Objective
To compare the perioperative outcomes of intracorporeal (ICUD) vs extracorporeal urinary diversion (ECUD) after robot‐assisted radical cystectomy (RARC).
Patients and Methods
We ...retrospectively reviewed the prospectively maintained International Robotic Cystectomy Consortium (IRCC) database. A total of 972 patients from 28 institutions who underwent RARC were included. Propensity score matching was used to match patients based on age, gender, body mass index (BMI), American Society of Anesthesiologists Score (ASA) score, Charlson Comorbidity Index (CCI) score, prior radiation and abdominal surgery, receipt of neoadjuvant chemotherapy, and clinical staging. Matched cohorts were compared. Multivariate stepwise logistic and linear regression models were fit to evaluate variables associated with receiving ICUD, operating time, 90‐day high‐grade complications (Clavien–Dindo Classification Grade ≥III), and 90‐day readmissions after RARC.
Results
Utilisation of ICUD increased from 0% in 2005 to 95% in 2018. The ICUD patients had more overall complications (66% vs 58%, P = 0.01) and readmissions (27% vs 17%, P = 0.01), but not high‐grade complications (21% vs 24%, P = 0.22). A more recent RC era and ileal conduit diversion were associated with receiving an ICUD. Higher BMI, ASA score ≥3, and receiving a neobladder were associated with longer operating times. Shorter operating time was associated with male gender, older age, ICUD, and centres with a larger annual average RC volume. Longer intensive care unit stay was associated with 90‐day high‐grade complications. Higher CCI score, prior radiation therapy, neoadjuvant chemotherapy, and ICUD were associated with a higher risk of 90‐day readmissions.
Conclusions
Utilisation of ICUD has increased over the past decade. ICUD was associated with more overall complications and readmissions compared to ECUD, but not high‐grade complications.
Medical robotics has significant potential for treating patients rapidly and comfortably. Surgical and rehabilitation robotic systems comprise a major portion of medical robots. Both types of robots ...have unique advantages that are continually improved upon day after day and year after year. This book critically examines the development and historical evolution of medical robotics with a particular focus on urologic robotic surgery.
Objective
After radical prostatectomy, prostate‐specific antigen(PSA) value measuring ≥0.1 ng/mL is defined as persistent PSA(pPSA) and in many studies, it was found to be associated with aggressive ...disease and poor prognosis. Our aim in this study is to point out the pathological and clinical factors affecting pPSA among the patients who underwent robot‐assisted radical prostatectomy(RARP) in an experienced academic centre and to make a useful risk grouping algorithm that can predict pPSA value based on operative data.
Methods
We examined records of 1273 patients who underwent RARP retrospectively. Preoperative, operative and postoperative data were collected. Based on the PSA values (ng/mL) measured after 4‐to‐8 weeks of RARP, patients were divided into two groups as pPSA group (Group1)(n = 97) with PSA values ≥0.1 ng/mL and undetectable PSA group (Group2)(n = 778) with PSA values <0.1 ng/mL. Later on, Group1 was further divided into Group1a (PSA:0.1‐0.2 ng/mL) and Group 1b (PSA≥0.2 ng/mL) to evaluate biochemical recurrence(BCR).
Results
Multivariate logistic regression analyses of the collected data revealed that preoperative PSA≥20 ng/mL, operation time, a postoperative international society of urological pathology (ISUP) grade of ≥4, pT 3‐4 and pN were independently associated with pPSA. Based on these results, a risk grouping algorithm predicting pPSA was developed. By looking at the risk grouping algorithm pPSA was found in 98.9% of the cases with a preoperative PSA value of ≥20 ng/mL, an operation time of 150 min, a postoperative ISUP grade of 4‐5, a positive lymphovascular invasion (LVI) status, pT3‐T4, and pN+; while pPSA was found in 25.5% of the cases with a preoperative PSA value of <20 ng/mL, an operation time of 100 min, a postoperative ISUP grade of <4‐5, a negative LVI status, pT<3‐4 and pN‐. The estimated BCR‐free survival time was 16.3 months in Group 1a and 57.0 months in Group2 (P < .001). Adjuvant treatment ratio was 64.9% in Group1 and 7.1% in Group2 (P < .001).
Conclusion
For the patients who underwent RARP, factors associated with aggressive disease can predict the PSA persistence. To plan our treatment modalities accurately, an applicable risk grouping algorithm in daily practice would be useful.
Objectives
To evaluate the postoperative complication and mortality rate following laparoscopic radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) in octogenarians.
Patients and ...Methods
We conducted a retrospective analysis comparing postoperative complication and mortality rates depending on age in a consecutive series of 1890 patients who underwent RARC with ICUD for bladder cancer between 2004 and 2018 in 10 European centres. Outcomes of patients aged <80 years and those aged ≥80 years were compared with regard to postoperative complications (Clavien–Dindo grading) and mortality rate. Cancer‐specific mortality (CSM) and other‐cause mortality (OCM) after surgery were calculated using the non‐parametric Aalen‐Johansen estimator.
