Cosimo De Nunzio

Sapienza University of Rome, Roma, Latium, Italy

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Publications (135)351.94 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Metabolic syndrome is a cluster of several metabolic abnormalities, its prevalence is increasing worldwide. To summarize the most recent evidence regarding the relationship between metabolic syndrome, its components and the oncological outcomes in bladder cancer patients, a National Center for Biotechnology Information PubMed search for relevant articles either published or e-published up to March 2014 was carried out by combining the following Patient population, Intervention, Comparison, Outcome terms: metabolic syndrome, obesity, body mass index, hyperglycemia, insulin resistance, diabetes, hypertension, dyslipidemia, bladder cancer, risk, mortality, cancer specific survival, disease recurrence and progression. Metabolic syndrome is a complex, highly prevalent disorder, and central obesity, insulin resistance, dyslipidemia and hypertension are its main components. Published findings would suggest that metabolic syndrome per se might be associated with an increased risk of bladder cancer in male patients, but it did not seem to confer a risk of worse prognosis. Considering the primary components of metabolic syndrome (hypertension, obesity and dyslipidemia), available data are uncertain, and it is no possible to reach a conclusion yet on either a direct or an indirect association with bladder cancer risk and prognosis. Only with regard to type 2 diabetes mellitus, available data would suggest a potential negative correlation. However, as the evaluation of bladder cancer risk and prognosis in patients with metabolic disorders is certainly complex, further studies are urgently required to better assess the actual role of these metabolic disorders.
    International Journal of Urology 11/2014; · 1.73 Impact Factor
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    ABSTRACT: Surgery for male infertility includes three main areas: varicocele surgery, recanalization of seminal tract, sperm retrieval.Varicocele treatment in infertily is still controversial. Recent scientific evidence appears to demonstrate that in selected cases varicocele treatment is beneficial in improving semen parameters and pregnancy rate. The key for the success of treatment seems to be a correct indication. It is our opinion that varicocele should be treated in presence of abnormal semen parameters, when clinically significant, and in adolescents with atrophy of the affected testis. So far, no specific technique, either surgical, microsurgical or sclerotherapic, can be considered the gold standard. Good results in our hands have been obtained with the microsurgical lymphatic sparing high ligation of internal spermatic vein.Innovations in surgery for seminal tract obstructions include the new tubular invagination techniques for epididimovasostomy, which showed excellent results with a simplified and time-saving microsurgical approach. In distal obstructions, a new transperineal ultrasound-guided approach has been proposed for the diagnostic work-up and treatment. Advantages of this technique and of the TURED must be balanced with those of immediate sperm retrieval for ART.In sperm retrieval, microTESE represents the most important surgical evolution in non-obstructive azoospermia. We have recently proposed a new stepwise approach starting with a minimal equatorial incision for conventional testicular biopsy which is extended to perform microTESE only when no sperm is retrieved. In this way microTESE is offered only to patients who really need it. Another field of innovation is sperm retrieval for ICSI in patients with Klinefelter Syndrome.
    Urologia. 09/2014;
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    ABSTRACT: AimsTo present the teaching module “Measurement of Post-void residual urine.”Methods This module has been prepared by a Working Group of the ICS Urodynamics Committee. The methodology used included comprehensive literature review, consensus formation by the members of the Working Group, and review by members of the ICS Urodynamics Committee core panel.ResultsIn this ICS teaching module the evidence for and relevance of PVR measurement in patients with lower urinary tract dysfunction (LUTD) is summarized; in short: The interval between voiding and post-void residual (PVR) measurement should be of short duration and ultrasound bladder volume measurement is preferred to urethral catheterization. There is no universally accepted definition of a significant residual urine volume. Large PVR (>200–300 ml) may indicate marked bladder dysfunction and may predispose to unsatisfactory treatment results if for example, invasive treatment for bladder outlet obstruction (BOO) is undertaken. PVR does not seem to be a strong predictor of acute urinary retention and does not indicate presence of BOO specifically. Although the evidence base is limited, guidelines on assessment of LUTS generally include PVR measurement.Conclusion Measurement of PVR is recommended in guidelines and recommendations on the management of LUTS and urinary incontinence, but the level of evidence for this measurement is not high. This manuscript summarizes the evidence and provides practice recommendations for teaching purposes in the framework of an ICS teaching module. Neurourol. Urodynam. © 2014 Wiley Periodicals, Inc.
