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Objectives Patients and Methods Results Conclusion To assess the comparative effectiveness of robot‐assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) vs open radical cystectomy (ORC) for bladder cancer (BC).We conducted a real‐life monocentric study including all consecutive patients who underwent RARC with ICUD or ORC for BC at our institution from 2014 to 2023. Uni‐ and multivariable logistic and Cox regression analyses were used to compare perioperative, oncological and stricture outcomes between both groups by calculating odds (ORs) and hazard (HRs) ratios with their corresponding 95% confidence intervals (CIs), respectively.Overall, 316 patients underwent either RARC with ICUD (n = 228 [72.2%]) or ORC (n = 88 [27.8%]). The perioperative benefits of RARC vs ORC included decreased risks of major blood loss (OR 0.10, 95% CI 0.04–0.23; P < 0.001), perioperative transfusion (OR 0.30, 95% CI 0.16–0.57; P < 0.001), 90‐day major complications (OR 0.56, 95% CI 0.29–0.99; P = 0.04), and prolonged initial length of hospital stay (OR 0.20, 95% CI 0.09–0.35; P < 0.001), as well as more days alive and out of the hospital within 90 days of surgery (OR 2.56, 95% CI 1.46–4.6; P < 0.01). In addition, the use of RARC vs ORC was associated with a higher lymph node (LN) count (OR 3.35, 95% CI 1.83–6.30; P < 0.001), while there was no significant difference in recurrence‐free (HR 0.72, 95% CI 0.49–1.07; P = 0.1), cancer‐specific (HR 0.69, 95% CI 0.43–1.10; P = 0.1), overall (HR 0.76, 95% CI 0.47–1.20; P = 0.3) and uretero‐ileal stricture‐free (HR 1.18, 95% CI 0.62–2.25; P = 0.6) survival between both groups after a median (interquartile range) follow‐up of 42.3 (16.4–73.8) months.Our real‐world study supports the effectiveness of RARC with ICUD vs ORC for BC. We generally observed better perioperative outcomes, as well as similar oncological—except for higher LN count—and uretero‐ileal stricture outcomes after RARC with ICUD vs ORC. [ABSTRACT FROM AUTHOR]

Objectives: To comprehensively compare quality-of-life (QoL) outcomes between open partial nephrectomy (OPN) and robot-assisted PN (RAPN) from the randomised ROBOtic-assisted versus Conventional Open Partial nephrectomy (ROBOCOP) II trial, as QoL data comparing OPN and RAPN are virtually non-existent, especially not from randomised controlled trials (RCTs)., Patients and Methods: The ROBOCOP II was a single-centre, open-label RCT between OPN and RAPN. The pre-planned analyses of QoL outcomes are presented. Data were analysed descriptively in a modified intention-to-treat population., Results: A total of 50 patients underwent surgery. At postoperative Day 90 (POD90), there was no significant difference for the Kidney Disease Quality of Life-Short Form questionnaire score (mean [sd] OPN 72 [20] vs RAPN 76 [15], P = 0.850), while there were advantages for RAPN in the subdomains of 'Pain' (P = 0.006) and 'Physical functioning' (P = 0.011) immediately after surgery. For the European Organisation for Research and Treatment of Cancer quality of life questionnaire 30-item core there were overall advantages directly after surgery (mean [sd] score OPN 63 [20] vs RAPN 75 [17], P = 0.031), as well as for the subdomains 'Fatigue' (P = 0.026), 'Pain' (P = 0.002) and 'Constipation' (P = 0.045) but no differences at POD90. There were no differences for the EuroQoL five Dimensions five Levels questionnaire at POD90 (mean [sd] score OPN 70 [22] vs RAPN 72 [17], P = 1.0) or at any other time point. Finally, no significant differences were found for the overall Convalescence and Recovery Evaluation questionnaire score at POD90 (mean [sd] OPN 84 [13] vs RAPN 86 [10], P = 0.818) but less pain in the RAPN group (P = 0.017) directly after surgery., Conclusions: Pain and physical functioning as subdomains of QoL are improved after RAPN compared to OPN in the early postoperative course, while there are no differences anymore after 3 months., (© 2024 The Author(s). BJU International published by John Wiley & Sons Ltd on behalf of BJU International.)

