Introduction and Objective: Given the favorable cancer-specific survival rates in localized prostate cancer and the negative impact of whole-gland treatments on functional outcomes, the field is moving toward precision strategies such as focal therapy and organ-sparing surgery. We aim to report medium-term functional and oncologic outcomes for the initial Single-Port Robotic Transvesical Partial Prostatectomy (SP-TVRAPP) patient cohort. Materials and Methods: We analyzed a prospectively maintained database of 20 patients who underwent SP-TVRAPP between February 2021 and March 2024. Inclusion criteria were prostate-specific antigen (PSA) ≤10 ng/mL, clinical stage ≤ cT2b, ISUP Grade Group ≤3, unilateral lesions on multiparametric magnetic resonance imaging (mpMRI) with positive biopsy cores on the same side, and preoperative IIEF-5 ≥ 17. We also considered bilateral prostate cancer in the anterior zone and invisible mpMRI tumors confirmed by unilateral positive biopsies. Results: At baseline, patients had an average age of 61 years, a median PSA of 4.8 ng/mL (interquartile range [IQR]: 3.7-7.7), and a median Sexual Health Inventory for Men (SHIM) score of 24 (IQR: 18-25). All procedures were completed without complications, need for additional ports, or conversion. After a median hospital stay of 4.2 hours, 94% of cases were discharged without opioid prescriptions, and Foley catheters were removed after approximately 4 days. At 6 weeks, 3, 6, and 12 months postprocedure, potency rates, defined as a SHIM score ≥17, were 45.0%, 77.7%, 83.3%, and 87.5%, respectively. When potency was defined as having erections sufficient for penetration, the rates were 80.0%, 88.8%, 88.8%, and 93.7% for the same time intervals. Regarding urinary function, 60.0% were continent at 1 week, increasing to 85.0% by 6 weeks, 88.8% at both 3 and 6 months, and reaching 93.7% at 12 months postsurgery. Oncologically, 30.0% experienced upgrading and 40.0% upstaging within this cohort. Negative surgical margins were attained in 85.0% of the cases and the median PSA was 0.4 ng/mL 12 months after SP-TVRAPP. Two men were found to have residual GG1 cancer in the protocol biopsies and are currently on active surveillance. At a mean follow-up of 15.5 months (0.2-34.8) months, none of the patients has required secondary interventions, and all remain free of both clinically significant residual prostate cancer and metastatic disease. Conclusions: SP-TVRAPP represents a promising treatment for certain patients with localized prostate cancer. This targeted surgical method has been associated with faster postoperative recovery and has demonstrated high rates of early recovery in erectile function and urinary continence while ensuring oncologic safety.

INTRODUCTION:Single-port (SP) robotic surgical system performs well in small anatomical spaces, which makes it suitable for retroperitoneal robotic partial nephrectomy (RPN). However, there is limited evidence comparing the safety and feasibility of SP RPN to multiport (MP) RPN. To address this gap in evidence, we sought to analyze and compare the safety of retroperitoneal RPN between SP and MP approaches. METHODS:This is a retrospective cohort study using data from the Single Port Advanced Research Consortium (SPARC) and a multicenter database of patients who underwent retroperitoneal RPN using either SP or MP between 2017 and 2023. Baseline, perioperative, and postoperative data were compared using t-tests, Mann-Whitney U test, χ2 test, and Fisher exact test. Multivariable analyses were conducted using robust and Poisson regressions. RESULTS:A total of 286 patients (SP RPN, n = 86 [30%]; MP RPN, n = 200 [70%]) underwent retroperitoneal RPN. R.E.N.A.L nephrometry score and tumor location were significantly different between the 2 groups. Notably, the ischemia time was significantly shorter in the MP group (16 vs. SP, 22 minutes, P < 0.001). Adjusting for baseline characteristics, the ischemia time was approximately 7.89 minutes longer for patients in the SP group compared to the MP group, on average (95% CI: 5.87, 9.92; P < 0.001). No significant differences were observed in operative time, EBL, blood transfusion, conversion rates, LOS, PSM, and overall 30-day postoperative complications between the 2 groups. CONCLUSION:Our study shows that retroperitoneal SP and MP RPN have comparable perioperative and postoperative outcomes, except for the longer ischemia time in the SP platform. SP RPN is a safe and viable alternative; however, further research is needed to explore its potential benefits, cost-effectiveness, and long-term oncologic outcomes.

