Case Series: Computed Tomography Features of Extraskeletal Osteosarcoma in Six Dogs.

The objective of the present case series was to investigate the various computed tomography findings of six dogs diagnosed with extraskeletal osteosarcoma (exOSA) at several locations. Among the tumors evaluated, four were subcutaneous, one was mammary, and one involved the intestinal tract. Intralesional mineralization was observed in all six dogs. Most of the tumors were moderately calcified, exhibited amorphous mineralization, and were heterogeneous on post-contrast imaging. Three of the tumors were peripherally enhanced, and regional lymphadenopathy was identified in two of the dogs, which was presumed to be metastatic. No lymph node calcification was reported. Although the presence of intralesional mineralization is not a pathognomonic finding, it was consistently identified in the present case series. Therefore, exOSA should be considered in the differential diagnosis when mineralization occurs in a mass unrelated to osseous structures.

Deep learning-based diagnosis of stifle joint diseases in dogs.

In this retrospective, analytical study, we developed a deep learning-based diagnostic model that can be applied to canine stifle joint diseases and compared its accuracy with that achieved by veterinarians to verify its potential as a reliable diagnostic method. A total of 2382 radiographs of the canine stifle joint from cooperative animal hospitals were included in a dataset. Stifle joint regions were extracted from the original images using the faster region-based convolutional neural network (R-CNN) model, and the object detection accuracy was evaluated. Four radiographic findings: patellar deviation, drawer sign, osteophyte formation, and joint effusion, were observed in the stifle joint and used to train a residual network (ResNet) classification model. Implant and growth plate groups were analyzed to compare the classification accuracy against the total dataset. All deep learning-based classification models achieved target accuracies exceeding 80%, which is comparable to or slightly less than those achieved by veterinarians. However, in the case of drawer signs, further research is necessary to improve the low sensitivity of the model. When the implant group was excluded, the classification accuracy significantly improved, indicating that the implant acted as a distraction. These results indicate that deep learning-based diagnoses can be expected to become useful diagnostic models in veterinary medicine.

Case report: Radiography and computed tomography of tension pneumoperitoneum caused by gastric perforation in a dog.

Tension pneumoperitoneum is characterized by excessive accumulation of gas in the peritoneal cavity, which leads to cardiorespiratory distress. We present the case of a 4-year-old female Labrador retriever who presented with a severe abdominal distension and panting. Radiography revealed a large volume of free gas in the peritoneal cavity with decreased serosal detail. After emergency needle decompression, ultrasound-guided aspiration of the peritoneal effusion helped confirm septic peritonitis. Computed tomography revealed a gastric mass measuring approximately 3.7 × 5.0 × 5.5 cm, which was suspected to have caused the gastric perforation. A large volume of free gas was present in the peritoneal cavity, causing compression and centralization of the abdominal organs. A low-attenuating cleft suggestive of perforation site near the gastric mass was also observed. Exploratory laparotomy confirmed gastric perforation of approximately 2.2 cm adjacent to the gastric mass. The patient was finally diagnosed with tension pneumoperitoneum caused by gastric perforation. The mass was resected with a 1-2-cm surgical margin, and imprinting cytology indicated gastric carcinoma. The patient was aggressively treated with fluid, analgesic, antithrombotic, and antibacterial therapy. However, the patient's condition continued to deteriorate, and euthanasia was performed at the owner's request. Our report is the first to describe the multimodal imaging features of a dog with tension pneumoperitoneum secondary to gastric perforation caused by gastric neoplasm.

Utility of Contemporary Health Screening in the Diagnosis of Bladder Cancer.