Objective: To assess histopathological outcomes, as well as feasibility and safety of targeted microwave ablation (TMA) via the Trinity® system (KOELIS, La Tronche, France)., Patients and Methods: Prospective, single-institution, interventional Phase IIa study with an 'ablate-and-resect' design. In all, 11 patients diagnosed with localised prostate cancer (PCa) underwent TMA via the Trinity system under conscious sedation in an outpatient setting using a single transrectal TATO® 18-G antenna with different treatment regimens. Magnetic resonance imaging (MRI) and robot-assisted radical prostatectomy (RARP) were conducted at 7 days and 1 month after TMA, respectively. Nine patients received RARP, and two patients chose to withdraw their consent following TMA. These men chose an active surveillance protocol upon confirmation of a low-risk prostate cancer diagnosis. Functional outcomes and adverse events were evaluated at baseline and follow-up visits using validated questionnaires. Prostate volumetry and confirmation of necrosis were carried out through MRI and whole-mount histopathological examination., Results: The TMA was successfully executed, and all patients were discharged on the same day. No severe adverse events (Common Terminology Criteria for Adverse Events Grade ≥3) were reported at the 7-day and 1-month follow-up visits. Additionally, no declines were observed in urinary, sexual and ejaculation functional outcomes. T1-weighted MRI revealed clear and well-defined ablation zones. The RARP was executed without difficulty, particularly during the dissection of the posterior plane. As a result, no intraoperative complications were encountered. Histopathological assessment on surgical specimens confirmed the absence of viable cells, indicating complete necrosis of the ablative zone if a power intensity >10 W was used during TMA. Ablation zone volumetry revealed no notable distinctions between the three-dimensional segmentation of the virtual ablation zone at TMA (median volume: 2 mL) and MRI (median volume: 1.923 mL). Conversely, a significant reduction was noted in the surgical specimen (median volume: 0.221 mL)., Conclusions: Targeted microwave ablation via the Trinity system for localised PCa treatment proves to be a secure and feasible procedure, with complete necrosis evidence within the ablation zone on surgical specimens., (© 2024 BJU International.)

Objectives: To assess the impact of the learning curve (LC) on perioperative and long-term functional outcomes of a consecutive single-centre series of robot-assisted radical cystectomy with Padua intracorporeal orthotopic neobladder., Patients and Methods: Patients treated between 2013 and 2022 were included, with ≥1 year of follow-up. The entire cohort was divided in tertiles. Categorical and continuous variables were compared. Joinpoint regression analysis was used to identify significant changes over the decade in linear slope of the 1-year day- and night-time continence. Uni- and multivariable Cox regression analyses identified predictors of day- and night-time continence recovery. Day-time continence was defined as 'totally dry' (no pads), night-time continence as pad wetness ≤50 mL (one safety pad)., Results: Overall, 200 patients were included. The mean hospital stay (P = 0.002) and 30-day complications (P = 0.04) significantly reduced over time; the LC significantly impacted on Trifecta achievement (P < 0.001). The 1-year day- and night-time continence probabilities displayed a significant improving trend (day-time continence annual average percentage change [AAPC] 11.45%, P < 0.001; night-time continence AAPC 10.05%, P = 0.009). The LC was an independent predictor of day- (hazard ratio [HR] 1.008; P < 0.001) and night-time continence (HR 1.004; P = 0.03) over time., Conclusion: Patients at the beginning of the LC had significantly longer hospitalisations, more postoperative complications, and lower Trifecta rates. At the 10-year analyses, we observed a significant improving trend for both the 1-year day- and night-time continence probabilities, highlighting the crucial role of the LC. However, we are unable to assess the case volume needed to achieve a plateau in terms of day- and night-time continence rates., (© 2024 BJU International.)

