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Objective To describe the incidence and clinical outcomes of seminal vesicle invasion (SVI) at salvage radical prostatectomy (SRP) and to describe the accuracy of SV biopsy. As SRP is used after biochemical recurrence (BCR) of prostate cancer after radiotherapy (RT) to gain local oncological control. The SVs receive lower doses of radiation from external-beam RT (EBRT) to avoid rectal exposure and are not targeted with brachytherapy (BT) with low-risk prostate cancer. Patients and Methods SRP was performed on 206 men with BCR after RT at a tertiary care institution between 1998 and 2011. Post-RT biopsy and SRP specimens were reviewed by a genitourinary pathologist. Results SVI was detected in 65 (32%) of 206 patients. No difference was found between EBRT alone (65% vs 63%) and BT (29% vs 31%) with or without EBRT in patients with SVI. Men with SVI had higher rates of cT3 disease (20% vs 8%) and Gleason score ≥ 8 at SRP (52% vs 21%). BCR-free survival at 5 years was 18% and 56% in patients with and without SVI (hazard ratio 2.85, 95% confidence interval 1.87–4.36, P < 0.001), yet the rate of local recurrence was low (11%). Prostate cancer was identified in nine of 18 patients who underwent SV biopsy and was the only location of prostate cancer in two patients. Conclusions SVI is a prognostic indicator for BCR after SRP, but local recurrence in patients with SVI after SRP remains low. We recommend SV biopsy to improve staging and cancer detection in men with BCR after radiotherapy.

Objective To determine whether post-radiotherapy (RT) biopsy (PRB) adequately predicts the presence, location, and histological features of cancer in the salvage radical prostatectomy (SRP) specimen. Before salvage treatment, a PRB is required to confirm the presence of locally recurrent or persistent cancer and to determine the extent and location of the prostate cancer. Patients and Methods SRP was performed between 1998 and 2011 on 198 patients. All patients underwent a PRB. PRB and SRP specimens were evaluated by a genitourinary pathologist. Patients had external-beam RT alone (EBRT; 71%) or brachytherapy with or without EBRT (29%). Results Of the men undergoing SRP, 26 (14%) were clinical stage ≥T3, with 13% of PRBs with Gleason score ≥8. Cancer was unilateral in 120 (61%) biopsies, with contralateral or bilateral prostate cancer at SRP in 49%. In the SRP specimen, cancer was multifocal in 57%. Cancer was upgraded at SRP in 58% of men, with 20% having an increase in primary Gleason grade. The accuracy of PRB varied by region from 62% to 76%, with undetected cancers ranging from 12% to 26% and most likely to occur at the mid-gland. Conclusions Radiation-recurrent prostate cancers were often multifocal, and biopsy missed up to 20% of tumours. More than half of the cancers were upgraded at SRP, and many that were unilateral on PRB were bilateral at SRP.

What's known on the subject? and What does the study add? Micropapillary bladder cancer is a high grade variant with poor prognosis. There is no consensus about patients with micropapillary bladder cancer receiving neoadjuvant chemotherapy, but many suggest that radical cystectomy should not be delayed. Data from this study suggest that patients with micropapillary bladder cancer have a similar rate of response to neoadjuvant chemotherapy to that of patients with urothelial carcinoma. If these patients have pT0 disease, their survival is significantly improved at 2 years. Objective To describe the pathological outcomes of patients with muscle-invasive micropapillary bladder cancer who have undergone neoadjuvant chemotherapy. Patients and Methods A total of 82 patients with muscle-invasive micropapillary bladder cancer were treated between 1997 and 2010. After excluding those with metastatic disease, micropapillary histology only at radical cystectomy (RC), and chemo-radiation as primary treatment, 44 patients remained. All patients had ≥cT2 disease before chemotherapy/surgery. The median follow-up after RC was 28 months. Neoadjuvant chemotherapy was initiated in 29 (66%) patients and all patients underwent RC (93%) or partial cystectomy (7%). Results Micropapillary histology was diagnosed at first transurethral resection in 37 (84%) patients. Final RC pathology revealed pT0 in 15 (34%) patients and positive lymph nodes in 13 (31%) patients. Down-staging to pT0 occurred in 13 (45%) of those who received neoadjuvant chemotherapy compared with two (13%) of those who did not (P = 0.049). Patients with pT0 disease with micropapillary histology had higher overall survival rates (25 vs. 92%) and lower rates of bladder cancer recurrence (21 vs. 79%) at the 24-month follow-up. Conclusions Almost half of the patients responded completely to neoadjuvant chemotherapy with a pT0 rate of 45%; therefore, patients with the micropapillary variant of urothelial carcinoma should not be excluded from consideration for neoadjuvant chemotherapy.

