Minerva Urology and Nephrology最新文献

{"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":"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":"518-527"},"PeriodicalIF":4.2,"publicationDate":"2025-08-01","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":"Parenchymal volume and functional recovery after clamped partial nephrectomy: potential discrepancies.","authors":"Kieran Lewis, Akira Kazama, Carlos Munoz Lopez, Nityam Rathi, Eran N Maina, Angelica Bartholomew, Jayant Siva, Anne Wong, Jason M Scovell, Rebecca A Campbell, Nima Almassi, Robert Abouassaly, Samuel C Haywood, Christopher Weight, Yunlin Ye, Wen Dong, Zhiling Zhang, Steven C Campbell","doi":"10.23736/S2724-6051.25.06350-5","DOIUrl":"https://doi.org/10.23736/S2724-6051.25.06350-5","url":null,"abstract":"<p><strong>Background: </strong>Parenchymal-volume-analysis (PVA) appears superior to nuclear-renal-scans (NRS) for assessing split-renal-function (SRF). Our objective was to evaluate how ischemia during PN impacts the accuracy of PVA for estimating functional outcomes.</p><p><strong>Methods: </strong>Partial nephrectomy (PN) patients (2010-2022) with pre/postoperative NRS and cross-sectional imaging were retrospectively analyzed. Differences between NRS and PVA-derived ipsilateral SRF estimates were evaluated in warm/cold ischemia subgroups. The relationship between ischemia time and PVA/NRS discordance was evaluated with linear and segmented-regression. Correction for PVA overestimation was applied to a previously published cohort of PN patients managed with prolonged-ischemia.</p><p><strong>Results: </strong>Among 437 PN, 246(56%)/191(44%) were managed with warm/cold ischemia, with median ischemia times of 21/28 minutes, respectively. Preoperative PVA and NRS-based ipsilateral SRF estimates were nearly identical (r=0.94). Post-PN, median PVA-based estimates of ipsilateral SRF were significantly higher than NRS-derived estimates for patients managed with warm-ischemia (WI)(44% vs. 42%, P=0.001), which was not observed with hypothermia. Segmented-regression revealed increasing PVA/NRS discordance only after 24 minutes of WI (P=0.04). No relationship was observed between ischemia time and PVA/NRS discordance for hypothermia or limited WI. Correcting for PVA overestimation in an independent cohort demonstrated that functional decline associated with prolonged WI was 2-3 fold greater than estimated by PVA alone.</p><p><strong>Conclusions: </strong>PVA is highly accurate for predicting SRF in PN patients preoperatively and for assessing functional outcomes in patients managed with hypothermia or limited WI. However, with prolonged WI, there is discordance between parenchymal volume and function that progressively increases beyond 24 minutes. Avoidance of prolonged WI should be considered in patients with solitary kidneys and/or significant pre-existing chronic kidney disease.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"77 4","pages":"479-489"},"PeriodicalIF":4.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978227","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":"Robotic ureteroplasty with lingual mucosa graft: a multi-institutional experience.","authors":"Shuaishuai Chai, Yuancheng Zhou, Manshun Dong, Gong Cheng, Wei Xiang, Yongqiang You, Qiuxuan Yu, Ruoyu Li, Chaoqi Liang, Jingdong Yuan, Xingyuan Xiao, Bing Li","doi":"10.23736/S2724-6051.25.06433-X","DOIUrl":"10.23736/S2724-6051.25.06433-X","url":null,"abstract":"<p><strong>Background: </strong>The management of long proximal ureteral strictures poses a significant challenge, with traditional options such as renal autotransplantation or bowel interposition associated with substantial morbidity. This study explores the use of robotic ureteroplasty with lingual mucosal graft (RU-LMG) as a minimally invasive approach for treating complex ureteral strictures. We present a multi-institutional cohort to evaluate its effectiveness in managing proximal and mid-ureteral strictures.</p><p><strong>Methods: </strong>This multi-center, retrospective study analyzed perioperative data from 76 patients who underwent RU-LMG at three institutions between January 2021 and December 2023. Patients were selected based on the presence of proximal or mid-ureteral strictures not amenable to primary ureteroureterostomy due to periureteral fibrosis or excessive stricture length. Success was defined as the absence of hydronephrosis, flank pain, or imaging-confirmed obstruction.