    Neurourology and Urodynamics 09/2014; · 2.67 Impact Factor
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    ABSTRACT: To analyze clinicopathological features and survival of surgically treated patients with renal cell carcinoma (RCC)≥80 years of age in comparison with patients between the ages of 60 and 70 years.
    Urologic oncology. 08/2014;
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    ABSTRACT: Bioactive compounds from plants (i.e., Serenoa repens) are often used in medicine in the treatment of several pathologies, among which benign prostatic hyperplasia (BPH) associated to lower urinary tract symptoms (LUTS).
    BMC Urology 08/2014; 14(1):63. · 1.69 Impact Factor
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    Andrea Tubaro, Cosimo De Nunzio
    European Urology 06/2014; 65(6):1220-1. · 10.48 Impact Factor
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    ABSTRACT: Renal artery aneurysm is a rare disorder with a high mortality rate in the event of rupture, the most frequent complication, which can also occur in lesions smaller than those indicated for treatment by current criteria. Surgery is still the first-line treatment, although a growing trend toward endovascular management of visceral artery aneurysms has emerged because of the high efficacy and low invasiveness that has been demonstrated by several authors. Treatment of wide-necked aneurysms and, depending on location, those at renal artery bifurcations or distal branches is more complex and may require invasive surgical techniques, such as bench surgery.
    BMC Urology 05/2014; 14(1):42. · 1.69 Impact Factor
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    ABSTRACT: Schwannomas are tumours arising from Schwann cells, which sheath the peripheral nerves. Here, we report a rare case of left intrascrotal, extratesticular schwannoma. Although rare, scrotal localisation of schwannomas has been reported in male children, adult men, and elderly men. They are usually asymptomatic and are characterised by slow growth. Patients generally present with an intrascrotal mass that is not associated with pain or other clinical signs, and such cases are self-reported by most patients. Imaging modalities (such as ultrasonography, computed tomography, and magnetic resonance imaging) can be used to determine tumour size, exact localisation, and extension. However, the imaging findings of schwannoma are non-specific. Therefore, only complete surgical excision can result in diagnosis, based on histological and immunohistochemical analyses. If the tumour is not entirely removed, recurrences may develop, and, although malignant change is rare, this may occur, especially in patients with a long history of an untreated lesion. Thus, follow up examinations with clinical and imaging studies are recommended for scrotal schwannomas. A 52-year-old man presented with a 3-year history of asymptomatic scrotal swelling. Physical examination revealed a palpable, painless, soft mass in the left hemiscrotum. After surgical removal of the mass, its histological features indicated schwannoma. Schwannoma should be considered in cases of masses that are intrascrotal but extratesticular. Ultrasonography provides the best method of confirming the paratesticular localisation of the tumour, before surgical removal allows histopathological investigation and definitive diagnosis. Surgery is the standard therapeutic approach. To prevent recurrence, particular care should be taken to ensure complete excision. This case report includes a review of the literature on scrotal schwannomas.
    BMC Urology 04/2014; 14(1):32. · 1.69 Impact Factor
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    ABSTRACT: Objective Evidence suggests an association between MetS and lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE). We summarized and meta-analyzed the current literature concerning MetS and BPE, focusing on all the components of MetS and their relationship with prostate volume, transitional zone volume, PSA and urinary symptoms. Methods An extensive PubMed and Scopus search was performed including the following keywords: “metabolic syndrome” (MetS), “diabetes”, “hypertension”, “obesity” and “dyslipidaemia” combined with “lower urinary tract symptoms” (LUTS), “benign prostatic enlargement” (BPE), “benign prostatic hyperplasia” (BPH) and “prostate". ResultsOut of the retrieved articles, 82 were selected for detailed evaluation, and 8 were included in this review. The eight studies enrolled a total of 5403 patients, of which 1426 (26.4%) had MetS defined according to current classification.Subjects with MetS had significantly higher total prostate volume when compared to those without MetS (+1.8 [95% CI: 0.74;2.87] ml; p<0.001).Conversely, no differences were observed between subjects with or without MetS for IPSS total or LUTS subdomain scores.Meta-regression analysis showed that differences in total prostate volume were significantly higher in older (adj r=0.09; p=0.02), obese patients (adj r=0.26; p<0.005) and low serum HDL cholesterol concentrations (adj r=-0.33; p<0.0001). Conclusions Our results underline the exacerbating role of MetS-induced metabolic derangements in the development of BPE.Obese, dyslipidemic, and aged men have a higher risk of having MetS as a determinant of their prostate enlargement.
