Pub Date : 2020-09-29DOI: 10.23736/S0393-2249.20.03899-0
M. Moschovas, S. Bhat, T. Rogers, D. Thiel, F. Onol, S. Roof, M. Sighinolfi, B. Rocco, V. Patel
INTRODUCTION Robotic surgical technology has evolved to include a new platform specifically designed for the single-port (SP) approach. Benefits of the Da Vinci SP are still under investigation. This study aimed to review the urological literature since the first report of the use of the platform. EVIDENCE ACQUISITION We performed a systematic literature review of PubMed, Medline, and Web of Science databases on June 15th, 2020 searching for all available articles of da Vinci SP use from December 2014 (date of the first clinical report of da Vinci SP in the urology) until June 1st, 2020 following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. EVIDENCE SYNTHESIS A total of 43 articles were eligible for inclusion. Ten studies reported different surgeries and techniques on cadavers while the rest described the clinical experience of different groups. We divided our article and tables into pre-clinical experience with surgery on cadavers, radical prostatectomy (RP) approach, and multiple types of procedures described in the same study. CONCLUSIONS The application of da Vinci SP in urologic procedures after five yearsof the first clinical investigation is feasible and safe. Radical prostatectomy is the most common intervention performed with this robot. Some groups described benefits in terms of less postoperative pain and early discharge, especially with the extraperitoneal approach. However, further studies with larger sample sizes and longer follow-up are awaited.
机器人手术技术已经发展到包括一个专门为单端口(SP)入路设计的新平台。达芬奇SP的益处仍在调查中。本研究旨在回顾自首次报道使用该平台以来的泌尿学文献。我们于2020年6月15日对PubMed、Medline和Web of Science数据库进行了系统的文献综述，根据系统评价和荟萃分析(PRISMA)指南的首选报告项目，检索了2014年12月(达芬奇SP在泌尿科首次临床报告的日期)至2020年6月1日期间所有可用的达芬奇SP使用文章。总共有43篇文章符合纳入条件。10项研究报告了不同的尸体手术和技术，其余研究描述了不同群体的临床经验。我们将文章和表格分为尸体手术的临床前经验，根治性前列腺切除术(RP)方法，以及同一研究中描述的多种类型的手术。结论经过5年的首次临床研究，达芬奇SP在泌尿外科手术中的应用是可行和安全的。根治性前列腺切除术是该机器人最常用的干预手段。一些小组描述了术后疼痛减少和早期出院的好处，特别是腹腔外入路。然而，更大的样本量和更长的随访时间有待进一步的研究。
{"title":"Applications of the da Vinci Single Port (SP) robotic platform in urology: a systematic literature review.","authors":"M. Moschovas, S. Bhat, T. Rogers, D. Thiel, F. Onol, S. Roof, M. Sighinolfi, B. Rocco, V. Patel","doi":"10.23736/S0393-2249.20.03899-0","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.03899-0","url":null,"abstract":"INTRODUCTION\u0000Robotic surgical technology has evolved to include a new platform specifically designed for the single-port (SP) approach. Benefits of the Da Vinci SP are still under investigation. This study aimed to review the urological literature since the first report of the use of the platform.\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000We performed a systematic literature review of PubMed, Medline, and Web of Science databases on June 15th, 2020 searching for all available articles of da Vinci SP use from December 2014 (date of the first clinical report of da Vinci SP in the urology) until June 1st, 2020 following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u0000A total of 43 articles were eligible for inclusion. Ten studies reported different surgeries and techniques on cadavers while the rest described the clinical experience of different groups. We divided our article and tables into pre-clinical experience with surgery on cadavers, radical prostatectomy (RP) approach, and multiple types of procedures described in the same study.\u0000\u0000\u0000CONCLUSIONS\u0000The application of da Vinci SP in urologic procedures after five yearsof the first clinical investigation is feasible and safe. Radical prostatectomy is the most common intervention performed with this robot. Some groups described benefits in terms of less postoperative pain and early discharge, especially with the extraperitoneal approach. However, further studies with larger sample sizes and longer follow-up are awaited.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75524302","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 : 2020-09-01DOI: 10.23736/S0393-2249.20.03834-5
A. Tubaro, M. Niero, B. Adalig, Z. Lulic, Janet Plastino, Carie L. Kimbrough, M. Manyak
BACKGROUND Benign prostatic hyperplasia (BPH), a progressive condition and common cause of lower urinary tract symptoms (LUTS), is underdiagnosed in primary care, impacting patient outcomes. Here, we evaluate the utility of a BPH screening tool in general practice, to identify men confirmed to have BPH after urologist assessment of diagnostic test results. METHODS A 3-item questionnaire was developed to discriminate between LUTS due to BPH versus other conditions, and was translated and validated cross-culturally. Its utility was assessed in a cohort study (FDC116114/NCT02757963) conducted in 47 centers across France, Germany, Italy, Russia, and Spain. The study enrolled men ≥50 years of age presenting to general practice clinics with a score of ≥3 on the BPH screening tool or ≥8 on the International Prostate Symptom Score (IPSS). In total, 561 men completed the study. The primary endpoint was the proportion of patients with a urologist-confirmed BPH diagnosis among those with a positive result on the BPH screening tool (score ≥3) and serum prostate specific antigen (PSA) ≥2ng/mL. RESULTS The primary endpoint was fulfilled; 88.3% (95% CI: 84.9, 91.2) of patients had urologistconfirmed BPH diagnoses among those with positive results on the BPH screening tool and serum PSA ≥2ng/mL, similar to the proportion seen with IPSS ≥8 and serum PSA ≥2ng/mL (87.7%; 95% CI 84.6, 90.4). CONCLUSIONS The BPH screening tool, in conjunction with serum PSA, demonstrated adequate predictive value by allowing general practitioners to quickly screen men presenting with different medical conditions but identified as having urological symptoms.
