Early Implementation of Robotic Training in Surgical and Surgical Subspecialty Residency.

Background: Robotic surgery has emerged as an operative tool for many elective and urgent surgical procedures. The purpose of this study was to evaluate early surgical trainees' experiences and opinions of robotic surgery.

Methods: An introductory robotic training course consisting of online da Vinci Xi/X training and in-person, hands on training was implemented for residents and medical students across surgical subspecialties at a single institution.

Learning curve for magnetic resonance imaging/ultrasound fusion prostate biopsy in detecting prostate cancer using cumulative sum analysis.

Background: Targeted magnetic resonance (MR) with ultrasound (US) fusion-guided biopsy has been shown to improve detection of prostate cancer. The implementation of this approach requires integration of skills from radiologists and urologists. Objective methods for assessment of learning curves, such as cumulative sum (CUSUM) analysis, may be helpful in identifying the presence and duration of a learning curve.

Determining the component-based operative time learning curve for robotic-assisted radical prostatectomy.

Objectives: To determine the learning curve (LC) of total operative time and the discrete components of the robotic-assisted radical prostatectomy (RARP) for a recent robotic fellowship-trained urologic surgeon.

Materials And Methods: We performed a retrospective analysis of RARP procedures performed by a single new attending surgeon from August 2015 to April 2019. Patients' demographics and operative details were assessed.

PSA density is complementary to prostate MP-MRI PI-RADS scoring system for risk stratification of clinically significant prostate cancer.

Background: While prostate multiparametric-magnetic resonance imaging (MP-MRI) has improved the diagnosis of clinically significant prostate cancer (CSPC), the complementary use of prostate-specific antigen (PSA) levels to risk-stratify for CSPC requires further study. The objective of this project was to determine if prostate MP-MRI and PSA can provide complementary insights into CSPC risk stratification.

Methods: In an IRB-approved study, pathologic outcomes from patients who underwent MR/US fusion-targeted prostate biopsy were stratified by various parameters including PSA, PSA density (PSAD), age, race, and PI-RADS v2 score.

MRI-guided focal laser ablation of prostate cancer: a prospective single-arm, single-center trial with 3 years of follow-up.

Purpose: We aimed to assess post-interventional and 36-month follow-up results of a single-center, single-arm, in-bore phase I trial of focal laser ablation (FLA) guided by multiparametric magnetic resonance imaging (mpMRI).

Methods: FLA procedures were done in-bore MRI using a transperineal approach. Primary endpoints were feasibility and safety expressed as lack of grade 3 complications.

Race as a predictor of pathologic response to neoadjuvant chemotherapy at time of cystectomy for bladder cancer.

Unlabelled: INTRODUCTION Complete pathologic response (pT0) at time of cystectomy after neoadjuvant chemotherapy (NAC) has been associated with significantly improved clinical outcomes. The goal of this study is to examine whether race is a predictor of pT0 response to NAC at time of cystectomy.

Materials And Methods: We analyzed the records of patients diagnosed with a non-metastatic (M0) muscle-invasive (cT2+) urothelial cell bladder cancer in the National Cancer Database (NCDB) who underwent a cystectomy from 2006 to 2014.

Litigation Patterns in Oncologic Nephrectomies: A 30-Year Review.

The litigious environment encompassing the medical-legal domain is an increasing concern for surgical fields, with urology being no exception. The objective of our study was to systematically review, evaluate, and summarize the factors associated with oncologic nephrectomy litigation to determine possible factors contributing to verdicts or settlements. Publicly available verdict reports were retrieved using the Westlaw legal database (Reuters).

Surgery associated with increased survival compared to radiation in clinically localized Gleason 9-10 prostate cancer: a SEER analysis.

Purpose: Men with Gleason score 9-10 prostate cancer have worse outcomes compared to those with Gleason 8 disease. Upfront treatments remain controversial for these patients. Using the Surveillance, Epidemiology, and End Results (SEER) database, we evaluated the impact of initial treatment with external beam radiation therapy (EBRT), external beam radiation therapy with brachytherapy (EBRT + BT), or surgery on prostate cancer-specific mortality (PCSM) and overall mortality (OM) in Gleason 9-10 disease.

Role of metabolic imaging in diagnosis of primary, metastatic, and recurrent prostate cancer.

