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BACKGROUND: The aim of this study was to investigate the long-term effects of ureteral stenting and the exact timing of stent removal in favor of surgery in patients with idiopathic retroperitoneal fibrosis (IRF). SUMMARY: Medline research terms of "idiopathic retroperitoneal fibrosis" AND " medical therapy" OR "ureteral stenting" OR "surgical treatment" were done. Systematic reviews and observational and clinical studies were analyzed to obtain indication regarding the objective of the study for a narrative review. Ninety-two papers were analyzed. The treatment of IRF includes the monitoring of retroperitoneal fibrotic process spread and the prevention of abdominal organs entrapment. Treatment of ureteral obstruction includes medical therapy and ureteral stenting (US) or percutaneous nephrostomy (PNS) to overcome the worsening of renal function. Up to now, the timing of US or PNS removal is not yet clear, both for the complexity of evaluating the efficacy of the medical therapy and demonstrating the resolution of obstructive nephropathy. Moreover, it is not yet clear if the long-term ureteral stent placement or PNS is able to maintain an efficient renal function. Ureterolysis with a laparoscopic robot-assisted approach is now considered as an ultimate treatment for ureteral obstruction, limiting the progression of kidney impairment and improving the quality of life of patients, although nephrologists are generally abdicant regarding the potential switch toward the surgical approach. KEY MESSAGES: Prospective studies regarding the long-term effects of US on the renal function impairment in patients with IRF should be structured to obtain adequate information on the exact timing for the surgical approach.
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Fibrosis Retroperitoneal , Obstrucción Ureteral , Humanos , Obstrucción Ureteral/cirugía , Fibrosis Retroperitoneal/tratamiento farmacológico , Fibrosis Retroperitoneal/cirugía , Estudios Prospectivos , Calidad de Vida , Riñón/fisiologíaRESUMEN
INTRODUCTION: Intestinal anastomosis can be performed by hand suturing (single layer or double layer) or by a mechanical suturing machine. The aim of the study was to compare complications, operative time, and costs of the intestinal anastomosis techniques. METHODS: A retrospective comparative study was conducted including patients who underwent radical cystectomy and uretero-ileo-cutaneostomy or vescica ileale Padovana orthotopic neobladder. Double-layered hand-sewn intestinal anastomosis (HS-IA) were performed using Vicryl stitches. Mechanical-stapled intestinal anastomosis (MS-IA) were performed with a mechanical stapler. RESULTS: Data of 195 patients who underwent were collected. 100 (51.3%) patients underwent HS-IA and 95 (48.7%) patients underwent MS-IA. Considering the complications classified according to Clavien-Dindo, a statistical difference with higher incidence for grade one in the HS-IA both in the ileal conduit group and in the neobladder one than the MS-IA (15.8% and 8.7%, respectively, in HS-IA vs. 1.7% and none in MS-IA). There is not a significant difference in time to flatus and time to defecation. Difference is recorded in the ileal conduit groups for the length of stay (10 days, range 9-12 with HS-IA vs. 13 days range 12-16 days with MS-IA (p < 0.001). The cost of the suture thread used for a single operation was 0.40 euros, whereas the overall cost of a disposable mechanical stapler and one refill was 350.00 . CONCLUSION: Both HS-IA and MS-IA are safe and effective for patients. The cost for the stapling device is 350 , in contrast, the cost for Vicryl sutures is negligible.
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Neoplasias de la Vejiga Urinaria , Derivación Urinaria , Humanos , Cistectomía/métodos , Estudios Retrospectivos , Análisis Costo-Beneficio , Poliglactina 910 , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria/métodos , Anastomosis Quirúrgica/métodosRESUMEN
Urothelial carcinoma (UC), the sixth most common cancer in Western countries, includes upper tract urothelial carcinoma (UTUC) and bladder carcinoma (BC) as the most common cancers among UCs (90-95%). BC is the most common cancer and can be a highly heterogeneous disease, including both non-muscle-invasive (NMIBC) and muscle-invasive (MIBC) forms with different oncologic outcomes. Approximately 80% of new BC diagnoses are classified as NMIBC after the initial transurethral resection of the bladder tumor (TURBt). In this setting, intravesical instillation of Bacillus Calmette-Guerin (BCG) is the current standard treatment for intermediate- and high-risk patients. Unfortunately, recurrence occurs in 30% to 40% of patients despite adequate BCG treatment. Radical cystectomy (RC) is currently considered the standard treatment for NMIBC that does not respond to BCG. However, RC is a complex surgical procedure with a recognized high perioperative morbidity that is dependent on the patient, disease behaviors, and surgical factors and is associated with a significant impact on quality of life. Therefore, there is an unmet clinical need for alternative bladder-preserving treatments for patients who desire a bladder-sparing approach or are too frail for major surgery. In this review, we aim to present the strategies in BCG-unresponsive NMIBC, focusing on novel molecular therapeutic targets.
