BACKGROUND:The concept of clinical remission in chronic rhinosinusitis with nasal polyps (CRSwNP) is gaining growing relevance in the era of biologic therapies. However, current definitions remain heterogeneous and lack standardized, operational criteria. This variability limits comparability across studies and hinders the implementation of remission as a therapeutic target in routine practice. OBJECTIVE:To develop a multidisciplinary, evidence-based, and clinically applicable definition of clinical remission in CRSwNP, integrating symptom-based, endoscopic, therapeutic, and timing-related criteria, and to evaluate expert consensus on the development of a composite remission score. METHODS:A 3-round Delphi consensus was conducted among experts participating in the Rhinosinusitis Italian Network. Across the 3 rounds, experts rated the statements using a 5-point Likert scale. Positive or negative consensus was defined as ≥70% agreement or disagreement, respectively. Descriptive statistics assessed the convergence and stability of responses. RESULTS:Experts agreed that remission requires meeting concurrent criteria across 4 domains: timing (≥12 months), absence of systemic corticosteroid use or surgical indication, symptom thresholds (Sino-Nasal Outcome Test-22 <20 plus symptoms and hyposmia visual analog scale ≤3), and endoscopic thresholds (Nasal Polyp Score and modified Lund-Kennedy score, both 0 for complete remission and both ≤2 for partial remission). Consensus emerged on differentiating complete and partial remission, on introducing the concept of sustained remission (≥24 months), and on the need for a composite remission score with weighted components and category thresholds. CONCLUSION:This Delphi consensus provides the first operational, multidomain definition of complete and partial clinical remission in CRSwNP, developed independently by a large multidisciplinary panel and informed by patient perspectives. The proposed criteria offer a practical framework to standardize remission assessment and support its adoption as a therapeutic goal.

Standardization of the methodological and interpretative criteria for nasal citology through a structured expert consensus. Using a modified Delphi process, 100 members of the Italian Academy of Nasal Cytology (AICNA)—including allergists, otorhinolaryngologists, and pulmonologists—participated in three iterative rounds of evaluation of 30 statements addressing sampling, staining, microscopic assessment, and clinical interpretation. This consensus represents the first expert-based standardisation of nasal cytology methodology and interpretation, providing a robust framework for clinical and research applications. Nasal cytology is a simple, minimally invasive, and reproducible diagnostic technique that enables direct assessment of nasal epithelial and inflammatory cells. Despite its increasing use in the diagnosis and follow-up of allergic and non-allergic rhinitis, methodological variability has hindered its full standardisation. Consensus was defined as ≥ 70

BACKGROUND:The role of post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) in non-seminomatous germ cell tumour (NSGCT) patients with persistently elevated serum tumour markers remains controversial, although traditional management favours salvage chemotherapy. This study aimed to re-define the surgical and oncologic outcomes of salvage PC-RPLND. METHODS:We select 107 (2008-2023) consecutive NSGCT patients undergoing PC-RPLND with elevated markers after ≥1 chemotherapy line. Multivariable linear regression models (MLRM), and Cox proportional hazards models recurrence-free survival (RFS) and overall survival (OS) were used. RESULTS:Definitive histology revealed viable GCT (47.7%), post-pubertal teratoma (32.7%), fibro-necrotic tissue (FNT) (11.4%), and somatic malignancy (8.4%). After a median follow-up of 45 months, overall 5-year RFS was 54% and OS was 68%. Outcomes varied significantly by histology: post-pubertal teratoma had superior 5-year OS (96%) and RFS (77%), while somatic malignancy and FNT predicted worse RFS (MCRM HRs 23.11 and 28.77, respectively). Larger residual mass size correlated with higher relapse risk and increased probability of somatic malignancy. Advanced stage and increasing chemotherapy lines also associated with poorer outcomes. CONCLUSIONS:Salvage PC-RPLND for marker-positive NSGCT achieved meaningful survival, particularly for patients with post-pubertal teratoma. These findings support surgery, even as first-line salvage, when teratoma or somatic malignancy is suspected.

