Roberto Miano

Mental Health Center of Denver, Denver, Colorado, United States

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Publications (83)240.81 Total impact

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    ABSTRACT: Focal therapy is a relatively new and extremely attractive option of treatment for prostate cancer. It has been described as the "middle approach" between active surveillance and radical treatment, aiming to destroy the tumor itself or the region containing the tumor in order to preserve surrounding non-cancerous tissue. The goal is to maintain disease control at acceptable levels, while preserving erectile, urinary, and rectal function. While a lot of technologies have been described for delivering targeted therapy to the prostate, such as cryoablation, high intensity focused ultrasound, photodynamic therapy, irreversible electroporation and laser, the key point is the patient selection. Recent advances in mpMRI and the introduction of new biopsy techniques that use MR images as a guidance, have significantly improved localization of the tumor lesions and the detection rate, evolving prostate biopsy toward targeted rather than systematic biopsies. The future challenge to clinicians is to precisely risk-stratify patients to differentiate between those who would profit from focal treatment and who would not. Forthcoming research efforts should pursue to identify molecular, genetic, and imaging characteristics that distinguish aggressive prostate tumors from indolent lesions.
    Minerva urologica e nefrologica = The Italian journal of urology and nephrology 05/2015; · 0.70 Impact Factor
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  • European Urology Supplements 04/2015; 14(2):e680. DOI:10.1016/S1569-9056(15)60673-X · 3.37 Impact Factor
  • 30th Annual Congress of European Urology; 03/2015
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    ABSTRACT: Metabolism processes reflect the health state of human body. On this basis it is possible to look at the human body as a biosystem transfer function having as inputs the sources originated from environmental and as outputs the metabolic fluids of the body. The chemical composition of these fluids depends on the specific interactions inside the body. A particular pathological state could modify the chemical fingerprint of some sources like skin emissions, breath, urine. In this work the authors have analysed the fingerprint of patients affected by prostate cancer of urine headspace by means of a gas sensors array. This work follows a pilot study performed on behalf of authors in which a characterization of these patterns has been preliminarily investigated.
    Procedia Engineering 12/2014; 87:320-323. DOI:10.1016/j.proeng.2014.11.672
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    ABSTRACT: Aim of this study was to make a comparison between penile cuff test (PCT) and standard pressure-flow study (PFS) in the preoperative evaluation of patients candidates for trans-urethral resection of prostate (TURP) for benign prostatic obstruction (BPO). We enrolled male patients with lower urinary tract symptoms candidates for TURP. Each of them underwent a PCT and a subsequent PFS. A statistical analysis was performed: sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), likelihood ratio and ratio of corrected classified were calculated. Fisher exact test was used to evaluate relationships between PCT and maximal urine flow (Qmax): a p-value < 0.05 was considered statistically significant. We enrolled 48 consecutive patients. Overall, at PCT 31 patients were diagnosed as obstructed and 17 patients as unobstructed. At the subsequent PFS, 21 out of 31 patients diagnosed as obstructed at PCT were confirmed to be obstructed; one was diagnosed as unobstructed; the remaining 9 patients appeared as equivocal. Concerning the 17 patients unobstructed at PCT, all of them were confirmed not to be obstructed at PFS, with 10 equivocal and 7 unobstructed. The rate of correctly classified patients at PCT was 79% (95%-CI 65%-90%). About detecting obstructed patients, PCT showed a SE of 100% and a SP of 63%. The PPV was 68%, while the NPV was 100%. PCT can be an efficient tool in evaluating patients candidates for TURP. In particular, it showed good reliability in ruling out BPO because of its high NPV, with a high rate of correctly classified patients overall. Further studies on a huger number of patients are needed, including post-operative follow-up as well.
    BMC Urology 12/2014; 14(1):103. DOI:10.1186/1471-2490-14-103 · 1.94 Impact Factor
  • ICS, Rio De Janeiro; 10/2014
