Minerva Urology and Nephrology最新文献

{"title":"The impact of purified protein derivative prior to intravesical bacillus Calmette-Guérin for the treatment of patients with non-muscle invasive bladder cancer.","authors":"Mohamed Zawky, Asmaa Elsayed, Amira Awadallah, Ahmed Abdelhalim, Hassan Abolenein, Ahmed Shokeir","doi":"10.23736/S2724-6051.23.05515-5","DOIUrl":"10.23736/S2724-6051.23.05515-5","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study is to investigate the impact of the intradermal injection of purified protein derivative (PPD) and PPD skin test reactions on the oncological outcomes of patients with non-muscle invasive bladder cancer (NMIBC) treated by trans-urethral resection of bladder tumor (TURBT) and adjuvant intravesical BCG.</p><p><strong>Methods: </strong>The study included 100 consecutive patients with NMIBC prospectively given intradermal PPD 1-2 weeks before starting BCG therapy. Another 100 patients with NMIBC not given intradermal PPD before starting BCG were chosen as a historical control. The control group was chosen to be matching with the study group regarding baseline characteristics. The study group was divided into 2 subgroups with positive and negative reaction to PPD skin test. Oncological outcomes, immunological markers (TNF-α and IL-6) changes and BCG side effects were evaluated.</p><p><strong>Results: </strong>There were no significant differences between patients who received PPD or not regarding the 2-year recurrence free survival (RFS) rates and progression-free survival (PFS) rates and immunological markers changes. The 2-year RFS and PFS rates were significantly higher in patients with positive reactions. Post-induction values of immunological markers increased in all patients with a significant increase in patients with positive reactions. BCG side effects were significantly higher in patients with positive reactions.</p><p><strong>Conclusions: </strong>The intradermal injection of PPD before intravesical BCG has no impact on oncological outcomes of patients with NMIBC treated with TURBT and intravesical BCG. However, the PPD skin test reactions before BCG therapy can predict the oncological outcomes, BCG side effects and the immunological outcomes of patients.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"474-483"},"PeriodicalIF":4.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term effects of bowel function on global health quality of life after radical cystectomy.","authors":"Salvatore Siracusano, Paolo Gontero, Ettore Mearini, Ciro Imbimbo, Alchiede Simonato, Fabrizio Dal Moro, Gianluca Giannarini, Francesco Montorsi, Renzo Colombo, Francesco Porpiglia, Riccardo Bartoletti, Andrea Minervini, Marta Rossanese, Antonio Porcaro, Federico Romantini, Igino A Magli, Savio D Pandolfo, Renato Talamini, Marco Racioppi, Vincenzo Ficarra, Cristina Lonardi","doi":"10.23736/S2724-6051.24.05730-6","DOIUrl":"10.23736/S2724-6051.24.05730-6","url":null,"abstract":"<p><strong>Background: </strong>Radical cystectomy (RC) shows an important impact on quality of life (QoL), for various clinical aspects. The aim of our study was to evaluate the short-term bowel function in patients that underwent RC.</p><p><strong>Methods: </strong>Two hundred and six patients with MIBC underwent RC with ONB or IC urinary diversion. QoL was measured using the EORTC QLQ C30 and the Short-Form SF-36 questionnaires before surgery and at 12 months postoperatively. Baseline characteristics, including demographic profile, BMI, Charlson Comorbidity Index (CCI), modified Frailty Index (m-FI), pathological tumor stage, Clavien-Dindo grade, and neo-adjuvant chemotherapy were recorded and compared.</p><p><strong>Results: </strong>The uni-variate and multivariate analysis (OR) were performed for constipation, diarrhea and m-FI of patients underwent RC for localized MIBC according to global health status score (poor/good vs. very good). Multivariate analysis showed that constipation medium/high was significant associated with global health status poor/good (OR=2.39; 95% CI: 1.22-4.71; P=0.01); Diarrhea medium/high was associated with global health status poor/good (OR=2.85; 95% CI:1.18-6.92; P=0.02), and m-FI ≥2 score (OR=2.13; 95% CI: 0.99-4.57; P=0.05).