Urinary microRNAs (miRNAs) are promising noninvasive biomarkers for cancer detection, but their clinical utility is reduced by inconsistent normalization strategies, reducing reproducibility and comparability across studies. In this study, we assessed the stability of miR-20a as an endogenous normalizer for urinary miRNA profiling in clear cell renal cell carcinoma (ccRCC) while standardizing the pre-analytical phase using a urine stabilizing solution. Ninety-nine urine samples were analyzed: 47 from healthy individuals, 30 from ccRCC patients pre-surgery, and 22 post-operative patients. Six candidate miRNAs-miR-20a, miR-15b, miR-16, miR-15a, miR-210-3p, and miR-let-7b-were quantified via RT-qPCR. Stability analysis with RefFinder, integrating multiple algorithms (geNorm, normFinder, BestKeeper, and ΔCt methods), identified miR-20a as the most stable among the six candidates. Raw Ct values of miR-20a were normally distributed (Shapiro-Wilk test, p > 0.05), with no significant intergroup differences (one-way ANOVA, F(2.96) = 2.324, p = 0.103) and minimal intragroup variability (CV% 4.98-6.38). MiR-20a expression remained stable across different tumor staging, grading, and urine storage durations. These findings confirm miR-20a as a robust endogenous normalizer for urinary miRNA analyses and support the feasibility of developing reproducible urinary liquid biopsy workflows for ccRCC, even in settings where immediate sample processing is not feasible.

BACKGROUND:Clear cell renal cell carcinoma (ccRCC) is the most prevalent kidney cancer subtype and, in most cases, it is incidentally diagnosed, as early-stage disease is often asymptomatic. Therefore, the identification of stable, noninvasive biomarkers is a major unmet clinical need. Urinary microRNAs (miRNAs) have emerged as promising candidates since they are extraordinarily stable in urine and show a close relationship with tumour biology. METHODS:In this study, urinary expression levels of five miRNAs (miR-15a, miR-15b, miR-16, miR-210, and miR-let-7b) were analysed in RCC patients before surgery, 5 days after, and one month after surgery, and compared to healthy controls. RESULTS:Non-parametric analyses revealed significant postoperative decreases for miR-15a (p = 0.002), miR-16 (p = 0.025), miR-210 (p = 0.030), and in the overall miRNA Sum (p = 0.002), suggesting that these miRNAs are directly linked to tumour presence. In the comparison between preoperative and one-month postoperative samples, miR-let-7b (p = 0.049) and the global miRNA Sum (p = 0.037) remained significantly reduced after intervention, indicating a partial normalisation of urinary miRNA profiles. Correlation analyses demonstrated positive associations between specific miRNAs and clinical parameters such as age, ischemia time, and surgical time, reinforcing their potential relevance to tumour biology and treatment response. CONCLUSIONS:These findings support urinary miRNAs as promising, minimally invasive biomarkers for ccRCC diagnosis and postoperative monitoring.

Renal surgery for localized renal cell carcinoma carries substantial risk of acute kidney injury (AKI) regardless of surgical approach. This prospective study evaluated early biohumoral markers for AKI detection after robotic renal surgery and assessed their prognostic value for 12-month functional outcomes. Adults undergoing robotic renal tumor surgery with a healthy contralateral kidney were enrolled; AKI followed KDIGO 2012 criteria. Biomarkers measured at baseline and 2/24/72 h were serum β2-microglobulin (sβ2) serum IL-6, as well as urinary β2-microglobulin (uβ2), cystatin C (uC), and α2-macroglobulin (uα2M). Kidney function at 12 months was staged according to KDOQI criteria. Among 170 patients (35 radical nephrectomy, RN; 135 partial nephrectomy, PN), 33 developed AKI, more frequently after RN (p < 0.001); baseline biomarkers levels were similar. sβ2 was significantly higher at 2/24/72 h, and at 2 h, it achieved an AUC of 0.78 (cut-off 0.17: sensitivity 82%, specificity 60%), remaining the earliest independent predictor of AKI (p = 0.015). IL-6 differed at 24 h (AUC 0.80), uC at 72 h (AUC 0.73) and uβ2 at 72 h (AUC 0.66). Clinical AKI predicted KDOQI stage progression at 12 months (p < 0.001). Bulldog clamps (mean ischemia time 17.2 ± 6.9 min) were not associated with AKI (p = 0.99) or with KDOQI stage progression (p = 0.54). RN confers a higher AKI risk than PN. sβ2 at 2 h is the earliest actionable marker, complemented by IL-6 (24 h) and uC (72 h); short warm ischemia during robotic PN appears safe. Sequential multimarker assessment may improve recognition of AKI and support timely nephroprotective strategies.

