Seven patients with Peyronie's disease were treated by surgical exposure of the fibrous plaque an... more Seven patients with Peyronie's disease were treated by surgical exposure of the fibrous plaque and dermo-jet injection of steroids into the plaque under direct vision. Relief of pain was obtained in 2 of 3 patients and curvature was only moderately improved in 2 of 7 patients. One of 4 patients who were unable to perform coitus because of the curvature noted improvement after the injections. The low rate of response in this small series of patients would suggest that there is no additional benefit in the use of the dermo-jet over percutaneous injection of the plaques. The latter procedure can be performed more easily on a repeated basis over a longer period. Two patients whose plaques were excised and replaced by a dermal inlay raft have' lnfclaoocl res onse to treatment an it woul a ear t uif1liistechnique is use ul for the patient who has failed to respond to conservative measures an who is~~.fgni1icantlY-disabled by the disease. ••
Therapeutic strategies for prostate cancer (PCa) have been evolving dramatically worldwide. The c... more Therapeutic strategies for prostate cancer (PCa) have been evolving dramatically worldwide. The current article reports on the evolution of surgical management strategies for PCa in Italy. The data from two independent Italian multicenter projects, the MIRROR-SIU/LUNA (started in 2007, holding data of 890 patients) and the Pros-IT-CNR project (started in 2014, with data of 692 patients), were compared. Differences in patients’ characteristics were evaluated. Multivariable logistic regression models were used to identify characteristics associated with robot-assisted (RA) procedure, nerve sparing (NS) approach, and lymph node dissection (LND). The two cohorts did not differ in terms of age and prostate-specific antigen (PSA) levels at biopsy. Patients enrolled in the Pros-IT-CNR project more frequently were submitted to RA (58.8% vs 27.6%, p < 0.001) and NS prostatectomy (58.4% vs. 52.9%, p = 0.04), but received LND less frequently (47.7% vs. 76.7%, p < 0.001), as compared to the MIRROR-SIU/LUNA patients. At multivariate logistic models, Lower Gleason Scores (GS) and PSA levels were significantly associated with RA prostatectomy in both cohorts. As for the MIRROR-SIU/LUNA data, clinical T-stage was a predictor for NS (OR = 0.07 for T3, T4) and LND (OR = 2.41 for T2) procedures. As for Pros-IT CNR data, GS ≥ (4 + 3) and positive cancer cores ≥ 50% were decisive factors both for NS (OR 0.29 and 0.30) and LND (OR 7.53 and 2.31) strategies. PCa management has changed over the last decade in Italian centers: RA and NS procedures without LND have become the methods of choice to treat newly medium–high risk diagnosed PCa.
The public reporting burden for this collection of information is estinated to average 1 hour per... more The public reporting burden for this collection of information is estinated to average 1 hour per response, including the tine for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comrents regarding this burden estinate or any other aspect of tis collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
Prostate cancer is one of the most common male cancers in industrialized countries and it occurs ... more Prostate cancer is one of the most common male cancers in industrialized countries and it occurs mainly in men older than 50 years. In light of a rapidly ageing population it seems certain tha increasingly many septuagenarians with significant life-expectancy will present with prostate cancer to urologist. However currently there is a lack of consensus on prostate cancer and its treatment in the cohort of men ≥ 70 years of age. Although elderly men are often recommended a watchfull waiting option based on lower life expentancy and potentially slow disease progression, recent evidences indicate suggest a potential benefit of radical prostatectomy in selected older patients. The aim of this review is to illustrate the evidences demonstrating the efficacy and safety and of radical prostatectomy in patients over 70. Also, are presented the results of a small Italian study on patients aged ≥ 70 years with clinically localized prostate cancer undergoing radical prostatectomy. The results ...
