Pub Date : 2021-04-01DOI: 10.23736/S0393-2249.19.03492-1
D. Bianchi, V. Iacovelli, I. Parisi, F. Petta, G. Gaziev, L. Topazio, P. Bove, G. Vespasiani, Enrico Finazzi Agrò
BACKGROUND The aim of this cross-sectional study is to evaluate the "real life" data of patients following successful treatment with PTNS for overactive bladder syndrome (OAB) or non-obstructive voiding dysfunction (NOVD) at a 7-year follow- up after the procedure. METHODS Patients who were successfully treated with PTNS for OAB or NOVD between February 2008 and January 2009 were contacted for a telephonic interview seven years after the end of their PTNS stimulation protocol. Patients who agreed to the interview were asked to complete a global response assessment (GRA). Patients in the OAB category completed the OAB short-form questionnaire Symptom Bother Scale (OAB-q SF) and the OAB Health-Related Quality of Life Scale (OAB HRQL), and NOVD patients were evaluated using the International Prostate Symptom Score - voiding questions (v-IPSS). Results of both questionnaires were compared with those obtained seven years previously, at the time of the initial PTNS treatment. RESULTS Seventeen patients were identified in our database. Sixteen agreed to the interview, but the remaining patient was unreachable and was therefore considered as lost at follow-up. Eight patients were classified into the OAB group, and eight were classified into the NOVD group. No patient reported a worsening condition after PTNS. Six of the eight patients (75%) in the OAB group gave positive responses in the GRA. All patients in the NOVD group gave positive responses in the GRA. CONCLUSIONS Despite some limitations, this study shows that the majority of patients who responded to PTNS considered themselves still improved at a seven- year follow-up. Larger studies are needed to confirm our results, but our study has the novel advantage of showing data derived from "real life" over the longest follow- up yet considered in the literature.
{"title":"Real-life data on long-term follow-up of patients successfully treated with percutaneous tibial nerve stimulation (PTNS).","authors":"D. Bianchi, V. Iacovelli, I. Parisi, F. Petta, G. Gaziev, L. Topazio, P. Bove, G. Vespasiani, Enrico Finazzi Agrò","doi":"10.23736/S0393-2249.19.03492-1","DOIUrl":"https://doi.org/10.23736/S0393-2249.19.03492-1","url":null,"abstract":"BACKGROUND\u0000The aim of this cross-sectional study is to evaluate the \"real life\" data of patients following successful treatment with PTNS for overactive bladder syndrome (OAB) or non-obstructive voiding dysfunction (NOVD) at a 7-year follow- up after the procedure.\u0000\u0000\u0000METHODS\u0000Patients who were successfully treated with PTNS for OAB or NOVD between February 2008 and January 2009 were contacted for a telephonic interview seven years after the end of their PTNS stimulation protocol. Patients who agreed to the interview were asked to complete a global response assessment (GRA). Patients in the OAB category completed the OAB short-form questionnaire Symptom Bother Scale (OAB-q SF) and the OAB Health-Related Quality of Life Scale (OAB HRQL), and NOVD patients were evaluated using the International Prostate Symptom Score - voiding questions (v-IPSS). Results of both questionnaires were compared with those obtained seven years previously, at the time of the initial PTNS treatment.\u0000\u0000\u0000RESULTS\u0000Seventeen patients were identified in our database. Sixteen agreed to the interview, but the remaining patient was unreachable and was therefore considered as lost at follow-up. Eight patients were classified into the OAB group, and eight were classified into the NOVD group. No patient reported a worsening condition after PTNS. Six of the eight patients (75%) in the OAB group gave positive responses in the GRA. All patients in the NOVD group gave positive responses in the GRA.\u0000\u0000\u0000CONCLUSIONS\u0000Despite some limitations, this study shows that the majority of patients who responded to PTNS considered themselves still improved at a seven- year follow-up. Larger studies are needed to confirm our results, but our study has the novel advantage of showing data derived from \"real life\" over the longest follow- up yet considered in the literature.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79229835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01DOI: 10.23736/S0393-2249.19.03440-4
J. Daza, A. Beksac, M. Kannappan, Julio T Chong, R. Abaza, A. Hemal, J. Sfakianos, K. Badani
BACKGROUND In some cases, preservation of adrenal gland could be at risk in patients with cT1 and cT2 RCC. The aim of this study is to evaluate tumor-related factors that can potentially increase the risk of simultaneous adrenalectomy during robotic-assisted laparoscopic radical nephrectomy (RALRN) in patients with cT1 - cT2 disease and the impact of performing such procedure on recurrence-free survival (RFS) and complication rates. METHODS We used a multi-institutional kidney cancer database where we identified patients who underwent RALRN with or without adrenalectomy. We evaluated the tumor-related characteristics that could potentially increase the risk of adrenal gland resection of these patients. We also reported RFS at 12 - 24 months of follow-up, which was compared with an inverse probability of treatment weighted (IPTW) multivariable cox proportional hazards regression model and post-operative complications, which was compared with an IPTW multivariable logistic regression model. RESULTS Tumor size, cT stage, pT stage, histologic subtype, sarcomatoid differentiation, BMI, lymph node involvement, metastatic disease, Fuhrman grade do not increase the risk of simultaneous adrenalectomy during RALRN. Moreover, RALRN with adrenalectomy had no significant benefit in RFS. No differences in post-operative complications were noted. CONCLUSIONS Our evaluated tumor-related characteristics did not show to impact the incidence of simultaneous adrenalectomy. Adrenal gland resection T does not provide significant benefit in recurrence-free survival. We consider that RALRN with adrenalectomy should be reserved only for patients with adrenal compromise as stated previously regardless that it has shown to be a safe procedure.
