Late complications of robot-assisted radical cystectomy with totally intracorporeal urinary diversion

Introduction and objectives: To evaluate late complications in a large cohort of patients undergoing robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD). Materials and methods: We prospectively enrolled patients who underwent RARC and ICUD between August 2012 and June 2019. We excluded patients with Ejection fraction < 36%, retinal vasculopathy, ventriculoperitoneal shunts, and those treated without curative intent. All complications and their onset date have been recorded, defined, and graded according to Clavien classification adapted for radical cystectomy. Results: 210 patients were included, 76% of whom were men, with a mean age of 62 years. Urinary diversions used were Padua Ileal Bladder (PIB) in 80% of cases, and ileal conduit (IC) in 20% of patients (generally older and with more comorbidity). The mean follow-up was 30 ± 22 months. The stenosis rate of uretero-ileal anastomosis was 14%, while a reduction in eGFR (≥ 20%) was observed in about half of the cases. UTIs occurred in 37% of the patients, especially in the first 12 months. Only 2% of patients had bowel occlusion, whereas incisional hernia, lymphocele, and systemic events (metabolic acidosis and major cardiovascular events) occurred respectively in 20%, 10%, and 1% of cases. Conclusions: Our study evaluates first late complications in a cohort of patients who underwent RARC with ICUD. These data are encouraging and in line with findings from a historical series of open radical cystectomy (ORC). This study is a further step in supporting RARC as a safe and effective surgical option for the treatment of muscle-invasive bladder cancer (MIBC) in tertiary referral centers

Higher testosterone serum levels are associated with a higher childbirth in patients treated for testicular cancer

Aim of our study was to assess fertility of patients treated with orchifunicolectomy for testicular cancer. A retrospective analysis of patients undergoing orchifunicolectomy for testicular cancer was conducted in three centers from 2000 to 2019. Demographic, clinical and histological characteristics of the patients were recorded. Adjuvant treatments were recorded. Number of pregnancies, number of children, cryopreservation, in vitro fertilization were recorded as well as postoperative testosterone serum level. Risk factors for pregnancy were evaluated. Univariate and multivariate analysis were performed to evaluate factors influencing pregnancy rates

Effect of vacation on urinary symptoms in healthcare workers. An Italian multicenter study

Aim of our study was to assess the impact of vacation on urinary symptoms in health care workers. Between March 2018 to October 2019 a survey was carried out by enrolling health care system workers in three centers. Demographic and clinical characteristics of health care workers (i.e. age, smoking status, medical history) were collected. Urinary symptoms work related quality of life and health were assessed before and after two weeks’ vacation with validated questionnaires: Overactive Bladder Questionnaire Short Form (OABqsf), nocturia episodes,Work-relatedQuality of Life (WRQOL) and SF-36 questionnaires. As well, NS workers (NSWs), defined as working at least one time aweek from 8 pmto 8 am,were compared to traditional workers (TWs). Wilcoxon rank test was performed to test significant differences before and after vacation. Mann Whitney test was performed to assess differences between NSWs and TWs

Head to Head Impact of Margin, Ischemia, Complications, Score Versus a Novel Trifecta Score on Oncologic and Functional Outcomes After Robotic-assisted Partial Nephrectomy: Results of a Multicenter Series