BACKGROUND: To evaluate the utility of contemporary health screening (HS) in the diagnosis of bladder cancer (BCa). METHODS: We retrospectively reviewed 279,683 individuals who underwent HS between February 1995 and April 2015. Among these individuals, 74 were diagnosed with BCa within a year after the HS and were included in the analysis. Screen-detected BCa was defined as when a referral was made to a urologist due to microscopic hematuria (MH) on urinalysis, abnormal imaging, or any urological symptoms observed at the HS. Screen-undetected BCa was defined as when no referral was made to a urologist because of no abnormality observed at the HS, but a visit to a urological outpatient clinic later was followed by a BCa diagnosis. The incidences of screen-detected BCa and BCa in the Korean population were compared. Clinicopathological characteristics were compared between the screen-detected BCa and screen-undetected BCa groups. RESULTS: The detection rate of BCa was 17.2 per 100,000, which exceeded the 2020 estimated national crude incidence rate of 9.3 per 100,000 by approximately 1.7 times. Among the 74 patients diagnosed with BCa within a year after HS, 48 (64.9%) had screen-detected BCa. The screen-detected BCa group had a higher T stage (p = 0.009) and grade (p = 0.019) than the screen-undetected BCa group. However, the overall survival was not significantly different between the two groups (p = 0.677). A positive correlation between the MH grade and the T stage was identified (p = 0.001). CONCLUSION: Although HS is not focused on BCa screening, contemporary HS can contribute to the detection of BCa.

Comparison between T2-weighted two-dimensional and three-dimensional fast spin-echo MRI sequences for characterizing thoracolumbar intervertebral disc disease in small-breed dogs.

Magnetic resonance imaging (MRI) is a standard test for diagnosis and treatment planning in dogs with degenerative thoracolumbar intervertebral disc disease (IVDD). However, published studies evaluating three-dimensional fast-spin echo (3D-FSE) pulse sequences for dogs with IVDD are currently limited. Aims of this retrospective, observational study were to compare findings from T2-weighted two- and three-dimensional fast spin-echo sequences (2D- and 3D-FSE, respectively) for a group of small breed dogs with thoracolumbar IVDD. Inclusion criteria were dogs with IVDD that underwent 1.5-Tesla MRI using both 2D-FSE and 3D-FSE sequences. For each dog and sequence, five pathologic indices were recorded: epidural fat discontinuation, vertebral canal compromise, spinal cord signal change, disc degeneration, and nerve root compression. Two independent investigators also scored visibility of the facet joint, intervertebral foramen, nerve roots, spinal cord grey-white matter differentiation, intervertebral discs, and epidural fat. The Wilcoxon signed-rank test was used to evaluate the between-sequence differences in pathologic indices and visibility scores. Interobserver agreement was measured using Cohen's weighted kappa along with 95% confidence intervals. A total of 21 dogs were sampled. The 3D-FSE sequences had higher pathologic indices of vertebral canal compromise (P = 0.020) and spinal cord signal change (P = 0.046) than 2D-FSE sequences. Furthermore, 3D-FSE sequences had higher visibility scores for the facet joint, intervertebral foramen, and nerve root structures (P < 0.001). Findings from the current supported the use of 3D-FSE sequences over 2D-FSE sequences for the evaluation of IVDD and visualization of spinal structures in small breed dogs.

Case Report: Multimodality Imaging of Infectious Sacroiliitis and Retroperitoneal Abscess Causing Hindlimb Ataxia in a Young Dog.

A 3-month-old intact male Labrador Retriever was presented for falling trauma and hindlimb ataxia. Radiography indicated radiolucent left sacroiliac joint with irregular margin. Computed tomography revealed thickened sublumbar muscles and hypoattenuated sacroiliac joint while magnetic resonance imaging demonstrated abscess at retroperitoneum and gluteal muscle. Ultrasonography showed lytic left sacroiliac joint with retroperitoneal fluid, and fine needle aspiration resulted Staphylococcus aureus. Hindlimb ataxia was attributed to infectious sacroiliitis and its secondary retroperitoneal abscess. As far as the authors' knowledge, this is the first report of multimodality imaging of infectious sacroiliitis with retroperitoneal abscess caused by S. aureus in a dog.

Biomarkers Associated with Tumor Heterogeneity in Prostate Cancer.

