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Bernardo Maria Cesare ROCCO

Professore Ordinario presso: Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa


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Pubblicazioni

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 - Effectiveness of D-mannose, Hibiscus sabdariffa and Lactobacillus plantarum therapy in prevention of infectious events following urodynamic study [Articolo su rivista]
Milandri, Riccardo; Maltagliati, Matteo; Bocchialini, Tommaso; Del Prete, Chiara; Bianchi, Giampaolo; Rocco, Bernardo M; Micali, Salvatore
abstract

The urodynamic study is an invasive examination that allows a thorough evaluation of the functional activity of the lower urinary tract (bladder, urethra). The execution of urodynamic study exposes the patient to the risk of contracting infections of the lower urinary tract. Prevention of urinary tract infections consists in the avoidance of risk factors and prophylaxis with antimicrobial and non-antimicrobial measures. In this article, we aimed to evaluate the effectiveness of a phytotherapeutic product composed of D-mannose, Hibiscus sabdariffa, and Lactobacillus plantarum in the prevention of infectious events following invasive urodynamic examination.


2018 - Nerve-sparing in salvage robot-assisted prostatectomy: surgical technique, oncological and functional outcomes at a single high-volume institution [Articolo su rivista]
Bonet, Xavier; Ogaya-Pinies, Gabriel; Woodlief, Tracey; Hernandez-Cardona, Eduardo; Ganapathi, Hariharan; Rogers, Travis; Coelho, Rafael F.; Rocco, Bernardo; Vigués, Francesc; Patel, Vipul
abstract

Objective: To show the feasibility, oncological and functional outcomes of neurovascular bundle (NVB) preservation during salvage robot-assisted radical prostatectomy (RARP). Patients and Methods: In the present institutional review board-approved retrospective analysis, between January 2008 and March 2016, 80 patients underwent salvage RARP, performed by a single surgeon (V.P), because of local recurrence after primary treatment. These patients were categorized into two groups depending on the degree of nerve-sparing (NS) performed: a good-NS group (≥50% of NVB preservation) and a poor-NS group (<50% of NVB preservation). A standard transperitoneal six-port technique, using the DaVinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA), was performed, and either an anterograde or a retrograde approach was used for NVB preservation. Validated questionnaires were used preoperatively (Sexual Health Inventory for Men [SHIM] and American Urological Association scores). Potency after salvage RARP was defined as the ability to achieve a successful erection with penetration >50% of the time, while full continence after salvage RARPwas defined as 0 pads used. The Kaplan–Meier method was used for survival and predictive estimations, and regression models were used to identify the predictors of potency, continence and biochemical failure (BCF). Results: The potency rate at 12 months was higher in the good-NS group (25.6% vs 4.3%; P = 0.036) regardless of previous SHIM score, and good NS tended to be predictive of potency after salvage RARP (P = 0.065). The full continence rate at 12 months and BCF rate were similar in the two groups, and non-radiation primary treatment was the only predictor of continence at 12 months after salvage RARP (P = 0.033). Conclusions: Our data support the feasibility and safety of NVB preservation for salvage RARP conducted in select patients in a high-volume institution and the subsequent better recovery of adequate erections for intercourse.


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 - Posterior reconstruction of the rhabdosphincter [Monografia/Trattato scientifico]
Rocco, Bernardo; Grasso, Angelica A. C.; De Lorenzis, Elisa; Sandri, Marco; Bianchi, Giampaolo
abstract

Urinary incontinence is still one of the major drawbacks following radical prostatectomy. It is considered even more bothersome than erectile dysfunction, even if its incidence is lower. According to the 2015 EAU guidelines mean continence rates at 12 months range from 89 to 100% for patients treated with robot-assisted RP (RARP) to 80-97% for patients treated with retropubic RP (Guidelines on prostate cancer, Arnhem, 2015).


2018 - Re: Lebentrau S, Gilfrich C, Vetterlein MW, Schumacher H, Spachmann PJ, Brookman-May SD, Fritsche HM, Schostak M, Wagenlehner F, Burger M, May M, MR2 study group (2017) Impact of the medical specialty on knowledge regarding multidrug-resistant organisms and strategies toward antimicrobial stewardship. Int Urol Nephrol 49:1311–1318 [Articolo su rivista]
Sighinolfi, Maria Chiara; Rocco, Bernardo; Micali, Salvatore; Orlando, Gabriella; Venturelli, Claudia; Mussini, Cristina; Bianchi, Giampaolo
abstract

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2018 - Re: Positron Emission Tomography/Computed Tomography-based Assessments of Androgen Receptor Expression and Glycolytic Activity as a Prognostic Biomarker for Metastatic Castration-resistant Prostate Cancer [Articolo su rivista]
Rocco, Bernardo; Eissa, Ahmed; Bianchi, Giampaolo
abstract

Positron Emission Tomography/Computed Tomography-Based Assessments of Androgen Receptor Expression and Glycolytic Activity as a Prognostic Biomarker for Metastatic Castration-Resistant Prostate Cancer. [JAMA Oncol. 2018]


2018 - Re: Shock-wave Lithotripsy for Pediatric Patients: Which Nomogram Can Better Predict Postoperative Outcomes? From Yanaral F, Ozgor F, Savun M, Agbas A, Akbulut F, Sarilar O [Articolo su rivista]
Sighinolfi, Maria Chiara; Rocco, Bernardo; Micali, Salvatore; Bianchi, Giampaolo
abstract

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2018 - Retrograde Release of the Neurovascular Bundle with Preservation of Dorsal Venous Complex During Robot-assisted Radical Prostatectomy: Optimizing Functional Outcomes [Articolo su rivista]
de Carvalho, Paulo Afonso; Barbosa, João A. B. A.; Guglielmetti, Giuliano B.; Cordeiro, Maurício Dener; Rocco, Bernardo; Nahas, William C.; Patel, Vipul; Coelho, Rafael Ferreira
abstract

Background: Robot-assisted laparoscopic radical prostatectomy (RARP) presents consistent oncological outcomes for prostate cancer; yet continence and potency results are not uniform. We present a technical modification for RARP which preserves the nerves and vascular structures anterior to the prostate aiming to optimize functional outcomes. Objective: To present oncological and functional results of a modified technique for RARP. Design, setting, and participants: Prospective, noncontrolled case series including 128 consecutive patients undergoing RARP performed by a single surgeon (R.F.C). Surgical procedure: RARP with retrograde release of the neurovascular bundle and preservation of dorsal venous complex. Measurements: Potency was defined as a Sexual Health Inventory for Men score of ≥17; continence was defined as use of no pads. Oncological results analyzed were positive surgical margins (PSM) rates and biochemical recurrence (BCR)-free survival. BCR was defined as prostate-specific antigen >0.2 ng/ml. Complications were graded according to the Clavien-Dindo classification. Results and limitations: Median patient age was 63.5 yr. Median skin-to-skin time was 78 min. Median length of hospital stay was 1 d, with seven patients (5.5%) hospitalized for more than 24 h. Median intraoperative bleeding was 200 ml and two patients required postoperative blood transfusion (1.6%). Four patients (3.1%) had grade ≥3 complications. Biochemical recurrence (BCR) occurred in nine of 128 patients (7%) and median time to BCR was 6 mo. Overall PSM rate was 13.3% (17 of 128 patients). PSM rate was 9% among patients with pT2 disease (8/89) and 27% in patients with pT3 (9/38). Continence was reached immediately in 85.9% of the patients and 98.4% were continent at1 yr. At 1 mo postoperatively, 60 patients were potent (53%), while 98 patients among 113 (86%) were potent 1 yr after surgery. A limitation of this study is that it was a noncomparative study. Conclusions: Retrograde release of the neurovascular bundle with preservation of dorsal venous complex during RARP is safe and associated with excellent oncological and functional outcomes. Future comparative studies are needed. Patient summary: Robot-assisted radical prostatectomy (RARP) presents consistent oncological outcomes for prostate cancer; yet continence and potency results are not uniform. We present a technical modification for RARP aiming to preserve the nerves and vascular structures anterior to the prostate. We evaluated 128 consecutive patients with clinically localized or locally advanced prostate cancer undergoing RARP with our modified technique of retrograde release of the neurovascular bundles with dorsal vein sparing. We have shown that this technique is safe, effective and associated with early recovery of continence and sexual function after surgery.


2018 - Role of Bed Assistant During Robot-assisted Radical Prostatectomy: The Effect of Learning Curve on Perioperative Variables [Articolo su rivista]
Albo, Giancarlo; De Lorenzis, Elisa; Gallioli, Andrea; Boeri, Luca; Zanetti, Stefano P.; Longo, Fabrizio; Rocco, Bernardo; Montanari, Emanuele
abstract

Background: A remote interaction between a console surgeon (CS) and a bedside surgeon (BS) makes the role of the latter critical. No conclusive data are reported about the length of the learning curve of a BS. Objective: To highlight the role of a BS during robot-assisted radical prostatectomy (RARP) and to analyze the effect of the learning curve of a BS on intra- and postoperative outcomes. Design, setting, and participants: From June 2013 to September 2016, 129 RARPs were performed by one expert CS (>1000 RARPs) and two BSs (residents). According to the learning curve of the BS, the patients were divided into three groups: group 1 (first 20 procedures), group 2 (21–40 procedures), and group 3 (>40 procedures). Outcome measurements and statistical analysis: Preoperative variables, pathological data, operating time (OT), blood loss (BL), number of lymph nodes excised (LE), length of hospital stay (LHS), and time to catheter removal (CR) were analyzed. Linear/logistic regression analyses tested the impact of BS experience on surgical outcomes. T test and chi-square test compared the outcomes of the two BSs. Results and limitations: Perfect interaction between CSs and BSs are requested to obtain the optimal exposure and avoid any conflict. On the linear regression model, BS learning curve was not related to OT, BL, LHS, and CR, but was related to LE (r2= 0.09; p = 0.03). On multivariate analyses, no correlation between BS experience and OT, BL, LHS, CR, LE, margin status, and complications (all p > 0.05) was found. Comparing the two BSs, no difference was found for the abovementioned outcomes in the first 40 surgeries (all p > 0.05). Study limitations include the limited cohort of patients and its retrospective nature. Conclusions: In this study, BS learning curve does not appear to influence the surgical outcomes; good experience of the CS was probably the explanation. Patient summary: In our experience, it is the primary surgeon who dictates the perioperative outcomes during robot-assisted radical prostatectomy. In this study, bedside surgeon learning curve does not appear to influence the surgical outcomes; good experience of the console surgeon was probably the explanation. In our experience, it is the primary surgeon who dictates the perioperative outcomes during robot-assisted radical prostatectomy.


2018 - Role of Clinical and Surgical Factors for the Prediction of Immediate, Early and Late Functional Results, and its Relationship with Cardiovascular Outcome after Partial Nephrectomy: Results from the Prospective Multicenter RECORd 1 Project [Articolo su rivista]
Antonelli, Alessandro; Mari, Andrea; Longo, Nicola; Novara, Giacomo; Porpiglia, Francesco; Schiavina, Riccardo; Ficarra, Vincenzo; Carini, Marco; Minervini, Andrea; Amparore, Daniele; Artibani, Walter; Bertolo, Riccardo; Bianchi, Giampaolo; Bocciardi, Aldo Massimo; Borghesi, Marco; Brunocilla, Eugenio; Campi, Riccardo; Chindemi, Andrea; Falsaperla, Mario; Fiori, Cristian; Furlan, Maria; Fusco, Fernando; Giancane, Saverio; Li Marzi, Vincenzo; Mirone, Vincenzo; Morgia, Giuseppe; Rocco, Bernardo; Rovereto, Bruno; Serni, Sergio; Simeone, Claudio; Tellini, Riccardo; Terrone, Carlo; Verze, Paolo; Volpe, Alessandro; Zattoni, Filiberto
abstract

Purpose: We sought to determine the predictors of short-term and long-term renal function impairment after partial nephrectomy. Materials and Methods: Clinical data on 769 consecutive patients who underwent partial nephrectomy were prospectively recorded at a total of 19 urological Italian centers from 2009 to 2012 in the RECORd 1 (Italian Registry of Conservative Renal Surgery) Project. We extracted clinical data on 708 of these patients who were alive, free of recurrent disease and with a minimum 2-year functional followup. Results: Of the patients 47.3% underwent open, 36.6% underwent laparoscopic and 16.1% underwent robot-assisted partial nephrectomy. The median baseline estimated glomerular filtration rate was 84.5 ml/minute/1.73 m2(IQR 69.9–99.1). Immediate (day 3 postoperatively), early (month 1) and late (month 24) renal function impairment greater than 25% from baseline was identified in 25.3%, 21.6% and 14.8% of cases, respectively. Female gender and the baseline estimated glomerular filtration rate were independent predictors of immediate, early and late renal function impairment. Age at diagnosis was an independent predictor of immediate and late impairment. Uncontrolled diabetes was an independent predictor of late impairment only. Open and laparoscopic approaches, and pedicle clamping were independent predictors of immediate and early renal function impairment. Overall 58 of 529 patients (11%) experienced postoperative cardiovascular events. Body mass index and late renal function impairment were independent predictors of those events. Conclusions: Surgically modifiable factors were significantly associated with worse immediate and early functional outcomes after partial nephrectomy while clinically unmodifiable factors affected renal function during the entire followup. Late renal function impairment is an independent predictor of postoperative cardiovascular events.


2018 - Supra-pubic versus urethral catheter after robot-assisted radical prostatectomy: systematic review of current evidence [Articolo su rivista]
Bertolo, Riccardo; Tracey, Andrew; Dasgupta, Prokar; Rocco, Bernardo; Micali, Salvatore; Bianchi, Giampaolo; Hampton, Lance; Tewari, Ash K.; Porpiglia, Francesco; Autorino, Riccardo
abstract

Purpose: To provide latest evidence on the use of suprapubic catheter (SPC) versus urethral catheter (UC) after robot-assisted laparoscopic radical prostatectomy (RARP). Materials and methods: A systematic revision of literature was performed up to September 2017 using different search engines (Pubmed, Ovid, Scopus) to identified studies comparing the use of SPC versus standard UC after RARP. Identification and selection of the studies were conducted according to the preferred reporting items for systematic reviews and meta-analysis criteria. For continuous outcomes, the weighted mean difference (WMD) was used as a summary measure, whereas the odds ratio (OR) or risk ratio (RR) with 95% confidence interval (CI) was calculated for binary variables. RR was preferred in cases of a high number of events to avoid overestimation. Pooled estimates were calculated using the random-effect model to account for clinical heterogeneity. All statistical analyses were performed using Review manager 5 (Cochrane Collaboration, Oxford, UK). Results: Eight studies were identified and included in this systematic review, namely 3 RCTs, 4 non-randomized prospective studies, and one retrospective study. A total of 966 RARP cases were collected for the cumulative analysis. Among them, 492 patients received standard UC and 474 SPC placement after RARP. UC patients had higher baseline PSA (WMD 0.44 ng/ml; p = 0.02). Visual Analog Scale (VAS) score was found to be significantly lower in patients with SPC at postoperative day 7 (WMD 0.53; 95% CI 0.13–0.93; p = 0.009). Regarding penile pain, a significant difference in favor of the SPC group was found at postoperative day 7 assessment (WMD 1.2; 95% CI 0.82–1.6; p < 0.001). More patients in the SPC group reported “not at all” or “minimal pain” at this time point (OR 0.17, 95% CI 0.06, 0.44; p < 0.001). No significant differences were found in terms of continence recovery rate at 6–12 weeks between the groups (UC 78.7%, 88.2%; RR 0.92, 95% CI 0.84, 1.01; p = 0.09). Similarly, no differences were found in terms of catheter-related issues (p = 0.17). However, UC patients had lower likelihood of overall complications (OR 0.44, 95% CI 0.21–0.89, p = 0.02). Conclusions: Available evidence suggests that the use of SPC can be a viable option for postoperative urine drainage after RARP, as it can translate into decreased postoperative pain without carrying a significant higher risk of catheter-related complications. Further investigation seems to be warranted, ideally within the framework of a multicentre randomized study with standardized analysis of outcomes.


2018 - The occurrence of intraoperative complications during partial nephrectomy has a significant impact on postoperative outcome: results from the RECORd1 project [Articolo su rivista]
Minervini, Andrea; Mari, Andrea; Borghesi, Marco; Antonelli, Alessandro; Bertolo, Riccardo; Bianchi, Giampaolo; Brunocilla, Eugenio; Ficarra, Vincenzo; Fiori, Cristian; Longo, Nicola; Mirone, Vincenzo; Morgia, Giuseppe; Porpiglia, Francesco; Rocco, Bernardo; Serni, Sergio; Simeone, Claudio; Tellini, Riccardo; Volpe, Alessandro; Carini, Marco; Schiavina, Riccardo
abstract

We sought to analyze the predictive factors of intraoperative complications in patients submitted to PN and the impact of intraoperative complications on postoperative outcomes.


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.


2018 - Training in urological robotic surgery. Future perspectives [Articolo su rivista]
El Sherbiny, Ahmed; Eissa, Ahmed; Ghaith, Ahmed; Morini, Elena; Marzotta, Lucilla; Sighinolfi, Maria Chiara; Micali, Salvatore; Bianchi, Giampaolo; Rocco, Bernardo
abstract

As robotics are becoming more integrated into the medical field, robotic training is becoming more crucial in order to overcome the lack of experienced robotic surgeons. However, there are several obstacles facing the development of robotic training programs like the high cost of training and the increased operative time during the initial period of the learning curve, which, in turn increase the operative cost. Robotic-assisted laparoscopic prostatectomy is the most commonly performed robotic surgery. Moreover, robotic surgery is becoming more popular among urologic oncologists and pediatric urologists. The need for a standardized and validated robotic training curriculum was growing along with the increased number of urologic centers and institutes adopting the robotic technology. Robotic training includes proctorship, mentorship or fellowship, telementoring, simulators and video training. In this chapter, we are going to discuss the different training methods, how to evaluate robotic skills, the available robotic training curriculum, and the future perspectives.


2017 - Decision-making tools in prostate cancer: From risk grouping to nomograms [Articolo su rivista]
Fontanella, Paolo; Benecchi, Luigi; Grasso, Angelica; Patel, Vipul; Albala, David; Abbou, Claude; Porpiglia, Francesco; Sandri, Marco; Rocco, Bernardo; Bianchi, Giampaolo
abstract

INTRODUCTION: Prostate cancer (PCa) is the most common solid neoplasm and the second leading cause of cancer death in men. After the Partin tables were developed, a number of predictive and prognostic tools became available for risk stratification. These tools have allowed the urologist to better characterize this disease and lead to more confident treatment decisions for patients. The purpose of this study is to critically review the decision-making tools currently available to the urologist, from the moment when PCa is first diagnosed until patients experience metastatic progression and death. EVIDENCE ACQUISITION: A systematic and critical analysis through Medline, EMBASE, Scopus and Web of Science databases was carried out in February 2016 as per the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) statement. The search was conducted using the following key words: "prostate cancer," "prediction tools," "nomograms." EVIDENCE SYNTHESIS: Seventy-two studies were identified in the literature search. We summarized the results into six sections: Tools for prediction of life expectancy (before treatment), Tools for prediction of pathological stage (before treatment), Tools for prediction of survival and cancer-specific mortality (before/after treatment), Tools for prediction of biochemical recurrence (before/after treatment), Tools for prediction of metastatic progression (after treatment) and in the last section biomarkers and genomics. CONCLUSIONS: The management of PCa patients requires a tailored approach to deliver a truly personalized treatment. The currently available tools are of great help in helping the urologist in the decision-making process. These tests perform very well in high-grade and low-grade disease, while for intermediate-grade disease further research is needed. Newly discovered markers, genomic tests, and advances in imaging acquisition through mpMRI will help in instilling confidence that the appropriate treatments are being offered to patients with prostate cancer.


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 1–5 and 15 (IIEF 1–5 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 ≥ 17; adherence to our erectile rehabilitation protocol; (c) 1-year follow-up. Outcomes were measured as mean IIEF score, EFR (IIEF < 17 or ≥17), grade of ED: severe (IIEF < 17), moderate (17–21), mild (22–25) and no ED (>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 - Editorial Comment on: Three-Layer Two-Step Posterior Reconstruction Using Peritoneum during Robot-Assisted Radical Prostatectomy to Improve Recovery of Urinary Continence: A Prospective Comparative Study by Ogawa et al. A [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Bianchi, Giampaolo
abstract

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2017 - Extended versus standard pelvic lymphadenectomy during robot-assisted radical prostatectomy: the role of extended template as an independent predictor of lymph node invasion with comparable morbidity burden [Articolo su rivista]
Mistretta, Francesco A; Boeri, Luca; Grasso, Angelica A; Lo Russo, Vito; Albo, Giancarlo; De Lorenzis, Elisa; Maggioni, Marco; Palmisano, Franco; Dell'Orto, Paolo; Bosari, Silvano; Rocco, Bernardo Maria Cesare
abstract

To assess oncologic and surgical outcomes in patients subjected to standard (S) versus extended (E) pelvic lymph node dissection (PLND) during robot-assisted radical prostatectomy (RARP).


2017 - Magnetic resonance imaging in prostate cancer detection and management: A systematic review [Articolo su rivista]
Monni, Fabio; Fontanella, Paolo; Grasso, Angelica; Wiklund, Peter; Ou, Yen-Chuan; Randazzo, Marco; Rocco, Bernardo; Montanari, Emanuele; Bianchi, Giampaolo
abstract

INTRODUCTION: The aim of our work was to evaluate the role of multi-parametric magnetic resonance imaging (mp-MRI) in detection and management of prostate cancer (PC); specifically investigating the efficacy of mpMRI-based biopsy techniques in terms of diagnostic yield of significant prostate neoplasm and the improved management of patients who choose conservative treatments or active surveillance. EVIDENCE ACQUISITION: A systematic and critical analysis through Medline, Embase, Scopus and Web of Science databases was carried out in March 2016, following the PRISMA ("Preferred Reporting Items for Systematic Reviews and Meta-Analyses") statement. The search was conducted using the following key words: "MRI/TRUS-fusion biopsy," "PIRADS," "prostate cancer," "magnetic resonance imaging (MRI)," "multiparametric MRI (mpMRI)," "systematic prostate biopsy (SB)," "targeted prostate biopsy (TPB)." English language articles were reviewed for inclusion ability. EVIDENCE SYNTHESIS: Sixty-six studies were selected in order to evaluate the characteristics and limitations of traditional sample biopsy, the role of mpMRI in detection of PC, specifically the increased degree of diagnostic accuracy of targeted prostate biopsy compared to systematic biopsy (12 cores), and to transperineal saturation biopsies with trans-rectal ultrasound (TRUS) only. MpMRI can detect index lesions in approximately 90% of cases when compared to prostatectomy specimen. The diagnostic performance of biparametric MRI (T2w + DWI) is not inferior to mpMRI, offering valid options to diminish cost- and time-consumption. Since approximately 10% of significant lesions are still MRIinvisible, systematic cores biopsy seem to still be necessary. The analysis of the different techniques shows that in-bore MRI-guided biopsy and MRI/TRUS-fusion-guided biopsy are superior in detection of significant PC compared to visual estimation alone. MpMRI proved to be very effective in active surveillance, as it prevents underdetection of significant PC and it assesses low-risk disease accurately. In higher-risk disease, presurgical MRI may change the clinically-based surgical plan in up to a third of cases. CONCLUSIONS: Targeted prostate biopsy, guided by mpMRI, is able to improve diagnostic accuracy and to reduce the detection of insignificant PC. Since the negative predictive value (NPV) of mpMRI is still imperfect, systematic cores biopsy should not be omitted for optimal staging of disease. A process of a progressive and periodic evolution in the detection and radiological classification of prostate lesions (such as PIRADS), is still needed in patients in active surveillance and in radical prostatectomy planning.


2017 - Robotic Bladder Outlet Procedures [Capitolo/Saggio]
Gargollo, Patricio; Manzoni, Gianantonio; Rocco, Bernardo Maria Cesare
abstract

This book presents the state of the art across the entire field of pediatric robotic surgery, including thoracic, abdominal, oncologic, gynecologic, and urologic procedures. Indications for each type of robotic surgery are clearly set out and technical aspects are described in detail, illustrating the patient’s position and explaining the robotic assessment and the optimal use of robotic instruments. Anesthetic issues and the management of robotic complications are discussed, and managerial aspects are also considered, with provision of helpful suggestions on how to approach robotic surgery in each pediatric department. For surgeons who wish to start using the pediatric robotic approach, simple illustrations of robotic assessment and principles of robotic surgery are included. Pediatric robotic surgery has undergone significant development in recent years, and the technology is now applied to a variety of pediatric diseases beyond urology. This book has been written by a group of world-renowned pioneers of pediatric robotic surgery and will appeal to pediatric surgeons of all disciplines, to residents, and to hospital general managers and medical directors.


2017 - Safety of Live Robotic Surgery: Results from a Single Institution [Articolo su rivista]
Ogaya-Pinies, Gabriel; Abdul-Muhsin, Haidar; Palayapalayam-Ganapathi, Hariharan; Bonet, Xavier; Rogers, Travis; Rocco, Bernardo; Coelho, Rafael; Hernandez-Cardona, Eduardo; Jenson, Cathy; Patel, Vipul
abstract

Background: Live surgery events (LSEs) have become one of the most attended activities at surgical meetings and provide a unique opportunity for the audience to observe the decision-making process used by skilled and experienced surgeons in real time. However, there is an ongoing discussion on whether patients treated during LSE are at higher risk of complications. Objective: To examine LSE outcomes for robot-assisted radical prostatectomy (RARP) and establish patient safety and efficacy. Design, setting, and participants: From January 2008 to April 2016, >9000 patients underwent RARP at our institution, performed by a single surgeon. From this group, 36 patients underwent live RARP surgery (LS group) transmitted via video link from our institution to an external congress. A control group was obtained from our database to compare outcomes between the LS group and patients undergoing RARP under regular circumstances. The data were prospectively collected in a customized database and retrospectively analyzed. Intervention: All patients underwent RARP performed by a single surgeon at our institution. Outcome measurements and statistical analysis: Postoperative outcomes were compared between the LS (n = 36) and the control (n = 108) groups using Student's t test and analysis of variance for continuous variables, and a two-tailed Fisher's exact test for categorical variables. Statistical significance was set at p <. 0.05. Results and limitations: There were no significant differences in baseline characteristics (age, body mass index, comorbidities, preoperative Gleason score, Sexual Health Inventory for Men score and American Urological Association symptom score) between the groups. The median console time was shorter for the LS group (73. min, interquartile range [IQR] 70-79) than for the control group (78. min, IQR 75-87; p = 0.0371). No major complications were reported in either group, and only four minor complications were observed in the control group (p = 0.2415). After median follow-up of 31 mo (IQR 18-50), only one patient (2.77%) in the LS group experienced biochemical recurrence, compared to four (3.71%) in the control group (p = 0.7927). There was no significant difference in continence rates between the LS and control groups (97.22% vs 93.52%; p = 0.7768). No differences in potency rate were evident by the end of the follow-up period (LS 69.44%, control group 70.37%; p = 0.8432). The retrospective nature, the lack of randomization, and the single-institution experience are limitations of the study. Conclusions: In this series of live transmitted RARPs, perioperative results (oncological and functional outcomes and complications) were similar to those found in daily practice. After careful patient selection, LSEs are safe with minimal patient morbidity in the hands of an experienced surgeon working with a familiar surgical team. Further evaluation of the results from other surgeons at other centers is necessary. Patient summary: We investigated the safety of surgeries broadcast live from our institution. We found that outcomes were similar to those for patients undergoing surgery under regular circumstances in terms of the rate of complications and oncological and functional outcomes. We conclude that live transmitted surgery is safe in well-selected patients in the hands of an experienced surgeon. We evaluated the safety of live robot-assisted radical prostatectomy by analyzing live transmitted surgeries performed in our institution. The perioperative results (oncological and functional outcomes and complications) were similar to those found in daily practice.


2017 - Symplastic glomus tumor of the urinary bladder treated by robot-assisted partial cystectomy: a case report and literature review [Articolo su rivista]
Palmisano, Franco; Gadda, Franco; Spinelli, Matteo G; Maggioni, Marco; Rocco, Bernardo Maria Cesare; Montanari, Emanuele
abstract

Glomus tumors arising in the urinary bladder are extremely rare, and only two cases have been reported in the English Literature. We present a case of a 58-year-old man with an asymptomatic mass of the anterior wall of the bladder that measured 2.5 × 2.5 cm. Endoscopic excision was performed, and the tumor was diagnosed as symplastic glomus tumor. The patient finally underwent robotic-assisted partial cystectomy, and he remains healthy without any recurrence to date.After reviewing this case and previous reports, we analyzed the clinicopathologic features and treatment options for this rare neoplasm.


2017 - Urinary Continence Recovery after Radical Prostatectomy-Anatomic/Reconstructive and Nerve Sparing Techniques to Improve Outcomes [Articolo su rivista]
Pavlovich, Christian P; Rocco, Bernardo Maria Cesare; Druskin, Sasha C; Davis, John W.
abstract

In an editorial board moderated debate format, two experts in prostate cancer surgery are challenged with presenting the key strategies in radical prostatectomy that improve urinary functional outcomes. Dr Bernardo Rocco was tasked with arguing the facts that support the anatomic preservation and reconstruction steps that improve continence. Drs. Christian Pavlovich and Sasha Druskin were tasked with arguing the facts supporting neurovascular bundle and high anterior release surgical planes that improve continence. Associate Editor John Davis moderates the debate, and outlines the current status of validated patient questionnaires that can be used to evaluate urinary continence, and recent work that allows measuring what constitutes a "clinically significant" difference that either or both of these surgical techniques could influence. A review of raw data from a publication from Dr. Pavlovich's team demonstrates how clinically relevant differences in patient reported outcomes can be correlated to technique. A visual atlas is presented from both presenting teams, and Dr. Davis demonstrates further reproducibility of technique. This article is protected by copyright. All rights reserved.


2016 - Construct, content and face validity of the camera handling trainer (CHT) : a new E-BLUS training task for 30° laparoscope navigation skills [Articolo su rivista]
D., Veneziano; A., Minervini; J., Beatty; P., Fornara; A., Gozen; F., Greco; J. F., Langenhuijsen; L., Lunelli; D., Overgaauw; J., Rassweiler; Rocco, Bernardo Maria Cesare; R. S., Salas; S., Shariat; R. M., Sweet; G., Simone; C., Springer; A., Tuccio; B., van Cleynenbreugel; P., Weibl; P., Cozzupoli
abstract

Purpose: Assessing construct, face and content validity of the camera handling trainer (CHT), a novel low-fidelity training device for 30° laparoscope navigation skills. Methods: We developed a custom-designed box trainer with clinically based graphic targets. A total of 117 participants, stratified according to their previous experience (novice, competent, expert), took part to a CHT session and subsequently were asked to fill out a survey to assess the impact of the CHT on their 30° laparoscope navigation skills. Sixty of them were also studied for task performance during a 1-h session, with multiple time measurements. Results: All participants, regardless of the previous experience, significantly improved their performance after the CHT session. Regarding construct validity, the mean task performance on the last measurement for novice group was found to be comparable to the mean first attempt of both competent (p = 0.12) and expert (p = 0.24) participants. All participants agreed that “the CHT is a valid training tool” and that “the CHT should be part of the regular dry laboratory training sessions”, assessing both face and content validity. Limitations include the need for assessment of predictive validity. Conclusions: The CHT is a valid training tool for 30° laparoscope navigation and thus should be considered as one of the fundamental exercises during basic laparoscopic hands-on training sessions for urologists.


2016 - Do we need new high-risk criteria for surgically treated renal cancer patients to improve the outcome of future clinical trials in the adjuvant setting? : results of a comprehensive analysis based on the multicenter CORONA database [Articolo su rivista]
I., Wolff; M., May; B., Hoschke; R., Zigeuner; L., Cindolo; G., Hutterer; L., Schips; O., De Cobelli; Rocco, Bernardo Maria Cesare; C., De Nunzio; A., Tubaro; I., Coman; B., Feciche; M., Truss; O., Dalpiaz; R., Figenshau; K., Madison; M., Sánchez Chapado; M., Santiago Martin; L., Salzano; G., Lotrecchiano; S., Shariat; M., Hohenfellner; R., Waidelich; C., Stief; K., Miller; S., Pahernik; S., Brookman May
abstract

Background: Since there is still an unmet need for potent adjuvant strategies for renal cancer patients with high progression risk after surgery, several targeted therapies are currently evaluated in this setting. We analyzed whether inclusion criteria of contemporary trials (ARISER, ASSURE, SORCE, EVEREST, PROTECT, S-TRAC, ATLAS) correctly identify high-risk patients. Methods: The study group comprised 8873 patients of the international CORONA-database after surgery for non-metastatic renal cancer without any adjuvant treatment. Patients were divided into potentially eligible high-risk and assumable low-risk patients who didn't meet inclusion criteria of contemporary adjuvant clinical trials. The ability of various inclusion criteria for disease-free survival (DFS) prediction was evaluated by Harrell's c-index. Results: During a median follow-up of 53 months 15.2% of patients experienced recurrence (5-year-DFS 84%). By application of trial inclusion criteria, 24% (S-TRAC) to 47% (SORCE) of patients would have been eligible for enrollment. Actual recurrence rates of eligible patients ranged between 29% (SORCE) and 37% (S-TRAC) opposed to <10% in excluded patients. Highest Hazard Ratio for selection criteria was proven for the SORCE-trial (HR 6.42; p < 0.001), while ASSURE and EVEREST reached the highest c-index for DFS prediction (both 0.73). In a separate multivariate Cox-model, two risk-groups were identified with a maximum difference in 5-year-DFS (94% vs. 61%). Conclusion: Results of contemporary adjuvant clinical trials will not be comparable as inclusion criteria differ significantly. Risk assessment according to our model might improve patient selection in clinical trials by defining a high-risk group (28% of all patients) with a 5 year-recurrence rate of almost 40%.


