You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment (1)1 Apr 2013887 IS A DEDICATED OPERATIVE TEAM REALLY NECESSARY FOR ROBOTIC SURGERY? Trisha Fleet, Betty Skipper, and Satyan Shah Trisha FleetTrisha Fleet Albuquerque, NM More articles by this author , Betty SkipperBetty Skipper Albuquerque, NM More articles by this author , and Satyan ShahSatyan Shah Albuquerque, NM More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.458AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A consistent operative team is often cited as critical for robotic surgery. However, this is largely based on expert opinion. We determined how nursing and beside assistant experience affected surgical outcomes, at a center without a dedicated robotic team. METHODS Radical prostatectomies performed with robotic assistance (RALP) at a university teaching hospital from program inception to March 2012 were reviewed. For each case, we tabulated the number of prior RALPs each member of the operative team (circulating nurse, surgical tech, beside resident surgeon) had assisted with. Individuals were proficient after participating in 10 cases, and the overall team was proficient if at least 2 of the 3 individual assistants were proficient. Logistic regression models were used to assess the effect proficiency of individual team members and the overall team had on long operative time (top tertile or >266 minutes) and occurrence of positive surgical margins (PSMs). Odds ratios were adjusted for 9 possible confounders. RESULTS One surgeon performed 177 RALPs with 96 unique operative teams. The mean number of RALPs performed by each team was 1.8 (range 1-13), with 62 teams assisting with only 1 case (65%). On multivariate analysis, proficiency of the nurse (OR 0.43, 95% CI 0.21-0.87, p=0.02) and surgeon experience above 100 cases (OR 0.19, 95% CI 0.08-0.43, p<0.001) independently reduced the odds of long operative time. Individually, proficiency of the nurse, tech or resident did not significantly influence occurrence of PSMs, which were seen in 17 of 142 (11.9%) pT2 cases and 30 of 177 (16.9%) total RALPs. However, overall team proficiency independently reduced the odds of a PSM (OR 0.30, 95% CI 0.12-0.71, p=0.007). CONCLUSIONS A dedicated team isnÆt required to achieve favorable outcomes with robotic surgery. However, proficiency of nursing staff and assistants independently reduced positive margins and operative time. A dedicated team is therefore advisable because it may further improve outcomes. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e366 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Trisha Fleet Albuquerque, NM More articles by this author Betty Skipper Albuquerque, NM More articles by this author Satyan Shah Albuquerque, NM More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

BACKGROUND:We report on the natural history of lower urinary tract symptoms (LUTS) and urinary continence in patients with median lobe enlargement (MLE) after robotic radical prostatectomy (RP).METHODS:Patients treated with RP from October 2008 to March 2012 completed American Urological Association symptom index (AUAI) and continence assessments at the preoperative visit and each postoperative visit. Two cohorts were established based on the presence or absence of a median lobe intraoperatively.RESULTS:A total of 698 validated questionnaires were completed by 175 patients with a median of 4 AUAI scores per patient. The 36 patients (21%) with MLE required a longer time to achieve urinary continence (P = .05, log-rank test), although ultimately, no difference was seen in long-term continence probability between the two cohorts (P = .63). On multivariate analysis, the presence of a median lobe reduced the odds of early continence recovery (P = .02). By use of a generalized estimating equation, the cohort-average AUAI scores after RP are presented. Patients with MLE had faster improvement in LUTS after surgery, whereas those without MLE had temporary worsening in LUTS before improvement.CONCLUSION:Patients with MLE have a different natural history of LUTS and continence after RP as compared with patients without this finding. Therefore, radiographic or cystoscopic evaluation for the presence of a median lobe before RP may improve patient counseling about urinary outcomes.

