Nuova ricerca

Salvatore MICALI

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

Home | Curriculum(pdf) | Didattica |


Pubblicazioni

2024 - The use of Versius CMR for pelvic surgery: a multicentric analysis of surgical setup and early outcomes [Articolo su rivista]
Sighinolfi, M. C.; De Maria, M.; Meneghetti, J.; Felline, M.; Ceretti, A. P.; Mosillo, L.; Catalano, C.; Morandi, A.; Calcagnile, T.; Panio, E.; Sangalli, M.; Turri, F.; Terzoni, S.; Assumma, S.; Sarchi, L.; Afonina, M.; Marconi, A.; Bianchi, P. P.; Micali, S.; Rocco, B.; Gaia, G.
abstract

IntroductionVersius CMR is a novel robotic system characterized by an open surgical console and independent bedside units. The system has potentials of flexibility and versatility, and has been used in urological, gynecological, and general surgical procedure. The aim is to depict a comprehensive analysis of the Versius system for pelvic surgery.MethodsThis is a study involving two Institutions, ASST Santi Paolo and Carlo, Milan, and Apuane Hospital, Massa, Italy. All interventions performed in the pelvic area with the Versius were included. Data about indications, intra-, and post-operative course were prospectively collected and analyzed.ResultsA total of 171 interventions were performed with the Versius. Forty-two of them involved pelvic procedures. Twenty-two had an oncological indication (localized prostate cancer), the remaining had a non-oncological or functional purpose. The mostly performed pelvic procedure was radical prostatectomy (22) followed by annexectomy (9). No intra-operative complication nor conversion to other approaches occurred. A Clavien II complication and one Clavien IIIb were reported. Malfunctioning/alarms requiring a power cycle of the system occurred in 2 different cases. An adjustment in trocar placement according to patients' height was required in 2 patients undergoing prostatectomy, in which the trocar was moved caudally. In two cases, a pelvic prolapse was repaired concomitant with other gynecological procedures.ConclusionsPelvic surgery with the Versius is feasible without major complications; either dissection and reconstructive steps could be accomplished, provided a proper OR setup and trocar placement are pursued. Versius can be easily adopted by surgeons of different disciplines and backgrounds; a further multi-specialty implementation is presumed and long-term oncological and functional outcomes are awaited.

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

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

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

2023 - Digital real-time microscopy of ex-vivo tissues: A novel strategy to control surgical accuracy [Articolo su rivista]
Sighinolfi, Maria Chiara; Cimadamore, Alessia; Cassani, Alessandra; Assumma, Simone; Sarchi, Luca; Filippi, Beatrice; Turri, Filippo; Reggiani Bonetti, Luca; Maiorana, Antonino; Eissa, Ahmed; Micali, Salvatore; Montironi, Rodolfo; Rocco, Bernardo
abstract

Introduction: Ex-vivo FCM is a novel digital optical technique that provides images of fresh tissues in a real-time fashion with magnification to subcellular details of a flattened unprocessed sample. Digital images are hematoxylin-eosin-like and can be shared and interpreted remotely. In urology, FCM has been successfully applied for prostate tissue interpretation, either during biopsy and radical prostatectomy. Possible applications of FCM may reflect those of frozen section analysis and can be extended to all fields in which the intra-operative microscopical control is advisable. Materials and methods: This is an investigative prospective case series that aims to explore FCM feasibility in novel surgical settings and provide a depiction of FCM digital images in those fields. The definite purpose is to check the accuracy of surgical specimen during the following interventions: (a) trans-urethral resection of bladder tumors, to confirm the presence of muscular layer; (b) biopsy of a retroperitoneal mass, to check for the location and quality of cores; (c) training in robotic radical prostatectomy, to control surgical margins after a nerve sparing performed by a trainee. To this aim, we collected FCM images during seven surgical procedures. FCM findings were compared to those from the final histopathological analysis and the agreement was assessed. Results: In all cases, FCM digital images were obtained in the OR. FCM was able to confirm the presence of muscular layer in TURB specimen, the presence of lymphomatous tissue, surgical margins at prostate specimen. FCM intra-operative interpretation was consistent with final histopathology in all cases. Conclusions: Ex vivo FCM may represent a novel approach to control the quality of specimens, likely to tailor surgical strategy in a real-time fashion. Moreover, digitalization represents a step toward the implementation of telepathology in clinical practice.

2023 - External validation of yonsei nomogram predicting chronic kidney disease development after partial nephrectomy: An international, multicenter study [Articolo su rivista]
Abdel Raheem, Ali; Landi, Isotta; Alowidah, Ibrahim; Capitanio, Umberto; Montorsi, Francesco; Larcher, Alessandro; Derweesh, Ithaar; Ghali, Fady; Mottrie, Alexander; Mazzone, Elio; De Naeyer, Geert; Campi, Riccardo; Sessa, Francesco; Carini, Marco; Minervini, Andrea; Raman, Jay D; Rjepaj, Chris J; Kriegmair, Maximilian C; Autorino, Riccardo; Veccia, Alessandro; Mir, Maria Carmen; Claps, Francesco; Choi, Young Deuk; Ham, Won Sik; Santok, Glen Denmer; Tadifa, John Paul; Syling, Justin; Furlan, Maria; Simeone, Claudio; Bada, Maida; Celia, Antonio; Carrión, Diego M; Aguilera Bazan, Alfredo; Ruiz, Cristina Ballesteros; Malki, Manar; Barber, Neil; Hussain, Muddassar; Micali, Salvatore; Puliatti, Stefano; Ghaith, Ahmed; Hagras, Ayman; Ghoneem, Ayman M; Eissa, Ahmed; Alqahtani, Abdulrahman; Rumaih, Abdullah; Alwahabi, Abdelaziz; Alenzi, Mohammed Jayed; Pavan, Nicola; Traunero, Fabio; Antonelli, Alessandro; Porcaro, Antonio Benito; Illiano, Ester; Costantini, Elisabetta; Rha, Koon Ho
abstract

Objective: To externally validate Yonsei nomogram. Methods: From 2000 through 2018, 3526 consecutive patients underwent on-clamp PN for cT1 renal masses at 23 centers were included. All patients had two kidneys, preoperative eGFR ≥60 ml/min/1.73 m2, and a minimum follow-up of 12 months. New-onset CKD was defined as upgrading from CKD stage I or II into CKD stage ≥III. We obtained the CKD-free progression probabilities at 1, 3, 5, and 10 years for all patients by applying the nomogram found at https://eservices.ksmc.med.sa/ckd/. Thereafter, external validation of Yonsei nomogram for estimating new-onset CKD stage ≥III was assessed by calibration and discrimination analysis. Results and limitation: Median values of patients' age, tumor size, eGFR and follow-up period were 47 years (IQR: 47-62), 3.3 cm (IQR: 2.5-4.2), 90.5 ml/min/1.73 m2 (IQR: 82.8-98), and 47 months (IQR: 27-65), respectively. A total of 683 patients (19.4%) developed new-onset CKD. The 5-year CKD-free progression rate was 77.9%. Yonsei nomogram demonstrated an AUC of 0.69, 0.72, 0.77, and 0.78 for the prediction of CKD stage ≥III at 1, 3, 5, and 10 years, respectively. The calibration plots at 1, 3, 5, and 10 years showed that the model was well calibrated with calibration slope values of 0.77, 0.83, 0.76, and 0.75, respectively. Retrospective database collection is a limitation of our study. Conclusions: The largest external validation of Yonsei nomogram showed good calibration properties. The nomogram can provide an accurate estimate of the individual risk of CKD-free progression on long-term follow-up.

2023 - How do endoscopic bladder tumor resection techniques affect pathology practice? EAU Section of Uro-Technology (ESUT) and Uropathology (ESUP) survey [Articolo su rivista]
Guven, S.; Colecchia, M.; Oltulu, P.; Bonfante, G.; Enikeev, D.; Esen, H.; Herrmann, T.; Lusuardi, L.; Micali, S.; Somani, B.; Skolarikos, A.; Breda, A.; Liatsikos, E.; Redorta, J. P.; Gozen, A. S.
abstract

Purpose: We aimed to examine how different endoscopic bladder tumor resection techniques affect pathologists’ clinical practice patterns. Methods: An online survey including 28 questions clustered in four main sections was prepared by the ESUT ERBT Working Group and released to the pathologists working in the institutions of experts of the ESUT Board and the working groups and experts in the uropathology working group. A descriptive analysis was performed using the collected data. Results: Sixty-eight pathologists from 23 countries responded to the survey. 37.3% of the participants stated that they always report the T1 sub-staging. Of those who gave sub-staging, 61.3% used T1a, b. 85.2% think that en bloc samples provide spatial orientation faster than piecemeal samples, and 60% think en bloc samples are timesaving during an inspection. 55.7% stated that whether the tissue sample is en bloc or piecemeal is essential. 57.4% think en bloc sample reduces turnaround time and is cost-effective for 44.1%. A large number of pathologists find that the pathology examination of piecemeal samples has a longer learning curve. Conclusion: The survey shows that pathologists think that they can diagnose faster, accurately, and cost-effectively with ERBT samples, but they do not often encounter them in practice. Moreover, en bloc samples may be a better choice in pathology resident training. Evidence from real-life observational pathology practice and clinical research can reveal the current situation more clearly and increase awareness on proper treatment in endoscopic management of bladder tumors.

2023 - Rare perinephric myxoid pseudotumor of fat causing ureteropelvic junction obstruction: a case report [Articolo su rivista]
Amato, M; Piazza, P; Ferrari, I; Biolcati, S; Franceschini, T; Puliatti, S; Micali, S; Manferrari, F
abstract

Ureteropelvic junction obstruction (UPJO) is a congenital or acquired functionally significant impairment of urinary transport from the renal pelvis to the ureter. Congenital UPJO typically results from intrinsic disease such as the presence of an aperistaltic segment of the ureter, aberrant vessels or kidney abnormalities. Rare conditions can sometimes mimic an UPJO. We present a case of an 86-year-old woman with a UPJO diagnosed on CT. The patient was counseled on treatment options and elected to undergo a left uretherorenoscopy (URS) plus left laparoscopic pyeloplasty. The definitive histopathologic diagnosis was perinephric myxoid pseudotumor of fat, an extremely rare neoplasm, mass-forming. To the best of our knowledge, this is the first known case of a pseudotumor of fat causing UPJO. 6-month follow-up showed neither recurrence nor residual UPJO. We describe a rare presentation of extrinsic perinephric myxoid pseudotumor of fat causing UPJ obstruction. In elderly patients with no history of malignancy, UPJ obstruction can occur because of atypical masses.

2023 - Semen Analysis in “Urology-Naïve” Patients: A Chance of Uroandrological Screening in Young Males [Articolo su rivista]
Puliatti, S.; Toso, S.; Ticonosco, M.; Rabito, S.; Sighinolfi, M. C.; Ferrari, R.; Rochira, V.; Santi, D.; Trenti, T.; Navarra, M.; Ferretti, S.; Montano, L.; Micali, S.
abstract

(1) Background: While females start their gynecological examinations during puberty, only few men decide to be visited by urologists in their youth. Given the participation in the EcoFoodFertility research project, our department had the opportunity to screen young males that were supposedly healthy. (2) Results: from January 2019 to July 2020, we evaluated 157 patients with sperm, blood analysis, and uroandrological examinations. The inclusion criteria were age 18–40 and absence of previous urological disease (urology-naïve). The primary endpoint of the study was to record uroandrological diseases that are occasionally discovered during examination in asymptomatic young men. The average age was 26.9 years (range 18–40); average testicular volume was 15.7 mL (range 12–22 mL); and 45.2% reported abnormal semen analysis: 62 cases of teratozoospermia, 27 asthenozoospermia, 18 oligozoospermia, and 2 azoospermia were discovered respectively; 4/157 patients were diagnosed with hypogonadism; 2 cases with suspicious testicular mass resulted in testicular cancer; and 31 suspected varicoceles and 8 patients with mild sexual dysfunctions were managed. (3) Conclusions: an uroandrological evaluation of young asymptomatic males allowed for the prompt diagnosis of different urological conditions, including cancerous ones, in our series. Despite being debatable, combining urological counselling with physical examination, semen analysis, and a laboratory profile could be useful and cost-effective in order to ameliorate male health.

2022 - "VirtualBasket" ureteroscopic holmium laser lithotripsy: intraoperative and early postoperative outcomes [Articolo su rivista]
Bozzini, G.; Maltagliati, M.; Berti, L.; Besana, U.; Calori, A.; Pastore, A. L.; Gozen, A.; Govorov, A.; Liatsikos, E.; Micali, S.; Rocco, B.; Tunc, L.; Buizza, C.
abstract

BACKGROUND: The "VirtualBasket" technology (Cook Medical, Bloomington, IN, USA) is the result of pulse modulation during holmium laser emission: the laser emits part of the energy to create an initial bubble, and a second pulse is emitted when the vapor bubble is at its maximum expansion, so that it can pass through the previously created vapor channel. The aim of this study was to outline the outcomes of the "VirtualBasket" technology in ureteral and renal stones. METHODS: 160 Patients were randomly assigned to holmium laser lithotripsy with or without the "VirtualBasket" technology in ureteric or renal cases (40 per 4 groups). All procedures were performed by four experienced urologists. The Quanta System Cyber Ho 100W laser generator with 365 µm fibers was used for all the ureteral cases, whereas 272 µm fibers were used for all the cases in the renal pelvis. Demographic data, stone parameters, perioperative complications and success rates were compared. A statistical analysis was carried out to assess patients' data and outcomes. All the reported P values were obtained with the two-sided exact method at the conventional 5% significance level. The degree of stone retropulsion was graded on a Likert scale from zero (no retropulsion) to 3 (maximum retropulsion). RESULTS: All groups were comparable in terms of age, and preoperative stone size (ureter stone size: 1.2 vs. 1.1 cm; renal pelvis stone size: 1.55 vs. 1.62 cm). Compared to the regular mode, the "VirtualBasket" technology was associated with significantly lower fragmentation time (mean time for ureteral stones: 20.4 vs. 16.1 minutes, P<0.05; mean time for renal stones: 28.7 vs. 19.8 minutes, P<0.05) and total procedural time (mean time for ureteral stones 49 vs. 35.7 minutes; mean time for renal stones 67.1 vs. 52.4 minutes). There were no significant differences in terms of energy delivered to the stones, intraoperative complications and success rate at 1 month. The "VirtualBasket" technology was associated with significantly lower retropulsion. CONCLUSIONS: The "VirtualBasket" technology is associated with significantly lower fragmentation and procedural times. The reduced fragmentation time is a result of the significantly lower retropulsion of the stones during laser lithotripsy, which improves stone fragmentation efficiency.

2022 - Comparison between prone and supine nephrolithotomy in pediatric population: a double center experience [Articolo su rivista]
Campobasso, D.; Bocchialini, T.; Bevilacqua, L.; Guarino, G.; Di Pietro, C.; Granelli, P.; Mezzogori, D.; Salsi, P.; Oltolina, P.; Gatti, C.; Puliatti, S.; Ceccarelli, P. L.; Maestroni, U.; Frattini, A.; Bianchi, G.; Micali, S.; Ferretti, S.
abstract

Purpose: Stone disease in the pediatric age is an increasing issue. Percutaneous Nephrolithotomy (PNL) can be used for larger and complex stones. As in adults it can be performed in the supine or prone position. Methods: We retrospectively reviewed two centers’ experience in prone and supine PNL in children to analyze its results and complications. Results: 33 patients underwent prone and 19 supine procedures. Patients in the prone group were younger than in the supine, while no significant differences were found in stone burden, access size, operative time or complications. Complications were: 8 and 4 Clavien 1 for the prone and supine group, respectively, one case of urosepsis (4b) in the prone and 2 cases of Clavien 3 in the supine group (double J stent placement for renal colic and ureteroscopy for steinstrasse). Tubeless procedures and mean nephrostomy time were in favor of the supine group, whereas fluoroscopy time and ureteral drainage stay were in support of the prone group. Stone free rate was better in the supine group (83.3 vs 66.6%), possibly reflecting the capability to perform a combined approach in 12 patients (allowing to reach all the calyx with simultaneous anterograde and retrograde access) or younger age in the prone group (13 vs 2 patients ≤5 years), with no differences in stone burden. Conclusions: Supine approach seems to guarantee higher stone-free rates. Larger series are necessary to determine what the best technique is in terms of X-ray exposure, operative time and complications.

2022 - Congenital cysts of the lower male genitourinary tract: a disorder with various treatment approaches and pitfalls-case report [Articolo su rivista]
Moretti, M.; Campobasso, D.; Inzillo, R.; Grande, M.; Facchini, F.; Larosa, M.; Kwe, J. E.; Carlinfante, G.; Pozzoli, G. L.; Zizzo, M.; Micali, S.; Frattini, A.
abstract

BACKGROUND: The cysts of the male pelvic floor represent a rare clinical entity. Their origin is linked to an altered development of paramesonephric and mesonephric ducts during embryogenesis. CASE PRESENTATION: We report our experience regarding two patients presenting cysts of the ejaculatory system treated with open and mini-invasive surgery. The patients referred to our clinic with nonspecific symptoms and the diagnosis was obtained by radiological investigations. The patient treated with an open approach developed a pelvic purulent collection and a fistula of the prostatic urethra, managed with surgical drainage and prolonged bladder catheterization. On the other hand, the patient treated with laparoscopic approach did not develop any complications. No sexual or ejaculatory disorders were reported. CONCLUSIONS: Patients with congenital cysts of the pelvic floor must be adequately informed about the risks and benefits of surgery and a careful counseling is mandatory before surgery. Treatment is recommended for symptomatic patients and an endoscopic approach is associated with a high rate of recurrence. A laparoscopic approach, when possible, is desirable.

2022 - Conservative treatment of upper urinary tract urothelial carcinoma (UTUC) in patients with imperative indications: Not only an option [Articolo su rivista]
Campobasso, D.; Puliatti, S.; Micali, S.; Maestroni, U. V.
abstract

2022 - Green light laser enucleation of the prostate with early apical release is safe and effective: single center experience and revision of the literature [Articolo su rivista]
Ferrari, G.; Rabito, S.; Gatti, L.; Ntep, N. N.; Vitelli, F. D.; Marchioni, M.; Rocco, B. M.; Micali, S.; Ferrari, R.; Cindolo, L.
abstract

BACKGROUND: Green Light laser enucleation of the prostate (GreenLEP) is an endoscopic treatment to treat bladder outlet obstruction in men with large prostate (>100 cc). Herein, we describe our GreenLEP series and describe its safety and efficacy. METHODS: Between February 2014 and April 2019, 120 patients from a single center underwent en-bloc GreenLEP with early apical release. All procedures were performed with the AMS XPS laser generator (set: 120 W for vaporization and 20 W for coagulation). Morcellation was carried out with the Wolf Piranha morcellator. Data concerning the pre-, intra- and postoperative outcomes were prospectively collected. The follow-up data at 6, 12 months and at the last control were collected. RESULTS: The median age was 66.0 (IQR: 61.0-71.0) years; 37.5% of the patients were under antiplatelet/anticoagulant therapy, 15.0% had indwelling catheter history. The median prostate volume and the baseline PSA value were 98.5 mL (IQR 83.0-130.0) and 4.2 ng/mL (IQR: 3.2-6.8), respectively. The median operative and lasing time were 65.0 (IQR: 51.0-83.5) and 6.0 (IQR: 6.0-10.0) minutes, respectively. In the postoperative period 1 patient was transfused. The median follow-up was 18.0 (IQR: 12.0-39.5) months. All patients had significant improvement in terms of improvement of uroflowmetry (median from 9 mL/sec [IQR 7.8, 11.0] to 20.0 [IQR 18.0, 22.0], P<0.001) and symptoms control (IPSS median score from 26.0 mL/sec [IQR 22.0, 28.0] to 7.0 [IQR 6.0, 8.0], P<0.001]) over time. After 12 months 1 patient complained of stress incontinence (1 pad/day) and 1 of "de novo"wet urgency. CONCLUSIONS: En-bloc GreenLEP with early apical release is a safe and effective procedure even for large volume prostates. It allows us to limit the use of laser energy and shorten the operating times with stable and satisfactory longterm outcomes.

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

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

2022 - Laparoscopic assisted mini-ECIRS for ectopic kidney lithiasis: A case report and literature review [Articolo su rivista]
Amato, M.; Piazza, P.; Deruyver, Y.; Del Favero, L.; Van den Broeck, T.; Sarchi, L.; Scarcella, S.; Bravi, C. A.; Puliatti, S.; Micali, S.; Van Haute, C.; Van Cleynenbreugel, B.
abstract

INTRODUCTION: Ectopic kidney is a rare anatomic variant with an incidence of about 1 in 900. Renal stones can pose a challenge when a standard approach is not possible. Laparoscopic-assisted endourologic procedure can be a feasible and safe choice. CASE REPORT AND LITERATURE REVIEW: We present a case of 32 years old man with spastic quadriplegia, megacolon and pelvic kidney undergoing intervention of laparoscopic-assisted Mini ECIRS for staghorn stone of the left pelvic kidney. To the best of our knowledge, only 59 cases are reported in the literature concerning laparoscopically assisted encdourologic treatment which seems a feasible, safe and adaptable technique in selected complex cases. CONCLUSION: Laparoscopic-assisted mini ECIRS is a viable option for the treatment of ectopic kidney stones. This technique should be considered when anatomical anomalies are encountered, to avoid puncture-related complications.

2022 - Low-intensity Extracorporeal Shockwave Therapy for the Management of Postprostatectomy Erectile Dysfunction: A Systematic Review of the Literature [Articolo su rivista]
Sighinolfi, M. C.; Eissa, A.; Bellorofonte, C.; Mofferdin, A.; Eldeeb, M.; Assumma, S.; Panio, E.; Calcagnile, T.; Stroppa, D.; Bozzini, G.; Gaia, G.; Terzoni, S.; Sangalli, M.; Micali, S.; Rocco, B.
abstract

Context: Erectile dysfunction (ED) following radical prostatectomy is a concern for patients and their partners. Low-intensity extracorporeal shockwave therapy (LI-ESWT) can potentially enhance tissue repair and regeneration. The aim of the current study was to systematically review the literature to assess the role of LI-ESWT in the management of patients with postprostatectomy ED. Evidence acquisition: Two authors independently performed a systematic search of the PubMed and Web of Science databases to identify all relevant articles. Non-English reports, case reports, reviews, letters, and editorials were excluded. Risk of bias was assessed according to the GRADE guidelines. Evidence synthesis: Nine articles met the inclusion criteria and were included in the qualitative analysis. All the studies included were published between 2015 and 2022 and the majority of them compared phosphodiesterase type 5 inhibitors (PDE5Is) alone versus a combination of LI-ESWT and PDE5Is. Only three studies were randomized controlled trials (RCTs). In general, there is no standardized protocol for LI-ESWT for postprostatectomy ED. In comparisons of LI-ESWT + PDE5Is versus PDE5Is alone, some authors found a statistically significant improvement in erectile function with LI-ESWT + PDE5Is. The starting time for LI-ESWT differed among the studies, ranging from 3 d to 6 mo after surgery. The main limitations of the review are the scarcity of studies, small sample sizes, high risk of bias, and high heterogeneity among studies. Conclusions: There is currently limited evidence on the use of LI-ESWT either alone or in combination with PDE5Is in penile rehabilitation protocols after prostatectomy. However, small clinical trials with short follow-up show that LI-ESWT could potentially play a role in the management of postprostatectomy ED in the future. Further RCTs with larger sample sizes are needed. Patient summary: Despite limited reports in the literature, low-intensity shockwave therapy after removal of the prostate is a promising noninvasive treatment for dealing with erectile dysfunction after surgery.

