Electromotive Drug Administration of Mitomycin C (EMDA/MMC) versus Intravesical Immunotherapy with Bacillus Calmette-Guérin (BCG) in Intermediate and High Risk Non Muscle Invasive Bladder Cancer.

BACKGROUND: Although TURB of tumor (TURBT) by itself can eradicate a non-muscle-invasive bladder cancer (NMIBC) completely, these tumors commonly recur and can progress to MIBC. It is, therefore, necessary to consider adjuvant therapy in most patients. The primary objective of the present study was to report our experience with EMDA/MMC and BCG, considering efficacy, progression, and recurrence, as adjuvant therapy in NMIBC patients; the secondary objective was to assess the efficacy of EMDA/MMC versus BCG as a comparative treatment. METHODS: Between April 2016 and February 2020, a series of 216 patients, with a diagnosis of intermediate- and high-risk NMIBC after TURBT, underwent adjuvant intravesical therapy. In 26 cases with a failure of the treatment, in patients unfit and unwilling for radical cystectomy, a repeated intravesical therapy was performed (2 had a twice repetition). Out of 244 adjuvant therapies, 140 EMDA/MMC and 104 BCG treatments were done. The following data were collected for each patient: baseline demographics and clinical data and perioperative and postoperative data. Overall patients' adjuvant intravesical therapies were included in a prospectively maintained institutional database, and a retrospective chart review was performed. We collected data on 2 main outcomes, recurrence-free survival (defined as a negative cystoscopy, cytology, and/or histology at the evaluation time point) and progression-free survival (defined as a negative cystoscopy or a nonprogressive tumor recurrence). RESULTS: The NMIBC progression rate was higher in BCG than EMDA/MMC but not statistically significant (respectively, 4.2% vs. 2.5%; p = 0.703). In the overall population, the risk of NMIBC recurrence was higher after BCG than EMDA/MMC (p = 0.025). In the subgroups of 59 paired patients with similar characteristics, no difference was observed between groups in NMIBC progression and recurrence. CONCLUSIONS: Our findings suggest that EMDA/MMC and BCG are safe and reproducible approaches as adjuvant treatment in NMIBC. EMDA/MMC permits to achieve a fine oncological management as adjuvant treatment in NMIBC, which is not less than that obtained with BCG.

Robot-Assisted Extraperitoneal Radical Prostatectomy for Giant Multilocular Prostatic Cystadenoma: A Case Report and Literature Review.

A 48-year-old man with a medical history of hypertension and no family history of prostate cancer presented with abdominal distension, lower abdominal pain, and lower urinary symptoms. Physical examination revealed a palpable mass in the lower abdomen, and a digital rectal examination detected a firm mass on the anterior side of the rectum. Laboratory tests showed an elevated PSA level (7.9 ng/mL). Imaging studies indicated a solid mass connected to the prostate's posterior and rectum's anterior walls, along with bladder compression. Transperitoneal biopsy and histological analysis led to a diagnosis of a stromal tumor with uncertain potential malignancy. Considering the absence of apparent malignancy signs and the smooth outer wall of the tumor, the patient underwent, for the first time in the literature, a robot-assisted radical extraperitoneal prostatectomy for complete macroscopic resection. The surgery involved excision of the bulky pelvic mass, preservation of the urethra, and anatomical reconstruction. The postoperative course was uneventful, and we discharged the patient with no complications. The pathological examination documented the diagnosis of multilocular prostatic cystadenoma. Post-surgery follow-up examinations, including PSA levels and imaging scans, showed no signs of tumor recurrence. At the 3-, 6-, and 9-month follow-ups, the patient was asymptomatic and had fully recovered, with no urinary or sexual dysfunction reported.

Intravesical Treatment with Electro-Mediated Administration of Mytomicin C as Prophylaxis for Intermediate and High-Risk Nonmuscle-Invasive Bladder Cancer: A Retrospective Multicenter Study.