BACKGROUND:Active surveillance (AS) is standard for early-stage prostate cancer, though intensive monitoring continues due to concerns about reclassification to Grade Group (GG) ⩾ 2. We hypothesized that simple and inexpensive clinical parameters could identify patients with indolent disease for whom less intensive monitoring is safe. METHODS:We analyzed upgrading to ISUP Grade Group (GG) ⩾ 2 in a large cohort of low-risk prostate cancer (PCa) patients on AS. We used mixed-effects logistic regression to develop a model predicting non-upgrading at the next follow-up biopsy, based on routine time-updated clinical-pathological variables. RESULTS:While annual reclassification persisted at a rate between 10.4% and 17.5% up to the 7th year, upgrades were predominantly GG2. Routine parameters powerfully stratified risk. Patients with a very unfavorable Prostate Specific Antigen (PSA) doubling time had a 40.5% upgrading rate versus 9.5% for those with a favorable value. The final model is based on baseline PSA density and number of positive cores, time-updated age and PSA doubling time category, detection of cancer in the last surveillance biopsy. The model showed moderate discrimination (0.73) in predicting non-upgrading. CONCLUSIONS:Many patients on AS have indolent disease but steady upgrading justifies monitoring. A model using simple, routine parameters and PSA doubling time can identify those at minimal risk of reclassification, enabling a safe reduction in biopsy intensity. This advocates for a risk-adaptive AS protocol, reserving advanced tools like MRI or biomarkers for the few higher-risk cases.

BACKGROUND:The role of surgical exploration and frozen sections (FSs) in monorchid patients with testicular nodules is still not well defined. We tested the role of surgical exploration and FSs in monorchid patients and the impact on the chance of testis sparing surgery (TSS). METHODS:We identified 81 consecutive monorchid patients with testicular nodules between 2008 and 2024 candidates to surgical exploration and FSs. The statistical significance of differences in medians and proportions was tested with the Wilcoxon rank sum and Chi-square tests. Multivariable logistic regression models (MLRMs) were used. RESULTS:Testicular lesions number was available in 61 patients and was one in 35 (57.4%) of those, two in 15 (24.6%), three in 7 (11.5%) and more than three in 4 (6.5%). Median larger lesion size was 12 mm (IQR 9-20 mm). FSs were performed in 59 (73%) patients and showed germ-cell tumor (GCT) in 53 (65.4%). Orchidectomy was performed in 68 patients (84%). In 55 of 56 patients (98.3%) definitive histology confirmed FSs. Thirteen (16%) had TSS including 7 patients with seminomatous GCT, of those none had disease relapse at follow-up. At MLRMs older age was associated with lower probability of GCT (Odds Ratio 0.91, Confidence Interval 0.84-0.99, P value 0.03). CONCLUSIONS:FSs are feasible and reliable in monorchid patients following a history of GCT. Nonetheless, TSS is rarely performed, as most of these patients actually have GCT. The few ones who had TSS had excellent oncological results.

IntroductionChronic rhinosinusitis (CRS) is a prevalent inflammatory disease of the upper airways, frequently characterized by recurrence and impaired quality of life. Persistent inflammation and bacterial biofilms contribute to disease chronicity. Topical plant-derived therapies may offer a preventive strategy in long-term CRS management. This study evaluated the effectiveness of a Pistacia lentiscus–based nasal medical device in reducing the impact of CRS recurrence on patients' daily life.MethodsIn this retrospective, observational, single- center case-control study, 100 adult patients with chronic rhinosinusitis (CRS) and recurrent disease were identified and included from clinical records. Patients were stratified according to prior exposure to nasal drops containing ultra-fractionated Pistacia lentiscus oil in addition to isotonic saline nasal irrigation, or to isotonic saline nasal irrigation alone, according to routine clinical practice. All patients had undergone a 12-month follow-up regimen with assessments available at baseline, 30 days, and 12 months. The primary outcome was symptom severity measured using the Sino-Nasal Outcome Test (SNOT-22). Secondary outcomes included nasal cytology parameters, biofilm presence, nasal discharge, bacterial elements, supranuclear stria, and ciliary motility.ResultsOf the 100 identified subjects, 92 were included in the final analysis due to loss to follow-up. In the exposed group, SNOT-22 scores showed a 40.6% reduction after the first month, compared with a 7.8% reduction observed in the control group (p < 0.001). Only patients exposed to Pistacia lentiscus oil demonstrated statistically significant reductions over time in nasal discharge (p < 0.005), biofilm presence (p < 0.005), and bacterial elements (p < 0.05), while no significant changes were observed in the control group for these parameters. Ciliary motility remained unchanged in both groups across the study period.DiscussionOverall, within the limits of this retrospective case-control design, patients exposed to Pistacia lentiscus oil in addition to standard saline irrigation showed greater improvement in patient-reported symptoms and selected cytological markers compared with patients treated with saline irrigation alone.

