Purpose There is currently no consensus regarding the optimal treatment strategy for patients presenting with synchronous bilateral renal masses. The decision to perform bilateral procedures on the same intervention or in staged... more
Purpose There is currently no consensus regarding the optimal treatment strategy for patients presenting with synchronous bilateral renal masses. The decision to perform bilateral procedures on the same intervention or in staged procedures is debated. The aim of this manuscript is to analyse the outcomes of simultaneous robot-assisted partial nephrectomy (RAPN) in a series of patients with bilateral renal masses treated at five Italian robotic institutions. Methods Data from a prospectively maintained multi-institutional database on patients subjected to simultaneous RAPN between November 2011 and July 2019 were reviewed. RAPNs were performed with da Vinci Si or Xi surgical system by expert robotic surgeons. Baseline demographics and clinical features, peri- and post-operative data were collected. Results Overall, 27 patients underwent simultaneous bilateral RAPN, and 54 RAPNs were performed without need of conversion; median operative time was 250 minutes, median estimated blood loss was 200 mL. Renal artery clamping was needed for 27 (50%) RAPNs with a median warm ischemia time of 15 minutes and no case of acute kidney injury. Complications were reported in 7 (25.9%) patients, mainly represented by Clavien 2 events (6 blood transfusions). Positive surgical margins were assessed in 2 (3.7%) of the renal cell carcinoma. At the median follow-up of 30 months, recurrence-free survival was 100%. Conclusion Our data showed that, in selected patients and expert hands, simultaneous bilateral RAPNs could be a safe and feasible procedure with promising results for the treatment of bilateral synchronous renal masses.
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In a meaningful proportion of cases, CBAVD has been recognised as a probable consequence of cftr gene mutations. This lead to a further enlargement of the spectrum of clinical pictures due to "cftr deficiency". More recently,... more
In a meaningful proportion of cases, CBAVD has been recognised as a probable consequence of cftr gene mutations. This lead to a further enlargement of the spectrum of clinical pictures due to "cftr deficiency". More recently, the identification of a polymorphism in intron 8 regulating the level of correct cftr transcription, shed new light on the genotype-fenotype correlation of cftr mutations. Unfortunately, little information is still available on the clinical manifestations of CBAVD other than infertility. History, clinical picture, sweat test and genotype were carefully evaluated in a series of 21 patients affected by CBAVD, selected on the basis of otherwise unexplained obstructive azoospermia. History collection was especially addressed to respiratory symptoms. Family history was always negative for CF. Nevertheless, personal history showed respiratory symptoms in 18 cases (86%) 9/21 (43%) patients suffered from chronic sinusitis and one of these had had a pneumothor...
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INTRODUCTION Unusual metastatic sites of renal cell carcinoma (RCC) are not infrequent. We report a rare case of solitary pharyngeal metastasis as first presentation of RCC. CASE DESCRIPTION A 74 years-old man was referred to our hospital... more
INTRODUCTION Unusual metastatic sites of renal cell carcinoma (RCC) are not infrequent. We report a rare case of solitary pharyngeal metastasis as first presentation of RCC. CASE DESCRIPTION A 74 years-old man was referred to our hospital due to rapidly progressive dyspnoea and dysphagia. Physical examination showed a large right para-pharyngeal mass. Imaging findings showed a 5.5 cm mass, suspicious for malignancy, which extended to right para and retro-pharyngeal spaces with compression of the major right cervical vessels, C2-C3 vertebral bodies osteolysis, dural sac compression and dislocation. Futhermore, a small (2.6 × 2 cm) mass located at the upper pole of the right kidney was shown. Patient underwent partial trans-oral removal of the mass. Pathological examination and immunochemistry resulting strongly suggestive for metastatic RCC. Considering the metastatic stage of the tumour and the rapidly progressive clinical worsening with poor performance status, we offered the patie...
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INTRODUCTION To compare oncological and functional results of robot-assisted radical prostatectomy (RARP) and brachytherapy (BT) with a single-center prospective randomized study. MATERIALS AND METHODS From January 2012 to January 2014,... more
INTRODUCTION To compare oncological and functional results of robot-assisted radical prostatectomy (RARP) and brachytherapy (BT) with a single-center prospective randomized study. MATERIALS AND METHODS From January 2012 to January 2014, 165 patients with low risk prostate cancer, prostate volume ≤ 50 g, normal urinary (IPSS ≤ 7 and mean flow rate ≥ 15 mL/sec) and erectile functions (IIEF-5 > 17) were enrolled and randomly assigned to the RARP or BT group. Our end points included the comparison of biochemical recurrence-free survival rates, urinary function (IPSS and EPIC scores) and potency rates (IIEF-5 score) at different time points during the first 2 years after surgery between the two groups. RESULTS The biochemical recurrence-free survival rates were 96.1% and 97.4% for the BT and RARP groups, respectively (p = 0.35). Significantly higher IPSS scores were assessed in the BT than in the RARP group at all the postoperative time points (p < 0.05). Significantly higher conti...
