Isolated recurrence in remnants of the seminal vesicles (SV) after treatment of primary prostate cancer (PCa) has become a more frequent entity with the widespread use of more sensitive next-generation imaging modalities. Salvage vesiculectomy is hypothesized to be a worthwhile management option in these patients. The primary goal of this study is to describe the surgical technique of this new treatment option. Secondary outcomes are peri- and post-operative complications and early oncological outcomes. Retrospective multicenter study, including 108 patients with solitary recurrence in the SV treated between January 2009 and June 2022, was performed. Patients with local recurrences outside the SVs or with metastatic disease were excluded. Both SVs were resected using a robot-assisted or an open approach. In selected cases, a concomitant lymphadenectomy was performed. Overall, 31 patients (29

Introduction and Objectives: Robot-assisted simple prostatectomy (RASP) and holmium laser enucleation of the prostate (HoLEP) are both well-established, minimally invasive surgical treatment options for lower urinary tract symptoms caused by benign prostatic enlargement. We have reported the first comparative analysis of both techniques in patients with prostates of & GE;200 cc.Materials and Methods: Between 2009 and 2020 a total of 53 patients with a prostate volume of & GE;200 cc were surgically treated at OLV Hospital Aalst (Belgium): 31 underwent RASP and 22 underwent HoLEP. Preoperative and postoperative assessments included uroflowmetry with maximum urinary flow rate (Qmax) and postvoid residual volume (PVR), as well as the International Prostate Symptom Score (IPSS) and quality of life (IPSS-QoL). The complication rates were evaluated according to the Clavien-Dindo Classification.Results: Patients treated with RASP had significantly larger prostate volumes compared with HoLEP (median 226 cc vs 204.5 cc, p = 0.004). After a median follow-up of 14 months, both groups showed a significant improvement in the maximum flow rate (+10.60 mL/s vs +10.70 mL/s, p = 0.724) and a reduction of the IPSS score (-12.50 vs -9, p = 0.246) as well as improvement of the QoL (-3 vs -3, p = 0.880). Median operative time was similar in both groups (150 minutes vs 132.5 minutes, p = 0.665). The amount of resected tissue was lower in the RASP group (134.5 g vs 180 g, p = 0.029) and there was no significant difference in postoperative prostate-specific antigen (1.2 ng/mL vs 0.8 ng/mL, p = 0.112). Despite a similar median catheterization time (3 days vs 2 days, p = 0.748), the median hospitalization time was shorter in the HoLEP group (4 days vs 3 days, p = 0.052). Complication rates were similar in both groups (32% vs 36%, p = 0.987).Conclusion: Our results suggest similar outcomes for RASP and HoLEP in patients with very large prostates & GE;200 cc. These findings will require external validation at other high-volume centers.

OBJECTIVES:An increasing number of urologists is switching from transrectal (TR) to transperineal (TP) biopsy procedures for the diagnosis of prostate cancer. Local anesthesia (LA) might be advantageous in terms of patient management, risks and costs. We aimed to evaluate the tolerability and complication rates of TP prostate biopsy performed under LA. METHODS:This is a monocentric, prospective, comparative, observational cohort study. Between July 2020 and July 2021 we included 128 consecutive patients (TR, n = 61; TP, n = 67), with a suspicion of prostate cancer. Transrectal vs. transperineal prostate biopsies were both performed under LA. To evaluate the tolerability we administered a validated visual analog pain score (VAS) during the different steps of the biopsy procedure as well as at 12-, 24- and 48-hours post procedure. The International Prostate Symptom Score (IPSS) questionnaire was administered before the procedure and at the same time intervals. The presence of hematuria, hematospermia, rectal blood loss, acute retention and febrile urinary tract infection (UTI) were also monitored. RESULTS:There were no significant differences in pain or IPSS between groups, except for a significantly higher pain score during the LA of the prostate in the TP group. In general, complication rates were similar, only the prevalence of hematuria at 24 hours was significantly higher in the TP group, as was rectal blood loss at 12 hours postprocedure in the TR group. CONCLUSIONS:In conclusion, our study showed that transperineal prostate biopsy under local anesthesia could be performed with similar pain scores and complication rates, compared to the transrectal procedure.