{"title":"Identifying tumor-related risk factors for simultaneous adrenalectomy in patients with cT1 - cT2 kidney cancer during robotic assisted laparoscopic radical nephrectomy.","authors":"J. Daza, A. Beksac, M. Kannappan, Julio T Chong, R. Abaza, A. Hemal, J. Sfakianos, K. Badani","doi":"10.23736/S0393-2249.19.03440-4","DOIUrl":"https://doi.org/10.23736/S0393-2249.19.03440-4","url":null,"abstract":"BACKGROUND\u0000In some cases, preservation of adrenal gland could be at risk in patients with cT1 and cT2 RCC. The aim of this study is to evaluate tumor-related factors that can potentially increase the risk of simultaneous adrenalectomy during robotic-assisted laparoscopic radical nephrectomy (RALRN) in patients with cT1 - cT2 disease and the impact of performing such procedure on recurrence-free survival (RFS) and complication rates.\u0000\u0000\u0000METHODS\u0000We used a multi-institutional kidney cancer database where we identified patients who underwent RALRN with or without adrenalectomy. We evaluated the tumor-related characteristics that could potentially increase the risk of adrenal gland resection of these patients. We also reported RFS at 12 - 24 months of follow-up, which was compared with an inverse probability of treatment weighted (IPTW) multivariable cox proportional hazards regression model and post-operative complications, which was compared with an IPTW multivariable logistic regression model.\u0000\u0000\u0000RESULTS\u0000Tumor size, cT stage, pT stage, histologic subtype, sarcomatoid differentiation, BMI, lymph node involvement, metastatic disease, Fuhrman grade do not increase the risk of simultaneous adrenalectomy during RALRN. Moreover, RALRN with adrenalectomy had no significant benefit in RFS. No differences in post-operative complications were noted.\u0000\u0000\u0000CONCLUSIONS\u0000Our evaluated tumor-related characteristics did not show to impact the incidence of simultaneous adrenalectomy. Adrenal gland resection T does not provide significant benefit in recurrence-free survival. We consider that RALRN with adrenalectomy should be reserved only for patients with adrenal compromise as stated previously regardless that it has shown to be a safe procedure.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82691810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-13DOI: 10.23736/S0393-2249.20.04178-8
A. Morozov, E. Barret, D. Veneziano, V. Grigoryan, G. Salomon, I. Fokin, M. Taratkin, E. Poddubskaya, J. Gómez Rivas, S. Puliatti, Z. Okhunov, G. Cacciamani, E. Checcucci, José L. Marenco Jiménez, D. Enikeev
BACKGROUND We provide a systematic analysis of NSS to assess and summarize the risks and benefits of NSS in high-risk PCa. METHODS We have undertaken a systematic search of original articles at 3 databases (Medline (PubMed), Scopus, and Web of Science). Original articles in English containing outcomes of nerve-sparing RP for high-risk PCa were included. The primary outcomes were oncological results: the rate of positive surgical margins and biochemical relapse. The secondary outcomes were functional results: EF and urinary continence. RESULTS The rate of positive surgical margins differed considerably, from zero to 47%. The majority of authors found no correlation between NSS and a positive surgical margin rate. The rate of biochemical relapse ranged from 9.3% to 61%. Most of the articles lacked data on OR for positive margin and biochemical relapse. The presented results showed no effect of NS on positive margin (OR=0.81, 0.6-1.09) or biochemical relapse (HR=0.93, 0.52 1.64). A strong association between NSS and potency rate was observed. Without NSS, between 0% and 42% of patients were potent, with unilateral 79-80%, with bilateral - up to 90-100%. Urinary continence was not strongly associated with NSS and was relatively good in both patients with or without NSS. CONCLUSIONS NSS may provide benefits for patients with urinary continence and significantly improves EF in high-risk patients. Moreover, it is not associated with an increased risk of relapse in short- and middle-term follow-up. However, the advantages of using such a surgical technique are unclear.
{"title":"A systematic review of nerve-sparing surgery for high-risk prostate cancer.","authors":"A. Morozov, E. Barret, D. Veneziano, V. Grigoryan, G. Salomon, I. Fokin, M. Taratkin, E. Poddubskaya, J. Gómez Rivas, S. Puliatti, Z. Okhunov, G. Cacciamani, E. Checcucci, José L. Marenco Jiménez, D. Enikeev","doi":"10.23736/S0393-2249.20.04178-8","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04178-8","url":null,"abstract":"BACKGROUND\u0000We provide a systematic analysis of NSS to assess and summarize the risks and benefits of NSS in high-risk PCa.\u0000\u0000\u0000METHODS\u0000We have undertaken a systematic search of original articles at 3 databases (Medline (PubMed), Scopus, and Web of Science). Original articles in English containing outcomes of nerve-sparing RP for high-risk PCa were included. The primary outcomes were oncological results: the rate of positive surgical margins and biochemical relapse. The secondary outcomes were functional results: EF and urinary continence.\u0000\u0000\u0000RESULTS\u0000The rate of positive surgical margins differed considerably, from zero to 47%. The majority of authors found no correlation between NSS and a positive surgical margin rate. The rate of biochemical relapse ranged from 9.3% to 61%. Most of the articles lacked data on OR for positive margin and biochemical relapse. The presented results showed no effect of NS on positive margin (OR=0.81, 0.6-1.09) or biochemical relapse (HR=0.93, 0.52 1.64). A strong association between NSS and potency rate was observed. Without NSS, between 0% and 42% of patients were potent, with unilateral 79-80%, with bilateral - up to 90-100%. Urinary continence was not strongly associated with NSS and was relatively good in both patients with or without NSS.\u0000\u0000\u0000CONCLUSIONS\u0000NSS may provide benefits for patients with urinary continence and significantly improves EF in high-risk patients. Moreover, it is not associated with an increased risk of relapse in short- and middle-term follow-up. However, the advantages of using such a surgical technique are unclear.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84741015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-13DOI: 10.23736/S0393-2249.20.04191-0
A. Grosso, F. di Maida, A. Mari, R. Campi, A. Crisci, G. Vignolini, L. Masieri, M. Carini, A. Minervini
BACKGROUND Aim of the study was to describe our totally intracorporeal robotic ileal ureter replacement technique, reporting perioperative and mid-term results and compare it with previous similar experiences, specifically focusing on technical considerations. METHODS Three patients were submitted to robotic ileal ureter substitution for long ureteral defects in our institution during 2019. The procedures were carried out fully intracorporeally. Two patients received a complete replacement of the urinary tract using an ileal segment, while in one patient the lower ureteral stump was maintained, and an ileal-ureter anastomosis was performed distally. Patients' baseline characteristics, as well as, perioperative and mid-term results were collected. A detailed description of the technique is reported and compared with prior similar experiences. RESULTS Median operative time was 270 (range 240-300) min. No Clavien-Dindo complications >2 were collected. All patients experienced a fast return to oral intake and canalization. Antegrade pyelography, performed a 1-month follow-up, revealed full passage of the medium contrast in those patients submitted to complete ileal ureter replacement while, in the third one, stenosis at the level of ileal-ureter anastomoses was found. CONCLUSIONS Robotic ileal ureter replacement can be performed completely intracorporeal with optimal results and limited complication rate, in selected cases. According to our considerations, specific surgical steps are needed to reduce the risks related to this procedure, including avoiding partial ileal substitution.
