Technical and anatomical challenges to approach robotic-assisted radical prostatectomy in patients with Urolift®

ABSTRACT Introduction Urolift® is a surgical modality to treat lower urinary tract symptoms (LUTS) in patients with enlarged prostates (1). However, the inflammatory process caused by the device usually displaces the prostate's anatomical landmarks and challenges surgeons performing robotic-assisted radical prostatectomy (RARP). In this video, we will illustrate several technical challenges in patients with Urolift ® who underwent RARP. Material and Methods We performed a video compilation with several surgical steps illustrating key aspects and critical details of the anterior bladder neck access, lateral bladder dissection from the prostate, and posterior prostate dissection to avoid ureteral and neural bundles injuries. Results We perform our RARP technique with our standard approach in all patients (2 -6). The beginning of the case is performed like every patient with an enlarged prostate. We first identify the anterior bladder neck and then complete its dissection with Maryland and Scissors. However, extra care must be taken in the anterior and posterior bladder neck approach due to the clips found during the dissection. The challenge starts when opening the lateral sides of the bladder until the base of the prostate. It is crucial to perform the bladder neck dissection beginning at the internal plane of the bladder wall. Such dissection is the easiest way to recognize the anatomical landmarks and potential foreign materials, such as clips, placed during previous surgeries. We cautiously work around the clip to avoid using cautery on the top of the metal clips because energy is transmitted from one edge to the other of the Urolift ®. This can be dangerous if the edge of the clip is close to the ureteral orifices. The clips are usually removed to minimize cautery conduction energy. Finally, after isolating and removing the clips, the prostate dissection and subsequent surgical steps are continued with our conventional technique. Before proceeding, we ensure that all clips are removed from the bladder neck to avoid complications during the anastomosis. Conclusions Robotic-assisted radical prostatectomy in patients with Urolift ® is challenging due to modified anatomical landmarks and intense inflammatory processes in the posterior bladder neck. When dissecting the clips placed next to the base of the prostate, it is crucial to avoid cautery because energy conduction to the other edge of the Urolift ® can cause thermal damage to the ureters and neural bundles.

Comparing the outcomes of robotic assisted radical prostatectomy in black and white men: Experience of a high-volume center

ABSTRACT Background: Global cancer incidence ranks Prostate Cancer (CaP) as the second highest overall, with Africa and the Caribbean having the highest mortality. Previous literature suggests disparities in CaP outcomes according to ethnicity, specifically functional and oncological are suboptimal in black men. However, recent data shows black men achieve post radical prostatectomy (RP) outcomes equivalent to white men in a universally insured system. Our objective is to compare outcomes of patients who self-identified their ethnicity as black or white undergoing RP at our institution. Materials and methods: From 2008 to 2017, 396 black and 4929 white patients underwent primary robotic-assisted radical prostatectomy (RARP) with a minimum follow-up of 5 years. Exclusion criteria were concomitant surgery and cancer status not available. A propensity score (PS) match was performed with a 1:1, 1:2, and 1:3 ratio without replacement. Primary endpoints were potency, continence recovery, biochemical recurrence (BCR), positive surgical margins (PSM), and post-operative complications. Results: After PS 1:1 matching, 341 black vs. 341 white men with a median follow-up of approximately 8 years were analyzed. The overall potency and continence recovery at 12 months was 52% vs 58% (p=0.3) and 82% vs 89% (p=0.3), respectively. PSM rates was 13.4 % vs 14.4% (p = 0.75). Biochemical recurrence and persistence PSA was 13.8% vs 14.1% and 4.4% vs 3.2% respectively (p=0.75). Clavien-Dindo complications (p=0.4) and 30-day readmission rates (p=0.5) were similar. Conclusion: In our study, comparing two ethnic groups with similar preoperative characteristics and full access to screening and treatment showed compatible RARP results. We could not demonstrate outcomes superiority in one group over the other. However, this data adds to the growing body of evidence that the racial disparity gap in prostate cancer outcomes can be narrowed if patients have appropriate access to prostate cancer management. It also could be used in counseling surgeons and patients on the surgical intervention and prognosis of prostate cancer in patients with full access to gold-standard screening and treatment.