BACKGROUND: Prostate cancers exhibit intratumor heterogeneity (ITH), like other cancer types. The ITH may affect diverse phenotypes such as treatment response, drug resistance, and clinical outcomes. It is crucial to consider ITH to understand tumorigenesis. METHODS: Genomic and transcriptomic profiles of prostate cancer patients were investigated to determine which markers are correlated with the degree of tumor heterogeneity. In addition, the correlation between the immune activity and clonality of tumors was examined. RESULTS: Tumor heterogeneity across all prostate cancer samples was variable. However, ITH events were dependent on genomic and clinical features. Interestingly, prostate-specific antigen score increased in tumors with multiple subclones, indicating high-grade tumor heterogeneity. On the other hand, CD8-positive T-cell activation decreased in highly heterogeneous tumors. Intriguingly, PTEN deletion was prominently enriched in high heterogeneity groups, with a strong association with heterozygous loss. Expression of major genes including PTEN, CDC42EP5, RNLS, GP2, NETO2, and AMPD3 was closely related to tumor heterogeneity in association with PTEN deletion. CONCLUSIONS: In prostate cancer, ITH, a potential factor affecting tumor progression, is associated with PTEN deletion and cytotoxic T cell inactivation.

Effect of Detrusor Overactivity on Functional Outcomes After Holmium Laser Enucleation of the Prostate in Patients With Benign Prostatic Obstruction.

OBJECTIVE: To investigate the effect of detrusor overactivity (DO) on functional outcomes after holmium laser enucleation of the prostate (HoLEP). MATERIALS AND METHODS: One hundred ten men with benign prostatic obstruction were evaluated retrospectively. International Prostate Symptom Score, International Continence Society male questionnaire short form, 3-day voiding diary, and uroflowmetry with postvoid residual were evaluated preoperatively and at 3 and 6 months postoperatively. The patients underwent urodynamic study preoperatively and were divided into the DO group (58 of 110, 52.7%) and the non-DO group (52 of 100, 47.3%). RESULTS: Patients in the DO group were older than those in the non-DO group (71.4 vs 66.4 years), although prostate volume and degree of obstruction were not significantly different between the 2 groups. All International Prostate Symptom Score and uroflowmetry parameters improved significantly at the 3- and 6-month follow-ups. Storage symptoms in both groups were comparable preoperatively (9.7 vs 8.6); these improved similarly in both groups during follow-up (5.0 vs 4.0, 6-month follow-up). The number of patients taking anticholinergics increased significantly after HoLEP, from a baseline of 17 patients to 49 patients at the 3-month follow-up and 39 at the 6-month follow-up. More patients in the DO group were taking anticholinergics at the end of the follow-up period (48.3% vs 21.2%). CONCLUSION: Although the storage symptoms improved significantly in both groups, a significant number of patients with DO group took anticholinergics after HoLEP. We recommend that surgeons should counsel the possibility of taking anticholinergics in the early postoperative period to the patients with DO at baseline.

Efficacy of Holmium Laser Enucleation of the Prostate Based on Patient Preoperative Characteristics.

PURPOSE: To evaluate the efficacy of holmium laser enucleation of the prostate (HoLEP) in relation to prostate size and urodynamic parameters, including bladder outlet obstruction index (BOOI), presence of detrusor overactivity, and detrusor contractility, and to investigate factors predictive of HoLEP success. METHODS: This retrospective analysis of prospective data included 174 consecutive patients treated with HoLEP at Samsung Medical Center from 2009 to 2013. Prostate-specific antigen, prostate size, urodynamic parameters, and International Prostate Symptom Score (IPSS)/quality of life (QoL) were evaluated preoperatively, while prostate-specific antigen, uroflowmetry/postvoid residual (PVR) urine, and IPSS were measured six months after HoLEP. Two definitions of treatment success were established based on the following three variables: IPSS, maximum flow rate (Qmax), and QoL index. Factors predictive of HoLEP success were identified using multiple logistic regression analysis. RESULTS: IPSS/QoL, Qmax, and PVR improved significantly following HoLEP. Improvements in IPSS and PVR were more significant in the BOOI≥40 group compared to the BOOI<40 group, with overall success rates of 93.7% and 73.6%, respectively. Thus, the BOOI≥40 group had a significantly higher success rate, and BOOI≥40 was a significant predictor of HoLEP success based on the multivariate analyses. CONCLUSIONS: We found good surgical outcomes after HoLEP, and specifically patients with a higher BOOI had a greater chance of surgical success.

Nationwide database of surgical treatment pattern for patients with stress urinary incontinence in Korea.

