bertaccini, E. Balestrazzi, Emanuela Marcelli, A. Mottaran, Eugenio Brunocilla, Rita Golfieri, Laura Cercenelli, Alberta Cappelli, Pietro Piazza, Francesco V. Costa, Barbara Bortolani, Arianna Rustici, Riccardo Schiavina, Caterian Gaudiano, Sara Boschi, Matteo Droghetti, E. Molinaroli, Bianchi, Lorenzo, Schiavina, Riccardo, Bortolani, Barbara, Cercenelli, Laura, Gaudiano, Caterian, Mottaran, Angelo, Droghetti, Matteo, Chessa, Francesco, Boschi, Sara, Molinaroli, Enrico, Balestrazzi, Eleonora, Costa, Francesco, Rustici, Arianna, Carpani, Giulia, Piazza, Pietro, Cappelli, Alberta, Bertaccini, Alessandro, Golfieri, Rita, Marcelli, Emanuela, and Brunocilla, Eugenio
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medicine.medical_specialty ,Urology ,medicine.medical_treatment ,Urinary system ,Kidney Volume ,Logistic regression ,Nephrectomy ,Robotic Surgical Procedures ,medicine.artery ,Linear regression ,medicine ,Humans ,Warm Ischemia ,Renal artery ,Univariate analysis ,business.industry ,Robot-assisted partial nephrectomy ,Three-dimensional parameters ,Kidney Neoplasms ,Renal cancer ,Sample size determination ,Radiology ,Three-dimensional modeling ,Comprehension ,business ,Complication - Abstract
Background Three-dimensional (3D) models improve the comprehension of renal anatomy. Objective To evaluate the impact of novel 3D-derived parameters, to predict surgical outcomes after robot-assisted partial nephrectomy (RAPN). Design, setting, and participants Sixty-nine patients with cT1-T2 renal mass scheduled for RAPN were included. Three-dimensional virtual modeling was achieved from computed tomography. The following volumetric and morphological 3D parameters were calculated: VT (volume of the tumor); VT/VK (ratio between tumor volume and kidney volume); CSA3D (ie, contact surface area); UCS3D (contact to the urinary collecting system); Tumor-Artery3D: tumor’s blood supply by tertiary segmental arteries (score = 1), secondary segmental artery (score = 2), or primary segmental/main renal artery (scoren = 3); ST (tumor’s sphericity); ConvT (tumor’s convexity); and Endophyticity3D (ratio between the CSA3D and the global tumor surface). Intervention RAPN with a 3D model. Outcome measurements and statistical analysis Three-dimensional parameters were compared between patients with and without complications. Univariate logistic regression was used to predict overall complications and type of clamping; linear regression was used to predict operative time, warm ischemia time, and estimated blood loss. Results and limitations Overall, 11 (15%) individuals experienced overall complications (7.2% had Clavien ≥3 complications). Patients with urinary collecting system (UCS) involvement at 3D model (UCS3D = 2), tumor with blood supply by primary or secondary segmentary arteries (Tumor-Artery3D = 1 and 2), and high Endophyticity3D values had significantly higher rates of overall complications (all p ≤ 0.03). At univariate analysis, UCS3D, Tumor-Artery3D, and Endophyticity3D are significantly associated with overall complications; CSA3D and Endophyticity3D were associated with warm ischemia time; and CSA3D was associated with selective clamping (all p ≤ 0.03). Sample size and the lack of interobserver variability are the main limits. Conclusions Three-dimensional modeling provides novel volumetric and morphological parameters to predict surgical outcomes after RAPN. Patient summary Novel morphological and volumetric parameters can be derived from a three-dimensional model to describe surgical complexity of renal mass and to predict surgical outcomes after robot-assisted partial nephrectomy.
