Reliable Prediction of Post-Operative Complications’ Rate Using the G8 Screening Tool: A Prospective Study on Elderly Patients Undergoing Surgery for Kidney Cancer

Abstract: In the last years the incidence of renal neoplasms has been steadily increasing, along with the average age of patients at the time of diagnosis. Surgical management for localized disease is becoming more challenging because of patients’ frailty. We conducted a multi-center prospective study to evaluate the role of the G8 as a screening tool in the assessment of intra and post-operative complications of elderly patients ( 70 y.o.) undergoing surgery for kidney cancer. A total of 162 patients were prospectively enrolled between January 2015 to January 2019 and divided into two study groups (frail vs. not-frail) according to their geriatric risk profile based on G8 score. Several factors (i.e., age, CCI, ASA score, preoperative anemia, RENAL score, surgical procedures, and techniques) were analyzed to identify whether any of them would configure as a statistically significant predictor of surgical complications. According to the G8 Score, 90 patients were included in the frail group. A total of 52 frail patients vs. 4 non-frail patients developed a postoperative complication of any kind (p < 0.001). Of these, 11 were major complications and all occurred in the frail group. Our results suggest that the G8 screening tool is an effective and useful instrument to predict the risk of overall complications in elderly patients prior to renal surgery

Diagnosis of prostate cancer with magnetic resonance imaging in men treated with 5-alpha-reductase inhibitors

Purpose The primary aim of this study was to evaluate if exposure to 5-alpha-reductase inhibitors (5-ARIs) modifies the effect of MRI for the diagnosis of clinically significant Prostate Cancer (csPCa) (ISUP Gleason grade >= 2).Methods This study is a multicenter cohort study including patients undergoing prostate biopsy and MRI at 24 institutions between 2013 and 2022. Multivariable analysis predicting csPCa with an interaction term between 5-ARIs and PIRADS score was performed. Sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values of MRI were compared in treated and untreated patients.Results 705 patients (9%) were treated with 5-ARIs [median age 69 years, Interquartile range (IQR): 65, 73; median PSA 6.3 ng/ml, IQR 4.0, 9.0; median prostate volume 53 ml, IQR 40, 72] and 6913 were 5-ARIs naive (age 66 years, IQR 60, 71; PSA 6.5 ng/ml, IQR 4.8, 9.0; prostate volume 50 ml, IQR 37, 65). MRI showed PIRADS 1-2, 3, 4, and 5 lesions in 141 (20%), 158 (22%), 258 (37%), and 148 (21%) patients treated with 5-ARIs, and 878 (13%), 1764 (25%), 2948 (43%), and 1323 (19%) of untreated patients (p < 0.0001). No difference was found in csPCa detection rates, but diagnosis of high-grade PCa (ISUP GG >= 3) was higher in treated patients (23% vs 19%, p = 0.013). We did not find any evidence of interaction between PIRADS score and 5-ARIs exposure in predicting csPCa. Sensitivity, specificity, PPV, and NPV of PIRADS >= 3 were 94%, 29%, 46%, and 88% in treated patients and 96%, 18%, 43%, and 88% in untreated patients, respectively.Conclusions Exposure to 5-ARIs does not affect the association of PIRADS score with csPCa. Higher rates of high-grade PCa were detected in treated patients, but most were clearly visible on MRI as PIRADS 4 and 5 lesions.Trial registration The present study was registered at ClinicalTrials.gov number: NCT05078359

Reliable Prediction of Post-Operative Complications’ Rate Using the G8 Screening Tool: A Prospective Study on Elderly Patients Undergoing Surgery for Kidney Cancer

In the last years the incidence of renal neoplasms has been steadily increasing, along with the average age of patients at the time of diagnosis. Surgical management for localized disease is becoming more challenging because of patients’ frailty. We conducted a multi-center prospective study to evaluate the role of the G8 as a screening tool in the assessment of intra and post-operative complications of elderly patients (≥70 y.o.) undergoing surgery for kidney cancer. A total of 162 patients were prospectively enrolled between January 2015 to January 2019 and divided into two study groups (frail vs. not-frail) according to their geriatric risk profile based on G8 score. Several factors (i.e., age, CCI, ASA score, preoperative anemia, RENAL score, surgical procedures, and techniques) were analyzed to identify whether any of them would configure as a statistically significant predictor of surgical complications. According to the G8 Score, 90 patients were included in the frail group. A total of 52 frail patients vs. 4 non-frail patients developed a postoperative complication of any kind (p < 0.001). Of these, 11 were major complications and all occurred in the frail group. Our results suggest that the G8 screening tool is an effective and useful instrument to predict the risk of overall complications in elderly patients prior to renal surgery