Introduction: Transvesical radical prostatectomy allows for direct access to the bladder and prostate that completely avoids the peritoneal cavity and allows for minimal disturbance to the extraperitoneal space or the iliac fossa. We sought to evaluate the safety and effectiveness of a single-port transvesical approach in the treatment of patients with prior kidney transplantation. Methods: Single port transvesical radical prostatectomy was performed on two patients with prior kidney transplantation, including one patient with two prior kidney transplants. Flexible cystoscopy was used for assistance in accessing the bladder intraoperatively in the patient with two prior transplants to avoid injury to either transplant ureteral orifice. Results: Both patients had similar preoperative pathology, operative times, estimated blood loss (EBL), and hospital stay. There were no intraoperative or postoperative complications in either patient. While both patients showed high-risk pathology, surgical margins were negative in both cases and the latest postoperative PSA at 6 weeks was undetectable. Both patients had good recovery of continence after surgery, with 0 and 1 pads per day at a 6-week follow-up. Conclusion: Single port transvesical radical prostatectomy is safe and feasible in patients with prior renal transplantation. No biochemical recurrence was recorded on the latest follow-up. Objective: To demonstrate the safety and technique of Transvesical (TV) Single-Port (SP) robot-assisted radical prostatectomy (RARP) in patients with prior kidney transplantation (KT). Patients and surgical procedure: Between 2022 and 2023, we performed SP TV RARP on two patients with prior KT who were diagnosed with clinically significant prostate cancer. The technique was demonstrated in a 62-year-old male patient with two prior KT. Flexible cystoscopy was used to evaluate the bladder intraoperatively to avoid injury to the transplant and native ureteral orifices. Results: Both procedures were completed without any evidence of perioperative complications. Patients 1 and 2 who underwent SP TV RARP had overall similar operative times i.e. 193 and 173 min respectively, and estimated blood loss (EBL), i.e. 100 ml and 50 ml respectively. They were discharged within 24 h of hospital stay. There were no intraoperative or postoperative complications in the cohort.The final pathology showed high-risk Gleason Grade (GG) 4 prostate cancer, surgical margins were negative in both cases. The latest postoperative prostate-specific antigen (PSA) at 6 weeks was undetectable. Both patients had good recovery of continence after surgery, with 0 and 1 pads per day at a 6-week follow-up. Conclusion: SP TV RARP is safe and feasible in patients with prior KT. No biochemical recurrence (BCR) was recorded on the latest follow-up.

This study aims to describe the surgical steps for the single-port low anterolateral extraperitoneal approach to pyeloplasty, report its feasibility, and share the initial outcomes of our experience. We analyzed all consecutive patients who underwent single-port low anterolateral extraperitoneal pyeloplasty due to ureteropelvic junction obstruction (UPJO). The surgical steps included a pure single-port approach through a 3.5 cm low anterolateral incision two fingerbreadths above the superior pubic ramus. The ureter was localized and followed cranially, a dismembered pyeloplasty was performed, and a running ureteropelvic anastomosis was completed. No drains were placed. The urinary catheter was removed upon discharge, and the ureteral stent after 3–5 weeks. A total of eight cases (two adults and six children) were completed successfully, without complications or conversions. Median operative time, console time, and estimated blood loss were 208.5 min, 114.5 min, and 10.0 ml, respectively. All patients were discharged within 24 h, except for one that required urinary output observation due to retention. There were no major postoperative complications. The median pain score at discharge was 0/10. Only one patient was prescribed PRN opioids at discharge. The readmission rate was 0.0

Introduction Patients with proctocolectomy and ileal pouch-anal anastomosis (PC-IPAA) face unique challenges in managing prostate cancer due to their hostile abdomens and heightened small bowel mucosa radiosensitivity. In such cases, external beam radiation therapy (EBRT) is contraindicated, and while brachytherapy provides a safer option, its oncologic effectiveness is limited. The Single-Port Transvesical Robot-Assisted Radical Prostatectomy (SP TV-RARP) offers promise by avoiding the peritoneal cavity. Our study aims to evaluate its feasibility and outcomes in patients with PC-IPAA.Methods A retrospective evaluation was done on patients with PC-IPAA who had undergone SP TV-RARP from June 2020 to June 2023 at a high-volume center. Outcomes and clinicopathologic variables were analyzed.Results Eighteen patients underwent SP TV-RARP without experiencing any complications. The median hospital stay was 5.7 h, with 89% of cases discharged without opioids. Foley catheters were removed in an average of 5.5 days. Immediate urinary continence was seen in 39% of the patients, rising to 76 and 86% at 6- and 12-month follow-ups. Half of the cohort had non-organ confined disease on final pathology. Two patients with ISUP GG3 and GG4 exhibited detectable PSA post-surgery and required systemic therapy; both had SVI, multifocal ECE, and large cribriform pattern. Positive surgical margins were found in 44% of cases, mostly Gleason pattern 3, unifocal, and limited. After 11.1 months of follow-up, no pouch failure or additional BCR cases were found.Conclusion Patients with PC-IPAA often exhibit aggressive prostate cancer features and may derive the greatest benefit from surgical interventions, particularly given that radiation therapy is contraindicated. SP TV-RARP is a safe option for this group, reducing the risk of bowel complications and promoting faster recovery.

