Pub Date : 2020-11-17DOI: 10.23736/S0393-2249.20.04052-7
N. Vuong, J. Ferrière, C. Michiels, L. Calen, L. Tesi, G. Capon, H. Bensadoun, E. Alezra, V. Estrade, G. Robert, F. Bladou, J. Bernhard
BACKGROUND To assess the feasibility of Robot-assisted Radical nephrectomy with Inferior Vena Cava Thrombectomy (RRVCT) and compare peri operative and oncological outcomes of this approach to open surgery for renal tumors with Level 1-2 Inferior Vena Cava (IVC) Thrombus. METHODS We performed a retrospective analysis of patients surgically treated for renal cancer with IVC level 1-2 thrombus in the Urology department of Bordeaux University Hospital between December 2015 and December 2019. Patients were stratified by surgical approach in two groups : open vs robotic procedures. Pre, per and post-operative data were collected within the framework of the UroCCR project (NCT03293563). Univariate and multivariate analysis using regression models were performed. RESULTS A total of 40 patients underwent Radical Nephrectomy (RN) with IVC tumor thrombus. Open and robotic surgery represented respectively 30 and 10 cases. The two groups were comparable regarding pre-operative tumor and patient characteristics. Robotic procedures were associated with lower Estimated Blood Loss (EBL) (500 vs. 1250mL, p = 0.02), shorter Intensive Care Unit stay (2 vs. 4 days, p = 0.03) and decrease of global Length Of Stay (LOS) (7 vs. 10 days, p < 0.01). Operative Time (OT) was significantly longer in the robotic group (350.5 vs. 208 min, p < 0.01). No difference were observed between the two approaches regarding complications and oncological outcomes. CONCLUSIONS Robotic approach induced lower bleeding and shorter LOS but required longer OT. This technique is feasible and safe for selected cases and experimented surgical team. Complications rate and oncological outcomes are not different compared to standard open procedures.
目的:评估机器人辅助根治性肾切除术联合下腔静脉血栓切除术(RRVCT)的可行性，并比较该方法与伴有1-2级下腔静脉血栓的肾肿瘤开放手术的围手术期和肿瘤预后。方法回顾性分析2015年12月至2019年12月在波尔多大学医院泌尿外科手术治疗的伴有IVC 1-2级血栓的肾癌患者。患者按手术入路分为两组:开放手术和机器人手术。术前、术中和术后数据在UroCCR项目(NCT03293563)框架内收集。采用回归模型进行单因素和多因素分析。结果40例伴有下腔静脉肿瘤血栓的患者行根治性肾切除术。开放手术30例，机器人手术10例。两组在术前肿瘤和患者特征方面具有可比性。机器人手术与较低的估计失血量(EBL)(500对1250mL, p = 0.02)、较短的重症监护病房住院时间(2天对4天，p = 0.03)和减少的总住院时间(LOS)(7天对10天，p < 0.01)相关。机器人组手术时间(OT)明显长于机器人组(350.5 min vs. 208 min, p < 0.01)。两种方法在并发症和肿瘤预后方面没有观察到差异。结论机器人入路出血少，术后LOS短，但手术时间较长。该技术在特定病例和实验外科团队中是可行和安全的。与标准开放手术相比，并发症发生率和肿瘤预后没有差异。
{"title":"Robot-assisted versus open surgery for radical nephrectomy with level 1-2 vena cava tumor thrombectomy : a French monocenter experience (UroCCR study #73).","authors":"N. Vuong, J. Ferrière, C. Michiels, L. Calen, L. Tesi, G. Capon, H. Bensadoun, E. Alezra, V. Estrade, G. Robert, F. Bladou, J. Bernhard","doi":"10.23736/S0393-2249.20.04052-7","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04052-7","url":null,"abstract":"BACKGROUND\u0000To assess the feasibility of Robot-assisted Radical nephrectomy with Inferior Vena Cava Thrombectomy (RRVCT) and compare peri operative and oncological outcomes of this approach to open surgery for renal tumors with Level 1-2 Inferior Vena Cava (IVC) Thrombus.\u0000\u0000\u0000METHODS\u0000We performed a retrospective analysis of patients surgically treated for renal cancer with IVC level 1-2 thrombus in the Urology department of Bordeaux University Hospital between December 2015 and December 2019. Patients were stratified by surgical approach in two groups : open vs robotic procedures. Pre, per and post-operative data were collected within the framework of the UroCCR project (NCT03293563). Univariate and multivariate analysis using regression models were performed.\u0000\u0000\u0000RESULTS\u0000A total of 40 patients underwent Radical Nephrectomy (RN) with IVC tumor thrombus. Open and robotic surgery represented respectively 30 and 10 cases. The two groups were comparable regarding pre-operative tumor and patient characteristics. Robotic procedures were associated with lower Estimated Blood Loss (EBL) (500 vs. 1250mL, p = 0.02), shorter Intensive Care Unit stay (2 vs. 4 days, p = 0.03) and decrease of global Length Of Stay (LOS) (7 vs. 10 days, p < 0.01). Operative Time (OT) was significantly longer in the robotic group (350.5 vs. 208 min, p < 0.01). No difference were observed between the two approaches regarding complications and oncological outcomes.\u0000\u0000\u0000CONCLUSIONS\u0000Robotic approach induced lower bleeding and shorter LOS but required longer OT. This technique is feasible and safe for selected cases and experimented surgical team. Complications rate and oncological outcomes are not different compared to standard open procedures.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89590081","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 : 2020-11-17DOI: 10.23736/S0393-2249.20.04073-4
V. Ficarra, S. Caloggero, M. Rossanese, G. Giannarini, A. Crestani, G. Ascenti, G. Novara, F. Porpiglia
