Multicenter Phase II Clinical Trial of Gemcitabine and Cisplatin as Neoadjuvant Chemotherapy for Patients With High-Grade Upper Tract Urothelial Carcinoma.

Purpose: Neoadjuvant chemotherapy (NAC) has proven survival benefits for patients with invasive urothelial carcinoma of the bladder, yet its role for upper tract urothelial carcinoma (UTUC) remains undefined. We conducted a multicenter, single-arm, phase II trial of NAC with gemcitabine and split-dose cisplatin (GC) for patients with high-risk UTUC before extirpative surgery to evaluate response, survival, and tolerability.

Methods: Eligible patients with defined criteria for high-risk localized UTUC received four cycles of split-dose GC before surgical resection and lymph node dissection.

Open Versus Robotic Cystectomy: A Propensity Score Matched Analysis Comparing Survival Outcomes.

Background: To assess the differential effect of robotic assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) on survival outcomes in matched analyses performed on a large multicentric cohort.

Methods: The study included 9757 patients with urothelial bladder cancer (BCa) treated in a consecutive manner at each of 25 institutions. All patients underwent radical cystectomy with bilateral pelvic lymphadenectomy.

Differences in trends in the use of robot-assisted and open radical cystectomy and changes over time in peri-operative outcomes among selected centres in North America and Europe: an international multicentre collaboration.

Objectives: To compare trends in the use of robot-assisted radical cystectomy (RARC) and changes over time in peri-operative outcomes in selected North American and European centres.

Materials And Methods: We conducted a retrospective evaluation of 2401 patients treated with open radical cystectomy (ORC) or RARC for bladder cancer at 12 centres in North America and Europe between 2006 and 2018. We used the Kruskal-Wallis and chi-squared test to evaluate differences between continuous and categorical variables.

Comparative Effectiveness in Perioperative Outcomes of Robotic versus Open Radical Cystectomy: Results from a Multicenter Contemporary Retrospective Cohort Study.

Background: The comparative effectiveness of robotic-assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) in terms of perioperative outcomes is still a matter of debate affecting payors, physicians, and patients.

Objective: To evaluate comparative perioperative and longer-term morbidity of RARC versus ORC in a multicenter contemporary retrospective cohort of patients.

Design, Setting, And Participants: This retrospective multicenter study included patients with bladder cancer treated with radical cystectomy at 10 academic centers between 2000 and 2017.

Propensity-score-matched comparison of soft tissue surgical margins status between open and robotic-assisted radical cystectomy.

Introduction: The use of robotic-assisted radical cystectomy (RARC) is becoming more widespread. While its safety is accepted, its oncological efficacy as compared to the current standard, open radical cystectomy (ORC), remains debatable.

Materials And Methods: The aim of this study is to compare the rates of positive soft tissue surgical margins (STSM), between patients treated with RARC or ORC, using a large contemporaneous collaborative database.

A comparison of preliminary oncologic outcome and postoperative complications between patients undergoing either open or robotic radical cystectomy.

Purpose: To compare complications and outcomes in patients undergoing either open radical cystectomy (ORC) or robotic-assisted radical cystectomy (RRC).

Materials And Methods: We retrospectively identified patients that underwent ORC or RRC between 2003- 2013. We statistically compared preliminary oncologic outcomes of patients for each surgical modality.

A 10-Item Checklist Improves Reporting of Critical Procedural Elements during Transurethral Resection of Bladder Tumor.

Purpose: Previous studies have demonstrated significant variation in recurrence rates after transurethral resection of bladder tumor, likely due to differences in surgical quality. We sought to create a framework to define, measure and improve the quality of transurethral resection of bladder tumor using a surgical checklist.

Materials And Methods: We formed a multi-institutional group of urologists with expertise with bladder cancer and identified 10 critical items that should be performed during every high quality transurethral bladder tumor resection.

Process Improvements Positively Impact the Use of Intravesical Mitomycin C after Transurethral Resection of Nonmuscle Invasive Bladder Cancer in a Large, Urban Urology Practice.

