BACKGROUND:An accurate estimation of progression risk in patients with prostate cancer (PCa) amenable to active surveillance (AS) is still an unmet need. Among available biomarkers, we considered Prolaris cell-cycle progression (CCP) test, "triple hit" phenotype (ERG overexpression, PTEN and prostein expression loss) and elevated expression levels of TMPRSS2-ERG gene fusions. METHODS:We performed a case-control study, enrolling patients that entered the AS programme at our tertiary referral Institution. Men subsequently undergoing radical prostatectomy for progression were considered as "cases", while men still on AS at the end of the follow-up period were labeled as "controls". CCP test, triple hit and TMPRSS2-ERG expression analyses were performed on tumoral tissue retrieved from biopsies at enrollment. Their ability to distinguish "cases" and "controls" was evaluated. According to power analysis, the study required 40 patients. RESULTS:Patients had comparable baseline characteristics. CCP test suggested to continue AS in 75% of controls and to undergo an active treatment in 75% of cases. CCP molecular score (HR 8.5, p = 0.02) was significantly associated with progression in multivariable logistic regression. No significant differences were found in terms of "triple hit" or TMPRSS2:ERG expression. IHC analysis was feasible only in 17 patients due to insufficient material. CONCLUSIONS:CCP test may be a useful tool to estimate the risk of progression in PCa patients and guide the decision between AS and active treatment. Triple hit phenotype or TMPRSS:ERG fusion status was not associated with progression.

You have accessJournal of UrologyMisc. Benign/ Transplant/ Renovascular (V06)1 May 2024V06-07 ROBOT ASSISTED 3D MODEL & INDOCYANINE GUIDED URETERAL REIMPLANTATION IN RENAL TRANSPLANT PATIENTS: 4 EMBLEMATIC CASES FROM OUR SERIES Federico Lavagno, Marco Allasia, Marco Oderda, Alessandro Marquis, Daniele D'Agate, Alessandro Greco, Giuseppe Pasquale, Andrea Bosio, and Paolo Gontero Federico LavagnoFederico Lavagno , Marco AllasiaMarco Allasia , Marco OderdaMarco Oderda , Alessandro MarquisAlessandro Marquis , Daniele D'AgateDaniele D'Agate , Alessandro GrecoAlessandro Greco , Giuseppe PasqualeGiuseppe Pasquale , Andrea BosioAndrea Bosio , and Paolo GonteroPaolo Gontero View All Author Informationhttps://doi.org/10.1097/01.JU.0001010048.21113.99.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The outcomes of kidney transplants have improved significantly in recent years, leading to a reduction in morbidity and mortality. Even though, urological complications occur in the 2–10%. The ureteral stenosis of the graft ureter is the most common, with a probability of 0.5%–6.3%. Usually presenting within the first few weeks, or the first year, the most common site of stenosis is the ureterovesical junction. Several imaging are useful to assess hydronephrosis, including ultrasonography, CT, MR and scintigraphy.Once ureteric obstruction is confirmed, urinary diversion must be undertaken with a percutaneous nephrostomy insertion or a retrograde stent positioning. Definitive treatment include percutaneous balloon dilatation if technically feasible, followed by temporary ureteric stent placement. If the stenosis recurs after stent removal, surgical revision or long-term ureteric stenting is advocated. METHODS: Patients with ureteral stenosis were treated at our centre with a robot assisted technique (Da Vinci Xi), with the use of pre operative 3D models of the anatomy (Medics Srl © - Hyper Accuracy 3D®) and the auxilium of green indocyanine. Even if the scheduled intervention was the reimplantation of the ureteral graft to the bladder, this was not always possible. Step 1 is to identify and isolate the graft ureter transperitoneally with the aid of indocyanine (Firefly ™ Fluorescence Imaging for Da Vinci®) and the anastomotic stricture is transected and removed. This is often a challenging procedure due to sclerotic tissues. After the transverse opening of the isolated bladder a tension-free uretero-vesical anastomosis in single absorbable 4/0 stitches on a 6 Fr JJ ureteral stent complete the anastomosis. In other cases, as in the second video presented, due to sclerotic tissue the operation was converted to harvesting a Boari-Casati flap with the bladder mucosa. In the fourth case, intraoperatively, the transplanted ureter was found to be malacic and not useful for replanting, therefore the transplanted ureter had to be excised and the native ureter was used to create an anastomosis with the renal pelvis of the transplanted kidney. RESULTS: To date, 7 patients (5 F and 2 M) with distal graft ureteral stenosis, planned for ureteral reimplantation, were treated with a robot assisted technique (Da Vinci Xi). The mean time to onset of ureteral stricture was 3.5 months. Mean operative time was 217 minutes. Mean pre-op s-CR was 2.3 mg/dl, while post operative s-CR1.36 mg/dl. After 1 month observation mean s-CR was 1.45 mg/dl. CONCLUSIONS: Reconstructive surgery for renal transplant complications is often challenging. The transperitoneal robotic approach with the use of 3D reconstructions and indocyanine could help in the identification and isolation of the ureter. 3D guidance can also make it easier to identify the renal vessels and the pelvis. On the other hand, the high costs of robotic surgery, further burdened by the use of 3D models, need to be considered. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e378 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Federico Lavagno More articles by this author Marco Allasia More articles by this author Marco Oderda More articles by this author Alessandro Marquis More articles by this author Daniele D'Agate More articles by this author Alessandro Greco More articles by this author Giuseppe Pasquale More articles by this author Andrea Bosio More articles by this author Paolo Gontero More articles by this author Expand All Advertisement PDF downloadLoading ...

