Background and objective: During laparoscopic pyeloplasty, double-J ureteral stents are routinely placed to protect the anastomosis from urinary leakage. However, no consensus exists on the optimal double-J ureteral stent indwelling time. This study aims to evaluate the impact of a short compared to a long double-J ureteral stent indwelling time on long-term functional outcomes ans complications following minimally invasive pyeloplasty. Methods: A prospective randomized single-surgeon series compared 2- versus 6-wk indwelling time. Renal scintigraphy was performed preoperatively, and at 6 and 24 mo postoperatively. Diuretic renography was performed 3 mo postoperatively. From year 2 to 5, patients were followed mainly with interviews. Key findings and limitations: The median follow-up was 66 (range 29-104) mo. Preoperatively, all 82 patients were symptomatic and renal scintigraphy revealed an obstruction. Diuretic renography documented regular morphology and kinetics in all patients at 3 mo. Six months postoperatively, renal scintigraphy detected unobstructed drainage in 84% of patients in group A (2 wk) and in 95% of patients in group B (6 wk; p = 0.237). At 2 yr, the rate of unobstructed drainage increased to 97% in group A and 96% in group B (p = 0.962). In patients with scintigraphically delayed tracer transportation, additional diuretic renography proved regular morphology and contrast media kinetics. No stent-related complications and urinary leakage were observed. All patients were asymptomatic at the last follow-up. Conclusions and clinical implications: Our long-term data demonstrate that 2 wk of double-J ureteral stenting following pyeloplasty provides similar functional outcome to 6 wk of stenting. Furthermore, no stent-related complications occurred. This finding may safely be applied to all pyeloplasty patients. Patient summary: Without comprising overall functional success or increasing the rate of complications, patients following minimally invasive pyeloplasty benefit from a short double-J stent indwelling time. (c) 2025 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY-NC-ND license (http://creative- commons.org/licenses/by-nc-nd/4.0/).

Background:Whether seminal vesicles play a role in sexual activity in men is unknown. No study so far has compared the neural processing of visual sexual stimuli in men depending on the filling state of the seminal vesicles.Objective:To evaluate potential specific cortical activation by visual sexual stimuli with distended and empty seminal vesicles.Design setting and participants:A prospective case-control trial was conducted. Six male individuals underwent two visits on 2 consecutive days for hormone analyses; Derogatis Interview for Sexual Functioning (DISF) questionnaire; functional magnetic resonance imaging (fMRI) with passively viewing sexual, neutral, positive, and negative emotional pictures; and structural pelvic MRI. After the first visit, the participants had to empty seminal vesicles by masturbation. During fMRI, every participant viewed alternating blocks of sexual, neutral, positive, and negative emotional pictures.Outcome measurements and statistical analysis:Comparisons between days 1 and 2 were evaluated using paired t tests.Results and limitations:No significant differences were observed regarding hormone analyses, DISF questionnaire score, and arousal scoring between days 1 and 2. Seminal vesicle volume was significantly lower on day 2 (p = 0.003). Significantly higher activation was observed in the right precentral gyrus, middle frontal gyrus, and right superior temporal sulcus when contrasted for sexual over neutral (p < 0.05).Conclusions:In response to pictures with sexual emotional content, significantly higher activation was detected in brain areas involved in motor preparation (arousal) and coding of desirability of visual sexual stimuli in men with distended seminal vesicles than in the same men with emptied seminal vesicles. This suggests that the filling state of the seminal vesicles may influence sexual desire in men.Patient summary:We compared brain activity of men with filled and emptied seminal vesicles by functional magnetic resonance imaging. We found that men with filled seminal vesicles had higher activation of brain areas involved in arousal and sexual desire.