BACKGROUND: Single-port robot-assisted simple prostatectomy is a minimally invasive alternative for patients with large benign prostatic hyperplasia with severe symptoms and/or failure of medical treatment. In recent literature, the rate of incidental prostate cancer after simple prostatectomy ranges from 1.8% to 13.0%. Our objective is to report the rate of incidental prostate cancer after single-port robot-assisted simple prostatectomy and to compare our findings to other approaches. METHODS: A Single-Port Advanced Research Consortium [SPARC] multi-institutional retrospective analysis of all initial consecutive single-port robot-assisted simple prostatectomy cases performed from 2019 to 2023 by eleven surgeons from six centers. Our primary outcome was the rate of incidental prostate cancer in adenoma specimens. We used descriptive statistics to analyze the data. RESULTS: A total of 235 cases were performed successfully without conversions or additional ports. Eleven patients (4.6%) were found to have incidental prostate cancer on pathological analysis. The median percentage of tissue involved by the tumor was 5%. The overall rate of clinically significant prostate cancer was 2.1%. Most cases were Gleason Grade Group 1 (55%). Those with Grade Group <= 3 were subsequently managed with active surveillance with a median followup of 17 months. A patient with Gleason Grade Group 4 underwent an uncomplicated multi-port robot-assisted radical prostatectomy with satisfactory functional and oncological outcomes. CONCLUSIONS: Initial multi-institutional experience with single-port robot-assisted simple prostatectomy showed an incidental prostate cancer rate of 4.6%, comparable to MP, laparoscopic, and open techniques.

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) I (PD01)1 May 2024PD01-05 ANALYZING THE PERCENTAGE OF POSITIVE 68GA-PSMA-PET/CT SCANS BASED ON PSA RANGES ACROSS DISTINCT INDICATIONS FOR THE SCAN Shayan Ahmad, Maya N. Ataya, Clint D. Bahler, Michael O. Koch, Mark A. Green, Mark Tann, Ethan L. Ferguson, and Heather L. Huelster Shayan AhmadShayan Ahmad , Maya N. AtayaMaya N. Ataya , Clint D. BahlerClint D. Bahler , Michael O. KochMichael O. Koch , Mark A. GreenMark A. Green , Mark TannMark Tann , Ethan L. FergusonEthan L. Ferguson , and Heather L. HuelsterHeather L. Huelster View All Author Informationhttps://doi.org/10.1097/01.JU.0001009540.33579.43.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET) is an imaging technique used to identify patients with biochemically recurrent (BCR) prostate cancer and determine their plan of treatment. This study aims to analyze the percentage of positive PSMA-PET scans based on prostate specific antigen (PSA) ranges and the indications for the scans. METHODS: A retrospective analysis was conducted on a cohort of 347 patients, with BCR prostate cancer, who underwent PSMA-PET scans at Indiana University Hospital from May 2017 to November 2021. These scans were categorized into 4 different groups according to their indications: BCR post prostatectomy, BCR post radiation, BCR post prostatectomy and radiation, and Stage 4, defined as patients who had chemotherapy, CRPC, or evidence of distant metastasis. The results of the PSMA-PET scans were documented, the PSA values were divided into distinct ranges for each indication, and the percentage of positive scans for each range was evaluated. RESULTS: The probability of having a positive scan was 60% for patients with BCR post prostatectomy, 86.3% for patients with post radiation, 67.1% post prostatectomy and salvage radiation, and 95% for stage 4. Furthermore, when PSA values were stratified into different ranges, an increasing trend in the probability of positive scans was seen with rising PSA values for patients in the BCR post prostatectomy, and BCR post radiation groups. A threshold PSA value of 1 was observed for patients in stage 4, above which 100% of the scans were positive. Interestingly, across all indications, a PSA value of 10 or higher was almost certain to yield a positive scan, with the only exception being a patient in the BCR post prostatectomy and radiation group. Positive scans for a PSA value of<0.1 were not noticed within any indication, but at a PSA>0.2 resulted in a positive scan greater than 50% of the time. CONCLUSIONS: This study illustrates the relationship between the PSA values and the probability of a positive PSMA-PET scan according to the indication for the scan. From this we can conclude that stage 4 has the highest probability of a positive scan. In addition, in the majority of scans, a PSA of greater than 10 was associated with being 100% positive. Source of Funding: Telix Pharmaceuticals and Al Christy Prostate Cancer Foundation © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e64 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Shayan Ahmad More articles by this author Maya N. Ataya More articles by this author Clint D. Bahler More articles by this author Michael O. Koch More articles by this author Mark A. Green More articles by this author Mark Tann More articles by this author Ethan L. Ferguson More articles by this author Heather L. Huelster More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Oncology/Penile & Testis Oncology/Misc. Oncology I (V09)1 May 2024V09-07 CLINICAL UTILITY OF PRECISION 3D PRINTED MODEL FOR PREOPERATIVE PLANNING AND SURGICAL REHEARSAL Nicolas A. Soputro, Ethan L. Ferguson, Jason Scovell, Roxana Ramos-Carpinteyro, and Jihad Kaouk Nicolas A. SoputroNicolas A. Soputro , Ethan L. FergusonEthan L. Ferguson , Jason ScovellJason Scovell , Roxana Ramos-CarpinteyroRoxana Ramos-Carpinteyro , and Jihad KaoukJihad Kaouk View All Author Informationhttps://doi.org/10.1097/01.JU.0001009528.33572.9e.