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OBJECTIVES Aim of the study is to verify if a stress reaction due to G8 meeting, held in Genoa on July 2001, can produce a mass stress reaction and influence negatively people sexuality and so the birth rate. MATERIALS AND METHODS 402... more
OBJECTIVES Aim of the study is to verify if a stress reaction due to G8 meeting, held in Genoa on July 2001, can produce a mass stress reaction and influence negatively people sexuality and so the birth rate. MATERIALS AND METHODS 402 citizens (221 men and 181 women ranging in age from 25 to 52 years, mean 39) have been invited to answer two questionnaires concerning their sexual activity and their feelings before, during and after the G8 meeting. After 9,10 and 11 months we have valued the birth rate in Genoa. RESULTS 30 people (7%) did not answer the two questionnaires. 12 people (3%) answered the questionnaire wrongly and were excluded from the study. 228 people (63%) didn't report changes about their sexual activity, during G8 meeting. 120 people (33%) reported a decrease of sexual intercourses and of sexual desire; 12 people (4%) reported an increase of these parameters. 54% of our population reported a definite anxiety. We want to emphasize the high number of people that h...
Research Interests: Italy, Humans, Female, Male, Riots, and 5 moreMiddle Aged, Questionnaires, Adult, Archivio Storico Italiano, and Coitus
OBJECTIVES The Urinary Bladder Cancer (UBC) test is a marker that detects urinary fragments of cytokeratin 8 and 18. The aim of this study is to evaluate the usefulness of the pre and post operative UBC test to detect early recurrences of... more
OBJECTIVES The Urinary Bladder Cancer (UBC) test is a marker that detects urinary fragments of cytokeratin 8 and 18. The aim of this study is to evaluate the usefulness of the pre and post operative UBC test to detect early recurrences of a bladder tumor in the first year after the transurethral resection of a bladder tumor. MATERIALS AND METHODS A multicentric perspective study on 36 patients with superficial bladder cancer (pTa-pT1) treated with transurethral resection (TUR) was performed. Each patient underwent 4 specific urine collections: 1) preoperatively, 2) 3 days after TUR, 3) 7 days after TUR, 4) 30 days after TUR. UBC was analysed on urine with the IRMA method and the cut off value of 12 mg/L was used. Cystoscopy was performed after 3, 6, 9, and 12 months after TUR, with the aim of identifying all cancer recurrences in the first year postoperatively. Statistical analyses to identify differences between patients with or without early recurrence were performed in accordance...
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Objective: To report the results of a survey supported by the Italian Andrological Association (ASS.A.I.), aimed at documenting sexual disorders in a large population of patients who visited general practitioners for general health... more
Objective: To report the results of a survey supported by the Italian Andrological Association (ASS.A.I.), aimed at documenting sexual disorders in a large population of patients who visited general practitioners for general health problems. Methods: Between April and October 2016, 15,000 questionnaires were distributed to general practitioners throughout Italy and made available to all the people who visited the doctor’s offices. The data were collated separately for age ranges, 15–30, 31–50 and 51–65 years, respectively. Results: A final sample of 5441 questionnaires was evaluable (4000 men and 1441 women). Sexual disorders were reported by 1795 out of 5441 (33.0%) patients. Among the male population, phimosis, varicocele, prostate and testicular disorders were the most common conditions interfering with sexuality, being reported by 42.0%, 37.0%, 39.0% and 31.0% of the sample, respectively. Furthermore, erectile dysfunction, sexually transmitted diseases, infertility, premature ej...
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ABSTRACT Introduction: Among the several options that have been proposed in recent years for the management of male stress urinary incontinence (SUI), stem cell therapy represents a new frontier in treatment. The aim of this paper is to... more
ABSTRACT Introduction: Among the several options that have been proposed in recent years for the management of male stress urinary incontinence (SUI), stem cell therapy represents a new frontier in treatment. The aim of this paper is to update the current status of stem cell therapy in animal and human studies for the management of iatrogenic male SUI. Areas covered: A literature review was conducted based on MEDLINE/PubMed searches for English articles using a combination of the following keywords: stem cell therapy, urinary incontinence, prostatectomy, regenerative medicine, mesenchymal stem cells. Expert opinion: The few studies reported in the literature have demonstrated short-term safety and promising results of stem cell therapy in treating male SUI. However, many aspects need to be clarified before stem cell therapy can be introduced into daily urologic practice. In fact, important issues such as the limitations of these studies in terms of small sample sizes and short follow-ups, the incomplete knowledge of the mechanism of action of stem cells, the technical details regarding the delivery method and the best sources of stem cells, the safety risks regarding genomic or epigenetic changes and potential immune reactions in the longer term need to be identified in more stringent clinical trials.
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Research Interests:
To retrospectively report our mid- to long-term results following suburethral tension adjustable sling (Remeex system) implantation for stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). Fifty female patients... more
To retrospectively report our mid- to long-term results following suburethral tension adjustable sling (Remeex system) implantation for stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). Fifty female patients with severe SUI due to ISD underwent Remeex system positioning between May 2002 and March 2013 (mean follow-up 83.8 months, median follow-up 85.4 months). Before surgery, patients were evaluated by physical examination, translabial ultrasonography, cystoscopy, urodynamics, 1 hr pad test and compilation of quality-of-life questionnaire. Postoperatively, based on the physical examination and pad test, patients were stratified into three groups: (i) Cured: perfectly dry patients at stress test, pad weight 0-1 g; (ii) Improved: patients with mild to moderate incontinence, pad weight 2-50 g; and (iii) Failed: unchanged or worsened patients, pad weight >50 g. At 7-years mean follow-up, 45 (90.0%) patients were cured, three (6.0%) were improved, and two ...
