INTRODUCTION:Transurethral resection of the bladder tumor (TURBT) followed by intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is a standard treatment for high-risk non muscle-invasive bladder cancer (NMIBC). However, due to potential risk of dissemination, current guidelines recommend caution when proposing BCG treatment in immunocompromised patients. Our aim was to assess the efficacy and safety of BCG treatment in immunocompromised patients. MATERIALS AND METHODS:Patients aged ≥18 with a diagnosis of bladder cancer (BC) who underwent BCG therapy in 2007-2021, were identified in the MerativeTM Marketscan® Research Commercial and Medicare databases. Multivariable Cox proportion hazard regressions adjusted by relevant confounders were performed to investigate the influence of immunosuppression on the events associated with progression and recurrence of BC, both in the unmatched cohort and after 1:2 propensity score matching (PSM). Also, subgroup analysis on progression in patients without cancer other than BC was conducted. RESULTS:Immunocompromised and immunocompetent patients had similar rates of disseminated BCG infection after intravesical immunotherapy. However, immunocompromised patients had shorter progression-free survival and higher probability of progression (aHR: 1.23, 95% CI: 1.11-1.38), as well as shorter recurrence-free survival and a higher probability of recurrence (aHR: 1.13, 95% CI: 1.05-1.20). Similar significant associations were observed in the PSM cohort. A subgroup analysis of patients without any additional oncological diagnoses beyond BC confirmed a higher likelihood of progression in the immunocompromised group (aHR: 1.34, 95% CI: 1.15-1.56). CONCLUSIONS:BCG immunotherapy is safe in immunocompromised patients. Nevertheless, the efficacy of intravesical BCG in these patients might be suboptimal thus advocating the need for appropriate counselling and a possible lower threshold to consider radical treatment.

Introduction: Radical cystectomy (RC) is the gold standard for urothelial cT2-4a, N0, M0 muscle-invasive bladder cancer (MIBC). However, bladder-sparing strategies (BSS) such as Trimodality Therapy (TMT) have emerged as alternative treatments for a select group of localized muscle-confined (cT2) urothelial bladder cancers. Accordingly, reliable preoperative staging and a reliable risk factor assessment linked to pathological upstaging play a key role in adequate counselling and patient selection for BSS. Patients and Methods: cT2 MIBC patients undergoing RC at our institution from 2014 to 2024 were reviewed. Preoperative staging modalities, demographics, and tumour and patient characteristics were assessed. Multivariable logistic regression was applied to explore the relative effect of confounders on any pathological upstaging from robot-assisted or open RC specimens. Subgroup analysis according to the local upstaging (>pT2) or nodal dissemination (pN+) was also performed. Results: N = 275 RCs were included (73.5% males, 26.5% females). Upstaging was documented in n = 141 (51%) cases. Of these, n = 125 (45.5%) were upstaged locally (>pT2) and n = 35 (23%) yielded pN+ disease. Preoperative parameters like gender, the number of TURBTs, previous BCG exposure, and concomitant CIS did not significantly influence the risk of any kind of upstaging (p > 0.05). At multivariable analysis, neoadjuvant chemotherapy (NAC) and multi-disciplinary team (MDT) discussion were found protective (odds ratio [OR]: 0.4, 95%CI 0.2-0.7, p = 0.001 and OR: 0.51, 95%CI 0.2-0.9, p = 0.01). Preoperative FDG-PET assessment yielded higher risk for later pN upstaging (OR: 1.8, 95%CI 1-3, p = 0.05). HG/G3 features at TURBT along with mixed/pure histology variants in RC specimens were the most relevant independent predictors for both any and pT upstaging (OR: 4.3, 95%CI 1-34, p = 0.04 and OR: 2.3, 95%CI 1.1-4.6, p = 0.02 for any upstaging and OR: 5.6, 95%CI 1.3-36, p = 0.02 and OR: 2.5, 95%CI 1.3-5, p = 0.01 for pT upstaging, respectively). Conclusions: In this study, over half of the patients undergoing RC for cT2 were upstaged at the final pathology. Therefore, adequate counselling and examining the non-conventional criteria for prognosis is mandatory in the contemporary era of bladder-preservation strategies.