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Carcinoma de Células Transicionales , Mycobacterium bovis , Neoplasias Vesicales sin Invasión Muscular , Neoplasias de la Vejiga Urinaria , Humanos , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Vacuna BCG/uso terapéutico , Calidad de VidaRESUMEN
Background and Objectives: To date, sparse evidence exists about the impact of inflammatory serum markers in predicting perioperative complications after radical cystectomy (RC) for bladder cancer (BC). Here, we evaluated the role of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), C-reactive protein (CRP), and plasma fibrinogen in predicting perioperative morbidity and unplanned 30-days readmission after RC for BC. Materials and methods: We relied on a collaborative database of 271 patients who underwent open RC for cT1-4a N0 M0 BC between January 2012 and December 2022. Univariable and multivariable binomial logistic regression analyses were performed to assess the odds ratio (OR) with 95% confidence intervals (CI) testing the ability of each serum marker to predict postoperative complications (any-grade and major complications), and 30-days unplanned readmission. Results: The median age at RC was 73 yr (IQR 67-79). A total of 182 (67.2%) patients were male and the median BMI was 25.2 (IQR 23.2-28.4). Overall, 172 (63.5%) patients had a Charlson Comorbidity Index (CCI) greater than 2 points and 98 (36.2%) were current smokers at the time of RC. Overall, 233 (86.0%) patients experienced at least one complication after RC. Of these, 171 (63.1%) patients had minor complications (Clavien-Dindo grade 1-2) while 100 (36.9%) experienced major complications (Clavien-Dindo grade ≥ 3). According to multivariable analysis, current smoking status, high plasma fibrinogen, and preoperative anemia were independently associated with major complications (OR 2.10, 95%CI 1.15-4.90, p = 0.02), (OR 1.51, 95%CI 1.26-1.98, p = 0.09), and (OR 1.35, 95%CI 1.17-2.57, p = 0.03), respectively. Overall, 56 (20.7%) patients experienced a 30-days unplanned readmission. According to univariable analysis, high preoperative CRP and hyperfibrinogenemia were significantly associated with an increased risk of unplanned readmission (OR 2.15, 95%CI 1.15-4.16, p = 0.02; OR 2.18, 95%CI 1.13-4.44, p = 0.02, respectively). Conclusions: In our study, the preoperative immune-inflammation signature described by NLR, PLR, LMR, SII, and CRP showed a low reliability in predicting perioperative course after RC. Preoperative anemia and hyperfibrinogenemia were independent predictors of major complications. Further studies are pending in order to draw definitive conclusions.
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Cistectomía , Neoplasias de la Vejiga Urinaria , Humanos , Masculino , Femenino , Cistectomía/efectos adversos , Reproducibilidad de los Resultados , Neoplasias de la Vejiga Urinaria/cirugía , Morbilidad , Biomarcadores , Inflamación/complicaciones , Estudios Retrospectivos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugíaRESUMEN
PURPOSE: To investigate the effects of different antibiotic prophylaxis regimens in patients with diabetes mellitus (DM) candidates to trans-rectal ultrasound-guided prostate biopsy (TRUSPB). METHODS: 143 outpatients with DM who underwent TRUSPB during the period 2018-2020 were selected from a cohort of 1150 patients in 3 different institutions. Exclusion criteria were allergies, concomitant anti-platelet therapies and uncontrolled DM. Different antibiotic prophylaxis regimens were adopted. Bacterial resistance levels to fluoroquinolones into the different communities were also collected. Univariable and multivariable binomial logistic regression analyses were used to assess the odds ratio (OR) with 95% confidence intervals (CIs) testing the risk of infective complications' occurrence after adjusting for clinical covariates. RESULTS: Overall, DM patients were significantly associated with infective complications' occurrence (p < 0.001). No differences on the event of sepsis were found between diabetic and non-diabetic patients. Clinically relevant infections with fever > 37 °C were found in 9.1% and 1.5% (p < 0.001) in diabetic and non-diabetic patients, respectively. Trimethoprim-sulphametoxazole and fluoroquinolones were six times more efficient than Cefixime in non-diabetic patients. Fluoroquinolones confirmed the same effect in diabetic patients although the level of resistance in the period of study decreased only from 56 to 46%. CONCLUSION: Fluoroquinolones were active in antibiotic prophylaxis of diabetic patients who had undergone to TRUSPB independently from the level of bacterial resistance found in the community. These results conflict with the recent European warning and support the Japanese and American guidelines on the topic.
