Promoting patient followup treatment with intra-detrusor onabotulinumtoxinA for overactive bladder.

INTRODUCTION: We aimed to characterize patient-related factors that promote followup of repeat onabotulinumtoxinA treatments for overactive bladder via a mixed-methods approach. METHODS: A retrospective chart review was conducted for patients who received intra-detrusor injection of onabotulinumtoxinA at our institution from 2011-2018, who were then surveyed to evaluate their experience, knowledge, and perceptions regarding onabotulinumtoxinA treatment and followup. Patients who received one onabotulinumtoxinA treatment and patients who underwent multiple treatments were compared to assess followup rates following initial treatment, group characteristics, patient comfort, and patient knowledge of needed retreatment. RESULTS: A total of 29.3% of patients received a single treatment and 70.7% of patients received multiple treatments. There was no difference in clinical, demographic, or intake variables between groups. Patients receiving multiple treatments reported having their first procedure in the operating room and reported greater improvement in symptoms and procedure comfort. This group was also more likely to understand that repeat treatments are necessary than those undergoing one treatment. CONCLUSIONS: No research to date has systematically explored patient-reported factors that promote retreatment of onabotulinumtoxinA for overactive bladder. This novel, mixed-methods approach indicates that patient comfort and patient knowledge were the strongest predictors of previous retreatment and anticipated retreatment, suggesting concrete avenues for improved periprocedural patient counselling and education.

The use of high resolution optical coherence tomography to evaluate robotic radical prostatectomy specimens.

OBJECTIVE: Optical coherence tomography (OCT) is a unique technology, developed to provide high resolution, cross sectional images of human tissue. The objective of this study was to explore the feasibility of OCT for the evaluation of positive surgical margins and extra capsular extension in robotic prostatectomy specimens and compare it to histopathology. MATERIALS AND METHODS: Radical prostatectomy was performed in 100 patients. Twenty OCT images of each specimen were taken from the base of the seminal vesicles (SV), apical and vesicle margins, peripheral and posterolateral area and any palpable nodule. Predictions were made regarding positive surgical margin, SV involvement, capsular invasion and compared with the final histopathology. RESULTS: A total of 2000 OCT images were taken and analyzed. Out of 100 specimens, 85 had T2 disease, 15 had T3 disease with a median Gleason's score of 7 (range 6 to 9) and 10 had positive surgical margins. We predicted 21 specimens to have positive margins based on OCT images out of which 7 were truly positive and 14 were falsely positive. Based on OCT images, 79 specimens were predicted to have negative margins out of which 76 were truly negative and 3 were falsely negative. We found the sensitivity, specificity, positive predictive value and negative predictive value to be 70%, 84%, 33% and 96% respectively. CONCLUSION: Our initial feasibility study established the template for the visual OCT characteristics of the prostate, SV and cancerous tissue. The negative predictive value of evaluating surgical margins was high.

Perinephric Hematoma and Hemorrhagic Shock as a Rare Presentation for an Acutely Obstructive Ureteral Stone with Forniceal Rupture: A Case Report.

BACKGROUND: Spontaneous perinephric hematoma (SPH) secondary to a forniceal rupture as the first presenting sign for an obstructive ureteral stone in a patient without history of urolithiasis has not been described previously. CASE PRESENTATION: We report a 70-year-old Caucasian male patient who presented to our emergency room with fever, altered mental status, and left flank pain. He had a temperature of 103.3°F, tachycardia, but stable blood pressure. He had left flank tenderness. A computed tomography scan of the abdomen/pelvis with intravenous contrast revealed an intracapsular hematoma (13.3 × 10.0 × 6.4 cm) with an active bleeding and a 1.1 cm left proximal ureteral stone. The patient became quickly hemodynamically unstable and was taken for emergent exploratory laparotomy and left nephrectomy. An active bleeding was encountered secondary to a (2.4 × 2.0 cm) lateral capsular defect in the kidney. CONCLUSION: Hemorrhagic/septic shock as a presenting sign for an obstructive ureteral stone may require an emergent nephrectomy in a hemodynamically unstable patient.

Laparoscopic inguinal hernia repair during laparoscopic radical prostatectomy.