</p><p><strong>Conclusions: </strong>Diarrhea and constipation are associated with a lower QoL in cystectomized patients, both with ONB or IC urinary diversion; such association is especially significant in more fragile patients (Frailty Index ≥2).</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"452-457"},"PeriodicalIF":4.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation of a nomogram for outcome prediction in management of medium-sized (1-2 cm) kidney stones.","authors":"Maria C Sighinolfi, Tommaso Calcagnile, Marco Ticonosco, Shaniko Kaleci, Stefano DI Bari, Simone Assumma, Luca Sarchi, Enrico Panio, Riccardo Ferrari, Adele Piro, Alberto Ragusa, Silvia Ciarlariello, Rodrigo D DA Silva, Roberto LA Rocca, Ester Illiano, Alessio Paladini, Francesco Persico, Davide Giraudo, Enrico DE Marzo, Riccardo Grisanti, Guglielmo Mantica, Esteban Emiliani, Massimo Madonia, Michele Salvetti, Pierfrancesco Bassi, Emanuele Montanari, Pierluigi Bove, Alchiede Simonato, Timothy D Averch, Francesco Porpiglia, Alessandro Calarco, Sebastiano Bruschetta, Fabio Manferrari, Francisco P Daels, Maria A Cerruto, Alessandro Antonelli, Giorgio Mazzon, Antonio Celia, Claudio Simeone, Stefano Zaramella, Alberto Saita, Elisabetta Costantini, Ettore Mearini, Mauro DE Dominicis, Vincenzo Mirone, Fernando J Kim, Stefania Ferretti, Stefano Puliatti, Bernardo Rocco, Salvatore Micali","doi":"10.23736/S2724-6051.24.05672-6","DOIUrl":"10.23736/S2724-6051.24.05672-6","url":null,"abstract":"<p><strong>Background: </strong>Stone nomogram by Micali et al., able topredict treatment failure of shock-wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) in the management of single 1-2 cm renal stones, was developed on 2605 patients and showed a high predictive accuracy, with an area under ROC curve of 0.793 at internal validation. The aim of the present study is to externally validate the model to assess whether it displayed a satisfactory predictive performance if applied to different populations.</p><p><strong>Methods: </strong>External validation was retrospectively performed on 3025 patients who underwent an active stone treatment from December 2010 to June 2021 in 26 centers from four countries (Italy, USA, Spain, Argentina). Collected variables included: age, gender, previous renal surgery, preoperative urine culture, hydronephrosis, stone side, site, density, skin-to-stone distance. Treatment failure was the defined outcome (residual fragments >4 mm at three months CT-scan).</p><p><strong>Results: </strong>Model discrimination in external validation datasets showed an area under ROC curve of 0.66 (95% 0.59-0.68) with adequate calibration. The retrospective fashion of the study and the lack of generalizability of the tool towards populations from Asia, Africa or Oceania represent limitations of the current analysis.</p><p><strong>Conclusions: </strong>According to the current findings, Micali's nomogram can be used for treatment prediction after SWL, RIRS and PNL; however, a lower discrimination performance than the one at internal validation should be acknowledged, reflecting geographical, temporal and domain limitation of external validation studies. Further prospective evaluation is required to refine and improve the nomogram findings and to validate its clinical value.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"484-490"},"PeriodicalIF":4.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of 3D printing model combined PCNL in kidney stones: a systematic review and meta-analysis.","authors":"Guo Y Ai, Zhen Zhou, Zhicong Huang, Jian Zhong, Shusheng Liu, Weijie Liu, Xuliang Pang, Wei Zhu","doi":"10.23736/S2724-6051.24.05720-3","DOIUrl":"10.23736/S2724-6051.24.05720-3","url":null,"abstract":"<p><strong>Introduction: </strong>With the continuous advancement of medical imaging, 3D printing technology is emerging. This technology allows for the representation of complex objects in a model form. This research aims to delve into the irreplaceable value of percutaneous nephrolithotomy (PCNL) in conjunction with 3D printed models in urinary stone surgery. This forward-looking approach provides doctors with a new perspective, enabling them to plan and execute surgeries with greater precision, ultimately delivering a safer and more efficient treatment experience for patients. We evaluated the literature on PCNL for the kidney stones with the introduction of 3D printing models and conducted a meta-analysis. The assessed parameters included stone clearance rate, operation time, hospital stay, blood loss, puncture accuracy, and the rate of complications.