S. Zaramella

Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort

INTRODUCTION Standardized methods of reporting complications after radical cystectomy (RC) and urinary diversions (UD) are necessary to evaluate the morbidity associated with this operation to evaluate the modified Clavien classification system (CCS) in grading perioperative complications of RC and UD in a real life cohort of patients with bladder cancer. MATERIALS AND METHODS A consecutive series of patients treated with RC and UD from April 2011 to March 2012 at 19 centers in Italy was evaluated. Complications were recorded according to the modified CCS. Results were presented as complication rates per grade. Univariate and binary logistic regression analysis were used for statistical analysis. RESULTS RESULTS AND LIMITATIONS 467 patients were enrolled. Median age was 70 years (range 35-89). UD consisted in orthotopic neobladder in 112 patients, ileal conduit in 217 patients and cutaneous ureterostomy in 138 patients. 415 complications were observed in 302 patients and were classified as Clavien type I (109 patients) or II (220 patients); Clavien type IIIa (45 patients), IIIb (22 patients); IV (11 patients) and V (8 patients). Patients with cutaneous ureterostomy presented a lower rate (8%) of CCS type ≥IIIa (p = 0.03). A longer operative time was an independent risk factor of CCS ≥III (OR: 1.005; CI: 1.002-1.007 per minute; p = 0.0001). CONCLUSIONS In our study, RC is associated with a significant morbidity (65%) and a reduced mortality (1.7%) when compared to previous experiences. The modified CCS represents an easily applicable tool to classify the complications of RC and UD in a more objective and detailed way.

The R.E.N.A.L. Nephrometric Nomogram Cannot Accurately Predict Malignancy or Aggressiveness of Small Renal Masses Amenable to Partial Nephrectomy

INTRODUCTION/BACKGROUND The prediction of histology of SRM could be essential for their management. The RNN is a statistical tool designed to predict malignancy or high grading of enhancing renal masses. In this study we aimed to perform an external validation of the RNN in a cohort of patients who received a PN for SRM. MATERIALS AND METHODS This was a multicentric study in which the data of 506 consecutive patients who received a PN for cT1a SRM between January 2010 and January 2013 were analyzed. For each patient, the probabilities of malignancy and aggressiveness were estimated preoperatively using the RNN. The performance of the RNN was evaluated according to receiver operating characteristic (ROC) curve, calibration plot, and decision curve analyses. RESULTS The area under the ROC curve for malignancy was 0.57 (95% confidence interval [CI], 0.51-0.63; P = .031). The calibration plot showed that the predicted probability of malignancy had a bad concordance with observed frequency (Brier score = 0.17; 95% CI, 0.15-0.19). Decision curve analysis confirmed a poor clinical benefit from use of the system. The estimated area under the ROC curve for high-grade prediction was 0.57 (95% CI, 0.49-0.66; P = .064). The calibration plot evidenced a bad concordance (Brier score = 0.15; 95% CI, 0.13-0.17). Decision curve analysis showed the lack of a remarkable clinical usefulness of the RNN when predicting aggressiveness. CONCLUSIONS The RNN cannot accurately predict histology in the setting of cT1a SRM amenable to PN.

Large bladder diverticula: a comparison between laparoscopic excision and endoscopic fulguration

Abstract Objective: The treatment of bladder diverticula consists of diverticulectomy, mainly by a laparoscopic approach or transurethral resection of the diverticular neck and fulguration of the mucosa. The endoscopic approach is generally dedicated to small diverticula. The aim of this study was to compare laparoscopic diverticulectomy versus endoscopic fulguration for bladder diverticula larger than 4 cm. Materials and methods: A retrospective review of the medical records of consecutive patients undergoing endoscopic or laparoscopic treatment for bladder diverticula larger than 4 cm at two tertiary hospitals was performed. Therapeutic success was defined as either complete resolution or a decrease of at least 80% in the size of the diverticulum. Complications were recorded and graded according to the Clavien–Dindo classification. Results: All patients were treated with transurethral resection of the prostate in the same operative session. The endoscopic group included a cohort of 20 male patients. The median age, diverticular diameter and operative time were 65 years, 7 cm and 62.5 min, respectively. No early postoperative complications were observed. Therapeutic success was achieved in 15 cases (75%). The laparoscopic group included a cohort of 13 male patients with a median age of 63 years and median diverticular diameter of 7.0 cm. The median operative time was 185 min (p < 0.0001). Two grade III postoperative complications were observed (15.3%). Therapeutic success was achieved in all patients (100%). Conclusions: Acquired bladder diverticula larger than 4 cm can be effectively managed either by a laparoscopic approach or by endoscopic fulguration.

539 The prediction of the trifecta outcome from clinical variables in patients candidates to partial nephrectomy for t1 renal tumors

1University of Study of Florence, Dept. of Urology, Florence, Italy, 2University of Brescia, Dept. of Urology, Brescia, Italy, 3Bassano del Grappa Hospital, Dept. of Urology, Bassano del Grappa, Italy, 4Hospital of Abano Terme, Dept. of Urology, Padua, Italy, 5, S. Pio Da Pietralcina Hospital, Dept. of Urology, Vasto, Italy, 6Regina Elena Hospital, Dept. of Urology, Milan, Italy, 7Carlo Poma Hospital, Dept. of Urology, Mantova, Italy, 8Maggiore Della Carità Hospital, Dept. of Urology, Novara, Italy, 9Ospedale Misericordia, Dept. of Urology, Grosseto, Italy

259 Robotic-assisted versus open partial nephrectomy: A prospective multicenter comparison study of perioperative outcomes (AGILE project)

1University of Florence, Dept. of Urology, Florence, Italy, 2University of Brescia, Dept. of Urology, Brescia, Italy, 3Hospital of Bassano Del Grappa, Dept. of Urology, Bassano del Grappa, Italy, 4University of Udine, Dept. of Urology, Udine, Italy, 5Hospital of Abano Terme, Dept. of Urology, Abano Terme, Italy, 6University of Milan, Dept. of Urology, Milan, Italy, 7Hospital Carlo Poma, Dept. of Urology, Mantova, Italy, 8Hospital “Maggiore Della Carità”, Dept. of Urology, Novara, Italy

What is the best number of core to improve saturation biopsy detection rate

Prostate core saturation biopsy (SB) is today considered in patients where clinical or biochemical hypothesis of prostate cancer (PCa) is still present after previous normal core biopsies. The tech...