Angelo Totaro

Catholic University of the Sacred Heart | UNICATT · School of Urology

A steep Trendelenburg (ST) position combined with pneumoperitoneum may cause alterations in cerebral blood flow with the possible occurrence of postoperative cognitive disorders. No studies have yet investigated if these alterations may be associated with the occurrence of postoperative cognitive disorders. The aim of the study was to evaluate the...

Background: The goal of precision medicine in prostate cancer (PCa) is to individualize the treatment according to the patient's germline mutation status. PCa has a very high rate of genetic predisposition compared with other cancers in men, with an estimated rate of cancers ascribable to hereditary factors of 5-15%. Methods: A systematic search...

Partial nephrectomy (PN) is the gold standard treatment for localized renal masses. Robot-assisted PN (RAPN) has overcome laparoscopy’s technical limitations, greatly expanding the indications of minimally invasive PN, which is dominated by renal artery clamping in almost all published series. We compared off-clamp RAPN (OFFC-RAPN) with the open ap...

Background: Recently, it was reported that the Bladder EpiCheck test is likely to represent a valid tool in the diagnostic process of patients who have suspected bladder carcinoma, with some controversial management decisions because of the technical limitations of cytology. Methods: Two hundred ninety patients with a diagnosis of nonmuscle-inva...

Aim: The aim of this study is to assess whether there are some correlations between radiomics and baseline clinical-biological data of prostate cancer (PC) patients using Fluorine-18 Fluoroethylcholine (18F-FECh) PET/CT. Methods: Digital rectal examination results (DRE), Prostate-Specific Antigen (PSA) serum levels, and bioptical-Gleason Score (...

Background: To date, robotic surgery in urology is well established all over the world. The newest platform on the market is the HUGO™ RAS system, developed by Medtronic. In this paper we provide a brief description of the system and describe our system set-up and surgical approach with this new platform in our initial experience of robotic radica...

Catheter-related bladder discomfort (CRBD), affecting surgical patients requiring large catheters, is often intolerable. In this prospective controlled study, we compared the efficacy of three analgesic approaches in the management of CRBD. Here, 33 patients undergoing robot-assisted laparoscopic prostatectomy (RALP) were allocated to the following...

Robot-assisted radical prostatectomy (RARP) is the most adopted treatment for localized prostate cancer. The aim of this study was to explore the learning curves (LC) for overall and site-specific positive surgical margins (PSM) occurrence after RARP of multiple surgeons within a step-structured mentor-initiated training program. The study included...

Purposes Little research exists on potential learning curve for male sling procedures. We aimed to perform a learning curve analysis of a single surgeon’s experience of sling placement evaluating multiple outcomes and using the cumulative sum failure methodology. Methods The study included 65 consecutive patients that underwent implantation of a f...

Purpose Our aim was to explore the relation between FA and ADC, number and length of the periprostatic neurovascular fibers (PNF) by means of 1.5 T Diffusion Tensor Imaging (DTI) imaging through a multivariate linear regression analysis model. Methods For this retrospective study, 56 patients (mean age 63.5 years), who underwent 1.5-T prostate MRI...

Introduction Ureteropelvic junction obstruction is a pathology typically diagnosed in childhood. Nevertheless, some clinically silent cases may be unnoticed until adulthood. Case description We report the case of a 53-year-old female with hydronephrosis due to ureteropelvic junction stenosis diagnosed in the adulthood, who subsequently developed o...

Prostate cancer is the second most commonly diagnosed cancer in man. Since the first MRI was performed, enormous progress has been made in diagnosis, treatment, and follow up of PCa, mainly due to multiparametric prostatic MRI (mpMRI). Although mpMRI has become the best imaging tool for identifying PCa, some limitations still exist. Prostate imagin...

PurposeThe knowledge of periprostatic nerve fiber (pNF) is still incomplete by means of conventional MRI. The purpose of our study was to demonstrate if DTI imaging is able to depict anatomical features of pNF.Methods For this retrospective study, fifty-six patients (mean age 63.5 years), who underwent 1.5-T prostate MRI, including 32 directions DT...

Zinner syndrome (ZS) is a rare congenital malformation due to abnormal development of the urogenital tract. It is caused by a growth failure of the distal part of the Müllerian duct in early embryogenesis. It is characterised by the triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. Ov...

Background Atypical small acinar proliferation (ASAP) occurs in approximately 5% of prostate biopsies. Approximately 30%–40% of these patients may develop prostate cancer (PCa) within a 5-year period, often not clinically significant. Current guidelines recommend a repeat biopsy within 3–6 months after the initial diagnosis, but it seem not to be t...

Biopsy proven Gleason score is essential to decide treatment modalities for prostate cancer, either surgical (radical prostatectomy) or non-surgical (active surveillance, watchful waiting, radiation therapy and hormone therapy). Several studies indicated that biopsy proven Gleason score may underestimate Gleason score at radical prostatectomy, henc...