Traditionally, in extraperitoneal robot-assisted radical prostatectomy (EP-RARP), a pneumo-Retzius is obtained by using a CO2 insufflation pressure of 12–15 mmHg. However, EP surgery is associated with an increase in CO2 absorption and consequent hypercapnia and acidosis. This study aimed to compare the effect of low CO2 pressure (8 mmHg) with the conventional gas pressure in EP-RARP. We enrolled patients with low-risk prostate cancer who had undergone total nerve-sparing RARP using our PERUSIA (Posterior, Extraperitoneal, Robotic, Under Santorini, Intrafascial, Anterograde) technique. The exclusion criteria were the presence of chronic lung disease, a positive biopsy core from the anterior zone, or a shift to a transperitoneal approach. Cardiopulmonary parameters were measured at the induction of anesthesia (T0); at 5 (T1) and 60 (T2) minutes after starting CO₂ insufflation; and immediately after dorsal venous complex dissection before urethro-vesical anastomosis (T3). Data from 120 consecutive patients were retrospectively analyzed from a prospectively maintained database. Patients were divided into two groups based on the CO2 insufflation pressure (8 vs. 12 mmHg). No significant differences were detected in mean operative time, time required for trocar positioning, mean estimated blood loss, or complications between the two groups. The only significant difference was in the partial pressure of carbon dioxide, which was higher at T3 in Group 2 (p=0.005), with a consequent reduction in arterial pH. However, no significant difference (p = 0.44) was found regarding acidosis between the two groups at all timepoints. RARP has become a standard procedure in urological surgery for the treatment of localized prostate cancer. However, the CO2 insufflation required to create a surgical workspace may lead to cardiopulmonary complications, especially in patients with pre-existing respiratory conditions. This study compared the effects of a lower insufflation pressure (8 mmHg) vs. the standard pressure (12 mmHg) during EP-RARP. The findings suggest that using a low and constant pressure can reduce CO2 absorption into the bloodstream without increasing intraoperative or postoperative complications. This approach may expand eligibility for EP-RARP to include patients with chronic pulmonary diseases by enhancing the safety and tolerability of the procedure.

BACKGROUND:Minimally invasive surgical treatments (MISTs) for benign prostatic hyperplasia (BPH) are increasingly adopted due to fewer complications and better preservation of ejaculatory function. However, real-world data on patient selection and clinical application in Italy remain scarce. METHODS:Patients undergoing Aquablation, Rezum, iTIND, TPLA, or PUL from October 2022 to December 2024 were prospectively enrolled by 15 Italian centers in the SIU Research Network. Baseline clinical, anatomical, and functional data were collected via a secure digital platform. Data were recorded using standardized electronic case report forms, and patient-reported outcomes were gathered through validated questionnaires administered at baseline and during follow-up. RESULTS:A total of 312 patients were enrolled: 30 (9.6%) Aquablation, 97 (31.1%) Rezum, 49 (15.7%) iTIND, 108 (34.6%) TPLA, and 28 (9.0%) PUL. iTIND patients were the youngest (median age 47, IQR 42-57), had the lowest prostate volume (30 mL, IQR 27.5-40), lowest comorbidity scores, and poorest Qmax (6.2 mL/s, IQR 5-8). Aquablation and TPLA were adopted for larger prostates (70 mL, IQR 50-80 and 67 mL, IQR 45-85, respectively). Median lobe was most frequent in Rezum (56.7%) patients. PUL patients had the lowest post-void residual (20 mL, IQR 5-60). Rezum and TPLA patients reported better ejaculatory function (P<0.02), while iTIND patients showed the highest dysfunction (P<0.05). Baseline QoL scores were comparable across groups. CONCLUSIONS:This interim analysis shows that MIST adoption in Italy is influenced by prostate size, age, comorbidities, and functional profiles. The findings describe baseline selection patterns only, with postoperative outcomes to be reported in future analyses.