Purpose To assess the patient experience and satisfaction after the implementation in routine of a personalized, digital programme before and after same-day discharge (SDD) robot-assisted radical prostatectomy (RARP).Methods The study is a pre/post-interventional, multi-surgeon, unicentre, prospective study. All consecutive patients undergoing SDD RARP were included during a 6-month period. After a pre-interventional assessment of the satisfaction rate (n = 26), all patients (n = 46) were introduced to the Betty. Care platform and followed the BETTY COACHING programme which included a specific radical prostatectomy module. The primary endpoint was patient satisfaction 6 weeks after SDD RARP. Secondary endpoints were hospital stay, readmission and complications rates, unplanned visits, and remote monitoring data.Results Median age and PSA were 66 years and 7.0 ng/ml. Lymph node-dissection and nerve-sparing procedures were performed in 41.3 and 87.0% of patients, respectively. Median operative time and blood loss were 80 min and 150 ml, respectively. The 90-day rates of unplanned visits, readmission and complications were improved after the digital tool implementation (2.2, 2.2, and 8.7%, respectively). Mean satisfaction score was 9.6 out of 10 (8.0 before implementation). Median duration of pain was 2 days after discharge, with median pain intensity of 2/10. Median duration of daily active use of remote monitoring was 34 days. The urinary continence rate was 91.3% 6 weeks after surgery in the postinterventional cohort.Conclusions The implementation of a personalized, surgery-specific, digital programme combining prehabilitation, patient education, rehabilitation, patient-reported outcome measurement and remote monitoring, improves patient experience and satisfaction and could help promoting early discharge even after a major surgery.

BJU InternationalEarly View Research Letter One-year outcomes of same-day-discharge robot-assisted radical prostatectomy Alae Touzani, Alae Touzani orcid.org/0000-0003-3087-3518 Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France Urology Department, Centre International d Casablanca, Casablanca, Morocco Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MoroccoSearch for more papers by this authorDaniele D'Agate, Daniele D'Agate Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, FranceSearch for more papers by this authorClaudia Kesch, Claudia Kesch Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, FranceSearch for more papers by this authorGiorgio Calleris, Giorgio Calleris orcid.org/0000-0003-3831-1632 Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, FranceSearch for more papers by this authorBogdan Buhas, Bogdan Buhas Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, FranceSearch for more papers by this authorRawad Abou-Zahr, Rawad Abou-Zahr Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, FranceSearch for more papers by this authorRazvan-George Rahota, Razvan-George Rahota orcid.org/0000-0003-2875-2936 Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, FranceSearch for more papers by this authorAdil Ouzzane, Adil Ouzzane Urology Department, Institut d'Urologie Auxerre, Polyclinique Sainte Marguerite, Auxerres, France Urology Department, Centre International d Casablanca, Casablanca, MoroccoSearch for more papers by this authorBenjamin Pradère, Benjamin Pradère Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, FranceSearch for more papers by this authorChristophe Tollon, Christophe Tollon Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, FranceSearch for more papers by this authorAlberto Martini, Alberto Martini orcid.org/0000-0003-1272-7154 Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, FranceSearch for more papers by this authorGuillaume Ploussard, Corresponding Author Guillaume Ploussard [email protected] orcid.org/0000-0002-6004-2152 Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France Correspondence: Guillaume Ploussard, La Croix du Sud Hospital, 52, chemin de Ribaute, 31130 Quint Fonsegrives, France. e-mail: [email protected]Search for more papers by this author Alae Touzani, Alae Touzani orcid.org/0000-0003-3087-3518 Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France Urology Department, Centre International d Casablanca, Casablanca, Morocco Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MoroccoSearch for more papers by this authorDaniele D'Agate, Daniele D'Agate Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, FranceSearch for more papers by this authorClaudia Kesch, Claudia Kesch Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, FranceSearch for more papers by this authorGiorgio Calleris, Giorgio Calleris orcid.org/0000-0003-3831-1632 Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, FranceSearch for more papers by this authorBogdan Buhas, Bogdan Buhas Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, FranceSearch for more papers by this authorRawad Abou-Zahr, Rawad Abou-Zahr Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, FranceSearch for more papers by this authorRazvan-George Rahota, Razvan-George Rahota orcid.org/0000-0003-2875-2936 Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, FranceSearch for more papers by this authorAdil Ouzzane, Adil Ouzzane Urology Department, Institut d'Urologie Auxerre, Polyclinique Sainte Marguerite, Auxerres, France Urology Department, Centre International d Casablanca, Casablanca, MoroccoSearch for more papers by this authorBenjamin Pradère, Benjamin Pradère Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, FranceSearch for more papers by this authorChristophe Tollon, Christophe Tollon Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, FranceSearch for more papers by this authorAlberto Martini, Alberto Martini orcid.org/0000-0003-1272-7154 Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, FranceSearch for more papers by this authorGuillaume Ploussard, Corresponding Author Guillaume Ploussard [email