Pub Date : 2020-11-01DOI: 10.23736/S0393-2249.20.04054-0
U. Carbonara, Jennifer Lee, F. Crocerossa, A. Veccia, L. Hampton, D. Eun, R. Autorino
BACKGROUND Despite hospital length of stay (LOS) being shorter for robot-assisted partial nephrectomy (RAPN) compared to its open counterpart, several series in the literature report on average a LOS of 2-3 days or more. We aimed to assess factors predicting a prolonged length of stay (beyond a single overnight stay) in patients undergoing RAPN. METHODS Patients who underwent RAPN between 2010 and 2019 at two U.S. Centers were included and divided into two groups according to LOS: the study group included all patients who were discharged on POD1, whereas the control group included patients with LOS≥2 days. Demographics, surgical and perioperative outcomes were compared between the groups. Multivariable logistic regression analyses were used to identify independent predictors of LOS≥2. RESULTS Overall, 173 (60.5%) patients discharged on POD1, and 113 (39.5%) discharged on POD≥2. Patients in the study group presented a lower mean BMI (29 vs. 32, p=0.02). Retroperitoneal approach was performed in 13.3% patients with shorter LOS (p<0.001). There was a statistically significant difference in median OT (144 vs. 168min, p=0.005) and WIT (19 vs. 23min, p=0.001). We observed six postoperative complications (3.6%) in patients discharged on POD1 and 35 (30.5%) in control group (p<0.001). Major complications (Clavien-Dindo grade≥III) were observed in 3 of POD1 patients (1.8 vs. 6.1%, p<0.001). There was no difference in hospital readmission rate. On logistic regression analysis, independent predictors of prolonged LOS were OT (OR 1.01, 95%C.I.: 1.0-1.2, p=0.001), and occurrence of a postoperative complication (OR 2.2, 95%C.I. 2.0-2.5, p<0.001). CONCLUSIONS Our findings confirm that a single overnight stay after RAPN is feasible and safe. In our experience, and within the limitations of the present analysis, prolonged operative time and occurrence of immediate postoperative complications translate into higher risk of prolonged hospital stay. Besides adopting a minimally invasive approach, surgeons should also implement perioperative care pathways facilitating early discharge without increasing the risk of readmission.
{"title":"Single overnight stay after robot-assisted partial nephrectomy: a bi-center experience.","authors":"U. Carbonara, Jennifer Lee, F. Crocerossa, A. Veccia, L. Hampton, D. Eun, R. Autorino","doi":"10.23736/S0393-2249.20.04054-0","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04054-0","url":null,"abstract":"BACKGROUND\u0000Despite hospital length of stay (LOS) being shorter for robot-assisted partial nephrectomy (RAPN) compared to its open counterpart, several series in the literature report on average a LOS of 2-3 days or more. We aimed to assess factors predicting a prolonged length of stay (beyond a single overnight stay) in patients undergoing RAPN.\u0000\u0000\u0000METHODS\u0000Patients who underwent RAPN between 2010 and 2019 at two U.S. Centers were included and divided into two groups according to LOS: the study group included all patients who were discharged on POD1, whereas the control group included patients with LOS≥2 days. Demographics, surgical and perioperative outcomes were compared between the groups. Multivariable logistic regression analyses were used to identify independent predictors of LOS≥2.\u0000\u0000\u0000RESULTS\u0000Overall, 173 (60.5%) patients discharged on POD1, and 113 (39.5%) discharged on POD≥2. Patients in the study group presented a lower mean BMI (29 vs. 32, p=0.02). Retroperitoneal approach was performed in 13.3% patients with shorter LOS (p<0.001). There was a statistically significant difference in median OT (144 vs. 168min, p=0.005) and WIT (19 vs. 23min, p=0.001). We observed six postoperative complications (3.6%) in patients discharged on POD1 and 35 (30.5%) in control group (p<0.001). Major complications (Clavien-Dindo grade≥III) were observed in 3 of POD1 patients (1.8 vs. 6.1%, p<0.001). There was no difference in hospital readmission rate. On logistic regression analysis, independent predictors of prolonged LOS were OT (OR 1.01, 95%C.I.: 1.0-1.2, p=0.001), and occurrence of a postoperative complication (OR 2.2, 95%C.I. 2.0-2.5, p<0.001).\u0000\u0000\u0000CONCLUSIONS\u0000Our findings confirm that a single overnight stay after RAPN is feasible and safe. In our experience, and within the limitations of the present analysis, prolonged operative time and occurrence of immediate postoperative complications translate into higher risk of prolonged hospital stay. Besides adopting a minimally invasive approach, surgeons should also implement perioperative care pathways facilitating early discharge without increasing the risk of readmission.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89813057","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 : 2020-11-01DOI: 10.23736/S0393-2249.20.03844-8
A. Nini, F. Muttin, F. Cianflone, C. Carenzi, R. Lucianò, M. Catena, A. Larcher, M. Salvioni, W. Cazzaniga, F. Pederzoli, R. Matloob, R. Colombo, M. Paganelli, A. Salonia, A. Briganti, C. Doglioni, A. Zangrillo, F. de Cobelli, P. Rigatti, M. Freschi, G. Cornero, R. Nicoletti, L. Aldrighetti, F. Montorsi, U. Capitanio, R. Bertini