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation, Renal Vascular Surgery (II)1 Apr 20132316 DOES THE USE OF URETERAL STENTS IN RENAL TRANSPLANT ALLOGRAFTS INCREASE THE RISK OF MULTI-DRUG RESISTANT URINARY TRACT INFECTIONS OR DECREASE LONG TERM FUNCTION OF THE ALLOGRAFT? Trisha Fleet, Hannah Kerr, Donald Wenner, Yitong Liu, Susan Paine, Antonia Harford, and Michael Davis Trisha FleetTrisha Fleet Albuquerque, NM More articles by this author , Hannah KerrHannah Kerr Albuquerque, NM More articles by this author , Donald WennerDonald Wenner Albuquerque, NM More articles by this author , Yitong LiuYitong Liu Albuquerque, NM More articles by this author , Susan PaineSusan Paine Albuquerque, NM More articles by this author , Antonia HarfordAntonia Harford Albuquerque, NM More articles by this author , and Michael DavisMichael Davis Albuquerque, NM More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2257AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Post renal transplant infectious complications are largely due to urinary tract infections (UTIs). We determined whether the use of a stent increased the risk of developing a multi-drug resistant urinary tract infection in renal transplant patients or affected long term function of the allograft. METHODS We retrospectively analyzed our transplant cases from 2006-2009 (N=172). We divided our cohort into stented or non-stented. We analyzed the cases for development of first post transplant UTI. We further analyzed these positive urine cultures for the presence of multidrug resistance. Of the patients that developed infections we looked at gender, race, ethnicity, preoperative GU anatomic anomalies, and postoperative complications and whether these variables had any significance in the development of postoperative multidrug resistant UTI. Stents were removed at 3 weeks posttransplant. Comparisons of variables between the two cohorts were evaluated using the SAS statistical software. T-test and Chi square were utilized to compare the 2 cohorts with p< 0.05 considered significant. RESULTS Our data analysis found that there was no significant difference in the development of a multidrug resistant UTI in stented versus non-stented patients. Factors having significance in posttransplant multidrug resistant UTI development were female gender (p=0.02) and postoperative complications (p=0.001). Patients with prior GU abnormalities had an increased incidence of postoperative UTI however this did not reach statistical significance. There was no significant difference by race or age. The graft function was the same whether patients had a stent or no stent. CONCLUSIONS Our data shows that the risk of development of a multidrug resistant UTI was not increased by the use of a stent at the time of transplant. The risk of multidrug resistant UTI is increased if the patient is female, has had prior GU anomalies, or had postoperative complications. Stented (n= 117) Non-stented (n= 55) p value UTI (n= 94) 63 (53.8%) 31 (56.4%) 0.66 MDRO UTI (n= 63) 40 (63.5%) 23 (41.8%) 0.56 3 Month eGFR Mean (+/−SD) 64.8 (21.9) 65.1 (17.0) 0.93 12 Month eGFR Mean (+/−SD) 65.9 (20.8) 64.2 (21.7) 0.63 24 Month eGFR Mean (+/−SD) 64.4 (21.3) 65.8 (26.0) 0.73 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e950 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Trisha Fleet Albuquerque, NM More articles by this author Hannah Kerr Albuquerque, NM More articles by this author Donald Wenner Albuquerque, NM More articles by this author Yitong Liu Albuquerque, NM More articles by this author Susan Paine Albuquerque, NM More articles by this author Antonia Harford Albuquerque, NM More articles by this author Michael Davis Albuquerque, NM More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyMale Voiding Dysfunction and Infection1 Apr 2013V410 TIPS FOR PRESERVING PUDENDAL NERVE INNERVATION TO THE MALE URINARY SPHINCTER DURING PELVIC SURGERY Satyan Shah, Trisha Fleet, Maxx Gallegos, and Betty Skipper Satyan ShahSatyan Shah Albuquerque, NM More articles by this author , Trisha FleetTrisha Fleet Albuquerque, NM More articles by this author , Maxx GallegosMaxx Gallegos Albuquerque, NM More articles by this author , and Betty SkipperBetty Skipper Albuquerque, NM More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1799AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The urinary rhabdosphincter is innervated by branches of the pudendal nerve, but the anatomic course of these nerves is underappreciated. We provide tips on how to identify and preserve these “continence nerves” during pelvic surgery. METHODS Video clips from 7 robotic-assisted radical prostatectomies show keys to successful preservation of pudendal nerve branches to the urinary sphincter: 1) close inspection of the lateral surface of the prostate after opening the endopelvic fascia 