We evaluated the feasibility and impact on short- and long-term functional outcomes of very early catheter removal on postoperative day (POD) 2 after robot-assisted radical prostatectomy (RARP). To the best of our knowledge, this is the first multisurgeon study with the largest cohort on very early (POD 2) catheter removal after RARP with follow-up of >1 yr. In 255/369 patients (69%) treated with RARP +/- pelvic lymph node dissection, the catheter was removed on POD 2. Among the 255 patients, 33 (13%) required recatheterisation because of acute urinary retention after catheter removal. Of these 33 patients, five (2%) also experienced anastomotic leakage after catheter removal. The early (<= 3 mo) urinary continence rate was 67% and the median time to urinary continence recovery was 1 mo. After median follow-up of 18 mo (interquartile range 13-24), 236 patients (88%) were continent. No anastomotic strictures occurred. Our observations confirm the feasibility and safety of POD 2 catheter removal after RARP and support its adoption for selected patients. Patient summary: After removal of the prostate for cancer, patients have a urinary catheter inserted. We investigated whether earlier removal of the catheter affects long-term urinary continence. The results show that it may be safe to remove the catheter on postoperative day 2 for selected patients. (C) 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Background: International guidelines suggest the use of anatomic scores to predict surgical outcomes after partial nephrectomy (PN). We aimed at validating the use of Simplified PADUA Renal (SPARE) nephrometry score in robot-assisted PN (RAPN). Materials and methods: Three hundred and sixty-eight consecutive RAPN patients were included. Primary endpoints were overall complications, postoperative acute kidney injury (AKI) and TRIFECTA achievement. Secondary endpoint was estimated glomerular filtration rate (eGFR) decrease at last follow-up. Multivariable logistic and linear regression models were used. Results: Of 368 patients, 229 (62%) vs. 116 (31%) vs. 23 (6.2%) harboured low-vs. intermediate-vs. high-risk renal mass, according to SPARE classification. SPARE score predicted higher risk of overall complications (Odds ratio [OR]: 1.23, 95%CI 1.09-1.39; P < 0.001), and postoperative AKI (OR: 1.20, 95%CI 1.08-1.35; P < 0.01). Moreover, SPARE score was associated with lower TRIFECTA achievement (OR: 0.89, 95%CI 0.81-0.98; P = 0.02). Predicted accuracy was 0.643, 0.614 and 0.613, respectively. After a median follow-up of 40 (IQR: 21-66) months, eGFR decrease ranged from-7% in low-risk to-17% in high-risk SPARE. Conclusions: SPARE scoring system predicts surgical success in RAPN patients. Moreover, SPARE score is associated with eGFR decrease at long-term follow-up. Thus, the adoption of SPARE score to objectively assess tumor complexity prior to RAPN may be preferable. (C) 2021 Elsevier Inc. All rights reserved.

