Cosimo De Nunzio

Sant'Andrea Medical Hospital, Spezia, Liguria, Italy

Are you Cosimo De Nunzio?

Claim your profile

Publications (163)519.85 Total impact

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This study aimed to evaluate the behavior of non-muscle-invasive bladder cancer (NMIBC) in patients submitted to transurethral bladder resection (TURB) comparing subjects in chronic therapy with aspirin, statins, or both drugs to untreated ones. This retrospective study was conducted on 574 patients diagnosed with NMIBC who underwent TURB between March 2008 and April 2013. The study population was divided into two main groups: treated (aspirin and/or statins) and untreated. The treated group was further divided into three therapeutic subgroups: Group A (100 mg of aspirin, daily for at least two years); Group B (20 mg or more of statins, daily for at least two years); and Group C (100 mg of aspirin and 20 mg of statins together).The mean follow-up of patients was 45.06 months. No significant differences were observed among the different groups at baseline. On multivariate analysis, statin treatment, smokers and high stage disease (T1) achieved the level of independent risk factor for the occurrence of a recurrence. When patients were stratified according to the different treatment; patients treated with statins (Group B) presented an higher rate of failure (56/91 patients; 61.5%) when compared to Group A (42/98 patients; 42.9%), Group C (56/98; 57.1%) and (133/287 patients; 46.3%). This difference corresponds to a significant difference in recurrence failure free survival (p = 0.01). Our results suggest that long-term treatment with aspirin in patients with NMIBC might play a role on reducing the risk of tumor recurrence. In contrast, in our investigation data from statins and combination treatment groups showed increased recurrence rates. A long-term randomized prospective study could definitively assess the possible role of this widely used drugs in NMIBC.
    BMC Cancer 12/2015; 15(1):1152. DOI:10.1186/s12885-015-1152-x · 3.32 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: This study aimed to evaluate the behavior of non-muscle-invasive bladder cancer (NMIBC) in patients submitted to transurethral bladder resection (TURB) comparing subjects in chronic therapy with aspirin, statins, or both drugs to untreated ones. METHODS: This retrospective study was conducted on 574 patients diagnosed with NMIBC who underwent TURB between March 2008 and April 2013. The study population was divided into two main groups: treated (aspirin and/or statins) and untreated. The treated group was further divided into three therapeutic subgroups: Group A (100 mg of aspirin, daily for at least two years); Group B (20 mg or more of statins, daily for at least two years); and Group C (100 mg of aspirin and 20 mg of statins together).The mean follow-up of patients was 45.06 months. RESULTS: No significant differences were observed among the different groups at baseline. On multivariate analysis, statin treatment, smokers and high stage disease (T1) achieved the level of independent risk factor for the occurrence of a recurrence. When patients were stratified according to the different treatment; patients treated with statins (Group B) presented an higher rate of failure (56/91 patients; 61.5%) when compared to Group A (42/98 patients; 42.9%), Group C (56/98; 57.1%) and (133/287 patients; 46.3%). This difference corresponds to a significant difference in recurrence failure free survival (p = 0.01). CONCLUSIONS: Our results suggest that long-term treatment with aspirin in patients with NMIBC might play a role on reducing the risk of tumor recurrence. In contrast, in our investigation data from statins and combination treatment groups showed increased recurrence rates. A long-term randomized prospective study could definitively assess the possible role of this widely used drugs in NMIBC.
    BMC Cancer 03/2015; 15(1). DOI:10.1186/s12885-015-1152-x. · 3.32 Impact Factor
  • Andrea Tubaro, Cosimo De Nunzio
  • Urology 03/2015; 85(3):559-60. DOI:10.1016/j.urology.2014.11.038 · 2.13 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The current TNM system for renal cell carcinoma (RCC) merges perirenal fat invasion (PFI) and renal vein invasion (RVI) as stage pT3a despite limited evidence concerning their prognostic equivalence. In addition, the prognostic value of PFI compared to pT1-pT2 tumors remains controversial. To analyze the prognostic significance of PFI, RVI, and tumor size in pT1-pT3a RCC. Data for 7384 pT1a-pT3a RCC patients were pooled from 12 centers. Patients were grouped according to stages and PFI/RVI presence as follows: pT1-2N0M0 (n=6137; 83.1%), pT3aN0M0 + PFI (n=1036; 14%), and pT3aN0M0 (RVI ± PFI; n=211; 2.9%). Radical nephrectomy or nephron-sparing surgery (NSS) (1992-2010). Cancer-specific survival was estimated using the Kaplan-Meier method. Univariate and multivariate Cox proportional-hazards regression models, as well as sensitivity and discrimination analyses, were used to evaluate the impact of