Background: Postoperative readmission rates following radical cystectomy remain significant. Early identification of emerging complications could potentially allow for immediate institution of therapy. Objective: To intensify postoperative patient-physician communication via a cellphone-based health care application (CHA) and to evaluate its potential for early detection of complications. Design, setting, and participants: This was a pilot study involving 18 radical cystectomy patients. During the first 30 d, patients received a push cellphone notification twice a week requesting data input into the CHA. This was reduced to once a week from day 31 to day 90. De-identified recorded data were reviewed by the surgeon involved. If deemed necessary, patients were contacted by the surgeon via telephone to obtain more detailed clinical information. Outcome measurements and statistical analysis: Descriptive statistics were used. Results and limitations: Of the 18 patients enrolled, all completed the 90-d reporting period. On two occasions, interventions were necessary on the basis of data recorded on the CHA. One neobladder patient was given antibiotic therapy for pyelonephritis. Another patient reported weight loss and nausea with clinical suspicion of metabolic acidosis, and his sodium bicarbonate and fluid intake were increased. Limitations include the small number of cases from a single low-volume center. Conclusions: CHA-based monitoring of clinical parameters within the crucial 90-d postoperative period following radical cystectomy provides meaningful information. In this pilot study, two potential readmissions were possibly avoided on the basis of recorded basic vital signs and early intervention. Patient summary: Besides regular clinic follow-up visits after radical cystectomy, additional aids such as a cellphone-based health care application can provide treating physicians with relevant clinical information and may help to identify imminent deviations from normal postoperative recovery at an early stage.

You have accessJournal of UrologyBladder Cancer: Invasive IV (PD47)1 Apr 2019PD47-02 INTENSIFIED AND STANDARDIZED DIGITAL COMMUNICATION WITH CYSTECTOMY PATIENTS POTENTIALLY IS A SIMPLE AND EFFECTIVE WAY TO DECREASE READMISSIONS Frederic Birkhäuser, Felix Moltzahn, Jean-Luc Zehnder, Sebastian Flückiger, Daniel Hasler, and Pascal Zehnder* Frederic BirkhäuserFrederic Birkhäuser More articles by this author , Felix MoltzahnFelix Moltzahn More articles by this author , Jean-Luc ZehnderJean-Luc Zehnder More articles by this author , Sebastian FlückigerSebastian Flückiger More articles by this author , Daniel HaslerDaniel Hasler More articles by this author , and Pascal Zehnder*Pascal Zehnder* More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556758.93252.c8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Readmission rates after cystectomy remain considerable despite established enhanced recovery after surgery concepts. We developed a cell phone-based application (APP) to intensify and standardize patient-physician communication. The aim was to evaluate the APP's potential in terms of early complication detection, physician intervention and herewith prevention of readmissions following cystectomy. METHODS: Pilot series with 18 cystectomy patients (9 neobladders, 9 conduits). During hospital stay, the APP was downloaded on the patient's cell phone and instructions given. The first month, patients received twice a week a push notification indicating that data input was required. This was reduced to once a week in month 2-3. As variables, body weight, body temperature, fluid intake/output volumes, nausea/vomiting (yes/no), defecation (yes/no) and a pain score were chosen for the recording. Patients were also offered space for individual remarks. Recorded data were checked by the surgeon using the same APP. If deemed necessary, patients were contacted (surgeon) to get more clinical information allowing to decide, whether a control visitation was required. Finally, patients were asked to estimate the usefulness of the APP. RESULTS: 5 patients could not be enrolled (no cell phone). All 18 study patients completed the 90 days period. Overall, 95% of push notifications were answered. No patient skipped more than one data input. No one required readmission. Two times, interceptions were necessary. One neobladder patient with fever 3 weeks after discharge was given antibiotic therapy for suspicion of beginning pyelonephritis. Another patient with weight loss and nausea and therefore suspicion of metabolic acidosis after 2 months was advised to increase his sodium-bicarbonate and fluid intake. All participants felt reassured having a chance to communicate with their surgeon and judged the APP as an extremely valuable tool. CONCLUSIONS: APP-based recording of clinical parameters within the fragile 90-day post cystectomy period provides the surgeon with meaningful information. In this pilot series, two potential readmissions could be omitted due to relatively simple interceptions by the involved surgeon. Compliance was excellent. All patients estimated this straight forward communication tool as reassuring and extremely valuable. The modifiable APP can potentially be used for any kind of therapy control within all medical specialties. Source of Funding: None Lucerne, Switzerland© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e837-e838 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Frederic Birkhäuser More articles by this author Felix Moltzahn More articles by this author Jean-Luc Zehnder More articles by this