</p><p><strong>Results: </strong>Of the 76 patients, 48 (63.2%) underwent onlay ureteroplasty, while 28 (36.8%) received augmented anastomotic RU-LMG. Omental wrapping or coverage of the reconstructed ureter was performed in 73 patients (96.1%). The average length of the stricture and graft were 4.0 cm (range: 2.0-11.5 cm) and 4.1 cm (range: 2.0-12.0 cm), respectively. The mean operative time was 205.5 minutes (range: 95-380 minutes), with a mean blood loss of 70.9 mL (range: 10-400 mL). There were no open conversions or intraoperative complications. The follow-up period ranged from 13 to 48 months (mean: 27 months), with a 100% success rate (76/76 patients).</p><p><strong>Conclusions: </strong>RU-LMG is a safe, effective, and feasible technique for managing complex proximal or mid-ureteral strictures, with excellent medium-term outcomes and minimal morbidity.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"77 4","pages":"500-507"},"PeriodicalIF":4.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978341","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":"Chronic kidney disease and cardiovascular disease risk: exploring the role of socioeconomic position in a large cohort from Northwest Italy.","authors":"Lucia Dansero, Alberto Catalano, Roberto Gnavi, Federica Turatto, Fulvio Ricceri, Savino Sciascia","doi":"10.23736/S2724-6051.25.06223-8","DOIUrl":"https://doi.org/10.23736/S2724-6051.25.06223-8","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a global health concern, acknowledged as a major contributor to cardiovascular diseases (CVD). However, its impact within the Italian population is still poorly understood, with limited research exploring the role of socioeconomic factors in this relationship. Our study aims to investigate the CVD risks in CKD patients and the role of socioeconomic position (SEP) in Italy, using data from the Piedmont Longitudinal Study.</p><p><strong>Methods: </strong>We included all individuals aged 60-80, resident in the Piedmont region. Validated algorithms were used to identify CKD and CVD from the 1^st January 2013 until the 31^st December 2018. We used cause-specific Cox proportional hazard models to investigate the risk of CVD, fatal and non-fatal CVD, coronary heart disease (CHD) and cerebrovascular events in subjects with CKD.</p><p><strong>Results: </strong>The cohort included 1,010,180 individuals, with 31,299 incident cases of CKD identified during the follow-up. CKD patients were older, mostly males, and had lower socioeconomic position. CKD subjects faced an increased risk for all outcomes compared to non-CKD individuals, with a 2.64-fold higher risk of all CVD events. Stratification by SEP highlighted consistently elevated risks for CKD subjects, with the lowest socioeconomic position associated with the highest risk.</p><p><strong>Conclusions: </strong>The study emphasized the significant association between CKD and CVD persisting across socioeconomic strata. The findings highlight socioeconomic disparities, emphasizing the importance of a multidisciplinary care approach and further research to address inequalities in the CKD-CVD relationship.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"77 4","pages":"553-560"},"PeriodicalIF":4.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978160","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":"Development of novel patient selection algorithm for multi-port versus single-port robotic radical prostatectomy approaches.","authors":"Nicolas A Soputro, Jaya S Chavali, Roxana Ramos-Carpinteyro, Adriana M Pedraza, Carter D Mikesell, Jihad Kaouk","doi":"10.23736/S2724-6051.25.06440-7","DOIUrl":"https://doi.org/10.23736/S2724-6051.25.06440-7","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to develop a patient selection algorithm to better guide clinical decision-making towards the different approaches of multi-port (MP) and single-port (SP) robotic radical prostatectomy (RARP).