Purpose: Urological training in Singapore has seen a reduction in length of training and shortened working hours to fit requirements of the residency model. Virtual reality(VR) simulators may contribute as an adjunct to shorten the learning curve and acquire surgical skills. This study assesses the construct validity of a transurethral resection of prostate(TURP) simulator and its pilot study in urological residents. Methods: The study first assessed the construct validity of the VirtaMed UroS™️ simulator with 12 novices and 12 experts. A pilot study involving 12 junior(JR) and 15 senior urology residents(SR) was then conducted. Participants were given 2 attempts to complete the same task. Performance indicators include: Percentage of prostate resected(PR), Completion time, the time that loop diathermy was active without tissue contact(TAWC), percentage of capsule resection(CR). Results: Construct validity was demonstrated: experts had significantly greater PR (40.6% vs 11.9%, p<0.05) and less TAWC than novices (0.13s vs 13.9s, p<0.05). JR demonstrated an increase in PR (13.3% vs 26.7%, p=0.0005) and a decrease in TAWC when comparing attempts (4.5s vs 1.3s, p= 0.003). Although statistically insignificant, increased PR (30.2 vs 40.5, p=0.1) and decreased TAWC (1.1 vs 0.9, p=0.84) was demonstrated when comparing attempts by SR. In the 2 nd attempt, both groups demonstrated a decrease in TAWC with JR showing a greater decrease (2.9 vs 0.4, p<0.05). Conclusion: This pilot experience shows that the TURP simulator may provide time-efficient learning to supplement urological training. Further research and incorporation of VR simulation is needed to develop more robust and comprehensive training programmes.

Abstract Purpose: Urological training in Singapore has seen a reduction in length of training and shortened working hours to fit requirements of the residency model. Virtual reality(VR) simulators may contribute as an adjunct to shorten the learning curve and acquire surgical skills. This study assesses the construct validity of a transurethral resection of prostate(TURP) simulator and its pilot study in urological residents. Methods: The study first assessed the construct validity of the VirtaMed UroS™️ simulator with 12 novices and 12 experts. A pilot study involving 12 junior(JR) and 15 senior urology residents(SR) was then conducted. Participants were given 2 attempts to complete the same task. Performance indicators include: Percentage of prostate resected(PR), Completion time, the time that loop diathermy was active without tissue contact(TAWC), percentage of capsule resection(CR). Results: Construct validity was demonstrated: experts had significantly greater PR (40.6% vs 11.9%, p<0.05) and less TAWC than novices (0.13s vs 13.9s, p<0.05). JR demonstrated an increase in PR (13.3% vs 26.7%, p=0.0005) and a decrease in TAWC when comparing attempts (4.5s vs 1.3s, p= 0.003). Although statistically insignificant, increased PR (30.2 vs 40.5, p=0.1) and decreased TAWC (1.1 vs 0.9, p=0.84) was demonstrated when comparing attempts by SR. In the 2nd attempt, both groups demonstrated a decrease in TAWC with JR showing a greater decrease (2.9 vs 0.4, p<0.05). Conclusion: This pilot experience shows that the TURP simulator may provide time-efficient learning to supplement urological training. Further research and incorporation of VR simulation is needed to develop more robust and comprehensive training programmes.

Detectable plasma Epstein-Barr virus (EBV) DNA post-RT implies a poor prognosis, but Hui et al. reported a model that could sub-stratify these patients by an EBV DNA cut-off of 500 copies/mL. Detection limits however vary between different EBV DNA assays, which could lead to false positives at low EBV DNA levels. We investigated the EBV DNA kinetics and survival in patients harboring a detectable, but non-quantifiable EBV DNA post-RT (≤265 copies/mL; termed as MRD).

