Incisional Hernia in a 12-mm Nonbladed Trocar Site Following Laparoscopic Nephrectomy

Non-bladed trocars and radially dilating systems are considered less traumatic to the abdominal wall because they do not incise the fascia itself. Since the fascia is not cut, it has believed that the fascia closes by itself. Consequently, several authors have suggested that closure of the abdominal fascia may be unnecessary when such non-bladed laparoscopic trocars are used. We report of a case in which a port site hernia was diagnosed at the site of a 12 mm non-bladed trocar 11 days after laparoscopic nephrectomy. Although it may be true that in many cases port site closure is unnecessary and does not result in bowel herniation, this case along with a prior report serve as important reminders that port site hernias are possible even in the use of non-bladed or radial dilating systems, and that there exists a number of potential variables that may predispose to herniation and consequently the ability to predict such events in individual patients remains uncertain. As such, we recommend closing 10 mm or larger port sites irrespective of trocar design

Health Behavior Changes in White and African American Prostate Cancer Survivors

Prostate cancer prognosis may be improved by healthy behaviors; however, little is known regarding whether prostate cancer survivors make health behavior changes post-diagnosis, and there is no data on racial/ethnic differences. This study explored patterns of, and factors that influence healthy behavior changes in diet, physical activity, and dietary supplement use among whites and African Americans (n=30), 45–70 years, ≅1 year after diagnosis with localized prostate cancer. Data were collected by telephone using semi-structured qualitative interviews. The mean participant age was 59.6 years, 77% had attended college, 87% were married, and 22% were retired. The majority (58%) had improved their diet since diagnosis, defined as eating more fruits/vegetables and less fat. Although 77% reported regular use of at least one dietary supplement before diagnosis, several discontinued use post-diagnosis. Sixty-seven percent exercised regularly before diagnosis and most of these (75%) continued post-diagnosis; however, time and health constraints were barriers. Physician recommendation and family support strongly influenced positive changes. Except for more post-diagnosis dietary improvements in African Americans, there were few racial differences in patterns/motives for behavior changes. Most respondents were motivated to maintain and/or adopt healthy behavioral changes post-diagnosis. Nurses/physicians are encouraged to inform their prostate cancer patients about the benefits of healthy eating and regular exercise and the absence of scientific evidence regarding the benefits/risks of most supplements, particularly herbal formulations

Enhanced Recovery after Urological Surgery: A Contemporary Systematic Review of Outcomes, Key Elements, and Research Needs

Enhanced Recovery after Surgery (ERAS) programs are multimodal care pathways that aim to decrease intra-operative blood loss, decrease postoperative complications, and reduce recovery times

Gender Differences in Compensation, Job Satisfaction and Other Practice Patterns in Urology

The proportion of women in urology has increased from <0.5% in 1981 to 10% today. Furthermore, 33% of students matching in urology are now female. This analysis sought to characterize the female workforce in urology in comparison to men with regard to income, workload, and job satisfaction

Prevention and management of complications following robot-assisted radical cystectomy: lessons learned after >250 consecutive cases

An increasing number of case series of robot-assisted radical cystectomy describe complication rates comparable to open series. Conflicting reports describe various pre-operative factors as predictors of post-operative complications. Furthermore, learning curves complicate these predictors and should also be taken into account. Despite these variables, there are a number of considerations, including patient selection, peri-operative care pathway, intra-operative technique and equipment choice that we have found to decrease post-operative complications and improve patient outcomes. In this topic paper, we briefly review the literature surrounding complication rates following robot-assisted radical cystectomy as well as describe our experience after >250 cases, outlining our suggestions for avoidance of surgical complications when building a practice that incorporates this technique

Meta-analysis of Clear Cell Renal Cell Carcinoma Gene Expression Defines a Variant Subgroup and Identifies Gender Influences on Tumor Biology

Clear cell renal cell carcinoma (ccRCC) displays molecular and histologic heterogeneity. Previously described subsets of this disease, ccA and ccB, were defined based on multigene expression profiles, but it is unclear whether these subgroupings reflect the full spectrum of disease or how these molecular subtypes relate to histologic descriptions or gender

Nutritional predictors of complications following radical cystectomy

To determine the impact of preoperative nutritional status on the development of surgical complications following cystectomy using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP)

Trends in Stage-Specific Incidence Rates for Urothelial Carcinoma of the Bladder in the United States: 1988 to 2006

Bladder cancer is notable for a striking heterogeneity of disease-specific risks. Among the approximately 75% of incident cases found to be superficial to the muscularis propria at the time of presentation (non-muscle-invasive bladder cancer), the risk of progression to the lethal phenotype of muscle-invasive disease is strongly associated with stage and grade of disease. Given the suggestion of an increasing percentage of low-risk cases in hospital-based registry data in recent years, the authors hypothesized that population-based data may reveal changes in the stage distribution of early-stage cases

Resident involvement and experience do not affect perioperative complications following robotic prostatectomy

Most urologic training programs use robotic prostatectomy (RP) as an introduction to teach residents appropriate robotic technique. However, concerns may exist regarding differences in RP outcomes with resident involvement. Our objective was therefore to evaluate whether resident involvement affects complications, operative time, or length of stay following RP