Minerva Urology and Nephrology最新文献

{"title":"A pretreatment nomogram to predict muscle-invasiveness in high-risk upper tract urothelial carcinoma (ROBUUST 2.0 collaborative group).","authors":"Francesco Ditonno, Antonio Franco, Eugenio Bologna, Alessandro Veccia, Riccardo Bertolo, Linhui Wang, Firas Abdollah, Marco Finati, Giuseppe Simone, Gabriele Tuderti, Emma Helstrom, Andres Correa, Ottavio De Cobelli, Matteo Ferro, Francesco Porpiglia, Daniele Amparore, Enrico Checcucci, Antonio Tufano, Sisto Perdonà, Raj Bhanvadia, Vitaly Margulis, Stephan Broenimann, Nirmish Singla, Dhruv Puri, Ithaar H Derweesh, Dinno F Mendiola, Mark L Gonzalgo, Reuben Ben-David, Reza Mehrazin, Sol C Moon, Soroush Rais-Bahrami, Courtney Yong, Chandru P Sundaram, Farshad S Moghaddam, Alireza Ghoreifi, Hooman Djaladat, Riccardo Autorino, Zhenjie Wu, Alessandro Antonelli","doi":"10.23736/S2724-6051.25.05934-8","DOIUrl":"https://doi.org/10.23736/S2724-6051.25.05934-8","url":null,"abstract":"<p><strong>Background: </strong>The ability to predict muscle invasion in the final pathology of upper tract urothelial carcinoma (UTUC) patients after radical nephroureterectomy (RNU) potentially influences the selection of the most appropriate treatment modality. The present study aims to develop a model predicting muscle-invasive status in high-risk UTUC.</p><p><strong>Methods: </strong>The ROBUUST (RObotic surgery for Upper tract Urothelial cancer - UTUC - STudy) 2.0 dataset is an international, multicenter registry of patients undergoing curative surgery for UTUC between 2015 and 2022. Data about high-risk patients, classified according to EAU and NCCN prognostic stratification criteria, who underwent RNU were retrieved. The primary outcome was the identification of muscle-invasiveness. Two multivariable models, differing in the inclusion of biopsy-related data, were fitted with pT stage results at final pathology. Their predictive ability was calculated using the area under the receiver operating characteristic curve and decision curve analysis (DCA). A nomogram was developed using the model demonstrating the highest area under the curve (AUC) and clinical net benefit.</p><p><strong>Results: </strong>In the overall cohort, 1558 patients met the inclusion criteria, with 934 patients having ≥pT2 disease. Patients in the ≥pT2 cohort had significantly worse oncological outcomes in terms of metastases, all-cause, and cancer-specific deaths (all P<0.001). The biopsy-related model had the highest AUC (74%) and the highest net benefit in DCA. The DCA showed an improvement in the clinical risk prediction of muscle-invasiveness, and a reduction in the number of upfront or unnecessary RNU, at every ≥pT2 probability threshold.</p><p><strong>Conclusions: </strong>The proposed prognostic model is a valuable tool for estimating the risk of muscle-invasiveness in high-risk UTUC patients, owing to its optimal predictive ability and user-friendly design.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"77 1","pages":"57-68"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782068","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":"Assessing the influence of smoking on inflammatory markers in bacillus Calmette Guérin response among bladder cancer patients: a novel machine-learning approach.","authors":"Matteo Ferro, Octavian S Tataru, Giuseppe Fallara, Cristian Fiori, Matteo Manfredi, Francesco Claps, Rodolfo Hurle, Nicolò M Buffi, Giovanni Lughezzani, Massimo Lazzeri, Achille Aveta, Savio D Pandolfo, Biagio Barone, Felice Crocetto, Pasquale Ditonno, Giuseppe Lucarelli, Francesco Lasorsa, Giuseppe Carrieri, Gian M Busetto, Ugo G Falagario, Francesco Del Giudice, Martina Maggi, Francesco Cantiello, Marco Borghesi, Carlo Terrone, Pierluigi Bove, Alessandro Antonelli, Alessandro Veccia, Andrea Mari, Stefano Luzzago, Raul Gherasim, Ciprian Todea-Moga, Andrea Minervini, Gennaro Musi, Francesco A Mistretta, Roberto Bianchi, Marco Tozzi, Francesco Soria, Paolo Gontero, Michele Marchioni, Letizia M Janello, Daniela Terracciano, Giorgio I Russo, Luigi Schips, Sisto Perdonà, Riccardo Autorino, Michele Catellani, Chiara Sighinolfi, Emanuele Montanari, Savino M DI Stasi, Francesco Porpiglia, Bernardo Rocco, Ottavio de Cobelli, Roberto Contieri","doi":"10.23736/S2724-6051.24.05876-2","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05876-2","url":null,"abstract":"<p><strong>Background: </strong>Approximately 70% of bladder cancer is diagnosed as non-muscle invasive (NMIBC) and inflammation is known to impact the oncological outcomes. Adjuvant intravesical BCG in intermediate/high risk can lower recurrence and progression. The efficacy of intravesical BCG can be impacted by smoking effects on systemic inflammation.