Purpose Of Review: The present review describes the current role of metabolic imaging techniques such as multiparametric MRI (mpMRI), magnetic resonance spectroscopic imaging (MRSI), hyperpolarized MRSI, and positron emission tomography (PET) in the diagnosis of primary prostate cancer, surveillance of low-grade disease, detection of metastases, and evaluation of biochemical recurrence after therapy.

Recent Findings: The natural history of prostate cancer ranges from indolent disease that is optimally monitored by active surveillance, to highly aggressive disease that can be lethal. Current diagnostic methods remain imperfect in noninvasively distinguishing between silent versus aggressive tumors.

Characterization of a learning curve for robotic cystectomy with intracorporeal urinary diversion at two institutions using the cumulative sum (CUSUM) method.

Introduction: Robotic cystectomy with intracorporeal urinary diversion (RCID) is a technically challenging procedure. It is understood that this approach has a learning curve; however, limited studies have characterized this learning curve. The cumulative sum (CUSUM) method plots the learning curve.

Impact of preoperative prostate magnetic resonance imaging on the surgical management of high-risk prostate cancer.

Objective: To evaluate the effect of adding multiparametric magnetic resonance imaging (mpMRI) to pre-surgical planning on surgical decision making for the management of high-risk prostate cancer (HRPC).

Patients And Methods: A survey was designed to query multiple centers on surgical decisions of 41 consecutive HRPC cases seen from 2012 to 2015. HRPC was defined by the National Comprehensive Cancer Center Network guidelines.

The Use of Multiparametric Magnetic Resonance Imaging (mpMRI) in the Detection, Evaluation, and Surveillance of Clinically Significant Prostate Cancer (csPCa).

Purpose Of Review: With the long-standing controversy surrounding the use of prostate-specific antigen (PSA) for the detection, evaluation, and surveillance of prostate cancer, there is a need for a minimally invasive technique to identify and risk-stratify these patients. Additionally, in an effort to reduce the number of unnecessary biopsies and identify clinically significant prostate cancer (csPCa), there has been a shift in practice towards the use of multiparametric magnetic resonance imaging (mpMRI) in conjunction with decision-making regarding prostate cancer diagnosis and management. In the current review, we summarize the data regarding the use of mpMRI in the detection, evaluation, and surveillance of csPCa.

Hyperpolarized C magnetic resonance imaging, using metabolic imaging to improve the detection and management of prostate, bladder, and kidney urologic malignancies.

Approximately 25% of the 2 million new cancer diagnoses in the United States in 2018 were comprised of malignancies of the urogenital system. Of these cancers, 75% occurred in the kidney/renal pelvis, prostate, and urinary bladder. Early diagnosis is beneficial to long-term survival.

Injury severity score associated with concurrent bladder injury in patients with blunt urethral injury.

Background: Delayed diagnosis of concurrent bladder damage in a patient with blunt urethral trauma can lead to a high rate of morbidity. In patients with a high index of suspicion, genitourinary workup is recommended. In complicated patients with multi-trauma, this workup has a risk of being delayed.

Evaluation of Cancer Specific Mortality with Surgery versus Radiation as Primary Therapy for Localized High Grade Prostate Cancer in Men Younger Than 60 Years.

Purpose: The optimal primary treatment of localized high grade prostate cancer in younger men remains controversial. The objective of this project was to compare the impact of initial radical prostatectomy vs radiation therapy on survival outcomes in young men less than 60 years old with high grade prostate cancer.

Materials And Methods: We retrospectively analyzed the records of men younger than 60 years in the SEER (Surveillance, Epidemiology and End Results) database who underwent initial surgery or radiation therapy of high grade (Gleason score 8 or greater) localized (N0M0 TNM stage) prostate cancer from 2004 to 2012.

A Magnetic Resonance Imaging-Based Prediction Model for Prostate Biopsy Risk Stratification.

Importance: Multiparametric magnetic resonance imaging (MRI) in conjunction with MRI-transrectal ultrasound (TRUS) fusion-guided biopsies have improved the detection of prostate cancer. It is unclear whether MRI itself adds additional value to multivariable prediction models based on clinical parameters.

Objective: To determine whether an MRI-based prediction model can reduce unnecessary biopsies in patients with suspected prostate cancer.

The Metabolic Phenotype of Prostate Cancer.

Prostate cancer is the most common non-cutaneous cancer in men in the United States. Cancer metabolism has emerged as a contemporary topic of great interest for improved mechanistic understanding of tumorigenesis. Prostate cancer is a disease model of great interest from a metabolic perspective.