{"title":"Totally intracorporeal robotic ileal ureter replacement: focus on surgical technique and outcomes.","authors":"A. Grosso, F. di Maida, A. Mari, R. Campi, A. Crisci, G. Vignolini, L. Masieri, M. Carini, A. Minervini","doi":"10.23736/S0393-2249.20.04191-0","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04191-0","url":null,"abstract":"BACKGROUND\u0000Aim of the study was to describe our totally intracorporeal robotic ileal ureter replacement technique, reporting perioperative and mid-term results and compare it with previous similar experiences, specifically focusing on technical considerations.\u0000\u0000\u0000METHODS\u0000Three patients were submitted to robotic ileal ureter substitution for long ureteral defects in our institution during 2019. The procedures were carried out fully intracorporeally. Two patients received a complete replacement of the urinary tract using an ileal segment, while in one patient the lower ureteral stump was maintained, and an ileal-ureter anastomosis was performed distally. Patients' baseline characteristics, as well as, perioperative and mid-term results were collected. A detailed description of the technique is reported and compared with prior similar experiences.\u0000\u0000\u0000RESULTS\u0000Median operative time was 270 (range 240-300) min. No Clavien-Dindo complications >2 were collected. All patients experienced a fast return to oral intake and canalization. Antegrade pyelography, performed a 1-month follow-up, revealed full passage of the medium contrast in those patients submitted to complete ileal ureter replacement while, in the third one, stenosis at the level of ileal-ureter anastomoses was found.\u0000\u0000\u0000CONCLUSIONS\u0000Robotic ileal ureter replacement can be performed completely intracorporeal with optimal results and limited complication rate, in selected cases. According to our considerations, specific surgical steps are needed to reduce the risks related to this procedure, including avoiding partial ileal substitution.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89194114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-13DOI: 10.23736/S0393-2249.20.04135-1
Pengxiu Lin, Minhong Wu, Hong-li Gu, L. Tu, Shilan Liu, Zhiling Yu, Qingsheng Chen, Cailing Liu
INTRODUCTION We reviewed current studies and performed a meta-analysis to compare outcomes between laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) treating complex renal tumors (RENAL score ≥ 7 or maximum clinical tumor size > 4cm). EVIDENCE ACQUISITION Using the databases of PubMed, Embase, and the Cochrane Library, a comprehensive literature search was performed in April, 2020. Pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using fixed-effect or random-effect model. Publication bias was evaluated by funnel plots. EVIDENCE SYNTHESIS Ten observational studies including 5193 patients (LPN: 1574; RAPN: 3619) were included. There was no significant difference between the two groups regarding conversion to open (P = 0.07) surgery, all complications (P = 0.12), grade 1-2 complications (P = 0.10), grade 3-5 complications (P = 0.93), operative time (P = 0.94), estimated blood loss (P = 0.17). Patients undergoing LPN had a significant higher rate of conversion to radical (OR: 4.33; 95% CI: 2.01-9.33; p < 0.001), a longer ischemia time (IT, P < 0.001; WMD: 3.02 min; 95% CI, 1.67 to 4.36), a longer length of stay (LOS, P < 0.001; WMD: 0.67 days; 95% CI, 0.35 to 0.99), a lower rate of positive surgical margin (P = 0.03; OR: 0.71; 95% CI, 0.53 to 0.96), a greater eGFR decline (P < 0.001; WMD: 2.41 ml/min/1.73 m2; 95% CI, 1.22 to 3.60), a higher rate of CKD upstaging (P < 0.001; OR:2.44; 95% CI, 1.54 to 3.87). No obvious publication bias was observed. CONCLUSIONS For complex renal tumors, RAPN is more favorable than LPN in terms of lower rate of conversion to radical surgery, shorter IT, shorter LOS, less eGFR decline, and lower rate of CKD upstaging. Methodological limitations of observational studies should be taken into account in interpreting these results.
