Rosario Leonardi - Academia.edu (original) (raw)

Papers by Rosario Leonardi

Research paper thumbnail of Laser Circumcision: A New Technique

IntechOpen eBooks, Feb 15, 2023

Research paper thumbnail of External validation of Resorlu-Unsal stone score in predicting outcomes after retrograde intrarenal surgery. Experience from a single institution

Archivio italiano di urologia, andrologia, Sep 26, 2022

Results: The present study included a total of 79 patients. Mean patient age was 55.1 ± 15.4 year... more Results: The present study included a total of 79 patients. Mean patient age was 55.1 ± 15.4 years with a mean stone size was 14.2 ± 4.4 mm. Overall, 62/79 (78.4%) patients were stone free after the initial treatment. After applying RUSS, 36 (45.6%), 29 (36.7%), 10 (12.6%), and 4 (5.1%) patients had a score of 0, 1, 2, and 3, respectively. On multivariate logistic regression RUSS (OR = 0.220; 95%CI: 0.086-0.567; p = 0.002) was identified as the only predictor of postoperative stone-free status. Conclusions: RUSS is a user-friendly scoring system that may predict postoperative stone-free rate after RIRS with great efficacy and accuracy.

Research paper thumbnail of Histological evaluation of prostatic tissue following transurethral laser resection (TULaR) using the 980 nm diode laser

PubMed, Mar 1, 2010

Objectives: In the present study, we performed for the first time an histological evaluation afte... more Objectives: In the present study, we performed for the first time an histological evaluation after 980 nm diode laser treatment of bladder outlet obstruction secondary to benign prostatic hypertrophy (BPH). The aim was to demonstrate the possibility of obtaining sufficient tissue for histological examination and the possibility of obtaining an histological diagnosis on the specimen obtained by laser resection. Materials and methods: 86 patients with BPH were selected for laser surgery and 10 patients for transurethral prostate resection. The prostate tissue samples collected from laser surgery and transurethral resection of the prostate (TURP) were fixed in 10% formalin and serial sections with a slice thickness of 5-7 micron embedded in paraffin and stained with haematoxylin and eosin. Results: Samples obtained using the 980 nm diode laser ranged in size from 4 mm to 30 mm and showed brownish, smooth margins. Lasered tissue showed a coagulation rim of 0.5 mm (range: 0.2-1 mm) and adjacent to the vaporized tissue, coagulated connective tissue and glandular epithelia were seen. Beyond this zone a complete detachment of glandular epithelia from the connective tissue was observed. Stromal oedema associated with ectasic vessels but without extravasation of red blood cells, haemosiderin deposition and haemorrhagic areas were also retrieved. All cases showed occlusion of small vessels beyond the zone of coagulated tissue. Unlike laser treatment, samples obtained from TURP showed extravasation of red blood cells, haemosiderin deposition and haemorrhagic areas. Conclusions: The 980 nm diode laser provides high rates of tissue ablation, associated with excellent haemostasis. It has been shown that tissue samples can be obtained with this technique, which allow a histological diagnosis of BPH to be made. The current method involving the 980 nm diode laser induces a vaporesection of prostate tissue and the acronym of TULaR (transurethral laser resection) has therefore been created to describe this technique.

Research paper thumbnail of TULA DUAL: Trans Urethral Laser Ablation of recurrent bladder tumors in outpatient setting

Archivio italiano di urologia, andrologia, Feb 22, 2023

Bladder cancer (BCa) is the second most common cancer in urological clinical practice, after pros... more Bladder cancer (BCa) is the second most common cancer in urological clinical practice, after prostate adenocarcinoma. Usually occurs in patients between 60 and 70 years old, three times more frequently in men than women (1, 2). About 75% of bladder cancer are pTa or pT1 (3), even more frequently considering a population younger than 40 years old. Early detection is of paramount importance since allows to find tumors when they are still superficial and therefore with a better prognosis. Management of Non Muscle Invasive Bladder Cancer (NMIBC) accordingly to EAU guidelines (4), is based on intravesical chemotherapy and endourological procedures (transurethral resection of bladder cancer), which requires operating theater, anesthesiologic assistance, scrub nurses and dedicated instruments . Trans Urethral Resection of the Bladder Tumor (TURBT) is the gold standard in the treatment of NMIBC accordingly to the literature and it is in fact a mature procedure with a standardized technique, but it is still facing some challenges and risks such as difficult control of cutting depth, stimulation of the obturator nerve, bladder perforation and iliac vascular injury (7). For these reasons, it is interesting to study how other technologies are growing and how we could use them in this so frequent and ubiquitarian disease management. In particular, recently there is a great interest in transurethral laser surgery and especially regarding its comparison to standard TURBT. Some studies showed similar results in both oncological and safeness terms (8-12). The en bloc laser techniques might allow a clearer cut of the tumor base, simplifying pathologist reading of the surgical samples (13). Furthermore, BCa has a 1-and 5-year recurrence rates that can be very high, and several patients require additional TURBT during follow-up (4, 14). One of the recent problems of healthcare organizations is to address the current shortage of operating theater resources, reducing costs, while guaranteeing the best possible treatment for the patients. From this point of view, the possibility to treat some carefully selected BCa recurrences patients with on an outpatient basis would represent an important saving in both economic and organizational terms, reducing hospitalization and discomfort for the patient and his family. According to these pressing needs, we present our experience of an innovative outpatient laser treatment ("TULA DUAL") in a BCa relapsed patient. We highlight the case of an 85 years-old woman in follow-up over the previous five years for NMIBC (urothelial bladder cancer, pTa LG). She was ineligible for standard TURBT because of age and several comorbidities which led to an ASA IV score. She was taking medical therapy for atrial fibrillation (anticoagulation therapy), hypertension and diabetes mellitus, added to recurring episodes of hematuria. During a follow up cystoscopy were endoscopically detected over 20 lesions highly suspected for BCa recurrence. The lesions were pink, papillary and typically aspect of non-muscle invasive lesions. The most of these lesions were millimetric, three of these had a plant base of about one centimeter. A recent urinary cytology was negative for high grade BCa while a Kidney-Ureters-Bladder Ultrasound didn't show hydronephrosis or further suspicious findings. In this situation we should have organized an operating theater to perform a TURB, suspending the anticoagulation therapy; but instead, considering the anamnesis and the clinical condition, we decided accordingly to the patient to perform the TULA DUAL procedure. The TULA DUAL is an endoscopic procedure, executed with a DUAL laser (diode laser technology 980-1470 wave length) in local anesthesia or even without it, in an ambulatory setting. It allows the contemporary vaporization and hemostasis of tissues. Patients are summoned in ambulatory, where is administered a one-shoot antibiotic prophylaxis according to current guidelines for endoscopic operative procedures such as TURBT (15).

