Giacomo Novara - Academia.edu (original) (raw)

Papers by Giacomo Novara

Research paper thumbnail of Nomograms in Urologic Oncology: Lights and Shadows

Journal of Clinical Medicine

Decision-making in urologic oncology involves integrating multiple clinical data to provide an an... more Decision-making in urologic oncology involves integrating multiple clinical data to provide an answer to the needs of a single patient. Although the practice of medicine has always been an “art” involving experience, clinical data, scientific evidence and judgment, the creation of specialties and subspecialties has multiplied the challenges faced every day by physicians. In the last decades, with the field of urologic oncology becoming more and more complex, there has been a rise in tools capable of compounding several pieces of information and supporting clinical judgment and experience when approaching a difficult decision. The vast majority of these tools provide a risk of a certain event based on various information integrated in a mathematical model. Specifically, most decision-making tools in the field of urologic focus on the preoperative or postoperative phase and provide a prognostic or predictive risk assessment based on the available clinical and pathological data. More r...

Research paper thumbnail of Gadolinium-Based Contrast Media Nephrotoxicity in Kidney Impairment: The Physio-Pathological Conditions for the Perfect Murder

Journal of Clinical Medicine

Gadolinium-based contrast media (GBCM) toxicity in patients with kidney disease is a concern for ... more Gadolinium-based contrast media (GBCM) toxicity in patients with kidney disease is a concern for the possible development of systemic nephrogenic fibrosis and possible renal complications. This review focuses on the pathological mechanisms underlying the potential kidney toxicity of gadolinium. Gadolinium, as a free compound (Gd3+), is highly toxic in humans because it competes with divalent calcium (Ca2+) and magnesium (Mg2+) ions, interfering in some relevant biologic processes. Its toxicity is blunted by the complexing of Gd3+ with a carrier, allowing its use in magnetic resonance imaging. The binding reaction between gadolinium and a carrier is thermodynamically reversible. Consequently, under some conditions, gadolinium can be released in the interstitial space as a free Gd3+ compound with the possibility of toxicity. Other metals such as iron, copper, and calcium can interfere with the binding between gadolinium and its carrier because they compete for the same binding site. T...

Research paper thumbnail of The Impact of Centralised Services on Metric Reflecting High-quality Performance: Outcomes from 1110 Consecutive Radical Cystectomies at a Single Centre

Research paper thumbnail of 919Prognostic relevance of tumour necrosis in conventional renal cell carcinoma: A multivariate analysis of 388 patients

European Urology Supplements

Research paper thumbnail of Multidisciplinary teams for the proper management of patients with genitourinary tumors: When topics set scientific societies' agenda

Tumori, 2018

The multidisciplinary management of oncologic patients is identified as the bottom line element o... more The multidisciplinary management of oncologic patients is identified as the bottom line element of quality in tumor care. In 2015, 7 Italian scientific societies representing the specialists involved in the diagnosis and treatment of genitourinary tumors joined efforts in the Italian uro-oncologic multidisciplinary teams (MDTs) project. The aims were to promote the reorganization of genitourinary cancer care, switching to a multidisciplinary approach, reach a consensus on the core elements for the setup of MDTs in genitourinary oncology, and support health policy makers and managers in remodeling of the assistance and care of uro-oncologic patients on a national level. The first activity was the setup of 5 working groups, given the task of exploring selected topics: general principles, organization of MDTs, minimal requirements, economic evaluation, and relations with authorities. The groups participated in the writing of a document that was approved by the scientific societies and ...

Research paper thumbnail of Efficacy and Safety of Sacral and Percutaneous Tibial Neuromodulation in Non-neurogenic Lower Urinary Tract Dysfunction and Chronic Pelvic Pain: A Systematic Review of the Literature

European urology, Jan 11, 2018

Neuromodulation is considered in patients with non-neurogenic lower urinary tract dysfunction (LU... more Neuromodulation is considered in patients with non-neurogenic lower urinary tract dysfunction (LUTD) not responsive to conservative treatment. To systematically review the available studies on efficacy and safety of sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) in non-neurogenic LUTDs not responsive to conservative treatments. A literature research was conducted in PubMed/Medline and Scopus, restricted to articles in English, published between January 1998 and June 2017, with at least 20 patients and 6 mo of follow-up. Twenty-one reports were identified. Concerning SNM, the improvement of ≥50% in leakage episodes ranged widely between 29% and 76%. Overall dry rate ranged between 43% and 56%. Overall success/improvement rate in PTNS varied between 54% and 59%. Symptom improvement or efficacy in interstitial cystitis/bladder pain syndrome patients appeared to be lower compared with other indications in both techniques. Safety data showed fewer side effe...

