OBJECTIVE:Renal Tumor biopsy (RTB) can assist clinicians in determining the most suitable approach for treatment of renal cancer. However, RTB's limitations in accurately determining histology and grading have hindered its broader adoption and data on the concordance rate between RTB results and final pathology after surgery are unavailable. Therefore, we aimed to develop a machine learning algorithm to optimize RTB technique and to investigate the degree of concordance between RTB and surgical pathology reports. MATERIALS AND METHODS:Within a prospectively maintained database, patients with indeterminate renal masses who underwent RTB at a single tertiary center were identified. We recorded and analyzed the approach (US vs. CT), the number of biopsy cores (NoC), and total core tissue length (LoC) to evaluate their impact on diagnostic outcomes. The K-Nearest Neighbors (KNN), a non-parametric supervised machine learning model, predicted the probability of obtaining pathological characterization and grading. In surgical patients, final pathology reports were compared with RTB results. RESULTS:Overall, 197 patients underwent RTB. Overall, 89.8% (n=177) and 44.7% (n=88) of biopsies were informative in terms of histology and grading, respectively. The discrepancy rate between the pathology results from renal tissue biopsy (RTB) and the final pathology report following surgery was 3.6% (n=7) for histology and 5.0% (n=10) for grading. According to the machine learning model, a minimum of 2 cores providing at least 0.8 cm of total tissue should be obtained to achieve the best accuracy in characterizing the cancer. Alternatively, in cases of RTB with more than two cores, no specific minimum tissue threshold is required. CONCLUSIONS:The discordance rates between RTB pathology and final surgical pathology are notably minimal. We defined an optimal renal biopsy strategy based on at least 2 cores and at least 0.8 cm of tissue or at least 3 cores and no minimum tissue threshold. PATIENTS SUMMARY:RTB is a useful test for kidney cancer, but it's not always perfect. Our study shows that it usually matches up well with what doctors find during surgery. Using machine learning can make RTB even better by helping doctors know how many samples to take. This helps doctors treat kidney cancer more accurately.

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy II (PD39)1 May 2024PD39-11 REDO FOCAL THERAPY FOR RECURRENT LOCALIZED PROSTATE CANCER: A SINGLE INSTITUTION EXPERIENCE Daniele Cignoli, Luigi Candela, Andrea Rodriguez-Serrano, David Lopez, Armando Stabile, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Camille Lanz, Eric Barret, Annick Mombet, Petr Macek, Xavier Cathelineau, and Lara Rodriguez-Sanchez Daniele CignoliDaniele Cignoli , Luigi CandelaLuigi Candela , Andrea Rodriguez-SerranoAndrea Rodriguez-Serrano , David LopezDavid Lopez , Armando StabileArmando Stabile , Andrea SaloniaAndrea Salonia , Alberto BrigantiAlberto Briganti , Francesco MontorsiFrancesco Montorsi , Camille LanzCamille Lanz , Eric BarretEric Barret , Annick MombetAnnick Mombet , Petr MacekPetr Macek , Xavier CathelineauXavier Cathelineau , and Lara Rodriguez-SanchezLara Rodriguez-Sanchez View All Author Informationhttps://doi.org/10.1097/01.JU.0001008924.16121.42.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Focal therapy [FT] for localized Prostate Cancer [PCa] is associated with a not negligible rate of recurrence after treatment. With this study, we aimed to assess the safety and efficacy of redoFT [rFT]. METHODS: 48 patients treated with rFT (HIFU or cryotherapy [CRYO]) because of recurrence after a previous FT for low- and intermediate-risk PCa at one European high-volume center between 2009 and 2018, were retrospectively analyzed. The primary outcome of the study was to assess failure free-survival (FFS, defined as post rFT positive biopsy within ISUP≥2, whole gland or systemic salvage treatment, PCa metastasis and/or PCa specific death) and radical treatment free-survival (TFS, radical prostatectomy [RP], radiotherapy [RT], and/or hormone therapy [HT] after rFT). Secondly, Multivariable Cox regression analysis [MVA] was used to predict the effect of %∆PSA after rFT (defined as the ratio between PSA nadir and pre-rFT PSA) on the outcomes. Covariates were age, pre-rFT PSA and PSA density [PSAd], ISUP, mm of positive biopsy cores and treatment type. RESULTS: All 48 patients included in the analyses underwent a first FT (67% HIFU and 33% CRYO) for low- and intermediate-risk PCa (63% ISUP1 and 37% ISUP2-3) and a rFT (71% HIFU and 29% CRYO) because of recurrence. Median %∆PSA, after rFT, was 47%(IQR: 22-63). Median FU, after rFT, was 54mos (IQR:32-70). Treatment failure rate after rFT was 50% (24pts). Among recurrences, 58% (14pts) were infield to rFT location, while outfield in 42% (10pts). 58% were ISUP 2, 38% ISUP 3 and 4% ISUP 4. Median FFS was 63mos (95%CI 27-NA). Because of recurrence, 23pts (48%) underwent whole gland treatment, namely RP(8%), RT(23%), HT(4%) or a combination(13%). Median TFS was 41mos (95%CI 30-NA). PCa metastasis occurred in 2 patients and no PCa specific death were registered. At MVA, %∆PSA after rFT was an independent predictor of both FFS (HR: 0.25, 95%CI: 0.08-0.75, p=0.01) and TFS (HR: 0.20, 95%CI: 0.06-0.65, p=0.007). Overall, 9pts (19%) experienced early complications after rFT, 8(17%) were Clavien 1 and 1(2%) Clavien 2. CONCLUSIONS: With a low rate of complications, rFT seems to be a good option in case of recurrence after a previous FT as approximately half of patients who experience PCa recurrence after their initial FT treatment may be able to postpone or even avoid the need for more invasive radical therapies. Multicenter studies are warranted. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e817 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Daniele Cignoli More articles by this author Luigi Candela More articles by this author Andrea Rodriguez-Serrano More articles by this author David Lopez More articles by this author Armando Stabile More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Camille Lanz More articles by this author Eric Barret More articles by this author Annick Mombet More articles by this author Petr Macek More articles by this author Xavier Cathelineau More articles by this author Lara Rodriguez-Sanchez More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy I (MP25)1 May 2024MP25-01 FOCAL THERAPY FOR PROSTATE CANCER: A TREATMENT OPTION RESERVED FOR THE IDEAL CANDIDATE? Daniele Cignoli, Andrea Rodriguez-Serrano, David Lopez, Armando Stabile, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Camille Lanz, Eric Barret, François Rozet, Petr Macek, Xavier Cathelineau, and Lara Rodriguez-Sanchez Daniele CignoliDaniele Cignoli , Andrea Rodriguez-SerranoAndrea Rodriguez-Serrano , David LopezDavid Lopez , Armando StabileArmando Stabile , Andrea SaloniaAndrea Salonia , Alberto BrigantiAlberto Briganti , Francesco MontorsiFrancesco Montorsi , Camille LanzCamille Lanz , Eric BarretEric Barret , François RozetFrançois Rozet , Petr MacekPetr Macek , Xavier CathelineauXavier Cathelineau , and Lara Rodriguez-SanchezLara Rodriguez-Sanchez View All Author Informationhttps://doi.org/10.1097/01.JU.0001008692.26556.39.