You have accessJournal of UrologyCME1 May 2022PD45-11 PERI-OPERATIVE OUTCOMES OF OPEN VERSUS ROBOT-ASSISTED SIMPLE PROSTATECTOMY: RESULTS FROM TWO HIGH-VOLUME CENTRES Simone Scarcella, Angelo Mottaran, Carlo Andrea Bravi, Luca Sarchi, Pietro Piazza, Marco Paciotti, Marco Amato, Stefano Puliatti, Paolo Umari, Carlo Giuloni, Giulio Milanese, Lucio Dell’Atti, Daniele Castellani, Edward Lambert, Jonathan Vollemaere, Dries Develtere, Ralf Veys, Marijn Goossens, Jolien Van der Jeugt, Andrea Galosi, and Alexandre Mottrie Simone ScarcellaSimone Scarcella More articles by this author , Angelo MottaranAngelo Mottaran More articles by this author , Carlo Andrea BraviCarlo Andrea Bravi More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Pietro PiazzaPietro Piazza More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Marco AmatoMarco Amato More articles by this author , Stefano PuliattiStefano Puliatti More articles by this author , Paolo UmariPaolo Umari More articles by this author , Carlo GiuloniCarlo Giuloni More articles by this author , Giulio MilaneseGiulio Milanese More articles by this author , Lucio Dell’AttiLucio Dell’Atti More articles by this author , Daniele CastellaniDaniele Castellani More articles by this author , Edward LambertEdward Lambert More articles by this author , Jonathan VollemaereJonathan Vollemaere More articles by this author , Dries DeveltereDries Develtere More articles by this author , Ralf VeysRalf Veys More articles by this author , Marijn GoossensMarijn Goossens More articles by this author , Jolien Van der JeugtJolien Van der Jeugt More articles by this author , Andrea GalosiAndrea Galosi More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002613.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Simple prostatectomy is the treatment of choice for symptomatic benign prostatic hyperplasia (BPH), and it should be recommended in prostate glands >80cc. Although functional outcomes of the open approach (OSP) are undoubtedly favourable, the robotic approach (RASP) is gaining consensus thanks to its safety and reduced morbidity. However, data of RASP is scarce, and the majority of published series described small cohorts with short follow-up. We aimed to investigate perioperative outcomes of RASP and OSP in a large cohort of patients from two urological referral centres. METHODS: We analyzed data of 357 consecutive men with symptomatic BPH who received OSP or RASP at two referral centres [OLV Hospital (Aalst, Belgium) and United Hospitals (Ancona, Italy)] from 2011 to 2021. Multivariable regressions (MVA) investigated variables associated with postoperative complications after adjusting for age, Body Mass Index (BMI), Charlson Comorbidity Index (CCI), prostate volume, concurrent bladder stone or diverticula, indwelling catheter, surgical approach (OSP vs. RASP), operative time (OT) and estimated blood loss (EBL). RESULTS: A total of 201 (56%) and 156 (44%) men received OSP and RASP, respectively. Overall, median (interquartile range [IQR]) age and CCI were 70 (65-76) years and 3 (2-4), with no differences between the groups (both p>0.05). Median [IQR] prostate volume was slightly higher in the RASP vs. OSP group (median: 164 vs. 153 cc; p=0.08). As compared to men receiving OSP, OT was longer in the RASP group (124 vs. 89 minutes), with lower EBL (395 vs. 761 ml), shorter catheterisation time (3 vs. 10 days) and length of stay (LOS) (4 vs. 8 days; all medians; all p<0.001). The rate of overall post-operative complications was higher in the OSP vs. RASP group (33% vs. 24%; p=0.05), especially of Clavien-Dindo grade ≥3 (15% vs. 5%; p=0.003), with higher rates of postoperative blood transfusions (28% vs. 1%; p<0.001). On MVA, the probability of postoperative complications was higher for older men (odds ratio [OR]: 1.13; 95% confidence interval [CI]: 1.07, 1.23; p=0.047) and for men who had higher EBL (OR: 1.45; 95%CI: 1.02, 1.53; p=0.001), whereas the association between surgical approach and overall postoperative complications was not statistically significant (OR: 0.88; 95% CI 0.64, 1.27; p=0.1). CONCLUSIONS: As compared to OSP, RASP allows for lower postoperative complications and blood transfusions and thus, it might be considered an option for the treatment of symptomatic BPH according to physician’s preference. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e787 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Simone Scarcella More articles by this author Angelo Mottaran More articles by this author Carlo Andrea Bravi More articles by this author Luca Sarchi More articles by this author Pietro Piazza More articles by this author Marco Paciotti More articles by this author Marco Amato More articles by this author Stefano Puliatti More articles by this author Paolo Umari More articles by this author Carlo Giuloni More articles by this author Giulio Milanese More articles by this author Lucio Dell’Atti More articles by this author Daniele Castellani More articles by this author Edward Lambert More articles by this author Jonathan Vollemaere More articles by this author Dries Develtere More articles by this author Ralf Veys More articles by this author Marijn Goossens More articles by this author Jolien Van der Jeugt More articles by this author Andrea Galosi More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement PDF downloadLoading ...