Introduction: The role of urethrectomy at the time of Robotic-Assisted or Open Radical Cystectomy (RARC, ORC) is controversial. Whether urethrectomy should be performed at the time of RARC/ORC or delayed up to a 3–6 month interval is unclear. We performed a retrospective cohort analysis of perioperative and survival outcomes in patients with high-risk NMIBCs or non-metastatic MIBCs at our institution who underwent either concomitant or deferred urethrectomy after RC. Materials and Methods: cTis-T1 or cT2-T4, N0-1, M0 BC patients who underwent RARC or ORC from 2009 to 2024 were reviewed. Clinical, demographic, tumour, and patient characteristics and perioperative variables were assessed across concomitant and delayed urethrectomy groups. Multivariate logistic analysis was performed to estimate the impact of significant variables on intraoperative and postoperative outcomes. Univariable Kaplan–Meier and multivariable Cox regression modelling was implemented to explore the relative effect of time of urethrectomy on progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). Results: A total of n = 58 patients (n = 47 delayed vs. n = 11 concomitant) with similar demographic characteristics were included. The concomitant urethrectomy group experienced longer operative time and greater blood loss (379 ± 65 min and 430 ± 101 mL vs. 342 ± 82 min and 422 ± 125 mL, with p = 0.049 and p = 0.028, respectively). Hospital readmission rates were higher in the concomitant urethrectomy group (36.4% vs. 8.5%, p = 0.016; OR: 17.9; 95% CI 1.2–265; p = 0.036). In Cox regression analysis, the timing of urethrectomy had no influence on PFS, CSS, or OS (all p > 0.05). Conclusions: Our study suggests that urethrectomy can be safely deferred unless urothelial disease is clearly present pre- or intraoperatively without compromising survival outcome and with the advantage of reducing surgical morbidity at the time of RC.

BACKGROUND:Partial nephrectomy (PN) is the gold-standard treatment for T1 renal-cell carcinoma, which is associated with a significant risk of complications. Tumor ablation (TA) can be implemented in chosen patients with small renal masses. The aim was to evaluate perioperative outcomes and health-care costs of PN and TA. METHODS:Patients aged ≥18 with renal mass diagnosis, who underwent PN/TA in 2007-2021, were identified in the MerativeTM Marketscan® Research Commercial and Medicare databases. Complication rates, probability and time to second surgery, as well as hospital costs (2021 US dollars) of PN and TA were evaluated. The rate of preoperative renal mass biopsies over the years was assessed. Finally, subgroup analyses for types of second surgeries (TA, PN, radical nephrectomy) were performed. RESULTS:Twenty-four thousand forty-five patients with kidney tumors were included. The majority (85.7%) underwent PN. Over the years, preoperative renal biopsies have become more common. TA was associated with a significantly lower risk of complications (adjusted odds ratio [aOR]: 0.56, 95% confidence interval [CI]: 0.50-0.63) and lower costs (aOR: 0.23, 95% CI: 0.20-0.26) than PN. The analysis of specific complications found that only wound-related complications had no significant difference in risk between the procedures (aOR: 0.65, 95%CI: 0.41-1.02). However, TA patients were at higher risk of a second procedure (adjusted hazard ratio: 1.25, 95%CI: 1.05-1.49). CONCLUSIONS:TA is associated with significantly fewer complications and lower costs than PN. However, patients undergoing TA require re-operation more frequently, possibly due to higher recurrence rates. These factors need to be considered when selecting the most appropriate treatment for patients with renal tumors.