Objective: To report a single‐institution experience with totally intracorporeal neobladder urinary diversion (UD) after robot‐assisted laparoscopic radical cystectomy (RARC). Patients and methods: A total of 158 patients underwent totally intracorporeal neobladder UD after RARC between 2003 and 2016. Patient demographics, intraoperative and pathological data, 30‐ and 90‐day perioperative mortality and complications were recorded. Complications were classified according to the modified Clavien–Dindo classification. The 5‐year overall (OS) and cancer‐specific survival (CSS) rates were estimated by Kaplan–Meier plots. Results: Most of the patients were male (84%) and had clinical T Stage ≤2 (87%). The mean operation time was 359 (SD ±98) min, with a median (range) estimated blood loss of 300 (50–2200) mL. Most of the men (86%) received a nerve‐sparing procedure and 38% of the females an organ‐sparing approach. A lymph node dissection was performed in 156 (99%) patients, with a median (range) yield of 23 (7–48) nodes. Conversion to open surgery occurred in five patients (3%). We recorded negative margins in 156 patients (99%). The median (range) follow‐up was 34 (1–170) months, with 30‐ and 90‐day mortality rates of 0%. Clavien–Dindo Grade III–IV complications occurred in 29 of 158 (18%) patients at 30‐days and in eight of 158 (5%) between 30–90 days, resulting into a 90‐day overall high‐grade complication rate of 23%. The unadjusted estimated 5‐years recurrence‐free survival, CSS and OS rates were 70%, 72%, and 71%, respectively. Conclusion: In our present series the complication and oncological results were similar to open RC series, suggesting that RARC followed by totally intracorporeal neobladder UD is a safe and feasible alternative. [ABSTRACT FROM AUTHOR]

Objective: To introduce a modified sequential vascular control strategy, mimicking the open 'milking' technique principle, for the early release of the first porta hepatis (FPH) and to stop cardiopulmonary bypass (CPB) in level III–IV robot‐assisted inferior vena cava (IVC) thrombectomy (RA‐IVCTE). Patients and methods: From November 2014 to June 2019, 27 patients with a level III–IV IVC tumour thrombus (IVCTT) underwent RA‐IVCTE in our department. The modified sequential control strategy was used in 12 cases. Previously, we released the FPH after the thrombus was resected and the IVC was closed completely, and CPB was stopped at the end of surgery (15 patients). Presently, using our modified strategy, we place another tourniquet inferior to the second porta hepatis (SPH) once the proximal thrombus is removed from the IVC below the SPH. Then, we suture the right atrium and perform early release of the FPH, and stop CPB. Finally, tumour thrombectomy, vascular reconstruction, and radical nephrectomy are performed. Results: Compared with the previous strategy, the modified steps resulted in a shorter median FPH clamping (19 vs 47 min, P < 0.001) and CPB times (60 vs 87 min, P < 0.05); a lower rate of Grade II–IV perioperative complications (25% vs 60%, P < 0.05); and better postoperative hepatorenal and coagulation function, including better median serum alanine aminotransferase (172.7 vs 465.4 U/L, P < 0.001), aspartate aminotransferase (282.4 vs 759.8 U/L, P < 0.001), creatinine (113.4 vs 295 μmol/L, P < 0.01), blood urea nitrogen (7.3 vs 16.7 mmol/L, P < 0.01), and D‐dimer (5.9 vs 20 mg/L, P < 0.001) levels. Conclusion: With the early release of the FPH and stopping CPB, the modified sequential vascular control strategy in level III–IV RA‐IVCTE reduced the perioperative risk for selected patients and improved the feasibility and safety of the surgery. We would recommend this approach to other centres that plan to develop robotic surgery for renal cell carcinoma with level III–IV IVCTT in the future. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effects of surgeon experience, body habitus, and bony pelvic dimensions on surgeon performance and patient outcomes after robot‐assisted radical prostatectomy (RARP). Patients, Subjects and Methods: The pelvic dimensions of 78 RARP patients were measured on preoperative magnetic resonance imaging and computed tomography by three radiologists. Surgeon automated performance metrics (APMs [instrument motion tracking and system events data, i.e., camera movement, third‐arm swap, energy use]) were obtained by a systems data recorder (Intuitive Surgical, Sunnyvale, CA, USA) during RARP. Two analyses were performed: Analysis 1, examined effects of patient characteristics, pelvic dimensions and prior surgeon RARP caseload on APMs using linear regression; Analysis 2, the effects of patient body habitus, bony pelvic measurement, and surgeon experience on short‐ and long‐term outcomes were analysed by multivariable regression. Results: Analysis 1 showed that while surgeon experience affected the greatest number of APMs (P < 0.044), the patient's body mass index, bony pelvic dimensions, and prostate size also affected APMs during each surgical step (P < 0.043, P < 0.046, P < 0.034, respectively). Analysis 2 showed that RARP duration was significantly affected by pelvic depth (β = 13.7, P = 0.039) and prostate volume (β = 0.5, P = 0.024). A wider and shallower pelvis was less likely to result in a positive margin (odds ratio 0.25, 95% confidence interval [CI] 0.09–0.72). On multivariate analysis, urinary continence recovery was associated with surgeon's prior RARP experience (hazard ratio [HR] 2.38, 95% CI 1.18–4.81; P = 0.015), but not on pelvic dimensions (HR 1.44, 95% CI 0.95–2.17). Conclusion: Limited surgical workspace, due to a narrower and deeper pelvis, does affect surgeon performance and patient outcomes, most notably in longer surgery time and an increased positive margin rate. [ABSTRACT FROM AUTHOR]