</p><p><strong>Methods: </strong>A retrospective study was performed on an institutional review board (IRB) -approved database to identify all consecutive patients who underwent transperitoneal MP, extraperitoneal SP, and transvesical SP-RARP between 2018 and 2024. Baseline clinicodemographic variables were collected. Univariate and multivariate regression analyses were used to construct two separate nomograms to predict the likelihood of MP versus SP-RARP as well as extraperitoneal versus transvesical SP-RARP.</p><p><strong>Results: </strong>RARP was completed in 529 patients, which included 91 (17.2%) transperitoneal MP-RARP, 195 (36.9%) extraperitoneal SP-RARP, and 243 (45.9%) transvesical SP-RARP. All SP cases were successfully completed without the need for conversion or additional ports. When comparing MP versus SP, lower prostate cancer risk categories, smaller prostate glands, and a more significant history of previous abdominal surgery as represented by a higher Hostile Abdomen Index (HAI) were identified as clinically significant predictors of SP-RARP. Within the SP-RARP cohort, all three aforementioned variables and the absence of any adverse features on preoperative magnetic resonance imaging (MRI) favored transvesical over extraperitoneal SP-RARP. Internal validation of the two nomograms demonstrated reasonable performance with an area under the curve (AUC) of 0.73 and 0.77, respectively. Considering the optimal cutoff points of 0.87 and 0.54 for the two models, all cases of SP-RARP and transvesical SP-RARP who scored above the threshold demonstrated superior perioperative outcomes.</p><p><strong>Conclusions: </strong>Herein, we have developed a novel patient selection algorithm aimed at better guiding clinical decision-making in the evolving landscape of contemporary RARP approaches. The findings highlighted in this study, which was based on more than five years of clinical experience, can be useful for institutions seeking to adopt or expand their SP-RARP practices and to ensure optimal perioperative outcomes.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"77 4","pages":"508-517"},"PeriodicalIF":4.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978188","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":"Trends and incidence of postoperative reported events associated with penile prosthesis. An analysis of the food and drug administration's manufacturer and user facility device experience database.","authors":"Riccardo Lombardo, Filippo Zammitti, Antonio Nacchia, Alessandro Guercio, Beatrice Turchi, Matteo Romagnoli, Giuseppe Santoro, Antonio Franco, Giorgia Tema, Antonio Cicione, Andrea Fuschi, Yazan Al Salhi, Antonio L Pastore, Andrea Tubaro, Cosimo DE Nunzio","doi":"10.23736/S2724-6051.25.06309-8","DOIUrl":"https://doi.org/10.23736/S2724-6051.25.06309-8","url":null,"abstract":"<p><strong>Background: </strong>Real life data on adverse events of penile prosthesis are lacking. Aim of this study is to summarize medical device reports (MDRs) related to penile prosthesis implants within the Manufacturer and User Facility Device Experience (MAUDE) database held by The Food and Drug Administration (FDA).</p><p><strong>Methods: </strong>We examined all MDRs from MAUDE database reported in the last ten years related to each FDA-approved penile implant. Event descriptions were reviewed and classified into specific event types. Outcome measures included specific penile prosthesis and reported events as detailed by the MDRs. All data is in line with the Health Insurance Portability and Accountability Act (HIPAA). Pooled Relative risk was used to compare data.</p><p><strong>Results: </strong>Overall, in 10 years, 1340 reports were sent, with the highest number of events reported between 2019 and 2022. Overall, 1240/1340 (92%) were reported as injury while 91/1340 (7%) as implant malfunction. Infection (181/1340: 14%), Erosion (144/1340: 11%), Pain (68/1340: 5%) and Perforation (47/1340: 4%) were the most frequently reported adverse events (AEs). In terms of manufacturer: 675/1340 (50%) were from Boston Scientific, 198/1340 (15%) were Coloplast and 463/1340 (35%) were AMS. When comparing different producers on disproportional analysis, Coloplast presented a higher risk of infection when compared to Boston Scientific and AMS (PRR= 1.5-2.62; P<0.05). Perforation, pain, failure to implant and erosion incidence were comparable between manufacturers.