Dear Editor,We aimed to describe the management of the intraoperative injury of the right external iliac artery that occurred during robot-assisted right nephroureterectomy with bladder cuff excision.Surgery was sched...Dear Editor,We aimed to describe the management of the intraoperative injury of the right external iliac artery that occurred during robot-assisted right nephroureterectomy with bladder cuff excision.Surgery was scheduled for suspected urothelial carcinoma of the distal ureter in a 60-year-old woman.The patient involved in the present research signed a dedicated form to consent to the publication of images and/or information about her.Past medical history included Brugada syndrome diagnosed in 2015,and hypercholesterolemia.Past surgical history included one cesarean section only.Family history included ovarian cancer(sister),colorectal cancer(mother),and kidney cancer(father).展开更多
Objective:Infectious complications after partial nephrectomy(PN)remain a significant concern.We aimed to analyze predictive factors of postoperative infectious complications(PICs)occurring after PN.Methods:Data on pat...Objective:Infectious complications after partial nephrectomy(PN)remain a significant concern.We aimed to analyze predictive factors of postoperative infectious complications(PICs)occurring after PN.Methods:Data on patients undergoing PN for renal masses between January 2018 and May 2023 were retrieved from prospectively maintained institutional database and retrospectively analyzed.Patients were stratified into two groups based on the occurrence of PICs during admission for PN.A PIC was defined by clinical and/or imaging findings of an infectious process plus microbial isolation upon culture examination.Multivariable logistic regression analysis after adjusting for potential confounders evaluated predictors of a PIC.Results:Six-hundred and twenty-seven patients underwent PN;rough incidence of PICs was 11%,with median time to PIC onset of 1(interquartile range 0–3)day.Compared to patients without PIC events,the PIC group showed a significantly higher proportion of open surgeries(54%vs.20%,p<0.001),bleeding events(23%vs.10%,p<0.01),postoperative transfusion(19%vs.5.0%,p<0.001),and urinary leakage(4.2%vs.0.18%,p=0.01),and a statistically significantly higher median hemoglobin drop from baseline(−2.6 g/dL vs.−1.7 g/dL,p=0.001).At multivariable logistic regression,the odds of experiencing a PIC were statistically significantly lower after minimally-invasive surgery compared to open surgery(odds ratio 0.32,95%confidence interval 0.17–0.59),and higher for patients who received transfusion(odds ratio 1.68,95%confidence interval 1.10–2.54).Conclusion:We underlined factors that impact the occurrence of PICs and,consequently,duration of hospitalization following PN.By addressing these predictors,clinicians can promote enhanced patient recovery.展开更多
The study aimed to test if Briganti’s 2012 nomogram could be associated with the risk of prostate cancer (PCa) progression in European Association of Urology (EAU) intermediate-risk patients treated with robotic surg...The study aimed to test if Briganti’s 2012 nomogram could be associated with the risk of prostate cancer (PCa) progression in European Association of Urology (EAU) intermediate-risk patients treated with robotic surgery. From January 2013 to December 2021, 527 consecutive patients belonging to the EAU intermediate-risk class were selected. Briganti’s 2012 nomogram, which predicts the risk of pelvic lymph node invasion (PLNI), was assessed as a continuous and dichotomous variable that categorized up to the median of 3.0%. Disease progression defined as biochemical recurrence and/or metastatic progression was evaluated by Cox proportional hazards (univariate and multivariate analysis). After a median follow-up of 95.0 months (95% confidence interval [CI]: 78.5–111.4), PCa progression occurred in 108 (20.5%) patients who were more likely to present with an unfavorable nomogram risk score, independently by the occurrence of unfavorable pathology including tumor upgrading and upstaging as well as PLNI. Accordingly, as Briganti’s 2012 risk score increased, patients were more likely to experience disease progression (hazard ratio [HR] = 1.060;95% CI: 1.021–1.100;P = 0.002);moreover, it also remained significant when dichotomized above a risk score of 3.0% (HR = 2.052;95% CI: 1.298–3.243;P < 0.0001) after adjustment for clinical factors. In the studied risk population, PCa progression was independently predicted by Briganti’s 2012 nomogram. Specifically, we found that patients were more likely to experience disease progression as their risk score increased. Because of the significant association between risk score and tumor behavior, the nomogram can further stratify intermediate-risk PCa patients, who represent a heterogeneous risk category for which different treatment paradigms exist.展开更多
