Peter L. Steinberg

YouTube as source of prostate cancer information.

OBJECTIVES Patients can search the Internet for prostate cancer information, and YouTube is a popular Web site that they may consult. We analyzed the prostate cancer videos on YouTube for information content and the presence of bias. METHODS YouTube was searched for videos about prostate-specific antigen (PSA) testing, radiotherapy, and surgery for prostate cancer. The included videos were in English and <10 minutes long. Two physician viewers watched each video and assigned a score for information content (excellent, fair, poor) and bias (for, against, neutral, or balanced). A third viewer arbitrated any discrepancies. The kappa statistic was used to measure interobserver variability, and Pearsons test was used to assess correlation. RESULTS A total of 14 PSA videos, 5 radiotherapy videos, and 32 surgery videos were analyzed. The PSA testing videos averaged 1480 +/- 2196 views and 146 +/- 174 s long and had an average viewer rating of 3.1 +/- 2.1 (viewer rating scale 0-5). The surgery videos averaged 2044 +/- 3740 views and 172 +/- 122 s long and had an average viewer rating of scored 3 +/- 2.2. The radiotherapy videos averaged 287 +/- 255 views and 97 +/- 45 s long and had a score of 1.8 +/- 2.5. The information content was fair or poor for 73% of all videos. The bias for surgery, radiotherapy, or PSA testing was present in 69% of videos; 0% of videos were biased against treatment or PSA testing. The interobserver variability was well above than expected by chance alone. CONCLUSIONS The results of our study have shown that although some videos are robust sources of information, given the preponderance of modest and unbalanced information among reviewed videos, YouTube is an inadequate source of prostate cancer information for patients.

The Cost of Learning Robotic-Assisted Prostatectomy

OBJECTIVES To describe the costs associated with the learning curve of robotic-assisted prostatectomy (RAP). METHODS A theoretical model of the cost of operative time during the learning curve for RAP was constructed. Within the theoretical model varying rates of improvement were considered, and once the learning curve was complete, the total cost of operative time was calculated. This cost was then compared with an actual series of RAP, whose operative time and associated costs during the learning curve were also calculated. RESULTS In the theoretical model, surgeons improved at rates of 1, 5, or 10 minutes per case, and began the learning curve that required 8 or 9 hours to perform a single RAP. At the end of the learning curve it took either 3 or 4 hours. The most expensive learning curve was 360 cases long and cost

Robotic-assisted radical cystectomy: current technique and outcomes

1.3 million; the least expensive learning curve was 24 cases and cost

Impact of Repeated Hilar Clamping on Renal Function During Laparoscopic and Robot-Assisted Partial Nephrectomy

95,000. The literature search involved 8 series, with a range of learning curves from 13 to 200 cases. The least expensive learning curve was

Re: Karim Bensalah, Margaret Pearle and Yair Lotan. Cost-effectiveness of medical expulsive therapy using alpha-blockers for the treatment of distal ureteral stones. Eur urol 2008;53:411-9.

49,613 and the most expensive learning curve was

Radiation Therapy and Sorafenib: Clinical Data and Rationale for the Combination in Metastatic Renal Cell Carcinoma

554,694. The average learning curve was 77 cases and cost

Fluoroscopy-guided percutaneous renal access.

217,034. CONCLUSIONS Costs associated with operative time while learning RAP are substantial, and should be considered when deciding whether to implement RAP at an individual institution. RAP may best be suited to high volume prostatectomy centers, in which the learning curve can be rapidly traversed, and associated costs minimized.

Validation of a Novel, Tissue-Based Simulator for Robot-Assisted Radical Prostatectomy

Robotic-assisted radical cystectomy continues to evolve as a surgical option in the management of muscle-invasive bladder cancer. Current oncologic outcomes appear comparable in the short-term with open radical cystectomy. Long-term follow-up, however, remains lacking for this emerging technique. Modern robotic technology allows a comparable extent of pelvic lymph node dissection as open surgery, a previous criticism of the procedure. Complications compare very favorably to open surgery in comparative series, and blood loss and transfusion rates are routinely lower. Length of stay has been shortened in some series, though not uniformly. Finally, robotic assistance can increase the cost of radical cystectomy.

Re: Hervé Baumert, Andrew Ballaro, Carlos Arroyo, Amir V. Kaisary, Peter F.A. Mulders and Ben C. Knipscheer. The Use of Polymer (Hem-o-lok) Clips for Management of the Renal Hilum During Laparoscopic Nephrectomy. Eur Urol 2006;49:816–9

BACKGROUND AND PURPOSE Conventional wisdom and small animal studies suggest repeated hilar clamping during partial nephrectomy is deleterious to renal function. We describe the impact of repeated renal hilar clamping during laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RPN) on the overall function of the operated kidney. PATIENTS AND METHODS A retrospective analysis of all patients undergoing RPN or LPN with repeated hilar clamping was performed. Patient and tumor characteristics were recorded. All patients had preoperative and postoperative mercaptoacetyltriglycine (MAG)3 renal scans, and the change in function was calculated. Change in glomerular filtration rate (GFR) was calculated with the modified Modification of Diet in Renal Disease equation as well. RESULTS Seven patients were studied with an average age of 60 and a body mass index of 32. Tumors averaged 3.6 cm, and there were four and three right- and left-sided tumors, respectively. The reasons for repeated clamping were bleeding in three patients and either gross or microscopic positive margins in four patients, all of whom had repeated resection. The average initial clamp time was 20 minutes, and the average reclamp time was 12 minutes. The average operative time was 185 minutes. and average blood loss was 171 mL. All renal units were functioning postoperatively. The average change in absolute renal function on the operated kidney was -4.9%, and the relative loss of function was -10%, both measured on MAG3 scan. The average GFR before surgery was 61.4 (mL/min/1.73m(2)); after surgery, the average GFR was 57.1 (mL/min/1.73m(2)), for an average loss of -7%. The range of change in GFR was from 0% to -23%. CONCLUSIONS Although not optimal, repeated clamping of the renal hilum during partial nephrectomy to control bleeding or to obtain a clear surgical margin is associated with minimal loss of renal function.

EVALUATING “STONE FREE STATUS” IN CONTEMPORARY UROLOGIC LITERATURE

The sensitivity and cost analysis of medical expulsive therapy for stone disease by Bensalah and colleagues [1] excluded the costs of ureteral stent removal in the analysis. Accounting for the side effects of ureteral stenting would prove a challenging exercise, as would assessing the added costs therein; however, the cost for removal of a ureteral stent after ureteroscopy is certainly real. Costs of stent removal vary, but an additional