BACKGROUND: Topical therapy of nonmuscle-invasive bladder cancer (NMIBC) is based on immunotherapy with Bacillus Calmette-Guerin and chemotherapy administered by passive instillation, but an active drug administration achieves a better concentration of the drugs in the bladder. AIM: This study aimed to investigate the effectiveness of electromotive drug administration (EMDA) of mitomycin C (EMDA/MMC) in intermediate- and high-risk NMIBC patients 6 months after the end of induction treatment. MATERIALS AND METHODS: Sixty-five patients diagnosed with histologically confirmed NMIBC, with a complete transurethral resection of all visible tumors underwent EMDA/MMC. Primary endpoint was the proportion of responders at 3 or 6 months. RESULTS: Data on follow-up were available for 62 subjects at 3 months and 45 at 6 months. EMDA was effective in intermediate- and high-risk patients: because of the small number of cases no conclusions can be drawn on the efficacy in the low-risk group. No difference in the response to treatment between intermediate- (83.3%) and high-risk (84%) patients could be seen. CONCLUSIONS: EMDA/MMC is a useful technique for an effective and safe treatment of primary and recurrent NMIBC, and a valuable therapeutic option in intermediate- and high-risk NMIBC patients.

The role of surgery in metastatic squamous cell carcinoma of the penis.

PURPOSE OF REVIEW: Prognosis of penile squamous cell cancer (PeSCC) depends on the involvement of the groin(s) as first step. We introduce the current available evidences that should rule the use of surgery in the management of PeSCC. RECENT FINDINGS: Prophylactic inguinal node dissection in patients with no palpable nodes associates with immediate and long-term side-effects in up to 70% of patients. Recent findings support selective intervention based on early identification of dynamic sentinel node biopsy (DSNB) with false negative rate of 4-12%. Adequate node retrieval and extending surgery to the pelvis have been addressed as important key factors as staging and therapeutic factors in patients with nodal metastases. Pelvic dissections could be spared only in patients with small (< 3 cm), limited (< 3 nodes) and no extranodal extension. Bilateral pelvic dissection should be recommended in case of involvement of bilateral nodes of at least four. Cisplatin-based neo-adjuvant chemotherapy has a moderate activity, whereas adjuvant chemotherapy associates with prolonged survival in a proportion of patients. SUMMARY: In case of nodal metastases, surgery still represents the most effective treatment. Preventive surgery could be driven by DSNB, which needs an accurate multistep pathway. Extent of surgery is of paramount importance, and inguinal only and unilateral dissections should be reserved to selected patients with the most favorable features. Definitive conclusions concerning perioperative chemotherapy cannot be drawn.

Histopathological characteristics of microfocal prostate cancer detected during systematic prostate biopsy.

OBJECTIVE: To evaluate the prevalence of adverse pathological features and the percentage of multifocal and/or bilateral disease in a series of patients who underwent radical prostatectomy (RP) for unique, microfocal prostate cancer (miPCa) detected on prostate biopsy in the pre-active surveillance (AS) era. PATIENTS AND METHODS: In this retrospective, multi-institutional study, we analysed the clinical records of 131 consecutive patients who underwent either retropubic or robot-assisted RP for miPCa at two referral centres from January 2000 to December 2011. miPCa was defined as a neoplastic lesion present in ≤10% of core with biopsy Gleason score not applicable or biopsy Gleason score 6. RESULTS: There were 17 (13%) pT3-4 prostate cancers and a single case (0.8%) of pN+ tumour. Moreover, 31 (24.1%) patients had a Gleason score of >6 in the RP specimen. Therefore, unfavourable pathological features (pT3-4/N+ and/or Gleason score >6) were present in 40 (30.5%) patients. The median (interquartile range) prostate-specific antigen (PSA) density was 0.11 (0.09-0.17) and 0.16 (0.11-0.24) ng/mL/mL in patients with favourable and unfavourable pathological characteristics, respectively (P = 0.003). The receiver operating characteristic curve had an area under the curve value of 0.67 (95% confidence interval 0.56-0.77) for PSA density to predict the risk of unfavourable pathological features. CONCLUSION: Patients with miPCa who are candidates for an AS protocol should be adequately informed that in ≈30% of cases the cancer might be locally advanced and/or with a Gleason score of >6. Those unfavourable pathological characteristics could be predicted by the PSA density value. Further studies should investigate the role of a more extensive biopsy sampling to reduce the risk of under-staging and/or under-grading in patients with an initial diagnosis of miPCa.

The role of inflammation in lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and its potential impact on medical therapy.