ObjectivesRadical cystectomy (RC) represents the gold standard treatment for high-risk bladder cancer. Despite evidence suggesting that surgical experience correlates with perioperative and oncologic outcomes of robot-assisted RC (RARC), validated tools to assess its quality objectively are lacking. We aimed to evaluate the impact of RC-Pentafecta (absence of early major complications, absence of urinary diversion related sequelae at ≤12 months, absence of soft tissue surgical margins, ≥16 lymph nodes at final pathology and absence of clinical recurrence at ≤12 months) on oncological outcomes and the role of surgical experience on its achievement.Materials and methodsWe retrospectively evaluated 366 patients undergoing RARC with intracorporeal urinary diversion in a single tertiary centre with a minimum of 1 year follow-up. Surgeries were performed using the DaVinci Xi system according to a previously described technique. Kaplan-Meier curves were used to investigate 5-years overall survival and cancer specific mortality-free survival (CSS) according to RC-Pentafecta achievement. Multivariable Cox's regressions were performed to evaluate the impact of RC-Pentafecta on overall mortality. Multivariable logistic regressions were performed to explore the effect of surgical experience on RC-pentafecta achievement. Locally weighted scatterplot smoother function was used to graphically explore this relationship.ResultsPatients achieving RC-Pentafecta showed higher 5-year overall survival (71.8% vs. 59.6%, P < 0.001) and CSS (84% vs. 71%, P < 0.001) when compared with patients not achieving it. At multivariable Cox's regression, RC-Pentafecta achievement (HR 0.57, P = 0.03), positive surgical margins (HR 2.48, P = 0.002), pN+ (HR 2.23, P = 0.002), pT≥3 (HR 1.71, P = 0.04) and current smoking status (HR 2.4, P = 0.006) were significant predictors of overall mortality. At multivariable logistic regression surgical experience (OR 1.2, P < 0.001), age (OR 0.93, P = 0.04), previous prostate surgery (OR 0.7, P = 0.02) and pT≥3 (OR 0.8, P = 0.03) were independent predictors of RC-Pentafecta achievement. A linear relationship between surgical experience and RC-Pentafecta achievement, without reaching a plateau, was observed.ConclusionsRC-Pentafecta is a valuable tool to assess surgical quality of RARC and the experience of the center where the surgery is performed and may be used to identify “referral” centers for treatment of high-risk bladder cancer.

Long-term oncologic data on patients undergoing robot-assisted radical cystectomy (RARC) for non-metastatic bladder cancer (BCa) are limited. The purpose of this study is to describe long-term oncologic outcomes of patients receiving robotic radical cystectomy at a high-volume European Institution. We analyzed data of 107 patients treated with RARC between 2003 and 2012 at a high-volume robotic center. Clinical, pathologic, and survival data at the latest follow-up were collected. Clinical recurrence (CR)-free survival, cancer-specific mortality (CSM)-free survival, and overall survival (OS) were plotted using Kaplan–Meier survival curves. Cox proportional hazard models investigated predictors of CR and CSM. Competing-risk regressions were utilized to depict cumulative incidences of death from BCa and death from other causes after RARC at long term. Pathologic nonorgan-confined BCa was found in 40% of patients, and 7 (7%) patients had positive soft tissue surgical margins. Median (interquartile range [IQR]) number of nodes removed was 11 (6, 14), and 26% of patients had pN + disease. Median (IQR) follow-up for survivors was 123 (117, 149) months. The 12-year CR-free, CSM-free and overall survival were 55% (95% confidence interval [CI] 44%, 65%), 62% (95% CI 50%, 72%), and 34% (95% CI 24%, 44%), respectively. Nodal involvement on final pathology was associated with poor prognosis on multivariable competing risk analysis. The cumulative incidence of non-cancer death exceeded that of death from BCa after approximately ten years after RARC. We provided relevant data on oncologic outcomes of RARC at a high-volume robotic center, with acceptable rates of clinical recurrence and cancer-specific survival at long-term. In patients treated with RARC, the cumulative incidence of death from causes other than BCa is non-negligible, and should be taken into consideration for post-operative follow-up.