protected] orcid.org/0000-0002-6004-2152 Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France Correspondence: Guillaume Ploussard, La Croix du Sud Hospital, 52, chemin de Ribaute, 31130 Quint Fonsegrives, France. e-mail: [email protected]Search for more papers by this author First published: 08 May 2024 https://doi.org/10.1111/bju.16391Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share 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Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Ploussard G. Robotic surgery in urology: facts and reality. What are the real advantages of robotic approaches for prostate cancer patients? Curr Opin Urol 2018; 28: 153–158 10.1097/MOU.0000000000000470 PubMedWeb of Science®Google Scholar 2Ploussard G, Almeras C, Beauval JB et al. Same-day discharge surgery for robot-assisted radical prostatectomy in the era of ERAS and prehabilitation pathways: a contemporary, comparative, feasibility study. World J Urol 2022; 40: 1359–1365 10.1007/s00345-020-03119-w PubMedGoogle Scholar 3Dobbs RW, Nguyen TT, Shahait M et al. Outpatient robot-assisted radical prostatectomy: are patients ready for same-day discharge? J Endourol 2020; 34: 450–455 10.1089/end.2019.0796 PubMedWeb of Science®Google Scholar 4Ploussard G, Loison G, Almeras C et al. One-day Prehabilitation program before robotic radical prostatectomy in daily practice: routine feasibility and benefits for patients and hospitals. Eur Urol Open Sci 2020; 21: 14–16 10.1016/j.euros.2020.06.009 PubMedGoogle Scholar 5Faria EF, Machado RD, Gualberto RJC et al. Patient's safety and satisfaction on same day discharge after robotic and laparoscopic radical prostatectomy versus discharge after 24 or 48 h: a longitudinal randomized prospective study. BMC Urol 2023; 23: 149 10.1186/s12894-023-01318-2 PubMedGoogle Scholar 6Ploussard G, Dumonceau O, Thomas L et al. Multi-institutional assessment of routine same day discharge surgery for robot-assisted radical prostatectomy. J Urol 2020; 204: 956–961 10.1097/JU.0000000000001129 PubMedWeb of Science®Google Scholar 7Uy M, Millan B, Jones C et al. Successful same-day discharge for robot-assisted radical prostatectomy: a systematic review and meta-analysis. Urol Pract 2022; 9: 294–305 10.1097/UPJ.0000000000000305 PubMedGoogle Scholar 8Abaza R, Murphy C, Bsatee A, Brown DH Jr, Martinez O. Single-port robotic surgery allows same-day discharge in majority of cases. Urology 2021; 148: 159–165 10.1016/j.urology.2020.08.092 PubMedGoogle Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Background: Targeted microwave ablation (TMA) is a novel modality of focal therapy to treat localized prostate cancer (PCa). We evaluated its short-term functional and oncologic outcomes. Method: We performed a single-center, prospective, interventional phase I-II pilot trial (NCT04627896). TMA was performed in 11 patients with a single intracapsular MRI-visible lesion <= 12 mm, International Society of Urological Pathology (ISUP) grade <= 2, Prostate Specific Antigen (PSA) < 20 ng/mL, and a 5-mm safety distance from apex and rectum. Patients were treated with a 12 W very low-loss microwaves ablation system, guided by 3D ultrasound/MRI fusion imaging. Follow-up consisted in clinical visits, PSA and validated questionnaires. MRI was scheduled at five months and rebiopsy at six months. The primary endpoints of study were safety and efficacy (absence of tumour in the treated area). Results: No severe complications were reported. All patients were discharged the same day of treatment without bladder catheter. No significant changes in PSA or questionnaires scores were reported. At rebiopsy, no cancer was found in five patients (45%); eight patients (73%) had an absence of in-field PCa and nine patients (82%) had an absence of in-field ISUP >= 2 PCa. New cancer foci outside the treated area were found in three patients (27%). Limitations of this study were the very limited sample size, the short follow-up, and the lack of a comparator. Conclusions: TMA guided by fusion imaging is a safe modality with good ablative efficacy. [GRAPHICS]

Background: Electronic health can help improve perioperative outcomes and overcome organizational constraints related to human resources and health care-related costs. In this initial report, we assess patient compliance with a digital platform including pre- and rehabilitation programs, checklists, electronic patient-reported outcomes (ePROs), and remote monitoring after surgery. Materials and Methods: Twenty-four patients undergoing major uro-oncological surgery were prospectively included and followed from the surgical decision time point to the 3-month follow-up visit by Betty.care app. The primary end-point was patient compliance with the digital tool materials, grouped into four domains: safety, education, ePRO collection, and remote monitoring. Results and Limitations: The mean age was 62 years. The mean hospital stay was 1.8 days (50% of outpatient surgeries). Four complications occurred (16.7%), including one emergency readmission. The compliance of patients for fulfilling or reading all safety, education, and ePRO questionnaires was 79.2%, 76.5%, and 86.2%, respectively. The activation of real-time notifications as predefined by Betty.care detected half of the complications. All the generated alerts were related to a confirmed postoperative grade 2 or 3 complication. The mean duration of daily remote monitoring was 18.5 days after discharge. Satisfaction with their perioperative pathway was scored 8.4 out of 10 by patients. Conclusions: In conclusion, the implementation of a mobile app that provides a holistic approach to the perioperative period, integrating prehabilitation, rehabilitation, ePRO collection, checklists, and remote monitoring is feasible in clinical practice with good patient compliance. These preliminary findings suggest that the Betty.care digital platform could improve outcomes, facilitate recovery, and secure at-home discharge.