背景:良性前列腺增生(BPH)是一种进行性疾病，也是下尿路症状(LUTS)的常见原因，在初级保健中诊断不足，影响患者的预后。在这里，我们评估了BPH筛查工具在一般实践中的效用，以识别经泌尿科医生评估诊断测试结果后确诊患有BPH的男性。方法采用3项问卷对BPH所致LUTS与其他情况下LUTS进行区分，并进行跨文化翻译和验证。在法国、德国、意大利、俄罗斯和西班牙的47个中心进行的队列研究(FDC116114/NCT02757963)中评估了其效用。该研究招募了年龄≥50岁，在全科诊所就诊，BPH筛查工具评分≥3分或国际前列腺症状评分(IPSS)评分≥8分的男性。总共有561名男性完成了这项研究。主要终点是泌尿科医生确诊的BPH诊断患者在BPH筛查工具(评分≥3)和血清前列腺特异性抗原(PSA)≥2ng/mL阳性结果患者中所占的比例。结果主要终点达到;在BPH筛查工具阳性且血清PSA≥2ng/mL的患者中，有88.3% (95% CI: 84.9, 91.2)的患者被泌尿科医生确诊为BPH，与IPSS≥8和血清PSA≥2ng/mL的患者比例相似(87.7%;95% ci 84.6, 90.4)。结论BPH筛查工具，结合血清PSA，显示出足够的预测价值，允许全科医生快速筛查出现不同医疗条件但确定有泌尿系统症状的男性。
{"title":"Evaluation of a 3-item screening tool to identify men with benign prostatic enlargement/obstruction in a primary care cohort.","authors":"A. Tubaro, M. Niero, B. Adalig, Z. Lulic, Janet Plastino, Carie L. Kimbrough, M. Manyak","doi":"10.23736/S0393-2249.20.03834-5","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.03834-5","url":null,"abstract":"BACKGROUND\u0000Benign prostatic hyperplasia (BPH), a progressive condition and common cause of lower urinary tract symptoms (LUTS), is underdiagnosed in primary care, impacting patient outcomes. Here, we evaluate the utility of a BPH screening tool in general practice, to identify men confirmed to have BPH after urologist assessment of diagnostic test results.\u0000\u0000\u0000METHODS\u0000A 3-item questionnaire was developed to discriminate between LUTS due to BPH versus other conditions, and was translated and validated cross-culturally. Its utility was assessed in a cohort study (FDC116114/NCT02757963) conducted in 47 centers across France, Germany, Italy, Russia, and Spain. The study enrolled men ≥50 years of age presenting to general practice clinics with a score of ≥3 on the BPH screening tool or ≥8 on the International Prostate Symptom Score (IPSS). In total, 561 men completed the study. The primary endpoint was the proportion of patients with a urologist-confirmed BPH diagnosis among those with a positive result on the BPH screening tool (score ≥3) and serum prostate specific antigen (PSA) ≥2ng/mL.\u0000\u0000\u0000RESULTS\u0000The primary endpoint was fulfilled; 88.3% (95% CI: 84.9, 91.2) of patients had urologistconfirmed BPH diagnoses among those with positive results on the BPH screening tool and serum PSA ≥2ng/mL, similar to the proportion seen with IPSS ≥8 and serum PSA ≥2ng/mL (87.7%; 95% CI 84.6, 90.4).\u0000\u0000\u0000CONCLUSIONS\u0000The BPH screening tool, in conjunction with serum PSA, demonstrated adequate predictive value by allowing general practitioners to quickly screen men presenting with different medical conditions but identified as having urological symptoms.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75276369","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 : 2020-09-01DOI: 10.23736/S0393-2249.20.03785-6
M. Marchioni, J. Cheaib, T. Takagi, N. Pavan, A. Antonelli, W. Everaerts, M. Heck, K. Rha, A. Mottrie, J. Kaouk, U. Capitanio, E. Lima, A. Veccia, S. Crivellaro, E. Linares, A. Celia, F. Porpiglia, R. Autorino, M. Di Nicola, L. Schips, P. Pierorazio, M. Mir
BACKGROUND To test the effect of active surveillance (AS) versus primary intervention (PI) on overall mortality (OM) in elderly patients diagnosed with SRM. METHODS Elderly patients (75 years or older) diagnosed with SRMs (< 4cm) and treated with either PI [i.e. partial nephrectomy or kidney ablation] or AS between 2009 and 2018 were abstracted from the REnal SURGery in the Elderly (RESURGE) and Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) datasets, respectively. OM rates were estimated among groups with Kaplan Meier method and Cox proportional hazards regression models after applying inverse probability of treatment weighting (IPTW). Multivariable logistic regression model was used to estimate IPTW. Covariates of interest were those unbalanced and/or significantly correlated with the treatment choice or with OM. RESULTS A total of 483 patients were included; 121 (25.1%) underwent AS. 60 patients (12.4%) died. Overall, 6.7% of all deaths were related to cancer. IPTW-Kaplan Meier curves showed a 5-year overall survival rates of 70.0 ± 3.5% and 73.2 ± 4.8% in AS and PI groups, respectively (IPTW-Log-rank p-value=0.308). IPTW-Cox regression model did not show meaningfully increased OM rates in AS group (HR=1.31, 95% CI: 0.69-2.49). CONCLUSIONS AS represents an appealing treatment option for very elderly patients presenting with SRM, as it avoids the risks of a PI while not compromising the survival outcomes of these patients.
