You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I (PD22)1 May 2024PD22-02 SINGLE-PORT SURGERY DELIVERS IMPROVED COSMESIS COMPARED TO MULTI-PORT SURGERY REGARDLESS OF INCISION SITE Michael Raver, Mason Henrich, Qilin Cao, Katherine Kim, Sarah Brink, Ruth Sanchez De La Rosa, Gregory Lovallo, Ravi Munver, Mubashir Billah, Mutahar Ahmed, and Michael Stifelman Michael RaverMichael Raver , Mason HenrichMason Henrich , Qilin CaoQilin Cao , Katherine KimKatherine Kim , Sarah BrinkSarah Brink , Ruth Sanchez De La RosaRuth Sanchez De La Rosa , Gregory LovalloGregory Lovallo , Ravi MunverRavi Munver , Mubashir BillahMubashir Billah , Mutahar AhmedMutahar Ahmed , and Michael StifelmanMichael Stifelman View All Author Informationhttps://doi.org/10.1097/01.JU.0001009504.18450.e0.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: One potential advantage of single-port (SP) robotic surgery compared to multi-port (MP) robotic surgery is improved cosmesis. The only study in urology patients to suggest this finding did not assess differences by incision site. Our study evaluated SP, MP, incision location, age, gender, and prior abdominal surgery as predictors of cosmesis and scar consciousness. METHODS: This is a cohort study using an IRB-approved prospective GU reconstruction database. Patients at least 3 months from surgery were emailed and called to complete the Consciousness subsection of the Patient Scar Acceptance Questionnaire. Bothersome was defined as a score of 11 or greater. Overall consciousness was scored with a single item as "not conscious" or "conscious". Cronbach's alpha was calculated to ensure reliability (0.81). Median time from surgery to survey was recorded. Cochran-Mantel-Haenszel (CMH) chi-squared test and logistic regression were performed to assess how age, gender, prior surgery and incision location affect cosmesis. RESULTS: There were 92 patients with 52 MP and 40 SP, of which 26 were umbilical SP and 14 were non-umbilical SP. Median time from surgery to survey for SP and MP was 28 (IQR 15,36) and 30 (IQR 21,51) weeks. Bothersome score is reported in Table 1. Overall, SP was less bothersome than MP (10% vs 29%). When differentiating by age, there was no significant difference in bothersome score of SP vs MP over 40 (11% vs 22%), whereas patients under 40 had significant decrease in consciousness (8% vs 55%).Logistic regression findings are reported in Table 2. SP had improved cosmesis and lower consciousness. Age was not predictive of cosmesis but did predict consciousness, with younger patients more likely to be conscious. Gender, prior abdominal surgery, and SP incision location did not make a difference in cosmesis or consciousness. CONCLUSIONS: This study confirms that SP has better patient-reported cosmetic outcomes compared to MP, especially among younger patients. The cosmetic benefits of SP do not appear to be affected by choice of incision location. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e460 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Michael Raver More articles by this author Mason Henrich More articles by this author Qilin Cao More articles by this author Katherine Kim More articles by this author Sarah Brink More articles by this author Ruth Sanchez De La Rosa More articles by this author Gregory Lovallo More articles by this author Ravi Munver More articles by this author Mubashir Billah More articles by this author Mutahar Ahmed More articles by this author Michael Stifelman More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction and Objective: One potential advantage of single-port (SP) robotic surgery compared with multiport (MP) robotic surgery is improved cosmesis. The only studies in urology patients to suggest this finding did not assess differences based on incision site. Our study evaluated SP, MP, incision location, age, gender, and prior abdominal surgery as predictors of cosmesis and scar consciousness for reconstructive procedures.Methods: This is a cohort study using an institutional review board-approved prospective genitourinary reconstruction database. Patients at least 3 months from surgery were emailed and called to complete the Consciousness subsection of the Patient Scar Assessment Questionnaire. Bothersome was defined as a score of 11 or greater. Overall consciousness was scored with a single item as "not conscious" or "conscious." Pearson's chi-squared, Wilcoxon rank sum, Fisher's exact test, and logistic regression were performed to assess how age, gender, prior surgery, and incision location affect cosmesis.Results: There were 111 patients (54 MP, 57 SP), of which 27 were SP umbilical, 14 were SP midline nonumbilical, and 16 were SP lower quadrant. On univariate analysis the periumbilical incision had the lowest consciousness. Age was associated with Bother (p = 0.012) and Consciousness (p = 0.002), whereas gender, prior abdominal surgery, and incision site were not significant. On logistic regression, all SP incisions were less likely to be bothered compared with MP, although only SP umbilical was statistically significant (odds ratio [OR] = 0.08, 95% confidence interval [CI]: 0.01,0.38; p = 0.005). Age was also significant on logistic regression for Bother (OR = 0.96, 95% CI: 0.93,0.99; p = 0.005). Gender and prior abdominal surgery were not associated with Bother or Consciousness.Conclusions: SP periumbilical incisions provide the best outcomes for cosmesis compared with other SP incision sites and MP incisions. This finding should be discussed and taken into account when planning surgical approaches for patients undergoing urinary reconstruction, especially in patients younger than 40 years of age.

