 |
Stefano PULIATTI
Ricercatore t.d. art. 24 c. 3 lett. B
Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa
|
Home |
Curriculum(pdf) |
Didattica |
Pubblicazioni
2023
- A nomogram to predict pathologic T2 stage in candidates to robot-assisted radical prostatectomy with iT3 prostate cancer on preoperative multiparametric MRI: results from a multi-institutional collaboration
[Articolo su rivista]
Bravi, Carlo A; Mazzone, Elio; Dell'Oglio, Paolo; Covas Moschovas, Marcio; Martini, Alberto; Rosiello, Giuseppe; Piazza, Pietro; Mottaran, Angelo; Paciotti, Marco; Sarchi, Luca; Puliatti, Stefano; Knipper, Sophie; DE Groote, Ruben; Schiavina, Riccardo; Rocco, Bernando; Galfano, Antonio; Briganti, Alberto; Montorsi, Francesco; Patel, Vipul; Mottrie, Alexandre
abstract
: In candidates to robot-assisted radical prostatectomy (RARP) for locally advanced (iT3) prostate cancer on preoperative MRI, the performance of MRI for local staging is demonstrably suboptimal, and currently no prediction tools that might help surgeons in preoperative planning are available. We analyzed data of 685 patients with iT3 prostate cancer (PCa) who received RARP at five participating institutions between 2012 and 2020. Multivariable logistic regression model investigated predictors of pT2 disease among variables available before surgery (i.e: preoperative PSA, biopsy ISUP group, clinical T stage on digital rectal examination-DRE, prostate volume on MRI, PIRADS score of index lesion, seminal vesicles invasion on MRI, location suspicious for T3 disease on MRI). Coefficients from such model were used to build a nomogram to predict organ-confined (i.e. pT2) disease on final pathology. Internal validation was performed using the leave-one-out cross-validation. Median (interquartile range) preoperative PSA was 7.5 (5.2, 11.9) ng/ml, and 280 (41%) and 216 (32%) had biopsy ISUP group 4-5 disease and palpable disease on DRE, respectively. Preoperative MRI was suspicious for iT3 disease on the mid-posterior part of the gland in 485 (71%) men, and 527 (77%) men had a PIRADS 5 lesion. After surgery, a total of 192 (28%) patients had organ-confined disease (i.e. pT2). All variables fitted into the model and were considered to build the nomogram. After internal validation, the AUC was 73% (95% confidence interval: 69%, 77%). Awaiting external validation, we provided data that is relevant to optimize surgical strategy in men diagnosed with iT3 PCa who are scheduled for RARP.
2023
- Artificial intelligence evaluation of confocal microscope prostate images: our preliminary experience
[Articolo su rivista]
Bianchi, G.; Puliatti, S.; Rodriguez, N.; Micali, S.; Bertoni, L.; Reggiani Bonetti, L.; Caramaschi, S.; Bolelli, F.; Pinamonti, M.; Rozze, D.; Grana, C.
abstract
2023
- Asymptomatic bacteriuria in candidates for active treatment of renal stones: results from an international multicentric study on more than 2600 patients
[Articolo su rivista]
Calcagnile, T; Sighinolfi, M C; Rocco, B; Assumma, S; Di Bari, S; Panio, E; Pescuma, A; Ticonosco, M; Tosi, G; Oltolina, P; Resca, S; Kaleci, S; Galli, R; Curti, P; Schips, L; Ditonno, P; Villa, L; Ferretti, S; Bergamaschi, F; Bozzini, G; Eissa, A; Zoeir, A; Sherbiny, A El; Frattini, A; Prati, A; Fedelini, P; Okhunov, Z; Tubaro, A; Landman, J; Bianchi, G; Puliatti, S; Micali, S
abstract
: The occurrence of asymptomatic bacteriuria concomitant to urolithiasis is an issue for patients undergoing renal stone treatment. Disposing of a preoperative urine culture is essential to reduce the risk of septic events. The endpoint of the study is to report which characteristics of candidates for renal stone treatment are frequently associated with positive urine culture. 2605 patients were retrospectively enrolled from 14 centers; inclusion criteria were age > 18 and presence of a single renal stone 1-2 cm in size. The variables collected included age, gender, previous renal surgery, comorbidities, skin-to-stone distance, stone size, location, density, presence of hydronephrosis. After a descriptive analysis, the association between continuous and categorical variables and the presence of positive urine culture was assessed using a logistic regression model. Overall, 240/2605 patients (9%) had preoperative bacteriuria. Positive urine culture was more frequent in females, patients with previous renal interventions, chronic kidney disease, congenital anomalies, larger stones, increased density. Multivariate analysis demonstrated that previous renal interventions (OR 2.6; 95% CI 1.9-3.4; p < 0.001), renal-related comorbidities (OR 1.31; 95% CI 1.19-1.4; p < 0.001), higher stone size (OR 1.06; 95% CI 1.02-1.1; p = 0.01) and density (OR 1.00; 95% CI 1.0-1.00; p = 0.02) were associated with bacteriuria; male gender and lower caliceal location were inversely related to it. Beyond expected risk factors, such as female gender, other parameters are seemingly favoring the presence of positive urine culture. The awareness of variables associated with bacteriuria allows to assess which individuals are at increased risk of presenting bacteriuria and reduce the rate of septic complications.
2023
- External validation of yonsei nomogram predicting chronic kidney disease development after partial nephrectomy: An international, multicenter study
[Articolo su rivista]
Abdel Raheem, Ali; Landi, Isotta; Alowidah, Ibrahim; Capitanio, Umberto; Montorsi, Francesco; Larcher, Alessandro; Derweesh, Ithaar; Ghali, Fady; Mottrie, Alexander; Mazzone, Elio; De Naeyer, Geert; Campi, Riccardo; Sessa, Francesco; Carini, Marco; Minervini, Andrea; Raman, Jay D; Rjepaj, Chris J; Kriegmair, Maximilian C; Autorino, Riccardo; Veccia, Alessandro; Mir, Maria Carmen; Claps, Francesco; Choi, Young Deuk; Ham, Won Sik; Santok, Glen Denmer; Tadifa, John Paul; Syling, Justin; Furlan, Maria; Simeone, Claudio; Bada, Maida; Celia, Antonio; Carrión, Diego M; Aguilera Bazan, Alfredo; Ruiz, Cristina Ballesteros; Malki, Manar; Barber, Neil; Hussain, Muddassar; Micali, Salvatore; Puliatti, Stefano; Ghaith, Ahmed; Hagras, Ayman; Ghoneem, Ayman M; Eissa, Ahmed; Alqahtani, Abdulrahman; Rumaih, Abdullah; Alwahabi, Abdelaziz; Alenzi, Mohammed Jayed; Pavan, Nicola; Traunero, Fabio; Antonelli, Alessandro; Porcaro, Antonio Benito; Illiano, Ester; Costantini, Elisabetta; Rha, Koon Ho
abstract
Objective: To externally validate Yonsei nomogram. Methods: From 2000 through 2018, 3526 consecutive patients underwent on-clamp PN for cT1 renal masses at 23 centers were included. All patients had two kidneys, preoperative eGFR ≥60 ml/min/1.73 m2, and a minimum follow-up of 12 months. New-onset CKD was defined as upgrading from CKD stage I or II into CKD stage ≥III. We obtained the CKD-free progression probabilities at 1, 3, 5, and 10 years for all patients by applying the nomogram found at https://eservices.ksmc.med.sa/ckd/. Thereafter, external validation of Yonsei nomogram for estimating new-onset CKD stage ≥III was assessed by calibration and discrimination analysis. Results and limitation: Median values of patients' age, tumor size, eGFR and follow-up period were 47 years (IQR: 47-62), 3.3 cm (IQR: 2.5-4.2), 90.5 ml/min/1.73 m2 (IQR: 82.8-98), and 47 months (IQR: 27-65), respectively. A total of 683 patients (19.4%) developed new-onset CKD. The 5-year CKD-free progression rate was 77.9%. Yonsei nomogram demonstrated an AUC of 0.69, 0.72, 0.77, and 0.78 for the prediction of CKD stage ≥III at 1, 3, 5, and 10 years, respectively. The calibration plots at 1, 3, 5, and 10 years showed that the model was well calibrated with calibration slope values of 0.77, 0.83, 0.76, and 0.75, respectively. Retrospective database collection is a limitation of our study. Conclusions: The largest external validation of Yonsei nomogram showed good calibration properties. The nomogram can provide an accurate estimate of the individual risk of CKD-free progression on long-term follow-up.
2023
- Long-term oncologic outcomes of robot-assisted radical cystectomy: update series from a high-volume robotic center beyond 10 years of follow-up
[Articolo su rivista]
Bravi, Carlo A; Piazza, Pietro; Mazzone, Elio; Dell'Oglio, Paolo; Rosiello, Giuseppe; Martini, Alberto; Stabile, Armando; Moschini, Marco; Amato, Marco; Sarchi, Luca; Peraire, Maria; Farinha, Rui; Scarcella, Simone; Puliatti, Stefano; Knipper, Sophie; Berquin, Camille; Develtere, Dries; Sinatti, Celine; Van Puyvelde, Hannah; De Groote, Ruben; De Naeyer, Geert; D'Hondt, Frederiek; Schatteman, Peter; Briganti, Alberto; Montorsi, Francesco; Mottrie, Alexandre
abstract
Long-term oncologic data on patients undergoing robot-assisted radical cystectomy (RARC) for non-metastatic bladder cancer (BCa) are limited. The purpose of this study is to describe long-term oncologic outcomes of patients receiving robotic radical cystectomy at a high-volume European Institution. We analyzed data of 107 patients treated with RARC between 2003 and 2012 at a high-volume robotic center. Clinical, pathologic, and survival data at the latest follow-up were collected. Clinical recurrence (CR)-free survival, cancer-specific mortality (CSM)-free survival, and overall survival (OS) were plotted using Kaplan-Meier survival curves. Cox proportional hazard models investigated predictors of CR and CSM. Competing-risk regressions were utilized to depict cumulative incidences of death from BCa and death from other causes after RARC at long term. Pathologic nonorgan-confined BCa was found in 40% of patients, and 7 (7%) patients had positive soft tissue surgical margins. Median (interquartile range [IQR]) number of nodes removed was 11 (6, 14), and 26% of patients had pN + disease. Median (IQR) follow-up for survivors was 123 (117, 149) months. The 12-year CR-free, CSM-free and overall survival were 55% (95% confidence interval [CI] 44%, 65%), 62% (95% CI 50%, 72%), and 34% (95% CI 24%, 44%), respectively. Nodal involvement on final pathology was associated with poor prognosis on multivariable competing risk analysis. The cumulative incidence of non-cancer death exceeded that of death from BCa after approximately ten years after RARC. We provided relevant data on oncologic outcomes of RARC at a high-volume robotic center, with acceptable rates of clinical recurrence and cancer-specific survival at long-term. In patients treated with RARC, the cumulative incidence of death from causes other than BCa is non-negligible, and should be taken into consideration for post-operative follow-up.
2023
- Rare perinephric myxoid pseudotumor of fat causing ureteropelvic junction obstruction: a case report
[Articolo su rivista]
Amato, M; Piazza, P; Ferrari, I; Biolcati, S; Franceschini, T; Puliatti, S; Micali, S; Manferrari, F
abstract
Ureteropelvic junction obstruction (UPJO) is a congenital or acquired functionally significant impairment of urinary transport from the renal pelvis to the ureter. Congenital UPJO typically results from intrinsic disease such as the presence of an aperistaltic segment of the ureter, aberrant vessels or kidney abnormalities. Rare conditions can sometimes mimic an UPJO. We present a case of an 86-year-old woman with a UPJO diagnosed on CT. The patient was counseled on treatment options and elected to undergo a left uretherorenoscopy (URS) plus left laparoscopic pyeloplasty. The definitive histopathologic diagnosis was perinephric myxoid pseudotumor of fat, an extremely rare neoplasm, mass-forming. To the best of our knowledge, this is the first known case of a pseudotumor of fat causing UPJO. 6-month follow-up showed neither recurrence nor residual UPJO. We describe a rare presentation of extrinsic perinephric myxoid pseudotumor of fat causing UPJ obstruction. In elderly patients with no history of malignancy, UPJ obstruction can occur because of atypical masses.
2023
- Semen Analysis in “Urology-Naïve” Patients: A Chance of Uroandrological Screening in Young Males
[Articolo su rivista]
Puliatti, S.; Toso, S.; Ticonosco, M.; Rabito, S.; Sighinolfi, M. C.; Ferrari, R.; Rochira, V.; Santi, D.; Trenti, T.; Navarra, M.; Ferretti, S.; Montano, L.; Micali, S.
abstract
(1) Background: While females start their gynecological examinations during puberty, only few men decide to be visited by urologists in their youth. Given the participation in the EcoFoodFertility research project, our department had the opportunity to screen young males that were supposedly healthy. (2) Results: from January 2019 to July 2020, we evaluated 157 patients with sperm, blood analysis, and uroandrological examinations. The inclusion criteria were age 18–40 and absence of previous urological disease (urology-naïve). The primary endpoint of the study was to record uroandrological diseases that are occasionally discovered during examination in asymptomatic young men. The average age was 26.9 years (range 18–40); average testicular volume was 15.7 mL (range 12–22 mL); and 45.2% reported abnormal semen analysis: 62 cases of teratozoospermia, 27 asthenozoospermia, 18 oligozoospermia, and 2 azoospermia were discovered respectively; 4/157 patients were diagnosed with hypogonadism; 2 cases with suspicious testicular mass resulted in testicular cancer; and 31 suspected varicoceles and 8 patients with mild sexual dysfunctions were managed. (3) Conclusions: an uroandrological evaluation of young asymptomatic males allowed for the prompt diagnosis of different urological conditions, including cancerous ones, in our series. Despite being debatable, combining urological counselling with physical examination, semen analysis, and a laboratory profile could be useful and cost-effective in order to ameliorate male health.
2022
- "Augmented reality" applications in urology: a systematic review
[Articolo su rivista]
Roberts, Sidney; Desai, Aditya; Checcucci, Enrico; Puliatti, Stefano; Taratkin, Mark; Kowalewski, Karl-Friedrich; Gomez Rivas, Juan; Rivero, Ines; Veneziano, Domenico; Autorino, Riccardo; Porpiglia, Francesco; Gill, Inderbir S; Cacciamani, Giovanni E
abstract
INTRODUCTION: Augmented reality (AR) applied to surgical procedures refers to the superimposition of preopera-tive or intraoperative images into the operative field. Augmented reality has been increasingly used in myriad surgical specialties including urology. The following study reviews advance in the use of AR for improvements in urologic outcomes.EVIDENCE ACQUISITION: We identified all descriptive, validity, prospective randomized/nonrandomized tri-als and retrospective comparative/noncomparative studies about the use of AR in urology until March 2021. The Medline, Scopus, and Web of Science databases were used for literature search. We conducted the study selection according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis State-ment) Guidelines. We limited included studies to only those using AR, excluding all that used virtual reality technology.EVIDENCE SYNTHESIS: A total of 60 studies were identified and included in the present analysis. Overall, 19 studies were descriptive/validity/phantom studies for specific AR methodologies, 4 studies were case reports, and 37 studies included clinical prospective/retrospective comparative studies.CONCLUSIONS: Advances in AR have led to increasing registration accuracy as well as increased ability to identify anatomic landmarks and improve outcomes during urologic procedures such as RARP and robot-assisted partial nephrec-tomy.
2022
- Artificial intelligence for renal cancer: From imaging to histology and beyond
[Articolo su rivista]
Kowalewski, K. -F.; Egen, L.; Fischetti, C. E.; Puliatti, S.; Juan, G. R.; Taratkin, M.; Ines, R. B.; Sidoti Abate, M. A.; Muhlbauer, J.; Wessels, F.; Checcucci, E.; Cacciamani, G.
abstract
Artificial intelligence (AI) has made considerable progress within the last decade and is the subject of contemporary literature. This trend is driven by improved computational abilities and increasing amounts of complex data that allow for new approaches in analysis and interpretation. Renal cell carcinoma (RCC) has a rising incidence since most tumors are now detected at an earlier stage due to improved imaging. This creates considerable challenges as approximately 10%–17% of kidney tumors are designated as benign in histopathological evaluation; however, certain co-morbid populations (the obese and elderly) have an increased peri-interventional risk. AI offers an alternative solution by helping to optimize precision and guidance for diagnostic and therapeutic decisions. The narrative review introduced basic principles and provide a comprehensive overview of current AI techniques for RCC. Currently, AI applications can be found in any aspect of RCC management including diagnostics, perioperative care, pathology, and follow-up. Most commonly applied models include neural networks, random forest, support vector machines, and regression. However, for implementation in daily practice, health care providers need to develop a basic understanding and establish interdisciplinary collaborations in order to standardize datasets, define meaningful endpoints, and unify interpretation.
2022
- Assessing pentafecta achievement after robot-assisted radical cystectomy and its association with surgical experience: Results from a high-volume institution
[Articolo su rivista]
Piazza, P.; Bravi, C. A.; Puliatti, S.; Cacciamani, G. E.; Knipper, S.; Amato, M.; Dell'Oglio, P.; Mazzone, E.; Rosiello, G.; Farinha, R.; Sarchi, L.; Scarcella, S.; Wisz, P.; Schiavina, R.; Develtere, D.; De Backer, P.; De Groote, R.; D'Hondt, F.; Mottrie, A.
abstract
Objectives: Radical cystectomy (RC) represents the gold standard treatment for high-risk bladder cancer. Despite evidence suggesting that surgical experience correlates with perioperative and oncologic outcomes of robot-assisted RC (RARC), validated tools to assess its quality objectively are lacking. We aimed to evaluate the impact of RC-Pentafecta (absence of early major complications, absence of urinary diversion related sequelae at ≤12 months, absence of soft tissue surgical margins, ≥16 lymph nodes at final pathology and absence of clinical recurrence at ≤12 months) on oncological outcomes and the role of surgical experience on its achievement. Materials and methods: We retrospectively evaluated 366 patients undergoing RARC with intracorporeal urinary diversion in a single tertiary centre with a minimum of 1 year follow-up. Surgeries were performed using the DaVinci Xi system according to a previously described technique. Kaplan-Meier curves were used to investigate 5-years overall survival and cancer specific mortality-free survival (CSS) according to RC-Pentafecta achievement. Multivariable Cox's regressions were performed to evaluate the impact of RC-Pentafecta on overall mortality. Multivariable logistic regressions were performed to explore the effect of surgical experience on RC-pentafecta achievement. Locally weighted scatterplot smoother function was used to graphically explore this relationship. Results: Patients achieving RC-Pentafecta showed higher 5-year overall survival (71.8% vs. 59.6%, P < 0.001) and CSS (84% vs. 71%, P < 0.001) when compared with patients not achieving it. At multivariable Cox's regression, RC-Pentafecta achievement (HR 0.57, P = 0.03), positive surgical margins (HR 2.48, P = 0.002), pN+ (HR 2.23, P = 0.002), pT≥3 (HR 1.71, P = 0.04) and current smoking status (HR 2.4, P = 0.006) were significant predictors of overall mortality. At multivariable logistic regression surgical experience (OR 1.2, P < 0.001), age (OR 0.93, P = 0.04), previous prostate surgery (OR 0.7, P = 0.02) and pT≥3 (OR 0.8, P = 0.03) were independent predictors of RC-Pentafecta achievement. A linear relationship between surgical experience and RC-Pentafecta achievement, without reaching a plateau, was observed. Conclusions: RC-Pentafecta is a valuable tool to assess surgical quality of RARC and the experience of the center where the surgery is performed and may be used to identify “referral” centers for treatment of high-risk bladder cancer.
