482 results on '"Alberto Breda"'
Search Results
2. Outcomes of Salvage Robotic-assisted Radical Prostatectomy in the last decade: systematic review and perspectives of referral centers.
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Marcio Covas Moschovas, Carlo Andrea Bravi, Paolo Dell'Oglio, Filippo Turri, Ruben de Groote, Nikolaos Liakos, Mike Wenzel, Christoph Würnschimmel, Fabrizio Di Maida, Federico Piramide, Iulia Andras, Alberto Breda, Alexandre Mottrie, Vipul Patel, and Alessandro Larcher
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Salvage Robotic-assisted radical prostatectomy ,prostate cancer recurrence ,robotic surgery ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
ABSTRACT Purpose: Salvage robotic-assisted radical prostatectomy (S-RARP) has gained prominence in recent years for treating patients with cancer recurrence following non-surgical treatments of Prostate Cancer. We conducted a systematic literature review to evaluate the role and outcomes of S-RARP over the past decade. Materials and Methods: A systematic review was conducted, encompassing articles published between January 1st, 2013, and June 1st, 2023, on S-RARP outcomes. Articles were screened according to PRISMA guidelines, resulting in 33 selected studies. Data were extracted, including patient demographics, operative times, complications, functional outcomes, and oncological outcomes. Results: Among 1,630 patients from 33 studies, radiotherapy was the most common primary treatment (42%). Operative times ranged from 110 to 303 minutes, with estimated blood loss between 50 to 745 mL. Intraoperative complications occurred in 0 to 9% of cases, while postoperative complications ranged from 0 to 90% (Clavien 1-5). Continence rates varied (from 0 to 100%), and potency rates ranged from 0 to 66.7%. Positive surgical margins were reported up to 65.6%, and biochemical recurrence ranged from 0 to 57%. Conclusion: Salvage robotic-assisted radical prostatectomy in patients with cancer recurrence after previous prostate cancer treatment is safe and feasible. The literature is based on retrospective studies with inherent limitations describing low rates of intraoperative complications and small blood loss. However, potency and continence rates are largely reduced compared to the primary RARP series, despite the type of the primary treatment. Better-designed studies to assess the long-term outcomes and individually specify each primary therapy impact on the salvage treatment are still needed. Future articles should be more specific and provide more details regarding the previous therapies and S-RARP surgical techniques.
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- 2024
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3. Evaluation of predictive factors for i-CLARAS (intraoperative complications in laparoscopic renal and adrenal surgery): a multicentre international retrospective cohort study
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Angelo Territo, Giuseppe Di Buono, Salvatore Buscemi, Guglielmo Mantica, Vincenzo Falco, Vital Hevia Palacios, Paolo Verri, Rodrigo Antelo Antelo, Jesus Emmanuel Rosas-Nava, Nicolae Crisan, Iulia Andras, Fabio Medas, Giuseppe Amato, Giorgio Romano, Alberto Breda, Antonino Agrusa, and i-CLARAS (intraoperative Complication in Laparoscopic Renal and Adrenal Surgery) Research Collaborative Study Group
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Medicine ,Science - Abstract
Abstract The laparoscopic approach represents the standard of treatment for renal and adrenal diseases, and its use is increasing even outside referral centres. Although most procedures are routinely performed, intraoperative complications do not occur, and the rate and predictive factors of these complications have not been established. The aim of this study was to evaluate the incidence and type of intraoperative complications and to identify predictive factors in patients undergoing laparoscopic renal and adrenal surgery. This was a cohort, multicentre, international retrospective study. Patients who underwent laparoscopic renal and adrenal surgeries between April 2017 and March 2022 were included in the study. Bivariate analysis was performed using contingency tables and the χ2 test for independent samples to compare qualitative variables and the T test and Mood test for continuous variables. Multivariate analysis was performed using a logistic regression model to obtain adjusted odds ratios. A total of 2374 patients were included in the study. Intraoperative complications were reported for 8.09% of patients who underwent renal surgery, with the most common complications reported being hollow viscus and vascular complications, and for 6.75% of patients who underwent adrenal surgery, with the most common complication reported being parenchymatous viscous complications. Multivariate analysis revealed that both adrenal and renal surgery radiological preoperative factors, such as invasive features during adrenalectomy and the RENAL score during nephrectomy, are predictive factors of intraoperative complications. In contrast to existing data, surgeon experience was not associated with a reduction in the incidence of perioperative complications.
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- 2024
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4. Robot-assisted oncologic pelvic surgery with Hugo™ robot-assisted surgery system: A single-center experience
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Angelo Territo, Alessandro Uleri, Andrea Gallioli, Josep Maria Gaya, Paolo Verri, Giuseppe Basile, Alba Farré, Alejandra Bravo, Alessandro Tedde, Óscar Rodríguez Faba, Joan Palou, and Alberto Breda
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Bladder cancer ,Prostate cancer ,Radical cystectomy ,Radical prostatectomy ,Robotic surgery ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Objective: To report the outcomes of intra- and extra-peritoneal robot-assisted radical prostatectomy (RARP) and robot-assisted radical cystectomy (RARC) with Hugo™ robot-assisted surgery (RAS) system (Medtronic, Minneapolis, MN, USA). Methods: Data of twenty patients who underwent RARP and one RARC at our institution between February 2022 and January 2023 were reported. The primary endpoint of the study was to report the surgical setting of Hugo™ RAS system to perform RARP and RARC. The secondary endpoint was to assess the feasibility of RARP and RARC with this novel robotic platform and report the outcomes. Results: Seventeen patients underwent RARP with a transperitoneal approach, and three with an extraperitoneal approach; and one patient underwent RARC with intracorporeal ileal conduit. No intraoperative complications occurred. Median docking and console time were 12 (interquartile range [IQR] 7–16) min and 185 (IQR 177–192) min for transperitoneal RARP, 15 (IQR 12–17) min and 170 (IQR 162–185) min for extraperitoneal RARP. No intraoperative complications occurred. One patient submitted to extraperitoneal RARP had a urinary tract infection in the postoperative period that required an antibiotic treatment (Clavien-Dindo Grade 2). In case of transperitoneal RARP, two minor complications occurred (one pelvic hematoma and one urinary tract infection; both Clavien-Dindo Grade 2). Conclusion: Hugo™ RAS system is a novel promising robotic platform that allows to perform major oncological pelvic surgery. We showed the feasibility of RARP both intra- and extra-peritoneally and RARC with intracorporeal ileal conduit with this novel platform.
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- 2023
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5. The First Entirely 3D-Printed Training Model for Robot-assisted Kidney Transplantation: The RAKT Box
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Riccardo Campi, Alessio Pecoraro, Graziano Vignolini, Pietro Spatafora, Arcangelo Sebastianelli, Francesco Sessa, Vincenzo Li Marzi, Angelo Territo, Karel Decaestecker, Alberto Breda, and Sergio Serni
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Three-dimensional printing ,Renal transplantation ,Robotics ,Simulation ,Training ,Diseases of the genitourinary system. Urology ,RC870-923 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: Robot-assisted kidney transplantation (RAKT) is increasingly performed at selected referral institutions worldwide. However, simulation and proficiency-based progression training frameworks for RAKT are still lacking, making acquisition of the RAKT-specific skill set a critical unmet need for future RAKT surgeons. Objective: To develop and test the RAKT Box, the first entirely 3D-printed, perfused, hyperaccuracy simulator for vascular anastomoses during RAKT. Design, setting and participants: The project was developed in a stepwise fashion by a multidisciplinary team including urologists and bioengineers via an iterative process over a 3-yr period (November 2019–November 2022) using an established methodology. The essential and time-sensitive steps of RAKT were selected by a team of RAKT experts and simulated using the RAKT Box according to the principles of the Vattituki-Medanta technique. The RAKT Box was tested in the operating theatre by an expert RAKT surgeon and independently by four trainees with heterogeneous expertise in robotic surgery and kidney transplantation. Surgical procedure: Simulation of RAKT. Measurements: Video recordings of the trainees’ performance of vascular anastomoses using the RAKT Box were evaluated blind by a senior surgeon according to the Global Evaluative Assessment of Robotic Skills (GEARS) and Assessment of Robotic Console Skills (ARCS) tools. Results and limitations: All participants successfully completed the training session, confirming the technical reliability of the RAKT Box simulator. Tangible differences were observed among the trainees in both anastomosis time and performance metrics. Key limitations of the RAKT Box include lack of simulation of the ureterovesical anastomosis and the need for a robotic platform, specific training instruments, and disposable 3D-printed vessels. Conclusions: The RAKT Box is a reliable educational tool to train novice surgeons in the key steps of RAKT and may represent the first step toward the definition of a structured surgical curriculum in RAKT. Patient summary: We describe the first entirely 3D-printed simulator that allows surgeons to test the key steps of robot-assisted kidney transplantation (RAKT) in a training environment before performing the procedure in patients. The simulator, called the RAKT Box, has been successfully tested by an expert surgeon and four trainees. The results confirm its reliability and potential as an educational tool for training of future RAKT surgeons.
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- 2023
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6. Robot-assisted radical cystectomy and ileal conduit with Hugo™ RAS system: feasibility, setting and perioperative outcomes
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Josep Maria Gaya, Alessandro Uleri, Isabel Sanz, Giuseppe Basile, Paolo Verri, Pedro Hernandez, Angelo Territo, Oscar Rodríguez Faba, Andrea Gallioli, Alberto Breda, and Joan Palou
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Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
ABSTRACT Introduction: Robotic approach has shown its feasibility and safety with respect to open approach for radical cystectomy (1). The performances of Hugo™ RAS system (Medtronic, Minneapolis, USA) have been demonstrated in several clinical scenarios (2-5). We report the feasibility and surgical settings of the first series of robot-assisted radical cystectomy (RARC) with intracorporeal ileal-conduit performed with Hugo™ RAS system. Methods: Two patients were submitted to RARC with ileal conduit at our institution. The trocar placement scheme and the operating room setting with docking angles of the four arms were already described (6). A 12-mm and a 5-mm trocar for the assistant were placed. In both cases, an ileal-conduit with a Wallace type-1 uretero-enteric derivation was performed intra-corporeally. Results: The first patient was a 71-year-old male with a very-high risk non-muscle invasive bladder cancer(BC), and the second patient was a 64-year-old male with a diagnosis of T2 high-grade BC. Operative times were 360 and 420 minutes with a docking time of 12 and 9 minutes, respectively. No intraoperative complications occurred. The estimated blood loss was 200ml and 400ml, respectively. The second patient developed an ileus on postoperative day 4 (Clavien-Dindo grade 2). No positive surgical margins were recorded. No recurrence nor progression occurred during follow-up. Conclusion: RARC with intracorporeal ileal conduit urinary diversion is feasible with Hugo™ RAS system. We provided insight into the surgical setting using this novel robotic platform to help new adopters to face this challenging procedure. These findings may help a wider distribution of robotic programs for BC treatment.