You have accessJournal of UrologyCME1 Apr 2023MP80-14 EXTRAPERITONEAL SINGLE-PORT ROBOTIC RADICAL PROSTATECTOMY IN OVER 700 PATIENTS: UPDATED MULTI-INSTITUTIONAL COHORT STUDY FROM THE SPARC COLLABORATION Ethan Ferguson, Jennifer L. Nguyen, Roxana Ramos, Grace Chen, Kennedy Okhawere, Samantha Wilder, Ruth Sanchez De La Rosa, Jaya Chavali, Indu Saini, James Peabody, Ketan K. Badani, Craig Rogers, Jeffrey Nix, Jean Joseph, Michael Stifelman, Simone Crivellaro, Mutahar Ahmed, Moses Kim, and Jihad Kaouk Ethan FergusonEthan Ferguson More articles by this author , Jennifer L. NguyenJennifer L. Nguyen More articles by this author , Roxana RamosRoxana Ramos More articles by this author , Grace ChenGrace Chen More articles by this author , Kennedy OkhawereKennedy Okhawere More articles by this author , Samantha WilderSamantha Wilder More articles by this author , Ruth Sanchez De La RosaRuth Sanchez De La Rosa More articles by this author , Jaya ChavaliJaya Chavali More articles by this author , Indu SainiIndu Saini More articles by this author , James PeabodyJames Peabody More articles by this author , Ketan K. BadaniKetan K. Badani More articles by this author , Craig RogersCraig Rogers More articles by this author , Jeffrey NixJeffrey Nix More articles by this author , Jean JosephJean Joseph More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , Simone CrivellaroSimone Crivellaro More articles by this author , Mutahar AhmedMutahar Ahmed More articles by this author , Moses KimMoses Kim More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: An extraperitoneal approach to single-port (SP) robot-assisted radical prostatectomy has been demonstrated with proposed benefits in decreased morbidity, single incision, and same-day discharge. We sought to determine the perioperative and early postoperative outcomes in a large, multi-institutional setting. METHODS: SP extraperitoneal radical prostatectomy was performed in 712 patients between February 2019 and October 2022. All procedures were performed by experienced robotic surgeons from eight tertiary medical centers. Data from baseline demographics, perioperative and early postoperative outcomes were collected prospectively and analyzed retrospectively RESULTS: All reported procedures were completed without open conversion, blood transfusions, or intraoperative complications. The median follow-up time was 11.7 months for the entire cohort. The median age, BMI and preoperative PSA were 64 years, 27.9kg/m2, and 6.4 ng/mL, respectively. About 30% of the patients had at least one previous abdominal surgery. On pathology, high risk disease was noted in 12% and lymph node involvement on final pathology was present in 5.8%. Extraprostatic extension was noted in 38% and positive surgical margins were present in 30.2% of cases. Lymphadenectomy was performed in 85% of patients and the median lymph node yield was 5 nodes. There were no intraoperative complications and inadvertent peritoneal entry with insufflation was rare (0.6%) and managed conservatively. Postoperative complications occurred in 11.8%. The median length of stay and foley catheter duration were 8 hours and 7 days, respectively. Postoperative recovery of continence was 69% at 3 months and 88% at 6 months. Recovery of potency was 35.6% at 6 months. CONCLUSIONS: Single-port extraperitoneal robotic radical prostatectomy is safe and feasible for management of clinically localized prostate cancer. Analysis from a large multi-institutional cohort shows promising single incision and short hospital length of stay without compromise in early functional or oncologic outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1157 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ethan Ferguson More articles by this author Jennifer L. Nguyen More articles by this author Roxana Ramos More articles by this author Grace Chen More articles by this author Kennedy Okhawere More articles by this author Samantha Wilder More articles by this author Ruth Sanchez De La Rosa More articles by this author Jaya Chavali More articles by this author Indu Saini More articles by this author James Peabody More articles by this author Ketan K. Badani More articles by this author Craig Rogers More articles by this author Jeffrey Nix More articles by this author Jean Joseph More articles by this author Michael Stifelman More articles by this author Simone Crivellaro More articles by this author Mutahar Ahmed More articles by this author Moses Kim More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF downloadLoading ...

