Pub Date : 2024-06-01DOI: 10.23736/S2724-6051.24.05737-9
Francesco Ditonno, Antonio Franco, Alessandro Veccia, Eugenio Bologna, Linhui Wang, Firas Abdollah, Marco Finati, Giuseppe Simone, Gabriele Tuderti, Emma Helstrom, Andreas Correa, Ottavio DE Cobelli, Matteo Ferro, Francesco Porpiglia, Daniele Amparore, Antonio Tufano, Sisto Perdonà, Raj Bhanvadia, Vitaly Margulis, Andres Brönimann, Nirmish Singla, Dhruv Puri, Ithaar H Derweesh, Dinno F Mendiola, Mark L Gonzalgo, Reuben Ben-David, Reza Mehrazin, Sol C Moon, Soroush Rais-Bahrami, Courtney Yong, Farshad Sheybaee Moghaddam, Alireza Ghoreifi, Chandru P Sundaram, Zhenjie Wu, Hooman Djaladat, Alessandro Antonelli, Riccardo Autorino
Background: The role of kidney-sparing surgery in patients with high-risk upper urinary tract urothelial carcinoma is controversial. The present study aimed to assess oncological and functional outcomes of robot-assisted distal ureterectomy in patients with high-risk distal ureteral tumors.
Methods: The ROBUUST 2.0 multicenter international (2015-2022) dataset was used for this retrospective cohort analysis. High-risk patients with distal ureteral tumors were divided based on type of surgery: robot-assisted distal ureterectomy or robot-assisted nephroureterectomy. A survival analysis was performed for local recurrence-free survival, distant metastasis-free survival, and overall survival. After adjusting for clinical features of the high-risk prognostic group, Cox proportional hazard model was plotted to evaluate significant predictors of time-to-event outcomes.
Results: Overall, 477 patients were retrieved, of which 58 received robot-assisted distal ureterectomy and 419 robot-assisted nephroureterectomy, respectively, with a mean (±SD) follow-up of 29.6 months (±2.6). The two groups were comparable in terms of baseline features. At survival analysis, no significant difference was observed in terms of recurrence-free survival (P=0.6), metastasis-free survival (P=0.5) and overall survival (P=0.7) between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy. At Cox regression analysis, type of surgery was never a significant predictor of worse oncological outcomes. At last follow-up patients undergoing robot-assisted distal ureterectomy had significantly better postoperative renal function.
Conclusions: Comparable outcomes in terms of recurrence-free survival, metastasis-free survival, and overall survival between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy patients, and better postoperative renal function preservation in the former group were observed. Kidney-sparing surgery should be considered as a potential option for selected patients with high-risk distal ureteral UTUC.
{"title":"Robotic distal ureterectomy for high-risk distal ureteral urothelial carcinoma: a retrospective multicenter comparative analysis (ROBUUST 2.0 collaborative group).","authors":"Francesco Ditonno, Antonio Franco, Alessandro Veccia, Eugenio Bologna, Linhui Wang, Firas Abdollah, Marco Finati, Giuseppe Simone, Gabriele Tuderti, Emma Helstrom, Andreas Correa, Ottavio DE Cobelli, Matteo Ferro, Francesco Porpiglia, Daniele Amparore, Antonio Tufano, Sisto Perdonà, Raj Bhanvadia, Vitaly Margulis, Andres Brönimann, Nirmish Singla, Dhruv Puri, Ithaar H Derweesh, Dinno F Mendiola, Mark L Gonzalgo, Reuben Ben-David, Reza Mehrazin, Sol C Moon, Soroush Rais-Bahrami, Courtney Yong, Farshad Sheybaee Moghaddam, Alireza Ghoreifi, Chandru P Sundaram, Zhenjie Wu, Hooman Djaladat, Alessandro Antonelli, Riccardo Autorino","doi":"10.23736/S2724-6051.24.05737-9","DOIUrl":"10.23736/S2724-6051.24.05737-9","url":null,"abstract":"<p><strong>Background: </strong>The role of kidney-sparing surgery in patients with high-risk upper urinary tract urothelial carcinoma is controversial. The present study aimed to assess oncological and functional outcomes of robot-assisted distal ureterectomy in patients with high-risk distal ureteral tumors.