PADUA Score Research Articles

Validation of three prediction models for thrombosis recurrence in antiphospholipid syndrome patients based on a prospective cohort

ObjectivesTo validate the performance of the adjusted global antiphospholipid syndrome (APS) score (aGAPSS), Padua score and Caprini score to predict thrombosis recurrence in APS.MethodsConsecutive thrombotic-APS patients were included. aGAPSS, Padua...

Padua Score and Coagulopathy Parameters on Survival of COVID-19 Patients at Prof Dr. R. D. Kandou General Hospital Manado

BACKGROUND: Coagulopathy in coronavirus disease 2019 (COVID-19) patients causes a prothrombotic state that increases the risk of thromboembolism. The Padua score and coagulopathy parameter including D-dimer values, fibrinogen, prothrombin time (PT), activated partial thromboplastin time (aPTT), and platelet counts are very important parameters to determine risk of thrombosis and mortality in hospitalized COVID-19 patients. AIM: This study aimed to assess the prognosis of COVID-19 patients with Padua score and coagulopathy parameters. METHODS: This retrospective cohort study was conducted in tertiary university hospital, Prof. Dr. R. D. Kandou Hospital Manado, Indonesia from October 2020 to July 2021. Patients admitted with final diagnosis of COVID-19 confirmed with positive reverse transcriptase-polymer chain reaction test were included in the study. The data were refined by excluding the patients under 18 years old and the patients with no blood test results, D-dimer values, fibrinogen values, PT values, aPTT values, and platelet counts. The association of Padua score and coagulopathy parameters with survival of COVID-19 patients was analyzed by multivariate cox regression and Kaplan–Meier analysis. RESULTS: The probability of survival on day 14 in patients with Padua score <4, D-dimer <0.5 mg/dl, PT ≤16 s, aPTT ≤39 s, and platelets >150,000/μL was 100%, 100%, 84.6%, 81.5%, and 81.4%, respectively. COVID-19 survival was influenced by Padua score ≥4 (heart rate [HR] = 4.199; CI 95% 2.221–7.936), D-dimer ≥0.5 mg/L (HR = 4.772; CI 95% 2.244–10.147), PT >16 s (HR = 2.124; CI 95% 1.608–2.805), aPTT >39 s (HR = 1.449; CI 95% 1.080–1.943), and platelet count <150000/μL (HR = 2.056; CI 95% 1.489–2.840). Padua score has the highest probability of mortality compared to the other coagulopathy parameters (p < 0.001; HR = 3.655; CI 95% 1.927–6.932). CONCLUSION: There was an association of Padua score, D-dimer value, PT value, aPTT value, and platelet count on survival of COVID-19 patients. Padua score being the most influential variable on survivals.

Preoperative 3D model guidance for robotic-partial nephrecto- my: a case report of intraoperative vascular injury and its man- agement

Partial nephrectomy (PN) is increasingly used in the treatment of renal cell carcinoma and is now considered the “gold standard” treatment for T1 lesions. However, it is still considered a challenging procedure. Several imaging modalities have been tested to improve PN outcomes. One of the most intriguing is 3D reconstruction, which can be used for both preoperative planning and intraoperative decision making. In the following case, we describe an intraoperative vascular injury that occurred during robot-assisted PN (RAPN), despite accurate preoperative 3D-guided planning, and its management. The patient undergoing PN was 57 years old and had an incidental diagnosis of a 17 mm left-sided renal lesion located on the posterior surface of the kidney at the lower pole. Based on the CT scan, a virtual 3D reconstruction was obtained, which highlighted the presence of a saccular dilatation of the main artery. Selective clamping of a segmental artery feeding the posterior surface of the lower pole of the kidney was planned. The RENAL nephrometry and PADUA score were calculated with a value of 4p and 6, respectively. Despite a thorough preoperative planning, a lesion of the dilatation of the main artery was identified with a large bleeding which was managed by global clamping of the kidney followed by selective suturing. In conclusion, PN remains a challenging procedure even for experienced and skilled surgeons. The occurrence of intraoperative complications is not anecdotal. The introduction of the robotic console and new intraoperative tools such as 3D models have reduced the risk of adverse events, but their complete elimination is still utopian due to the extreme complexity of the procedure.

Robotic-assisted partial nephrectomy nightmare: poor clamping and tumor rupture

An 82-year-old Caucasian male patient was referred to our center because of the incidental finding of a nodule in the middle third of the right kidney during a screening abdominal ultrasound. No local or systemic symptom could be associated with the renal mass on initial evaluation. The patient underwent an abdominal contrastenhanced CT scan, which revealed a mass in the outer middle third of the right kidney measuring 4.5 × 3.5 cm, predominantly exophytic, with contact to the collecting system and an enhancement pattern suspicious for primary renal malignancy. Tumor complexity was classified as PADUA score 9 and Renal Score 9x. Clinical stage was cT1bN0M0. Total procedure time was 130 min. Estimated blood loss was 800 mL and warm ischemia time was 24 min. Intraoperative complications were tumor rupture and increased bleeding. The postoperative course was uneventful. Meticulous preoperative planning including contrast enhanced CT with 1 mm thick slices and 3D reconstruction imaging is critical. Comprehensive dissection of the renal hilum must be performed to access the exact number of vessels vascularizing the kidney and to provide adequate ischemia of the renal parenchyma for clean visualization during tumor resection to avoid nightmares such as positive margins and tumor rupture.