Introduction: To compare the efficacy of artificial urinary sphincter (AUS) versus retrourethral transobturator sling (RTS) in men with moderate postprostatectomy urinary incontinence (PPI) using the propensity score-matching (PSM) to enhance the validity of the comparison (Canadian Task Force classification II-2). Patients and methods: Consecut...

Background and Aims Nephrolithiasis is a medical condition characterized by high prevalence among the general population both in Europe and in the U.S. and it is responsible for high costs reaching up to $10 billion per year. It is associated with specific comorbidities such as obesity, arterial hypertension, diabetes mellitus, metabolic syndrome a...

We report an unusual case of a 53-year-old male patient, previously undergone an extra-anatomic right-to-left iliofemoral bypass graft, who has developed gross hematuria after 4 months. The cystoscopic examination revealed a wall injury due to the presence of the graft crossing the bladder. Iatrogenic bladder injuries during vascular surgery are ex...

Objective: To evaluate prospectively midterm outcomes of a new titanium-coated fixed polypropylene sling for male stress urinary incontinence. Materials and methods: From 01/2013 to 06/2016, 44 consecutive patients with incontinence caused by radical prostatectomy (39) or TURP (5) underwent transobturator two-arm titanium-coated sling (TiLOOP Ma...

Aims: The injection of botulinum neurotoxin A (BTA) into the prostate represents a minimally invasive treatment in patients with lower urinary tract symptoms (LUTS) associated to benign prostatic hyperplasia (BPH). We evaluated the effectiveness of BTA in treating patients with BPH unresponsive to combined medical therapy (CMT), using urodynamic i...

Background: Prostate cancer (PCa) is the most commonly diagnosed malignancy in men and the second leading cause of cancer death in developed countries. Despite the primary treatments, 20-30% of patients experience a recurrence. The main objective of this study was to evaluate the clinical efficacy of salvage HIFU after radical prostatectomy in ter...

Prostate cancer is the most common urologic neoplasm and the second leading cause of cancer-related death among men in many developed countries. Given the highly heterogeneous behaviour of the disease, there is a great need for prognostic factors, in order to stratify the clinical risk and give the best treatment options to the patient. Clinical fa...

Scopo Riportare i risultati a medio termine su efficacia e sicurezza di una nuova sling per l'incontinenza da sforzo post-chirurgica maschile. Materiali e metodi: Studio prospettico monocentrico. Dal 11/2012 al 12/2014, 25 pazienti affetti da incontinenza urinaria da sforzo dopo prostatectomia radicale (21) o dopo TURP (4) sono stati sottoposti a...

To determine efficacy and safety of OnabotulinumtoxinA (BoNT-A) injection therapy in medically refractory patients with lower urinary tract symptoms (LUTS) due to primary bladder-neck dysfunction (PBND). Thirty-five consecutive ambulatory males diagnosed with PBND and refractory to medical therapy, with IPSS > 15, Qmax < 15 ml/sec, and total prosta...

<_14_ARTICLE_ABSTRACT>Brachytherapy (BT), using either a low-dose-rate (LDR) or mostly high-dose-rate (HDR) technique, is the device able to deliver the highest dose-rate in the most conformal way. It is used as monotherapy or in combination with external beam radiotherapy (EBRT). LDR-BT is mostly used as monotherapy; HDR-BT is combined with EBRT +...

Abstract High-intensity focused ultrasound (HIFU) is a minimally invasive therapy applied for prostate cancer that capitalizes on the coagulation necrosis that occurs at temperatures greater than 60°C. Owing to a lack of long-term follow-up data the procedure is still considered experimental treatment. As primary therapy, HIFU is indicated in patie...

Objectives: Non-muscle-invasive bladder cancer is characterized by a high recurrence rate after primary transurethral resection. In case of bacillus Calmette-Guérin-refractory neoplasms, cystectomy is the gold standard. In this study the effects of thermochemotherapy with mitomycin C were evaluated in high-risk bladder cancer nonresponders to prev...

Background: Chronic inflammation may play a role in prostate carcinogenesis. Molecular alterations of the Suppressor of Cytokine Signaling (SOCS)-3 can contribute to explain the pleiotropic role of interleukin (IL)-6 in this type of cancer. Recently, the methylation of SOCS3 gene has been demonstrated to cause the non-expression of the protein, be...

Background: To analyze data from the cultural examinations of different biological fluids, obtained from urologic patients from January 2007 to April 2010, in order to describe the incidence of infections in our setting. Methods: In the period of reference a urine culture was carried out for every patient admitted, in case of suspected urinary t...

Dynamic contrast enhanced magnetic resonance improves prostate cancer detection. The aims of this paper are to verify whether wash-in-rate parameter (speed of contrast uptake in dynamic contrast enhanced magnetic resonance) can help to differentiate prostate cancer from non-neoplastic T2-weighted hypointense lesions within prostate gland and to ass...