INTRODUCTIONWe investigated the impact of Coronavirus Disease 2019 (COVID-19) pandemic on urological services by analyzing current attitudes and practices of urologists in the Southeast Asian (SEA) countries and create ways for improvement.MATERIALS AND METHODSQuantitative data were used as critical indicators of workload of urological services from each country in SEA. Qualitative data analysis was done to describe the current state of attitudes of urologists against COVID-19 in the region. A strengths, weaknesses, opportunities, and threats (SWOT) analysis was performed to formulate strategic action plans.RESULTSA total of seven urologists from six SEA countries completed the survey. Approximately 21-40% reduction in elective surgeries and outpatient visits, as stated by 42.9% and 57.1% of respondents, respectively was noted. Collectively, most respondents (71.4%) experienced <20% reduction in emergency visits. Various strategies were utilized as reaction to the pandemic. These include utilization of virtual communication platforms, pre-surgical COVID-19 screening, and limited number of accepted outpatient appointments and surgeries. Face to face patient consultations were still considered needed by many urologists although most countries had prohibited direct patient contact. The national response of countries such as Malaysia, Singapore, Thailand, and Vietnam were successful in controlling the pandemic. However, Indonesia and Philippines struggled because of the limited testing and tracing capabilities. Through the SWOT analysis, strategies were identified which can help overcome COVID-19 and any other future pandemics: (1) restarting the urological services in a safe and sustainable manner; (2) optimizing financial and infrastructural capacities; and (3) regional collaboration to strengthen the health systems.CONCLUSIONCOVID-19 negatively impacted many health aspects, especially the delivery of urological services in SEA. Therefore, to ensure sustainability of urological services during the pandemic crisis, health care system should focus on safe, resilient, and adaptive approach with regional collaboration.

We performed a large-scale comparative transcriptome analysis between an EA and NA cohort of localized PCa to interrogate for demographic-specific differences in molecular profiles that could account for tumor aggression and poor survival. We utilized a cohort of 162 EA PCa patients who were treated at a single institution between 2006 to 2021. Tumors were sampled from diagnostic biopsies following central review of the Gleason score (GS) and tumor cellularity by an expert pathologist, then profiled using the Decipher transcriptome assay. Propensity-score matching (PSM) to 100,529 NA cases from the Decipher GRID database (Veracyte, CA) yielded a PSM cohort of 810 NA PCa for comparative analyses of 273 gene-signatures, including the 22-gene genomic classifier (GC). Distant metastasis-free survival (DMFS) was used for survival analyses. The EA cohort comprised of 38 (23%) NCCN-defined low-/favorable intermediate-, 22 (14%) unfavorable intermediate-, and 102 (63%) high-/very high-risk PCa. 92 (57%) and 70 (43%) patients were classified as GC low/intermediate- (≤0.6) and high-risk (>0.6), respectively. GC high-risk was associated with inferior DMFS (HR 3.53 [95%CI:0.9–13.3], P=0.06). Comparisons between the EA, PSM and full (unmatched) NA cohorts revealed a lower proportion of ERG+ (14% vs 31% vs 41%, P<0.001), PTEN loss (7% vs 20% vs 14%, P<0.001), and AR average/high (64% vs 75% vs 90%, P<0.001) PCa, while proportions of luminal-basal PCa were comparable between the EA and PSM NA cohorts. Interrogation of the tumor microenvironment revealed lower angiogenesis, lower effector T cell activation, and higher immune suppression (MDSC, Treg, and PDL2) signature scores in EA than NA PCa, with largest differences observed in luminal B PCa. Luminal B and PCa with high angiogenesis scores had worse DMFS (HR 2.98 [0.9-10.2]; HR 6.06 [1.3-28.2], respectively) in the EA cohort. Herein, we validated the Decipher GC for prognostication, and using a large reference population of NA PCa tumors, identified several demographic-specific transcriptomic features, which may have implications on the efficacy of new therapeutic agents in EA men with PCa.

