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We assessed the impact of focal therapy on perioperative, oncologic and functional outcomes in men who underwent salvage robotic assisted radical prostatectomy compared to primary robotic assisted radical prostatectomy.Focal therapy was performed in patients presenting with Gleason score 3 + 3 or 3 + 4, clinical stage cT2a or less, serum prostate specific antigen 15 ng/ml or less, unilateral positive biopsy, maximum length of any positive core less than 10 mm and life expectancy greater than 10 years. Focal therapy was defined as target ablation of the index lesion plus a 1 cm safety margin in the normal ipsilateral prostatic parenchyma. The salvage group included 22 men who underwent salvage prostatectomy after focal therapy failure. The primary group was defined using matched pair 1:2 selection of 44 of 2,750 patients treated with primary prostatectomy. The primary and secondary end points were the between group differences in functional and oncologic outcomes, respectively.Complication rates were comparable (p0.05). Pad-free probability was comparable between the groups at 1 and 2 years (p = 0.8). Recovery of erectile function was significantly lower after salvage robotic assisted radical prostatectomy (p = 0.008), which also showed a significantly lower probability of cumulative biochemical recurrence-free survival compared to primary robotic assisted radical prostatectomy (56.3% vs 92.4% at 2 years, p = 0.001). Salvage prostatectomy demonstrated a significantly increased risk of biochemical recurrence (HR 4.8, 95% CI 1.67-13.76, p = 0.004). Study limitations included the retrospective nature, the lack of randomization and the short followup.Salvage robotic assisted radical prostatectomy after focal therapy failure is feasible with acceptable complication rates. However, patients assigned to primary focal therapy should be advised about a poorer prognosis in terms of oncologic control and lower erectile recovery rates in case of a future salvage surgery.

INTRODUCTION AND OBJECTIVES: Laparoscopic pyeloplasty has been considered the gold-standard treatment for adults with ureteropelvic junction obstruction (UPJO). Likewise, it is well established in adults that a symptomatic non-functioning renal unit should be removed. This study aimed to evaluate safety, kidney function recovery and symptoms improvement after laparoscopic pyeloplasty in adults with poorly functioning kidneys due to UPJO. METHODS: Retrospective data analysis from August 2008 to November 2015, from a prospectively maintained database, was performed. Patients with poorly functioning kidney who underwent Anderson-Hynes dismembered laparoscopic pyeloplasty were included. In one patient, the retroperitoneal approach was preferred due to multiple previous abdominal surgeries. Poor function was defined as a split renal function of 15% in renal scintigraphy with Tc-99m DMSA. Pre and postoperative data were compared regarding differential renal function (DRF) and symptoms. Success was defined as split renal function stabilization (absolute variation of less than 5% in renal scintigraphy) and symptoms improvement. Outcome (renal function stabilization, intra and pos-op complications and symptoms) was further compared to a similar group of patients who underwent Anderson-Hynes dismembered laparoscopic pyeloplasty in normal functioning renal units. RESULTS: We identified 167 patients who underwent laparoscopic pyeloplasty in our service. From those, 14 patients had poor renal function, with a mean age of 37 years (23 60 years). No major intra or post-operative complications were seen. At a mean follow up of 21.2 months (4-53 m) all patients reported symptoms improvement, no cases of recurrent pyelonephritis or stone formation was seen. Until this date, no patient needed further surgical treatment as re-pyeloplasty, endoscopic treatment or nephrectomy. Complete symptom resolution was seen in 10 patients (71%). One patient, despite showing complete symptom resolution, had decreased postoperative DRF in renal scintigraphy. Overall success rate was 92.8% (13/14). Split renal function remained stable in 11 patients (78,6%), considerably decreased in 1 (7.1%) and considerably increased in 2 (14.3%) patients. Renal function stabilization, intra and post-operative complications were statically similar (p>0.05) when compared to patients with normal functioning renal units who underwent the same procedure. No patient with normal functions renal units showed improvement in DRF measured with Tc99m DMSA. CONCLUSIONS: Laparoscopic pyeloplasty is an alternative to nephrectomy in adults with poorly functioning kidneys due to UPJO, enabling good symptom control with possible considerable improvement in renal function. In this study, laparoscopic pyeloplasty in this of patients showed similar outcomes and success rates to those presented by patients with normal functioning renal units.