Predictors of residual tumor at re-staging transurethral resection for high-risk non-muscle invasive bladder cancer

7Author of the Study: Re-staging transurethral resection of bladder tumor re-TURBt is nowadays considered the gold-standard treatment for patients with non-muscle invasive bladder cancer (NMIBC) harboring high-risk features. Although the rationale behind it’s well established in the current guidelines, it must be considered its potential morbidity, procedure-related costs and the need of general or locoregional anesthesia. To assess a risk-adapted strategy, we analyzed the role of clinicopathological, laboratory and surgical predictors of residual tumor at the time of re-TURBt in a single- Institution series of T1 NIMIBC. Materials and Methods: A prospectively maintained internal databasewas queried. Data about 114 consecutive patients who underwent re-TURBt for T1 NMIBC were analyzed. Binomial logistic regression models were applied to evaluate residual tumor predictors. Step function was used to select the best model according to the Akaike Information Criterion (AIC). Results: Of these 114 patients, 97 were men (85.1%) and 17 were women (14.9%). The median age of the participants at the time of the interventionswas 73 years (IQR 68–79). Regarding smoking habits, 36 patients were no smokers (31.6%), 47 were former smokers (41.2%), and 31 were active smokers (27.2%). The Charlson Comorbidity Index (CCI) was ≥ 2 in 53 cases (46.5%), 1 in 35 cases (30.7%) and 0 in the remaining 26 (22.8%). In 48.2% of cases, the tumor was multifocal. Detrusor muscle was present in 97 (81,5%) samples of the first TURBt. Residual tumor was present in 40 (35.1%) patients. Pathological stage at re-TURBt was pTa in 7.9%, pT1 in 23.7% and pT2 in 3.5% of cases. In the remaining 40 patients with residual disease, the histologic stage of the lesion was pTa in 7.9%, pT1 in 23.7% and pT2 in 3.5% of cases. In 19.3% of patients, a high-grade tumor was found at re-TURBT. After multivariate binomial logistic regression analysis, we observed that age (OR 1.05; 95% CI 1.01–1.11; p = 0.02), previous history for bladder neoplasm (OR 3.14; 95% CI 1.10–11.10; p = 0.04), presence of preoperative anemia (OR 5. 4; 95% CI 1.36–9.65; p = 0.02), preoperative platelet count (OR 1.01; 95% CI 1.00–1.01; p = 0.02), preoperative high neutrophil-to-lymphocyte ratio (NLR) (OR1.23; 95% CI 1.01–1. 55; p = 0.05), training level of the surgeon (OR 0.09; 95% CI 0.01–0.42; p = 0.01), and tumor grading (OR 2.71; 95% CI 1.14–8.43; p = 0.04)were independently associated with outcome. The Area Under the Curve (AUC) of the model was 0.80. Conclusions: Increasing age, preoperative anemia, impaired neutrophil- to-lymphocyte ratio, and high-grade tumor at first TURBt were independent risk factors for residual tumor at re-TURBt. These initial Results may allow a more accurate selection of patients to be considered for re-TURBt. Further investigations are needed.openopenFabio Traunero; Francesco Claps; Petra Vogrig; Giovanni Liguori; Nicola Pavan; Francesca Vedovo; Carlo TrombettaTraunero, Fabio; Claps, Francesco; Vogrig, Petra; Liguori, Giovanni; Pavan, Nicola; Vedovo, Francesca; Trombetta, Carl

MP58-13 The role of G8 screening tool in Elderly population undergoing radical cystectomy: preliminary evaluation