OBJECTIVES:To evaluate the clinically-significant prostate cancer (csCaP) detection rate of systematic (SBx) vs. targeted biopsy (TBx), after accounting for the overlapping systematic cores within the MRI regions of interest. MATERIALS AND METHODS:We identified 398 consecutive men who underwent both transperineal systematic and targeted biopsy between January 2015 to January 2019. We reclassified overlapping systematic cores in the MRI regions of interest as target cores. The detection rates of SBx and TBx were compared using McNemar's test. RESULTS:Detection rate of csCaP (grade group ≥2) was 42% (168/398). Median number of systematic and targeted cores were 23 (IQR 19-29) and 9 (IQR 6-12) respectively. A median of 3 (IQR 2-4) overlapping systematic cores were reclassified as targeted cores. After accounting for overlap, csPC detection rate on SBx decreased from 37% and 21% while the csCaP detection rate of TBx increased from 34% to 39% (both P < 0.001), with TBx having a better detection rate (39% vs. 21%, P < 0.001). A previous negative biopsy was associated with a lower risk of having csCaP on non-targeted SBx (OR 0.27, 95% CI: 0.12 - 0.58, P = 0.001). Only 5% (13/243) of those who had no cancer detected on TBx had csCaP on non-targeted SBx compared to 45% (70/155) of those who had csCaP on TBx (P< 0.001). CONCLUSIONS:The utility of SBx in detecting csCaP decreases after accounting for overlap into the MRI region of interest, especially in men with a prior negative biopsy. Overlapping systematic cores improve the csCaP detection rate on TBx.

A 72-year-old woman presented to Singapore General Hospital (Singapore) in June, 2019, with 2 months of gross haematuria, complicated by obstructive uropathy of the solitary right kidney from blood clots. She had a history of left radical nephrectomy 8 years ago, for which the initial histology was positive for a pT2aN0M0 Fuhrman Grade II clear-cell renal cell carcinoma with no sarcomatoid components, and the margins were clear of tumour after surgery. She remained recurrence-free on follow-up with yearly ultrasound of the right kidney and chest x-rays in her home country of Bangladesh.

ObjectivesTo evaluate variables that can predict synchronous metastasis in patients presenting with small renal masses.MethodsWe reviewed our institution’s prospectively maintained database of 565 patients diagnosed with small renal masses (≤4 cm) over a 16‐year period. Variables associated with synchronous metastasis and subsequent relapse were analyzed using χ2 and logistic regression models.ResultsA total of 16 patients (2.7%) presented with synchronous metastasis. Just three patients with tumor size <3 cm had metastatic disease at presentation. On multivariate analyses, tumor size >3 cm, symptomatic cancer, age >65 years and ipsilateral synchronous tumors were independent predictors of M1 renal cell carcinoma. A weighted predictive model (concordance index 0.786) showed that a score ≥2 significantly increases the risk of synchronous metastasis (7.9% vs <1% for score <2, P < 0.01, hazard ratio 12.56, 95% confidence interval 5.52–22.85). A total of 498 (90.7%) patients underwent nephrectomies, 27 (4.9%) had ablative therapies and 24 (4.4%) continued on active surveillance/watchful waiting. Over a median follow‐up period of 62.8 months, 30 patients (6.1%) had disease recurrence. On multivariate analyses, higher Fuhrman grade and lymphovascular invasion were independent predictors of recurrence. A separate predictive model (concordance index 0.723) showed that either pathological outcome increases recurrence risk up to 15% (P < 0.01, hazard ratio 11.83, 95% confidence interval 5.82–18.76).ConclusionsSeveral clinical variables can better identify the metastatic potential of small renal masses. The two proposed predictive models can be valuable tools in future clinical practice.

