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Article ; Online: Varicocele

Antonio Franco / Flavia Proietti / Veronica Palombi / Gabriele Savarese / Michele Guidotti / Costantino Leonardo / Fabio Ferro / Claudio Manna / Giorgio Franco

Journal of Clinical Medicine, Vol 12, Iss 4062, p

To Treat or Not to Treat?

2023 Volume 4062

Abstract: Varicocele treatment in infertility still remains controversial. It is clear, in fact, that in many patients, varicocele has no impact on fertility. Recent scientific evidence demonstrated that varicocele treatment is beneficial in improving semen ... ...

Abstract	Varicocele treatment in infertility still remains controversial. It is clear, in fact, that in many patients, varicocele has no impact on fertility. Recent scientific evidence demonstrated that varicocele treatment is beneficial in improving semen parameters and pregnancy rate when an appropriate selection of patients is made. The purpose of treating varicocele in adults is mainly to improve current fertility status. On the other hand, the goal of treatment in adolescents is to prevent testicular injury and maintain testicular function for future fertility. Hence, the key to the success of varicocele treatment seems to be a correct indication. The aim of this study is to review and summarize current evidence in managing varicocele treatment focusing on the controversies regarding surgical indications in adolescent and adult patients, and in other specific situations such as azoospermia, bilateral or subclinical varicocele, and prior to ART.
Keywords	varicocele repair ; varicocelectomy ; ART ; infertility ; Medicine ; R
Subject code	616
Language	English
Publishing date	2023-06-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Arteriovenous fistula after robotic partial nephrectomy

Antonio Tufano, MD / Vincenzo Asero, MD / Flavia Proietti, MD / Rocco Simone Flammia, MD / Giorgio Franco, MD / Costantino Leonardo, MD

Radiology Case Reports, Vol 17, Iss 7, Pp 2550-

Case report and narrative review

2022 Volume 2553

Abstract: Arteriovenous fistulas (AVF) of the kidney are uncommon. They may be acquired, idiopathic or arise of congenital arteriovenous malformation. Acquired renal AVF are mostly iatrogenic due to the increasing number of mini-invasive nephron surgery. We report ...

Abstract	Arteriovenous fistulas (AVF) of the kidney are uncommon. They may be acquired, idiopathic or arise of congenital arteriovenous malformation. Acquired renal AVF are mostly iatrogenic due to the increasing number of mini-invasive nephron surgery. We report a case of renal AVF in a 65-year-old woman previously treated with left robotic partial nephrectomy (PN), which was successfully treated by endovascular coiling.
Keywords	Arterio-venous fistula ; Vascular lesion ; Partial nephrectomy ; Embolization ; Medical physics. Medical radiology. Nuclear medicine ; R895-920
Language	English
Publishing date	2022-07-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The Value of Fournier’s Gangrene Scoring Systems on Admission to Predict Mortality

Antonio Tufano / Piervito Dipinto / Francesco Passaro / Umberto Anceschi / Giorgio Franco / Rocco Simone Flammia / Flavia Proietti / Luca Antonelli / Giovanni Battista Di Pierro / Francesco Prata / Roberta Rullo / Sisto Perdonà / Costantino Leonardo

Journal of Personalized Medicine, Vol 13, Iss 1283, p

A Systematic Review and Meta-Analysis

2023 Volume 1283

Abstract: Objective: To systematically review and meta-analyze the predictive value of the Fournier gangrene severity index (FGSI), the simplified FGSI (SFGSI), and the Uludag FGSI (UFGSI) on mortality in patients affected by Fournier’s Gangrene (FG). Methods: A ... ...