A chronic prostatic inflammation seems to play a crucial role in benign prostatic hyperplasia (BPH) pathogenesis and progression. Therefore, inflammation could represent a new potential target for medical therapy of lower urinary tract symptoms (LUTS) due to BPH (LUTS/BPH). This review article analyzes the evidence supporting the role of inflammation in the onset and progression of BPH, and it assesses the potential impact of previous mechanisms on medical therapy of LUTS/BPH. Literature data support the role of inflammation as a relevant factor in the pathogenesis of BPH. Indeed, several data favour the role of infiltrating lymphocytes in the development and progression of prostate adenoma as an effect of a self-maintaining remodeling process. Although available drugs commonly used in the treatment of LUTS/BPH do not exhibit an anti-inflammatory activity, it seems to be obvious considering the inflammation as a new target in the treatment of LUTS/BPH. Drugs currently investigated for the treatment of prostatic inflammation include the hexanic lipidosterolic extract of Serenoa repens, nonsteroidal anti-inflammatory drugs, and vitamin D receptor agonists.

A matched-analysis on short-term and long-term (up to 5 years of follow-up) urinary incontinence outcomes after robot-assisted radical prostatectomy with and without anterior and posterior reconstruction: data on 1358 patients.

PURPOSE: We report a comparative monocentric study with a short and long-term follow-up with the aim to assess differences about urinary continence outcomes in patients treated with Robot-Assisted Radical Prostatectomy (RARP) with two different techniques: with anterior and posterior reconstruction and without any kind of reconstruction. MATERIALS AND METHODS: From January 2016 to September 2021, at the Department of Urology of the "F. Miulli" Hospital of Acquaviva delle Fonti, in Italy, 850 eligible patients underwent extraperitoneal RARP with anterior and posterior reconstruction and 508 without reconstructions. RESULTS: In patients undergoing RARP with reconstructions 1 month after surgery the urinary continence was preserved in 287/850 patients (33.8%), 3 months after surgery in 688/850 (81%), 6 months in 721/850 (84.8%), 12 months in 734/850 (86.3%), 18 months in 671/754 (89%), 24 months in 696/754 (92.3%), 36 months in 596/662 (90%), 48 months in 394/421 (93.6%), 60 months in 207/212 (97.6%). In patients undergoing RARP without reconstruction 1 month after surgery urinary continence was preserved in 99/508 (19.4%), after 3 months in 276/508 (54.3%), 6 months in 305/508 (60%), 12 months in 329/508 (64.7%), 18 months in 300/456 (65.7%), 24 months in 295/456 (64.7%), 36 months in 268/371 (72.3%), 48 months in 181/224 (81%), 60 months in 93/103 (90.3%). CONCLUSION: In our case study, the RARP with anterior and posterior reconstruction technique is associated with a statistically significant higher rate (up to 48 months of follow-up) and a faster recovery of urinary continence compared to the technique without reconstructions.

Robotic pyelolithotomy for the treatment of large renal stones: a single-center experience over seven years.

BACKGROUND: Urolithiasis prevalence varies globally between 1-20%, influenced by regional factors. Robotic pyelolithotomy (RPL) presents an interesting alternative to PCNL, considered the gold standard for symptomatic stones smaller than 20 mm, as it carries a risk of significant complications. However, studies on RPL are limited, especially in anatomically complex cases, where RPL proves to be particularly useful. The study aims to update and review outcomes of RPL in a high-volume robotic center. METHODS: A retrospective analysis of 153 patients treated with RPL for staghorn kidney stones at a single center from February 2016 to December 2023 was conducted. Data including demographics, preoperative renal function, stone characteristics, operative and postoperative outcomes, and costs were collected. Stone-free rates (SFR) and complications were assessed at follow-up intervals up to 12 months post-surgery. RESULTS: The study showed an initial 3-month stone-free rate (SFR) of 93.5%, which decreased to 83.5% at 12-months. This trend may reflect new stone formation rather than procedure failure. Sub-analysis revealed a significant difference in SFR between patients with pelvic and pyelocalyceal stones at each follow-up. Multivariate regression analysis identified in the pyelocalyceal group that higher BMI and larger stones were associated with higher failure rates at both 6 and 12 months. CONCLUSIONS: RPL is a safe and effective treatment for large renal stones, offering a high SFR and low complication rate. It is particularly beneficial in cases with complex anatomy or requiring concurrent renal procedures. However, patient selection is crucial, considering factors like stone location and size. Further research is needed to compare RPL with other treatment methods.