Research paper thumbnail of Intensive simulation training on urological mini-invasive procedures using Thiel-embalmed cadavers: The IAMSurgery experience

Archivio italiano di urologia, andrologia, Jun 23, 2020

Research paper thumbnail of Endoscopic laser en bloc removal of bladder tumor. Surgical radicality and improvement of the pathological diagnostic accuracy

Archivio italiano di urologia, andrologia, Jun 29, 2022

No conflict of interest declared. nostic and therapeutic method even if, this technique, has been... more No conflict of interest declared. nostic and therapeutic method even if, this technique, has been associated with significant complications (bleeding, bladder perforation, obturator nerve reflex, and even bladder explosion) (3). Another problem is incomplete primary endoscopic resection with absence of muscle tissue in the samples and uncertainty of the margins, which often leads to reprogramming, especially in T1, a second look TUR after forty days from the first intervention, with an increase in costs for public health and discomfort for patients, especially in this period of pandemic not yet fully resolved (4). We know that TURBT "incising and scattering" procedure contradicts the basic surgical oncologic principles of take out the tumor "en bloc" with sure margins of resection and histopathology evaluation of wall invasion. Another problem is the possible seeding of exfoliated cancer cells (5). Each urologist has his/her own experience in endoscopic treatment of bladder tumors, which refers, in particular, to the type of energy used during the surgical procedure. Monopolar energy in cutting loop is the most used current for the treatment of NMIBC although it is correlated with some adverse events including blood loss or disorder of electrolyte balance for mannitol absorption. Recently, use of bipolar energy has spread due to reduced risk of metabolic alterations and improved precision of resections (6-8). In 1984, Food and Drug Administration (FDA) approved the use of laser in bladder resection. In the last 10 years, various types of laser energy have been used for the endoscopic treatment of bladder cancer, due to their efficient tissue vaporization and hemostatic effect as well as high safety (Holmium and Thullium, in particular). The use of laser surgery helps in "en bloc" resection and can provide an intact tissue specimen for a more accurate pathological evaluation; it also reduce the risk of dissemination of malignant cells (9-11). Our study, therefore, aims to verify if diode laser "en-bloc" surgery of bladder tumors could be able to improve the diagnostic rate and to reduce the risk of positive margins and incomplete resection of the bladder base implant of the neoplasm. We want also to evaluate safety and reduction of catheterization and hospitalization time. was over 12 months. Patients age range was from 45 to 75 years. Maximum diameter of the lesions was 3.0 cm. For each patient, a cold forceps biopsy sample was performed. Results: All samples collected presented detrusorial layer. Pathological exam showed: 28 (14.8%) Ta, G1-G2; 7 (3.7%) T3, G2-G3; 14 (7.4%) T1, G2-G3 and 140 ( 74.1%) Ta, G2-G3. No complications occurred during or after surgery. At a median follow-up period of 6 months, we had no recurrence in the previous site of tumor. In the follow up at 3/6/12 months in 4 cases we had recurrence in different sites of bladder wall. Conclusions: Laser "en bloc" resection is an effective, feasible, and safe treatment for bladder tumor. It could be a valid alternative to monopolar and bipolar resection in small bladder cancer treatment.

Research paper thumbnail of Reporting ChAracteristics of cadaver training and sUrgical studies: The CACTUS guidelines

International Journal of Surgery

INTRODUCTION Recent systematic reviews highlighted increasing use of cadaveric models in surgical... more INTRODUCTION Recent systematic reviews highlighted increasing use of cadaveric models in surgical training but reports on the characteristics of the models and their impact on training are lacking, as well as standardized recommendations on how to ensure the quality of surgical studies. The aim of our survey was to provide an easy guideline that would improve the quality of the studies involving cadavers for surgical training and research. METHODS After accurate literature review regarding surgical training on cadaveric models, a draft of the CACTUS guidelines involving 10 different items was drawn. Afterwards, the items were improved by questionnaire uploaded and spread to the experts in the field via Google form. The guideline was then reviewed following participants feedback, ergo, items that scored between 7 and 9 on nine-score Likert scale by 70% of respondents, and between 1 and 3 by fewer than 15% of respondents, were included in the proposed guideline, while items that scored between 1 and 3 by 70% of respondents, and between 7 and 9 by 15% or more of respondents were not. The process proceeded with Delphi rounds until the agreement for all items was unanimous. RESULTS In total, 42 participants agreed to participate and 30 (71.4%) of them completed the Delphi survey. Unanimous agreement was almost always immediate concerning approval and ethical use of cadaver and providing brief outcome statement in terms of satisfaction in the use of the cadaver model through a short questionnaire. Other items were subjected to the minor adjustments. CONCLUSION 'CACTUS' is a consensus-based guideline in the area of surgical training, simulation and anatomical studies and we believe that it will provide a useful guide to those writing manuscripts involving human cadavers.

Research paper thumbnail of Robotic surgery in patients with achondroplastic dwarfism: evaluation of risks and issues in an anatomical challenging bilateral partial nephrectomy

Journal of Robotic Surgery, 2019

The reports on the performance of robotic surgery in patients with dwarfism are anecdotal; anesth... more The reports on the performance of robotic surgery in patients with dwarfism are anecdotal; anesthesiological issues and a challenging anatomy are the main factors that lead most of surgeons to prefer a more traditional approach. We present a case of bilateral robotic partial nephrectomy in a patient affected by achondroplastic dwarfism and aim to evaluate risks and issues in this type of surgery.