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- 2024
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7. Resection Techniques During Robotic Partial Nephrectomy: A Systematic Review
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Riccardo Bertolo, Alessio Pecoraro, Umberto Carbonara, Daniele Amparore, Pietro Diana, Stijn Muselaers, Michele Marchioni, Maria Carmen Mir, Alessandro Antonelli, Ketan Badani, Alberto Breda, Ben Challacombe, Jihad Kaouk, Alexandre Mottrie, Francesco Porpiglia, Jim Porter, Andrea Minervini, and Riccardo Campi
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Enucleation ,Enucleoresection ,Outcomes ,Partial Nephrectomy ,Resection ,Robot ,Diseases of the genitourinary system. Urology ,RC870-923 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Context: The resection technique used to excise tumor during robotic partial nephrectomy (RPN) is of paramount importance in achieving optimal clinical outcomes. Objective: To provide an overview of the different resection techniques used during RPN, and a pooled analysis of comparative studies. Evidence acquisition: The systematic review was conducted according to established principles (PROSPERO: CRD42022371640) on November 7, 2022. A population (P: adult patients undergoing RPN), intervention (I: enucleation), comparator (C: enucleoresection or wedge resection), outcome (O: outcome measurements of interest), and study design (S) framework was prespecified to assess study eligibility. Studies reporting a detailed description of resection techniques and/or evaluating the impact of resection technique on outcomes of surgery were included. Evidence synthesis: Resection techniques used during RPN can be broadly classified as resection (non-anatomic) or enucleation (anatomic). A standardized definition for these is lacking. Out of 20 studies retrieved, nine compared “standard” resection versus enucleation. A pooled analysis did not reveal significant differences in terms of operative time, ischemia time, blood loss, transfusions, or positive margins. Significant differences favoring enucleation were found for clamping management (odds ratio [OR] for renal artery clamping 3.51, 95% confidence interval [CI] 1.13–10.88; p = 0.03), overall complications (OR for occurrence 0.55, 95% CI 0.34–0.87; p = 0.01) major complications (OR for occurrence 0.39, 95% CI 0.19–0.79; p = 0.009), length of stay (weighted mean difference [WMD] −0.72 d, 95% CI −0.99 to −0.45; p
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- 2023
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8. Kidney Transplant Outcomes in Elderly Population: A Systematic Review and Meta-analysis
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Alberto Artiles, Ana Domínguez, José Daniel Subiela, Romain Boissier, Riccardo Campi, Thommas Prudhomme, Alessio Pecoraro, Alberto Breda, Francisco Javier Burgos, Angelo Territo, and Vital Hevia
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Kidney transplant ,Elderly population ,Geriatric ,Renal transplantation ,Systematic review ,Meta-analysis ,Diseases of the genitourinary system. Urology ,RC870-923 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Context: Owing to population ageing, a growing number of kidney transplants (KTs) in elderly population are being performed. KT is the best treatment for patients with end-stage renal disease (ESRD). However, in older patients, the decision between dialysis and KT can be difficult due to potential inferior outcomes. Few studies have been published addressing this issue, and literature outcomes are controversial. Objective: To conduct a systematic review and meta-analysis to appraise the evidence about outcomes of KT in elderly patients (>70 yr). Evidence acquisition: A systematic review and meta-analysis (PROSPERO registration: CRD42022337038) was performed. Search was conducted on PubMed and LILACS databases. Comparative and noncomparative studies addressing outcomes (overall survival [OS], graft survival [GS], complications, delayed graft function [DGF], primary nonfunction, graft loss, estimated glomerular filtrate rate, or acute rejection) of KT in people older than 70 yr were included. Evidence synthesis: Of the 10 357 yielded articles, 19 met the inclusion criteria (18 observational studies, one prospective multicentre study, and no randomised controlled trials), enrolling a total of 293 501 KT patients. Comparative studies reporting enough quantitative data for target outcomes were combined. There were significant inferior 5-yr OS (relative risk [RR], 1.66; 95% confidence interval [CI], 1.18–2.35) and 5-yr GS in the elderly group (RR, 1.37; 95% CI, 1.14–1.65) to those in the
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- 2023
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9. The IRON Study: Investigation of Robot-assisted Versus Open Nephron-sparing Surgery
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Carlo Andrea Bravi, Giuseppe Rosiello, Elio Mazzone, Andrea Minervini, Andrea Mari, Fabrizio Di Maida, Karim Bensalah, Benoit Peyronnet, Zine-Eddine Khene, Riccardo Schiavina, Lorenzo Bianchi, Alexandre Mottrie, Geert De Naeyer, Alessandro Antonelli, Maria Furlan, Koon Ho Rha, Ahmad Almujalhem, Ithaar Derweesh, Aaronw Bradshaw, Jihak Kaouk, Guilherme Sawczyn, Riccardo Bertolo, Alberto Breda, Francesco Montorsi, Umberto Capitanio, and Alessandro Larcher
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Robotic surgery ,Urological procedures ,Robot-assisted partial nephrectomy ,Open partial nephrectomy ,Perioperative outcomes ,Complications ,Diseases of the genitourinary system. Urology ,RC870-923 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: Current literature does not provide large-scale data regarding clinical outcomes of robot-assisted (RAPN) versus open (OPN) partial nephrectomy. Moreover, data assessing predictors of long-term oncologic outcomes after RAPN are scarce. Objective: To compare perioperative, functional, and oncologic outcomes of RAPN versus OPN, and to investigate the predictors of oncologic outcomes after RAPN. Design, setting, and participants: This study included 3467 patients treated with OPN (n = 1063) or RAPN (n = 2404) for a single cT1–2N0M0 renal mass from 2004 to 2018 at nine high-volume European, North American, and Asian institutions. Outcome measurements and statistical analysis: The study outcomes were short-term postoperative, functional, and oncologic outcomes. Regression models investigated the effect of surgical approach (open vs Robot assisted) on study outcomes, and interaction tests were used for subgroup analyses. Propensity score matching for demographic and tumor characteristics was used in sensitivity analyses. Multivariable Cox-regression analyses identified predictors of oncologic outcomes after RAPN. Results and limitations: Baseline characteristics were similar between patients receiving RAPN and OPN, with only few differences. After adjusting for confounding, RAPN was associated with lower odds of intraoperative (odds ratio [OR]: 0.39, 95% confidence interval [CI]: 0.22, 0.68) and Clavien-Dindo ≥2 postoperative (OR: 0.29, 95% CI: 0.16, 0.50) complications (both p 0.05 on interaction tests). On multivariable analyses, we found no differences between the two techniques with respect to functional and oncologic outcomes (all p > 0.05). Overall, there were 63 and 92 local recurrences and systemic progressions, respectively, with a median follow-up after surgery of 32 mo (interquartile range: 18, 60). Among patients receiving RAPN, we assessed predictors of local recurrence and systemic progression with discrimination accuracy (ie, C-index) that ranged from 0.73 to 0.81. Conclusions: While cancer control and long-term renal function did not differ between RAPN and OPN, we found that the intra- and postoperative morbidity—especially in terms of complications—was lower after RAPN than after OPN. Our predictive models allow surgeons to estimate the risk of adverse oncologic outcomes after RAPN, with relevant implications for preoperative counseling and follow-up after surgery. Patient summary: In this comparative study on robotic versus open partial nephrectomy, functional and oncologic outcomes were similar between the two techniques, with lower morbidity—especially in terms of complications—for robot-assisted surgery. The assessment of prognosticators for patients receiving robot-assisted partial nephrectomy may help in preoperative counseling and provides relevant data to tailor postoperative follow-up.
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- 2023
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10. The Learning Curve for Radical Nephrectomy for Kidney Cancer: Implications for Surgical Training
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Alessandro Larcher, Francesco Cei, Federico Belladelli, Giuseppe Rosiello, Carlo Andrea Bravi, Giuseppe Fallara, Giuseppe Basile, Roberta Lucianò, Pierre Karakiewicz, Alexandre Mottrie, Alberto Breda, Alberto Briganti, Andrea Salonia, Roberto Bertini, Francesco Montorsi, and Umberto Capitanio
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Kidney cancer ,Surgery ,Radical nephrectomy ,Surgical experience ,Learning curve ,Surgical training ,Diseases of the genitourinary system. Urology ,RC870-923 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Although radical nephrectomy (RN) is the most common treatment for kidney cancer, no data on the learning curve for RN are available. In this study we investigated the effect of surgical experience (EXP) on RN outcomes using data for 1184 patients treated with RN for a cT1–3a cN0 cM0 renal mass. EXP was defined as the total number of RNs performed by each surgeon before the patient’s operation. The primary study outcomes were all-cause mortality, clinical progression, Clavien-Dindo grade ≥2 postoperative complications (CD ≥2), and the estimated glomerular filtration rate (eGFR). Secondary outcomes were operative time, estimated blood loss, and length of stay. Multivariable analyses adjusted for case mix revealed no evidence of association between EXP and all-cause mortality (p = 0.7), clinical progression (p = 0.2), CD ≥2 (p = 0.6), or 12-mo eGFR (p = 0.9). Conversely, EXP was associated with shorter operative time (estimate −0.9; p < 0.01). Mortality, cancer control, morbidity, and renal function might not be affected by EXP. The very large cohort examined and the extensive follow-up support the validity of these negative findings. Patient summary: For patients with kidney cancer undergoing surgical removal of a kidney, those treated by novice surgeons have similar clinical outcomes to those treated by experienced surgeons. Thus, this procedure represents a convenient scenario for surgical training if longer operating theatre time can be planned.
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- 2023
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11. Combined Reporting of Surgical Quality and Cancer Control after Surgical Treatment for Penile Tumors with Inguinal Lymph Node Dissection: The Tetrafecta Achievement
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Aldo Brassetti, Umberto Anceschi, Gabriele Cozzi, Julian Chavarriaga, Pavel Gavrilov, Josep Maria Gaya Sopena, Alfredo Maria Bove, Francesco Prata, Mariaconsiglia Ferriero, Riccardo Mastroianni, Leonardo Misuraca, Gabriele Tuderti, Giulia Torregiani, Marco Covotta, Diego Camacho, Gennaro Musi, Rodolfo Varela, Alberto Breda, Ottavio De Cobelli, and Giuseppe Simone
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penile cancer ,inguinal lymphadenectomy ,Tetrafecta ,surgical quality ,survival ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: To optimize results reporting after penile cancer (PC) surgery, we proposed a Tetrafecta and assessed its ability to predict overall survival (OS) probabilities. Methods: A purpose-built multicenter, multi-national database was queried for stage I–IIIB PC, requiring inguinal lymphadenectomy (ILND), from 2015 onwards. Kaplan–Meier (KM) method assessed differences in OS between patients achieving Tetrafecta or not. Univariable and multivariable regression analyses identified its predictors. Results: A total of 154 patients were included in the analysis. The 45 patients (29%) that achieved the Tetrafecta were younger (59 vs. 62 years; p = 0.01) and presented with fewer comorbidities (ASA score ≥ 3: 0% vs. 24%; p < 0.001). Although indicated, ILND was omitted in 8 cases (5%), while in 16, a modified template was properly used. Although median LNs yield was 17 (IQR: 11–27), 35% of the patients had Tetrafecta cohort displayed significantly higher OS probabilities (Log Rank = 0.01). Uni- and multivariable logistic regression analyses identified age as the only independent predictor of Tetrafecta achievement (OR: 0.97; 95%CI: 0.94–0.99; p = 0.04). Conclusions: Our Tetrafecta is the first combined outcome to comprehensively report results after PC surgery. It is widely applicable, based on standardized and reproducible variables and it predicts all-cause mortality.
