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"The robotic approach for radical cystectomy has become increasingly adopted by the urologic oncology community, as it has been shown to have equivalent oncologic outcomes with shorter hospital stay and fewer perioperative transfusions. Consensus guidelines from expert surgeons have been published to provide guidance on all aspects of how to implement the robotic approach in the urologic oncology clinic."

Objective To assess the impact of neoadjuvant chemotherapy (NAC) on survival outcomes in a contemporary cohort of patients with in upper tract urothelial carcinoma (UTUC). Methods The National Cancer Database was queried from 2004 to 2015 to identify subjects who underwent nephroureterectomy for UTUC. Kaplan-Meier method with log-rank test was performed to compare all-cause mortality between patients who received preoperative chemotherapy to those who did not at each pathologic (p) TNM stage group: T1-4N0, N+, and M+ disease. Associations for all-cause mortality were identified using an adjusted Cox regression analysis. Results A total of 10,315 chemoeligible subjects were included in the analysis. A total of 296 (2.9%) of patients received NAC prior to NU. Kaplan-Meier survival curves of the entire cohort demonstrated an overall survival advantage associated with administration of NAC (P = .017). Stratified by clinical staging, subjects with nonorgan-confined tumors had improved overall survival outcomes with NAC administration (P = .012). On multivariate analysis there was a statistically significant improvement in overall survival between in patients who received NAC. Of patients in the preoperative chemotherapy group who had clinically nonorgan-confined disease, 27.1% had organ-confined disease at time of surgery compared to 1.4% of those who underwent surgery as initial therapy. Conclusion In a contemporary cohort of subjects who underwent nephroureterectomy for UTUC, administration of NAC in patients with high-grade nonorgan-confined disease led to higher rates of pathologic downstaging and was associated with improved overall survival.

Erectile dysfunction (ED) is defined as the inability to maintain an erection that allows for satisfactory sexual intercourse. Metabolic syndrome, a constellation of symptoms that increase a patient’s risk of developing cardiovascular disease, have been correlated with ED. In fact, ED is considered to be an important indicator that a patient may be at risk for a cardiovascular event within 5 years of ED onset. Metabolic syndrome is multifactorial in nature; therefore its effects on erectile function are also likely multifactorial. In this chapter, we discuss the literature on the relationship of metabolic syndrome and its components with erectile function, and whether interventions aimed at treating the components of metabolic syndrome may improve erectile function.

Metabolic syndrome is a constellation of cardiovascular risk factors that have been correlated with the development of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). Although multiple studies have demonstrated a relationship between metabolic syndrome and BPH/LUTS, the mechanism(s) by which this occurs has yet to be elucidated. Metabolic syndrome is thought to arise from a combination of genetic and environmental (namely, intake of excessive empty calories, lack of physical activity, etc.) factors and has been steadily increasing in prevalence in the United States and worldwide. Since many components of metabolic syndrome can be addressed with lifestyle changes, and since several of these interventions are similar to those recommended for patients presenting with LUTS due to BPH, the literature describing the relationship between metabolic syndrome and LUTS due to BPH is described in this chapter.

INTRODUCTION AND OBJECTIVE:Minority serving hospitals (MSH) serve the highest percentage of black and Hispanic patients. Independent of patient and provider factors, treatment at MSH may result in ...

INTRODUCTION AND OBJECTIVE:Telemedicine is an innovative field that resulted in an increase in health care access and reduction of associated costs. The role of telemedicine in a postoperative sett...

Objective To evaluate the differences in surgical outcomes of patients with cervical spondylotic myelopathy with and without congenital cervical spinal stenosis (CCSS). Methods Institutional review board approval was obtained to conduct a retrospective chart review of patients with cervical spondylotic myelopathy who underwent decompression and fusion surgeries from 2010–2016 at a single institution. CCSS was identified using the Torg-Pavlov ratio on lateral cervical radiographs. Pre- and postoperative outcome measures were assessed using the modified Japanese Orthopedic Association (mJOA) and the EuroQol 5-dimension questionnaire (EQ-5D). Results Of 208 patients, Torg-Pavlov ratio identified 85 patients with CCSS. There were no significant differences between the CCSS patient and control patient groups in EuroQol 5-dimension questionnaire and mJOA scores at all 4 designated time points in the study (preoperative, earliest postoperative, 6 month postoperative, and 1 year postoperative). Although not statistically significantly, there was a notable trend for patients with CCSS to be less likely to have mJOA-defined severe myelopathy at the postoperative (odds ratio [OR], 0.75; P = 0.38), 6 month postoperative (OR, 0.66; P = 0.20), and 1 year postoperative (OR, 0.64; P = 0.14) time points. Conclusions Postoperatively, compared with non-CCSS patients, patients with congenital cervical stenosis reported equal quality of life for all markers. Our findings suggest that in patients with CCSS and relatively mild symptoms of myelopathy, equal consideration should be given for surgical intervention. The findings of this study warrant further large-scale, multi-institutional investigation to further understand the generalizability of these surgical outcome results.

PurposeTo validate prognostic factors and determine the impact of obesity, hypertension, smoking and diabetes mellitus (DM) on risk of recurrence after surgery in patients with localized renal cell carcinoma (RCC).Materials and methodsWe performed a retrospective cohort study among patients that underwent partial or radical nephrectomy at Weill Cornell Medicine for RCC and collected preoperative information on RCC risk factors, as well as pathological data. Cases were reviewed for radiographic evidence of RCC recurrence. A Cox proportional-hazards model was developed to determine the contribution of RCC risk factors to recurrence risk. Disease-free survival and overall survival were analyzed using the Kaplan-Meier method and log-rank test.ResultsWe identified 873 patients who underwent surgery for RCC between the years 2000-2015. In total 115 patients (13.2%) experienced a disease recurrence after a median follow up of 4.9 years. In multivariate analysis, increasing pathological T-stage (HR 1.429, 95% CI 1.265-1.614) and Nuclear grade (HR 2.376, 95% CI 1.734-3.255) were independently associated with RCC recurrence. In patients with T1-2 tumors, DM was identified as an additional independent risk factor for RCC recurrence (HR 2.744, 95% CI 1.343-5.605). Patients with DM had a significantly shorter median disease-free survival (1.5 years versus 2.6 years, p = 0.004), as well as median overall survival (4.1 years, versus 5.8 years, pConclusionsWe validated high pathological T-stage and nuclear grade as independent risk factors for RCC recurrence following nephrectomy. DM is associated with an increased risk of recurrence among patients with early stage disease.