PURPOSE To identify and standardize computed tomography (CT) features having a potential role in predicting aggressiveness of malignant parenchymal renal tumors suitable for partial nephrectomy (PN). METHODS We performed a non-systematic review of the recent literature to evaluate the potential impact of CT variables proposed by the Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma in predicting aggressiveness of newly diagnosed malignant parenchymal renal tumors. Variables were: clinical tumor size, tumor growth rate, enhancement characteristics, amount of cystic component, polar and capsular location, tumor margins, and distance between tumor and renal sinus. Unfavorable behavior was defined as: 1) renal cell carcinoma (RCC) with stage ≥ pT3; 2) nuclear grade 3 or 4; 3) presence of sarcomatoid de-differentiation; or 4) non-clear cell subtypes with unfavorable prognosis (type 2 papillary RCC, collecting duct or renal medullary carcinoma, unclassified RCC). RESULTS Beyond clinical tumor size, tumor growth rate, enhancement characteristics, amount of cystic component, tumor margins and distance between tumor and renal sinus are highly relevant features predicting an unfavorable behavior. Moreover, several studies supported the role of necrosis as preoperative predictor of tumor aggressiveness. Peritumoral and intratumoral vasculature as well as capsule status are emerging variables that need to be further evaluated. CONCLUSIONS Tumor size, enhancement characteristics, tumor margins and distance to the renal sinus are highly relevant CT features predicting biological aggressiveness of malignant parenchymal renal tumors. Combination of these parameters might be useful to generate tools to predict the unfavorable behavior of renal tumors suitable for PN.
{"title":"Computed tomography features predicting aggressiveness of malignant parenchymal renal tumors suitable for partial nephrectomy: a review.","authors":"V. Ficarra, S. Caloggero, M. Rossanese, G. Giannarini, A. Crestani, G. Ascenti, G. Novara, F. Porpiglia","doi":"10.23736/S0393-2249.20.04073-4","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04073-4","url":null,"abstract":"PURPOSE\u0000To identify and standardize computed tomography (CT) features having a potential role in predicting aggressiveness of malignant parenchymal renal tumors suitable for partial nephrectomy (PN).\u0000\u0000\u0000METHODS\u0000We performed a non-systematic review of the recent literature to evaluate the potential impact of CT variables proposed by the Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma in predicting aggressiveness of newly diagnosed malignant parenchymal renal tumors. Variables were: clinical tumor size, tumor growth rate, enhancement characteristics, amount of cystic component, polar and capsular location, tumor margins, and distance between tumor and renal sinus. Unfavorable behavior was defined as: 1) renal cell carcinoma (RCC) with stage ≥ pT3; 2) nuclear grade 3 or 4; 3) presence of sarcomatoid de-differentiation; or 4) non-clear cell subtypes with unfavorable prognosis (type 2 papillary RCC, collecting duct or renal medullary carcinoma, unclassified RCC).\u0000\u0000\u0000RESULTS\u0000Beyond clinical tumor size, tumor growth rate, enhancement characteristics, amount of cystic component, tumor margins and distance between tumor and renal sinus are highly relevant features predicting an unfavorable behavior. Moreover, several studies supported the role of necrosis as preoperative predictor of tumor aggressiveness. Peritumoral and intratumoral vasculature as well as capsule status are emerging variables that need to be further evaluated.\u0000\u0000\u0000CONCLUSIONS\u0000Tumor size, enhancement characteristics, tumor margins and distance to the renal sinus are highly relevant CT features predicting biological aggressiveness of malignant parenchymal renal tumors. Combination of these parameters might be useful to generate tools to predict the unfavorable behavior of renal tumors suitable for PN.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84968002","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 : 2020-11-17DOI: 10.23736/S0393-2249.20.03992-2
C. de Nunzio, S. Giglio, V. Baldassarri, R. Cirombella, G. Mallel, A. Nacchia, A. Tubaro, A. Vecchione
BACKGROUND Aim of this study was to evaluate the roles of inflammation and autophagy in obese patients with Benign prostatic Hyperplasia (BPH) and Lower Urinary Tract Symptoms (LUTS). METHODS We analyzed 150 surgical specimens from patients underwent Transurethral Resection of the Prostate (TURP) for LUTS/BPH (Median age 70.3±8.1 years, Median BMI 25.7±4.0 kg/m2 and median PSA 6.0±5.4 ng/ml). All surgical specimens were investigated for the presence inflammatory infiltrates, according to the standardized classification of chronic prostatitis of the National Institute of Health. The Inflammatory Score (IS Score) was calculated. High IS score was defined as ≥7. Each sample was stained for anti-LC3B (cell signalling) and for anti-P62/SQSTM1 (MBL) according to manufacturer's suggestions and scored as follow: 0=No dots; 1=detectable dots in 5-25% of cells; 2=readily detectable dots in 25-75% of cells; 3=dots in >75% of cells. High percentage of p62 or LC3B was defined as >25%, whereas low percentage of p62 or LC3B was defined as <25% of cells with dots. RESULTS Overall 74/150 (49.3%) patients were overweight or obese (BMI >25 kg/m2). Obese patients presented a higher inflammatory score. Obese/overweight patients presented a lower percentage of LC3B (58/74; 78.4%) and higher of p62 (49/74; 66.2%) compared to those of normal weight, which it means a deactivated autophagy (p<0.05). At multivariate analysis LC3B (OR: 0.22; CI: 0.069-0.70; p=: 0.01) percentage and BMI (OR:1.118;CI: 1.001-1.250; p=: 0.04) were independent risk factors of prostatic inflammation (IS ≥ 7). CONCLUSIONS Here we confirm the association between obesity and prostatic inflammatory infiltrates and present the first evidence of autophagy deregulation in obese patients with LUTS/BPH. Further studies should better investigate this relationship and provide new possible therapeutic targets.