OBJECTIVES:To evaluate safety and early and long-term efficacy of CO2 laser conservative treatments for nonulcerative squamous cell carcinoma (SCC) of the penis. MATERIAL AND METHODS:Within our institutional database (2002-2022, included), we identified 122 consecutive cT1-2 cN0 cM0 patients with penile SCC who underwent conservative CO2 laser treatments. Histologically confirmed local relapses were recorded. Local relapses were classified as early recurrences when occurring <2 years and as late new tumor recurrences when occurring >2 years after first laser treatment. Predictors of disease relapse were analyzed with univariable and multivariable Cox regression models (MCRMs). RESULTS:Median follow-up was 36 months [Interquartile range (IQR) 21-73 months]. Median age was 62 years (IQR: 51-69 years). Median largest lesion size was 10 mm (IQR 5-15 mm). 62 patients had penile intraepithelial neoplasia (PeIN) (51.6%), 30 had pT1 m (24.6%), 28 had pT1 (23%) and 1 had pT2 (0.8%), 2 patients were classified as pTx. In case of invasive lesions, tumor Grade was G1 in 37 (60.7%), G2 in 20 (32.8%), G3 in 4 (6.5%). Early and late recurrences occurred in 28 (22%) and in 21 patients (18%), respectively. Proportion of penis preservation was 93.4% and 92.6% at 2 and 5 years. pT1 stage [Hazard Ratio (HR) 13, Confidence Interval (CI) 1.4-73, p-value 0.02] and flat lesions (HR 7.9, CI 1.06-59, 0.04) achieved independent predictor status for late recurrences. No cancer related deaths were recorded after a median follow-up of 36 months. CONCLUSIONS:As far as we know, this is the largest cohort of patients with penile cT1-T2 SCC who underwent conservative CO2 laser treatment. The vast majority (92%) of these patients preserved their organ at 5 years. Some factors can be of use in preventing or anticipating late recurrences.

AIM OF THE STUDY:Incidental small testicular masses (STMs) pose the dilemma of invasive Vs surveillance. To test miRNA 371 kit (M371, CE approved) in predicting germ cells tumor (GCT) in patients with STM. METHODS:Thirty-two consecutive men with a STM between 5 and 20 mm have been prospectively accrued. All patients had miRNA 371 blood testing before surgery. Serum miRNA processation was standardized and certified and following transcription into cDNA with an endogeneous control. The Relative Quantity (RQ) was determined by quantitative polymerase chain reaction (qPCR) following preamplification. Different RQ cut-offs were tested. The results of pre-surgery 371 miRNA were compared to definitive pathology. RESULTS:Median lesion size was 14 mm (IQR 8-18 mm). 21 of 32 patients (65.6 %) had GCTs: 14 seminomatous (S)GCTs, 6 non-seminomatous (NS)GCTs, 1 in-situ germ cell neoplasia (GCNIS). Median RQ was 57.50 (IQR 18.50, 223.75) among GCT patients and 5.00 (IQR 1.00, 13.50) in patients without GCTs. We tested for sensitivity (SE), specificity (SP), positive (PPV) and negative predictive value (NPV) at different RQ cut-offs of 5 and 10. SE, SP, PPV and NPV were 100 %, 45 %, 78.1 %, 100 % 95.2 %, 63.7 %, 83.6 %, 87.3 %, respectively. CONCLUSIONS:Serum miRNA 371 can predict GCTs in selected patients with 5-20 mm STM. These results need to be refined by standardizing the analytical process.