{"title":"Active surveillance for small renal masses in elderly patients does not increase overall mortality rates compared to primary intervention: a propensity score weighted analysis.","authors":"M. Marchioni, J. Cheaib, T. Takagi, N. Pavan, A. Antonelli, W. Everaerts, M. Heck, K. Rha, A. Mottrie, J. Kaouk, U. Capitanio, E. Lima, A. Veccia, S. Crivellaro, E. Linares, A. Celia, F. Porpiglia, R. Autorino, M. Di Nicola, L. Schips, P. Pierorazio, M. Mir","doi":"10.23736/S0393-2249.20.03785-6","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.03785-6","url":null,"abstract":"BACKGROUND\u0000To test the effect of active surveillance (AS) versus primary intervention (PI) on overall mortality (OM) in elderly patients diagnosed with SRM.\u0000\u0000\u0000METHODS\u0000Elderly patients (75 years or older) diagnosed with SRMs (< 4cm) and treated with either PI [i.e. partial nephrectomy or kidney ablation] or AS between 2009 and 2018 were abstracted from the REnal SURGery in the Elderly (RESURGE) and Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) datasets, respectively. OM rates were estimated among groups with Kaplan Meier method and Cox proportional hazards regression models after applying inverse probability of treatment weighting (IPTW). Multivariable logistic regression model was used to estimate IPTW. Covariates of interest were those unbalanced and/or significantly correlated with the treatment choice or with OM.\u0000\u0000\u0000RESULTS\u0000A total of 483 patients were included; 121 (25.1%) underwent AS. 60 patients (12.4%) died. Overall, 6.7% of all deaths were related to cancer. IPTW-Kaplan Meier curves showed a 5-year overall survival rates of 70.0 ± 3.5% and 73.2 ± 4.8% in AS and PI groups, respectively (IPTW-Log-rank p-value=0.308). IPTW-Cox regression model did not show meaningfully increased OM rates in AS group (HR=1.31, 95% CI: 0.69-2.49).\u0000\u0000\u0000CONCLUSIONS\u0000AS represents an appealing treatment option for very elderly patients presenting with SRM, as it avoids the risks of a PI while not compromising the survival outcomes of these patients.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88605413","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 : 2020-08-04DOI: 10.23736/S0393-2249.20.03747-9
D. Veneziano, G. Patruno, M. Talso, T. Tokas, S. Proietti, A. Porreca, G. Kamphuis, S. Biyani, E. Emiliani, M. Cepeda Delgado, Lopez Maria De Mar Perez, R. Miano, S. Ferretti, N. Macchione, P. Kallidonis, E. Montanari, G. Tripepi, A. Ploumidis, G. Cacciamani, Estevão Lima, B. Somani
BACKGROUND Pi-score (Performance Improvement score) has been proven to be reliable to measure performance improvement during E-BLUS hands-on training sessions. Our study is aimed to adapt and test the score to EST s1 (Endoscopic Stone Treatment step 1) protocol, in consideration of its worldwide adoption for practical training. METHODS The Pi-score algorithm considers time measurement and number of errors from two different repetitions (first and fifth) of the same training task and compares them to the relative task goals, to produce an objective score. Data were obtained from the first edition of 'ART in Flexible Course', during 4 courses in Barcelona and Milan. Collected data were independently analysed by the experts for Pi assessment. Their scores were compared for inter-rater reliability. The average scores from all tutors were then compared to the PI-score provided by our algorithm for each participant, in order to verify their statistical correlation. Kappa Statistics was used for comparison analysis. RESULTS 16 Hands-on Training expert tutors and 47 3rd year residents in Urology were involved. Concordance found between the 16 proctors' scores was the following: Task1=0.30 ("fair"); Task2=0.18 ("slight"); Task3=0.10 ("slight"); Task4=0.20, ("slight"). Concordance between Pi-score results and proctor average scores per-participant was the following: Task1=0.74 ("substantial"); Task2=0.71 ("substantial"); Task3=0.46 ("moderate"); Task4=0.49 ("moderate"). CONCLUSIONS Our exploratory study demonstrates that Pi-score can be effectively adapted to EST s1. Our algorithm successfully provided an objective score that equals the average performance improvement scores assigned by of a cohort of experts, in relation to a small amount of training attempts.