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- 2023
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12. Implementing a Checklist for Transurethral Resection of Bladder Tumor to Standardize Outcome Reporting: When High-quality Resection Could Influence Oncological Outcomes
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Pietro Diana, Michael Baboudjian, Andrea Gallioli, Angelo Territo, Sofia Fontanet, Paula Izquierdo, Alessandro Uleri, Paolo Verri, Óscar Rodriguez-Faba, Josep Maria Gaya, Francesco Sanguedolce, Joan Palou, and Alberto Breda
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Urothelial cancer ,Endoscopy ,Resection ,Diagnosis ,Treatment ,Diseases of the genitourinary system. Urology ,RC870-923 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Several randomized controlled trials (RCTs) comparing en bloc resection of bladder tumor (ERBT) to conventional transurethral resection of bladder tumor (cTURBT) have reported controversial results. In particular, the 1-yr recurrence rate ranged from 5% to 40% for ERBT and from 11% to 31% for cTURBT. We provide an updated analysis of an RCT comparing the 1-yr recurrence rate for ERBT versus cTURBT for a cohort of 219 patients comprising 123 (56.2%) in the ERBT group and 96 (43.8%) in the cTURBT group. At 1 yr, 11 patients in the ERBT group and 12 in the cTURBT group experienced recurrence. The heterogeneity in recurrence observed in other RCTs could be explained by the scarce and heterogeneous adoption of tools and techniques that have been proved to lower the recurrence rate, supporting the need for implementation of a TURBT checklist. This prompted us to create a checklist of items for RCTs to standardize how TURBT is performed in trials, facilitate comparison between studies, assess the applicability of results in real-life practice, and provide a push towards high-quality resections to improve oncological outcomes. The checklist could have utility as a user-friendly guide for reporting TURBT procedures to improve our understanding of trials involving this procedure. Patient summary: We compared the recurrence rate at 1 year for bladder cancer treated with two different approaches to remove bladder tumors in our center. The rates were comparable for the two groups. Other studies have found widely differing recurrence rates, so we propose use of a checklist to standardize these procedures and provide more consistent outcomes for patients.
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- 2023
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13. Fe de errores de «Recomendaciones para el trasplante renal de donante vivo»
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Miguel Ángel Frutos, Marta Crespo, María de la Oliva Valentín, Ángel Alonso-Melgar, Juana Alonso, Constantino Fernández, Gorka García-Erauzkin, Esther González, Ana M. González-Rinne, Lluis Guirado, Alex Gutiérrez-Dalmau, Jorge Huguet, José Luis López del Moral, Mireia Musquera, David Paredes, Dolores Redondo, Ignacio Revuelta, Carlos J. Van-der Hofstadt, Antonio Alcaraz, Ángel Alonso-Hernández, Manuel Alonso, Purificación Bernabeu, Gabriel Bernal, Alberto Breda, Mercedes Cabello, José Luis Caro-Oleas, Joan Cid, Fritz Diekmann, Laura Espinosa, Carme Facundo, Marta García, Salvador Gil-Vernet, Miquel Lozano, Beatriz Mahillo, María José Martínez, Blanca Miranda, Federico Oppenheimer, Eduard Palou, María José Pérez-Saez, Lluis Peri, Oscar Rodríguez, Carlos Santiago, Guadalupe Tabernero, Domingo Hernández, Beatriz Domínguez-Gil, and Julio Pascual
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Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2023
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14. Recommendations for living donor kidney transplantation
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Miguel Ángel Frutos, Marta Crespo, María de la Oliva Valentín, Ángel Alonso-Melgar, Juana Alonso, Constantino Fernández, Gorka García-Erauzkin, Esther González, Ana M. González–Rinne, Lluis Guirado, Alex Gutiérrez-Dalmau, Jorge Huguet, José Luis López del Moral, Mireia Musquera, David Paredes, Dolores Redondo, Ignacio Revuelta, Carlos J Van-der Hofstadt, Antonio Alcaraz, Ángel Alonso-Hernández, Manuel Alonso, Purificación Bernabeu, Gabriel Bernal, Alberto Breda, Mercedes Cabello, José Luis Caro-Oleas, Joan Cid, Fritz Diekmann, Laura Espinosa, Carme Facundo, Marta García, Salvador Gil-Vernet, Miquel Lozano, Beatriz Mahillo, María José Martínez, Blanca Miranda, Federico Oppenheimer, Eduard Palou, María José Pérez-Saez, Lluis Peri, Oscar Rodríguez, Carlos Santiago, Guadalupe Tabernero, Domingo Hernández, Beatriz Domínguez-Gil, and Julio Pascual
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Living kidney donor ,Living kidney transplant ,Guidelines ,Renal transplantation ,Legal ,Ethical ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
This Guide for Living Donor Kidney Transplantation (LDKT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this Guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes.Moreover, the role of living donors in the current KT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDKT, offer additional ways to treat renal patients with an incompatible donor.Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations.This Guide does not forget that LDKT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able take them into account. Experience over recent years has led to progress in risk analysis, to protect donors’ health. This aspect always has to be taken into account by LDKT programmes when evaluating potential donors.Finally, this Guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees. Resumen: Esta guía de recomendaciones para el TR de donante vivo (TRDV) es un documento elaborado con el patrocinio de la Sociedad Española de Nefrología, la Sociedad Española de Trasplantes y la Organización Nacional de Trasplantes que actualiza la calidad de la evidencia disponible para ofrecer el mejor tratamiento de la insuficiencia renal crónica cuando se disponga de un donante vivo potencial. El objetivo principal de esta guía es proporcionar a los profesionales con responsabilidad en los estudios previos del donante vivo y del receptor trasplantado, las mejores herramientas para tomar decisiones en beneficio del donante vivo y del receptor del trasplante.Además, en el contexto actual del TR, el donante vivo debe recuperar el protagonismo que alcanzó en un pasado reciente. Para ello, las nuevas modalidades de donación HLA y/o ABO incompatible, así como la donación cruzada disponibles en diversos centros con experiencia en TRDV, son oportunidades adicionales para el tratamiento de enfermos renales que tienen un donante incompatible.Los buenos resultados en supervivencia del paciente y del injerto están ampliando las circunstancias de aceptación de donantes vivos de riñón, incluyendo donantes de mayor edad y otros con algunos condicionantes que incluyen antecedentes o alteraciones límite que, cuando son evaluados con criterios objetivos, pueden aportar un numero adicional de trasplantes.No se ha obviado en esta guía que el TRDV puede representar algún riesgo para el que dona. Estos problemas que pueden aparecer a corto o largo plazo tienen que ser objeto principal de valoración previa a la donación y presentados al potencial donante para que en ejercicio de su autonomía los asuma o rechace. La experiencia acumulada en los últimos años ha permitido avanzar en el análisis de riesgos para preservar la salud de los donantes, aspecto que debe estar siempre presente en los responsables de programas de TRDV cuando se procede al estudio de idoneidad de un potencial donante.Finalmente, esta guía ha sido estructurada para facilitar la toma de decisiones con recomendaciones y sugerencias ante incertidumbres derivadas de los resultados en los exhaustivos estudios predonación. Y todo ello, con el objetivo de que el consentimiento informado que debe certificar la calidad de los estudios y la información proporcionada a donante y receptor, alcancen las mayores garantías posibles.
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- 2022
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15. Small renal masses in kidney transplantation: Overview of clinical impact and management in donors and recipients
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Alberto Piana, Iulia Andras, Pietro Diana, Paolo Verri, Andrea Gallioli, Riccardo Campi, Thomas Prudhomme, Vital Hevia, Romain Boissier, Alberto Breda, and Angelo Territo
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Small renal mass ,Renal cancer ,Kidney transplantation ,Nephron-sparing treatment ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Kidney transplantation is the best replacement treatment for the end-stage renal disease. Currently, the imbalance between the number of patients on a transplant list and the number of organs available constitutes the crucial limitation of this approach. To expand the pool of organs amenable for transplantation, kidneys coming from older patients have been employed; however, the combination of these organs in conjunction with the chronic use of immunosuppressive therapy increases the risk of incidence of graft small renal tumors. This narrative review aims to provide the state of the art on the clinical impact and management of incidentally diagnosed small renal tumors in either donors or recipients. According to the most updated evidence, the use of grafts with a small renal mass, after bench table tumor excision, may be considered a safe option for high-risk patients in hemodialysis. On the other hand, an early small renal mass finding on periodic ultrasound-evaluation in the graft should allow to perform a conservative treatment in order to preserve renal function. Finally, in case of a renal tumor in native kidney, a radical nephrectomy is usually recommended.
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- 2022
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16. Benefit and Harm of Active Surveillance for Biopsy-proven Renal Oncocytoma: A Systematic Review and Pooled Analysis
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Michael Baboudjian, Daniel Moser, Takafumi Yanagisawa, Bastien Gondran-Tellier, Eva M. Compérat, Damien Ambrosetti, Laurent Daniel, Cyrille Bastide, Shahrokh F. Shariat, Eric Lechevallier, Pietro Diana, Alberto Breda, Benjamin Pradere, and Romain Boissier
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Oncocytoma ,Renal ,Biopsy ,Surveillance ,Review ,Diseases of the genitourinary system. Urology ,RC870-923 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Context: Active surveillance (AS) of biopsy-proven renal oncocytomas may reduce overtreatment. However, on biopsy, the risk of misdiagnosis owing principally to entities with peculiar hybrids and overlap morphology, and phenotypes argues for early intervention. Objective: To assess the benefit and harm of AS in biopsy-proven renal oncocytoma. Evidence acquisition: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). We systematically searched PubMed, Scopus, and Web of Science databases from September 26 up to October 2021, for studies that analyzed the outcomes of AS in patients with biopsy-proven renal oncocytoma. Evidence synthesis: A total of ten studies with 633 patients met our inclusion criteria and were included for analysis. After a median follow-up of 34.5 mo (95% confidence interval [CI] 30.6–38.4), the overall definitive treatment rate from AS to definitive treatment was 17.3% (n = 75/433, six studies). The pooled pathological agreement between the initial renal mass biopsy and the surgical pathology report was 91.1%. The main indications for surgery during follow-up were rapid tumor growth and patient request. The pooled median growth rate was 1.55 mm/yr (95% CI 0.9–2.2). No metastasis or death related to renal oncocytoma was reported. Conclusions: Annual tumor growth of biopsy-proven renal oncocytoma is low. AS is oncologically safe, with favorable compliance of patients. Crossover to definitive treatment revealed a strong concordance between biopsy and final pathology. Further studies on the long-term outcomes of AS are needed. Patient summary: In this study, we examined the benefit and harm of active surveillance (AS) in biopsy-proven oncocytoma. Based on the available data, AS appears oncologically safe and may represent a promising alternative to immediate treatment. Patients should be included in AS decision discussions.