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical simulation using 3D-printed kidney and prostate models has been developed with potential benefits including patient education, surgical training, and preoperative planning. In this video, we present our experience in using patient-specific 3D-printed models for surgical rehearsals in a case of complex partial nephrectomy and a partial prostatectomy. METHODS: The partial nephrectomy case pertained to an otherwise healthy 57-year-old man with an incidental finding of a right 2.8 cm completely endophytic renal mass that was isointense in most of the MRI sequences. The RENAL nephrometry score for the lesion was 10p. The patient who underwent partial prostatectomy was a 56-year-old with localized Gleason 3+4 prostate cancer on the left anterior transition zone that was identified on MRI Fusion Transperineal biopsy. Segmentations of the preoperative MRI were used to create a 1:1 scale silicon-based 3D-printed model. Rehearsal procedures were performed using the DaVinci Xi and SP robotic systems for the partial nephrectomy and transvesical partial prostatectomy, respectively. RESULTS: The kidney model allowed for a better appreciation of the tumor location, which was initially thought to be in the mid-lower pole but instead was located more superiorly in the malrotated kidney. Surgical approach was able to be confirmed by following one of the segmental branches towards the upper pole, which led to an immediate tumor identification on the intraoperative ultrasound in vivo. The prostate model, on the other hand, were used to simulate direct transvesical access, robot docking, tumor excision, and vesicourethral anastomosis. Both procedures were completed successfully with negative surgical margins and without any evidence of perioperative complications. For the partial prostatectomy case, urinary continence and full sexual potency (SHIM=25) were able to be achieved within one week of the surgery. Repeat MRI and biopsy in one year demonstrated no evidence of recurrence. CONCLUSIONS: A 3D-printed model of the kidney, bladder, and prostate can be used to simulate various urological procedures with potential benefits in surgical planning and education. Despite the close resemblance of the material to that of normal human tissues and the 0.4 mm accuracy of the model to the reconstructed preoperative images, the models were still limited by way of simulating certain anatomical and physiological features, such as segmental vascular branches, bleeding, and capacity for performing ultrasonographical confirmation. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e637 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Nicolas A. Soputro More articles by this author Ethan L. Ferguson More articles by this author Jason Scovell More articles by this author Roxana Ramos-Carpinteyro More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction In recent years, the introduction of the purpose-built Single-Port (SP) robotic platform (Intuitive Surgical, Sunnyvale, CA) have allowed for the development of a more regionalized approach to robotic radical prostatectomy (RARP), such as with the advent of the Transvesical approach. The novel technique provided the opportunity for an enhanced postoperative recovery with most patients able to be discharged on the same day without requiring any opioids and with many achieving earlier return of urinary continence. Despite these benefits, there remains limited evidence on the impact of this novel technique on the pathologic and oncologic outcomes, which we sought to evaluate in this present study. Methods A retrospective review was performed on prospectively collected data of 169 patients who underwent SP Transvesical or Multi-Port (MP) Transperitoneal RARP by a single surgeon between 2015 and 2022. All SP Transvesical cases were completed entirely from within the bladder using the purpose-built SP platform with all instruments inserted through the multichannel cannula of the dedicated SP Access Kit (Intuitive Surgical, Sunnyvale, CA) via a single 3.5cm suprapubic incision. Preoperative clinicopathologic characteristics, as well as final histopathology outcomes, were compared. Univariate Cox proportional hazard analysis was used to evaluate the impact of the surgical approach on biochemical recurrence-free survival within 12 months. Results SP Transvesical and MP Transperitoneal RARP were completed in 85 and 84 patients, respectively. Preoperative clinicopathologic and prostatectomy histopathologic features were similar between the two groups. The two approaches were associated with identical positive surgical margin rates (SP 20% vs. MP 26%, p=0.36). At a median follow-up of 12 months, there were no differences in the rates of biochemical recurrence between the groups (p=0.38). Univariate Cox proportional hazard analysis did not consider surgical approach to be an independent predictor of biochemical recurrence (HR 0.53, 95%CI 0.13–2.23, p=0.39). Conclusions SP Transvesical RARP provided a similar short-term oncologic control as the gold standard MP approach with similar surgical margin status and 1-year biochemical recurrence rates.