INTRODUCTION AND OBJECTIVES:Non-muscle-invasive bladder cancer (NMIBC) patients need a strict follow-up with cystoscopy (UCS) and voided urinary cytology (vUC) due to high rate of recurrence and progression. To reduce invasiveness and costs, a new diagnostic biomarker, namely Xpert Monitor BCⓇ-detecting 5 mRNAs in voided urine-, has been proposed. We test Xpert Monitor BCⓇ ability to detect tumor recurrence at an early point during follow-up of high risk (HR) or very high risk (VHR) NMIBC patients, aiming at evaluating reliability of this test as a single procedure. MATERIALS AND METHODS:Between September 2022 and July 2023 included, 80 HR or VHR NMIBC patients were prospectively enrolled. Both naïve and previously treated patients (including Bacillus Calmette-Guérin-BCG-and/or systemic immunotherapy) were admitted. Patients with known upper urinary tract urothelial carcinoma (UTUC) were excluded. Xpert Monitor BCⓇ test was carried out on precystoscopy voided urine samples. In case of suspicious urethra-cystoscopy (UCS), a transurethral resection (TURB) or a biopsy was indicated. vUC was usually prescribed to be performed prior to UCS. Negative predictive value (NVP), positive predictive value (PPV), sensitivity (SE) and specificity (SP) of Xpert Monitor BCⓇ and vUC, were assessed and compared with UCS and secondarily with histology at TURB/bladder biopsy. Patients who proceeded with follow-up underwent a second evaluation with Xpert Monitor BCⓇ test. RESULTS:Seventy-six patients were evaluable. Median age was 70 years (interquartile range [IQR] 65-78) and 62 (81.6%) patients were male. VHR patients were 14 (18.4%), 47 (61.8%) had a history of carcinoma in situ (CIS) and 37 (49.3%) had multifocal disease while 51 patients (67.1%) had recurrent bladder cancer (BC). BC recurred in 15 patients (19.7%): in 3 of them as a muscle-invasive bladder cancer (MIBC). Xpert Monitor BCⓇ showed a NPV, PPV, SE, SP of 95.3% (41/43), 57.6% (19/33), 90.5% (19/21) and 74.5% (41/55) respectively. When available, vUC displayed a NPV of 78.9% (30/38), a PPV of 75% (3/4), a SE of 27.3% (3/11) and a SP of 96.7% (30/31). Twenty patients underwent a subsequent Xpert Monitor BCⓇ test and UCS during their follow-up, and 3 had a bladder cancer recurrence. Of note Xpert Monitor BCⓇ was positive in all those 3 patients who previously tested positive despite a negative UC. CONCLUSIONS:High NPV and SE of Xpert Monitor BCⓇ are confirmed in our HR and VHR NMIBC series. Apparent false positive tests may be regarded as suspicious for persistent/recurrent disease. Implementation of Xpert Monitor BCⓇ aiming at improving cancer detection is supported by these findings, and a single test based follow-up may be explored.

In recent years, it was recognized that type-2 inflammation connects nasal polyposis and severe asthma (SA) in addition to other type-2 diseases. Thus, some biological drugs developed for SA appeared to exert a favourable effect also in nasal polyposis. So far, there are several trials supporting this concept; therefore, some monoclonal antibodies already used for SA were assessed also in chronic rhinosinusistis with nasal polyposis (CRSwNP), with promising results.Since different specialists are involved in the management of nasal polyposis (eg, pulmonologists, ENT specialists, allergists, immunologists, pediatricians), it was felt that an updated educational and informative document was needed to better identify the indications of biological therapies in nasal polyposis. We collected the main Italian scientific societies, and prepared (under the umbrella of Allergic Rhinitis and its Impact on Asthma, ARIA) a document endorsed by all societies, to provide a provisional statement for the future use of monoclonal antibodies (MAbs) as a medical treatment for polyposis, possibly associated with SA. The above mentioned document was the first endorsed document on this aspect, and the additional evidence required an update. The current pathogenic knowledge and the experimental evidence are herein reviewed, and some suggestions for a correct prescription and follow-up are provided.

