125 research outputs found
Sex-sparing robot-assisted radical cystectomy with intracorporeal padua ileal neobladder in female: surgical technique, perioperative, oncologic and functional outcomes
No full textOur 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
Robot-assisted deferred cytoreductive nephrectomy in metastatic renal cell carcinoma following immune checkpoint inhibitors plus tyrosine-kinase inhibitor
No full textObjective: This video aims to demonstrate the safety and feasibility of performing deferred cytoreductive nephrectomy (dCN) using robotic assistance in patient treated with immunotherapy for metastatic renal cell carcinoma (mRCC). Patients and surgical procedure: A 62-year-old woman, affected by right metastatic renal cell carcinoma, showed partial response after 4 cycles of Pembrolizumab and Axitinib. Multidisciplinary team consultation decided for cytoreductive right radical nephrectomy with adrenalectomy. After anatomical landmarks identification, inferior vena cava (IVC) was progressively exposed, until identifying the renal hilum. During surgery, small bleeding occurred, and Weck-clips were placed to control the arterial flow. Nephrectomy proceeded without complications. Right adrenal gland, suspected of metastasis, was removed. Results: No intra- and post-operative high-grade Clavien-Dindo complications occurred, and the patient was discharged in post-operative day 3. Final pathology revealed clear cell renal cell carcinoma with sarcomatoid features, Furhman grade 4, with metastatic lesion in the omolateral adrenal gland (pT3a pM1) Conclusion: Robot-assisted dCN is feasible and safe after immune checkpoint inhibitor-based combination therapy in patients affected by mRCC
Response to Re: External beam radiotherapy and radical prostatectomy are associated with better survival in Asian prostate cancer patients
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What the urologist needs to know before radical prostatectomy: MRI effective support to pre-surgery planning
No full textBackground: Radical prostatectomy (RP) is recommended in case of localized or locally advanced prostate cancer (PCa), but it can lead to side effects, including urinary incontinence (UI) and erectile dysfunction (ED). Magnetic resonance imaging (MRI) is recommended for PCa diagnosis and staging, but it can also improve preoperative risk-stratification. Purpose: This nonsystematic review aims to provide an overview on factors involved in RP side effects, highlighting anatomical and pathological aspects that could be included in a structured report. Evidence synthesis: Considering UI evaluation, MR can investigate membranous urethra length (MUL), prostate volume, the urethral sphincter complex, and the presence of prostate median lobe. Longer MUL measurement based on MRI is linked to a higher likelihood of achieving continence restoration. For ED assessment, MRI and diffusion tensor imaging identify the neurovascular bundle and they can aid in surgery planning. Finally, MRI can precisely describe extra-prostatic extension, prostate apex characteristics and lymph-node involvement, providing valuable preoperative information for PCa treatment. Conclusions: Anatomical principals structures involved in RP side effects can be assessed with MR. A standardized MR report detailing these structures could assist urologists in planning optimal and tailored surgical techniques, reducing complications, and improving patients' care.Background: Radical prostatectomy (RP) is recommended in case of localized or locally advanced prostate cancer (PCa), but it can lead to side effects, including urinary incontinence (UI) and erectile dysfunction (ED). Magnetic resonance imaging (MRI) is recommended for PCa diagnosis and staging, but it can also improve preoperative risk-stratification. Purpose: This nonsystematic review aims to provide an overview on factors involved in RP side effects, highlighting anatomical and pathological aspects that could be included in a structured report. Evidence synthesis: Considering UI evaluation, MR can investigate membranous urethra length (MUL), prostate volume, the urethral sphincter complex, and the presence of prostate median lobe. Longer MUL measurement based on MRI is linked to a higher likelihood of achieving continence restoration. For ED assessment, MRI and diffusion tensor imaging identify the neurovascular bundle and they can aid in surgery planning. Finally, MRI can precisely describe extra-prostatic extension, prostate apex characteristics and lymph-node involvement, providing valuable preoperative information for PCa treatment. Conclusions: Anatomical principals structures involved in RP side effects can be assessed with MR. A standardized MR report detailing these structures could assist urologists in planning optimal and tailored surgical techniques, reducing complications, and improving patients’ care
Impacts of Neoadjuvant Chemotherapy on Perioperative Outcomes in Patients with Bladder Cancer Treated with Radical Cystectomy: A Single High-Volume Center Experience
No full textBackground: Less than 30% of patients with muscle-invasive bladder cancer (MIBC)
receive neoadjuvant chemotherapy (NAC), and reasons for underuse remain unclear. One potential
explanation is the concern for the increased risk of perioperative morbidity and mortality. The aim
of this study is to investigate the impact of NAC on the risk of detrimental perioperative outcomes
in patients with MIBC treated with radical cystectomy (RC). (2) Methods: We identified patients
receiving RC for MIBC (T2-4a N0 M0) from 2016 to 2022. Moreover, 1:1 propensity score matching
(PSM) was applied between RC alone versus RC plus NAC, and our analysis tested the association
between NAC status and peri-operative outcomes. (3) Results: Among the 317 patients treated
with RC for identified MIBC, 98 (31%) received NAC. Patients treated with NAC were younger
(median yr. 64 vs. 71; p < 0.001), with a lower Charlson Comorbidity Index (3 vs. 4; p > 0.001), and
received more frequently continent urinary diversion (61 vs. 32%, p < 0.001). About 43% of patients
in each group were treated with robot-assisted radical cystectomy (RARC) with totally intracorporeal
urinary diversion (ICUD). After PSM, no differences were detected for the outcomes considered.