author Sebastian Flückiger More articles by this author Daniel Hasler More articles by this author Pascal Zehnder* More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyRobotics – Renal1 Apr 2015V9-12 ROBOTIC-ASSISTED PYELOPLASTY IN TWO PATIENTS WITH DUPLEX KIDNEYS AND LOWER POLE URETERO-PELVIC JUNCTION OBSTRUCTION BUT DIFFERING DISTANCE TO THE URETERAL JUNCTION Thomas von Rütte, Frédéric D. Birkhäuser, George N. Thalmann, and Pascal Zehnder Thomas von RütteThomas von Rütte More articles by this author , Frédéric D. BirkhäuserFrédéric D. Birkhäuser More articles by this author , George N. ThalmannGeorge N. Thalmann More articles by this author , and Pascal ZehnderPascal Zehnder More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2287AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteral duplication combined with uretero-pelvic junction obstruction (UPJO) is a rare clinical constellation, typically affecting the lower moiety. In patients with the ureteral junction in proximity to the UPJO, the surgical treatment requires more attention. Understanding of the local anatomy and blood supply is mandatory to perform successful reconstruction. METHODS Our video illustrates preoperative work up, surgical management and follow-up in two patients with an UPJO of the lower moiety in a left duplex kidney but with differing proximal incomplete ureteral duplications. Retrograde uretero-pyelography with consecutive DJ-stent placement was performed prior to pyeloplasty. The first patient revealed a short (5mm), the second a long lower pole (60mm) ureteral length. Besides the optical port, 2 robotic and a 5mm assistant trocar were used for the trans peritoneal approach with the patients in a flank position. Following reflection of the descending colon, the duplicated ureters were dissected cranially. The stenotic ureteral segments were resected and the ureters spatulated over 1.5cm. In the patient with the short ureteral segment, the enlarged lower pole pyelon was reduced in size. In order to prevent ischemic complications, this ureteral segment was resected and an upper to lower pole uretero-pyelostomy was performed. Finally, the pyeloplasty was confected. In the second patient with the long lower pole ureteral segment, a standard pyeloplasty for the lower moiety was performed. RESULTS Surgical time was 3.5 hours, estimated blood loss 50 ml and length of hospital stay 5 days in both patients. Intravenous urography after 3 months showed symmetric nephrographic and urographic phases. Both patients are free of symptoms since they underwent surgery. CONCLUSIONS Robotic assisted surgery is a successful approach for the treatment of a lower pole UPJO in a duplex kidney. Careful preoperative imaging is essential to understand the local anatomy. Specifically, the length of the ureteral segment between the UPJO and the ureteral junction determined the reconstructive approach. In addition, intraoperative findings may impact the surgical strategy. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e778-e779 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thomas von Rütte More articles by this author Frédéric D. Birkhäuser More articles by this author George N. Thalmann More articles by this author Pascal Zehnder More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Introduction: We present an updated version of our previously validated robotic partial nephrectomy (RPN) training model,1,2 which includes the reconstructive part of the procedure in addition to the tumor excision component. Material and Methods: For this pilot series, participants were recruited as novice (zero console cases), intermediate (1, but <100 cases), and expert (≥100 console cases). After parenchymal resection with opening of the collecting system, a 5-cm Styrofoam ball mimicking a lower pole tumor was glued on an ex vivo porcine kidney. Each participant performed an RPN using the da Vinci SI Surgical System to excise the Styrofoam tumor. For reconstruction and hemostasis, two horizontal mattress sutures were applied. Renal artery and collecting system were perfused respecting physiologic conditions to test hemostasis and watertightness. Participants completed a poststudy questionnaire assessing training model realism and utility and were anonymously judged by expert reviewers using a validated laparoscopic assessment tool.3 Focusing on expenses per kidney: the preparation time is around 10 min and the costs for disposables (tissue, Styrofoam ball, glue, and fixation) is ∼5 to 10 USD (without training instruments). Results: The 13 participants included 7 novices, 2 intermediates, and 4 experts. Overall, surgeons rated the training model as “very realistic” (median visual analogue score [VAS] 8/10) (face validity). Expert surgeons rated it as an “extremely useful” training tool for residents and attendings (median VAS 9/10) (content validity).4 Experts outscored all others on overall performance (p<0.05) (construct validity). Additionally, the video displays in a head-to-head manner the way an expert surgeon outscores a novice on individual metrics. Thereby, model validation and training potential are demonstrated. Conclusions: Our perfused RPN training model has demonstrated face, content, and construct validity. Herewith tumors of any complexity and reconstruction can be simulated without patients at risk. In addition, the easy to build up, reproducible, and cheap model can be used, for example, within a residency training program. It allows to evaluate individual learning curves and to differentiate distinct surgical skills. No competing financial interests exist. Runtime of video: 7 mins 52 secs

