G. Cattaneo

Mini-retroperitoneoscopic clampless partial nephrectomy for "low-complexity" renal tumours (PADUA score ≤8)

An alternative to conventional laparoscopy when looking for virtually scarless surgery is mini-laparoscopy, a reproducible technique that preserves the triangulation concept. A drawback of this approach is the poor image quality provided by mini-scopes. The introduction of the SPIEs technology, a novel endoscopic camera allowing for better visualisation of anatomic details even with 3-mm optics, has boosted the use of a mini-laparoscopic approach in our centre for laparoscopic partial nephrectomy (LPN) to treat low-complexity renal masses. Allowing for inclusion criteria, 10 consecutive patients who satisfied inclusion criteria were enrolled in our prospective study undergoing clampless mini-retroperitoneoscopic LPN performed by a single surgeon with laparoscopic expertise. Preliminary data show that the approach seems to be safe and effective, with comparable outcomes to conventional LPN. Larger sample size and comparative studies are needed to confirm these findings. The evaluation of cosmetic results will be the focus of further studies.

High prostate cancer gene 3 (PCA3) scores are associated with elevated Prostate Imaging Reporting and Data System (PI-RADS) grade and biopsy Gleason score, at magnetic resonance imaging/ultrasonography fusion software-based targeted prostate biopsy after a previous negative standard biopsy.

To determine the association among prostate cancer gene 3 (PCA3) score, Prostate Imaging Reporting and Data System (PI‐RADS) grade and Gleason score, in a cohort of patients with elevated prostate‐specific antigen (PSA), undergoing magnetic resonance imaging/ultrasonography fusion software‐based targeted prostate biopsy (TBx) after a previous negative randomised ‘standard’ biopsy (SBx).

Temporary implantable nitinol device (TIND): a novel, minimally invasive treatment for relief of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH): feasibility, safety and functional results at 1 year of follow‐up

To report the first clinical experience with a temporary implantable nitinol device (TIND; Medi‐Tate®) for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).

High PCA3 scores are associated to elevated Prostate Imaging Reporting and Data System (PI-RADS) grade and biopsy Gleason Score, at MRI/US fusion software-based targeted prostate biopsy after a previous negative standard biopsy.

To determine the association among prostate cancer gene 3 (PCA3) score, Prostate Imaging Reporting and Data System (PI‐RADS) grade and Gleason score, in a cohort of patients with elevated prostate‐specific antigen (PSA), undergoing magnetic resonance imaging/ultrasonography fusion software‐based targeted prostate biopsy (TBx) after a previous negative randomised ‘standard’ biopsy (SBx).

Multiparametric Magnetic Resonance/Ultrasound Fusion Prostate Biopsy: Number and Spatial Distribution of Cores for Better Index Tumor Detection and Characterization

Purpose: We evaluated the minimum core number for better index tumor detection to determine the best core site as well as biopsy Gleason score heterogeneity in the same index lesion. The aim was to optimize the highest Gleason score detection. Materials and Methods: A total of 327 patients with negative digital rectal examination underwent magnetic resonance imaging/transrectal ultrasound fusion targeted biopsy for elevated/rising prostate specific antigen and/or 1 or more detectable lesions on multiparametric magnetic resonance imaging after a previous negative standard biopsy. Depending on the diameter of each index lesion (8 or less, or greater than 8 mm) 4 or 6 cores, respectively, were taken according to a well determined sequence. Results: Of the patients 166 (50.7%) had prostate cancer, including 79 (47.6%) with an 8 mm or less index lesion and 87 (52.4%) with a greater than 8 mm index lesion. Of patients with an index tumor 8 mm or less 7 (8.9%) had 1, 31 (39.2%) had 2, 27 (34.2%) had 3 and 14 (17.7%) had 4 positive cores. Similarly, of patients with a lesion greater than 8 mm 8 (9.2%) had 1, 30 (34.5%) had 2, 13 (14.9%) had 3, 14 (16.1%) had 4, 12 (13.8%) had 5 and 10 (11.5%) had 6 positive cores. The major prevalence of positive cores was observed in the center of the target. Gleason score heterogeneity was found in 12.6% of those with an 8 mm or less target vs 26.4% with a target greater than 8 mm. In the center of the target there was a slight prevalence of Gleason pattern 4 or greater, or a lesser pattern. Conclusions: Approaching magnetic resonance imaging/transrectal ultrasound fusion targeted biopsy with a single core might be inadequate. Rather, taking 2 cores in the center of the index lesion may provide more accurate cancer detection and optimize the chances of finding the highest Gleason pattern.

3-Year follow-up of temporary implantable nitinol device implantation for the treatment of benign prostatic obstruction

To report 3‐year follow‐up results of the first implantations with a temporary implantable nitinol device (TIND®; Medi‐Tate Ltd., Or Akiva, Israel) for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).

