David B. Samadi

Transition from laparoscopic to robotic partial nephrectomy: the learning curve for an experienced laparoscopic surgeon.

The transition from laparoscopic partial nephrectomy to robotic partial nephrectomy was found to be too rapid for an experienced laparoscopic surgeon.

Intraoperative Management of Robotic-Assisted Versus Open Radical Prostatectomy

Robotic-assisted laparoscopic radical prostatectomy was found to be a shorter procedure characterized by minimal blood loss, reduced fluid requirements, and shorter hospital stay compared with traditional open procedures.

A percutaneous subcostal approach for intercostal stones.

PURPOSE Percutaneous upper pole access may be obtained via the supracostal or subcostal approach. The more cranial the location of the percutaneous nephrostomy tract, the greater the risk of incurring intrathoracic complications. We describe a technique for safely accessing the upper pole calix via a subcostal approach, even when the stone is located well above the 12th rib. In our patient the stone was located between the 11th and 12th ribs, and the upper pole extended to above the 10th rib. METHODS A 78-year-old man with multiple medical problems had a symptomatic upper right pole stone located between 11th and 12th ribs. Due to its size (3 x 2.2 cm), neither a ureteroscopic nor shockwave approach was thought feasible. We elected to angle the access tract both laterally and cranially in order to course below the 12th rib, but still enter the upper pole calix. RESULTS Although this tract entered the calix obliquely, instruments were readily passed after sheath placement and the stone was completely removed. An ultrasonic lithotripsy device and suction was used to fragment and evacuate the stone. Postoperatively there were no intrathoracic or pulmonary complications. CONCLUSIONS The direct percutaneous approach to the upper pole of the kidney requires careful methodology based on a clear understanding of the anatomy of the kidney and surrounding structures. For upper-pole renal calculi located above the 12th rib that are not amenable to shockwave lithotripsy or ureteroscopy, a subcostal angled percutaneous approach can be safely made in selected cases. With this method, the risk of intrathoracic complications may be reduced.

Combined Robotic-Assisted Laparoscopic Prostatectomy and Laparoscopic Hemicolectomy

This case suggests that robotic procedures combined with other minimally invasive procedures may offer benefit in carefully selected patients.

‘Mohs surgery of the prostate’: the utility of in situ frozen section analysis during robotic prostatectomy: MOHS SURGERY OF THE PROSTATE

Study Type – Therapy (case series) Level of Evidence 4

Robotic prostatectomy in a patient with hemophilia.

The authors suggest that the decreased blood loss associated with laparoscopic surgery coupled with appropriate perioperative factor transfusions can minimize the risk of hemorrhage in patients with Hemophilia A who require prostatectomy.

Combined robotic radical prostatectomy and robotic radical nephrectomy.

This is an initial report of a combined robotic procedure for 2 urologic malignancies.

Continuing Robotically? The Completion of a Robot-Assisted Radical Prostatectomy After Laparotomy

The laparoscopic management of difficult adhesions can be quite challenging for even the most experienced of laparoscopic surgeons. We describe a case of managing a suspected enterotomy with a laparotomy during a robot-assisted radical prostatectomy and the surgical options after repair. The case was complicated by a Meckels diverticulum fused and continuous with a urachal cyst, itself a rare occurrence. After the excision of the Meckels diverticulum–urachal complex, the laparotomy incision was closed, and the prostatectomy was performed robotically. We discuss the controversies regarding continuation of a planned robotic procedure after a midline laparotomy.

MP77-14 DIABETES MELLITUS, METFORMIN AND PROSTATE CANCER: RESULTS OF A PROSTATE CANCER DATABASE ANALYSIS

INTRODUCTION AND OBJECTIVES: Chemoprevention of prostate cancer has long been an interesting topic. Data have shown that Metformin is associated with lower prostate specific antigen levels. A recent study showed that Metformin can modify gene expression in prostate cancer cells. Literature is controversial on the role of metformin in prostate cancer prevention. This study was designed to assess relationship of diabetes mellitus and metformin with prostate cancer. METHODS: A database of patients with prostate cancer was searched for patients with diabetes mellitus taking medications. Patients with diabetes mellitus prior to prostate cancer detection were detected. Data were imported into SPSS v. 21 for analysis. After primary analysis, patients taking metformin were compared to diabetic patients not taking metformin and non-diabetic patients. RESULTS: Between March 2003 and October 2016, there were 3,645 patients in the database of which 228 (6.2%) were diagnosed with diabetes mellitus prior to the time of prostate cancer detection. In diabetic group, 139 patients were using metformin products prior to surgery. There were additional 35 patients who were taking metformin for other conditions rather than diabetes mellitus. A general comparison of characteristics of diabetic and non-diabetic patients in the study is shown in table 1. Diabetic patients were more commonly black, had higher BMI, Higher D’Amico risk and higher American Society of Anesthesiologist risk classification (all p<0.05). There was no significant difference between diabetic patients taking metformin and diabetic patients on other treatment plans. Analysis of patients taking metformin with other patients (diabetic and non-diabetic) showed no significant difference in terms of prostate cancer characteristics. CONCLUSIONS: Diabetes mellitus might impact the course of prostate cancer development. The results of the study does not support the protective effect of metformin on prostate cancers in diabetic or nondiabetic.

MP36-08 HIGH INCIDENCE OF OCCULT POSITIVE URINE CULTURES AT TIME OF TURP: OUR EXPERIENCE IN 100 CONSECUTIVE PATIENTS

RESULTS: Mean age was 59 11.46 and 60 13.65 years for groups A and B respectively. Diabetes mellitus was detected in 9 (56.25%) and 6 (37.5%) patients in groups A and B respectively, hypertension in 7 (43.75%) and 6 (37.5%) patients in groups A and B respectively and two patients (12.5%) with liver cirrhosis in each group. The mean size of the abscess was 3.36 0.86 and 3.04 0.86 cm in groups A and B respectively (p1⁄40.29). The abscess recurred in 5 patients (31.25%) and in one patient (6.25%) in groups A and B respectively (p1⁄40.08). TRUS guided aspiration was done for all recurrent cases except for 2 patients (12.5%) in group A required trans urethral deroofing of the recurrent abscess. The mean hospital stay was 12.9 4.05 and 7.25 2.40 days for groups A and B respectively (p1⁄40.000). In group A one patient (6.25%) was complicated by urethrorectal fistula, while in group B one patient (6.25%) was complicated by septic shock, three patients (13.75%) with epididmoorchitis and two patients (12.5%) with urethral stricture. CONCLUSIONS: Patients with prostatic abscess treated with TRUS guided aspiration show less morbidity, higher recurrence rate and longer hospital stay than those treated with transurethral deroofing