Objectives: To predict urinary continence recovery after robot‐assisted radical prostatectomy (RARP) using a deep learning (DL) model, which was then used to evaluate surgeon's historical patient outcomes. Subjects and Methods: Robotic surgical automated performance metrics (APMs) during RARP, and patient clinicopathological and continence data were captured prospectively from 100 contemporary RARPs. We used a DL model (DeepSurv) to predict postoperative urinary continence. Model features were ranked based on their importance in prediction. We stratified eight surgeons based on the five top‐ranked features. The top four surgeons were categorized in 'Group 1/APMs', while the remaining four were categorized in 'Group 2/APMs'. A separate historical cohort of RARPs (January 2015 to August 2016) performed by these two surgeon groups was then used for comparison. Concordance index (C‐index) and mean absolute error (MAE) were used to measure the model's prediction performance. Outcomes of historical cases were compared using the Kruskal–Wallis, chi‐squared and Fisher's exact tests. Results: Continence was attained in 79 patients (79%) after a median of 126 days. The DL model achieved a C‐index of 0.6 and an MAE of 85.9 in predicting continence. APMs were ranked higher by the model than clinicopathological features. In the historical cohort, patients in Group 1/APMs had superior rates of urinary continence at 3 and 6 months postoperatively (47.5 vs 36.7%, P = 0.034, and 68.3 vs 59.2%, P = 0.047, respectively). Conclusion: Using APMs and clinicopathological data, the DeepSurv DL model was able to predict continence after RARP. In this feasibility study, surgeons with more efficient APMs achieved higher continence rates at 3 and 6 months after RARP. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate automated performance metrics (APMs) and clinical data of experts and super‐experts for four cardinal steps of robot‐assisted radical prostatectomy (RARP): bladder neck dissection; pedicle dissection; prostate apex dissection; and vesico‐urethral anastomosis. Subjects and Methods: We captured APMs (motion tracking and system events data) and synchronized surgical video during RARP. APMs were compared between two experience levels: experts (100–750 cases) and super‐experts (2100–3500 cases). Clinical outcomes (peri‐operative, oncological and functional) were then compared between the two groups. APMs and outcomes were analysed for 125 RARPs using multi‐level mixed‐effect modelling. Results: For the four cardinal steps selected, super‐experts showed differences in select APMs compared with experts (P < 0.05). Despite similar PSA and Gleason scores, super‐experts outperformed experts clinically with regard to peri‐operative outcomes, with a greater lymph node yield of 22.6 vs 14.9 nodes, respectively (P < 0.01), less blood loss (125 vs 130 mL, respectively; P < 0.01), and fewer readmissions at 30 days (1% vs 13%, respectively; P = 0.02). A similar but nonsignificant trend was seen for oncological and functional outcomes, with super‐experts having a lower rate of biochemical recurrence compared with experts (5% vs 15%, respectively; P = 0.13) and a higher continence rate at 3 months (36% vs 18%, respectively; P = 0.14). Conclusion: We found that experts and super‐experts differed significantly in select APMs for the four cardinal steps of RARP, indicating that surgeons do continue to improve in performance even after achieving expertise. We hope ultimately to identify associations between APMs and clinical outcomes to tailor interventions to surgeons and optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To compare the oncological outcomes of percutaneous cryoablation (PCA) vs robot‐assisted partial nephrectomy (RAPN) for the treatment of T1 renal tumours. Patients and Methods: We conducted a retrospective study in all patients treated by RAPN or PCA for malignant renal tumours in one of four centres between 2009 and 2016. Tumours were paired one by one using radiological tumour stage and RENAL nephrometry score (package matchit, R software version 3.2.2). Malignancy was confirmed by biopsy for all patients in the PCA group. Patient characteristics before and after matching and oncological results were compared between the two groups. Cox regression, adjusted for age, treatment type, histological type and margins, was used to identify factors associated with time to local recurrence. Positive margins were defined histologically in the RAPN group and radiologically in the PCA group. Results: A total of 647 patients were identified; 470 underwent RAPN and 177 underwent PCA. After matching, there was no significant difference between the two groups (RAPN, n = 177; PCA, n = 177) with regard to tumour stage, RENAL nephrometry score, tumour size (27.6 vs 25.9 mm; P = 0.07) and gender ratio. Patients in the PCA group remained significantly older (69.9 vs 59.8 years; P < 0.001). The absolute recurrence rate was 2.8% in the RAPN group vs 8.4% in the PCA group (P = 0.03). The 5‐year recurrence‐free survival rate was 85% in the PCA group vs 95% in the RAPN group (log‐rank P = 0.02). In multivariate analysis, the presence of positive margins and the type of treatment were the two factors significantly associated with local recurrence (P < 0.001 and P = 0.046, respectively). Conclusion: The local recurrence rate after PCA was significantly higher than after RAPN for T1 renal tumours. Incomplete treatment was the main criterion associated with recurrence. The recurrence rate may have been overestimated in the PCA group because of closer radiological follow‐up in these patients. [ABSTRACT FROM AUTHOR]

