ABSTRACT – XXIII CONGRESSO NAZIONALE SOCIETÀ ITALIANA DI DIAGNOSTICA

measure of a system's exposure to threats.

RISK LEVEL (LR) score = vulnerability index X the impact index. The Team evaluates for the CRITICAL PDTA (STEMI, TRAUMA and STROKE) which failure modes are risky and which require or develop a BCP.

Results. An external body conducted an inspection visit last September, verifying the Company's ability to react and respond to emergency scenarios. They evaluated the compliance and adherence to the international standard's requirements. Our University Hospital of Marches has been working according to the BCP criteria since October 2022. It is the first company in the world to certify the PDTA processes for business continuity ISO 22301:2019. This certification project envisaged a planning process which lasted approximately 12 months. This process included the identification of suitable PDTAs for a BCP through an accurate BIA process (1 month), the creation of structural procedures (23 procedures in 3 months), the redefinition and updating of the PDTAs in the light of the business continuity plan (3 months), the preparation of exercises aimed at guaranteeing and satisfying operational continuity and assistance objectives (3 months) and finally the awareness and training of our stakeholders regarding its correct application (2 months). Exercises and testing have been instrumental in ensuring that the strategies, policies, plans and procedures are adequate to meet business continuity objectives (3).

Conclusion. Every single disruption in a Healthcare Company will produce direct economic damages closely linked to its structure and resources, but also indirect ones, i.e. more closely linked to patients who do not use the healthcare services provided by the structure itself. Using ISO 22301 and a structured corporate BCP program through an accurate BIA process will undoubtedly promote economic savings to healthcare facilities by promoting operational continuity for critical assets for the provision of their services, including goods and services stock-up.

References.

1. Capparelli J, Chionna G, Riglietti G. What makes for effective business continuity implementation? J Bus Contin Emer Plan. 2022; 15(4):302-311.

2. Zawada B. The practical application of ISO 22301. J Bus Contin Emer Plan. 2014; 8(1):83-90.

3. Sever MS, Remuzzi G, Vanholder R. Disaster medicine and response: Optimizing life-saving potential. Am J Disaster Med. 2018; 13(4):253-264.

Traunero F18, Montanari E19, Boeri L19, Maggi M20, Del Giudice F20, Bove P21, Forte V21, Ficarra V22, Alario G22, Gilante M22, Pagliarulo E23, Tafuri A23, Mirone V15, Schips L13, Antonelli A9, Gontero P10, Cormio L1,24, Sciarra A20, Porpiglia F8, Bassi P6, Di Tonno P7, Boström PJ12, De Cobelli O3, Messina E25, Panebianco V25, Carrieri G1.

1 Department of Urology and organ transplantation, university of Foggia, Foggia, Italy;

2 Department of Urology, Karolinska University Hospital Solna, Sweden;

3 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden;

4 Department of Radiology, University of Turku, Turku, Finland; Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland;