Colovesical fistulas (CVFs) are abnormal connections between the colon and bladder, most commonly associated with complicated diverticular disease. The standard treatment involves bowel resection to remove the fistulous tract and reduce the risk of recurrence. This study aimed to evaluate the feasibility and safety of laparoscopic and robotic conservative surgery for CVFs, avoiding bowel resection. Between 2012 and 2019, 12 consecutive patients underwent conservative treatment: 5 with a laparoscopic approach and 7 with a robotic approach. Perioperative outcomes showed shorter operative time and lower blood loss in the robotic group (101 min vs. 144 min, p = 0.02; 47 mL vs. 176 mL, p = 0.02). No surgical conversions were required, and the complication rate was low. One recurrence occurred in the laparoscopic group due to extensive diverticular disease. Short- and long-term outcomes demonstrated favorable functional results, with a reduced risk of complications compared to traditional bowel resection. The robotic technique provided advantages in operative time and blood loss. A conservative approach is an option for selected patients, particularly those with non-extensive diverticular disease.

Background and Objective. The significance of microRNAs (miRNAs) in relation to neoplastic diseases; such as renal carcinoma carcinoma (RCC); has been brought to light by recent studies. Analyzing the main urinary miRNAs implicated in RCC and their potential diagnostic use was the goal of this systematic review of the literature. Methods. This systematic review was performed following the PROSPERO protocol CRD42024550716. Our literature search strategies were deciding which database to include (Pubmed; EMBASE and Clinicaltrial.gov) and composing strings with words related to urinary miRNA in patients with RCC. Key findings and limitations. After screening; 10 papers were included from the 593 records that the systematic review found. No miRNA was investigated in more than one paper by different authors. The miR-210 and let-7 family were the most investigated and resulted upregulated in RCC cases compared to controls. Five papers reported different expression of miRNAs in urine samples before and after surgery: miR-15a; miR-34a-5p; miR-200a-3p; miR-205-5p; miR-210; miR-210-3p; miR-365a-3p and let-7d-5p levels decreased after nephrectomy. Meta-analysis was not performed since the included studies were heterogeneous; in terms of studied miRNA; of the normalizer used during stabilization phase; and histologic type of RCC (clear cell RCC; papillary RCC; unspecified RCC). Conclusions. Considering the variability and heterogeneity of the obtained results; as well as the vastness of the topic; expanding research in this field appears highly promising. To support further advancements; it would be useful to establish a database that consolidates international findings.

Background: In recent years, research has highlighted the importance of microRNAs (miRNAs) in the context of oncological diseases, including renal cell carcinoma (RCC). The aim of this systematic review of the literature was to analyze the main serum miRNAs involved in RCC and their potential diagnostic power. Methods: This systematic review was performed following the PROSPERO protocol CRD42024550709. Literature search strategies were developed composing strings with text words related to serum miRNA in RCC for PubMed, EMBASE and Clinicaltrial.gov. The studies enrolling adult populations with RCC and healthy controls measuring circulating miRNAs were included. Results: We found 500 records, and 26 papers were included after screening. Four studies found that miR-210, the most investigated miRNA, was overexpressed in RCC patients compared to controls, while one reported no statistical difference. The expression of some miRNAs was consistently lower in cases compared to healthy controls, such as miR-1-3p and miR-129-5p, while others (miR-221, miR-222, miR-224-5p and miR-1233) were consistently upregulated. Conclusions: Circulating miRNAs represent a promising avenue for the non-invasive diagnosis of RCC. Future research should focus on standardization, validation in larger cohorts and the development of multi-marker diagnostic panels to address these current limitations and pave the way for miRNA-based diagnostics in RCC.

Background: Sclerosing perivascular epithelioid cell tumors (PEComas) are rare mesenchymal neoplasms, typically benign but occasionally exhibiting aggressive behavior. This study reports a case of sclerosing PEComa of the adrenal gland that was treated with robotic partial adrenalectomy, with 13 years of follow-up and a review of the literature. Methods: A 48-year-old woman presented with abdominal pain. Imaging revealed a 10 × 9 cm adrenal mass displacing adjacent structures. MRI and 18F-FDG PET-CT suggested angiomyolipoma. Robotic partial adrenalectomy was performed. Intraoperative frozen section analysis identified the mass as angiomyolipoma, while final histopathology confirmed it as a sclerosing PEComa. Results: This case highlights the advantages of robotic surgery in the management of large adrenal tumors, allowing complete tumor removal while preserving functional adrenal tissue. The extended 13-year follow-up is significant, given the potential for recurrence or malignant transformation reported in other cases. A literature review identified 39 reported cases of sclerosing PEComas, with few documenting long-term outcomes. Conclusions: This is a documented case of robotic partial adrenalectomy for sclerosing PEComa. The findings support robotic surgery as a safe effective approach for managing this rare tumor, with excellent functional and oncological results. Extended follow-up reinforces the tumor’s benign behavior and the importance of long-term monitoring in PEComas.