This IRB-approved prospective pilot study evaluates the safety and feasibility of performing stereotactic robot-assisted transperineal MRI-US fusion targeted prostate biopsy under local anaesthesia (LA) with sedation. 30 patients who underwent robotic transperineal prostate biopsy between September 2017 and June 2018 were recruited. All biopsies were performed with the iSR’obot Mona Lisa® and BK3000 ultrasound system. Intravenous paracetamol 1 g, with midazolam and fentanyl were given at positioning. After administration of 5 mL of 1%-lidocaine into the perineal skin 2 cm above and lateral to the anus, periapical prostatic block with 10 mL mixture of 1%-Lidocaine and 0.5%-Marcaine was given. The median age of patients was 66 years (range 53–80 years). Median PSA and mean prostate volume were 8.1 ng/ml (range 4.2–20.6 ng/ml) and 40.1 cc (range 18.6–70 cc). 24 (80.0%) patients had targeted prostate biopsy, with median number of targeted cores of 8 (range 5–16). All patients had saturation biopsy and median number of saturation cores was 21 (range 9–48). Mean dose of intravenous midazolam given was 1.5 mg (range 0–5 mg) and intravenous fentanyl was 75 mcg (10–150 mcg). No patient required conversion to GA. Two patients required motion compensation of 3 mm and 7.5 mm, respectively, due minor movement. Immediate post-operative pain score was 0 for all patients. 29 of 30 patients (96.7%) were discharged within 24 h of procedure. There were no immediate severe complications. Adenocarcinoma was detected in 19/30 (63.3%) cases. This pilot feasibility study showed that stereotactic robotic transperineal MRI-US fusion targeted prostate biopsy can be safely and accurately performed under LA with sedation.

To compare the outcomes of active surveillance (AS) series between African American men (AAM) and non-AAM diagnosed with low-risk prostate cancer at 3 medical centers.Between 2005 and 2012, 214 men accepted AS on the basis of favorable clinical features and parameters after initial and repeat biopsy. Failure was defined as increase in Gleason score >6, total positive cores >33%, maximum cancer volume in any core >50%, or a prostate-specific antigen >10 ng/mL. Disease progression and overall AS failure were compared between the 2 groups.Of 214 men, 75 were excluded, leaving 67 AAM and 72 non-AAM on AS. Median age at diagnosis was 64 and 67 years for AAM and non-AAM, respectively, and median follow-up was 34 and 46 months, respectively. During this time, 44 AAM (66%) remained on AS, and 23 (34%) underwent treatment, of whom 6 (26%) were treated by patient choice and 17 (74%) because of disease progression. In the non-AAM group, 59 (82%) men remained on AS, and 13 (18%) underwent treatment, 8 (62%) were treated by patient choice and 5 (38%) because of disease progression. The 3-year freedom from overall treatment was 74% and did not differ by race (P = .06). The 3-year freedom from disease progression was 85%, where AAM were at significantly higher risk of disease progression (hazard ratio = 3.8; 95% confidence interval: 1.4-10.4; P = .01).Our study suggests a higher disease progression rate in AAM who choose AS for low-risk prostate cancer compared with non-AAM, signifying a potential need for closer follow-up and more stringent enrollment criteria in AAM.

INTRODUCTION AND OBJECTIVES: A thermo-sensitive antiadhesive with a property of sol-gel transition was manufactured by a physical mixture of Poloxamer, Chitosan and Gelatin.Poloxamerbased thermo-sensitive sol-gel has been developed to reduce the incidence of postoperative adhesion formation.The purpose of this study was to evaluate the effect of poloxamer-based thermo-sensitive sol-gel instillation after transurethral resection of the prostate (TURP) on preventing urethral stricture.METHODS: A total of 198 patients underwent TURP for benign prostatic hyperplasia.Recruited patients were randomly divided into two groups: Groups A and B. Patients in group A (100 patients, experimental group) received poloxamer-based thermo-sensitive sol-gel instillation, and patients in the group B (98 patients, control group) received lubricant instillation after TURP.Each patient was evaluated at 4 weeks (V1), 12 weeks (V2), and 24 weeks (V3) after the surgery.The effectiveness of poloxamer-based thermo-sensitive sol-gel instillation was evaluated based on the International Prostate Symptom Score (IPSS)/Quality of Life (QoL), Overactive bladder questionnaire (OAB-q), peak urine ï:‚ow rate (Qmax), voided volume, postvoid residual volume (PVR) and cystoscopy.RESULTS: Among 198 initial participants, 80 patients in group A and 83 patients in group B had completed theexperiment.There were no significant difference in IPSS/QoL, and OAB-q.However, Qmax (mL/ sec) showed significant difference between group A and group B (18.92AE9.98 vs. 15.58AE9.24,p[0.028) in 24 weeks after surgery.Also, result of PVR (mL) 24 weeks after surgery had significant difference between group A and group B (17.81AE28.33 vs. 30.12AE51.92, p[0.061).By Cystoscopy, urethral stricture after TURP was seen in 2 of 80 subjects in group A and 10 of 83 subjects in group B (p[0.023).CONCLUSIONS: Poloxamer-based thermo-sensitive sol-gel instillation after TURP decreased the incidence of urethral stricture.