The bladder neck preservation in robot assisted radical prostatectomy: Surgical and pathological outcome.

INTRODUCTION: The post-prostatectomy incontinence is influenced by multiple elements, anatomic components and biological factors. The bladder neck preservation, more accurate during robot assisted radical prostatectomy, works on two anatomic components responsible for post-prostatectomy continence. The bladder neck preservation spares the internal sphincter, which is responsible for passive continence, and results in earlier return to continence and lower rates of post-prostatectomy incontinence. Moreover, this surgical technique spares the zone of urothelium coaptation and provides primary resistance to the urine to maintain postprostatectomy continence. The potential risk of bladder neck positive surgical margins (PSM) may prevent the usage of the bladder neck preservation. AIM: The purpose of this study is to evaluate the surgical and pathological outcome in prostate cancer patients underwent robot assisted radical prostatectomy with bladder neck preservation. MATERIALS AND METHODS: Prospectively, we have collected demographic, clinical, surgical and pathological data of prostate cancer patients underwent robot assisted radical prostatectomy with bladder neck preservation, from January 2014 to December 2016, in Urological Clinic of the University of Padua. Moreover, it was valued the presence of alterations or continuous solutions of specimen external capsule, attributable to the surgical technique of bladder neck preservation, by microscopic and macroscopic pathological analysis. RESULTS: According to D'Amico risk classification, 40 patients (45.4%) had a low risk neoplasia, 35 patients (39.8%) had an intermediate risk neoplasia, 13 patients (14.8%) had an high risk neoplasia. The median prostatic volume, valued on specimen, was 30.84 cc (21.5-44.75 cc). The median prostatic weight, valued on specimen, was 51 gr (36-67 gr). The pathological stage of disease was pT2a in 11 cases (12.5%), pT2b in 37 cases (42.1%), pT3a in 28 cases (31.8%), pT3b in 12 cases (13.6%). The pathological stage of lymph node involvement was pNx in 17 cases (19.3%), pN0 in 66 cases (75%), pN1 in 5 cases (5.7%). The prostate cancers diagnosed had a Gleason score at specimen of 6 in 10 cases (10.4%), 7 (3+4) in 30 cases (34.1%), 7 (4+3) in 20 cases (22.7%), 8 in 19 cases (21.6%) and 9 in 9 cases (10.2%). The prostatic base was involved by neoplasia in 14 patients (15.9%); of these, 5 patients (35.7%) had bladder neck PSM. The patients with bladder neck PSM had: a pathological stage of disease as pT3a in 2 cases (40%) and pT3b in 3 cases (60%); a pathological stage of lymph node involvement as pN0 in 2 cases (40%) and pN1 in 3 cases (60%); a Gleason score at specimen of 8 in 3 cases (60%) and 9 in 2 cases (40%); multiple PSM. Nobody had alterations or continuous solutions of specimen external capsule, attributable to surgical technique of bladder neck preservation. CONCLUSIONS: The bladder neck preservation, during robot assisted radical prostatectomy, is a safe oncological procedure resulting in a good functional outcome, about post-prostatectomy continence, working on two anatomic components responsible for post-prostatectomy continence. The bladder neck PSM are linked to neoplasia with adverse pathological features, rather than the bladder neck preservation.

Nephron sparing surgery for the treatment of renal masses: A single center experience.