Objective:Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma often coexist and share common underlying pathophysiological mechanisms. This study addresses challenges in the diagnosis and treatment of multimorbid patients with CRSwNP and asthma providing new insights for their management. Methods:Using a modified Delphi method, a scientific board of 40 Italian clinicians (pulmonologists, allergists/clinical immunologists, and ear, nose, and throat specialists) developed consensus statements regarding the multimorbid patient with severe CRSwNP and asthma and including the disease burden, assessment, treatment and multidisciplinary management of multimorbid patients. Results:All statements reached consensus. Experts acknowledged the substantial disease burden, the key pathophysiological role of type 2 inflammation in multimorbid patients and the need for multidisciplinary care. The use of biologics represents a highly effective therapeutic opportunity for patients with comorbidities, optimising overall outcomes. Integrated care pathways and regular multidisciplinary re-assessment were deemed essential for treatment decisions and improved care in multimorbid patients. Conclusions:This consensus highlights the value of a multidisciplinary approach for multimorbid CRSwNP and asthma patients, advocating for endotype-driven therapies and standardised pathways in clinical practice.

BackgroundChronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory condition characterized by persistent nasal obstruction, discharge, facial pressure, and olfactory dysfunction. CRSwNP significantly impairs quality of life (QoL), with olfactory loss being a particularly distressing symptom that affects food enjoyment, personal safety, and social interactions.MethodsThis study investigated the experiences of Italian patients with CRSwNP. A cross-sectional quantitative and qualitative survey (Google Forms questionnaire), collecting data on diagnosis, symptomatology, QoL impact, and treatment experiences was developed and distributed.ResultsThere were 155 respondents, with over half diagnosed with CRSwNP for more than a decade. Nasal obstruction was the primary symptom leading to medical consultation. Corticosteroid therapy and surgery showed limited and variable effectiveness in olfactory restoration. Biologic therapy, particularly dupilumab, demonstrated promising results, with approximately half of the patients reporting complete smell restoration.ConclusionsCRSwNP significantly affected patients' QoL, with olfactory dysfunction being a common and impactful symptom. While current treatments provide symptom relief, they do not always result in sustained olfactory improvement. Biologic therapy emerged as a promising option for olfactory restoration, underscoring the importance of personalized treatment strategies. Further research is warranted to explore the mechanisms of olfactory recovery and to optimize treatment protocols for CRSwNP.

BACKGROUND:Olfactory dysfunction affects up to 22% of the population. Accurate assessment is vital for diagnosis and tracking outcomes, often using patient-reported outcome measures (PROMs). AIMS:We aimed to develop and validate a novel questionnaire for assessing olfactory and gustatory dysfunction. METHODS:A systematic review identified existing smell and taste questionnaires, followed by item generation and selection. After two Delphi cycles and consultation with a large panel of smell and taste experts, the Smell-Qx questionnaire was developed. A validation study recruited patients from smell and taste clinics (cases) and general ENT clinics (controls) to complete the Smell-Qx. Additionally, patients with smell and taste disorders underwent psychophysical testing using Sniffin' Stick Threshold, Discrimination, and Identification (TDI) tests. RESULTS:The Smell-Qx is an 11-domain instrument, with five core domains used for total score calculation and six history/quality-of-life domains for obtaining a comprehensive history. The validation study recruited 60 participants (32 patients with smell/taste disorders and 28 controls). Items showed acceptable to significant internal consistency (Cronbach's α: 0.64-0.97) and test-retest reliability (ICC: 0.65-0.99, p < 0.001). The Smell-Qx was effective at distinguishing patients with smell and taste disorders from controls (t = 9.99, df = 58, p < 0.0001). Concurrent criterion validity was good with overall SATD-related quality of life (r = 0.43, p = 0.015), as well as with the smell loss domain and overall smell TDI scores (r = -0.54, p = 0.011). CONCLUSION:The Smell-Qx is a reliable and valid PROM for assessing olfactory and self-reported gustatory disorders, capturing symptom severity and quality-of-life impact. It can integrate into a multi-modal assessment approach alongside psychophysical testing.