Research paper thumbnail of The Role of Novel Bladder Cancer Diagnostic and Surveillance Biomarkers—What Should a Urologist Really Know?

International Journal of Environmental Research and Public Health, Aug 5, 2022

The aim of this review is to analyze and describe the current landscape of bladder cancer diagnos... more The aim of this review is to analyze and describe the current landscape of bladder cancer diagnostic and surveillance biomarkers. We researched the literature from 2016 to November 2021 to find the most promising new molecules and divided them into seven different subgroups based on their function and location in the cell. Although cystoscopy and cytology are still the gold standard for diagnosis and surveillance when it comes to bladder cancer (BCa), their cost is quite a burden for national health systems worldwide. Currently, the research is focused on finding a biomarker that has high negative predictive value (NPV) and can exclude with a certainty the presence of the tumor, considering missing it could be disastrous for the patient. Every subgroup has its own advantages and disadvantages; for example, protein biomarkers cost less than genomic ones, but on the other hand, they seem to be less precise. We tried to simplify this complicated topic as much as possible in order to make it comprehensible to doctors and urologists that are not as familiar with it, as well as encourage them to actively participate in ongoing research.

Research paper thumbnail of TULA DUAL: Trans Urethral Laser Ablation of recurrent bladder tumors in outpatient setting

Archivio Italiano di Urologia e Andrologia

To the Editor, Bladder cancer (BCa) is the second most common cancer in urological clinical pract... more To the Editor, Bladder cancer (BCa) is the second most common cancer in urological clinical practice, after prostate adenocarcinoma. Usually occurs in patients between 60 and 70 years old, three times more frequently in men than women. About 75% of bladder cancer are pTa or pT1, even more frequently considering a population younger than 40 years old. Early detection is of paramount importance since allows to find tumors when they are still superficial and therefore with a better prognosis

Research paper thumbnail of An original mininvasive corporoplasty technique for penile curvature without circumcision

Archivio Italiano di Urologia e Andrologia

Objective: We describe an original minimally invasive penile plication technique with scrotal or ... more Objective: We describe an original minimally invasive penile plication technique with scrotal or infrapubic access, not requiring circumcision, for penile curvature of different severity and types. This technique can be used to correct both congenital and acquired curvatures, mono or bidirectional deformities. Materials and methods: Between 2012 and 2018 we treated 134 patients suffering from congenital curvature (33) and acquired curvature from Peyronie's disease (101). The average curvature was 62.2° (± 30.4°). Preoperative evaluation included prostaglandin E1 injection with photographic documentation and measurement of penile angulation, administration of IIEF- 15, vasoactive penile Doppler ultrasound, analysis of thermal and vibratory sensitivity with Genito-Sensory-Analyzer (GSA) and assessment of nocturnal penile stiffness with Rigiscan, performed twice, for a detailed evaluation of patient’s erectile function. Scrotal access was performed in patients with dorsal and/or la...

Research paper thumbnail of Laser Circumcision: A New Technique

Circumcision - Advances and New Perspectives

In this chapter, we would like to enlighten the importance of circumcision as a feasible and some... more In this chapter, we would like to enlighten the importance of circumcision as a feasible and sometimes necessary surgical technique. In particular, laser circumcision seems to be more effective than other minimally invasive techniques in terms of safety, reproducibility of the technique, learning curve, and reduced execution times. Moreover, it is associated with low rates of all circumcision complications: no bleeding, no postoperative edema, and rapid functional recovery. The aesthetic results are very pleasing.

Research paper thumbnail of The Role of Novel Bladder Cancer Diagnostic and Surveillance Biomarkers—What Should a Urologist Really Know?

International Journal of Environmental Research and Public Health

The aim of this review is to analyze and describe the current landscape of bladder cancer diagnos... more The aim of this review is to analyze and describe the current landscape of bladder cancer diagnostic and surveillance biomarkers. We researched the literature from 2016 to November 2021 to find the most promising new molecules and divided them into seven different subgroups based on their function and location in the cell. Although cystoscopy and cytology are still the gold standard for diagnosis and surveillance when it comes to bladder cancer (BCa), their cost is quite a burden for national health systems worldwide. Currently, the research is focused on finding a biomarker that has high negative predictive value (NPV) and can exclude with a certainty the presence of the tumor, considering missing it could be disastrous for the patient. Every subgroup has its own advantages and disadvantages; for example, protein biomarkers cost less than genomic ones, but on the other hand, they seem to be less precise. We tried to simplify this complicated topic as much as possible in order to ma...

Research paper thumbnail of Re: “Guidelines for cadaver dissection in education and research of clinical medicine (The Japan Surgical Society and The Japanese Association of Anatomists)”

Research paper thumbnail of Endoscopic laser en bloc removal of bladder tumor. Surgical radicality and improvement of the pathological diagnostic accuracy

Archivio Italiano di Urologia e Andrologia

Introduction: Bladder cancer is one of the most common tumors among the general population. The f... more Introduction: Bladder cancer is one of the most common tumors among the general population. The first surgical approach to the tumor is often the transurethral resection with monopolar or bipolar loop. Recently, laser energy has become an alternative for resection of small bladder tumor, because it allows to obtain high quality samples with the “en bloc” technique. Our study aims to show the results of endoscopic diode laser treatment of bladder tumor up to three centimeters in maximum diameter. Materials and methods: 189 patients underwent “en bloc” resection with diode dual length laser (980 nm-1470 nm). Follow up was over 12 months. Patients age range was from 45 to 75 years. Maximum diameter of the lesions was 3.0 cm. For each patient, a cold forceps biopsy sample was performed. Results: All samples collected presented detrusorial layer. Pathological exam showed: 28 (14.8%) Ta, G1-G2; 7 (3.7%) T3, G2-G3; 14 (7.4%) T1, G2-G3 and 140 ( 74.1%) Ta, G2-G3. No complications occurred d...

