External validation of nomograms including MRI features for the prediction of side-specific extraprostatic extension.

BACKGROUND: Prediction of side-specific extraprostatic extension (EPE) is crucial in selecting patients for nerve-sparing radical prostatectomy (RP). Multiple nomograms, which include magnetic resonance imaging (MRI) information, are available predict side-specific EPE. It is crucial that the accuracy of these nomograms is assessed with external validation to ensure they can be used in clinical practice to support medical decision-making. METHODS: Data of prostate cancer (PCa) patients that underwent robot-assisted RP (RARP) from 2017 to 2021 at four European tertiary referral centers were collected retrospectively. Four previously developed nomograms for the prediction of side-specific EPE were identified and externally validated. Discrimination (area under the curve [AUC]), calibration and net benefit of four nomograms were assessed. To assess the strongest predictor among the MRI features included in all nomograms, we evaluated their association with side-specific EPE using multivariate regression analysis and Akaike Information Criterion (AIC). RESULTS: This study involved 773 patients with a total of 1546 prostate lobes. EPE was found in 338 (22%) lobes. The AUCs of the models predicting EPE ranged from 72.2% (95% CI 69.1-72.3%) (Wibmer) to 75.5% (95% CI 72.5-78.5%) (Nyarangi-Dix). The nomogram with the highest AUC varied across the cohorts. The Soeterik, Nyarangi-Dix, and Martini nomograms demonstrated fair to good calibration for clinically most relevant thresholds between 5 and 30%. In contrast, the Wibmer nomogram showed substantial overestimation of EPE risk for thresholds above 25%. The Nyarangi-Dix nomogram demonstrated a higher net benefit for risk thresholds between 20 and 30% when compared to the other three nomograms. Of all MRI features, the European Society of Urogenital Radiology score and tumor capsule contact length showed the highest AUCs and lowest AIC. CONCLUSION: The Nyarangi-Dix, Martini and Soeterik nomograms resulted in accurate EPE prediction and are therefore suitable to support medical decision-making.

Complete substitution of the left ureter with vermicular appendix during hemicolectomy for cancer in an adult patient.

We demonstrated that a complete left ureteral substitution with appendix is a feasible and safe technique. To our knowledge, this is the first case of a successful complete substitution of the left ureter with vermicular appendix in an adult patient reported in the literature.

"b-MAP": un nuevo diagrama para comunicar datos en varias áreas de una vejiga evaluada endoscópicamente / "b-MAP": A new diagram for reporting data on various areas of an endoscopically evaluated bladder

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Specific learning curve for port placement and docking of da Vinci(®) Surgical System: one surgeon's experience in robotic-assisted radical prostatectomy.

Port placement and docking of the da Vinci(®) Surgical System is fundamental in robotic-assisted laparoscopic radical prostatectomy (RALP). The aim of our study was to investigate learning curves for port placement and docking of robots (PPDR) in RALP. This manuscript is a retrospective review of prospectively collected data looking at PPDR in 526 patients who underwent RALP in our institute from April 2005 to May 2010. Data included patient-factor features such as body mass index (BMI), and pre-, intra- and post-operative data. Intra-operative information included operation time, subdivided into anesthesia, PPDR and console times. 526 patients underwent RALP, but only those in whom PPDR was performed by the same surgeon without laparoscopic and robotic experience (F.D.M.) were studied, totalling 257 cases. The PPDR phase revealed an evident learning curve, comparable with other robotic phases. Efficiency improved until approximately the 60th case (P < 0.001), due more to effective port placement than to docking of robotic arms. In our experience, conversion to open surgery is so rare that statistical evaluation is not significant. Conversion due to robotic device failure is also very rare. This study on da Vinci procedures in RALP revealed a learning curve during PPDR and throughout the robotic-assisted procedure, reaching a plateau after 60 cases.

Long-term results of surgical management of pulmonary metastases from renal cell carcinoma.

BACKGROUND: Metastatic renal cell carcinoma (RCC) has a poor prognosis and conventional treatments such as chemoradiotherapy show little efficacy. Surgical resection of pulmonary metastases from RCC is a widely accepted treatment, even if selection criteria based on prognostic factors have still not been defined. The aim of this study was to determine the long-term survival, clinical outcome and prognostic factors after surgery. METHODS: Between 1988 and 2004, 59 patients underwent resection of pulmonary metastases from RCC. Univariate and multivariate analysis of prognostic factors was carried out. RESULTS: Complete resection was achieved in 54 (91.5 %) patients. No intra- or postoperative mortality occurred, 5 (8.5 %) patients experienced postoperative complications. Overall, the 1-, 3-, and 5-year survival rates were 86.5 %, 63 % and 53 %, respectively. Age at the time of pulmonary resection was found to be the only independent factor influencing prognosis. CONCLUSION: Pulmonary resection of metastases from RCC is a safe and effective treatment associated with a low morbidity and mortality and with high long-term survival. The lack of other effective therapies suggests use of the surgical approach whenever possible.

A novel approach for accurate prediction of spontaneous passage of ureteral stones: support vector machines.