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Infecciones Bacterianas , Diabetes Mellitus , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Profilaxis Antibiótica/métodos , Infecciones Bacterianas/prevención & control , Biopsia/métodos , Diabetes Mellitus/epidemiología , Fluoroquinolonas/uso terapéutico , Humanos , Masculino , Próstata/patología , Recto/microbiologíaRESUMEN
BACKGROUND: Gas in the renal excretory system is described as a consequence of recent procedures but it can be a sign of severe conditions such as fistulas or infections; however, gas-containing renal stones are only rarely encountered. PURPOSE: To describe the association of gas-containing renal stones and urinary tract infection. MATERIAL AND METHODS: We performed a retrospective evaluation of the clinical and imaging findings in a series of six patients with gas-containing renal stones and compared our findings with those of patients with gas-containing renal stones reported in the literature. Urine and stone cultures were used as a diagnostic standard for urinary tract infection. RESULTS: Including the present series, there is a total of 21 patients with gas-containing renal stones in the literature. Based on clinical presentation, urinary tract infection could be suspected in 10 (57%) patients, while urine and/or stone cultures showed infection in 18 of 19 (95%) patients, with only one case with no bacterial growth in both (5%); in the remaining patient the information was not available. CONCLUSION: Gas-containing renal stones are a rarely reported entity usually diagnosed with computed tomography. They are a radiological sign often associated with urinary tract infection that can also be encountered in patients with non-specific renal symptoms.
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Cálculos Renales , Infecciones Urinarias , Humanos , Riñón/diagnóstico por imagen , Cálculos Renales/complicaciones , Cálculos Renales/diagnóstico por imagen , Estudios Retrospectivos , Infecciones Urinarias/complicaciones , Infecciones Urinarias/diagnóstico por imagen , Infecciones Urinarias/microbiologíaRESUMEN
Background and Objectives: The aim was to compare the intra and postoperative outcomes between the Enhanced Recovery After Surgery (ERAS) protocol versus the standard of care protocol (SCP) in patients who underwent radical cystectomy performed by a single surgeon. Materials and Methods: A retrospective comparative study was conducted including patients who underwent radical cystectomy from 2017 to 2020. Length of stay (LOS), incidence of ileus, early postoperative complications, and number of re-hospitalizations within 30 days were considered as primary comparative outcomes of the study. Results: Data were collected for 91 patients who underwent cystectomy, and 70 and 21 patients followed the SCP and ERAS protocol, respectively. The mean age of the patients was 70.6 (SD 9.5) years. Although there was a statistically significant difference in time to flatus (TTF) [3 (2.7−3) vs. 1 (1−2 IQR) days, p < 0.001, in the SC hospital and in the ERAS center respectively], no difference was reported in time to first defecation (TTD) [5 (4−6) vs. 4 (3−5.8), p = 0.086 respectively]. The median LOS in the SCP group was 12 (IQR 11−13) days vs. 9 (IQR 8−13 p = 0.024). In the postoperative period, patients reported 22 complications (37% in SCP and 42.8% in ERAS group, p = 0.48). Conclusions: The study reveals how even partial adherence to the ERAS protocols leads to similar outcomes when compared to SCP. As a single surgeon series, our study confirmed the role of surgeons in reducing complications and improving surgical outcomes.