</p><p><strong>Conclusions: </strong>According to MAUDE database, the most frequent complications related to penile prosthesis are infections, erosions, pain, and perforation. Coloplast prosthesis seem to be associated with a higher risk of infection.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"77 4","pages":"546-552"},"PeriodicalIF":4.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978249","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":"YAU renal cancer spotlight on dual checkpoint inhibition in non-clear cell renal cell carcinoma: a worthy enough contender?","authors":"Ronan Flippot, Mariangela Calabrese, Daniele Amparore, Riccardo Campi","doi":"10.23736/S2724-6051.25.06630-3","DOIUrl":"https://doi.org/10.23736/S2724-6051.25.06630-3","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"77 4","pages":"566-570"},"PeriodicalIF":4.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978278","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":"Robot-assisted pyeloplasty with the New Hugo™ RAS: step-by-step surgical settings and technique.","authors":"Alberto Ragusa, Francesco Prata, Andrea Iannuzzi, Francesco Tedesco, Matteo Pira, Angelo Civitella, Loris Cacciatore, Giovanni Muto, Roberto Scarpa, Rocco Papalia","doi":"10.23736/S2724-6051.25.06067-7","DOIUrl":"https://doi.org/10.23736/S2724-6051.25.06067-7","url":null,"abstract":"<p><strong>Background: </strong>We present our step-by-step experience regarding the feasibility and surgical setup for a case series of robotic pyeloplasty using the new Hugo^™ RAS System.</p><p><strong>Methods: </strong>Five consecutives robotic pyeloplasties have been performed, through a trans-peritoneal route. Three robotic ports were placed under direct vision, including an optical 11-mm robotic trocar, and two 8-mm operative robotic ports. Two laparoscopic ports for bed-assistant were placed between robotic ports and below the camera port to avoid clashes. Only three arm carts were used and located behind the back of the patient to leave more working space to the bed-assistant space and avoid internal or external clashes between robotic arms. After docking and paracolic gutter incision, kidney lower pole identification, UPJ stenosis excision, and spatulation of the ureter with double J ureteral catheter placement were key steps of our procedure.</p><p><strong>Results: </strong>Median Docking and Console time were 4 minutes (IQR: 4-5) and 115 minutes (IQR:105-120), respectively. No intraoperative complications occurred. No additional ports placement was necessary. No robotic instrument clashed, nor clashes between the robotic arms and the bed-assistant were observed. Estimated blood loss was negligible. The patients were discharged on postoperative day 3 after bladder catheter and abdominal drain removal. No complications were recorded within the first 30 postoperative days. Finally, a median follow-up of 4 (IQR: 3-8) reported satisfactory outcomes.</p><p><strong>Conclusions: </strong>In the setting of robotic pyeloplasty, this novel platform showed a user-friendly docking system, providing satisfactory perioperative outcomes with a simple three-arms configuration.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509409","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 feasibility and acceptability of a (mobile) application for men with lower urinary tract symptoms: a pilot study.","authors":"Stavros Gravas, Georgios Chasiotis, Mauro Gacci, Gokhan Calik, Andrea Liaci, Athanasios Dellis, Petros Sountoulides, M Pilar Laguna, Jean DE LA Rosette","doi":"10.23736/S2724-6051.25.06352-9","DOIUrl":"https://doi.org/10.23736/S2724-6051.25.06352-9","url":null,"abstract":"<p><strong>Background: </strong>The growing use of smartphones offers a key opportunity to monitor BPO/LUTS through well-designed medical apps. The primary objective of the study was to assess the feasibility and acceptability of a mobile app (MyBPHCare) for men with lower urinary tract symptoms (LUTS). Secondary objectives included medical adherence using electronic reminders and compliance of treatment with current guidelines.