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    ABSTRACT: Laparoscopic radical nephrectomy (LRN) is the actual gold-standard for the treatment of clinically localized renal cell carcinoma (RCC) (cT1-2 with no indications for nephron-sparing surgery). Limited evidence is currently available on the role of robotics in the field of radical nephrectomy. The aim of the current study was to provide a systematic review of the current evidence on the role of robotic radical nephrectomy (RRN) and to analyze the comparative studies between RRN and open nephrectomy (ON)/LRN.
    BMC Urology 09/2014; 14(1):75. DOI:10.1186/1471-2490-14-75 · 1.94 Impact Factor
  • Societè Internationale d'Urologie, Glosgow; 09/2014
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    ABSTRACT: Laparoscopic nephrectomy (LN) in end-stage autosomic-dominant polycystic kidney disease (ADPKD) requires a large abdominal incision for the specimen extraction. The objective of this study was to describe our technique of LN for end-stage ADPKD followed by morcellation (LNM) of the specimen and extraction through a minimal abdominal incision. The medical records of 19 consecutive patients who underwent pretransplant LNM between 2008 and 2011 by a single experienced laparoscopic surgeon were analyzed. Morcellation was performed with the Gynecare Morcellex (TM) Tissue morcellator, Ethicon. All cases but one were completed laparoscopically. Mean specimen weight was 1,026.8 g. Mean duration of the procedure, estimated blood loss, and hospital stay were 131.3 min, 52.1 ml, and 7.9 days, respectively. Specimens were extracted through a 12-mm trocar in 10/18 patients and through a 3-cm incision in 9/18 cases. Postoperatively, three complications were observed (Clavien grades II, I, and II). The only case of incisional hernia was observed in the converted procedure. Major limitation of the study is its retrospective design. In our preliminary series and in the hands of a very experienced laparoscopist, LNM for ADPKD appears as a modern, mini-invasive, and safe technique. Specimen's extraction through a small abdominal incision reduces postoperative pain and incisional hernias and guarantees the final cosmetic result of laparoscopy. The reduced overall morbidity could reduce the period between nephrectomy and transplantation.
    Surgical Endoscopy 08/2014; 29(1). DOI:10.1007/s00464-014-3663-y · 3.31 Impact Factor
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    ABSTRACT: BackgroundBacillus Calmette-Guérin (BCG) is considered the most effective treatment to reduce recurrence and progression of non-muscle invasive bladder cancer (NMIBC) but can induce local side effects leading to treatment discontinuation or interruption. Aim of this exploratory study is to investigate if the sequential administration of Hyaluronic acid (HA) may reduce local side effects of BCG.Methods30 consecutive subjects undergoing BCG intravesical administration for high risk NMIBC were randomized to receive BCG only (Group A) or BCG and HA (Group B). A 1 to 10 Visual Analog Scale (VAS) for bladder pain, International Prostate Symptom Score (IPSS) and number of micturitions per day were evaluated in the two groups before and after six weekly BCG instillations. Patients were also evaluated at 3 and 6 months by means of cystostopy and urine cytology.ResultsOne out of 30 (3,3%) patients in group A dropped out from the protocol, for local side effects. Mean VAS for pain was significantly lower in group B after BCG treatment (4.2 vs. 5.8, p = 0.04). Post vs. pre treatment differences in VAS for pain, IPSS and number of daily micturitions were all significantly lower in group B. Three patients in group A and 4 in group B presented with recurrent pathology at 6 month follow up.ConclusionsThese preliminary data suggest a possible role of HA in reducing BCG local side effects and could be used to design larger randomized controlled trials, assessing safety and efficacy of sequential BCG and HA administration.Trial registrationNCT02207608 (ClinicalTrials.gov) 01/08/2014Policlinico Tor Vergata Ethics Committee, resolution n 69–2011.
    BMC Urology 08/2014; 14(1):64. DOI:10.1186/1471-2490-14-64 · 1.94 Impact Factor