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Recuperación Mejorada Después de la Cirugía , Cirujanos , Neoplasias de la Vejiga Urinaria , Anciano , Cistectomía/efectos adversos , Cistectomía/métodos , Humanos , Tiempo de Internación , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugía , Estudios RetrospectivosRESUMEN
BACKGROUND: Peyronie's disease is an idiopathic fibrotic disease affecting the penile tunica albuginea. Among other resulting deformities, the more common penile curvature should be assessed preferentially with in-office goniometric estimation after pharmacologically induced erection, although clearly invasive and uncomfortable. AIM: In the present pilot study, we investigated the usefulness for the patient and the surgeon of a 3-dimensional (3D) reconstruction of the penile curvature obtained through photogrammetry software in clinical evaluation and surgical planning. METHODS: Enrolled patients received alprostadil 10 µg by intracavernous injection. Then, the medical personnel took a sequence of up to 50 photographs in orthostatism via a smartphone and processed them to obtain a 3D model of the whole groin area with 3DF Zephyr free software (3Dflow SRL, Verona, Italy), to take measurements of the penile curvature with MeshLab software (National Research Council of Italy, Rome, Italy) and to simulate the results after corporoplasty with Blender software (Blender Foundation, Amsterdam, the Netherlands). Finally, we submitted a 1-5 Likert scale to patients and surgeons investigating their satisfaction with the use of the 3D model during preoperative counseling, surgical planning, and the esthetic results after surgery. OUTCOMES: We investigated the patient and surgeon satisfaction with the use of the 3D model in understanding/evaluating the pathology and the surgical planning during the preoperative visit and the satisfaction with the final esthetic results in relation to the preoperative model itself. RESULTS: 4 patients were included. The median photographs acquisition and computer processing time were 39 seconds and 347.5 minutes, respectively. All the patients and surgeons involved gave a score of ≥4 to all the items investigated. CLINICAL IMPLICATIONS: The 3D model of the penile curvature is very useful both to the patient and the surgeon to understand the severity of the disease and the possible surgical management. STRENGTH & LIMITATIONS: This is a pilot study including only 4 cases, but it is the first experience in which the patients with Peyronie's disease had the possibility to see a virtual 3D model of their penile curvature and final esthetic results after corporoplasty, based on 3 freely available computer applications. CONCLUSION: Our pilot study has shown that it is possible to quickly obtain a sequence of photographs to create an accurate virtual 3D model of the penis of patients with Peyronie's disease, helping the patients and the surgeon during preoperative counseling and surgical planning. Pavone C, Abrate A, Altomare S, et al. Is Kelami's Method Still Useful in the Smartphone Era? The Virtual 3-Dimensional Reconstruction of Penile Curvature in Patients With Peyronie's Disease: A Pilot Study. J Sex Med 2021;18:209-214.
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Induración Peniana , Humanos , Italia , Masculino , Países Bajos , Induración Peniana/cirugía , Pene/cirugía , Proyectos Piloto , Teléfono InteligenteRESUMEN
PURPOSE: Therapeutic strategies for prostate cancer (PCa) have been evolving dramatically worldwide. The current article reports on the evolution of surgical management strategies for PCa in Italy. METHODS: The data from two independent Italian multicenter projects, the MIRROR-SIU/LUNA (started in 2007, holding data of 890 patients) and the Pros-IT-CNR project (started in 2014, with data of 692 patients), were compared. Differences in patients' characteristics were evaluated. Multivariable logistic regression models were used to identify characteristics associated with robot-assisted (RA) procedure, nerve sparing (NS) approach, and lymph node dissection (LND). RESULTS: The two cohorts did not differ in terms of age and prostate-specific antigen (PSA) levels at biopsy. Patients enrolled in the Pros-IT-CNR project more frequently were submitted to RA (58.8% vs 27.6%, p < 0.001) and NS prostatectomy (58.4% vs. 52.9%, p = 0.04), but received LND less frequently (47.7% vs. 76.7%, p < 0.001), as compared to the MIRROR-SIU/LUNA patients. At multivariate logistic models, Lower Gleason Scores (GS) and PSA levels were significantly associated with RA prostatectomy in both cohorts. As for the MIRROR-SIU/LUNA data, clinical T-stage was a predictor for NS (OR = 0.07 for T3, T4) and LND (OR = 2.41 for T2) procedures. As for Pros-IT CNR data, GS ≥ (4 + 3) and positive cancer cores ≥ 50% were decisive factors both for NS (OR 0.29 and 0.30) and LND (OR 7.53 and 2.31) strategies. CONCLUSIONS: PCa management has changed over the last decade in Italian centers: RA and NS procedures without LND have become the methods of choice to treat newly medium-high risk diagnosed PCa.