Introduction: We assessed the rate of intravesical mitomycin C therapy in patients with nonmuscle invasive bladder cancer who underwent transurethral resection of the bladder, as well as the impact of procedural changes governing its use.

Methods: A retrospective review of our bladder cancer database identified patients who underwent transurethral resection of the bladder with mitomycin C therapy during January 2008 to July 2014. Since our mitomycin C protocols were revised during 2013, patients were stratified based on date of service.

Multiple intra-renal artery aneurysms causing renal obstruction managed with radical nephrectomy.

A 46-year-old male with a history of hypertension presented with symptoms of persistent abdominal fullness and a non-pulsatile abdominal mass. Subsequent computed tomographic angiography studies revealed the presence multiple large renal aneurysms from the segmental branches of the renal artery and an enlarged hydronephrotic kidney with minimal parenchyma. The renal deterioration appeared to be as a result of an obstruction caused by the large intra-renal aneurysms at the level of the renal calyces.

Urinary Bother as a Predictor of Postsurgical Changes in Urinary Function After Robotic Radical Prostatectomy.

Objective: To characterize changes in indices of urinary function in prostatectomy patients with presurgical voiding symptoms.

Methods: A retrospective analysis of our prostate cancer database identified robot-assisted radical prostatectomy patients between April 2007 and December 2011 who completed pre- and postsurgical (24 months) Expanded Prostate Cancer Index Composite-26 surveys. Gleason score, margins, D'Amico risk, prostate-specific antigen, radiotherapy, and nerve-sparing status were tabulated.

Gross haematuria associated with penetration of an inferior vena cava filter into the right renal collecting system.

Inferior vena cava (IVC) filters are a viable alternative for patients with venous thromboembolic disease for whom standard anticoagulation therapy is contraindicated. Rare complications associated with their use, however, include misplacement and IVC penetration. We report a case of a 63-year-old woman who developed gross haematuria following IVC filter penetration into both the right renal collecting system and renal pelvis, for which open caval removal and reconstruction was required.

Surgical complications associated with robotic urologic procedures in elderly patients.

Introduction: Urologic malignancies are often diagnosed at an older age, and are increasingly managed utilizing robotic-assisted surgical techniques. As such, we assessed and compared peri-postoperative complication rates following robotic urologic surgery in elderly and younger patients.

Materials And Methods: A retrospective analysis of IRB-approved databases and electronic medical records identified patients who underwent robotic-assisted urologic surgery between December 2003-September 2013.

Active surveillance of renal masses: an analysis of growth kinetics and clinical outcomes stratified by radiological characteristics at diagnosis.

Aims: To determine the growth rate of renal masses (RMs) under active surveillance (AS), and to describe the clinical outcome of AS patients.

Materials And Methods: We conducted a retrospective review of an AS database to obtain demographics, radiological and pathologic characteristics and RM size of patients. RMs were followed at 6-12 month intervals for ≥1 year with computed tomography (CT), magnetic resonance imaging (MRI), or renal ultrasound.

Clinical and radiographic characteristics governing the selection of therapy of small renal masses.

Introduction: Renal masses are commonly managed by partial nephrectomy (PN) or active surveillance (AS). We assessed the impact of patient demographics and clinical indices in determining treatment decisions of renal masses between these two options.

Materials And Methods: We retrospectively reviewed our renal mass database to retrieve demographic and clinical records of patients who underwent immediate PN or entered a >= 12 month period of AS during February 1999 to May 2014.

Prognostic indices of perioperative outcome following transperitoneal laparoscopic adrenalectomy.

Objectives: We sought to identify preoperative patient and tumor characteristics that may be useful prognostic indicators of postsurgical outcome in patients undergoing laparoscopic adrenalectomy (LA).

Subjects And Methods: Data from 92 patients who underwent 93 transabdominal LA procedures between 2006-2012 were retrieved. Patients were stratified based on estimated blood loss (EBL), length of stay (LOS), and perioperative complications.

Impact of active surveillance on pathology and nerve sparing status.