2022
- Basic Skills Training in Robotic Surgery: Dry and Wet-Lab Models and Their Application in Robotic Training Pathways
[Capitolo/Saggio]
Mazzone, Elio; Dell???oglio, Paolo; Puliatti, Stefano
abstract
2022
- Comment on: "Impact of the preoperative modified Glasgow Prognostic Score on disease outcome after radical cystectomy for urothelial carcinoma of the bladder"
[Articolo su rivista]
Taratkin, M.; Morozov, A.; Checcucci, E.; Gomez Rivas, J.; Puliatti, S.; Rivero Belenchon, I.; Kowalewski, K. -F.; Cacciamani, G. E.
abstract
2022
- Comparison between prone and supine nephrolithotomy in pediatric population: a double center experience
[Articolo su rivista]
Campobasso, D.; Bocchialini, T.; Bevilacqua, L.; Guarino, G.; Di Pietro, C.; Granelli, P.; Mezzogori, D.; Salsi, P.; Oltolina, P.; Gatti, C.; Puliatti, S.; Ceccarelli, P. L.; Maestroni, U.; Frattini, A.; Bianchi, G.; Micali, S.; Ferretti, S.
abstract
Purpose: Stone disease in the pediatric age is an increasing issue. Percutaneous Nephrolithotomy (PNL) can be used for larger and complex stones. As in adults it can be performed in the supine or prone position. Methods: We retrospectively reviewed two centers’ experience in prone and supine PNL in children to analyze its results and complications. Results: 33 patients underwent prone and 19 supine procedures. Patients in the prone group were younger than in the supine, while no significant differences were found in stone burden, access size, operative time or complications. Complications were: 8 and 4 Clavien 1 for the prone and supine group, respectively, one case of urosepsis (4b) in the prone and 2 cases of Clavien 3 in the supine group (double J stent placement for renal colic and ureteroscopy for steinstrasse). Tubeless procedures and mean nephrostomy time were in favor of the supine group, whereas fluoroscopy time and ureteral drainage stay were in support of the prone group. Stone free rate was better in the supine group (83.3 vs 66.6%), possibly reflecting the capability to perform a combined approach in 12 patients (allowing to reach all the calyx with simultaneous anterograde and retrograde access) or younger age in the prone group (13 vs 2 patients ≤5 years), with no differences in stone burden. Conclusions: Supine approach seems to guarantee higher stone-free rates. Larger series are necessary to determine what the best technique is in terms of X-ray exposure, operative time and complications.
2022
- Concomitant robot-assisted laparoscopic surgeries for upper and lower urinary tract malignancies: a comprehensive literature review
[Articolo su rivista]
Scarcella, S.; Castellani, D.; Piazza, P.; Giulioni, C.; Sarchi, L.; Amato, M.; Bravi, C. A.; Lores, M. P.; Farinha, R.; Knipper, S.; Palagonia, E.; Skrobot, S. A.; Develtere, D.; Berquin, C.; Sinatti, C.; Van Puyvelde, H.; De Groote, R.; Umari, P.; De Naeyer, G.; Dell'Atti, L.; Milanese, G.; Puliatti, S.; Teoh, J. Y. -C.; B. Galosi, A.; Mottrie, A.
abstract
Worldwide, we have witnessed an expansion of robot-assisted laparoscopic surgery (RALS) and thanks to the global adoption of high-resolution diagnostic imaging technologies, an increased incidence of newly diagnosed prostatic, renal and bladder cancers has been recorded with concurrent second primary urological cancer diagnoses increasing by 1.5%. Diverse authors have reported their findings concerning synchronous multi-visceral malignances robotic treatment within the scientific literature. The aim of this study is to comprehensively review all reported articles describing concurrent upper and lower RALS using a singular robotic port scheme within the same intervention for renal malignances and concomitant prostatic or bladder cancers. To the best of our knowledge and vigorous literature search, this is the first study that comprehensively evaluates and reports all combined upper and lower urinary tract surgeries published so far. In carefully selected patients, thanks to multidisciplinary preoperative assessment and surgical planning a combined robotic approach can reduce the morbidity, complications, hospital admissions and the overall length of hospitalization.
2022
- Conservative treatment of upper urinary tract urothelial carcinoma (UTUC) in patients with imperative indications: Not only an option
[Articolo su rivista]
Campobasso, D.; Puliatti, S.; Micali, S.; Maestroni, U. V.
abstract
2022
- Development and Validation of the Metric-Based Assessment of a Robotic Dissection Task on an Avian Model
[Articolo su rivista]
Puliatti, S.; Amato, M.; Mazzone, E.; Rosiello, G.; De Groote, R.; Berquin, C.; Piazza, P.; Farinha, R.; Mottrie, A.; Gallagher, A. G.
abstract
Introduction: The introduction of robot-assisted surgical devices requires the application of objective performance metrics to verify performance levels. Objective: To develop and validate (face, content, response process, and construct) the performance metrics for a robotic dissection task using a chicken model. Methods: In a procedure characterization, we developed the performance metrics (i.e., procedure steps, errors, and critical errors) for a robotic dissection task, using a chicken model. In a modified Delphi panel, 14 experts from four European Union countries agreed on the steps, errors, and critical errors (CEs) of the task. Six experienced surgeons and eight novice urology surgeons performed the robotic dissection task twice on the chicken model. In the Delphi meeting, 100% consensus was reached on five procedure steps, 15 errors and two CEs. Novice surgeons took 20 min to complete the task on trial 1 and 14 min during trial two, whereas experts took 8.2 min and 6.5 min. On average, the Expert Group completed the task 56% faster than the Novice Group and made 46% fewer performance errors. Results: Sensitivity and specificity for procedure errors and time were excellent to good (i.e., 1.0-0.91) but poor (i.e., 0.5) for step metrics. The mean interrater reliability for the assessments by two robotic surgeons was 0.91 (Expert Group inter-rater reliability = 0.92 and Novice Group = 0.9). Conclusions: We report evidence which supports the demonstration of face, content, and construct validity for a standard and replicable basic robotic dissection task on the chicken model.
2022
- Development and validation of the metric-based assessment of a robotic vessel dissection, vessel loop positioning, clip applying and bipolar coagulation task on an avian model
[Articolo su rivista]
Puliatti, S.; Amato, M.; Mazzone, E.; Rosiello, G.; De Groote, R.; Piazza, P.; Sarchi, L.; Farinha, R.; Mottrie, A.; Gallagher, A. G.
abstract
The evolution of robotic technology and its diffusion does not seem to have been adequately accompanied by the development and implementation of surgeon training programs that ensure skilled and safe device use at the start of the learning curve. The objective of the study is to develop and validate performance metrics for vessel dissection, vessel loop positioning, clip applying and bipolar coagulation using an avian model. Three robotic surgeons and a behavioral scientist characterized the performance metrics of the task according to the proficiency-based progression methodology. Fourteen experienced robotic surgeons from different European countries participated in a modified online Delphi consensus. Eight experienced surgeons and eight novices performed the robotic task twice. In the Delphi meeting, 100% consensus was reached on the performance metrics. Novice surgeons took 26 min to complete the entire task on trial 1 and 20 min on trial 2. Experts took 10.1 min and 9.5 min. On average the Expert Group completed the task 137% faster than the Novice Group. The amount of time to reach the vessel part of the task was also calculated. Novice surgeons took 26 min on trial 1 and 20 min on trial 2. Experts took 5.5 min and 4.8 min. On average the experts reached the vessel 200% faster than the novices. The Expert Group made 155% fewer performance errors than the Novice Group. The mean IRR of video-recorded performance assessments for all metrics was 0.96 (95% confidence intervals (CI) lower = 0.94–upper = 0.98). We report the development and validation for a standard and replicable basic robotic vessel dissection, vessel loop positioning, clip applying and bipolar coagulation task on an avian model. The development of objective performance metrics, based on a transparent and fair methodology (i.e., PBP), is the first fundamental step toward quality assured training. This task developed on the avian model proved to have good results in the validation study.
2022
- Does quality assured eLearning provide adequate preparation for robotic surgical skills; a prospective, randomized and multi-center study
[Articolo su rivista]
Puliatti, S.; Amato, M.; Farinha, R.; Paludo, A.; Rosiello, G.; De Groote, R.; Mari, A.; Bianchi, L.; Piazza, P.; Van Cleynenbreugel, B.; Mazzone, E.; Migliorini, F.; Forte, S.; Rocco, B.; Kiely, P.; Mottrie, A.; Gallagher, A. G.
abstract
Purpose: In particular after the onset of the COVID-19 pandemic, there was a precipitous rush to implement virtual and online learning strategies in surgery and medicine. It is essential to understand whether this approach is sufficient and adequate to allow the development of robotic basic surgical skills. The main aim of the authors was to verify if the quality assured eLearning is sufficient to prepare individuals to perform a basic surgical robotic task. Methods: A prospective, randomized and multi-center study was conducted in September 2020 in the ORSI Academy, International surgical robotic training center. Forty-seven participants, with no experience but a special interest in robotic surgery, were matched and randomized into four groups who underwent a didactic preparation with different formats before carrying out a robotic suturing and anastomosis task. Didactic preparation methods ranged from a complete eLearning path to peer-reviewed published manuscripts describing the suturing, knot tying and task assessment metrics. Results: The primary outcome was the percentage of trainees who demonstrated the quantitatively defined proficiency benchmark after learning to complete an assisted but unaided robotic vesico-urethral anastomosis task. The quantitatively defined benchmark was based on the objectively assessed performance (i.e., procedure steps completed, errors and critical errors) of experienced robotic surgeons for a proficiency-based progression (PBP) training course. None of the trainees in this study demonstrated the proficiency benchmarks in completing the robotic surgery task. Conclusions: PBP-based e-learning methodology is an effective training method avoiding critical errors in the suturing and knotting task. Quality assured online learning is insufficient preparation for robotic suturing and knot tying anastomosis skills. Trial registration: ClinicalTrials.gov Identifier: NCT04541615.
2022
- Early Catheter Removal on Postoperative Day 2 After Robot-assisted Radical Prostatectomy: Updated Real-life Experience with the Aalst Technique
[Articolo su rivista]
Develtere, D.; Rosiello, G.; Piazza, P.; Bravi, C. A.; Pandey, A.; Berquin, C.; Sinatti, C.; Van Puyvelde, H.; Puliatti, S.; Amato, M.; Farinha, R.; Pauwels, E.; De Groote, R.; Schatteman, P.; De Naeyer, G.; D'Hondt, F.; Mottrie, A.
abstract
We evaluated the feasibility and impact on short- and long-term functional outcomes of very early catheter removal on postoperative day (POD) 2 after robot-assisted radical prostatectomy (RARP). To the best of our knowledge, this is the first multisurgeon study with the largest cohort on very early (POD 2) catheter removal after RARP with follow-up of >1 yr. In 255/369 patients (69%) treated with RARP ± pelvic lymph node dissection, the catheter was removed on POD 2. Among the 255 patients, 33 (13%) required recatheterisation because of acute urinary retention after catheter removal. Of these 33 patients, five (2%) also experienced anastomotic leakage after catheter removal. The early (≤3 mo) urinary continence rate was 67% and the median time to urinary continence recovery was 1 mo. After median follow-up of 18 mo (interquartile range 13–24), 236 patients (88%) were continent. No anastomotic strictures occurred. Our observations confirm the feasibility and safety of POD 2 catheter removal after RARP and support its adoption for selected patients. Patient summary: After removal of the prostate for cancer, patients have a urinary catheter inserted. We investigated whether earlier removal of the catheter affects long-term urinary continence. The results show that it may be safe to remove the catheter on postoperative day 2 for selected patients.
2022
- Effect of Direct-Acting Antiviral Drugs on Erectile Functions among Hepatitis C Patients: A Prospective Interventional Study
[Articolo su rivista]
Alhefnawy, Mohamed; Mohey, Ahmed; Fathi, Ahmed; Mansour, Ahmed; Abd-Elsalam, Sherief; Eissa, Ahmed; Hagras, Ayman; Puliatti, Stefano; Almekaty, Khaled
abstract
Erectile dysfunction (ED) is one of the extrahepatic manifestations of hepatitis C virus infection that greatly affects patients' quality of life. Unfortunately, some of the drugs used for HCV treatment may have a negative impact on the patient's erectile function such as the pegylated interferon. Currently, with the introduction of directacting antiviral drugs, there are scarce data in the literature about its potential impact on erectile function. In these settings, we aimed to assess the impact of sofosbuvir-based therapy on male erectile function.
2022
- Initial Experience and Evaluation of a Nomogram for Outcome Prediction in Management of Medium-sized (1–2 cm) Kidney Stones
[Articolo su rivista]
Micali, S.; Sighinolfi, M. C.; Iseppi, A.; Morini, E.; Calcagnile, T.; Benedetti, M.; Ticonosco, M.; Kaleci, S.; Bevilacqua, L.; Puliatti, S.; De Nunzio, C.; Arada, R.; Chiancone, F.; Campobasso, D.; Eissa, A.; Bonfante, G.; Simonetti, E.; Cotugno, M.; Galli, R.; Curti, P.; Schips, L.; Ditonno, P.; Villa, L.; Ferretti, S.; Bergamaschi, F.; Bozzini, G.; Zoeir, A.; Sherbiny, A. E.; Frattini, A.; Fedelini, P.; Okhunov, Z.; Tubaro, A.; Landman, J.; Bianchi, G.; Rocco, B.
abstract
Shockwave lithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy are recommended as treatment options for solitary medium-sized (1–2 cm) renal stones. A nomogram was developed to predict treatment failure of the three procedures, based on preoperative variables.
2022
- Laparoscopic assisted mini-ECIRS for ectopic kidney lithiasis: A case report and literature review
[Articolo su rivista]
Amato, M.; Piazza, P.; Deruyver, Y.; Del Favero, L.; Van den Broeck, T.; Sarchi, L.; Scarcella, S.; Bravi, C. A.; Puliatti, S.; Micali, S.; Van Haute, C.; Van Cleynenbreugel, B.
abstract
INTRODUCTION: Ectopic kidney is a rare anatomic variant with an incidence of about 1 in 900. Renal stones can pose a challenge when a standard approach is not possible. Laparoscopic-assisted endourologic procedure can be a feasible and safe choice. CASE REPORT AND LITERATURE REVIEW: We present a case of 32 years old man with spastic quadriplegia, megacolon and pelvic kidney undergoing intervention of laparoscopic-assisted Mini ECIRS for staghorn stone of the left pelvic kidney. To the best of our knowledge, only 59 cases are reported in the literature concerning laparoscopically assisted encdourologic treatment which seems a feasible, safe and adaptable technique in selected complex cases. CONCLUSION: Laparoscopic-assisted mini ECIRS is a viable option for the treatment of ectopic kidney stones. This technique should be considered when anatomical anomalies are encountered, to avoid puncture-related complications.
2022
- New imaging technologies for robotic kidney cancer surgery
[Articolo su rivista]
Puliatti, S.; Eissa, A.; Checcucci, E.; Piazza, P.; Amato, M.; Ferretti, S.; Scarcella, S.; Rivas, J. G.; Taratkin, M.; Marenco, J.; Rivero, I. B.; Kowalewski, K. -F.; Cacciamani, G.; El-Sherbiny, A.; Zoeir, A.; El-Bahnasy, A. M.; De Groote, R.; Mottrie, A.; Micali, S.
abstract
Objective: Kidney cancers account for approximately 2% of all newly diagnosed cancer in 2020. Among the primary treatment options for kidney cancer, urologist may choose between radical or partial nephrectomy, or ablative therapies. Nowadays, robotic-assisted partial nephrectomy (RAPN) for the management of renal cancers has gained popularity, up to being considered the gold standard. However, RAPN is a challenging procedure with a steep learning curve. Methods: In this narrative review, different imaging technologies used to guide and aid RAPN are discussed. Results: Three-dimensional visualization technology has been extensively discussed in RAPN, showing its value in enhancing robotic-surgery training, patient counseling, surgical planning, and intraoperative guidance. Intraoperative imaging technologies such as intracorporeal ultrasound, near-infrared fluorescent imaging, and intraoperative pathological examination can also be used to improve the outcomes following RAPN. Finally, artificial intelligence may play a role in the field of RAPN soon. Conclusion: RAPN is a complex surgery; however, many imaging technologies may play an important role in facilitating it.
2022
- Patients' perceptions of quality of care delivery by urology residents: A nationwide study
[Articolo su rivista]
Mantica, G.; Chierigo, F.; Gallo, F.; Cocci, A.; Esperto, F.; Patruno, G.; Diminutto, A.; Cerasuolo, M.; Campi, R.; Barale, M.; Ragonese, M.; Bettin, L.; Zanetti, S.; Bianchi, L.; Principi, E.; Puliatti, S.; Cancrini, F.; Parnanzini, D.; Bianchi, G.; Grande, P.; Primiceri, G.; Cavacece, F.; Schiralli, P.; Amparore, D.; Farullo, G.; Di Mauro, M.; Durante, J.; Baldesi, R.; Carobbio, F.; Russo, G. I.; Luperto, E.; La Rocca, R.; Cacciamani, G. E.
abstract
Objective: To present the results of a nationwide survey among urological patients to evaluate their perception of the quality of care provided by residents. Methods: An anonymous survey was distributed to patients who were referred to 22 Italian academic institutions. The survey aimed to investigate the professional figure of the urology resident as perceived by the patient. Results: A total of 2587 patients were enrolled in this study. In all, 51.6% of patients were able to correctly identify a urology resident; however, almost 40% of respondents discriminated residents from fully trained urologists based exclusively on their young age. Overall, 98.2% patients rated the service provided by the resident as at least sufficient. Urology trainees were considered by more than 50% of the patients interviewed to have good communication skills, expertise and willingness. Overall, patients showed an excellent willingness to be managed by urology residents. The percentage of patients not available for this purpose showed an increasing trend that directly correlated with the difficulty of the procedure. Approximately 5–10% of patients were not willing to be managed by residents for simple procedures such as clinical visits, cystoscopy or sonography, and up to a third of patients were not prepared to undergo any surgical procedure performed by residents during steps in major surgery, even if the residents were adequately tutored. Conclusions: Our data showed that patients have a good willingness to be managed by residents during their training, especially for medium- to low-difficulty procedures. Furthermore, the majority of patients interviewed rated the residents' care delivery as sufficient. Urology trainees were considered to have good communication skills, expertise and willingness.