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Prostatectomía/métodos , Prostatectomía/tendencias , Neoplasias de la Próstata/cirugía , Anciano , Humanos , Italia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de TiempoRESUMEN
Phosphodiesterase-5 inhibitors are the first-line therapy for erectile dysfunction (ED) after radical prostatectomy (RP). This single-centre open-label uncontrolled study evaluated the efficacy and safety of the new sildenafil orodispersible film (ODF) in ED treatment after RP. Sildenafil 100 mg ODF was administered twice a week for 3 months to patients under 75 years of age, with a Framingham cardiovascular risk score < 20% and a pre-operative International Index of Erectile Function (IIEF)-5 score ≥ 17, who had undergone open RP between 2016 and 2018. Erectile function was assessed pre-operatively, post-operatively and after treatment through the IIEF-5 score, the Sexual Encounter Profile Question (SEP-Q) 2 and SEP-Q3; adverse events (AE) were also investigated after 3 months. A total of 65 patients with a median (25th-75th percentile) post-operative IIEF-5 score of 8 (7-9) were treated. Nine (13.8%) patients reported AE of mild/moderate grade and discontinued treatment. A significant IIEF-5 score median (25th-75th percentile) increase of 10 (0-12) was found after treatment in the other 56 patients (p < .001). Sildenafil 100 mg ODF was effective in ED after RP in terms of improved IIEF-5 score and improved SEP-Q2 and SEP-Q3 in 67.9% of patients. It could represent a valid alternative for those patients with low compliance to tablet intake.
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Disfunción Eréctil , Disfunción Eréctil/tratamiento farmacológico , Disfunción Eréctil/etiología , Humanos , Masculino , Erección Peniana , Inhibidores de Fosfodiesterasa 5/uso terapéutico , Prostatectomía/efectos adversos , Citrato de Sildenafil/uso terapéutico , Resultado del TratamientoRESUMEN
OBJECTIVES: To compare overall (OS), cancer-specific (CSS), recurrence-free survival (RFS) and postoperative renal function amongst patients with upper tract urothelial carcinoma (UTUC) of the distal (lower lumbar and pelvic) ureter, electively treated with segmental resection and termino-terminal anastomosis (TT) vs bladder cuff removal and ureteric re-implantation (RR). PATIENTS AND METHODS: A multicentre retrospective study, including 84 patients diagnosed with UTUC of the distal ureter and treated with TT or RR, is presented. The primary endpoint was to compare TT and RR in terms of OS, CSS and RFS. As a secondary outcome, we compared the postoperative creatinine values as an index of renal function in the two groups. RESULTS: Of 521 patients with UTUC, 65 (77.4%) and 19 (22.6%) patients underwent RR and TT, respectively. Pre- and postoperative characteristics were not statistically different between the two groups. The median follow-up period was 22.7 months. Patients treated with TT and those treated with RR did not have significantly different 5-year OS, CSS or RFS (73.7% vs 92.3%, P = 0.052; 94.7% vs 95.4%, P = 0.970: and 63.2% vs 53.9%, P = 0.489, respectively). No difference in postoperative creatinine variation emerged in association with the surgical technique (P = 0.411). CONCLUSION: Patients treated with TT or RR for UTUC showed comparable OS, CSS, RFS and postoperative renal function. Our data suggest that bladder cuff removal is not imperative in the treatment of distal ureteric UTUC, and TT can be a safe solution in selected cases.