Introduction: We assessed whether, in comparison to immediate surgery, a time delay in performing radical prostatectomy (RP) in patients electing to undergo a period of active surveillance (AS) of low grade prostate cancer, is associated with adverse pathologic features, biochemical recurrence and the ability to perform effective nerve sparing surgery.

Materials And Methods: From our RP database of 2769 patients, we identified 41 men under AS who subsequently underwent RP. This study group was compared to control group A (164 patients who chose RP rather than AS), matched for prostate-specific antigen (PSA) and initial diagnostic biopsy characteristics.

Spontaneous bladder perforation unrelated to trauma or surgery.

Urinary bladder ruptures (UBR) typically result from either blunt or penetrating trauma, or from iatrogenic surgical injuries. Patients typically present with symptoms including lower abdominal pain, haematuria, dysuria and anuria. Here, we report on a rare case of spontaneous bladder perforation.

Single-stage renal transplantation-urinary diversion: a novel surgical approach.

Introduction: This article reports outcomes of 2 patients who received a single-stage renal transplantation and concomitant urinary-diversion procedure.

Technical Considerations: We followed the clinical diagnosis and outcome of 2 patients who underwent renal transplantation and urinary diversion as a single-stage procedure by retrospectively reviewing a Hartford Hospital Institutional Review Board-approved kidney database. Patient demographics, renal function, and surgical outcomes were examined.

Malignant renal angiomyolipoma without tuberous sclerosis.

A 68-year-old woman presented with abdominal pain, fatigue, anorexia and night sweats. Imaging studies identified a vascular mass extending from the upper pole of the right kidney with anterior displacement to the abdominal midline, consistent with renal cell carcinoma. A radical nephrectomy and right pelvic lymph node dissection was performed.

Prostate biopsy volume predicts final tumor volume.

Aim: To assess the ability of prostate biopsy volume to effectively predict actual tumor volume, and whether increasing the number of prostate biopsy cores improves the ability to forecast actual tumor volume.

Methods: 765 patients who underwent robotic radical prostatectomy (2009-2010) were identified. Of these, 663 had complete demographics, biopsy, and final pathology data available.

Predictors of postoperative decline in estimated glomerular filtration rate in patients undergoing robotic partial nephrectomy.

Purpose: To identify prognostic indicators of estimated glomerular filtration rate (eGFR) following robotic partial nephrectomy (RPN).

Materials And Methods: In a retrospective study of RPN patients, we examined data describing age, gender, eGFR, body mass index (BMI), tumor size (TS), length of stay, and estimated blood loss (EBL). Changes in eGFR (i.

An unusually large leiomyoma of the prostate.

Prostate leiomyomas are benign mesenchymal smooth muscle tumors devoid of glandular elements within the prostate or juxta-prostatic position. Leiomyomas develop in organs containing smooth muscle, including the kidney, bladder and seminal vesicle. Prostate leiomyomas are either a pure form or associated with benign prostate hyperplasia, and diagnosis is challenging, with definitive identification relying on pathology.

The impact of body mass index on perioperative outcomes in robot-assisted laparoscopic partial nephrectomy.

Background And Purpose: Obese patients undergoing surgical procedures are at increased risk for perioperative morbidity. The purpose of this study is to determine whether there is an association with body mass index (BMI), clinicopathologic features, and perioperative outcomes and complications in patients undergoing robot-assisted laparoscopic partial nephrectomy (RPN).

Patients And Methods: Medical records of 283 patients who underwent RPN between 2007 and 2012 were reviewed from an Institutional Review Board approved database.

da Vinci Skills Simulator construct validation study: correlation of prior robotic experience with overall score and time score simulator performance.

Objective: To assess the construct validity of the da Vinci Skills Simulator (Intuitive Surgical, Sunnyvale, CA). Ideally, a well-designed simulator should demonstrate construct validity, which is defined in this study as the correlation between robotic surgical experience and performance on the simulator.

Patients And Methods: Thirty-nine surgeons (18 [46%] group I [0-20 robotic cases]; 8 [21%] group II [21-150 robotic cases]; and 13 [33%] group III [>150 robotic cases]) were enrolled from September 2010 to December 2010.