What you need to know: updates in penile cancer staging.

PURPOSE: We sought to discuss the updates in the 8th edition (8E) of The American Joint Committee on Cancer (AJCC) staging for penile cancer and to provide relevant evidence associated with the major changes that occurred. METHODS: A comprehensive search of PubMed® and Web of Science® was performed for relevant English language articles from 2004 through 2019. Literature resulting from this search were reviewed and articles pertinent to penile cancer staging changes were included. RESULTS: Modifications were observed in the tumor and nodal staging. In the 8E AJCC, Ta disease indicates noninvasive localized squamous cell carcinoma, which allows for inclusion of other historical variants. T1 is subcategorized into T1a and T1b according to existence of lymphovascular invasion, perineural invasion and high-grade tumor. This subcategorization demonstrates different risks for lymph node (LN) metastases and will affect decision strategy when opting for inguinal lymphadenectomy. Urethral invasion is no longer a differentiator between T2 and T3 disease, as T2 includes invasion of the corpus spongiosum and T3 involves invasion of the corpus cavernosum. For nodal staging, pN1 has been increased from a single LN metastases to two unilateral inguinal LN metastases, while pN2 has been modified to three or more inguinal LN metastases. This change was evidenced by demonstrating no significant difference in disease specific mortality between the previous edition's pN1 and pN2. CONCLUSIONS: The 8E penile cancer staging provides several modifications that have relevant clinical implications in the management of penile cancer. Nevertheless, it requires refinements that allow for better staging of penile tumors.

Progress on Management of Penile Cancer in 2020.

OPINION STATEMENT: Management of penile cancer represents a challenge to urologic oncologists due to the disease's rarity and sparse data in the literature. Squamous cell carcinoma represents the most common histologic subtype of penile cancer. Penile cancer has a disastrous effect on patients' psychological and physical health. Penile cancer accounts for approximately 1% of cancer deaths in the USA annually. However, in recent years, the management of penile cancer has achieved marked progress in both diagnostic and therapeutic approaches with the intent to avoid radical surgeries. The traditional total penile amputation has been replaced by penile preserving procedures in many patients. Nowadays, total penile amputation (total penectomy) is preserved only for patients with proximal lesions. The introduction of minimally invasive surgical techniques in the management of penile cancer-infiltrated lymph nodes has been reported. Given the dismal prognosis with conventional cytotoxic therapies, new systemic therapies have been investigated in patients with locally advanced or metastatic penile cancer. Multiple studies have shown promising outcomes. All these efforts have resulted in a remarkable improvement in patient quality of life. The objectives of our review are to update clinicians on the advances in the management of penile cancer and to summarize the recent guidelines and recommendations.

Organ Sparing Surgery for Penile Cancer: A Systematic Review.

PURPOSE: Although penile cancer represents only 1% of all male cancers, the traditional treatment, total or subtotal penectomy, carries devastating psychological and functional outcomes. Organ sparing surgery is an attractive option if it can provide satisfactory cancer control equivalent to or nearly equivalent to standard techniques. This approach is meeting increasing acceptance. We offer a timely comprehensive review to increase awareness of these procedures and their applicability, to evaluate the techniques objectively and to provide guidance to the practicing urologist. MATERIALS AND METHODS: A PubMed® search was conducted using the key words "organ sparing/conserving" in "penile cancer" alone or in combination with "partial penectomy," "glansectomy," "glans resurfacing," "penile reconstruction," "laser," "Mohs," "outcomes" and "quality of life." RESULTS: Many techniques of organ sparing surgery in patients with penile cancer have been described through the years. To be practical and useful, a requirement of all these procedures is achievement of complete tumor excision confirmed by negative intraoperative frozen section and final pathological margins. Although organ sparing surgery carries a greater risk of local recurrence than penile amputation, overall patient survival is generally unaffected. Following strict indications and appropriate patient selection cancer specific survival after organ sparing surgery is equivalent to that of established techniques with the added benefits of improved quality of life and more acceptable morbidity. CONCLUSIONS: In properly selected patients with penile cancer organ sparing surgery provides comparable oncologic outcomes to conventional techniques, including total and subtotal amputations. Many patients are able to urinate while standing and a significant number are able to have intercourse.

