Minimally Invasive Pyelolithotomy: Comparison of Robot-assisted and Laparoscopic Techniques
Paolo Corsi, MD, Urologist, Daniele D’Agostino, MD, Urologist, Marco Giampaoli, MD, Urologist, Angelo Porreca, MD, Urologist, Daniele Romagnoli, MD, Urologist, Walter Artibani, MD, Professor, Abano Terme Hospital, Abano Terme (PD), Italy, Riccardo Schiavina, MD, Professor, Eugenio Brunocilla, MD, Professor, Giacomo Saraceni, MD, Urologist, Marco Garofalo, MD, Urologist, Bologna, Italy, Federico Mineo Bianchi, MD, Urologist, University of Bologna Bologna, Italy, Simone Crivellaro, MD, Urologist, University of Illinois at Chicago, Chicago, IL, USA
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Objectives: To compare the perioperative and short-term outcomes of robotic pyelolithotomy (RP) and laparoscopic pyelolithotomy (LP) for the treatment of renal stones.
Materials and methods: We retrospectively evaluated 39 patients who underwent robotic or laparoscopic pyelolithotomy from January 2015 to December 2018.
Results: The preoperative characteristics of the two groups were comparable. The mean operative time was 173 ± 51 and 182 ± 62 min in the RP and LP groups, respectively (p=0.6). Blood loss and length of hospital stay with the robotic approach were lower than those with the laparoscopic approach (210 ± 180 ml vs. 639 ± 412 ml, p<0.001, and 3.8 ± 3 days vs. 7.3 ± 2.8 days, p=0.001). A complete stone-free status was achieved in 17 (85%) patients in the RP group and 8 (42%) in the LP group (p=0.01). Post-operative complications with the two approaches were also similar.
Conclusions: In some selected cases, laparoscopic and robotic pyelolithotomy are alternative procedures for large, multiple and complex kidney stones. The robotic approach was associated with less intraoperative blood loss and fewer days of hospitalization compared to the laparoscopic method, and also gives a better stone-free rate.
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Robot-Assisted Radical Cystectomy with Intracorporeal Orthotopic Ileal Neobladder: A Safe Strategy in Elderly Patients? Results of Propensity Score Matching in a Single High-Volume Center
Daniele Romagnoli, MD, Urologist, Paolo Corsi, MD, Urologist, Daniele D’Agostino, MD, Urologist, Marco Giampaoli, MD, Urologist, Walter Artibani, MD, Urology Professor, Angelo Porreca, MD, Head of Urology Unit, Policlinico Abano Terme, Abano Terme, Padua (PD), Italy, Federico Mineo Bianchi, MD, Urology Resident, Lorenzo Bianchi, MD, Urologist, Eugenio Brunocilla, MD, Full Professor, Francesco Chessa, MD, Urologist, Riccardo Schiavina, MD, Urology Professor, Clinica Urologica Universitaria, Bologna (BO) Italy
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Aim: To compare surgical, functional and early survival outcomes for robot-assisted radical cystectomy (RARC) with intracorporeal orthotopic neobladder (ONB) reconstruction in patients age ≥ 75 y to those in patients age < 75 y using Propensity Score Matching.
Methods: We collected data from 15 patients age ≥ 75 y from among 60 consecutive RARC with ONB reconstruction performed at our institution from January 2015 to July 2018. All procedures were performed by a single surgeon after modular training under the supervision of a skilled surgeon. Demographic, surgical, functional and survival data were prospectively collected and compared to the corresponding data from 15 patients from the same series age < 75 y, matched according to the ASA score, body mass index, clinical stage and associated carcinoma in situ using Propensity Score Matching.
Results: There were no significant differences between the two groups with regard to preoperative parameters, such as ASA score, BMI and preoperative stage. The same homogeneity was found for intraoperative parameters, such as operation time, number of nodes retrieved and ONB time. The only statistically significant difference noted was in the percentage of nerve-sparing procedures, which was higher in the younger patient group (p < 0.001). The percentages of early and late postoperative complications were higher in the older patients, but the differences were not statistically significant. Moreover, there were no differences among the two populations in terms of functional outcomes (daytime and nighttime continence, potency), or in either cancer-specific or overall mortality.