</p><p><strong>Methods: </strong>Our retrospective, multicenter study with data from 1.313 NMIBC patients aimed to assess the impact of smoking and the systemic inflammatory status on BCG response in T1G3 bladder cancer, using a machine-learning CART based algorithm.</p><p><strong>Results: </strong>In a median of 50-month follow-up (IQR 41-75), 344 patients experienced progression to muscle invasive or metastatic disease and 65 died due to bladder cancer. A CART algorithm has been employed to stratify patients in three prognostic clusters using smoking status, LMR (lymphocytes to monocytes ratio), NLR (neutrophil-to-lymphocyte ratio) and PLR (platelet-to-lymphocyte ratio) as variables. Cox regression models revealed a 1.5-fold (HR 1.66, 95%, CI 1.20-2.29, P=0.002) and three-fold (HR 2.99, 95% CI 2.08-4.30, P<0.001) risk of progression, in intermediate and high risk NMIBC respectively, compared to the low-risk group. The model's concordance index was 0.66.</p><p><strong>Conclusions: </strong>Our study provides an insight into the influence of smoking on inflammatory markers and BCG response in NMIBC patients. Our machine-learning approach provides clinicians a valuable tool for risk stratification, treatment, and decision-making. Future research in larger prospective cohorts is required for validating these findings.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774689","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":"Which is easier for beginners: supine or prone position percutaneous nephrolithotomy? Assessment of the learning curve in novice urologists through a randomized clinical trial.","authors":"Ahmed Zoeir, Hussein Mamdoh, Ayman Moussa, Ali Abdel-Raheem, Tarek Gameel, Ahmed Elsherbeny, Abdullah Al Debeiky, Khaled Almekaty, Maged Ragab, Ahmed Tawfik, Stefano Puliatti, Stefania Ferretti, Salvatore Micali, Silvia Proietti, Mon Mon Oo, Guido Giusti, Osama Elashry, Abdelhamid Elbahnasy, Magdy Sabaa, Mohamed Abo El-Enen, Giampaolo Bianchi, Ahmed Eissa","doi":"10.23736/S2724-6051.24.05974-3","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05974-3","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous nephrolithotomy (PCNL) could be performed in both prone and supine positions. Each position has its own advantages and disadvantages. \"Learning curve\" is a graph that represents progress of a skill against the time needed to master the technique. We hypothesized that supine PCNL might have a shorter learning curve by novice urologists compared to prone PCNL based on the findings of previous studies assessing the learning curve of both techniques. The aim of this study is to assess the learning curve of prone and supine PCNL among novice urologists to detect which is easier for the beginners.</p><p><strong>Methods: </strong>One hundred and fifty patients undergoing PCNL for renal stones were included and divided into two groups; Group A included 75 patients undergoing supine PCNL and Group B included 75 patients undergoing prone PCNL. Subsequently, each group was subdivided into three subgroups of 25 patients to allow the evaluation of the learning curve of the two novice surgeons as regards: operative time, fluoroscopy time, stone free rate, and complications.</p><p><strong>Results: </strong>The mean operative time in group A decreased from of 111.8±13.91 minutes to 84.2±15.86 minutes, and thereafter, decreased to 78.4±12.97 minutes in the three consecutive subgroups. Similarly, in group B, the mean operative time decreased from 122±23.76 minutes to 110.2±17.05 minutes, and thereafter, further decreased to 82±15.34 minutes. The operative time plateau was reached after 25 and 50 cases in groups A and B, respectively. The overall stone free rate, and complications were comparable in both groups.</p><p><strong>Conclusions: </strong>Both supine and prone PCNL are safe and effective; however, supine PCNL may be associated with significantly shorter learning curve.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 6","pages":"748-758"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016190","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 and validation of a nomogram to predict impacted ureteral stones via machine learning.","authors":"Yuanjiong Qi, Shushuai Yang, Jingxian Li, Haonan Xing, Qiang Su, Siyuan Wang, Yue Chen, Shiyong Qi","doi":"10.23736/S2724-6051.24.05856-7","DOIUrl":"10.23736/S2724-6051.24.05856-7","url":null,"abstract":"<p><strong>Background: </strong>To develop and evaluate a nomogram for predicting impacted ureteral stones using some simple and easily available clinical features.