{"title":"The performance improvement-score algorithm applied to endoscopic stone. Treatment step 1 protocol.","authors":"D. Veneziano, G. Patruno, M. Talso, T. Tokas, S. Proietti, A. Porreca, G. Kamphuis, S. Biyani, E. Emiliani, M. Cepeda Delgado, Lopez Maria De Mar Perez, R. Miano, S. Ferretti, N. Macchione, P. Kallidonis, E. Montanari, G. Tripepi, A. Ploumidis, G. Cacciamani, Estevão Lima, B. Somani","doi":"10.23736/S0393-2249.20.03747-9","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.03747-9","url":null,"abstract":"BACKGROUND\u0000Pi-score (Performance Improvement score) has been proven to be reliable to measure performance improvement during E-BLUS hands-on training sessions. Our study is aimed to adapt and test the score to EST s1 (Endoscopic Stone Treatment step 1) protocol, in consideration of its worldwide adoption for practical training.\u0000\u0000\u0000METHODS\u0000The Pi-score algorithm considers time measurement and number of errors from two different repetitions (first and fifth) of the same training task and compares them to the relative task goals, to produce an objective score. Data were obtained from the first edition of 'ART in Flexible Course', during 4 courses in Barcelona and Milan. Collected data were independently analysed by the experts for Pi assessment. Their scores were compared for inter-rater reliability. The average scores from all tutors were then compared to the PI-score provided by our algorithm for each participant, in order to verify their statistical correlation. Kappa Statistics was used for comparison analysis.\u0000\u0000\u0000RESULTS\u000016 Hands-on Training expert tutors and 47 3rd year residents in Urology were involved. Concordance found between the 16 proctors' scores was the following: Task1=0.30 (\"fair\"); Task2=0.18 (\"slight\"); Task3=0.10 (\"slight\"); Task4=0.20, (\"slight\"). Concordance between Pi-score results and proctor average scores per-participant was the following: Task1=0.74 (\"substantial\"); Task2=0.71 (\"substantial\"); Task3=0.46 (\"moderate\"); Task4=0.49 (\"moderate\").\u0000\u0000\u0000CONCLUSIONS\u0000Our exploratory study demonstrates that Pi-score can be effectively adapted to EST s1. Our algorithm successfully provided an objective score that equals the average performance improvement scores assigned by of a cohort of experts, in relation to a small amount of training attempts.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75357733","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 : 2020-08-04DOI: 10.23736/S0393-2249.20.03723-6
M. Gacci, M. Marchioni, P. De Francesco, C. Natoli, F. Calabrò, T. Losanno, Cito Giammartin, S. Serni, L. Doni, C. de Nunzio, M. De Tursi, M. Valeriani, S. Giacinti, M. Álvarez-Maestro, M. Scarcia, G. Ludovico, G. Del Bene, G. Simone, M. Ferriero, G. Tuderti, P. Bove, A. Laudisi, G. Carrieri, L. Cormio, P. Verze, R. La Rocca, M. Falsaperla, V. Frantellizzi, F. Greco, M. Di Nicola, L. Schips, L. Cindolo
BACKGROUND Metastatic castration-resistant prostate cancer (mCRPC) is the final stage of pCa history and represents a clinically relevant phenotype with an elevated burden of mortality. The aim of the present study is to evaluate the efficacy and safety of enzalutamide in a "real-life" setting in mCRPC patients. METHODS Data about all mCRPC patients treated with enzalutamide from September 2017 to September 2018 were collected. Demographics, comorbidities, clinical parameters, outcomes, toxicity, overall survival and progression free survival were analyzed. RESULTS Overall 158 patients were enrolled. Mean age was 75.8 (±8.7) years with a baseline median PSA of 16.5 (IQR 7.4-47.8) ng/mL. The median follow-up lasted 7.7 (IQR 4-14.1) months. Of all the 10.1% of patients reported grade 3-4 adverse events. 43.7% of patients experienced a progression. Overall the 6 and 12 months PFS rates were 69.5% (95% CI: 61.7-78.3%) and the 45.6% (95% CI: 36.5-57.1%); a median baseline PSA >16 ng/mL (HR:2.0, 95% CI: 1.2-3.3, p=0.005), the use of opioid (HR:3.1, 95% CI 1.9-5.0, p<0.001), a previous treatment (abiraterone, docetaxel or abiraterone + docetaxel) were significantly associated with higher rates of cancer progression. Conversely, a brief pain questionnaire of 0-1 (HR: 0.4, 95% CI: 0.2-0.7, p<0.001), a 12 weeks 50% PSA reduction (HR: 0.4, 95% CI: 0.2-0.8, p=0.006) and a longer time to mCRPC (HR: 0.4, 95% CI: 0.3-0.7, p=0.002) were related to lower cancer progression rates. CONCLUSIONS Our data shows an effective and safe profile of enzalutamide in a "realworld" perspective in patients with mcRPC.
{"title":"Enzalutamide in patients with castration-resistant prostate cancer: retrospective, multicenter, real life study.","authors":"M. Gacci, M. Marchioni, P. De Francesco, C. Natoli, F. Calabrò, T. Losanno, Cito Giammartin, S. Serni, L. Doni, C. de Nunzio, M. De Tursi, M. Valeriani, S. Giacinti, M. Álvarez-Maestro, M. Scarcia, G. Ludovico, G. Del Bene, G. Simone, M. Ferriero, G. Tuderti, P. Bove, A. Laudisi, G. Carrieri, L. Cormio, P. Verze, R. La Rocca, M. Falsaperla, V. Frantellizzi, F. Greco, M. Di Nicola, L. Schips, L. Cindolo","doi":"10.23736/S0393-2249.20.03723-6","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.03723-6","url":null,"abstract":"BACKGROUND\u0000Metastatic castration-resistant prostate cancer (mCRPC) is the final stage of pCa history and represents a clinically relevant phenotype with an elevated burden of mortality. The aim of the present study is to evaluate the efficacy and safety of enzalutamide in a \"real-life\" setting in mCRPC patients.\u0000\u0000\u0000METHODS\u0000Data about all mCRPC patients treated with enzalutamide from September 2017 to September 2018 were collected. Demographics, comorbidities, clinical parameters, outcomes, toxicity, overall survival and progression free survival were analyzed.