The safety and feasibility of simultaneous robotic repair of an inguinal hernia during robotic-assisted laparoscopic prostatectomy: a systematic review and meta-analysis.

PURPOSE: This study intended to assess the safety and feasibility of performing concurrent robotic-assisted laparoscopic prostatectomy (RALP) and robotic inguinal hernia repair (RIHR). METHOD: We systematically searched the PubMed, Embase and Cochrane Library database up to the year 2020 to identify studies that assessed patients who underwent RALP and RIHR in the same settings. RESULTS: Thirteen studies were considered suitable for a systematic review and seven for Meta-analysis. RALP and RIHR were associated with significantly longer operative time. RIHR added on average 26 min to the operation time (8, 45 95% CI, p = 0.005, I2 97%). Concurrent RALP and RIHR was not associated with a higher incidence of blood loss (-13, 6 95% CI, p = 0.43, I2 18%), length of stay (-0.08, 0.06 95% CI, p = 0.73, I2 0%) or early postoperative complications. CONCLUSION: Concurrent robotic repair of an inguinal hernia during RALP appears feasible and safe. Urologists should be encouraged to repair hernias encountered during RALP keeping in mind possible complications including wound infection, mesh infection, chronic inguinal pain and recurrence of hernia.

Is primary ureteroscopy an alternative to emergency stenting in terms of quality and cost?

INTRODUCTION: The aim of this article was to investigate quality and cost benefits of managing urolithiasis by primary ureteroscopic procedures (P-URS) during index admission to hospital. With the rise in prevalence of urolithiasis, the focus has shifted to manage these patients during their first admission rather than using temporary measures like emergency stenting (ES) or nephrostomies which are followed by deferred ureteroscopic procedures (D-URS). We compared results of P-URS, D-URS and ES procedures in terms of quality and cost benefits. MATERIAL AND METHODS: Data was collected retrospectively for all P-URS, D-URS and ES procedures performed during year 2019. A total of 85 patients underwent ES while as 138 patients underwent elective URS (26 had P-URS and 112 had D-URS). The quality assessment was based in relation to patient factors including- number of procedures per patient, number of days spent at hospital, number of days off work. Cost analysis included theatre and hospital stay expenses, loss of working days. RESULTS: This study revealed that the average hospital stay of patients on index admission who had a ES was 1.35 days (Total 3.85) and who had P-URS was 1.78 days (Total 2.78). Overall, additional expenditure in patients who did not undergo primary URS was in the range of 1800-2000€ (excluding loss of work for patients, who needed to return for multiple procedures). CONCLUSIONS: We conclude approach of P-URS and management of stones in index admission is very effective in both improving quality of patients as well as bringing down cost expenditure effectively.

Ureteric stenting vs not stenting following uncomplicated ureteroscopic lithotripsy: A prospective randomised trial.

OBJECTIVE: To compare three groups of patients who underwent uncomplicated ureteroscopic lithotripsy (URSL) and to evaluate whether stenting could be eliminated after the procedure, as there is no consensus about whether a ureteric stent should be placed after uncomplicated ureteroscopy for stone retrieval. PATIENTS AND METHODS: In this randomised clinical trial (NCT04145063) 105 patients underwent uncomplicated URSL for ureteric stones. They were prospectively randomised into three groups: Group 1 (34 patients) with a double pigtail ureteric stent, Group 2 (35 patients) with a double pigtail ureteric stent with extraction string, and Group 3 (36 patients) with no ureteric stent placed after the procedure. The outcomes measured were: postoperative visual analogue scale (VAS) score for flank pain and dysuria score, urgency, frequency, suprapubic pain, haematuria, analgesia requirement, operative time, re-hospitalisation, and return to normal physical activity. RESULTS: The mean (SD) operative time was significantly longer in groups 1 and 2 compared to Group 3, at 22.2 (9.1), 20.2 (6) and 15.1 (7.1) min, respectively (P < 0.001). The results of the VAS for flank pain and dysuria scores, urgency, frequency, haematuria, and suprapubic pain showed a significant difference at all time-points of follow-up, being significantly higher in groups 1 and 2 compared to Group 3 (all P < 0.001). Further analysis showed that measured outcomes, and analgesia need for groups 1 and 2 were similar, at all time-points except at week 1 and 1 month where Group 2 patients' had less symptoms (P < 0.001). CONCLUSION: Double pigtail ureteric stent placement appears to be unnecessary in procedures considered 'uncomplicated' by operating urologists during surgery. The advantages of the double pigtail ureteric stent with extraction string over the double pigtail ureteric stent only include earlier and easier removal with earlier relief of symptoms, and less analgesia requirements. ABBREVIATIONS: KUB: plain abdominal radiograph of the kidneys, ureters and bladder; URSL: ureteroscopic lithotripsy; VAS: visual analogue scale.