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  1. Article ; Online: Robot-assisted radical cystectomy with totally intracorporeal urinary diversion: surgical and early functional outcomes through the learning curve in a single high-volume center.

    Porreca, A / Mineo Bianchi, F / Romagnoli, D / D'Agostino, D / Corsi, P / Giampaoli, M / Salvaggio, A / Bianchi, L / Schiavina, R / Brunocilla, E / Artibani, W

    Journal of robotic surgery

    2019  Volume 14, Issue 2, Page(s) 261–269

    Abstract: The aim of the study is to report surgical and early functional outcomes of first 100 patients undergoing robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD) in a single center. The main surgeon (A.P.) attended a ...

    Abstract The aim of the study is to report surgical and early functional outcomes of first 100 patients undergoing robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD) in a single center. The main surgeon (A.P.) attended a modular training program at a referring center mentored by a worldwide-recognized robotic surgeon (P.W.). The program consisted of: (a) 10 h of theoretical lessons; (b) video session (c) step-by-step in vivo modular training. Each procedure was performed as taught, without any technique variation. Demographics, intra-operative data and post-operative complications, along with early functional outcomes, were recorded for each patient. We retrospectively evaluated the first consecutive 100 patients submitted to RARC with totally ICUD from July 2015 to December 2018. Median age at surgery was 69 years (IQR 60-74). 52 (52%), 32 (32%), and 17 (17%) patients received orthotopic neobladder, ileal conduit and uretero-cutaneostomy, respectively. Median operative time was 410 min. A median number of lymph nodes retrieved were 27 and median estimated blood loss was 240 mL with median hospitalization time of 7 days. All procedures were completed successfully without open conversion. A statistically significant improvement was found in the late (30-90 post-operative days) post-operative complications (p = 0.02) and operative time for urinary derivation. At multivariate logistic regression model ASA score ≥ 3 (OR = 4.2, p = 0.002) and number of lymph nodes retrieved (OR = 1.16, p = 0.02) were found to be predictors of 90-day complications. An adequate modular training is paramount to obtain successful results and reduce the learning curve of RARC, as demonstrated by our experience.
    MeSH term(s) Aged ; Cystectomy/education ; Cystectomy/methods ; Female ; Humans ; Learning Curve ; Male ; Robotic Surgical Procedures/education ; Robotic Surgical Procedures/methods ; Treatment Outcome ; Urinary Bladder Neoplasms/surgery ; Urinary Diversion/education ; Urinary Diversion/methods
    Language English
    Publishing date 2019-05-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 2268283-1
    ISSN 1863-2491 ; 1863-2483
    ISSN (online) 1863-2491
    ISSN 1863-2483
    DOI 10.1007/s11701-019-00977-4
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  2. Article ; Online: Comparison between "In-bore" MRI guided prostate biopsy and standard ultrasound guided biopsy in the patient with suspicious prostate cancer: Preliminary results.

    D'Agostino, Daniele / Mineo Bianchi, Federico / Romagnoli, Daniele / Corsi, Paolo / Giampaoli, Marco / Schiavina, Riccardo / Brunocilla, Eugenio / Artibani, Walter / Porreca, Angelo

    Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica

    2019  Volume 91, Issue 2

    Abstract: Objectives: To evaluate the detection rate of prostate cancer (PCa) in patients who underwent to "in bore" Magnetic Resonance Imaging -guided prostate (MRI-GB) biopsy compared to the standard transrectal ultrasound guided prostate biopsy (TRUS-GB).: ... ...

