OBJECTIVE:To assess the oncological outcomes of targeted microwave ablation (TMA) using organ-based tracking (OBT) Fusion® via KOELIS Trinity® (KOELIS, Meylan, France) in men with intermediate-risk prostate cancer (PCa): the VIOLETTE trial (ClinicalTrials.gov identifier: NCT04582656) PATIENTS AND METHOD: In this prospective phase II, multicentre European study, men with a prostate-specific antigen (PSA) level <20 ng/mL, a single magnetic resonance imaging (MRI)-visible lesion ≤15 mm, International Society of Urological Pathology (ISUP) Grade Group 2 on MRI-targeted biopsy, and clinical T stage ≤2, were enrolled. The microwave applicator was placed using OBT Fusion guidance, either transperineally or transrectally. The primary endpoint was the absence of clinically significant PCa (csPCa), defined as ISUP Grade Group ≥2, within the treated area at 12 months. Secondary endpoints included safety, functional outcomes using validated measures, and the need for subsequent radical treatment. RESULTS:A total of 76 patients were treated across six centres with 66 (87%) completing the 12-month follow-up. At 6 months, six patients had csPCa after positive MRI control, including four within the treated area. At 12 months, csPCa was detected in 15 additional patients, including nine in-field recurrences, yielding an 81% in-field csPCa-free rate. Five serious adverse events in three patients were reported. Sexual (-2.5 points; P < 0.001) and ejaculatory (-1 points; P < 0.001) scores decreased significantly, whereas urinary function remained stable. Radical treatment was required in four (5.2%) patients at 12 months. CONCLUSION:Targeted microwave ablation using OBT Fusion technology appears to be a safe and effective focal therapy procedure for localised intermediate-risk PCa. The VIOLETTE trial achieved its primary endpoint, with 81% patients free of in-field csPCa at 12 months.

Background: Iatrogenic lesions of the distal ureter represent a frequent and feared complication of abdominal surgery that is traditionally managed by ureteral reimplantation. The aim of this systematic review (SR) is to summarize the published literature on the role of minimally invasive ureteroureterostomy (UU) in the surgical treatment of non-neoplastic distal ureteral lesions. Methods: We performed a comprehensive literature search on PubMed, Embase, and Cochrane CENTRAL including published peer-reviewed studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The intra-, peri-, and postoperative outcomes as well as the safety profile and the success rates of minimally invasive UU are presented. Results: Seven retrospective studies with 116 patients were included in this SR. If the basic principles of the ureteral reconstructive procedure are followed, both laparoscopic and robotic UU are feasible, safe, and with a success rate ranging between 81.8% and 100%, depending on the definition of success. A single comparative study documented a significant difference in operative time and length of hospitalization in favor of robotic UU. The success of both laparoscopic and robotic UU has been mainly evaluated in the short and intermediate follow-up. Conclusion: Minimally invasive UU may represent a viable treatment option for the treatment of non-neoplastic distal ureter pathology such as iatrogenic injuries or radiotherapy-induced stenosis. Larger, prospective studies adopting a standard definition of the postoperative success are required to affirm UU as a first-line option in the management of benign distal ureteral lesions.

In the era of robotic prostate surgery, various techniques have been developed to improve functional outcomes. Urinary continence has shown satisfactory results, but the preservation of lateral nerves to the periprostatic capsule is only achievable by sparing the pubovesical complex. This study aims to present the first cases of lateral-approach robot-assisted radical prostatectomy (LRRP) performed by a novice surgeon. We conducted a retrospective analysis of 70 prostate cancer patients who underwent LRRP between October 2019 and September 2021, analyzing the perioperative and functional outcomes. The median operative time and intraoperative blood loss were 102 (92–108) minutes and 150 (130–180) mL, respectively. Five minor postoperative complications were reported, and the median hospital stay was 2 (1–2) days. Eleven positive surgical margins occurred. Potency and urinary continence recovery were achieved in 59 (84%) and 66 (94%) patients, respectively, 12 months after surgery. Our analysis shows that LRRP is a safe and effective procedure for prostate cancer surgery. Continence and potency recovery required a short learning curve, with an acceptable recovery rate even in the initial cases.