Study Type – Prognosis (individual cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Ductal prostate cancer is a rare histological variant of prostate cancer. The incidence, natural history and outcomes of patients with ductal have not been described. We demonstrate that ductal prostate cancers often present with advanced stage and a high percentage of men die from their disease. OBJECTIVE • To use the national Surveillance, Epidemiology, and End Results (SEER) cancer registry to describe the natural history, national incidence and treatment patterns for ductal prostate cancer (PCa) over the last 20 years, as the available literature on ductal PCa is limited to small case series because of few patient numbers. PATIENTS AND METHODS • From the SEER registry, 693 men with ductal PCa were identified from 1970. • The demographics, clinical features and cause of death data were collected from men with ductal and acinar histological types. RESULTS • The incidence of ductal PCa has increased over each decade, but the overall percentage of ductal relative to acinar PCa has remained stable. • Men with ductal PCa were more likely to present with advanced disease (30% T3 with ductal PCa, compared with 7% with acinar PCa). • Men with ductal PCa underwent similar rates of radical surgery, lower rates of radiotherapy but a higher frequency of outlet (transurethral resection) procedures. • Men with ductal PCa had a significantly greater rate of death from PCa (12% vs 4%) than men with acinar PCa. • Comparing PCa-specific mortality, men with ductal PCa had similar rates of death to men with Gleason 4 + 4 grade acinar PCa. CONCLUSIONS • Despite a stable incidence, ductal PCa remains an aggressive PCa usually presenting with advanced clinical stage and resulting in a high rate of PCa-specific mortality similar to Gleason 4 + 4 acinar PCa. • Patients would probably benefit from combined modalities including radical surgery, radiotherapy and palliative outlet procedures.

Objective • Urethral strictures located in the fossa navicularis are common and are often managed with meatotomy or meatoplasty. • Few data have described the outcomes for men after urethroplasty or patient satisfaction following these procedures. Methods • In all, 93 men at two different institutions underwent surgical repair of distal urethral stricture disease using meatotomy (73) or meatoplasty (20), with 13/20 (65%) of the latter group undergoing substitution urethroplasty. • In patients with lichen sclerosus (LS), all involved tissue was excised prior to reconstruction. • In a subset of men undergoing meatotomy, patient satisfaction was evaluated by questionnaire. Results • Average clinical follow-up for men undergoing distal urethroplasty was 61 months. • Successful reconstruction requiring no further intervention occurred in 84% of men overall. Subgroup analysis revealed success in 87% of men with meatotomy, 75% with meatoplasty and 66% with substitution urethroplasty. • Men with LS had a significantly greater rate of stricture recurrence (20.5% vs 7.5%, P= 0.04). • Of the subset of men who completed a patient-based questionnaire 84% reported they were either satisfied or very satisfied with the results of their meatotomy. Conclusions • We report the success of distal urethral stricture management. • Meatal strictures may be approached successfully in a stepwise manner progressing from meatotomy to meatoplasty for longer recurrent strictures, with a high overall success rate for meatotomy. • Although substitution grafts may be useful for men with longer distal strictures and those with LS, the risk of recurrence was significantly higher in this cohort.

Objective • To describe our experience with surgical management of transplant ureteral strictures over a 6-year period. Patients and methods • The present study identified patients who underwent open reconstruction for transplant ureteral strictures between March 2002 and May 2008 after kidney or kidney-pancreas transplantation. • Baseline clinical characteristics were documented, including age at transplantation and reconstruction, serum creatinine levels, immunosuppressive drug regimen, and comorbidities. • Postoperative complications were noted, including urinary tract infections, stricture recurrence and graft failure. • Successful reconstructions were defined as stable allograft function with unobstructed outflow not requiring repeat dilation, ureterotomy or stent placement. Results • Median age at the time of reconstruction was 51 years and the mean time from transplantation was 62 months. • Seven of the 13 patients had failed previous balloon dilation. • The patients were followed for a median of 41 months and a successful repair was achieved in 10 of 13 patients. • Ureteral strictures recurred in two patients who received ureteroneocystostomies, which were subsequently managed with chronic stent exchanges. • Another recurrence involved a 1.5-cm anastomotic stricture 6 months postoperatively, which was balloon-dilated and has remained recurrence-free for 16 months. Conclusions • Patients who present > 6 months after renal transplantation with ureteral strictures that are recalcitrant to endoscopic management can safely undergo open surgical ureteral reconstruction without subsequent renal or graft failure. • Further investigation involving a larger patient cohort is required to confirm these initial results.