</p><p><strong>Methods: </strong>The ROBUUST 2.0 multicenter international (2015-2022) dataset was used for this retrospective cohort analysis. High-risk patients with distal ureteral tumors were divided based on type of surgery: robot-assisted distal ureterectomy or robot-assisted nephroureterectomy. A survival analysis was performed for local recurrence-free survival, distant metastasis-free survival, and overall survival. After adjusting for clinical features of the high-risk prognostic group, Cox proportional hazard model was plotted to evaluate significant predictors of time-to-event outcomes.</p><p><strong>Results: </strong>Overall, 477 patients were retrieved, of which 58 received robot-assisted distal ureterectomy and 419 robot-assisted nephroureterectomy, respectively, with a mean (±SD) follow-up of 29.6 months (±2.6). The two groups were comparable in terms of baseline features. At survival analysis, no significant difference was observed in terms of recurrence-free survival (P=0.6), metastasis-free survival (P=0.5) and overall survival (P=0.7) between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy. At Cox regression analysis, type of surgery was never a significant predictor of worse oncological outcomes. At last follow-up patients undergoing robot-assisted distal ureterectomy had significantly better postoperative renal function.</p><p><strong>Conclusions: </strong>Comparable outcomes in terms of recurrence-free survival, metastasis-free survival, and overall survival between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy patients, and better postoperative renal function preservation in the former group were observed. Kidney-sparing surgery should be considered as a potential option for selected patients with high-risk distal ureteral UTUC.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2023-12-13DOI: 10.23736/S2724-6051.23.05458-7
Ayhan Karakose, Yasin Yitgin
Background: The aim of this study was to investigate the efficacy, safety, and outcomes of the combination of low ıntensity external shock wave therapy (Li-ESWT) and platelet-rich plasma (PRP) therapy in acute phase Peyronie's disease (PD).
Methods: The datas of patients admitted with acute phase Peyronie's between January 2014 and January 2022 were reviewed retrospectively. In total, we included total 159 patients who used combination of vitamin E 600 mg/day plus colchicine 1.5 mg/day plus oral daily 5 mg tadalafil (N.=77) in group 1 and received Li-ESWT+PRP combination therapy plus oral daily 5 mg tadalafil (N.=82) in group 2. We noted characteristics of fibrous plaques, pain status, penile curvature degree, and erectile function parameters. All patients were visited at the 3rd and 12th months after the treatment.
Results: Preoperative demographic characteristics were similar in the two groups. There was a statistically significant improvement in the mean plaque size, penile curvature degree, IIEF-5 and VAS scores in the intervention group after the treatment. Ecchymosis and hematoma were not observed at the injection site and Li-ESWT application areas in the intervention group. No local or systemic drug reactions were noted in either group.
Conclusions: Combination of Li-ESWT and PRP are highly effective and safety to early treatment in the acute phase PD.
研究背景本研究旨在探讨低强度体外冲击波疗法(Li-ESWT)和富血小板血浆疗法(PRP)联合治疗急性期佩罗尼氏病(PD)的疗效、安全性和结果:回顾性分析2014年1月至2022年1月期间收治的急性期佩罗尼氏病患者的数据。我们共纳入了159名患者,其中第1组患者使用维生素E 600 mg/天+秋水仙碱1.5 mg/天+每日口服5 mg他达拉非(N=77)的组合疗法,第2组患者接受Li-ESWT+PRP组合疗法+每日口服5 mg他达拉非(N=82)的组合疗法,我们记录了纤维斑块的特征、疼痛状况、阴茎弯曲程度和勃起功能参数。所有患者均在治疗后第3个月和第12个月接受了回访:结果:两组患者术前的人口统计学特征相似。结果:两组患者术前人口统计学特征相似,治疗后干预组患者的平均斑块大小、阴茎弯曲度、IIEF-5 和 VAS 评分均有明显改善。干预组的注射部位和Li-ESWT应用区域未观察到瘀斑和血肿。两组均未发现局部或全身药物反应:结论:Li-ESWT和PRP联合疗法对急性期脊髓灰质炎的早期治疗非常有效和安全。
{"title":"A new alternative approach to management of acute phase Peyronie's disease: low intensity extracorporeal shockwave therapy and platelet-rich plasma.","authors":"Ayhan Karakose, Yasin Yitgin","doi":"10.23736/S2724-6051.23.05458-7","DOIUrl":"10.23736/S2724-6051.23.05458-7","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to investigate the efficacy, safety, and outcomes of the combination of low ıntensity external shock wave therapy (Li-ESWT) and platelet-rich plasma (PRP) therapy in acute phase Peyronie's disease (PD).