    Abstract Objectives: To evaluate the detection rate of prostate cancer (PCa) in patients who underwent to "in bore" Magnetic Resonance Imaging -guided prostate (MRI-GB) biopsy compared to the standard transrectal ultrasound guided prostate biopsy (TRUS-GB).
    Materials and methods: Between January 2017 and March 2015 a cohort of 39 consecutive patients was prospectively enrolled. All the patients underwent an "in-bore" guided MRI prostatic biopsy and subsequently ultrasound-guided standard prostate biopsy.
    Results: Median age of patients was 65.5 years (SD ± 6.6), median total PSA serum level was 6.6 ng/ml (SD ± 4.1), median prostate total volume was 51.1 cc (SD ± 26.7). Thirty of 39 (76.9%) were biopsy-naïve patients while 7/39 (17.9%) had at least one previous negative random TRUS-GB; 2/39 (5.1%) patients were already diagnosed as PCa and were on active surveillance. In 18/39 (53.8%) men Pca was diagnosed; as regards the MRI-GB results related to the PI-RADS score, biopsies of PIRADS 3 lesions were positive in 5/18 cases (27.8%), while the number of positive cases of PI-RADS 4 and 5 lesions was 7/11 (63.6%) and 6/10 (60%)respectively. At the histological examination, 4/39 (10.3%) had a PCa ISUP grade group 1, 11/39 (28.2%) had a ISUP 2, 6/39(15.4%) had a ISUP grade group 3 and 2/39 (5.1%) had a ISUP 4-5.
    Conclusions: MRI-GB represents a promising technique that may offer some of advantages compared to standard systematic TRUSGB. Our preliminary experience in MRI-GB resulted safe and feasible and represents a viable procedure for the diagnosis and characterization of PCa.
    MeSH term(s) Aged ; Cohort Studies ; Humans ; Image-Guided Biopsy/methods ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Neoplasm Grading ; Prospective Studies ; Prostate-Specific Antigen/blood ; Prostatic Neoplasms/diagnosis ; Prostatic Neoplasms/pathology ; Ultrasonography, Interventional/methods
    Chemical Substances Prostate-Specific Antigen (EC 3.4.21.77)
    Language English
    Publishing date 2019-07-02
    Publishing country Italy
    Document type Comparative Study ; Journal Article
    ZDB-ID 1153526-x
    ISSN 2282-4197 ; 1120-8538 ; 1124-3562
    ISSN (online) 2282-4197
    ISSN 1120-8538 ; 1124-3562
    DOI 10.4081/aiua.2019.2.87
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  3. Article ; Online: Is Fast Track protocol a safe tool to reduce hospitalization time after radical cystectomy with ileal urinary diversion? Initial results from a single high-volume centre.

    Romagnoli, Daniele / Schiavina, Riccardo / Bianchi, Lorenzo / Borghesi, Marco / Chessa, Francesco / Mineo Bianchi, Federico / Angiolini, Andrea / Casablanca, Carlo / Giampaoli, Marco / Corsi, Paolo / D'Agostino, Daniele / Brunocilla, Eugenio / Porreca, Angelo

    Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica

    2020  Volume 91, Issue 4, Page(s) 230–236

    Abstract: Introduction and aim: Radical Cystectomy (RC) with ileal urinary diversion is one of the most complex urological surgical procedure, and many Fast Track (FT) protocols have been described to reduce hospitalization, without increasing postoperatory ... ...