Research paper thumbnail of MP53-10 THE Role of Selectmdx in Men Undergoing Primary Prostate Biopsy: A Prospective Multi-Institutional Study

Journal of Urology

increment of 7-12% across the board. CONCLUSIONS: Our machine learning model has the potential to... more increment of 7-12% across the board. CONCLUSIONS: Our machine learning model has the potential to not only automate but also vastly enhance the utility to detect PCa early and aid in clinical decision making. Given the accuracy of our current model, we are hopeful of producing an automated software workflow that will aid in identifying tumor areas, determining their severity, and influencing treatment decisions.

Research paper thumbnail of Adaptation and validation of an Italian version of the Prostate Cancer Specific Quality of Life Instrument (PROSQOLI)

European review for medical and pharmacological sciences, 2016

OBJECTIVE The Prostate Cancer Specific Quality of Life Instrument (PROSQOLI) is a measure of heal... more OBJECTIVE The Prostate Cancer Specific Quality of Life Instrument (PROSQOLI) is a measure of health-related quality of life (HRQoL) in advanced hormone-resistant prostate cancer. In this study, we aimed at performing a cross-cultural adaptation and validation of the Italian version of the PROSQOLI. PATIENTS AND METHODS The original version of the PROSQOLI underwent several turnarounds of translations. A total of 472 patients treated with radical prostatectomy, radiotherapy or medical therapy were enrolled for the validation of the questionnaire. The PROSQOLI was administered together with the SF-12. Reliability indexes were calculated by using Cronbach alpha. To evaluate the validity of the construct, relationships between PROSQOLI and SF12 were assessed. The ANOVA test was used to evaluate the differences between groups of patients who had received different treatments. RESULTS The reliability coefficient was 0.91. Item-to-total correlation indices were in most cases >0.70. The ...

Research paper thumbnail of External validation of Resorlu-Unsal stone score as predictor of outcomes after retrograde intrarenal surgery

International urology and nephrology, 2016

To externally validate Resorlu-Unsal stone score (RUSS) and to evaluate its predictive accuracy. ... more To externally validate Resorlu-Unsal stone score (RUSS) and to evaluate its predictive accuracy. Data of patients who underwent retrograde intrarenal surgery (RIRS) between October 2013 and June 2015 were collected. RUSS was applied to all patients, and the nomogram was externally validated. Area under the curve (AUC) was used for clinical validity assessment. A total of 85 patients were included in the study. Mean patient age was 54.3 ± 16.5, and mean stone size was 12.0 ± 6.21 mm. After applying RUSS, 56.5, 28.2, 9.41, and 5.88 % had score 0, 1, 2, and 3, respectively. RUSS was significantly associated with stone location and size. Postoperative stone-free rate was 74.1 %. Postoperative outcomes were significantly associated with RUSS and stone size. RUSS was found to be the only significant independent predictor in multivariate analysis, while it provided high predictive accuracy with an estimated AUC of 0.707. RUSS is a simple scoring system that may predict postoperative stone-...

Research paper thumbnail of UP-02.034 Multicentre Study on the Efficacy and Tolerability of Permixon® in Patients with Chronic Benign Prostate Conditions Associated with Inflammation

Urology, 2011

less than 40cmc, PSAϽ1.5 ng/ml, no urinary tract infection and 3 months with tamsulosin 0.4 mg/da... more less than 40cmc, PSAϽ1.5 ng/ml, no urinary tract infection and 3 months with tamsulosin 0.4 mg/daily without an IPSS decrease of at least 30%). Patients with any type of previous medication for BPH before that 3 month period as well as those with severe renal, hepatic diseases or with atrio-ventricular blocks or arrhythmias were not included in the study. The maximum urinary flow rate (Q max) preand post-combined treatment, IPSS and post void residual volume were assessed. The treatment consisted in tamsulosin HCl 0.4 mg/ once daily ϩ tolterodine 2x2 mg/ day. Results: The mean age of the patients was 67 yrs. A total number of 96 patients completed the study. IPSS score decreased from 15 to 7, Q max from 17 ml/sec to 17.5ml/sec and postvoid residual volume from 30 to 55 ml. None of the patients developed acute urinary retention during the treatment period. Conclusion: Despite the low increase in postvoid residual volume, the combined treatment proved its safety and efficacy in patients non-responsive to tamsulosin treatment alone.

Research paper thumbnail of Preliminary results on selective light vaporization with the side-firing 980 nm diode laser in benign prostatic hyperplasia: an ejaculation sparing technique

Prostate Cancer and Prostatic Diseases, 2009

This study examined efficacy and safety of the 980 nm side-firing diode laser operating at a powe... more This study examined efficacy and safety of the 980 nm side-firing diode laser operating at a power of 100 W in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). Patients were selected for surgery on the basis of maximum urinary flow rate (Qmax) p15 ml/s or transvesically measured post-voiding residual volume (PVR) 4100 ml in conjunction with an International Prostate Symptom Score (IPSS) 47. Laser therapy was conducted under spinal anaesthesia. Qmax, IPSS, prostate volume, PVR, IPSS-Quality of Life (QoL) questionnaire and ejaculatory function were measured at baseline and at 1, 3, 6 and 12 months post-laser therapy. A total of 52 consecutive patients aged 52-65 years with mean (s.d.) prostate volume of 45.14 (9.15) g were treated. All patients were able to leave the hospital at a mean (s.d.) of 5 (2) h after the procedure. Mean (s.d.) follow-up was 100 (75.49) days. A significant reduction in IPPS was reported at 1 month (Po0.0001) and this was maintained through to 6 months. Significant durable improvements in Qmax, PVR and IPSS-QoL score were also reported for all patients (Po0.0001). No severe complications were reported, including any cases of urinary incontinence or significant irritative symptoms. None of the patients complained of a worsening of erectile function. This early experience in a pilot study with the 980 nm diode laser seems promising in the short-term and long-term outcome is being monitored.