BACKGROUND: There is a paucity of data describing the ability of margin, ischemia, complications, score (MIC) and trifecta in predicting long-term outcomes of robotic-assisted partial nephrectomy (RAPN).OBJECTIVE: To compare a novel trifecta (negative margins, no significant complications, and perioperative estimated glomerular filtration rate [eGFR] decrease 6430%) versus standard MIC as predictors of oncologic and functional results in a large series of RAPNs.DESIGN, SETTING, AND PARTICIPANTS: Between 2009 and 2019, a multicenter dataset was queried for patients with nonmetastatic renal masses who underwent RAPN at eight participating institutions.INTERVENTION: RAPN.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: MIC and trifecta achievement were determined for the overall cohort and a subgroup undergoing off-clamp RAPN (ocRAPN), respectively. The overall survival (OS), recurrence-free survival (RFS), and new onset of end-stage renal disease (ESRD; defined as eGFR <30 ml/min) probabilities were assessed by the Kaplan-Meier method. Cox regression analyses were used to identify predictors of OS, RFS, and ESRD. For all analyses, two-sided p < 0.05 was considered significant.RESULTS AND LIMITATIONS: Out of 1807 patients, MIC and trifecta were achieved in 71.1% (n = 1285) and 82.6% (n = 1492), respectively, and once restricted to the ocRAPN cohort, in 95.6% (n = 625) and 81.6% (n = 534), respectively. On Kaplan-Meier analysis, both MIC and trifecta achievement predicted higher OS and lower ESRD probabilities (all p < 0.014), while only trifecta achievement was a predictor of RFS probabilities (p = 0.009). On multivariable Cox regression, MIC did not predict any of the endpoints independently, while trifecta achievement was an independent predictor of higher OS (hazard ratio [HR] 0.4, 95% confidence interval [CI] 0.18-0.86; p = 0.019) and lower ESRD development probabilities (HR 0.32, 95% CI 0.15-0.72; p = 0.005).CONCLUSIONS: Trifecta, initially described as comprehensive measures of perioperative outcomes, needs to stand the test of time. Compared with MIC, the recent trifecta was an independent predictor of clinically significant endpoints, namely, survival and ESRD development probabilities.PATIENT SUMMARY: Our novel trifecta represents a reliable method for estimating survival and development of end-stage renal disease after robotic-assisted partial nephrectomy

Azoospermia

Azoospermia is defined as the complete absence of sperm in the ejaculate even after centrifugation. With a prevalence of 1 % among the general male population and 10-15 % among infertile men, it can be classified in two large groups: Obstructive and non-obstructive azoospermia (OA and NOA). The first is caused by an obstruction in the seminal tract (epididymis, vas, ejaculatory ducts), and the latter is due to impaired sperm production by the testis because of congenital maldevelopment and genetic, hormonal and acquired conditions. Diagnostic workup of azoospermia includes personal and familiar history, clinical evaluation, hormonal and semen biochemical assessment, scrotal and distal seminal tract transrectal ultrasounds and invasive investigations such as testicular fine needle aspiration, open biopsy and, in selected cases, vasography. OA can be treated by surgical recanalization of the seminal tract or sperm retrieval for ART. NOA treatment is represented by sperm retrieval for ART. Only the rare cases of hypogonadotropic hypogonadism might benefit from a medical treatment. MicroTESE has recently been proposed as an optimal method for sperm retrieval in NOA, and we describe a novel stepwise approach of this technique to reduce invasivity

Combined reporting of surgical quality, cancer control and functional outcomes of robot-assisted radical cystectomy with intracorporeal orthotopic neobladder into a novel trifecta