Research paper thumbnail of 390 Prognostic Factors in Chromophobe Renal Cell Carcinoma: Results from a Retrospective Multicenter Series

European Urology Supplements

Research paper thumbnail of 501 External Validation of the Preoperative Karakiewicz Nomogram in a Multicenter Series of Patients with Renal Cell Carcinoma Treated with Radical or Partial Nephrectomy

European Urology Supplements

Research paper thumbnail of Low Pressure Robot-assisted Radical Prostatectomy With the AirSeal System at OLV Hospital: Results From a Prospective Study

Clinical genitourinary cancer, Jan 2, 2017

Limited studies examined effects of pneumoperiotneum during robot-assisted radical prostatectomy ... more Limited studies examined effects of pneumoperiotneum during robot-assisted radical prostatectomy (RARP) and with AirSeal. The aim of this study was to assess the effect on hemodynamics of a lower pressure pneumoperitoneum (8 mmHg) with AirSeal, during RARP in steep Trendelenburg 45° (ST). This is an institutional review board-approved, prospective, interventional, single-center study including patients treated with RARP at OLV Hospital by one extremely experienced surgeon (July 2015-February 2016). Intraoperative monitoring included: arterial pressure, central venous pressure, cardiac output, heart rate, stroke volume, systemic vascular resistance, intrathoracic pressure, airways pressures, left ventricular end-diastolic and end-systolic areas/volumes and ejection fraction, by transesophageal echocardiography, an esophageal catheter, and FloTrac/Vigileo system. Measurements were performed after induction of anesthesia with patient in horizontal (T0), 5 minutes after 8 mmHg pneumoper...

Research paper thumbnail of Efficacy and Safety of Hexanic Lipidosterolic Extract of Serenoa repens (Permixon) in the Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: Systematic Review and Meta-analysis of Randomized Controlled Trials

European Urology Focus, 2016

A recent Cochrane Collaboration meta-analysis of randomized controlled trials (RCTs) evaluating t... more A recent Cochrane Collaboration meta-analysis of randomized controlled trials (RCTs) evaluating the efficacy of different extracts of Serenoa repens in relieving lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) concluded that these extracts were no more effective than placebo. However, among all Serenoa repens extracts, Permixon (Pierre Fabre Medicament, Paris, France) has the highest activity and the most accurate standards of drug preparation and extraction. To evaluate the efficacy and safety of Permixon in the treatment of LUTS/BPH. A systematic review and meta-analysis of the literature was performed in January 2016 using the Medline, Scopus, and Web of Science databases, searching for the term Serenoa repens in all fields of the records. Only RCTs reporting on efficacy and safety of Permixon in the treatment of LUTS/BPH were selected. The systematic search identified 12 RCTs: 7 compared Permixon with placebo; 2 compared Permixon with tamsulosin; 2 compared Permixon plus tamsulosin with, respectively, placebo plus tamsulosin and tamsulosin alone; and 1 compared Permixon with finasteride. Permixon was significantly more effective than placebo in reducing the number of nocturnal voids (weighted mean difference [WMD] -0.31; p=0.03) and increasing maximum flow rate (Qmax; WMD 3.37; p<0.0001). The rates of overall adverse events (odds ratio [OR] 1.12; p=0.92) and withdrawal (OR 1.52; p=0.60) were similar for Permixon and placebo. Permixon was as effective as tamsulosin monotherapy and short-term therapy with finasteride in improving International Prostate Symptom Score (WMD 1.15; 95% confidence interval [CI], -1.11 to 3.40; p=0.32) and Qmax (WMD -0.16; 95% CI, -0.60 to 0.28; p=0.48). The combination of Permixon and tamsulosin was more effective than Permixon alone for relieving LUTS (WMD 0.31; 95% CI, 0.13-0.48; p<0.01) but not for improving Qmax (WMD 0.10; 95% CI -0.02 to 0.21; p=0.10). Permixon had a favorable safety profile, with a very limited impact with regard to ejaculatory dysfunction compared with tamsulosin (0.5% vs 4%; p=0.007) and with regard to decreased libido and impotence compared with short-term finasteride (2.2% and 1.5% vs 3% and 2.8%, respectively). The conclusions of the recent Cochrane meta-analysis on Serenoa repens in the treatment of LUTS/BPH apparently do not apply to Permixon. Our meta-analysis showed that Permixon decreased nocturnal voids and Qmax compared with placebo and had efficacy in relieving LUTS similar to tamsulosin and short-term finasteride. Moreover, Permixon had a favorable safety profile with a very limited impact on sexual function, which is significantly affected by all other drugs used to treat LUTS/BPH. A systematic review of the literature showed that Permixon was effective for relieving urinary symptoms due to prostate enlargement and improving urinary flow compared with placebo. Permixon had efficacy similar to tamsulosin and short-term finasteride in relieving urinary symptoms. Permixon was well tolerated and had a very limited impact on sexual function.