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Concerning FT inclusion criteria for PCa, our aim was to assess the consequences of treating patients who do not meet the ideal FT candidate profile due to non-compliance with all the inclusion criteria recommended by the FT community. METHODS: 282 pts treated with HIFU or cryotherapy for ISUP 1-2 PCa at one European center (2009-2018) were retrospectively analyzed. Pts were divided into 3 groups:G1=perfect candidates (30 pts) (ISUP 2, PSA<15ng/ml, MRI single visible lesions≤12 mm, max 1 positive core ISUP 1 outside target lesion); G2=ISUP 1 (181 pts);G3=ISUP 2 not included in G1 (71 pts). Furthermore, a sub-analysis only considering ISUP 2 pts was conducted, comparing G1 to pts who were not ideal candidates for only one single criterion. These were divided into 3 groups: SG2=with a single MRI lesion ≥12mm (5 pts); SG3=with more than 1 lesion at MRI (8 pts); SG4=with more than 1 positive core outside target (28 pts). Inverse Probability of Treatment Weighting (IPTW) was employed to compare groups in terms of recurrence-Free Survival (RFS, defined as a ≥ISUP2 positive biopsy during follow-up [FU], ISUP1 was considered recurrence only in case of infield location for pts of G2), Treatment-Free Survival (TFS, defined as the need for a second treatment, whether focal or radical) and Progression-Free Survival (PFS, local progression or distant metastasis). RESULTS: No differences were found between groups in terms of pts' baseline characteristics, except for PCa's specific features. Median FU was 75 mos (IQR: 54-105). Overall, 187pts (66%) had recurrence; 77% of G1, 60% of G2 and 78% of G3. Among recurrences 65% of G1, 62% of G2 and 60% of G3 were infield; outfield in 4% of G1, 14% of G2 and 9% of G3; remaining both infield and outfield. 161pts (57%) needed additional treatments after FT (60% of G1, 54% of G2 and 65% of G3). RFS and TFS were higher for G2 [68mos (95%CI 52-90), p<0.001 and 87mos (95%CI 70-101), p=0.04], but no differences were found between G1 [18mos (95%CI 13-56) and 50mos (95%CI 35-NA)] and G3 [34mos (95%CI 26-49) and 50mos (95%CI 40-63)]. No differences were found in terms of PFS. Furthermore, in the sub-analysis, no differences were found in terms of RFS, TFS and PFS between G1 and all subgroups. CONCLUSIONS: Expanding FT inclusion criteria appears safe and acceptable, allowing more patients to benefit from FT. Further and multicentre studies are needed. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e403 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Daniele Cignoli More articles by this author Andrea Rodriguez-Serrano More articles by this author David Lopez More articles by this author Armando Stabile More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Camille Lanz More articles by this author Eric Barret More articles by this author François Rozet More articles by this author Petr Macek More articles by this author Xavier Cathelineau More articles by this author Lara Rodriguez-Sanchez More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III (MP44)1 May 2024MP44-03 THE IMPACT OF ISCHEMIA TIME ON RENAL FUNCTION IN PATIENTS WITH MICROCIRCULATION IMPAIRMENT DURING PARTIAL NEPHRECTOMY FOR RCC Francesco Cei, Daniele Cignoli, Federico Belladelli, Chiara Re, Giacomo Musso, Francesco Trevisani, Arianna Bettiga, Pierre Karakiewicz, Par Stattin, Isaline Rowe, Roberta Lucianò, Giuseppe Rosiello, Daniela Canibus, Francesco Fiorio, Roberto Bertini, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Alessandro Larcher, and Umberto Capitanio Francesco CeiFrancesco Cei , Daniele CignoliDaniele Cignoli , Federico BelladelliFederico Belladelli , Chiara ReChiara Re , Giacomo MussoGiacomo Musso , Francesco TrevisaniFrancesco Trevisani , Arianna BettigaArianna Bettiga , Pierre KarakiewiczPierre Karakiewicz , Par StattinPar Stattin , Isaline RoweIsaline Rowe , Roberta LucianòRoberta Lucianò , Giuseppe RosielloGiuseppe Rosiello , Daniela CanibusDaniela Canibus , Francesco FiorioFrancesco Fiorio , Roberto BertiniRoberto Bertini , Andrea SaloniaAndrea Salonia , Alberto BrigantiAlberto Briganti , Francesco MontorsiFrancesco Montorsi , Alessandro LarcherAlessandro Larcher , and Umberto CapitanioUmberto Capitanio View All Author Informationhttps://doi.org/10.1097/01.JU.0001009508.69111.d0.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In patients with microcirculation impairment elected for partial nephrectomy (PN) to treat a renal mass, arterial clamping and ischemia time (IT) might not be tolerated and increase significantly the risk of renal function detriment. The aim of the study was to investigate functional outcomes after PN in patients with microcirculation impairment. METHODS: Prospectively collected data were obtained from a cohort of 186 patients with pre-existing microcirculation impairment who underwent elective PN for cT1-2 cN0 cM0 RCC. Microcirculation impairment was defined as the presence of long-term uncontrolled hypertension and diabetes, peripheral vasculopathy, or vascular nephropathy. IT was defined as the duration of clamping of the main renal artery with no refrigeration. The primary outcome of the study was evaluation of the effect of WIT on renal function postoperatively, at 6 months and in the long term. The secondary outcome of the study was haemorrhagic risk, defined as estimated blood loss (EBL) or peri-operative transfusions. Multivariable linear, logistic and Cox regression analyses (MVA), accounting for age, Charlson comorbidity index, clinical size, preoperative eGFR and year of surgery, were used. RESULTS: 139 patients (75%) underwent PN with WIT and 47 (25%) without. The baseline median eGFR was 71 mL/min/1.73 m2 for the on-clamp population and 61.4 mL/min/1.73 m2 for the off-clamp population. At multivariable analyses predicting renal function, longer WIT was associated with decreased postoperative eGFR (Est: −0.23, [p<0.001]). Conversely, no association between WIT and eGFR was recorded at 6-month or long-term follow-up (all p>0.1). At MVA predicting haemorrhagic risk, clampless resection with no ischaemia time and PN with short WIT was associated with an increased EBL (Est: −25.77, [p=0.03]) and peri-operative transfusion rate (Est: −0.017, [p=0.04]). CONCLUSIONS: Patients and clinicians should be aware that performing PN with very limited or even with zero WIT in patients with a pre-existing microcirculation impairment doesn't improve long-term renal function outcomes and increases bleeding and need for peri-operative transfusions. Our findings support hilum preparation and clamping even in patients with microcirculation impairment. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e731 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Francesco Cei More articles by this author Daniele Cignoli More articles by this author Federico Belladelli More articles by this author Chiara Re More articles by this author Giacomo Musso More articles by this author Francesco Trevisani More articles by this author Arianna Bettiga More articles by this author Pierre Karakiewicz More articles by this author Par Stattin More articles by this author Isaline Rowe More articles by this author Roberta Lucianò More articles by this author Giuseppe Rosiello More articles by this author Daniela Canibus More articles by this author Francesco Fiorio More articles by this author Roberto Bertini More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Alessandro Larcher More articles by this author Umberto Capitanio More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy I (MP25)1 May 2024MP25-15 LESSONS LEARNED: IMPROVED SELECTION AND TREATMENT OUTCOMES FOR FOCAL THERAPY FOR EARLY ADOPTION TO LATEST EXPERIENCE Andrea Rodriguez-Serrano, David Alejandro López Vázquez, Daniele Cignoli, Estefanía Linares-Espinós, Camille Lanz, Natalie Cathala, Eric Barret, Petr Macek, Xavier Cathelineau, and Lara Rodriguez-Sánchez Andrea Rodriguez-SerranoAndrea Rodriguez-Serrano , David Alejandro López VázquezDavid Alejandro López Vázquez , Daniele CignoliDaniele Cignoli , Estefanía Linares-EspinósEstefanía Linares-Espinós , Camille LanzCamille Lanz , Natalie CathalaNatalie Cathala , Eric BarretEric Barret , Petr MacekPetr Macek , Xavier CathelineauXavier Cathelineau , and Lara Rodriguez-SánchezLara Rodriguez-Sánchez View All Author Informationhttps://doi.org/10.1097/01.JU.0001008692.26556.39.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Focal therapy (FT) is a treatment option for localized prostate cancer (PCa) in selected patients. This study aims to provide insights into trends over 14 years of experience in FT, focusing on patient selection and treatment outcomes. METHODS: A single-center retrospective analysis was conducted on 420 patients who underwent FT between 2009 and 2023. We assessed our institution's experience with FT, utilizing Joinpoint Regression Analysis (JPRA) to calculate the annual percent change (APC) for key patient selection variables such as PSA, PSA density(dPSA), ISUP risk group, multifocality, energy modalities, treatment extension, and clinically significant recurrences (CSR) (infield and outfield). RESULTS: The baseline median PSA and PSAd were 6 ng/ml(1.6-24.9) and 0.17(0.04-1.2), respectively. HIFU was indicated for 271 patients(64.5%), Cryo for 117(27.8%), and electroporation (IRE) for 32(7.6%). Of all patients, 48.6% had ISUP grade 1 PCa, and 51.4% had ISUP≥2. Analysis showed a non-significant increasing trend in median PSA (APC: 0.9, 95%CI[-0.3-2.1]) and multifocal lesions (APC: 6, 95%CI[-3.9-17]). Conversely, dPSA exhibited a declining trend (APC: 0.1, 95%CI[-2.3-2.1]). Significant annual trends were observed in pre-treatment ISUP: ISUP 1 patients decreased (APC: -20, 95%CI[-13.6 to -6.5], p<0.01), while ISUP 2 patients increased (APC: 18.7, 95%CI[9 to 29], p<0.01). For ISUP 3 and 4 patients, analysis couldn´t be established due to the limited number of cases (ISUP 3: 6, and ISUP 4: 1). Treatment extension trends displayed a non-significant annual increase in hemiablation (APC: 1.1, 95%CI[-6.8-10]) and a slight decline in focal ablation (APC: -1.2, 95% CI[-4.6-2.4]). Energy modality trends revealed a significant increase in HIFU (APC: 5.2, 95%CI[0.1-11], p<0.01) and IRE (APC: 23.8, 95%CI[9-41], p<0.01), while cryo decreased (APC: -16.9, 95%CI[-23.4 to -9.6], p<0.01). Annual reductions in CSR were evident across all categories (total, infield and outfield) (Figure 1), although didn't reach statistical significance. CONCLUSIONS: Over 14 years, we observed a shift towards the treatment of more aggressive diseases while still maintaining favorable oncological outcomes, in terms of CSR. This can be attributed to improved patient selection and advancements in treatment techniques. Download PPT Source of Funding: There is not source of funding © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e410 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Andrea Rodriguez-Serrano More articles by this author David Alejandro López Vázquez More articles by this author Daniele Cignoli More articles by this author Estefanía Linares-Espinós More articles by this author Camille Lanz More articles by this author Natalie Cathala More articles by this author Eric Barret More articles by this author Petr Macek More articles by this author Xavier Cathelineau More articles by this author Lara Rodriguez-Sánchez More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance II (MP51)1 May 2024MP51-03 PREOPERATIVE OR INTRAOPERATIVE RENAL BIOPSY INCREASES THE ACCURACY IN PREDICTING LYMPH NODE INVASION IN PATIENTS WITH RENAL CELL CARCINOMA Federico Belladelli, Chiara Re, Francesco Cei, Giacomo Musso, Giuseppe Rosiello, Daniele Cignoli, Daniela Canibus, Francesco Fiorio, Roberto Bertini, Andrea Salonia, Francesco De Cobelli, Giorgio Brembilla, Morgan Rouprêt, Antonio Esposito, Anna Palmisano, Ciro Piccolo, Marco Gambirasio, Roberta Lucianò, Nazario Tenace, Alberto Briganti, Francesco Montorsi, Alessandro Larcher, and Umberto Capitanio Federico BelladelliFederico Belladelli , Chiara ReChiara Re , Francesco CeiFrancesco Cei , Giacomo MussoGiacomo Musso , Giuseppe RosielloGiuseppe Rosiello , Daniele CignoliDaniele Cignoli , Daniela CanibusDaniela Canibus , Francesco FiorioFrancesco Fiorio , Roberto BertiniRoberto Bertini , Andrea SaloniaAndrea Salonia , Francesco De CobelliFrancesco De Cobelli , Giorgio BrembillaGiorgio Brembilla , Morgan RouprêtMorgan Rouprêt , Antonio EspositoAntonio Esposito , Anna PalmisanoAnna Palmisano , Ciro PiccoloCiro Piccolo , Marco GambirasioMarco Gambirasio , Roberta LucianòRoberta Lucianò , Nazario TenaceNazario Tenace , Alberto BrigantiAlberto Briganti , Francesco MontorsiFrancesco Montorsi , Alessandro LarcherAlessandro Larcher , and Umberto CapitanioUmberto Capitanio View All Author Informationhttps://doi.org/10.1097/01.JU.0001009492.49624.4b.