Association between fibrinogen-to-albumin ratio and prognosis of patients with heart failure.

Systemic inflammation is closely associated with the development and progression of heart failure (HF), increasing vulnerability to thromboembolic events. This retrospective cohort study assessed the potential of the fibrinogen-to-albumin ratio (FAR), a new inflammatory biomarker, as a prognostic indicator for HF risk. One thousand one hundred and sixty six women and 826 men with a mean age of 70.70 ± 13.98 years were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV v2.0) database. Additionally, a second cohort was obtained, including 309 patients from the Second Affiliated Hospital of Wenzhou Medical University. The relationship between FAR and the prognosis of HF was evaluated using multivariate analysis, propensity score-matched analysis, and subgroup analysis. Fibrinogen-to-albumin ratio was an independent risk factor for 90-day all-cause mortality (hazard ratio: 1.19; 95% confidence interval (CI): 1.01-1.40), 1-year all-cause mortality (hazard ratio: 1.23; 95% confidence interval: 1.06-1.41), and length of hospital stay (LOS) (β: 1.52; 95% CI: 0.67-2.37) in the MIMIC-IV dataset, even after adjusting for potential covariates. These findings were verified in the second cohort (β: 1.82; 95% CI: 0.33-3.31) and persisted after propensity score-matching and subgroup analysis. FAR was positively correlated with C-reactive protein, NT-proBNP, and Padua score. The correlation between FAR and NT-proBNP (R = .3026) was higher than with fibrinogen (R = .2576), albumin (R = -.1822), platelet-to-albumin ratio (R = .1170), and platelet-to-lymphocyte ratio (R = .1878) (ps < .05). Fibrinogen-to-albumin ratio is an independent risk prognostic factor for 90-day, 1-year all-cause mortality and LOS among HF patients. Inflammation and prothrombotic state may underlie the relationship between FAR and poor prognosis in HF.

Perioperative, functional, and oncologic outcomes of minimally-invasive surgery for highly complex renal tumors (RENAL or PADUA score ≥ 10): an evidence-based analysis.

The primary objective of the current study is to undertake a comparative analysis of the effectiveness and safety of minimally-invasive partial nephrectomy (MIPN; including laparoscopic and robotic approaches) and open partial nephrectomy (OPN) for the treatment of highly complex renal tumors (defined as PADUA or RENAL score ≥ 10). A comprehensive search was conducted in four electronic databases (PubMed, Web of Science, Embase, and Cochrane Library) to identify relevant studies published in the English language up to April 2023. The current study employed Review Manager 5.4 and encompassed controlled trials of both MIPN and OPN for the treatment of highly complex renal tumors. This study comprised a total of eight comparative trials involving 1161 patients. MIPN demonstrated a significant reduction in length of hospital stay (weighted mean difference [WMD] - 2.08days, 95% confidence interval [CI] - 2.48, - 1.68; p < 0.00001), blood loss (WMD - 39.86mL, 95% CI - 75.32, - 4.39; p = 0.03), transfusion rates (odds ratio [OR] 0.30, 95% CI 0.13, 0.71; p = 0.006), and overall complications (OR 0.46, 95% CI 0.31, 0.70; p = 0.0003). However, there were no significant differences between MIPN and OPN in terms of operative time, warm ischemia time, conversion to radical nephrectomy rates, renal functional and oncologic outcomes. This study reveals that MIPN presents several benefits in comparison to OPN, including decreased length of hospital stay, blood loss, transfusion rates, and complications, while still offering renal functional and oncological outcomes that are comparable to those of OPN in patients with highly complex renal tumors.

Robotic-assisted tumor enucleation versus robotic-assisted partial nephrectomy for intermediate and high complexity renal cell carcinoma: a single-institution experience

ObjectivesTo compare the perioperative and oncological outcomes of robotic-assisted tumor enucleation (RATE) and robotic-assisted partial nephrectomy (RAPN) in the treatment of intermediate and high complexity renal cell carcinoma (RCC).MethodsWe retrospectively collected the data of 359 patients with intermediate and high complexity RCC who underwent RATE and RAPN. The perioperative, oncological, and pathological outcomes of the two groups were compared, and univariate and multivariate analyses were used to evaluate the risk factors for warm ischemia time (WIT) > 25 min.ResultsCompared with RAPN group, patients in RATE group had shorter operative time (P < 0.001), shorter WIT (P < 0.001), and less estimated blood loss (EBL) (P < 0.001). The decrease rate of estimated glomerular filtration rate (eGFR) in RATE group was better than that in RAPN group (P < 0.001). Multivariable analysis showed that RAPN and higher PADUA score were independent risk factors for WIT > 25 min (both P < 0.001). The rate of positive surgical margin was similar between the two groups, but the local recurrence rate of the RATE group was higher than that of the RAPN group (P = 0.027).ConclusionsRATE and RAPN have similar oncological outcomes for the treatment of intermediate and high complexity RCC. In addition, RATE was superior to RAPN in perioperative outcomes.

