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GIAMPAOLO BIANCHI

Docente a contratto
Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa

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Pubblicazioni

2023 - Artificial intelligence evaluation of confocal microscope prostate images: our preliminary experience [Articolo su rivista]
Bianchi, G.; Puliatti, S.; Rodriguez, N.; Micali, S.; Bertoni, L.; Reggiani Bonetti, L.; Caramaschi, S.; Bolelli, F.; Pinamonti, M.; Rozze, D.; Grana, C.
abstract

2023 - Asymptomatic bacteriuria in candidates for active treatment of renal stones: results from an international multicentric study on more than 2600 patients [Articolo su rivista]
Calcagnile, T; Sighinolfi, M C; Rocco, B; Assumma, S; Di Bari, S; Panio, E; Pescuma, A; Ticonosco, M; Tosi, G; Oltolina, P; Resca, S; Kaleci, S; Galli, R; Curti, P; Schips, L; Ditonno, P; Villa, L; Ferretti, S; Bergamaschi, F; Bozzini, G; Eissa, A; Zoeir, A; Sherbiny, A El; Frattini, A; Prati, A; Fedelini, P; Okhunov, Z; Tubaro, A; Landman, J; Bianchi, G; Puliatti, S; Micali, S
abstract

: The occurrence of asymptomatic bacteriuria concomitant to urolithiasis is an issue for patients undergoing renal stone treatment. Disposing of a preoperative urine culture is essential to reduce the risk of septic events. The endpoint of the study is to report which characteristics of candidates for renal stone treatment are frequently associated with positive urine culture. 2605 patients were retrospectively enrolled from 14 centers; inclusion criteria were age > 18 and presence of a single renal stone 1-2 cm in size. The variables collected included age, gender, previous renal surgery, comorbidities, skin-to-stone distance, stone size, location, density, presence of hydronephrosis. After a descriptive analysis, the association between continuous and categorical variables and the presence of positive urine culture was assessed using a logistic regression model. Overall, 240/2605 patients (9%) had preoperative bacteriuria. Positive urine culture was more frequent in females, patients with previous renal interventions, chronic kidney disease, congenital anomalies, larger stones, increased density. Multivariate analysis demonstrated that previous renal interventions (OR 2.6; 95% CI 1.9-3.4; p < 0.001), renal-related comorbidities (OR 1.31; 95% CI 1.19-1.4; p < 0.001), higher stone size (OR 1.06; 95% CI 1.02-1.1; p = 0.01) and density (OR 1.00; 95% CI 1.0-1.00; p = 0.02) were associated with bacteriuria; male gender and lower caliceal location were inversely related to it. Beyond expected risk factors, such as female gender, other parameters are seemingly favoring the presence of positive urine culture. The awareness of variables associated with bacteriuria allows to assess which individuals are at increased risk of presenting bacteriuria and reduce the rate of septic complications.

2022 - Initial Experience and Evaluation of a Nomogram for Outcome Prediction in Management of Medium-sized (1–2 cm) Kidney Stones [Articolo su rivista]
Micali, S.; Sighinolfi, M. C.; Iseppi, A.; Morini, E.; Calcagnile, T.; Benedetti, M.; Ticonosco, M.; Kaleci, S.; Bevilacqua, L.; Puliatti, S.; De Nunzio, C.; Arada, R.; Chiancone, F.; Campobasso, D.; Eissa, A.; Bonfante, G.; Simonetti, E.; Cotugno, M.; Galli, R.; Curti, P.; Schips, L.; Ditonno, P.; Villa, L.; Ferretti, S.; Bergamaschi, F.; Bozzini, G.; Zoeir, A.; Sherbiny, A. E.; Frattini, A.; Fedelini, P.; Okhunov, Z.; Tubaro, A.; Landman, J.; Bianchi, G.; Rocco, B.
abstract

Shockwave lithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy are recommended as treatment options for solitary medium-sized (1–2 cm) renal stones. A nomogram was developed to predict treatment failure of the three procedures, based on preoperative variables.

2022 - Psychological distress among patients awaiting histopathologic results after prostate biopsy: An unaddressed concern [Articolo su rivista]
Sarchi, Luca; Eissa, Ahmed; Puliatti, Stefano; Amato, Marco; Assumma, Simone; Calcagnile, Tommaso; Ticonosco, Marco; Iseppi, Andrea; Toso, Stefano; Sighinolfi, Maria Chiara; Bianchi, Giampaolo; Micali, Salvatore; Rocco, Bernardo
abstract

Background: Prostate cancer is the most commonly diagnosed neoplasm in men. From the introduction of PSA testing, an increasing number of men undergoes prostate biopsy (PBX). While the physical side effects of PBx have been well investigated, its psychological impact has been under-evaluated.Aim: The aim of our study is to investigate the presence of psychological distress (anxiety and depression) in patients waiting for histopathological results after prostate biopsy (PBx).Methods: From February to April 2019, 51 consecutive patients undergoing prostate biopsies at our institution were included. Age, PSA, DRE, familiarity for prostate cancer, number of previous biopsies, type of anesthesia, number of cores were recorded. All patients filled the Hospital Anxiety and Depression Scale (HADS), a psychometric Likert-scale questionnaire, before receiving the histopathological results of their PBx.Results: The prevalence of psychological distress among patients awaiting histopathologic results is 41% (21/51 patients), with anxiety being the main component of their distress. On multivariate analysis, PSA, family history, and repeat biopsy were significantly associated with anxiety and depression.Conclusion: Patients undergoing PBx experience a burden of psychological distress waiting for histopathologic results, especially anxiety. Appropriate counseling should be offered to patients at high risk of developing psychological distress after PBx. Future goals would include technological improvements to shorten the time between biopsy and definitive results.

2021 - A survey-based study on the spread of en-bloc resection of bladder tumors among IEA and ESUT members [Articolo su rivista]
Bonfante, Giulia; Puliatti, Stefano; Sighinolfi, Maria C; Eissa, Ahmed; Ciarlariello, Silvia; Ferrari, Riccardo; Ticonosco, Marco; Goezen, Ali Serdar; Guven, Selcuk; Rassweiler, Jens; Bianchi, Giampaolo; Rocco, Bernardo; Micali, Salvatore
abstract

2021 - COVID-19 and slowdown of residents' activity: Feedback from a novel e-learning event and overview of the literature [Articolo su rivista]
Calcagnile, Tommaso; Sighinolfi, Maria Chiara; Sarchi, Luca; Assumma, Simone; Filippi, Beatrice; Bonfante, Giulia; Cassani, Alessandra; Spandri, Valentina; Turri, Filippo; Puliatti, Stefano; Bozzini, Giorgio; Moschovas, Marcio; Bianchi, Giampaolo; Micali, Salvatore; Rocco, Bernardo
abstract

Objective: To evaluate the impact of an e-learning online event, created for supporting resident's training during the slowdown of surgical and clinical activities caused by COVID-19 pandemic. An overview of PubMed literature depicting the state of the art of urology residency in the COVID-19 era was performed as well, to contextualize the issue.Methods: An online learning event for residents was set up at the beginning of the pandemic; the faculty consisted of experts in urology who provided on-line lectures and videos on surgical anatomy, procedures, updates in guidelines, technology, training. The audience was composed of 30-500 attendees from Italy, USA, India and Belgium. A questionnaire to analyze relevance, satisfaction and popularity of the lessons was mailed to 30 local residents.Results and limitations: Almost all residents defined the web environment suitable to achieve the learning outcomes; the method, the number and the competence of the faculty were appropriate/excellent. Most of the younger residents (81.8%) stated their surgical knowledge would improve after the course; 72.7% declared they would take advantage into routine inpatients clinical activity. Nineteen more expert residents agreed that the course would improve their surgical knowledge and enhance their practical skills; almost all stated that the initiative would change their outpatients and inpatients practice. Overall, 44 articles available in PubMed have addressed the concern of urological learning and training during the pandemic from different standpoints; four of them considered residents' general perception towards web-based learning programs.Conclusions: The paper confirms residents' satisfaction with e-learning methods and, to our knowledge, is the first one focusing on a specific event promptly settled up at the beginning of the outbreak. Web-based educational experience developed during the pandemic may represent the very basis for the implementation of prospective on-site training and overall scientific update of future urologists.

2021 - Current and future perspectives of digital microscopy with fluorescence confocal microscope for prostate tissue interpretation: A narrative review [Articolo su rivista]
Rocco, B.; Cimadamore, A.; Sarchi, L.; Bonetti, L. R.; Bertoni, L.; Azzoni, P.; Assumma, S.; Turri, F.; Bozzini, G.; Eissa, A.; Micali, S.; Bianchi, G.; Maiorana, A.; Montironi, R.; Pellacani, G.; Sighinolfi, M. C.
abstract

Fluorescence confocal microscopy (FCM) is an optical imaging technique providing digital microscopical images of fresh tissue in a real time fashion, without conventional processing. FCM has been widely applied in several fields of dermatology, including the detection of basal cell carcinoma and of cutaneous inflammatory diseases. The aim of the paper is to provide an overview of FCM applications in the field of prostate tissue interpretation and prostate cancer (PCa) detection. A Literature search (PubMed & Web of Science) was performed to identify articles concerned with the clinical and surgical applications of FCM in prostatic and periprostatic tissues interpretation. Overall, six articles were identified. All articles investigated the level of agreement between FCM and conventional histopathological analysis (hematoxylin-eosin, HE) for the discrimination between normal and PCa tissues. An investigative article on prostate samples retrieved from radical prostatectomy (RP) specimens and an atlas of FCM digital images from the same series were found. Two prospective clinical trials, comparing FCM and HE, pointed out a “substantial” to “almost perfect” discriminative performance of FCM for the diagnosis of PCa on prostate biopsy core. Finally, two studies investigated the intra-operative role of FCM during RP for the control of surgical dissection. In this setting, FCM could be used to analyse samples retrieved from suspicious peri-prostatic areas; FCM has also been tested for an en-face evaluation of flat slices obtained from the systematic sampling of the posterolateral aspects of the prostate, in a NeuroSAFE-like approach. Generally, FCM provides digital microscopical images of fresh tissue in a real time fashion, without requiring conventional processing. Currently, available studies confirmed a high concordance with conventional pathology for the detection of PCa. Further studies are required to validate the technology, to evaluate ISUP score attribution and to implement the fields of application of FCM for the treatment of prostate diseases.

2021 - Diagnostic bias during the COVID-19 era: COVID-19 or renal abscess? [Articolo su rivista]
Amato, Marco; Eissa, Ahmed; Rosiello, Giuseppe; Farinha, Rui; Piazza, Pietro; Sighinolfi, Maria Chiara; Rocco, Bernardo; Bianchi, Giampaolo; Micali, Salvatore; Mottrie, Alexandre; Puliatti, Stefano
abstract

The Coronavirus disease-2019 (COVID-19) has been declared as a pandemic in March 2020 by the World Health Organization (WHO). Since then, this pandemic has dramatically affected the entire world, even radically influencing the way patients are framed at triage. Symptoms and tests in most cases lead to a correct diagnosis; however, error may be around the corner.

2021 - Digital Frozen Sections with Fluorescence Confocal Microscopy During Robot-assisted Radical Prostatectomy: Surgical Technique [Articolo su rivista]
Rocco, B.; Sarchi, L.; Assumma, S.; Cimadamore, A.; Montironi, R.; Reggiani Bonetti, L.; Turri, F.; De Carne, C.; Puliatti, S.; Maiorana, A.; Pellacani, G.; Micali, S.; Bianchi, G.; Sighinolfi, M. C.
abstract

Background: Robot-assisted radical prostatectomy (RARP) involves a tradeoff between oncological control and functional outcomes. Intraoperative control of surgical margins (SMs) may help in ensuring the safety of the dissection. Fluorescence confocal microscopy (FCM) is an effective method for interpretation of prostate tissue and provides digital images with an appearance similar to hematoxylin-eosin staining. Objective: To describe an alternative technique to NeuroSAFE for intraoperative evaluation of neurovascular-adjacent margins shaved from ex vivo specimens using FCM analysis. Design, setting, and participants: This was a prospective study of 24 patients undergoing RARP with intraoperative FCM control of margin status. Surgical procedure: After surgical dissection, SMs are sectioned from the fresh prostate using the Mohs technique (shaving): three slices from the apex and the right and left posterolateral aspects are obtained. Digital images of the shavings are immediately acquired via FCM and shared with a remote pathologist. In the case of a positive SM, a focal secondary resection of the bundle can be performed owing to the ability of FCM to locate a region of interest on the flat sample. Measurements: The primary outcome measure was the rate of negative margins at neurovascular-adjacent sites. Oncological and functional outcomes for patients with 1 yr of follow-up are also reported. Results and limitations: All patients had negative SMs in shavings from neurovascular-adjacent areas at final histopathology; four underwent a secondary resection with final conversion to negative SM status. Nine of ten patients with 1-yr follow-up are free of biochemical recurrence (prostate-specific antigen persistence in one pN1 case), nine are fully continent, and four of the five with preoperative potency have recovered their sexual function. Conclusions: Digital frozen sections with FCM during RARP may represent an alternative to NeuroSAFE for possible optimization of functional outcomes without compromising oncological safety. Patient summary: We developed a technique to ensure complete removal of cancer tissue during surgical removal of the prostate. Tissue specimens are examined via digital microscopy in real time during the operation. This allows the surgeon to remove more tissue if cancer is detected at the margins of a specimen, while avoiding unnecessary removal of healthy tissue.

2021 - Feasibility of a telementoring approach as a practical training for transurethral enucleation of the benign prostatic hyperplasia using bipolar energy: a pilot study [Articolo su rivista]
Amato, M.; Eissa, A.; Puliatti, S.; Secchi, C.; Ferraguti, F.; Minelli, M.; Meneghini, A.; Landi, I.; Guarino, G.; Sighinolfi, M. C.; Rocco, B.; Bianchi, G.; Micali, S.
abstract

Introduction: Telementoring is one of the applications of telemedicine capable of bringing highly experienced surgeons to areas lacking expertise. In the current study, we aimed to assess a novel telementoring application during the learning curve of transurethral enucleation of the prostate using bipolar energy (TUEB). Material and methods: A telementoring system was developed by our engineering department. This application was used to mentor ten prospective cases of TUEB performed by an expert endourologist (novice to the TUEB). A questionnaire was filled by the operating surgeon and the mentor to provide subjective evaluation of the telementoring system. Finally, the outcomes of these patients were compared to a control group consisting of ten consecutive patients performed by the mentor. Results: Ten consecutive TUEB were performed using this telementoring application. Delayed and interrupted connection were experienced in two and one patients, respectively; however, their effect was minor, and they did not compromise the safety of the procedure. None of the patients required conversion to conventional transurethral resection of the prostate. Only one patient in our series experienced grade IIIb complication. Conclusion: The telementoring application for TUEB is promising. It is a simple and low-cost tool that could be a feasible option to ensure patients’ safety during the initial phase of the learning curve without time and locations constraints for both the mentor and the trainee; However, it should be mentioned that telementoring cannot yet replace the traditional surgical training with the mentor and trainee being in the operative room. Further studies are required to confirm the current results

2021 - Prostatic artery embolization for the management of benign prostatic hyperplasia/lower urinary tract symptoms in elderly patients unfit for surgery: Our initial experience [Articolo su rivista]
Amato, Marco; Eissa, Ahmed; Puliatti, Stefano; Di Chiacchio, Giuseppe; Malossi, Marcello; Fiocchi, Federica; Torricelli, Pietro; Sighinolfi, Mari A Chiara; Milandri, Riccardo; Zoeir, Ahmed; Gameel, Tarek; Micali, Salvatore; Bianchi, Giampaolo; Rocco, Bernardo
abstract

To evaluate the safety and efficacy of prostatic artery embolization in the management of LUTS secondary to BPH in elderly patients unfit for surgery.

2020 - Augmented Reality and Robotic-Assistance for Percutaneous Nephrolithotomy [Articolo su rivista]
Ferraguti, Federica; Minelli, Marco; Farsoni, Saverio; Bazzani, Stefano; Bonfe, Marcello; Vandanjon, Alexandre; Puliatti, Stefano; Bianchi, Giampaolo; Secchi, Cristian
abstract

2020 - COVID-19 and urology: a comprehensive review of the literature [Articolo su rivista]
Puliatti, S.; Eissa, A.; Eissa, R.; Amato, M.; Mazzone, E.; Dell'Oglio, P.; Sighinolfi, M. C.; Zoeir, A.; Micali, S.; Bianchi, G.; Patel, V.; Wiklund, P.; Coelho, R. F.; Bernhard, J. -C.; Dasgupta, P.; Mottrie, A.; Rocco, B.
abstract

Objective: To discuss the impact of COVID-19 on global health, particularly on urological practice and to review some of the available recommendations reported in the literature. Material and Methods: In the current narrative review the PubMed database was searched to identify all the related reports discussing the impact of COVID-19 on the urological field. Results: The COVID-19 pandemic is the latest and biggest global health threat. Medical and surgical priorities have changed dramatically to cope with the current challenge. These changes include postponements of all elective outpatient visits and surgical procedures to save facilities and resources for urgent cases and patients with COVID-19 patients. This review discuss some of the related changes in urology. Conclusions: Over the coming weeks, healthcare workers including urologists will be facing increasingly difficult challenges, and consequently, they should adopt triage strategy to avoid wasting of medical resources and they should endorse sufficient protection policies to guard against infection when dealing with COVID-19 patients.

2020 - Digital Biopsy with Fluorescence Confocal Microscope for Effective Real-time Diagnosis of Prostate Cancer: A Prospective, Comparative Study [Articolo su rivista]
Rocco, Bernardo; Sighinolfi, Maria Chiara; Sandri, Marco; Spandri, Valentina; Cimadamore, Alessia; Volavsek, Metka; Mazzucchelli, Roberta; Lopez-Beltran, Antonio; Eissa, Ahmed; Bertoni, Laura; Azzoni, Paola; Reggiani Bonetti, Luca; Maiorana, Antonino; Puliatti, Stefano; Micali, Salvatore; Paterlini, Maurizio; Iseppi, Andrea; Rocco, Francesco; Pellacani, Giovanni; Chester, Johanna; Bianchi, Giampaolo; Montironi, Rodolfo
abstract

A microscopic analysis of tissue is the gold standard for cancer detection. Hematoxylin-eosin (HE) for the reporting of prostate biopsy (PB) is conventionally based on fixation, processing, acquisition of glass slides, and analysis with an analog microscope by a local pathologist. Digitalization and real-time remote access to images could enhance the reporting process, and form the basis of artificial intelligence and machine learning. Fluorescence confocal microscopy (FCM), a novel optical technology, enables immediate digital image acquisition in an almost HE-like resolution without requiring conventional processing.

2020 - Digital frozen section of the prostate surface during radical prostatectomy: a novel approach to evaluate surgical margins [Articolo su rivista]
Rocco, B.; Sighinolfi, M. C.; Cimadamore, A.; Reggiani Bonetti, L.; Bertoni, L.; Puliatti, S.; Eissa, A.; Spandri, V.; Azzoni, P.; Dinneen, E.; Shaw, G.; Nathan, S.; Micali, S.; Bianchi, G.; Maiorana, A.; Pellacani, G.; Montironi, R.
abstract

2020 - Ex vivo fluorescence confocal microscopy: prostatic and periprostatic tissues atlas and evaluation of the learning curve [Articolo su rivista]
Bertoni, L.; Puliatti, S.; Reggiani Bonetti, L.; Maiorana, A.; Eissa, A.; Azzoni, P.; Bevilacqua, L.; Spandri, V.; Kaleci, S.; Zoeir, A.; Sighinolfi, M. C.; Micali, S.; Bianchi, G.; Pellacani, G.; Rocco, B.; Montironi, R.
abstract

Ex vivo fluorescence confocal microscopy (FCM) is an optical technology that provides fast H&E-like images of freshly excised tissues, and it has been mainly used for “real-time” pathological examination of dermatological malignancies. It has also shown to be a promising tool for fast pathological examination of prostatic tissues. We aim to create an atlas for FCM images of prostatic and periprostatic tissues to facilitate the interpretation of these images. Furthermore, we aimed to evaluate the learning curve of images interpretation of this new technology. Eighty fresh and unprepared biopsies obtained from radical prostatectomy specimens were evaluated using the FCM VivaScope® 2500 M-G4 (Mavig GmbH, Munich, Germany; Caliber I.D.; Rochester NY, USA) by two pathologists. Images of FCM with the corresponding H&E are illustrated to create the atlas. Furthermore, the two pathologists were asked to re-evaluate the 80 specimens after 90 days interval in order to assess the learning curve of images’ interpretation of FCM. FCM was able to differentiate between different types of prostatic and periprostatic tissues including benign prostatic glands, benign prostatic hyperplasia, high-grade intraepithelial neoplasm, and prostatic adenocarcinoma. As regards the learning curve, FCM demonstrated a short learning curve. We created an atlas that can serve as the base for urologists and pathologists for learning and interpreting FCM images of prostatic and periprostatic tissues. Furthermore, FCM images is easily interpretable; however, further studies are required to explore the potential applications of this new technology in prostate cancer diagnosis and management.

2020 - Real-time assessment of surgical margins during radical prostatectomy: a novel approach that uses fluorescence confocal microscopy for the evaluation of peri-prostatic soft tissue [Articolo su rivista]
Rocco, B.; Sighinolfi, M. C.; Bertoni, L.; Spandri, V.; Puliatti, S.; Eissa, A.; Reggiani Bonetti, L.; Azzoni, P.; Sandri, M.; De Carne, C.; Turri, F.; Cimadamore, A.; Montironi, R.; Maiorana, A.; Micali, S.; Bianchi, G.; Pellacani, G.
abstract

2020 - “Real-time” Assessment of Surgical Margins During Radical Prostatectomy: State-of-the-Art [Articolo su rivista]
Eissa, A.; Zoeir, A.; Sighinolfi, M. C.; Puliatti, S.; Bevilacqua, L.; Del Prete, C.; Bertoni, L.; Azzoni, P.; Reggiani Bonetti, L.; Micali, S.; Bianchi, G.; Rocco, B.
abstract

Histopathologic examination of the pathologic specimens using hematoxylin & eosin stains represents the backbone of the modern pathology. It is time-consuming; thus, “real-time” assessment of prostatic and periprostatic tissue has gained special interest in the diagnosis and management of prostate cancer. The current study focuses on the review of the different available techniques for “real-time” evaluation of surgical margins during radical prostatectomy (RP). We performed a comprehensive search of the Medline database to identify all the articles discussing “real-time” or intraoperative assessment of surgical margins during RP. Several filters were applied to the search to include only English articles performed on human subjects and published between January 2000 and March 2019. The search revealed several options for pathologic assessment of surgical margins including intraoperative frozen sections, confocal laser endomicroscopy, optical spectroscopy, photodynamic diagnosis, optical coherence tomography, multiphoton microscopy, structured illumination microscopy, 3D augmented reality, and ex vivo fluorescence confocal microscope. Frozen section represents the gold standard technique for real-time pathologic examinations of surgical margins during RP; however, several other options showed promising results in the initial clinical trials, and considering the rapid development in the field of molecular and cellular imaging, some of these options may serve as an alternative to frozen section.

2019 - Effect of puboprostatic ligament reconstruction on continence recovery after robot-assisted laparoscopic prostatectomy: our initial experience [Articolo su rivista]
Puliatti, Stefano; Elsherbiny, Ahmed; Eissa, Ahmed; Pirola, Giacomo; Morini, Elena; Squecco, Denise; Inzillo, Raffaele; Zoeir, Ahmed; Iseppi, Andrea; Sighinolfi, Maria Chiara; Micali, Salvatore; Rocco, Bernardo; Bianchi, Giampaolo
abstract

Prostate cancer represents a serious health problem worldwide. Radical prostatectomy is the gold standard for management of localized prostate cancer. Urinary incontinence is among the most common complications affecting RALP patients' post-operative quality of life. Several surgical modifications were introduced to overcome this problem including the puboprostatic ligament reconstruction. In this study, we discuss our technique of anterior reconstruction of the puboprostatic ligament during RALP and its effect on the continence outcome postoperatively.

2019 - 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.

2019 - Ex-vivo Fluorescence Confocal Microscopy: The First Application For Real-Time Pathologic Examination of Prostatic Tissue [Articolo su rivista]
Puliatti, Stefano; Bertoni, Laura; Pirola, Giacomo Maria; Azzoni, Paola; Bevilacqua, Luigi; Eissa, Ahmed; Elsherbiny, Ahmed; Sighinolfi, Maria Chiara; Chester, Johanna; Rocco, Bernardo; Micali, Salvatore; Bagni, Ilaria; Reggiani Bonetti, Luca; Maiorana, Antonino; Malvehy, Josep; Longo, Caterina; Montironi, Rodolfo; Bianchi, Giampaolo; Pellacani, Giovanni
abstract

Prostate cancer "real time" intra-operative pathological examination currently utilizes frozen section, despite the many inherent limitations of this procedure. Ex vivo Fluorescence Confocal Microscopy (FCM) is a novel technology, which provides fast microscopic fluorescence and reflectance tissue imaging. FCM has been proven beneficial in colorectal, breast, thyroid and skin lesions. However, it was never applied in urology. The aim of our study is to report the first application of FCM in the urologic field assessing its diagnostic accuracy for non-neoplastic and cancerous prostate tissue (prostatic adenocarcinoma) compared to the gold standard histopathological diagnoses.

2019 - External validation of a novel side-specific, multiparametric magnetic resonance imaging-based nomogram for the prediction of extracapsular extension of prostate cancer: preliminary outcomes on a series diagnosed with multiparametric magnetic resonance imaging-targeted plus systematic saturation biopsy [Articolo su rivista]
Sighinolfi, Maria Chiara; Sandri, Marco; Torricelli, Pietro; Ligabue, Guido; Fiocchi, Federica; Scialpi, Michele; Eissa, Ahmed; Reggiani Bonetti, Luca; Puliatti, Stefano; Bianchi, Giampaolo; Rocco, Bernardo
abstract

no abstract

2019 - Is Extraprostatic Extension of Cancer Predictable? A Review of Predictive Tools and an External Validation based on a Large and a Single Center Cohort of Prostate Cancer Patients [Articolo su rivista]
Rocco, Bernardo; Sighinolfi, Maria Chiara; Sandri, Marco; Eissa, Ahmed; Elsherbiny, Ahmed; Zoeir, Ahmed; Tadzia, Harvey; Palayapalayam, Hariharan; Kameh, Darian; Coelho, Rafael; Puliatti, Stefano; Zuccolotto, Paola; Montironi, Rodolfo; Wiklund, Peter; Micali, Salvatore; Bianchi, Giampaolo; Patel, Vipul
abstract

Our aim was to review and externally validate all the available predictive tools (PTs) predicting EPE using the area under the curve (AUC), calibration plots and scaled brier score. A literature search was performed showing 19 models predicting EPE. External validation (EV) was carried out on 6360 prostate cancer (PCa) patients submitted to RP. Most of the PTs showed poor discrimination and unsatisfactory calibration. The majority of the available PTs are not reliable for the prediction of EPE in populations other than the development one; thus, they may not be completely appropriate for patients' counselling or for surgical strategy preplanning.

2019 - Nephron-Sparing Surgery [Capitolo/Saggio]
Puliatti, S; Ferrari, N; Rocco, B; Bianchi, G; Micali, S
abstract

Abstract Kidney disease is a crippling disease that affects approximately ten percent of the population worldwide, with more than 2.6 million individuals estimated to receive renal replace therapy. Chronic kidney disease (CKD) is fast becoming a major public health issue even in resource poor settings, with some estimates predicting a disproportionate increase in countries such as China and India. Consequently, renal protection has become a vital and critical component of prevention. While observational data suggests that awareness remains low, the concept of renal protection is currently under-recognized in promoting recovery as well as preventing further renal loss. Kidney Protection: Strategies for Renal Preservation is a clinically applicable review of the current medical care and research that aims to address the awareness gap. The authors combine renal protection research and clinical practices with an interdisciplinary approach that is inclusive of nephrology,urology, critical care, anesthesia, emergency medicine and clinical medicine.Written by experts in the field of nephrology, the authors have also included applicable photographs and line drawings. The specific topics covered include: protection of the kidneys in hypertension, diabetes and heart disease, exposure to contrast including coronary angiogram, atherosclerosis, and more. This handbook is formatted to emphasize clinical practice points and major systemic illnesses. Additionally, it features the latest evidence-based practice guidelines for optimal renal outcomes, thus, making it a concise reference for the busy clinician interested in understanding the basics of kidney disease assessment, renal injury prevention, and renal preservation.

2019 - 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, M. C.; Rocco, B.; Micali, S.; Bianchi, G.; Sandri, M.
abstract

2019 - Regenerative potential of human dental pulp stem cells in the treatment of stress urinary incontinence: In vitro and in vivo study [Articolo su rivista]
Zordani, Alessio; Pisciotta, Alessandra; Bertoni, Laura; Bertani, Giulia; Vallarola, Antonio; Giuliani, Daniela; Puliatti, Stefano; Mecugni, Daniela; Bianchi, Giampaolo; De Pol, Anto; Carnevale, Gianluca
abstract

OBJECTIVES: To evaluate the regenerative potential of human dental pulp stem cells (hDPSCs) in an animal model of stress urinary incontinence (SUI). SUI, an involuntary leakage of urine, is due to physical stress involving an increase in bladder pressure and a damage of external urethral sphincter affecting muscles and nerves. Conventional therapies can only relieve the symptoms. Human DPSCs are characterized by peculiar stemness and immunomodulatory properties and might provide an alternative tool for SUI therapy. MATERIALS AND METHODS: In vitro phase: hDPSCs were induced towards the myogenic commitment following a 24 hours pre-conditioning with 5-aza-2'-deoxycytidine (5-Aza), then differentiation was evaluated. In vivo phase: pudendal nerve was transected in female rats to induce stress urinary incontinence; then, pre-differentiated hDPSCs were injected in the striated urethral sphincter. Four weeks later, urethral sphincter regeneration was assayed through histological, functional and immunohistochemical analyses. RESULTS: Human DPSCs were able to commit towards myogenic lineage in vitro and, four weeks after cell injection, hDPSCs engrafted in the external urethral sphincter whose thickness was almost recovered, committed towards myogenic lineage in vivo, promoted vascularization and an appreciable recovery of the continence. Moreover, hDPSCs were detected within the nerve, suggesting their participation in repair of transected nerve. CONCLUSIONS: These promising data and further investigations on immunomodulatory abilities of hDPSCs would allow to make them a potential tool for alternative therapies of SUI.

2019 - Reliability of the different versions of Partin tables in predicting extraprostatic extension of prostate cancer: a systematic review and meta-analysis [Articolo su rivista]
Eissa, Ahmed; Elsherbiny, Ahmed; Zoeir, Ahmed; Sandri, Marco; Pirola, Giacomo; Puliatti, Stefano; Del Prete, Chiara; Sighinolfi, Maria Chiara; Micali, Salvatore; Rocco, Bernardo; Bianchi, Giampaolo
abstract

Accurate prediction of extraprostatic extension (EPE) of prostate cancer (PCa) is the keystone for deciding whether to perform a neurovascular bundle sparing (NVBs) radical prostatectomy or not, which will subsequently affect the postoperative functional outcomes especially potency. Partin tables are the most commonly used predictive tools (PTs) for prediction of EPE. Moreover, they are the most commonly externally validated. In these settings, the aim of our work is to perform a systematic review of the literature and a meta-analysis for the discriminative performance of the different versions of Partin tables for EPE prediction.

2019 - 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.

2019 - The safety of extracorporeal shock wave lithotripsy: an undervalued issue [Articolo su rivista]
Sighinolfi, M. C.; Sandri, M.; Eissa, A.; El Sherbiny, A.; Micali, S.; Bianchi, G.; Rocco, B.
abstract

Extracoroporeal shock wave lithotripsy (SWL) with its characteristics—named the absence of anesthesia requirement, the outpatient basis and the substantial lack of severe immediate side effects—has been considered for decades the non-invasive treatment of urolithiasis [1]. However, in more recent years, SWL renown has been challenged by the widespread diffusion of endourology; together, as time goes by, some concerns on long-term safety of SWL have been raised as well. Hypertension and diabetes are regarded as possible long-term drawbacks, and their risk after SWL has been addressed by a recent manuscript from Fankauser et al [2]. Authors reported in 2018 on the prevalence of hypertension and diabetes—assessed with a questionnaire mailed in 2015—in a series of 764 patients treated with SWL between 1993 and 2013. Authors concluded that SWL of kidney stones was in general associated with higher prevalence of these side effects compared to control groups, even after adjusting for age and gender. Fankauser et al. should be recommended for the large series and the median follow-up of 13.7 years. However, the variability of time-lapse between the date of SWL treatment and the 2015 assessment could bother the quality of data analysis and interpretation; renal fibrosis and scarring as well as pancreatic damage—hypothesized as cause of secondary hypertension and diabetes—should require a supposed long time to exert their detrimental effect. We would like to remark a further covariate to be pointed up. The matter of SWL safety—in terms of macroscopical or microscopical injury to tissues—cannot put aside from the modality of stone focusing. A radio-opaque renal stone can be targeted both with fluoroscopy and ultrasonography (US). Opposite to the former, US targeting of a renal stone allows the real time and continuous control of shock wave focal point and pathway; as a result, US checking may protect against the extensive injury to renal parenchyma or against the accidental damage to adjacent organs. After a 16-year-old experience with Dornier Lithotripter S (GmBh, Germany) with most of the kidney stones focused with US, we reported on the safety of SWL both on the overall population [3] and considering apart the elderly subgroup [4]; an interim analysis on 100 subjects with 10-year follow-up after a renal SWL [5] found that the development of new onset hypertension or diabetes mellitus was unaffected by SWL and consistent with the incidence of the general population, matched for age group. As a conclusion, we would like to underline that the long-term safety of SWL—based on a precise and monitored treatment together with a proper indication—can still be regarded as adequate and should not be forgotten even in the current era of multiple minimally invasive technologies available to treat urolithiasis.

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 - Magnetic Resonance Imaging-Based Prediction of Prostate Cancer Risk [Articolo su rivista]
Bianchi, Giampaolo; Sighinolfi, Maria Chiara; Rocco, Bernardo
abstract

no abstract available

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 [Capitolo/Saggio]
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 Maria Cesare; Micali, Salvatore; Orlando, Gabriella; Venturelli, Claudia; Mussini, Cristina; Bianchi, Giampaolo
abstract

na

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 - 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 - Seminal Cell-Free DNA Assessment as a Novel Prostate Cancer Biomarker [Articolo su rivista]
Mandrioli, M.; Manfredini, M.; Micali, S.; Cotugno, M.; Ozben, T.; Pellacani, G.; Tomasi, A.; Ponti, G.; Maccaferri, M.; Bianchi, G.; Del Prete, C.
abstract

Background: Cell-free DNA (cfDNA) includes circulating DNA fragments which can be obtained from different human biological samples. It originates from apoptotic and/or necrotic cells or it is actively secreted by cancer cells. To our knowledge the quantification and size distribution assessment of seminal plasma cfDNA from prostate cancer patients was never assessed. Objective: The aim of our study was to the identify identifation of a novel sensitive non-invasive biomarker of prostate cancer, through the fluorimetric quantification and the electrophoretic analysis of seminal cfDNA in healthy individuals and prostate cancer patients. Results: The concentration of seminal plasma cfDNA in prostate cancer patient was 2243.67 ± 1758 ng/µl. In healthy individuals was 57.7 ± 6.79 ng/µl. Electrophoresis showed broad difference between healthy individuals and patients who showed presented a distinct characteristic DNA ladder fragmentationsmear ranging from 100bp to 2000 10.000 bp. Conclusion: Human seminal fluid can be a valuable source of cfDNA in the setting of liquid biopsy procedures for the identification of novel oncological biomarkers. Seminal plasma cfDNA from prostate cancer patients is significantly more concentrated than from age-matched healthy controls. Fluorimetric measurement and electrophoretic assessment allow a reliable quantification and characterization of seminal plasma cfDNA, which can be used routinely in prostate cancer screening programs.

2018 - Seminal cell free DNA concentration levels discriminate between prostate cancer and benign prostatic hyperplasia [Articolo su rivista]
Ponti, Giovanni; Maccaferri, Monia; Micali, Salvatore; Manfredini, Marco; Milandri, Riccardo; Bianchi, Giampaolo; Pellacani, Giovanni; Kaleci, Shaniko; Chester, Johanna; Conti, Andrea; Prete, Chiara Del; Tomasi, Aldo
abstract

Background/Aim: Seminal plasma cfDNA (scfDNA) was recently proposed as a novel PCa biomarker. Our aim was to evaluate whether scfDNA could discriminate PCa from benign prostate hyperplasia (BPH) patients. Patients and Methods: A cohort of 43 patients (18 and 25 pathology proven PCa and BPH patients), and 13 healthy age-matched control subjects were enrolled. scfDNA quantification was performed. Data were analyzed through ANOVA testing. Results: Average scfDNA concentrations were 1,407.83 ng/μl, 128.13 ng/μl and 78.09 ng/μl for PCa patients, BPH patients and healthy subjects, respectively. Statistical analysis showed a significant difference among the groups, allowing for distinction of patients with optimal accuracy. A cut-off level of 450 ng/μl scfDNA was identified for the differentiation of PCa and BPH patients. Conclusion: scfDNA concentrations are significantly different between PCa patients and BPH patients. scfDNA is a promising biomarker with several applications in PCa diagnosis, screening programs and therapeutic monitoring.

2018 - Seminal cell-free DNA assessment as a novel prostate cancer biomarker [Relazione in Atti di Convegno]
Ponti, Giovanni; Maccaferri, Monia; Mandrioli, Mauro; Ozbenc, Tomris; Manfredini, Marco; Micali, Salvatore; Cotugno, Michele; Bianchi, Giampaolo; Pellacani, Giovanni; Tomasi, Aldo
abstract

n.d.

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 - The value of fluorimetry (Qubit) and spectrophotometry (NanoDrop) in the quantification of cell-free DNA (cfDNA) in malignant melanoma and prostate cancer patients [Articolo su rivista]
Ponti, Giovanni; Maccaferri, Monia; Manfredini, Marco; Kaleci, Shaniko; Mandrioli, Mauro; Pellacani, Giovanni; Ozben, Tomris; Depenni, Roberta; Bianchi, Giampaolo; Pirola, Giacomo Maria; Tomasi, Aldo
abstract

Background Circulating cell-free tumor DNA (cfDNA) is of crucial interest in oncology. cfDNA constitutes a potential prognostic and therapeutic marker for different solid tumors and can be used in the diagnostic and therapeutic management of cancer patients for which nowadays there are no valid laboratory markers. In the present study, the quality and quantity of the cfDNA were assessed by different quantification procedures, in order to identify the potential applications of these techniques in the preliminary cfDNA quantification. Methods Qubit with single (ss) and double strand (ds) DNA assay kits, NanoDrop and quantitative Real Time PCR (qPCR), were adopted to assess the cfDNA in the blood samples of 18 melanoma patients, 67 prostate cancer patients and 15 healthy controls. Results The quantification by NanoDrop (average value 8.48 ng/μl, 95% confidence limit (CL) = 7.23–9.73), Qubit ssDNA (average value 23.08 ng/μl, CL = 19.88–26.28), dsDNA (average value 4.32 ng/μl, CL = 3.52–5.12) assay kits and qPCR (average value 0.39 ng/μl, CL = 0.31–0.47) revealed differences among the four procedures. Qubit 2.0 ss-DNA kit gave higher cfDNA concentration values for all the samples analyzed. In detail, Qubit ssDNA assay revealed higher sensitivity in the quantification of small amounts of pure ss-DNA and ds-DNA, while NanoDrop allowed the assessment of the purity of cfDNA samples. Conclusions The NanoDrop and Qubit 2.0 measurements were analyzed in order to define their correlation with qPCR cfDNA assessment, showing good correlation values with the qPCR that should be considered the “gold standard”. In our proposal, the sequential combination of NanoDrop and Qubit ssDNA methods should be adopted for a cost-effective preliminary assessment of total circulating cfDNA in melanoma and prostate cancer patients, and only discordant values should undergo qPCR assessment.

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.

2018 - Validation of prostate cancer biomarkers and inflammation: a proteomic study [Relazione in Atti di Convegno]
Ozben, T; Bergamini, S; Bellei, E; Cuoghi, A; Bianchi, G; Tomasi, A
abstract

Analysis of serum proteome to investigate possible confounding paramenters in the discrimination between prostate cancer nad benign prostatic hyperplasia

2017 - Abiraterone Acetate for Treatment of Metastatic Castration-resistant Prostate Cancer in Chemotherapy-naive Patients: An Italian Analysis of Patients' Satisfaction [Articolo su rivista]
Cindolo, Luca; Natoli, Clara; De Nunzio, Cosimo; De Tursi, Michele; Valeriani, Maurizio; Giacinti, Silvana; Micali, Salvatore; Rizzo, Mino; Bianchi, Giampaolo; Martorana, Eugenio; Scarcia, Marcello; Ludovico, Giuseppe Mario; Bove, Pierluigi; Laudisi, Anastasia; Selvaggio, Oscar; Carrieri, Giuseppe; Bada, Maida; Castellan, Pietro; Topazio, Luca; Boccasile, Stefano; Ditonno, Pasquale; Chiodini, Paolo; Schips, Luigi
abstract

This article highlights the possible role of “patient-reported outcomes” in the evaluation of a new therapy. Abiraterone acetate is a novel treatment for metastatic prostate cancer characterized by good safety and oncologic efficacy. Few studies have investigated patients' satisfaction with treatment. Our data show that abiraterone acetate is associated with good satisfaction with treatment and that patient's satisfaction can be a predictor of good oncologic outcomes. Introduction Abiraterone acetate (AA) gives a significant improvement in survival for patients with metastatic castration-resistant prostate cancer (mCRPC) before and after chemotherapy and has a favorable effect on patients' health-related quality of life and pain. Only a few studies have investigated patient-reported outcomes (PROs) in AA treatment for mCRPC. The aim of this study was to investigate patients' satisfaction in men affected by mCRPC treated with AA. Materials and Methods This was a retrospective analysis of a database of consecutive chemonaive patients with progressive mCRPC. Patients were treated with AA until disease progression, death, or unacceptable toxicity. Evaluation was performed at baseline and every 4 weeks by means of physical examination and laboratory studies. Eastern Cooperative Oncology Group score, pain symptoms, treatment-related toxicity, prostate-specific antigen (PSA), and overall and progression-free survival were recorded. Satisfaction with treatment was investigated at 6 months by means of a 4-point arbitrary scale. Results One-hundred twenty-eight patients were enrolled. Patients' satisfaction with treatment was “greatly improved” in 36.1% of patients and “improved” in 32.4% of them. Patients with higher satisfaction had lower baseline and final PSA values (P < .05), lower PSA levels at 12 weeks (P = .080), and less pain symptoms and lower Brief Pain Inventory scores (P = .001). Satisfaction with treatment was significantly correlated with baseline PSA level (P = .018), presence of pain (P = .007), duration of androgen deprivation therapy >12 months (P = .025), and number of hormonal manipulations (P = .051). Progression-free survival significantly correlated with patient satisfaction (P < .001). Conclusion AA is safe and well tolerated in chemonaive mCRPC patients, ensures good oncological and PROs. Patient's satisfaction is a predictor of progression-free survival.

