1,721,012 research outputs found
The role of robotic cystectomy in the salvage and palliative setting as new standard of care
Full text linkObjective: To compare surgical and survival outcomes of robot-assisted (RARC) vs open (ORC) radical cystectomy with cutaneous ureterostomy (CU) for the treatment of frail patients with limited life expectancy diagnosed with bladder cancer (BC).
Methods: Our prospectively maintained database was searched for cystectomy cases with CU, from June 2016 onwards. The study population was split into two groups, according to surgical approach. Baseline characteristics and surgical outcomes were compared: Mann-Whitney and Kruskal-Wallis tests were used for categorical variables, the χ2-test for continuous ones. Logistic regression analyses (LRA) identified predictors of major bleeding events (MBE) (which either caused a hemoglobin loss ≧ 3.5 g/dl or required blood transfusion) and re-operation within 30 days from surgery. Kaplan-Meier (KM) method estimated the impact of the robotic approach on overall survival (OS) and Cox regression analysis (CRA) assessed its predictors.
Results: overall, 145 patients were included: 30% (n=43) underwent RARC. Baseline characteristics and tumor stages distribution were comparable in the two groups but those receiving a robot-assisted approach showed significantly reduced times to flatus, bowel and hospital discharge (all p < 0.001). Although operation time was longer in this cohort, MBE (60% vs 89%) and postoperative severe complications (0 vs 8%) (both p <0.001) were less frequent, compared to ORC.
At LRA, RARC independently predicted MBE (OR: 0.26; 95%CI 0.09-0.72; p=0.02) but not the need for reintervention. At KM analysis, the minimally-invasive approach was associated with a significant advantage in terms of OS (LogRank = 0.03) and this result was confirmed at CRA (HR: 0.39; 95%CI 0.14-0.94; p=0.04).
Conclusions: RARC with CU may represent the nove standard of care to treat highly comorbid patients with advanced BC as, compared to ORC, it provides significant advantages in terms of transfusion rate and severe post-operative complications while ensuring a prompt recovery and discharge
Tamsulosin or silodosin adjuvant treatment is ineffective in improving shockwave lithotripsy outcome. A short-term follow-up randomized, placebo-controlled study
No full textIntroduction: The role of α-blockers after shockwave lithotripsy (SWL) is controversial. The aim of our study was to evaluate the effect of tamsulosin and silodosin after SWL for kidney stones. Methods: From 2012 onward, a consecutive series of patients undergoing SWL were prospectively enrolled and randomized by closed envelopes in three groups receiving tamsulosin 0.4 mg (A), silodosin 8 mg (B), and placebo (C) daily for 21 days after SWL. Anthropometrics, stone size, and location were recorded before SWL. Visual analogue scale (VAS) score was collected at 6, 12, and 24 hours after treatment to evaluate patients' discomfort. Stone-free rate was assessed 1 and 3 weeks postoperatively. Complications and medical treatment-related adverse events (AEs) were recorded. Differences in VAS score, stone-free rate, and complications were compared among the groups. Results: Overall, 60 patients were enrolled. Mean stone sizes were 10.28 ± 2.46 mm, 10.45 ± 1.73 mm, and 9.23 ± 2.04 mm in groups A, B, and C, respectively (p = 0.474). There was no significant difference between the three groups with regard to stone location. Comparable energy was used to treat patients from the three groups. The overall 3-week stone-free rate was 53%: 58% in the tamsulosin group, 47% in the silodosin group, and 55% in the placebo group (p = 0.399). No significant differences were observed in the VAS scores reported by the groups at 6 hours (p = 1.254), 12 hours (p = 0.075), and 24 hours (p = 0.490). Overall, 12 complications were reported: 11 patients (7 in group C and 4 in group B) needed analgesics for colic, and 1 patient (group B) was surgically treated for Steinstrasse. Tamsulosin was superior to placebo (p = 0.008) and silodosin (p = 0.021) in preventing complications; no difference between silodosin and placebo (p = 0.629) was noted. Conclusions: Tamsulosin and silodosin are ineffective in increasing stone-free rate as well as early patients' discomfort after extracorporeal lithotrips
Metabolic syndrome and smoking are associated with an increased risk of nocturia in male patients with benign prostatic enlargement