Integrating interprofessional education in community-based learning activities: case study.

Faculty of Medicine/Suez Canal University (FOM/SCU) students are exposed to clinical practice in primary care settings within the community, in which they encounter patients and begin to work within interprofessional health teams. However, there is no planned curricular interaction with learners from other professions at the learning sites. As in other schools, FOM/SCU faces major challenges with the coordination of community-based education (CBE) program, which include the complexity of the design required for Interprofessional Education (IPE) as well as the attitudinal barriers between professions. The aim of the present review is to: (i) describe how far CBE activities match the requirements of IPE, (ii) explore opinions of graduates about the effectiveness of IPE activities, and (iii) present recommendations for improvement. Graduates find the overall outcome of their IPE satisfactory and believe that it produces physicians who are familiar with the roles of other professions and can work in synergy for the sake of better patient care. However, either a specific IPE complete module needs to be developed or more IPE specific objectives need to be added to current modules. Moreover, coordination with stakeholders from other health profession education institutes needs to be maximized to achieve more effective IPE.

Potential years of life lost due to urogenital cancer in the United States: trends from 1972 to 2006 based on data from the SEER database.

PURPOSE: Urogenital cancer is a major health problem in the United States. We assessed potential years of life lost secondary to genitourinary cancer in the United States from 1972 to 2006 using the SEER (Surveillance, Epidemiology and End Results) database. We report trends in potential years of life lost during the same period. MATERIALS AND METHODS: Potential years of life lost were calculated to assess premature mortality trends for ureter, bladder, kidney and renal pelvis, penis, testis and prostate cancers. Calculations were based on SEER cancer mortality data. Potential years of life lost up to and including age 75 years were calculated by and across genders in 5-year increments between 1972 and 2006. RESULTS: A total of 7,733,235 potential years of life were lost in men and women. In each gender the greatest potential loss was for kidney and renal pelvis cancer related mortality. In each gender no improvement in the potential loss due to ureteral and bladder cancer related mortality was observed during 3 decades. In males the greatest decrease in potential years of life lost was for testicular cancer, followed by prostate cancer. CONCLUSIONS: There has been an increasing trend in potential years of life lost related to urogenital cancer during the last 35 years for males and females. This trend is mainly due to an increase in kidney cancer. The continued increase in potential years of life lost due to renal cancer and the lack of a decrease in the loss in those with bladder cancer should alert urologists and health care policy makers to deficient areas that most need to be addressed.

Evaluating health-related quality of life as a prognostic tool for overall survival in routine cancer care for older patients with bladder cancer: A US based study.

PURPOSE: Health-related quality of life (HRQoL) outcomes, in addition to being useful for monitoring a person's health and well-being, may also predict overall survival (OS) in cancer patients. This study's objective was to examine the association of longitudinally assessed HRQoL and OS in patients with a history of bladder cancer (BC). MATERIALS AND METHODS: This longitudinal retrospective cohort study used the 1998 to 2013 Surveillance, Epidemiology and End Results database linked with Medicare Health Outcomes Survey. Study cohort included patients having HRQoL assessments both pre- and post-BC diagnosis using Short Form-36/Veterans Rand-12. Using Cox Proportional Hazards adjusted for demographics, tumor characteristics, and surgery type, we studied the associations of 3-point difference in HRQoL assessed pre- and post-BC diagnosis and change from pre-to-post diagnosis with overall survival. RESULTS: The study cohort included 438 BC patients with deceased patients (n = 222; 50.7%) being significantly older than those alive (77.2 vs. 75.4 years; P = 0.004). Adjusting for covariates, a 3-point difference in physical HRQoL (physical component summary [PCS]) pre-, post-, and pre-to-post BC diagnosis was associated with respectively 6.1%, 8.7%, and 7.3% (P < 0.01 for all) decreased risk of death for higher PCS. Similarly, a 3-point difference in mental HRQoL (mental component summary [MCS]) post-BC diagnosis was associated with 4.5% (P < 0.05) decreased risk of death for higher MCS. CONCLUSIONS: Associations between PCS/MCS and OS imply that elderly BC patients with better physical/mental health are more likely to survive longer. Monitoring HRQoL in routine cancer care would facilitate early detection of HRQoL decline and enable timely intervention by clinicians to improve OS.