You have accessJournal of UrologyCME1 Apr 2023V10-06 INTRAOPERATIVE USE OF PET/CT SPECIMEN IMAGER TO GUIDE ROBOTIC RADICAL PROSTATECTOMY AND PELVIC LYMPH NODE DISSECTION Marco Oderda, Serena Grimaldi, Giorgio Calleris, Daniele D'Agate, Federico Lavagno, Alessandro Marquis, Giancarlo Marra, Desireé Deandreis, and Paolo Gontero Marco OderdaMarco Oderda , Serena GrimaldiSerena Grimaldi , Giorgio CallerisGiorgio Calleris , Daniele D'AgateDaniele D'Agate , Federico LavagnoFederico Lavagno , Alessandro MarquisAlessandro Marquis , Giancarlo MarraGiancarlo Marra , Desireé DeandreisDesireé Deandreis , and Paolo GonteroPaolo Gontero View All Author Informationhttps://doi.org/10.1097/JU.0000000000003328.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Today, PSMA is the most accurate radiopharmaceutical in PCa and it can be used as a tracer to identify PCa foci in resected specimens. To do so, a small, high-resolution PET/CT-imaging device (XEOS AURA®) was developed, with near five-fold optimization in spatial resolution as opposed to the standard clinical PET/CT devices. Aim of this feasibility study was to test the intraoperative use of this brand-new PET/CT specimen imager to guide robot-assisted radical prostatectomy (RARP) and pelvic lymph node dissection (PLND). METHODS: To date, we performed three cases of RARP and PLND with intraoperative use of XEOS AURA® specimen imager. All patients underwent preoperative staging with MRI and PSMA PET/CT. Surgeries were performed with Da Vinci Xi robot. During trocar placement, an intravenous injection of 68-Ga PSMA, 2 mBq/kg, was performed. Lymph nodes were immediately removed through the 12-mm assistant trocar and inserted into the specimen imager for analysis. After complete excision, the prostate was removed through a short Pfannestiel incision while maintaining CO2 insufflation, and analysed with the specimen imager to check for positive margins (PSM) before doing the urethra-vesical anastomosis. RESULTS: On average, the time required by XEOS AURA® to analyse each specimen was 12 minutes (SD 3). Total and positive nodal yield were 17.3 (5.8) and 0.3 (0.5 SD), respectively. PET/CT specimen imager showed a marked uptake for the only positive node retrieved, and a diffuse, weak uptake in several negative nodes. There was a good correspondence between marked uptake and node positivity, reflecting also preoperative PET/CT findings (Table 1). XEOS AURA® was useful to predict negative surgical margins, although in one locally advanced case this evaluation was uncertain. CONCLUSIONS: The use of PET/CT specimen imager is safe and feasible. The intraoperative knowledge of prostate cancer (PCa) location within lymph nodes or inside the prostate is essential to improve the oncological radicality of the procedure while safely pushing the boundaries of a hyper-conservative surgery. Source of Funding: University of Turin © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e927 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Metrics Author Information Marco Oderda More articles by this author Serena Grimaldi More articles by this author Giorgio Calleris More articles by this author Daniele D'Agate More articles by this author Federico Lavagno More articles by this author Alessandro Marquis More articles by this author Giancarlo Marra More articles by this author Desireé Deandreis More articles by this author Paolo Gontero More articles by this author Expand All Advertisement PDF downloadLoading ...

INTRODUCTION:The aim of this feasibility study was to test the intraoperative use of this brand-new specimen PET/CT to guide robot-assisted radical prostatectomy and pelvic lymph node dissection. MATERIALS AND METHODS:Three cases of robot-assisted radical prostatectomy and pelvic lymph node dissection were performed with intraoperative use of the specimen imager. Surgeries were performed with Da Vinci Xi robot. An intravenous injection of 68Ga-PSMA-11 was performed in the OR and after complete excision, the specimens were analyzed with the imager. RESULTS:The average nodal yield was 17.3 (5.8 SD) nodes per patient. Specimen PET/CT images showed a focal uptake in a metastatic node (TBR 13.6), and no uptake or diffuse, faint uptake in negative nodes (TBR range: 1-5.3). The specimen imager provided intraoperative PET/CT images that clearly showed negative surgical margins in two patients, whereas the results were uncertain in a locally advanced case. CONCLUSION:The intraoperative use of the specimen PET/CT imager is safe and feasible and could improve the evaluation of prostate surgical margins and lymph node status.