{"title":"Comparison of outcomes between laparoscopic and robot-assisted partial nephrectomy for complex renal tumors (RENAL score ≥ 7 or maximum tumor size > 4cm): a systematic review and meta-analysis.","authors":"Pengxiu Lin, Minhong Wu, Hong-li Gu, L. Tu, Shilan Liu, Zhiling Yu, Qingsheng Chen, Cailing Liu","doi":"10.23736/S0393-2249.20.04135-1","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04135-1","url":null,"abstract":"INTRODUCTION\u0000We reviewed current studies and performed a meta-analysis to compare outcomes between laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) treating complex renal tumors (RENAL score ≥ 7 or maximum clinical tumor size > 4cm).\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000Using the databases of PubMed, Embase, and the Cochrane Library, a comprehensive literature search was performed in April, 2020. Pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using fixed-effect or random-effect model. Publication bias was evaluated by funnel plots.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u0000Ten observational studies including 5193 patients (LPN: 1574; RAPN: 3619) were included. There was no significant difference between the two groups regarding conversion to open (P = 0.07) surgery, all complications (P = 0.12), grade 1-2 complications (P = 0.10), grade 3-5 complications (P = 0.93), operative time (P = 0.94), estimated blood loss (P = 0.17). Patients undergoing LPN had a significant higher rate of conversion to radical (OR: 4.33; 95% CI: 2.01-9.33; p < 0.001), a longer ischemia time (IT, P < 0.001; WMD: 3.02 min; 95% CI, 1.67 to 4.36), a longer length of stay (LOS, P < 0.001; WMD: 0.67 days; 95% CI, 0.35 to 0.99), a lower rate of positive surgical margin (P = 0.03; OR: 0.71; 95% CI, 0.53 to 0.96), a greater eGFR decline (P < 0.001; WMD: 2.41 ml/min/1.73 m2; 95% CI, 1.22 to 3.60), a higher rate of CKD upstaging (P < 0.001; OR:2.44; 95% CI, 1.54 to 3.87). No obvious publication bias was observed.\u0000\u0000\u0000CONCLUSIONS\u0000For complex renal tumors, RAPN is more favorable than LPN in terms of lower rate of conversion to radical surgery, shorter IT, shorter LOS, less eGFR decline, and lower rate of CKD upstaging. Methodological limitations of observational studies should be taken into account in interpreting these results.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88376771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.23736/S0393-2249.20.04127-2
L. Afferi, M. Abufaraj, F. Soria, D. D’andrea, E. Xylinas, T. Seisen, M. Rouprêt, C. Lonati, A. De la taille, B. Peyronnet, E. Laukhtina, B. Pradère, A. Mari, W. Krajewski, M. Álvarez-Maestro, E. Kikuchi, K. Shigeta, P. Chłosta, F. Montorsi, A. Briganti, G. Simone, P. Ornaghi, M. Cerruto, A. Antonelli, Kazumasa Matsumoto, P. Karakiewicz, L. Mordasini, A. Mattei, S. Shariat, M. Moschini
BACKGROUND Radical nephroureterectomy (RNU) with the concomitant excision of the distal ureter and bladder cuff is the current standard of care for the treatment of muscle invasive and/or high-risk upper tract urothelial carcinoma (UTUC). In small uncontrolled studies, laparoscopic RNU has been suggested to be associated with better perioperative outcomes compared to open RNU. The aim of our study was to compare the perioperative oncological and functional outcomes of open RNU versus laparoscopic RNU after adjusting for preoperative baseline patient-related characteristics. METHODS We evaluated a multi institutional retrospective database composed by 1512 patients diagnosed with UTUC and treated with open or laparoscopic RNU between 1990 and 2016. Perioperative outcomes included operative time, blood loss, and length of hospital stay, as well as postoperative complications, readmission, reoperation, and mortality rates at 30 and 90 days from surgery. A 1:1 propensity score matching estimated using logistic regression with the teffects psmatch function of STATA 13® (caliper 0.2, no replacement) was performed using preoperative parameters such as: age, gender, body mass index (BMI), and American Society of Anesthesiologists (ASA) score. RESULTS Overall, 1007 (66.6%) patients were treated with open and 505 (33.4%) with laparoscopic RNU. Open RNU resulted into shorter median operative time (180 vs 230 min, p<0.001) and longer median hospital stay (10 vs 7 days, p<0.001) in comparison to laparoscopic RNU. No statistically significant difference was identified for the other variables of interest (all p>0.05). At multivariable linear regression after propensity score matching adjusted for lymph node dissection and year of surgery, laparoscopic RNU resulted in longer operative time (Coefficient 43.6, 95% CI 27.9-59.3, p<0.001) and shorter hospital stay (Coefficient -1.27, 95% CI -2.1 to -0.3, p=0.01) compared to open RNU, but the risk of other perioperative complications remained similar between the two treatments. CONCLUSIONS Laparoscopic RNU is associated with shorter hospital stay, but longer operative time in comparison to open RNU. Otherwise, there were no differences in other perioperative outcomes between these surgical modalities even after propensity score matching. The choice to offer laparoscopic or open RNU in the treatment of UTUC should not be based on concerns of different safety outcomes.
背景:根治性肾输尿管切除术(RNU)同时切除远端输尿管和膀胱袖是目前治疗肌肉侵袭性和/或高风险上路尿路上皮癌(UTUC)的标准治疗方法。在小型非对照研究中，与开放式RNU相比，腹腔镜RNU被认为与更好的围手术期预后相关。本研究的目的是在调整术前基线患者相关特征后，比较开放式RNU与腹腔镜RNU围手术期的肿瘤和功能结果。方法我们评估了一个多机构回顾性数据库，该数据库由1990年至2016年期间诊断为UTUC并接受开放或腹腔镜RNU治疗的1512例患者组成。围手术期结局包括手术时间、出血量、住院时间、术后并发症、再入院、再手术以及术后30天和90天的死亡率。使用术前参数，如年龄、性别、体重指数(BMI)和美国麻醉医师协会(ASA)评分，使用逻辑回归和STATA 13®(卡尺0.2，无更换)的效应psmatch函数进行1:1倾向评分匹配估计。结果开腹RNU 1007例(66.6%)，腹腔镜RNU 505例(33.4%)。开放RNU导致中位手术时间缩短(180分钟vs 230分钟，p0.05)。经倾向评分匹配校正淋巴结清扫和手术年份后的多变量线性回归分析，与开放式RNU相比，腹腔镜RNU的手术时间更长(系数43.6,95% CI 27.9 ~ 59.3, p<0.001)，住院时间更短(系数-1.27,95% CI -2.1 ~ -0.3, p=0.01)，但两种治疗之间其他围手术期并发症的风险保持相似。结论腹腔镜下RNU与开放式RNU相比，住院时间短，手术时间长。除此之外，即使在倾向评分匹配后，这些手术方式之间的其他围手术期结果也没有差异。在UTUC的治疗中，选择腹腔镜或开放式RNU不应基于不同的安全结果。