No full textBackground: To evaluate the relationship between cigarette smoking, metabolic syndrome (MetS) and nocturia in patients with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE). Methods: From 2009 onward, a consecutive series of patients with LUTS/BPE were enrolled. Symptoms were assessed using the International Prostate Symptom Score (IPSS). Age, body mass index (BMI), smoker status, prostate volume (PV), prostate-specific antigen (PSA) levels, fasting glucose levels, triglyceride levels, and high-density lipoprotein levels were recorded. MetS was defined according to Adult Treatment Panel III criteria. Moderate/severe nocturia was defined as nocturnal micturition episodes ≥2. Results: Overall 492 patients were enrolled with median age and BMI of 68 years (IQR 61/74) and 26.5 kg/m2 (IQR: 24/29), respectively. Moderate/severe nocturia was reported in 212 (43.1%) patients. MetS was diagnosed in 147 (29.9%) patients and out of them 89 (60.5%) complained moderate/severe nocturia (p = 0.001). Overall 187 (38%) patients were current smokers and out of them 99 (52%) presented moderate/severe nocturia(p = 0.034). Patients with moderate/severe nocturia were older (p = 0.001) and with larger prostate volume (p = 0.003). On multivariate analysis, age (OR: 1.067 per year, 95% CI: 1.036-1.098; p = 0.001), PV (OR: 1.011 per ml, 95% CI: 1.003-1.019; p = 0.006), MetS (OR: 2.509, 95% CI: 1.571-4.007; p = 0.001) and smoking (OR: 1.690, 95% CI: 1.061-2.693; p = 0.027) were associated with nocturia severity. Conclusions: MetS and smoking doubled the risk of moderate/severe nocturia in patients with LUTS and BPE. Assessing smoking and metabolic status in LUTS/BPE patients is suggested
Green light vaporization of the prostate. Is it an adult technique?
No full textINTRODUCTION: Intending to overcome transurethral resection of the prostate (TURF) in terms of safety maintaining its efficacy profile, have led to the introduction of minimally invasive laser therapies to treat men with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO), each one with its unique properties. The aim of this review was to analyze and summarize all the existing data regarding the 180 W Xcelerated Performance System (XPS) photoselective vaporization of the prostate (PVP).
EVIDENCE ACQUISITION: A systematic review was conducted: 45 papers were identified. After excluding those not in English language, duplicates, case reports and "expert opinion" papers, 39 articles were reviewed.
EVIDENCE SYNTHESIS: The XPS emits a 532 nm wavelength generated using a lithium triborate crystal in a quasi continuous mode through a 75011111, continuously saline-cooled, metal capped MoXyTM fibre. This system has overcome the previous model in terms of surgical and functional outcomes. Although several techniques have been proposed, the IGLU modular one is considered the standard approach for 180 W PVP. Authors estimated the need for at least 120 cases to reach an expert level of competence. The GOLIATH Study has proven the non-inferiority of XPS PVP to TURP. The procedure is safe and effective also in large glands but long operative times still represent an issue. Considering the total average costs, XPS PVP provides and advantage over TURP. International guidelines consider PVP the best option to manage patients receiving anticoagulants or with a high cardiovascular risk.
CONCLUSIONS: PVP should be considered an adult technique and, as suggested by the EAU Guidelines, is the best surgical option to manage patients receiving anticoagulant medication or with a high cardiovascular risk. The development of new surgical techniques such as APV, PEBE and seminal spearing approaches could represent a possibility to further implement the XPS indications. Dedicated unit could improve the management LUTS/BPO men
When to perform bone scan in patients with newly diagnosed prostate cancer: external validation of a novel risk stratification tool
No full textTo externally validate the performance characteristics of the Briganti's risk stratification tool for baseline staging bone scan in patients with newly diagnosed prostate cancer (PCa). From 2009 onwards, a consecutive series of patients with PCa were enrolled. All patients were staged to evaluate the presence of bone metastasis (BM) with a conventional total-body Tc 99 m MDP scintigraphy performed regardless of baseline PCa characteristics. The area under the curve (AUC) estimates were used to test the accuracy of the Briganti's risk stratification tool that recommended staging baseline bone scan for patients with a biopsy Gleason score > 7 or with a prostate-specific antigen (PSA) > 10 ng/ml and palpable disease (cT2/T3). The new tool was compared to the European Association of Urology (EAU) guideline. A total of 313 patients were consecutively enrolled. Median age was 68 (range 49-95 years), and median PSA was 7 ng/ml (range 0.81-2,670). Twenty (6.4 %) patients presented BMs. Patients with BMs were significantly older, with higher PSA and a higher Gleason score (p = 0.001). The novel Briganti's model was significantly (p = 0.001) more accurate (AUC: 0.75; CI: 0.632-0.859) than the EAU guideline (AUC: 0.64; CI: 0.52-0.761) for the prediction of BMs. Our study validated in a group of patients with PCa the novel risk stratification tool proposed by Briganti, which presented a higher accuracy for baseline staging bone scan when compared with the EAU guideline. In our experience, this approach would further reduce (about 60 %) the use of staging baseline bone scan without compromising the ability to detect BMs in patients with PCa