</p><p><strong>Evidence acquisition: </strong>We systematically searched the EMBASE, PubMed, Cochrane Library, SCIE, and Chinese Biomedical Literature Search databases for articles related to PCNL (Percutaneous Nephrolithotomy) with 3D printing models from January 2000 to January 2023. Data were managed and screened using Excel . Meta-analysis was performed for operation time, stone clearance rate, blood loss, puncture accuracy, length of hospital stay, and complications in PCNL combined with 3D printing model for kidney stone treatment. The quality of included articles was assessed using the risk of bias tool by the Cochrane Collaboration. Sensitivity analysis was conducted to assess the reliability of the results. Data were recorded using StataSE 17 software, and publication bias was examined using Egger's linear regression test.</p><p><strong>Evidence synthesis: </strong>We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to conduct a systematic search and screening of literature relevant to the use of 3D printed models in the treatment of kidney stones. We conducted an extensive literature search across several major academic databases, including EMBASE, PubMed, Cochrane Library, SCIE, and Chinese Biomedical Literature Search databases, to ensure comprehensive coverage of relevant studies. Following the PRISMA process of screening and analysis, we ultimately included 10 randomized controlled trials with a combined sample of 608 for systematic review.</p><p><strong>Conclusions: </strong>Across these studies, we identified the introduction of 3D printing models prior to surgery for kidney stones resulted in significant advantages for the experimental group compared to the control group in terms of operation time, stone clearance rates, puncture accuracy, hospital stay, blood loss, and the incidence of complications, providing valuable insights for further research and clinical practice.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 4","pages":"389-398"},"PeriodicalIF":4.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review and meta-analysis of the placebo effect on both semen quality and male infertility.","authors":"Elvira Utigalieva, Andrey Morozov, Ohad Shoshany, Aleksandr Suvorov, Mark Taratkin, Celeste Manfredi, Marco Falcone, Evgeny Bezrukov, Harun Fajkovic, Giorgio I Russo, Dmitry Enikeev","doi":"10.23736/S2724-6051.24.05559-9","DOIUrl":"10.23736/S2724-6051.24.05559-9","url":null,"abstract":"<p><strong>Introduction: </strong>Placebo influence on such objective indicators, as sperm quality and infertility, has not been studied previously, but some studies report that placebo may distort even objective outcomes. The aim of current study is to assess the placebo effect on fertility in patients suffering from sperm abnormalities and/or infertility.</p><p><strong>Evidence acquisition: </strong>We conducted a search of two databases (Scopus and MEDLINE) and identified placebo-controlled clinical trials which focused on sperm abnormalities and/or male infertility treatment. Primary outcomes included changes in semen parameters (volume, total count, sperm concentration in semen, progressive motility, morphology (normal cells)). Secondary outcomes included DNA fragmentation and change in pregnancy rate.</p><p><strong>Evidence synthesis: </strong>Seventy-seven articles published from 1983 to 2022 were included. Statistically significant changes were observed for the following values: total sperm count, mean change 0.16 (95% CI 0.05, 0.26); P=0.004, I²=75.1%; and progressive motility, mean change 0.13 (95% CI 0.02, 0.24); P=0.026, I²=84.9%. In contrast, placebo did not affect sperm concentration, sperm volume, sperm morphology or DNA fragmentation index. The publication bias for all the values measured with Egger's test and funnel plots was low.</p><p><strong>Conclusions: </strong>The current meta-analysis indicated a statistically significant increase of total sperm count and progressive motility in the placebo group. In contrast, placebo did not affect sperm concentration, sperm volume, sperm morphology and DNA fragmentation index. These findings should be considered while planning or analyzing placebo-controlled clinical trials.