{"title":"A comparison of perioperative outcomes of laparoscopic versus open nephroureterectomy for upper tract urothelial carcinoma: a propensity score matching analysis.","authors":"L. Afferi, M. Abufaraj, F. Soria, D. D’andrea, E. Xylinas, T. Seisen, M. Rouprêt, C. Lonati, A. De la taille, B. Peyronnet, E. Laukhtina, B. Pradère, A. Mari, W. Krajewski, M. Álvarez-Maestro, E. Kikuchi, K. Shigeta, P. Chłosta, F. Montorsi, A. Briganti, G. Simone, P. Ornaghi, M. Cerruto, A. Antonelli, Kazumasa Matsumoto, P. Karakiewicz, L. Mordasini, A. Mattei, S. Shariat, M. Moschini","doi":"10.23736/S0393-2249.20.04127-2","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04127-2","url":null,"abstract":"BACKGROUND\u0000Radical nephroureterectomy (RNU) with the concomitant excision of the distal ureter and bladder cuff is the current standard of care for the treatment of muscle invasive and/or high-risk upper tract urothelial carcinoma (UTUC). In small uncontrolled studies, laparoscopic RNU has been suggested to be associated with better perioperative outcomes compared to open RNU. The aim of our study was to compare the perioperative oncological and functional outcomes of open RNU versus laparoscopic RNU after adjusting for preoperative baseline patient-related characteristics.\u0000\u0000\u0000METHODS\u0000We evaluated a multi institutional retrospective database composed by 1512 patients diagnosed with UTUC and treated with open or laparoscopic RNU between 1990 and 2016. Perioperative outcomes included operative time, blood loss, and length of hospital stay, as well as postoperative complications, readmission, reoperation, and mortality rates at 30 and 90 days from surgery. A 1:1 propensity score matching estimated using logistic regression with the teffects psmatch function of STATA 13® (caliper 0.2, no replacement) was performed using preoperative parameters such as: age, gender, body mass index (BMI), and American Society of Anesthesiologists (ASA) score.\u0000\u0000\u0000RESULTS\u0000Overall, 1007 (66.6%) patients were treated with open and 505 (33.4%) with laparoscopic RNU. Open RNU resulted into shorter median operative time (180 vs 230 min, p<0.001) and longer median hospital stay (10 vs 7 days, p<0.001) in comparison to laparoscopic RNU. No statistically significant difference was identified for the other variables of interest (all p>0.05). At multivariable linear regression after propensity score matching adjusted for lymph node dissection and year of surgery, laparoscopic RNU resulted in longer operative time (Coefficient 43.6, 95% CI 27.9-59.3, p<0.001) and shorter hospital stay (Coefficient -1.27, 95% CI -2.1 to -0.3, p=0.01) compared to open RNU, but the risk of other perioperative complications remained similar between the two treatments.\u0000\u0000\u0000CONCLUSIONS\u0000Laparoscopic RNU is associated with shorter hospital stay, but longer operative time in comparison to open RNU. Otherwise, there were no differences in other perioperative outcomes between these surgical modalities even after propensity score matching. The choice to offer laparoscopic or open RNU in the treatment of UTUC should not be based on concerns of different safety outcomes.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77005247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.23736/S0393-2249.20.04076-X
M. Ferro, M. Marchioni, G. Lucarelli, V. M. Dorin, F. Soria, D. Terracciano, F. Mistretta, S. Luzzago, C. Buonerba, F. Cantiello, A. Mari, A. Minervini, A. Veccia, A. Antonelli, G. Musi, R. Hurle, G. Busetto, F. del Giudice, B. Chung, F. Berardinelli, S. Perdoná, P. Del Prete, V. Mirone, M. Borghesi, A. Porreca, P. Bove, R. Autorino, N. Crisan, A. R. Abu Farhan, M. Battaglia, P. Ditonno, G. Russo, M. Muto, R. Damiano, M. Manfredi, F. Porpiglia, O. de Cobelli, L. Schips
INTRODUCTION We aimed to test the hypothesis that the immune-modulatory effect of statins may improve survival outcomes in patients with non-muscle invasive bladder cancer (NMIBC). We focused on a cohort of patients diagnosed with high risk NMIBC, that were treated with intravesical BCG immunotherapy. PATIENTS AND METHODS We included patients at first diagnosis of T1 high grade NMIBC after transurethral resection of bladder (TURB). All procedures were performed at 18 different tertiary institutions between January 2002 and December 2012. Univariable and multivariable models were used to test differences in terms of residual tumour, disease recurrence, disease progression and overall mortality (OM) rates. RESULTS Overall, 1510 patients with T1 high grade NMIBC at TURB were included in our analyses. Of these, 402 (26.6%) were statin users. At multivariable analysis, statin use was associated with a higher rates of high grade BC at re-TURB (OR: 1.37, 95%CI: 1.04-1.78; p=0.022), while at follow-up it was not independently associated with OM (HR: 0.71, 95%CI: 0.50-1.03; p=0.068) and disease progression rates (HR: 0.97, 95%CI: 0.79-1.19; p=0.753). Conversely, statin use has been shown to be independently associated with a lower risk of recurrence (HR:0.80, 95%CI: 0.67-0.95; p=0.009). The median recurrence-free survival was 47 (95%CI 40-49) months for those classified as non-statin users vs. 53 (95%CI 48-68) months in those classified as statin users. CONCLUSIONS Statin daily intake do not compromise oncological outcomes in high risk NMIBC patients treated with BCG. Moreover, statin may have a beneficial effect on recurrence rates in this cohort of patients.