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A 66-year-old man presented to hospital with gross hematuria and clots. He had previously undergone surgical repair of a right iliac artery aneurysm with placement of a vascular prosthesis at the same hospital, which had resulted in iliac... more
A 66-year-old man presented to hospital with gross hematuria and clots. He had previously undergone surgical repair of a right iliac artery aneurysm with placement of a vascular prosthesis at the same hospital, which had resulted in iliac urethral stricture that required the placement of a right ureteral stent. He had attended repeatedly for recurrent ureteral stent replacement, with the most recent replacement having occurred 1 month before the current presentation. Ultrasonography, cystography, retrograde pyelography and provocative arteriography via a percutaneous right femoral arterial approach. An iliac-artery-ureteral fistula between the right ureter and a pseudoaneurysm of the right common iliac artery. The patient underwent placement of a covered, self-expandable vascular stent with angioplasty balloon, which resulted in complete exclusion of the pseudoaneurysm and fistula and resolution of the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s hematuria. A pigtail catheter was placed in the right ureter for 5 days and replaced with a double-J ureteral stent on day 6 after exclusion of the pseudoaneurysm; the patient was discharged from hospital on the same day. Color-Doppler ultrasonography of the right iliac vessels performed 2 months later showed patency of the right iliac artery. The patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s ureteral stent has been replaced every 2 months since his discharge without recurrence of hematuria.
Research Interests: Stents, Humans, Ultrasonography, Male, Hematuria, and 4 moreClinical Sciences, Aged, Vascular Fistula, and Ureter
To evaluate the dose-response relationship (D90 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;144 Gy: probable absence of biochemical failure) in patients with prostate cancer treated by iodine-125 (I-125)... more
To evaluate the dose-response relationship (D90 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;144 Gy: probable absence of biochemical failure) in patients with prostate cancer treated by iodine-125 (I-125) brachytherapy. From May 1999 to December 2006, 150 patients were treated by I-125 brachytherapy. The median follow-up was 60 months. All patients had clinical stage T1-T2, PSA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or =10 ng/ml, Gleason Scores &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 3+3=6, IPSS &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;14 ml/sec. and prostate weight &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;50 gr. Implantation was ultrasound-guided, using a real-time technique and loose seeds of I-125 (dose 160 Gy). After 30 days, a post-implantation assessment was performed by pelvic CT scan for a definitive evaluation of the D90. All patients were subjected to clinical evaluation, PSA dosage and compilation of IPSS and IEFF questionnaires. In the event of biochemical failure (ASTRO), a prostate biopsy was performed. A D90 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;144 Gy was considered the cut-off in order to predict the absence of biochemical failure. Biochemical failure was observed in 9 patients: 5 with positive and 4 with negative prostate biopsies. The D90 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;144 Gy cut-off was not achieved in 18 patients at the post-implantation assessment, however only 2 of them (one of whom had a positive biopsy) had biochemical failure (11.1%). On the other hand, only 2 of the 9 patients with biochemical failure had a D90 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 144 Gy while 6 patients had D90 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;150 Gy, 5 with positive prostate biopsies. In our experience, the D90 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;144 Gy cut-off does not seem to predict, in a reliable way, the control of prostate cancer following brachytherapy. Limitations of the analysis were the number of the patients, the learning curve, dosimetry processing and the relatively short follow-up.
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INTRODUCTION AND OBJECTIVES: Varicocele is the most common disease in infertile men and varicocelectomy remains the main treatment. During the last years a lot of drugs have been proposed in association with surgery. The aim of this study... more
INTRODUCTION AND OBJECTIVES: Varicocele is the most common disease in infertile men and varicocelectomy remains the main treatment. During the last years a lot of drugs have been proposed in association with surgery. The aim of this study is verify the effects of the association between menotropin and subinguinal varicocelectomy on sperm parameters and pregnancy rate.METHODS: 60 patients with left varicocele were randomized in three groups of 20 patients: patients of group A were treated with menotropin since diagnosis for three months; patients of group B were treated with menotropin but started the treatment three months after surgical treatment; patients of group C were treated only with varicocelectomy. We have tested sperm parameters before and after three, six and twelve months from surgical treatment. After six and twelve months from varicocelectomy we have verified the pregnancy rates in the three groups.RESULTS: After three months from surgical treatment, sperm parameters were significantly improved only in the group A (p < 0.05). After six months we have recorded a similar improvement even in the group B. After twelve months we have confirmed a significant improvement in groups A and B; the values were significantly higher than in the group C (p < 0.05). After six months the pregnancy rate was 42%, 25% and 22.2% respectively in the three groups. After twelve months we have recorded an important improvement of pregnancy rate in groups A and B (47% and 45% respectively) and a little improvement (27.7%) in group C.CONCLUSIONS: Our data show a significant improvement of sperm parameters in the two groups treated with menotropin respect to the group treated with only varicocelectomy. It could be responsible for a similar improvement of the pregnancy rate. The association between varicocelectomy and early use of menotropin seem to improve testis functional rehabilitation.