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- 2022
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17. New multiport robotic surgical systems: a comprehensive literature review of clinical outcomes in urology
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Morgan Salkowski, Enrico Checcucci, Alexander K. Chow, Craig C. Rogers, Firas Adbollah, Evangelos Liatsikos, Prokar Dasgupta, Gustavo C. Guimaraes, Jens Rassweiler, Alexander Mottrie, Alberto Breda, Simone Crivellaro, Jihad Kaouk, Francesco Porpiglia, and Riccardo Autorino
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Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Over the past 20 years, the field of robotic surgery has largely been dominated by the da Vinci robotic platform. Nevertheless, numerous novel multiport robotic surgical systems have been developed over the past decade, and some have recently been introduced into clinical practice. This nonsystematic review aims to describe novel surgical robotic systems, their individual designs, and their reported uses and clinical outcomes within the field of urologic surgery. Specifically, we performed a comprehensive review of the literature regarding the use of the Senhance robotic system, the CMR-Versius robotic system, and the Hugo RAS in urologic procedures. Systems with fewer published uses are also described, including the Avatera, Hintori, and Dexter. Notable features of each system are compared, with a particular emphasis on factors differentiating each system from the da Vinci robotic system.
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- 2023
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18. Simultaneous Bilateral Video–Endoscopic Inguinal Lymphadenectomy for Penile Carcinoma: Surgical Setting, Feasibility, Safety, and Preliminary Oncological Outcomes
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Josep M. Gaya, Giuseppe Basile, Pavel Gavrilov, Andrea Gallioli, Angelo Territo, Jorge Robalino, Pedro Hernandez, Raul Sanchez-Molina, Alejandra Bravo, Ferran Algaba, Jordi Huguet, Francesco Sanguedolce, Joan Palou, Antonio Rosales, and Alberto Breda
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penile carcinoma ,video–endoscopic inguinal lymphadenectomy ,inguinal lymph node dissection ,minimally invasive surgery ,invasive inguinal staging ,Medicine - Abstract
Introduction: Inguinal lymph node dissection (ILND) plays an important role for both staging and treatment purposes in patients diagnosed with penile carcinoma (PeCa). Video–endoscopic inguinal lymphadenectomy (VEIL) has been introduced to reduce complications, and in those patients elected for bilateral ILND, a simultaneous bilateral VEIL (sB-VEIL) has also been proposed. This study aimed to investigate the feasibility, safety, and preliminary oncological outcomes of sB-VEIL compared to consecutive bilateral VEIL (cB-VEIL). Material and methods: Clinical N0-2 patients diagnosed with PeCa and treated with cB-VEIL and sB-VEIL between 2015 and 2023 at our institution were included. Modified ILND was performed in cN0 patients, while cN+ patients underwent a radical approach. Intra- and postoperative complications, operative time, time of drainage maintenance, length of hospital stay and readmission within 90 days, as well as lymph node yield, were compared between the two groups. Results: Overall, 30 patients were submitted to B-VEIL. Of these, 20 and 10 patients underwent cB-VEIL and sB-VEIL, respectively. Overall, 16 (80%) and 7 (70%) patients were submitted to radical ILND due to cN1-2 disease in the cB-VEIL and sB-VEIL groups, respectively. No statistically significant difference emerged in terms of median nodal yield (13.5 vs. 14, p = 0.7) and median positive LNs (p = 0.9). sD-VEIL was associated with a shorter operative time (170 vs. 240 min, p < 0.01). No statistically significant difference emerged in terms of intraoperative estimated blood loss, length of hospital stay, time to drainage tube removal, major complications, and hospital readmission in the cB-VEIL and sB-VEIL groups, respectively (all p > 0.05). Conclusions: Simultaneous bilateral VEIL is a feasible and safe technique in patients with PeCA, showing similar oncological results and shorter operative time compared to a consecutive bilateral approach. Patients with higher preoperative comorbidity burden or anesthesiological risk are those who may benefit the most from this technique.
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- 2023
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19. Robot-Assisted Radical Prostatectomy in Renal Transplant Recipients: A Systematic Review
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Alberto Piana, Alessio Pecoraro, Flavio Sidoti, Enrico Checcucci, Muhammet İrfan Dönmez, Thomas Prudhomme, Beatriz Bañuelos Marco, Alicia López Abad, Riccardo Campi, Romain Boissier, Michele Di Dio, Francesco Porpiglia, Alberto Breda, and Angelo Territo
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robot-assisted radical prostatectomy ,renal transplant ,recipients ,kidney transplantation ,Medicine - Abstract
Robot-assisted radical prostatectomy (RARP) has been shown to achieve excellent oncological outcomes with a low rate of complications in patients with prostate cancer. However, data on RARP in renal transplant recipients (RT) are dispersed. A literature search was conducted through April 2023 using PubMed/Medline, Embase and Web of Science databases. The primary aim was to evaluate the safety, oncologic and clinical outcomes of RARP in RT recipients. The secondary aim was to identify surgical technique modifications required to avoid iatrogenic damage to the transplanted kidney. A total of 18 studies comprising 186 patients met the inclusion criteria. Age at the time of treatment ranged 43–79 years. Biopsy results showed a high prevalence of low- and intermediate-risk disease. Operative time ranged between 108.3 and 400 mins, while estimated blood loss ranged from 30 to 630 mL. Length of hospital stay ranged from 3 to 6 days whereas duration of catheterization was between 5 and 18 days. Perioperative complication rate was 17.1%. Overall positive surgical margin rate was 24.19%, while biochemical recurrence was observed in 10.21% (19/186 patients). Modifications to the standard surgical technique were described in 13/18 studies. Modifications in port placement were described in 7/13 studies and performed in 19/88 (21.6%) patients. Surgical technique for the development of the Retzius space was reported in 13/18 studies. Data on lymphadenectomy were reported in 15/18 studies. Bilateral lymphadenectomy was described in 3/18 studies and performed in 4/89 (4.5%) patients; contralateral lymphadenectomy was reported in 7/18 studies and performed in 41/125 (32.8%) patients. RARP in RTRs can be considered relatively safe and feasible. Oncological results yielded significantly worse outcomes in terms of PSM and BCR rate compared to the data available in the published studies, with an overall complication rate highly variable among the studies included. On the other hand, low graft damage during the procedure was observed. Main criticisms came from different tumor screening protocols and scarce information about lymphadenectomy techniques and outcomes among the included studies.
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- 2023
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20. The Metaverse in Urology: Ready for Prime Time. The ESUT, ERUS, EULIS, and ESU Perspective
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Enrico Checcucci, Giovanni Enrico Cacciamani, Daniele Amparore, Ali Gozen, Christian Seitz, Alberto Breda, Evangelos Liatsikos, and Francesco Porpiglia
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Diseases of the genitourinary system. Urology ,RC870-923 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Published
- 2022
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21. Robotic Versus Open Kidney Transplantation from Deceased Donors: A Prospective Observational Study
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Riccardo Campi, Alessio Pecoraro, Vincenzo Li Marzi, Agostino Tuccio, Saverio Giancane, Adriano Peris, Calogero Lino Cirami, Alberto Breda, Graziano Vignolini, and Sergio Serni
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Complications ,Deceased donor ,Kidney ,Renal function ,Robotic ,Transplant ,Diseases of the genitourinary system. Urology ,RC870-923 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: While robot-assisted kidney transplantation (RAKT) from living donors has been shown to achieve favourable outcomes, there is a lack of evidence on the safety and efficacy of RAKT as compared with the gold standard open kidney transplantation (OKT) in the setting of deceased donors, who represent the source of most grafts worldwide. Objective: To compare the intraoperative, perioperative, and midterm outcomes of RAKT versus OKT from donors after brain death (DBDs). Design, setting, and participants: Data from consecutive patients undergoing RAKT or OKT from DBDs at a single academic centre between October 2017 and December 2020 were prospectively collected. Intervention: RAKT or OKT. Outcome measurements and statistical analysis: The primary outcomes were intraoperative adverse events, postoperative surgical complications, delayed graft function (DGF), and midterm functional outcomes. A multivariable logistic regression analysis assessed the independent predictors of DGF, trifecta, and suboptimal graft function (estimated glomerular filtration rate [eGFR]
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- 2022
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22. Recomendaciones para el trasplante renal de donante vivo
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Miguel Ángel Frutos, Marta Crespo, María de la Oliva Valentín, Ángel Alonso-Melgar, Juana Alonso, Constantino Fernández, Gorka García-Erauzkin, Esther González, Ana M. González-Rinne, Lluis Guirado, Alex Gutiérrez-Dalmau, Jorge Huguet, José Luis López del Moral, Mireia Musquera, David Paredes, Dolores Redondo, Ignacio Revuelta, Carlos J. Van-der Hofstadt, Antonio Alcaraz, Ángel Alonso-Hernández, Manuel Alonso, Purificación Bernabeu, Gabriel Bernal, Alberto Breda, Mercedes Cabello, José Luis Caro-Oleas, Joan Cid, Fritz Diekmann, Laura Espinosa, Carme Facundo, Marta García, Salvador Gil-Vernet, Miquel Lozano, Beatriz Mahillo, María José Martínez, Blanca Miranda, Federico Oppenheimer, Eduard Palou, María José Pérez-Saez, Lluis Peri, Oscar Rodríguez, Carlos Santiago, Guadalupe Tabernero, Domingo Hernández, Beatriz Domínguez-Gil, and Julio Pascual
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Trasplante renal ,Donante vivo ,Guía Clínica ,Nefrectomía ,Inmunosupresión ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Resumen: Esta guía de recomendaciones para el TR de donante vivo (TRDV) es un documento elaborado con el patrocinio de la Sociedad Española de Nefrología, la Sociedad Española de Trasplantes y la Organización Nacional de Trasplantes que actualiza la calidad de la evidencia disponible para ofrecer el mejor tratamiento de la insuficiencia renal crónica cuando se disponga de un donante vivo potencial. El objetivo principal de esta guía es proporcionar a los profesionales con responsabilidad en los estudios previos del donante vivo y del receptor trasplantado, las mejores herramientas para tomar decisiones en beneficio del donante vivo y del receptor del trasplante.Además, en el contexto actual del TR, el donante vivo debe recuperar el protagonismo que alcanzó en un pasado reciente. Para ello, las nuevas modalidades de donación HLA y/o ABO incompatible, así como la donación cruzada disponibles en diversos centros con experiencia en TRDV, son oportunidades adicionales para el tratamiento de enfermos renales que tienen un donante incompatible.Los buenos resultados en supervivencia del paciente y del injerto están ampliando las circunstancias de aceptación de donantes vivos de riñón, incluyendo donantes de mayor edad y otros con algunos condicionantes que incluyen antecedentes o alteraciones límite que, cuando son evaluados con criterios objetivos, pueden aportar un numero adicional de trasplantes.No se ha obviado en esta guía que el TRDV puede representar algún riesgo para el que dona. Estos problemas que pueden aparecer a corto o largo plazo tienen que ser objeto principal de valoración previa a la donación y presentados al potencial donante para que en ejercicio de su autonomía los asuma o rechace. La experiencia acumulada en los últimos años ha permitido avanzar en el análisis de riesgos para preservar la salud de los donantes, aspecto que debe estar siempre presente en los responsables de programas de TRDV cuando se procede al estudio de idoneidad de un potencial donante.Finalmente, esta guía ha sido estructurada para facilitar la toma de decisiones con recomendaciones y sugerencias ante incertidumbres derivadas de los resultados en los exhaustivos estudios predonación. Y todo ello, con el objetivo de que el consentimiento informado que debe certificar la calidad de los estudios y la información proporcionada a donante y receptor, alcancen las mayores garantías posibles. Abstract: This guide for living donor renal transplantation (LDRT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes.Moreover, the role of living donors in the current RT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDRT, offer additional ways to treat renal patients with an incompatible donor.Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations.This guide does not forget that LDRT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able to take them into account. Experience over recent years has led to progress in risk analysis, to protect donors’ health. This aspect always has to be taken into account by LDRT programmes when evaluating potential donors.Finally, this guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees.