BACKGROUND: Nowadays, the partial nephrectomy (PN) not only is considered oncological equivalent to radical nephrectomy as renal tumor's treatment, but has also give benefits in quality of life and overall survival of patients. OBJECTIVES: The primary objective of the present study was to report our single center experience with NSS, predominantly performed by a robot assisted access, in a high-volume center with large experience with minimally invasive surgery. METHODS: Between June 2018 and January 2020, a consecutive series of 109 patients (pts) with a renal mass suspicious of renal cell carcinoma, feasible of NSS, detected by ultrasound and abdominal computed tomography (CT), underwent NSS and they were included in a prospectively maintained institutional database. Baseline demographics and clinical characteristics, perioperative and postoperative parameters, pathological data were recorded. RESULTS: The mean clinical maximum CT tumor diameter was 37.3 ± 19.6 mm (median 31.5 mm; interquartile range 25-45 mm). PADUA risk was low in 54 pts (49.5%), intermediate in 48 pts (44.0%), high in seven pts (6.4%). The clinical T stage was mostly pT1a (70.6%). NSS was performed by open surgery in nine pts (8.3%), laparoscopy in one pts (0.9%) and was robot assisted in 99 pts (90.8%). A simple enucleation was performed in 67 pts (61.5%), an enucleoresection was performed in 37 pts (33.9%) and a partial nephrectomy was performed in five pts (4.6%). Warm ischemia was performed in 41 pts (37.6%), with a mean warm ischemia time of 5.1 ± 7.1 min. The mean pathological maximum tumor diameter was 35.5 ± 21.7 mm (median 30 mm; interquartile range 22-40 mm). Overall PSM rate was 11.9% (13 pts). In 78% of cases no complication was recorded. No major complications (grade III-IV-V) were noted. CONCLUSION: Our findings suggest that NSS is a safe, reproducible and minimally invasive approach as treatment of small renal masses. NSS permits to achieve a fine oncological management without any worsening of renal function.

Electro-mediated drug administration of mitomycin C in preventing non-muscle-invasive bladder cancer recurrence and progression after transurethral resection of the bladder tumour in intermediate- and high-risk patients.

OBJECTIVE: To evaluate the effectiveness of electro-mediated drug administration of mitomycin C (EMDA/MMC) after transurethral resection of the bladder tumour (TURBT) in preventing non-muscle-invasive bladder cancer (NMIBC) recurrence and progression and to explore clinical and demographic factors associated with treatment response. PATIENTS AND METHODS: Between April 2016 and August 2019, 112 patients diagnosed with intermediate- or high-risk NMIBC underwent a TURBT followed by an EMDA/MMC treatment. The percentage of treatment responders and progression-free survivors at 3 and 6 months were evaluated. RESULTS: Follow-up data were available for 101 patients (90%) at 3 months and 92 (82%) at 6 months. Response rates to EMDA/MMC treatment were 85% at 3 months and 75% at 6 months, and progression-free rates were 94% and 90%, respectively. No statistically significant differences were seen between intermediate- and high-risk patients. A higher risk of tumour recurrence and progression was associated with previous Bacillus Calmette-Guérin (BCG) failure. According to the Clavien-Dindo classification, only low-grade complications were observed. CONCLUSIONS: EMDA/MMC after TURBT was associated with high response and progression-free rates at 3 and 6 months, with only low-grade adverse events. These results confirm the efficacy and safety of EMDA/MMC as a therapeutic option for both intermediate- and high-risk patients. However, patients with BCG failure responded poorly to EMDA/MMC.Abbreviations: ACCI: age-adjusted Charlson Comorbidity Index; CHT: chemohyperthermia; CIS: carcinoma in situ; EMDA: electro-mediated drug administration; EORTC: European Organisation for Research and Treatment of Cancer; IQR: interquartile range; (N)MIBC: (non-)muscle-invasive bladder cancer; MMC: mitomycin C; OR, odds ratio; TURBT: transurethral resection of the bladder tumour.

Is "extreme" bladder neck preservation in robot-assisted radical prostatectomy a safe procedure?

INTRODUCTION: The aim was to investigate the surgical and pathological outcomes of an "extreme" bladder neck preservation in prostate cancer patients treated with robotic radical prostatectomy. The greatest concern about the "extreme" bladder neck preservation is the potential risk of creating a positive surgical margin at the level of bladder neck. MATERIALS AND METHODS: We prospectively collected data from 88 patients with diagnosed prostate cancer who underwent robotic radical prostatectomy with "'extreme' bladder neck preservation." All surgical procedures were performed by the same expert surgeon (F.D.M.). In this study, "'extreme' bladder neck preservation" was considered when the length of the spared intraprostatic segment of bladder neck was ⩾1 cm. We compared the histopathologic data with those of a homogeneous similar cohort of 88 consecutive patients who underwent robotic radical prostatectomy without bladder neck preservation. RESULTS: The two groups analyzed were comparable according to clinical and pathological characteristics. A positive surgical margin at the level of bladder neck was found in five (5.7%) cases in the "extreme" bladder neck preservation group and in six cases (6.8%) in the no-bladder neck preservation group. The prostatic base was involved by neoplasia in 14 and 19 patients (15.9% and 21.6%, respectively); of these, five (35.7%) and six (31.6%) had positive surgical margin at the level of bladder neck, respectively. The pathological staging in positive surgical margin at the level of bladder neck patients was pT3 in five (100%) cases in the "extreme" bladder neck preservation group and in four (66.7%) cases when we decided not to preserve the bladder neck. CONCLUSION: We demonstrated that "extreme" bladder neck preservation is a safe oncological procedure with similar pathologic findings of a comparable no-bladder neck preservation series. Positive surgical margins at the level of bladder neck are linked to neoplasia with adverse pathological features, rather than the "extreme" bladder neck preservation procedure.