Research paper thumbnail of Laser Circumcision: A New Technique

IntechOpen eBooks, Feb 15, 2023

Research paper thumbnail of External validation of Resorlu-Unsal stone score in predicting outcomes after retrograde intrarenal surgery. Experience from a single institution

Archivio italiano di urologia, andrologia, Sep 26, 2022

Results: The present study included a total of 79 patients. Mean patient age was 55.1 ± 15.4 year... more Results: The present study included a total of 79 patients. Mean patient age was 55.1 ± 15.4 years with a mean stone size was 14.2 ± 4.4 mm. Overall, 62/79 (78.4%) patients were stone free after the initial treatment. After applying RUSS, 36 (45.6%), 29 (36.7%), 10 (12.6%), and 4 (5.1%) patients had a score of 0, 1, 2, and 3, respectively. On multivariate logistic regression RUSS (OR = 0.220; 95%CI: 0.086-0.567; p = 0.002) was identified as the only predictor of postoperative stone-free status. Conclusions: RUSS is a user-friendly scoring system that may predict postoperative stone-free rate after RIRS with great efficacy and accuracy.

Research paper thumbnail of Histological evaluation of prostatic tissue following transurethral laser resection (TULaR) using the 980 nm diode laser

PubMed, Mar 1, 2010

Objectives: In the present study, we performed for the first time an histological evaluation afte... more Objectives: In the present study, we performed for the first time an histological evaluation after 980 nm diode laser treatment of bladder outlet obstruction secondary to benign prostatic hypertrophy (BPH). The aim was to demonstrate the possibility of obtaining sufficient tissue for histological examination and the possibility of obtaining an histological diagnosis on the specimen obtained by laser resection. Materials and methods: 86 patients with BPH were selected for laser surgery and 10 patients for transurethral prostate resection. The prostate tissue samples collected from laser surgery and transurethral resection of the prostate (TURP) were fixed in 10% formalin and serial sections with a slice thickness of 5-7 micron embedded in paraffin and stained with haematoxylin and eosin. Results: Samples obtained using the 980 nm diode laser ranged in size from 4 mm to 30 mm and showed brownish, smooth margins. Lasered tissue showed a coagulation rim of 0.5 mm (range: 0.2-1 mm) and adjacent to the vaporized tissue, coagulated connective tissue and glandular epithelia were seen. Beyond this zone a complete detachment of glandular epithelia from the connective tissue was observed. Stromal oedema associated with ectasic vessels but without extravasation of red blood cells, haemosiderin deposition and haemorrhagic areas were also retrieved. All cases showed occlusion of small vessels beyond the zone of coagulated tissue. Unlike laser treatment, samples obtained from TURP showed extravasation of red blood cells, haemosiderin deposition and haemorrhagic areas. Conclusions: The 980 nm diode laser provides high rates of tissue ablation, associated with excellent haemostasis. It has been shown that tissue samples can be obtained with this technique, which allow a histological diagnosis of BPH to be made. The current method involving the 980 nm diode laser induces a vaporesection of prostate tissue and the acronym of TULaR (transurethral laser resection) has therefore been created to describe this technique.

Research paper thumbnail of TULA DUAL: Trans Urethral Laser Ablation of recurrent bladder tumors in outpatient setting

Archivio italiano di urologia, andrologia, Feb 22, 2023

Bladder cancer (BCa) is the second most common cancer in urological clinical practice, after pros... more Bladder cancer (BCa) is the second most common cancer in urological clinical practice, after prostate adenocarcinoma. Usually occurs in patients between 60 and 70 years old, three times more frequently in men than women (1, 2). About 75% of bladder cancer are pTa or pT1 (3), even more frequently considering a population younger than 40 years old. Early detection is of paramount importance since allows to find tumors when they are still superficial and therefore with a better prognosis. Management of Non Muscle Invasive Bladder Cancer (NMIBC) accordingly to EAU guidelines (4), is based on intravesical chemotherapy and endourological procedures (transurethral resection of bladder cancer), which requires operating theater, anesthesiologic assistance, scrub nurses and dedicated instruments . Trans Urethral Resection of the Bladder Tumor (TURBT) is the gold standard in the treatment of NMIBC accordingly to the literature and it is in fact a mature procedure with a standardized technique, but it is still facing some challenges and risks such as difficult control of cutting depth, stimulation of the obturator nerve, bladder perforation and iliac vascular injury (7). For these reasons, it is interesting to study how other technologies are growing and how we could use them in this so frequent and ubiquitarian disease management. In particular, recently there is a great interest in transurethral laser surgery and especially regarding its comparison to standard TURBT. Some studies showed similar results in both oncological and safeness terms (8-12). The en bloc laser techniques might allow a clearer cut of the tumor base, simplifying pathologist reading of the surgical samples (13). Furthermore, BCa has a 1-and 5-year recurrence rates that can be very high, and several patients require additional TURBT during follow-up (4, 14). One of the recent problems of healthcare organizations is to address the current shortage of operating theater resources, reducing costs, while guaranteeing the best possible treatment for the patients. From this point of view, the possibility to treat some carefully selected BCa recurrences patients with on an outpatient basis would represent an important saving in both economic and organizational terms, reducing hospitalization and discomfort for the patient and his family. According to these pressing needs, we present our experience of an innovative outpatient laser treatment ("TULA DUAL") in a BCa relapsed patient. We highlight the case of an 85 years-old woman in follow-up over the previous five years for NMIBC (urothelial bladder cancer, pTa LG). She was ineligible for standard TURBT because of age and several comorbidities which led to an ASA IV score. She was taking medical therapy for atrial fibrillation (anticoagulation therapy), hypertension and diabetes mellitus, added to recurring episodes of hematuria. During a follow up cystoscopy were endoscopically detected over 20 lesions highly suspected for BCa recurrence. The lesions were pink, papillary and typically aspect of non-muscle invasive lesions. The most of these lesions were millimetric, three of these had a plant base of about one centimeter. A recent urinary cytology was negative for high grade BCa while a Kidney-Ureters-Bladder Ultrasound didn't show hydronephrosis or further suspicious findings. In this situation we should have organized an operating theater to perform a TURB, suspending the anticoagulation therapy; but instead, considering the anamnesis and the clinical condition, we decided accordingly to the patient to perform the TULA DUAL procedure. The TULA DUAL is an endoscopic procedure, executed with a DUAL laser (diode laser technology 980-1470 wave length) in local anesthesia or even without it, in an ambulatory setting. It allows the contemporary vaporization and hemostasis of tissues. Patients are summoned in ambulatory, where is administered a one-shoot antibiotic prophylaxis according to current guidelines for endoscopic operative procedures such as TURBT (15).