Thromboembolic Events, Anticoagulation, and COVID-19: Preemptive Treatments and Risks After Vaccination

Thromboembolic Events, Anticoagulation, and COVID-19: Preemptive Treatments and Risks After Vaccination

Comparison between minimally invasive partial nephrectomy and open partial nephrectomy for complex renal tumors: a systematic review and meta-analysis.

The present study aimed to conduct a pooled analysis to compare the efficacy and safety of minimally invasive partial nephrectomy (MIPN) with open partial nephrectomy (OPN) in patients with complex renal tumors (defined as PADUA or RENAL score ≥7). The present study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, Supplemental Digital Content 1, http://links.lww.com/JS9/A394 . We conducted a systematic search of the PubMed, Embase, Web of Science, and Cochrane Library databases until October 2022. MIPN and OPN-controlled trials for complex renal tumors were included. The primary outcomes were perioperative results, complications, renal function, and oncologic outcomes. A total of 2405 patients were included in 13 studies. MIPN outperformed OPN in terms of hospital stay [weighted mean difference (WMD) -1.84 days, 95% CI -2.35 to -1.33; P <0.00001], blood loss (WMD -52.42ml, 95% CI -71.43 to -33.41; P <0.00001), transfusion rates [odds ratio (OR) 0.34, 95% CI 0.17-0.67; P =0.002], major complications (OR 0.59, 95% CI 0.40-0.86; P =0.007) and overall complications (OR 0.43, 95% CI 0.31-0.59; P <0.0001), while operative time, warm ischemia time, conversion to radical nephrectomy rates, estimated glomerular decline, positive surgical margins, local recurrence, overall survival, recurrence-free survival, and cancer-specific survival were not significantly different. The present study demonstrated that MIPN was associated with a shorter length of hospital stay, less blood loss, and fewer complications in treating complex renal tumors. MIPN may be considered a better treatment for patients with complex tumors when technically feasible.

Robotic Retroperitoneal Versus Transperitoneal Partial Nephrectomy: Outcomes and Learning Curve.

The robotic retroperitoneal approach for renal mass surgery was introduced in 2018 at the Department of Urology in the clinic of Leverkusen, Germany. Clinical criteria for the choice of the access site (trans- vs. retroperitoneal) are not clearly defined. The aim of this study was to explore the learning curve and the impact of the access site on clinical outcome, in order to elucidate which preoperative clinical criteria should be taken into account when choosing the renal approach site. This retrospective study included 107 patients who underwent robotic tumor surgery between June 2018 and March 2022 at the Department of Urology in the Clinic of Leverkusen, Germany. Data from 86 patients with transperitoneal robotic surgery of the kidney and 21 patients with retroperitoneal access were available for analysis. We evaluated the data of patients in a trans- and a retroperitoneal access group. The preoperative clinical data included anthropomorphic data, the Body Mass Index (BMI) as well as the Preoperative Aspects and Dimensions Used for Anatomical Classification of Renal Masses (PADUA) - score. Intraoperative and postoperative data such as blood loss, clamping time, renal function and the learning curve of the surgeons was used to evaluate the outcomes of the two groups. Operation time in the retroperitoneal group was significantly shorter (p=0.015). Operation-specific variables showed no significant difference between the two groups. PADUA score and hilar clamping time showed no difference (p=0.345 and p=0.130, respectively). The learning curve in the retroperitoneal access group unveiled a noticeable difference in the experience and mastery of the involved surgeons. Mastery of the retroperitoneal approach is readily possible for surgeons with previous experience in robotic renal surgery without compromising the operative morbidity. The PADUA-score seems most suitable as a preoperative clinical criterion for choosing the renal approach site.

Cumulative sum analysis (CUSUM) for evaluating learning curve (LC) of robotic-assisted laparoscopic partial nephrectomy (RALPN).

Robotic-assisted laparoscopic partial nephrectomy (RALPN) is becoming a standard treatment for localized renal tumors worldwide. Data on the learning curve (LC) of RALPN are still insufficient. In the present study, we have attempted to gain further insight in this area by evaluating the LC using cumulative summation analysis (CUSUM). A series of 127 robotic partial nephrectomies were performed by two surgeons at our center between January 2018 and December 2020. CUSUM analysis was used to evaluate LC for operative time (OT). The different phases of surgical experience were compared in terms of perioperative parameters and pathologic outcomes. In addition, multivariate linear regression analysis was used to confirm the results of the CUSUM analysis by adjusting the phases of surgical experience for the other confounding factors that may affect OT. The median age of patients was 62years, mean BMI was 28, and mean tumor size was 32mm. Tumor complexity was classified as low, intermediate, and high risk according to the PADUA score in 44%, 38%, and 18%, respectively. The mean OT was 205min, and trifecta was achieved in 72.4%. According to the CUSUM diagram, the LC of OT was divided into three phases: initial learning phase (18 cases), plateau phase (20 cases), and mastery phase (subsequent cases). The mean OT was 242, 208, and 190min in the first, second, and third phases, respectively (P < 0.001). Surgeon experience phases were significantly associated with OT in multivariate analysis considering other preoperative and operative parameters. Surgical outcome was comparable between the three phases in terms of complications and achievement of trifecta; hospital stay was shorter in the mastery phase than in the first 2 phases (4days vs 5days, P = 0.02). The LC for RALPN is divided into 3 performance phases with CUSUM. Mastery of surgical technique was achieved after performing 38 cases. The initial learning phase of RALPN has no negative impact on surgical and oncologic outcomes .