PURPOSE: Nationwide database regarding stress urinary incontinence (SUI) is important for evaluating treatment patterns for SUI and for establishing appropriate national policies regarding SUI management. The purpose of this present study was to investigate surgical treatment patterns for women with SUI and analyze the current status of SUI management in Korea by using a nationwide database. METHODS: Data used for investigating the surgical trends and changes in Korea were retrieved from the Health Insurance Review & Assessment Service from 2008 to 2011. RESULTS: The number of surgical cases of SUI decreased continuously from 2008 to 2011. The proportion of transvaginal surgery using a midurethral sling increased continuously. Sling procedures were most commonly performed for women in their 40s followed by women in their 50s. Transvaginal surgery using a single sling or a readjustable sling was performed from 5.6% to 6.1%, which showed no significant change in the number of surgical cases. CONCLUSIONS: There is a growing need for an appropriate national welfare policy and budget to care for aged and super-aged women in Korea. The early detection and intervention of silent SUI should be actively considered as an important preventive strategy to improve the quality of life in younger women.

Treatment outcomes according to neuropathic bladder sphincter dysfunction type after treatment of oxybutynin chloride in children with myelodysplasia.

PURPOSE: We investigated the treatment outcomes according to neuropathic bladder sphincter dysfunction (NBSD) type after oral oxybutynin (OBT) treatment in children with NBSD caused by myelodysplasia. METHODS: Among 334 pediatric patients who were diagnosed with NBSD caused by myelodysplasia, only children treated with oral OBT for more than 1 year with pre- and post-treatment urodynamic studies and dimercaptosuccinic acid (DMSA) were retrospectively reviewed. We compared pre- and post-treatment urodynamic parameters including maximum cystometric capacity (MCC), MCC/estimated bladder capacity (EBC), and compliance by NBSD type in children. We also compared renal scarring on pre- and post-treatment DMSA by NBSD type in children. RESULTS: Our study population was comprised of 81 children (45 boys and 36 girls), with a mean age of 4.2 ± 3.4 years. The mean follow-up duration was 4.5 (range 1.0-15.1) years. After OBT treatment, MCC was increased significantly in all types of NBSD from 110.3 ± 62.2 to 202.3 ± 103.9 ml (p < 0.05), compliance was significantly improved from 6.4 ± 6.1 to 11.1 ± 9.6 ml/cmH2O (p < 0.05), but MCC/EBC was slightly decreased from 75.2 ± 46.9 to 69.8 ± 33.3 % (p = 0.40). Sub-analyzed by NBSD type, the pre-treatment compliance of children with acontractile detrusor with spastic sphincter (n = 16) was markedly decreased compared with other types of NBSD. Acontractile detrusor with spastic sphincter demonstrated the worst renal deterioration on DMSA. CONCLUSIONS: Although increases in MCC/EBC were limited, oral OBT treatment markedly improved MCC and compliance in all NBSD types. Children who had acontractile detrusor with spastic sphincter had a relatively high probability of renal deterioration and required specific attention.

Pathologic implications of prostatic anterior fat pad.

OBJECTIVE: Lymph node status has significant pathologic implications in patients with prostate cancer. In this study, we have performed pathologic analysis of prostatic anterior fat pad (PAFP) excised during robot-assisted radical prostatectomy (RARP) to investigate the potential role of AFP on pathologic staging of prostate cancer. METHODS: A total of 258 consecutive patients underwent PAFP excision during RARP between July 2007 and June 2009. PAFP was removed and submitted en bloc to the pathology department and evaluated for the presence of lymphoid tissue and metastatic prostate cancer. Retrospective chart review was performed for all patients. RESULTS: Of the 258 patients, 30 (11.6%) had 1 or 2 PAFP lymph nodes and 228 (88.4%) men showed no lymphoid tissue in their PAFPs. Preoperatively, mean PSA level was higher in the former group. There were no significant pathologic differences between the 2 groups. Among the 30 patients with PAFP lymph nodes, 3 were positive for metastatic prostate cancer. All 3 of these patients had high-risk features preoperatively. In 1 patient, the pelvic lymph nodes were negative for metastatic prostate cancer. At 2-year follow-up, PSA level of this patient was undetectable. CONCLUSIONS: Herein, we demonstrated that the PAFP contained lymph nodes in over 11% of the patients undergoing RARP at our institution. Prostate cancer was upstaged in 1 patient as a result of PAFP excision. Since this patient is free of biochemical recurrence at 2 years, routine excision and pathologic analysis of PAFP should be considered in prostate cancer patients undergoing radical prostatectomy.

