Tommaso Silvestri

Quality of Life Assessment With Orthotopic Ileal Neobladder Reconstruction After Radical Cystectomy: Results From a Prospective Italian Multicenter Observational Study.

OBJECTIVE To assess health-related quality of life (HRQoL) parameters in patients who received radical cystectomy (RC) with ileal orthotopic neobladder (IONB) reconstruction and to identify clinic-pathologic predictors of HRQoL. PATIENTS AND METHODS From January 2010 to December 2013, a multicenter, retrospective on 174 RC-IONB patients was carried out. All patients completed the following questionnaires: the European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder cancer-specific instruments (QLQ-BLM30) and the IONB-Patient Reported Outcome (IONB-PRO). Univariate and multivariate analyses were computed to identify clinic-pathologic predictors of HRQoL. RESULTS Median age was 66 years (range, 31-83), and 91.4% of patients were men. Median follow-up period was 37 months (range, 3-247). The EORTC QLQ-C30 revealed that age >65 years, absence of urinary incontinence, and absence of peripheral vascular disease were independent predictors of deteriorated body image. A follow-up > 36 months and the presence of urinary incontinence were independent predictors of worsened urinary symptoms, whereas the absence of urinary incontinence was an independent predictor of a worsened body image according to EORTC QLQ-BLM30 results. A follow-up >36 months and the absence of urinary incontinence were independent predictors of better functioning in terms of relational life, emotional life, and fatigue as revealed by the IONB-PRO. CONCLUSION Age, presence of urinary incontinence, length of follow-up, and comorbidity status may influence postoperative HRQoL and should all be taken into account when counseling RC-IONB patients.

Development of a questionnaire specifically for patients with Ileal Orthotopic Neobladder (IONB)

BackgroundThe ileal orthotopic neobladder (IONB) is often used in patients undergoing radical cystectomy. The IONB allows to void avoiding the disadvantages of the external urinary diversion.In IONB patients the quality of life (QoL) appears compromised by the need to urinate voluntarily. The patients need to wake up at night interrupting the sleep-wake rhythm with consequences on social and emotional life.At present the QoL in IONB patients is evaluated by generic questionnaires. These are useful when IONB patients are compared with patients with different urinary diversions but they are less effective when only IONB patients are evaluated. To address this problem a specific questionnaire—the IONB-PRO—was developed.MethodsA) Based on a conceptual framework, narrative-based interviews were conducted on 35 IONB patients. A basic pool of 43 items was produced and organized throughout two clinical and four QoL dimensions. An additional 15 IONB patients were interviewed for face validity testing.B) Psychometric testing was conducted on 145 IONB patients. Both classic test strategy and Rasch analysis were applied. Psychometric properties of the resulting scales were comparatively tested against other QoL-validated scales.ResultsThe IONB-PRO questionnaire includes two sections: one on the QoL and a second section on the capability of the patient to manage the IONB. For evaluation of the QoL, three versions were delivered: 1) a basic 23-item QoL version (3 domains 23-items; alpha 0.86÷ 9.69), 2) a short-form 12-item QoL scale (alpha = 0.947), and 3) a short-form 15-item Rasch QoL scale (alpha = 0.967). Correlations of the long version scales with the corresponding dimensions of the EORTC-QLQ C30 and the EORTC-BLM30 were significant. The short forms exhibited significant correlations with the global health dimension of the EORTC-QLQ and with the urinary subscales of the EORTC-BLM30. The effect size was approximately 1.00 between patients at the 1-year follow-up period and those with 3, 5, and > 5-year follow-up periods for all scales. No relevant differences were observed between the 12-item short-form and the Rasch scale.ConclusionsThe IONB-PRO long and short-forms demonstrated a high level of internal consistency and reliability with an excellent discriminanting validity.

Sexually transmitted diseases: epidemiological and clinical aspects in adults

Sexually transmitted diseases (STDs) are the first 10 causes of unpleased diseases in young adult women in the world. The concept of STDs includes a series of syndromes caused by pathogens that can be acquired by sexual intercourse or sexual activity. Adolescents and young adults are responsible for only 25% of the sexually active population and they represent almost 50% of all newly acquired STDs. In this way, we evaluated the epidemiological and clinical aspects of most relevant pathogens as Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, Haemophilus Ducreyi, Trichomonas vaginalis, herpes simplex virus, human papilloma virus (HPV) with the exception of hepatitis, and HIV infections for which we suggest specific guidelines. To attain this objective, we analyzed the results of epidemiological and clinical aspects of STDs through a review of the literature using MEDLINE and PubMed database for original articles published using the terms “sexual transmitted disease, epidemiology, diagnosis and therapy” from 2005 to 2014.

Cryotherapy of Renal Lesions: Enhancement on Contrast-Enhanced Sonography on Postoperative Day 1 Does Not Imply Viable Tissue Persistence

To investigate whether persistent enhancement detected on contrast‐enhanced sonography at postoperative day 1 (early contrast‐enhanced sonography) after cryoablation of renal tumors implies the presence of residual viable tumor tissue, defined as residual enhancing tissue on reference imaging (computed tomography or magnetic resonance imaging) performed 6 months after the procedure.

Desmopressin in adult urological disease: clinical evidences

Desmopressin is a synthetic analogue of arginine vasopressin, commercially available since 1974. Desmopressin is proven effective for the treatment primary nocturnal enuresis and polyuria. It has been considered by several investigators for the treatment of nocturia with positive results and is now an established treatment for this indication. In this review, we assessed the available clinical data on desmopressin in adult urological disease.

