Can circumcision be avoided in adult male with phimosis? Results of the PhimoStopTM prospective trial

Background: Circumcision as surgical treatment of adult phimosis is not devoid of complications. Efficacy of alternative non-surgical options is unclear. PhimoStop (TM) is a therapeutic protocol which involves the use of appropriately shaped silicone tuboids of increasing size to obtain a non-forced dilation of the prepuce. The aim of the study was to evaluate the efficacy and durability of results of PhimoStop (TM) device for the treatment of adult male phimosis.Methods: A prospective trial was conducted between 2018 and 2020 on 85 consecutive adult male patients affected by phimosis and with an indication for circumcision. Patients were treated with PhimoStop (TM) protocol and they were evaluated at baseline and after treatment through a subjective (patient self-reported information on various domains of his sexual function) and an objective assessment (evaluation of phimosis severity grade according to the Kikiros scale pre- and post-treatment, re-assessment of indication for circumcision post-treatment and validated questionnaires scores). Primary endpoint was to avoid the scheduled circumcision in 33% of the patients enrolled.Results: Seventy-one patients (84%) completed the device usage phase as per study protocol. Median duration of tuboid application was 60 days. Thirty-seven patients (52.1%) had no indication for circumcision after treatment. Even considering patients lost to follow-up as failures, primary endpoint was reached in 43.5% of cases. There was a significant reduction of the grade of phimosis after treatment (P<0.001). Moreover IIEF-5 showed a statistically significant improvement after treatment (P< 0.001). Thirty/37 patients who met the primary endpoint (81%) still have a successful resolution of their phimosis avoiding circumcision at a median follow-up of 24 months.Conclusions: PhimoStop (TM) device is effective for the treatment of adult male phimosis of Kikiros grade < 2. The results seem to be durable in most patients at a median follow-up of 24 months. Randomized clinical trials are necessary in order to confirm our results and assess cost-efficacy

The ETS Homologous Factor (EHF) Represents a Useful Immunohistochemical Marker for Predicting Prostate Cancer Metastasis.

The main aim of this study was to investigate the risk of prostate cancer metastasis formation associated with the expression of ETS homologous factor (EHF) in a cohort of bioptic samples. To this end, the expression of EHF was evaluated in a cohort of 152 prostate biopsies including primary prostate cancers that developed metastatic lesions, primary prostate cancers that did not develop metastasis, and benign lesions. Data here reported EHF as a candidate immunohistochemical prognostic biomarker for prostate cancer metastasis formation regardless of the Gleason scoring system. Indeed, our data clearly show that primary lesions with EHF positive cells ≥40% had a great risk of developing metastasis within five years from the first diagnosis. Patients with these lesions had about a 40-fold increased risk of developing metastasis as compared with patients with prostate lesions characterized by a percentage of EHF positive cells ≤30%. In conclusion, the immunohistochemical evaluation of EHF could significantly improve the management of prostate cancer patients by optimizing the diagnostic and therapeutic health procedures and, more important, ameliorating the patient's quality of life

T1 Bladder Cancer: Comparison of the Prognostic Impact of Two Substaging Systems on Disease Recurrence and Progression and Suggestion of a Novel Nomogram

Background: The T1 substaging of bladder cancer (BCa) potentially impacts disease progression. The objective of the study was to compare the prognostic accuracy of two substaging systems on the recurrence and progression of primary pathologic T1 (pT1) BCa and to test a nomogram based on pT1 substaging for predicting recurrence-free survival (RFS) and progression-free survival (PFS).Methods: The medical records of 204 patients affected by pT1 BCa were retrospectively reviewed. Substaging was defined according to the depth of lamina propria invasion in T1(a-c) and the extension of the lamina propria invasion to T1-microinvasive (T1(m)) or T1-extensive (T1(e)). Uni- and multivariable Cox regression models evaluated the independent variables correlated with recurrence and progression. The predictive accuracies of the two substaging systems were compared by Harrell's C index. Multivariate Cox regression models for the RFS and PFS were also depicted by a nomogram.Results: The 5-year RFS was 47.5% with a significant difference between T1(c) and T1(a) (p = 0.02) and between T1(e) and T1(m) (p < 0.001). The 5-year PFS was 75.9% with a significant difference between T1(c) and T1(a) (p = 0.011) and between T1(e) and T1(m) (p < 0.001). Model T1(m-e) showed a higher predictive power than T1(a-c) for predicting RFS and PFS. In the univariate and multivariate model subcategory T1e, the diameter, location, and number of tumors were confirmed as factors influencing recurrence and progression after adjusting for the other variables. The nomogram incorporating the T1(m-e) model showed a satisfactory agreement between model predictions at 5 years and actual observations.Conclusions: Substaging is significantly associated with RFS and PFS for patients affected by T1 BCa and should be included in innovative prognostic nomograms