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- 2022
- Full Text
- View/download PDF
23. The future of robotic surgery in urology: from augmented reality to the advent of metaverse
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Enrico Checcucci, Paolo Verri, Daniele Amparore, Giovanni Enrico Cacciamani, Juan Gomez Rivas, Riccardo Autorino, Alex Mottrie, Alberto Breda, and Francesco Porpiglia
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Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2023
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- View/download PDF
24. Feasibility and optimal setting of robot-assisted partial nephrectomy with the novel 'hugo' robotic system: a pre-clinical study
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Carlo Andrea Bravi, Luca Sarchi, Angelo Mottaran, Marco Paciotti, Rui Farinha, Pietro Piazza, Pieter De Backer, Stefano Puliatti, Ruben De Groote, Geert De Naeyer, Anthony Gallagher, Alberto Breda, and Alexandre Mottrie
- Subjects
Robotic surgery ,Urological procedures ,Robot-assisted partial nephrectomy ,Pre-clinical study ,Feasibility ,HUGO robotic platform ,Surgery ,RD1-811 ,Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2022
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25. Radiation-induced haemorrhagic cystitis after prostate cancer radiotherapy: factors associated to hospitalization and treatment strategies
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Francesco Sanguedolce, Gemma Sancho Pardo, Asier Mercadé Sanchez, Josep Balaña Lucena, Francesca Pisano, Julio Calderón Cortez, Angelo Territo, Jordi Huguet Perez, Josep Gaya Sopeña, Cristina Esquina Lopez, Alberto Breda, and Joan Palou Redorta
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Prostate neoplasm ,Radiotherapy ,Hospitalization ,Hematuria ,Cystitis ,Risk factors ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Background: Late onset of radiation-induced haemorrhagic cystitis (RHC) after radiation therapy (RT) for prostate cancer (PCa) may present or evolve severely, requiring hospitalization with invasive interventions. In the present study, we have analysed the prevalence and risk factors associated with the onset of RHC. Methods: From January 2002 to May 2017, 1421 patients undertook RT for PCa as a primary, adjuvant, or salvage treatment option. RHC presented in 5.6% (n = 80) of the patients; the diagnosis was based on clinical and endoscopic characteristics. Variables in observation included patients, tumours, and RT-dosimetry characteristics. Patients with a previous history of bladder cancer were excluded. Univariate (Student t/Chi square) and uni-/multivariate Cox regression analysis were performed; the events and time-points were hospitalization and time-to-event, respectively. Results: There were 80 patients with a mean age at RT of 70.1 years (SD 6.4), mean time lag to RHC of 43.9 months (SD 37.5). Median Emergency attendance was two and three times for patients without/with hospitalization, respectively. There were in total 64 admissions with invasive treatment required in 26/36 (72.2%) of the patients hospitalised, including transurethral fulguration in 22 and radical cystectomy in 5. Patients at higher risk of hospitalization were those undertaking antiplatelet/anticoagulant treatment (HR:3.30; CI 95%:1.53–3.30; p = 0.002) and those treated with salvage RT with higher bladder volume receiving >70 Gy (bladder V70) (HR:1.03; CI 95%:1.01–1.05; p = 0.027). At receiving operating characteristic analysis, the cutoff for bladder V70 was 29%. Conclusion: Nearly half of patients presenting RHC may require invasive treatment including cystectomy. Risk factors associated with hospitalization are patients undertaking antiplatelet/coagulant treatment and bladder V70 > 29% in salvage RT patients.
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- 2021
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26. Comparing Oncological and Perioperative Outcomes of Open versus Laparoscopic versus Robotic Radical Nephroureterectomy for the Treatment of Upper Tract Urothelial Carcinoma: A Multicenter, Multinational, Propensity Score-Matched Analysis
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Nico C. Grossmann, Francesco Soria, Tristan Juvet, Aaron M. Potretzke, Hooman Djaladat, Alireza Ghoreifi, Eiji Kikuchi, Andrea Mari, Zine-Eddine Khene, Kazutoshi Fujita, Jay D. Raman, Alberto Breda, Matteo Fontana, John P. Sfakianos, John L. Pfail, Ekaterina Laukhtina, Pawel Rajwa, Maximillian Pallauf, Cédric Poyet, Giovanni E. Cacciamani, Thomas van Doeveren, Joost L. Boormans, Alessandro Antonelli, Marcus Jamil, Firas Abdollah, Guillaume Ploussard, Axel Heidenreich, Enno Storz, Siamak Daneshmand, Stephen A. Boorjian, Morgan Rouprêt, Michael Rink, Shahrokh F. Shariat, and Benjamin Pradere
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RNU ,UTUC ,transitional cell carcinoma ,treatment outcomes ,surgical approach ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Objectives: To identify correlates of survival and perioperative outcomes of upper tract urothelial carcinoma (UTUC) patients undergoing open (ORNU), laparoscopic (LRNU), and robotic (RRNU) radical nephroureterectomy (RNU). Methods: We conducted a retrospective, multicenter study that included non-metastatic UTUC patients who underwent RNU between 1990–2020. Multiple imputation by chained equations was used to impute missing data. Patients were divided into three groups based on their surgical treatment and were adjusted by 1:1:1 propensity score matching (PSM). Survival outcomes per group were estimated for recurrence-free survival (RFS), bladder recurrence-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS). Perioperative outcomes: Intraoperative blood loss, hospital length of stay (LOS), and overall (OPC) and major postoperative complications (MPCs; defined as Clavien–Dindo > 3) were assessed between groups. Results: Of the 2434 patients included, 756 remained after PSM with 252 in each group. The three groups had similar baseline clinicopathological characteristics. The median follow-up was 32 months. Kaplan–Meier and log-rank tests demonstrated similar RFS, CSS, and OS between groups. BRFS was found to be superior with ORNU. Using multivariable regression analyses, LRNU and RRNU were independently associated with worse BRFS (HR 1.66, 95% CI 1.22–2.28, p = 0.001 and HR 1.73, 95%CI 1.22–2.47, p = 0.002, respectively). LRNU and RRNU were associated with a significantly shorter LOS (beta −1.1, 95% CI −2.2–0.02, p = 0.047 and beta −6.1, 95% CI −7.2–5.0, p < 0.001, respectively) and fewer MPCs (OR 0.5, 95% CI 0.31–0.79, p = 0.003 and OR 0.27, 95% CI 0.16–0.46, p < 0.001, respectively). Conclusions: In this large international cohort, we demonstrated similar RFS, CSS, and OS among ORNU, LRNU, and RRNU. However, LRNU and RRNU were associated with significantly worse BRFS, but a shorter LOS and fewer MPCs.
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- 2023
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27. Prostate Cancer in Renal Transplant Recipients: Results from a Large Contemporary Cohort
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Giancarlo Marra, Francesco Soria, Federica Peretti, Marco Oderda, Charles Dariane, Marc-Olivier Timsit, Julien Branchereau, Oussama Hedli, Benoit Mesnard, Derya Tilki, Jonathon Olsburgh, Meghana Kulkarni, Veeru Kasivisvanathan, Cedric Lebacle, Oscar Rodriguez-Faba, Alberto Breda, Timo Soeterik, Giorgio Gandaglia, Paola Todeschini, Luigi Biancone, Paolo Gontero, and on behalf of the Collaborators
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prostate cancer ,renal transplant ,treatment ,robotic radical prostatectomy ,immunosuppression ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Objectives: The aim of this study was to assess the natural history of prostate cancer (PCa) in renal transplant recipients (RTRs) and to clarify the controversy over whether RTRs have a higher risk of PCa and poorer outcomes than non-RTRs, due to factors such as immunosuppression. Patients and Methods: We performed a retrospective multicenter study of RTRs diagnosed with cM0 PCa between 2001 and 2019. Primary outcomes were overall (OS) and cancer-specific survival (CSS). Secondary outcomes included biochemical recurrence and/or progression after active surveillance (AS) and evaluation of variables possibly influencing PCa aggressiveness and outcomes. Management modalities included surgery, radiation, cryotherapy, HIFU, AS, and watchful waiting. Results: We included 166 men from nine institutions. Median age and eGFR at diagnosis were 67 (IQR 60–73) and 45.9 mL/min (IQR 31.5–63.4). ASA score was >2 in 58.4% of cases. Median time from transplant to PCa diagnosis was 117 months (IQR 48–191.5), and median PSA at diagnosis was 6.5 ng/mL (IQR 5.02–10). The biopsy Gleason score was ≥8 in 12.8%; 11.6% and 6.1% patients had suspicion of ≥cT3 > cT2 and cN+ disease. The most frequent management method was radical prostatectomy (65.6%), followed by radiation therapy (16.9%) and AS (10.2%). At a median follow-up of 60.5 months (IQR 31–106) 22.9% of men (n = 38) died, with only n = 4 (2.4%) deaths due to PCa. Local and systemic progression rates were 4.2% and 3.0%. On univariable analysis, no major influence of immunosuppression type was noted, with the exception of a protective effect of antiproliferative agents (HR 0.39, 95% CI 0.16–0.97, p = 0.04) associated with a decreased risk of biochemical recurrence (BCR) or progression after AS. Conclusion: PCa diagnosed in RTRs is mainly of low to intermediate risk and organ-confined at diagnosis, with good cancer control and low PCa death at intermediate follow-up. RTRs have a non-negligible risk of death from causes other than PCa. Aggressive upfront management of the majority of RTRs with PCa may, therefore, be avoided.