2017 - Advantages of the supine transgluteal approach for distal ureteral stone extracorporeal shock wave lithotripsy: Outcomes based on CT characteristics [Articolo su rivista]
Galli, Riccardo; Sighinolfi, Maria C.; Micali, Salvatore; Martorana, Eugenio; Rosa, Marco; Mofferdin, Alessandro; Bianchi, Giampaolo
abstract

BACKGROUND: Extracorporeal shock wave lithotripsy (ESWL) for distal ureteral stones can be performed in prone or supine position. The aim of this study was to investigate the advantages brought by the supine transgluteal ESWL approach for distal ureteral stones treatment using real-time ultrasound (US), and to show how computerized tomography (CT) scan parameters may be related to the outcomes. METHODS: Seventy consecutive supine transgluteal ESWL of distal ureteral stones were performed. All patients had a pre-treatment CT scan. The following parameter were evaluated: Stone size, Hounsfield Units, skin-to-stone distance, sciaticum majus foramen width, stone to ureteral ostium distance, fragmentation and expulsion perception during the treatment, and the stone-free status. Stone focusing was obtained US, which allows a real-time visualization of stone location and fragmentation. Follow-up included a kidney ureter bladder (KUB) film and US examination at 2-3 weeks after treatment (median time: 18 days). Stone-free condition was defined as the complete absence of stone fragments. A linear regression analysis was used to assess the possible variables mostly related to stone-free status. P<0.05 was considered as significant. RESULTS: Median number of SWL sessions for patient was 1 (IQR: 1-1), mean 1.2±0.5. The re-treatment rate for stonefree patients was 18.3%. Stone-free rate was 85.7%. A clear and real time US stone fragmentation was perceived by the surgeon during the treatment in 42/70 (60%) of patients and correlated to the definitive stone-free status (P=0.04). Stone to ureteral ostium distance was the only variable affecting the stone-free condition (P=0.01). CONCLUSIONS: Supine transgluteal SWL of distal ureteral stones provide satisfactory outcomes in terms of stone-free rate. The distance of the stone to the ureteral ostium, measured by CT, appeared to be the only significant variable connected to SWL success.

2017 - Biparametric versus multiparametric mri with non-endorectal coil at 3t in the detection and localization of prostate cancer [Articolo su rivista]
Scialpi, Michele; Prosperi, Enrico; D'andrea, Alfredo; Martorana, Eugenio; Malaspina, Corrado; Palumbo, Barbara; Orlandi, Agostino; Falcone, Giuseppe; Milizia, Michele; Mearini, Luigi; Aisa, Maria Cristina; Scialpi, Pietro; De Domincis, Carlo; Bianchi, Giampaolo; Sidoni, Angelo
abstract

Aim: To assess the sensitivity of biparametric magnetic resonance imaging (bpMRI) with non-endorectal coil in the detection and localization of index (dominant) and nonindex lesions in patients suspected of having prostate cancer. Patients and Methods: We carried-out a retrospective analysis of multiparametric MRI (mpMRI) of 41 patients who underwent radical prostatectomy. Results of MRI for detection and localization of index and non-index lesions were correlated with those of histology. Results: No statistically significant difference in size was seen between tumor lesion at histology and index lesion at MRI. In 41 patients, a total of 131 tumors were identified at histology, while bpMRI (T2-weighted and diffusionweighted MRI) approach detected 181 lesions. bpMRI gave 27.6% false-positives and 3.3% false-negatives. Sensitivity in lesion detection by bpMRI increased with lesion size assuming high values for lesions 10 mm. For bpMRI and mpMRI, the sensitivity for detecting index lesions was the same and equal: 100% in the peripheral zone 97.6% and 94.7% in the entire prostate and transitional zone, respectively. Conclusion: bpMRI can be used alternatively to mpMRI to detect and localize index prostate cancer.

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 IIEFÂ&nbsp;≥Â&nbsp;17; adherence to our erectile rehabilitation protocol; (c) 1-year follow-up. Outcomes were measured as mean IIEF score, EFR (IIEFÂ&nbsp;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 (pÂ&nbsp;=Â&nbsp;0.65). Group B patients showed a trend toward a higher mean IIEF score 3Â&nbsp;months after surgery (pÂ&nbsp;=Â&nbsp;0.06) but no differences in terms of EFR (pÂ&nbsp;=Â&nbsp;1.000). Long-term results (6, 9, 12Â&nbsp;months after surgery) showed a significantly and progressively higher mean IIEF score (pÂ&nbsp;=Â&nbsp;0.04, 0.003, 0.003) and EFR (pÂ&nbsp;=Â&nbsp;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 12Â&nbsp;months (pÂ&nbsp;=Â&nbsp;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 - Effect of green tea catechins in patients with high-grade prostatic intraepithelial neoplasia: Results of a short-term double-blind placebo controlled phase II clinical trial [Articolo su rivista]
Micali, Salvatore; Territo, Angelo; Pirola, Giacomo Maria; Ferrari, Nancy; Sighinolfi, Maria Chiara; Martorana, Eugenio; Navarra, Michele; Bianchi, Giampaolo
abstract

Background and study objective: Several studies suggest a protective role of green tea catechins against prostate cancer (PCa). In order to evaluate the efficacy of green tea catechins for chemoprevention of PCa in patients with high-grade prostate intraepithelial neoplasia (HG-PIN) we performed a phase II clinical trial. Methods: Sixty volunteers with HG-PIN were enrolled to carry out a double-blind randomized placebo-controlled phase II clinical trial. Treated group took daily 600 mg of green tea catechins (Categ Plus®) for 1 year. Patients were screened at 6 and 12 months through prostatic biopsy and measurements of prostate-specific antigen (PSA). Results: Despite the statistically significant reduction of PSA observed in subjects who received green tea catechins for 6 and 12 months, we did not find any statistical difference in PCa incidence between the experimental groups neither after 6 nor after 12 months. However, throughout the one-year follow-up we observed very limited adverse effects induced by green tea catechins and a not significant improvement in lower urinary tract symptoms and quality of life. Conclusions: Although the small number of patients enrolled in our study and the relatively short duration of intervention, our findings seems to deny the efficacy of green tea catechins. However, results of our clinical study, mainly for its low statistical strength, suggest that the effectiveness of green tea catechins should be evaluated in both a larger cohort of men and longer trial.

2017 - Efficacy of pollen extract in association with group B vitamins for pain relief in chronic prostatitis/chronic pelvic pain syndrome: A survey of urologists' knowledge about its clinical application [Articolo su rivista]
Pirola, Giacomo Maria; Puliatti, Stefano; Bocchialini, Tommaso; Martorana, Eugenio; Micali, Salvatore; Bianchi, Giampaolo
abstract

Introduction and aim of the study: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPSS) is a pathology of high prevalence in Italian male population, difficult to diagnose and to treat and with poor response to conventional therapy. Aim of this study was to review the evidence of the literature about the therapeutic effects of a plant product containing flower pollen extracts and group B vitamins on symptoms resolution and amelioration of CP/CPPS patients' quality of life and to investigate the knowledge among practicing urologists about the clinical application of this product. Materials and methods: A group of 38 urologists was submitted to an investigational survey of the knowledge of the clinical applications of a plant product containing flower pollen extracts and group B vitamins Results: 71% of the urologists interviewed prescribed the plant product for CBP and CP/CPPS at least one time in a month and 11% prescribed it more than 5 times; 67% had evidence of clear ameliorations in pain relief and on patient's quality of life and 47% reported that the effectiveness is comparable to NSAIDs; 39% also reported a significant effect for the improvement of the urinary symptoms of patients. No gastric or general side effects have been noticed during the administration period of this plant product. Finally, the cost of the product has always reported to be sustainable for the patients. Conclusions: From the results of this investigational survey, we can state that the plant product containing flower pollen extracts and group B vitamins is well-known and demonstrated beneficial effects on symptoms resolution and amelioration of quality of life in patients with chronic prostatitis/chronic pelvic pain syndrome.

2017 - Is contrast enhancement needed for diagnostic prostate MRI? [Articolo su rivista]
Scialpi, Michele; Rondoni, Valeria; Aisa, Maria Cristina; Martorana, Eugenio; D'Andrea, Alfredo; Malaspina, Corrado Maria; Orlandi, Agostino; Galassi, Giorgio; Orlandi, Emanuele; Scialpi, Pietro; Dragone, Michele; Palladino, Diego; Simeone, Annalisa; Amenta, Michele; Bianchi, Giampaolo
abstract

Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) provides clinical guidelines for multiparametric magnetic resonance imaging (mpMRI) [T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)] of prostate. However, DCE-MRI seems to show a limited contribution in prostate cancer (PCa) detection and management. In our experience, DCE-MRI, did not show significant change in diagnostic performance in addition to DWI and T2WI [biparametric MRI (bpMRI)] which represent the predominant sequences to detect suspected lesions in peripheral and transitional zone (TZ). In this article we reviewed the role of DCE-MRI also indicating the potential contribute of bpMRI approach (T2WI and DWI) and lesion volume evaluation in the diagnosis and management of suspected PCa.

2017 - Lesion volume predicts prostate cancer risk and aggressiveness: validation of its value alone and matched with prostate imaging reporting and data system score [Articolo su rivista]
Martorana, Eugenio; Pirola, Giacomo Maria; Scialpi, Michele; Micali, Salvatore; Iseppi, Andrea; Bonetti, Luca Reggiani; Kaleci, Shaniko; Torricelli, Pietro; Bianchi, Giampaolo
abstract

Objective: To demonstrate the association between magnetic resonance imaging (MRI) estimated lesion volume (LV), prostate cancer detection and tumour clinical significance, evaluating this variable alone and matched with Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score. Patients and methods: We retrospectively analysed 157 consecutive patients, with at least one prior negative systematic prostatic biopsy, who underwent transperineal prostate MRI/ultrasonography fusion-targeted biopsy between January 2014 and February 2016. Suspicious lesions were delineated using a ‘region of interest’ and the system calculated prostate volume and LV. Patients were divided in groups considering LV (≤0.5, 0.5–1, ≥1 mL) and PI-RADS score (1–5). We considered clinically significant prostate cancer as all cancers with a Gleason score of ≥3 + 4 as suggested by PI-RADS v2. A direct comparison between MRI estimated LV (MRI LV) and histological tumour volume (HTV) was done in 23 patients who underwent radical prostatectomy during the study period. Differences between MRI LV and HTV were assessed using the paired sample t-test. MRI LV and HTV concordance was verified using a Bland–Altman plot. The chi-squared test and logistic and ordinal regression models were used to evaluate difference in frequencies. Results: The MRI LV and PI-RADS score were associated both with prostate cancer detection (both P &lt; 0.001) and with significant prostate cancer detection (P &lt; 0.001 and P = 0.008, respectively). When the two variables were matched, increasing LV increased the risk within each PI-RADS group. Prostate cancer detection was 1.4-times higher for LVs of 0.5–1 mL and 1.8-times higher for LVs of ≥1 mL; significant prostate cancer detection was 2.6-times for LVs of 0.5–1 mL and 4-times for LVs of ≥1 mL. There was a positive correlation between MRI LV and HTV (r = 0.9876, P &lt; 0.001). Finally, Bland–Altman analysis showed that MRI LV was underestimated by 4.2% compared to HTV. Study limitations include its monocentric and retrospective design and the limited cohort. Conclusions: This study demonstrates that PI-RADS score and the MRI LV, independently and in combination, are associated with prostate cancer detection and with tumour clinical significance.

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 - Prostatın biparametrik MRG’si [Articolo su rivista]
Scialpi, Michele; D’Andrea, Alfredo; Martorana, Eugenio; Malaspina, Corrado Maria; Aisa, Maria Cristina; Napoletano, Maria; Orlandi, Emanuele; Rondoni, Valeria; Scialpi, Pietro; Pacchiarini, Diamante; Palladino, Diego; Dragone, Michele; DI RENZO, Giancarlo; Simeone, Annalisa; Bianchi, Giampaolo; Brunese, Luca
abstract

Biparametric Magnetic Resonance Imaging (bpMRI) of the prostate combining both morphologic T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) is emerging as an alternative to multiparametric MRI (mpMRI) to detect, to localize and to guide prostatic targeted biopsy in patients with suspicious prostate cancer (PCa). BpMRI overcomes some limitations of mpMRI such as the costs, the time required to perform the study, the use of gadolinium-based contrast agents and the lack of a guidance for management of score 3 lesions equivocal for significant PCa. In our experience the optimal and similar clinical results of the bpMRI in comparison to mpMRI are essentially related to the DWI that we consider the dominant sequence for detection suspicious PCa both in transition and in peripheral zone. In clinical practice, the adoption of bpMRI standardized scoring system, indicating the likelihood to diagnose a clinically significant PCa and establishing the management of each suspicious category (from 1 to 4), could represent the rationale to simplify and to improve the current interpretation of mpMRI based on Prostate Imaging and Reporting Archiving Data System version 2 (PI-RADS v2). In this review article we report and describe the current knowledge about bpMRI in the detection of suspicious PCa and a simplified PI-RADS based on bpMRI for management of each suspicious PCa categories to facilitate the communication between radiologists and urologists.

2017 - Safety and efficacy of abiraterone acetate in chemotherapy-naive patients with metastatic castration-resistant prostate cancer: An Italian multicenter real life study [Articolo su rivista]
Cindolo, Luca; Natoli, Clara; De Nunzio, Cosimo; De Tursi, Michele; Valeriani, Maurizio; Giacinti, Silvana; Micali, Salvatore; Rizzo, Mino; Bianchi, Giampaolo; Martorana, Eugenio; Scarcia, Marcello; Ludovico, Giuseppe Mario; Bove, Pierluigi; Laudisi, Anastasia; Selvaggio, Oscar; Carrieri, Giuseppe; Bada, Maida; Castellan, Pietro; Boccasile, Stefano; Ditonno, Pasquale; Chiodini, Paolo; Verze, Paolo; Mirone, Vincenzo; Schips, Luigi
abstract

Background: To evaluate the safety and efficacy of abiraterone acetate (AA) in the real life clinical practice for men with chemotherapy-naïve metastatic castration-resistant prostate. Methods: A consecutive series of patients with mCRPC in 9 Italian tertiary centres treated with AA was collected. Demographics, clinical parameters, treatment outcomes and toxicity were recorded. The Brief Pain Inventory scale Q3 was tracked and patient treatment satisfaction was evaluated. Survival curves were estimated by the method of Kaplan-Meier and Cox regression and compared by the log-rank test statistic. Results: We included 145 patients (mean age 76.5y). All patients were on androgen deprivation therapy. Patients had prior radiotherapy, radical prostatectomy, both treatments or exclusive androgen deprivation therapy in 17%, 33%, 9% and 40%, respectively. 57% of the patients had a Gleason score higher more than 7 at diagnosis. 62% were asymptomatic patients. The median serum total PSA at AA start was 17 ng/mL (range 0,4-2100). The median exposure to AA was 10 months (range 1-35). The proportion of patients achieving a PSA decline ≥50% at 12 weeks was 49%. Distribution of patient satisfaction was 32% greatly improved, 38% improved, 24% not changed, 5.5% worsened. Grade 3 and 4 toxicity was recorded in 17/145 patients 11.7% (70% cardiovascular events, 30% critical elevation of AST/ALT levels). At the last follow-up, median progression free and overall survival were 17 and 26.5 months, respectively. Both outcomes significantly correlated with the presence of pain, patient satisfaction, PSA baseline and PSA decline. Conclusions: The AA is effective and well tolerated in asymptomatic or slightly symptomatic mCRPC in a real life setting. The survival outcomes are influenced by the presence of pain, patient satisfaction, baseline PSA and PSA decline. Trial registration: The study was retrospectively registered at ISRCTN as DOI: 10.1186/ISRCTN52513758 in date April the 30th 2016.

2017 - Score 3 prostate lesions: A gray zone for PI-RADS v2 [Articolo su rivista]
Scialpi, Michele; Martorana, Eugenio; Aisa, Maria Cristina; Rondoni, Valeria; D’Andrea, Alfredo; Bianchi, Giampaolo
abstract

Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) does not offer a precise guidance on the clinical management (biopsy or not biopsy) for PI-RADS v2 score 3 lesions. Lesion volume calculated on biparametric MRI (bpMRI) [T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI)] by introducing a cut-off of 0.5 mL, allows to distinguish the lesions assigned by the multiparametric MRI (mpMRI) to the category PI-RADS v2 score 3 in two subgroups: a) Indolent or low risk lesions with volume &lt;0.5 mL, and b) Significant or high risk lesions with volume ≥0.5 mL. For mpMRI lesions assigned to PI-RADS v2 score 3, we suggest the following management: 1) Subgroup a (low-risk lesion): Clinical surveillance (accurate evaluation of age and clinical informations, periodic monitoring of prostate specific antigen value and repeated bpMRI 1 year later); 2) Subgroup b (high-risk lesion): Targeted biopsy. The proposed management would reduce the use of unnecessary biopsies and increase the diagostic yield of significant prostate cancer of approximately 50% and 30% respectively. These approaches encourage the radiologist to adopt MRI lesion volume to improve PI-RADS v2 and to optimize the management of PI-RADS v2 score 3 lesions.

2017 - Value of triphasic MDCT in the differentiation of small renal cell carcinoma and oncocytoma [Articolo su rivista]
Scialpi, Michele; Martorana, Eugenio; Rondoni, Valeria; Eissa, Ahmed; Sherbiny, Ahmed El; Bevilacqua, Luigi; Ros, Luis H.; Escartín Martínez, Irene; Milizia, Michele; Manganaro, Lucia; Mazzei, Maria Antonietta; D'Andrea, Alfredo; Bianchi, Giampaolo
abstract

INTRODUCTION: Although differentiation between benign and malignant small renal tumors (≤4 cm) is still difficult, it is a demand for decision making and determining the treatment strategy. Our aim is to evaluate the role of multidetector row computed tomography (MDCT) in the differentiation of small renal clear cell carcinoma (RCC) and renal oncocytoma (RO).METHODS: We reviewed triphasic computed tomographic (CT) scans performed in 43 patients diagnosed with RCC (n = 23) and RO (n = 21). After an unenhanced CT phase of the upper abdomen, triple-phase acquisition included a cortico-medullary phase (CMP), a nephrographic phase (NP), and a pyelographic phase (PP), and lesions were evaluated both qualitatively and quantitatively.RESULTS: RCCs were hypervascular in 13 cases and hypovascular in 10 cases, while ROs were hypervascular in nine cases and hypovascular in 12 cases. Mean attenuation values (MAVs) for hypervascular RCCs and hypervascular ROs on unenhanced examination were 34.0 ± 7.1 and 31.3 ± 8.1 HU, respectively. Enhancement in CMP was 173.1 ± 45.2 HU for RCCs and 151.1 ± 36.0 HU for ROs and a gradual wash-out in NP (148.8 ± 34.3 and 137.1 ± 33.9 HU for RCCs and ROs, respectively) and in PP (98.2 ± 36.0 HU for RCCs and 79.4 ± 21.5 HU for ROs) was observed. MAV for hypovascular RCCs and hypovascular ROs on unenhanced examination were 32.4 ± 12.0 and 28.9 ± 8.0 HU, respectively. Both hypovascular RCCs and ROs showed a statistically significant difference in each post contrastographic phase.CONCLUSIONS: Absolute attenuation and the quantitative amount of the enhancement were not strong predictors for RO and RCC differentiation.

2016 - A retrospective analysis of the hemostatic effect of FloSeal in patients undergoing robot-assisted laparoscopic radical prostatectomy [Articolo su rivista]
Martorana, Eugenio; Ghaith, Ahmed; Micali, Salvatore; Pirola, Giacomo Maria; De Carne, Cosimo; Fidanza, Francesco; Bianchi, Giampaolo
abstract

Background: Perioperative bleeding is a potential complication of robot-assisted laparoscopic radical prostatectomy (RALP) that may worsen outcomes. The role of local hemostatic materials in RALP has not been adequately assessed. We evaluated the hemostatic impact of FloSeal (Baxter International Inc., Fremont, Calif., USA) in RALP. Methods: A retrospective analysis was performed of 392 consecutive patients with prostate cancer who underwent RALP at our institution between February 2008 and July 2014. The patients were divided into 2 consecutive homogenous groups based on the use of FloSeal. Group A included 200 patients who underwent RALP between February 2008 and May 2011, with hemostasis performed using only traditional techniques. Group B included the remaining 192 patients, who underwent RALP between June 2011 and July 2014 and received FloSeal 5 ml after traditional hemostatic methods. We compared the blood transfusion rate, the differences between immediate postoperative hemoglobin (Hb) and mean postoperative day 1 (POD1) Hb levels, difference between POD1 and least Hb levels and difference between immediate postoperative Hb and least Hb levels. Results: The intraoperative use of FloSeal significantly decreased the blood transfusions rate, from 8.5 to 2.1% (p = 0.004). FloSeal was also associated with significant improvements in the difference between the immediate postoperative Hb and POD1 Hb levels (p = 0.03), mean POD1 Hb and least Hb (p = 0.01) and mean immediate postoperative Hb and least Hb levels (p = 0.034). Conclusions: In this study, the use of FloSeal improves hemostatic outcomes in patients undergoing RALP compared with traditional hemostatic techniques, without increase of cost.

2016 - Chronic, nonspecific, postinfectious, retroperitoneal fibrosis and ureteral obstruction [Articolo su rivista]
Territo, Angelo; Micali, Salvatore; Manenti, Antonio; Martorana, Eugenio; Pirola, Giacomo Maria; Bianchi, Giampaolo
abstract

ABSTRACT Introduction: Two cases of severe ureteral obstruction following nonspecific, postinfectious, chronic retroperitoneal fibrosis are described, which both originated by a primitive intestinal pathology. Patients: This complication was observed in two women: first, 65 years old, submitted for ulcerative colitis to a total proctocolectomy, with ileo-pouch-anal anastomosis, complicated by an anastomotic fistula; and second, 66 years old, operated with an extended left hemicolectomy, for an adenocarcinoma of the recto-sigmoid colon complicated with a vaginal fistula. In these cases, computerized tomography demonstrated a unilateral hydronephrosis, secondary to a complete obstruction of the ureter; a subsequent nephro-ureterectomy became necessary. Histology demonstrated nonspecific inflammatory lesions. Discussions: Postinfectious, chronic inflammation of the retroperitoneum acts on the ureteral and peri-ureteral tissues, inducing an inflammatory and then a fibrotic process. Conclusions: We underline the opportunity of a precocious and radical treatment of every retroperitoneal infection. Keywords: Intestinal fistula, Retroperitoneal fibrosis, Retroperitoneal infection, Ureteral obstruction

2016 - Comparative assessment of cultures from oral and urethral stem cells for urethral regeneration [Articolo su rivista]
Corradini, F.; Zattoni, Michela; Barbagli, G.; Bianchi, Giampaolo; Giovanardi, M.; Serafini, Chiara; Genna, VINCENZO GIUSEPPE; Ribbene, A.; Balò, S.; Fidanza, Francesco Antonio; Lazzeri, M.; DE LUCA, Michele; Pellegrini, Graziella
abstract

Urethral reconstruction has received much attention in recent years, due to pathologies such as recurrence of urethral strictures after treatments. Various surgical techniques have been developed to obtain the best risk-benefit ratio, such as autologous grafts taken from the oral cavity. Tissue engineering and stem cells, growing tissue from a small biopsies, can further improve surgery, reducing invasiveness and morbidity. To determine whether urethra or other epithelia can be equally useful for urethra engineering, a comparison of clonogenic ability, proliferative potential and stem cell markers should be obtained. In this study, 19 biopsies from urethra, and 21 from oral mucosa were obtained from patients, during reconstructive surgery. Urethral and oral tissues were removed from the same donor, to develop primary cultures and cell characterization. The long term regenerative properties of both tissues was investigated in vitro by life span, clonal analysis and markers of different clonal types. Results revealed the same high proliferative potential for urethra and oral mucosa cultures, but maintenance of specific markers. Karyotype and growth factor dependence confirmed the normal phenotype of cultured cells. Clonal analysis of the proliferative compartment highlighted a very different proportion of stem and transient amplifying cells, characterised by dissimilar cell size profile and marker expression. In conclusion, both tissues can be cultured and preserve their stem cells in vitro. Few differences appeared in oral mucosa vs urethra, suggesting that they can be equally useful for tissue engineering of the urethral tract.

2016 - Evaluation of long-term side effects after shock-wave lithotripsy for renal calculi using a third generation electromagnetic lithotripter. [Articolo su rivista]
Pirola, Giacomo Maria; Micali, Salvatore; Sighinolfi, Maria Chiara; Martorana, Eugenio; Territo, Angelo; Puliatti, Stefano; Bianchi, Giampaolo
abstract

To assess the incidence of long-term side effects after shock-wave lithotripsy treatment performed with an electromagnetic Dornier Lithotripter S device. A specific follow-up was undertaken on a cohort of 100 selected patients that underwent SWL for a single renal stone in our center from 2002 to 2004. Previous and current data were compared using the Student t test. Factors associated with the incidence of hypertension and diabetes mellitus were determined. Ten years after treatment, mean serum creatinine level and glomerular filtration rate remained similar to previous values (serum creatinine level: 0.96 ± 0.22 vs. 0.92 ± 0.19 mg/dL; glomerular filtration rate: 92.8 ± 17.8 vs. 88.1 ± 21.7 mL/min). There were marked increases in blood cholesterol, blood pressure, and blood glucose levels, while smoking decreased. Age, glomerular filtration rate, body mass index, blood glucose and blood pressure at the time of treatment were significantly associated with the presence of hypertension and diabetes mellitus at follow-up; blood cholesterol was associated with diabetes mellitus development. After 10 years, overall renal function appeared to have been unaffected by shock-wave lithotripsy treatment. The increased rate of hypertension and diabetes mellitus were consistent with the incidence in the global population. This is the first report on the long-term safety of a third generation electromagnetic lithotripter, and indicates that there are no long-term sequelae.

2016 - 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

2016 - Laparoscopic access overview: Is there a safest entry method? [Articolo su rivista]
Bianchi, Giampaolo; Martorana, Eugenio; Ghaith, A; Pirola, Giacomo Maria; Rani, Matteo; Bove, P; Porpiglia, F; Manferrari, F; Micali, Salvatore
abstract

BACKGROUND: Laparoscopy is a minimally invasive technique to access the abdominal cavity, for diagnostic or therapeutic applications. Optimizing the access technique is an important step for laparoscopic procedures. The aim of this study is to assess the outcomes of different laparoscopic access techniques and to identify the safest one. METHODS: Laparoscopic access questionnaire was forwarded via e-mail to the 60 centers who are partners in working group for laparoscopic and robotic surgery of the Italian Urological Society (SIU) and their American and European reference centers. RESULTS: The response rate was 68.33%. The total number of procedures considered was 65.636. 61.5% of surgeons use Veress needle to create pneumoperitoneum. Blind trocar technique is the most commonly used, but has the greatest number of complications. Optical trocar technique seems to be the safest, but it's the less commonly used. The 28,2% of surgeons adopt open Hasson's technique. Total intra-operative complications rate was 3.3%. Open conversion rate was 0.33%, transfusion rate was 1.13%, and total post-operative complication rate was 2.53%. CONCLUSION: Laparoscopic access is a safe technique with low complication rate. Most of complications can be managed conservatively or laparoscopically. The choice of access technique can affect the rate and type of complications and should be planned according to surgeon experience, safety of each technique and patient characteristics. All access types have perioperative complications. According with our study, optical trocar technique seems to be the safest.

2016 - Management and therapeutic response of a prostate ductal adenocarcinoma: a still unknown tumour? [Articolo su rivista]
Martorana, Eugenio; Micali, Salvatore; Pirola, Giacomo Maria; REGGIANI BONETTI, Luca; Clo', Vera; Ghaith, A; Bianchi, Giampaolo
abstract

Ductal adenocarcinoma is a rare subtype of prostate cancer with a worse prognosis.Histologically, it is characterized by the presence of tall, pseudostratified columnar epithelium with abundant cytoplasm organized in a papillary or cribriform-papillary pattern. Several clinical differences distinguish this subtype of prostate cancer by the conventional acinar adenocarcinoma: exophytic growth into the prostatic urethra, different clinical presentation, different sites of metastasis and more aggressiveness. The rarity of this tumour forced to base our knowledge on small case series or on individual case reports, and does not help to establish appropriate guidelines. Therefore, the diagnosis of this tumour masks clinical implications that are still not well-understood.We report the case of a 69-year-old Caucasian man with a diagnosis of pure prostate ductal adenocarcinoma that early developed multiple metastases after radical prostatectomy. The patient started hormonal therapy with a fast biochemical and radiologic (positron emission tomography-computed tomography, PET-CT) hormonal escape. Therefore, we took the decision to perform chemotherapy with Taxotere along with prednisolone with a relative stability of prostate-specific antigen (PSA) level, but a new PET-CT scan showed a further progression of the disease. Finally, the patient underwent therapy with Abiraterone acetate that did not stop the cancer progression.No therapeutic options available showed a good control of disease progression. PSA proved to be a poor marker while, on the contrary, PET-CT scan has proved to be particularly useful in the management of the disease progression. More efforts are required to add new knowledge about this tumour and assess what is known until now.

2016 - Open Versus Laparoscopic Adrenalectomy for Adrenocortical Carcinoma: A Meta-analysis of Surgical and Oncological Outcomes [Articolo su rivista]
Autorino, Riccardo; Bove, Pierluigi; de Sio, Marco; Miano, Roberto; Micali, Salvatore; Cindolo, Luca; Greco, Francesco; Nicholas, Jilian; Fiori, Cristian; Bianchi, Giampaolo; Kim, Fernando J.; Porpiglia, Francesco
abstract

PURPOSE: This study was designed to determine the role of laparoscopic adrenalectomy (LA) in the surgical management of adrenocortical carcinoma (ACC). METHODS: A systematic literature review was performed on January 2, 2015 using PubMed. Article selection proceeded according to PRISMA criteria. Studies comparing open adrenalectomy (OA) to LA for ACC and including at least 10 cases per each surgical approach were included. Odds ratio (OR) was used for all binary variables, and weight mean difference (WMD) was used for the continuous parameters. Pooled estimates were calculated with the fixed-effect model, if no significant heterogeneity was identified; alternatively, the random-effect model was used when significant heterogeneity was detected. Main demographics, surgical outcomes, and oncological outcomes were analyzed. RESULTS: Nine studies published between 2010 and 2014 were deemed eligible and included in the analysis, all of them being retrospective case-control studies. Overall, they included 240 LA and 557 OA cases. Tumors treated with laparoscopy were significantly smaller in size (WMD -3.41 cm; confidence interval [CI] -4.91, -1.91; p &lt; 0.001), and a higher proportion of them (80.8 %) more at a localized (I-II) stage compared with open surgery (67.7 %) (odds ratio [OR] 2.8; CI 1.8, 4.2; p &lt; 0.001). Hospitalization time was in favor of laparoscopy, with a WMD of -2.5 days (CI -3.3, -1.7; p &lt; 0.001). There was no difference in the overall recurrence rate between LA and OA (relative risk [RR] 1.09; CI 0.83, 1.43; p = 0.53), whereas development of peritoneal carcinomatosis was higher for LA (RR 2.39; CI 1.41, 4.04; p = 0.001). No difference could be found for time to recurrence (WMD -8.2 months; CI -18.2, 1.7; p = 0.11), as well as for cancer specific mortality (OR 0.68; CI 0.44, 1.05; p = 0.08). CONCLUSIONS: OA should still be considered the standard surgical management of ACC. LA can offer a shorter hospital stay and possibly a faster recovery. Therefore, this minimally invasive approach can certainly play a role in this setting, but it should be only offered in carefully selected cases to avoid jeopardizing the oncological outcome.

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, 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 &lt;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 - Proteomic validation of biomarkers for discrimination of benign and malign prostatic hyperplasia [Abstract in Rivista]
Ozben, T; Bergamini, S; Bellei, E; Cuoghi, A; Bianchi, G; Tomasi, A
abstract

Use of proteomic techniques for the identification and validation of discriminating protein biomarkers in prostate cancer and BPH.

2016 - Rare metastatic sites of renal cell carcinoma: urethra and spermatic cord [Articolo su rivista]
Pirola, Giacomo M.; Martorana, Eugenio; Fidanza, Francesco A.; Bonetti, Luca Reggiani; Puliatti, Stefano; Bonora, Alessandra; Micali, Salvatore; Bianchi, Giampaolo
abstract

INTRODUCTION: About 20% of patients with a diagnosis of primary renal cell carcinoma (RCC) present directly with metastatic disease. The aim of the present manuscript is to describe, for the first time a RCC metastasis located to the distal female urethra and to present an update on metastatic locations to the male spermatic cord.MATERIALS AND METHODS: We report two cases of rare RCC metastases. The first concerns a 92-year-old female patient who came to our attention for recurrent urethral bleeding, which was initially believed to be secondary to urethral mucosal ectropion. Pathology demonstrated a RCC metastasis. The second concerns a 67-year-old male patient with a previous history of RCC who came to our attention for the finding of palpable, mobile and indolent right inguinal lump. Given the past history of malignancy, it was excised and revealed to be a RCC metastasis.DISCUSSION: In the first case, the pathologic specimen allowed the detection of an unknown renal tumor, whereas in the second, the previous neoplastic history of the patient has led clinicians to focus on a possible neoplastic recurrence, perform a correct excision of the node, and begin an early systemic therapy.CONCLUSIONS: These cases are emblematic of possible unexpected RCC metastasis. These findings should be taken into account in order to clarify the differential diagnosis and to address these patients to a correct therapeutic course.

2016 - Re: Critical Analysis of Early Recurrence after Laparoscopic Radical Cystectomy in a Large Cohort by the ESUT [Articolo su rivista]
Mynbaev, Ospan A.; Micali, Salvatore; Zordani, Alessio; Bianchi, Giampaolo
abstract

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2016 - Studer Orthotopic Neobladder: A Modified Surgical Technique [Articolo su rivista]
Bianchi, Giampaolo; Sighinolfi, Maria Chiara; Pirola, Giacomo Maria; Micali, Salvatore
abstract

OBJECTIVE: A modified technique for orthotopic ileal neobladder preparation is described. The Studer technique is the method most frequently used worldwide and seems to be an ideal reconstructive solution after radical cystectomy. METHODS: After radical cystectomy, urinary diversion is attained by means of a detubulized ileal segment. About 40 cm are used to create the reservoir and 15 cm for a tubular afferent limb. A spheroidal-shaped reservoir is then obtained with a conic distal part that will be anastomized to the urethral stump. After the reconstructive part, the neobladder and the afferent limb are attached to the levator ani and psoas muscles respectively. Post-operative results on a series of 36 patients are reported. RESULTS: The final shape of the reservoir was roughly spherical. A small amount of anastomotic strictures was registered. Renal function was not impaired after surgery, even at late follow-up. CONCLUSION: Even if the Studer technique is already well described, we believe that our technical changes may improve urinary tract restoration, and potentially decrease complications typical of urinary orthotopic diversion. Further cases are required to confirm possible advantages of the modified technique.

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 Maria Cesare; 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 - A snapshot of nephron-sparing surgery in Italy: A prospective, multicenter report on clinical and perioperative outcomes (the RECORd 1 project) [Articolo su rivista]
Schiavina, R.; Mari, A.; Antonelli, A.; Bertolo, R.; Bianchi, Giampaolo; Borghesi, M.; Brunocilla, E.; Fiori, C.; Longo, N.; Martorana, G.; Mirone, V.; Morgia, G.; Novara, G.; Porpiglia, F.; Rovereto, B.; Serni, S.; Simeone, C.; Sodano, M.; Terrone, C.; Carini, M.; Minervini, A.
abstract

INTRODUCTION: Nephron-sparing surgery (NSS) has become the standard of care for the surgical management of small and clinically localized renal cell carcinoma (RCC). The conservative management of those RCCs is increasing over time. Aim of this study was to report a snapshot of the clinical, perioperative and oncological results after NSS for RCC in Italy. MATERIAL AND METHODS: We evaluated all patients who underwent conservative surgical treatment for renal tumours between January 2009 and December 2012 at 19 urological Italian Centers (RECORd project). Perioperative, radiological and histopathological data were recorded. Surgical eras (2009 vs 2012 and year periods 2009-2010 vs 2011-2012) were compared. RESULTS: Globally, 983 patients were evaluated. More recently, patients undergoing NSS were found to be significantly younger (p = 0.05) than those surgically treated in the first study period, with a significantly higher rate of NSS with relative and imperative indication (p < 0.001). More recently, a higher percentage of procedures for cT1b or cT2 renal tumours was observed (p = 0.02). Utilization rate of open partial nephrectomy (OPN) constantly decreased during years, laparoscopic partial nephrectomy (LPN) remained almost constant while robot-assisted partial nephrectomy (RAPN) increased. The rate of clampless NSS constantly increased over time. The use of at least one haemostatic agent has been significantly more adopted in the most recent surgical era (p < 0.001). CONCLUSIONS: The utilization rate of NSS in Italy is increasing, even in elective and more complex cases. RAPN has been progressively adopted, as well as the intraoperative utilization of haemostatic agents and the rate of clampless procedures.

2015 - Advantages of single-puncture transperineal saturation biopsy of prostate: analysis of outcomes in 125 patients using our scheme [Articolo su rivista]
Martorana, Eugenio; Micali, Salvatore; Ghaith, Ahmed; REGGIANI BONETTI, Luca; Sighinolfi, Maria Chiara; Galli, Riccardo; Paterlini, Maurizio; Bianchi, Giampaolo
abstract

PURPOSE: Stereotactic biopsy has improved prostate cancer detection. Although the new approach is superior, standard procedure is still useful in a cohort of patients in whom MRI is not available. The standard saturation biopsy technique is still debatable. We describe our technique and analyze its outcomes. MATERIALS AND METHODS: One hundred twenty-five patients underwent saturation biopsy through a single transperineal access. Mean age was 64.73 year, mean PSA was 9.49 ng/ml, mean PSA density was 0.184, and mean prostate volume was 57.95 g. All patients underwent at least one previous prostatic biopsy: 24.8% of cases had diagnosis of atypical small acinar proliferation, 39.2% of cases had multifocal high-grade prostatic intraepithelial neoplasia, and 36% of cases had inflammation or benign prostatic hyperplasia. RESULTS: The detection rate was 38.4%. Prostate cancer occurred in 61.3% of patients with previous ASAP (p &lt; 0.007). Cancer detection rate decreased with increasing number of previous biopsy and with increasing prostate volume (p &lt; 0.001) and increased with increasing PSA density (p = 0.03). No major complications were reported. CONCLUSION: The traditional saturation biopsy may be useful when targeted biopsy cannot be used. Our technique is accurate for cancer detection. It can offer some advantages in comparison with other approaches.

2015 - Chemical and Mineralogical Analysis of Ureteral Stent Encrustation and Associated Risk Factors [Articolo su rivista]
Sighinolfi, Maria Chiara; Sighinolfi, Gian Paolo; Galli, Ermanno; Micali, Salvatore; Ferrari, Nancy; Mofferdin, Alessandro; Bianchi, Giampaolo
abstract

OBJECTIVE: To assess the burden and chemical and mineralogical composition of stent coating at both stent ends, with evaluation of associated risk factors. MATERIALS AND METHODS: A total of 40 consecutive patients submitted to ureteral-stent removal were considered. Stents were previously positioned for both urolithiasis and during the management of other urologic diseases and/or procedures. Mean indwelling time was 59.2 ± 7.5 days. ANALYTICAL PROCEDURES: Encrustations were submitted to chemical-mineralogical analysis as well as to their quantification. Quantification was achieved by measuring the weight of stent fragments before and after oxidative acid treatment to dissolve the deposited (both organic and inorganic) material. The analytical solution obtained by acid attack was used to acquire information on calcium and magnesium content with atomic-absorption spectroscopy. X-ray diffraction was used to determine the mineralogy of encrustations for a group of stent samples characterized by relatively high amounts of deposited material. RESULTS: The composition of encrustations at the proximal coil reflected the composition of stones in patients with urolithiasis. Whewellite was the more common encrustant. In a regression model, the variable mostly related to the burden of proximal encrustation was urolithiasis (P = .04), especially in frequent stone formers. At the distal coil, higher degrees of encrustation were related to urinary tract infection (P = .012) and patient's aging (P = .05), thus suggesting a possible association with a bladder outlet dysfunction. CONCLUSION: The present study highlighted some variables related to stent encrustation and seems to be the first one analyzing separately the two coils. Our outcomes suggest that the so-obtained risk factors have to be considered when positioning a ureteral stent.

2015 - Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group [Articolo su rivista]
Prezioso, D.; Strazzullo, P.; Lotti, T.; Bianchi, Giampaolo; Borghi, L.; Caione, P.; Carini, M.; Caudarella, R.; Ferraro, P. M.; Gambaro, G.; Gelosa, M.; Guttilla, A.; Illiano, E.; Martino, M.; Meschi, T.; Messa, P.; Miano, R.; Napodano, G.; Nouvenne, A.; Rendina, D.; Rocco, F.; Rosa, M.; Sanseverino, R.; Salerno, A.; Spatafora, S.; Tasca, A.; Ticinesi, A.; Travaglini, F.; Trinchieri, A.; Vespasiani, G.; Zattoni, F.
abstract

OBJECTIVE: Diet interventions may reduce the risk of urinary stone formation and its recurrence, but there is no conclusive consensus in the literature regarding the effectiveness of dietary interventions and recommendations about specific diets for patients with urinary calculi. The aim of this study was to review the studies reporting the effects of different dietary interventions for the modification of urinary risk factors in patients with urinary stone disease. MATERIALS AND METHODS: A systematic search of the Pubmed database literature up to July 1, 2014 for studies on dietary treatment of urinary risk factors for urinary stone formation was conducted according to a methodology developed a priori. Studies were screened by titles and abstracts for eligibility. Data were extracted using a standardized form and the quality of evidence was assessed. RESULTS: Evidence from the selected studies were used to form evidence-based guideline statements. In the absence of sufficient evidence, additional statements were developed as expert opinions. CONCLUSIONS: General measures: Each patient with nephrolithiasis should undertake appropriate evaluation according to the knowledge of the calculus composition. Regardless of the underlying cause of the stone disease, a mainstay of conservative management is the forced increase in fluid intake to achieve a daily urine output of 2 liters. HYPERCALCIURIA: Dietary calcium restriction is not recommended for stone formers with nephrolithiasis. Diets with a calcium content ≥ 1 g/day (and low protein-low sodium) could be protective against the risk of stone formation in hypercalciuric stone forming adults. Moderate dietary salt restriction is useful in limiting urinary calcium excretion and thus may be helpful for primary and secondary prevention of nephrolithiasis. A low-normal protein intake decrease calciuria and could be useful in stone prevention and preservation of bone mass. Omega-3 fatty acids and bran of different origin decreases calciuria, but their impact on the urinary stone risk profile is uncertain. Sports beverage do not affect the urinary stone risk profile. HYPEROXALURIA: A diet low in oxalate and/or a calcium intake normal to high (800-1200 mg/day for adults) reduce the urinary excretion of oxalate, conversely a diet rich in oxalates and/or a diet low in calcium increase urinary oxalate. A restriction in protein intake may reduce the urinary excretion of oxalate although a vegetarian diet may lead to an increase in urinary oxalate. Adding bran to a diet low in oxalate cancels its effect of reducing urinary oxalate. Conversely, the addition of supplements of fruit and vegetables to a mixed diet does not involve an increased excretion of oxalate in the urine. The intake of pyridoxine reduces the excretion of oxalate. HYPERURICOSURIA: In patients with renal calcium stones the decrease of the urinary excretion of uric acid after restriction of dietary protein and purine is suggested although not clearly demonstrated. HYPOCITRATURIA: The administration of alkaline-citrates salts is recommended for the medical treatment of renal stone-formers with hypocitraturia, although compliance to this treatment is limited by gastrointestinal side effects and costs. Increased intake of fruit and vegetables (excluding those with high oxalate content) increases citrate excretion and involves a significant protection against the risk of stone formation. Citrus (lemons, oranges, grapefruit, and lime) and non citrus fruits (melon) are natural sources of dietary citrate, and several studies have shown the potential of these fruits and/or their juices in raising urine citrate levels. CHILDREN: There are enought basis to advice an adequate fluid intake also in children. Moderate dietary salt restriction and implementation of potassium intake are useful in limiting urinary calcium excretion whereas dietary calcium restriction is not recommended

2015 - ERRATUM: Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group [Articolo su rivista]
Prezioso, Domenico; Strazzullo, Pasquale; Lotti, Tullio; Bianchi, Giampaolo; Borghi, Loris; Caione, Paolo; Carini, Marco; Caudarella, Renata; Ferraro, Manuel; Gambaro, Giovanni; Gelosa, Marco; Guttilla, Andrea; Illiano, Ester; Martino, Marangella; Meschi, Tiziana; Messa, Piergiorgio; Miano, Roberto; Napodano, Giorgio; Nouvenne, Antonio; Rendina, Domenico; Rocco, Francesco; Rosa, Marco; Sanseverino, Roberto; Salerno, Annamaria; Spatafora, Sebastiano; Tasca, Andrea; Ticinesi, Andrea; Travaglini, Fabrizio; Trinchieri, Alberto; Vespasiani, Giuseppe; Zattoni, Filiberto
abstract

Due to a technical error, Dr. Manuel Ferraro was omitted from the author list of this article. The correct author details appear above.

