Minerva Urology and Nephrology最新文献

{"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}

{"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":"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}

{"title":"Primary pyeloplasty for uretero-pelvic obstruction in the USA adult population with or without double-J indwelling ureteral stents. Insurance claims data on contemporary time to removal trends, perioperative complications, health care costs, and re-intervention rates.","authors":"Francesco Del Giudice, Deok Hyun Han, Anas Tresh, Shufeng Li, Satvir Basran, Vincenzo Asero, Carlo Maria Scornajenghi, Dalila Carino, Roberta Corvino, Matteo Ferro, Felice Crocetto, Benjamin Pradere, Andrea Gallioli, Wojciech Krajewski, Łukasz Nowak, Jan Łaszkiewicz, Tomasz Szydełko, Bernardo Rocco, Maria Chiara Sighinolfi, Ettore De Berardinis, Jonathan Kam, Rajesh Nair, Benjamin I Chung","doi":"10.23736/S2724-6051.24.05834-8","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05834-8","url":null,"abstract":"<p><strong>Background: </strong>Using a large population-based dataset, we primarily sought to compare postoperative complications, health-care expenditures, and re-intervention rates between patients diagnosed with ureteropelvic junction obstruction (UPJO) undergoing stented vs. non-stented pyeloplasty. The secondary objective was to investigate factors that influence the timing of DJ stent removal.</p><p><strong>Methods: </strong>Patients ≥18 years old with UPJO treated with primary open or minimally-invasive pyeloplasty were identified using the Merative™ Marketscan^® Databases between 2007-2021. Multivariable modeling was implemented to investigate the association between Double-J (DJ) stent placement and post-pyeloplasty complications, hospital costs, and re-intervention rates and the role of the perioperative predictors on time to DJ stent removal. Subgroup analyses stratified by ureteral stenting duration were additionally performed.</p><p><strong>Results: </strong>Out of 4872 patients who underwent primary pyeloplasty, 4154 (85.3%) had DJ placement. Postoperative complications were rare (N.=218, 4.47%) and not associated with ureteral stenting (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.55-1.12). The median cost for in-hospital charges was $21,775, with DJ stent placement independently increasing the median aggregate amount (OR: 1.29, 95% CI: 1.09-1.53). Overall, re-interventions were performed in 21.18% of patients, with DJ stenting found to be protective (OR: 0.79, 95% CI: 0.66-0.96). Higher Charlson Comorbidity Index, longer hospital stay, and open surgical approach were independent predictors for prolonged DJ stenting time to removal.</p><p><strong>Conclusions: </strong>Our study suggests that patients undergoing stent-less pyeloplasty did have a higher rate of secondary procedures, but not higher complications when compared to those undergoing stented procedures. Concurrently, the non-stented approach is associated with decreased health-care expenditures, despite the increased rates of secondary procedures.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 5","pages":"606-617"},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332213","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 - Hugo RAS platform for robotic partial nephrectomy: more evidence needed.","authors":"Riccardo Bertolo, Riccardo Campi, Daniele Amparore","doi":"10.23736/S2724-6051.24.06113-5","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.06113-5","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 5","pages":"657-659"},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332217","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":"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":"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}

{"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":"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}