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- 2022
41. Multiparametric ultrasound for the diagnosis of Leydig cell tumours in non‐palpable testicular lesions
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Beniamino Corcioni, Nicolò Brandi, Giovanni Marasco, Caterina Gaudiano, Antonio De Cinque, Federica Ciccarese, Amelio Ercolino, Riccardo Schiavina, Eugenio Brunocilla, Matteo Renzulli, and Rita Golfieri
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Male ,Endocrinology ,Testicular Neoplasms ,Reproductive Medicine ,Urology ,Endocrinology, Diabetes and Metabolism ,Elasticity Imaging Techniques ,Humans ,Leydig Cell Tumor ,Ultrasonography - Abstract
The widespread use of ultrasonography has led to an increased number of incidentally detected small non-palpable lesions, with Leydig cell tumours representing the majority of them.The ultrasonography, real-time elastography and contrast-enhanced ultrasonography features of a large series of non-palpable testicular lesions were evaluated, focusing on the differences between Leydig cell tumours and other testicular masses.Of the 4679 testicular ultrasonography examinations performed at the Authors' Institution between January 2009 and December 2018, 78 patients (1.7%) were incidentally diagnosed with at least one non-palpable lesion and were enrolled. Thirteen patients (16.6%) declined surgery and were thus excluded. The remaining 65 underwent surgical resection with frozen section analysis. The conventional ultrasonography, colour Doppler, real-time elastography and contrast-enhanced ultrasonography were performed by a radiologist having more than 10 years of experience. Demographic and clinical data were collected.Leydig cell tumours were detected in 32 patients, being the most frequent benign tumours (49.2%); of the non-Leydig cell tumours, 25 patients had malignant tumours, five non-neoplastic lesions and three other benign tumours. The Leydig cell tumour group had mostly infertility problems whereas the non-Leydig cell tumour group frequently experienced pain (p 0.001). Leydig cell tumours were all hypoechoic (32/32, 100%; p = 0.002), more frequently presented with well-defined margins compared to non-Leydig cell tumours (30/32, 93.8% vs. 19/33, 57.6%; p = 0.001) and tended to be smaller than non-Leydig cell tumours (5.3 mm [standard deviation 2.7 mm] vs. 10.6 mm [standard deviation 3.8 mm], respectively; p 0.001). The vascular pattern characterised by the rapid wash-in followed by the delayed wash-out observed during contrast-enhanced ultrasonography was significantly associated with the Leydig cell tumour histological diagnosis, even at multivariate analysis (odds ratio 480.5, p 0.001), and yielded a high diagnostic accuracy (area under the receiver operating characteristic curve 0.954, 95% confidence interval 0.903-1).Contrast-enhanced ultrasonography demonstrated high diagnostic accuracy in identifying benign testicular lesions, such as Leydig cell tumours; they are the most common non-palpable tumours detected in infertile men and may benefit from enucleation.
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- 2022
42. An Apparent Diffusion Coefficient-Based Machine Learning Model Can Improve Prostate Cancer Detection in the Grey Area of the Prostate Imaging Reporting and Data System Category 3: A Single-Centre Experience
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Bevilacqua, Caterina Gaudiano, Margherita Mottola, Lorenzo Bianchi, Beniamino Corcioni, Lorenzo Braccischi, Makoto Taninokuchi Tomassoni, Arrigo Cattabriga, Maria Adriana Cocozza, Francesca Giunchi, Riccardo Schiavina, Stefano Fanti, Michelangelo Fiorentino, Eugenio Brunocilla, Cristina Mosconi, and Alessandro
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prostate cancer ,machine learning ,PI-RADS 3 lesions ,prediction models ,magnetic resonance imaging - Abstract
The Prostate Imaging and Reporting Data System (PI-RADS) has a key role in the management of prostate cancer (PCa). However, the clinical interpretation of PI-RADS 3 score lesions may be challenging and misleading, thus postponing PCa diagnosis to biopsy outcome. Multiparametric magnetic resonance imaging (mpMRI) radiomic analysis may represent a stand-alone noninvasive tool for PCa diagnosis. Hence, this study aims at developing a mpMRI-based radiomic PCa diagnostic model in a cohort of PI-RADS 3 lesions. We enrolled 133 patients with 155 PI-RADS 3 lesions, 84 of which had PCa confirmation by fusion biopsy. Local radiomic features were generated from apparent diffusion coefficient maps, and the four most informative were selected using LASSO, the Wilcoxon rank-sum test (p < 0.001), and support vector machines (SVMs). The selected features where augmented and used to train an SVM classifier, externally validated on a holdout subset. Linear and second-order polynomial kernels were exploited, and their predictive performance compared through receiver operating characteristics (ROC)-related metrics. On the test set, the highest performance, equally for both kernels, was specificity = 76%, sensitivity = 78%, positive predictive value = 80%, and negative predictive value = 74%. Our findings substantially improve radiologist interpretation of PI-RADS 3 lesions and let us advance towards an image-driven PCa diagnosis.