\u0000\u0000\u0000RESULTS\u0000Overall 158 patients were enrolled. Mean age was 75.8 (±8.7) years with a baseline median PSA of 16.5 (IQR 7.4-47.8) ng/mL. The median follow-up lasted 7.7 (IQR 4-14.1) months. Of all the 10.1% of patients reported grade 3-4 adverse events. 43.7% of patients experienced a progression. Overall the 6 and 12 months PFS rates were 69.5% (95% CI: 61.7-78.3%) and the 45.6% (95% CI: 36.5-57.1%); a median baseline PSA >16 ng/mL (HR:2.0, 95% CI: 1.2-3.3, p=0.005), the use of opioid (HR:3.1, 95% CI 1.9-5.0, p<0.001), a previous treatment (abiraterone, docetaxel or abiraterone + docetaxel) were significantly associated with higher rates of cancer progression. Conversely, a brief pain questionnaire of 0-1 (HR: 0.4, 95% CI: 0.2-0.7, p<0.001), a 12 weeks 50% PSA reduction (HR: 0.4, 95% CI: 0.2-0.8, p=0.006) and a longer time to mCRPC (HR: 0.4, 95% CI: 0.3-0.7, p=0.002) were related to lower cancer progression rates.\u0000\u0000\u0000CONCLUSIONS\u0000Our data shows an effective and safe profile of enzalutamide in a \"realworld\" perspective in patients with mcRPC.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82187528","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 : 2020-08-04DOI: 10.23736/S0393-2249.20.03728-5
Stephen T. Ryan, Devin N. Patel, F. Ghali, Sunil H. Patel, R. Sarkar, Kendrick Yim, A. Eldefrawy*, B. Cotta, Aaron W Bradshawh, M. Meagher, Z. Hamilton, James D. Murphy, I. Derweesh
BACKGROUND The impact of positive surgical margins (PSM) on outcomes in partial nephrectomy (PN) is controversial. We investigated impact of PSM for patients undergoing PN on overall survival (OS) in different stages of renal cell carcinoma (RCC). METHODS Retrospective analysis of patients from the US National Cancer Database who underwent PN for cT1a-cT2b N0M0 RCC between 2004-13. Patients were stratified by pathological stage [pT1a, pT1b, pT2a, pT2b, and pT3a (upstaged)] and analyzed by margin status. Cox Regression multivariable analysis (MVA) was performed to investigate associations of PSM and covariates on all-cause mortality (ACM). Kaplan-Meier analysis (KMA) of OS was performed for PSM versus negative margin (NSM) by pathological stage. Subanalysis of Charlson Comorbidity Index 0 (CCI=0) subgroup was conducted to reduce bias from comorbidities. RESULTS We analyzed 42,113 PN [pT1a 33341 (79.2%) pT1a, pT1b 6689 (15.9%), pT2a 757 (1.8%), pT2b 165 (0.4%) and pT3a upstaged 1161 (2.8%)]. PSM occurred in 6.7% (2823) [pT1a 6.5%, pT1b 6.3%, pT2a 5.9%, pT2b 6.1%, pT3a 14.1% p<0.001]. On MVA, PSM was associated with 31% increase in ACM (HR 1.31, p<0.001), which persisted in CCI=0 subanalysis (HR 1.25, p<0.001). KMA revealed negative impact of PSM vs. NSM on 5-year OS: pT1 (87.3% vs. 90.9%, p<0.001), pT2 (86.7% vs. 82.5%, p=0.48), and upstaged pT3a (69% vs. 84.2%, p<0.001). CONCLUSIONS PSM after PN was independently associated with across-the-board decrement in OS, which worsened in pT3a disease and persisted in subanalysis of patients with CCI=0. PSM should prompt more aggressive surveillance or definitive resection strategies.
{"title":"Impact of positive surgical margins on survival after partial nephrectomy in localized kidney cancer: analysis of the National Cancer Database.","authors":"Stephen T. Ryan, Devin N. Patel, F. Ghali, Sunil H. Patel, R. Sarkar, Kendrick Yim, A. Eldefrawy*, B. Cotta, Aaron W Bradshawh, M. Meagher, Z. Hamilton, James D. Murphy, I. Derweesh","doi":"10.23736/S0393-2249.20.03728-5","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.03728-5","url":null,"abstract":"BACKGROUND\u0000The impact of positive surgical margins (PSM) on outcomes in partial nephrectomy (PN) is controversial. We investigated impact of PSM for patients undergoing PN on overall survival (OS) in different stages of renal cell carcinoma (RCC).\u0000\u0000\u0000METHODS\u0000Retrospective analysis of patients from the US National Cancer Database who underwent PN for cT1a-cT2b N0M0 RCC between 2004-13. Patients were stratified by pathological stage [pT1a, pT1b, pT2a, pT2b, and pT3a (upstaged)] and analyzed by margin status. Cox Regression multivariable analysis (MVA) was performed to investigate associations of PSM and covariates on all-cause mortality (ACM). Kaplan-Meier analysis (KMA) of OS was performed for PSM versus negative margin (NSM) by pathological stage. Subanalysis of Charlson Comorbidity Index 0 (CCI=0) subgroup was conducted to reduce bias from comorbidities.\u0000\u0000\u0000RESULTS\u0000We analyzed 42,113 PN [pT1a 33341 (79.2%) pT1a, pT1b 6689 (15.9%), pT2a 757 (1.8%), pT2b 165 (0.4%) and pT3a upstaged 1161 (2.8%)]. PSM occurred in 6.7% (2823) [pT1a 6.5%, pT1b 6.3%, pT2a 5.9%, pT2b 6.1%, pT3a 14.1% p<0.001]. On MVA, PSM was associated with 31% increase in ACM (HR 1.31, p<0.001), which persisted in CCI=0 subanalysis (HR 1.25, p<0.001). KMA revealed negative impact of PSM vs. NSM on 5-year OS: pT1 (87.3% vs. 90.9%, p<0.001), pT2 (86.7% vs. 82.5%, p=0.48), and upstaged pT3a (69% vs. 84.2%, p<0.001).\u0000\u0000\u0000CONCLUSIONS\u0000PSM after PN was independently associated with across-the-board decrement in OS, which worsened in pT3a disease and persisted in subanalysis of patients with CCI=0. PSM should prompt more aggressive surveillance or definitive resection strategies.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81701314","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 : 2020-08-01Epub Date: 2020-04-16DOI: 10.23736/S0393-2249.20.03813-8
Aldo Brassetti, Umberto Anceschi, Riccardo Bertolo, Mariaconsiglia Ferriero, Gabriele Tuderti, Manuela Costantini, Umberto Capitanio, Alessandro Larcher, Alessandro Antonelli, Alexander Mottrie, Andrea Minervini, Paolo Dell'oglio, Alessandro Veccia, Daniele Amparore, Rocco S Flammia, Riccardo Lombardo, Cosimo De Nunzio, Luigi Benecchi, Andrea Mari, Francesco Porpiglia, Francesco Montorsi, Jihad Kaouk, Riccardo Autorino, Michele Gallucci, Giuseppe Simone
Background: We proposed a new tool (named ROMe's) to summarize long-term outcomes after partial nephrectomy (PN), identified its predictors and generated a predicting nomogram.