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 4","pages":"423-435"},"PeriodicalIF":4.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urologists' proficiency in various donor nephrectomy approaches: a real-life survey, systematic review, and meta-analysis of randomized controlled trials.","authors":"Ahmed Eissa, Natali Rodriguez Peñaranda, Marco Ticonosco, Stefano Resca, Adele Piro, Marco Amato, Stefania Ferretti, Ahmed Elsherbiny, Abdelhamid El-Bahnasy, Ahmed Zoeir, Ayman Hagras, Ali Abdel Raheem, Ugo Boggi, Lucrezia Furian, Angelo Territo, Yasser Farahat, Giampaolo Bianchi, Selçuk Güven, Stefano Puliatti, Ali Gozen, Salvatore Micali","doi":"10.23736/S2724-6051.24.05789-6","DOIUrl":"10.23736/S2724-6051.24.05789-6","url":null,"abstract":"<p><strong>Introduction: </strong>Donor nephrectomy (DN) is a unique surgical procedure in urological practice, as it involves exposing a healthy individual to the potential risks of surgery. This type of surgery exhibits heterogeneity in terms of approach (open, laparoscopic, or robotic), each with its unique set of advantages and disadvantages. Consequently, there is currently a lack of universally agreed upon clear guidelines. In these settings, this study aims to evaluate transplantation surgeons' knowledge through a real-life survey and compare it with data from published randomized controlled trials (RCTs).</p><p><strong>Evidence acquisition: </strong>The study is divided into two parts, with the first part focusing on the outcomes of the real-life survey designed to assess surgeons' knowledge about different DN approaches and their real-world practices during the surgery. The second part involves a systematic review and meta-analysis of RCTs, specifically examining the outcomes of different surgical approaches to DN. The systematic review followed the PRISMA Guidelines and involved a search of PubMed and Web of Science for RCTs comparing the outcomes of different DN approaches. The risk of bias was assessed using the RoB-2 tool. The random effect model was mainly used to assess the mean difference of the included studies.</p><p><strong>Evidence synthesis: </strong>The study was conducted between July 2021 and January 2022 and surveyed 50 surgeons, of which 35 participants (70%) completed the survey. Regarding various approaches to DN, 97.14% of surgeons reported having experience with live DN, and 45.72% performed over 15 cases per year. The most performed approach was pure laparoscopic DN (68.57%). Pure laparoscopic DN was the preferred approach for 77.42% of respondents. The review process resulted in 335 articles, of which 35 were eligible for inclusion in the systematic review. In summary, most studies found that laparoscopic approaches, including standard, hand-assisted, LESS-DN, and mini-LDN, resulted in less postoperative pain, better cosmetic, and quicker recovery times compared to open approaches. The main limitation of the current study is the heterogeneity of the included studies.</p><p><strong>Conclusions: </strong>The study provides valuable insights into the practices of renal transplantation surgeons, offering a comprehensive comparison to level 1 studies (RCTs) in the field. It underscores the continued significance of ODN in contemporary practice, particularly in light of recommendations from the EAU guidelines on renal transplantation. This reaffirms the need to consider the advantages and disadvantages of various approaches, including factors such as cost, postoperative pain, and cosmetic outcomes. While robotic-assisted DN holds promise, their adoption remains variable, potentially due to limited robust evidence.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 4","pages":"399-422"},"PeriodicalIF":4.