</p><p><strong>Methods: </strong>The datas of patients admitted with acute phase Peyronie's between January 2014 and January 2022 were reviewed retrospectively. In total, we included total 159 patients who used combination of vitamin E 600 mg/day plus colchicine 1.5 mg/day plus oral daily 5 mg tadalafil (N.=77) in group 1 and received Li-ESWT+PRP combination therapy plus oral daily 5 mg tadalafil (N.=82) in group 2. We noted characteristics of fibrous plaques, pain status, penile curvature degree, and erectile function parameters. All patients were visited at the 3<sup>rd</sup> and 12<sup>th</sup> months after the treatment.</p><p><strong>Results: </strong>Preoperative demographic characteristics were similar in the two groups. There was a statistically significant improvement in the mean plaque size, penile curvature degree, IIEF-5 and VAS scores in the intervention group after the treatment. Ecchymosis and hematoma were not observed at the injection site and Li-ESWT application areas in the intervention group. No local or systemic drug reactions were noted in either group.</p><p><strong>Conclusions: </strong>Combination of Li-ESWT and PRP are highly effective and safety to early treatment in the acute phase PD.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138800078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.23736/S2724-6051.24.05511-3
Judith Stangl-Kremser, Laura Olivera, Sofia Giudici, Benjamin Pradere, Laura S Mertens, Simone Albisinni, Ekaterina Laukhtina, Francesco Del Giudice, Luca Afferi, Francesco Soria, Simone Sforza, Fardod O'Kelly, Rianne J Lammers, Mesrur S Silay, Andrea Minervini, Lorenzo Masieri, Ardavan Akhavan, Lisette A 't Hoen, Marco Moschini, Andrea Mari
Introduction: Consensus for Enhanced Recovery After Surgery (ERAS) in pediatrics has been achieved in neonatal intestinal surgery, yet it is not widely utilized in pediatric urology. We investigated the application of ERAS guidelines in pediatric urology, and determined its effects given the available level of evidence supporting the ERAS protocol in children.
Evidence acquisition: A systematic literature review including series providing adoption of fast-track recovery protocols for pediatric urology procedures was carried out. Main outcome measures were study characteristics, adherence to the 19 ERAS items, complication rates and length of hospital stay. Sub-group analysis by surgery type (hypospadias versus major surgery) was performed.
Evidence synthesis: Nine series with data from 1272 surgical pediatric cases were included. An enhanced recovery pathway was applied in 67.3% of the reports. Two series included patients undergoing hypospadias repair and ERAS items were insufficiently reported. Studies including children undergoing major procedures mentioned a median of 15 ERAS items, yet applied a median of 11 items. Median compliance rate was 88.9% (range 50-100). More ERAS guideline items were reported (applied or mentioned) in the most recently published studies.
Conclusions: There is limited reporting and use of the ERAS guidelines in urologic surgery particularly in hypospadias repair; whilst in major surgery in children, adherence and compliance rates vary widely. In more recent series there was an increase in ERAS items that have been mentioned and applied. Future research is needed to identify barriers and to overcome them in order to fully adopt and benefit from the ERAS pathway.
{"title":"Application of the ERAS guidelines in pediatric urological surgery: a systematic review.","authors":"Judith Stangl-Kremser, Laura Olivera, Sofia Giudici, Benjamin Pradere, Laura S Mertens, Simone Albisinni, Ekaterina Laukhtina, Francesco Del Giudice, Luca Afferi, Francesco Soria, Simone Sforza, Fardod O'Kelly, Rianne J Lammers, Mesrur S Silay, Andrea Minervini, Lorenzo Masieri, Ardavan Akhavan, Lisette A 't Hoen, Marco Moschini, Andrea Mari","doi":"10.23736/S2724-6051.24.05511-3","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05511-3","url":null,"abstract":"<p><strong>Introduction: </strong>Consensus for Enhanced Recovery After Surgery (ERAS) in pediatrics has been achieved in neonatal intestinal surgery, yet it is not widely utilized in pediatric urology. We investigated the application of ERAS guidelines in pediatric urology, and determined its effects given the available level of evidence supporting the ERAS protocol in children.