CREBZF, a novel Smad8-binding protein.

Smads are the secondary messengers of the transforming growth factor-ß (TGF-ß) signaling pathway. TGF-ß receptors phosphorylate the Receptor Smads (R-Smads) upon ligand binding; activated R-Smads translocate to the nucleus and function as transcription factors. Among the R-Smads, Smads 1, 5, and 8 mainly mediate signals in the bone morphogenetic proteins (BMPs) pathways, while Smads 2/3 mediate TGF-ß signaling. The regulation of Smads in the TGF-ß signal pathway has been well defined, but the relationship of Smads 1, 5, and 8 to the BMP pathways has been relatively understudied. To understand the specific regulation of BMP mediating Smads, we performed yeast two-hybrid screening using the Mad homology 2(MH2) domain of Smad8 as bait. In this screening, novel Smad-binding protein, CREBZF-a basic region-leucine zipper (bZIP) transcription factor-was identified. The interaction of CREBZF and Smads 1, 5, and 8 was confirmed by immunoprecipitation in a human prostate cancer cell line. Overexpression of CREBZF inhibited the promoter activity of BMP response element and abolished the cell growth inhibition induced by BMP-6. Thus, CREBZF inhibits the function of BMP-6 by interacting with Smads. The identification of this novel Smads-binding protein, among others will help us understand the modulation of BMP-signaling pathways.

Pathological findings following radical prostatectomy in patients who are candidates for active surveillance: impact of varying PSA levels.

Active surveillance is an acceptable treatment option in men with a low-risk prostate cancer. In the present study, we have retrospectively reviewed the outcomes of 509 men who fit the criteria for active surveillance but selected radical prostatectomy. Then, the impact of varying prostate-specific antigen (PSA) levels on the risk of upstaging and upgrading in these patients was assessed. Pathological characteristics of patients who fulfilled the inclusion criteria under three active surveillance criteria--those of the University of California-San Francisco, the National Cancer Institute and the European Association of Urology--were examined. The proportion of men who were deemed candidates for active surveillance but were subsequently upstaged or upgraded was determined. Of 509 patients, 186 (36.5%), 132 (25.9%) and 88 (17.3%) men fulfilled the active surveillance criteria, respectively. Upgrading (Gleason scores 7-10) ranged from 32.8% to 38.6%, while upstaging (≥pT3) ranged from 10.2% to 12.5%, depending on the three active surveillance criteria. After a median follow-up of 24 months, three patients developed a biochemical recurrence. When the impact of varying PSA levels was examined using a test for trend analysis in the context of PSA for each protocol, rates of upstaging were lower in men with PSA <4 ng ml(-1). However, there was no impact of varying PSA levels on upgrading. In conclusion, commonly used active surveillance protocols carry the risks of upgrading and upstaging. More reliable and accurate markers are needed to better stratify the risks of men who are appropriate candidates for active surveillance.

Impact of robot-assisted radical prostatectomy on health-related quality of life in patients with lower urinary tract symptoms.

OBJECTIVE: Lower urinary tract symptoms (LUTS) are a common complaint in patients with prostate cancer. We attempted to elucidate the effect of robot-assisted radical prostatectomy (RARP) on patients having different preoperative LUTS severity through analysis of postoperative health-related quality of life. METHODS: From 1/2006 to 9/2009, over 500 patients underwent RARP at our institution. Preoperative American Urologic Association Symptom Score (AUA-SS), preoperative Sexual Health Inventory for Men, and postoperative Expanded Prostate Cancer Index Composite were available in 183 of them. These patients were divided into three subgroups based on their AUA-SS as follows: mild AUA-SS (score 0-7) group, moderate AUA-SS (8-19) group, and severe AUA-SS (20-35) group. RESULTS: Of the 183 men, 94 (51.4%), 70 (38.2%), and 19 (10.4%) were in the mild, moderate, and severe group, respectively. In the comparison of Expanded Prostate Cancer Index Composite domain subscales with mean score, only urinary domain had significant differences among subgroups. Patients with high preoperative LUTS persistently showed a statistical trend for decreased urinary function (P = 0.056) and suffered more from urinary bother postoperatively (P < 0.01). In the analysis of urinary bother items, all items except "bleeding with urination" showed statistically significant differences among the subgroups (P < 0.05). CONCLUSIONS: Even after RARP, patients with severe preoperative LUTS continue to have significant symptoms postoperatively. In analyzing urinary bother items, all LUTS items, including dysuria, storage symptoms, and postmicturition or voiding symptoms, were higher in patients with high preoperative AUA-SS.

