Andreas Skolarikos

General Hospital of Komotini "Sismanoglio", Komotina, East Macedonia and Thrace, Greece

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Publications (157)502.21 Total impact


  • No preview · Article · Jan 2016

  • No preview · Article · Dec 2015 · European Urology Supplements
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    ABSTRACT: Objective: To report our experience with concomitant hernia repair during robot-assisted radical prostatectomy (RARP) with a non-prosthetic and tissue-based technique. Methods: We conducted a retrospective review on 1005 consecutive patients who underwent RARP between the years 2005-2015. 29 patients, who underwent 37 concurrent direct inguinal hernia repairs, were identified (group 1) and compared to a match control group of 29 patients who underwent RARP without hernia repair (group 2). Cases were matched 1:1 for age, body mass index and pathologic stage. The reinforcement of the floor was achieved with a modified posterior wall darn repair. The repair consisted of suturing the lateral edge of the rectus abdominis muscle sheath to the ileo-pectineal ligament (Cooper's ligament) with continuous prolene loose suture. This technique provided a tissue based repair and the final reinforcement of the floor was expected to ensue via the secondary fibrotic tissue development and maturing between the sutures. Results: From a total of 1005 patients who underwent RARP, 29 (2.8%) were pre-operatively identified with a primary direct inguinal hernia and underwent concomitant inguinal herniorrhaphy. The operative time was 147 mins for group 1 vs 143 mins for group 2 (p=0.8). Estimated blood loss was 175 ml for the group with the hernia repair vs 200ml for the group without repair (p=0.3). There were no Clavien-Dindo grade 1 complications observed in either of the groups. Mean follow-up period was 32.1 months for group 1 vs. 33.3 for group 2 (p=0.8). Importantly no hernia recurrences were observed. Conclusions Inguinal hernias represent an important surgical issue and may be repaired concurrently during radical prostatectomy in order to minimize the risks of post-operative complications. The concomitant repair of inguinal hernias during robotic radical prostatectomy utilizing a non-prosthetic is a safe and feasible alternative for primary direct hernia repair during prostatectomy.
    No preview · Article · Oct 2015 · Journal of endourology / Endourological Society
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    ABSTRACT: Objectives: Irreversible electroporation (IRE) is an ablative therapy with a low side-effect profile in prostate cancer. The objective was: 1) To compare the volumetric IRE ablation zone on grey-scale transrectal ultrasound (TRUS), contrast-enhanced ultrasound (CEUS) and multiparametric MRI (mpMRI) with histopathology findings; 2) To determine a reliable imaging modality to visualize the IRE ablation effects accurately. Methods: A prospective phase I-II study was performed in 16 patients scheduled for radical prostatectomy (RP). IRE of the prostate was performed 4 weeks before RP. Prior to, and 4 weeks after the IRE treatment, imaging was performed by TRUS, CEUS, and mpMRI. 3D-analysis of the ablation volumes on imaging and on H&E-stained whole-mount sections was performed. The volumes were compared and the correlation was calculated. Results: Evaluation of the imaging demonstrated that with T2-weighted MRI, dynamic contrast enhanced (DCE) MRI, and CEUS, effects of IRE are visible. T2MRI and CEUS closely match the volumes on histopathology (Pearson correlation r = 0.88 resp. 0.80). However, IRE is not visible with TRUS. Conclusions: mpMRI and CEUS are appropriate for assessing IRE effects and are the most feasible imaging modalities to visualize IRE ablation zone. The imaging is concordant with results of histopathological examination. Key points: • mpMRI and contrast-enhanced ultrasound are appropriate imaging modalities for assessing IRE effects • mpMRI and CEUS are the most feasible imaging modalities to visualize IRE ablation zone • The imaging is concordant with results of histopathological examination after IRE • Grey-scale US is insufficient for assessing IRE ablations.
    Full-text · Article · Oct 2015 · European Radiology
