Achille Aveta

Background/Objectives: Robot-assisted partial nephrectomy (RAPN) remains a technically demanding procedure, associated with a non-negligible risk of perioperative complications. This study aimed to assess the impact of preoperative planning and intraoperative navigation using patient-specific three-dimensional (3D) virtual model reconstructions on perioperative outcomes of RAPN. Methods: We analyzed 307 patients who underwent RAPN for renal tumors at a tertiary center between 2021 and 2024. Starting in 2023, 3D modeling (Medics3D) was integrated for selected cases (n = 69) and compared to a 2D-imaging control group (n = 238). The primary outcome was trifecta achievement, defined as the simultaneous presence of negative surgical margins, ≥90% preservation of preoperative eGFR at discharge, and absence of perioperative complications. Clamping strategies were categorized as on-clamp, selective/super-selective, or off-clamp. Mann–Whitney and Chi-squared tests compared the groups; multivariable logistic regression identified independent predictors of trifecta achievement. Results: Baseline characteristics were balanced between the 3D and control groups: median age (62 vs. 61 years, p = 0.5), BMI (28 vs. 26, p = 0.3), and eGFR (85 vs. 86 mL/min/1.73 m², p = 0.5). Median tumor size was 4.2 vs. 4.0 cm (p = 0.4), and RENAL complexity was comparable (p = 0.12). Selective or super-selective clamping was significantly more frequent in the 3D group (32% vs. 15%; p < 0.01). While WIT (17.5 vs. 18.5 min, p = 0.09) and complication rates (26% vs. 29%, p = 0.7) were similar, the 3D group showed a significantly lower rate of positive surgical margins (5% vs. 15%; p = 0.030). Trifecta achievement was significantly higher in the 3D group (51% vs. 32%; p = 0.004). On multivariable analysis, 3D modeling remained an independent predictor of trifecta achievement (OR 2.1, 95% CI 1.17–3.70; p = 0.013). Conclusions: The use of patient-specific 3D kidney reconstructions was associated with improved perioperative outcomes in patients undergoing RAPN. These findings support the integration of 3D modeling into routine surgical workflows to enhance operative precision and optimize patient outcomes.

Cedecea lapagei is a rare Gram-negative bacterium that has been infrequently associated with human infections. It is a non-encapsulated, facultative anaerobic organism that grows well in nonselective laboratory media and exhibits variable resistance patterns. Although Cedecea lapagei has been identified as a pathogen since 2006, reports of its clinical significance remain scarce, particularly in Europe. Here, we present the case of a 93-year-old male from Southern Italy, with multiple comorbidities and a history of urinary catheterization, who developed a urinary tract infection (UTI) caused by Cedecea lapagei. The patient was successfully treated with ciprofloxacin and fosfomycin, achieving clinical and microbiological healing. This report examines the substantial challenges associated with rare pathogens in clinical practice, focusing on the critical need for prompt and precise identification alongside tailored treatment strategies. Additionally, it highlights the pathogen’s alarming multidrug resistance capabilities, underscoring the urgent need for robust antimicrobial stewardship programs and comprehensive research into its epidemiological behavior and resistance mechanisms. Incorporating rare pathogens into differential diagnoses, particularly for elderly patients with recurrent UTIs, could improve patient outcomes significantly. Finally, these findings expand the limited existing data on Cedecea lapagei infections, providing valuable insights into more precise diagnostic methodologies and tailored therapeutic approaches.

Background/Objectives: Prostatic artery embolization (PAE) has emerged as a minimally invasive alternative for treating lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), particularly in high-risk surgical candidates. This study aims to evaluate the efficacy, safety, and clinical outcomes of PAE, combining a retrospective case series with a narrative review of the literature. Methods: A single-center retrospective analysis was conducted on 10 patients aged ≥ 70 years with moderate-to-severe LUTS due to BPH who underwent PAE between January 2021 and January 2024. Inclusion criteria included IPSS > 18, Qmax < 12 mL/s, prostate volume > 45 cc, and resistance to medical therapy. Embolization was performed using 300–500 µm tris-acryl gelatin microspheres via the PErFecTED technique. Follow-up included IPSS, Qmax, prostate volume (PV), PSA levels, and complications. A narrative review of 18 studies (n = 1539 patients) was also conducted to contextualize findings. Results: Technical success was achieved in all patients (100%), and clinical success (IPSS reduction ≥ 50%) in 90%. At 12 months, the following significant improvements were observed: mean IPSS decreased from 24 to 12 (p < 0.0001), Qmax increased from 8.7 to 12.6 mL/s (p < 0.0001), PV reduced from 66.4 to 49.4 cc (p < 0.0001), and PSA from 5.0 to 3.4 ng/mL (p < 0.0001). Outcomes remained stable up to 36 months. Two patients developed transient post-procedural fever; no major complications were recorded. Conclusions: PAE is a safe and effective treatment for LUTS related to BPH, offering durable symptom relief and minimal morbidity, particularly in elderly and comorbid patients. While the evidence supports its role as an alternative to TURP, larger prospective trials are necessary to confirm its long-term efficacy and optimize patient selection.