2015 - Minimally invasive surgery in Urology - Minimally Invasive Reconstructive Surgery [Altro]
Micali, Salvatore; Bianchi, Giampaolo
abstract

Committee 6: Minimally Invasive reconstructive surgery

2015 - Morphological and functional analysis of a cohort of patients undergoing orthotopic ileal neobladder [Articolo su rivista]
Pirola, Giacomo Maria; Micali, Salvatore; Territo, Angelo; Sighinolfi, Maria Chiara; Beato, Alessandra; Bianchi, Giampaolo
abstract

INTRODUCTION: This study was conducted between January 2001 and December 2013 to evaluate patient's outcomes after radical cystectomy and orthotopic ileal neobladder from a morphological and functional point of view at a median follow-up of 2 years. MATERIALS AND METHODS: A total of 48 eligible patents were included. We first report our technical modifications to Studer's neobladder. Sequently, after a medium follow-up of two years, we assessed morphology of the reservoir and voiding functionality of this patients cohort, submitting them to specific questionnaires and to uroflowmetry. RESULTS: Early and late postoperative data are available for 36 patients. From the morphological follow-up, 2 years after surgery, six patients had hydroureteronephrosis for vescico-ureteral reflux in four cases (11% of total) and uretero-neobladder anastomosis stenosis in the other two (5.6% of total). Neobladder shape always remained spherical, with a relative right lateralization in eight cases (22.2%). Regarding the nine patients subjected to uroflowmetry, seven (77.7%) highlighted the lack of postvoid residual urine, with a maximum urinary flow rate within the normal range in six of them. DISCUSSION: Improvements in surgical technique may help to reduce complications rate. From uroflowmetry analysis, we can observe that the mean filling pressure following surgery was relatively stable and urinary flow rate was mostly satisfactory. In patients without postvoid residual urine, all referred absence of daily incontinence and good quality of life. CONCLUSION: From this morpho-functional evaluation, our orthotopic Studer-modified ileal neobladder seems an ideal solution for urinary diversion, presenting functional features similar to native bladder and assuming a well-defined morphology, not changing in time.

2015 - The importance of inflammation in the search of prostate cancer biomarkers [Poster]
Bergamini, S; Bellei, E; Monari, E; Cuoghi, A; Reggiani Bonetti, L; Borelli, F; Sighinolfi, C; Bianchi, G; Ozben, T; Tomasi, A
abstract

The importance of inflammation in the search of prostate cancer biomarkers by proteomics.

2015 - Three-dimensional technology facilitates surgical performance of novice laparoscopy surgeons: A quantitative assessment on a porcine kidney model [Articolo su rivista]
Cicione, Antonio; Autorino, Riccardo; Laguna, M. Pilar; De Sio, Marco; Micali, Salvatore; Turna, Burak; Sanchez Salas, Rafael; Quattrone, Carmelo; Dias, Emanuel; Mota, Paulo; Bianchi, Giampaolo; Damano, Rocco; Rassweiler, Jens; Lima, Estevao
abstract

OBJECTIVE: To determine whether the use of 3-dimensional (3D) imaging translates into a better surgical performance of naïve urologic laparoscopic surgeons during pyeloplasty (PY) and partial nephrectomy (PN) procedures. MATERIALS AND METHODS: Eighteen surgeons without any previous laparoscopic experience were randomly assigned to perform PY and PN in a porcine model using initially 2-dimensional (2D) and 3D laparoscopy. A surgical performance score was rated by an "expert" tutor through a modified 5-item global rating scale contemplating operative field view, bimanual dexterity, efficiency, tissue handling, and autonomy. Overall surgical time, complications, subjective perception of participating surgeons, and inconveniences related to the 3D vision were recorded. RESULTS: No difference in terms if operative time was found between 2D or 3D laparoscopy for both the PY (P = .51) and the PN (P = .28) procedures. A better rate in terms of surgical performance score was noted by the tutors when the study participants were using 3D vs 2D, for both PY (3.6 [0.8] vs 3.0 [0.4]; P = .034) and PN (3.6 [0.51] vs 3.15 [0.63]; P = .001). No complications occurred in any of the procedures. Most (77.2%) of the participating naïve laparoscopic surgeons had the perception that 3D laparoscopy was overall easier than 2D. Headache (18.1%), nausea (18.1%), and visual disturbance (18.1%) were the most common issues reported by the surgeons during 3D procedures. CONCLUSION: Despite the absence of translation in a shorter operative time, the use of 3D technology seems to facilitate the surgical performance of naïve surgeons during laparoscopic kidney procedures on a porcine model.

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 Maria Cesare; 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.

2014 - Bilateral spermatic cord en bloc ligation by laparoendoscopic single-site surgery: preliminary experience compared to conventional laparoscopy [Articolo su rivista]
Micali, Salvatore; Ghaith, Ahmed; Martorana, Eugenio; Zordani, Alessio; Territo, Angelo; Bianchi, Giampaolo
abstract

BACKGROUND: Laparo Endoscopic Single-site Surgery (LESS) represents an evolution of minimally invasive surgery and aims to improve cosmetic outcome and reduce surgical trauma and complications associated with traditional laparoscopy. This study was performed to present our preliminary experience in bilateral spermatic cord ligation with the LESS technique and compare the results with the outcomes of conventional laparoscopic surgery. METHODS: Between June 2007 and May 2013, 24 patients were referred to our institute for bilateral varicocelectomy. The indications for this type of procedure were bilateral varicocele with impairment of semen parameters or chronic bilateral testicular pain. All procedures were performed via the same surgeon. The patients were divided into two groups according to the type of laparoscopic surgery. Group A included 10 patients underwent LESS technique while group B included the remaining 14 patients that underwent conventional laparoscopy. RESULTS: The comparison between the two techniques showed some important advantages for LESS: shorter operating time (45.4 min vs. 88.3 (P < .001), shorter hospital stay (16.6 hours vs. 51.4 hours) (P < .001), early return to the normal activity (2.3 days vs. 4.7 days) and better cosmetic outcomes. No conversions from LESS to conventional laparoscopy were necessary and blood loss was insignificant in all patients.All patients in the LESS group reported full satisfaction with the cosmetic outcome, whereas 85.7% of patients after conventional laparoscopy were fully satisfied with cosmesis. CONCLUSIONS: Bilateral spermatic cord ligation with LESS is an alternative to conventional laparoscopy. The procedure was successfully performed in all patients. The trans-umbilical approach offers the advantage of a better cosmetic result, shorter hospital stay and less postoperative pain.

2014 - Cranberry and Recurrent Cystitis: More than Marketing? [Articolo su rivista]
Micali, Salvatore; Isgro', Gianmarco; Bianchi, Giampaolo; Miceli, Natalizia; Calapai, Gioacchino; Navarra, Michele
abstract

Epidemiologic studies indicate that millions of people suffer from recurrent cystitis, a pathology requiring antibiotic prophylaxis and entailing high social costs. Cranberry is a traditional folk remedy for cystitis and, which, in the form of a variety of products and formulations has over several decades undergone extensive evaluation for the management of urinary tract infections (UTI). The aim of this retrospective study is to summarize and review the most relevant and recent preclinical and clinical studies on cranberries for the treatment of UTIs. The scientific literature selected for this review was identified by searches of Medline via PubMed. A variety of recent experimental evidence has shed light on the mechanism underlying the anti-adhesive properties of proanthrocyanidins, their structure-activity relationships, and pharmacokinetics. Analysis of clinical studies and evaluation of the cranberry efficacy/safety ratio in the prevention of UTIs strongly support the use of cranberry in the prophylaxis of recurrent UTIs in young and middle-aged women. However, evidence of its clinical use among other patients remains controversial.

2014 - Efficacy, usability and tolerability of a dynamic elbow orthosis after collateral ligament reconstruction: a prospective randomized study [Articolo su rivista]
Merolla, G.; Bianchi, P.; Porcellini, G.
abstract

Purpose: To assess the efficacy, usability and tolerability of a dynamic orthosis compared with a standard plaster splint after the reconstruction of elbow medial or lateral collateral ligaments (MCL, LCL).Methods: Twenty-six subjects undergoing MCL (n = 23) or LCL (n = 3) reconstruction were randomly assigned to immobilization with an orthosis (n = 13; group A “Innovator X”) or with a plaster splint (n = 13; group B “Plaster splint”). Outcome measures were visual analogue scale pain score, mid-arm (MA) circumference, grip strength, Oxford elbow score (OES) and range of motion (ROM). Patients were assessed at baseline and at 2, 6, 12 and 24 weeks.Results: Significant pain reduction was reported by all patients at 6, 12 and 24 weeks (p < 0.05). Mean MA circumference was significantly higher in group A at all time points (all p < 0.05). Mean grip strength was greater in group A on weeks 2 and 6 (p < 0.05), whereas the difference found on weeks 12 and 24 was not significant. The OES and passive ROM values of the two groups were not significantly different at any time point.Conclusions: The dynamic orthosis and the plaster splint both provided effective and safe elbow immobilization after MCL or LCL reconstruction. The orthosis provided greater pain reduction, faster recovery of muscle trophism and grip strength, and was better tolerated.

2014 - Inflammation: an important parameter in the search of prostate cancer biomarkers [Articolo su rivista]
Bergamini, Stefania; Bellei, Elisa; REGGIANI BONETTI, Luca; Monari, Emanuela; Cuoghi, Aurora; Francesco, Borelli; Sighinolfi, Maria Chiara; Bianchi, Giampaolo; T., Ozben; Tomasi, Aldo
abstract

Background A more specific and early diagnostics for prostate cancer (PCa) is highly desirable. In this study, being inflammation the focus of our effort, serum protein profiles were analyzed in order to investigate if this parameter could interfere with the search of discriminating proteins between PCa and benign prostatic hyperplasia (BPH). Methods Patients with clinical suspect of PCa and candidates for trans-rectal ultrasound guided prostate biopsy (TRUS) were enrolled. Histological specimens were examined in order to grade and classify the tumor, identify BPH and detect inflammation. Surface Enhanced Laser Desorption/Ionization-Time of Flight-Mass Spectrometry (SELDI-ToF-MS) and two-dimensional gel electrophoresis (2-DE) coupled with Liquid Chromatography-MS/MS (LC-MS/MS) were used to analyze immuno-depleted serum samples from patients with PCa and BPH. Results The comparison between PCa (with and without inflammation) and BPH (with and without inflammation) serum samples by SELDI-ToF-MS analysis did not show differences in protein expression, while changes were only observed when the concomitant presence of inflammation was taken into consideration. In fact, when samples with histological sign of inflammation were excluded, 20 significantly different protein peaks were detected. Subsequent comparisons (PCa with inflammation vs PCa without inflammation, and BPH with inflammation vs BPH without inflammation) showed that 16 proteins appeared to be modified in the presence of inflammation, while 4 protein peaks were not modified. With 2-DE analysis, comparing PCa without inflammation vs PCa with inflammation, and BPH without inflammation vs the same condition in the presence of inflammation, were identified 29 and 25 differentially expressed protein spots, respectively. Excluding samples with inflammation the comparison between PCa vs BPH showed 9 unique PCa proteins, 4 of which overlapped with those previously identified in the presence of inflammation, while other 2 were new proteins, not identified in our previous comparisons. Conclusions The present study indicates that inflammation might be a confounding parameter during the proteomic research of candidate biomarkers of PCa. These results indicate that some possible biomarker-candidate proteins are strongly influenced by the presence of inflammation, hence only a well-selected protein pattern should be considered for potential marker of PCa.

2014 - Open versus laparoscopic partial nephrectomy for clinical T1a renal masses: A matched-pair comparison of 280 patients with TRIFECTA outcomes (RECORd Project) [Articolo su rivista]
Minervini, Andrea; Siena, Giampaolo; Antonelli, Alessandro; Bianchi, Giampaolo; Bocciardi, Aldo Massimo; Cosciani Cunico, Sergio; Ficarra, Vincenzo; Fiori, Cristian; Fusco, Ferdinando; Mari, Andrea; Martorana, Giuseppe; Medica, Mauro; Mirone, Vincenzo; Morgia, Giuseppe; Porpiglia, Francesco; Rocco, Francesco; Rovereto, Bruno; Schiavina, Riccardo; Simeone, Claudio; Terrone, Carlo; Volpe, Alessandro; Carini, Marco; Serni, Sergio
abstract

AIM OF THE STUDY: To report a matched-pair comparative analysis between open (OPN) and laparoscopic partial nephrectomy (LPN) for clinical (c) T1a renal masses from a large prospective multicenter dataset. MATERIALS AND METHODS: The RECORd Project includes all patients who underwent OPN and LPN for kidney cancer between January 2009 and January 2011 at 19 Italian centers. Open and laparoscopic groups were compared regarding clinical, surgical, pathologic, functional results and TRIFECTA outcome. Multivariable logistic regression models were used to analyze predictors of WIT >25 min, surgical complications (SC) and the achievement of the TRIFECTA outcome. RESULTS: Overall, 301 patients had OPN and 149 LPN. Groups were matched 1:1 (140 matched pairs) for clinical diameter, tumor location and type of indication. Laparoscopic partial nephrectomy was associated with a significantly mean longer WIT (19.9 vs. 15.1 min; p < 0.001), and it was an independent predictor of a WIT >25 min (RR 6.29, p < 0.0001). The TRIFECTA was achieved in 78.6 and 74.3% after OPN and LPN (p = ns), respectively, and the surgical approach was not a predictor of a negative TRIFECTA and SC at multivariable analysis. At 6-month follow-up, no significant differences were observed between the OPN and LPN group both in estimated glomerular filtration rate (eGFR) (∆GFR 1.1 vs. 4.1 mL/min) and in new-onset stage III-V chronic kidney disease (CKD) rate (0 vs. 0.7%). CONCLUSION: No significant difference in achieving the TRIFECTA outcome was reported after OPN and LPN. LPN was associated with a significantly longer WIT. However, eGFR at 6-month follow-up did not differ significantly between the two surgical approaches.

2014 - Retroperitoneoscopic renal biopsy: still a good indication! [Articolo su rivista]
Micali, Salvatore; Dandrea, M; DE CARNE, Cosimo; Martorana, Eugenio; DE STEFANI, Stefano; Cappelli, Gianni; Bianchi, Giampaolo
abstract

The histological evaluation of the renal parenchyma is often essential in cases of several renal diseases and provides useful information in determining the prognosis and guiding treatment. In patients with contraindications to percutaneous kidney biopsy, retroperitoneal laparoendoscopic single-site surgery (LESS) is to be preferred as a minimally invasive technique. However, there are cases in which the LESS technique is difficult to perform, especially given that the learning curve is not optimal. We present a case of a Jehovah’s Witness patient with severe obesity, in whom conventional retroperitoneal laparoscopic renal biopsy was preferred to the LESS technique.

2014 - Retroperitoneoscopic single site renal biopsy surgery: right indicatioBMC Urology ns for the right technique. [Articolo su rivista]
Micali, Salvatore; Zordani, Alessio; Galli, Riccardo; Martorana, Eugenio; Micaela, Piccoli; Cappelli, Gianni; Bianchi, Giampaolo
abstract

Bacground: Laparoendoscopic single-site surgery (LESS) has been developed in an attempt to further reduce the morbidity and scarring associated with laparoscopic surgery. In patients in whom there are indications to perform a laparoscopic renal biopsy, LESS surgery is a valid alternative to mini invasive surgery and is becoming more common. We report our experience on 14 renal biopsy procedures performed in a retroperitoneal LESS. Methods: LESS renal biopsy was performed in 14 patients 18 to 80 years old (mean age 58.3 years) during a 36 month period. All procedures were performed by a single operator. The patient was in a standard flank position. The procedure was performed using a 2.5 cm, single incision via a retroperitoneal access at the Petit ’ s triangle. A 5 mm biopsy forceps was used to collect the specimen under direct vision, and haemostasis was obtained with an Argon beam probe and the application of oxidized regenerated cellulose gauze. Results: Biopsy was performed successfully in all cases. Mean operative time was 52.64 min, blood loss was minimal, and the hospital stay ranged from 12 to 24 hours. None of the patients required narcotics or additional analgesia in the postoperative period. No postoperative complications occurred. Conclusions: The LESS technique is safe, reliable (100% success), easy to learn, and offers subjective cosmetic benefits to the patient. Minimal hospitalization requirement following retroperitoneal LESS biopsy is an additional timely advantage over laparoscopic renal biopsy. We think that with the right indications (marked obesity, failure of previous percutaneous biopsy attempts, a solitary kidney and coagulopathy) LESS renal biopsy is a good alternative to laparoscopy. Our next step will be a randomized prospective study of LESS compared with laparoscopy for renal biopsy to support our findings.

2014 - Simple enucleation versus standard partial nephrectomy for clinical T1 renal masses: Perioperative outcomes based on a matched-pair comparison of 396 patients (RECORd project) [Articolo su rivista]
Longo, N.; Minervini, A.; Antonelli, A.; Bianchi, Giampaolo; Bocciardi, A. M.; Cunico, S. C.; Fiori, Chiara; Fusco, F; Giancane, S.; Mari, A.; Martorana, G.; Mirone, V.; Morgia, G.; Novara, G.; Porpiglia, F.; Raspollini, M. R.; Rocco, F.; Rovereto, B.; Schiavina, R.; Serni, S.; Simeone, Carmine; Verze, P.; Volpe, Annibale; Ficarra, V.; Carini, Marina
abstract

Simple enucleation versus standard partial nephrectomy for clinical T1 renal masses: perioperative outcomes based on a matched-pair comparison of 396 patients (RECORd project). Longo N1, Minervini A2, Antonelli A3, Bianchi G4, Bocciardi AM5, Cunico SC3, Fiori C6, Fusco F7, Giancane S2, Mari A2, Martorana G8, Mirone V1, Morgia G9, Novara G10, Porpiglia F6, Raspollini MR11, Rocco F12, Rovereto B13, Schiavina R8, Serni S2, Simeone C3, Verze P1, Volpe A14, Ficarra V10, Carini M2. Author information Abstract OBJECTIVES: To compare simple enucleation (SE) and standard partial nephrectomy (SPN) in terms of surgical results in a multicenter dataset (RECORd Project). MATERIALS AND METHODS: patients treated with nephron sparing surgery (NSS) for clinical T1 renal tumors between January 2009 and January 2011 were evaluated. Overall, 198 patients who underwent SE were retrospectively matched to 198 patients who underwent SPN. The SPN and SE groups were compared regarding intraoperative, early post-operative and pathologic outcome variables. Multivariable analysis was applied to analyze predictors of positive surgical margin (PSM) status. RESULTS: SE was associated with similar WIT (18 vs 17.8 min), lower intraoperative blood loss (177 vs 221 cc, p = 0.02) and shorter operative time (121 vs 147 min; p &lt; 0.0001). Surgical approach (laparoscopic vs. open), tumor size and type of indication (elective/relative vs absolute) were associated with WIT &gt;20 min. The incidence of PSM was significantly lower in patients treated with SE (1.4% vs 6.9%; p = 0.02). At multivariable analysis, PSM was related to the surgical technique, with a 4.7-fold increased risk of PSM for SPN compared to SE. The incidence of overall, medical and surgical complications was similar between SE and SPN. CONCLUSIONS: Type of NSS technique (SE vs SPN) adopted has a negligible impact on WIT and postoperative morbidity but SE seems protective against PSM occurrence. Copyright © 2014 Elsevier Ltd. All rights reserved.

2014 - Sodium iodide symporter (NIS) in extrathyroidal malignancies: Focus on breast and urological cancer [Articolo su rivista]
Micali, Salvatore; Bulotta, Stefania; Puppin, Cinzia; Territo, Angelo; Navarra, Michele; Bianchi, Giampaolo; Damante, Giuseppe; Filetti, Sebastiano; Russo, Diego
abstract

BACKGROUND: Expression and function of sodium iodide symporter (NIS) is requisite for efficient iodide transport in thyrocytes, and its presence in cancer cells allows the use of radioiodine as a diagnostic and therapeutic tool in thyroid neoplasia. Discovery of NIS expression in extrathyroidal tissues, including transformed cells, has opened a novel field of research regarding NIS-expressing extrathyroidal neoplasia. Indeed, expression of NIS may be used as a biomarker for diagnostic, prognostic, and therapeutic purposes. Moreover, stimulation of endogenous NIS expression may permit the radioiodine treatment of extrathyroidal lesions by concentrating this radioisotope. RESULTS: This review describes recent findings in NIS research in extrathyroidal malignancies, focusing on breast and urological cancer, emphasizing the most relevant developments that may have clinical impact. CONCLUSIONS: Given the recent progress in the study of NIS regulation as molecular basis for new therapeutic approaches in extrathyroidal cancers, particular attention is given to studies regarding the relationship between NIS and clinical-pathological aspects of the tumors and the regulation of NIS expression in the experimental models.

2014 - Validation of prostate cancer biomarkers and inflammation: a proteomic study [Abstract in Atti di Convegno]
Bergamini, S; Bellei, E; Monari, E; Cuoghi, A; Reggiani Bonetti, L; Borelli, F; Sighinolfi M., C; Bianchi, G; Ozben, T; Tomasi, A
abstract

Validation of prostate cancer biomarkers and inflammation by a proteomic approach

2013 - An objective comparison of novice trainees learning LESS versus traditional laparoscopy with the use of a pelvic trainer. [Articolo su rivista]
G., Isgrò; Micali, Salvatore; G., Pini; S., De Stefani; Gelmini, Roberta; Franzoni, Chiara; Bianchi, Giampaolo
abstract

OBJECTIVES: To compare the differences between LESS and SL among a population of subjects inexperienced of both techniques. MATERIALS AND METHODS: Participants were randomly assigned to the LESS or SL arm of the course; between the population examined, none had previous laparoscopic experience. The trial consisted in performing three increasingly difficult exercises either with LESS or standard laparoscopy. RESULTS: Time of execution and Objective Structured Assessment of Technical Skills score (OSATS) were recorded. Statistical analysis failed to detect any significant difference between the two arms of the trial. A trend in favor of standard laparoscopy was observed anyway. DISCUSSION: Our study evaluates the technical performance on a surgical simulator in the laboratory setting, with the use of standardized tasks and validated metrics. We believe that a controlled and safe environment aids objective evaluation of LESS compared to SL. Literature on this particular topic is somehow conflicting and heterogeneous. Our trial demonstrated that novices performed LESS tasks without any additional difficulties compared to standard laparoscopy. The aim of such investigation is to support knowledge of this new technology in order to facilitate its use in selected patients and surgical procedures.

2013 - Clinical and radiographic mid-term outcomes after shoulder resurfacing in patients aged 50 years old or younger [Articolo su rivista]
Merolla, G.; Bianchi, P.; Lollino, N.; Rossi, R.; Paladini, P.; Porcellini, G.
abstract

Purpose: Humeral resurfacing is a treatment option to conventional shoulder arthroplasty, conferring the advantages to preserve the bone stock and the normal joint geometry. Aim of the current study was to report clinical and radiographic mid-term outcomes in a population of 60 patients, aged 50 years or younger, who underwent shoulder resurfacing in osteoarthritis. Methods: The mean age was 48 ± 8.4, 36 were male and 24 female, dominant arm in 43 cases. Glenoid arthritis was treated in 36 cases (60 %) using a meniscus allograft in 22 cases, biologic patch in 4 cases and microfractures in 10 cases. Clinical and radiographic assessment was performed with Constant-Murley score and standard X-ray. Results: At an average follow-up of 44 months, the mean values of the constant score increased of 30 points (p &lt; 0.05), the pain decreased of 4.56 points (p &lt; 0.05) and the Simple Shoulder Test increased of 4.3 points (p &lt; 0.05). We found lower scores (p &gt; 0.05) in 9 patients (15 %) treated for glenoid arthritis using homologous meniscus (7 cases) and biologic patch (2 cases). A significant narrowing of joint space (5.92 mm postoperative versus 1.65 mm at 37 months) (p &lt; 0.05) was found in the 22 cases treated with meniscus interposition. In 4 cases with type A2 preoperative glenoid morphology and in 9 cases type B1, we registered significantly lower scores compared with the overall study population (p &lt; 0.01). Five unsatisfied patients (7 %), underwent to meniscus removal and glenoid reaming in 3 cases and conversion in total shoulder arthroplasty in 2 cases. Conclusions: Resurfacing arthroplasty is an effective device in young patients with advanced glenohumeral arthropathy; however, the high rate of postoperative glenoid erosion and the failure of biologic allograft lead us to consider glenoid replacement as the best option to improve clinical outcomes. © 2013 Istituto Ortopedico Rizzoli.

2013 - New trends in minimally invasive urological surgery. What is beyond the robot? [Articolo su rivista]
Micali, Salvatore; Pini, Giovannalberto; Teber, Dogu; Sighinolfi, Maria Chiara; DE STEFANI, Stefano; Bianchi, Giampaolo; Rassweiler, Jens
abstract

Purpose: To review the minimal-invasive development of surgical technique in urology focusing on nomenclature, history and outcomes of Laparo-Endoscopic Single-site Surgery (LESS), Natural Orifice Translumenal Endoscopic Surgery (NOTES) and Computer-Assisted Surgery (CAS). Methods: A comprehensive literature search was conducted in order to find article related to LESS, NOTES and CAS in urology. The most relevant papers over the last 10 years were selected in base to the experience from the panel of experts, journal, authorship and/or content. Results: Seven hundred and fifty manuscripts were found. Papers on LESS describe feasibility/safety in most of the procedures with a clinical experience of more than 300 cases and five compared results to standard laparoscopy without showing significant differences. NOTES accesses have been proved their feasibility/safety in experimental study. In human, the only procedures performed are on kidney and through a hybrid-Transvaginal route. New robots overcome the main drawbacks of the DaVinci® platform. The use of CAS is increasing its popularity in urology. Conclusions: LESS has been applied in clinical practice, but only ongoing technical and instrumental refinement will define its future role and overall benefit. The transition to a clinical application of NOTES seems at present only possible with multiple NOTES access and transvaginal access. Robot and Soft Tissue Navigation appear to be important to improve surgical skills. We are already witness to the advantages offered by the former even if costs need to be redefined based on pending long-term results. The latter will probably upgrade the quality of surgery in a near future. © 2010 Springer-Verlag.

2013 - Sodium/iodide symporter is expressed in the majority of seminomas and embryonal testicular carcinomas [Articolo su rivista]
Micali, Salvatore; Maggisano, V.; Cesinaro, A.; Celano, M.; Territo, A.; Reggiani Bonetti, L.; Sponziello, M.; Migaldi, Mario; Navarra, M.; Bianchi, Giampaolo; Filetti, S.; Russo, D.
abstract

Testicular cancer is the most frequent cancer in young men. The large majority of patients has a good prognosis, but in a small group of tumours the current treatments are not effective. Radioiodine is routinely used in the treatment of thyroid cancer and is currently investigated as a potential therapeutic tool even for extra-thyroid tumours able to concentrate this radioisotope. Expression of Na+/I- symporter (NIS), the glycoprotein responsible for iodide transport, has been demonstrated in normal testicular tissue. In this study, we analyzed NIS expression in a large series of testicular carcinomas. Our retrospective series included 107 patients operated for testicular tumours: 98 typical seminomas, 6 embryonal carcinomas, 1 mixed embryonal-choriocarcinoma and 2 Leydig cells tumours. Expression and regulation of NIS mRNA and protein levels were also investigated in human embryonal testicular carcinoma cells (NTERA) by real time RT-PCR and western blotting respectively. Immunohistochemical analysis showed presence of NIS in the large majority of seminomas (90/98) and embryonal carcinomas (5/7) of the testis, but not in Leydig cell carcinomas. Expression of NIS protein was significantly associated to the lymphovascular invasion. In NTERA cells treated with the histone deacetylase inhibitors SAHA and valproic acid, a significant increase of NIS mRNA (about 60 and 30 fold vs control, p&lt;0.001 and p&lt;0.01 respectively) and protein levels, resulting in enhanced ability to uptake radioiodine, was observed. Finally, NIS expression in testicular tumours with the more aggressive behavior is of interest for the potential use of targeting NIS to deliver radioiodine in malignant cells.

2013 - The influence of inflammation in the search of discriminatory biomarkers for prostate cancer: a proteomic study [Abstract in Rivista]
Bergamini, Stefania; REGGIANI BONETTI, Luca; Monari, Emanuela; Bellei, Elisa; Cuoghi, Aurora; Majorana, Antonino; Ozben, Tomis; Micali, Salvatore; Sighinolfi, Maria Chiara; Tomasi, Aldo; Bianchi, Giampaolo
abstract

background: Despite the improvements in clinical and surgical practice, prostate cancer (PCa) remains one of the most widespread cancer in male. The serum marker currently used for the diagnosis of PCa is the prostate-specific antigen (PSA), but its increase does not discriminate benign prostatic hyperplasia (BPH) from PCa. In our study, we investigated the serum protein expression of BPH compared to PCa, in order to identify by Surface Enhanced Laser Desorption/Ionization - Time of Flight - Mass Spectrometry (SELDI-ToF-MS) analysis distinctive protein profiles able to unquestionably discriminate patients with a benign prostate condition from those with a malignant situation. Moreover, we considered these conditions focusing on the co-existence of inflammation. Methods: Patients with clinical suspect of PCa (PSA elevation and/or palpable mass at digital rectal exploration) and candidates for trans-rectal ultrasound guided prostate biopsy were enrolled. The analysis of protein profile of 30 patients with PCa and 30 subjects with BPH was carried out. All histological specimens were examined in order to graduate and classify the tumor and to recognize the BPH condition and presence of inflammation, that was classed in chronic and acute and then graduated in mild, moderate and severe. Serum was depleted of the 6 high-abundance proteins by immunoaffinity chromatography prior to SELDI-ToF-MS analysis. Results: The comparison between protein spectra from PCa and BPH considering the inflammation parameter and excluding samples with moderate and/or severe inflammation, identified 17 differentially expressed protein peaks using H50 ProteinChip Array.The analysis of protein profile in presence of inflammation showed different protein peaks in the two groups, some of which overlapped with those found also in the comparison between PCa and BPH in absence of inflammation. Conclusions: The inflammation seems to lead a crucial contribution in the protein profile assessments of these conditions. On the basis of our results, we believe that certain different protein peaks could be reasonably associated to inflammation rather than to cancer. Therefore, inflammation might be a confounding parameter in the search of specific biomarkers to discriminate PCa from BPH.

2013 - Ultrasound-guided subacromial injections of sodium hyaluronate for the management of rotator cuff tendinopathy: A prospective comparative study with rehabilitation therapy [Articolo su rivista]
Merolla, G.; Bianchi, P.; Porcellini, G.
abstract

Background: Rotator cuff (RC) tendinopathy is a common cause of pain and shoulder dysfunction. The literature evidence suggests that a combination of overuse and extrinsic compression may induce chronic RC tendinopathy. Aim of the current study was to compare the results of subacromial sodium hyaluronate injections with rehabilitation therapy. Materials and methods: We enrolled 48 patients (M/F: 26/22; mean age: 50 years; shoulder right/left: 29/19) with persistent shoulder pain for at least 4 months. Exclusion criteria were as follows: RC tear, calcifying tendinitis, glenohumeral instability, osteoarthritis, rheumatic diseases, physical therapy and/or injection in the previous 4 months, shoulder surgery, anesthetic nerve block, trauma, and severe medical diseases. The included subjects received either two ultrasound-guided subacromial hyaluronic acid (HA) injections (25 patients, HA group) at baseline and 14 days, or underwent rehabilitation therapy (23 patients, Physio group) including active shoulder mobilization, soft tissue stretching and humeral head positioner and propeller muscles strengthening for 30 days (3 sessions every week). Clinical assessment of shoulder function was performed with visual analog scale score for pain (0-100), Oxford Shoulder Score (OSS), and Constant-Murley Score (CS). Overall, patients were examined at baseline, week 2, week 4, week 12, and week 24. Statistical significance was set at 5 % (p < 0.05). Results: Reduction in overall pain in the HA group was statistically significant at week 2 (p < 0.05) week 4 (p < 0.05), week 12 comparing to baseline. Similarly, pain subscores (at night and with activity) were significantly lower at week 2 (p < 0.05), week 4 (p < 0.05), and week 12 (p < 0.05), respectively. In the Physio group, pain decreased significantly at week 2 (p < 0.05) but not maintained at week 4 (p > 0.05), week 12 (p > 0.05), and week 24 (p > 0.05). CS and OSS in the HA group increased significantly at week 2 (p < 0.05), week 4 (p < 0.05), and week 12 (p < 0.05). A non-statistically significant increase in clinical scores was found at week 24 (p > 0.05). A significant improvement of CS and OSS we found in the Physio group at week 2 (p < 0.05), but not at weeks 4, 12, and 24 (p > 0.05). Conclusions: Subacromial HA injections could be an effective and safe alternative treatment for patients suffering from RC tendinopathy. We believe that the results of this study are encouraging but not lasting and we might suppose that a series of three to four subacromial sodium hyaluronate injections could provide good mid- and long-term clinical benefits. © 2013 Istituto Ortopedico Rizzoli.

2012 - Elective segmental ureterectomy for transitional cell carcinoma of the ureter: Long-term follow-up in a series of 73 patients [Articolo su rivista]
Simonato, Alchiede; Varca, V.; Gregori, A.; Benelli, Augusta; Ennas, M.; Lissiani, A.; Gacci, M.; DE STEFANI, Stefano; Rosso, Monica; Benvenuto, S.; Siena, Giuseppe; Belgrano, E.; Gaboardi, Francesco; Carini, Marina; Bianchi, Giampaolo; Carmignani, G.
abstract

OBJECTIVES • To report the long-term oncological outcome in patients with transitional cell carcinoma of the ureter electively treated with kidney-sparing surgery. • To compare our data with the few series reported in the literature. PATIENTS AND METHODS • We considered 73 patients with transitional cell carcinoma of the distal ureter treated in five Italian Departments of Urology. • The following surgeries were carried out: 38 reimplantations on psoas hitch bladder (52%), 21 end-to-end anastomoses (28.8%), 11 direct ureterocystoneostomies (15.1%) and three reimplantations on Boari flap bladder (4.1%). • The median follow-up was 87 months. RESULTS • Tumours were pTa in 42.5% of patients, pT1 in 31.5%, pT2 in 17.8% and pT3 in 8.2%. • Recurrence of bladder urothelial carcinoma was found in 10 patients (13.7%) after a median time of 28 months. • The bladder recurrence-free survival at 5 years was 82.2%. • The overall survival at 5 years was 85.3% and the cancer-specific survival rate at 5 years was 94.1%. CONCLUSION • Our data show that segmental ureterectomy procedures do not result in worse cancer control compared with data in the literature regarding nephroureterectomy. © 2012 The Authors.

2012 - Laparoendoscopic single-site upper urinary tract surgery: assessment of postoperative complications and analysis of risk factors [Articolo su rivista]
Greco, F; Cindolo, L; Autorino, R; Micali, Salvatore; Stein, Rj; Bianchi, Giampaolo; Fanizza, C; Schips, L; Fornara, P; Kaouk, J.
abstract

BACKGROUND: Laparoendoscopic single-site surgery (LESS) has been developed in an attempt to minimise the morbidity and scarring associated with surgical intervention. OBJECTIVE: To evaluate the incidence of and the risk factors for complications in patients undergoing LESS upper urinary tract surgery. DESIGN, SETTING, AND PARTICIPANTS: Between September 2007 and February 2011, 192 consecutive patients underwent LESS for upper urinary tract diseases at four institutions. MEASUREMENTS: All complications occurring at any time after surgery were captured, including the inpatient stay as well as in the outpatient setting. They were classified as early (onset<30 d), intermediate (onset 31-90 d), or late (onset>90 d) complications, depending on the date of onset. All complications were graded according to the modified Clavien classification. RESULTS AND LIMITATIONS: The patient population was generally young (mean: 55±18 yr of age), nonobese (mean body mass index [BMI]: 26.5±4.8 kg/m2), and healthy (mean preoperative American Society of Anaesthesiologists [ASA] score: 2±1). Forty-six patients had had prior abdominal surgery. Mean operative time was 164±63 min, with a mean estimated blood loss (EBL) of 147±221 ml. In 77 cases (40%), the surgeons required additional ports, with a standard laparoscopy conversion rate of 6%. Mean hospital stay was 3.3±2.3 d, and the mean visual analogue scale (VAS) score at discharge was 1.7±1.43. Thirty-three complications were recorded-30 early, 2 intermediate, and 1 late-for an overall complication rate of 17%. Statistically significant associations were noted between the occurrence of a complication and age, ASA score, EBL, length of stay (LOS), and malignant disease at pathology. Univariable and the multivariable analyses showed that a higher ASA score (incidence rate ratio [IRR]: 1.4; 95% confidence interval [CI], 1.0-2.1; p=0.034) and malignant disease at pathology (IRR: 2.5; 95% CI, 1.3-4.7; p=0.039) represented risk factors for complications. Poisson regression analysis over time showed a 23% non-statistically significant reduction in risk of complications every year (IRR: 0.77; 95% CI, 0.5-1.19; p=0.242). CONCLUSIONS: Malignant disease at pathology and high ASA score represent a predictive factor for complication after LESS for upper urinary tract surgery. Thus, surgeons approaching LESS should start with benign diseases in low-surgical-risk patients to minimise the likelihood of postoperative complications.

2012 - Microsurgical Testis-sparing Surgery in Small Testicular Masses Seven Years Retrospective Management and Results [Articolo su rivista]
De Stefani, Stefano; Isgrò, G; Varca, V; Pecchi, A; Bianchi, Giampaolo; Carmignani, G; Derchi, Le; Micali, Salvatore; Maccio, L; Simonato, A.
abstract

OBJECTIVE: To retrospectively evaluate the clinical outcomes of 20 patients diagnosed with a nonpalpable or small testicular mass (2 cm) at 2 academic urological department. Testis-sparing surgery (TSS) is currently performed routinely for the management of nonpalpable testicular masses. High reliability of frozen section examination (FSE) and high-frequency ultrasound (US) and the adoption of microsurgical techniques improved safety and feasibility of this technique.METHODS: From January 2004 to March 2011, 23 patients underwent microsurgical TSS. An inguinal approach was performed in 22 cases and a suprapubic incision in one bilateral case. All procedures were performed with an operating microscope, with warm ischemia in 21 cases and cold ischemia in 2 cases. Intraoperative US was performed before opening the albuginea. Mean operative time was 89 minutes.RESULTS: After mass excision, FSE was performed; only 2 seminomatous tumors were identified, and the remaining masses were benign lesions. After a mean follow-up >12 months, all patients are free of disease; no hypogonadism developed.CONCLUSIONS: TSS performed using an operating microscope allowed the preservation of testes for 21 patients diagnosed with small testicular and/or nonpalpable mass (<2 cm), without evidence of disease recurrence or de novo onset. This approach could be mandatory in the treatment of bilateral tumors or in solitary testis. Maintaining fertility is not the main goal of TSS because a great number of patients affected by testicular tumors are already infertile. Esthetic outcomes and sparing hormonal function are the main reasons for TSS.

2012 - Role of diffusion-weighted magnetic resonance imaging in prostate cancer evaluation [Articolo su rivista]
Rinaldi, Daniele; Fiocchi, Federica; Ligabue, Guido; Bianchi, Giampaolo; Torricelli, Pietro
abstract

Purpose: The authors analysed the role of diffusion-weighted imaging (DWI) as an additional tool in magnetic resonance (MR) evaluation of prostate cancer. Materials and methods: Forty-one patients with suspected prostate cancer underwent MR imaging (1.5 Tesla). A DWI sequence was added to the standard morphological protocol, with a maximum b value of 1,000 s/mm2. Diffusion maps were obtained, and the apparent diffusion coefficient (ADC) was calculated by drawing a region of interest (ROI) over healthy tissue and areas suspicious for malignancy. Histology was considered the gold standard. Results: The areas correctly classified by MR imaging (42/51) had a low signal intensity on T2-weighted imaging and low ADC value (0.99±0.15 mm2/s; p<0.01) compared with the healthy peripheral zone (PZ) (1.73±0.27 mm2/s; p<0.01). Nine areas classified as suspicious for malignancy on T2-weighted sequences showed high ADC (1.44±0.06 mm2/s; p<0.01) and were confirmed to be disease free by subsequent histological examination. The accuracy of morphofunctional MR imaging was 81.6% compared with 73.7% of the morphological analysis alone. Conclusions: The addition of DWI to the standard protocol increases the overall diagnostic performance of MR imaging in detecting prostatic cancer. Thus, DWI can help the clinician determine the most appropriate management strategy for the patient.

2012 - The clinical research office of the endourological society percutaneous nephrolithotomy global study: Nephrolithotomy in 189 patients with solitary kidneys [Articolo su rivista]
Bucuras, Viorel; Gopalakrishnam, Ganesh; J. Stuart, Wolf J. r.; Sun, Yinghao; Bianchi, Giampaolo; Erdogru, Tibet; De La Rosette, Jean
abstract

Background and Purpose: The study compared characteristics and outcomes in patients with solitary and bilateral kidneys who were treated with percutaneous nephrolithotomy (PCNL) in the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study. Patients and Methods: Data from consecutively treated patients from 96 centers worldwide were collated after a 1-year period. The following variables in patients undergoing PCNL with solitary or bilateral kidneys were compared: Prevalence, patient characteristics, intraoperative differences and outcomes, including bleeding and transfusion rates, renal function, and stone-free rates. Results: Data from 5803 patients were collated; 189 (3.3%) with solitary and 5556 (96.7%) with bilateral kidneys. Patient characteristics were well matched generally with the exception of cardiovascular disease and American Society of Anesthesiologists (ASA) risk scores, which were significantly greater in patients with solitary than with bilateral kidneys (P<0.0001 and P=0.004, respectively). Patients with solitary kidneys had also undergone significantly more procedures to remove calculi before this survey than bilateral patients (P= 00.049 -<0.0001). Levels of renal impairment were significantly greater (P<0.0001) and stone-free rates were significantly lower (P=0.001) post-PCNL in solitary than bilateral kidney patients. Although bleeding rates were the same in both groups, transfusion rates were significantly greater in solitary kidney patients (P=0.014). Conclusions: Patients with a solitary kidney had a higher cardiovascular risk and ASA score. Outcomes related to morbidity and stone-free rate were less favorable for solitary kidneys. © Copyright 2012, Mary Ann Liebert, Inc.

