Orietta Dalpiaz

Independent predictors of metachronous bladder transitional cell carcinoma (TCC) after nephroureterectomy for TCC of the upper urinary tract

To identify the prognostic factors predictive of metachronous bladder transitional cell carcinoma (TCC) in a multi‐institutional dataset of patients who had undergone nephroureterectomy (NU) for nonmetastatic upper urinary tract (UUT) TCC.

Validation of the pretreatment derived neutrophil-lymphocyte ratio as a prognostic factor in a European cohort of patients with upper tract urothelial carcinoma

Background:The value of a combined index of neutrophil and white cell counts, named derived neutrophil–lymphocyte ratio (dNLR), has recently been proposed as a prognosticator of survival in various cancer types. We investigated the prognostic role of the dNLR in a large European cohort of patients with upper tract urothelial carcinoma (UTUC).Methods:Data from 171 non-metastatic UTUC patients, operated between 1990 and 2012 at a single tertiary academic centre, were evaluated retrospectively. Cancer-specific- (CSS) as well as overall survival (OS) were assessed using the Kaplan–Meier method. To evaluate the independent prognostic significance of the dNLR, multivariate proportional Cox-regression models were applied. Additionally, the influence of the dNLR on the predictive accuracy of the multivariate model was further determined by Harrell’s concordance index (c-index).Results:The median follow-up period was 31 months. An increased dNLR was statistically significantly associated with shorter CSS (log-rank P=0.004), as well as with shorter OS (log-rank P=0.002). Multivariate analysis identified dNLR as an independent predictor for CSS (hazard ratio, HR=1.16, 95% confidence interval, CI=1.01–1.35, P=0.045), as well as for OS (HR=1.21, 95% CI=1.09–1.34, P<0.001). The estimated c-index of the multivariate model for OS was 0.68 without dNLR and 0.73 when dNLR was added.Conclusions:Patients with a high pretreatment dNLR could be predicted to show subsequently higher cancer-specific- as well as overall mortality after surgery for UTUC compared with those with a low pretreatment dNLR. Thus, this combined index should be considered as a potential prognostic biomarker in future.

Independent predictors of contralateral metachronous upper urinary tract transitional cell carcinoma after nephroureterectomy: Multi‐institutional dataset from three European centers

Objectives:  To identify the variables predictive of contralateral metachronous upper urinary tract transitional cell carcinoma (UUT‐TCC) after nephroureterectomy (NFU) for non‐metastatic UUT‐TCC.

Mid-term complications after placement of the male adjustable suburethral sling: a single center experience.

PURPOSE In recent years various sling systems have been proposed as a successful treatment option for male stress urinary incontinence. Reports about complication rates and failures are still scarce. MATERIALS AND METHODS We systematically reevaluated 29 male patients who received an Argus® suburethral sling for stress urinary incontinence between October 2006 and July 2007. RESULTS Overall 24 patients (83%) experienced a total of 37 complications at a median followup of 35 months (range 29 to 45), including 10 (35%) in acute urinary retention. The sling was removed in 10 patients (35%) due to urethral erosion (3), infection (2), system dislocation (2), urinary retention (2) and persistent pain (1). Eight men (27%) complained of significant perineal pain, necessitating continuous oral analgesics. In 1 patient ureteral reimplantation was done due to ureteral erosion from a dislocated sling. At followup only 5 men (17%) remained dry while 21 (72%) were dissatisfied with the clinical outcome. No available clinical variables were statistically significantly associated with any grade or high grade complications even on univariate analysis. CONCLUSIONS In our study cohort the Argus suburethral sling was associated with serious mechanical and infectious complications, and sparse functional results with negative impact on patient quality of life. Based on the results of this study significant changes are warranted in the sling system and in the implantation technique.

Validation of pretreatment neutrophil-lymphocyte ratio as a prognostic factor in a European cohort of patients with upper tract urothelial carcinoma.

To investigate the potential prognostic significance of the neutrophil–lymphocyte ratio (NLR) in a large European cohort of patients with upper urinary tract urothelial cell carcinoma (UUT‐UCC).

Time to recurrence is a significant predictor of cancer‐specific survival after recurrence in patients with recurrent renal cell carcinoma – results from a comprehensive multi‐centre database (CORONA/SATURN‐Project)

To assess the prognostic impact of time to recurrence (TTR) on cancer‐specific survival (CSS) after recurrence in patients with renal cell carcinoma (RCC) undergoing radical nephrectomy or nephron‐sparing surgery. To analyse differences in clinical and histopathological criteria between patients with early and late recurrence.

