Loic Baekelandt, Murat Akand, Thomas VAN DEN Broeck, Thomas Gevaert, Steven Joniau
{"title":"Transforming UTUC diagnostics: the potential of bladder Epicheck® in clinical practice.","authors":"Loic Baekelandt, Murat Akand, Thomas VAN DEN Broeck, Thomas Gevaert, Steven Joniau","doi":"10.23736/S2724-6051.24.06059-2","DOIUrl":"10.23736/S2724-6051.24.06059-2","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"654-656"},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876712","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}
Vineet Gauhar, Olivier Traxer, Daniele Castellani, Khi Y Fong, Saeed Bin Hamri, Mehmet I Gökce, Nariman Gadzhiev, Mariela Corrales, Vigen Malkhasyan, Deepak Ragoori, Boyke Soebhali, Karl Tan, Chu A Chai, Azimdjon N Tursunkulov, Yiloren Tanidir, Satyendra Persaud, Mohamed Elshazly, Wissam Kamal, Tzevat Tefik, Anil Shrestha, Ben H Chew, Mohamed A Lakmichi, Andrea B Galosi, Heng C Tiong, Christian Seitz, Bhaskar K Somani
{"title":"Operative outcomes 24 hours after retrograde intrarenal surgery for solitary renal calculi using a flexible and navigable suction ureteral access sheath. A prospective global multicenter study by the European Association of Urology Section on Urolithiasis.","authors":"Vineet Gauhar, Olivier Traxer, Daniele Castellani, Khi Y Fong, Saeed Bin Hamri, Mehmet I Gökce, Nariman Gadzhiev, Mariela Corrales, Vigen Malkhasyan, Deepak Ragoori, Boyke Soebhali, Karl Tan, Chu A Chai, Azimdjon N Tursunkulov, Yiloren Tanidir, Satyendra Persaud, Mohamed Elshazly, Wissam Kamal, Tzevat Tefik, Anil Shrestha, Ben H Chew, Mohamed A Lakmichi, Andrea B Galosi, Heng C Tiong, Christian Seitz, Bhaskar K Somani","doi":"10.23736/S2724-6051.24.05961-5","DOIUrl":"10.23736/S2724-6051.24.05961-5","url":null,"abstract":"<p><strong>Background: </strong>Suction techniques showed potential to improve outcomes of retrograde intra-renal surgery (RIRS). We assessed the 24-hour stone-free rate (SFR) and complications after RIRS using flexible and navigable suction ureteral access sheaths (FANS-UAS).</p><p><strong>Methods: </strong>Sixteen centers prospectively contributed to data (August 2023-October 2023). Inclusion criteria: age ≥18 years, single renal stone, pre and 24-hour post-RIRS CT scan. Exclusion criteria were: ureteral stone, anomalous kidney, multiple stones. SFR was divided into: 1) grade A - no fragments; 2) grade B - fragments ≤2 mm; 3) grade C - fragments 2.1-4 mm; and 4) grade D - fragments >4 mm. A multivariable logistic regression analysis model was performed to assess factors associated with the odds of having grade A stone-free status. Data are expressed as median (interquartile range), absolute numbers and frequencies, odds ratio (OR), and 95% confidence interval (CI).</p><p><strong>Results: </strong>One hundred forty-two patients with a median age of 52 years (40-61) were enrolled. 61.3% were males. Median stone volume was 1165 mm<sup>3</sup> (656-1936). Median operative time was 48.5 (36.25-71.75) min. Transient fever (37°C-37.5°C) occurred in 10 (7%) patients. No sepsis case occurred. 96.5% of patients were stone-free (Grade A+B). Grade A SFR was 52.8%. All patients were discharged within 48 hours. Bone window (OR 3.156 95% CI 1.177-9.130, P=0.027) was the only factor significantly associated with higher odds of 100% SFR, while stone volume (OR 0.999, 95% CI 0.999-1.000, P=0.007) was significantly associated with lower odds.</p><p><strong>Conclusions: </strong>Imaging and clinical evidence demonstrate excellent perioperative outcomes just 24 hours post RIRS with FANS-UAS. The technique demonstrates a good safety profile, ability for immediate high SFR, and a low rate of infective complications.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 5","pages":"625-634"},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332209","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}
