Testicular metastases from prostate carcinoma are exceedingly uncommon, particularly from the ductal histological subtype, which is associated with aggressive clinical behavior and a propensity for atypical metastatic dissemination. We report the case of a 73-year-old male with a history of prostate ductal adenocarcinoma (PDA) treated in 2018 with robot-assisted radical prostatectomy (RARP) and extended pelvic lymphadenectomy. Pathological staging was pT2c R0 N0 (0/53 nodes), and postoperative PSA was undetectable. The patient remained free of recurrence for 5 years. In March 2023, a biochemical recurrence prompted repeated thoracoabdominal computed tomography (CT) and pelvic magnetic resonance imaging (MRI) scans; neither study included dedicated scrotal imaging, and both were negative for recurrence. By March 2024, serum PSA had increased to 5.6 ng/mL, coinciding with the onset of progressive, painless enlargement of the left testicle. Scrotal ultrasonography revealed a solid mass replacing the left testicular parenchyma. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) and choline PET/CT showed a hypermetabolic lesion confined to the left testis, with no evidence of extratesticular disease. The patient underwent left inguinal orchiectomy. Histopathological examination revealed metastatic adenocarcinoma with papillary architecture, morphologically consistent with ductal prostate origin. PSA levels declined rapidly postoperatively, reaching 0.07 ng/mL within 40 days. At 13-month follow-up, the patient remained clinically and biochemically free of disease without further treatment. This case represents one of the few documented instances of solitary testicular metastasis from PDA. It underscores the importance of continued PSA monitoring and highlights that isolated testicular involvement, whereas rare, may confer a more favorable prognosis than typically expected in metastatic PDA. In selected cases, orchiectomy may serve both diagnostic and therapeutic roles, supporting a conservative postoperative approach.

Figure 4. (a) Post-temporary vascular occlusion (TeVO) digital subtraction angiography (DSA) of the celiac artery showed preserved patency of all Segment 6 and 7 arteries, including the one temporarily occluded with the coil (arrow). (b) Post- yttrium-90 radioembolization coronal reformat of bremsstrahlung single photon emission computed tomography/computed tomography (SPECT/CT) demonstrated uptake in the tumor and adjacent Segment 6 liver parenchyma with minimal uptake in

BackgroundThe coronavirus disease (COVID-19) pandemic has posed challenges to the global health care community, affecting the management of upper urinary tract stones. Materials and methodsThis retrospective study involved 9 Italian centers. We compared the 12-month period prior to COVID-19 (March 1, 2019, to February 28, 2020; Period A) with the COVID-19 period (March 1, 2020, to February 28, 2021, Period B). This study aimed to compare outcomes during Periods A and B, specifically focusing on the overall number of treatments, rate of urgent/elective cases, and operational complexity. ResultsA total of 4018 procedures were collected, comprising 2176 procedures during Period A and 1842 during Period B, indicating a loss of 15.35% (p < 0.001). In the elective cases, 1622 procedures were conducted in Period A, compared with 1280 in Period B, representing a 21.09% reduction in cases (p = 0.001). All types of stone treatments were affected: extracorporeal shock wave lithotripsy (-29.37%, p = 0.001), percutaneous nephrolithotomy (-26.47%, p = 0.008), retrograde surgeries for renal stones (-10.63%, p = 0.008), and semirigid ureterolithotripsy (-24.86%, p = 0.008). Waiting lists experienced significant delays during Period B. The waiting time (WT) for elective procedures increased during Period B (p < 0.001). For ureteral stones, the mean WT in Period A was 61.44 days compared with 86.56 days in Period B (p = 0.008). The WT for renal stones increased from 64.96 days in Period A to 85.66 days in Period B for retrograde intrarenal surgery (p = 0.008) and from 96.9 days to 1103.9 days (p = 0.035) for percutaneous nephrolithotomy procedures. ConclusionsOur study demonstrates that COVID-19 significantly disrupted endourological services across the country. Our data underline how patients received treatment over a prolonged period, potentially increasing the risk of stone-related complications and patient discomfort.

