Publications by authors named "Pietro Diana"
Although designed for in-office use, water vapor thermal therapy (Rezum™) remains a painful procedure, and oral±intravenous sedation is often required. Schelin Catheter® (ProstaLund AB, Lund, Sweden) is an innovative bladder catheter that delivers local anesthesia to the prostate in a sterile transurethral way. We aimed to evaluate the safety and feasibility of Rezum™ for male lower urinary tract symptoms due to benign prostatic obstruction (LUTS/BPO) with local anesthesia delivered with Schelin® catheter, and to report its first step-by-step video description.
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- En bloc resection of bladder tumor (ERBT) is a surgical technique aimed at improving bladder cancer removal compared to conventional transurethral resection (cTURBT), focusing on perioperative and cancer-related outcomes.
- A review of 17 studies found no significant differences in cancer recurrence or progression rates between ERBT and cTURBT, although ERBT was linked to better detection of detrusor muscle (DM) presence, and lower risks of bladder perforation and obturator nerve reflexes.
- ERBT resulted in longer surgery times but shorter catheterization and hospital stays, indicating a safer approach overall, despite the lack of major differences in long-term cancer outcomes.
Article Synopsis
- In a study of 4011 patients who had unilateral cT1a-b renal mass treated with partial nephrectomy, researchers aimed to explore how a surgeon's experience affects surgical outcomes, specifically acute kidney injury (AKI) and kidney function a year post-surgery.
- Previously, it was known that complications and ischemia times improved with surgeon experience, but there was limited data on long-term kidney function.
- The findings revealed no significant association between surgical experience and AKI or recovery of kidney function in either laparoscopic or robot-assisted techniques, suggesting other factors may play a more crucial role in these outcomes.
Article Synopsis
- A systematic review and meta-analysis examined the differences between open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC) by evaluating data from several randomized controlled trials (RCTs) regarding patient outcomes.
- The primary focus was on health-related quality of life (QoL) after surgery, with findings showing no significant differences in QoL, complication rates, or oncological outcomes between the two methods at 3 and 6 months post-surgery.
- RARC had advantages in transfusion rates but required longer operative times and incurred higher costs, making both procedures viable options for treating bladder cancer.
Background And Objective: Thulium fiber laser (TFL) emerged as a competitor of holmium:yttrium-aluminum-garnet (Ho:YAG) laser for anatomic enucleation of the prostate (AEEP) in men with lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). The aim was to compare the surgical outcomes of Ho:YAG and TFL for AEEP.
Methods: A literature search was conducted to identify reports published from inception until January 2024.
Article Synopsis
- The objective of the study was to create performance metrics for a standard transurethral resection of bladder tumors (TURBT) procedure and gain consensus from international experts on these metrics.
- The methodology involved defining the TURBT procedure through detailed phases, steps, and types of errors, followed by evaluation and refinement through a modified Delphi process with a panel of experienced urologists.
- The results showed that the Delphi panel reached a unanimous 100% consensus on the performance metrics, confirming their validity and paving the way for their use in training programs for TURBT.
Article Synopsis
- Deterioration of kidney function can lead to higher mortality rates, and it's unclear how different surgical options (partial nephrectomy [PN] vs. radical nephrectomy [RN]) for large renal masses impact long-term kidney health.
- A study analyzing data from 23 institutions showed that patients undergoing PN experienced significantly lower rates of acute kidney injury (AKI) and better recovery of kidney function at one year compared to those undergoing RN.
- The findings suggest that avoiding RN, when possible, is beneficial for preserving kidney function and reducing the risk of serious complications related to kidney health after surgery.
Background And Objective: Different training programs have been developed to improve trainee outcomes in urology. However, evidence on the optimal training methodology is sparse. Our aim was to provide a comprehensive description of the training programs available for urological robotic surgery and endourology, assess their validity, and highlight the fundamental elements of future training pathways.
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- * Surveys conducted among healthcare providers and patients revealed that only a minority of providers regularly offer RTB, even though most acknowledge its influence on management decisions.
- * Barriers to RTB implementation include limited availability, concerns about treatment delays, and a lack of strong evidence on the benefits of RTB, highlighting the need for further research to improve its use in kidney cancer management.
: to investigate the impact of age on renal function deterioration after robotic-assisted partial nephrectomy (RAPN) focusing on a decline to moderate and severe forms of chronic kidney disease (CKD). : This is a single center prospective analysis of patients who underwent RAPN. The outcomes include the development of de novo CKD-S 3a [estimated glomerular filtration rate (eGFR) < 60 mL/min/1.
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- - This multi-institutional study aimed to investigate the prognostic impact of histomorphological subtyping in patients with nonmetastatic papillary renal cell carcinoma (papRCC) who underwent curative surgery, involving 1,086 patients categorized into two subtypes.
- - Results showed that patients with type 2 papRCC were generally older, had larger tumors, and exhibited poorer survival rates, with lower 5-year recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) than type 1 patients.