An enduring debate in research revolves around the association between elevated endogenous testosterone levels and prostate cancer. This systematic review is intended to assess the present understanding of the role of...An enduring debate in research revolves around the association between elevated endogenous testosterone levels and prostate cancer. This systematic review is intended to assess the present understanding of the role of endogenous testosterone in the diagnosis and treatment of low- and intermediate-risk prostate cancer. Our search strategy was the following: (endogenous testosterone) AND (((low risk) OR (intermediate risk)) AND ((diagnosis) OR (treatment))) AND (prostate cancer);that was applied to PubMed, Web of Science, and Scopus databases to identify pertinent articles. Two investigators performed an independent selection following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The preliminary investigation detected 105 records, and 81 records remained after eliminating duplicates. Following the review of titles and abstracts, 71 articles were excluded. A comprehensive examination of the full text was conducted for 10 articles, excluding 3 of them. After revising the references of eligible articles, other 3 articles were included. We finally identified 10 suitable studies, including three main topics: (1) association between endogenous testosterone and European Association of Urology (EAU) risk classes;(2) association between endogenous testosterone density and the tumor load;and (3) association of endogenous testosterone with tumor upgrading and tumor upstaging. Actual literature about the impact of endogenous testosterone on low- and intermediate-risk prostate cancer is not numerous, but appears to be still conflicting. More investigations are needed to increase the consistency of the literature’s results.展开更多
Our aim is to evaluate the association between body mass index(BMI)and preoperative total testosterone(TT)levels with the risk of single and multiple metastatic lymph node invasion(LNI)in prostate cancer patients unde...Our aim is to evaluate the association between body mass index(BMI)and preoperative total testosterone(TT)levels with the risk of single and multiple metastatic lymph node invasion(LNI)in prostate cancer patients undergoing radical prostatectomy and extended pelvic lymph node dissection.Preoperative BMI,basal levels of TT,and prostate-specific antigen(PSA)were evaluated in 361 consecutive patients undergoing radical prostatectomy with extended pelvic lymph node dissection between 2014 and 2017・Patients were grouped into either nonmetastatic,one,or more than one metastatic lymph node invasion groups.The association among clinical factors and LNI was evaluated.LNI was detected in 52(14.4%)patients:28(7.8%)cases had one metastatic node and 24(6.6%)had more than one metastatic node.In the overall study population,BMI correlated inversely with TT(r=-0.256;P<0.0001).In patients without metastases,BMI inversely correlated with TT(r=-0.282;P<0.0001).In patients with metastasis,this correlation was lost.In the overall study population,BMI(odds ratio[OR]=1.268;P=0.005)was the only in dependent clinical factor associated with the risk of multiple metastatic LNI compared to cases with one metastatic node.In the nonmetastatic group,TT was lower in patients with BMI>28 kg m^2(P<0.0001).In patients with any LNI,this association was lost(P=0.232).The median number of positive nodes was higher in patients with BMI>28 kg m^2(P-0.048).In our study,overweight and obese patients had a higher risk of harboring multiple prostate cancer lymph node metastases and lower TT levels when compared to patients with normal BMI.展开更多
We tested the association between endogenous testosterone density(ETD;the ratio between endogenous testosterone[ET]and prostate volume)and prostate cancer(PCa)aggressiveness in very favorable low-and intermediate-risk...We tested the association between endogenous testosterone density(ETD;the ratio between endogenous testosterone[ET]and prostate volume)and prostate cancer(PCa)aggressiveness in very favorable low-and intermediate-risk PCa patients who underwent radical prostatectomy(RP).Only patients with prostate-specific antigen(PSA)within 10 ng ml^(-1),clinical stage T1c,and International Society of Urological Pathology(IsUP)grade group 1 or 2 were included.Preoperative ET levels up to 350 ng dl^(-1)were classified as abnormal.Tumor quantitation density factors were evaluated as the ratio between percentage of biopsy-positive cores and