Cost-analysis of robot-assisted radical cystectomy in Europe: A cross-country comparison.

BACKGROUND: Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is surging worldwide. Aim of the study was to perform a multicentric cost-analysis of RARC by comparing the gross cost of the intervention across hospitals in four different European countries. METHODS: Patients who underwent RARC + ICUD were recruited from eleven European centers in four European countries (Belgium, France, Netherlands, and UK) between 2015 and 2020. Costs were divided into six parts: cost for hospital stay, cost for ICU stay, cost for surgical theater occupation, cost for transfusion, cost for robotic instruments, and cost for stapling instruments. These costs were individually assessed for each patient. RESULTS: A total of 490 patients were included. Median operative time was 300(270-360) minutes and median hospital length-of-stay was 11(8-15) days. The average total cost of RARC was 14.794€ (95%CI 14.300-15.200€). A significant difference was found for the total cost, as well as the various subcosts abovementioned, between the four included countries. Different sets and types of robotic instruments were used by each center, leading to a difference in cost of robotic instrumentation. Nearly 84% of costs of RARC were due to hospital stay (42%), ICU stay (3%) and operative time (39%), while 16% of costs were due to robotic (8%) and stapling (8%) instruments. CONCLUSION: Costs and subcosts of RARC + ICUD vary significantly across European countries and are mainly dependent of hospital length-of-stay and operative time rather than robotic instrumentation. Decreasing length-of-stay and reducing operative time could help to decrease the cost of RARC and make it more widely accessible.

Prospective Assessment of the Sexual Function After Greenlight Endoscopic Enucleation and Greenlight 180W XPS Photoselective Vaporization of the Prostate.

OBJECTIVE: To evaluate the impact of Greenlight 180W photoselective vaporization of the prostate (PVP) and endoscopic enucleation of the prostate (GreenLEP) on ejaculatory and erectile functions. MATERIALS AND METHODS: Between January 2014 and September 2016, 440 men with low urinary tract symptoms or complications related to benign prostate obstruction with prostate >80 g and sexually active, underwent a PVP or GreenLEP performed by experienced surgeons at a single institution. Patients were matched in a 1:1 fashion according to preoperative transrectal ultrasonography prostatic volume and cardiovascular risk factors (smoking, diabetes, and hypertension). RESULTS: One hundred patients in each group were included. Mean prostatic volume were 110 g (95%CI: 101-118) and 107 g (95%CI: 99-115) in the GreenLEP and PVP groups, respectively (P = .68). Mean total energy delivered in the PVP group was 4.42 kJ/g (4.2-4.6). Surgical retreatment was required in 9 patients (10.1%) in the PVP group and none in the GreenLEP group (log rank test: P = .002). Mean prostate specific antigen level and International Prostate Symptom Score score were significantly lower in the GreenLEP group than in the PVP group at 3, 12, and 24 months (P <.001). Preserved antegrade ejaculation was reported in 24 patients (26.9%) in the PVP group vs 1 patient (1.2%) in the GreenLEP group at 12 months (P <.001). In multivariate analysis, age, history of coronary artery disease, and surgical treatment with PVP were independent factors of IIEF-5 decline. CONCLUSION: Despite a poor rate of preserved antegrade ejaculation, GreenLEP was associated with better erectile function outcomes possibly due to greater improvement of low urinary tract symptoms.

MRI assessment of tissue effects after 180-W XPS greenlight laser vaporization of the prostate.

BACKGROUND AND OBJECTIVE: Photoselective vaporization of the prostate (PVP) is an alternative to transurethral resection of the prostate (TURP) in the surgical management of Benign Prostate Obtruction (BPO), with a better hemostatic effect due to a coagulation depth of several millimeters. The objective of this study was to prospectively assess the tissue effects of PVP by Magnetic Resonance Imaging (MRI). MATERIALS AND METHODS: From December to February 2014, ten patients were included in a prospective study and underwent PVP performed by a single surgeon with the Greenlight™ laser 180-W XPS. A multiparametric MRI of the prostate (Siemens 3T Verio) was achieved the day before the procedure and post-operatively (2 days, 7 days, 3 and 6 months after the procedure). The prostate volume after tissue removal was determined. The depth of necrosis in the prostatic and peri-prostatic tissues were assessed at six different locations. RESULTS: The median age and pre-operative prostate volume were 70 years (64-76) and 48.1 ml (19-74.4), respectively. Median prostate volume significantly decreased post-operatively (P < 0.001): At 6 months, median prostate volume reduction was 44.2% (38.7-49.5) (P = 0.001) compared to pre-operative setting. Two and 7 days after the procedure, mean depths of necrosis were 2.5 mm (0-3) and 1.3 mm (0-2.4), respectively. No necrosis was reported 3 and 6 months after the procedure. CONCLUSIONS: PVP with Greenlight™ XPS 180-W is associated with a significant reduction of prostate volume. The depth of necrosis is low and homogeneous, resulting in a limited risk of peri-operative complications. Lasers Surg. Med. 49:577-581, 2017. © 2017 Wiley Periodicals, Inc.