You have accessJournal of UrologySurgical Technology & Simulation: Artificial Intelligence III (PD36)1 May 2024PD36-04 REMOTE DIGITAL SURVEILLANCE AND MACHINE LEARNING MODELLING TO PREDICT SURVIVAL FOLLOWING RADICAL CYSTECTOMY FOR BLADDER CANCER—A SECONDARY OUTCOME ANALYSIS OF THE IROC TRIAL Pramit Khetrapal, Yansong Liu, Gareth Ambler, Norman R. Williams, Ashwin Sridhar, Muhammad Shamim Khan, Imran Ahmad, Philip Charlesworth, Sanjeev Kotwal, Edward Rowe, Vishwanath Hanchanale, John McGrath, Nikhil Vasdev, Yukun Zhou, James W. F. Catto, Drobnjak Ivana, and John D. Kelly Pramit KhetrapalPramit Khetrapal , Yansong LiuYansong Liu , Gareth AmblerGareth Ambler , Norman R. WilliamsNorman R. Williams , Ashwin SridharAshwin Sridhar , Muhammad Shamim KhanMuhammad Shamim Khan , Imran AhmadImran Ahmad , Philip CharlesworthPhilip Charlesworth , Sanjeev KotwalSanjeev Kotwal , Edward RoweEdward Rowe , Vishwanath HanchanaleVishwanath Hanchanale , John McGrathJohn McGrath , Nikhil VasdevNikhil Vasdev , Yukun ZhouYukun Zhou , James W. F. CattoJames W. F. Catto , Drobnjak IvanaDrobnjak Ivana , and John D. KellyJohn D. Kelly View All Author Informationhttps://doi.org/10.1097/01.JU.0001008916.72488.6a.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Wearable devices allow for measurement of physical activity, potentially providing supplementary prognostic insights for predicting survival following radical cystectomy (RC), alongside commonly used conventional clinicopathological factors. The primary objective of this analysis is to assess the additional value of wearable device monitoring to pathological data in predicting survival. METHODS: The iROC randomised trial (NCT03049410) compared peri-operative recovery after intracorporeal robot-assisted RC (iRARC) vs open RC (ORC) for bladder cancer. Step-count data was collected using wrist-worn wearable devices, and maximum steps and average steps per day was calculated at baseline and 12 weeks post-RC. Stamina was measured using the 30 second chair-to-stand test at similar timepoints. Clinicopathological data and survival data was collected, and cross-sectional imaging was used to determine cancer recurrence. RESULTS: Among 338 patients in the iROC trial, 319 patients received RC. Overall survival following RC was 87% (319-41/319) patients and RFS was 82% (319-57/319) over a median follow-up of 33 months. Wearable device data was available for 165 patients for analysis. There was no significant reduction in maximum step-counts at baseline (mean 9388 , SD 4552) when compared with 3-months post-operatively (mean 8792, SD 4055). Using clinicopathological features including age, gender, BMI, pathological T-stage and surgical margin, we demonstrated an AUC of 74% to predict RFS which improved slightly to 76% on adding activity and stamina data. For prediction of OS, using clinicopathological features demonstrated an AUC of 71%, which improved to 81% with the addition of activity and stamina data. Kaplan Meier analysis with patients divided into low and high risk groups by the final model showed an increased PFS (99% vs 59%) and OS (98% vs 53%) in 33 months after surgery. CONCLUSIONS: Mobility data may offer information which could add value to traditional prognostic models for survival. With new wearable devices, activity data can be remotely collected alongside other biometric data such as heart rate which may further improve models to predict RFS and OS. Download PPT Source of Funding: The Urology Foundation and The Champniss Foundation © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e793 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Pramit Khetrapal More articles by this author Yansong Liu More articles by this author Gareth Ambler More articles by this author Norman R. Williams More articles by this author Ashwin Sridhar More articles by this author Muhammad Shamim Khan More articles by this author Imran Ahmad More articles by this author Philip Charlesworth More articles by this author Sanjeev Kotwal More articles by this author Edward Rowe More articles by this author Vishwanath Hanchanale More articles by this author John McGrath More articles by this author Nikhil Vasdev More articles by this author Yukun Zhou More articles by this author James W. F. Catto More articles by this author Drobnjak Ivana More articles by this author John D. Kelly More articles by this author Expand All Advertisement PDF downloadLoading ...