You have accessJournal of UrologyPenile & Testicular Cancer II (MP61)1 May 2024MP61-16 INTRAOPERATIVE INDOCYANINE GREEN FLUORESCENCE ANGIOGRAPHY IN INGUINAL WITH OR WITHOUT PELVIC LYMPH-NODE DISSECTION FOR PENILE SQUAMOUS CELL CARCINOMA (PeSCC) Carlo Silvani, Sebastiano Nazzani, Valentina Bernasconi, Martina Bruniera, Melanie Claps, Patrizia Giannatempo, Davide Biasoni, Tullio Torelli, Matteo Zimatore, Silvia Stagni, Alberto Macchi, Antonio Tesone, Emanuele Montanari, Mario Catanzaro, and Nicola Nicolai Carlo SilvaniCarlo Silvani , Sebastiano NazzaniSebastiano Nazzani , Valentina BernasconiValentina Bernasconi , Martina BrunieraMartina Bruniera , Melanie ClapsMelanie Claps , Patrizia GiannatempoPatrizia Giannatempo , Davide BiasoniDavide Biasoni , Tullio TorelliTullio Torelli , Matteo ZimatoreMatteo Zimatore , Silvia StagniSilvia Stagni , Alberto MacchiAlberto Macchi , Antonio TesoneAntonio Tesone , Emanuele MontanariEmanuele Montanari , Mario CatanzaroMario Catanzaro , and Nicola NicolaiNicola Nicolai View All Author Informationhttps://doi.org/10.1097/01.JU.0001009536.58867.87.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical inguinal lymph-node dissection (ILND) and inguino-pelvic lymph-node dissection (IPLND) for PeSCC associate with high complication rates. Specifically, wound complications affect up to 25% of patients treated with ILND. Intraoperative Indocyanine Green (ICG) Fluorescence Angiography has already been used in ILND for other malignancies to evaluate skin trophism to prevent skin necrosis with wound dehiscence. We aim to evaluate Intraoperative use of Indocyanine Green Fluorescence Angiography in PeSCC patients. METHODS: Since May 2023, we started a clinical trial focusing on any T cN1-cN3 cM0 peSCC patients planned for ILND or IPLND with or without concomitant penile surgery. IPLND were performed with a single vertical incision. Intraoperatively, before skin closure, ICG solution (25 mg of ICG dye in 10 ml of saline, 1 ml injected) was injected from a peripheral venous route. After 1 to 3 minutes the blood flow status of the skin flap was visible using an ICG fluorescence imaging camera. In cases where areas exhibited no fluorescence, we carefully trimmed the non-fluorescent sections of the skin flaps to prevent postoperative flap necrosis. RESULTS: We considered 12 patients for a total of 16 procedures. Specifically, 3 patients had unilateral ILND, and 2 patients had bilateral ILND. IPLND accounted for 56.25% of cases: 5 patients had unilateral and 2 had bilateral IPLND. Median age at diagnosis and median BMI were 67.5 years (57.5-69) and 30.23 (28.88-34.30), respectively. Four (33.3%) patients had diabetes and 5 (41.7%) ad an history of cardiovascular disease. Five (41.6%) were smokers or former smokers. Median number of retrieved inguinal and pelvic nodes for each side were 10 and 11, respectively. At definitive pathology 1 patients was pN1, 2 patients were pN2 and 6 patients were pN3. Out of pN3 cases, 4 had inguinal extra-nodal extension and 2 had pelvic nodal involvement. Median length of stay (LOS) was 5 days while median drainage tube stay time was 26 days. Out of 16 procedures, 8 postoperative complications were recorded: 3 (18.75%) were Clavien-Dindo IIIa (percutaneous lymphocele drainage of closed wound). Of note, the wound related complications were five (31.25%) but in as many as four it was a Clavien-Dindo I small wound dehiscence treated conservatively. One patient only (6.25%) suffered a complete wound dehiscence that required vacuum assisted closure placement (Clavien-Dindo II). Of note, no flap necrosis was observed. CONCLUSIONS: Wound management after ILND and IPLND for PeSCC remains challenging. Intraoperative use of ICG for skin flaps evaluation is promising. In our preliminary series, we observed an overall short LOS and a low rate of wound dehiscence. Greater numbers are needed to demonstrate that ICG could help in reducing wound dehiscence and LOS after nodal dissection in PeSCC patients. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1017 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Carlo Silvani More articles by this author Sebastiano Nazzani More articles by this author Valentina Bernasconi More articles by this author Martina Bruniera More articles by this author Melanie Claps More articles by this author Patrizia Giannatempo More articles by this author Davide Biasoni More articles by this author Tullio Torelli More articles by this author Matteo Zimatore More articles by this author Silvia Stagni More articles by this author Alberto Macchi More articles by this author Antonio Tesone More articles by this author Emanuele Montanari More articles by this author Mario Catanzaro More articles by this author Nicola Nicolai More articles by this author Expand All Advertisement PDF downloadLoading ...