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- 2022
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28. Pediatric Challenges in Robot-Assisted Kidney Transplantation
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Julien Grammens, Michal Yaela Schechter, Liesbeth Desender, Tom Claeys, Céline Sinatti, Johan VandeWalle, Frank Vermassen, Ann Raes, Caroline Vanpeteghem, Agnieszka Prytula, Mesrur Selçuk Silay, Alberto Breda, Karel Decaestecker, and Anne-Françoise Spinoit
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pediatric kidney transplantation ,kidney transplantation ,pediatric robot-assisted kidney transplantation ,robot-assisted kidney transplantation ,robotics ,robotic surgery ,Surgery ,RD1-811 - Abstract
Kidney transplantation is universally recognized as the gold standard treatment in patients with End-stage Kidney Disease (ESKD, or according to the latest nomenclature, CKD stage 5). Robot-assisted kidney transplantation (RAKT) is gradually becoming preferred technique in adults, even if applied in very few centra, with potentially improved clinical outcomes compared with open kidney transplantation. To date, only very few RAKT procedures in children have been described. Kidney transplant recipient patients, being immunocompromised, might be at increased risk for perioperative surgical complications, which creates additional challenges in management. Applying techniques of minimally invasive surgery may contribute to the improvement of clinical outcomes for the pediatric transplant patients population and help mitigate the morbidity of KT. However, many challenges remain ahead. Minimally invasive surgery has been consistently shown to produce improved clinical outcomes as compared to open surgery equivalents. Robot-assisted laparoscopic surgery (RALS) has been able to overcome many restrictions of classical laparoscopy, particularly in complex and demanding surgical procedures. Despite the presence of these improvements, many challenges lie ahead in the surgical and technical–material realms, in addition to anesthetic and economic considerations. RALS in children poses additional challenges to both the surgical and anesthesiology team, due to specific characteristics such as a small abdominal cavity and a reduced circulating blood volume. Cost-effectiveness, esthetic and functional wound outcomes, minimal age and weight to undergo RALS and effect of RAKT on graft function are discussed. Although data on RAKT in children is scarce, it is a safe and feasible procedure and results in excellent graft function. It should only be performed by a RAKT team experienced in both RALS and transplantation surgery, fully supported by a pediatric nephrology and anesthesiology team. Further research is necessary to better determine the value of the robotic approach as compared to the laparoscopic and open approach. Cost-effectiveness will remain an important subject of debate and is in need of further evaluation as well.
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- 2021
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29. Pentafecta for Radical Nephroureterectomy in Patients with High-Risk Upper Tract Urothelial Carcinoma: A Proposal for Standardization of Quality Care Metrics
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Frederik König, Nico C. Grossmann, Francesco Soria, David D’Andrea, Tristan Juvet, Aaron Potretzke, Hooman Djaladat, Alireza Ghoreifi, Eiji Kikuchi, Nozomi Hayakawa, Andrea Mari, Zine-Eddine Khene, Kazutoshi Fujita, Jay D. Raman, Alberto Breda, Matteo Fontana, John P. Sfakianos, John L. Pfail, Ekaterina Laukhtina, Pawel Rajwa, Maximilian Pallauf, Giovanni E. Cacciamani, Thomas van Doeveren, Joost L. Boormans, Alessandro Antonelli, Marcus Jamil, Firas Abdollah, Jeffrey Budzyn, Guillaume Ploussard, Axel Heidenreich, Siamak Daneshmand, Stephen A. Boorjian, Morgan Rouprêt, Michael Rink, Shahrokh F. Shariat, and Benjamin Pradere
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nephroureterectomy ,pentafecta ,quality ,upper tract urothelial carcinoma ,UTUC ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: Measuring quality of care indicators is important for clinicians and decision making in health care to improve patient outcomes. Objective: The primary objective was to identify quality of care indicators for patients with upper tract urothelial carcinoma (UTUC) and to validate these in an international cohort treated with radical nephroureterectomy (RNU). The secondary objective was to assess the factors associated with failure to validate the pentafecta. Design: We performed a retrospective multicenter study of patients treated with RNU for EAU high-risk (HR) UTUC. Outcome measurements and statistical analysis: Five quality indicators were consensually approved, including a negative surgical margin, a complete bladder-cuff resection, the absence of hematological complications, the absence of major complications, and the absence of a 12-month postoperative recurrence. After multiple imputations and propensity-score matching, log-rank tests and a Cox regression were used to assess the survival outcomes. Logistic regression analyses assessed predictors for pentafecta failure. Results: Among the 1718 included patients, 844 (49%) achieved the pentafecta. The median follow-up was 31 months. Patients who achieved the pentafecta had superior 5-year overall- (OS) and cancer-specific survival (CSS) compared to those who did not (68.7 vs. 50.1% and 79.8 vs. 62.7%, respectively, all p < 0.001). On multivariable analyses, achieving the pentafecta was associated with improved recurrence-free survival (RFS), CSS, and OS. No preoperative clinical factors predicted a failure to validate the pentafecta. Conclusions: Establishing quality indicators for UTUC may help define prognosis and improve patient care. We propose a pentafecta quality criteria in RNU patients. Approximately half of the patients evaluated herein reached this endpoint, which in turn was independently associated with survival outcomes. Extended validation is needed.
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- 2022
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30. Immunological Status of Bladder Cancer Patients Based on Urine Leukocyte Composition at Radical Cystectomy
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Elisabet Cantó, Óscar Rodríguez Faba, Carlos Zamora, Maria Mulet, Maria Soledad Garcia-Cuerva, Ana Palomino, Georgia Anguera, Alberto Breda, Pablo Maroto, and Sílvia Vidal
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MIBC ,urine ,leukocytes ,PD-L1 ,bladder ,Biology (General) ,QH301-705.5 - Abstract
Background: Bladder cancer (BC) is the ninth most common malignancy worldwide, with high rates of recurrence. The use of urine leukocyte composition at the time of radical cystectomy (RC) as a marker for the study of patients’ immunological status and to predict the recurrence of muscle-invasive bladder cancer (MIBC) has received little attention. Methods: Urine and matched peripheral blood samples were collected from 24 MIBC patients at the time of RC. Leukocyte composition and expression of PD-L1 and PD-1 in each subpopulation were determined by flow cytometry. Results: All MIBC patients had leukocytes in urine. There were different proportions of leukocyte subpopulations. The expression of PD-L1 and PD-1 on each subpopulation differed between patients. Neoadjuvant chemotherapy (NAC), smoking status, and the affectation of lymph nodes influenced urine composition. We observed a link between leukocytes in urine and blood circulation. Recurrent patients without NAC and with no affectation of lymph nodes had a higher proportion of lymphocytes, macrophages, and PD-L1+ neutrophils in urine than non-recurrent patients. Conclusions: Urine leukocyte composition may be a useful tool for analyzing the immunological status of MIBC patients. Urine cellular composition allowed us to identify a new subgroup of LN− patients with a higher risk of recurrence.
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- 2021
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31. From Inflammation to the Onset of Fibrosis through A2A Receptors in Kidneys from Deceased Donors
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Elena Guillén-Gómez, Irene Silva, Núria Serra, Francisco Caballero, Jesús Leal, Alberto Breda, Rody San Martín, Marçal Pastor-Anglada, José A. Ballarín, Lluís Guirado, and Montserrat M. Díaz-Encarnación
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fibrosis ,macrophage ,inflammation ,transplant ,kidney ,purinome ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Pretransplant graft inflammation could be involved in the worse prognosis of deceased donor (DD) kidney transplants. A2A adenosine receptor (A2AR) can stimulate anti-inflammatory M2 macrophages, leading to fibrosis if injury and inflammation persist. Pre-implantation biopsies of kidney donors (47 DD and 21 living donors (LD)) were used to analyze expression levels and activated intracellular pathways related to inflammatory and pro-fibrotic processes. A2AR expression and PKA pathway were enhanced in DD kidneys. A2AR gene expression correlated with TGF-β1 and other profibrotic markers, as well as CD163, C/EBPβ, and Col1A1, which are highly expressed in DD kidneys. TNF-α mRNA levels correlated with profibrotic and anti-inflammatory factors such as TGF-β1 and A2AR. Experiments with THP-1 cells point to the involvement of the TNF-α/NF-κB pathway in the up-regulation of A2AR, which induces the M2 phenotype increasing CD163 and TGF-β1 expression. In DD kidneys, the TNF-α/NF-κB pathway could be involved in the increase of A2AR expression, which would activate the PKA–CREB axis, inducing the macrophage M2 phenotype, TGF-β1 production, and ultimately, fibrosis. Thus, in inflamed DD kidneys, an increase in A2AR expression is associated with the onset of fibrosis, which may contribute to graft dysfunction and prognostic differences between DD and LD transplants.
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- 2020
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32. Evaluation of laparoscopic vs robotic partial nephrectomy using the margin, ischemia and complications score system: a retrospective single center analysis
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Stefano Ricciardulli, Qiang Ding, Xu Zhang, Hongzhao Li, Yuzhe Tang, Guoqiang Yang, Xiyou Wang, Xin Ma, Alberto Breda, and Antonio Celia
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Complications ,Laparoscopic partial nephrectomy ,Positive margins ,Robot-assisted partial nephrectomy ,Warm ischemia time ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Objective: To evaluate differences between Laparoscopic Partial Nephrectomy (LPN) and Robot-Assisted Partial Nephrectomy (RAPN) using the Margin, Ischemia and Complications (MIC) score system and to evaluate factors related with MIC success. Materials and Methods: Single centre retrospective study on 258 LPN and 58 RAPN performed between January 2012 and January 2014. Success was defined when surgical margins was negative, Warm Ischemia Time (WIT) was ≤ 20 minutes and no major complications occurred. Mann-Whitney-U and Pearson χ2 correlation were used to compare LPN and RAPN. A matched pair comparison was also performed. Spearman correlation (Rho) was used to evaluate the relationship between clinical, intra and post-operative and pathological patients characteristics with MIC score. A binary regression analysis was also performed to evaluate independent factors associated with MIC success. Results: The MIC rate in LPN and RAPN was 55% and 65.5% respectively. No differences in clinical, intra and post-operative outcomes between groups were found. Clinical tumor size (p-value: < 0.001; OR: 0.829; 95% CI: 0.697-0.987), PADUA score (p-value: < 0.001; OR: 0.843; 95% CI: 0.740-0.960), PADUA risk groups (intermediate; p-value: < 0.001; OR: 0.416; 95% CI: 0.238- 0.792; high: p-value: < 0.001; OR: 0.356; 95% CI: 0.199- 0.636), WIT (p-value: < 0.001; OR: 0.598; 95% CI: 0.530- 0.675) were independently associated with MIC. eGFR (< 60 vs ≥ 60 ml/min per 1.73 m2: p-value: < 0.001; OR: 3.356; 95% CI: 1.701-6.621) and Fuhrman nuclear grade (p-value: 0.014; OR: 1.798; 95% CI:1.129-2.865) were also independently associated with MIC. Conclusions: MIC score system is a simple and useful tool to report and to compare different surgical approach.