Objective: To report the development of the first robot‐assisted kidney transplantation (RAKT) programme from deceased donors, examining technical feasibility and early perioperative and functional outcomes at a referral academic centre. Patients and Methods: A RAKT programme was developed in 2016 at our institution following structured modular training. Specific inclusion/exclusion criteria for both living and deceased donors were set. Data from patients undergoing RAKT from January 2017 to April 2018 were prospectively collected in an a priori developed web‐based data set. RAKT followed the principles of the Vattikuti Urology Institute–Medanta technique, with specific technical modifications based on clinical recipient characteristics, as well as surgeon's skills and preference during the learning curve. Technical feasibility of RAKT from deceased donors and evaluation of perioperative and early functional outcomes were the main study endpoints. Results: In all, 17 RAKTs were performed during the study period. Of these, six were from living donors and 11 were from deceased donors. All RAKTs were successfully completed without need of conversion. The median (interquartile range [IQR]) console time was 190 (160–220) min and the median (IQR) estimated blood loss was 120 (110–140) mL. The median times to complete venous, arterial and uretero–vesical anastomoses were 21, 22 and 21 min, respectively. The median (IQR) length of stay was 8 (6–12) days. At a median (IQR) follow‐up of 8 (6–11) months, five (30%) complications were recorded. Of these, four (24%) were minor (Clavien–Dindo Grade I–II) and one major (Clavien–Dindo Grade IIIb, requiring graft nephrectomy). Overall, two patients were still on dialysis at last follow‐up. A significant improvement in graft function was recorded progressively at all postoperative time points. Conclusion: Our preliminary experience outlines that: (i) the development of a RAKT programme is feasible in centres experienced in robotic surgery and open kidney transplantation; (ii) RAKT from deceased donors is feasible from both a technical and logistical perspective; and (iii) RAKT from deceased donors appears to achieve favourable early postoperative and functional outcomes. Larger studies with longer follow‐up are needed to confirm these findings and compare the outcomes of RAKT from deceased donors with those from living donors. [ABSTRACT FROM AUTHOR]