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVES To present our operative and postoperative functional outcomes of sutured compared with endovascular staple ligation of the dorsal venous complex (DVC) during robot-assisted laparoscopic radical prostatectomy (RALP). Ligation of the DVC during RALP with an endovascular stapler has purported advantages of decreased apical positive surgical margin (PSM) rate, blood loss, and operative time when compared with suture ligation. PATIENTS AND METHODS In all, 162 patients who underwent RALP between October 2005 and April 2008 by one surgeon (R.B.N.) were assessed. We retrospectively analysed two different treatment groups: group 1 underwent DVC ligation with a single suture, while group 2 underwent endovascular staple ligation. RESULTS Of the 162 patients evaluated, 67 had suture ligation (group 1) and 95 had staple ligation (group 2) of the DVC. Baseline patient characteristics (age, body mass index, biopsy Gleason score, clinical stage) and tumour characteristics (specimen weight, tumour volume, pathological Gleason score and stage) did not differ between the groups. Estimated blood loss (494 mL vs 288 mL), time to dissect out, ligate and transect the DVC (30 min vs 24 min), apical PSM rate (13.4% vs 2.1%) differed significantly between groups 1 and 2 respectively, favouring staple ligation of the DVC. At 6 months follow-up, there was no difference between the groups for PSA recurrence (3.7% vs 0%), complete continence (63.4% vs 55.7%) and Sexual Health Inventory for Men score (8.4 vs 8.6). CONCLUSIONS In the present study, staple ligation of the DVC during RALP resulted in improved apical PSM rates, faster operative times and less blood loss.

OBJECTIVE To compare the outcomes between patients with stage T1a/b with those of patients with T1c cancer of the prostate treated with radical retropubic prostatectomy (RRP), as the appropriate management of clinical stage T1a/b prostate cancer is subject to debate; although many patients are managed expectantly, some have adverse pathological features suggesting that more active treatment might be beneficial. PATIENTS AND METHODS From 1983 to 2003, 3478 men had RRP by one surgeon. From this group, we retrospectively identified 29 men with clinical stage T1a and 83 with clinical stage T1b disease. Using statistical analysis we compared the treatment outcomes of these patients with those of 1774 men with clinical stage T1c disease. RESULTS Men with T1a/b disease had a significantly lower preoperative prostate-specific antigen (PSA) level, a greater proportion with organ-confined disease, and a lower mean/median prostatectomy Gleason score than those with T1c disease. Also, men with T1a/b disease were less likely to be potent before surgery, although the frequency of recovery of potency was similar among all groups. On multivariate analysis with age, year of surgery, PSA level and Gleason score, there was no statistical difference in the rates of biochemical recurrence and the 10-year overall survival rates. However, patients with T1b disease had a significantly lower cancer-specific survival. CONCLUSIONS T1a and T1b prostate cancer can be associated with aggressive pathological features and have a similar rate of progression as clinical stage T1c disease. That notwithstanding, most patients in the study were cured with RRP and had favourable long-term functional outcomes.

OBJECTIVE To describe the surgical outcomes and operative technique for reconstructing catheter-induced urethral erosion in men with a neurogenic bladder. PATIENTS AND METHODS This was a prospective study of 11 men (median age 45 years, range 26–52) who had elective urethroplasty for urethral erosion between 2004 and 2007 by one surgeon (C.M.G.). All men had a diagnosis of neurogenic bladder and indwelling catheter-induced urethral erosion. Reconstructive techniques included primary closure in six men, substitution urethroplasty with a penile skin graft in three, penile skin flap in one and a buccal mucosa graft in one. A two-stage approach was used in one man. RESULTS The median (range) length of erosion from the meatus before surgery was 6 (4–10) cm. The repair was successful in seven men at a mean (range) follow-up of 25 (8–46) months. Of those with recurrence of erosion, the median length of the resultant defect was 2 (2–3) cm. All recurrences were in the first five patients of this series. The median time to recurrence of erosion was 1 month and recurrence did not appear to be related to any particular surgical technique. Urethral catheter traction after surgery appeared to be one of the factors related to repair breakdown. CONCLUSION The reconstruction of catheter-induced urethral erosion in men with a neurogenic bladder is feasible. Primary closure appears to be the best reconstructive method for urethral erosion, and avoiding catheter traction after surgery contributes to successful urethroplasty.

included cystitis and/or recurrent pyelonephritis. Both arms of the study showed excellent cure rates, with more than 96% of patients demonstrating cure with either 7 or 14-day treatment course. Community acquired acute pyelonephritis in women can be treated with a 7-day course of ciprofloxacin. This observation was first made by Talan et al in 2000, although this study broadens these observations substantially by evaluating the efficacy of 7 days of ciprofloxacin in a much broader age range, including young and older women.