You have accessJournal of UrologyCME1 May 2022MP53-14 FEASIBILITY OF TRANSPERINEAL PROSTATE BIOPSIES UNDER LOCAL ANESTHESIA: A COMPARATIVE STUDY WITH THE TRANSRECTAL APPROACH Camille Berquin, Dries Develtere, Hannah Van Puyvelde, Elisabeth Pauwels, Ruben De Groote, Frederiek D'Hondt, Peter Schatteman, Alex Mottrie, and Geert De Naeyer Camille BerquinCamille Berquin More articles by this author , Dries DeveltereDries Develtere More articles by this author , Hannah Van PuyveldeHannah Van Puyvelde More articles by this author , Elisabeth PauwelsElisabeth Pauwels More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , Frederiek D'HondtFrederiek D'Hondt More articles by this author , Peter SchattemanPeter Schatteman More articles by this author , Alex MottrieAlex Mottrie More articles by this author , and Geert De NaeyerGeert De Naeyer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002628.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is an emerging shift from transrectal (TR) to transperineal (TP) prostate biopsies because of lower infection rates. In the past TP biopsies mostly involved general/spinal anesthesia, being perceived too painful for local anesthesia (LA). Therefor the aim of this study is to evaluate the feasibility of TP prostate biopsies under LA based on patient-reported outcome measurements (PROMs). METHODS: This study is a monocentric prospective observational cohort study with a non-inferiority design. Data were collected from all patients with a clinical suspicion of prostate cancer, eligible for LA, at the OLV Aalst Urology Department. The biopsy method was determined by the clinician based on the localization and volume of the suspect lesions on MRI and DRE. All patients received prophylactic fluoroquinolones. For the TP approach we used 30 mL of 1% Xylocaïne to obtain LA: 10 mL for the perineal skin and 20 mL for the periprostatic nerve block (PNB). Systemic biopsies and targeted biopsies were taken. In the TR group PNB of 10 mL was given for a classical template with 12 biopsy cores.To evaluate tolerability, we used a visual analog score (VAS) for pain during the different steps of the procedure: insertion of the TR probe, LA to the prostate and the biopsies. The TP group had an additional VAS score for the LA of the skin. IPSS was recorded at different times: baseline, after 12, 24 and 48 hours. At these times patients also received questionnaires about possible complications of the procedure (hematuria, hematospermia, rectal blood loss and fever). RESULTS: In total 128 patients got enrolled: 61 TR and 67 TP. The median age was 73y (IQR 66-78,5) and 68y (IQR 64-73) for the TR and TP group respectively. The median baseline IPSS were 6 (IQR 2,5-11) for the TP group and 7 (IQR 3-13) for the TP group. The mean VAS scores, IPSS and complications are listed per group in Table 1. Fever occurred in 2 patients (3,3%) in the TR group, while only in 1 patient (1,5%) in the TP group. All 3 were treated with oral antibiotics. Only 1 patient in the TP group (1,5%) suffered from urinary retention, for which he received a suprapubic catheter. CONCLUSIONS: Based on PROMs, we can conclude that TP biopsies under LA can be performed with similar pain scores and complications rates as TR biopsies. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e900 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Camille Berquin More articles by this author Dries Develtere More articles by this author Hannah Van Puyvelde More articles by this author Elisabeth Pauwels More articles by this author Ruben De Groote More articles by this author Frederiek D'Hondt More articles by this author Peter Schatteman More articles by this author Alex Mottrie More articles by this author Geert De Naeyer More articles by this author Expand All Advertisement PDF downloadLoading ...