Our study investigated the prognostic effect of inflammation-related blood markers in clear cell renal cell carcinoma. Of 4 markers studied, we found that the platelet/lymphocyte ratio is a robust prognostic marker of cancer-specific survival. Platelet/lymphocyte ratio improves the prognostic utility of the Leibovich risk groups and University of California, Los Angeles, integrated staging system. However, its prognostic utility has been limited in low-risk cancer. Objectives: Our objective was to evaluate the effect of the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), and red blood cell distribution width (RDW) on the survival outcomes of nonmetastatic clear cell renal cell carcinoma (ccRCC). Materials and Methods: We accessed our single-center, urologic-oncologic registry to extract the data for patients who had undergone nephrectomy for nonmetastatic ccRCC. The optimal cutoff for these markers was determined using X-tile software, and survival analyses using Cox regression were performed. Results: A total of 687 patients had undergone nephrectomy. The optimal cutoffs for NLR, PLR, LMR, and RDW were 3.3, 210, 2.4, and 14.3%, respectively. The NLR, PLR, LMR, and RDW were significantly associated with a larger pathologic tumor size, and stage, more aggressive Fuhrman grade, and the presence of tumor necrosis. After adjusting for age, baseline Eastern Cooperative Oncology Group, pathologic tumor and nodal stage, and Fuhrman grade, only PLR remained an independent prognostic marker for both cancer-specific survival (hazard ratio, 2.69; 95% confidence interval, 1.36-5.33; P = .004) and overall survival (hazard ratio, 2.19; 95% confidence interval, 1.36-3.50; P = .001). When the PLR was included with the Leibovich score and University of California, Los Angeles, integrated staging system, the Harrell's c-index increased from 0.854 to 0.876 and 0.751 to 0.810, respectively, for cancer-specific survival at 5 years after nephrectomy. When risk stratified by the Leibovich risk group and UCLA integrated staging system, PLR was a significant prognostic factor only within the intermediate- to high-risk groups. Conclusions: PLR is a robust prognostic marker in nonmetastatic ccRCC that clearly outperforms other inflammatory indexes in those who had undergone nephrectomy. However, its prognostic effect was limited in the low-risk category of ccRCC. (C) 2019 Elsevier Inc. All rights reserved.

OBJECTIVES:To investigate the trends in the presentation and surgical management of renal tumors at Singapore General Hospital, Singapore.METHODS:We accessed our uro-oncological registry to extract the clinicopathological data of patients with renal tumors who underwent nephrectomy from 2000 to 2015. Binary logistic regression was used to identify predictors of nephron-sparing surgery utilization, Clavien-Dindo grade ≥III complications and progression to stage ≥3 chronic kidney disease. Cox regression models were created to evaluate the proportional hazards of the risk factors for overall survival and cancer-specific survival.RESULTS:A total of 1208 cases of nephrectomy were carried out between 2000 and 2015. The proportion of cT1a tumors increased from 2000-2004 to 2010-2015, which was accompanied by the doubling of utilization rates of nephron-sparing surgery and minimally invasive surgery. Charlson Comorbidity Index score <2, asymptomatic presentation, clinical T1a tumors and having an estimated glomerular filtration rate ≥30 mL/min/1.73 m2 were all independent predictors of nephron-sparing surgery utilization. Age, symptomatic presentation and nephron-sparing surgery utilization were all significantly associated with greater odds of having Clavien-Dindo grade ≥III complications, whereas minimally invasive surgery was associated with decreased risk. The utilization of partial nephrectomy and minimally invasive surgery was significantly associated with a decreased risk of developing postoperative stage ≥3 chronic kidney disease. Both overall survival and cancer-specific survival were not significantly affected by whether nephron-sparing surgery was utilized.CONCLUSIONS:There has been an increasing proportion of small renal masses diagnosed incidentally with a shift towards nephron-sparing surgery for clinically localized tumors. With the adoption of nephron-sparing surgery, progression to stage 3 chronic kidney disease has decreased, without any compromise in oncological and survival outcomes.