2016 - Global minimally invasive pyeloplasty study in children: Results from the Pediatric Urology Expert Group of the European Association of Urology Young Academic Urologists working party [Articolo su rivista]
M. S., Silay; A. F., Spinoit; S., Undre; V., Fiala; Z., Tandogdu; T., Garmanova; A., Guttilla; A. A., Sancaktutar; B., Haid; M., Waldert; A., Goyal; E. C., Serefoglu; E., Baldassarre; G., Manzoni; A., Radford; R., Subramaniam; A., Cherian; P., Hoebeke; M., Jacobs; Rocco, Bernardo Maria Cesare; R., Yuriy; F., Zattoni; R., Kocvara; C. J., Koh
abstract

Introduction: Minimally invasive pyeloplasty (MIP) for ureteropelvic junction (UPJ) obstruction in children has gained popularity over the past decade as an alternative to open surgery. The present study aimed to identify the factors affecting complication rates of MIP in children, and to compare the outcomes of laparoscopic (LP) and robotic-assisted laparoscopic pyeloplasty (RALP). Materials and methods: The perioperative data of 783 pediatric patients (<18 years old) from 15 academic centers who underwent either LP or RALP with an Anderson Hynes dismembered pyeloplasty technique were retrospectively evaluated. Redo cases and patients with anatomic renal abnormalities were excluded. Demographics and operative data, including procedural factors, were collected. Complications were classified according to the Satava and modified Clavien systems. Failure was defined as any of the following: obstructive parameters on diuretic renal scintigraphy, decline in renal function, progressive hydronephrosis, or symptom relapse. Univariate and multivariate analysis were applied to identify factors affecting the complication rates. All parameters were compared between LP and RALP. Results: A total of 575 children met the inclusion criteria. Laparoscopy, increased operative time, prolonged hospital stay, ureteral stenting technique, and time required for stenting were factors influencing complication rates on univariate analysis. None of those factors remained significant on multivariate analysis. Mean follow-up was 12.8 ± 9.8 months for RALP and 45.2 ± 33.8 months for LP (P = 0.001). Hospital stay and time for stenting were shorter for robotic pyeloplasty (P < 0.05 for both). Success rates were similar between RALP and LP (99.5% vs 97.3%, P = 0.11). The intraoperative complication rate was comparable between RALP and LP (3.8% vs 7.4%, P = 0.06). However, the postoperative complication rate was significantly higher in the LP group (3.2% for RALP and 7.7% for LP, P = 0.02). All complications were of no greater severity than Satava Grade IIa and Clavien Grade IIIb. Discussion: This was the largest multicenter series of LP and RALP in the pediatric population. Limitations of the study included the retrospective design and lack of surgical experience as a confounder. Conclusions: Both minimally invasive approaches that were studied were safe and highly effective in treating UPJ obstruction in children in many centers globally. However, shorter hospitalization time and lower postoperative complication rates with RALP were noted. The aims of the study were met.


2016 - Laparoscopic and robotic ureteral stenosis repair : a multi-institutional experience with a long-term follow-up [Articolo su rivista]
R., Schiavina; S., Zaramella; F., Chessa; C. V., Pultrone; M., Borghesi; A., Minervini; A., Cocci; A., Chindemi; A., Antonelli; C., Simeone; V., Pagliarulo; P., Parma; A., Samuelli; A., Celia; B., De Concilio; Rocco, Bernardo Maria Cesare; E., De Lorenzis; G., La Manna; C., Terrone; M., Falsaperla; D., Dente; A., Porreca
abstract

The treatment of ureteral strictures represents a challenge due to the variability of aetiology, site and extension of the stricture; it ranges from an end-to-end anastomosis or reimplantation into the bladder with a Boari flap or Psoas Hitch. Traditionally, these procedures have been done using an open access, but minimally invasive approaches have gained acceptance. The aim of this study is to evaluate the safety and feasibility and perioperative results of minimally invasive surgery for the treatment of ureteral stenosis with a long-term follow-up. Data of 62 laparoscopic (n = 36) and robotic (n = 26) treatments for ureteral stenosis in 9 Italian centers were reviewed. Patients were followed according to the referring center's protocol. Laparoscopic and robotic approaches were compared. All the procedures were completed successfully without open conversion. Average estimated blood loss in the two groups was 91.2 ± 71.9 cc for the laparoscopic and 47.2 ± 32.3 cc for the robotic, respectively (p = 0.004). Mean days of hospitalization were 5.9 ± 2.4 for the laparoscopic group and 7.6 ± 3.4 for the robotic group (p = 0.006). No differences were found in terms of operative time and post-operative complications. After a median follow-up of 27 months, the robotic group yielded 2 stenosis recurrence, instead the laparoscopic group shows no cases of recurrence (p = 0.091). Minimally invasive approach for ureteral stenosis is safe and feasible. Both robotic and pure laparoscopic approaches may offer good results in terms of perioperative outcomes, low incidence of complications and recurrence.


2016 - Multicenter analysis of pathological outcomes of patients eligible for active surveillance according to PRIAS criteria [Articolo su rivista]
Grasso, A.A.; Cozzi, G.; De Lorenzis, E.; Ceruti, C.; Crivellaro, S.; Falsaperla, M.; Minervini, A.; Masieri, L.; Serni, S.; Porreca, A.; Zaramella, S.; Rocco, B.
abstract

AIM: To retrospectively analyze the pathological outcomes of patients meeting the Prostate Cancer Research International Active Surveillance (PRIAS) criteria who had undergone radical prostatectomy (RP). PATIENTS AND METHODS: Out of 2014 patients recruited for minimally invasive RP between 2008 and 2014 in 7 centers, 226 (11.2%) met the modified PRIAS criteria (clinical stage T1c/T2, PSA <10 ng/ml, 1--2 positive biopsy cores and Gleason score < 6). RESULTS: At pathological evaluation, Gleason score upgrade was reported in 47.3% of patients; 74 (32.7%), 10 (4.4%), 9 (3.9%) patients showed RP Gleason sum 7, 8 and 9, respectively. Upstaging was reported in 135 patients (59.7%). 12 (5.3%) and 4 (1.7 %) patients had T3a and T3b pathological stage respectively. CONCLUSIONS: Notwithstanding the PRIAS criteria can identify some PCa patients as low--risk, at pathological evaluation some of them harbored intermediate-- or high--risk disease. According to our data, patients eligible for AS should be carefully counseled about possible disease understaging.


2016 - PREDICTIVE FACTORS AND ONCOLOGICAL OUTCOMES OF PERSISTENTLY ELEVATED PROSTATE-SPECIFIC ANTIGEN IN PATIENTS FOLLOWING ROBOT ASSISTED RADICAL PROSTATECTOMY [Abstract in Rivista]
Kumar, A; Samavedi, S; Mouraviev, V; Hariharan, Pg; Rocco, B; Coelho, Rf; Patel, Vr
abstract

ND


2016 - Partial Nephrectomy in Clinical T1b Renal Tumors: Multicenter Comparative Study of Open, Laparoscopic and Robot-assisted Approach (the RECORd Project). [Articolo su rivista]
Porpiglia, F; Mari, A; Bertolo, R; Antonelli, A; Bianchi, Giampaolo; Fidanza, Francesco Antonio; Fiori, C; Furlan, M; Morgia, G; Novara, G; Rocco, Bernardo Maria Cesare; Rovereto, B; Serni, S; Simeone, C; Carini, M; Minervini, A.
abstract

OBJECTIVE: To evaluate perioperative results of open (OPN), laparoscopic (LPN), and robot-assisted partial nephrectomies (RAPN) and to identify predictive factors of Trifecta achievement for clinical T1b renal tumors in a multicenter prospective dataset. METHODS: Data of 285 patients who had OPN (133), LPN (57), or RAPN (95) for cT1b renal tumors were extracted from the RECORd Project. High-volume centers were defined as ≥50 overall cases of partial nephrectomy per year. Trifecta was defined as simultaneous absence of perioperative complications, negative surgical margins, and ischemia time <25 minutes. RESULTS: The 3 groups had comparable body mass index, preoperative hemoglobin, creatinine and estimated glomerular filtration rate, tumor clinical diameter, and growth pattern. LPN and RAPN were more frequently exclusive of high-volume centers. RAPN showed significantly lower median estimated blood loss compared with OPN and LPN. Trifecta was achieved in 62.4%, 63.2%, and 69.5% of OPN, LPN, and RAPN (P = NS) cases. Median warm ischemia time (WIT) was significantly shorter during OPN than during LPN and RAPN. RAPN had significantly shorter WIT compared with LPN. RAPN was significantly less morbid than OPN regarding intraoperative and postoperative complications. LPN (1.9%) and RAPN (2.5%) showed a lower rate of positive margins compared with OPN (6.8%) (P = NS). At multivariable analysis, exophytic tumor growth pattern, estimated blood loss, and high-volume centers were significant predictive factors for Trifecta achievement. CONCLUSION: Clinically, T1b renal tumors suitable for NSS can be safely treated by LPN or RAPN in high-volume centers. RAPN allows for significantly lower WIT and estimated blood loss with higher rate of Trifecta achievement compared with LPN.


2016 - Partial nephrectomy in clinical T1b renal tumors: multicentre comparative study of open, laparoscopic and robot-assisted approach (the RECORd Project) [Articolo su rivista]
Porpiglia, F.; Mari, A.; Bertolo, R.; Antonelli, A.; Bianchi, G.; Fidanza, F.; Fiori, C.; Furlan, M.; Morgia, G.; Novara, G.; Rocco, B.; Rovereto, B.; Serni, S.; Simeone, C.; Carini, M.; Minervini, A.
abstract

OBJECTIVES: To evaluate perioperative results of open (OPN), laparoscopic (LPN) and robot-assisted partial nephrectomy (RAPN) and to identify predictive factors of Trifecta achievement for clinical T1b renal tumors in a multicenter prospective dataset.METHODS: Data of 285 patients who had OPN (133), LPN (57) or RAPN (95) for cT1b renal tumors were extracted from the RECORd Project. High volume centers were defined as ≥ 50 overall cases of partial nephrectomy per year. Trifecta was defined as simultaneous absence of perioperative complications, negative surgical margins, ischemia time <25 minutes. RESULTS: The three groups had comparable BMI, preoperative haemoglobin, creatinine and eGFR, tumor clinical diameter and growth pattern. LPN and RAPN were more frequently exclusive of high volume centers. RAPN showed significantly lower median estimated blood loss compared to OPN and LPN. Trifecta was achieved in 62.4%, 63.2% and 69.5% OPN, LPN and RAPN (p=NS). Median WIT was significantly shorter during OPN than during LPN and RAPN. RAPN had significantly shorter WIT compared to LPN. RAPN was significantly less morbid than OPN regarding intraoperative and postoperative complications. LPN (1.9%) and RAPN (2.5%) showed a lower rate of positive margins compared to OPN (6.8%) (p=NS). At multivariable analysis, exophytic tumor growth pattern, estimated blood loss and high volume centers were significant predictive factors for Trifecta achievement. CONCLUSIONS: Clinically T1b renal tumors suitable for NSS can be safely treated by LPN or RAPN in high volume centers. RAPN allows for significantly lower WIT and EBL with higher rate of Trifecta achievement compared to LPN.


2016 - Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta-analysis [Articolo su rivista]
A. A. C., Grasso; F. A., Mistretta; M., Sandri; G., Cozzi; E., De Lorenzis; M., Rosso; G., Albo; F., Palmisano; A., Mottrie; A., Haese; M., Graefen; R., Coelho; V. R., Patel; Rocco, Bernardo Maria Cesare
abstract

To evaluate the influence of posterior musculofascial plate reconstruction (PR) on early return of continence after radical prostatectomy (RP); an updated systematic review of the literature. A systematic review of the literature was performed in June 2015, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and searching Medline, Embase, Scopus and Web of Science databases. We searched the terms posterior reconstruction prostatectomy, double layer anastomosis prostatectomy across the 'Title' and 'Abstract' fields of the records, with the following limits: humans, gender (male), and language (English). The authors reviewed the records to identify studies comparing cohorts of patients who underwent RP with or without restoration of the posterior aspect of the rhabdosphincter. A meta-analysis of the risk ratios estimated using data from the selected studies was performed. In all, 21 studies were identified, including three randomised controlled trials. The overall analysis of comparative studies showed that PR improved early continence recovery at 3-7, 30, and 90 days after catheter removal, while the continence rate at 180 days was statistically but not clinically affected. Statistically significantly lower anastomotic leakage rates were described after PR. There were no significant differences for positive surgical margins rates or for complications such as acute urinary retention and bladder neck stricture. The analysis confirms the benefits at 30 days after catheter removal already discussed in the review published in 2012, but also shows a significant advantage in terms of urinary continence recovery in the first 90 days. A multicentre prospective randomised controlled trial is currently being conducted in several institutions around the world to better assess the effectiveness of PR in facilitating an earlier recovery of postoperative urinary continence.


2016 - Predictive factors and oncological outcomes of persistently elevated prostate-specific antigen in patients following robot-assisted radical prostatectomy [Articolo su rivista]
A., Kumar; S., Samavedi; V., Mouraviev; A. S., Bates; R. F., Coelho; Rocco, Bernardo Maria Cesare; V. R., Patel
abstract

Our aim was to evaluate factors associated with persistently elevated prostate-specific antigen (PSA) and biochemical recurrence following robotic-assisted radical prostatectomy (RARP). The study population (N = 5300) consisted of consecutive patients who underwent RARP for localized prostate cancer by a single surgeon (VP) from January 2008 through July 2013. A query of our Institutional Review Board-approved registry identified 162 men with persistently elevated PSA (group A), defined as PSA level ≥0.1 ng/ml at 6 weeks after surgery, who were compared with rest of the cohort group having undetectable PSA, group B (<0.1 ng/ml). A univariate and multivariate logistic regression analysis was used to evaluate the significant association between various variables and the following: (1) persistently elevated PSA, (2) BCR (PSA value ≥0.2 ng/ml) on follow-up in the persistent PSA group. On multivariate analysis, only the following parameters were significantly associated with persistent PSA after RARP-preoperative [PSA >10 ng/ml (p = 0.01), Gleason Score ≥8 (p = 0.001) and clinical stage(p = 0.001)]; postoperative [pathologic stage (p = 0.001), extraprostatic extension (EPE, p = 0.01), lymph node positivity (p = 0.001), positive surgical margin (PSM, p = 0.02), Gleason score (p = 0.01) and tumor volume percent (p < 0.001)]. The mean follow-up was 38.1 months. The BCR was significantly higher in group A as compared to group B(52.47 vs 7.9 %) respectively; p = 0.01). The mean time to BCR was significantly lesser in group A as compared to group B(8.9 vs 21.1 months respectively; p = 0.01). The BCR-free survival rates at 1 year and 3 years were significantly lower statistically in the persistent PSA group in comparison to other groups (69.7 vs 97.3 % and 48.5 vs 92.1 %, respectively; p = 0.01). On multivariate logistic regression analysis in patients with persistent PSA on follow-up, preoperative PSA >10 ng/ml, postoperative Gleason score ≥8, postoperative stage ≥pT3, positive pelvic lymph nodes, PSM >3 mm and post-RARP PSA doubling time (DT) <10 months (p < 0.001) were significantly associated with BCR. In patients after RARP, factors associated with aggressive disease (high preoperative PSA, Gleason score ≥8, stage ≥T3, PSM, high tumor volume percent and EPE) predict PSA persistence. Although these patients with persistent PSA after RARP are more likely to have BCR and that too earlier than those patients with undetectable PSA after RARP, a significant proportion of these patients (47.53 %) remain free of BCR. This subset of patients is associated with these favorable parameters (preoperative PSA <10 ng/ml, post-RARP PSA DT ≥10 months, postoperative Gleason score <8, pathologic stage <pT3, PSM <3 mm and no lymph node involvement), thus potentially not requiring any adjuvant treatment.


2016 - Prostate cancer gene 3 assay in the magnetic resonance imaging (MRI)/ultrasonography fusion target biopsy era: a future to believe in [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Boeri, Luca
abstract

N/A


2016 - Re: Kidney-Failure Risk Projection for the Living Kidney-Donor Candidate [Articolo su rivista]
Rocco, Bernardo Maria Cesare; A. A. C., Grasso; M., Ferraresso; P., Messa
abstract

N/A


2016 - Robot-assisted Radical Prostatectomy and Extended Pelvic Lymph Node Dissection in Patients with Locally-advanced Prostate Cancer [Articolo su rivista]
G., Gandaglia; E., De Lorenzis; G., Novara; N., Fossati; R., De Groote; Z., Dovey; N., Suardi; F., Montorsi; A., Briganti; Rocco, Bernardo Maria Cesare; A., Mottrie
abstract

Background: Limited data are available on the role of robot-assisted radical prostatectomy (RARP) in patients with locally advanced prostate cancer (PCa). Objective: To describe our surgical technique of extrafascial RARP and extended pelvic lymph node dissection (ePLND) in locally advanced PCa. Design, setting, and participants: Ninety-four patients with clinical stage ≥T3 undergoing RARP with ePLND at three European centers between 2011 and 2015 were retrospectively evaluated. Surgical procedure: Surgery was performed using the DaVinci Si system. The anatomically defined ePLND included nodes overlying the external iliac axis, those in the obturator fossa, and around the internal iliac artery up to the ureter. RARP was performed using an extrafascial approach where the Denonvillers' fascia was dissected free and left on the posterior surface of the seminal vesicles. Measurements: Perioperative outcomes consisted of operative time, blood loss, length of hospital stay, and complications occurred within 30 d after surgery. Biochemical recurrence (BCR) was defined as two consecutive prostate-specific antigen values ≥0.2. ng/ml. Kaplan-Meier analyses assessed time to BCR and clinical recurrence. Multivariable Cox regression analyses assessed predictors of BCR. Results and limitations: Median operative time, blood loss, and length of hospital stay were 230. min, 200. ml, and 6 d. Overall, 12 (12.7%) patients experienced complications and five (5.3%), four (4.3%), and three (3.2%) patients had Clavien I, II, and III/IV complications. Overall, 72 (76.6%), 35 (37.2%), and 30 (32.3%) patients had pT3/4, pN1, and positive margins. The median number of nodes removed was 16. Overall, 19 (20.2%) and 21 (22.3%) patients received adjuvant radiotherapy and hormonal therapy. The median follow-up was 23.5 mo. At 3-yr follow-up, the BCR- and clinical recurrence-free survival rates were 63.3% and 95.8%. Pathologic stage, Gleason score, and positive margins represented predictors of BCR (all p ≤. 0.03). Our study is limited by its retrospective nature and by the follow-up duration. Conclusions: RARP represents a well-standardized, safe, and oncological effective option in patients with locally advanced PCa. Pathologic stage, Gleason score, and positive margins should be considered to select patients for multimodal approaches. Patient summary: Robot-assisted surgery represents a well-standardized, safe, and oncological effective option in men with locally advanced prostate cancer. Two out of three patients treated with this approach are free from recurrence at 3-yr follow-up. Pathologic stage, Gleason score, and positive surgical margins represent predictors of BCR and should be considered to select patients for multimodal approaches. We evaluated patients with locally advanced prostate cancer treated with robot-assisted radical prostatectomy and extended pelvic lymph node dissection. Our series demonstrates that this surgical approach is a safe and effective option in this setting, where only one out of 10 patients treated with robot-assisted radical prostatectomy experienced postoperative complications and two out of three patients were free from recurrence at the 3-yr follow-up.


2016 - SALVAGE ROBOTIC-ASSISTED LAPAROSCOPIC PROSTATECTOMY (SRARP) [Abstract in Rivista]
Syed, J.; Chew, C.; Vladimir, M.; Samavedi, S.; Ogaya-Pinies, G.; Ganapathi, H.; Kumar, A.; Coelho, R. F.; Rocco, B.; Patel, V. R.
abstract

INTRODUCTION & OBJECTIVES: There is a significant cohort of patients who experience recurrent prostate cancer after primary ablative therapy. Salvage robot assisted radical prostatectomy (sRARP) represents a feasible treatment option in these cases. The purpose of the study is to examine the functional and biochemical outcomes in a large series of sRARP performed by a single surgeon (VRP). MATERIAL & METHODS: We retrospectively reviewed our database of more than 6,500 patients who have undergone RARP. Over a period of 8 years (2008-2015) we identified 65 patients who have had sRARP following different types of primary ablative treatment failure. The Kaplan-Meier method was used to estimate survival. Both univariate and multivariate regression analysis were used to determine predictors of biochemical recurrence. RESULTS: The median interval from primary therapy to sRARP was 48 (range 26-85) months. The median age of patients undergoing sRARP was 69 (65-73) years. The 11 (16.9%) patients had positive surgical margins, 14 (21.6%) – extraprostatic extension and 16 (24.6%) seminal vesicle invasion (pT3b). There were no cases of rectal injury or any intraoperative complications. 16 (25%) patients had a biochemical failure after a median follow-up of 16.5 (6-56) months and 10 (15%) required adjuvant hormone therapy. 85% of patients that had sRALP were free of additional therapy at a median of 16.5 months. All 65 patients were continent prior to salvage RARP and 34 (52.3%) of them reported full continence after surgery (no pad used). The 29 (44.6%) of them partial continence1-2 pads and 5 (3.1%)≥ 3 pads, respectively. 19 (29.2%) patients were considered potent before sRARP and 9 (47.4%) of them retained potency after the sRARP. Tumour stage pT3b (seminal vesicle invasion), pre-op Gleason >7, and positive surgical margins were predictive of biochemical recurrence. CONCLUSIONS: Our series supports the feasibility of sRARP as a suitable treatment option for patients who have experienced local recurrence of prostate cancer. Our outcomes for biochemical recurrence, potency, and continence are reasonable, maintaining a reasonable balance between cancer control data, quality of life issues and risk of complications. Longer follow-up will be necessary in determining the full extent of sRARP in providing adequate cancer control and quality of life issues


2016 - Safety of selective nerve sparing in high risk prostate cancer during robot-assisted radical prostatectomy [Articolo su rivista]
A., Kumar; S., Samavedi; A. S., Bates; V., Mouraviev; R. F., Coelho; Rocco, Bernardo Maria Cesare; V. R., Patel
abstract

D'Amico high risk prostate cancer is associated with higher incidence of extra prostatic disease. It is recommended to avoid nerve sparing in high risk patients to avoid residual cancer. We report our intermediate term oncologic and functional outcomes in patients with preoperative D'Amico high risk prostate cancer, who underwent selective nerve sparing robot-assisted radical prostatectomy (RARP). Between Jan 2008 till June 2013, 557 patients underwent RARP for D'Amico high risk prostate cancer. The criteria for nerve sparing were as follows-complete: non palpable disease with <3 cores involvement on prostate biopsy; partial: non palpable disease with <4 cores involvement on prostate biopsy; none: clinically palpable disease with ≥4 cores involvement on prostate biopsy and intraoperative visual cues of locally advanced disease (loss of dissection planes, focal bulge of prostatic capsule). Degree of nerve sparing (NS) was graded intraoperatively by the surgeon independently at either side as side specific margins were assessed to predict subjectivity of the intraoperative judgment. Various data were collected and analyzed. Of 557 patients who underwent RARP 140 underwent complete (group 1), 358 patients underwent partial (group 2), and 59 patients underwent non-nerve-sparing procedure (group 3). There were no difference in preoperative characteristic between the groups (p = 0.678), but group 3 had higher Gleason score sum (p = 0.001), positive cores on biopsy (p = 0.001) and higher t stage (p = 0.001). Postoperatively Extra prostatic extension (p = 0.001), seminal vesicle invasion (p = 0.001), and tumor volume (p < 0.001) were higher in Group 3. Side specific positive surgical margins (PSMs) rates were higher for non-nerve-sparing compared to partial and complete nerve sparing RARP (p < 0.001; overall PSMs = 25.2 %). On univariate and multivariate analysis, nerve sparing did not affect PSMs (p > 0.05). The overall biochemical recurrence (BCR) rate at mean follow-up of 24.3 months was 19.21 %. The continence rate at 3 month was significantly higher in complete NS group in comparison to non-NS group (p = 0.020), however, this difference was not statistically significant at 1 year. Similarly, mean time to continence was significantly lower in complete NS group in comparison to non-NS group (p = 0.030). The potency rate was significantly higher and mean time to potency was significantly lower in complete NS group in comparison to non-NS group (p = 0.010 and 0.020, respectively). In high risk prostate cancer patients, selective nerve sparing during RARP, using the preoperative clinical variables (clinical stage and positive cores on biopsy) and surgeon's intraoperative perception, could provide reasonable intermediate term oncologic, functional outcomes (continence and potency) with acceptable perioperative morbidity and positive surgical margins rate. Use of these preoperative factors and surgeon's intraoperative judgment can appropriately evaluate high risk prostate cancer patients for nerve sparing RARP.


2016 - THE ROLE OF ROBOT-ASSISTED RADICAL PROSTATECTOMY AND EXTENDED PELVIC LYMPH NODE DISSECTION IN PATIENTS WITH LOCALLY ADVANCED PROSTATE CANCER: RESULTS FROM A MULTI-INSTITUTIONAL SERIES [Abstract in Rivista]
Gandaglia, G.; De Lorenzis, E.; Novara, G.; De Groote, R.; Rocco, B.; Mottrie, A.
abstract

INTRODUCTION & OBJECTIVES: Previous studies demonstrated that Robot-Assisted Radical Prostatectomy (RARP) might represent an oncologically safe option in patients with high-risk Prostate Cancer (PCa). However, none of these investigations focused on men with locally advanced disease (i.e., clinical stage T3 or greater). The aim of our study was to assess the safety and effectiveness of RARP in patients with locally advanced PCa treated at three high-volume European institutions. MATERIAL & METHODS: Overall, 94 patients with locally advanced disease defined by clinical stage ≥T3 undergoing RARP with extended pelvic lymph node dissection at three referral institutions between 2011 and 2015 were evaluated. Perioperative outcomes consisted of operative time, blood loss, Length of hospital Stay (LoS), and postoperative complications (categorized according to the Clavien-Dindo classification). Biochemical Recurrence (BCR) was defined as two consecutive PSA ≥0.2 ng/ml. Clinical recurrence was defined as the onset of metastases during follow-up. KaplanMeier analyses assessed time to BCR and clinical recurrence. Multivariable Cox regression analyses were performed to assess the predictors of recurrence. RESULTS: Median (IQR) age at surgery was 64.3 years. Median preoperative PSA was 9.7 ng/ml. Biopsy Gleason score was 6, 7, and 8-10 in 18 (19.1%), 51 (54.3%), and 25 (26.6%) patients, respectively. Overall, median operative time, blood loss and LoS were 230 min, 200 ml, and 6 days, respectively. Overall, 12 (12.7%) patients experienced postoperative complications. Overall, 5 (5.3%), 4 (4.3%), 2 (2.1%), and 1 (1.1%) patients had a Clavien I, II, III, and IV complications. Overall, 22 (23.4%), 31 (33.0%), 40 (42.6%), 1 (1.1%), and 35 (37.2%) patients had T2, T3a, ≥T3b, pT4, and pN1 disease, respectively. Overall, 30 (32.3%) patients had positive surgical margins. The median number of nodes removed was 16. Overall, 19 (20.2%) and 21 (22.3%) patients received adjuvant radiotherapy and hormonal therapy, respectively. Median (IQR) follow-up was 23.5 months. At 3-year follow-up, the BCR-free survival rate was 63.3%. In multivariable analyses, pathologic Gleason score 9-10, pathologic stage ≥T3b, and positive margins represented independent predictors of BCR (all P≤0.05). CONCLUSIONS: RARP represent a safe and effective option in patients with locally advanced PCa, where excellent oncologic outcomes are observed at short-term follow-up. In particular, two out of three patients are free from recurrence at 3 years after surgery. Pathologic stage, positive margins and Gleason score represent predictors of BCR and should be considered to select patients for multimodal approaches. Further studies with higher number of patients and longer follow-up are needed to confirm these findings.


2016 - THE USE OF SCAFFOLDING TISSUE BIOGRAFTS TO BOLSTER THE VESICOURETHRAL ANASTOMOSIS DURING SALVAGE ROBOT-ASSISTED RADICAL PROSTATECTOMY REDUCES LEAK RATES AND CATHETER TIMES [Abstract in Rivista]
Kadakia, Y.; Mouraviev, V.; Kumar, A.; Samavedi, S.; Coelho, R. F.; Rocco, B.; Ogaya-Pinies, G.; Ganapathi, H.; Marquinez, J.; Patel, V. R.
abstract

THE USE OF SCAFFOLDING TISSUE BIOGRAFTS TO BOLSTER THE VESICOURETHRAL ANASTOMOSIS DURING SALVAGE ROBOT-ASSISTED RADICAL PROSTATECTOMY REDUCES LEAK RATES AND CATHETER TIMES


2016 - URINARY PEPTIDOME AND PROTEOME ALTERATIONS RELATED TO TUMOR PROGRESSION AND INVASION IN RCC [Abstract in Rivista]
Chinello, C.; Grasso, M.; Cazzaniga, M.; De Sio, G.; Grasso, A.; Rocco, B.; Smith, A.; Zoppis, I.; Mauri, G.; Magni, F.
abstract

INTRODUCTION AND OBJECTIVES: Up to now, for renal cell carcinoma (RCC), tumor size and growth rate are the most used prognostic factors at diagnosis likely being related with potential progressive neoplasms. Moreover, the degree of the free tumor extension into renal vessel seems to contribute to disease-free survival and to influence prognosis. Thus, firstly, in order to highlight urinary peptidome signatures that might reflect kidney cancer progression, a systematic investigation by MALDI profiling was carried out identifying endogenous peptides that show a correlation between their abundance in urine and pT, tumor size and grade. Secondly, in order to explore proteome changes reflecting the local tumor infiltration through vena cava, a labelfree nLC MS/MS was performed in trypsinized urine from subjects affected by RCC at different level of invasion (vascular endothelium/ vein/ thrombosis). METHODS: Peptidomic evaluation of tumor progression was performed in 117 RCC urine samples, through the application of C8 functionalized magnetic beads purification followed by MALDI-TOF and statistical analysis for group comparisons and correlations. nLC-ESI-MS/MS was used for peptide identification. Urine proteome investigation correlated to different renal vein invasion extent was carried out by label-free nLC MS/MS strategy using FASP digested pools of 3 groups. Statistical evaluation was obtained by Progenesis QI for Proteomics. RESULTS: 15 endogenous peptides showed a statistically significant correlation between their urinary concentration and tumor size (only 3 negatively), 26 with pT (only 6 negatively), and only 5 with grade (only 1 positively). Most of them were differentially represented in urine of RCC patients compared to controls and for some of them varied according to pT or stage. Identity of several of them are likely to confirm their possible role in tumor progression. Proteomic labelfree approach regarding tumor invasion allowed to select 671 protein IDs significantly altered in at least one of the 3 group comparisons (fold change¼2). 12 of them showed a progressive increase from the endothelium wall infiltration to thrombosis CONCLUSIONS: These methodological approaches applied to urine may provide useful keys to highlight alterations triggered by RCC aggressiveness or vascular neoplastic infiltration from endothelial layer to vein ostium obstruction, better understand tumor protein handling aspects, and describe such a dynamic system as growing cancer cells are.