Objective To compare perioperative and functional outcomes of patients with cT1a or cT1b renal masses undergoing robotic partial nephrectomy ( RPN) in a large multi-institutional study Patients and Methods The present retrospective Institutional Review Board-approved multi-institutional study utilised a prospectively maintained database to identify patients undergoing RPN by six surgeons for a solitary cT1a ( n = 1 307) or cT1b ( n = 377) renal mass from 2006 to 2016. Perioperative and renal function outcomes at discharge and at a median follow-up of 12.2 months were compared in univariable and multivariable regression analyses adjusting for surgeon performing the procedure and date of surgery. Results In univariable analysis, cT1b masses were associated with longer operative time (190.0 vs 159.0 min, P < 0.001), longer warm ischaemia time (18.8 vs 15.0 min, P < 0.001), higher estimated blood loss (150.0 vs 100.0 mL, P < 0.001), more intraoperative complications (5.6% vs 2.4%, P = 0.034), and more surgical postoperative complications (10.1% vs 5.7%, P =0.002). Results were similar in multivariable analysis with additional findings including more overall postoperative complications (odds ratio 1.55, P = 0.015) and longer length of stay ( P < 0.001) associated with cT1b masses. There were no differences in the risk of progression of chronic kidney disease stage at 12.2 months, positive surgical margins, or major postoperative complications. Conclusions Although our study shows a longer operative time, longer warm ischemia time, and higher complication rate for patients undergoing RPN for cT1b renal masses, the magnitude of these differences is small. RPN should be considered for cT1b lesions when anatomical and spatial location allow for a feasible procedure. [ABSTRACT FROM AUTHOR]

Objectives To assess the feasibility of radical perineal cystoprostatectomy using the latest generation purpose-built single-port robotic surgical system. Materials and Methods In two male cadavers the da Vinci® SP1098 Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) was used to perform radical perineal cystoprostatectomy and bilateral extended pelvic lymph node dissection ( ePLND). New features in this model include enhanced high-definition three-dimensional optics, improved instrument manoeuvrability, and a real-time instrument tracking and guidance system. The surgery was accomplished through a 3-cm perineal incision via a novel robotic single-port system, which accommodates three double-jointed articulating robotic instruments, an articulating camera, and an accessory laparoscopic instrument. The primary outcomes were technical feasibility, intraoperative complications, and total robotic operative time. Results The cases were completed successfully without conversion. There were no accidental punctures or lacerations. The robotic operative times were 197 and 202 min. Conclusions In this preclinical model, robotic radical perineal cystoprostatectomy and ePLND was feasible using the SP1098 robotic platform. Further investigation is needed to assess the feasibility of urinary diversion using this novel approach and new technology. [ABSTRACT FROM AUTHOR]

Objectives To compare optimum outcome achievement in open partial nephrectomy (OPN) with that in robot-assisted partial nephrectomy (RAPN). Patients and methods Using our institutional partial nephrectomy (PN) database, we reviewed 605 cases performed for unifocal clinical T1 renal masses in non-solitary kidneys between 2011 and 2015. Tetrafecta, which was defined as negative surgical margins, freedom from peri-operative complications, ≥80% renal function preservation, and no chronic kidney disease upstaging, was chosen as the composite optimum outcome. Factors associated with tetrafecta achievement were assessed using multivariable logistic regression, with adjustment for age, gender, race, Charlson comorbidity score, body mass index, chronic kidney disease, tumour size, tumour complexity and approach. Results The overall tetrafecta achievement rate was 38%. Negative margins, freedom from complications, and optimum functional preservation were achieved in 97.1%, 73.6% and 54.2% of cases, respectively. For T1a masses, the tetrafecta achievement rate was similar between approaches (P = 0.97), but for T1b masses, the robot-assisted approach achieved significantly higher tetrafecta rates (43.0% vs 21.3%; P < 0.01). On multivariable analysis, the robot-assisted approach had 2.6-fold higher odds of tetrafecta achievement than the open approach, primarily because of lower peri-operative morbidity, specifically related to wound complications. Positive surgical margin rates and renal function preservation were similar in the two approaches. Conclusions Optimum outcomes are readily achieved regardless of PN approach. The robot-assisted approach may facilitate optimum outcome achievement for 4-7-cm masses by minimizing wound complications. [ABSTRACT FROM AUTHOR]