{"title":"Impairment of autophagy may represent the molecular mechanism behind the relationship between obesity and inflammation in patients with BPH and LUTS.","authors":"C. de Nunzio, S. Giglio, V. Baldassarri, R. Cirombella, G. Mallel, A. Nacchia, A. Tubaro, A. Vecchione","doi":"10.23736/S0393-2249.20.03992-2","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.03992-2","url":null,"abstract":"BACKGROUND\u0000Aim of this study was to evaluate the roles of inflammation and autophagy in obese patients with Benign prostatic Hyperplasia (BPH) and Lower Urinary Tract Symptoms (LUTS).\u0000\u0000\u0000METHODS\u0000We analyzed 150 surgical specimens from patients underwent Transurethral Resection of the Prostate (TURP) for LUTS/BPH (Median age 70.3±8.1 years, Median BMI 25.7±4.0 kg/m2 and median PSA 6.0±5.4 ng/ml). All surgical specimens were investigated for the presence inflammatory infiltrates, according to the standardized classification of chronic prostatitis of the National Institute of Health. The Inflammatory Score (IS Score) was calculated. High IS score was defined as ≥7. Each sample was stained for anti-LC3B (cell signalling) and for anti-P62/SQSTM1 (MBL) according to manufacturer's suggestions and scored as follow: 0=No dots; 1=detectable dots in 5-25% of cells; 2=readily detectable dots in 25-75% of cells; 3=dots in >75% of cells. High percentage of p62 or LC3B was defined as >25%, whereas low percentage of p62 or LC3B was defined as <25% of cells with dots.\u0000\u0000\u0000RESULTS\u0000Overall 74/150 (49.3%) patients were overweight or obese (BMI >25 kg/m2). Obese patients presented a higher inflammatory score. Obese/overweight patients presented a lower percentage of LC3B (58/74; 78.4%) and higher of p62 (49/74; 66.2%) compared to those of normal weight, which it means a deactivated autophagy (p<0.05). At multivariate analysis LC3B (OR: 0.22; CI: 0.069-0.70; p=: 0.01) percentage and BMI (OR:1.118;CI: 1.001-1.250; p=: 0.04) were independent risk factors of prostatic inflammation (IS ≥ 7).\u0000\u0000\u0000CONCLUSIONS\u0000Here we confirm the association between obesity and prostatic inflammatory infiltrates and present the first evidence of autophagy deregulation in obese patients with LUTS/BPH. Further studies should better investigate this relationship and provide new possible therapeutic targets.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88143447","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 : 2020-11-17DOI: 10.23736/S0393-2249.20.04043-6
A. Fuschi, Y. Al salhi, G. Velotti, L. Capone, A. Martoccia, P. P. Suraci, S. Scalzo, F. Annino, S. Khorrami, A. Asimakopoulos, Giorgio Bozzini, M. Falsaperla, Antonio Carbone, A. Pastore
BACKGROUND The aim of this study was to compare the perioperative and functional results between laparoscopic and robot-assisted simple prostatectomy (LSP and RASP) and Holmium laser enucleation of prostate (HoLEP) in prostate volumes ≥ 120 ml. The primary endpoint was to investigate and compare minimally invasive techniques in the management of large prostate gland volume, and the secondary endpoint was to evaluate the frequency and type of postoperative complications according to Clavien Dindo classification. METHODS This multicentre study was conducted on male patients with LUTS associated with BPO candidates for surgical treatment. The surgery approach choice in relation to the prostatic volume ≥ 120 ml was HoLEP or minimally invasive simple prostatectomy (LSP or RASP). All patients were prospectively randomized into three groups, according to a simple computed randomization: HoLEP, LSP and RASP groups. During the follow-up, all patients underwent post-operative control at 1, 3, 6, 12 and 24 months from the surgical procedure. RESULTS 110 male patients were randomized in three homogeneous groups: 36 in LSP, 32 in RASP and 42 in HoLEP group. During the follow-up (mean 26.15 months), despite the significant improvement compared to baseline results, no significant differences were shown, between the groups in terms of functional and perioperative outcomes. The only statistically significant data was reported for catheterization time, that resulted longer in the LSP group than RASP and HoLEP groups (p value: 0.002). Furthermore, MISP resulted in longer hospitalization, and lower rate of patients with new-onset irritative symptoms. CONCLUSIONS This prospective randomized study is the first to compare extraperitoneal LSP, RASP and HoLEP in the treatment of LUTS secondary to benign prostatic hyperplasia for prostate volumes ≥ 120 ml. Our findings confirm the safety and efficacy of MISP, demonstrating its equivalence in functional outcomes and perioperative morbidity in comparison to HoLEP.