clinicopathologic parameters on cancer-specific mortality (CSM). Compared to stage pT1-2, patients with stage pT3a RCC were significantly more often male (59.4% vs 53.1%) and older (64.9 vs 62.1 yr), more often had clear cell RCC (85.2% vs 77.7%), Fuhrman grade 3-4 (29.4% vs 13.4%), and tumor size >7cm (39.1% vs 13%), and underwent NSS less often (7.5% vs 36.6%; all p<0.001). According to multivariate analysis, CSM was significantly higher for the PFI and RVI ± PFI groups compared to pT1-2 patients (hazard ratio [HR] 1.94 and 2.12, respectively; p<0.001), whereas patients with PFI only and RVI ± PFI did not differ (HR 1.17; p=0.316). Tumor size instead enhanced CSM by 7% per cm in stage pT3a (HR 1.07; p<0.001) with a 7cm cutoff yielding the highest prediction accuracy. Since the prognostic impact of PFI and RVI on CSM seems to be comparable, merging both as stage pT3a RCC might be justified. Enhanced prognostic discrimination of stage pT3a RCC appears to be possible by applying a tumor size cutoff of 7cm within an alternative staging system. Prognosis prediction for patients with localized renal cell carcinoma up to stage pT3a can be enhanced by including tumor size with a cutoff of 7cm as an additional parameter in the TNM classification system. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
  • Neurourology and Urodynamics 01/2015; DOI:10.1002/nau.22727 · 2.67 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Central obesity can be associated with the development of benign prostatic enlargement (BPE) and with the worsening of lower urinary tract symptoms (LUTS). The aim of our study was to evaluate the impact of components of Metabolic Syndrome (MetS) on urinary outcomes after surgical therapy for severe LUTS due to BPE. A multicenter prospective study was conducted including 378 consecutive men surgically treated for large BPE with simple open prostatectomy (OP) or transurethral resection of the prostate (TURP), between January 2012 and October 2013. LUTS were measured by the International Prostate Symptom Score (IPSS), immediately before surgery and 6 to 12 months postoperatively. MetS was defined according the US National Cholesterol Education Program-Adult Treatment Panel III. The improvement of total and storage IPSS postoperatively was related to diastolic blood pressure and waist circumference (WC). WC>102 cm was associated with a higher risk of an incomplete recovery of both total IPSS (OR: 0.343, p=0.001) and storage IPSS (OR: 0.208, p<0.001), as compared to WC<102cm. Main limitations are: 1) population selected for a tertiary center 2) Use exclusively of IPSS questionnaire 3) Not inclusion of further data. Increased WC is associated with persistent postoperative urinary symptoms after surgical treatment of BPE. Obese men have a higher risk of persistent storage LUTS after TURP or OP. This article is protected by copyright. All rights reserved.
    BJU International 01/2015; DOI:10.1111/bju.13038 · 3.13 Impact Factor
  • Journal of endourology / Endourological Society 01/2015; DOI:10.1089/end.2015.0009 · 1.75 Impact Factor
  • Cosimo De Nunzio, Andrea Tubaro
    Nature Reviews Urology 01/2015; DOI:10.1038/nrurol.2014.360 · 4.79 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: AimsTo develop a nomogram predicting benign prostatic obstruction (BPO).Methods We included in this study 600 men with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE) who underwent standardized pressure flow studies (PFS) between 1996 and 2000. Complete clinical and urodynamic data were available for all patients. Variables assessed in univariate and multivariate logistic regression models consisted of IPSS, PSA, prostate size, maximal urinary flow rate (Qmax) at free flow, residual urine (RU), and bladder wall thickness (BWT). These were used to predict significant BPO (defined as a Schäfer grade ≥ 3 in PFS).ResultsA preliminary multivariate model, including IPSS, Qmax at free flow and RU, suggested that only Qmax at free flow was a statistically significant predictor of BPO (P = 0.00) with a predictive accuracy (PA) of 82%. Further development of the multivariate model showed how the inclusion of BWT did not increase PA. Only transitional zone volume (TZV) proved to be an additional statistically significant predictor for BPO (P = 0.00). The combination of Qmax at free flow and TZV demonstrated a PA of 83.2% and were included in the final nomogram format.Conclusions We developed a clinical nomogram, which is both accurate and well calibrated, which can be helpful in the management of patients with LUTS and BPE. External validation is warranted to confirm our findings. Neurourol. Urodynam. 9999:1–6, 2014. © 2014 Wiley Periodicals, Inc.