Research paper thumbnail of POD-05.05 Risk Stratification of Patients Who Are pT0N0 after Radical Cystectomy

Data Revues 00904295 V78i3ss S0090429511011411, Oct 14, 2011

Research paper thumbnail of Discrepancy between clinical and pathological stage: external validation of the impact on prognosis in an international radical cystectomy cohort

Bju International, Mar 1, 2011

Research paper thumbnail of 415 Prognostic Value of Concomitant Carcinoma in Situ in Patients Treated with Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

Research paper thumbnail of Many facets of chromosome 3p cytogenetic findings in clear cell renal carcinoma: the need for agreement in assessment FISH analysis to avoid diagnostic errors

Histology and Histopathology Cellular and Molecular Biology, Sep 1, 2011

Abnormalities of the locus chromosome 3p and the entire chromosome 3 are involved in the cancerog... more Abnormalities of the locus chromosome 3p and the entire chromosome 3 are involved in the cancerogenesis of clear cell renal carcinoma and may be detected by interphase fluorescence in situ hybridization (interphase FISH). We observed a variable detection rate of chromosome 3p/3 abnormalities in different series of clear cell renal carcinoma. Therefore, we focused on problematic issues when performing analysis on routinely available formalin-fixed and paraffin embedded tissue. A group of studies encountered a single approach to chromosome 3p detection, by using probe/s to map different codes of the short arm 3p without a control of the entire chromosome 3. Deletion of chromosome 3p and monosomy of chromosome 3 ranged from 38% to 100% in clear cell renal carcinoma. Cut-off values for the threshold were chosen randomly or obtained by calculation of the mean value plus 1 or 2 or 3 standard deviations. Loss of chromosome 3p was assessed either as the percentage of single signals on the total number of nuclei, or applying a double approach with corrections of control chromosome 3. Moreover, cut off values were sometimes arbitrarily corrected with the findings from normal adjacent renal parenchyma. A consensus of experts in the field is needed in order to define the best methodological approach and the appropriate threshold in assessment 3p deletion when interphase FISH is performed in clear cell renal carcinoma. This harbours relevant diagnostic and therapeutic implications, at light also of targeted therapies recently available to clear cell renal carcinoma.

Research paper thumbnail of Ucla Integrating Staging System and Ssign Score: Which is More Predictive?

Research paper thumbnail of 507 Papillary renal cell carcinoma: Clinical and pathological characteristics and prognostic factors

Research paper thumbnail of The ‘Stage, Size, Grade and Necrosis’ score is more accurate than the University of California Los Angeles Integrated Staging System for predicting cancer‐specific survival in patients with clear cell renal cell carcinoma

Research paper thumbnail of Urethral fixation technique improves early urinary continence recovery in patients who underwent Retropubic Radical Prostatectomy