CONTEXT:Differences in recovery, oncological, and quality of life (QoL) outcomes between open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC) for patients with bladder cancer are unclear. OBJECTIVE:This review aims to compare these outcomes within randomized trials of ORC and RARC in this context. The primary outcome was the rate of 90-d perioperative events. The secondary outcomes included operative, pathological, survival, and health-related QoL (HRQoL) measures. EVIDENCE ACQUISITION:Systematic literature searches of MEDLINE, Embase, Web of Science, and clinicaltrials.gov were performed up to May 31, 2022. EVIDENCE SYNTHESIS:Eight trials, reporting 1024 participants, were included. RARC was associated with a shorter hospital length of stay (LOS; mean difference [MD] 0.21, 95% confidence interval [CI] 0.03-0.39, p = 0.02) than and similar complication rates to ORC. ORC was associated with higher thromboembolic events (odds ratio [OR] 1.84, 95% CI 1.02-3.31, p = 0.04). ORC was associated with more blood loss (MD 322 ml, 95% CI 193-450, p < 0.001) and transfusions (OR 2.35, 95% CI 1.65-3.36, p < 0.001), but shorter operative time (MD 76 min, 95% CI 39-112, p < 0.001) than RARC. No differences in lymph node yield (MD 1.07, 95% CI -1.73 to 3.86, p = 0.5) or positive surgical margin rates (OR 0.95, 95% CI 0.54-1.67, p = 0.9) were present. RARC was associated with better physical functioning or well-being (standardized MD 0.47, 95% CI 0.29-0.65, p < 0.001) and role functioning (MD 8.8, 95% CI 2.4-15.1, p = 0.007), but no improvement in overall HRQoL. No differences in progression-free survival or overall survival were seen. Limitations may include a lack of generalization given trial patients. CONCLUSIONS:RARC offers various perioperative benefits over ORC. It may be more suitable in patients wishing to avoid blood transfusion, those wanting a shorter LOS, or those at a high risk of thromboembolic events. PATIENT SUMMARY:This study compares robot-assisted keyhole surgery with open surgery for bladder cancer. The robot-assisted approach offered less blood loss, shorter hospital stays, and fewer blood clots. No other differences were seen.

You have accessJournal of UrologyCME1 Apr 2023PD09-06 15-YEAR OUTCOMES OF ROBOT-ASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE INTERNATIONAL RADICAL CYSTECTOMY CONSORTIUM Usma Shabir, Jorge Daza, Grace Harrington, Mohammad Khan, Zuha Jaffar, Muhsinah Howlader, Claire Hannon, Zhe Jing, Jihad Kaouk, Bertram Yuh, James Peabody, Johar Raza Syed, Prokar Dasgupta, Mohammed Shamim Khan, Michael Stöckle, Eric Kim, Koon Rha, Peter Wiklund, Abolfazl Hosseini, Qiang Li, Ahmed A. Hussein, and Khurshid A. Guru Usma ShabirUsma Shabir More articles by this author , Jorge DazaJorge Daza More articles by this author , Grace HarringtonGrace Harrington More articles by this author , Mohammad KhanMohammad Khan More articles by this author , Zuha JaffarZuha Jaffar More articles by this author , Muhsinah HowladerMuhsinah Howlader More articles by this author , Claire HannonClaire Hannon More articles by this author , Zhe JingZhe Jing More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Bertram YuhBertram Yuh More articles by this author , James PeabodyJames Peabody More articles by this author , Johar Raza SyedJohar Raza Syed More articles by this author , Prokar DasguptaProkar Dasgupta More articles by this author , Mohammed Shamim KhanMohammed Shamim Khan More articles by this author , Michael StöckleMichael Stöckle More articles by this author , Eric KimEric Kim More articles by this author , Koon RhaKoon Rha More articles by this author , Peter WiklundPeter Wiklund More articles by this author , Abolfazl HosseiniAbolfazl Hosseini More articles by this author , Qiang LiQiang Li More articles by this author , Ahmed A. HusseinAhmed A. Hussein More articles by this author , and Khurshid A. GuruKhurshid A. Guru More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003240.