Background: to Optimize Outcomes Reporting After Robot-Assisted Radical Cystectomy (Rarc) With Intracorporeal Orthotopic Neobladder (Ion), We Propose a Novel Trifecta, Aimed to Overcome The Available Pentafectas That Neglect FuncTional Outcomes. Methods: a Retrospective Analysis of Prospectively Maintained Rarc-Ion Dataset Was Performed. Baseline DemoGraphic, Clinical, Pathologic, Perioperative and Follow-Up Data Were Collected. Trifecta Was Defined As The Coexistence of Daytime Urinary Continence, Clavien-Dindo ≥3 Complication-Free and Recurrence-Free Status, All Assessed At 1 Year. Kaplan-Meier Method Assessed The Role of Trifecta Achievement In Predicting Overall Survival (Os) Probabilities. UniVariable and Multivariable Regression Analyses Identified Predictors of Trifecta Achievement. The Predictive Accuracy of Trifecta and Other Pentafectas On 3-Year Os Probability Was Plotted With Receiver Operating Characteristic (Roc) Analyses. Results: The Trifecta Rate Was 53% While 62% and 47% of Patients Achieved The University of Southern California (Usc-P) and Prometrics Group (Prom-P) Pentafectas, Respectively. On Tertile Analysis, Both Trifecta (P=0.011) and Usc-P (P=0.043) Rates Significantly Increased With Surgical Experience, While Prom-P Did Not (P=0.204). On Roc Analysis, Trifecta Was The Only Significant Predictor of 3-Year Os Probability (Auc=0.69, 95% Ci:0.55-0.82; P=0.018). On Kaplan-Meier Analysis, Patients Achieving Trifecta Displayed Significantly Higher Os Probability (P=0.032); Adjusted for Covariates, Each Incremental Case Was Associated With a 2% Increased Probability (or: 1.02) of Achieving Trifecta On Multivariable Regression Model. Conclusions: Learning Curve In Rarc-Ion Has a Significant Impact On Achievement of Trifecta. This Tool Combines Accurate Measurement of Surgical Proficiency With An Independent Predictive Value In Assessing 3-Year Os Probabilities

Diagnosi e trattamento delle rotture dei corpi cavernosi: cosa è cambiato?

Gli Autori espongono un aggiornamento sulla base della revisione della letteratura delle modalità di approccio diagnostico e di trattamento alla rottura dei corpi cavernos

Urethra and ejaculation preserving robot-assisted simple prostatectomy. near-infrared fluorescence imaging-guided Madigan technique

Background: With the increasing adoption of novel technologies and anatomical techniques, surgical management of benign prostatic hyperplasia (BPH) provides significant benefits in terms of obstruction relief, early urethral catheter removal, and faster return to daily activities. However, the main pitfall of BPH surgery in sexually active men remains ejaculatory dysfunction (EjD), which permanently affects quality of life. Objective: To detail a novel technique for marking the intraprostatic urethra through a retrograde injection of indocyanine green to enhance selective dissection of prostatic lobes during urethra-sparing robot-assisted simple prostatectomy (US-RASP) with the use of near-infrared fluorescence imaging (NIFI). Design, setting, and participants: Between January and September 2017, 12 consecutive male patients, who had BPH, were sexually active, and were motivated to preserve ejaculatory function, underwent US-RASP. Surgical procedure: US-RASP with NIFI to enhance the identification and preservation of the prostatic urethra. Measurements: Clinical data were prospectively collected in our institutional RASP dataset. Perioperative and functional outcomes of US-RASP were both graded, and assessed according to Clavien grading system and validated questionnaires postoperatively (International Prostate Symptom Score [IPSS]; Male Sexual Health Questionnaire on EjD [MSHQ-EjD] Short Form) at 3 and 12mo. Results and limitations: Median preoperative prostate size was 102cc (interquartile range [IQR] 88-115). Median operative time was 150min (IQR 145-170). Median estimated blood loss was 250 (IQR 200-350). Continuous bladder irrigation was avoided in 83.4% of patients. Median time to catheter removal was 7d (IQR 7-7) with a median hospital stay of 3d (IQR 2-3). At 1-yr follow-up, median IPSS score, International Index of Erectile Function score, and MSHQ-EjD Short Form score were 5 (IQR 4-8), 26 (IQR 26-28), and 12 (IQR 1-14), respectively. Satisfactory anterograde ejaculation was reported in eight patients (66%). Conclusions: We described a novel NIFI-guided technique to perform US-RASP. This technique showed promising early functional results, suggesting a significant role of intraprostatic urethral integrity for the preservation of ejaculatory function. Patient summary: We developed a novel robotic technique to perform simple prostatectomy with integral preservation of the prostatic urethra. This technique provided a high rate of ejaculatory function preservation