Study Type – Therapy (prospective cohort) Level of Evidence 3a What's known on the subject? and What does the study add? Several short-term studies have shown that intraprostatic injection of botulinum toxin (BTX) improves lower urinary tract symptoms and flow parameters in patients with BPH, but information on patient-reported outcomes is lacking....

Prostate specific antigen (PSA) is still the best available tumour marker in prostate cancer (PCa), but presents some limits. Therefore, there is a need for novel markers in the detection and management of PCa. The 80-kDa soluble form of E-cadherin (sE-cad) and the cytokine IL-6 are being discussed as supplemental serum markers for PCa. In this stu...

To investigate the differential impact of lower urinary tract symptoms (LUTS) on female sexual function (FSF). In a cross-sectional study in Agostino Gemelli Hospital, Rome, Italy, 188 sexually active patients with LUTS, as assessed by self-reported questionnaires, underwent comprehensive urologic and urodynamic examination between January 2008 and...

The aim of the present paper was to review findings from the most relevant studies and to evaluate the value of current chemotherapy and surgery in advanced unresectable and metastatic bladder cancer. Studies were identified by searching the MEDLINE® and PubMed® databases up to 2011 using both medical subject heading (Mesh) and a free text strategy...

Study Type - Therapy (RCT) Level of Evidence 1b What's known on the subject? and What does the study add? Peri-operative pelvic floor muscle training reduces urinary incontinence for men undergoing radical prostatectomy (RP). A preoperative biofeedback session, combined with postoperative pelvic floor muscle training, and assisted sessions on a mon...

Despite recent improvements in detection and treatment, prostate cancer continues to be the most common malignancy and the second leading cause of cancer-related mortality. Thus, although survival rate continues to improve, prostate cancer remains a compelling medical health problem. The major goal of prostate cancer imaging in the next decade will...

Overactive bladder syndrome (OAB) is a highly prevalent condition associated with a significant impairment of patients' Quality of Life (QoL) because of its adverse effects on social, sexual, interpersonal, and professional functions. Cost-of-illness analyses showed the huge economic burden related to OAB for patients, public healthcare systems, an...

Urinary lithiasis is one of the most common benign urological diseases. There is growing evidence that a delicate equilibrium regulated by the function of proteins, soluble peptides, membrane proteins and intracellular mechanisms actually exists. We have studied the urinary protein composition of patients affected by calcium oxalate nephrolithiasis...

e15132 Background: Chronic inflammation and the subsequent tissutal alterations may play a key role in prostate carcinogenesis. Molecular alterations of the suppressor of cytokine signaling (SOCS)3, can contribute to explain the pleiotropic role of interleukin (IL)-6 in this type of cancer. In a recent study, we demonstrated that methylation of SOC...

The aim of this article is to describe the circumcision procedure during history, its therapeutic and preventive goals, with focus on bioethical, economic and law issues. The origins of this practice are lost in antiquity. It was performed since 3000 BC by the Egyptians for hygienic and religious reasons. Moreover, male circumcision is a religious...

Prostate cancer (PCa) remains a major health concern for the male population. Detection and primary diagnosis of PCa are based on digital rectal examination, serum prostate-specific antigen levels, and transrectal ultrasound (TRUS)-guided random biopsy. Moreover, the gold standard for detecting PCa, systematic biopsy, lacks sensitivity as well as g...

C l i n i c a U r o l o g i c a , D i p a r t i m e n t o d i S c i e n z e c h i r u r g i c h e , P o l i c l i n i c o A g o s t i n o G e m e l l i , U n i v e r s i t à C a t t o l i c a d e l S a c r o C u o r e , R o m a -I t a l i a C l i n i c a U r o l o g i c a , D i p a r t i m e n t o d i S c i e n z e c h i r u r g i c h e , P o l i c...

The current techniques used as the gold standard of care for the diagnosis and surveillance of urological malignancies such as cystoscopy, urine cytology and prostate-specific antigen (PSA) present many limitations such as invasiveness, insufficient accuracy and unsatisfactory cost-effectiveness. This is the reason for the explosion of interest in...

Renal cell carcinoma (RCC) is the 13th most common cancer worldwide and accounts for 4% of all adult malignancies. Herein the state of the art and recent advances in cross-sectional radiological imaging applied to RCC are reviewed, including ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography. Literatu...

Advances in imaging have an increasingly significant role in the diagnosis, staging and restaging of patients with bladder cancer. This paper reviews the current use of imaging in bladder neoplasms, comparing the different radiologic investigations, and discusses the potential applications of novel imaging techniques in the management of patients w...

The role of statistics in medical research starts at the planning stage of a clinical trial or laboratory experiment to establish the design and size of an experiment that will ensure a good prospect of detecting effects of clinical or scientific interest. Statistics is again used during data analysis (sample data) to make inferences valid in a wid...

Objective: The aim of the present paper is to review findings from the most relevant studies and evaluate the potential of new drugs in treatment of metastatic urothelial cancer. Methods: Studies were identified by searching MEDLINE and Pubmed databases up to 2009 using both medical subject heading (Mesh) and a free text strategy with the name o...