Vincenzo Ficarra, Riccardo Bartoletti, Marco Borghesi, Orazio Caffo, Cosimo DE Nunzio, Ugo G Falagario, Giorgio Gandaglia, Gianluca Giannarini, Andrea Minervini, Vincenzo Mirone, Francesco Porpiglia, Bernardo Rocco, Andrea Salonia, Paolo Verze, Giuseppe Carrieri
{"title":"Organized prostate cancer screening program: a proposal from the Italian Society of Urology (SIU).","authors":"Vincenzo Ficarra, Riccardo Bartoletti, Marco Borghesi, Orazio Caffo, Cosimo DE Nunzio, Ugo G Falagario, Giorgio Gandaglia, Gianluca Giannarini, Andrea Minervini, Vincenzo Mirone, Francesco Porpiglia, Bernardo Rocco, Andrea Salonia, Paolo Verze, Giuseppe Carrieri","doi":"10.23736/S2724-6051.24.06117-2","DOIUrl":"10.23736/S2724-6051.24.06117-2","url":null,"abstract":"<p><p>To contrast opportunistic PCa screening, the European Union Council suggested extending screening programs to PCa by recommending the implementation of a stepwise approach in the EU Countries to evaluate the feasibility and effectiveness of an organized program based on PSA testing in combination with additional MRI as a follow-up test. The objective of this expert-based document is to propose an organized PCa screening program according to the EU Council recommendations. The Italian Society of Urology (SIU) developed a team of experts with the aim to report 1) the most recent epidemiologic data about incidence, prevalence, and mortality of PCa; 2) the most important risk factors to identify categories of men with an increased risk to eventually develop the disease; 3) the most relevant studies presenting data on population-based screening; and 4) the current recommendations of the leading International Guidelines. According to previous evidence, the Panel proposed some indications to develop a new organized PCa screening program for asymptomatic men with a life-expectancy of at least fifteen years. The SIU Panel strongly supports the implementation of a pilot, organized PCa screening program inviting asymptomatic men in the age range of 50-55 years. Invited men who are already performing opportunistic screening will be randomized to continue opportunistic screening or to cross into the organized protocol. Men with PSA level ≤3 ng/mL and familiarity for PCa received a DRE as well as all those with PSA levels >3 ng/mL. All other men with PSA levels greater than 3 ng/mL proceed to secondary testing represented by mpMRI. Men with Prostate Imaging-Reporting and Data System (PI-RADS) lesions 3 and PSAD 0.15 ng/mL/cc or higher as well as those with PI-RADS 4-5 lesions proceed to targeted plus systematic prostate biopsy. The primary outcome of the proposed pilot PCa screening program will be the detection rate of clinically significant PCa defined as a tumor with a ISUP Grade Group ≥2. Main secondary outcomes will be the detection rate of aggressive PCa (ISUP Grade Group ≥4); the detection rate of insignificant PCa (ISUP Grade Group 1); the number of unnecessary prostate biopsy avoided, the metastasis-free survival, and the overall survival. Men will be invited over a one-year period. Preliminary analyses will be planned 2 and 5 years after the baseline enrollment. According to the recent EU Council recommendations on cancer screening, pilot studies evaluating the feasibility and effectiveness of PCa screening programs using PSA as the primary and mpMRI as the secondary screening test in selected cohorts of patients must be strongly promoted by scientific societies and supported by national governments.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 5","pages":"519-529"},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332210","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}