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is still debate regarding the role of lymph node dissection (LND) in patients with renal cell carcinoma (RCC). Specifically, it is still unclear which patients may benefit from LND and how information from renal mass biopsies may improve clinical decision-making. We aimed to identify predictors of lymph node invasion (LNI) by using clinical variables only (preoperative characteristics) and by adding the pathological information which can be derived during surgery relying on biopsy and intraoperative pathology. METHODS: Within a prospectively maintained database, patients with renal masses who underwent surgery with LND at a single tertiary center were identified. The Boruta machine learning algorithm was employed to select the relevant variables of interest among different pre-surgical clinical variables (age, sex, BMI, presence of comorbidities, smoke, presence of symptoms, lesion number, clinical size, cT, cN, lesion side and position, preoperative haemoglobin, platelets, and creatinine). Therefore, a predictive nomogram was derived from a multivariable logistic model developed to predict LNI at final pathology. Final pathology histological data was then used as a simulation for pre-operative biopsy data. ROC curve was used to test the accuracy of the prediction for each risk group. Decision Curve Analysis (DCA) was used to compare the clinical only vs. clinical + biopsy model. RESULTS: Overall, 3,626 patients underwent either PN or RN for RCC. Of these, 31% (n=1,114) underwent LND and 103 (3%) showed pathologically confirmed LNI. Boruta identified clinical lesion size, cT, cN, preoperative hemoglobin, platelets, and creatinine as variable of interest. The logistic model-derived nomogram showed an accuracy of 0.82 when predicting LNI at final pathology. At simulation of biopsy and intraoperative pathology, the inclusion of histology and grading in the predictive model increased the accuracy up to 0.88. At DCA, the clinical+biobsy model provided a higher net benefit when compared to the clinical-only model (Figure 1). CONCLUSIONS: Information which can be retrieved by a preoperative or an intraoperative renal biopsy can be used to accurately predict the risk of LNI. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e842 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Federico Belladelli More articles by this author Chiara Re More articles by this author Francesco Cei More articles by this author Giacomo Musso More articles by this author Giuseppe Rosiello More articles by this author Daniele Cignoli More articles by this author Daniela Canibus More articles by this author Francesco Fiorio More articles by this author Roberto Bertini More articles by this author Andrea Salonia More articles by this author Francesco De Cobelli More articles by this author Giorgio Brembilla More articles by this author Morgan Rouprêt More articles by this author Antonio Esposito More articles by this author Anna Palmisano More articles by this author Ciro Piccolo More articles by this author Marco Gambirasio More articles by this author Roberta Lucianò More articles by this author Nazario Tenace More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Alessandro Larcher More articles by this author Umberto Capitanio More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP56)1 May 2024MP56-15 CLINICAL CHARACTERISTICS OF PATIENTS WITH RENAL CANCER DO IMPACT MORE THAN ISCHEMIA TIME ON POST-OPERATIVE RENAL FUNCTION Giuseppe Rosiello, Giacomo Musso, Chiara Re, Francesco Cei, Federico Belladelli, Francesco Trevisani, Daniele Cignoli, Giuseppe Basile, Lucia Salerno, Alessandro Bertini, Isaline Rowe, Annamaria Ferrara, Elio Mazzone, Giorgio Gandaglia, Roberto Bertini, Francesco Montorsi, Andrea Salonia, Alessandro Larcher, and Umberto Capitanio Giuseppe RosielloGiuseppe Rosiello , Giacomo MussoGiacomo Musso , Chiara ReChiara Re , Francesco CeiFrancesco Cei , Federico BelladelliFederico Belladelli , Francesco TrevisaniFrancesco Trevisani , Daniele CignoliDaniele Cignoli , Giuseppe BasileGiuseppe Basile , Lucia SalernoLucia Salerno , Alessandro BertiniAlessandro Bertini , Isaline RoweIsaline Rowe , Annamaria FerraraAnnamaria Ferrara , Elio MazzoneElio Mazzone , Giorgio GandagliaGiorgio Gandaglia , Roberto BertiniRoberto Bertini , Francesco MontorsiFrancesco Montorsi , Andrea SaloniaAndrea Salonia , Alessandro LarcherAlessandro Larcher , and Umberto CapitanioUmberto Capitanio View All Author Informationhttps://doi.org/10.1097/01.JU.0001008940.44711.d4.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The role of warm ischemia time (WIT) on renal function recovery after partial nephrectomy (PN) is still debated. We aimed at quantifying the weighted effect of ischemia time vs. preoperative clinical risk factors, namely hypertension, smoking status and diabetes. METHODS: Within a prospectively maintained database, we identified 1,100 patients treated with PN at a single European high-volume center (2000–2022). Only patients with estimated glomerular filtration rate (eGFR)>=60 mL/min/1.73 m3 were included. Acute kidney injury was defined according to the RIFLE criteria. Multivariable logistic regression analyses estimated the risk of AKI after surgery according to each preoperative clinical risk factor and their combinations. A local polynomial smoother weighted function was used to graphically explore the risk of AKI according to preoperative risk factors and WIT. Covariates were age at surgery, preoperative eGFR, Charlson Comorbidity Index, ischemia time, estimated blood loss, and surgical approach (open vs. robotic). RESULTS: Overall, 86 patients (7.8%) had diabetes, 397 (36%) hypertension and 415 (38%) were currently or former smoker. Median age at surgery was 59 [Interquartile range (IQR): 50-67] years. Median clinical tumor size was 3.1 (IQR: 2.5-4.1) cm. Overall, 480 (44%) vs. 273 (25%) vs. 43 (4%) had 1 vs. 2 vs. 3 preoperative risk factors. After adjusting for several confounders, presence of 1 [Odds ratio (OR): 1.34; p=0.01] vs. 2 (OR: 1.85; p<0.001) vs. 3 (OR: 2.35; p=0.02) risk factors was associated with a significantly increased risk of AKI. The impact of WIT on postoperative AKI differed accordingly with the number of preoperative risk factors (Figure 1). CONCLUSIONS: WIT in patients undergoing PN does not seem to have an impact on short-term kidney function, namely postoperative AKI, in absence of preoperative clinical risk factors. Conversely, the combination of risk factors increases the detrimental effect of WIT on renal function after surgery. Referral to nephrologist should be considered in presence of clinical risk factors, especially in complex cases, where a prolonged ischemia time is foreseen. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e932 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Giuseppe Rosiello More articles by this author Giacomo Musso More articles by this author Chiara Re More articles by this author Francesco Cei More articles by this author Federico Belladelli More articles by this author Francesco Trevisani More articles by this author Daniele Cignoli More articles by this author Giuseppe Basile More articles by this author Lucia Salerno More articles by this author Alessandro Bertini More articles by this author Isaline Rowe More articles by this author Annamaria Ferrara More articles by this author Elio Mazzone More articles by this author Giorgio Gandaglia More articles by this author Roberto Bertini More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Alessandro Larcher More articles by this author Umberto Capitanio More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance I (MP36)1 May 2024MP36-14 HOW TO PERFORM THE OPTIMAL RENAL BIOPSY: A MACHINE LEARNING-BASED INDICATION Federico Belladelli, Chiara Re, Francesco Cei, Giacomo Musso, Giuseppe Rosiello, Daniele Cignoli, Daniela Canibus, Francesco Fiorio, Roberto Bertini, Andrea Salonia, Francesco De Cobelli, Giorgio Brembilla, Antonio Esposito, Anna Palmisano, Ciro Piccolo, Marco Gambirasio, Roberta Lucianò, Nazario Tenace, Alberto Briganti, Francesco Montorsi, Alessandro Larcher, and Umberto Capitanio Federico BelladelliFederico Belladelli , Chiara ReChiara Re , Francesco CeiFrancesco Cei , Giacomo MussoGiacomo Musso , Giuseppe RosielloGiuseppe Rosiello , Daniele CignoliDaniele Cignoli , Daniela CanibusDaniela Canibus , Francesco FiorioFrancesco Fiorio , Roberto BertiniRoberto Bertini , Andrea SaloniaAndrea Salonia , Francesco De CobelliFrancesco De Cobelli , Giorgio BrembillaGiorgio Brembilla , Antonio EspositoAntonio Esposito , Anna PalmisanoAnna Palmisano , Ciro PiccoloCiro Piccolo , Marco GambirasioMarco Gambirasio , Roberta LucianòRoberta Lucianò , Nazario TenaceNazario Tenace , Alberto BrigantiAlberto Briganti , Francesco MontorsiFrancesco Montorsi , Alessandro LarcherAlessandro Larcher , and Umberto CapitanioUmberto Capitanio View All Author Informationhttps://doi.org/10.1097/01.JU.0001008612.93052.9d.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal biopsies (RB) may not yield pathologic diagnosis and even in a larger proportion it is not possible to diagnose tumor grading. The aim of the study was to define by machine learning algorithms an optimal RB strategy. METHODS: Within a prospectively maintained database, patients with indeterminate renal masses who underwent RB at a single tertiary center were identified. We recorded and analyzed the guidance method (US/CT), number of biopsy cores (NoC), and total tissue length (LoC) to evaluate their influence on diagnostic outcomes, including histological characterization and grading. The Boruta algorithm was used to select relevant variables. Subsequently, the K-Nearest Neighbors (KNN), a non-parametric supervised machine learning model, predicted the probability of obtaining a pathological diagnosis including tumor grading based on the chosen variables. Decision boundaries from the KNN model guided the creation of diagnostic recommendations, which were tested using multivariable logistic regression. RESULTS: Overall, 197 patients underwent RB. Median tumor size was 2.5 cm (Interquartile range 2-3.2). The rate of non-diagnostic RB was 8.6% (n=17/197), and the rate of tumour grading not assessable was 35% (69/197). The median (IQR) NoC and LoC were 2 (1-3) and 1.2 (0.6-1.6) cm, respectively. When Boruta algorithm was used only NoC and LoC were selected. By employing a KNN algorithm (optimal K value=9), a predictive model was constructed using these variables, achieving an accuracy of 75%. The decision boundaries used by the model (Fig. 1) indicate that the minimum number of cores to be taken should be 2 and that these cores should provide at least 0.8 cm of tissue or, alternatively, in case of RB with more than two cores no minimum tissue threshold is required. At multivariable logistic regression analysis, these indications resulted associated with higher probability of histological characterization (p=0.02) and grading (p<0.01) after adjusting for BMI, lesion size, location, and year of biopsy. CONCLUSIONS: Employing various machine learning algorithms, we defined an optimal renal biopsy strategy based on at least 2 cores and at least 0.8 cm of tissue or at least 3 cores and no minimum tissue threshold. These recommendations should be implemented in clinical practice to reduce non-diagnostic RB. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e597 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Federico Belladelli More articles by this author Chiara Re More articles by this author Francesco Cei More articles by this author Giacomo Musso More articles by this author Giuseppe Rosiello More articles by this author Daniele Cignoli More articles by this author Daniela Canibus More articles by this author Francesco Fiorio More articles by this author Roberto Bertini More articles by this author Andrea Salonia More articles by this author Francesco De Cobelli More articles by this author Giorgio Brembilla More articles by this author Antonio Esposito More articles by this author Anna Palmisano More articles by this author Ciro Piccolo More articles by this author Marco Gambirasio More articles by this author Roberta Lucianò More articles by this author Nazario Tenace More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Alessandro Larcher More articles by this author Umberto Capitanio More articles by this author Expand All Advertisement PDF downloadLoading ...

Background Up to 15% of patients with locally advanced renal cell carcinoma (RCC) harbors tumor thrombus (TT). In those cases, radical nephrectomy (RN) and thrombectomy represents the standard of care. We assessed the impact of TT on long-term functional and oncological outcomes in a large contemporary cohort. Methods Within a prospective maintained database, 1207 patients undergoing RN for non-metastatic RCC between 2000 and 2021 at a single tertiary centre were identified. Of these, 172 (14%) harbored TT. Multivariable logistic regression analyses evaluated the impact of TT on the risk of postoperative acute kidney injury (AKI). Multivariable Poisson regression analyses estimated the risk of long-term chronic kidney disease (CKD). Kaplan Meier plots estimated disease-free survival and cancer specific survival. Multivariable Cox regression models assessed the main predictors of clinical progression (CP) and cancer specific mortality (CSM). Results Patients with TT showed lower BMI (24 vs. 26 kg/m(2)) and preoperative Hb (11 vs. 14 g/mL; all-p < 0.05). Clinical tumor size was higher in patients with TT (9.6 vs. 6.5 cm; p < 0.001). After adjusting for potential confounders, the presence of TT was significantly associated with a higher risk of postoperative AKI (OR 2.03, 95% CI 1.49-3.6; p < 0.001) and long-term CKD (OR: 1.32, 95% CI 1.10-1.58; p < 0.01). Notably, patients with TT showed worse long-term oncological outcomes and TT was a predictor for CP (2.02, CI 95% 1.49-2.73, p < 0.001) and CSM (HR 1.61, CI 95% 1.04-2.49, p < 0.03). Conclusions The presence of TT in RCC patients represents a key risk factor for worse perioperative, as well as long-term renal function. Specifically, patients with TT harbor a significant and early estimated glomerular filtration rate (eGFR) decrease. However, despite TT patients show a greater eGFR decline after surgery, they retain acceptable renal function, which remains stable over time.