2022 - Mediterranean Diet as a Shield against Male Infertility and Cancer Risk Induced by Environmental Pollutants: A Focus on Flavonoids [Articolo su rivista]
Montano, L.; Maugeri, A.; Volpe, M. G.; Micali, S.; Mirone, V.; Mantovani, A.; Navarra, M.; Piscopo, M.
abstract

The role of environmental factors in influencing health status is well documented. Heavy metals, polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls, dioxins, pesticides, ultrafine particles, produced by human activities put a strain on the body’s entire defense system. Therefore, together with public health measures, evidence-based individual resilience measures are necessary to mitigate cancer risk under environmental stress and to prevent reproductive dysfunction and non-communicable diseases; this is especially relevant for workers occupationally exposed to pollutants and/or populations residing in highly polluted areas. The Mediterranean diet is characterized by a high intake of fruits and vegetables rich in flavonoids, that can promote the elimination of pollutants in tissues and fluids and/or mitigate their effects through different mechanisms. In this review, we collected evidence from pre-clinical and clinical studies showing that the impairment of male fertility and gonadal development, as well as cancers of reproductive system, due to the exposure of organic and inorganic pollutants, may be counteracted by flavonoids.

2022 - New imaging technologies for robotic kidney cancer surgery [Articolo su rivista]
Puliatti, S.; Eissa, A.; Checcucci, E.; Piazza, P.; Amato, M.; Ferretti, S.; Scarcella, S.; Rivas, J. G.; Taratkin, M.; Marenco, J.; Rivero, I. B.; Kowalewski, K. -F.; Cacciamani, G.; El-Sherbiny, A.; Zoeir, A.; El-Bahnasy, A. M.; De Groote, R.; Mottrie, A.; Micali, S.
abstract

Objective: Kidney cancers account for approximately 2% of all newly diagnosed cancer in 2020. Among the primary treatment options for kidney cancer, urologist may choose between radical or partial nephrectomy, or ablative therapies. Nowadays, robotic-assisted partial nephrectomy (RAPN) for the management of renal cancers has gained popularity, up to being considered the gold standard. However, RAPN is a challenging procedure with a steep learning curve. Methods: In this narrative review, different imaging technologies used to guide and aid RAPN are discussed. Results: Three-dimensional visualization technology has been extensively discussed in RAPN, showing its value in enhancing robotic-surgery training, patient counseling, surgical planning, and intraoperative guidance. Intraoperative imaging technologies such as intracorporeal ultrasound, near-infrared fluorescent imaging, and intraoperative pathological examination can also be used to improve the outcomes following RAPN. Finally, artificial intelligence may play a role in the field of RAPN soon. Conclusion: RAPN is a complex surgery; however, many imaging technologies may play an important role in facilitating it.

2022 - Percutaneous and endoscopic combined treatment of bladder and renal lithiasis in mitrofanoff conduit [Articolo su rivista]
Inzillo, R.; Kwe, J. E.; Simonetti, E.; Milandri, R.; Grande, M.; Campobasso, D.; Ferretti, S.; Rocco, B.; Micali, S.; Frattini, A.
abstract

Introduction and Objectives: Treatment of bulky lithiasis in continent and non-continent urine storage reservoirs has been widely described and debated (1). Less is known about the optimal treatment in patients with a Mitrofanoff conduit. If voiding in these patients is incomplete, leading to recurrent symptomatic bacteriuria, formation of large lithiasis can be a common long-term complication (2, 3). Materials and Methods: This video describes a 19-year-old woman who underwent major open surgery at the age of six, with the configuration of a continent intestinal reservoir with a Mitrofanoff conduit. In 2020, she was referred to our center with a large stone in the reservoir and a minor stone in the inferior left renal calyx. We decided to proceed using a percutaneous approach with an “endovision technique” puncture for the bladder stone, combined with a retrograde intrarenal surgery for the renal stone. The MIP System “M size” was used to perform the percutaneous procedure, thus allowing a single-step dilation. The puncture and the dilation were followed endoscopically with a flexible ureterorenoscope avoiding the use of x-rays. The procedure was carried out as follows. The first step consisted in the insertion of a hydrophilic guidewire through the Mitrofanoff conduit. A flexible ureterorenoscope was then inserted coaxial to the guidewire. The percutaneous puncture, using an 80G needle, was followed endoscopically. Two guidewires were inserted, the first as a safety guidewire and the second for the tract dilation. The “single-step” dilation technique using the MIP system was performed and followed endoscopically. For the bladder lithotripsy, a dual-action lithotripter that combines ultrasonic and mechanical energy was used. Finally, a flexible ureterorenoscope and a basket for the retrieval of a single inferior caliceal stone were used. The procedure ended after positioning a single J stent in the left kidney and a nephrostomy tube in the reservoir. Results: The operative time was 80 minutes and the fluoroscopy time was 6 seconds. Hemoglobin and creatinine serum levels remained stable after the procedure and the patient was discharged on the third post-operative day, after removing both the single J and the nephrostomy tube. Follow-up lasted 12 months, with no bladder or renal stone recurrence, maintaining good continence of the Mitrofanoff conduit. Conclusion: In patients who have undergone several major surgeries a mini-invasive approach is advisable, not only for the morbidity of an open approach, but also for the increased risk of complications while handling an intestinal reservoir. Regarding a pure endoscopic approach, the passage of a nephroscope or a cystoscope through the Mitrofanoff conduit, combined with the continuous traction during the lithotripsy, could damage and compromise its continence. For this reason, the percutaneous approach is the most suitable method in these specific and rare cases.

2022 - Potential Contenders for the Leadership in Robotic Surgery [Articolo su rivista]
Farinha, R.; Puliatti, S.; Mazzone, E.; Amato, M.; Rosiello, G.; Yadav, S.; De Groote, R.; Piazza, P.; Bravi, C. A.; Koukourikis, P.; Rha, K. H.; Cacciamani, G.; Micali, S.; Wiklund, P.; Rocco, B.; Mottrie, A.
abstract

Purpose: To summarize the scientific published literature on new robotic surgical platforms with potential use in the urological field, reviewing their evolution from presentation until the present day. Our goal is to describe the current characteristics and possible prospects for these platforms. Materials and Methods: A nonsystematic search of the PubMed, Cochrane library's Central, EMBASE, MEDLINE, and Scopus databases was conducted to identify scientific literature about new robotic platforms other than the Da Vinci® system, reviewing their evolution from inception until December 2020. Only English language publications were included. The following keywords were used: "new robotic platforms,""Revo-I robot,""Versius robot,"and "Senhance robot."All relevant English-language original studies were analyzed by one author (R.F.) and summarized after discussion with an independent third party (E.M., S.Y., S.P., and M.A.). Results: Since 1995, Intuitive Surgical, Inc., with the Da Vinci surgical system, is the leading company in the robotic surgical market. However, Revo-I®, Versius®, and Senhance® are the other three platforms that recently appeared on the market with available articles published in peer-reviewed journals. Among these three new surgical systems, the Senhance robot has the most substantial scientific proof of its capacity to perform minimally invasive urological surgery and as such, it might become a contender of the Da Vinci robot. Conclusions: The Da Vinci surgical platform has allowed the diffusion of robotic surgery worldwide and showed the different advantages of this type of technique. However, its use has some drawbacks, especially its price. New robotic platforms characterized by unique features are under development. Of note, they might be less expensive compared with the Da Vinci robotic system. We found that these new platforms are still at the beginning of their technical and scientific validation. However, the Senhance robot is in a more advanced stage, with clinical studies supporting its full implementation.

2022 - Preclinical Validation of a Semi-Autonomous Robot for Transperineal Prostate Biopsy [Articolo su rivista]
Maris, B.; Fiazza, M. -C.; De Piccoli, M.; Tenga, C.; Palladino, L.; Puliatti, S.; Iseppi, A.; Ferrari, R.; Piro, A.; Bonetti, L. R.; Ligabue, G.; Tafuri, A.; Micali, S.; Fiorini, P.
abstract

Prostate biopsy is a manual procedure carried out mostly under ultrasound (US) guidance to confirm the presence of cancer. The standard biopsy is random and includes at least 12 insertions; targeted biopsy makes use of dedicated hardware and software, but is still performed manually. We present here the pre-clinical validation of PROST, a robot primarily designed to automate targeted transperineal biopsy. The overall validation of the system was performed on cadavers, while some features, such as image segmentation, were tested on human tissue. PROST is designed to minimize human error by introducing some autonomy in the execution of key steps of the procedure, i.e., target selection, image fusion and needle positioning. The protocol was approved by the ethics committee; 10 cadavers were included in the study. We envision that PROST has the potential to increase the detection of clinically significant prostate cancer, to simplify the procedure, to reduce human errors and to shorten training time. The use of a robot for the biopsy of the prostate will create the possibility to include also a treatment, such as focal ablation, to be delivered through the same system.

2022 - Procedural Robotic Skills Training [Capitolo/Saggio]
Puliatti, Stefano; Piazza, Pietro; Eissa, Ahmed; Bianchi, Lorenzo; Brunocilla, Eugenio; Micali, Salvatore
abstract

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

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

2022 - Rectal Perforation During Pelvic Surgery [Articolo su rivista]
Rocco, B.; Giorgia, G.; Simone, A.; Tommaso, C.; Mattia, S.; Stefano, T.; Ahmed, E.; Giorgio, B.; De Concilio, B.; Celia, A.; Micali, S.; Sighinolfi, M. C.
abstract

Rectal perforations during pelvic surgery are rare but serious complications. The occurrence of rectal involvement is generally lower than that of the involvement of other portions of the bowel. The urologic field is responsible for the majority of iatrogenic rectal injuries from pelvic surgery; general and gynecologic surgeries are prone to the occurrence as well, the latter especially in the case of rectal shaving for deep infiltrating endometriosis. Attention should be posed to the prevention of rectal injuries, especially in case of challenging or salvage procedures; some tricks may be recommended to avoid thermal and mechanical damages and to realize a safe dissection. Intraoperative detection of rectal injuries is of paramount importance; once confirmed, immediate management with the closure of the defect is recommended. In general, rectal injuries diagnosed after surgery are liable to significantly worse outcomes than those detected and managed intraoperatively. Patient summary: Rectal perforation is a rare but possible complication of pelvic surgeries. The more challenging the procedure (ie, surgery for locally advanced tumors or after radiation therapy), the higher the risk of rectal lesion. Intraoperative management of the injury should be attempted, with direct repair of the defect with or without fecal diversion.

2022 - Three-dimensional Model Reconstruction: The Need for Standardization to Drive Tailored Surgery [Articolo su rivista]
Checcucci, E.; Piazza, P.; Micali, S.; Ghazi, A.; Mottrie, A.; Porpiglia, F.; Puliatti, S.
abstract

: The clinical utility of three-dimensional virtual models has been widely explored for preoperative planning, patient counseling, surgical training, and intraoperative navigation. There is now a need for standardized methodology for construction of these models so that their utility can be realized in routine practice to achieve the goal of individualized treatment for patients.

2022 - Warm ischemia time length during on-clamp partial nephrectomy: does it really matter? [Articolo su rivista]
Abdel Raheem, A.; Alowidah, I.; Capitanio, U.; Montorsi, F.; Larcher, A.; Derweesh, I.; Ghali, F.; Mottrie, A.; Mazzone, H.; de Naeyer, G.; Campi, R.; Sessa, F.; Carini, M.; Minervini, A.; Raman, J. D.; Rjepaj, C. J.; Kriegmair, M. C.; Autorino, R.; Veccia, A.; Mir, M. C.; Claps, F.; Choi, Y. D.; Ham, W. S.; Tadifa, J. P.; Santok, G. D.; Furlan, M.; Simeone, C.; Bada, M.; Celia, A.; Carrion, D. M.; Aguilera Bazan, A.; Ballesteros Ruiz, C.; Malki, M.; Barber, N.; Hussain, M.; Micali, S.; Puliatti, S.; Alwahabi, A.; Alqahtani, A.; Rumaih, A.; Ghaith, A.; Ghoneem, A. M.; Hagras, A.; Eissa, A.; Alenzi, M. J.; Pavan, N.; Traunero, F.; Antonelli, A.; Porcaro, A. B.; Illiano, E.; Costantini, E.; Rha, K. H.
abstract

BaCKgroUnd: The impact of warm ischemia time (WiT) on renal functional recovery remains controversial. We examined the length of WiT>30 min on the long-term renal function following on-clamp partial nephrectomy (pn). MeThodS: data from 23 centers for patients undergoing on-clamp pn between 2000 and 2018 were analyzed. We included patients with two kidneys, single tumor, cT1, minimum 1-year follow-up, and preoperative eGFR≥60 mL/ min/1.73m2. Patients were divided into two groups according to WIT length: group I “WIT≤30 min” and group II “WiT>30 min.” a propensity-score matched analysis (1:1 match) was performed to eliminate potential confounding factors between groups. We compared egFr values, egFr (%) preservation, egFr decline, events of chronic kidney disease (CKd) upgrading, and CKd-free progression rates between both groups. Cox regression analysis evaluated WiT impact on upgrading of CKd stages. reSUlTS: The primary cohort consisted of 3526 patients: group i (n.=2868) and group ii (n.=658). after matching the final cohort consisted of 344 patients in each group. At last follow-up, there were no significant differences in median egFr values at 1, 3, 5, and 10 years (p>0.05) between the matched groups. in addition, the median egFr (%) preservation and absolute egFr change were similar (89% in group i vs. 87% in group ii, p=0.638) and (-10 in group i vs. -11 in group ii, p=0.577), respectively. The 5 years new-onset CKd-free progression rates were comparable in the non-matched groups (79% in group i vs. 81% in group ii, log-rank, p=0.763) and the matched groups (78.8% in group i vs. 76.3% in group ii, log-rank, p=0.905). Univariable Cox regression analysis showed that WiT>30 min was not a predictor of overall CKD upgrading (HR:0.953, 95%CI 0.829-1.094, P=0.764) nor upgrading into CKD stage ≥III (HR:0.972, 95%CI 0.805-1.173, p=0.764). retrospective design is a limitation of our study. ConClUSionS: our analysis based on a large multicenter international cohort study suggests that WiT length during PN has no effect on the long-term renal function outcomes in patients having two kidneys and preoperative eGFR≥60 mL/min/1.73m2,.

2021 - A prospective multicenter randomized comparison between Holmium Laser Enucleation of the Prostate (HoLEP) and Thulium Laser Enucleation of the Prostate (ThuLEP) [Articolo su rivista]
Bozzini, G.; Berti, L.; Aydogan, T. B.; Maltagliati, M.; Roche, J. B.; Bove, P.; Besana, U.; Calori, A.; Pastore, A. L.; Muller, A.; Micali, S.; Sighinolfi, M. C.; Rocco, B.; Buizza, C.
abstract

Purpose: To compare intra and perioperative parameters between HoLEP and ThuLEP in the treatment of benign prostatic hyperplasia and to evaluate clinical and functional outcomes of the two procedures with a 12-month follow-up. Methods: A prospective randomized study was performed on 236 consecutive patients who underwent ThuLEP (n = 115), or HoLEP (n = 121) in three different centers. Intra and perioperative parameters were analyzed: operative time, enucleated tissue weight, irrigation volume, blood loss, catheterization time, hospital stay and complications. Patients were evaluated preoperatively and 3 and 12 months postoperatively with the international prostate symptom score (IPSS), the quality of life (QoL) score, post-void residual volume (PVR), PSA and maximum flow rate (Qmax). Results: Preoperative variables in each study arm did not show any significant difference. Compared to HoLEP, ThuLEP showed similar operative time (63.69 vs 71.66 min, p = 0.245), enucleated tissue weight (48.84 vs 51.13 g, p = 0.321), catheterization time (1.9 vs 2.0 days, p = 0.450) and hospital stay (2.2 vs 2.8 days, p = 0.216), but resulted in less haemoglobin decrease (0.45 vs 2.77 g/dL, p = 0.005). HoLEP presented a significantly higher number of patients with postoperative acute urinary retention and stress incontinence. No significant differences were found in PSA, Qmax, PVR, IPSS and QoL score during follow-up. Conclusion: ThuLEP and HoLEP both relieved lower urinary tract symptoms equally, with high efficacy and safety. ThuLEP detemined reduced blood loss and early postoperative complications. Catheterization time, enucleated tissue, hospital stay, operative time and follow-up parameters did not show any significant difference.

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 - COVID-19 in european urology: Which lessons have we learned? [Articolo su rivista]
Rassweiler, J. J.; Pini, G.; Liatsikos, F.; Georgiev, M.; Roupret, M.; Breda, A.; Knoll, T.; Micali, S.; Stenzl, A.; Goezen, A. S.; Yanev, K.; Rassweiler-Seyfried, M. -C.
abstract

The coronavirus has challenged all medical systems worldwide. Herein both waves of COVID-19 (coronavirus disease 2019) in spring and autumn 2020 differ principally. Whereas Europe was hit by the first wave more or less unprepared, which was aggravated by the high virulence of COVID-19, the second wave is characterized by a much higher contagiosity of the virus with very high incidences. On the other hand the virus has attenuated, which is reflected by the significantly lower incidence-related mortality rate. However, the overall increasing number of infected patients represents again a great challenge for the medical management of the disease. France and Spain are doing better in comparison to Germany and Italy this time. The absolute number of deaths per week is higher than during the peak of the first wave. However, urologists in these countries have also experienced greater restrictions in their activities in the second shutdown than in Germany, where there is only a reduction of beds to between 75 and 90%. Mostly all levels are operated. Of importance for Germany, however, is the plateau on a high level for several weeks probably due to the reduced efficacy of a light lock-down. This finally resulted in a total lock-down in mid-December 2020. Subsequently in Germany some hospitals are also reaching their limits with similar consequences for the departments of urology facing a 50% reduction of beds and operating only level III and IV indications. Nevertheless, the management of urologic patients during the COVID-19 pandemic is carried out in Europa on a high standard. Therefor the risk of secondary harm to our patients is expected to be rather minimal in the long run.

2021 - Case report of life-threatening complications following cystectomy in a woman with neurogenic lower urinary tract dysfunction treated with indwelling bladder catheter for about 30 years [Articolo su rivista]
Maltagliati, M.; Sampogna, G.; Secco, S.; Galfano, A.; Montanari, E.; Micali, S.; Rocco, B.; Spinelli, M.
abstract

Patients with neurogenic lower urinary tract dysfunction (NLUTD), specially with indwelling bladder catheter (iBC), have an increased risk of developing bladder stones, incomplete bladder emptying, recurrent urinary tract infections, sepsis, urethral trauma and bladder cancer. We present the case of a patient with a large bladder stone in iatrogenic NLUTD treated with iBC for about 30 years, who underwent a cystectomy followed by several life-threatening complications, like septic episodes and multiple surgeries. Our case outlines the importance of limiting the time of iBC in favor of CIC to avoid severe complications. Clinicians should instruct on the correct CIC technique and hygiene practices, and monitor patients with periodic abdominal US in order to diagnose and treat precociously any disease, like bladder stones. (www.actabiomedica.it).

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 - Current evidence of ThuLEP for BPH: A review of literature [Articolo su rivista]
Bozzini, G.; Berti, L.; Maltagliati, M.; Sciorio, C.; Sighinolfi, M. C.; Micali, S.; Otero, J. R.; Buizza, C.; Rocco, B.
abstract

Endoscopic enucleation of the prostate (EEP) techniques for the treatment of benign prostatic hyperplasia (BPH) have become increasingly popular among urologists over the past 23 years. Despite the energy source employed, the aim of all these procedures is to endoscopically remove the prostatic lobes by enucleating them from the prostate surgical capsule. The reasons for which EEP has gained popularity among urologists are the reduction in complications and hospital stay compared to endoscopic gold standard Transurethral Resection of the Prostate (TURP), but especially the possibility to treat large prostates, allowing to abandon open simple prostatectomy (OP) and to avoid the burden related to open surgery. Holmium laser enucleation of the prostate (HoLEP) sets the basic principles of all EEP techniques in 1998 and has become the treatment of reference for BPH. Since then, various lasers have been developed and applied to prostatic enucleation. The thulium laser has a slightly shorter wavelength compared to the holmium laser and a continuous wave output, which increase vaporization and reduce penetration depth. These features make it ideal for prostatic enuclea-tion. A vapoenucleating technique called Thulium Laser Vapoenucleation of the Prostate was presented in 2009, followed by a blunt enucleating technique called Thulium Laser Enucleation of the Prostate in 2010. These techniques have become alternatives to HoLEP and TURP; however, the amount of literature and randomized controlled trials available are inferior compared to HoLEP. The aim of this review is to outline, describe, and discuss current evidence on thulium enucleating techniques.

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 - Disposable versus reusable ureteroscopes: A prospective multicenter randomized comparison [Articolo su rivista]
Bozzini, G.; Filippi, B.; Alriyalat, S.; Calori, A.; Besana, U.; Mueller, A.; Pushkar, D.; Romero-Otero, J.; Pastore, A.; Sighinolfi, M. C.; Micali, S.; Buizza, C.; Rocco, B.
abstract

Purpose: To compare reusable and disposable flexible ureteroscopes in terms of efficacy and safety for patients undergoing Retrograde Intrarenal Surgery (RIRS). Patients and Methods: Patients with a renal stone eligible for RIRS were enrolled in this multicenter, randomized, clinical trial study. Patients were randomized into two groups: Group A (90 patients) underwent RIRS with a reusable flexible ureteroscope and group B (90 patients) were treated with a disposable one. Results: The patients’ demographics, stone features and pre-operative urine cultures were comparable between the groups. The Stone Free Rates (SFRs) were not significantly different (86.6% and 90.0% for group A and group B, respectively, p=0.11) and the mean cost for each procedure was comparable (2321 € in group A vs 2543 € in group B, p=0.09). However, the days of hospitalization and of antibiotic therapy were higher in group A (p ≤ 0.05). The overall complication rate in group A was 8.8% whilst in group B it was 3.3% (p ≤ 0.05); in particular, group A exhibited a greater number of major complications (Clavien score IIIa-V). The overall postoperative infection rate was 16.6% in group A and 3.3% in group B (p ≤ 0.05). Furthermore, none of the patients in group B developed urosepsis or had a positive blood culture, while 3 patients in group A did (p<0.05). Conclusion: The use of disposable ureteroscopes is characterized by significantly lower post-operative complications and infection rates, while having comparable costs and SFRs vis à vis reusable ureteroscopes. Clinical Trial Registration Number: ISRCTN92289221.

2021 - Ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP): outcomes on a large cohort [Articolo su rivista]
Bozzini, G.; Berti, L.; Maltagliati, M.; Besana, U.; Calori, A.; Muller, A.; Sighinolfi, M. C.; Micali, S.; Pastore, A. L.; Ledezma, R.; Broggini, P.; Rocco, B.; Buizza, C.
abstract

Purpose: To assess the effects of a new ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP) technique on sexual functions and micturition, in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) and to evaluate how the surgical technique of ES-ThuLEP can lead to ejaculation preservation. Methods: A prospective study was carried out between January 2015 and January 2018 on patients with surgical indication for BPH, who wished to preserve ejaculation. The patients were treated with ES-ThuLEP and were evaluated before and 3 and 6 months after surgery. Three validated questionnaires (ICIQ-MLUTSsex, IIEF-5 and IPSS) were used to assess changes in ejaculation, erectile function and urinary symptoms. Uroflowmetry (Qmax and Qavg), post-void residual volume and voided volume were also evaluated, to assess micturition improvement. Patients with moderate to severe erectile dysfunction were excluded. Statistical analysis was performed with the Student’s t test, Chi-square test and logistic regression analysis. Results: Two hundred and eighty three patients were enrolled. Ejaculation was spared in 203 and 219 patients at 3 and 6 months after surgery. No significant differences were observed between erectile function before and after surgery: baseline IIEF-5 = 16.2 ± 4.47 vs 16.7 ± 2.9 (p = 0.419) and 17.7 ± 3.2 (p = 0.410) at 3 and 6 months. Significant improvement in urinary symptoms was achieved: baseline IPSS = 19.4 ± 7.24 vs 5.8 ± 4.3 (p = 0.032) and 3.9 ± 4.1 (p = 0.029) at 3 and 6 months. Conclusion: ES-ThuLEP effectively preserved ejaculation in over two thirds of the patients without compromising micturition improvement or erectile function. ES-ThuLEP could be a valid treatment option for BPH in young and sexually active men.

