Diapositiva 1 - Istituto Auxologico Italiano

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Diapositiva 1 - Istituto Auxologico Italiano
Department of Urology
Advanced Urotechnology Center
Istituto Auxologico Italiano
PD. Dr. Med. Andrea Cestari
Prof. Dr. Med. Patrizio Rigatti
Head of Department
Scientific Director
Department of Urology
Presidio Ospedaliero Capitanio
Via Mercalli 30, 20122 Milano
Outpatient Clinics
Centro Diagnostico S. Carlo
Via Pier Lombardo, 22
Milano
Centro di Ricerche e
Tecnologie Biomediche
Via Zucchi, 18
Cusano Milanino
Centro di Ricerca e
Cura dell’invecchiamento
Via Mosè Bianchi, 90
Milano
Istituto Scientifico
Ospedale S Luca
Piazzale Brescia 20
Milano
Istituto Scientifico S. Michele
Via Ariosto 13,
Milano
Centro Diagnostico
Via S. Francesco, 16
Pioltello
(Milano)
Istituto Scientifico
Ospedale S Giuseppe
Via Cadorna, 90
Piancavallo
Centro Diagnostico Meda
Corso della Resistenza, 23
Meda
Istituto Scientifico
Villa Caramona
Corso Mameli, 199
Verbania
Advanced Urotechnology Center / 1
• Our Institute is at the forefront of the international scene for
the technological level (first position in Europe)
• Experienced urologists trained all over the World
• High scientific activity
• International Referral Center for:
Intuitive (Robotic Surgery)
Karl Storz (Laparoscopy and Endourology)
Galil (Renal cryoablation)
Dr. A. Cestari is Directive Board Member of:
IEA
ESUT
EuRECA
Advanced Urotechnology Center / 2
• Advanced diagnosis for urological and andrological
pathology
• Minimally-Invasive surgery for urological and
andrological pathology
• Multidisciplinary treatment of oncological
metastatic diseases
• Diagnosis, therapy, rehabilitation and follow up
customized for each patient
Minimally Invasive Oncological Surgery
Radical Prostatectomy
Radical cystectomy with orthotopic neobladder
Partial nephrectomy
Radical nephrectomy
Minimally Invasive Reconstructive Surgery
Pielo-ureteral joint syndrome
Ureteral lesions (acquired)
Megaureter
Inguinal hernioplasty
Colpopexy
DaVinci Surgical System
Robot-assisted Radical Prostatectomy (RARP)
• Detailed anatomical vision
• Delicate handling of anatomical structures
significant reduction of a potential traumatic impact
Erectile Function Recovery After RARP
The rate of erectile function recovery at 12 and
24 months ranged from 54% to 90% and from
63% to 94%, respectively.
Ficarra et al. 2012
In our series 87% at 12 months
Urinary Continence Recovery After RARP
At 12 months, the rates of postoperative urinary
incontinence (continence defined as no pad use)
ranged from 4% to 31% (mean 16%); when
continence is defined as no pad or safety pad use,
from 8% to 11% (mean 9%).
Ficarra et al. 2012
In our series continence rate at 12-month 94%
Innovative Techniques
for
Minimally Invasive Surgery
3D – HD Laparoscopy
“Single-Site” Robotic surgery
Cestari A et al.
Eur Urol
2012;62:175-9
Minimally Invasive Oncological Surgery
Cryoablation for Renal Cancer
Crioablazione
Holmium Laser
Lithotripsy of bladder
stones, ureteral and renal
Retrograde Ureterotomy
Retrograde endopyelotomy
Uretrotomy
Conservative treatment of
urothelial tumors of the
upper urinary tract
Holmium Laser Enucleation of the Prostate
(HoLEP)
Instruments
• 550 μm, end-firing, quartz fibre and
• 80 W Ho:YAG laser
532 nm ‘Greenlight’ laser vaporisation
of prostate
• Vaporisation of prostatic tissue by a sudden increase
in tissue temperature from 50°C to 100°C.
• Green light emitted (λ=532 nm)
• Laser vaporisation using 80 W
Bipolar Transurethral Resection of the Prostate
Olympus Plasma Vaporisation System
Photodynamic diagnosis (PDD) with 5aminolevulinic acid (5-ALA) or
hexyl aminolevulinate (HAL)
Diagnosis and Follow-up of Patients with
Non-Muscle-Invasive Bladder Cancer
SPIES
(STORZ Professional Image Enhancement System)
• based on a computed
virtual chromoendoscopy
processing the color
components by means of
three specific filters
• improves the contrast
between abnormal and
normal bladder mucosa
Urinary Incontinence
Botulin Toxin A for refractory Overactive
Bladder
Sacral nerve stimulation
A form of electrical stimulation
therapy.
A wire with a small electrode tip
is implanted inside the body so
the tip is near the sacral nerve in
the lower spine.
Small electrical impulses activate
the sacral nerve, which controls
bladder function
Stress urinary incontinence in women
Laparoscopic
colposuspension
Mid-urethral slings for women with SUI
Tension-free
Vaginal Tape (TVT)
1.Skin-to-vagina
(top-down)
retropubic
direction
2.Transobturator
insertion (TVT-O)
Surgery for stress urinary incontinence in men
Fixed male sling - Continence restoration by:
1.urethral compression
(InVance®,Istop TOMS, Argus®)
2.repositioning the bulb of urethra
(AdVance)
Surgery for stress urinary incontinence in men
Non-circumferential compression device
(ProAct®)
Surgery for stress urinary incontinence in men
Artificial urinary sphincter
AMS 800TM Urinary Control System
Erectile Dysfunction
Penile prosthesis
1.low morbidity rate
2.highly effective ED
treatment
with
higher
treatment
satisfaction
3.excellent long-term
mechanical reliability
3-Pieces Penile Implant
- best penile rigidity
- natural flaccidity
- mechanical reliability
AMS 700
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