INTRODUCTION AND OBJECTIVES The G8 screening tool represents a valid instrument for the identification of functional decline in oncological geriatric patients (pts). Recently it has demonstrated good predictive value in surgery to identify fragile pts candidates for oncological abdominal surgery. Our study has the objective to define if G8 score is a good tool to identify the risk of post operative complications in elderly pts (= 70 years) undergoing radical cystectomy (RC). METHODS From January 2012 to August 2017 we recruited 56 pts 70 yrs or older at the surgical time, undergone RC. Median age was 76 yrs (SD 4,37). The G8 screening questionnaire was perfomed to all patients preoperatively, and fragile pts were identified with a score = 14. We registered intra operative complications, post operative complications and their gravity using Clavien Dindo scale, estimated glomerular filtration rate (eGFR) and its variation postoperatively, length of hospital stay after surgery and readmission rate within 30 days. We compared the clinicalpathological data between the frail (G8 score 14) group. Statistical analysis was made by computing software SPSS. RESULTS Median preoperative G8 score was 13,65 (SD 2,3). Pts were divided in fragile (N=35, 62,5%) and fit (N=21, 37,5%). Intra operative complications were registered in 1 pts (2,8 %) with G8 score =14 and 0 pt (0%) with G8>14 (p= 0,625). Post operative complications occurred in 24 pts (68,5 %) with G8 score =14 and 8 pts (38,09 %) with G8>14 (p=0,025), 12 and none of them had a Clavien Score = 3 respectevely (p= 0,015). Postoperative eGFR was 61,45 (SD 29,2) in G8=14 group and 57,66 (SD 25,84) in G8>14 group (p=0,62) and median variation between pre and postoperative eGFR was 7,8 (SD 27,43) and 8,0 (SD 26,01) for each group (p= 0,97). Median hospital stay was 25,45 days (SD 11,01) for fragile pts and 24,23 days (SD 11,32) for fit pts (p=0,69). 5 pts (14,28 %) with G8score=14 were readmitted within 30 days of discharge, and for 6 pts (28,57 %) with G8score>14 was necessary a new hospitalization (p= 0,298). No significative difference was registered for overall mortality (p= 0,23) and cancer related mortality (p= 0,53) between the two groups. CONCLUSIONS The G8 screening tool represents a good predictive instrument for RC morbidity, identifying fragile pts at risk of post operative complications and their severity. Further analyses are necessary to confirm the data obtained from this preliminary study

MP58-13 The role of G8 screening tool in Elderly population undergoing radical cystectomy: preliminary evaluation

INTRODUCTION AND OBJECTIVES The G8 screening tool represents a valid instrument for the identification of functional decline in oncological geriatric patients (pts). Recently it has demonstrated good predictive value in surgery to identify fragile pts candidates for oncological abdominal surgery. Our study has the objective to define if G8 score is a good tool to identify the risk of post operative complications in elderly pts (= 70 years) undergoing radical cystectomy (RC). METHODS From January 2012 to August 2017 we recruited 56 pts 70 yrs or older at the surgical time, undergone RC. Median age was 76 yrs (SD 4,37). The G8 screening questionnaire was perfomed to all patients preoperatively, and fragile pts were identified with a score = 14. We registered intra operative complications, post operative complications and their gravity using Clavien Dindo scale, estimated glomerular filtration rate (eGFR) and its variation postoperatively, length of hospital stay after surgery and readmission rate within 30 days. We compared the clinicalpathological data between the frail (G8 score 14) group. Statistical analysis was made by computing software SPSS. RESULTS Median preoperative G8 score was 13,65 (SD 2,3). Pts were divided in fragile (N=35, 62,5%) and fit (N=21, 37,5%). Intra operative complications were registered in 1 pts (2,8 %) with G8 score =14 and 0 pt (0%) with G8>14 (p= 0,625). Post operative complications occurred in 24 pts (68,5 %) with G8 score =14 and 8 pts (38,09 %) with G8>14 (p=0,025), 12 and none of them had a Clavien Score = 3 respectevely (p= 0,015). Postoperative eGFR was 61,45 (SD 29,2) in G8=14 group and 57,66 (SD 25,84) in G8>14 group (p=0,62) and median variation between pre and postoperative eGFR was 7,8 (SD 27,43) and 8,0 (SD 26,01) for each group (p= 0,97). Median hospital stay was 25,45 days (SD 11,01) for fragile pts and 24,23 days (SD 11,32) for fit pts (p=0,69). 5 pts (14,28 %) with G8score=14 were readmitted within 30 days of discharge, and for 6 pts (28,57 %) with G8score>14 was necessary a new hospitalization (p= 0,298). No significative difference was registered for overall mortality (p= 0,23) and cancer related mortality (p= 0,53) between the two groups. CONCLUSIONS The G8 screening tool represents a good predictive instrument for RC morbidity, identifying fragile pts at risk of post operative complications and their severity. Further analyses are necessary to confirm the data obtained from this preliminary study