prostate volume(biopsy-positive cores density,BPCD)and the ratio between percentage of cancer invasion at final pathology and prostate weight(tumor load density,TLD).Disease upgrading was coded as ISUP grade group>2,and progression as recurrence(biochemical and/or local and/or distant).Risk associations were evaluated by multivariable Cox and logistic regression models.Of 320 patients,151(47.2%)had intermediate-risk PCa.ET(median:402.3 ng dl^(-1))resulted abnormal in 111(34.7%)cases(median ETD:9.8 ng dl^(-1)ml^(-1)).Upgrading and progression occurred in 109(34.1%)and 32(10.6%)cases,respectively.Progression was predicted by ISUP grade group 2(hazard ratio[HR]:2.290;P=0.029)and upgrading(HR:3.098;P=0.003),which was associated with ISUP grade group 2(odds ratio[OR]:1.785;P=0.017)and TLD above the median(OR:2.261;P=0.001).After adjustment for PSAdensity and bodymass index(BMI),ETDabovethemedianwas positivelyassociatedwithBPCD(OR:3.404;P<0.001)and TLD(OR:5.238;P<0.001).Notably,subjects with abnormal ET were more likely to have higher BPCD(OR:5.566;P=0.002),as well as TLD(OR:14.998;P=0.016).Independently by routinely evaluated factors,as ETD increased,BPCD and TLD increased,but increments were higher for abnormal ET levels.In very favorable cohorts,ETD may further stratify the risk of aggressive PCa.展开更多
Objective:To investigate the effects of prostate cancer(PCa)surgery on the stress system and to identify potential independent factors associating with stress recovery.Methods:The design of the study was prospective a...Objective:To investigate the effects of prostate cancer(PCa)surgery on the stress system and to identify potential independent factors associating with stress recovery.Methods:The design of the study was prospective and PCa surgery included robot assisted radical prostatectomy(RARP)or retropubic radical prostatectomy(RRP).Between February 2013 to December 2014,315 consecutive patients were evaluated.The effects of PCa surgery on the stress system were measured by cortisol serum levels before and after surgery on postoperative day(POD)0,1,3,5 and 45.Cortisol variations in the population and subpopulation(RARP vs.RRP)of patients were investigated by statistical methods.Factors associating with stress recovery were assessed by simple linear regression(SLR)and multiple linear regression(MLR)analysis.Results:RARP was performed in 75.9%of cases.In the patient population,there were wide serum cortisol perioperative variations.PCa surgery triggered the stress system which immediately(POD 0)responded by cortisol overproduction which induced the negative feedback mechanism that started on POD 1,continued on POD 3,was still ongoing on POD 5 and completely settled on POD 45(stress recovery).In the subpopulation of patients,significantly lower cortisol serum levels were detected on POD 3e5 in RARP cases inwhomcortisol levels were close to preoperative levels(stress recovery)on POD 5.Independent predictive factors of serum cortisol on POD 5(stress recovery)were preoperative cortisol(p Z 0.02),cortisol levels on POD 3(p<0.0001)and RARP(p Z 0.03)in which the association was negative(stress recovery faster than RRP).Conclusion:Our study shows that PCa surgery immediately(POD 0)triggers the stress system which respond by overproduction of cortisol which induces the negative feedback mechanism that starts on POD 1,is still ongoing on POD 5,but is completely settled on POD 45.Moreover,after surgical trauma,our study gives evidence that the RARP procedure associates with stress recovery faster than RRP.Further confirmatory studies are required.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
Objectives:To test hypothesized associations between the ABO blood group(ABO-bg)system and the pathological features of prostate cancer(PCa).Material and methods:Between January 2013 and September 2019,1173 patients u...Objectives:To test hypothesized associations between the ABO blood group(ABO-bg)system and the pathological features of prostate cancer(PCa).Material and methods:Between January 2013 and September 2019,1173 patients underwent radical prostatectomy.Associations between ABO-bg levels and pathological features were evaluated using statistical methods.Results:Overall,1149 consecutive patients were evaluated using the ABO-bg system,which was represented by O-bg(42.8%)and A-bg(41.3%),followed by B-bg(11.1%)and AB-bg(4.8%).Only positive surgical margins(PSMs)was correlated with ABO-bg(Pearson correlation coefficient,r=0.071;p=0.017),and the risk was increased in group-O(odds ratio[OR],1.497;95%confidence interval,1.149-1.950;p=0.003)versus non-O-bg.In clinical and pathological models,O-bg was at increased risk of PSM after the adjustment for prostate-specific antigen,percentage of biopsy-positive cores,and high surgical volume(adjusted OR,1.546;95%confidence interval,1.180-2.026;p=0.002);however,the adjusted OR did not change after the adjustment for tumor load and stage as well as high surgical volume.Conclusions:In clinical PCa,the risk of PSM was higher in O-bg versus non-O-bg patients after the adjustment for standard predictors.Confirmatory studies are needed to confirm the association between ABO-bg and unfavorable PCa features.展开更多