2015 - A prospective, multicenter evaluation of predictive factors for positive surgical margins after nephron-sparing surgery for renal cell carcinoma: The record1 italian project [Articolo su rivista]
Schiavina, Riccardo; Serni, Sergio; Mari, Andrea; Antonelli, Alessandro; Bertolo, Riccardo; Bianchi, Giampaolo; Brunocilla, Eugenio; Borghesi, Marco; Carini, Marco; Longo, Nicola; Martorana, Giuseppe; Mirone, Vincenzo; Morgia, Giuseppe; Porpiglia, Francesco; Rocco, Bernardo; Rovereto, Bruno; Simeone, Claudio; Sodano, Mario; Terrone, Carlo; Ficarra, Vincenzo; Minervini, Andrea
abstract

The purpose of this study was to evaluate the predictors of positive margins in one of the largest available prospective multi-institutional studies. PATIENTS AND METHODS: We evaluated all patients who underwent NSS for radiologically diagnosed kidney tumors between January 2009 and December 2012 at 19 urological Italian centers (Registry of Conservative Renal Surgery [RECORd] project). Preoperative and anthropometric data, comorbidities, intraoperative and postoperative outcomes, and histological findings were analyzed. The negative and PSMs were compared according to the clinical and surgical variables. Multivariable logistic regression models were applied to analyze predictors of PSMs. RESULTS: Eight hundred consecutive patients were evaluated. Seven hundred sixty-one (95.1%) and 39 patients (4.9%) achieved negative and PSMs, respectively. Patients with PSMs were significantly older compared with those with negative margins (median age: 66.6 vs. 61.8 years, respectively; P = .001). A higher incidence of PSMs was observed when NSS was performed for renal masses located in the upper pole (P = .001). A lower rate of PSMs was found in patients treated with simple enucleation rather than standard PN (1.6% vs. 7.4%, respectively; P < .0001). A greater incidence of PSMs was found in Fuhrman 3/4 tumors (11.3%; P < .0001). At multivariable analysis, age (odds ratio [OR], 1.04; P = .01), upper pole tumor location (OR, 2.85; P = .005), standard PN (OR, 3.45; P = .004), and Fuhrman 3-4 nuclear grade (OR, 4.81; P = .001) were found to be independent predictors of PSMs. CONCLUSION: In our multi-institutional report, young age, simple enucleation, middle or lower tumor location, and low-grade tumor were demonstrated to be independent predictors of negative SMs.


2015 - Age stratified comparative analysis of perioperative, functional and oncologic outcomes in patients after robot assisted radical prostatectomy: a propensity score matched study [Articolo su rivista]
Kumar, A.; Samavedi, S.; Bates, A.S.; Cuevas, C.A.G.; Coelho, R.F.; Rocco, B.; Palmer, K.; Patel, V.R.
abstract

Introduction and objectives: Our goal was to evaluate the perioperative, functional and intermediate term oncological outcomes of robot assisted radical prostatectomy (RARP) in patients ≥70 years. Materials and methods: The study population (N = 3241) consisted of consecutive patients who underwent RARP for localized prostate cancer by a single surgeon (VP) from January 2008 through February 2012. A query of our Institutional Review Board approved registry identified 400 men ≥70 years of age, with good functional status (Charlson co-morbidity index <3). These patients were propensity score matched to younger patients. Perioperative and postoperative functional and oncologic outcomes for the two groups were compared. Results: Full nerve sparing as well as the ease of nerve sparing were similar in 2 groups. Intra-operative complications were comparable. Postoperative complication occurrence rates were similar. At mean follow up of 34.1 months and 37.2 months respectively in younger and older patients, the continence rate was comparable in 2 groups (91.3% and 87.3%).Average time to continence and potency were similar in 2 groups. A greater proportion of younger patients became potent than elderly (52.3% vs 33.5%,p < 0.001).The biochemical recurrence (BCR) rate was comparable in 2 groups (7.8% vs 8.3%; p = 0.79). The mean time to BCR was also comparable in 2 groups (16 months vs 22.6 months; p = 0.07). Conclusions: In appropriately selected patients (minimal comorbidities with CCI ≤2, life expectancy >10 years, localized prostate cancer) RARP is a reasonable option in patients ≥70 years and provides comparable perioperative, functional and intermediate term oncologic outcomes as compared to younger patients.


2015 - Continence outcomes of robot-assisted radical prostatectomy in patients with adverse urinary continence risk factors [Articolo su rivista]
Kumar, A.; Samavedi. S.; Bates, A.S.; Coelho, R.F.; Rocco, B.; Palmer, K.; Patel, V.R.
abstract

Objective To analyse the continence outcomes of robot-assisted radical prostatectomy (RARP) in suboptimal patients that have challenging continence recovery factors such as enlarged prostates, elderly patients, higher body mass index (BMI), salvage prostatectomy, and bladder neck procedures before RARP. Patients and Methods From January 2008 through November 2012, 4 023 patients underwent RARP by a single surgeon at our institution. Retrospective analysis of prospectively collected data identified 3 362 men who had minimum of 1-year follow-up. This cohort of patients was stratified into six groups: Group I, aged ≥70 years (451 patients); Group II, BMI ≥35 kg/m2 (197); Group III, prior bladder neck procedures (103); Group IV, prostate weight ≥80 g (280); and Group V, salvage prostatectomy (41). Group VI consisted of patients (2 447) with none of these risk factors. Continence outcomes at follow-up were analysed for all groups. Results The continence rate at 1 year and mean (sd) time to continence in different groups were: for patients aged ≥70 years, 85.6% and 3.2 (4.5) months; BMI of ≥35 kg/m2, 87.8% and 3.1 (4.5) months; prior bladder neck treatment, 82.4% and 3.4 (4.7) months; prostate weight of ≥80 g, 85.8% and 3.3 (4.4) months; salvage procedures, 51.3% and 6.6 (8.3) months; and in Group VI (none of the risk factors), 95.1% and 2.4 (3.2) months. The continence rate was significantly higher in group VI compared with the salvage group (group V) at the different follow-up intervals (P < 0.001). When compared with the other groups (I-IV), the continence rate, although higher, was not statistically significant at the different intervals in group VI (no risk). The mean time to continence was significantly lower in group VI compared with the other groups (I-V; P < 0.001). Conclusions This study has shown that selected risk factors adversely affect the time to return of continence after RARP, yet aside from salvage patients, there was no statistically significant difference demonstrated between the adverse-risk groups included. Patients undergoing salvage RP had significantly lower continence rates at the various intervals compared with the other groups. Patients with the risk factors identified should be counselled concerning expectations for achieving urinary continence.


2015 - DEHYDRATED HUMAN AMNIOTIC MEMBRANE ALLOGRAFT NERVE WRAP AROUND THE PROSTATIC NEUROVASCULAR BUNDLE ACCELERATES EARLY RETURN TO CONTINENCE AND POTENCY FOLLOWING RADICAL ROBOT ASSISTED RADICAL PROSTATECTOMY : A PROPENSITY SCORE MATCHED ANALYSIS [Abstract in Rivista]
Kumar, A.; Samavedi, S.; Bates, A.; Coelho, R.; Rocco, B.; Marquinez, J.; Camacho, I.; Jenson, C.; Palmer, K.; Patel, V.
abstract

INTRODUCTION AND OBJECTIVES: Allografts of dehydrated human amniotic membrane (dHAM) have cytokines and growth factors that have been shown to reduce the inflammatory response during tissue healing and promote nerve regeneration. We performed this study to evaluate the early quality of life outcomes after placement of dehydrated human amniotic membrane on the neurovascular bundle (NVB) during nerve sparing robot assisted laparoscopic prostatectomy (RALP) in a propensity score matched analysis. METHODS: From March 2013 to July 2014, 58 pre-operatively potent [Sexual Health Inventory for Men (SHIM) score >19] and continent patients underwent full nerve sparing RALP, followed by intraoperative dHAM placement at our institution. In each patient, dHAM was wrapped around the NVB following the RALP procedure. We performed propensity matching using our prospective database in matched, nongrafted patients from the same time period. Pre-, peri- and postoperative outcomes were analyzed between patient groups including time to return to continence and potency. RESULTS: The use of dHAM was not associated with increased operative time, blood loss or negative oncologic outcomes (p >0.50). The mean follow up was 4 months. Continence at 8 weeks returned in 79.3 % of patients the dHAM group and 72.4% of the group not receiving dHAM (p¼0.37). The mean time to continence and potency was significantly lower in dHAM group as compared to the matched non-dHAM group (1.21 months vs. 1.83 months, p¼0.03) and (1.34 months vs. 3.39 months, p¼0.007). Potency at 8 weeks returned in 63.8 % (n¼39) patients receiving dHAM patients and 51.7 % patients in the no-dHAM group (p¼0.13). There were no adverse effects related to the graft. CONCLUSIONS: The use of dehydrated human amniotic membrane allograft appears to hasten the early return of continence and potency in patients following RARP. Longer term follow up is required to assess the benefits over a broader period of time and to evaluate and potential negative events. A long term randomized trial is warranted. Short term results are very encouraging for patient care.


2015 - Dehydrated Human Amnion/Chorion Membrane Allograft Nerve Wrap Around the Prostatic Neurovascular Bundle Accelerates Early Return to Continence and Potency Following Robot-assisted Radical Prostatectomy: Propensity Score–matched Analysis [Articolo su rivista]
Patel, V.R.; Samavedi, S.; Bates, A.S.; Kumar, A.; Coelho, R.; Rocco, B.; Palmer, K.
abstract

We present a propensity-matched analysis of patients undergoing placement of dehydrated human amniotic membrane (dHAM) around the neurovascular bundle (NVB) during nerve-sparing (NS) robot-assisted laparoscopic prostatectomy (RARP). From March 2013 to July 2014, 58 patients who were preoperatively potent (Sexual Health Inventory for Men [SHIM] score >19) and continent (no pads) underwent full NS RARP. Postoperative outcomes were analyzed between propensity-matched graft and no-graft groups, including time to return to continence, potency, and biochemical recurrence. dHAM use was not associated with increased operative time or blood loss or negative oncologic outcomes (p>0.500). Continence at 8 wk returned in 81.0% of the dHAM group and 74.1% of the no-dHAM group (p=0.373). Mean time to continence was enhanced in group 1 patients (1.21 mo) versus (1.83 mo; p=0.033). Potency at 8 wk returned in 65.5% of the dHAM patients and 51.7% of the no-dHAM group (p=0.132). Mean time to potency was enhanced in group 1, (1.34 mo), compared to group 2 (3.39 mo; p=0.007). Graft placement enhanced mean time to continence and potency. Postoperative SHIM scores were higher in the dHAM group at maximal follow-up (mean score 16.2 vs 9.1). dHAM allograft use appears to hasten the early return of continence and potency in patients following RARP.


2015 - Deregulation of MIR-34b/Sox2 predicts prostate cancer progression [Articolo su rivista]
Forno, Irene; Ferrero, Stefano; Russo, Maria Veronica; Gazzano, Giacomo; Giangiobbe, Sara; Montanari, Emanuele; Del Nero, Alberto; Rocco, Bernardo; Albo, Giancarlo; Languino, Lucia R.; Altieri, Dario C.; Vaira, Valentina; Bosari, Silvano
abstract

Most men diagnosed with prostate cancer will have an indolent and curable disease, whereas approximately 15% of these patients will rapidly progress to a castrate-resistant and metastatic stage with high morbidity and mortality. Therefore, the identification of molecular signature(s) that detect men at risk of progressing disease remains a pressing and still unmet need for these patients. Here, we used an integrated discovery platform combining prostate cancer cell lines, a Transgenic Adenocarcinoma of the Mouse Prostate (TRAMP) model and clinically-annotated human tissue samples to identify loss of expression of microRNA-34b as consistently associated with prostate cancer relapse. Mechanistically, this was associated with epigenetics silencing of the MIR34B/C locus and increased DNA copy number loss, selectively in androgen-dependent prostate cancer. In turn, loss of miR-34b resulted in downstream deregulation and overexpression of the "stemness" marker, Sox2. These findings identify loss of miR-34b as a robust biomarker for prostate cancer progression in androgen-sensitive tumors, and anticipate a potential role of progenitor/stem cell signaling in this stage of disease. Copyright:


2015 - Evaluation of the prognostic significance of perirenal Fat invasion and tumor size in patients with pT1-pT3a localized renal cell carcinoma in a comprehensive multicenter study of the CORONA project : can we Improve prognostic discrimination for patients with stage pT3a tumors? [Articolo su rivista]
Brookman-May, S.D.; May, M.; Wolff, I.; Zigeuner, R.; Hutterer, G.C.; Cindolo, L.; Schips, L.; De Cobelli, O.; Rocco, B.; De Nunzio, C.; Tubaro, A.; Coman, I.; Truss, M.; Dalpiaz, O.; Feciche, B.; Figenshau, R.S.; Madison, K.; Sánchez-Chapado, M.; Del Carmen Santiago Martin, M.; Salzano, L.; Lotrecchiano, G.; Zastrow, S.; Wirth, M.; Sountoulides, P.; Shariat, S.; Waidelich, R.; Stief, C.; Gunia, S.
abstract

Background: The current TNM system for renal cell carcinoma (RCC) merges perirenal fat invasion (PFI) and renal vein invasion (RVI) as stage pT3a despite limited evidence concerning their prognostic equivalence. In addition, the prognostic value of PFI compared to pT1-pT2 tumors remains controversial. Objective: To analyze the prognostic significance of PFI, RVI, and tumor size in pT1-pT3a RCC. Design, setting, and participants: Data for 7384 pT1a-pT3a RCC patients were pooled from 12 centers. Patients were grouped according to stages and PFI/RVI presence as follows: pT1-2N0M0 (n = 6137; 83.1%), pT3aN0M0 + PFI (n = 1036; 14%), and pT3aN0M0 (RVI ± PFI; n = 211; 2.9%). Intervention: Radical nephrectomy or nephron-sparing surgery (NSS) (1992-2010). Outcome measurements and statistical analysis: Cancer-specific survival was estimated using the Kaplan-Meier method. Univariate and multivariate Cox proportional-hazards regression models, as well as sensitivity and discrimination analyses, were used to evaluate the impact of clinicopathologic parameters on cancer-specific mortality (CSM). Results and limitations: Compared to stage pT1-2, patients with stage pT3a RCC were significantly more often male (59.4% vs 53.1%) and older (64.9 vs 62.1 yr), more often had clear cell RCC (85.2% vs 77.7%), Fuhrman grade 3-4 (29.4% vs 13.4%), and tumor size >7. cm (39.1% vs 13%), and underwent NSS less often (7.5% vs 36.6%; all p <. 0.001). According to multivariate analysis, CSM was significantly higher for the PFI and RVI ± PFI groups compared to pT1-2 patients (hazard ratio [HR] 1.94 and 2.12, respectively; p <. 0.001), whereas patients with PFI only and RVI ± PFI did not differ (HR 1.17; p = 0.316). Tumor size instead enhanced CSM by 7% per cm in stage pT3a (HR 1.07; p <. 0.001) with a 7. cm cutoff yielding the highest prediction accuracy. Conclusions: Since the prognostic impact of PFI and RVI on CSM seems to be comparable, merging both as stage pT3a RCC might be justified. Enhanced prognostic discrimination of stage pT3a RCC appears to be possible by applying a tumor size cutoff of 7. cm within an alternative staging system. Patient summary: Prognosis prediction for patients with localized renal cell carcinoma up to stage pT3a can be enhanced by including tumor size with a cutoff of 7. cm as an additional parameter in the TNM classification system. The prognostic impact of perirenal fat and renal vein invasion in renal cell carcinoma patients is comparable, which justifies merger of both as stage pT3a. Prognostic discrimination of pT3a tumors can be enhanced by using a tumor size cutoff of 7. cm for additional stratification.


2015 - IMPACT OF NERVE SPARING ON POSTOPERATIVE CONTINENCE FOLLOWING ROBOT ASSISTED RADICAL PROSTATECTOMY: A PROPENSITY SCORE MATCHED STUDY [Abstract in Rivista]
Kumar, A.; Samavedi, S.; Mouraviev, V.; Hariharan, P. G.; Rocco, B.; Coelho, R. F.; Patel, V. R.
abstract

INTRODUCTION & OBJECTIVES: We evaluated the impact of nerve sparing during robot assisted radical prostatectomy (RARP) on postoperative continence outcomes in a single surgeon, single centre propensity score matched study. MATERIAL & METHODS: The study population consisted of 2362 patients who underwent RARP for localized prostate cancer by a single surgeon (VP) from January 2008 through May 2014. A query of our Institutional Review Board approved registry identified 92 men with nonnerve sparing (NNS, group 1) RARP who were computer-matched in a 1:1 ratio to 92 patients with complete nerve sparing (CNS: bilateral full nerve sparing, group 2) RARP and 92 patients with partial nerve sparing (PNS: unilateral full nerve sparing with or without contralateral partial nerve sparing and bilateral partial nerve sparing, group 3) RARP using a propensity score matched algorithm. Perioperative and postoperative functional outcomes for three groups were compared. Degree of nerve sparing (NS) was graded intra-operatively by the surgeon independently at either side as complete, partial or none. Postoperative continence was defined as using no pads per day. Followup data were collected at 6 weeks, 3, 6, 9, and 12 months to assess functional outcomes. RESULTS: When NNS group was compared with PNS group, all pre-operative clinical characteristics ,intraoperative and pathological parameters were comparable.At 3 months,the continence rate was significantly higher and mean time to continence was significantly lower in PNS group in comparison to NNS group(91.3% vs 72.1% respectively,p=0.01 and 2.19 months vs 3.91 months,p=0.03 ). However,on comparing CNS group with NNS group,NNS group has significantly higher clinical stage(p=0.03),D’Amico risk classification(p=0.04) and extraprostatic extension(p=0.03). However,at 3 months,the continence rate was significantly higher and mean time to continence was significantly lower in CNS group in comparison to NNS group(92.2% vs 72.1% respectively,p=0.01 and 2.03 months vs 3.91 months respectively,p=0.02 ). However, the continence rate was comparable in 3 groups at 1 year (94.1%, 92.7% and 84.7% respectively in CNS, PNS and NNS groups p =0.43). CONCLUSIONS: Neurovascular bundles(NVB) preservation (irrespective of complete or partial) during robot assisted radical prostatectomy results in an earlier return of postoperative urinary continence .A significantly higher number of patients achieve urinary continence between 0-3 months after surgery ,in comparison to propensity matched patients with non-nerve sparing procedure .Beyond 3 months post-surgery ,there was no difference in ability to achieve urinary continence regardless of NVB preservation status.


2015 - Impact of dehydrated human amniotic membrane allograft (AmnioFix) on continence and potency following robot-assisted radical prostatectomy [Articolo su rivista]
Kumar, A.; Samavedi, S.; Bates, A.S.; Coelho, R.F.; Rocco, B.; Marquinez, J.; Camacho, I.; Jenson, C.; Palmer, K.J.; Patel, V.R.
abstract

Introduction and Objectives: Allografts of dehydrated human amniotic membrane (dHAM) have cytokines and growth factors that have been shown to reduce the inflammatory response during tissue healing and promote nerve regeneration. This is the first reported study evaluating the early quality of life outcomes after placement of dHAM on the neurovascular bundle (NVB) during nerve-sparing robotassisted radical prostatectomy (RARP). We demonstrate our technique in this video. Methods: From March 2013 to July 2014, 58 preoperatively potent (Sexual Health Inventory for Men score >19) and continent patients underwent full nerve-sparing RARP, followed by intraoperative dHAM placement at our institution. In each patient, the dHAM was wrapped around the NVB following the RARP procedure. We performed propensity matching using our prospective database in matched nongrafted patients from the same time period. Pre-, peri-, and postoperative outcomes were analyzed between patient groups, including the time to return to continence and potency. Results: The use of dHAM was not associated with increased operative time, blood loss, or negative oncologic outcomes (p > 0.50). The mean follow-up was 4 months. Continence at 8 weeks returned in 79.3% of patients in the dHAM group and in 72.4% of patients in the group not receiving dHAM (p = 0.37). The mean time to continence and potency was significantly lower in the dHAM group compared to the matched non-dHAM group (1.21 vs 1.83 months, p = 0.03 and 1.34 vs 3.39 months, p = 0.007). Potency at 8 weeks returned in 63.8% (n = 39) of patients receiving dHAM and in 51.7% of patients in the non-dHAM group (p = 0.13). There were no adverse effects related to the graft. Conclusions: The use of dHAM allograft appears to hasten the early return of continence and potency in patients following RARP. Longer term follow up is required to assess the benefits over a broader period of time and to evaluate the potential negative events. A long-term randomized trial is warranted. Short-term results are encouraging for patient care.


2015 - Margini chirurgici positivi dopo prostatectomia radicale mini-invasiva: studio multicentrico [Positive surgical margin status after minimally invasive radical prostatectomy: a multicenter study] [Articolo su rivista]
Tafa, A.; Grasso, A.; Antonelli, A.; Bove, P.; Celia, A.; Ceruti, C.; Crivellaro, S.; Falsaperla, M.; Minervini, A.; Parma, P.; Porreca, A.; Zaramella, S.; De Lorenzis, E.; Cozzi, G.; Rocco, B.
abstract

Aim The aim of our study is to evaluate the status of positive margins (PSMs) comparing their incidence between aparoscopic radical prostatectomy (LRP) and robot assisted radical prostatectomy (RARP) in centers with medium case-load (50-150 cases/year). We also analyzed the correlations between surgical technique, nerve-sparing approach (NS), and incidence of PSMs, stratifying our results by pathological stage. Materials and methods We analyzed 1992 patients who underwent RP in various urologic centers. We evaluated the incidence of PSMs, and then we compared the stage-related incidence of PSMs, for both the techniques. Results We did not find a statistically significant difference between the two surgical modalities in the study regarding the overall incidence of PSMs. Conclusions In our retrospective study, we did not find any difference in terms of PSMs in RARP versus LRP. Our PSMs were not negligible, particularly in pT3 stages, compared with high-volume centers; surgical experience and patients’ selection can be a possible explanation.


2015 - Robot-Assisted Radical Prostatectomy [Capitolo/Saggio]
Rocco, B.; Coelho, R.F.; Cozzi, G.; De Lorenzis, E.; Patel, V.
abstract

In the field of oncologic urologic surgery, robot-assisted radical prostatectomy (RARP) represents the main application of the robotic approach. RARP is currently the leading urologic use of the da Vinci system, and more than 80 % of the radical prostatectomies performed in the USA in 2011 were carried out by robot-assisted surgery. Indications for RARP are the same with those for radical retropubic prostatectomy (RRP), and RARP has also been described as a salvage surgical treatment after radiotherapy (RT), brachytherapy, and high-intensity focused ultrasound. Under an oncological point of view, RARP offers at least the same results of RRP also in higher-risk patients. Extended lymph node dissection yielding a reasonably high number of lymph nodes is feasible during RARP. The mean complication rate of RARP is 9 % (range, 3–26 %). Twelve-month urinary incontinence rates after RARP range from 4 to 31 %, with significant advantage in favor of RARP in comparison with RRP and laparoscopic radical prostatectomy. RARP is associated with an incidence of 12- and 24-month erectile dysfunction ranging from 10 to 46 % and from 6 to 37 %, respectively. A significant advantage in favor of RARP in comparison with RRP in terms of 12 months’ potency rates has been observed. Concomitant good oncological, continence, and potency outcomes define the concept of “trifecta.” This chapter presents the technique for RARP described by Patel, which introduces some differences from the standard laparoscopic and robotic technique described previously.


2015 - Robot-assisted radical prostatectomy: recent advances [Articolo su rivista]
Mistretta, F.A.; Grasso, A.A.; Buffi, N.; Cozzi, G.; De Lorenzis, E.; Fiori, C.; Patel, V.R.; Porpiglia, F.; Scarpa, R.; Srinivas, S.; Rocco, B.
abstract

Robot assisted radical prostatectomy (RARP) represents the leading application of robotic surgery in the urologic field and it has become the main treatment option for localized prostate cancer (PCa) in the USA In the present review we summarized and critically analyzed the literature of the past five years about this widely used robotic procedure. RARP has continuously evolved in terms of technical modifications and procedural steps. Long-term data are now available, suggesting comparable oncological outcomes to those of open and laparoscopic radical prostatectomy. Good functional outcomes have also been demonstrated. Technological innovations and the introduction of more advanced robotic platforms featuring novel arm-integrated equipment, together with a mature clinical experience with the robotic approach, are likely to lead towards optimal outcomes. Despite the expanding clinical implementation of RARP in the management of prostate cancer, some issues related to this procedure remain matter of debate, such as costs, comparative outcomes versus other approaches, and its role in high risk disease.


2015 - Salvage robot assisted radical prostatectomy: a propensity matched study of perioperative, oncological and functional outcomes [Articolo su rivista]
Bates, A.S.; Samavedi, S.; Kumar, A.; Mouraviev, V.; Rocco, B.; Coelho, R.; Palmer, K.; Patel, V.R.
abstract

Background To report the perioperative, functional and oncological outcomes of salvage robot-assisted laparoscopic prostatectomy (s-RARP) in a propensity score-matched analysis. Study design 53 patients underwent s-RARP at our institution. Perioperative, functional and oncological outcomes were compared between propensity matched cohorts. Results Patients in the s-RARP group were at significantly higher risk based on the D'Amico classification system (p = 0.010). Estimated blood loss, complication rate, hospital stay, BCR risk, persistent cancer and time to return of potency were similar between groups (full nerve spare [NS] n = 22). In the s-RARP cohort there was a higher prevalence of lymphovascular invasion (26.4% versus 13.2%; p = 0.032), time to catheter removal and a higher prevalence of anastomotic leaks in the postoperative period (34.0% vs 5.7%, p < 0.010). The hazard ratio for return to potency regardless of nerve sparing in the s-RARP group was 0.47 (95% CI 0.25-0.88). Significantly more patients undergoing primary RARP with partial nerve sparing (NS) recovered continence (p < 0.001) and potency (p = 0.043) compared to partial NS s-RARP patients. The return to continence and potency did not differ between full NS cases (n = 22; p = 0.616). Conclusions Salvage RARP patients undergoing surgery have more high risk disease. Patients should be counseled that they are more likely to demonstrate anastomotic leakage on cystogram, and prolonged catheterization times. The time to potency and continence in s-RARP undergoing partial and no NS was significantly delayed (n = 49). The proportion of patients returning to potency and continence was also lower in our s-RARP group.


2015 - TriMatch comparison of the efficacy of FloSeal versus TachoSil versus no hemostatic agents for partial nephrectomy: Results from a large multicenter dataset [Articolo su rivista]
Antonelli, Alessandro; Minervini, Andrea; Mari, Andrea; Bertolo, Riccardo; Bianchi, Giampaolo; Lapini, Alberto; Longo, Nicola; Martorana, Giuseppe; Mirone, Vincenzo; Morgia, Giuseppe; Novara, Giacomo; Porpiglia, Francesco; Rocco, Bernardo; Rovereto, Bruno; Schiavina, Riccardo; Simeone, Claudio; Sodano, Mario; Terrone, Carlo; Ficarra, Vincenzo; Carini, Marco; Serni, Sergio
abstract

OBJECTIVES: To evaluate the efficacy of hemostatic agents, TachoSil and FloSeal, during partial nephrectomy using a large multicenter dataset. METHODS: Data of 1055 patients who underwent partial nephrectomy between January 2009 and December 2012 in 19 Italian centers were collected within an observational multicentric study (RECORd Project). The decision whether or not to use hemostatic agents after renorrhaphy and the type of hemostatic agents applied was adopted according to the centers' and surgeons' preference. A TriMatch propensity score analysis was applied to balance three study groups (no hemostatic agents, TachoSil, FloSeal) for sex, age, surgical indication (elective/relative vs imperative), clinical stage (cT1a vs cT1b), tumor exophyticity, approach (open vs minimally invasive), technique (standard partial nephrectomy vs simple enucleation), preoperative hemoglobin and creatinine. Postoperative complications and variation of hemoglobin and creatinine values between preoperative versus third postoperative day were compared. RESULTS: TriMatch analysis allowed us to obtain 66 well-balanced triplets. No differences were found in terms of outcomes between the study groups. CONCLUSIONS: The present findings suggest that adding hemostatic agents to renorraphy during partial nephrectomy does not provide better surgical outcomes.


2015 - Tumor size, stage and grade alterations of urinary peptidome in RCC [Articolo su rivista]
Chinello, Clizia; Cazzaniga, Marta; De Sio, Gabriele; Smith, Andrew James; Grasso, Angelica; Rocco, Bernardo; Signorini, Stefano; Grasso, Marco; Bosari, Silvano; Zoppis, Italo; Mauri, Giancarlo; Magni, Fulvio
abstract

Background: Several promising biomarkers have been found for RCC, but none of them has been used in clinical practice for predicting tumour progression. The most widely used features for predicting tumour aggressiveness still remain the cancer stage, size and grade. Therefore, the aim of our study is to investigate the urinary peptidome to search and identify peptides whose concentrations in urine are linked to tumour growth measure and clinical data. Methods: A proteomic approach applied to ccRCC urinary peptidome (n = 117) based on prefractionation with activated magnetic beads followed by MALDI-TOF profiling was used. A systematic correlation study was performed on urinary peptide profiles obtained from MS analysis. Peptide identity was obtained by LC-ESI-MS/MS. Results: Fifteen, twenty-six and five peptides showed a statistically significant alteration of their urinary concentration according to tumour size, pT and grade, respectively. Furthermore, 15 and 9 signals were observed to have urinary levels statistically modified in patients at different pT or grade values, even at very early stages. Among them, C1RL, A1AGx, ZAG2G, PGBM, MMP23, GP162, ADA19, G3P, RSPH3, DREB, NOTC2 SAFB2 and CC168 were identified. Conclusions: We identified several peptides whose urinary abundance varied according to tumour size, stage and grade. Among them, several play a possible role in tumorigenesis, progression and aggressiveness. These results could be a useful starting point for future studies aimed at verifying their possible use in the managements of RCC patients.


2015 - Tumori dell'alta via escretrice [Capitolo/Saggio]
E., Montanari; Rocco, Bernardo Maria Cesare; M., Poggio
abstract

Tumori dell'alta via escretrice


2015 - USE OF INTRA-OPERATIVE INDOCYANINE GREEN AND FIREFLY (R) TECHNOLOGY TO VISUALIZE THE "LANDMARK ARTERY" FOR NERVE SPARING ROBOT ASSISTED RADICAL PROSTATECTOMY [Abstract in Rivista]
Kumar, A.; Samavedi, S.; Bates, A.; Coelho, R.; Rocco, B.; Marquinez, J.; Jenson, C.; Palmer, K.; Patel, V.
abstract

INTRODUCTION AND OBJECTIVES: The “Landmark Artery” has been shown to be a valuable landmark during nerve sparing radical prostatectomy in improving the quality of the neurovascular bundle (NVB) preservation. Sometimes this landmark can be challenging to find due to inexperience of the surgeon or anatomical challenges. Our goal was to evaluate an innovative intra-operative tool, Near-infrared (NIR) Firefly technology in conjunction with intravenous indocyanine green (ICG) to help identification of this “Landmark Artery ”during nerve sparing(NS) robot assisted radical prostatectomy(RARP). METHODS: Ten patients underwent nerve sparing RARP. Prior to clamping the pedicle or dissection of the NVB,0.75 cc of ICG was given. The Firefly technology was engaged on the robotic console and a period of 20-40 seconds was allowed for the ICG to enter the vascular system. The landmark artery was then observed bilaterally. After this time period we switched back to the non-firefly mode and proceeded with out normal NS operation. Data was collected regarding the % chance of being able to visualize this landmark in the 10 patients. RESULTS: In ten patients 20 NVB were examined with the ICG and Firefly technology. The landmark prostatic artery and its pathway could be identified in 17/20 NVB (85%). In the other 3 patients we were unable to visualize the artery as it was underneath some large veins. The artery was seen visually in these patients during the normal NS surgery. The use of ICG did not significantly increase operative time or result in any immediate or long term complications. CONCLUSIONS: The use of ICG and Firefly technology during NS radical prostatectomy has the potential to more accurately and more frequently identify the landmark prostatic artery that runs along the NVB. For experienced and novice surgeons the pathway of this artery is valuable for NS and can help improve nerve sparing quality


2015 - Use of Intra-Operative Indocyanine Green and Firefly ® Technology to Visualize the “Landmark Artery” for Nerve Sparing Robot Assisted Radical Prostatectomy [Abstract in Rivista]
A., Kumar; S., Samavedi; A., Bates; R., Coelho; Rocco, Bernardo Maria Cesare; J., Marquinez; C., Jenson; K., Palmer; V., Patel
abstract

Use of Intra-Operative Indocyanine Green and Firefly ® Technology to Visualize the “Landmark Artery” for Nerve Sparing Robot Assisted Radical Prostatectomy


2014 - Bladder tumours in children : an interesting case report of TCC with a partial inverted growth pattern [Articolo su rivista]
D. A., El Rahman; G., Salvo; C., Palumbo; Rocco, Bernardo Maria Cesare; F., Rocco
abstract

Bladder urothelial carcinoma is typically a disease of older individuals and rarely occurs below the age of 40 years. There is debate and uncertainty in the literature regarding the clinicopathologic and prognostic characteristics of bladder urothelial neoplasms in younger patients compared with older patients, although no consistent age criteria have been used to define "younger" age group categories. We report on a 16 years old girl with transitional cell carcinoma of the bladder with a partial inverted growth pattern who presented with gross hematuria. Ultrasonography revealed a papillary lesion in the bladder; cystoscopic evaluation showed a 15 mm papillary lesion with a thick stalk located in the left bladder wall. Pathologic evaluation of the specimen was reported as "low grade transitional cell carcinoma of the bladder with a partial inverted growth pattern".


