Objectives:The study aimed to evaluate quality of nephrolithometric nomograms to predict stone-free rates(SFRs)and complication rates(CRs)in case of minimally invasive percutaneous nephrolithotomy(PNL).In the last dec...Objectives:The study aimed to evaluate quality of nephrolithometric nomograms to predict stone-free rates(SFRs)and complication rates(CRs)in case of minimally invasive percutaneous nephrolithotomy(PNL).In the last decade,nomograms have been introduced to estimate the SFRs and CRs of PNL.However,no data are available regarding their reliability in case of utilization of miniaturized devices.Herein we present a prospective multicentric study to evaluate reliability of Guy’s stone score(GSS),the stone size,tract length,obstruction,number of involved calyces,and essence of stone(S.T.O.N.E.)nephrolithometry score and Clinical Research Office of the Endourological Society(CROES)score in patients treated with minimally invasive PNL.Methods:We evaluated SFRs and CRs of 222 adult patients treated with miniaturized PNL.Patients were considered stone-free if no residual fragments of any size at post-operative unenhanced computed tomography scan.Patients demographics,SFRs,and CRs were reported and analyzed.Performances of nomograms were evaluated with the area under the curve(AUC).Results:We included 222 patients,the AUCs of GSS,CROES score,and S.T.O.N.E.nephrolithometry score were 0.69(95%confidence interval[CI]0.61-0.78),0.64(95%CI 0.56-0.73),and 0.62(95%CI 0.52-0.71),respectively.Regarding SFRs,at multivariate binomial logistic regression,only the GSS had significance with an odds ratio of 0.53(95%CI 0.31e0.95,p=0.04).We did not find significant correlation with complications,with only a trend for GSS.Conclusion:This is the first study evaluating nomograms in miniaturized PNL.They still show good reliability;however,our data showed lower performances compared to standard PNL.We emphasize the need of further studies to confirm this trend.A dedicated nomogram for minimally invasive PNL may be necessary.展开更多
Identification of reliable molecular biomarkers that can complement clinical practice represents a fascinating challenge in any cancer field.Urothelial carcinoma is a very heterogeneous disease and responses to system...Identification of reliable molecular biomarkers that can complement clinical practice represents a fascinating challenge in any cancer field.Urothelial carcinoma is a very heterogeneous disease and responses to systemic therapies,and outcomes after radical cystectomy are difficult to predict.Advances in molecular biology such as next generation sequencing and whole genome or transcriptomic analysis provide promising platforms to achieve a full understanding of the biology behind the disease and can identify emerging predictive biomarkers.Moreover,the ability to categorize patients’risk of recurrence after curative treatment,or even predict benefit from a conventional or targeted therapies,represents a compelling challenge that may reshape both selection for tailored treatment and disease monitoring.Progress has been made but currently no molecular biomarkers are used in the clinical setting to predict response to systemic agents in either neoadjuvant or adjuvant settings highlighting a relevant unmet need.Here,we aim to present the emerging role of molecular biomarkers in predicting response to systemic agents in urothelial carcinoma.展开更多
Dear Editor,The patient had a history of intermittent self-resolving episodes of gross haematuria and was referred to our department for a massive bleeding.At presentation,haemoglobin was 8.6 g/dL and creatinine was 1...Dear Editor,The patient had a history of intermittent self-resolving episodes of gross haematuria and was referred to our department for a massive bleeding.At presentation,haemoglobin was 8.6 g/dL and creatinine was 1.37 mg/dL.He was hemodynamically stable,but suffered an important anemization in the subsequent days requiring multiple blood transfusions.In his medical history,it was reported that he had type II diabetes mellitus and the implantation of a right iliac-femoral stent 10 years before.展开更多
Background The coronavirus disease(COVID-19)pandemic has posed challenges to the global health care community,affecting the management of upper urinary tract stones.Materials and methods This retrospective study invol...Background The coronavirus disease(COVID-19)pandemic has posed challenges to the global health care community,affecting the management of upper urinary tract stones.Materials and methods This retrospective study involved 9 Italian centers.We compared the 12-month period prior to COVID-19(March 1,2019,to February 28,2020;Period A)with the COVID-19 period(March 1,2020,to February 28,2021,Period B).This study aimed to compare outcomes during Periods A and B,specifically focusing on the overall number of treatments,rate of urgent/elective cases,and operational complexity.Results A total of 4018 procedures were collected,comprising 2176 procedures during Period A and 1842 during Period B,indicating a loss of 15.35%(p<0.001).In the elective cases,1622 procedures were conducted in Period A,compared with 1280 in Period B,representing a 21.09%reduction in cases(p=0.001).All types of stone treatments were affected:extracorporeal shock wave lithotripsy(−29.37%,p=0.001),percutaneous nephrolithotomy(−26.47%,p=0.008),retrograde surgeries for renal stones(−10.63%,p=0.008),and semirigid ureterolithotripsy(−24.86%,p=0.008).Waiting lists experienced significant delays during Period B.The waiting time(WT)for elective procedures increased during Period B(p<0.001).For ureteral stones,the mean WT in Period A was 61.44 days compared with 86.56 days in Period B(p=0.008).The WT for renal stones increased from 64.96 days in Period A to 85.66 days in Period B for retrograde intrarenal surgery(p=0.008)and from 96.9 days to 1103.9 days(p=0.035)for percutaneous nephrolithotomy procedures.Conclusions Our study demonstrates that COVID-19 significantly disrupted endourological services across the country.Our data underline how patients received treatment over a prolonged period,potentially increasing the risk of stone-related complications and patient discomfort.展开更多