Introduction: The orthotopic neobladder is the type of urinary diversion (UD) that most closely resembles the original bladder. However, in the literature the urodynamic aspects are scarcely analysed. Objective: To provide the first systematic review (SR) on the urodynamic (UDS) outcomes of the ileal orthotopic neobladders (ONB). Continence outcomes are also presented. Methods: A PubMed, Embase and Cochrane CENTRAL search for peer-reviewed studies on ONB published between January 2001–December 2022 was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Results and Conclusion: Fifty-nine manuscripts were eligible for inclusion in this SR. A great heterogeneity of data was encountered. Concerning UDS parameters, the pooled mean was 406.2 mL (95% CI: 378.9–433.4 mL) for maximal (entero)cystometric capacity (MCC) and 21.4 cmH2O (95% CI: 17.5–25.4 cmH2O) for Pressure ONB at MCC. Postvoid-residual ranged between 4.9 and 101.6 mL. The 12-mo rates of day and night-time continence were 84.2% (95% CI: 78.7–89.1%) and 61.7% (95% CI: 51.9–71.1%), respectively.Despite data heterogeneity, the ileal ONB seems to guarantee UDS parameters that resemble those of the native bladder. Although acceptable rates of daytime continence are reported the issue of high rates of night-time incontinence remains unsolved. Adequately designed prospective trials adopting standardised postoperative care, terminology and methods of outcome evaluation as well as of conduction of the UDS in the setting of ONB are necessary to obtain homogeneous follow-up data and to establish UDS guidelines for this setting.

Purpose: The intraperitoneal leak of urine is considered as a major cause of peritoneal inflammatory reaction that could lead to paralytic ileus. Our aim was to document the effect of urine on the peritoneal surface. Methods: Seven white minipigs (one control-six tests) underwent standardized general anaesthesia. In three test pigs urine was aspirated from the bladder and instilled in the peritoneal cavity. In the remaining three pigs a continuous urine leak was created through section of the ureter. At 4 and 10h laparoscopic harvesting of slices of the parietal peritoneum at the level of the Douglas pouch, lateral pelvic wall and subdiaphragmatic area was performed. Ileum slices were also obtained at 10h. The slices were microscopically evaluated for inflammatory infiltrate (INI) of the peritoneum according to the Sydney system classification. Results: The presence of urine in the peritoneum induces distention of the ileum. At 4h, a light-moderate INI was observed to two pigs of both test groups but not to the control pig. At 10h a light-moderate INI appeared in the peritoneal slices of the control pig. Moreover, three out of six pigs of both test groups showed some degree of INI of the parietal peritoneum. The histologic evaluation of the slices of the distended ileum did not reveal INI. Conclusions: The intraperitoneal urine induces distention of the bowel but no inflammation of the visceral peritoneum in the short term (10h). Other than inflammation mechanisms through which the urine induces small ileum distention should be investigated.

BACKGROUND:The prostatic urethra (PU) is conventionally resected during robot-assisted radical prostatectomy (RALP). Recent studies demonstrated the feasibility of the extended PU preservation (EPUP).AIMS:To describe the histologic features of the PU.METHODS:The PU was evaluated using cystoprostatectomy and RALP specimens. Cases of PU infiltration by prostate cancer or distortion by benign hyperplastic nodules were excluded. The thickness of the chorion and distance between the urothelium and prostate glands were measured. Prostate-specific antigen expression in the PU epithelium was evaluated with immunohistochemistry. Descriptive statistics were used.RESULTS:Six specimens of PU were examined. Histologically, the following layers of the PU were observed: (1) urothelium with basal membrane, (2) chorion, and (3) prostatic peri-urethral fibromuscular tissue. The chorion measures between 0.2 and 0.4 mm. There is not a distinct urethral muscle layer, but rather muscular fibers that originate near the prostatic stroma and are distributed around the PU. This muscular tissue appears to be mainly represented in the basal and apical urethra, but not in the middle urethra. The mean distance between the chorion and prostatic glands is 1.74 mm, with significant differences between base of the prostate, middle urethral portion, and apex (2.5 vs. 1.49 vs. 1.23 mm, respectively). PSA-expressing cells are abundant in the PU epithelium, coexisting with urothelial cells.CONCLUSIONS:The exiguity of thickness of the PU chorion, short distance from glandular tissue, and coexistence of PSA-expressing cells in the epithelium raise important concerns about the oncologic safety of EPUP.