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Carcinoma in Situ/cirugía , Reimplantación/métodos , Uréter/cirugía , Neoplasias Ureterales/cirugía , Vejiga Urinaria/cirugía , Anastomosis Quirúrgica , Biomarcadores de Tumor/metabolismo , Creatinina/metabolismo , Supervivencia sin Enfermedad , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Neoplasias Ureterales/mortalidadAsunto(s)
Sepsis , Infecciones Urinarias , Humanos , Monocitos , Sepsis/diagnóstico , Biomarcadores , Infecciones Urinarias/diagnósticoRESUMEN
The aim of this study was to evaluate abiraterone's efficacy in Italian patients affected with metastatic prostate cancer progressing after treatment with docetaxel. We conducted a retrospective analysis of 60 patients. Prostate-specific antigen (PSA) reduction in serum was the primary endpoint for evaluating the efficacy of abiraterone in combination with prednisone treatment, whereas reduced pain, safety, progression-free survival, response rate, and overall survival (OS) were secondary endpoints. A significant correlation was noticed between PSA response and OS. Further, the Index Bravais-Pearson (r) correlation allowed us to observe a significant negative interdependence between PSA response and reduction in pain of 0.57 (95% confidence interval: -0.30 to 0.80) (P=0.005). Meanwhile, regression analysis revealed that PSA levels are predictive of OS. There was a positive correlation with OS, which showed a value of R to 0.50 with a slope of 1.44 (P=0.0021). Abiraterone is a well-tolerated and effective treatment modality for patients affected with metastatic castration-resistant prostate cancer. The drug has a better tolerability profile, gives significant pain relief, and increases the survival rate.
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Androstenos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Neoplasias de la Próstata Resistentes a la Castración/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Androstenos/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Docetaxel , Humanos , Calicreínas/sangre , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Prednisona/administración & dosificación , Prednisona/efectos adversos , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata Resistentes a la Castración/sangre , Neoplasias de la Próstata Resistentes a la Castración/patología , Estudios Retrospectivos , Taxoides/uso terapéuticoRESUMEN
The aim of our work was to evaluate the long-term changes in symptoms (median 42 months) and to analyze data for any negative predictive factors for the application of the procedure, in patients who underwent to urethroplasty with dorsal buccal mucosa graft. During the period from 2010 to 2015 27 patients were examined. Than they underwent urethroplasty using dorsal buccal mucosa graft (graft of 4 x 2.5 cm). The evaluation of symptoms has been addressed through the application of the IPSS Quality of Life Questionnaire (International Prostatic Symptoms Score) and the evaluation of urinary flow has been carried out by a comparative analysis between the pre- and post-operative uroflowmetry. As our study has shown, data obtained by the screening tests in the post-operative follow-up indicate that there is an increase in the maximum flow of urine until 1 month after surgery. The results in the long-term follow-up are different because they show a partial reduction of the maximum flow although it is maintained around an average value of 23 ml/s being still higher than the maximum flow in the pre-operative period. According to our results it follows that there is a low failure rate of the procedure after a median of 42 months. Only in patients with urethral stenosis longer than 2 cm, a lower long term success is achieved. From what we could observe, this length of the stenosis seems to be the only negative predictive factor for long-term maintenance of a good Quality of Life in patients undergoing the procedure. The results obtained from our study confirm literature data according to which, the gold standard for 2-cm long bulbar urethral stricture whose lumen is well preserved with circumferential spongiofibrosis limited to 1-2 mm is the dorsal graft urethroplasty with buccal mucosa that in our study showed success rates higher of 80% after a median follow up of 42 months and a percentage of relapse-free patients of 82.1% ( median 3.5 years).
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Mucosa Bucal/trasplante , Calidad de Vida , Estrechez Uretral/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Adulto , Anciano , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Periodo Posoperatorio , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , Uretra/cirugía , Adulto JovenRESUMEN
PURPOSE: To describe the sonographic findings observed in the testis in patients who have undergone testicle-sparing surgery and surgical biopsies. METHODS: We reviewed the color Doppler sonographic findings from 14 patients after testicular interventions: 2 open biopsy procedures for infertility and 12 testicle-sparing surgical procedures (1 for spontaneous intratesticular hemorrhage and 11 for small tumors). Ten patients had benign tumors; one had a malignancy. Three patients were symptomatic; all others were studied as follow-up. RESULTS: Hypoechoic and hypovascular lesions at site of surgery were seen in 10 of the 11 patients after tumorectomy; no changes were observed in one patient. The lesions were either linear or an irregularly triangular shape, located at the surgical site, and interpreted as scars. Retraction of the testicular surface was detected in two cases. In the eight patients who underwent follow-up, lesions disappeared in one case, became smaller in two, and remained stable in five. Of the two patients who underwent biopsy, one developed peritesticular hematoma, and both had late hypoechoic scars in the testis. CONCLUSIONS: Hypoechoic and hypovascular scars are a "normal" postoperative pattern after testicle-sparing surgery. They are either linear or triangular, with rectilinear margins. Such findings need to be correctly interpreted and not misinterpreted as recurrences.