    Abstract Introduction and aim: Radical Cystectomy (RC) with ileal urinary diversion is one of the most complex urological surgical procedure, and many Fast Track (FT) protocols have been described to reduce hospitalization, without increasing postoperatory complications. We present the one-year results of a dedicated protocol developed at a high volume centre.
    Materials and methods: The FT protocol was designed after a review of the literature and a multidisciplinary collegiate discussion, and it was applied to patients scheduled to open RC with intestinal urinary diversion. To validate its feasibility, we compared its results with data collected from a 1:1 matched population of patients who had undergone the same surgical procedure, without the implementation of the FT protocol.
    Results: We enrolled in the FT group 11 (55%) patients scheduled to RC with ileal conduit diversion, and 9 patients (45%) scheduled to orthotopic neobladder (Studer) substitution, while a numerically equivalent population was enrolled in the control group, matched according to age at surgery, BMI, gender, ASA score, CCI, preoperative stage and type of urinary diversion. No statistically significant difference was found in terms of pre-operatory and intra-operatory domains. Median overall age was 71 years (Inter Quartile Range - IQR: 63-76) and mean operatory time was 276 ± 57 minutes. Hospitalization time was significantly reduced in the FT group, considering oralization and canalization items we found a significant advantage in the FT group. No statistically significant difference was found in the control of the post-operatory pain. We found no difference, in terms of both early and late complications ratio, among the two populations. Complications graded Clavien ≥ 3 were found in 4 patients of the control group (20%), while in only one patient (5%) in the Fast Track group, though this difference was not statistically significant.
    Conclusions: The Fast Track protocol developed in this study has proven to be effective in significantly reducing hospitalization time in patients submitted to RC with intestinal urinary diversion, without increasing post-operatory complications ratio.
    MeSH term(s) Aged ; Cystectomy/methods ; Female ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Operative Time ; Postoperative Complications/epidemiology ; Prospective Studies ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Urinary Bladder Neoplasms/surgery ; Urinary Diversion/methods
    Language English
    Publishing date 2020-01-14
    Publishing country Italy
    Document type Comparative Study ; Journal Article ; Validation Study
    ZDB-ID 1153526-x
    ISSN 2282-4197 ; 1120-8538 ; 1124-3562
    ISSN (online) 2282-4197
    ISSN 1120-8538 ; 1124-3562
    DOI 10.4081/aiua.2019.4.230
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  4. Article ; Online: MRI/TRUS FUSION guided biopsy as first approach in ambulatory setting: Feasibility and performance of a new fusion device.

    D'Agostino, Daniele / Mineo Bianchi, Federico / Romagnoli, Daniele / Giampaoli, Marco / Corsi, Paolo / Del Rosso, Alessandro / Schiavina, Riccardo / Brunocilla, Eugenio / Porreca, Angelo

    Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica

    2020  Volume 91, Issue 4, Page(s) 211–217

    Abstract: Purpose: To evaluate the detection rate of Magnetic Resonance Imaging/Transrectal Ultrasound (MRI/TRUS) Fusion Biopsy performed in a series of patients with suspicious prostate cancer in an ambulatory setting.: Materials and methods: Between March ... ...

    Abstract Purpose: To evaluate the detection rate of Magnetic Resonance Imaging/Transrectal Ultrasound (MRI/TRUS) Fusion Biopsy performed in a series of patients with suspicious prostate cancer in an ambulatory setting.
    Materials and methods: Between March 2018 and January 2019 a series of 155 patients undergoing MRI/TRUS fusionguided biopsy were prospectively enrolled. All patients presented a suspected diagnosis for prostate cancer because of raised Prostate Specific Antigen (PSA) serum level and/or abnormal physical examination (digital rectal examination), and showed at least one suspicious area at the multiparametric Magnetic Resonance Imaging (mpMRI).
    Results: Of 155 patients, 58 (37.4%) were biopsy-naïve, 97 (62.6%) had at least 1 previous negative TRUS-guided biopsy. The median age of the patient cohort was 66 years (IQR, 61- 69); the median prebiopsy PSA value was 7.1 ng/ml (IQR, 5- 8.9). Overall, the Fusion-TB findings were positive in 94 of 155 patients with a detection rate (DR) of 60%; a significantly high DR was obtained in terms of clinically significant prostate cancer (csPCa) by Fusion-TB (61 pts; 41.9%). The overall DR in the 121 biopsy-naive patients was 60.6%. In the subgroup of the 34 patients with at least 1 previous set of TRUS-GB, overall DR was 39.3% (35/50).
    Conclusions: The targeted MRI/TRUS fusion-guided biopsy represents a safe and accurate approach for diagnosis of csPCa, especially in patient with previous TRUS guided biopsy negative and suspicious prostate cancer.
    MeSH term(s) Aged ; Ambulatory Care ; Feasibility Studies ; Humans ; Image-Guided Biopsy/methods ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Prospective Studies ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/pathology ; Rectum ; Ultrasonography, Interventional
    Language English
    Publishing date 2020-01-13
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 1153526-x
    ISSN 2282-4197 ; 1120-8538 ; 1124-3562
    ISSN (online) 2282-4197
    ISSN 1120-8538 ; 1124-3562
    DOI 10.4081/aiua.2019.4.211
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  5. Article ; Online: Secondary bladder amyloidosis due to Crohn's disease: a case report and literature review.