{"title":"Association of statin use and oncological outcomes in patients with first diagnosis of T1 high grade non-muscle invasive urothelial bladder cancer: results from a multicentre study.","authors":"M. Ferro, M. Marchioni, G. Lucarelli, V. M. Dorin, F. Soria, D. Terracciano, F. Mistretta, S. Luzzago, C. Buonerba, F. Cantiello, A. Mari, A. Minervini, A. Veccia, A. Antonelli, G. Musi, R. Hurle, G. Busetto, F. del Giudice, B. Chung, F. Berardinelli, S. Perdoná, P. Del Prete, V. Mirone, M. Borghesi, A. Porreca, P. Bove, R. Autorino, N. Crisan, A. R. Abu Farhan, M. Battaglia, P. Ditonno, G. Russo, M. Muto, R. Damiano, M. Manfredi, F. Porpiglia, O. de Cobelli, L. Schips","doi":"10.23736/S0393-2249.20.04076-X","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04076-X","url":null,"abstract":"INTRODUCTION\u0000We aimed to test the hypothesis that the immune-modulatory effect of statins may improve survival outcomes in patients with non-muscle invasive bladder cancer (NMIBC). We focused on a cohort of patients diagnosed with high risk NMIBC, that were treated with intravesical BCG immunotherapy.\u0000\u0000\u0000PATIENTS AND METHODS\u0000We included patients at first diagnosis of T1 high grade NMIBC after transurethral resection of bladder (TURB). All procedures were performed at 18 different tertiary institutions between January 2002 and December 2012. Univariable and multivariable models were used to test differences in terms of residual tumour, disease recurrence, disease progression and overall mortality (OM) rates.\u0000\u0000\u0000RESULTS\u0000Overall, 1510 patients with T1 high grade NMIBC at TURB were included in our analyses. Of these, 402 (26.6%) were statin users. At multivariable analysis, statin use was associated with a higher rates of high grade BC at re-TURB (OR: 1.37, 95%CI: 1.04-1.78; p=0.022), while at follow-up it was not independently associated with OM (HR: 0.71, 95%CI: 0.50-1.03; p=0.068) and disease progression rates (HR: 0.97, 95%CI: 0.79-1.19; p=0.753). Conversely, statin use has been shown to be independently associated with a lower risk of recurrence (HR:0.80, 95%CI: 0.67-0.95; p=0.009). The median recurrence-free survival was 47 (95%CI 40-49) months for those classified as non-statin users vs. 53 (95%CI 48-68) months in those classified as statin users.\u0000\u0000\u0000CONCLUSIONS\u0000Statin daily intake do not compromise oncological outcomes in high risk NMIBC patients treated with BCG. Moreover, statin may have a beneficial effect on recurrence rates in this cohort of patients.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82515217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.23736/S0393-2249.20.04032-1
C. Palumbo, A. Bruni, A. Antonelli, W. Artibani, P. Bassi, F. Bertoni, P. Borghetti, S. Bracarda, A. Cicchetti, R. Corvò, M. Gacci, G. Ingrosso, S. Magrini, M. Maruzzo, V. Mirone, R. Montironi, G. Muto, M. Noale, A. Porreca, E. Russi, L. Triggiani, A. Tubaro, R. Valdagni, S. Maggi, G. Conti
BACKGROUND This study analyzes patient health-related quality of life (QoL) 24-month after prostate cancer (PCa) diagnosis within the PROState cancer monitoring in ITaly from the National Research Council (Pros-IT CNR) study. METHODS Pros-IT CNR is an ongoing, longitudinal and observational study, considering a convenience sample of patients enrolled at PCa diagnosis and followed at 6, 12, 24, 36, 48 and 60 months from the diagnosis. Patients were grouped according to the treatment received: nerve sparing radical prostatectomy (NSRP), non-nerve sparing radical prostatectomy (NNSRP), radiotherapy (RT), radiotherapy plus androgen deprivation (RT plus ADT) and active surveillance (AS). QoL was measured through the Italian versions of SF-12 and UCLA-PCI questionnaires at diagnosis and at 6-12 and 24-month. The minimal clinically important difference (MCID) was defined as half a standard deviation of the baseline domain. RESULTS Overall, 1 537 patients were included in the study. The decline in urinary function exceeded the MCID at each timepoint only in the NSRP and NNSRP groups (at 24 months -14.7, p<0.001 and - 19.7, p<0.001, respectively). The decline in bowel function exceeded the MCID only in the RT (-9.1, p=0.02) and RT plus ADT groups at 12 months (-10.3, p=0.001); after 24 months, most patients seem to recover their bowel complaints. The decline in sexual function exceeded the MCID at each timepoint in the NNSRP, NSRP and RT plus ADT groups (at 6 months -28.7, p<0.001, -37.8, p<0.001, -20.4, p<0.001, respectively). CONCLUSIONS Although all the treatments were relatively well-tolerated over the 24 month period following PCa diagnosis, each had a different impact on QoL.