2021 - Exceptional response to immunotherapy in association with radiotherapy in patient with breast metastasis from urothelial carcinoma: A case report [Articolo su rivista]
Bonfante, G.; Fantinel, E.; Masini, C.; Bergamaschi, F.; Micali, S.; Rocco, B.
abstract

Most common sites of metastasis of urothelial carcinoma (UC) are lungs, liver, lymph nodes and bone. Pembrolizumab, a humanized monoclonal antibody directed against programmed cell death protein-1 (PD-1), represents an effective second-line therapy for advanced UC. Radiotherapy has been shown to induce a mechanism of immunogenic cell death (ICD) resulting in immune memory and advantageous systemic effects. We present the first case of breast metastasis (BM) from a UC described in literature who had an exceptional response to second-line therapy with pembrolizumab in association with radiotherapy, showing the efficacy of combining immunotherapy and radiotherapy even in patients with atypical metastatic sites.

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 - Holmium laser enucleation of the prostate with Virtual Basket mode: faster and better control on bleeding [Articolo su rivista]
Bozzini, G.; Maltagliati, M.; Besana, U.; Berti, L.; Calori, A.; Sighinolfi, M. C.; Micali, S.; Roche, J. B.; Gozen, A.; Mueller, A.; Pushkar, D.; Liatsikos, E.; Boldini, M.; Buizza, C.; Rocco, B.
abstract

Background: To compare clinical intra and early postoperative outcomes between conventional Holmium laser enucleation of the prostate (HoLEP) and Holmium laser enucleation of the prostate using the Virtual Basket tool (VB-HoLEP) to treat benign prostatic hyperplasia (BPH). Methods: This prospective randomized study enrolled consecutive patients with BPH, who were assigned to undergo either HoLEP (n = 100), or VB-HoLEP (n = 100). All patients were evaluated preoperatively and postoperatively, with particular attention to catheterization time, operative time, blood loss, irrigation volume and hospital stay. We also evaluated the patients at 3 and 6 months after surgery and assessed maximum flow rate (Qmax), postvoid residual urine volume (PVR), the International Prostate Symptom Score (IPSS) and the Quality of Life score (QOLS). Results: No significant differences in preoperative parameters between patients in each study arm were found. Compared to HoLEP, VB-HoLEP resulted in less hemoglobin decrease (2.54 vs. 1.12 g/dl, P = 0.03) and reduced operative time (57.33 ± 29.71 vs. 42.99 ± 18.51 min, P = 0.04). HoLEP and VB-HoLEP detrmined similar catheterization time (2.2 vs. 1.9 days, P = 0.45), irrigation volume (33.3 vs. 31.7 l, P = 0.69), and hospital stay (2.8 vs. 2.7 days, P = 0.21). During the 6-month follow-up no significant differences in IPSS, Qmax, PVR, and QOLS were demonstrated. Conclusions: HoLEP and VB-HoLEP are both efficient and safe procedures for relieving lower urinary tract symptoms. VB-HoLEP was statistically superior to HoLEP in blood loss and operative time. However, procedures did not differ significantly in catheterization time, hospital stay, and irrigation volume. No significant differences were demonstrated in QOLS, IPSS, Qmax and PVR throughout the 6-month follow-up. Trial Registration: Current Controlled Trials ISRCTN72879639; date of registration: June 25th, 2015. Retrospectively registred.

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

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

2021 - Review of nomograms to counsel patients after oncologic surgery: a support for telemedicine to stratify the risk of relapse and customize the follow-up scheduling [Articolo su rivista]
Sighinolfi, M. C.; Zoeir, A.; Eissa, A.; Sarchi, L.; Assumma, S.; Calcagnile, T.; Filippi, B.; Moschovas, M.; Bhat, S.; Puliatti, S.; Micali, S.; Bozzini, G.; Patel, V.; Rocco, B.
abstract

2021 - The dramatic COVID-19 outbreak in italy is responsible of a huge drop in urological surgical activity: A multicenter observational study [Articolo su rivista]
Rocco, B.; Sighinolfi, M. C.; Sandri, M.; Altieri, V.; Amenta, M.; Annino, F.; Antonelli, A.; Baio, R.; Bertolo, R.; Bocciardi, A.; Borghesi, M.; Bove, P.; Bozzini, G.; Cacciamani, G.; Calori, A.; Caffarelli, A.; Celia, A.; Cocci, A.; Corsaro, A.; Costa, G.; Ceruti, C.; Cindolo, L.; Crivellaro, S.; Dalpiaz, O.; D'Agostino, D.; Dall'Oglio, B.; Falabella, R.; Falsaperla, M.; Finocchiaro, M.; Gaboardi, F.; Galfano, A.; Gallo, F.; Grego, F.; Leonardo, C.; Nucciotti, R.; Oderda, M.; Pagliarulo, V.; Parma, P.; Pastore, L.; Pini, G.; Porreca, A.; Pucci, L.; Schenone, M.; Schiavina, R.; Sciorio, C.; Spirito, L.; Tafuri, A.; Terrone, C.; Umari, P.; Varca, V.; Veneziano, D.; Verze, P.; Volpe, A.; Micali, S.; Berti, L.; Zaramella, S.; Minervini, A.
abstract

OBJECTIVE: Italy is facing the COVID-19 outbreak with an abrupt reorganization of its national health-system, in order to augment care provision to symptomatic patients. The sudden shift of personnel and resources towards COVID-19 care has led to the reduction of surgery, with possible severe drawbacks. The aim of the study is to describe the trend in surgical volume in urology, in Italy. MATERIALS AND METHODS: Thirty-three urological units with physicians affiliated to the AGILE consortium were involved in a survey. Urologists were asked to report the amount of surgical elective procedures week-by-week, from the beginning of the emergency to the following month. RESULTS: The 33 hospitals involved in the study account, globally, for 22,945 beds and are distributed in 13/20 Italian regions. Before the outbreak, the involved urology units performed an overall amount of 1,213 procedures per week, half of which were oncological. One month later, the amount of surgery declined by 78%. Lombardy, the first region with positive-cases, experienced a 94% reduction. The decrease in oncological and non-oncological surgical activity was 35,9% and 89%, respectively. The trend of the decline showed a delay of roughly 2 weeks for the other regions. CONCLUSION: Italy, the country with the highest fatality rate from COVID-19, is experiencing a sudden decline in surgical activity. It is inversely related to the increase in COVID-19 care, with potential harm particularly in the oncological field. The Italian experience can be helpful for future surgical pre-planning in other countries not so hardly hit by the disease yet.

2021 - The microbiological profile of patients with Fournier's gangrene: A retrospective multi-institutional cohort study [Articolo su rivista]
Cipriani, Chiara; Iacovelli, Valerio; Sandri, Marco; Bertolo, Riccardo; Maiorino, Francesco; Antonucci, Francesco; Micali, Salvatore; Rocco, Bernardo; Puliatti, Stefano; Ferrarese, Paolo; Benedetto, Giuseppe; Minervini, Andrea; Cocci, Andrea; Pastore, Antonio Luigi; Al Salhi, Yazan; Antonelli, Alessandro; Morena, Tonino; Volpe, Alessandro; Poletti, Filippo; Celia, Antonio; Zeccolini, Guglielmo; Leonardo, Costantino; Proietti, Flavia; Finazzi Agrò, Enrico; Bove, Pierluigi
abstract

Objectives: To evaluate the role of the microbiological profile and of disease-related factors in the management of patients affected with Fournier's gangrene (FG).Patients and methods: Data regarding patients admitted for FG at nine Italian Hospitals (March 2007-June 2018) were collected. Patients were stratified according to the number of microorganisms documented: Group A - one microorganism; Group B - two microorganisms; Group C - more than three microorganisms. Baseline blood tests, dedicated scoring systems, predisposing risk factors, disease's features, management and post-operative course were analyzed. UpSet technique for visualizing set intersections in a matrix layout and Cuzick's nonparametric test for trend across ordered groups were used.Results: Eighty-one patients were available for the analysis: 18 included in Group A, 32 in Group B, 31 in Group C. The most common microorganism isolated was Escherichia coli. In Group B-C, Escherichia coli was often associated to Enterococcus faecalis, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Statistically significant positive association was highlighted among the number of pathogens (Group A vs B vs C) and serum C-reactive Protein (p < 0.001), procalcitonin (p = 0.02) and creatinine (p = 0.03). Scoring systems were associated with the number of microorganisms detected (p < 0.02). A significant association between the number of microorganisms and the use of VAC therapy and need of a fecal diversion was found (p < 0.02). The number of microorganisms was positively associated with the length of stay (LOS) (p = 0.02). Ten weeks after initial debridement, wound closure was achieved in 11 (91.7%), 22 (84.6%) and 20 (80%) patients in Group A, B, and C, respectively, with no differences in overall survival.Conclusion: Polymicrobial infections in FG are positively associated with inflammatory scores, the need for fecal diversion and the LOS. This results may help the counseling and the clinical management of this rare niche of patients.

2021 - The role of vacuum-assisted closure (VAC) therapy in the management of FOURNIER’S gangrene: a retrospective multi-institutional cohort study [Articolo su rivista]
Iacovelli, V.; Cipriani, C.; Sandri, M.; Filippone, R.; Ferracci, A.; Micali, S.; Rocco, B.; Puliatti, S.; Ferrarese, P.; Benedetto, G.; Minervini, A.; Cocci, A.; Pastore, A. L.; Al Salhi, Y.; Antonelli, A.; Morena, T.; Volpe, A.; Poletti, F.; Celia, A.; Zeccolini, G.; Leonardo, C.; Proietti, F.; Finazzi Agro, E.; Bove, P.
abstract

Purpose: To explore the role of vacuum assisted closure (VAC) therapy versus conventional dressings in the Fournier’s gangrene wound therapy. Patients and Methods: This is a retrospective multi-institutional cohort study. Data of 92 patients from nine centers between 2007 and 2018 were retrospectively analyzed. After surgery, patient having a local or a disseminated FG were managed with VAC therapy or with conventional dressings. The 10-weeks wound closure cumulative rate and OS were analyzed. Results: Of the 92 patients, 62 (67.4%) showed local and 30 (32.6%) a disseminated FG. After surgery, 19 patients (20.7%) with local and 14 (15.2%) with disseminated FG underwent to VAC therapy; 43 (46.7%) with local and 16 (17.4%) with disseminated FG were treated using conventional dressings. The multivariable logistic regression analysis demonstrated that the VAC in patients with disseminated FG led to a higher cumulative rate of wound closure than patients treated with no-VAC (OR = 6.5; 95% CI 1.1–37.4, p = 0.036). The Kaplan–Meier survival curves for the OS showed a significant difference between no-VAC patients with local and disseminated FG (OS rate at 90 days 0.90, 95% CI 0.71–0.97 vs 0.55, 95% CI 0.24–0.78, respectively; p = 0.039). Cox regression confirmed that no-VAC patients with disseminated FG showed the lowest OS (hazard ratio adjusted for sex and age HR = 3.4, 95% CI 1.1–10.4; p = 0.033). Conclusions: In this large cohort study, VAC therapy in patients with disseminated FG may offer an advantage in terms of 10-weeks wound closure cumulative rate and OS at 90 days after initial surgery.

2021 - Toward autonomous robotic prostate biopsy: a pilot study [Articolo su rivista]
Maris, B.; Tenga, C.; Vicario, R.; Palladino, L.; Murr, N.; De Piccoli, M.; Calanca, A.; Puliatti, S.; Micali, S.; Tafuri, A.; Fiorini, P.
abstract

Purpose: We present the validation of PROST, a robotic device for prostate biopsy. PROST is designed to minimize human error by introducing some autonomy in the execution of the key steps of the procedure, i.e., target selection, image fusion and needle positioning. The robot allows executing a targeted biopsy through ultrasound (US) guidance and fusion with magnetic resonance (MR) images, where the target was defined. Methods: PROST is a parallel robot with 4 degrees of freedom (DOF) to orient the needle and 1 DOF to rotate the US probe. We reached a calibration error of less than 2 mm, computed as the difference between the needle positioning in robot coordinates and in the US image. The autonomy of the robot is given by the image analysis software, which employs deep learning techniques, the integrated image fusion algorithms and automatic computation of the needle trajectory. For safety reasons, the insertion of the needle is assigned to the doctor. Results: System performance was evaluated in terms of positioning accuracy. Tests were performed on a 3D printed object with nine 2-mm spherical targets and on an anatomical commercial phantom that simulates human prostate with three lesions and the surrounding structures. The average accuracy reached in the laboratory experiments was 1.30±0.44mm in the first test and 1.54±0.34mm in the second test. Conclusions: We introduced a first prototype of a prostate biopsy robot that has the potential to increase the detection of clinically significant prostate cancer and, by including some level of autonomy, to simplify the procedure, to reduce human errors and shorten training time. The use of a robot for the biopsy of the prostate will create the possibility to include also a treatment, such as focal ablation, to be delivered through the same system.

2020 - A consecutive series of patients undergoing trans-urethral cystolithotripsy with ballistic lithotripsy by a tertiary referral center for neurogenic bladder [Articolo su rivista]
Maltagliati, M.; Sampogna, G.; Citeri, M.; Stefaniaguerrer, C.; Zanollo, L. G.; Rizzato, L.; Montanari, E.; Micali, S.; Rocco, B.; Spinelli, M.
abstract

Background and aim of the work: Patients with neurogenic bladder (NB) have an increased risk of developing bladder stones due to bladder catheter, incomplete bladder emptying, recurrent urinary tract infections, and immobilization. In these patients, minimally invasive treatments are usually adopted, as noninvasive extracorporeal shockwave lithotripsy is limited by the risk of not clearing all stone fragments, and open surgery is usually discouraged. The aim of our study was to present our experience with trans-urethral cystolithotripsy (TUCL) in patients treated by a tertiary referral center for NB. Methods: We retrospectively collected pre-, intra-and post-operative data from our patients, who underwent TUCL from October 2013 to October 2019. The procedure was performed with a 24 Fr cystoscope and a ballistic lithotripter. Lapaxy was performed with Ellik bladder evacuator. All procedures were performed by two expert surgeons. Stone-free rate (SFR) was defined as the percentage of patients with absence of residual fragments >2 mm in diameter. Results: We performed consecutively 91 TUCLs in 75 patients during the selected period. SFR was 94.1%. Intra-and post-operative complications occurred in one (1.1%) patient. Our statistical analysis outlined the SFR was affected in a statistically significant way by sex, NB etiology, stone cumulative diameter, and operative time. Conclusion: Our series proved the safety and efficacy of TUCL with ballistic lithotripsy in NB patients. Further multicenter randomized controlled trials are mandatory to validate definitively TUCL as the gold standard therapy for bladder urolithiasis in NB patients, and to identify risk factors limiting the SFR. (www.actabiomedica.it).

2020 - Adjustable bulbourethral male sling: Experience after 30 cases of moderate to severe male stress urinary incontinence [Articolo su rivista]
Cotugno, M.; Martens, D.; Destro, P. C.; Potenzoni, M.; Prati, A.; Pirola, G.; Maggi, M.; Rocco, B. M. C.; Micali, S.
abstract

Objective: To report our experience using the Argus perineal sling from July 2015 to April 2018 for male stress urinary incontinence (SUI) after prostatic surgery. To evaluate the safety, efficacy and health-related quality of life in patients undergoing this procedure. Patients and methods: The positioning of an adjustable bulbourethral male sling provides a perineal incision, exposure of the bulbospongiosus muscle and the application of the sling bearing on it with transobturator passage of the two extremities with out-in technique. To modulate the bearing tension on the urethra, with a rigid cystoscope the Retrogade Leak Point Pressure is measured, increasing it by 10-15 cm of H20 from baseline. We retrospectively evaluated the results of this implant performed by the same operator on 30 patients who presented post-operative SUI from medium to severe (> = 2 pads/day, pad test at one hour > = 11 g). Mean operative time and possible intra and postoperative complications were evaluated. Postoperatively each patient was reassessed according to the following parameters: number of pads consumed/die, pad tesy at one hour, ICQS-F, any related side effects. Results: After the intervention, 21 of 30 patients (70% of the total) were totally continent (< 1 pad / day, pad test at 1 h < 1-2 g, ICQS-F < 11), out of them 4 required a single adjustment at 3 months in order to achieve this result. 9 of 30 patients (30 %) achieved a clinically significant improvement without obtaining total continence (mean reduction of the n° pads/day: -2.5 ± 1 DS; average reduction of the pad test at 1 h: -20 g ± 4 DS; ICQS-F average reduction: -6 points ± 2 DS), out of them 5 required a 3 month adjustment to obtain these improvements resulting, 4 needed 2 adjustments resulting because the first adjustment was not satisfactory and one who ameliorated from severe to moderate incontinence decided to live in this clinical condition. Conclusions: The results of our study show that the positioning of this sling represents a valid treatment for the moderate and severe post-surgical male SUI. The possibility of adjusting the tension of the sleeve in a "second look" makes the intervention adaptable according to the results obtained. Only multicentric clinical trials on larger series would clarify and eventually confirm the clinical benefits of this sling in post-surgical male SUI.

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 - Effects of D-Mannose, Ellirose™ and lactobacillus plantarum in treatment of urinary tract recurrent infections (rUTIs): A survey of urologists knowledge about its clinical application [Articolo su rivista]
Milandri, R.; Bocchialini, T.; Maltagliati, M.; Cotugno, M.; Simonetti, E.; Ferretti, S.; Maestroni, U. V.; Rocco, B. M. C.; Micali, S.
abstract

Background and aim of the work: Urinary tract infections (UTIs) and recurrent urinary tract infections (rUTIs) are widespread disease and almost half of all women will experience at least one episode of cystitis during their life. Aim of this study was to review the evidence of literature about the therapeutic and preventive effects of a product containing D-Mannose, Ellirose™ and Lactobacollus Plantarum on patients’ symptoms, quality of life and recurrence of UTIs and to investigate the practicing urologists’ knowledge about the clinical application of this product. Materials: We administrated an investigational survey about clinical use of a phytotherapeutic product made of D-Mannose, Ellirose™ and Lactobacollus Plantarum to 12 residents in Urology at the University of Modena and Reggio Emilia and to 32 urologists working in the provinces of Modena, Reggio Emilia and Parma. Results: 61% of physicians have diagnosed rUTIs in 3-6 patients during a month, and 7% of them in more than 6 patients during the same period of time. By these results rUTIs appear as common pathological conditions. 59% prescribed the product at least 1 time a month and 14% prescribed it more than 5 times. 43% administrated the product after out-patient invasive examinations as cistoscopy and urodynamic exam for UTIs prevention. 55% noticed a significant improvement in patient’s QoL (Quality of Life) suffering from rUTIs. Furthermore 48% also reported a significant effect for the improvement of urinary symptoms of patients. No gastric or general side effects have been noticed during the administration period. Finally the cost of integrator has been reported affordable for the great majority of patients. Conclusions: Many studies in Literature have shown that D-Mannose and H. sabdariffa (Ellirose™) reduce the risk of development of rUTIs opposing colonization and proliferation of uropathogenic bacteria in urinary tract. Our investigational survey about the administration of a phytotherapeutic product showed that this product is well-known and has a proved positive impact. (www.actabiomedica.it).

2020 - En-bloc resection of bladder tumors (ERBT) for pathological staging: the value of lateral margins analysis [Abstract in Rivista]
Eissa, Ahmed; Zoeir, Ahmed; Ciarlariello, Silvia; Sarchi, Luca; Sighinolfi, Maria Chiara; Ghaith, Ahmed; Puliatti, Stefano; Inzillo, Raffaele; Reggiani Bonetti, Luca; Rizzo, Mino; Rocco, Bernardo; Micali, Salvatore
abstract

In endoscopic resection of colorectal tumours, the pathological assessment of the lateral margins is a strong predictor of tumor recurrence after resection. The aims of the current study are to evaluate the value of the peritumoral margins assessment in ERBT on tumor recurrence.

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

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

2020 - Experience of a tertiary referral center in managing bladder cancer in conjunction with neurogenic bladder [Articolo su rivista]
Sampogna, G.; Maltagliati, M.; Galfano, A.; Bocciardi, A.; Rocco, B.; Micali, S.; Montanari, E.; Spinelli, M.
abstract

Study design: Case series. Objectives: The aim of this study was to present our experience with the management of bladder cancer (BCa) in individuals followed for neurogenic bladder (NB). Setting: An Italian tertiary referral center for NB. Methods: We retrospectively collected all pre-operative, intra-operative, and post-operative data of our NB cases with BCa, diagnosed from 2004 to 2019. Results: We included ten cases: eight with acquired spinal cord injury (SCI) and two with myelomeningocele (MMC). Considering individuals with acquired SCI, the median age at BCa diagnosis and time since SCI were 53 and 34 years, respectively. One out of seven cases had positive urine cytology. All cases underwent a radical cystectomy, diagnosing squamous cell carcinoma (SCC) and transitional cell carcinoma in 60 and 40% cases, respectively. Surgical-related complications occurred after 90% procedures. Three out of eight individuals with acquired SCI died 2, 12, and 80 months after the diagnosis. Both individuals with MMC presented no evidence of disease after 24 and 27 months. Conclusions: BCa in individuals with NB proved to be associated with a diagnosis at an advanced stage and a high rate of surgical complications. In this population we advocate annual genitourinary ultrasound exam and urine cytology, and cystoscopy in all cases of macrohematuria. Considering the low accuracy of urine cytology and the difficult-to-interpret inflamed bladder walls at cystoscopy in NB, a patient-tailored follow-up schedule based on specific risk factors (e.g., smoking status, indwelling urinary catheter) is mandatory to diagnose and treat BCa at an early stage.