Procalcitonin as prognostic factor in patients with Fournier's gangrene

Introduction: Fournier's Gangrene (FG) has still a mortality rate up to 45%. Several studies identified prognostic factors but there is a knowledge gap concerning procalcitonin (PCT) levels and mortality risk in FG. This study is aimed to assess the role of PCT as prognostic factor in FG. Materials and methods: The medical records of 20 male FG patients admitted at the Department of Urology of "Cattinara" Hospital, University of Trieste between January 2019 and November 2020 were retrospectively reviewed. Clinical, demographic, microbiological data were collected. The Fournier's Gangrene Severity Index (FGSI) was calculated for each patient. Results: Thirteen (65%) of 20 patients survived. Median age was 58 years (IQR 51-88), 15 patients (75%) had a Charlson Comorbidity Index (CCI) score > 2, 1 (5%) equal to 0, 4 to 1 (20%). Median FGSI score was 6 (IQR 2-12) and median PCT 0.8 ng/ml (IQR 0.04-2.12). At multivariate analysis PCT levels >0.05 ng/ml were associated with an increased overall mortality risk (OR 2.14, CI 1.25-4.27, p = 0.002). CCI score > 2 (OR 1.51, CI 1.01-2.59, p = 0.04), Streptococcical etiology (OR 3.41, CI 2.49-4.61, p = 0.002) and FGSI score >9 (OR 1.41, CI 1.19-2.21, p = 0.004) were associated with unfavorable outcome. Conclusion: PCT might be a prognostic factor in FG. CCI and FGSI are useful tools in mortality risk stratification. Streptococcical etiology is associated with unfavorable outcome. Further larger clinical trials are pending

Plication surgery does not produce additional loss of length in Peyronie’s disease patients

Nesbit's procedure remains a cornerstone in surgical management of Peyronie's disease, despite the subjective loss of penile length. This retrospective study demonstrates that the perceived length loss has already occurred prior to surgery and that the Nesbit's procedure does not produce additional loss of length. Ninety-one patients who had undergone Nesbit's procedure between 2017 and 2022 at the Department of Urology of the University of Trieste were enrolled in the study. Preoperative stretched penile length and postoperative stretched penile length were measured. The curvature was uniplanar in 78 patients and biplanar in the remainder. Mean degree of the main curvature was 52.58° ± 14.13° and mean number of plications was 2.42 ± 1.07. Analysis revealed that the median of the differences between preoperative stretched penile length and postoperative stretched penile length was not significant (p = 0.466). According to our results, no significant penile shortening occurs as immediate consequence of Nesbit's procedure, as length is defined by the shorter side of the shaft affected by Peyronie's disease. Hence the length loss should have to be attributed to Peyronie's disease itself and could have been accurately predicted preoperatively allowing for a more accurate counseling of patients. Further studies are pending to assess potential postoperative loss of length due to scarring contracture

Validation of the Italian Version of the Peyronie’s Disease Questionnaire (PDQ)

Peyronie's disease (PD) is a connective tissue disorder characterized by the formation of fibrous plaques in the tunica albuginea of the penis which can result in pain, deformity and erectile dysfunction (ED). The Peyronie's Disease Questionnaire (PDQ) assesses the severity of symptoms, including pain, penile curvature and ED, as well as the impact on sexual function, emotional well-being, and overall quality of life of PD patients. Previous studies validated the PDQ in languages other than English and confirmed its test-retest reliability and clinical utility. Despite this, in many countries the unavailability of an adequate PDQ validation in native language hampers its use in clinical practice. In the present non-interventional, observational study we aimed at validating the Italian version of the PDQ (PDQ-I). Between January 2019 and November 2021, 79 PD patients from 6 Italian high-volume centers were administrated the PDQ-I in two separated office visits distanced by a period of 6 months. Intraclass correlation coefficients (ICCs) were used to evaluate the association between the three PDQ scale scores at visit 1 and 2. Paired t-tests were used to evaluate significant score changes between the 2 visits. Cronbach's alpha was used to assess internal consistency reliability. PDQ-I demonstrated an excellent test-retest reliability in the Italian population (ICC 0.78-0.92) as well as a strong internal consistency, with all three scale scores showing a Cronbach's alpha coefficient above 0.70. PDQ-I proved to be a useful tool which allows to reliably evaluate Italian PD patients' quality of life in both everyday andrological practice and clinical research. External validation of our results is pending

Fluorescence Confocal Microscopy in Urological Malignancies: Current Applications and Future Perspectives

Fluorescence confocal microscopy (FCM) represents a novel diagnostic technique able to provide real-time histological images from non-fixed specimens. As a consequence of its recent developments, FCM is gaining growing popularity in urological practice. Nevertheless, evidence is still sparse, and, at the moment, its applications are heterogeneous. We performed a narrative review of the current literature on this topic. Papers were selected from the Pubmed, Embase, and Medline archives. We focused on FCM applications in prostate cancer (PCa), urothelial carcinoma (UC), and renal cell carcinoma (RCC). Articles investigating both office and intraoperative settings were included. The review of the literature showed that FCM displays promising accuracy as compared to conventional histopathology. These results represent significant steps along the path of FCM's formal validation as an innovative ready-to-use diagnostic support in urological practice. Instant access to a reliable histological evaluation may indeed significantly influence physicians' decision-making process. In this regard, FCM addresses this still unmet clinical need and introduces intriguing perspectives into future diagnostic pathways. Further studies are required to thoroughly assess the whole potential of this technique