BACKGROUND Scarce data are available regarding the technique and outcomes for patients with RCC and Mayo III caval thrombi. To report surgical and oncological outcomes of RCC patients with Mayo III thrombi treated with radical nephrectomy and thrombectomy after liver mobilization (LM) and Pringle Manoeuvre (PM). METHODS Retrospective analysis of surgical technique, outcomes and cancer control in 19 patients undergoing LM and PM in a single tertiary care institution. RESULTS Overall, 78% of the patients had performance status ECOG 1 and 58% had a comorbidity index >2. Median surgical time was 305 minutes (IQR 264-440). Intraoperative complications were reported for 39% of patients and postoperative ones for 58% (only Grade 1 and 2). Intensive Care Unit support was necessary in 16% of the cases. Median length of hospital stay was 9 days (IQR 7-11). Thirty- and 90-day mortality were 5% and 15%. Twoyear overall survival and cancer-specific survival were 60% and 62%, respectively. CONCLUSIONS We reported surgical techniques, intra and perioperative complications and follow-up in the largest cohort of RCC patients requiring LM and PM.
{"title":"Perioperative and oncologic outcomes of open radical nephrectomy and inferior vena cava thrombectomy with liver mobilization and Pringle maneuver for Mayo III level tumor thrombus: single institution experience.","authors":"A. Nini, F. Muttin, F. Cianflone, C. Carenzi, R. Lucianò, M. Catena, A. Larcher, M. Salvioni, W. Cazzaniga, F. Pederzoli, R. Matloob, R. Colombo, M. Paganelli, A. Salonia, A. Briganti, C. Doglioni, A. Zangrillo, F. de Cobelli, P. Rigatti, M. Freschi, G. Cornero, R. Nicoletti, L. Aldrighetti, F. Montorsi, U. Capitanio, R. Bertini","doi":"10.23736/S0393-2249.20.03844-8","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.03844-8","url":null,"abstract":"BACKGROUND\u0000Scarce data are available regarding the technique and outcomes for patients with RCC and Mayo III caval thrombi. To report surgical and oncological outcomes of RCC patients with Mayo III thrombi treated with radical nephrectomy and thrombectomy after liver mobilization (LM) and Pringle Manoeuvre (PM).\u0000\u0000\u0000METHODS\u0000Retrospective analysis of surgical technique, outcomes and cancer control in 19 patients undergoing LM and PM in a single tertiary care institution.\u0000\u0000\u0000RESULTS\u0000Overall, 78% of the patients had performance status ECOG 1 and 58% had a comorbidity index >2. Median surgical time was 305 minutes (IQR 264-440). Intraoperative complications were reported for 39% of patients and postoperative ones for 58% (only Grade 1 and 2). Intensive Care Unit support was necessary in 16% of the cases. Median length of hospital stay was 9 days (IQR 7-11). Thirty- and 90-day mortality were 5% and 15%. Twoyear overall survival and cancer-specific survival were 60% and 62%, respectively.\u0000\u0000\u0000CONCLUSIONS\u0000We reported surgical techniques, intra and perioperative complications and follow-up in the largest cohort of RCC patients requiring LM and PM.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78614687","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 : 2020-11-01DOI: 10.23736/S0393-2249.20.03925-9
M. Gacci, I. Greco, W. Artibani, P. Bassi, F. Bertoni, S. Bracarda, A. Briganti, G. Carmignani, L. Carmignani, G. Conti, R. Corvò, C. de Nunzio, F. Fusco, P. Graziotti, S. Maggi, S. Magrini, V. Mirone, R. Montironi, G. Muto, M. Noale, S. Pecoraro, A. Porreca, U. Ricardi, E. Russi, A. Salonia, A. Simonato, S. Serni, A. Tubaro, V. Zagonel, G. Crepaldi
BACKGROUND Prostate cancer (PCa) is the second most common neoplasm in male patients. To date, there's no certain indication about the maximum waiting time (WT) acceptable for treatment beginning and the impact on oncological and functional outcomes has not been well established. METHODS Data from the National Research Council PCa monitoring multicenter project in Italy (Pros-IT CNR) were prospectively collected and analyzed. WT was defined as the time from the bioptical diagnosis of PCa to the first treatment received. Patients were divided in two groups, using a time frame of 90 days. Quality of life was measured through the Italian version of the University of California Los Angeles-Prostate Cancer Index (UCLA-PCI) and of the Short-Form Health Survey (SF-12). The occurrence of upgrading, upstaging, presence of lymph node metastasis and positive surgical margins at the final histopathological diagnosis, and PSA at 12 months follow-up were evaluated. RESULTS The overall median WT was 93 days. The logistic multivariable model confirmed that age, being resident in Southern regions of Italy and T staging at diagnosis were significantly associated with a WT >90 days. At 6 months from diagnosis the mean SF-12 score for the emotionalpsychological component was significantly lower in WT ≥ 90 days group (p=0.0428). Among patients treated with surgical approach, no significant differences in oncological outcomes were found in the two groups. CONCLUSIONS In our study age, clinical T stage and provenance from Southern regions of Italy are associated with a WT > 90 days. WT might have no impact on functional and oncological outcome.
