You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP20)1 May 2024MP20-18 Laser Enucleation of the Prostate versus Robot Assisted Simple Prostatectomy: Head-to-Head Comparison Ella Taubenfeld, Robert Chang, Jared Faith, Aleem Khan, Bertie Zhang, Sarah Razavi, Alexa Meyer, and Lee Richstone Ella TaubenfeldElla Taubenfeld , Robert ChangRobert Chang , Jared FaithJared Faith , Aleem KhanAleem Khan , Bertie ZhangBertie Zhang , Sarah RazaviSarah Razavi , Alexa MeyerAlexa Meyer , and Lee RichstoneLee Richstone View All Author Informationhttps://doi.org/10.1097/01.JU.0001008732.80104.31.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic assisted simple prostatectomy (RASP) and laser enucleation of the prostate (LEP) are the two mainstays of minimally invasive therapies for the surgical management of enlarged prostate (>80 ml). In this study, we aim to compare perioperative and postoperative outcomes in patients treated with LEP versus RASP. METHODS: We performed a retrospective review of patients treated with LEP or RASP within a single health system from 2014-2021. Demographic data, perioperative outcomes, and postoperative outcomes were collected. Data was analyzed using descriptive statistics and comparative analyses were performed in R software. RESULTS: A total of 448 patients were identified; 347 patients underwent LEP and 101 underwent RASP, with a median follow-up of 108.9 weeks in the LEP group and 82.3 weeks in the RASP group (p=0.53). Groups were comparable in terms of demographic data. Patients who underwent RASP had significantly larger prostates than patients who underwent LEP (mean 137cc vs. 100cc, p<0.0001). In terms of operative outcomes, the LEP group had significantly shorter operative time (mean 129 min vs. 198 min, p<0.0001), lower estimated blood loss (median 100mL vs. 200mL, p<0.0001), and less tissue volume removed (mean 53.0g vs. 77.7g, p=0.0001) (Table 1). Postoperatively, there were no significant differences in Clavien complications (Table 1). Patients who underwent RASP were more likely to have longer length of post-operative catheters (median 9 days vs. 1 day in the LEP group, p<0.0001) and have post-operative de novo erectile dysfunction (ED) compared to the LEP group (11.2% vs. 4.2%, p=0.013). Patients in the LEP group were more likely to experience post-operative stress urinary incontinence (SUI) (40.1% vs. 13.1%, p<0.0001). CONCLUSIONS: Comparisons of outcomes in LEP versus RASP remain underpowered in the literature. This study shows that both LEP and RASP are safe and efficacious procedures with clinically comparable post-operative PVR nadirs. Patients who underwent LEP had decreased operative time and blood loss, though with smaller baseline prostates and less volume resected. While both procedures are safe, the complication profiles differ in terms of ED and SUI. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e327 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ella Taubenfeld More articles by this author Robert Chang More articles by this author Jared Faith More articles by this author Aleem Khan More articles by this author Bertie Zhang More articles by this author Sarah Razavi More articles by this author Alexa Meyer More articles by this author Lee Richstone More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 May 2022MP40-18 OFFICE-BASED FLEXIBLE URETEROSCOPY FOR ACTIVE SURVEILLANCE FOR UPPER TRACT UROTHELIAL CARCINOMA FOLLOWING NEPHRON-SPARING SURGERY Nathan Colin Wong, Sameh Naim, Jonathan Wagmeister, Ariel Schulman, Bertie Zhang, John Phillips, Muhammad Choudhury, and Majid Eshghi Nathan Colin WongNathan Colin Wong More articles by this author , Sameh NaimSameh Naim More articles by this author , Jonathan WagmeisterJonathan Wagmeister More articles by this author , Ariel SchulmanAriel Schulman More articles by this author , Bertie ZhangBertie Zhang More articles by this author , John PhillipsJohn Phillips More articles by this author , Muhammad ChoudhuryMuhammad Choudhury More articles by this author , and Majid EshghiMajid Eshghi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002600.