INTRODUCTION:The learning curves analysed to date for robot-assisted laparoscopic prostatectomy are based on arbitrary cut-offs of the total cases.METHODS:We analysed a large dataset of robot-assisted laparoscopic prostatectomies from a single centre between 2008 and 2019 for assessment of the learning curve for perioperative outcomes with respect to time and individual cases.RESULTS:A total of 1,406 patients were evaluated, with mean operative time 198.08 minutes and mean console time 161.05 minutes. A plot of operative time and console time showed an initial decline followed by a near-constant phase. The inflection points were detected at 1,398 days (308th case) for operative time and 1,470 days (324th case) for console time, with a declining trend of 8.83 minutes and 7.07 minutes, respectively, per quarter-year (p<0.001). Mean estimated blood loss showed a 70.04% reduction between the start (214.76ml) and end (64.35ml) (p<0.001). The complication rate did not vary with respect to time (p=0.188) or the number of procedures (p=0.354). There was insufficient evidence to claim that the number of operations (p=0.326), D'Amico classification (p=0.114 for intermediate versus low; p=0.158 for high versus low) or time (p=0.114) was associated with the odds of positive surgical margins.CONCLUSIONS:It takes about 300 cases and nearly 4 years to standardise operative and console times, with a requirement of around 80 cases per annum for a single surgical team in the initial years to optimise the outcomes of robot-assisted laparoscopic prostatectomy.

OBJECTIVES:Traditionally anterior prostatic fat (APF) hasn't been included in pelvic lymph node (LN) dissection templates following radical prostatectomy. In this study we evaluate the incidence of lymphoid tissue in the APF and the incidence of LN metastasis in APF in patients who have undergone robotic-assisted laparoscopic radical prostatectomy (RALP).METHODS:A prospective database of RALP has been maintained between January 2010 and September 2015. APF is routinely excised and sent separately for histopathological evaluation to identify lymphoid tissue and metastatic prostate cancer.RESULTS:A total of 629 underwent RALP. Forty-six (7.3%) of the patients had lymphoid tissue on histopathological evaluation. Two patients had meta-static disease. Both patients with positive LNs were intermediate risk on pre-operative evolution (A-PSA 16.6 ng/ml, Gleason 3 + 4; B PSA 7.3 ng/ml, Gleason 4 + 3) and upgraded on final prostate pathological evaluation to high risk disease (A-Gleason 4 + 5, pT3b, B-Gleason 4 + 3, pT4).CONCLUSION:There appears to be lymphatic drainage to the APF from the prostate. Hence APF should be included in pelvic LN dissection templates when lymphadenectomy is contemplated in patients undergoing radical prostatectomy.

INTRODUCTION The diagnostic yield of transrectal ultrasonography (TRUS) guided prostate biopsy is influenced by many patient and procedure specific factors. However, the role of operator specific factors remains inadequately defined. This study investigated the association of diagnostic outcome of TRUS guided biopsy with operator skill level. METHODS This study looked at a consecutive cohort of 690 men undergoing their first extended pattern TRUS guided prostate biopsy by 27 operators over a 24-month period in a single institution. Logistic regression was used for statistical analysis. RESULTS Biopsies performed by consultants (odds ratio [OR]: 2.35, p=0.004) and senior trainees (OR: 2.37, p=0.002) in patients with prostate specific antigen levels of <10ng/ml were more likely to be positive than those performed by junior trainees (cancer detection rate 50.0%, 50.3% and 29.9% respectively). Furthermore, biopsies performed by junior trainees yielded a significantly higher proportion of prostate cancers with a Gleason score of ≥3+4 than those performed by senior trainees (OR: 2.11, p=0.031) and consultants (OR: 2.40, p=0.013) (81.4%, 67.5% and 64.6% respectively). No significant differences emerged between operator skill groups for complications, rebiopsy rates or the number of prostate cancers found during the follow-up period (median: 34 months) of patients with a negative biopsy. CONCLUSIONS Level of operator experience is associated with the diagnostic outcome of extended pattern TRUS guided biopsy. The findings of this study imply that case selection, self-audit and expert supervision for the duration of the learning curve should form the basis of biopsy training.