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aimed to report the long-term follow-up of bladder cancer patients who underwent robot-assisted radical cystectomy (RARC) 15 years ago or more utilizing the International Radical Cystectomy Consortium (IRCC) database. METHODS: Patients who underwent RARC before 2007 were identified. Kaplan-Meier method was used to depict recurrence-free (RFS), disease-specific (DSS) and overall survival (OS). Multivariate COX regression model was used to identify the variables associated with RFS, DSS and OS. RESULTS: 271 patients were identified. Median follow-up time is 10 year (IQR 6-13) years. Twenty-five patients (10%) received neoadjuvant chemotherapy, 75 (28%) received neobladder, 117 (43%) had pT3/T4 and 63 (23%) had pN+ disease. RFS, DSS and OS were 60%, 63% and 30% at 15 years, respectively (Figure 1). Multivariate analysis showed that pT stage and pN+ remain the determinants of survival outcomes (Table 1). CONCLUSIONS: Locally advanced disease remains the main determinant of survival after RARC. Source of Funding: Vattikuti Foundation © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e241 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Usma Shabir More articles by this author Jorge Daza More articles by this author Grace Harrington More articles by this author Mohammad Khan More articles by this author Zuha Jaffar More articles by this author Muhsinah Howlader More articles by this author Claire Hannon More articles by this author Zhe Jing More articles by this author Jihad Kaouk More articles by this author Bertram Yuh More articles by this author James Peabody More articles by this author Johar Raza Syed More articles by this author Prokar Dasgupta More articles by this author Mohammed Shamim Khan More articles by this author Michael Stöckle More articles by this author Eric Kim More articles by this author Koon Rha More articles by this author Peter Wiklund More articles by this author Abolfazl Hosseini More articles by this author Qiang Li More articles by this author Ahmed A. Hussein More articles by this author Khurshid A. Guru More articles by this author Expand All Advertisement PDF downloadLoading ...

Urinary tract infection (UTI) is a common condition defined as the presence of bacteria within the urine above a certain threshold (usually >100,000 m/L). The lifetime risk in women is estimated to be 50%, of whom 25% will develop recurrence within 6 months. Unfortunately, the use of antibiotics to treat and manage recurrent UTI (rUTI) is a growing problem, due to the burden of growing antibiotic resistance on public health. As such, new approaches to manage rUTI are being investigated and developed. Competitive inoculation via instillation of Escherichia coli 83972 or HU2117 in the bladder is a new prophylactic non-antimicrobial therapy for rUTIs. It utilizes the principle of the protective nature of asymptomatic bacteriuria to prevent recurrence of symptomatic UTIs. However, the effectiveness and safety of this technique remains unclear. This systematic review examined the current outcomes data on competitive inoculation as an effective and safe treatment for rUTI prophylaxis. Based on a limited number of studies, current evidence suggests that competitive inoculation is an effective and safe prophylactic measure against UTIs in a select group of patients with incomplete bladder emptying. However, administration of the technology is both resource and time intensive, and there is strong data demonstrating low successful colonisation rates. Competitive inoculation is an alternative to antibiotics only to rUTI patients with incomplete bladder emptying. There is no evidence to suggest that the technology would be suitable for other subsets of rUTI patients. Further randomized controlled trials should be conducted to improve the evidence base before drawing conclusions for clinical practice, and ideas to improve colonisation rates and simplify the administration process should be explored.