INTRODUCTION:When performing a nerve-sparing (NS) robotic radical prostatectomy (RARP), cancer location based on multiparametric MRI (mpMRI) is essential, as well as the location of positive biopsy cores outside mpMRI targets. The aim of this pilot study was to assess the feasibility of intraoperative 3D-TRUS-mpMRI elastic fusion imaging to guide RARP and to evaluate its impact on the surgical strategy.METHODS:We prospectively enrolled 11 patients with organ-confined mpMRI-visible prostate cancer (PCa), histologically confirmed at transperineal fusion biopsy using Koelis Trinity. Before surgery, the 3D model of the prostate generated at biopsy was updated, showing both mpMRI lesions and positive biopsy cores, and was displayed on the Da Vinci robotic console using TilePro™ function.RESULTS:Intraoperative 3D modeling was feasible in all patients (median of 6 min). The use of 3D models led to a major change in surgical strategy in six cases (54%), allowing bilateral instead of monolateral NS, or monolateral NS instead of non-NS, to be performed. At pathologic examination, no positive surgical margins (PSMs) were reported. Bilateral PCa presence was detected in one (9%), four (36%), and nine (81%) patients after mpMRI, biopsy, and RARP, respectively. Extracapsular extension was found in two patients (18%) even if it was not suspected at MRI.CONCLUSIONS:Intraoperative 3D-TRUS-mpMRI modeling with Koelis Trinity is feasible and reliable, helping the surgeon to maximize functional outcomes without increasing the risk of positive surgical margins. The location of positive biopsy cores must be registered in 3D models, given the rates of bilateral involvement not seen at mpMRI.

You have accessJournal of UrologyCME1 Apr 2023V03-11 LAPAROSCOPIC NEPHRECTOMY FOR POLYCYSTIC KIDNEY: A VIDEO-ILLUSTRATED CASE SERIES OF TRANSPERITONEAL AND RETROPERITONEAL APPROACHES Daniele D'Agate, Giorgio Calleris, Marco Allasia, Marco Oderda, Alessandro Marquis, Giancarlo Marra, Federico Vitiello, Federico Lavagno, Matteo de Bellis, Gabriele Montefusco, Francesco Bracco, and Paolo Gontero Daniele D'AgateDaniele D'Agate More articles by this author , Giorgio CallerisGiorgio Calleris More articles by this author , Marco AllasiaMarco Allasia More articles by this author , Marco OderdaMarco Oderda More articles by this author , Alessandro MarquisAlessandro Marquis More articles by this author , Giancarlo MarraGiancarlo Marra More articles by this author , Federico VitielloFederico Vitiello More articles by this author , Federico LavagnoFederico Lavagno More articles by this author , Matteo de BellisMatteo de Bellis More articles by this author , Gabriele MontefuscoGabriele Montefusco More articles by this author , Francesco BraccoFrancesco Bracco More articles by this author , and Paolo GonteroPaolo Gontero More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003241.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Both transperitoneal (TP) and retroperitoneal (RP) laparoscopic nephrectomies (NT) have been described for autosomal dominant polycystic kidney disease (APKD), and no conclusive evidence exists about the best approach. We present in this video the step-by-step procedure for both techniques. Perioperative data of a single-institutional case-series are reported. METHODS: A retrospective review of the NTs in APKD patients in between June 2020 and April 2022 was conducted. The TP approach requires the positioning of three 12-mm ports and one 5-mm ports, the mobilisation of the colon, the incision of Gerota’s fascia and the development of the psoas plane to identify the renal pedicle. Renal vessels and ureter are clipped by Hem-o-lok ® and divided. The RP approach usually requires the positioning of a first 12-mm trocar at the apex of the XII rib; the RP space is developed using a dedicated balloon; two more 12-mm trocars are placed at the posterior axillary line and in the iliac fossa. The psoas plane allows an early access to the renal pedicle; the renal vessels and the ureter are ligated by Hem-o-lok ® and divided. In both approaches, the puncture and the suction of the major cysts is frequent during dissection; adrenal-sparing approach was feasible in all cases; a modified Gibson incision is made for kidney extraction. RESULTS: Six consecutive patients were enrolled, 3 of whom were treated by TP and 3 by RP-NT. Two patients were on haemodialysis and 2 had already undergone a renal transplantation. Mean age was 49 and 57 years, maximum kidney diameter was 28.25 and 30 cm and mean operative time was 171 and 210 min, respectively for RP and TP. No conversion to open surgery was made. The reason for NT was represented by symptomatic polycystic kidney in 5 cases; surgery was required solely in preparation to kidney transplantation in 1 TP case. No Clavien 3 grade complications or greater were recorded; postoperative sepsis occurred in 2 TP patients, haematoma in 1 TP and 1 RP cases, blood transfusions were required in 2 TP and 1 RP cases, 1 RP patient experienced a deep venous thrombosis. The hospitalization time ranged from 5 to 31 days. No significant worsening of the renal function was observed at discharge. CONCLUSIONS: At present, the scarce existing data do not suggest the superiority of an approach over the other one. Both RP and TP approaches for nephrectomy of polycystic kidneys are feasible in experienced hands and the choice must be tailored on patient characteristics and surgeon’s preference. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e249 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniele D'Agate More articles by this author Giorgio Calleris More articles by this author Marco Allasia More articles by this author Marco Oderda More articles by this author Alessandro Marquis More articles by this author Giancarlo Marra More articles by this author Federico Vitiello More articles by this author Federico Lavagno More articles by this author Matteo de Bellis More articles by this author Gabriele Montefusco More articles by this author Francesco Bracco More articles by this author Paolo Gontero More articles by this author Expand All Advertisement PDF downloadLoading ...