OBJECTIVES:To verify if the maximum thickness of the ureteral wall at the stone site (m-UWT) can affect the outcomes of primary retrograde ureteroscopic lithotripsy (P-URSL) within a single-center dataset. MATERIAL AND METHODS:We retrospectively reviewed data on 354 consecutive URSL performed from January 2020 to May 2022 at "Fondazione Poliambulanza" in Brescia (Italy). We included patients older than 18 years who underwent URSL for a single ureteral stone with a maximum diameter ranging from 5 to 10 mm. Patients with anatomical abnormalities, a positive preoperative urinary culture, or without a NCCT performed during the acute event were excluded. Patients were treated in an emergency setting (P-URSL within 48 h from the diagnosis of acute ureteral colic) or in a delayed one (D-URSL after a period of maximum 90 days of ureteral double-j stenting). For the resulting 139 patients we recorded demographic, clinical and stone-related features and perioperative data. We processed these data by univariate and multivariate analysis, and with a logistic regression analysis. RESULTS:Of the 139 included procedures, 63 were P-URSL and 76 D-URSL. At the univariate analysis we found that stone diameter (OR 0.845, p = 0.017), stone volume (OR 0.023, p = 0.001), stone density (OR 0.998, p = 0.000) and m-UWT (OR 0.499, p = 0.013) are predictors of P-URSL. Stone density (OR 0.998, p = 0.002) is an independent predictor of P-URSL at the multivariate analysis. At a logistic regression analysis, a distal ureteric position (OR 0.189, p = 0.014), stone diameter (OR 1.289, p = 0.006), and m-UWT (OR 2.297, p = 0.02) were found to be statistically significant predictors of incomplete stone clearance in patients undergoing P-URSL. m-UWT is the only predictor of short-term postoperative adverse events in patients undergoing P-URSL (OR 3.386, p < 0.001). From a descriptive analysis, it emerged that an increased m-UWT (>2 mm) significantly correlates to an endoscopic finding of ureteritis' signs and to an increase in operative time, hospital stay and post-procedural stenting time. A m-UWT greater than 2 mm also correlates with a lower stone free rate (SFR) and with a significant increase in both short and long-term postoperative complications. CONCLUSIONS:Our study confirmed a connection between m-UWT and poor endoscopic findings, as well as a direct correlation with the main morphometric parameters of the stone and finally with the outcomes of P-URSL itself. Further studies are necessary to validate our results, so that m-UWT might be routinely considered a useful tool in the decision-making process for P-URSL.

Background and ObjectivesAge might influence the choice of surgical approach, type of urinary diversion (UD) and lymph node dissection (LND) in patients candidate to radical cystectomy (RC) for urothelial bladder cancer (UBC). Similarly, age may enhance surgical morbidity and worsen perioperative outcomes. We tested the impact of age (octogenarian vs. younger patients) on surgical decision making and peri- and postoperative outcomes of RC. MethodsNon-metastatic muscle-invasive UBC patients treated with RC at 18 high-volume European institutions between 2006 and 2021 were identified and stratified according to age (>= 80 vs. <80 years). Intraoperative Complications Assessment and Reporting with Universal Standards and European Association of Urology guidelines recommendations were accomplished in collection and reporting of, respectively, intraoperative and postoperative complications. Multivariable logistic regression models (MVA) tested the impact of age on outcomes of interest. Sensitivity analyses after 1:3 propensity score matching were performed. ResultsOf 1955 overall patients, 251 (13%) were >= 80-year-old. Minimally invasive RC was performed in 18% and 40% of octogenarian and younger patients, respectively (p < 0.001). UD without bowel manipulation (ureterocutaneostomy, UCS) was performed in 31% and 7% of octogenarian and younger patients (p < 0.001). LND was delivered to 81% and 93% of octogenarian and younger patients (p < 0.001). At MVA, age >= 80 years independently predicted open approach (odds ratio [OR]: 1.55), UCS (OR: 3.70), and omission of LND (OR: 0.41; all p <= 0.02).Compared to their younger counterparts, octogenarian patients experienced higher rates of intraoperative (8% vs. 4%, p = 0.04) but not of postoperative complications (64% vs. 61%, p = 0.07). At MVA, age >= 80 years was not an independent predictor of length of stay, intraoperative or postoperative transfusions and complications, and readmissions (all p values >0.1). These results were replicated in sensitivity analyses. ConclusionsAge >= 80 years does not independently portend worse surgical outcomes for RC. However, octogenarians are unreasonably more likely to receive open approach and UCS diversion, and less likely to undergo LND.