2020 - Outcomes of minimally invasive partial nephrectomy among very elderly patients: Report from the resurge collaborative international database [Articolo su rivista]
Larcher, A.; Wallis, C. J. D.; Pavan, N.; Porpiglia, F.; Takagi, T.; Tanabe, K.; Rha, K. H.; Raheem, A. A.; Yang, B.; Zang, C.; Perdona, S.; Quarto, G.; Maurer, T.; Amiel, T.; Schips, L.; Castellucci, R.; Crivellaro, S.; Dobbs, R.; Baiamonte, G.; Celia, A.; De Concilio, B.; Furlan, M.; Lima, E.; Linares, E.; Micali, S.; Amparore, D.; De Naeyer, G.; Trombetta, C.; Hampton, L. J.; Tracey, A.; Bindayi, A.; Antonelli, A.; Derweesh, I.; Mir, C.; Montorsi, F.; Mottrie, A.; Autorino, R.; Capitanio, U.
abstract

The aim of the study was to perform a comprehensive investigation of clinical outcomes of robot-assisted partial nephrectomy (RAPN) or laparoscopic partial nephrectomy (LPN) in elderly patients presenting with a renal mass. The REnal SURGery in Elderly (RESURGE) collaborative database was queried to identify patients aged 75 or older diagnosed with cT1-2 renal mass and treated with RAPN or LPN. Study outcomes were: overall complications (OC); warm ischemia time (WIT) and 6-month estimated glomerular filtration rate (eGFR); positive surgical margins (PSM), disease recurrence (REC), cancer-specific mortality (CSM) and other-cause mortality (OCM). Descriptive statistics, Kaplan-Meier, smoothed Poisson plots and logistic and linear regression models (MVA) were used. Overall, 216 patients were included in this analysis. OC rate was 34%, most of them being of low Clavien grade. Median WIT was 17 minutes and median 6-month eGFR was 54 ml/min/1.73 m2. PSM rate was 5%. After a median follow-up of 20 months, the 5-year rates of REC, CSM and OCM were 4, 4 and 5%, respectively. At MVA predicting perioperative morbidity, RAPN relative to LPN (odds ratio [OR] 0.33; p <0.0001) was associated with lower OC rate. At MVA predicting functional outcomes, RAPN relative to LPN was associated with shorter WIT (estimate [EST]-4.09; p <0.0001), and with higher 6-month eGFR (EST 6.03; p = 0.01). In appropriately selected patients with small renal masses, minimally-invasive PN is associated with acceptable perioperative outcomes. The use of a robotic approach over a standard laparoscopic approach can be advantageous with respect to clinically relevant outcomes, and it should be preferred when available.

2020 - Partial versus radical nephrectomy in very elderly patients: a propensity score analysis of surgical, functional and oncologic outcomes (RESURGE project) [Articolo su rivista]
Mir, M. C.; Pavan, N.; Capitanio, U.; Antonelli, A.; Derweesh, I.; Rodriguez-Faba, O.; Linares, E.; Takagi, T.; Rha, K. H.; Fiori, C.; Maurer, T.; Zang, C.; Mottrie, A.; Umari, P.; Long, J. -A.; Fiard, G.; De Nunzio, C.; Tubaro, A.; Tracey, A. T.; Ferro, M.; De Cobelli, O.; Micali, S.; Bevilacqua, L.; Torres, J.; Schips, L.; Castellucci, R.; Dobbs, R.; Quarto, G.; Bove, P.; Celia, A.; De Concilio, B.; Trombetta, C.; Silvestri, T.; Larcher, A.; Montorsi, F.; Palumbo, C.; Furlan, M.; Bindayi, A.; Hamilton, Z.; Breda, A.; Palou, J.; Aguilera, A.; Tanabe, K.; Raheem, A.; Amiel, T.; Yang, B.; Lima, E.; Crivellaro, S.; Perdona, S.; Gregorio, C.; Barbati, G.; Porpiglia, F.; Autorino, R.
abstract

Purpose: To compare the outcomes of PN to those of RN in very elderly patients treated for clinically localized renal tumor. Patients and methods: A purpose-built multi-institutional international database (RESURGE project) was used for this retrospective analysis. Patients over 75 years old and surgically treated for a suspicious of localized renal with either PN or RN were included in this database. Surgical, renal function and oncological outcomes were analyzed. Propensity scores for the predicted probability to receive PN in each patient were estimated by logistic regression models. Cox proportional hazard models were estimated to determine the relative change in hazard associated with PN vs RN on overall mortality (OM), cancer-specific mortality (CSM) and other-cause mortality (OCM). Results: A total of 613 patients who underwent RN were successfully matched with 613 controls who underwent PN. Higher overall complication rate was recorded in the PN group (33% vs 25%; p = 0.01). Median follow-up for the entire cohort was 35 months (interquartile range [IQR] 13–63 months). There was a significant difference between RN and PN in median decline of eGFR (39% vs 17%; p < 0.01). PN was not correlated with OM (HR = 0.71; p = 0.56), OCM (HR = 0.74; p = 0.5), and showed a protective trend for CSM (HR = 0.19; p = 0.05). PN was found to be a protective factor for surgical CKD (HR = 0.28; p < 0.01) and worsening of eGFR in patients with baseline CKD. Retrospective design represents a limitation of this analysis. Conclusions: Adoption of PN in very elderly patients with localized renal tumor does not compromise oncological outcomes, and it allows better functional preservation at mid-term (3-year) follow-up, relative to RN. Whether this functional benefit translates into a survival benefit remains to be determined.

2020 - Percorso diagnostico-terapeutico per il paziente con calcolosi renale: update 2020 [Articolo su rivista]
Cupisti, A.; Trinchieri, A.; Lombardi, M.; Agostini, S.; Arcidiacono, T.; Beltrami, P.; Berri, E.; Bevilacqua, L.; Campo, S.; Cannavo, R.; Croppi, E.; Casarrubea, G.; Caviglioli, C.; Crisci, A.; D'Addessi, A.; Sio, M.; Fantuzzi, A.; Fusaro, M.; Gambaro, G.; Garofalo, M.; Micali, S.; Marangella, M.; Petrarulo, M.; Piccinocchi, G.; Sessa, A.; Tasca, A.; Vezzoli, G.; Vitale, C.; Zattoni, F.
abstract

La storia naturale della calcolosi urinaria è quella di una patologia che tende a recidivare e che può associarsi ad aumentato rischio di malattia renale cronica, ossea e cardiovascolare. Per questo una ampia valutazione clinico-metabolica del paziente è di grande importanza sin dalla prima presentazione della calcolosi, allo scopo di impostare un appropriato trattamento preventivo. Il percorso diagnostico-terapeutico che viene proposto si compone di una accurata valutazione al fine di evidenziare malattie sistemiche e/o i principali fattori di rischio per la calcolosi, la malattia cronica renale, cardiovascolare e ossea; l'esecuzione di uno studio metabolico articolato su più livelli secondo la gravità della malattia e la presenza o meno di fattori di rischio; l'esecuzione di indagini strumentali appropriate; la terapia medica della calcolosi renale. Le informazioni così raccolte consentono di impostare un trattamento preventivo consistente in norme di carattere generale e, se necessario, di interventi farmacologici o nutrizionali specifici. Il documento è stato realizzato dal Gruppo Italiano Multidisciplinare di Studio per la Calcolosi Renale, ed è indirizzato a tutte le figure professionali impegnate nella gestione del paziente affetto da nefrolitiasi a partire dal medico di pronto soccorso fino al medico di medicina generale, passando dall'urologo, nefrologo, radiologo e dal dietista. Il "Percorso diagnostico-terapeutico per il paziente con calcolosi urinaria", è stato pubblicato sul Giornale Italiano di Nefrologia nel 2010: a distanza di 10 anni esatti, viene riproposto, emendato e aggiornato in questo articolo, che vuole essere un aiuto di semplice, rapida e agile lettura ed applicazione, indirizzato alla buona pratica clinica nel paziente con calcolosi renale.

2020 - Positive surgical margin during radical prostatectomy: overview of sampling methods for frozen sections and techniques for the secondary resection of the neurovascular bundles [Articolo su rivista]
Sighinolfi, M. C.; Eissa, A.; Spandri, V.; Puliatti, S.; Micali, S.; Reggiani Bonetti, L.; Bertoni, L.; Bianchi, G.; Rocco, B.
abstract

Objective: The aim of the paper is to provide an overview of intraoperative sampling methods for frozen section (FS) analysis and of surgical techniques for a secondary neurovascular bundle (NVB) resection, as the method of surgical margin (SM) sampling and the management of a positive SM (PSM) at the nerve-sparing (NS) area are under evaluated issues. FS analysis during radical prostatectomy (RP) can help to tailor the plane of dissection based on cancer extension and thus extend the indications for NS surgery. Evidence Acquisition: We performed a PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science, Cochrane Library, and Elton B. Stephens Co. (EBSCO)host search to include articles published in the last decade, evaluating FS analysis in the NS area and surgical attempts to convert a PSM to a negative status. Evidence Synthesis: Overall, 19 papers met our inclusion criteria. The ways to collect samples for FS analysis included: systematic (analysing the whole posterolateral aspect of the prostate specimen, i.e., neurovascular structure-adjacent frozen-section examination [NeuroSAFE]); magnetic resonance imaging (MRI)-guided (biopsies from MRI-suspicious areas, retrieved by the surgeon in a cognitive way); and random biopsies from the soft periprostatic tissues. Techniques to address a PSM in the NS area included: full resection of the spared NVB, from its caudal to cranial aspect, often including the rectolateral part of the Denonvilliers’ fascia; partial resection of the NVB, in cases where sampling attempts to localise a PSM; incremental approach, meaning a partial or full resection that extends until no prostate tissue is found in the soft periprostatic environment. Conclusions: There is no homogeneity in prostate sampling for FS analysis, although most recent evidence is moving toward a systematic sampling of the entire NS area. The management of a PSM is variable and can be affected by the sampling strategy (difficult localisation of the persisting tumour at the NVB). The difficult identification of the exact soft tissue location contiguous to a PSM could be considered as the critical point of FS analysis and of spared-NVB management.

2020 - Radical penectomy, a compromise for life: results from the PECAD study [Articolo su rivista]
Ghahhari, Jamil; Marchioni, Michele; Spiess, Philippe E; Chipollini, Juan J; Nyirády, Peter; Varga, Judith; Ditonno, Pasquale; Boccasile, Stefano; Primiceri, Giulia; De Nunzio, Cosimo; Tema, Giorgia; Tubaro, Andrea; Veccia, Alessandro; Antonelli, Alessandro; Musi, Gennaro; De Cobelli, Ottavio; Conti, Andrea; Puliatti, Stefano; Micali, Salvatore; Álvarez-Maestro, Mario; Quesada Olarte, José; Diogenes, Erico; Lima, Marcos Venicio Alves; Tracey, Andrew; Guruli, Georgi; Autorino, Riccardo; Sountoulides, Petros; Sosnowski, Roman; Schips, Luigi; Cindolo, Luca
abstract

The use of organ sparing strategies to treat penile cancer (PC) is currently supported by evidence that has indicated the safety, efficacy and benefit of this surgery. However, radical penectomy still represents up to 15-20% of primary tumor treatments in PC patients. The aim of the study was to evaluate efficacy in terms of overall survival (OS) and disease-free survival (DFS) of radical penectomy in PC patients.

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

2020 - Second-look turbt: Evaluation of anatomopatological and oncologic results in a single center [Articolo su rivista]
Maltagliati, M.; Varca, V.; Milandri, R.; Salvatore, M.; Cesare Rocco, B. M.; Gregori, A.
abstract

Introduction: T1 bladder cancer is associated with a high risk of recurrence and progression; concomitant carcinoma in situ and/or multifocality are negative prognostic factors. Persistent disease after resection of T1 tumours has been observed in 33-55% of patients, and after resection of High-grade (HG) Ta tumour in 41,4%. It has been demonstrated that a second TURB can increase recurrence-free survival and it can make a restaging of the cancer. Patients and methods: From January 2011 to December 2016, 87 patients with superficial bladder tumor (Ta-T1), undergoing TURB and routine repeat TURB (Re-TURB) 4-6 weeks after the initial resection, were included in the study. Re-TURB was applied to the scar of the first resection and other suspicious lesions in the bladder. After the second-look, we studied the follow-up of each patient. Results: Specimens obtained during the second TURBT showed no tumor in 47 (54,02%) patients; 40 (45,98%) patients had residual cancer: 34 of them had cancer of the same stage, 6 patients of pT1 had a lower stage, and 3 had a higher stage. 5 patient underwent radical cistectomy immediatly after re-TURBT. During the first year of follow up, 15 patients had a recurrent bladder cancer; 2 of them underwent radical cistectomy. Conclusions: T1 bladder cancer is an high risk tumor, so that second-look TURBT is a valuable procedure for accurate staging of nonmuscle-invasive bladder cancer and it can guarantee a better eradicationof the neoplasm.

2020 - Shock wave lithotripsy for a renal stone in a tetraplegic patient as a trigger for life-threatening posterior reversible encephalopathy syndrome [Articolo su rivista]
Sampogna, G.; Maltagliati, M.; Rocco, B.; Micali, S.; Montanari, E.; Spinelli, M.
abstract

Shock wave lithotripsy (SWL) is considered a non-invasive treatment for urinary stones and usually advocated for frail patients with spinal cord injury (SCI). We report a life-threatening complication, called posterior reversible encephalopathy syndrome (PRES), in a tetraplegic person who underwent SWL for a small renal stone. Based on our experience, we recommend performing SWL with caution in SCI patients and in tertiary referral hospitals that can promptly manage similar severe complications.

2020 - Three-dimensional virtual reconstruction with DocDo: A novel interactive tool to score renal mass complexity [Abstract in Rivista]
Rocco, Bernardo; Sighinolfi, Maria Chiara; Dourado Menezes, Aurus; Eissa, Ahmed; Inzillo, Raffaele; Sandri, Marco; Puliatti, Stefano; Turri, Filippo; Ciarlariello, Silvia; Amato, Marco; De Carne, Cosimo; Sarchi, Luca; Bozzini, Giorgio; Bianchi, Giampaolo; Micali, Salvatore
abstract

The pre-operative knowledge of the complexity of a renal mass is the cornerstone to plan a partial nephrectomy(PN) [1]. Given the multiple issues characterizing it - size, protrusion out from renal parenchyma, longitudinal and coronal location, proximity to the hilum - nephrometric scoring systems have been proposed during the last decade[2, 3]; RENAL and PADUA classifications are the mostly used [4-6].

2020 - UROLOGIA PER STUDENTI E MEDICI CHIRUGHI [Monografia/Trattato scientifico]
Micali, Salvatore; Rocco, Bernardo Maria Cesare
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 - Adherence to EAU guidelines on penile cancer translates into better outcomes: a multicenter international study [Articolo su rivista]
Cindolo, Luca; Spiess, Philippe E.; Bada, Maida; Chipollini, Juan J.; Nyirády, Peter; Chiodini, Paolo; Varga, Judith; Ditonno, Pasquale; Battaglia, Michele; De Nunzio, Cosimo; Tema, Giorgia; Veccia, Alessandro; Antonelli, Alessandro; Musi, Gennaro; De Cobelli, Ottavio; Conti, Andrea; Micali, Salvatore; Maestro, Mario Alvarez; Olarte, José Quesada; Diogenes, Erico; Lima, Marcos Venicio Alves; Tracey, Andrew; Guruli, Georgi; Autorino, Riccardo; Sountoulides, Petros; Schips, Luigi
abstract

Introduction: We aimed to evaluate adherence to the EAU guidelines (GL) on penile cancer (PC) with regard to primary surgical treatment and management of lymph nodes and to estimate the influence of adherence to GL on clinical outcome. Materials and methods: This is a retrospective multicenter study (PEnile Cancer ADherence study, PECAD Study) on PC patients treated at 12 European and American centers between 2010 and 2016. Adherence to the EAU GL on the surgical management of the primary penile tumor and lymphadenectomy was evaluated. Descriptive analyses were performed, and survival curves were estimated. Results: Data on 425 patients were considered for the analysis. The EAU GL on surgical treatment of the primary tumor and lymphadenectomy were respected in 74.8% and 73.7% of cases, respectively. Survival analysis showed that adherence to the GL on primary penile surgery was significantly associated with a good overall survival [adjusted HR 0.40 (95% CI 0.20–0.83, p value = 0.014)]. Also, the adherence to the GL on lymphadenectomy was statistically significantly associated with overall survival [adjusted HR 0.48 (95% CI 0.24–0.96, p value = 0.038)]. Limited follow-up and retrospective design represent limitations of this study. Conclusions: Our findings suggest that there is a good adherence to the EAU GL on PC. However, this should be further reinforced, endorsed and encouraged as it might translate into better clinical outcomes for PC patients.

2019 - Adherence to the EAU guidelines on Penile Cancer Treatment: European, multicentre, retrospective study [Articolo su rivista]
Bada, M.; Berardinelli, F.; Nyirady, P.; Varga, J.; Ditonno, P.; Battaglia, M.; Chiodini, P.; De Nunzio, C.; Tema, G.; Veccia, A.; Antonelli, A.; Cindolo, L.; Simeone, C.; Puliatti, S.; Micali, S.; Schips, L.
abstract

Purpose: The European Association of Urology (EAU) guidelines for penile cancer (PC) are exclusively based on retrospective studies and have low grades of recommendation. The aim of this study was to assess the adherence to guidelines by investigating the management strategies for primary tumours and inguinal lymph nodes. Methods: We retrospectively reviewed the clinical charts of 176 PC patients who underwent surgery in eight European centres from 2010 to 2016. The stage and grade were assessed according to the 2009 AJCC–UICC TNM classification system. To assess adherence rates, we compared theoretical and practical adherence to the EAU guidelines. Results: Overall, 176 patients were enrolled. Partial amputation was the most frequent surgical approach (39%). 53.7% of tumours were stage Tis-T1b and the remaining 46.3% were stage T2-T4. Palpable lymph nodes were detected in 30.1% of patients and 45.1% underwent lymphadenectomy (LY). A sizeable group of tumours (43.2%) were N0. For primary treatment, adherence to the EAU guidelines was good (66%). In non-adherent cases, reasons for discrepancy were patient’s choice (17%), surgeon’s preference (36%), and other causes (47%). For LY, the guideline adherence was 70%, with either patient’s or surgeon’s choice or other causes accounting for discrepancy in 28, 20, and 52% of non-adherent cases, respectively. Conclusion: Adherence to the EAU guidelines for PC was quite high across the eight European centres involved in the study. This notwithstanding, strategies for further improvement should be developed and evenly adopted.

2019 - Drug-Induced Urolithiasis in Pediatric Patients [Articolo su rivista]
Sighinolfi, Maria Chiara; Eissa, Ahmed; Bevilacqua, Luigi; Zoeir, Ahmed; Ciarlariello, Silvia; Morini, Elena; Puliatti, Stefano; Durante, Viviana; Ceccarelli, Pier Luca; Micali, Salvatore; Bianchi, Giampaolo; Rocco, Bernardo
abstract

Drug-induced nephrolithiasis is a rare condition in children. The involved drugs may be divided into two different categories according to the mechanism involved in calculi formation. The first one includes poorly soluble drugs that favor the crystallization and calculi formation. The second category includes drugs that enhance calculi formation through their metabolic effects. The diagnosis of these specific calculi depends on a detailed medical history, associated comorbidities and the patient's history of drug consumption. There are several risk factors associated with drug-induced stones, such as high dose of consumed drugs and long duration of treatment. Moreover, there are some specific risk factors, including urinary pH and the amount of fluid consumed by children. There are limited data regarding pediatric lithogenic drugs, and hence, our aim was to perform a comprehensive review of the literature to summarize these drugs and identify the possible mechanisms involved in calculi formation and discuss the management and preventive measures for these calculi.

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

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

2019 - 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 - 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 - Multi-institutional Evaluation of Producing and Testing a Novel 3D-Printed Laparoscopic Trainer [Articolo su rivista]
Parkhomenko, E.; Yoon, R.; Okhunov, Z.; Patel, R. M.; Dolan, B.; Kaler, K.; Schwartz, M. J.; Shah, P. H.; Bierwiler, H.; Gamboa, A. J.; Miano, R.; Germani, S.; Fabbro, D. D.; Zordani, A.; Micali, S.; Kavoussi, L. R.; Clayman, R. V.; Landman, J.
abstract

To create, distribute, and evaluate the efficacy of a portable, cost effective 3D-printed laparoscopic trainer for surgical skills development.

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 - Outcomes of Partial and Radical Nephrectomy in Octogenarians – A Multicenter International Study (Resurge) [Articolo su rivista]
Antonelli, A.; Veccia, A.; Pavan, N.; Mir, C.; Breda, A.; Takagi, T.; Rha, K. H.; Maurer, T.; Zhang, C.; Long, J. -A.; De Nunzio, C.; Lima, E.; Ferro, M.; Micali, S.; Quarto, G.; Linares, E.; Celia, A.; Schips, L.; Bove, P.; Larcher, A.; Fiori, C.; Mottrie, A.; Bindayi, A.; Trombetta, C.; Silvestri, T.; Palou, J.; Faba, O. R.; Tanabe, K.; Yang, B.; Fiard, G.; Tubaro, A.; Torres, J. N.; De Cobelli, O.; Bevilacqua, L.; Castellucci, R.; Tracey, A.; Hampton, L. J.; Montorsi, F.; Perdona, S.; Simeone, C.; Palumbo, C.; Capitanio, U.; Derweesh, I.; Porpiglia, F.; Autorino, R.
abstract

OBJECTIVE: To analyze the outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in octogenarian patients. METHODS: The RESURGE (REnal SUrgery in the Eldely) multi-institutional database was queried to identify patients ≥80 years old who had undergone a PN or RN for a renal tumor. Multivariable binary logistic regression estimated the association between type of surgery and occurrence of complications. Multivariable Cox regression model assessed the association between type of surgery and All-Causes Mortality. RESULTS: The study analyzed 585 patients (median age 83 years, IQR 81-84), 364 of whom (62.2%) underwent RN and 221 (37.8%) PN. Patients undergoing RN were older (P = .0084), had larger tumor size (P < .0001) and higher clinical stage (P < .001). At multivariable analysis for complications, the only significant difference was found for lower risk of major postoperative complications for laparoscopic RN compared to open RN (OR: 0.42; P = .04). The rate of significant (>25%) decrease of eGFR in PN and RN was 18% versus 59% at 1 month, and 23% versus 65% at 6 months (P < .0001). After a median follow-up time of 39 months, 161 patients (31%) died, of whom 105 (20%) due to renal cancer. CONCLUSION: In this patient population both RN and PN carry a non-negligible risk of complications. When surgical removal is indicated, PN should be preferred, whenever technically feasible, as it can offer better preservation of renal function, without increasing the risk of complications. Moreover, a minimally invasive approach should be pursued, as it can translate into lower surgical morbidity.

2019 - Quick assessment of cell-free DNA in seminal fluid and fragment size for early non-invasive prostate cancer diagnosis [Articolo su rivista]
Ponti, Giovanni; Maccaferri, Monia; Manfredini, Marco; Micali, Salvatore; Torricelli, Federica; Milandri, Riccardo; Del Prete, Chiara; Ciarrocchi, Alessia; Ruini, Cristel; Benassi, Luisa; Bettelli, Stefania; Kaleci, Shaniko; Ozben, Tomris; Tomasi, Aldo
abstract

Liquid biopsy consists in the quantification and qualification of circulating cell-free DNA (cfDNA) and tumor-derived DNA (ctDNA) for cancer recognition. Recently, the characterization of seminal cfDNA (scfDNA) has been reported as a possible biomarker for prostate cancer (PCa) diagnosis.