You have accessJournal of UrologyRobotics – Renal1 Apr 2015V9-07 FAST BUT NOT FURIOUS - IMPROVE YOUR SURGICAL SKILLS FOR THE RACE AGAINST TIME DURING ROBOTIC-ASSISTED PARTIAL NEPHRECTOMY USING A VALIDATED PERFUSED TRAINING MODEL Philipp Markus Huber, George N. Thalmann, Frédéric D. Birkhäuser, Andrew J. Hung, Monish Aron, Inderbir S. Gill, Mihir M. Desai, and Pascal Zehnder Philipp Markus HuberPhilipp Markus Huber More articles by this author , George N. ThalmannGeorge N. Thalmann More articles by this author , Frédéric D. BirkhäuserFrédéric D. Birkhäuser More articles by this author , Andrew J. HungAndrew J. Hung More articles by this author , Monish AronMonish Aron More articles by this author , Inderbir S. GillInderbir S. Gill More articles by this author , Mihir M. DesaiMihir M. Desai More articles by this author , and Pascal ZehnderPascal Zehnder More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2282AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We present an updated version of our previously validated robotic partial nephrectomy (RPN) training model. That includes the reconstructive part of the procedure in addition to the tumor excision component. METHODS For this pilot series, participants were recruited as novice (zero console cases), intermediate (one, but < 100 cases), and expert (≥ 100 console cases). Following parenchymal resection with opening of the collecting system, a 5cm Styrofoam ball mimicking a lower pole tumor was glued on an ex vivo porcine kidney. Each participant performed a RPN using the da Vinci SI Surgical System to excise the Styrofoam tumor. For reconstruction and hemostasis, two horizontal mattress sutures were applied. Renal artery and collecting system were perfused respecting physiologic conditions to test hemostasis and watertightness. Participants completed a post-study questionnaire assessing training model realism and utility and were anonymously judged by expert reviewers using a validated laparoscopic assessment tool. Focusing on expenses per kidney: Preparation time is around 10min and costs for disposables (tissue, Styrofoam ball, glue and fixation) approx. 5-10 USD (without training instruments). RESULTS The 13 participants included 7 novices, 2 intermediates, and 4 experts. Overall, surgeons rated the training model as “very realistic” (median visual analogue score (VAS) 8/10) (face validity). Expert surgeons rated it as an “extremely useful” training tool for residents and attendings (median VAS 9/10) (content validity). Experts outscored all others on overall performance (p<0.05) (construct validity). Additionally the video displays in a head to head fashion the way an expert surgeon outscores a novice on individual metrics. Thereby, model validation and training potential are demonstrated. CONCLUSIONS Our perfused RAPN training model has demonstrated face, content and construct validity. Herewith tumors of any complexity and reconstruction can be simulated without patients at risk. In addition, the easy to build up, reproducible and cheap model can be used e.g. within a residency training program to objectives evaluate individual learning curves and to differentiate distinct surgical skills. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e777 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Philipp Markus Huber More articles by this author George N. Thalmann More articles by this author Frédéric D. Birkhäuser More articles by this author Andrew J. Hung More articles by this author Monish Aron More articles by this author Inderbir S. Gill More articles by this author Mihir M. Desai More articles by this author Pascal Zehnder More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVE:To update our previous analysis of the clinical and pathological impact of the change in the submission of lymphadenectomy specimens from en bloc to 13 separate anatomically defined packets, which took place at the University of Southern California in May 2002, and to determine whether lymph node (LN) packeting resulted in any change in oncological outcomes.PATIENTS AND METHODS:A total of 846 patients who underwent radical cystectomy (RC) with super-extended LN dissection for cTxN0M0 bladder cancer between January 1996 and December 2007 were identified. Specimens of 376 patients were sent en bloc (group 1), and specimens of 470 patients were sent in 13 separate anatomical packets (group 2).RESULTS:The pathological tumour stage distribution and the proportion of LN-positive patients (group 1: 82 patients [22%] versus group 2: 99 patients [21%]; P = 0.80) were similar between the two groups: the median [range] number of total LNs identified increased significantly (group 1: 32 [10-97] versus group 2: 65 [10-179]; P < 0.001). LN density decreased (group 1, 11% versus group 2, 4%; P = 0.005). The median [range] number of positive LNs removed was similar (group 1: 0 [0-30] versus group 2: 0 [0-97]; P = 0.87). No nodal stage shift was observed. The 5-year overall survival (group 1: 58% versus group 2: 59%; P = 0.65) and recurrence-free survival rates (group 1: 68% versus group 2: 70%; P = 0.57) were similar.CONCLUSIONS:The incidence of patients with positive LNs remained unchanged, regardless of how the LN specimen was submitted. Submitting 13 separate nodal packets significantly increased the total LN yield, but did not result in a significant increase in the number of positive LNs or a consecutive nodal stage shift and did not affect oncological outcomes. Based on these results LN density is not an accurate prognosticator.