</p><p><strong>Methods: </strong>This was an observational cohort pilot study conducted in Greece, Türkiye, and Italy. Patients with LUTS, treatment-naïve or under treatment, older than 40 years were eligible. Patients received standard care according to physician's practice and duration of follow-up was 6 months. Standard questionnaires, diagnostic tools, medication, and follow-up visits were employed. Feasibility, acceptance, and satisfaction were assessed using a standardized, translated and validated app rating user questionnaire (uMARS). Patients' adherence to treatment and physicians' with guidelines were also recorded.</p><p><strong>Results: </strong>From a total of 157 patients, 68.15% filled in the uMARS questionnaire. All uMARS mean scores ranged between \"Acceptable\" and \"Good\": App Quality (3.43), Engagement (3.21), Functionality (3.47), Aesthetics (3.37), and Information (3.68). 96.3% of the participants would recommend using the app. Recorded adherence to medication was 47.85%, while a discrepancy between guidelines and real-life practice was found.</p><p><strong>Conclusions: </strong>MyBPHCare app is a possibly feasible application for virtually monitoring men with LUTS with good acceptance from the patients.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509410","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 anesthesia impact of regionalized insufflation with transvesical single port robot-assisted radical prostatectomy.","authors":"Nicolas A Soputro, Carter D Mikesell, Salim K Younis, Samarpit Rai, Lin Wang, Adriana M Pedraza, Jihad Kaouk","doi":"10.23736/S2724-6051.25.06307-4","DOIUrl":"https://doi.org/10.23736/S2724-6051.25.06307-4","url":null,"abstract":"<p><strong>Background: </strong>To evaluate for any differences between the intraoperative oxygenation and ventilation outcomes between single port (SP) extraperitoneal (EP) and transvesical (TV) robot-assisted radical prostatectomy (RARP) with the standard multi-port (MP) transperitoneal (TP) approach.</p><p><strong>Methods: </strong>A retrospective review was performed on the prospectively maintained, IRB-approved database to identify 962 consecutive patients who underwent MP TP, SP EP, and SP TV RARP between 2015 and 2024. A 1:1 propensity-matched analysis was completed based on the patient's age, Body Mass Index (BMI), as well as comorbidities based on the Charlson Comorbidity Index (CCI) and American Society of Anesthesiologists' (ASA) physical status classification score. Intraoperative anesthesia parameters collected included the lowest recorded oxygen saturation (SpO<inf>2</inf>), highest end-tidal carbon dioxide (ETCO<inf>2</inf>), highest respiratory rate (RR), the highest positive end-expiratory pressure (PEEP) setting, as well as the total intraoperative doses of propofol, rocuronium, and fentanyl.</p><p><strong>Results: </strong>Based on our propensity-matched analysis, 603 patients were included, which comprised 201 cases of MP TP, SP EP, and SP TV RARP, respectively. Our cohort had a median age of 63.5 years (IQR 58.5-68.1 years), a median BMI of 28.4 kg/m² (IQR 25.9-31.7 kg/m²), a median CCI of 4 (IQR 3-5), and a median ASA Score of 3 (IQR 2-3). All procedures were completed without any conversion, intraoperative complications, or need for blood transfusion. Notably, the SP TV RARP was associated with significant improvements in both SpO<inf>2</inf> and ETCO<inf>2</inf> (median lowest SpO<inf>2</inf>, MP TP 95% vs. SP EP 96% vs. SP TV 98%, P<0.001; median highest ETCO<inf>2</inf>, MP TP 45 vs. SP EP 42 vs. SP TV 40 mmHg, P<0.001). Compared to MP-RARP, the SP technique was associated with a significantly decreased use of intraoperative fentanyl (median, MP TP 200 vs. SP EP 175 vs. SP TV 150 mcg, P<0.001) yet without any statistically significant differences between the SP EP and SP TV approaches (P=0.223).</p><p><strong>Conclusions: </strong>Herein, we demonstrated the benefits of pneumovesicum with the regionalized SP TV approach in improving intraoperative oxygenation, ventilation, as well as perioperative analgesia requirements, especially when compared to the standard TP MP-RARP. These resulting improvements hold promise for further enhancements in perioperative outcomes and patient safety, especially in patients with pre-existing cardiopulmonary comorbidities.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"77 3","pages":"330-337"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318690","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}