{"title":"If not now, then when? The need for new evidence in the robotic management of upper tract urothelial carcinoma.","authors":"Fabrizio DI Maida, Carlo A Bravi, Ruben DE Groote, Federico Piramide, Filippo Turri, Mike Wenzel, Gopal Sharma, Christoph Würnschimmel, Iulia Andras, Edward Lambert, Paolo Dell'oglio, Marcio Covas Moschovas, Riccardo Campi, Nikolaos Liakos, Antonio A Grosso, Francesco Montorsi, Alberto Briganti, Alexandre Mottrie, Andrea Minervini, Alessandro Larcher","doi":"10.23736/S2724-6051.24.05795-1","DOIUrl":"10.23736/S2724-6051.24.05795-1","url":null,"abstract":"<p><p>Current guidelines recommend radical nephroureterectomy with bladder cuff excision as the standard surgical treatment for high-risk upper tract urothelial carcinoma (UTUC). While large evidence is available regarding open and laparoscopic nephroureterectomy, data focusing on robotic nephroureterectomy (RNU) in UTUC are mostly limited with mixed results, especially in locally advanced disease. In light of the recent introduction of new robotic platforms, it is of utmost importance to further investigate oncologic outcomes associated with RNU. Moreover, stronger data exploring different operative settings (i.e. robotic arms and trocars placement) for the new robotic systems are eagerly warranted. To give an answer to such open clinical questions, the Junior ERUS/Young Academic Urologist Working Group on Robot-assisted Surgery designed a multicentric project involving different high-volume centers across the world. The aim of the study will be exploring surgical and oncologic outcomes of RNU, specifically focusing on several clinical unmet needs, such as best operative setting for new robotic platforms, lymph node dissection (LDN) template and robotic bladder cuff management.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"640-645"},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753380","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":"Effect of irrigation solution temperature on complications of percutaneous nephrolithotomy: a systematic review of the literature, meta-analysis and trial sequential analysis of randomized clinical trials.","authors":"Henrique L Lepine, Fernanda M Llata, Breno C Porto, Nathalie C Hobaica, Carlo C Passerotti, Rodrigo A Sanderberg, Everson L Artifon, Jose P Otoch, Jose A da Cruz","doi":"10.23736/S2724-6051.24.05731-8","DOIUrl":"10.23736/S2724-6051.24.05731-8","url":null,"abstract":"<p><strong>Introduction: </strong>The optimal temperature of irrigation solution in patients undergoing PCNL is still unclear. Accordingly, this study aims to investigate the effects of different irrigation solution temperatures (cold/room temperature irrigation fluid versus warm/body temperature fluid). Our primary endpoint was hypothermia rate. Secondary outcomes were shivering rate, mean temperature decrease, mean patient final temperature, blood loss, and operative time.</p><p><strong>Evidence acquisition: </strong>This systematic review was conducted in accordance with PRISMA guidelines. Multiple databases were searched in November 2023. Among 299 studies screened, eight were selected for full-text review, resulting in four randomized clinical trials that fit inclusion criteria and desired outcomes. Studies selection and data extraction were performed by multiple reviewers and a random-effects model was used for pooling of data.</p><p><strong>Evidence synthesis: </strong>The primary outcome, hypothermia rate, showed a significant statistical difference between groups, occurring less frequently in the experimental group (35-37 ºC) than in the cold/room temperature irrigation group (RR 0.64;95%CI 0.46, 0.89; P<0.008; I²=33%). Secondary outcomes such as shivering rate (RR 0.46; 95%CI 0.31, 0.67; P<0.0001; I²=0%) and mean final temperatures (MD 0.43; 95%CI 0.12, 0.75; I²=82%) also showed statistically significant differences between groups, favoring the irrigation with heated fluid.</p><p><strong>Conclusions: </strong>There was a decreased rate of hypothermia and shivering among patients undergoing PCNL with warm irrigation fluid. Mean final temperatures were also higher in the experimental group. As to blood loss, mean hemoglobin decrease showed no statistically significant difference between groups, prompting further investigation of the influence of Irrigation solution temperature on blood loss volume.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"554-562"},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180999","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 single port robotic surgical \"toolbox\": a primer for beginners.","authors":"Francesco Ditonno, Antony A Pellegrino, Antonio Franco, Luca Morgantini, Celeste Manfredi, Eugenio Bologna, Leslie Claire Licari, Francesco Porpiglia, Alessandro Antonelli, Simone Crivellaro, Riccardo Autorino","doi":"10.23736/S2724-6051.24.05766-5","DOIUrl":"10.23736/S2724-6051.24.05766-5","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study is to provide a comprehensive overview of the da Vinci Single Port robotic platform, including instruments and tools that can aid in implementing the use of this novel platform.</p><p><strong>Methods: </strong>Footage recorded during various Single port robotic urologic procedures and dry labs performed at two US institutions was used as video material. A step-by-step guide illustrating key points on OR set-up, platform, instruments, trocar configurations, intraoperative suctioning, bedside assistance were discussed and highlighted.</p><p><strong>Results: </strong>The Single port surgeon console resembles the Xi console but includes upgraded software. The 6-mm biarticulated instruments incorporate an elbow and a wrist flexible joint. These instruments are deployed through the Access port. Access port kit includes the Access port, and a 25-mm multichannel trocar accommodating an 8-mm flexible scope, and three 6-mm robotic instruments. The 0° endoscope has two sets of articulation: a fixed one, and a distal one, allowing for three movements, selected with a hand command, the \"Camera Adjust\", the \"Camera Control\" and the \"Relocation.\" The \"Cobra mode,\" is an extra setting that allows the camera to wing out and move laterally relative to the working instruments. Suction is preferably performed with the Remotely Operated Suction Irrigation system.</p><p><strong>Conclusions: </strong>Herein we provide a detailed guide to the main technical nuances of the Single port platform and a practical overview of the instrumentation that is used during Single port robotic procedures. Knowledge of the toolbox that is used during Single port robotic surgery is key for those approaching for the first time this novel technology.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 5","pages":"635-639"},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332215","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":"Embracing innovation while preserving tradition: single-port robotics landing in Europe.","authors":"Riccardo Bertolo, Alessandro Veccia, Alessandro Antonelli","doi":"10.23736/S2724-6051.24.06037-3","DOIUrl":"10.23736/S2724-6051.24.06037-3","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"652-653"},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753379","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}