COVID-19 pandemic strongly modified the organizations of our clinical practice. Strict containment measures have been adopted to limit the disease diffusion. In particular, hospital face-to-face post ...discharge and follow up visits have been reduced. Although cancelling or deferring appointments seems to be a pragmatic approach, this solution may have a devasting long-term impact on health medical care and on patients. In this context, telemedicine and remote consultations may have the potential to provide healthcare minimizing virus exposure. In this paper we describe how Multidisciplinary team (MDT) reorganized genitourinary cancer care delivery at our Institute (AO SS Antonio e Biagio e Cesare Arrigo, Alessandria), taking advantage of telematic means. Furthermore, we present our preliminary results regarding patients' satisfaction.
To the Editor,
The exact time to stop bladder cancer patient’s follow-up is not well known and there is not a clear recommendation on if and when stop to follow a patient managed for muscle invasive ...bladder cancer (MIBC). Major urological guidelines do not provide a precise indication on the timing of follow-up, and there is currently no real consensus on optimal time schedule ....
Objective: To assess the influence of biochemical recurrence (BCR) risk groups and PSA kinetics on the outcomes of radioguided surgery against prostate-specific membrane antigen (PSMA-RGS). ...Currently, neither BCR risk group nor PSA doubling time (PSA-DT), or PSA velocity (PSA-V) are actively assigned or relevant for counseling prior to PSMA-RGS. Methods: We retrospectively analyzed PSMA-RGS cases for oligorecurrent prostate cancer between 2014 and 2023. BCR risk groups, PSA-DT, and PSA-V were analyzed as predictors for complete biochemical response (cBR, PSA < 0.2 ng/mL), BCR-free, and therapy-free survival (BCRFS, TFS). Results: Of 374 included patients, only 21/374 (6%) and 201/374 (54%) were classified as low- and high-risk BCR (no group assignment possible in 152/374, 41%). A total of 13/21 (62%) patients with low- and 120/201 (60%) with high-risk BCR achieved cBR (p = 1.0). BCR classification was no predictor for BCRFS (HR:1.61, CI: 0.70–3.71, p = 0.3) or subsequent TFS (HR:1.07, CI: 0.46–2.47, p = 0.9). A total of 47/76 (62%) patients with PSA-DT ≤ 6 mo and 50/84 (60%) with PSA-DT > 6 mo achieved cBR (p = 0.4). PSA-DT was not associated with cBR (OR: 0.99, CI: 0.95–1.03, p = 0.5), BCRFS (HR: 1.00, CI: 0.97–1.03, p = 0.9), or TFS (HR: 1.02, CI: 0.99–1.04, p = 0.2). Consistent negative findings were recorded for PSA-V. Conclusions: The BCR risk groups and PSA kinetics do not predict the oncological success of PSMA-RGS performed at low absolute PSA values. Indolent low-risk BCR is rarely treated by PSMA-RGS.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
: While systematic reviews highlight the advantages of laparoscopic nephrectomy over traditional open surgery, the impact of an assistant's experience on surgical outcomes remains unclear. This study ...aims to evaluate whether the level of assistant expertise influences laparoscopic nephrectomy outcomes.
: Retrospective data from our institutional database were analyzed for patients who underwent laparoscopic nephrectomy between January 2018 and December 2022. Procedures were performed by a highly experienced surgeon, including postgraduate year (PGY)-3 to PGY-5 residents as assistants. Senior-level assistants had completed at least 10 procedures. Patient characteristics, surgical outcomes, and postoperative details were collected. Multivariable linear and logistic regression models were performed to test the effect of assistant experience (low vs. high) on estimated blood loss (EBL), length of stay (LOS), operative time (OT), and postoperative complications.
: 105 patients were included, where 53% had highly experienced assistants and 47% had less experienced ones. Low assistant experience and higher BMI predicted longer operative time (OT), confirmed by multivariable regression (β = 40.5, confidence interval CI 18.7-62.3,
< 0.001). Assistant experience did not significantly affect EBL or LOS after adjusting for covariates (β = -14.2, CI -91.8-63.3,
= 0.7 and β = -0.83, CI -2.7-1.02,
= 0.4, respectively). There was no correlation between assistant experience and postoperative complications.
: Assistant experience does not significantly impact complications, EBL, and LOS in laparoscopic nephrectomy. Surgeries with less experienced assistants had longer OT, but the overall clinical impact seems limited. Trainee involvement remains safe, guided by experienced surgeons.