2014 - Concordance between biopsy and radical prostatectomy specimen Gleason score in internal and external pathology facilities [Articolo su rivista]
A. A. C., Grasso; G., Cozzi; C., Palumbo; G., Albo; Rocco, Bernardo Maria Cesare
abstract

Biopsy Gleason score (bGS) is an important tool for staging and decision making in patients with prostate cancer. Therefore, the data from biopsy should be both reproducible across different pathologists and predictive of the true underlying tumour. We evaluated the agreement between bGS with prostatectomy Gleason score (pGS) comparing patients who underwent prostate biopsy at our hospital with those who did it at an outside facility.


2014 - Die postoperative prognose des chromophoben nierenzellkarzinoms. Eine vergleichende analyse anhand der multinationalen CORONA-Datenbank [Articolo su rivista]
M., May; R., Zigeuner; A., Aziz; L., Cindolo; C., Gilfrich; L., Schips; O., De Cobelli; Rocco, Bernardo Maria Cesare; C., De Nunzio; A., Tubaro; I., Coman; B., Feciche; M., Truss; B., Hoschke; O., Dalpiaz; A., Stoltze; F., Fenske; H. M., Fritsche; T., Chromecki; S., Lebentrau; R. S., Figenshau; K., Madison; M., Sanchez Chapado; M., Del Carmen Santiago Martin; L., Salzano; G., Lotrecchiano; S., Joniau; R., Waidelich; C. G., Stief; S., Brookman May; Mitglieder des CORONA, Projects; Projektgruppe Young Academic Urologists Renal Cancer, Group; European Association of, Urology
abstract

N/A


2014 - Do young patients with renal cell carcinoma feature a distinct outcome after surgery? A comparative analysis of patients age 40 years or less versus patients in the seventh decade of life based on the multinational CORONA database [Articolo su rivista]
A., Aziz; M., May; R., Zigeuner; M., Pichler; T., Chromecki; L., Cindolo; L., Schips; O., De Cobelli; Rocco, Bernardo Maria Cesare; C., De Nunzio; A., Tubaro; I., Coman; M., Truss; O., Dalpiaz; B., Hoschke; C., Gilfrich; B., Feciche; F., Fenske; P., Sountoulides; R. S., Figenshau; K., Madison; M., Sánchez Chapado; M. D. C. S., Martin; W. F., Wieland; L., Salzano; G., Lotrecchiano; R., Waidelich; C., Stief; S., Brookman May
abstract

PURPOSE: We analyzed the distinct clinicopathological features and prognosis of patients with renal cell carcinoma age 40 years or less compared to a reference group of patients 60 to 70 years old. MATERIALS AND METHODS: Overall 2,572 patients retrieved from a multicenter international database comprised of 6,234 patients with surgically treated renal cell carcinoma were included in this retrospective study. Clinical and histopathological features of 297 patients 40 years old or younger (4.8%) were compared to those of 2,275 patients (36.5%) 60 to 70 years old, who served as the reference group. Median followup was 59 months. The impact of young age and further parameters on disease specific mortality and all cause mortality was evaluated by multivariate Cox proportional hazards regression analyses. RESULTS: Young patients more frequently underwent nephron sparing surgery (27% vs 20%, p = 0.008) and regional lymph node dissection compared to older patients (38% vs 32%, p = 0.025). Organ confined tumor stage (81% vs 70%, p <0.001), smaller tumor diameter (4.5 vs 4.7 cm, p = 0.014) and chromophobe subtype (10% vs 4%, p <0.001) were significantly more frequent in young patients. On multivariate analysis older patients had a higher disease specific (HR 2.21, p <0.001) and all cause mortality (HR 3.05, p <0.001). The c indices for the Cox models were 0.87 and 0.78, respectively. However, integration of the variable age group did not significantly increase the predictive accuracy of the disease specific and all cause mortality models. CONCLUSIONS: Young patients with renal cell carcinoma (40 years old or younger) have significantly different frequencies of clinical and histopathological features, and a significantly lower all cause and disease specific mortality compared to patients 60 to 70 years old.


2014 - IMPACT OF GENDER IN NEPHRON-SPARING SURGERY: COMPARISON OF PERIOPERATIVE AND PATHOLOGICAL OUTCOMES FROM THE DEFINITIVE RESULTS OF RECORD1 PROJECT [Abstract in Rivista]
Mari, A.; Villari, D.; Sessa, F.; Antonelli, A.; Bertolo, R.; Bianchi, G.; Bigazzi, B.; Longo, N.; Martorana, G.; Mirone, V.; Morgia, G.; Porpiglia, F.; Rocco, B.; Rovereto, B.; Schiavina, R.; Simeone, C.; Sodano, M.; Volpe, A.; Novara, G.; Serni, S.; Carini, M.; Minervini, A.
abstract

IMPACT OF GENDER IN NEPHRON-SPARING SURGERY: COMPARISON OF PERIOPERATIVE AND PATHOLOGICAL OUTCOMES FROM THE DEFINITIVE RESULTS OF RECORD1 PROJECT


2014 - Indication for and Extension of Pelvic Lymph Node Dissection During Robot-assisted Radical Prostatectomy : An Analysis of Five European Institutions [Articolo su rivista]
N., Suardi; A., Larcher; A., Haese; V., Ficarra; A., Govorov; N. M., Buffi; J., Walz; Rocco, Bernardo Maria Cesare; M., Borghesi; T., Steuber; G., Pini; A., Briganti; A. M., Mottrie; G., Guazzoni; F., Montorsi; D., Pushkar; H., Van Der Poel
abstract

Background Several reports have shown that patients who undergo minimally invasive radical prostatectomy have a lower chance of undergoing pelvic lymph node dissection (PLND), irrespective of the disease characteristics. Objective We evaluated the rate and extension of PLND in patients who underwent robot-assisted radical prostatectomy (RARP). We tested the adherence of the indication for PLND to the European Association of Urology (EAU) guidelines. Design, setting, and participants Our study was a multi-institutional retrospective analysis of prospectively collected data on 2985 consecutive patients who underwent RARP at five high-volume European institutions. Patients were stratified according to preoperative cancer risk group. Intervention RARP. Outcome measurements and statistical analysis The rate and extent of PLND across different institutions were analyzed. Univariable and multivariable logistic regression models evaluated the association between preoperative variables and the probability of receiving PLND, as well as the presence of lymph node invasion (LNI). Finally, the probability of LNI was calculated for each patient, and the indication for PLND was compared with the EAU guidelines' indications. Results and limitations A lymph node dissection was performed in 1777 patients (59.7%; 34.5% of low-risk patients, 64.9% of intermediate-risk patients, and 91.2% of high-risk patients). These rates were different across institutions: 5.0-41.4% in low-risk patients (p < 0.001), 31.3-81.4% in intermediate-risk patients (p < 0.001), and 84.6-96.4% in high-risk patients (p = 0.06). The mean and median number of nodes removed was 10.8, and 122 patients (4.1%) had nodal metastases. At multivariable analysis, the institution represented an independent predictor of PLND (p < 0.001). Of patients with current indication for PLND (EAU guidelines), 77.8% actually received the procedure. Limitations were the retrospective study design with different pathologic assessment and lack of follow-up data. Conclusions PLND is performed in a high proportion of patients undergoing RARP in high-volume centers in Europe for whom the procedure is indicated by the EAU guidelines, but significant differences exist among institutions. An effort toward a more rigorous standardization of PLND is advocated. Patient summary In this paper, we investigated the indication for and extension of pelvic lymph node dissection (PLND) in different institutions in Europe. Despite PLND being widely performed, significant variations with regard to PLND do exist among different institutions. Therefore, a thrust toward more rigorous attention to PLND is advocated.


2014 - Management of early prostate cancer [Articolo su rivista]
Rocco, Bernardo Maria Cesare; A., Conti; E., De Lorenzis
abstract

Management of Early Prostate Cancer


2014 - Primary large cell neuroendocrine carcinoma of the renal pelvis : a case report [Articolo su rivista]
C., Palumbo; M., Talso; P. G., Dell'Orto; G., Cozzi; E., De Lorenzis; A., Conti; M., Maggioni; Rocco, Bernardo Maria Cesare; A., Maggioni; F., Rocco
abstract

We report a case of primary large cell neuroendocrine carcinoma of the renal pelvis, diagnosed in a 79-year-old man. The abdominal computed tomography showed a solid, vegetant lesion in the left renal pelvis, conditioning marked hydronephrosis. The patient underwent radical nephroureterectomy. The histological examination showed a large cell neuroendocrine carcinoma associated with a high-grade urothelial carcinoma, with local invasion (pT3). Large cell renal neuroendocrine carcinomas are rare tumors with an aggressive course and a bad prognosis. At present, only five cases were reported in literature.


2014 - Radical prostatectomy or watchful waiting in early prostate cancer : Re [Articolo su rivista]
Rocco, Bernardo Maria Cesare; G., Cozzi
abstract

N/A


2014 - Results of a comparative study analyzing octogenarians with renal cell carcinoma in a competing risk analysis with patients in the seventh decade of life [Articolo su rivista]
M., May; L., Cindolo; R., Zigeuner; O., De Cobelli; Rocco, Bernardo Maria Cesare; C., De Nunzio; A., Tubaro; I., Coman; M., Truss; O., Dalpiaz; I., Wolff; B., Feciche; F., Fenske; M., Pichler; L., Schips; R. S., Figenshau; K., Madison; M., Sánchez Chapado; M. d. C., Santiago Martin; L., Salzano; G., Lotrecchiano; R., Waidelich; C., Stief; P., Sountoulides; S., Brookman May
abstract

Objectives: To analyze clinicopathological features and survival of surgically treated patients with renal cell carcinoma (RCC)≥80 years of age in comparison with patients between the ages of 60 and 70 years. Materials and methods: The data for 2,516 patients with a median follow-up of 57 months were retrieved from a multinational database (Collaborative Research on Renal Neoplasms Association [CORONA]), including data for 6,234 consecutive patients with RCC after radical or partial nephrectomy. Comparative analysis of clinicopathological features of 241 octogenarians (3.9% of the database) and 2,275 reference patients between the ages of 60 and 70 years (36.5%) was performed. Multivariable regression analysis adjusted for competing risks was applied to identify the effect of advanced age on cancer-specific mortality (CSM) and other-cause mortality (OCM). Furthermore, instrumental variable analysis was employed to reduce residual confounding by unmeasured parameters. Results: Significantly more women were present (50% vs. 40%, P = 0.004), and significantly less often nephron-sparing surgery was performed in octogenarians compared with the reference group (11% vs. 20%, P<0.001). Although median tumor size and stages did not significantly defer, older patients less often had advanced or metastatic disease (N+/M1) (4.6% vs. 9.6%, P = 0.009). On multivariable analysis, higher CSM (hazard ratio = 1.48, P = 0.042) and OCM rates (hazard ratio = 4.32, P<0.001) were detectable in octogenarians ( c-indices = 0.85 and 0.72, respectively). Integration of the variable age group in multivariable models significantly increased the predictive accuracy regarding OCM (6%, P<0.001), but not for CSM. Limitations are based on the retrospective study design. Conclusions: Octogenarian patients with RCC significantly differ in clinical features and display significantly higher CSM and OCM rates in comparison with their younger counterparts.


2014 - Transperineal versus transrectal prostate biopsy for predicting the final laterality of prostate cancer : are they reliable enough to select patients for focal therapy? Results from a multicenter international study [Articolo su rivista]
R., Miano; C., De Nunzio; F. J., Kim; Rocco, Bernardo Maria Cesare; P., Gontero; C., Vicentini; S., Micali; M., Oderda; S., Masciovecchio; A. D., Asimakopoulos
abstract

N/A


2013 - 1076 Independent validation of the 2010 TNM staging system for renal cell carcinoma : does it improves predictive accuracy in cancer-specific mortality compared to 2002 TNM? [Abstract in Rivista]
R., Zigeuner; L., Schips; O., De Cobelli; Rocco, Bernardo Maria Cesare; Roscigno, M.; Shariat, S. F.; May, M.; Novara, G.; Zigeuner, R.; Schips, L.; De Cobelli, O.; De Nunzio, C.; Feciche, B.; Truss, M.; Pahernik, S.; Wirth, M. P.; Longo, N.; Simonato, A.; Serni, S.; Siracusano, S.; Volpe, A.; Morgia, G.; Martorana, G.; Francesco, M.; Ficarra, V.; Brookman-May, S.
abstract

INTRODUCTION AND OBJECTIVES The 2009 TNM staging system provided several changes in pT classification: pT2 stage is splitted in pT2a (<= 10 cm) and pT2b (>10 cm); patients with tumor thrombus invading the renal vein are classified as pT3a; infiltration of the wall of the vena cava as pT3c; direct invasion of the adrenal gland is inserted in pT4 stage. Moreover all nodal involvement is classified as pN1. We aimed to analyze wether the new TNM staging system is more accurate than the 2002 TNM classification in predicting the risk of cancer-specific mortality (CSM). GoMETHODS We retrospectively analyzed data of 14040 consecutive patients who underwent radical nephrectomy or nephron-sparing surgery for RCC, between 1987 and 2008. The Kaplan-Meier method and univariable and multivariable Cox regression analyses were used to determine the effect of the 2002 TNM and of the new TNM staging system on CSM. Finally, we compared the accuracy of the 2002 TNM and of the 2009 TNM staging system calculation the area under the ROC curve. Mantel-Haentzel test evaluated the differences in predictive accuracy between the two different classification. GoRESULTS Median follow-up was 63 months (2-290). According to 2002 TNM staging system, no difference was found in survival between pT3c and pT4 patients at univariable analyses. According to the 2009 TNM staging system, pT3c and pT4 patients showed similar survival. The predictive accuracy of pT 2002 and pT2009 was 73.7 and 73.9%, respectively, at univariable analysis. At multivariable Cox regression analysis, both 2002 pT and the new pT classification resulted as independent predictors of the risk of CSM, after adjusting for distant metastases and nodal involvement. Finally, the model including 2002 TNM and the new TNM staging system showed similar accuracy in predicting CSM (AUC= 80.5 vs 80.6%; p=0.89). GoCONCLUSIONS in the TNM 2009, the reclassification in pT2a and pT2b disease seems to really distinguish two groups of patients with different prognosis, as well as in case of pT3a, pT3b and pT3c subgroup of patients. However, no difference was found in CSM between pT3c and pT4 patients according to both 2002 and 2009 TNM classification. The new TNM staging system is an accurate tool to predict CSM, but does not improve accuracy in predicting patient outcomes with respect to the 2002 TNM staging system. Further improvement in patient risk stratification will be required.


2013 - Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort [Articolo su rivista]
C., De Nunzio; L., Cindolo; C., Leonardo; A., Antonelli; C., Ceruti; G., Franco; M., Falsaperla; M., Gallucci; M., Alvarez Maestro; A., Minervini; V., Pagliarulo; P., Parma; S., Perdonà; A., Porreca; Rocco, Bernardo Maria Cesare; L., Schips; S., Serni; M., Serrago; C., Simeone; G., Simone; R., Spadavecchia; A., Celia; P., Bove; S., Zaramella; S., Crivellaro; R., Nucciotti; A., Salvaggio; B., Frea; V., Pizzuti; L., Salsano; A., Tubaro
abstract

N/A


2013 - Assessing the accuracy and generalizability of the preoperative and postoperative Karakiewicz nomograms for renal cell carcinoma : results from a multicentre European and US study [Articolo su rivista]
L., Cindolo; P., Chiodini; S., Brookman May; O., De Cobelli; M., May; S., Squillacciotti; C., De Nunzio; A., Tubaro; I., Coman; B., Feciche; M., Truss; M. P., Wirth; O., Dalpiaz; T. F., Chromecki; S. F., Shariat; M., Sanchez Chapado; M., Del Carmen Santiago Martin; Rocco, Bernardo Maria Cesare; L., Salzano; G., Lotrecchiano; F., Berardinelli; L., Schips
abstract

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: The preoperative and postoperative Karakiewicz models for RCC are considered among the best prognostic tools available for clinical counseling. Nevertheless, their predictive acuracy was externally validated only in two papers: by the same author and in an independent sample of Asian patients. However, these models have not been externally validated in truly independent multicentre series of patients. Our study demonstrated that these models 1) provide robust prognostic information; 2) were robustly built; 3) are useful also in population far from the original series. The present results are the first to show the validity and generalizability of Karakiewicz nomograms, which are based on surgical series from European centres, for large-, mid- and small-volume European and American centres. OBJECTIVE: To assess the accuracy and generalizability of the pre- and postoperative Karakiewicz nomograms for predicting cancer-specific survival (CSS) in patients with renal cell carcinoma (RCC). PATIENTS AND METHODS: This retrospective study included 3231 patients from European and US centres, who were treated by radical or partial nephrectomy for RCC between 1992 and 2010. Prognostic scores for each patient were calculated and the primary endpoint was CSS. Discriminating ability was assessed by Harrell's c-index for censored data. The 'validation by calibration' method proposed by Van Houwelingen was used for checking the calibration of covariate effects. Calibration was graphically explored. RESULTS: Local and systemic symptoms were present in 23.2% and 9.1% of the patients, respectively. The median follow-up (FU) was 49 months. At the last FU, 408 cancer-related deaths were recorded, Kaplan-Meier estimates of CSS (with 95% confidence intervals [CIs]) at 5 and 10 years were 0.86 (0.84-0.87) and 0.77 (0.75-0.80), respectively. Both nomograms discriminated well. Stratified c-indices for CSS were 0.784 (95% CI 0.753-0.814) for the preoperative nomogram, and 0.842 (95% CI 0.816-0.867) for the postoperative one, with a significant difference between the two values (P < 0.001). The covariate-based predictions on our data for both nomograms were valid. The calibration plots showed no relevant departures from ideal predictions. CONCLUSIONS: The results suggest that the postoperative Karakiewicz nomogram discriminates substantially better than the preoperative one. These nomogram-based predictions may be used as benchmark data for pretreatment and postoperative decision-making in patients at various stages of RCC.


2013 - Erratum to : Open versus robotic-assisted partial nephrectomy: a multicenter comparison study of perioperative results and complications [Articolo su rivista]
A., Minervini; G., Vittori; A., Antonelli; A., Celia; S., Crivellaro; D., Dente; V., Di Santo; B., Frea; M., Gacci; A., Gritti; L., Masieri; A., Morlacco; A., Porreca; Rocco, Bernardo Maria Cesare; P., Parma; C., Simeone; S., Zaramella; M., Carini; S., Serni
abstract

N/A


2013 - Features Associated with Recurrence Beyond 5 Years After Nephrectomy and Nephron-Sparing Surgery for Renal Cell Carcinoma: Development and Internal Validation of a Risk Model (PRELANE score) to Predict Late Recurrence Based on a Large Multicenter Database (CORONA/SATURN Project). [Articolo su rivista]
Brookman May, S; May, M; Shariat, Sf; Xylinas, E; Stief, C; Zigeuner, R; Chromecki, T; Burger, M; Wieland, Wf; Cindolo, L; Schips, L; De Cobelli, O; Rocco, Bernardo Maria Cesare; De Nunzio, C; Feciche, B; Truss, M; Gilfrich, C; Pahernik, S; Hohenfellner, M; Zastrow, S; Wirth, Mp; Novara, G; Carini, M; Minervini, A; Simeone, C; Antonelli, A; Mirone, V; Longo, N; Simonato, A; Carmignani, G; Ficarra, V; members of the CORONA, Project; the SATURN, Project
abstract

N/A


2013 - Functional outcomes after treatment for prostate cancer [Articolo su rivista]
Rocco, Bernardo Maria Cesare; De Lorenzis, E.; Palumbo, C.
abstract

Long-term functional outcomes after treatment for localized prostate cancer. [N Engl J Med. 2013]


2013 - Gender differences in clinicopathological features and survuval in surgically treated patints with renal cell carcinoma: an analysis of the multicenter CORONA database [Articolo su rivista]
M., May; A., Aziz; R., Zigeuner; T., Chromecki; L., Cindolo; L., Schips; O., De Cobelli; Rocco, Bernardo Maria Cesare; C., De Nunzio; A., Tubaro; I., Coman; M., Truss; O., Dalpiaz; B., Hoschke; C., Gilfrich; B., Feciche; A., Stoltze; F., Fenske; H. M., Fritsche; R. S., Figenshau; K., Madison; M., Sanchez Chapado; M. D., Martin; L., Salzano; G., Lotrechiano; S., Joniau; R., Waidelich; C., Stief; S., Brookman May; the CORONA project the Young Academic Urologists Renal Cancer, Group
abstract

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2013 - Important technical modifications to improve outcomes in robotic assisted radical prostatectomy - lessons learned after 5.000 cases [Abstract in Rivista]
Rocco, Bernardo Maria Cesare; Giedelman, C.; Muhsin, H. A.; Schatloff, O.; Samavedi, S.; Coelho, R.; Palmer, K.; Chauhan, S.; Sivaraman, A.; Patel, V.
abstract

Important technical modifications to improve outcomes in robotic assisted radical prostatectomy - lessons learned after 5.000 cases


2013 - Nuances in nerve sparing during robotic assisted radical prostatectomy [Abstract in Rivista]
Rocco, Bernardo Maria Cesare; Giedelman, C.; Muhsin, H. A.; Schatloff, O.; Samavedi, S.; Coelho, R.; Palmer, K.; Chauhan, S.; Sivaraman, A.; Patel, V.
abstract

INTRODUCTION AND OBJECTIVES: We have previously published our work identifying anatomical landmarks for grading of nerve sparing. We now demonstrate further nuances in nerve preservation during Robotic assisted Radical Prostatectomy. METHODS: The present study is a combination of a single surgeon experience after 5000 patients and a compilation of videos detailing some possible scenarios that surgeons might face when performing nerve sparing. RESULTS: Case 1: 55 year old man with PSA of 5, SHIM score 25, DRE reveals T1c with and low volume disease. Complete bilateral nerve sparing is performed. Case 2: 60 year old man with SHIM score of 25, PSA of 7.2, and normal DRE. During the dissection of NVB, the surgeon initially misses the correct plane then correcting it to proceed Vol. 189, No. 4S, Supplement, Monday, May 6, 2013 THE JOURNAL OF UROLOGY e521 more medially and preserve the capsular artery, thereby achieving a full nerve spare. Case 3: is a 47 year old man with a SHIM score of 25, and an intermediate risk grade cancer having a partial nerve sparing. In Case four, we show you the technique to protect the base during robot-assisted radical prostatectomy. All patients had negative surgical margins. CONCLUSIONS: Nerve sparing should be tailored according to the patient’s preoperative pathology as well as intraoperative tissue characteristics. Surgeon’s experience plays a key part. Preoperative pathology and intraoperative visual cues as well as attention to tissue planes are paramount to achieve good outcomes.


2013 - Perineural invasion as a predictor of extraprostatic extension of prostate cancer : a systematic review and meta-analysis [Articolo su rivista]
G., Cozzi; Rocco, Bernardo Maria Cesare; A., Grasso; M., Rosso; D., Abed El Rahman; I., Oliva; M., Talso; B., Costa; A., Tafa; C., Palumbo; F., Gadda; F., Rocco
abstract

A systematic review of the literature was performed to assess the relationship between the presence of perineural invasion (PNI) at prostate biopsy and extraprostatic extension (EPE) of prostate cancer. In August 2012, Medline, Embase, Scopus and Web of Science databases were searched. A "free-text" protocol using the terms "perineural invasion prostate cancer" was applied. Studies published only as abstracts and reports from meetings were not included in this review. In total, 341 records were retrieved from Medline, 507 from Embase, 374 from Scopus and 65 from the Web of Science database. The records were reviewed to identify studies correlating the presence of PNI with that of EPE. A cumulative analysis was conducted using Review Manager software v. 5.1 (Cochrane Collaboration, Oxford, UK). In univariate analysis, PNI showed a statistically significant association with pT3 tumours (p < 0.00001), which could be observed for both pT3a (p < 0.0001) and pT3b (p < 0.0001). In conclusion, the cumulative analysis shows a statistically significant higher incidence of EPE in patients who had PNI at needle biopsy. The main limitation of the analysis was that it was not possible to perform a multivariate analysis. Further attempts to build a nomogram for the prediction of EPE could include the presence of PNI at needle biopsy.


2013 - Perioperative and early oncological outcomes after robot-assisted radical prostatectomy (RARP) in morbidly obese patients : a propensity score-matched study [Articolo su rivista]
H., Abdul Muhsin; C., Giedelman; S., Samavedi; O., Schatloff; R., Coelho; Rocco, Bernardo Maria Cesare; K., Palmer; G., Ebra; V., Patel
abstract

N/A


2013 - Posterior reconstruction of the rhabdosphincter [Capitolo/Saggio]
Rocco, Bernardo Maria Cesare; G., Albo; G., Cozzi; P., Acquati; F., Rocco
abstract

N/A


2013 - Prognostic effect of sarcomatoid dedifferentiation in patients with surgically treated renal cell carcinoma : a matched-pair analysis [Articolo su rivista]
S., Brookman May; M., May; S. F., Shariat; R., Zigeuner; T., Chromecki; L., Cindolo; L., Schips; O., De Cobelli; Rocco, Bernardo Maria Cesare; C., De Nunzio; A., Tubaro; B., Feciche; I., Coman; M., Truss; S., Pahernik; M. P., Wirth; S., Zastrow; O., Dalpiaz; F., Fenske; R., Waidelich; C., Stief; S., Gunia
abstract

BACKGROUND: The aim of this study was to assess the prognostic relevance of SD in patients with RCC. PATIENTS AND METHODS: Among 8126 RCC patients surgically treated at 12 academic centers (members of the Collaborative Research on Renal Neoplasms Association [CORONA] project), 316 patients (3.9%) had SD with sarcomatoid areas comprising at least 10% of the tumor tissue. After propensity score-based matched-pair analysis, 281 with and 281 matched RCC patients without SD remained available for direct comparison of cancer-specific survival (CSS). Median follow-up was 36.5 months (interquartile range, 15-82). Uni- and multivariable Cox proportional hazards regression analyses were performed to assess the prognostic value of parameters. RESULTS: In univariable analysis, there was no difference in CSS between patients with or without SD (1 and 5 years CSS, 79% vs. 83% and 59% vs. 64%, respectively; hazard ratio, 1.21; P = .16). Multivariable analysis in patients with SD identified metastatic dissemination at the time of surgery, pT-stage, nodal status, and tumor size as independent predictors of CSS. This study was limited by its retrospective multicenter design and lack of central histopathological review. CONCLUSION: Sarcomatoid dedifferentiation was not an independent predictor of CSS in surgically treated RCC patients in the present matched-pair series. Because pathology reports form the basis on which study specimens are selected for further studies, which are clearly needed to advance our understanding of the prognostic value of SD in RCC, it is imperative that pathologists reliably report on absence or presence and the estimated percentage of a coexisting sarcomatoid component.


2013 - Robotic prostatectomy : an update on functional and oncologic outcomes [Articolo su rivista]
G., Cozzi; E., De Lorenzis; C., Palumbo; P., Acquati; G., Albo; P., Dell'Orto; A., Grasso; Rocco, Bernardo Maria Cesare
abstract

Since the first procedure performed in 2000, robotic-assisted radical prostatectomy (RARP) has been rapidly gaining increasing acceptance from both urologists and patients. Today, RARP is the dominant treatment option for localised prostate cancer (PCa) in the United States, despite the absence of any prospective randomised trial comparing RARP with other procedures. Robotic systems have been introduced in an attempt to reduce the difficulty involved in performing complex laparoscopic procedures and the related steep learning curve. The recognised advantages of this kind of minimally invasive surgery are three-dimensional (3D) vision, ten-fold magnification, Endowrist technology with seven degrees of freedom, and tremor filtration. In this article, we examine this technique and report its functional (in terms of urinary continence and potency) and oncologic results. We also evaluate the potential advantages of RARP in comparison with open and laparoscopic procedures. Copyright:


2013 - Robotics in uro-oncologic surgery [Articolo su rivista]
E., De Lorenzis; C., Palumbo; G., Cozzi; M., Talso; M., Rosso; B., Costa; F., Gadda; Rocco, Bernardo Maria Cesare
abstract

In urology, the main use for the robotic technique has been in radical prostatectomy for prostate cancer. Robotic surgery for other organs, such as the kidneys and bladder, has been less explored. However, partial nephrectomy or radical nephroureterectomy can be difficult for inexperienced laparoscopic surgeons. The advent of the da Vinci robot, with multijointed endowristed instruments and stereoscopic vision, decreases the technical difficulty of intracorporeal suturing and improves the reconstructive steps. The objective of this article is to offer an overview of all robotic procedures recently developed in the field of urology. We evaluate the feasibility of these procedures and their potential advantages and disadvantages. We also describe perioperative, postoperative, and oncologic outcomes of robot-assisted surgery as well as perform a comparison with open and laparoscopic techniques. Comparative data and an adequate follow-up are needed to demonstrate equivalent oncologic outcomes in comparison with traditional open or laparoscopic procedures. Copyright:


2013 - Testing the AGILE database for an external validation of a nomogram to predict malignacy or aggressiveness of renal masses, based on R.E.N.A.L. score [Abstract in Rivista]
A., Antonelli; A., Minervini; L., Cindolo; A., Porreca; S., Crivellaro; P., Parma; S., Zaramella; Rocco, Bernardo Maria Cesare; P., Bove; V., Pagliarulo; A., Celia; C., Ceruti; M., Falsaperla; R., Nuciotti
abstract

Testing the AGILE database for an external validation of a nomogram to predict malignacy or aggressiveness of renal masses, based on R.E.N.A.L. score


2012 - A MULTI-INSTITUTIONAL ANALYSIS OF PENTAFECTA OUTCOMES AFTER ROBOTIC ASSISTED RADICAL PROSTATECTOMY IN HIGH VOLUME CENTERS [Abstract in Rivista]
Muhsin, Ha; Chauhan, S; Samavedi, S; Schatloff, O; Sivaraman, A; Giedelman, C; Sooriakumaran, P; Srivastava, A; El Rahman, Da; Urzua, C; Coelho, R; Palmer, K; Badani, K; Rocco, Bernardo Maria Cesare; Tewari, A; Patel, V.
abstract

A MULTI-INSTITUTIONAL ANALYSIS OF PENTAFECTA OUTCOMES AFTER ROBOTIC ASSISTED RADICAL PROSTATECTOMY IN HIGH VOLUME CENTERS


2012 - Algoritmi terapeutici [Capitolo/Saggio]
Rocco, Bernardo Maria Cesare; Albo, G; Dell'Orto, P.
abstract

N/A


2012 - BPH : state of the art in the surgical treatment [Articolo su rivista]
A. C., Grasso; G., Albo; G., Cozzi; M. G., Spinelli; M., Talso; P. G., Dell'Orto; M., Ferruti; Rocco, Bernardo Maria Cesare; F., Rocco
abstract

TURP has been considered the gold standard for surgical treatment of BPH for many years. Symptoms relief, improvement in maximum flow rate and reduction of post void residual urine have been reported in several experiences. Nevertheless, concerns have been reported in terms of safety outcomes: intracapsular perforation, TUR syndrome, bleeding. In the recent years the use of new forms of energy and devices such as bipolar resector, Ho: YAG and potassium-titanyl-phosphate laser are challenging the role of traditional TURP for BPH surgical treatment. In 1999 TURP represented 81% of surgical treatment for BPH versus 39% in 2005. We have analyzed guidelines and recent literature to evaluate the role of the most relevant new surgical approaches compared to TURP for the treatment of BPH.


2012 - Current status of salvage robot-assisted laparoscopic prostatectomy for radiorecurrent prostate cancer. [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Cozzi, G; Spinelli, Mg; Grasso, A; Varisco, D; Coelho, Rf; Patel, Vr
abstract

Radiation therapy (RT) is one of the treatment options for prostate cancer (PCa). Transperineal low-dose rate brachytherapy (BT) is another safe and effective technique for low-risk PCa. Recurrence after RT for localized PCa can be defined by a PSA value of 2 ng/mL above the nadir after RT, and biochemical recurrence (BCR) rate after RT is 40-60 %. In case of radiorecurrent PCa, treatment options include salvage radical prostatectomy (RP), cryotherapy, high-intensity focused ultrasound (HIFU), and salvage BT. Only salvage RP has cancer control results for over 10-year follow-up in a substantial portion of patients (30-40 %). However, salvage RP is technically demanding, and experienced surgeons are needed; in fact, RT-induced cystitis, fibrosis, and tissue plane obliteration can lead to significant complications, such as rectal injuries, anastomotic stricture, and urinary incontinence. This review describes indications, oncologic and functional outcomes, surgical techniques, and complications of salvage robot-assisted RP.