Comparison of the predictive value of Padua and the IMPEDE assessment scores for venous thromboembolism in patients with newly diagnosed multiple myeloma: A single institution experience

Objective: To compare the predictive efficacy of the two thrombosis risk assessment scores (Padua and IMPEDE scores) in venous thromboembolism (VTE) within 6 months in patients with newly diagnosed multiple myeloma (NDMM) in China. Methods: This study reviewed the clinical data of 421 patients with NDMM hospitalized in Beijing Jishuitan Hospital from April 2014 to February 2022. The sensitivity, specificity, accuracy, and Youden index of the two scores were calculated to quantify the thrombus risk assessment of VTE by the Padua and IMPEDE scores. The receiver operating characteristics curves of the two evaluation scores were drawn. Results: The incidence of VTE was 14.73%. The sensitivity, specificity, accuracy, and Youden index of the Padua score were 100%, 0%, 14.7%, and 0% and that of the IMPEDE score was 79%, 44%, 49.2%, and 23%, respectively. The areas under the curve of Padua and IMPEDE risk assessment scores were 0.591 and 0.722, respectively. Conclusion: IMPEDE score is suitable for predicting VTE within 6 months in patients with NDMM.

Thrombotic Events Are Unusual Toxicities of Chimeric Antigen Receptor T-Cell Therapies.

Chimeric antigen receptor (CAR) T-cell therapy has greatly transformed the treatment and prognosis of B-cell hematological malignancies. As CAR T-cell therapy continues to be more readily adopted and indications increase, the field's recognition of emerging toxicities will continue to grow. Among the adverse events associated with CAR T-cell therapy, cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity (ICANS) are the most common toxicities, while thrombotic events represent an under-reported, life-endangering complication. To determine thrombosis incidence post CAR T-cell therapy, we performed a multi-center, retrospective study on CAR T-cell therapy adult patients (N = 140) from Indiana University Simon Cancer Center and the University of North Carolina Medical Center treated from 2017 to 2022 for relapsed and refractory B-cell acute lymphoblastic leukemia (B-ALL, N = 3), diffuse large B-cell lymphoma (DLBCL, N = 92), follicular lymphoma (FL, N = 9), mantle cell lymphoma (MCL, N = 2), and multiple myeloma (MM, N = 34). We report 10 (7.14%) thrombotic events related to CAR T-cell therapy (DLBCL: N = 8, FL: N = 1, MM: N = 1) including 9 primary venous events and 1 arterial event that occurred with median time of 23.5 days post CAR T-cell infusion. In search of parameters associated with such events, we performed multivariate analyses of coagulation parameters (i.e., PT, PTT, and D-Dimer), scoring for adverse events (Padua Score and ISTH DIC Score) and grading for CAR T-cell toxicity severity (CRS grade and ICANS grade) and found that D-Dimer peak elevation and ICANS grade were significantly associated with post-CAR T-cell infusion thrombosis. While the pathophysiology of CAR T-cell associated coagulopathy remains unknown, our study serves to develop awareness of these emerging and unusual complications.

The Occurrence and Risk Factors of Stroke Complicated by Venous Thromboembolism

To investigate the occurrence and the risk factors of stroke complicated by venous thromboembolism. A total of 2709 stroke patients who received treatment at our hospital between January 2018 and June 2021 were selected. The incidence of stroke complicated by venous thromboembolism was analyzed and the risk factors of stroke complicated by venous thromboembolism were investigated by logistic regression. Among the 2709 stroke patients, 390 had venous thromboembolism, resulting in 14.39% incidence of venous thromboembolism. Among them, 383 patients (14.14%) had deep venous thrombosis (DVT), 4 patients (0.15%) had pulmonary thromboembolism (PTE), and 3 cases (0.11%) had DVT combined with PTE. According to the analysis of unconditional multivariate logistic regression model, age>60 years, concomitant hypertension, concomitant diabetes, bedrest time after admission≥3 days, D-dimer (D-D)≥0.95 mg/mL, triglyceride (TG)≥1.83 mmol/L, Barthel Index (BI) score≤9 points, and Padua score>4 points after admission were independent risk factors for stroke complicated by venous thromboembolism ( P<0.05), while anticoagulation therapy was a protective factor ( P<0.05). Stroke complicated by venous thromboembolism is associated, to some degree, with age, concomitant hypertension, concomitant diabetes, bedrest time, D-D, TG, BI score, Padua score, and whether anticoagulant therapy is administered or not. Interventions in line with relevant risk factors should be strengthened to effectively reduce the risk of stroke complicated by venous thromboembolism.