文摘Dear Editor,We aimed to describe the management of the intraoperative injury of the right external iliac artery that occurred during robot-assisted right nephroureterectomy with bladder cuff excision.Surgery was scheduled for suspected urothelial carcinoma of the distal ureter in a 60-year-old woman.The patient involved in the present research signed a dedicated form to consent to the publication of images and/or information about her.Past medical history included Brugada syndrome diagnosed in 2015,and hypercholesterolemia.Past surgical history included one cesarean section only.Family history included ovarian cancer(sister),colorectal cancer(mother),and kidney cancer(father).
文摘Objective:Infectious complications after partial nephrectomy(PN)remain a significant concern.We aimed to analyze predictive factors of postoperative infectious complications(PICs)occurring after PN.Methods:Data on patients undergoing PN for renal masses between January 2018 and May 2023 were retrieved from prospectively maintained institutional database and retrospectively analyzed.Patients were stratified into two groups based on the occurrence of PICs during admission for PN.A PIC was defined by clinical and/or imaging findings of an infectious process plus microbial isolation upon culture examination.Multivariable logistic regression analysis after adjusting for potential confounders evaluated predictors of a PIC.Results:Six-hundred and twenty-seven patients underwent PN;rough incidence of PICs was 11%,with median time to PIC onset of 1(interquartile range 0–3)day.Compared to patients without PIC events,the PIC group showed a significantly higher proportion of open surgeries(54%vs.20%,p<0.001),bleeding events(23%vs.10%,p<0.01),postoperative transfusion(19%vs.5.0%,p<0.001),and urinary leakage(4.2%vs.0.18%,p=0.01),and a statistically significantly higher median hemoglobin drop from baseline(−2.6 g/dL vs.−1.7 g/dL,p=0.001).At multivariable logistic regression,the odds of experiencing a PIC were statistically significantly lower after minimally-invasive surgery compared to open surgery(odds ratio 0.32,95%confidence interval 0.17–0.59),and higher for patients who received transfusion(odds ratio 1.68,95%confidence interval 1.10–2.54).Conclusion:We underlined factors that impact the occurrence of PICs and,consequently,duration of hospitalization following PN.By addressing these predictors,clinicians can promote enhanced patient recovery.
文摘The study aimed to test if Briganti’s 2012 nomogram could be associated with the risk of prostate cancer (PCa) progression in European Association of Urology (EAU) intermediate-risk patients treated with robotic surgery. From January 2013 to December 2021, 527 consecutive patients belonging to the EAU intermediate-risk class were selected. Briganti’s 2012 nomogram, which predicts the risk of pelvic lymph node invasion (PLNI), was assessed as a continuous and dichotomous variable that categorized up to the median of 3.0%. Disease progression defined as biochemical recurrence and/or metastatic progression was evaluated by Cox proportional hazards (univariate and multivariate analysis). After a median follow-up of 95.0 months (95% confidence interval [CI]: 78.5–111.4), PCa progression occurred in 108 (20.5%) patients who were more likely to present with an unfavorable nomogram risk score, independently by the occurrence of unfavorable pathology including tumor upgrading and upstaging as well as PLNI. Accordingly, as Briganti’s 2012 risk score increased, patients were more likely to experience disease progression (hazard ratio [HR] = 1.060;95% CI: 1.021–1.100;P = 0.002);moreover, it also remained significant when dichotomized above a risk score of 3.0% (HR = 2.052;95% CI: 1.298–3.243;P < 0.0001) after adjustment for clinical factors. In the studied risk population, PCa progression was independently predicted by Briganti’s 2012 nomogram. Specifically, we found that patients were more likely to experience disease progression as their risk score increased. Because of the significant association between risk score and tumor behavior, the nomogram can further stratify intermediate-risk PCa patients, who represent a heterogeneous risk category for which different treatment paradigms exist.