2012 - Does the Presence of Median Lobe Affect Outcomes of Robot-Assisted Laparoscopic Radical Prostatectomy? [Articolo su rivista]
Coelho, Rf; Chauhan, S; Guglielmetti, Gb; Orvieto, Ma; Sivaraman, A; Palmer, Kj; Rocco, Bernardo Maria Cesare; Coughlin, G; El Hassan, R; Dall'Oglio, Mf; Patel, Vr
abstract

Purpose: To determine whether the presence of median lobe (ML) affects perioperative outcomes, positive surgical margin (PSM) rates, and recovery of urinary continence after robot-assisted radical prostatectomy (RARP). Patients and Methods: We analyzed 1693 consecutive patients undergoing RARP performed by a single surgeon. Patients were analyzed in two groups based on the presence or not of a ML identified during RARP. Perioperative outcomes, PSM rates, and recovery of urinary continence were compared between the groups. Continence was assessed using validated questionnaires, and it was defined as the use of "no pads" postoperatively. Results: A ML was identified in 323 (19%) patients. Both groups had similar estimated blood loss, length of hospital stay, pathologic stage, complication rates, anastomotic leakage rates, overall PSM rates, and PSM rate at the bladder neck. The median overall operative time was slightly greater in patients with ML (80 vs 75 min, P < 0.001); however, there was no difference in the operative time when stratifying this result by prostate weight. Continence rates were also similar between patients with and without ML at 1 week (27.8% vs 27%, P = 0.870), 4 weeks (42.3% vs 48%, P = 0.136), 12 weeks (82.5% vs 86.8%, P = 0.107), and 24 weeks (91.5% vs 94.1%, P = 0.183) after catheter removal. Finally, the median time to recovery of continence was similar between the groups (median: 5 wks, 95% confidence interval [CI]: 4.41-5.59 vs median: 5 wks, CI 4.66-5.34; log rank test, P = 0.113). Conclusion: The presence of a ML does not affect outcomes of RARP performed by an experienced surgeon.


2012 - Evidence-based critical analysis of robotic prostatectomy outcomes [Capitolo/Saggio]
Rocco, Bernardo Maria Cesare; Melegari, S; Cohelo, R; Patel, V.
abstract

N/A


2012 - IMPORTANT TECHNICAL MODIFICATIONS TO IMPROVE OUTCOMES IN RARP - LESSONS LEARNED AFTER 5.000 CASES [Abstract in Rivista]
Giedelman, C; Chauhan, S; Schatloff, O; Sivaraman, A; Abdul Muhsin, H; Coelho, R; Rocco, Bernardo Maria Cesare; Palmer, K; Patel, V.
abstract

IMPORTANT TECHNICAL MODIFICATIONS TO IMPROVE OUTCOMES IN RARP - LESSONS LEARNED AFTER 5.000 CASES


2012 - Improving outcomes for early return of urinary continence [Capitolo/Saggio]
Rocco, Bernardo Maria Cesare; Cozzi, G; Melegari, S; Patel, V.
abstract

N/A


2012 - Launching a successful robotic program [Monografia/Trattato scientifico]
Palmer, Kenneth J.; Orvieto, Marcelo A.; Rocco, Bernardo M.; Patel, Vipul R.
abstract

In spite of the substantial benefits of robotic surgery (RS) over standard laparoscopy, performing robotic surgery still requires for the surgeon to undergo a necessary learning curve (LC), in order to ensure the safe introduction of this technology. In this setting the adoption of RS at any institution requires the establishment of a well-structured plan and certain key elements to be in place to ensure successful implementation of a robotics program. A thorough initial design and implementation lead to the execution of clinical services, which meet previously established goals. Once the execution phase is established, the next step is to focus on maintenance and growth to maximize the benefits of the program We portray the necessary phases for creating a successful robotic program, paying special attention to the aspects that allowed our facility to create a profitable robotic-assisted laparoscopic prostatectomy program The true success and durability of RS will depend on long-term outcomes. For individual programs, a thorough infrastructure is necessary to approachoverall profitability and efficiency. Initial planning is dependent on a risk/benefit analysis, economic model, and lead surgeon. Realistic early expectations often require a substantial initial investment An OR team, hospital administration support, possible OR modification, and continued marketing become the next agenda. Each focus area should be established prior to the launch of the program. Finally, it is important to frequently review the goals of the program in the initial phase because early identification of problem areas, possible changes to improve efficiency or outcomes, and justification for the risk/cost of a program can all be obtained and handled ahead of time


2012 - Modified technique of robotic-assisted simple prostatectomy: advantages of a vesico-urethral anastomosis [Articolo su rivista]
R. F., Cohelo; S., Chauhan; A., Sivaraman; K. J., Palmer; M. A., Orvieto; Rocco, Bernardo Maria Cesare; G., Coughlin; V. R., Patel
abstract

OBJECTIVES To describe a technical modification during robotic-assisted simple prostatectomy (RASP) aiming to decrease perioperative blood loss, shorten the length of hospital stay and eliminate the need of postoperative continuous bladder irrigation. To describe perioperative outcomes, pathological findings and functional outcomes of our single-surgeon series using this technique. METHODS We analysed six consecutive patients who underwent RASP using our technical modification between February and September 2010. Transrectal ultrasonography (TRUS) guided prostate biopsy was performed in all cases and revealed benign prostatic hyperplasia in two cases and benign prostatic hyperplasia plus chronic prostatitis in four cases. The mean estimated prostate volume in the TRUS was 157 +/- 74 (range 90-300) mL and the average preoperative International Prostate Symptom score was 19.8 +/- 9.6 (10-32). Two patients were in urinary retention before surgery. Our technique of RASP includes the standard operative steps reported during open and laparoscopic simple prostatectomy; however, with the addition of some technical modifications during the reconstructive part of the procedure. Following the resection of the adenoma, instead of performing the classical 'trigonization' of the bladder neck and closure of the prostatic capsule, we propose three modified surgical steps: plication of the posterior prostatic capsule, a modified van Velthoven continuous vesico-urethral anastomosis and, finally, suture of the anterior prostatic capsule to the anterior bladder wall. RESULTS The patients' average age was 69 +/- 4.9 (63-74) years; the mean estimated blood loss was 208 +/- 66 (100-300) mL and the mean operative time was 90 +/- 17.6 (75-120) min. All patients were discharged on postoperative day 1 without the need of continuous bladder irrigation at any time after RASP. No blood transfusion or perioperative complications were reported. The mean weight of the surgical specimen was 145 +/- 41.6 (84-186) g. Histopathological evaluation revealed benign prostatic hyperplasia plus chronic prostatitis in five patients and prostatic adenocarcinoma (Gleason score 3 + 3, pT1a) with negative surgical margins in one patient. The mean serum prostate-specific antigen level decreased from 7 +/- 2.5 (4.211) ng/mL preoperatively to 1.05 +/- 0.8 (0.22.5) after RASP. Significant improvement from baseline was reported in the average International Prostate Symptom score (average preoperative vs postoperative, 19.8 +/- 9.6 vs 5.5 +/- 2.5, P = 0.01) and in mean maximum urine flow (average preoperative vs postoperative 7.75 +/- 3.3 vs 19 +/- 4.5 mL/s, P = 0.019) at 2 months after RASP. All patients were continent (defined as the use of no pads) at 2 months after RASP. CONCLUSIONS Our modified technique of RASP is a safe and feasible option for treatment of lower urinary tract symptoms caused by large prostatic adenomas. Potential advantages of our technique include reduced blood loss, lower blood transfusion rates and shorter length of hospital stay with no need of postoperative continuous bladder irrigation. Larger series with longer follow-up are necessary to determine long-term outcomes in comparison to open simple prostatectomy or to the standard technique of RASP.


2012 - NUANCES IN NERVE SPARING DURING RARP [Abstract in Rivista]
Giedelman, Ca; Schatloff, O; Chauhan, S; Coelho, R; Palmer, K; Sivaraman, A; Rocco, Bernardo Maria Cesare; Lee, Sy; Patel, V.
abstract

NUANCES IN NERVE SPARING DURING RARP


2012 - NUANCES IN NERVE SPARING DURING RARP [Abstract in Rivista]
Giedelman, C; Abdul Mushin, H; Schatloff, O; Chauhan, S; Sivaraman, A; Coelho, R; Rocco, Bernardo Maria Cesare; Palmer, K; Patel, V.
abstract

INTRODUCTION & OBJECTIVES: We have previously published our work identifying anatomical landmarks for grading of nerve sparing. We now demonstrate further nuances in nerve preservation during RARP. MATERIAL & METHODS: The present study is a combination of a single surgeon experience after 5000 patients and a compilation of videos detailing some possible scenarios that surgeons might face when performing nerve sparing. RESULTS: Case 1: 55 year old man with PSA of 5, SHIM score 25, DRE reveals T1c with and low volume disease. Complete bilateral nerve sparing is performed. Case 2: 60 year old man with SHIM score of 25, PSA of 7.2, and normal DRE. During the dissection of NVB, the surgeon initially misses the correct plane then correcting it to proceed more medially and preserve the capsular artery, thereby achieving a full nerve spare. Case 3: is a 47 year old man with a SHIM score of 25, and an intermediate risk grade cancer having a partial nerve sparing. In Case four, we show you the technique to protect the base during robot-assisted radical prostatectomy. All patients had negative surgical margins. CONCLUSIONS: Case 1: 55 year old man with PSA of 5, SHIM score 25, DRE reveals T1c with and low volume disease. Complete bilateral nerve sparing is performed. Case 2: 60 year old man with SHIM score of 25, PSA of 7.2, and normal DRE. During the dissection of NVB, the surgeon initially misses the correct plane then correcting it to proceed more medially and preserve the capsular artery, thereby achieving a full nerve spare. Case 3: is a 47 year old man with a SHIM score of 25, and an intermediate risk grade cancer having a partial nerve sparing. In Case four, we show you the technique to protect the base during robot-assisted radical prostatectomy. All patients had negative surgical margins.


2012 - Optimising prostate biopsy [Articolo su rivista]
Djavan, B; Rocco, Bernardo Maria Cesare
abstract

N/A


2012 - POSTERIOR RECONSTRUCTION OF THE RHABDOSPHINCTER IMPROVES EARLY RECOVERY OF URINARY CONTINENCE AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY [Abstract in Rivista]
Pushkar, D.; Govorov, A.; Rasner, P.; Kolontarev, K.; Rocco, B.
abstract

Context In 2001, Rocco et al. described a surgical technique whose aim was the reconstruction of the posterior musculofascial plate after radical prostatectomy (RP) to improve early return to urinary continence. Since then, many surgeons have applied this technique—either as it was described or with some modification—to open, laparoscopic, and robot-assisted RP. Objective To review the outcomes reported in comparative studies analysing the influence of reconstruction of the posterior aspect of the rhabdosphincter after RP. The main outcome evaluated was urinary continence at 3–7 d, 30–45 d, 90 d, 180 d, and 1 yr after catheter removal. Evidence acquisition A systematic review of the literature was performed in November 2011, searching the Medline, Embase, Scopus, and Web of Science databases. A “free-text” protocol using the terms posterior reconstruction of the rhabdosphincter, posterior rhabdosphincter, and early continence was applied. Studies published only as abstracts and reports from meetings were not included in this review. One thousand seven records were retrieved from the Medline database, 1541 from the Embase database, 1357 from the Scopus database, and 1041 from the Web of Science database. The authors reviewed the records to identify studies comparing cohorts of patients who underwent RP with or without restoration of the posterior aspect of the rhabdosphincter. Only papers evaluating use of this technique as the only technical modification among the groups were included. A cumulative analysis was conducted using Review Manager v.5.1 software (Cochrane Collaboration, Oxford, UK). Evidence synthesis Eleven studies were identified in the literature search, including two randomised controlled trials (RCTs), which were negative studies. The cumulative analysis of comparative studies showed that reconstruction of the posterior musculofascial plate improves early return of continence within the first 30 d after RP (p = 0.004), while continence rates 90 d after surgery are not affected by use of the reconstruction technique. The statistical significance of the reconstruction seems to decrease when higher continence rates are reported. Use of posterior rhabdosphincter reconstruction does not seem to be related to positive surgical margin (PSM) rates or with complications like acute urinary retention (AUR) and bladder neck stricture (BNS). Some studies suggested lower anastomotic leakage rates with the posterior musculofascial plate reconstruction technique. Conclusions The role of reconstruction of the posterior musculofascial plate in terms of earlier continence recovery is encouraging but still controversial. Methodological flaws and poor surgical standardisation seem to be the major causes. In two RCTs and one parallel (not randomised) group trial, posterior rhabdosphincter reconstruction offered no significant advantage for return of early continence after RP. No significant complications related to the posterior musculofascial plate reconstruction technique have been reported so far. A multicentre RCT is necessary to clarify the possible role of the technique in terms of earlier continence recovery.


2012 - PREDICTORS OF COMPLETE NERVE SPARING DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY [Abstract in Rivista]
Schatloff, O; Sivaraman, A; Chauhan, S; Giedelman, C; Samavedi, S; Abdul Muhsin, H; Coelho, R; Rocco, Bernardo Maria Cesare; Palmer, K; Patel, V.
abstract

PREDICTORS OF COMPLETE NERVE SPARING DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY


2012 - PROPOSAL OF A METHOD TO ASSESS AND REPORT THE EXTENT OF RESIDUAL NERVE TISSUE PRESENT ON RADICAL PROSTATECTOMY SPECIMENS [Abstract in Rivista]
Schatloff, O; Chauhan, S; Sivaraman, A; Abdul Muhsin, H; Samavedi, S; Giedelman, C; Coelho, R; Rocco, Bernardo Maria Cesare; Palmer, K; Patel, V.
abstract

Objective: Use of nerve sparing (NS) prostatectomy in highrisk prostate cancer (HRCaP) is controversial, due to the higher incidence of extraprostatic extension of tumor. However we believe that in a subset of HRCaP, with clinically localized disease, favourable biopsy characteristics and disease which is macroscopically feasible for resection that it is possible to perform a NS-RALP without compromising oncological safety. We analyzed our outcomes in preoperative high-risk patients according to D’Amico risk stratification and nerve preservation. Materials and Methods: An institutional review board (IRB) approved, prospective robot assisted radical prostatectomy (RARP) database was analyzed retrospectively. Of 1,720 patients who underwent RARP, 147 patients had a PSA >20, Gleason 8 or more and clinical stage T2c–T4. Bilateral full nerve sparing (BNS) and partial nerve sparing (PNS) was performed when oncologically feasible. Biochemical Recurrence (BCR) was defined as >0.2 ng/ml; Continence as the use of ‘no pads’; potency as the ability to achieve and maintain satisfactory erections firm enough for sexual intercourse for more than 50% of the times, with or without the use of PDE 5 inhibitors. Results: The mean follow-up (± SD) was 19 months (6.9). Mean serum psa was 8.5 ± 7.32. Bilateral, partial and nonnerve sparing was done in 22.1%, 40% and 37.9% respectively. Histopathological evaluation showed 52.1% of tumors to be organ confined. Extraprostatic extension was present in 24.3% and overall positive surgical margins (PSM) were present in 21.4% of which pT2 PSM rate was 5.4%. Overall BCR rate was 16.4% and ranged from 22.9% in NNS, 12.54% in PNS and 12.9% BNS. This difference was not significant. The overall potency rates were 66.1% for PNS and 87.1% for BNS. Overall continence rates were for both PNS and BNS were above 90%. The trifecta was achieved in 60% of PNS and 71% of BNS. Conclusion: Nerve sparing in RARP is feasible without compromising oncological safety in selected preoperatively high-risk patients. The short term outcomes are comparable to open series with similar cohorts. Surgeon experience and precise preoperative characterization tumor is essential to identify the subset of patients in whom nerve sparing is feasible.


2012 - Posterior Musculofascial Reconstruction After Radical Prostatectomy: A Systematic Review of the Literature [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Cozzi, G; Spinelli, Mg; Coelho, Rf; Patel, Vr; Tewari, A; Wiklund, P; Graefen, M; Mottrie, A; Gaboardi, F; Gill, Is; Montorsi, F; Artibani, W; Rocco, F.
abstract

Context: In 2001, Rocco et al. described a surgical technique whose aim was the reconstruction of the posterior musculofascial plate after radical prostatectomy (RP) to improve early return to urinary continence. Since then, many surgeons have applied this technique-either as it was described or with some modification-to open, laparoscopic, and robot-assisted RP. Objective: To review the outcomes reported in comparative studies analysing the influence of reconstruction of the posterior aspect of the rhabdosphincter after RP. The main outcome evaluated was urinary continence at 3-7 d, 30-45 d, 90 d, 180 d, and 1 yr after catheter removal. Evidence acquisition: A systematic review of the literature was performed in November 2011, searching the Medline, Embase, Scopus, and Web of Science databases. A "freetext'' protocol using the terms posterior reconstruction of the rhabdosphincter, posterior rhabdosphincter, and early continence was applied. Studies published only as abstracts and reports from meetings were not included in this review. One thousand seven records were retrieved from the Medline database, 1541 from the Embase database, 1357 from the Scopus database, and 1041 from the Web of Science database. The authors reviewed the records to identify studies comparing cohorts of patients who underwent RP with or without restoration of the posterior aspect of the rhabdosphincter. Only papers evaluating use of this technique as the only technical modification among the groups were included. A cumulative analysis was conducted using Review Manager v. 5.1 software (Cochrane Collaboration, Oxford, UK). Evidence synthesis: Eleven studies were identified in the literature search, including two randomised controlled trials (RCTs), which were negative studies. The cumulative analysis of comparative studies showed that reconstruction of the posterior musculofascial plate improves early return of continence within the first 30 d after RP (p = 0.004), while continence rates 90 d after surgery are not affected by use of the reconstruction technique. The statistical significance of the reconstruction seems to decrease when higher continence rates are reported. Use of posterior rhabdosphincter reconstruction does not seem to be related to positive surgical margin (PSM) rates or with complications like acute urinary retention (AUR) and bladder neck stricture (BNS). Some studies suggested lower anastomotic leakage rates with the posterior musculofascial plate reconstruction technique. Conclusions: The role of reconstruction of the posterior musculofascial plate in terms of earlier continence recovery is encouraging but still controversial. Methodological flaws and poor surgical standardisation seem to be the major causes. In two RCTs and one parallel (not randomised) group trial, posterior rhabdosphincter reconstruction offered no significant advantage for return of early continence after RP. No significant complications related to the posterior musculofascial plate reconstruction technique have been reported so far. A multicentre RCT is necessary to clarify the possible role of the technique in terms of earlier continence recovery. (c) 2012 Published by Elsevier B.V. on behalf of European Association of Urology.


2012 - RATE, LOCATION AND PREDICTIVE FACTORS OF POSITIVE SURGICAL MARGINS IN HIGH-RISK PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL PROSTATECTOMY [Abstract in Rivista]
Schatloff, O; Chauhan, S; Sivaraman, A; Samavedi, S; Giedelman, C; Abdul Muhsin, H; Coelho, R; Rocco, Bernardo Maria Cesare; Palmer, K; Patel, V.
abstract

RATE, LOCATION AND PREDICTIVE FACTORS OF POSITIVE SURGICAL MARGINS IN HIGH-RISK PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL PROSTATECTOMY


2012 - Radical prostatectomy: posterior reconstruction [Capitolo/Saggio]
Rocco, Bernardo Maria Cesare; Albo, G.
abstract

N/A


2012 - Reply from Authors re: Khurshid R. Ghani, Mani Menon. Posterior Reconstruction: Weighing the Evidence. Eur Urol 2012;62:791-3 The Posterior Reconstruction Debate [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Cozzi, G; Spinelli, Mg; Coelho, Rf; Santoro, L; Patel, Vr; Rocco, F.
abstract

N/A


2012 - The Powerful Impact of Double-Layered Posterior Rhabdosphincter Reconstruction on Early Recovery of Urinary Continence After Robot-Assisted Radical Prostatectomy [Articolo su rivista]
Gondo, T; Yoshioka, K; Hashimoto, T; Nakagami, Y; Hamada, R; Kashima, T; Shimodaira, K; Takeuchi, H; Satake, N; Tachibana, M; Rocco, Bernardo Maria Cesare
abstract

Background and Purpose: The usefulness of posterior rhabdosphincter reconstruction (PR) during robot-assisted radical prostatectomy (RARP) has still been controversial. We investigated the association of several factors, including the Rocco original double-layered PR, with early recovery of urinary continence after RARP. Patients and Methods: Between August 2006 and April 2011, a single surgeon at Tokyo Medical University Hospital performed 206 RARPs. Of these 206 patients, 199 eligible patients were enrolled in this study. We retrospectively analyzed the correlation of several perioperative factors, including surgical techniques, with early recovery of urinary continence 1 month after catheter removal. Continence was defined as no use or the use of only one safety pad. Results: Univariate analysis showed that surgeon experience, lateral approach of bladder neck preservation, bladder neck reconstruction, anterior reconstruction, and the Rocco double-layered PR were significantly associated with early recovery of urinary continence 1 month after catheter removal. Preoperative prostate-specific antigen level, body mass index, and attempted nerve-sparing (NS) procedures, however, were not significantly associated with early recovery of urinary continence. Multivariate logistic regression analysis showed that the Rocco PR and attempted NS were the only independent predictive factors of urinary continence recovery 1 month after catheter removal (odds ratio [OR], 15.01; 95% confidence interval [CI], 3.413-66.67; P = 0.0003 and OR, 2.248; 95% CI, 1.048-4.975; P = 0.0402, respectively). When we applied NS as well as the Rocco PR, the recovery rates of continence at 1 month after catheter removal was 85.3%. Conclusions: The Rocco double-layered PR and attempted NS and not surgeon experience were the significant independent predictive factors of early recovery of urinary continence after RARP. NS procedures positively influenced early recovery of urinary continence only when they were applied with the PR technique.


2012 - The Role of the Prostatic Vasculature as a Landmark for Nerve Sparing During Robot-Assisted Radical Prostatectomy [Articolo su rivista]
Patel, Vr; Schatloff, O; Chauhan, S; Sivaraman, A; Valero, R; Coelho, Rf; Rocco, Bernardo Maria Cesare; Palmer, Kj; Kameh, D.
abstract

Background: Macroscopic landmarks are lacking to identify the cavernosal nerves (CNs) during radical prostatectomy. The prostatic and capsular arteries run along the lateral border of the prostate and could help identify the location of the CNs during robotassisted radical prostatectomy (RARP). Objective: Describe the visual cues that have helped us achieve consistent nerve sparing (NS) during RARP, placing special emphasis on the usefulness of the prostatic vasculature (PV). Design, setting, and participants: Retrospective video analysis of 133 consecutive patients who underwent RARP in a single institution between January and February 2011. Surgical procedure: NS was performed using a retrograde, antegrade, or combined approach. Measurements: A landmark artery (LA) was identified running on the lateral border of the prostate corresponding to either a prostatic or capsular artery. NS was classified as either medial or lateral to the LA. The area of residual nerve tissue on surgical specimens was measured to compare the amount of NS between the groups. Results and limitations: We could identify an LA in 73.3% (195 of 266) of the operated sides. The area of residual nerve tissue was significantly different whether the NS was performed medial (between the LA and the prostate) or lateral to the LA (between the LA and pelvic side wall): median (interquartile range) of 0 (0-3) mm(2) versus14 (9-25) mm2; p < 0.001, respectively. Conclusions: The PV is an identifiable landmark during NS. Fine tailoring on the medial border of an LA can consistently result in a complete or almost complete NS, whereas performing the NS on its lateral border results in several degrees of incomplete NS. (C) 2011 European Association of Urology. Published by Elsevier B. V. All rights reserved.


2011 - Acute toxicity of image-guided hypofractionated radiotherapy for prostate cancer: Nonrandomized comparison with conventional fractionation [Articolo su rivista]
Jereczek Fossa, Ba; Zerini, D; Fodor, C; Santoro, L; Cambria, R; Garibaldi, C; Tagaste, B; Vavassori, A; Cattani, F; Alterio, D; Gherardi, F; Serafini, F; Rocco, Bernardo Maria Cesare; Musi, G; De Cobelli, O; Orecchia, R.
abstract

Objectives: To compare acute toxicity of prostate cancer image-guided hypofractionated radiotherapy (hypo-IGRT) with conventional fractionation without image-guidance (non-IGRT). To test the hypothesis that the potentially injurious effect of hypofractionation can be counterbalanced by the reduced irradiated normal tissue volume using IGRT approach. Materials and methods: One hundred seventy-nine cT1-T2N0M0 prostate cancer patients were treated within the prospective study with 70.2 Gy/26 fractions (equivalent to 84 Gy/42 fractions, alpha/beta 1.5 Gy) using IGRT (transabdominal ultrasound, ExacTrac X-Ray system, or cone-beam computer tomography). Their prospectively collected data were compared with data of 174 patients treated to 80 Gy/40 fractions with non-IGRT. The difference between hypo-IGRT and non-IGRT cohorts included fractionation (hypofractionation vs. conventional fractionation), margins (hypo-IGRT margins: 7 mm and 3 mm, for all but posterior margins; respectively; non-IGRT margins: 10 and 5 mm, for all but posterior margins, respectively), and use of image-guidance or not. Multivariate analysis was performed to define the tumor-, patient-, and treatment-related predictors for acute toxicity. Results: All patients completed the prescribed radiotherapy course. Acute toxicity in the hypo-IGRT cohort included rectal (G1: 29.1%; G2: 11.2%; 03: 1.1%) and urinary events (G1: 33.5%; G2: 39.1%; 03: 5%). Acute toxicity in the non-IGRT patients included rectal (G 1 : 16.1%; 02: 6.3%) and urinary events (G1: 36.2%; 02: 20.7%; 03: 0.6%). In 1 hypo-IGRT and 2 non-IGRT patients, radiotherapy was temporarily interrupted clue to acute toxicity. The incidence of mild (G1-2) rectal and bladder complications was significantly higher for hypo-IGRT (P = 0.0014 and P < 0.0001, respectively). Multivariate analysis showed that hypo-IGRT (P = 0.001) and higher PSA (P = 0.046) are correlated with higher acute urinary toxicity. No independent factor was identified for acute rectal toxicity. No significant impact of IGRT system on acute toxicity was observed. Conclusions: The acute toxicity rates were low and similar in both study groups with some increase in mild acute urinary injury in the hypo-IGRT patients (most probably due to the under-reporting in the retrospectively analyzed non-IGRT cohort). The higher incidence of acute bowel reactions observed in hypo-TORT group was not significant in the multivariate analysis. Further investigation is warranted in order to exclude the bias due to the nonrandomized character of the study. (C) 2011 Elsevier Inc. All rights reserved.


2011 - Collecting System Invasion and Fuhrman Grade But Not Tumor Size Facilitate Prognostic Stratification of Patients With pT2 Renal Cell Carcinoma [Articolo su rivista]
Brookman May, S; May, M; Zigeuner, R; Shariat, Sf; Scherr, Ds; Chromecki, T; Moch, H; Wild, Pj; Mohamad Al Ali, B; Cindolo, L; Wieland, Wf; Schips, L; De Cobelli, O; Rocco, Bernardo Maria Cesare; Santoro, L; De Nunzio, C; Tubaro, A; Coman, I; Feciche, B; Truss, M; Dalpiaz, O; Hohenfellner, M; Gilfrich, C; Wirth, Mp; Burger, M; Pahernik, S.
abstract

Purpose: The 7th edition of TNM for renal cell carcinoma introduced a subdivision of pT2 tumors at a 10 cm cutoff. In the present multicenter study the influence of tumor size as well as further clinical and histopathological parameters on cancer specific survival in patients with pT2 tumors was evaluated. Materials and Methods: A total of 670 consecutive patients with pT2 tumors (10.4%) of 6,442 surgically treated patients with all tumor stages were pooled (mean followup 71.4 months). Tumors were reclassified according to the current TNM classification, and subdivided in stages pT2a and pT2b. Cancer specific survival was analyzed using the Kaplan-Meier method, and univariable and multivariable analyses were used to assess the influence of several parameters on survival. Results: Tumor size continuously applied and subdivided at 10 cm or alternative cutoffs did not significantly influence cancer specific survival. In addition to N/M stage, Fuhrman grade and collecting system invasion also had an independent influence on survival. Integration of a dichotomous variable subsuming Fuhrman grade and collecting system invasion (grade 3/4 and/or collecting system invasion present vs grade 1/2 and collecting system invasion absent) into multivariate models including established prognostic parameters resulted in improvement of predictive abilities by 11% (HR 2.3, p <0.001) for all pT2 cases and 151% (HR 3.1, p <0.001) for stage pT2N0M0 cases. Conclusions: Tumor size did not have a significant influence on cancer specific survival in pT2 tumors, neither continuously applied nor based on various cutoff values. To enhance prognostic discrimination, multifactorial staging systems including pathological features should be implemented. The prognostic relevance of the variable subsuming Fuhrman grade and collecting system invasion should be considered for future evaluation.


2011 - DOES PROSTATE WEIGHT AFFECT PERIOPERATIVE OUTCOMES, POSITIVE SURGICAL MARGIN RATES AND FUNCTIONAL OUTCOMES AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY PERFORMED BY AN EXPERIENCED SURGEON? [Abstract in Rivista]
Acquati, P; Rocco, Bernardo Maria Cesare; Albo, G; Sivaraman, A; Chauhan, S; Palmer, Kj; Coelho, Rf; Patel, Vr
abstract

DOES PROSTATE WEIGHT AFFECT PERIOPERATIVE OUTCOMES, POSITIVE SURGICAL MARGIN RATES AND FUNCTIONAL OUTCOMES AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY PERFORMED BY AN EXPERIENCED SURGEON?


2011 - Editorial Comment [International Braz J Urol. V. 37, 4] [Abstract in Rivista]
Hyungsun, Kim; Fernando, J.; Rocco, B.
abstract

Editorial comment. pp.441-442. In INTERNATIONAL BRAZ J UROL - ISSN:1677-5538 vol. 34


2011 - Experience with robotic lobectomy for lung cancer. [Articolo su rivista]
Veronesi, G; Agoglia, Bg; Melfi, F; Maisonneuve, P; Bertolotti, R; Bianchi, Pp; Rocco, Bernardo Maria Cesare; Borri, A; Gasparri, R; Spaggiari, L.
abstract

OBJECTIVE: In this study, we analyze our experience so far with robotic pulmonary lobectomy, compare it with published data, and suggest a learning curve for the operation. METHODS: Ninety-one patients with suspected or proven clinical stage I-III lung cancer underwent robotic lobectomy. Selection criteria included lesion <5 cm and normal respiratory function. One surgeon performed the operations using the da Vinci system with three ports and a 3-cm utility thoracotomy. RESULTS: Median duration of operation was 239 (range 85-411) minutes, 260 minutes in the first 18 patients and 221 minutes in the remaining 73 cases (P=0.01). Median hospitalization declined from 6 days in the first 18 cases to 5 days in the remaining cases (P=0.002). Conversion rate and number of complications reduced nonsignificantly from the initial to later series. Major complications occurred in 11% of the first 18 cases and 4% of the later cases. The number of lymph nodes removed did not change over the two series. There was no 30-day postoperative mortality. After a median follow-up of 24 months, 80 of 91 patients were alive with no sign of disease. CONCLUSIONS: Our data suggest that about 20 operations are required to achieve surgical competence. Robotic lobectomy appears safe, oncologically radical, and associated with shorter postoperative hospitalization than open surgery.


2011 - FROM LEONARDO TO DA VINCI: THE HISTORY OF ROBOT-ASSISTED SURGERY IN UROLOGY [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Albo, G; Coelho, Rf
abstract

N/A


2011 - I questionari validati [Capitolo/Saggio]
Rocco, Bernardo Maria Cesare; Albo, G; Melegari, S.
abstract

N/A


2011 - Incidence of lymphoceles after robot-assisted pelvic lymph node dissection [Articolo su rivista]
Orvieto, Ma; Coelho, Rf; Chauhan, S; Palmer, Kj; Rocco, Bernardo Maria Cesare; Patel, Vr
abstract

OBJECTIVE To determine the incidence and predictive factors of lymphocele formation in patients undergoing pelvic lymph node dissection (PLND) during robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS Between April and December 2008, 76 patients underwent PLND during RARP for >= cT2c, prostate-specific antigen level >= 10, Gleason score >= 7 prostate cancer. All patients were prospectively followed up with pelvic computed tomography 6-12 weeks after the procedure. All patients received s.c. heparin preoperatively and postoperatively. PLND was limited to zones 1 and 2 as defined by Studer. Plasma-kinetic bipolar forceps were used for haemostasis during PLND. RESULTS At a mean follow-up of 10.8 weeks, 51% (39/76) of patients had developed a lymphocele. Of these 39 lymphoceles 32 (82%) were unilateral and seven (18%) were bilateral. The mean (range) lymphocele size was 4.3 x 3.2 (1.5-12.3) cm; 41% of lymphoceles were < 4 cm, 53.9% were 4-10 cm, and 5.1% were > 10 cm in diameter. Six of the 39 lymphoceles (15.4%) were clinically symptomatic. The symptoms were as follows: pelvic pressure in five patients, abdominal distension with ileus in three patients, leg pain/weakness in one patient and costovertebral tenderness in one patient. Two lymphoceles required intervention. On the logistic regression model the presence of nodal metastases, tumour volume in the prostate specimen and extracapsular extension (ECE) were independent risk factors for the development of a lymphocele. There was no correlation between estimated blood loss, body mass index, pathological Gleason score or number nodes dissected and the presence of lymphocele. CONCLUSIONS The incidence of lymphoceles was higher than anticipated given the believed protective effect of the transperitoneal approach against lymphocele formation. The risk of lymphocele seemed to increase linearly with the presence of more extensive disease, particularly ECE and nodal involvement. The benefit of PLND during RARP should be weighed against the elevated risk of lymphocele formation and its potential complications.