2022
- Potential Contenders for the Leadership in Robotic Surgery
[Articolo su rivista]
Farinha, R.; Puliatti, S.; Mazzone, E.; Amato, M.; Rosiello, G.; Yadav, S.; De Groote, R.; Piazza, P.; Bravi, C. A.; Koukourikis, P.; Rha, K. H.; Cacciamani, G.; Micali, S.; Wiklund, P.; Rocco, B.; Mottrie, A.
abstract
Purpose: To summarize the scientific published literature on new robotic surgical platforms with potential use in the urological field, reviewing their evolution from presentation until the present day. Our goal is to describe the current characteristics and possible prospects for these platforms. Materials and Methods: A nonsystematic search of the PubMed, Cochrane library's Central, EMBASE, MEDLINE, and Scopus databases was conducted to identify scientific literature about new robotic platforms other than the Da Vinci® system, reviewing their evolution from inception until December 2020. Only English language publications were included. The following keywords were used: "new robotic platforms,""Revo-I robot,""Versius robot,"and "Senhance robot."All relevant English-language original studies were analyzed by one author (R.F.) and summarized after discussion with an independent third party (E.M., S.Y., S.P., and M.A.). Results: Since 1995, Intuitive Surgical, Inc., with the Da Vinci surgical system, is the leading company in the robotic surgical market. However, Revo-I®, Versius®, and Senhance® are the other three platforms that recently appeared on the market with available articles published in peer-reviewed journals. Among these three new surgical systems, the Senhance robot has the most substantial scientific proof of its capacity to perform minimally invasive urological surgery and as such, it might become a contender of the Da Vinci robot. Conclusions: The Da Vinci surgical platform has allowed the diffusion of robotic surgery worldwide and showed the different advantages of this type of technique. However, its use has some drawbacks, especially its price. New robotic platforms characterized by unique features are under development. Of note, they might be less expensive compared with the Da Vinci robotic system. We found that these new platforms are still at the beginning of their technical and scientific validation. However, the Senhance robot is in a more advanced stage, with clinical studies supporting its full implementation.
2022
- Preclinical Validation of a Semi-Autonomous Robot for Transperineal Prostate Biopsy
[Articolo su rivista]
Maris, B.; Fiazza, M. -C.; De Piccoli, M.; Tenga, C.; Palladino, L.; Puliatti, S.; Iseppi, A.; Ferrari, R.; Piro, A.; Bonetti, L. R.; Ligabue, G.; Tafuri, A.; Micali, S.; Fiorini, P.
abstract
Prostate biopsy is a manual procedure carried out mostly under ultrasound (US) guidance to confirm the presence of cancer. The standard biopsy is random and includes at least 12 insertions; targeted biopsy makes use of dedicated hardware and software, but is still performed manually. We present here the pre-clinical validation of PROST, a robot primarily designed to automate targeted transperineal biopsy. The overall validation of the system was performed on cadavers, while some features, such as image segmentation, were tested on human tissue. PROST is designed to minimize human error by introducing some autonomy in the execution of key steps of the procedure, i.e., target selection, image fusion and needle positioning. The protocol was approved by the ethics committee; 10 cadavers were included in the study. We envision that PROST has the potential to increase the detection of clinically significant prostate cancer, to simplify the procedure, to reduce human errors and to shorten training time. The use of a robot for the biopsy of the prostate will create the possibility to include also a treatment, such as focal ablation, to be delivered through the same system.
2022
- Procedural Robotic Skills Training
[Capitolo/Saggio]
Puliatti, Stefano; Piazza, Pietro; Eissa, Ahmed; Bianchi, Lorenzo; Brunocilla, Eugenio; Micali, Salvatore
abstract
2022
- Proficiency-based progression training for robotic surgery skills training: a randomized clinical trial
[Articolo su rivista]
De Groote, R.; Puliatti, S.; Amato, M.; Mazzone, E.; Rosiello, G.; Farinha, R.; Paludo, A.; Desender, L.; Van Cleynenbreugel, B.; Bunting, B. P.; Mottrie, A.; Gallagher, A. G.; Larcher, A.; Uvin, P.; Decoene, J.; Tuyten, T.; D'Hondt, M.; Hubert, N.; Chatzopoulos, C.; De Troyer, B.
abstract
Objective: To determine whether proficiency-based progression (PBP) training leads to better robotic surgical performance compared to traditional training (TT), given that the value of PBP training for learning robotic surgical skills is unclear. Materials and Methods: The PROVESA trial is a multicentric, prospective, randomized and blinded clinical study comparing PBP training with TT for robotic suturing and knot-tying anastomosis skills. A total of 36 robotic surgery-naïve junior residents were recruited from 16 training sites and 12 residency training programmes. Participants were randomly allocated to metric-based PBP training or the current standard of care TT, and compared at the end of training. The primary outcome was percentage of participants reaching the predefined proficiency benchmark. Secondary outcomes were the numbers of procedure steps and errors made. Results: Of the group that received TT, 3/18 reached the proficiency benchmark versus 12/18 of the PBP group (i.e. the PBP group were ~10 times as likely to demonstrate proficiency [P = 0.006]). The PBP group demonstrated a 51% reduction in number of performance errors from baseline to the final assessment (18.3 vs 8.9). The TT group demonstrated a marginal improvement (15.94 vs 15.44) in errors made. Conclusions: The PROVESA trial is the first prospective randomized controlled trial on basic skills training in robotic surgery. Implementation of a PBP training methodology resulted in superior surgical performance for robotic suturing and knot-tying anastomosis performance. Compared to TT, better surgical quality could be obtained by implementing PBP training for basic skills in robotic surgery.
2022
- Psychological distress among patients awaiting histopathologic results after prostate biopsy: An unaddressed concern
[Articolo su rivista]
Sarchi, Luca; Eissa, Ahmed; Puliatti, Stefano; Amato, Marco; Assumma, Simone; Calcagnile, Tommaso; Ticonosco, Marco; Iseppi, Andrea; Toso, Stefano; Sighinolfi, Maria Chiara; Bianchi, Giampaolo; Micali, Salvatore; Rocco, Bernardo
abstract
Background: Prostate cancer is the most commonly diagnosed neoplasm in men. From the introduction of PSA testing, an increasing number of men undergoes prostate biopsy (PBX). While the physical side effects of PBx have been well investigated, its psychological impact has been under-evaluated.Aim: The aim of our study is to investigate the presence of psychological distress (anxiety and depression) in patients waiting for histopathological results after prostate biopsy (PBx).Methods: From February to April 2019, 51 consecutive patients undergoing prostate biopsies at our institution were included. Age, PSA, DRE, familiarity for prostate cancer, number of previous biopsies, type of anesthesia, number of cores were recorded. All patients filled the Hospital Anxiety and Depression Scale (HADS), a psychometric Likert-scale questionnaire, before receiving the histopathological results of their PBx.Results: The prevalence of psychological distress among patients awaiting histopathologic results is 41% (21/51 patients), with anxiety being the main component of their distress. On multivariate analysis, PSA, family history, and repeat biopsy were significantly associated with anxiety and depression.Conclusion: Patients undergoing PBx experience a burden of psychological distress waiting for histopathologic results, especially anxiety. Appropriate counseling should be offered to patients at high risk of developing psychological distress after PBx. Future goals would include technological improvements to shorten the time between biopsy and definitive results.
2022
- Reply to Marc Furrer, Niranjan J. Sathianathen, and Nathan Lawrentschuk's Letter to the Editor re: Pietro Piazza, Luca Sarchi, Stefano Puliatti, Carlo Andrea Bravi, Sophie Knipper, Alexandre Mottrie. The Unsolved Issue of Reporting of Late Complications in Urology. Eur Urol 2021;80:527–528
[Articolo su rivista]
Piazza, P.; Sarchi, L.; Puliatti, S.; Mottrie, A.
abstract
2022
- Robot-Assisted Adrenalectomy Workup and Management
[Capitolo/Saggio]
Puliatti, Stefano; Piazza, Pietro; Murphy, Declan; Canda, Erdem
abstract
Robot-assisted approach for adrenalectomy is feasible and safe. Although adrenalectomy is a purely extirpative procedure requiring no further reconstruction, wristed instruments, increased precision, and magnified three-dimensional vision may aid in dissection of large and small vessels and more precise delineation of the tumor lesion during both radical and partial adrenalectomies. These advantages may allow more surgeons, including those with limited laparoscopic experience, to offer their patients an effective and minimally invasive approach to adrenalectomy.
2022
- Robot-assisted radical prostatectomy feasibility and setting with the Hugo™ robot-assisted surgery system
[Articolo su rivista]
Sarchi, L.; Mottaran, A.; Bravi, C. A.; Paciotti, M.; Farinha, R.; Piazza, P.; Puliatti, S.; De Groote, R.; De Naeyer, G.; Gallagher, A.; Breda, A.; Mottrie, A.
abstract
2022
- Selective Suturing or Sutureless Technique in Robot-assisted Partial Nephrectomy: Results from a Propensity-score Matched Analysis
[Articolo su rivista]
Farinha, R.; Rosiello, G.; Paludo, A. D. O.; Mazzone, E.; Puliatti, S.; Amato, M.; De Groote, R.; Piazza, P.; Berquin, C.; Montorsi, F.; Schatteman, P.; De Naeyer, G.; D'Hondt, F.; Mottrie, A.
abstract
Background: Despite efforts aimed at preserving renal function, the functional decline after robot-assisted partial nephrectomy (RAPN) is not negligible. To address the risk of intraparenchymal vessel injuries during renorrhaphy, with consequent loss of functional renal parenchyma, we introduced a new surgical technique for RAPN. Objective: To compare perioperative patient outcomes between selective-suturing or sutureless RAPN (suRAPN) and standard RAPN (stRAPN). Design, setting, and participants: Ninety-two consecutive patients undergoing RAPN for a renal mass performed by a high-volume surgeon at a European tertiary center were included. Propensity-score matching was used to account for baseline differences between suRAPN and stRAPN patients. Intervention: RAPN using a selective-suturing or sutureless technique versus standard RAPN. Outcome measurements and statistical analysis: Perioperative outcomes included operative time, blood loss, length of stay, and intraoperative and 30-d postoperative complications. We also evaluated trifecta achievement (warm ischemia time ≤25 min, negative surgical margins, and no perioperative complications) and the incidence of postoperative acute kidney injury (AKI). We applied χ2 tests, t tests, and Kruskal-Wallis tests to assess differences in perioperative outcomes between suRAPN and stRAPN. Results and limitations: Overall, 29 patients (31%) were treated with suRAPN. Only one suRAPN patient experienced intraoperative complications (p = 0.9). Two suRAPN patients (6.9%) and four stRAPN patients (13.8%) experienced 30-d postoperative complications (p = 0.3). Operative time (110 vs 150 min; p < 0.01) and length of stay (2 vs 3 d; p = 0.02) were shorter for suRAPN than for stRAPN. The trifecta outcome was achieved in 25 suRAPN patients (86%) and 20 stRAPN patients (70%; p = 0.1). Only one suRAPN patient (3.4%) versus five stRAPN patients (17%) experienced postoperative AKI (p = 0.2). Finally, the decrease in the estimated glomerular filtration rate at 6-mo follow-up was lower in the suRAPN (−5.2%) than in the stRAPN group (−9.1%; p < 0.01). Lack of randomization represents the main study limitation. Conclusions: A selective-suturing or sutureless technique in RAPN is feasible and safe. Moreover, suRAPN is a lower-impact surgical procedure. We obtained promising results for trifecta and functional outcomes, but prospective randomized trials are needed to validate the impact of selective suturing or a sutureless technique on long-term functional outcomes. Patient summary: We assessed a new technique in robotic surgery to remove part of the kidney because of kidney cancer. Our new technique involves selective suturing or no suturing of the area from where the tumor is removed. We found that the rate of complications did not increase and the operating time and length of hospital stay were shorter using this new technique. Avoiding suturing of the tumor resection bed during robot-assisted partial nephrectomy is a safe and feasible procedure and achieves lower-impact surgery, leading to shorter operative times and hospital stays. We obtained promising trifecta (warm ischemia time ≤25 min, negative surgical margins, and no perioperative complications) and functional outcomes.
2022
- Short Time Delay Between Previous Prostate Biopsy for Prostate Cancer Assessment and Holmium Laser Enucleation of the Prostate Correlates with Worse Perioperative Outcomes
[Articolo su rivista]
Piazza, P.; Bianchi, L.; Giampaoli, M.; Droghetti, M.; Casablanca, C.; Ercolino, A.; Beretta, C.; Recenti, D.; Balestrazzi, E.; Puliatti, S.; Rosiello, G.; Amato, M.; Romagnoli, D.; D'Agostino, D.; Gaudiano, C.; Golfieri, R.; Porreca, A.; Mottrie, A.; Schiavina, R.
abstract
Background: No data are available regarding the impact of time between a previous transrectal prostate biopsy (PB) and holmium laser enucleation of the prostate (HoLEP) on perioperative outcomes. Objective: To evaluate the impact of time from PB to HoLEP on perioperative outcomes. Design, setting, and participants: A total of 172 consecutive patients treated with HoLEP within 12 mo of a single previous transrectal PB at two tertiary centers were included. Outcome measurements and statistical analysis: Patients were stratified into two groups according to the median time from PB to HoLEP (namely, ≤6 and >6 mo). The primary outcome was intraoperative complications. Multivariate logistic regressions were used to identify the predictors of intraoperative complications. Linear regressions were used to test the association between the time from PB to HoLEP and intraoperative complications, enucleation efficiency, and enucleation time. Results and limitations: In total, 93 (54%) and 79 (46%) patients had PB ≤ 6 and >6 mo before HoLEP, respectively. Patients in PB ≤ 6 mo group experienced higher rates of intraoperative complications than those in PB > 6 mo group (14% vs 2.6%, p = 0.04). At multivariable analysis, time between PB and HoLEP was an independent predictor of intraoperative complications (odds ratio: 0.74; 95% confidence interval: 0.6–0.9; p = 0.006). Finally, the risk of intraoperative complications reduced by 1.5%, efficiency of enucleation increased by 4.1%, and enucleation time reduced by 1.7 min for each month passed from PB to HoLEP (all p ≤ 0.006). Selection of patients with only one previous PB represents the main limitation. Conclusions: The time from PB to HoLEP of ≤6 mo is associated with a higher risk of intraoperative complications, lower enucleation efficacy, and longer enucleation time. Patient summary: Patients with a prostate biopsy (PB) ≤6 mo before holmium laser enucleation of the prostate (HoLEP) had significantly worse outcomes than those with a PB > 6 mo before HoLEP.
2022
- Simplified PADUA renal (SPARE) nephrometry score validation and long-term outcomes after robot-assisted partial nephrectomy
[Articolo su rivista]
Rosiello, G.; Piazza, P.; Puliatti, S.; Mazzone, E.; Amato, M.; Tames, V.; Farinha, R.; De Groote, R.; Berquin, C.; Develtere, D.; Sinatti, C.; Larcher, A.; Capitanio, U.; D'Hondt, F.; Schatteman, P.; Briganti, A.; Montorsi, F.; De Naeyer, G.; Mottrie, A.
abstract
Background: International guidelines suggest the use of anatomic scores to predict surgical outcomes after partial nephrectomy (PN). We aimed at validating the use of Simplified PADUA Renal (SPARE) nephrometry score in robot-assisted PN (RAPN). Materials and methods: Three hundred and sixty-eight consecutive RAPN patients were included. Primary endpoints were overall complications, postoperative acute kidney injury (AKI) and TRIFECTA achievement. Secondary endpoint was estimated glomerular filtration rate (eGFR) decrease at last follow-up. Multivariable logistic and linear regression models were used. Results: Of 368 patients, 229 (62%) vs. 116 (31%) vs. 23 (6.2%) harboured low- vs. intermediate- vs. high-risk renal mass, according to SPARE classification. SPARE score predicted higher risk of overall complications (Odds ratio [OR]: 1.23, 95%CI 1.09–1.39; P < 0.001), and postoperative AKI (OR: 1.20, 95%CI 1.08–1.35; P < 0.01). Moreover, SPARE score was associated with lower TRIFECTA achievement (OR: 0.89, 95%CI 0.81–0.98; P = 0.02). Predicted accuracy was 0.643, 0.614 and 0.613, respectively. After a median follow-up of 40 (IQR: 21–66) months, eGFR decrease ranged from -7% in low-risk to -17% in high-risk SPARE. Conclusions: SPARE scoring system predicts surgical success in RAPN patients. Moreover, SPARE score is associated with eGFR decrease at long-term follow-up. Thus, the adoption of SPARE score to objectively assess tumor complexity prior to RAPN may be preferable.
2022
- Standardization of Training
[Capitolo/Saggio]
Mottrie, Alexandre; Sarchi, Luca; Puliatti, Stefano; Gallagher, Anthony G.
abstract
2022
- Surgical Education and Learning Theory
[Capitolo/Saggio]
Mottrie, Alexandre; Peraire Lores, Maria; Puliatti, Stefano; Gallagher, Anthony G.
abstract
Surgical education has evolved over the last three decades due to changes in surgery
starting with the adoption of minimally invasive and image-guided surgical techniques.
It has therefore driven change in the traditional approach to the teaching and in
the acquisition of new surgical skills, both technical and non-technical. Always considering
the educational theory principles, the simulation will undoubtedly play a crucial
role and will become a basic step for assessing certain skill competencies before progression
to real-life scenarios. It will enhance the development of skills, knowledge,
and attitudes generating a new generation of successful medical trainers and learners.
2022
- Technical Advances in Robotic Renal Surgery
[Capitolo/Saggio]
Puliatti, Stefano; Bravi, Carlo Andrea; De Backer, Pieter; Canda, Erdem
abstract
2022
- The Importance of e-learning
[Capitolo/Saggio]
Puliatti, Stefano; Piazza, Pietro; Kiely, Patrick; Sighinolfi, Maria Chiara; Schiavina, Riccardo; Rocco, Bernardo
abstract
2022
- Three-dimensional Model Reconstruction: The Need for Standardization to Drive Tailored Surgery
[Articolo su rivista]
Checcucci, E.; Piazza, P.; Micali, S.; Ghazi, A.; Mottrie, A.; Porpiglia, F.; Puliatti, S.
abstract
: The clinical utility of three-dimensional virtual models has been widely explored for preoperative planning, patient counseling, surgical training, and intraoperative navigation. There is now a need for standardized methodology for construction of these models so that their utility can be realized in routine practice to achieve the goal of individualized treatment for patients.