To investigate clinical and radiological differences between kidney metastases to the lung (RCCM +) and metachronous lung cancer (LC) detected during follow-up in patients surgically treated for Renal Cell Carcinoma (RCC). cM0 surgically-treated RCC who harbored a pulmonary mass during follow-up were retrospectively scrutinized. Univariate logistic regression assessed predictive features for differentiating between LC and RCCM + . Multivariable analyses (MVA) were fitted to predict factors that could influence time between detection and histological diagnosis of the pulmonary mass, and how this interval could impact on survivals. 87

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V (MP67)1 May 2024MP67-07 RISKS AND BENEFITS OF PARTIAL NEPHRECTOMY WITH LIMITED OR WITHOUT ISCHEMIA TIME IN THE EXTREME SCENARIO OF PATIENTS WITH A SOLITARY KIDNEY Francesco Cei, Daniele Cignoli, Andrea Minervini, Andrea Mari, Fabrizio Di Maida, Karim Bensalah, Benoit Peyronnet, Riccardo Schiavina, Lorenzo Bianchi, Alexandre Mottrie, Geert De Naeyer, Ruben De Groote, Alessandro Antonelli, Riccardo Bertolo, Koon Ho Rha, Ahmad Almujalhem, Ithaar Derweesh, Aaron W. Bradshaw, Jihad Kaouk, Guilherme V. Sawczyn, Alberto Breda, Umberto Capitanio, Francesco Montorsi, and Alessandro Larcher Francesco CeiFrancesco Cei , Daniele CignoliDaniele Cignoli , Andrea MinerviniAndrea Minervini , Andrea MariAndrea Mari , Fabrizio Di MaidaFabrizio Di Maida , Karim BensalahKarim Bensalah , Benoit PeyronnetBenoit Peyronnet , Riccardo SchiavinaRiccardo Schiavina , Lorenzo BianchiLorenzo Bianchi , Alexandre MottrieAlexandre Mottrie , Geert De NaeyerGeert De Naeyer , Ruben De GrooteRuben De Groote , Alessandro AntonelliAlessandro Antonelli , Riccardo BertoloRiccardo Bertolo , Koon Ho RhaKoon Ho Rha , Ahmad AlmujalhemAhmad Almujalhem , Ithaar DerweeshIthaar Derweesh , Aaron W. BradshawAaron W. Bradshaw , Jihad KaoukJihad Kaouk , Guilherme V. SawczynGuilherme V. Sawczyn , Alberto BredaAlberto Breda , Umberto CapitanioUmberto Capitanio , Francesco MontorsiFrancesco Montorsi , and Alessandro LarcherAlessandro Larcher View All Author Informationhttps://doi.org/10.1097/01.JU.0001009496.54470.10.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Growing evidence suggests that ischemia time [IT] has far less influence on postoperative renal function compared to other factors. However, the information available on the trade-off for risk and benefit of IT on long-term renal function in case patients with solitary kidney [SK] elected for partial nephrectomy [PN] is scarce. Accordingly, the aim of the study is to evaluate the potential benefit and harms of no or limited IT during PN in patients with solitary kidney. METHODS: This study included 244 single-kidney patients treated with elective PN for a single cT1–2N0M0 renal mass at nine high-volume European, North American, and Asian institutions. IT was defined as the duration of clamping of the main renal artery. The primary outcome of the study was postoperative, 1-year and long-term renal function defined as estimated glomerular filtration rate [eGFR]. The secondary outcome of the study were estimated blood loss [EBL] and perioperative transfusions. We relied on linear, logistic and Cox regression analysis [MVA] accounting for age, comorbidities, clinical size, preoperative eGFR and year of surgery to assess the impact of IT on the study outcomes. RESULTS: Off-clamp PN was performed in 127 patients (52%). The median duration of IT for patients treated with on-clamp strategy was 18 minutes. At MVA predicting renal function, longer IT resulted associated with decreased postoperative eGFR (Est -0.37; p=0.03). Conversely, no association between IT and eGFR was recorded at 1 year (Est -0.04; p=0.7) or at long term follow-up (Est -0.28; p=0.07). At MVA predicting hemorrhagic risk, IT resulted associated with EBL (Est -6.16; p=0.04) and perioperative transfusion (OR 0.99; p=0.01; Figures 1A-1B). CONCLUSIONS: In SK patients, performing off-clamp PN is associated with improved renal function at short term assessment only and at long term follow-up, any advantage relative to on-clamp PN phases out. Conversely, off-clamp PN increases hemorrhagic risk. These findings support hilum preparation and on-clamp PN even in the extreme scenario of SK patients. Despite being the largest cohort of SK patients available to date, our conclusions may require further validation through larger sample sizes and even longer IT to confirm the hypothesis of a neutral impact of IT on renal function. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1099 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Francesco Cei More articles by this author Daniele Cignoli More articles by this author Andrea Minervini More articles by this author Andrea Mari More articles by this author Fabrizio Di Maida More articles by this author Karim Bensalah More articles by this author Benoit Peyronnet More articles by this author Riccardo Schiavina More articles by this author Lorenzo Bianchi More articles by this author Alexandre Mottrie More articles by this author Geert De Naeyer More articles by this author Ruben De Groote More articles by this author Alessandro Antonelli More articles by this author Riccardo Bertolo More articles by this author Koon Ho Rha More articles by this author Ahmad Almujalhem More articles by this author Ithaar Derweesh More articles by this author Aaron W. Bradshaw More articles by this author Jihad Kaouk More articles by this author Guilherme V. Sawczyn More articles by this author Alberto Breda More articles by this author Umberto Capitanio More articles by this author Francesco Montorsi More articles by this author Alessandro Larcher More articles by this author Expand All Advertisement PDF downloadLoading ...

Male infertility (MI) has been widely associated with the development of certain comorbidities and to a lower overall general health status. Higher risks of developing oncological, autoimmune, and chronic disorders among infertile individuals have led researchers to further investigate this issue. Recent clinical studies have been focusing more onto the concept of general health status and mortality. Overall, it has been postulated and subsequently demonstrated that the coexistence of specific diseases and semen alterations may lead to a decreased lifespan. As in Western countries, fatherhood is increasingly delayed in time, and aging might play an important role as a confounding factor for the after-mentioned statements. Although this holds true, even after adjusting for age, it emerges a worrisome picture regarding MI, lower general health status, and increased mortality. The aim of this nonsystematic narrative review is to provide an overview of the most relevant and recent findings on the topic.

