Dimitrios Moschonas

Urinary continence four weeks following Retzius-sparing robotic radical prostatectomy: The UK experience:

Objective: The purpose of this study was to investigate urinary continence four weeks following Retzius-sparing robot-assisted radical prostatectomy. Patients and methods: Forty patients with T2–T3 prostate cancer underwent Retzius-sparing-robot-assisted radical prostatectomy and their results were compared with those from the 40 patients having robot-assisted radical prostatectomy done by the same surgeon immediately prior to the adoption of Retzius-sparing-robot-assisted radical prostatectomy. Results: Patients in the two groups had similar age, body mass index, prostate specific antigen, biopsy Gleason sum, clinical stage, d’Amico risk profile, blood loss, prostate weight and post-operative hospital stay. Median operating time (200 (interquartile range=155–266) vs 223 (interquartile range=100–238) min; p=0.05) and catheterisation (8 (interquartile range=8–8) vs 14 (interquartile range=14–14) days; p<0.0001) were shorter in the Retzius-sparing group, many of whom had suprapubic catheters inserted. The overall complication rate was lower in Retzius-sparing patients (2.5% vs 8.0%; p=0.36). Positive surgical margin rates were similar for Retzius-sparing and non-Retzius-sparing patients and decreased with greater experience with the Retzius-sparing technique: 16.7% vs 7.7% for pT2 (p=0.65) and 31.8% vs 14.3% for pT3 (p=0.44). Initial prostate specific antigen was <0.1 ng/ml in 97.5% and 100%, respectively (p=1.00). At four weeks post-operation 0, 1 and 2 pads/day were needed in the Retzius-sparing group in 90.0%, 7.5% and 2.5% of patients, compared to 37.5% (p<0.0001), 32.5% (p=0.01) and 30% (p=0.002) of men having conventional surgery. Conclusion: Retzius-sparing-robot-assisted radical prostatectomy is faster than the anterior approach to the prostate, allows a shorter catheterisation time and produces dramatically better continence results at four weeks with 90% of patients being pad-free and 97.5% of patients needing 0–1 pads/day.

Robotic-Assisted Radical Hysterectomy with Anterior and Posterior Exenteration-Urological Perspectives

Pelvic exenteration for gynecological malignancies is, without doubt, one of the most challenging surgical procedures. Pelvic exenteration, namely radical hysterectomy plus cystectomy and urinary diversion, is associated with significant morbidity and mortality. While it was only recently that urologists were able to apply the techniques and principles of open radical cystectomy to the rapidly evolving field of robot-assisted surgery, the advantages of robot-assisted surgery in terms of lower blood loss and faster recovery were obvious although they come at the price of increased operative time and monetary cost. In this chapter we are also going to discuss the complications of radical hysterectomy and pelvic exenteration that are related to the urinary tract, namely ureteral and bladder injuries. There has been significant improvement in both the early identification and the minimally invasive management of ureteral injuries, therefore one could argue that open surgery will soon be historical for those kind of iatrogenic injuries.

PD36-06 IS FOUR DAYS HOSPITAL STAY AFTER ROBOTIC ASSISTED RADICAL CYSTECTOMY FEASIBLE? A MULTIDISCIPLINARY ENHANCED RECOVERY PROGRAM CHALLENGE

Overall survival was estimated using the Kaplan-Meier method and compared with the log-rank test. RESULTS: A total of 56 patients were identified for this study. 14 of the 56 patients (25%) who underwent adjuvant cisplatin-based chemotherapy were determined to be sarcopenic. Overall survival after the start of adjuvant therapy for sarcopenic patients was 25.12 months, as compared to non-sarcopenic patients who demonstrated an overall survival of 44.30 months (p<0.05). The 5-year survival rates were 21% and 36% for the two groups, respectively. While the time to local and distant recurrences was greater in the non-sarcopenic patients, as compared to those with sarcopenia, there was no statistically significant difference. CONCLUSIONS: Our analysis has indicated that patients with sarcopenia have a worse overall survival when treated with adjuvant chemotherapy after radical cystectomy. In order to conclude whether sarcopenic patients should be receiving adjuvant therapy, future studies must match these patients with sarcopenic patients who met criteria to receive adjuvant chemotherapy after radical cystectomy, yet decided to forego treatment.