2011 - LIMITED VERSUS EXTENDED PELVIC LYMPHADENECTOMY DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY: IMPACT ON THE NUMBER OF NODES AND ON NODAL INVASION [Abstract in Rivista]
Mistretta, F. A.; De Lorenzis, E.; Grasso, A. A. C.; Albo, G.; Rocco, B.; Rocco, F.
abstract

LIMITED VERSUS EXTENDED PELVIC LYMPHADENECTOMY DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY: IMPACT ON THE NUMBER OF NODES AND ON NODAL INVASION


2011 - Massive recurring angiomyxoma of the scrotum in a obese man [Articolo su rivista]
Rocco, F; Cozzi, G; Spinelli, Mg; Rocco, Bernardo Maria Cesare; Albo, G; Finkelberg, E; Oliva, I; Fontanella, P; Varisco, D; Moneghini, L; Talso, M; Palumbo, C.
abstract

Aggressive angiomyxoma (AAM) is a rare mesenchymal benign myxoid tumor, characterized by locally infiltrative nature and high recurrence rate. AAM occurs almost exclusively in adult females, arising from the soft tissue of the pelvic region: to our knowledge, only 43 cases occurring in men have been reported. We report a case of massive recurrence of scrotal AAM in a 46-year-old obese man, who already underwent surgery for the same disease in 2004 and 2005. The mass had a circumference of 106 cm and weighted 30 kg. It was impossible to appreciate the testes and to find the penis. The patient underwent scrotal resection, bilateral orchidopexia and transposition of the penis, by means of a preputial flap. Residual scrotal skin was modeled in order to create a neoscrotum, where the testes were placed and secured with interrupted sutures. Histologic examination showed diffuse angiomyxoma-like lipomatosis. After three months, the patient presented with local relapse which also involved the external urethral orifice. © F Rocco et al., 2011.


2011 - OUTCOMES AND PREDICTORS FOR EARLY RETURN OF URINARY CONTINENCE AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY [Abstract in Rivista]
Chauhan, S; Orvieto, M; Coelho, Rf; Rocco, Bernardo Maria Cesare; Sivaraman, A.
abstract

OUTCOMES AND PREDICTORS FOR EARLY RETURN OF URINARY CONTINENCE AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY


2011 - Pentafecta: A New Concept for Reporting Outcomes of Robot-Assisted Laparoscopic Radical Prostatectomy [Articolo su rivista]
Patel, Vr; Sivaraman, A; Coelho, Rf; Chauhan, S; Palmer, Kj; Orvieto, Ma; Camacho, I; Coughlin, G; Rocco, Bernardo Maria Cesare
abstract

Background: Widespread use of prostate-specific antigen screening has resulted in younger and healthier men being diagnosed with prostate cancer. Their demands and expectations of surgical intervention are much higher and cannot be adequately addressed with the classic trifecta outcome measures. Objective: A new and more comprehensive method for reporting outcomes after radical prostatectomy, the pentafecta, is proposed. Design, setting, and participants: From January 2008 through September 2009, details of 1111 consecutive patients who underwent robot-assisted radical prostatectomy performed by a single surgeon were retrospectively analyzed. Of 626 potent men, 332 who underwent bilateral nerve sparing and who had 1 yr of follow-up were included in the study group. Measurements: In addition to the traditional trifecta outcomes, two perioperative variables were included in the pentafecta: no postoperative complications and negative surgical margins. Patients who attained the trifecta and concurrently the two additional outcomes were considered as having achieved the pentafecta. A logistic regression model was created to evaluate independent factors for achieving the pentafecta. Results and limitations: Continence, potency, biochemical recurrence-free survival, and trifecta rates at 12 mo were 96.4%, 89.8%, 96.4%, and 83.1%, respectively. With regard to the perioperative outcomes, 93.4% had no postoperative complication and 90.7% had negative surgical margins. The pentafecta rate at 12 mo was 70.8%. On multivariable analysis, patient age (p = 0.001) was confirmed as the only factor independently associated with the pentafecta. Conclusions: A more comprehensive approach for reporting prostate surgery outcomes, the pentafecta, is being proposed. We believe that pentafecta outcomes more accurately represent patients' expectations after minimally invasive surgery for prostate cancer. This approach may be beneficial and may be used when counseling patients with clinically localized disease. (C) 2011 European Association of Urology. Published by Elsevier B. V. All rights reserved.


2011 - Positive Surgical Margins After Robotic Assisted Radical Prostatectomy: A Multi-Institutional Study [Articolo su rivista]
Patel, Vr; Coelho, Rf; Rocco, Bernardo Maria Cesare; Orvieto, M; Sivaraman, A; Palmer, Kj; Kameh, D; Santoro, L; Coughlin, Gd; Liss, M; Jeong, W; Malcolm, J; Stern, Jm; Sharma, S; Zorn, Kc; Shikanov, S; Shalhav, Al; Zagaja, Gp; Ahlering, Te; Rha, Kh; Albala, Dm; Fabrizio, Md; Lee, Di; Chauhan, S.
abstract

Purpose: Positive surgical margins are an independent predictive factor for biochemical recurrence after radical prostatectomy. We analyzed the incidence of and associative factors for positive surgical margins in a multi-institutional series of 8,418 robotic assisted radical prostatectomies. Materials and Methods: We analyzed the records of 8,418 patients who underwent robotic assisted radical prostatectomy at 7 institutions. Of the patients 323 had missing data on margin status. Positive surgical margins were categorized into 4 groups, including apex, bladder neck, posterolateral and multifocal. The records of 6,169 patients were available for multivariate analysis. The variables entered into the logistic regression models were age, body mass index, preoperative prostate specific antigen, biopsy Gleason score, prostate weight and pathological stage. A second model was built to identify predictive factors for positive surgical margins in the subset of patients with organ confined disease (pT2). Results: The overall positive surgical margin rate was 15.7% (1,272 of 8,095 patients). The positive surgical margin rate for pT2 and pT3 disease was 9.45% and 37.2%, respectively. On multivariate analysis pathological stage (pT2 vs pT3 OR 4.588, p <0.001) and preoperative prostate specific antigen (4 or less vs greater than 10 ng/ml OR 2.918, p <0.001) were the most important independent predictive factors for positive surgical margins after robotic assisted radical prostatectomy. Increasing prostate weight was associated with a lower risk of positive surgical margins after robotic assisted radical prostatectomy (OR 0.984, p <0.001) and a higher body mass index was associated with a higher risk of positive surgical margins (OR 1.032, p <0.001). For organ confined disease preoperative prostate specific antigen was the most important factor that independently correlated with positive surgical margins (4 or less vs greater than 10 ng/ml OR 3.8, p <0.001). Conclusions: The prostatic apex followed by a posterolateral site was the most common location of positive surgical margins after robotic assisted radical prostatectomy. Factors that correlated with cancer aggressiveness, such as pathological stage and preoperative prostate specific antigen, were the most important factors independently associated with an increased risk of positive surgical margins after robotic assisted radical prostatectomy.


2011 - Preliminary Analysis of the Feasibility and Safety of Salvage Robot-Assisted Radical Prostatectomy After Radiation Failure: Multi-Institutional Perioperative and Short-Term Functional Outcomes [Articolo su rivista]
Chauhan, S; Patel, Mb; Coelho, R; Liss, M; Rocco, Bernardo Maria Cesare; Sivaraman, Ak; Palmer, Kj; Coughlin, Gd; Ferrigni, Rg; Castle, Ep; Ahlering, Te; Parra Davila, E; Patel, Vr
abstract

Background and Purpose: Open radical prostatectomy after radiation treatment failure for prostate cancer is associated with significant morbidity. The purpose of the study is to report multi-institutional experiences while performing salvage robot-assisted radical prostatectomy (sRARP). Patients and Methods: We retrospectively identified 15 patients with biopsy-proven prostate cancer after definitive radiotherapy who underwent sRARP in three academic institutions over a 20-month period. Continence was defined as the use of 0 pads after surgery. Potency was defined as the ability to achieve erections adequate enough for penetration with or without the use of phosphodiesterase-5 inhibitors. Biochemical recurrence after sRARP was defined as a prostate-specific antigen value of >0.2 ng/mL. Results: Radiation treatment consisted of external-beam radiation therapy (XRT) in five cases, interstitial radioactive 125-iodine brachytherapy (BT) in five cases, proton beam therapy in two cases, and XRT followed by interstitial radioactive 125-iodine BT in three cases. The median operative time, the median estimated blood loss, and the median length of hospital stay were 140.5 min (interquartile range [IQR] 97.5-157 min), 75 mL (IQR 50-100 mL), and 1 day (IQR 1-2 d), respectively. There were no rectal injuries. Two (13.3%) patients had a positive surgical margin. A total of three (20%) patients had postoperative complications. One patient had a deep vein thrombosis (Clavien grade II), one had wound infection (Clavien grade II), and one patient had an anastomotic leak (Clavien gradeId). An anastomotic stricture (Clavien grade IIIa) later developed in this same patient, which was managed by direct visual internal urethrotomy. Of the patients, 71.4% were continent. At a median follow-up of 4.6 months (IQR 3-9.75 mos), four (28.6%) patients presented with biochemical recurrence after sRARP. Conclusions: The challenge during sRALP is the presence of extensive fibrosis and loss of dissection planes secondary to radiation therapy. It is a technically challenging but feasible procedure. The early complication rates were low, and early continence rates are encouraging.


2011 - ROBOT ASSISTED DISMEMBERED PYELOPLASTY: MULTI-INSTITUTIONAL OUTCOMES [Abstract in Rivista]
Sivaraman, A; Chauhan, S; Coelho, Rf; Palmer, Kj; Orvieto, M; Patel, Vr; Munver, R; Levilee, R; Rocco, Bernardo Maria Cesare; Byrd, V.
abstract

Introduction & Objectives: The video presents our technique of Robotic-Assisted Laparoscopic Dismembered Pyeloplasty (RALDP) for primary and secondary repair of UPJO. Materials & Methods: These have been dicussed in the video. Results: These have been discussed in the video. Conclusions: RALDP is a safe, efficacious and viable option for either primary or secondary repair of UPJO with excellent outcomes, high success rate, and a low incidence of complications.


2011 - ROBOTIC SALVAGE PROSTATECTOMY FOR RADIO-RECURRENT PROSTATE CANCER [Abstract in Rivista]
Sivaraman, A; Chauhan, S; Coelho, Rf; Orvieto, M; Palmer, Kj; Rocco, Bernardo Maria Cesare; Patel, Vr
abstract

Introduction & Objectives: To demonstrate and highlight the technical difficulties in robotic salvage prostatectomy for radio recurrent prostate cancer. We also show the differences in technique for proton beam, external beam radiotherapy as well as Brachytherapy. Materials & Methods: This video exemplifies our technique for robotic salvage prostatectomy. We show prostatectomy in patients who have undergone primary external beam, proton beam and brachytherapy. The difference in the distortion of anatomy, the technique of obtaining a plane in the endopelvic fascia, posterior plane dissection, avoiding and recognizing rectal injury and nuances of apical dissection are described. Results: The video defines areas in which a cautious approach is necessary and highlights techniques needed to achieve a good Oncological outcome without complications.Though functional outcomes are not optimal the benefits of Oncological cure out weigh’s this aspect in salvage prostatectomy.Proton Beam radiotherapy is most difficult compared to external beam and Brachytherapy. Brachytherapy is relatively easier but the apical dissection may be difficult if the seeds have been placed outside the prostate. Conclusions: Robotic salvage prostatectomy for Radiorecurrent prostate cancer is a technically demanding procedure. There is a considerable learning curve to achieve an acceptable level of efficacy and safety. With careful attention to detail complications can be minimized.


2011 - Recent advances in the surgical treatment of benign prostatic hyperplasia [Articolo su rivista]
Rocco, Bernardo; Albo, Giancarlo; Ferreira, Rafael Coelho; Spinelli, Matteo; Cozzi, Gabriele; Dell'Orto, Paolo; Patel, Vipul; Rocco, Francesco
abstract

TURP for many years has been considered the gold standard for surgical treatment of BPH. Symptoms relief, improvement in Maximum flow rate and reduction of post void residual urine have been reported in several experiences. Notwithstanding a satisfactory efficacy, concerns have been reported in terms of safety outcomes:intracapsular perforation, TUR syndrome, bleeding with a higher risk of transfusion particularly in larger prostates have been extensivelyreported in the literature. In the recent years the use of new forms of energy and devices suchas bipolar resector, Ho: YAG and potassium-titanyl-phosphate laserare challenging the role of traditional TURP for BPH surgical treatment. In 1999 TURP represented the 81% of surgical treatment for BPHversus 39% of 2005. Is this a marketing driven change or is there areal advantage in new technologies? We analyzed guidelines and higher evidence studies to evaluate therole of the most relevant new surgical approaches compared to TURPfor the treatment of BPH. In case of prostates of very large size the challenge is ongoing, withminimally invasive laparoscopic approach and most recently roboticapproach. We will evaluate the most recent literature on thisemerging field. © 2011, SAGE Publications. All rights reserved.


2011 - Robotic technologies in surgical oncology training and practice [Articolo su rivista]
Orvieto, Ma; Marchetti, P; Castillo, Oa; Coelho, Rf; Chauhan, S; Rocco, Bernardo Maria Cesare; Ardila, B; Mathe, M; Patel, Vr
abstract

The modern-day surgeon is frequently exposed to new technologies and instrumentation. Robotic surgery (RS) has evolved as a minimally invasive technique aimed to improve clinical outcomes. RS has the potential to alleviate the inherent limitations of laparoscopic surgery such as two dimensional imaging, limited instrument movement and intrinsic human tremor. Since the first reported robot-assisted surgical procedure performed in 1985, the technology has dramatically evolved and currently multiple surgical specialties have incorporated RS into their daily clinical armamentarium. With this exponential growth, it should not come as a surprise the ever growing requirement for surgeons trained in RS as well as the interest from residents to receive robotic exposure during their training. For this reason, the establishment of set criteria for adequate and standardized training and credentialing of surgical residents, fellows and those trained surgeons wishing to perform RS has become a priority. In this rapidly evolving field, we herein review the past, present and future of robotic technologies and its penetration into different surgical specialties. (C) 2010 Elsevier Ltd. All rights reserved.


2011 - SALVAGE ROBOT ASSISTED RADICAL PROSTATECTOMY: SINGLE SURGEON EXPERIENCE [Abstract in Rivista]
Chauhan, S; Schatloff, O; Coelho, R; Ko, Yh; Valero, R; Rocco, Bernardo Maria Cesare; Sivaraman, A; Palmer, K; Patel, V.
abstract

SALVAGE ROBOT ASSISTED RADICAL PROSTATECTOMY: SINGLE SURGEON EXPERIENCE


2011 - SALVAGE ROBOT-ASSISTED RADICAL PROSTATECTOMY: SINGLE SURGEON EXPERIENCE [Abstract in Rivista]
Rocco, Bernardo Maria Cesare; Albo, G; Acquati, P; Palmer, Kj; Chauhan, S; Sivaraman, A; Coelho, Rf; Patel, Vr
abstract

SALVAGE ROBOT-ASSISTED RADICAL PROSTATECTOMY: SINGLE SURGEON EXPERIENCE


2011 - THE ROLE OF THE PROSTATIC VASCULATURE AS AN INTRAOPERATIVE LANDMARK FOR NERVE SPARING DURING ROBOT ASSISTED RADICAL PROSTATECTOMY [Abstract in Rivista]
Schatloff, O; Chauhan, S; Valero, R; Ko, Yh; Sivaraman, A; Coelho, Rf; Orvieto, Ma; Rocco, Bernardo Maria Cesare; Kameh, D; Palmer, Kj; Patel, Vr
abstract

THE ROLE OF THE PROSTATIC VASCULATURE AS AN INTRAOPERATIVE LANDMARK FOR NERVE SPARING DURING ROBOT ASSISTED RADICAL PROSTATECTOMY


2011 - [Ralp and Rocco stitch: original technique]. FT Ralp e Rocco stitch: tecnica originale. [Articolo su rivista]
Spinelli, Mg; Cozzi, G; Grasso, A; Talso, M; Varisco, D; Abed El Rahman, D; Acquati, P; Albo, G; Rocco, Bernardo Maria Cesare; Maggioni, A; Rocco, F.
abstract

Incontinence and impotence are the two chief drawbacks of radical prostatectomy (RP). Incontinence is the most relevant for most of the patients, even if there is high variability in terms of prevalence and definition of continence. Incontinence seems the result of several factors, the most important being the surgical injury of some structures and the biomechanical instability associated with vesicourethral anastomosis. In the posterior urethra, which guarantees the continence mechanism, two functionally independent regions can be recognized: the proximal and the distal. The proximal region can be identified with the bladder neck, while the distal region is the rhabdosphincter urethrae. Concerning the distal functional region, two kinds of strategy can be applied: the preservation of puboprostatic ligaments and urethral attachments, or the reconstruction of the urethral rhabdosphincter, which can be anterior, posterior or total. We describe our technique of choice for posterior reconstruction, first described by Rocco and then modified by Patel et al.


2010 - A Critical Analysis of the Current Knowledge of Surgical Anatomy Related to Optimization of Cancer Control and Preservation of Continence and Erection in Candidates for Radical Prostatectomy [Articolo su rivista]
Walz, Jochen; Burnett Arthur, L.; Costello Anthony, J.; Eastham James, A.; Graefen, Markus; Guillonneau, Bertrand; Menon, Mani; Montorsi, Francesco; Myers Robert, P.; Rocco, Bernardo Maria Cesare; Villers, Arnauld
abstract

Context: Detailed knowledge of the anatomy of the prostate and adjacent tissues is mandatory during radical prostatectomy to ensure reliable oncologic and functional outcomes. Objective: To review critically and to summarize the available literature on surgical anatomy of the prostate and adjacent structures involved in cancer control, erectile function, and urinary continence. Evidence acquisition: A search of the PubMed database was performed using the keywords radical prostatectomy, anatomy, neurovascular bundle, fascia, pelvis, and sphincter. Relevant articles and textbook chapters were reviewed, analyzed, and summarized. Evidence synthesis: Anatomy of the prostate and the adjacent tissues varies substantially. The fascia surrounding the prostate is multilayered, sometimes either fused with the prostate capsule or clearly separated from the capsule as a reflection of interindividual variations. The neurovascular bundle (NVB) is situated between the fascial layers covering the prostate. The NVB is composed of numerous nerve fibers superimposed on a scaffold of veins, arteries, and variable amounts of adipose tissue surrounding almost the entire lateral and posterior surfaces of the prostate. The NVB is also in close, cage-like contact to the seminal vesicles. The external urethral sphincter is a complex structure in close anatomic and functional relationship to the pelvic floor, and its fragile innervation is in close association to the prostate apex. Finally, the shape and size of the prostate can significantly modify the anatomy of the NVB, the urethral sphincter, the dorsal vascular complex, and the pubovesical/puboprostatic ligaments. Conclusions: The surgical anatomy of the prostate and adjacent tissues involved in radical prostatectomy is complex. Precise knowledge of all relevant anatomic structures facilitates surgical orientation and dissection during radical prostatectomy and ideally translates into both superior rates of cancer control and improved functional outcomes postoperatively. (C) 2009 European Association of Urology. Published by Elsevier B. V. All rights reserved.


2010 - CONTINENCE, POTENCY AND ONCOLOGIC OUTCOMES AFTER ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: THE SEARCH FOR THE TRIFECTA-EARLY RESULTS [Abstract in Rivista]
Coelho, Rf; Chauhan, S; Orvieto, Ma; Rocco, Bernardo Maria Cesare; Sivaraman, A; Palmer, K; Patel, V.
abstract

CONTINENCE, POTENCY AND ONCOLOGIC OUTCOMES AFTER ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: THE SEARCH FOR THE TRIFECTA-EARLY RESULTS


2010 - CORRELATION BETWEEN ACUTE AND LATE TOXICITY IN 973 PROSTATE CANCER PATIENTS TREATED WITH THREE-DIMENSIONAL CONFORMAL EXTERNAL BEAM RADIOTHERAPY [Articolo su rivista]
Jereczek Fossa, Ba; Zerini, D; Fodor, C; Santoro, L; Serafini, F; Cambria, R; Vavassori, A; Cattani, F; Garibaldi, C; Gherardi, F; Ferrari, A; Rocco, Bernardo Maria Cesare; Scardino, E; de Cobelli, O; Orecchia, R.
abstract

Purpose: To analyze the correlation between acute and late injury in 973 prostate cancer patients treated with radiotherapy and to evaluate the effect of patient-, tumor-, and treatment-related variables on toxicity. Methods and Materials: Of the 973 patients, 542 and 431 received definitive or postprostatectomy radiotherapy, respectively. Three-dimensional conformal radiotherapy included a six-field technique and two-dynamic arc therapy. Toxicity was classified according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. The correlation between acute and late toxicity (incidence and severity) was assessed. Results: Multivariate analysis showed that age <= 65 years (p=.06) and use of the three-dimensional, six-field technique (p<0001) correlated significantly with greater acute rectal toxicity. The three-dimensional, six-field technique (p=.0002), dose >70 Gy (p=.014), and radiotherapy duration (p=.05) correlated with greater acute urinary toxicity. Acute rectal toxicity (p<.0001) was the only factor that correlated with late rectal injury on multivariate analysis. Late urinary toxicity correlated with acute urinary events (p<.0001) and was inversely related to the use of salvage radiotherapy (p=.018). A highly significant correlation was found between the incidence of acute and late events for both rectal (p<.001) and urinary (p<.001) reactions. The severity of acute toxicity (Grade 2 or greater) was predictive for the severity of late toxicity for both rectal and urinary events (p<.001). Conclusion: The results of our study have shown that the risk of acute reactions depends on both patient-related (age) and treatment-related (dose, technique) factors. Acute toxicity was an independent significant predictor of late toxicity. These findings might help to predict and prevent late radiotherapy-induced complications. (C) 2010 Elsevier Inc.


2010 - CYBERKNIFE ROBOTIC IMAGE-GUIDED STEREOTACTIC RADIOTHERAPY FOR ISOLATED RECURRENT PRIMARY, LYMPH NODE OR METASTATIC PROSTATE CANCER [Articolo su rivista]
Jereczek Fossa Barbara, Alicjia; Fariselli, Laura; Beltramo, Giancarlo; Fodor Cristana, Iuliana; Santoro, Luigi; Zerini, Dario; Gherardi, Federica; Ascione, Carmen; Zanetti Isa, Bossi; Mauro, Roberta; Bianchi Livia, Corinna; Bergantin, Achille; Vavassori, Andrea; Ivaldi Giovanni, Battista; de Cobelli, Ottavio; Rocco, Bernardo Maria Cesare; Albo, Giancarlo; Scardino, Epifanio; Musi, Gennaro; Verweij, Fabrizio; Matei Deliu, Victor; Roberto, Orecchia
abstract

N/A


2010 - Continence, potency and oncological outcomes after robotic-assisted radical prostatectomy: early trifecta results of a high-volume surgeon [Articolo su rivista]
Patel, Vr; Coelho, Rf; Chauhan, S; Orvieto, Ma; Palmer, Kj; Rocco, Bernardo Maria Cesare; Sivaraman, A; Coughlin, G.
abstract

OBJECTIVE center dot To evaluate early trifecta outcomes after robotic-assisted radical prostatectomy (RARP) performed by a high-volume surgeon. PATIENTS AND METHODS center dot We evaluated prospectively 1100 consecutive patients who underwent RARP performed by one surgeon. In all, 541 men were considered potent before RARP; of these 404 underwent bilateral full nerve sparing and were included in this analysis. center dot Baseline and postoperative urinary and sexual functions were assessed using self-administered validated questionnaires. center dot Postoperative continence was defined as the use of no pads; potency was defined as the ability to achieve and maintain satisfactory erections for sexual intercourse > 50% of times, with or without the use of oral phosphodiesterase type 5 inhibitors; Biochemical recurrence (BCR) was defined as two consecutive PSA levels of > 0.2 ng/mL after RARP. center dot Results were compared between three age groups: Group 1, < 55 years, Group 2, 56-65 years and Group 3, > 65 years. RESULTS center dot The trifecta rates at 6 weeks, 3, 6, 12, and 18 months after RARP were 42.8%, 65.3%, 80.3%, 86% and 91%, respectively. center dot There were no statistically significant differences in the continence and BCR-free rates between the three age groups at all postoperative intervals analysed. center dot Nevertheless, younger men had higher potency rates and shorter time to recovery of sexual function when compared with older men at 6 weeks, 3, 6 and 12 months after RARP (P < 0.01 at all time points). center dot Similarly, younger men also had a shorter time to achieving the trifecta and had higher trifecta rates at 6 weeks, 3 and 6 months after RARP compared with older men (P < 0.01 at all time points). CONCLUSION center dot RARP offers excellent short-term trifecta outcomes when performed by an experienced surgeon. center dot Younger men had a shorter time to achieving the trifecta and higher overall trifecta rates when compared with older men at 6 weeks, 3 and 6 months after RARP.


2010 - DOES ROBOTIC SURGERY AFFECT KATTAN'S POSTOPERATIVE 5-YEAR CANCER-FREE SURVIVAL FORECAST MORE THAN OPEN SURGERY [Abstract in Rivista]
Matei Deliu, Victor; Rocco, Bernardo Maria Cesare; Melegari, Sara; Albo, Giancarlo; Detti, Serena; Brescia, Antonio; De Cobelli, Ottavio
abstract

DOES ROBOTIC SURGERY AFFECT KATTAN'S POSTOPERATIVE 5-YEAR CANCER-FREE SURVIVAL FORECAST MORE THAN OPEN SURGERY


2010 - Early Complication Rates in a Single-Surgeon Series of 2500 Robotic-Assisted Radical Prostatectomies: Report Applying a Standardized Grading System [Articolo su rivista]
Coelho, R. F.; Palmer, K. J.; Rocco, Bernardo Maria Cesare; Moniz, R. R.; Chauhan, S; Orvieto, M. A.; Coughlin, G; Patel, V. R.
abstract

Background: Perioperative complications following robotic-assisted radical prostatectomy (RARP) have been previously reported in recent series. Few studies, however, have used standardized systems to classify surgical complications, and that inconsistency has hampered accurate comparisons between different series or surgical approaches. Objective: To assess trends in the incidence and to classify perioperative surgical complications following RARP in 2500 consecutive patients. Design, setting, and participants: We analyzed 2500 patients who underwent RARP for treatment of clinically localized prostate cancer (PCa) from August 2002 to February 2009. Data were prospectively collected in a customized database and retrospectively analyzed. Intervention: All patients underwent RARP performed by a single surgeon. Measurements: The data were collected prospectively in a customized database. Complications were classified using the Clavien grading system. To evaluate trends regarding complications and radiologic anastomotic leaks, we compared eight groups of 300 patients each, categorized according the surgeon's experience (number of cases). Results and limitations: Our median operative time was 90 min (interquartile range [IQR]: 75-100 min). The median estimated blood loss was 100 ml (IQR: 100-150 ml). Our conversion rate was 0.08%, comprising two procedures converted to standard laparoscopy due to robot malfunction. One hundred and forty complications were observed in 127 patients (5.08%). The following percentages of patients presented graded complications: grade 1, 2.24%; grade 2, 1.8%; grade 3a, 0.08%; grade 3b, 0.48%; grade 4a, 0.40%. There were no cases of multiple organ dysfunction or death (grades 4b and 5). There were significant decreases in the overall complication rates (p = 0.0034) and in the number of anastomotic leaks (p < 0.001) as the surgeon's experience increased. Conclusions: RARP is a safe option for treatment of clinically localized PCa, presenting low complication rates in experienced hands. Although the robotic system provides the surgeon with enhanced vision and dexterity, proficiency is only accomplished with consistent surgical volume; complication rates demonstrated a tendency to decrease as the surgeon's experience increased. (C) 2010 European Association of Urology. Published by Elsevier B. V. All rights reserved.


2010 - HOW TO ACHIEVE EARLY CONTINENCE AFTER ROBOTIC- ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY (RARP): EVOLUTION OF THE SURGICAL TECHNIQUE [Abstract in Rivista]
Coelho, Rf; Chauhan, S; Orvieto, Ma; Rocco, Bernardo Maria Cesare; Palmer, K; Patel, V.
abstract

HOW TO ACHIEVE EARLY CONTINENCE AFTER ROBOTIC- ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY (RARP): EVOLUTION OF THE SURGICAL TECHNIQUE


2010 - INTRAOPERATIVE RADIOTHERAPY FOR LOCALLY ADVANCED PROSTATE CANCER: A MATCHED PAIR ANALYSIS [Abstract in Rivista]
Mazzoleni, Federica; Albo, Giancarlo; Rocco, Bernardo Maria Cesare; Melegari, Sara; Jereczek Fossa Barbara, A.; Detti, Serena; Santoro, Luigi; Vavassori, Andrea; Matei Deliu, V.; Orecchia, Roberto; de Cobelli, Ottavio
abstract

Abstract OBJECTIVE: To evaluate a novel approach with intraoperative radiotherapy (IORT) administered in the surgical field, after pelvic lymphadenectomy (PL) and before radical retropubic prostatectomy (RRP), evaluating acute and late toxicity, complications and biochemical progression-free survival (bPFS), as the adequate treatment of locally advanced prostate cancer is still a controversial issue. PATIENTS AND METHODS: Between June 2005 and October 2007, 33 consecutive patients with intermediate-risk or locally advanced prostate cancer were selected for PL + IORT + RRP. IORT was delivered by a mobile linear accelerator in the operating room (electron beam, 12 Gy at 90% isodose). According to the pathological findings further adjuvant radio- or hormone therapy could be administered. The median follow-up was 16 months. This group was compared retrospectively with a historical group of 100 patients who had undergone RRP and further adjuvant therapy, selected with equivalent criteria. The comparison was conducted as a matched-pair analysis. The perioperative outcomes (surgical time, estimated blood loss, blood transfusions, days of catheterization, days of drainage, days of hospitalization), continence as the functional outcome, acute and late toxicity, rate of complications and bPFS were evaluated and compared. RESULTS: The baseline characteristics of the two groups were equivalent but the node count and the number of positive lymph nodes was higher in the IORT group. The IORT group had longer surgery, and a shorter hospital stay and catheterization. There were no differences in continence rate, and no major complications in either group. The acute and late toxicity and bPFS were equivalent. A retrospective comparison and the short follow-up were the major limitations. CONCLUSIONS: IORT administered before RRP seems a feasible approach, with little effect on the variables evaluated.


2010 - LAPAROSCOPIC ROBOT-ASSISTED MICROWAVE ABLATION OF SMALL RENAL CARCINOMA [Abstract in Rivista]
Matei De Liu, Victor; Rocco, Bernardo Maria Cesare; Verweij, Fabrizio; Mazzoleni, Federica; Musi, Gennaro; Nordio, Andrea
abstract

n/a


2010 - Metachronous bladder metastases from renal cell carcinoma: a case report and review of the literature. [Articolo su rivista]
Melegari, Simona; Albo, G.; Rocco, B.; Verweij, F.; Abbinante, M.; De Cobelli, O.
abstract

INTRODUCTION: adrenal gland, parotid gland, pharynx, eye and bladder are rare localizations of metastases of renal cell carcinoma (RCC). We report a case of metachronous RCC metastases to the bladder in a patient with a medical history of transitional cell carcinoma (TCC) of the bladder. MATERIALS AND METHODS: a case study and review of the relevant literature are presented. RESULTS: during a follow-up cystoscopy examination following treatment of TCC, a single 5-mm lesion was detected and endoscopically resected. The histology of the resected sample was confirmed to be RCC, comparable to a primary kidney cancer and not recurrent TCC. CONCLUSION: the patient had a probability of metastases three years after nephrectomy of 62.9%. Survival rates following single metastasectomy are 60% and 38% at three and five years, respectively; metachronous diagnosis has a better prognosis than synchronous. During RCC follow-up, each lesion should be considered as a possible metastasis of RCC.