OBJECTIVE: To describe our experience of simultaneous laparoscopic radical prostatectomy (LRP) and inguinal hernia repair (LIHR) with a non-absorbable mesh, as there are few reports of simultaneous herniorrhaphy during LRP. PATIENTS AND METHODS: Forty patients who had simultaneous LIHR and LRP were retrospectively reviewed. All operations were completed via antegrade techniques using a non-absorbable mesh for the LIHR, as the results with absorbable mesh were disappointing. RESULTS: In all, 48 clinically apparent hernias were repaired in 40 patients (mean age 60 years). Of these, 13 were left-sided, 23 right-sided, and six bilateral; 19 were direct, 14 indirect, two pantaloon, three femoral, and in 10 the type was not recorded. The mean operative duration was 172 min and the mean hospital stay was 1.5 days. Two patients had a urine leak after surgery, which resolved with no further intervention, and two developed a pelvic lymphocele, one at 4 months and the other at 2 months after surgery. Two patients required urinary catheter re-insertion for retention after surgical catheter removal at 9 and 10 days after surgery, respectively. One patient developed a deep venous thrombosis 19 days after surgery. Of the 40 patients, 36 (90%) were followed for a mean of 10 months; none had a hernia recurrence on the repaired side, while two developed a new symptomatic contralateral hernia. CONCLUSIONS: LIHR is a successful and reliable way to treat symptomatic patients who are treated surgically for prostate cancer.

Robotic-assisted laparoscopic radical prostatectomy: The Ohio State University technique.

Robotic radical prostatectomy is a new innovation in the surgical treatment of prostate cancer. The technique is continuously evolving. In this article we demonstrate The Ohio State University technique for robotic radical prostatectomy. Robotic radical prostatectomy is performed using the da Vinci surgical system. The video demonstrates each step of the surgical procedure. Preliminary results with robotic prostatectomy demonstrate the benefits of minimally invasive surgery while also showing encouraging short-term outcomes in terms of continence, potency and cancer control. Robotic radical prostatectomy is an evolving technique that provides a minimally invasive alternative for the treatment of prostate cancer. Our experience with the procedure now stands at over 1,300 cases.

Robot assisted laparoscopic pyeloplasty: a review of the current status.

BACKGROUND: Over the last decade minimally invasive endourologic and laparoscopic techniques have become the first line therapies for primary UPJ obstruction. Robotic assisted laparoscopic pyeloplasty for the correction of ureteropelvic junction has achieved outcomes comparable to those of open and laparoscopic techniques. We present a comprehensive review of the current literature of robotic assisted pyeloplasty. METHODS: We performed a systemic review of all the current literature examining demographic data, intra operative parameters and post-operative outcomes. RESULTS: In most published series in the literature, the operative time ranges from 122 to 300 minutes and the operative time ranges from 27 to 77 ml. Most series considers subjective improvement in the symptoms and improved drainage on post-operative diuretic renal scan as the measures of success. The reported success rates vary from 89 to 100%. CONCLUSION: Robotic pyeloplasty is a feasible alternative to laparoscopic pyeloplasty. Short-term results indicate equivalent outcomes with the laparoscopic procedure. Long-term studies are still needed to compare robotic and open pyeloplasty outcomes, and to define the role of robotic pyeloplasty in a cost prohibitive health care system.

Laparoscopic radical prostatectomy in a renal allograft recipient.

In the current immunosuppression era, most renal transplant recipients with a functioning allograft are living healthier and longer lives. In men, because of prostate-specific antigen screening, more patients are diagnosed with early prostate cancer and offered curative treatment with radical prostatectomy. Laparoscopic radical prostatectomy is an accepted minimally invasive treatment for a middle-aged man with organ-confined prostate cancer. To our knowledge, laparoscopic prostatectomy has not yet been reported in renal transplant recipients. This is a case report of laparoscopic prostatectomy for biopsy-proven localized prostate cancer in a renal transplant recipient.

The use of high resolution optical coherence tomography to evaluate robotic radical prostatectomy specimens

OBJECTIVE: Optical coherence tomography (OCT) is a unique technology, developed to provide high resolution, cross sectional images of human tissue. The objective of this study was to explore the feasibility of OCT for the evaluation of positive surgical margins and extra capsular extension in robotic prostatectomy specimens and compare it to histopathology. MATERIAL AND METHODS: Radical prostatectomy was performed in 100 patients. Twenty OCT images of each specimen were taken from the base of the seminal vesicles (SV), apical and vesicle margins, peripheral and posterolateral area and any palpable nodule. Predictions were made regarding positive surgical margin, SV involvement, capsular invasion and compared with the final histopathology. RESULTS: A total of 2000 OCT images were taken and analyzed. Out of 100 specimens, 85 had T2 disease, 15 had T3 disease with a median Gleason's score of 7 (range 6 to 9) and 10 had positive surgical margins. We predicted 21 specimens to have positive margins based on OCT images out of which 7 were truly positive and 14 were falsely positive. Based on OCT images, 79 specimens were predicted to have negative margins out of which 76 were truly negative and 3 were falsely negative. We found the sensitivity, specificity, positive predictive value and negative predictive value to be 70 percent, 84 percent, 33 percent and 96 percent respectively. CONCLUSION: Our initial feasibility study established the template for the visual OCT characteristics of the prostate, SV and cancerous tissue. The negative predictive value of evaluating surgical margins was high.