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The grade of systemic inflammation, immune inhibition, and gut dysbiosis as prognostic factors for bladder cancer recurrence: a metabolomics approach.","authors":"Greta Petrella, Giorgia Ciufolini, Sara Lentini, Francesco Montorsi, Andrea Salonia, Massimo Pieri, Simone Albisinni, Riccardo Vago, Daniel Oscar Cicero","doi":"10.23736/S2724-6051.24.05747-1","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05747-1","url":null,"abstract":"<p><strong>Background: </strong>The risk of recurrence for non-muscle invasive bladder cancer (NMIBC) is high, and the current methods of predicting it rely on clinical and histopathological markers. Personalized risk assessment can be improved by including new prognostic biomarkers. Our research explores the potential of urinary metabolomics to predict cancer recurrence in NMIBC patients within three years.</p><p><strong>Methods: </strong>Fifty NMIBC patients were included in the study. Urine samples were collected at diagnosis and before TUR-BT. After three years, patients were classified as relapsed or non-relapsed. An NMR-based metabolomics approach was used to measure the concentration of 44 metabolites in the urine of these patients at the time of their diagnosis. This method provides a comprehensive view of many urinary compounds potentially valuable for discriminating relapsing from non-relapsing patients. The measured metabolic profiles were analyzed through multivariate analysis, probability ROC curves, and Mann-Whitney tests.</p><p><strong>Results: </strong>Seven metabolites were involved in NMIBC recurrence prediction. We interpret their alteration as the consequence of three main events: gut dysbiosis, systemic inflammation, and immune inhibition. Since these compounds have already been proposed for BC diagnosis, what distinguishes their role as prognostic or diagnostic is the grade of their alteration. Limitations: small sample size; further research to confirm urinary compounds' correlation with physiological processes.</p><p><strong>Conclusions: </strong>This study exploits urinary metabolic profiles to predict NMIBC recurrence. Specific metabolites are found to be significantly related to cancer relapse. The study highlights the grade of inflammation, immune suppression, and gut dysbiosis in predicting cancer recurrence.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a structured rehabilitation program on urinary continence in patients with intermediate high-risk prostate cancer undergoing robotic-assisted laparoscopic prostatectomy.","authors":"Pier P Avolio, Vittorio Fasulo, Giovanni Lughezzani, Cesare Saitta, Marco Paciotti, Roberto Gatti, Filippo Russo, Maria V Fantacci, Massimo Lazzeri, Davide Maffei, Luisa Pasini, Alberto Saita, Rodolfo Hurle, Paolo Casale, Nicolò M Buffi","doi":"10.23736/S2724-6051.24.05848-8","DOIUrl":"10.23736/S2724-6051.24.05848-8","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"384-387"},"PeriodicalIF":4.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of venous thromboembolism before open or minimally-invasive radical cystectomy in the USA: insurance claims data on perioperative outcomes and healthcare costs.","authors":"Francesco Del Giudice, Anas Tresh, Shufeng Li, Satvir Basran, Sophia G Prendiville, Federico Belladelli, Ettore DE Berardinis, Vincenzo Asero, Carlo M Scornajenghi, Dalila Carino, Matteo Ferro, Bernardo Rocco, Gian Maria Busetto, Ugo Falagario, Riccardo Autorino, Felice Crocetto, Biagio Barone, Benjamin Pradere, Wojciech Krajewski, Łukasz Nowak, Tomasz Szydełko, Marco Moschini, Andrea Mari, Simone Crivellaro, Francesco Porpiglia, Cristian Fiori, Daniele Amparore, Renate Pichler, Abhay Rane, Benjamin Challacombe, Rajesh Nair, Benjamin I Chung","doi":"10.23736/S2724-6051.24.05699-4","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05699-4","url":null,"abstract":"<p><strong>Background: </strong>The relationship between venous thromboembolism (VTE) and solid malignancy has been established over the decades. With rising projected rates of bladder cancer (BCa) worldwide as well as increasing number of patients experiencing BCa and VTE, our aim is to assess the impact of a preoperative VTE diagnosis on perioperative outcomes and health-care costs in BCa cases undergoing radical cystectomy (RC).</p><p><strong>Methods: </strong>Patients ≥18 years of age with BCa diagnosis and undergoing open or minimally invasive (MIS) RC were identified in the Merative™ Marketscan^® Research Databases between 2007 and 2021. The association of previous VTE history with 90-day complication rates, postoperative VTE events, rehospitalization, and total hospital costs (2021 USA dollars) was determined by multivariable logistic regression modeling adjusted for patient and perioperative confounders. Sensitivity analysis on VTE degree of severity (i.e., pulmonary embolism [PE] and/or peripheral deep venous thrombosis [DVT]) was also examined.