You have accessJournal of UrologyOutstanding Posters: Benign Disease1 Apr 2014OP2-01 A TWO WEEKS DJ STENT INDWELLING TIME IS SAFE AND SUFFICIENT FOR PATIENTS UNDERGOING DISMEMBERED PYELOPLASTY - LONG TERM DATA FROM A PROSPECTIVE RANDOMIZED TRIAL Thomas von Rütte, Frédéric D. Birkhäuser, George N. Thalmann, and Pascal Zehnder Thomas von RütteThomas von Rütte More articles by this author , Frédéric D. BirkhäuserFrédéric D. Birkhäuser More articles by this author , George N. ThalmannGeorge N. Thalmann More articles by this author , and Pascal ZehnderPascal Zehnder More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2551AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES DJ stents are widely used in patients who undergo dismembered pyeloplasty for uretero-pelvic junction obstruction. However there exist no consensus in terms of optimal stent indwelling time. We therefore evaluated the impact of a short (group A: 2 weeks) compared to a long (group B: 6 weeks) indwelling time on stent related complications and functional outcome. METHODS Prospective randomized single surgeon series including 82 patients (group A: 41, group B: 41) who underwent minimally invasive dismembered pyeloplasty from 2007 to 2013 at our institution. Preoperatively, baseline split kidney function (scintigraphy) was assessed in all patients. Routinely, retrograde examination with consecutive DJ (4.8 Charr/French, Percuflex Plus Ureteral Stent with HydroPlusTM Coating, Boston Scientific) placement was performed immediately prior to pyeloplasty. The evaluation of functional outcome was based on objective (renal scintigraphy at 6, 24, 36, 60 months, diuretic renography at 3 months) and subjective findings (flank pain). Statistical analysis was performed with Fisher-test. RESULTS Median follow up was 24 months (range 3-60) in group A and 24 months (range 3-60) in group B. None of the patients encountered a stent related complication (infection, obstruction, dislocation). Postoperatively, diuretic renography at 3 months showed unobstructed drainage in all 82 patients. Renal scintigraphy detected improved drainage in 91% (32/35) of patients at 6 months and 95% (18/19) of patients at 24 months in group A compared to 95% (36/38) of patients and 96% (23/24) of patients in group B, respectively (p=0.666, p=1). Subjectively, 100% (41/41) of patients in group A compared to 98% (40/41) of patients in group B were free of symptoms at last follow up (p= 1). CONCLUSIONS Our data demonstrate that 2 weeks stenting provides similarly good periinterventional and functional results compared to 6 weeks stenting. Hence, we suggest that all patients following dismembered pyeloplasty should be uniformly treated with a two weeks DJ stent indwelling interval. © 2014FiguresReferencesRelatedDetails Volume 191 Issue 4S April 2014 Page: e387 Advertisement Copyright & Permissions© 2014Metrics Author Information Thomas von Rütte More articles by this author Frédéric D. Birkhäuser More articles by this author George N. Thalmann More articles by this author Pascal Zehnder More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVE:To analyse the long-term outcomes of patients with lymph node (LN)-positive bladder cancer, who did not receive any adjuvant therapy after radical cystectomy (RC) and extended pelvic lymph node dissection (ePLND).PATIENTS AND METHODS:We conducted a retrospective, combined cohort analysis based on two prospectively maintained cystectomy databases from the University of Southern California and the University of Bern. Eligible patients underwent RC with ePLND for cN0M0 disease but were found to have LN-positive disease. No patient had neoadjuvant therapy, and all had negative surgical margins. Kaplan-Meier plots were used to estimate recurrence-free survival (RFS) and overall survival (OS). Subgroup comparisons were performed using log-rank tests, and multivariable analysis was based on Cox proportional hazard models.RESULTS:Of 521 patients with LN-positive disease, 251 (48%) never received