To describe the incidence and clinical outcomes of seminal vesicle invasion (SVI) at salvage radical prostatectomy (SRP) and to describe the accuracy of SV biopsy. As SRP is used after biochemical recurrence (BCR) of prostate cancer after radiotherapy (RT) to gain local oncological control. The SVs receive lower doses of radiation from external-beam RT (EBRT) to avoid rectal exposure and are not targeted with brachytherapy (BT) with low-risk prostate cancer.SRP was performed on 206 men with BCR after RT at a tertiary care institution between 1998 and 2011. Post-RT biopsy and SRP specimens were reviewed by a genitourinary pathologist.SVI was detected in 65 (32%) of 206 patients. No difference was found between EBRT alone (65% vs 63%) and BT (29% vs 31%) with or without EBRT in patients with SVI. Men with SVI had higher rates of cT3 disease (20% vs 8%) and Gleason score ≥ 8 at SRP (52% vs 21%). BCR-free survival at 5 years was 18% and 56% in patients with and without SVI (hazard ratio 2.85, 95% confidence interval 1.87-4.36, P0.001), yet the rate of local recurrence was low (11%). Prostate cancer was identified in nine of 18 patients who underwent SV biopsy and was the only location of prostate cancer in two patients.SVI is a prognostic indicator for BCR after SRP, but local recurrence in patients with SVI after SRP remains low. We recommend SV biopsy to improve staging and cancer detection in men with BCR after radiotherapy.

To determine whether post-radiotherapy (RT) biopsy (PRB) adequately predicts the presence, location, and histological features of cancer in the salvage radical prostatectomy (SRP) specimen. Before salvage treatment, a PRB is required to confirm the presence of locally recurrent or persistent cancer and to determine the extent and location of the prostate cancer.SRP was performed between 1998 and 2011 on 198 patients. All patients underwent a PRB. PRB and SRP specimens were evaluated by a genitourinary pathologist. Patients had external-beam RT alone (EBRT; 71%) or brachytherapy with or without EBRT (29%).Of the men undergoing SRP, 26 (14%) were clinical stage ≥T3, with 13% of PRBs with Gleason score ≥8. Cancer was unilateral in 120 (61%) biopsies, with contralateral or bilateral prostate cancer at SRP in 49%. In the SRP specimen, cancer was multifocal in 57%. Cancer was upgraded at SRP in 58% of men, with 20% having an increase in primary Gleason grade. The accuracy of PRB varied by region from 62% to 76%, with undetected cancers ranging from 12% to 26% and most likely to occur at the mid-gland.Radiation-recurrent prostate cancers were often multifocal, and biopsy missed up to 20% of tumours. More than half of the cancers were upgraded at SRP, and many that were unilateral on PRB were bilateral at SRP.

To describe the pathological outcomes of patients with muscle-invasive micropapillary bladder cancer who have undergone neoadjuvant chemotherapy.A total of 82 patients with muscle-invasive micropapillary bladder cancer were treated between 1997 and 2010. After excluding those with metastatic disease, micropapillary histology only at radical cystectomy (RC), and chemo-radiation as primary treatment, 44 patients remained. All patients had ≥cT2 disease before chemotherapy/surgery. The median follow-up after RC was 28 months. Neoadjuvant chemotherapy was initiated in 29 (66%) patients and all patients underwent RC (93%) or partial cystectomy (7%).Micropapillary histology was diagnosed at first transurethral resection in 37 (84%) patients. Final RC pathology revealed pT0 in 15 (34%) patients and positive lymph nodes in 13 (31%) patients. Down-staging to pT0 occurred in 13 (45%) of those who received neoadjuvant chemotherapy compared with two (13%) of those who did not (P = 0.049). Patients with pT0 disease with micropapillary histology had higher overall survival rates (25 vs. 92%) and lower rates of bladder cancer recurrence (21 vs. 79%) at the 24-month follow-up.Almost half of the patients responded completely to neoadjuvant chemotherapy with a pT0 rate of 45%; therefore, patients with the micropapillary variant of urothelial carcinoma should not be excluded from consideration for neoadjuvant chemotherapy.