You have accessJournal of UrologyCME1 May 2022MP23-11 PERIOPERATIVE COMPLICATIONS AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER: AN INTERNATIONAL MULTICENTER COLLABORATION Chiara Lonati, Luca Afferi, Ettore Di Trapani, Stefania Zamboni, Claudio Simeone, Alberto Briganti, Francesco Montorsi, Giuseppe Simone, Francesco Soria, M. Carmen Mir, Rafael Sanchez-Salas, Mathieu Roumiguié, Alessandro Antonelli, Kees Hendricksen, Agostino Mattei, Christian D. Fankhauser, Roberto Carando, Jeremy Y.C. Teoh, Shahrokh F. Shariat, Simone Albisinni, Rodolfo Hurle, Angelo Peroni, Evanguelos Xylinas, Wojciech Krajewski, Morgan Roupret, and Marco Moschini Chiara LonatiChiara Lonati More articles by this author , Luca AfferiLuca Afferi More articles by this author , Ettore Di TrapaniEttore Di Trapani More articles by this author , Stefania ZamboniStefania Zamboni More articles by this author , Claudio SimeoneClaudio Simeone More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , Francesco SoriaFrancesco Soria More articles by this author , M. Carmen MirM. Carmen Mir More articles by this author , Rafael Sanchez-SalasRafael Sanchez-Salas More articles by this author , Mathieu RoumiguiéMathieu Roumiguié More articles by this author , Alessandro AntonelliAlessandro Antonelli More articles by this author , Kees HendricksenKees Hendricksen More articles by this author , Agostino MatteiAgostino Mattei More articles by this author , Christian D. FankhauserChristian D. Fankhauser More articles by this author , Roberto CarandoRoberto Carando More articles by this author , Jeremy Y.C. TeohJeremy Y.C. Teoh More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat More articles by this author , Simone AlbisinniSimone Albisinni More articles by this author , Rodolfo HurleRodolfo Hurle More articles by this author , Angelo PeroniAngelo Peroni More articles by this author , Evanguelos XylinasEvanguelos Xylinas More articles by this author , Wojciech KrajewskiWojciech Krajewski More articles by this author , Morgan RoupretMorgan Roupret More articles by this author , and Marco MoschiniMarco Moschini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002562.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate incidence of perioperative complications after radical cystectomy (RC) for bladder cancer (BCa), assessing risk factors for intra- and post-operative complications. METHODS: We retrospectively analyzed data of 4,731 patients treated with RC for BCa among 25 tertiary referral centers between 2001 and 2020. Intra-operative complications included gastrointestinal (GI), vascular, nerve injury, position-related skin and peripheral nerve lesion, and death. Post-operative complications were coded as early (<30 days) and late (30-90 days) complications, including infectious, GI, genitourinary (GU), hematological, cardiac, wound complications, and death. Multivariable logistic regression models (LGRs) were applied to evaluate independent predictors of intra- and post-operative complications; covariates consisted of demographic features and perioperative outcomes. RESULTS: Open, laparoscopic, and robotic RC were performed in 69.1%, 10.7%, 20.2% of patients, respectively; conversion from robotic to open technique was recorded in 3 patients. Overall, 3.8% of patients experienced intra-operative complications: vascular injury occurred in 40.6% of cases, followed by GI injury (32.8%); intra-operative death occurred in 1.1% of cases (Fig. 1A). Overall, 64.1% of patients experienced post-operative complications (early: 57.6% and late: 17.9%). Infectious complications occurred in 26% of patients, followed by anemia (20.3%), and GI (18.3%) complications. Death due to early and late complications occurred in 1.5% and 0.6% of patients, respectively (Fig. 1B). At multivariable LGMs prior abdominal surgery (odd ratio [OR]: 1.87; p=0.005) and surgeon experience (>250 RC/surgeon: OR: 0.27; p=0.003) were independent predictors of intra-operative complications, while female gender (OR: 0.66; p=0.03), anticoagulant therapy (OR: 2.05; p=0.04), and post-operative transfusions (OR: 4.84; p <0.001) were independent predictors of post-operative complications. Surgical RC technique was not an independent predictor of complication. CONCLUSIONS: RC is still burden with an increased rate of perioperative complications. Risk factors for perioperative complications include scarce surgeon experience, prior abdominal surgery, and post-operative transfusions. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e385 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chiara Lonati More articles by this author Luca Afferi More articles by this author Ettore Di Trapani More articles by this author Stefania Zamboni More articles by this author Claudio Simeone More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Giuseppe Simone More articles by this author Francesco Soria More articles by this author M. Carmen Mir More articles by this author Rafael Sanchez-Salas More articles by this author Mathieu Roumiguié More articles by this author Alessandro Antonelli More articles by this author Kees Hendricksen More articles by this author Agostino Mattei More articles by this author Christian D. Fankhauser More articles by this author Roberto Carando More articles by this author Jeremy Y.C. Teoh More articles by this author Shahrokh F. Shariat More articles by this author Simone Albisinni More articles by this author Rodolfo Hurle More articles by this author Angelo Peroni More articles by this author Evanguelos Xylinas More articles by this author Wojciech Krajewski More articles by this author Morgan Roupret More articles by this author Marco Moschini More articles by this author Expand All Advertisement PDF DownloadLoading ...