Da Vinci SP radical prostatectomy: a multicentric collaboration and step-by-step techniques

ABSTRACT Introduction Several techniques of robotic-assisted radical prostatectomy (RARP) using the da Vinci SP (SP) have been described since its clearance by the FDA (Food and Drug Administration) in 2018 ( 1 , 2 ). Even with the expanding literature about this robot, the SP technology has been restricted to a few centers in the US and Asia due to the recent release of this robot in the marked.3 In this scenario, we provided, in this video compilation, a consensus of SP referral centers describing the current approaches and techniques of da Vinci SP Radical prostatectomy (SP-RARP). Surgical Technique We have illustrated five different techniques, including transperitoneal, extraperitoneal, Retzius-sparing, transvesical, and transperineal ( 4 - 6 ). Each surgery demonstrated crucial steps from the trocar placement until anastomosis. All approaches follow anatomic concepts and landmarks to minimize positive surgical margins, optimize oncological outcomes and promote optimal functional recovery. The trocar placement and the use of an assistant port were selected according to the operative technique of each institution. None of these surgeries had intra- or postoperative complications, and the pain management until discharge was controlled without using narcotics. All patients were discharged in less than 16 hours of surgery. Conclusion Robotic-assisted radical prostatectomy performed with the da Vinci SP is feasible and safe with optimal perioperative outcomes. Five different approaches were described in this video compilation, and we believe that the technical details provided by this multicentric collaboration are crucial for centers willing to initiate the SP approach to radical prostatectomy.

TV coverage of the 25th of January revolution and its impact on political socialization of children in late childhood stage

Problem: The main problem lies in the question of how much influence did the follow up of the 25th of January Revolution's events had on the political socialization of our children?

Objectives: This study is designed to identify the degree of influence and the change in political behavior that has happened to our children as a result of the follow up of the events of the 25th of January Revolution

Type and Methodology: The researcher used the field sample survey method on a sample of children in late childhood stage between the ages [9-12] years

Population and Sample: The study was applied to a sample of 400 boys and girls [9-12] years old-late childhood stage in urban and rural, in Giza, Sharkiya, and Qalubiya

Tools: Survey Questionnaire

Results: The study confirmed that a slight shift occurred in the character of the Egyptian childen as a result of events that they witnesses since the 25th of January Revolution and beyound. and they became familiar with a lot of information regarding these issues, The study clearly confirmed that a number of children interacted with the media directly and have become more confident to interact with media and discuss what they prodcast with the ability to oppose media openions, The study also confirmed the tendency of a significant proportion of children to the electronic media where they participated by commenting on what has been broadcasted by TV channels of political programs through the websites of such channels, The study also confirmed that all the sample followed the events of the 25th of January Revolution and that they were interested in the beginning of the revolution and most of them participated in the events at least by raising the national flag in the window of their houses and a few of them watched the events of violence and participated in violence with no regret, and that there is a small percentage of them was hit or arrested, and The study also confirmed that their participation in the students' unions elections and political events

Treatment cinematic drama of political issues and the realization teenagers Egyptians to the concept of democracy

Introduction: Numerous Arab cinema films with political subjects before and after the revolution of January 25 and then revolution June 30, and the reality of those movies offered by satellite show that they reflect the previous regime's practices on the one hand and focuses on issues of democracy on the other hand, are racing satellite channels, especially those specialized in drama showing these films not only because it is a new film, but it touches on interesting issues were heroes symbols of power which leads to increased opportunities for those movies and carries different implications and multiple views of a content that reflects the thought of seeing those movies and what may affect the perception of Egyptian youth political situation the concept of democracy in society

Methods: This study is based on the survey method as the most appropriate scientific methods to collect field data on the phenomenon of certain clarify, interpret and explain the relationships between relational variables

Society and Sample: The field study of Egyptian society teens who age range to 18 years old and due to the difficulty of conducting the study to study the entire complex [Teenagers Egyptians] have been pulling a single sample of 200 teenagers from the Egyptians to the application of the study consists

Results: The most important results of the study is same for movies 100% for males and females and the high viewing of the sample of movies in specialized satellite channels at a rate of rate 95.7% of the total sample, The number of Egyptian movies watched by respondents in the weekly satellite channels specialized results showed one movie a week at a rate of 57.4% and from 3 to 5 movies a week at a rate of 27.4% and then six more films at a rate 14.9% and on the most important movies watched by respondents and dealing with political issues