Research paper thumbnail of Intensive simulation training on urological mini-invasive procedures using Thiel-embalmed cadavers: The IAMSurgery experience

Archivio italiano di urologia, andrologia, Jun 23, 2020

Research paper thumbnail of Endoscopic laser en bloc removal of bladder tumor. Surgical radicality and improvement of the pathological diagnostic accuracy

Archivio italiano di urologia, andrologia, Jun 29, 2022

No conflict of interest declared. nostic and therapeutic method even if, this technique, has been... more No conflict of interest declared. nostic and therapeutic method even if, this technique, has been associated with significant complications (bleeding, bladder perforation, obturator nerve reflex, and even bladder explosion) (3). Another problem is incomplete primary endoscopic resection with absence of muscle tissue in the samples and uncertainty of the margins, which often leads to reprogramming, especially in T1, a second look TUR after forty days from the first intervention, with an increase in costs for public health and discomfort for patients, especially in this period of pandemic not yet fully resolved (4). We know that TURBT "incising and scattering" procedure contradicts the basic surgical oncologic principles of take out the tumor "en bloc" with sure margins of resection and histopathology evaluation of wall invasion. Another problem is the possible seeding of exfoliated cancer cells (5). Each urologist has his/her own experience in endoscopic treatment of bladder tumors, which refers, in particular, to the type of energy used during the surgical procedure. Monopolar energy in cutting loop is the most used current for the treatment of NMIBC although it is correlated with some adverse events including blood loss or disorder of electrolyte balance for mannitol absorption. Recently, use of bipolar energy has spread due to reduced risk of metabolic alterations and improved precision of resections (6-8). In 1984, Food and Drug Administration (FDA) approved the use of laser in bladder resection. In the last 10 years, various types of laser energy have been used for the endoscopic treatment of bladder cancer, due to their efficient tissue vaporization and hemostatic effect as well as high safety (Holmium and Thullium, in particular). The use of laser surgery helps in "en bloc" resection and can provide an intact tissue specimen for a more accurate pathological evaluation; it also reduce the risk of dissemination of malignant cells (9-11). Our study, therefore, aims to verify if diode laser "en-bloc" surgery of bladder tumors could be able to improve the diagnostic rate and to reduce the risk of positive margins and incomplete resection of the bladder base implant of the neoplasm. We want also to evaluate safety and reduction of catheterization and hospitalization time. was over 12 months. Patients age range was from 45 to 75 years. Maximum diameter of the lesions was 3.0 cm. For each patient, a cold forceps biopsy sample was performed. Results: All samples collected presented detrusorial layer. Pathological exam showed: 28 (14.8%) Ta, G1-G2; 7 (3.7%) T3, G2-G3; 14 (7.4%) T1, G2-G3 and 140 ( 74.1%) Ta, G2-G3. No complications occurred during or after surgery. At a median follow-up period of 6 months, we had no recurrence in the previous site of tumor. In the follow up at 3/6/12 months in 4 cases we had recurrence in different sites of bladder wall. Conclusions: Laser "en bloc" resection is an effective, feasible, and safe treatment for bladder tumor. It could be a valid alternative to monopolar and bipolar resection in small bladder cancer treatment.

Research paper thumbnail of Reporting ChAracteristics of cadaver training and sUrgical studies: The CACTUS guidelines

International Journal of Surgery

INTRODUCTION Recent systematic reviews highlighted increasing use of cadaveric models in surgical... more INTRODUCTION Recent systematic reviews highlighted increasing use of cadaveric models in surgical training but reports on the characteristics of the models and their impact on training are lacking, as well as standardized recommendations on how to ensure the quality of surgical studies. The aim of our survey was to provide an easy guideline that would improve the quality of the studies involving cadavers for surgical training and research. METHODS After accurate literature review regarding surgical training on cadaveric models, a draft of the CACTUS guidelines involving 10 different items was drawn. Afterwards, the items were improved by questionnaire uploaded and spread to the experts in the field via Google form. The guideline was then reviewed following participants feedback, ergo, items that scored between 7 and 9 on nine-score Likert scale by 70% of respondents, and between 1 and 3 by fewer than 15% of respondents, were included in the proposed guideline, while items that scored between 1 and 3 by 70% of respondents, and between 7 and 9 by 15% or more of respondents were not. The process proceeded with Delphi rounds until the agreement for all items was unanimous. RESULTS In total, 42 participants agreed to participate and 30 (71.4%) of them completed the Delphi survey. Unanimous agreement was almost always immediate concerning approval and ethical use of cadaver and providing brief outcome statement in terms of satisfaction in the use of the cadaver model through a short questionnaire. Other items were subjected to the minor adjustments. CONCLUSION 'CACTUS' is a consensus-based guideline in the area of surgical training, simulation and anatomical studies and we believe that it will provide a useful guide to those writing manuscripts involving human cadavers.

Research paper thumbnail of Robotic surgery in patients with achondroplastic dwarfism: evaluation of risks and issues in an anatomical challenging bilateral partial nephrectomy

Journal of Robotic Surgery, 2019

The reports on the performance of robotic surgery in patients with dwarfism are anecdotal; anesth... more The reports on the performance of robotic surgery in patients with dwarfism are anecdotal; anesthesiological issues and a challenging anatomy are the main factors that lead most of surgeons to prefer a more traditional approach. We present a case of bilateral robotic partial nephrectomy in a patient affected by achondroplastic dwarfism and aim to evaluate risks and issues in this type of surgery.