The aim of the study was to demonstrate the expression of Toll-like receptor (TLR)-8 and to confi... more The aim of the study was to demonstrate the expression of Toll-like receptor (TLR)-8 and to confirm the expression of TLR-7 on bladder transitional cell carcinomas (TCCs) analyzing the changes in expression between low-grade (LG) and high-grade (HG) and between non-muscle invasive (NMIBC) and muscle-invasive (MIBC) bladder cancers. In our study, 25 patients who underwent transurethral resection (TURB) for bladder TCC have been selected. Thirteen of those had an LG form,while the other cases were classified as HG; the lesions were NMIBC in 18 patients and MIBC in the others seven. The analysis of TLRs expression has been performed by immuno histochemistry. TRL-8 expression seems to be higher in MIBC (85%) than in NMIBC (78%), but it is associated with a reduced percentage of immuno reactive cells and with a lower intensity. The expression had a large nuclear localization in NMIBC (80%), althoughit was mainly cytoplasmic in MIBC (72%). TLR-7 was expressed in all NMIBC samples (where t...
A case of gross haematuria due to an ureteric-iliac artery fistula We report a case of a 75-year-... more A case of gross haematuria due to an ureteric-iliac artery fistula We report a case of a 75-year-old man presented with gross haematuria and left hydronephrosis due to an ureteric iliac- artery fistula . Medical history included a previous positioning of aorto-bisiliac graft and an iliac artery stent placed to exclude an hypogastric aneurysm. A retrograde pyelography revealed a compression of the middle ureter and an extravasation of contrast at that level, for this reason a double J stent was inserted. Contrast-enhanced computed tomography showed the presence of a fistula between the left ureter and the internal iliac. The patient underwent endovascular treatment using a stent-graft with the subsequent patient's recovery. Ureteric iliac-artery fistula is a rare condition and it generally manifests with life threatening gross bleeding. We suggest a multidisciplinary clinical approach in order to achieve the best results for the patient and to avoid severe complications. Endovasc...
A 23-year-old man immigrated from Sri Lanka came to our observation for an acute painful volume i... more A 23-year-old man immigrated from Sri Lanka came to our observation for an acute painful volume increase of the right scrotum without fever. Clinical examination suggested a diagnosis of testis torsion. An exploratory surgical procedure was performed. An inflammatory spermatic cord and epididymis with a purple nodule of the middle portion were found. The nodule was excised and sent to pathologist that diagnosed a filarial infection. The patient was successfully treated with diethylcarbamazine.
Archivio italiano di urologia, andrologia : organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia, 2001
We report our experience in the management of priapism. In a 2-year period we observed 7 patients... more We report our experience in the management of priapism. In a 2-year period we observed 7 patients of whom 4 presented with low flow and 3 with high flow priapism. In 2 of the patients with ischemic priapism, simple blood aspiration from the corpora allowed for a quick detumescence, while in the other 2 cases a derivative intervention (1 spongio cavernous and 1 glans cavernous) had to be performed. In all the 3 patients with high flow priapism we performed a superselective arteriography that obtained the visualisation of the arteriovenous fistula. These patients restarted their sexual activity after about three months. At six months a patient with low flow priapism restored sexual activity due to sildenafil 50 mg. The importance of distinguishing low and high flow priapism was confirmed.
Introduction: The aim of our study is to verify the effects of doxazosin on sexual function in pa... more Introduction: The aim of our study is to verify the effects of doxazosin on sexual function in patients with benign prostatic hyperplasia (BPH). Materials and Methods: We enrolled 102 patients with BPH, selected by nine Italian Urology Departments. Patients were evaluated with the International Prostatic Symptom Score (I-PSS) and divided into two groups: those with intact sexual activity and those with erectile dysfunction. According to the International Index of Erectile Function (IIEF), the second cohort was divided into three subgroups on the basis of the degree of erectile dysfunction degree (severe, moderate or mild). All patients underwent 3 months of therapy with doxazosin. The effects of doxazosin on sexual activity and on voiding symptoms were monitored at 1, 2 and 3 months with IIEF and I-PSS scales. Results: Eightysix of the 102 initial patients (84%) were monitored until follow-up was completed. The follow-up at 1 month showed a significant decrease in the I-PSS (p ! 0.0001) from 20.2 B 2.01 (base visit) to 13.1 B 2.21. The mean IIEF was 19.24 B 6.59 at baseline and 1 month later the score reached 21.44 B 5.40, thus showing a statistically significant increase (p = 0.0177). This is more evident in the group presenting with severe to moderate erectile dysfunction. I-PSS and IIEF do not significantly change at the 2-and 3-month follow-ups. Conclusions: The use of doxazosin improved sexual function in patients with BPH.