Healthcare costs and resource utilization associated with renal cell carcinoma among older Americans: A longitudinal case-control study using the SEER-Medicare data.

OBJECTIVES: To determine 1-year and 5-year total healthcare costs and healthcare resource (HRU) associated with renal cell carcinoma (RCC) in older Americans, from a healthcare sector perspective. MATERIALS AND METHODS: This was a longitudinal, retrospective cohort study using the Surveillance, Epidemiology and End Results-Medicare linked data (2006-2014), which included older (≥66 years) patients with primary RCC and 1:5 matched noncancer controls. Patients/controls were followed from diagnosis (pseudo-diagnosis for controls) until death or up to loss-to-follow-up (censored). Per-patient average 1-year and 5-year cumulative total and incremental total healthcare costs and HRU were reported. RESULTS: A total of 11,228 RCC patients were matched to 56,140 controls. Per-patient cumulative average 1-year (incremental = $38,291 [$36,417-$40,165]; $57,588 vs. $19,297) and 5-year (incremental = $68,004 [$55,123-$80,885]; $183,550 vs. $115,547) total costs (excluding prescription drug costs) were 3 and 1.6 times higher for RCC vs. controls. These estimates were 3.6 and 1.7 times higher for RCC vs. controls when prescription costs were included in total costs. Prescription drug costs accounted for 8.4% (incremental = $3,715) and 18.1% (incremental = $15,375) of the 1-year and 5-year incremental total costs, respectively. RCC patients had greater cumulative number of hospitalizations, emergency department visits and prescriptions in 1- and 5-years, compared to controls. CONCLUSIONS: Average first year total cost for a patient with incident diagnosis of RCC is substantially higher than that for controls and it varies depending on the stage at diagnosis. Study findings could help in planning future resource allocation and in determining research and unmet needs in this patient population.

Mycophenolate mofetil in pediatric renal transplantation: a single center experience.

We assessed our long-term experience with regards to the safety and efficacy of MMF in our pediatric renal transplant population and compared it retrospectively to our previous non-MMF immunosuppressive regimen. Forty-seven pediatric renal transplants received MMF as part of their immunosuppressive protocol in the period from January 1997 till October 2006 (MMF group). A previously reported non-MMF group of 59 pediatric renal transplants was included for comparative analysis (non-MMF group). The MMF group comprised 29 boys and 18 girls, whereas the non-MMF group comprised 34 boys and 25 girls. Mean age was 11.7 and 12 yr in the MMF and non-MMF groups, respectively. The incidence of acute rejection episodes was 11 (23.4%) and 14 (24%) in the MMF and non-MMF group, respectively. Two (3.3%) grafts were lost in the non-MMF group compared with one (2.1%) in the MMF group. Twenty-one (44.68%) patients in the MMF group developed post-transplant infections compared with 12 (20.33%) in the non-MMF group (p < 0.0001). In conclusion, the use of MMF in pediatric renal transplantation was not associated with a lower rejection rate or immunological graft loss. It did, however, result in a significantly higher rate of viral infections.

Association of Health-Related Quality of Life with Overall Survival in Older Americans with Kidney Cancer: A Population-Based Cohort Study.