背景:前列腺癌(PCa)是男性患者中第二常见的肿瘤。到目前为止，还没有确切的迹象表明治疗开始时可接受的最大等待时间(WT)，对肿瘤和功能结果的影响也没有很好地确定。方法对意大利国家研究委员会PCa监测多中心项目(pro - it CNR)的数据进行前瞻性收集和分析。WT定义为从PCa的生物光学诊断到第一次接受治疗的时间。患者被分为两组，使用90天的时间框架。生活质量是通过加州大学洛杉矶分校前列腺癌指数(UCLA-PCI)和短期健康调查(SF-12)的意大利版来衡量的。评估最终组织病理学诊断时升级、分期、淋巴结转移和手术切缘阳性的发生情况，以及随访12个月时PSA的变化。结果总中位WT为93天。logistic多变量模型证实，年龄、居住在意大利南部地区和诊断时的T分期与WT >90天显著相关。在诊断后6个月，WT≥90天组情绪心理成分的平均SF-12评分显著低于对照组(p=0.0428)。在接受手术治疗的患者中，两组的肿瘤预后无显著差异。在我们的研究中，年龄、临床T分期和来自意大利南部地区的来源与WT > 90天相关。WT可能对功能和肿瘤结果没有影响。
{"title":"The waiting time for prostate cancer treatment in Italy: analysis from the Pros-IT CNR study.","authors":"M. Gacci, I. Greco, W. Artibani, P. Bassi, F. Bertoni, S. Bracarda, A. Briganti, G. Carmignani, L. Carmignani, G. Conti, R. Corvò, C. de Nunzio, F. Fusco, P. Graziotti, S. Maggi, S. Magrini, V. Mirone, R. Montironi, G. Muto, M. Noale, S. Pecoraro, A. Porreca, U. Ricardi, E. Russi, A. Salonia, A. Simonato, S. Serni, A. Tubaro, V. Zagonel, G. Crepaldi","doi":"10.23736/S0393-2249.20.03925-9","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.03925-9","url":null,"abstract":"BACKGROUND\u0000Prostate cancer (PCa) is the second most common neoplasm in male patients. To date, there's no certain indication about the maximum waiting time (WT) acceptable for treatment beginning and the impact on oncological and functional outcomes has not been well established.\u0000\u0000\u0000METHODS\u0000Data from the National Research Council PCa monitoring multicenter project in Italy (Pros-IT CNR) were prospectively collected and analyzed. WT was defined as the time from the bioptical diagnosis of PCa to the first treatment received. Patients were divided in two groups, using a time frame of 90 days. Quality of life was measured through the Italian version of the University of California Los Angeles-Prostate Cancer Index (UCLA-PCI) and of the Short-Form Health Survey (SF-12). The occurrence of upgrading, upstaging, presence of lymph node metastasis and positive surgical margins at the final histopathological diagnosis, and PSA at 12 months follow-up were evaluated.\u0000\u0000\u0000RESULTS\u0000The overall median WT was 93 days. The logistic multivariable model confirmed that age, being resident in Southern regions of Italy and T staging at diagnosis were significantly associated with a WT >90 days. At 6 months from diagnosis the mean SF-12 score for the emotionalpsychological component was significantly lower in WT ≥ 90 days group (p=0.0428). Among patients treated with surgical approach, no significant differences in oncological outcomes were found in the two groups.\u0000\u0000\u0000CONCLUSIONS\u0000In our study age, clinical T stage and provenance from Southern regions of Italy are associated with a WT > 90 days. WT might have no impact on functional and oncological outcome.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"131 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89229330","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 : 2020-11-01DOI: 10.23736/S0393-2249.20.03843-6
A. Ercolino, M. Droghetti, R. Schiavina, L. Bianchi, F. Chessa, F. Mineo Bianchi, U. Barbaresi, A. Angiolini, C. Casablanca, A. Mottaran, E. Molinaroli, C. Pultrone, H. Dababneh, A. Bertaccini, E. Brunocilla
BACKGROUND We aimed at comparing perioperative outcomes in patients submitted to radical cystectomy followed by Fast Track (FT) protocol or standard management, and propose a definition of Trifecta, to improve standardized quality assessment for RC. METHODS We considered 191 patients submitted to RC between January 2017 and January 2019. Patients followed FT or standard management according to surgeon's preference. Preoperative and intraoperative characteristics, alongside with postoperative outcomes were compared between the two groups. Trifecta was defined as follows: inhospital stay (HS) ≤ 10 days, time to defecation (TtD) below the overall mean and no major (≥ Clavien-Dindo grade III) complications. Finally, Trifecta achievement rates were assessed in both groups. RESULTS 75 patients (39%) followed the FT protocol and 116 (61%) standard management. The two groups were homogeneous for preoperative, intraoperative and pathological characteristics. Patients in the FT group had shorter TtD (5 vs. 6 days p=0.006), HS (12 vs. 14 days p=0.008) and lower readmission rate (8% vs. 19% p=0.04). Early complication rates and grades were similar, while less late complications were found in FT group (6.7% vs. 21.6% p=0,006). Trifecta achievement rate was higher for FT group (31% vs. 8% p<0.001). Single-item failure percentages for HS, TtD and major grade complications were respectively 90%, 60% and 19%, with no difference between the two groups. CONCLUSIONS FT protocol can safely consent faster bowel recovery and earlier discharge after RC, plus reducing readmission rates. Using a Trifecta incorporating essential perioperative outcomes, could improve standardized quality assessment for RC.