2011 - Can prostatitis to be a confounding parameter in prostatic proteomic profile designation? [Abstract in Rivista]
Bergamini, Stefania; REGGIANI BONETTI, Luca; Monari, Emanuela; Bellei, Elisa; Maiorana, Antonino; Ozben, T.; Tomasi, Aldo; Micali, Salvatore; Bianchi, Giampaolo
abstract

N/A

2011 - How effective is extracorporeal shock wave lithotripsy of ureteral stones with Dornier Lithotripter S EMSE 220F-XXP? A prospective and preliminary assessment [Articolo su rivista]
Sighinolfi, Maria Chiara; Micali, Salvatore; DE STEFANI, Stefano; Pini, Giovannalberto; Rivalta, Massimo; Cianci, Filippo; Bianchi, Giampaolo
abstract

AIM: To report our preliminary series with the Doli S EMSE 220F-XXP, the upgraded version of the previous Dornier Lithotripter S EMSE 220, for treatment of ureteral stones. METHODS: Since July 2006, a total of 200 patients with ureteral stones were submitted to shock wave lithotripsy (SWL) with Doli S EMSE 220F-XXP. Mean stone size was 9.3 mm (range 6-18 mm). Ureteral stone location was proximal in 75, middle in 34, and distal in 91. Follow-up was carried out at 6 weeks after the treatment, by means of kidney-ureter-bladder (KUB) film and ultrasound, or helical computed tomography (CT). RESULTS: The overall stone-free rate was 89.5\%, and the effectiveness quotient was 80. Stratifying by stone site, the stone-free rate was 93.3, 67.6, and 94.5\% for proximal, middle, and distal location, respectively. Mean number of sessions per patient was 1.14. Analgesia with intravenous ketorolac or tramadol was required in 42.5\% of cases. No significant side-effects were recorded. CONCLUSIONS: The new Doli S EMSE 220F-XXP provides similar characteristics to the Doli S EMSE 220 in terms of safety and lack of major complications, when dealing with ureteral stones; the improvement in stone disintegration is particularly evident for distal location, for which the number of pulses and the intensity of treatment can be greatly increased and the upgraded power of the device can be widely applied.

2011 - Retroperitoneal laparoendoscopic Single-Site Surgery: Preliminary experience in kidney and ureteral indications [Articolo su rivista]
Micali, Salvatore; Isgrò, G; DE STEFANI, Stefano; Pini, G; Sighinolfi, Mc; Bianchi, Giampaolo
abstract

The advantages of retroperitoneoscopic technique are well known. We decided to combine this access with the emerging laparoendoscopic single-site surgery (LESS) technique. We present our preliminary data on 11 renoureteral procedures and describe our retroperitoneoscopic LESS technique. As of March 2009, 10 patients were submitted to retroperitoneal LESS and divided into three groups: Group A, 3 patients underwent ureterolithotomy; Group B, 4 patients underwent renal cyst ablation; Group C, 4 patients underwent renal biopsy. Retroperitoneal access was obtained with an optical trocar. After retroperitoneal space blunt dissection, a multichannel port was placed. Standard and bent 5-mm instruments were used; we also used a 5-mm flexible laparoscope as a single procedure in group A. Ten of 11 procedures were completed without conversion; a single case in group A was converted to open surgery. Retroperitoneoscopic LESS is a safe and feasible procedure for renal biopsy and renal cyst ablation, with shorter convalescence time, less postoperative pain, and better cosmetic outcomes. LESS ureterolithotomy was more challenging for the lack of triangulation, resulting in a prolonged convalescence period. In addition, bent laparoscopic instruments are not suitable for retroperitoneal space; the multichannel port leaks carbon dioxide due to the flank position. Therefore LESS pelvic trainer practice is imperative in this case.

2011 - Testicular metastasis of signet ring cell tumour of unknown origin: Diagnostic features of a tricky case [Articolo su rivista]
Saredi, G.; Rivalta, Massimo; Sighinolfi, Maria Chiara; Rossi, Giuseppina; Fidanza, Francesco Antonio; Guarasci, Cristian; Cesinaro, A. M.; De Maria, N.; De Stefani, Stefano; Bianchi, Giampaolo
abstract

We introduce the diagnostic complexity of a testicular metastasis by signet ring cell adenocarcinoma of unknown origin. Testicular metastases are a rare event but, particular after 50 years of age, a testicular mass could represent a metastasis. © 2011 Blackwell Verlag GmbH.

2010 - Confronto dell’apprendimento dei principi di tecnica laparoscopica standard versus LESS: Analisi dei risultati ottenuti su pelvic trainer. [Poster]
Micali, Salvatore; Gelmini, Roberta; G., Pini; C., Franzoni; G., Isgrò; C., Guarasci; Bianchi, Giampaolo
abstract

Confronto dell’apprendimento dei principi di tecnica laparoscopica standard versus LESS: Analisi dei risultati ottenuti su pelvic trainer

2010 - Diagnostic and therapeutic approach in patients with urinary calculi [Articolo su rivista]
Gruppo di studio multidisciplinare per la calcolosi, Renale; E., Croppi; A., Cupisti; M., Lombardi; M., Marangella; R., Sanseverino; F., Carrano; D’Addressi, ; Fm, Drudi; G., Gambaro; Micali, Salvatore; Pg, Simeoni; A., Tasca; Terribile, M.; F., Zattoni; B., Baggio; Bianchi, Giampaolo; R., Caudarella; E., Cicerello; S., Cosciani Cunico; A. R., D'Angelo; G., Mossetti; G., Muto; A., Novenne; M., Prampolini; P., Strazzullo; A., Trinchieri; G., Vezzoli
abstract

The natural history of urolithiasis includes the risk of recurrence and of the development of chronic kidney and/or bone disease, which is why a thorough clinical and metabolic evaluation of these patients is of the utmost importance at disease onset. This paper is aimed at identifying the type of urolithiasis, the related risk factors, and the corresponding treatment options. The diagnostic and therapeutic approach described here includes 1) accurate history taking to detect secondary nephrolithiasis and screen for the main risk factors for kidney and bone disease; 2) metabolic evaluation graded according to different complexity levels based on the severity of the disease and the presence of risk factors; 3) carrying out appropriate imaging procedures. The resulting information allows to plan treatment based either on general rules of lifestyle and diet, or on selected medical intervention, if necessary. This report, which is based on current guidelines, was produced by the Gruppo Italiano di Studio Multidisciplinare per la Calcolosi Renale. It is addressed to all professionals involved in the management of patients suffering from nephrolithiasis, first of all general practitioners, who often become involved immediately at the onset of the disease.

2010 - Efficacy of tamsulosin treatment after extracorporeal shock wave lithotripsy of stones located in the kidney: A prospective and randomized study on 129 patients. [Poster]
Mc, Sighinolfi; Micali, Salvatore; A., Mofferdin; G., Pini; G., Isgrò; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Efficacy of tamsulosin treatment after extracorporeal shock wave lithotripsy of stones located in the kidney: A prospective and randomized study on 129 patients.

2010 - Efficacy of tansulosin treatment after extracorporeal shock wave lithotripsyof renal stones: a randomized and prospective study on 129 patients [Abstract in Atti di Convegno]
Mc, Sighinolfi; Micali, Salvatore; A., Mofferdin; G., Pini; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

PURPOSE: Phyllanthus niruri is a plant used in Brazilian folk medicine for the treatment of urolithiasis. We assessed the efficacy of P. niruri after extracorporeal shock wave lithotripsy for renal stones.MATERIALS AND METHODS: We prospectively evaluated 150 patients with renal stones that were as large as 25 mm and composed of calcium oxalate. All patients received 1 to 3 extracorporeal shock wave lithotripsy sessions by Dornier Lithotriptor S. After treatment 78 of 150 patients (52%) underwent therapy with Uriston, a P. niruri extract (2 gm daily) for at least 3 months (group 1). Otherwise 72 of 150 patients (48%) were used as a control group (group 2). No significant difference in stone size between the 2 groups was found. Stone clearance was assessed after 30, 60, 90 and 180 days by abdominal x-ray and ultrasound scan.RESULTS: Stone-free rate (stone-free defined as the absence of any stone or residual fragments less than 3 mm) was 93.5% in group 1 and 83.3% in group 2 (p = 0.48) at the end point of the followup (180 days). For lower caliceal stones (56 patients) the stone-free rate was 93.7% in the treatment group and 70.8% in the control group (p = 0.01). Re-treatment need for group 1 was 39.7% and for group 2 it was 43.3% (p = 0.2). No side effects were recorded with extracorporeal shock wave lithotripsy or P. niruri therapy.CONCLUSIONS: Regular self-administration of P. niruri after extracorporeal shock wave lithotripsy for renal stones results in an increased stone-free rate that appears statistically significant for lower caliceal location. Its efficacy and the absolute lack of side effects make this therapy suitable to improve overall outcomes after extracorporeal shock wave lithotripsy for lower pole stones.

2010 - Erratum: Does needle calibre affect pain and complication rates in patients undergoing transperineal prostate biopsy? A prospective, randomized trial by Giovanni Saredi et al. (Asian Journal of Andrology (2009) 11 (678-682) DOI: 10.1038/aja.2009.43) [Articolo su rivista]
Saredi, Giovanni; Sighinolfi, Maria Chiara; Fidanza, Francesco Antonio; DE STEFANI, Stefano; Micali, Salvatore; Maurizio, Paterlini; D'Amico, Roberto; Bianchi, Giampaolo
abstract

[No abstract available]

2010 - Expression of the sodium/iodide symporter in human prostate adenocarcinoma [Articolo su rivista]
M., Navarra; Micali, Salvatore; Sm, Lepore; Am, Cesinaro; M., Celano; Mc, Sighinolfi; C., De Gaetani; S., Filetti; Bianchi, Giampaolo; D., Russo
abstract

OBJECTIVE: To analyze expression of the sodium/iodide symporter (NIS) in tissue specimen from a large series of patients with prostate adenocarcinoma. Few data are available on the NIS expression in prostate tumor tissues. METHODS: NIS protein expression was examined by immunohistochemistry in 78 tumor tissue specimen and their non-neoplastic counterparts. Total ribonucleic acid was extracted for semiquantitative reverse transcription polymerase chain reaction analysis of NIS transcript. The relationship between NIS expression and Gleason score, prostate-specific antigen levels and stage was also investigated. RESULTS: NIS protein was expressed in 41 of 78 prostate cancer (52.4%) and was located predominantly intracellularly, whereas immunoreactivity was missing in nontumor hyperplastic prostatic tissue. Absence of expression was mainly because of reduced or lost gene transcription, as detected by reverse transcription polymerase chain reaction. A statistically significant relationship was detected between presence of NIS expression and some markers of aggressiveness including stage > or =pT2a (P = .007) and Gleason score > or =8 (P = .014). CONCLUSIONS: Our data demonstrate the presence of NIS transcript and protein in about half of prostate cancer tissues and its relationship with clinical markers of aggressiveness. Thus, it may potentially serve as a biomarker for defining individuals with biologically active prostate cancer.

2010 - Expulsive medical therapy with alpha blockers in female and pediatric urolithiasis: Efficacy and safety of an off-label treatment. [Poster]
Mc, Sighinolfi; Micali, Salvatore; G., Pini; G., Isgrò; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Expulsive medical therapy with alpha blockers in female and pediatric urolithiasis: Efficacy and safety of an off-label treatment.

2010 - Fisiopatologia delle uropatie ostruttive [Capitolo/Saggio]
Bianchi, Giampaolo; M., Motta; Micali, Salvatore; DE STEFANI, Stefano
abstract

Fisiopatologia delle uropatie ostruttive

2010 - Fluid intake in urolithiasis: Analysis of patients referring to an ESWL centre. [Poster]
Mc, Sighinolfi; Micali, Salvatore; G., Pini; G., Isgrò; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Fluid intake in urolithiasis: Analysis of patients referring to an ESWL centre.

2010 - Iperplasia prostatica benigna- Turp monopolare e bipolare [Altro]
Micali, Salvatore; Guarisci, C.; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Capitolo X del libro

2010 - LaparoEndoscopic Single-site Surgery (LESS) nostra esperienza preliminare retroperitoneoscopica [Abstract in Rivista]
Micali, Salvatore; G., Pini; Sighinolfi, M. C.; G., Isgrò; F., Annino; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

LaparoEndoscopic Single-site Surgery (LESS) nostra esperienza preliminare retroperitoneoscopica

2010 - NOTES trans vescicale nel modello porcino: varicocelectomia con cistoscopio flessibile e laser al thulio [Abstract in Rivista]
G., Pini; Micali, Salvatore; F., Branco; L., Osorio; C., Pinto; Bianchi, Giampaolo; E., Lima
abstract

NOTES trans vescicale nel modello porcino: varicocelectomia con cistoscopio flessibile e laser al thulio

2010 - POTENTIAL ROLE OF PROTEOMIC ANALYSIS IN PROSTATE CANCER DIAGNOSIS [Abstract in Rivista]
Bianchi, Giampaolo; Sighinolfi, Maria Chiara; Bergamini, Stefania; Bellei, Elisa; Monari, Emanuela; Cuoghi, Aurora; Micali, Salvatore; DE STEFANI, Stefano; Tomasi, Aldo
abstract

not available

2010 - Pieloplastica transmesocolica robot-assistita [Abstract in Rivista]
Bianchi, Giampaolo; G., Pini; F., Annino; Micali, Salvatore; A., Beato; DE STEFANI, Stefano
abstract

Pieloplastica transmesocolica robot-assistita

2010 - Prima procedura NOTES trans vescicale nel cadavere maschio umano. Peritoneoscopia con strumento rigido e biopsia epatica. Un passo verso l’applicazione clinica [Abstract in Rivista]
G., Pini; Micali, Salvatore; F., Branco; L., Osorio; C., Pinto; Bianchi, Giampaolo; E., Lima
abstract

Prima procedura NOTES trans vescicale nel cadavere maschio umano. Peritoneoscopia con strumento rigido e biopsia epatica. Un passo verso l’applicazione clinica

2010 - Retroperitoneoscopia single-site surgery (LESS): Nostra esperienza clinica preliminare [Abstract in Atti di Convegno]
Micali, Salvatore; G., Pini; Sighinolfi, M. C.; G., Isgrò; F., Annino; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Retroperitoneoscopia single-site surgery (LESS): Nostra esperienza clinica preliminare

2010 - Retroperitoneoscopic single site surgery (LESS): preliminary clinical experience. [Poster]
Micali, Salvatore; Mc, Sighinolfi; G., Pini; G., Isgrò; F., Annino; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Retroperitoneoscopic single site surgery (LESS): preliminary clinical experience.

2010 - Robotic assisted laparoscopic radical prostatectomy: lateral approach to the bladder neck preservation in case of median lobe. [Abstract in Rivista]
F., Annino; A., Beato; C., De Carne; Micali, Salvatore; Sighinolfi, M. C.; DE STEFANI, Stefano; Bianchi, Giampaolo; F., Annino
abstract

Robotic assisted laparoscopic radical prostatectomy: lateral approach to the bladder neck preservation in case of median lobe.

2010 - Role of green tea cathechins in the treatment of patients with high grade intraephitelial prostatic neoplasia. [Abstract in Atti di Convegno]
Micali, Salvatore; G., Isgrò; N., Ferrari; A., Beato; Sighinolfi, M. C.; G., Pini; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Role of green tea cathechins in the treatment of patients with high grade intraephitelial prostatic neoplasia.

2010 - Sexual function and quality of life in women with urinary incontinence treated by a complete pelvic floor rehabilitation program (biofeedback, functional electrical stimulation, pelvic floor muscles exercises, and vaginal cones). [Articolo su rivista]
Rivalta, M; Sighinolfi, Mc; Micali, Salvatore; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

INTRODUCTION: Urinary incontinence (UI) is a debilitating condition that can cause discomfort, embarrassment, loss of confidence; it can lead to withdrawal from social life, and adversely affects physical and mental health, sexual function and quality of life (QoL) in women. AIM: The aim is to determine the impact of combined pelvic floor rehabilitation (PFR) on UI, female sexual dysfunction, and QoL. MAIN OUTCOME MEASURES: Female Sexual Function Index questionnaire (FSFI) and King's Health Questionnaire (KHQ). METHODS: Sixteen patients with UI were selected and underwent a complete PFR program (biofeedback, functional electrical stimulation, pelvic floor muscles exercises, and vaginal cones). Patient filled out the FSFI questionnaire and the KHQ at the baseline and at follow-up. RESULTS: After PFR none of the patients reported urine leakage during sexual activity. Resolution of incontinence was achieved in 13 (81.25%) women. Only three (18.75%) patients had positive 1-hour pad test after the treatment. There was significant difference between pad test leakage before and after the PFR (P &lt; 0.001). The mean Stamey incontinence score was 1.37 +/- 0.5 at the baseline vs. 0.25 +/- 0.57 at the follow up (P &lt; 0.001). Before PFR, FSFI total score ranged from 25.8 to 2 (mean 14.65 +/- 6.88), after treatment the FSFI total score ranged from 36 to 2 (mean 22.65 +/- 9.5) (P &lt; 0.001). The improvement of the scores in the six FSFI domains, 5 months after the conclusion of PFR, was statistically significant (desire, arousal, lubrication, orgasm, satisfaction, and pain). All the nine domains in the KHQ presented a low average score after treatment and the improvements were statistically significant. CONCLUSIONS: PFR led to a significant difference in the daily use of pads, 1-hour pad test, and Stamey incontinence scores. The treatment caused an improvement in patient's QoL index and sexual function.

2010 - Stato dei margini chirurgici nella neoplasia prostatica [Abstract in Atti di Convegno]
DE STEFANI, Stefano; F., Annino; Mc, Sighinolfi; A., Beato; C., De Carne; Micali, Salvatore; Bianchi, Giampaolo
abstract

Stato dei margini chirurgici nella neoplasia prostatica

2010 - Transmesocolicrobot-assisted pyeloplasty [Abstract in Rivista]
Bianchi, Giampaolo; G., Pini; F., Annino; Micali, Salvatore; Sighinolfi, M. C.; DE STEFANI, Stefano
abstract

Transmesocolicrobot-assisted pyeloplasty

2010 - Ureterolitotomia retroperitoneoscopica in tecnica LESS ibrida [Abstract in Rivista]
Micali, Salvatore; G., Pini; Sighinolfi, M. C.; G., Isgrò; F., Annino; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Ureterolitotomia retroperitoneoscopica in tecnica LESS ibrida

2010 - Urinary incontinence and sport: first and preliminary experience with a combined pelvic floor rehabilitation program in three female athletes. [Articolo su rivista]
Rivalta, Massimo; Sighinolfi, Maria Chiara; Micali, Salvatore; DE STEFANI, Stefano; Torcasio, Francesca; Bianchi, Giampaolo
abstract

A relationship between sport or fitness activities and urinary incontinence (UI) previously has been described in women. We report our preliminary experience with the use of a complete pelvic floor rehabilitation program in three female athletes affected by UI. The athletes were submitted to a combined pelvic floor rehabilitation program, including biofeedback, functional electrical stimulation, pelvic floor muscle exercises, and vaginal cones. After the scheduled rehabilitation scheme, none of the patients reported incontinence, nor referred to urine leakage during sport or during daily life. We therefore conclude that UI that affects female agonistic athletes may be effectively treated with this combined approach.

2009 - Analisi proteo mica nella neoplasia prostatica: Risultati preliminari e nuove prospettive. [Poster]
Bianchi, Giampaolo; Sighinolfi, M. C.; Micali, Salvatore; DE STEFANI, Stefano; Bergamini, Stefania; Bellei, E.; Monari, Emanuela; Cuoghi, A.; Tomasi, Aldo
abstract

Analisi proteo mica nella neoplasia prostatica: Risultati preliminari e nuove prospettive.

2009 - Biofeedback, electrical stimulation, pelvic floor muscle exercises, and vaginal cones: a combined rehabilitative approach for sexual dysfunction associated with urinary incontinence. [Articolo su rivista]
Rivalta, Massimo; Sighinolfi, Maria Chiara; DE STEFANI, Stefano; Micali, Salvatore; A., Mofferdin; Grande, Marco Serafino; Bianchi, Giampaolo
abstract

INTRODUCTION: Urinary incontinence (UI) is often associated with sexual dysfunction. We present our preliminary experience with a combined rehabilitative approach consisting of biofeedback, functional electrical stimulation, pelvic floor muscle exercises, and vaginal cones. AIM: The potential impact of such practice on UI and sexual function was analyzed in our case series and discussed. MAIN OUTCOME MEASURES AND METHODS: We evaluated three women affected by UI and sexual dysfunction. The patients underwent combined pelvic floor rehabilitation (PFR), kept voiding diaries, and filled out the Female Sexual Function Index (FSFI questionnaire) before and after the completion of PFR. We evaluated each domain score, including desire, arousal, lubrication, orgasm, satisfaction, and pain. RESULTS: After the combined rehabilitation program, none of them had UI requiring pad use or referred urine leakage during sexual activity, including intercourse. Before PFR, FSFI score ranged from 16 to 21; after treatment, the FSFI score ranged from 22.1 to 29.3. There was an improvement in patients regarding desire, arousal, lubrication, orgasm, satisfaction, and pain. CONCLUSIONS: A complete rehabilitation can provide a beneficial effect on sexual function. A larger trial, on a more extended female population, is currently in progress, in order to confirm our findings. The effectiveness of a complete PFR scheme, together with the lack of side effects, makes it a suitable approach to sexual dysfunction that is associated with UI.

2009 - Combined laparoscopic transpyelic ballistic litotripsy and renal cyst ablation. [Abstract in Rivista]
G., Pini; Micali, Salvatore; M. C., Sighinolfi; F., Annino; A., \beato; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Combined laparoscopic transpyelic ballistic litotripsy and renal cyst ablation.

2009 - Concomitante ablazione di cisti renale e litotrissia balistica pielo-caliceale in approccio laparoscopico: primo case report. [Abstract in Rivista]
G., Pini; Micali, Salvatore; C., De Carne; F., Annino; Bianchi, Giampaolo
abstract

Concomitante ablazione di cisti renale e litotrissia balistica pielo-caliceale in approccio laparoscopico: primo case report.

2009 - Does needle calibre affect pain and complication rates in patients undergoing transperineal prostate biopsy? A prospective, randomized trial [Articolo su rivista]
Sighinolfi, Maria Chiara; Fidanza, Francesco Antonio; DE STEFANI, Stefano; Micali, Salvatore; M., Paterlini; D'Amico, Roberto; Bianchi, Giampaolo; Saredi, G
abstract

Transperineal prostate biopsy is a procedure that can be used to obtain histological samples from the prostate. To improve both the quality of the biopsy core samples and prostate cancer detection, we are currently performing a prospective, randomized trial comparing prostate biopsy samples obtained using an 18 G-needle to those obtained using a 16 G needle. The aim of this preliminary study was to evaluate pain and complication rates in both groups in order to assess whether performing a prostate biopsy with a larger calibre needle is a feasible procedure. One hundred and eighty-seven patients undergoing transperineal prostate biopsy were prospectively evaluated and divided into two groups. The first group (94 patients, Group A) received a transperineal prostate biopsy using a 16 G-needle and the second group (93 patients, Group B) underwent transperineal prostate biopsy with an 18 G-needle. Anaesthesia was obtained with a single perineal injection at the prostatic apex in all subjects. A visual analogue scale (VAS) and facial expression scale (FES) were used to assess pain during multiple steps of the procedure in each group. A detailed questionnaire was used to obtain information about drug use because it could potentially influence the pain and complications that patients experienced. Two weeks after the procedure, early and late complications were evaluated. Statistical analysis was carried out using non-parametric tests. Prostate Specific Antigen (PSA) and drug use were similar at baseline between the two groups. Pain during prostate biopsy, which was measured with both the VAS and FES instruments, did not differ significantly between the 18- and 16 G-needle groups, and no significant differences were found in early or late complication rates between the groups. Transperineal prostate biopsy with a 16 G-needle is a feasible procedure in terms of pain and complication rates. Further studies with larger patient populations are required to assess whether or not this procedure can improve prostate cancer detection rates.

2009 - Dornier Lithotripter S 220 F EMSE: the first report of over 1000 treatments [Articolo su rivista]
Micali, Salvatore; Sighinolfi, Maria Chiara; Grande, Marco Serafino; Rivalta, Massimo; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

OBJECTIVE: To assess the short-term efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) with the standard Dornier Lithotripter S 220 F EMSE in the treatment of a large population of 736 patients with renal and ureteral stones. This is the only report with more than 1000 treatments performed with this device. METHODS: Between January 2003 and July 2006, a total of 479 renal and 257 ureteral stones were treated with 1168 ESWL sessions. ESWL was performed on an outpatient basis. Patients were evaluated after 1 and 3 months. Stone size and location, total number of shockwaves, stone-free rate, and complications were investigated. RESULTS: The stone-free rate for renal calculi was 60.5% at 1 month and 82.5% at 3 months. The stone-free rate for ureteral stones was 58% at 1 month and 82.9% at 3 months. The overall stone-free rate was 59.6% at 1 month and 82.5% at 3 months. Anesthesia was not needed in any case. Analgesia with hospital admission was necessary in 15 patients (2.0%). The major complications observed were renal hematoma in only 1 patient (0.1%), obstruction with sepsis in 3 patients (0.4%), and steinstrasse development in 5 patients (0.7%). CONCLUSIONS: The Dornier Lithotripter S 220 F EMSE is a safe and effective tool in the treatment of urolithiasis; the lack of invasiveness and absence of anesthesia confirm its worthy role as an alternative to ureterorenoscopy and percutaneous nephrolitotomy.

2009 - Efficacy of calcium channel blockers and alpha-adrenoceptor antagonist to facilitate ureteral stone expulsion after ESWL [Capitolo/Saggio]
Micali, Salvatore; M., Grande; M. C., Sighinolfi; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Efficacy of calcium channel blockers and alpha-adrenoceptor antagonist to facilitate ureteral stone expulsion after ESWL

2009 - Esperienza preliminare con Dornier Lithotripter EMSE 220 XXP: Analisi dei primi 631 trattamenti. [Poster]
M. C., Sighinolfi; Micali, Salvatore; DE STEFANI, Stefano; F., Cianci; M., Grande; Bianchi, Giampaolo
abstract

Esperienza preliminare con Dornier Lithotripter EMSE 220 XXP: Analisi dei primi 631 trattamenti.

2009 - Extracorporeal shock wave lithotripsy and short term renal injury: Multivariate analysis of the variables potentially involved. [Poster]
M. C., Sighinolfi; Micali, Salvatore; DE STEFANI, Stefano; M., Rivalta; F., Annino; Bianchi, Giampaolo
abstract

Extracorporeal shock wave lithotripsy and short term renal injury: Multivariate analysis of the variables potentially involved.

2009 - Giant genital cavernous haemangioma: Case description and surgical management [Articolo su rivista]
Sighinolfi, Maria Chiara; Bonetti, L. R.; DE STEFANI, Stefano; M., Pinelli; Micali, Salvatore; Maiorana, Antonino; L., Schirosi; G., Sartori; DE GAETANI, Carmela; Bianchi, Giampaolo
abstract

Giant genital haemangiomas are rare occurrences. Once properly diagnosed, they should be managed by surgery with wide and deep margins. We present a clinical case and provide suggestions for diagnosis and treatment of this unusual pathology.

2009 - Ginkgo Biloba e disfunzione erettile: Risultati di un’analisi preliminare prospettica, non randomizzata [Abstract in Atti di Convegno]
A., Mofferdin; Sighinolfi, M. C.; DE STEFANI, Stefano; Micali, Salvatore; M., Rivalta; F., Cianci; Bianchi, Giampaolo
abstract

Ginkgo Biloba e disfunzione erettile: Risultati di un’analisi preliminare prospettica, non randomizzata

2009 - Ginkgo Biloba: Potenziale applicazione nella disfunzione erettile [Abstract in Atti di Convegno]
M. C., Sighinolfi; Micali, Salvatore; A., Mofferdin; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Ginkgo Biloba: Potenziale applicazione nella disfunzione erettile

2009 - Impatto dell’esperienza laparoscopica e dell’aiuto sulla curva di apprendimento della prostatectomia radicale robot assistita in termini di tempi chirurgici e costi. [Abstract in Rivista]
F., Annino; A., Beato; C., De Carne; Micali, Salvatore; M. C., Sighinolfi; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Impatto dell’esperienza laparoscopica e dell’aiuto sulla curva di apprendimento della prostatectomia radicale robot assistita in termini di tempi chirurgici e costi.

2009 - Impatto dell’esperienza laparoscopica e dell’aiuto sulla curva di apprendimento della prostatectomia radicale robot assistita in termini di tempi chirurgici e costi. [Abstract in Atti di Convegno]
F., Annino; A., Beato; C., De Carne; Micali, Salvatore; M. C., Sighinolfi; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Impatto dell’esperienza laparoscopica e dell’aiuto sulla curva di apprendimento della prostatectomia radicale robot assistita in termini di tempi chirurgici e costi.

2009 - Importanza dell’esperienza laparoscopica sulla curva di apprendimento della prostatectomia radicale robot assistita in termini di tempi chirurgici e costi. [Abstract in Atti di Convegno]
F., Annino; Micali, Salvatore; A., Beato; F., Fidanza; Sighinolfi, M. C.; C., De Carne; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Importanza dell’esperienza laparoscopica sulla curva di apprendimento della prostatectomia radicale robot assistita in termini di tempi chirurgici e costi.

2009 - Knotted ureteral catheter in an 83-year-old man: case presentation and urological non-invasive management in the elderly [Articolo su rivista]
Rivalta, M; Sighinolfi, Mc; Micali, Salvatore; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Ureteral catheters are important devices in the management of upper urinary tract obstruction; severe complications due to insertion or stent permanence are unusual. We report the clinical case and management of a knotted ureteral stent in an 83-year-old man.

2009 - La PCNL in situazioni complesse di calcolosi renale: La nostra esperienza. [Poster]
C., Di Pietro; M., Grande; M. C., Sighinolfi; Micali, Salvatore; C., De Carne; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

La PCNL in situazioni complesse di calcolosi renale: La nostra esperienza.

2009 - Laparoscopic simultaneous treatment of peripelvic renal cysts and stones: case series. [Articolo su rivista]
Micali, Salvatore; DE STEFANI, Stefano; Bianchi, Giampaolo; Pini, Giovannalberto; Sighinolfi, Maria Chiara; Annino, Filippo
abstract

INTRODUCTION: Renal multiple peripelvic cysts are often symptomatic. Obstruction of renal hilum and the collecting system leads to hydronephrosis and could promote formation of stones. Managing both entities at the same time needs a new approach to minimize complications and improve success rates. We report for the first time five cases of symptomatic multiple peripelvic cysts and concomitant kidney stones treated by a laparoscopic approach. PATIENTS AND METHODS: Between 2003 and 2007 three men and two women, with a median age of 60 years with peripelvic renal cyst and synchronous kidney stones underwent a laparoscopic ablation of cysts, concomitant pyelolithotomy, and stone removal with a flexible auxiliary cystoscope. Mean cyst size was 45 mm (range 15-70 mm). Mean stone size was 25 mm (range 10-33 mm). RESULTS: The mean operative time was 173 minutes (range 150-235 minutes). There were neither intraoperative complications nor conversions to open surgery. Mean blood lost was less than 100 mL, and mean hospital stay was 3.2 days (range 3-5 days). After removal of ureteral catheter, patients were asymptomatic and without signs of hydronephrosis. Computed tomography after 6 months showed clearance of all cysts and stones without sign of recurrence. DISCUSSION: Laparoscopic management of urolithiasis should be an alternative choice of treatment in some particular and selected indication. Concomitant symptomatic peripelvic cysts and kidney stones could justify simultaneous laparoscopic management. The procedure is technically challenging but safe and effective, and it avoids a staged treatment.

2009 - Laparoscopic ureterolithotomy: a comparison between the transperitoneal and the retroperitoneal approach during the learning curve [Articolo su rivista]
P., Bove; Micali, Salvatore; R., Miano; G., Mirabile; DE STEFANI, Stefano; E., Botteri; Bianchi, Giampaolo; G., Vespasiani
abstract

PURPOSE: To compare the transperitoneal approach and the retroperitoneal approach in the laparoscopic management of ureteral stones, at two different urologic centers during the learning curve period. MATERIALS AND METHODS: We prospectively evaluated 35 consecutive laparoscopic ureterolithotomies performed by two different urologists during their learning curve period in laparoscopy. Each surgeon used a different approach: Transperitoneal (group A) and retroperitoneal (group B). Timing for patients' positioning, trocar placement, ureter isolation, stone extraction, and suturing were recorded to compare the transperitoneal with the retroperitoneal method. Intraoperative complications and perioperative morbidity were also reported. RESULTS: Eighteen procedures were performed using the transperitoneal method (group A) and 17 using the retroperitoneal method (group B). Significant differences between group A and B were observed in terms of time for access to the operating field (mean times 14 and 24 min, respectively, P = < 0.001); time for suturing the ureter (mean times 16 and 28 min, respectively, P = < 0.001); and total operative time (mean times 75 and 102 min, respectively, P = 0.002). No statistical differences were observed for any other parameters. Blood loss was minimal in all cases (mean losses 50 and 45 mL, respectively, P = 0.852); and hemotransfusion was not needed by either group. At the 12-month follow-up, no cases of ureteral stricture were recorded. CONCLUSIONS: We suggest that urologists in training for laparoscopy perform laparoscopic ureterolithotomy using a transperitoneal route. In expert hands, both transperitoneal and retroperitoneal approaches are feasible, and the choice depends on personal preference.

2009 - Litotrissia extracorporea della calcolosi ureterale pre-vescicale: Posizione prona o supina? [Abstract in Atti di Convegno]
M. C., Sighinolfi; Micali, Salvatore; M., Rivalta; M., Grande; F., Cianci; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Litotrissia extracorporea della calcolosi ureterale pre-vescicale: Posizione prona o supina?

2009 - Litotrissia extracorporea della calcolosi ureterale pre-vescicale: Posizione prona o supina? [Abstract in Rivista]
M. C., Sighinolfi; Micali, Salvatore; M., Rivalta; M., Grande; F., Cianci; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Litotrissia extracorporea della calcolosi ureterale pre-vescicale: Posizione prona o supina

2009 - L’epidemiologia dei LUTS e dell’IPB [Capitolo/Saggio]
Micali, Salvatore; G., Isgrò; Bianchi, Giampaolo
abstract

L’epidemiologia dei LUTS e dell’IPB

2009 - Neovescica ileale orto topica secondo Studer: Modifiche di tecnica e risultati morfologici [Abstract in Atti di Convegno]
Bianchi, Giampaolo; G., Saredi; Sighinolfi, M. C.; Micali, Salvatore; A., Beato; DE STEFANI, Stefano
abstract

Neovescica ileale orto topica secondo Studer: Modifiche di tecnica e risultati morfologici

2009 - Plastica del giunto pielo-ureterale robot assistita. Nostra esperienza [Abstract in Rivista]
Bianchi, Giampaolo; F., Annino; A., Beato; C., De Carne; Micali, Salvatore; DE STEFANI, Stefano
abstract

Plastica del giunto pielo-ureterale robot assistita. Nostra esperienza

2009 - Potential effectiveness of pelvic floor rehabilitation treatment for postradical prostatectomy incontinence, climacturia, and erectile dysfunction: a case series [Articolo su rivista]
Sighinolfi, Maria Chiara; Rivalta, Massimo; A., Mofferdin; Micali, Salvatore; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

INTRODUCTION: Radical prostatectomy is the treatment of choice for prostate cancer; although novel techniques have significantly reduced its side effects, the procedure can provoke urinary incontinence of various degrees and/or erectile dysfunction. AIM: We evaluate the effect of a complete pelvic floor rehabilitation program on both incontinence and erectile dysfunction, including climacturia, in a preliminary case series. MAIN OUTCOMES MEASURES: Pad usage and International Index of Erectile Function (IIEF-15) Questionnaire. METHODS: Three male patients, previously submitted to nerve and bladder neck sparing radical prostatectomy, presented with urinary incontinence, climacturia and erectile dysfunction of new onset. We decided to manage those subjects with a pelvic-floor rehabilitation program consisting of active pelvic-floor muscle exercises, electromyography biofeedback for strength and endurance, electrical stimulation. The whole program lasted 4 months, with weekly sessions, including general advices on lifestyle changes. Pad usage for incontinence and IIEF-15 were used to assess symptoms before and after the procedure. RESULTS: Before a complete rehabilitation program, pad usage was 1 per day in all the subjects, and the score for erectile function was set at 17 (range 15-20). After the procedure, all the patients experienced a satisfying urinary continence and an improvement in erectile function (mean IIEF score: 22, range 19-24). Similarly, climacturia seems to be subjectively reduced in all the subjects. CONCLUSION: Pelvic floor muscles exercises seem to result in an improved urinary continence and erectile function after radical prostatectomy. Since this is the first clinical case series dealing with this topic, our outcomes are encouraging and suggest the potential usefulness of such noninvasive treatment modality

2009 - Preliminary analysis of 2-years experience with dornier Lithotripter EMSE 220 XXP [Poster]
M. C., Sighinolfi; Micali, Salvatore; F., Cianci; G., Pini; A., Beato; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Preliminary analysis of 2-years experience with dornier Lithotripter EMSE 220 XXP.

2009 - Prostatectomia radicale robot assistita: Risultati oncologico-funzionali dopo il primo anno di attività [Abstract in Rivista]
Bianchi, Giampaolo; A., Beato; F., Annino; C., De Carne; Micali, Salvatore; DE STEFANI, Stefano
abstract

Prostatectomia radicale robot assistita: Risultati oncologico-funzionali dopo il primo anno di attività

2009 - Re: Somani BK et al.: Successful Management of "Overlooked" Ureteral Stent in Transplant Kidney (Urology 2008;72:1012) [Articolo su rivista]
M. C., Sighinolfi; Micali, Salvatore; M., Grande; F., Fidanza; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

The authors present a case of successful management of an encrusted ureteral stent in a transplant kidney using cystolitholapaxy and percutaneous nephrolithotomy with electromechanical lithotripsy.

2009 - Reply [Articolo su rivista]
Micali, Salvatore; Sighinolfi, Maria Chiara; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

[No abstract available]

2009 - Retroperitoneoscopic hybrid-less ureterolithotomy. [Abstract in Rivista]
Micali, Salvatore; G., Pini; M. C., Sighinolfi; F., Cianci; Bianchi, Giampaolo
abstract

Retroperitoneoscopic hybrid-less ureterolithotomy.

2009 - Retrospective descriptive analysis of the physiological kinetics of prostate-specific antigen in men older than 75 years. [Articolo su rivista]
Sighinolfi, Maria Chiara; Micali, Salvatore; DE STEFANI, Stefano; A., Cicero; Cianci, Filippo; Giacometti, Marco; Bianchi, Giampaolo
abstract

Several studies have compared prostate-specific antigen (PSA) kinetics in men with and without cancer, but there has been no adequate analysis of the longitudinal variation in PSA. The aim of this study was to assess the fluctuations in PSA in a cohort of elderly men in an attempt to define a physiological pattern of PSA kinetics. We searched a specific cohort of patients aged &gt; 75 years and with PSA value &lt; 2.0 ng mL(-1). A history of all PSA values over the past 10 years was compiled for each patient to create a database of patients fitting the following criteria: (1) minimum of five PSA measurements, (2) over at least 5 years. Exclusion criteria were: (1) PSA &lt; 0.2 ng mL(-1) at each measurement and (2) having had more than one PSA test per year. In all, 1 327 patients (mean age: 78.52 years) fit the inclusion criteria. The mean variation from the first to the last PSA test was 0.05 +/- 0.43, with a mean follow-up of 6.79 +/- 1.71 years. Over the same period, the mean fluctuation from the lowest to the highest PSA value was 0.04 +/- 0.55 (P = 0.925). The mean annual PSA velocity (PSAV) was calculated by dividing the mean variation from the first to the last PSA test by the number of years of observation for each patient and was set at 0.0104 +/- 0.1050. Concluding, in a large-scale cohort of elderly individuals considered healthy and evaluated for a considerable follow-up, the average annual PSAV as well as the average fluctuation from the lowest to the highest PSA value are insignificant.

2009 - Robotic assisted transperitoneal dismember pyeloplasty: Our experience. [Abstract in Rivista]
F., Annino; A., Beato; C., De Carne; DE STEFANI, Stefano; Micali, Salvatore; Bianchi, Giampaolo
abstract

Robotic assisted transperitoneal dismember pyeloplasty: Our experience.

2009 - Robotic assisted transperitoneal dismember pyeloplasty: Our experience. [Poster]
F., Annino; A., Beato; C., De Carne; DE STEFANI, Stefano; Micali, Salvatore; Bianchi, Giampaolo
abstract

Robotic assisted transperitoneal dismember pyeloplasty: Our experience

2009 - Robotic-assisted laparoscopic radical prostatectomy: results of our first 100 cases. [Poster]
A., Beato; F., Annino; C., De Carne; Micali, Salvatore; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Robotic-assisted laparoscopic radical prostatectomy: results of our first 100 cases.

2009 - Single trocar surgery-Preliminary retroperitoneal experience [Abstract in Rivista]
Micali, Salvatore; G., Pini; M. C., Sighinolfi; M., Rivalta; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Single trocar surgery-Preliminary retroperitoneal experience

2009 - Stent ureterali in corso di litotrissia extracorporea: Quale ruolo? [Poster]
Sighinolfi, M. C.; Micali, Salvatore; DE STEFANI, Stefano; A., Beato; F., Annino; M., Rivalta; C., De Carne; Bianchi, Giampaolo
abstract

Stent ureterali in corso di litotrissia extracorporea: Quale ruolo?

2009 - Tension-and energy-free robotic-assisted laparoscopic radical prostatectomy: Application during the learning curve [Abstract in Rivista]
F., Annino; A., Beato; C., De Carne; Micali, Salvatore; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Tension-and energy-free robotic-assisted laparoscopic radical prostatectomy: Application during the learning curve

2009 - Transmesocolic robotic-assisted pyeloplasty. [Abstract in Rivista]
Bianchi, Giampaolo; G., Pini; F., Annino; Micali, Salvatore; A., Beato; DE STEFANI, Stefano
abstract

Transmesocolic robotic-assisted pyeloplasty.

2009 - Trattamento dei carcinomi renali in stadio avanvato: i nostri 8 anni di esperienza. [Poster]
Bianchi, Giampaolo; C., De Carne; F., Fidanza; F., Annino; Micali, Salvatore; Sighinolfi, M. C.; DE STEFANI, Stefano
abstract

Trattamento dei carcinomi renali in stadio avanvato: i nostri 8 anni di esperienza.

2009 - Un anno di letteratura urologica sulla calcolosi urinaria [Articolo su rivista]
Micali, Salvatore; M. C., Sighinolfi; G., Pini; N., Ferrari; M., Rivalta; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Un anno di letteratura urologica sulla calcolosi urinaria

2009 - Un anno di letteratura urologica sulla calcolosi urinaria [Capitolo/Saggio]
Micali, Salvatore; M. C., Sighinolfi; G., Pini; N., Ferrari; M., Rivalta; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

La calcolosi urinaria rappresentaper l’urologo parte integrante dellapratica clinica quotidiana. Un adeguatotrattamento clinico richiedeun’estesa conoscenza in ambitometabolico, l’individuazione di unalitiasi ricorrente, le varie opzionidiagnostiche, la gestione della colicarenale acuta, la terapia medicaespulsiva e la rimozione attiva deicalcoli. Negli anni Ottanta, l’efficacia di una tecnica rivoluzionaria,quale la litotrissia extracorporea ad onded’urto (Shock Wave Lithotripsy - SWL), e la progressivascomparsa della chirurgia a cielo aperto, hanno drasticamentemutato il panorama terapeutico della calcolosi;ad oggi la procedura più invasiva nel trattamento deigrossi calcoli rimane paradossalmente la nefrolitotrissiapercutanea (PNL). Negli ultimi decenni, i continui progressiin campo endoscopico, permessi dall’introduzionecontinua di nuove tecnologie, hanno rivoluzionato inmodo duraturo la terapia mini-invasiva.Nostro obiettivo è quello di presentare le recenti innovazioninel trattamento dell’urolitiasi.

2009 - Ureteral stent durino extracorporeal shock wave lithotripsy: which role? [Poster]
M. C., Sighinolfi; Micali, Salvatore; A., Beato; DE STEFANI, Stefano; G., Pini; Bianchi, Giampaolo
abstract

Ureteral stent durino extracorporeal shock wave lithotripsy: which role?