Impact of Partin nomogram on presurgical planning: intrafascial versus interfascial nerve sparing during robot-assisted radical prostatectomy.

We studied the impact of using the Partin nomogram in tailoring the nerve sparing approach during robot-assisted radical prostatectomy. From July 2008 to July 2009, 168 patients underwent robot-assisted radical prostatectomy with bilateral nerves spared. All of the first 70 patients (cohort I) had intrafascial nerve sparing, while the Partin nomogram was used to determine the nerve sparing approach in the next 98 patients (cohort II). In patients with a probability greater than 53% of having pathologically non-organ-confined disease, conventional interfascial nerve sparing was performed; otherwise, intrafascial nerve sparing was carried out. Preoperative patient demographics were similar between the two cohorts. In cohort II, 68 and 30 patients had the bilateral nerves spared intrafascially and interfascially, respectively. Overall, the prevalence of pT3 disease in cohort I was 24.3% and in cohort II was 21.4%. The positive surgical margin rate in cohort I was 15.7% while that in cohort II was 6.1%. There was no significant difference in positive surgical margin rate in organ-confined (pT2) disease between the two groups (7.5 and 5.2%). On the other hand, pT3 positive surgical margin rate was significantly reduced in cohort II (41.2 and 4.8%, P = 0.013). Using the Partin nomogram in deciding interfascial versus intrafascial nerve sparing during robot-assisted radical prostatectomy gave a significant reduction of positive surgical margin rate in pT3 prostate cancers.

Bone morphogenetic protein signaling: implications in urology.

The bone morphogenetic proteins (BMPs), as members of the transforming growth factor-beta (TGF-beta) superfamily, not only control bone formation, but also regulate multiple key steps during embryonic development and differentiation. Furthermore, BMPs play critical roles in maintaining the homeostasis of the cardiovascular, pulmonary, reproductive, urogenital, and nervous systems in adult life. Like all members of the TGF-beta superfamily, BMP signaling is mediated through a heteromeric complex of type I and type II transmembrane serine/threonine kinase receptors. The subsequent signal transduction cascade includes either the canonical Smad-dependent or non-canonical Smad-independent pathways. Reflecting the critical function of BMPs, BMP signaling is tightly regulated at multiple steps by various mechanisms including extracellular endogenous antagonists, neutralizing antibodies/extracellular soluble receptor domains, small molecule inhibitors, cytoplasmic inhibitory Smads, and transcriptional co-repressors. Recently, dorsomorphin, the first small molecule inhibitor of BMP signaling, was identified and suggested as a useful tool for dissecting the mechanisms of signaling pathways and for developing novel therapeutics for diverse human diseases that are related to the BMP signaling pathways. In this article, we discuss various mechanisms involved in regulating BMP signaling pathways and their implications for urology.

Clavien classification of complications after the initial series of robot-assisted radical prostatectomy: the Cancer Institute of New Jersey/Robert Wood Johnson Medical School experience.