背景:我们旨在比较快速通道(FT)方案或标准管理下根治性膀胱切除术患者的围手术期预后，并提出三氟替尼的定义，以提高根治性膀胱切除术的标准化质量评估。方法:我们纳入了2017年1月至2019年1月期间提交RC的191例患者。根据术者的喜好，患者可选择FT或标准处理。比较两组患者术前、术中特征及术后结果。三氟替尼的定义为:住院时间(HS)≤10天，排便时间(TtD)低于总体平均时间，无重大(≥Clavien-Dindo III级)并发症。最后，对两组的三连片成功率进行评估。结果75例(39%)患者采用FT方案，116例(61%)患者采用标准管理。两组术前、术中及病理特征均相同。FT组患者TtD较短(5天对6天p=0.006)， HS较短(12天对14天p=0.008)，再入院率较低(8%对19% p=0.04)。早期并发症发生率和分级相似，FT组晚期并发症发生率较低(6.7% vs. 21.6% p= 0.006)。FT组的三连片成功率更高(31%比8% p<0.001)。HS、TtD、严重级并发症单项失败率分别为90%、60%、19%，两组间差异无统计学意义。结论sft方案可使术后肠恢复更快，出院更早，降低再入院率。使用纳入围手术期基本预后的三连片可以提高RC的标准化质量评估。
{"title":"Postoperative outcomes of Fast Track enhanced recovery protocol in open radical cystectomy: comparison with standard management in a high-volume center and Trifecta proposal.","authors":"A. Ercolino, M. Droghetti, R. Schiavina, L. Bianchi, F. Chessa, F. Mineo Bianchi, U. Barbaresi, A. Angiolini, C. Casablanca, A. Mottaran, E. Molinaroli, C. Pultrone, H. Dababneh, A. Bertaccini, E. Brunocilla","doi":"10.23736/S0393-2249.20.03843-6","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.03843-6","url":null,"abstract":"BACKGROUND\u0000We aimed at comparing perioperative outcomes in patients submitted to radical cystectomy followed by Fast Track (FT) protocol or standard management, and propose a definition of Trifecta, to improve standardized quality assessment for RC.\u0000\u0000\u0000METHODS\u0000We considered 191 patients submitted to RC between January 2017 and January 2019. Patients followed FT or standard management according to surgeon's preference. Preoperative and intraoperative characteristics, alongside with postoperative outcomes were compared between the two groups. Trifecta was defined as follows: inhospital stay (HS) ≤ 10 days, time to defecation (TtD) below the overall mean and no major (≥ Clavien-Dindo grade III) complications. Finally, Trifecta achievement rates were assessed in both groups.\u0000\u0000\u0000RESULTS\u000075 patients (39%) followed the FT protocol and 116 (61%) standard management. The two groups were homogeneous for preoperative, intraoperative and pathological characteristics. Patients in the FT group had shorter TtD (5 vs. 6 days p=0.006), HS (12 vs. 14 days p=0.008) and lower readmission rate (8% vs. 19% p=0.04). Early complication rates and grades were similar, while less late complications were found in FT group (6.7% vs. 21.6% p=0,006). Trifecta achievement rate was higher for FT group (31% vs. 8% p<0.001). Single-item failure percentages for HS, TtD and major grade complications were respectively 90%, 60% and 19%, with no difference between the two groups.\u0000\u0000\u0000CONCLUSIONS\u0000FT protocol can safely consent faster bowel recovery and earlier discharge after RC, plus reducing readmission rates. Using a Trifecta incorporating essential perioperative outcomes, could improve standardized quality assessment for RC.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"366 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84911272","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 : 2020-11-01DOI: 10.23736/S0393-2249.20.04002-3
A. Şahan, Erdinç Dinçer, O. Özkaptan, A. Çubuk, K. Ertaş, B. Eryıldırım, O. Akça
BACKGROUND This study aimed to evaluate the possible effect of anterior calyceal stones on the surgical outcomes of percutaneous nephrolithotomy. METHODS Consecutive patients with complex kidney stones from 2012 to 2020 were evaluated retrospectively. In total, 219 patients were divided into 2 groups based on the presence of anterior calyceal stones (group 1; n=89) or not (group 2; n=130). The groups were compared in terms of surgical outcomes (i.e., stonefree rate [SFR], operation time, and hemoglobin drop) and complications. RESULTS The patient demographics and stone characteristics were similar between the groups. Multiple access was more frequently done in group 1 than it was in group 2 (47.2% vs. 30.8%; p = 0.014), and the SFR was lower in group 1 (51.7%) than it was in group 2 (67.7%; p = 0.017). Of the anterior calyceal stones in group 1, 42.6% could not be cleaned. However, when excluding patients who have only anterior residual stones from the statistical analysis, the groups had similar SFRs (68.5% vs. 67.7% for group 1 and group 2, respectively). CONCLUSIONS The presence of complex kidney stones with anterior calyceal extension are associated with higher residual stones rates in the anterior calyx. Also, it increases multiple access, the operation time, and level of hemoglobin drop.