Precision medicine in localized bladder cancer: Personalizing therapies to improve outcomes.

In the last decades, only few improvements have been made in the comprehension of bladder cancer tumor leading to few improvements in the development of new diagnostic and therapeutic approaches.However, in the last years several step forwards in the field of precision medicine have been made. In this review we focused on some of these elements such as the available biomarkers, the role of enhanced transurethral resection of the bladder and the role of the molecular classification in defining prognosis and therapeutic approaches in bladder cancer patients. Although several progresses have been made, at the time none of the existing biomarkers appear to be able to safely avoid the need of cystoscopy during the follow up of bladder cancer patients. However, these biomarkers representan important tool to follow up patients with a less invasive methods and in the near future might be able to substitute the need of cystoscopy. Enhanced transurethral resection technique can in some cases reduce the risk of recurrence during follow up, although its impact on survival outcomes is still under debate. Transurethral resection of the bladder represents a fundamental diagnostic and therapeutic step in the management of bladder cancer and these techniques can successfully improve its outcomes. Finally, the molecular classification of the bladder cancer represents one of the most exciting novelty in this field, improving consistently the knowledge of bladder cancer. Improvements regarding prognoses and therapeutics can be achieved although data stil need validation.

En las ultimas décadas, pocas mejoras se han hecho en la comprensión del cáncer de vejiga, llevándonos a tener muy poco desarrollo de nuevas técnicas diagnósticas y terapéuticas. En cambio, en los últimos años, varios pasos adelante se han realizado en este campo de la medicina de precisión. En este resumen nos centraremos en algunos elementos importantes como los biomarcadores, el papel de la resección transuretral de vejiga y el papel de las clasificaciones moleculares, en definir el pronóstico y nuevas terapias en pacientes con cáncer de vejiga. Algún progreso se ha conseguido, pero ninguno de los biomarcadore sexistentes parece ser capaz de evitar con seguridad la cistoscopia durante el seguimiento del cáncer de vejiga.A unque estos biomarcadores representan una herramienta importante en el seguimiento de pacientes con métodos menos invasivos y en un futuro no muy lejano podrán substituir a la cistoscopia. La técnica de resección transuretral mejorada en algunos casos reduce elriesgo de recurrencia durante el seguimiento, aunque el impacto en supervivencia aún está en debate. La resección transuretral de vejiga representa un paso fundamental para el diagnóstico y tratamiento en el manejo del cáncer de vejiga y estas técnicas pueden mejorar los resultados. Finalmente, la clasificación molecular del cáncer de vejiga representa una de las novedades mas interesantes en este campo, mejorando de forma consistente los conocimientos del cáncer de vejiga. Las mejoras en relación al pronóstico y tratamiento pueden ser conseguidas aunque los datos aún requieren validación.

Could pollen extract in association with vitamins be favorable in the reduction of chronic prostatic inflammation? A case-series analysis.

The aim of the present case-series analysis was to assess the safety and efficacy of pollen extract in association with vitamins in order to reduce the chronic prostatic inflammation in patients with class IV chronic prostatitis (CP). Nineteen non-consecutive patients performed a prostate biopsy for a suspect of prostate cancer. The biopsy histopathological examination showed a class IV CP, in presence of mild/moderate/high degree of inflammation, in association with an extensive (multiple biopsy sites, i.e., ≥ 3) high-grade prostatic intraepithelial neoplasia PIN (HGPIN) and/or atypical small acinar proliferation (ASAP). According to EAU Prostate Cancer Guidelines prostate biopsy was repeated after 6 months, because of the presence of extensive HGPIN or ASAP. Oral administration of pollen extract in association with vitamins (two capsules every 24 h) was prescribed until the repeat biopsy. Repeat biopsy histopathological examination showed, in 13 patients (68.4%), a lower degree of inflammation (absent/mild/moderate).