PURPOSE: To study the safety and feasibility of robot-assisted radical prostatectomy (RARP) for the surgical management of localized prostate cancer, we analyzed perioperative parameters and the pattern of complications in our patients who underwent RARP. PATIENTS AND METHODS: After the performance of more than 600 RARP over a 4-year period by a single surgeon using the daVinci® robot system at the Cancer Institute of New Jersey/Robert Wood Johnson Medical School, we reviewed the medical records of the first 200 patients retrospectively. All patients were divided into four groups according to the order of case numbers to compare intergroup differences in preoperative characteristics and perioperative parameters. Perioperative complications were determined in all patients, and complications were classified according to the Clavien classification system. RESULTS: The mean operative time was 212 minutes, and the mean blood loss was 189 mL. The mean length of hospital stay was 1.13 days. Overall, 12% (24 men) experienced various perioperative complications among the 200 patients. Of the total 24 patients, 5 (20.8%) men experienced intraoperative complications, and 19 (79.2%) men showed postoperative complications. Rectal injury occurred in two (8.3%) men, and the injury was repaired primarily using two-layer suture techniques without any sequelae. Three (12.5%) patients had femoral neuropathy, and urinary retention developed in 7 (25.0%) patients. Among our 200 patients, no transfusion was needed intraoperatively and postoperatively. There were nine (4.5%) patients in the Clavien grade I complications category, and another 9 (4.5%) men were classified as grade II complications. Six (3.0%) men had grade IIIb complications, and there were no grade IV or V complications. CONCLUSIONS: In our initial series of RARP procedures, we experienced low morbidity, with the overall complication rate of 12%. After implementing minor modifications, most of the early complications were prevented. Rectal injuries, if recognized intraoperatively, can be repaired primarily.

Early assessment of patient satisfaction and health-related quality of life following robot-assisted radical prostatectomy.

Impairments in health-related quality of life (HRQOL) and patient satisfaction after definitive treatment for localized prostate cancer can be significant. We assessed patient satisfaction associated with HRQOL following robot-assisted radical prostatectomy (RARP). Prostate cancer-specific HRQOL was assessed using 50 items from the Expanded Prostate Cancer Index Composite and postoperative satisfaction parameters. According to the satisfaction level, 218 consecutive patients were divided into the following three groups: group 1, extremely satisfied (n = 140); group 2, satisfied (n = 54); and group 3, uncertain, dissatisfied and extremely dissatisfied patients (n = 24). Peri-operative characteristics were not significantly different among the three groups. When the mean domain-specific HRQOL subscale scores were compared, there were no statistical differences in urinary and sexual function between groups 1 and 2. Patients in group 2 were more bothered by these domains than those in group 1. Group 3 had significantly lower scores in bowel and hormonal bother than the other groups and significantly lower scores in bowel function when compared to group 1. In daily life related to HRQOL, satisfaction is mainly determined by personal perception and interpretation rather than the objective status of urinary and sexual function. More interestingly, patients in the dissatisfied group were more likely to have bladder and bowel storage symptoms. Additional work is necessary to identify the factors associated with increased risk of pelvic organ storage symptoms following RARP.

Functional and oncologic outcomes comparing interfascial and intrafascial nerve sparing in robot-assisted laparoscopic radical prostatectomies.

INTRODUCTION: The impact of intrafascial versus interfascial nerve sparing during radical prostatectomy on oncologic and postoperative outcome is still controversial. This manuscript compares the outcomes of intrafascial versus interfascial techniques of nerve sparing used during robot-assisted laparoscopic radical prostatectomy (RALRP) at our institution. MATERIALS AND METHODS: Of the 171 patients who underwent RALRP at our institution from January 2006 through December 2007, the charts of 147 patients who underwent bilateral nerve sparing procedure were reviewed retrospectively. During the study period, the preferred technique of nerve sparing at our institution changed from the conventional interfascial approach to athermal intrafascial robotic (AIR) approach. The rates of positive surgical margins (+SMs), continence, and potency were measured. RESULTS: Perioperative characteristics and complication rates were similar between the two groups. Continence rates at 1, 3, and 6 months increased from 27.3%, 68.8%, and 93.5%, respectively, after the interfascial procedure to 68.6%, 84.3%, and 92.9% after the AIR procedure. Potency rates at 3, 6, and 9 months in the interfascial group were 16.7%, 43.8%, and 66.7%, respectively, whereas in the AIR group they improved to 24.2%, 81.8%, and 90.9%. The rates of +SMs in pT2 disease were 5.88% in the interfascial group and 7.55% in the AIR group (not significant), whereas in pT3, +SMs were 22.2% in the interfascial group and 41.18% in the AIR group (p < 0.05). CONCLUSION: AIR technique greatly improved potency rate and shortened the time to return of continence following RALRP. This improved outcome, though, was achieved at the price of higher +SM rates in patients with pT3 disease.