</p><p><strong>Evidence acquisition: </strong>A systematic literature review including series providing adoption of fast-track recovery protocols for pediatric urology procedures was carried out. Main outcome measures were study characteristics, adherence to the 19 ERAS items, complication rates and length of hospital stay. Sub-group analysis by surgery type (hypospadias versus major surgery) was performed.</p><p><strong>Evidence synthesis: </strong>Nine series with data from 1272 surgical pediatric cases were included. An enhanced recovery pathway was applied in 67.3% of the reports. Two series included patients undergoing hypospadias repair and ERAS items were insufficiently reported. Studies including children undergoing major procedures mentioned a median of 15 ERAS items, yet applied a median of 11 items. Median compliance rate was 88.9% (range 50-100). More ERAS guideline items were reported (applied or mentioned) in the most recently published studies.</p><p><strong>Conclusions: </strong>There is limited reporting and use of the ERAS guidelines in urologic surgery particularly in hypospadias repair; whilst in major surgery in children, adherence and compliance rates vary widely. In more recent series there was an increase in ERAS items that have been mentioned and applied. Future research is needed to identify barriers and to overcome them in order to fully adopt and benefit from the ERAS pathway.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.23736/S2724-6051.24.05532-0
Aldo Brassetti, Giuseppe Chiacchio, Umberto Anceschi, Alfredo Bove, Mariaconsiglia Ferriero, Simone D'Annunzio, Leonardo Misuraca, Salvatore Guaglianone, Gabriele Tuderti, Riccardo Mastroianni, Francesco Tedesco, Loris Cacciatore, Flavia Proietti, Simone R Flammia, Cosimo De Nunzio, Gabriele Cozzi, Costantino Leonardo, Andrea B Galosi, Giuseppe Simone
Introduction: Inguinal lymph nodes dissection (ILND) is recommended in patients presenting with high-risk penile (PC) or vulvar cancers (VC). Though, this surgical procedure is underused because of its anticipated morbidity. Minimally invasive approaches were proposed to minimize complications associated with open surgery. In this review, we analyze current available data exploring intra and perioperative outcomes of robot-assisted ILND (RAIL).
Evidence acquisition: On April 9th, 2023, a literature search was conducted using the PubMed and Scopus databases. The search employed the combination of the following terms: ("robotic assisted" OR "robot-assisted" OR "robotic") AND ("inguinal lymph node dissection" OR "lymphadenectomy") AND ("penile cancer" OR "vulvar cancer"). Out of the 404 identified articles, 18 were used for the present scoping review and their results were reported according to the PRISMA statement.
Evidence synthesis: Data on 171 patients, ranging in age from 32 to 85 years, were obtained. Most of them (90.6%) harbored a penile squamous cell carcinoma and presented with no palpable nodes (85%). Operation time (OT) ranged between 45 and 300 min. Estimated blood loss varied from 10 to 300 mL. One single intra-operative complication was reported and one conversion to open was recorded. The lymph nodes (LNs) count spanned from 3 to 26 per groin, with 17 studies reporting a median yield >7 nodes. Hospital stay was 1-7 days, while the duration of drainage ranged from 4 to 72 days. Post-operative complications included lymphocele (22.2%; 0-100%), lymphedema (13.4%; 0-40%), cellulitis (11.1%; 0-25%), skin necrosis (8.7%; 0-15.4%). seroma (3.5%; 0-20%) and wound breakdown/wound infection (2.9%; 0-10%). Out of the included studies, 7 provided at least a 12-month follow-up, with recurrence-free rates ranging from 50% to 100% in patients affected by penile cancer and from 92% to 100% in vulvar cancer patients.
Conclusions: The available evidence on RAIL for the treatment of PC and VC is limited. The approach appears to be safe and effective, as it provides an adequate lymph node yield while ensuring a minimally morbid postoperative course and a short hospital stay.