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Testículo/diagnóstico por imagen , Ultrasonografía , Estudios de Seguimiento , Humanos , Infertilidad/diagnóstico por imagen , Infertilidad/etiología , Masculino , Recurrencia Local de Neoplasia , Estudios Retrospectivos , Neoplasias Testiculares/complicaciones , Neoplasias Testiculares/diagnóstico por imagen , Neoplasias Testiculares/cirugía , Testículo/cirugíaAsunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Pandemias , Neumonía Viral/epidemiología , Derivación y Consulta/estadística & datos numéricos , Enfermedades Urológicas/complicaciones , COVID-19 , Infecciones por Coronavirus/complicaciones , Humanos , Incidencia , Italia/epidemiología , Neumonía Viral/complicaciones , SARS-CoV-2 , Enfermedades Urológicas/epidemiologíaRESUMEN
Toll-like receptor 4 (TLR4), a component of the innate immune system, is recognized to promote tubulointerstitial inflammation in overt diabetic nephropathy (DN). However, there is no information on immune activation in resident renal cells at an early stage of human DN. In order to investigate this, we studied TLR4 gene and protein expression and TLR4 downward signaling in kidney biopsies of 12 patients with type 2 diabetes and microalbuminuria, and compared them with 11 patients with overt DN, 10 with minimal change disease (MCD), and control kidneys from 13 patients undergoing surgery for a small renal mass. Both in microalbuminuria and in overt DN, TLR4 mRNA and protein were overexpressed 4- to 10-fold in glomeruli and tubules compared with the control kidney and in MCD. In addition, NF-κB signaling was about fourfold higher in the glomeruli. TNF-α, IL6, CCR2, CCL5, and CCR5 mRNAs were markedly (about three- to fivefold) upregulated in microdissected glomeruli. While IL6, CCL2 and CCR5-mRNA, and CD68 were overexpressed in the tubulointerstitial compartment in clinical DN, they were not expressed in microalbuminuria. In a 6-year follow-up of microalbuminuric patients, glomerular TLR4 gene expression was associated with the subsequent loss of kidney function. Thus, innate immunity is activated in the glomeruli of patients with diabetic microalbuminuria. Enhanced TLR4 signaling may contribute to the progression occurring after the incipient, microalbuminuric form of nephropathy evolves to overt disease.
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Albuminuria/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Nefropatías Diabéticas/metabolismo , Glomérulos Renales/química , ARN Mensajero/metabolismo , Receptor Toll-Like 4/metabolismo , Albuminuria/inmunología , Antígenos CD/genética , Antígenos de Diferenciación Mielomonocítica/genética , Biomarcadores/química , Quimiocina CCL5/genética , Quimiocina CCL5/metabolismo , Diabetes Mellitus Tipo 2/complicaciones , Nefropatías Diabéticas/inmunología , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Inmunidad Innata , Interleucina-6/genética , Interleucina-6/metabolismo , Túbulos Renales/química , Masculino , Persona de Mediana Edad , Nefrosis Lipoidea/metabolismo , Receptores CCR2/genética , Receptores CCR2/metabolismo , Receptores CCR5/genética , Receptores CCR5/metabolismo , Transducción de Señal , Receptor Toll-Like 4/genética , Factor de Transcripción ReIA/metabolismo , Factor de Necrosis Tumoral alfa/genética , Factor de Necrosis Tumoral alfa/metabolismo , Regulación hacia ArribaRESUMEN
INTRODUCTION: Before radical prostatectomy (RP), a nomogram [Briganti et al., Eur Urol 2012;61:584-592] permits to measure the probability of specimen-confined (SC) disease (pT2-pT3a, node negative with negative margins) in high-risk prostate cancer (PCa). The aim of our study was to perform an external validation of this nomogram. MATERIALS AND METHODS: Between 2007 and 2011, 623 patients with high-risk PCa (prostate-specific antigen (PSA) >20 ng/ml and/or biopsy Gleason score ≥8 and/or clinical stage T3) underwent RP and pelvic lymph node dissection at tertiary referral centers. Multivariable logistic regression models predicting the presence of SC disease were built in; we then used the area under curve of the receiver operating characteristic analysis to quantify accuracy of the nomogram to predict SC disease. The extent of over- or underestimation was evaluated within calibration plots. RESULTS: 29% (181/623) of men had SC disease at RP. Preoperative PSA, biopsy Gleason score and stage differed significantly (all p < 0.001) between men with SC disease and those without. External validation of the nomogram showed an acceptable accuracy (area under curve: 66.3, 95% CI 62.4-70%) and a perfect calibration plot. CONCLUSIONS: The external cohort validates the original nomogram, with perfect calibration characteristics. The adequate although reduced accuracy may reflect the wide spectrum and behavior of the so-called high-risk PCa.