You have accessJournal of UrologyProstate Cancer: Staging II (PD45)1 May 2024PD45-09 IDENTIFYING SITES OF PROSTATE CANCER RECURRENCE IN 68Ga-PSMA PET/CT BASED ON SCAN INDICATION Maya N. Ataya, Clint D. Bahler, Michael O. Koch, Mark Tann, Mark A. Green, Heather L. Huelster, Ethan L. Ferguson, and Shayan Ahmad Maya N. AtayaMaya N. Ataya , Clint D. BahlerClint D. Bahler , Michael O. KochMichael O. Koch , Mark TannMark Tann , Mark A. GreenMark A. Green , Heather L. HuelsterHeather L. Huelster , Ethan L. FergusonEthan L. Ferguson , and Shayan AhmadShayan Ahmad View All Author Informationhttps://doi.org/10.1097/01.JU.0001008792.09108.b4.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET) has emerged as a crucial method for evaluating individuals experience biochemically recurrent (BCR) prostate cancer. This study aims to identify and contrast sites of recurrence using PSMA-PET imagining, depending on the scan's indication. METHODS: Our study retrospectively analyzed individuals who had undergone PSMA-PET scans at Indiana University Hospital between May 2015 and November 2021. The analysis revealed 347 patients who had received PSMA-PET scans due to biochemical recurrence. These patients were categorized according to the scan's indication: 166 patients for BCR post prostatectomy, 66 patients for BCR post-radiation, 75 patients for BCR post prostatectomy and radiation, and 40 patients for Stage 4, defined as those who had undergone chemotherapy or showed evidence of distant metastasis on other imaging modalities. RESULTS: Positive scans were observed in 60% of patients with BCR following prostatectomy, 86% of patients after radiation, 66% in patients after prostatectomy and radiation, and 95% of patients classified as stage 4. Among patients with biochemical recurrence following prostatectomy, the most frequent site of recurrence was the bone (18%), followed by local lymph nodes (16%) and the prostate fossa (13%). For patients experiencing biochemical recurrence after radiation, the prostate (33%) was the most prevalent site of recurrence, followed by bone (22%). Moreover, for patients who had BCR after prostatectomy and salvage radiation, the bone was also the most common site of recurrence (18.6%), followed by local lymph nodes (16%). Among patients in the Stage 4 category, the most common site of recurrence was the bone (50%), followed by visceral metastases (20%). CONCLUSIONS: The site of prostate cancer recurrence varied by indication. Notably, after prostatectomy monotherapy only 13% of scans where positive in the prostate fossa alone while 18% were positive in bone. For post radiation failures, the most common site was the prostate at 33%. PSA recurrence after prostatectomy with salvage radiation tended to be distant lymph nodes (15%), bone (19%), or visceral (15%). Source of Funding: Telix Pharmaceuticals and Al Christy Prostate Cancer Foundation © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e970 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Maya N. Ataya More articles by this author Clint D. Bahler More articles by this author Michael O. Koch More articles by this author Mark Tann More articles by this author Mark A. Green More articles by this author Heather L. Huelster More articles by this author Ethan L. Ferguson More articles by this author Shayan Ahmad More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Staging I (PD17)1 May 2024PD17-10 PREDICTING POSITIVE 68GA-PSMA PET/CT SCANS IN BIOCHEMICAL RECURRENCE FOLLOWING PROSTATECTOMY Maya N. Ataya, Clint D. Bahler, Michael O. Koch, Mark A. Green, Mark Tann, Ethan L. Ferguson, Heather L. Huelster, and Shayan Ahmad Maya N. AtayaMaya N. Ataya , Clint D. BahlerClint D. Bahler , Michael O. KochMichael O. Koch , Mark A. GreenMark A. Green , Mark TannMark Tann , Ethan L. FergusonEthan L. Ferguson , Heather L. HuelsterHeather L. Huelster , and Shayan AhmadShayan Ahmad View All Author Informationhttps://doi.org/10.1097/01.JU.0001010044.70939.31.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET), is a cutting-edge imaging technique that is increasingly being used in the evaluation of patients with biochemical recurrence (BCR) after definitive prostate cancer treatment. The primary aim of this study is to investigate the clinical and pathological factors that predict positive PSMA-PET scans in patients experiencing biochemical recurrence following radical prostatectomies (RP). METHODS: A retrospective review was carried out on a cohort of prostate cancer patients who underwent PSMA-PET scans at Indiana University Hospital within the period spanning from May 2017 to November 2021, identifying 400 total patients and 241 patients who had undergone PSMA-PET scans as part of their assessment for BCR post prostatectomy with no previous evidence of distant metastasis. The patients were then categorized into two groups based on the outcome of the scans: those with positive results and those with negative results. We gathered and compared clinical and pathological variables collected from patients with positive and negative PSMA-PET scans. RESULTS: Among the 241 patients identified, 151(62%) patients were identified with positive scans. Notably, cancer stage, surgical margins, and seminal vesical invasion were not found to be predictive of a positive PSMA-PET scan. PSA level at the time of the scan, ISUP, years between treatment and scan were observed to be significantly associated with predicting a positive PSMA-PET scan. In the univariate logistical regression analysis, a PSA value ≥0.2, ISUP ≥4, and ≥5 years since treatment demonstrated an odds ratio (OR) of 7.8.