    BJU International 03/2014; · 3.05 Impact Factor
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    ABSTRACT: Prostate cancer (PCa) is the most common malignancy in elderly men. The progressive ageing of the world male population will further increase the need for tailored assessment and treatment of PCa patients. The determinant role of androgens and sexual hormones for PCa growth and progression has been established. However, several trials on androgens and PCa are recently focused on urinary continence, quality of life, and sexual function, suggesting a new point of view on the whole endocrinological aspect of PCa. During aging, metabolic syndrome, including diabetes, hypertension, dyslipidemia, and central obesity, can be associated with a chronic, low-grade inflammation of the prostate and with changes in the sex steroid pathways. These factors may affect both the carcinogenesis processes and treatment outcomes of PCa. Any treatment for PCa can have a long-lasting negative impact on quality of life and sexual health, which should be assessed by validated self-reported questionnaires. In particular, sexual health, urinary continence, and bowel function can be worsened after prostatectomy, radiotherapy, or hormone treatment, mostly in the elderly population. In the present review we summarized the current knowledge on the role of hormones, metabolic features, and primary treatments for PCa on the quality of life and sexual health of elderly Pca survivors.
    International Journal of Endocrinology 01/2014; 2014:470592. · 2.52 Impact Factor
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    ABSTRACT: Introduction To evaluate the impact of metabolic syndrome (MetS) and its components on the early complications observed in patients treated with radical cystectomy (RC) and urinary diversion. Patients and Methods We retrospectively analysed 346 patients with bladder cancer undergoing RC with standard lymphadenectomy, according to the procedure suggested by the International Consultation on Bladder Cancer ( ICUD-EAU), and urinary diversion. All early complications within 90 days of surgery were recorded and collected according to the 10 Martin criteria and classified according to the established five grade of modified Clavien classification system (CCS). MetS was defined according to the National Cholesterol Educational Program’s Third Adult Treatment Panel. A binary logistic regression analysis were used to analyze MetS and, separately, its single components, as possible independent risk factors for high grade complications. Results A total of 323 complications occurred in 231 patients (66.8%). The rates for low grade (CCS I-II) and high grade complications (CCS III-V), as well as mortality within 90 days (CCS V), were 80.8, 19.2 and 1.7%, respectively. At univariate analysis, MetS patients showed a higher rate of high grade complications compared to without MetS patients (p<0.001). At binary logistic regression analysis, MetS (OR 1.3, p=0.010), waist circumference (OR 1.9, p=0.022) and, only in single model, urinary diversion (OR 1.3, p=0.024) were independent risk factors for high grade complications. Conclusion RC is a major surgical procedure with significant early complications rate, nevertheless the majority are low grade complications. MetS and, separately, waist circumference are associated with high grade complications.
    Clinical Genitourinary Cancer 01/2014; · 1.43 Impact Factor
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    ABSTRACT: Der chromophobe Subtyp (chNZK) stellt die dritthäufigste histologische Variante des Nierenzellkarzinoms (NZK) dar. Aufgrund der relativen Seltenheit dieses Subtyps liegt derzeit nur eine Arbeit vor, die eine gezielte Analyse der klinischen und histopathologischen Kriterien sowie des Überlebens von mehr als 200 Patienten mit chNZK leistet.Die Datenbank dieser multinationalen Studie bildeten 6234 NZK-Patienten aus 11 Zentren, die durch (partielle) Nephrektomie behandelt wurden. 259 Patienten mit chNZK (4,2 %) wurden hinsichtlich ihrer klinischen und histopathologischen Kriterien 4994 Patienten mit klarzelligem Subtyp (80,1 %) gegenübergestellt und stellten somit die Studiengruppe dieser retrospektiven Untersuchung dar. Anhand von multivariablen Cox-Regressionsanalysen wurde der unabhängige Einfluss des chromophoben Subtyps auf das tumorspezifische Überleben und Gesamtüberleben geprüft. Der mediane Beobachtungszeitraum betrug 59 (,,interquartile range“: 29–106) Monate.Patienten mit chNZK waren im Vergleich zu Patienten mit klarzelligem Subtyp signifikant jünger (60 vs. 63,2 Jahre; p Patienten mit chNZK und kNZK unterscheiden sich signifikant in der Verteilung der klinischen und histopathologischen Kriterien. Im Vergleich besteht für Patienten mit chNZK in der univariablen Analyse des tumorspezifischen Überlebens ein signifikanter Vorteil, der sich nach Modelladjustierung mit den etablierten Risikofaktoren nivelliert.