You have accessJournal of UrologyCME1 Apr 2023PD36-12 MEASURING OBJECTIVE RECOVERY OF ACTIVITY LEVELS USING WEARABLE DEVICES FOLLOWING OPEN VS INTRACORPOREAL ROBOTIC CYSTECTOMY: SECONDARY OUTCOMES ANALYSIS OF THE IROC RANDOMIZED TRIAL Pramit Khetrapal, James Catto, Gareth Ambler, Norman Williams, Tarek Al-Hammouri, Muhammad Shamim Khan, Ramesh Thurairaja, Rajesh Nair, Senthil Nathan, Ashwin Sridhar, Imran Ahmad, Philip Charlesworth, Christopher Blick, Marcus Cumberbatch, Syed Hussain, Sanjeev Kotwal, Anthony Koupparis, John Mcgrath, Aidan Noon, Edward Rowe, Nikhil Vasdev, Parasdeep Bains, Vishwanath Hanchanale, and John Kelly Pramit KhetrapalPramit Khetrapal More articles by this author , James CattoJames Catto More articles by this author , Gareth AmblerGareth Ambler More articles by this author , Norman WilliamsNorman Williams More articles by this author , Tarek Al-HammouriTarek Al-Hammouri More articles by this author , Muhammad Shamim KhanMuhammad Shamim Khan More articles by this author , Ramesh ThurairajaRamesh Thurairaja More articles by this author , Rajesh NairRajesh Nair More articles by this author , Senthil NathanSenthil Nathan More articles by this author , Ashwin SridharAshwin Sridhar More articles by this author , Imran AhmadImran Ahmad More articles by this author , Philip CharlesworthPhilip Charlesworth More articles by this author , Christopher BlickChristopher Blick More articles by this author , Marcus CumberbatchMarcus Cumberbatch More articles by this author , Syed HussainSyed Hussain More articles by this author , Sanjeev KotwalSanjeev Kotwal More articles by this author , Anthony KoupparisAnthony Koupparis More articles by this author , John McgrathJohn Mcgrath More articles by this author , Aidan NoonAidan Noon More articles by this author , Edward RoweEdward Rowe More articles by this author , Nikhil VasdevNikhil Vasdev More articles by this author , Parasdeep BainsParasdeep Bains More articles by this author , Vishwanath HanchanaleVishwanath Hanchanale More articles by this author , and John KellyJohn Kelly More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003334.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy is associated with significant morbidity and extended recovery time. No previous randomized trials have used objective measures such as fitness trackers to measure recovery in mobility. In this study, we compare recovery of mobility in open and intracorporeal robotic cystectomy in the randomised setting of the iROC trial. METHODS: The iROC randomized trial (ClinicalTrials.gov Identifier: NCT03049410) compared recovery following iRARC vs ORC for bladder cancer. Physical activity levels were measured by collecting mean and maximum number of steps taken per day over a 7-day period using Misfit Shine (Fossil Group Inc.) and number of chair-to-stands (CTS) in 30 seconds at baseline, as well as 5 days, 5 weeks and 12 weeks post-operatively. Complications in the post-operative period were measured using the Clavien-Dindo (CD) classification at 30 days (early) and 90 days (late). RESULTS: Among 260 patients who provided wearable device data, there was no difference in average (iRARC 6430 (SD 3189) vs ORC 6550 (SD 2864)) or maximum (iRARC 9659 (SD 5238) vs ORC 9525 (SD 4039)) step-counts at baseline. There was no significant difference in absolute step-counts between iRARC and ORC at any of the post-operative timepoints. However, there was a significant difference in recovery of average steps (iRARC 34.7% vs ORC 24.6%, p=0.042) but not maximum steps favoring iRARC at the 5-day timepoint when compared to baseline, no difference was noted in other timepoints. Recovery of CTS was significantly different at 5 weeks (iRARC 84.6% vs ORC 74.0%, p=0.013) favoring