Methods: A retrospective analysis of a multicenter dataset of patients with non-metastatic pT1-3a renal cell carcinoma was performed. Baseline demographic, clinical, pathologic and perioperative data were collected. ROMe's was defined as the concomitant lack of cancer-recurrences, death and newly onset Chronic Kidney Disease (CKD), at long term follow-up. Kaplan-Meier method investigated the predictive role of Trifecta on ROMe's achievement. Univariable and multivariable Cox regression analyses identified its predictors. A nomogram was generated and its accuracy was quantified using concordance index (CI). A calibration plot was obtained with 200 bootstraps resampling to explore nomogram performance at 5 years and decision curve analyses (DCA) assessed the net benefit of the model at 12, 36 and 60 months.
Results: We included 927 patients. The rates of ROMe's were 82%, 72% and 56% at 1, 3 and 5 years follow-up. At Kaplan-Meier analysis, patients who achieved Trifecta displayed a significantly higher probability of ROMe's (log rank P<0.001). Young age (OR=0.982; P=0.001), low RENAL score (OR=0.86; P=0.037), high preoperative filtration rate (OR=1.02; P<0.001) and Trifecta achievement (OR=2.03; P=0.015), were independent predictors of ROMe's. The nomogram showed a CI of 0.76 at 60 months. The 5-years calibration plot confirmed a good discrimination accuracy (0.74); on DCA, the net benefit of using the model was evident for probabilities >30%.
Conclusions: We conceived a triad to summarize the main long-term oncologic and functional outcomes after PN and generated a predicting nomogram.
背景:我们提出了一种新的工具(命名为ROMe’s)来总结部分肾切除术(PN)后的长期预后，确定其预测因素并生成预测nomogram。方法:对非转移性pT1-3a肾细胞癌患者的多中心数据集进行回顾性分析。收集基线人口统计学、临床、病理和围手术期资料。在长期随访中，ROMe被定义为没有癌症复发、死亡和新发慢性肾脏疾病(CKD)。Kaplan-Meier法研究了Trifecta对ROMe成绩的预测作用。单变量和多变量Cox回归分析确定了其预测因子。生成nomogram并使用concordance index (CI)对其准确性进行量化。通过200次自举重新采样获得校准图，以探索5年的nomogram性能，并通过决策曲线分析(decision curve analysis, DCA)评估模型在12、36和60个月的净效益。结果:纳入927例患者。随访1年、3年和5年时，ROMe的发生率分别为82%、72%和56%。Kaplan-Meier分析显示，服用三连片的患者出现ROMe (log rank P30%)的概率显著提高。结论:我们设想了一个三重指标来总结PN后主要的长期肿瘤和功能结果，并生成了预测图。
{"title":"Comprehensive long-term assessment of outcomes following robot-assisted partial nephrectomy for renal cell carcinoma: the ROMe's achievement and its predicting nomogram.","authors":"Aldo Brassetti, Umberto Anceschi, Riccardo Bertolo, Mariaconsiglia Ferriero, Gabriele Tuderti, Manuela Costantini, Umberto Capitanio, Alessandro Larcher, Alessandro Antonelli, Alexander Mottrie, Andrea Minervini, Paolo Dell'oglio, Alessandro Veccia, Daniele Amparore, Rocco S Flammia, Riccardo Lombardo, Cosimo De Nunzio, Luigi Benecchi, Andrea Mari, Francesco Porpiglia, Francesco Montorsi, Jihad Kaouk, Riccardo Autorino, Michele Gallucci, Giuseppe Simone","doi":"10.23736/S0393-2249.20.03813-8","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.03813-8","url":null,"abstract":"<p><strong>Background: </strong>We proposed a new tool (named ROMe's) to summarize long-term outcomes after partial nephrectomy (PN), identified its predictors and generated a predicting nomogram.</p><p><strong>Methods: </strong>A retrospective analysis of a multicenter dataset of patients with non-metastatic pT1-3a renal cell carcinoma was performed. Baseline demographic, clinical, pathologic and perioperative data were collected. ROMe's was defined as the concomitant lack of cancer-recurrences, death and newly onset Chronic Kidney Disease (CKD), at long term follow-up. Kaplan-Meier method investigated the predictive role of Trifecta on ROMe's achievement. Univariable and multivariable Cox regression analyses identified its predictors. A nomogram was generated and its accuracy was quantified using concordance index (CI). A calibration plot was obtained with 200 bootstraps resampling to explore nomogram performance at 5 years and decision curve analyses (DCA) assessed the net benefit of the model at 12, 36 and 60 months.</p><p><strong>Results: </strong>We included 927 patients. The rates of ROMe's were 82%, 72% and 56% at 1, 3 and 5 years follow-up. At Kaplan-Meier analysis, patients who achieved Trifecta displayed a significantly higher probability of ROMe's (log rank P<0.001). Young age (OR=0.982; P=0.001), low RENAL score (OR=0.86; P=0.037), high preoperative filtration rate (OR=1.02; P<0.001) and Trifecta achievement (OR=2.03; P=0.015), were independent predictors of ROMe's. The nomogram showed a CI of 0.76 at 60 months. The 5-years calibration plot confirmed a good discrimination accuracy (0.74); on DCA, the net benefit of using the model was evident for probabilities >30%.</p><p><strong>Conclusions: </strong>We conceived a triad to summarize the main long-term oncologic and functional outcomes after PN and generated a predicting nomogram.</p>","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37840760","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 : 2020-08-01Epub Date: 2020-04-07DOI: 10.23736/S0393-2249.20.03868-0
Daniele Amparore, Francesco Claps, Giovanni E Cacciamani, Francesco Esperto, Cristian Fiori, Giovanni Liguori, Sergio Serni, Carlo Trombetta, Marco Carini, Francesco Porpiglia, Enrico Checcucci, Riccardo Campi