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- 2015
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33. Staging of renal cell carcinoma: Current concepts
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John S Lam, Tobias Klatte, and Alberto Breda
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Kidney cancer ,molecular markers ,nomograms ,prognosis ,staging ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
The most important and widely utilized system for providing prognostic information following surgical management for renal cell carcinoma (RCC) is currently the tumor, nodes, and metastasis (TNM) staging system. An accurate and clinically useful staging system is an essential tool used to provide patients with counseling regarding prognosis, select treatment modalities, and determining eligibility for clinical trials. Data published over the last few years has led to significant controversies as to whether further revisions are needed and whether improvements can be made with the introduction of new, more accurate predictive prognostic factors. Staging systems have also evolved with an increase in the understanding of RCC tumor biology. Molecular tumor biomarkers are expected to revolutionize the staging of RCC by providing more effective prognostic ability over traditional clinical variables alone. This review will examine the components of the TNM staging system, current staging modalities including comprehensive integrated staging systems, and predictive nomograms, and introduce the concept of molecular staging for RCC.
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- 2009
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34. ANÁLISE TÉRMICA PARA UMA CÂMARA DE COMBUSTÃO DE UMA BANCADA EXPERIMENTAL PARA AVALIAÇÃO DE DESGASTE EM VÁLVULAS E SEDES DE VÁLVULAS AUTOMOTIVAS, SUBMETIDAS A ENSAIOS EM ALTA TEMPERATURA
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Mascarenhas, Luis Alberto Breda, primary, Gomes, Jefferson de Oliveira, additional, Portela, Andrey Teixeira, additional, Oliveira, Turan Dias, additional, and Santos, Alex Álisson Bandeira, additional
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- 2023
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35. Expanding inclusion criteria for active surveillance in intermediate-risk prostate cancer: a machine learning approach
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Michael Baboudjian, Alberto Breda, Thierry Roumeguère, Alessandro Uleri, Jean-Baptiste Roche, Alae Touzani, Vito Lacetera, Jean-Baptiste Beauval, Romain Diamand, Guiseppe Simone, Olivier Windisch, Daniel Benamran, Alexandre Fourcade, Gaelle Fiard, Camille Durand-Labrunie, Mathieu Roumiguié, Francesco Sanguedolce, Marco Oderda, Eric Barret, Gaëlle Fromont, Charles Dariane, Anne-Laure Charvet, Bastien Gondran-Tellier, Cyrille Bastide, Eric Lechevallier, Joan Palou, Alain Ruffion, Roderick C. N. Van Der Bergh, Alexandre Peltier, and Guillaume Ploussard
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Urology - Published
- 2023
36. Long-term Recurrence and Progression Patterns in a Contemporary Series of Patients with Carcinoma In Situ of the Bladder With or Without Associated Ta/T1 Disease Treated with Bacillus Calmette-Guérin: Implications for Risk-adapted Follow-up
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José Daniel, Subiela, Óscar, Rodríguez Faba, Júlia, Aumatell, Daniel Antonio, Gonzalez-Padilla, Antonio, Rosales Bordes, Jorge, Huguet, Wojciech, Krajewski, Ferran, Algaba, David, López Curtis, Jennifer, Brasero Burgos, Álvaro, Sánchez González, Miguel Ángel, Jiménez Cidre, Francisco Javier, Burgos Revilla, Alberto, Breda, and Joan, Palou
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Urology - Abstract
Limited data are available on patients with carcinoma in situ (CIS) of the bladder managed according to current clinical practice guidelines.To assess the patterns of recurrence, progression to muscle-invasive bladder cancer (MIBC), and upper tract urothelial carcinoma (UTUC) in patients with CIS, and to compare the effectiveness of adequate versus inadequate bacillus Calmette-Guérin (BCG) immunotherapy.A retrospective analysis of 386 patients with CIS of the bladder with or without associated pTa/pT1 disease treated with BCG between 2008 and 2015.Kaplan-Meier estimations and an inverse probability of treatment weighting (IPTW)-Cox regression were performed to compare recurrence-free survival (RFS) and progression-free survival (PFS) and UTUC incidence over time for patients who received adequate versus inadequate BCG treatment.The median follow-up was 70.5 mo. At 5 and 10 yr, RFS was 82% and 52%, PFS was 93.6% and 75.8%, and UTUC incidence was 1.7% and 2.9%, respectively. Most recurrence (73.6%) and progression (69.1%) events occurred in the first 3 yr of follow-up, while 38.7% of UTUC incident events were recorded after 5 yr of follow-up. IPTW-Cox regression revealed that patients who received BCG treatment had a lower risk of recurrence (hazard ratio [HR] 0.21, 95% confidence interval [CI] 0.13-0.34), progression (HR 0.46, 95% CI 0.25-0.87), and UTUC incidence (HR 0.24, 95% CI 0.09-0.64). Limitations include the retrospective design and potential selection bias.Patients with CIS of the bladder show a high risk of recurrence, progression, and UTUC incidence. Most of these outcomes occur during the first 3 yr of follow-up, but a significant proportion of the events occur at long-term follow-up. Although receipt of adequate BCG treatment improves outcomes, intensive and long-term surveillance may be warranted.We investigated the long-term cancer control outcomes for patients with carcinoma in situ (CIS; cancerous cells that have not spread from where they first formed) of the bladder. Patients with CIS have a high risk of cancer recurrence and progression. Treatment with bacillus Calmette-Guérin (BCG) improves outcomes.
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- 2023
37. Diagnostic Accuracy of Clinical Lymph Node Staging for Upper Tract Urothelial Cancer Patients
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Maximilian Pallauf, David D’Andrea, Frederik König, Ekaterina Laukhtina, Takafumi Yanagisawa, Morgan Rouprêt, Siamak Daneshmand, Hooman Djaladat, Alireza Ghoreifi, Francesco Soria, Kazutoshi Fujita, Stephen A. Boorjian, Aaron M. Potretzke, Andrea Mari, Mathieu Roumiguié, Alessandro Antonelli, Alberto Bianchi, Zine-Eddine Khene, John P. Sfakianos, Marcus Jamil, Joost L. Boormans, Jay D. Raman, Nico C. Grossmann, Alberto Breda, Axel Heidenreich, Francesco Del Giudice, Nirmish Singla, Shahrokh F. Shariat, Benjamin Pradere, and Urology
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SDG 3 - Good Health and Well-being ,Urology - Abstract
Purpose:Treatment options for the management of upper tract urothelial cancer are based on accurate staging. However, the performance of conventional cross-sectional imaging for clinical lymph node staging (N-staging) remains poorly investigated. This study aims to evaluate the diagnostic accuracy of conventional cross-sectional imaging for upper tract urothelial cancer N-staging.Materials and Methods:This study was a multicenter, retrospective, observational study. We included 865 nonmetastatic (M0) upper tract urothelial cancer patients treated with curative intended surgery and lymph node dissection who had been staged with conventional cross-sectional imaging before surgery. We compared clinical (c) and pathological (p) N-staging results to evaluate the concordance of node-positive (N+) and node-negative (N0) disease and calculate cN-staging's diagnostic accuracy.Results:Conventional cross-sectional imaging categorized 750 patients cN0 and 115 cN+. Lymph node dissection categorized 641 patients pN0 and 224 pN+. The cN-stage was pathologically downstaged in 6.8% of patients, upstaged in 19%, and found concordant in 74%. The sensitivity and specificity of cN-staging were 25% (95% CI 20; 31) and 91% (95% CI 88; 93). Positive and negative likelihood ratios were 2.7 (95% CI 2.0; 3.8) and 0.83 (95% CI 0.76; 0.89). The area under the receiver operating characteristics curve (0.58, 95% CI 0.55; 0.61) revealed low diagnostic accuracy.Conclusions:Conventional cross-sectional imaging had low sensitivity in detecting upper tract urothelial cancer pN+ disease. However, cN+ increased the likelihood of pN+ by almost threefold. Thus, conventional cross-sectional imaging is a rule-in but not a rule-out test. Lymph node dissection should remain the standard during extirpative upper tract urothelial cancer surgery to obtain accurate N-staging. cN+ could be a strong argument for early systemic treatment.
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- 2023
38. International Expert Consensus on Metric-based Characterization of Robot-assisted Partial Nephrectomy
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Rui Farinha, Alberto Breda, James Porter, Alexandre Mottrie, Ben Van Cleynenbreugel, Jozef Vander Sloten, Angelo Mottaran, and Anthony G. Gallagher
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Urology - Abstract
Robot-assisted partial nephrectomy (RAPN) training usually takes place in vivo, and methods vary across countries/institutions. No common system exists to objectively assess trainee ability to perform RAPN at predetermined performance levels prior to in vivo practice. The identification of objective performance metrics for RAPN training is a crucial starting point to improve training and surgical outcomes.We sought to identify objective performance metrics that best characterize a reference approach to RAPN, and obtain face and content validity from procedure experts through a modified Delphi meeting.During a series of online meetings, a core metrics team of three RAPN experts and a senior behavioral scientist performed a detailed task deconstruction of a transperitoneal left-sided RAPN procedure.Based on published guidelines, manufacturers' instructions, and unedited videos of RAPN, the team identified performance metrics that constitute an optimal approach for training purposes. The metrics were then subjected to an in-person modified international Delphi panel meeting with 19 expert surgeons.Eleven procedure phases, with 64 procedure steps, 43 errors, and 39 critical errors, were identified. After the modified Delphi process, the international expert panel added 13 metrics (two steps), six were deleted, and three were modified; 100% panel consensus on the resulting metrics was obtained. Limitations are that the metrics are applicable only to left-sided RAPN cases and some might have been excluded.Performance metrics that accurately characterize RAPN procedure were developed by a core group of experts. The metrics were then presented to and endorsed by an international panel of very experienced peers. Reliable and valid metrics underpin effective, quality-assured, structured surgical training for RAPN.We organize a meeting among robot-assisted partial nephrectomy (RAPN) experts to identify and reach consensus on objective performance metrics for RAPN training. The metrics are a crucial starting point to improve and quality assure surgical training and patients' clinical outcomes.
