Can robot-assisted kidney transplantation provide higher quality of life than open kidney transplantation during the early postoperative period?

PURPOSE: Purpose of this study is to investigate the quality of life (QoL) in patients with end-stage renal disease who underwent open or robot-assisted kidney transplantation (OKT and RAKT). MATERIALS AND METHODS: Patients who underwent OKT and RAKT at Bakirkoy Sadi Konuk Training and Research Hospital between June 2016 and December 2018 constituted the target population of this study. The patient group was divided into two groups as per the surgical technique (ie, open vs. robot-assisted). Demographic data, preoperative and postoperative data of all patients were collected prospectively. The QoL of the patients was assessed preoperatively and on the postoperative 30th day. RESULTS: Sixty-seven patients who underwent OKT and 60 patients who underwent RAKT were included. The mean patient age and BMI were calculated as 40.9 ± 11.6 years and 24.4 ± 2.9 kg/m2 , respectively. Patients in the RAKT group were significantly younger than the patients in the OKT group (P = .002). There were no significant differences between the two groups in terms of gender, BMI, ASA and the ratio of premptive patients. The mean preoperative hemoglobin level was significantly higher in the OKT group than the RAKT group (P = .003). While mean total ischemia time was shorter in the "open" group, intraoperative blood loss and incision length were shorter in the RAKT group. Duration of surgical drainage and hospital stay was shorter in the "robot-assisted" group. There was no significant difference between the groups in terms of SF-36 subparameters preoperatively. The physical component scores of the QoL questionnaire revealed that postoperative impairment of quality of life in the early postoperative period was more significant in the OKT than the RAKT. CONCLUSION: Patients who underwent RAKT have a higher QoL than the patients who were treated with OKT as per their self-reported QoL scores in the early postoperative period.

Robot-assisted radical perineal prostatectomy: a review of 95 cases.

OBJECTIVES: To assess the early functional and oncological outcomes of a large series of patients who underwent robot-assisted radical perineal prostatectomy (RPP). MATERIALS AND METHODS: We retrospectively analysed the patients who underwent robot-assisted RPP for localized prostate cancer between November 2016 and September 2018. Patients who had locally advanced disease proven on biopsy or were suspected to have locally advanced disease on multiparametric magnetic resonance imaging and patients who had a contraindication for the exaggerated lithotomy position were not included in this study. Patient demographics, preoperative and postoperative variables, complications and follow-up times were recorded. RESULTS: A total of 95 patients were included. Their mean ± sd age was 61.5 ± 6.5 years. The median (interquartile range [IQR]) preoperative prostate-specific antigen level was 6.1 (3.7) ng/mL, the median (IQR) operating time was 140 (25) min, and the mean ± sd blood loss was 67.4 ± 17 mL. Pelvic lymph node dissection (PLND) was performed for 12 patients (12.6%). The median (IQR) hospital stay was 1 (1) days. Positive surgical margins were present in eight patients (8.4%). After catheter removal, the immediate continence rate was 41%. Continence rates were 78%, 87% and 91%, respectively, 3, 6 and 12 months after surgery. Potency rates were 49%, 69% and 77%, respectively, 3, 6 and 12 months after surgery for patients who had adequate potency preoperatively. The median (IQR) follow-up time was 13 (3.1) months. CONCLUSION: We conclude that robot-assisted RPP is a reliable and effective surgical technique that can be employed in the treatment of localized prostate cancer regardless of prostate volume, especially in patients with a history of abdominal surgery. As an additional advantage, PLND can be performed through the same incision.

Short term outcomes of high power (80 W) potassium-titanyl-phosphate laser vaporization of the prostate.

PURPOSE: We have evaluated the safety and efficacy of 80 W potassium-titanyl-phosphate (KTP) laser in the treatment of patients with lower urinary system symptoms (LUTS) due to benign prostatic hyperplasia. MATERIALS AND METHODS: A total of 186 patients with LUTS have been evaluated using the International Prostate Symptom Score (IPSS) and quality of life (QoL) scoring questionnaire. Volume of prostate, post-micturition volume of residual urine (PVR), maximum flow rate (Qmax) and serum prostate specific antigen (PSA) values were determined. Laser vaporization of the prostate with an 80 W KTP was applied to all the patients. IPSS and QoL scores were evaluated on postoperative days 30, 90 and 180. The below values were measured on the postoperative days mentioned respectively: Qmax-15, 30 and 90; PSA-1, 15, 30 and 60; PVR-90. RESULTS: The results of 186 patients, who underwent KTP laser treatment, have been evaluated. Mean age of the patients was 66+/-8 (47-90). Mean volume of prostates, mean operative time and mean energy delivery were 48.1+/-13.2 ml (26-70), 57+/-17 minutes (10-120) and 105+/-37 kJ (20-350), respectively. Following the procedures, Foley catheters were removed after a mean time of 7.59+/-0.9 hours (6-13). Compared with the preoperative period, IPSS, QoL, PVR and Qmax values decreased significantly during the postoperative period (p<0.01). Mean preoperative PSA value was 2.59+/-0.9 ng/ml (0.28-4). There were statistically significant increases in PSA values on postoperative day 1 (p<0.001). However, on postoperative day 15, PSA values decreased as low as preoperative values. There was moderate dysuria in 55 (30%) patients with a mean duration of 2 months and mild hematuria in 10 (18%) patients with a mean duration of 1 month postoperatively. Urinary tract infection occurred in 12 (6%) patients. None of the patients had fever or required re-catheterization. We observed contracture of the bladder neck in 2 (1%) patients and clot retention in 2 (1%) patients. Urinary incontinence due to operation was not observed. CONCLUSIONS: KTP laser vaporization of the prostate is a treatment method which can be used in patients at high risk of anesthesia. This procedure is safe and effective in that it quickly relieves bladder outlet obstruction symptoms and has a low rate of postoperative complications. However, long-term follow-up studies are called for in order to ascertain whether the results of this procedure are durable or not.