    Droghetti, Matteo / Ercolino, Amelio / Piazza, Pietro / Bianchi, Lorenzo / Fabbrizio, Benedetta / Giunchi, Francesca / Mineo Bianchi, Federico / Barbaresi, Umberto / Casablanca, Carlo / Tonin, Elena / Mottaran, Angelo / Fiorentino, Michelangelo / Schiavina, Riccardo / Brunocilla, Eugenio

    CEN case reports

    2020  Volume 9, Issue 4, Page(s) 413–417

    Abstract: The presence of amyloid deposits in bladder walls is a rare histological finding. It can be linked to primary (limited to bladder) or secondary (systemic, associated with chronic inflammatory disorders) amyloidosis. Secondary bladder involvement is very ... ...

    Abstract The presence of amyloid deposits in bladder walls is a rare histological finding. It can be linked to primary (limited to bladder) or secondary (systemic, associated with chronic inflammatory disorders) amyloidosis. Secondary bladder involvement is very uncommon; it usually presents with gross hematuria, which is challenging to manage, due to frail bladder mucosa and/or necrosis. We present a case of 54-year old man with secondary bladder amyloidosis due to Crohn's disease, that caused gross hematuria and severe anemia, which was managed conservatively by endoscopic transurethral resection, diatermocoagulation, clot evacuation and urinary drainage by bilateral percutaneous nephrostomy, with spontaneous resolution. Secondary bladder amyloidosis is a rare condition that presents with severe hematuria, difficult to control with standard management. Owing to chronic nature of the disease, treatment should be aimed to a conservative approach whenever possible. In case of failure, invasive procedures should be considered as salvage therapies.
    MeSH term(s) Amyloidosis/diagnosis ; Amyloidosis/etiology ; Amyloidosis/pathology ; Amyloidosis/therapy ; Anemia/etiology ; Crohn Disease/complications ; Endoscopy/methods ; Hematuria/etiology ; Hematuria/prevention & control ; Hematuria/surgery ; Humans ; Male ; Middle Aged ; Nephrostomy, Percutaneous/methods ; Severity of Illness Index ; Treatment Outcome ; Urinary Bladder Diseases/pathology
    Language English
    Publishing date 2020-06-22
    Publishing country Japan
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 2660492-9
    ISSN 2192-4449 ; 2192-4449
    ISSN (online) 2192-4449
    ISSN 2192-4449
    DOI 10.1007/s13730-020-00497-3
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  6. Article ; Online: Postoperative outcomes of Fast-Track-enhanced recovery protocol in open radical cystectomy: comparison with standard management in a high-volume center and Trifecta proposal.

    Ercolino, Amelio / Droghetti, Matteo / Schiavina, Riccardo / Bianchi, Lorenzo / Chessa, Francesco / Mineo Bianchi, Federico / Barbaresi, Umberto / Angiolini, Andrea / Casablanca, Carlo / Mottaran, Angelo / Molinaroli, Enrico / Pultrone, Cristian / Dababneh, Hussam / Bertaccini, Alessandro / Brunocilla, Eugenio

    Minerva urology and nephrology

    2020  Volume 73, Issue 6, Page(s) 763–772

    Abstract: Background: We aimed at comparing perioperative outcomes in patients submitted to radical cystectomy followed by Fast Track (FT) protocol or standard management, and propose a definition of Trifecta, to improve standardized quality assessment for RC.: ...

