Preoperative International Prostate Symptom Score Predictive of Inguinal Hernia in Patients Undergoing Robotic Prostatectomy.

PURPOSE: Studies have shown that encountering an inguinal hernia during robotic radical prostatectomy is not uncommon. We reviewed our experience with simultaneous robotic prostatectomy and mesh hernia repair to identify variables predictive of a hernia. MATERIALS AND METHODS: Our cohort consisted of 693 consecutive men who underwent robotic radical prostatectomy as performed by 1 surgeon. Hernias were repaired with mesh composed of equal parts of absorbable polyglecaprone-25 and nonabsorbable polypropylene monofilament. Preoperative variables potentially predictive of an inguinal hernia were evaluated. RESULTS: Inguinal hernias were encountered in 55 of 639 patients (8.6%), of which 22.3% were bilateral for a total of 68 hernia sides. Only 26 of 55 hernias (47.2%) were evident preoperatively. Men with a preoperative I-PSS (International Prostate Symptom Score) of 15 or greater had a 22.4% chance (30 of 134) of requiring a hernia repair compared with 5% in those without such a score (OR 5.54, 95% CI 3.13-9.81, p <0.0001). There were no differences between the hernia and nonhernia groups in prostate size, body mass index, age, blood loss, transfusions, operative time, length of stay or any Clavien grade II-V complication. In 47 patients there was 1 recurrence at a median followup of 27.9 months. There were no cases of mesh associated pain or erosion. CONCLUSIONS: Independent of prostate size, men with preoperative lower urinary tract dysfunction were at 5 times the risk of a hernia at robotic radical prostatectomy (22.4% vs 5%). Given that half of the hernias were subclinical, patients with an I-PSS of 15 or greater should be counseled about the potential need for hernia repair at robotic radical prostatectomy.

Metallic ureteral stents: a cost-effective method of managing benign upper tract obstruction.

INTRODUCTION: The management of patients with upper urinary tract obstruction who are not candidates for definitive reconstruction often presents a challenge. We report our initial experience with the Resonance (Cook Urological, Spencer, IN) metallic ureteral stent for the management of benign ureteral obstruction and present a comparative cost analysis of metallic to standard polymer stent use. METHODS: Data were retrospectively gathered on all patients undergoing metallic ureteral stent placement for benign causes from July 2007 to February 2009. Baseline demographics, previous method of drainage, pre- and postoperative creatinine levels, procedural complications, stent-related side effects, and metallic stent dwell time were recorded. The cost of stent maintenance for polymer and metallic stents for a 12-month interval was calculated for each patient. RESULTS: Fifteen stents were placed in 13 patients to manage obstruction due to a variety of benign etiologies. Metallic stents provided adequate drainage in 12/13 patients, but were discontinued prematurely in 3 patients (2 for voiding symptoms, 1 for hematuria). Eight patients had their metallic stents changed after a mean time of 11.6 months, with no encrustation. The yearly cost associated with polymer and metallic stent use was $23,999 and $11,183, respectively. This amounted to a $10,394 annual cost reduction (43%) for each patient. CONCLUSIONS: Metallic ureteral stents provide effective upper tract drainage for the majority of patients with benign upper tract obstruction, with significant cost benefit, largely because of the shorter exchange interval.

Cost analysis and clinical applicability of the Resonance metallic ureteral stent.

The Resonance metallic stent is a new wire-based ureteral stent that was initially developed for patients with malignant ureteral obstruction. Potential advantages over traditional stents include resistance to encrustation and to external compression, allowing for increased dwell times and the maintenance of upper tract drainage when traditional polymer stents have failed. We present a comparative cost analysis of Resonance metallic and standard polymer stent use in patients with benign urinary obstruction and review the literature regarding the Resonance stent.

A novel technique for the removal of minimally encrusted ureteral stents.

The removal of encrusted ureteral stents typically necessitates secondary treatment modalities, such as ureteroscopy, extracorporeal shock wave lithotripsy, or antegrade nephroscopy. We present a novel technique for the removal of minimally encrusted stents using a suture and a ureteral access sheath.