Intracorporeal Urinary Diversion of Robot-Assisted Radical Cystectomy

With the widespread utilization of robot-assisted radical cystectomy (RARC) that demonstrated non-inferiority compared to open radical cystectomy in terms of several outcomes, urinary diversions are now performed for both extracorporeal and intracorporeal procedures. The potential benefits of intracorporeal urinary diversion (ICUD) include smaller incisions, reduced pain, reduced intraoperative blood loss, reduced bowel handling and exposure, and third space loss. ICUD following radical cystectomy requires many steps and a careful stepwise progression. Surgical volumes (RARCs per year) per center and per surgeon appear to be correlated with a reduction in complications. The European Association of Urology guidelines recommend that hospitals should perform at least 10, and preferably more than 20 operations annually. With the aim of generalizing ICUD, this chapter will discuss the following items: (1) Technique of intracorporeal ileal conduit; (2) Perioperative comparison of intracorporeal and extracorporeal urinary diversion in RARC; (3) Hybrid technique in robot-assisted intracorporeal ileal conduit; and (4) Intracorporeal ileal neobladder

Value of Flemish Version of the Triage Risk Screening Tool in Predicting Unfavorable Outcomes after Elective Cancer Surgery: A Propensity Score-Matched Retrospective Cohort Study

Introduction: The Flemish version of the Triage Risk Screening Tool (fTRST), derived from the Triage Risk Screening Tool for assessing risk of readmission to the emergency department, is increasingly used as a simple screening tool in oncology. This study aimed to evaluate the utility of the fTRST in the context of elective surgical treatment for urologic cancer patients. Methods: We included 886 patients who underwent major urologic cancer surgery at our institution between 2020 and 2022 and underwent preoperative screening, including fTRST. We set the fTRST cutoff at 2 and used propensity score matching and multivariate regression analysis to assess how fTRST affected two postoperative outcomes: ambulation failure and delirium. Results: Of the 886 patients, 693 (78%) had an fTRST score <2, and 193 (22%) had an fTRST score ≥2 (high likelihood of frailty). After matching the groups by propensity scores, we compared the outcomes of 131 patients in each group. We found that the group with fTRST ≥2 had significantly higher rates of ambulation failure (15 vs. 11%, p = 0.03) and delirium (16 vs. 11%, p = 0.008) than the group with fTRST <2. Multivariate logistic regression analysis showed that fTRST score ≥2 was an independent risk factor for postoperative ambulation failure (odds ratio [OR] = 4.05, p = 0.02), along with age ≥75 years (OR = 6.62, p = 0.02), preoperative benzodiazepine medications (OR = 5.12, p = 0.01), and receiving radical cystectomy (OR = 9.30, p = 0.02). Similarly, for delirium, fTRST score ≥2 was an independent risk factor (OR = 2.88, p = 0.03), along with preoperative benzodiazepine medications (OR = 4.38, p = 0.002). Conclusion: The fTRST might be a screening tool with great potential for identifying patients at high risk for unfavorable postoperative outcomes in elective urologic cancer surgery

A wide spectrum of clinical and brain MRI findings in patients with SLC19A3 mutations

<p>Abstract</p> <p>Background</p> <p>SLC19A3 (solute carrier family 19, member 3) is a thiamin transporter with 12 transmembrane domains. Homozygous or compound heterozygous mutations in <it>SLC19A3 </it>cause two distinct clinical phenotypes, biotin-responsive basal ganglia disease and Wernicke's-like encephalopathy. Biotin and/or thiamin are effective therapies for both diseases.</p> <p>Methods</p> <p>We conducted on the detailed clinical, brain MRI and molecular genetic analysis of four Japanese patients in a Japanese pedigree who presented with epileptic spasms in early infancy, severe psychomotor retardation, and characteristic brain MRI findings of progressive brain atrophy and bilateral thalami and basal ganglia lesions.</p> <p>Results</p> <p>Genome-wide linkage analysis revealed a disease locus at chromosome 2q35-37, which enabled identification of the causative mutation in the gene <it>SLC19A3</it>. A pathogenic homozygous mutation (c.958G > C, [p.E320Q]) in <it>SLC19A3 </it>was identified in all four patients and their parents were heterozygous for the mutation. Administration of a high dose of biotin for one year improved neither the neurological symptoms nor the brain MRI findings in one patient.</p> <p>Conclusion</p> <p>Our cases broaden the phenotypic spectrum of disorders associated with <it>SLC19A3 </it>mutations and highlight the potential benefit of biotin and/or thiamin treatments and the need to assess the clinical efficacy of these treatments.</p

Simultaneous robot‐assisted laparoscopic radical prostatectomy and inguinal hernia repair using a polypropylene mesh: Report of two cases