5 Urologic cancer surgery department, Istituto Europeo di Oncologia, Milano, Italy;

6 Department of Urology, Catholic University Medical School "A. Gemelli" Hospital, Rome, Italy;

7 Department of Urology, Andrology and Kidney Transplantation, University of Bari, Bari, Italy;

8 Department of Urology, Azienda Ospedaliera Universitaria “San Luigi Gonzaga”, University of Turin, Turin, Italy;

9 Azienda Ospedaliera Universitaria Integrata di Verona, UOC Urologia;

10 Dept of Surgical Sciences, Citta della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy;

11 Institute of Biomedicine, University of Turku and Department of Pathology, Turku University Hospital, Turku, Finland;

12 Department of Urology, University of Turku and Turku University hospital, Turku, Finland;

13 Department of Urology, Universita "G.d'Annunzio", ChietiPescara, Italy;

14 Department of oncologic Urology, "Regina Elena" National Cancer Institute, Rome, Italy;

15 Department of Urology, University of Naples Federico II, Naples, Italy;

16 IRCCS Policlinico San Donato, Milan, Italy;

17 Department of Urology, Ente Ecclesiastico Miulli, Acquaviva delle Fonti, Italy;

18 Clinica Urologica di Trieste, Trieste, Italy;

19 Department of Urology, IRCCS Foundation Ca' GrandaMaggiore Policlinico Hospital, Milan, Italy;

20 Department of Maternal Infant and Urological Sciences, Sapienza Rome University, Rome, Italy;

21 Department of Urology, San Carlo di Nancy Hospital, Rome, Italy;

22 Department of Urology, University of Messina, Messina, Italy;

23 Department of Urology, Vito Fazzi Hospital, Lecce, Italy;

24 Department of Urology, Ospedale L. Bonomo, Andria, Italy;

Diagnosis

OF PROSTATE CANCER WITH MULTIPARAMETRIC MRI IN MEN TREATED WITH 5-ALPHAREDUCTASE INHIBITORS: RESULTS OF A MULTICENTER INTERNATIONAL COLLABORATION

Falagario UG1,2, Lantz A2,3, Jambor I4, Busetto GM1, Bettocchi C1, Luzzago S5, Ferro M5, Totaro A6, Racioppi M6, Carbonara U7, Manfredi M8, Daietti D9, Porcaro A9, Nordström T3, Bjornebo L3, Ordeda M10, Soria F10, Taimen P11, Aronen HJ4, Perez IM4, Ettala O12, Marchioni M13, Simone G14, Ferrero M14, Brassetti A14, Napolitano L15, Carmignani L16, Ludovico G17, Scarcia M17, Trombetta C18, Claps F18,

25 Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy.

Introduction and Objective. 5-alpha reductase inhibitors (5-ARIs) are widely used for treatment of patients with bladder outlet obstruction symptoms. The aim of this study was to evaluate accuracy of Magnetic Resonance imaging (MRI) of the prostate for the diagnosis of clinically significant Prostate Cancer (csPCa) in men treated with 5-ARIs.

Methods. Retrospective analysis of an international database (PROMOD) including data of patients undergoing prostate biopsy with a pre-biopsy MRI in 24 European institutions. Patients treated with 5-ARIs for at least three months at the time of MRI were included in the study group while 5-ARIs naïve patients were used as controls. Outcome of the study was csPCa defined as Biopsy Gleason Grade (GG) ≥2. Negative (NPV) and positive (PPV) predictive values were used to assess the accuracy of MRI in predicting the outcome of interest. Results. 7346 patients were eligible for the present study. 696 patients were treated with 5-ARIs. They were older (66 vs 70), had lower PSA values (6.7 vs 6.3, p 0.001) and larger prostate volumes (49 vs 54, p<0.0001). Prostate MRI showed PIRADS 3, 4 and 5 lesions in 25, 42 and 21% of the patients in the control group and 22, 36 and 23% of the patients in the 5-ARI’s group (p <0.0001). Central zone and transition zone lesions were more frequent in the 5-ARI’s group. There was no difference in csPCa (GG≥2) detection rates (41% vs 40%, p 0.8), however detection of GG 1 PCa was higher in the control group (18% vs 15%) and the detection of high Grade PCa (GG≥3) was significantly higher in patients treated with 5ARI’s (20% vs 24%, p 0.019). At multivariable logistic regression analysis, treatment with 5-ARI’s was found to be correlated with diagnosis of high Grade PCa (GG≥3). The accuracy of mpMRI was similar in the two groups with no difference in PPV, NPV and detection rates by PIRADS score.

Conclusion. MpMRI proved to have similar diagnostic accuracy for prebiopsy risk stratification both in patients who underwent treatment with 5-ARIs and who did not. Moreover, a higher rate of high grade PCa was detected in patients treated with 5-ARIs, and most of them were clearly visible on MRI and classified as PIRADS 4 and 5 lesions. Finally, in contrast to serum PSA values, PSA density and MRI are not affected by treatment with 5-ARIs and should be considered the first tools for the decision whether to proceed to prostate biopsy.

Approccio Conservativo Nel

TRATTAMENTO DELLE PICCOLE MASSE DEL RENE TRAPIANTATO: ESPERIENZA PRELIMINARE CON CRIOABLAZIONE

Lospalluto M, Spilotros M, Palella G, Dell’Atti C, Selvaggio O, Soldano S, Matera M, Miacola C, Tedeschi M, Lucarelli G, Battaglia M, Ditonno P.