BACKGROUND: Radical cystectomy (RC) shows an important impact on quality of life (QoL), for various clinical aspects. The aim of our study was to evaluate the short-term bowel function in patients that underwent RC.METHODS: Two hundred and six patients with MIBC underwent RC with ONB or IC urinary diversion. QoL was measured using the EORTC QLQ C30 and the Short-Form SF-36 questionnaires before surgery and at 12 months postoperatively. Baseline characteristics, including demographic profile, BMI, Charlson Comorbidity Index (CCI), modified Frailty Index (m-FI), pathological tumor stage, Clavien-Dindo grade, and neo-adjuvant chemotherapy were recorded and compared.RESULTS: The uni-variate and multivariate analysis (OR) were performed for constipation, diarrhea and m-FI of patients underwent RC for localized MIBC according to global health status score (poor/good vs very good). Multivariate analysis showed that constipation medium/high was significant associated with global health status poor/good (OR=2.39; 95% CI: 1.22-4.71; P=0.01); Diarrhea medium/high was associated with global health status poor/good (OR=2.85; 95% CI:1.18-6.92; P=0.02), and m-FI ≥2 score (OR=2.13; 95% CI: 0.99-4.57; P=0.05).CONCLUSIONS: Diarrhea and constipation are associated with a lower QoL in cystectomized patients, both with ONB or IC urinary diversion; such association is especially significant in more fragile patients (Frailty Index ≥2).

Objective: Fournier's gangrene (FG) is a rare, life-threatening necrotizing fasciitis primarily affecting the perineal, genital, and perianal regions. This rapidly progressing bacterial infection predominantly affects middleaged and elderly men. This multicenter study aims to describe the management in a wide cohort of Fournier's gangrene cases that presented to three tertiary centers with early extensive surgical debridement. Materials and Methods: We retrospectively collect data from patients with FG who were referred to the Urology Clinic of the Department of Medicine and Surgery (Perugia), the Urological Andrological Surgery and Minimally Invasive Techniques Unit (Terni) of the University of Perugia, and the Urology Unit of the Surgery Department of the Macerata Civic Hospital between January 2019 and March 2024 for onset of classic signs and symptoms of FG. Extensive surgical debridement was immediately performed under general anesthesia to reach normochromic and vascularized tissue in wide and depth extension, assuring vital and healthy margins. For all patients, intravenous daptomycin plus piperacillin/tazobactam were administered. Results: 28 male patients with FG underwent early surgical debridement. In two cases, orchidectomy and partial penectomy were required during surgical debridement due to extensive necrosis. Colon diversion and urinary diversion were not necessary for any of the patients. 32.1% complications were recorded according to the Clavien Dindo classification; 6 patients died in the perioperative. Excluding death data, the average duration of antibiotic therapy was 22.0±9.1 days, and the average length of stay was 17.6±11.8 days. Conclusions: Fournier's gangrene has high mortality rates. It requires timely surgical debridement and antibiotic therapy to achieve positive outcomes. This study shows that a primary extensive debridement can help reduce the need for further intervention and shorten the hospital stay.