The objective of this study was to optimally predict the spontaneous passage of ureteral stones in patients with renal colic by applying for the first time support vector machines (SVM), an instance of kernel methods, for classification. After reviewing the results found in the literature, we compared the performances obtained with logistic regression (LR) and accurately trained artificial neural networks (ANN) to those obtained with SVM, that is, the standard SVM, and the linear programming SVM (LP-SVM); the latter techniques show an improved performance. Moreover, we rank the prediction factors according to their importance using Fisher scores and the LP-SVM feature weights. A data set of 1163 patients affected by renal colic has been analyzed and restricted to single out a statistically coherent subset of 402 patients. Nine clinical factors are used as inputs for the classification algorithms, to predict one binary output. The algorithms are cross-validated by training and testing on randomly selected train- and test-set partitions of the data and reporting the average performance on the test sets. The SVM-based approaches obtained a sensitivity of 84.5% and a specificity of 86.9%. The feature ranking based on LP-SVM gives the highest importance to stone size, stone position and symptom duration before check-up. We propose a statistically correct way of employing LR, ANN and SVM for the prediction of spontaneous passage of ureteral stones in patients with renal colic. SVM outperformed ANN, as well as LR. This study will soon be translated into a practical software toolbox for actual clinical usage.

Pharmacokinetic study of intravesical gemcitabine in carcinoma in situ of the bladder refractory to bacillus Calmette-Guérin therapy.

INTRODUCTION: Gemcitabine, a chemotherapeutic agent, has been shown to be active against transitional cell cancer of the bladder. The aim of the study was to determine the pharmacokinetic profile of gemcitabine, administered intravesically in patients with carcinoma in situ(CIS). MATERIAL AND METHODS: Nine patients with CIS refractory to intravesical bacillus Calmette-Guérin (BCG) therapy were enrolled. Gemcitabine was given in 50 ml 0.9% NaCl by catheterization and held in the bladder for 1 h, once weekly for 6 consecutive weeks. The pharmacokinetics for gemcitabine metabolites were performed in plasma and serum. Dose levels were: 1,000, 1,250, and 1,500 mg. Clinical evaluation was repeated 4 weeks after therapy and thereafter every 6 months. RESULTS: Grade-1 neutropenia was observed only in 1 patient. Grade-1 urinary frequency and hematuria were observed in 1 and 3 patients, respectively. No grade 2-4 toxicity or clinically relevant myelosuppression were observed. Gemcitabine was detectable in serum, but with an irrelevant pharmacological effect, in only 1 patient treated with 1,500 mg of gemcitabine. With regard to activity, after 6 instillations of this drug, 4 complete responses were observed. CONCLUSION: Intravesical gemcitabine is well tolerated and safe. No systemic absorption with a clinical or pharmacological effect was detected and only slightly irritative bladder symptoms were observed. These results warrant further investigation in phase-II trials.

[Synchronous and metachronous bilateral tumors of the testis: a single institution experience of 11 cases and review of the literature]. / I tumori bilaterali del testicolo sincroni e metacroni: esperienza di un singolo Centro Urologico su 11 casi e revisione della letteratura.

Bilateral testicular tumors represent a very rare event and account for 2.7% of all testicular neoplasms. 15% of bilateral testicular tumors occurs simultaneously in both testicles, but in 85% of cases the second neoplasia appears in the remaining testicles of patients affected by unilateral testicular tumor after a very variable period of time. The aim of this work was to value our experience on 11 cases of bilateral testis tumors: six arised simultaneously in both gonads (five germ cell tumors and one Leydig cell tumor) and five with metachronous appearance (all germ cell tumors). A comprehensive valuation has been made considering other cases reported in literature until 1996, in order to identify predisposing conditions to bilateral disease. Examining separately synchronous and metachronous neoplasms, as far as we know, only 218 cases of simultaneous bilateral testicular tumors are reported in literature, and most of them are pure seminomas; however, after 1988 this result has been reversed in favour of neoplasms with non-seminomatous elements: this data suggests inadequate classification in the past. Moreover, considering 243 cases of metachronous neoplasms, 126 of them (51.9%) began as non-seminomatous tumors: this disagrees with an old belief that patients affected by seminoma are more prone to develop a second tumor in the remaining testicle. It has been also possible to confirm that testis sparing surgery allows to maintain both fertility and endocrinous function. This technique can be used in any potentially benign neoplasms (as Leydig cell tumors) while the same treatment modality, although already reported in literature, needs more experience to be considered as a successful therapy for germinal tumors.

[Prevention and early diagnosis of testicular neoplasms]. / Prevenzione e diagnosi precoce nella neoplasia testicolare.

Aetiology of testicular cancer is still poorly characterized, so the prevention is unlikely to achieve. A fundamental issue is early detection as delay in presentation is a common feature in patients affected by this disease. Moreover there is much evidence suggesting a significant association between delay in diagnosis and clinical stage at presentation particularly for nonseminomas. 176 valuable patients with non seminomatous germ cell tumors of the testis had a clearly identifiable interval from first symptoms until diagnosis; mean delay was 13.9 weeks, and there was a correlation between difference in delay of I clinical stage patients (mean: 10.0 weeks) and III stage patients (mean: 18.6 weeks) ANOVA: p < 0.035. These data suggest that encouraging programmes in order to provide more informations on testicular cancer and testicular self examination (TSE) may contribute to reduce the number of young men requiring toxic treatment and major surgery and even may reduce mortality.