{"title":"Robot-assisted inguinal lymphadenectomy to treat penile and vulvar cancers: a scoping review.","authors":"Aldo Brassetti, Giuseppe Chiacchio, Umberto Anceschi, Alfredo Bove, Mariaconsiglia Ferriero, Simone D'Annunzio, Leonardo Misuraca, Salvatore Guaglianone, Gabriele Tuderti, Riccardo Mastroianni, Francesco Tedesco, Loris Cacciatore, Flavia Proietti, Simone R Flammia, Cosimo De Nunzio, Gabriele Cozzi, Costantino Leonardo, Andrea B Galosi, Giuseppe Simone","doi":"10.23736/S2724-6051.24.05532-0","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05532-0","url":null,"abstract":"<p><strong>Introduction: </strong>Inguinal lymph nodes dissection (ILND) is recommended in patients presenting with high-risk penile (PC) or vulvar cancers (VC). Though, this surgical procedure is underused because of its anticipated morbidity. Minimally invasive approaches were proposed to minimize complications associated with open surgery. In this review, we analyze current available data exploring intra and perioperative outcomes of robot-assisted ILND (RAIL).</p><p><strong>Evidence acquisition: </strong>On April 9<sup>th</sup>, 2023, a literature search was conducted using the PubMed and Scopus databases. The search employed the combination of the following terms: (\"robotic assisted\" OR \"robot-assisted\" OR \"robotic\") AND (\"inguinal lymph node dissection\" OR \"lymphadenectomy\") AND (\"penile cancer\" OR \"vulvar cancer\"). Out of the 404 identified articles, 18 were used for the present scoping review and their results were reported according to the PRISMA statement.</p><p><strong>Evidence synthesis: </strong>Data on 171 patients, ranging in age from 32 to 85 years, were obtained. Most of them (90.6%) harbored a penile squamous cell carcinoma and presented with no palpable nodes (85%). Operation time (OT) ranged between 45 and 300 min. Estimated blood loss varied from 10 to 300 mL. One single intra-operative complication was reported and one conversion to open was recorded. The lymph nodes (LNs) count spanned from 3 to 26 per groin, with 17 studies reporting a median yield >7 nodes. Hospital stay was 1-7 days, while the duration of drainage ranged from 4 to 72 days. Post-operative complications included lymphocele (22.2%; 0-100%), lymphedema (13.4%; 0-40%), cellulitis (11.1%; 0-25%), skin necrosis (8.7%; 0-15.4%). seroma (3.5%; 0-20%) and wound breakdown/wound infection (2.9%; 0-10%). Out of the included studies, 7 provided at least a 12-month follow-up, with recurrence-free rates ranging from 50% to 100% in patients affected by penile cancer and from 92% to 100% in vulvar cancer patients.</p><p><strong>Conclusions: </strong>The available evidence on RAIL for the treatment of PC and VC is limited. The approach appears to be safe and effective, as it provides an adequate lymph node yield while ensuring a minimally morbid postoperative course and a short hospital stay.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The objective of this retrospective, multicenter study was to analyze the factors associated with the development of urogenital sepsis after percutaneous nephrolithotomy (PCNL) and to establish a nomogram prediction model of urogenital sepsis after PCNL.
Methods: A total of 2066 postoperative PCNL patients were included from three medical institutions: Zunyi Medical University Hospital, Beijing Jishuitan Hospital Guizhou Hospital, and Fenggang County People's Hospital. Clinical data of 1623 patients from the Department of Urology of Zunyi Medical University Hospital were randomized into a training cohort (Zunyi training cohort, N.=1139) and an internal validation cohort (Zunyi internal validation cohort, N.=484) using computer generated random numbers in a 7:3 ratio. Univariate and multivariate logistic regression analyses were performed on the compliance training cohort to identify risk factors for urogenital sepsis after PCNL and to develop a column line graph prediction model based on these risk factors. Finally, Zunyi internal validation cohort and two external validation cohorts (Guiyang external cohort, N.=306; Fenggang external cohort, N.=137) were used to validate the prognostic accuracy of the nomogram prediction model. R4.2.2 statistical software was used for all statistical data analyses.
Results: Multifactorial logistic regression analysis of the Zuiyi training cohort (N.=1139) identified five independent risk factors associated with urogenital sepsis after PCNL, including urine culture positivity (odds ratio [OR]=5.29, P<0.001), urine nitrite positivity (OR=5.97, P<0.001), operation time ≥60 min (OR=4.4, P=0.0037), residual stone (OR=5.18, P<0.001), and size ≥30 mm (OR=3.22, P=0.0086). Nomogram were constructed based on these independent risk factors. The area under the curve (AUC) of the nomogram model was 0.907 in the in-progress sample and 0.948 after internal validation. The AUC of the model was 0.855 and 0.804 after external validation of the Guiyang external validation cohort and the Fenggang validation cohort, respectively, indicating good discrimination ability. The calibration curves of the nomogram showed good agreement, and the decision curve analysis demonstrated high clinical utility.
Conclusions: Based on the clinical independent risk factors such as positive urine culture, positive urine nitrite, operation time ≥60min, stone residue, stone size ≥30mm, nomogram prediction model of urogenital sepsis after PCNL was established, which can provide reference for urologists to develop preoperative evaluation and treatment strategies for patients with percutaneous nephrolithotomy.