{"title":"The impact of anterior calyceal stones on the outcomes of percutaneous nephrolithotomy for complex kidney stones: a comparative study.","authors":"A. Şahan, Erdinç Dinçer, O. Özkaptan, A. Çubuk, K. Ertaş, B. Eryıldırım, O. Akça","doi":"10.23736/S0393-2249.20.04002-3","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04002-3","url":null,"abstract":"BACKGROUND\u0000This study aimed to evaluate the possible effect of anterior calyceal stones on the surgical outcomes of percutaneous nephrolithotomy.\u0000\u0000\u0000METHODS\u0000Consecutive patients with complex kidney stones from 2012 to 2020 were evaluated retrospectively. In total, 219 patients were divided into 2 groups based on the presence of anterior calyceal stones (group 1; n=89) or not (group 2; n=130). The groups were compared in terms of surgical outcomes (i.e., stonefree rate [SFR], operation time, and hemoglobin drop) and complications.\u0000\u0000\u0000RESULTS\u0000The patient demographics and stone characteristics were similar between the groups. Multiple access was more frequently done in group 1 than it was in group 2 (47.2% vs. 30.8%; p = 0.014), and the SFR was lower in group 1 (51.7%) than it was in group 2 (67.7%; p = 0.017). Of the anterior calyceal stones in group 1, 42.6% could not be cleaned. However, when excluding patients who have only anterior residual stones from the statistical analysis, the groups had similar SFRs (68.5% vs. 67.7% for group 1 and group 2, respectively).\u0000\u0000\u0000CONCLUSIONS\u0000The presence of complex kidney stones with anterior calyceal extension are associated with higher residual stones rates in the anterior calyx. Also, it increases multiple access, the operation time, and level of hemoglobin drop.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88497719","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 : 2020-11-01DOI: 10.23736/S0393-2249.20.04099-0
A. Sebastianelli, S. Morselli, P. Spatafora, A. Liaci, L. Gemma, C. Zaccaro, L. Vignozzi, M. Maggi, K. McVary, S. Kaplan, C. Chapple, S. Gravas, S. Serni, M. Gacci
BACKGROUND To assess the impact of Tadalafil 5mg/die plus Tamsulosin 0.4mg/die combination therapy on LUTS and ED, according to presence vs. absence of Mets. METHODS 75 consecutive men presenting with ED and LUTS were enrolled. Patients were divided into two groups according to MetS presence. All subjects were treated with combination therapy for 12 weeks. Patients were re-evaluated after treatment with Uroflowmetry and PVR, IPSS, IPSS QoL, OAB-q and IIEF-5. RESULTS After enrollment, 50 patients were included: 31(62.0%) with MetS and 19(38.0%) without MetS. At baseline, patients without MetS showed a significantly better IPSS, IIEF and OAB-q, as compared to those with MetS. After 12 weeks of combination therapy LUTS, ED and flowmetry significantly improved in both groups(p<0.001). The improvement after 12 weeks was similar between groups in all parameters(p>0.05), except for ΔOAB-q that was significantly better for patients with MetS(p=0.028). Nevertheless, total IPSS, all IPSS subscores and OAB-q were significantly better at 12 weeks in men without MetS(p<0.05). Despite IIEF-5 was significantly different at baseline, after 12 weeks of combination therapy, erectile function was similar in men with or without METS:16.3±3.8 vs 7.7±4.7(p=0.238). No serious AE was reported and complications were comparable between groups(p>0.05). CONCLUSIONS Patients with MetS have worse LUTS and ED profiles. However, tadalafil plus tamsulosin combination treatment provided them a similar ED profile and a greater relief of OAB symptoms at the end of the trial. Combination therapy had the same safety profile in men besides MetS. Further randomized controlled trials are needed.
