Purpose: To assess feasibility, toxicity and biochemical relapse-free survival (b-RFS) for a group of organ confined (OC) Saudi prostate cancer patients treated by hypo-fractionated Volumetric Modulated Arc Radiation Therapy (VMAT) Simultaneous Integrated Boost (SIB) Elective Nodal Irradiation (ENI) whole pelvic radiotherapy (WPRT).Patients and methods: Between March 2009 and January 2014, 29 OC prostate cancer patients; median age 64 years, PS 0-1 were treated in King Faisal Specialist Hospital - Riyadh, Kingdom of Saudi Arabia using VMAT-SIB-ENI-WPRT, to a total dose of 70 Gy in 28 fractions. Twenty Four patients (83%) were treated with neo-adjuvant; concurrent androgen deprivation therapy (ADT). Median follow-up (FU) was 42 months (range: 18-72 months).Results: The 3-year actuarial b-RFS for low/intermediate and high risk groups were 100%, and 48%, respectively (p = 0.09) with a median FU period of 34 months (range: 14-53 months). Gleason Score (p = 0.02), and pretreatment PSA (p = 0.01) were predictive for biochemical failure on univariate analysis; with no observed prostate cancer-related deaths. Grade 2 acute/late GI and GU toxicities were 28%/0% and 17%/10% respectively with no reported grade 3/4 toxicities. Four 50%) out of the 8 patients with baseline partial potency, retained sexual function on long term follow-up.Conclusions: Hypo-fractionation dose escalation VMAT-SIB-ENI-WPRT using 2 arcs is a feasible technique for intermediate/high risk OC prostate cancer patients, with acceptable rates of acute/late toxicities, much favorable planning target volume (PTV) coverage, and shorter overall treatment time. Prospective randomized controlled trials are encouraged to confirm its equivalence to other fractionation schemes. (C) 2016 National Cancer Institute, Cairo University. Production and hosting by Elsevier B. V. This is an open access article under the CC BY-NC-ND license.

INTRODUCTION:The purpose of this video is to demonstrate the use of the robot to perform a transmesocolonic pyelolithotomy of a horseshoe kidney.MATERIALS AND METHODS:A 35-year old female presented with vague abdominal pain. CT scan imaging revealed the presence of a left horseshoe kidney with multiple pelvicalyceal stones. The patient was positioned in the supine position. A total of 4 ports were introduced. A 3-arm da Vinci robotic surgical system was docked, and the arms were connected. First, the dilated renal pelvis was identified behind the thin mesocolon. The mesocolon was entered and renal pelvis was dissected completely from the surrounding fat. Then, the renal pelvis was opened after adequate dissection and stones were visualized inside the calyces. By Prograsp forceps, stones were removed from all the calyces under vision and were extracted from the assistant trocar. Finally, the pylotomy incision was closed using 4 0 Maxon in a continuous fashion and the mesocolon was closed using 3 0 PDS interrupted sutures. A JP drain was placed.RESULT:Operative time was forty-five minutes, blood loss was 100 ml. The patient was discharged after 48 hours with no immediate complications.CONCLUSION:The utilization of minimal invasive surgery using the robot to extract multiple pelvicalyceal stones from a horseshoe kidney without reflecting the mesocolon proved to be a feasible and novel way in the management of complex stone disease improving the outcome with minimal morbidity.

Introduction: Multiple case reports and reviews have been described in the literature for bladder wall leiomyoma resection via different approaches.The minimally invasive partial cystectomy remains the most widely accepted technique; however, case reports for enucleation of bladder wall leiomyoma have also been described.The purpose of this video is to demonstrate the robotic extramucosal excision of a bladder wall leiomyoma, without cystotomy, but with complete removal of the muscular layer.Materials and Methods: A 35-year old male present with lower urinary tract symptoms and imaging showed bladder wall mass with histopathology showed leiomyoma.The patient consented for mass excision with the possibility of a partial cystectomy.The patient was placed in the supine, 30-degree Trendelenburg position during the procedure.A total of 4 ports were inserted.A 3-arm da Vinci robotic surgical system was docked, and the arms were connected.Extramucosal excision was accomplished without cystotomy and muscle approximation was achieved by 2 0 Vicryle.Result: The operative time was 90 minutes, blood loss of approximately 50mL and the patient was discharged after 72 hours with no immediate complications and a 6 months follow-up showed no recurrence.Conclusion: Such a technique results in complete excision of the tumor, without cystotomy, and also maintains an intact mucosa.These steps, in addition to decreasing the risk of local recurrence, also shorten the period of postoperative catheterization and hospitalization.