{"title":"Holmium laser enucleation of prostate versus minimally invasive simple prostatectomy for large volume (≥ 120 ml) prostate glands: a prospective multicenter randomized study.","authors":"A. Fuschi, Y. Al salhi, G. Velotti, L. Capone, A. Martoccia, P. P. Suraci, S. Scalzo, F. Annino, S. Khorrami, A. Asimakopoulos, Giorgio Bozzini, M. Falsaperla, Antonio Carbone, A. Pastore","doi":"10.23736/S0393-2249.20.04043-6","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04043-6","url":null,"abstract":"BACKGROUND\u0000The aim of this study was to compare the perioperative and functional results between laparoscopic and robot-assisted simple prostatectomy (LSP and RASP) and Holmium laser enucleation of prostate (HoLEP) in prostate volumes ≥ 120 ml. The primary endpoint was to investigate and compare minimally invasive techniques in the management of large prostate gland volume, and the secondary endpoint was to evaluate the frequency and type of postoperative complications according to Clavien Dindo classification.\u0000\u0000\u0000METHODS\u0000This multicentre study was conducted on male patients with LUTS associated with BPO candidates for surgical treatment. The surgery approach choice in relation to the prostatic volume ≥ 120 ml was HoLEP or minimally invasive simple prostatectomy (LSP or RASP). All patients were prospectively randomized into three groups, according to a simple computed randomization: HoLEP, LSP and RASP groups. During the follow-up, all patients underwent post-operative control at 1, 3, 6, 12 and 24 months from the surgical procedure.\u0000\u0000\u0000RESULTS\u0000110 male patients were randomized in three homogeneous groups: 36 in LSP, 32 in RASP and 42 in HoLEP group. During the follow-up (mean 26.15 months), despite the significant improvement compared to baseline results, no significant differences were shown, between the groups in terms of functional and perioperative outcomes. The only statistically significant data was reported for catheterization time, that resulted longer in the LSP group than RASP and HoLEP groups (p value: 0.002). Furthermore, MISP resulted in longer hospitalization, and lower rate of patients with new-onset irritative symptoms.\u0000\u0000\u0000CONCLUSIONS\u0000This prospective randomized study is the first to compare extraperitoneal LSP, RASP and HoLEP in the treatment of LUTS secondary to benign prostatic hyperplasia for prostate volumes ≥ 120 ml. Our findings confirm the safety and efficacy of MISP, demonstrating its equivalence in functional outcomes and perioperative morbidity in comparison to HoLEP.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86094702","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 : 2020-11-17DOI: 10.23736/S0393-2249.20.04151-X
U. Carbonara, G. Simone, U. Capitanio, A. Minervini, C. Fiori, A. Larcher, E. Checcucci, D. Amparore, F. Crocerossa, A. Veccia, S. Weprin, P. Ditonno, A. Brassetti, A. Bove, A. Mari, A. Grosso, M. Carini, F. Montorsi, L. Hampton, M. Gallucci, F. Porpiglia, R. Autorino
BACKGROUND The role of robot-assisted partial nephrectomy (RAPN) in the management of renal masses has exponentially grown over the past 10 years. Nevertheless, data on long term outcomes of the procedure remains limited. Herein we report oncological and functional outcomes of patients who underwent RAPN for a malignant mass with a median follow-up of 7-yr, the longest follow-up to date. METHODS A retrospective analysis of an international multicenter database was performed. All consecutive patients undergoing surgery between 2009 and 2013 with a minimum of 3-yr follow-up and complete data on renal function were included. Demographics, surgical and perioperative outcomes were analyzed. Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analysis. RESULTS Overall, our study cohort was composed of eighty-five patients with a median follow-up of 88mo. Median clinical tumor size was 3cm, with mostly (74.1%) clinical stage T1a, and median R.E.N.A.L. score 6. Final histopathologic analysis revealed clear cell RCC in 76.5% of cases. PSM was present in 7 patients (8.2%). Eleven overall deaths (12.9%) occurred in the cohort during the follow-up period. Two of these (2.33%) were attributed to metastatic RCC. The OS, CSS, and DFS rates were 91.7, 97.7, and 91.7% at 84mo, respectively. Regarding the renal functional outcomes, seventeen patients (20.1%) presented a CKD upstaging in our cohort. CONCLUSIONS Our findings show excellent 7-year oncologic and functional outcomes of the procedure, which duplicate those achieved in historical series of open and laparoscopic surgery.