2019 - Re: Accurate Quantification of Residual Cancer Cells in Pelvic Washing Reveals Association with Cancer Recurrence following Robot-Assisted Radical Cystectomy [Articolo su rivista]
Sighinolfi, M. C.; Rocco, B.; Micali, S.; Bianchi, G.
abstract

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 - 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 - Right open nephrectomy under combined spinal and peridural operative anesthesia and analgesia (CSE): A new anesthetic approach in abdominal surgery [Articolo su rivista]
Prati, Andrea; Rocco, M. C. Bernardo; Micali, Salvatore; Potenzoni, Michele; Cantoni, Federico; Martens, Daniel; Villani, Fabio; Cantadori, Luca; Dallaglio, Matteo; Cotugno, Michele
abstract

2019 - Robotic assisted radical cystectomy: insights on long term oncological outcomes from the International Robotic Cystectomy Consortium [Articolo su rivista]
Sighinolfi, Maria Chiara; Micali, Salvatore; Eissa, Ahmed; Picozzi, Stefano Carlo Maria; Puliatti, Stefano; Rocco, Bernardo
abstract

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 - Entry techniques in laparoscopic radical and partial nephrectomy: A multicenter international survey of contemporary practices [Articolo su rivista]
Bove, Pierluigi; Iacovelli, Valerio; Sandri, Marco; Carilli, Marco; Cindolo, Luca; Autorino, Riccardo; Kavoussi, Louis R.; Micali, Salvatore; Porpiglia, Francesco; Rha, Koon H.; Kim, Fernando J.
abstract

BACKGROUND: There is no clear consensus as to the optimal method of entry in laparoscopic renal surgery and no reports have compared them in Urology. To analyze contemporary practice patterns in entry technique and port placement for laparoscopic kidney surgery. METHODS: We identified 60 high volume urological laparoscopic centers. A purpose-built questionnaire was sent to surgeons. The survey included 22 questions regarding access techniques and port configuration during laparoscopic kidney surgery. Data on were collected and retrospectively analyzed. Concordance among port configurations was assessed using Cohen's Kappa statistics. RESULTS: The survey was sent to 60 surgeons and completed by 32 of them. Surgical procedures included were laparoscopic radical nephrectomy (1177 LRN/year) and laparoscopic partial nephrectomy (1047 LPN/year). The transperitoneal route was preferred (85%). Hasson technique was used for the access in 55% of the cases. Patient lateral recumbent position is the most frequently used during the port placement (41%). Although there is a high variability in the port positioning among the surgeons, in more than 90% of cases it was found a specific concordance in triangulation of optics and operating trocars. There were no significant differences between port configuration in LRN and LPN. Limitations include retrospective design and limited sample. CONCLUSIONS: A standard port configuration has not been previously reported in urological literature. Our study suggests that the transperitoneal approach, the Hasson technique and a specific triangulation of optics and operating trocars have a significant concordance in some high volume laparoscopic urologic centers.

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 - 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 - 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 - Seminal cell-free DNA molecular profile as a novel diagnostic and prognostic prostate cancer biomarkers [Articolo su rivista]
Ponti, Giovanni; Maccaferri, Monia; Manfredini, Marco; Cotugno, Michele; Pellacani, Giovanni; Conti, Andrea; Micali, Salvatore; Mandrioli, Mauro; Tomasi, Aldo
abstract

n.d.

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

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

2018 - The role of 68Ga-PSMA PET/CT scan in biochemical recurrence after primary treatment for prostate cancer: a systematic review of literature [Articolo su rivista]
Eissa, Ahmed; El Sherbiny, Ahmed; Coelho, Rafael F; Rassweiler, Jens; Davis, John W; Porpiglia, Francesco; Patel, Vipul R; Prandini, Napoleone; Micali, Salvatore; Sighinolfi, Maria C; Puliatti, Stefano; Rocco, Bernardo; Bianchi, Giampaolo
abstract

Recurrence after primary treatment of prostate cancer is one of the major challenges facing urologists. Biochemical recurrence is not rare and occurs in up to one third of the patients undergoing radical prostatectomy. Management of biochemical recurrence is tailored according to the site and the burden of recurrence. Therefore, developing an imaging technique to early detect recurrent lesions represents an urgent need. Positron emission tomography (PET) of 68Ga-labelled prostate-specific membrane antigen (68Ga-PSMA) is an emerging imaging modality that seems to be a promising tool with capability to localize recurrent prostate cancer. Our aim was a systematic review of literature was done to evaluate the role of 68Ga-PSMA PET/CT scan in patients with recurrent prostate cancer after primary radical treatment.

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

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

2017 - 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 - 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 - 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 - 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 - 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.

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 - Erratum: Three-Dimensional Technology Facilitates Surgical Performance of Novice Laparoscopy Surgeons: A Quantitative Assessment on a Porcine Kidney Model (Urology 2015;85:(1252-1256) [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, Giampoalo; Damiano, Rocco; Rassweiler, Jens; Lima, Estevao
abstract

ok

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 - Hydronephrosis in pregnancy [Capitolo/Saggio]
Zordani, A.; Bevilacqua, L.; Micali, S.
abstract

In this chapter we provide a critical and practical overview of the clinical management of hydronephrosis during pregnancy, which represents a very common and sometimes problematic scenario for the practising urologist.

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 - 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

ok

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 - 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 - 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 - 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.

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 - Cooperation of histone deacetylase inhibitors SAHA and valproic acid in promoting sodium/iodide symporter expression and function in rat Leydig testicular carcinoma cells [Articolo su rivista]
Maggisano, V.; Puppin, C.; Celano, M.; D'Agostino, M.; Sponziello, M.; Micali, S.; Navarra, M.; Damante, G.; Filetti, S.; Russo, D.
abstract

The presence of the sodium/iodide symporter (NIS) is the prerequisite for the use of the radioiodine in the treatment of thyroid cancer. Thus, stimulators of NIS expression and function are currently investigated in cellular models of various human malignancies, also including extrathyroid cancers. In this study, we analyzed the effects of the histone deacetylase inhibitors (HDACi), suberoylanilide hydroxamic acid (SAHA) and valproic acid (VPA), on NIS expression and function in rat Leydig testicular carcinoma cells (LC540). LC540 cells were exposed to SAHA 3 μM and VPA 3 mM (alone and in combination), and cell viability evaluated by MTT assay and cell counting, NIS mRNA and protein levels by using, respectively, real-time RT-PCR and western blotting. NIS function was evaluated by iodide uptake assay. We found that both HDACi were able to stimulate the transcription of NIS gene, but not its protein expression, while the association of SAHA and VPA increased both NIS transcript and protein levels, resulting in significant sixfold enhancement of radioiodine uptake capacity of LC540 cells. These data demonstrate the presence of an epigenetic control of NIS expression in Leydig tumor cells, suggesting the possibility to use the combination of these two HDACi for a radioiodine-based treatment of these malignancies. © 2013 Springer Science+Business Media New York.

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 - Hem-O-Lok clip: A neglected cause of severe bladder neck contracture and consequent urinary incontinence after robot-assisted laparoscopic radical prostatectomy [Articolo su rivista]
Cormio, Luigi; Massenio, Paolo; Lucarelli, Giuseppe; Di Fino, Giuseppe; Selvaggio, Oscar; Micali, Salvatore; Carrieri, Giuseppe
abstract

Background: Hem-o-lok clips are widely used during robot-assisted and laparoscopic radical prostatectomy to control the lateral pedicles. There are a few reports of hem-o-lok clip migration into the bladder or vesico-urethral anastomosis and only four cases of hem-o-lok clip migration resulting into bladder neck contracture. Herein, we describe the first case, to our knowledge, of hem-o-lok clip migration leading to severe bladder neck contracture and subsequent stress urinary incontinence. Case presentation. A 62-year-old Caucasian man underwent robot-assisted laparoscopic radical prostatectomy for a T1c Gleason 8 prostate cancer. One month after surgery the patient was fully continent; however, three months later, he presented with acute urinary retention requiring suprapubic drainage. Urethroscopy showed a hem-o-lok clip strongly attached to the area between the vesico-urethral anastomosis and the urethral sphincter and a severe bladder neck contracture behind it. Following cold-knife urethral incision and clip removal, the bladder neck contracture was widely resected. At 3-month follow-up, the patient voided spontaneously with a peak flow rate of 9.5 ml/sec and absence of post-void residual urine, but leaked 240 ml urine at the 24-hour pad test. To date, at 1-year follow-up, his voiding situation remains unchanged. Conclusions: The present report provides further evidence for the risk of hem-o-lok clip migration causing bladder neck contracture, and is the first to demonstrate the potential of such complication to result into stress urinary incontinence. © 2014 Cormio et al.; licensee BioMed Central Ltd.

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 - Robotic radical nephrectomy for renal cell carcinoma: A systematic review [Articolo su rivista]
Asimakopoulos, Anastasios D.; Miano, Roberto; Annino, Filippo; Micali, Salvatore; Spera, Enrico; Iorio, Beniamino; Vespasiani, Giuseppe; Gaston, Richard
abstract

BACKGROUND: Laparoscopic radical nephrectomy (LRN) is the actual gold-standard for the treatment of clinically localized renal cell carcinoma (RCC) (cT1-2 with no indications for nephron-sparing surgery). Limited evidence is currently available on the role of robotics in the field of radical nephrectomy. The aim of the current study was to provide a systematic review of the current evidence on the role of robotic radical nephrectomy (RRN) and to analyze the comparative studies between RRN and open nephrectomy (ON)/LRN. METHODS: A Medline search was performed between 2000-2013 with the terms "robotic radical nephrectomy", "robot-assisted laparoscopic nephrectomy", "radical nephrectomy". Six RRN case-series and four comparative studies between RRN and (ON)/pure or hand-assisted LRN were identified. RESULTS: Current literature produces a low level of evidence for RRN in the treatment of RCC, with only one prospective study available. Mean operative time (OT) ranges between 127.8-345 min, mean estimated blood loss (EBL) ranges between 100-273.6 ml, and mean hospital stay (HS) ranges between 1.2-4.3 days. The comparison between RRN and LRN showed no differences in the evaluated outcomes except for a longer OT for RRN as evidenced in two studies. Significantly higher direct costs and costs of the disposable instruments were also observed for RRN. The comparison between RRN and ON showed that ON is characterized by shorter OT but higher EBL, higher need of postoperative analgesics and longer HS. CONCLUSIONS: No advantage of robotics over standard laparoscopy for the treatment of clinically localized RCC was evidenced. Promising preliminary results on oncologic efficacy of RRN have been published on the T3a-b disease. Fields of wider application of robotics should be researched where indications for open surgery still persist.

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

N/A

2013 - 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 - Current state of laparoscopic and robotic surgery [Capitolo/Saggio]
Rassweiler, J. J.; Hruza, M.; Frede, T.; Micali, S.
abstract

Minimally invasive surgical innovation has exploded in recent times. Currently, conventional laparoscopy is most widely adopted as the costs are relatively low. However, robotics and single port surgery are leading a revolution in surgery for wealthy health-care systems. We explore the historical and contemporary areas of this evolution.

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 - Recent finding and new technologies in nephrolitiasis: A review of the recent literature [Articolo su rivista]
Rosa, Marco; Usai, Paolo; Miano, Roberto; Kim, Fernando J.; Agrò, Enrico Finazzi; Bove, Pierluigi; Micali, Salvatore
abstract

This review summarizes recent literature on advances regarding renal and ureteral calculi, with particular focus in areas of recent advances in the overall field of urolithiasis. Clinical management in everyday practice requires a complete understanding of the issues regarding metabolic evaluation and subgrouping of stone-forming patients, diagnostic procedures, effective treatment regime in acute stone colic, medical expulsive therapy, and active stone removal. In this review we focus on new perspectives in managing nephrolitihiasis and discuss recentadvances, including medical expulsive therapy, new technologies, and refinements of classical therapy such as shock wave lithotripsy, give a fundamental modification of nephrolithiasis management. Overall, this field appears to be the most promising, capable of new developments in ureterorenoscopy and percutaneous approaches. Further improvements are expected from robotic-assisted procedures, such as flexible robotics in ureterorenoscopy.

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.

2012 - La robotica in Urologia [Capitolo/Saggio]
Micali, Salvatore
abstract

La robotica in Urologia

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 - Minilaparoscopy, needlescopy and microlaparoscopy: decreasing invasiveness, maintaining the standard laparoscopic approach [Articolo su rivista]
G., Pini; F., Porpiglia; Micali, Salvatore; J., Rassweiler
abstract

OBJECTIVES: To review the development of miniaturized laparoscopic instruments with particular attention to the urological field and focusing on nomenclature, history and outcomes. METHODS: A comprehensive literature search was conducted in order to find articles related to Minilaparoscopy, Needlescopy, Microlaparoscopy. The most relevant papers over the last 30 years were selected in base to the experience from the panel of experts, journal, authorship and /or content. RESULTS: 258 manuscripts were found, 14 of them review, 126 about general surgery, 86 gynecology, 55 urology, 31 thoracic surgery. Minilaparoscopy is the main topic in 169 papers, Needlescopy in 58 and Microlaparoscopy in 32. No clinical randomized trials are available in urology. Most significant articles are 4 prospective non-randomized match-case control. CONCLUSIONS: We are facing a Minilaparoscopy of second-generation with superior performance granted by new endoscopes and most effective instruments. Up to date, Minilaparoscopy has demonstrated in almost all urologic indication to be feasible, safe and able to improve cosmetic and postoperative pain control. Anyway, clinical randomized trials are still lacking and only studies from other discipline can corroborate this trend.

2012 - Minimally Invasive Techniques in Lower Urinary Tract Reconstruction [Capitolo/Saggio]
A., Srinivasan; G., Isgrò; Micali, Salvatore
abstract

Cap. 98

2012 - TURP monopolare e bipolare [Capitolo/Saggio]
Micali, Salvatore; C., Guarasci; DE STEFANI, Stefano; Bianchi, Giulio
abstract

TURP monopolare e bipolare

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 - Computer-assisted surgery [Articolo su rivista]
Micali, Salvatore
abstract

The broad range of Computer Assisted Surgery (CAS) represents the integration of computer technology in surgical procedures for presurgical planning, guiding or manipulation. Surgical robots and surgical endoscopic navigation are the most challenging applications to urology. A surgical robot is defined as a computer-controlled manipulator with artificial sensing which can be programmed to move, and position tools to carry out surgical tasks. In urology, robots have been tested in two areas: endourology and laparoscopy. Surgical navigation allows the surgeon to process data from pre- and intraoperative sources, aiming at purification and presentation of the most relevant information. Image-guided systems (IGS), augmented reality (AR) and navigation in endoscopic soft tissue surgery represent the three main topics of surgical urological navigation. IGS involve matching the coordinates from medical imaging (preoperative registration) with coordinates from the patient in the operating room (registration and updating images). IGS have become the standard of care in providing navigational assistance during neurosurgery, offering subsurface and functional information to the surgeon.

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 - Low-cost reusable instrumentation for laparoendoscopic single-site nephrectomy: assessment in a porcine model [Articolo su rivista]
R., Autorino; F. J., Kim; A., Rane; M., De Sio; R. J., Stein; R., Damiano; Micali, Salvatore; J., Correia Pinto; J. H., Kaouk; E., Lima
abstract

PURPOSE: To test different sets of prebent instruments and a new reusable access device for laparoendoscopic single-site (LESS) surgery. MATERIALS AND METHODS: Three surgeons with previous experience in LESS performed 12 nephrectomies in six pigs. In all procedures, a multichannel access device (X-CONE) and a 5-mm extra-long telescope were used. Four sets of prebent instruments with different profiles (S-portal) were tested: Standard (one straight scissors and one curved grasper), Cuschieri, Carus, and Leroy set (each of them consisting of two curved instruments with different configurations). Assessment was performed based on both objective (procedure time; time to manage the pedicle; time to free kidney) and subjective parameters (entry/exit of instruments; triangulation; dissection up/down; dissection lateral; retraction; interdependence). The subjective assessment tool used was a Likert type scale (1 = easy to 5 = prohibitive). The access device was assessed by using objective (time to complete insertion of device after skin incision) and subjective (significant air leakage, movement constraint) parameters. RESULTS: Time to insertion of the X-CONE was <1 minute in all the cases. Surgeons reported significant insufflant leakage in 58% of cases. The procedure was completed in 10/12 (83%) cases. Mean operative time was 8.3 ± 4.2 minutes, being lower for the Carus group (4.5 min) and higher for the standard group (13 min). Among the different sets, the standard one obtained the best mean scores for all subjective parameters. CONCLUSIONS: X-CONE allows easy abdominal access, and its reusable properties represent cost savings for LESS compared with disposable devices. Prebent instruments might also represent attractive low-cost tools for LESS.

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 - The application of natural orifice surgery for adenocarcinoma of the prostate [Articolo su rivista]
B., Duty; O., Roy; Micali, Salvatore; L., Richstone; M., Vira; M., Schwartz; L. K., Kavoussi
abstract

Prostate cancer remains the most common solid organ malignancy in men. Unfortunately, surgical management of this disease is often associated with significant morbidity. In an effort to decrease the invasiveness and deleterious impact on quality of life associated with prostate cancer surgery, minimally invasive techniques have been applied to this disease. At present, the robotic-assisted laparoscopic radical prostatectomy has become the most commonly performed surgical treatment modality for adenocarcinoma of the prostate. Recently, several centers within the United States have begun to evaluate the feasibility of applying natural orifice translumenal endoscopic surgery to prostate cancer. This review article details the initial work done on cadaveric and canine models to develop the transurethral radical prostatectomy procedure. Potential advantages and disadvantages of this modality, as well as challenges facing its continued development, are highlighted.

2011 - Urologia per la scuola di Medicina - La robotica in urologia [Altro]
Micali, Salvatore
abstract

Appendice 2 del libro

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 - Position: prone or supine is the issue of percutaneous nephrolithotomy [Articolo su rivista]
R., Miano; C., Scoffone; C., De Nunzio; S., Germani; C., Cracco; P., Usai; A., Tubaro; Fj, Kim; Micali, Salvatore; International Translation Research in Uro Sciences, Team
abstract

INTRODUCTION: The prone position has been considered the only position for percutaneous access to the kidney for the past 25 years, whereas the supine Valdivia position has recently started to gain acceptance, although it was originally described in the late 1980s. Even more recently, the Galdakao-modified supine Valdivia position was described. However, there is no consensus on which is the best position for percutaneous nephrolithotomy, and the choice is currently based on the surgeon's preference. MATERIALS AND METHODS: The prone, supine, and modified supine positions are described, pointing out the advantages, disadvantages, and results of each technique. RESULTS: A number of potential advantages have been described for the supine over the prone position: less cardiovascular change; no need for patient repositioning (with less associated risk of central and peripheral nervous system injury); less X-ray exposure to the surgeon; and less risk of colonic injury. The recently described Galdakao-modified supine Valdivia position allows for a simultaneous anterograde and retrograde approach to the renal cavities for the one-stage treatment of complex renal stones or concurrent renal and ureteral calculi. Moreover, the use of a flexible ureteroscope allows for Endovision puncture to achieve perfect access to the kidney. CONCLUSIONS: The prone position still represents the standard for percutaneous access to the kidney, and other positions should be compared with this position. However, the supine and the modified supine positions have potentially important advantages for both patients and surgeons that need to be investigated in a large randomised trial to define their superiority over the traditional prone position.

2010 - Pre-bent instruments for laparoendoscopic single-site surgery (LESS): assessment for less nephrectomy [Abstract in Rivista]
E., Lima; R., Autorino; F., Kim; A., Rane; M., De Sio; Micali, Salvatore; J., Kaouk; J., Correia Pinto
abstract

Pre-bent instruments for laparoendoscopic single-site surgery (LESS): assessment for less nephrectomy

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 - Reusable access device and pre-bent instruments for LESS nephrectomy: Experimental evaluation [Poster]
R., Autorino; F. J., Kim; J., Kaouk; A., Rane; M., De Sio; R., Damiano; Micali, Salvatore; J., Correia Pinto; E., Lima
abstract

Reusable access device and pre-bent instruments for LESS nephrectomy: Experimental evaluation

2010 - Reusable access device for laparo-endoscopic single site surgery (LESS):): assessment in porcine model [Abstract in Rivista]
E., Lima; R., Autorino; F., Kim; A., Rane; M., De Sio; Micali, Salvatore; J., Kaouk; J., Correia Pinto
abstract

Reusable access device for laparo-endoscopic single site surgery (LESS)

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 an "Overlooked" Ureteral Stent in a Transplant Kidney [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 - 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 - Noninvasive management of obstructing ureteral stones using electromagnetic extracorporeal shock wave lithotripsy (Surgical Endoscopy DOI: 10.1007/s00464-008-9766-6) [Articolo su rivista]
Sighinolfi, M. C.; Micali, S.; De Stefani, S.; Saredi, G.; Mofferdin, A.; Grande, M.; Bianchi, G.
abstract

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 - 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 - Extracorporeal shockwave lithotripsy: Can Phyllanthus niruri affect the efficacy of extracorporeal shock wave lithotripsy for renal stones? A randomized, prospective, long-term study - Commentary [Articolo su rivista]
Micali, S.; Sighinolfi, M. C.; Celia, A.; De Stefani, S.; Grande, M.; Cicero, A. F.; Bianchi, G.; Paterson, R. F.
abstract

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 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 - 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 - 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 [Capitolo/Saggio]
Micali, Salvatore; C., De Carne; M., Grande; M. C., Sighinolfi; DE STEFANI, Stefano; Bianchi, Giampaolo
abstract

Approccio terapeutico alla calcolosi urinaria

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 - 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 - 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 - 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 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 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 - Indwelling ureteral stents and sexuality: A prospective and multivariate analysis [Abstract in Atti di Convegno]
Micali, S.; Sighinolfi, M. C.; Mofferdin, A.; Ferrari, N.; Giacometti, M.; Rivalta, M.; De Stefani, S.; Bianchi, G.
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

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 - 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 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

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 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

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 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 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 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

k,jg

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 - Preservation of inosine on renal tissue during shockwave application in rat model [Poster]
De Stefani, S; De Carne, C; Di Pietro, C; Micali, Salvatore; Marzona, L; DE POL, Anto; Volpi, Nicola; Bianchi, G.
abstract

Preservation of inosine on renal tissue during 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 - 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 - 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 - Pediatric laparoscopic renal biopsy: techniques and indication. In: Minimally invasive urologic surgery [Capitolo/Saggio]
P., Caione; Micali, Salvatore
abstract

Pediatric laparoscopic renal biopsy: techniques and indication. In: Minimally invasive urologic surgery

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 - Seminal vescicle disease. In: Minimally invasive urologic surgery [Capitolo/Saggio]
Micali, Salvatore; P., Bove
abstract

Seminal vescicle disease. In: Minimally invasive urologic surgery

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. [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 - 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 - 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 - Is telesurgery a new reality? Our experience with laparoscopic and percutaneous procedures. [Relazione in Atti di Convegno]
Bove, P; Stoianovici, D; Micali, Salvatore; Patriciu, A; Grassi, N; Jarrett, Tw; Vespasiani, G; Kavoussi, Lr
abstract

BACKGROUND: Minimally invasive surgery offers many advantages, but its correct practice is associated with a steep learning curve. Telesurgery allows a surgeon at a remote site to guide and teach surgeons at a primary site by utilizing robotic devices, telecommunications, and video technology, thereby reducing complications.PATIENTS AND METHODS: From September 1998 to July 2000, 17 procedures were telementored between two sites 9230 km apart: a primary operating room at the Policlinico Casilino "Tor Vergata" University of Rome and a remote site at the Johns Hopkins Medical Institutions in Baltimore. Of these procedures, 14 were laparoscopic cases: 8 spermatic vein ligations, 2 retroperitoneal renal biopsies, 3 simple nephrectomies, and 1 pyeloplasty. Three procedures were carried out to obtain percutaneous renal access. All procedures were performed with the help of two robots: the first robot, AESOP, for the orientation of the laparoscope, and the second one, PAKY, to perform the percutaneous renal access. In addition to the robotic device, the system provided four ISDN lines, a PC with dedicated software to manage the connection, audio and video connections, an external video camera with a panoramic view of the operating room, and remote control of the electrocautery and the Telestrator.RESULTS: All the procedures were accomplished with an uneventful postoperative course. Ten operative cases were telementored successfully. In five cases, it was not possible to establish a connection to the remote site, and two procedures were converted to open surgery because of intraoperative complications. The time delay of the image transmission was <1 second.CONCLUSION: This preliminary experience has demonstrated the feasibility of international telementoring. It could provide education to surgeons and decrease the likelihood of complications attributable to inexperience with new techniques.