    Abstract Background: We aimed at comparing perioperative outcomes in patients submitted to radical cystectomy followed by Fast Track (FT) protocol or standard management, and propose a definition of Trifecta, to improve standardized quality assessment for RC.
    Methods: We considered 191 patients submitted to RC between January 2017 and January 2019. Patients followed FT or standard management according to surgeon's preference. Preoperative and intraoperative characteristics, alongside with postoperative outcomes were compared between the two groups. Trifecta was defined as follows: in-hospital stay (HS) ≤ 10 days, time to defecation (TtD) below the overall mean and no major (≥ Clavien-Dindo grade III) complications. Finally, Trifecta achievement rates were assessed in both groups.
    Results: Seventy-five patients (39%) followed the FT protocol and 116 (61%) standard management. The two groups were homogeneous for preoperative, intraoperative and pathological characteristics. Patients in the FT group had shorter TtD (5 vs. 6 days P=0.006), HS (12 vs. 14 days P=0.008) and lower readmission rate (8% vs. 19% P=0.04). Early complication rates and grades were similar, while less late complications were found in FT group (6.7% vs. 21.6% P=0.006). Trifecta achievement rate was higher for FT group (31% vs. 8% P<0.001). Single-item failure percentages for HS, TtD and major grade complications were respectively 90%, 60% and 19%, with no difference between the two groups.
    Conclusions: FT protocol can safely consent faster bowel recovery and earlier discharge after RC, plus reducing readmission rates. Using a Trifecta incorporating essential perioperative outcomes, could improve standardized quality assessment for RC.
    MeSH term(s) Cystectomy/adverse effects ; Humans ; Length of Stay ; Postoperative Period ; Urinary Bladder ; Urinary Bladder Neoplasms/surgery
    Language English
    Publishing date 2020-11-17
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 3062840-4
    ISSN 2724-6442
    ISSN (online) 2724-6442
    DOI 10.23736/S2724-6051.20.03843-6
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  7. Article ; Online: The role of magnetic resonance imaging-guided biopsy for diagnosis of prostate cancer; comparison between FUSION and "IN-BORE" approaches.

    D'Agostino, Daniele / Casablanca, Carlo / Mineo Bianchi, Federico / Corsi, Paolo / Romagnoli, Daniele / Giampaoli, Marco / Fiori, Cristian / Schiavina, Riccardo / Brunocilla, Eugenio / Artibani, Walter / Porreca, Angelo

    Minerva urology and nephrology

    2020  Volume 73, Issue 1, Page(s) 90–97

    Abstract: Background: The aim of the present study is to evaluate the difference in terms of feasibility and detection rate of two magnetic resonance imaging (MRI) guided biopsy approaches (MRI fusion versus "in-bore" MRI) in a single tertiary center.: Methods!# ...

    Abstract Background: The aim of the present study is to evaluate the difference in terms of feasibility and detection rate of two magnetic resonance imaging (MRI) guided biopsy approaches (MRI fusion versus "in-bore" MRI) in a single tertiary center.
    Methods: We retrospectively identified 297 patients with suspected prostate cancer who underwent MRI based target prostate biopsy (FUSION or "in-bore" approaches) between January 2016 and January 2018 in a single tertiary center.
    Results: Lesion site (peripheral vs. central) and localization (anterior vs. posterior) were equally comparable among two groups, but maximum diameter of multiparametric-MRI Index lesion was slightly superior in the in-bore MRI-GB group (14 vs. 12 mm, P=0.002). Mean random biopsy cores taken were 11.2±2.1, with 1.3±2 positive cores in FUSION-GB group. Mean number of targeted biopsy cores taken was significantly superior in the FUSION-GB group as compared to the in-bore MRI-GB group (2.6±0.7 vs.1.7±1, P<0.001), whereas mean number of positive targeted biopsy cores was comparable between two groups (1±1.3 vs.1±0.9, P=0.1). 70 (45.5%) and 75 (52.8%) patients had positive targeted bioptic cores at pathologic examination among FUSION-GB and in-bore MRI-GB groups, respectively (P=0.2). Bioptical ISUP grade was also comparable among two groups (P=0.2) in multivariate analysis PI-RADS Score (OR=3.04 and OR=8.32 for PI-RADS 4 and 5, respectively) and PSA density (OR=2.69) were identified as independent predictors of positive targeted cores at histological examination (P<0.001 and P=0.01, respectively).
    Conclusions: In-bore MRI-GB approaches represent a promising technique that may offer some advantages compared to standard systematic FUSION-GB despite higher costs of in bore-procedure. Our experience, although not showing a clear advantage between the FUSION technique and the "in-bore" technique, resulted safe and feasible and represents a viable procedure for the diagnosis and characterization of prostate especially in a subgroup of patient with clinically significant disease. Further investigations are needed in order to identify the best approach for MRI-GB.
    MeSH term(s) Aged ; Humans ; Image-Guided Biopsy/methods ; Magnetic Resonance Imaging, Interventional/methods ; Male ; Middle Aged ; Neoplasm Grading ; Predictive Value of Tests ; Prostate-Specific Antigen/analysis ; Prostatic Neoplasms/diagnosis ; Prostatic Neoplasms/diagnostic imaging ; Retrospective Studies
    Chemical Substances Prostate-Specific Antigen (EC 3.4.21.77)
    Language English
    Publishing date 2020-05-26
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 3062840-4
    ISSN 2724-6442
    ISSN (online) 2724-6442
    DOI 10.23736/S2724-6051.20.03550-X
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  8. Article ; Online: The pathological and clinical features of anterior lesions of prostate cancer: Evaluation in a single cohort of patients.