B-TURP versus HoLEP. Peri-operative outcomes and complications in frail elderly (>75 y.o.) patients. A prospective randomized study

Background: The aim of this study was to compare the peri-operative and functional results between trans-urethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS) in middle-old patients. Materials and methods: This prospective single-center study included patients over 75 years old treated with B-TURP or HoLEP for BPH associated with LUTS with prostate volume (PV) <100 mL. Primary endpoints were the intra-operative blood loss, percentage of loss of hemoglobin, blood transfusion, complications, and the comparison of functional outcomes. All patients were evaluated at 1, 3, 6, and 12 months of follow-up. Results: Overall, 96 patients undergoing HoLEP and 104 B-TURP were eligible and enrolled for the study. Post-operative results showed statistically significant differences between the two groups, all in favor of HoLEP group, specifically in terms of removed prostate tissue, PV reduction rate, hemoglobin values at 24 h, hemoglobin loss, operative time, length of hospitalization, days of catheterization, and urinary flow rates. There was no significant difference in terms of postvoid residual urine volume, perioperative complication, blood transfusion, International Prostate Symptom Score (IPSS), and IPSS quality of life scores. Conclusions: In middle-old patients, the HoLEP technique represents a prostate size-independent treatment option with a more favorable safety profile defined by less bleeding, lower blood transfusions, and a significantly lower hemoglobin drop than B-TURP

Total and caspase-cleaved cytokeratin 18 in chronic cholecystitis: A prospective study

<p>Abstract</p> <p>Background</p> <p>Cell death mode has been studied in cancer, autoimmune, and neurodegenerative diseases. In this study, apoptosis and necrosis are investigated for the first time in patients with chronic calculous cholecystitis.</p> <p>Methods and materials</p> <p>Thirty five (35) patients (27 women and 8 men, aged 55.65 ± 13.48 years) with symptomatic chronic calculous cholecystitis underwent laparoscopic cholecystectomy. The early specific apoptotic tendency (caspase-cleaved cytokeratin 18) was studied in these patients with M30 Apoptosense ELISA and the total cytokerarin 18 (both derived from apoptosis and necrosis) with M65 ELISA. The ratio M30/M65 (caspase-cleaved to total cytokeratin 18) was also computed. According to the histopathological examination, the patients were divided in two groups: group A included patients with chronic inactive cholecystitis (n = 10), and group B those with chronic active cholecystitis (n = 25).</p> <p>Results</p> <p>The concentrations of caspase-cleaved cytokerarin 18 (CK18), and especially those of total CK18, were higher in bile samples than in serum samples. In group B, there were significant differences between serum and bile samples regarding both caspase-cleaved CK18 and total CK18. Cells staining positive for caspase-cleaved CK18 were present in the epithelial cells of the mucosa of the gallbladder.</p> <p>Conclusion</p> <p>CK18 is expressed in the gallbladder epithelial cells. The concentrations of both caspase-cleaved CK18 and total CK18 were higher in bile samples than in serum samples. The levels of total CK18, as well as caspase-cleaved CK18, do not seem to differ between active and inactive chronic cholecystitis.</p

Synthesis Characterization and catalytic reactivity heterotrimetallic complexes with type Ru-M-M΄ (M=Mo,W and M΄=Ru, Rh) Ru-M-M΄ (M=Mo,W and M΄=Ru, Rh)