Introduction The Immune compleX Predictive Index (iXip) is a predictive tool for prostate cancer (PCa) diagnosis that integrates PSA, PSA-IgM, prostate volume, and patient age. The aim of the study was to assess the correlation between iXip and clinically significant PCa in patients who underwent radical prostatectomy. Material and Methods A prospective multicenter study was conducted from February 2018 to August 2019 enrolling 235 patients. Stepwise-selected predictors were used to estimate multivariate regression models for each outcome, the reference model with only the set of predictors and the same model with the addition of iXip. The prediction accuracy of the two models was assessed calculating the partial area under the receiver operating characteristic curve. Results The ROC curve analysis showed significant differences in terms of partial area under the curve between iXip and pathological Gleason Score ≥ 7 and between iXip and tumor volume ≥ 2.5 mm3. The scatter plot analysis showed a positive linear correlation between iXip and tumor volume (considered as a continuous variable). The subpopulations with pT3–4 disease and cT3 disease and with positive surgical margins showed a significant linear relationship between iXip and tumor volume. Conclusion We found elements supporting a possible correlation between iXip and aggressive PCa in terms of Gleason Score ≥ 7 and tumor volume ≥ 2.5 mm3.

Background: Lombardy has been the first and one of the most affected European regions during the first and second waves of the novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]). Objective: To evaluate the impact of coronavirus disease 2019 (COVID-19) on all urologic activities over a 17-wk period in the three largest public hospitals in Lombardy located in the worst hit area in Italy, and to assess the applicability of the authorities' recommendations provided for reorganising urology practice. Design, setting, and participants: A retrospective analysis of all urologic activities performed at three major public hospitals in Lombardy (Brescia, Bergamo, and Milan), from January 1 to April 28, 2020, was performed. Outcome measurements and statistical analysis: Join-point regression was used to identify significant changes in trends for all urologic activities. Average weekly percentage changes (AWPCs) were estimated to summarise linear trends. Uro-oncologic surgeries performed during the pandemic were tabulated and stratified according to the first preliminary recommendations by Stensland et al (Stensland KD, Morgan TM, Moinzadeh A, et al. Considerations in the triage of urologic surgeries during the COVID-19 pandemic. Eur Urol 2020;77:663-6) and according to the level of priority recommended by European Association of Urology guidelines. Results and limitations: The trend for 2020 urologic activities decreased constantly from weeks 8-9 up to weeks 11-13 (AWPC range -41%, -29.9%; p < 0.001). One-third of uro-oncologic surgeries performed were treatments that could have been postponed, according to the preliminary urologic recommendations. High applicability to recommendations was observed for non-muscle-invasive bladder cancer (NMIBC) patients with intermediate/emergency level of priority, penile and testicular cancer patients, and upper tract urothelial cell carcinoma (UTUC) and renal cell carcinoma (RCC) patients with intermediate level of priority. Low applicability was observed for NMIBC patients with low/high level of priority, UTUC patients with high level of priority, prostate cancer patients with intermediate/high level of priority, and RCC patients with low level of priority. Conclusions: During COVID-19, we found a reduction in all urologic activities. High-priority surgeries and timing of treatment recommended by the authorities require adaptation according to hospital resources and local incidence. Patient summary: We assessed the urologic surgeries that were privileged during the first wave of coronavirus disease 2019 (COVID-19) in the three largest public hospitals in Lombardy, worst hit by the pandemic, to evaluate whether high-priority surgeries and timing of treatment recommended by the authorities are applicable. Pandemic recommendations provided by experts should be tailored according to hospital capacity and different levels of the pandemic. (C) 2021 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology.