PD40-12 FUNCTIONAL OUTCOMES PREDICTION AFTER ROBOTIC PARTIAL NEPHRECTOMY USING PADUA SCORE ASSESSED WITH 3D VIRTUAL MODELS: PRELIMINARY RESULTS OF A COLLABORATIVE ERUS STUDY

PD40-12 FUNCTIONAL OUTCOMES PREDICTION AFTER ROBOTIC PARTIAL NEPHRECTOMY USING PADUA SCORE ASSESSED WITH 3D VIRTUAL MODELS: PRELIMINARY RESULTS OF A COLLABORATIVE ERUS STUDY

MP58-11 IDENTIFYING THE OPTIMAL WARM ISCHEMIA TIME CUT-OFF DURING ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR cT1 RENAL MASSES

You have accessJournal of UrologyCME1 Apr 2023MP58-11 IDENTIFYING THE OPTIMAL WARM ISCHEMIA TIME CUT-OFF DURING ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR cT1 RENAL MASSES Luigi Nocera, Angelo Mottaran, Carlo Bravi, Adele Piro, Luca Sarchi, Marco Paciotti, Maria Peraire Lores, Eleonora Balestrazzi, Federico Piramide, Ruben De Groote, Melle, Belgium, Geert De Naeyer, and Alexandre Mottrie Luigi NoceraLuigi Nocera More articles by this author , Angelo MottaranAngelo Mottaran More articles by this author , Carlo BraviCarlo Bravi More articles by this author , Adele PiroAdele Piro More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Maria Peraire LoresMaria Peraire Lores More articles by this author , Eleonora BalestrazziEleonora Balestrazzi More articles by this author , Federico PiramideFederico Piramide More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , Melle Melle More articles by this author , Belgium Belgium More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003311.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot-assisted partial nephrectomy (RAPN) is the gold-standard treatment for T1 renal masses. To reduce bleeding, renal artery clamping is often required, and several cut-offs for the ‘safe’ duration of intraoperative warm ischemia time (WIT) have been proposed. However, due to the lack of systematic and detailed analysis, the optimal cutoff is still subject of significant debate. We aimed to identify the best WIT cut-off to predict acute kidney injury (AKI). METHODS: We relied on 305 patients treated with RAPN between 2009 and 2020. All patients were treated by highly experienced surgeons. Patients undergoing clampless RAPN, as well as patients harbouring multiple masses, were excluded. The primary endpoint was AKI defined as a rise >0.3 mg/dL between pre- and post-operative creatinine or a 1.5-fold higher value of creatinine at discharge as compared to baseline creatinine. Multivariable Cox regression models examined the impact of WIT on AKI after adjustments for age, sex, pre-operative creatinine, solitary kidney, chronic kidney disease, clinical tumor size and PADUA score. The C-index was used to identify the WIT cut-off with highest accuracy. RESULTS: Median age was 63 years (interquartile range [IQR]: 54, 71) and the majority of patients were male (197, 67%). 15 (5%) patients had a solitary kidney, 17 (6%) harbored chronic kidney disease, while median pre-operative creatinine was 0.9 mg/dL (IQR: 0.8, 1.0). Median tumor size was 3.1 cm (IQR: 2.0, 4.3) and median PADUA score was 8 (IQR: 7, 10). Median WIT time was 14 minutes (IQR: 10, 18). Overall, 47 (15%) patients experienced AKI before discharge. On multivariable Cox regression models, all variables with the exception of PADUA score, represented independent predictors of AKI (all p<0.05). The WIT cut-off associated with the highest accuracy in predicting AKI was 19 minutes (C-index: 83.5%). When individuals were stratified according to the 19 minutes cut-off, AKI was present in 12% vs 28% of those with an WIT time below vs. above the threshold (Figure 1). CONCLUSIONS: Consensus for appropriate duration of ischemia during RAPN for T1 renal masses is lacking. Here, we performed detailed and systematic cut-off analyses of WIT and identified an optimal cut-off of 19 minutes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e799 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luigi Nocera More articles by this author Angelo Mottaran More articles by this author Carlo Bravi More articles by this author Adele Piro More articles by this author Luca Sarchi More articles by this author Marco Paciotti More articles by this author Maria Peraire Lores More articles by this author Eleonora Balestrazzi More articles by this author Federico Piramide More articles by this author Ruben De Groote More articles by this author Melle More articles by this author Belgium More articles by this author Geert De Naeyer More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement PDF downloadLoading ...

MP58-07 THE IMPACT OF 3D MODELS ON SURGICAL OUTCOMES OF RAPN: IS CT SCAN BECOMING OBSOLETE?