iRARC, but not at 5 days or 12 weeks post-operatively. Early and late major complications (CD≥3) were associated with a delayed recovery of maximum steps at 5 weeks (p=0.014) and 12 weeks (p=0.019) respectively, with no difference in average step-counts. CONCLUSIONS: Wearable devices offer a new way to measure post-operative recovery. In the randomized setting, iRARC was associated with faster recovery of mobility in the early post-operative period (5 days post-operatively), but this effect was not sustained into the 5th week post-operatively. However, recovery in CTS counts were significantly different at 5 weeks and may be more useful in capturing differences in the later peri-operative period. Major complications were associated with a delayed recovery in step-counts. Source of Funding: The Urology Foundation and the Champniss Foundation © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e985 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pramit Khetrapal More articles by this author James Catto More articles by this author Gareth Ambler More articles by this author Norman Williams More articles by this author Tarek Al-Hammouri More articles by this author Muhammad Shamim Khan More articles by this author Ramesh Thurairaja More articles by this author Rajesh Nair More articles by this author Senthil Nathan More articles by this author Ashwin Sridhar More articles by this author Imran Ahmad More articles by this author Philip Charlesworth More articles by this author Christopher Blick More articles by this author Marcus Cumberbatch More articles by this author Syed Hussain More articles by this author Sanjeev Kotwal More articles by this author Anthony Koupparis More articles by this author John Mcgrath More articles by this author Aidan Noon More articles by this author Edward Rowe More articles by this author Nikhil Vasdev More articles by this author Parasdeep Bains More articles by this author Vishwanath Hanchanale More articles by this author John Kelly More articles by this author Expand All Advertisement PDF downloadLoading ...

Due to its advantages over open surgery and conventional laparoscopy, uptake of robot-assisted surgery has rapidly increased. It is important to know whether the existing open or laparoscopic skills of robotic novices shorten the robotic surgery learning curve, potentially reducing the amount of training required. This systematic review aims to assess psychomotor skill transfer to the robot in clinical and simulated settings. PubMed, EMBASE, Cochrane Library and Scopus databases were systematically searched in accordance with PRISMA guidelines from inception to August 2021 alongside website searching and citation chaining. Article screening, data extraction and quality assessment were undertaken by two independent reviewers. Outcomes included simulator performance metrics or in the case of clinical studies, peri- and post-operative metrics. Twenty-nine studies met the eligibility criteria. All studies were judged to be at high or moderate overall risk of bias. Results were narratively synthesised due to heterogeneity in study designs and outcome measures. Two of the three studies assessing open surgical skill transfer found evidence of successful skill transfer while nine of twenty-seven studies evaluating laparoscopic skill transfer found no evidence. Skill transfer from both modalities is most apparent when advanced robotic tasks are performed in the initial phase of the learning curve but quality and methodological limitations of the existing literature prevent definitive conclusions. The impact of incorporating laparoscopic simulation into robotic training curricula and on the cost effectiveness of training should be investigated.