{"title":"Robot-assisted partial nephrectomy: 7-year outcomes.","authors":"U. Carbonara, G. Simone, U. Capitanio, A. Minervini, C. Fiori, A. Larcher, E. Checcucci, D. Amparore, F. Crocerossa, A. Veccia, S. Weprin, P. Ditonno, A. Brassetti, A. Bove, A. Mari, A. Grosso, M. Carini, F. Montorsi, L. Hampton, M. Gallucci, F. Porpiglia, R. Autorino","doi":"10.23736/S0393-2249.20.04151-X","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04151-X","url":null,"abstract":"BACKGROUND\u0000The role of robot-assisted partial nephrectomy (RAPN) in the management of renal masses has exponentially grown over the past 10 years. Nevertheless, data on long term outcomes of the procedure remains limited. Herein we report oncological and functional outcomes of patients who underwent RAPN for a malignant mass with a median follow-up of 7-yr, the longest follow-up to date.\u0000\u0000\u0000METHODS\u0000A retrospective analysis of an international multicenter database was performed. All consecutive patients undergoing surgery between 2009 and 2013 with a minimum of 3-yr follow-up and complete data on renal function were included. Demographics, surgical and perioperative outcomes were analyzed. Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analysis.\u0000\u0000\u0000RESULTS\u0000Overall, our study cohort was composed of eighty-five patients with a median follow-up of 88mo. Median clinical tumor size was 3cm, with mostly (74.1%) clinical stage T1a, and median R.E.N.A.L. score 6. Final histopathologic analysis revealed clear cell RCC in 76.5% of cases. PSM was present in 7 patients (8.2%). Eleven overall deaths (12.9%) occurred in the cohort during the follow-up period. Two of these (2.33%) were attributed to metastatic RCC. The OS, CSS, and DFS rates were 91.7, 97.7, and 91.7% at 84mo, respectively. Regarding the renal functional outcomes, seventeen patients (20.1%) presented a CKD upstaging in our cohort.\u0000\u0000\u0000CONCLUSIONS\u0000Our findings show excellent 7-year oncologic and functional outcomes of the procedure, which duplicate those achieved in historical series of open and laparoscopic surgery.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87404713","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 : 2020-11-17DOI: 10.23736/S0393-2249.20.04061-8
D. Memmos, I. Mykoniatis, P. Sountoulides, A. Anastasiadis, N. Pyrgidis, F. Greco, L. Cindolo, D. Hatzichristou, E. Liatsikos, P. Kallidonis
INTRODUCTION To evaluate the effect of antibiotic prophylaxis (AP) on asymptomatic bacteriuria (AB) and urinary tract infection (UTI) in patients with sterile urine undergoing ESWL. EVIDENCE ACQUISITION PubMed, Scopus, Web of Science and Cochrane Registry were searched systematically for randomized clinical trials assessing the effect of AP in patients with sterile urine undergoing SWL up to May 2020. Risk ratios were used to compare dichotomous outcomes. A stratified analysis was performed depending on the risk of bias assessment of the included studies. Subgroup analysis was performed in patients that underwent instrumentation of the urinary tract. EVIDENCE SYNTHESIS 16 studies were evaluated including 2442 patients. When evaluating all the included studies (regardless of the risk of bias assessment), the risk of AB was RR: 0.88, 95% CI:0.64-1.21, p=0.42 and the risk of UTI was RR: 0.55 95% CI: 0.22-1.36, p=0.19. When excluding the high risk of bias studies the risk for AB was RR: 0.9, 95% CI: 0.63-1.28, p=0.55 and for UTI RR: 1.18, 95% CI: 0.38-3.72, p=0.77. When evaluating patients that underwent instrumentation of the urinary tract the risk for AB was RR:0.92, 95% CI: 0.66-1.27, p=0.6 and for UTI was RR: 0.69, 95% CI: 0.22-2.22, p-0.54. CONCLUSIONS AP is not necessary for patients with sterile urine prior to ESWL for the prevention of UTI. Also, patients that undergo instrumentation of the urinary tract prior to or during ESWL do not benefit from antibiotic prophylaxis but further research is required.
{"title":"Evaluating the utility of antibiotic prophylaxis prior to ESWL in patients with sterile urine: a systematic review and meta-analysis.","authors":"D. Memmos, I. Mykoniatis, P. Sountoulides, A. Anastasiadis, N. Pyrgidis, F. Greco, L. Cindolo, D. Hatzichristou, E. Liatsikos, P. Kallidonis","doi":"10.23736/S0393-2249.20.04061-8","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04061-8","url":null,"abstract":"INTRODUCTION\u0000To evaluate the effect of antibiotic prophylaxis (AP) on asymptomatic bacteriuria (AB) and urinary tract infection (UTI) in patients with sterile urine undergoing ESWL.\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000PubMed, Scopus, Web of Science and Cochrane Registry were searched systematically for randomized clinical trials assessing the effect of AP in patients with sterile urine undergoing SWL up to May 2020. Risk ratios were used to compare dichotomous outcomes. A stratified analysis was performed depending on the risk of bias assessment of the included studies. Subgroup analysis was performed in patients that underwent instrumentation of the urinary tract.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u000016 studies were evaluated including 2442 patients. When evaluating all the included studies (regardless of the risk of bias assessment), the risk of AB was RR: 0.88, 95% CI:0.64-1.21, p=0.42 and the risk of UTI was RR: 0.55 95% CI: 0.22-1.36, p=0.19. When excluding the high risk of bias studies the risk for AB was RR: 0.9, 95% CI: 0.63-1.28, p=0.55 and for UTI RR: 1.18, 95% CI: 0.38-3.72, p=0.77. When evaluating patients that underwent instrumentation of the urinary tract the risk for AB was RR:0.92, 95% CI: 0.66-1.27, p=0.6 and for UTI was RR: 0.69, 95% CI: 0.22-2.22, p-0.54.\u0000\u0000\u0000CONCLUSIONS\u0000AP is not necessary for patients with sterile urine prior to ESWL for the prevention of UTI. Also, patients that undergo instrumentation of the urinary tract prior to or during ESWL do not benefit from antibiotic prophylaxis but further research is required.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79514498","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 : 2020-11-17DOI: 10.23736/S0393-2249.20.04146-6
E. Checcucci, A. Pecoraro, S. De Cillis, M. Manfredi, D. Amparore, R. Aimar, F. Piramide, S. Granato, G. Volpi, R. Autorino, C. Fiori, F. Porpiglia
INTRODUCTION Urinary incontinence is one of the most scared sequelae of robot assisted radical prostatectomy (RARP). Therefore, different surgical modifications, aimed to restore the original anatomy, were proposed to overcome this issue. The purpose of this study is to assess which is the best reconstruction technique (posterior only: PR; anterior only: AR; total: TR) compared to the standard approach for continence recovery after RARP in a tertiary care centre. EVIDENCE ACQUISITION After establishing an a priori protocol, a systematic electronic literature search was conducted in May 2019. The article selection proceeded in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and was registered (PROSPERO registry number 131667). The risk of bias and the quality assessment of the included studies were performed. Simple pooled analysis was performed for continence rates according to the definition of continence (0 pad vs. 0-1 pad) and the different types of reconstruction at 1, 4, 12, 24, 52 weeks after RARP. Complication rate, operative and console time and estimated blood loss were pooled. Two-side test of proportion and T-test were used to compare rates and mean, respectively. EVIDENCE SYNTHESIS Six studies meeting the inclusion criteria were found and included in the analysis. All the included studies were of "poor" or "good" quality. A high or moderate risk of bias was recorded. TR showed higher continence recovery rates, compared to their anterior reconstruction counterpart at 1, 4, 12, 24, 52 weeks (p <0.001 at all time-points). At 12 weeks TR showed the highest continence rates (p<0.001), followed by AR and PR. No statistically significant differences were recorded regarding anastomosis-related complication rates (anastomosis stricture p=0.08; urine leakage p=0.1). CONCLUSIONS In patients undergoing RARP, TR facilitates a faster and higher continence recovery compared to standard approach or PR or AR only.