2022
- Three-dimensional Model-assisted Minimally Invasive Partial Nephrectomy: A Systematic Review with Meta-analysis of Comparative Studies
[Articolo su rivista]
Piramide, Federico; Kowalewski, Karl-Friedrich; Cacciamani, Giovanni; Rivero Belenchon, Ines; Taratkin, Mark; Carbonara, Umberto; Marchioni, Michele; De Groote, Ruben; Knipper, Sophie; Pecoraro, Angela; Turri, Filippo; Dell'Oglio, Paolo; Puliatti, Stefano; Amparore, Daniele; Volpi, Gabriele; Campi, Riccardo; Larcher, Alessandro; Mottrie, Alex; Breda, Alberto; Minervini, Andrea; Ghazi, Ahmed; Dasgupta, Prokar; Gozen, Ali; Autorino, Riccardo; Fiori, Cristian; Di Dio, Michele; Gomez Rivas, Juan; Porpiglia, Francesco; Checcucci, Enrico
abstract
Context: Use of three-dimensional (3D) guidance for nephron-sparing surgery (NSS) has increased in popularity, especially for laparoscopic and robotic approaches. Different 3D visualization modalities have been developed as promising new tools for surgical planning and intraoperative navigation. Objectives: To summarize and evaluate the impact of 3D models on minimally invasive NSS in terms of perioperative, functional, and oncological outcomes. Evidence acquisition: A systematic literature search was conducted in December 2021 using the Medline (PubMed), Embase (Ovid), Scopus, and Web of Science databases. The protocol was registered on PROSPERO (CRD42022300948). The search strategy used the PICOS (Population, Intervention, Comparison, Outcome, Study design) criteria and article selection was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias and the quality of the articles included were assessed. A dedicated data extraction form was used to collect the data of interest. Meta-analysis was performed using the Mantel-Haenszel method for binary outcomes, with results summarized as the odds ratio (OR), and the inverse variance method for continuous data, with results reported as the mean difference (MD). All effect estimates are reported with the 95% confidence interval (CI) and p ≤ 0.05 was considered statistically significant. All analyses were performed using R software and the meta package. Evidence synthesis: The initial electronic search identified 450 papers, of which 17 met the inclusion criteria and were included in the analysis. Use of 3D technology led to a significant reduction in the global ischemia rate (OR 0.22, 95% CI 0.07-0.76; p = 0.02) and facilitated more frequent enucleation (OR 2.54, 95% CI 1.36-4.74; p < 0.01) and less frequent opening of the collecting system (OR 0.36, 95% CI 0.15-0.89; p = 0.03) and was associated with less blood loss (MD 23.1 ml, 95% CI 31.8-14.4; p < 0.01). 3D guidance for NSS was associated with a significant reduction in the transfusion rate (OR 0.20, 95% CI 0.07-0.56; p < 0.01). There were no significant differences in rates of conversion to radical nephrectomy, minor and major complications, change in glomerular filtration rate, or surgical margins (all p > 0.05). Conclusions: 3D guidance for NSS is associated with lower rates of detriment and surgical injury to the kidney. Specifically, a lower amount of nontumor renal parenchyma is exposed to ischemia or sacrificed during resection, and opening of the collecting system is less frequent. However, use of 3D technology does not lead to significant improvements in oncological or functional outcomes. Patient summary: We reviewed the use of three-dimensional tools for minimally invasive surgery for partial removal of the kidney in patients with kidney cancer. The evidence suggests that these tools have benefits during surgery, but do not lead to significant improvements in cancer control or functional outcomes for patients.
2022
- Training and Challenges to Perform Robot-Assisted Renal Surgeries
[Capitolo/Saggio]
Puliatti, Stefano; Piazza, Pietro; Farinha, Rui; Raju, Thomas; Gallagher, Anthony G.
abstract
Robot-assisted renal surgery training is still under definition, and validated robotic curricula are still lacking. The implementation of the proficiency-based progression (PBP) training model can provide an objective and effective tool to help develop skills and create standardized and efficient curricula.
2022
- Validated Training Curricula in Robotic Urology
[Capitolo/Saggio]
De Groote, Ruben; Puliatti, Stefano; Mazzone, Elio; Dell???oglio, Paolo; Mottrie, Alexandre; Gallagher, Anthony G.
abstract
2022
- Warm ischemia time length during on-clamp partial nephrectomy: does it really matter?
[Articolo su rivista]
Abdel Raheem, A.; Alowidah, I.; Capitanio, U.; Montorsi, F.; Larcher, A.; Derweesh, I.; Ghali, F.; Mottrie, A.; Mazzone, H.; de Naeyer, G.; Campi, R.; Sessa, F.; Carini, M.; Minervini, A.; Raman, J. D.; Rjepaj, C. J.; Kriegmair, M. C.; Autorino, R.; Veccia, A.; Mir, M. C.; Claps, F.; Choi, Y. D.; Ham, W. S.; Tadifa, J. P.; Santok, G. D.; Furlan, M.; Simeone, C.; Bada, M.; Celia, A.; Carrion, D. M.; Aguilera Bazan, A.; Ballesteros Ruiz, C.; Malki, M.; Barber, N.; Hussain, M.; Micali, S.; Puliatti, S.; Alwahabi, A.; Alqahtani, A.; Rumaih, A.; Ghaith, A.; Ghoneem, A. M.; Hagras, A.; Eissa, A.; Alenzi, M. J.; Pavan, N.; Traunero, F.; Antonelli, A.; Porcaro, A. B.; Illiano, E.; Costantini, E.; Rha, K. H.
abstract
BaCKgroUnd: The impact of warm ischemia time (WiT) on renal functional recovery remains controversial. We examined the length of WiT>30 min on the long-term renal function following on-clamp partial nephrectomy (pn). MeThodS: data from 23 centers for patients undergoing on-clamp pn between 2000 and 2018 were analyzed. We included patients with two kidneys, single tumor, cT1, minimum 1-year follow-up, and preoperative eGFR≥60 mL/ min/1.73m2. Patients were divided into two groups according to WIT length: group I “WIT≤30 min” and group II “WiT>30 min.” a propensity-score matched analysis (1:1 match) was performed to eliminate potential confounding factors between groups. We compared egFr values, egFr (%) preservation, egFr decline, events of chronic kidney disease (CKd) upgrading, and CKd-free progression rates between both groups. Cox regression analysis evaluated WiT impact on upgrading of CKd stages. reSUlTS: The primary cohort consisted of 3526 patients: group i (n.=2868) and group ii (n.=658). after matching the final cohort consisted of 344 patients in each group. At last follow-up, there were no significant differences in median egFr values at 1, 3, 5, and 10 years (p>0.05) between the matched groups. in addition, the median egFr (%) preservation and absolute egFr change were similar (89% in group i vs. 87% in group ii, p=0.638) and (-10 in group i vs. -11 in group ii, p=0.577), respectively. The 5 years new-onset CKd-free progression rates were comparable in the non-matched groups (79% in group i vs. 81% in group ii, log-rank, p=0.763) and the matched groups (78.8% in group i vs. 76.3% in group ii, log-rank, p=0.905). Univariable Cox regression analysis showed that WiT>30 min was not a predictor of overall CKD upgrading (HR:0.953, 95%CI 0.829-1.094, P=0.764) nor upgrading into CKD stage ≥III (HR:0.972, 95%CI 0.805-1.173, p=0.764). retrospective design is a limitation of our study. ConClUSionS: our analysis based on a large multicenter international cohort study suggests that WiT length during PN has no effect on the long-term renal function outcomes in patients having two kidneys and preoperative eGFR≥60 mL/min/1.73m2,.
2022
- Will renorrhaphy become obsolete? Evaluation of a new hemostatic sealant
[Articolo su rivista]
Farinha, Rui; De Groote, Ruben; Zondervan, Patricia J; Paciotti, Marco; Roozen, Edwin; Head, Stuart; Sarchi, Luca; Bravi, Carlo; Mottaran, Angelo; Puliatti, Stefano; De Backer, Pieter; De Naeyer, Geert; Mottrie, Alexandre
abstract
Background: In robot-assisted partial nephrectomy (RAPN) renorrhaphy is used to achieve hemostatic control of the tumoral resection bed, with detrimental impact on renal function. Hemostatic agents are used to achieve rapid and optimal hemostasis. GATT-Patch is a new hemostatic sealant that has already demonstrated promising results. Objective: Compare GATT-Patch and standard renorrhaphy in terms of hemostatic capacity, ischemia time and prevention of urinary leakage after RAPN in a porcine model. Design, setting and participants: In this preclinical randomized controlled trial, four pigs underwent 32 RAPNs. After resection, GATT-patch application and performance of classic renorrhaphy were randomized. After the procedure, the resection bed was re-inspected. A necropsy study evaluated the adhesiveness of the patch and retrograde pyelography was performed to determine the leakage burst pressure. Intervention: Application of GATT-patch and performance of classic renorrhaphy were randomized and surgeons blinded to the hemostatic technique to be performed. Outcome measurements and statistical analysis: Warm ischemia, hemostatic control, active bleeding during hemostatic control, total procedure time, bleeding at reinspection and presence of urinary leakage on retrograde pyelography were recorded. Continuous variables were compared using the Student t-test. Categorical variables were compared using the Chi-square or Fisher's exact test. Results and limitations: GATT-Patch reduced warm ischemia time, time to achieve hemostatic control, active bleeding time, and total procedure time, achieving hemostasis in 100% of the cases. Rebleeding at reinspection occurred in 0% of the GATT-patch group. Renal parenchyma damage was observed in 100% of renorrhaphy cases and in 0% of GATT-Patch cases. Conclusions: GATT-Patch guaranteed optimal hemostasis and urine sealant effect after RAPN in porcine models. Compared to renorrhaphy, we observed a reduction in warm ischemia time, total procedure time, and potential reduction in healthy parenchyma loss.
2021
- A Systematic Review and Meta-analysis on the Impact of Proficiency-based Progression Simulation Training on Performance Outcomes
[Articolo su rivista]
Mazzone, Elio; Puliatti, Stefano; Amato, Marco; Bunting, Brendan; Rocco, Bernardo; Montorsi, Francesco; Mottrie, Alexandre; Gallagher, Anthony G
abstract
To analyze all published prospective, randomized, and blinded clinical studies on the proficiency-based progression (PBP) training using objective performance metrics.
2021
- A survey-based study on the spread of en-bloc resection of bladder tumors among IEA and ESUT members
[Articolo su rivista]
Bonfante, Giulia; Puliatti, Stefano; Sighinolfi, Maria C; Eissa, Ahmed; Ciarlariello, Silvia; Ferrari, Riccardo; Ticonosco, Marco; Goezen, Ali Serdar; Guven, Selcuk; Rassweiler, Jens; Bianchi, Giampaolo; Rocco, Bernardo; Micali, Salvatore
abstract
2021
- A systematic review of nerve-sparing surgery for high-risk prostate cancer
[Articolo su rivista]
Morozov, Andrey; Barret, Eric; Veneziano, Domenico; Grigoryan, Vagarshak; Salomon, Georg; Fokin, Igor; Taratkin, Mark; Poddubskaya, Elena; Gomez Rivas, Juan; Puliatti, Stefano; Okhunov, Zhamshid; Cacciamani, Giovanni E; Checcucci, Enrico; Marenco Jiménez, José L; Enikeev, Dmitry
abstract
We provide a systematic analysis of nerve-sparing surgery (NSS) to assess and summarize the risks and benefits of NSS in high-risk prostate cancer (PCa).
2021
- Bilateral kidney metastases from adenoid cystic carcinoma of lung: a case report and literature review
[Articolo su rivista]
Piazza, Pietro; Oliveira Paludo, Artur de; Puliatti, Stefano; Rosiello, Giuseppe; Farinha, Rui; Amato, Marco; Schiavina, Riccardo; Brunocilla, Eugenio; Berquin, Camille; De Groote, Ruben; Thielman, Louis; Mottrie, Alexandre; De Naeyer, Geert
abstract
Adenoid cystic carcinoma (ACC) is a rare malignant tumor, usually arising from salivary glands and rarely found in other locations. ACC is characterized by asymptomatic course, slow growth pattern, perineural invasion and high incidence of late metastasis. Renal localization of metastasis is rare. Only 12 cases of renal metastasis were published and, to our best knowledge, no case of bilateral metastasis to the kidney has ever been reported. We present a case of a 58 years old woman with bilateral renal metastasis from ACC of the right lung after fourteen years from lobectomy and radiotherapy for the primary presentation. The patient underwent bilateral robot-assisted partial nephrectomy in a two-stage approach. Despite its rare incidence and slow growth, ACC metastasis may simulate primary papillary renal carcinoma and occur many years after primary treatment. Therefore, lifelong follow-up, including abdominal imaging, is recommended.
2021
- COVID-19 and slowdown of residents' activity: Feedback from a novel e-learning event and overview of the literature
[Articolo su rivista]
Calcagnile, Tommaso; Sighinolfi, Maria Chiara; Sarchi, Luca; Assumma, Simone; Filippi, Beatrice; Bonfante, Giulia; Cassani, Alessandra; Spandri, Valentina; Turri, Filippo; Puliatti, Stefano; Bozzini, Giorgio; Moschovas, Marcio; Bianchi, Giampaolo; Micali, Salvatore; Rocco, Bernardo
abstract
Objective: To evaluate the impact of an e-learning online event, created for supporting resident's training during the slowdown of surgical and clinical activities caused by COVID-19 pandemic. An overview of PubMed literature depicting the state of the art of urology residency in the COVID-19 era was performed as well, to contextualize the issue.Methods: An online learning event for residents was set up at the beginning of the pandemic; the faculty consisted of experts in urology who provided on-line lectures and videos on surgical anatomy, procedures, updates in guidelines, technology, training. The audience was composed of 30-500 attendees from Italy, USA, India and Belgium. A questionnaire to analyze relevance, satisfaction and popularity of the lessons was mailed to 30 local residents.Results and limitations: Almost all residents defined the web environment suitable to achieve the learning outcomes; the method, the number and the competence of the faculty were appropriate/excellent. Most of the younger residents (81.8%) stated their surgical knowledge would improve after the course; 72.7% declared they would take advantage into routine inpatients clinical activity. Nineteen more expert residents agreed that the course would improve their surgical knowledge and enhance their practical skills; almost all stated that the initiative would change their outpatients and inpatients practice. Overall, 44 articles available in PubMed have addressed the concern of urological learning and training during the pandemic from different standpoints; four of them considered residents' general perception towards web-based learning programs.Conclusions: The paper confirms residents' satisfaction with e-learning methods and, to our knowledge, is the first one focusing on a specific event promptly settled up at the beginning of the outbreak. Web-based educational experience developed during the pandemic may represent the very basis for the implementation of prospective on-site training and overall scientific update of future urologists.
2021
- Comment on: "Fusion US/MRI prostate biopsy using a computer aided diagnostic (CAD) system"
[Articolo su rivista]
Sholklapper, T.; Checcucci, E.; Puliatti, S.; Taratkin, M.; Marenco, J.; Kowalewski, K. -F.; Gomez Rivas, J.; Rivero, I.; Lebastchi, A.; Abreu, A.; Cacciamani, G. E.
abstract
2021
- Comment on: "Predictive factors for opioid-free management after robotic radical prostatectomy: The value of a single-port robotic platform"
[Articolo su rivista]
Puliatti, S.; Piazza, P.; Cacciamani, G. E.; Gomez Rivas, J.; Taratkin, M.; Marenco, J. L.; Rivero Belenchon, I.; Kowalewski, K. -F.; Checcucci, E.
abstract
2021
- Correction to: Concomitant robot-assisted laparoscopic surgeries for upper and lower urinary tract malignancies: a comprehensive literature review (Journal of Robotic Surgery, (2021), 10.1007/s11701-021-01317-1)
[Articolo su rivista]
Scarcella, S.; Castellani, D.; Piazza, P.; Giulioni, C.; Sarchi, L.; Amato, M.; Bravi, C. A.; Lores, M. P.; Farinha, R.; Knipper, S.; Palagonia, E.; Skrobot, S. A.; Develtere, D.; Berquin, C.; Sinatti, C.; Van Puyvelde, H.; De Groote, R.; Umari, P.; De Naeyer, G.; Dell'Atti, L.; Milanese, G.; Puliatti, S.; Teoh, J. Y. -C.; Galosi, A. B.; Mottrie, A.
abstract
Unfortunately, the given name and family name of the author Andrea B. Galosi was incorrectly tagged in the xml data, therefore it is abbreviated wrongly in PubMed. The correct given name is Andrea B and family name is Galosi.
2021
- Diagnostic bias during the COVID-19 era: COVID-19 or renal abscess?
[Articolo su rivista]
Amato, Marco; Eissa, Ahmed; Rosiello, Giuseppe; Farinha, Rui; Piazza, Pietro; Sighinolfi, Maria Chiara; Rocco, Bernardo; Bianchi, Giampaolo; Micali, Salvatore; Mottrie, Alexandre; Puliatti, Stefano
abstract
The Coronavirus disease-2019 (COVID-19) has been declared as a pandemic in March 2020 by the World Health Organization (WHO). Since then, this pandemic has dramatically affected the entire world, even radically influencing the way patients are framed at triage. Symptoms and tests in most cases lead to a correct diagnosis; however, error may be around the corner.
2021
- Digital Frozen Sections with Fluorescence Confocal Microscopy During Robot-assisted Radical Prostatectomy: Surgical Technique
[Articolo su rivista]
Rocco, B.; Sarchi, L.; Assumma, S.; Cimadamore, A.; Montironi, R.; Reggiani Bonetti, L.; Turri, F.; De Carne, C.; Puliatti, S.; Maiorana, A.; Pellacani, G.; Micali, S.; Bianchi, G.; Sighinolfi, M. C.
abstract
Background: Robot-assisted radical prostatectomy (RARP) involves a tradeoff between oncological control and functional outcomes. Intraoperative control of surgical margins (SMs) may help in ensuring the safety of the dissection. Fluorescence confocal microscopy (FCM) is an effective method for interpretation of prostate tissue and provides digital images with an appearance similar to hematoxylin-eosin staining. Objective: To describe an alternative technique to NeuroSAFE for intraoperative evaluation of neurovascular-adjacent margins shaved from ex vivo specimens using FCM analysis. Design, setting, and participants: This was a prospective study of 24 patients undergoing RARP with intraoperative FCM control of margin status. Surgical procedure: After surgical dissection, SMs are sectioned from the fresh prostate using the Mohs technique (shaving): three slices from the apex and the right and left posterolateral aspects are obtained. Digital images of the shavings are immediately acquired via FCM and shared with a remote pathologist. In the case of a positive SM, a focal secondary resection of the bundle can be performed owing to the ability of FCM to locate a region of interest on the flat sample. Measurements: The primary outcome measure was the rate of negative margins at neurovascular-adjacent sites. Oncological and functional outcomes for patients with 1 yr of follow-up are also reported. Results and limitations: All patients had negative SMs in shavings from neurovascular-adjacent areas at final histopathology; four underwent a secondary resection with final conversion to negative SM status. Nine of ten patients with 1-yr follow-up are free of biochemical recurrence (prostate-specific antigen persistence in one pN1 case), nine are fully continent, and four of the five with preoperative potency have recovered their sexual function. Conclusions: Digital frozen sections with FCM during RARP may represent an alternative to NeuroSAFE for possible optimization of functional outcomes without compromising oncological safety. Patient summary: We developed a technique to ensure complete removal of cancer tissue during surgical removal of the prostate. Tissue specimens are examined via digital microscopy in real time during the operation. This allows the surgeon to remove more tissue if cancer is detected at the margins of a specimen, while avoiding unnecessary removal of healthy tissue.