背景:本研究分析意大利国家研究委员会(pro - it CNR)研究中前列腺癌监测诊断后24个月患者健康相关生活质量(QoL)。方法sppro - it CNR是一项持续的、纵向的观察性研究，考虑了在PCa诊断时登记的患者样本，并在诊断后6、12、24、36、48和60个月进行随访。根据患者接受的治疗方法进行分组:保留神经根治性前列腺切除术(NSRP)、不保留神经根治性前列腺切除术(NNSRP)、放疗(RT)、放疗加雄激素剥夺(RT + ADT)和主动监测(AS)。生活质量在诊断时、6-12个月和24个月时通过意大利语版SF-12和UCLA-PCI问卷进行测量。最小临床重要差异(MCID)定义为基线域的一半标准差。结果共纳入1537例患者。只有NSRP组和NNSRP组在每个时间点的泌尿功能下降超过了MCID(在24个月时分别为-14.7,p<0.001和- 19.7,p<0.001)。12个月时，仅RT组(-9.1,p=0.02)和RT + ADT组(-10.3,p=0.001)肠道功能下降超过MCID;24个月后，大多数患者似乎恢复了他们的肠道疾病。NNSRP组、NSRP组和RT + ADT组的性功能下降在各时间点均超过MCID(6个月时分别为-28.7,p<0.001， -37.8, p<0.001， -20.4, p<0.001)。结论在前列腺癌诊断后的24个月期间，虽然所有治疗方法的耐受性都相对较好，但每种治疗方法对生活质量的影响不同。
{"title":"Health-related quality of life 24-month after prostate cancer diagnosis: an update from the Pros-IT CNR prospective observational study.","authors":"C. Palumbo, A. Bruni, A. Antonelli, W. Artibani, P. Bassi, F. Bertoni, P. Borghetti, S. Bracarda, A. Cicchetti, R. Corvò, M. Gacci, G. Ingrosso, S. Magrini, M. Maruzzo, V. Mirone, R. Montironi, G. Muto, M. Noale, A. Porreca, E. Russi, L. Triggiani, A. Tubaro, R. Valdagni, S. Maggi, G. Conti","doi":"10.23736/S0393-2249.20.04032-1","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04032-1","url":null,"abstract":"BACKGROUND\u0000This study analyzes patient health-related quality of life (QoL) 24-month after prostate cancer (PCa) diagnosis within the PROState cancer monitoring in ITaly from the National Research Council (Pros-IT CNR) study.\u0000\u0000\u0000METHODS\u0000Pros-IT CNR is an ongoing, longitudinal and observational study, considering a convenience sample of patients enrolled at PCa diagnosis and followed at 6, 12, 24, 36, 48 and 60 months from the diagnosis. Patients were grouped according to the treatment received: nerve sparing radical prostatectomy (NSRP), non-nerve sparing radical prostatectomy (NNSRP), radiotherapy (RT), radiotherapy plus androgen deprivation (RT plus ADT) and active surveillance (AS). QoL was measured through the Italian versions of SF-12 and UCLA-PCI questionnaires at diagnosis and at 6-12 and 24-month. The minimal clinically important difference (MCID) was defined as half a standard deviation of the baseline domain.\u0000\u0000\u0000RESULTS\u0000Overall, 1 537 patients were included in the study. The decline in urinary function exceeded the MCID at each timepoint only in the NSRP and NNSRP groups (at 24 months -14.7, p<0.001 and - 19.7, p<0.001, respectively). The decline in bowel function exceeded the MCID only in the RT (-9.1, p=0.02) and RT plus ADT groups at 12 months (-10.3, p=0.001); after 24 months, most patients seem to recover their bowel complaints. The decline in sexual function exceeded the MCID at each timepoint in the NNSRP, NSRP and RT plus ADT groups (at 6 months -28.7, p<0.001, -37.8, p<0.001, -20.4, p<0.001, respectively).\u0000\u0000\u0000CONCLUSIONS\u0000Although all the treatments were relatively well-tolerated over the 24 month period following PCa diagnosis, each had a different impact on QoL.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79900112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.23736/S0393-2249.20.04125-9
Nassib F. Abou Heidar, Muhieddine Labban, Jad A. Najdi, Anwar Al Shami, Oussama G. Nasrallah, R. Nasr
BACKGROUND Ureteral stones pose a high economic and medical burden among Emergency Department (ED) admissions. Management strategies vary from expectant therapy to surgical interventions. Since predictors of ureteral spontaneous stone passage (SSP) are still not well understood, we sought to create a novel nomogram to guide management decisions. METHODS Charts were retrospectively reviewed for patients who presented to our institution's ED with non-febrile renal colic and received a radiological diagnosis of ureteral stone ≤10 mm. Demographic, clinical, laboratory, and non-contrast CT data were collected. This novel nomogram incorporates the serum neutrophil-to-lymphocyte ratio (NLR) as a potential predictor of SSP. The model was derived from a multivariate logistic regression and was validated on a different cohort. A receiver operator characteristic (ROC) curve was constructed and the area under the curve (AUC) was computed. RESULTS A total of 1186 patients presented to our ED between January 2010 and October 2018. We randomly divided our population into a derivation and validation cohort in one to five ratio. A stone size ≥ 7 mm was the strongest predictor of SSP failure; OR=9.47; 95%CI (6.03-14.88). Similarly, a NLR ≥ 3.14 had 2.17; (1.58-2.98) the odds of retained stone. SSP failure was also correlated with proximal position, severe hydronephrosis, and leukocyte esterase ≥ 75, p=0.02, p=0.05, and p=0.006, respectively. The model had an AUC of 0.804 (0.776-0.832). The nomogram was also used to compute the risk of SSP failure (AUC 0.769 (0.709 - 0.829). CONCLUSIONS Our novel nomogram can be used as a predictor for SSP and can be used clinically in decision making.