BJU International, 2016

to describe step by step an original urethra-vesical anastomosis technique (Urethral fixation) in... more to describe step by step an original urethra-vesical anastomosis technique (Urethral fixation) in patients who underwent retropubic radical prostatectomy (RRP) and compare the observed early urinary continence recovery rates with those reported in a control group receiving a standard anastomosis technique. Moreover, we identified the predictors of early urinary continence recovery. We compared 70 patients who underwent RRP with urethral fixation technique with a contemporary control group of 51 patients who received RRP with a standard urethra-vesical anastomosis. In the study group, the urethra-vesical anastomosis was performed using 8 single stitches. Specifically, to avoid retraction and/or deviations we fixed the urethral stump laterally to the medial portion of levator ani muscle. Moreover, to maintain the normal position in the context of pelvic floor we fixed the urethra sphincter deeper to the medial dorsal rafe using a 3-0 PDS stitch at 6 o'clock before completing the incision of the urethral wall. Urinary continence recovery was evaluated 1 week, 1, 2 and 3 months after catheter removal. Patients self-reporting no urine leak were considered continent. Univariable and multivariable analyses were used to identify predictors of urinary incontinence at different follow-ups. The two evaluated groups resulted comparable for all the pre-operative variables. One week after catheter removal, 32 (45.7%) patients in the study group and 10 (19.6%) in the control group were continents (p=0.01), respectively. Similarly, 1 month after catheter removal, 46 (65.7%) patients in the urethral fixation group and 16 (31.4%) declared to be continent (p=0.001), respectively. Two months after catheter removal, 59 (84.3%) patients in the study group and 21 (41.2%) in the control group were continents (p<0.001), respectively. Finally, 3-mo after catheter removal, 63 (90%) patients in the study group and 32 (62.7%) in the control ones were continents (p=0.001), respectively. The urethral fixation technique turned out to be an independent predictor of urinary continence recovery 1 week (OR 4.305; p=0.002); 1 month (OR 4.784; p<0.001); 2 months (OR 7.678; p<0.001) and 3 months (OR 5.152; p=0.001) after catheter removal. The urethral fixation technique significantly improves early urinary continence recovery in comparison with standard technique. Moreover, our study confirmed that this surgical technique is able to be a independent predictors of urinary continence recovery 1-week, 1-mo, 2-mo and 3-mo after catheter removal. This article is protected by copyright. All rights reserved.

Research paper thumbnail of UP-01.072 Clinical Impact of Body Mass Index on the Outcome of the SPARC-Sling System for the Treatment of Female Stress Urinary Incontinence

Research paper thumbnail of No overt influence of lymphadenectomy on cancer-specific survival in organ-confined versus locally advanced upper urinary tract urothelial carcinoma undergoing radical nephroureterectomy: a retrospective international, multi-institutional study

World Journal of Urology, Jun 1, 2011

Lymph node dissection (LND) is not routinely performed during radical nephroureterectomy (RNU) in... more Lymph node dissection (LND) is not routinely performed during radical nephroureterectomy (RNU) in upper tract urothelial carcinomas (UTUC), and its clinical relevance is unclear. The purpose of the present study was to evaluate the impact of LND on clinical outcomes in a large multicenter series of RNU for UTUC. Detailed data on 785 patients subject to RNU were provided by nine international academic centers. The choice to perform lymphadenectomy was determined by the treating surgeon. All pathology slides were evaluated by dedicated genitourinary pathologists. Univariable and multivariable Cox regression models evaluated the association of nodal status with recurrence-free (RFS) and cancer-specific (CSS) survival. One hundred and ninety patients had LND. Pathological N stage was pN0 in 17%, pNx in 76%, and pN+ in 7%. The median follow-up period of the entire cohort was 34 months (interquartile range [IQR]: 15-65 months). Overall, five-year RFS and CSS estimates were 72.2 and 76%, respectively. In multivariable Cox regression analyses, pN0/pNx substaging was not an independent predictor of either RFS (hazard ratio [HR]: 1.1; P = 0.631) or CSS (HR: 1.3; P = 0.223). Similar results were obtained in a subgroup analysis limited to patients with organ-confined disease (HR: 0.9; P = 0.907 for RFS; HR: 0.4; P = 0.419 for CSS). Conversely, in patients with locally advanced disease, patients with pN0 disease have significantly better cancer-related outcomes (HR: 0.3; P < 0.001 for RFS; HR: 0.3; P < 0.001 for CSS). The present series suggests pNx is more significantly associated with a worse prognosis than pN0, but only in patients with locally advanced UTUC.

