Department of Urology Advanced Urotechnology Center Istituto Auxologico Italiano

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1 Department of Urology Advanced Urotechnology Center Istituto Auxologico Italiano PD. Dr. Med. Andrea Cestari Head of Department Prof. Dr. Med. Patrizio Rigatti Scientific Director

2 Department of Urology Presidio Ospedaliero Capitanio Via Mercalli 30, Milano

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4 Outpatient Clinics Centro Diagnostico S. Carlo Via Pier Lombardo, 22 Milano Centro di Ricerca e Cura dell invecchiamento Via Mosè Bianchi, 90 Milano Istituto Scientifico S. Michele Via Ariosto 13, Milano Centro Diagnostico Meda Corso della Resistenza, 23 Meda Centro di Ricerche e Tecnologie Biomediche Via Zucchi, 18 Cusano Milanino Istituto Scientifico Ospedale S Luca Piazzale Brescia 20 Milano Centro Diagnostico Via S. Francesco, 16 Pioltello (Milano) Istituto Scientifico Ospedale S Giuseppe Via Cadorna, 90 Piancavallo Istituto Scientifico Villa Caramona Corso Mameli, 199 Verbania

5 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

6 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

7 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

8 DaVinci Surgical System

9 Robot-assisted Radical Prostatectomy (RARP) Detailed anatomical vision Delicate handling of anatomical structures significant reduction of a potential traumatic impact

10 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 In our series 87% at 12 months

11 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 In our series continence rate at 12-month 94%

12 Innovative Techniques for Minimally Invasive Surgery

13 3D HD Laparoscopy

14 Single-Site Robotic surgery Cestari A et al. Eur Urol 2012;62:175-9

15 Minimally Invasive Oncological Surgery Cryoablation for Renal Cancer Crioablazione

16 Holmium Laser Lithotripsy of bladder stones, ureteral and renal Retrograde Ureterotomy Retrograde endopyelotomy Uretrotomy Conservative treatment of urothelial tumors of the upper urinary tract

17 Holmium Laser Enucleation of the Prostate (HoLEP) Instruments 550 μm, end-firing, quartz fibre and 80 W Ho:YAG laser

18 532 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

19 Bipolar Transurethral Resection of the Prostate Olympus Plasma Vaporisation System

20 Photodynamic diagnosis (PDD) with 5- aminolevulinic acid (5-ALA) or hexyl aminolevulinate (HAL) Diagnosis and Follow-up of Patients with Non-Muscle-Invasive Bladder Cancer

21 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

22 Urinary Incontinence

23 Botulin Toxin A for refractory Overactive Bladder

24 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 Sacral nerve stimulation

25 Stress urinary incontinence in women Laparoscopic colposuspension

26 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)

27 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)

28 Surgery for stress urinary incontinence in men Non-circumferential compression device (ProAct )

29 Surgery for stress urinary incontinence in men Artificial urinary sphincter AMS 800 TM Urinary Control System

30 Erectile Dysfunction

31 Penile prosthesis 1.low morbidity rate 2.highly effective ED treatment with higher treatment satisfaction 3.excellent long-term mechanical reliability

32 3-Pieces Penile Implant - best penile rigidity - natural flaccidity - mechanical reliability AMS 700

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