{"title":"Development and validation of a predictive model for post-percutaneous nephrolithotomy urinary sepsis: a multicenter retrospective study.","authors":"Leibo Wang, Daobing Li, Wei He, Guanyu Shi, Jianpo Zhai, Zhuangding Cen, Feng Xu, Hao Xie, Zhibing Yu, Guoqiang Zhao, Chishou Mo, Qi Lv, Wu Tian","doi":"10.23736/S2724-6051.23.05396-X","DOIUrl":"10.23736/S2724-6051.23.05396-X","url":null,"abstract":"<p><strong>Background: </strong>The objective of this retrospective, multicenter study was to analyze the factors associated with the development of urogenital sepsis after percutaneous nephrolithotomy (PCNL) and to establish a nomogram prediction model of urogenital sepsis after PCNL.</p><p><strong>Methods: </strong>A total of 2066 postoperative PCNL patients were included from three medical institutions: Zunyi Medical University Hospital, Beijing Jishuitan Hospital Guizhou Hospital, and Fenggang County People's Hospital. Clinical data of 1623 patients from the Department of Urology of Zunyi Medical University Hospital were randomized into a training cohort (Zunyi training cohort, N.=1139) and an internal validation cohort (Zunyi internal validation cohort, N.=484) using computer generated random numbers in a 7:3 ratio. Univariate and multivariate logistic regression analyses were performed on the compliance training cohort to identify risk factors for urogenital sepsis after PCNL and to develop a column line graph prediction model based on these risk factors. Finally, Zunyi internal validation cohort and two external validation cohorts (Guiyang external cohort, N.=306; Fenggang external cohort, N.=137) were used to validate the prognostic accuracy of the nomogram prediction model. R4.2.2 statistical software was used for all statistical data analyses.</p><p><strong>Results: </strong>Multifactorial logistic regression analysis of the Zuiyi training cohort (N.=1139) identified five independent risk factors associated with urogenital sepsis after PCNL, including urine culture positivity (odds ratio [OR]=5.29, P<0.001), urine nitrite positivity (OR=5.97, P<0.001), operation time ≥60 min (OR=4.4, P=0.0037), residual stone (OR=5.18, P<0.001), and size ≥30 mm (OR=3.22, P=0.0086). Nomogram were constructed based on these independent risk factors. The area under the curve (AUC) of the nomogram model was 0.907 in the in-progress sample and 0.948 after internal validation. The AUC of the model was 0.855 and 0.804 after external validation of the Guiyang external validation cohort and the Fenggang validation cohort, respectively, indicating good discrimination ability. The calibration curves of the nomogram showed good agreement, and the decision curve analysis demonstrated high clinical utility.</p><p><strong>Conclusions: </strong>Based on the clinical independent risk factors such as positive urine culture, positive urine nitrite, operation time ≥60min, stone residue, stone size ≥30mm, nomogram prediction model of urogenital sepsis after PCNL was established, which can provide reference for urologists to develop preoperative evaluation and treatment strategies for patients with percutaneous nephrolithotomy.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49693837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.23736/S2724-6051.24.05623-4
Esther García Rojo, Vital Hevia Palacios, R. Brime Menéndez, J. F. Feltes Ochoa, J. Justo Quintas, F. Lista Mateos, Karim Touijer, J. Romero Otero
BACKGROUND Robot-assisted partial nephrectomy (RAPN) has emerged as the preferred approach for T1 renal-cell-carcinoma. As new robotic platforms like Hugo RAS emerge, we seek to understand their potential in achieving similar RAPN outcomes as the established Da Vinci system. METHODS A prospective single-center comparative study was conducted, and 50 patients selected for RAPN were enrolled (25 Da Vinci Xi; 25 Hugo RAS). The choice of robotic system was based solely on hospital logistics criteria. Surgeries were performed by expert surgeons. Demographic data, tumor characteristics, operative details and postoperative outcomes were collected. SPSS version 22.0 was used for statistical analyses. RESULTS The average age of patients was 62.52±9.47 years, with no significant differences in median age, sex, and nephrometry scores between groups. Da Vinci group showed a significantly shorter docking time (12.56 vs. 20.08 min; P<0.01), while other intraoperative measures like console time and warm ischemia time were similar. The Hugo RAS group had a shorter renorraphy time (14.33 vs. 18.84 min; P=0.024). Postoperative outcomes and surgical margin positivity showed no significant differences. Each group had one patient (4%) who developed major surgical complications (Clavien IIIa). Trifecta rates were comparable between both groups (Da Vinci 88% vs. Hugo RAS 84%; P=0.93). CONCLUSIONS Initial findings suggest similar perioperative outcomes for RAPN when using Hugo RAS compared to the Da Vinci system. Further research with long-term follow-up is necessary to evaluate oncological and functional outcomes.