The low incidence of partial segmental thrombosis of the corpus cavernosum (PSTCC) means its management is guided by isolated case reports. Erectile function is an important outcome that has not been described quantitatively in the literature. We present two cases of PSTCC managed conservatively. Although both patients reported resolution of local symptoms, formal analysis of sexual function at follow-up review has revealed that only one achieved complete recovery.

We present a review on the increasing indications for the use of positron emission tomography (PET) in uro-oncology. In this review we describe the details of the different types of PET scans, indications for requesting PET scans in specific urological malignancy and the interpretation of the results.

Objectives . The aims of this study were to compare the outcomes of robotic assisted laparoscopic prostatectomy (RALP) between patients who had larger (≥75 g) and smaller (<75 g) prostates and to evaluate the performance of PSA density (PSAD) in determining the oncological outcome of surgery. Methods and Materials . 344 patients who underwent RALP at a single institution were included in the study. Preoperative risk factors and postoperative, oncological outcomes, erectile function, and continence status were recorded prospectively. Results . During a mean follow-up of 20 months, biochemical recurrencePSA>0.2was observed in 15 patients (4.3%). Prostate size ≥75 g was associated with lower Gleason score on final pathologyP=0.004and lower pathological stageP=0.02but an increased length of hospital stayP=0.05. PSAD on binary logistic regression independently predicted biochemical recurrence (BCR) when defined as postoperative PSA >0.1P=0.001and PSA >0.2P=0.039. In both instances PSA was no longer a significant independent predictor. Conclusions . RALP in large prostates (≥75 g, <150 g) is as safe as RALP in smaller prostates and is associated with a lower pathological grade and stage. Higher PSAD is independently associated with BCR and is superior to PSA as a predictor of BCR after RALP.

INTRODUCTION:Robotic radical prostatectomy (RRP) is an established treatment for prostate cancer in selected centres with appropriate expertise. We studied our single-centre experience of developing a RRP service and subsequent training of 2 additional surgeons by the initial surgeon and the introduction of United Kingdom's first nationally accredited robotic fellowship training programme. We assessed the learning curve of the 3 surgeons with regard to peri-operative outcomes and oncological results.PATIENTS AND METHODS:Three hundred consecutive patients underwent RRP between November 2008 and August 2012. Patients were divided into 3 equal groups (Group 1, case 1-100; Group 2, case 101-200; and Group 3, case 201-300). Age, ASA score, preoperative co-morbidities and indications for laparoscopic radical prostatectomy were comparable for all 3 patient groups. Peri-operative and oncological outcomes were compared across all 3 groups to assess the impact of the learning curve for laparoscopic radical prostatectomy. All surgical complications were classified using the Clavien-Dindo system.RESULTS:The mean age was 60.7 years (range 41-74). There was a significant reduction in the mean console time (p < 0.001), operating time (p < 0.001), mean length of hospital stay (p < 0.001) and duration of catheter (p < 0.001) between the 3 groups as the series progressed. The two most important factors predictive of positive surgical margins (PSM) at RRP were the initial prostate specific antigen (PSA) and tumor stage at diagnosis. The overall PSM rate was 26.7%. For T2/T3 tumors the incidence of PSM reduced as the series progressed (Group 1-22%, Group 2-32% and Group 3-26%). The incidence of major complications i.e. grade Clavien-Dindo system score ≤ III was 2% (6/300).CONCLUSION:RRP is a safe procedure with low morbidity. As surgeons progress through the learning curve peri-operative parameters and oncological outcomes improve. This learning curve is not affected by the introduction of a fellowship-training programme. Using a carefully structured mentored approach, RRP can be safely introduced as a new procedure without compromising patient outcomes.