In the global emergency scenario caused by COVID-19 pandemic, the Urology residents' training might be critically affected. To provide insights on this issue, a 25-item online Survey was sent to all Italian residents one month after the first case of COVID-19 in Italy, to evaluate their routine involvement in "clinical" (on-call duty, outpatient visits, diagnostic procedures) and "surgical" (endoscopic, open and minimally invasive surgery) training activities before and during the COVID-19 period. Overall, 351 of 577 (60.8%) residents completed the Survey. Before the COVID-19 pandemic, the proportion of residents routinely involved in "clinical" and "surgical" activities ranged from 79.8% to 87.2% and from 49.3% to 73.5%, respectively. In the COVID-19 period, the proportion of residents experiencing a severe reduction (>40%) or complete suppression (>80%) of training exposure ranged between 41.1% and 81.2% for "clinical" activities while between 44.2% and 62.1% for "surgical" activities. This reduction was even more pronounced for residents attending the final year of training. Our study is the first to provide real-life data on how Urology residency training can be impaired during an emergency period. To address this challenge, strategies aiming to increase the use of telemedicine, "smart learning" programs and tele-mentoring of surgical procedures, are warranted.
{"title":"Impact of the COVID-19 pandemic on urology residency training in Italy.","authors":"Daniele Amparore, Francesco Claps, Giovanni E Cacciamani, Francesco Esperto, Cristian Fiori, Giovanni Liguori, Sergio Serni, Carlo Trombetta, Marco Carini, Francesco Porpiglia, Enrico Checcucci, Riccardo Campi","doi":"10.23736/S0393-2249.20.03868-0","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.03868-0","url":null,"abstract":"<p><p>In the global emergency scenario caused by COVID-19 pandemic, the Urology residents' training might be critically affected. To provide insights on this issue, a 25-item online Survey was sent to all Italian residents one month after the first case of COVID-19 in Italy, to evaluate their routine involvement in \"clinical\" (on-call duty, outpatient visits, diagnostic procedures) and \"surgical\" (endoscopic, open and minimally invasive surgery) training activities before and during the COVID-19 period. Overall, 351 of 577 (60.8%) residents completed the Survey. Before the COVID-19 pandemic, the proportion of residents routinely involved in \"clinical\" and \"surgical\" activities ranged from 79.8% to 87.2% and from 49.3% to 73.5%, respectively. In the COVID-19 period, the proportion of residents experiencing a severe reduction (>40%) or complete suppression (>80%) of training exposure ranged between 41.1% and 81.2% for \"clinical\" activities while between 44.2% and 62.1% for \"surgical\" activities. This reduction was even more pronounced for residents attending the final year of training. Our study is the first to provide real-life data on how Urology residency training can be impaired during an emergency period. To address this challenge, strategies aiming to increase the use of telemedicine, \"smart learning\" programs and tele-mentoring of surgical procedures, are warranted.</p>","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37806952","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 : 2020-08-01DOI: 10.23736/S0393-2249.19.03387-3
R. Choo, A. Nehra, F. Zattoni, L. Pagliaro, R. Karnes
PURPOSE To evaluate whether there is any benefit in adding postoperative adjuvant concurrent radiotherapy and chemotherapy (RT-CHT) for penile cancer with regional lymph node metastasis (RLNM). MATERIALS AND METHODS A single institution, retrospective study was conducted for a total of 23 patients with RLNM from penile squamous cell carcinoma. All underwent a definitive surgical intervention for both primary tumor and RLNM. Of these, 11 patients received adjuvant concurrent RT and CHT within 3 months after surgery (RT-CHT Group), while 12 patients received no additional treatment (Surveillance Group). Overall survival was calculated with the Kaplan-Meier method. The difference in survival between the two groups was tested using the log-rank test. A potential prognostic factor for survival was evaluated using a univariate Cox-proportional hazards model. RESULTS Median follow-up for the entire group was 15.8 months (17.1 months for the RT-CHT group and 10.7 months for the Surveillance Group). Overall survival at 1 and 2 years were 54.5% and 27.2%, respectively, for the RT-CHT Group, compared to 57.1% and 28.4% for the Surveillance Group (log-rank=0.68). On a univariate analysis, the number of involved lymph nodes and the presence of pN3 disease were associated with poor prognosis (p>0.001 and p=0.049, respectively). The RT-CHT Group had more extensive RLNM with a higher median number of positive nodes (5 vs. 3) and more pN3 disease (72.7% vs. 16.7%) than the Surveillance Group. The rate of complications requiring hospitalization was higher in the RT-CHT Group (63.6% vs. 16.6%; p=0.02), as was the rate of systemic complications (34.7% vs. 0%; p <0.01). CONCLUSIONS Penile cancer with extensive RLNM carries a poor prognosis. Despite having more extensive RLNM, the RT-CHT group had a similar overall survival as the Surveillance Group. This suggests a potential benefit of postoperative adjuvant concurrent RT-CHT for patients with extensive RLNM, although it carries an increased risk of complications. Further study is warranted to assess the benefit-to-risk ratio of this combined adjuvant therapy.