Surveillance is the standard management in low-risk cN0 penile squamous cell carcinoma (peSCC) patients. We report on main oncological outcomes of a series of low-risk cN0 peSCC patients. Patients underwent primary tumor surgery and either observation or dynamic sentinel node biopsy. Observation is a safe and effective management for low-risk peSCC patients. Younger patients may be offered a mini-invasive staging. Introduction: Surveillance is the standard management in low-risk cN0 penile squamous cell carcinoma (peSCC) patients. However, no previous analysis focused on early and long-term outcomes of these patients. We report on main oncological outcomes of a large series of low-risk cN0 peSCC patients. Patients and Methods: Between 1980 and 2017 included, 93 evaluable consecutive low-risk (ie, pT1a G1 cN0M0) peSCC patients underwent primary tumor surgery and either observation (74) or dynamic sentinel node biopsy (DSNB) (19) following a clinical diagnosis of T1 in 66 (71%), T2 in 15 (16.1%) and Tx in 12 (12.9%) patients, respectively. The statistical significance of differences in medians and proportions was tested with the Kruskal-Wallis and chi-square tests. Kaplan-Meier plots illustrated 5-year inguinal relapse (IR)-free survival rates. Results: Median age was 60 years (IQR: 50-69 years). Median follow-up was 92 months (IQR 54-133 months). Surveillance was more frequently adopted in clinical (c)T1 than in cT2 tumors (79.7% vs. 36.8%). None of 19 patients who had DSNB had nodal metastasis. Overall, 7 (7.5%) out of 93 pT1aG1cN0 peSCC patients had IR after a median interval of 9 months. Of note, 1 patient only relapsed after 12 months of surveillance. After stratification according to IR, relapses occurred more frequently in younger patients (59 vs. 64 years, P < .001). The 5-year IR-free survival rates for the entire cohort was 92% (95% Confidence interval [CI] 87-98%). Conclusions: Observation is a safe and effective management for low-risk peSCC patients. Younger patients may be offered a miniinvasive staging as an alternative.

