1,721,012 research outputs found
Reply to Francesco Montorsi and Giorgio Gandaglia's Letter to the Editor re: Riccardo Autorino, Homayoun Zagar, Mirandolino B. Mariano, et al. Perioperative Outcomes of Robotic and Laparoscopic Simple Prostatectomy: A European'American Multi-institutional Analysis. Eur Urol 2015;68:86-94; Re: Matthew Bultitude, Ben Challacombe. Simple Prostatectomy: A Step Too Far for Laparoscopy? Eur Urol 2015;68:95-6. Eur Urol 2015;68:e7-8
No full textRobotic-assisted laparoscopic surgery: Recent advances in urology
No full textThe aim of the present review is to summarize recent developments in the field of urologic robotic surgery. A nonsystematic literature review was performed to retrieve publications related to robotic surgery in urology and evidence-based critical analysis was conducted by focusing on the literature of the past 5 years. The use of the da Vinci Surgical System, a robotic surgical system, has been implemented for the entire spectrum of extirpative and reconstructive laparoscopic kidney procedures. The robotic approach can be applied for a range of adrenal indications as well as for ureteral diseases, including benign and malignant conditions affecting the proximal, mid, and distal ureter. Current evidence suggests that robotic prostatectomy is associated with less blood loss compared with the open surgery. Besides prostate cancer, robotics has been used for simple prostatectomy in patients with symptomatic benign prostatic hyperplasia. Recent studies suggest that minimally invasive radical cystectomy provides encouraging oncologic outcomes mirroring those reported for open surgery. In recent years, the evolution of robotic surgery has enabled urologic surgeons to perform urinary diversions intracorporeally. Robotic vasectomy reversal and several other robotic andrological applications are being explored. In summary, robotic-assisted surgery is an emerging and safe technology for most urologic operations. The acceptance of robotic prostatectomy during the past decade has paved the way for urologists to explore the entire spectrum of extirpative and reconstructive urologic procedures. Cost remains a significant issue that could be solved by wider dissemination of the technology
Nephron-sparing surgery for tumors in a solitary kidney
No full textPurpose of review: Presence of a tumor in a solitary kidney is an absolute indication for performing nephron-sparing surgery (NSS). In the past two decades, new modalities for treatment of small renal mass have emerged but despite their evolution and promising results, partial nephrectomy remains the cornerstone of surgical treatment in this setting. Herein, we review the literature surrounding NSS in patients with a solitary kidney. Recent findings: Data from large retrospective, single and multi-institutional series indicate that open partial nephrectomy in patients with a solitary kidney can achieve oncological control as well as renal function preservation with acceptable complication profile. Available data indicate that employing parenchymal cooling can mitigate the deleterious effects of prolonged clamp time during partial nephrectomy. Introduction of laparoscopic and, more recently, robotic approach have allowed minimally invasive approach in selected patients undergoing partial nephrectomy. Large comparative studies comparing minimally invasive approaches to open technique are lacking. Summary: Established and emerging NSS techniques along with our better understating of the factors affecting function after surgery have fostered improvement of delivery of care in the setting of renal tumor(s) in a solitary kidney. Future developments should focus on minimizing the invasiveness of treatments while further improving cancer control and functional preservation. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Molecular markers of systemic therapy response in urothelial carcinoma
Full text linkIdentification of reliable molecular biomarkers that can complement clinical practice represents a fascinating challenge in any cancer field. Urothelial carcinoma is a very heterogeneous disease and responses to systemic therapies, and outcomes after radical cystectomy are difficult to predict. Advances in molecular biology such as next generation sequencing and whole genome or transcriptomic analysis provide promising platforms to achieve a full understanding of the biology behind the disease and can identify emerging predictive biomarkers. Moreover, the ability to categorize patients' risk of recurrence after curative treatment, or even predict benefit from a conventional or targeted therapies, represents a compelling challenge that may reshape both selection for tailored treatment and disease monitoring. Progress has been made but currently no molecular biomarkers are used in the clinical setting to predict response to systemic agents in either neoadjuvant or adjuvant settings highlighting a relevant unmet need. Here, we aim to present the emerging role of molecular biomarkers in predicting response to systemic agents in urothelial carcinoma
