ROBOT-ASSISTED LAPAROSCOPIC HYSTEROSACROPEXY FOR PELVIC ORGAN PROLAPSE

Introduction Pelvic organ prolapse (POP) surgery can be performed either transperineally or transabdominally. The individual woman\u2019s surgical history and goals, as well as her individual risk for surgical complications, prolapse recurrence and de novo symptoms impact the selection of surgical route. Transabdominal repairs are the most common surgical procedures for POP and are associated to recurrence rates up to 10%, whereas transperineal approaches are reported to be a source of higher recurrence rates. Transabdominal procedures can be performed either by laparotomy or by laparoscopy. Recently several series have reported that laparoscopic approach to treat POP (with or without robotic assistance) is feasible and safe with good short and intermediate-term results, comparable to open approaches. This paper describes the technical aspects of robot-assisted laparoscopic hysterosacropexy (RALHSP) using the da Vinci surgical system. Design Since 2006, 10 consecutive patients with POP (mean age 54.5 years), who wished to preserve the uterus, underwent RALHSP as single reconstructive procedure. Two surgeons performed all procedures with the same technique. All complications were collected at a 90-day follow-up using the standardised Clavien classification system. The following outcomes were evaluated: operative time, blood loss, complications, in hospital stay, catheterization time, cure rate. The surgical steps were: bilateral dissection of the perimetrium; identification and extraperitonealization of the uterine cervix; incision of the peritoneum at presacral level and distal to the cervix; placement of a 20 x 2.5 cm polypropylene mesh, willing to embrace the cervix, secured to the anterior longitudinal sacral legament with 0 Tycron stitches; mesh extraperitonealization. Results Al procedures were performed successfully using the Robot-assisted approach. No additional reconstructive procedures were thought to be necessary at the end of surgery. The mean operative time was 103 minutes; the mean blood loss was 18 mL. Neither intra- nor major post-operative complications occurred. According to the Clavien classification system, 4 patients (40%) had grade 1 early complications (two nausea episodes, two electrolyte disturbance); and one patient (10%) had grade 2 complication (diarrhoea). At a mean follow-up of 9.3 months all patients declared themselves satisfied with the anatomical and functional results achieved. Conclusion RALHSP represents an effective option for the management of POP in selected women who wish to preserve the uterus. Moreover da Vinci robotic system allows performing similar procedures to those performed by standard laparoscopy or laparotomy without increasing the morbidity rate when compared to standard laparoscopy, and allows the same functional results

Impact of gastrointestinal side effects on patients’ reported quality of life trajectories after radiotherapy for prostate cancer: Data from the prospective, observational pros-it CNR study

Radiotherapy (RT) represents an important therapeutic option for the treatment of localized prostate cancer. The aim of the current study is to examine trajectories in patients’ reported quality of life (QoL) aspects related to bowel function and bother, considering data from the PROState cancer monitoring in ITaly from the National Research Council (Pros-IT CNR) study, analyzed with growth mixture models. Data for patients who underwent RT, either associated or not associated with androgen deprivation therapy, were considered. QoL outcomes were assessed over a 2-year period from the diagnosis, using the Italian version of the University of California Los Angeles-Prostate Cancer Index (Italian-UCLA-PCI). Three trajectories were identified for the bowel function; having three or more comorbidities and the use of 3D-CRT technique for RT were associated with the worst trajectory (OR = 3.80, 95% CI 2.04–7.08; OR = 2.17, 95% CI 1.22–3.87, respectively). Two trajectories were identified for the bowel bother scores; diabetes and the non-Image guided RT method were associated with being in the worst bowel bother trajectory group (OR = 1.69, 95% CI 1.06–2.67; OR = 2.57, 95% CI 1.70–3.86, respectively). The findings from this study suggest that the absence of comorbidities and the use of intensity modulated RT techniques with image guidance are related with a better tolerance to RT in terms of bowel side effects

Disease-specific and general health-related quality of life in newly diagnosed prostate cancer patients: The Pros-IT CNR study

Background: The National Research Council (CNR) prostate cancer monitoring project in Italy (Pros-IT CNR) is an observational, prospective, ongoing, multicentre study aiming to monitor a sample of Italian males diagnosed as new cases of prostate cancer. The present study aims to present data on the quality of life at time prostate cancer is diagnosed. Methods: One thousand seven hundred five patients were enrolled. Quality of life is evaluated at the time cancer was diagnosed and at subsequent assessments via the Italian version of the University of California Los Angeles-Prostate Cancer Index (UCLA-PCI) and the Short Form Health Survey (SF-12). Results: At diagnosis, lower scores on the physical component of the SF-12 were associated to older ages, obesity and the presence of 3+ moderate/severe comorbidities. Lower scores on the mental component were associated to younger ages, the presence of 3+ moderate/severe comorbidities and a T-score higher than one. Urinary and bowel functions according to UCLA-PCI were generally good. Almost 5% of the sample reported using at least one safety pad daily to control urinary loss; less than 3% reported moderate/severe problems attributable to bowel functions, and sexual function was a moderate/severe problem for 26.7%. Diabetes, 3+ moderate/severe comorbidities, T2 or T3-T4 categories and a Gleason score of eight or more were significantly associated with lower sexual function scores at diagnosis. Conclusions: Data collected by the Pros-IT CNR study have clarified the baseline status of newly diagnosed prostate cancer patients. A comprehensive assessment of quality of life will allow to objectively evaluate outcomes of different profile of care