Seven N-nitroso compounds (NOC), known to induce kidney tumors in rats, were assayed for DNA-dama... more Seven N-nitroso compounds (NOC), known to induce kidney tumors in rats, were assayed for DNA-damaging activity in primary cultures of human and rat kidney cells. DNA fragmentation was measured by the alkaline elution technique. Positive responses were obtained in cells of both species with N-nitrosodimethylamine (32 mM), N-nitrosodiethylamine (32 mM), N-nitrosodi-n-propylamine (10 mM), N-ethyl-N-hydroxyethylnitrosamine (18 mM), and streptozotocin (1 mM). N-nitrosodiethanolamine and N-nitrosomorpholine were inactive at the highest concentration tested (32 mM). The responses of human kidney cells were qualitatively similar to those of rat kidney cells, but statistically significant differences between the two species in the DNA-damaging potencies were observed with N-ethyl-N-hydroxyethylnitrosamine and streptozotocin, both more genotoxic in rat cells. Taken as a whole, the results suggest on the one hand that the five active NOC might be carcinogenic for the kidney in humans, and on the other hand that the rat kidney cell/DNA damage assay is a valid model for predicting the genotoxic potential of NOC in human kidney cells.
Introduction Cancer of the prostate (PCa) is now recognized as one of the most important medical ... more Introduction Cancer of the prostate (PCa) is now recognized as one of the most important medical problems facing the male population. In Europe, PCa is the most common solid neoplasm, with an incidence rate of 214 cases per 1000 men, outnumbering lung and colorectal cancer (1). According to the EAU guidelines, the main diagnostic tools to obtain evidence of PCa include DRE, serum concentration of PSA and transrectal ultrasonography (TRUS). But, does TRUS affect the diagnostic process? Material and Methods Between March 2007 and March 2011 we performed 441 prostate biopsies to compare the results with clinical, laboratory and ultrasonographic features of every patient. We investigated sensitivity, specificity, accuracy, positive and negative predictive value and likelihood ratio about every diagnostic tool (PSA, DRE and TRUS). Results The transrectal ultrasonographyhas a low diagnostic accuracy for prostate cancer because it shows: low sensitivity and specificity (higher incidence of...
Postoperative femoral neuropathy is not a well-recognized complication in urology. We report 2 ca... more Postoperative femoral neuropathy is not a well-recognized complication in urology. We report 2 cases of femoral nerve palsy due to compression ascribed to the use of the self-retaining retractor. In the first case, the left femoral nerve was injured, and in the second case nerve injury was bilateral and synchronous. The clinical symptoms were a weakness of the quadriceps muscle and sensory anesthesia of the surrounding skin.
Left radical nephrectomy is the second most common cause of incidental splenectomy during transab... more Left radical nephrectomy is the second most common cause of incidental splenectomy during transabdominal oncological surgery in the upper left quadrant of the abdomen. The potential sequelae of splenic ablation are often underestimated and generally no systematic planned efforts have been undertaken to avoid a splenic injury. We evaluated the incidence of iatrogenic splenectomy in 333 cases of left radical nephrectomy for renal cancer performed at our institute between 1970 and 1999. Two slightly different surgical techniques were adopted and after 1995 particular attention was paid to the possible causes of intraoperative splenic injury and how to avoid it. In the first group of patients (1970-1994) an anterolateral xipho-umbilical-subcostal approach was used, and in the second group (1995-1999) a cruciate &quot;Mercedes-like&quot; incision was always adopted. The incidence of iatrogenic splenectomy in the first group of patients was 13.2%, and only 2.6% in the second group. The mortality rate in the first group of patients was 6%; no mortality has been recorded in the second group. Postoperative infections averaged 12.1% in the first group and 11.6% in the second, without any difference between the two groups. However, if we consider the incidence of postoperative infections in splenectomy cases, the incidence reaches 24.2% in the first group versus no cases in the second. Incidental splenectomy is a potentially severe complication of transabdominal left radical nephrectomy and is often considered a price that has to be paid, particularly in cases of large tumoral masses. A more detailed knowledge of splenic anatomy, a critical consideration of the intraoperative factors that may lead to splenectomy, and the adoption of a surgical tactic borrowed from the techniques of liver transplant significantly lower the incidence of iatrogenic splenectomy.