背景:根据有无Mets，评估他达拉非5mg/ kg +坦索罗辛0.4mg/ kg联合治疗对LUTS和ED的影响。方法入选75例连续出现ED和LUTS的男性。根据MetS的存在将患者分为两组。所有患者均采用联合治疗12周。治疗后再用尿流仪、PVR、IPSS、IPSS QoL、OAB-q和IIEF-5对患者进行评估。结果入组后，纳入50例患者:31例(62.0%)有MetS, 19例(38.0%)无MetS。在基线时，与有MetS的患者相比，无MetS的患者IPSS、IIEF和OAB-q明显更好。联合治疗12周后，两组患者的LUTS、ED和血流测量均显著改善(p0.05)，除了ΔOAB-q在met患者中显著改善(p=0.028)。然而，在没有MetS的男性中，总IPSS、所有IPSS亚评分和OAB-q在12周时明显更好(p0.05)。结论met患者有较差的LUTS和ED特征。然而，他达拉非加坦索罗辛联合治疗在试验结束时为他们提供了相似的ED特征和更大的OAB症状缓解。除了肿瘤转移，联合治疗在男性中也具有相同的安全性。需要进一步的随机对照试验。
{"title":"Outcomes of combination therapy with daily Tadalafil 5mg plus Tamsulosin 0.4mg to treat lower urinary tract symptoms and erectile dysfunction in men with or without metabolic syndrome.","authors":"A. Sebastianelli, S. Morselli, P. Spatafora, A. Liaci, L. Gemma, C. Zaccaro, L. Vignozzi, M. Maggi, K. McVary, S. Kaplan, C. Chapple, S. Gravas, S. Serni, M. Gacci","doi":"10.23736/S0393-2249.20.04099-0","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04099-0","url":null,"abstract":"BACKGROUND\u0000To assess the impact of Tadalafil 5mg/die plus Tamsulosin 0.4mg/die combination therapy on LUTS and ED, according to presence vs. absence of Mets.\u0000\u0000\u0000METHODS\u000075 consecutive men presenting with ED and LUTS were enrolled. Patients were divided into two groups according to MetS presence. All subjects were treated with combination therapy for 12 weeks. Patients were re-evaluated after treatment with Uroflowmetry and PVR, IPSS, IPSS QoL, OAB-q and IIEF-5.\u0000\u0000\u0000RESULTS\u0000After enrollment, 50 patients were included: 31(62.0%) with MetS and 19(38.0%) without MetS. At baseline, patients without MetS showed a significantly better IPSS, IIEF and OAB-q, as compared to those with MetS. After 12 weeks of combination therapy LUTS, ED and flowmetry significantly improved in both groups(p<0.001). The improvement after 12 weeks was similar between groups in all parameters(p>0.05), except for ΔOAB-q that was significantly better for patients with MetS(p=0.028). Nevertheless, total IPSS, all IPSS subscores and OAB-q were significantly better at 12 weeks in men without MetS(p<0.05). Despite IIEF-5 was significantly different at baseline, after 12 weeks of combination therapy, erectile function was similar in men with or without METS:16.3±3.8 vs 7.7±4.7(p=0.238). No serious AE was reported and complications were comparable between groups(p>0.05).\u0000\u0000\u0000CONCLUSIONS\u0000Patients with MetS have worse LUTS and ED profiles. However, tadalafil plus tamsulosin combination treatment provided them a similar ED profile and a greater relief of OAB symptoms at the end of the trial. Combination therapy had the same safety profile in men besides MetS. Further randomized controlled trials are needed.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77189351","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 : 2020-10-09DOI: 10.23736/S0393-2249.20.04177-6
F. Porpiglia, D. Amparore, E. Checcucci, C. Fiori, W. Artibani, R. Scarpa
{"title":"The revolution of congress meetings and scientific events: how to navigate among their heterogeneous modalities?","authors":"F. Porpiglia, D. Amparore, E. Checcucci, C. Fiori, W. Artibani, R. Scarpa","doi":"10.23736/S0393-2249.20.04177-6","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04177-6","url":null,"abstract":"","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75947082","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 : 2020-10-05DOI: 10.23736/S0393-2249.20.04051-5
S. Albisinni, R. Diamand, C. de Nunzio
{"title":"The train has already left the station: analyzing the rise of PSMA PET/CT as new standard for staging high risk prostate cancer.","authors":"S. Albisinni, R. Diamand, C. de Nunzio","doi":"10.23736/S0393-2249.20.04051-5","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04051-5","url":null,"abstract":"","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80566854","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 : 2020-10-05DOI: 10.23736/S0393-2249.20.04042-4
L. Peng, Wei Wang, Xiao-shuai Gao, Xing-peng Di, D. Luo
INTRODUCTION To comprehensively assess the effectiveness and safety of fluoroless ureteroscopy (URS) vs conventional URS for urinary stones. EVIDENCE ACQUISITION An exhaustive search of PubMed, EMBASE, Web of Science and Cochrane Library were performed to find eligible researches before May 2020. Result parameters including stone-free rate (SFR), operation time, repeat procedure rate and complication rate were assessed using RevMan 5.3. EVIDENCE SYNTHESIS 7 studies (5 retrospective studies and 2 prospective randomized controlled trials) involving 1404 individuals were included. Pooled results demonstrated that the operation time in fluoroless URS group was slightly longer than conventional URS group (weighted mean difference [MD]=2.79, p=0.0001), but no statistically significant differences regarding SFR (odds ratio [OR]=1.18, p=0.57), repeat procedure rate (OR=1.32, p=0.52), and total complication rate (OR=0.75, p=0.16) were observed between two techniques. CONCLUSIONS Fluoroless URS is equally safe and effective to conventional URS procedure with zero radiation exposure. However, it needs to be cautiously conducted in selected patients and fluoroscopy equipment should always be available intraoperatively.