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 [Poster]
A., Celia; Micali, Salvatore; C., Di Pietro; P., Bove; L. R., Kavoussi; Bianchi, Giampaolo
abstract

Trocar seeding in urology laparoscopy

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 - 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 - Accesso percutaneo al rene con un robot controllato a distanza: Esperienza in telechirurgia con “PAKY” [Poster]
Micali, Salvatore; P., Bove; D., Stoianovici; S., Sansalone; G., Virgili; L. R., Kavoussi; G., Vespasiani
abstract

Acesso percutaneo al rene con un robot controllato a distanza: Esperienza in telechirurgia con “PAKY”

2002 - Acesso percutaneo al rene con un robot controllato a distanza: Esperienza in telechirurgia con “PAKY”. [Poster]
Micali, Salvatore; P., Bove; D., Stoianovici; S., Sansalone; G., Virgili; L. R., Kavoussi; G., Vespasiani
abstract

Acesso percutaneo al rene con un robot controllato a distanza: Esperienza in telechirurgia con “PAKY”.

2002 - Is telesurgery a new reality? Our experience in laparoscopic and percutaneous procedures [Poster]
Micali, Salvatore; P., Bove; D., Stoianovici; A., Patriciu; R., Miano; L. R., Kavoussi
abstract

Is telesurgery a new reality? Our experience in laparoscopic and percutaneous procedures

2002 - Laparoscopic bilateral varicocelectomy: Our technique with three 5-mm trocars [Poster]
P., Bove; Micali, Salvatore; R., Miano; S., Germani; G., Virgili; G., Vespasiani
abstract

Laparoscopic bilateral varicocelectomy: Our technique with three 5-mm trocars

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 - Preparation of the patient. In Retroperitoneoscopy and extraperitoneal laparoscopy in pediatric and adult urology [Capitolo/Saggio]
M., Bitelli; Micali, Salvatore
abstract

Preparation of the patient. In Retroperitoneoscopy and extraperitoneal laparoscopy in pediatric and adult urology

2002 - Prospettive in laparoscopia urologica: Esperienza su alcune indicazioni relative [Abstract in Rivista]
P., Bove; Micali, Salvatore; G., Virgili; P., Caione; L., Mavilla; G., Vespasiani
abstract

Prospettive in laparoscopia urologica: Esperienza su alcune indicazioni relative

2002 - Quattro anni di laparoscopia pediatrica: Nostre impressioni [Poster]
P., Caione; Micali, Salvatore; G., Collura; M., De Dominicis; N., Capozza; F., Micali
abstract

Quattro anni di laparoscopia pediatrica: Nostre impressioni

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

Renal staghorn calculosis: Endourological treatment.

2002 - Retroperitoneal access. In Retroperitoneoscopy and extraperitoneal laparoscopy in pediatric and adult urology [Capitolo/Saggio]
Micali, Salvatore; P., Caione
abstract

Retroperitoneal access. In Retroperitoneoscopy and extraperitoneal laparoscopy in pediatric and adult urology

2002 - Retroperitoneal laparoscopic wedge resection for small renal tumor [Abstract in Rivista]
L., Mavilla; Micali, Salvatore; G., Virgili; P., Bove; R., Miano; G., Vespasiani
abstract

Retroperitoneal laparoscopic wedge resection for small renal tumor

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

2001 - Double-J ureteral stents: An alternative to external urinary stents in orthotopic bladder substitution [Articolo su rivista]
Micali, Salvatore; P., De Carli; R., Miano; D., O’Sullivan; L., Lamanna; F., Micali
abstract

OBJECTIVE: The aim of this study was to compare advantages and disadvantages of using double-J or external stents to preserve the uretero-ileal anastomosis in patients receiving an orthotopic neobladder. METHODS: 77 consecutive patients with bladder cancer who underwent radical cystoprostatectomy and Studer neobladder were evaluated. All patients received a direct spatulated end-to-side uretero-ileal anastomosis in the afferent loop (Nesbit technique). In 45 patients (group A), the stents (Bracci ureteral splint) were brought our through the reservoir and anchored to the skin; in 32 patients (group B), an internal double-J stent was used. Median follow-up was 30 months. RESULTS: 9 (11.5%) uretero-ileal anastomosis strictures in group A and 7 (11.6%) in group B were observed. There was a significant difference in the side of stricture with a greater prevalence on the left side (p<0.004). Stricture formation and side were not related to the type of stent used. 14 (20%) neobladder-ureteral refluxes occurred, with a non-significant difference between the two groups (p = 0.37). 12 patients (86%) were asymptomatic; two patients developed pyelonephritis and needed antibiotic treatment. Neobladder catheter was removed after 17 days (range: 15-18 days) and 14 days (range: 12-15 days), respectively, in group A and group B with an earlier discharge of the patients in group B. There was a significant difference in mean hospital stay between the two groups (Mann-Whitney test p<0.0001). Discomfort related to the stent was mild for most of the patients of group B (84%). CONCLUSIONS: Internal stenting is an equally effective alternative to external stent in patients undergoing bladder replacement. The use of double-j stents appears to be associated with minimal discomfort, earlier mobilization and a shorter hospital stay.

2001 - Remote percutaneous renal access using a new automated telesurgical robotic system [Articolo su rivista]
J., Bauer; B. R., Lee; D., Stoianovici; J. T., Bishoff; Micali, Salvatore; F., Micali; L. R., Kavoussi
abstract

Previous clinical application of remote telesurgery has been the use of a novel system of video teleconferencing equipment along with remote control of a laparoscopic camera at distances over 11,000 miles. Recently, a robotic system has been developed to assist with percutaneous renal surgery. This robot has been incorporated into the telesurgical system to allow remote needle placement into the renal collecting system under radiological guidance. The main component of the telesurgical system is a low degree of freedom robot called "PAKY" (percutaneous access of the kidney). It is custom designed for fluoroscopic guided percutaneous needle insertion into the renal collecting system. The robot is a six-degrees of freedom device. However, when the skin entry site is fixed and held in position, only two degrees of freedom are required to orient the needle in the correct plane for accurate insertion. Remote control of the robot was accomplished over a plain old telephone system (POTS) line. On June 17, 1998, the first remote telerobotic percutaneous renal access procedure was performed between the Johns Hopkins Hospital, Baltimore, Maryland, and Tor Vergata University, Rome, Italy. This new telesurgical robot was successful in term of obtaining percutaneous access within 20 min, with two attempts to obtain entry into the collecting system. This robot represents the first system for performing remote telesurgical interventions in the kidney and demonstrates the feasibility and safety of assisting accurate and rapid needle access to the kidney during percutaneous procedures.

2001 - Retroperitoneal laparoscopic access in children using a direct vision technique [Articolo su rivista]
Micali, Salvatore; P., Caione; G., Virgili; N., Capozza; M., Scarfini; F., Micali
abstract

PURPOSE: Retroperitoneal procedures were initiated in 1992 by balloon dissection of the retroperitoneum. More recently a new type of retroperitoneal access has been obtained by directly entering the retroperitoneum using the Visiport visual trocar. We present our initial experience with direct visual access to the retroperitoneum in the pediatric population. MATERIALS AND METHODS: A total of 31 children underwent retroperitoneal laparoscopy, including renal biopsy in 22, varicocelectomy in 5, renal cyst ablation in 3 and pyelolithotomy for a staghorn stone in 1. Patients were placed in the full flank position. A maximum of 3 ports was used and the initial trocar was placed under direct vision. The laparoscope was then used to dissect bluntly a working space in the retroperitoneum. RESULTS: All procedures were successful. Blood loss was minimal. Operative time was 4 hours for pyelolithotomy and less than 1 for the other procedures. Mean hospital stay was 1.5 days and all patients returned to normal activity at a mean of 6 days. Two minor complications developed. The peritoneum was inadvertently entered in 1 case, in which no further treatment was necessary and convalescence was uneventful and short. In another case severe arrhythmia developed, resulting in an aborted procedure. CONCLUSIONS: This technique is simple, safe and does not require extensive laparoscopic experience.

2001 - Retroperitoneal laparoscopic renal surgery in children without clips [Abstract in Rivista]
Micali, Salvatore; P., Caione; L., Storti; N., Capozza; M., Scarfini; F., Micali
abstract

Retroperitoneal laparoscopic renal surgery in children without clips

2001 - Right varicocele associated with inferior vena cava malformation in situs inversus: percutaneous treatment with retrograde sclerotherapy [Articolo su rivista]
P., Preziosi; R., Miano; M., Bitelli; M. G., Ciolfi; Micali, Salvatore; F., Micali
abstract

Isolated right varicocele is a rare condition. It could be secondary to a retroperitoneal neoplastic mass involving the right internal spermatic vein, but sometimes, an anatomic variant must be considered. We present a case of a young man with situs inversus and right varicocele, a mirror image of the normal condition, associated with inferior vena cava malformation, who was treated successfully with retrograde selective percutaneous sclerotherapy of the right internal spermatic vein. Selective sclerotherapy of the internal spermatic vein at the time of venography has proved to be a valuable therapeutic option in right-sided varicocele associated with anatomic abnormalities.

2001 - Two robotic devices applied on urological telesurgery [Poster]
Micali, Salvatore; P., Bove; E., Vannozzi; G., Vespasiani; D., Stoianovici; L. R., Kavoussi
abstract

Two robotic devices applied on urological telesurgery

2001 - Uninary N-Acetyl-Beta-D-Glucosaminidase (NAG) concentration in spinal cord injury patients: Relationships with urodynamic parameters. [Articolo su rivista]
E., Finazzi Agro`; Micali, Salvatore; M., Maccarrone; A., Giannantoni; A., D`amico; G., Vespasiani
abstract

OBJECTIVES: To investigate the relationships between urinary N-acetyl-beta-D-glucosaminidase (NAG) concentrations and urodynamic parameters in patients with spinal cord injury (SCI). NAG has been proposed as a marker of renal damage.METHODS: Twenty-three patients with SCI were evaluated with urodynamic studies. Urine samples were collected from the 23 patients and 10 healthy volunteers, the NAG levels were evaluated, and the urodynamic parameters were compared with the urinary NAG levels. The patients were divided into two groups according to the amplitude of the hyperreflexic detrusor contractions (HDCs): group A, patients with an HDC amplitude of 40 cm H(2)O or greater, and group B, patients with an HDC amplitude of less than 40 cm H(2)O; group C was composed of healthy volunteers. The urinary NAG concentrations in the three groups were compared.RESULTS: A positive correlation was found between the urinary NAG levels and the HDC amplitude and detrusor leak point pressure (P = 0.015 and 0.007, respectively). The urinary NAG concentration was 3.38 U/g in group A, 2.14 U/g in group B, and 2.12 U/g in group C. The differences in the urinary NAG concentrations between groups A and B and between groups A and C were statistically significant (P = 0.03 and P <0.001, respectively). The concentrations between groups B and C were comparable.CONCLUSIONS: In our experience, the only urodynamic parameters that clearly and positively correlated with the urinary NAG levels were those expressing the amplitude of intravesical pressure. This result stresses the importance of reducing the intravesical pressure in patients with SCI using alternative treatments or surgical procedures if the usual conservative therapies are not effective.

2001 - Urinary N-acetyl-beta-D-glucosaminidase concentration in patients with spinal cord injury: relationship with urodynamic parameters [Articolo su rivista]
E., Finazzi Agro’; Micali, Salvatore; M., Maccarrone; A., D’Amico; G., Vespasiani; P., Pasqualetti; C., Caltagirone
abstract

OBJECTIVES: To investigate the relationships between urinary N-acetyl-beta-D-glucosaminidase (NAG) concentrations and urodynamic parameters in patients with spinal cord injury (SCI). NAG has been proposed as a marker of renal damage. METHODS: Twenty-three patients with SCI were evaluated with urodynamic studies. Urine samples were collected from the 23 patients and 10 healthy volunteers, the NAG levels were evaluated, and the urodynamic parameters were compared with the urinary NAG levels. The patients were divided into two groups according to the amplitude of the hyperreflexic detrusor contractions (HDCs): group A, patients with an HDC amplitude of 40 cm H(2)O or greater, and group B, patients with an HDC amplitude of less than 40 cm H(2)O; group C was composed of healthy volunteers. The urinary NAG concentrations in the three groups were compared. RESULTS: A positive correlation was found between the urinary NAG levels and the HDC amplitude and detrusor leak point pressure (P = 0.015 and 0.007, respectively). The urinary NAG concentration was 3.38 U/g in group A, 2.14 U/g in group B, and 2.12 U/g in group C. The differences in the urinary NAG concentrations between groups A and B and between groups A and C were statistically significant (P = 0.03 and P <0.001, respectively). The concentrations between groups B and C were comparable. CONCLUSIONS: In our experience, the only urodynamic parameters that clearly and positively correlated with the urinary NAG levels were those expressing the amplitude of intravesical pressure. This result stresses the importance of reducing the intravesical pressure in patients with SCI using alternative treatments or surgical procedures if the usual conservative therapies are not effective.

2000 - Efficacy of epidural anesthesia for retroperitoneoscopic renal biopsy [Articolo su rivista]
Micali, Salvatore; T. W., Jarrett; P., Pappa; M., Taccone Gallucci; G., Virgili; G., Vespasiani
abstract

Laparoscopic procedures are performed using general anesthesia due to the perceived limitations of regional anesthesia in the upper abdomen and retroperitoneum. We present our initial experience with epidural anesthesia for retroperitoneal laparoscopic renal biopsy

2000 - Feasibility of telementoring between Baltimore (USA) and Rome (Italy): the first five cases [Articolo su rivista]
Micali, Salvatore; G., Virgili; E., Vannozzi; N., Grassi; T. W., Jarrett; J. J., Bauer; G., Vespasiani; L. R., Kavoussi
abstract

BACKGROUND AND PURPOSE: Telemedicine is the use of telecommunication technology to deliver healthcare. Telementoring has been developed to allow a surgeon at a remote site to offer guidance and assistance to a less-experienced surgeon. We report on our experience during laparoscopic urologic procedures with mentoring between Rome, Italy, and Baltimore, USA. MATERIAL AND METHODS: Over a period of 3 months, two laparoscopic left spermatic vein ligations, one retroperitoneal renal biopsy, one laparoscopic nephrectomy, and one percutaneous access to the kidney were telementored. Transperitoneal laparoscopic cases were performed with the use of AESOP, a robotic for remote manipulation of the endoscopic camera. A second robot, PAKY, was used to perform radiologically guided needle orientation and insertion for percutaneous renal access. In addition to controlling the robotic devices, the system provided real-time video display for either the laparoscope or an externally mounted camera located in the operating room, full duplex audio, telestration over live video, and access to electrocautery for tissue cutting or hemostasis. RESULTS: All procedures were accomplished with an uneventful postoperative course. One technical failure occurred because the robotic device was not properly positioned on the operating table. The round-trip delay of image transmission was less than 1 second. CONCLUSION: International telementoring is a feasible technique that can enhance surgeon education and decrease the likelihood of complications attributable to inexperience with new operative techniques.

2000 - International Surgical Telementoring Using a Robotic Arm: Our Experience [Articolo su rivista]
J. J., Bauer; B. R., Lee; J. T., Bishoff; G., Janetschek; P., Bunyaratavej; W., Kamolpronwijit; S., Ratchanon; S., O'Kelley; J. A., Cadeddu; Micali, Salvatore; F., Micali; M. K., Li; P., Goh; D., Png; L. R., Kavoussi
abstract

To determine the clinical utility of delivering remote subspecialty surgical care using a novel telesurgical mentoring system with current telemedicine technology. A personal computer-based system was developed to immerse a surgical specialist into a distant operating room utilizing public telephone lines. This system incorporates standard video conferencing (VTC) hardware with live video telestration (white boarding) capability and remote robotic control of a laparoscope camera. From Baltimore, Maryland, multiple laparoscopic surgical procedures were conducted to demonstrate the ability to telementor less experienced surgeons placed at remote locations in Austria, Thailand, Italy, and Singapore. Telecommunications links were successfully established to these remote locations that ranged in distance from approximately 4500 to 11,000 miles. There was no perceptible impact of time delay on the surgical procedures. All procedures were successfully completed without complications. This successful demonstration of international telementoring suggests that remote mentoring is a viable method of instructing less experienced surgeons through potentially complex surgical procedures. This novel approach in projecting expert surgical care may improve patient access to specialty care on a worldwide basis.

2000 - Laparoscopic education programme for urologists and gynaecologists [Poster]
Micali, Salvatore; M., De Dominicis; G., Virgili; R., Miano; E., Finazzi Agro’; G., Vespasiani
abstract

Laparoscopic education programme for urologists and gynaecologists

2000 - Percutaneous renal access with a robot remote controlled: Our preliminary experience [Poster]
Micali, Salvatore; P., Bove; N., Grassi; G., Vespasiani; G., Virgili; F., Micali
abstract

Percutaneous renal access with a robot remote controlled: Our preliminary experience

2000 - Remote robotic surgery for obtaining percutaneous renal access-A video presentation. [Abstract in Rivista]
W. W., Roberts; B. R., Lee; D., Stoianovici; J. T., Bishoff; R. H., Taylor; Micali, Salvatore; M. K., Li; L. R., Kavoussi
abstract

Remote robotic surgery for obtaining percutaneous renal access-A video presentation.

2000 - Remote telesurgical mentoring: feasibility and efficacy [Relazione in Atti di Convegno]
J. J., Bauer; B. R., Lee; D., Stoianovici; J. T., Bishoff; G., Janetschek; P., Bunyaratavej; W., Kamolpronwijit; S., Ratchanon; S., O’Kelley; J. A., Cadeddu; Micali, Salvatore; F., Micali; M. K., Li; P., Goh; D., Png; L. R., Kavoussi
abstract

Abstract We report our experience in performing telesurgically-mentored procedures from Baltimore, MD to Thailand, Austria, Italy and Singapore. We additionally report on a case of remote robotic manipulation using a robot designed for Percutaneous Access of the Kidney (PAKY). Telementoring was performed using a video teleconferencing platform including audio, video, real-time video telestration and remote control of the AESOP robotic arm that manipulates the laparoscopic camera. The international telementoring was achieved over 3- ISDN lines (384 Kilobytes/sec). The robotic arm and PAKY robot were controlled over a separate analog POTS line. Telecommunications links were successfully established to these remote locations that ranged in distance from approximately 4,500-11,000 miles. There was no perceptible impact of time delay on the surgical procedures. All procedures were successfully completed without additional complications. Multiple laparoscopic surgeries to include varicocelectomy (4), nephrectomy (4), adrenalectomy (1) and cholecystectomies (2) were demonstrated. Remote robotic percutaneous access to the kidney was successfully conducted within fifteen minutes from Baltimore, Maryland to Rome, Italy.

2000 - Retroperitoneal laparoscopic cyst ablation with the use of Ultracision scalpel. [Abstract in Rivista]
P., Caione; Micali, Salvatore; G., Virgili; R., Miano; N., Capozza; F., Micali:
abstract

Retroperitoneal laparoscopic cyst ablation with the use of Ultracision scalpel.

2000 - Retroperitoneal laparoscopic nephrectomy in children without clips [Abstract in Rivista]
Micali, Salvatore; P., Caione; L., Storti; N., Capozza; A., Lais; F., Micali
abstract

Retroperitoneal laparoscopic nephrectomy in children without clips

2000 - Retroperitoneal laparoscopic nephrolitotomy in children as an alternative to PCNL [Abstract in Rivista]
Micali, Salvatore; J., Valla’; G., Vespasiani; M., Scarfini; E., Matarazzo; P., Micali
abstract

Retroperitoneal laparoscopic nephrolitotomy in children as an alternative to PCNL

2000 - Retroperitoneal laparoscopy for renal biopsy in children [Articolo su rivista]
P., Caione; Micali, Salvatore; S., Rinaldi; N., Capozza; A., Lais; E., Matarazzo; G., Maturo; F., Micali
abstract

PURPOSE: We report our experience with the retroperitoneal laparoscopic approach for treating pediatric patients and when the percutaneous needle approach is not possible due to uncontrolled hypertension, bleeding disorders, anti-clotting medications and anatomical abnormalities. MATERIALS AND METHODS: Retroperitoneal laparoscopic renal biopsy was performed in 20 patients 2 to 18 years old (mean age 9.7) during a 16-month period. At the same time 53 percutaneous needle biopsies and 1 open biopsy were performed. The child is in a flank position, and 2 trocars are used via a direct vision approach. The first trocar is 12 mm. in diameter and positioned on the posterior axillary line, and the second trocar is 5 mm. in diameter and is entered 4 cm. anteriorly. Gentle dissection is done to free the lower pole of the selected kidney, biopsy forceps are used to grasp the specimen under direct vision and the biopsy site is fulgurated using bipolar electrocautery. RESULTS: Biopsy was performed successfully in all cases except 1, which was converted to an open procedure. Mean operative time was 40 minutes, blood loss was minimal and mean hospital stay was 1.2 days postoperatively. No pain medication was required postoperatively, and all patients returned to their usual activities within 3 to 5 days. A minor intraoperative complication, which was a peritoneal tear with no postoperative sequelae, occurred in 1 case. CONCLUSIONS: The retroperitoneal laparoscopic technique is simple and safe, and does not require extensive laparoscopic experience. We believe that this approach is reliable, and has less morbidity and several advantages compared to open surgery. It should be selected as the first choice for treating pediatric patients when percutaneous needle renal biopsy is contraindicated.

2000 - Robots and telecommunications in laparoscopic surgery: Our initial experience on 14 telesurgical procedures in urology [Poster]
G., Vespasiani; Micali, Salvatore; E., Vannozzi; G., Virgili; E., Spera; F., Micali
abstract

Robots and telecommunications in laparoscopic surgery: Our initial experience on 14 telesurgical procedures in urology

1999 - A training program for basic urologic laparoscopy [Abstract in Rivista]
M., Bitelli; Micali, Salvatore; G., Virgili; C., Carboni; P., Pappa; P., Bove; G., Vespasiani
abstract

A training program for basic urologic laparoscopy

1999 - Extracorporeal piezoelectric shockwave lithotripsy of ureteral stones: Are second-generation lithotripter obsolete? [Articolo su rivista]
G., Virgili; E., Mearini; Micali, Salvatore; R., Miano; G., Vespasiani; M., Porena
abstract

BACKGROUND: The role of extracorporeal shockwave lithotripsy (SWL) for ureteral calculi is still being debated. We evaluated our results in a large series to clarify the role of this modality. PATIENTS AND METHODS: A total of 478 patients with solitary ureteral stones were treated by in situ piezoelectric extracorporeal shockwave lithotripsy (SWL) using a Wolf Piezolith 2300 ultrasound-guided lithotripter. Two hundred fifty stones (52.3%) were located in the upper ureter and 228 (47.7%) in the distal ureter. Seventy of the upper ureteral stones were located in the ureteropelvic junction and 180 in the lumbar ureter. The diameter of the stones ranged from 5 to 30 mm. Four hundred sixty-seven patients were followed up for a mean of 4 months. RESULTS: Four hundred forty patients (94.2%) were stone free after in situ SWL alone. Complete removal of all stone fragments was achieved in 95.4% of the 216 patients with calculi of 5 to 10 mm in diameter, in 94.3% of the 229 with stones of 11 to 20 mm, and in 81.8% of the 22 with calculi of 21 to 30 mm. In situ treatment completely removed 61 of 69 ureteropelvic junction stones (88.4%), 166 of 175 lumbar stones (94.8%), and 213 of 223 distal ureteral stones (95.5%). In situ treatment failed in 27 stones (5.8%). After 4 months, 12 stone fragments and 15 unfragmented stones persisted despite retreatments and required endoscopic procedures. The mean number of sessions and shockwaves per patient was 1.8 and 4884, respectively. Morbidity was low. Renal colic in 57 patients (11.9%) was managed successfully by analgesics. In 36 patients, stone fragments obstructed the ureter; in 28 of these 36 (78%), the obstruction was resolved and the patients were stone free after in situ retreatments alone. All these results were achieved on an outpatient basis without sedation or local or general anesthesia. CONCLUSION: Piezoelectric SWL is an effective and noninvasive method for eliminating ureteral stones. Second-generation ultrasound-guided lithotripters are not yet obsolete.