To assess the health-related quality of life (HRQoL) of patients with prostate cancer up to 24 months after treatment in a contemporary large diverse population. Patients and Methods Patients with newly diagnosed prostate cancer from March 2011 to January 2014 in our healthcare system were included. The Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire was administered before treatment, and at 1, 3, 6, 12, 18, and 24 months after treatment up to November 2014 for all methods of treatment. The Kruskall-Wallis test was used to compare the distribution of each EPIC-26 domain score at each time point, and mixed models were used to assess the overall scores over the period after treatment. Results In all, 5 727 patients were included. There were data for 3 422, 2 329, 2 017, 1 922, 1 772, 1 260, and 837 patients before treatment, and at 1, 3, 6, 12, 18, and 24 months after treatment, respectively. At 1 month, bowel scores were the lowest for patients that had had radiation therapy, and urinary irritative symptoms were the lowest for those who had had brachytherapy. There were sexual function declines for all the treatment methods, with surgery having the steepest decline; open radical prostatectomy (ORP) had a greater decline than robot-assisted laparoscopic prostatectomy (RALP). Patients who underwent RALP had a better return of sexual function, approaching that of brachytherapy and radiation therapy at 24 months. Urinary incontinence (UI) also declined the most in surgical patients, with RALP patients improving slightly more than ORP patients at 12–24 months. Conclusions Patients' HRQoL after prostate cancer treatment varies by treatment method. Notably, sexual function recovers most for RALP patients. UI remains worse at 24 months after surgery, compared to other methods of prostate cancer treatment. [ABSTRACT FROM AUTHOR]

Objectives To assess the impact of approach on surgical outcomes in otherwise healthy obese patients undergoing partial nephrectomy for small renal masses. Patients and Methods Using our institutional partial nephrectomy database, we abstracted data on otherwise healthy (Charlson comorbidity score ≤1 and bilateral kidneys), obese patients (body mass index >30 kg/m2) with small renal masses (<4 cm) treated between 2011 and 2015. The primary outcomes were intra-operative transfusion, operating time, length of hospital stay ( LOS), and postoperative complications. The association between approach, open ( OPN) vs robot-assisted partial nephrectomy ( RAPN), and outcomes was assessed by univariable and multivariable logistic regression analyses. Covariates included age, gender, obesity severity, tumour size and tumour complexity. Results Of 237 obese patients undergoing partial nephrectomy, 25% underwent OPN and 75% underwent RAPN. Apart from larger tumour size in the OPN group (2.8 vs 2.5 cm; P = 0.02), there was no significant difference between groups. The rate of intra-operative blood transfusion (1.1 vs 10%; P = 0.01), the median operating time (180 vs 207 min; P < 0.01) and the median ischaemia time (19.5 vs 27 min; P < 0.01) were all greater for OPN. The LOS was significantly shorter for RAPN (3 vs 4 days; P < 0.01). While the overall complication rate was higher for OPN (15.8 vs 31.7%; P < 0.01), major complications were not significantly different (5.6 vs 1.7%; P = 0.20). On multivariable analyses, OPN independently predicted longer operating time, longer length of stay, and more overall complications. Conclusions At a high-volume centre, the robot-assisted approach offers less blood transfusion, shorter operating time, faster recovery, and fewer peri-operative complications compared with the open approach in obese patients undergoing partial nephrectomy for small renal masses. In this setting, RAPN may be a preferable treatment option. [ABSTRACT FROM AUTHOR]