- - While type 2 was a significant predictor for RFS and CSS, it had no significant impact on OS, highlighting the need for further understanding of how these
Article Synopsis
- The review compares three different surgical approaches (transvesical, extravesical, endoscopic) for managing the bladder cuff during radical nephroureterectomy (RNU) to determine their efficacy.
- A total of 19 studies involving 6,581 patients were analyzed, revealing that rates of bladder recurrence, metastasis, and cancer-related deaths were not significantly different among the approaches.
- The study concludes that there is no high-level evidence favoring one technique over the others, indicating that the extravesical approach is as effective as the transvesical approach regarding oncological and perioperative outcomes.
Objective: To create and validate 2 models called RENSAFE (RENalSAFEty) to predict postoperative acute kidney injury (AKI) and development of chronic kidney disease (CKD) stage 3b in patients undergoing partial (PN) or radical nephrectomy (RN) for kidney cancer.
Methods: Primary objective was to develop a predictive model for AKI (reduction >25% of preoperative eGFR) and de novo CKD≥3b (<45 ml/min/1.73m), through stepwise logistic regression.
Article Synopsis
- - A new predictive model was developed to assess long-term kidney function impairment after partial nephrectomy (PN), using data from patients who underwent minimally invasive surgery between 2005 and 2022.
- - A machine-learning approach, specifically the classification and regression tree (CART) method, identified key predictors of chronic kidney disease (CKD) stage changes in 381 patients over an average follow-up of 69 months, with 27% experiencing CKD progression.
- - The model classified patients into four clusters based on their CKD progression risk, demonstrating that initial CKD stage and overall health status (ACCI) are crucial in determining long-term outcomes, potentially guiding more attentive patient monitoring post-surgery.
Article Synopsis
- The study aimed to assess the benefits of second-look ureteroscopy (SU) for patients with upper tract urothelial carcinoma (UTUC) by identifying tumor presence and its impact on various survival rates.
- Out of 85 patients evaluated between 2016 and 2021, the cancer detection rate at SU was found to be 44.7%, with positive SU correlating with higher recurrence rates and more aggressive treatments.
- The findings suggest that SU is especially useful for spotting patients at risk of early recurrence, and that it can be safely delayed in individuals with low-grade or small tumors beyond 8 weeks.
Article Synopsis
- This research aims to enhance the understanding of clear-cell renal cell carcinoma (ccRCC) with venous tumor thrombus (VTT) to better select candidates for additional therapy based on their recurrence risk.
- The study retrospectively analyzed data from 604 patients with nonmetastatic ccRCC, finding that discrepancies in tumor grade between the primary tumor and VTT significantly influenced disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS).
- Incorporating tumor grade discrepancy into predictive models improved their accuracy, indicating that this information can lead to more personalized and effective treatment strategies for patients.
Article Synopsis
- The study reviews existing research on outpatient endoscopic enucleation of the prostate to assess its feasibility and outcomes for treating benign prostatic obstruction.
- A thorough literature search identified ten studies for the systematic review, with a total of 1942 patients, and a meta-analysis involving 1228 patients, showing a high success rate for same-day discharge (84%) and a low unplanned readmission rate (3%).
- The findings suggest that same-day discharge after this procedure is both feasible and safe for well-selected patients, with lower rates of postoperative readmission and complications compared to standard care protocols.
Article Synopsis
- * Research indicates that outcomes of SP-robotic PN are comparable to traditional multi-arm robotic surgery, with some studies showing less postoperative pain and overall lower complexity in treated renal masses.
- * Further prospective studies are needed to evaluate long-term effectiveness and safety, as current data suggests SP-robotic PN is feasible and safe, though cost-effectiveness remains unstudied.
Article Synopsis
- - The study examines various resection techniques in robotic partial nephrectomy (RPN) and their impact on clinical outcomes, highlighting the importance of methodology in achieving optimal results.
- - A systematic review of 20 studies indicated no major differences in operative metrics like time and blood loss, but enucleation showed advantages in terms of complication rates and recovery time compared to standard resection.
- - The authors call for standardized definitions and reporting of resection techniques to improve consistency and understanding in the urological field and enhance patient outcomes.
Article Synopsis
- - ADHD affects about 5% of children globally and is marked by inattention, hyperactivity, and impulsivity, with each child exhibiting unique cognitive traits that complicate therapy selection.
- - This study aimed to identify objective clinical biomarkers for evaluating treatment effectiveness in ADHD by analyzing DNA methylation patterns in two distinct subgroups of children before and after therapy.
- - Findings revealed unique methylation patterns in specific areas of the DAT1 gene, suggesting that these could serve as reliable molecular indicators of treatment success, paving the way for personalized medicine approaches in ADHD care.
Article Synopsis
- The study investigates the Hugo™ RAS system, a robotic platform used for robot-assisted partial nephrectomy (RAPN), with no prior data available on its use in this surgical context.
- Ten patients were enrolled, and the study tracked various pre, intra, and post-operative metrics to assess the system's performance.
- Results showed that the Hugo™ RAS system is feasible for RAPN, with manageable complication rates and no positive surgical margins, providing insights for future robotic surgeries using this technology.*