2010 - PERIOPERATIVE COMPLICATIONS IN ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY [Abstract in Rivista]
Albo, G; Melegari, S; Rocco, Bernardo Maria Cesare; Detti, S; Verweij, F; De Cobelli, O.
abstract

PERIOPERATIVE COMPLICATIONS IN ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY


2010 - PERIOPERATIVE OUTCOMES, POSITIVE SURGICAL MARGIN (PSM) RATES, AND SHORT-TERM FUNCTIONAL OUTCOMES AFTER ROBOTIC-ASSISTED RADICAL PROSTATECTOMY (RARP) IN OVERWEIGHT AND OBESE PATIENTS [Abstract in Rivista]
Coelho, Rf; Chauhan, S; Orvieto, Ma; Sivaraman, A; Palmer, K; Rocco, Bernardo Maria Cesare; Coughlin, G; Patel, V.
abstract

PERIOPERATIVE OUTCOMES, POSITIVE SURGICAL MARGIN (PSM) RATES, AND SHORT-TERM FUNCTIONAL OUTCOMES AFTER ROBOTIC-ASSISTED RADICAL PROSTATECTOMY (RARP) IN OVERWEIGHT AND OBESE PATIENTS


2010 - Posterior Rhabdosphincter Reconstruction During Robot-assisted Radical Prostatectomy: Critical Analysis of Techniques and Outcomes [Articolo su rivista]
Gautam, G; Rocco, Bernardo Maria Cesare; Patel, Vr; Zorn, Kc
abstract

Many centers have recently implemented posterior rhabdosphincter reconstruction (PRR) into robot-assisted radical prostatectomy (RARP) with the objective of earlier continence recovery. We comprehensively review the anatomic and functional changes occurring post prostatectomy along with the reconstructive techniques and published outcomes of PRR. Several case control studies show a better continence rate within the first 3 months, whereas the only randomized control trial presents a conflicting conclusion. Unfortunately, all reported studies lack uniform surgical technique, continence definition, and measures, making comparison difficult. Although initial results appear favorable, the true continence benefit of PRR remains debatable and requires further research. UROLOGY 76: 734-742, 2010. (C) 2010 Published by Elsevier Inc.


2010 - Predictive Factors for Positive Surgical Margins and Their Locations After Robot-Assisted Laparoscopic Radical Prostatectomy [Articolo su rivista]
Coelho, R. F.; Chauhan, S; Orvieto, M. A.; Palmer, K. J.; Rocco, Bernardo Maria Cesare; Patel, V. R.
abstract

Background: Positive surgical margin (PSM) after radical prostatectomy (RP) has been shown to be an independent predictive factor for cancer recurrence. Several investigations have correlated clinical and histopathologic findings with surgical margin status after open RP. However, few studies have addressed the predictive factors for PSM after robot-assisted laparoscopic RP (RARP). Objective: We sought to identify predictive factors for PSMs and their locations after RARP. Design, setting, and participants: We prospectively analyzed 876 consecutive patients who underwent RARP from January 2008 to May 2009. Intervention: All patients underwent RARP performed by a single surgeon with previous experience of > 1500 cases. Measurements: Stepwise logistic regression was used to identify potential predictive factors for PSM. Three logistic regression models were built: (1) one using preoperative variables only, (2) another using all variables (preoperative, intraoperative, and postoperative) combined, and (3) one created to identify potential predictive factors for PSM location. Preoperative variables entered into the models included age, body mass index (BMI), prostate-specific antigen, clinical stage, number of positive cores, percentage of positive cores, and American Urological Association symptom score. Intra-and postoperative variables analyzed were type of nerve sparing, presence of median lobe, percentage of tumor in the surgical specimen, gland size, histopathologic findings, pathologic stage, and pathologic Gleason grade. Results and limitations: In the multivariable analysis including preoperative variables, clinical stage was the only independent predictive factor for PSM, with a higher PSM rate for T3 versus T1c (odds ratio [OR]: 10.7; 95% confidence interval [CI], 2.6-43.8) and for T2 versus T1c (OR: 2.9; 95% CI, 1.9-4.6). Considering pre-, intra-, and postoperative variables combined, percentage of tumor, pathologic stage, and pathologic Gleason score were associated with increased risk of PSM in the univariable analysis (p < 0.001 for all variables). However, in the multivariable analysis, pathologic stage (pT2 vs pT1; OR: 2.9; 95% CI, 1.9-4.6) and percentage of tumor in the surgical specimen (OR: 8.7; 95% CI, 2.2-34.5; p = 0.0022) were the only independent predictive factors for PSM. Finally, BMI was shown to be an independent predictive factor(OR: 1.1; 95% CI, 1.0-1.3; p = 0.0119) for apical PSMs, with increasing BMI predicting higher incidence of apex location. Because most of our patients were referred from other centers, the biopsy technique and the number of cores were not standardized in our series. Conclusions: Clinical stage was the only preoperative variable independently associated with PSM after RARP. Pathologic stage and percentage of tumor in the surgical specimen were identified as independent predictive factors for PSMs when analyzing pre-, intra-, and postoperative variables combined. BMI was shown to be an independent predictive factor for apical PSMs. (C) 2010 European Association of Urology. Published by Elsevier B. V. All rights reserved.


2010 - Project of improving communication and care quality from diagnosis to follow up focusing on patient [Articolo su rivista]
Meola, E.; Suardi, T.; Del Grande, D.; Rocco, Bernardo Maria Cesare; Lilliu, S.; Detti, S.; Musi, G.; Basile, G.; De Cobelli, O.
abstract

N/A


2010 - ROBOT-ASSISTED REPAIR OF RECTOVESICAL FISTULA RESULTING FROM ROBOTIC RADICAL PROSTATECTOMY [Abstract in Rivista]
Matei Deliu, Victor; Rocco, Bernardo Maria Cesare; Musi, Gennaro; Zambito, Stefano; Mombelli, Gabriella; De Cobelli, Ottavio
abstract

ROBOT-ASSISTED REPAIR OF RECTOVESICAL FISTULA RESULTING FROM ROBOTIC RADICAL PROSTATECTOMY


2010 - Reply from Authors re: Manfred P. Wirth and Michael Froehner. Radical Prostatectomy-Only Centers: The Future in Genitourinary Surgery? Eur Urol 2010;57:953-4 [Articolo su rivista]
Coelho, Rf; Rocco, Bernardo Maria Cesare; Patel, V. R.
abstract

N/A


2010 - Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers [Articolo su rivista]
Coelho, Rf; Rocco, Bernardo Maria Cesare; Patel, Mb; Orvieto, Ma; Chauhan, S; Ficarra, V; Melegari, S; Palmer, Kj; Patel, Vr
abstract

Purpose: To critically review perioperative outcomes, positive surgical margin (PSM) rates, and functional outcomes of several large series of retropubic radical prostatectomy (RRP), laparoscopic RP (LRP), and robotassisted radical prostatectomy (RARP) currently available in the literature. Methods: A Medline database search was performed from November 1994 to May 2009, using medical subject heading search terms "prostatectomy" and "Outcome Assessment (Health Care)" and text words "retropubic," "robotic," and "laparoscopic." Only studies with a sample size of 250 or more patients were considered. Weighted means were calculated for all outcomes using the number of patients included in each study as the weighing factor. Results: We identified 30 articles for RRP, 14 for LRP, and 14 for RARP. The mean intraoperative and postoperative RRP transfusion rates for RRP, LRP, and RARP were 20.1%, 3.5%, and 1.4%, respectively. The weighted mean postoperative complication rates for RRP, LRP, and RARP were 10.3% (4.8% to 26.9%), 10.98% (8.9 to 27.7%), and 10.3% (4.3% to 15.7%), respectively. RARP revealed a mean overall PSM rate of 13.6%, whereas LRP and RRP yielded a PSM of 21.3% and 24%, respectively. The weighted mean continence rates at 12 month follow-up for RRP, LRP, and RARP were 79%, 84.8%, and 92%, respectively. The weighted mean potency rates for patients who underwent unilateral or bilateral nerve sparing, at 12 month follow-up, were 43.1% and 60.6% for RRP, 31.1% and 54% for LRP, and 59.9% and 93.5% for RARP. Conclusion: RRP, LRP, and RARP performed in high-volume centers are safe options for treatment of patients with localized prostate cancer, presenting similar overall complication rates. LRP and RARP, however, are associated with decreased operative blood loss and decreased risk of transfusion when compared with RRP. Our analysis including high-volume centers also showed lower weighted mean PSM rates and higher continence and potency rates after RARP compared with RRP and LRP. However, the lack of randomized trials precludes definitive conclusions.


2010 - SALVAGE ROBOTIC-ASSISTED RADICAL PROSTATECTOMY (SRALP) FOR TREATMENT OF RADIO-RECURRENT PROSTATE CANCER: DESCRIPTION OF TECHNIQUE AND MULTI-INSTITUTIONAL OUTCOMES [Abstract in Rivista]
Coelho, Rf; Patel, Mb; Chauhan, S; Orvieto, Ma; Liss, M; Ahlering, T; Ferrigni, R; Castle, E; Joseph, J; Sivaraman, A; Rocco, Bernardo Maria Cesare; Palmer, K; Patel, V.
abstract

Introduction: Depending on initial prognostic factors, 10 to 60% of men who undergo definitive radiation therapy (RT) for localized prostate cancer (Pca) may experience biochemical recurrence (BCR). However, no consensus exists on the optimal salvage therapy for patients with local recurrence following RT. Herein we present our technique of sRALP and report a multiinstitutional experience with sRALP for treatment of recurrent prostate cancer after primary radiotherapy. Materials and Methods, Including a Description of the Video: We evaluated 15 patients who underwent sRALP for treatment of locally recurrent Pca at 4 different institutions between March 2007 and December 2008. Six patients had brachytherapy, four had external beam RT (EBRT), two had proton beam RT and three received brachytherapy with an EBRT boost. All patients had Pca on biopsy after RT, with negative CT and bone scan. The mean follow-up was 20.5 months. In this video, we present our technique of sRALP in a patient with BCR after definitive proton beam RT. Results: The mean time to BCR after RT was 32.39 months. The mean estimated blood loss was 76.67 ml and the mean operative time was 125.25 min. 3 patients (20%) presented BCR (PSA > 0.2), at 4 and 6 months; all 3 patients had negative surgical margins and underwent bilateral PLND which revealed no evidence of malignancy. There were no rectal injuries, blood transfusions, or conversion to open surgery; 3 pts developed postoperative DVT requiring anticoagulation. Eleven (73%) patients were continent (0 pads per day) with a minimum follow-up of three months after sRALP; no patients reported erections adequate for sexual intercourse. Conclusions: sRALP is a safe and feasible option for treatment of locally recurrent prostate cancer after definitive RT. Encouraging oncologic and functional outcomes with low perioperative morbidity were demonstrated in our multi-institutional series.


2010 - SINGLE LAPAROSCOPIC ROBOT-ASSISTED RADICAL PROSTATECTOMY (RARP) LEARNING CURVE OF A NAIVE SURGEON [Abstract in Rivista]
Albo, G; Melegari, S; Ambruosi, C; Rocco, Bernardo Maria Cesare; Santoro, L; Detti, S; Verweij, F; De Cobelli, O.
abstract

SINGLE LAPAROSCOPIC ROBOT-ASSISTED RADICAL PROSTATECTOMY (RARP) LEARNING CURVE OF A NAIVE SURGEON


2010 - Techniques of Nerve-Sparing and Potency Outcomes Following Robot-Assisted Laparoscopic Prostatectomy [Articolo su rivista]
Chauhan, S; Coelho, R. F.; Rocco, Bernardo Maria Cesare; Palmer, K. J.; Orvieto, M. A.; Patel, V. R.
abstract

Purpose: Nerve sparing radical prostatectomy is the gold standard for the treatment of prostate cancer. Over the past decade, more and more surgeons and patients are opting for a robot-assisted procedure. The purpose of this paper is to briefly review different techniques and outcomes of nerve sparing robot assisted laparoscopic prostatectomy (RALP). Materials and Methods: We performed a MEDLINE search from 2001 to 2009 using the keywords "robotic prostatectomy", "cavernosal nerve", "pelvic neuroanatomy", "potency", "outcomes" and "comparison". Extended search was also performed using the references from these articles. Results: Several techniques of nerve sparing are available in literature for RALP, which have been described in this manuscript. These include, "the veil of Aphrodite", "athermal retrograde neurovascular release", "clipless antegrade nerve sparing" and "clipless cautery free technique". The comparative and the non comparative series showing outcomes of RALP have been described in the manuscript. Conclusions: The basic principles for nerve sparing revolve around minimal traction, athermal dissection, and approaching the correct planes. It has not been documented if any one technique is better than the other. Regardless of technique, patient selection, wise clinical judgment and a careful dissection are the keys to achieve optimal oncological outcomes following RALP.


2010 - [Robot-assisted laparoscopic prostatectomy: surgical technique]. FT Prostatectomia laparoscopica robot assistita: tecnica chirurgica. [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Coelho R., F; Albo, G; Patel, V. R.
abstract

Prostate tumours are among the most frequently diagnosed solid tumours in males (a total of 192,280 new cases in the USA in 2009); since the approval of the PSA test by the Food and Drug Administration in 1986, incidence has risen significantly, particularly in the '90s; furthermore the spread of the PSA test has led to an increased frequency of cancer diagnosis at the localised stage. The standard treatment for tumour of the prostate is retropubic radical prostatectomy (RRP) which however is not morbidity-free, e.g. intraoperative bleeding, urinary incontinence and erectile dysfunction. This is why the interest of the scientific community has turned increasingly to mini-invasive surgical procedures able to achieve the same oncological results as the open procedure, but which also reduce the impact of the treatment on these patients' quality of life. The first step in this direction was laparoscopic prostatectomy described by Schuessler in 1992 and standardised by Gaston in 1997. However, the technical difficulty inherent in this procedure has limited its more widespread use. In May 2000 Binder and Kramer published a report on the first robot-assisted prostatectomy (RARP) using the Da Vinci system (da Vinci TM, Intuitive Surgical, Sunnyvale, CA, USA). From the original experience, RARP, which exploits the advantages of an enlarged, three-dimensional view and the ability of the instruments to move with 7 degrees of freedom, the technique has spread enormously all over the world. At the time of writing, in the USA, RARP is the most common therapeutic option for the treatment of prostate tumour at localised stage. In the present study we describe the RARP technique proposed by dr. Vipul Patel, head of the Global Robotic Institute (Orlando Fl).


2009 - Anatomical reconstruction of the rhabdosphincter after radical prostatectomy [Articolo su rivista]
Rocco, Francesco; Rocco, Bernardo Maria Cesare
abstract

N/A


2009 - Anatomical reconstruction of the rhabdosphincter after radical prostatectomy: Surgery illustrated - focus on details [Articolo su rivista]
Rocco, Francesco; Rocco, Bernardo
abstract

Anatomical reconstruction of the rhabdosphincter after radical prostatectomy: Surgery illustrated - focus on details


2009 - BUILDING A ROBOTIC PROGRAM [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Lorusso, A.; Coelho, R. E.; Palmer, K. J.; Patel, V. R.
abstract

N/A


2009 - Benign splenosis mimicking peritoneal seeding in a bladder cancer patient: A case report [Articolo su rivista]
Rizzo, Stefania; Monfardini, Lorenzo; Belmonte, Maddalena; Rocco, Bernardo; Bellomi, Massimo
abstract

Introduction: Splenosis is a post-traumatic autotrasplantation and proliferation of splenic tissue in ectopic sites. These implants may mimic malignancy in healthy patients or peritoneal metastases in cancer patients. When a previous history of splenic injury is known, the finding of soft tissue nodules in many thoracic and abdominal locations might raise the suspicion of the benign condition of splenosis, in order to avoid unnecessary surgery or chemotherapy. Case presentation: A 56-year-old man with history of persistent hematuria from bladder cancer was referred to our Institution for suspected peritoneal carcinosis. For staging purposes he underwent abdominal computed tomography and ultrasound. The integration of patient's history and imaging results led to the diagnosis of peritoneal splenosis. The patient therefore underwent regular Trans Urethral Resection of Bladder for the known malignancy; while no treatment was necessary for splenosis. Two years follow-up was negative for metastases. Conclusion: Splenosis is a benign condition after traumatic splenectomy which should be taken into account in the differential diagnosis with peritoneal seeding of malignancy because its appearance may resemble malignancy. © 2009 Rizzo et al; licensee BioMed Central Ltd.


2009 - Benign splenosis mimicking peritoneal seeding in a bladder cancer patient: a case report. [Articolo su rivista]
Rizzo, Stefania; Monfardini, Lorenzo; Belmonte, Maddalena; Rocco, Bernardo; Bellomi, Massimo
abstract

N/A


2009 - CLASSIFICATION AND TRENDS OF COMPLICATIONS IN 2500 ROBOTIC-ASSISTED RADICAL PROSTATECTOMIES [Abstract in Rivista]
Palmer, K. J.; Coelho R., Ferreira; Rocco, Bernardo Maria Cesare; Chauhan, S.; Coughlin, G.; Patel, V.
abstract

BACKGROUND: Perioperative complications following robotic-assisted radical prostatectomy (RARP) have been previously reported in recent series. Few studies, however, have used standardized systems to classify surgical complications, and that inconsistency has hampered accurate comparisons between different series or surgical approaches. OBJECTIVE: To assess trends in the incidence and to classify perioperative surgical complications following RARP in 2500 consecutive patients. DESIGN, SETTING, AND PARTICIPANTS: We analyzed 2500 patients who underwent RARP for treatment of clinically localized prostate cancer (PCa) from August 2002 to February 2009. Data were prospectively collected in a customized database and retrospectively analyzed. INTERVENTION: All patients underwent RARP performed by a single surgeon. MEASUREMENTS: The data were collected prospectively in a customized database. Complications were classified using the Clavien grading system. To evaluate trends regarding complications and radiologic anastomotic leaks, we compared eight groups of 300 patients each, categorized according the surgeon's experience (number of cases). RESULTS AND LIMITATIONS: Our median operative time was 90min (interquartile range [IQR]: 75-100min). The median estimated blood loss was 100ml (IQR:100-150ml). Our conversion rate was 0.08%, comprising two procedures converted to standard laparoscopy due to robot malfunction. One hundred and forty complications were observed in 127 patients (5.08%). The following percentages of patients presented graded complications: grade 1, 2.24%; grade 2, 1.8%; grade 3a, 0.08%; grade 3b, 0.48%; grade 4a, 0.40%. There were no cases of multiple organ dysfunction or death (grades 4b and 5). There were significant decreases in the overall complication rates (p=0.0034) and in the number of anastomotic leaks (p<0.001) as the surgeon's experience increased. CONCLUSIONS: RARP is a safe option for treatment of clinically localized PCa, presenting low complication rates in experienced hands. Although the robotic system provides the surgeon with enhanced vision and dexterity, proficiency is only accomplished with consistent surgical volume; complication rates demonstrated a tendency to decrease as the surgeon's experience increased.


2009 - CONTINENCE AND POTENCY RATES FOLLOWING RADICAL PROSTATECTOMY VERSUS RADIATION THERAPY IN MEN WITH T3 PROSTATE CANCER. 10 YEAR FOLLOW UP [Abstract in Rivista]
Kuehhas, F.; Rocco, Bernardo Maria Cesare; Hoffmann, P.; Van Velthoven, R.; Brausi, M.; Kaisary, A.; Anagnostou, T.; Dobronski, P.; Djavan, B.
abstract

Introduction & Objectives: To evaluate oncological and functional outcomes of radical prostatectomy and radiation therapy in men with cT3 prostate cancer and to analyse independent factors allowing an accurate patient selection. Material & Methods: Between 1993 and 2006 a total of 695 patients with cT3 Prostate cancer and PSA < 25ng/ mL were treated either by radiation therapy (n=302) with the MD Anderson scheme (78 Gy and hormone therapy, XRT+HT) or radical prostatectomy with lymphadenectomy (n=393)(RPE). Treatment allocation was strictly selected for each centre to avoid selection bias. Follow up was routinely done at 3 month intervals. Progression free survival and cancer specific survival was calculated for each group and a neural network created to investigate the impact of grade, PSA and age. In addition continence (<1 pad) and potency rates were evaluated. With respect PSA, lower PSA(<4) performed worse than men with intermediate PSA, whereas young men clearly had the worse outcome. When comparing treatment strategies, radiation+HT was equal to RPE in men with GS<7, PSA 4-10 and close to RPE in men older than 60. Otherwise RPE performed better in terms of DSS and CSS. Conclusions: Men with cT3 prostate cancer do represent an inhomogeneous cohort. Men < 60 years, PSA < 4 or PSA >10 and GS >7 show better DSS and CSS with radical prostatectomy versus radiation therapy at 5 and 10 years follow up. Continence and potency results were equal and strongly age dependent.


2009 - IMMUNOMAGNETIC QUANTIFICATION OF CIRCULATING TUMOUR CELLS (CTCS) AS NEW PROGNOSTIC AND PREDICTIVE FACTOR IN CASTRATION RESISTANT PROSTATE CANCER (CRPC): PRELIMINARY RESULTS [Abstract in Rivista]
Cossu Rocca, M.; Verri, E.; Sandri, M. T.; Marenghi, C.; Botteri, E.; Adamoli, L.; Curigliano, G.; De Cobelli, O.; Rocco, Bernardo Maria Cesare; Zorzino, L.; Cassatella, M. C.; Nole, F.
abstract

Introduction & Objectives: The increasing need to improve the capability of monitoring cancer diseases and to tailor therapies to patients has incited researchers to define new markers able to modify therapeutic decision. Circulating tumour cells (CTCs) seems to have predictive and prognostic impact in several solid tumours and also in CRPC. We aimed to explore the prevalence and role of CTCs levels in this population. Material & Methods: Since September 2006 we collected blood samples from 35 pts with CRPC treated with chemotherapy. Whole blood samples of each patient are collected into the Cell Save Preservative Tube (Veridex LLC, Raritan, NJ) and analysed for CTCs. Mononuclear cells fraction are isolated using epithelial cell antibody-coated magnetic nanoparticles, fluorescently labelled. Then CTCs are identified with automated fluorescent microscopy. Timing of collection was baseline, after three, six, nine weeks of treatment and during every instrumental evaluation until disease progression. Results: To date 35 of planned 54 pts have been enrolled. Median age: 72 (55-84). Median basal PSA was 131 (12.5-2899). Preliminary results showed 71% prevalence of intact CTCs >5/7.5 mL and 50% prevalence of intact CTCs >20/7.5mL. CTCs number ranged from 0 to 1959/7.5 mL (mean 143; median 19.5). The median value of basal CTCs correlate with the number of previous CRPC treatments even if the statistical significance is not still reached (p-value 0.099). At the basal determination, CTCs show a positive correlation with PSA levels (p-value=0.003), alkaline phosphatase determination (p-value <0.001) and a negative correlation with Hb (p-value 0.039). A value of CTCs >20 after 6 weeks from the beginning of the therapy is correlated with a significant decrease in progression free survival (p-value 0.025). Conclusions: Our data showed a significant high level of CTCs in the majority of CRPC pts. CTCs seem to confirm their prognostic and predictive value but we need a larger sample population and a longer follow up period in order to confirm the data.


2009 - Intraoperative radiotherapy during radical prostatectomy for intermediate-risk to locally advanced prostate cancer: treatment technique and evaluation of perioperative and functional outcome vs standard radical prostatectomy, in a matched-pair analysis [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Jereczek Fossa Barbara, A.; Matei Deliu, Victor; Verweij, Fabrizio; Santoro, Luigi; Vavassori, Andrea; Ospina Juan, Camillo; Cedeira, Francisco; Ciocca, Mario; Orecchia, Roberto; de Cobelli, Ottavio
abstract

OBJECTIVE To evaluate a novel approach with intraoperative radiotherapy (IORT) administered in the surgical field, after pelvic lymphadenectomy (PL) and before radical retropubic prostatectomy (RRP), evaluating acute and late toxicity, complications and biochemical progression-free survival (bPFS), as the adequate treatment of locally advanced prostate cancer is still a controversial issue. PATIENTS AND METHODS Between June 2005 and October 2007, 33 consecutive patients with intermediate-risk or locally advanced prostate cancer were selected for PL + IORT + RRP. IORT was delivered by a mobile linear accelerator in the operating room (electron beam, 12 Gy at 90% isodose). According to the pathological findings further adjuvant radio- or hormone therapy could be administered. The median follow-up was 16 months. This group was compared retrospectively with a historical group of 100 patients who had undergone RRP and further adjuvant therapy, selected with equivalent criteria. The comparison was conducted as a matched-pair analysis. The perioperative outcomes (surgical time, estimated blood loss, blood transfusions, days of catheterization, days of drainage, days of hospitalization), continence as the functional outcome, acute and late toxicity, rate of complications and bPFS were evaluated and compared. RESULTS The baseline characteristics of the two groups were equivalent but the node count and the number of positive lymph nodes was higher in the IORT group. The IORT group had longer surgery, and a shorter hospital stay and catheterization. There were no differences in continence rate, and no major complications in either group. The acute and late toxicity and bPFS were equivalent. A retrospective comparison and the short follow-up were the major limitations. CONCLUSIONS IORT administered before RRP seems a feasible approach, with little effect on the variables evaluated.


2009 - Periurethral Suspension Stitch During Robot-Assisted Laparoscopic Radical Prostatectomy: Description of the Technique and Continence Outcomes [Articolo su rivista]
Patel Vipul, R.; Coelho Rafael, F.; Palmer Kenneth, J.; Rocco, Bernardo Maria Cesare
abstract

Background Several studies have shown that robot-assisted laparoscopic radical prostatectomy (RALP) is feasible, with favorable complication rates and short hospital times. However, the early recovery of urinary continence remains a challenge to be overcome. Objective We describe our technique of periurethral retropubic suspension stitch during RALP and report its impact on early recovery of urinary continence. Design, setting, and participants We analyze prospectively 331 consecutive patients who underwent RALP, 94 without the placement of suspension stitch (group 1) and 237 with the application of the suspension stitch (group 2). Surgical procedure The only difference between the groups was the placement of the puboperiurethral stitch after the ligation of the dorsal venous complex (DVC). The periurethral retropubic stitch was placed using a 12-in monofilament polyglytone suture on a CT-1 needle. The stitch was passed from right to left between the urethra and DVC, and then through the periostium on the pubic bone. The stitch was passed again through the DVC, and then through the pubic bone in a figure eight, and then tied. Measurements Continence rates were assessed with a self-administered validated questionnaire (Expanded Prostate Cancer Index Composite [EPIC]) at 1, 3, 6, and 12 mo after the procedure. Continence was defined as the use of no absorbent pads or no leakage of urine. Results and limitations In group 1, the continence rate at 1, 3, 6, and 12 mo postoperatively was 33%, 83%, 94.7%, and 95.7%, respectively; in group 2, the continence rate was 40%, 92.8%, 97.9%, and 97.9%, respectively. The suspension technique resulted in significantly greater continence rates at 3 mo after RALP (p = 0.013). The median/mean interval to recovery of continence was also statistically significantly shorter in the suspension group (median: 6 wk; mean: 7.338 wk; 95% confidence interval [CI]: 6.387–8.288) compared to the nonsuspension group (median: 7 wk; mean: 9.585 wk; 95% CI: 7.558–11.612; log rank test, p = 0.02). Conclusions The suspension stitch during RALP resulted in a statistically significantly shorter interval to recovery of continence and higher continence rates at 3 mo after the procedure.


2009 - Phase II trial of estramustine phosphate and oral etoposide in patients with hormone-refractory prostate cancer [Articolo su rivista]
Spitaleri, G.; Matei, D. V.; Curigliano, G.; Detti, S.; Verweij, F.; Zambito, S.; Scardino, E.; Rocco, Bernardo Maria Cesare; Nole, F.; Ariu, L.; De Pas, T.; de Braud, F.; De Cobelli, O.
abstract

N/A


2009 - Re: Assessment of Early Continence After Reconstruction of the Periprostatic Tissues in Patients Undergoing Computer Assisted (Robotic) Prostatectomy: Results of a 2 Group Parallel Randomized Controlled Trial [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Rocco, Francesco
abstract

N/A


2009 - Re: Assessment of Early Continence After Reconstruction of the Periprostatic Tissues in Patients Undergoing Computer Assisted (Robotic) Prostatectomy: Results of a 2 Group Parallel Randomized Controlled Trial. M. Menon, F. Muhletaler, M. Campos and J. O. Peabody J Urol 2008; 180: 1018-1023 [Articolo su rivista]
Rocco, Bernardo; Rocco, Francesco
abstract

Assessment of early continence after reconstruction of the periprostatic tissues in patients undergoing computer assisted (robotic) prostatectomy: results of a 2 group parallel randomized controlled trial. [J Urol. 2008]


2009 - Robotic vs open prostatectomy in a laparoscopically naive centre: a matched-pair analysis [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Matei Deliu, Victor; Melegari, Sara; Ospina Juan, Camilo; Mazzoleni, Federica; Errico, Giacomo; Mastropasqua, Mauro; Santoro, Luigi; Detti, Serena; de Cobelli, Ottavio
abstract

OBJECTIVE To compare the early oncological, perioperative and functional outcomes of robotic-assisted radical prostatectomy (RARP) vs open retropubic RP (RRP) in a laparoscopically naive centre, as robotic assistance aids the laparoscopically naive surgeon in minimally invasive prostate surgery, by offering magnification and superior dexterity. PATIENTS AND METHODS From 1 November 2006 to 31 December 2007, 120 patients had RARP; this group was followed prospectively and evaluated for early oncological, perioperative and functional outcomes (measured at 3, 6 and 12 months after surgery), and compared to a historical control group of consecutive patients who had RRP from 20 May 2004 to 28 February 2007. All patients were operated by the same laparoscopically naive surgeons. The comparison was by matched-pair analysis. RESULTS The baseline characteristics of the two groups were equivalent, although there was a higher percentage of patients with pT3/pT4 disease in the RRP group. As a proxy for oncological outcome, positive surgical margins were equivalent in the two groups (22% RARP vs 25% RRP, P = 0.77). The overall mean (range) surgical duration was significantly longer in RARP group, at 215 (165-450) min vs 160 (90-240) min in the RRP group (P < 0.001). However, RARP had a statistically significant advantage over RRP for estimated blood loss, of 200 vs 800 mL (P < 0.001), duration of catheterization (6 vs 7 days P < 0.001) and length of stay (3 vs 6 days, P < 0.001) The 3, 6 and 12-month continence rates were 70%, 93% and 97% vs 63%, 83% and 88% after RARP and RRP, respectively (P = 0.15, 0.011 and 0.014). The 3, 6 and 12 month overall potency recovery rate was 31%, 43% and 61% vs 18%, 31% and 41%, after RARP and RRP, respectively (P = 0.006, 0.045 and 0.003). CONCLUSION Our initial experience showed the feasibility of RARP in a laparoscopically naive centre. RRP seems to be a faster procedure, whereas RARP provided better results in terms of estimated blood loss, hospitalization and functional results. The early oncological outcome seemed to be equivalent in the two groups.


2009 - Robotic-assisted radical prostatectomy: a review of current outcomes [Articolo su rivista]
Coelho Rafael, F.; Chauhan, Sanket; Palmer Kenneth, J.; Rocco, Bernardo Maria Cesare; Patel Manoj, B.; Patel Vipul, R.
abstract

With the widespread diffusion of the screening for prostate cancer, the disease has been diagnosed more commonly in the organ-confined stage, and in younger and healthier men. For these patients, radical prostatectomy (RP) is still the standard treatment. In an effort to decrease the morbidity associated with open RP, minimally invasive approaches have been described, including robotic-assisted RP (RALP). Almost one decade after the introduction of RALP, large and mature series have now been reported. We reviewed the outcomes of the largest series of RALP published recently. We searched Medline for reports published between 2006 and 2009, to identify articles describing intraoperative data, surgical complications, oncological outcomes, continence and potency rates after RALP. Relevant articles were selected and the outcomes evaluated.