{"title":"Spontaneous ureteral stone passage: a novel and comprehensive nomogram.","authors":"Nassib F. Abou Heidar, Muhieddine Labban, Jad A. Najdi, Anwar Al Shami, Oussama G. Nasrallah, R. Nasr","doi":"10.23736/S0393-2249.20.04125-9","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04125-9","url":null,"abstract":"BACKGROUND\u0000Ureteral stones pose a high economic and medical burden among Emergency Department (ED) admissions. Management strategies vary from expectant therapy to surgical interventions. Since predictors of ureteral spontaneous stone passage (SSP) are still not well understood, we sought to create a novel nomogram to guide management decisions.\u0000\u0000\u0000METHODS\u0000Charts were retrospectively reviewed for patients who presented to our institution's ED with non-febrile renal colic and received a radiological diagnosis of ureteral stone ≤10 mm. Demographic, clinical, laboratory, and non-contrast CT data were collected. This novel nomogram incorporates the serum neutrophil-to-lymphocyte ratio (NLR) as a potential predictor of SSP. The model was derived from a multivariate logistic regression and was validated on a different cohort. A receiver operator characteristic (ROC) curve was constructed and the area under the curve (AUC) was computed.\u0000\u0000\u0000RESULTS\u0000A total of 1186 patients presented to our ED between January 2010 and October 2018. We randomly divided our population into a derivation and validation cohort in one to five ratio. A stone size ≥ 7 mm was the strongest predictor of SSP failure; OR=9.47; 95%CI (6.03-14.88). Similarly, a NLR ≥ 3.14 had 2.17; (1.58-2.98) the odds of retained stone. SSP failure was also correlated with proximal position, severe hydronephrosis, and leukocyte esterase ≥ 75, p=0.02, p=0.05, and p=0.006, respectively. The model had an AUC of 0.804 (0.776-0.832). The nomogram was also used to compute the risk of SSP failure (AUC 0.769 (0.709 - 0.829).\u0000\u0000\u0000CONCLUSIONS\u0000Our novel nomogram can be used as a predictor for SSP and can be used clinically in decision making.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79194821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.23736/S0393-2249.20.04160-0
G. Marra, M. P. Laguna, J. Walz, C. Pavlovich, F. Bianco, J. Gregg, A. Lebastchi, H. Lepor, P. Macek, S. Rais-Bahrami, C. Robertson, D. Rukstalis, G. Salomon, O. Ukimura, A. Abreu, Y. Barbe, X. Cathelineau, G. Gandaglia, A. George, J. Rivas, Rajan T Gupta, N. Lawrentschuk, V. Kasivisvanathan, D. Lomas, B. Malavaud, D. Margolis, Y. Matsuoka, S. Mehralivand, M. Moschini, M. Oderda, H. Orabi, A. Rastinehad, M. Remzi, A. Schulman, T. Shin, T. Shiraishi, A. Sidana, S. Shoji, A. Stabile, M. Valerio, V. Tammisetti, Wei Phin Tan*, W. van den Bos, A. Villers, Peter Willemse, J. J. de la Rosette, T. Polascik, R. Sanchez-Salas
BACKGROUND Focal Therapy (FT) for Prostate Cancer (PCa) is promising. However, long-term oncological results are awaited and there is no consensus on follow-up strategies. Molecular biomarkers (MB) may be useful in selecting, treating and following up men undergoing FT, though there is limited evidence in this field to guide practice. We aimed to conduct a consensus meeting, endorsed by the Focal Therapy Society, amongst a large group of experts, to understand the potential utility of MB in FT for localised PCa. MATERIALS AND METHODS A 38-item questionnaire was built following a literature search. The authors then performed three rounds of a Delphi Consensus using DelphiManager, using the GRADE grid scoring system, followed by a face-to-face expert meeting. Three areas of interest were identified and covered concerning MB for FT, i) the current/present role; ii) the potential/future role; iii) the recommended features for future studies. Consensus was defined using a 70% agreement threshold. RESULTS Of 95 invited experts, 42 (44.2%) completed the three Delphi rounds. Twenty-four items reached a consensus and they were then approved at the meeting involving (n=15) experts. Fourteen items reached a consensus on uncertainty, or they did not reach a consensus. They were re-discussed, resulting in a consensus (n=3), a consensus on a partial agreement (n=1), and a consensus on uncertainty (n=10). A final list of statements were derived from the approved and discussed items, with the addition of three generated statements, to provide guidance regarding MB in the context of FT for localised PCa. Research efforts in this field should be considered a priority. CONCLUSIONS The present study detailed an initial consensus on the use of MB in FT for PCa. This is until evidence becomes available on the subject.
{"title":"Molecular biomarkers in the context of focal therapy for prostate cancer: recommendations of a Delphi Consensus from the Focal Therapy Society.","authors":"G. Marra, M. P. Laguna, J. Walz, C. Pavlovich, F. Bianco, J. Gregg, A. Lebastchi, H. Lepor, P. Macek, S. Rais-Bahrami, C. Robertson, D. Rukstalis, G. Salomon, O. Ukimura, A. Abreu, Y. Barbe, X. Cathelineau, G. Gandaglia, A. George, J. Rivas, Rajan T Gupta, N. Lawrentschuk, V. Kasivisvanathan, D. Lomas, B. Malavaud, D. Margolis, Y. Matsuoka, S. Mehralivand, M. Moschini, M. Oderda, H. Orabi, A. Rastinehad, M. Remzi, A. Schulman, T. Shin, T. Shiraishi, A. Sidana, S. Shoji, A. Stabile, M. Valerio, V. Tammisetti, Wei Phin Tan*, W. van den Bos, A. Villers, Peter Willemse, J. J. de la Rosette, T. Polascik, R. Sanchez-Salas","doi":"10.23736/S0393-2249.20.04160-0","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04160-0","url":null,"abstract":"BACKGROUND\u0000Focal Therapy (FT) for Prostate Cancer (PCa) is promising. However, long-term oncological results are awaited and there is no consensus on follow-up strategies. Molecular biomarkers (MB) may be useful in selecting, treating and following up men undergoing FT, though there is limited evidence in this field to guide practice. We aimed to conduct a consensus meeting, endorsed by the Focal Therapy Society, amongst a large group of experts, to understand the potential utility of MB in FT for localised PCa.\u0000\u0000\u0000MATERIALS AND METHODS\u0000A 38-item questionnaire was built following a literature search. The authors then performed three rounds of a Delphi Consensus using DelphiManager, using the GRADE grid scoring system, followed by a face-to-face expert meeting. Three areas of interest were identified and covered concerning MB for FT, i) the current/present role; ii) the potential/future role; iii) the recommended features for future studies. Consensus was defined using a 70% agreement threshold.\u0000\u0000\u0000RESULTS\u0000Of 95 invited experts, 42 (44.2%) completed the three Delphi rounds. Twenty-four items reached a consensus and they were then approved at the meeting involving (n=15) experts. Fourteen items reached a consensus on uncertainty, or they did not reach a consensus. They were re-discussed, resulting in a consensus (n=3), a consensus on a partial agreement (n=1), and a consensus on uncertainty (n=10). A final list of statements were derived from the approved and discussed items, with the addition of three generated statements, to provide guidance regarding MB in the context of FT for localised PCa. Research efforts in this field should be considered a priority.\u0000\u0000\u0000CONCLUSIONS\u0000The present study detailed an initial consensus on the use of MB in FT for PCa. This is until evidence becomes available on the subject.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73540314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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