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation II (PD32)1 May 2024PD32-07 LIMITATIONS OF IIEF-15 IN THE PREOPERATIVE ASSESSMENT OF PATIENTS UNDERGOING SURGERY FOR PROSTATE DISEASE Giuseppe Maiolino, Francesca Mucciardi, Domenico Rizzo, Raffaele La Mura, Miriam Russo, Alessio Paladini, Ettore Mearini, and Giovanni Cochetti Giuseppe MaiolinoGiuseppe Maiolino , Francesca MucciardiFrancesca Mucciardi , Domenico RizzoDomenico Rizzo , Raffaele La MuraRaffaele La Mura , Miriam RussoMiriam Russo , Alessio PaladiniAlessio Paladini , Ettore MeariniEttore Mearini , and Giovanni CochettiGiovanni Cochetti View All Author Informationhttps://doi.org/10.1097/01.JU.0001009364.27111.54.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: IIEF-15, its Erectile Function domain (EF), and its short form (IIEF-5) are the most widely employed PROMs for evaluating erectile function. However, these instruments exhibit several issues: 1) the current use of therapies for erectile dysfunction is not taken into consideration; 2) many items focus on penetration only, excluding other forms of sexual activity; 3) every item, except 15, refers to sexual activity in the last 4 weeks. As a result, a man with no recent sexual activity but with normal erectile function could be classified as affected by severe ED. The primary aim of our study is to determine the percentage of patients without sexual activity during the four weeks before IIEF-15 administration but with a normal erectile function, thereby identifying instances where the use of IIEF-15 may be challenging. METHODS: We prospectively collected data from patients undergoing RARP for PCa and BPH-surgery in our high-volume center from June'22 to September'23. Preoperative questionnaire (IIEF-15, BDI, 12-Item Short Form Survey, IPSS) were administered to all patients. Age, BMI, smoking status, educational level and marital status were recorded. Based on self-reported presence or absence of sexual activity in the last 4 weeks, patients were divided into 2 groups: SAI (preoperative Sexual Activity/Intercourse) and nSAI (no preoperative SAI). In the latter we assessed the percentage of patients with a normal erectile function, here defined as a score≥4 on item 15. Uni- and multivariate logistic regression was performed with all variables collected to find independent predictive factor for the absence of sexual activity in the last 4 weeks. RESULTS: We collected data from 178 patients. 98 (55.1%) declared absence of sexual activity in the last 4 weeks. Among them, 38 (38.8%) reported a normal erectile function. In the group SAI and nSAI, the EF of IIEF-15 was 22.5±6.4 and 3.02±1.5, respectively. Patients in SAI group were statistically significant younger (67.5 vs 69.7, p<0.04). In nSAI group divorced and widowed patients were statistically significant more (p 0.05). No statistically significant difference was found between patients admitted for RARP and for BPH-surgery (p: 0.89). At uni- and multivariate logistic regression only age (OR: 1.05, p=0.05) resulted as independent predictive factor for the absence of sexual activity in the last 4 weeks. CONCLUSIONS: More than half of the patients report no sexual activity in the four weeks leading up to IIEF-15 administration in a preoperative setting for prostate surgery. Among them, nearly 40% have normal erectile function but may be misclassified as having severe ED. When using the EF domain of IIEF-15 for research purposes to assess the erectile function of a patient cohort, it is advisable to always report the percentage of patients who have or have not engaged in sexual activity or intercourse in the last four weeks, especially in older patients. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e705 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Giuseppe Maiolino More articles by this author Francesca Mucciardi More articles by this author Domenico Rizzo More articles by this author Raffaele La Mura More articles by this author Miriam Russo More articles by this author Alessio Paladini More articles by this author Ettore Mearini More articles by this author Giovanni Cochetti More articles by this author Expand All Advertisement PDF downloadLoading ...

BACKGROUND: Stone nomogram by Micali et al. , able topredict treatment failure of shock-wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) in the management of single 1-2 cm renal stones, was developed on 2605 patients and showed a high predictive accuracy, with an area under ROC curve of 0.793 at internal validation. The aim of the present study is to externally validate the model to assess whether it displayed a satisfactory predictive performance if applied to different populations. METHODS: External validation was retrospectively performed on 3025 patients who underwent an active stone treatment from December 2010 to June 2021 in 26 centers from four countries (Italy, USA, Spain, Argentina). Collected variables included: age, gender, previous renal surgery, preoperative urine culture, hydronephrosis, stone side, site, density, skin-to-stone distance. Treatment failure was the defined outcome (residual fragments >4 mm at three months CT-scan). RESULTS: Model discrimination in external validation datasets showed an area under ROC curve of 0.66 (95% 0.590.68) with adequate calibration. The retrospective fashion of the study and the lack of generalizability of the tool towards populations from Asia, Africa or Oceania represent limitations of the current analysis. CONCLUSIONS: According to the current findings, Micali's nomogram can be used for treatment prediction after SWL, RIRS and PNL; however, a lower discrimination performance than the one at internal validation should be acknowledged, reflecting geographical, temporal and domain limitation of external validation studies. Further prospective evaluation is required to refine and improve the nomogram findings and to validate its clinical value. ( Cite this article as: Sighinolfi MC, Calcagnile T, Ticonosco M, Kaleci S, Di Bari S, Assumma S, et al. External validation of a nomogram for outcome prediction in management of medium-sized (1-2 cm) kidney stones. Minerva Urol Nephrol 2024 May 10. DOI: 10.23736/S2724-6051.24.05672-6)