(p<0.001), 2.9(p=0.006), and 2.0(p=0.03) respectively. This clinically significant association remained prominent in the multivariate logistical regression with PSA value ≥0.2, ISUP ≥4, and ≥5 years since treatment demonstrating OR of 8.8(p<0.001), 4.2 (p=0.001), and 2.2(p=0.04) respectively. CONCLUSIONS: This study illustrated that among patients with biochemical recurrence post prostatectomy undergoing PSMA-PET scans a PSA value ≥0.2, ISUP ≥4, and ≥5 years since treatment were found to be clinically significant predictors of a positive PSMA-PET result. Source of Funding: Telix Pharmaceuticals and Al Christy Prostate Cancer Foundation © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e374 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Maya N. Ataya More articles by this author Clint D. Bahler More articles by this author Michael O. Koch More articles by this author Mark A. Green More articles by this author Mark Tann More articles by this author Ethan L. Ferguson More articles by this author Heather L. Huelster More articles by this author Shayan Ahmad More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction We aim to report our surgical technique, functional and radiological outcomes of single port (SP) extraperitoneal robotic pediatric pyeloplasty through a low anterior (3 cm) access using a da-Vinci single -port (SP) robotic surgical system in the pediatric population. Material and methods We present our initial series of 6 pediatric patients that underwent robotic SP extraperitoneal pyeloplasty between 2022 and 2023. Patient clinicopathologic variables and perioperative outcomes were collected prospectively. Results All cases of SP extraperitoneal pyeloplasty were completed without any intraoperative complications or conversion to an open, laparoscopic, or multi -port robotic pyeloplasty. Total operative times including cystoscopy ranged from 178 min to 240 min. All patients tolerated the surgery with minimal postsurgical pain and no narcotic requirement. No intraoperative or immediate postoperative complications were recorded in the cohort. There were no readmissions after discharge at a median follow-up of 12 months (6-18 months) in our series. Conclusions Single port extraperitoneal pyeloplasty is a safe and feasible option for upper tract reconstruction in pediatric patients. All patients had complete resolution of symptoms and improvement of hydronephrosis on follow-up imaging.

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP37)1 May 2024MP37-16 SINGLE-PORT ROBOTIC TRANSVESICAL PARTIAL PROSTATECTOMY: A NEW FORM OF FOCAL TREATMENT IN PROSTATE CANCER Adriana Marcela Pedraza Bermeo, Ethan L. Ferguson, Roxana Ramos-Carpinteyro, Nicolas Soputro, Jaya Chavali, Carter Mikesell, and Jihad Kaouk Adriana Marcela Pedraza BermeoAdriana Marcela Pedraza Bermeo , Ethan L. FergusonEthan L. Ferguson , Roxana Ramos-CarpinteyroRoxana Ramos-Carpinteyro , Nicolas SoputroNicolas Soputro , Jaya ChavaliJaya Chavali , Carter MikesellCarter Mikesell , and Jihad KaoukJihad Kaouk View All Author Informationhttps://doi.org/10.1097/01.JU.0001008948.02935.01.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Given the favorable cancer-specific survival rates in localized prostate cancer and the negative impact of whole-gland treatments on functional outcomes, the field is moving towards precision strategies such as focal therapy and organ-sparing surgery. We aim to report medium-term functional and oncologic outcomes for the initial Single-Port Robotic Transvesical Partial Prostatectomy (SP-TVRAPP) patient cohort. METHODS: We retrospectively analyzed a prospectively maintained database of 17 patients who underwent SP-TVRAPP between February 2021 and February 2023. Inclusion criteria were PSA ≤10 ng/mL, clinical stage ≤cT2b, ISUP Grade Group ≤3, unilateral lesion on mpMRI with positive biopsy cores on the same side, and preoperative IIEF-5 ≥17. We also considered bilateral cancer in the anterior zone and invisible mpMRI tumors confirmed by unilateral positive biopsies. RESULTS: At baseline, patients had an average age of 61 years, a median PSA of 4.8 ng/mL (IQR 3.7-7.7), and a median SHIM score of 23 (IQR 18-25). Procedures were complication-free, with no need for extra ports or conversion. After a median hospital stay of 3.9 hours, 94% were discharged without opioid prescriptions, and Foley catheters were removed after about 4 days. Potency (SHIM ≥17) was achieved by 35.3%, 68.7%, and 81.2% at 6 weeks, 3 months, and 6 months, respectively, with 37.5% not needing phosphodiesterase type 5 inhibitors. Regarding urinary function, 82.3% were continent at 6 weeks, increasing to 93.7% at 3 and 6 months. Oncologically, 29% were upgraded, 35% upstaged, and 82% had negative surgical margins. Median PSA was 0.4 ng/ml (IQR 0.2-1.2) twelve months after SP-TVRAPP. Two men had residual GG1 cancer in follow-up biopsies and are on active surveillance. At a mean follow-up of 15.2 (range 6.2-29.5) months, none of the patients have required secondary interventions, and all remain free of both clinically significant residual prostate cancer and metastatic disease. CONCLUSIONS: SP-TVRAPP is a promising approach for selected patients with localized prostate cancer. This focal surgical technique resulted in an expedited postoperative recovery and yielded high rates of erectile function and urinary continence while maintaining oncologic safety. Further studies are needed to verify these findings and assess long-term outcomes. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e609 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Adriana Marcela Pedraza Bermeo More articles by this author Ethan L. Ferguson More articles by this author Roxana Ramos-Carpinteyro More articles by this author Nicolas Soputro More articles by this author Jaya Chavali More articles by this author Carter Mikesell More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP56)1 May 2024MP56-10 LONG-TERM ONCOLOGICAL AND FUNCTIONAL OUTCOMES FOLLOWING ROBOTIC PARTIAL AND RADICAL NEPHRECTOMY IN PATIENTS WHO SURVIVED BEYOND FIVE YEARS Nicolas A. Soputro, Ethan L. Ferguson, Roxana Ramos-Carpinteyro, Jaya S. Chavali, Adriana M. Pedraza, Carter Mikesell, Khaleed Fareed, Ryan Berglund, Robert J. Stein, Georges P. Haber, Steven C. Campbell, Christopher J. Weight, and Jihad Kaouk Nicolas A. SoputroNicolas A. Soputro , Ethan L. FergusonEthan L. Ferguson , Roxana Ramos-CarpinteyroRoxana Ramos-Carpinteyro , Jaya S. ChavaliJaya S. Chavali , Adriana M. PedrazaAdriana M. Pedraza , Carter MikesellCarter Mikesell , Khaleed FareedKhaleed Fareed , Ryan BerglundRyan Berglund , Robert J. SteinRobert J. Stein , Georges P. HaberGeorges P. Haber , Steven C. CampbellSteven C. Campbell , Christopher J. WeightChristopher J. Weight , and Jihad KaoukJihad Kaouk View All Author Informationhttps://doi.org/10.1097/01.JU.0001008940.44711.d4.