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    ABSTRACT: Context: Management of urinary stones is a major issue for most urologists. Treatment modalities are minimally invasive and include extracorporeal shockwave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PNL). Technological advances and changing treatment patterns have had an impact on current treatment recommendations, which have clearly shifted towards endourologic procedures. These guidelines describe recent recommendations on treatment indications and the choice of modality for ureteral and renal calculi. Objective: To evaluate the optimal measures for treatment of urinary stone disease. Evidence acquisition: Several databases were searched to identify studies on interventional treatment of urolithiasis, with special attention to the level of evidence. Evidence synthesis: Treatment decisions are made individually according to stone size, location, and (if known) composition, as well as patient preference and local expertise. Treatment recommendations have shifted to endourologic procedures such as URS and PNL, and SWL has lost its place as the first-line modality for many indications despite its proven efficacy. Open and laparoscopic techniques are restricted to limited indications. Best clinical practice standards have been established for all treatments, making all options minimally invasive with low complication rates. Conclusion: Active treatment of urolithiasis is currently a minimally invasive intervention, with preference for endourologic techniques. Patient summary: For active removal of stones from the kidney or ureter, technological advances have made it possible to use less invasive surgical techniques. These interventions are safe and are generally associated with shorter recovery times and less discomfort for the patient.
    No preview · Article · Sep 2015 · European Urology
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    ABSTRACT: The Authors report a complete study concerning complications, the imaging and functional results, the clinical outcome and the quality of life in patients treated with VIP 95 patients with localized bladder TCC (T2N0M0) were evaluated. Follow up points were 1st, 3rd, 6th, 12th, 18th, 24th and 36th month with clinical and ultrasound evaluation. At 6th, 12th and 36th month CT pyelography and urodynamic evaluation were performed and we used a questionnaire for subjective bladder function and the EORTC QLQ C-30 questionnaire to evaluate quality of Perioperative complications were ileus (2 patients; 2.1%) (Clavien Grade IIIb), one postoperative death (1.0%) (Clavien Grade 10 and a resuscitated cardiac arrest (1.0%) (Clavien Grade IVa). Postoperative complications were incisional hernias (n=4 patients; 4.21%) (Clavien Grade I) and hydronephrosis in five patients (5.26%) due to ureteric/neobladder stricture (Clavien Grade IIIb). Urine retention due to neobladder neck stenosis was observed in one patient (1.0%) (Clavien Grade IIIb) and an ileo-neobladder fistula in one (1.0%) patient (Clavien Grade IIIb). During follow up there were two cancer related deaths (2.1%). According to urodynamic evaluations neobladder capacity increased, end-filling pressure and Qmax decreased while residual urine and the number of intrinsic contractions remained stable. Continence rates and quality of life were high and stable during follow up. VIP technique for bladder substitution is a relatively easy technique with low rate of complications, good functional results which respect the patient's quality of life.
    Full-text · Article · Sep 2015
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    ABSTRACT: Abstract In the current meta-analysis we analyzed the data of randomized studies on MET implemented following SWL for renal and ureteral stones. Pooled results demonstrated the efficacy of α-blockers, nifedipine, Rowatinex and Uriston in increasing stone clearance. In addition the time to stone elimination, the intensity of pain, the formation of steinstrasse and the need for auxillary procedures were reduced mainly with α-blockers. Expulsion rate was not correlated with the type of α-blocker, the stone diameter and the stone location. Although more studies are needed, our results show that MET for residual fragments after SWL should be implemented in clinical practice.
    No preview · Article · Sep 2015 · Urology