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Research Interests: Italy, Humans, Female, Male, Riots, and 5 moreMiddle Aged, Questionnaires, Adult, Archivio Storico Italiano, and Coitus
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In a meaningful proportion of cases, CBAVD has been recognised as a probable consequence of cftr gene mutations. This lead to a further enlargement of the spectrum of clinical pictures due to... more
In a meaningful proportion of cases, CBAVD has been recognised as a probable consequence of cftr gene mutations. This lead to a further enlargement of the spectrum of clinical pictures due to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;cftr deficiency&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;. More recently, the identification of a polymorphism in intron 8 regulating the level of correct cftr transcription, shed new light on the genotype-fenotype correlation of cftr mutations. Unfortunately, little information is still available on the clinical manifestations of CBAVD other than infertility. History, clinical picture, sweat test and genotype were carefully evaluated in a series of 21 patients affected by CBAVD, selected on the basis of otherwise unexplained obstructive azoospermia. History collection was especially addressed to respiratory symptoms. Family history was always negative for CF. Nevertheless, personal history showed respiratory symptoms in 18 cases (86%) 9/21 (43%) patients suffered from chronic sinusitis and one of these had had a pneumothorax. Other 9 (43%) patients had chronic nasal obstruction, due to recurrent nasal poliposis in two cases. Sweat test was clearly abnormal in 15/21 (71%) and borderline in the remaining 6 patients (29%). Genetic analysis allowed detection of one mutation in 15/21 patients (71%). Our data show that respiratory symptoms may be present in CBAVD patients, so that CBAVD cannot be merely considered a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;genital form&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; of CF.
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The aim of this study was to determine the incidence of sexual dysfunction in patients with benign prostatic hyperplasia (BPH). During the last 6 months 88 patients (mean age 65 years, range 55-78) suffering from BPH, without other... more
The aim of this study was to determine the incidence of sexual dysfunction in patients with benign prostatic hyperplasia (BPH). During the last 6 months 88 patients (mean age 65 years, range 55-78) suffering from BPH, without other chronic disease, were studied. Andrological evaluation enabled us to find erectile dysfunction in 52% of patients, ejaculation problems in 41% and decrease of libido in 54%. Due to the great impact of these disturbances in patients&amp;amp;amp;amp;#39; quality of life, we believe that clinical and therapeutic approach in BPH patients should be global, with both urological and andrological assessment.
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We report our first simultaneous bilateral robot assisted partial nephrectomy (RAPN) in order to show and critically discuss the feasibility of this procedure. Materials and methods A 69-year-old male patient visited our department due to... more
We report our first simultaneous bilateral robot assisted partial nephrectomy (RAPN) in order to show and critically discuss the feasibility of this procedure. Materials and methods A 69-year-old male patient visited our department due to incidental finding of bilateral mesorenal small masses (2.5 cm on the right and 3.5 cm on the left) suspicious for malignancy. We started from the right side with patient in flank position. Port placement: 12-mm periumbilical camera port, two 8-mm robotic ports in wide ''V''configuration, additional 12 mm assistant port on the midline between the umbilicus and symphysis pubis. A right unclamping RAPN with sliding clip renorrhaphy was performed. The trocars were removed and the robot undocked. Without interrupting the anesthesiological procedures, the patient was reported in supine position and, after 180 degrees rotation of the surgical bed, was newly placed in contralateral flank position. Using both the previous periumbilical and ...
To evaluate the dose-response relationship (D90 >144 Gy: probable absence of biochemical failure) in patients with prostate cancer treated by iodine-125 (I-125) brachytherapy. From May 1999 to December 2006, 150 patients were treated... more
To evaluate the dose-response relationship (D90 >144 Gy: probable absence of biochemical failure) in patients with prostate cancer treated by iodine-125 (I-125) brachytherapy. From May 1999 to December 2006, 150 patients were treated by I-125 brachytherapy. The median follow-up was 60 months. All patients had clinical stage T1-T2, PSA < or =10 ng/ml, Gleason Scores < or = 3+3=6, IPSS >14 ml/sec. and prostate weight <50 gr. Implantation was ultrasound-guided, using a real-time technique and loose seeds of I-125 (dose 160 Gy). After 30 days, a post-implantation assessment was performed by pelvic CT scan for a definitive evaluation of the D90. All patients were subjected to clinical evaluation, PSA dosage and compilation of IPSS and IEFF questionnaires. In the event of biochemical failure (ASTRO), a prostate biopsy was performed. A D90 >144 Gy was considered the cut-off in order to predict the absence of biochemical failure. Biochemical failure was observed in 9 patie...
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The aim of this study was to verify the efficacy and safety of intravesical treatment combining sodium hyaluronate (HA) and chondroitin sulfate (CS) in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). Between February... more
The aim of this study was to verify the efficacy and safety of intravesical treatment combining sodium hyaluronate (HA) and chondroitin sulfate (CS) in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). Between February 2010 and May 2011, 20 consecutive women with IC/BPS were treated with intravesical instillations containing sodium HA (1.6%; 800 mg/50 ml) and sodium CS (2%; 1 g/50 ml) weekly for the first month, biweekly for the second month, and then monthly for at least 3 months. Before and after treatment, all patients filled in the Interstitial Cystitis Symptom Index and Problem Index (ICSI/ICPI), the Patient Health Questionnaire 9 and the Pelvic Pain and Urgency/Frequency Patient Symptom Scale (PUF). Treatment efficacy was assessed by comparing the pre- and post-treatment mean scores of the three questionnaires using Student&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s t test (p value &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05 was considered significant). Statistically significant mean decreases in ICSI (from 13.0 to 9.3; p = 0.0003), ICPI (from 11.35 to 8.85; p = 0.0078) and PUF (from 20.0 to 15.75; p = 0.0007) questionnaire scores were seen. No cases of side effects or complications were observed. The mean follow up was 5 months. Despite the limitations of this study, the outcomes confirmed the role of combination therapy with HA and CS as a safe and effective option for the treatment of IC/BPS. Further randomized controlled studies with a higher number of patients and a longer follow-up period are needed to confirm these results.