目的:综合评价无氟输尿管镜(URS)与常规输尿管镜治疗尿路结石的有效性和安全性。证据获取我们对PubMed、EMBASE、Web of Science和Cochrane Library进行了详尽的检索，以在2020年5月之前找到符合条件的研究。采用RevMan 5.3软件对结石无结石率(SFR)、手术时间、重复手术率及并发症发生率进行评估。证据综合:纳入7项研究(5项回顾性研究和2项前瞻性随机对照试验)，涉及1404人。合并结果显示，无荧光URS组的手术时间略长于常规URS组(加权平均差[MD]=2.79, p=0.0001)，但两种技术在SFR(优势比[OR]=1.18, p=0.57)、重复手术率(OR=1.32, p=0.52)和总并发症率(OR=0.75, p=0.16)方面无统计学差异。结论无氟尿路与常规尿路同样安全有效，且无辐射暴露。然而，在选定的患者中需要谨慎进行，术中应始终提供透视设备。
{"title":"Fluoroless versus conventional ureteroscopy for urinary stones: a systematic review and meta-analysis.","authors":"L. Peng, Wei Wang, Xiao-shuai Gao, Xing-peng Di, D. Luo","doi":"10.23736/S0393-2249.20.04042-4","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.04042-4","url":null,"abstract":"INTRODUCTION\u0000To comprehensively assess the effectiveness and safety of fluoroless ureteroscopy (URS) vs conventional URS for urinary stones.\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000An exhaustive search of PubMed, EMBASE, Web of Science and Cochrane Library were performed to find eligible researches before May 2020. Result parameters including stone-free rate (SFR), operation time, repeat procedure rate and complication rate were assessed using RevMan 5.3.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u00007 studies (5 retrospective studies and 2 prospective randomized controlled trials) involving 1404 individuals were included. Pooled results demonstrated that the operation time in fluoroless URS group was slightly longer than conventional URS group (weighted mean difference [MD]=2.79, p=0.0001), but no statistically significant differences regarding SFR (odds ratio [OR]=1.18, p=0.57), repeat procedure rate (OR=1.32, p=0.52), and total complication rate (OR=0.75, p=0.16) were observed between two techniques.\u0000\u0000\u0000CONCLUSIONS\u0000Fluoroless URS is equally safe and effective to conventional URS procedure with zero radiation exposure. However, it needs to be cautiously conducted in selected patients and fluoroscopy equipment should always be available intraoperatively.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88424535","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 : 2020-10-05DOI: 10.23736/S0393-2249.20.03960-0
E. X. Keller, V. de Coninck, S. Proietti, M. Talso, E. Emiliani, A. Ploumidis, G. Mantica, B. Somani, O. Traxer, R. Scarpa, F. Esperto
INTRODUCTION Percutaneous nephrolithotomy (PNL) can be performed either in prone or supine position. This study aimed at gathering together randomized controlled trials (RCTs) comparing efficacy and safety between prone and supine PNL. EVIDENCE ACQUISITION Systematic review of literature was conducted using the Scopus, Medline and Web of Science databases. Study selection, data extraction and quality assessment were independently assessed by two authors. Meta-analysis was performed with Review Manager 5.3. Sensitivity analyses were performed to exclude studies with high risk of bias. EVIDENCE SYNTHESIS Pooled data from 12 studies including 1290 patients were available for analysis. Only one study was found to have overall low risk of bias. Significantly shorter operative time was found in favor of supine PNL (mean difference 13 minutes, 95% confidence interval (CI) 3.4 - 22.7; p < 0.01). Stone-free rate (SFR) ≥ 14 days after surgery was significantly higher in prone PNL (odds ratio (OR) 2.15, 95% CI 1.07 - 4.34; p = 0.03). Significantly higher fever rate was found in prone PNL (OR 1.60, 95% CI 1.03 - 2.47; p = 0.04). Overall SFR, hospital stay length, complications rate, transfusions rate and blood loss, as well as non-lower calyx puncture rate, puncture attempts and tubeless intervention rate did not differ between prone and supine PNL (p > 0.05). CONCLUSIONS Efficacy of PNL seems balanced between prone and supine position, with comparable overall SFR and shorter operative time in favor of supine PNL. Safety of PNL appears in favor of supine PNL, with lower fever rate. Because of study heterogeneity and possible risks of outcome bias, results from this study should be interpreted with caution. Altogether, both prone and supine PNL account for appropriate therapy options.