2009 - Valutazione dell’emodinamica peniena nei soggetti affetti da eiaculazione precoce [Poster]
Sighinolfi, M. C.; A., Mofferdin; DE STEFANI, Stefano; Micali, Salvatore; N., Ferrari; M., Rivalta; F., Cianci; Bianchi, Giampaolo
abstract

Valutazione dell’emodinamica peniena nei soggetti affetti da eiaculazione precoce

2008 - Analisi descrittiva della cinetica del PSA in 1327 soggetti non affetti da carcinoma prostatico [Abstract in Atti di Convegno]
M. C., Sighinolfi; N., Ferrari; F., Fidanza; M., Giacometti; Micali, Salvatore; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Analisi descrittiva della cinetica del PSA in 1327 soggetti non affetti da carcinoma prostatico

2008 - Concomitant thrans-peritoneal laparoscopic management of para-pelvic cysts and staghorn upper pole caliceal stone. [Abstract in Rivista]
Micali, Salvatore; C., De Carne; F., Annino; G., Pini; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Concomitant thrans-peritoneal laparoscopic management of para-pelvic cysts and staghorn upper pole caliceal stone.

2008 - ESWL vs endourologia: efficacia [Capitolo/Saggio]
Micali, Salvatore; M., Grande; M. C., Sighinolfi; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

ESWL vs endourologia: efficacia

2008 - Endometriosi urinaria: presentazione ed analisi di 8 casi clinici in un singolo centro [Abstract in Atti di Convegno]
C. Di Pietro M., C.; Sighinolfi G., Saredi; Micali, Salvatore; DE STEFANI, Stefano; F., Annino; C., De Carne; Bianchi, Giampaolo
abstract

Endometriosi urinaria: presentazione ed analisi di 8 casi clinici in un singolo centro

2008 - Esperienza preliminare con Dornier Lithotripter S EMSE 220 XXP:analisi dei primi 631 trattamenti [Abstract in Atti di Convegno]
M. C., Sighinolfi; Micali, Salvatore; DE STEFANI, Stefano; M., Grande; A., Mofferdin; F., Annino; Bianchi, Giampaolo
abstract

Esperienza preliminare con Dornier Lithotripter S EMSE 220 XXP:analisi dei primi 631 trattamenti.

2008 - Espressione della proteina simporto sodio/iodio (NIS)nell’adenocarcinoma prostatico [Poster]
Micali, Salvatore; M. C., Sighinolfi; M., Rivalta; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Espressione della proteina simporto sodio/iodio (NIS)nell’adenocarcinoma prostatico

2008 - Evaluation of emergency extracorporeal shock wave lithotripsy for obstructing ureteral stones. Editorial comment [Recensione in Rivista]
Micali, Salvatore; DE STEFANI, Stefano; Bianchi, Giampaolo; Sighinolfi, Maria Chiara
abstract

Evaluation on Emergency Shock wave lithotripsy for obstructive ureteral stones.

2008 - Extracorporeal shock wave lithotripsy in an elderly population: how to prevent complications and make the treatment safe and effective. [Articolo su rivista]
Sighinolfi, Mc; Micali, Salvatore; Grande, M; Mofferdin, A; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

INTRODUCTION: The aim of our study is to consider the feasibility and the results of shock wave lithotripsy (SWL) in an elderly cohort of patients, considering different diseases and concomitant morbidity.MATERIALS AND METHODS: From January 2003 up to July 2006, a total of 1100 SWL treatments were performed in our Stone Centre with Dornier Lithotripter S device. We retrospectively analyzed all the treatments carried out in patients older than 70 years of age, collecting a total of 130 patients. The average age was 75.1 years (range: 70-89). Stone location was renal in 95 and ureteral in 45 patients. Information about SWL outcomes and complications were collected as well as patient's characteristics and treatment modalities.RESULTS: Average stone size was 10.2+/-3.4 and 8.7+/-3.1 for the renal and ureteral location, respectively. 73 out of 140 patients (52.1%) were stone free after a single treatment; 49 patients (35%) required an adjunctive session, whereas SWL was unsuccessful in 18 (12.8%) patients. We observed 64, 24, 21, 10, 31 cases of concomitant arterial hypertension, diabetes mellitus, chronic renal failure, solitary kidney condition and previous neoplastic pathologies. A total of 8 and 6 subjects had previous cardiac surgery and atrial fibrillation respectively, thus requiring a warfarin scheduled conversion to low molecular weight heparin. Five patients had a pace maker implant and three patients an abdominal aortic aneurism. No SWL-related complications were found in this series considering both urological and systemic features.CONCLUSION: SWL represents the treatment of choice for urolithiasis, and it has to be recommended especially to geriatric patients. In those subjects, SWL complications can be avoided with a proper and personalized preparation, together with an ECG and ultrasound continuously monitored procedure.

2008 - Extracorporeal shock wave lithotripsy of an encrusted ureteral stent in transplanted kidney: an amazing solution! [Poster]
M. C., Sighinolfi; Micali, Salvatore; M., Grande; F., Fidanza; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Extracorporeal shock wave lithotripsy of an encrusted ureteral stent in transplanted kidney: an amazing solution!

2008 - Extracorporeal shock wave lithotripsy with an electromagnetic lithotriptor and implantable cardioverter defibrillator: case presentation and review of the literature. [Poster]
M. C., Sighinolfi; Micali, Salvatore; DE STEFANI, Stefano; A., Mofferdin; F., Cianci; F., Malagnino; Bianchi, Giampaolo
abstract

Extracorporeal shock wave lithotripsy with an electromagnetic lithotriptor and implantable cardioverter defibrillator: case presentation and review of the literature.

2008 - Extracorporeal shock wave treatment for pre-vescical ureteral stones: Prone or supine position? [Poster]
M. C., Sighinolfi; Micali, Salvatore; M., Grande; F., Cianci; G., Romani; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Extracorporeal shock wave treatment for pre-vescical ureteral stones: Prone or supine position?

2008 - Extracorporeal shock wave treatment in prone or supine position: which approach offers better outcomes? [Poster]
M. C., Sighinolfi; Micali, Salvatore; M., Grande; M., Rivalta; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Extracorporeal shock wave treatment in prone or supine position: which approach offers better outcomes?

2008 - How effective is extracorporeal shock wave lithotripsy with modern lithotripter devices? A prospective and preliminary assessment. [Poster]
M. C., Sighinolfi; Micali, Salvatore; M., Grande; F., Annino; A., Mofferdin; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

How effective is extracorporeal shock wave lithotripsy with modern lithotripter devices? A prospective and preliminary assessment.

2008 - Impact of laparoscopic experience and fellowship on learning curve for robotic assisted laparoscopic radical prostatectomy. [Poster]
Bianchi, Giampaolo; F., Annino; C., De Carne; Micali, Salvatore; M. C., Sighinolfi; DE STEFANI, Stefano
abstract

Impact of laparoscopic experience and fellowship on learning curve for robotic assisted laparoscopic radical prostatectomy.

2008 - Impatto del calibro dell’ago bioptico sulle complicanze e sulla percezione del dolore durante biopsie prostatiche [Abstract in Atti di Convegno]
F., Annino; G., Saredi; M. C., Sighinolfi; F., Fidanza; Micali, Salvatore; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Impatto del calibro dell’ago bioptico sulle complicanze e sulla percezione del dolore durante biopsie prostatiche

2008 - Knotted ureteral catheter in uretero-cutaneous stoma: case presentation and management. [Poster]
Micali, Salvatore; M., Rivalta; M. C., Sighinolfi; F., Cianci; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Knotted ureteral catheter in uretero-cutaneous stoma: case presentation and management.

2008 - Knotted urethral catheter in an 80-year-old woman: prevention and management of this unusual complication [Articolo su rivista]
M. C., Sighinolfi; DE STEFANI, Stefano; Micali, Salvatore; A., Mofferdin; A., Beato; N., Ferrari; Bianchi, Giampaolo
abstract

Intravesical catheter knotting represents a rare event, especially described in paediatric literature. We report a case of a catheter knot, occurring in an 80-year-old woman, managed by means of sustained traction.

2008 - La Litotrissia extracorporea nei pazienti con defibrillatore cardiaco: descrizione di un caso e revisione della letteratura. [Poster]
M. C., Sighinolfi; Micali, Salvatore; DE STEFANI, Stefano; M., Grande; F., Cianci; Bianchi, Giampaolo
abstract

La Litotrissia extracorporea nei pazienti con defibrillatore cardiaco: descrizione di un caso e revisione della letteratura.

2008 - La PCNL in situazioni complesse di calcolosi renale: la nostra esperienza [Abstract in Atti di Convegno]
C., Di Pietro; M. C., Sighinolfi; Micali, Salvatore; C., De Carne; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

La PCNL in situazioni complesse di calcolosi renale: la nostra esperienza

2008 - Linfoadenectomia inguinale per neoplasia del pene e melanoma dell’arto inferiore: revisione critica di 14 casi [Poster]
DE STEFANI, Stefano; M. C., Sighinolfi; G., Saredi; Micali, Salvatore; F., Fidanza; F., Annino; C., De Carne; Bianchi, Giampaolo
abstract

Linfoadenectomia inguinale per neoplasia del pene e melanoma dell’arto inferiore: revisione critica di 14 casi

2008 - Litotrissia extracorporea della calcolosi ureterale pre-vescicale : posizione prona o supina? [Abstract in Atti di Convegno]
M. C., Sighinolfi; Micali, Salvatore; DE STEFANI, Stefano; M., Grande; F., Cianci; C., De Carne; Bianchi, Giampaolo
abstract

Litotrissia extracorporea della calcolosi ureterale pre-vescicale : posizione prona o supina?

2008 - Muscle- and nerve-sparing bulbar urethroplasty: a new technique [Articolo su rivista]
G., Barbagli; DE STEFANI, Stefano; Annino, Filippo; DE CARNE, Cosimo; Bianchi, Giampaolo
abstract

BACKGROUND: To describe a new surgical technique for the repair of bulbar urethral strictures to preserve the bulbospongiosum muscle and its perineal innervation. OBJECTIVE: Surgical steps of muscle- and nerve-sparing bulbar urethroplasty are described. The outcome is provided regarding semen sequestration and postvoiding dribbling. DESIGN, SETTING, AND PARTICIPANTS: We performed the procedure in 12 patients (average age: 43.58 yr) with bulbar urethral strictures (average stricture length: 4.47 cm). SURGICAL PROCEDURE: Six patients underwent urethroplasty using a ventral oral mucosal onlay graft, and six patients underwent urethroplasty using a dorsal oral mucosal onlay graft. In all patients, the surgical approach to the bulbar urethra was made avoiding dissection of the bulbospongiosum muscle from the corpus spongiosum and leaving the central tendon of the perineum intact. MEASUREMENTS: Clinical outcome was considered a failure when any postoperative instrumentation was needed. The primary outcome examined the technical feasibility of the muscle- and nerve-sparing bulbar urethroplasty. The secondary outcome examined the presence or absence of postoperative postvoid dribbling and semen sequestration using a nonvalidated questionnaire (Appendix). RESULTS AND LIMITATIONS: In all patients, postoperative voiding cystourethrography was performed 3 wk after surgery and no urethral sacculation was evident. Urethrography were repeated after 6 mo and 12 mo. No postvoid dribbling or semen sequestration was demonstrated in all patients at 6 mo and 12 mo after surgery. No patient showed stricture recurrence. The average follow-up was 15.25 mo (range 12 mo to 26 mo, median 13.5 mo). CONCLUSIONS: Bulbar urethroplasty preserving the bulbospongiosum muscle, the central tendon of the perineum, and the perineal nerves is a safe, feasible, minimally invasive alternative to traditional bulbar urethroplasty.

2008 - Noninvasive management of obstructing ureteral stones using electromagnetic extracorporeal shock wave lithotripsy [Articolo su rivista]
Sighinolfi, Maria Chiara; Micali, Salvatore; DE STEFANI, Stefano; G., Saredi; A., Mofferdin; Grande, Marco Serafino; Bianchi, Giampaolo
abstract

BACKGROUND: Extracorporeal shock wave lithotripsy (ESWL) represents noninvasive management of urolithiasis. Since the first HM3 model, technological progress has improved the efficacy and safety of this treatment. The current study aimed to evaluate the role of ESWL as a first-line emergency therapy of renal colic due to ureteral stone with impaired renal function. METHODS: This prospective study enrolled all the patients admitted from the emergency room with acute renal colic meeting the following criteria: serum creatinine level ranging from 1.5 to 2.5 mg/dl, hydronephrosis, ureteral stones 6 to 15 mm in size, body mass index less than 30, normal renal function at baseline, and no evidence of urinary tract infection. The patients were submitted to a single-session emergency treatment using Dornier Litothripter S. Follow-up assessment, performed at 24 and 72 h, included radiologic and ultrasound examinations with renal function serum assessment. The end points were a decrease in creatinine level and a stone-free condition. RESULTS: A total of 40 patients were eligible for the study. The mean creatinine level at admission was 1.93 +/- 0.26 mg/dl. After the treatment, renal function recovery occurred for 34 subjects (85%), with a significant global decrease in creatinine levels (p = 0.00). The global stone-free rate 72 h after SWL was 67.5% (27/40). The patients with residual fragments were managed using re-SWL (n = 7) and endoscopic technique (n = 6). CONCLUSIONS: Emergency SWL represents an effective tool in the treatment of ureteral stones with hydronephrosis and slight renal impairment. Although complete stone clearance after one treatment still remains a difficult target, the actual role of SWL in the management of acute obstruction is to obtain ureteral canalization and renal function recovery.

2008 - PSA velocità in una popolazione sana a confronto con soggetti affetti da tumore della prostata: un rilevante ed affidabile marcatore di neoplasia [Abstract in Atti di Convegno]
M. C., Sighinolfi; Micali, Salvatore; M., Giacometti; N., Ferrari; F., Fidanza; DE STEFANI, Stefano; C., De Carne; Bianchi, Giampaolo
abstract

PSA velocità in una popolazione sana a confronto con soggetti affetti da tumore della prostata: un rilevante ed affidabile marcatore di neoplasia

2008 - Previous experience with Dornier Lithotripter EMSE 220 XXP: critical analysis of the first 809 treatments of renal stones. [Poster]
M. C., Sighinolfi; Micali, Salvatore; M., Grande; M., Rivalta; F., Annino; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Previous experience with Dornier Lithotripter EMSE 220 XXP: critical analysis of the first 809 treatments of renal stones.

2008 - Prostatectomia radicale robot assistita. Risultati preliminari durante la learning curve. [Abstract in Atti di Convegno]
Bianchi, Giampaolo; F., Annino; Micali, Salvatore; DE STEFANI, Stefano; M. C., Sighinolfi; C., De Carne
abstract

Prostatectomia radicale robot assistita. Risultati preliminari durante la learning curve.

2008 - Quale è il profilo scientifico del congresso della società Italiana di urologia: Analisi del tasso di pubblicazioni dei congressi SIU 2003-2006 [Poster]
R., Miano; Micali, Salvatore; M., Rivalta; Bianchi, Giampaolo; C., De Nunzio; A., Tubaro; E., Finazzi Agrò; G., Vespasiani
abstract

Quale è il profilo scientifico del congresso della società Italiana di urologia: Analisi del tasso di pubblicazioni dei congressi SIU 2003-2006

2008 - Re: Indwelling Ureteral Stents and Sexual Health: A Prospective, Multivariate Analysis. M. C. Sighinolfi, S. Micali, S. De Stefani, A. Mofferdin, M. Grande, M. Giacometti, N. Ferrari, M. Rivalta and G. Bianchi J Urol 2007; 178: 229-231 [Recensione in Rivista]
M. C., Sighinolfi; Micali, Salvatore; DE STEFANI, Stefano; A., Mofferdin; M., Grande; M., Giacometti; N., Ferrari; M., Rivalta; Bianchi, Giampaolo
abstract

Reply by Authors During the last few decades progress in endourology has led to a widespread application of such techniques, and procedures such as ureteral stenting and nephrostomic drainage have become routinely adopted. As a result, the number of patients dealing with these devices has rapidly increased, thus focusing attention on the related quality of life. Consistent with this statement, Joshi et al developed the Ureteral Stent Symptom Questionnaire in 2003,1 which represents a validated instrument to assess stent related bother, concerns and impact on global quality of life. [5] and [7] The USSQ actually addresses in a proper and detailed approach the whole of urinary symptoms, as well as the consequent bother that so frequently affects these patients. Domains regarding pain and stent related therapies (antibiotics, painkillers) are accurately designed. Furthermore, work, occupation, social activities and relationships are considered with regard to ureteral stent permanence. Sexuality is assessed in the questionnaire by 4 questions, investigating the presence vs absence of sexual activity, and then dealing with pain and sexual satisfaction. As a result, all crucial points of stent related sexuality are analyzed according to the questionnaire. However, the aim of our study was to perform a detailed analysis of all the domains connected to sexuality in both genders with particular attention to erectile function, which has been so widely addressed in the last decade.8 Moreover, since female sexuality represents a complexity of events, we attempted to investigate all steps of the process to emphasize the critical points. In this setting the use of the International Index of Erectile Function-5 and the Female Sexual Function Index seems to be an adequate choice, matching our aims more properly. Furthermore, an additional end point of the study was to investigate thoroughly the sequential changes that occur in sexual health before and after stent insertion, and this goal can be achieved only with specific questionnaires administered to the patient before the procedure. Since the recent literature focuses on the relationship between erectile dysfunction and lower urinary tract symptoms,9 we analyzed the correlation between urinary complaints and sexual dysfunction. Although this outcome can be assessed even with the USSQ, the use of specific questionnaires considering different sorts of symptoms is highly recommended to perform a critical and statistical analysis. Behind this consideration, our outcomes are consistent with those previously reported in other studies. Ureteral stenting is a simple and safe procedure for the urologist but has significant consequences on the routine life of the patient in all of its main areas. The USSQ is a consistent and reliable instrument to analyze those concerns, and physicians have to consider this tool in urological practice. References 1H.B. Joshi, N. Newns, A. Stainthorpe, R.P. MacDonagh, F.X. Keeley Jr, A.G. Timoney Ureteral Stent Symptom Questionnaire: development and validation of a multidimensional quality of life measure

2008 - Robotic assisted laparoscopic transperitoneal prostatectomy: preliminary results of the first 45 cases [Poster]
Bianchi, Giampaolo; F., Annino; C., De Carne; Micali, Salvatore; M. C., Sighinolfi; DE STEFANI, Stefano
abstract

Robotic assisted laparoscopic transperitoneal prostatectomy: preliminary results of the first 45 cases.

2008 - Saturation biopsies: esperienza di un singolo centro ed utilità nella pratica urologica [Abstract in Atti di Convegno]
M., Rivalta; M. C., Sighinolfi; G., Saredi; C., Di Pietro; M., Paterlini; Micali, Salvatore; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Saturation biopsies: esperienza di un singolo centro ed utilità nella pratica urologica

2008 - Shockwave lithotripsy and the protective role of inosine: Early and late evaluation in an experimental model [Articolo su rivista]
DE STEFANI, Stefano; Micali, Salvatore; DE CARNE, Cosimo; Sighinolfi, Maria Chiara; DI PIETRO, Corradino; Marzona, Laura; Volpi, Nicola; Bianchi, Giampaolo
abstract

Purpose: Extracorporeal shockwave lithotripsy ( SWL) is one of the most common treatments for urinary stones. Despite technological improvements, it may cause side effects varying from minor reversible microscopic damage to severe large renal hematomas. The aim of our experimental study is to assess the efficacy of inosine in avoidance of acute renal damage after SWL. Materials and Methods: We used 25 Wistar rats that had previously had left nephrectomy. The rats were divided into three groups: group A consisted of 10 rats undergoing renal SWL; group B consisted of 10 rats that received adjunctive treatment with IP injection of inosine 40 minutes before SWL; and group C consisted of 5 rats that served as controls. N-acetylglucosaminidase ( NAG) and lactate dehydrogenase ( LDH) concentrations were evaluated 24 hours before and 24 hours after SWL. All the rats were subsequently sacrificed ( 4 rats in group A and 4 in group B at 48 hours post-SWL, and the remaining rats were sacrificed 30 days post-SWL). Renal tissue was submitted to histologic and electron microscopic examination to assess early and late alterations. Results: NAG and LDH values were significantly increased after SWL in group A ( P &lt; 0.001), while no significant NAG and LDH differences were detected in group B ( P &lt; 0.16). Early histologic examination revealed a considerable amount of cellular degeneration in group A with ultrastructural vacuolization and disruption of lysosomal membranes; the tubular features and cellular structures appeared to be well preserved in group B. No late histologic alterations were evident in any of the specimens. Conclusions: Inosine is helpful and protective in the prevention of early microscopic damage to renal parenchyma due to SWL.

2008 - Tumor seeding after open nephroureterectomy for ureteral transitional cell carcinoma [Articolo su rivista]
G., Saredi; C., Di Pietro; R., Spasciani; DE STEFANI, Stefano; M. C., Sighinolfi; Micali, Salvatore; Bianchi, Giampaolo
abstract

Skeletal muscle metastases following cancer surgery are rare. Few cases of abdominal wall metastasis have been reported in the literature and attributed to tumor seeding after laparoscopic surgery or percutaneous nephrostomy. We report a case of abdominal tumor seeding after open nephroureterectomy managed by means of a surgical and medical approach.

2008 - Tumor seeding in sede di drenaggio successivo a prostatectomia radicale (PR) retropubica: presentazione di un caso revisione della letteratura [Abstract in Atti di Convegno]
F., Annino; F., Fidanza; Micali, Salvatore; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Tumor seeding in sede di drenaggio successivo a prostatectomia radicale (PR) retropubica: presentazione di un caso revisione della letteratura

2008 - Urological concerns: Should trans-urethral catheter be located over or under the thigh? [Articolo su rivista]
DE STEFANI, Stefano; Sighinolfi, Maria Chiara; Micali, Salvatore; A., Mofferdin; DE CARNE, Cosimo; Grande, Marco Serafino; Rivalta, Massimo; Bianchi, Giampaolo
abstract

INTRODUCTION: Bladder catheterization is a common practice after several surgical procedures; a wrong trans-urethral catheter position can affect the outcomes of some urological maneuvers. We assess with a physical model the variation of intra-vesical pressures due to different locations of the catheter. MATERIALS AND METHODS: Using a plastic bag fulfilled with 5l of normal saline, we try to reproduce bladder condition assessing pressures in case of catheter located over or under the thigh. RESULTS: In case of catheter over the thigh, the flow of liquid is not allowed, and only a pressure of 23 cm of water induces the passage of fluid. CONCLUSION: A wrong catheter position may adversely affect intravesical pressures; this finding has to be taken into consideration, especially when dealing with post-urological surgery catheterization.

2008 - Well-differentiated giant scrotal liposarcoma: case presentation and management [Articolo su rivista]
Sighinolfi, M. C.; DE STEFANI, Stefano; Micali, Salvatore; G., Saredi; F., Fidanza; A., Dotti; L., Reggiani Bonetti; C., De Gaetani; Bianchi, Giampaolo
abstract

Scrotal liposarcoma is an uncommon disease, usually found after the fifth decade. We describe the case of a well-differentiated scrotal liposarcoma associated with a considerable inflammatory reaction, treated with surgical ablation.

2007 - Bacille Calmette-Guérin intravesical instillation and erectile function: is there a concern? [Articolo su rivista]
Sighinolfi, M. C.; Micali, Salvatore; DE STEFANI, Stefano; A., Mofferdin; N., Ferrari; M., Giacometti; Bianchi, Giampaolo
abstract

The aim of our study was to evaluate the effect of bacille Calmette-Guerin (BCG) therapy on erectile function in a cohort of male patients affected by non-muscle invasive bladder cancer. Thirty male patients undergoing BCG treatment for non-muscle invasive bladder cancer were enrolled in the study. Their mean age was 60.4 years. None of the patients had risk factors for erectile dysfunction (ED). All subjects underwent a BCG standard schedule therapy (once weekly instillation for 6 weeks). International Index of Erectile Function (IIEF-5) and International Prostate Symptom score (I-PSS) were addressed to the patients during the treatment schedule (at fourth or fifth instillation) and 1 month after the last instillation. The mean IIEF-5 score was 17.6 +/- 6.7 during therapy and 21.7 +/- 2.92 a month after the last instillation (P = 0.008). Baseline ED and the association with lower urinary tract symptoms are variables significantly connected with post-treatment results (P = 0.016 and 0.00 respectively) whereas the age seems not to be related to ED (P = 0.256). No major side effects were recorded. It is concluded that BCG treatment is effective for prophylaxis of non-muscle invasive bladder cancer; however, it may induce a high incidence of ED. Although this effect is transient and reversible, erectile failure is another source of psychological distress that adversely affects the quality of life of men undergoing BCG treatment.

2007 - Case-control study of toenail cadmium and prostate cancer risk in Italy [Articolo su rivista]
Vinceti, Marco; M., Venturelli; C., Sighinolfi; P., Trerotoli; F., Bonvicini; A., Ferrari; Bianchi, Giampaolo; G., Serio; Bergomi, Margherita; Vivoli, Gianfranco
abstract

A role of cadmium exposure in prostate cancer etiology has been suggested by epidemiologic and laboratory studies, but conclusive evidence on this topic is still lacking. We investigated the relation between cadmium exposure, estimated by determining toenails cadmium levels, and prostate cancer risk in forty patients newly diagnosed with prostate cancer and fifty-eight hospital controls recruited in two provinces from southern and northern Italy. We found an excess cancer risk in subjects in the third and fourth (highest) quartiles of toenail cadmium concentration (odds ratio 1.3 and 4.7, respectively) compared with subjects in the bottom quartile. Results were basically unchanged when limiting the analysis to each province or entering toenail cadmium concentrations as continuous values in the regression model (P=0.004). Despite the limited statistical stability of the point estimates, these findings appear to support the hypothesis that cadmium exposure increases prostate cancer risk. (c) 2006 Elsevier B.V All rights reserved.

2007 - Concomitant trans-peritoneal laparoscopic management of para-pelvic cyst and clearance of staghorn upper pole caliceal stone [Abstract in Rivista]
Micali, Salvatore; G., Pini; M. C., Sighinolfi; M., Grande; C., De Carne; DE STEFANI, Stefano; F., Fidanza; Bianchi, Giampaolo
abstract

Concomitant trans-peritoneal laparoscopic management of para-pelvic cyst and clearance of staghorn upper pole caliceal stone

2007 - Disfunzione erettile con associata eiaculazione precoce di lieve entità: risultati preliminari di una terapia con sildenafil citrato. [Poster]
A., Mofferdin; M. C., Sighinolfi; DE STEFANI, Stefano; Micali, Salvatore; M., Rivalta; F., Cianci; Bianchi, Giampaolo
abstract

Disfunzione erettile con associata eiaculazione precoce di lieve entità: risultati preliminari di una terapia con sildenafil citrato.

2007 - Dornier Lithotripter S: La prima casistica con oltre 1000 trattamenti [Abstract in Atti di Convegno]
Micali, Salvatore; M., Grande; M. C., Sighinolfi; C., De Carne; F., Fidanza; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Dornier Lithotripter S: La prima casistica con oltre 1000 trattamenti

2007 - Dornier Lithotripter S: La prima casistica con oltre 1000 trattamenti [Abstract in Rivista]
Micali, Salvatore; M., Grande; M. C., Sighinolfi; C., De Carne; F., Fidanza; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Dornier Lithotripter S: La prima casistica con oltre 1000 trattamenti

2007 - Dornier lithotripter S: The first report with more than 1000 treatments. [Poster]
M., Grande; Micali, Salvatore; M. C., Sighinolfi; C., De Carne; F., Fidanza; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Dornier lithotripter S: The first report with more than 1000 treatments.

2007 - Efficacia e sicurezza del puntamento fluoroscopico nella litotrissia extracorporea. [Poster]
M. C., Sighinolfi; Micali, Salvatore; T., Costi; M., Grande; F., Cianci; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Efficacia e sicurezza del puntamento fluoroscopico nella litotrissia extracorporea.

2007 - Efficacia in vitro del phyllantus niruri su frammenti litiasici di ossalato di calcio: Esperienza preliminare. [Poster]
M. C., Sighinolfi; Micali, Salvatore; G. P., Sighinolfi; N., Ferrari; DE STEFANI, Stefano; M., Grande; Bianchi, Giampaolo
abstract

Efficacia in vitro del phyllantus niruri su frammenti litiasici di ossalato di calcio: Esperienza preliminare.

2007 - Efficacy of expulsive therapy using nifedipine or tamsulosin, both associated with ketoprofene, after shock wave lithotripsy of ureteral stones [Articolo su rivista]
Micali, Salvatore; M., Grande; M. C., Sighinolfi; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Extracorporeal shock wave lithotripsy (ESWL) is currently considered one of the main treatments for ureteral stones. Some studies have reported the effectiveness of pharmacologic therapies (calcium antagonists or alpha-blockers) in facilitating ureteral stone expulsion after ESWL. We prospectively evaluated the efficacy, after ESWL, of nifedipine on upper-middle ureteral stones, and tamsulosin on lower ureteral stones, both associated to ketoprofene as anti-edema agent. From January 2003 to March 2005 we prospectively evaluated 113 patients affected by radiopaque or radiolucent ureteral stones. Average stone size was 10.16 +/- 2.00 mm (range 6-14 mm). Thirty-seven stones were located in the upper ureter, 27 in the middle ureter, and 49 in the lower ureter. All patients received a single session of ESWL (mean number of shock waves: 3,500) by means of a Dornier Lithotripter S (mean energy power for each treatment: 84%). Both ultrasound and X-ray were used for stone scanning. After treatment, 63 of 113 patients were submitted to medical therapy to aid stone expulsion: nifedipine 30 mg/day for 14 days administered to 35 patients with upper-middle ureteral stones (group A1) and tamsulosin 0.4 mg/day for 14 days administered to 28 patients with stones located in the distal ureter (group A2). The remaining 50 patients were used as a control group (29 upper-middle ureteral stones-B1-and 21 lower ureteral stones-B2-), receiving only pain-relieving therapy. No significant difference in stone size between the groups defined was observed. Stone clearance was assessed 1 and 2 months after ESWL by means of KUB, ultrasound scan and/or excretory urography. A stone-free condition was defined as complete stone clearance or the presence of residual fragments smaller than 3 mm in diameter. The stone-free rates in the expulsive medical therapy group were 85.7 and 82.1% for the nifedipine (A1) and tamsulosin (A2) groups respectively; stone-free rates in the control groups were 51.7 and 57.1% (B1 and B2, respectively). Five patients (14.3%) in group A1, 5 (17.8%) in group A2, 14 (48.3%) in group B1 and 9 (42.8%) in group B2 were not stone-free after a single ESWL session and required ESWL re-treatment or an endoscopic treatment. Medical therapy following ESWL to facilitate ureteral stone expulsion results in increased 1- and 2-month stone-free rates and in a lower percentage of those needing re-treatment. The efficacy of nifedipine for the upper-mid ureteral tract associated with ketoprofene makes expulsive medical therapy suitable for improving overall outcomes of ESWL treatment for ureteral stones.

2007 - Expression of the sodium/iodine symporter in prostate cells: A novel target for radioiodine-based treatment of prostate cancer? [Poster]
M., Navarra; Micali, Salvatore; S., Lepore; A., Cesinaro; F., Fidanza; M. C., Sighinolfi; C., De Gaetani; Bianchi, Giampaolo; D., Russo
abstract

Expression of the sodium/iodine symporter in prostate cells: A novel target for radioiodine-based treatment of prostate cancer?

2007 - Fluoroscopic focusing for shock wave lithotripsy: A safe procedure for an effective treatment [Abstract in Rivista]
M. C., Sighinolfi; T., Costi; Micali, Salvatore; M., Grande; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Fluoroscopic focusing for shock wave lithotripsy: A safe procedure for an effective treatment.

2007 - Immediate improvement in penile hemodynamics after cessation of smoking: previous results [Articolo su rivista]
M. C., Sighinolfi; A., Mofferdin; DE STEFANI, Stefano; Micali, Salvatore; A. F., Cicero; Bianchi, Giampaolo
abstract

OBJECTIVES: To assess the chronologic relationship between the cessation of smoking and the restoration of erectile function. Smoking is associated with an increased risk of erectile dysfunction. METHODS: Twenty active smokers (20 to 40 cigarettes/day) affected by erectile dysfunction (International Index of Erectile Function 5-item score less than 21) were enrolled in the study. The mean age was 40 years. All the patients underwent penile color Doppler ultrasonography during the basic and dynamic phases (10 microg prostaglandin E1). A second Doppler evaluation was performed 24 to 36 hours after cessation of smoking. The peak systolic velocity (PSV) and end-diastolic velocity (EDV) were recorded. The PSV and EDV cutoff value was 30 cm/s and 5 cm/s, respectively. RESULTS: Of the 20 patients, 10 (50%) had normal PSV values but only 5 (25%) had normal EDV values at the baseline Doppler evaluation. All the patients (100%) had normal PSV values at the second penile Doppler evaluation after smoking withdrawal, and 17 (85%) also had normal EDV values. The average PSV was 40.1 and 50.3 cm/s (P = 0.09) and the mean EDV was 6.8 and 2.4 cm/s (P <0.01) at the baseline penile Doppler examination and after smoking withdrawal, respectively. CONCLUSIONS: Within 24 to 36 hours of the cessation of cigarette smoking, the color Doppler parameters demonstrated a significant improvement in EDV and a trend toward an increase in PSV. Additional clinical evaluation is required to further characterize the expeditious improvement in erectile function after the cessation of smoking.

2007 - In vitro effect of Phyllantus niruri on calcium oxalate stone fragments: A preliminary experience. [Poster]
M. C., Sighinolfi; Micali, Salvatore; G. P., Sighinolfi; N., Ferrari; DE STEFANI, Stefano; M., Grande; Bianchi, Giampaolo
abstract

In vitro effect of Phyllantus niruri on calcium oxalate stone fragments: A preliminary experience.

2007 - In vitro effect of phyllantus niruri on calcium oxalate stone fragments: A preliminary experience [Abstract in Atti di Convegno]
M. C., Sighinolfi; N., Ferrari; G., Sighinolfi; M., Grande; Micali, Salvatore; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

In vitro effect of phyllantus niruri on calcium oxalate stone fragments: a preliminary experience.

2007 - Indwelling ureteral stents and sexual health: a prospective, multivariate analysis [Articolo su rivista]
Sighinolfi, M. C.; Micali, Salvatore; De Stefani, Stefano; Mofferdin, A.; Grande, A.; Giacometti, M.; Ferrari, N.; Rivalta, M.; Bianchi, Giampaolo
abstract

PURPOSE: Ureteral stents are common devices in urological practice. However, a stent may provoke lower urinary tract symptoms that severely affect quality of life. We evaluated the relationship between ureteral stents and male erection/female sexuality. MATERIALS AND METHODS: A total of 30 men and 20 women undergoing ureteral stent positioning were considered. Patients affected by risk factors for erectile dysfunction or hormonal and metabolic alterations were excluded. Hystero-ovariectomy and menopause were considered exclusion criteria. Three questionnaires were administered before stenting and 45 to 60 days after stent positioning, including the International Prostate Symptom Score, the International Index of Erectile Function-5 for men and the Female Sexual Function Index for women. RESULTS: Mean age was 45 years in men and 39 years in women. The mean+/-SD International Index of Erectile Function-5 score was 23.2+/-1.27 and the mean Female Sexual Function Index score was 32.15+/-2.71 before stent positioning. No lower urinary tract symptoms were reported before the procedure. After the ureteral stent was indwelling the mean International Index of Erectile Function-5 score was 13.5+/-4.01 and the mean Female Sexual Function Index score was 23.6+/-14.66 (p=0.000 and 0.007, respectively). Of 30 men 25 reported a pathological International Index of Erectile Function-5 score and 6 of 20 women denied any sexual activity due to stent related anxiety, resulting in the minimum Female Sexual Function Index score. In the remaining 14 women sexual life was not significantly impaired by the ureteral stent (p=0.08). CONCLUSIONS: Ureteral stents impaired the quality of sexual life in male and female subjects. In men the most important distress was in regard to erectile function, probably related to lower urinary tract symptoms. Conversely female sexuality appeared to be severely impaired due to stent related psychological concerns.

2007 - La litotrissia extracorporea come trattamento di scelta per la calcolosi reno ureterale dopo by pass intestinale. [Poster]
Micali, Salvatore; M. C., Sighinolfi; M., Grande; A., Beato; L., Piccagliani; S., De Bernardinis; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

La litotrissia extracorporea come trattamento di scelta per la calcolosi reno ureterale dopo by pass intestinale.

2007 - Laparoscopic radical cystectomy: An Italian survey [Articolo su rivista]
Sighinolfi, Maria Chiara; Micali, Salvatore; Celia, A; DE STEFANI, Stefano; Grande, Marco Serafino; Rivalta, Massimo; Bianchi, Giampaolo
abstract

BACKGROUND: Radical cystectomy with urinary diversion is the current gold standard procedure for muscle-invasive bladder cancer. However, laparoscopic radical cystectomy (LRC) has evolved rapidly worldwide during the past decade, despite its complexity due to both the demolitive step with management of a highly aggressive cancer and the reconstructive step. The authors performed a survey to assess the Italian experience with LRC and urinary diversion in an effort to point out the volume of the procedure in their country, providing some surgical details. METHODS: A total of 10 Italian urologic departments with experts in laparoscopic urologic surgery were contacted and asked to participate in a two-page survey concerning indications for cystectomy, laparoscopic technique, intra- and postoperative complications, and follow-up evaluation of the procedure when available. RESULTS: Five sites elected to participate, and a total of 83 LRCs were collected. All centers used five trocar ports. The mean operative time was 8 h and 40 min, and the estimated blood loss was 376 ml. In two cases, the procedure was converted to open surgery. Postoperative complications consisted of one urinary leakage, one fistula, and one atrium rupture. A retrieval sac was used in all cases. Urinary diversions consisted of 43 ileal conduits, 26 orthotopic diversions, and 14 other techniques. The mean follow-up period was 9 months (range, 1-36 months). No tumor seeding was recorded. CONCLUSIONS: The LRC procedure is feasible although technically demanding. The morbidity of this procedure is evident, but may be reduced with further experience. Bowel management and reconstruction remain the most challenging part of the procedure.

2007 - Nefrolitotrissia percutanea con plurimi accessi ecoguidati per calcolosi a stampo complessa [Abstract in Rivista]
Micali, Salvatore; C., Di Pietro; DE STEFANI, Stefano; F., Annino; C., De Carne; Bianchi, Giampaolo
abstract

Nefrolitotrissia percutanea con plurimi accessi ecoguidati per calcolosi a stampo complessa

2007 - Quattro anni di esperienza con Dornier Lithotripter S: Analisi di oltre 1100 casi. [Poster]
Micali, Salvatore; M. C., Sighinolfi; M., Grande; F., Cianci; A., Annino; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Quattro anni di esperienza con Dornier Lithotripter S: Analisi di oltre 1100 casi.

2007 - Ruolo del Phillantus niruri (Uriston) come terapia adiuvante alla litotrissia extracorporea per i calcoli renali [Abstract in Rivista]
Micali, Salvatore; M., Grande; M. C., Sighinolfi; DE STEFANI, Stefano; C., De Carne; F., Fidanza; Bianchi, Giampaolo
abstract

Ruolo del Phillantus niruri (Uriston) come terapia adiuvante alla litotrissia extracorporea per i calcoli renali

2007 - Ruolo del Phillantus niruri (Uriston) come terapia adiuvante alla litotrissia extracorporea per i calcoli renali [Abstract in Atti di Convegno]
Micali, Salvatore; M., Grande; M. C., Sighinolfi; DE STEFANI, Stefano; C., De Carne; F., Fidanza; Bianchi, Giampaolo
abstract

Ruolo del Phillantus niruri (Uriston) come terapia adiuvante alla litotrissia extracorporea per i calcoli renali

2007 - Safety and efficacy of fluoroscopic focusing for shock wave lithotripsy. [Poster]
M. C., Sighinolfi; Micali, Salvatore; T., Costi; M., Grande; DE STEFANI, Stefano; F., Fidanza; Bianchi, Giampaolo
abstract

Safety and efficacy of fluoroscopic focusing for shock wave lithotripsy.

2007 - Safety and tolerability of shock wave lithotripsy in an elderly population. [Poster]
M. C., Sighinolfi; Micali, Salvatore; M., Grande; DE STEFANI, Stefano; N., Ferrari; Bianchi, Giampaolo
abstract

INTRODUCTION: The aim of our study is to consider the feasibility and the results of shock wave lithotripsy (SWL) in an elderly cohort of patients, considering different diseases and concomitant morbidity. MATERIALS AND METHODS: From January 2003 up to July 2006, a total of 1100 SWL treatments were performed in our Stone Centre with Dornier Lithotripter S device. We retrospectively analyzed all the treatments carried out in patients older than 70 years of age, collecting a total of 130 patients. The average age was 75.1 years (range: 70-89). Stone location was renal in 95 and ureteral in 45 patients. Information about SWL outcomes and complications were collected as well as patient's characteristics and treatment modalities. RESULTS: Average stone size was 10.2+/-3.4 and 8.7+/-3.1 for the renal and ureteral location, respectively. 73 out of 140 patients (52.1%) were stone free after a single treatment; 49 patients (35%) required an adjunctive session, whereas SWL was unsuccessful in 18 (12.8%) patients. We observed 64, 24, 21, 10, 31 cases of concomitant arterial hypertension, diabetes mellitus, chronic renal failure, solitary kidney condition and previous neoplastic pathologies. A total of 8 and 6 subjects had previous cardiac surgery and atrial fibrillation respectively, thus requiring a warfarin scheduled conversion to low molecular weight heparin. Five patients had a pace maker implant and three patients an abdominal aortic aneurism. No SWL-related complications were found in this series considering both urological and systemic features. CONCLUSION: SWL represents the treatment of choice for urolithiasis, and it has to be recommended especially to geriatric patients. In those subjects, SWL complications can be avoided with a proper and personalized preparation, together with an ECG and ultrasound continuously monitored procedure.

2007 - Shock wave lithotripsy as primari treatment of urolithiasis after intestinal by-pass. [Poster]
M. C., Sighinolfi; Micali, Salvatore; F., Fidanza; M., Grande; L., Piccagliani; G., De Bernardinis; DE STEFANI, Stefano; N., Ferrari; Bianchi, Giampaolo
abstract

Shock wave lithotripsy as primari treatment of urolithiasis after intestinal by-pass.

2007 - Studio prospettico sulla ureterolitotomia laparoscopica: Approccio trans e retroperitoneale a confronto. [Abstract in Rivista]
P., Bove; Micali, Salvatore; G., Mirabile; R., Miano; A., Campagna; E., Buttero; Bianchi, Giampaolo; G., Vespasiani
abstract

Studio prospettico sulla ureterolitotomia laparoscopica: Approccio trans e retroperitoneale a confronto.

2007 - The use of fibrin glue in bulbar ureteral reconstraction [Abstract in Rivista]
G., Barbagli; DE STEFANI, Stefano; F., Annino; M. C., Sighinolfi; Micali, Salvatore; Bianchi, Giampaolo
abstract

The use of fibrin glue in bulbar ureteral reconstraction

2006 - A prospective evaluation of long-term therapy with tadalafil and penile haemodinamics at color doppler ultrasound. [Poster]
A., Mofferdin; M. C., Sighinolfi; DE STEFANI, Stefano; Micali, Salvatore; G., Peluso; Bianchi, Giampaolo
abstract

A prospective evaluation of long-term therapy with tadalafil and penile haemodinamics at color doppler ultrasound

2006 - Approccio terapeutico alla calcolosi urinaria [Articolo su rivista]
Micali, Salvatore; DE CARNE, Cosimo; Grande, Marco Serafino; Sighinolfi, Maria Chiara; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Approccio terapeutico alla calcolosi urinaria

2006 - Approccio terapeutico alla calcolosi urinaria [Capitolo/Saggio]
Micali, Salvatore; C., De Carne; M., Grande; M. C., Sighinolfi; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Approccio terapeutico alla calcolosi urinaria

2006 - Benign intratesticular schwannoma: A rare finding. [Articolo su rivista]
M. C., Sighinolfi; A., Mofferdin; DE STEFANI, Stefano; A., Celia; Micali, Salvatore; G., Saredi; G., Rossi; R., Valli; Bianchi, Giampaolo
abstract

Schwannoma is a peripheral nerve tumour, occasionally located in the genitourinary tract. We described an extremely rare case of intratesticular neurinoma in a 79-year-old patient.