BACKGROUND: Our purpose was to evaluate associations between health-related quality of life (HRQoL) and overall survival (OS) in a population-based sample of kidney cancer (KC) patients in the US. METHODS: We analyzed a longitudinal cohort (n = 188) using the Surveillance, Epidemiology, and End Results (SEER) database linked with the Medicare Health Outcomes Survey (MHOS; 1998-2014). We included KC patients aged ≥65 years, with a completed MHOS during baseline (pre-diagnosis) and another during follow-up (post-diagnosis). We reported HRQoL as physical component summary (PCS) and mental component summary (MCS) scores and OS as number of months from diagnosis to death/end-of-follow-up. Findings were reported as adjusted hazard ratios (aHRs (95% CI)) from Cox Proportional Hazard models. RESULTS: The aHRs associated with a 3-point lower average (baseline and follow-up) or a 3-point within-patient decline (change) in HRQoL with OS were: (a) baseline: PCS (1.08 (1.01-1.16)) and MCS (1.09 (1.01-1.18)); (b) follow-up: PCS (1.21 (1.12-1.31)) and MCS (1.11 (1.04-1.19)); and (c) change: PCS (1.10 (1.02-1.18)) and MCS (1.02 (0.95-1.10)). CONCLUSIONS: Reduced HRQoL was associated with worse OS and this association was strongest for post-diagnosis PCS, followed by change in PCS and pre-diagnosis PCS. Findings highlight the prognostic value of HRQoL on OS, emphasize the importance of monitoring PCS in evaluating KC prognosis, and contribute additional evidence to support the implementation of patient-reported outcomes in clinical settings.

Concurrent Penile Prosthesis and Artificial Urinary Sphincter versus Penile Prosthesis and Male Sling: A National Multi-Institutional Analysis of National Surgical Quality Improvement Program Database Comparing Postoperative Morbidity.

PURPOSE: We aimed to assess the 30-day morbidity in patients undergoing combined insertion of penile prosthesis (PP) and artificial urinary sphincter (AUS) vs. PP and male sling (MS). MATERIALS AND METHODS: The National Surgical Quality Improvement Program database was queried to identify patients who underwent placement of AUS or MS combined with PP. Patient demographics, postoperative morbidity including complications, readmission and reoperation rates were recorded. Student t-test and chi-square or Fischer's exact test were used as appropriate. RESULTS: Forty-one patients met selection criteria between 2010 and 2016. Overall, 26 patients received PP and AUS vs. 15 that received PP and MS. Average age was similar in both groups (64.8±6.6 years vs. 62.3±6.3 years, p=0.254). Diabetes mellitus was more prevalent in PP+MS group compared to AUS+PP group (46.7% vs. 11.5%, p=0.022). Average length of stay was higher in PP+AUS group compared to PP+MS group (2.2±0.6 days vs. 1.8±0.4 days, p=0.017). Postoperative morbidity was reported in four patients in PP+AUS group. No reported complications in PP+MS group. In PP+AUS group, complications included one patient who developed urinary tract infection, one developed surgical site infection, readmission in two for postoperative infection, and one return to the operating room. No reported prosthesis explantation or revision in either groups. CONCLUSIONS: Our results showed that 30-day morbidity was recorded in the PP+AUS group and none in the PP+MS group. The complication and readmission rates remain comparable to the previous reports in both groups.

Changing Trends in Management Following Artificial Urinary Sphincter Surgery for Male Stress Urinary Incontinence: An Analysis of the National Surgical Quality Improvement Program Database.

OBJECTIVE: To characterize the safety and practice patterns of artificial urinary sphincter (AUS) placement on a population level. Increasingly AUS implantation has shifted to be an outpatient surgery; however, there is a lack of large-scale research evaluating factors associated with early (≤ 24 hours) versus late (>24 hours) discharges and complications in men following AUS placement. We utilized the National Surgical Quality Improvement Program (NSQIP) database to identify and compare factors and outcomes associated with each approach. METHODS: NSQIP database was queried for men undergoing AUS placement between 2007 and 2016. Patients were classified as either early discharge (ED ≤ 24 hours) and late discharge (LD > 24 hours). Baseline demographics, operating time, and complications were compared between the 2 groups. Multivariate logistic regression evaluated factors associated with discharge timing and 30-day complications. RESULTS: A total of 1176 patients were identified and were classified as ED in 232 and LD in 944 patients. Operative time was shorter in ED (83 minutes) compared to LD (95 minutes, P < .001). Hypertension was more prevalent among LD patients (60.3% vs 69.1% for ED and LD respectively, P < .001). The 30-day complication rate was similar in both groups (ED: 4.3% vs LD: 3.4%, P = .498). Multivariable analysis revealed that surgery after 2012 was associated with ED (OR = 3.66, P < .001). CONCLUSION: At the national level, there are no differences in postoperative morbidity between early and late discharges. There is a trend toward more ED, specifically after 2012. A prospective study on the feasibility and safety of outpatient AUS is needed.