Pudendal Nerve Entrapment (PNE) may determine chronic pelvic pain associated with symptoms related to its innervation area. This study aimed to present the technique and report the outcomes of the first series of robot-assisted pudendal nerve release (RPNR). 32 patients, who were treated with RPNR in our centre between January 2016 and July 2021, were recruited. Following the medial umbilical ligament identification, the space between this ligament and the ipsilateral external iliac pedicle is progressively dissected to identify the obturator nerve. The dissection medial to this nerve identifies the obturator vein and the arcus tendinous of the levator ani, which is cranially inserted into the ischial spine. Following the cold incision of the coccygeous muscle at the level of the spine, the sacrospinous ligament is identified and incised. The pudendal trunk (vessels and nerve) is visualized, freed from the ischial spine and medially transposed. The Median duration of symptoms was 7 (5, 5–9) years. The median operative time was 74 (65–83) minutes. The median length of stay was 1 (1–2) days. There was only a minor complication. At 3 and 6 months after surgery, a statistically significant pain reduction has been encountered. Furthermore, the Pearson correlation coefficient reported a negative relationship between the duration of pain and the improvement in NPRS score, − 0.81 (p = 0.01). RPNR is a safe and effective approach for the pain resolution caused by PNE. Timely nerve decompression is suggested to enhance outcomes.

Background: Numerous continence-sparing radical prostatectomy techniques have been developed to enhance postoperative early continence (EC) recovery; however, evidence regarding the best approach remains controversial. The objectives are to provide a critical appraisal of various prostatectomy techniques, based on the evidence of quality-assessed randomized control trials (RCTs); to summarize the immediate continence and the EC reported; and to propose a new standardization for continence outcomes reporting. Methods: Data acquired from five medical registries were reported to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Evidence from published, English, full-text RCTs reporting postoperative urinary continence outcomes within 6 months from surgery was included. The heterogeneity of surgical techniques and continence definitions did not allow a meta-analysis. All RCTs were critically appraised, and quality assessed. Results: In total, 39 RCTs were included: 19 of 39 studies were low-quality RCTs, presenting small cohort, monocentric, or single-surgeon data. The best RCT-supported evidence is in favor of robot-assisted radical prostatectomy (RARP) compared with laparoscopic radical prostatectomy (LRP) and of the Retzius-sparing (RS) technique over the traditional prostatectomy. Other techniques such as bladder neck and puboprostatic ligament (PPL) preservation, posterior reconstruction with or without combination of anterior suspension technique, and nerve-sparing (NS) approach seem to enhance EC. Oppositely, the endopelvic fascia preservation, bladder neck mucosa eversion/plication/slings, and the selective ligature of dorsal venous complex (DVC) were not significantly associated with EC improvements. RCTs are lacking on pubovesical complex-sparing, seminal vesicle preservation, anterior reconstruction of the puboprostatic collar, musculofascial reconstruction, and DVC suspension to the periosteum of the pubic bone techniques. Conclusions: RARP and RS have high-quality evidence supporting their ability to enhance postoperative EC recovery. NS, bladder neck, and PPL preservation may contribute to better EC recovery, although the evidence level is low. Further multicenter RCTs are needed to establish the optimal combination of standard surgical techniques. A new continence outcome-reporting standardization was proposed.

Background: The capacity of a given shape of an orthotopic ileal neobladder (ONB) varies significantly, although the same length of preterminal ileum is utilised. Objective: To investigate the variability of the human ileal width and to create a mathematical formula that calculates its impact on the neobladder capacity. Design, setting, and participants: During 50 consecutive cases of robotic pelvic sur-gery, a segment of preterminal ileum was identified and the width was measured. A mathematical formula was created to calculate, for a given ileal length and width, the neobladder capacity and, for a given ileal width and neobladder capacity, the length of the (pre)terminal ileum to harvest. The accuracy of our model was tested on 28 pouches created by swine ileum. Outcome measurements and statistical analysis: The interindividual variability of the ileal width and its impact on the ileal neobladder capacity was investigated. Results and limitations: The mean hemicircumference of the human distal ileum is 2. 43 +/- 0.39 cm (range 2-3.5 cm). According to our geometric model and as confirmed in the swine model, an increase of 1 cm in ileal width increases the neobladder capacity by 85%. The Pearson correlation coefficient reported a strong positive rela-tionship between the formula-calculated and effective volumes of the pouch (r = 0.97). Moreover, for the same target capacity, 1 cm of difference in the ileal width implies harvesting 20 cm less ileum. A lack of testing on humans and appli-cation only to spheroidal neobladders are the main limits. Conclusions: The ileal width impacts the capacity of the ONB. For a given type of ONB, no standard length of ileum should be harvested; instead, the length should be tailored to the width of the ileum for a given patient. Clinical studies are required to confirm our model.