经皮肾镜取石术(PNL)可以俯卧位或仰卧位进行。本研究旨在收集随机对照试验(rct)，比较俯卧位和仰卧位PNL的疗效和安全性。证据获取使用Scopus、Medline和Web of Science数据库对文献进行系统综述。研究选择、数据提取和质量评估由两位作者独立评估。采用Review Manager 5.3进行meta分析。进行敏感性分析以排除高偏倚风险的研究。证据综合来自12项研究，包括1290例患者的汇总数据可用于分析。只有一项研究发现总体偏倚风险较低。仰卧位PNL手术时间明显缩短(平均差13分钟，95%可信区间(CI) 3.4 ~ 22.7;P < 0.01)。术后≥14天的无结石率(SFR)明显高于俯卧PNL(优势比(OR) 2.15, 95% CI 1.07 - 4.34;P = 0.03)。易发PNL患者的发热率明显较高(OR 1.60, 95% CI 1.03 - 2.47;P = 0.04)。俯卧位与仰卧位PNL患者的总SFR、住院时间、并发症发生率、输血率、失血量、非低位花萼穿刺率、穿刺次数、无管干预率差异无统计学意义(p > 0.05)。结论俯卧位和仰卧位对PNL的疗效基本一致，总的SFR相当，手术时间更短，有利于仰卧位PNL。PNL的安全性倾向于仰卧位PNL，发热率较低。由于研究的异质性和可能的结果偏倚风险，本研究的结果应谨慎解释。总之，俯卧位和仰卧位的PNL都是适当的治疗选择。
{"title":"Prone versus supine PNL: a systematic review and metaanalysis of current literature.","authors":"E. X. Keller, V. de Coninck, S. Proietti, M. Talso, E. Emiliani, A. Ploumidis, G. Mantica, B. Somani, O. Traxer, R. Scarpa, F. Esperto","doi":"10.23736/S0393-2249.20.03960-0","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.03960-0","url":null,"abstract":"INTRODUCTION\u0000Percutaneous nephrolithotomy (PNL) can be performed either in prone or supine position. This study aimed at gathering together randomized controlled trials (RCTs) comparing efficacy and safety between prone and supine PNL.\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000Systematic review of literature was conducted using the Scopus, Medline and Web of Science databases. Study selection, data extraction and quality assessment were independently assessed by two authors. Meta-analysis was performed with Review Manager 5.3. Sensitivity analyses were performed to exclude studies with high risk of bias.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u0000Pooled data from 12 studies including 1290 patients were available for analysis. Only one study was found to have overall low risk of bias. Significantly shorter operative time was found in favor of supine PNL (mean difference 13 minutes, 95% confidence interval (CI) 3.4 - 22.7; p < 0.01). Stone-free rate (SFR) ≥ 14 days after surgery was significantly higher in prone PNL (odds ratio (OR) 2.15, 95% CI 1.07 - 4.34; p = 0.03). Significantly higher fever rate was found in prone PNL (OR 1.60, 95% CI 1.03 - 2.47; p = 0.04). Overall SFR, hospital stay length, complications rate, transfusions rate and blood loss, as well as non-lower calyx puncture rate, puncture attempts and tubeless intervention rate did not differ between prone and supine PNL (p > 0.05).\u0000\u0000\u0000CONCLUSIONS\u0000Efficacy of PNL seems balanced between prone and supine position, with comparable overall SFR and shorter operative time in favor of supine PNL. Safety of PNL appears in favor of supine PNL, with lower fever rate. Because of study heterogeneity and possible risks of outcome bias, results from this study should be interpreted with caution. Altogether, both prone and supine PNL account for appropriate therapy options.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83817991","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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