Maneuver to improve exposure during radical perineal prostatectomy.

OBJECTIVES: Radical perineal prostatectomy (RPP) has an important place as a management option for prostate cancer. Herein we describe an adaptation that we found to significantly help the exposure during this procedure. METHODS: After opening the urethra, the long Lowsley tractor is changed to the short tractor. Caudal traction facilitates the dissection up to the bladder neck, which is opened. Classically, at this point an umbilical tape or Penrose drain substitutes the short tractor. Because of the limitation in the amount of traction that can be applied without fracturing through the tissue, we have utilized traction sutures placed in both right and left lobes of the prostate instead of the Penrose drain. RESULTS: Traction on these sutures resulted in excellent exposure and greatly facilitated the posterior dissection of the prostate as well as seminal vesicles dissection. CONCLUSIONS: This small addition to the standard technique of RPP helps with complete dissection of the prostate and seminal vesicles. We recommend replacing the traditional Penrose traction with these sutures placed in the lateral lobes of the prostate.

Vessel and Muscle Sparing Techniques in Bulbous Urethroplasty: A Review.

INTRODUCTION: Excision and primary anastomosis has emerged as a standard of care for urethral strictures in men with satisfactory results for urethral patency. Several improvements, particularly in repair of proximal bulbous strictures, aim to preserve the vascular pedicle and avoid violating the bulbospongiosus muscle and its innervation during perineal access to the urethra. For patients with anterior urethral strictures these techniques may offer benefits such as decreased sexual dysfunction, post-void dribbling and ejaculatory changes. We describe techniques for and potential functional effects of bulbar artery sparing and bulbospongiosus muscle sparing excision and primary anastomosis, as well as pertinent anatomical principles. METHODS: We searched PubMed® and Web of Science™ for relevant articles using the keywords "urethroplasty," "urethral reconstruction," "anterior," "bulbous," "vessel sparing," "muscle sparing," "non-transecting," "bulbar artery" and "bulbospongiosus." Two authors independently screened results, and articles not relevant or not written in English were excluded. RESULTS: Preservation of proximal urethral blood supply is imperative, particularly for patients with multiple prior urethral reconstructions, hypospadias or potential need for artificial sphincter for incontinence (eg after prostatectomy). Since vessel sparing excision and primary anastomosis was first described, there have been several modifications with promising outcomes. In the same context bulbospongiosus muscle sparing urethroplasty has been described and is associated with favorable outcomes for post-void dribbling and ejaculatory dysfunction. CONCLUSIONS: Preservation of vessels, nerves and muscles around the urethra is associated with favorable functional outcomes. Short-term results are reassuring, although longer followup and more uniform criteria for measuring patient reported outcomes are needed.

Changes in health-related quality of life outcomes in older patients with kidney cancer: A longitudinal cohort analysis with matched controls.

BACKGROUND: Current evidence regarding health-related quality of life (HRQoL) changes among patients with kidney cancer (KC) is limited. We characterized HRQoL changes from before (baseline) to after (follow-up) diagnosis of KC in older Americans relative to matched controls, and identified sociodemographic and clinical factors associated with HRQoL changes in older patients with KC. MATERIALS AND METHODS: This longitudinal, population-based, retrospective cohort study used data from Surveillance, Epidemiology and End Results linked with Medicare Health Outcomes Survey, 1998-2013. Participants aged ≥65 years with baseline and follow-up survey data were identified. Those with primary KC (n = 186) were matched to adults without cancer (n = 558). HRQoL (physical component summary and mental component summary [MCS]) changes in KC patients were compared using generalized linear mixed-effects models to those of controls. Regression models were used to identify baseline factors associated with HRQoL changes. RESULTS: The adjusted least squares mean (95% confidence interval) reduction in physical component summary from baseline to follow-up was greater in KC patients vs. controls (-4.1 [-5.6, -2.7] vs. -2.3 [-3.1, -1.4], P = 0.025). While the reduction in MCS was similar in both groups (-2.4 [-3.9, -0.8] vs. -1.5 [-2.4, -0.6], P = 0.338). Lower income and distant stage KC predicted greater declines in MCS among KC patients. CONCLUSION: KC significantly affects overall general health in older patients, with sociodemographic factors and distant KC predicting greater reductions in HRQoL. Findings may help clinicians set patient expectations about their HRQoL post-diagnosis and increase clinician awareness of risk factors for HRQoL deterioration.