All patients undergoing a radical prostatectomy (RP) using any surgical approach, be it open, laparoscopic, or robotic, are at risk of developing postprostatectomy urinary incontinence. This side effect of RP has an effect on the patient's quality of life and can be associated with moderate to severe postoperative morbidity. The authors present a review of the etiology and prevention strategies of postprostatectomy urinary incontinence. Based on the current literature, the authors conclude that there is a paucity of studies that can accurately answer the exact anatomic and physiologic etiologies of postprostatectomy urinary incontinence. The aim of urologic surgeons performing RP should be to reduce the rate of postoperative incontinence rather than attempting to treat it once it has occurred. Further studies aimed at providing a detailed anatomic map of the pelvic anatomy related to continence will help to improve surgical techniques and reduce postoperative urinary incontinence following RP.

This article is an editorial, and it doesn't include an abstract. Full text of this article is available in HTML and PDF.Cite this article as: Vasdev N, Mafeld S, Fuge O, Lane T, Boustead G, Adshead JM, Soomro NA. The results of 2013 survey to evaluate laparoscopic and partial nephrectomy practice in the United Kingdom. Int J Cancer Ther Oncol 2014; 2(2):02022.DOI: http://dx.doi.org/10.14319/ijcto.0202.2

OBJECTIVE:To investigate Tumour-Node-Metastasis (TNM) stage and demographics at presentation in a very large, contemporary UK cohort of patients with bladder cancer and compare them with other published series, as little published data exists on the pathological characteristics of bladder cancer at presentation.PATIENTS AND METHODS:The British Association of Urological Surgeons (BAUS) Section of Oncology started a new urological tumour registry in 1998. We performed a data analysis of all bladder cancer cases between 1999 and 2008. Tumour TNM stage, grade and histopathological diagnosis were reviewed along with standard epidemiological data.RESULTS:In all, 69,712 bladder cancer registrations were recorded. Complete T, N and M stage and grade was available for 32,240 patients. The male to female ratio of the study population was 3:1 and the overall median (sd, range) age at presentation was 73 (11.6, 6-108) years. Final pathological T staging showed that non-muscle-invasive bladder cancer accounted for 75% of cases with the remaining 25% being muscle-invasive disease. Of these patients, 8% had nodal disease and 4% other metastatic sites at presentation. The tumour grade was G1-2 in 65% and G3 in 35% of cases. Transitional cell carcinoma (TCC) accounted for 92%, squamous cell carcinoma and adenocarcinomas 1.5% each, with 5% other histological variants.CONCLUSIONS:Non-muscle-invasive TCC accounted for 75% of bladder cancer cases in the UK. The 1973 World Health Organization classification remains in widespread use amongst pathologists in the UK. Obtaining complete and standardised staging and pathology reporting systems in bladder cancer remains a challenge.

A number of patients are diagnosed with renal malignancies incidentally worldwide. Once a diagnosis of a renal malignancy is established, after a careful evaluation, patients can be offered a robotic nephrectomy or partial nephrectomy. We present a review of the physiologic and anesthetic considerations in elderly patients who are being considered for robotic renal surgery.

