Introduction: Evidence that smoking cessation at first diagnosis of nonmuscle-invasive bladder cancer (NMIBC) reduces the risk of recurrence is lacking. The aim of our prospective study was to analyze the association between patients' changes in smoking habits after diagnosis and recurrencefree survival (RFS). Patients: After transurethral resection of primary NMIBC, patients were classified as "ex-smokers," i.e., those definitively stopping, and as "active smokers," i.e., those continuing or restarting to smoke. Smoking status was reassessed every 3 months during the first year and every 6 months thereafter. Data on patients' demographics, smoking status, tumor characteristics, treatments, and follow-up were collected. Statistical analysis was performed adopting SPSS 15.0.1 and R3.4.2 software. Results: Out of 194 patients, 67 (34.5%) quit smoking after the diagnosis, while 127 (65.5%) did not. The clinical and pathological characteristics were homogeneously distributed. At a median follow-up of 38 months, 106 patients (54.6%) recurred, 33 (49.2%) ex-and 73 (60.3%) active smokers with a 3-year RFS of 42.3 and 50.7%, respectively (p = 0.55). No statistically significant association between recurrence, pathological features of the primary tumor, and patient smoking habits after diagnosis was detected. Results were not statistically influenced by the intensity (cigarette/day) and duration (years) of smoking. In multivariate analysis, cigarette smoking cessation at diagnosis did not significantly reduce tumor recurrence. Conclusion: In our prospective study, more than half of our patients recurred at 3 years. In multivariate analysis, smoking cessation did not significantly reduce tumor recurrence. However, the 8.4% reduction in favor of the ex-smokers suggests the need of larger studies with longer follow-ups. Surprisingly, only 35% of smokers definitively quit after diagnosis. The urologists should play a more active role to persuade the patients to stop smoking at first cancer diagnosis.
INTRODUCTION AND OBJECTIVES: Elderly patients are a vulnerable population at increased risk for treatment-related toxicity. Almost 25% of the urological population is older than 75 years. Methods to reduce the morbidity from surgery are eagerly awaited. ASA classification is a system for assessing the fitness of patients before surgery worldwide adopted. A frailty index predicting adverse outcomes in urologic oncological major surgeries was validated by Lascano (1) and simplified by Chappidi (2) for radical cystectomy. The aim of our prospective study was to compare the modified frailty index (mFI) and the ASA score in consecutive patients undergoing urological procedures for oncological and non-oncological diseases.METHODS: Consecutive patients undergoing urological procedures were prospectively entered. The surgical intervention were classified as follows: 1. Major open/laparoscopic; 2. Lower urinary tract endoscopy; 3. Upper urinary tract procedures; 4 Minor surgery. For all patients age, ASA score, BMI, serum albumin, smoking history and routine hematological exams were preoperatively recorded. mFI was calculated. Operative time, hospital length of stay and post-operative complications according to Clavien-Dindo classification were recorded.RESULTS: 247 consecutive patients, 203 men and 44 women underwent urological surgery. Age was over 75 years in 53 (21%) patients. Patients' characteristics are given in table 1. While 239 (97%) were assigned in ASA 2 and 3 categories, they resulted more widely distributed among the 5 MFI levels.Particularly of the 165 patients classified as ASA 3-4, 37 (22.4%) only were allocated in 3-5 mFI index and on the contrary of the 82 patients in ASA 1-2 classes, 79 (96.3%) were allocated in 0-2 mFI categories.At univariate analysis both ASA and mFI were not associated with any complications (p[0.76 and p[0.67), serious complications (p[0.06 and p[0.49), and late complications rates (p[0.46 and p[0.28). mFI was associated with age (p<0.05) only, while ASA index only with age (p<0.05), readmission rate (p[0.03) and length of hospital stay (p[0.004).CONCLUSIONS: A correspondence between ASA and mFI emerges only for low risk classes, since 22% only of the patients classified as ASA 3-4 resulted allocated in the corresponding high risk classes of mFI. In Both mFI and ASA were not associated with complication incidence when oncological and non oncological urologic surgery is considered.
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) receptor, angiotensin-converting enzyme 2 (ACE2), has been identified in the human testis, but the risk of transmission of SARS-CoV-2 through sexual intercourse still needs to be defined. The goal of our study was to determine if SARS-CoV-2 is detectable in the semen of patients suffering or recovering from coronavirus disease-19 (COVID-19), still testing positive at nasopharyngeal swabs but showing mild or no symptoms at the time of sampling. Detection of SARS-CoV-2 RNA in semen was performed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) and nested PCR targeting open reading frame (ORF) 1ab. Medical history of the enrolled patients was taken, including COVID-19-correlated symptoms, both at the time of diagnosis and at the time of interview. Results of real-time RT-PCR and nested PCR in semen showed no evidence of SARS-CoV-2 RNA in the 36 patients suffering or recovering from COVID-19 but still positive in a nasopharyngeal swab, from over 116 patients enrolled in the study. SARS-CoV-2 detection and persistence in semen would have an impact on both clinical practice and public health strategies, but our results would suggest that SARS-CoV-2 is not present in the semen of men recovering from COVID-19.
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