Introduction We report two cases where robotic‐assisted laparoscopic radical prostatectomy and inguinal hernia repair were performed simultaneously. Case presentation In case one, hernia repair was performed by implantation of 3D Max™ mesh and closure of the peritoneum. Total console time was 156 min, of which hernia repair took 21 min. In case two, hernia repair was performed using Ventralight™ ST mesh. Total console time was 181 min, of which hernia repair took 23 min. Pelvic lymph node dissection was performed in case two but not in case one. Both patients were discharged 7 days postoperatively without severe complications or mesh infection. Conclusion It may be possible to perform robotic‐assisted laparoscopic radical prostatectomy and inguinal hernia repair simultaneously

Control of bleeding from a recurrent tumor at a uretero‐ileal anastomosis by electrocoagulation via an ileal conduit

Introduction Bladder cancer is characterized by spatial and temporal recurrence in the urinary tract. We describe a case of recurrence at a uretero‐ileal anastomosis after radical cystectomy and nephroureterectomy. It was difficult to control bleeding from the tumor, but hemostasis was achieved. Case presentation A 73‐year‐old man with a history of radical cystectomy and reconstruction of the ileal conduit and right nephroureterectomy was diagnosed with recurrence at the uretero‐ileal anastomosis site. Bleeding from the tumor could not be controlled by flexible gastrointestinal endoscopy. The patient underwent coagulation via an ileal conduit approach using a rigid scope and bipolar electrocautery, which is usually a modality for transurethral resection. Conclusion This is the first report in which a modality normally used for transurethral resection was used to control bleeding in a patient with an ileal conduit. This application is useful in cases open surgery or additional irradiation might be difficult

Sarcopenia as a Prognostic Biomarker of Advanced Urothelial Carcinoma

<div><p>Objectives</p><p>Sarcopenia, a novel concept reflecting the degenerative loss of skeletal muscle mass, is an objective indicator of cancer cachexia. We investigated its role as a prognostic biomarker in advanced urothelial carcinoma (UC) patients.</p><p>Methods</p><p>This retrospective study consisted of 88 UC patients with cT4 and/or metastases to lymph nodes/distant organs. Skeletal muscle index (SMI), an indicator of whole-body muscle mass, was measured from computed tomography (CT) images at the diagnosis. Sarcopenia was defined as SMIs of <43 cm²/m² for males with body mass index (BMI) <25 cm²/m², <53 cm²/m² for males with BMI ≥25 cm²/m², and <41 cm²/m² for females. Predictors of overall survival (OS) were examined using Cox proportional hazard models.</p><p>Results</p><p>Sixty-seven patients (76%) died during the median follow-up of 13 months. The median OS rate was 13 months. Multivariate analysis revealed that SMI was a significant and independent predictor of shorter OS (hazard ratio (HR) 0.90, <i>P</i> <0.001). In the present cohort, 53 (60%) were diagnosed with sarcopenia. The median OS rates were 11 and 31 months for sarcopenic and non-sarcopenic patients, respectively (<i>P</i> <0.001). On multivariate analysis, sarcopenia was a significant and independent predictor of shorter OS (HR 3.36, <i>P</i> <0.001), along with higher C-reactive protein (CRP) (<i>P</i> = 0.001), upper urinary tract cancer (<i>P</i> = 0.007), higher lactate dehydrogenase (LDH) (<i>P</i> = 0.047), and higher alkaline phosphatase (ALP) (<i>P</i> = 0.048).</p><p>Conclusion</p><p>Sarcopenia, which is readily evaluated on routine CT scans, is a useful prognostic biomarker of advanced UC. Non-sarcopenic patients can expect long-term survival. Evaluating sarcopenia can be helpful for decision-making processes in the management of advanced UC patients.</p></div

A Case of Renal Pelvic Cancer Complicated by Horseshoe Kidney Treated with RoboSurgeon Gasless Single-Port Retroperitoneoscopic Nephroureterectomy

A 78-year-old man who had a horseshoe kidney (HSK) visited us because of gross hematuria and suspicious urine cytology. CT and MRI revealed a right renal pelvic tumor of 28 mm in diameter. He underwent gasless single-port retroperitoneoscopic nephroureterectomy with division of the isthmus via the right pararectal small incision using the RoboSurgeon system. Pathological diagnosis was invasive urothelial carcinoma, grade 3, pT3, pN0, LVI0, RM0. He was discharged from hospital on the 6th postoperative day without any perioperative complication. He has no evidence of disease clinically and radiologically 19 months after the operation. Only a few cases of upper tract urothelial carcinoma complicated by HSK treated with minimally invasive surgery have been reported in English literature. This is the first case successfully managed with RoboSurgeon gasless single-port retroperitoneoscopic nephroureterectomy