{"title":"The importance of anatomical reconstruction for continence recovery after robot assisted radical prostatectomy: a systematic review and pooled analysis from referral centres.","authors":"E. Checcucci, A. Pecoraro, S. De Cillis, M. Manfredi, D. Amparore, R. Aimar, F. Piramide, S. Granato, G. Volpi, R. Autorino, C. Fiori, F. Porpiglia","doi":"10.23736/S0393-2249.20.04146-6","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04146-6","url":null,"abstract":"INTRODUCTION\u0000Urinary incontinence is one of the most scared sequelae of robot assisted radical prostatectomy (RARP). Therefore, different surgical modifications, aimed to restore the original anatomy, were proposed to overcome this issue. The purpose of this study is to assess which is the best reconstruction technique (posterior only: PR; anterior only: AR; total: TR) compared to the standard approach for continence recovery after RARP in a tertiary care centre.\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000After establishing an a priori protocol, a systematic electronic literature search was conducted in May 2019. The article selection proceeded in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and was registered (PROSPERO registry number 131667). The risk of bias and the quality assessment of the included studies were performed. Simple pooled analysis was performed for continence rates according to the definition of continence (0 pad vs. 0-1 pad) and the different types of reconstruction at 1, 4, 12, 24, 52 weeks after RARP. Complication rate, operative and console time and estimated blood loss were pooled. Two-side test of proportion and T-test were used to compare rates and mean, respectively.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u0000Six studies meeting the inclusion criteria were found and included in the analysis. All the included studies were of \"poor\" or \"good\" quality. A high or moderate risk of bias was recorded. TR showed higher continence recovery rates, compared to their anterior reconstruction counterpart at 1, 4, 12, 24, 52 weeks (p <0.001 at all time-points). At 12 weeks TR showed the highest continence rates (p<0.001), followed by AR and PR. No statistically significant differences were recorded regarding anastomosis-related complication rates (anastomosis stricture p=0.08; urine leakage p=0.1).\u0000\u0000\u0000CONCLUSIONS\u0000In patients undergoing RARP, TR facilitates a faster and higher continence recovery compared to standard approach or PR or AR only.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84840731","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 : 2020-11-17DOI: 10.23736/S0393-2249.20.04088-6
C. de Nunzio, O. Voglino, A. Cicione, G. Tema, L. Cindolo, M. Bada, R. Lombardo, A. Nacchia, A. Trucchi, L. Schips, M. Gacci, Martina Milanesi, G. Cito, S. Serni, A. Tubaro
BACKGROUND Alpha-blockers (ABs) are considered the standard treatment after initial management of acute urinary retention (AUR). However, no data are available on the predictors of a successful trial without catheter (TWOC) in patients previously on treatment with ABs and 5alpha reductase inhibitors (5ARI). Aim of our study was to investigate prostate ultrasound parameters as predictors of TWOC outcome. METHODS A consecutive series of patients, on treatment with ABs alone or in combination with 5ARI, experiencing AUR were prospectively enrolled. Clinical data (i.e.age, body mass index (BMI) and IPSS), urinary ultrasound features including hydronephrosis, prostate volume-TRUS, bladder wall thickness (BWT), intravesical prostatic protrusion more than 10mm (IPP≥10) were related to TWOC outcome performed seven days after AUR. A binary logistic regression analysis was computed to detect predictors of successful TWOC. RESULTS Overall,143 patients with a median age of 72 years (IQR 64-77) were enrolled. Seventy-mine patients (54%) with smaller prostate volume (59(IQR 52-74) Vs 99 (IQR 74-125) ml, p=0.008) and a thinner BWT (5(IQR 4.8-5.2) Vs 5.2 (4.7-5.5) mm p=0.001) recovered voiding at TWOC. IPP≥10 was less common in patients with successful TWOC 11(14%) vs 33(52%), p=0.001. On multivariate analysis, IPP<10mm (OR 6.10 (95%CI 2.61-14.20), p=0.001), lower IPSS (OR 0.95 (95%CI 0.89-0.99), p= 0.045), smaller TRUS (OR 0.96 (95%CI 0.95-0.97), p=0.001), thinner BWT OR 1.23 (95%CI 0.73-0,92) p=0.001were the independent predictors of voiding recovery. CONCLUSIONS Patients receiving medical treatment for BPH and experiencing AUR still present a 54% probability of a successful TWOC. Ultrasound may help to identify patients with successful TWOC.
