Cosimo De Nunzio

Sapienza University of Rome, Roma, Latium, Italy

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Publications (147)470.43 Total impact

  • Journal of endourology / Endourological Society 01/2015; · 1.75 Impact Factor
  • Cosimo De Nunzio, Andrea Tubaro
    Nature Reviews Urology 01/2015; · 4.79 Impact Factor
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    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; · 2.67 Impact Factor
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    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; · 12.48 Impact Factor
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    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; · 1.80 Impact Factor
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    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. · 2.13 Impact Factor
  • European Urology 10/2014; · 12.48 Impact Factor
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    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. · 1.94 Impact Factor
  • Andrea Tubaro, Federica Puccini, Cosimo De Nunzio
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    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.
    Urologia. 09/2014; 81(Suppl. 24):12-16.
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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; · 3.36 Impact Factor
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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. · 1.94 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. · 1.94 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. · 1.94 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 04/2014; · 1.69 Impact Factor
  • European Urology Supplements 04/2014; 13(1):e773. · 3.37 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; · 3.13 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. · 1.52 Impact Factor

Publication Stats

727 Citations
470.43 Total Impact Points

Institutions

  • 2001–2014
    • Sapienza University of Rome
      • • Department of Internal and Specialized Medicine
      • • Department of Psychology
      Roma, Latium, Italy
  • 2013
    • Klinikum St. Elisabeth Straubing GmbH
      Straubing, Bavaria, Germany
    • Universität Regensburg
      • Department of Urology
      Regensburg, 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
  • 2011–2013
    • Stab. Ospedaliero P. Pio Da Pietrelcina
      Campi Salentina, Apulia, Italy
  • 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