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Background: Three-dimensional (3D) models improve the comprehension of renal anatomy., Objective: To evaluate the impact of novel 3D-derived parameters, to predict surgical outcomes after robot-assisted partial nephrectomy (RAPN)., Design, Setting, and Participants: Sixty-nine patients with cT1-T2 renal mass scheduled for RAPN were included. Three-dimensional virtual modeling was achieved from computed tomography. The following volumetric and morphological 3D parameters were calculated: V T (volume of the tumor); V T /V K (ratio between tumor volume and kidney volume); CSA 3D (ie, contact surface area); UCS 3D (contact to the urinary collecting system); Tumor-Artery 3D : tumor's blood supply by tertiary segmental arteries (score = 1), secondary segmental artery (score = 2), or primary segmental/main renal artery (scoren = 3); S T (tumor's sphericity); Conv T (tumor's convexity); and Endophyticity 3D (ratio between the CSA 3D and the global tumor surface)., Intervention: RAPN with a 3D model., Outcome Measurements and Statistical Analysis: Three-dimensional parameters were compared between patients with and without complications. Univariate logistic regression was used to predict overall complications and type of clamping; linear regression was used to predict operative time, warm ischemia time, and estimated blood loss., Results and Limitations: Overall, 11 (15%) individuals experienced overall complications (7.2% had Clavien ≥3 complications). Patients with urinary collecting system (UCS) involvement at 3D model (UCS 3D  = 2), tumor with blood supply by primary or secondary segmentary arteries (Tumor-Artery 3D  = 1 and 2), and high Endophyticity 3D values had significantly higher rates of overall complications (all p ≤ 0.03). At univariate analysis, UCS 3D , Tumor-Artery 3D , and Endophyticity 3D are significantly associated with overall complications; CSA 3D and Endophyticity 3D were associated with warm ischemia time; and CSA 3D was associated with selective clamping (all p ≤ 0.03). Sample size and the lack of interobserver variability are the main limits., Conclusions: Three-dimensional modeling provides novel volumetric and morphological parameters to predict surgical outcomes after RAPN., Patient Summary: Novel morphological and volumetric parameters can be derived from a three-dimensional model to describe surgical complexity of renal mass and to predict surgical outcomes after robot-assisted partial nephrectomy., (Copyright © 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Background: No data are available regarding the impact of time between a previous transrectal prostate biopsy (PB) and holmium laser enucleation of the prostate (HoLEP) on perioperative outcomes., Objective: To evaluate the impact of time from PB to HoLEP on perioperative outcomes., Design, Setting, and Participants: A total of 172 consecutive patients treated with HoLEP within 12 mo of a single previous transrectal PB at two tertiary centers were included., Outcome Measurements and Statistical Analysis: Patients were stratified into two groups according to the median time from PB to HoLEP (namely, ≤6 and >6 mo). The primary outcome was intraoperative complications. Multivariate logistic regressions were used to identify the predictors of intraoperative complications. Linear regressions were used to test the association between the time from PB to HoLEP and intraoperative complications, enucleation efficiency, and enucleation time., Results and Limitations: In total, 93 (54%) and 79 (46%) patients had PB ≤ 6 and >6 mo before HoLEP, respectively. Patients in PB ≤ 6 mo group experienced higher rates of intraoperative complications than those in PB > 6 mo group (14% vs 2.6%, p = 0.04). At multivariable analysis, time between PB and HoLEP was an independent predictor of intraoperative complications (odds ratio: 0.74; 95% confidence interval: 0.6-0.9; p = 0.006). Finally, the risk of intraoperative complications reduced by 1.5%, efficiency of enucleation increased by 4.1%, and enucleation time reduced by 1.7 min for each month passed from PB to HoLEP (all p ≤ 0.006). Selection of patients with only one previous PB represents the main limitation., Conclusions: The time from PB to HoLEP of ≤6 mo is associated with a higher risk of intraoperative complications, lower enucleation efficacy, and longer enucleation time., Patient Summary: Patients with a prostate biopsy (PB) ≤6 mo before holmium laser enucleation of the prostate (HoLEP) had significantly worse outcomes than those with a PB > 6 mo before HoLEP., (Copyright © 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Background: Augmented reality (AR) is a novel technology adopted in prostatic surgery., Objective: To evaluate the impact of a 3D model with AR (AR-3D model), to guide nerve sparing (NS) during robot-assisted radical prostatectomy (RARP), on surgical planning., Design, Setting, and Participants: Twenty-six consecutive patients with diagnosis of prostate cancer (PCa) and multiparametric magnetic resonance imaging (mpMRI) results available were scheduled for AR-3D NS RARP., Intervention: Segmentation of mpMRI and creation of 3D virtual models were achieved. To develop AR guidance, the surgical DaVinci video stream was sent to an AR-dedicated personal computer, and the 3D virtual model was superimposed and manipulated in real time on the robotic console., Outcome Measurements and Statistical Analysis: The concordance of localisation of the index lesion between the 3D model and the pathological specimen was evaluated using a prostate map of 32 specific areas. A preliminary surgical plan to determinate the extent of the NS approach was recorded based on mpMRI. The final surgical plan was reassessed during surgery by implementation of the AR-3D model guidance., Results and Limitations: The positive surgical margin (PSM) rate was 15.4% in the overall patient population; three patients (11.5%) had PSMs at the level of the index lesion. AR-3D technology changed the NS surgical plan in 38.5% of men on patient-based and in 34.6% of sides on side-based analysis, resulting in overall appropriateness of 94.4%. The 3D model revealed 70%, 100%, and 92% of sensitivity, specificity, and accuracy, respectively, at the 32-area map analysis., Conclusions: AR-3D guided surgery is useful for improving the real-time identification of the index lesion and allows changing of the NS approach in approximately one out of three cases, with overall appropriateness of 94.4%., Patient Summary: Augmented reality three-dimensional guided robot-assisted radical prostatectomy allows identification of the index prostate cancer during surgery, to tailor the surgical dissection to the index lesion and to change the extent of nerve-sparing dissection., (Copyright © 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.)