Seven patients with Peyronie's disease were treated by surgical exposure of the fibrous plaque an... more Seven patients with Peyronie's disease were treated by surgical exposure of the fibrous plaque and dermo-jet injection of steroids into the plaque under direct vision. Relief of pain was obtained in 2 of 3 patients and curvature was only moderately improved in 2 of 7 patients. One of 4 patients who were unable to perform coitus because of the curvature noted improvement after the injections. The low rate of response in this small series of patients would suggest that there is no additional benefit in the use of the dermo-jet over percutaneous injection of the plaques. The latter procedure can be performed more easily on a repeated basis over a longer period. Two patients whose plaques were excised and replaced by a dermal inlay raft have' lnfclaoocl res onse to treatment an it woul a ear t uif1liistechnique is use ul for the patient who has failed to respond to conservative measures an who is~~.fgni1icantlY-disabled by the disease. ••
Therapeutic strategies for prostate cancer (PCa) have been evolving dramatically worldwide. The c... more Therapeutic strategies for prostate cancer (PCa) have been evolving dramatically worldwide. The current article reports on the evolution of surgical management strategies for PCa in Italy. The data from two independent Italian multicenter projects, the MIRROR-SIU/LUNA (started in 2007, holding data of 890 patients) and the Pros-IT-CNR project (started in 2014, with data of 692 patients), were compared. Differences in patients’ characteristics were evaluated. Multivariable logistic regression models were used to identify characteristics associated with robot-assisted (RA) procedure, nerve sparing (NS) approach, and lymph node dissection (LND). The two cohorts did not differ in terms of age and prostate-specific antigen (PSA) levels at biopsy. Patients enrolled in the Pros-IT-CNR project more frequently were submitted to RA (58.8% vs 27.6%, p < 0.001) and NS prostatectomy (58.4% vs. 52.9%, p = 0.04), but received LND less frequently (47.7% vs. 76.7%, p < 0.001), as compared to the MIRROR-SIU/LUNA patients. At multivariate logistic models, Lower Gleason Scores (GS) and PSA levels were significantly associated with RA prostatectomy in both cohorts. As for the MIRROR-SIU/LUNA data, clinical T-stage was a predictor for NS (OR = 0.07 for T3, T4) and LND (OR = 2.41 for T2) procedures. As for Pros-IT CNR data, GS ≥ (4 + 3) and positive cancer cores ≥ 50% were decisive factors both for NS (OR 0.29 and 0.30) and LND (OR 7.53 and 2.31) strategies. PCa management has changed over the last decade in Italian centers: RA and NS procedures without LND have become the methods of choice to treat newly medium–high risk diagnosed PCa.
The public reporting burden for this collection of information is estinated to average 1 hour per... more The public reporting burden for this collection of information is estinated to average 1 hour per response, including the tine for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comrents regarding this burden estinate or any other aspect of tis collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
Prostate cancer is one of the most common male cancers in industrialized countries and it occurs ... more Prostate cancer is one of the most common male cancers in industrialized countries and it occurs mainly in men older than 50 years. In light of a rapidly ageing population it seems certain tha increasingly many septuagenarians with significant life-expectancy will present with prostate cancer to urologist. However currently there is a lack of consensus on prostate cancer and its treatment in the cohort of men ≥ 70 years of age. Although elderly men are often recommended a watchfull waiting option based on lower life expentancy and potentially slow disease progression, recent evidences indicate suggest a potential benefit of radical prostatectomy in selected older patients. The aim of this review is to illustrate the evidences demonstrating the efficacy and safety and of radical prostatectomy in patients over 70. Also, are presented the results of a small Italian study on patients aged ≥ 70 years with clinically localized prostate cancer undergoing radical prostatectomy. The results ...