2021
- Editorial Comment to Nosocomial SARS-CoV-2 infection in urology departments: Results of a prospective multicentric study
[Articolo su rivista]
Puliatti, S.; Eissa, A.
abstract
2021
- Feasibility of a telementoring approach as a practical training for transurethral enucleation of the benign prostatic hyperplasia using bipolar energy: a pilot study
[Articolo su rivista]
Amato, M.; Eissa, A.; Puliatti, S.; Secchi, C.; Ferraguti, F.; Minelli, M.; Meneghini, A.; Landi, I.; Guarino, G.; Sighinolfi, M. C.; Rocco, B.; Bianchi, G.; Micali, S.
abstract
Introduction: Telementoring is one of the applications of telemedicine capable of bringing highly experienced surgeons to areas lacking expertise. In the current study, we aimed to assess a novel telementoring application during the learning curve of transurethral enucleation of the prostate using bipolar energy (TUEB). Material and methods: A telementoring system was developed by our engineering department. This application was used to mentor ten prospective cases of TUEB performed by an expert endourologist (novice to the TUEB). A questionnaire was filled by the operating surgeon and the mentor to provide subjective evaluation of the telementoring system. Finally, the outcomes of these patients were compared to a control group consisting of ten consecutive patients performed by the mentor. Results: Ten consecutive TUEB were performed using this telementoring application. Delayed and interrupted connection were experienced in two and one patients, respectively; however, their effect was minor, and they did not compromise the safety of the procedure. None of the patients required conversion to conventional transurethral resection of the prostate. Only one patient in our series experienced grade IIIb complication. Conclusion: The telementoring application for TUEB is promising. It is a simple and low-cost tool that could be a feasible option to ensure patients’ safety during the initial phase of the learning curve without time and locations constraints for both the mentor and the trainee; However, it should be mentioned that telementoring cannot yet replace the traditional surgical training with the mentor and trainee being in the operative room. Further studies are required to confirm the current results
2021
- New Ultra-minimally Invasive Surgical Treatment for Benign Prostatic Hyperplasia: A Systematic Review and Analysis of Comparative Outcomes
[Articolo su rivista]
Checcucci, E.; Veccia, A.; De Cillis, S.; Piramide, F.; Volpi, G.; Amparore, D.; Pecoraro, A.; Piana, A.; Granato, S.; Verri, P.; Sica, M.; Meziere, J.; Carbonaro, B.; Piscitello, S.; Zamengo, D.; Cacciamani, G.; Okhunov, Z.; Puliatti, S.; Taratkin, M.; Marenco, J.; Gomez Rivas, J.; Veneziano, D.; Carbonara, U.; Russo, G. I.; De Luca, S.; Manfredi, M.; Fiori, C.; Autorino, R.; Porpiglia, F.
abstract
Context: Benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS) is diagnosed in up to 80% of men during their lifetime. Several novel ultra-minimally invasive surgical treatments (uMISTs) for BPH/benign prostatic obstruction (BPO) have become available over the past 5 yr. Objective: To evaluate the perioperative and functional outcomes of recently introduced uMISTs for BPH/BPO, including Urolift, Rezūm, temporary implantable nitinol device, prostatic artery embolization (PAE), and intraprostatic injection. Evidence acquisition: A systematic literature search was conducted in December 2020 using Medline (via PubMed), Embase (via Ovid), Scopus, and Web of Science (registered on PROSPERO as CRD42021225014). The search strategy used PICO criteria and article selection was conducted in accordance with the PRISMA guidelines. The risk of bias and the quality of the articles included were assessed. A dedicated data extraction form was used to collect the data of interest. Pooled and cumulative analyses were performed to compare perioperative and functional outcomes between study groups. A random-effects model using the DerSimonian and Laird method was used to evaluate heterogeneity. Stata version 15.0 software was used for all statistical analyses. Evidence synthesis: The initial electronic search identified 3978 papers, of which 48 ultimately met the inclusion criteria and were included in the analysis. Pooled analysis revealed a uMIST benefit in terms of International Prostate Symptom Score (IPSS; −9.81 points, 95% confidence interval [CI] −11.37 to −8.25 at 1 mo; −13.13 points, 95% CI −14.98 to −11.64 at 12 mo), maximum flow rate (from +3.66 ml/s, 95% CI 2.8–4.5 to +4.14 ml/s, 95% CI 0.72–7.56 at 12 mo), and postvoid residual volume (−10.10 ml, 95% CI −27.90 to 7.71 at 12 mo). No negative impact was observed on scores for the International Index of Erectile Function-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction bother and function scales (overall postintervention change in pooled median score of 1.88, 95% CI 1.34–2.42 at the start of follow-up; and 1.04, 95% CI 0.28–1.8 after 1 yr), or the IPSS-Quality of Life questionnaire. Conclusions: Novel uMISTs can yield fast and effective relief of LUTS without affecting patient quality of life. Only Rezūm, UroLift, and PAE had a minimal impact on patients’ sexual function with respect to baseline, especially regarding preservation of ejaculation. Patient summary: We reviewed outcomes for recently introduced ultra-minimally invasive surgical treatments for patients with lower urinary tract symptoms caused by benign prostate enlargement or obstruction. The evidence suggests that these novel techniques are beneficial in terms of controlling symptoms while preserving sexual function. Take Home Message: Novel ultra-minimally invasive treatments can yield fast and effective relief of lower urinary tract symptoms without affecting a patient's quality of life.
2021
- Objective assessment of intraoperative skills for robot-assisted radical prostatectomy (RARP): results from the ERUS Scientific and Educational Working Groups Metrics Initiative
[Articolo su rivista]
Mottrie, A.; Mazzone, E.; Wiklund, P.; Graefen, M.; Collins, J. W.; De Groote, R.; Dell'Oglio, P.; Puliatti, S.; Gallagher, A. G.
abstract
Objective: To develop and seek consensus from procedure experts on the metrics that best characterise a reference robot-assisted radical prostatectomy (RARP) and determine if the metrics distinguished between the objectively assessed RARP performance of experienced and novice urologists, as identifying objective performance metrics for surgical training in robotic surgery is imperative for patient safety. Materials and methods: In Study 1, the metrics, i.e. 12 phases of the procedure, 81 steps, 245 errors and 110 critical errors for a reference RARP were developed and then presented to an international Delphi panel of 19 experienced urologists. In Study 2, 12 very experienced surgeons (VES) who had performed >500 RARPs and 12 novice urology surgeons performed a RARP, which was video recorded and assessed by two experienced urologists blinded as to subject and group. Percentage agreement between experienced urologists for the Delphi meeting and Mann–Whitney U- and Kruskal–Wallis tests were used for construct validation of the newly identified RARP metrics. Results: At the Delphi panel, consensus was reached on the appropriateness of the metrics for a reference RARP. In Study 2, the results showed that the VES performed ~4% more procedure steps and made 72% fewer procedure errors than the novices (P = 0.027). Phases VIIa and VIIb (i.e. neurovascular bundle dissection) best discriminated between the VES and novices. Limitations: VES whose performance was in the bottom half of their group demonstrated considerable error variability and made five-times as many errors as the other half of the group (P = 0.006). Conclusions: The international Delphi panel reached high-level consensus on the RARP metrics that reliably distinguished between the objectively scored procedure performance of VES and novices. Reliable and valid performance metrics of RARP are imperative for effective and quality assured surgical training.
2021
- Prostatic artery embolization for the management of benign prostatic hyperplasia/lower urinary tract symptoms in elderly patients unfit for surgery: Our initial experience
[Articolo su rivista]
Amato, Marco; Eissa, Ahmed; Puliatti, Stefano; Di Chiacchio, Giuseppe; Malossi, Marcello; Fiocchi, Federica; Torricelli, Pietro; Sighinolfi, Mari A Chiara; Milandri, Riccardo; Zoeir, Ahmed; Gameel, Tarek; Micali, Salvatore; Bianchi, Giampaolo; Rocco, Bernardo
abstract
To evaluate the safety and efficacy of prostatic artery embolization in the management of LUTS secondary to BPH in elderly patients unfit for surgery.
2021
- Reply to Nikolaos Grivas and Henk G. van der Poel's Letter to the Editor re: Rui Farinha, Giuseppe Rosiello, Artur De Oliveira Paludo, et al. Selective Suturing or Sutureless Technique in Robot-assisted Partial Nephrectomy: Results from a Propensity-score Matched Analysis. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2021.03.019
[Articolo su rivista]
Farinha, Rui; Rosiello, Giuseppe; Puliatti, Stefano; Mottrie, Alexandre
abstract
2021
- Review of nomograms to counsel patients after oncologic surgery: a support for telemedicine to stratify the risk of relapse and customize the follow-up scheduling
[Articolo su rivista]
Sighinolfi, M. C.; Zoeir, A.; Eissa, A.; Sarchi, L.; Assumma, S.; Calcagnile, T.; Filippi, B.; Moschovas, M.; Bhat, S.; Puliatti, S.; Micali, S.; Bozzini, G.; Patel, V.; Rocco, B.
abstract
2021
- Robot-assisted Cystectomy with Intracorporeal Urinary Diversion After Pelvic Irradiation for Prostate Cancer: Technique and Results from a Single High-volume Center
[Articolo su rivista]
Piazza, P.; Rosiello, G.; Chacon, V. T.; Puliatti, S.; Amato, M.; Farinha, R.; Schiavina, R.; Brunocilla, E.; Berquin, C.; Develtere, D.; Sinatti, C.; Van Puyvelde, H.; De Groote, R.; Schatteman, P.; De Naeyer, G.; D'Hondt, F.; Mottrie, A.
abstract
Background: Radiation therapy (RT) for prostate cancer (PCa) treatment is burdened by high rates of late urinary adverse events (UAEs). The feasibility of robot-assisted cystectomy (RAC) with intracorporeal urinary diversion (ICUD) for treatment of high-grade UAEs has never been assessed. Objective: To report perioperative outcomes, early (≤90 d) and late (>90 d) complications among patients undergoing RAC for UAEs after RT. Design, setting, and participants: We retrospectively evaluated 32 patients undergoing RAC with ICUD for UAEs in a single tertiary centre. Surgical procedure: Surgery was performed using a da Vinci Xi system with adaptation for the primary treatment. Measurements: Perioperative outcomes included estimated blood loss (EBL), operative time (OT), intraoperative complications, and length of stay (LOS). Data for early and late postoperative complications were collected using the quality criteria recommended by the European Association of Urology. Univariate logistic regressions were performed to test the effect of baseline and perioperative characteristics on early postoperative complications. Results and limitations: The median age-adjusted Charlson comorbidity index (ACCI) was 6 (IQR 5–7). The indication for RAC was hemorrhagic radiation cystitis in 29 cases (91%), contracted bladder in two cases (6.2%), and urinary fistula in one case (3.1%). The median EBL, OT, and LOS were 250 ml, 330 min, and 10 d, respectively. A total of 31 (97%) patients received an ileal conduit. The 90-d rate of Clavien-Dindo grade ≥IIIa complications was 28%. The late complication rate was 46% and the perioperative mortality rate was 0%. On univariate analyses, ACCI was the only parameter correlated with the risk of early complications (odds ratio 1.75, 95% confidence interval 1.05–2.9; p = 0.03). The median follow-up was 30 mo (IQR 15–40). The lack of comparison with open cystectomy represents the main limitation. Conclusions: RAC for UAEs in patients with a history of pelvic irradiation is a feasible option in high-volume centers. The use of new technologies can help to overcome some of the technical difficulties and reduce the risk of perioperative and late complications. Patient summary: We report our experience with robot-assisted surgery for removal of the bladder in the management of urinary problems after radiation therapy for prostate cancer. When performed by highly experienced surgeons, this is a feasible procedure with outcomes and early and late complication rates that are acceptable.
2021
- Robotic-assisted versus open simple prostatectomy: Results from a systematic review and meta-analysis of comparative studies
[Articolo su rivista]
Scarcella, S.; Castellani, D.; Gauhar, V.; Teoh, J. Y. -C.; Giulioni, C.; Piazza, P.; Bravi, C. A.; De Groote, R.; De Naeyer, G.; Puliatti, S.; Galosi, A. B.; Mottrie, A.
abstract
Purpose: To review safety and efficacy of robotic-assisted simple prostatectomy (RASP) compared to open simple prostatectomy (OP). Materials and Methods: A comprehensive literature search was performed to assess the differences in perioperative course and functional outcomes in patients with benign prostatic hyperplasia and surgical indication. The incidences of complications were pooled using the Cochran–Mantel–Haenszel Method and expressed as odds ratio (OR), 95% confidence interval (CI), and p-values. Perioperative course and functional outcomes were pooled using the inverse variance of the mean difference (MD), 95% CI, and p-values. Analyses were two-tailed and the significance was set at p<0.05. Results: Eight studies were accepted. Meta-analysis showed significantly longer surgical time (MD, 43.72; 95% CI, 30.57–56.88; p<0.00001) with a significantly lower estimated blood loss (MD,-563.20; 95% CI,-739.95 to-386.46; p<0.00001) and shorter postoperative stay (MD,-2.85; 95% CI,-3.72 to-1.99; p<0.00001) in RASP. Catheterization time did not differ (MD, 0.65; 95% CI,-2.17 to 3.48; p=0.65). The risk of blood transfusion was significantly higher in OP (OR, 0.23; 95% CI, 0.17–0.33; p<0.00001). The risk of re-catheterization (OR, 1.96; 95% CI, 0.32–11.93; p=0.47), postoperative urinary infections (OR, 0.89; 95% CI, 0.23–3.51; p=0.87) and 30-day readmission rate (OR, 0.96; 95% CI, 0.61–1.51; p=0.86) did not differ. At 3-month follow-up, functional outcomes were simi-lar. Conclusions: RASP demonstrated a better perioperative outcome and equal early functional outcomes as compared to OP. These findings should be balanced against the longer operative time and higher cost of robotic surgery.
2021
- Standardization in Surgical Education (SISE): Development and Implementation of an Innovative Training Program for Urologic Surgery Residents and Trainers by the European School of Urology in Collaboration with the ESUT and EULIS Sections of the EAU
[Articolo su rivista]
Somani, B.; Brouwers, T.; Veneziano, D.; Gozen, A.; Ahmed, K.; Liatsikos, E.; Sarica, K.; Palou, J.; Rassweiler, J.; Biyani, C. S.; Oliveira, T. R. D.; Mottrie, A.; Gallagher, A.; Breda, A.; Poppel, H. V.; Mcillhenney, C.; Sedelaar, M.; Puliatti, S.; Jain, S.; Loenen, R. V.; Cleynenbreugel, B. V.
abstract
2021
- Structured robot-assisted surgery training curriculum for residents in Urology and impact on future surgical activity
[Articolo su rivista]
Beulens, A. J. W.; Vaartjes, L.; Tilli, S.; Brinkman, W. M.; Umari, P.; Puliatti, S.; Koldewijn, E. L.; Hendrikx, A. J. M.; van Basten, J. P.; van Merrienboer, J. J. G.; Van der Poel, H. G.; Bangma, C. H.; Wagner, C.
abstract
To gain insight into the availability of training for robot assisted surgery (RAS) and the possibility to perform RAS during Dutch residency curriculum and to analyze the effects on surgical skills by the introduction of an advanced course in RAS for residents. A combination of a validated snap shot survey and a prospective cohort study. Structured advanced RAS training including virtual reality (VR) simulation, dry and wet lab facility at ORSI academy (Belgium). A snap-shot survey has been sent to all the residents and specialists in Urology graduated during the years 2017–2020 in Netherlands. Among residents, only last year residents (5th and 6th year) have been considered for the RAS training. Although most of the residents (88.2%) and young urologists (95%) were asked to follow a basic training or meet basic requirements before starting RAS, the requirements set by the educators were different from center to center. Some of them were required to attend only an online course on RAS, whereas others were asked to achieve threshold scores at VR simulator and participate in a standardized course at a training institute. The attendance to a structured advanced course in RAS showed a significant increase in surgical skills. Our study shows residents in urology are allowed to perform RAS during their residency though the criteria for starting RAS differ significantly amongst the teaching hospitals. To guarantee a basic level of skills and knowledge a structured, (multi-step) training and certification program for RAS should be implemented.
2021
- Technical Refinements in Superextended Robot-assisted Radical Prostatectomy for Locally Advanced Prostate Cancer Patients at Multiparametric Magnetic Resonance Imaging
[Articolo su rivista]
Mazzone, Elio; Dell'Oglio, Paolo; Rosiello, Giuseppe; Puliatti, Stefano; Brook, Nicholas; Turri, Filippo; Larcher, Alessandro; Beato, Sergi; Andras, Iulia; Wisz, Pawel; Pandey, Abhishek; De Groote, Ruben; Schatteman, Peter; De Naeyer, Geert; D'Hondt, Frederiek; Mottrie, Alexandre
abstract
The feasibility and efficacy of robot-assisted radical prostatectomy (RARP) in locally advanced prostate cancer (PCa) patients with iT3 lesion at magnetic resonance imaging (MRI) are currently not explored.
2021
- The Click-On gamma probe, a second-generation tethered robotic gamma probe that improves dexterity and surgical decision-making
[Articolo su rivista]
Azargoshasb, S.; van Alphen, S.; Slof, L. J.; Rosiello, G.; Puliatti, S.; van Leeuwen, S. I.; Houwing, K. M.; Boonekamp, M.; Verhart, J.; Dell'Oglio, P.; van der Hage, J.; van Oosterom, M. N.; van Leeuwen, F. W. B.
abstract
Purpose: Decision-making and dexterity, features that become increasingly relevant in (robot-assisted) minimally invasive surgery, are considered key components in improving the surgical accuracy. Recently, DROP-IN gamma probes were introduced to facilitate radioguided robotic surgery. We now studied if robotic DROP-IN radioguidance can be further improved using tethered Click-On designs that integrate gamma detection onto the robotic instruments themselves. Methods: Using computer-assisted drawing software, 3D printing and precision machining, we created a Click-On probe containing two press-fit connections and an additional grasping moiety for a ProGrasp instrument combined with fiducials that could be video tracked using the Firefly laparoscope. Using a dexterity phantom, the duration of the specific tasks and the path traveled could be compared between use of the Click-On or DROP-IN probe. To study the impact on surgical decision-making, we performed a blinded study, in porcine models, wherein surgeons had to identify a hidden 57Co-source using either palpation or Click-On radioguidance. Results: When assembled onto a ProGrasp instrument, while preserving grasping function and rotational freedom, the fully functional prototype could be inserted through a 12-mm trocar. In dexterity assessments, the Click-On provided a 40% reduction in movements compared to the DROP-IN, which converted into a reduction in time, path length, and increase in straightness index. Radioguidance also improved decision-making; task-completion rate increased by 60%, procedural time was reduced, and movements became more focused. Conclusion: The Click-On gamma probe provides a step toward full integration of radioguidance in minimal invasive surgery. The value of this concept was underlined by its impact on surgical dexterity and decision-making.