</p><p><strong>Methods: </strong>From June 2019 to July 2022, 480 patients who underwent ureteroscopic lithotripsy (URSL) for ureteral calculi were enrolled in the study. From the eligible study population between June 2019 and December 2020, a training and validation set was randomly generated in a 7:3 ratio. To further evaluate the generalization performance of the nomogram, we performed an additional validation using the data from January 2021 to July 2022. Lasso regression analysis was used to identify the most useful predictive features. Subsequently, a multivariate logistic regression algorithm was applied to select independent predictive features. The predictive performance of the nomogram was assessed using Receiver Operating Characteristic (ROC) curves, calibration curves and decision Curve Analysis (DCA). The Hosmer-Lemeshow Test was utilized to evaluate the overall goodness of fit of the nomogram.</p><p><strong>Results: </strong>Multivariate logistic regression analysis showed that flank pain, hydronephrosis, stone length/width, HU below (Hounsfield unit density of the ureter center below the stone), HU above/below (HU above divided by HU below) and UWT (ureteral wall thickness) were ascertained as independent predictors of impacted ureteral stones. The nomogram showed outstanding performance within the training dataset, with the area under the curve (AUC) of 0.907. Moreover, the AUC was 0.874 in the validation dataset. The ROC curve, calibration curve, DCA curve and Hosmer-Lemeshow Test suggested that the nomogram maintains excellent clinical applicability and demonstrates commendable performance. Similar results were achieved in the test dataset as well.</p><p><strong>Conclusions: </strong>We established a nomogram that can be effectively used for preoperative diagnosis of impacted ureteral stones, which is of great significance for the treatment of this disease.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"736-747"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876740","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":"Pre-clinical evaluation of telesurgery with the Toumai microport: the standpoint from multiplatform users.","authors":"Bernardo Rocco, Vipul Patel, Marcio Covas Moschovas, Giorgia Gaia, Maria C Sighinolfi","doi":"10.23736/S2724-6051.24.06091-9","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.06091-9","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 6","pages":"671-673"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016154","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":"Retroperitoneal approach in robotic partial nephrectomy: unveiling new perspectives on its adoption.","authors":"Filippo Turri, Bernardo Rocco, Chiara Sighinolfi","doi":"10.23736/S2724-6051.24.06271-2","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.06271-2","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 6","pages":"788-790"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016159","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":"Unmet needs in the management of patients with bilateral synchronous renal masses: the rationale for clinical decision-making.","authors":"Pietro Diana, Daniele Amparore, Riccardo Bertolo, Umberto Capitanio, Selcuk Erdem, Onder Kara, Tobias Klatte, Maximilian C Kriegmair, Carme Mir, Eduard Roussel, Riccardo Campi","doi":"10.23736/S2724-6051.24.05894-4","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05894-4","url":null,"abstract":"<p><strong>Background: </strong>Bilateral synchronous renal masses (BSRMs) are a rare finding, and the optimal treatment strategy remains undetermined. This study depicts the management of BSRM at eight European high-volume centers.</p><p><strong>Methods: </strong>This is a retrospective analysis of prospective institutional databases collecting all patients presenting with clinical T1-2 N0 M0 BSRMs between 1993 and 2020 at 8 tertiary referral high-volume centers for renal cancer treatment in Europe. The treatment options included active surveillance (AS), tumor ablation (TA) and surgery (partial and radical nephrectomy).</p><p><strong>Results: </strong>Overall, 134 patients were analyzed. Renal mass biopsy prior treatment was performed in 8% of cases. 15%, 4%, and 81% of patients underwent AS, a combination of surgery and TA, and bilateral (one-stage or two-stage) surgery. Among patients undergoing bilateral surgery (N.=109), a staged approach was chosen in 78% (N.