Research paper thumbnail of The Role of Novel Bladder Cancer Diagnostic and Surveillance Biomarkers—What Should a Urologist Really Know?

International Journal of Environmental Research and Public Health, Aug 5, 2022

The aim of this review is to analyze and describe the current landscape of bladder cancer diagnos... more The aim of this review is to analyze and describe the current landscape of bladder cancer diagnostic and surveillance biomarkers. We researched the literature from 2016 to November 2021 to find the most promising new molecules and divided them into seven different subgroups based on their function and location in the cell. Although cystoscopy and cytology are still the gold standard for diagnosis and surveillance when it comes to bladder cancer (BCa), their cost is quite a burden for national health systems worldwide. Currently, the research is focused on finding a biomarker that has high negative predictive value (NPV) and can exclude with a certainty the presence of the tumor, considering missing it could be disastrous for the patient. Every subgroup has its own advantages and disadvantages; for example, protein biomarkers cost less than genomic ones, but on the other hand, they seem to be less precise. We tried to simplify this complicated topic as much as possible in order to make it comprehensible to doctors and urologists that are not as familiar with it, as well as encourage them to actively participate in ongoing research.

Research paper thumbnail of TULA DUAL: Trans Urethral Laser Ablation of recurrent bladder tumors in outpatient setting

Archivio Italiano di Urologia e Andrologia

To the Editor, Bladder cancer (BCa) is the second most common cancer in urological clinical pract... more To the Editor, Bladder cancer (BCa) is the second most common cancer in urological clinical practice, after prostate adenocarcinoma. Usually occurs in patients between 60 and 70 years old, three times more frequently in men than women. About 75% of bladder cancer are pTa or pT1, even more frequently considering a population younger than 40 years old. Early detection is of paramount importance since allows to find tumors when they are still superficial and therefore with a better prognosis

Research paper thumbnail of An original mininvasive corporoplasty technique for penile curvature without circumcision

Archivio Italiano di Urologia e Andrologia

Objective: We describe an original minimally invasive penile plication technique with scrotal or ... more Objective: We describe an original minimally invasive penile plication technique with scrotal or infrapubic access, not requiring circumcision, for penile curvature of different severity and types. This technique can be used to correct both congenital and acquired curvatures, mono or bidirectional deformities. Materials and methods: Between 2012 and 2018 we treated 134 patients suffering from congenital curvature (33) and acquired curvature from Peyronie's disease (101). The average curvature was 62.2° (± 30.4°). Preoperative evaluation included prostaglandin E1 injection with photographic documentation and measurement of penile angulation, administration of IIEF- 15, vasoactive penile Doppler ultrasound, analysis of thermal and vibratory sensitivity with Genito-Sensory-Analyzer (GSA) and assessment of nocturnal penile stiffness with Rigiscan, performed twice, for a detailed evaluation of patient’s erectile function. Scrotal access was performed in patients with dorsal and/or la...

Research paper thumbnail of Laser Circumcision: A New Technique

Circumcision - Advances and New Perspectives

In this chapter, we would like to enlighten the importance of circumcision as a feasible and some... more In this chapter, we would like to enlighten the importance of circumcision as a feasible and sometimes necessary surgical technique. In particular, laser circumcision seems to be more effective than other minimally invasive techniques in terms of safety, reproducibility of the technique, learning curve, and reduced execution times. Moreover, it is associated with low rates of all circumcision complications: no bleeding, no postoperative edema, and rapid functional recovery. The aesthetic results are very pleasing.

Research paper thumbnail of The Role of Novel Bladder Cancer Diagnostic and Surveillance Biomarkers—What Should a Urologist Really Know?

International Journal of Environmental Research and Public Health

The aim of this review is to analyze and describe the current landscape of bladder cancer diagnos... more The aim of this review is to analyze and describe the current landscape of bladder cancer diagnostic and surveillance biomarkers. We researched the literature from 2016 to November 2021 to find the most promising new molecules and divided them into seven different subgroups based on their function and location in the cell. Although cystoscopy and cytology are still the gold standard for diagnosis and surveillance when it comes to bladder cancer (BCa), their cost is quite a burden for national health systems worldwide. Currently, the research is focused on finding a biomarker that has high negative predictive value (NPV) and can exclude with a certainty the presence of the tumor, considering missing it could be disastrous for the patient. Every subgroup has its own advantages and disadvantages; for example, protein biomarkers cost less than genomic ones, but on the other hand, they seem to be less precise. We tried to simplify this complicated topic as much as possible in order to ma...

Research paper thumbnail of Re: “Guidelines for cadaver dissection in education and research of clinical medicine (The Japan Surgical Society and The Japanese Association of Anatomists)”

Research paper thumbnail of Endoscopic laser en bloc removal of bladder tumor. Surgical radicality and improvement of the pathological diagnostic accuracy

Archivio Italiano di Urologia e Andrologia

Introduction: Bladder cancer is one of the most common tumors among the general population. The f... more Introduction: Bladder cancer is one of the most common tumors among the general population. The first surgical approach to the tumor is often the transurethral resection with monopolar or bipolar loop. Recently, laser energy has become an alternative for resection of small bladder tumor, because it allows to obtain high quality samples with the “en bloc” technique. Our study aims to show the results of endoscopic diode laser treatment of bladder tumor up to three centimeters in maximum diameter. Materials and methods: 189 patients underwent “en bloc” resection with diode dual length laser (980 nm-1470 nm). Follow up was over 12 months. Patients age range was from 45 to 75 years. Maximum diameter of the lesions was 3.0 cm. For each patient, a cold forceps biopsy sample was performed. Results: All samples collected presented detrusorial layer. Pathological exam showed: 28 (14.8%) Ta, G1-G2; 7 (3.7%) T3, G2-G3; 14 (7.4%) T1, G2-G3 and 140 ( 74.1%) Ta, G2-G3. No complications occurred d...