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- 2023
39. Optimizing decision-making process of benign uretero-enteric anastomotic stricture treatment after radical cystectomy
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Josep M. Gaya, Angelo Territo, Giuseppe Basile, Andrea Gallioli, Christian Martínez, Morena Turco, Michael Baboudjian, Paolo Verri, Alessandro Tedde, Alessandro Uleri, Iacopo Meneghetti, Jordi Huguet, Antonio Rosales, Francesco Sanguedolce, Oscar Rodriguez-Faba, Joan Palou, and Alberto Breda
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Urology - Published
- 2023
40. Oncological and Renal Function Outcomes in Patients Who Underwent Simultaneous Radical Cystectomy and Nephroureterectomy for Synchronous or Metachronous Panurothelial Carcinoma
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José Daniel Subiela, Daniel A. González-Padilla, Jorge Huguet, Júlia Aumatell, Oscar Rodríguez-Faba, Wojciech Krajewski, Alejandro Hevia Feliu, Cesar Mínguez, José López Plaza, Alberto Artiles Medina, Pablo Gajate, Miguel Ángel Jiménez Cidre, Javier Burgos Revilla, Alberto Breda, and Joan Palou
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Urology - Abstract
To assess clinical outcomes of patients who underwent simultaneous radical cystectomy (RC) and radical nephroureterectomy (RNU) for panurothelial carcinoma (PanUC).A retrospective analysis of 67 patients who underwent simultaneous RC and unilateral RNU for PanUC, from 1996 to 2017. Kaplan-Meier estimates for remnant urothelium recurrence-free survival (RRFS), metastasis-free survival (MFS), overall survival (OS), and cancer-specific survival (CSS) were performed. Cox multivariate models were constructed.The median follow-up was 38 months, 29.8% of patients had a recurrence, 34.3% had metastasis, 67.2% of patients died from any cause, and 37.3% died from urothelial carcinoma. OS and CSS rates at 5 years were 44% and 61%, respectively. In multivariate analysis, progression to muscle-invasive bladder cancer before surgery, presence of muscle-invasive stages at RC and/or RNU, and prostatic urethra involvement were predictors for worse MFS and CSS. Forty-one patients (61.2%) had an estimated glomerular filtration rate (eGFR)60 ml/min before surgery and the number rose to 56 (83.5%) after surgery; 29.8% patients needed renal function replacement therapy after surgery (16 haemodialysis and 4 renal transplant).Patients with PanUC who undergo simultaneous surgery have adverse oncological (only 4 out of every 10 remain alive at 5 years) and functional outcomes (1 out of 3 will need renal function replacement therapy after surgery). Up to a third of the patients had a recurrence (urethra or contralateral kidney) within 18 months, justifying close surveillance or considering prophylactic urethrectomy. These data should help in counsel on morbidity and life expectancy.
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- 2023
41. DNA Methylation Urine Biomarkers Test in the Diagnosis of Upper Tract Urothelial Carcinoma: Results from a Single-Center Prospective Clinical Trial
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Angelo Territo, Andrea Gallioli, Pietro Diana, Romain Boissier, Matteo Fontana, Josep Maria Gaya, Francesco Sanguedolce, Julio Calderón, Alberto Piana, Sofia Fontanet, Ferran Algaba, Joan Palou, and Alberto Breda
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Carcinoma, Transitional Cell ,Urinary Bladder Neoplasms ,diagnosis ,Urology ,epigenomics ,Biomarkers, Tumor ,Humans ,biomarkers ,Prospective Studies ,DNA Methylation ,Neoplasm Recurrence, Local - Abstract
Purpose: The correct risk categorization and staging of upper tract urothelial cancer (UTUC) is key for disease management. Computerized tomography urography and urinary cytology have limited accuracy for risk stratification of UTUC. Ureteroscopy may increase the risk of bladder cancer recurrence. Recently, Bladder EpiCheckTM (EpiCheck) showed a high accuracy in the detection of bladder cancer. The aim of the study is to investigate the diagnostic accuracy of EpiCheck in the clinical management of UTUC and to compare it with urinary cytology. Materials and Methods: In this single-arm, blinded, prospective, single-center study (February 2019eDecember 2020), all patients who were candidates for ureteroscopy for suspicion of UTUC were included. Bladder and upper urinary tract (UUT) samples were collected before ureteroscopy to test for cytology and Epicheck. EpiCheck accuracy was calculated in bladder and UUT samples and compared to cytology. Results: EpiCheck resulted diagnostic in 83/86 (97%) and 73/75 (97%) of UUT and bladder samples. Histology was positive in 47/83 (57%) and 42/73 (58%) cases, respectively. In UUT samples, EpiCheck yielded a sensitivity/specificity/negative predictive value (NPV)/positive predictive value of 83%/79%/77%/84% vs 59%/88%/61%/87% of cytology. The sensitivity/NPV for high-grade tumors was 96%/97% for EpiCheck vs 71%/86% for cytology. EpiCheck indicated ureteroscopy in 45/80 (56%) patients, missing 17%/4% of all/high-grade UTUC with 9% of unnecessary ureteroscopy. In bladder samples, the sensitivity/NPV for high-grade tumors was 71%/88% for EpiCheck and 59%/87% for cytology. Conclusions: Epicheck may be an important tool to decrease the number of unnecessary ureteroscopy. The clinical implementation of EpiCheck in UTUC warrants further investigation in multicentric prospective randomized trials.
- Published
- 2022
42. INOVANDO A EDUCAÇÃO CORPORATIVA COM MICROLEARNING E GAMIFICAÇÃO
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Minho, Marcelle, primary, Soares, Thaís Araújo, additional, Dantas, Igor Nogueira Oliveira, additional, Cayres, Victor, additional, Cristofoletti, Sergio Eduardo, additional, Lima, Ricardo Santos, additional, and Mascarenhas, Luis alberto Breda, additional
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- 2019
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43. Health-related quality of life in patients with metastatic hormone-sensitive prostate cancer treated with androgen receptor signaling inhibitors: the role of combination treatment therapy
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Luca Afferi, Mattia Longoni, Marco Moschini, Giorgio Gandaglia, Alicia K. Morgans, Richard Cathomas, Agostino Mattei, Alberto Breda, Roberto Mario Scarpa, Rocco Papalia, Cosimo de Nunzio, and Francesco Esperto
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Cancer Research ,Oncology ,Urology - Published
- 2023
44. MP63-04 ONE YEAR ONCOLOGICAL OUTCOME UPDATED ANALYSIS OF a SINGLE-CENTER PROSPECTIVE, RANDOMIZED, CONTROLLED, NON-INFERIORITY TRIAL: EN BLOC VS. CONVENTIONAL TRANSURETHRAL RESECTION OF BLADDER TUMOR
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Pietro Diana, Andrea Gallioli, Angelo Territo, Óscar Rodriguez-Faba, Josep Maria Gaya, Francesco Sanguedolce, Jordi Huguet, Ruben Parada, Julia Aumatell, Alejandra Bravo, Ferran Algaba, Joan Palou, and Alberto Breda
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Urology - Published
- 2023
45. MP69-08 FOLLOW-UP INTENSITY SCHEME FOR UPPER TRACT UROTHELIAL CARCINOMA AFTER NEPHRON-SPARING SURGERY
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Giuseppe Basile, Andrea Gallioli, Paolo Verri, Julia Aumatell, Sofia Fontanet, Alessandro Uleri, Francesco Sanguedolce, Oscar Rodriguez-Faba, Angelo Territo, Alberto Martini, Joan Palou, and Alberto Breda
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Urology - Published
- 2023
46. MP69-14 THE IMPLEMENTATION OF SYSTEMATIC BIOPSIES IN THE ENDOSCOPIC MANAGEMENT OF UPPER TRACT UROTHELIAL CANCER
- Author
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Andrea Gallioli, Angelo Territo, Basile Giuseppe, Pietro Diana, Paolo Verri, Francesco Sanguedolce, Josep Maria Gaya, Pavel Gavrilov, Alessandro Uleri, Sofia Fontanet, Paula Izquierdo, Jordi Huguet, Ferran Algaba, Joan Palou, and Alberto Breda
- Subjects
Urology - Published
- 2023
47. PD21-06 ONCOLOGICAL OUTCOMES IN IMMUNOCOMPROMISED VS IMMUNOCOMPETENT PROSTATE CANCER PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS
- Author
-
Francesco Sanguedolce, Alessandro Tedde, Michael Baboudjian, Alessandro Uleri, Paolo Verri, Giuseppe Basile, Andrea Gallioli, Angelo Territo, Edgar Cristian Suquilanda Piedra, Jorge Miguel Robalino Aldaz, Jordi Huguet Pérez, Josep Maria Gaya Sopena, Massimo Madonia, Joan Palou Redorta, and Alberto Breda
- Subjects
Urology - Published
- 2023
48. MP69-07 ONCOLOGICAL OUTCOMES OF SECOND-LOOK URETEROSCOPY FOR UPPER TRACT UROTHELIAL CARCINOMA: A SINGLE CENTER EXPERIENCE
- Author
-
Andrea Gallioli, Giuseppe Basile, Paolo Verri, Angelo Territo, Paula Izquierdo, Jose Maria Gaya, Francesco Sanguedolce, Alessandro Uleri, Julia Aumatell, Jorge Huguet, Joan Palou, and Alberto Breda
- Subjects
Urology - Published
- 2023
49. MP25-15 INTERNATIONAL EXPERTS CONSENSUS ON PERFORMANCE METRICS FOR A TRANSURETHRAL RESECTION OF BLADDER
- Author
-
Marco Paciotti, Pietro Diana, Pieve Emanuele, Andrea Gaglioli, Ruben De Groote, RUI FARINHA, Vincenzo Ficarra, Richard Gaston, Paolo Gontero, Rodolfo Hurle Rozzano, Luis Martínez-Piñeiro, Andrea Minervini, Vito Pansadoro, Ben Van Cleynenbreugel, Peter Wiklund, Paolo Casale Rozzano, Giovanni Lughezzani, Stefano Mancon, Alessandro Uleri, Alexandre Mottrie, Joan palou, Anthony G. Gallagher, Alberto Breda, and Nicolò Buffi
- Subjects
Urology - Published
- 2023
50. MP25-12 OUTCOMES OF SUPERVISED RESIDENT COMPARED TO ATTENDINGS IN TRANSURETHRAL RESECTION OF BLADDER CANCER: THE IMPORTANCE OF MENTORING
- Author
-
Pietro Diana, Andrea Gallioli, Angelo Territo, Óscar Rodriguez-Faba, Josep Maria Gaya, Francesco Sanguedolce, Jordi Huguet, Ruben parada, Julia Aumatell, Alejandra Bravo, Ferran Algaba, Joan Palou, and Alberto Breda
- Subjects
Urology - Published
- 2023
Catalog
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