    D'Agostino, Daniele / Corsi, Paolo / Colicchia, Michele / Romagnoli, Daniele / Busetto, Gian Maria / Ferro, Matteo / Tafuri, Alessandro / Cevenini, Matteo / Mineo Bianchi, Federico / Giampaoli, Marco / Porreca, Angelo

    Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica

    2020  Volume 92, Issue 2

    Abstract: Introduction: The aim of our work is to evaluate the principal differences of the pathological features in prostate cancer (PCa) lesions comparing those in the anterior region of the gland (APCa) to those in the posterior zone (PPCa) among patients who ... ...

    Abstract Introduction: The aim of our work is to evaluate the principal differences of the pathological features in prostate cancer (PCa) lesions comparing those in the anterior region of the gland (APCa) to those in the posterior zone (PPCa) among patients who underwent to robotic-assisted radical prostatectomy (RP).
    Material and methods: A total of 85 consecutive patients (mean age 66; IQR 62-71) with clinically suspected PCa were studied with multiparametric magnetic resonance of prostate before prostate biopsies. The prostate biopsies were RM-guided (60 inbore biopsy (MR-GB) and 25 Fusion-biopsy (FB). A total of 72 cases were eligible for robotic RP. An experienced genitourinary pathologist reviewed the histopathology of the tissue specimens of the patients after RP. The exclusion criteria were as follows: previous hormonotherapy, radiotherapy and chemotherapy for others cancers.
    Results: Based on the histological diagnosis, after RP, 68 anterior prostate cancer, and 107 posterior lesions were found. We further subcategorized lesions into peripheral and central zones for each the anterior and posterior lesions. The specific distribution of lesions by pathologic stage was: T2 = 74 (42.3%), T3a = 87 (49.7%), T3b = 12 (6.9%), T4 = 2 (1.1%) cases. Tumor volume of posterior neoplasms ranged from 0.04 to 20.35 cm3, with a median of 3.39 cm3. Anterior tumor volume ranged from 0.17 to 15 cm3, with a median volume of 2.54 cm3: PPCa were larger than APCa but the difference in size was not significant. The prostate cancer grade group (GG) I was distributed as 16.6% and 36% in anterior and posterior lesions cases. GG II and III was 43.8% and 31.5% in anterior and posterior cases, respectively. Comparatively, GG IV-V showed 39.6% and 32.5% for anterior and posterior lesions respectively (p < 0.001). Extraprostatic extention of neoplasm (EPE) was found more frequently in anterior cases (31.4%) than in in posterior cases (25.1%), but without significant difference. Lymphovascular invasion was similar in both the groups: 24% and 28.6% in anterior and posterior group, respectively. Anterior lesions showed a significantly higher rate of lymph node metastasis (9.3%) than posterior lesions (3.4%) (p < 0.005).
    Conclusion: In our study, we have found EPE, often associated with worse prognosis, more frequently (but not significantly) present in anterior lesions among PCa patients. Although posterior lesions are often related to pT3b stage, in our findings, anterior lesions were more often associated with a more aggressive neoplasm with more frequent nodal involvements.
    MeSH term(s) Aged ; Biopsy ; Cohort Studies ; Humans ; Male ; Middle Aged ; Prostate/pathology ; Prostatectomy/methods ; Prostatic Neoplasms/pathology ; Prostatic Neoplasms/surgery ; Robotic Surgical Procedures
    Language English
    Publishing date 2020-06-23
    Publishing country Italy
    Document type Comparative Study ; Journal Article
    ZDB-ID 1153526-x
    ISSN 2282-4197 ; 1120-8538 ; 1124-3562
    ISSN (online) 2282-4197
    ISSN 1120-8538 ; 1124-3562
    DOI 10.4081/aiua.2020.2.102
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  9. Article ; Online: Patterns of positive surgical margins after open radical prostatectomy and their association with clinical recurrence.