Background:The intracorporeal orthotopic modified-Y "Bordeaux" neobladder (iYNB) was first described in 2016. No urodynamic evaluation of this neobladder has yet been performed. Objective:To present the urodynamic features of the iYNB and incontinence-specific health-related quality of life (HRQoL) outcomes. Design setting and participants:We prospectively assessed 26 patients operated between September 2018 and November 2020. Surgical procedure:Robotic radical cystectomy for malignant disease of the bladder and iYNB, performed by a single surgeon, were used. Measurements:Three months after surgery and in November 2021, consenting patients underwent clinical evaluation and multichannel urodynamic study (UDS). The incontinence quality of life (I-QoL) questionnaire was used to evaluate HRQoL. Continence was classified into day- and nighttime, and clinically defined as the use of zero pads. A descriptive statistical analysis was performed. Results and limitations:The mean age at surgery was 65.4 yr. The mean follow-up period was 27 mo (12-38). The mean time for the neobladder reconstruction was 192 min (110-340). The mean maximum capacity was 431 cm3 (range 200-553). The mean postvoid residual was 101.6 ml (0-310), and the rate of clean intermittent catheterization was 17.6%. With the exception of a significant reduction in the volume of the first sensation of bladder fullness, no other statistically significant changes in the UDS parameters of both the storage and the voiding phase were observed over time. Day- and nighttime continence rates were 58.8% and 23.5%, respectively. The mean postoperative I-QoL score was 103.3 (89-110). Limitations include the small number of patients and short follow-up. Conclusions:The UDS evaluation of iYNB demonstrates that both the volumetric and the pressure characteristics are acceptable and may enhance quality of life. Prospective studies with larger numbers of patients and longer follow-up are needed to further evaluate the iYNB. Patient summary:The "Bordeaux" neobladder provides acceptable urodynamic outcomes. It is associated with high levels of health-related quality of life and good rates of continence in patients.

Robot-assisted radical cystectomy (RARC) continues to expand, and several surgeons start training for this complex procedure. This calls for the development of a structured training program, with the aim to improve patient safety during RARC learning curve. A modified Delphi consensus process was started to develop the curriculum structure. An online survey based on the available evidence was delivered to a panel of 28 experts in the field of RARC, selected according to surgical and research experience, and expertise in running training courses. Consensus was defined as ≥80% agreement between the responders. Overall, 96.4% experts completed the survey. The structure of the RARC curriculum was defined as follows: (1) theoretical training; (2) preclinical simulation-based training: 5-d simulation-based activity, using models with increasing complexity (ie, virtual reality, and dry- and wet-laboratory exercises), and nontechnical skills training session; (3) clinical training: modular console activity of at least 6 mo at the host center (a RARC case was divided into 11 steps and steps of similar complexity were grouped into five modules); and (4) final evaluation: blind review of a video-recorded RARC case. This structured training pathway will guide a starting surgeon from the first steps of RARC toward independent completion of a full procedure. Clinical implementation is urgently needed. PATIENT SUMMARY: Robot-assisted radical cystectomy (RARC) is a complex procedure. The first structured training program for RARC was developed with the goal of aiding surgeons to overcome the learning curve of this procedure, improving patients' safety at the same time.