    Neurourology and Urodynamics 12/2014; DOI:10.1002/nau.22705 · 2.67 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Little is known about drug adherence in men treated for lower urinary tract symptoms (LUTS). Benign prostatic hyperplasia (BPH) is one of the causes of LUTS. To examine adherence to pharmacological therapy and its clinical value in men with LUTS. Population-based cohort study using an administrative prescription database and hospital discharge codes for 1.5 million men aged ≥40 yr treated with alpha blockers (ABs) and 5-alpha reductase inhibitors (5ARIs) alone or in combination (CT). Therapy with ABs and/or 5ARIs. The 1-yr and long-term adherence; hospitalization rates for BPH and BPH surgery. Multivariate Cox proportional hazards regression model, propensity score matching, and sensitivity analyses. The 1-yr adherence was 29% in patients exposed to at least 6-mo therapy. Patients on CT had a higher discontinuation rate in the first 2 yr compared to those on monotherapy (p<0.0001). Overall hospitalization rates for BPH and BPH surgery were 9.04 and 12.6 per 1000 patient-years, respectively. A lower risk of hospitalization was observed for 5ARI compared to AB therapy (hazard ratio [HR] 0.46 and 0.23; p<0.0001). CT was associated with a reduced risk of hospitalization for BPH surgery (HR 0.94; p<0.0001) compared to AB. Discontinuation of drug treatment was an independent risk factor for hospitalization for BPH and BPH surgery (HR 1.65 and 2.80; p<0.0001) regardless of therapeutic group. Limitations include the paucity of clinical measures and the absence of patient-reported outcomes. Adherence to pharmacological therapy for BPH is low and could affect clinical outcomes. Long-term 5ARI and CT use was associated with an independent reduced risk of hospitalization for BPH surgery. Our findings suggest the need for new strategies to increase patient adherence to prescribed treatment and more appropriate prescribing by physicians. Our research shows that adherence to prescribed pharmacological therapy is crucial in the management of patients suffering from lower urinary tract symptoms. Moreover, pharmacological therapy can prevent disease progression. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
    European Urology 11/2014; DOI:10.1016/j.eururo.2014.11.006 · 12.48 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the association between metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) in patients with benign prostatic enlargement (BPE). From 2009 onward, a consecutive series of patients with LUTS-BPE were enrolled. Patients were evaluated using the International Prostate Symptom Score (IPSS) and ultrasonographic prostate volume. Body mass index, waist circumference, and blood pressure were measured. Blood samples were collected for prostate-specific antigen levels, fasting glucose levels, triglyceride levels, high-density lipoprotein levels, and testosterone levels. MetS was defined according to Adult Treatment Panel III (ATP III). The risk of detecting LUTS as a function of MetS was evaluated using the logistic regression analysis. A total of 431 patients were enrolled with a median age and prostate-specific antigen level of 67 years (61-73 years) and 3 ng/mL (2.2-4.3 ng/mL), respectively; median body mass index was 27 kg/m2 (25-29 kg/m(2)); median testosterone was 3.9 ng/mL (3.1-4.7 ng/mL); median IPSS was 8 (4-14), median prostate volume was 43 mL (35-56 mL). One hundred three of 431 patients (23.8%) presented with a MetS. Patients with MetS presented a higher IPSS storage subscore (4; interquartile range, 2-7 vs 3; interquartile range 1-7; P = .002). On multivariate analysis, the presence of MetS was associated with an increased risk of an IPSS storage subscore ≥4 (odds ratio, 1.782; 95% confidence interval, 1.045-3.042; P = .030). In our single-center study, MetS is associated with an increased risk of storage symptoms in patients with BPE. Although these results should be confirmed, and the pathophysiology is yet to be understood, it can be assumed that MetS and its metabolic components should be considered as possible factors involved in LUTS-BPE pathogenesis. Copyright © 2014 Elsevier Inc. All rights reserved.
    Urology 11/2014; 84(5):1181-7. DOI:10.1016/j.urology.2014.07.018 · 2.13 Impact Factor
  • [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; 22(1). DOI:10.1111/iju.12644 · 1.80 Impact Factor
  • European Urology 10/2014; DOI:10.1016/j.eururo.2014.10.016 · 12.48 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Overactive bladder (OAB)/ storage lower urinary tract symptoms (LUTS) have a high prevalence affecting up to 90% of men over 80 years. The role of sufficient therapies appears crucial. In the present review, we analyzed the mechanism of action of tolterodine extended-release (ER) with the aim to clarify its efficacy and safety profile, as compared to other active treatments of OAB/storage LUTS.
    BMC Urology 10/2014; 14(1):84. DOI:10.1186/1471-2490-14-84 · 1.94 Impact Factor
  • Andrea Tubaro, Federica Puccini, Cosimo De Nunzio
    [Show abstract] [Hide abstract]