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    ABSTRACT: The aim of the current study was to evaluate the use of fresh-frozen concurrently with embalmed cadavers as initial training models for flexible ureteroscopy (fURS) in a group of urologists who were inexperienced in retrograde intrarenal surgery (RIRS). Twelve urologists involved in a cadaveric fURS training course were enrolled into this prospective study. All the participants were inexperienced in fURS. Theoretical lectures and step-by-step tips and tricks video presentations on fURS were used to incorporate the technical background of the procedure to the hands-on-training course and to standardize the operating steps of the procedure. An 8-item survey was administered to the participants upon initiation and at the end of the course. Pre- and post-training scores were similar for each question. All the participants successfully completed the hands-on-training tasks. Mean pre-training duration [3.56 ± 2.0 min (range 1.21-7.46)] was significantly higher than mean post-training duration [1.76 ± 1.54 min (range 1.00-6.34)] (p = 0.008). At the end of the day, the trainers checked the integrity of the collecting system both by endoscopy and by fluoroscopy and could not detect any injury of the upper ureteral wall or pelvicalyceal structures. The functionality of the scopes was also checked, and no scope injury (including a reduction in the deflection capacity) was noted. The fURS simulation training model using soft human cadavers has the unique advantage of perfectly mimicking the living human tissues. This similarity makes this model one of the best if not the perfect simulator for an effective endourologic training.
    No preview · Article · Aug 2015 · World Journal of Urology
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    ABSTRACT: Low-dose computed tomography (CT) has become the first choice for detection of ureteral calculi. Conservative observational management of renal stones is possible, although the availability of minimally invasive treatment often leads to active treatment. Acute renal colic due to ureteral stone obstruction is an emergency that requires immediate pain management. Medical expulsive therapy (MET) for ureteral stones can support spontaneous passage in the absence of complicating factors. These guidelines summarise current recommendations for imaging, pain management, conservative treatment, and MET for renal and ureteral stones. Oral chemolysis is an option for uric acid stones.
    No preview · Article · Aug 2015 · European Urology
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    ABSTRACT: Purpose Irreversible electroporation (IRE) is a novel minimally invasive therapy for prostate cancer using short electric pulses to ablate prostate tissue. The purpose of this study is to determine the IRE effects in prostate tissue and correlate electrode configuration with the histology of radical prostatectomy (RP) specimens. We hypothesize that the area within the electrode configuration is completely ablated and that the area within the electrode configuration is predictive for the ablated area after treatment. Methods A prospective phase I/II study was conducted in 16 consecutive patients with histopathologically confirmed prostate cancer scheduled for RP. Focal or extended IRE treatment of the prostate was performed 4 weeks prior to RP. The locations of the electrodes were used to calculate the planned ablation zone. Following RP, the specimens were processed into whole-mount sections, histopathology (PA) was assessed and ablation zones were delineated. The area of the tissue alteration was determined by measuring the surface. The planned and the histological ablation zones were compared, analysed per individual patient and per protocol (focal vs. extended). Results All cells within the electrode configuration were completely ablated and consisted only of necrotic and fibrotic tissue without leaving any viable cells. The histological ablation zone was always larger than the electrodes configuration (2.9 times larger for the 3 electrodes configuration and 2.5 times larger for the ≥4 electrode configuration). These ablation effects extended beyond the prostatic capsule in the neurovascular bundle in 13 out of 15 cases. Conclusions IRE in prostate cancer results in completely ablated, sharply demarcated lesions with a histological ablation zone beyond the electrode configuration. No skip lesions were observed within the electrode configuration. Clinical trials ClinicalTrials.gov Identifier: NCT01790451 https:// clinicaltrials. gov/ ct2/ show/ NCT01790451
    Full-text · Article · Aug 2015 · World Journal of Urology