Treatment paths for localised prostate cancer in Italy: The results of a multidisciplinary, observational, prospective study (Pros-IT CNR)

Background There are several treatments available to newly diagnosed prostate cancer (PCA) patients. Although surgery and radiotherapy (RT) with or without androgen deprivation therapy (ADT) are widely adopted treatment options for localized PCA together with active surveillance (AS), there is no consensus nor randomised trials on treatment selection, prospective quality of life (QOL), along with toxicity outcomes and according to treatment modality in the Italian population. The current study aimed to describe clinical-therapeutic features and QOL at PCA diagnosis, according to different treatment patterns in a large prospective, Italian population, enrolled in the Pros-IT CNR study. Methods The Pros-IT CNR is an on-going national, multicenter, observational, prospective study on patients affected by PCA who have been referred by 97 Italian Urology, Radiation Oncology and Medical Oncology facilities participating in the project. The possible relationships between the treatment patterns reported in the 6 month follow-up case report form and patients\u2019 features at diagnosis were evaluated using exploratory multiple correspondence analysis (MCA) and other data analysis method. Results At diagnosis, surgery and AS patients were significantly younger, had fewer comorbidities, lower PSA levels and Gleason Score (GS) values; they were also diagnosed at an earlier stage of disease with respect to the RT or ADT patients who showed significantly worse QoL scores at the time of diagnosis. Conclusions An analysis of the data collected at baseline and 6 months later uncovered substantial differences in ages, comorbidities, clinical and QOL features in the various treatment groups. These findings do not fully reflect the current PCA treatment guidelines and suggest the need for a multidisciplinary consensus guideline to ameliorate both the counselling and treatments of PCA patients

Urology in the Time of Coronavirus: Reduced Access to Urgent and Emergent Urological Care during the Coronavirus Disease 2019 Outbreak in Italy

none62The coronavirus disease 2019 (COVID-19) pandemic has put a substantial burden on the Italian healthcare system, resulting in the restructuring of hospitals to care for COVID-19 patients. However, this has likely impacted access to care for patients experiencing other conditions. We aimed to quantify the impact of COVID-19 on access to care for patients with urgent/emergent urological conditions throughout Italy. Materials and Methods: A questionnaire was sent to 33 urological units in the AGILE consortium, asking clinicians to report on the number of urgent/emergent urological patients seen and/or undergoing surgery over a 3-week period during the peak of the COVID-19 outbreak and a reference week prior to the outbreak. ANOVA and linear regression models were used to quantify these changes. Results: Data from 27 urological centres in Italy showed a decrease from 956 patients/week seen just prior to the outbreak to 291 patients/week seen by the end of the study period. There was a difference in the number of patients with urgent/emergent urological disease seen within/during the different weeks (all p values < 0.05). A significant decrease in the number of patients presenting with haematuria, urinary retention, urinary tract infection, scrotal pain, renal colic, or trauma and urgent/emergent cases that required surgery was reported (all p values < 0.05). Conclusion: In Italy, during the COVID-19 outbreak there has been a decrease in patients seeking help for urgent/emergent urological conditions. Restructuring of hospitals and clinics is mandatory to cope with the COVID-19 pandemic; however, the healthcare system should continue to provide adequate levels of care also to patients with other conditions.openPorreca A.; Colicchia M.; D'Agostino D.; Amenta M.; Corsaro A.; Zaramella S.; Zegna L.; Gallo F.; Schenone M.; Bozzini G.; Calori A.; Pastore A.L.; Al Salhi Y.; Sciorio C.; Spirito L.; Varca V.; Marenghi C.; Greco F.; Altieri V.M.; Verze P.; Barba C.; Antonelli A.; Cerruto M.A.; Falabella R.; Di Bello S.; Leonardo C.; Tufano A.; Volpe A.; Umari P.; Parma P.; Nidini M.; Pini G.; Borghesi M.; Terrone C.; Cacciamani G.E.; Sighinolfi M.C.; Busetto G.M.; Wennberg A.M.; Finocchiaro M.; Falsaperla M.; Oderda M.; Ceruti C.; Rocco B.; Schiavina R.; Bianchi L.; Mari A.; Di Maida F.; Dalpiaz O.; Celia A.; Pirozzi M.; Bove P.; Iacovelli V.; Cafarelli A.; Cindolo L.; Ferrari G.; Gatti L.; Pirola G.; Annino F.; Pucci L.; Romagnoli D.; Artibani W.; Minervini A.Porreca, A.; Colicchia, M.; D'Agostino, D.; Amenta, M.; Corsaro, A.; Zaramella, S.; Zegna, L.; Gallo, F.; Schenone, M.; Bozzini, G.; Calori, A.; Pastore, A. L.; Al Salhi, Y.; Sciorio, C.; Spirito, L.; Varca, V.; Marenghi, C.; Greco, F.; Altieri, V. M.; Verze, P.; Barba, C.; Antonelli, A.; Cerruto, M. A.; Falabella, R.; Di Bello, S.; Leonardo, C.; Tufano, A.; Volpe, A.; Umari, P.; Parma, P.; Nidini, M.; Pini, G.; Borghesi, M.; Terrone, C.; Cacciamani, G. E.; Sighinolfi, M. C.; Busetto, G. M.; Wennberg, A. M.; Finocchiaro, M.; Falsaperla, M.; Oderda, M.; Ceruti, C.; Rocco, B.; Schiavina, R.; Bianchi, L.; Mari, A.; Di Maida, F.; Dalpiaz, O.; Celia, A.; Pirozzi, M.; Bove, P.; Iacovelli, V.; Cafarelli, A.; Cindolo, L.; Ferrari, G.; Gatti, L.; Pirola, G.; Annino, F.; Pucci, L.; Romagnoli, D.; Artibani, W.; Minervini, A