    ABSTRACT: No consensus has ever been reached on the predictive value of serum prostate specific antigen(PSA) for the diagnosis of prostate cancer. Limitations of PSA testing in clinical practice have beenoften discussed in the peer-reviewed literature following data derived from clinical trials such as theProstate Cancer Prevention Trial (PCPT) and the Reduction by Dutasteride of Prostate Cancer Events(REDUCE) study that showed a linear rise in the risk of prostate cancer with increasing PSA levels.Benign prostatic hyperplasia is a known confounding factor for the use of PSA as a marker of prostatecancer. Increased prostate volume observed with ageing, urinary retention, acute and chronicinflammatory conditions of the prostate, sexual activity and digital rectal examination may all cause anincrease of PSA values. Both finasteride and dutasteride, 5-alpha reductase inhibitors (5ARI) used inthe treatment of BPH, are known to induce a significant decrease of serum PSA levels close to 50%.The observed change in PSA values following 5ARI treatment has raised questions about the accuracyof PSA testing for the early diagnosis of prostate cancer in patients on finasteride/dutasteride treatment.Careful analysis of data from various clinical trials on pharmacological treatment of LUTS due toBPH suggested that the accuracy of PSA testing is not just maintained but rather increased following5ARI use. Then, the question of PSA accuracy during 5ARI treatment can be considered closed.
  • [Show abstract] [Hide abstract]
    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; DOI:10.5301/uro.5000088
  • [Show abstract] [Hide abstract]
    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; DOI:10.1002/nau.22671 · 2.67 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: 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. Materials and methods: The data for 2,516 patients with a median follow-up of 57 months were retrieved from a multinational database (Collaborative Research on Renal Neoplasms Association [CORONA]), including data for 6,234 consecutive patients with RCC after radical or partial nephrectomy. Comparative analysis of clinicopathological features of 241 octogenarians (3.9% of the database) and 2,275 reference patients between the ages of 60 and 70 years (36.5%) was performed. Multivariable regression analysis adjusted for competing risks was applied to identify the effect of advanced age on cancer-specific mortality (CSM) and other-cause mortality (OCM). Furthermore, instrumental variable analysis was employed to reduce residual confounding by unmeasured parameters. Results: Significantly more women were present (50% vs. 40%, P = 0.004), and significantly less often nephron-sparing surgery was performed in octogenarians compared with the reference group (11% vs. 20%, P < 0.001). Although median tumor size and stages did not significantly defer, older patients less often had advanced or metastatic disease (N+/M1) (4.6% vs. 9.6%, P = 0.009). On multivatiable analysis, higher CSM (hazard ratio = 1.48, P = 0.042) and OCM rates (hazard ratio = 4.32, P < 0.001) were detectable in octogenarians (c-indices = 0.85 and 0.72, respectively). Integration of the variable age group in multivariable models significantly increased the predictive accuracy regarding OCM (6%, P < 0.001), but not for CSM. Limitations are based on the retrospective study design. Conclusions: Octogenarian patients with RCC significantly differ in clinical features and display significantly higher CSM and OCM rates in comparison with their younger counterparts.
    Urologic Oncology 08/2014; 32(8). DOI:10.1016/j.urolonc.2014.04.013 · 3.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BackgroundBioactive 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).DiscussionThere are different techniques of extraction, also used in combination, with the aim of enhancing the amount of the target molecules, gaining time and reducing waste of solvents. However, the qualitative and quantitative composition of the bioactives depends on the extractive process, and so the brands of the recovered products from the same plant are different in terms of clinical efficacy (no product interchangeability among different commercial brands).SummaryIn this review, we report on several and recent extraction techniques and their impact on the composition/biological activity of S. repens-based available products.
    BMC Urology 08/2014; 14(1):63. DOI:10.1186/1471-2490-14-63 · 1.94 Impact Factor
    This article is viewable in ResearchGate's enriched format

Publication Stats

881 Citations
519.85 Total Impact Points

Institutions

  • 2004–2015
    • Sant'Andrea Medical Hospital
      Spezia, Liguria, Italy
    • The American University of Rome
      Roma, Latium, Italy
  • 2001–2015
    • Sapienza University of Rome
      • • Department of Experimental Medicine
      • • Department of Clinical and Molecular Medicine
      • • Department of Internal and Specialized Medicine
      Roma, Latium, Italy
  • 2013–2014
    • University of Florence
      • Dipartimento di Scienze Biomediche, Sperimentali e Cliniche
      Florens, Tuscany, Italy
  • 2006–2014
    • Sant´Andrea Hospital
      Roma, Latium, Italy
  • 2011
    • Indianapolis Zoo
      Indianapolis, Indiana, United States
    • University of Rome Tor Vergata
      Roma, Latium, Italy
  • 2009
    • Cardarelli Hospital
      Napoli, Campania, Italy