BACKGROUND:Salvage radical prostatectomy (sRP) historically yields poor functional outcomes and high complication rates. However, recent reports on robotic sRP show improved results. Our objectives were to evaluate sRP oncological outcomes and predictors of positive margins and biochemical recurrence (BCR). METHODS:We retrospectively collected data of sRP for recurrent prostate cancer after local nonsurgical treatment at 18 tertiary referral centers in United States, Australia and Europe, from 2000 to 2016. SM and BCR were evaluated in a univariate and multivariable analysis. Overall and cancer-specific survival were also assessed. RESULTS:We included 414 cases, 63.5% of them performed after radiotherapy. Before sRP the majority of patients had biopsy Gleason score (GS) ≤7 (55.5%) and imaging negative or with prostatic bed involvement only (93.3%). Final pathology showed aggressive histology in 39.7% (GS ≥9 27.6%), with 52.9% having ≥pT3 disease and 16% pN+. SM was positive in 29.7%. Five years BCR-Free, cancer-specific survival and OS were 56.7%, 97.7% and 92.1%, respectively. On multivariable analysis pathological T (pT3a odds ratio [OR] 2.939, 95% confidence interval [CI] 1.469-5.879; ≥pT3b OR 2.428-95% CI 1.333-4.423) and N stage (pN1 OR 2.871, 95% CI 1.503-5.897) were independent predictors of positive margins. Pathological T stage ≥T3b (OR 2.348 95% CI 1.338-4.117) and GS (up to OR 7.183, 95% CI 1.906-27.068 for GS >8) were independent predictors for BCR. Limitations include the retrospective nature of the study and limited follow-up. CONCLUSIONS:In a contemporary series, sRP showed promising oncological control in the medium term despite aggressive pathological features. BCR risk increased in case of locally advanced disease and higher GS. Future studies are needed to confirm our findings.

Identifying predictors of positive surgical margins (PSM) and biochemical recurrence (BCR) after radical prostatectomy (RP) may assist clinicians in formulating prognosis. Aim of the study was to report the midterm oncologic outcomes, to identify the risk factors for PSM and BCR and assess the impact of the PSM on BCR-free survival following robot-assisted laparoscopic radical prostatectomy (RALP). From 2005 to 2010, 1679 consecutive patients underwent transperitoneal RALP. Data was retrospectively collected by an independent statistical company and analyzed in 2014. Median postoperative follow-up was 33.5 mo. BCR was defined as any detectable serum prostate-specific antigen (PSA) ≥ 0.2 ng/mL in two consecutive measurements. BCR-free survival was estimated using the Kaplan–Meier method. Univariate and multivariate analysis were applied to identify risk factors for PSM and BCR. In pN0/pNx cancers, pathologic stage was pT2 in 1186 patients (71.8%), pT3 in 455 patients (27.6%), and pT4 in 11 patients (0.6%). PSM rate was 17.4% and 36.9% of pT2 and pT3 cancers, respectively. Pathologic Gleason score was < 7, = 7 and > 7 in 42.1%, 53% and 4.9% of the patients, respectively. Overall BCR-free survival was 73.1% at 5 years; the 5-year BCR-free survival was 87.9% for pT2 with negative surgical margins. PSA, Gleason score (both bioptic and pathologic), pathologic stage (pT) and surgeon's volume were significant independent predictors of PSM. PSA, pathologic Gleason score, pT and PSM were significant independent predictors of BCR-free survival. Seminal vesicle-sparing, nerve-sparing approach and the extent of nerve-sparing (intra vs interfascial dissection) did not negatively affect margin status or BCR rates. PSMs are a predictor of BCR. Being the only modifiable factor influencing the PSM rate, surgical experience is confirmed as a key factor for high-quality oncologic outcomes.

There is little evidence regarding salvage radical prostatectomy (sRP) for M0 castration-resistant prostate cancer (CRPC). We reviewed oncological results and complications for 23 men with radiographically recurrent M0 CRPC undergoing sRP at six institutions. Sixteen and ten men experienced at least one and one major (Clavien >2) complication, respectively. After sRP, nine men became incontinent, including two with severe incontinence. The majority of men had aggressive extraprostatic disease (≥pT3b 56.5%; pN1 30.4%; Gleason ≥8 65.2%). Postoperatively 69.6% reached undetectable prostate-specific antigen (PSA) without androgen deprivation therapy (ADT). Seven men had postoperative PSA persistence and six had CRPC persistence. Among the others, biochemical recurrence (BCR) occurred in 68.7% and CRPC in 58.8% at a median of 11 and 31 mo from sRP, respectively. At median follow-up of 4 yr, 17.4% were disease-free, 34.4% had died from PC, and 4.3% had died from other causes. sRP for M0 CRPC is feasible although the risk of complications is significant. A minority of patients can be cured and a significant proportion experience prolonged BCR- and CRPC-free status, thus delaying the need for systemic treatments. Further studies are needed to clarify the role of sRP for M0 CRPC in the era of new antiandrogen therapies. PATIENT SUMMARY: Salvage radical prostatectomy for radiorecurrent M0 castration-resistant prostate cancer (CRPC) is feasible, although continence outcomes are suboptimal and the risk of complications is significant. Survival is promising: some men can be cured and others experience a period without evidence of PC or CRPC. More research is needed to confirm our findings and demonstrate survival benefits.