INTRODUCTION Prestenting of the ureter is commonly performed to allow for passive dilation and better access to the urinary system during subsequent procedures. There is no level 1 evidence on the duration of prestenting and EAU guidelines suggest a 1-2 weeks duration. MATERIALS AND METHODS Our primary aim is to investigate the optimal duration required for prestenting in a porcine model. Our secondary aim is to compare the ureteral wall compliance between the stented and the unstented ureters. METHODS Three female pigs between 40 and 50 kg were used. We modified a human protocol for performing intravenous pyelograms in our study to obtain ureteral measurements on days 0, 5, 7, and 14. Unilateral stenting on days 0, 5, and 7 was performed. On day 14, bilateral nephroureterectomy was performed, and ureteral compliance was measured in the stent and unstented ureter. RESULTS There were significant ureteral dilation between days 0 and 5 for all three pigs (p1 = 0.001, p2 ≤ 0.001 and p3 = 0.01). The rate of dilation appears to plateau after day 5 (p1 = 0.416, p2 = 0.344, and p3 = 0.774). Ureteral compliance in the stented ureter is better than in a nonstent ureter (p1 = 1.44 vs 0.13, p2 = 0.8 vs 0.04, p3 = 0.62 vs 0.2). An unexpected observation was the ureteral dilation and increased tortuosity in the unstented ureter in two of the three pigs (p1 = 0.152, p2 = 0.007). CONCLUSION Our results suggest that optimal prestenting may be achieved in 5 days in a porcine model. It can potentially form the basis to start randomized human trials.

You have accessJournal of UrologyBladder & Urethra: Anatomy, Physiology & Pharmacology I (MP11)1 Apr 2019MP11-20 THE PREDICTIVE ACCURACY BETWEEN CLINICAL STAGING AND PATHOLOGICAL STAGING IN PATIENTS WITH PRIMARY URETHRAL CARCINOMA Tina Schubert*, Kirk A. Keegan, Markus A. Kuczyk, Mario Kramer, Oliver Patschan, Allen Sim, Tokru Nakagawa, Daniel Joyce, Michael Drumm, Jason A. Efstathiou, Hubert Kübler, and Georgios Gakis Tina Schubert*Tina Schubert* More articles by this author , Kirk A. KeeganKirk A. Keegan More articles by this author , Markus A. KuczykMarkus A. Kuczyk More articles by this author , Mario KramerMario Kramer More articles by this author , Oliver PatschanOliver Patschan More articles by this author , Allen SimAllen Sim More articles by this author , Tokru NakagawaTokru Nakagawa More articles by this author , Daniel JoyceDaniel Joyce More articles by this author , Michael DrummMichael Drumm More articles by this author , Jason A. EfstathiouJason A. Efstathiou More articles by this author , Hubert KüblerHubert Kübler More articles by this author , and Georgios GakisGeorgios Gakis More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555184.87550.3cAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: There is a paucity of data regarding the predictive value of clinical staging on pathological outcomes in primary urethral carcinoma (PUC). Therefore, we aimed to analyse the concordance between clinical and pathological staging in an international cohort of patients without neoadjuvant treatment. METHODS: 75 patients diagnosed with PUC in 7 centers were included. Clinical staging was based on cross-sectional imaging. ROC analyses were conducted to analyze the predictive accuracy. RESULTS: Clinical tumor stage was cTa in 12 patients (16%), cTis in 11 (15%), cT1 in 23 (31%), cT2 in 15 (20%), cT3 in 10 (13%) and cT4 in 4 (5%). Pathological tumor staging was pTX in 7 patients (9%), pT0 in 1 (1%), pTa in 10 (13%), pTis in 9 (12%), pT1 in 13 (17%), pT2 in 17 (23%), pT3 in 11 (15%) and pT4 in 7 (9%). Clinical nodal stage was cN0 in 53 (71%), cN+ in 8 (11%) and cNX in 14 (19%). Among the 43 patients who underwent regional lymph node dissection, pathological nodal staging was pN0 in 34 (79%) and pN+ in 9 (21%). A high degree of concordance between clinical and pathologic tumor and nodal staging (≥cT2/cN+ vs.