Background: PSA density and an elevated PI-RADS score are among the strongest predictors of prostate cancer (PCa) in a fusion biopsy. Positive family history, hypertension, diabetes, and obesity have also been associated with the risk of developing PCa. We aim to identify predictors of the prostate cancer detection rate (CDR) in a series of patients undergoing a fusion biopsy. Methods: We retrospectively evaluated 736 consecutive patients who underwent an elastic fusion biopsy from 2020 to 2022. Targeted biopsies (2–4 cores per MRI target) were followed by systematic mapping (10–12 cores). Clinically significant PCa (csPCa) was defined as ISUP score ≥ 2. Uni- and multi-variable logistic regression analyses were performed to identify predictors of CDR among age, body mass index (BMI), hypertension, diabetes, positive family history, PSA, a positive digital rectal examination (DRE), PSA density ≥ 0.15, previous negative biopsy status, PI-RADS score, and size of MRI lesion. Results: The median patients’ age was 71 years, and median PSA was 6.6 ng/mL. A total of 20% of patients had a positive digital rectal examination. Suspicious lesions in mpMRI were scored as 3, 4, and 5 in 14.9%, 55.0%, and 17.5% of cases, respectively. The CDR was 63.2% for all cancers and 58.7% for csPCa. Only age (OR 1.04, p < 0.001), a positive DRE (OR 1.75, p = 0.04), PSA density (OR 2.68, p < 0.001), and elevated PI-RADS score (OR 4.02, p = 0.003) were significant predictors of the CDR in the multivariable analysis for overall PCa. The same associations were found for csPCa. The size of an MRI lesion was associated with the CDR only in uni-variable analysis (OR 1.07, p < 0.001). BMI, hypertension, diabetes, and a positive family history were not predictors of PCa. Conclusions: In a series of patients selected for a fusion biopsy, positive family history, hypertension, diabetes, or BMI are not predictors of PCa detection. PSA-density and PI-RADS score are confirmed to be strong predictors of the CDR.

Salvage radical prostatectomy after primary radiotherapy (sRP) is considered a challenging procedure. We highlight the complications of sRP and detail critical surgical steps to help prevent them. A nonsystematic literature review in PubMed using the term "salvage radical prostatectomy" was performed on December 1,2021. Salvage robot-assisted RP (sRARP) cases and imaging materials were used to create an educational video providing practical examples. Owing to radiation-induced changes in the prostate and surrounding tissues after radiotherapy, sRP is typically more challenging than primary RP. Among its critical steps are incision of the endopelvic fascia, bladder neck dissection with attempts at sparing the neck, development of posterior planes between the prostate and rectum, and dissection of the prostatic apex. Complication rates are significant, in particular for bladder neck contracture (0-16%) and anastomotic leakage (10-33%). Rectal injury is now rare (<2%) but still feared; careful adherence to surgical principles is required to avoid this complication. Functional outcomes are nonoptimal, with a high risk of urinary incontinence (severe incontinence in similar to 25% of men). sRARP is a challenging urological procedure and should be performed by experienced surgeons. Thorough knowledge of the surgical anatomy and a meticulous technique for the most difficult surgical steps are crucial to minimise complications and to improve patient outcomes. Patient summary: In patients with prostate cancer, removal of the prostate because of cancer recurrence after primary treatment with radiotherapy can be difficult because of radiation-induced tissue damage. This challenging procedure should be performed by experienced surgeons to minimise the risk of complications. (C) 2022 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology.

Background:Focal therapy has emerged as an interesting option for localized low- to intermediate-risk prostate cancer (PCa). Targeted microwave ablation (TMA) is a novel FT modality involving targeted delivery of microwave energy under multiparametric magnetic resonance imaging (MRI)/ultrasound guidance. Objective:To describe the step-by-step procedure for TMA and report early functional outcomes. Design setting and participants:This was an experimental phase 1-2 trial in 11 patients diagnosed with a single, MRI-visible PCa lesion of up to 12 mm, scored as International Society of Urological Pathology grade group (GG) 1 or 2. Surgical procedure:Transperineal TMA under MRI/ultrasound image fusion guidance. Measurements:We recorded patient and PCa features; intraoperative and postoperative parameters; pain (Visual Analog Scale [VAS]) and adverse events (Common Terminology Criteria for Adverse Events v5.0); and prostate-specific antigen (PSA), International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5) scores at 1 wk and 1, 3, and 6 mo. Results and limitations:The median patient age was 67 yr (interquartile range [IQR] 18). Median PSA was 5.4 ng/ml (IQR 1.8), median prostate volume was 51 cm3 (IQR 35), and median lesion size on MRI was 10 mm (IQR 4). Ten patients had GG 2 PCa and one had GG 1 disease. The median procedure time was 40 min (IQR 30). No intraoperative complications were reported. All treatments were performed on a day-case basis and no patients were discharged with a urinary catheter. Postoperatively, no grade ≥2 complications were reported. No significant changes in PSA (p = 0.46), IPSS (p = 0.39), or IIEF-5 scores (p = 0.18) scores were reported. The postoperative VAS score at 24 h was 0 for all patients. Conclusions:TMA is safe, feasible, and well tolerated in patients with low- to intermediate-risk PCa. Oncological outcomes are still awaited. Patient summary:Targeted microwave therapy is safe and feasible for selected patients with low- to intermediate-risk prostate cancer. The procedure is well tolerated and does not require a urinary catheter after the procedure. Cancer control outcomes are still awaited.