{"title":"Ultrasound prostate parameters as predictors of successful trial without catheter after acute urinary retention in patients ongoing medical treatment for benign prostatic hyperplasia: a prospective multicenter study.","authors":"C. de Nunzio, O. Voglino, A. Cicione, G. Tema, L. Cindolo, M. Bada, R. Lombardo, A. Nacchia, A. Trucchi, L. Schips, M. Gacci, Martina Milanesi, G. Cito, S. Serni, A. Tubaro","doi":"10.23736/S0393-2249.20.04088-6","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04088-6","url":null,"abstract":"BACKGROUND\u0000Alpha-blockers (ABs) are considered the standard treatment after initial management of acute urinary retention (AUR). However, no data are available on the predictors of a successful trial without catheter (TWOC) in patients previously on treatment with ABs and 5alpha reductase inhibitors (5ARI). Aim of our study was to investigate prostate ultrasound parameters as predictors of TWOC outcome.\u0000\u0000\u0000METHODS\u0000A consecutive series of patients, on treatment with ABs alone or in combination with 5ARI, experiencing AUR were prospectively enrolled. Clinical data (i.e.age, body mass index (BMI) and IPSS), urinary ultrasound features including hydronephrosis, prostate volume-TRUS, bladder wall thickness (BWT), intravesical prostatic protrusion more than 10mm (IPP≥10) were related to TWOC outcome performed seven days after AUR. A binary logistic regression analysis was computed to detect predictors of successful TWOC.\u0000\u0000\u0000RESULTS\u0000Overall,143 patients with a median age of 72 years (IQR 64-77) were enrolled. Seventy-mine patients (54%) with smaller prostate volume (59(IQR 52-74) Vs 99 (IQR 74-125) ml, p=0.008) and a thinner BWT (5(IQR 4.8-5.2) Vs 5.2 (4.7-5.5) mm p=0.001) recovered voiding at TWOC. IPP≥10 was less common in patients with successful TWOC 11(14%) vs 33(52%), p=0.001. On multivariate analysis, IPP<10mm (OR 6.10 (95%CI 2.61-14.20), p=0.001), lower IPSS (OR 0.95 (95%CI 0.89-0.99), p= 0.045), smaller TRUS (OR 0.96 (95%CI 0.95-0.97), p=0.001), thinner BWT OR 1.23 (95%CI 0.73-0,92) p=0.001were the independent predictors of voiding recovery.\u0000\u0000\u0000CONCLUSIONS\u0000Patients receiving medical treatment for BPH and experiencing AUR still present a 54% probability of a successful TWOC. Ultrasound may help to identify patients with successful TWOC.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"415 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74980896","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 : 2020-11-12DOI: 10.23736/S0393-2249.20.04008-4
M. Ferriero, U. Anceschi, A. Bove, L. Bertini, R. Flammia, G. Zeccolini, B. de Concilio, G. Tuderti, R. Mastroianni, L. Misuraca, A. Brassetti, S. Guaglianone, M. Gallucci, A. Celia, G. Simone
BACKGROUND To investigate the impact of Computer Aided Diagnostic (CAD) system on the detection rate of prostate cancer (PCa) in a series of fusion prostate biopsy (FPB). METHODS Two prospective transperineal FPB series (with or without CAD assistance) were analyzed and PCa detection rates compared with per patient and per target analyses. Chi-Square and Mann-Whitney test were used to compare categorical and continuous variables, respectively. Univariable and multivariable regression analyses were applied to identify predictors of any and clinically-significant (cs) PCa detection. Subgroup analyses were performed after stratifying for PIRADS Score and lesion location. RESULTS Out of 183 FPB, 89 were performed with CAD assistance. At per patient analysis the detection rate of any PCa and of cs PCa were 56.3% and 30.6%, respectively; the aid of CAD was negligible for either any PCa or csPCa detection rates (p=0.45 and p=0.99, respectively). Conversely in a per target analysis, CAD-assisted biopsy had significantly higher positive predictive value (PPV) for any PCa versus MRI-only group (58%vs37.8%, p=0.001). PI-RADS Score was the only independent predictor of any and csPCa, either in per patient or per target multivariable regression analysis (all p<0.029). In a subgroup per patient analysis of anterior/transitional zone lesions, csPCa detection rate was significantly higher in the CAD cohort (54.5%vs11.1%, respectively; p=0.028), and CAD assistance was the only predictor of csPCa detection (p=0.013). CONCLUSIONS CAD assistance for FPB seems to improve detection of csPCa located in anterior/transitional zone. Enhanced identification and improved contouring of lesions may justify higher diagnostic performance.