=85) of cases treating the lower complexity tumor first in 51/85 (60%) cases and in 34/85 (40%) treating the higher complexity tumor first. Concordance of the histological analysis was found in 77% of patients with 10% of bilateral benign masses.</p><p><strong>Conclusions: </strong>Even if considering only referral centers, a high heterogeneity for decision-making in the treatment of BSRM should be expected. Advances in genetic diagnosis, the implementation of novel imaging technologies, and the strengthening role of alternative treatment, may lead to a standardized decision-making process in the setting of BSRMs.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 6","pages":"691-697"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016240","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":"Ejaculation preservation in BPH: a question of size?","authors":"Marco Finati, Luca Cindolo, Gian Maria Busetto, Davide Arcaniolo, Sisto Perdonà, Giuseppe Lucarelli, Alessandro Veccia, Achille Aveta, Riccardo Autorino, Savio D Pandolfo","doi":"10.23736/S2724-6051.24.06269-4","DOIUrl":"10.23736/S2724-6051.24.06269-4","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 6","pages":"794-796"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016210","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":"Percutaneous nephrolithotomy vs. robotic pyelolithotomy for large renal stones: an inverse probability treatment weighting analysis.","authors":"Stefano Moretto, Michele Zazzara, Filippo Marino, Mauro Ragonese, Marcello Scarcia, Ugo Gradilone, Pierluigi Russo, Marco Montesi, Nicolò Lentini, Roberta Pastorino, Giuseppe M Ludovico, Francesco Pinto","doi":"10.23736/S2724-6051.24.06074-9","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.06074-9","url":null,"abstract":"<p><strong>Background: </strong>The American Urologic Association (AUA) and the European Association of Urology (EAU) guidelines endorse percutaneous nephrolithotomy (PCNL) for symptomatic stones larger than 20 mm despite significant risks such as bleeding and urosepsis. Robotic pyelolithotomy (RPL) is emerging as an appealing alternative to PCNL, particularly for patients with anatomical variations like pelvic or horseshoe kidneys, malrotation, previous unsuccessful PCNL, and congenital renal anomalies such as ureteropelvic junction obstruction (UPJO).</p><p><strong>Methods: </strong>A retrospective observational study was conducted involving patients from Miulli Hospital and A. Gemelli University Hospital between February 2016 and December 2023. Adults with large renal stones, including both pelvic and caliceal stones, who underwent either RPL or PCNL were included. The primary outcome was the Stone-Free Rate (SFR) at 12 months. Secondary outcomes included operative time, estimated blood loss, delta hemoglobin, delta creatinine, hospital stay length, and complications. This study compares the effectiveness and outcomes of PCNL and RPL using Propensity Score-Inverse Probability Treatment Weighting (PS-IPTW) analysis.</p><p><strong>Results: </strong>No statistically significant differences were found in the 12-month SFR between RPL and PCNL, both in the calyceal-pelvic (73.6% vs. 70.6%; P=0.722) and pelvic groups (91% vs. 91.7%; P=1). Complication rates were also similar between RPL and PCNL in both the calyceal-pelvic (15.4% vs. 14.3%; P=0.856) and renal pelvic groups (27.3% vs. 10.8%; P=0.225, with Clavien-Dindo Grade ≥3 complications in 9% vs. 8.9% and 4.4% vs. 0%, respectively. RPL showed significant advantages in operation time in the pyelocaliceal (P<0.001) and pelvic groups (P=0.006), delta creatinine (P=0.018) in the pyelocaliceal group, and hospital stay length in the pelvic group (P=0.011).</p><p><strong>Conclusions: </strong>RPL demonstrated similar success and complication rates compared to PCNL, with significantly lower intraoperative time, delta creatinine rate, and hospital stay length. RPL is a safe, effective, and minimally invasive treatment option, particularly valuable for large renal stones in patients with complex anatomy and those requiring concomitant renal reconstructive procedures.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 6","pages":"726-735"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016213","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":"What conclusions can (and cannot) be drawn three years after transperineal laser ablation of prostate?","authors":"Paolo Minafra, Gaetano DE Rienzo, Pasquale Ditonno","doi":"10.23736/S2724-6051.24.06008-7","DOIUrl":"10.23736/S2724-6051.24.06008-7","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"804-805"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753381","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}