Reply to Konstantinos P. Economopoulos, Aliki Stamou, and Theodoros N. Sergentanis' Letter to the Editor re: Luis Felipe Brandao, Riccardo Autorino, Humberto Laydner, et al. Robotic Versus Laparoscopic Adrenalectomy: A Systematic Review and Meta-analysis. Eur Urol 2014; 65: 1154-61
No full textUniversidade Federal de São Paulo, Paulista Sch Med, Dept Urol, São Paulo, BrazilCleveland Clin, Glickman Urol & Kidney Inst, Cleveland, OH 44106 USAUniv Hosp, Inst Urol, Cleveland, OH 44106 USAUniversidade Federal de São Paulo, Paulista Sch Med, Dept Urol, São Paulo, BrazilWeb of Scienc
Incidence and Risk Factors for 30-Day Readmission in Patients Undergoing Nephrectomy Procedures: A Contemporary Analysis of 5276 Cases from the National Surgical Quality Improvement Program Database
No full textObjective To explore factors associated with readmission after nephrectomy procedures using a large national database. Materials and Methods A national surgical outcomes database, the American College of Surgeon-National Surgical Quality Improvement Program registry, was queried for data on all patients undergoing open partial nephrectomy (OPN), minimally invasive (laparoscopic + robotic) partial nephrectomy (MIPN), and minimally invasive radical nephrectomy (MIRN) in 2011 and 2012. Patients undergoing these procedures were identified using the Current Procedural Terminology codes. The primary outcome was unplanned 30-day hospital readmission. A multivariate logistic regression model was constructed to assess for factors independently associated with the primary outcome. Results Overall, 5276 cases were identified and included in the analysis: 1411 OPN (26.7%), 2210 MIPN (41.8%), and 1655 MIRN (31.3%). Overall, the 30-day readmission rate was 5.9% (7.8% for OPN, 4.5% for MIPN, and 6.1% for MIRN). On multivariate analysis, the odds for 30-day readmission for MIPN was approximately 70% that of OPN (P =.012). The odds for 30-day readmission for 2012 was about 80% of that of 2011 (P <.001). History of steroid use and of bleeding disorder and occurrence of postoperative transfusion increase the odds of readmission by approximately 2 (P =.005, P =.038, and P <.001, respectively). A postoperative urinary infection increased the odds of readmission by 5.5 (P <.001). Conclusion Contemporary 30-day readmission rates after nephrectomy procedures are influenced by specific patients' characteristics as well as postoperative adverse events. Moreover, contemporary MIPN seems to carry lower odds of readmission than OPN. It remains to be determined to what extent these findings are influenced by the expanding role of robotic technology
Partial Nephrectomy Versus Radical Nephrectomy for Clinical T1b and T2 Renal Tumors: A Systematic Review and Meta-analysis of Comparative Studies
No full textBackground Partial nephrectomy (PN) is the reference standard of management for a cT1a renal mass. However, its role in the management of larger tumors (cT1b and cT2) is still under scrutiny. Objective To conduct a meta-analysis assessing functional, oncologic, and perioperative outcomes of PN and radical nephrectomy (RN) in the specific case of larger renal tumors (â¥cT1b). The primary endpoint was an overall analysis of cT1b and cT2 masses. The secondary endpoint was a sensitivity analysis for cT2 only. Evidence acquisition A systematic literature review was performed up to December 2015 using multiple search engines to identify eligible comparative studies. A formal meta-analysis was performed for studies comparing PN to RN for both cT1b and cT2 tumors. In addition, a sensitivity analysis including the subgroup of studies comparing PN to RN for cT2 only was conducted. Pooled estimates were calculated using a fixed-effects model if no significant heterogeneity was identified; alternatively, a random-effects model was used when significant heterogeneity was detected. For continuous outcomes, the weighted mean difference (WMD) was used as summary measure. For binary variables, the odds ratio (OR) or risk ratio (RR) was calculated with 95% confidence interval (CI). Statistical analyses were performed using Review Manager 5 (Cochrane Collaboration, Oxford, UK). Evidence synthesis Overall, 21 case-control studies including 11 204 patients (RN 8620; PN 2584) were deemed eligible and included in the analysis. Patients undergoing PN were younger (WMD â2.3 yr; p 7 cm). In this subset of patients, the estimated blood loss was higher for PN (WMD 107.6 ml; p < 0.001), as was the likelihood of complications (RR 2.0; p < 0.001). Both the