Robot-assisted radical cystectomy with intracorporeal neobladder: impact of learning curve and long-term assessment of functional outcomes
No full textBACKGROUND: There is paucity of data about functional outcomes of Robot-assisted Radical Cystectomy (RARC) with intracorporeal orhotopic neobladder (ICON), and the impact of learning curve (LC) on those outcomes remains to be addressed. We aimed to report long-term functional outcomes of our single center series of RARC with ICON, assessing the role of LC in their achievement.METHODS: Patients treated with Robot assisted radical cystectomy with intracorporeal orthotopic neobladder in our center between January 2012 an August 2019 were retrospectively analysed. Preoperative, clinical, perioperative, pathologic and functional data were reported. The first cases were divided in tertiles, for assessing the impact of learning curve on the outcomes evaluated. Long-term functional outcomes of the whole cohort were evaluated.RESULTS: Overall, 167 patients were included. Concerning tertiles analysis, operative time (p<0.001), incidence of low (p=0.002) and high grade (p=0.001) complications and hospital stay (p=0.04) decreased significantly over time. Day-time continence recovery probability was significantly lower in the initial case series (1-yr rate 68.4%, 87% and 89.8 for I, II and III tertile, respectively; p=0.04;). Accordingly, Trifecta achievement was significantly higher in II and III tertiles (p=0.01). At a median follow- up of 34 months, the incidence of significant renal function deterioration of the whole cohort was 16.7%. Overall, 12, 24 and 60-mo day-time continence rates were 74.8 %, 82.7 % and 82.7 %.CONCLUSIONS: Patients treated at the beginning of the learning curve show worse perioperative and functional results. Once standardized the procedure, complications rates, hospital stay and daytime continence recovery experienced a significant improvement. At a long-term analysis of functional outcomes of our patients, renal function preservation and continence recovery results are encouraging
Monopolar Transurethral Enucleation of Prostatic Adenoma: Preliminary Report
No full textTo describe preliminary results of our monopolar transurethral enucleation of prostatic adenoma
(mTUEPA). A consecutive series of male patients treated with mTUEPA, a retrograde enucleation of the prostatic
adenoma performed by means of a standard monopolar resectoscope, were prospectively enrolled.
Symptoms, uroflowmetry parameters, and post-voiding residual were assessed at baseline
and at 1, 6, and 12 months postoperatively. Prostate volume was evaluated at baseline by means
of transrectal ultrasound. Antiplatelet and anticoagulant drugs were stopped at least 1 week before
the operation. Forty-seven patients were enrolled. Mean preoperative prostate volume was 64.9 ± 28.5 g. When
assessed at baseline, the mean total International Prostatic Symptoms Score was 15.2 ± 3.9, peak
flow rate (Qmax) was 8.4 ± 2.9 mL/s and the post-voiding residual was 103.2 ± 90.6 mL. Four weeks
after surgery, patients reported a mean International Prostatic Symptoms Score of 5.3 ± 3. This
lower urinary tract symptoms relief was further maintained at 6 and 12 months after surgery. A
significant postoperative improvement in uroflowmetry parameters was described, being the 6 and
12 months mean Qmax of 23.4 ± 10.6 mL/s and 18.8 ± 9.2 mL/s, respectively (P < .001). Overall,
14 postoperative complications were reported by 13 of 47 (27.6%) patients: most of them were
minor complications (Clavien-Dindo Grade I-II), whereas 1 patient reported capsule perforation
during surgery, requiring interruption of the procedure and its further completion (Clavien-
Dindo IIIb). mTUEPA is a safe and effective technique, merging the principles of laser enucleation and the
advantages of mechanical enucleation with standard monopolar transurethral resection of the prostate
equipment
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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