The aim of the study was to demonstrate the expression of Toll-like receptor (TLR)-8 and to confi... more The aim of the study was to demonstrate the expression of Toll-like receptor (TLR)-8 and to confirm the expression of TLR-7 on bladder transitional cell carcinomas (TCCs) analyzing the changes in expression between low-grade (LG) and high-grade (HG) and between non-muscle invasive (NMIBC) and muscle-invasive (MIBC) bladder cancers. In our study, 25 patients who underwent transurethral resection (TURB) for bladder TCC have been selected. Thirteen of those had an LG form,while the other cases were classified as HG; the lesions were NMIBC in 18 patients and MIBC in the others seven. The analysis of TLRs expression has been performed by immuno histochemistry. TRL-8 expression seems to be higher in MIBC (85%) than in NMIBC (78%), but it is associated with a reduced percentage of immuno reactive cells and with a lower intensity. The expression had a large nuclear localization in NMIBC (80%), althoughit was mainly cytoplasmic in MIBC (72%). TLR-7 was expressed in all NMIBC samples (where t...
A case of gross haematuria due to an ureteric-iliac artery fistula We report a case of a 75-year-... more A case of gross haematuria due to an ureteric-iliac artery fistula We report a case of a 75-year-old man presented with gross haematuria and left hydronephrosis due to an ureteric iliac- artery fistula . Medical history included a previous positioning of aorto-bisiliac graft and an iliac artery stent placed to exclude an hypogastric aneurysm. A retrograde pyelography revealed a compression of the middle ureter and an extravasation of contrast at that level, for this reason a double J stent was inserted. Contrast-enhanced computed tomography showed the presence of a fistula between the left ureter and the internal iliac. The patient underwent endovascular treatment using a stent-graft with the subsequent patient's recovery. Ureteric iliac-artery fistula is a rare condition and it generally manifests with life threatening gross bleeding. We suggest a multidisciplinary clinical approach in order to achieve the best results for the patient and to avoid severe complications. Endovasc...
A 23-year-old man immigrated from Sri Lanka came to our observation for an acute painful volume i... more A 23-year-old man immigrated from Sri Lanka came to our observation for an acute painful volume increase of the right scrotum without fever. Clinical examination suggested a diagnosis of testis torsion. An exploratory surgical procedure was performed. An inflammatory spermatic cord and epididymis with a purple nodule of the middle portion were found. The nodule was excised and sent to pathologist that diagnosed a filarial infection. The patient was successfully treated with diethylcarbamazine.
Archivio italiano di urologia, andrologia : organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia, 2001
We report our experience in the management of priapism. In a 2-year period we observed 7 patients... more We report our experience in the management of priapism. In a 2-year period we observed 7 patients of whom 4 presented with low flow and 3 with high flow priapism. In 2 of the patients with ischemic priapism, simple blood aspiration from the corpora allowed for a quick detumescence, while in the other 2 cases a derivative intervention (1 spongio cavernous and 1 glans cavernous) had to be performed. In all the 3 patients with high flow priapism we performed a superselective arteriography that obtained the visualisation of the arteriovenous fistula. These patients restarted their sexual activity after about three months. At six months a patient with low flow priapism restored sexual activity due to sildenafil 50 mg. The importance of distinguishing low and high flow priapism was confirmed.
Introduction: The aim of our study is to verify the effects of doxazosin on sexual function in pa... more Introduction: The aim of our study is to verify the effects of doxazosin on sexual function in patients with benign prostatic hyperplasia (BPH). Materials and Methods: We enrolled 102 patients with BPH, selected by nine Italian Urology Departments. Patients were evaluated with the International Prostatic Symptom Score (I-PSS) and divided into two groups: those with intact sexual activity and those with erectile dysfunction. According to the International Index of Erectile Function (IIEF), the second cohort was divided into three subgroups on the basis of the degree of erectile dysfunction degree (severe, moderate or mild). All patients underwent 3 months of therapy with doxazosin. The effects of doxazosin on sexual activity and on voiding symptoms were monitored at 1, 2 and 3 months with IIEF and I-PSS scales. Results: Eightysix of the 102 initial patients (84%) were monitored until follow-up was completed. The follow-up at 1 month showed a significant decrease in the I-PSS (p ! 0.0001) from 20.2 B 2.01 (base visit) to 13.1 B 2.21. The mean IIEF was 19.24 B 6.59 at baseline and 1 month later the score reached 21.44 B 5.40, thus showing a statistically significant increase (p = 0.0177). This is more evident in the group presenting with severe to moderate erectile dysfunction. I-PSS and IIEF do not significantly change at the 2-and 3-month follow-ups. Conclusions: The use of doxazosin improved sexual function in patients with BPH.