Research Interests: Fertility, Adolescent, Prospective studies, Humans, Female, and 3 moreMale, Young Adult, and Sex Factors
In a meaningful proportion of cases, CBAVD has been recognised as a probable consequence of cftr gene mutations. This lead to a further enlargement of the spectrum of clinical pictures due to "cftr deficiency". More recently,... more
In a meaningful proportion of cases, CBAVD has been recognised as a probable consequence of cftr gene mutations. This lead to a further enlargement of the spectrum of clinical pictures due to "cftr deficiency". More recently, the identification of a polymorphism in intron 8 regulating the level of correct cftr transcription, shed new light on the genotype-fenotype correlation of cftr mutations. Unfortunately, little information is still available on the clinical manifestations of CBAVD other than infertility. History, clinical picture, sweat test and genotype were carefully evaluated in a series of 21 patients affected by CBAVD, selected on the basis of otherwise unexplained obstructive azoospermia. History collection was especially addressed to respiratory symptoms. Family history was always negative for CF. Nevertheless, personal history showed respiratory symptoms in 18 cases (86%) 9/21 (43%) patients suffered from chronic sinusitis and one of these had had a pneumothor...
Research Interests:
Aim of the study is to verify if a stress reaction due to G8 meeting, held in Genoa on July 2001, can produce a mass stress reaction and influence negatively people sexuality and so the birth rate. 402 citizens (221 men and 181 women... more
Aim of the study is to verify if a stress reaction due to G8 meeting, held in Genoa on July 2001, can produce a mass stress reaction and influence negatively people sexuality and so the birth rate. 402 citizens (221 men and 181 women ranging in age from 25 to 52 years, mean 39) have been invited to answer two questionnaires concerning their sexual activity and their feelings before, during and after the G8 meeting. After 9,10 and 11 months we have valued the birth rate in Genoa. 30 people (7%) did not answer the two questionnaires. 12 people (3%) answered the questionnaire wrongly and were excluded from the study. 228 people (63%) didn't report changes about their sexual activity, during G8 meeting. 120 people (33%) reported a decrease of sexual intercourses and of sexual desire; 12 people (4%) reported an increase of these parameters. 54% of our population reported a definite anxiety. We want to emphasize the high number of people that had anxiety even in the group that didn...
Research Interests: Italy, Humans, Female, Male, Riots, and 5 moreMiddle Aged, Questionnaires, Adult, Archivio Storico Italiano, and Coitus
Research Interests: Robotics, Ergonomics, Italy, Humans, Female, and 7 moreMale, Recurrence, Prevalence, Middle Aged, Questionnaires, Adult, and Occupational Diseases
Even if brachytherapy (BT) in low-risk prostate cancer (CaP) is a common practice since more than 20 and 10 years in U.S.A. and Italy, respectively, it is still an uncommon procedure because of the problems related to the organization and... more
Even if brachytherapy (BT) in low-risk prostate cancer (CaP) is a common practice since more than 20 and 10 years in U.S.A. and Italy, respectively, it is still an uncommon procedure because of the problems related to the organization and collaboration among urologists, radiotherapists and physics, to the competition of alternative therapies, to dogmatic and educational beliefs, and to the poor knowledge of this technique. Between May 1999 and September 2010, 250 patients with low risk CaP underwent I125BT using a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;real time&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; approach; the seeds implantation was performed using Mick applicator, in the first 190 patients, and the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Quick-Link&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; technique in the last 60 cases. Oncologic results were reported in the first 150 cases with a mean follow-up of 95 months, while functional outcomes and complications were assessed in all the patients at different time points with a mean follow-up of 65 months. A good quality implantation was assessed in 88% of patients (D90 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;140 Gy). Overall, a biochemical failure was assessed, in accordance with Phoenix criteria, in 10 patients (6.6%). Among these patients, the prostatic biopsy showed a CaP in 6/10 patients, who underwent retropubic radical prostatectomy (4 pts) and external RT (2 pts); only one patient developed a systemic progression with secondary bone lesions and died after 122 months and 36 months from BT and RRP, respectively. The 4/10 patients with negative biopsy were treated with total androgen blockade (2 pts) and with watchful waiting (2 pts). Regarding functional results, we assessed a moderate incidence of irritative disorders (70%) during the first six months and a good recovery of erectile function after one year from surgery (78.8%). Brachytherapy in the low-grade risk prostatic cancer represents a good alternative to RRP with excellent functional and oncologic results
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Introduction: The aim of this paper is to report the outcomes of 30 (first) robot-assisted pyeloplasties (RPs) performed at our institute for the treatment of ureteropelvic junction obstruction (UPJO).
Methods: In the period between March... more
Introduction: The aim of this paper is to report the outcomes of 30 (first) robot-assisted pyeloplasties (RPs) performed at our institute for the treatment of ureteropelvic junction obstruction (UPJO).
Methods: In the period between March 2005 and September 2012, 30 RPs due to UPJO have been performed at our institute using a three arms Da Vinci Robot, standard version. All the procedures were performed transperitoneally with Anderson-Hynes technique. 29/30 (97%) patients were affected by primary UPJO and 1/30 (3%) reported a recurrent disease. The access foresaw the positioning of three robotic trocars (one 12 mm trocar for the camera and two 8-mm trocars for the robotic arms) and one assistant 12 mm trocar. The anastomosis was confectioned on a double-J ureteral tutor with 4/0 monocryl running sutures. Outcome success was defined as resolution of preoperative symptoms and ureteropelvic junction obstruction, confirmed by the improvement of the diuretic renogram. Mean follow-up was 48.3 months (range 5-96).
