Robotic-assisted laparoscopic radical cystectomy: surgical and oncological outcomes.

PURPOSE: Our first 91 consecutive cases undergoing a robotic assisted cystectomy were analyzed regarding perioperative outcomes, pathological stages and surgical complications. MATERIALS AND METHODS: Between 2007 and 2010 a total of 91 patients (76 male and 15 female), 86 with clinically localized bladder cancer and 5 with non-urothelial tumors underwent a radical robotic assisted cystectomy. We analyzed the perioperative factors, length of hospital stay, pathological outcomes and complication rates. RESULTS: Mean age was 65.6 years (range 28 to 82). Among the 91 patients, 68 were submitted to an ileal conduit and 23 to a neobladder procedure for urinary diversion. Mean operating time was 412 min (range: 243-618 min) and mean blood loss was 294 mL (range: 50-2000 mL). In 29 % of the cases with urothelial carcinoma the T-stage was pT1 or less, 38 % were pT2; 26 % and 7 % were classified as pT3 and pT4, respectively. 14 % of cases had lymph node positive disease. Mean number of lymph nodes removed was 15 (range 4 to 33). Positive surgical margins occurred in 2 cases (2.1 %). Mean days to flatus were 2.13, bowel movement 2.88 and inpatient stay 18.8 (range: 10-33). There were 45 postoperative complications with 11 % major (Clavien grade 3 or higher). At a mean follow-up of 15 months 10 patients had disease recurrence and 6 died of the disease. CONCLUSIONS: Our experience demonstrates that robotic assisted radical cystectomies for the treatment of bladder cancers seems to be very promising regarding surgical and oncological outcomes.

Robotic-assisted laparoscopic radical cystectomy: surgical and oncological outcomes

PURPOSE:Our first 91 consecutive cases undergoing a robotic assisted cystectomy were analyzed regarding perioperative outcomes, pathological stages and surgical complications. MATERIALS AND METHODS: Between 2007 and 2010 a total of 91 patients (76 male and 15 female), 86 with clinically localized bladder cancer and 5 with non-urothelial tumors underwent a radical robotic assisted cystectomy. We analyzed the perioperative factors, length of hospital stay, pathological outcomes and complication rates. RESULTS: Mean age was 65.6 years (range 28 to 82). Among the 91 patients, 68 were submitted to an ileal conduit and 23 to a neobladder procedure for urinary diversion. Mean operating time was 412 min (range: 243-618 min.) and mean blood loss was 294 mL (range: 50-2000 mL). In 29% of the cases with urothelial carcinoma the T-stage was pT1 or less, 38% were pT2; 26% and 7% were classified as pT3 and pT4, respectively. 14% of cases had lymph node positive disease. Mean number of lymph nodes removed was 15 (range 4 to 33). Positive surgical margins occurred in 2 cases (2.1%). Mean days to flatus were 2.13, bowel movement 2.88 and inpatient stay 18.8 (range: 10-33). There were 45 postoperative complications with 11% major (Clavien grade 3 or higher). At a mean follow-up of 15 months 10 patients had disease recurrence and 6 died of the disease. CONCLUSIONS: Our experience demonstrates that robotic assisted radical cystectomies for the treatment of bladder cancers seems to be very promising regarding surgical and oncological outcomes.

A single center prospective study: prediction of postoperative general quality of life, potency and continence after radical retropubic prostatectomy.

PURPOSE: We investigated the importance of patient and tumor characteristics to predict continence, potency, and physical and mental health 1 year after radical prostatectomy. MATERIALS AND METHODS: This prospective study included 236 patients who underwent open radical retropubic prostatectomy at a single institution between January 2005 and October 2007. We used validated questionnaires, including the Short Form General Health Survey, the International Index of Erectile Function and the International Consultation of Incontinence Questionnaire, to evaluate postoperative health related quality of life, erectile function and continence, respectively. Questionnaires were completed at months 3, 6 and 12 postoperatively. RESULTS: At 1-year followup 75%, 73%, 75% and 26% of patients had returned to baseline physical health, mental health, continence and potency, respectively. Mental health recovered more slowly than physical health. Preoperative prostate specific antigen less than 20 ng/ml, nerve sparing technique, no intraoperative or postoperative complications, no adjuvant treatment and attendance at a postoperative rehabilitation program were significant factors that positively influenced the outcome in regard to health related quality of life, and postoperative potency and continence (p <0.05). CONCLUSIONS: Predictors can be used when counseling patients who are preparing themselves for radical retropubic prostatectomy. This study highlights the mental impact of this surgery on these patients. We propose that men should undergo a combined mental and physical counseling program before surgery to predict postoperative health related quality of life, potency and continence after radical retropubic prostatectomy.

Uni- vs. multiloculated pelvic lymphoceles: differences in the treatment of symptomatic pelvic lymphoceles after open radical retropubic prostatectomy.