A Novel Technique for Robotic Simple Prostatectomy: An Evolution of Retzius-sparing Technique

OBJECTIVE To present a novel surgical concept by using the trans-Douglas approach to perform a robotic-assisted simple prostatectomy (RASP) for high-volume benign prostate hyperplasia. This transposition from oncological surgery enables performance of a better bladder neck sparing adenomectomy with good functional results. MATERIALS AND METHODS The index patient is a 67-year-old man with a history of severe urinary flow outlet obstruction. Combination medical therapy is not effective. Transrectal ultrasound scan detected a 130-cm3 enlarged prostate with middle lobe. The International Prostate Symptoms Score (IPSS) was 30. The patient was scheduled for a RASP with a trans-Douglas approach to preserve the bladder neck. The patient was put in 30° Trendelenburg position. Six ports were placed across the lower abdomen: four 8-mm robotic trocars and 2 assistant trocars (12 and 5 mm). The parietal peritoneum was incised at the anterior surface of the Douglas space, according to the access to the prostate described by Bocciardi. The Denonvillier fascia was opened, seminal vesicles were exposed, and above the vesicles, the prostatic capsule was incised. The adenoma, together with the middle lobe, was split by the capsule from the base to the verumontanum. The bladder neck was advanced and remodeled to the distal urethral mucosa and then closed to the prostatic capsule by a double-layer suture. The peritoneal breach was closed. RESULTS The operation time was 120 minutes. Blood loss was 80 cc. There was no perioperative or postoperative complication. The catheter was removed after 4 days. Uroflowmetry showed a peak flow of 30 mL/s. Pathologic examination was negative for tumor. After 60 days, the IPSS score was 8. CONCLUSION Trans-Douglas-RASP is a safe and effective minimally invasive treatment for benign prostate hyperplasia. It is a novel technique to perform bladder neck sparing prostatic adenomectomy and could be 1 more field of application of robotic technology.

MP58-13 THE ROLE OF G8 SCREENING TOOL IN ELDERLY POPULATION UNDERGOING RADICAL CYSTECTOMY: PRELIMINARY EVALUATION

INTRODUCTION AND OBJECTIVES: The molecular mechanisms of muscle invasion in bladder cancer (BC) are still unknown. Based on the microRNA (miRNA) signature of BC by deep sequencing, we recently found that several double-stranded mature miRNAs derived from the same pre-miRNAs acted as tumor suppressors by regulating common target genes. In this study, we focused on miR-199 family members (miR-199a-3p/-5p and miR-199b-3p/-5p) that were downregulated in the signature. The aim of this study was to investigate the functional role of miR-199 family members and to identify molecular targets that contribute to tumor invasion in BC. METHODS: Expression levels of these miRNAs in 32 BC clinical samples and 12 normal bladder epithelia (NBE) and cell lines (T24 and BOY) were evaluated by qRT-PCR. Cell proliferation, migration, and invasion assays were performed in these miRNAs transfected BC cells. In silico analysis by using TargetScan and GEO database were applied to identify candidate target genes of these miRNAs. Luciferase reporter assays were carried out to determine whether these miRNAs directly bind to the target gene. We performed loss-of-function studies by using si-RNA transfectants to evaluate the functional role of target gene. We confirmed the target gene expression and the correlations between miR-199 family and the target gene expression by The Cancer Genome Atlas (TCGA) database (408 BCs and 19 NBE). RESULTS: The expression levels of these miRNAs were significantly reduced in clinical BCs (P < 0.005). Restoration of these miRNAs significantly inhibited cell migration and invasion in BC cells (P < 0.0001). Luciferase reporter assays identified integrin a3 (ITGA3) as a target gene directly regulated by these miRNAs. TCGA database showed that ITGA3 expression was significantly upregulated in BC compared with NBE (P 1⁄4 0.0063) and there were significant negative correlations between ITGA3 and miR-199 family expression (P < 0.05). Immunohistochemistry demonstrated ITGA3 expression was significantly upregulated in BCs compared with NBE (P 1⁄4 0.0038) and highly expressed in patients with advanced tumor stage (T2 or more) (P 1⁄4 0.048). Loss-of-function study showed that cell migration and invasion were significantly inhibited in si-ITGA3 transfectans (P < 0.0001). CONCLUSIONS: Recent studies showed that ITGA3 functions as extracellular matrix (ECM) receptor and contributes to cancer cell migration and invasion. Our data suggested that ITGA3 was directly regulated by miR-199 family and could be a novel therapeutic target in BC.

Intraoperative Ultrasound in Renal Surgery

Management of renal cell carcinoma (RCC) has evolved in the middle of the last century and particularly in the last decade, and this is due to a significant improvement in surgical techniques and the arrival of new technologies that can help both during the operation and in preoperative staging. Surgery remains the definitive therapy and the means of a cure. According to the American and European Urological Association guidelines, partial nephrectomy (PN) should be offered to all patients who have T1 tumours (i.e. tumours <7 cm), and it has been found to have comparable, possibly better, survival than radical nephrectomy (RN).

A singular case of polyorchidism

We report a case of polyorchidism, a rare congenital anomaly, frequently discovered by chance. At current knowledge is still not defined which is the best clinical and therapeutic approach as well the best follow- up scheme due to the unclear malignant potential and rate of complications if a conservative approach is used. MRI (Magnetic Resonance Imaging) seems to be a good method to discriminate this mass from others pathological findings but there is still not enough evidence to standardize the procedure.