1999 - Feasibility of telementoring between Baltimore (USA) and Rome (Italy): the first five cases [Poster]
Micali, Salvatore; G., Vespasiani; E., Finazzi Agro’; G., Virgili; R. G., Moore; L. R., Kavoussi; F., Micali
abstract

BACKGROUND AND PURPOSE: Telemedicine is the use of telecommunication technology to deliver healthcare. Telementoring has been developed to allow a surgeon at a remote site to offer guidance and assistance to a less-experienced surgeon. We report on our experience during laparoscopic urologic procedures with mentoring between Rome, Italy, and Baltimore, USA. MATERIAL AND METHODS: Over a period of 3 months, two laparoscopic left spermatic vein ligations, one retroperitoneal renal biopsy, one laparoscopic nephrectomy, and one percutaneous access to the kidney were telementored. Transperitoneal laparoscopic cases were performed with the use of AESOP, a robotic for remote manipulation of the endoscopic camera. A second robot, PAKY, was used to perform radiologically guided needle orientation and insertion for percutaneous renal access. In addition to controlling the robotic devices, the system provided real-time video display for either the laparoscope or an externally mounted camera located in the operating room, full duplex audio, telestration over live video, and access to electrocautery for tissue cutting or hemostasis. RESULTS: All procedures were accomplished with an uneventful postoperative course. One technical failure occurred because the robotic device was not properly positioned on the operating table. The round-trip delay of image transmission was less than 1 second. CONCLUSION: International telementoring is a feasible technique that can enhance surgeon education and decrease the likelihood of complications attributable to inexperience with new operative techniques.

1999 - Is there a correlation between bladder pressure and urinary N-Acetil-Beta-D-Glucosaminidase (NAG) concentration in patients with spinal cord injury (SCI)? [Abstract in Atti di Convegno]
E., Finazzi Agro'; Micali, Salvatore; M., Maccarrone; M., Biterlli; M., Valitutti; G., Vespasiani
abstract

To investigate the relationships between urinary N-acetyl-beta-D-glucosaminidase (NAG) concentrations and urodynamic parameters in patients with spinal cord injury (SCI). NAG has been proposed as a marker of renal damage.METHODS:Twenty-three patients with SCI were evaluated with urodynamic studies. Urine samples were collected from the 23 patients and 10 healthy volunteers, the NAG levels were evaluated, and the urodynamic parameters were compared with the urinary NAG levels. The patients were divided into two groups according to the amplitude of the hyperreflexic detrusor contractions (HDCs): group A, patients with an HDC amplitude of 40 cm H(2)O or greater, and group B, patients with an HDC amplitude of less than 40 cm H(2)O; group C was composed of healthy volunteers. The urinary NAG concentrations in the three groups were compared.RESULTS:A positive correlation was found between the urinary NAG levels and the HDC amplitude and detrusor leak point pressure (P = 0.015 and 0.007, respectively). The urinary NAG concentration was 3.38 U/g in group A, 2.14 U/g in group B, and 2.12 U/g in group C. The differences in the urinary NAG concentrations between groups A and B and between groups A and C were statistically significant (P = 0.03 and P <0.001, respectively). The concentrations between groups B and C were comparable.CONCLUSIONS:In our experience, the only urodynamic parameters that clearly and positively correlated with the urinary NAG levels were those expressing the amplitude of intravesical pressure. This result stresses the importance of reducing the intravesical pressure in patients with SCI using alternative treatments or surgical procedures if the usual conservative therapies are not effective.

1999 - Is there a correlation between bladder pressure and urinary N-Acetil-Beta-D-Glucosaminidase (NAG) concentration in patients with spinal cord injury (SCI)? [Abstract in Rivista]
E., Finazzi Agro'; Micali, Salvatore; M., Maccarrone; M., Biterlli; M., Valitutti; G., Vespasiani
abstract

Is there a correlation between bladder pressure and urinary N-Acetil-Beta-D-Glucosaminidase (NAG) concentration in patients with spinal cord injury (SCI)?

1999 - Laparoscopic genitourinary surgery utilizing 20 mm Hg intra-abdominal pressure [Articolo su rivista]
Adams, J. B.; Moore, R. G.; Micali, S.; Marco, A. P.; Kavoussi, L. R.
abstract

Traditional practice has dictated that intra-abdominal pressure during laparoscopy be kept at or below 15 mm Hg to minimize the risk of cardiovascular and pulmonary complications. This study was undertaken to determine if maintaining an intra-abdominal pressure of 20 mm Hg could be utilized safely during genitourinary laparoscopy. We reviewed the intraoperative records of 76 consecutive patients undergoing various endoscopic urologic procedures at an intra-abdominal pressure of 20 mm Hg to assess physiologic changes and complications. The records were examined for operating time, minute ventilation (MV), end-tidal CO2 (ETCO2), and peak inspiratory pressure (PIP), which were compared with the preinsufflation values. Also, in the first 39 patients, initial insufflation volumes were recorded at 15 mm Hg and then again when pressure was raised to 20 mm Hg. The mean operating time was 186 ± 90 min. There was an average 22% increase in the sufflated volume when the pressure was elevated from 15 to 20 mm Hg. To maintain a suitable ETCO2, the anesthesiologist needed to increase the MV an average of 2.9 ± 2.0 L/min. Increases in ETCO2 (average 4.5 ± 4.6 mm Hg) and PIP (6.9 ± 3.6 mm Hg) were noted. In two cases, the intra-abdominal pressure had to be decreased from 20 to 15 mm Hg because of inability to maintain an acceptable ETCO2. Subcutaneous emphysema was noted in three patients, which resolved spontaneously within 24 hr. In one patient, asymptomatic pneumomediastinum was noted after a 6-hr procedure. Intra- abdominal insufflation can be safely maintained at 20 mm Hg in most patients. This higher pressure improves maintenance of the pneumoperitoneum.

1999 - Laparoscopic genitourinary surgery utilizing 20mmHg intra-addominal pressure. [Articolo su rivista]
J. B., Adams; R. G., Moore; Micali, Salvatore; A. P., Marco; L. R., Kavoussi
abstract

Traditional practice has dictated that intra-abdominal pressure during laparoscopy be kept at or below 15 mm Hg to minimize the risk of cardiovascular and pulmonary complications. This study was undertaken to determine if maintaining an intra-abdominal pressure of 20 mm Hg could be utilized safely during genitourinary laparoscopy. We reviewed the intraoperative records of 76 consecutive patients undergoing various endoscopic urologic procedures at an intra-abdominal pressure of 20 mm Hg to assess physiologic changes and complications. The records were examined for operating time, minute ventilation (MV), end-tidal CO2 (ETCO2), and peak inspiratory pressure (PIP), which were compared with the preinsufflation values. Also, in the first 39 patients, initial insufflation volumes were recorded at 15 mm Hg and then again when pressure was raised to 20 mm Hg. The mean operating time was 186 +/- 90 min. There was an average 22% increase in the sufflated volume when the pressure was elevated from 15 to 20 mm Hg. To maintain a suitable ETCO2, the anesthesiologist needed to increase the MV an average of 2.9 +/- 2.0 L/min. Increases in ETCO2 (average 4.5 +/- 4.6 mm Hg) and PIP (6.9 +/- 3.6 mm Hg) were noted. In two cases, the intra-abdominal pressure had to be decreased from 20 to 15 mm Hg because of inability to maintain an acceptable ETCO2. Subcutaneous emphysema was noted in three patients, which resolved spontaneously within 24 hr. In one patient, asymptomatic pneumomediastinum was noted after a 6-hr procedure. Intra-abdominal insufflation can be safely maintained at 20 mm Hg in most patients. This higher pressure improves maintenance of the pneumoperitoneum.

1999 - Measurement of urinary N-Acetyl-Beta-D-glucosaminidase to assess renal ischemia during laparoscopic operation [Articolo su rivista]
Micali, Salvatore; R. I., Silver; H. S., Kaufman; V. D., Douglas; G. M., Marley; A. W., Partin; R. G., Moore; L. R., Kavoussi; S. G., Docimo
abstract

BACKGROUND: Oliguria during laparoscopy is a well-documented phenomenon of unknown etiology. Experimental evidence suggests that renal perfusion is reduced during pneumoperitoneum. N-acetyl-beta-D-glucosaminidase (NAG), which is present in renal tubular cells, is released into the urine in response to tubular insults. In this study, urinary NAG was measured before and after procedures to assess for ischemic renal injury. METHODS: A total of 31 patients underwent laparoscopic procedures while 28 patients had conventional surgery. Urine was obtained first at the time of preoperative Foley catheter placement and later during the recovery room stay. NAG levels were measured and indexed to urinary creatinine. RESULTS: Operative time for the laparoscopy group was 105 min (range, 15-255); for the conventional group, it was 179 min (range, 75-385) (P < 0.05). No differences were noted between pre- and postoperative NAG levels or between the groups. There was no correlation between urinary NAG levels and operative time. CONCLUSION: Pneumoperitoneum is not associated with a change in the urinary concentration of NAG. This finding suggests that there is no significant renal tubular injury associated with laparoscopic surgery

1999 - Pediatric retroperitoneoscopic renal biopsy: Experience in 25 cases. [Poster]
Micali, Salvatore; P., Caione; A., Lais; N., Capozza; G., Maturo; R., Miano; F., Micali
abstract

Pediatric retroperitoneoscopic renal biopsy: Experience in 25 cases

1999 - Retroperitoneoscopic in child: The Visiport technique. [Abstract in Rivista]
P., Caione; Micali, Salvatore; R. G., Moore; G., Maturo; E., Matarazzo; N., Capozza; F., Micali
abstract

Retroperitoneoscopic in child: The Visiport technique.

1998 - Clinical significance of fever after percutaneous nephrolithotomy [Articolo su rivista]
J. A., Cadeddu; R. N., Chen; J. T., Bishoff; Micali, Salvatore; A., Kumar; R. G., Moore; L. R., Kavoussi
abstract

OBJECTIVES: In the immediate postoperative period after percutaneous stone removal, body temperature elevations are common. Pyrexia after a percutaneous nephrolithotomy (PCNL) generates concern because of the possibility of urinary extravasation and bacteremia. We reviewed our experience with PCNL to determine the clinical significance of a postoperative fever before discharge from the hospital. METHODS: Between July 1994 and December 1996, 63 patients underwent 69 PCNLs. Each had documented negative urine cultures preoperatively and received prophylactic antibiotics at the time of surgery. For each case, clinical and operative charts were reviewed to determine stone composition, fever during hospital stay, postoperative bacteriologic cultures, postoperative white blood cell count (WBC), and clinical course. RESULTS: Complete data were available for 66 procedures. Eight patients (12%) had at least one body temperature reading between 38.0 and 38.5 degrees C. Eleven patients (16.7%) had at least one temperature greater than 38.5 degrees C. Each patient with a temperature greater than 38.5 degrees C was hemodynamically stable with negative blood and urine cultures. No patient with a fever between 38.0 and 38.5 degrees C was cultured. Stone analysis did not demonstrate any association between postoperative fever and stone composition (including 22 struvite stones). Postoperative WBC also did not predict pyrexia. Fever alone did not prolong hospital stay. CONCLUSIONS: In patients with negative urine cultures who are prophylaxed with immediate preoperative antibiotics and maintained on postoperative antibiotics, pyrexia after PCNL does not require an immediate bacteriologic evaluation in those who are hemodynamically stable.

1998 - Factors involved in gas embolism after laparoscopic injury to inferior vena cava [Articolo su rivista]
D. C., O' Sullivan; Micali, Salvatore; T. D., Averch; S., Buffer; T., Reyerson; P., Schulam; L. R., Kavoussi
abstract

This study evaluated the incidence and factors involved in the occurrence of gas embolism after laparoscopic injuries. A 5-MHz transesophageal echocardiographic (TEE) probe was placed in 11 anesthetized pigs and used to examine the right cardiac chambers and pulmonary artery. A calibrated carbon dioxide analyzer continuously measured end-tidal carbon dioxide (ETCO2). The ventilatory settings were adjusted to achieve a baseline ETCO2 between 25 and 28 mm Hg. A blinded dose-response curve for TEE and ETCO2 measurements were created by injecting 0.0007 to 1.5 mL/kg of CO2 gas intravenously. Venotomies (N = 22) were created laparoscopically in the inferior vena cava (IVC) of the study animals. All TEE images were videotaped and correlated with laparoscopic events. Embolic episodes were classified by comparison with images recorded during the bolus studies. A variety of methods for obtaining hemostasis and repairing the venotomies were evaluated and their effects on gas embolism were studied. No emboli were noted when the venotomies were bleeding freely, the hole was directly occluded, or the proximal IVC was compressed. Marked embolism was seen with distal IVC occlusion or when there had been significant blood loss. In this situation, manipulation of the hole and higher intraperitoneal pressures led to higher degrees of embolization. No emboli were seen in an open control group except after significant bleeding. The TEE is the most sensitive method of detecting gas emboli; however, the majority of episodes are not clinically significant. Embolism of CO2 occurs when central venous pressure is decreased by blood loss or distal compression. When significant venous bleeding occurs, intravascular volume should be maintained and the bleeding site should be directly occluded.

1998 - Il test NMP22 nella diagnostica del carcinoma trasizionale della vescica. 12 mesi di esperienza [Poster]
P., De Carli; R., Miano; F., Valente; R., Cantiani; Micali, Salvatore; G. M., Gandolfo
abstract

Il test NMP22 nella diagnostica del carcinoma trasizionale della vescica. 12 mesi di esperienza

1998 - Laparoscopic renal biopsy [Articolo su rivista]
L. F., Gimenez; Micali, Salvatore; R. N., Chen; R. G., Moore; L. R., Kavoussi
abstract

BACKGROUND: Renal biopsy continues to be a pivotal tool and frequently indispensable diagnostic procedure in the clinical assessment of proteinuria and or unexplained renal disease. Laparoscopic renal biopsy has recently been reported as an alternative to open renal biopsy. METHODS: Thirty-two patients who had proteinuria and/or renal insufficiency underwent laparoscopic renal biopsy at our center. The indications for biopsy included failed percutaneous biopsy (N = 3), morbid obesity (14), solitary kidney (5), chronic anticoagulation/coagulopathy (6), religious consideration (refusal of potential blood transfusion) (2), multiple bilateral renal cysts and body habitus (1 case each). The kidney was approached via a laparoscopic retroperitoneal route (retroperitoneoscopy) using a two port technique. The lower pole of the kidney was localized using blunt dissection, laparoscopic cup biopsies were performed, and hemostasis was achieved using standard techniques. RESULTS: All biopsies were successfully completed laparoscopically with sufficient tissue obtained for histopathological diagnosis in all cases. Mean estimated blood loss was 25.9 ml (range 5 to 100). None of the patients required parenteral narcotics during the perioperative period. Operative time ranged from 0.8 to 3.0 hours (mean 1.5). Mean hospital stay was 1.7 days (range 0 to 7). Sixteen patients were treated as outpatients. Patients returned to normal activity at a mean of 1.7 weeks (range 0.3 to 3.0) postoperatively. In one patient, the spleen was inadvertently biopsied without consequence. An additional patient developed a postoperative 300 cc perinephric hematoma that resolved without the need for intervention. One postoperative mortality occurred on postoperative day seven secondary to a perforated peptic ulcer in a patient undergoing high-dose steroid therapy for lupus nephritis. CONCLUSION: Laparoscopic renal biopsy is a safe, reliable, minimally invasive alternative to open renal biopsy for patients in whom a closed percutaneous approach is either a relative or absolute contraindication, which can be performed on an outpatient basis.

1998 - Laparoscopic renal biopsy in children: Preliminary experience [Poster]
Micali, Salvatore; P., Caione; A., Lais; G., Vespasiani; E., Matarazzo; F., Micali
abstract

Laparoscopic renal biopsy in children: Preliminary experience

1998 - L’accesso laparoscopico al retroperitoneo in pazienti pediatrici: esperienza preliminare [Poster]
P., Caione; Micali, Salvatore; A., Lais; N., Capozza; M., Bitelli; E., Matarazzo; F., Micali
abstract

L’accesso laparoscopico al retroperitoneo in pazienti pediatrici: esperienza preliminare

1998 - One-day laparoscopic surgery [Articolo su rivista]
Micali, Salvatore; M., Bitelli; F., Torelli; M., Valitutti; F., Micali
abstract

Since ten years laparoscopic techniques have been employed as alternatives of many established open procedures in gynecologic, abdominal and finally urologic surgery. Laparoscopic techniques show significant advantages compared to open surgery, such as less hospitalization, reduced need of analgesic drugs, quick return to daily activities and far a better cosmetic results. Laparoscopic surgery has been advocated for urologic, uro-gynecologic and andrologic diseases. Since 1983 one-day surgery was proposed for only a few gynecologic and abdominal procedures and only recently for laparoscopic renal biopsy and abdominal testis evaluation. In these preliminary experiences the conditions for a correct management of laparoscopic one-day surgery have been clearly pointed out: 1. correct surgical indication; 2. through knowledge of surgical technique; 3. duration of the procedure less than 90 minutes; 4. correct anesthesia. Technique of anesthesia must be adapted to the surgical procedure required, its duration and the physical features of the patient. General anesthesia is usually preferred for either longer and more complex procedures or when a higher abdominal insufflation pressure is needed. Spinal or local anesthesia are preferred for simpler procedures or when only one trocar is required. At date only few urologic procedures seem to be suitable to one-day laparoscopic surgery. 1) Varicocele: although laparoscopic varicocelectomy in one-day surgery has never been reported previously, it can be performed in a short time, only 3 trocars are needed and insufflation pressure can be maintained within 15 mm Hg. 2) Renal biopsy and marsupialization of renal cysts. These are usually managed percutaneously but in some particular indications procedures under direct vision should be preferable. Both are short-lasting and only superficial general anesthesia is required; as surgical access is retroperitoneal only two trocars are sufficient; at date only renal biopsies have previously been reported. 3) Diagnostic procedures on abdominal testis. The procedure is brief only superficial general anesthesia is needed and only one trocar is required. Conclusions. One-day laparoscopic surgery will require in the future a more and more strict cooperation between urologists and anesthetists in order to tailor the correct anesthesiological and laparoscopic technique to the procedure required and the features of the patient.

1998 - Rischio di embolia da CO2 durante interventi laparoscopici e riparazione endoscopica di danni vascolari [Poster]
Micali, Salvatore
abstract

Rischio di embolia da CO2 durante interventi laparoscopici e riparazione endoscopica di danni vascolari

1998 - Robotic telemanipulation for percutaneous renal access [Poster]
D., Stoianovici; B. R., Lee; J. T., Bishoff; Micali, Salvatore; L. L., Whitcomb; R. H., Taylor; L. R., Kavoussi
abstract

Robotic telemanipulation for percutaneous renal access

1998 - Thechnique for laparoscopic renal cryosurgery in selected patients [Abstract in Rivista]
D. Y., Chen; J. T., Bishoff; S. V., Jackman; R. B., Chen; Micali, Salvatore; F. F., Marshall; L. R., Kavoussi
abstract

Thechnique for laparoscopic renal cryosurgery in selected patients

1998 - Ureteral stricture formation after removal of impacted calculi [Articolo su rivista]
Roberts, W. W.; Cadeddu, J. A.; Micali, S.; Kavoussi, L. R.; Moore, R. G.
abstract

Purpose: We retrospectively evaluated the records of 21 patients a mean of 46.1 years old with ureteral stones that had been impacted for greater than 2 months to determine predisposing factors for stricture formation. Materials and Methods: Between January 1993 and September 1996, 21 patients were referred for ureteral stones that had remained unchanged in location for at least 2 months. In 11 patients previous attempts at stone removal had failed. Each patient underwent successful stone extraction by retrograde or percutaneous antegrade ureteroscopy, or laparoscopic or open ureterolithotomy. Outcome was determined by reviewing the clinical records and radiographic studies, including excretory urography and nephrostography. Results: Average duration of stone impaction before definitive treatment was 8.8 months (range 2 to 48) and mean stone size was 10.3 mm. (range 1 to 30). All stones were calcium based. There were 3 proximal, 8 mid and 10 distal ureteral calculi. At a mean followup of 7 months ureteral strictures developed in 5 patients (24%) at the previous stone site. Mean duration of stone impaction was 11 months (range 5 to 17) in patients with stricture versus 8.2 months (range 2 to 48) in those with no stricture. Four of the 5 strictures occurred in patients who had had iatrogenic ureteral perforation during previous unsuccessful attempts at stone removal. Conclusions: Ureteral stone impaction more than 2 months in duration is associated with a 24% incidence of stricture formation. Ureteral perforation at the site of the stone was identified as the primary risk factor for stricture formation in these cases.

1998 - Ureteral stricture formation following removal of impacted calculi [Articolo su rivista]
W. W., Roberts; J. A., Cadeddu; Micali, Salvatore; L. R., Kavoussi; R. G., Moore
abstract

PURPOSE: We retrospectively evaluated the records of 21 patients a mean of 46.1 years old with ureteral stones that had been impacted for greater than 2 months to determine predisposing factors for stricture formation. MATERIALS AND METHODS: Between January 1993 and September 1996, 21 patients were referred for ureteral stones that had remained unchanged in location for at least 2 months. In 11 patients previous attempts at stone removal had failed. Each patient underwent successful stone extraction by retrograde or percutaneous antegrade ureteroscopy, or laparoscopic or open ureterolithotomy. Outcome was determined by reviewing the clinical records and radiographic studies, including excretory urography and nephrostography. RESULTS: Average duration of stone impaction before definitive treatment was 8.8 months (range 2 to 48) and mean stone size was 10.3 mm. (range 1 to 30). All stones were calcium based. There were 3 proximal, 8 mid and 10 distal ureteral calculi. At a mean followup of 7 months ureteral strictures developed in 5 patients (24%) at the previous stone site. Mean duration of stone impaction was 11 months (range 5 to 17) in patients with stricture versus 8.2 months (range 2 to 48) in those with no stricture. Four of the 5 strictures occurred in patients who had had iatrogenic ureteral perforation during previous unsuccessful attempts at stone removal. CONCLUSIONS: Ureteral stone impaction more than 2 months in duration is associated with a 24% incidence of stricture formation. Ureteral perforation at the site of the stone was identified as the primary risk factor for stricture formation in these cases.

1998 - Utility of the harmonic scalpel for laparoscopic partial nephrectomy [Articolo su rivista]
S. V., Jackman; J. A., Cadeddu; R. N., Chen; Micali, Salvatore; J. T., Bishoff; B. R., Lee; R. G., Moore; L. R., Kavoussi
abstract

Laparoscopic partial nephrectomy (LPN) remains a technically challenging procedure largely because of the lack of methods for obtaining consistent parenchymal hemostasis. The objective of this study was to determine if the extent of resection influences the ability of the harmonic scalpel to achieve hemostasis and to define the cases in which the harmonic scalpel is appropriate for LPN. Thirty LPNs were performed in a 25-kg domestic pig model. The blunt blade of the laparoscopic harmonic scalpel (LaparoSonic Coagulating Shears; Ethicon Endo-Surgery, Cincinnati, OH) at power level 5 was used to divide the parenchyma. Control of the renal hilar vessels was not obtained. Three standardized types of resections were performed: I = peripheral wedge biopsy; II = upper- or lower-pole nephrectomy; and III = heminephrectomy. Bleeding was graded on a scale from 0 to 4: 0 = no hemostasis; 1 = steady bleeding; 2 = moderate bleeding; 3 = parenchymal oozing; and 4 = dry. Hemostasis grades of 2 or less were clinically significant bleeding necessitating supplemental coagulation. The mean hemostasis scores showed a significant (P < 0.02) trend toward inadequate hemostasis with increasing extent of resection: 3.3 for Type I, 3.0 for Type II, and 2.4 for Type III. The percent of kidneys with grade 2 bleeding or worse was 9% for Type I surgery, 25% for Type II, and 57% for Type III. Successful hemostasis with the harmonic scalpel correlates with the extent of parenchymal resection in the porcine model. Most wedge excisions can be done with the harmonic scalpel alone, whereas larger resections necessitate supplemental coagulation. On the basis of this study, heminephrectomies with the harmonic scalpel are not recommended because of the high incidence of significant hemorrhage.