PURPOSE:Preservation of renal parenchyma is a major goal when performing a partial nephrectomy. IRIS anatomical visualization software generates a segmented 3D model, allowing improved visualization of the tumor and surrounding structures. We hypothesize that using IRIS intraoperatively during partial nephrectomy on complex tumors increases the precision of surgical procedures and therefore may result in more tissue preservation.METHODS:We identified 74 non-IRIS and 19 IRIS patients who underwent partial nephrectomy, with nephrometry scores of 9, 10, and 11. Propensity scores were used to match 18 pairs of patients on nephrometry score, age, and tumor volume. Pre- and postoperative imaging (MRI/CT) was obtained. Volumes of the preoperative tumor and preoperative whole kidney were obtained to calculate predicted postoperative whole kidney volume and then compared to actual postoperative whole kidney volume.RESULTS:Mean differences between predicted and actual postoperative whole kidney volumes were 19.2 cm3 (SD=20.2) and 32 cm3 (SD=16.1, P = .0074) for IRIS and non-IRIS groups, respectively. The mean improvement in precision for the IRIS procedure was 12.8 cm3 (95% confidence interval, 2.5 to Inf; P = .02). There was no significant change in mean glomerular filtration rate from baseline to 6 months postoperatively between IRIS and non-IRIS groups (-6.39, SD=15.8 vs -9.54, SD=13.3; P = .5). No significant differences in complication rates (0 vs 1, P = .2), worsening glomerular filtration rate staging (5 vs 4, P = 1), and >25% decrease in glomerular filtration rate (3 vs 4, P = 1) were found between IRIS and non-IRIS groups.CONCLUSIONS:We demonstrated that using IRIS intraoperatively when performing partial nephrectomy on complex tumors is associated with improved surgical precision.

OBJECTIVE To compare robot-assisted simple prostatectomy intraoperative and postoperative outcomes between single-port (SP) and multiport (MP) robotic systems in a multi-institutional setting.METHODS We analyzed all-consecutive robot-assisted simple prostatectomy cases done in 5 centers from January 2017 to October 2022. Data were analyzed with descriptive statistics and compared with appropriate tests depending on the type of variable and distribution. Statistical significance was considered when P < .05.RESULTS A total of 405 cases were analyzed: 249 and 156 were MP and SP, respectively. Operative times were similar between groups (P = .62). Estimated blood loss during surgery was significantly lower with the SP robot (P < .001). Postoperatively, the SP approach required a significantly shorter hospital stay, less use of opioids, and a shorter duration of Foley catheter (P < .001). There was no significant difference between the post-operative Clavien-Dindo & GE;3 complication rate (P = .30). The 30-day readmission rate of MP (10.8%) was significantly higher than for SP (0%) (P < .001). De novo urge incontinence was more common in the MP group (P = .02).CONCLUSION The SP robotic approach to simple prostatectomy is advantageous when it comes to post-operative comfort for patients. Specifically, it requires a shorter hospital stay, less use of opioids, and a shorter Foley catheter duration. UROLOGY 176: 94-101, 2023. & COPY; 2023 Elsevier Inc. All rights reserved.

You have accessJournal of UrologyCME1 Apr 2023PD20-10 ETHNIC DISPARITIES IN CLINICAL PRESENTATION AND SURGICAL OUTCOMES FOR HISPANIC PATIENTS WITH LOCALIZED RENAL MASSES Teona Iarajuli, Jennifer Nguyen, Ruth Sanchez De La Rosa, Tanner Corse, Jacquelyn Roth, Hunter Halsey, Martin Malik, Fahad Sheckley, Suzannah Sorin, Simon Gelman, Mubashir Billah, Gregory Lovallo, Ravi Munver, Mutahar Ahmed, and Michael Stifelman Teona IarajuliTeona Iarajuli More articles by this author , Jennifer NguyenJennifer Nguyen More articles by this author , Ruth Sanchez De La RosaRuth Sanchez De La Rosa More articles by this author , Tanner CorseTanner Corse More articles by this author , Jacquelyn RothJacquelyn Roth More articles by this author , Hunter HalseyHunter Halsey More articles by this author , Martin MalikMartin Malik More articles by this author , Fahad SheckleyFahad Sheckley More articles by this author , Suzannah SorinSuzannah Sorin More articles by this author , Simon GelmanSimon Gelman More articles by this author , Mubashir BillahMubashir Billah More articles by this author , Gregory LovalloGregory Lovallo More articles by this author , Ravi MunverRavi Munver More articles by this author , Mutahar AhmedMutahar Ahmed More articles by this author , and Michael StifelmanMichael Stifelman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003286.