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Escisión del Ganglio Linfático/métodos , Prostatectomía/métodos , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Calibración , Estudios de Cohortes , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Nomogramas , Probabilidad , Antígeno Prostático Específico/metabolismo , Curva ROC , Análisis de Regresión , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
We report a patient with myxoid liposarcoma of the spermatic cord in whom combined use of both ultrasound (US) and MRI helped to suggest the diagnosis. The lesion was solid at US and vascularized at color Doppler. T1-weighted MRI did not show fat within it; on T2-weighted images it had high signal intensity, with a cyst-like appearance. It is known that fat-poor myxoid liposarcomas with high water content may mimic a cystic lesion on non-contrast-enhanced MR; then, a combination of MRI findings, suggesting a cyst, and of US findings, showing the mass was actually solid and vascularized, allowed preoperatively the diagnosis of fat-poor myxoid liposarcoma.
Asunto(s)
Neoplasias de los Genitales Masculinos/diagnóstico , Liposarcoma Mixoide/diagnóstico , Imagen por Resonancia Magnética , Cordón Espermático , Ultrasonografía Doppler en Color , Anciano , Humanos , Masculino , Cordón Espermático/diagnóstico por imagenRESUMEN
Background and objective: Several novel multiport robotic systems have been developed and introduced in clinical practice after regulatory approval. The objective of this systematic review was to assess the evolution status of novel robotic platforms approved for clinical use in urological surgery according to the IDEAL framework. Methods: A systematic review was conducted using the Medline and Scopus databases according to the updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (CRD42024503227). Comparative or noncomparative studies reporting on any urological procedures performed with novel robotic platforms (Hugo RAS; Versius, KangDuo, Senhance, REVO-I, Avatera, Hinotori, Dexter, or Toumai) were selected and included in the analysis. Key findings and limitations: Seventy-four eligible studies were included, of which 67 (90.5%) were noncomparative surgical series representing developmental or explorative studies according to the IDEAL criteria. Only one randomised controlled trial (comparing KangDuo vs da Vinci robot-assisted partial nephrectomy) was included. The trial showed comparable perioperative outcomes between the two robotic systems. Four studies assessed clinical outcomes for patients undergoing urological procedures using a REVO-I (1 study), Senhance (2 studies), or Hinotori (1 study) system in comparison to the same procedures performed using a da Vinci system. All studies revealed outcomes comparable to those with the da Vinci system. Limitations include the small sample size in all studies, and assessment of first-generation novel platforms versus the fourth-generation multiarm da Vinci system in most of the comparative studies. Conclusions and clinical implications: A few poor-quality studies have compared the use of novel robotic platforms to da Vinci systems in urological surgery and demonstrated comparable results. Most studies can be classified as developmental or explorative, representing the initial steps of clinical research. Large multicentre series are needed to understand whether these novel robots could offer advantages beyond cost reductions over the da Vinci systems. Patient summary: We reviewed research on new robotic systems for surgery in urology. Several studies have shown the feasibility and safety of these new robots during the most common procedures. Very few studies have assessed clinical outcomes with the new robots in comparison to the reference standard, which is a fourth-generation da Vinci robot. Large multicentre studies are needed to understand whether the new robots could offer advantages other than cost savings over the da Vinci robot.