Contemporary urologic minilaparoscopy : indications, techniques, and surgical outcomes in a multi-institutional European cohort

OBJECTIVES: To provide an analytical overview of contemporary indications, techniques, and outcomes of urologic minilaparoscopy (ML) in multiple European centers. METHODS: Data of patients who had undergone a minilaparoscopic urologic procedure at nine European institutions between 2009 and 2012 were retrospectively gathered. Surgical procedures were classified as upper or lower urinary tract and as ablative or extirpative and reconstructive. The main surgical outcome parameters were analyzed and relevant operative data related to the surgical technique were recorded. RESULTS: Overall, 192 patients (mean age 45.25±17.8 years) were included in the analysis. Most of them were nonobese (mean body mass index [BMI] 24.7±3.6?kg/m(2)) at low estimated surgical risk (mean American Society of Anesthesiologists [ASA] 1.69±0.68). Indications for surgery were mostly nononcologic (132 cases, 68.8%). Most of the procedures were done in the upper urinary tract (133 cases, 69.2%) and were mostly with a reconstructive intent (109 cases, 56.7%). Overall operative time was 132.7±52.3 minutes with an estimated blood loss of 60.9±47.6?mL while the mean hospital stay was 5±2.1 days. Most of the postoperative complications were low Clavien grade (1 and 2), with only one (0.5%) grade 3 and one (0.5%) grade 4 complications recorded. CONCLUSIONS: A broad range of common procedures can be safely and effectively performed with ML techniques. By duplicating the principles of standard laparoscopy, but potentially offering less surgical scar and trauma, ML can be regarded as a viable option when looking for a virtually "scarless" surgery

Long-Term Outcomes of the Implant of a Periurethral Constrictor for Stress Urinary Incontinence Following Radical Prostatectomy

Objectives: to assess morbidity, effectiveness and quality of life (QoL) of implant of Silimed periurethral constrictor (PC) in a consecutive series of patients who had stress urinary incontinence following radical prostatectomy. Material and Methods: a prospective non-randomized study designed on patients who underwent implant of Silimed PC. Primary end point was postoperative morbidity and secondary end points were effectiveness of implant and QoL. We performed a sub-analysis of men who received previous radiation and we compared the subpopulation with radiation-na\uefve patients. Results: nineteen patients (31.6%) received pelvic radiation therapy prior implant. All procedures were completed successfully with median operative time of 55 min. We recorded 47 (78.3%) postoperative complications in 30 men. Twenty-three men (38.3%) developed urethral erosion at median follow-up of 27.5 months, and 1 man (1.9%) had rectourethral fistula at 2 months. Risk of urethral erosion increased significantly among patients who received radiation (63.1 vs. 26.8%; p < 0.001). In 12 cases (20%), we recorded malfunctioning of the reservoir requiring replacement. Conclusion: The implant of Silimed device is not safe due to a high risk of urethral erosion. Careful patient selection and detailed counseling are mandatory when considering the implant of PC in adult patients

Assessment of predictors of renal cell carcinoma progression after nephrectomy at short and intermediate term follow-up and implication on surveillance protocols

Prediction of risk of RCC progression after surgery is important for follow-up planning. We identified predictors of progression-free survival (PFS) and cancer-specific survival (CSS) in a large single institutional cohort and investigated patterns and sites of progression according to stage and grade

PD51-12 Comparison of mid-term oncological outcomes of active surveillance and percutaneous cryoablation of small renal masses

INTRODUCTION AND OBJECTIVES Partial nephrectomy (PN) is considered the standard approach for small renal masses (SRMs). Active surveillance (AS) and ablative therapies represent emerging strategies for older and comorbid patients due to the indolent behaviour of most SRMs and to the high competing risk mortality. Aim of this study was to compare the mid-term oncological outcomes of AS and percutaneous cryoablation (PCA) of small renal masses (SRMs). METHODS Data regarding PCA and AS in patients with a single T1a renal tumors were collected prospectively at two large academic centers. 60 patients underwent PCA and 77 were enrolled in a AS protocol. The minimum follow-up period was 6 months. The most frequent indications for AS were severe comorbidities (48,1%), <15 mm renal masses (23,4%) and advanced age (15,6%). All patients in AS were followed with a standardized protocol including serial imaging (US, CT or MRI) every 6 months during the first 3 years and yearly thereafter. Tumor progression was defined as the reach of a 4 cm threshold in maximum diameter or a tumor volume doubling time <12 months. All PCA procedures were performed with a percutaneous approach. A double freeze-thaw cycle was performed using a mean of 2 sealed argon 17G cryoprobes per patient. Tumor progression after PCA was defined as a new nodular enhancement in the ablation zone or the enlargement of the ablated tumor 3 months after the treatment. RESULTS 14 masses showed dimensional progression during AS and 9 were surgically removed after a median follow-up of 30 months. 3 patients in the PCA group experienced progression and underwent a repeat ablation with a median follow-up of 24 months. Progression free survival (PFS) at 2 years was 94,8% and 95,0% for AS and PCA group, respectively. None of the patients progressed to metastatic disease. Overall survival at 2 years was 93,5% and 95,0% in the AS and PCA group, respectively. In the PCA group the complication rate was 5% (Clavien grade 1-2). CONCLUSIONS There are no good quality studies comparing the oncological outcomes of AS and PCA. Comparing AS to an active treatment is not an easy task due to the different definitions of the oncological endpoints such as PFS. With these limitations this study shows that both AS and PCA represent viable and safe treatment options for elderly and comorbid patients with SRMs