Alberto Martini, Jean-Christophe Bernhard, Ugo G Falagario, Guillaume Herman, Arna Geshkovska, Zine-Eddine Khene, François Audenet, Cecile Champy, Franck Bruyere, Muriel Rolland, Thibaut Waeckel, Martin Lorette, Nicolas Doumerc, Louis Surlemont, Bastien Parier, Thibault Tricard, Nicolas Branger, Constance Michel, Gaëlle Fiard, Alexis Fontenil, Maxime Vallée, Julien Guillotreau, Jean-Jacques Patard, Charlotte Joncour, Romain Boissier, Idir Ouzaid, Frédéric Panthier, Olivier Belas, Richard Mallet, Pierre Gimel, Stéphane DE Vergie, Pierre Bigot, Jean B Beauval
{"title":"Oncologic surveillance after surgical treatment for clinically localized kidney cancer: UroCCR study n. 129.","authors":"Alberto Martini, Jean-Christophe Bernhard, Ugo G Falagario, Guillaume Herman, Arna Geshkovska, Zine-Eddine Khene, François Audenet, Cecile Champy, Franck Bruyere, Muriel Rolland, Thibaut Waeckel, Martin Lorette, Nicolas Doumerc, Louis Surlemont, Bastien Parier, Thibault Tricard, Nicolas Branger, Constance Michel, Gaëlle Fiard, Alexis Fontenil, Maxime Vallée, Julien Guillotreau, Jean-Jacques Patard, Charlotte Joncour, Romain Boissier, Idir Ouzaid, Frédéric Panthier, Olivier Belas, Richard Mallet, Pierre Gimel, Stéphane DE Vergie, Pierre Bigot, Jean B Beauval","doi":"10.23736/S2724-6051.24.05857-9","DOIUrl":"10.23736/S2724-6051.24.05857-9","url":null,"abstract":"<p><strong>Background: </strong>In 2021, the EAU Guidelines implemented a novel, expert opinion-based follow-up scheme, with a three-risk-category system for clear cell (cc) and non-cc renal cell carcinoma (non-ccRCC) after surgery with curative intent. We aimed to validate the novel follow-up scheme and provide data-driven recurrence estimates according to risk groups, to confirm or implement the oncologic surveillance strategy.</p><p><strong>Methods: </strong>We identified 5,320 patients from a prospectively maintained database involving 28 French referral centers. The risk of recurrence, as either loco-regional or distant, was evaluated with the Kaplan-Meier method for each group (low- intermediate- or high-risk) according to ccRCC or non-ccRCC histology. The noncumulative distribution of recurrences was graphically investigated through the LOWESS smoother.</p><p><strong>Results: </strong>Two thousand two hundred ninety-three (58%), 926 (23%), and 738 (19%) had low-, intermediate, and high-risk ccRCC, and 683 (50%), 297 (22%), and 383 (28%) had low-, intermediate, and high-risk non-ccRCC, respectively. Median follow-up for survivors was 46 months. Overall, 661 patients experienced recurrence. Over time, the noncumulative risk of recurrence was approximately 10% for low-risk cc-RCC, non-ccRCC, and intermediate-risk non-ccRCC, with non-significant difference among the three recurrence functions (P=0.9). At 5-year, time point after which imaging should be de-intensified to biennial, the noncumulative risks of recurrence were: for intermediate risk ccRCC and non-ccRCC: 15% and 11%, respectively; for high-risk ccRCC and non-ccRCC: 24% and 8%, respectively. Among high-risk non-ccRCC patients there were 9 recurrences at 3-month. There was no significant difference between the recurrence function of high-risk non-ccRCC patients with negative imaging at 3-month and the one of intermediate-risk ccRCC (P=0.3).</p><p><strong>Conclusions: </strong>Given the relatively low recurrence risk of patients with intermediate-risk non-ccRCC, those individuals could be followed up with a similar strategy to the low-risk category. Similarly, patients with high-risk non-ccRCC with negative imaging at 3-month, could be followed up similarly to intermediate-risk ccRCC after the 3-month time point.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 5","pages":"578-587"},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332208","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}
Francesco DI Rocco, Giulia Dal Gesso, Eleonora Rosato, Enrico Finazzi Agrò, Hein VAN Poppel, Jens Rassweiler, Philip E VAN Kerrebroeck, Simone Albisinni