Objective: Treatment for bladder diverticula may become necessary in case of incomplete bladder emptying or recurrent urinary tract infections (UTIs). When bladder outlet obstruction is present, a simultaneous desobstructive procedure can be performed. In this video, we present our technique for a transvesical approach in robot-assisted bladder diverticulectomy (RABD) and discuss its outcomes.Patients and Surgical Procedure: We retrospectively analyzed the outcomes of 23 patients who underwent a transvesical RABD between March 2015 and May 2020 at the OLV hospital of Aalst. After retrograde filling, a cystotomy is performed. The orifices are identified and the bladder diverticulum is observed. The mucosa covering the diverticular neck is incised and the plane between the mucosa and the muscularis is identified. The mucosa is separated from the surrounding structures. The base of the diverticulum is transected using cautery. The defect is closed with a barbed suture.Results: Median age was 66 years (interquartile range [IQR] 60-69). The number of diverticula removed ranged from 1 to 3. Ten patients were treated with diverticulectomy alone, 12 underwent a simultaneous adenomectomy, 1 a radical prostatectomy. Median operative was 140 minutes (IQR 120-180), median estimated blood loss was 250 mL (IQR 28-438). Median catheterization time was 2 days (IQR 1-5), median hospitalization time 3 days (IQR 2-4). One patient developed urinary leakage after catheter removal, one patient developed a UTI. Median follow-up was 9 months (IQR 3.5-14). No late postoperative complications nor relapse were recorded. Average postvoid residual was 42 mL (IQR 0-111), with a median decline of 120 mL (IQR -402 to -33).Conclusions: Transvesical approach for RABD is a safe and reliable technique that gives the advantage of a quick localization of the diverticulum and orifices, and direct access to the prostate when simultaneous desobstruction is necessary. Catheterization time is short. No relapse has been observed.

Worldwide, we have witnessed an expansion of robot-assisted laparoscopic surgery (RALS) and thanks to the global adoption of high-resolution diagnostic imaging technologies, an increased incidence of newly diagnosed prostatic, renal and bladder cancers has been recorded with concurrent second primary urological cancer diagnoses increasing by 1.5%. Diverse authors have reported their findings concerning synchronous multi-visceral malignances robotic treatment within the scientific literature. The aim of this study is to comprehensively review all reported articles describing concurrent upper and lower RALS using a singular robotic port scheme within the same intervention for renal malignances and concomitant prostatic or bladder cancers. To the best of our knowledge and vigorous literature search, this is the first study that comprehensively evaluates and reports all combined upper and lower urinary tract surgeries published so far. In carefully selected patients, thanks to multidisciplinary preoperative assessment and surgical planning a combined robotic approach can reduce the morbidity, complications, hospital admissions and the overall length of hospitalization.

