Use of Fluoroscopy and Potential Long-Term Radiation Effects on Cataract Formation

INTRODUCTION: The lens of the eye is extremely susceptible to radiation and long-term exposure can induce cataract formation. Our objective was to explore the risk of cataract formation for urologists at our institution. METHODS: A retrospective review of a multisurgeon database of fluoroscopic cases between October 2013 to December 2014 was queried. Procedures were performed by different subspecialties and ranged from stent insertion/ureteroscopy to percutaneous nephrolithotomy. Fluoroscopic parameters were recorded from all cases and the radiation dosimetry was calculated through methods described by the National Council on Radiation Protection. The data were extrapolated to determine the risk of cataract formation. The technical specifications of the GE OEC 990 mobile C-arm unit were used for calculations. RESULTS: A total of 780 cases were analyzed, of which 182 were endourology cases. Average fluoroscopic time was 34.86 seconds per case. Average tube potential and current were 86.84 kV and 1.95 mA, respectively. Pediatric urologists utilized fluoroscopy the least, 11.84 seconds per case (p = 0.0022). Endourology trained faculty had fluoroscopy exposure of 68.35 seconds per case (p < 0.0001), whereas others were exposed 26.24 seconds per case (p < 0.0001). For the highest exposed urologist, the estimated dose to the eyes was 5.64 μGy per case. Total estimated cumulative dose over the study timeframe was 997.58 μGy, or 748.19 μGy per year. CONCLUSIONS: The defined threshold in the absorbed dose for cataract formation is 0.5 Gy. Resident exposure was the highest, at 11% of the annual limit, and the most exposed urologists had an estimated dose of 5% of the annual limit. At current exposure levels, it would not be feasible to reach the stated safety limit during 50 to 60 years of practice. However, changing exposure guidelines could result in stricter safety limits

Open versus robotic cystectomy: Comparison of outcomes

Open radical cystectomy (ORC) is the current gold standard treatment for muscle invasive bladder cancer. As surgeons become more proficient in minimally invasive and robotic surgical techniques, the number of patients undergoing robotic-assisted radical cystectomy (RARC) is increasing. Although minimally invasive methods are on the rise, research that critically compares open surgery with robotic methods is limited. In this review, we surveyed and appraised the current literature comparing ORC and RARC with regards to perioperative, functional, and oncologic outcomes in order to distinguish the benefits and disadvantages of each method. Here we report that RARC is associated with several perioperative advantages over ORC such as lower estimated blood loss and transfusion rate, and possibly faster gastrointestinal recovery, lower narcotic requirement, and shorter length of stay. ORC is less costly and permits less time in the operating room. Recent data suggests that there is no difference between ORC and RARC when comparing urinary continence and postoperative quality of life. Moreover, ORC and RARC are both associated with similar rates of obtaining positive surgical margins, lymph node yield, and recurrence. However, RARC patients had an increased likelihood of having distant metastases to extrapelvic lymph nodes and the peritoneum. At this point, it is unclear if ORC or RARC has superior patient outcomes, and more research is needed to ascertain management-altering conclusions

Dedicated robotics team reduces pre-surgical preparation time

Context: Robot-Assisted Laparoscopic Radical Prostatectomy (RALRP) requires significant preoperative setup time for the room, staff, and surgical platform. The utilization of a dedicated robotics operating room (OR) staff may facilitate efficiency and decrease costs. Aims: We sought to determine the degree to which preoperative time decreased as experience was gained. Materials and Methods: A total of 476 patients with a mean age of 60.2 years were evaluated (11/2006 to 1/2010). Data was assimilated through an institutional review board approved blinded, prospective database. Utilizing time from patient arrival in the OR to robot docking as preoperative preparation, our experience was evaluated. Age, body mass index (BMI), and American Society of Anesthesiologists risk scores (ASA) were compared. Statistical Analysis Used: Analysis of variance; Two-sample t-test for unequal variances. Results: The first and last 100 cases were found to have similar age (P=0.27), BMI (P=0.11), and ASA (P=0.09). The average preoperative times were 66. 4 and 53.4 min, respectively (P<0.05). The second 100 patients treated were found to have a significantly shorter preoperative time when compared to the first 100 patients (P<0.05). When the first 100 cases were divided into cohorts of 10 cases the mean preoperative time for the first through fourth cohorts were 80.5, 69.3, 78.8, and 64.7 min, respectively. After treatment of our first 30 patients we found a significant drop in preoperative time. This persisted throughout the remainder of our experience. Conclusions: From the time of patient arrival a number of tasks are accomplished by the non-physician operating room staff during RALRP. The use of a consistent staff can decrease preoperative setup times and, therefore, the overall length of surgery