adjuvant therapy. Although the pathological stage distribution was similar, the 251 patients who did not receive adjuvant therapy were older and had both fewer total and positive LNs than those who underwent adjuvant therapy. The median RFS for patients treated with RC alone was 1.6 years. Recurrences mainly occurred <2 years after RC, resulting in 5- and 10-year RFS rates of 32 and 26%, respectively. Pathological T stage, the total number of LNs and the number of positive LNs detected were independent predictors of RFS and OS.CONCLUSIONS:In this study, 25% of patients with documented LN metastases who did not receive adjuvant therapy were cured with RC and ePLND; however, a few relapses may occur later than 3 years. Predictors of survival were pathological T stage, the number of total LNs and the number of positive LNs identified.

Objective To evaluate oncological outcome trends over the last three decades in patients after radical cystectomy ( RC ) and extended pelvic lymph node ( LN ) dissection. Patients and Methods Retrospective analysis of the U niversity of S outhern C alifornia ( USC ) RC cohort of patients (1488 patients) operated with intent to cure from 1980 to 2005 for biopsy confirmed muscle‐invasive urothelial bladder cancer. To focus on outcomes of unexpected ( cN0M0 ) LN ‐positive patients, the USC subset was extended with unexpected LN ‐positive patients from the U niversity of B erne ( UB ) (combined subgroup 521 patients). Patients were grouped and compared according to decade of surgery (1980–1989/1990–1999/≥2000). Survival probabilities were calculated with K aplan– M eier plots, log‐rank tests compared outcomes according to decade of surgery, followed by multivariable verification. Results The 10‐year recurrence‐free survival was 78–80% in patients with organ‐confined, LN ‐negative disease, 53–60% in patients with extravesical, yet LN ‐negative disease and ≈30% in LN ‐positive patients. Although the number of patients receiving systemic chemotherapy increased, no survival improvement was noted in either the entire USC cohort, or in the combined LN ‐positive USC‐UB cohort. In contrast, patient age at surgery increased progressively, suggesting a relative survival benefit. Conclusions Radical surgery remains the mainstay of therapy for muscle‐invasive bladder cancer. Yet, our study reveals predictable outcomes but no survival improvement in patients undergoing RC over the last three decades. Any future survival improvements are likely to result from more effective systemic treatments and/or earlier detection of the disease.

Pelvic lymph node dissection (PLND) in patients with bladder cancer varies widely in extent, technique employed, and pathological workup of specimens. The present paper provides an overview of the existing evidence regarding the effectiveness of PLND and elucidates the interactions between patient, surgeon, pathologist, and treating institution as well as their cumulative impact on the final postoperative lymph node (LN) staging. Bladder cancer patients undergoing radical cystectomy with extended PLND appear to have better oncologic outcomes compared to patients undergoing radical cystectomy and limited PLND. Attempts have been made to define and assess the quality of PLND according to the number of lymph nodes identified. However, lymph node counts depend on multiple factors such as patient characteristics, surgical template, pathological workup, and institutional policies; hence, meticulous PLND within a defined and uniformly applied extended template appears to be a better assurance of quality than absolute lymph node counts. Nevertheless, the prognosis of the patients can be partially predicted with findings from the histopathological evaluation of the PLND specimen, such as the number of positive lymph nodes, extracapsular extension, and size of the largest LN metastases. Therefore, particular prognostic parameters should be addressed within the pathological report to guide the urologist in terms of patient counseling.