    Bianchi, Lorenzo / Schiavina, Riccardo / Borghesi, Marco / Casablanca, Carlo / Chessa, Francesco / Mineo Bianchi, Federico / Pultrone, Cristian / Vagnoni, Valerio / Ercolino, Amelio / Dababneh, Hussam / Fiorentino, Michelangelo / Brunocilla, Eugenio

    Minerva urologica e nefrologica = The Italian journal of urology and nephrology

    2019  Volume 72, Issue 4, Page(s) 464–473

    Abstract: Background: We report long-term oncologic outcomes in patients with positive surgical margins (PSMs) at radical prostatectomy (RP) and the oncologic impact of different scenarios of PSMs presentation.: Methods: We selected 494 men with at least 3 ... ...

    Abstract Background: We report long-term oncologic outcomes in patients with positive surgical margins (PSMs) at radical prostatectomy (RP) and the oncologic impact of different scenarios of PSMs presentation.
    Methods: We selected 494 men with at least 3 years follow-up after surgery. PSMs patterns were recorded as: burden (focal vs. multifocal), site (apical-anterior vs. posterolateral vs. base-bladder neck vs. multiple) and side (unilateral vs. bilateral). Kaplan-Meier curves depicted the clinical recurrence-free survival (CR-FS) rates at 10-year in the overall population, after biochemical recurrence and according to different PSMs patterns. Multivariate Cox-regression analysis was performed to predict CR.
    Results: Overall, PSMs sites were apical-anterior, postero-lateral, base-bladder neck and multiple in 19.8%, 23.7%, 3.4% and 43.8%, respectively. Out of 494 patients, 278 (56.3%) had a focal margin, while 216 (43.7%) had a multifocal margin. In 268 (54.3%) and 87 (17.6%) men, PSMs were unilateral and bilateral, respectively. Median follow-up was 93 months. No significant differences were found in CR-FS rates after stratifying according to burden and site of PSMs. Men with unilateral PSMs experienced significant higher CR-FS rates compared to those with bilateral PSMs (87.1% vs. 71.3% at 10 years, P<0.001). At multivariate Cox regression Gleason score 8-10 (HR: 2.53, Confidence Interval [CI]: 1.01-6.33; P=0.04), pathologic stage pT3b-pT4 (HR 3.02, CI: 1.60-7.85; P=0.02) and adjuvant radiotherapy (HR: 0.30, CI: 0.11-0-86; P=0.02) were independent predictors of CR.
    Conclusions: Men with bilateral PSMs had higher risk to experience CR, suggesting that the different patterns of PSMs, should be considered during patients counseling to guide postoperative treatments. Retrospective nature of the study and restricted number of patients included consist of main limitations.
    MeSH term(s) Aged ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Margins of Excision ; Middle Aged ; Neoplasm Grading ; Neoplasm Recurrence, Local ; Progression-Free Survival ; Prostatectomy/methods ; Prostatic Neoplasms/surgery ; Retrospective Studies ; Survival Analysis ; Treatment Outcome
    Language English
    Publishing date 2019-05-28
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 632505-1
    ISSN 1827-1758 ; 0393-2249 ; 0026-4989
    ISSN (online) 1827-1758
    ISSN 0393-2249 ; 0026-4989
    DOI 10.23736/S0393-2249.19.03269-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Can preoperative multiparametric MRI avoid unnecessary prostate biopsies before holmium laser enucleation of the prostate? Preliminary results of a multicentric cohort of patients.