2008 - Early continence recovery after robotic prostatectomy with restoration of posterior aspect of the rhabdosphincter [Abstract in Rivista]
Rocco, B.; Matei, D. V.; Bonghi, A.; Cedeira, F.; Pimentel, M.; De Cobelli, O.
abstract

Early continence recovery after robotic prostatectomy with restoration of posterior aspect of the rhabdosphincter


2008 - Editorial Comment [Int Braz J Urol vol.34, 1] [Articolo su rivista]
Rocco, Bernardo; Pimentel, Marcelo
abstract

Editorial Comment


2008 - Evaluation of Core and Surface Body Temperatures, Prevalence, Onset, Duration and Severity of Hot Flashes in Men after Bilateral Orchidectomy for Prostate Cancer EDITORIAL COMMENT [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Pimentel, Marcelo
abstract

N/A


2008 - Frequency of TZ cancers in men with negative biopsies and persistenly elevated PSA levels [Abstract in Rivista]
Djavan, Bob; Rocco, Bernardo Maria Cesare; Herwig, Ralf; Brausi, Maurizio; Zlotta Alexandre, R.; Ravery, Vincent; Hammerer, Paul; Anagnostou, Theodore; Margreiter, Markus; Kuehhas, Franklin; Harik, Mike; Lepor, Hans; Marberger, Michael
abstract

Frequency of TZ cancers in men with negative biopsies and persistenly elevated PSA levels


2008 - Intraoperative radiotherapy for locally advanced prostate cancer: The experience of the European institute of oncology [Abstract in Rivista]
Vavassori, Andrea; Ciocca, Mario; Jereczek, Barbara; Zerini, Dario; Ivaldi, Giovanni; Fodor, Cristiana; Lazzari, Roberta; Cattani, Federica; Rondi, Elena; Garibaldi, Cristina; Cambria, Raffaella; Matei, Victor; Scardino, Epifanio; Verweij, Fabrizio; Musi, Gennaro; Rocco, Bernardo Maria Cesare; De Cobelli, Ottavio; Orecchia, Roberto
abstract

INTRODUCTION AND OBJECTIVE: To present the technique adopted for intraoperative radiotherapy (IORT) for locally advanced prostate cancer. METHODS: Between June 2005 and February 2007, 24 patients (pts) with non-metastatic prostate cancer were treated with IORT before prostatectomy as part of their surgical procedure. Median DJHZDV\HDUVUDQJH7HQSWVZHUHFODVVL¿HGDV 7FSWVDV•77KHPHGLDQL36$ZDVQJPODQGWKH median bioptic Gleason Score was 7. According to NCCN 2007, risk group distribution was as follows: intermediate risk 2 pts (8.33%) and high risk 22 pts (91.67%). A total of 11 pts (45.83%) were treated with neoadjuvant hormones. Immediately before IORT prostate dimensions and rectum depth were measured with intraoperative ultrasound. IORT was delivered by a mobile linear accelerator in the operating room. The prescribed dose was 12 Gy at the 90% isodose. In vivo dosimetry was performed. Three months later, postoperative external beam radiotherapy (EBRT) of 45-50,4 Gy in 25-28 fractions was prescribed to the prostatic bed alone and whole pelvis in case of pT3-4 pN0 and pN1, respectively. RESULTS: According to the MSKCC nomograms, the mean SUHRSHUDWLYHSUREDELOLW\RIRUJDQFRQ¿QHGGLVHDVHH[WUDFDSVXODUGLVHDVH and lymph node involvement were 8%, 40% and 25% respectively. 3RVWRSHUDWLYHKLVWRORJLFDO¿QGLQJVZHUHDVIROORZVPHGLDQ*6UDQJH 6-9), pT2 7 pts (29,2%), pT3 14 pts (58,3), pT4 3 (12,5%), pN0 12 pts, S1SWV2UJDQFRQ¿QHGGLVHDVHS7S15ZDVGLDJQRVHGLQ pts (16.6%) and no further radiation treatment was prescribed. Based RQWKHGH¿QLWLYHKLVWRORJLFDOUHSRUWVSRVWRSHUDWLYHSHOYLFDQGSURVWDWLF bed EBRT is planned in 12 and 8 pts, respectively. After a median follow up of 9.2 months (range 3.3-15.7) only 1 patient had evidence of biochemical relapse. No patients had major acute rectal toxicity. No acute urinary toxicity was observed in 6 patients, 17 patients had G1 toxicity. No increased risk of urinary incontinence was recorded. CONCLUSIONS: IORT delivered before prostatectomy appeared a feasible and safe approach for prostate cancer, showing a satisfactory dose coverage to the prostate bed with relatively low rectal wall dose. Longer follow-up is needed to evaluate late toxicity and clinical control.


2008 - Preservation of the tip of the seminal vesicle does improve potency rates following radical prostatectomy [Abstract in Rivista]
Diavan, B.; Rocco, Bernardo Maria Cesare; Ravery, V.; Hammerer, P.; Zotta, A.; Brausi, M.; Kaisary, A.; Anagnostou, T.; Dobronski, P.; Mariberger, M.
abstract

Material & Methods: Using the database of the European study on radical prostatectomy (653(DQG PHQ ZKR XQGHUZHQW UDGLFDO UHWURSXELF SURVWDWHFWRP\ EHWZHHQ DQGDWRWDORISDWLHQWVZHUHLGHQWLᚏHGZKRKDGXQGHUJRQHELODWHUDOQHUYHVSDULQJ and preservation of the tip of the seminal vesicle (GROUP 1). Potency and continence results were compared to a matched group of 1424 men who also underwent a bilateral nerve sparing procedure without preservation of the seminal vesicle tip during the same period (GROUP 2). Results: 2YHUDOOFRQWLQHQFHUDWHSDGDW\HDUZDVZLWKD&,&RQWLQHQFH WLPHNLQHWLFVDWPRDWPRDWPRDQGDWPR$ GLᚎHUHQFHZDVVHHQZKHQFRPSDULQJSK\VLFLDQDQGSDWLHQWJXLGHGTXHVWLRQQDLUHVZLWK respect to continence (physicians judging rates more favourably).A constant relative increase in Nerve-sparing (uni- and bilateral) procedures was observed with highest rates 1998-2000, and reaching a steady state thereafter (at 71,4% of all cases). Potency results and time kinetics in both groups are: Potency GROUP 1* GROUP 2 PR 8-15% 9-16% 6 mo 21-26% 12 mo 59-86% 49-71% ,Q*URXSDQGLQPHQ\HDUVRIDJHSRWHQF\UDWHVLQFUHDVHGWRDQG DWDQGPRUHVSHFWLYHO\1RVWDWLVWLFDOVLJQLᚏFDQWGLᚎHUHQFHVZHUHREVHUYHG with respect to margin status (p=0.002) and progression free survival rates (p=0.001) at a mean of 8 years follow up Conclusions: )XQFWLRQDOUHVXOWVRIUDGLFDOUHWURSXELFSURVWDWHFWRP\KDVVLJQLᚏFDQWO\HYROYHG over the past 12 years. Highest rates in potency (59-86%) were observed at 1 year post surgery in men with bilateral nerve sparing procedures. Preservation of the tip of the seminal YHVLFOHV VLJQLᚏFDQWO\ LQFUHDVHG SRVW ದ53( SRWHQF\ UDWHV ZLWKRXW MHRSDUGL]LQJ RQFRORJLFDO outcomes. 713 SUTURELESS VESICO-URETHRAL ANASTOMOSIS AFTER RADICAL PROSTATECTOMY: INITIAL CLINICAL FEASIBILITY DATA FROM THE CONT


2008 - Radical prostatectomy versus radiation therapy in men with T3 prostate cancer. 10 year follow up [Abstract in Rivista]
Djavan, B.; Ravery, V.; Hammerer, P.; Herwig, R.; Zlotta, A.; Brausi, M.; Kaisary, A.; Anagnostou, T.; Dobronski, P.; Marberger, M.; Rocco, Bernardo Maria Cesare
abstract

Introduction & Objectives: To evaluate oncological outcomes of radical prostatectomy and an accurate patient selection.


2007 - Benefit on biochemical control of adjuvant radiation therapy in patients with pathologically involved seminal vesicles after radical prostatectomy [Articolo su rivista]
Greco, Carlo; Castiglioni, Simona; Fodor, Andrei; De Cobelli, Ottavio; Longaretti, Nadia; Rocco, Bernardo Maria Cesare; Vavassori, Andrea; Orecchia, Roberto
abstract

N/A


2007 - Early continence recovery after open radical prostatectomy with restoration of the posterior aspect of the rhabdosphincter [Articolo su rivista]
Rocco, Francesco; Carmignani, Luca; Acquati, Pietro; Gadda, Franco; Dell'Orto, Paolo; Rocco, Bernardo Maria Cesare; Casellato, Stefano; Gazzano, Giacomo; Consonni, Dario
abstract

N/A


2007 - Editorial comment on: Prostate biopsies guided by three-dimensional real-time (4-D) transrectal ultrasonography on a phantom: comparative study versus two-dimensional transrectal ultrasound-guided biopsies [Articolo su rivista]
Rocco, Bernardo Maria Cesare
abstract

N/A


2007 - European study of radical prostatectomy: Time trends in Europe, 1993-2005 [Articolo su rivista]
Djavan, Bob; Ravery, Vincent; Rocco, Bernardo Maria Cesare; Zlotta, Alexandre; Brausi, Maurizio; Margreiter, Markus; Hammerer, Peter; Kaisary, Amir; Anagnostou, Theodore; Romics, Imre; Dobronski, Pitor; De Cobelli, Ottavio; Marberger, Michael
abstract

N/A


2007 - Gefitinib combined with endocrine manipulation in patients with hormone-refractory prostate cancer: quality of life and surrogate markers of activity [Articolo su rivista]
Curigliano, Giuseppe; Sandri Maria, Teresa; Renne, Giuseppe; Zorzino, Laura; Scardino, Epifanio; Rocco, Bernardo Maria Cesare; Spitaleri, Gianluca; De Pas, Tommaso; Noberasco, Cristina; Nole, Franco; Verweij, Fabrizio; Matei, Victor; De Cobelli, Ottavio; De Braud, Filippo
abstract

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2007 - Indications for saturation biopsies of the prostate: Where do we stand? [Abstract in Rivista]
Diavan, B.; Rocco, Bernardo Maria Cesare; Zlotta, A.; Herwig, R.; Margreiter, M.; Hank, M.; Kuehhas, F.; Brausi, M.; Pushkar, D.; Ravery, V.; Anagnostou, T.; Kaisary, A.; Marberger, M.
abstract

Introduction & Objectives: Recent results of the European Prostate Cancer Detection study (EPCDS) and the 3 dimensional reconstruction of cancers detected on first and repeat biopsy suggested that cancers detected on repeat biopsy were located in more dorso-lateral (para-rectal) and apical location. The Vienna nomograms further identified the optimal number of cores required. The purpose of this study was to evaluate the value and legacy of saturation biopsies (22 cores) versus a novel modified biopsy protocol. Material & Methods: A total of 593 patients were evaluated in 8 European University centers. 212 patients with a total PSA (2.5-10 ng/mL) and an initial negative biopsy underwent a repeat saturation biopsy. A second group of 382 consecutive patients underwent repeat biopsy with a novel modified biopsy protocol using the Vienna nomograms and aiming at the apical and dorso-lateral regions. Uniand multivariate statistical analysis using the SAS system (CARY, North Carolina) and ROC curves were performed to compare cancer detection rates and distribution. Results: Cancer detection rate on first biopsy was 28.7%. Cancer detection rate on saturation repeat biopsy was 22.8%. Using the novel biopsy protocol, cancer detection rate upon repeat biopsy was 18.7%. As compared to patients diagnosed with PCa after the first set of biopsies, patients diagnosed after the second set had larger total prostate (tot vol.) and transition zone volumes (TZ vol.) (45.2 ± 11.0cc vs 33.7 ± 9.6cc, p = 0.0001 and 22.0 ± 6.5cc vs. 11.8 ± 8.3cc, p = 0.0001). These findings were identical to cancers detected on first and repeat biopsy with the saturation and modified protocol (p = 0.33). Morbidity of both the saturation and modified protocol biopsies were identical (p = 0.12), however significantly higher than with the standard octant biopsy protocol (p = 0.003). Using the cumulative logistic plot analysis the probability of a positive first/repeat biopsy core was analyzed. The dorsolateral biopsy cores (p = 0.001), followed by the apical (p = 0.02) and transition zone biopsy cores (p = 0.04) were the most common sites of cancer on repeat biopsy. On multivariate analysis, patients with HG-PIN on first biopsy, PSA > 8 ng/mL, tot vol. >50 cc, TZ vol 20-40cc, TZ/PZ ratio < 0.4 and a negative prior history of biopsies had a significantly higher detection rate on saturation biopsy. Conclusions: Saturation biopsy and modified biopsy protocols using volume/age charts resulted in a 69-78% improvement of the cancer detection rate on repeat biopsy as compared to standard repeat biopsies technique. However, saturation biopsies were not necessary in all patients with negative initial biopsies. Saturation biopsies were beneficial in patients with HG-PIN on first biopsy, PSA > 8 ng/mL, tot Vol >50 cc, TZ vol 20-40cc, TZ/PZ ratio < 0.4 and a negative prior history of biopsies resulting in a further 37% increase in detection rates.


2007 - Intraoperative radiotherapy for locally advanced prostate cancer: Treatment technique and ultra sound-based analysis of dose distribution [Articolo su rivista]
Orecchia, Roberto; Jereczek-Fossa, Barbara A.; Ciocca, Mario; Vavassori, Andrea; Cambria, Raffaella; Cattani, Federica; Zerini, Dario; Matei, Deliu V.; Rocco, Bernardo; Verweij, Fabrizio; Scardino, Epifanio; De Cobelli, Ottavio
abstract

Background: To present the technique and dose distribution of intraoperative radiotherapy (IORT) for prostate cancer. Patients and Methods: Pelvic lymphadenectomy, prostate IORT and radical retropubic prostatectomy was performed in 11 prostate cancer patients. Prostate thickness and rectum depth were measured with intraoperative ultrasound. IORT was delivered by a mobile linear accelerator in the operating room (electron beam, 12 Gy at 90% isodose). Results: The mean preoperative probability of organ-confined disease was 10% (Memorial Sloan Kettering Cancer Center nomograms). Mean prostate thickness, width and length were 3.4 cm, 4.6 and 4.9 cm, respectively. Mean rectum depth was 3.3 cm. Mean doses to the posterior prostate capsule, 5-mm lateral prostate margins and at the subsequent uretheral stump area were 4.6 Gy, 8.7 Gy and 11.3 Gy, respectively. Maximum mean rectal dose was 4.9 Gy. Conclusion: IORT appeared a feasible approach for prostate cancer, showing a satisfactory dose coverage to the prostate bed with relatively low rectal dose. However, high variability in dose distribution calls for further study of patient selection criteria and dosimetry.


2007 - Is the era of prostate-specific antigen over? [Articolo su rivista]
Djavan, Bob; Rocco, Bernardo Maria Cesare; Stangelberger, Anton; De Cobelli, Ottavio; Marberger, Michael
abstract

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2007 - Locally advanced prostate cancer: Biochemical results from a prospective phase II study of intermittent androgen suppression for men with evidence of prostate-specific antigen recurrence after radiotherapy [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Scardino, Epifanio; de Cobelli, Ottavio
abstract

N/A


2007 - Pharmacogenetics determinants of anticancer activity of intravescical gemcitabine in patients with superficial transitional cell carcinoma (TCC) of the bladder [Articolo su rivista]
Verweij, Fabrizio; Matel Victor, D.; Scardino, Epifanio; Rocco, Bernardo Maria Cesare; Musi, Gennaro; Besana, Umberto; Zambito, Stefano; Pimentel, Marcelo; Pedroso, Eduardo; de Cobelli, Ottavio; de Braud, Filippo; Curigliano, Giuseppe; Spitaleri, Gianluca; Pece, Salvatore; Danesi, Romano; Mey, Valentina; Giovanetti, Elisa; Nanizzi, Sara
abstract

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2007 - Posterior reconstruction of the rhabdosphincter allows a rapid recovery of continence after transperitoneal videolaparoscopic radical prostatectomy [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Gregori, Andrea; Stener, Silvio; Santoro, Luigi; Bozzola, Andrea; Galli, Stefano; Knez, Roberto; Scieri, Francesco; Scaburri, Alessandra; Gaboardi, Franco
abstract

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2007 - Predictors of prostate cancer in the transition zone: Results of a multicenter trial. [Articolo su rivista]
Djavan, Bob; Rocco, Bernardo Maria Cesare; Brausi, Maurizio; Zlotta Alexandre, R.; Ravery, Vincent; Hammerer, Peter; Anagnostou, Theodore; Naegele, Ralph; Margreiter, Markus; Harik, Mike; Lepor, Herbert; Marberger, Michael
abstract

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2007 - Premature administration of alprostadil post-prostatectomy: Effects on the drop out? [Abstract in Rivista]
Matei, D. V.; Pimentel, M.; Pedroso, E.; Rocco, B.; Verweij, F.; Scardino, E.; Musi, G.; Besana, U.; Zambito, S.; Djavan, B.; De Cobelli, O.
abstract

743 PREMATURE ADMINISTRATION OF ALPROSTADIL POST-PROSTATECTOMY: EFFECTS ON THE DROP OUT?


2007 - Robotic prostatectomy: facts or fiction? [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Djavan, Bob
abstract

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2007 - Saturation biopsies of the prostate: When and how? Results of a prospective European multicenter study [Abstract in Rivista]
Rocco, Bernardo Maria Cesare; Djavan, B.; Zlotta, A. R.; Herwig, R.; Margreiter, M.; Harik, M.; Kuehhas, F.; Brausi, M.; Pushkar, D.; Ravery, V.; Anagnostou, T.; Kaisary, A.; Marberger, M.
abstract

Saturation biopsies of the prostate: When and how? Results of a prospective European multicenter study.


2006 - European study on radical prostatectomy (ESRPE) - Part II: Functional results and changes 1993-2004 [Abstract in Rivista]
Vienna, Bd; Rocco, Bernardo Maria Cesare; Ravery, V; Hammerer, P; Zlotta, A; Brausi, M; Kaisary, A; Anagnostou, T; Dobronski, P; Marberger, M.
abstract

INTRODUCTION & OBJECTIVES: To evaluate Oncological results of radical retropubic prostatectomy in Western and Eastern Europe from 1993-2004. MATERIAL & METHODS: In these retrospective evaluations 10,553 men who underwent radical retropubic prostatectomy between 1993 and 2004 were evaluated and onco-pathological data and features collected. Besides Pathological features, margin status at various stages, PSA recurrence rates were evaluated. RESULTS: In patients with clinically localised disease and a PSA 2.5-15 ng/mL, 81% underwent radical prostatectomy and 17% opted for radiation therapy and 2% opted for watchful waiting. Overall, Positive margin rates decreased from 38% to 18%, from 1993-2004. The biggest fall in the margin rate was observed between 1996 and 1999. Margin rates for pT2 cancers were 7.4-21.9%. The positive margin rate signifi cantly correlated with the number of surgeons involved per service and the total number of cases performed. (p=0.004). PSA recurrence rates at 3 and 7 years were 3.7-7.9% and 28.4-35.8%, respectively. The lowest rates in positive margins and PSA recurrence were seen in those centres performing > 200 cases per year. A constant relative increase in Nerv-sparing (uni- and bilateral) procedures was observed with highest rates 1998-2000, and reaching a plateau thereafter (at 71,4% of all cases). Distribution of positive margins did not differ signifi cantly over time despite changes in stage: 44.8% of + margins were located at the apex, 39.7% at the posterolateral aspect and 15.5% at the bladder neck. Immediate and long term Surgical complications (7 ESOU defi ned complications) decreased signifi cantly over time from 28.6% (1993-1995) to 13.2% (1996- 2004) of all cases. Equally, medical complications (non-surgical) decreased from 9.4% (1993-1995) to 4.2% (1996-2004) Complication rates remained unchanged (plateau) from 1999 to 2004. OR time decreased from 281 min (125-640) to 188 min (64-355) in the periods 1993-1995 to 2001-2004, respectively. Transfusion rates, although highly variable due to different local practices, decreased form 21.6% (1993-1994) to 8.6% (2001-2004). CONCLUSIONS: Radical retropubic prostatectomy has signifi cantly evolved over the past 12 years. A favourable trend was observed in OR time, transfusion rate, surgical and medical complication rates, margin status and biochemical recurrence rates. This favourable trend reached a steady state (plateau) between 2000- 2004 and continues as such. Best outcomes were seen in those centres performing > 200 cases per year and in those with the lowest surgeon/case ratio.


2006 - European study on radical prostatectomy (ESRPE)-Part 1: Surgical and oncological results and changes 1993-2004 [Abstract in Rivista]
Djavan, B; Rocco, Bernardo Maria Cesare; Ravery, V; Hammerer, P; Zlotta, A; Brausi, M; Kaisary, A; Anagnostou, T; Dobronski, P; Marberger, M.
abstract

European study on radical prostatectomy (ESRPE)-Part 1: Surgical and oncological results and changes 1993-2004


2006 - Posterior reconstruction of the rhabdosphincter allows rapid recovery of urinary continence after laparoscopic RP: A preliminary report on a two-arm prospective randomised trial [Abstract in Rivista]
Gregori, A.; Rocco, B.; Stener, S.; Galli, S.; Knez, R.; Scieri, F.; Varca, V.; Gaboardi, F.
abstract

Posterior reconstruction of the rhabdosphincter allows rapid recovery of urinary continence after laparoscopic RP: A preliminary report on a two-arm prospective randomised trial


2006 - Restoration of posterior aspect of rhabdosphincter shortens continence time after radical retropubic prostatectomy [Articolo su rivista]
Rocco, F; Carmignani, L; Acquati, P; Gadda, F; Dell'Orto, P; Rocco, Bernardo Maria Cesare; Bozzini, G; Gazzano, G; Morabito, A.
abstract

N/A


2006 - Sensitivity and detection rate of a 12-core trans-perineal prostate biopsy: Preliminary report [Articolo su rivista]
Rocco, Bernardo Maria Cesare; de Cobelli, O; Leon, Me; Ferruti, M; Mastropasqua, Mg; Matei, Dv; Gazzano, G; Verweij, F; Scardino, E; Musi, G; Djavan, B; Rocco, F.
abstract

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2006 - Transition zone cancers on first and multiple repeat biopsies: Frequency, pathological and biochemical features [Abstract in Rivista]
Djavan, B; Brausi, M; Zlotta, A; Ravery, V; Hammerer, P; Anagnostou, T; Rocco, Bernardo Maria Cesare; Hank, M; Marihart, S; Marberger, M.
abstract

Transition zone cancers on first and multiple repeat biopsies: Frequency, pathological and biochemical features


2005 - Autoantibodies in prostate cancer. [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Djavan, Bob; de Cobelli, Ottavio
abstract

N/A


2005 - Gn-RH antagonist possible response, after Gn-RH agonist failure in a man with metastatic prostate cancer [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Ferrari, M; Scardino, E; Matei, Dv; Verweij, F; Varela, R; De Cobelli, O.
abstract

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2005 - Re: Is tumor volume an independent prognostic factor in clinically localized prostate cancer? [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Varela, R; Verweij, F.
abstract

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2005 - Synchronous collecting duct carcinoma and papillary renal cell carcinoma: A case report and review of the literature [Articolo su rivista]
Matei, Dv; Rocco, Bernardo Maria Cesare; Varela, R; Verweij, F; Scardino, E; Renne, G; De Cobelli, O.
abstract

The coexistence of multiple and synchronous primary neoplasms in the same organ (including kidney) has only rarely been described in the literature. We herein present a case of collecting duct carcinoma (CDC) combined with papillary renal carcinoma (RCC) having a 57-month disease-free survival. CDC is a rather rare and aggressive neoplasm of the kidney. Sharing probably the same embryological origin, synchronous or metachronous association with in situ or papillary transitional cell carcinoma (TCC) may be found; association with RCC has been only once reported in the literature. The high incidence of c-erbB-2 oncogene amplification in CDC further characterizes this tumor as a separate entity from renal cell carcinoma, and shows some genetic characteristics in common with TCC. The histohgical diagnosis of Bellini CDC can be confirmed by the positive immuno-histochemical staining with a collecting duct marker and distal tubule marker and negative staining with a proximal tubule marker.


2005 - TESTING THE AGILE DATABASE FOR AN EXTERNAL VALIDATION OF A NOMOGRAM TO PREDICT MALIGNANCY OR AGGRESSIVENESS OF RENAL MASSES, BASED ON RENAL SCORE [Articolo su rivista]
Antonelli, A.; Minervini, A.; Cindolo, L.; Porreca, A.; Crivellaro, S.; Parma, P.; Zaramella, S.; Rocco, B.; Bove, P.; Pagliarulo, V.; Celiall, A.; Ceruti, C.; Falsaperla, M.; Nuciotti, R.
abstract

Gn-RH agonists or surgical castration are considered standard treatment for patients affected by metastatic prostate cancer. Despite greater cost, chemical castration is often considered the treatment of choice as it is psychologically better tolerated. We report our experience of one patient undergoing treatment with Gn-RH agonist who developed an early resistance to the administered drug, with serum testosterone levels within the range of normality.


2004 - Magnetic resonance imaging combined with artificial erection for local staging of penile cancer [Articolo su rivista]
Scardino, E; Villa, G; Bonomo, G; Matei, Dv; Verweij, F; Rocco, Bernardo Maria Cesare; Varela, R; de Cobelli, O.
abstract

N/A


2004 - Prospective randomized trial comparing flutamide as adjuvant treatment versus observation after radical prostatectomy for locally advanced, lymph node-negative prostate cancer. [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Matei, Dv; de Cobelli, O; Rocco, F.
abstract

N/A


2004 - Prostate cancer with low PSA levels [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Matei, Dv; de Cobelli, O.
abstract

N/A


2004 - Prostate cancer with low PSA levels [4] (multiple letters) [Articolo su rivista]
Beatty, Peter A.; Glaser, Alan I.; Rocco, Bernardo; Matei, Deliu Victor; De Cobelli, Ottavio; Datta, Milton W.; Berman, Jules J.; Dhir, Rajiv
abstract

Prostate cancer with low PSA levels [4] (multiple letters)


2004 - Re: An evaluation of the decreasing incidence of positive surgical margins in a large retropubic prostatectomy series - M. Han, A. W. Partin, D. Y Chan and P. C. Walsh - J Urol, 171 : 23-26, 2004 [Articolo su rivista]
Rocco, Bernardo Maria Cesare; de Cobelli, O; Rocco, F.
abstract

N/A


2003 - Late solitary thyroid carcinoma metastasis to the kidney: A case report [Articolo su rivista]
Matei, Dv; Verweij, F; Scardino, E; Rocco, Bernardo Maria Cesare; Renne, G; Tradati, N; De Cobelli, O.
abstract

Secondary tumour to the kidney is quite frequent. Even if, theoretically, all solid tumours may give rise to renal metastasis, secondary lesions to the kidney occur more commonly in patients with lung and breast cancer, melanoma and lymphoma. Only 15 cases of renal metastasis arising from a follicular thyroid carcinoma have been reported in the literature. Rarely, metastases to the kidney present as primary renal tumours and may be treated surgically for that mistaken diagnosis. Nevertheless, in patients with solitary late distant metastasis of thyroid cancer, complete surgical resection may be proposed, followed by (131)I ablation in order to offer a better chance of prolonged survival. We describe a case of a renal mass undergoing radical surgery and revealing itself as a solitary metastasis from follicular carcinoma of the thyroid, appearing 10 years after total thyroidectomy and (131)I ablation therapy.


2003 - Spermatic cord liposarcoma: A report of four cases [Articolo su rivista]
Matei, Dv; Rocco, Bernardo Maria Cesare; Scardino, E; Verweij, F; Renne, G; Fasani, R; De Cobelli, O.
abstract

N/A


2002 - Predictors of prostate cancer in the transition zone: Results of a multicenter trial [Abstract in Rivista]
Djavan, B.; Rocco, B.; Brausi, M.; Zlotta, A. R.; Ravery, V.; Hammerer, P.; Anagnostou, T.; Naegele, R.; Margreiter, M.; Harik, M.; Lepor, H.; Marberger, M.
abstract

Predictors of prostate cancer in the transition zone: Results of a multicenter trial


2002 - [Pathology and physiopathology of urethral stenosis]. FT Anatomia patologica e fisiopatologia delle stenosi uretrali. [Articolo su rivista]
Rocco, Bernardo Maria Cesare; Gazzano, Giacomo; Gadda, Franco; Casellato, Stefano; Acquati, Pietro; Grisotto, Massimo; Bosari, Silvano; Rocco, Francesco
abstract

N/A


2001 - Epidemiologia e fisiopatologia dell'incontinenza urinaria post prostatectomia radicale (RRP) [Abstract in Rivista]
Montanari, E.; Del Nero, A.; Bernardini, P.; Trinchieri, A.; Zanetti, G.; Rocco, B.
abstract

Beginning in the 1980s, a series of anatomical discoveries were introduced to modify the classic retropubic radical prostatectomy proposed by Millin in 1942 in an effort to reduce intra and postoperative complications such as intraoperative bleeding and postoperative erectile dysfunction and incontinence. Urinary incontinence post retropubic "anatomical" radical prostatectomy remains a distressing problem for the patient and the physician rating from 6 to 20% even in the hands of experienced surgeons from high volume Academic Centers. The reason for the discrepancy in results is unclear and should be searched in surgical experience of the surgeon, volume of surgical activity of the Center, and selection of the patients undergoing the radical retropubic procedure. In the Literature we identified methodological factors which can bias the data on post radical retropubic prostatectomy such as 1) Consensus is lacking on definition of continence and/or incontinence following radical retropubic prostatectomy 2) Different surgical techniques are compared: sphincter damaging, versus repairing, versus preserving; bladder neck sparing versus non sparing; nerve sparing versus non sparing 3) Patients with preoperative urinary incontinence are included in the series and the preoperative continence status is not known. 4) Different timing in registration of incontinence. 5) Different methods in data collection. This latter seems to be the most important reason for discrepancy in the collection of the data. Self administered questionnaires oriented to evaluate incontinence analyzed by a third party seem to be the most powerful and objective tool for post prostatectomy incontinence rating. Post prostatectomy incontinence may be attributed to sphincter dysfunction as a result of surgical injury during prostatic surgery and/or to bladder dysfunction including detrusor instability and decreased compliance resulting in stress or urge or mixed stress/urge postoperative incontinence. In the Literature bladder dysfunction is considered to be responsible or jointly responsible for post RRP incontinence in a rate as high as 93%. More recently, a major role is considered to be played in post RRP incontinence pathophysiology by intrinsic sphincter insufficiency. Rarely bladder dysfunction is an isolated cause of incontinence. Moreover the symptom of stress incontinence accurately predicts the finding of intrinsic sphincter deficiency. The apical dissection and the preservation of the intrinsic sphincter remain the most complex parts of RRP and the keys to the maintenance of postoperative urinary continence.


2001 - Hormone therapy in prostate cancer [Articolo su rivista]
Rocco, F; Gadda, F; Rocco, Bernardo Maria Cesare; Acquati, P; Grisotto, M.
abstract

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2001 - Protesi ReMeEx (Regolazione Meccanica Esterna) per incontinenza: Tecnica d'impianto e regolazione [Articolo su rivista]
Mantovani, F.; Confalonieri, S.; Rocco, B.; Pisani, E.
abstract

Protesi ReMeEx (Regolazione Meccanica Esterna) per incontinenza: Tecnica d'impianto e regolazione


2001 - [Epidemiology and physiopathology of urinary incontinence after radical prostatectomy]. FT Epidemiologia e fisiopatologia dell'incontinenza urinaria post prostatectomia radicale (RRP). [Articolo su rivista]
Montanari, E; Del Nero, A; Bernardini, P; Trinchieri, A; Zanetti, G; Rocco, Bernardo Maria Cesare
abstract

N/A


1999 - Specialist training schools and specialist trainees: From teaching methodology to occupational prospects, present-day reality, future plans. The Milanese experience in an education program involving the General Hospital structure [Abstract in Rivista]
Pisani, E.; Maggioni, A.; Montanari, E.; Mandressi, A.; Rocco, B.
abstract

As a result of the insufficient practical training offered by the University of Milan in organizing and managing the School of Specialization in Urology we initiated an experimental University/Hospital collaboration in the training programme in the academic year 1995/96. We selected and gradually involved the Urology Units in the Lombardy Region in providing medical personnel, teaching aids, didactic material and tutors. The Units we considered suitable for teaching were made a part of our Speciality School and their Chiefs requested to teach and form part of the School Board. This Board has approved a Regulation that specializing trainees practice in the appointed units for a period of no less than six months, starting in the second year second semester. The trainee rotation programme is co-ordinated by the School Board only and the practical training and tutorials are checked periodically by examining the trainees' log-books and from input from the Chiefs. The initiative has received the approval of both the trainees and the hospital personnel. 1. We have considerably improved the quality of practical training for the trainees. 2. We have raised the standard of teaching in the School by involving nationally famous professors. 3. We have temporarily placed a growing number of specializing trainees in the appointed units to involve them in the day-to-day activities on the hospital wards. They receive adequate retribution and earn credits for their future careers.


1999 - Ultrasound-fluoroscopy guided access to the intrarenal excretory system [Articolo su rivista]
Montanari, E; Serrago, M; Esposito, N; Rocco, Bernardo Maria Cesare; Kartalas Goumas, I; Del Nero, A; Zanetti, G; Trinchieri, A; Pisani, E.
abstract

N/A