{"title":"Fusion US/MRI prostate biopsy using a Computer Aided Diagnostic (CAD) system.","authors":"M. Ferriero, U. Anceschi, A. Bove, L. Bertini, R. Flammia, G. Zeccolini, B. de Concilio, G. Tuderti, R. Mastroianni, L. Misuraca, A. Brassetti, S. Guaglianone, M. Gallucci, A. Celia, G. Simone","doi":"10.23736/S0393-2249.20.04008-4","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04008-4","url":null,"abstract":"BACKGROUND\u0000To investigate the impact of Computer Aided Diagnostic (CAD) system on the detection rate of prostate cancer (PCa) in a series of fusion prostate biopsy (FPB).\u0000\u0000\u0000METHODS\u0000Two prospective transperineal FPB series (with or without CAD assistance) were analyzed and PCa detection rates compared with per patient and per target analyses. Chi-Square and Mann-Whitney test were used to compare categorical and continuous variables, respectively. Univariable and multivariable regression analyses were applied to identify predictors of any and clinically-significant (cs) PCa detection. Subgroup analyses were performed after stratifying for PIRADS Score and lesion location.\u0000\u0000\u0000RESULTS\u0000Out of 183 FPB, 89 were performed with CAD assistance. At per patient analysis the detection rate of any PCa and of cs PCa were 56.3% and 30.6%, respectively; the aid of CAD was negligible for either any PCa or csPCa detection rates (p=0.45 and p=0.99, respectively). Conversely in a per target analysis, CAD-assisted biopsy had significantly higher positive predictive value (PPV) for any PCa versus MRI-only group (58%vs37.8%, p=0.001). PI-RADS Score was the only independent predictor of any and csPCa, either in per patient or per target multivariable regression analysis (all p<0.029). In a subgroup per patient analysis of anterior/transitional zone lesions, csPCa detection rate was significantly higher in the CAD cohort (54.5%vs11.1%, respectively; p=0.028), and CAD assistance was the only predictor of csPCa detection (p=0.013).\u0000\u0000\u0000CONCLUSIONS\u0000CAD assistance for FPB seems to improve detection of csPCa located in anterior/transitional zone. Enhanced identification and improved contouring of lesions may justify higher diagnostic performance.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79304167","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 : 2020-11-12DOI: 10.23736/S0393-2249.20.03890-4
P. Verze, I. Sokolakis, C. Manfredi, Claudia Colla' Ruvolo, G. Hatzichristodoulou, J. Romero‐Otero
INTRODUCTION Penile Prosthesis Implantation (PPI), performed with or without adjunct straightening techniques, is one of the available surgical options in cases of Peyronie's disease (PD) with concomitant erectile dysfunction (ED). The aim of the study was to systematically identify and evaluate evidence regarding IPP in patients with PD and ED. EVIDENCE ACQUISITION Using Cochrane's methodological recommendations on systematic reviews, we conducted a systematic review of the literature on clinical research regarding the use of PPI, alone or in combination with any straightening maneuvers in the treatment of patients with PD and ED. The search was carried until January 2020. We included studies in English language with primary population patients with PD and ED who underwent IPP with the intent to treat the PD. All studies that were not original clinical research articles, reported insufficient data or included fewer than 5 patients were excluded from the final analysis. EVIDENCE SYNTHESIS In total 43 clinical articles with more than 2,000 patients (n=2,143) investigating the effects of penile prosthesis implantation (PPI) for the treatment of PD with or without ED were included in the study. Depending on the severity of the penile curvature, additional penile deformities (i.e. hourglass deformity), penile length, prior operations and surgeons experience, 6 main categories of surgical techniques of PPI for penile straightening and treatment of PD were identified: PPI only, PPI with modelling of the penis, PPI with plication of the penis on the convex side of the curvature, PPI with plaque incision(s), PPI with plaque incision/excision plus grafting and PPI with grafting and penile lengthening. CONCLUSIONS Overall, patients with PD and ED can expect excellent outcomes with PPI against a minimal risk of side effects. No definite conclusions can be made regarding which technique is superior.
{"title":"Penile prosthesis implant in the management of Peyronies' disease: a systematic review of the literature.","authors":"P. Verze, I. Sokolakis, C. Manfredi, Claudia Colla' Ruvolo, G. Hatzichristodoulou, J. Romero‐Otero","doi":"10.23736/S0393-2249.20.03890-4","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.03890-4","url":null,"abstract":"INTRODUCTION\u0000Penile Prosthesis Implantation (PPI), performed with or without adjunct straightening techniques, is one of the available surgical options in cases of Peyronie's disease (PD) with concomitant erectile dysfunction (ED). The aim of the study was to systematically identify and evaluate evidence regarding IPP in patients with PD and ED.\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000Using Cochrane's methodological recommendations on systematic reviews, we conducted a systematic review of the literature on clinical research regarding the use of PPI, alone or in combination with any straightening maneuvers in the treatment of patients with PD and ED. The search was carried until January 2020. We included studies in English language with primary population patients with PD and ED who underwent IPP with the intent to treat the PD. All studies that were not original clinical research articles, reported insufficient data or included fewer than 5 patients were excluded from the final analysis.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u0000In total 43 clinical articles with more than 2,000 patients (n=2,143) investigating the effects of penile prosthesis implantation (PPI) for the treatment of PD with or without ED were included in the study. Depending on the severity of the penile curvature, additional penile deformities (i.e. hourglass deformity), penile length, prior operations and surgeons experience, 6 main categories of surgical techniques of PPI for penile straightening and treatment of PD were identified: PPI only, PPI with modelling of the penis, PPI with plication of the penis on the convex side of the curvature, PPI with plaque incision(s), PPI with plaque incision/excision plus grafting and PPI with grafting and penile lengthening.\u0000\u0000\u0000CONCLUSIONS\u0000Overall, patients with PD and ED can expect excellent outcomes with PPI against a minimal risk of side effects. No definite conclusions can be made regarding which technique is superior.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81439594","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：