    Giampaoli, Marco / Bianchi, Lorenzo / D'agostino, Daniele / Corsi, Paolo / Romagnoli, Daniele / Mineo Bianchi, Federico / Del Rosso, Alessandro / Schiavina, Riccardo / Brunocilla, Eugenio / Artibani, Walter / Porreca, Angelo

    Minerva urologica e nefrologica = The Italian journal of urology and nephrology

    2019  Volume 71, Issue 5, Page(s) 524–530

    Abstract: Background: Holmium laser enucleation of the prostate (HoLEP) is a surgical technique that allows to safely and effectively treat bladder outlet obstruction due to benign prostate enlargement and retrieve an adequate surgical specimen. We investigated ... ...

    Abstract Background: Holmium laser enucleation of the prostate (HoLEP) is a surgical technique that allows to safely and effectively treat bladder outlet obstruction due to benign prostate enlargement and retrieve an adequate surgical specimen. We investigated the role of multiparametric magnetic resonance imaging of the prostate (mpMRI) as a tool to exclude incidental prostate cancer (iPCa) and to compare mpMRI alone with a contextual transrectal ultrasound guided biopsy (TRUS-GB).
    Methods: Retrospective multicentric evaluation of 244 patients underwent to HoLEP with a suspicion of prostate cancer (PCa) due to raised PSA and/or abnormal digital rectal examination (DRE) and a negative mpMRI (PI-RADS score <3), was performed. Of these, 118 patients had only a negative mpMRI (MRI group) while 126 had a negative mpMRI and a contextual preoperative negative TRUS-GB (MRI + TRUS-GB group). Comparison between the two groups, univariate and multivariate analysis were conducted in order to identify any predictive factors of iPCa.
    Results: Median age, PSA, prostate volume and PSA density were 64.0 years (IQR: 58.0-69.0), 6.10 ng/mL (IQR: 4.76-9.65), 86.0 cc (IQR: 65.0-115.0), 50.0 cc (IQR: 37.5-80.0) and 0.08 ng/mL/cc (IQR: 0.06-0.10), respectively. In surgical specimen, iPCa was detected in 21 cases (8.8%). No statistically differences between MRI and MRI + TRUS-GB group were found in terms of iPCa (7.6% and 8.5%, respectively), pathological T stage and ISUP Grade Group. A contextual TRUS-GB added to mpMRI did not correlate to iPCa either at uni- and multivariate analysis while a significant correlation of a PSA density >0.15 ng/mL/cc was found only at univariate analysis.
    Conclusions: Including a mpMRI in clinical evaluation of patients eligible to HoLEP with a preoperative PCa suspicion leads to low the rates of iPCa and might avoid unnecessary TRUS-GB.
    MeSH term(s) Aged ; Cohort Studies ; Humans ; Image-Guided Biopsy ; Laser Therapy/methods ; Lasers, Solid-State ; Male ; Middle Aged ; Multiparametric Magnetic Resonance Imaging/methods ; Prostate/pathology ; Prostate/surgery ; Prostatic Hyperplasia/diagnostic imaging ; Prostatic Hyperplasia/pathology ; Prostatic Hyperplasia/surgery ; Retrospective Studies ; Treatment Outcome ; Ultrasonography, Interventional ; Urinary Bladder Neck Obstruction/etiology ; Urinary Bladder Neck Obstruction/surgery
    Language English
    Publishing date 2019-06-04
    Publishing country Italy
    Document type Journal Article ; Multicenter Study
    ZDB-ID 632505-1
    ISSN 1827-1758 ; 0393-2249 ; 0026-4989
    ISSN (online) 1827-1758
    ISSN 0393-2249 ; 0026-4989
    DOI 10.23736/S0393-2249.19.03463-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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