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP15)1 Sep 2021MP15-16 VERY EARLY CATHETER REMOVAL ON POSTOPERATIVE DAY 2 AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY: REPORTING ON EARLY COMPLICATIONS AND FUNCTIONAL RESULTS Dries Develtere, Giuseppe Rosiello, Pietro Piazza, Abhishek Pandey, Camille Berquin, Sinatti Celine, Hannah Van Puyvelde, Stefano Puliatti, Marco Amato, Rui Farhina, Elisabeth Pauwels, Ruben De Groote, Peter Schatteman, Geert De Naeyer, Frederiek D'Hondt, and Alexandre Mottrie Dries Develtere Dries Develtere More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Pietro PiazzaPietro Piazza More articles by this author , Abhishek PandeyAbhishek Pandey More articles by this author , Camille BerquinCamille Berquin More articles by this author , Sinatti CelineSinatti Celine More articles by this author , Hannah Van PuyveldeHannah Van Puyvelde More articles by this author , Stefano PuliattiStefano Puliatti More articles by this author , Marco AmatoMarco Amato More articles by this author , Rui FarhinaRui Farhina More articles by this author , Elisabeth PauwelsElisabeth Pauwels More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , Peter SchattemanPeter Schatteman More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , Frederiek D'HondtFrederiek D'Hondt More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001996.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Presence of an indwelling urinary catheter following robot-assisted radical prostatectomy (RARP) is reported as a significant bother. Moreover, it’s presence can lead to several catheter-related issues, with a significant burden on patients’ life. The current study aims to evaluate the feasibility of postoperative day (POD 2) catheter removal after RARP and to assess its impact on short- and long-term urinary continence (UC). METHODS: Patient characteristics and perioperative data were prospectively collected for 402 consecutive patients treated with RARP ± pelvic lymph node dissection (PLND) between January 2018 and July 2019. After exclusion, (locally advanced prostate cancer, missing follow-up data) final population consisted of 369 patients. Postoperative complications and UC were retrospectively analyzed. Ethical committee approval has been obtained. RESULTS: 255 (70%) patients underwent catheter removal on POD 2. 65 (25%) received PLND. 1 patient experienced a major postoperative complication [Clavien Dindo Classification (CDC) > IIIa]. 33 (12.9%) required re-catheterization due to acute urinary retention (AUR) after catheter removal (CDC I). 5 (2%) patients required re-catheterization due to AUR combined with anastomotic leakage. After a median follow-up of 18 months [Interquartile range (IQR) 13-24] 236 (93%) patients recovered UC. Early UC rate was 67% and median time to UC recovery was 1 month (IQR: 0-4). No anastomotic strictures were recorded. Age at surgery (p=0.1), prostate volume (p=0.6), and voiding LUTS (p=0.2) were not associated with the risk of retention after POD 2 catheter removal. CONCLUSIONS: Indwelling catheter removal on POD 2 after RARP is a safe option in patients with localized PCa, with acceptable rates of AUR and anastomotic leakage, and without impact on short- and long-term functional outcomes . Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e270-e270 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dries Develtere More articles by this author Giuseppe Rosiello More articles by this author Pietro Piazza More articles by this author Abhishek Pandey More articles by this author Camille Berquin More articles by this author Sinatti Celine More articles by this author Hannah Van Puyvelde More articles by this author Stefano Puliatti More articles by this author Marco Amato More articles by this author Rui Farhina More articles by this author Elisabeth Pauwels More articles by this author Ruben De Groote More articles by this author Peter Schatteman More articles by this author Geert De Naeyer More articles by this author Frederiek D'Hondt More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement Loading ...

