Susanna Grande
University of Turin
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Featured researches published by Susanna Grande.
European Urology | 2013
Francesco Porpiglia; Ivano Morra; Marco Lucci Chiarissi; M. Manfredi; F. Mele; Susanna Grande; F. Ragni; M. Poggio; C. Fiori
BACKGROUND The advantages of robot-assisted radical prostatectomy (RARP) over laparoscopic radical prostatectomy (LRP) have rarely been investigated in randomised controlled trials. OBJECTIVE To compare RARP and LRP in terms of the functional, perioperative, and oncologic outcomes. The main end point of the study was changes in continence 3 mo after surgery. DESIGN, SETTING, AND PARTICIPANTS From January 2010 to January 2011, 120 patients with organ-confined prostate cancer were enrolled and randomly assigned (using a randomisation plan) to one of two groups based on surgical approach: the RARP group and the LRP group. INTERVENTION All RARP and LRP interventions were performed with the same technique by the same single surgeon. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The demographic, perioperative, and pathologic results, such as the complications and prostate-specific antigen (PSA) measurements, were recorded and compared. Continence was evaluated at the time of catheter removal and 48 h later, and continence and potency were evaluated after 1, 3, 6, and 12 mo. The student t test, Mann-Whitney test, χ(2) test, Pearson χ(2) test, and multiple regression analysis were used for statistics. RESULTS AND LIMITATIONS The two groups (RARP: n=60; LRP: n=60) were comparable in terms of demographic data. No differences were recorded in terms of perioperative and pathologic results, complication rate, or PSA measurements. The continence rate was higher in the RARP group at every time point: Continence after 3 mo was 80% in the RARP group and 61.6% in the LRP group (p=0.044), and after 1 yr, the continence rate was 95.0% and 83.3%, respectively (p=0.042). Among preoperative potent patients treated with nerve-sparing techniques, the rate of erection recovery was 80.0% and 54.2%, respectively (p=0.020). The limitations included the small number of patients. CONCLUSIONS RARP provided better functional results in terms of the recovery of continence and potency. Further studies are needed to confirm our results.
European Urology | 2009
Francesco Porpiglia; C. Fiori; Susanna Grande; Ivano Morra; Roberto Mario Scarpa
BACKGROUND Continence after laparoscopic radical prostatectomy is critical to patients and to surgeons. In this setting, the management of deep venous complex (DVC) without involvement of the sphincter fibres could be an important step of the procedure. OBJECTIVE To evaluate the effects of a personal selective suture of the plexus (selective ligature of the deep venous complex [SLDVC]) on continence, blood loss, and surgical margin status during laparoscopic radical prostatectomy (LRP). DESIGN, SETTING, AND PARTICIPANTS We planned a prospective randomised study. Sixty consecutive patients with clinically localised prostate cancer were involved in the study and were divided into two groups: group A (30 patients) underwent LRP with extraperitoneoscopic approach with standard management of DVC; group B (30 patients) underwent LRP with SLDVC. INTERVENTION In group A, a standard ligature of DVC was performed (ligature and subsequent section); in group B, a selective ligature of DVC after its section was performed. MEASUREMENTS Continence was evaluated during follow-up visits at catheter removal, and after 1, 3, 6, and 12 mo, perioperative variables and pathologic features of specimens were recorded. RESULTS AND LIMITATIONS The two groups were comparable in terms of age, body mass index (BMI), prostate-specific antigen (PSA) values, and Gleason score at biopsy. No differences were found between the two groups in terms of operative times, blood loss, catheterisation time, and postoperative stay or histologic status. As far as continence rate is concerned, a significant difference was recorded between the groups (53% in group A vs 80% in group B) after 3 mo. CONCLUSIONS This selective ligature of the DVC after its section can contribute to early recovery of continence. Our data suggest that SLDVC compromises neither the safety of the procedure nor its oncologic effectiveness.
Clinical Genitourinary Cancer | 2013
Valentina Bertaglia; Marcello Tucci; C. Fiori; Emiliano Aroasio; M. Poggio; Consuelo Buttigliero; Susanna Grande; Andrea Saini; Francesco Porpiglia; Alfredo Berruti
BACKGROUND Controversy exists about whether testosterone serum levels at a cutoff point of < 50 ng/dL during luteinizing hormone-releasing hormone analogue (LHRHA) treatment are related to the outcome of patients with prostate cancer. We assessed the relationship between serum testosterone levels after 6 months of LHRHA therapy and disease outcome in a consecutive series of patients with prostate cancer. PATIENTS AND METHODS Serum testosterone levels were measured prospectively in a cohort of patients given LHRHA for 6 months. End points were time to progression (TTP) and overall survival (OS). RESULTS The study population was 153 patients: 54 with metastatic disease and 99 with biochemical failure. In multivariate analysis, adjustment for age, baseline serum prostatic specific antigen (PSA) levels, Gleason score, and disease stage, testosterone levels < 50 ng/dL failed to be associated with TTP and OS. A cutoff of < 20 ng/dL was associated with a nonsignificant lower risk of progression (adjusted hazard ratio [HR] 0.58; 95% confidence interval [CI] 0.30-1.15; P = .12) and a significant lower risk of death (adjusted HR, 0.19; 95% CI, 0.04-0.76; P = .02). Only 25 patients attained serum testosterone levels < 20 ng/dL. Using a receiver operating characteristic curve (ROC), we found that a testosterone value of 30 ng/dL offered the best overall sensitivity and specificity for prediction of death. Serum testosterone levels < 30 ng/mL were associated with a significantly lower risk of death (adjusted HR, 0.45; 95% CI, 0.22-0.94; P = .034. CONCLUSIONS Serum testosterone levels lower than the currently adopted cutoff of 50 ng/dL have a prognostic role in patients with prostate cancer receiving LHRHA and are a promising surrogate parameter of LHRHA efficacy.