A comparative study of robot-assisted laparoscopic intracorporeal versus open urinary diversion.

AIMS: Robot-assisted laparoscopic intracorporeal urinary diversion (ICUD) has several potential benefits of a smaller incision and reduced pain over extracorporeal urinary diversion (ECUD). We compared the perioperative outcomes of patients who have undergone these procedures with or without cystectomy. SUBJECTS AND METHODS: This study is a retrospective chart review of patients who underwent ICUD and ECUD in a single tertiary referral hospital. Patient demographics, perioperative outcomes, and the 90-day postoperative complications were collected. STATISTICAL ANALYSIS USED: The statistical analyses were performed using the Chi-square test for categorical variables which are specified as frequency (percentage). RESULTS: Thirty-five patients who underwent urinary diversion procedure were identified for inclusion in the study. Of these patients, 14 underwent ICUD and 21 underwent ECUD. The mean operative time was longer in the ICUD group compared to that of the ECUD (457.14 ± 103.91 and 388.29 ± 110.17, respectively, P = 0.07). The median blood loss was statistically significantly lower in the ICUD group (250 ml) than in the ECUD group (450 ml, P = 0.05). The mean hospital stay was marginally longer for the ECUD group (8.1 days) as compared to the ICUD group (6.3 days, P = 0.17). There was no difference in the readmission or reoperation rates after 30 days. The 90-day complication rate was not statistically significantly different between the two groups, but a trend favoring ICUD (64%) over ECUD (71%, P = 0.656) was noted. CONCLUSIONS: Robot-assisted ICUD is associated with decreased blood loss, and there is a trend toward fewer postoperative complications and shorter hospital stays.

Perioperative mortality and morbidity of outpatient versus inpatient robot-assisted radical prostatectomy: A propensity matched analysis.

OBJECTIVES: To compare the early (≤30 days) postoperative mortality and morbidity in patients who underwent robot-assisted radical prostatectomy (RARP) and were discharged the same surgery day to a propensity score matched patient population of RARP who stayed >1 day in hospital. METHODS: The National Surgical Quality Improvement Program data of the American College of Surgeons was queried to identify patients who underwent RARP with same day hospital discharge (OPG) and those who stayed >1 day (IPG). Each OPG patient was matched to 5 IPG patients using a propensity score. Rates of early postoperative mortality, morbidity, reoperation and readmission were described for both groups. The risks of morbidity and mortality in the OPG patients compared to IPG patients were reported as a relative risk (RR, 95% CI), for adjusting for the matched study design. RESULTS: A total of 258 patients in OPG were matched to 1,290 IPG patients. Early postoperative mortality was recorded in only 2 (0.2%) IPG patients. Comparing OPG to IPG, the overall morbidity (3.1% vs. 4.7%, RR: 0.65, CI: 0.32-1.35), reoperation rates (2.3% vs. 0.8%, RR: 1.82, CI: 0.63, 5.28), and readmission rates (2.6% vs. 3.9%, RR: 0.5, CI: 0.30, 1.55) were low and not significantly different between the 2 groups. CONCLUSIONS: The overall rates of early postoperative morbidity, mortality, readmission, and reoperation were low among outpatient RARP patients. These outcomes were also not significantly different than a propensity score matched group of inpatient RARP patients.

Evaluation of factors and short-term postoperative morbidity associated with early versus late discharge following urethroplasty.