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nephron-sparing surgery (NSS) for upper tract urothelial carcinoma (UTUC) offers select patients renal preservation but demands close surveillance including routine ureteroscopy that typically require general anesthesia. We report feasibility and our experience in utilizing ureteric orifice meatotomy to facilitate office-based flexible ureteroscopy under local anesthesia. METHODS: A retrospective chart review was conducted including consecutive patients who underwent NSS of UTUC at our tertiary center. Patients underwent ureteric orifice meatotomy followed by attempted flexible ureteroscopy in the office setting under local anesthesia with transurethral 2% lidocaine jelly. Otherwise, patients underwent routine ureteroscopic surveillance under general anesthesia and all patients underwent routine cross-sectional imaging including 3-D ‘virtual ureteroscopy’ by reconstruction of CT urography to evaluate for disease recurrence. RESULTS: A total of 16 patients (7 male; 9 female) with UTUC were treated with NSS – 9/16 (56%) were initially managed ureteroscopically and 7/16 (44%) percutaneously. Median age at diagnosis was 79 (IQR 71.5, 81.5) and median follow-up was 3 years (IQR 2, 3.5). The majority of patients had high grade disease (75%) and tumor location was typically renal pelvis (10/16; 63%) followed by distal ureter (4), mid ureter (1) and proximal ureter (1). A total of 3/16 (18%) had history of contralateral UTUC, 3/16 (18.8%) had solitary kidney and 10/16 (62%) had concomitant bladder cancer. A total of 10/16 patients (63%) who underwent ureteric orifice meatotomy tolerated flexible ureteroscopy in an office-based setting under local anesthesia, the rest required general anesthesia. Overall, 8/16 (50%) had disease recurrence, typically at the location of their initial site of disease. Of the 10 patients with renal pelvic disease, 6 (60%) recurred in the renal pelvis. Of the 6 patients with ureteral disease, 2 (33%) recurred in the ureter. Of those who recurred, 4 (50%) were successfully managed with ongoing endoscopic therapy and 4 (50%) ultimately underwent radical nephroureterectomy, 3 of which had disease upstaging on final pathology. There were 2 deaths related to comorbidities, both of who had a solitary kidney. There were no UTUC-related deaths. CONCLUSIONS: In select patients with UTUC who undergo NSS, ureteric orifice meatotomy is feasible and allows the majority of patients to tolerate office based flexible ureteroscopy under local anesthesia without compromising oncologic outcomes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e682 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Colin Wong More articles by this author Sameh Naim More articles by this author Jonathan Wagmeister More articles by this author Ariel Schulman More articles by this author Bertie Zhang More articles by this author John Phillips More articles by this author Muhammad Choudhury More articles by this author Majid Eshghi More articles by this author Expand All Advertisement PDF downloadLoading ...

INTRODUCTION AND OBJECTIVE: To describe our surgical technique for single port (SP) transvesical robotic radical prostatectomy using the da Vinci SP ^ a surgical system (Intuitive Surgical, Sunnyvale, CA, USA). METHODS: Sixty-eight patients underwent SP radical prostatectomy through a transvesical approach. Patient selection criteria was localized intermediate risk prostate cancer. Through a 3 cm suprapubic midline incision the bladder was entered and the Da Vinci Single-Port Access Kit was used for access. Floating docking technique was used. Through the access kit, the dedicated multichannel port, an 8 mm assistant port, and the remotely operated suction irrigation system were introduced. The surgical steps for transvesical radical prostatectomy were performed in the following order. 1) Posterior bladder neck dissection, 2) Vas deferens and seminal vesicle dissection, 3) Posterior dissection, 4) Anterior bladder neck and prostate dissection, 5) Pedicle and neurovascular bundle dissection, 6) Posterior Reconstruction and Urethrovesical Anostomosis, 7) removal of prostate through a single incision and bladder closure. RESULTS: Mean patients' age was 62.2 years and the mean preoperative prostate-speci fi c antigen (PSA) was 6.4 ng/mL. Single port robotic transvesical radical prostatectomy was performed successfully in 68 patients successfully without the need for additional port placement or open conversions. Average operative time was 210 minutes. Mean estimated blood loss was 116 mL. Eight patients had positive surgical margins (11.8%). Median length of stay was 4 hours (outpatient setting). Median time with a Foley catheter after surgery was 4.1 days. 46 patients (75.4%) had immediate continence (0-1 pad) after foley removal. Continence rate was 96.7% at postoperative No perioperative or postoperative complications were recorded. CONCLUSIONS: SP transvesical robotic radical prostatectomy is a novel approach that provides advantages including single incision, no additional ports, minimal opioid use, immediate continence, and same day discharge without compromising intraoperative and oncological outcomes.

