Assessment of complication and functional outcome reporting in the minimally invasive prostatectomy literature from 2006 to the present.

To query the minimally invasive urological literature from 2006 to the middle of 2010, focusing on complications and functional outcome reporting in laparoscopic radical prostatectomy (LRP) and robot-assisted LRP (RALP), to see if there has been an improvement in the overall reporting of complications. We performed a Medline search using the Medical Subject Heading terms 'prostatectomy', 'laparoscopy', 'robotics', and 'minimally invasive'. We then applied the Martin criteria for complications reporting to the selected articles. We identified 51 studies for a total of 32,680 patients. When excluding functional outcomes the outpatient complications reporting was 20/51 (39.2%). In all, 35% and 43% of papers did not list any method for recording continence and potency, respectively. A complication grading system was only used in 30 studies (58.8%). Of the 16 papers using a grading scale in 2006-2007, only 31.3% used the Clavien system, compared with 69% from 2008 to the first half of 2010. In all, 27% of papers used some form of risk-factor analysis for complications. Multivariate analysis was used in 43% of papers, 29% looked at body mass index, while one looked at prostate weight, and another age. There has been an overall improvement in complications reporting in the minimally invasive RP literature since 2005. However, most studies still do not fulfil many of the criteria necessary for standardised complication reporting. Functional outcome reporting remains poor and unstandardised. Given our current reliance on observational studies, increased efforts should be made to standardise all complication outcomes reporting.

Total reconstruction of the vesico-urethral junction.

OBJECTIVE: We describe a novel technique of total vesico-urethral reconstruction, which combines the tactics of previous surgeons, and compare the outcome of our innovative changes for return to early continence with prostatectomies with no or partial reconstruction of the vesico-urethral junction. PATIENTS AND METHODS: Between 1 January 2005 and 5 June 2007 a cohort of 700 patients undergoing robotic radical prostatectomy were prospectively evaluated. Patients in 2005 (214) served as a control group, they received no additional methods to provide support to the vesico-urethral junction; a standard anastomosis was made. Patients in 2006 (304) received an anterior reconstruction only, to provide additional vesico-urethral anastomotic support. Patients in 2007 (182) received the total reconstructive procedure, which included an anterior reconstruction and posterior reconstruction. Outcome data were collected using standardized health-related quality-of-life measures, which included the Expanded Prostate Cancer Index Composite survey, International Prostate Symptom Score, International Index of Erectile Function, and then re-verified by telephone interview with a standardized questionnaire. The follow-up intervals were 1, 6, 12, 24 and 52 weeks. Continence was defined as no pad usage or one small liner used for security purposes only. Baseline variables were also collected. RESULTS: The percentage of patients who had achieved continence in the control group were: 13%, 35%, 50%, 62% and 82% at the 1-, 6-, 12-, 24- and 52-week follow-up, respectively. The percentage of patients who had achieved continence in the anterior reconstruction group were 27%, 59%, 77%, 86%, and 91%, respectively. The total reconstruction group had continence rates of 38%, 83%, 91%, and 97% at 1, 6, 12, and 24 weeks, respectively. At all the follow-up intervals the continence rate was significantly less in the control group than in the anterior reconstruction group and the total reconstruction group (P < 0.01). CONCLUSIONS: The total reconstruction procedure is a safe and effective way to achieve an early return to continence. No adverse effects have been observed because of its employment and our data validates that it does provide a statistically significant early return to continence compared with no reconstructive efforts or with only anterior reconstructive efforts.

Effect of visceral obesity on minimally invasive partial nephrectomy.

OBJECTIVE: To assess the relationship between visceral obesity and perioperative parameters in patients undergoing laparoscopic or robotic-assisted partial nephrectomy. METHODS: We retrospectively reviewed the medical records of 118 patients who underwent minimally invasive partial nephrectomy. On preoperative imaging, perinephric, visceral, and subcutaneous fat were measured. Higher estimated blood loss, complications, and warm ischemia time were used as surrogates of increased operation difficulty. We examined the association between the 3 groups of patients (ie low, medium, and high fat) with demographic and clinical characteristics. Multivariate analysis was performed to determine whether various measurements of obesity adversely affected surgical outcomes and complexity. RESULTS: No statistically significant differences were found between perioperative parameters and either perinephric, visceral, or subcutaneous fat. There was no association between changes in renal function and different fat groups. Multivariate analysis for estimated blood loss, complication rates, and warm ischemia time adjusted for age, race, sex, nephrometry score, Charlson comorbidities score, and other fat types, failed to demonstrate any significant differences. Increasing perinephric fat content was associated with higher visceral (P <.0005), but not subcutaneous fat (P = .55). Hypertension was associated with perinephric (P = .02) and visceral (P = .04), but not subcutaneous obesity (P = .08). Neither Charlson comorbidity nor American Society of Anesthesiologists scores showed any significant association with different fat types. CONCLUSION: Individual patterns of obesity, namely subcutaneous, visceral, and perinephric, do not increase surgical complexity for minimally invasive partial nephrectomy by experienced surgeons. Furthermore, this operation can be performed safely with comparable complications and outcomes in moderately obese patients without compromising renal function.