Research paper thumbnail of Nomograms in Urologic Oncology: Lights and Shadows

Journal of Clinical Medicine

Decision-making in urologic oncology involves integrating multiple clinical data to provide an an... more Decision-making in urologic oncology involves integrating multiple clinical data to provide an answer to the needs of a single patient. Although the practice of medicine has always been an “art” involving experience, clinical data, scientific evidence and judgment, the creation of specialties and subspecialties has multiplied the challenges faced every day by physicians. In the last decades, with the field of urologic oncology becoming more and more complex, there has been a rise in tools capable of compounding several pieces of information and supporting clinical judgment and experience when approaching a difficult decision. The vast majority of these tools provide a risk of a certain event based on various information integrated in a mathematical model. Specifically, most decision-making tools in the field of urologic focus on the preoperative or postoperative phase and provide a prognostic or predictive risk assessment based on the available clinical and pathological data. More r...

Research paper thumbnail of Gadolinium-Based Contrast Media Nephrotoxicity in Kidney Impairment: The Physio-Pathological Conditions for the Perfect Murder

Journal of Clinical Medicine

Gadolinium-based contrast media (GBCM) toxicity in patients with kidney disease is a concern for ... more Gadolinium-based contrast media (GBCM) toxicity in patients with kidney disease is a concern for the possible development of systemic nephrogenic fibrosis and possible renal complications. This review focuses on the pathological mechanisms underlying the potential kidney toxicity of gadolinium. Gadolinium, as a free compound (Gd3+), is highly toxic in humans because it competes with divalent calcium (Ca2+) and magnesium (Mg2+) ions, interfering in some relevant biologic processes. Its toxicity is blunted by the complexing of Gd3+ with a carrier, allowing its use in magnetic resonance imaging. The binding reaction between gadolinium and a carrier is thermodynamically reversible. Consequently, under some conditions, gadolinium can be released in the interstitial space as a free Gd3+ compound with the possibility of toxicity. Other metals such as iron, copper, and calcium can interfere with the binding between gadolinium and its carrier because they compete for the same binding site. T...

Research paper thumbnail of The Impact of Centralised Services on Metric Reflecting High-quality Performance: Outcomes from 1110 Consecutive Radical Cystectomies at a Single Centre

Research paper thumbnail of 919Prognostic relevance of tumour necrosis in conventional renal cell carcinoma: A multivariate analysis of 388 patients

European Urology Supplements

Research paper thumbnail of Multidisciplinary teams for the proper management of patients with genitourinary tumors: When topics set scientific societies' agenda

Tumori, 2018

The multidisciplinary management of oncologic patients is identified as the bottom line element o... more The multidisciplinary management of oncologic patients is identified as the bottom line element of quality in tumor care. In 2015, 7 Italian scientific societies representing the specialists involved in the diagnosis and treatment of genitourinary tumors joined efforts in the Italian uro-oncologic multidisciplinary teams (MDTs) project. The aims were to promote the reorganization of genitourinary cancer care, switching to a multidisciplinary approach, reach a consensus on the core elements for the setup of MDTs in genitourinary oncology, and support health policy makers and managers in remodeling of the assistance and care of uro-oncologic patients on a national level. The first activity was the setup of 5 working groups, given the task of exploring selected topics: general principles, organization of MDTs, minimal requirements, economic evaluation, and relations with authorities. The groups participated in the writing of a document that was approved by the scientific societies and ...

Research paper thumbnail of Efficacy and Safety of Sacral and Percutaneous Tibial Neuromodulation in Non-neurogenic Lower Urinary Tract Dysfunction and Chronic Pelvic Pain: A Systematic Review of the Literature

European urology, Jan 11, 2018

Neuromodulation is considered in patients with non-neurogenic lower urinary tract dysfunction (LU... more Neuromodulation is considered in patients with non-neurogenic lower urinary tract dysfunction (LUTD) not responsive to conservative treatment. To systematically review the available studies on efficacy and safety of sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) in non-neurogenic LUTDs not responsive to conservative treatments. A literature research was conducted in PubMed/Medline and Scopus, restricted to articles in English, published between January 1998 and June 2017, with at least 20 patients and 6 mo of follow-up. Twenty-one reports were identified. Concerning SNM, the improvement of ≥50% in leakage episodes ranged widely between 29% and 76%. Overall dry rate ranged between 43% and 56%. Overall success/improvement rate in PTNS varied between 54% and 59%. Symptom improvement or efficacy in interstitial cystitis/bladder pain syndrome patients appeared to be lower compared with other indications in both techniques. Safety data showed fewer side effe...