(4) Conclusions: NAC is not associated with a higher rate of perioperative complications, including
patients who received RARC with ICUD
Simulation and Training in Robot-Assisted Urological Surgery: From Model to Patient
No full text(1) Background: Simulation-based training has revolutionized surgical education, providing a solution to the changing demands of surgical training and performance. The increasing demand for standardized training in robotic surgery has accelerated the adoption of simulation-based training as a necessary component of modern surgical education. This study examines the existing literature on training approaches employed in robot-assisted urological surgery; (2) Methods: The authors conducted a standardized search of online databases. Upon collecting the articles, the authors assessed their relevance and content before proceeding with the drafting of the text; (3) Results: The use of simulators is supported by convincing evidence that shows an advantage in the acquisition of robotic skills. Urological societies have created detailed training programs for robotic surgery that guide beginners through the entire process of skill acquisition; (4) Conclusions: The future landscape for robotic urology training is likely to involve organized, obligatory, and centralized training, which may be overseen by urologic associations
Vesical imaging-reporting and data system (VI-RADS) for assessment of response to systemic therapy for bladder cancer: preliminary report
No full textPurpose The Vesical Imaging-Reporting and Data System (VI-RADS) criteria are expanding, providing fine differentiation of bladder wall layers involvement. We aimed to explore the feasibility of a novel categorical scoring, the Neoadjuvant chemotherapy VI-RADS (nacVI-RADS) for radiologic assessment of response (RaR), to define the spectrum of treatment response among patients with muscle invasive bladder cancer (MIBC).Methods Ten consecutive patients diagnosed with non-metastatic MIBC were prospectively enrolled and addressed to NAC and underwent mpMRI before staging resection and after the chemotherapy cycles. The follow-up MRI assessment was performed using the nacVI-RADS algorithm for evaluation of response to therapy. NacVI-RADS categorically define complete RaR, based on prior VI-RADS score, presence of residual disease, tumor size, and infiltration of the muscularis propria.Results NacVI-RADS categories were able to match all the final radical cystectomy pathology both for complete pT0 responders and for the patients defined as partial or minimal responders, who only showed some RaR inter-scoring class downstaging.Conclusion This report is the preliminary evidence of the feasibility of nacVI-RADS criteria. These findings might lead to possible paradigmatic shifts for cancer-specific survival risk assessment and to possibly drive the therapeutic decision through active surveillance programs, bladder-sparing modalities, or to the standard of care
MRI for risk stratification of muscle invasion by upper tract urothelial carcinoma: a feasibility study
No full textBackground Magnetic resonance imaging (MRI) is recommended in patients with upper tract urothelial carcinoma (UTUC) only when computed tomography (CT) is contraindicated. However, CT does not allow distinguishing ureter wall layers, making impossible to assess muscle invasion, a factor contributing to differentiate high- from low-risk UTUCs, which require different therapeutic approaches. We investigated the feasibility of MRI assessment of UTUC muscle invasion.Methods From June 2022 to March 2023, we prospectively enrolled patients suspected of UTUC, i.e., with positive urinary tract ultrasound and/or ureteroscopy, or positive urinary cytology and/or hematuria but negative cystoscopy and bladder ultrasound at two Italian centers. They underwent CT followed by MRI (<= 24 h apart), independently reported by two experienced radiologists, blinded from histopathology results. After imaging confirmation, they all underwent nephroureterectomy and histopathology analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the receiver operating characteristic curve (AUC) were calculated.Results Thirty-nine lesions were detected in 30 patients on both CT and MRI. Muscle-invasive UTUC prevalence was 81% (21/26) among patients with MRI suspicion and 8% (1/13) among those without MRI suspicion (p < 0.001). Considering the assessment of muscle-layer invasion, the more experienced reader achieved 95% sensitivity (95% confidence interval 82-100), 71% specificity (47-88), 81% PPV (63-93), 92% NPV (70-100), 85% accuracy (67-96), and 0.84 AUC (0.70-0.98). Inter-reader agreement was substantial (kappa = 0.73).Conclusions MRI showed a promising diagnostic performance for the assessment of UTUC risk of muscle invasion.Relevance statement Resulting feasible both in technical and clinical terms, MRI could be helpful for upper tract urothelial carcinomas pre-operative risk stratification, to allow a personalized patients' management. These results play in favor of promoting preoperative MRI for UTUC, as already proven for bladder cancer
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