背景机器人辅助肾部分切除术(RAPN)已成为治疗T1肾细胞癌的首选方法。随着新机器人平台(如 Hugo RAS)的出现,我们试图了解它们在实现与已有的达芬奇系统类似的 RAPN 结果方面的潜力。机器人系统的选择完全基于医院的后勤标准。手术由专家外科医生实施。收集了人口统计学数据、肿瘤特征、手术细节和术后结果。结果患者的平均年龄为(62.52±9.47)岁,组间在中位年龄、性别和肾功能评分方面无明显差异。达芬奇组对接时间明显更短(12.56 分钟对 20.08 分钟;P<0.01),而其他术中指标,如控制台时间和热缺血时间相似。雨果RAS组的肾造影时间更短(14.33分钟对18.84分钟;P=0.024)。术后结果和手术边缘阳性率无显著差异。每组均有一名患者(4%)出现主要手术并发症(Clavien IIIa)。结论初步研究结果表明,与达芬奇系统相比,使用Hugo RAS进行RAPN手术的围手术期结果相似。有必要进一步开展长期随访研究,以评估肿瘤和功能方面的结果。
{"title":"Da Vinci and Hugo RAS Platforms for robot-assisted partial nephrectomy: a preliminary prospective comparative analysis of the outcomes.","authors":"Esther García Rojo, Vital Hevia Palacios, R. Brime Menéndez, J. F. Feltes Ochoa, J. Justo Quintas, F. Lista Mateos, Karim Touijer, J. Romero Otero","doi":"10.23736/S2724-6051.24.05623-4","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05623-4","url":null,"abstract":"BACKGROUND\u0000Robot-assisted partial nephrectomy (RAPN) has emerged as the preferred approach for T1 renal-cell-carcinoma. As new robotic platforms like Hugo RAS emerge, we seek to understand their potential in achieving similar RAPN outcomes as the established Da Vinci system.\u0000\u0000\u0000METHODS\u0000A prospective single-center comparative study was conducted, and 50 patients selected for RAPN were enrolled (25 Da Vinci Xi; 25 Hugo RAS). The choice of robotic system was based solely on hospital logistics criteria. Surgeries were performed by expert surgeons. Demographic data, tumor characteristics, operative details and postoperative outcomes were collected. SPSS version 22.0 was used for statistical analyses.\u0000\u0000\u0000RESULTS\u0000The average age of patients was 62.52±9.47 years, with no significant differences in median age, sex, and nephrometry scores between groups. Da Vinci group showed a significantly shorter docking time (12.56 vs. 20.08 min; P<0.01), while other intraoperative measures like console time and warm ischemia time were similar. The Hugo RAS group had a shorter renorraphy time (14.33 vs. 18.84 min; P=0.024). Postoperative outcomes and surgical margin positivity showed no significant differences. Each group had one patient (4%) who developed major surgical complications (Clavien IIIa). Trifecta rates were comparable between both groups (Da Vinci 88% vs. Hugo RAS 84%; P=0.93).\u0000\u0000\u0000CONCLUSIONS\u0000Initial findings suggest similar perioperative outcomes for RAPN when using Hugo RAS compared to the Da Vinci system. Further research with long-term follow-up is necessary to evaluate oncological and functional outcomes.","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141027470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.23736/S2724-6051.23.05515-5
M. Zawky, Asmaa Elsayed, Amira Awadallah, Ahmed Abdelhalim, Hassan Abolenein, Ahmed Shokeir
BACKGROUND The aim of this study is to investigate the impact of the intradermal injection of purified protein derivative (PPD) and PPD skin test reactions on the oncological outcomes of patients with non-muscle invasive bladder cancer (NMIBC) treated by trans-urethral resection of bladder tumor (TURBT) and adjuvant intravesical BCG. METHODS The study included 100 consecutive patients with NMIBC prospectively given intradermal PPD 1-2 weeks before starting BCG therapy. Another 100 patients with NMIBC not given intradermal PPD before starting BCG were chosen as a historical control. The control group was chosen to be matching with the study group regarding baseline characteristics. The study group was divided into 2 subgroups with positive and negative reaction to PPD skin test. Oncological outcomes, immunological markers (TNF-α and IL-6) changes and BCG side effects were evaluated. RESULTS There were no significant differences between patients who received PPD or not regarding the 2-year recurrence free survival (RFS) rates and progression-free survival (PFS) rates and immunological markers changes. The 2-year RFS and PFS rates were significantly higher in patients with positive reactions. Post-induction values of immunological markers increased in all patients with a significant increase in patients with positive reactions. BCG side effects were significantly higher in patients with positive reactions. CONCLUSIONS The intradermal injection of PPD before intravesical BCG has no impact on oncological outcomes of patients with NMIBC treated with TURBT and intravesical BCG. However, the PPD skin test reactions before BCG therapy can predict the oncological outcomes, BCG side effects and the immunological outcomes of patients.