</p><p><strong>Results: </strong>Out of 8759 RC procedures, 743 (8.48%) had a previous positive history for any VTE including 245 (32.97%) PE, 339 (45.63%) DVT and 159 (21.40%) superficial VTE. Overall, history of VTE before RC was strongly associated with almost any worse postoperative outcomes including higher risk for any and apparatus-specific 90-days postoperative complications (odds ratio [OR]: 1.21, 95% CI, 1.02-1.44). Subsequent incidence of new VTE events (OR: 7.02, 95% CI: 5.93-8.31), rehospitalization (OR: 1.25, 95% CI: 1.06-1.48), other than home/self-care discharge status (OR: 1.53, 95% CI: 1.28-1.82), and higher health-care costs related to the RC procedure (OR: 1.43, 95% CI: 1.22-1.68) were significantly associated with a history of VTE.</p><p><strong>Conclusions: </strong>Preoperative VTE in patients undergoing RC significantly increases morbidity, post-procedure VTE events, hospital length of stay, rehospitalizations, and increased hospital costs. These findings may help during the BCa counseling on risks of surgery and hopefully improve our ability to mitigate such risks.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 3","pages":"320-330"},"PeriodicalIF":4.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary PSA-ZINC biomarker outperforms standard of care in early detection of prostate cancer.","authors":"Daniele Amparore, Sabrina DE Cillis, Stefano Granato, Michele Ortenzi, Marcello Della Corte, Michele Sica, Alberto Piana, Paolo Verri, Stefano DE Luca, Matteo Manfredi, Cristian Fiori, Giulio Mengozzi, Enrico Bergamaschi, Giuseppe Mariella, Sergio Occhipinti, Francesco Porpiglia","doi":"10.23736/S2724-6051.24.05783-5","DOIUrl":"10.23736/S2724-6051.24.05783-5","url":null,"abstract":"<p><strong>Background: </strong>Urine is a promising biological fluid for prostate cancer (PCa) diagnostics due to its non-invasive collection and wide range of biomarkers. The aim of this study was to assess the role of urinary PSA (uPSA) and urinary Zinc (uZinc) as biomarkers for the diagnosis of PCa in combination with routine parameters of standard of care (SOC - blood PSA, abnormal DRE, age) and MRI in patients candidates for prostate biopsy.</p><p><strong>Methods: </strong>Urine samples after prostatic massages were collected from men with suspected PCa scheduled for prostate biopsy. Quantification of uPSA was performed by ECLIA platform and confirmed by ELISA assay, while uZinc measurement was evaluated by ICP-MS and confirmed by colorimetric in vitro assay. Six multivariate logistic regression analysis were performed to assess diagnostic performance of uPSA and uZinc (urine), SOC and MRI alone, and combination of MRI+SOC, MRI+urine and SOC+MRI+urine. The discriminative power of the logistic models was assessed by calculating the area under the receiver operating characteristic (ROC) curves (AUC).</p><p><strong>Results: </strong>Two hundred thirty-eight patients were included in the analysis; 145 of them were diagnosed with PCa. Urine test showed a better discrimination of HS from CP, in respect of uPSA and uZinc alone, both for PCa of any grade and Gleason Score ≥7 (4+3) (AUC 0.804 and 0.823 respectively). ROC curve combining SOC+MRI+urine showed an AUC=0.882, that is statistically different from SOC or MRI alone, or MRI+SOC (P=0.0001, P=0.0001, and P=0.008 respectively). PCa risk algorithm designed considering SOC+MRI+urine results in potential reduction of 57% of unnecessary biopsies compared to the current standard parameters.</p><p><strong>Conclusions: </strong>The loss of uPSA and Zinc production and secretion during neoplastic transformation of the prostate could potentially represent a hallmark of PCa. Its combination with age, PSA and DRE, as well as with mpMRI could represent an interesting approach to improve the diagnostic accuracy of PCa.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"340-350"},"PeriodicalIF":4.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141307400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}