Background:Most prostate cancer (PCa) recurrences after nonsurgical first-line treatment are managed with androgen deprivation therapy (ADT). When local treatment is indicated, salvage focal treatment (FT) may achieve outcomes similar to those after salvage radical prostatectomy (sRP), with lower morbidity. However, descriptions of the topography of PCa recurrence are scarce. Objective:To describe the characteristics and topography of recurrent PCa at sRP. Design setting and participants:We performed a review of the final pathology for consecutive men undergoing sRP at a single centre between 2007 and 2021. Outcome measurements and statistical analysis:Clinical and pathological outcomes and recurrence localisation (standardised map) were recorded. Suitability for salvage FT was evaluated using criteria defined a priori. Results and limitations:We included 41 men who underwent sRP after whole-gland treatment (82.9% primary radiotherapy). Of these, 68.3% had grade group ≥3 and 46.3% had pT3 disease, including nine men (22%) with seminal vesicle involvement >1 cm. The pN+ rate was 29.3%. Surgical margins were positive in 39% (mostly at the apex, 21.9%). PCa was located at <3 mm from the apex in 68% of cases. The segment most frequently involved was the mid-gland (93%). The median prostate and index lesion (IL) volume was 31.4 cm3 (interquartile range [IQR] 23-37) and 2 cm3 (IQR 0.5-6), respectively. A solitary IL was present in 63.4% of cases, while 7.3% had whole-gland PCa involvement. Overall, 56% of the men (n = 23) were deemed suitable for salvage FT (although seven had pN+ disease). The sample size, single-centre retrospective design, and unavailability of magnetic resonance imaging data are the main limitations. Conclusions:According to sRP pathology, radiorecurrent PCa is an aggressive disease, frequently showing extraprostatic extension, positive margins, and apical involvement. The majority of cases still harbour a solitary index lesion and a consistent proportion may be suitable for a gland-preserving strategy. Patient summary:In this report we looked at the location of prostate cancer recurrence within the prostate gland after radiotherapy or ablation, in which energy (such as heat, cold, or laser energy) is used to kill cells. We found that although these recurrences are often high-grade locally advanced disease, around half of cases might be suitable for a gland-preserving salvage treatment.

Introduction:Currently, the majority of prostate cancer (PCa) recurrences after non-surgical first-line treatment are managed with androgen-deprivation therapy (ADT). Salvage radical prostatectomy (sRP) is a curative alternative to ADT but yields significant morbidity. Preliminary evidence from focal salvage treatments shows similar oncological control but lower morbidity compared to sRP. Among available ablative focal energies, irreversible electroporation (IRE) is a treatment modality that proved promising, especially in treating apical lesions, where PCa most often recurs. Our aim is to test the safety of salvage IRE for recurrent PCa. Methods:We performed a single-arm pilot feasibility study (IDEAL stage 2a): SAFE, SAlvage Focal irreversible Electroporation for recurrent localized PCa. Twenty patients with biopsy-proven PCa recurrence after primary non-surgical (radiation or ablation) treatment were included. All men will undergo mpMRI ± targeted biopsies, pre-operative PSMA-PET staging before inclusion and sIRE. Outcomes will be evaluated through internationally validated questionnaires and morbidity scales. All men will undergo a control biopsy at one year. Results:Primary objectives were the evaluation of the safety of sIRE (and patients' quality of life) after treatment. Secondary objectives were the evaluation of functional outcomes, namely, continence and erectile function changes and evaluation of short-term oncological efficacy. Conclusions:SAFE is the second pilot study to evaluate sIRE and the first one performed according to the most recent diagnostic and staging imaging standards. sIRE may provide a curative option for recurrent PCa together with lower comorbidities compared to sRP.