You have accessJournal of UrologyCME1 Apr 2023MP58-07 THE IMPACT OF 3D MODELS ON SURGICAL OUTCOMES OF RAPN: IS CT SCAN BECOMING OBSOLETE? Luigi Nocera, Carlo Bravi, Angelo Mottaran, Adele Piro, Luca Sarchi, Marco Paciotti, Maria Peraire Lores, Eleonora Balestrazzi, Federico Piramide, Rui Farinha, Pieter De Backer, Ruben De Groote, and Alexandre Mottrie Luigi NoceraLuigi Nocera More articles by this author , Carlo BraviCarlo Bravi More articles by this author , Angelo MottaranAngelo Mottaran More articles by this author , Adele PiroAdele Piro More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Maria Peraire LoresMaria Peraire Lores More articles by this author , Eleonora BalestrazziEleonora Balestrazzi More articles by this author , Federico PiramideFederico Piramide More articles by this author , Rui FarinhaRui Farinha More articles by this author , Pieter De BackerPieter De Backer More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003311.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since their inception 3D virtual models have helped clinician in surgical indication and preoperative planning, as well as in intraoperative guidance. The added value of 3D models was particularly true in robot-assisted partial nephrectomy (RAPN) given the wide spectrum of possible tumor locations and anatomical variants. We aimed to examine the impact of 3D virtual models on surgical outcomes in a tertiary referral center. METHODS: We relied on 474 patients in our prospectively maintained renal cancer database treated with RAPN between 2009 and 2021. Patients harbouring multiple masses were excluded. The endpoints of the analyses were: 1) presence of positive surgical margins (PSM); 2) warm ischemia time (WIT) and 3) length of stay (LOS). Multivariable regressions examined the impact of the use of 3D virtual model on PSM, WIT and LOS. For all models, the adjustment for casemix included: age, sex, tumor size, tumor side, clinical T stage, PADUA score and estimated blood loss (EBL). RESULTS: Overall, median age was 64 years (interquartile range [IQR]: 55, 73). Median (IQR) tumor size and PADUA score were 3.1 (2.1, 4.5) cm and 8 (7, 10), whereas tumor side was more frequently right (54%). Median WIT was 13 minutes (IQR: 6, 19). OR console time and blood loss were 120 minutes (IQR: 90, 150) and 200 ml (IQR: 100-300), respectively. Median LOS was 3 days (IQR: 3, 5) and 7% of patients had PSM on final pathology. A 3D model was reconstructed for 84 (18%) patients. Patients with reconstructed 3D virtual models had more complex tumors (median PADUA score 9 vs. 8, p<0.05). No other statistically significant differences were recorded, although patients with available 3D models were older (66 vs. 64 years), less frequently male (63% vs. 71%), and exhibited longer WIT (14 vs. 13 minutes), shorter LOS (3 vs. 4 days) and lower PSM rate (3.6% vs 7.4%) (all p>0.05). On multivariable logistic regression models, 3D virtual model usage was an independent predictor of lower PSM rate (odds ratio [OR]: 0.27; p<0.05). Similarly, on multivariable Poisson regressions, 3D virtual model usage was an independent predictor of shorter WIT (OR 0.78; p<0.05) and shorter LOS (OR: 0.82; p<0.01). CONCLUSIONS: Our findings suggest a potentially crucial role of 3D virtual reconstructions for candidates to RAPN for both surgical planning and intraoperative guidance. Indeed, the use of 3D virtual models led to an improvement of potentially both oncological (reduction in PSM) and functional outcomes (reduction in WIT). Further studies are required to confirm these findings at long-term follow-up. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e798 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luigi Nocera More articles by this author Carlo Bravi More articles by this author Angelo Mottaran More articles by this author Adele Piro More articles by this author Luca Sarchi More articles by this author Marco Paciotti More articles by this author Maria Peraire Lores More articles by this author Eleonora Balestrazzi More articles by this author Federico Piramide More articles by this author Rui Farinha More articles by this author Pieter De Backer More articles by this author Ruben De Groote More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement PDF downloadLoading ...

PD07-04 OFF-CLAMP ROBOTIC PARTIAL NEPHRECTOMY: 10-YEAR SURVIVAL AND FUNCTIONAL OUTCOMES FROM A HIGH-VOLUME SINGLE CENTER SERIES