Breast cancer is one of the most important causes of premature mortality in women worldwide. Around 12% of breast cancer patients will develop metastatic disease, a stage associated with poor ...prognosis, and only 26% of patients are likely to survive for at least 5 years after being diagnosed. Although the most common sites where breast cancer tends to spread are bones, lungs, brain, and liver, it is important that physicians consider other less frequent organs and viscera, like the bladder, as a target destination. In this article we report our experience with this rare form of metastases and a systematic literature review. We analyzed case reports, case series, and review articles present in PubMED/MEDLINE up to March 2022. We excluded the nonrelevant articles, editorials, letters to the editor, and articles written in other languages. We identified a total of 302 articles, with 200 articles being removed before screening; therefore, the total number of abstracts reviewed was 102. Fifty-five articles were excluded before full text review because they did not meet the inclusion criteria, and one article was not retrievable. Therefore, we included a total of 45 articles in this review. The intention of this review is to highlight the importance of the early detection of bladder metastases and to facilitate the diagnostic process for the responsible physician. The most common signs and symptoms and breast cancer subtype associated with bladder metastases, as well as overall survival after their detection, were all assessed. Bladder metastases from metastatic breast cancer are prevalent in the invasive, lobular breast cancer subtype; most patients present with hematuria (39.5%) and the relative 5-year survival rate is 2%. The main limitations of this review are the low number of cases reported in the literature, clinical and pathological differences between the individual cases, and absence of the control group. This study was not funded.
To the Editor, Bladder cancer is one of the most common cancers in humans, representing the 7th and 17th type of neoplasm in both genders. Its incidence and mortality are quite heterogeneous in ...different countries and are due to different risk factors, quality and prevalence of healthcare and the possibility of early diagnosis and treatment of the tumor and its potential recurrences ....
To the Editor, In recent years, alternative solutions have been proposed to obtain effective results comparable to TURP, which is currently considered the gold standard, and laser vapo-enucleation ...techniques (1, 2), but with the possibility of maintaining sexual functions. In recent years there has been a growing trend towards ejaculation preservation. Although the results of TURP (3), and most laser enucleation techniques are undoubted in the Benign Prostatic Hyperplasia (BPH) and Lower Urinary Tract Symptoms (LUTS) management, they often lack in the preservation of ejaculation. All the alternative recently proposed interventions (Rezum, AquaBeam, Urolift, TPLA, i-TIND, LEST) are procedures considered by some authors to be promising in both managing BPO and preserving sexual functions. However, all these methods are limited by a lack of long-term follow-up that would evaluate the efficacy over time, possible complications related to the method and the correct patient selection for a specific method. The aim of this letter is to summarize the available evidence and provide clinicians with practical recommendations on the use of the brand new minimally invasive techniques for the management of BPO. ....
Foot-and-mouth disease (FMD) is endemic in Iran and associated with a large impact on the livestock industry. Livestock mobility is recognized as one of the most important risk factors for FMD and ...other infectious livestock diseases’ introduction and dissemination. The description of temporal and spatial aspects of livestock mobility networks in Iran provides insights into FMD epidemiology. It also assists in the formulation of recommendations to mitigate the risk of animal disease transmission through livestock movements. This study is the first spatiotemporal description of official/registered cattle, sheep, goat, and camel movements in Iran, using records related to the period from March 2020 to August 2021 extracted from the Iran Veterinary Organization (IVO) Quarantine system. It shows that the static networks drawn by the movements of small ruminants, cattle, and camels to farms or slaughterhouses are complex and highlights the predominance of a few provinces and towns. In particular, the results show that Razavi Khorasan and West Azerbaijan provinces, major provinces for the Iranian livestock sector, are provinces where significant volumes of small ruminants and cattle are moved (from, to, or within) and, therefore, should be prioritized for targeted and timely risk reduction interventions. This study produces some of the necessary inputs for the risk assessment of FMD and similar transboundary animal diseases (TADs) spread within Iran, which is needed to regularly update the national risk-based control strategy for FMD and other TADs.
penile curvature is a rare condition, classified as congenital or acquired (Peyronie's disease) (PD). Surgical correction is the standard treatment. It's common practice to associate circumcision ...with penile de-gloving to prevent complications. In this paper we evaluate the feasibility of penile surgery avoiding circumcision.
patients presenting with penile curvature were treated using a modified Nesbit procedure. Patients were divided into group A if they opted for a prepuce-sparing surgery and the others into group B. Patients were evaluated pre and postoperatively and postoperative complications were assessed. The 5-item International Index of Erectile Function (IIEF-5) was administered before and 6 months after surgery and we compared the difference of mean value using T-Test.
Group A and B were made of 53 and 16 patients respectively. Median age was 59 years interquartile range (IQR) 12 in A and 62 (IQR 9) in B (p = 0.2). Median curvature was 40° (IQR 40°) in A and 40 ° (IQR 30°) in B (p = 0.62). Mean difference between pre- and post-operative IEFF was 1.9 ± 2 in A and 2.6 ± 2.1 in B (p = 0.36).
According to our experience, surgical correction of penile curvature without performing circumcision could be a safe and feasible strategy. We recommend performing circumcision only in patients who present with pre-operative phimosis.
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