    Der Urologe 01/2014; 53(2). · 0.46 Impact Factor
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    ABSTRACT: Introduction: Before radical prostatectomy (RP), a nomogram [Briganti et al., Eur Urol 2012;61:584-592] permits to measure the probability of specimen-confined (SC) disease (pT2-pT3a, node negative with negative margins) in high-risk prostate cancer (PCa). The aim of our study was to perform an external validation of this nomogram. Materials and Methods: Between 2007 and 2011, 623 patients with high-risk PCa (prostate-specific antigen (PSA) >20 ng/ml and/or biopsy Gleason score ≥8 and/or clinical stage T3) underwent RP and pelvic lymph node dissection at tertiary referral centers. Multivariable logistic regression models predicting the presence of SC disease were built in; we then used the area under curve of the receiver operating characteristic analysis to quantify accuracy of the nomogram to predict SC disease. The extent of over- or underestimation was evaluated within calibration plots. Results: 29% (181/623) of men had SC disease at RP. Preoperative PSA, biopsy Gleason score and stage differed significantly (all p < 0.001) between men with SC disease and those without. External validation of the nomogram showed an acceptable accuracy (area under curve: 66.3, 95% CI 62.4-70%) and a perfect calibration plot. Conclusions: The external cohort validates the original nomogram, with perfect calibration characteristics. The adequate although reduced accuracy may reflect the wide spectrum and behavior of the so-called high-risk PCa. © 2013 S. Karger AG, Basel.
    Urologia Internationalis 12/2013; · 1.07 Impact Factor
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    ABSTRACT: Aim: The aim of our study is to value the efficacy of self-expanding Allium ureteral stent in the treatment of ureteral stenosis. Methods: From 2010 to 2013, we treated 12 patients, aged from 23 to 64 years. Six patients were affected by congenital UPJ obstruction, four patients by iatrogenic unilateral ureteral stenosis and two patients by bilateral ureteral stenosis. All the patients showed hydronephrosis before the stenotic lesion and pain. In all the patients, we use a 30 Fr, 10 cm length self-expanding Allium ureteral stent. The medium follow-up is 10 months after Allium stent removal. Results: All the patients were immediately free of pain after the procedure. We didn't experience intra, peri and postoperative complications. In all the patients, a complete correction of the stenotic lesion was obtained. No recurrence of stenosis occurred during follow-up. Conclusion: Self-expanding allium ureteral stent represents an effective treatment of ureteral stenosis in patients not suitable for surgery.
    Minerva urologica e nefrologica = The Italian journal of urology and nephrology 12/2013; 65(4):277-283. · 0.63 Impact Factor
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    ABSTRACT: Purpose: To explore the association between serum levels of Sex Hormone Binding Globulin (SHBG) and the risk of developing prostate cancer (PCa) as well as high grade disease in men undergoing prostate biopsy. Materials and Methods: Between 2006 and 2012, we prospectively enrolled 740 patients with no history of PCa undergoing prostate biopsy. Before biopsy general data of the patient DRE, PSA and BMI were recorded. The risk of detecting cancer and high grade cancer was assessed as a function of SHBG using crude and adjusted logistic regressions. Results: Serum levels of SHBG were not associated with an increased risk of PCa or high grade disease. Age (OR 1.027 95% CI 1.003-1.052 p = 0.027), DRE (OR 3.391 95% CI 2.258-5.092 p = 0.000) and PSA (OR 1.078 95% CI 1.037-1.120 p = 0.000) were found to be independent predictors of prostate cancer risk. Age (OR 1.051 95% CI 1.009-1.095 p = 0.016), DRE (OR 2.519 95% CI 1.384-4.584 p = 0.000), BMI (OR 1.098 95% CI 1.011-1.193 p = 0.027) and PSA (OR 1.074 95% CI 1.014-1.137 p = 0.015) were found to be independent predictors of high grade disease. Conclusions: In our cohort of patients, serum levels of SHBG are not predictive of PCa or high grade disease. According to our experience SHBG should not be considered a biomarker in PCa diagnosis neither a marker for high grade disease.
