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Andrea Minervini

Publications and source records attributed to Andrea Minervini.

17 recordsLinked to original sources
PubMed2007

Physical activity of men with chronic prostatitis/chronic pelvic pain syndrome not satisfied with conventional treatments--could it represent a valid option? The physical activity and male pelvic pain trial: a double-blind, randomized study.

PURPOSE: Chronic prostatitis/chronic pelvic pain syndrome is a major healthcare burden. Affected patient quality of life is poor and currently no investigated treatments have significant long-term benefit. We performed a preliminary investigation of the role of physical activity and its effects on select patients with chronic prostatitis/chronic pelvic pain syndrome. MATERIALS AND METHODS: Between 2002 and 2004 we recruited a volunteer sample of 231 eligible males 20 to 50 years old with chronic prostatitis/chronic pelvic pain syndrome who were unresponsive to conventional treatments and free of any contraindication for moderate intensity physical exercise. This group was screened and, if in accordance with study inclusion/exclusion criteria, patients were randomized into 2 groups. Participants were randomly assigned to the aerobic exercise group (52) and the placebo/stretching and motion exercises group (51). Main outcome measures were the Italian version of the National Institutes of Health Chronic Prostatitis Symptom Index, Beck Depression Inventory, State Anxiety Inventory-Y and a pain intensity visual analog scale administered at baseline, and 6 and 18 weeks. RESULTS: At 18 weeks 36 subjects (75%) in the aerobic exercise group vs 40 (81.63%) in the placebo/stretching and motion exercises group completed the 18-week program and evaluation. Differences between the 2 groups were found in total National Institutes of Health Chronic Prostatitis Symptom Index, pain and quality life impact subscales, and pain visual analog score (ANCOVA p = 0.006, 0.0009, 0.02 and 0.003, respectively). CONCLUSIONS: Improvements in the aerobic exercise group were significantly superior compared to those in the placebo/stretching and motion exercises group. Aerobic exercise represents a valid treatment option and it should be further investigated in a larger study with longer followup.

Adult↗
PubMed2006

Simple enucleation for the treatment of PT1a renal cell carcinoma: our 20-year experience.

OBJECTIVES: To evaluate the safety and efficacy of simple enucleation as a conservative treatment for pT1a RCC, and to report on the incidence of major complications, local recurrence, and progression-free and disease-specific survival rates. METHODS: We retrospectively reviewed the data of 232 patients who had nephron-sparing surgery (NSS) by simple enucleation between 1986 and 2004 for sporadic, unilateral, pathologically confirmed pT1a RCC. The patients' status was evaluated last in September 2005. The mean (median, range) follow-up was 76 (61, 12-225) months. RESULTS: The mean (SD, median, range) tumor greatest dimension was 2.8 (0.78, 2.85, 0.6-4) cm. The histopathologic review according to the International Union Against Cancer and American Joint Commission for Cancer (1997) classification revealed 198 clear cell (85.3%), 18 papillary (7.8%), 15 chromophobe (6.5%) and one (0.4%) collecting duct RCCs. There were no major complications, such as prolonged acute tubular necrosis/chronic renal insufficiency and bleeding requiring open reoperation. One patient developed postoperative late retroperitoneal fluid collection consistent with urinoma, which required aspiration, drainage position and JJ stenting for 3 weeks. The 5- and 10-year cancer-specific survival were 96.7% and 94.7%, respectively. The 5- and 10-year progression-free survival were 96% and 94%, respectively. Overall, 13 (6.4%) patients had disease progression, three of whom had local recurrences alone (1.5%) elsewhere in the kidney; none had local recurrence at the level of the enucleation bed. CONCLUSIONS: Simple tumor enucleation is a safe and acceptable nephron-sparing treatment that provides excellent long-term local control and cancer-specific survival rates.

Adult↗
PubMed2006

Does rate matter? The results of a randomized controlled trial of 60 versus 120 shocks per minute for shock wave lithotripsy of renal calculi.