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    ABSTRACT: The prestigious Jackson Hole Seminars (JHS) successfully gathered several world leaders in academic urology and urologists in private practice for a unique scientific experience in Wyoming, USA. Unfortunately, this year Dr. Ralph Hopkins' seat was empty but his spirit continue to be the driving force for the meeting's excellence and friendship. The JHS has pioneered the concept of a Critique Panel comprised of previous speakers that would discuss in depth the presentations of the faculty chosen by the scientific board of the JHS. The 2014 JHS featured Dr. Fernando J. Kim, the President of JHS, Dr. Robert Flanigan, the Program Chair, and the Critique Panel that included: Drs. Peter Albertsen, Arthur Burnett, Michael Coburn, Ann Gormley, and Marshal Stoller. The invited speakers were: Drs. Leonard Gomella (1st prize), Olivier Traxer (2nd prize), Jennifer Anger, Anthony Bella, Jim Hu, and Allen Morey. Some of the in depth discussions and topics are highlighted.
    The Canadian Journal of Urology 04/2014; 21(2):7185-7. · 0.91 Impact Factor
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    ABSTRACT: Background:To evaluate the efficacy of prostate cancer (PCa) detection by the electronic nose (EN) on human urine samples.Methods:Urine samples were obtained from candidates of prostate biopsy (PB). Exclusion criteria were a history of urothelial carcinoma or other malignant disease, urine infection, fasting for <12 h before PB or ingestion of alcohol or foods that might alter the urine smell in the last 24 h. The initial part of the voided urine and the midstream were collected separately in two sterile containers. Both samples were analyzed by the EN immediately after the collection. All patients underwent a standard transperineal, transrectal-ultrasound-guided PB. The pathological results were compared with the outcomes of the EN. Sensitivity and specificity of EN were assessed.Results:Forty-one men were included in the study. Fourteen out of the 41 patients were positive for PCa. Midstream urine did not correlate significantly neither with a positive nor with a negative PB. Instead, significantly different results on the initial part of the urine stream between positive and negative PBs were obtained. The EN correctly recognized 10 out of the 14 cases (that is, sensitivity 71.4% (confidence interval (CI) 42-92%)) of PCa while four were false negatives. Moreover, the device recognized as negative 25 out of the 27 (that is, specificity 92.6% (CI 76-99%)) samples of negative PBs, with only two false positives.Conclusions:We believe this is the first demonstration of an olfactory imprinting of the initial part of the urine stream in patients with PCa that was revealed by an EN, with high specificity.Prostate Cancer and Prostatic Disease advance online publication, 1 April 2014; doi:10.1038/pcan.2014.11.
    Prostate cancer and prostatic diseases 04/2014; DOI:10.1038/pcan.2014.11 · 2.83 Impact Factor
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    ABSTRACT: Objectives: To evaluate the histopathology of small renal tumor biopsies following cryoablation. Methods: We retrospectively evaluated small renal tumor biopsy specimens after cryoablation treatment for renal cell carcinoma and determined the ability to differentiate tumor types, effect on nuclear grading, immunohistochemical staining, and if the number of freeze cycles affected interpretation. Results: Of the biopsy specimens, 66% were diagnostic of tumor and 34% showed normal renal parenchyma. Tumor subtype was determined in 91% of diagnostic cases. Nuclear grading was affected due to freeze effect, complicating the assessment of chromatin pattern and nucleolar details at low magnification. In particular, the distinction between Fuhrman nuclear grades I and II was compromised; these were designated as low nuclear grade. Immunohistochemical staining was retained similar to untreated tumors. Tumor subtyping was not affected after one or two freeze cycles. Conclusions: Biopsies performed immediately after cryoablation can be used to render an optimal histologic diagnosis.
    American Journal of Clinical Pathology 01/2014; 141(1):35-42. DOI:10.1309/AJCP6Y3FHDLMILKT · 3.01 Impact Factor
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    ABSTRACT: BACKGROUND Prostate cancer (PCa) is the most commonly diagnosed cancer in men in the Western Countries. When prostatectomy fails to eradicate the primary tumor, PCa is generally refractory to all therapeutic approaches. Valproic acid (VPA) is a promising anticancer agent recently assigned to the class of histone deacetylase (HDAC) inhibitors. However molecular mechanisms underlying VPA action in PCa cells are largely unknown and further experimental validation to prove its potential application in clinic practice is needed.RESULTSIn our study we show that VPA is a potent inducer of neuro-endocrine transdifferentiation (NET) in androgen receptor null PCa cells, both in vitro and in vivo. NET was an early event detectable through the expression of neuro-endocrine (NE) markers within 72 hr after VPA