1997 - Benign Schwannoma surrounding and obstructing the ureteropelvic junction: First case report [Articolo su rivista]
Micali, Salvatore; G., Virgili; G., Vespasiani; A., Silecchia; P., D’Alessandro; F., Micali
abstract

With a varied presentation and a difficult preoperative diagnosis, schwannoma accounts for only a small percentage of retroperitoneal tumors. Moreover, malignant schwannoma of the adrenal gland, kidney and renal pelvis has previously been described. We report the first case of benign schwannoma causing obstruction by external compression of the ureteropelvic junction. A case report of a male patient who complained of a 3-month history of dull lumbar pain on the right side is reported. Using intravenous pyelogram, sonography and computed tomography a benign tumor of the retroperitoneum was suspected. Upon exploration, the suspected diagnosis of the tumor's retroperitoneal origin was confirmed. After the histological and immunohistochemical studies the diagnosis was verified. The diagnosis, treatment and histological features of benign schwannoma are discussed. A brief review of the literature is also included.

1997 - Clinical significance of fever after percutaneous nephrolithotomy [Poster]
J. A., Cadeddu; A., Cumar; R. N., Chen; Micali, Salvatore; J. T., Bishoff; R. G., Moore; L. R., Kavoussi
abstract

OBJECTIVES: In the immediate postoperative period after percutaneous stone removal, body temperature elevations are common. Pyrexia after a percutaneous nephrolithotomy (PCNL) generates concern because of the possibility of urinary extravasation and bacteremia. We reviewed our experience with PCNL to determine the clinical significance of a postoperative fever before discharge from the hospital. METHODS: Between July 1994 and December 1996, 63 patients underwent 69 PCNLs. Each had documented negative urine cultures preoperatively and received prophylactic antibiotics at the time of surgery. For each case, clinical and operative charts were reviewed to determine stone composition, fever during hospital stay, postoperative bacteriologic cultures, postoperative white blood cell count (WBC), and clinical course. RESULTS: Complete data were available for 66 procedures. Eight patients (12%) had at least one body temperature reading between 38.0 and 38.5 degrees C. Eleven patients (16.7%) had at least one temperature greater than 38.5 degrees C. Each patient with a temperature greater than 38.5 degrees C was hemodynamically stable with negative blood and urine cultures. No patient with a fever between 38.0 and 38.5 degrees C was cultured. Stone analysis did not demonstrate any association between postoperative fever and stone composition (including 22 struvite stones). Postoperative WBC also did not predict pyrexia. Fever alone did not prolong hospital stay. CONCLUSIONS: In patients with negative urine cultures who are prophylaxed with immediate preoperative antibiotics and maintained on postoperative antibiotics, pyrexia after PCNL does not require an immediate bacteriologic evaluation in those who are hemodynamically stable.

1997 - Do impacted stones increase the risk of ureteral stricture formation? [Poster]
W. W., Roberts; R. G., Moore; J. A., Cadeddu; Micali, Salvatore; L. R., Kavoussi
abstract

Do impacted stones increase the risk of ureteral stricture formation?

1997 - Factors in gas embolism following laparoscopic injury to vena cava [Poster]
D., O’Sullivan; Micali, Salvatore; T., Averch; S., Buffer; P., Schulam; L. R., Kavoussi
abstract

This study evaluated the incidence and factors involved in the occurrence of gas embolism after laparoscopic injuries. A 5-MHz transesophageal echocardiographic (TEE) probe was placed in 11 anesthetized pigs and used to examine the right cardiac chambers and pulmonary artery. A calibrated carbon dioxide analyzer continuously measured end-tidal carbon dioxide (ETCO2). The ventilatory settings were adjusted to achieve a baseline ETCO2 between 25 and 28 mm Hg. A blinded dose-response curve for TEE and ETCO2 measurements were created by injecting 0.0007 to 1.5 mL/kg of CO2 gas intravenously. Venotomies (N = 22) were created laparoscopically in the inferior vena cava (IVC) of the study animals. All TEE images were videotaped and correlated with laparoscopic events. Embolic episodes were classified by comparison with images recorded during the bolus studies. A variety of methods for obtaining hemostasis and repairing the venotomies were evaluated and their effects on gas embolism were studied. No emboli were noted when the venotomies were bleeding freely, the hole was directly occluded, or the proximal IVC was compressed. Marked embolism was seen with distal IVC occlusion or when there had been significant blood loss. In this situation, manipulation of the hole and higher intraperitoneal pressures led to higher degrees of embolization. No emboli were seen in an open control group except after significant bleeding. The TEE is the most sensitive method of detecting gas emboli; however, the majority of episodes are not clinically significant. Embolism of CO2 occurs when central venous pressure is decreased by blood loss or distal compression. When significant venous bleeding occurs, intravascular volume should be maintained and the bleeding site should be directly occluded.

1997 - Is laparoscopic oliguria anischemic phenomenon? Mesurement of urinary N-Acetyl-ß-D-Glucosaminidase levels [Poster]
Micali, Salvatore; R. I., Silver; H. S., Kaufman; V. D., Douglas; G. M., Marley; A. W., Partin; R. G., Moore; L. R., Kavoussi; S. G., Docimo
abstract

Is laparoscopic oliguria anischemic phenomenon? Mesurement of urinary N-Acetyl-ß-D-Glucosaminidase levels

1997 - La biopsia renale in laparoscopia [Poster]
R. N., Chen; Micali, Salvatore; R. G., Moore; L. R., Kavoussi
abstract

La biopsia renale in laparoscopia

1997 - Laparoscopic infrared imaging [Abstract in Rivista]
W. W., Roberts; Micali, Salvatore; P. G., Schulam; T. D., Averch; L., Bonnell; L. R., Kavoussi
abstract

Laparoscopic infrared imaging

1997 - Laparoscopic renal biopsy [Abstract in Rivista]
R. N., Chen; R. G., Moore; Micali, Salvatore; J., Bishoff; B. R., Lee; S. V., Jackman; L. R., Kavoussi:
abstract

BACKGROUND: Renal biopsy continues to be a pivotal tool and frequently indispensable diagnostic procedure in the clinical assessment of proteinuria and or unexplained renal disease. Laparoscopic renal biopsy has recently been reported as an alternative to open renal biopsy. METHODS: Thirty-two patients who had proteinuria and/or renal insufficiency underwent laparoscopic renal biopsy at our center. The indications for biopsy included failed percutaneous biopsy (N = 3), morbid obesity (14), solitary kidney (5), chronic anticoagulation/coagulopathy (6), religious consideration (refusal of potential blood transfusion) (2), multiple bilateral renal cysts and body habitus (1 case each). The kidney was approached via a laparoscopic retroperitoneal route (retroperitoneoscopy) using a two port technique. The lower pole of the kidney was localized using blunt dissection, laparoscopic cup biopsies were performed, and hemostasis was achieved using standard techniques. RESULTS: All biopsies were successfully completed laparoscopically with sufficient tissue obtained for histopathological diagnosis in all cases. Mean estimated blood loss was 25.9 ml (range 5 to 100). None of the patients required parenteral narcotics during the perioperative period. Operative time ranged from 0.8 to 3.0 hours (mean 1.5). Mean hospital stay was 1.7 days (range 0 to 7). Sixteen patients were treated as outpatients. Patients returned to normal activity at a mean of 1.7 weeks (range 0.3 to 3.0) postoperatively. In one patient, the spleen was inadvertently biopsied without consequence. An additional patient developed a postoperative 300 cc perinephric hematoma that resolved without the need for intervention. One postoperative mortality occurred on postoperative day seven secondary to a perforated peptic ulcer in a patient undergoing high-dose steroid therapy for lupus nephritis. CONCLUSION: Laparoscopic renal biopsy is a safe, reliable, minimally invasive alternative to open renal biopsy for patients in whom a closed percutaneous approach is either a relative or absolute contraindication, which can be performed on an outpatient basis.

1997 - Laparoscopic repair of intra-operative venous injuries [Abstract in Rivista]
D., O’Sullivan; Micali, Salvatore; S., Buffer; T., Averch; P., Schulam; L. R., Kavoussi
abstract

Laparoscopic repair of intra-operative venous injuries

1997 - L’oliguria in corso di laparoscopia: assenza di danno tubulare renale dopo valutazione con N-acetil- ß-D-glucosaminidasi [Poster]
Micali, Salvatore; R. I., Silver; H. S., Kaufman; V. D., Douglas; G. M., Marley; A. W., Partin; R. G., Moore; L. R., Kavoussi; S. G., Docimo
abstract

L’oliguria in corso di laparoscopia: assenza di danno tubulare renale dopo valutazione con N-acetil- ß-D-glucosaminidasi

1997 - L’utilizzo degli stents a doppio-J come alternativa agli stents esterni nelle neovesciche ileali ortotopiche [Abstract in Rivista]
P., De Carli; Micali, Salvatore; L., Lamanna; V., Pompeo; G, Vespasiani; A., Cancrini
abstract

L’utilizzo degli stents a doppio-J come alternativa agli stents esterni nelle neovesciche ileali ortotopiche

1997 - Retroperitoneoscopic renal biopsy in extremely obese patients [Articolo su rivista]
R. N., Chen; R. G., Moore; Micali, Salvatore; L. R., Kavoussi
abstract

OBJECTIVES: Retroperitoneoscopic renal biopsy can be technically challenging in extremely obese patients because of loss of surgical landmarks and difficulty in identifying the kidney within retroperitoneal adipose tissue. We present our experience with retroperitoneoscopic renal biopsy in extremely obese patients and describe our surgical technique. METHODS: We performed retroperitoneoscopic renal biopsies on 8 extremely obese patients (body mass index greater than 40). Mean patient weight was 144.3 kg. Three patients presented with acute renal failure and 5 presented with nephrotic range proteinuria. Retroperitoneoscopic renal biopsy was indicated based on extreme obesity alone in 3 patients, 2 patients had failed previous attempts at percutaneous biopsy, 1 patient had a solitary kidney, 1 patient required chronic anticoagulation, and 1 patient was a Jehovah's Witness. Intraoperative ultrasonography and an anatomic approach facilitated the dissection and identification of the kidney. RESULTS: All eight retroperitoneoscopic renal biopsies were completed successfully without complication and all patients were discharged within 24 hours of the procedure. Sufficient tissue for pathologic diagnosis was obtained in all cases. Mean operating room time was 153 minutes and mean estimated blood loss was 71 mL. The patients returned to normal activity at a mean of 1.8 weeks. CONCLUSIONS: With the use of intraoperative ultrasonography and a systematic, anatomic approach, retroperitoneoscopic renal biopsy can be successfully completed in extremely obese patients. This procedure can be reliably performed on an outpatient basis with minimal morbidity and should be considered a viable alternative to open renal biopsy.

1997 - Retroperitoneoscopic renal biopsy in morbidly obese patients [Poster]
R. N., Chen; Micali, Salvatore; R. G., Moore; J. T., Bishoff; S. V., Jackman; B., Lee; L. R., Kavoussi
abstract

Retroperitoneoscopic renal biopsy in morbidly obese patients

1997 - Risk of carbon dioxide embolism from laparoscopic venous injuries [Poster]
D., O’Sullivan; Micali, Salvatore; T. D., Averch; S., Buffer; P. G., Schulam; R. G., Moore; L. R., Kavoussi
abstract

Risk of carbon dioxide embolism from laparoscopic venous injuries

1997 - The role of laparoscopy in the treatment of renal and ureteral calculi [Articolo su rivista]
Micali, Salvatore; R. G., Moore; T. D., Averch; J. B., Adams; L. R., Kavoussi
abstract

PURPOSE: We assessed the efficacy of laparoscopy in the treatment of renal and ureteral stones. MATERIALS AND METHODS: Laparoscopic stone extraction was attempted in 11 men and 6 women 22 to 75 years old, including 6 with ureteral and 11 with renal calculi. Of the renal stones 9 were associated with a concomitant pathological condition requiring surgery. Four patients had multiple stones (2 to 93) and stone size ranged from 2 to 60 mm. (mean 15.6). RESULTS: Stones from 15 of 17 patients were removed successfully via laparoscopic techniques. Operative time ranged from 2.33 to 6.35 hours (mean 4.9). Prolonged operating times were associated with ancillary or failed procedures. Blood loss ranged from 20 to 350 ml. (mean 132.9), narcotic requirement from 0 to 100 mg. morphine (mean 26) and hospital stay from 1 to 15 days (mean 4.5). The 3 postoperative complications included prolonged ileus (2) and a retroperitoneal urinoma requiring secondary drainage. CONCLUSIONS: Laparoscopic stone removal is safe and feasible. Indications for this approach include urinary stones associated with an anatomical abnormality requiring urinary tract reconstruction and calculi for which other minimally invasive therapies failed.

1997 - Ureteral anastomosis in the orthotopic ileal neobladder: Comparison of 2 techniques [Articolo su rivista]
P., De Carli; Micali, Salvatore; D., O’Sullivan; G., Mainiero; G., Cusumano; H., Fattahi; A., Cancrini
abstract

PURPOSE: The functional results and complications of 2 different ureteroileal anastomoses were evaluated in patients with bladder cancer undergoing radical cystectomy and orthotopic ileal bladder substitution. MATERIALS AND METHODS: Between 1989 and 1995, 102 patients underwent creation of a low pressure neobladder. In the first 50 cases the ureteroileal anastomosis was created with a split-cuff nipple technique as an additional antireflux mechanism. In the next 52 cases the ureteroileal anastomoses were constructed via the direct end-to-side technique counting on the antireflux protection of the afferent tubular limb. RESULTS: Stenosis occurred in 7 of the 100 ureters (6 patients) treated with the split-cuff nipple technique and 7 of 104 treated with a direct end-to-side anastomosis. This complication occurred more commonly in the left ureter (11 of 14 patients). Reflux was noted at cystography in 10 cases with the split-cuff nipple method and 12 with end-to-side anastomoses, and was symptomatic in only 3 patients. Four ureteral strictures were treated successfully with primary open repair. Percutaneous dilation and stenting were performed for 8 ureteral strictures: 2 cases were successful, 3 failed and 3 are unresolved. CONCLUSIONS: We observed no differences between the antireflux split-cuff and end-to-side anastomoses with regard to stricture formation or ureteral reflux. Therefore, we do not believe that there is a need to create antireflux ureteral anastomoses due to the tubular afferent ileal segment and given that the reflux is asymptomatic in most patients. Strictures may be treated with percutaneous balloon dilation and stenting but open repair appeared to be more effective

1997 - Utiliy of armonic scalpel for laparoscopic partial nephrectomy: correlation with the extent of resection [Abstract in Rivista]
J. A., Cadeddu; R. N., Chen; Micali, Salvatore; J. T., Bishoff; B., Lee; S., Jackman; R. G., Moore; L. R., Kavoussi
abstract

Utiliy of armonic scalpel for laparoscopic partial nephrectomy: correlation with the extent of resection

1997 - Utilizzo dei raggi infrarossi (IR) in laparoscopia [Abstract in Rivista]
Micali, Salvatore; L., Bonnell; P. G., Schulam; T. D., Averch; R. G., Moore; L. R., Kavoussi
abstract

Utilizzo dei raggi infrarossi (IR) in laparoscopia

1996 - Complications of extraperitoneal balloon dilation [Articolo su rivista]
J. B., Adams; Micali, Salvatore; R. G., Moore; R. K., Babayan; L. R., Kavoussi
abstract

The success of balloon dissection techniques has given laparoscopic surgeons the option of a direct extraperitoneal approach to urologic disease. Unfortunately, these techniques are not without risks. We report on four cases of complications secondary to balloon dilation. In two instances, balloon misplacement caused dissection between muscle layers. This resulted in conversion to an open procedure in one instance and to a postoperative flank hernia in another. Balloon rupture with loose fragments occurred in two patients. In one of these cases, the peritoneum was lacerated, with balloon fragments displaced within the peritoneal cavity.

1996 - Endoscopic ballistic lithottripsy in the treatment of bladder calculi in patients with neurogenic voiding dysfunction [Articolo su rivista]
G., Vespasiani; F., Pesce; E., Finazzi Agrò; G., Virgili; A., Giannantoni; Micali, Salvatore; F., Micali
abstract

Bladder stones represent a troublesome complication in patients suffering from neurogenic voiding dysfunction, in whom prompt and effective therapy is required. A variety of endoscopic lithotripsy methods are available; however, current devices can be tedious to use. We have treated 17 patients affected by bladder calculi and spinal cord injury or multiple sclerosis by means of the ballistic lithotripter EMS Swiss Lithoclast. The mean diameter of the stones was 2.7 cm. The mean operative time was 27 minutes. There were five intraoperative complications, including crises of autonomic dysreflexia (three patients) and light hematuria (two patients). There was no malfunction of the lithotripter and no long-term complications. All the patients were stone free at 6 months postoperatively. In conclusion, endoscopic lithotripsy with the ballistic lithotripter proved to be a very effective, rapid, and safe method for treating bladder calculi in patients with neurogenic bladders

1996 - Laparoscopic repair of enterocele [Articolo su rivista]
J. A., Cadeddu; Micali, Salvatore; R. G., Moore; L. R., Kavoussi
abstract

The repair of an enterocele has classically been via a transvaginal or open abdominal route. With the availability of minimally invasive procedures, we applied established laparoscopic techniques to enterocele repair. Three women with a history of hysterectomy had a symptomatic enterocele as well as a cystocele or rectocele. Each underwent a transperitoneal laparoscopic enterocele repair prior to a transvaginal rectocele or cystocele repair or laparoscopic colposuspension. Using three trocars and transvaginal digital manipulation, the enterocele was reduced and repaired utilizing a modified Moschocowitz technique. The cul-de-sac was obliterated by approximating the posterior vaginal fascia to the anterior wall of the rectum with a running suture. There was no operative morbidity. The average length of stay was 3.3 days. All patients were asymptomatic with no enterocele recurrence identified during a mean follow-up of 10.5 (range 7-15) months. Laparoscopic enterocele repair is a feasible surgical procedure with minimal morbidity. A larger series with longer follow-up is necessary before the efficacy and proper indications for this minimally invasive procedure are determined

1996 - The role of laparoscopy in the treatment of kidney and ureteral calculi [Abstract in Rivista]
Micali, Salvatore; R. G., Moore; T. D., Averch; J. B., Adams; L. R., Kavoussi
abstract

Abstract PURPOSE: We assessed the efficacy of laparoscopy in the treatment of renal and ureteral stones. MATERIALS AND METHODS: Laparoscopic stone extraction was attempted in 11 men and 6 women 22 to 75 years old, including 6 with ureteral and 11 with renal calculi. Of the renal stones 9 were associated with a concomitant pathological condition requiring surgery. Four patients had multiple stones (2 to 93) and stone size ranged from 2 to 60 mm. (mean 15.6). RESULTS: Stones from 15 of 17 patients were removed successfully via laparoscopic techniques. Operative time ranged from 2.33 to 6.35 hours (mean 4.9). Prolonged operating times were associated with ancillary or failed procedures. Blood loss ranged from 20 to 350 ml. (mean 132.9), narcotic requirement from 0 to 100 mg. morphine (mean 26) and hospital stay from 1 to 15 days (mean 4.5). The 3 postoperative complications included prolonged ileus (2) and a retroperitoneal urinoma requiring secondary drainage. CONCLUSIONS: Laparoscopic stone removal is safe and feasible. Indications for this approach include urinary stones associated with an anatomical abnormality requiring urinary tract reconstruction and calculi for which other minimally invasive therapies failed.

1995 - Advanced analysis in the pressure-flow study: a comparison of methods [Abstract in Rivista]
A., Giannantoni; F., Pesce; E., Finazzi Agrò; F. R., Tamburro; Micali, Salvatore; A., Silecchia; G., Vespasiani
abstract

Advanced analysis in the pressure-flow study: a comparison of methods

1995 - Anastomosi ureterali nella neovescica ileale: Tecniche a confronto. [Poster]
P., De Carli; Micali, Salvatore; L., Carpanese; A., Cancrini
abstract

Anastomosi ureterali nella neovescica ileale: Tecniche a confronto.

1995 - Nerve-sparing radical prostatectomy in with clinically organ confined prostate canceer: morbidity, cancer control quality of life and survival [Articolo su rivista]
F., Micali; G., Vespasiani; S. M., Di Stasi; G., Virgili; M., Valitutti; M., Bitelli; Micali, Salvatore; G. O., Mele; M., Valenti
abstract

Nerve-sparing radical prostatectomy in with clinically organ confined prostate canceer: morbidity, cancer control quality of life and survival

1995 - The use of the AMS triple balloon rectal catheter in the study of perineal floor activity [Abstract in Rivista]
F., Pesce; A., Mollo; M., Valitutti; Micali, Salvatore; A., Giurioli; S., Manca; G., Virgili; A., Mollo; G., Mele; S., Moretti
abstract

The use of the AMS triple balloon rectal catheter in the study of perineal floor activity

1994 - Somministrazione topica elettrostimolata di mitomycina C su parete di vescica umana. Studio in vitro [Abstract in Rivista]
S. M., Di Stasi; G., Vespasiani; G., Virgili; A., Giannantoni; Micali, Salvatore; E., Finazzi Agrò; F., Micali
abstract

Somministrazione topica elettrostimolata di mitomycina C su parete di vescica umana. Studio in vitro.

1994 - Urethral diverticuli in patients with spinal cord injury: echografic study [Articolo su rivista]
G., Virgili; P., Andreassi; F., Tamburro; Micali, Salvatore; F., Torelli; A., Giurioli; G., Vespasiani
abstract

Urethral diverticula, a not infrequent complication in patients with spinal cord injuries, usually involve the bulbous urethra which is particularly exposed to the trauma of catheterism. Indeed, the frequent association of urethral trauma and infection is often the cause of diverticula in these patients. Diagnosis is made by ascending urethrogram, voiding cystourethrogram and urethroscopy. Eight patients between 20 and 45 years of age with spinal cord injuries who had used an indwelling catheter for periods ranging from 1 to 18 months and who presented urethral diverticula at conventional investigation, underwent transperineal and penile contact ultrasonography using 3.5 and 7.5 MhZ real-time scanners. Ultrasonography was performed during intraurethral injection of saline solution through a catheter positioned near the external urethral meatus. Before the scan all patients had undergone a neuro-urological physical examination, urine analysis and culture, renal and bladder ultrasonography, ascending urethrogram and voiding cystourethrogram, urethroscopy and urodynamic investigation. Ultrasonography identified all urethral diverticula, defined them morphologically, visualized the diverticula filling and emptying phases and evaluated urethral wall and periurethral tissue characteristics, without exposing patients to any dangerous gonadal irradiation. Ultrasonography cannot replace radiological investigation but is a valid alternative in cases of contrast medium allergy, when monitoring inoperable diverticula and in postoperative follow-ups