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    ABSTRACT: To compare B-TURP vs. M-TURP safety/secondary outcomes including efficacy in patients with large PV or severe LUTS. From July 2006 to June 2009, TURP candidates were recruited in four centers, randomized 1:1 into M-TURP/B-TURP arm and followed-up to 36 months. Post hoc data analysis from patients with large PV or severe LUTS is presented. Patients with large PV or severe LUTS were defined as those with trans-rectal ultrasound-based PV >80ml or IPSS >19. Safety was estimated using sodium/hemoglobin changes immediately post-surgery; complications during early postoperative period (up to 6 weeks), short-term (up to 12 months) and midterm (up to 36 months) follow-up. Secondary outcomes included among others efficacy quantified by changes in maximum urine flow rate, post-void residual urine volume and IPSS compared with baseline. 279 patients were randomized. Post hoc analysis of data from patients with large PV or severe LUTS was based on A) 62/279 (22.3%) (M-TURP, n=32; B-TURP, n=30) or B) 126/279 (45.2%) participants (M-TURP, n=57; B-TURP, n=69). Mean (SD) PV was 108.0 (25.9) ml (M-TURP) and 108.9 (23.4) ml (B-TURP) (p=0.756). Mean (SD) IPSS was 25.0 (4.2) (M-TURP) and 25.3 (3.7) (B-TURP) (p=0.402). Neither safety nor any secondary outcome differed significantly between arms throughout follow-up. The only exception was sodium drop (analysis A); significantly greater after M-TURP (-4.2 vs. -0.7 mmol/L; p=0.023) not translating into significant difference in TUR-syndrome rates (M-TURP: 1/32 vs. 0/30; p=1.000). B-TURP and M-TURP show similar safety/efficacy in these patients' subpopulations. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Aug 2015 · The Journal of urology
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    ABSTRACT: INTRODUCTION & OBJECTIVES: The aim of the current meta-analysis was to analyze the data of randomized and quasi- randomized studies on α-blockers implemented following ESWL for renal and ureteral stones. MATERIAL & METHODS: We first conducted a search of CENTRAL, WEB OF SCIENCE, PUBMED and SCOPUS using selected search terms. Subgroup analyses were a priori planned to be performed depending on the: type of α-blocker (i.e alfuzosin, terazosin, doxazosin, Urapidil), size and location of stones. All results were combined for meta-analysis with the Review Manager. RESULTS: 21 studies were analyzed including 1877 patients. Only 5 trials were placebo-controlled; the others compared α-blocker with a control group in which analgesics, NSAIDs or antispasmodics were allowed. Mean stone size ranged from 7.5 mm to 16.2 mm. Stones were located in the kidney/upper ureter, middle ureter and lower ureter in 1051, 6, 574 patients, respectively. Treatment duration ranged from 4.14 days to 12 weeks, or until stone passage if before than 12 weeks. Follow-up varied from 15 to 90 days. Mean time to passage ranged from 4.14 to 30.7 days. There was a benefit of a higher stone-free rate for those patients who have taken α-blockers at 2 weeks (OR=2.77, p<0.001), 1 month(OR=1.97, p<0.001), 2 months (OR=1.77, p<0.005) and 3 months (OR=1.71, p<0.0005) of follow-up. Τhe group receiving α-blockers had significantly decreased time to stone expulsion (WMD: -2.60 days, p<0.0001) in comparison to the control group. Furthermore, compared to patients who received placebo, the patients who received α-blockers experienced pain less frequently (OR=0.21, p<0.001) with less intensity (STD=-0.57, p=0.03). Steinstrasse formation was significantly less frequent in the α-blocker group at 2 weeks (OR=0.20, p=0.02) and 3 months (OR=0.45, p=0.008). Νo significant difference was detected regarding the stone-free rate between the various types of α-blockers at 2 weeks (p=0.51), 1 month (p=0.57) and 3 months after lithotripsy (p=0.54). In addition, no significant difference in the stone clearance rate at 2 weeks (p=0.81), 1 month (p=0.07) and 2 months (p=0.44) was detected between the different stone sizes (≤10 mm vs. > 10 mm). Similarly the stone-free rate was not altered by stone location at 2 weeks (p=0.81) and 1 month (p=0.50) after SWL. Overall, α-blockers were well tolerated in most patients and with just a few adverse effects. CONCLUSIONS: Evidence suggests that MET using α-blockers can be suggested as an adjuvant treatment after SWL owing to theirs expulsive efficacy, pain reduction, and safety profile. However, due to clinical heterogeneity among the included studies, conclusions drawn from our pooled results should be interpreted cautiously
    No preview · Article · Apr 2015 · European Urology Supplements