Conclusions: RARC with totally intracorporeal ONB diversion can be offered to older patients with an expectation of good surgical, functional and early survival outcomes, although further studies with a larger sample size will be needed to confirm these results.
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Monocenter Experience with 532 Nm Laser Photoselective-Vaporization of the Prostate by GreenLight XPS™ Laser: Is It Really an Endourological Joker Card?
Jamil Ghahhari, MD, Urology Resident, Carlo D’Orta, MD, Urology Resident, Ambra Rizzoli, MD, Urology Resident, Michele Marchioni, MD, Urology Resident, Giulia Primiceri, MD, Urology Resident, Piergustavo De Francesco, MD, Urology Resident, Angelo Civitella, MD, Urology Resident, Mario Di Lecce, MD, Urology resident, Pietro Castellan, MD, Consultant in Urology, Roberto Castellucci, MD, Consultant in Urology, Department of Urology, SS. Annunziata Hospital, “G.D’Annunzio” University of Chieti, Chieti, Italy, Fabio Neri, MD, Consultant in Urology, Fabiola Raffaella Tamburro, MD, Consultant in Urology, Luca Cindolo MD, FEBU, PhD, Consultant in Urology, Department of Urology, “S. Pio da Pietrelcina” Hospital, Vasto, Italy, Luigi Schips, MD, Professor, Director, Department of Urology, SS. Annunziata Hospital, “G.D’Annunzio” University of Chieti, Chieti, Italy
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Introduction: In our study, we reported on our monocenter experience with GreenLight (GL) Xcelerated Performance System (XPS)™ /MoXy™ laser fiber (American Medical Systems Inc., Minnetonka, Minnesota), examining its efficacy, safety, and its ability to effectively treat lower urinary tract symptoms (LUTS) in benign prostate obstruction (BPO). We also explored and compared the three different endoscopic approaches used for GL treatment of benign prostatic hyperplasia (BPH), standard photovaporization (PVP), anatomical PVP, and GreenLight XPS™ enucleation of the prostate.
Materials and Methods: Between February 2013 and April 2017, 140 patients, with an average age of 67.7 years (range 47–85), were treated using the XPS™/MoXy™ system in a single-operative urologic center. The data were retrospectively analyzed with an assessment of the main intra- and postoperative outcomes at three, six, 12, and 18 months comparing both subjective (international prostate symptom score [IPSS]) and objective (uroflow [Qmax] parameters and prostate volume) parameters to the preoperative data. Patients underwent standard PVP, anatomical PVP, or prostate photo-selective en-bloc enucleation (PEBE) according to surgeon preferences.
Results: Median prostate volume (MPV) and prostate-specific antigen (PSA) were 69cc and 3.24 ng/dl, respectively. An indwelling catheter, at the time of surgery, was observed in 15% of men. Median operative-laser time and energy applied were 56.4 minutes, 26.5 minutes, and 245813 kJ. Outpatient surgery was feasible with median length of stay at 48 hours. Significant improvement in IPSS and Qmax are observed at all endpoints. No significant intraoperative complications were reported. When stratifying postoperative complications according to the Cavien-Dindo classification, only two cases of high-degree emerged (grades III-IV).
Conclusion: Our data confirm that in treating men with symptomatic benign prostate disease, the GreenLight XPS™/MoXy™ laser fiber is safe and able to achieve challenging results in terms of clinical outcomes and prostate volume reduction. Balance between functional outcomes and complications was great without statistically significant differences, in terms of outcomes, between the different surgical techniques.
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Delayed and Life-Threatening Hematuria Following Percutaneous Nephrostomy Placement
Daniele Castellani, MD, Consultant Urologist, ASL Viterbo-Belcolle Hospital,
Viterbo, Italy
Introduction: Percutaneous nephrostomy (PN) is a common urological procedure with mild complications in most cases.
Case Description: We present a case of massive and life-threatening hematuria, presenting 29 days following PN. This is an uncommon complication of PN due to a delayed rupture of a pseudoaneurysm (PA) arising from a segmental artery. Bleeding was successfully treated by percutaneous trans-arterial super-selective embolization.
Conclusions: Hematuria, due to PA formation, should always be kept in mind in case of late hematuria following PN, as it needs to be promptly treated. Super-selective arterial embolization with metallic coils is an effective procedure to stop bleeding, and it may be a valid substitute for surgical intervention.
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3-12-2017
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