PD18-06 5 YEARS FOLLOW-UP OF A PROSPECTIVE RANDOMISED CONTROLLED TRIAL COMPARING LAPAROSCOPIC VERSUS ROBOT-ASSISTED RADICAL PROSTATECTOMY: ONCOLOGICAL AND FUNCTIONAL OUTCOMES

evaluated the association of the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) with sociodemographic characteristics, family history of PC, global health score/quality of life (EORTC quality of life questionnaire-C30 subscale), depression/anxiety (Patient Health Questionnaire 4), latest PSA-level >1⁄4 0.2 ng/ml, time since RP and current therapy using hierarchical multiple regression analysis. RESULTS: Mean age at survey was 75.2 years with a median follow-up of 11.5 years. The final regression model showed younger age, lower global health status/quality of life, higher depression/anxiety scores, higher latest PSA-level and shorter time since RP predicting a higher level of PSAand PC Anxiety, respectively. Familial PC predicted only for PSA-Anxiety (all p < 0.05). The final regression model explained 12% of the variance for PSA-Anxiety and 24% for PCAnxiety. CONCLUSIONS: PC-specific anxiety is still relevant even many years after surgery. Besides depression and anxiety, younger age, shorter time since RP and a rising PSA-level play an important role during follow-up. Survivors who fulfill these characteristics are at higher risk to develop PC-specific anxiety which have need to be kept in mind by the treating physician regarding to a successful follow-up.

The role of chitosan membranes application on the neurovascular bundles during robot-assisted radical prostatectomy: Preliminary results of a phase II study

INTRODUCTION & OBJECTIVES: Erectile dysfunction and urinary incontinence are the main postoperative sequelae in patients undergoing radical prostatectomy. The introduction of robotics in surgery for prostate cancer has helped the improvement of the oncological and functional results with more precise nerve-sparing tecnique. In parallel to this, in recent years, studies in bio-medical field proposed the application of bio-materials aimed to support nerves regeneration. The aim of the study was to evaluate the eventual improvement of functional results after nerve-sparing robot-assisted radical prostatectomy (RARP) after the application of chitosan membranes on the neurovascular bundles. MATERIAL & METHODS: From July 2015 to June 2016 98 patients who underwent nerve-sparing RARP with a pre-operative IIEF> 20 were enrolled; the chitosan membrane (CM) was applied intraoperatively. Preoperative, intraoperative, postoperative, pathological and functional variables and oncological results were analyzed. Patients were defined as continent if 0 pad or 1 Safety pad was used; they were defined as potent with a score > 2 to Question 2 of the EPIC-Sexual Assessment Questionnaire (valid erections for intercourse or masturbation). The functional results were evaluated at 1 ,2 and 3 months after catheter removal. Specifically for the purpose of the study, a cohort of consecutive patients to whom CM was not applied was matched-paired after propensity score analysis to be the control group (nCM). RESULTS: The protocol did not result in an increase in operative time, intraoperative blood loss, rate of peri- and postoperative complications and worsening of the oncological results. Nerve sparing technique was bilateral interfascial in 58, interfascial/intrafascial unilateral in 24 and in bilateral intrafascial in 16 patients. In the CM group 36 (36.34%), 47 (47.93%) and 54 (54.08%) patients were potent at 1, 2 and 3 months after surgery, respectively. In the nCM group potent patients were found to be 31 (31,63%), 41 (41.81%) and 45 (45.91%), respectively (p-value: ns). Considering only patients who could benefit from a complete preservation of neurovascular bundles (intrafascial bilateral nerve-sparing), 7 (43.75%), 11 (68.75%) and 12 (75.00%) had an early recovery of potency in the CM group at 1, 2 and 3 months after surgery, respectively; in the nCM group 6 (37,50%), 9 (56.25%) and 10 (62.50%) achieved a recovery of potency (p-value:ns). Concerning the recovery of urinary continence, no differences were found. CONCLUSIONS: The application of chitosan membranes on the neurovascular bundles during RARP is safe and feasible. Functional results showed a trend towards a faster recovery of sexual potency in patients who received CM, without substantial differences in the recovery of continence. Larger sample size are needed to eventually found a statistically significant difference in potency recovery rate derived from chitosan application.

Ureteroscopy: is it the best?:

Over the last 40 years the treatment of urolithiasis passed from open surgical therapies to minimally invasive approaches. From the introduction of the first ureteroscopes in ‘80s many technological improvements allowed to reduce endourological instruments’ size, ensuring in the meanwhile an increasingly high success rate in the resolution of the urolithiasis. The purpose of the study is to review the current role of the ureteroscopy(URS) in the treatment of urinary stones. A non-systematic review was performed considering the most recent Guidelines and results from Literature. The results confirm that, considering ureteral calculi, the stone-free rate (SFR) for URS is significantly higher than for ESWL in the treatment of distal ureteral stones <10 mm and >10 mm. Endoscopy has a first-line role also in the treatment of proximal ureteral stones >10 mm, together with ESWL. Retreatment rate and ancillary procedures are also lower in patients treated with URS, despite it is more invasive if compared with ESWL. Recent data are available in Literature about the treatment of nephrolithiasis with Retrograde Intra-Renal Surgery (RIRS). RIRS is the first-line treatment, together with ESWL, for stones <20 mm, and second choice for stones >20 mm. However, for large renal stones the role of RIRS is still being discussed. In conclusion, the majority of urinary stones can be treated by rigid or flexible URS. Further studies are required to clarify the role of endoscopy in the treatment of large stones, especially if compared to percutaneous approaches.