Research paper thumbnail of 390 Prognostic Factors in Chromophobe Renal Cell Carcinoma: Results from a Retrospective Multicenter Series

European Urology Supplements

Research paper thumbnail of 501 External Validation of the Preoperative Karakiewicz Nomogram in a Multicenter Series of Patients with Renal Cell Carcinoma Treated with Radical or Partial Nephrectomy

European Urology Supplements

Research paper thumbnail of Low Pressure Robot-assisted Radical Prostatectomy With the AirSeal System at OLV Hospital: Results From a Prospective Study

Clinical genitourinary cancer, Jan 2, 2017

Limited studies examined effects of pneumoperiotneum during robot-assisted radical prostatectomy ... more Limited studies examined effects of pneumoperiotneum during robot-assisted radical prostatectomy (RARP) and with AirSeal. The aim of this study was to assess the effect on hemodynamics of a lower pressure pneumoperitoneum (8 mmHg) with AirSeal, during RARP in steep Trendelenburg 45° (ST). This is an institutional review board-approved, prospective, interventional, single-center study including patients treated with RARP at OLV Hospital by one extremely experienced surgeon (July 2015-February 2016). Intraoperative monitoring included: arterial pressure, central venous pressure, cardiac output, heart rate, stroke volume, systemic vascular resistance, intrathoracic pressure, airways pressures, left ventricular end-diastolic and end-systolic areas/volumes and ejection fraction, by transesophageal echocardiography, an esophageal catheter, and FloTrac/Vigileo system. Measurements were performed after induction of anesthesia with patient in horizontal (T0), 5 minutes after 8 mmHg pneumoper...

Research paper thumbnail of Efficacy and Safety of Hexanic Lipidosterolic Extract of Serenoa repens (Permixon) in the Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: Systematic Review and Meta-analysis of Randomized Controlled Trials

European Urology Focus, 2016

A recent Cochrane Collaboration meta-analysis of randomized controlled trials (RCTs) evaluating t... more A recent Cochrane Collaboration meta-analysis of randomized controlled trials (RCTs) evaluating the efficacy of different extracts of Serenoa repens in relieving lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) concluded that these extracts were no more effective than placebo. However, among all Serenoa repens extracts, Permixon (Pierre Fabre Medicament, Paris, France) has the highest activity and the most accurate standards of drug preparation and extraction. To evaluate the efficacy and safety of Permixon in the treatment of LUTS/BPH. A systematic review and meta-analysis of the literature was performed in January 2016 using the Medline, Scopus, and Web of Science databases, searching for the term Serenoa repens in all fields of the records. Only RCTs reporting on efficacy and safety of Permixon in the treatment of LUTS/BPH were selected. The systematic search identified 12 RCTs: 7 compared Permixon with placebo; 2 compared Permixon with tamsulosin; 2 compared Permixon plus tamsulosin with, respectively, placebo plus tamsulosin and tamsulosin alone; and 1 compared Permixon with finasteride. Permixon was significantly more effective than placebo in reducing the number of nocturnal voids (weighted mean difference [WMD] -0.31; p=0.03) and increasing maximum flow rate (Qmax; WMD 3.37; p<0.0001). The rates of overall adverse events (odds ratio [OR] 1.12; p=0.92) and withdrawal (OR 1.52; p=0.60) were similar for Permixon and placebo. Permixon was as effective as tamsulosin monotherapy and short-term therapy with finasteride in improving International Prostate Symptom Score (WMD 1.15; 95% confidence interval [CI], -1.11 to 3.40; p=0.32) and Qmax (WMD -0.16; 95% CI, -0.60 to 0.28; p=0.48). The combination of Permixon and tamsulosin was more effective than Permixon alone for relieving LUTS (WMD 0.31; 95% CI, 0.13-0.48; p<0.01) but not for improving Qmax (WMD 0.10; 95% CI -0.02 to 0.21; p=0.10). Permixon had a favorable safety profile, with a very limited impact with regard to ejaculatory dysfunction compared with tamsulosin (0.5% vs 4%; p=0.007) and with regard to decreased libido and impotence compared with short-term finasteride (2.2% and 1.5% vs 3% and 2.8%, respectively). The conclusions of the recent Cochrane meta-analysis on Serenoa repens in the treatment of LUTS/BPH apparently do not apply to Permixon. Our meta-analysis showed that Permixon decreased nocturnal voids and Qmax compared with placebo and had efficacy in relieving LUTS similar to tamsulosin and short-term finasteride. Moreover, Permixon had a favorable safety profile with a very limited impact on sexual function, which is significantly affected by all other drugs used to treat LUTS/BPH. A systematic review of the literature showed that Permixon was effective for relieving urinary symptoms due to prostate enlargement and improving urinary flow compared with placebo. Permixon had efficacy similar to tamsulosin and short-term finasteride in relieving urinary symptoms. Permixon was well tolerated and had a very limited impact on sexual function.