2021
- The Impact of Previous Prostate Surgery on Surgical Outcomes for Patients Treated with Robot-assisted Radical Cystectomy for Bladder Cancer
[Articolo su rivista]
Rosiello, G.; Piazza, P.; Tames, V.; Farinha, R.; Paludo, A.; Puliatti, S.; Amato, M.; Mazzone, E.; De Groote, R.; Berquin, C.; Develtere, D.; Veys, R.; Sinatti, C.; Schiavina, R.; De Naeyer, G.; Schatteman, P.; Carpentier, P.; Montorsi, F.; D'Hondt, F.; Mottrie, A.
abstract
Background: The feasibility and safety of robot-assisted radical cystectomy (RARC) may be undermined by unfavorable preoperative surgical characteristics such as previous prostate surgery (PPS). Objective: To compare perioperative outcomes for patients undergoing RARC with versus without a history of PPS. Design, setting, and participants: The study included 220 consecutive patients treated with RARC and pelvic lymph node dissection for bladder cancer at a single European tertiary centre. Of these, 43 had previously undergone PPS, defined as transurethral resection of the prostate/holmium laser enucleation of the prostate (n = 21) or robot-assisted radical prostatectomy (n = 22). Surgical procedure: RARC in patients with a history of PPS. Measurements: Data on postoperative complications were collected according to the quality criteria for accurate and comprehensive reporting of surgical outcomes recommended by the European Association of Urology guidelines. Multivariable logistic, linear, and Poisson regression analyses were performed to test the effect of PPS on surgical outcomes. Results and limitations: Overall, 43 patients (20%) were treated with RARC after PPS. Operative time (OT) was longer in the PPS group (360 vs 330 min; p < 0.001). Patients with PPS experienced higher rates of intraoperative complications (19% vs 6.8%) and higher rates of 30-d (67% vs 39%), and Clavien-Dindo >3 (33% vs 16%) postoperative complications (all p < 0.05). Moreover, the positive surgical margin (PSM) rate after RARC was higher in the PPS group (14% vs 4%; p = 0.03). On multivariable analyses, PPS at RARC independently predicted higher risk of intraoperative (odds ratio [OR] 2.10, 95% confidence interval [CI] 1.04–6.21; p = 0.01) and 30-d complications (OR 2.26, 95% CI 1.05–5.22; p = 0.02), as well as longer OT (relative risk [RR] 1.03, 95% CI 1.00–1.05; p = 0.02) and length of stay (RR 1.13, 95% CI 1.02–1.26; p = 0.02). Lack of randomization represents the main limitation. Conclusions: RARC in patients with a history of PPS is feasible, but it is associated with a higher risk of complications and longer OT and length of stay. Moreover, higher PSM rates have been reported for these patients. Thus, measures aimed at improving surgical outcomes appear to be warranted. Patient summary: We investigated the effect of previous prostate surgery (PPS) on surgical outcomes after robot-assisted removal of the bladder. We found that patients with PPS have a higher risk of complications and longer hospitalization after bladder removal. These patients deserve closer evaluation before this type of bladder operation. Robot-assisted radical cystectomy for bladder cancer in patients with a history of previous prostate surgery is feasible, even if it is associated with worse perioperative outcomes. Thus, measures aimed at improving surgical outcomes in this patient population appear to be warranted.
2021
- The Unsolved Issue of Reporting of Late Complications in Urology
[Articolo su rivista]
Piazza, P.; Sarchi, L.; Puliatti, S.; Bravi, C. A.; Knipper, S.; Mottrie, A.
abstract
Lack of uniformity in the reporting of late complications hampers the quality of data available on surgical outcomes. Adoption of standardized criteria and a taxonomy for reporting of late complications is urgently needed.
2021
- The Use of Augmented Reality to Guide the Intraoperative Frozen Section During Robot-assisted Radical Prostatectomy
[Articolo su rivista]
Bianchi, L.; Chessa, F.; Angiolini, A.; Cercenelli, L.; Lodi, S.; Bortolani, B.; Molinaroli, E.; Casablanca, C.; Droghetti, M.; Gaudiano, C.; Mottaran, A.; Porreca, A.; Golfieri, R.; Romagnoli, D.; Giunchi, F.; Fiorentino, M.; Piazza, P.; Puliatti, S.; Diciotti, S.; Marcelli, E.; Mottrie, A.; Schiavina, R.
abstract
Background: Multiparametric magnetic resonance imaging (mpMRI) can guide the surgical plan during robot-assisted radical prostatectomy (RARP), and intraoperative frozen section (IFS) can facilitate real-time surgical margin assessment. Objective: To assess a novel technique of IFS targeted to the index lesion by using augmented reality three-dimensional (AR-3D) models in patients scheduled for nerve-sparing RARP (NS-RARP). Design, setting, and participants: Between March 2019 and July 2019, 20 consecutive prostate cancer patients underwent NS-RARP with IFS directed to the index lesion with the help of AR-3D models (study group). Control group consists of 20 patients matched with 1:1 propensity score for age, clinical stage, Prostate Imaging Reporting and Data System score v2, International Society of Urological Pathology grade, prostate volume, NS approach, and prostate-specific antigen in which RARP was performed by cognitive assessment of mpMRI. Surgical procedure: In the study group, an AR-3D model was superimposed to the surgical field to guide the surgical dissection. Tissue sampling for IFS was taken in the area in which the index lesion was projected by AR-3D guidance. Measurements: Chi-square test, Student t test, and Mann-Whitney U test were used to compare, respectively, proportions, means, and medians between the two groups. Results and limitations: Patients in the AR-3D group had comparable preoperative characteristics and those undergoing the NS approach were referred to as the control group (all p ≥ 0.06). Overall, positive surgical margin (PSM) rates were comparable between the two groups; PSMs at the level of the index lesion were significantly lower in patients referred to AR-3D guided IFS to the index lesion (5%) than those in the control group (20%; p = 0.01). Conclusions: The novel technique of AR-3D guidance for IFS analysis may allow for reducing PSMs at the level of the index lesion. Patient summary: Augmented reality three-dimensional guidance for intraoperative frozen section analysis during robot-assisted radical prostatectomy facilitates the real-time assessment of surgical margins and may reduce positive surgical margins at the index lesion.
2021
- The microbiological profile of patients with Fournier's gangrene: A retrospective multi-institutional cohort study
[Articolo su rivista]
Cipriani, Chiara; Iacovelli, Valerio; Sandri, Marco; Bertolo, Riccardo; Maiorino, Francesco; Antonucci, Francesco; Micali, Salvatore; Rocco, Bernardo; Puliatti, Stefano; Ferrarese, Paolo; Benedetto, Giuseppe; Minervini, Andrea; Cocci, Andrea; Pastore, Antonio Luigi; Al Salhi, Yazan; Antonelli, Alessandro; Morena, Tonino; Volpe, Alessandro; Poletti, Filippo; Celia, Antonio; Zeccolini, Guglielmo; Leonardo, Costantino; Proietti, Flavia; Finazzi Agrò, Enrico; Bove, Pierluigi
abstract
Objectives: To evaluate the role of the microbiological profile and of disease-related factors in the management of patients affected with Fournier's gangrene (FG).Patients and methods: Data regarding patients admitted for FG at nine Italian Hospitals (March 2007-June 2018) were collected. Patients were stratified according to the number of microorganisms documented: Group A - one microorganism; Group B - two microorganisms; Group C - more than three microorganisms. Baseline blood tests, dedicated scoring systems, predisposing risk factors, disease's features, management and post-operative course were analyzed. UpSet technique for visualizing set intersections in a matrix layout and Cuzick's nonparametric test for trend across ordered groups were used.Results: Eighty-one patients were available for the analysis: 18 included in Group A, 32 in Group B, 31 in Group C. The most common microorganism isolated was Escherichia coli. In Group B-C, Escherichia coli was often associated to Enterococcus faecalis, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Statistically significant positive association was highlighted among the number of pathogens (Group A vs B vs C) and serum C-reactive Protein (p < 0.001), procalcitonin (p = 0.02) and creatinine (p = 0.03). Scoring systems were associated with the number of microorganisms detected (p < 0.02). A significant association between the number of microorganisms and the use of VAC therapy and need of a fecal diversion was found (p < 0.02). The number of microorganisms was positively associated with the length of stay (LOS) (p = 0.02). Ten weeks after initial debridement, wound closure was achieved in 11 (91.7%), 22 (84.6%) and 20 (80%) patients in Group A, B, and C, respectively, with no differences in overall survival.Conclusion: Polymicrobial infections in FG are positively associated with inflammatory scores, the need for fecal diversion and the LOS. This results may help the counseling and the clinical management of this rare niche of patients.
2021
- The role of vacuum-assisted closure (VAC) therapy in the management of FOURNIER’S gangrene: a retrospective multi-institutional cohort study
[Articolo su rivista]
Iacovelli, V.; Cipriani, C.; Sandri, M.; Filippone, R.; Ferracci, A.; Micali, S.; Rocco, B.; Puliatti, S.; Ferrarese, P.; Benedetto, G.; Minervini, A.; Cocci, A.; Pastore, A. L.; Al Salhi, Y.; Antonelli, A.; Morena, T.; Volpe, A.; Poletti, F.; Celia, A.; Zeccolini, G.; Leonardo, C.; Proietti, F.; Finazzi Agro, E.; Bove, P.
abstract
Purpose: To explore the role of vacuum assisted closure (VAC) therapy versus conventional dressings in the Fournier’s gangrene wound therapy. Patients and Methods: This is a retrospective multi-institutional cohort study. Data of 92 patients from nine centers between 2007 and 2018 were retrospectively analyzed. After surgery, patient having a local or a disseminated FG were managed with VAC therapy or with conventional dressings. The 10-weeks wound closure cumulative rate and OS were analyzed. Results: Of the 92 patients, 62 (67.4%) showed local and 30 (32.6%) a disseminated FG. After surgery, 19 patients (20.7%) with local and 14 (15.2%) with disseminated FG underwent to VAC therapy; 43 (46.7%) with local and 16 (17.4%) with disseminated FG were treated using conventional dressings. The multivariable logistic regression analysis demonstrated that the VAC in patients with disseminated FG led to a higher cumulative rate of wound closure than patients treated with no-VAC (OR = 6.5; 95% CI 1.1–37.4, p = 0.036). The Kaplan–Meier survival curves for the OS showed a significant difference between no-VAC patients with local and disseminated FG (OS rate at 90 days 0.90, 95% CI 0.71–0.97 vs 0.55, 95% CI 0.24–0.78, respectively; p = 0.039). Cox regression confirmed that no-VAC patients with disseminated FG showed the lowest OS (hazard ratio adjusted for sex and age HR = 3.4, 95% CI 1.1–10.4; p = 0.033). Conclusions: In this large cohort study, VAC therapy in patients with disseminated FG may offer an advantage in terms of 10-weeks wound closure cumulative rate and OS at 90 days after initial surgery.
2021
- Toward autonomous robotic prostate biopsy: a pilot study
[Articolo su rivista]
Maris, B.; Tenga, C.; Vicario, R.; Palladino, L.; Murr, N.; De Piccoli, M.; Calanca, A.; Puliatti, S.; Micali, S.; Tafuri, A.; Fiorini, P.
abstract
Purpose: We present the validation of PROST, a robotic device for prostate biopsy. PROST is designed to minimize human error by introducing some autonomy in the execution of the key steps of the procedure, i.e., target selection, image fusion and needle positioning. The robot allows executing a targeted biopsy through ultrasound (US) guidance and fusion with magnetic resonance (MR) images, where the target was defined. Methods: PROST is a parallel robot with 4 degrees of freedom (DOF) to orient the needle and 1 DOF to rotate the US probe. We reached a calibration error of less than 2 mm, computed as the difference between the needle positioning in robot coordinates and in the US image. The autonomy of the robot is given by the image analysis software, which employs deep learning techniques, the integrated image fusion algorithms and automatic computation of the needle trajectory. For safety reasons, the insertion of the needle is assigned to the doctor. Results: System performance was evaluated in terms of positioning accuracy. Tests were performed on a 3D printed object with nine 2-mm spherical targets and on an anatomical commercial phantom that simulates human prostate with three lesions and the surrounding structures. The average accuracy reached in the laboratory experiments was 1.30±0.44mm in the first test and 1.54±0.34mm in the second test. Conclusions: We introduced a first prototype of a prostate biopsy robot that has the potential to increase the detection of clinically significant prostate cancer and, by including some level of autonomy, to simplify the procedure, to reduce human errors and shorten training time. The use of a robot for the biopsy of the prostate will create the possibility to include also a treatment, such as focal ablation, to be delivered through the same system.
2021
- Training novice robot surgeons: Proctoring provides same results as simulator-generated guidance
[Articolo su rivista]
Beulens, A. J. W.; Hashish, Y. A. F.; Brinkman, W. M.; Umari, P.; Puliatti, S.; Koldewijn, E. L.; Hendrikx, A. J. M.; van Basten, J. P.; van Merrienboer, J. J. G.; Van der Poel, H. G.; Bangma, C. H.; Wagner, C.
abstract
To understand the influence of proctored guidance versus simulator generated guidance (SGG) on the acquisition dexterity skills in novice surgeons learning RAS (robot assisted surgery). Prospective non-blinded 3-arm randomised controlled trial (RTC). Exclusion criteria: previous experience in RAS or robotic surgery simulation. The participants were assigned to three different intervention groups and received a different form of guidance: (1) proctored guidance, (2) simulator generated guidance, (3) no guidance, during training on virtual reality (VR) simulator. All participants were asked to complete multiple questionnaires. The training was the same in all groups with the exception of the intervention part. Catharina Hospital Eindhoven, The Netherlands. A total of 70 Dutch medical students, PhD-students, and surgical residents were included in the study. The participants were randomly assigned to one of the three groups. Overall, all the participants showed a significant improvement in their dexterity skills after the training. There was no significant difference in the improvement of surgical skills between the three different intervention groups. The proctored guidance group reported a higher participant satisfaction compared to the simulator-generated guidance group, which could indicate a higher motivation to continue the training. This study showed that novice surgeons. Significantly increase their dexterity skills in RAS after a short time of practicing on simulator. The lack of difference in results between the intervention groups could indicate there is a limited impact of “human proctoring” on dexterity skills during surgical simulation training. Since there is no difference between the intervention groups the exposure alone of novice surgeons to the robotic surgery simulator could possibly be sufficient to achieve a significant improvement of dexterity skills during the initial steps of RAS learning.
2021
- Ureteral access sheath-related injuries vs. post-operative infections. Is sheath insertion always needed? A prospective randomized study to understand the lights and shadows of this practice
[Articolo su rivista]
Bozzini, G.; Bevilacqua, L.; Besana, U.; Calori, A.; Pastore, A.; Romero Otero, J.; Macchi, A.; Broggini, P.; Breda, A.; Gozen, A.; Inzillo, R.; Puliatti, S.; Sighinolfi, M. C.; Rocco, B.; Liatsikos, E.; Muller, A.; Buizza, C.
abstract
Objective: To compare intraoperative ureteral injuries in RIRS with UAS insertion with the rate of postoperative infections after RIRS without UAS insertion. Patients and methods: In this randomized trial, patients who received an indication for RIRS between January 2017 and December 2017 were divided into two groups. Group A had no UAS insertion and Group B had UAS insertion. Post-Ureteroscopic Lesion Scale (PULS) grading was performed after UAS or flexible ureteroscope removal. Proximal, middle and distal ureteral lesions were evaluated and compared according to the PULS scale. Additionally, patients in both groups were followed postoperatively to assess any infective complication. Results: The evaluation comprised 181 patients, 89 for group A and 92 for group B. Overall stone-free rate, clinically insignificant residual fragments, and final stone-free rate were 41.4%, 53.5%, and 95%, respectively. There were 33 (37.1%) patients with ureteral lesions in group A while 42 (45.6%) patients had ureteral lesions in group B, with no significant difference. On the other hand, the overall presence of postoperative infection rate was much higher for Group A (37.1% vs 16.3% P = .03). Conclusions: UAS insertion does not result in a higher number of ureteral injuries. UAS insertion during RIRS allows a lower rate of postoperative infections. Clinical Trial Registration Number (ISRCTN registry number): 55546280.
2021
- Urinary frequency in COVID-19 patients
[Articolo su rivista]
Zoeir, Ahmed; Eissa, Ahmed; Moussa, Ayman; Abdel Raheem, Ali; Mamdoh, Hussein; Puliatti, Stefano; Sighinolfi, Maria Chiara; Rocco, Bernardo
abstract
2021
- Urology residents simulation training improves clinical outcomes in laparoscopic partial nephrectomy
[Articolo su rivista]
Paludo, A. D. O.; Knijnik, P.; Brum, P.; Cachoeira, E.; Gorgen, A.; Burttet, L.; Cabral, R.; Puliatti, S.; Rosito, T.; Berger, M.; Neto, B. S.
abstract
Background: Partial nephrectomy (PN) is the preferred modality of treatment for small renal masses. Laparoscopic partial nephrectomy (LPN) has been adopted worldwide and a fundamental role is played by surgical skills. The need for skill instruction outside the operating room is well recognized in the modern models of surgery residency training. We aim to investigate the impact of residents’ laparoscopic surgical skills training on the successful implementation of LPN in a reference public teaching hospital in southern Brazil. Methods: We accessed all patients undergoing LPN by senior's urology residents at Hospital de Clínicas de Porto Alegre. Patients were stratified in 2 periods of time named ‘LPN eras’ 1 and 2, to report the training impact on the outcome. LPN era 1 was from October 2012 to February 2017 and LPN era 2 from March 2017 to June 2019. All the senior residents of LPN era 2 followed a simulation training divided into 4 years with a total training time of 244 hours before performing the LPN. Residents from LPN era 1 did not have simulation training. Results: 124 patients underwent LPN during the study period, 53 (42.7%) of those were performed in LPN era 1 and 71 (57.3%) in LPN era 2. Baseline characteristics of the patients in the two groups were similar. The training performed by LPN era 2 residents was able to significantly reduce estimated blood loss, ischemia time and LOS with p value respectively 0.007, 0.001 and 0.001. LPN era 2 group also reached Trifecta in 77.5% of patients, being significantly more than in the LPN era 1 (p = 0.007). Conclusions: Simulation in residents surgical training was able to improve clinical outcomes in LPN. These data reinforce the fundamental importance of adequate residents training before performing surgery on a patient.
2020
- Augmented Reality and Robotic-Assistance for Percutaneous Nephrolithotomy
[Articolo su rivista]
Ferraguti, Federica; Minelli, Marco; Farsoni, Saverio; Bazzani, Stefano; Bonfe, Marcello; Vandanjon, Alexandre; Puliatti, Stefano; Bianchi, Giampaolo; Secchi, Cristian
abstract
2020
- COVID-19 and dermatology: a comprehensive guide for dermatologists
[Articolo su rivista]
Fahmy, D. H.; El-Amawy, H. S.; El-Samongy, M. A.; Fouda, A. A.; Soliman, S. H.; El-Kady, A.; Farnetani, F.; Conti, A.; Zoeir, A.; Eissa, A.; Eissa, R.; Puliatti, S.; Sighinolfi, M. C.; Rocco, B.; Pellacani, G.
abstract
2020
- COVID-19 and urology: a comprehensive review of the literature
[Articolo su rivista]
Puliatti, S.; Eissa, A.; Eissa, R.; Amato, M.; Mazzone, E.; Dell'Oglio, P.; Sighinolfi, M. C.; Zoeir, A.; Micali, S.; Bianchi, G.; Patel, V.; Wiklund, P.; Coelho, R. F.; Bernhard, J. -C.; Dasgupta, P.; Mottrie, A.; Rocco, B.
abstract
Objective: To discuss the impact of COVID-19 on global health, particularly on urological practice and to review some of the available recommendations reported in the literature. Material and Methods: In the current narrative review the PubMed database was searched to identify all the related reports discussing the impact of COVID-19 on the urological field. Results: The COVID-19 pandemic is the latest and biggest global health threat. Medical and surgical priorities have changed dramatically to cope with the current challenge. These changes include postponements of all elective outpatient visits and surgical procedures to save facilities and resources for urgent cases and patients with COVID-19 patients. This review discuss some of the related changes in urology. Conclusions: Over the coming weeks, healthcare workers including urologists will be facing increasingly difficult challenges, and consequently, they should adopt triage strategy to avoid wasting of medical resources and they should endorse sufficient protection policies to guard against infection when dealing with COVID-19 patients.