You have accessJournal of UrologyCME1 Apr 2023PD07-04 OFF-CLAMP ROBOTIC PARTIAL NEPHRECTOMY: 10-YEAR SURVIVAL AND FUNCTIONAL OUTCOMES FROM A HIGH-VOLUME SINGLE CENTER SERIES Gabriele Tuderti, Riccardo Mastroianni, Umberto Anceschi, Simone D'Annunzio, Alfredo Maria Bove, Aldo Brassetti, Mariaconsiglia Ferriero, Leonardo Misuraca, Salvatore Guaglianone, Michele Gallucci, and Giuseppe Simone Gabriele TudertiGabriele Tuderti More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Simone D'AnnunzioSimone D'Annunzio More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Michele GallucciMichele Gallucci More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003231.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The adoption of Off-clamp (Off-C) robotic partial nephrectomy (RPN) is led by the intent to maximize renal functional preservation. There is paucity of evidences about long-term functional outcomes of Off-c RPN. The aim of this study was to report peri-operative, and long term functional and survival outcomes of a single high-volume center series of Off-C RPN. METHODS: A prospective renal cancer institutional database was queried, and data of consecutive patients treated with Off-C RPN between 2010 and 2015 in a high-volume center were collected. Baseline, preoperative, perioperative, oncological and functional outcomes were assessed. Trifecta was defined as the coexistence of negative margins, no Clavien-Dindo ≥3 complications and ≤30% postoperative estimated glomerular filtration rate reduction. Kaplan-Meier analysis was performed to assess survival and renal functional outcomes. Univariable and multivariable analyses were carried out to identify predictors of Trifecta achievement and renal function deterioration over time. RESULTS: Overall, 530 patients with a mean follow-up of 57.8 months were included. Severe perioperative complications occured in 1.9% of patients. Trifecta was achieved in 80.9% of cases. The 8-year recurrence-free survival, cancer-specific survival and overall survival rates were 96.8%, 99% and 96.4%, respectively. Patients with baseline eGFR ≥60 ml/min displayed a negligible risk of long term severe renal function deterioration (10-yr newly onset Chronic kidney disease (CKD) stage 3b risk: 8.1% for patients with preop CKD stage 1, 4.9% for patients with preop CKD stage 2). At multivariable analysis, the increasing tumor complexity (PADUA score) was the only indipendent predictor of Trifecta achievement reduction. Concerning functional outcomes, age at surgery was the only independent predictor of developing newly-onset CKD stage≥3b (HR 1.10, 95% CI 1.009-1.19–0.98;p=0.03). CONCLUSIONS: Off-C RPN represents a safe surgical approach with a negligible risk of severe perioperative complications occurrence. With regard to functional outcomes, at 10-yr evaluation renal function deterioration is mainly driven by patients ageing. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e162 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gabriele Tuderti More articles by this author Riccardo Mastroianni More articles by this author Umberto Anceschi More articles by this author Simone D'Annunzio More articles by this author Alfredo Maria Bove More articles by this author Aldo Brassetti More articles by this author Mariaconsiglia Ferriero More articles by this author Leonardo Misuraca More articles by this author Salvatore Guaglianone More articles by this author Michele Gallucci More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...

PD07-06 RENAL TUMOR PLANAR EXTENSION IN THREE-DIMENSIONAL MODEL AS A NOVEL TECHNIQUE FOR PREOPERATIVE ASSESSMENT OF ROBOTIC PARTIAL NEPHRECTOMY

You have accessJournal of UrologyCME1 Apr 2023PD07-06 RENAL TUMOR PLANAR EXTENSION IN THREE-DIMENSIONAL MODEL AS A NOVEL TECHNIQUE FOR PREOPERATIVE ASSESSMENT OF ROBOTIC PARTIAL NEPHRECTOMY Xinfei Li, Kunlin Yang, Xiaoteng Yu, Zhongyuan Zhang, Cuijian Zhang, Lin Cai, Zheng Zhang, Cheng Shen, Jin Tao, Dapeng Wu, Xuepei Zhang, Hailong Hu, Liqun Zhou, and Xuesong Li Xinfei LiXinfei Li More articles by this author , Kunlin YangKunlin Yang More articles by this author , Xiaoteng YuXiaoteng Yu More articles by this author , Zhongyuan ZhangZhongyuan Zhang More articles by this author , Cuijian ZhangCuijian Zhang More articles by this author , Lin CaiLin Cai More articles by this author , Zheng ZhangZheng Zhang More articles by this author , Cheng ShenCheng Shen More articles by this author , Jin TaoJin Tao More articles by this author , Dapeng WuDapeng Wu More articles by this author , Xuepei ZhangXuepei Zhang More articles by this author , Hailong HuHailong Hu More articles by this author , Liqun ZhouLiqun Zhou More articles by this author , and Xuesong LiXuesong Li More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003231.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To describe a tumor planar extension technique in three-dimensional (3D) model and assess its practicability in robot-assisted partial nephrectomy (RAPN). METHODS: A total of 231 patients with a renal tumor who underwent RAPN between Mar 2019 and Mar 2022 was prospectively enrolled. The 3D model was obtained based on enhanced CT urography. The tumor plane was extended equidistantly (10 mm) according to the original shape. The patients were divided into the collecting system involvement (CSI) group and the collecting system negative (CSN) group based on the relationship between the extended plane and the collecting system. The evaluation indicators included operative time, ischemia time, positive margin, major complication, and trifecta outcome (negative margin, ischemic time ≤25min, no major complication). RESULTS: The tumor diameter was 2.9 (0.8-10.0) cm. Median PADUA score was 8 (6-15). There were 173 and 58 patients in CSN and CSI groups, respectively. The operative time was 110.3±36.2 and 116.9 ± 36.6 min in CSN and CSI groups (p=0.228). The ischemic time in CSI group was significantly longer than that in CSN group (26.7±10.0 vs 21.0 ± 7.8 min, p<0.001). The patients in CSI group had a higher positive margin rate (1.72% vs. 0.58%) and higher risk of complications (8.62% vs 5.78%), but there was no statistical significance. Patients in CSI group whose ischemia time greater than 25 min was significantly more than that in CSN group (44.83% vs 21.39%, p=0.001). The failure rate in trifecta outcome in CSI group was significantly higher (46.55% vs 24.42%, p=0.003). The area under ROC curve in predicting trifecta outcome was 0.599 (p=0.017) based on the relationship between the tumor planar extension and the collecting system. CONCLUSIONS: The 3D tumor planar extension is a novel technique for tumor anatomy assessment and helps predict surgical outcomes of RAPN. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e164 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Xinfei Li More articles by this author Kunlin Yang More articles by this author Xiaoteng Yu More articles by this author Zhongyuan Zhang More articles by this author Cuijian Zhang More articles by this author Lin Cai More articles by this author Zheng Zhang More articles by this author Cheng Shen More articles by this author Jin Tao More articles by this author Dapeng Wu More articles by this author Xuepei Zhang More articles by this author Hailong Hu More articles by this author Liqun Zhou More articles by this author Xuesong Li More articles by this author Expand All Advertisement PDF downloadLoading ...