Results
A total of 1726 patients aged <80 years and 164 aged ≥80 years were included in the analysis. The 30‐ and 90‐day rate for high‐grade (Clavien–Dindo grades III–V) complications were 15% and 21% for patients aged <80 years compared to 11% and 13% for patients aged ≥80 years (P = 0.2 and P = 0.03), respectively. In a multivariable logistic regression analysis adjusting for pre‐ and postoperative variables, age ≥80 years was not an independent predictor of high‐grade complications (odds ratio 0.6, 95% confidence interval 0.3–1.1; P = 0.12). The non‐cancer‐related 90‐day mortality was 2.3% for patients aged ≥80 years and 1.8% for those aged <80 years, respectively (P = 0.7). The estimated 12‐month CSM and OCM rates for those aged <80 years were 8% and 3%, and for those aged ≥80 years, 15% and 8%, respectively (P = 0.009 and P < 0.001).
Conclusions
The minimally invasive approach to RARC with ICUD for bladder cancer in well‐selected elderly patients (aged ≥80 years) achieved a tolerable high‐grade complication rate; the 90‐day postoperative mortality rate was driven by cancer progression and the non‐cancer‐related rate was equivalent to that of patients aged <80 years. However, an increased OCM rate in this elderly group after the first year should be taken into account. These results will support clinicians and patients when balancing cancer‐related vs treatment‐related risks and benefits.
The forum focused on talks and presentations with discussions covering almost all areas of prostatic diseases, including both benign prostatic conditions and prostate cancer, their diagnosis, ...imaging, multidisciplinary treatment, and preventive care. There were six sessions on benign prostatic hyperplasia (BPH) and chronic prostatitis, screening and imaging for prostate cancer, molecular markers and pathology of prostate cancer, localized prostate cancer, metastatic prostate cancer, and challenging cases in prostate cancer. The topics discussed during this meeting were NIH perspective on benign prostatic disease, innovations in medical and surgical treatment of BPH, prostate biopsy, prebiopsy imaging in prostate cancer, prevention and early detection of prostate cancer, new molecular markers in prostate cancer, genomic classifiers in prostate cancer, Gleason scoring to prognostic grade grouping, circulating tumor cells and their role in prostate cancer, update on histopathological evaluation of lymphadenectomy specimens from prostate cancer patients, androgen deprivation therapy in localized prostate cancer, radical prostatectomy in patients older than 75 years, focal treatment in prostate cancer, role of open radical prostatectomy, continence increasing measures at radical prostatectomy, surgery for high-risk prostate cancer, role of chemotherapy in advanced prostate cancer, how to handle surgical margin positivity, timing of antiandrogens in metastatic prostate cancer, current concepts of treatment of bone metastasis in prostate cancer, mechanisms and treatment of castration resistance in prostate cancer, multimodal treatment in prostate cancer, immunotherapy in prostate cancer, and who should treat castration-resistant prostate cancer: urologist or medical oncologist?
Objective. This prospective study aimed to explore the potential diagnostic value of endocan levels in bladder cancer by investigating a possible association of serum and urine endocan levels with ...the stage and grade of bladder tumors in patients with nonmuscle-invasive bladder cancer (NMIBC) in terms of risk stratification. Materials and Methods. Participants included 66 male patients with NMIBC. Patients with full pathology results, NMIBC stage T1, and healthy controls were categorized as groups 1, 2, and 3, respectively. Patients were further classified into high- and low-grade groups following their pathology results. Risk classification according to the European Association of Urology (EAU) was assigned to patients with NMIBC, and associations of risk groups with serum and urine endocan levels were analyzed. An enzyme-linked immunosorbent assay was used to identify serum and urine endocan concentrations. Results. Serum endocan levels according to pathological staging were significantly higher in groups 1 and 2 than in group 3. The urine endocan level was statistically significantly higher in group 2 than in group 3 p<0.001. The predictive power of the urine endocan level was evaluated for its ability to predict T1 disease, revealing an area under the curve of 0.735 and a threshold of 903. The EAU classification was evaluated according to risk groups, and the urine endpoint was statistically significantly higher in the univariate analysis for the high and very high-risk groups p=0.034. Conclusion. Our results indicate that endocan levels hold significant promise in prognostic feature evaluation in NMIBC, particularly in the context of screening patients with hematuria.
Robotic-assisted surgery has benefits for patients, but there are challenges to working in this field. In Turkey, training is not provided for nurses working in robotic-assisted surgery, and national ...legislation on nurses’ roles in these settings has not been implemented. This study aimed to demonstrate the roles and experiences of nurses in robotic-assisted surgery in Turkey. This study was conducted as a mixed-methods research. The qualitative data were analysed by content analysis. More than half of the nurses had received basic training in robotic-assisted surgery. Qualitative data consisted of five themes, including the effects of robotic surgery, feelings and thoughts on robotic surgery, working as a nurse in robotic surgery settings, responsibilities of nurses and competence of nurses working in robotic surgery settings. Determining the working conditions and roles of nurses working in robotic-assisted surgery settings by policymakers in regulations is crucial for improving the quality of nursing care and the outcomes of patients.
Prostate cancer is a prevalent problem in male healthcare. The previous decades have witnessed some significant improvements in the knowledge of aetiology and pathology, as well as practice of ...screening, treatment, and follow-up of the disease. A downstaging at the time of the diagnosis and increase in the survival were vivid with the advancements, albeit the screening of the disease using regular prostate specific antigen measurements was previously debated. In this paper, the authors aimed to inform the reader on the course of the prostate cancer along a century by sailing along the chapters of the old urology textbooks.
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