Patients' perceptions of quality of care delivery by urology residents: A nationwide study

Objective To present the results of a nationwide survey among urological patients to evaluate their perception of the quality of care provided by residents. Methods An anonymous survey was distributed to patients who were referred to 22 Italian academic institutions. The survey aimed to investigate the professional figure of the urology resident as perceived by the patient. Results A total of 2587 patients were enrolled in this study. In all, 51.6% of patients were able to correctly identify a urology resident; however, almost 40% of respondents discriminated residents from fully trained urologists based exclusively on their young age. Overall, 98.2% patients rated the service provided by the resident as at least sufficient. Urology trainees were considered by more than 50% of the patients interviewed to have good communication skills, expertise and willingness. Overall, patients showed an excellent willingness to be managed by urology residents. The percentage of patients not available for this purpose showed an increasing trend that directly correlated with the difficulty of the procedure. Approximately 5-10% of patients were not willing to be managed by residents for simple procedures such as clinical visits, cystoscopy or sonography, and up to a third of patients were not prepared to undergo any surgical procedure performed by residents during steps in major surgery, even if the residents were adequately tutored. Conclusions Our data showed that patients have a good willingness to be managed by residents during their training, especially for medium- to low-difficulty procedures. Furthermore, the majority of patients interviewed rated the residents' care delivery as sufficient. Urology trainees were considered to have good communication skills, expertise and willingness

Use of AUC7 adjuvant carboplatin in patients with stage I seminoma: systematic review of the literature

Purpose: Among the adjuvant options to be proposed to patients with stage I seminoma after orchiectomy, the administration of a single cycle of carboplatin, at the dosage reaching an area under the curve of 7 mg/mL/min (AUC7), is a relatively recent introduction in clinical practice. Methods: On April 1, 2016, we performed a systematic review of the literature to identify studies on the use of AUC7 carboplatin in the adjuvant setting for stage I seminoma patients. The studies were identified by searching the PubMed electronic database from July 2005 up to April 2016. The aim of this review is to clarify the state of art of this adjuvant option. Results: Adjuvant AUC7 carboplatin is an effective adjuvant treatment, able to reduce relapse rate in stage I seminoma patients. The heterogeneity of the methods for estimation and measurement of glomerular filtration rate represents an important issue in the administration of the optimal dose of carboplatin. Even with the lack of validated prognostic factors for relapses, a risk-adapted choice is commonly used to identify the optimal patient to be proposed this treatment. Conclusions: One cycle of AUC7 carboplatin is an effective, feasible, and safe adjuvant option to be discussed with stage I seminoma patients

Long-term response to first-line trabectedin in an elderly female patient with a metastatic leiomyosarcoma unfit for anthracycline

Systemic chemotherapy comprising anthracycline monotherapy is the standard regimen for metastatic soft tissue sarcomas, particularly leiomyosarcomas, which have limited sensitivity to ifosfamide. However, the optimal chemotherapy regimen for elderly patients, especially those considered unfit for anthracyclines, is undefined. Trabectedin is a potent marine-derived antineoplastic drug with documented activity in liposarcomas and leiomyosarcomas. It is registered in Europe for the treatment of adult patients with advanced soft tissue sarcoma, after failure of anthracyclines and ifosfamide, or who are unsuited to receive these agents. We report the long-term response to first-line trabectedin therapy in an elderly patient with metastatic leiomyosarcoma unfit for standard therapy. A 66-year-old woman underwent resection of a pelvic epithelioid leiomyosarcoma with positive margins in December 2002, followed by postoperative radiotherapy. In February 2012, she was diagnosed with multiple lung lesions and local relapse in the pelvis. As she was considered unsuitable for both anthracycline and ifosfamide because of cardiovascular comorbidities and because she was highly anxious at the prospect of developing alopecia, vomiting, and fatigue, we commenced treatment with trabectedin at 75% of the standard dose of 1.5 mg/m(2) every 3 weeks. Treatment was well tolerated, and the patient continued treatment for 25 cycles, with disease stabilization according to the RECIST criteria and a partial response according to the Choi criteria. Disease progression was observed in November 2013 and the patient died 20 months after the diagnosis of metastases. Trabectedin may represent an alternative option for highly selected elderly patients with metastatic sarcoma and unfit for anthracyclines; careful monitoring of toxicities is strongly recommended

Role of dose exposure and inflammatory status in a single center, real-world analysis of sunitinib in patients with metastatic renal cell carcinoma

Aim, patients & methods: To evaluate the real-world setting use of sunitinib, we reviewed data of our patients from January 2007 to December 2014. Results: In 114 patients, sunitinib was used as first-line TKI. Out of 110 evaluable patients, 5 complete responses, 37 partial responses, 42 stabilizations were reported. Median progression-free survival and overall survival (OS) were 14.3 and 28.4 months. Patients who received >= 4 full-dose cycles had a better OS (p = 0.02). A neutrophil-lymphocyte ratio <3 was associated both with OS and progression-free survival (50.4 vs 8.4 and 20.0 vs 3.3 months). Conclusion: Sunitinib is active and feasible. Patients receiving <4 full-dose cycles or having increased neutrophil-lymphocyte ratio achieved worse outcomes: therefore, these are present potential predictive factors