ABSTRACT Introduction: Vesico-vaginal fistula (VVF) is a rare event in Western countries and are mainly consequent to iatrogenic injuries (1, 2). When conservative management fails, surgical repair is needed, although timing and surgical approach (open or minimally invasive (3)) are still controversial (4, 5). Herein we present a step-by-step description of robot-assisted vesico-vaginal fistula repair. Material and Methods: From 2015 to 2018 six patients underwent robotic vesico-vaginal fistula repair. Pre-operative cystoscopy was performed to identify the fistulous tract. The ureters were stented. A small catheter was inserted in the fistula. A longitudinal cystotomy was performed, then a dissection of the posterior bladder from the anterior vaginal wall was performed and the fistolous tract was excised. The vagina was sutured horizontally. Four patients underwent omental flap and two pericolic fat interposition. The bladder was closed with a double-layer suture. Results: All the vesico-vaginal fistulas developed after previous gynaecological surgery. The median operative time was 160 minutes [interquartile range (IQR) (146-177)]. Intraoperative blood loss was 25 (IQR 0-50) mL. No post-operative complications were recorded. Ureteral stents were removed at 4th post-operative day. Catheter was removed 13 (IQR 11-15) days after surgery after cystography assessment. One patient had Clavien I complication (ileus). Surgical pathology report was negative. No fistula recurrence was reported during follow-up. Conclusions: In our experience, robot-assisted fistula repair is a feasible and safe procedure. It presents the advantages of minimally invasive approaches and seems to provide low morbidity and good outcomes. Compared to transvaginal approach, the robotics allows to manage more complex cases with high success rate (6).

BACKGROUND:Preoperative surgical planning before partial nephrectomy (PN) is a time-consuming and fragmentary process.OBJECTIVES:To evaluate the differences in the perception of renal anatomy between holographic reconstruction (HR) versus computed tomography (CT) in patients who are candidate to PN.METHODS:CT scans of 10 consecutive patients with intermediate/high complexity renal masses (R.E.N.A.L. score > 8) scheduled for robot-assisted PN were translated into HR. Seven raters independently described how they interpreted several anatomical details from CT and HR respectively. The exams were presented unpaired and randomly. Inter-observer agreement and evaluation time were assessed. A questionnaire inquired clinical utility of CT and HR. Inter-observer agreement was measured by the Cohen's kappa test. Evaluation time for CT and HR was compared by the Kruskal-Wallis test, overall and per rater. Examiners answered to the questionnaire following a Likert scale.RESULTS:HR showed a higher inter-observer agreement, reaching a good level (k > 0.6) for almost all the anatomical details considered. Conversely, CT generally provided a fair or poor agreement (k < 0.6). The evaluation time was shorter for HR (mean 1.7 vs. 3.4 min, p < 0.0001). All raters declared that HR could facilitate preoperative planning before PN.CONCLUSIONS:HR can be useful for preoperative surgical planning before PN to ease the understanding of anatomy.