2020
- Development and validation of the objective assessment of robotic suturing and knot tying skills for chicken anastomotic model
[Articolo su rivista]
Puliatti, S.; Mazzone, E.; Amato, M.; De Groote, R.; Mottrie, A.; Gallagher, A. G.
abstract
Background: To improve patient safety, there is an imperative to develop objective performance metrics for basic surgical skills training in robotic surgery. Objective: To develop and validate (face, content, and construct) the performance metrics for robotic suturing and knot tying, using a chicken anastomotic model. Design, setting and participants: Study 1: In a procedure characterization, we developed the performance metrics (i.e., procedure steps, errors, and critical errors) for robotic suturing and knot tying, using a chicken anastomotic model. In a modified Delphi panel of 13 experts from four EU countries, we achieved 100% consensus on the five steps, 18 errors and four critical errors (CE) of the task. Study 2: Ten experienced surgeons and nine novice urology surgeons performed the robotic suturing and knot tying chicken anastomotic task. The mean inter-rater reliability for the assessments by two experienced robotic surgeons was 0.92 (95% CI, 0.9–0.95). Novices took 18.5 min to complete the task and experts took 8.2 min. (p = 0.00001) and made 74% more objectively assessed performance errors than the experts (p = 0.000343). Conclusions: We demonstrated face, content, and construct validity for a standard and replicable basic anastomotic robotic suturing and knot tying task on a chicken model. Patient summary: Validated, objective, and transparent performance metrics of a robotic surgical suturing and knot tying tasks are imperative for effective and quality assured surgical training.
2020
- Digital Biopsy with Fluorescence Confocal Microscope for Effective Real-time Diagnosis of Prostate Cancer: A Prospective, Comparative Study
[Articolo su rivista]
Rocco, Bernardo; Sighinolfi, Maria Chiara; Sandri, Marco; Spandri, Valentina; Cimadamore, Alessia; Volavsek, Metka; Mazzucchelli, Roberta; Lopez-Beltran, Antonio; Eissa, Ahmed; Bertoni, Laura; Azzoni, Paola; Reggiani Bonetti, Luca; Maiorana, Antonino; Puliatti, Stefano; Micali, Salvatore; Paterlini, Maurizio; Iseppi, Andrea; Rocco, Francesco; Pellacani, Giovanni; Chester, Johanna; Bianchi, Giampaolo; Montironi, Rodolfo
abstract
A microscopic analysis of tissue is the gold standard for cancer detection. Hematoxylin-eosin (HE) for the reporting of prostate biopsy (PB) is conventionally based on fixation, processing, acquisition of glass slides, and analysis with an analog microscope by a local pathologist. Digitalization and real-time remote access to images could enhance the reporting process, and form the basis of artificial intelligence and machine learning. Fluorescence confocal microscopy (FCM), a novel optical technology, enables immediate digital image acquisition in an almost HE-like resolution without requiring conventional processing.
2020
- Digital frozen section of the prostate surface during radical prostatectomy: a novel approach to evaluate surgical margins
[Articolo su rivista]
Rocco, B.; Sighinolfi, M. C.; Cimadamore, A.; Reggiani Bonetti, L.; Bertoni, L.; Puliatti, S.; Eissa, A.; Spandri, V.; Azzoni, P.; Dinneen, E.; Shaw, G.; Nathan, S.; Micali, S.; Bianchi, G.; Maiorana, A.; Pellacani, G.; Montironi, R.
abstract
2020
- En-bloc resection of bladder tumors (ERBT) for pathological staging: the value of lateral margins analysis
[Abstract in Rivista]
Eissa, Ahmed; Zoeir, Ahmed; Ciarlariello, Silvia; Sarchi, Luca; Sighinolfi, Maria Chiara; Ghaith, Ahmed; Puliatti, Stefano; Inzillo, Raffaele; Reggiani Bonetti, Luca; Rizzo, Mino; Rocco, Bernardo; Micali, Salvatore
abstract
In endoscopic resection of colorectal tumours, the pathological assessment of the lateral margins is a strong predictor of tumor recurrence after resection. The aims of the current study are to evaluate the value of the peritumoral margins assessment in ERBT on tumor recurrence.
2020
- Ex vivo fluorescence confocal microscopy: prostatic and periprostatic tissues atlas and evaluation of the learning curve
[Articolo su rivista]
Bertoni, L.; Puliatti, S.; Reggiani Bonetti, L.; Maiorana, A.; Eissa, A.; Azzoni, P.; Bevilacqua, L.; Spandri, V.; Kaleci, S.; Zoeir, A.; Sighinolfi, M. C.; Micali, S.; Bianchi, G.; Pellacani, G.; Rocco, B.; Montironi, R.
abstract
Ex vivo fluorescence confocal microscopy (FCM) is an optical technology that provides fast H&E-like images of freshly excised tissues, and it has been mainly used for “real-time” pathological examination of dermatological malignancies. It has also shown to be a promising tool for fast pathological examination of prostatic tissues. We aim to create an atlas for FCM images of prostatic and periprostatic tissues to facilitate the interpretation of these images. Furthermore, we aimed to evaluate the learning curve of images interpretation of this new technology. Eighty fresh and unprepared biopsies obtained from radical prostatectomy specimens were evaluated using the FCM VivaScope® 2500 M-G4 (Mavig GmbH, Munich, Germany; Caliber I.D.; Rochester NY, USA) by two pathologists. Images of FCM with the corresponding H&E are illustrated to create the atlas. Furthermore, the two pathologists were asked to re-evaluate the 80 specimens after 90 days interval in order to assess the learning curve of images’ interpretation of FCM. FCM was able to differentiate between different types of prostatic and periprostatic tissues including benign prostatic glands, benign prostatic hyperplasia, high-grade intraepithelial neoplasm, and prostatic adenocarcinoma. As regards the learning curve, FCM demonstrated a short learning curve. We created an atlas that can serve as the base for urologists and pathologists for learning and interpreting FCM images of prostatic and periprostatic tissues. Furthermore, FCM images is easily interpretable; however, further studies are required to explore the potential applications of this new technology in prostate cancer diagnosis and management.
2020
- Le patologie del surrene
[Capitolo/Saggio]
Puliatti, Stefano; Eissa, Ahmed; Amato, Marco; Toso, Stefano; Mottrie, Alexandre
abstract
2020
- Positive surgical margin during radical prostatectomy: overview of sampling methods for frozen sections and techniques for the secondary resection of the neurovascular bundles
[Articolo su rivista]
Sighinolfi, M. C.; Eissa, A.; Spandri, V.; Puliatti, S.; Micali, S.; Reggiani Bonetti, L.; Bertoni, L.; Bianchi, G.; Rocco, B.
abstract
Objective: The aim of the paper is to provide an overview of intraoperative sampling methods for frozen section (FS) analysis and of surgical techniques for a secondary neurovascular bundle (NVB) resection, as the method of surgical margin (SM) sampling and the management of a positive SM (PSM) at the nerve-sparing (NS) area are under evaluated issues. FS analysis during radical prostatectomy (RP) can help to tailor the plane of dissection based on cancer extension and thus extend the indications for NS surgery. Evidence Acquisition: We performed a PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science, Cochrane Library, and Elton B. Stephens Co. (EBSCO)host search to include articles published in the last decade, evaluating FS analysis in the NS area and surgical attempts to convert a PSM to a negative status. Evidence Synthesis: Overall, 19 papers met our inclusion criteria. The ways to collect samples for FS analysis included: systematic (analysing the whole posterolateral aspect of the prostate specimen, i.e., neurovascular structure-adjacent frozen-section examination [NeuroSAFE]); magnetic resonance imaging (MRI)-guided (biopsies from MRI-suspicious areas, retrieved by the surgeon in a cognitive way); and random biopsies from the soft periprostatic tissues. Techniques to address a PSM in the NS area included: full resection of the spared NVB, from its caudal to cranial aspect, often including the rectolateral part of the Denonvilliers’ fascia; partial resection of the NVB, in cases where sampling attempts to localise a PSM; incremental approach, meaning a partial or full resection that extends until no prostate tissue is found in the soft periprostatic environment. Conclusions: There is no homogeneity in prostate sampling for FS analysis, although most recent evidence is moving toward a systematic sampling of the entire NS area. The management of a PSM is variable and can be affected by the sampling strategy (difficult localisation of the persisting tumour at the NVB). The difficult identification of the exact soft tissue location contiguous to a PSM could be considered as the critical point of FS analysis and of spared-NVB management.
2020
- Radical penectomy, a compromise for life: results from the PECAD study
[Articolo su rivista]
Ghahhari, Jamil; Marchioni, Michele; Spiess, Philippe E; Chipollini, Juan J; Nyirády, Peter; Varga, Judith; Ditonno, Pasquale; Boccasile, Stefano; Primiceri, Giulia; De Nunzio, Cosimo; Tema, Giorgia; Tubaro, Andrea; Veccia, Alessandro; Antonelli, Alessandro; Musi, Gennaro; De Cobelli, Ottavio; Conti, Andrea; Puliatti, Stefano; Micali, Salvatore; Álvarez-Maestro, Mario; Quesada Olarte, José; Diogenes, Erico; Lima, Marcos Venicio Alves; Tracey, Andrew; Guruli, Georgi; Autorino, Riccardo; Sountoulides, Petros; Sosnowski, Roman; Schips, Luigi; Cindolo, Luca
abstract
The use of organ sparing strategies to treat penile cancer (PC) is currently supported by evidence that has indicated the safety, efficacy and benefit of this surgery. However, radical penectomy still represents up to 15-20% of primary tumor treatments in PC patients. The aim of the study was to evaluate efficacy in terms of overall survival (OS) and disease-free survival (DFS) of radical penectomy in PC patients.
2020
- Real-time assessment of surgical margins during radical prostatectomy: a novel approach that uses fluorescence confocal microscopy for the evaluation of peri-prostatic soft tissue
[Articolo su rivista]
Rocco, B.; Sighinolfi, M. C.; Bertoni, L.; Spandri, V.; Puliatti, S.; Eissa, A.; Reggiani Bonetti, L.; Azzoni, P.; Sandri, M.; De Carne, C.; Turri, F.; Cimadamore, A.; Montironi, R.; Maiorana, A.; Micali, S.; Bianchi, G.; Pellacani, G.
abstract
2020
- Selecting the Most Appropriate Oncological Treatment for Patients with Renal Masses During the COVID-19 Pandemic: Recommendations from a Referral Center
[Articolo su rivista]
Moschovas, M. C.; Mazzone, E.; Puliatti, S.; Mottrie, A.; Patel, V.
abstract
2020
- Three-dimensional virtual reconstruction with DocDo: A novel interactive tool to score renal mass complexity
[Abstract in Rivista]
Rocco, Bernardo; Sighinolfi, Maria Chiara; Dourado Menezes, Aurus; Eissa, Ahmed; Inzillo, Raffaele; Sandri, Marco; Puliatti, Stefano; Turri, Filippo; Ciarlariello, Silvia; Amato, Marco; De Carne, Cosimo; Sarchi, Luca; Bozzini, Giorgio; Bianchi, Giampaolo; Micali, Salvatore
abstract
The pre-operative knowledge of the complexity of a renal mass is the cornerstone to plan a partial nephrectomy(PN) [1]. Given the multiple issues characterizing it - size, protrusion out from renal parenchyma, longitudinal and coronal location, proximity to the hilum - nephrometric scoring systems have been proposed during the last decade[2, 3]; RENAL and PADUA classifications are the mostly used [4-6].
2020
- Training in robot-assisted surgery
[Articolo su rivista]
Puliatti, S.; Mazzone, E.; Dell'Oglio, P.
abstract
Purpose of reviewThe aim of this narrative review is to identify the currently available training programs in the field of robotic-assisted surgery.Recent findingsThe lack of well trained robotic surgeons represents the main obstacle facing robotic surgery. This calls for development of structured robotic training programs in order to improve patient safety and outcomes. Structured curriculum should consist of theoretical training (e-learning, case observation), preclinical simulation-based training (virtual reality simulation, dry and wet lab), clinical modular training, and final evaluation. Tele-mentoring might reveal mandatory in future curricula development. To date, several training programs are currently available for robotic surgery. However, the majority lack of clinical modular training that consists of progressive, proficiency-based training through surgical steps with increasing levels of complexity. Moreover, many of these curricula lack validation.SummaryThis recent literature analysis suggests that there is an urgent need to develop and validate new structured training curricula for robotic surgery. This allows to improve the skills of the surgeons and of their team and to prevent patients from being used as a training module optimizing their safety.
2020
- “Real-time” Assessment of Surgical Margins During Radical Prostatectomy: State-of-the-Art
[Articolo su rivista]
Eissa, A.; Zoeir, A.; Sighinolfi, M. C.; Puliatti, S.; Bevilacqua, L.; Del Prete, C.; Bertoni, L.; Azzoni, P.; Reggiani Bonetti, L.; Micali, S.; Bianchi, G.; Rocco, B.
abstract
Histopathologic examination of the pathologic specimens using hematoxylin & eosin stains represents the backbone of the modern pathology. It is time-consuming; thus, “real-time” assessment of prostatic and periprostatic tissue has gained special interest in the diagnosis and management of prostate cancer. The current study focuses on the review of the different available techniques for “real-time” evaluation of surgical margins during radical prostatectomy (RP). We performed a comprehensive search of the Medline database to identify all the articles discussing “real-time” or intraoperative assessment of surgical margins during RP. Several filters were applied to the search to include only English articles performed on human subjects and published between January 2000 and March 2019. The search revealed several options for pathologic assessment of surgical margins including intraoperative frozen sections, confocal laser endomicroscopy, optical spectroscopy, photodynamic diagnosis, optical coherence tomography, multiphoton microscopy, structured illumination microscopy, 3D augmented reality, and ex vivo fluorescence confocal microscope. Frozen section represents the gold standard technique for real-time pathologic examinations of surgical margins during RP; however, several other options showed promising results in the initial clinical trials, and considering the rapid development in the field of molecular and cellular imaging, some of these options may serve as an alternative to frozen section.
2019
- Adherence to the EAU guidelines on Penile Cancer Treatment: European, multicentre, retrospective study
[Articolo su rivista]
Bada, M.; Berardinelli, F.; Nyirady, P.; Varga, J.; Ditonno, P.; Battaglia, M.; Chiodini, P.; De Nunzio, C.; Tema, G.; Veccia, A.; Antonelli, A.; Cindolo, L.; Simeone, C.; Puliatti, S.; Micali, S.; Schips, L.
abstract
Purpose: The European Association of Urology (EAU) guidelines for penile cancer (PC) are exclusively based on retrospective studies and have low grades of recommendation. The aim of this study was to assess the adherence to guidelines by investigating the management strategies for primary tumours and inguinal lymph nodes. Methods: We retrospectively reviewed the clinical charts of 176 PC patients who underwent surgery in eight European centres from 2010 to 2016. The stage and grade were assessed according to the 2009 AJCC–UICC TNM classification system. To assess adherence rates, we compared theoretical and practical adherence to the EAU guidelines. Results: Overall, 176 patients were enrolled. Partial amputation was the most frequent surgical approach (39%). 53.7% of tumours were stage Tis-T1b and the remaining 46.3% were stage T2-T4. Palpable lymph nodes were detected in 30.1% of patients and 45.1% underwent lymphadenectomy (LY). A sizeable group of tumours (43.2%) were N0. For primary treatment, adherence to the EAU guidelines was good (66%). In non-adherent cases, reasons for discrepancy were patient’s choice (17%), surgeon’s preference (36%), and other causes (47%). For LY, the guideline adherence was 70%, with either patient’s or surgeon’s choice or other causes accounting for discrepancy in 28, 20, and 52% of non-adherent cases, respectively. Conclusion: Adherence to the EAU guidelines for PC was quite high across the eight European centres involved in the study. This notwithstanding, strategies for further improvement should be developed and evenly adopted.
2019
- Drug-Induced Urolithiasis in Pediatric Patients
[Articolo su rivista]
Sighinolfi, Maria Chiara; Eissa, Ahmed; Bevilacqua, Luigi; Zoeir, Ahmed; Ciarlariello, Silvia; Morini, Elena; Puliatti, Stefano; Durante, Viviana; Ceccarelli, Pier Luca; Micali, Salvatore; Bianchi, Giampaolo; Rocco, Bernardo
abstract
Drug-induced nephrolithiasis is a rare condition in children. The involved drugs may be divided into two different categories according to the mechanism involved in calculi formation. The first one includes poorly soluble drugs that favor the crystallization and calculi formation. The second category includes drugs that enhance calculi formation through their metabolic effects. The diagnosis of these specific calculi depends on a detailed medical history, associated comorbidities and the patient's history of drug consumption. There are several risk factors associated with drug-induced stones, such as high dose of consumed drugs and long duration of treatment. Moreover, there are some specific risk factors, including urinary pH and the amount of fluid consumed by children. There are limited data regarding pediatric lithogenic drugs, and hence, our aim was to perform a comprehensive review of the literature to summarize these drugs and identify the possible mechanisms involved in calculi formation and discuss the management and preventive measures for these calculi.
2019
- Effect of puboprostatic ligament reconstruction on continence recovery after robot-assisted laparoscopic prostatectomy: our initial experience
[Articolo su rivista]
Puliatti, Stefano; Elsherbiny, Ahmed; Eissa, Ahmed; Pirola, Giacomo; Morini, Elena; Squecco, Denise; Inzillo, Raffaele; Zoeir, Ahmed; Iseppi, Andrea; Sighinolfi, Maria Chiara; Micali, Salvatore; Rocco, Bernardo; Bianchi, Giampaolo
abstract
Prostate cancer represents a serious health problem worldwide. Radical prostatectomy is the gold standard for management of localized prostate cancer. Urinary incontinence is among the most common complications affecting RALP patients' post-operative quality of life. Several surgical modifications were introduced to overcome this problem including the puboprostatic ligament reconstruction. In this study, we discuss our technique of anterior reconstruction of the puboprostatic ligament during RALP and its effect on the continence outcome postoperatively.
2019
- Ex-vivo Fluorescence Confocal Microscopy: The First Application For Real-Time Pathologic Examination of Prostatic Tissue
[Articolo su rivista]
Puliatti, Stefano; Bertoni, Laura; Pirola, Giacomo Maria; Azzoni, Paola; Bevilacqua, Luigi; Eissa, Ahmed; Elsherbiny, Ahmed; Sighinolfi, Maria Chiara; Chester, Johanna; Rocco, Bernardo; Micali, Salvatore; Bagni, Ilaria; Reggiani Bonetti, Luca; Maiorana, Antonino; Malvehy, Josep; Longo, Caterina; Montironi, Rodolfo; Bianchi, Giampaolo; Pellacani, Giovanni
abstract
Prostate cancer "real time" intra-operative pathological examination currently utilizes frozen section, despite the many inherent limitations of this procedure. Ex vivo Fluorescence Confocal Microscopy (FCM) is a novel technology, which provides fast microscopic fluorescence and reflectance tissue imaging. FCM has been proven beneficial in colorectal, breast, thyroid and skin lesions. However, it was never applied in urology. The aim of our study is to report the first application of FCM in the urologic field assessing its diagnostic accuracy for non-neoplastic and cancerous prostate tissue (prostatic adenocarcinoma) compared to the gold standard histopathological diagnoses.