PURPOSE: To determine factors associated with early (same-day) versus late (> 1 day) discharge of male patients following urethroplasty, and to compare short-term (30-day) postoperative morbidity and mortality across the two groups. METHODS: Using the National Surgical Quality Improvement Program database (2005-2016), patients who underwent urethroplasty with same-day hospital discharge (early) and those who stayed > 1 day (late) were identified. Extracted data included patient characteristics, comorbidities, preoperative labs, and 30-day postoperative complications. Multivariable logistic regressions determined factors associated with early (vs. late) discharge and the likelihood of having a complication in those who were discharged early (vs. late). Adjusted odds ratios and 95% CIs were reported. RESULTS: N = 1435 male urethroplasty patients were identified, of which 396 (27.6%) were discharged early and 1039 (72.4%) were discharged late. White race (OR [95% CI]: 2.21 [1.44, 3.38]), urethroplasty performed in/after year 2011 (4.23 [2.51, 7.15]), and anterior (vs. posterior) urethroplasty without tissue transfer (1.65 [1.17, 2.34]) were significantly associated with increased likelihood of early discharge. However, every 10-min increase in operation time (0.88 [0.86, 0.90]) decreased the odds of early discharge. When short-term postoperative complications were compared between the two groups, patients discharged early had a lower likelihood of being readmitted (0.35 [0.14, 0.88]) compared to those discharged late. Rates of mortality, complications, or reoperation were similar between the groups. CONCLUSIONS: Predictors of early discharge following urethroplasty include shorter operating time, white race, and having an anterior (vs. posterior) urethroplasty without tissue transfer. Patients discharged early had a lower likelihood of being readmitted.

Early Postoperative Morbidity of Robotic Versus Open Radical Cystectomy in Obese Patients.

Aims: To compare the 30-day postoperative complications of robotic radical cystectomy (RRC) vs open radical cystectomy (ORC) in obese patients (body mass index ≥30) with bladder cancer (BC). Methods: The National Surgical Quality Improvement Program database was queried to identify obese BC patients who underwent RRC or ORC between 2005 and 2016. Patient demographics, postoperative mortality rate, morbidity, operating time (OPTIME), length of stay (LOS), readmission, and reoperation rates were recorded and compared between the two groups. Each RRC patient was matched with three ORC patients using a propensity score approach. Results: Four hundred forty-two RRC patients were matched with 1326 ORC patients. No difference in early postoperative mortality rate between RRC and ORC (0.7% vs 1.3%, relative risk, RR [95% confidence interval CI]: 0.27 [0.07-1.02]). Compared with ORC, the RRC group showed shorter mean OPTIME (364.7 [standard deviation, SD = 133.4] vs 387.8 [SD = 129.7] minutes, p = 0.001) and mean LOS (7.1 [SD = 5.6] vs 10.6 [SD = 6.6] days, p < 0.001). Compared with ORC, the RR of developing the following events in RRC group was lower: 30-day postoperative any complication (45%), any wound occurrence (64%), blood transfusion (70%), superficial surgical-site infection (78%), and wound disruption (77%). There was no difference in the RR of any-cause readmission (RR [95% CI]: 0.77 [0.57-1.05]) and reoperation (RR [95% CI]: 0.48 [0.22-1.04]) between the two groups. Conclusions: The study revealed that RRC for obese BC patients is associated with shorter OPTIME, shorter LOS, and lower risk of early postoperative complications when compared with a matched group of patients who received ORC. In addition, no difference in early postoperative mortality rate between RRC and ORC was observed.

Management of the Clinically Negative (cN0) Groin Penile Cancer Patient: A Review.

To determine the role of noninvasive, minimally invasive diagnostic modalities and current management recommendations for cN0 PNC, a literature review using PubMed and Web of Science search engines were conducted. We found that for predicting ILN+: physical exam has limitations, nomograms are not validated, conventional computerized tomography/magnetic resonance imaging/positron imaging tomography scans have minimal role, and dynamic sentinel lymph node biopsy is the most reliable minimally invasive modality. Adverse pathological features: G3, stage ≥ T2, presence of LVI, and rare histopathological variants are important predictors of ILN+ and their presence warrants prophylactic ILND or dynamic sentinel lymph node biopsy. In the absence of these adverse pathological features conservative management is justified.