文摘Objectives:The study aimed to evaluate quality of nephrolithometric nomograms to predict stone-free rates(SFRs)and complication rates(CRs)in case of minimally invasive percutaneous nephrolithotomy(PNL).In the last decade,nomograms have been introduced to estimate the SFRs and CRs of PNL.However,no data are available regarding their reliability in case of utilization of miniaturized devices.Herein we present a prospective multicentric study to evaluate reliability of Guy’s stone score(GSS),the stone size,tract length,obstruction,number of involved calyces,and essence of stone(S.T.O.N.E.)nephrolithometry score and Clinical Research Office of the Endourological Society(CROES)score in patients treated with minimally invasive PNL.Methods:We evaluated SFRs and CRs of 222 adult patients treated with miniaturized PNL.Patients were considered stone-free if no residual fragments of any size at post-operative unenhanced computed tomography scan.Patients demographics,SFRs,and CRs were reported and analyzed.Performances of nomograms were evaluated with the area under the curve(AUC).Results:We included 222 patients,the AUCs of GSS,CROES score,and S.T.O.N.E.nephrolithometry score were 0.69(95%confidence interval[CI]0.61-0.78),0.64(95%CI 0.56-0.73),and 0.62(95%CI 0.52-0.71),respectively.Regarding SFRs,at multivariate binomial logistic regression,only the GSS had significance with an odds ratio of 0.53(95%CI 0.31e0.95,p=0.04).We did not find significant correlation with complications,with only a trend for GSS.Conclusion:This is the first study evaluating nomograms in miniaturized PNL.They still show good reliability;however,our data showed lower performances compared to standard PNL.We emphasize the need of further studies to confirm this trend.A dedicated nomogram for minimally invasive PNL may be necessary.
文摘Identification of reliable molecular biomarkers that can complement clinical practice represents a fascinating challenge in any cancer field.Urothelial carcinoma is a very heterogeneous disease and responses to systemic therapies,and outcomes after radical cystectomy are difficult to predict.Advances in molecular biology such as next generation sequencing and whole genome or transcriptomic analysis provide promising platforms to achieve a full understanding of the biology behind the disease and can identify emerging predictive biomarkers.Moreover,the ability to categorize patients’risk of recurrence after curative treatment,or even predict benefit from a conventional or targeted therapies,represents a compelling challenge that may reshape both selection for tailored treatment and disease monitoring.Progress has been made but currently no molecular biomarkers are used in the clinical setting to predict response to systemic agents in either neoadjuvant or adjuvant settings highlighting a relevant unmet need.Here,we aim to present the emerging role of molecular biomarkers in predicting response to systemic agents in urothelial carcinoma.
文摘Dear Editor,The patient had a history of intermittent self-resolving episodes of gross haematuria and was referred to our department for a massive bleeding.At presentation,haemoglobin was 8.6 g/dL and creatinine was 1.37 mg/dL.He was hemodynamically stable,but suffered an important anemization in the subsequent days requiring multiple blood transfusions.In his medical history,it was reported that he had type II diabetes mellitus and the implantation of a right iliac-femoral stent 10 years before.
文摘Background The coronavirus disease(COVID-19)pandemic has posed challenges to the global health care community,affecting the management of upper urinary tract stones.Materials and methods This retrospective study involved 9 Italian centers.We compared the 12-month period prior to COVID-19(March 1,2019,to February 28,2020;Period A)with the COVID-19 period(March 1,2020,to February 28,2021,Period B).This study aimed to compare outcomes during Periods A and B,specifically focusing on the overall number of treatments,rate of urgent/elective cases,and operational complexity.Results A total of 4018 procedures were collected,comprising 2176 procedures during Period A and 1842 during Period B,indicating a loss of 15.35%(p<0.001).In the elective cases,1622 procedures were conducted in Period A,compared with 1280 in Period B,representing a 21.09%reduction in cases(p=0.001).All types of stone treatments were affected:extracorporeal shock wave lithotripsy(−29.37%,p=0.001),percutaneous nephrolithotomy(−26.47%,p=0.008),retrograde surgeries for renal stones(−10.63%,p=0.008),and semirigid ureterolithotripsy(−24.86%,p=0.008).Waiting lists experienced significant delays during Period B.The waiting time(WT)for elective procedures increased during Period B(p<0.001).For ureteral stones,the mean WT in Period A was 61.44 days compared with 86.56 days in Period B(p=0.008).The WT for renal stones increased from 64.96 days in Period A to 85.66 days in Period B for retrograde intrarenal surgery(p=0.008)and from 96.9 days to 1103.9 days(p=0.035)for percutaneous nephrolithotomy procedures.Conclusions Our study demonstrates that COVID-19 significantly disrupted endourological services across the country.Our data underline how patients received treatment over a prolonged period,potentially increasing the risk of stone-related complications and patient discomfort.