文摘An enduring debate in research revolves around the association between elevated endogenous testosterone levels and prostate cancer. This systematic review is intended to assess the present understanding of the role of endogenous testosterone in the diagnosis and treatment of low- and intermediate-risk prostate cancer. Our search strategy was the following: (endogenous testosterone) AND (((low risk) OR (intermediate risk)) AND ((diagnosis) OR (treatment))) AND (prostate cancer);that was applied to PubMed, Web of Science, and Scopus databases to identify pertinent articles. Two investigators performed an independent selection following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The preliminary investigation detected 105 records, and 81 records remained after eliminating duplicates. Following the review of titles and abstracts, 71 articles were excluded. A comprehensive examination of the full text was conducted for 10 articles, excluding 3 of them. After revising the references of eligible articles, other 3 articles were included. We finally identified 10 suitable studies, including three main topics: (1) association between endogenous testosterone and European Association of Urology (EAU) risk classes;(2) association between endogenous testosterone density and the tumor load;and (3) association of endogenous testosterone with tumor upgrading and tumor upstaging. Actual literature about the impact of endogenous testosterone on low- and intermediate-risk prostate cancer is not numerous, but appears to be still conflicting. More investigations are needed to increase the consistency of the literature’s results.
文摘Our aim is to evaluate the association between body mass index(BMI)and preoperative total testosterone(TT)levels with the risk of single and multiple metastatic lymph node invasion(LNI)in prostate cancer patients undergoing radical prostatectomy and extended pelvic lymph node dissection.Preoperative BMI,basal levels of TT,and prostate-specific antigen(PSA)were evaluated in 361 consecutive patients undergoing radical prostatectomy with extended pelvic lymph node dissection between 2014 and 2017・Patients were grouped into either nonmetastatic,one,or more than one metastatic lymph node invasion groups.The association among clinical factors and LNI was evaluated.LNI was detected in 52(14.4%)patients:28(7.8%)cases had one metastatic node and 24(6.6%)had more than one metastatic node.In the overall study population,BMI correlated inversely with TT(r=-0.256;P<0.0001).In patients without metastases,BMI inversely correlated with TT(r=-0.282;P<0.0001).In patients with metastasis,this correlation was lost.In the overall study population,BMI(odds ratio[OR]=1.268;P=0.005)was the only in dependent clinical factor associated with the risk of multiple metastatic LNI compared to cases with one metastatic node.In the nonmetastatic group,TT was lower in patients with BMI>28 kg m^2(P<0.0001).In patients with any LNI,this association was lost(P=0.232).The median number of positive nodes was higher in patients with BMI>28 kg m^2(P-0.048).In our study,overweight and obese patients had a higher risk of harboring multiple prostate cancer lymph node metastases and lower TT levels when compared to patients with normal BMI.
文摘We tested the association between endogenous testosterone density(ETD;the ratio between endogenous testosterone[ET]and prostate volume)and prostate cancer(PCa)aggressiveness in very favorable low-and intermediate-risk PCa patients who underwent radical prostatectomy(RP).Only patients with prostate-specific antigen(PSA)within 10 ng ml^(-1),clinical stage T1c,and International Society of Urological Pathology(IsUP)grade group 1 or 2 were included.Preoperative ET levels up to 350 ng dl^(-1)were classified as abnormal.Tumor quantitation density factors were evaluated as the ratio between percentage of biopsy-positive cores and prostate volume(biopsy-positive cores density,BPCD)and the ratio between percentage of cancer invasion at final pathology and prostate weight(tumor load density,TLD).Disease upgrading was coded as ISUP grade group>2,and progression as recurrence(biochemical and/or local and/or distant).Risk associations were evaluated by multivariable Cox and logistic regression models.Of 320 patients,151(47.2%)had intermediate-risk PCa.ET(median:402.3 ng dl^(-1))resulted abnormal in 111(34.7%)cases(median ETD:9.8 ng dl^(-1)ml^(-1)).Upgrading and progression occurred in 109(34.1%)and 32(10.6%)cases,respectively.Progression was predicted by ISUP grade group 2(hazard ratio[HR]:2.290;P=0.029)and upgrading(HR:3.098;P=0.003),which was associated with ISUP grade group 2(odds ratio[OR]:1.785;P=0.017)and TLD above the median(OR:2.261;P=0.001).After adjustment for PSAdensity and bodymass index(BMI),ETDabovethemedianwas positivelyassociatedwithBPCD(OR:3.404;P<0.001)and TLD(OR:5.238;P<0.001).Notably,subjects with abnormal ET were more likely to have higher BPCD(OR:5.566;P=0.002),as well as TLD(OR:14.998;P=0.016).Independently by routinely evaluated factors,as ETD increased,BPCD and TLD increased,but increments were higher for abnormal ET levels.In very favorable cohorts,ETD may further stratify the risk of aggressive PCa.