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aim to determine if Hispanic patients differed in clinical presentation and surgical management of renal masses compared to Non-Hispanic Caucasian patients in our Northern New Jersey catchment area. METHODS: We utilized an IRB-approved renal mass database including 1017 patients who underwent partial or radical nephrectomy at our institution between May 2017 and April 2022. We evaluated 1017 patients who identified as either “Hispanic” or “Non-Hispanic Caucasian.” Continuous data was analyzed using the Wilcoxon Rank Sum test. Categorical data was analyzed using Chi-Squared and Fisher's Exact Tests where appropriate. RESULTS: 134 patients (13.18%) self-identified as Hispanic and 883 (86.82%) identified as Non-Hispanic Caucasian (Table 1). In terms of presentation, Hispanic patients were significantly younger on average (56.95 vs 63.92, p=0.0000), more likely to be female (48.51% vs 33.64%, p=0.0001), and less likely to have a history of tobacco use (29.10% vs 43.57%, p=0.018). Hispanic patients had lower incidences of coronary vascular disease (1.491% vs 6.0%, p=0.0315) and chronic kidney disease prior to undergoing surgery (16.39% vs 24.47%, p=0.0158). There was no significant difference in rates of undergoing radical nephrectomy between the two groups (29.66% vs 24.5%, p=0.6212). There was no significant difference in changes from baseline preoperative eGFR (-11.99 vs -13.31 mL/min/1.73 m2, p=0.6012). Additionally, there was no significant difference in the rate of major complications (1.63% vs 2.29%, p=1.0), readmissions (6.67% vs 4.96%, p=0.4328), or mortality (2.99% vs 2.27%, p=1.000). CONCLUSIONS: In our Northern New Jersey population, we found that Hispanic patients presented with renal masses at younger ages with less comorbidities and less prior tobacco use in comparison to Non-Hispanic Caucasian patients. We did not identify significant differences in surgical management, perioperative or long-term outcomes between these cohorts. Our findings suggest that high volume, quaternary medical centers may reduce inequalities in access to care for patients from ethnic minorities. Source of Funding: No funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e588 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Teona Iarajuli More articles by this author Jennifer Nguyen More articles by this author Ruth Sanchez De La Rosa More articles by this author Tanner Corse More articles by this author Jacquelyn Roth More articles by this author Hunter Halsey More articles by this author Martin Malik More articles by this author Fahad Sheckley More articles by this author Suzannah Sorin More articles by this author Simon Gelman More articles by this author Mubashir Billah More articles by this author Gregory Lovallo More articles by this author Ravi Munver More articles by this author Mutahar Ahmed More articles by this author Michael Stifelman More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023MP59-06 A TOTAL OF 405 CASES OF SINGLE-PORT VS MULTI-PORT ROBOT-ASSISTED SIMPLE PROSTATECTOMY: A MULTI-INSTITUTIONAL COHORT FROM THE SPARC GROUP Roxana Ramos, Ethan Ferguson, Kennedy E. Okhawere, Teona Iarajuli, Samantha Wilder, Ruben S. Calvo, Jaya S Chavali, Indu Saini, Ruth Sanchez De La Rosa, James Peabody, Simone Crivellaro, Craig Rogers, Michael Stifelman, Mutahar Ahmed, Ketan Badani, and Jihad Kaouk Roxana RamosRoxana Ramos More articles by this author , Ethan FergusonEthan Ferguson More articles by this author , Kennedy E. OkhawereKennedy E. Okhawere More articles by this author , Teona IarajuliTeona Iarajuli More articles by this author , Samantha WilderSamantha Wilder More articles by this author , Ruben S. CalvoRuben S. Calvo More articles by this author , Jaya S ChavaliJaya S Chavali More articles by this author , Indu SainiIndu Saini More articles by this author , Ruth Sanchez De La RosaRuth Sanchez De La Rosa More articles by this author , James PeabodyJames Peabody More articles by this author , Simone CrivellaroSimone Crivellaro More articles by this author , Craig RogersCraig Rogers More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , Mutahar AhmedMutahar Ahmed More articles by this author , Ketan BadaniKetan Badani More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Single-port (SP) robot-assisted simple prostatectomy (RASP) is a novel approach for patients with obstructive benign prostatic hyperplasia. Our aim is to report updated data comparing SP vs multi-port (MP) robotic systems. METHODS: We analyzed all consecutive RASP cases done in 5 centers in the US from January 2017 to October 2022. Measures of central tendency were compared with t-test or Mann-Whitney U test depending on their distribution. Frequencies were compared with Chi-square. Statistical significance was considered when p≤0.05. RESULTS: A total of 405 cases were analyzed, 249 MP and 156 SP. The SP group patients were significantly more symptomatic (p=0.0001). Estimated blood loss during surgery was significantly lower with SP (p=0.00001). Even though the rate of intraoperative complications was higher with SP (3.2% vs 0.4%), the difference was not significant (p=0.06). Postoperatively, SP approach required significantly shorter time of hospital stay, less use and amount of opioids, and shorter time with Foley catheter (all p’s=0.00001). There was no significant difference between the post-operative Clavien Dindo ≥3 complication rate (MP 2.4% vs SP 0.6%) Furthermore, the 30-day readmission rate of MP (10.8%) was significantly higher than SP’s (0%) (p=0.00001). CONCLUSIONS: The SP robotic approach for simple prostatectomy is advantageous when it comes to postoperative comfort for the patients. Specifically it requires shorter hospital stay, less use and amount of opioids, shorter Foley catheter duration, and less readmission rate. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e808 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roxana Ramos More articles by this author Ethan Ferguson More articles by this author Kennedy E. Okhawere More articles by this author Teona Iarajuli More articles by this author Samantha Wilder More articles by this author Ruben S. Calvo More articles by this author Jaya S Chavali More articles by this author Indu Saini More articles by this author Ruth Sanchez De La Rosa More articles by this author James Peabody More articles by this author Simone Crivellaro More articles by this author Craig Rogers More articles by this author Michael Stifelman More articles by this author Mutahar Ahmed More articles by this author Ketan Badani More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023MP68-15 DOES UTILIZING IRIS, A SEGMENTED THREE-DIMENSIONAL MODEL, PRESERVE RENAL PARENCHYMAL VOLUME DURING ROBOTIC PARTIAL NEPHRECTOMY? Teona Iarajuli, Christina Caviasco, Tanner Corse, Katherine Kim, Jennifer Nguyen, Ruth Sanchez DE LA Rosa, Simon Gelman, Nick Spagnuolo, Hannah Sidoti, Mitchell Miller, and Michael Stifelman Teona IarajuliTeona Iarajuli More articles by this author , Christina CaviascoChristina Caviasco More articles by this author , Tanner CorseTanner Corse More articles by this author , Katherine KimKatherine Kim More articles by this author , Jennifer NguyenJennifer Nguyen More articles by this author , Ruth Sanchez DE LA RosaRuth Sanchez DE LA Rosa More articles by this author , Simon GelmanSimon Gelman More articles by this author , Nick SpagnuoloNick Spagnuolo More articles by this author , Hannah SidotiHannah Sidoti More articles by this author , Mitchell MillerMitchell Miller More articles by this author , and Michael StifelmanMichael Stifelman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003331.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Preservation of renal parenchymal volume is one of the major goals of surgeons performing a partial nephrectomy (PN). IRIS anatomical visualization software generates a segmented 3D model, allowing surgeons to better visualize the tumor, renal vasculature, collecting system, and their relationship. We hypothesize that using a segmental 3D model intra-operatively during PN on complex tumors would improve renal parenchymal volume preservation. METHODS: We identified 74 non-IRIS and 19 IRIS patients who underwent PN from January 1st, 2019 to January 1st, 2022, with nephrometry scores of 9, 10, 11, and had complete pre and postoperative axial imaging. We completed propensity score matching (PSM) based on nephrometry score, age, BMI, and tumor volume and finalized 18 PS matched pairs. Pre and postoperative imaging (MRI or CT) were obtained from patient charts on Fuji PACS and quality screened by our researchers. Volumes of the preoperative renal tumor mass and whole kidney volume were obtained and used to calculate predicted postoperative volume. Measured postoperative renal volumes were compared to the predicted postoperative volumes. Statistical analysis was performed using a paired one-sided t-test. All analyses were performed using R. RESULTS: The mean predicted postoperative kidney volume in the IRIS and non-IRIS groups were 194.1 cm3 (71.5) and 218.9 cm3 (SD=48.9), and postoperative whole kidney volume was 175.0 cm3 (SD=73.5) and 186.9 cm3 (SD=47.2). Mean difference between predicted and actual postoperative whole kidney volume in the IRIS group was statistically smaller, 19.2 cm3 (SD=20.2), than the non-IRIS group, 32 cm3 (SD=16.1, p=0.0074). Percent difference from predicted kidney volume in the IRIS group was 10.9% vs. 17.1% in the non-IRIS group. There was no significant change in mean GFR from baseline to 6-month postoperative period between IRIS and non-IRIS groups (-6.39, SD=15.8 vs. -9.54, SD=13.3; p=0.374). Additionally, no significant difference in complication rates (0 vs. 1, p=0.235), frequency of patients who experienced worsening GFR staging (5 vs 4, p=1.00) and >25% decrease in GFR levels (3 vs. 4, p=1.00) were found between IRIS and non-IRIS groups respectively. CONCLUSIONS: We demonstrated that using a segmental 3D model intra-operatively when performing a partial nephrectomy on complex tumors improves renal parenchymal preservation. The long-term clinical significance of this preservation remains to be determined. Source of Funding: No Funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e959 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Teona Iarajuli More articles by this author Christina Caviasco More articles by this author Tanner Corse More articles by this author Katherine Kim More articles by this author Jennifer Nguyen More articles by this author Ruth Sanchez DE LA Rosa More articles by this author Simon Gelman More articles by this author Nick Spagnuolo More articles by this author Hannah Sidoti More articles by this author Mitchell Miller More articles by this author Michael Stifelman More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023PD27-06 SINGLE-PORT ROBOTIC RADICAL PROSTATECTOMY IN OVER 1,100 CONSECUTIVE PATIENTS FROM THE MULTI-INSTITUTIONAL SPARC COLLABORATION Ethan Ferguson, Roxana Ramos, Graham Hale, Jennifer Nguyen, Marcio Moschovas, Samantha Wilder, Kennedy Okhawere, Ruth Sanchez De La Rosa, Alp Tuna Beksac, Indu Saini, James Peabody, Ketan K. Badani, Craig Rogers, Jean Joseph, Vipul Patel, Michael Stifelman, Jeffrey Nix, Moses Kim, Mutahar Ahmed, Simone