Introduction: The morbidities associated with transperitoneal route for robot-assisted radical prostatectomy are postoperative ileus and potential bowel injuries. The extraperitoneal approach avoids the peritoneal cavity and potential associated morbidity. We report our technique and the perioperative and short-term postoperative outcomes of our series. Materials and Methods: Between May 2016 and April 2017, 15 consecutive patients who met inclusion criteria (body mass index [BMI] < 30, D'amico low- to intermediate-risk prostate cancer, prostate volume <60 mL, and no previous laparotomy) were recruited prospectively. The extraperitoneal space was created posterior to the subumbilical rectus sheath in the preperitoneal fat plane with a balloon dissector. A five- to six-port technique was used with reduced Trendelenburg angle. Antegrade dissection of prostate was performed. Vesicourethral anastomoses were by the Velthoven technique with modified Rocco's stitch. Patient demographics, characteristics, and peri- and postoperative short-term outcomes were analyzed. Results: The median age was 64 (range 57–70) years and mean prostate volume was 46.3 ± 12.0cc. The mean prostate specific antigen (PSA) was 7.5 ± 2.8 µg/L. The mean BMI was 23.8 ± 2.2 kg/m2. All 15 patients underwent extraperitoneal approach effectively. The mean umbilical to pubic symphysis distance was 15.0 ± 0.8 cm. The mean setup time (creation of extraperitoneal space and robot docking) was 25.7 ± 11.0 minutes and mean total operative time was 215.4 ± 43.5 minutes. The mean Trendelenburg degree was 17.1 ± 3.5. Mean estimated blood loss was 115.8 ± 71.8 mL. There was a small peritoneal breach during balloon dilatation in a patient with previous open appendicectomy and another with previous open hernia repair. Two (13.3%) and 14 (93.3%) patients had standard pelvic lymph node and nerve-sparing dissections, respectively. Postoperatively no patients had ileus, intraabdominal, or other significant Clavien–Dindo complications. Thirteen (86.7%) patients passed flatus and had diet on postoperative day (POD) 1. Nine (60.0%) patients were discharged within 24 hours and the rest on POD 2. All patients received paracetamol 1 g when needed, whereas four required single dose intramuscular pethidine for breakthrough pain. Pathologic stage was pT0, pT2a, and pT2c in 1 (6.7%), 12 (80.0%), and 2 (13.3%) patients, respectively, representing downstaging in 1 (6.7%, pT0 in the prior-transurethral resection of prostate patient). One patient had focal (<1 mm) positive margins (anterior apical) with the majority (93.3%) having complete resection. At a mean of 126 ± 85.7 days, 14 patients (93.3%) achieved undetectable nadir PSA (<0.03 µg/L). Overall continence rate was 86.7% at 3 months. The follow-up duration was not long enough to meaningfully report recovery of erectile function. Conclusion: Total extraperitoneal resection of prostate, an extraperitoneal organ, in selected patients enables ileus-free early discharges. No competing financial interests exist. Runtime of video: 6 mins 49 secs