Postoperative complications and short-term oncological outcomes of patients aged ≥80 years undergoing robot-assisted radical cystectomy.

PURPOSE: To assess complication rates and early oncological outcomes of patients aged ≥80 years who underwent robot-assisted radical cystectomy (RARC). METHODS: A total of 368 consecutive patients underwent radical cystectomy from April 2001 to September 2013 in a tertiary referral center. Sixty-one patients aged ≥80 years underwent RARC and constitute the cohort of interest. Complications arising within 30 and 90 days of surgery were graded using the modified Clavien classification and were additionally categorized by organ system using a standardized complication reporting system. Recurrence-free survival, disease-specific survival and overall survival were calculated using Kaplan-Meier curves. RESULTS: Median age was 83 years (range 80-94). Twenty-nine (48 %) of all tumor specimens were stage ≥pT3. The median number of nodes removed was 19 (range 6-67). The soft tissue positive margin rate was 10 %. A total of 27 (44 %) patients had complications within 90 days, of which 9 had major complications. Two patients (3 %) died from surgical complications within 90 days. At a median follow-up of 13 months, 12 (20 %) patients had developed recurrent cancer and subsequently died from disease. An additional 13 (21 %) patients died from non-cancer-related causes. The median overall survival time was 36.0 months. At 2 years, recurrence-free, cancer-specific and overall survival rates were 73, 74 and 61 %, respectively. CONCLUSIONS: In patients aged ≥80 years, RARC is feasible with acceptable perioperative morbidity and favorable short-term oncological outcomes. Therefore, RARC should be considered a valid option for carefully selected patients aged ≥80 years with bladder cancer.

Current devices, outcomes, and pain management considerations in penile implant surgery: an updated review of the literature.

Penile prosthesis surgery is a definitive treatment for erectile dysfunction (ED). The two categories of penile prosthesis are endorsed by professional guidelines, inflatable penile prosthesis (IPP) and malleable penile prosthesis (MPP). Each modality of penile prosthesis offers distinct advantages and incorporates specific design features, allowing for personalized device selection that aligns with individual needs and preferences. While the overall complication rate of penile implant surgery remains low, surgeons should maintain a high index of suspicion for complications in the perioperative time period. Multimodal analgesic regimens including nerve blocks and narcotic-free pathways should be administered to manage perioperative pain. Finally, the high patient satisfaction after penile prosthesis surgery underscores the success of this ED treatment option.

Early Post-Operative Events After Urethroplasty in Obese Patients: A Multi-Institutional Retrospective Series.

OBJECTIVE: To compare early urethroplasty outcomes in non-obese, obese and morbidly obese patients undergoing urethroplasty for urethral stricture disease. The impact of obesity on outcomes is poorly understood but will be increasingly important as obesity continues to rise. METHODS: Patients underwent urethroplasty at one of the 5 institutions between January 2016 and December 2020. Obese (BMI 30-39.9, n = 72) and morbidly obese (BMI >40, n = 49) patients were compared to normal weight (BMI <25, n = 29) and overweight (BMI 25-29.9, n = 51) patients. Demographics, comorbidities, and stricture characteristics were collected. Outcomes including complications, recurrence, and secondary interventions were compared using univariate and multivariate analysis. RESULTS: Two hundred and one patients (Mean BMI 34.1, Range 18.4-65.2) with mean age 52.2 years (SD=17.2) were analyzed. Median follow-up time was 3.71 months. Obese patients were younger (P = .008), had more anterior (P <.001), iatrogenic and LS-associated strictures (P = .036). Sixty-day complication rate was 26.3% with no differences between cohorts (P = .788). Around 9.5% of patients had extravasation at catheter removal, 18.9% reported stricture recurrence, and 7.4% required additional interventions. Obese patients had greater estimated blood loss (P = .001) and length of stay (P = .001). On multivariate analysis, smoking associated with contrast leak (OR 7.176, 95% CI 1.13-45.5) but not recurrence or need for intervention (P = .155, .927). CONCLUSION: Obese patients in our cohort had more anterior, iatrogenic, and LS-related strictures. However, obesity is not associated with complications, contrast leak, secondary interventions, or recurrence. Obese had higher blood loss and length of stay. Urethroplasty is safe and effective in obese patients.