Introduction and objectives
To evaluate late complications in a large cohort of patients undergoing robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD).
...Materials and methods
We prospectively enrolled patients who underwent RARC and ICUD between August 2012 and June 2019. We excluded patients with Ejection fraction < 36%, retinal vasculopathy, ventriculoperitoneal shunts, and those treated without curative intent. All complications and their onset date have been recorded, defined, and graded according to Clavien classification adapted for radical cystectomy.
Results
210 patients were included, 76% of whom were men, with a mean age of 62 years. Urinary diversions used were Padua Ileal Bladder (PIB) in 80% of cases, and ileal conduit (IC) in 20% of patients (generally older and with more comorbidity). The mean follow-up was 30 ± 22 months. The stenosis rate of uretero-ileal anastomosis was 14%, while a reduction in eGFR (≥ 20%) was observed in about half of the cases. UTIs occurred in 37% of the patients, especially in the first 12 months. Only 2% of patients had bowel occlusion, whereas incisional hernia, lymphocele, and systemic events (metabolic acidosis and major cardiovascular events) occurred respectively in 20%, 10%, and 1% of cases.
Conclusions
Our study evaluates first late complications in a cohort of patients who underwent RARC with ICUD. These data are encouraging and in line with findings from a historical series of open radical cystectomy (ORC). This study is a further step in supporting RARC as a safe and effective surgical option for the treatment of muscle-invasive bladder cancer (MIBC) in tertiary referral centers.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Aim of the study was to evaluate efficacy and efficiency of 180-watt Green-Light XPS (GL-XPS) laser photoselective vaporization of the prostate (PVP) in patients under 5-Alpha-Reductase Inhibitors ...(5ARI) treatment.
A consecutive series of patients with lower urinary tract symptoms due to benign prostatic enlargement treated by PVP with the GL-XPS were enrolled. Patients were divided in two groups according to the chronic use (>6 months) of 5ARI. These two groups were compared on lasing density (kilojoules per prostate volume), vaporization efficiency (prostate volume per lasing time), vaporization power (kilojoules per lasing time), Prostate Specific Antigen (PSA) reduction from baseline, symptom score change from baseline and uroflowmetry parameters improvement. Follow-up was performed at 3, 6 and 12 months with International Prostate Symptom Score, Uroflowmetry parameters and PSA.
Overall 193 patients were enrolled. Out of them 87/193 (45%) were on 5ARI treatment. No significant differences were recorded between the two groups at baseline. Median age was 68 years old and median prostate volume was 60 ml. In terms of laser efficiency, no statistically significant differences were recorded in terms of lasing time (25 min vs. 24.5 min; p>0.05); energy used (250 kJ vs. 221 kJ; p>0.05), lasing density (6.8 kJ/ml vs. 6.6 kJ/ml, p>0.05), vaporization efficiency (1.4 ml/min vs. 1.3 ml/min, p>0.05) and vaporization power (9.6 kJ/min vs. 9.4 kJ/min; p>0.05). Finally, no significant differences were also recorded postoperatively in the two groups in terms of PSA reduction, improvement in symptom score and uroflowmetry parameters (p>0.05).
Thirty-seven efficacy and efficiency outcomes were not statistically different between the two groups. 5ARI does not reduce the performance and ability of the 180-watt Green-Light XPS laser system.
•Recto-Vesical Fistula is a rare but severe complication of Radical Prostatectomy.•There is no consensus regarding the optimal Recto-Vesical Fistula treatment.•In the present paper, a robotic ...transabdominal approach was attempted, with favorable results.
Recto-urethral fistulae (RUF) and recto-vesical fistulae (RVF) are usually related to prostate cancer (PCa) treatment, mainly radical prostatectomy (RP), and a 0.53–9% fistulization rate was observed. Although conservative management is attempted, spontaneous healing is anecdotal and surgical management is often required. Most authors suggested an open approach as less common alternative, due to higher morbidity 1. Nowadays robotic-assisted surgery represents a viable option.
we report the case of 71 years-old men who developed an RVF after robot-assisted RP for a Prognostic-Grade-Group 3, pT3bN0 PCa. A conservative attempt, including a transurethral catheter and a colostomy was unsuccessful. A transanal closure according to the Latzko technique was subsequently attempted without results. Then, a robot-assisted transperitoneal repair was planned.
before surgery, ureteral stents were positioned. The patient was placed in a low lithotomy position and trocars were arranged as per conventional robot-assisted pelvic surgery. A wide cystotomy was performed at the dome so that the fistula could be visualized and a Pollack catheter was inserted through it. Then, the recto-vesical space was developed, mainly with blunt dissection and cold scissors. The fistulous tract was excised both from the rectal and bladder sides. A double-layer interrupted suture was performed to close both the anterior aspect of the rectum and the bladder. The water tightness of the bladder was assessed with saline solution. An omental flap was then placed between the rectum and the bladder to separate the two suture lines.
although over 40 techniques have been described which all share the basic principles for urinary fistula surgical repair, there is no consensus on the optimal treatment. In the last decades, most cases were managed through a transperineal or transanal open approach. With the introduction of robotic surgical systems, the transabdominal approach could be considered a viable option.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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