{"title":"Are Italian urologists and nurses ready for electronic instructions for use? A nationwide survey.","authors":"Francesco DI Rocco, Giulia Dal Gesso, Eleonora Rosato, Enrico Finazzi Agrò, Hein VAN Poppel, Jens Rassweiler, Philip E VAN Kerrebroeck, Simone Albisinni","doi":"10.23736/S2724-6051.24.05966-4","DOIUrl":"10.23736/S2724-6051.24.05966-4","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"536-539"},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753377","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}
Francesco Dibitetto, Roberto Castellucci, Pierluigi Russo, Filippo Marino, Filippo Gavi, Mauro Ragonese, Nazario Foschi, Domenico Nigro, Asgar Akhundov, Lorenzo Defidio, Salvatore Sansalone, Luca Cindolo, Mauro DE Dominicis
{"title":"Extraperitoneal robot-assisted radical prostatectomy by the da Vinci and Versius System: first comparative analysis.","authors":"Francesco Dibitetto, Roberto Castellucci, Pierluigi Russo, Filippo Marino, Filippo Gavi, Mauro Ragonese, Nazario Foschi, Domenico Nigro, Asgar Akhundov, Lorenzo Defidio, Salvatore Sansalone, Luca Cindolo, Mauro DE Dominicis","doi":"10.23736/S2724-6051.24.05792-6","DOIUrl":"10.23736/S2724-6051.24.05792-6","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted surgery (particularly with the da Vinci Surgical System) has revolutionized urological interventions. The advent of the Versius Surgical System introduces a compelling alternative. This study compares outcomes of extraperitoneal robot-assisted radical prostatectomy (eRARP) using da Vinci and Versius, presenting the largest case series to date.</p><p><strong>Methods: </strong>A retrospective analysis of 106 consecutive patients undergoing eRARP (July 2021-July 2023) with da Vinci and Versius. Surgical techniques involved extraperitoneal approaches, with a single surgeon ensuring consistency. Baseline characteristics, perioperative outcomes, and pathology results were analyzed.</p><p><strong>Results: </strong>Baseline characteristics were comparable between da Vinci and Versius groups. While no significant differences were observed in overall operative time, estimated blood loss, and length of hospital stay, variations were noted in pelvic lymphadenectomy rates and nerve-sparing procedures. Pathology results revealed no significant disparities in International Society of Urological Pathology (ISUP) grades and positive surgical margins. However, a notable difference emerged in pathological N stage, with Versius showing a higher percentage of positive lymph nodes.</p><p><strong>Conclusions: </strong>This study provides a comprehensive comparative analysis of da Vinci and Versius in eRARP, representing the largest case series to date. While overall outcomes were similar, nuances in lymphadenectomy rates and Pathological N stage merit attention. Ongoing research and longer-term follow-up will refine our understanding, guiding urological surgeons in optimal robotic system selection.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"570-577"},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876741","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}
Roxana Ramos-Carpinteyro, Nicolas Soputro, Adriana M Pedraza, Ruben S Calvo, Michael Raver, Celeste Manfredi, Yuzhi Wang, Jaya S Chavali, Kennedy Okhawere, Carter Mikesell, Ethan Ferguson, Michael Stifelman, Ketan K Badani, Riccardo Autorino, Craig Rogers, Mutahar Ahmed, Zeyad R Schwen, Simone Crivellaro, Jihad Kaouk