recurrence rate (RR 0.61; p = 0.004) and cancer-specific mortality (RR 0.65; p = 0.03) were lower for PN. Conclusions PN is a viable treatment option for larger renal tumors, as it offers acceptable surgical morbidity, equivalent cancer control, and better preservation of renal function, with potential for better long-term survival. For T2 tumors, PN use should be more selective, and specific patient and tumor factors should be considered. Further investigation, ideally in a prospective randomized fashion, is warranted to better define the role of PN in this challenging clinical scenario. Patient summary We performed a cumulative analysis of the literature to determine the best treatment option in cases of localized kidney tumor of higher clinical stage (T1b and T2, as based on preoperative imaging). Our findings suggest that removing only the tumor and saving the kidney might be an effective treatment modality in terms of cancer control, with the advantage of preserving the kidney function. However, a higher risk of perioperative complications should be taken into account when facing larger tumors (clinical stage T2) with kidney-sparing surgery
Positive surgical margin in robot-Assisted radical prostatectomy: Correlation with pathology findings and risk of biochemical recurrence
No full textBACKGROUND: To analyze the correlation of surgical margin status with other findings on final pathology and risk of biochemical recurrence (BCR) in patients undergoing robot-Assisted radical prostatectomy (RALP). METHODS: Bundang Prostatectomy Database was reviewed to identify patients who underwent RARP from 2007 to 2011 and had a positive surgical margin (PSM) on final pathology. Pathology findings were reviewed. BCR-free survival was calculated using the Kaplan-Meier method. Cox univariable and multi-variable regression models were used to find the correlation between clinicopathologic factors and BCR. RESULTS: Eight hundred and fifteen patients were included in the analysis: 118 (14.48%) had apical positive margin, 152 (18.65%) had a positive margin in another site, and 545 (66.87%) had negative surgical margins. In patients with only apical PSM, stratified by clinical stage, Kaplan-Meier analysis demonstrated significant difference in BCR-free survival between the groups (log rank P<0.001). Multivariable Cox proportional hazards model showed maximal percentage of positive core is the strongest predictor of BCR (HR=3.131, P<0.001). Multivariable Cox proportional hazards model showed PSM is one of the powerful predictor of postoperative BCR (HR=3.123, P<0.001). CONCLUSIONS: PSM after RALP is one of the powerful predictor of BCR and apical PSM is relatively less powerful predictor of BCR. Maximal percentage of positive core is the most powerful preoperative predictors of BCR. Clinical stage and biopsy Gleason score are also associated with pathologic outcomes and BCR free survival rates in patients with positive apical margin only
Urinary continence after robot-assisted laparoscopic radical prostatectomy: The impact of intravesical prostatic protrusion
No full textPurpose: To assess the impact of intravesical prostatic protrusion (IPP) on the outcomes of robot-assisted laparoscopic prostatectomy (RALP). Materials and Methods: The medical records of 1094 men who underwent RALP from January 2007 to March 2013 were analyzed using our database to identify 641 additional men without IPP (non-IPP group). We excluded 259 patients who presented insufficient data and 14 patients who did not have an MRI image. We compared the following parameters: preoperative transrectal ultrasound, prostate specific antigen (PSA), clinicopathologic characteristics, intraoperative characteristics, postoperative oncologic characteristics, minor and major postoperative complications, and continence until postoperative 1 year. IPP grade was stratified by grade into three groups: Grade 1 (IPPâ¤5 mm), Grade 2 (5 mm10 mm). Results: Of the 821 patients who underwent RALP, 557 (67.8%) experienced continence at postoperative 3 months, 681 (82.9%) at 6 months, and 757 (92.2%) at 12 months. According to IPP grade, there were significant differences in recovering full continence at postoperative 3 months, 6 months, and 12 months (p<0.001). On multivariate analysis, IPP was the most powerful predictor of postoperative continence in patients who underwent RALP (p<0.001). Using a generalized estimating equation model, IPP also was shown to be the most powerful independent variable for postoperative continence in patients who underwent RALP (p<0.001). Conclusion: Patients with low-grade IPP have significantly higher chances of recovering full continence. Therefore, the known IPP grade will be helpful during consultations with patients before RALP
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