Results: All procedures have been completed robotically and no conversion was needed.
Mean operative times, blood losses and hospital stay were respectively 189 minutes (range 105-420), 60 mL (range 25-100) and 4.2 days (range 2-14).
29/30 patients were cured, with a success rate of 97%.
As regards mild complications, 3/30 patients (10%) reported a moderate abdominal pain a few hours after surgery, which was successfully treated with common analgesic drugs.
As for major complications, one patient (3%) developed ileus, probably due to a mild urine extravasation through the ureteropelvic suture, which spontaneously disappeared three days after surgery.
Conclusion: RP seems to be a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;new gold standard&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; in the treatment of UPJO.
The three-dimensional versatility and the outstanding accuracy of robot-assisted intracorporeal suturing produced excellent results after the first procedures without requiring a previous &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;sound&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; laparoscopic experience.
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To present our initial experience with brachytherapy (BT) as a primary salvage procedure for the treatment of prostate cancer (PCa) local recurrence following radical retropubic prostatectomy (RRP). From December 2009 to May 2010, three... more
To present our initial experience with brachytherapy (BT) as a primary salvage procedure for the treatment of prostate cancer (PCa) local recurrence following radical retropubic prostatectomy (RRP). From December 2009 to May 2010, three patients underwent salvage BT due to local recurrences of high risk PCa after extrafascial RRP without additional adjuvant therapies. Local recurrence was confirmed by prostate biopsy and the relapse was well defined by endorectal ultrasonography and magnetic resonance imaging. Metastatic screening was negative. The patients were followed-up according to the American Brachytherapy Society guidelines. The median dose delivered to 90% of the local relapse (D90) was 115 Gy. The three patients reached a prostate specific antigen (PSA) nadir value within the first year that remained stable at a mean follow-up of 32 months. As regards morbidity, moderate de novo urgency was reported by only one patient. We think that our data confirms the feasibility and safety of salvage BT as a possible alternative option to external beam radiotherapy (EBRT) for the treatment of locally recurrent PCa in selected patients when performed by experienced centers. However, larger series of patients with longer follow-ups are needed to define the oncologic role of this procedure.
Research Interests:
Introduction: Brachytherapy (BT) with real-time technique for the treatment of low and medium risk prostate cancer (CaP) has been a well known practice for over 25 years in the USA and for over
15 years in Italy. However, it is an... more
Introduction: Brachytherapy (BT) with real-time technique for the treatment of low and medium risk prostate cancer (CaP) has been a well known practice for over 25 years in the USA and for over
15 years in Italy. However, it is an uncommon procedure, because of problems related to the organization and cooperation among urologists, radiotherapists and physics, to the competition of alternative therapies, to dogmatic and educational beliefs, and to the poor knowledge of this technique.
Methods: Between May1999 and July 2013, 400 patients with low and medium risk CaP underwent I 125 BT using a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;real-time&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; approach. The seeds implantation was performed using a Mick applicator in the first 190 patients and the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;QuickLink&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; technique in the last 210 cases. Oncologic results were reported for the first 250 cases with a mean follow-up of 10 years, while functional outcomes and complications were assessed in 350 patients with a minimum follow-up of 1 year.
Results: A good quality implantation was assessed in 90% of the patients (D90&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;145 Gy). A biochemical failure was assessed, based on Phoenix criteria, in 12 patients (4.8%). Out of these patients,
10 underwent prostate biopsy (the other 2 patients showed a systemic disease). The biopsy showed a CaP in 6/10 patients who underwent retropubic radical prostatectomy (4 patients) and external radiotherapy (2 patients) respectively. The remaining 4/10 patients with negative biopsy were treated with total androgen blockade (3 patients) and watchful waiting (1 patient) respectively. Functional results showed an incidence of postoperative irritative disorders in 70% of the patients during the first six months and a good recovery of erectile function in 78.8% and 68.2% of the patients after one and five years from BT respectively.
Conclusion: Brachytherapy is a good alternative to radical prostatectomy in the low and medium risk prostatic cancers with excellent oncologic and functional results.
Research Interests:
Research Interests:
Injury of the ureter is a potential complication of any difficult abdominopelvic surgical procedure, with an incidence ranging between 0.5% and 10% in most series. The treatment depends on the severity and the place of the lesion. The... more
Injury of the ureter is a potential complication of any difficult abdominopelvic surgical procedure, with an incidence ranging between 0.5% and 10% in most series. The treatment depends on the severity and the place of the lesion. The severe mid and upper ureteral injuries usually require complex treatment procedures, which can be contraindicated in case of severe comorbidities with high anesthesiologic risk. We report our experience in the endoscopic treatment with Wallgraft stenting of complete iatrogenic iliac ureteral injury in a high-risk surgical patient. A 74-year-old female patient was admitted at our department due to a complete lesion of the right iliac ureter following right iliac artery aneurysm repair with iatrogenic ileal injury. The patient was in coma, affected by severe respiratory insufficiency, sepsis and uroperitoneum. These conditions contraindicated a general anesthesia encumbering the positioning of a nephrostomy, and influenced our indication of Wallgraft stent placement. The Wallgraft endoprosthesis (10 x 50 mm) is a self-expanding super-alloy metallic high flexible stent covered by PET, which can be placed at the level of the lesion using fluoroscopy after introducing an angiographic catheter and guidewire. This procedure is usually indicated in the treatment of vascular lesions. After positioning the Wallgraft stent, pyelography showed a complete closure of the lesion. The patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s clinical condition improved quickly and remained stable at a follow-up of 45 months. Although the Wallgraft stent positioning cannot be considered as a standard treatment for all the complete ureteral lesions, it can be proposed in the management of some patients with severe comorbidities, which do not allow any other approach.