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- 2023
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43. STEREOSCOPIC AUGMENTED REALITY FOR INTRAOPERATIVE GUIDANCE IN ROBOTIC SURGERY
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LORENZO TARTARINI, SCHIAVINA RICCARDO, LORENZO BIANCHI, SIMONE LODI, CATERINA GAUDIANO, BARBARA BORTOLANI, LAURA CERCENELLI, EUGENIO BRUNOCILLA, and EMANUELA MARCELLI
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Biomedical Engineering - Abstract
Augmented reality (AR) technology is increasingly adopted in the surgical field and recently it has been also introduced in robotic-assisted urologic surgery. This work describes the design and development of an AR intraoperative guide system with stereoscopic visualization (SAR, stereoscopic augmented reality) for the Da Vinci surgical robot. As a major novelty, the developed SAR system allows the surgeon to have the virtual 3D model of patient anatomy superimposed on the real field, without losing the stereoscopic view of the operative field. The workflow starts with the 3D model generation of the anatomical district of interest for surgery, from patient diagnostic imaging. Then, the 3D model is uploaded in the developed SAR application, navigated using a 3D space mouse, and superimposed to the operative field using computer vision algorithms. The SAR system was tested during 30 robot-assisted surgeries, including 20 partial nephrectomies, 1 kidney explant, and 9 radical prostatectomies. The SAR guidance system received overall great appreciation from surgeons and helped in localizing hidden structures, such as arteries or tumoral masses, increasing the understanding of surgical anatomy with depth perception, and facilitating intraoperative navigation. Future efforts will be addressed to improve the automatic superimposition of digital 3D models on the intraoperative view.
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- 2023
44. The new classification of renal cell carcinoma: what is the clinical issue?
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Pietro PIAZZA, Lorenzo BIANCHI, Michelangelo FIORENTINO, Caterina GAUDIANO, Francesca GIUNCHI, Eugenio BRUNOCILLA, and Riccardo SCHIAVINA
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Nephrology ,Urology - Published
- 2023
45. MP46-04 THE IMPACT OF CUMULATIVE SMOKING STATUS ON PERIOPERATIVE MORBIDITY AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY
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Pietro Piazza, Carlo Bravi, Adele Piro, Luca Sarchi, Marco Paciotti, Maria Peraire Lores, Eleonora Balestrazzi, Luigi Nocera, null Melle, null Belgium, Angelo Mottaran, Federico Piramide, Ruben De Groote, Geert De Naeyer, Frederiek D'hondt, Rui Farinha, Riccardo Schiavina, Eugenio Brunocilla, and Alexandre Mottrie
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Urology - Published
- 2023
46. MP11-09 SECOND LINE PSMA-TARGETED SALVAGE TREATMENT IN PATIENTS WITH miN1/M1a-b OLIGORECURRENT PCa
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Lorenzo Bianchi, Eleonora Balestrazzi, Francesco Ceci, Francesco Costa, Matteo Droghetti, Alessandro Pissavini, Pietro Piazza, Andrea Farolfi, Riccardo Mei, Paolo Castellucci, Stefano Puliatti, Giorgio Gandaglia, Alessandro Larcher, Alexandre Mottrie, Alberto Briganti, Alessio Giuseppe Morganti, Stefano Fanti, Francesco Montorsi, Riccardo Schiavina, and Eugenio Brunocilla