{"title":"Incidental prostate carcinoma after single-port robot-assisted simple prostatectomy: a multi-institutional report (SPARC).","authors":"Roxana Ramos-Carpinteyro, Nicolas Soputro, Adriana M Pedraza, Ruben S Calvo, Michael Raver, Celeste Manfredi, Yuzhi Wang, Jaya S Chavali, Kennedy Okhawere, Carter Mikesell, Ethan Ferguson, Michael Stifelman, Ketan K Badani, Riccardo Autorino, Craig Rogers, Mutahar Ahmed, Zeyad R Schwen, Simone Crivellaro, Jihad Kaouk","doi":"10.23736/S2724-6051.24.05886-5","DOIUrl":"10.23736/S2724-6051.24.05886-5","url":null,"abstract":"<p><strong>Background: </strong>Single-port robot-assisted simple prostatectomy is a minimally invasive alternative for patients with large benign prostatic hyperplasia with severe symptoms and/or failure of medical treatment. In recent literature, the rate of incidental prostate cancer after simple prostatectomy ranges from 1.8% to 13.0%. Our objective is to report the rate of incidental prostate cancer after single-port robot-assisted simple prostatectomy and to compare our findings to other approaches.</p><p><strong>Methods: </strong>A Single-Port Advanced Research Consortium [SPARC] multi-institutional retrospective analysis of all initial consecutive single-port robot-assisted simple prostatectomy cases performed from 2019 to 2023 by eleven surgeons from six centers. Our primary outcome was the rate of incidental prostate cancer in adenoma specimens. We used descriptive statistics to analyze the data.</p><p><strong>Results: </strong>A total of 235 cases were performed successfully without conversions or additional ports. Eleven patients (4.6%) were found to have incidental prostate cancer on pathological analysis. The median percentage of tissue involved by the tumor was 5%. The overall rate of clinically significant prostate cancer was 2.1%. Most cases were Gleason Grade Group 1 (55%). Those with Grade Group ≤3 were subsequently managed with active surveillance with a median follow-up of 17 months. A patient with Gleason Grade Group 4 underwent an uncomplicated multi-port robot-assisted radical prostatectomy with satisfactory functional and oncological outcomes.</p><p><strong>Conclusions: </strong>Initial multi-institutional experience with single-port robot-assisted simple prostatectomy showed an incidental prostate cancer rate of 4.6%, comparable to MP, laparoscopic, and open techniques.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 5","pages":"588-595"},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332207","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}
Alberto Piana, Alessio Pecoraro, Alicia López-Abad, Thomas Prudhomme, Beatriz Bañuelos Marco, Hakan Bahadir Haberal, M İrfan Dönmez, Riccardo Campi, Angelo Territo
{"title":"Comment on: \"URS for de-novo urolithiasis after kidney transplantation: a systematic review of the literature\".","authors":"Alberto Piana, Alessio Pecoraro, Alicia López-Abad, Thomas Prudhomme, Beatriz Bañuelos Marco, Hakan Bahadir Haberal, M İrfan Dönmez, Riccardo Campi, Angelo Territo","doi":"10.23736/S2724-6051.24.06160-3","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.06160-3","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 5","pages":"667-669"},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332205","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}
Vincenzo Ficarra, Riccardo Bartoletti, Marco Borghesi, Cosimo DE Nunzio, Ugo G Falagario, Giorgio Gandaglia, Gianluca Giannarini, Andrea Minervini, Vincenzo Mirone, Francesco Porpiglia, Bernardo Rocco, Andrea Salonia, Paolo Verze, Giuseppe Carrieri
{"title":"Prostate cancer diagnostic pathway in men with lower urinary tract symptoms or performing opportunistic screening: The Italian Society of Urology (SIU) position paper.","authors":"Vincenzo Ficarra, Riccardo Bartoletti, Marco Borghesi, Cosimo DE Nunzio, Ugo G Falagario, Giorgio Gandaglia, Gianluca Giannarini, Andrea Minervini, Vincenzo Mirone, Francesco Porpiglia, Bernardo Rocco, Andrea Salonia, Paolo Verze, Giuseppe Carrieri","doi":"10.23736/S2724-6051.24.06118-4","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.06118-4","url":null,"abstract":"<p><strong>Background: </strong>Voluntary PCa screening frequently results in excessive use of unnecessary diagnostic tests and an increasing risk of detection of indolent PCa and unaffordable costs for the various national health systems. In this scenario, the Italian Society of Urology (Società Italiana di Urologia, SIU) proposes an organized flow chart guiding physicians to improve early diagnosis of significant PCa avoiding unnecessary diagnostic tests and prostate biopsy.