2) nerve mobilization outside the layers of periprostatic fascia, prior to potency-nerve sparing 3) identification of associated “worm-like” vasculature and 4) contralateral traction on the lateral surface of the prostate. Because the continence nerves are lateral to the cavernous nerves, a potency-nerve sparing procedure will often result in preservation these “continence nerves”, without formal mobilization. However, the techniques demonstrated in this video are particularly important when the potency nerves are to be widely excised. RESULTS Prospective identification of the continence nerves began with case 87 of our robotic prostatectomy program. Of the 89 subsequent cases through March 2012, the continence nerve(s) were identified and preserved in 50 (56%). Kaplan-Meier analysis showed no difference in the time to recovery of continence, regardless of whether or not the continence nerve(s) had been identified (log rank test, p=0.90). CONCLUSIONS We demonstrate techniques to preserve pudendal nerve innervation responsible for urinary continence. Preservation of these branches may be particularly valuable when the potency nerves are to be widely excised. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e166 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Satyan Shah Albuquerque, NM More articles by this author Trisha Fleet Albuquerque, NM More articles by this author Maxx Gallegos Albuquerque, NM More articles by this author Betty Skipper Albuquerque, NM More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Journal of the American College of Surgeons 215(3):p S149, September 2012. | DOI: 10.1016/j.jamcollsurg.2012.06.384

You have accessJournal of UrologyUrothelial Cancer: Natural History & Pathophysiology/Marker1 Apr 2012393 TIME INTERVAL AFTER PROSTATE RADIOTHERAPY AFFECTS THE GRADE AND HISTOLOGY OF SUBSEQUENT BLADDER CANCER RESULTS OF A SEER STUDY Satyan Shah, Richard Hoffman, Trisha Fleet, Anthony Smith, and Charles Wiggins Satyan ShahSatyan Shah Albuquerque, NM More articles by this author , Richard HoffmanRichard Hoffman Albuquerque, NM More articles by this author , Trisha FleetTrisha Fleet Albuquerque, NM More articles by this author , Anthony SmithAnthony Smith Albuquerque, NM More articles by this author , and Charles WigginsCharles Wiggins Albuquerque, NM More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.457AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder cancer (BC) in the setting of prior prostate radiotherapy (XRT) is more often high grade. However, it is unclear whether the latency period following XRT influences pathologic features of subsequent BC. We used population-level data to determine the temporal association between XRT and occurrence of high-grade and variant histology BC. METHODS The SEER database was used to identify incident prostate cancer cases between 1990-2007 meeting the following criteria: 1) malignant behavior 2) age at diagnosis > 40 years 3) treatment with XRT as part of initial cancer-directed therapy 4) subsequent development of BC 1 or more years after diagnosis. Only cases histologically confirmed with active follow-up were considered. Cases were stratified into 3 groups, based on the time elapsed after XRT and before development of subsequent BC. Group 1 developed BC 1-4 years after XRT, Group 2 developed BC 5-9 years after XRT, and Group 3 developed BC 10 or more years after treatment. We compared the frequency of high-grade and variant histology BC in each group using chi-square analysis. Variant histology was defined as the following histological types: carcinosarcoma, small cell carcinoma, sarcomatoid, spindle cell carcinoma, or pseudosarcomatous transitional cell carcinoma. RESULTS A total of 1570 cases met the inclusion criteria with 761 in Group 1, 593 in Group 2, and 216 in Group 3. As more time elapsed after prostate XRT, subsequent BC was more frequently high grade (31.9% in Group 1 vs. 37.4% in Group 2 vs. 44.9% in Group 3, p=0.0001). Variant histology BC developed in only 15 of 1570 cases (0.9%). However, increasing time interval between prostate XRT and subsequent BC was also associated with increased frequency of variant histology (0.4% in Group 1 vs. 1.2% in Group 2 vs. 2.3% in Group 3, p=0.03). CONCLUSIONS Incident bladder cancers diagnosed following prostate radiotherapy were increasingly likely over time to be high grade and of variant histology. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e161 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Satyan Shah Albuquerque, NM More articles by this author Richard Hoffman Albuquerque, NM More articles by this author Trisha Fleet Albuquerque, NM More articles by this author Anthony Smith Albuquerque, NM More articles by this author Charles Wiggins Albuquerque, NM More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...