Validation of the preoperative plasma fibrinogen level as a prognostic factor in a European Cohort of patients with localized upper tract urothelial carcinoma

PURPOSE Fibrinogen is thought to have a potentially significant role in the progression and metastatic spread of different human cancers. A recent study from Asia indicated that elevated preoperative plasma fibrinogen might be associated with a worse outcome in patients with surgically treated localized upper tract urothelial carcinoma. We validated the prognostic impact of this potential biomarker in a European cohort of patients with localized upper tract urothelial carcinoma. MATERIALS AND METHODS We evaluated data on 167 patients with nonmetastatic upper tract urothelial carcinoma who underwent surgery between 1990 and 2012 at a single tertiary academic center. Patients were categorized using an optimal cutoff value of preoperative plasma fibrinogen. Patient cancer specific and overall survival was assessed using the Kaplan-Meier method. Univariate and multivariate Cox regression models were performed for each end point. The influence of fibrinogen on the predictive accuracy of the multivariate model was further determined by the Harrell c-index. RESULTS Multivariate analysis identified increased preoperative plasma fibrinogen as an independent prognostic factor for cancer specific survival (HR 3.00, 95% CI 1.32-6.80, p = 0.008) and overall survival (HR 2.48, 95% CI 1.31-4.68, p = 0.005). The estimated c-index of the multivariate model for cancer specific survival was 0.72 without fibrinogen and 0.74 when fibrinogen was added. The risk model that we developed significantly differentiated between low, intermediate and high risk groups for cancer related death (p <0.001). CONCLUSIONS Elevated fibrinogen seems to represent a negative prognostic factor for cancer specific and overall survival in patients with upper tract urothelial carcinoma. This parameter should be considered an additional prognostic factor for upper tract urothelial carcinoma in the future.

Chronic pelvic pain in women: still a challenge.

Chronic pelvic pain (CPP), a common condition particularly in reproductive‐aged women, causes disability and distress, and significantly compromises quality of life and affects healthcare costs. The pathogenesis of CPP is still poorly understood and consequently poorly managed. Furthermore, the lack of a consensus on the definition of CPP greatly hinders epidemiological studies. Patients present with various associated problems, including bladder or bowel dysfunction, gynaecological pathologies or sexual dysfunction, and other systemic or constitutional symptoms. Other conditions, e.g. depression, anxiety and drug addiction, can also coexist. Effective management presupposes an integrated knowledge of all pelvic organs and other systems, including musculoskeletal, neurological and psychiatric systems. The key to treating CPP is to treat it as the complex disease it is. Treatment options range from conservative medical therapy to surgical intervention, and are primarily directed towards symptom relief. Unsatisfactory results of treatment render this condition a frustrating problem for both patients and physicians.

Haemostatic sealants in nephron-sparing surgery: what surgeons need to know

Surgical haemostatic agents have been increasingly applied for the control of bleeding, and have excellent potential in laparoscopy. Several factors are important when evaluating the use of sealants. We present a brief overview of the history, composition and mechanism of action of sealants, together with a report on experimental studies and clinical experience with haemostatic sealants. We searched for reports on haemostatic agents and their use in renal parenchymal haemostasis; 15 animal models studies and 11 papers on clinical experience were included. The development of haemostatic agents and instruments is allowing the wider diffusion of challenging procedures. Several experimental animal studies have shown the efficacy and safety of sealants for haemostasis during nephron‐sparing surgery. Clinical studies confirm the effectiveness of synthetic or fibrin glue, in particular during laparoscopic surgery. Sealants are effective and safe topical agents to control bleeding during nephron‐sparing surgery. They should not be viewed as an alternative, but as complementary agents to be used to improve surgical outcomes. Further prospective studies are necessary to validate their role in relation to other haemostatic support techniques.

Single-stage dorsal inlay split-skin graft for salvage anterior urethral reconstruction

To report our initial experience and extended follow‐up of single‐stage dorsal inlay skin‐graft urethroplasty for salvaging recurrent anterior urethral stricture (AUS), as urethral reconstruction remains a challenge, particularly in patients with recurrent AUS after previous surgery, and a paucity of local skin frequently requires free graft reconstruction techniques.