目的探讨阴茎癌合并区域淋巴结转移(RLNM)术后增加辅助放化疗(RT-CHT)是否有益处。材料与方法对23例阴茎鳞状细胞癌RLNM患者进行单机构回顾性研究。所有患者都接受了原发性肿瘤和RLNM的明确手术干预。其中，11例患者在术后3个月内同时接受辅助RT和CHT治疗(RT-CHT组)，12例患者未接受额外治疗(观察组)。用Kaplan-Meier法计算总生存期。两组的生存差异采用log-rank检验。使用单变量cox -比例风险模型评估潜在的生存预后因素。结果全组中位随访时间为15.8个月(RT-CHT组17.1个月，监测组10.7个月)。RT-CHT组1年和2年的总生存率分别为54.5%和27.2%，而监测组为57.1%和28.4% (log-rank=0.68)。在单变量分析中，受累淋巴结的数量和pN3疾病的存在与预后不良相关(p>0.001和p=0.049)。RT-CHT组的RLNM更广泛，阳性淋巴结中位数更高(5比3)，pN3疾病更多(72.7%比16.7%)。RT-CHT组并发症住院率更高(63.6% vs. 16.6%;P =0.02)，全身性并发症发生率(34.7% vs 0%;p < 0.01)。结论膀胱癌伴广泛RLNM预后较差。尽管有更广泛的RLNM, RT-CHT组的总生存率与监视组相似。这表明对于广泛的RLNM患者，术后辅助并发RT-CHT有潜在的益处，尽管它会增加并发症的风险。需要进一步的研究来评估这种联合辅助治疗的获益-风险比。
{"title":"Is there any benefit in adding postoperative adjuvant concurrent radiotherapy and chemotherapy for penile cancer with regional lymph node metastasis?","authors":"R. Choo, A. Nehra, F. Zattoni, L. Pagliaro, R. Karnes","doi":"10.23736/S0393-2249.19.03387-3","DOIUrl":"https://doi.org/10.23736/S0393-2249.19.03387-3","url":null,"abstract":"PURPOSE\u0000To evaluate whether there is any benefit in adding postoperative adjuvant concurrent radiotherapy and chemotherapy (RT-CHT) for penile cancer with regional lymph node metastasis (RLNM).\u0000\u0000\u0000MATERIALS AND METHODS\u0000A single institution, retrospective study was conducted for a total of 23 patients with RLNM from penile squamous cell carcinoma. All underwent a definitive surgical intervention for both primary tumor and RLNM. Of these, 11 patients received adjuvant concurrent RT and CHT within 3 months after surgery (RT-CHT Group), while 12 patients received no additional treatment (Surveillance Group). Overall survival was calculated with the Kaplan-Meier method. The difference in survival between the two groups was tested using the log-rank test. A potential prognostic factor for survival was evaluated using a univariate Cox-proportional hazards model.\u0000\u0000\u0000RESULTS\u0000Median follow-up for the entire group was 15.8 months (17.1 months for the RT-CHT group and 10.7 months for the Surveillance Group). Overall survival at 1 and 2 years were 54.5% and 27.2%, respectively, for the RT-CHT Group, compared to 57.1% and 28.4% for the Surveillance Group (log-rank=0.68). On a univariate analysis, the number of involved lymph nodes and the presence of pN3 disease were associated with poor prognosis (p>0.001 and p=0.049, respectively). The RT-CHT Group had more extensive RLNM with a higher median number of positive nodes (5 vs. 3) and more pN3 disease (72.7% vs. 16.7%) than the Surveillance Group. The rate of complications requiring hospitalization was higher in the RT-CHT Group (63.6% vs. 16.6%; p=0.02), as was the rate of systemic complications (34.7% vs. 0%; p <0.01).\u0000\u0000\u0000CONCLUSIONS\u0000Penile cancer with extensive RLNM carries a poor prognosis. Despite having more extensive RLNM, the RT-CHT group had a similar overall survival as the Surveillance Group. This suggests a potential benefit of postoperative adjuvant concurrent RT-CHT for patients with extensive RLNM, although it carries an increased risk of complications. Further study is warranted to assess the benefit-to-risk ratio of this combined adjuvant therapy.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87017006","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 : 2020-08-01Epub Date: 2020-05-20DOI: 10.23736/S0393-2249.20.03930-2
Roberto Gennari, Richard Naspro
{"title":"Do we need an ad-hoc informed consent for patients treated in the COVID-19 era? The risk of falling from heroes to zeros.","authors":"Roberto Gennari, Richard Naspro","doi":"10.23736/S0393-2249.20.03930-2","DOIUrl":"https://doi.org/10.23736/S0393-2249.20.03930-2","url":null,"abstract":"","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37955491","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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