Seven N-nitroso compounds (NOC), known to induce kidney tumors in rats, were assayed for DNA-dama... more Seven N-nitroso compounds (NOC), known to induce kidney tumors in rats, were assayed for DNA-damaging activity in primary cultures of human and rat kidney cells. DNA fragmentation was measured by the alkaline elution technique. Positive responses were obtained in cells of both species with N-nitrosodimethylamine (32 mM), N-nitrosodiethylamine (32 mM), N-nitrosodi-n-propylamine (10 mM), N-ethyl-N-hydroxyethylnitrosamine (18 mM), and streptozotocin (1 mM). N-nitrosodiethanolamine and N-nitrosomorpholine were inactive at the highest concentration tested (32 mM). The responses of human kidney cells were qualitatively similar to those of rat kidney cells, but statistically significant differences between the two species in the DNA-damaging potencies were observed with N-ethyl-N-hydroxyethylnitrosamine and streptozotocin, both more genotoxic in rat cells. Taken as a whole, the results suggest on the one hand that the five active NOC might be carcinogenic for the kidney in humans, and on the other hand that the rat kidney cell/DNA damage assay is a valid model for predicting the genotoxic potential of NOC in human kidney cells.
Introduction Cancer of the prostate (PCa) is now recognized as one of the most important medical ... more Introduction Cancer of the prostate (PCa) is now recognized as one of the most important medical problems facing the male population. In Europe, PCa is the most common solid neoplasm, with an incidence rate of 214 cases per 1000 men, outnumbering lung and colorectal cancer (1). According to the EAU guidelines, the main diagnostic tools to obtain evidence of PCa include DRE, serum concentration of PSA and transrectal ultrasonography (TRUS). But, does TRUS affect the diagnostic process? Material and Methods Between March 2007 and March 2011 we performed 441 prostate biopsies to compare the results with clinical, laboratory and ultrasonographic features of every patient. We investigated sensitivity, specificity, accuracy, positive and negative predictive value and likelihood ratio about every diagnostic tool (PSA, DRE and TRUS). Results The transrectal ultrasonographyhas a low diagnostic accuracy for prostate cancer because it shows: low sensitivity and specificity (higher incidence of...
Postoperative femoral neuropathy is not a well-recognized complication in urology. We report 2 ca... more Postoperative femoral neuropathy is not a well-recognized complication in urology. We report 2 cases of femoral nerve palsy due to compression ascribed to the use of the self-retaining retractor. In the first case, the left femoral nerve was injured, and in the second case nerve injury was bilateral and synchronous. The clinical symptoms were a weakness of the quadriceps muscle and sensory anesthesia of the surrounding skin.
Left radical nephrectomy is the second most common cause of incidental splenectomy during transab... more Left radical nephrectomy is the second most common cause of incidental splenectomy during transabdominal oncological surgery in the upper left quadrant of the abdomen. The potential sequelae of splenic ablation are often underestimated and generally no systematic planned efforts have been undertaken to avoid a splenic injury. We evaluated the incidence of iatrogenic splenectomy in 333 cases of left radical nephrectomy for renal cancer performed at our institute between 1970 and 1999. Two slightly different surgical techniques were adopted and after 1995 particular attention was paid to the possible causes of intraoperative splenic injury and how to avoid it. In the first group of patients (1970-1994) an anterolateral xipho-umbilical-subcostal approach was used, and in the second group (1995-1999) a cruciate &quot;Mercedes-like&quot; incision was always adopted. The incidence of iatrogenic splenectomy in the first group of patients was 13.2%, and only 2.6% in the second group. The mortality rate in the first group of patients was 6%; no mortality has been recorded in the second group. Postoperative infections averaged 12.1% in the first group and 11.6% in the second, without any difference between the two groups. However, if we consider the incidence of postoperative infections in splenectomy cases, the incidence reaches 24.2% in the first group versus no cases in the second. Incidental splenectomy is a potentially severe complication of transabdominal left radical nephrectomy and is often considered a price that has to be paid, particularly in cases of large tumoral masses. A more detailed knowledge of splenic anatomy, a critical consideration of the intraoperative factors that may lead to splenectomy, and the adoption of a surgical tactic borrowed from the techniques of liver transplant significantly lower the incidence of iatrogenic splenectomy.
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