Abstract	Objective: To systematically review and meta-analyze the predictive value of the Fournier gangrene severity index (FGSI), the simplified FGSI (SFGSI), and the Uludag FGSI (UFGSI) on mortality in patients affected by Fournier’s Gangrene (FG). Methods: A search was performed in PubMed, Web of Science, Embase, and the Cochrane Library, from January 2000 to May 2023, to identify original cohorts comparing data between surviving and non-surviving FG patients. The statistical analysis consisted of two parts. First, the mean and standard deviation (SD) of the FGSI, SFGSI, and UFGSI at admission were extrapolated from each study, and the pooled mean difference (MD) with 95% confidence interval (95% CI) was obtained using the Der Simonian–Laird random-effect model. Second, to evaluate the accuracy of the FGSI, SFGSI, and UFSGI in predicting mortality, true positive (TP), false positive (FP), true negative (TN), and false negative (FN) values were extracted where possible and reported in 2 × 2 contingency tables. The sensitivity, specificity, and AUC values were pooled, and summary receiver operating characteristic (SROC) curves were constructed. Results: Overall, forty studies comprising 2257 patients were included. The pooled analysis revealed that the FGSI, SFGSI, and UFGSI values at admission were higher in non-survivors than survivors (MD: 5.53 (95% CI: 4.68–6.37); MD: 2.41 (95% CI: 1.06–3.77); and MD: 5.47 (95% CI: 3.68–7.26), respectively). Moreover, the AUC values of the FGSI, SFGSI, and UFGSI were 0.90 (95% CI: 0.87–0.92), 0.84 (95% CI: 0.80–0.87), and 0.94 (95% CI: 0.92–0.96), respectively. Conclusions: The higher scores of the FGSI, SFGSI, and UFGSI on admission were associated with mortality. Moreover, when comparing accuracy rates, the UFGSI exhibited the highest AUC value.
Keywords	Fournier gangrene ; mortality ; infection ; Fournier gangrene severity index ; FGSI ; Medicine ; R
Subject code	310
Language	English
Publishing date	2023-08-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The Value of Contrast-Enhanced Ultrasound (CEUS) in Differentiating Testicular Masses

Antonio Tufano / Rocco Simone Flammia / Luca Antonelli / Rocco Minelli / Giorgio Franco / Costantino Leonardo / Vito Cantisani

Applied Sciences, Vol 11, Iss 8990, p

A Systematic Review and Meta-Analysis

2021 Volume 8990

Abstract: Ultrasound (US) still represents the mainstay of scrotal imaging. However, contrast-enhanced ultrasound (CEUS) is a relatively novel, but increasingly utilized diagnostic modality. In consequence, we performed a systematic review (SR) and pooled meta- ... ...

Abstract	Ultrasound (US) still represents the mainstay of scrotal imaging. However, contrast-enhanced ultrasound (CEUS) is a relatively novel, but increasingly utilized diagnostic modality. In consequence, we performed a systematic review (SR) and pooled meta-analysis to investigate the diagnostic performance of CEUS in the evaluation of testicular masses (TM). A SR up to June 2021 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The diagnostic performance of CEUS was evaluated basing on two different endpoints: neoplastic vs. non-neoplastic and malignant vs. benign TM. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) from eligible studies were pooled and summary receiver operating characteristic (SROC) curves were constructed for each endpoint. Overall, six qualified studies were deemed suitable for this meta-analysis. Diagnostic performance of CEUS showed an accuracy of 0.96 in detecting neoplastic masses (sensitivity of 0.89, PPV of 0.85, specificity of 0.62, and NPV of 0.69) and an accuracy of 0.96 in detecting malignant masses (sensitivity of 0.86, PPV of 0.73, specificity of 0.87, and NPV of 0.91). Taken together, CEUS may represent a promising minimally invasive diagnostic tool for characterization of TM, since it allows clinicians to identify neoplastic lesions and exclude malignant tumor.
Keywords	testis tumor ; contrast-enhanced ultrasound ; testicular neoplasm ; testicular masses ; Technology ; T ; Engineering (General). Civil engineering (General) ; TA1-2040 ; Biology (General) ; QH301-705.5 ; Physics ; QC1-999 ; Chemistry ; QD1-999
Subject code	610
Language	English
Publishing date	2021-09-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Minimally Invasive Partial vs. Total Adrenalectomy for the Treatment of Unilateral Primary Aldosteronism

Rocco Simone Flammia / Umberto Anceschi / Antonio Tufano / Eugenio Bologna / Flavia Proietti / Alfredo Maria Bove / Leonardo Misuraca / Riccardo Mastroianni / Giuseppe Tirone / Alessandro Carrara / Lorenzo Luciani / Tommaso Cai / Costantino Leonardo / Giuseppe Simone

Journal of Clinical Medicine, Vol 11, Iss 1263, p

A Systematic Review and Meta-Analysis

2022 Volume 1263

Abstract: Background: This systematic review and metanalysis was conducted to assess differences between perioperative and functional outcomes in patients undergoing minimally-invasive partial (mi-PA) and total adrenalectomy (mi-TA) for unilateral primary ... ...