PURPOSE: In this study we prospectively compared 2 rates of shock wave delivery, 60 and 120 shock waves per minute, to determine whether rate affects outcome with the Dornier Lithotripter S, a lithotriptor with an electromagnetic shock wave source, for renal calculi. MATERIALS AND METHODS: A total of 104 patients with uncomplicated single renal calculus were randomized and treated. Following a single treatment patients were reviewed at 3 months to determine outcome. A plain abdominal x-ray was performed and the size of any residual fragments was noted. Four patients were lost to followup, 1 in the 60 shock waves per minute group and 3 in the 120 shock waves per minute group. RESULTS: Of the 100 patients with complete followup 49 were treated at 60 shock waves per minute and 51 at 120 shock waves per minute. There was no statistically significant difference between mean stone area treated (p = 0.32) or additional analgesic use in the form of patient controlled alfentanil (p = 0.82). A successful outcome was defined by fragments smaller than 4 mm or stone-free status. At 60 shock waves per minute 59% of patients had a successful outcome compared with 61% at 120 shock waves per minute (p = 0.87) following a single treatment. Post-treatment complications were similar in both groups at 8% for 120 shock waves per minute and 10% for 60 shock waves per minute (p = 0.68). CONCLUSIONS: There was no significant difference in patient controlled analgesia use, complications or outcome between rates 60 and 120. Contrary to previous studies these results suggest that a slower rate of shock wave delivery during extracorporeal shock wave lithotripsy for renal calculi does not improve treatment efficacy with the Dornier Lithotripter S.

Adolescent↗
PubMed2006

Cancer progression after anterograde radical prostatectomy for pathologic Gleason score 8 to 10 and influence of concomitant variables.

OBJECTIVES: To evaluate the outcome in patients with clinically localized prostate cancer and pathologic Gleason score 8 to 10 disease treated by anterograde radical prostatectomy, either alone for node-negative disease or with early hormonal therapy for node-positive disease, and to characterize the prognostic significance of other pathologic variables. METHODS: A total of 729 patients underwent radical prostatectomy for clinically localized prostate cancer between 1989 and 2003. We identified 116 patients (15.9%) with specimen Gleason score 8 or greater. The mean follow-up was 48 months (range 6 to 145). RESULTS: The 5-year biochemical-free survival rate for those with pT2, pT3a, and pT3b diseases was 100%, 65.1%, and 10.5%, respectively (P < or =0.05). The 5-year biochemical-free survival rate for those with specimen Gleason score 8 and 9 was 72.1% and 38.2%, respectively (P < or =0.05). The incidence of positive surgical margins was 14.6% and led to a high pT3a specimen-confined detection rate. The preoperative prostate-specific antigen level, primary Gleason pattern, and surgical margin status had no statistically significant impact on biochemical recurrence-free survival. The multivariate Cox model showed seminal vesicle invasion to be the only independent prognostic factor. The 3 and 5-year progression-free survival rate of the 45 node-positive patients was 72.6% and 60.5%, respectively. CONCLUSIONS: Our findings emphasize the need for early diagnosis, which can make this disease curable by radical prostatectomy alone, and show that poorly differentiated prostate cancer that has invaded the capsule can be cured by surgery. Biochemical recurrence represented a common event in pT3b and Gleason score 9 disease, suggesting a possible role for early adjuvant treatment.

Aged↗
PubMed2006

Simple enucleation for the treatment of renal cell carcinoma between 4 and 7 cm in greatest dimension: progression and long-term survival.

PURPOSE: We present our findings in a series of patients treated with simple enucleation for RCC 4 to 7 cm in greatest dimension. We specifically report the incidence of local and systemic recurrence, and the disease specific survival rate. MATERIALS AND METHODS: We retrospectively reviewed clinical and pathological data on 71 patients who underwent nephron sparing surgery by simple enucleation between 1986 and 2004 for sporadic, unilateral, pathologically confirmed, 4 to 7 cm RCC. Patients with a solitary kidney due to previous RCC treated with radical nephrectomy were excluded from study. None of the patients had preoperative or intraoperative suspicion of positive nodes. All patients were free of distant metastases before surgery (M0). Patient status was last evaluated in May 2005. Mean followup was 74 months (median 51, range 12 to 225). RESULTS: Pathological review according to the 2002 TNM classification showed that 42% of the tumors (30 of 71) were pT1a, 44% (31 of 71) were pT1b and 14% (10 of 71) were pT3a. Mean tumor greatest dimension +/- SD was 4.7 +/- 0.81 cm (median 4.5, range 4.0 to 7.0) cm. None of the patients died within the first 30 days of surgery. There were no major complications requiring open reoperation, such as bleeding and urinary leakage/urinoma. Five and 8-year cancer specific survival was 85.1% and 81.6%, respectively. Five-year cancer specific survival in patients with pT1a (4 cm), pT1b and pT3a disease was 95.7%, 83.3% and 58.3%, respectively (pT1a vs pT1b p = 0.254, pT1a vs pT3a p = 0.006 and pT1b vs pT3a p = 0.143). Overall 10 patients experienced progressive disease (14.9%), of whom 3 had local recurrence (4.5%) alone or local recurrence associated with distant metastases. CONCLUSIONS: Simple tumor enucleation is a useful and acceptable approach to nephron sparing surgery for 4 to 7 cm RCC. It provides long-term cancer specific survival rates similar to those of radical nephrectomy and is not associated with a greater risk of local recurrence than partial nephrectomy for RCC less than 4 cm in greatest dimension.