Crivellaro, and Jihad Kaouk Ethan FergusonEthan Ferguson More articles by this author , Roxana RamosRoxana Ramos More articles by this author , Graham HaleGraham Hale More articles by this author , Jennifer NguyenJennifer Nguyen More articles by this author , Marcio MoschovasMarcio Moschovas More articles by this author , Samantha WilderSamantha Wilder More articles by this author , Kennedy OkhawereKennedy Okhawere More articles by this author , Ruth Sanchez De La RosaRuth Sanchez De La Rosa More articles by this author , Alp Tuna BeksacAlp Tuna Beksac More articles by this author , Indu SainiIndu Saini More articles by this author , James PeabodyJames Peabody More articles by this author , Ketan K. BadaniKetan K. Badani More articles by this author , Craig RogersCraig Rogers More articles by this author , Jean JosephJean Joseph More articles by this author , Vipul PatelVipul Patel More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , Jeffrey NixJeffrey Nix More articles by this author , Moses KimMoses Kim More articles by this author , Mutahar AhmedMutahar Ahmed More articles by this author , Simone CrivellaroSimone Crivellaro More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003305.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical prostatectomy using the single-port (SP) robotic platform has been performed using a variety of surgical approaches. We sought to report the outcomes of a large multi-institutional series and compare techniques. METHODS: From 2/2019 to 10/2022, SP robotic radical prostatectomy was performed in 1,103 patients by experienced robotic surgeons at nine institutions from the SPARC collaboration. Perioperative data and early postoperative outcomes were collected prospectively and analyzed retrospectively. RESULTS: SP radical prostatectomy was performed using transperitoneal (TP, n=244), extraperitoneal (EP, n=712), and transvesical (TV, n=147) approaches. All procedures were completed successfully without intraoperative complications or open conversion. About 30% of all patients had a history of prior abdominal surgery, with significant differences noted based on operative technique; 50% TV, 30% EP, and 3% TP. The EP approach was associated with higher NCCN risk and biopsy Gleason scores, as well as a higher lymph node yield than in other approaches. Opioid were prescribed in 20% and pain scores at discharge were low for all patients. Significant differences were identified in postoperative parameters including the performance of lymphadenectomy, inpatient hospital stay, and foley catheter duration. The TV approach was associated with a lower rate of positive margins (18.2%) compared with EP (30.2%) and TP (30.1%). Follow up duration for the entire series was 10.8 months. CONCLUSIONS: We reported the outcomes of a large series of single-port radical prostatectomy with promising short hospital stay and pain scores. Compared with other techniques, the transvesical approach is associated with shorter length of stay, faster time to continence, and a lower rate of positive surgical margins. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e743 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ethan Ferguson More articles by this author Roxana Ramos More articles by this author Graham Hale More articles by this author Jennifer Nguyen More articles by this author Marcio Moschovas More articles by this author Samantha Wilder More articles by this author Kennedy Okhawere More articles by this author Ruth Sanchez De La Rosa More articles by this author Alp Tuna Beksac More articles by this author Indu Saini More articles by this author James Peabody More articles by this author Ketan K. Badani More articles by this author Craig Rogers More articles by this author Jean Joseph More articles by this author Vipul Patel More articles by this author Michael Stifelman More articles by this author Jeffrey Nix More articles by this author Moses Kim More articles by this author Mutahar Ahmed More articles by this author Simone Crivellaro More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE To evaluate the risk of postoperative hernia following different approaches of single-port robotassisted radical prostatectomy (SP-RARP).METHODS A retrospective review was performed on patients who underwent SP-RARP between February 2019 and December 2022. Demographic and clinical information was collected from the multidatabase. Data were analyzed using IBM Statistical Packaging for Social Sciences (SPSS) version 29.0 with descriptive statistics as presented.RESULTS A total of 1103 patients were identified, consisting of 244 (22.1%), 712 (64.6%), and 147 (13.3%) cases performed via transperitoneal, extraperitoneal (EP), and transvesical (TV) approaches, respectively. During a median follow-up time of 11 months (interquartile range 5.717.1 months), only two cases of incisional hernia were reported. Both cases occurred following transperitoneal SP-RARP with one patient requiring surgical repair. There remains no evidence of postoperative hernia following EP and TV SP-RARP at the completion of our review.CONCLUSION SP-RARP was associated with low risk for postoperative hernia. The risk was lower following TV and EP SP-RARP where the peritoneum is preserved. UROLOGY 180: 151-159, 2023. (c) 2023 Elsevier Inc. All rights reserved.