Objective To compare outcomes between robot-assisted partial nephrectomy ( RAPN) and open PN ( OPN) for completely endophytic renal tumours. Patients and Methods We retrospectively reviewed 1 230 consecutive cases, consisting of 823 RAPNs and 407 OPNs, performed for renal mass at a single academic tertiary centre between 2011 and 2016. Of these, data on 87 RAPN and 56 OPN cases for completely endophytic renal tumours were analysed. Patient and tumour characteristics, operative, postoperative, functional, and oncological outcomes were compared between groups. Results Apart from a higher prevalence of solitary kidney among OPN cases ( RAPN, 5.7% vs OPN, 21.4%; P = 0.005), demographic characteristics were similar between the groups. There were no statistically significant differences in tumour size ( P = 0.07), tumour stage ( P = 0.3), margin status ( P = 0.48), malignant tumour subtypes ( P = 0.51), and grades ( P = 0.61) between the groups. Also, there were no statistically significant differences among the groups for warm ischaemia time ( P = 0.15), cold ischaemia time ( P = 0.28), and intraoperative ( P = 0.75) or postoperative (Clavien-Dindo Grade I-V, P = 0.08; Clavien-Dindo Grade III-V, P = 0.85) complication rates. The patients in the RAPN group had a shorter length of stay ( P < 0.001), less estimated blood loss ( P < 0.001), and lower intraoperative transfusion rates (0% vs 7.1%, P = 0.02). No local recurrences occurred during a median (interquartile range) follow-up of 15.2 (7-27.2) and 18.1 (8.2-30.9) months in the RAPN and OPN groups, respectively. There was no difference in estimated glomerular filtration rate preservation rates between groups for the early ( P = 0.26) and latest ( P = 0.22) functional follow-up. Conclusion For completely endophytic renal tumours, both OPN and RAPN have excellent outcomes when performed by experienced surgeons at a high-volume centre. For skilled robotic surgeons, RAPN is a safe and effective alternative to OPN with the advantages of shorter length of stay and less blood loss. [ABSTRACT FROM AUTHOR]

Objectives: To develop a surgical technique to achieve greater depth of the neovaginal cavity in transgender patients undergoing scrotovaginoplasty, and to propose a method for restoring neovaginal integrity in case of lack of genital skin or reduction of the depth due to scarring after infections or ischaemic processes., Methods: Eight patients were selected to undergo scrotovaginoplasty with scrotal graft and peritoneal flap augmentation in one operating session as a modification of Zhao's original technique. The age of the patients ranged from 25 to 65 years. The first step of the procedure was standard penile inversion vaginoplasty, avoiding suturing of the superior side of the skin cylinder. The skin cylinder was pushed into the abdominal cavity through the perineal access. Afterwards a laparoscopic/robotic approach was used: a single peritoneal flap was harvested from the posterior bladder surface, incised, dissected, pedicled on the neovaginal dome, overturned and and sutured all-round to the neovagina. The sides were adapted to obtain a 'cul-de-sac'., Results: The average operating time was 6 ± 1.5 h, and patients' hospitalization lasted 6 days. There were no intra- or postoperative complications. Postoperative management was the same as that usually reported in BJUI for patients undergoing standard scrotovaginoplasty., Conclusions: The use of this technique represents a good solution for increasing neovaginal depth by harvesting a large peritoneal vascularized flap, without significantly affecting postoperative management or increasing complications, as frequently observed using the colovaginoplasty technique., (© 2022 BJU International.)

Objective: To determine whether proficiency-based progression (PBP) training leads to better robotic surgical performance compared to traditional training (TT), given that the value of PBP training for learning robotic surgical skills is unclear., Materials and Methods: The PROVESA trial is a multicentric, prospective, randomized and blinded clinical study comparing PBP training with TT for robotic suturing and knot-tying anastomosis skills. A total of 36 robotic surgery-naïve junior residents were recruited from 16 training sites and 12 residency training programmes. Participants were randomly allocated to metric-based PBP training or the current standard of care TT, and compared at the end of training. The primary outcome was percentage of participants reaching the predefined proficiency benchmark. Secondary outcomes were the numbers of procedure steps and errors made., Results: Of the group that received TT, 3/18 reached the proficiency benchmark versus 12/18 of the PBP group (i.e. the PBP group were ~10 times as likely to demonstrate proficiency [P = 0.006]). The PBP group demonstrated a 51% reduction in number of performance errors from baseline to the final assessment (18.3 vs 8.9). The TT group demonstrated a marginal improvement (15.94 vs 15.44) in errors made., Conclusions: The PROVESA trial is the first prospective randomized controlled trial on basic skills training in robotic surgery. Implementation of a PBP training methodology resulted in superior surgical performance for robotic suturing and knot-tying anastomosis performance. Compared to TT, better surgical quality could be obtained by implementing PBP training for basic skills in robotic surgery., (© 2022 BJU International.)