    International braz j urol: official journal of the Brazilian Society of Urology 12/2013; 39(6):793-9.
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    ABSTRACT: Percutaneous Tibial Nerve Stimulation (PTNS) has been proposed for the treatment of overactive bladder syndrome (OAB), non-obstructive urinary retention (NOUR), neurogenic bladder, paediatric voiding dysfunction and chronic pelvic pain/painful bladder syndrome (CPP/PBS). Despite a number of publications produced in the last ten years, the role of PTNS in urinary tract dysfunctions remains unclear. A systematic review of the papers on PTNS has been performed with the aim to better clarify potentialities and limits of this technique in the treatment of OAB syndrome and in other above mentioned urological conditions. A literature search using MEDLINE and ISI web was performed. Search terms used were "tibial nerve" and each of the already mentioned conditions, with no time limits. An evaluation of level of evidence for each paper was performed. PTNS was found to be effective in 37-100% of patients with OAB, in 41-100% of patients with NOUR and in up to 100% of patients with CPP/PBS, children with OAB/dysfunctional voiding and patients with neurogenic pathologies. No major complications have been reported.Randomized controlled trials are available only for OAB (4 studies) and CPP/PBS (2 studies). Level 1 evidence of PTNS efficacy for OAB is available. Promising results, to be confirmed by randomized controlled studies, have been obtained in the remaining indications considered. PTNS is an effective and safe option to treat OAB patients. Further studies are needed to assess the role of PTNS in the remaining indications and to evaluate the long term durability of the treatment. Further research is needed to address several unanswered questions about PTNS.
    BMC Urology 11/2013; 13(1):61. · 1.69 Impact Factor
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    ABSTRACT: To evaluate the applicability of a modified Clavien classification system (CCS) in grading postoperative complications of transurethral resection of bladder tumours (TURB). A series of patients undergoing monopolar TURB from April 2011 to March 2012 at five Italian centers were enrolled. All complications occurring within the first 30-day postoperative period were prospectively recorded and graded according to the CCS. Overall, 275 patients were included. Median age was 71 (63/78) years; median BMI was 28 (25.4/30.8) Kg/m(2), median tumour size was 2 (1-3) cm; median number of tumour lesions was 1 (1-3). Median operative time was 30 (20/45) min. Fifty-seven complications were recorded in 43 patients. Overall postoperative morbidity rate was 16%. Most of the complications were not serious and classified as Clavien type I (42 cases; 74%) or II (8 cases, 14%). Higher grade complications were scarce: CCS IIIa in 1 case (2%) and CCS IIIb in six cases (10%). No TURB related death was reported. Six patients were re-operated due to significant bleeding or clot retention on postoperative days 2-7. On univariate (73.5 ± 38 versus 36.7 ± 21.6 min) and multivariate analysis longer operative time was an independent predictor of complications (OR: 1.06 per min, 95%CI 1.04-1.08, p = 0.001). A modified CCS can be used as a standardized tool to objectively define the complications of TURB which confirms to be a safe procedure with a low surgical morbidity. This tool can be used to aid in patient counselling and to facilitate scientific assessment.