of the procedures were ambulatory. All patients were released with anticholinergics and bladder catheterizing. 9 of 10 patients with simple VVF reported postoperative clinical improvement. 9 of 13 patients with complex VF had complete resolution of incontinence after removal of the catheter. The median follow-up was 10 months. CONCLUSIONS: NOTES is a minimally invasive technique useful for the initial approach of patients with a VF. It is a reproducible, short-time and potentially ambulatory technique. This approach favors the closure of VVF, VPF and even VEF in non-oncological, oncological and irradiated patients, it is a useful option in patients with previous dif fi cult abdominal approaches without the need to perform open bladder or transabdominal surgery. Multicentric prospective studies are needed for further conclusions. INTRODUCTION OBJECTIVE: Patients with spina bi fi da (SB) may be refractory to medical management and catheterization. Historically, these patients will go on to receive enterocystoplasty. Intravesical injection of botulinum toxin (IVB) has been adopted in the adult and pediatric SB population and gained FDA approval in August 2011. The objectives of this study were to compare utilization trends of IVB and enterocystoplasty in the pediatric and adult SB population, and to evaluate their outcomes post-treatment. We hypothesize that IVB use has increased over time, and that there has been a corresponding decrease in enterocystoplasty. METHODS: We identi fi ed patients with SB in the Truven Ana-lytics MarketScan commercial insurance database from 2008-2017 and strati fi ed them into adult and pediatric samples. Initial procedure was identi fi ed as either IVB or enterocystoplasty. The annual rate of treat-ments was measured and a change in treatment rate was identi fi ed using breakpoint analysis. Time to enterocysplasty was calculated using survival analysis and factors associated with clinical outcomes up to 10 years after index procedure were determined using multivariate Poisson regression. an Very enterocystoplasty patients after IVB. Patients who received IVB as the index procedure experienced signi fi cantly lower rates of hospitalization (RR 0.67; 95% CI 0.54-0.82), emergency department visits (RR 0.86; 95% CI 0.74-0.99), and an increased rate of urologic procedures (RR 1.51; 95% CI 1.33-1.72). CONCLUSIONS: The annual rate of IVB use has increased among patients with SB. There was a signi fi cant rise in the use of IVB noted around the time of FDA approval for this indication in August 2011. Few of these patients go on to receive enterocystoplasty. Patients who receive IVB experience lower rates of hospitalization and emer- gency department visits compared to patients who receive enterocystoplasty.

You have accessJournal of UrologyCME1 May 2022MP29-15 COMPARISON OF PERIOPERATIVE OUTCOMES BETWEEN TRANSVESICAL SINGLE PORT AND INTRAVESICAL MULTIPORT ROBOTIC ASSISTED SIMPLE PROSTATECTOMY: A SINGLE CENTER STUDY Bilal Ahmed Khan, Tanner Corse, Jay Zaifman, Ruth Sanchez De La Rosa, Sarah Brink, Janmejay Hingu, Suzannah Sorin, Ravi Munver, Michael Stifelman, and Mutahar Ahmed Bilal Ahmed KhanBilal Ahmed Khan More articles by this author , Tanner CorseTanner Corse More articles by this author , Jay ZaifmanJay Zaifman More articles by this author , Ruth Sanchez De La RosaRuth Sanchez De La Rosa More articles by this author , Sarah BrinkSarah Brink More articles by this author , Janmejay HinguJanmejay Hingu More articles by this author , Suzannah SorinSuzannah Sorin More articles by this author , Ravi MunverRavi Munver More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , and Mutahar AhmedMutahar Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002572.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Single Port (SP) robotic approach is a new technology that can be utilized in the surgical treatment of benign prostatic hyperplasia (BPH). While studies have compared the outcomes of robotic versus open approach, this is the first study to compare perioperative outcomes of the transvesical SP to the intravesical multiport (MP) robotic approach for simple prostatectomy. METHODS: This is a retrospective, single-center study involving 69 patients who underwent SP or MP simple prostatectomy for BPH between 2019 and 2021. Demographic, intraoperative, and postoperative data were collected and compared. Opioid use was reported in Morphine Milligrams Equivalents (MME). Continuous data was analyzed using the Wilcoxon Rank Sum test. Categorical data was analyzed using Chi-Squared and Fisher's Exact Tests where appropriate. RESULTS: Of the 69 patients included, 20 (28.99%) underwent a transvesical SP and 49 (71.01%) underwent an intravesical MP approach through the posterior aspect of the bladder. There were no significant differences between age, body mass index (BMI), ethnicity, and comorbidities between the two groups. The SP approach was used on significantly smaller median prostate sizes in comparison to the MP approach (83.50 g vs 150.0 g, p=0.00009). The SP approach demonstrated significantly lower estimated blood loss (50.0 vs 100.0, p=0.0001) and lower postoperative opioid use (1.3 MME vs 8.3 MME, p=0.004). There were no significant differences between groups in regards to operating times and peri-operative complications. CONCLUSIONS: This study represents the first comparison between SP and MP approaches for simple prostatectomy. SP simple prostatectomy demonstrated decreased estimated blood loss and postoperative opioid requirements with similar operating time and rate of complications when compared to the MP approach. Further research into the long term efficacy and safety of the SP approach are needed for this indication. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e475 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bilal Ahmed Khan More articles by this author Tanner Corse More articles by this author Jay Zaifman More articles by this author Ruth Sanchez De La Rosa More articles by this author Sarah Brink More articles by this author Janmejay Hingu More articles by this author Suzannah Sorin More articles by this author Ravi Munver More articles by this author Michael Stifelman More articles by this author Mutahar Ahmed More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 May 2022PD56-11 COMPARISON OF INTERMEDIATE OUTCOMES OF SINGLE PORT AND MULTIPORT ROBOTIC ASSISTED PARTIAL NEPHRECTOMY Janmejay Hingu, Tanner Corse, Jay Zaifman, Ruth Sanchez De La Rosa, Bilal Ahmed Khan, Kevin Alter, Fahad Sheckley, Suzannah Sorin, Gregory Lovallo, Ravi Munver, Mutahar Ahmed, and Michael Stifelman Janmejay HinguJanmejay Hingu More articles by this author , Tanner CorseTanner Corse More articles by this author , Jay ZaifmanJay Zaifman More articles by this author , Ruth Sanchez De La RosaRuth Sanchez De La Rosa More articles by this author , Bilal Ahmed KhanBilal Ahmed Khan More articles by this author , Kevin AlterKevin Alter More articles by this author , Fahad SheckleyFahad Sheckley More articles by this author , Suzannah SorinSuzannah Sorin More articles by this author , Gregory LovalloGregory Lovallo More articles by this author , Ravi MunverRavi Munver More articles by this author , Mutahar AhmedMutahar Ahmed More articles by this author , and Michael StifelmanMichael Stifelman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002636.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This study aims to compare intermediate surgical outcomes in patients following single port (SP) and multiport (MP) robotic assisted partial nephrectomy (RAPN). METHODS: This is a prospective, single-center study involving 267 patients who underwent SP or MP RAPN between 2017 and 2021 with at least 3 months since surgery and two documented follow up visits. Continuous data was analyzed using the Wilcoxon Rank Sum test. Categorical data was analyzed using Chi-Squared and Fisher's Exact Tests where appropriate. To assess intermediate outcomes, we utilized data from patient visits closest to 6 months following surgery with a median 28 (IQR: 16, 30) and 27 weeks (IQR: 17, 29) for SP and MP, respectively. Disease Free Survival was compared using the Logrank-test and the Kaplan Meier estimator model. RESULTS: 22 patients (8.23%) underwent SP RAPN and 245 (91.76%) underwent MP RAPN (Table 1) with a median follow up of 35 and 47 weeks, respectively. At time of presentation, there was no significant difference in age, sex, race, chronic kidney disease stage, diabetes status, hypertensive status, or nephrometry score between SP and MP except patients who underwent SP were significantly more likely to have a lower body mass index (26.2 vs 28.7 kg/m2, p=0.027). In terms of intermediate outcomes, there was no significant difference in changes from baseline preoperative creatinine (+0.21 vs +0.09 mg/dL, p=0.160) and eGFR (-29.7 vs -11.8 mL/min/1.73 m2, p=0.520) at the time of 6 month follow up. There was no significant difference in disease recurrence (0.0% vs 4.07%, p=1.0) or disease-free survival (p=0.510) between the two approaches (Figure 1). CONCLUSIONS: Single port robotic assisted partial nephrectomy appears to be an effective treatment modality with equivalent intermediate outcomes to the multiport approach. Further studies are needed to validate long term outcomes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e957 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Janmejay Hingu More articles by this author Tanner Corse More articles by this author Jay Zaifman More articles by this author Ruth Sanchez De La Rosa More articles by this author Bilal Ahmed Khan More articles by this author Kevin Alter More articles by this author Fahad Sheckley More articles by this author Suzannah Sorin More articles by this author Gregory Lovallo More articles by this author Ravi Munver More articles by this author Mutahar Ahmed More articles by this author Michael Stifelman More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE:To compare the perioperative results and intermediate-term functional outcomes of single port and multiport robotic-assisted laparoscopic prostatectomy by using a propensity-score analysis.MATERIALS AND METHODS:We evaluated all patients who underwent robotic prostatectomy by 3 urologic surgeons at our institution between January 2019 and October 2020. Demographic, intraoperative, and postoperative data were collected and assessed. Patients were matched based on body mass index, Gleason group, and prostate volume using the optimal matching method.RESULTS:Overall, 98 and 165 patients underwent single port and multiport robotic prostatectomy, respectively. Following propensity-score matching, 98 multiport cases were matched 1:1 to single port cases. The median operative time was lower for multiport (111.5 vs 147.0 minutes, P = .0000). Single port had a lower median estimated blood loss (50.0 vs 75.0 mL, P = .0006), pain score on postoperative day 0 (1.0 vs 2.0, P = .0004), opioid use at postoperative day 1 (0.0 [IQR 0.0-5.0] vs 0.0 MME [IQR 0.0-7.5], P = .0058), cumulative opioid use (2.0 vs 7.0 MME, P = .0008), and lymph node yield (4.0 vs 7.0 nodes, P = .0051). Single port had a greater percentage of men regain full erectile function by 6 months (23.8% vs 4.8%, P = .002).CONCLUSION:The single port robotic system is a safe option for localized prostate cancer treatment, offering superior pain control and comparable perioperative results and intermediate-term functional outcomes compared to the multiport robotic approach.