You have accessJournal of UrologyProstate Cancer: Detection & Screening (V)1 Apr 20132216 THE ASSOCIATION OF THE DIAGNOSTIC OUTCOME OF THE TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY WITH THE OPERATOR EXPERIENCE: IMPLICATIONS FOR TRAINING Sergey Tadtayev, Adam Hussein, Lewis Carpenter, Nikhil Vasdev, and Gregory Boustead Sergey TadtayevSergey Tadtayev Stevenage, United Kingdom More articles by this author , Adam HusseinAdam Hussein Stevenage, United Kingdom More articles by this author , Lewis CarpenterLewis Carpenter Hatfield, United Kingdom More articles by this author , Nikhil VasdevNikhil Vasdev Stevenage, United Kingdom More articles by this author , and Gregory BousteadGregory Boustead Stevenage, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2125AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is established that a number of factors influence the diagnostic outcome of the transrectal ultrasound-guided (TRUS) prostate biopsy, however the there is a paucity of data on the effect of the operator experience. The aim of this study was to investigate the association of the level of operator experience with the diagnostic outcome of the TRUS biopsy: cancer detection rate (CDR) and Gleason grade of the detected cancers. We also evaluated the learning curve of the least experienced operators. METHODS We conducted a review of 690 consecutive patients who underwent their first TRUS biopsy in a single institution over a 24 months period. Biopsies were undertaken by 7 consultants, 11 senior trainees practicing TRUS > 1 year and 9 junior trainees who started their TRUS training during the study period. Logistic regression was used for statistical analysis. RESULTS The analysis of the whole cohort has demonstrated that TRUS biopsies performed by more experienced operators were more likely to be positive, yet a lower proportion of cancers found by the least experienced operators was of Gleason 6 grade (Juniors vs Seniors OR 0.41, p=0.006, CI 0.22-0.77, Juniors vs Consultants OR 0.34, p=0.001, CI 0.18-0.65). However, upon stratification by serum PSA (<10 ng/mL vs ≥ 10 ng/mL), the difference in the positive biopsy outcome between the least and more experienced operators has only reached statistical significance in < 10 ng/mL group. We could not identify an evidence of a learning curve amongst the juniors. CONCLUSIONS We have demonstrated that in the patient cohort with the serum PSA < 10 ng/mL the more experienced operators had more positive biopsies, which is likely due to superior prostate sampling as suggested by a higher proportion of Gleason 6 cancers found by these operators. Junior trainees should focus their TRUS biopsy practice on the patient group with high PSA values in order not to jeopardise the diagnostic outcome of the biopsies in patients with PSA in the “grey zone” < 10 ng/mL. Patient/biopsy characteristics Consultants Senior trainees Junior trainees Whole cohort Number of patients (%) 225 (32.60%) 316 (45.79%) 149 (21.61%) Median age, years, (IQR) 68 (14) 68 (13) 67 (11) Median PSA, ng/mL, (IQR) 8.5 (9.9) 8.45 (8.25) 8.8 (9.5) Median prostate volume, cm2 46 47.5 40 Mean number of cores 12.21 12.54 12.38 CDR,% 64% 59.49% 46.98% Gleason 7 and above,% 64.58% 67.55% 81.42% PSA < 10 ng/mL Number of patients (%) 130 (32.17%) 187 (46.28%) 87 (21.55%) Median age, years 64.5 66 65 Median PSA, ng/mL 6.1 6.3 6.7 CDR,% 50% 50.26% 29.88% PSA ≥ 10 ng/mL Number of patients (%) 95 (33.21%) 129 (45.10%) 62 (21.69%) Median age, years 74 72 71 Median PSA, ng/mL 17 20.4 18.05 CDR,% 83.16% 72.86% 70.96% Group Operators Odds Ratio p 95% confidence intervals Whole cohort Junior vs Senior trainees 1.90 0.003 1.24-2.92 Juniors vs Consultants 2.41 <0.001 1.53-3.80 PSA < 10 ng/mL Junior vs Senior trainees 2.37 0.002 1.38-4.07 Juniors vs Consultants 2.35 0.004 1.32-4.16 PSA ≥ 10 ng/mL Junior vs Senior trainees 1.10 0.784 0.56-2.15 Juniors vs Consultants 2.02 0.073 0.94-4.35 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e908-e909 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sergey Tadtayev Stevenage, United Kingdom More articles by this author Adam Hussein Stevenage, United Kingdom More articles by this author Lewis Carpenter Hatfield, United Kingdom More articles by this author Nikhil Vasdev Stevenage, United Kingdom More articles by this author Gregory Boustead Stevenage, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...