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (PD43)1 Apr 2020PD43-04 SALVAGE RADICAL PROSTATECTOMY FOR RECURRENT PROSTATE CANCER: ONCOLOGICAL OUTCOMES OF A CONTEMPORARY MULTICENTER STUDY Giancarlo Marra*, Paolo Gontero, Paolo Alessio, Giorgio Calleris, Marco Oderda, Fernando Munoz, Claudia Filippini, Estefania Linares, Rafael Sanchez-Salas, Sanchia Goonewardene, Prokar Dasgupta, Ben Challacombe, Rick Popert, Declan Cahill, David Gillatt, Raj Persad, Juan Palou, Steven Joniau, Thierry Piechaud, Alexandre De La Taille, Morgan Roupret, Simone Albisinni, Alessandro Morlacco, Giorgio Gandaglia, Alexander Mottrie, Joseph Smith, Andre Berger, Monish Aron, Andre Abreu, Inderbir S. Gill, Henk Van Dar Poel, Derya Tilki, Declan Murphy, Nathan Lawrentschuk, John Davis, and Robert Jeffrey Karnes Giancarlo Marra*Giancarlo Marra* More articles by this author , Paolo GonteroPaolo Gontero More articles by this author , Paolo AlessioPaolo Alessio More articles by this author , Giorgio CallerisGiorgio Calleris More articles by this author , Marco OderdaMarco Oderda More articles by this author , Fernando MunozFernando Munoz More articles by this author , Claudia FilippiniClaudia Filippini More articles by this author , Estefania LinaresEstefania Linares More articles by this author , Rafael Sanchez-SalasRafael Sanchez-Salas More articles by this author , Sanchia GoonewardeneSanchia Goonewardene More articles by this author , Prokar DasguptaProkar Dasgupta More articles by this author , Ben ChallacombeBen Challacombe More articles by this author , Rick PopertRick Popert More articles by this author , Declan CahillDeclan Cahill More articles by this author , David GillattDavid Gillatt More articles by this author , Raj PersadRaj Persad More articles by this author , Juan PalouJuan Palou More articles by this author , Steven JoniauSteven Joniau More articles by this author , Thierry PiechaudThierry Piechaud More articles by this author , Alexandre De La TailleAlexandre De La Taille More articles by this author , Morgan RoupretMorgan Roupret More articles by this author , Simone AlbisinniSimone Albisinni More articles by this author , Alessandro MorlaccoAlessandro Morlacco More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Alexander MottrieAlexander Mottrie More articles by this author , Joseph SmithJoseph Smith More articles by this author , Andre BergerAndre Berger More articles by this author , Monish AronMonish Aron More articles by this author , Andre AbreuAndre Abreu More articles by this author , Inderbir S. GillInderbir S. Gill More articles by this author , Henk Van Dar PoelHenk Van Dar Poel More articles by this author , Derya TilkiDerya Tilki More articles by this author , Declan MurphyDeclan Murphy More articles by this author , Nathan LawrentschukNathan Lawrentschuk More articles by this author , John DavisJohn Davis More articles by this author , and Robert Jeffrey KarnesRobert Jeffrey Karnes More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000930.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Men with biochemical recurrence (BCR) after primary treatment can be managed with curative intent by salvage radical prostatectomy (sRP). Historical series show high complication rates and poor outcomes, while better results are reported in novel robotic sRP procedures. We assessed the contemporary oncological outcomes of sRP in large multicentre recent series. METHODS: Between 2000 and 2016, 629 men with BCR underwent sRP at 18 tertiary referral centres. We retrospectively collected pre-, intra and post-surgery clinical and histological data. A follow up <6 months, pre-sRP castration-resistant disease, laparoscopic approach or unavailability of the data with no revision were adopted as exclusion criteria. A post-operative PSA >0,2 ng/ml was used to define biochemical recurrence (BCR). A multivariable logistic regression model was used to test predictor of BCR and positive surgical margins (PSM). RESULTS: A total of 414 cases were included, with a median PSA of 4,2 ng/ml. Primary treatment was represented by radiotherapy (63.5%), brachytherapy (25.7%) or others (13.6%). At confirmatory biopsy before salvage surgery, more than half of the patients had Gleason score ≤7 (55.5%) and organ-confined, node-negative disease at imaging (93.3%). Final pathology showed instead