Abstract	Background: This systematic review and metanalysis was conducted to assess differences between perioperative and functional outcomes in patients undergoing minimally-invasive partial (mi-PA) and total adrenalectomy (mi-TA) for unilateral primary aldosteronism (uPHA). Material and Methods: Multiple scientific databases (PUBMED, Web of Science, and Cochrane Library) were searched up to November 2021 for surgical series comparing mi-PA vs. mi-TA for uPHA according to the PRISMA statement. Primary outcomes of interest were perioperative and functional outcomes. Results: Overall, a total of 802 patients from six eligible studies were identified, with mi-PA and mi-TA performed in 40.4% ( n = 324) and 59.6% ( n = 478) of cases, respectively. No differences were recorded between the two groups according to number of transfusions, EBL and Clavien–Dindo complications ≥2. Similarly, no differences in clinical success, persistence of postoperative hypokalemia and improvement in HTN were reported between mi-PA and mi-TA. Conclusions: In a uPHA setting, mi-PA and mi-TA provide comparable perioperative and functional outcomes despite the use of mi-PA remains limited to patients with small adenoma size, or hereditary/bilateral disease. Due to limited use of standardized reporting criteria in most of current series, the quest for a superiority of mi-PA over mi-TA in the treatment of uPHA still remains open.
Keywords	unilateral primary aldosteronism ; Conn’s syndrome ; partial adrenalectomy ; total adrenalectomy ; PASO ; Medicine ; R
Subject code	610
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Sex-Sparing Robot-Assisted Radical Cystectomy with Intracorporeal Padua Ileal Neobladder in Female

Gabriele Tuderti / Riccardo Mastroianni / Simone Flammia / Mariaconsiglia Ferriero / Costantino Leonardo / Umberto Anceschi / Aldo Brassetti / Salvatore Guaglianone / Michele Gallucci / Giuseppe Simone

Journal of Clinical Medicine, Vol 9, Iss 2, p

Surgical Technique, Perioperative, Oncologic and Functional Outcomes

2020 Volume 577

Abstract: Our aim was to illustrate our technique of sex-sparing (SS)-robot-assisted radical cystectomy (RARC) in female patients receiving an intracorporeal neobladder (iN). From January 2013 to June 2018, 11 female patients underwent SS-RARC-iN at a single ... ...

Abstract	Our aim was to illustrate our technique of sex-sparing (SS)-robot-assisted radical cystectomy (RARC) in female patients receiving an intracorporeal neobladder (iN). From January 2013 to June 2018, 11 female patients underwent SS-RARC-iN at a single tertiary referral center. Inclusion criteria were a cT ≤ 2 N0 M0 bladder tumor at baseline imaging (CT or MRI) and an absence of tumors in the bladder neck, trigone and urethra at TURB. Baseline, perioperative, and outcomes at one year were reported. The median operative time was 255 min and the median hospital stay was seven days. Low-grade Clavien complications occurred in four patients (36.3%), while high-grade complications were not observed in any. Seven patients (63.7%) had an organ-confined disease at the pathologic specimen; nodal involvement and positive surgical margins were not detected in any of the cases. At a median follow-up of 28 months (IQR 14−51), no patients developed new onset of chronic kidney disease stage 3b. After one year, daytime and nighttime continence rates were 90.9% and 86.4% respectively. Quality of life as well as physical and emotional functioning improved significantly over time (all p ≤ 0.04), while urinary symptoms and sexual function worsened at three months with a significant recovery taking place at one year (all p ≤ 0.04). Overall, 8 out of 11 patients (72.7%) were sexually active at the 12-month evaluation. In select female patients, SS-RARC-iN is an oncologically sound procedure associated with favorable perioperative and functional outcomes.
Keywords	bladder cancer ; female ; intracorporeal neobladder ; outcomes ; radical cystectomy ; robotic ; sex-sparing ; Medicine ; R
Language	English
Publishing date	2020-02-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: External Validation of a Novel Comprehensive Trifecta System in Predicting Oncologic and Functional Outcomes of Partial Nephrectomy

Umberto Anceschi / Rocco Simone Flammia / Daniele Mattevi / Antonio Tufano / Aldo Brassetti / Maria Consiglia Ferriero / Gabriele Tuderti / Leonardo Misuraca / Alfredo Maria Bove / Riccardo Mastroianni / Davide Marsiliani / Marco Puglisi / Tommaso Cai / Costantino Leonardo / Michele Gallucci / Gianni Malossini / Lorenzo Giuseppe Luciani / Giuseppe Simone

Journal of Clinical Medicine, Vol 11, Iss 796, p

Results of a Multicentric Series

2022 Volume 796

Abstract: Background: To validate a novel trifecta for evaluating outcomes of partial nephrectomy (PN) on a multicentric dataset. Methods: Between 2007 and 2020, three renal cancer databases were queried for patients with solitary renal masses who underwent PN (n = ...