In this Ph.D. Thesis we report the syntheses and the characterizations of new heterobimetallic tetrathiomolybdato-complexes of Rh(I), of one heterotrimetallic tetrathiomolybdato-complex with Rh(I) and Ru(II), of heteropentametallic tetrathiomolybdato-complexes with Rh(I) and Ni(II) or Cu(I) and of one heterobimetallic tetrathiotungstato-complex of Rh(I). We also report interesting correlations between electronic properties of these complexes and the catalytic activity of one heterobimetallic tetrathiomolybdato-complex in the homogeneous hydrogenation of 1-hexene. The starting material for the syntheses of the tetrathiomolybdato-complexes is the novel complex (PPh4)[(η4-cod)Rh(μ-S)2MoS2]. The X-ray crystal structure of this complex is reported. It crystallizes in the monoclinic system Ρ2(1)/c having elementary cell dimensions α=8,588A, β=16,089A και γ=16,075A. The molecular structure of the complex anion shows a perfect planarity for the 4-membered Rh(μ-S)2Mo ring and the existence of bonding interaction between the metal centers (Rh···Mo 2,8787A). The heterobimetallic tetrathiomolybdato-complexes (PPh4)[(P(OPh3)2Rh(μ-S)2MoS2], (PPh4) [(dppe)Rh(μ-S)2MoS2], (PPh4)[(cis-dppen)Rh(μ-S)2MoS2], (PPh4)[(dppb)Rh(μ-S)2MoS2] and (PPh4) [(cycloexylNC)Rh(μ-S)2MoS2] were synthesized and characterized with spectroscopic methods (UV-Vis and 31P, 13C NMR). Upon carbonylation of (PPh4)[(η4-cod)Rh(μ-S)2MoS2] the dicarbonyl-species (PPh4)[(CO)2Rh(μ-S)2MoS2] is formed, which was characterized with IR spectroscopy, ν(CO) 2064, 2012 cm-1. We have also synthesized the heterotrimetallic complex [(PhNCHS)(CO)(PPh3)Ru(μ-S)2Mo(μ-S)2Rh(cis-dppen)] and the heteropentametallic complexes [(cis-dppen)Rh(μ-S)2Mo(μ-S)2Ni(μ-S)2 Mo(μ-S)2Rh(cis-dppen)], (PPh4)[(η4-cod)Rh(μ-S)2Μο(μ-S)2Cu(μ-S)2Μο(μ-S)2Rh(η4-cod)], (PPh4) [(P(OPh3))2Rh(μ-S)2Mo(μ-S)2Cu(μ-S)2Mo(μ-S)2Rh(P(OPh)3)2] and (PPh4)[(dppe)Rh(μ-S)2Mo(μ-S)2 Cu(μ-S)2Mo(μ-S)2Rh(dppe)], which were characterized with spectroscopic methods (UV-Vis and 31P NMR). The synthesis and spectroscopic characterization (UV-Vis and 31P NMR) of the heterobimetallic tetrathiotungstato-complex (PPh4)[(P(OPh)3)2Rh(μ-S)2WS2] is also reported. We also report interesting correlations found between electronic parameters derived from electronic spectra, which originate from the electronic communication between the terminal metal centers of the complexes. We have found that the energy of the electronic transition ν(Rh>Mo) is predictable for different complexes with the same terminal ligands and that ν(Rh>Mo) for complexes with monodentate trivalent phosphorus ligands correlates linearly with Tolman's electronic parameter. We finally found that (PPh4)[(η4-cod)Rh(μ-S)2MoS2] is an active catalyst precursor for the homogeneous catalytic hydrogenation of 1-hexene (10 atm, θ=50°C), which is very interesting from the fact that the complex does not contain trivalent phosphorus ligands.Στην παρούσα διδακτορική διατριβή παρουσιάζονται οι συνθέσεις και οι χαρακτηρισμοί ετεροδιμεταλλικών τετραθειομολυβδαινατο- και τετραθειοβολφραματο-συμπλόκων του Rh(I), ενός ετεροτριμεταλλικού τετραθειομολυβδαινατο-συμπλόκου με Rh(I) και Ru(II) και ετεροπενταμεταλλικών τετραθειομολυβδαινατο-συμπλόκων με Rh(Ι) και Ni(ΙΙ) ή Cu(Ι).. Παράλληλα παρουσιάζονται ενδιαφέρουσες συσχετίσεις μεταξύ ηλεκτρονικών ιδιοτήτων των ενώσεων αυτών, καθώς και η καταλυτική δραστικότητα στην αντίδραση υδρογόνωσης του 1-εξενίου ενός ετεροδιμεταλλικού τετραθειομολυβδαινατο-συμπλόκου του Rh(I). Όλες οι συνθέσεις για τα τετραθειομολυβδαινατο-σύμπλοκα γίνονται με πρώτη ύλη το σύμπλοκο (PPh4)[(η4-cod)Rh(μ-S)2MoS2]. To σύμπλοκο αυτό συντέθηκε και απομονώθηκε υπό τη μορφή άλατος με PPh4+ και χαρακτηρίστηκε δομικά με κρυσταλλογραφία ακτίνων-Χ. Κρυσταλλώνεται