You have accessJournal of UrologyCME1 May 2022PD42-02 RESULTS OF THE INTRACORPOREAL ROBOTIC VS OPEN CYSTECTOMY (IROC) MULTI-CENTRE RANDOMISED TRIAL Pramit Khetrapal, James Catto, Gareth Ambler, Frederico Ricciardi, Shamim Khan, Andrew Feber, Simon Dixon, Norman Williams, Imran Ahmed, Philip Charlesworth, Marcus Cumberbatch, Syed Hussain, Aidan Noon, Sanjeev Kotwal, Edward Rowe, Anthony Koupparis, John McGrath, Nikhil Vasdev, Chris Brew-Graves, Daryl Hagan, John Kelly, and iROC Trial Study Group Pramit KhetrapalPramit Khetrapal More articles by this author , James CattoJames Catto More articles by this author , Gareth AmblerGareth Ambler More articles by this author , Frederico RicciardiFrederico Ricciardi More articles by this author , Shamim KhanShamim Khan More articles by this author , Andrew FeberAndrew Feber More articles by this author , Simon DixonSimon Dixon More articles by this author , Norman WilliamsNorman Williams More articles by this author , Imran AhmedImran Ahmed More articles by this author , Philip CharlesworthPhilip Charlesworth More articles by this author , Marcus CumberbatchMarcus Cumberbatch More articles by this author , Syed HussainSyed Hussain More articles by this author , Aidan NoonAidan Noon More articles by this author , Sanjeev KotwalSanjeev Kotwal More articles by this author , Edward RoweEdward Rowe More articles by this author , Anthony KoupparisAnthony Koupparis More articles by this author , John McGrathJohn McGrath More articles by this author , Nikhil VasdevNikhil Vasdev More articles by this author , Chris Brew-GravesChris Brew-Graves More articles by this author , Daryl HaganDaryl Hagan More articles by this author , John KellyJohn Kelly More articles by this author , and iROC Trial Study Group More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002603.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The role of minimal access surgery using a robotic platform to perform radical cystectomy and intracorporeal diversion is unclear and the potential for gain such as early recovery and reduced complication rates are largely based on observational case series. METHODS: The iROC trial is the first RCT comparing intracorporeal robot-assisted RC (iRARC) vs open RC (ORC). Nine centres in the UK recruited patients into the iROC trial with a 1:1 randomisation. The primary endpoint of the trial was days alive and out of hospital within 90 days following surgery (90DAOH). Secondary outcomes were survival, complications, physical activity, quality of life (QoL) and cancer recurrenceTrial registration: ISRCTN13680280 and NCT03049410. RESULTS: 338 patients were randomised, of which 317 had cystectomy and 21 did not have cystectomy. Of these, 301 (95.0%) received their allocated approach. Most participants were male (78.9%), the average age was 69 years (SD 8.2), 19 (6.0%) were over 80 years old and most were current or ex-smokers (71%). 34% received neoadjuvant chemotherapy. Most patients underwent ileal conduit reconstruction (89%). Patients randomised to iRARC spent more days out of hospital (median 82 days (IQR 76 to 84)) than those receiving Open RC (80 (72 to 83 days (72 to 83) for ORC (p=0.012); adj. p=0.012) within 90 days of surgery. This reflected shorter lengths of stay (iRARC median 7 days (6 to 10) versus ORC 8 (6 to 14)) and fewer readmissions. 6 (1.8%) participants died within 90 days of surgery (including 4 who received ORC). Differences were seen in the rate and type of post-operative complications. WHODAS 2.0 and EORTC QLQ-C30 QoL scores reported improved outcomes from iRARC compared to ORC until 12 weeks post-op, but were similar by 26 weeks. Activity levels measured by fitness trackers were significantly higher in the immediate post-operative period, but not significantly different by 5 weeks post-operatively. No difference in cancer recurrence or overall survival was seen. CONCLUSIONS: In this trial, patients undergoing iRARC spent fewer days in hospital within 90 days of surgery, and may offer quicker recovery than ORC. No difference was detected in overall or cancer specific survival. Source of Funding: Funded by The Urological Foundation and the Champniss Foundation © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e695 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pramit Khetrapal More articles by this author James Catto More articles by this author Gareth Ambler More articles by this author Frederico Ricciardi More articles by this author Shamim Khan More articles by this author Andrew Feber More articles by this author Simon Dixon More articles by this author Norman Williams More articles by this author Imran Ahmed More articles by this author Philip Charlesworth More articles by this author Marcus Cumberbatch More articles by this author Syed Hussain More articles by this author Aidan Noon More articles by this author Sanjeev Kotwal More articles by this author Edward Rowe More articles by this author Anthony Koupparis More articles by this author John McGrath More articles by this author Nikhil Vasdev More articles by this author Chris Brew-Graves More articles by this author Daryl Hagan More articles by this author John Kelly More articles by this author iROC Trial Study Group More articles by this author Expand All Advertisement PDF DownloadLoading ...