Abstract	Background: To validate a novel trifecta for evaluating outcomes of partial nephrectomy (PN) on a multicentric dataset. Methods: Between 2007 and 2020, three renal cancer databases were queried for patients with solitary renal masses who underwent PN (n = 649). Trifecta was estimated for overall cohort and contributing centers. Overall survival (OS), cancer-specific survival (CSS) and end-stage renal disease (ESRD) probabilities were assessed by Kaplan–Meier. Cox regression was used to identify predictors of OS, CSS, ESRD. For all analyses, a p < 0.05 was considered significant. Results: At a median follow-up of 22.7 months (IQR 12.5–76.5) overall trifecta was 76.7% [Centre A; (n = 230; 68.6%), B (n = 68; 77.3%), C (n = 200; 88.4%); p = 0.001). On Kaplan–Meier, patients achieving trifecta exhibited higher OS ( p = 0.024), higher CSS ( p = 0.015) and lower ESRD rates ( p = 0.024). On multivariable analysis, age (HR 1.04; 95% CI 1.01–1.08) and trifecta (HR 0.34; 95% CI 0.15–0.76) were independent predictors of OS while pT stage (HR 1.95; 95% CI 0.45–8.43) and trifecta (HR 0.33; 95% CI 0.16–0.67) were predictors of CSS (each p < 0.01). Preoperative CKD stage ≥ 3a (HR 13.1; 95% CI 4.07–42.6) and trifecta (HR 0.41; 95% CI 0.19–0.87) were independent predictors of ESRD (each p < 0.05). Conclusions: On external validation, trifecta was an independent predictor of all PN endpoints, regardless of hilar control and ischemia duration.
Keywords	partial nephrectomy ; trifecta ; survival ; end-stage renal disease (ESRD) ; ischemia ; Medicine ; R
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Contrast-Enhanced Ultrasound (CEUS) in the Evaluation of Renal Masses with Histopathological Validation—Results from a Prospective Single-Center Study

Antonio Tufano / Francesco Maria Drudi / Flavia Angelini / Eleonora Polito / Milvia Martino / Antonio Granata / Giovanni Battista Di Pierro / Eriselda Kutrolli / Matteo Sampalmieri / Vittorio Canale / Rocco Simone Flammia / Daniele Fresilli / Michele Bertolotto / Costantino Leonardo / Giorgio Franco / Vito Cantisani

Diagnostics, Vol 12, Iss 1209, p

2022 Volume 1209

Abstract: Background: To evaluate the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) in characterizing between malignant and benign renal lesions confirmed by histological examination. Methods: Overall, 110 patients, for a total of 118 renal masses ... ...

Abstract	Background: To evaluate the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) in characterizing between malignant and benign renal lesions confirmed by histological examination. Methods: Overall, 110 patients, for a total of 118 renal masses previously identified at CT and MRI underwent CEUS. An expert radiologist evaluated morphological, qualitative and quantitative parameters. Acquired data were analyzed to assess the value of each parameter to differentiate between malignant and benign lesions. Results: Histological results of 118 renal masses showed 88 (75%) malignant lesions and 30 (25%) benign lesions. Among morphological features, inhomogeneous echogenicity was the best predictor of malignancy depicting a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 76%, 76%, 88% and 57%, respectively. Among qualitative parameters, the most reliable parameter was the presence of pseudo-capsule. Here, sensitivity, specificity, positive PPV and NPV were 85%, 86%, 94% and 71%, respectively. Among quantitative parameters, the most reliable parameters were peak intensity (PI) and the area under the (AUC) with sensitivity, specificity, PPV and NPV values of 94%, 92%, 96% and 87% and 99%, 92%, 97% and 97%, respectively. Finally, the most reliable parameters were combined to distinguish between benign and malignant lesions. The best combination obtained was restricted to CEUS parameters (PI and AUC). Here, sensitivity, specificity, PPV, NPV and accuracy rate were 93%, 100%, 100%, 83% and 93%, respectively. Conclusions: CEUS increases the US accuracy to discriminate between benign and malignant renal lesions.
Keywords	contrast-enhanced ultrasound (CEUS) ; renal cancer ; renal masses ; perfusion ; quantitative analysis ; Medicine (General) ; R5-920
Subject code	616
Language	English
Publishing date	2022-05-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The Effect of Sex on Disease Stage and Survival after Radical Cystectomy in Non-Urothelial Variant-Histology Bladder Cancer

Journal of Clinical Medicine, Vol 12, Iss 1776, p

2023 Volume 1776

Abstract: Background: Female sex in patients treated by radical cystectomy (RC) is associated with more advanced stage and worse survival. However, studies supporting these findings mostly or exclusively relied on urothelial carcinoma of the urinary bladder (UCUB) ...