Adult↗
PubMed2006

Outcome of penile prosthesis implantation for treating erectile dysfunction: experience with 504 procedures.

OBJECTIVE: To evaluate the outcome of penile prosthesis surgery for different types of prosthesis. PATIENTS AND METHODS: The notes of 447 men who had 504 penile prosthesis implanted between August 1975 and December 2000 were evaluated. Of the prostheses inserted, 393 were malleable, 81 were three-piece inflatable and 30 were self-contained hydraulic prostheses. The mean (range) age of the men was 52 (21-78) years; 404 men had primary implants and 43 had revision surgery after operations at other institutions. The mean follow-up was 50 (1-297) months. RESULTS: Of the 447 men, 22 were lost to follow-up immediately after surgery. The most serious postoperative complications were infection (8%) and erosion (5%), which was more common in diabetic patients (10%) and after pelvic trauma with a urethral injury (21%). Of 482 prostheses, 21 failed mechanically (4%) and revision surgery was needed for 5% of the prostheses inserted (24/482). Overall, 89% (377/425) of men could have sexual intercourse and 344 (81%) were satisfied with the results. CONCLUSIONS: Of the men implanted with a penile prosthesis, 81% were satisfied with the outcome and an even higher proportion were satisfied with the inflatable prostheses. Dissatisfaction was mainly due to complications that resulted in removal of the prosthesis.

Adult↗
PubMed2005

Antegrade versus retrograde endopyelotomy for pelvi-ureteric junction (PUJ) obstruction.

OBJECTIVES: To compare complication and success rates of antegrade and retrograde endopyelotomy performed over 10 years and to define possible risk factors associated with treatment failure. METHODS: From 1994 to 2004, 61 patients underwent a total of 68 endoscopic treatments: 19 antegrade and 49 retrograde endopyelotomy procedures. Antegrade endopyelotomy was always performed using diathermy. In the first 18 procedures retrograde endopyelotomy was performed using diathermy. In the most recent 30 procedures the incision was made using holmium laser. Endoluminal ultrasound was used in 78% of retrograde endopyelotomy and in 5% of antegrade endopyelotomy. RESULTS: The retrograde endopyelotomy patients demonstrated significantly lower complication rates (12.5% vs. 42%) and shorter hospital stay (1.5 vs. 7 days) than the antegrade endopyelotomy patients. The mean follow up of the patients who remained free from disease recurrence during the study period was 46 and 24 months for the antegrade and retrograde endopyelotomy group, respectively. The overall success rate (mean time to failure) of antegrade and retrograde endopyelotomy was 56% (31 months) and 70% (17 months), respectively. There was no statistically significant increase in the overall success rate of retrograde endopyelotomy using endoluminal ultrasound per se. Stratifying retrograde endopyelotomy by the type of energy used for the incision, the overall success rate (mean time to failure) was 80% (10 months) and 53% (21 months) for Holmium laser and diathermy, respectively (p = 0.0626). CONCLUSIONS: The overall success of antegrade and retrograde endopyelotomy in this series appears to be largely a factor of lead-time bias and is similar enough to recommend retrograde endopyelotomy with holmium laser on the basis of its relative safety and shorter hospital stay.

Adolescent↗
PubMed2005

Evaluation of renal function and upper urinary tract morphology in the ileal orthotopic neobladder with no antireflux mechanism.