Urology in the Time of Coronavirus: Reduced Access to Urgent and Emergent Urological Care during the Coronavirus Disease 2019 Outbreak in Italy

The coronavirus disease 2019 (COVID-19) pandemic has put a substantial burden on the Italian healthcare system, resulting in the restructuring of hospitals to care for COVID-19 patients. However, this has likely impacted access to care for patients experiencing other conditions. We aimed to quantify the impact of COVID-19 on access to care for patients with urgent/emergent urological conditions throughout Italy. Materials and Methods: A questionnaire was sent to 33 urological units in the AGILE consortium, asking clinicians to report on the number of urgent/emergent urological patients seen and/or undergoing surgery over a 3-week period during the peak of the COVID-19 outbreak and a reference week prior to the outbreak. ANOVA and linear regression models were used to quantify these changes. Results: Data from 27 urological centres in Italy showed a decrease from 956 patients/week seen just prior to the outbreak to 291 patients/week seen by the end of the study period. There was a difference in the number of patients with urgent/emergent urological disease seen within/during the different weeks (all p values < 0.05). A significant decrease in the number of patients presenting with haematuria, urinary retention, urinary tract infection, scrotal pain, renal colic, or trauma and urgent/emergent cases that required surgery was reported (all p values < 0.05). Conclusion: In Italy, during the COVID-19 outbreak there has been a decrease in patients seeking help for urgent/emergent urological conditions. Restructuring of hospitals and clinics is mandatory to cope with the COVID-19 pandemic; however, the healthcare system should continue to provide adequate levels of care also to patients with other conditions

Urology in the Time of Coronavirus: Reduced Access to Urgent and Emergent Urological Care during the Coronavirus Disease 2019 Outbreak in Italy

The coronavirus disease 2019 (COVID-19) pandemic has put a substantial burden on the Italian healthcare system, resulting in the restructuring of hospitals to care for COVID-19 patients. However, this has likely impacted access to care for patients experiencing other conditions. We aimed to quantify the impact of COVID-19 on access to care for patients with urgent/emergent urological conditions throughout Italy. Materials and Methods: A questionnaire was sent to 33 urological units in the AGILE consortium, asking clinicians to report on the number of urgent/emergent urological patients seen and/or undergoing surgery over a 3-week period during the peak of the COVID-19 outbreak and a reference week prior to the outbreak. ANOVA and linear regression models were used to quantify these changes. Results: Data from 27 urological centres in Italy showed a decrease from 956 patients/week seen just prior to the outbreak to 291 patients/week seen by the end of the study period. There was a difference in the number of patients with urgent/emergent urological disease seen within/during the different weeks (all p values < 0.05). A significant decrease in the number of patients presenting with haematuria, urinary retention, urinary tract infection, scrotal pain, renal colic, or trauma and urgent/emergent cases that required surgery was reported (all p values < 0.05). Conclusion: In Italy, during the COVID-19 outbreak there has been a decrease in patients seeking help for urgent/emergent urological conditions. Restructuring of hospitals and clinics is mandatory to cope with the COVID-19 pandemic; however, the healthcare system should continue to provide adequate levels of care also to patients with other conditions