2006 - Bulbar urethroplasty with dorsal onlay buccal mucosal graft and fibrin glue [Articolo su rivista]
G., Barbagli; DE STEFANI, Stefano; M. C., Sighinolfi; F., Annino; Micali, Salvatore; Bianchi, Giampaolo
abstract

OBJECTIVES: We describe a new surgical technique with the use of fibrin glue for bulbar urethra reconstruction using a dorsal buccal mucosal onlay graft. METHODS: Six patients with a mean age of 43 yr underwent bulbar urethroplasty with dorsal onlay buccal mucosal graft and fibrin glue. The urethra was mobilised from the corpora cavernosa and opened along its dorsal surface. The buccal mucosal graft was applied on the corpora cavernosa using 2 ml of fibrin glue. Two interrupted polyglactin 5-0 sutures were used to fix the apices of the graft to the underlying albuginea of the corpora cavernosa. The urethra was rotated back to cover the graft and an adjunctive fibrin glue was injected over the urethra. RESULTS: The mean operative time was 100 min (range, 90-120 min). No intraoperative or postoperative complications were observed. Voiding cystourethrography was performed when the catheter was removed 2 wk after surgery. Urine culture, uroflowmetry, and urethrography were repeated after 6 and 12 mo and annually thereafter. Mean follow-up was 16 mo (range, 12-24 mo). No restrictures at the anastomotic sites were demonstrated in any of the patients 6 and 12 mo after surgery. CONCLUSIONS: The use of fibrin glue represents a slight but significant step toward perfecting the surgical technique of bulbar urethral reconstruction.

2006 - Cadmio e rischio di tumore alla prostata [Abstract in Rivista]
Venturelli, Marianna; Vinceti, Marco; Ferrari, Angela; Bonvicini, Francesca; Bussetti, Pamela; Bianchi, Giampaolo; Sighinolfi, Maria Chiara; Farinetti, Alberto; Trerotoli, P; Serio, G; Bergomi, Margherita; Vinceti, M.
abstract

Obiettivi: In questo studio abbiamo esaminato il possibile ruolo del cadmio nell'eziologia della neoplasia prostatica attraverso l'uso di un indicatore di esposizione a lungo termine come la matrice ungueale, in due differenti regioni italiane.Metodi: Abbiamo reclutato 40 casi e 58 controlli rispettivamente presso le cliniche urologiche e quelle chirurgiche dei policlinici universitari di Modena e Bari. L'età dei soggetti reclutati varia dai 43 a 83 anni. Ogni partecipante ha fornito un campione di unghie dei piedi sul quale effet¬tuare la determinazione quantitativa degli elementi, previo lavaggio e mineralizzazione in forno a microonde, mediante spettrofotometria di assorbimento atomico con atomizzazione in fornetto di grafite. I dati sono stati elaborati statisticamente attraverso il software Stata 9.1 al fine di calcolare il rischio relativo di neoplasia prostatica mediante il calcolo del rischio relativo (RR) nei differenti intervalli di esposizione dati dai terzili utilizzati come cutoff.Risultati:1I rischio di neoplasia prostatica è risultato maggiore nel terzile internedio (RR=1.7 -IC95% 0.5/6.4) e più elevato (RR=4.3- IC95% 1.3/ 13.8) (p-trend 0.029)di esposizione a cadmio, sia nell'intera casistica che considerando i dati disaggregati per provincia. L'introduzione delle variabili confondenti quali bmi, abitudini tabagiche e dieta ha modificato sensibil¬mente le stime del rischio relativo.Conclusioni: I risultati prodotti dallo studio che abbiamo condotto, pur con la bassa stabilità statistica dovuta alle ridotte dimensioni della casistica, ci conducono a sostenere l'ipotesi, già suggerita da studi epidemiologici e di laboratorio, che l'esposizione a cadmio possa incrementare il rischio di tu¬more prostatico.

2006 - Calcolosi ureterale ostruente con associato peggioramento della funzionalità renale: Può la litotrissia extracorporea rappresentare un trattamento d’urgenza? [Abstract in Atti di Convegno]
M. C., Sighinolfi; A., Celia; Micali, Salvatore; M., Grande; A., Beato; DE STEFANI, Stefano; A., Mofferdin; N., Ferrari; Bianchi, Giampaolo
abstract

Calcolosi ureterale ostruente con associato peggioramento della funzionalità renale: Può la litotrissia extracorporea rappresentare un trattamento d’urgenza?

2006 - Calcolosi ureterale ostruente con associato peggioramento della funzionalità renale: Può la litotrissia extracorporea rappresentare un trattamento d’urgenza? [Abstract in Atti di Convegno]
M. C., Sighinolfi; A., Celia; Micali, Salvatore; M., Grande; A., Beato; DE STEFANI, Stefano; A., Mofferdin; Bianchi, Giampaolo
abstract

Calcolosi ureterale ostruente con associato peggioramento della funzionalità renale: Può la litotrissia extracorporea rappresentare un trattamento d’urgenza?

2006 - Can Phyllanthus niruri affect the efficacy of extracorporeal shock wave lithotripsy for renal stones? A randomized, prospective, long-term study [Articolo su rivista]
Micali, Salvatore; Sighinolfi, Maria Chiara; A., Celia; DE STEFANI, Stefano; Grande, Marco Serafino; A. F., Cicero; Bianchi, Giampaolo
abstract

PURPOSE: Phyllanthus niruri is a plant used in Brazilian folk medicine for the treatment of urolithiasis. We assessed the efficacy of P. niruri after extracorporeal shock wave lithotripsy for renal stones. MATERIALS AND METHODS: We prospectively evaluated 150 patients with renal stones that were as large as 25 mm and composed of calcium oxalate. All patients received 1 to 3 extracorporeal shock wave lithotripsy sessions by Dornier Lithotriptor S. After treatment 78 of 150 patients (52%) underwent therapy with Uriston, a P. niruri extract (2 gm daily) for at least 3 months (group 1). Otherwise 72 of 150 patients (48%) were used as a control group (group 2). No significant difference in stone size between the 2 groups was found. Stone clearance was assessed after 30, 60, 90 and 180 days by abdominal x-ray and ultrasound scan. RESULTS: Stone-free rate (stone-free defined as the absence of any stone or residual fragments less than 3 mm) was 93.5% in group 1 and 83.3% in group 2 (p = 0.48) at the end point of the followup (180 days). For lower caliceal stones (56 patients) the stone-free rate was 93.7% in the treatment group and 70.8% in the control group (p = 0.01). Re-treatment need for group 1 was 39.7% and for group 2 it was 43.3% (p = 0.2). No side effects were recorded with extracorporeal shock wave lithotripsy or P. niruri therapy. CONCLUSIONS: Regular self-administration of P. niruri after extracorporeal shock wave lithotripsy for renal stones results in an increased stone-free rate that appears statistically significant for lower caliceal location. Its efficacy and the absolute lack of side effects make this therapy suitable to improve overall outcomes after extracorporeal shock wave lithotripsy for lower pole stones.

2006 - Changes in peak systolic velocity induced by chronic therapy with phosphodiesterase type-5 inhibitor [Articolo su rivista]
M. C., Sighinolfi; A., Mofferdin; DE STEFANI, Stefano; A., Celia; Micali, Salvatore; A. F., Cicero; Bianchi, Giampaolo
abstract

The aim of this study was to assess the influence of chronic therapy with phosphodiesterase type-5 inhibitor on penile haemodynamics at colour Doppler ultrasound. Thirty patients affected by erectile dysfunction (ED) of different aetiology tested with the International Index of Erectile Function (IIEF-5) were evaluated with penile colour Doppler ultrasound during basic and dynamic phases (10 microg PGE1) before and after chronic self-administration of sildenafil citrate (dosage: 100 mg as required, two to three times a week) for a period of 5-20 months (mean: 12.3). Treatment was interrupted 14-21 days before the second ultrasound evaluation. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were recorded by means of colour Doppler; cut off values were 25 and 5 cm s(-1) respectively. Data were compared by nonparametric tests. Twenty-two of the 30 patients showed normal pre-treatment PSV, while eight of 30 had an insufficient arterial flow. Mean pre-treatment EDV was 4.7 +/- 0.5. After chronic therapy with sildenafil, a global improvement of 10.5% on PSV was seen (P &lt; 0.001), without any statistical difference between patients with normal pre-treatment peak and those with a borderline one. No statistically significant changes were found for EDV (P = 0.98). It is concluded that chronic therapy with phosphodiesterase-5 inhibitor results in a significant improvement in PSV values, probably due to a penile chronic vasoactive enhancement.

2006 - Comparative evaluation between external phased array coil at 3 T and endorectal coil at 1.5 T - Preliminary results [Articolo su rivista]
Torricelli, Pietro; Cinquantini, F; Ligabue, Guido; Bianchi, Giampaolo; Sighinolfi, P; Romagnoli, R.
abstract

Objective: The aim of this study was to compare the image quality and the diagnostic accuracy of endorectal coil 1.5 T MRI (erMRI) and phased-array coil 3 T MRI (3-T MRI) in the pretherapeutic staging of prostate cancer. Methods: Twenty-nine consecutive patients, with pathological proven prostate cancer, have been examined in the same week with both erMRI and 3-T MRI. Two radiologists independently evaluated the image quality focusing on the following points: cancer tissue conspicuity, capsular infiltration and tumor involvement of seminal vesicles, neuro-vascular bundles, and apex. The radiologists assigned to each one of the above findings an image-quality score ranging from 1 to 5 (with 1 meaning not visible, 2 poorly visible, 3 fairly visible, 4 well visible with some artifacts, and 5 clearly visible without artifacts). Afterwards a comparative evaluation of the mean score obtained respectively by erMRI and 3 T MRI was done. Twenty-two of these 29 patients underwent radical prostatectomy. Assuming as gold standard the pathological report from the resected specimen, we compared the diagnostic accuracy of 3TMRI and erMRI in differentiating between tumors confined within the prostate gland (stage &lt;= T2) and tumors extending through the prostatic capsule (stages T3 and T4). Results: erMRI's image quality was found to be statistically significantly better than 3 T MRI's in evaluating tumor conspicuity, capsular infiltration, and seminal vesicles involvement. On the other hand, considering apex and NVB involvement no statistically significant difference was found between the 2 techniques. On the diagnosis of intracapsular or extracapsular tumor spread 3 T MRI and erMRI showed a comparable performance of sensitivity (75% vs. 83%), specificity (90% vs. 90%), positive predictive value (90% vs. 90%), and negative predictive value (75% vs. 81%). Conclusions: During preoperative prostate cancer staging, 3 T MRI, despite a slightly worse image quality, can provide comparable diagnostic information to erMRI.

2006 - Correlazione fra stent ureterali e sessualità: Analisi prospettica e multivariata [Abstract in Atti di Convegno]
M. C., Sighinolfi; DE STEFANI, Stefano; A., Mofferdin; A., Celia; M., Giacometti; M., Rivalta; Micali, Salvatore; Bianchi, Giampaolo
abstract

Correlazione fra stent ureterali e sessualità: Analisi prospettica e multivariata

2006 - Correlazione fra stent ureterali e sessualità: Analisi prospettica e multivariata [Abstract in Atti di Convegno]
M. C., Sighinolfi; DE STEFANI, Stefano; A., Mofferdin; A., Celia; M., Giacometti; M., Rivalta; N., Ferrari; Micali, Salvatore; Bianchi, Giampaolo
abstract

Correlazione fra stent ureterali e sessualità: Analisi prospettica e multivariata

2006 - Correlazione fra stent ureterali e sessualità: Analisi prospettica e multivariata [Abstract in Rivista]
M. C., Sighinolfi; DE STEFANI, Stefano; A., Mofferdin; A., Celia; M., Giacometti; M., Rivalta; N., Ferrari; Micali, Salvatore; Bianchi, Giampaolo
abstract

Correlazione fra stent ureterali e sessualità: Analisi prospettica e multivariata

2006 - Dorsal buccal mucosaonlay graft bulbar urethroplasty using fibrine glue [Abstract in Rivista]
G., Barbagli; DE STEFANI, Stefano; M. C., Sighinolfi; F., Annino; Micali, Salvatore; Bianchi, Giampaolo
abstract

Dorsal buccal mucosaonlay graft bulbar urethroplasty using fibrine glue

2006 - Experience with fibrin glue in bulbar urethral reconstruction using dorsal buccal mucosa graft [Articolo su rivista]
G., Barbagli; DE STEFANI, Stefano; Mc, Sighinolfi; Ca, Pollastri; F., Annino; Micali, Salvatore; Bianchi, Giampaolo
abstract

Buccal mucosa dorsal onlay graft urethroplasty represents a widespread method for bulbar urethral stricture repair. We describe a modified procedure with the use of fibrin glue applied on the receiving bed before graft location.

2006 - Fattori di rischio ambientali e comportamentali del tumore alla prostata in due popolazioni italiane. [Abstract in Atti di Convegno]
Venturelli, Marianna; Vinceti, Marco; Bergomi, Margherita; Sighinolfi, Maria Chiara; Bianchi, Giampaolo; Malavolti, Marcella; Battistini, Nino Carlo; Farinetti, Alberto; Trerotoli, P; Serio, A; Vivoli, Gianfranco
abstract

Obiettivi: Ci siamo proposti di valutare il ruolo della dieta e di alcuni elementi in traccia di interesse tossicologico e nutrizionale (cadmio, selenio, rame e zinco) nell'eziologia della neoplasia prostatica in due popolazioni italiane, quella emiliana e quella pugliese.Metodi: Abbiamo reclutato un campione di 45 pazienti affetti da neoplasia prostatica di diagnosi recente e di 68 controlli di popolazione presso i Policlinici universitari di Bari e di Modena, limitando la selezione ai soggetti di età superiore a 45 anni e residenti da almeno 10 anni nelle due province. I controlli sono stati selezionati con metodo casuale tra i soggetti afferenti alle Divisioni chirurgiche dei due ospedali per sottoporsi ad interventi di piccola chirurgia, appaiandoli per età ai pazienti (±5anni). Per la determinazione quantitativa degli oligoelementi, previo lavaggio e mineralizzazione delle unghie con HN03 in forno a microonde, abbiamo utilizzato la tecnica AAS con atomizzazione in fometto di grafite (Cd,Se,Cu) e in fiamma (Zn), utilizzando quale materiale di riferimento campioni certificati di capelli umani CRM 397 e GBW 09101. La valutazione della dieta è stata effettuata mediante la somministrazione dei questionari semiquantitativi di frequenza alimentare dello studio europeo 'EPIC'.Risultati: Abbiamo osservato nei casi, rispetto ai controlli, livelli più elevati di cadmio (0.108 vs. 0.034 ug/g) e di rame (5.07 vs. 3.78 ug/lg), mentre non abbiamo riscontrato differenze particolari per selenio e zinco. Il rischio di neoplasia prostatica non è tuttavia risultato associato a nessuno degli elementi studiati. L'analisi dei dati disaggregati sotto il profilo geografico ci ha mostrato rilevanti differenze soprattutto per quanto riguardo il cadmio. I pazienti di Bari hanno infatti evidenziato concentrazioni medie pari a 0.168 ug/g contro i 0.044 ug/g dei controlli, mentre per i soggetti modenesi abbiamo osservato rispettivamente 0.042 e 0.027 ug/g. Per quanto riguarda la dieta, il rischio di tumore pro statico è apparso direttamente associato all'apporto di alcune variabili alimentari, in particolare proteine animali, lipidi animali, acidi grassi saturi totali, alcool, calcio e vitamina D, mentre l'introduzione di proteine vegetali, carboidrati e amido è risultata inversamente corre lata col rischio di patologia.Conclusioni: I risultati di questo studio debbono essere valutati con una certa cautela a causa delle dimensioni limitate della casistica, anche se l'utilizzazione di un bioindicatore particolarmente adatto a stimare l'esposizione a medio termine, le unghie, e di un questionario alimentare completo e validato sotto il profilo epidemiologico ne favoriscono l'attendibilità. I risultati delle determinazioni effettuate sulle unghie non suggeriscono che cadmio, selenio, rame e zinco esercitino un ruolo nelI'eziopatogenesi della neoplasia prostatica. Per quanto riguarda la dieta, abbiamo individuato incrementi del rischio in associazione a variabili alimentari già corre late in studi condotti in altri Paesi a questo tipo di neoplasia, che sembrano confermare come anche in queste due popolazioni italiane, caratterizzate da sensibili differenze sul piano della dieta abituale e presumibilmente delle esposizioni ambientali, la dieta eserciti un ruolo non marginale nel determinismo di questa patologia.

2006 - Laparoscopic adrenalectomy of an insidiose retroperitoneal mass. [Abstract in Rivista]
Micali, Salvatore; F., Annino; M. C., Sighinolfi; A., Cestari; A., Celia; G., Guazzoni; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Laparoscopic adrenalectomy of an insidiose retroperitoneal mass.

2006 - Management of bleeding during laparoscopic adrenalectomy: A case report [Abstract in Rivista]
Bianchi, Giampaolo; Micali, Salvatore; A., Celia; F., Annino; M. C., Sighinolfi; M., Grande; DE STEFANI, Stefano
abstract

Management of bleeding during laparoscopic adrenalectomy: A case report

2006 - Medical therapy of urolithiasis. [Articolo su rivista]
Micali, Salvatore; Grande, Marco Serafino; Sighinolfi, Maria Chiara; DE CARNE, Cosimo; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Nephrolithiasis treatment has become easier and less invasive with the development of extracorporeal shockwave lithotripsy (SWL) and endourologic techniques. However, medical therapy represents a well-established and complementary approach that can improve the efficacy of SWL and endourology. During recent decades, pharmacologic intervention has become more effective in stone disease: drugs can control the pain of renal colic, interfere at various levels in lithogenesis, and contribute to the expulsion of stones. It is well known that lithogenesis is a multifactorial process influenced by environmental-nutritional factors (low urinary volume, diet rich in animal protein, etc) and metabolic alterations; i.e., hypercalciuria, hyperuricosuria, and deficiency of stone-inhibiting factors (citrate, magnesium, glycosaminoglycans [GAGs]). Specific drugs such as citrate, allopurinol, and thiazide represent highly effective treatments for the promoting factors. Furthermore, recent findings suggest an interesting role for a phytotherapeutic agent, Phillantus niruri, and its inhibitory action on calcium oxalate crystallization related to the higher incorporation of GAGs into the calculi. Another step forward in medical management of stone disease is expulsive therapy. Many studies have proven the efficacy of medical expulsive therapy with nifedipine and alpha-blockers: their specific action on ureteral smooth muscle in association with anti-edema drugs accounts for their efficacy in expelling ureteral stones. In this paper, we provide an update on the medical treatment of stone disease, focusing our attention on what is known and what is new in renal colic and litholithic and expulsive medical therapy.

2006 - Multiple US-guided access for percutaneous nephrolithotripsy: A case report [Abstract in Rivista]
Micali, Salvatore; C., Di Pietro; F., Annino; M. C., Sighinolfi; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Multiple US-guided access for percutaneous nephrolithotripsy: A case report

2006 - Nefrolitotrissia percutanea con plurimi accessi eco-guidati per calcolosi a stampo complessa [Abstract in Rivista]
Bianchi, Giampaolo; C., Di Pietro; Micali, Salvatore; F., Annino; B., Baisi
abstract

Nefrolitotrissia percutanea con plurimi accessi eco-guidati per calcolosi a stampo complessa

2006 - Obstracting ureteral stones with renal impairment: Can shock wave lithotripsy represent an emergency treatment? [Abstract in Rivista]
Micali, Salvatore; M. C., Sighinolfi; N., Ferrari; A., Beato; DE STEFANI, Stefano; M., Rivalta; M., Grande; Bianchi, Giampaolo
abstract

Obstracting ureteral stones with renal impairment: Can shock wave lithotripsy represent an emergency treatment

2006 - Phyllanthus Niruri and metabolic evaluation on urinary samples: A prospective study. [Poster]
Micali, Salvatore; M. C., Sighinolfi; N., Ferrari; M., Grande; C., De Carne; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Phyllanthus Niruri and metabolic evaluation on urinary samples: A prospective study

2006 - Squamous cell carcinoma of the prostate [Articolo su rivista]
DI PIETRO, Corradino; Celia, Antonio; DE STEFANI, Stefano; Saredi, Giovanni; BIANCHI, Giampaolo
abstract

Primary squamous cell carcinoma of the prostate is an extremely uncommon malignancy, accounting for less than 0.2-1% of all prostatic cancers. We report one case of primary squamous cell carcinoma of the prostate. This patient presented with lower urinary tract symptoms with acute urinary retention after TURP.

2006 - Surrenalectomia laparoscopica per voluminoso ancient schwannoma retroperitoneale: case report. [Abstract in Rivista]
Micali, Salvatore; F., Annino; A., Cestari; G., Peluso; A., Celia; DE STEFANI, Stefano; G., Guazzoni; Bianchi, Giampaolo
abstract

Surrenalectomia laparoscopica per voluminoso ancient schwannoma retroperitoneale: case report.

2006 - Una nuova uretroplastica bulbare con mucosa buccale: tecnica chirurgica e risultati preliminari. [Poster]
G., Barbagli; M. C., Sighinolfi; C. A., Pollastri; F., Annino; Micali, Salvatore; Bianchi, Giampaolo
abstract

Una nuova uretroplastica bulbare con mucosa buccale: tecnica chirurgica e risultati preliminari.

2006 - Ureterolitotomia retroperitoneoscopica: Case report. [Abstract in Rivista]
Micali, Salvatore; A., Celia; DE STEFANI, Stefano; F., Annino; M., Grande; M. C., Sighinolfi; Bianchi, Giampaolo
abstract

Ureterolitotomia retroperitoneoscopica: Case report.

2006 - Valutazione prospettica dell’assunzione cronica di Phyllanthus Niruri e studio metabolico urinario [Abstract in Atti di Convegno]
M. C., Sighinolfi; A., Celia; Micali, Salvatore; N., Ferrari; M., Corinti; M., Grande; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Valutazione prospettica dell’assunzione cronica di Phyllanthus Niruri e studio metabolico urinario

2006 - Valutazione prospettica dell’assunzione cronica di Phyllanthus Niruri e studio metabolico urinario [Abstract in Atti di Convegno]
M. C., Sighinolfi; A., Celia; Micali, Salvatore; M., Corinti; F., Annino; M., Grande; N., Ferrari; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Valutazione prospettica dell’assunzione cronica di Phyllanthus Niruri e studio metabolico urinario

2006 - Valutazione prospettica dell’assunzione cronica di Phyllanthus Niruri e studio metabolico urinario [Abstract in Rivista]
M. C., Sighinolfi; A., Celia; Micali, Salvatore; M., Corinti; F., Annino; M., Grande; N., Ferrari; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Valutazione prospettica dell’assunzione cronica di Phyllanthus Niruri e studio metabolico urinario

2005 - A knotted multi-length ureteral stent: a rare complication [Articolo su rivista]
DE STEFANI, Stefano; Micali, Salvatore; Mofferdin, A.; B., Baisi; A., Celia; Bianchi, Giampaolo; M. C., Sighinolfi
abstract

Ureteral catheters represent essential devices in the management of upper urinary tract obstruction; complications are unusual. Knotting of the stent at its proximal coiled end is a very rare but potentially dangerous event that should be promptly recognized.

2005 - Bizarre leiomyoma of scrotum [Articolo su rivista]
A., Celia; M., Bruschi; DE STEFANI, Stefano; B., Baisi; A. M., Cesinaro; Micali, Salvatore; M. C., Sighinolfi; Bianchi, Giampaolo
abstract

Genital leiomyomas of the scrotal skin are extremely rare benign tumors, originating from the tunica dartos of the scrotum. We report our experience with one patients with scrotal bizarre leiomyoma.

2005 - Complicanze emorragiche in laparoscopia: nostra esperienza durante una surrenalectomia. [Abstract in Rivista]
Bianchi, Giampaolo; Micali, Salvatore; A., Celia; F., Annino; M. C., Sighinolfi; M., Grande; DE STEFANI, Stefano
abstract

Complicanze emorragiche in laparoscopia: nostra esperienza durante una surrenalectomia.

2005 - Efficacia della terapia medica espulsiva (nifedipina o tamsulosina) nella calcolosi ureterale dopo trattamento eswl. [Abstract in Rivista]
Micali, Salvatore; M., Grande; M., Corinti; C., De Carne; A., Celia; M. C., Sighinolfi; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Efficacia della terapia medica espulsiva (nifedipina o tamsulosina) nella calcolosi ureterale dopo trattamento eswl.

2005 - Efficacia della terapia medica espulsiva (nifedipina o tamsulosina) nella calcolosi ureterale dopo trattamento eswl. [Abstract in Atti di Convegno]
Micali, Salvatore; A., Celia; M. C., Sighinolfi; M., Grande; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Efficacia della terapia medica espulsiva (nifedipina o tamsulosina) nella calcolosi ureterale dopo trattamento eswl

2005 - Efficacia e tollerabilità dell’ ESWL per calcoli reno-ureterali: uno studioretrospettivoa lungo termine. [Abstract in Rivista]
Micali, Salvatore; C., Di Pietro; A., Celia; M. C., Sighinolfi; M., Grande; G., Peluso; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Efficacia e tollerabilità dell’ ESWL per calcoli reno-ureterali: uno studioretrospettivoa lungo termine.

2005 - Efficacy of expulsive medical therapy using nifedipine or tamsulosin after shock wave lithotripsy of ureteral stones. [Poster]
Micali, Salvatore; A., Celia; M. C., Sighinolfi; M., Grande; M., Bisi; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Extracorporeal shock wave lithotripsy (ESWL) is currently considered one of the main treatments for ureteral stones. Some studies have reported the effectiveness of pharmacologic therapies (calcium antagonists or alpha-blockers) in facilitating ureteral stone expulsion after ESWL. We prospectively evaluated the efficacy, after ESWL, of nifedipine on upper-middle ureteral stones, and tamsulosin on lower ureteral stones, both associated to ketoprofene as anti-edema agent. From January 2003 to March 2005 we prospectively evaluated 113 patients affected by radiopaque or radiolucent ureteral stones. Average stone size was 10.16 +/- 2.00 mm (range 6-14 mm). Thirty-seven stones were located in the upper ureter, 27 in the middle ureter, and 49 in the lower ureter. All patients received a single session of ESWL (mean number of shock waves: 3,500) by means of a Dornier Lithotripter S (mean energy power for each treatment: 84%). Both ultrasound and X-ray were used for stone scanning. After treatment, 63 of 113 patients were submitted to medical therapy to aid stone expulsion: nifedipine 30 mg/day for 14 days administered to 35 patients with upper-middle ureteral stones (group A1) and tamsulosin 0.4 mg/day for 14 days administered to 28 patients with stones located in the distal ureter (group A2). The remaining 50 patients were used as a control group (29 upper-middle ureteral stones-B1-and 21 lower ureteral stones-B2-), receiving only pain-relieving therapy. No significant difference in stone size between the groups defined was observed. Stone clearance was assessed 1 and 2 months after ESWL by means of KUB, ultrasound scan and/or excretory urography. A stone-free condition was defined as complete stone clearance or the presence of residual fragments smaller than 3 mm in diameter. The stone-free rates in the expulsive medical therapy group were 85.7 and 82.1% for the nifedipine (A1) and tamsulosin (A2) groups respectively; stone-free rates in the control groups were 51.7 and 57.1% (B1 and B2, respectively). Five patients (14.3%) in group A1, 5 (17.8%) in group A2, 14 (48.3%) in group B1 and 9 (42.8%) in group B2 were not stone-free after a single ESWL session and required ESWL re-treatment or an endoscopic treatment. Medical therapy following ESWL to facilitate ureteral stone expulsion results in increased 1- and 2-month stone-free rates and in a lower percentage of those needing re-treatment. The efficacy of nifedipine for the upper-mid ureteral tract associated with ketoprofene makes expulsive medical therapy suitable for improving overall outcomes of ESWL treatment for ureteral stones

2005 - Eswl con Dornier Lithotripter S: puntamento radiologico o ecografico? [Abstract in Rivista]
Micali, Salvatore; A., Celia; DE STEFANI, Stefano; M., Grande; R., Spasciani; F., Annino; C., De Carne; Bianchi, Giampaolo
abstract

Eswl con Dornier Lithotripter S: puntamento radiologico o ecografico?

2005 - Experimental varicocele in the rat: early evaluation of the nitric oxide levels and histological alterations in the testicular tissue. [Articolo su rivista]
DE STEFANI, Stefano; Silingardi, Vittorio; Micali, Salvatore; A., Mofferdin; Sighinolfi, Maria Chiara; A., Celia; Bianchi, Giampaolo; Giulini, Simone; Volpe, Annibale; Giusti, Federica; Maiorana, Antonino
abstract

The relationship between varicocele and male infertility remains to be explained. Oxidative damage because of the testicular venous backflow may represent one of the causes of gonad injury and seems to precede the histological alteration. Therefore measuring the values of spermatic or intratesticular nitric oxide (NO) could be useful in evaluating this oxidative distress. The aim of this study is to assess the role of testicular NO in early detection of the damages induced by an experimental varicocele in the Wistar rat. A left varicocele was induced in 10 animals (group A). A control group of 10 rats was performed (group B). Animals were killed 3 months after the operation. Both testicles were harvested, weighed and sectioned in two equal parts: one for the evaluation of the NO level and the other one for histological examination. All the rats in group A showed a conspicuous dilatation of the left spermatic vein. The histopathological analysis was normal in both the groups. Biochemistry showed a meaningful statistical difference (P < 0.001) in the concentrations of NO among the specimens of the left and right gonads in group A but no difference was found in group B. The increase in NO values and the presence of other oxidant agents represent the first sign of testicular distress and it seems to anticipate histopathological changes. As it is well known that a great difference exist between human and animal sperm, NO could therefore in the future be taken into consideration together with others parameters for the evaluation of patient who is affected by varicocele.

2005 - Focusing our attention on trocar seeding! [Capitolo/Saggio]
Bianchi, Giampaolo; Micali, Salvatore; A., Celia; A., Caruso; G., Breda
abstract

Focusing our attention on trocar seeding!

2005 - Laparoscopic adrenal surgery: New frontiers [Articolo su rivista]
Micali, Salvatore; G., Peluso; DE STEFANI, Stefano; A., Celia; M. C., Sighinolfi; M., Grande; Bianchi, Giampaolo
abstract

After about 10 years of experience, laparoscopic adrenalectomy has become the gold standard for the treatment of adrenal lesions. Here, we describe the presenting features, imaging methods, and current surgical approaches to diseases of the adrenal gland. There is general agreement on the suitability of the laparoscopic approach for benign adrenal lesions, but controversy exists about using laparoscopy for suspected adrenal malignancy, metastasis, and partial adrenalectomy. This article reviews the literature on laparoscopic adrenalectomy. In particular, we focus our attention on the new surgical approaches to the gland. We evaluate the indications, operative techniques, and tools for partial adrenalectomy, and we discuss new surgical strategies such as cryosurgery and radiofrequency ablation.

2005 - Laparoscopic adrenalectomy of an insidious retroperitoneal mass [Abstract in Rivista]
Micali, Salvatore; G., Peluso; A., Cestari; A., Celia; DE STEFANI, Stefano; G., Guazzoni; Bianchi, Giampaolo
abstract

Laparoscopic adrenalectomy of an insidious retroperitoneal mass

2005 - Laparoscopic radical cystectomy: An Italian survey. [Poster]
A., Celia; Micali, Salvatore; M. C., Sighinolfi; G., Peluso; M., Bruschi; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

BACKGROUND: Radical cystectomy with urinary diversion is the current gold standard procedure for muscle-invasive bladder cancer. However, laparoscopic radical cystectomy (LRC) has evolved rapidly worldwide during the past decade, despite its complexity due to both the demolitive step with management of a highly aggressive cancer and the reconstructive step. The authors performed a survey to assess the Italian experience with LRC and urinary diversion in an effort to point out the volume of the procedure in their country, providing some surgical details. METHODS: A total of 10 Italian urologic departments with experts in laparoscopic urologic surgery were contacted and asked to participate in a two-page survey concerning indications for cystectomy, laparoscopic technique, intra- and postoperative complications, and follow-up evaluation of the procedure when available. RESULTS: Five sites elected to participate, and a total of 83 LRCs were collected. All centers used five trocar ports. The mean operative time was 8 h and 40 min, and the estimated blood loss was 376 ml. In two cases, the procedure was converted to open surgery. Postoperative complications consisted of one urinary leakage, one fistula, and one atrium rupture. A retrieval sac was used in all cases. Urinary diversions consisted of 43 ileal conduits, 26 orthotopic diversions, and 14 other techniques. The mean follow-up period was 9 months (range, 1-36 months). No tumor seeding was recorded. CONCLUSIONS: The LRC procedure is feasible although technically demanding. The morbidity of this procedure is evident, but may be reduced with further experience. Bowel management and reconstruction remain the most challenging part of the procedure.

2005 - Laparoscopic telementored adrenalectomy: The Italian experience [Articolo su rivista]
M., Bruschi; Micali, Salvatore; F., Porpiglia; A., Celia; DE STEFANI, Stefano; M., Grande; R. M., Scarpa; Bianchi, Giampaolo
abstract

BACKGROUND: Laparoscopy is widely accepted as the gold standard for adrenalectomy. Telementoring has been developed to reduce the complications associated with surgeon inexperience. We report our preliminary experience with laparoscopic telementored adrenalectomy. METHODS: From July 2002 to May 2003, eight laparoscopic telementored adrenalectomies were performed between two separate operating sites 430 km apart. Six of these procedures were monolateral laparoscopic adrenalectomies, and one was bilateral. All cases were performed by an expert open surgeon who was skilled in laparoscopic procedure but who had no experience in laparascopic adrenalectomy RESULTS: All the procedures were successfully performed in a telementored fashion. The mean operative times, blood loss, and postoperative morbidity results were comparable to those for standard laparoscopic adrenalectomies reported in the literature. CONCLUSIONS: This preliminary experience has demonstrated the feasibility of national telementoring. It is a viable method that can potentially add to surgical education and decrease the likelihood of complications due to inexperience with new techniques.

2005 - Lithotriptor S and treatment of radiotrasparent stones located in the distal ureter. [Abstract in Rivista]
A., Celia; Micali, Salvatore; M. C., Sighinolfi; DE STEFANI, Stefano; M., Grande; Bianchi, Giampaolo
abstract

Lithotriptor S and treatment of radiotrasparent stones located in the distal ureter.

2005 - Management of bleeding during laparoscopic adrenalectomy: A case report [Abstract in Rivista]
Bianchi, Giampaolo; Micali, Salvatore; DE STEFANI, Stefano; A., Celia; M. C., Sighinolfi; M., Grande; F., Annino
abstract

Management of bleeding during laparoscopic adrenalectomy: A case report

2005 - May Phyllanthus Niruri (Uriston) affect the efficacy of ESWL on renal stones? A prospective, randomised short term study. [Poster]
A., Celia; Micali, Salvatore; M. C., Sighinolfi; M., Grande; C., Di Pietro; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

May Phyllanthus Niruri (Uriston) affect the efficacy of ESWL on renal stones? A prospective, randomised short term study.

2005 - May Phyllantus niruri affect the efficacy of renal stones? A prospective, randomized, short term study [Articolo su rivista]
Celia, A.; Micali, S.; Sighinolfi, M. C.; Grande, M.; Di Pietro, C.; De Stefani, S.; Bianchi, Giampaolo
abstract

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2005 - Metallic ureteral stent: Our preliminary experience [Abstract in Rivista]
A., Celia; Micali, Salvatore; M. C., Sighinolfi; M., Grande; A., Mofferdin; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Metallic ureteral stent: Our preliminary experience

2005 - Miglioramento dell’emodinamica peniena dopo astensione dal fumo: Risultati preliminari [Poster]
M. C., Sighinolfi; A., Mofferdin; DE STEFANI, Stefano; M., Corinti; A., Celia; Micali, Salvatore; Bianchi, Giampaolo
abstract

Miglioramento dell’emodinamica peniena dopo astensione dal fumo: Risultati preliminari

2005 - Miglioramento dell’emodinamica peniena dopo astensione dal fumo: Risultati preliminari. [Poster]
A., Mofferdin; M. C., Sighinolfi; M., Corinti; DE STEFANI, Stefano; Micali, Salvatore; Bianchi, Giampaolo
abstract

Miglioramento dell’emodinamica peniena dopo astensione dal fumo: Risultati preliminari.

2005 - Phyllantus Niruri (Uriston) as an adjuvant therapy after ESWL of lower caliceal stones: Prospective and randomized study [Abstract in Atti di Convegno]
Micali, Salvatore; M. C., Sighinolfi; A., Celia; A., Mofferdin; M., Corinti; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Phyllantus Niruri (Uriston) a san adjuvant therapy after ESWL of lower caliceal stones: Prospective and randomized study.

2005 - Preservation of Inosine on renal tissue durino shockwave application in rat model. [Poster]
Micali, Salvatore; DE STEFANI, Stefano; C., De Carne; C., Di Pietro; L., Marzola; DE POL, Anto; Volpi, Nicola; M. C., Sighinolfi; A., Celia; Bianchi, Giampaolo
abstract

Preservation of Inosine on renal tissue durino shockwave application in rat model.

2005 - Può il Phyllanthus Niruri (Uriston) migliorare l’efficacia della ESWL nel trattamento della calcolosi renale? Studio prospettico randomizzato a breve termine [Abstract in Atti di Convegno]
A., Celia; M. C., Sighinolfi; Micali, Salvatore; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Può il Phyllanthus Niruri (Uriston) migliorare l’efficacia della ESWL nel trattamento della calcolosi renale? Studio prospettico randomizzato a breve termine

2005 - Può l’assunzione cronica di Tadalafil migliorare l’emodinamica peniena? Risultati preliminari. [Abstract in Atti di Convegno]
A., Mofferdin; M. C., Sighinolfi; F., Annino; A., Celia; DE STEFANI, Stefano; Micali, Salvatore; Bianchi, Giampaolo
abstract

Può l’assunzione cronica di Tadalafil migliorare l’emodinamica peniena? Risultati preliminari.

2005 - Retroperitoneal laparoscopy ureterolithotomy: A case-report. [Abstract in Rivista]
Micali, Salvatore; A., Celia; DE STEFANI, Stefano; M., Grande; M. C., Sighinolfi; Bianchi, Giampaolo
abstract

Retroperitoneal laparoscopy ureterolithotomy: A case-report.

2005 - Sacrocolpopexy: Long term follow-up [Articolo su rivista]
Peluso, Giuseppe; Celia, A.; Bruschi, Morgan; Silingardi, Vittorio; Sighinolfi, Maria Chiara; Bianchi, Giampaolo
abstract

[No abstract available]

2005 - Studio caso-controllo sui rapporti tra neoplasia prostatica e elementi in traccia [Abstract in Rivista]
Bergomi, Margherita; Venturelli, Marianna; Serio, G; Bianchi, Giampaolo; Trerotoli, G; Sighinolfi, Maria Chiara; Malavolti, Marcella; Bonvicini, Francesca; Ferrari, Angela; Farinetti, Alberto; Vinceti, Marco; Castiglia, P; Sansebastiano, G; Vivoli, Gianfranco
abstract

OBIETTIVI: Abbiamo condotto uno studio multicentrico caso-controllo al fine di valutare il ruolo di alcuni elementi in traccia di interesse tossicologico e nutrizionale (cadmio, selenio, rame e zinco) ed altri fattori ambientali e comportamentali nell’eziopatogenesi della neoplasia prostatica. La valutazionedell’esposizione a tali elementi è stata effettuata misurandone le concentrazioni nelle unghie quali bioindicatori di esposizione a medio-lungo termine.METODI: Sia i casi che i controlli, appaiati per età, sono stati reclutati dalle unità operative di Bari e Modena presso le cliniche urologiche e quelle chirurgiche dei rispettivi policlinici universitari. La determinazione degli oligoelementi è stata effettuata, previo lavaggio e mineralizzazione delle unghie con HNO3 in forno amicroonde, mediante spettrofotometria di assorbimento atomico con atomizzazione in fornetto di grafite per cadmio, selenio e rame, e in fiamma per lo zinco. RISULTATI:Nella popolazione complessiva presa in esame, abbiamo osservato livelli medi più elevati sia di cadmio che di rame nei 45 casi rispetto ai 68 controlli, mentre non abbiamo riscontrato particolari differenze per selenio e zinco. Le concentrazionimedie nelle unghie dei casi e dei controlli sono risultate rispettivamente per il cadmio pari a 0,108 e 0,068μg/g e per il rame pari a 5,07 e 3,78μg/g, mentre per lo zinco abbiamo riscontrato una media di 119.06μg/g per i casi e 111.04μg/g neicontrolli. Abbiamo successivamente effettuato il calcolo dell’OR quale stima del rischio relativo, utilizzando le concentrazioni quali variabili continue (ptrend) nonché dicotomiche (con cut-off pari alla mediana nei controlli). Nella popolazione complessiva presa in esame, l’OR è risultato pari a 2.57 (p=0.026) per il cadmio, OR=1.31 (0.548) per il selenio, OR=1.3 (p=0.529) per ilrame ed infine OR=1.81 (p=0.161) per lo zinco. L’analisi sui valori continui ha inoltre suggerito una possibile relazione tra esposizione a rame e rischio di neoplasia prostatica.L’analisi dei dati disaggregati sotto il profilo geografico ha fattoemergere rilevanti differenze soprattutto per quanto riguardo il cadmio. I pazienti di Bari hanno infatti evidenziato concentrazioni medie pari a 0.168 μg/g contro i 0.045 μg/g dei controlli, mentre per i soggetti dell’unità modenese abbiamo osservato rispettivamente 0.042 e 0.08μg/g. Il selenio ha invece evidenziatoconcentrazioni medie pari a 0.466μg/g nei casi e 0.468μg/g nei controlli a Modena, mentre i corrispondenti valori per la popolazione barese sono risultati pari a 0.627μg/g e 0.583μg/g. Le concentrazioni di rame nella popolazione baresesono risultate, rispettivamente nei casi e nei controlli, pari a 4.72 e 4.08μg/g, mentre per i soggetti modenesi abbiamo riscontrato 5.43 e 3.66μg/g. Infine le concentrazioni di zinco riscontrate nei pazienti affetti da neoplasia prostatica sono risultate pari a 116.98μg/g nei pazienti di Bari e 115.67μg/g nei relativi controlli,con corrispondenti valori nella casistica modenese pari a 121.14μg/g e108.83μg/g. Per quanto riguarda i rischi relativi di neoplasia, gli unici incrementi di un certo rilievo sono relativi alla casistica di Bari in associazione all’esposizione a cadmio (p-trend 0.054) e nella popolazione di Modena in associazione all’esposizione a rame (p-trend 0.096) e zinco (p-trend 0.092).CONCLUSIONI:I nostri risultati, considerando le limitate dimensioni del campione, sembrano supportare l’ipotesi, già avanzata da altri Autori, che l’ esposizione a cadmio può esercitare un ruolo nell’eziopatogenesi della neoplasia prostatica, mentre non sonoemerse indicazioni che suggeriscano un coinvolgimento del selenio. Per quello che riguarda il rame e lo zinco è necessario approfondire i dati attraverso un ampliamento del campione.