Abstract	Background: Female sex in patients treated by radical cystectomy (RC) is associated with more advanced stage and worse survival. However, studies supporting these findings mostly or exclusively relied on urothelial carcinoma of the urinary bladder (UCUB) and did not address non-urothelial variant-histology bladder cancer (VH BCa). We hypothesized that female sex is associated with a more advanced stage and worse survival in VH BCa, similarly to that of UCUB. Materials and Methods: Within the SEER database (2004–2016), we identified patients aged ≥18 years, with histologically confirmed VH BCa, and treated with comprehensive RC. Logistic regression addressing the non-organ-confined (NOC) stage, as well as cumulative incidence plots and competing risks regression addressing CSM for females vs. males, were fitted. All analyses were repeated in stage-specific and VH-specific subgroups. Results: Overall, 1623 VH BCa patients treated with RC were identified. Of those, 38% were female. Adenocarcinoma ( n = 331, 33%), neuroendocrine tumor ( n = 304, 18%), and other VH ( n = 317, 37%) were less frequent in females but not squamous cell carcinoma ( n = 671, 51%). Across all VH subgroups, female patients had higher NOC rates than males did (68 vs. 58%, p < 0.001), and female sex was an independent predictor of NOC VH BCa (OR = 1.55, p = 0.0001). Overall, five-year cancer-specific mortality (CSM) were 43% for females vs. 34% for males (HR = 1.25, p = 0.02). Conclusion: In VH BC patients treated with comprehensive RC, female sex is associated with a more advanced stage. Independently of stage, female sex also predisposes to higher CSM.
Keywords	muscle-invasive bladder cancer ; adenocarcinoma ; neuroendocrine carcinoma ; variant-histology ; squamous cell carcinoma ; radical cystectomy ; Medicine ; R
Language	English
Publishing date	2023-02-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Diagnostic Performance of Magnetic Resonance Imaging for Preoperative Local Staging of Penile Cancer

Rocco Simone Flammia / Antonio Tufano / Luca Antonelli / Arianna Bernardotto / Alberto A. Castro Bigalli / Zhen Tian / Marc C. Smaldone / Pierre I. Karakiewicz / Valeria Panebianco / Costantino Leonardo

Applied Sciences, Vol 11, Iss 7090, p

A Systematic Review and Meta-Analysis

2021 Volume 7090

Abstract: Invasion of the tunica albuginea (TA) and/or urethra are key factors in determining the feasibility of organ-preserving surgery in penile cancer (PC). Magnetic resonance imaging (MRI) appeared to be a promising technique for preoperative local staging. ... ...

Abstract	Invasion of the tunica albuginea (TA) and/or urethra are key factors in determining the feasibility of organ-preserving surgery in penile cancer (PC). Magnetic resonance imaging (MRI) appeared to be a promising technique for preoperative local staging. We performed a systematic review (SR) and pooled meta-analysis to investigate the diagnostic performance of MRI in preoperative local staging of primary PC. An SR up to May 2021 was performed according to the PRISMA statement. The diagnostic performance of MRI was evaluated according to TA invasion, urethra invasion, and pT-stage ≥ 2. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) from eligible studies were pooled and summary receiver operating characteristic (SROC) curves were constructed. Overall, seven qualified studies were deemed suitable. Diagnostic performance of MRI showed an accuracy of 0.89 for TA invasion (sensitivity 0.78, PPV 0.79, specificity 0.91, and NPV 0.90); an accuracy of 0.88 for urethra invasion (sensitivity 0.65, PPV 0.46, specificity 0.86, and NPV 0.93); an accuracy of 0.90 for pT ≥ 2 (sensitivity 0.86, PPV 0.84, specificity 0.70, and NPV 0.73).Currently available evidence indicates that MRI might be a one-stop shop for local staging of primary PC and play a central role with regard to conservative surgical management.
Keywords	penile neoplasms ; magnetic resonance imaging ; organ sparing surgery ; penile amputation ; radical penectomy ; Technology ; T ; Engineering (General). Civil engineering (General) ; TA1-2040 ; Biology (General) ; QH301-705.5 ; Physics ; QC1-999 ; Chemistry ; QD1-999
Subject code	610
Language	English
Publishing date	2021-07-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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