Research paper thumbnail of POD-05.05 Risk Stratification of Patients Who Are pT0N0 after Radical Cystectomy

Data Revues 00904295 V78i3ss S0090429511011411, Oct 14, 2011

Research paper thumbnail of Discrepancy between clinical and pathological stage: external validation of the impact on prognosis in an international radical cystectomy cohort

Bju International, Mar 1, 2011

Research paper thumbnail of 415 Prognostic Value of Concomitant Carcinoma in Situ in Patients Treated with Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

Research paper thumbnail of Many facets of chromosome 3p cytogenetic findings in clear cell renal carcinoma: the need for agreement in assessment FISH analysis to avoid diagnostic errors

Histology and Histopathology Cellular and Molecular Biology, Sep 1, 2011

Abnormalities of the locus chromosome 3p and the entire chromosome 3 are involved in the cancerog... more Abnormalities of the locus chromosome 3p and the entire chromosome 3 are involved in the cancerogenesis of clear cell renal carcinoma and may be detected by interphase fluorescence in situ hybridization (interphase FISH). We observed a variable detection rate of chromosome 3p/3 abnormalities in different series of clear cell renal carcinoma. Therefore, we focused on problematic issues when performing analysis on routinely available formalin-fixed and paraffin embedded tissue. A group of studies encountered a single approach to chromosome 3p detection, by using probe/s to map different codes of the short arm 3p without a control of the entire chromosome 3. Deletion of chromosome 3p and monosomy of chromosome 3 ranged from 38% to 100% in clear cell renal carcinoma. Cut-off values for the threshold were chosen randomly or obtained by calculation of the mean value plus 1 or 2 or 3 standard deviations. Loss of chromosome 3p was assessed either as the percentage of single signals on the total number of nuclei, or applying a double approach with corrections of control chromosome 3. Moreover, cut off values were sometimes arbitrarily corrected with the findings from normal adjacent renal parenchyma. A consensus of experts in the field is needed in order to define the best methodological approach and the appropriate threshold in assessment 3p deletion when interphase FISH is performed in clear cell renal carcinoma. This harbours relevant diagnostic and therapeutic implications, at light also of targeted therapies recently available to clear cell renal carcinoma.

Research paper thumbnail of Ucla Integrating Staging System and Ssign Score: Which is More Predictive?

Research paper thumbnail of 507 Papillary renal cell carcinoma: Clinical and pathological characteristics and prognostic factors

Research paper thumbnail of The ‘Stage, Size, Grade and Necrosis’ score is more accurate than the University of California Los Angeles Integrated Staging System for predicting cancer‐specific survival in patients with clear cell renal cell carcinoma

Research paper thumbnail of Urethral fixation technique improves early urinary continence recovery in patients who underwent Retropubic Radical Prostatectomy