2005 - Transrectal contrast-enhanced (Levovist) ultrasonography in evaluation of urinary leakage after radical prostatectomy: a preliminary report [Articolo su rivista]
DE STEFANI, Stefano; M. C., Sighinolfi; A., Mofferdin; M., Paterlini; Micali, Salvatore; A., Celia; G., Peluso; Bianchi, Giampaolo
abstract

Quick postoperative catheter removal remains one of the main goals of radical prostatectomy, but it leads to a greater risk of urinary leakage. Transrectal ultrasonography with enhancing contrast medium (Levovist) is a simple, effective, and minimally invasive examination to evaluate vesicourethral integrity.

2005 - Trombosi parziale dei corpi cavernosi e terapia conservativa. Descrizione di un caso clinico e revisione della letteratura. [Poster]
M. C., Sighinolfi; A., Mofferdin; A., Celia; Micali, Salvatore; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Trombosi parziale dei corpi cavernosi e terapia conservativa. Descrizione di un caso clinico e revisione della letteratura.

2004 - Changes in peak sistolic velocity induced by chronic therapy with sildenafil citrate. [Abstract in Rivista]
Mofferdin, A.; Sighinolfi, M. C.; DE STEFANI, Stefano; Micali, Salvatore; Celia, A.; Silingardi, V.; Cicero, A. F. G.; Bianchi, Giampaolo
abstract

Changes in peak sistolic velocity induced by chronic therapy with sildenafil citrate.

2004 - Dornier Lithotripter S: i primi 50 trattamenti nel nostro dipartimento [Abstract in Rivista]
Micali, Salvatore; A., Celia; C., Di Pietro; DE STEFANI, Stefano; C., De Carne; Bianchi, Giampaolo
abstract

Dornier Lithotripter S: i primi 50 trattamenti nel nostro dipartimento

2004 - Dornier lithotripter S - The first 50 treatments in our department [Articolo su rivista]
C., Di Pietro; Micali, Salvatore; DE STEFANI, Stefano; A., Celia; C., De Carne; Bianchi, Giampaolo
abstract

INTRODUCTION: We assessed the short-term efficacy of extracorporeal shockwave lithotripsy with the Dornier Lithotripter S in the treatment of renal and ureteral stones. MATERIALS AND METHODS: Between February and April 2003, 32 renal and 19 ureteral stones were treated. Patients were evaluated 1 and 3 months afterwards. Stone size and location, total number of shockwaves and the stone-free rate were taken into consideration. RESULTS: The stone-free rate for ureteral stones was 63% at 1 month and 84.2% at 3 months. The stone-free rate for renal calculi was 75% at 1 month and 87.5% at 3 months. The overall stone-free rate was 70.6% at 1 month and 86.3% at 3 months. Analgesia was necessary in 12 patients (23.5%). No serious complications were seen, except for one steinstrasse. CONCLUSIONS: The Dornier Lithotripter S is very effective in the treatment of renal and ureteral calculi.

2004 - ESWL with Dornier Lithotripter S: radiological or ultrasound focusing? [Poster]
A., Celia; Micali, Salvatore; DE STEFANI, Stefano; M., Bisi; M., Grande; C., De Carne; Bianchi, Giampaolo
abstract

ESWL with Dornier Lithotripter S: radiological or ultrasound focusing?

2004 - Enucleoresezione renale laparoscopica transperitoneale mediante dispositivo Tissuelink. [Abstract in Rivista]
A., Celia; Micali, Salvatore; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Enucleoresezione renale laparoscopica transperitoneale mediante dispositivo Tissuelink.

2004 - Extracorporeal shock wave lithotripsy: our experience with Dornier Lithotripter S. [Poster]
Micali, Salvatore; A., Celia; C., De Carne; C., Di Pietro; M., Bisi; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Extracorporeal shock wave lithotripsy: our experience with Dornier Lithotripter S.

2004 - Human cervical mucus can act in vitro as a selective barrier against spermatozoa carrying fragmented DNA and chromatin structural abnormalities [Articolo su rivista]
Bianchi, Giampaolo; A., De Agostini; J., Fournier; C., Guidetti; N., Tarozzi; D., Bizzaro; Manicardi, Gian Carlo
abstract

Purpose: We have carried out experiments to determine if human cervical mucus can act as an in vitro selective barrier against spermatozoa morphologically normal that carry genetic structural abnormalities. Methods: Sperm chromatin abnormalities have been evaluated by Chromomycin A(3) and endogenous nick translation. Results: The data obtained have shown that spermatozoa possessing higher levels of DNA protamination are more proficient in crossing the cervical mucus barrier. Moreover, the levels of positivity to endogenous nick translation treatment was practically zero in such spermatozoa. Conclusions: We suggest that sperm penetration of cervical mucus could be used to select sperm preparations free of fragmented DNA or chromatin structural abnormalities for assisted reproduction.

2004 - Il tumor seeding nella laparoscopia urologica: una indagine internazionale. [Abstract in Rivista]
A., Celia; Micali, Salvatore; P., Bove; DE STEFANI, Stefano; M. C., Sighinolfi; C., Di Pietro; C., De Carne; Bianchi, Giampaolo
abstract

Il tumor seeding nella laparoscopia urologica: una indagine internazionale.

2004 - Intracavernous prostaglandin E1 infusion in diabetes with associated ischemic necrosis of the gland penis [Articolo su rivista]
M. C., Sighinolfi; DE STEFANI, Stefano; A., Mofferdin; Micali, Salvatore; A., Celia; Bianchi, Giampaolo
abstract

Penile necrosis is a rare event. It has been described as acomplication of diabetes or in systemic vasculitis.1 Ischemicdamages may also arise following genital reconstructive surgery.Necrosis of the glans is generally the first evidence of abroader lesion that may involve the urethra and perineum inso-called Fournier’s necrotizing fasciitis.2 A solitary lesion of theglans without shaft involvement has been described rarely. Ahyperbaric camera represents one of the best therapeutic solutionsin these patients, although intracavernous infusion ofprostaglandin has been shown to be particularly effective.

2004 - La biopsia renale laparoscopica [Abstract in Rivista]
A., Celia; Micali, Salvatore; C., De Carne; M. C., Sighinolfi; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

La biopsia renale laparoscopica

2004 - Laparoscopic renal tumorectomy with Tissuelink [Abstract in Rivista]
A., Celia; Micali, Salvatore; DE STEFANI, Stefano; M. C., Sighinolfi; C., De Carne; A., Mofferdin; Bianchi, Giampaolo
abstract

Laparoscopic renal tumorectomy with Tissuelink

2004 - Non Hodgkin lymphoma of the ureter: a rare disease [Articolo su rivista]
Celia, A; DE STEFANI, Stefano; Bruschi, M; Micali, Salvatore; Sighinolfi, Mc; Bianchi, Giampaolo
abstract

Non urotelial malignant neoplasm of the ureter has been rarely described, usually arising from muscular, vascular and nervous tissue. Primary lymphoma of the ureter is an uncommon finding; we report a case of primary Non Hodgkin Lymphoma of the ureter in young woman.

2004 - Prima telechirurgia in Italia: due esperti uniscono la propria esperienza [Abstract in Rivista]
Micali, Salvatore; A., Celia; M., Bruschi; DE STEFANI, Stefano; C., De Carne; Bianchi, Giampaolo
abstract

Prima telechirurgia in Italia: due esperti uniscono la propria esperienza

2004 - Telementored Laparoscopy Between Italian University. Engineering and Urology Section Of the Endourological Society.19 th Annual Meeting. 8 May 2004, San Francisco (Usa). [Poster]
Micali, Salvatore; A., Celia; P., Bove; F., Porpiglia; R. M., Scarpa; G., Vespasiani; Bianchi, Giampaolo
abstract

Telementored Laparoscopy Between Italian University

2004 - Telementored laparoscopic adrenalectomy between Italian universities. [Abstract in Rivista]
Micali, Salvatore; F., Porpiglia; A., Celia; M. C., Sighinolfi; M., Grande; R. M., Scarpa; Bianchi, Giampaolo
abstract

Telementored laparoscopic adrenalectomy between Italian universities.

2004 - Telesurgical laparoscopy adrenalectomy between Modena and Turin. [Abstract in Rivista]
Micali, Salvatore; A., Celia; B., Baisi; F., Porpiglia; R. M., Scarpa; Bianchi, Giampaolo
abstract

Telesurgical laparoscopy adrenalectomy between Modena and Turin.

2004 - Tumor seeding following urologic laparoscopy: An international survey [Poster]
Micali, Salvatore; A., Celia; B., Baisi; P., Bove; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

PURPOSE: During the last 10 years laparoscopy has been applied to treat most urological pathology including malignancies. There has been concern regarding peritoneal dissemination and port site metastases. We undertook a survey to assess the incidence of this occurrence.MATERIALS AND METHODS: A total of 50 international urology departments with experts in laparoscopic urological surgery were contacted for this study. Each site was asked to complete a 2-page survey regarding the volume of laparoscopic urological procedures and port site recurrences.RESULTS: Nineteen sites elected to participate. A total of 18750 laparoscopic procedures were performed, of which 10912 were for cancer. These included 2604 radical nephrectomies, 559 nephroureterectomies, 555 partial nephrectomies, 27 segmental ureterectomies, 3665 radical prostatectomies, 1869 pelvic lymph node dissections, 479 retroperitoneal lymph node dissections, 336 adrenalectomies and 108 procedures listed as other. Tumor seeding was reported in 13 cases (0.1%), including 3 nephroureterectomies for transitional cell carcinoma, 4 nephrectomies (incidental transitional cell carcinoma), 4 adrenalectomies for metastases, 1 retroperitoneal lymph node dissection for testicular cancer and 1 pelvic lymph node dissection for cancer of the penis. Port seeding occurred in 10 cases (0.09%) and peritoneal spread in 3 cases (0.03%).CONCLUSIONS: The incidence of tumor seeding after laparoscopic oncological surgery is rare and does not appear greater than what has been historically reported for open surgery. Tumor seeding seems to be most commonly related to the removal of high grade tumors and deviation from oncological surgical principles.

2004 - Tumor seeding in urological laparoscopy: An international survey [Articolo su rivista]
Micali, Salvatore; Celia, A; Bove, P; DE STEFANI, Stefano; Sighinolfi, Mc; Kavoussi, Lr; Bianchi, Giampaolo
abstract

Purpose: During the last 10 years laparoscopy has been applied to treat most urologicalpathology including malignancies. There has been concern regarding peritoneal disseminationand port site metastases. We undertook a survey to assess the incidence of this occurrence.Materials and Methods: A total of 50 international urology departments with experts inlaparoscopic urological surgery were contacted for this study. Each site was asked to complete a2-page survey regarding the volume of laparoscopic urological procedures and port site recurrences.Results: Nineteen sites elected to participate. A total of 18,750 laparoscopic procedures wereperformed, of which 10,912 were for cancer. These included 2,604 radical nephrectomies, 559nephroureterectomies, 555 partial nephrectomies, 27 segmental ureterectomies, 3,665 radicalprostatectomies, 1,869 pelvic lymph node dissections, 479 retroperitoneal lymph node dissections,336 adrenalectomies and 108 procedures listed as other. Tumor seeding was reported in 13cases (0.1%), including 3 nephroureterectomies for transitional cell carcinoma, 4 nephrectomies(incidental transitional cell carcinoma), 4 adrenalectomies for metastases, 1 retroperitoneallymph node dissection for testicular cancer and 1 pelvic lymph node dissection for cancer of thepenis. Port seeding occurred in 10 cases (0.09%) and peritoneal spread in 3 cases (0.03%).Conclusions: The incidence of tumor seeding after laparoscopic oncological surgery is rare anddoes not appear greater than what has been historically reported for open surgery. Tumorseeding seems to be most commonly related to the removal of high grade tumors and deviationfrom oncological surgical principles.

2003 - Calcolosi renale a stampo: Trattamento endourologico [Abstract in Atti di Convegno]
A., Celia; Micali, Salvatore; C., Di Pietro; P., Beltrami; M. C., Sighinolfi; A., Mofferdin; Bianchi, Giampaolo
abstract

Calcolosi renale a stampo: Trattamento endourologico

2003 - Calcolosi renale a stampo: Trattamento endourologico. [Poster]
A., Celia; Micali, Salvatore; C., Di Pietro; P., Beltrami; M. C., Sighinolfi; A., Mofferdin; Bianchi, Giampaolo
abstract

Calcolosi renale a stampo: Trattamento endourologico.

2003 - Calcolosi renale a stampo: Trattamento endourologico. [Abstract in Rivista]
A., Celia; Micali, Salvatore; C., Di Pietro; P., Beltrami; M. C., Sighinolfi; A., Mofferdin; Bianchi, Giampaolo
abstract

Calcolosi renale a stampo: Trattamento endourologico

2003 - Endoscopic recanalization of ureterointestinal stenosis in patient with orthotopic neo-bladder (Vescica ileale padovana). [Abstract in Rivista]
Bianchi, Giampaolo; M., Bruschi; C., Di Pietro; M., Spagni; G., Saredi; Micali, Salvatore
abstract

Endoscopic recanalization of ureterointestinal stenosis in patient with orthotopic neo-bladder (Vescica ileale padovana).

2003 - Litotrissia percutanea (PCNL): Un litotritore a doppia sorgente di energia. [Abstract in Rivista]
M., Spagni; A., Celia; DE STEFANI, Stefano; Micali, Salvatore; Bianchi, Giampaolo
abstract

Litotrissia percutanea (PCNL): Un litotritore a doppia sorgente di energia.

2003 - Nefrolitotomia percutanea in due tempi nella calcolosi renale. [Poster]
A., Celia; Micali, Salvatore; R., Miano; M., De Santis; P., Preziosi; C. A., Pollastri; G., Vespasiani; Bianchi, Giampaolo
abstract

Nefrolitotomia percutanea in due tempi nella calcolosi renale.

2003 - Nefrolitotomia percutanea nella calcolosi renale: Tecnica in due tempi [Abstract in Rivista]
Micali, Salvatore; A., Celia; R., Miano; M., De Santis; P., Preziosi; C. A., Pollastri; G., Vespasiani; Bianchi, Giampaolo
abstract

Nefrolitotomia percutanea nella calcolosi renale: Tecnica in due tempi

2003 - Our preliminary experience with Dornier Lithotripter S. [Poster]
C., Di Pietro; Micali, Salvatore; DE STEFANI, Stefano; A., Celia; C., De Carne; Bianchi, Giampaolo
abstract

Our preliminary experience with Dornier Lithotripter S.

2003 - Percutaneous nephrolitotripsy in patients with solitary kidney. Our experience [Poster]
C., Di Pietro; M., Bruschi; N., Ghidini; Micali, Salvatore; G., Saredi; Bianchi, Giampaolo
abstract

Percutaneous nephrolitotripsy in patients with solitary kidney. Our experience

2003 - Prima esperienza telechirurgica in Italia: Due esperti uniscono la propria esperienza per migliorare il risultato! [Abstract in Rivista]
Micali, Salvatore; F., Porpiglia; M. C., Sighinolfi; R., Tarabuzzi; N., Grassi; A., Celia; DE STEFANI, Stefano; R. M., Scarpa; Bianchi, Giampaolo
abstract

Prima esperienza telechirurgica in Italia: Due esperti uniscono la propria esperienza per migliorare il risultato!

2003 - Telechirurgica puramente Italia: Modena aiuta Roma! [Abstract in Rivista]
Micali, Salvatore; P., Bove; M. C., Sighinolfi; E., Vannozzi; N., Grassi; A., Celia; G., Vespasiani; Bianchi, Giampaolo
abstract

Telechirurgica puramente Italia: Modena aiuta Roma!

2003 - Telesurgery between Italian University: First experience [Poster]
Micali, Salvatore; N., Grassi; A., Celia; P., Bove; F., Porpiglia; R. M., Scarpa; G., Vespasiani; Bianchi, Giampaolo
abstract

Telesurgery between Italian University: First experience

2003 - Telesurgical laparoscopic adrenalectomy between Modena and Turin. [Abstract in Rivista]
Micali, Salvatore; N., Grassi; C., Di Pietro; A., Celia; F., Porpiglia; R. M., Scarpa; Bianchi, Giampaolo
abstract

Telesurgical laparoscopic adrenalectomy between Modena and Turin.

2003 - Trocar seeding in urology laparoscopy [Abstract in Atti di Convegno]
A., Celia; M. C., Sighinolfi; Micali, Salvatore; Bianchi, Giampaolo
abstract

Trocar seeding in urology laparoscopy

2003 - Trocar seeding in urology laparoscopy [Poster]
A., Celia; Micali, Salvatore; C., Di Pietro; P., Bove; L. R., Kavoussi; Bianchi, Giampaolo
abstract

Trocar seeding in urology laparoscopy

2003 - Ureterorenoscopia semplificata, con guide Nitinol [Abstract in Rivista]
M., Bruschi; V., Silingardi; Micali, Salvatore; A., Mofferdin; M., Paterlini; N., Ghidini; Bianchi, Giampaolo
abstract

Ureterorenoscopia semplificata, con guide Nitinol

2002 - Nitinol guidewires semplified ureterorenoscopy? [Poster]
M., Bruschi; A., Celia; Micali, Salvatore; A., Mofferdin; M., Paterlini; N., Ghidini; Bianchi, Giampaolo
abstract

Nitinol guidewires semplified ureterorenoscopy?

2002 - Percutaneous nephrolitotomy (PCNL): A combined source lithotriptor. [Abstract in Rivista]
M., Spagni; A., Celia; Micali, Salvatore; B., Baisi; G., Saredi; Bianchi, Giampaolo
abstract

Percutaneous nephrolitotomy (PCNL): A combined source lithotriptor.

2002 - Percutaneous nephrolitotomy treatment of renal stone: Two steps tecnique. [Poster]
Micali, Salvatore; A., Celia; R., Miano; M., De Santis; P., Preziosi; C., Pollastri; G., Vespasiani; Bianchi, Giampaolo
abstract

Percutaneous nephrolitotomy treatment of renal stone: Two steps tecnique.

2002 - Renal staghorn calculosis: Endourological treatment. [Poster]
Bianchi, Giampaolo; P., Beltrami; A., Celia; Micali, Salvatore; A., Mofferdin
abstract

Renal staghorn calculosis: Endourological treatment.

2002 - Two steps percutaneous nephrolitotomy [Abstract in Rivista]
A., Celia; Micali, Salvatore; B., Baisi; M., De Santis; C., Di Pietro; Bianchi, Giampaolo
abstract

Two steps percutaneous nephrolitotomy

1999 - Endourological treatment of renal staghorn calculosis. Our results after 10 years experience [Articolo su rivista]
P., Beltrami; G., Malossini; G., Giusti; M., Lodde; Bianchi, Giampaolo; G., Mobilio
abstract

Endourological treatment of renal staghorn calculosis. Our results after 10 years experience

1999 - Retroperitoneal lymphadenectoy for clinical stage 1 NSGCT: laparoscopy vs open surgery [Articolo su rivista]
G., Giusti; P., Beltrami; C., Talllarigo; G., Malossini; Bianchi, Giampaolo
abstract

Retroperitoneal lymphadenectoy for clinical stage 1 NSGCT: laparoscopy vs open surgery

1998 - La fibrosi retroperitoneale idiopatica: terapia laparoscopica [Articolo su rivista]
Bianchi, Giampaolo; P., Beltrami; G., Giusti
abstract

La fibrosi retroperitoneale idiopatica: terapia laparoscopica

1998 - La neoplasia renale parenchimale nell’anziano [Articolo su rivista]
Bianchi, Giampaolo
abstract

La neoplasia renale parenchimale nell’anziano

1998 - Renal staghorn calculosis: our experience with the percutaneous treatment with or without extracorporeal shock wave lithotripsy [Articolo su rivista]
Bianchi, Giampaolo; G., Malossini; P., Beltrami; G., Mobilio; G., Giusti; G., Caluccio
abstract

OBJECTIVES: In this paper we report our results in the treatment of renal staghorn stones by percutaneous lithotripsy (PCNL) with or without extracorporeal shock wave lithotripsy (ESWL). METHODS/RESULTS: Over a period of 5 years, 244 patients with renal calculosis were treated by PCNL in our Department. Seventy-four of these were cases of renal staghorn calculosis: 44 presented a partial staghorn stone and in 30 cases the stone formation completely occupied the pyelocalieal cavity. We performed first a PCNL via a rigid nephroscope. Stones were crushed using an ultrasonic lithotrite; an electrohydraulic probe was used when the calculus was resistant to ultrasound. The patients were submitted to one or more percutaneous treatments followed by extracorporeal lithotripsy to complete the operation, when required. The patients were divided into two groups according to the type of stone: the first group comprised 59 patients with a partial or complete simple staghorn stone and the second comprised 15 patients with a complete complex staghorn stone. Complete resolution was achieved in 55 of the 59 cases (93.2%) in the first group and in 9 of the 15 cases (60%) in the second. We had no complications. CONCLUSIONS: Our experience confirms that PCNL is the elective treatment for partial and complete staghorn stones and ESWL in these types of stones must be utilized only as ancillary treatment for residual fragments

1998 - Unilateral laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell testicular neoplasm [Articolo su rivista]
Bianchi, Giampaolo; P., Beltrami; G., Giusti; C., Tallarigo; G., Mobilio
abstract

OBJECTIVE: The aim of this study is to evaluate the reliability of laparoscopic retroperitoneal lymph node dissection (LRPLND) in the management of clinical stage I nonseminomatous germ cell tumors (NSGCT). METHODS: Since June 1993, unilateral LRPLND was performed in 6 patients diagnosed with clinical stage I NSGCT. All patients had undergone prior radical orchiectomy. The testicular cancer was left-sided in 3 cases and right-sided in the other 3 cases. Preoperative staging by means of tumor marker assessment, computerized tomography scan of the chest and abdomen and chest X-ray was unremarkable for metastatic disease. RESULTS: All procedures were accomplished without any complications in a mean time of 325 min (275-420 min). The estimated perioperative blood loss was minimal (< 50 ml), and none of the patients required blood transfusion. In the case of the first patient, the hospital stay was 18 days due to a widespread subcutaneous emphysema. In the remaining 5 cases, the average hospitalization was 4.8 days, ranging from 4 to 6 days. The patients resumed normal activities within 12-27 days (mean 16.16 days) postoperatively. The mean number of lymph nodes removed was 6.8, ranging from 5 to 9. Histologic examination of the dissected lymph nodes revealed microscopic metastases from embryonal carcinoma in 2 patients. Both of these patients received adjuvant chemotherapy. The mean follow-up period is 21.3 months, ranging from 6 to 36 months. To date, no relapses have been observed. CONCLUSION: In accordance with other reports, we believe that LRPLND is both feasible and effective. However, the definitive assessment of the efficacy and morbidity of this diagnostic procedure requires a larger and more comprehensive series as well as longer follow-up

1998 - Unilateral laparoscopic retroperitoneal lymphadenectomy for clinical stage I nonseminomatous testicular cancer [Articolo su rivista]
G., Giusti; P., Beltrami; C., Talllarigo; G., Malossini; Bianchi, Giampaolo
abstract

Since June 1993, unilateral laparoscopic retroperitoneal lymph-node dissection (LRPLND) has been performed in six patients with clinical Stage I nonseminomatous germ-cell tumors (NSGCT). All of the patients had undergone prior radical orchiectomy. The testicular cancer was left-sided in three cases and right-sided in three cases. Preoperative staging by means of tumor marker assessment, CT scan of the chest and abdomen, and chest radiography was unremarkable for metastatic disease. All procedures were accomplished without any complications in a mean time of 325 minutes (275-420 minutes). The estimated perioperative and postoperative blood loss was minimal, and none of the patients required blood transfusion. In the case of the first patient, the hospital stay was 18 days because of a widespread subcutaneous emphysema. In the remaining five cases, the average hospitalization was 4.8 days (range 4-6 days). The patients resumed normal activities within 12 to 27 days (mean 16.16 days) postoperatively. The mean number of lymph nodes removed was 6.8 (range 5-9). Histologic examination of these nodes revealed microscopic metastases from embryonal carcinoma in two patients, both of whom were subjected to adjuvant chemotherapy. The mean follow-up period is 27.1 months (range 12-42 months). To date, no relapses have been observed. In accordance with other reports, we believe that LRPLND is both feasible and effective. However, larger and more comprehensive studies with long-term follow-up are required to determine whether this approach is reliable and definitely superior to standard open surgery in the management of clinical Stage I NSGCT.

1997 - Il razionale delle scelte diagnostiche e terapeutiche nella neoplasia della prostata [Articolo su rivista]
A., Boltar; S., Bianco; C., Maganja; Bianchi, Giampaolo
abstract

Il razionale delle scelte diagnostiche e terapeutiche nella neoplasia della prostata

1997 - The analysis of costs and refunds of treatment for urinary lithiasis [Articolo su rivista]
P., Beltrami; G., Malossini; G., Giusti; V., Ficarra; Bianchi, Giampaolo; C., Tallarigo; L., Comunale
abstract

The analysis of costs and refunds of treatment for urinary lithiasis

1996 - Le linfoadenectomie chirurgiche laparoscopiche nella patologia oncologica urologica [Articolo su rivista]
Bianchi, Giampaolo; P., Beltrami
abstract

Bianchi G., Beltrami P.: Le linfoadenectomie chirurgiche laparoscopiche nella patologia oncologica urologica

1996 - Sperm chromatin anomalies can influence decondensation after intracytoplasmic sperm injection [Articolo su rivista]
Sakkas, D; Urner, F; Bianchi, Giampaolo; Bizzaro, D; Wagner, I; Jaquenoud, N; Manicardi, Gian Carlo; Campana, A.
abstract

In this study we investigated whether morphology and chromatin anomalies in human spermatozoa can influence fertilization after intracytoplasmic sperm injection (ICSI). We examined unfertilized oocytes, using the fluorochrome Hoechst 33342, to determine whether a relationship exists between failure of fertilization and sperm chromatin quality, Sperm chromatin packaging quality was assessed using the chromomycin A(3) (CMA(3)) fluorochrome, and the presence of DNA damage in spermatozoa, using in-situ nick translation, Normal males present sperm parameters with a normal morphology of >20%, CMA(3) fluorescence of <30% and exhibit endogenous nicks in <10% of their spermatozoa, When patients were separated according to these values no difference was observed in their fertilization rates after ICSI, When the unfertilized ICSI oocytes were examined, we found that patients with CMA(3) fluorescence of <30% and nicks in <10% of their spermatozoa had only 17.5 and 21.6% respectively of their unfertilized oocytes containing spermatozoa that remained condensed, In contrast, patients with higher CMA(3) and nick values had a significantly higher number, 41.2 and 48.9%, of their unfertilized oocytes containing condensed spermatozoa. Sperm morphology did not show any such pattern, The percentage of spermatozoa which had initiated decondensation in unfertilized oocytes was not influenced by morphology, CMA(3) fluorescence or nicks, In light of these results we postulate that poor chromatin packaging and/or damaged DNA may contribute to failure of sperm decondensation after ICSI and result in failure of fertilization.

1996 - Triple therapy with azithromycin, omeprazole, and amoxicillin is highly effective in the eradication of Helicobacter pylori: A controlled trial versus omeprazole plus amoxicillin [Articolo su rivista]
Bertoni, G; Sassatelli, R; Nigrisoli, E; Tansini, P; Bianchi, Giampaolo; Dellacasa, G; Bagni, A; Bedogni, G.
abstract

Background: Azithromycin is a new-generation, acid-stable macrolide antibiotic that achieves remarkably high concentrations in gastric tissue, persisting above the MIG(90) for Helicobacter pylori over a 5-day period after a single 500-mg oral dose. Methods: We evaluated a new metronidazole-free triple therapy with omeprazole 20 mg b.i.d. plus amoxicillin 1 g b.i.d. (both for 14 days) and azithromycin 500 mg mane (for the first 3 days only) (group I) versus double therapy with omeprazole 20 mg b.i.d. plus amoxicillin 1 g t.i.d., both for 14 days (group II). H. pylori status was determined by urease test and histology before and 6 wk after completion of therapy, Results: Ninety-two patients with peptic ulcer disease or nonulcer dyspepsia completed the study. H. pylori infection was eradicated in 44 (91.6%) of 48 patients randomized to receive triple therapy versus 26 (59.1%) of 44 who received double therapy (p < 0.001), Smoking, but not omeprazole pretreatment, proved to be a risk factor for treatment failure only in the double-therapy group (p = 0.05). All ulcers healed by the time of the 8-wk endoscopic control, Side effects, usually minor, were recorded in 12.5% and 9.1% of patients, respectively (NS), but therapy had to be discontinued in one patient in group I and in three in group II (NS), Conclusions: Two-week triple therapy with omeprazole, amoxicillin, and (for the first 3 days) low-dose azithromycin is highly effective in eradicating H. pylori. This regimen is safe and well-tolerated, and we recommend that it be used as first-line treatment, as an alternative to less-effective omeprazole-amoxicillin double therapy, Moreover, azithromycin appears to be a new, promising antibiotic for future innovative anti-H. pylori combinations.

1995 - Il trattamento laparoscopico del varicocele [Articolo su rivista]
Bianchi, Giampaolo; P., Beltrami; C., Tallarigo; G., Giusti; A., Mofferdin; G., Malossini
abstract

Il trattamento laparoscopico del varicocele

1995 - L'analisi del DNA mediante citometria a flusso nelle neoplasie renali trattate conservativamente [Articolo su rivista]
P., Beltrami; M., Lazzarotto; G., Giusti; C., Tallarigo; G., Malossini; L. S., Azzolina; Bianchi, Giampaolo; G., Mobilio
abstract

L'analisi del DNA mediante citometria a flusso nelle neoplasie renali trattate conservativamente

1995 - Le fistole vescico-vaginali: revisione della letteratura e nostra esperienza [Articolo su rivista]
G., Malossini; P., Beltrami; Bianchi, Giampaolo; C., Tallarigo; L., Motta; P., Curti; R., Baldassarre; L., Comunale; G., Mobilio
abstract

Le fistole vescico-vaginali: revisione della letteratura e nostra esperienza

1995 - Multuple System Atrophy and Autonomic failure with early urogenital onset [Articolo su rivista]
G., Giusti; L. G., Giovanni; P., Tonin; Bianchi, Giampaolo; D., Schiavone; R., Baldassarre; F., Kalantary Rad; C., Ballista; C., Tallarigo
abstract

Multuple System Atrophy and Autonomic failure with early urogenital onset

1995 - The treatment of diverticula of the female urethra [Articolo su rivista]
G., Malossini; P., Curti; G., Giusti; C., Tallarigo; L., Comunale; Bianchi, Giampaolo
abstract

The treatment of diverticula of the female urethra

1995 - Total androgenic blockade: a review [Articolo su rivista]
Bianchi, Giampaolo; P., Beltrami; L., Motta; G., Mobilio
abstract

Total androgenic blockade: a review

1994 - Controversie in tema di diagnosi e stadiazione del carcinoma prostatico: il ruolo dell'esplorazione rettale e delle metodiche di imaging [Articolo su rivista]
C., Tallarigo; A., D'Amico; P., Curti; P., Beltrami; Bianchi, Giampaolo
abstract

Controversie in tema di diagnosi e stadiazione del carcinoma prostatico: il ruolo dell'esplorazione rettale e delle metodiche di imaging

1994 - Surgical repair of congenital penile curvature [Articolo su rivista]
G., Malossini; M., Tontodonati; R., Baldassare; C., Tallarigo; Bianchi, Giampaolo; P., Curti; P., Beltrami; L., Comunale
abstract

Congenital penile curvature is not such a rare pathology and it is responsible for important aesthetic and functional problems. This malformation, can render intercourse difficult and painful, but it can be cured with a simple surgical procedure that almost always guarantees excellent results. In this work we report on the treatment of 48 patients (aged 16-34) with congenital penile curvature with a follow-up of 6 months to 10 years. The aetiology is also briefly analysed. A discussion follows on the diagnostic criteria for better interpretation of the main characteristics of this problem in relation to its functional appearance. A comparison of different surgical techniques is also shown, focusing over the procedure we perform: plissettage of the tunica albuginea. This technique is performed through a penile skin incision opposite to the maximal curvature of the organ, exposure of the tunica albuginea and the positioning of one or more series of stitches. The overall results show that 44 out of 48 patients were fully satisfied both from the aesthetic and functional points of view, while 4 were partly satisfied from the aesthetic point of view alone.

1994 - Vesicovaginal fistulas: our experience and review of literature [Articolo su rivista]
G., Malossini; P., Beltrami; Bianchi, Giampaolo; C., Tallarigo; L., Motta; P., Curti; R., Baldassarre; L., Comunale; G., Mobilio
abstract

Vesicovaginal fistulas (VVF) still represent a sad complication of surgery of the female genital system. In this article an extensive review of the literature was conducted, analyzing the etiological, pathological and clinical aspects, as well as the therapeutical problems. For this purpose, we have compared the many surgical techniques proposed for treatment of VVF and have also evaluated their results. Furthermore, we report on our series of 35 patients who had undergone treatment for VVF.

1993 - Analisi del DNA mediante citometria a flusso nei tumori del testicolo [Relazione in Atti di Convegno]
P., Beltrami; P., Curti; M., Lazzarotto; A., Albarello; L. S., Azzolina; C., Tallarigo; Bianchi, Giampaolo
abstract

Analisi del DNA mediante citometria a flusso nei tumori del testicolo

1993 - I diverticoli dell'uretra femminile: valutazione della casistica e razionale per l'impiego delle tecniche di imaging [Articolo su rivista]
P., Curti; C., Tallarigo; G., Malossini; S., Cavalleri; M., Lazzarotto; L., Comunale; Bianchi, Giampaolo
abstract

I diverticoli dell'uretra femminile: valutazione della casistica e razionale per l'impiego delle tecniche di imaging

1993 - Il trattamento laparoscopico del varicocele [Articolo su rivista]
Bianchi, Giampaolo; C., Tallarigo; S., Cavalleri; D., Schiavone; G., Malossini; P., Beltrami
abstract

Il trattamento laparoscopico del varicocele

1993 - L'ureterocalicostomia: nostra esperienza [Articolo su rivista]
G., Mobilio; Bianchi, Giampaolo; P., Curti; R., Pianon; G., Poletti; L., Comunale
abstract

L'ureterocalicostomia: nostra esperienza

1993 - La chirurgia della incontinenza urinaria femminile [Articolo su rivista]
C., Tallarigo; L., Comunale; Bianchi, Giampaolo; G., Malossini; A., Rovasio
abstract

La chirurgia della incontinenza urinaria femminile

1993 - La linfadenectomia pelvica laparoscopica [Relazione in Atti di Convegno]
Bianchi, Giampaolo
abstract

La linfadenectomia pelvica laparoscopica

1993 - La linfadenectomia pelvica laparoscopica per neoplasia vescicale [Articolo su rivista]
Bianchi, Giampaolo; P., Beltrami; C., Tallarigo; D., Schiavone; S., Cavalleri; G., Mobilio
abstract

La linfadenectomia pelvica laparoscopica per neoplasia vescicale

1993 - Le sindromi disautonomiche a precoce esordio urogenitale. Nostra esperienza clinica [Relazione in Atti di Convegno]
G., Giusti; C., Tallarigo; L. G., Bongiovanni; L., Comunale; Bianchi, Giampaolo; D., Schiavone; R., Pianon; R., Baldassarre; A., Rovasio
abstract

Le sindromi disautonomiche a precoce esordio urogenitale. Nostra esperienza clinica

1993 - MATHEMATICAL-MODELING OF AMINO ACID-DERIVED UREA SYNTHESIS [Articolo su rivista]
Bianchi, Giampaolo; Bolzani, R; Marchesini, G; Sarti, E.
abstract

MATHEMATICAL-MODELING OF AMINO ACID-DERIVED UREA SYNTHESIS

1993 - MODEL-DERIVED ASSESSMENT OF UREA APPEARANCE IN RESPONSE TO ALANINE INFUSION - A QUANTITATIVE MEASURE OF LIVER-FUNCTION IN CIRRHOSIS [Articolo su rivista]
Bianchi, Giampaolo; Marchesini, G; Bolzani, R; Fabbri, A; Sarti, E; Pisi, E.
abstract

A three compartment mathematical model was used to analyse the urea response to an alanine infusion in six control subjects, and in 15 patients with liver cirrhosis and variable degree of hepatocellular failure. Model-derived coefficients were used to calculate two parameters (Y(max) and T(max)), able to describe the theoretical response of the conversion of amino acid derived nitrogen into urea, in response to a unit impulse in alanine concentration. They correspond to the maximum rate of conversion of nitrogen from an intermediary pool into urea and to the time delay between the impulse and Y(max), respectively. In cirrhosis, the apparent volume of distribution of infused alanine was smaller than in controls, while the conversion of alanine nitrogen into an intermediary pool of nitrogen and finally into urea nitrogen were both reduced. Also Y(max) was reduced by 50% in cirrhosis, whereas T(max) was increased by 50%, and both significantly correlated with galactose elimination capacity (GEC; R2 = 0.706 and R2 = 0.505, respectively) and with antipyrine clearance (Ap Cl; R2 = 0.823 and R2 = 0.576 respectively). Model-derived assessment of urea appearance in response to alanine infusion is able to quantify the functional liver cell mass, and may prove useful for the study of nitrogen metabolism in cirrhosis, mainly in relation to encephalopathy.

1993 - Our experience with extracorporeal shock wave lithotripsy (ESWL) in the treatment of uretheral stones [Articolo su rivista]
G., Mobilio; Bianchi, Giampaolo; G., Malossini; D., Schiavone; S., Cavalleri; R., Baldassarre; P., Curti; A., D'Amico
abstract

Our experience with extracorporeal shock wave lithotripsy (ESWL) in the treatment of uretheral stones

1992 - "Rationale" per un programma per la gestione informatizzata del Day Hospital [Relazione in Atti di Convegno]
P., Curti; D., Schiavone; C., Tallarigo; S., Cavalleri; Bianchi, Giampaolo
abstract

"Rationale" per un programma per la gestione informatizzata del Day Hospital

1992 - Clinical and instrumental evaluation of erectile impotence: a proposal of a diagnostic protocol [Articolo su rivista]
G., Malossini; P., Beltrami; R., Baldassarre; P., Curti; Bianchi, Giampaolo; L., Comunale; M., Lazzarotto; G., Mansueto; G., Piubello
abstract

There has been increasing interest in recent years in patients complaining of erectile dysfunction. This has prompted research and the development of diagnostic procedures aimed at allowing increasingly rapid characterization of the type of impotence involved (psychogenic or organic) and thus the most effective treatment. In this preliminary study, we present our study methodology in patients with erectile dysfunction, emphasising in particular the diagnostic procedures best suited to revealing the presence of an organic cause in the pathogenesis of impotence.

1992 - Diagnostic ant therapeutic problems in multicentric renal angiomyolipoma [Articolo su rivista]
C., Tallarigo; R., Baldassarre; Bianchi, Giampaolo; L., Comunale; G., Olivo; M., Pea; F., Bonetti; G., Martignoni; G., Zamboni; G., Mobilio
abstract

Multicentric renal angiomyolipoma is a rare form of benign tumor. However, its effective incidence as evaluated in autopsy studies may be as high as 8%. There are 2 main types of renal angiomyolipoma, that is isolated forms and those associated with other diseases, such as phakomatosis, polycystic kidneys and fibromuscular dysplasia. The tumor may also display malignant behavior with local invasiveness and regional lymph node involvement. However, the clinical course is benign and multicentricity is important for prognosis. Histopathological diagnosis often is difficult. Immunohistochemical analysis of surgical specimens using a panel of monoclonal antibodies, including HMB-45 and actin, enabled us to make a definitive diagnosis in 3 cases of multicentric renal angiomyolipoma.

1992 - Due anni di esperienza nell'archiviazione computerizzata dei trattamenti di litotrissia extracorporea [Articolo su rivista]
Bianchi, Giampaolo; P., Curti; D., Schiavone; S., Cavalleri; L., Comunale; G., Mobilio
abstract

Due anni di esperienza nell'archiviazione computerizzata dei trattamenti di litotrissia extracorporea

1992 - Fine needle vs resection biopsies for FCM DNA analysis of renal and testicular tumors [Articolo su rivista]
L., Azzolina; P., Beltrami; Bianchi, Giampaolo; P., Curti; N., Franzolin; F., Marchioretto; D., Schiavone; G., Mobilio
abstract

Fine needle vs resection biopsies for FCM DNA analysis of renal and testicular tumors

1992 - Flow cytometry on fine needle aspirates of renal tumours [Articolo su rivista]
Bianchi, Giampaolo; P., Beltrami; C., Tallarigo; N., Franzolin; L. S., Azzolina; G., Mobilio
abstract

Flow cytometry on fine needle aspirates of renal tumours

1992 - Il mielolipoma del surrene: analisi di due casi. [Relazione in Atti di Convegno]
P., Curti; R., Pianon; L., Comunale; Bianchi, Giampaolo; C., Tallarigo; G., Malossini; D., Schiavone; R., Baldassarre; S., Cavalleri
abstract

Il mielolipoma del surrene: analisi di due casi.

1992 - Il trattamento delle cisti renali mediante puntura ed alcoolizzazione [Relazione in Atti di Convegno]
Bianchi, Giampaolo; S., Cavalleri; A., D'Amico; C., Tallarigo; G., Malossini; R., Pianon; G., Poletti; P., Beltrami
abstract

Il trattamento delle cisti renali mediante puntura ed alcoolizzazione

1992 - Il trattamento extracorporeo della calcolosi reno-ureterale con Dornier MFL-5000 [Relazione in Atti di Convegno]
G., Mobilio; Bianchi, Giampaolo; G., Malossini; D., Schiavone; S., Cavalleri; R., Baldassarre; P., Curti; A., D'Amico; G., Carluccio; P., Beltrami
abstract

Il trattamento extracorporeo della calcolosi reno-ureterale con Dornier MFL-5000

1992 - L'enucleazione come trattamento di scelta delle neoplasie renali di basso stadio e grado [Articolo su rivista]
C., Tallarigo; L., Comunale; Bianchi, Giampaolo; S., Cavalleri; G., Novella; L., Motta; P., Beltrami; G., Mobilio
abstract

L'enucleazione come trattamento di scelta delle neoplasie renali di basso stadio e grado

1992 - L'impiego della litotrissia extracorporea nella rimozione di stent ureterale calcifico [Articolo su rivista]
P., Curti; G., Malossini; S., Cavalleri; G., Carluccio; A., D'Amico; P., Beltrami; Bianchi, Giampaolo
abstract

L'impiego della litotrissia extracorporea nella rimozione di stent ureterale calcifico

1992 - La calcolosi renale a stampo: quale strategia terapeutica? [Articolo su rivista]
G., Mobilio; Bianchi, Giampaolo; G., Malossini; P., Beltrami; G., Carluccio
abstract

La calcolosi renale a stampo: quale strategia terapeutica

1992 - La linfadenectomia pelvica laparoscopica [Articolo su rivista]
Bianchi, Giampaolo; C., Tallarigo; S., Cavalleri; D., Schiavone; P., Beltrami; G., Mobilio
abstract

La linfadenectomia pelvica laparoscopica

1992 - La litotrissia extracorporea ad onde d'urto nel trattamento della calcolosi in rene a ferro di cavallo [Articolo su rivista]
S., Cavalleri; P., Curti; A., D'Amico; G., Malossini; R., Baldassarre; D., Schiavone; Bianchi, Giampaolo
abstract

La litotrissia extracorporea ad onde d'urto nel trattamento della calcolosi in rene a ferro di cavallo

1992 - Recenti progressi per una più accurata analisi FCM del DNA nell'iperplasia prostatica benigna [Articolo su rivista]
R., Pianon; P., Curti; D., Schiavone; A., D'Amico; P., Beltrami; L. S., Azzolina; N., Franzolin; Bianchi, Giampaolo; G., Mobilio
abstract

Recenti progressi per una più accurata analisi FCM del DNA nell'iperplasia prostatica benigna

1992 - Refertazione automatizzata con computer: applicazione alla uroflussometria [Articolo su rivista]
D., Schiavone; Bianchi, Giampaolo; P., Beltrami; A., Rovasio; L., Comunale; G., Mobilio:
abstract

Refertazione automatizzata con computer: applicazione alla uroflussometria

1992 - Role of urodynamics and neurophysiology in the diagnosis of vesico-urethral dysfunctions due to autonomic failure [Articolo su rivista]
G., Giusti; C., Tallarigo; L. G., Bongiovanni; L., Comunale; Bianchi, Giampaolo; D., Schiavone; R., Pianon; R., Baldassarre; A., Rovasio
abstract

Role of urodynamics and neurophysiology in the diagnosis of vesico-urethral dysfunctions due to autonomic failure

1992 - Ruolo dell'analisi del DNA mediante citometria a flusso nei tumori renali [Articolo su rivista]
G., Mobilio; Bianchi, Giampaolo; N., Franzolin; P., Beltrami; M., Lazzarotto
abstract

Ruolo dell'analisi del DNA mediante citometria a flusso nei tumori renali

1992 - Scheda computerizzata per uno studio prospettico sul trattamento dell'iperplasia prostatica benigna con ipertermia [Articolo su rivista]
D., Schiavone; Bianchi, Giampaolo; P., Curti; G., Malossini; C., Tallarigo; L., Comunale
abstract

Scheda computerizzata per uno studio prospettico sul trattamento dell'iperplasia prostatica benigna con ipertermia

1992 - Spermatic cord torsion [Articolo su rivista]
G., Malossini; P., Curti; L., Comunale; Bianchi, Giampaolo; R., Baldassarre; G., Carluccio; G., Poletti
abstract

Torsion of the spermatic cord constitutes a surgical emergency. Morphologically and functionally, the fate of the compromised testis largely depends on the time elapsed between the acute episode and surgical intervention. Patients who had been treated for testicular torsion by our group from 1976 to 1989 were requested to return for outpatient evaluation. These patient were divided into two groups according to the time elapsed between the diagnosis and surgical intervention. We observed that surgical correction within 12 hours following presentation permitted testicular salvage. Testicular volume was generally preserved and remained normal or slightly diminished. However, when the time elapsed was over 12 hours, testicular atrophy was observed in 46% of the patients. We can conclude, therefore, that detorsion must be performed as soon as possible. Vaginalis testis eversion will generally achieve stable and lasting fixation.