    European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 11/2013; · 2.56 Impact Factor
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    ABSTRACT: Biopsy Gleason score (GS), in combination with other clinical parameters, is important to take a therapeutic decision for patients with diagnosis of localized prostate cancer. However, preoperative GS is often upgraded after a radical prostatectomy. Increasing the amount of tissue in prostate biopsy may be a way to avoid this issue. We evaluate the influence of a larger biopsy needle size on the concordance between biopsy and pathological GS. We analyzed paired biopsies and prostatectomy specimens from 104 cases of men with clinically localized prostate cancer. At the time of prostate biopsy, the patients were prospectively randomized into two needle groups (16-Gauge [G] and 18G) using a 1:1 ratio. GS concordance was estimated performing kappa statistic testing, overall concordance rate and risk to under grade biopsy GS=6. A logistic regression analysis was performed to evaluate the patients' characteristics as possible risk factors. The overall concordance between prostate biopsy and pathological GS was 76.9% and 75.6% (p = 0.875) and the k values were 0.821 and 0.811 (p = 0.424), respectively, for 16G and 18G needle study groups. The risk to undergrade a biopsy GS=6 was 21.1% and 15.4% (p = 0.709) using a 16G and 18G needle, respectively. Age, prostate-specific antigen, prostate volume and needle calibre were not independently associated with a higher risk of GS discordance. Needle size does not affect the concordance between biopsy and pathological GS. Although GS is not the only way to determine treatment, it is still an unresolved urological issue.
    Canadian Urological Association journal = Journal de l'Association des urologues du Canada 09/2013; 7(9-10):E567-71. · 1.66 Impact Factor
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    ABSTRACT: To analyze distinct clinico-pathological features and prognosis of patients with renal cell carcinoma aged =40 years in comparison to a reference group of patients aged 60-70 years. Overall 2.572 patients retrieved from a multi-center international database comprising of 6.234 patients with surgically treated renal cell carcinoma were included in this retrospective study. Clinical and histopathological features of 297 patients aged =40 years (4.8%) were analyzed in comparison with 2275 patients (36.5%) aged 60-70 years, who represented the reference group. The median follow-up was 59 months. The impact of young age and further parameters on disease-specific mortality and all-cause mortality was evaluated by multivariable Cox proportional-hazards regression analyses. Young patients underwent more frequently nephron-sparing surgery (27% vs. 20%; p=0.008) and regional lymph node dissection in comparison to older patients (38% vs. 32%; p=0.025). Organ-confined tumor stages (81% vs. 70%; p<0.001), smaller tumor diameters (4.5 cm vs. 4.7 cm; p=0.014), and chromophobe subtype (10% vs. 4%; p<0.001) were significantly more frequent in young patients. On multivariable analysis, older patients had a higher disease-specific (HR 2.21; p<0.001) and all-cause mortality (HR 3.05; p<0.001). The c-indices for the Cox models were 0.87 and 0.78, respectively. However, integration of the variable age group did not significantly gain predictive accuracy of the disease-specific and all-cause-mortality models. Young renal cell carcinoma patients (=40 years) display significantly different frequencies of clinical and histopathological features and show a significantly lower all-cause and disease-specific mortality compared to patients at the age between 60-70 years.
    The Journal of urology 08/2013; · 3.75 Impact Factor
  • Andrea Tubaro, Cosimo De Nunzio
    BJU International 08/2013; 112(3):281-2. · 3.05 Impact Factor

Publication Stats

642 Citations
351.94 Total Impact Points


  • 2001–2014
    • Sapienza University of Rome
      • • Department of Internal and Specialized Medicine
      • • Department of Psychology
      Roma, Latium, Italy
  • 2013
    • Universität Regensburg
      • Department of Urology
      Regensburg, Bavaria, Germany
    • Klinikum St. Elisabeth Straubing GmbH
      Straubing, Bavaria, Germany
  • 2012–2013
    • Sant'Andrea Medical Hospital
      Spezia, Liguria, Italy
    • Universita' degli Studi "Magna Græcia" di Catanzaro
      Catanzaro, Calabria, Italy
    • U.S. Department of Veterans Affairs
      Washington, Washington, D.C., United States
    • Aristotle University of Thessaloniki
      • Faculty of Medicine
      Thessaloníki, Kentriki Makedonia, Greece
  • 2004–2013
    • Sant´Andrea Hospital
      Roma, Latium, Italy
  • 2009
    • Northwestern University
      • Department of Urology
      Evanston, IL, United States
  • 2008
    • University of Rome Tor Vergata
      • Dipartimento di Biopatologia e Diagnostica per Immagini
      Roma, Latium, Italy
  • 2006
    • University of Texas Southwestern Medical Center
      • Department of Urology
      Dallas, TX, United States
  • 2003
    • Istituto Regina Elena - Istituti Fisioterapici Ospitalieri
      Roma, Latium, Italy