OBJECTIVE:To show how to perform a robot-assisted partial nephrectomy and bilateral pyelolithotomy in ectopic pelvic kidneys. This is a congenital abnormality of position and rotation1 frequently associated with urolithiasis.2 Renal cell carcinoma is a very rare event in pelvic kidneys.3,4 These 2 findings in the same patient could be a surgical challenge and whenever possible a "one stage" treatment is preferred.MATERIALS AND METHODS:A 44-year-old male with bilateral pelvic kidneys admitted because of left back pain. Abdominal CT scan showed a 17 mm stone in the left renal pelvis, a 12 mm stones in the right pelvis and a 34 × 27 mm right lower pole renal mass. A robotic surgery was indicated. Patient was placed in Trendelenburg position with ports configuration as for transperitoneal radical prostatectomy. The right kidney was firstly approached: after isolation of the ureter and suspension of the renal artery, a clampless partial nephrectomy was performed; then through a longitudinal pyelotomy the stone was extracted. To minimize the opening of the posterior peritoneum covering the left kidney, the site of the stone was identified by intraoperative ultrasound; then, through a longitudinal pyelotomy the stone was extracted. Given the watertight sutures and the lack of ureteral obstructions no pigtails ureteral catheters were inserted. A Jackson-Pratt drainage was placed through the inferior port.RESULTS:Consolle time was 190 minutes. Estimated Blood Loss (EBL) was 50 ml. No complications were reported. The drain was removed on the second postoperative day, assessed that creatinine dosage was equal to serum. The length of stay was 4 days. Histopathology showed a pT1a G2 clear cell renal cell carcinoma with negative surgical margins, while stones analysis was calcium oxalate.CONCLUSION:With the availability of robotic technology, the indications for minimally invasive surgery may be safely expanded to include concomitant morbidities in uncommon presentations.

INTRODUCTION AND OBJECTIVES: Ductal carcinoma of the prostate (DAC) is a rare histological subtype of prostate cancer (PC).Although it is reported to be an aggressive tumor, often with locally advanced and/or metastatic disease at presentation, the available literature still lacks of reports on treatment recommendations since there are still controversies about the optimal therapeutic approach.We present our 20-year outcome of multidisciplinary management of non-metastatic DAC (nmDAC).METHODS: A retrospective analysis of our Institutional Urology-Radiation Oncology database was performed.Patients (pts) with nmDAC undergoing radical treatment were included.All these pts were discussed at our multidisciplinary Oncology board in order to highly personalize the treatment.The cohort was divided into three groups according to received treatment: group A surgery (either radical prostatectomy or cystectomy), group B surgery and post-operative radiation therapy (RT, either adjuvant or salvage) and group C RT alone.Kaplan-Meier method was used to estimate survival outcome, after adjusting for predictive variable (age, comorbidities, pathological stage, histology).Statistical analysis was performed using SPSSv20, considering statistically significant p value <0,05.RESULTS: The features of the population in study are summarized in Table 1.From 1997 to 2016, about 8470 PC pts underwent radical treatment at our Institution, 71 were diagnosed with nmDAC (0.84%): group A with 21 patients (29.6%), group B 27 (38%) and group C 23 (32.4%).Histological examination showed 17 pure DAC (23.9%) and 56 mixed DAC and acinar adenocarcinoma (78.9%).At a median follow-up time of 60 and 120 months, overall survival (OS) was 86% and 70% respectively for group A, 100% and 92% for group B, 65% and 49% for group C (p¼0.054).Pure DAC undergoing surgery showed an OS at a median follow up of 60 months of 34%, while adding post-operative RT leads to a OS of 100% (p¼0.029).CONCLUSIONS: DAC is a rare, often aggressive subtype of PC, especially in pure form.Our large series seems to support the role of a radical, aggressive, combined therapeutic approach, when feasible, in order to achieve better local disease control and long-term survival outcome.

PurposeProspective randomized trial to compare standard vs delayed approach to dorsal vascular complex (s-DVC vs d-DVC) in robot-assisted radical prostatectomy (RARP).MethodsPatients scheduled for RARP were randomized into a 1:1 ratio to receive either s-DVC or d-DVC by two experienced surgeons. In s-DVC arm an eight-shaped single stitch was given at the beginning of the procedure and the DVC was subsequently cut at time of apical dissection; in d-DVC arm the plexus was transected at the end of prostatectomy, prior to apex dissection and then sutured. Primary endpoint was difference in estimated blood loss (EBL) and a sample size of 226 cases was calculated; ad interim analysis was planned after 2/3 of recruitment.ResultsEndpoint was reached at ad interim analysis after 162 cases (81s-DVC, 81 d-DVC) and recruitment was, therefore, interrupted. Baseline and tumor characteristics were overlapping. EBL was significantly higher in d-DVC arm (mean EBL 107 vs 65ml, p=0.003), but without differences in post-operative hemoglobin, transfusions and complications. Overall PSM rate was higher in d-DVC arm (21.0 vs 14.8%, p=0.323), with statistical significance relatively to organ-confined disease (15.5 vs 3.6%, p=0.031). Apical involvement was instead significantly higher in s-DVC arm (prevalence in PSM patients 66.7 vs 23.5%, p=0.020). Post-operative PSA, continence and potency rates were similar between groups.ConclusionsStandard and delayed approaches to DVC are safe and lead to similar functional outcomes. A delayed approach exposes to a higher risk of PSM in organ-confined disease but with a lower risk of apical involvement.