1992 - The effects of unilateral spermatic cord torsion on fertility. A review of the literature and evaluation of the authors' own cases [Articolo su rivista]
P., Curti; G., Malossini; G., Piubello; L., Comunale; Bianchi, Giampaolo; C., Tallarigo; R., Baldassarre; D., Schiavone; S., Cavalleri; A., D'Amico; L., Motta; L., Monaco
abstract

The effects of unilateral spermatic cord torsion on fertility. A review of the literature and evaluation of the authors' own cases

1992 - The use of extracorporeal lithotripsy to remove calcified ureteral stents [Articolo su rivista]
Bianchi, Giampaolo; G., Malossini; S., Cavalleri; P., Curti; G., Carluccio
abstract

The use of extracorporeal lithotripsy to remove calcified ureteral stents

1992 - Un caso di ematoma perirenale spontaneo(sindrome di Wunderlich) da adenocarcinoma renale. [Relazione in Atti di Convegno]
L., Comunale; A., Lotto; S., Cavalleri; A., D'Amico; R., Baldassarre; P., Curti; G., Novella; L., Motta; Bianchi, Giampaolo
abstract

Un caso.di ematoma perirenale spontaneo(sindrome di Wunderlich) da adenocarcinoma renale.

1991 - Centro per il trattamento della calcolosi: gestione computerizzata dalla prenotazione al controllo post-trattamento. [Articolo su rivista]
S., Cavalleri; D., Schiavone; R., Baldassarre; Bianchi, Giampaolo; G., Mobilio
abstract

Centro per il trattamento della calcolosi: gestione computerizzata dalla prenotazione al controllo post-trattamento.

1991 - Continuous monitoring of nocturnal penile tumescence and rigidity in the evaluation of erection disorders. Preliminary data [Articolo su rivista]
G., Malossini; R., Baldassarre; A., Lotto; G., Piubello; L., Comunale; Bianchi, Giampaolo; G., Mobilio
abstract

Nocturnal penile tumescence measurements continues to be an important step in the diagnosis of impaired erectile function. We present our experience with this technique employed on 65 patients who consulted at our andrologic center. Our results corroborate the importance of the NPR-R test with the Rigi-Scan in the evaluation of this pathology to ensure these patients receive the most appropriate treatment.

1991 - Female detrusor instability: a 3-year retrospective evaluation [Articolo su rivista]
C., Tallarigo; D., Schiavone; Bianchi, Giampaolo; R., Pianon; R., Baldassarre; G., Carluccio; A., Rovasio
abstract

Female detrusor instability: a 3-year retrospective evaluation

1991 - Il ganglioneuroma retroperitoneale [Articolo su rivista]
S., Cavalleri; P., Curti; R., Pianon; L., Comunale; Bianchi, Giampaolo; G., Malossini
abstract

Il ganglioneuroma retroperitoneale

1991 - Il ruolo dell'analisi del DNA mediante citometria a flusso nell'identificare i falsi positivi citologici da flogosi [Articolo su rivista]
N., Franzolin; Bianchi, Giampaolo; P., Beltrami; R., Chignola; R., Pianon; A., D'Amico; L. S., Azzolina; G., Tridente; G., Mobilio
abstract

Il ruolo dell'analisi del DNA mediante citometria a flusso nell'identificare i falsi positivi citologici da flogosi

1991 - L'analisi del DNA mediante citometria a flusso nei tumori del rene. [Articolo su rivista]
Bianchi, Giampaolo; P., Beltrami; N., Franzolin; R., Chignola; P., Curti; D., Schiavone; C., Tallarigo; G., Malossini; L. S., Azzolina; G., Mobilio
abstract

L'analisi del DNA mediante citometria a flusso nei tumori del rene.

1991 - La litotrissia extracorporea ad onde d'urto (ESWL) nel trattamento della calcolosi urinaria: la nostra esperienza sui primi 400 casi trattati con il litotritore Dornier MFL 5000 [Articolo su rivista]
G., Mobilio; Bianchi, Giampaolo; N., Franzolin; G., Malossini; S., Cavalleri; P., Curti; R., Baldassarre; A., D'Amico
abstract

La litotrissia extracorporea ad onde d'urto (ESWL) nel trattamento della calcolosi urinaria: la nostra esperienza sui primi 400 casi trattati con il litotritore Dornier MFL 5000

1991 - La nostra esperienza nel trattamento percutaneo della calcolosi renale a stampo [Articolo su rivista]
Bianchi, Giampaolo; G., Malossini; P., Beltrami; G., Carluccio; E., Marzoli; D., Schiavone; G., Mobilio
abstract

La nostra esperienza nel trattamento percutaneo della calcolosi renale a stampo

1991 - Le stenosi uretrali post TURP: studio prospettico multicentrico su 477 casi [Articolo su rivista]
P., Graziotti; G., Breda; F., Faccioli; M., Scanzi; D., Lavelli; A., Calabrò; V., Pegoraro; G., Anselmo; Bianchi, Giampaolo; A., Piccinnelli; D., Xausa; M., Meneguolo; V., De Luca; F., Di Tonno; F., Voltolina; M., Pizzarella; L., Faggiano; R., Pianon
abstract

Le stenosi uretrali post TURP: studio prospettico multicentrico su 477 casi

1991 - Osservazioni su 75 casi di neoplasia del testicolo trattati presso la Divisione Clinicizzata di Urologia di Verona [Articolo su rivista]
C., Tallarigo; L., Comunale; Bianchi, Giampaolo; A., Rovasio; D., Schiavone; R., Baldassarre; R., Pianon; M., Rahmati
abstract

Osservazioni su 75 casi di neoplasia del testicolo trattati presso la Divisione Clinicizzata di Urologia di Verona

1991 - Our experience with the percutaneous treatment of renal staghorn calculosis [Articolo su rivista]
Bianchi, Giampaolo; G., Malossini; P., Beltrami; G., Carluccio; E., Marzoli; D., Schiavone; G., Mobilio
abstract

Our experience with the percutaneous treatment of renal staghorn calculosis

1991 - Scheda per archiviazione con computer dei dati citologici, istologici e citometrici [Articolo su rivista]
P., Beltrami; D., Schiavone; Bianchi, Giampaolo; A., D'Amico
abstract

Scheda per archiviazione con computer dei dati citologici, istologici e citometrici

1991 - Small urothelial carcinoma: diagnosis and treatment by cold forceps biopsy [Articolo su rivista]
Bianchi, Giampaolo; P., Novelli; P., Beltrami; M., Bonzanini; G., Mobilio
abstract

From 1987 to 1988 we used cold biopsy forceps to remove completely 92 urothelial neoplasms ranging from 0.3 to 3 mm. Rigid biopsy forceps were used. The urologist usually treats these bladder neoplasms by diathermy coagulation, which obviously makes histological study impossible. On the other hand, due to the small size of these lesions even removal with the cutting loop inevitably causes deep regressive modifications that prevent accurate morphological evaluation. Histological examination of the neoplasms removed revealed the presence of low to medium grade (stage Ta, grades 1 to 2) noninfiltrating papillary carcinoma in 75 cases, high grade (stage Ta, grade 3) noninfiltrating papillary carcinoma in 9 and medium to high grade (stage T1, grades 2 to 3) infiltrating papillary carcinoma in 8, 1 of which had areas of squamous cell carcinoma. This method enabled us to study the morphology of the urothelial lesions in the initial phase. In our study population the number of high grade lesions and/or lesions with early signs of infiltration (17 of 92) appears to be noteworthy despite the small size of the tumors.

1991 - Struttura di una cartella clinica computerizzata per la gestione totale di un paziente in un reparto di un centro ospedaliero [Articolo su rivista]
R., Pianon; D., Schiavone; A., D'Amico; Bianchi, Giampaolo
abstract

Struttura di una cartella clinica computerizzata per la gestione totale di un paziente in un reparto di un centro ospedaliero

1991 - The management of urinary stones by extracorporeal shock-wave lithotripsy (ESWL): our experience using the MFL 5000 Dornier Lithotriptor [Articolo su rivista]
G., Mobilio; Bianchi, Giampaolo; G., Malossini; S., Cavalleri; P., Curti; N., Franzolin; D., Schiavone; A., D'Amico
abstract

The management of urinary stones by extracorporeal shock-wave lithotripsy (ESWL): our experience using the MFL 5000 Dornier Lithotriptor

1991 - Un caso di ematoma perirenale spontaneo (sindrome di Wunderlich) da adenocarcinoma renale [Articolo su rivista]
L., Comunale; A., Lotto; S., Cavalleri; A., D'Amico; R., Baldassarre; Bianchi, Giampaolo
abstract

Un caso di ematoma perirenale spontaneo (sindrome di Wunderlich) da adenocarcinoma renale

1991 - Urinary incontinence in ederly women. Clinical and urodynamic evaluation [Articolo su rivista]
R., Baldassarre; C., Tallarigo; R., Pianon; Bianchi, Giampaolo; P., Beltrami; D., Schiavone; P., Curti; A., Rovasio
abstract

Urinary incontinence in ederly women. Clinical and urodynamic evaluation

1990 - Centro per il trattamento della calcolosi: E.S.W.L., endourologia. Gestione computerizzata dalla prenotazione al controllo post-trattamento [Articolo su rivista]
S., Cavalleri; D., Schiavone; R., Baldassarre; Bianchi, Giampaolo; G., Mobilio
abstract

Centro per il trattamento della calcolosi: E.S.W.L., endourologia. Gestione computerizzata dalla prenotazione al controllo post-trattamento

1990 - Confronto tra criopreservazione e fissazione in etanolo di biopsie vescicali e prostatiche per l'analisi citofluorimetrica [Articolo su rivista]
N., Franzolin; P., Beltrami; R., Pianon; L. S., Azzolina; L., Comunale; Bianchi, Giampaolo; G., Mobilio
abstract

Confronto tra criopreservazione e fissazione in etanolo di biopsie vescicali e prostatiche per l'analisi citofluorimetrica

1990 - Flow cytometry (FCM) on fine needle aspiration of renal tumours [Articolo su rivista]
Bianchi, Giampaolo; P., Beltrami; C., Tallarigo; N., Franzolin; G., Mobilio
abstract

Flow cytometry (FCM) on fine needle aspiration of renal tumour

1990 - Il ruolo dell'analisi del DNA mediante citometria a flusso nell'identificare i falsi positivi citologici da flogosi. [Articolo su rivista]
N., Franzolin; Bianchi, Giampaolo; R., Pianon; P., Beltrami; A., D'Amico; R., Chignola; A., Iannucci; G., Mobilio
abstract

Il ruolo dell'analisi del DNA mediante citometria a flusso nell'identificare i falsi positivi citologici da flogosi.

1990 - Il tumore renale: considerazioni cliniche e terapeutiche in 350 casi trattati negli ultimi anni [Articolo su rivista]
Bianchi, Giampaolo; S., Cavalleri; A., D'Amico; L., Comunale; D., Schiavone; G., Poletti; C., Tallarigo; P., Beltrami
abstract

Il tumore renale: considerazioni cliniche e terapeutiche in 350 casi trattati negli ultimi anni

1990 - L'angiomiolipoma renale multicentrico: contributo dell'immunoistochimica alla risoluzione di un problema clinico [Articolo su rivista]
C., Tallarigo; R., Baldassarre; Bianchi, Giampaolo; G., Novella; M., Pea; M., Bonzanini
abstract

L'angiomiolipoma renale multicentrico: contributo dell'immunoistochimica alla risoluzione di un problema clinico

1990 - L'anticorpo monoclonale correlato ai melanociti HMB45 è caratteristicamente espresso nell'angiomiolipoma renale [Articolo su rivista]
M., Pea; F., Bonetti; M., Bonzanini; A., Mombello; D., Ferrari; G., Zamboni; R., Colombari; A., Scarpa; C., Tallarigo; Bianchi, Giampaolo; L., Fiore Donati
abstract

L'anticorpo monoclonale correlato ai melanociti HMB45 è caratteristicamente espresso nell'angiomiolipoma renale

1990 - L'incontinenza urinaria nella donna anziana. Valutazione clinica e urodinamica [Articolo su rivista]
R., Baldassarre; C., Tallarigo; R., Pianon; Bianchi, Giampaolo; P., Beltrami; D., Schiavone; A., Rovasio
abstract

L'incontinenza urinaria nella donna anziana. Valutazione clinica e urodinamica

1990 - La citometria a flusso su agoaspirato e su campioni di tessuto di tumori renali. [Articolo su rivista]
Bianchi, Giampaolo; P., Beltrami; R., Chignola; N., Franzolin; C., Tallarigo; A., D'Amico; D., Schiavone; A., Iannucci; G., Mobilio
abstract

La citometria a flusso su agoaspirato e su campioni di tessuto di tumori renali.

1990 - MATHEMATICAL-MODEL TO ANALYZE UREA SYNTHESIS FOLLOWING ALANINE INFUSION IN CONTROL SUBJECTS AND IN PATIENTS WITH LIVER-CIRRHOSIS [Articolo su rivista]
Bolzani, R; Bianchi, Giampaolo; Marchesini, G; Sarti, E.
abstract

AbstractA three-compartment model was used to analyse the urea response to an alanine infusion in control subjects and patients with liver cirrhosis. Discriminant analysis showed a good separation between model coefficients of the two groups. A single parameter was derived, able to quantify the liver functional capacity. The method provides a useful diagnostic tool in patients with liver disease.

1990 - Ruolo della cistomanometria nella valutazione della incontinenza urinaria da stress. [Articolo su rivista]
C., Tallarigo; L., Comunale; Bianchi, Giampaolo; D., Schiavone; R., Pianon; R., Baldassarre; C., Monaco; A., Rovasio
abstract

Ruolo della cistomanometria nella valutazione della incontinenza urinaria da stress.

1990 - Small urothelial carcinoma: diagnosis and treatment by cold forceps biopsy [Articolo su rivista]
Bianchi, Giampaolo; P., Novelli; P., Beltrami; M., Bonzanini; G., Mobilio
abstract

From 1987 to 1988 we used cold biopsy forceps to remove completely 92 urothelial neoplasms ranging from 0.3 to 3 mm. Rigid biopsy forceps were used. The urologist usually treats these bladder neoplasms by diathermy coagulation, which obviously makes histological study impossible. On the other hand, due to the small size of these lesions even removal with the cutting loop inevitably causes deep regressive modifications that prevent accurate morphological evaluation. Histological examination of the neoplasms removed revealed the presence of low to medium grade (stage Ta, grades 1 to 2) noninfiltrating papillary carcinoma in 75 cases, high grade (stage Ta, grade 3) noninfiltrating papillary carcinoma in 9 and medium to high grade (stage T1, grades 2 to 3) infiltrating papillary carcinoma in 8, 1 of which had areas of squamous cell carcinoma. This method enabled us to study the morphology of the urothelial lesions in the initial phase. In our study population the number of high grade lesions and/or lesions with early signs of infiltration (17 of 92) appears to be noteworthy despite the small size of the tumors.

1990 - Struttura di una cartella clinica computerizzata per la gestione totale di un paziente in un reparto di un centro ospedaliero [Articolo su rivista]
R., Pianon; D., Schiavone; A., D'Amico; Bianchi, Giampaolo
abstract

Struttura di una cartella clinica computerizzata per la gestione totale di un paziente in un reparto di un centro ospedaliero

1990 - The treatment of renal cysts by percutaneous puncture and alcohol instillation: our experience [Articolo su rivista]
Bianchi, Giampaolo; S., Cavalleri; A., D'Amico; P., Beltrami; C., Tallarigo; G., Malossini; G., Mobilio
abstract

The treatment of renal cysts by percutaneous puncture and alcohol instillation: our experience

1990 - Trattamento chirurgico conservativo delle neoplasie renali [Relazione in Atti di Convegno]
G., Mobilio; G., Novella; L., Comunale; Bianchi, Giampaolo; G., Malossini; C., Tallarigo
abstract

Trattamento chirurgico conservativo delle neoplasie renali

1990 - Treatment of renal cysts by percutaneous drainage and alcoholization. Our experience [Articolo su rivista]
Bianchi, Giampaolo; S., Cavalleri; A., D'Amico; C., Tallarigo; G., Malossini; P., Beltrami
abstract

Since many years renal cysts have been treated by percutaneous puncture and successive aspiration. The introduction of various sclerosing substances has been associated with this manoeuvre. In our study we examined 44 patients with renal cysts submitted to percutaneous puncture, aspiration and injection with 95% ethanol. We thought right to leave a small pig tail catheter so that the sclerosing substance could be easily and completely eliminated allowing the adhesion of the cystic walls in the following days, without any accumulation of cystic and/or exudative liquid. The follow up (12-24 months) has shown no relapsing in 40/44 cases. Only in 4 patients a cyst was present, but with dimensions lower than 30% of the original volume

1990 - Urethral stricures following endoscopic surgery: cooperative prospectic study on 605 patients [Articolo su rivista]
P., Graziotti; G., Anselmo; Bianchi, Giampaolo; G., Breda; S., Cosciani Cunico; A., Meneghini; F., Merlo; E., Marzoli; D., Xausa; T., Zambolin; P., Zucchetta
abstract

Urethral stricures following endoscopic surgery: cooperative prospectic study on 605 patients

1990 - Valutazione citofluorimetrica del DNA dell'urotelio nei tumori superficiali della vescica prima e dopo terapia antiblastica endocavitaria [Articolo su rivista]
N., Franzolin; Bianchi, Giampaolo; L., Comunale; A., D'Amico; G., Novella; L. S., Azzolina; G., Mobilio
abstract

Valutazione citofluorimetrica del DNA dell'urotelio nei tumori superficiali della vescica prima e dopo terapia antiblastica endocavitaria

1989 - Analisi citofluorimetrica del DNA nel tumore superficiale della vescica: correlazione tra fase S e prognosi [Articolo su rivista]
N., Franzolin; L. S., Azzolina; Bianchi, Giampaolo; D., Schiavone; P., Beltrami; G., Mobilio
abstract

Analisi citofluorimetrica del DNA nel tumore superficiale della vescica: correlazione tra fase S e prognosi

1989 - Caratterizzazione citofluorimetrica del DNA nel tessuto prostatico ipertrofico e neoplastico con metodo di colorazione semplificato. Rapporto preliminare [Articolo su rivista]
N., Franzolin; Bianchi, Giampaolo; L. S., Azzolina; R., Pianon; L., Comunale; G., Mobilio
abstract

Caratterizzazione citofluorimetrica del DNA nel tessuto prostatico ipertrofico e neoplastico con metodo di colorazione semplificato. Rapporto preliminare

1989 - Diagnosi e trattamento del carcinoma uroteliale di "piccole dimensioni" mediante biopsia con pinza fredda [Articolo su rivista]
Bianchi, Giampaolo; P., Novelli; N., Franzolin; P., Beltrami; G., Mobilio
abstract

Diagnosi e trattamento del carcinoma uroteliale di "piccole dimensioni" mediante biopsia con pinza fredda

1989 - La nostra esperienza nel trattamento del varicocele primitivo con embolizzazione mediante palloncino e scleroterapia [Articolo su rivista]
A., Lotto; Bianchi, Giampaolo; G., Taddei; G., Malossini; S., Imperio; P., Beltrami; C., Fugazzola; G., Mobilio
abstract

La nostra esperienza nel trattamento del varicocele primitivo con embolizzazione mediante palloncino e scleroterapia

1989 - Mappa vescicale "cieca" o mirata con microcistoscopia? [Articolo su rivista]
G., Mobilio; Bianchi, Giampaolo; P., Novelli; A., Lotto; N., Franzolin; S., Cavalleri
abstract

Mappa vescicale "cieca" o mirata con microcistoscopia?

1989 - Trattamento chirurgico conservativo delle neoplasie renali [Articolo su rivista]
Mobilio, G.; Novella, G.; Comunale, L.; Bianchi, Giampaolo; Malossini, G.; Tallarigo, C.
abstract

Trattamento chirurgico conservativo delle neoplasie renali

1989 - Valutazione comparativa tra citologia ed analisi citofluorimetrica del DNA nucleare del liquido di lavaggio delle neoplasie vescicali [Articolo su rivista]
N., Franzolin; Bianchi, Giampaolo; G., Malossini; G., Novella; L. S., Azzolina; G., Mobilio
abstract

Valutazione comparativa tra citologia ed analisi citofluorimetrica del DNA nucleare del liquido di lavaggio delle neoplasie vescicali

1988 - Analisi citofluorimetrica del DNA nel tumore superficiale della vescica: correlazione tra fase S e prognosi. [Articolo su rivista]
N., Franzolin; L. S., Azzolina; Bianchi, Giampaolo; D., Schiavone; P., Beltrami; G., Mobilio
abstract

Analisi citofluorimetrica del DNA nel tumore superficiale della vescica: correlazione tra fase S e prognosi.

1988 - Caratterizzazione citofluorimetrica del DNA nel tessuto prostatico ipertrofico e neoplastico con metodo di colorazione semplificato. Rapporto preliminare [Articolo su rivista]
N., Franzolin; Bianchi, Giampaolo; L. S., Azzolina; R., Pianon; L., Comunale; G., Mobilio
abstract

Caratterizzazione citofluorimetrica del DNA nel tessuto prostatico ipertrofico e neoplastico con metodo di colorazione semplificato. Rapporto preliminare

1988 - Diagnosi e trattamento nel carcinoma uroteliale di "piccole dimensioni" mediante biopsia con pinza fredda. [Articolo su rivista]
Bianchi, Giampaolo; P., Novelli; N., Franzolin; P., Beltrami; L., Comunale; G., Mobilio
abstract

Diagnosi e trattamento nel carcinoma uroteliale di "piccole dimensioni" mediante biopsia con pinza fredda.

1988 - Evaluation of the results and tolerance of prolonged treatment with mepartricin [Articolo su rivista]
Bianchi, Giampaolo; P., Curti; M., De Iorio; G., Mobilio
abstract

Evaluation of the results and tolerance of prolonged treatment with mepartricin

1988 - I diverticoli dell'uretra femminile [Articolo su rivista]
Bianchi, Giampaolo; G., Malossini; S., Cavalleri; P., Curti; P., Comunale; G., Novella; G., Mobilio
abstract

I diverticoli dell'uretra femminile

1988 - L'oncocitoma renale. Descrizione di un caso [Articolo su rivista]
C., Tallarigo; R., Baldassarre; G., Malossini; A., Lotto; Bianchi, Giampaolo; A., Rovasio; F., Marino
abstract

L'oncocitoma renale. Descrizione di un caso

1988 - La nostra esperienza nel trattamento del varicocele primitivo con embolizzazione mediante palloncino e scleroterapia [Articolo su rivista]
A., Lotto; Bianchi, Giampaolo; G., Malossini; G., Taddei; C., Fugazzola; G., Mobilio
abstract

La nostra esperienza nel trattamento del varicocele primitivo con embolizzazione mediante palloncino e scleroterapia

1988 - Mappa vescicale "cieca" o mirata con microcistoscopia? [Articolo su rivista]
G., Mobilio; Bianchi, Giampaolo; P., Novelli; A., Lotto; N., Franzolin; S., Cavalleri
abstract

Mappa vescicale "cieca" o mirata con microcistoscopia

1988 - Polipo fibroepitelial del ureter [Articolo su rivista]
G., Malossini; A., Lotto; P., Curti; P., Novelli; Bianchi, Giampaolo; C., Tallarigo
abstract

Polipo fibroepitelial del ureter

1988 - Prognosis of superficial bladder tumors as studied by DNA flow cytometry. A report on a double blind study of 120 patients [Articolo su rivista]
G., Mobilio; B., Tribukait; N., Franzolin; L. S., Azzolina; G., Tridente; Bianchi, Giampaolo; P., Beltrami; P., Curti
abstract

Prognosis of superficial bladder tumors as studied by DNA flow cytometry. A report on a double blind study of 120 patients

1988 - Trattamento del carcinoma prostatico avanzato con lo Zoladex, un agonista dell'LHRH: risultati di uno studio multicentrico di fase II. [Articolo su rivista]
A. R., Bianco; V., Iaffaioli; D., Albano; U., Ferraris; A., Bono; E., Pozzi; F., Calabresi; F., Angelini; G., Cruciani; U., Delli Ponti; G., Gallo; A., Frugoni; G., Mobilio; Bianchi, Giampaolo; A., Morelli; T., Aymer; G., Robustelli Della Cuna; P., Preti; F., Selvaggi; M., Battaglia; E., Usai; P. G., Manca; R., Scarpa; D., Vicini; C., Dellera
abstract

Trattamento del carcinoma prostatico avanzato con lo Zoladex, un agonista dell'LHRH: risultati di uno studio multicentrico di fase II.

1988 - Valutazione comparativa tra citologia ed analisi citofluorimetrica del DNA nucleare del liquido di lavaggio nelle neoplasie vescicali [Articolo su rivista]
N., Franzolin; Bianchi, Giampaolo; G., Malossini; G., Novella; L. S., Azzolina; G., Mobilio
abstract

Valutazione comparativa tra citologia ed analisi citofluorimetrica del DNA nucleare del liquido di lavaggio nelle neoplasie vescicali

1987 - Computerized axial tomography of urinary bladder tumours using oily contrast medium [Articolo su rivista]
Bianchi, Giampaolo; C., Procacci; R., Caudana; G., Malossini; D., Schiavone; G., Grasso; G., Mobilio
abstract

Computerized axial tomography of urinary bladder tumours using oily contrast medium

1987 - Il tumore primitivo dell'uretra prostatica [Articolo su rivista]
S., Cavalleri; G., Malossini; L., Comunale; P., Novelli; Bianchi, Giampaolo
abstract

Il tumore primitivo dell'uretra prostatica

1987 - Le cisti parapieliche [Articolo su rivista]
Bianchi, Giampaolo; S., Cavalleri; L., Comunale; G., Malossini
abstract

Le cisti parapieliche

1987 - Protein-sparing peripheral parenteral nutrition in urologic surgery [Articolo su rivista]
G., Malossini; S., Cavalleri; Bianchi, Giampaolo; I., Carpi; L., Lamberti; G., Scroccaro
abstract

The use of parenteral nutrition in patients operated on for cystectomy is a basic post-operative therapeutic aid used for maintaining an adequate state of nutrition. In the present paper, the authors report the results of a study conducted for the purposes of comparing the efficacy of protein-sparing parenteral nutrition versus TPN.

1987 - The vesicosigmoidal fistula: diagnosis and surgical tretment [Articolo su rivista]
Malossini, G.; Cavalleri, S.; Comunale, L.; Bianchi, Giampaolo; Dagradi, V.; Piccinelli, D.; Lolli, P.; Delaini G. C., : The vesicosigmoidal fistula: diagnosis; Surgical, Tretment
abstract

The authors report their experience in the diagnosis and treatment of 10 cases of vesicosigmoidal fistula. In accordance with the literature the most frequent presenting symptoms were of urinary origin. For the diagnosis urography was helpful, cystography and cystoscopy allowed the observation of a fistulous orifice, while barium enema confirmed, or removed probable doubts about the nature of the intestinal pathology. Surgical treatment varied from one-stage to multi-stage procedures

1986 - Malignant fibrohistiocytoma: a rare localization at the level of the glands [Articolo su rivista]
Bianchi, Giampaolo; M., Querena; R., Pisa; G., Malossini
abstract

Malignant fibrohistiocytoma: a rare localization at the level of the glands

1986 - Pheochromocytoma of the urinary bladder [Articolo su rivista]
G., Malossini; A., Lotto; R., Pisa; S., Petracco; Bianchi, Giampaolo
abstract

Pheochromocytoma of the urinary bladder.

1985 - A case of anomalous adrenal position: the adrenal-renal heterotopia. [Articolo su rivista]
G., Malossini; S., Cavalleri; Bianchi, Giampaolo
abstract

The authors describe a case of adrenal-renal heterotopia. The embryological basis for this anomaly and its clinical significance are reviewed.

1985 - Considerations regarding a case of leiomyoma of the urinary bladder [Articolo su rivista]
S., Petracco; G., Malossini; C., Tallarigo; P., Novelli; Bianchi, Giampaolo
abstract

In spite of its rarity, leiomyoma of the bladder deserves to be better known as its diagnosis is not always obvious, depending as it does mainly on urography confirmed by anatomo-pathological examination, and particularly because its treatment is simple and the prognosis always favourable, a fact worthy of note in dealing with a tumour of the bladder.

1985 - Diagnostic value of urinary cyclic AMP measurement in patients with calcium nephrolithiasis [Articolo su rivista]
Bianchi, Giampaolo; G., Galvanini; D., Schiavone; R., Facchinetti; G., Malossini; V., Lo Cascio; G., Mobilio
abstract

One hundred patients with recurrent calcium nephrolithiasis were submitted to the Pak test. At fasting state hypercalciuria was found in 27 cases, while a group of 16 further patients became hypercalciuric after oral calcium load. Only measurement of urinary cAMP excretion in both conditions made it possible to diagnose renal hypercalciuria in 9 out of 27 patients in the former group; according to test results 4 patients were expected to have primary hyperparathyroidism, but afterwards the disease was identified in only one case.

1985 - Dichloromethylene-diphosphonate in patients with prostatic carcinoma metastatic to the skeleton [Articolo su rivista]
S., Adami; G., Salvagno; G., Guarrera; BIANCHI, Giampaolo; R., Dorizzi; S., Rosini; G., Mobilio; V., Lo Cascio
abstract

A total of 17 patients with multiple osteoblastic bone metastases owing to prostatic carcinoma was treated with 2-dichloromethylene-diphosphonate, a powerful inhibitor of bone resorption. The drug was given intravenously (300 mg.) for 2 weeks and then orally (3,200 mg.) or intramuscularly (100 mg.) for 4 to 11 weeks. A definite improvement in pain, assessed by daily consumption of analgesic drugs and by an analogic scale, was observed within 10 days in 16 of the 17 patients. Four patients confined to bed rest for pain were able to walk after 2 weeks and reversal of paralysis also was noted in 1 patient. Transient changes in serum calcium (decreasing) and alkaline phosphatase (increasing) were observed in most patients. In the 3 patients in whom it was performed, repeated bone scanning showed a partial regression of pathological areas in 2 and the complete disappearance of most pathological areas in 1. Our results suggest that 2-dichloromethylene-diphosphonate may represent an important supportive treatment in patients with bone metastases owing to prostatic carcinoma, providing sustained relief of pain and regression of bone destruction without undesirable side effects.

1985 - Il seminoma retroperitoneale primitivo. Descrizione di un caso [Articolo su rivista]
G., Malossini; N., Franzolin; A., Rovasio; Bianchi, Giampaolo
abstract

Il seminoma retroperitoneale primitivo. Descrizione di un caso

1985 - L'adenome nephrogenique de la vessie [Articolo su rivista]
G., Malossini; A., Lotto; D., Schiavone; A., Iannucci; Bianchi, Giampaolo
abstract

L'adenome nephrogenique de la vessie

1985 - Malignes Lymphom mit primaerer Blasenlokalisation [Articolo su rivista]
Bianchi, Giampaolo; G., Malossini; A., Rovasio; F., Bonetti; F., Menestrina
abstract

The malignant lymphoma with primary localisation in the urinary bladder rarely occurs in the clinic. The therapy essentially depends on the position and the extension of the tumour. Despite their malignity these tumours seem, however, to have a relatively good prognosis

1985 - Quiste multilocular del rinon. [Articolo su rivista]
G., Malossini; S., Cavalleri; D., Schiavone; A., Scarpa; Bianchi, Giampaolo
abstract

Quiste multilocular del rinon

1985 - Trattamento con diclorometilendifosfonato delle metastasi ossee da carcinoma prostatico [Articolo su rivista]
G., Mobilio; Bianchi, Giampaolo; D., Schiavone; S., Adami; S., Rasini; V., Lo Cascio
abstract

Trattamento con diclorometilendifosfonato delle metastasi ossee da carcinoma prostatico

1984 - About two cases of leiomyosarcoma of the spermatic cord [Articolo su rivista]
Bianchi, Giampaolo; C., Tallarigo; A., Lotto; G., Malossini; D., Schiavone
abstract

About two cases of leiomyosarcoma of the spermatic cord

1984 - Il papilloma invertito della vescica [Articolo su rivista]
Bianchi, Giampaolo; D., Schiavone; P., Novelli; S., Cavalleri; G., Malossini
abstract

Il papilloma invertito della vescica

1984 - L'amiloidosi primitiva isolata della vescica. Descrizione di un caso [Articolo su rivista]
G., Malossini; P., Novelli; Bianchi, Giampaolo
abstract

L'amiloidosi primitiva isolata della vescica. Descrizione di un caso

1984 - L'eritroplasia di Queyrat. Presentazione di un caso clinico e revisione della letteratura [Articolo su rivista]
D., Schiavone; G., Malossini; R., Pisa; P., Novelli; Bianchi, Giampaolo
abstract

L'eritroplasia di Queyrat. Presentazione di un caso clinico e revisione della letteratura

1984 - Un caso di uretere bifido a branca cieca [Articolo su rivista]
G., Malossini; A., Lotto; S., Petracco; Bianchi, Giampaolo
abstract

Un caso di uretere bifido a branca cieca

1983 - Venous imprint on the superioir infundibulum. An unusual pyelographic appearance [Articolo su rivista]
A., Cavalli; Bianchi, Giampaolo
abstract

Venous imprints on the upper urinary tract are common urographic findings but are rarely documented by renal angiography. The authors describe an unusual urographic appearance of a vascular imprint on the superior infundibulum due to a normal venous trunk. In this case retrograde phlebography was performed for a complete diagnosis.

1982 - Accessory duct of the urethra. Report of a case [Articolo su rivista]
C., Tallarigo; N., Franzolin; A., Cavalli; Bianchi, Giampaolo
abstract

Accessory duct of the urethra. Report of a case

1982 - Il dotto accessorio dell'uretra. Considerazioni su tre casi [Articolo su rivista]
Bianchi, Giampaolo; C., Tallarigo; A., Lotto; S., Petracco
abstract

Il dotto accessorio dell'uretra. Considerazioni su tre casi

1981 - Choice between US and CT in the radiological approach to the renal masses [Articolo su rivista]
G., Mobilio; A., Cavalli; Bianchi, Giampaolo; C., Fugazzola; C., Procacci; L., Mazzi
abstract

The diagnostic reliability of ultrasound (US) and computed tomography (CT) has been analyzed in 114 patients with renal masses (RM) detected by urography and consequently submitted to both exams. A flowchart is suggested in order to avoid useless examinations; accordingly, the US examination is always justified in the study of RM as opposed to the CT examination (requested only in 50% of RM) and angiography (requested only in 35% of RM).

1981 - Complete duplication of bladder and urethra with related anomalies [Articolo su rivista]
Bianchi, Giampaolo; A., Cavalli; C., Tallarigo; A., Di Palma
abstract

Complete duplication of bladder and urethra with related anomalies

1981 - La sindrome di Fraley. Considerazioni su tre casi [Articolo su rivista]
G., Mobilio; A., Cavalli; Bianchi, Giampaolo; D., Armani
abstract

La sindrome di Fraley. Considerazioni su tre casi

1981 - Preoperative arterial occlusion in renal tumors: 3 years experience [Articolo su rivista]
G., Mobilio; A., Cavalli; Bianchi, Giampaolo
abstract

The authors describe their experience in preoperative embolization of 42 renal neoplasms. In all cases but one Gelfoam has been used for arterial occlusion with just a few and transient complications. Good hemostatic effect and décollement have been obtained irrespective of the diameter and vascularization of the tumor. To avoid late décollement difficulties and reduce the duration of clinical sequels the authors prefer, at present, to resort to surgery within 24 hours of embolization.

1981 - Su di un caso di leiomiosarcoma della vescica [Articolo su rivista]
Bianchi, Giampaolo; A., Cavalli; C., Tallarigo; F., Bonetti; R., Mencarelli; A., Iannucci
abstract

Su di un caso di leiomiosarcoma della vescica

1981 - Vantaggi e limiti della tomografia assiale computerizzata nella stadiazione delle neoplasie vescicali [Articolo su rivista]
G., Mobilio; Bianchi, Giampaolo; A., Cavalli
abstract

Vantaggi e limiti della tomografia assiale computerizzata nella stadiazione delle neoplasie vescicali

1980 - L'autoplastica cutanea in due tempi nel trattamento delle stenosi infette dell'uretra penieno-bulbare e membranosa [Articolo su rivista]
Bianchi, Giampaolo; A., Cavalli; C., Tallarigo
abstract

L'autoplastica cutanea in due tempi nel trattamento delle stenosi infette dell'uretra penieno-bulbare e membranosa

1980 - Molding catheterism in the treatment of TB ureter stenoses: A ten-year experiment [Articolo su rivista]
A., Cavalli; Bianchi, Giampaolo; N., Franzolin; C., Tallarigo
abstract

The authors describe their experience with molding catheterism for the treatment of TB ureter stenoses, both primitive and secondary after using chemotherapy. 85% of the cases treated with this method proved to be successful, which led the authors to recommend it prior to proceeding to any surgical treatment.

1980 - Multilocular Cyst of the Kidney: is CT a diagnostica aid [Articolo su rivista]
G., Mobilio; Bianchi, Giampaolo; A., Cavalli; R., Mencarelli
abstract

Multilocular Cyst of the Kidney: is CT a diagnostica aid

1980 - Renojejunal fistula caused by xanthogranulomatous pyelonephritis [Articolo su rivista]
Bianchi, Giampaolo; N., Franzolin
abstract

Renojejunal fistula caused by xanthogranulomatous pyelonephritis

1979 - L'angiomiolipoma isolato del rene. Considerazioni su 4 casi [Articolo su rivista]
G., Mobilio; A., Cavalli; Bianchi, Giampaolo; C., Tallarigo
abstract

L'angiomiolipoma isolato del rene. Considerazioni su 4 casi

1979 - La calcolosi delle vie urinarie. Spunti di terapia endoscopica [Articolo su rivista]
G., Mobilio; Bianchi, Giampaolo; C., Tallarigo; A., Cavalli
abstract

La calcolosi delle vie urinarie. Spunti di terapia endoscopica

1979 - Ruolo della tomografia assiale computerizzata nella patologia espansiva renale [Articolo su rivista]
G., Mobilio; Bianchi, Giampaolo; A., Cavalli; S., Petracco; C., Fugazzola; C., Procacci; P., Quarta Colosso; F., Di Prima
abstract

Ruolo della tomografia assiale computerizzata nella patologia espansiva renale

1979 - Selective arterial embolization in renal tumors [Articolo su rivista]
F., Frasson; C., Fugazzola; BIANCHI, Giampaolo; N., Franzolin; A., Caresano; C., Del Favero; S., Comelli
abstract

Selective arterial embolization with Gelfoam was performed in 45 cases of hypernephroma. In 33 cases this technique has been utilized as preoperative procedure and almost always (97%) nephrectomy was facilitated: 97% of the cases had slight or moderate operative bleeding; in 82% of the cases separation of the tumor-containing kidney from adjacent tissues was easy. Embolization has been employed in 12 inoperable patients and was effective mainly in management of bleeding. Angiographic controls after embolization (from 13 to 162 days) were performed 8 times and it was assessed that the efficacy of the procedure on primary tumor growth is limited in time by renal artery revascularization. The embolized patients never presented severe complications, except several episodes of transitory renal failure.

1978 - Le ipercalciurie: effetti metabolici indotti dalla terapia con diuretici tiazidici [Articolo su rivista]
G., Mobilio; I., Bianchi; Bianchi, Giampaolo; G., Galvanini; O., Sidoti; S., Adami; L., Cominacini; L., Comunale; V., Lo Cascio
abstract

Le ipercalciurie: effetti metabolici indotti dalla terapia con diuretici tiazidici

1976 - Modificazioni delle catecolamine renali dopo legatura dell'arteria epatica nel ratto [Articolo su rivista]
G., Breda; Bianchi, Giampaolo; G., Farello; P., Gandolfi; G., Toffano
abstract

Modificazioni delle catecolamine renali dopo legatura dell'arteria epatica nel ratto

1975 - Faecal stasis and bacteriuria: experimental research in rats [Articolo su rivista]
G., Breda; Bianchi, Giampaolo; U., Bonomi; I., Piacentini; G., Farello
abstract

Faecal stasis and bacteriuria: experimental research in rats

1975 - Il colesterolo e i fosfolipidi renali dopo legatura dell'arteria epatica nel ratto [Articolo su rivista]
Bianchi, Giampaolo; G., Breda; G., Farello; P., Gandolfi; G., Toffano
abstract

Il colesterolo e i fosfolipidi renali dopo legatura dell'arteria epatica nel ratto

1975 - Modificazioni delle catecolamine renali dopo legatura del coledoco nel ratto [Articolo su rivista]
G., Breda; Bianchi, Giampaolo; G., Farello; P., Gandolfi; G., Toffano
abstract

Modificazioni delle catecolamine renali dopo legatura del coledoco nel ratto

1975 - Study of renal cholesterol and phospholipids after ligation of the common bile duct in rats [Articolo su rivista]
G., Farello; P., Gandolfi; G., Toffano; Bianchi, Giampaolo; G., Breda
abstract

Study of renal cholesterol and phospholipids after ligation of the common bile duct in rats

1974 - Applicazioni cliniche della manometria del bacinetto renale attraverso pielostomia economica [Articolo su rivista]
G., Breda; G., Farello; G., Querci; Bianchi, Giampaolo
abstract

Applicazioni cliniche della manometria del bacinetto renale attraverso pielostomia economica

1974 - Pielomanometria percutanea translombare. Studio comparativo con altre metodiche [Articolo su rivista]
G., Breda; G., Farello; G., Querci; Bianchi, Giampaolo; A., Brunetti
abstract

Pielomanometria percutanea translombare. Studio comparativo con altre metodiche