{"title":"The impact of purified protein derivative prior to intravesical bacillus Calmette-Guérin for the treatment of patients with non-muscle invasive bladder cancer.","authors":"M. Zawky, Asmaa Elsayed, Amira Awadallah, Ahmed Abdelhalim, Hassan Abolenein, Ahmed Shokeir","doi":"10.23736/S2724-6051.23.05515-5","DOIUrl":"https://doi.org/10.23736/S2724-6051.23.05515-5","url":null,"abstract":"BACKGROUND\u0000The aim of this study is to investigate the impact of the intradermal injection of purified protein derivative (PPD) and PPD skin test reactions on the oncological outcomes of patients with non-muscle invasive bladder cancer (NMIBC) treated by trans-urethral resection of bladder tumor (TURBT) and adjuvant intravesical BCG.\u0000\u0000\u0000METHODS\u0000The study included 100 consecutive patients with NMIBC prospectively given intradermal PPD 1-2 weeks before starting BCG therapy. Another 100 patients with NMIBC not given intradermal PPD before starting BCG were chosen as a historical control. The control group was chosen to be matching with the study group regarding baseline characteristics. The study group was divided into 2 subgroups with positive and negative reaction to PPD skin test. Oncological outcomes, immunological markers (TNF-α and IL-6) changes and BCG side effects were evaluated.\u0000\u0000\u0000RESULTS\u0000There were no significant differences between patients who received PPD or not regarding the 2-year recurrence free survival (RFS) rates and progression-free survival (PFS) rates and immunological markers changes. The 2-year RFS and PFS rates were significantly higher in patients with positive reactions. Post-induction values of immunological markers increased in all patients with a significant increase in patients with positive reactions. BCG side effects were significantly higher in patients with positive reactions.\u0000\u0000\u0000CONCLUSIONS\u0000The intradermal injection of PPD before intravesical BCG has no impact on oncological outcomes of patients with NMIBC treated with TURBT and intravesical BCG. However, the PPD skin test reactions before BCG therapy can predict the oncological outcomes, BCG side effects and the immunological outcomes of patients.","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141056506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.23736/S2724-6051.24.05888-9
Francesco Esperto, Antonio Testa, Angelo Territo, Eliodoro Faiella, Rocco Papalia, Roberto M Scarpa
{"title":"Applications of augmented reality in urology: expanding its potentials and fields of usage.","authors":"Francesco Esperto, Antonio Testa, Angelo Territo, Eliodoro Faiella, Rocco Papalia, Roberto M Scarpa","doi":"10.23736/S2724-6051.24.05888-9","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05888-9","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.23736/S2724-6051.24.05879-8
Marco Paciotti, Carlo A Bravi, Federico Piramide, Angelo Mottaran, Luca Sarchi, Paolo Dell'oglio, Filippo Turri, Fabrizio DI Maida, Nikolaos Liakos, Iulia Andras, Marcio Covas Moschovas, Mike Wenzel, Gabriele Sorce, Christoph Wurnschimmel, Edward Lambert, Ruben DE Groote, Alessandro Larcher
{"title":"Urological surgery with the Hugo RAS™ System: insights into system adaptability.","authors":"Marco Paciotti, Carlo A Bravi, Federico Piramide, Angelo Mottaran, Luca Sarchi, Paolo Dell'oglio, Filippo Turri, Fabrizio DI Maida, Nikolaos Liakos, Iulia Andras, Marcio Covas Moschovas, Mike Wenzel, Gabriele Sorce, Christoph Wurnschimmel, Edward Lambert, Ruben DE Groote, Alessandro Larcher","doi":"10.23736/S2724-6051.24.05879-8","DOIUrl":"10.23736/S2724-6051.24.05879-8","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-01-17DOI: 10.23736/S2724-6051.23.05693-8
Carlo Bettocchi, Anna Ricapito, Ugo Falagario, Oscar Selvaggio, Pasquale Annese, Vito Mancini, Gian Maria Busetto, Luigi Cormio, Giuseppe Carrieri
{"title":"ZSI-375 artificial urinary sphincter: efficacy, safety, and long-term outcomes.","authors":"Carlo Bettocchi, Anna Ricapito, Ugo Falagario, Oscar Selvaggio, Pasquale Annese, Vito Mancini, Gian Maria Busetto, Luigi Cormio, Giuseppe Carrieri","doi":"10.23736/S2724-6051.23.05693-8","DOIUrl":"10.23736/S2724-6051.23.05693-8","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139478838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}