Background: The feasibility and safety of robot-assisted radical cystectomy (RARC) may be undermined by unfavorable preoperative surgical characteristics such as previous prostate surgery (PPS). Objective: To compare perioperative outcomes for patients undergoing RARC with versus without a history of PPS. Design, setting, and participants: The study included 220 consecutive patients treated with RARC and pelvic lymph node dissection for bladder cancer at a single European tertiary centre. Of these, 43 had previously undergone PPS, defined as transurethral resection of the prostate/holmium laser enucleation of the prostate (n = 21) or robot assisted radical prostatectomy (n = 22). Surgical procedure: RARC in patients with a history of PPS. Measurements: Data on postoperative complications were collected according to the quality criteria for accurate and comprehensive reporting of surgical outcomes recommended by the European Association of Urology guidelines. Multivariable logistic, linear, and Poisson regression analyses were performed to test the effect of PPS on surgical outcomes. Results and limitations: Overall, 43 patients (20%) were treated with RARC after PPS. Operative time (OT) was longer in the PPS group (360 vs 330 min; p < 0.001). Patients with PPS experienced higher rates of intraoperative complications (19% vs 6.8%) and higher rates of 30-d (67% vs 39%), and Clavien-Dindo >3 (33% vs 16%) postoperative complications (all p < 0.05). Moreover, the positive surgical margin (PSM) rate after RARC was higher in the PPS group (14% vs 4%; p = 0.03). On multivariable analyses, PPS at RARC independently predicted higher risk of intraoperative (odds ratio [OR] 2.10, 95% confidence interval [CI] 1.04-6.21; p = 0.01) and 30-d complications (OR 2.26, 95% CI 1.05-5.22; p = 0.02), as well as longer OT (relative risk [RR] 1.03, 95% CI 1.00-1.05; p = 0.02) and length of stay (RR 1.13, 95% CI 1.02-1.26; p = 0.02). Lack of randomization represents the main limitation. Conclusions: RARC in patients with a history of PPS is feasible, but it is associated with a higher risk of complications and longer OT and length of stay. Moreover, higher PSM rates have been reported for these patients. Thus, measures aimed at improving surgical outcomes appear to be warranted. Patient summary: We investigated the effect of previous prostate surgery (PPS) on surgical outcomes after robot-assisted removal of the bladder. We found that patients with PPS have a higher risk of complications and longer hospitalization after bladder removal. These patients deserve closer evaluation before this type of bladder operation. (c) 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.

BACKGROUND:Radiation therapy (RT) for prostate cancer (PCa) treatment is burdened by high rates of late urinary adverse events (UAEs). The feasibility of robot-assisted cystectomy (RAC) with intracorporeal urinary diversion (ICUD) for treatment of high-grade UAEs has never been assessed. OBJECTIVE:To report perioperative outcomes, early (≤90 d) and late (>90 d) complications among patients undergoing RAC for UAEs after RT. DESIGN, SETTING, AND PARTICIPANTS:We retrospectively evaluated 32 patients undergoing RAC with ICUD for UAEs in a single tertiary centre. SURGICAL PROCEDURE:Surgery was performed using a da Vinci Xi system with adaptation for the primary treatment. MEASUREMENTS:Perioperative outcomes included estimated blood loss (EBL), operative time (OT), intraoperative complications, and length of stay (LOS). Data for early and late postoperative complications were collected using the quality criteria recommended by the European Association of Urology. Univariate logistic regressions were performed to test the effect of baseline and perioperative characteristics on early postoperative complications. RESULTS AND LIMITATIONS:The median age-adjusted Charlson comorbidity index (ACCI) was 6 (IQR 5-7). The indication for RAC was hemorrhagic radiation cystitis in 29 cases (91%), contracted bladder in two cases (6.2%), and urinary fistula in one case (3.1%). The median EBL, OT, and LOS were 250 ml, 330 min, and 10 d, respectively. A total of 31 (97%) patients received an ileal conduit. The 90-d rate of Clavien-Dindo grade ≥IIIa complications was 28%. The late complication rate was 46% and the perioperative mortality rate was 0%. On univariate analyses, ACCI was the only parameter correlated with the risk of early complications (odds ratio 1.75, 95% confidence interval 1.05-2.9; p =  0.03). The median follow-up was 30 mo (IQR 15-40). The lack of comparison with open cystectomy represents the main limitation. CONCLUSIONS:RAC for UAEs in patients with a history of pelvic irradiation is a feasible option in high-volume centers. The use of new technologies can help to overcome some of the technical difficulties and reduce the risk of perioperative and late complications. PATIENT SUMMARY:We report our experience with robot-assisted surgery for removal of the bladder in the management of urinary problems after radiation therapy for prostate cancer. When performed by highly experienced surgeons, this is a feasible procedure with outcomes and early and late complication rates that are acceptable.

Abstract An inflammatory myofibroblastic tumor (IMT) can arise anywhere in the body. IMT is a spindle-cell neoplasm not prone to metastasize although it has an important potential of local expansio...