MP47-05 SUTURELESS OFF-CLAMP ROBOT-ASSISTED PARTIAL NEPHRECTOMY: INDICATION, FEASIBILITY AND FUNCTIONAL OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023MP47-05 SUTURELESS OFF-CLAMP ROBOT-ASSISTED PARTIAL NEPHRECTOMY: INDICATION, FEASIBILITY AND FUNCTIONAL OUTCOMES Riccardo Mastroianni, Gabriele Tuderti, Umberto Anceschi, Alfredo Maria Bove, Aldo Brassetti, Manuela Costantini, Simone D'annunzio, Mariaconsiglia Ferriero, Leonardo Misuraca, Andrea Iannuzzi, Alberto Ragusa, Rocco Papalia, Salvatore Guaglianone, and Giuseppe Simone Riccardo MastroianniRiccardo Mastroianni More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Manuela CostantiniManuela Costantini More articles by this author , Simone D'annunzioSimone D'annunzio More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Andrea IannuzziAndrea Iannuzzi More articles by this author , Alberto RagusaAlberto Ragusa More articles by this author , Rocco PapaliaRocco Papalia More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Minimizing renal function loss during robot-assisted partial nephrectomy (RAPN) is a primary surgical outcome. There are few reports about sutureless RAPN and this procedure has intrinsic selection bias, being renorraphy a mandatory step to manage major bleeding sources and unintended urinary tract violation. The aim of this study was to describe predictors of performing renorraphy, and to compare perioperative and functional outcomes between sutureless and conventional renorraphy RAPN. METHODS: Our single center IRB approved renal cancer database was queried for “RAPN” and “renorraphy””. After a standardization process, all consecutive patients treated between Jan 2020 and May 2022 underwent off-clamp RAPN with a sutureless intent. Renal stump coagulation was used to control bleeding sources after RAPN. Intraoperative evidences of urinary tract violation was the only indication to perform renorraphy. Baseline and postoperative outcomes were collected. Continuous and categorical variables were compared using Mann-Whitney and Chi-Square tests. Logistic regression analysis was performed to identify predictors of renorraphy. Kaplan-Meier (KM) analysis and the log-rank test were performed to compare probabilities of developing newly onset chronic kidney disease (CKD) stage≥3 between cohorts. RESULTS: Out of 269 patients included, sutureless approach was successully completed in 246 patients. Both cohorts were homogeneous for baseline features except for PADUA score (p=0.028). No differences occurred postoperatively (Table 1). On multivariable analysis, nearness to collecting system ≤4mm was the only independent predictor of need for renorraphy (p=0.008 - Table 2). Overall, 108 patients had a renal tumor nearness ≤4mm to collecting system and sutureless intent failure probability was 16%. At KM analysis, performing renorraphy did not impact on probabilities of developning CKD stage ≥3 (2yrs: sutureless: 16.3%±2.9 vs renorraphy: 19.0%±10.5; p=0.71). CONCLUSIONS: Nearness to urinary collecting system predicts probability of performing renorraphy, which had negligible impact on perioperative and early functional outcomes. Safety, feasibility and functional outcomes of sutureless RAPN were confirmed, even if larger cohorts and randomized controlled trials are needed to obtain stronger evidences. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e644 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Riccardo Mastroianni More articles by this author Gabriele Tuderti More articles by this author Umberto Anceschi More articles by this author Alfredo Maria Bove More articles by this author Aldo Brassetti More articles by this author Manuela Costantini More articles by this author Simone D'annunzio More articles by this author Mariaconsiglia Ferriero More articles by this author Leonardo Misuraca More articles by this author Andrea Iannuzzi More articles by this author Alberto Ragusa More articles by this author Rocco Papalia More articles by this author Salvatore Guaglianone More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...