BJUI | 2005
Francesco Porpiglia; F. Ragni; Carlo Terrone; Julien Renard; Francesca Musso; Susanna Grande; Cecilia Maria Cracco; Gianpaolo Ghignone; Roberto Mario Scarpa
Associate Editor
International Journal of Urology | 2005
Francesco Porpiglia; Carlo Terrone; Marco Cossu; Julien Renard; Susanna Grande; Roberto Mario Scarpa
Abstract We describe our technique of laparoscopic diverticulectomy under ultrasound (US) guidance after a transurethral resection of prostate (TURP) in the treatment of patients with benign prostatic hyperplasia and bladder diverticulum. A standard TURP is performed with an Iglesias resectoscope. A 12‐Fr Foley catheter is positioned in the diverticulum and the catheter balloon is then inflated with 30 mL of water; then a Tiemann catheter is placed through the urethra into the bladder. A US probe is inserted through the 12 mm port placed in the right side by the surgeon, then laparoscopic transperitoneal bladder diverticulectomy is performed under US guidance. In our experience, the use of endolaparoscopic US makes identification and dissection of the diverticulum easy, safe and effective, even when the procedure has to be performed in disadvantageous anatomic conditions such as lateral‐posterior diverticulum or post‐TURP imbibition of pelvic tissue.
International Journal of Urology | 2010
C. Fiori; Ivano Morra; Andrea Di Stasio; Susanna Grande; Roberto Mario Scarpa; Francesco Porpiglia
We present our results in terms of feasibility, safety and efficacy of flexible pneumocystoscopy during double J stenting in patients undergoing laparoscopic pyeloplasty (LP). The patient is placed on the flank at a 45° angle. Laparoscopic pyeloplasty according to the Anderson–Hynes technique is carried out by transperitoneal access. After completing the running suture of the posterior wall of the uretero‐pyelic anastomosis, the double J stent is placed in a retrograde manner with a pneumocystoscopy using flexible cystoscope. Thirty‐six patients were prospectively evaluated; 28 of these were treated with standard LP and 8 with robot‐assisted LP. Mean operative time was 124 min, whereas double J stenting time was 4.2 min (2–6). We observed one case of cranial migration of the stent, forcing us to repeat the procedure, which was completed without complications. No ancillary procedures or X‐ray control were necessary. Retrograde double J stenting using flexible pneumocystoscopy during laparoscopic and robot assisted pyeloplasty is feasible, easy, safe and effective. The procedure can be completed without changing the patients position and without the use of X‐ray.
The Journal of Urology | 2017
Mauro Mari; Alesandra Ambu; S. Guercio; Francesco Mangione; Maria Teresa Carchedi; Susanna Grande; Maurizio Bellina
METHODS: Between January 1992 and April 2016, 51 children (27 boys and 24 girls) underwent a Mitrofanoff appendico-vesicostomy as external continent urinary diversion. we exclude at once those presented at end stage renal failure and required renal transplantation. The remaining (45) were aged between 5 and 15 years (mean 10.27); all of them underwent MAV in their right iliac fossa. Etiologies were dominated by neuropathic bladder (41 cases) ,mainly due to spina bifida defect with myelo-meningocele ; a posterior urethral valves causing altered bladder (2 cases) and complicated bladder exstrophy (2 cases). Diagnosis was established at advanced stage in all patients with mild renal failure (11) or moderate renal insufficiency in (34) with mean creatinine clearance of( 41 ml/min/1.73m2). RESULTS: The average follow-up was approximately 135 months (ranging from 12 to 256 months). All children became continent, 43 (95% ) after a single intervention. Minor complications consisted mainly on difficulties in intermittent catheterization (11.2%), they were treated merely by external stoma refection. The renal function deteriorated to severe renal failure (1 case), 6 years after surgery, then the patient underwent renal transplantation in his left iliac fossa; it remained stable at better levels with no need to dialysis, in 33 cases (average creatinine clearance of 58 ml/min/ 1.73m2), with mean follow up of 9 years; it returned to normal (11 cases). In addition, intermittent self-catheterization was well accepted by all children and their families, with complete readaptation to daily activities with good quality of life . CONCLUSIONS: The Mitrofanoff appendico-vesicostomy operation is usually associated to good results in children who suffer of some form of renal insufficiency. It ensures better continence status and a satisfactory educational rehabilitation. Our results demonstrate that it could also stabilize damaged renal function for quite a long time before renal replacement programmes if it was associated to mild or moderate renal failure.
European Urology | 2008
C. Scoffone; Cecilia Maria Cracco; Marco Cossu; Susanna Grande; M. Poggio; Roberto Mario Scarpa
European Urology | 2006
Francesco Porpiglia; Carlo Terrone; Julien Renard; Susanna Grande; Francesca Musso; Marco Cossu; Francesca Vacca; Roberto Mario Scarpa
European Urology Supplements | 2005
Francesco Porpiglia; F. Vacca; M. Cossu; J. Renard; F. Musso; Susanna Grande; Carlo Terrone; Roberto Mario Scarpa