The variation of selective uNGAL levels after robot-assisted partial nephrectomy: Early results of a prospective single center study.

OBJECTIVES: Acute kidney injury (AKI) secondary to nephron-sparing surgery represents a significant problem in order to preserve renal function. Since serum creatinine alone underestimates the early detection of AKI several biomarker have been investigated. Neutrophil Gelatinase-Associated Lipocalin (NGAL) is considered a good biomarker for AKI. MATERIALS AND METHODS: We report our experience in 28 patients affected by localized renal cell carcinoma and submitted to robot-assisted partial nephrectomy (RAPN). In each patient selective urinary NGAL levels were dosed before surgery, then 2 and 48 hours after the procedure, through a ureteral catheter inserted into the excretory axis of the operated kidney. Moreover, we evaluated split renal function of the preserved renal parenchyma by a 99mTC-DTPA renal scintigraphy, performed before surgery and three months later. RESULTS: AKI was diagnosed, according to internationally criteria, in 3 patients (10.7%). The baseline selective urinary NGAL level was 20.02 ng/ml. This level significantly increased after surgery with a selective urinary NGAL level that reached 56.36 ng/ml (p < 0.0001). Moreover, a significant reduction in 99mTC-DTPA clearance of the operated kidneys after three months was detected (p < 0.0001). CONCLUSIONS: Selective urinary NGAL assay represent a sensitive biomarker of acute kidney injury after robotic nephron sparing surgery, capable of predicting the functional outcome of the operated kidney.

Robotic pyelolithotomy for the treatment of large renal stones: a single-center experience.

BACKGROUND: Few studies have reported robotic pyelolithotomy (RPL) series; furthermore, the most of all have reported small and single-center series. Herein we report our experience from 70 cases of complex kidney stones treated with RPL at our surgical center; this study reports the largest series of RPL in a minimal invasive experienced center. METHODS: Between February 2016 and March 2018, 70 patients with complex renal stones (Guy's Stone Score: 4) underwent RPL and included in a prospectively maintained institutional database. Baseline characteristics, clinical data, perioperative data, postoperative data and stone free status were assessed by descriptive statistics. RESULTS: Of 70 patients, 72.85% presented renal pelvis stones. The mean maximum stone diameter was 33.1±14.5 mm (median 30 mm; interquartile range 22-40 mm). Mean total operative duration was 122.5±34.4 min (median 120 min; interquartile range 105-135 min). In two patients (2.8%), a grade III complications were noted; no major complications (grade IV-V) were noted. The complete SFR, after a single robotic procedure, was 92.8%. CONCLUSIONS: Our findings suggest that RPL is a safe, reproducible and minimally invasive approach as treatment of large renal stones when endoscopic treatment failed or was not available. RPL permits to achieve an excellent stone free status, in a single definitive procedure.

Extraperitoneal robot-assisted radical prostatectomy: a high-volume surgical center experience.

BACKGROUND: Herein we report our high-volume single center experience with extraperitoneal robot-assisted radical prostatectomy (eRARP) in patients with prostate cancer (PCa). METHODS: A retrospective chart review of our prospectively maintained institutional PCa database was performed to analyze eRARP cases done between April 2009 and March 2016. Nerve-sparing technique was applied in accordance with Tewari. Baseline characteristics, surgical outcomes, continence and erectile function were assessed by descriptive statistics. RESULTS: Of 1354 patients, 61% had intermediate-risk disease. Mean total operative duration was 146±44 min (median 140 minutes; interquartile range 120-160 minutes). In 91.7% of case no complication was recorded. Gleason Score on final pathology was mostly 6 (43.3%) or 7 (3+4) (32.3%). The pathological T stage was mostly pT2c (53.8%). Patients who had a bilateral nerve sparing procedure showed the best functional results, with 81.2% continence rate at 1 month, and 65% reported recovery of erectile function at 3 months postoperation. CONCLUSIONS: eRARP is a safe, reproducible, and effective procedure for the surgical treatment of prostate cancer. Superior functional outcome can be achieved when a bilateral intrafascial nerve-sparing approach can be performed.