Cancer stem cells (CSCs) are a subpopulation with self-renewal and differentiation capacities believed to be responsible for tumor initiation, progression, and recurrence. These cells exhibit unique metabolic features that contribute to their stemness and survival in hostile tumor microenvironments. Like non-stem cancer cells, CSCs primarily rely on glycolysis for ATP production, akin to the Warburg effect. However, CSCs also show increased dependence on alternative metabolic pathways, such as oxidative phosphorylation (OXPHOS) and fatty acid metabolism, which provide necessary energy and building blocks for self-renewal and therapy resistance. The metabolic plasticity of CSCs enables them to adapt to fluctuating nutrient availability and hypoxic conditions within the tumor. Recent studies highlight the importance of these metabolic shifts in maintaining the CSC phenotype and promoting cancer progression. The CSC model suggests that a small, metabolically adaptable subpopulation drives tumor growth and therapy resistance. CSCs can switch between glycolysis and mitochondrial metabolism, enhancing their survival under stress and dormant states. Targeting CSC metabolism offers a promising therapeutic strategy; however, their adaptability complicates eradication. A multi-targeted approach addressing various metabolic pathways is essential for effective CSC elimination, underscoring the need for further research into specific CSC markers and mechanisms that distinguish their metabolism from normal stem cells for successful therapeutic intervention.

Background: Penile cancer (PC) is a rare malignancy with poor prognosis. To date, reliable preoperative biomarkers for lymph node status and prognosis are still lacking. This study aims to explore the potential role of preoperative platelet-to-lymphocyte ratio (PLR) as a predictor of inguinal lymph node invasion in PC patients.Methods: Retrospective analysis was conducted on anamnestic, clinical, and laboratory data of PC patients who underwent surgical treatment between January 2016 and October 2023. Inguinal lymphadenectomy was performed as per EAU guidelines. PLR, calculated as the ratio between platelet-to-lymphocyte values obtained from preoperative blood analyses, was assessed within 30 days before surgery. Patients were categorized into pN- (no lymph node metastasis) and pN+ (lymph node metastasis confirmed pathologically). Statistical analyses included Kruskal-Wallis and Mann-Whitney U tests, univariate logistic regression, and ROC curve analysis with Youden index, assuming p<0.05 as statistically significant.Results: Overall, 60 PC patients were retrospectively involved in the study. A total of 36 (60%) patients reported ILN metastases, confirmed by inguinal lymphadenectomy (pN+), while no ILN metastases (pN-) were reported in 24 (40%) patients. The AUC for predicting ILN metastasis by preoperative PLR was 0.71 (p=0.014). According to the ROC curve analysis and the Youden Index, a cut-off for PLR was set at 122.4. On Univariable logistic regression analysis, the presence of T stage ≥ 2 (OR = 3.21; 95% CI: 1.43-7.47, p=0.011), lymphovascular invasion (OR = 3.78; 95% CI: 1.56-5.90, p=0.003), clinical node-positive disease (OR = 19.86; 95% CI: 5.91-41.03, p 122.4 (OR = 7.22; 95% CI: 1.41-22.71, p=0.0148) were independent predictors of pN+ disease.Conclusions: The current study confirms the relationship between cancer and inflammation. When elevated preoperatively, PLR may be associated with inguinal lymph node invasion in PC patients.

Article: Ejaculation preservation in BPH: a question of size? - Minerva Urology and Nephrology 2024 December;76(6):794-6 - Minerva Medica - Journals

To date, the increased awareness of the impact of microbes on human health has promoted scientific interest in microbiome studies for diagnostic and therapeutic purposes, revealing correlations between specific taxa and cancer. In particular, numerous species of Porphyromonas have been associated with several types of tumors. Previously, we studied the urobiome using Next-Generation Sequencing (NGS), and found an increase in Porphyromonas somerae in first morning urine of subjects affected by bladder cancer (BCa). Here, we aimed to confirm the presence of P. somerae in BCa patients by using droplet digital Polymerase Chain Reaction (ddPCR), testing a cohort of 102 male subjects over 50 years. Our findings showed a significant increase in P. somerae in the urine of the BCa group within both ddPCR and NGS, and a correlation between the two methods was observed at a statistical level. Moreover, P. somerae’s identification with ddPCR confirmed a significant association between this bacterium and the presence of BCa, highlighting its potential role as a biomarker. This allows us to propose the ddPCR as a suitable method for first-stage BCa screening and follow-up.

The incidence of testicular cancer (TC) has been rapidly increasing over the past years. Diagnosis and early treatment have shown good oncological control, guaranteeing the patient different treatment approaches according to histology and tumor stage. Currently, physicians usually prioritize oncological outcomes over sexual outcomes and quality of life, considering as a first aim the overall survival of the patients; however, differently from other neoplasms, quality of life is still strongly affected among TC patients, and sexual outcomes are frequently compromised after each TC treatment. Several studies have suggested that each treatment approach may be associated with sexual dysfunctions, including erectile dysfunction, ejaculatory disorders, fertility issues, and hormonal changes. Since testicular cancer patients are more frequently young men, the subject of this work is substantial and should be analyzed in detail to help specialists in the management of this disease. The aim of the current narrative review is to generally describe every treatment for TC, including surgery, chemotherapy, radiotherapy, and retroperitoneal lymph node dissection, and to establish which sexual dysfunction may be specifically associated with each therapy.