στο μονοκλινές κρυσταλλικό σύστημα Ρ2(1)/c με διαστάσεις στοιχειώδους κυψελίδας α=8,588A, β=16,089A και γ=16,075A. Η μοριακή δομή δείχνει ότι η γεωμετρία του τετραμελούς δακτυλίου Rh(μ-S)2Mo είναι τέλεια επίπεδη και ότι υπάρχει δεσμική αλληλεπίδραση Ροδίου-Μολυβδαινίου (Rh···Mo 2,8787A). Συντέθηκαν τα ετεροδιμεταλλικά σύμπλοκα (PPh4)[(P(OPh3)2Rh(μ-S)2MoS2], (PPh4) [(dppe)Rh(μ-S)2MoS2], (PPh4)[(cis-dppen)Rh(μ-S)2MoS2], (PPh4)[(dppb)Rh(μ-S)2MoS2] και (PPh4) [(cycloexylNC)Rh(μ-S)2MoS2], τα οποία χαρακτηρίσθηκαν με φασματοσκοπικές μεθόδους (UV-Vis και 31Ρ,13C ΝΜR). Με καρβονυλίωση του (PPh4)[(η4-cod)Rh(μ-S)2MoS2] προκύπτει το δικαρβoνυλο-σύμπλοκο (PPh4)[(CO)2Rh(μ-S)2MoS2] το οποίο χαρακτηρίσθηκε με φασματοσκοπία IR, ν(CO) 2064, 2012 cm-1. Επίσης συντέθηκαν το ετεροτριμεταλλικό σύμπλοκο [(PhNCHS)(CO)(PPh3)Ru(μ-S)2Mo(μ-S)2Rh(cis-dppen)] και τα ετεροπενταμεταλλικά σύμπλοκα [(cis-dppen)Rh(μ-S)2Mo(μ-S)2Ni(μ-S)2 Mo(μ-S)2Rh(cis-dppen)], (PPh4)[(η4-cod)Rh(μ-S)2Μο(μ-S)2Cu(μ-S)2Μο(μ-S)2Rh(η4-cod)], (PPh4) [(P(OPh3))2Rh(μ-S)2Mo(μ-S)2Cu(μ-S)2Mo(μ-S)2Rh(P(OPh)3)2] και (PPh4)[(dppe)Rh(μ-S)2Mo(μ-S)2 Cu(μ-S)2Mo(μ-S)2Rh(dppe)], τα οποία χαρακτηρίσθηκαν με φασματοσκοπικές μεθόδους (UV-Vis και 31P ΝΜR). Συντέθηκε επίσης το ετεροδιμεταλλικό σύμπλοκο (PPh4)[(P(OPh)3)2Rh(μ-S)2WS2] χρησιμοποιώντας ως αρχική ύλη το PPh4[(η4-cod)Rh(μ-S)2WS2], για το οποίο προτείνουμε ένα διαφορετικό τρόπο σύνθεσης από αυτόν που έχει αναφερθεί στη βιβλιογραφία. Το σύμπλοκο αυτό χαρακτηρίστηκε με φασματοσκοπίες UV-Vis και 31P NMR. Παρουσιάζονται ενδιαφέρουσες συσχετίσεις ηλεκτρονικών ιδιοτήτων των συμπλόκων, οι οποίες σχετίζονται με τη δεσμική ηλεκτρονική πυκνότητα που είναι απεντοπισμένη καθ΄όλη την έκταση των τετραμελών δακτυλίων Μ΄(μ-S)2M με αποτέλεσμα την ηλεκτρονική επικοινωνία μεταξύ των ακραίων μεταλλικών κέντρων. Βάσει αυτών προκύπτει ότι η τιμή της ενέργειας του μεγίστου απορρόφησης της ηλεκτρονικής μετάπτωσης ν(Rh>Mo) είναι προβλέψιμη για διαφορετικά σύμπλοκα με ίδιους ακραίους υποκαταστάτες, επι πλέον δε ότι οι ν(Rh>Mo) συσχετίζονται γραμμικά με την ηλεκτρονική παράμετρο του Τolman, για σύμπλοκα με ακραίους μονοσχιδείς υποκαταστάτες τρισθενούς φωσφόρου. Τέλος βρέθηκε ότι το διμεταλλικό σύμπλοκο (PPh4)[(η4-cod)Rh(μ-S)2MoS2] είναι πρόδρομος καταλύτης για την υδρογόνωση του 1-εξενίου (10 atm, θ=50°C), που είναι ιδιαίτερα ενδιαφέρον δεδομένης της απουσίας υποκαταστατών τρισθενούς φωσφόρου

Robot-assisted laparoscopic radical prostatectomy with intrafascial dissection of the neurovascular bundles and preservation of the pubovesical complex: A step-by-step description of the technique

The preservation of sexual potency after radical prostatectomy has always been the topic of much anxiety and debate. While cancer control and urinary continence are of supreme importance, the preservation of sexual function completes the trifecta that both patient and surgeon strive to achieve. The introduction of robotic assistance to modern laparoscopic surgery has provided many advantages, the two greatest being improved three-dimensional magnified vision and wristed instrumentation. These technical enhancements provide the surgeon with improved surgical tools that have the potential to facilitate a more precise surgical approach. One of the potential advantages during robot-assisted laparoscopic prostatectomy (RALP) is improving visualization, control, and dissection of the neurovascular bundle (NVB). With this article, we provide the description of our current technique of intrafascial, tension and energy-free dissection of the NVB during RALP, aiming to maximize the preservation of the periprostatic neuronal network and improve erectile function outcomes. A step-by-step description of the preservation of the pubovesical complex is also provided