  • No preview · Article · Apr 2015 · European Urology Supplements
  • A. Dellis · A. Skolarikos · F. Keeley · A. Panagopoulos · A. Papatsoris

    No preview · Article · Apr 2015 · European Urology Supplements
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    ABSTRACT: To determine the efficacy and safety of flexible ureterorenoscopy (fURS) for the treatment of single intrarenal calculi and further stratify the efficacy by stone burden. CROES collected prospective data on consecutive patients with urinary stones treated with URS at 114 centers worldwide for 1 year. Only patients who underwent fURS for a solitary renal stone where included in the present study. Pre- and intraoperative characteristics, and post- operative outcomes were evaluated. The relationships between stone size and stone-free rate (SFR), operative time, complications, hospital stay, and need for retreatment were explored. and limitations: A total of 1210 patients with solitary kidney stones <10mm (52.2%), 10-20mm (43.2%) and >20mm (4.6%) were treated with fURS. There was a negative correlation between SFR and stone size when adjusted for BMI. Operating time showed a positive correlation with stone size when adjusted for BMI. Single session SFR was 90% for stones <10mm and 80% for stones <15 mm. Patients with stones >20mm achieved a 30% SFR, more often needed retreatment and were more often readmitted. There were no differences in overall complication rates for different stone sizes. However, patients with a stone >20mm had a higher probability of developing fever after fURS as compared to patients with smaller stones. Our data indicate that fURS for a single intrarenal stone is a safe procedure. Best results after single session fURS were obtained for stones <15mm. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Feb 2015 · The Journal of Urology
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    ABSTRACT: The aim of the present review was to compare state‐of‐the‐art care and future perspectives for the detection and treatment of non‐muscle‐invasive transitional cell carcinoma (TCC) of the bladder. We provide a summary of the third expert meeting on ‘Optimising the management of non‐muscle‐invasive bladder cancer, organized by the European Association of Urology Section for Uro‐Technology (ESUT) in collaboration with the Section for Uro‐Oncology (ESOU), including a systematic literature review. The article includes a detailed discussion on the current and future perspectives for TCC, including photodynamic diagnosis, optical coherence tomography, narrow band imaging, the Storz Professional Image Enhancement system, magnification and high definition techniques. We also provide a detailed discussion of future surgical treatment options, including en bloc resection and tumour enucleation. Intensive research has been conducted to improve tumour detection and there are promising future perspectives, that require proven clinical efficacy. En bloc resection of bladder tumours may be advantageous, but is currently considered to be experimental.
    No preview · Article · Feb 2015 · BJU International
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    Preview · Article · Jan 2015
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    ABSTRACT: An optimum metabolic evaluation strategy for urinary stone patients has not been clearly defined. To evaluate the optimum strategy for metabolic stone evaluation and management to prevent recurrent urinary stones. Several databases were searched to identify studies on the metabolic evaluation and prevention of stone recurrence in urolithiasis patients. Special interest was given to the level of evidence in the existing literature. Reliable stone analysis and basic metabolic evaluation are highly recommended in all patients after stone passage (grade A). Every patient should be assigned to a low- or high-risk group for stone formation. It is highly recommended that low-risk stone formers follow general fluid and nutritional intake guidelines, as well as lifestyle-related preventative measures to reduce stone recurrences (grade A). High-risk stone formers should undergo specific metabolic evaluation with 24-h urine collection (grade A). More specifically, there is strong evidence to recommend pharmacological treatment of calcium oxalate stones in patients with specific abnormalities in urine composition (grades A and B). Treatment of calcium phosphate stones using thiazides is only highly recommended when hypercalciuria is present (grade A). In the presence of renal tubular acidosis (RTA), potassium citrate and/or thiazide are highly recommended based on the relative urinary risk factor (grade A or B). Recommendations for therapeutic measures for the remaining stone types are based on low evidence (grade C or B following panel consensus). Diagnostic and therapeutic algorithms are presented for all stone types based on the best level of existing evidence. Metabolic stone evaluation is highly recommended to prevent stone recurrences. In this report, we looked at how patients with urolithiasis should be evaluated and treated in order to prevent new stone formation. Stone type determination and specific blood and urine analysis are needed to guide patient treatment. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
    No preview · Article · Nov 2014 · European Urology
  • Andreas Skolarikos · Andreas Dellis · Thomas Knoll
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    ABSTRACT: The simultaneous surgical management of ureteropelvic junction obstruction (UPJO) with concomitant renal stones has evolved the last 20 years; hence, the ideal minimally invasive technique is still controversial. Laparoscopic and robot-assisted laparoscopic operations allow precise surgical maneuvers and were thought to simplify the reconstruction steps of the procedure, especially in the treatment of complex cases with large stones. The aim of this study was to summarize the available perioperative and functional outcomes of minimally invasive available techniques. A non-systematic review of the literature was performed using a free-text protocol in the MEDLINE database. The terms used were "ureteropelvic junction obstruction," "renal calculi" and "renal stones." Furthermore, other significant relevant studies cited in the reference lists of the selected papers were also evaluated in the structure of this review. Currently, available evidence suggests that both laparoscopic and robotic-assisted techniques offer excellent surgical solutions in the field of UPJO reconstruction and renal stones removal. In the hands of experienced surgeons, laparoscopic and robotic pyeloplasty with concomitant stone removal is a safe procedure with high stone-free rates and UPJ patency. Minimally invasive pyeloplasty should constitute the first choice of treatment for concomitant renal stones and ureteropelvic junction obstruction.
    No preview · Article · Nov 2014 · Urolithiasis

  • No preview · Article · Nov 2014 · European Urology Supplements

Publication Stats

2k Citations
502.21 Total Impact Points

Institutions

  • 1999-2015
    • General Hospital of Komotini "Sismanoglio"
      Komotina, East Macedonia and Thrace, Greece
  • 2007-2014
    • Harokopion University of Athens
      Athínai, Attica, Greece
  • 2013
    • University of Groningen
      Groningen, Groningen, Netherlands
  • 2009
    • Thriasio General Hospital of Elefsina
      Lepsina, Attica, Greece
  • 2008
    • Laiko Hospital
      • Department of Radiology
      Athínai, Attica, Greece
  • 2003
    • The Newcastle upon Tyne Hospitals NHS Foundation Trust
      Newcastle-on-Tyne, England, United Kingdom