PURPOSE: Long-term renal function is crucial in orthotopic bladder substitutions, and can be influenced by several factors including ureteral obstruction, urinary infection and reflux. In this study we investigated the prevalence of renal functional impairment and the incidence of morphological alterations of the upper urinary tract in patients who had a low pressure ileal neobladder constructed with no antireflux mechanism. MATERIALS AND METHODS: From 1996 to 2002, 70 men received a W-shaped neobladder using refluxing ureterointestinal anastomoses and short afferent limb. Final evaluation of patient status was in November 2003. A total of 20 patients died during followup and mean followup of the remaining 50 patients was 50 months (range 21 to 89). Kidney morphology was evaluated using technetium diethylenetetraminepentaacetic acid nuclear renography and ultrasonography. Total and separate renal function were evaluated by measuring plasma creatinine and glomerular filtration rate (GFR), the latter measured as the renal clearance of technetium diethylenetetraminepentaacetic acid. Measured values of GFR were compared with the results from a group of healthy subjects of the same age. RESULTS: The anastomotic stricture rate was 4%, 2 severe strictures occurred 2 and 4 months after surgery, while 2 moderate strictures were detected with renal scans during the study. Renal scintigraphy revealed an excretory phase within the normal range in 67 of 99 renoureteral units (68%), a short delay in collecting system drainage associated with mild and transient pelvicaliceal dilatation in 23 (23%), and dilatation of the upper urinary tract in the remaining 9 (9%) including obstructive in 2 (2%) and not obstructive in 7 (7%). Mean (+SD) total GFR of the patients was 89.7 (19.6) ml per minute per 1.73 m. Mean total GFR of the control group was 90.6 (11.4) ml per minute per 1.73 m. The comparison between measured GFR of patients and the control group showed no statistically significant difference. CONCLUSIONS: Our medium-term data support the assumption that the lack of any antireflux mechanism in orthotopic neobladder, per se, has no detrimental effect on renal function.

Aged↗
PubMed2005

Progression and long-term survival after simple enucleation for the elective treatment of renal cell carcinoma: experience in 107 patients.

PURPOSE: We present our findings in a series of T1a renal cell carcinoma treated with elective simple enucleation, specifically reporting the incidence of local recurrence, and progression-free and disease specific survival rates. MATERIALS AND METHODS: A total of 107 patients who underwent elective nephron sparing surgery performed with simple enucleation from January 1989 to December 2000 were studied retrospectively. None of the patients had preoperative or intraoperative suspicion of positive nodes. All patients were free from distant metastases before surgery (M0). Patient status was last evaluated in July 2004. Mean (median, range) followup was 88.3 (84, 44 to 175) months. RESULTS: Pathological review according to the 2002 TNM classification showed that 95% (102 of 107) of tumors were pT1a, 4% (4 of 107) pT1b and 1% (1 of 107) pT3a. Mean (SD, median, range) tumor greatest dimension was 2.7 (0.93, 2.5, 0.6 to 5) cm. None of the patients died in the immediate postoperative period (within the first 30 days). There were no major complications such as bleeding and urinary leakage/urinoma requiring reoperation. The 5 and 10-year cancer specific survival was 99% and 97.8%, respectively. The 5 and 10-year progression-free survival was 98.1% and 94.7%, respectively. Overall 3 patients had disease progression (2.8%) of whom 2 (1.9%) were local recurrence, 1 alone and 1 associated with distant metastases diagnosed 12 months earlier. CONCLUSIONS: Simple tumor enucleation is a safe and acceptable approach for elective nephron sparing surgery. It provides excellent long-term progression-free and cancer specific survival rates, and is not associated with an increased risk of local recurrence compared with partial nephrectomy.

Aged↗
PubMed2005

Intracapsular clear cell renal carcinoma: ploidy status improves the prognostic value of the 2002 TNM classification.