Lymphangioma of the urinary bladder is a very rare tumour inadulthood. Robotic partial cystectomy is evolving for treatmentof a limited number of bladder tumours. We describe a case ofan adult woman with a bladder dome lymphangioma for whichrobotic partial cystectomy was carried out.

Robotic reconstruction of the retrocaval ureter is gaining momentum as the method of choice for surgically treating this rare condition. Maintaining the retrocaval ureteric segment further facilitates the procedure. We report a case of a 23-year-old man who underwent intraperitoneal robotic resection anastomosis and repositioning of the retrocaval ureter. We also discuss the advantages of this technique.

Despite the observed stage migration and earlier detection of renal masses, patients still present with locally advanced renal cell carcinoma. These patients represent a difficult oncologic challenge. Despite our ability to do surgical resection to cure the disease, survival often remains limited. In this paper, we describe the role and indication for surgical resection for patients with enlarged retroperitoneal lymph nodes, invasion of adjacent organs, invasion into the vena cava or locally recurrent disease. The development of new strategies, including effective drugs to be used in association with surgical resection, will clearly be an essential step to further improve the outcome of these patients.

In this report, guidelines for the evaluation, medical and surgical management of transitional cell carcinoma of testicular germ cell tumors is presented. It is categorized according to the stage of the disease using the tumor node metastasis staging system, 7th edition. The recommendations are presented with supporting level of evidence.

In this report, guidelines for the evaluation, medical and surgical management of renal cell carcinoma is presented. It is categorized according to the stage of the disease using the tumor node metastasis staging system, 7th edition. The recommendations are presented with supporting evidence level.

In this report guidelines for the evaluation, medical and surgical management of transitional cell carcinoma of urinary bladder is presented. It is categorized according to the stage of the disease using the tumor node metastasis staging system, 7th edition. The recommendations are presented with supporting level of evidence.

In this report, guidelines for the evaluation, medical and surgical management is presented. It is categorized according to the stage of the disease using the tumor node metastasis staging system, 7th edition. The recommendations are presented with supporting level of evidence.

OBJECTIVE:To evaluate our experience with surgical resection of renal cell carcinoma (RCC) with inferior vena cava (IVC) involvement and examine the relationship between prognosis and tumour extent.PATIENTS AND METHODS:A retrospective review of nephrectomy performed between 1985 and 2005 identified 50 patients presenting with tumour thrombus extension into the IVC. Clinical characteristics and outcome were evaluated.RESULTS:Of the 50 patients evaluated, 7, 26, 10 and 7 presented with level I, II, III and IV thrombus, respectively. Major postoperative complications occurred in 16% of patients. Local or distant failure occurred in 25 (64%) patients. The mean time to recurrence was 10 months. Only supra-diaphragmatic extension of the tumour thrombus was predictive of disease recurrence.CONCLUSION:Locally advanced RCC with IVC thrombus remains associated with significant local and distant failure rate. The level of thrombus extension is significantly associated with disease recurrence. Effective adjuvant therapy is needed to improve outcome in this patient population.

BACKGROUND. Active surveillance (AS) with deferred treatment is an established management option for patients with prostate cancer and favorable clinical parameters. The impact of repeat biopsy after diagnosis was examined in a cohort of men with prostate cancer on AS.METHODS. In all, 186 men with prostate cancer with favorable parameters or who refused treatment were conservatively managed by AS. Of these, 92 patients had at least I biopsy after diagnosis. Patients were followed every 3 to 6 months with prostate-specific antigen (PSA) and physical examination and were offered rebiopsy annually or if there were any changes on physical examination or in the PSA value. Disease progression while on AS was defined as having >= 1 of the following: >= cT2b disease, >= 3 positive cores, >50% of cancer in at least I core, or a predominant Gleason pattern of 4 in rebiopsies.RESULTS. The median age of the patients at the time of diagnosis was 67 years (range, 49-78 years). The median follow-up was 76 months (range, 20-169 months). Of the 92 patients who underwent repeat biopsies, 42 patients, 25 patients, 13 patients, 10 patients, and 2 patients had 1, 2, 3, 4, and 5 rebiopsies, respectively. A total of 34 patients (36%) demonstrated disease progression on rebiopsy. The first rebiopsy was positive for cancer in 48 patients (52.2%) and negative in 44 patients (47.8%). The 5-year actuarial progression-free probability was 82% for patients with a negative first repeat biopsy compared with 50% for patients with a positive first rebiopsy (P = .02). A PSA doubling time <67 months was associated an increased risk of disease progression on biopsy.CONCLUSIONS. Negative rebiopsy in patients with prostate cancer on AS is associated with low-volume disease. The result of first repeated biopsy appears to have a strong impact on disease progression. Patients with a positive first repeated biopsy should be considered for treatment. An intensive biopsy protocol within the first 2 years is required to identify and treat those patients.