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Infectious complication is a risk of bacille Calmette-Guérin instillation. Urine analysis in asymptomatic patients has been used as a measure to reduce infections. This study suggests that screening urine analysis prior to bacille Calmette-Guérin instillation did not affect the rate of urinary tract infections.• To discover if the routine use of urine analysis decreases the rate of urinary tract infection (UTI) complications after bacille Calmette-Guérin (BCG) administration.• A retrospective review of the outcomes of 202 patients undergoing BCG treatment for bladder cancer at two medical centres with different pre-BCG screening strategies was performed. • The medical records of 100 patients who received BCG by one urologist at Memorial Sloan-Kettering Cancer Center (MSKCC) were reviewed. No patient received a urine analysis immediately prior to BCG treatment. • Similarly, 102 patients who received BCG at Northwestern Memorial Hospital (NMH) were reviewed. Patients at NMH were screened by urine analysis for pyuria and bacteriuria before BCG treatment, and, if clinically indicated, BCG instillation was delayed for the results of the urine culture. • If the urine culture confirmed infection, then the patient was treated before restarting BCG instillation.• At MSKCC, 100 patients underwent 600 BCG treatments. • After BCG administration, symptomatic UTI occurred in three patients (3%), successfully treated with antibiotics. • No patients developed BCG sepsis or required hospitalization due to infection. • At NMH, 102 patients underwent 612 BCG treatments. • Pre-BCG urine analysis was positive for pyuria (defined as white blood cells5 per high-power field) in 27.8%, and positive for bacteriuria (defined as any bacteria on microscopy) in 18.1%. • Based on the results of pre-screening urine analysis, BCG instillation was delayed 15 times (2.5%). • Overall, three patients (3%) had culture-proven UTIs after BCG instillation. • No patients developed BCG sepsis or required hospitalization in either group and there were no significant differences in the frequency of UTIs.• Urine analysis can safely be omitted before administration of BCG in asymptomatic patients. • Omission of urine analysis could save time and expense during the office-based treatment of bladder cancer.

To use the national Surveillance, Epidemiology, and End Results (SEER) cancer registry to describe the natural history, national incidence and treatment patterns for ductal prostate cancer (PCa) over the last 20 years, as the available literature on ductal PCa is limited to small case series because of few patient numbers.From the SEER registry, 693 men with ductal PCa were identified from 1970. The demographics, clinical features and cause of death data were collected from men with ductal and acinar histological types.The incidence of ductal PCa has increased over each decade, but the overall percentage of ductal relative to acinar PCa has remained stable. Men with ductal PCa were more likely to present with advanced disease (30% T3 with ductal PCa, compared with 7% with acinar PCa). Men with ductal PCa underwent similar rates of radical surgery, lower rates of radiotherapy but a higher frequency of outlet (transurethral resection) procedures. Men with ductal PCa had a significantly greater rate of death from PCa (12% vs 4%) than men with acinar PCa. Comparing PCa-specific mortality, men with ductal PCa had similar rates of death to men with Gleason 4 + 4 grade acinar PCa.Despite a stable incidence, ductal PCa remains an aggressive PCa usually presenting with advanced clinical stage and resulting in a high rate of PCa-specific mortality similar to Gleason 4 + 4 acinar PCa. Patients would probably benefit from combined modalities including radical surgery, radiotherapy and palliative outlet procedures.

• Urethral strictures located in the fossa navicularis are common and are often managed with meatotomy or meatoplasty. • Few data have described the outcomes for men after urethroplasty or patient satisfaction following these procedures.• In all, 93 men at two different institutions underwent surgical repair of distal urethral stricture disease using meatotomy (73) or meatoplasty (20), with 13/20 (65%) of the latter group undergoing substitution urethroplasty. • In patients with lichen sclerosus (LS), all involved tissue was excised prior to reconstruction. • In a subset of men undergoing meatotomy, patient satisfaction was evaluated by questionnaire.• Average clinical follow-up for men undergoing distal urethroplasty was 61 months. • Successful reconstruction requiring no further intervention occurred in 84% of men overall. Subgroup analysis revealed success in 87% of men with meatotomy, 75% with meatoplasty and 66% with substitution urethroplasty. • Men with LS had a significantly greater rate of stricture recurrence (20.5% vs 7.5%, P= 0.04). • Of the subset of men who completed a patient-based questionnaire 84% reported they were either satisfied or very satisfied with the results of their meatotomy.• We report the success of distal urethral stricture management. • Meatal strictures may be approached successfully in a stepwise manner progressing from meatotomy to meatoplasty for longer recurrent strictures, with a high overall success rate for meatotomy. • Although substitution grafts may be useful for men with longer distal strictures and those with LS, the risk of recurrence was significantly higher in this cohort.