You have accessJournal of UrologyCME1 Apr 2023MP58-15 LAWTON INSTRUMENTAL ACTIVITIES OF DAILY LIVING SCALE IDENTIFIES PATIENTS AT HIGH-RISK OF ADVERSE OUTCOMES AFTER KIDNEY SURGERY FOR RENAL CANCER: A PROSPECTIVE CLINICAL STUDY Giuseppe Rosiello, Gianfranco Baiamonte, Giuseppe Basile, Giuseppe Fallara, Chiara Re, Giacomo Musso, Francesco Cei, Daniele Cignoli, Giulio Avesani, Natasha Disabato, Giulia Villa, Mattia Boarin, Daniela Canibus, Pierre I. Karakiewicz, Federico Dehò, Nazareno Suardi, Alberto Briganti, Andrea Salonia, Francesco Montorsi, Alessandro Larcher, and Umberto Capitanio Giuseppe RosielloGiuseppe Rosiello More articles by this author , Gianfranco BaiamonteGianfranco Baiamonte More articles by this author , Giuseppe BasileGiuseppe Basile More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Chiara ReChiara Re More articles by this author , Giacomo MussoGiacomo Musso More articles by this author , Francesco CeiFrancesco Cei More articles by this author , Daniele CignoliDaniele Cignoli More articles by this author , Giulio AvesaniGiulio Avesani More articles by this author , Natasha DisabatoNatasha Disabato More articles by this author , Giulia VillaGiulia Villa More articles by this author , Mattia BoarinMattia Boarin More articles by this author , Daniela CanibusDaniela Canibus More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , Federico DehòFederico Dehò More articles by this author , Nazareno SuardiNazareno Suardi More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , and Umberto CapitanioUmberto Capitanio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003311.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Frailty is a clinical syndrome associated with delayed recovery and suboptimal outcomes after surgery. Frailty scales have been suggested for identifying frailty before kidney cancer surgery. In this prospective clinical study, we aimed at assessing the role of Lawton Instrumental Activities of Daily Living (IADL) scale in predicting surgical outcomes in patients undergoing partial or radical nephrectomy for renal cell carcinoma (RCC). METHODS: Between January 2021 and June 2022, 98 consecutive patients surgically treated for cT1-2 RCC were prospectively enrolled. The IADL scale was calculated for each patient at hospital admission. Postoperative complications were prospectively collected using Clavien-Dindo classification. Acute kidney injury (AKI) was defined according to the RIFLE criteria. Multivariable logistic and linear regression models tested the association between iADL score and postoperative complications, as well as length of stay (LOS) and postoperative AKI, after adjusting for age, preoperative eGFR, blood loss and tumor characteristics. RESULTS: Overall, 98 patients were included. Of these, 21 (21%) had IADL <6. Median age at surgery and clinical size were 62 [Interquartile range (IQR): 53-71] years and 5 (IQR: 3.4-7) cm. Median preoperative eGFR was 70 (IQR: 56-91) mL/min. Finally, median LOS was 5 (IQR: 4-7) days. Overall, the rate of postoperative complications was 13% (5% of major complications defined as Clavien-Dindo >3). Overall, 22 (22%) out of 98 patients experienced postoperative AKI. At MVA, increasing IADL score predicted lower risk of overall complications [Odds ratio (OR): 0.35, 95%CI 0.22-0.48; p<0.001] and shorter LOS (Relative risk: 0.28, 95%CI 0.19-0.41; p<0.001). Moreover, increasing IADL was independently associated with lower risk of postoperative AKI after surgery (OR: 0.64, 95%CI 0.47-0.88; p<0.01). CONCLUSIONS: Assessing preoperative IADL score allows the identification of patients at increased risk of suboptimal outcomes after surgery for kidney cancer. Therefore, frailty assessment allows the stratification of surgical risks and, potentially, the implementation of dedicated management which may help in protecting frail patients from suboptimal outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e801 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giuseppe Rosiello More articles by this author Gianfranco Baiamonte More articles by this author Giuseppe Basile More articles by this author Giuseppe Fallara More articles by this author Chiara Re More articles by this author Giacomo Musso More articles by this author Francesco Cei More articles by this author Daniele Cignoli More articles by this author Giulio Avesani More articles by this author Natasha Disabato More articles by this author Giulia Villa More articles by this author Mattia Boarin More articles by this author Daniela Canibus More articles by this author Pierre I. Karakiewicz More articles by this author Federico Dehò More articles by this author Nazareno Suardi More articles by this author Alberto Briganti More articles by this author Andrea Salonia More articles by this author Francesco Montorsi More articles by this author Alessandro Larcher More articles by this author Umberto Capitanio More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023MP64-08 99mTC- SESTAMIBI SPECT/CT FOR THE CHARACTERIZATION OF SMALL RENAL MASSES: INITIAL EXPERIENCE FROM a TERTIARY REFERRAL CENTER Alessandro Bertini, Francesco Cei, Chiara Re, Giacomo Musso, Giuseppe Rosiello, Giuseppe Fallara, Giuseppe Basile, Daniele Cignoli, Daniela Canibus, Gino Pepe, Luigi Gianolli, Francesco DE Cobelli, Giorgio Brembilla, Roberta Lucianò, Nazario Tenace, Rayan Matloob, Roberto Bertini, Alberto Briganti, Francesco Montorsi, Andrea Salonia, Alessandro Larcher, and Umberto Capitanio Alessandro BertiniAlessandro Bertini More articles by this author , Francesco CeiFrancesco Cei More articles by this author , Chiara ReChiara Re More articles by this author , Giacomo MussoGiacomo Musso More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Giuseppe BasileGiuseppe Basile More articles by this author , Daniele CignoliDaniele Cignoli More articles by this author , Daniela CanibusDaniela Canibus More articles by this author , Gino PepeGino Pepe More articles by this author , Luigi GianolliLuigi Gianolli More articles by this author , Francesco DE CobelliFrancesco DE Cobelli More articles by this author , Giorgio BrembillaGiorgio Brembilla More articles by this author , Roberta LucianòRoberta Lucianò More articles by this author , Nazario TenaceNazario Tenace More articles by this author , Rayan MatloobRayan Matloob More articles by this author , Roberto BertiniRoberto Bertini More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , and Umberto CapitanioUmberto Capitanio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003322.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Initial studies on 99mTc-Sestamibi Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) on small renal masses (SMR) suggested its use to characterize renal oncocytoma (RO) from renal cell carcinoma (RCC). In this case series, we present the initial cases managed at our tertiary referral center. METHODS: We prospectively collected data on 40 consecutive patients with a SMR diagnosed at our institution and submitted to 99mTc- SPECT/CT at our Institution between May 2021 and September 2022. Of all, pathological data, either from biopsy or surgery, are available for 25 patients. We assessed the sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPP) and the diagnostic accuracy (through the Area Under the roc Curve - AUC) of the 99mTc- SPECT/CT to differentiate oncocytoma and benign renal masses from malignant ones. RESULTS: Of 25 patients, 7 (28%) were females and 18 (72%) males. Median age at diagnosis was 64.9 (95% CI 57.1-72.1). Median max diameter at imaging was 3 cm (IQR 2.6-3.3). The SMR was diagnosed in 2 cases with the solely MRI (8%), in 12 cases with a CT scan (48%) and in 11 with both (44%). In 7 cases the SMR resulted positive at the 99mTc- SPECT/CT scan, suggesting a high-density mitochondrial tissue. 10 cases were submitted to biopsy and 15 to robotic partial nephrectomy. Of 10 biopsies, 2 SMRs were also treated with ablation and 1 which resulted positive for clear cell (cc)RCC was submitted to active surveillance. Overall, there were 9 oncocytomas, 8 ccRCC, 6 papillary tumors (of which 1 type I and 3 type II), 1 chronic nephritis and 1 cystic lesion with low probability of malignancy. Overall, for oncocytomas, SE was 55.5%, SP 87.5%, PPV 71.4% and NPV 77.8. The accuracy in differentiating oncocytomas from SMR of other nature was 74.6%. Considering all kind of benign SMRs, SE was 50%, SP 86.7%, PPV 71.4% and NPV 72.2%. The accuracy in differentiating benign from malignant SMR was 71.8%. CONCLUSIONS: Despite the relatively small sample size and the initial experience, 99mTc- SPECT/CT should be regarded as a promising, non-invasive technique with good accuracy in the detection of renal oncocytoma. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e883 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alessandro Bertini More articles by this author Francesco Cei More articles by this author Chiara Re More articles by this author Giacomo Musso More articles by this author Giuseppe Rosiello More articles by this author Giuseppe Fallara More articles by this author Giuseppe Basile More articles by this author Daniele Cignoli More articles by this author Daniela Canibus More articles by this author Gino Pepe More articles by this author Luigi Gianolli More articles by this author Francesco DE Cobelli More articles by this author Giorgio Brembilla More articles by this author Roberta Lucianò More articles by this author Nazario Tenace More articles by this author Rayan Matloob More articles by this author Roberto Bertini More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Alessandro Larcher More articles by this author Umberto Capitanio More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract Introduction Erectile dysfunction (ED) has been demonstrated to be reasonably prevalent among young men (≤40 yr). Objective We aimed to i) assess changes in patterns of reported ED in men ≤ 40 yr, and ii) compare the sociodemographic and clinical characteristics of ED men ≤ 40 yr vs. > 40 yr of age over a 8-yr period at a single academic centre. Methods Comprehensive data of 1179 patients seeking first medical help for ED and assessed by a single Sexual Medicine expert between 2013 and 2021 were analysed. Health-significant comorbidities were scored using the Charlson comorbidity index. All patients completed the International Index of Erectile Function (IIEF) at baseline. Descriptive statistics tested the sociodemographic and clinical characteristics of ED men ≤ 40 yr vs. > 40 yr of age. Within the two groups, multivariable linear regression models tested the association between advancing age and IIEF scores. Local polynomial regression models were applied to explore and graphically display ≤ 40 yr patients’ likelihood to report ED over the analysed time frame and to display changes of the IIEF-EF scores over increasing age between the two groups (≤ 40 yr vs. > 40 yr). Results Overall, median (IQR) age was 52 (41-62) yr. Median (IQR) IIEF-EF was 18 (15-22) at baseline. Of all, 268 (22.7%) were ≤ 40 yr whereas 911 (77.3%) were > 40 yr at baseline. Rates of severe ED according to IIEF-EF did not differ between men ≤ 40 yr and >40yr (60 (22.4%) vs. 155 (17%)). No significant differences were found for the IIEF domains (-IS, -OS, -SD) but IIEF-OF domains, which scored higher in younger men (9 () vs. 8 (), p=0.002). At baseline, younger patients reported less comorbidities, less active smoking, lower BMI, higher total testosterone (tT) levels than older patients (all p 40 yr, increasing age was linearly correlated with decreasing IIE-EF (all p 40 yr). Conclusions We observed that one out of five men seeking first medical help for ED at a single academic centre were younger than 40 yr. This trend has remained stable over the last 8-years, but slightly lower than the previous decade. Increasing age among younger patients is not associated with worse erectile function as oppositely occurs among patients > 40 yr. Disclosure No

ABSTRACT Introduction Peyronie's disease is a benign condition involving the tunica albuginea of the corpora cavernosa of the penis. Objectives To investigate whether patients’ age has an impact in terms of Peyronie's disease (PD) clinical characteristics at presentation. Methods Data from a group of 110 consecutive patients aged >18 and <70 years with PD and seeking first medical attention at a single andrological tertiary-referral centre, with a complete clinical assessment and who completed the IIEF-15 and PDQ questionnaires were included in the study. Descriptive statistics was used to compare categorical and continuous variables, between young (≤45 years) and old (>45 years) patients at presentation. Linear and logistic regression analyses tested the association between age and PDQ subscales (Pain, Bother and Symptoms) or IIEF-erectile function domain scores (IIEF-EF ≤26), after adjusting for Charlson Comorbidity Index (CCI), Body Mass Index (BMI), duration of PD (as self-reported by the patient) and smoking habit. LOWESS curve was used to graphically investigate the association between age and PDQ pain score. Results Of 110, 28 (25%) patients were ≤45 years old. Young patients had lower BMI [median (IQR) 24.3 (22.5-25.6) vs. 25.2 (23.7-27.8); p=0.01] and CCI [CCI≥1 in 1 patient (3.6%) vs. 23 (28%); p=0.014) compared to older patients. No differences were found between groups in terms of severity of the penile curvature, PD duration and plaque size. PDQ pain score was 6 (2.8-12.8) for young and 3 (0-8) for older patients (p=0.03). No differences were found in terms of PDQ-symptoms and bother scores, and for IIEF domain scores. At regression analysis, younger age was associated with significant higher PDQ-pain scores at presentation (Coeff 4.45; 95%CI 1.06:7.84; p=0.011). No further associations were observed between age and the other questionnaires. The figure depicts the higher PDQ-pain scores in young compared to older age. Conclusion Younger PD patients are at higher risk of complaining penile pain at presentation. No difference in terms of symptoms, PD-associated bother, erectile function and other clinical and morphometric characteristics were found between younger and older patients at first assessment. Disclosure Work supported by industry: no.

BACKGROUND: The influence of age and comorbidities during decision-making for patients with renal cell carcinoma remains controversial. OBJECTIVE: To comprehensively review the available evidence regarding the impacts of age and comorbidities on the decision to perform partial nephrectomy (PN). EVIDENCE ACQUISITION: A systematic review was conducted in accordance with PRISMA and registered with PROSPERO (CRD42022344759). Only randomized control trials, prospective cohort studies, registry-based studies, or single/multi-institutional retrospective cohort studies comparing PN to other therapeutic options for cT1N0M0 renal masses were considered. The primary outcome was to assess differences in patients’ baseline characteristics between different treatments in order to investigate how those aspects have influenced clinical decision-making. Finally, perioperative outcomes were compared across the different options. EVIDENCE SYNTHESIS: Overall, patients who underwent PN were 3 to 11 years younger than those who underwent other treatments. Baseline renal function was slightly better in patients who underwent PN than in those who underwent radical nephrectomy (RN), active surveillance (AS), or tumor ablation. Patients undergoing PN had an average pre-treatment eGFR 4 to 6 points (mL/min/1.73 m2) higher than patients undergoing RN or tumor ablation. Likewise, the proportion of baseline chronic kidney disease (CKD) before treatment was higher in patients undergoing other treatments, with a rate of CKD between 6% and 56% higher compared with that for PN. A slightly higher proportion of baseline diabetes mellitus (DM) and cardiovascular comorbidities (CVD) were found in patients who underwent PN than in those who underwent RN (20% vs. 21% for DM and 37% vs. 41% for CVD). On average, patients who underwent AS and tumor ablation had more comorbidities, in terms of Charlson comorbidity index (CCI), DM, and CVD (50% vs. 38% for CCI ≥2; 25% vs. 20% for DM; and 43% vs. 37% for CVD). In terms of Eastern Cooperative Oncology Group (ECOG) Performance Status and American Society of Anesthesiologists (ASA) classification, no major differences were found between PN and other treatments, but a trend emerged whereby more fit patients underwent PN compared with RN (16% of ECOG >1 for PN vs. 18% for RN and 15% of ASA grade ≥3 for PN vs. 26% for RN). Again, tumor ablation was preferred for less fit patients (31% of ASA grade ≥3). No study included in our systematic review reported the baseline frailty status of patients treated for cT1 renal masses. The rates of perioperative complications and length of hospital stay (LOS) were similar between different techniques. CONCLUSIONS: Patients who underwent PN tended to be younger and fitter than those who underwent other available treatments for cT1 renal masses. Since this technique aims at reducing renal function impairment after surgery, a greater effort should be made to optimize patient selection to include more comorbid patients for whom PN might be useful.