You have accessJournal of UrologyPenile & Testicular Cancer II (MP61)1 May 2024MP61-17 ORGAN PRESERVATION AND ONCOLOGICAL EFFICACY OF PENISCOPICALLY CONTROLLED CO2 LASER EXCISION OF PENILE SQUAMOUS CELL CARCINOMA: EARLY AND LATE RESULTS IN a HIGH-VOLUME CENTER Carlo Silvani, Vito Lorusso, Sebastiano Nazzani, Alberto Macchi, Tullio Torelli, Silvia Stagni, Antonio Tesone, Melanie Claps, Patrizia Giannatempo, Matteo Zimatore, Laura Cattaneo, Biagio Paolini, Ruggero Darisi, Davide Biasoni, Emanuele Montanari, Mario Catanzaro, and Nicola Nicolai Carlo SilvaniCarlo Silvani , Vito LorussoVito Lorusso , Sebastiano NazzaniSebastiano Nazzani , Alberto MacchiAlberto Macchi , Tullio TorelliTullio Torelli , Silvia StagniSilvia Stagni , Antonio TesoneAntonio Tesone , Melanie ClapsMelanie Claps , Patrizia GiannatempoPatrizia Giannatempo , Matteo ZimatoreMatteo Zimatore , Laura CattaneoLaura Cattaneo , Biagio PaoliniBiagio Paolini , Ruggero DarisiRuggero Darisi , Davide BiasoniDavide Biasoni , Emanuele MontanariEmanuele Montanari , Mario CatanzaroMario Catanzaro , and Nicola NicolaiNicola Nicolai View All Author Informationhttps://doi.org/10.1097/01.JU.0001009536.58867.87.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate safety and early and long-term efficacy of CO2 laser conservative treatments for non-ulcerative squamous cell carcinoma (SCC) of the penis. METHODS: Within our institutional database (2002–2022, included), we identified 122 consecutive cT1-2 cN0 cM0 patients with penile SCC who underwent conservative CO2 laser treatments. Histologically confirmed local relapses were recorded. Local relapses were classified as early ecurrences when occurring <2 years and as late new tumor recurrences when occurring >2 years after first laser treatment. Predictors of disease relapse were analyzed with univariable and multivariable Cox regression models (MCRMs). RESULTS: Median follow-up was 36 months [Interquartile range (IQR) 21-73 months]. Median age was 62 years (IQR: 51-69 years). Median largest lesion size was 10 mm (IQR 5-15 mm). Usual SCC (86.9%) was the most frequent histology followed by basaloid SCC (5.7%) and other SCC (7.4%). 62 patients had penile intraepithelial neoplasia (PeIN) (51.6%), 30 had pT1m (24.6 %), 28 had pT1 (23%) and one had pT2 (0.8%), two patients were classified as pTx. In case of infiltrative lesions, tumor Grade was G1 in 37 (60.7%), G2 in 20 (32.8%), G3 in 4 (6.5%). No immediate complications were recorded. Four patients experienced postoperative phimosis and one had meatal stenosis (Clavien Dindo >2 complications: 4.1%). After first excision, 25 patients (20.5 %) underwent radicalization, due to positive margins or aggressive disease. During the follow up 49 patients had recurrent disease. Early and late recurrences occurred in 28 (22%) and in 21 patients (18%), respectively. Recurrences were treated with new CO2 laser excision in 39 (80%), partial amputation in 8 (16%), glansectomy and circumcision (2%) in one patient each (2%). Proportion of penis preservation was 93.4% and 92.6% at 2 and 5 years. Independent predictors of overall and early recurrences were not identified at MCRMs. Conversely, pT1 stage [Hazard Ratio (HR) 13, Confidence Interval (CI) 1.4–73, p-value 0.02] and flat lesions (HR 7.9, CI 1.06–59, 0.04) achieved independent predictor status for late recurrences. Finally, two patients developed inguinal nodal disease during follow-up. No cancer related deaths were recorded after a median follow-up of 36 months. CONCLUSIONS: As far as we know, this is the largest cohort of patients with penile cT1-T2 SCC who underwent conservative CO2 laser treatment. Although recurrences were as frequent as 40% in a time span of three years, the vast majority (92%) of these patients preserved their organ at 5 years. Some factors can be of use in preventing or anticipating late recurrences. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1018 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Carlo Silvani More articles by this author Vito Lorusso More articles by this author Sebastiano Nazzani More articles by this author Alberto Macchi More articles by this author Tullio Torelli More articles by this author Silvia Stagni More articles by this author Antonio Tesone More articles by this author Melanie Claps More articles by this author Patrizia Giannatempo More articles by this author Matteo Zimatore More articles by this author Laura Cattaneo More articles by this author Biagio Paolini More articles by this author Ruggero Darisi More articles by this author Davide Biasoni More articles by this author Emanuele Montanari More articles by this author Mario Catanzaro More articles by this author Nicola Nicolai More articles by this author Expand All Advertisement PDF downloadLoading ...

Objective Rhinosinusitis is a chronic condition characterized by frequent episodes of recurrence; its main treatment is pharmacological and this therapy should be continued for a long time until stabilization of the problem. Some patients, however, often must resort to targeted therapies for disease recurrences, which is why targeted preventive treatments are sought. Methods In the study performed, Pistacia lentiscus oil was used. Two groups of patients were studied with endoscopy, SNOT 22 and Nasal Cytology to evaluate nasal cellularity and ciliar motility. Results Pistacia lentiscus oil has the ability to reduce mucosal inflammation, by destroying and preventing the formation of biofilm. Conclusion The study showed that daily administration of Pistacia lentiscus oil significantly reduced the presence of biofilm. Moreover, continuous use of a lentiscus oil wash significantly reduced patients’ symptoms and improved their quality of life according to the Snot 22 questionnaire.