文摘Objective:To investigate the effects of prostate cancer(PCa)surgery on the stress system and to identify potential independent factors associating with stress recovery.Methods:The design of the study was prospective and PCa surgery included robot assisted radical prostatectomy(RARP)or retropubic radical prostatectomy(RRP).Between February 2013 to December 2014,315 consecutive patients were evaluated.The effects of PCa surgery on the stress system were measured by cortisol serum levels before and after surgery on postoperative day(POD)0,1,3,5 and 45.Cortisol variations in the population and subpopulation(RARP vs.RRP)of patients were investigated by statistical methods.Factors associating with stress recovery were assessed by simple linear regression(SLR)and multiple linear regression(MLR)analysis.Results:RARP was performed in 75.9%of cases.In the patient population,there were wide serum cortisol perioperative variations.PCa surgery triggered the stress system which immediately(POD 0)responded by cortisol overproduction which induced the negative feedback mechanism that started on POD 1,continued on POD 3,was still ongoing on POD 5 and completely settled on POD 45(stress recovery).In the subpopulation of patients,significantly lower cortisol serum levels were detected on POD 3e5 in RARP cases inwhomcortisol levels were close to preoperative levels(stress recovery)on POD 5.Independent predictive factors of serum cortisol on POD 5(stress recovery)were preoperative cortisol(p Z 0.02),cortisol levels on POD 3(p<0.0001)and RARP(p Z 0.03)in which the association was negative(stress recovery faster than RRP).Conclusion:Our study shows that PCa surgery immediately(POD 0)triggers the stress system which respond by overproduction of cortisol which induces the negative feedback mechanism that starts on POD 1,is still ongoing on POD 5,but is completely settled on POD 45.Moreover,after surgical trauma,our study gives evidence that the RARP procedure associates with stress recovery faster than RRP.Further confirmatory studies are required.
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.
文摘Objectives:To test hypothesized associations between the ABO blood group(ABO-bg)system and the pathological features of prostate cancer(PCa).Material and methods:Between January 2013 and September 2019,1173 patients underwent radical prostatectomy.Associations between ABO-bg levels and pathological features were evaluated using statistical methods.Results:Overall,1149 consecutive patients were evaluated using the ABO-bg system,which was represented by O-bg(42.8%)and A-bg(41.3%),followed by B-bg(11.1%)and AB-bg(4.8%).Only positive surgical margins(PSMs)was correlated with ABO-bg(Pearson correlation coefficient,r=0.071;p=0.017),and the risk was increased in group-O(odds ratio[OR],1.497;95%confidence interval,1.149-1.950;p=0.003)versus non-O-bg.In clinical and pathological models,O-bg was at increased risk of PSM after the adjustment for prostate-specific antigen,percentage of biopsy-positive cores,and high surgical volume(adjusted OR,1.546;95%confidence interval,1.180-2.026;p=0.002);however,the adjusted OR did not change after the adjustment for tumor load and stage as well as high surgical volume.Conclusions:In clinical PCa,the risk of PSM was higher in O-bg versus non-O-bg patients after the adjustment for standard predictors.Confirmatory studies are needed to confirm the association between ABO-bg and unfavorable PCa features.