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II1 Apr 2018MP11-02 OUTCOMES OF A PHASE III RANDOMIZED CONTROLLED TRIAL COMPARING PREVENTIVE VERSUS DELAYED LIGATION OF DORSAL VASCULAR COMPLEX DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY Carlotta Palumbo, Alessandro Antonelli, Simone Francavilla, Marco Lattarulo, Stefania Zamboni, Alessandro Veccia, Maria Furlan, Enrico De Marzo, Angelo Peroni, and Claudio Simeone Carlotta PalumboCarlotta Palumbo More articles by this author , Alessandro AntonelliAlessandro Antonelli More articles by this author , Simone FrancavillaSimone Francavilla More articles by this author , Marco LattaruloMarco Lattarulo More articles by this author , Stefania ZamboniStefania Zamboni More articles by this author , Alessandro VecciaAlessandro Veccia More articles by this author , Maria FurlanMaria Furlan More articles by this author , Enrico De MarzoEnrico De Marzo More articles by this author , Angelo PeroniAngelo Peroni More articles by this author , and Claudio SimeoneClaudio Simeone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.368AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The ligation of the dorsal vascular complex (DVC) during robot-assisted radical prostatectomy (RARP) can be done either before (preventive ligation, PL) or after (delayed ligation, DL) its transection. We evaluated in a prospective randomized setting whether a DL of the DVC impacted on perioperative, functional and oncological outcomes as compared to PL during RARP. METHODS After IRB approval, patients submitted to RARP and provided an informed consent were randomized. RARP was performed through a transperitoneal approach with either PL (1-0 Monocryl® CT-1, before bladder neck dissection) or DL (3-0 Monocryl® UR-6, once the prostatectomy completed). Primary endpoint was estimated blood loss (EBL); considering significant a difference ?30 ml, a sample size of 226 patients were calculated (two-sided a of 0.05 and 80% power). Secondary endpoints were: transfusion rate, positive surgical margins (PSMs), apical PSMs and 1-month PSA and continence (0-1 security pad/day). Differences were compared using Pearson chi-square test or Mann-Whitney test as appropriate (p<0.05 was considered statistically significant). RESULTS Overall, 243 patients were randomized from August 2016 to August 2017 (136 patients with PL and 107 with DL). A shift from DL to PL was observed in 26 patients (24%) and from PL to DL in 8 (6%). These patients were excluded from final analysis. The two groups had comparable baseline characteristics (table 1). EBL was higher in DL group (mean 91±120 SD vs 107±134 SD in PL and DL respectively) but not significant (p=0.251). Two patients (1.6%) in PL and 1 (1.3%) in DL group required transfusion (p=0.854). PSM rate was 19% and 21% in PL and DL, respectively (p=0.712); among patients with PSM apical involvement was significantly higher in PL group (58% vs 23%, p=0.027). 1- 3- 6- and 12-months median PSA values were comparable between groups. No differences in terms of 1- 3- and 6-months continence rate were found (84% vs 76% p=0.207, 95% vs 91% p=0.4, 97.2% vs 97.9% p=0.807, respectively). CONCLUSIONS A DL of the DVC is not detrimental on perioperative outcomes and it could play a protective role in managing the prostate apex. These findings could allow the surgeon to opt for the best method tailored on patient needs and disease characteristics. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e126-e127 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Carlotta Palumbo More articles by this author Alessandro Antonelli More articles by this author Simone Francavilla More articles by this author Marco Lattarulo More articles by this author Stefania Zamboni More articles by this author Alessandro Veccia More articles by this author Maria Furlan More articles by this author Enrico De Marzo More articles by this author Angelo Peroni More articles by this author Claudio Simeone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...