Abrogation of survival disparity between Black and White individuals after the USPSTF′s 2012 prostate‐specific antigen–based prostate cancer screening recommendation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163646/2/cncr33179.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163646/1/cncr33179_am.pd

Performing all major surgical procedures robotically will prolong wait times for surgery

This article aimed to assess the burden of scheduling major urologic oncology procedures if all cases were performed robotically and to determine whether this would increase the time a patient would have to wait for surgery. We retrospectively determined the number of prostatectomies, radical nephrectomies, partial nephrectomies, and cystectomies at a single institution for one calendar year. A hypothetical situation was then constructed where all procedures were performed robotically. Using the allotted number of days that each surgeon was able to schedule robotic procedures, we analyzed the amount of time it would take to schedule and complete all cases. Five fellowship-trained surgeons were included in the study and accounted for 317 surgical cases. Three of the surgeons had dedicated robotic surgery (RS) time (block time), while two surgeons scheduled when there was non-dedicated RS time (open time) available. If all cases were performed robotically an additional 32 days would be needed, which could significantly increase the wait time to surgery. The limited number of robotic systems available in most hospitals creates a bottleneck effect; whereby increasing the number of cases would considerably lengthen the waiting time patients have for surgery. As RS becomes increasingly more commonplace in urology and other surgical fields, this could create a significant problem for health care systems

Disparities in the Use of Continent Urinary Diversions after Radical Cystectomy for Bladder Cancer

BACKGROUND: Radical cystectomy (RC) with ileal conduit (IC) or continent diversion (CD) is standard treatment for high-risk non-invasive and muscle-invasive bladder cancer. OBJECTIVE: Our aim is to study contemporary trends in the utilization of ICs and CDs in patients undergoing RC. METHODS: Using the National Inpatient Sample 2001-2012, we identified all patients diagnosed with a malignant bladder neoplasm who underwent RC followed by IC or CD. Patient demographics, comorbidities, length of stay (LOS), and in-hospital complications, mortality, and costs were compared. Multivariable logistic regression analysis, Chi square, and t-tests were used for analysis. RESULTS: Between 2001-2012, approximately 69,049 ICs and 6,991 CDs were performed. CDs increased from 2001 to 2008, but declined after 2008 (p < 0.0001). Patients of all ages received ICs at a higher rate than CDs (40-59 years: 79.5% vs. 20.5%; 60-69 years: 88.0% vs. 12.0%; p < 0.0001). There was a difference in males vs. females (10.2% vs. 4.0%; OR 2.36) and Caucasians vs. African Americans (9.0% vs. 6.7%; OR 1.49) when comparing CD rates. CD rates were highest in the West, urban teaching centers, and large hospitals (p < 0.001). ICs were associated with higher rates of overall postoperative complications (p = 0.0185) including infection (p = 0.002) and mortality (p < 0.0001). In-hospital costs were greater for the CD group. CONCLUSIONS: The number of CDs has declined recently. Patients of all ages are more likely to receive ICs than CDs. Gender, racial, and geographic disparities exist among those receiving CDs. CDs are associated with lower rates of in-hospital complications and mortality, but higher in-hospital costs