Purpose of review The mainstays of the management of clinically localized prostate cancer have historically rested upon active surveillance, radiation therapy, or radical prostatectomy. Although both radiation and surgical treatment of localized prostate cancer can achieve excellent oncologic outcomes, the subsequent potential adverse effects of urinary stress incontinence and erectile dysfunction are unappealing to patients. This has led to investigational studies centered upon focal treatment of the cancerous lesion, with the aim to improve quality-of-life outcomes. In this review, we describe numerous novel modalities, including nanoparticle ablation and irreversible electroporation, which are being utilized for the focal treatment of clinically localized prostate cancer. Recent findings Although many of these novel therapies are in their investigational infancy, several have revealed very promising results both in their post-treatment pathologic outcomes as well as objective quality-of-life measures. Summary Initial data regarding novel focal therapy for prostate cancer treatment show promising short-term outcomes in regards to oncologic and quality-of-life assessments. Further investigational studies are needed to determine inclusion criteria for the selection of optimal candidates.

You have accessJournal of UrologyBladder & Upper Tract Urothelial Oncology (V13)1 Sep 2021V13-01 EXTENDED URETERAL MEATOTOMY FOR OUTPATIENT CHEMOTHERAPY ADMINISTRATION AND URETEROSCOPY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA Nikhil Gopal, Sameh Naim, Bertie Zhang, John Phillips, and Majid Eshghi Nikhil GopalNikhil Gopal More articles by this author , Sameh NaimSameh Naim More articles by this author , Bertie ZhangBertie Zhang More articles by this author , John PhillipsJohn Phillips More articles by this author , and Majid EshghiMajid Eshghi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002100.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with ureteral tumors managed endoscopically often benefit from adjuvant immuno-chemotherapy and require interval upper tract surveillance with ureteroscopy. However, both often require general anesthesia, which can be problematic for a predominantly elderly population with multiple co-morbidities. Here we describe an endoscopic technique of ureteral meatotomy to not only predictably allow for reflux of intravesical agents through the ureter, but also to allow upper tract endoscopy to be performed in the office setting. METHODS: From 2015-2021, we performed ureteral meatotomy on 10 patients. All patients who underwent this procedure had upper tract urothelial tumors deemed suitable for primary endoscopic management, based on patient’s clinical characteristics; tumor number; size; location; and/or biopsy grade.Under general anesthesia, a 10 F dual lumen ureteral catheter or 6-12 F Nottingham dilator was inserted into the distal ureter in order to allow for alignment of the ureter towards the bladder neck and to ensure the orifice is incised in the correct direction. Using either a Holmium laser or Collin’s knife, a full-thickness 2 cm incision was made on the distal intramural ureter at the 12 o’clock position, until the anterior portion of the catheter was visualized. Intraoperative cystogram was used to confirm ureteral reflux. A double J stent was then left in place for 3 weeks for mucosal healing and reshaping of the distal ureteral segment. Postoperatively, patients underwent 6 cycles of mitomycin, either via indwelling Foley catheter or nephrostomy tube. Lower and upper urinary tract surveillance was performed using flexible cystoscope and/or ureteroscope in the office every 3-6 months for the first two years and annually thereafter. RESULTS: 10 patients with average age of 77 years, 40% of whom were male, underwent ureteral meatotomy between 2015 and 2021. 90% of tumors were either in the distal ureter or UPJ/renal pelvis. Average tumor size was 1.6 cm. 70% of tumors were low grade on biopsy. 3 patients had concomitant bladder cancer. There were no complications associated with chemotherapy instillation. Of the patients who had only upper tract disease, none developed a new recurrence in the bladder. CONCLUSIONS: We describe a novel anterior intramural ureteral incision technique in patients with ureteral tumors managed endoscopically that reliably allows for both chemotherapy administration and upper tract surveillance in an office setting. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1078-e1078 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nikhil Gopal More articles by this author Sameh Naim More articles by this author Bertie Zhang More articles by this author John Phillips More articles by this author Majid Eshghi More articles by this author Expand All Advertisement Loading ...