Treatment of Pelvic Floor Disorders Following Neobladder.

Radical cystectomy remains the gold standard treatment for organ-confined high-grade recurrent or muscle-invasive bladder cancer. Orthotopic neobladder urinary diversion following cystectomy represents an option for patients wishing for continent urinary diversion. Female patients who undergo radical cystectomy with orthotopic bladder substitution are at risk for developing both common and neobladder-specific disorders of the pelvic floor, including urinary incontinence, hypercontinence, vaginal prolapse, and neobladder-vaginal fistula. Each of these sequelae can have significant impact on the patient's quality of life. Due to the increased frequency of orthotopic neobladder creation in women, subspecialty urologists are more likely to confront such pelvic floor disorders in bladder cancer survivors. This review presents the most current information on the treatment of pelvic floor disorders after orthotopic bladder substitution.

Shortened operative time for pediatric robotic versus laparoscopic dismembered pyeloplasty.

INTRODUCTION: Robotic-assisted laparoscopic pyeloplasty (RALP) is increasingly becoming the standard procedure for management of ureteropelvic junction obstruction (UPJO) in the pediatric population, but few studies have shown a clear advantage over the more technically demanding laparoscopic pyeloplasty (LP) in children. The objective was to study the patients treated with RALP or LP at our institution and the associated outcomes for each minimally invasive approach for the correction of UPJO. MATERIALS AND METHODS: Our laparoscopic and robotic database was queried to identify all patients with a history of primary robotic-assisted or laparoscopic dismembered pyeloplasty for the correction of UPJO performed at our institution from January 2010 through November 2013 and were retrospectively reviewed. We analyzed age, surgical time, blood loss, hospital stay length, postoperative complications, and success rate. RESULTS: Seventy-three total patients were identified as having RALP or LP during this time period with five patients excluded from the analysis. We identified 55 patients with RALP and 13 patients with LP. No differences in success rate or postoperative complications were found for the two cohorts. The length of procedure was significantly shorter for the RALP group compared to the LP group.

Post-Chemotherapy Robotic Retroperitoneal Lymph Node Dissection: Institutional Experience.

PURPOSE: There is little literature on robotic retroperitoneal lymph node dissection (RRPLND) in the difficult post-chemotherapy (PC) setting. We report on the outcome of RRPLND in patients with PC-residual masses. MATERIALS AND METHODS: Between 2011 and 2015, we performed 12 PC-RRPLND. Mean patient age was 37.8 years. Mean body mass index was 30.78. Nine (75%) patients had nonseminomatus germ cell tumor (NSGCT) and three (25%) patients had seminoma tumors. Cancer stage was III in six (50%), II-C in three (25%), II-B in two (16.7%), and II-A in one (8.03%). International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic classification in the NSGCT was good in six, intermediate in two, and poor in one, and was good in the three seminoma patients. RESULTS: The procedure was completed effectively in 11 (91.7%) patients. Mean operative time was 312 minutes. The mean estimated blood loss was 475 mL. Mean hospital stay was 3.2 days. Mean number of lymph node excised was 12. Six of the excised masses were ≥5 cm (N3), largest was 7.5 cm. Pathology showed teratoma in five (45.5%), benign/necrosis in five (45.5%), and viable germ cells in one (9%). Major complication (Clavien ≥3) occurred in one patient and minor (Clavien ≤2) in two. Antegrade ejaculation was preserved in eight patients and in one could not be assessed. At a median follow-up of 31 months, no infield or outfield relapses occurred. CONCLUSIONS: Robotic PC-retroperitoneal lymph node dissection (RPLND) is technically feasible and with acceptable morbidity. It is associated with low blood loss and short hospital stay. More research is needed to assess the long-term outcome and to compare standard open RPLND.

Partial Nephrectomy in the Overweight Patient: an Overview.

The diagnosis and treatment of kidney cancer continues to evolve with advances in imaging and surgical approaches. The use of nephron sparing surgery (NSS) has become the operation of choice for treating small renal masses. Yet, technical difficulty and a variety of approaches have left debate for best method in the overweight population. This review summarizes the current knowledge in the open, laparoscopic, and robotic approaches to identify key risk factors, general assessments, complication rates, and the influence of body habitus for each approach.

Arcuate retinotomy for the repair of large macular holes.

BACKGROUND AND OBJECTIVE: To present a case series to elucidate a novel technique that involves the creation of an arcuate retinotomy in the treatment of large macular holes after failed primary repair. PATIENTS AND METHODS: retrospective chart review. Six eyes (six patients) with large macular holes, all of which had failed primary repair, underwent 25 gauge pars plana vitrectomy revision coupled with full thickness arcuate retinotomy temporal to the macular hole and fluid-gas exchange. The main outcome measure was anatomic macular hole closure based on optical coherence tomography (OCT), with visual acuity and visual field evaluation as secondary outcome measures. RESULTS: Five of the six patients (83%) had successful hole closure with three of the six patients (50%) exhibiting improvement in visual acuity. CONCLUSION: Arcuate retinotomy is a new approach that may aide in the repair of large macular holes not otherwise amenable to closure with traditional techniques.