treatment and it was associated to a reduction in the overall cell proliferation. When we interrupted VPA treatment we observed the recovery in residual cells of the basal proliferation rate both in vitro and in a xenograft model. The NET process was related to Bcl-2 over-expression in non-NE PCa cells and to the activation of PPARγ in NE cells. The use of specific PPARγ antagonist was able to reduce significantly the expression of NE markers induced by VPA.CONCLUSIONS Our data indicate that the use of VPA as monotherapy in PCa has to be considered with extreme caution, since it may induce an unfavorable NET. In order to counteract the VPA-induced NET, the inhibition of PPARγ may represent a suitable adjuvant treatment strategy and awaits further experimental validation. Prostate 68: 588–598, 2008. © 2008 Wiley-Liss, Inc.
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    ABSTRACT: This study aimed to compare the pentafecta rates between laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RALP) and to identify prognostic factors predicting the pentafecta for each technique. This prospective comparative study enrolled 248 consecutive male patients 70 years of age or younger with clinically localized prostate cancer [PCa: age ≤70 years, prostate-specific antigen (PSA) ≤10 ng/ml, biopsy Gleason score ≤7] who were fully continent, potent, and candidates for bilateral nerve-sparing (BNS) LRP or RALP. The pentafecta rates between LRP and RALP were compared. A logistic regression model was created to evaluate independent factors for achieving pentafecta. In the final analysis, 91 LRP and 136 RALP patients were evaluated. The median follow-up period was 21 months for the 91 LRP patients and 18 months for the 136 RALP patients (p = 0.07). Of the 227 patients, 87 reached pentafecta [25 LRP patients (27.5 %) vs 62 RALP patients (45.6 %), p = 0.006]. Of the 140 patients who failed pentafecta, 90 (64.3 %) missed a single parameter, and the difference between the groups was significant (80 % LRP vs 53.3 % RALP, p = 0.007). Lower age, lower pathologic stage, and RALP are significantly associated with pentafecta as independent factors. For the pT3 disease, the two techniques did not differ significantly. Patients submitted to BNS RP have low possibilities of achieving pentafecta. Use of the robotic platform by a single surgeon significantly enhances the possibility of achieving pentafecta independently of age and pathologic stage. Potency was the most difficult outcome to reach after surgery, and it was the main factor leading to pentafecta failure. LRP and RALP provide equivalent pentafecta rates for the pT3 disease and similar "tetrafecta" outcomes when potency recovery is not included among the postoperative expectations of the patient.
    Surgical Endoscopy 06/2013; 27(11). DOI:10.1007/s00464-013-3046-9 · 3.31 Impact Factor
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    ABSTRACT: This review summarizes recent literature on advances regarding renal and ureteral calculi, with particular focus in areas of recent advances in the overall field of urolithiasis. Clinical management in everyday practice requires a complete understanding of the issues regarding metabolic evaluation and subgrouping of stone-forming patients, diagnostic procedures, effective treatment regime in acute stone colic, medical expulsive therapy, and active stone removal. In this review we focus on new perspectives in managing nephrolitihiasis and discuss recentadvances, including medical expulsive therapy, new technologies, and refinements of classical therapy such as shock wave lithotripsy, give a fundamental modification of nephrolithiasis management. Overall, this field appears to be the most promising, capable of new developments in ureterorenoscopy and percutaneous approaches. Further improvements are expected from robotic-assisted procedures, such as flexible robotics in ureterorenoscopy.
    BMC Urology 02/2013; 13(1):10. DOI:10.1186/1471-2490-13-10 · 1.94 Impact Factor

Publication Stats

897 Citations
240.81 Total Impact Points

Institutions

  • 2014
    • Mental Health Center of Denver
      Denver, Colorado, United States
  • 1996–2014
    • University of Rome Tor Vergata
      • • Dipartimento di Biopatologia e Diagnostica per Immagini
      • • Dipartimento di Medicina dei Sistemi
      Roma, Latium, Italy
  • 2007–2010
    • Sapienza University of Rome
      • Department of Internal and Specialized Medicine
      Roma, Latium, Italy
  • 2009
    • Sant'Andrea Medical Hospital
      Spezia, Liguria, Italy
  • 2001
    • Istituto Regina Elena - Istituti Fisioterapici Ospitalieri
      Roma, Latium, Italy