</p><p><strong>Methods: </strong>According to available evidence and international guidelines [i.e., European Association of Urology (EAU), American Association of Urology (AUA) and National Comprehensive Cancer Network (NCCN)] on PCa, a Panel of expert urologists selected by Italian Society of Urology (SIU, Società Italiana di Urologia) proposed some indications to develop a stepwise diagnostic pathway based on the diagnostic tests mainly used in the clinical practice. The final document was submitted to six expert urologists for external revision and approval. Moreover, the final document was shared with patient advocacy groups.</p><p><strong>Results: </strong>In voluntary men and symptomatic patients with elevated PSA value (>3 ng/mL), the Panel strongly discourage the use of antibiotic agents in absence of urinary tract infection confirmed by urine culture. DRE remains a key part of the urologic physical examination helping urologists to correctly interpret PSA elevation and prioritizing the execution of multiparametric Magnetic Resonance Imaging (mpMRI) in presence of suspicious PCa. Men with negative mpMRI and low clinical suspicion of PSA (PSA density < 0.20 ng/mL/cc, negative DRE findings, no family history) can be further monitored. Men with negative mpMRI and a higher risk of PCa (familial history, suspicious DRE, PSAD>0.20 ng/mL/cc or PSA>20 ng/mL) should be considered for systematic prostate biopsy. While PI-RADS 4-5 lesions represent a strong indication for prostate biopsy, PI-RADS 3 lesions should be further stratified according to PSAD values and prostate biopsy performed when PSAD is higher than 0.20. Accreditation, certification, and quality audits of radiologists and centers performing prostatic mpMRI should be strongly considered. The accessibility and/or the waiting list for MRI examinations should be also evaluated in the diagnostic pathway. The panel suggests performing transperineal or transrectal targeted plus systematic biopsies as standard of care.</p><p><strong>Conclusions: </strong>Scientific societies must support the use of shared diagnostic pathway with the aim to increase the early detection of significant PCa reducing a delayed diagnosis of advanced PCa. Moreover, a shared diagnostic pathway can reduce the incorrect use of antibiotic, the number of unnecessary laboratory and radiologic examinations as well as of prostate biopsies.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 5","pages":"530-535"},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332214","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}
Federico Piramide, Fabrizio DI Maida, Carlo A Bravi, Filippo Turri, Iulia Andras, Edward Lambert, Christoph Würnschimmel, Mike Wenzel, Marcio Covas Moschovas, Ahmed Eraky, Danny D Carbin Joseph, Nikolaos Liakos, Marco Paciotti, Gabriele Sorce, Stefano Tappero, Paolo Dell'oglio, Ruben DE Groote, Alessandro Larcher
{"title":"Balancing oncological control and renal function: the emerging role of robotic distal ureterectomy in upper tract urothelial carcinoma.","authors":"Federico Piramide, Fabrizio DI Maida, Carlo A Bravi, Filippo Turri, Iulia Andras, Edward Lambert, Christoph Würnschimmel, Mike Wenzel, Marcio Covas Moschovas, Ahmed Eraky, Danny D Carbin Joseph, Nikolaos Liakos, Marco Paciotti, Gabriele Sorce, Stefano Tappero, Paolo Dell'oglio, Ruben DE Groote, Alessandro Larcher","doi":"10.23736/S2724-6051.24.06159-7","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.06159-7","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 5","pages":"663-666"},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332204","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}