PURPOSE: To evaluate the treatment of symptomatic pelvic lymphoceles (SPL) after performing radical retropubic prostatectomy (RRP) and pelvic lymphadenectomy (PLA) simultaneously. MATERIAL AND METHODS: We analyzed, in a retrospective study, 250 patients who underwent RRP with PLA simultaneously. Only patients with SPL were treated using different non- and invasive procedures such as percutaneous aspiration, percutaneous catheter drainage (PCD) with or without sclerotherapy, laparoscopic lymphocelectomy (LL) and open marsupialization (OM). RESULTS: Fifty-two patients (21%) had postoperative subclinical pelvic lymphoceles. Thirty patients (12%) developed SPL. Fifteen patients with noninfected uniloculated lymphocele (NUL) healed spontaneously after performing PCD. The remaining seven patients required sclerotherapy with additional doxycycline. After performing PCD, NUL healed better and faster than noninfected multiloculated lymphocele (NML) (success rate: 80% vs. 16%, respectively). Twenty-seven percent of patients treated initially with PCD, with or without sclerotherapy had persistent lymphocele. All patients were successfully treated with LL. Only one patient had an abscess as a major complication of a persistent SPL after PCD and sclerotherapy and was treated via an open laparotomy. CONCLUSIONS: Symptomatic NUL can be treated using PCD with or without sclerotherapy. If this therapy fails as first-line treatment, laparoscopic lymphocelectomy should be considered within a short period of time in order to achieve successful treatment. NML should be treated using a laparoscopic approach in centers where this type of expertise is available. Infected lymphoceles are drained externally. In these cases, percutaneous or open external drainage with adequate antibiotic coverage is preferable.

Uni- vs. multiloculated pelvic lymphoceles: differences in the treatment of symptomatic pelvic lymphoceles after open radical retropubic prostatectomy

PURPOSE: To evaluate the treatment of symptomatic pelvic lymphoceles (SPL) after performing radical retropubic prostatectomy (RRP) and pelvic lymphadenectomy (PLA) simultaneously. MATERIAL AND METHODS:We analyzed, in a retrospective study, 250 patients who underwent RRP with PLA simultaneously. Only patients with SPL were treated using different non- and invasive procedures such as percutaneous aspiration, percutaneous catheter drainage (PCD) with or without sclerotherapy, laparoscopic lymphocelectomy (LL) and open marsupialization (OM). RESULTS: Fifty-two patients (21 percent) had postoperative subclinical pelvic lymphoceles. Thirty patients (12 percent) developed SPL. Fifteen patients with noninfected uniloculated lymphocele (NUL) healed spontaneously after performing PCD. The remaining seven patients required sclerotherapy with additional doxycycline. After performing PCD, NUL healed better and faster than noninfected multiloculated lymphocele (NML) (success rate: 80 percent vs. 16 percent, respectively). Twenty-seven percent of patients treated initially with PCD, with or without sclerotherapy had persistent lymphocele. All patients were successfully treated with LL. Only one patient had an abscess as a major complication of a persistent SPL after PCD and sclerotherapy and was treated via an open laparotomy. CONCLUSIONS: Symptomatic NUL can be treated using PCD with or without sclerotherapy. If this therapy fails as first-line treatment, laparoscopic lymphocelectomy should be considered within a short period of time in order to achieve successful treatment. NML should be treated using a laparoscopic approach in centers where this type of expertise is available. Infected lymphoceles are drained externally. In these cases, percutaneous or open external drainage with adequate antibiotic coverage is preferable.

First male apocrine genital carcinoma mimicking a penile cancer.

Perineal apocrine carcinoma is a rare malignant tumor that has its origin in the apocrine sudoriparous glands of the genital and perianal regions. It often progresses quietly and metastasizes in the superficial inguinal and retrorectal lymph nodes. We report a case of a genital apocrine carcinoma located at the penile basis. To our knowledge our report represents the first case of a pathologically confirmed genital apocrine carcinoma mimicking a penile cancer.

Prepubertal testicular tumors: frequently overlooked.

OBJECTIVE: Prepubertal testicular tumors are fundamentally distinct from their adult counterparts. We reviewed our 10-year, two-institution experience with respect to diagnosis and treatment. MATERIAL AND METHODS: A retrospective review was performed of all testicular tumors diagnosed between 1996 and 2006 in males younger than 14 years. We analyzed clinical characteristics, diagnostic procedures, treatment methods, histopathologic findings and outcome. RESULTS: Of 15 primary testicular tumors, eight (53%) were germ-cell tumors (three teratomas, two yolk sac tumors, one seminoma, one embryonic carcinoma and one choriocarcinoma), four (27%) tumor-like lesions (epidermoid cysts), two (13%) gonadal stromal tumors (a Leydig and a Sertoli cell tumor), and one (7%) gonadoblastoma with gonadal dysgenesis. All boys were presented with a painless scrotal mass and four (27%) of them with elevated tumor markers. Ten cases (66%) were misdiagnosed by urologists preoperatively and presented for treatment of congenital or acquired scrotal disorders. Twelve children (80%) were treated with radical orchiectomy and three (20%) with a testis-sparing procedure. At a mean 4-year follow-up no patient has presented with recurrent tumor in the residual or contralateral testicle. Postoperative physical examination and scrotal ultrasound were obtained in 14 patients at a median follow-up of 48.2 months, and there was no evidence of tumor progression. One boy with a choriocarcinoma (stage IV) died due to distant metastases. CONCLUSIONS: Benign teratoma and epidermoid cysts were the most common prepubertal testicular tumors. Any suspicion of a testicular tumor warrants an inguinal approach to prevent scrotal violation of the tumor. Our limited experience with testis-sparing procedures supports the current trends that organ-confined surgery should be performed for benign lesions such as teratoma, Leydig cell tumor and epidermoid cysts based on frozen biopsy findings.