Research paper thumbnail of MP53-10 THE Role of Selectmdx in Men Undergoing Primary Prostate Biopsy: A Prospective Multi-Institutional Study

Journal of Urology

increment of 7-12% across the board. CONCLUSIONS: Our machine learning model has the potential to... more increment of 7-12% across the board. CONCLUSIONS: Our machine learning model has the potential to not only automate but also vastly enhance the utility to detect PCa early and aid in clinical decision making. Given the accuracy of our current model, we are hopeful of producing an automated software workflow that will aid in identifying tumor areas, determining their severity, and influencing treatment decisions.

Research paper thumbnail of Adaptation and validation of an Italian version of the Prostate Cancer Specific Quality of Life Instrument (PROSQOLI)

European review for medical and pharmacological sciences, 2016

OBJECTIVE The Prostate Cancer Specific Quality of Life Instrument (PROSQOLI) is a measure of heal... more OBJECTIVE The Prostate Cancer Specific Quality of Life Instrument (PROSQOLI) is a measure of health-related quality of life (HRQoL) in advanced hormone-resistant prostate cancer. In this study, we aimed at performing a cross-cultural adaptation and validation of the Italian version of the PROSQOLI. PATIENTS AND METHODS The original version of the PROSQOLI underwent several turnarounds of translations. A total of 472 patients treated with radical prostatectomy, radiotherapy or medical therapy were enrolled for the validation of the questionnaire. The PROSQOLI was administered together with the SF-12. Reliability indexes were calculated by using Cronbach alpha. To evaluate the validity of the construct, relationships between PROSQOLI and SF12 were assessed. The ANOVA test was used to evaluate the differences between groups of patients who had received different treatments. RESULTS The reliability coefficient was 0.91. Item-to-total correlation indices were in most cases >0.70. The ...

Research paper thumbnail of External validation of Resorlu-Unsal stone score as predictor of outcomes after retrograde intrarenal surgery

International urology and nephrology, 2016

To externally validate Resorlu-Unsal stone score (RUSS) and to evaluate its predictive accuracy. ... more To externally validate Resorlu-Unsal stone score (RUSS) and to evaluate its predictive accuracy. Data of patients who underwent retrograde intrarenal surgery (RIRS) between October 2013 and June 2015 were collected. RUSS was applied to all patients, and the nomogram was externally validated. Area under the curve (AUC) was used for clinical validity assessment. A total of 85 patients were included in the study. Mean patient age was 54.3 ± 16.5, and mean stone size was 12.0 ± 6.21 mm. After applying RUSS, 56.5, 28.2, 9.41, and 5.88 % had score 0, 1, 2, and 3, respectively. RUSS was significantly associated with stone location and size. Postoperative stone-free rate was 74.1 %. Postoperative outcomes were significantly associated with RUSS and stone size. RUSS was found to be the only significant independent predictor in multivariate analysis, while it provided high predictive accuracy with an estimated AUC of 0.707. RUSS is a simple scoring system that may predict postoperative stone-...

Research paper thumbnail of UP-02.034 Multicentre Study on the Efficacy and Tolerability of Permixon® in Patients with Chronic Benign Prostate Conditions Associated with Inflammation

Urology, 2011

less than 40cmc, PSAϽ1.5 ng/ml, no urinary tract infection and 3 months with tamsulosin 0.4 mg/da... more less than 40cmc, PSAϽ1.5 ng/ml, no urinary tract infection and 3 months with tamsulosin 0.4 mg/daily without an IPSS decrease of at least 30%). Patients with any type of previous medication for BPH before that 3 month period as well as those with severe renal, hepatic diseases or with atrio-ventricular blocks or arrhythmias were not included in the study. The maximum urinary flow rate (Q max) preand post-combined treatment, IPSS and post void residual volume were assessed. The treatment consisted in tamsulosin HCl 0.4 mg/ once daily ϩ tolterodine 2x2 mg/ day. Results: The mean age of the patients was 67 yrs. A total number of 96 patients completed the study. IPSS score decreased from 15 to 7, Q max from 17 ml/sec to 17.5ml/sec and postvoid residual volume from 30 to 55 ml. None of the patients developed acute urinary retention during the treatment period. Conclusion: Despite the low increase in postvoid residual volume, the combined treatment proved its safety and efficacy in patients non-responsive to tamsulosin treatment alone.

Research paper thumbnail of Preliminary results on selective light vaporization with the side-firing 980 nm diode laser in benign prostatic hyperplasia: an ejaculation sparing technique

Prostate Cancer and Prostatic Diseases, 2009

This study examined efficacy and safety of the 980 nm side-firing diode laser operating at a powe... more This study examined efficacy and safety of the 980 nm side-firing diode laser operating at a power of 100 W in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). Patients were selected for surgery on the basis of maximum urinary flow rate (Qmax) p15 ml/s or transvesically measured post-voiding residual volume (PVR) 4100 ml in conjunction with an International Prostate Symptom Score (IPSS) 47. Laser therapy was conducted under spinal anaesthesia. Qmax, IPSS, prostate volume, PVR, IPSS-Quality of Life (QoL) questionnaire and ejaculatory function were measured at baseline and at 1, 3, 6 and 12 months post-laser therapy. A total of 52 consecutive patients aged 52-65 years with mean (s.d.) prostate volume of 45.14 (9.15) g were treated. All patients were able to leave the hospital at a mean (s.d.) of 5 (2) h after the procedure. Mean (s.d.) follow-up was 100 (75.49) days. A significant reduction in IPPS was reported at 1 month (Po0.0001) and this was maintained through to 6 months. Significant durable improvements in Qmax, PVR and IPSS-QoL score were also reported for all patients (Po0.0001). No severe complications were reported, including any cases of urinary incontinence or significant irritative symptoms. None of the patients complained of a worsening of erectile function. This early experience in a pilot study with the 980 nm diode laser seems promising in the short-term and long-term outcome is being monitored.