2019
- External validation of a novel side-specific, multiparametric magnetic resonance imaging-based nomogram for the prediction of extracapsular extension of prostate cancer: preliminary outcomes on a series diagnosed with multiparametric magnetic resonance imaging-targeted plus systematic saturation biopsy
[Articolo su rivista]
Sighinolfi, Maria Chiara; Sandri, Marco; Torricelli, Pietro; Ligabue, Guido; Fiocchi, Federica; Scialpi, Michele; Eissa, Ahmed; Reggiani Bonetti, Luca; Puliatti, Stefano; Bianchi, Giampaolo; Rocco, Bernardo
abstract
no abstract
2019
- Is Extraprostatic Extension of Cancer Predictable? A Review of Predictive Tools and an External Validation based on a Large and a Single Center Cohort of Prostate Cancer Patients
[Articolo su rivista]
Rocco, Bernardo; Sighinolfi, Maria Chiara; Sandri, Marco; Eissa, Ahmed; Elsherbiny, Ahmed; Zoeir, Ahmed; Tadzia, Harvey; Palayapalayam, Hariharan; Kameh, Darian; Coelho, Rafael; Puliatti, Stefano; Zuccolotto, Paola; Montironi, Rodolfo; Wiklund, Peter; Micali, Salvatore; Bianchi, Giampaolo; Patel, Vipul
abstract
Our aim was to review and externally validate all the available predictive tools (PTs) predicting EPE using the area under the curve (AUC), calibration plots and scaled brier score. A literature search was performed showing 19 models predicting EPE. External validation (EV) was carried out on 6360 prostate cancer (PCa) patients submitted to RP. Most of the PTs showed poor discrimination and unsatisfactory calibration. The majority of the available PTs are not reliable for the prediction of EPE in populations other than the development one; thus, they may not be completely appropriate for patients' counselling or for surgical strategy preplanning.
2019
- Nephron-Sparing Surgery
[Capitolo/Saggio]
Puliatti, S; Ferrari, N; Rocco, B; Bianchi, G; Micali, S
abstract
Abstract
Kidney disease is a crippling disease that affects approximately ten percent of the population worldwide, with more than 2.6 million individuals estimated to receive renal replace therapy. Chronic kidney disease (CKD) is fast becoming a major public health issue even in resource poor settings, with some estimates predicting a disproportionate increase in countries such as China and India. Consequently, renal protection has become a vital and critical component of prevention. While observational data suggests that awareness remains low, the concept of renal protection is currently under-recognized in promoting recovery as well as preventing further renal loss. Kidney Protection: Strategies for Renal Preservation is a clinically applicable review of the current medical care and research that aims to address the awareness gap. The authors combine renal protection research and clinical practices with an interdisciplinary approach that is inclusive of nephrology,urology, critical care, anesthesia, emergency medicine and clinical medicine.Written by experts in the field of nephrology, the authors have also included applicable photographs and line drawings. The specific topics covered include: protection of the kidneys in hypertension, diabetes and heart disease, exposure to contrast including coronary angiogram, atherosclerosis, and more. This handbook is formatted to emphasize clinical practice points and major systemic illnesses. Additionally, it features the latest evidence-based practice guidelines for optimal renal outcomes, thus, making it a concise reference for the busy clinician interested in understanding the basics of kidney disease assessment, renal injury prevention, and renal preservation.
2019
- Regenerative potential of human dental pulp stem cells in the treatment of stress urinary incontinence: In vitro and in vivo study
[Articolo su rivista]
Zordani, Alessio; Pisciotta, Alessandra; Bertoni, Laura; Bertani, Giulia; Vallarola, Antonio; Giuliani, Daniela; Puliatti, Stefano; Mecugni, Daniela; Bianchi, Giampaolo; De Pol, Anto; Carnevale, Gianluca
abstract
OBJECTIVES:
To evaluate the regenerative potential of human dental pulp stem cells (hDPSCs) in an animal model of stress urinary incontinence (SUI). SUI, an involuntary leakage of urine, is due to physical stress involving an increase in bladder pressure and a damage of external urethral sphincter affecting muscles and nerves. Conventional therapies can only relieve the symptoms. Human DPSCs are characterized by peculiar stemness and immunomodulatory properties and might provide an alternative tool for SUI therapy.
MATERIALS AND METHODS:
In vitro phase: hDPSCs were induced towards the myogenic commitment following a 24 hours pre-conditioning with 5-aza-2'-deoxycytidine (5-Aza), then differentiation was evaluated. In vivo phase: pudendal nerve was transected in female rats to induce stress urinary incontinence; then, pre-differentiated hDPSCs were injected in the striated urethral sphincter. Four weeks later, urethral sphincter regeneration was assayed through histological, functional and immunohistochemical analyses.
RESULTS:
Human DPSCs were able to commit towards myogenic lineage in vitro and, four weeks after cell injection, hDPSCs engrafted in the external urethral sphincter whose thickness was almost recovered, committed towards myogenic lineage in vivo, promoted vascularization and an appreciable recovery of the continence. Moreover, hDPSCs were detected within the nerve, suggesting their participation in repair of transected nerve.
CONCLUSIONS:
These promising data and further investigations on immunomodulatory abilities of hDPSCs would allow to make them a potential tool for alternative therapies of SUI.
2019
- Reliability of the different versions of Partin tables in predicting extraprostatic extension of prostate cancer: a systematic review and meta-analysis
[Articolo su rivista]
Eissa, Ahmed; Elsherbiny, Ahmed; Zoeir, Ahmed; Sandri, Marco; Pirola, Giacomo; Puliatti, Stefano; Del Prete, Chiara; Sighinolfi, Maria Chiara; Micali, Salvatore; Rocco, Bernardo; Bianchi, Giampaolo
abstract
Accurate prediction of extraprostatic extension (EPE) of prostate cancer (PCa) is the keystone for deciding whether to perform a neurovascular bundle sparing (NVBs) radical prostatectomy or not, which will subsequently affect the postoperative functional outcomes especially potency. Partin tables are the most commonly used predictive tools (PTs) for prediction of EPE. Moreover, they are the most commonly externally validated. In these settings, the aim of our work is to perform a systematic review of the literature and a meta-analysis for the discriminative performance of the different versions of Partin tables for EPE prediction.
2019
- Robotic assisted radical cystectomy: insights on long term oncological outcomes from the International Robotic Cystectomy Consortium
[Articolo su rivista]
Sighinolfi, Maria Chiara; Micali, Salvatore; Eissa, Ahmed; Picozzi, Stefano Carlo Maria; Puliatti, Stefano; Rocco, Bernardo
abstract
2018
- A novel nomogram for predicting ECE of prostate cancer
[Articolo su rivista]
Rocco, Bernardo; Sighinolfi, Maria Chiara; Sandri, Marco; Puliatti, Stefano; Bianchi, Giampaolo
abstract
no abstract available
2018
- A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy
[Articolo su rivista]
Patel, Vipul R.; Sandri, Marco; Grasso, Angelica A. C.; De Lorenzis, Elisa; Palmisano, Franco; Albo, Giancarlo; Coelho, Rafael F.; Mottrie, Alexander; Harvey, Tadzia; Kameh, Darian; Palayapalayam, Hariharan; Wiklund, Peter; Bosari, Silvano; Puliatti, Stefano; Zuccolotto, Paola; Bianchi, Giampaolo; Rocco, Bernardo
abstract
OBJECTIVES:
To create a statistical tool for the estimation of extracapsular extension (ECE) level of prostate cancer and determine the nerve-sparing (NS) approach that can be safely performed during radical prostatectomy (RP).
PATIENTS AND METHODS:
A total of 11 794 lobes, from 6 360 patients who underwent robot-assisted RP between 2008 and 2016 were evaluated. Clinicopathological features were included in a statistical algorithm for the prediction of the maximum ECE width. Five multivariable logistic models were estimated for: presence of ECE and ECE width of >1, >2, >3, and >4 mm. A five-zone decision rule based on a lower and upper threshold is proposed. Using a graphical interface, surgeons can view patient's pre-treatment characteristics and a curve showing the estimated probabilities for ECE amount together with the areas identified by the decision rule.
RESULTS:
Of the 6 360 patients, 1 803 (28.4%) were affected by non-organ-confined disease. ECE was present in 1 351 lobes (11.4%) and extended beyond the capsule for >1, >2, >3, and >4 mm in 498 (4.2%), 261 (2.2%), 148 (1.3%), 99 (0.8%) cases, respectively. ECE width was up to 15 mm (interquartile range 1.00-2.00). The five logistic models showed good predictive performance, the area under the receiver operating characteristic curve was: 0.81 for ECE, and 0.84, 0.85, 0.88, and 0.90 for ECE width of >1, >2, >3, and >4 mm, respectively.
CONCLUSION:
This novel tool predicts with good accuracy the presence and amount of ECE. Furthermore, the graphical interface available at www.prece.it can support surgeons in patient counselling and preoperative planning.
© 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.
KEYWORDS:
extracapsular extension; nomogram; prostate; prostate cancer; robotic prostatectomy; staging
2018
- Non-conservative management of simple Renal cysts IN adults: A comprehensive review of literature
[Articolo su rivista]
Eissa, Ahmed; El Sherbiny, Ahmed; Martorana, Eugenio; Pirola, Giacomo M.; Puliatti, Stefano; Scialpi, Michele; Micali, Salvatore; Rocco, Bernardo; Liatsikos, Evangelos; Breda, Alberto; Porpiglia, Francesco; Bianchi, Giampaolo
abstract
INTRODUCTION: Renal cysts are common findings in nearly 10% of general population. According to Bosniak classification, they are classified into simple and complex renal cysts based on their CT characteristics. The majority of simple renal cysts are asymptomatic and require no intervention. Once they become symptomatic or complicated, a nonconservative management should be considered. EVIDENCE ACQUISITION: This paper is a narrative review of existing manuscripts regarding the non-conservative management of renal cysts. To perform it a search through PubMed was carried out in January 2017. The search was conducted using the following key words: "simple renal cysts," "non-conservative management," "treatment outcomes comparison" etc. EVIDENCE SYNTHESIS: We found 1880 publications that were reviewed by 2 of our authors, and only 46 manuscripts were considered for this review. The most common treatment were investigated and compared to understand the best treatment modality in accordance with patients' and cysts' characteristics. Different treatment modalities are available for the management of simple renal cysts. Surgical exploration is a historical procedure that is no longer used. Simple aspiration without sclerotherapy has high recurrence rate (20-80%), so sclerosants agents are recommended. Ethanol is the most commonly used sclerosing agent with high efficacy up to 97%. Laparoscopy is the gold standard for management in large cysts especially in younger patients. Other techniques are described for parapelvic renal cysts like percutaneous endoscopic ablation and ureteroscopic marsupialization. CONCLUSIONS: Different factors affect the treatment decision including natural history of the cyst, presence of symptoms and/or complications and patients' choice. This literature overview shows that ethanol percutaneous sclerotherapy and laparoscopy are the most commonly reported treatment modality for simple renal cysts.
2018
- The role of 68Ga-PSMA PET/CT scan in biochemical recurrence after primary treatment for prostate cancer: a systematic review of literature
[Articolo su rivista]
Eissa, Ahmed; El Sherbiny, Ahmed; Coelho, Rafael F; Rassweiler, Jens; Davis, John W; Porpiglia, Francesco; Patel, Vipul R; Prandini, Napoleone; Micali, Salvatore; Sighinolfi, Maria C; Puliatti, Stefano; Rocco, Bernardo; Bianchi, Giampaolo
abstract
Recurrence after primary treatment of prostate cancer is one of the major challenges facing urologists. Biochemical recurrence is not rare and occurs in up to one third of the patients undergoing radical prostatectomy. Management of biochemical recurrence is tailored according to the site and the burden of recurrence. Therefore, developing an imaging technique to early detect recurrent lesions represents an urgent need. Positron emission tomography (PET) of 68Ga-labelled prostate-specific membrane antigen (68Ga-PSMA) is an emerging imaging modality that seems to be a promising tool with capability to localize recurrent prostate cancer. Our aim was a systematic review of literature was done to evaluate the role of 68Ga-PSMA PET/CT scan in patients with recurrent prostate cancer after primary radical treatment.
2017
- Does topical hemostatic agent (Floseal®) have a long-term adverse effect on erectile function recovery after nerve-sparing robot-assisted radical prostatectomy?
[Articolo su rivista]
Martorana, Eugenio; Rocco, Bernardo; Kaleci, Shaniko; Pirola, Giacomo Maria; Bevilacqua, Luigi; Bonetti, Luca Reggiani; Puliatti, Stefano; Micali, Salvatore; Bianchi, Giampaolo
abstract
Objectives: To investigate the long-term effects of Floseal® on erectile function recovery (EFR) after nerve-sparing robot-assisted radical prostatectomy (RALP). Methods: We prospectively collected results of the self-administered International Index Erectile Function Questionnaire 1â5 and 15 (IIEF 1â5 and 15) of 532 consecutive patients who underwent RALP for prostate cancer in our institution between October 2007 and December 2015. Patients were divided into two groups according to Floseal® application after prostatectomy. They were enrolled according to the following criteria: (a) bilateral nerve-sparing procedure; (b) preoperative IIEF â¥Â 17; adherence to our erectile rehabilitation protocol; (c) 1-year follow-up. Outcomes were measured as mean IIEF score, EFR (IIEF 25). Results: A total of 120 patients were enrolled. Group A included 40 consecutive patients who received traditional hemostasis, and Group B included 80 consecutive patients in which Floseal® was additionally used. No differences were observed in terms of preoperative mean IIEF score (p = 0.65). Group B patients showed a trend toward a higher mean IIEF score 3 months after surgery (p = 0.06) but no differences in terms of EFR (p = 1.000). Long-term results (6, 9, 12 months after surgery) showed a significantly and progressively higher mean IIEF score (p = 0.04, 0.003, 0.003) and EFR (p = 0.043, 0.027, 0.004) in Group A patients. Comparison between the groups in terms of severe, moderate, mild and no ED becomes significant at 9 and 12 months (p = 0.002, 0.006). Conclusion: The results of our study suggest that local use of Floseal® worsens the long-term erectile function recovery in patients selected for nerve-sparing RALP.
2017
- Efficacy of pollen extract in association with group B vitamins for pain relief in chronic prostatitis/chronic pelvic pain syndrome: A survey of urologists' knowledge about its clinical application
[Articolo su rivista]
Pirola, Giacomo Maria; Puliatti, Stefano; Bocchialini, Tommaso; Martorana, Eugenio; Micali, Salvatore; Bianchi, Giampaolo
abstract
Introduction and aim of the study: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPSS) is a pathology of high prevalence in Italian male population, difficult to diagnose and to treat and with poor response to conventional therapy. Aim of this study was to review the evidence of the literature about the therapeutic effects of a plant product containing flower pollen extracts and group B vitamins on symptoms resolution and amelioration of CP/CPPS patients' quality of life and to investigate the knowledge among practicing urologists about the clinical application of this product. Materials and methods: A group of 38 urologists was submitted to an investigational survey of the knowledge of the clinical applications of a plant product containing flower pollen extracts and group B vitamins Results: 71% of the urologists interviewed prescribed the plant product for CBP and CP/CPPS at least one time in a month and 11% prescribed it more than 5 times; 67% had evidence of clear ameliorations in pain relief and on patient's quality of life and 47% reported that the effectiveness is comparable to NSAIDs; 39% also reported a significant effect for the improvement of the urinary symptoms of patients. No gastric or general side effects have been noticed during the administration period of this plant product. Finally, the cost of the product has always reported to be sustainable for the patients. Conclusions: From the results of this investigational survey, we can state that the plant product containing flower pollen extracts and group B vitamins is well-known and demonstrated beneficial effects on symptoms resolution and amelioration of quality of life in patients with chronic prostatitis/chronic pelvic pain syndrome.
2016
- Evaluation of long-term side effects after shock-wave lithotripsy for renal calculi using a third generation electromagnetic lithotripter.
[Articolo su rivista]
Pirola, Giacomo Maria; Micali, Salvatore; Sighinolfi, Maria Chiara; Martorana, Eugenio; Territo, Angelo; Puliatti, Stefano; Bianchi, Giampaolo
abstract
To assess the incidence of long-term side effects after shock-wave lithotripsy treatment performed with an electromagnetic Dornier Lithotripter S device. A specific follow-up was undertaken on a cohort of 100 selected patients that underwent SWL for a single renal stone in our center from 2002 to 2004. Previous and current data were compared using the Student t test. Factors associated with the incidence of hypertension and diabetes mellitus were determined. Ten years after treatment, mean serum creatinine level and glomerular filtration rate remained similar to previous values (serum creatinine level: 0.96 ± 0.22 vs. 0.92 ± 0.19 mg/dL; glomerular filtration rate: 92.8 ± 17.8 vs. 88.1 ± 21.7 mL/min). There were marked increases in blood cholesterol, blood pressure, and blood glucose levels, while smoking decreased. Age, glomerular filtration rate, body mass index, blood glucose and blood pressure at the time of treatment were significantly associated with the presence of hypertension and diabetes mellitus at follow-up; blood cholesterol was associated with diabetes mellitus development. After 10 years, overall renal function appeared to have been unaffected by shock-wave lithotripsy treatment. The increased rate of hypertension and diabetes mellitus were consistent with the incidence in the global population. This is the first report on the long-term safety of a third generation electromagnetic lithotripter, and indicates that there are no long-term sequelae.
2016
- Rare metastatic sites of renal cell carcinoma: urethra and spermatic cord
[Articolo su rivista]
Pirola, Giacomo M.; Martorana, Eugenio; Fidanza, Francesco A.; Bonetti, Luca Reggiani; Puliatti, Stefano; Bonora, Alessandra; Micali, Salvatore; Bianchi, Giampaolo
abstract
INTRODUCTION: About 20% of patients with a diagnosis of primary renal cell carcinoma (RCC) present directly with metastatic disease. The aim of the present manuscript is to describe, for the first time a RCC metastasis located to the distal female urethra and to present an update on metastatic locations to the male spermatic cord.MATERIALS AND METHODS: We report two cases of rare RCC metastases. The first concerns a 92-year-old female patient who came to our attention for recurrent urethral bleeding, which was initially believed to be secondary to urethral mucosal ectropion. Pathology demonstrated a RCC metastasis. The second concerns a 67-year-old male patient with a previous history of RCC who came to our attention for the finding of palpable, mobile and indolent right inguinal lump. Given the past history of malignancy, it was excised and revealed to be a RCC metastasis.DISCUSSION: In the first case, the pathologic specimen allowed the detection of an unknown renal tumor, whereas in the second, the previous neoplastic history of the patient has led clinicians to focus on a possible neoplastic recurrence, perform a correct excision of the node, and begin an early systemic therapy.CONCLUSIONS: These cases are emblematic of possible unexpected RCC metastasis. These findings should be taken into account in order to clarify the differential diagnosis and to address these patients to a correct therapeutic course.