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) has long been established as the preferred treatment for small and localized renal masses, with a strong emphasis towards the balance between renal function preservation and satisfactory oncological outcomes. With the increasing utilization of robotic surgery for both PN and radical nephrectomy (RN), this study sought to evaluate the long-term functional and oncological trajectories in patients who survived beyond five years following robotic PN and RN. METHODS: A retrospective review was performed on the prospectively maintained, IRB-approved database to identify 1816 patients who underwent primary robotic PN and RN between 2006 and 2018. Patients with a long-term follow-up of at least five years were included. Exclusion criteria included those with known genetic mutations and whose procedures were performed for benign indications. Statistical analysis was performed using the R Project for Statistical Computing. RESULTS: A total of 769 PN and 142 RN cases were included. At a median follow-up duration of nearly 100 months, the RCC-specific mortality rates were similar between the groups at 1.1% and without any significant differences in terms of the local recurrence and metastatic-free survival rates. We did not identify any patient with pT4 disease in our RN cohort. In terms of functional outcomes, the 5- and 10-year chronic kidney disease (CKD) progression-free survival rates were 74.5% and 65.9% following PN and 53% and 46.4% after RN, respectively (p<0.05). Older age, higher BMI, and longer ischemia time were identified as potential predictors for CKD progression following PN. CONCLUSIONS: Compared to RN, PN conferred a better long-term CKD progression-free survival whilst maintaining similarly satisfactory oncological outcomes. Despite clinically significant CKD upstaging being evident in some cases, most of our patients demonstrated relatively stable and good preservation of renal function throughout the long follow-up duration of up to 15 years. Download PPTDownload PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e929 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Nicolas A. Soputro More articles by this author Ethan L. Ferguson More articles by this author Roxana Ramos-Carpinteyro More articles by this author Jaya S. Chavali More articles by this author Adriana M. Pedraza More articles by this author Carter Mikesell More articles by this author Khaleed Fareed More articles by this author Ryan Berglund More articles by this author Robert J. Stein More articles by this author Georges P. Haber More articles by this author Steven C. Campbell More articles by this author Christopher J. Weight More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction Simple prostatectomy for benign prostatic hyperplasia (BPH) is reserved for patients with severe symptoms and/or resistance to conservative treatment. Although the preoperative workup usually includes prostate-specific antigen (PSA) and digital rectal examination (DRE), there is no established screening protocol for prostate cancer prior to a simple prostatectomy.;In recent literature, the rate of incidental prostate cancer (iPCa) after simple prostatectomy ranges between 2.5% to 40.0%, 1.7% to 7.0%, and 8.9% to 9.9% for multi-port (MP) robot-assisted, laparoscopic, and open, respectively.The single-port (SP) transvesical (TV) robot-assisted approach is a minimally invasive alternative to simple prostatectomy. It involves the excision of the prostatic adenoma (without morcellation) and reconstruction of the prostatic fossa. Furthermore, it allows for concomitant treatment of bladder diverticula and stones. Our aim is to report the iPCa detection rate following SP TV robot-assisted simple prostatectomy (RASP). Methods This is a single-center study that analyzes all consecutive SP TV RASP cases performed from February 2019 to June 2023 by three surgeons. The procedure consists of two major steps: 1) Excision of the prostatic adenoma. 2) A 360° mucosal advancement flap reconstruction. The primary outcome was the rate of iPCa in the series. Secondary outcomes included perioperative prostate cancer screening and postoperative management of the patients in which iPCa was found. We used descriptive statistics to analyze the data. Results A total of 116 cases were reviewed and iPCa was found in 6 (5.17%) patients. Detailed results are shown in Figure 1. The median age was 70 years. Only one of the six patients had had a previous prostate intervention. The median PSA and prostate volume were 5.2 ng/ml and 130 cc, respectively. Notably, the lower prostate-volume patients were candidates for RASP due to comorbid bladder diseases (diverticula and stones). Three patients presented with urinary retention. All patients had preoperative imaging studies, an MRI showed a PI-RADS 2 lesion in one of the patients, the rest were unremarkable for lesions. Biopsies were taken for three patients and no adenocarcinoma was found. The median specimen weight was 71.4 g. Four patients had GG1 disease, one GG2, and one GG4, this patient underwent MP RARP three months later. The rest are on active surveillance with a median follow-up of 17 months. Conclusions The incidence of prostate cancer in the initial experience with SP TV RASP is 5.17%. Lab and imaging studies are not enough to exclude malignancy preoperatively; therefore, pathological analysis is crucial after the excision of prostatic adenoma. In our experience, MP RARP is feasible three months after SP RASP.