high grading in 39.7% (gleason ≥9 27.6%), with more than half having non-organ-confined disease (52.9%). pN1 was present in 16%. Nearly 1 out of 3 patinets had PSM (29.7%). Figure 1 reports 5-years BCR-Free, CSS and OS: 56.7%, 97.7% and 92.1% respectively. On multivariate analysis: PSM were predicted by pT staging (pT3a OR 2.9 - 95%CI 1.5-5.9; ≥pT3b OR 2.4 – 95%CI 1.3-4.4) and nodal disease (pN1 OR 2.9 - 95%CI 1.5-5.9); BCR was associated with pT staging ≥T3b (OR 2.3 95%CI 1.3-4.1) and tumor grading (GS>8 OR 7.3 – 95%CI 1.9-27.1). CONCLUSIONS: In our multicenter series, sRP yielded acceptable oncological outcomes on the short-medium term, notwithstanding the advanced pathological characteristics encountered at final pathology. Extra-organ disease and higher gleason score enhance BCR risk. Further research is recommended to confirm our findings. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e901-e902 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giancarlo Marra* More articles by this author Paolo Gontero More articles by this author Paolo Alessio More articles by this author Giorgio Calleris More articles by this author Marco Oderda More articles by this author Fernando Munoz More articles by this author Claudia Filippini More articles by this author Estefania Linares More articles by this author Rafael Sanchez-Salas More articles by this author Sanchia Goonewardene More articles by this author Prokar Dasgupta More articles by this author Ben Challacombe More articles by this author Rick Popert More articles by this author Declan Cahill More articles by this author David Gillatt More articles by this author Raj Persad More articles by this author Juan Palou More articles by this author Steven Joniau More articles by this author Thierry Piechaud More articles by this author Alexandre De La Taille More articles by this author Morgan Roupret More articles by this author Simone Albisinni More articles by this author Alessandro Morlacco More articles by this author Giorgio Gandaglia More articles by this author Alexander Mottrie More articles by this author Joseph Smith More articles by this author Andre Berger More articles by this author Monish Aron More articles by this author Andre Abreu More articles by this author Inderbir S. Gill More articles by this author Henk Van Dar Poel More articles by this author Derya Tilki More articles by this author Declan Murphy More articles by this author Nathan Lawrentschuk More articles by this author John Davis More articles by this author Robert Jeffrey Karnes More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction The aims of this study were to test a novel simulation platform suitable for flexible cystoscopy using a standard scope, to assess the platform's proposed use as a training tool for flexible cystoscopy, and to assess the user experience through surveyed response. Methods Thirty-one urologists (11 novices, 20 experts) were evaluated using a novel light-based bladder model and standard flexible cystoscope. Time to complete full inspection of the simulated bladder was measured, and the scope trajectory was recorded. Participants also completed a survey of the training platform. Results Thirty participants completed a simulated inspection of a portable bladder model with a mean ± SD time for 153.1 ± 76.1 seconds. One participant failed to complete. Novice urologists (defined as those having completed less than 50 flexible cystoscopies in clinic) had a mean ± SD time of 176.9 ± 95.8 seconds, whereas with experts, this decreased to 139.3 ± 60.7 seconds. Dynamic trajectory maps identified “blind spots” within each user's cystoscopy performance. In a poststudy follow-up, 27 participants considered the tool valuable or extremely valuable for training, whereas 19 participants considered that the tool either very well or excellently replicated the clinical setting. All participants ranked the tool as very good or excellent for overall quality of training. Discussion Advances in electronic technology make portable low-cost models a potential low-cost alternative to endourology training platforms. In providing a quantifiable measure of user performance, the tool may shorten the learning curve in flexible cystoscopy and, potentially, reduce clinical errors and provide quantifiable measures for further clinical training.