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Urology - Published
- 2023
47. MP58-04 PROPOSAL AND INTERNAL VALIDATION OF A NOMOGRAM FOR THE PREDICTION OF LOCAL RECURRENCE FREE-SURVIVAL AFTER PERCUTANEOUS ABLATION FOR CT1 RENAL MASSES
- Author
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Angelo Mottaran, Luigi Nocera, Lorenzo Bianchi, Stefano Luzzago, Marco Bandini, Pietro Piazza, Antonio Celia, Carla Serra, Francesco Modestino, Antonio De Cinque, Rita Golfieri, Gennaro Musi, Andrea Gallina, Francesco De Cobelli, Giovanni Mauri, Franco Orsi, Umberto Capitanio, null Milan, null Italy, Riccardo Schiavina, Ottavio De Cobelli, Francesco Montorsi, and Eugenio Brunocilla
- Subjects
Urology - Published
- 2023
48. PD10-08 THE PROGNOSTIC IMPACT OF PREOPERATIVE PSMA-PET ON EARLY ONCOLOGICAL OUTCOMES IN PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY: RESULTS OF A MULTI-CENTER ANALYSIS
- Author
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Simone Scuderi, Giorgio Gandaglia, Armando Stabile, Elio Mazzone, Francesco Barletta, Nicolai Huebner, Eugenio Brunocilla, Agostino Mattei, Luca Afferi, Shahrok Shariat, Giancarlo Marra, Junlong Zhuang, Hongqian Guo, Riccardo Schiavina, Lorenzo Bianchi, Fabio Zattoni, Giuseppe Reitano, Pawel Rajwa, Juan Gomez Rivas, Claudia Kesch, Enrico Checcucci, Francesco Porpiglia, Edoardo Cisero, Daniele Amparore, Maria Picchio, Francesco Montorsi, and Alberto Briganti
- Subjects
Urology - Published
- 2023
49. MP41-20 EFFECTIVENESS OF RADIOMIC TUMOR ZONE OF TRANSITION (ZOT) FEATURES IN THE AUTOMATED DISCRIMINATION OF ONCOCYTOMA FROM CLEAR CELL RENAL CANCER
- Author
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Lorenzo Bianchi, Elena Tonin, Pietro Piazza, Gianluca Carlini, Caterina Gaudiano, Rita Golfieri, Nico Curti, Riccardo Schiavina, Francesca Giunchi, Riccardo Biondi, Damiano Caruso, Enrico Giampieri, Alessandra Merlotti, Daniele Dall'Olio, Claudia Sala, Sara Pandolfi, Daniel Remondini, Arianna Rustici, Luigi Vincenzo Pastore, Leonardo Scarpetti, Barbara Bortolani, Eugenio Brunocilla, Emanuela Marcelli, Francesca Coppola, and Gastone Castellani
- Subjects
Urology - Published
- 2023
50. MP61-12 WHICH MEN WITH CN1 PROSTATE CANCER AT PSMA PET/CT REPRESENT THE IDEAL CANDIDATE TO RADICAL PROSTATECTOMY? DEVELOPMENT OF A NOVEL RISK STRATIFICATION TOOL FOR INDIVIDUALIZED APPROACHES BASED ON A LARGE, MULTI-INSTITUTIONAL SERIES
- Author
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Francesco Barletta, Elio Mazzone, Giorgio Gandaglia, Lorenzo Bianchi, Riccardo Schiavina, Luca Afferi, Agostino Mattei, Fabio Zattoni, Giuseppe Reitano, Pawel Rajwa, Shahrok Shariat, Claudia Kesch, Juan Gomez Rivas, Giancarlo Marra, Hongqian Guo, Junlong Zhuang, Daniele Amparore, Francesco Porpiglia, Nicolai Huebner, Eugenio Brunocilla, Enrico Checcucci, Fabrizio Dal Moro, Jesus Moreno-Sierra, Christopher Darr, Alida Sartorello, Francesco Montorsi, and Alberto Briganti
- Subjects
Urology - Published
- 2023
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