PURPOSES: The TNM classification has been revised for the 2002 edition of the UICC publication to better stratify patients with intracapsular renal cell carcinoma (RCC) but few studies have been published to date to validate this new classification. Moreover, additional prognostic factors seem to be necessary to improve the prediction of intracapsular tumor aggressiveness and the definition of patient subgroups at high risk for metastases. We report the long-term results of the new TNM scheme. We evaluated the impact of DNA content, S-phase and MIB-1 (Dako, Glostrup, Denmark) score. MATERIALS AND METHODS: A total of 136 patients with intracapsular clear cell RCC and a mean followup of 74 months were reclassified. Tumor specific survival (TSS) was compared with nuclear grade (NG), DNA content and proliferative status (S-phase fraction and MIB-1 score). RESULTS: TSS was 92%, 81.1% and 40.1% for pT1a, pT1b and pT2, respectively (p <0.05). TSS according to DNA ploidy status (diploid vs aneuploid) was pT1a-95.2% vs 68.6% (p <0.05), pT1b-90% vs 46.7% (p <0.05) and pT2-49.2% vs 25% (p not significant). DNA ploidy was also significantly associated with survival when adjusted for NG. There was no significant association between TSS and MIB-1 score or tumor S-phase fraction. CONCLUSIONS: The 2002 TNM classification is a useful prognostic factor for evaluating organ confined RCC of the clear cell subtype. Evaluation of the DNA content in clear cell RCC appears to significantly improve the predictive value of the TNM staging system, especially in the pT1a and pT1b categories. Fuhrman NG alone or combined should be routinely used in such patients.

Adenocarcinoma, Clear Cell↗
PubMed2004

Solitary floating vena caval thrombus as a late recurrence of renal cell carcinoma.

We report an unusual case of solitary thrombus floating in the inferior vena cava (IVC) in a patient who underwent radical nephrectomy for a renal cell carcinoma (RCC) of the right kidney extended into the renal vein with no capsular and perinephric tissue invasion (pT3b). Twenty months after surgery, a routine computed tomography scan identified an intraluminal mass floating in the IVC. Cavotomy and thrombectomy with no caval resection were successfully performed. A review of the literature showed only three previous published cases of RCC recurring in the IVC only, with no local recurrence or distant metastases. We outline the possible etiology of these unusual and solitary recurrences in the IVC and we emphasize the need for a strict surveillance for all patients with RCC and especially for those with pT1b, pT2 and pT3 disease. An early diagnosis of this rare recurrence can permit an easy removal of the thrombus with no caval resection and graft replacement, making this disease potentially curable by surgery.

Aged↗
PubMed2002

Prognostic value of nuclear grading in patients with intracapsular (pT1-pT2) renal cell carcinoma. Long-term analysis in 213 patients.

BACKGROUND: The TNM classification system considers tumor size and, in particular tumor, greatest dimension as the only prognostic indicator for intracapsular renal cell carcinoma (RCC). The objective of the current study was to evaluate the role of nuclear grading and its importance as a prognostic indicator in patients with intracapsular (T1-T2) RCC. METHODS: A retrospective study was performed on 213 patients with RCC limited to the kidney who were free from distant metastases at the time of diagnosis and who underwent radical nephrectomy from January 1990 to November 1999. All patients were staged according to the 1997 TNM classification system. Nuclear grading was determined according to the criteria proposed by Fuhrman et al. The patients' status was evaluated last in November 2000. The mean follow-up was 52 months (range, 12-130 months). The probability of survival was estimated by using the Kaplan-Meier method, with the long-rank test used to estimate differences among levels of the analyzed variables. A multivariate Cox proportional hazards model was performed to estimate the relative importance of the variables in predicting survival. RESULTS: The 5-year disease specific survival rates for patients with pT1 and pT2 tumors were 93.5% and 61.1%, respectively. The 5-year disease specific survival rates for patients with Grade 1, Grade 2, and Grade 3-4 tumors were 95.9%, 86.8%, and 60.1%, respectively. A comparison of the survival curves both by stage and grade showed a statistically significant difference. For patients with pT1 lesions, the 5-year disease specific survival rate was 94.2% for patients with Grade 1-2 disease and 89.8% for patients with Grade 3-4 disease. For patients with pT2 lesions, the 5-year disease specific survival rate was 72.2% for patients with Grade 1-2 disease and 20% for patients with Grade 3-4 disease. CONCLUSIONS: Within intracapsular tumors that measure > 7.0 cm in greatest dimension, nuclear grade is an important morphologic variable for predicting long-term survival. Identification of patients with nuclear Grade 3-4 tumors is important prognostically to determine the metastatic potential of pT2 tumors, because this subgroup of patients may benefit from adjuvant immunotherapy.

Adult↗