Celiprolol versus metoprolol and propranolol on vascular reactivity and serum lipid profile in experimental animals

In the present study, the effects of the 2 cardioselective beta-adrenoceptive blockers; celiprolol and metoprolol on serum lipid profile and on the isolated aortic strip were investigated in comparison with the standard non-selective beta-blocker propranolol. The influence of the 3 beta-blockers on serum lipid profile was determined by measuring the total triglycerides [TG], total cholesterol [TG,], high density lipoprotein cholesterol [HDL-C], and low density lipoprotein cholesterol [LDL-C] in serum of adult male albino rats. Celiprolol [40 mg/kg] metoprolol [l0 mg/kg,]; and propranolol [10mg/kg]; were given orally once daily to adult rats for 2 months. Statistical analysis of the results revealed that celiprolol significantly decreased the serum levels of TG; TC; LDL-C; and significantly increased HDL-C serum levels. While, metoprolol induced insignificant changes in serum lipid profile. On the other hand, propranolol was found to significantly increase LDL-G; TG; and TC levels, while it significantly decreased HDL-C level. On the isolated rabbit aortic strip, the addition of celiprolol [l6ug/ml bath] was found to significantly decrease the contractile response of the aortic strip to different concentrations of phenylephrine. Metoprolol and propranolol, on the other hand, were found to induce insignificant changes on the contractile responses of the isolated rabbit aortic strip to phenylephrine. So, celiprolol might be a suitable alternative to the currently used cadioselective BB; when the issues of hyperlipidemia and quality of life are to be dealt with in a hypertensive cardiac patient

Comparative study of the antihypertensive and metabolic effects of the angiotensin II antagonist valsartan versus captopril in rats

Angiotensin II is a key hormone of the renin-angiotensin system which regulates blood pressure. Valsartan is a highly selective and specific direct angiotensin II antagonist. It inhibits angiotensin II binding to the angiotensin II receptor subtype ATI and blocks the pressor effect of angiotensin II in a dose-dependent manner. This study was conducted to evaluate the antihypertensive effect of valsartan comparing it to the converting enzyme inhibitor captopril, as well as their effect on glucose and insulin levels in blood of fasting rats. 70 adult albino rats were used in this study. Captopril and valsartan were given to 2 groups of rats [each of 10 rats] in a dose of 3 mg/kg orally daily for 3 weeks to study their effect on serum glucose and insulin levels in normal fasting adult rats .It was found that captopril significantly decreased serum glucose values from 91.4 [3.92 to 75.9 [0.48 [p<0.05]; while it significantly increased serum insulin values from 11.45 [1.2 to 15.97[0.48 [p< 0.05]. On the other hand, valsartan induced insignificant changes in either glucose or insulin values. It was found that valsartan has approximately an equipotent antihypertensive effect compared to captopril in the 2-kidney-One clip adult hypertensive rats, when given daily orally for 4 weeks. Captopril significantly decreased the systolic blood pressure from 167.7[3.4 to 140.9 [2.7 with 15.98% reduction [P< 0.001] by the end of the 4th week; while valsartan also significantly decreased the systolic blood pressure from 166.54.2 to 145.62.5 [p< 0.001] with 12.55% reduction at the end of the 4th week. In renal hypertensive rats [2K-IC] pretreated by hydrochlorothiazide [2.25mg/kg b.w.] orally daily for 3weeks, captopril induced a sharp significant drop of blood pressure when given orally as a single dose [5mg/kg b.w.] especially in the first hour, from 148.3[2.1 to 132.7[3.1 with 10.5% reduction [p< 0.001]. On time other hand. valsartan, induced a slow non-significant fall of blood pressure after the same period with the same dose and route of administration, from 147.9[3.1 to 141.7[3.2 with 4.19% reduction, [p> 0.05]. It is concluded that valsartan could replace angiotensin converting enzyme inhibitors in patients who are liable to suffer from angioedema or could not tolerate dry persistent cough Associated with, the increase of bradykinin and prostaglandin levels following ACEIs administration. The lack of time first dose phenomenon as reported by this investigation, could be an added advantage of valsartan over captopril. Also, because at the lack of adverse metabolic effects on glucose tolerance valsartan could prove to be the second choice drug in diabetic hypertensive patients who could not tolerate ACEIs