Stem cells, biomarkers and genetic profiling: approaching future challenges in Urology.

Urological research is facing future challenges, the most difficult one is the fast and meaningful transfer of the massive amount of data from research basic to clinical practice. Between the most important issues that research should focus in the next years are targeting of tumor stem cells, clinical application of biomarkers, and wide application of genetic profiling of urological neoplasms. Several clinical implications are expected, from diagnosis to selection of candidates for different treatment modalities, to modulation of sequential treatment plans, to prognosis. A number of clinical trials based on research data from the hottest issues are in the pipeline. In this review, we will focus on new insights from recent work worlwide in urological research, with particular attention to high-risk nonmuscle-invasive and muscle-invasive bladder cancer, prostate cancer, and kidney cancer. Cancer care is moving towards a personalized approach in patient management. The most important issues in urological research point strongly in this direction and show an enormous potential for the rapid landing of Urology in the era of personalized medicine.

Laparoscopic Postchemotherapy Retroperitoneal Lymph-Node Dissection Can Be a Standard Option in Defined Nonseminomatous Germ Cell Tumor Patients.

BACKGROUND: Residual retroperitoneal masses in NSGCT need postchemotherapy retroperitoneal lymph-node dissection (PC-RPLND). Open (O) PC-RPLND is a standardized procedure, but morbidity is not negligible and mostly attributable to laparotomy. Laparoscopic (L) PC-RPLND may improve tolerability profile. We evaluated viability, toxicity, and short to medium-term oncologic outcome of L-PC-RPLND following well-defined selection criteria. PATIENTS AND METHODS: Since February 2011, consecutive patients with a unilateral residual mass (≥1 cm or growing), normalized markers, and limited encasement of inferior vena cava and/or aorta were candidate to unilateral L-PC-RPLND. Surgical performances, histology, hospital stay, complications within 30 days, and survival were recorded. Patients were regularly followed up. Adjuvant chemotherapy was not provided. RESULTS: Sixty-seven patients (stage IIA = 14; IIB = 41; IIC = 7; III = 5), representing 29% of all those candidate to PC-RPLND in this time frame, underwent L-PC-RPLND up to August 2015. Median size of the mass was 27 mm (interquartile range [IQR] 15-31). Median operative time was 234 minutes (IQR 184-250). Three procedures were converted to open surgery. Mean hospital stay was 3 days (IQR 2-4). Out of three (4.5%), one grade III (lymphocele requiring drainage) complication occurred. Sixty-six (98.5%) patients maintained antegrade ejaculation. Histology revealed teratoma in 76%, fibronecrotic tissue in 21%, and viable cancer in 3% patients. All patients are alive and event free after a median follow-up of 21 months (IQR 10-30). CONCLUSIONS: In a referral center, L-PC-RPLND is a transferable option for a proportion of patients with a residual mass. Tolerability is acceptable, and current oncologic outcome is consistent with a safe oncologic profile.

Will Multi-Parametric Magnetic Resonance Imaging be the Future Tool to Detect Clinically Significant Prostate Cancer?

Multi-parametric magnetic resonance imaging is an emerging imaging modality for diagnosis, staging, characterization, and treatment planning of prostate cancer. In this report, we reviewed the literature for studies assessing the accuracy of multi-parametric magnetic resonance imaging in detecting clinically significant prostate cancer, and we critically examined the future role of this imaging tool in various clinical diagnostic settings. There is accumulating evidence suggesting a high accuracy of multi-parametric magnetic resonance imaging in ruling out clinically significant disease. Although definition for clinically significant disease widely varies, the negative predictive value is very high at up to 98%. Multi-parametric magnetic resonance imaging should, thus, be further evaluated for application in different clinical scenarios in which it is desirable to reduce the proportion of unnecessary prostate biopsies and to limit the detection of indolent disease, such as opportunistic screening, persistent prostate cancer suspicion in men with previous negative prostate biopsies, and eligibility for active surveillance. Continued improvement in standardization of technical parameters, functional sequences, and image reporting systems is a pre-requisite for a rapid and successful dissemination of this imaging modality.