You have accessJournal of UrologyProstate Cancer: Detection & Screening II (MP20)1 Apr 2020MP20-04 FEASIBILITY AND ACCURACY OF TRANSPERINEAL FREE-HAND MPMRI TARGETED PROSTATE BIOPSIES UNDER LOCAL ANESTHESIA: A MULTICENTER PROSPECTIVE COHORT OF 1,014 PATIENTS Giancarlo Marra*, Junlong Zhuang, Mattia Beltrami, Giorgio Calleris, Xiaozhi Zhao, Alessandro Marquis, Yansheng Kan, Marco Oderda, Haifeng Huang, Riccardo Faletti, Qing Zhang, Luca Molinaro, Wei Wang, Laura Bergamasco, Stefano Tappero, Daniele D'Agate, Hongquian Guo, and Paolo Gontero Giancarlo Marra*Giancarlo Marra* More articles by this author , Junlong ZhuangJunlong Zhuang More articles by this author , Mattia BeltramiMattia Beltrami More articles by this author , Giorgio CallerisGiorgio Calleris More articles by this author , Xiaozhi ZhaoXiaozhi Zhao More articles by this author , Alessandro MarquisAlessandro Marquis More articles by this author , Yansheng KanYansheng Kan More articles by this author , Marco OderdaMarco Oderda More articles by this author , Haifeng HuangHaifeng Huang More articles by this author , Riccardo FalettiRiccardo Faletti More articles by this author , Qing ZhangQing Zhang More articles by this author , Luca MolinaroLuca Molinaro More articles by this author , Wei WangWei Wang More articles by this author , Laura BergamascoLaura Bergamasco More articles by this author , Stefano TapperoStefano Tappero More articles by this author , Daniele D'AgateDaniele D'Agate More articles by this author , Hongquian GuoHongquian Guo More articles by this author , and Paolo GonteroPaolo Gontero More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000853.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: No large, multi-centre prospective cohort assessing the detection rate, the tolerability and the complications of mpMRI targeted fusion transperineal biopsy (TPFBx) under local anesthesia (LA) has been published. Pros and cons of transperineal and transrectal routes for prostate Bx are still up for debate. METHODS: At two tertiary referral institutions, we prospectively screened for inclusion 1,327 men with a positive mpMRI undergoing TPFBx under LA, from Sep2016 to May2019. Patients with known PCa, >80 y and/or a PSA >20 ng/ml were excluded. Both targeted and systematic sampling was always performed. Two definitions of clinically significant prostate cancer (CSPCa) were employed (D1: START criteria; D2: ISUP score >6). Peri-procedural pain (NRS), timings, erectile (IIEF-5) and urinary (IPSS) function and complications were registered. We also evaluated PCa predictors. RESULTS: We included 1014 patients (aged 66.8 ±7.4 and with a PSA of 8.1 ±4.1ng/mL), presenting a total of 1424 mpMRI lesions. Four-hundred CSPCa (39.4%) and 45 nCSPCa (4.4%) according to D1 were diagnosed; Pirads 3, 4 and 5 corresponded to 15.4%, 46.2% and 73.9% CSPCa rate, respectively. Procedure-associated pain was acceptable (NRS 3.1 ±2.3); total biopsy duration was 15.9 ±4.9 mins. No differences in pre- and post-biopsy erectile or urinary function were observed (p=0.45 and p=0.58), respectively. We registered low complications rates (Clavien 2 n=1, Clavien >2 n=0) and no single post-biopsy sepsis. Age, PSAd, DRE and Pirads were predictors of CSPCa diagnosis, while Asiatic race and previous biopsies were negatively associated with detection, in multivariable analysis (D1 and D2). Target zone (anterior and/or apical) was not associated with detection. CONCLUSIONS: TPFBx performed under LA entail high CSPCa detection, good patient tolerability and short procedural time in an outpatient setting. Serious complications and infections seem to be very rare. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e308-e308 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giancarlo Marra* More articles by this author Junlong Zhuang More articles by this author Mattia Beltrami More articles by this author Giorgio Calleris More articles by this author Xiaozhi Zhao More articles by this author Alessandro Marquis More articles by this author Yansheng Kan More articles by this author Marco Oderda More articles by this author Haifeng Huang More articles by this author Riccardo Faletti More articles by this author Qing Zhang More articles by this author Luca Molinaro More articles by this author Wei Wang More articles by this author Laura Bergamasco More articles by this author Stefano Tappero More articles by this author Daniele D'Agate More articles by this author Hongquian Guo More articles by this author Paolo Gontero More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE:To evaluate the feasibility of "in-office" TPFBx under local anesthesia (LA).MATERIALS AND METHODS:We prospectively screened for eligibility data of 724 consecutive men undergoing either TPFBx (target and systematic cores) or TPSBx (systematic cores only) from September 2016 to June 2018 due to suspicion of prostate cancer (CaP), according to predefined exclusion criteria.RESULTS:We included 459 men (TPFBx n = 279 including n = 338 mpMRI lesions, Pi-RADS 4 in 63.6%; TPSBx n = 180). Median procedural time and maximum pain were 19 minutes and 5 numeric rating scale (NRS) points; pain was highest at the time of LA. Only 1 major complication occurred (Clavien 3a). Hematuria and hematospermia were frequent (72.6% and 54.2%). Vaso-vagal reactions and AUR were rare (0.7% and 0.4%). No cases of UTI and 1 case of fever were recorded. No significant changes in erectile and urinary functions were noted from baseline compared to 40 days after TPFBx (P = .86 and P = .89). In comparison with TPSBx the sole differences were pain during prostatic sampling (P = .03), duration of hematospermia (P <.0001) and procedural time (P <.001) all higher for TPFBx. Clinically significant (cs) CaP was detected in n = 150 (53.8%) patients in the TPFBx group (34.9%, 51.7%, and 75% of Pirads 3, 4, and 5, respectively). Addition of systematic cores detected n = 25 csCaP that were missed by targeted cores (17.4% of all csCaP).CONCLUSION:TPFBx under LA are feasible, yielding high tolerability, low complications, no impact on erectile and urinary function and good csCaP detection. Addition of systematic to targeted cores remains recommended. Further studies are needed to confirm our findings.