Research Interests:
To compare the oncological and functional outcomes reported after radical retropubic prostatectomy (RRP) versus brachytherapy (BT) in the treatment of low-risk prostatic cancer (CaP). Between May 1999 and October 2002, 200 patients (mean... more
To compare the oncological and functional outcomes reported after radical retropubic prostatectomy (RRP) versus brachytherapy (BT) in the treatment of low-risk prostatic cancer (CaP). Between May 1999 and October 2002, 200 patients (mean age 65.3 +/- 8.7) were enrolled and randomized into two groups of 100 patients each to undergo RRP (group 1) or BT (group 2). Prior to and following treatment, all patients were evaluated by physical examination, PSA assay and compilation of IPSS, IIEF-5 and EORTC-QLQ-C30/PR25 questionnaires. Oncological results were reported at 5 years, while functional outcomes were reported at 6 months, and 1 and 5 years mean follow-up. Of the 200 patients studied, 174 completed the 5-year follow-up assessment. With regards to oncological outcomes, similar 5-year biochemical disease-free survival rates were reported for RRP (91.0%) or BT (91.7%). At 6 months and 1 year, both techniques produced a significant decrease in quality of life aspects, while group 2 patients reported a significantly higher and longer lasting rate of urinary irritative disorders and better erective function than group 1. No differences in functional outcomes were encountered after 5 years in either group. RRP and BT are two different options for the treatment of low-risk CaP, which produce different short-term sequelae in terms of urinary disorders and erective functions, but similar biochemical disease-free survival. Further studies with a higher number of patients and a longer follow-up are needed to evaluate their comparative effectiveness on overall disease-specific survival and metastatic disease.
Research Interests: Nephrology, Surgery, Urology, Cancer, Quality of life, and 19 moreBrachytherapy, Treatment, Treatment Outcome, Prostate Cancer, Comparative Study, Erectile dysfunction, Prospective studies, Humans, Male, Risk factors, Clinical Sciences, Aged, Middle Aged, Questionnaires, Group, Physical examination, Risk Factors, Low Risk, and Prospective Study
To evaluate retrospectively the objective and subjective parameters in 42 male patients who underwent bone anchored sub-urethral sling positioning (BAUS) for SUI (stress urinary incontinence) due to ISD (intrinsic sphincter deficiency).... more
To evaluate retrospectively the objective and subjective parameters in 42 male patients who underwent bone anchored sub-urethral sling positioning (BAUS) for SUI (stress urinary incontinence) due to ISD (intrinsic sphincter deficiency). Patients with SUI due to radical retropubic prostatectomy (36 patients), transurethral resection of prostate (5 patients) and open simple prostatectomy (1 patient) underwent BAUS positioning between July 1999 and September 2005 (mean FU = 41 months). Before and after surgery, the patients were evaluated by physical examination, urethrocystoscopy, urodynamics, 1 h pad test and QoL questionnaire. Surgical technique involved perineal implantation to the pubic rami using four anchors of a sub-urethral sling made of synthetic (26 patients), biological (4 patients) or mixed (12 patients) material. Patients were stratified into three groups: (1) Cured: dry patients at stress test, pad weight 0-1 g. (2) Improved: patients with mild-moderate incontinence, pad weight 2-50 g. (3) Failed: unchanged patients, pad weight &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 50 g. At the final follow-up visit cured, improved and failed patients were 26 (62%), 4 (8%) and 12 (30%), respectively. Mean pad weight significantly decreased from 104.6 to 47.3 g (55%) and mean total questionnaire score significantly increased to 50.7 (66%). Mean ALPP significantly increased to 50.4 cmH2O (44.8%). Better results were seen with synthetic slings. Main complications were perineal pain (76%), detrusor overactivity (12%) and sling infection (4.8%). BAUS implantation is a safe, effective, minimally invasive option for iatrogenic male incontinence due to ISD. It compares favourably with AUS.