Dipartimento dell’Emergenza e dei Trapianti d’Organo- Unità di Urologia, Andrologia e Trapianto di Rene. Università degli Studi di Bari.

Le tecniche ablative focali per il trattamento mini-invasivo delle piccole masse renali rappresenta un campo in continua evoluzione ed applicabile per lesioni inferiori ai 4 cm (T1a) in particolar modo in pazienti che presentano comorbidità e per questo motivo non idonei a trattamento chirurgico, pazienti anziani o monorene. La diagnosi di neoplasie del rene trapiantato rappresenta una sfida terapeutica principalmente perché una eventuale nefrectomia parziale potrebbe causare una significativa perdita di massa nefronica sana. Il trattamento con crioablazione, tecnica capace di determinare la distruzione della lesione tramite congelamento delle cellule tumorali, in questi pazi- enti rappresenta un approccio possibile per salvaguardare il tessuto sano trattando la massa tumorale. La crioablazione si avvale dell’utilizzo di criosonde ad argon capaci di generare una temperatura target pari o inferiore a -40°. L’evidenza scientifica a supporto di questo approccio in particolare in pazienti trapiantati di rene resta tuttavia scarsa e basata su studi di qualità limitata. Descriviamo la nostra esperienza preliminare del trattamento mediante questa metodica di una lesione cistica complessa del terzo medio posteriore del rene trapiantato in fossa iliaca destra in paziente maschio di 49 anni per cui il trattamento chirurgico risultava non idoneo. La procedura, TC-guidata per la verifica del corretto posizionamento delle sonde, si è basata su due cicli di congelamento (10 min) e riscaldamento (5 min) per una durata totale di 50 minuti in anestesia locale e sedazione. Al termine è stata documentata mediante TC la formazione di una “iceball” estesa per 5-10 mm oltre il limite della lesione target e non sono state registrate complicanze peri e post-operatorie. In base a questa preliminare esperienza il trattamento con crioablazione delle neoplasie del rene trapiantato rappresenta un’opzione terapeutica sicura in pazienti selezionati sebbene per quanto riguarda le conclusioni sugli outcome oncologici necessitiamo di numeri maggiori di pazienti trattati e follow-up significativi.

EFFICACIA E SICUREZZA DELLA BIOPSIA PERCUTANEA ECOGUIDATA DEL RENE NATIVO. CASE SERIES MONOCENTRICA

Zito A, Fontò G, Protopapa P, Napoli M De Pascalis A.

Introduzione. La biopsia renale percutanea (BRP) dei reni nativi rappresenta uno strumento fondamentale per la diagnosi e la gestione delle malattie renali. L’adozione della guida ecografica e la disponibilità di procedure interventistiche ha consentito di ridurre drasticamente l’incidenza delle complicanze.

La gravità delle complicanze è classificata in maggiore (emorragia incoercibile con necessità di trasfusione di sangue e/o procedura radiologica o chirurgica invasiva; fistola artero-venosa che richiede procedura radiologica invasiva; ipotensione grave da anemizzazione severa; ostruzione renale acuta; insufficienza renale; sepsi; Page kidney; morte) e minore (dolore al fianco severo; calo dell’ematocrito che non necessita di emotrasfusione; ematuria macroscopica; ematoma perinefrico subcapsulare che si risolve spontaneamente; fistola artero-venosa a risoluzione spontanea). In questo studio, abbiamo analizzato efficacia e sicurezza delle PRB nel nostro centro.

Materiali e metodi. Sono state considerate tutte le BRP consecutive effettuate nella nostra Unità Operativa di Nefrologia, Dialisi e Trapianto nel periodo dal 1/01/2018 al 33/09/2022. Si è riportato il numero e il tipo di complicanze e le diagnosi riscontrate.

La popolazione biopsiata ha presentato queste manifestazioni cliniche: anomalie urinarie, sindrome nefrosica, insufficienza renale acuta. Le BRP sono state eseguite in regime di ricovero previo consenso informato e sotto