Introduction: Prostate cancer diagnosis and treatment is challenging in surgically complex patients. Radical prostatectomy can be performed without peritoneal entry using novel single-port (SP) transperineal (TP) and transvesical (TV) approaches. We sought to examine the outcomes of radical prostatectomy using novel TP and TV approaches in patients with extensive prior abdominal surgeries. Materials and Methods: From 2019 to 2023, 51 patients with extensive prior abdominal surgeries were identified who underwent TP (18) and SP TV (33) robotic radical prostatectomy. Indications included history of various surgeries with open laparotomy, including J-pouch reconstruction (22, 43%), active stoma (14, 27%), and open bowel resection (9, 18%). In all patients, 12/51 (24%) had a history of incisional hernia repair with mesh. A retrospective analysis was performed. Results: All cases were completed without open conversion, bowel injuries, or blood transfusions. Length of stay was 5.6 hours for TV and 22 hours for TP. No opioids were prescribed in 91% of TV vs 56% of TP. One intraoperative complication (ureteral injury) occurred in a patient undergoing the TP approach. Postoperative complications were noted in 14/51 (27%), including 10/18 (56%) TP vs 4/33 (12%) TV. High-grade complications (Clavien 3) occurred in three patients (6%, all TP). Pathologic staging showed pT3 in 26/51 (17 TV vs 9 TP), while the remainder were pT2. Biochemical recurrences were noted in four patients (8%, three TV and one TP). Immediate continence was noted in 30% of TV patients. Long-term continence after 12 months was 92% in TV and 67% in TP. Conclusions: In patients with extensive prior abdominal surgeries, radical prostatectomy is feasible using a TP or TV approach. No bowel injuries or open conversion were observed. The SP TV approach offers advantages of shorter hospital stay, shorter catheter duration, less opioid use, fewer complications, and improved continence recovery.

Objective The single port robotic transvesical approach has been used for simple and radical prostatectomy. This video shows a single port, transvesical approach to a bladder neck contracture repair. Patients and surgical procedure The patient is a 66-year-old male with a history of BPH and two prior TURPs. He developed a bladder neck contracture and underwent an incision of the bladder neck. However, his symptoms returned, and he went into retention requiring indwelling catheterization. Cystoscopy showed a short, 16Fr bladder neck contracture. He elected for a robotic bladder neck contracture repair. The repair was performed with the single port robot using the transvesical approach. We made a 3 cm suprapubic incision, accessed the space of Retzius through the midline, filled the bladder, and made a small cystotomy. The access port was placed directly into the bladder. We dissected around the contracture and carried the dissection distally toward the urethra. We excised the contracture at the verumontanum. The urothelium was advanced to the urethra using two running 3-0 stratafix sutures. A catheter was place prior to closure of the bladder and fascia. Results The procedure time was 106 minutes with 55 minutes of console time and little blood loss. Pathology showed urothelium with inflammation and fibrosis. The patient was discharged with an indwelling catheter, which was removed on postoperative day 6. The patient was able to void to completion. At one month follow up, he was continent. Cystoscopy showed a patent, healing bladder neck and healing cystotomy closure. At around 9 months follow up, the patient was voiding well with Qmax 17.3 ml/s and PVR 3 ml. He has urinary frequency and urgency managed with oral medications. Conclusions The transvesical single port robotic approach is a minimally invasive option for repair of bladder neck contracture. While this patient had a short stricture, longer or denser strictures may require more complex reconstruction such as Y-V-plasty or even prostatectomy. However, the single port robot would also facilitate these intraoperative adjustments.