Research Interests: Quality of life, Treatment Outcome, Urinary incontinence, Humans, Male, and 13 moreArthroscopy, Follow-up studies, Clinical Sciences, Aged, Stress Testing, Middle Aged, Cost Benefit Analysis, Retrospective Studies, Group, Physical examination, SURGICAL TECHNIQUE, Iatrogenic Disease, and Minimally Invasive
Research Interests:
Research Interests: Nephrology, Urology, Treatment Outcome, Prospective studies, Humans, and 14 moreTestosterone, Placebo, Chronic Disease, Male, Randomised Controlled Trial, Clinical Sciences, Intestinal absorption, Middle Aged, Prostatitis, Adult, Pelvic Pain, Luteinizing Hormone, Estradiol, and Follicle stimulating hormone
Research Interests:
A 66-year-old man presented to hospital with gross hematuria and clots. He had previously undergone surgical repair of a right iliac artery aneurysm with placement of a vascular prosthesis at the same hospital, which had resulted in iliac... more
A 66-year-old man presented to hospital with gross hematuria and clots. He had previously undergone surgical repair of a right iliac artery aneurysm with placement of a vascular prosthesis at the same hospital, which had resulted in iliac urethral stricture that required the placement of a right ureteral stent. He had attended repeatedly for recurrent ureteral stent replacement, with the most recent replacement having occurred 1 month before the current presentation. Ultrasonography, cystography, retrograde pyelography and provocative arteriography via a percutaneous right femoral arterial approach. An iliac-artery-ureteral fistula between the right ureter and a pseudoaneurysm of the right common iliac artery. The patient underwent placement of a covered, self-expandable vascular stent with angioplasty balloon, which resulted in complete exclusion of the pseudoaneurysm and fistula and resolution of the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s hematuria. A pigtail catheter was placed in the right ureter for 5 days and replaced with a double-J ureteral stent on day 6 after exclusion of the pseudoaneurysm; the patient was discharged from hospital on the same day. Color-Doppler ultrasonography of the right iliac vessels performed 2 months later showed patency of the right iliac artery. The patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s ureteral stent has been replaced every 2 months since his discharge without recurrence of hematuria.
Research Interests: Pathology, Radiology, Imaging, Stents, Humans, and 7 moreUltrasonography, Male, Hematuria, Clinical Sciences, Aged, Vascular Fistula, and Ureter
Research Interests: Urology, Quality of life, Treatment Outcome, Risk assessment, Probability, and 17 moreUrinary incontinence, Humans, QOL, Male, Urodynamics, Follow-up studies, Clinical Sciences, Aged, Middle Aged, Time Factors, Retrospective Studies, Age Factors, Risk Assessment, prosthesis Design, Iatrogenic Disease, Cohort Studies, and Postoperative Complications
Laparoscopic pyeloplasty (LP) has proved to be an effective minimally invasive treatment for ureteropelvic junction obstruction (UPJO). However, its application is still limited by the challenge of the laparoscopic learning curve, which... more
Laparoscopic pyeloplasty (LP) has proved to be an effective minimally invasive treatment for ureteropelvic junction obstruction (UPJO). However, its application is still limited by the challenge of the laparoscopic learning curve, which seems to be overcome by the recent introduction of robot assistance. The aim of this manuscript is to show our outcomes after the first robot-assisted laparoscopic pyeloplasties (RP)
Research Interests:
The aim of this review is to critically compare the different procedures performed for the treatment of ureteropelvic junction obstruction (UPJO) in order to identify, currently, the best treatment that a urologist should propose to... more
The aim of this review is to critically compare the different procedures performed for the treatment of ureteropelvic junction obstruction (UPJO) in order to identify, currently, the best treatment that a urologist should propose to patients with this condition. Three different types of procedures were assessed: open pyeloplasty (OP), endopyelotomy, and laparoscopic pyeloplasty (LP). Regarding efficacy, success rates of 94.1, 62-83, and 95.9-97.2% were reported for OP, endopyelotomy, and LP, respectively. Concerning operative time and length of hospital stay, no extensive data are available in the literature, although endopyelotomy seems to provide shorter times with respect to those reported after OP and LP. Regarding the complication rate, it was very similar after the different techniques and due to the respective approaches. Overall, our data support the conclusion that LP provided a balance between the highly successful technique reported by OP and the quick postoperative recovery provided by the endoscopic approach. Anyway, in spite of these clear advantages, the reproducibility of LP is still strongly limited by the challenge of the learning curve. The da Vinci robot (Intuitive Surgical, Inc., Sunnyvale, CA), providing an extraordinary vision and precision of surgical movement, appears to be changing this scenario, allowing naïve surgeons to achieve very good results after few procedures. In this setting, robot-assisted pyeloplasty seems to be emerging as the new standard of care in the patients with UPJO, which will further take place over the other techniques once its costs decrease.
Research Interests:
The increasing number of prostatectomies entails an increasing number of patients suffering from iatrogenic incontinence despite improved surgical techniques. The severity of this problem often requires invasive treatments such as... more
The increasing number of prostatectomies entails an increasing number of patients suffering from iatrogenic incontinence despite improved surgical techniques. The severity of this problem often requires invasive treatments such as periurethral injection of bulking agents, artificial urinary sphincter (AUS) implantation, and sub-urethral sling positioning. The artificial urethral sphincter has represented, until today, the gold standard but, in the recent years, sling systems have been investigated as minimally invasive alternative options. Today, three different sling procedures are commonly performed: bone-anchored, readjustable, and trans-obturator slings systems. The aim of this review is to critically report the current status of sling systems in the treatment of iatrogenic male incontinence. MEDLINE and PubMed databases were searched and all articles between 1974 and 2009 were evaluated. With regard to bone-anchored, readjustable, and trans-obturator slings systems, cure rates ranged between 58.0% and 86.0%, 55.5% and 73.0%, and 40.0% and 63.0%, respectively, while major complication rates ranged between 0 and 14.5%, 10.0 and 22.2%, and 0 and 10.0%, respectively. Suburethral slings are the only alternative techniques which can be favorably compared with the AUS, showing more advantages with respect to AUS implantations which are mainly represented by a quick and less invasive approach, low morbidity, and low costs. In spite of the difficulty in identifying the most effective sling procedure, overall, sling systems can be recommended for patients with persistent mild or moderate incontinence. However, the indication can also be extended to patients with severe incontinence, after appropriate counseling, allowing AUS implantation in the event of sling failure.