BJU International, 2016

to describe step by step an original urethra-vesical anastomosis technique (Urethral fixation) in... more to describe step by step an original urethra-vesical anastomosis technique (Urethral fixation) in patients who underwent retropubic radical prostatectomy (RRP) and compare the observed early urinary continence recovery rates with those reported in a control group receiving a standard anastomosis technique. Moreover, we identified the predictors of early urinary continence recovery. We compared 70 patients who underwent RRP with urethral fixation technique with a contemporary control group of 51 patients who received RRP with a standard urethra-vesical anastomosis. In the study group, the urethra-vesical anastomosis was performed using 8 single stitches. Specifically, to avoid retraction and/or deviations we fixed the urethral stump laterally to the medial portion of levator ani muscle. Moreover, to maintain the normal position in the context of pelvic floor we fixed the urethra sphincter deeper to the medial dorsal rafe using a 3-0 PDS stitch at 6 o'clock before completing the incision of the urethral wall. Urinary continence recovery was evaluated 1 week, 1, 2 and 3 months after catheter removal. Patients self-reporting no urine leak were considered continent. Univariable and multivariable analyses were used to identify predictors of urinary incontinence at different follow-ups. The two evaluated groups resulted comparable for all the pre-operative variables. One week after catheter removal, 32 (45.7%) patients in the study group and 10 (19.6%) in the control group were continents (p=0.01), respectively. Similarly, 1 month after catheter removal, 46 (65.7%) patients in the urethral fixation group and 16 (31.4%) declared to be continent (p=0.001), respectively. Two months after catheter removal, 59 (84.3%) patients in the study group and 21 (41.2%) in the control group were continents (p<0.001), respectively. Finally, 3-mo after catheter removal, 63 (90%) patients in the study group and 32 (62.7%) in the control ones were continents (p=0.001), respectively. The urethral fixation technique turned out to be an independent predictor of urinary continence recovery 1 week (OR 4.305; p=0.002); 1 month (OR 4.784; p<0.001); 2 months (OR 7.678; p<0.001) and 3 months (OR 5.152; p=0.001) after catheter removal. The urethral fixation technique significantly improves early urinary continence recovery in comparison with standard technique. Moreover, our study confirmed that this surgical technique is able to be a independent predictors of urinary continence recovery 1-week, 1-mo, 2-mo and 3-mo after catheter removal. This article is protected by copyright. All rights reserved.

Research paper thumbnail of UP-01.072 Clinical Impact of Body Mass Index on the Outcome of the SPARC-Sling System for the Treatment of Female Stress Urinary Incontinence

Research paper thumbnail of No overt influence of lymphadenectomy on cancer-specific survival in organ-confined versus locally advanced upper urinary tract urothelial carcinoma undergoing radical nephroureterectomy: a retrospective international, multi-institutional study

World Journal of Urology, Jun 1, 2011

Lymph node dissection (LND) is not routinely performed during radical nephroureterectomy (RNU) in... more Lymph node dissection (LND) is not routinely performed during radical nephroureterectomy (RNU) in upper tract urothelial carcinomas (UTUC), and its clinical relevance is unclear. The purpose of the present study was to evaluate the impact of LND on clinical outcomes in a large multicenter series of RNU for UTUC. Detailed data on 785 patients subject to RNU were provided by nine international academic centers. The choice to perform lymphadenectomy was determined by the treating surgeon. All pathology slides were evaluated by dedicated genitourinary pathologists. Univariable and multivariable Cox regression models evaluated the association of nodal status with recurrence-free (RFS) and cancer-specific (CSS) survival. One hundred and ninety patients had LND. Pathological N stage was pN0 in 17%, pNx in 76%, and pN+ in 7%. The median follow-up period of the entire cohort was 34 months (interquartile range [IQR]: 15-65 months). Overall, five-year RFS and CSS estimates were 72.2 and 76%, respectively. In multivariable Cox regression analyses, pN0/pNx substaging was not an independent predictor of either RFS (hazard ratio [HR]: 1.1; P = 0.631) or CSS (HR: 1.3; P = 0.223). Similar results were obtained in a subgroup analysis limited to patients with organ-confined disease (HR: 0.9; P = 0.907 for RFS; HR: 0.4; P = 0.419 for CSS). Conversely, in patients with locally advanced disease, patients with pN0 disease have significantly better cancer-related outcomes (HR: 0.3; P < 0.001 for RFS; HR: 0.3; P < 0.001 for CSS). The present series suggests pNx is more significantly associated with a worse prognosis than pN0, but only in patients with locally advanced UTUC.