• To describe our experience with surgical management of transplant ureteral strictures over a 6-year period.• The present study identified patients who underwent open reconstruction for transplant ureteral strictures between March 2002 and May 2008 after kidney or kidney-pancreas transplantation. • Baseline clinical characteristics were documented, including age at transplantation and reconstruction, serum creatinine levels, immunosuppressive drug regimen, and comorbidities. • Postoperative complications were noted, including urinary tract infections, stricture recurrence and graft failure. • Successful reconstructions were defined as stable allograft function with unobstructed outflow not requiring repeat dilation, ureterotomy or stent placement.• Median age at the time of reconstruction was 51 years and the mean time from transplantation was 62 months. • Seven of the 13 patients had failed previous balloon dilation. • The patients were followed for a median of 41 months and a successful repair was achieved in 10 of 13 patients. • Ureteral strictures recurred in two patients who received ureteroneocystostomies, which were subsequently managed with chronic stent exchanges. • Another recurrence involved a 1.5-cm anastomotic stricture 6 months postoperatively, which was balloon-dilated and has remained recurrence-free for 16 months.• Patients who present6 months after renal transplantation with ureteral strictures that are recalcitrant to endoscopic management can safely undergo open surgical ureteral reconstruction without subsequent renal or graft failure. • Further investigation involving a larger patient cohort is required to confirm these initial results.

To present our operative and postoperative functional outcomes of sutured compared with endovascular staple ligation of the dorsal venous complex (DVC) during robot-assisted laparoscopic radical prostatectomy (RALP). Ligation of the DVC during RALP with an endovascular stapler has purported advantages of decreased apical positive surgical margin (PSM) rate, blood loss, and operative time when compared with suture ligation.In all, 162 patients who underwent RALP between October 2005 and April 2008 by one surgeon (R.B.N.) were assessed. We retrospectively analysed two different treatment groups: group 1 underwent DVC ligation with a single suture, while group 2 underwent endovascular staple ligation.Of the 162 patients evaluated, 67 had suture ligation (group 1) and 95 had staple ligation (group 2) of the DVC. Baseline patient characteristics (age, body mass index, biopsy Gleason score, clinical stage) and tumour characteristics (specimen weight, tumour volume, pathological Gleason score and stage) did not differ between the groups. Estimated blood loss (494 mL vs 288 mL), time to dissect out, ligate and transect the DVC (30 min vs 24 min), apical PSM rate (13.4% vs 2.1%) differed significantly between groups 1 and 2 respectively, favouring staple ligation of the DVC. At 6 months follow-up, there was no difference between the groups for PSA recurrence (3.7% vs 0%), complete continence (63.4% vs 55.7%) and Sexual Health Inventory for Men score (8.4 vs 8.6).In the present study, staple ligation of the DVC during RALP resulted in improved apical PSM rates, faster operative times and less blood loss.

OBJECTIVES To assess the outcomes of elderly men with prostate cancer treated with robot-assisted radical prostatectomy (RARP), because more healthy elderly men will present with localized prostate cancer and many will seek surgical treatment as the population ages. PATIENTS AND METHODS Between 2005 and 2008, 203 men had RARP performed by one surgeon; patients were categorized into two groups based on their age (≥70 vs

OBJECTIVE To report our experience with ligation of the bulbar urethra for treating refractory stress incontinence in a selected group of young men with neuropathic bladders secondary to myelomeningocele (MM), in whom primary anti-incontinence procedures had failed. PATIENTS AND METHODS Persistent urethral incontinence leading to chronic perineal skin ulceration can occur in these patients, despite aggressive medical and surgical efforts to decrease wetting by increasing bladder capacity, compliance and outlet resistance. Four young men with MM had bulbar urethral ligation; all had undergone a previous ileocystoplasty and functioning continent catheterizable channels (CCC, three appendicovesicostomies, one Monti procedure). Three patients had primary bladder neck procedures using rectus fascia slings, and secondary attempts were made at urethral bulking in two patients. All patients had persistent incontinence through their native urethra, with dry intervals of