Argus-T Sling in 182 Male Patients: Short-term Results of a Multicenter Study

OBJECTIVE To evaluate the short-term results with Argus-T sling in patients with post-prostatectomy incontinence (PPI).MATERIALS AND METHODS A total of 182 patients with PPI were treated with Argus-T sling at 5 urologic centers from June 2008 to March 2013. The preoperative evaluation included medical history, pad count (1-2 pads: mild PPI; 3-5 pads: moderate PPI; > 5 pads: severe PPI), visual analog scale on continence, quality of life score scale, physical examination, cystoscopy, and urodynamic evaluation. Postoperative evaluation was performed 6 weeks postoperatively, and late follow-up was achieved in April 2013. We considered a successful result when patients were cured (0-1 pads/24 hours) and or improved (1-2 pads/24 hours or a reduction in pad per day usage greater than 50%).RESULTS Twenty-one (11.8%), 96 (52.7%), and 65 (35.7%) patients have mild, moderate, and severe incontinence, respectively. At the median follow-up of 22 months, the overall success rate was 86.2%. We obtained successful results of 95% in mild incontinence, 78% in moderate incontinence and 70% in severe incontinence. In cured and improved patients, we observed a statistically significant amelioration of quality of life (P <. 0001). Sling regulation was carried out in 42.9% of cases, whereas its removal occurred in 9.3% of cases. Postoperative complications were reported in 14.3% of patients. In patients with previous radiotherapy, we observed a successful result in 61.2% of cases.CONCLUSION This study represents the first report that shows short-term results of Argus-T positioning in a large population. Argus-T seems to offer good outcomes in patients with mild and moderate PPI. (C) 2017 Elsevier Inc

Risk factors of positive surgical margins after robot-assisted radical prostatectomy in high-volume center: results in 732 cases

The aim of the study was to evaluate clinical, pathological and peri-operative factors associated with the risk of positive surgical margins (PSM) after robot-assisted radical prostatectomy (RARP) in a high-volume center. The study is a retrospective analysis of prospectively collected data. We excluded cases who were under androgen deprivation or had prior treatments. The population included negative cases (control group) and PSM subjects (study groups). The logistic regression model assessed the independent association of factors with the risk of PSM. From January 2013 to December 2017, 732 patients underwent RARP. Extended pelvic lymph node dissection was performed in 342 cases (46.7%). Overall, 192 cases (26.3%) had PSM. Independent factors associated with the risk of focal PSM were body mass index (odds ratio, OR\u2009=\u20090.936; p\u2009=\u20090.021), percentage of biopsy-positive cores (BPC; OR\u2009=\u20091.012; p\u2009=\u20090.004), pathological extracapsular extension (OR\u2009=\u20092.702; p\u2009&lt;\u20090.0001), seminal vesicle invasion (OR\u2009=\u20092.889; p\u2009&lt;\u20090.0001) and high-volume surgeon (OR\u2009=\u20090.607; p\u2009=\u20090.006). In high-volume centers, features related to host, tumor biology and surgeon are independent factors associated with the risk of PSM after RARP, which are decreased by the high-volume surgeon. The inverse association between BMI and PSM risk needs further clinical research. These issues should be discussed when counseling patients

Adjuvant Carboplatin Treatment in 115 Patients With Stage I Seminoma: Retrospective Multicenter Survey

This retrospective multicenter survey analyzed modalities of dose calculation, dose reductions, acute toxicities, and relapse rate of adjuvant AUC 7 carboplatin in 115 stage I seminoma patients. The study confirms the feasibility and safety of AUC 7 carboplatin in every day clinical practice with a relapse rate of 5.2%. Dose reduction should be proscribed.Background: The administration of carboplatin AUC 7 has become a standard adjuvant option for patients undergoing orchiectomy for stage I seminoma, in alternative to radiotherapy on retroperitoneal lymphnodes or surveillance. The toxicity of AUC 7 carboplatin appeared manageable in the pivotal trial of Oliver et al, but dose ranges were not reported. Fear of toxicity may induce arbitrary dose reductions, which may potentially compromise patients' outcome. Patients and Methods: We reviewed adjuvant carboplatin administration in 115 stage I seminoma patients followed in 11 Italian medical oncology centers since 2005. Clinical and pathological data, modality of carboplatin dose calculation, dose reductions, toxicities, and relapses were recorded. Results: Median age was 35 years (range, 18-65 years), adverse prognostic factors were either T &gt;= 4 cm (17.4%) or rete testis invasion (28.7%), both of them (35.7%), none or unspecified (18.3%). GFR was estimated mainly by Cockroft-Gault formula (55.7%) or Jeliffe formula (26.1%), with a median of 105 mL/min (range, 75-209 mL/min). The median dose of carboplatin was 900 mg (range, 690-1535 mg). A dose reduction &gt; 10% was applied to 14 patients. Toxicities were mild fatigue, moderate nausea/vomiting, 5.2% of grade 3 to 4 thrombocytopenia. After a median follow-up of 22.1 months, 5.2% of patients have relapsed in the retroperitoneal lymph nodes. None of the patients that relapsed were treated with reduced dose. All but one achieved complete remission with salvage chemotherapy. Conclusions: Adjuvant AUC 7 carboplatin reduce relapses of stage I seminoma patients to 5.2%, with manageable toxicities. Dose reductions should be proscribed