Robot-assisted excision of seminal vesicle cyst associated with ipsilateral renal agenesis.

Seminal vesicle cysts (SVCs) associated with other genitourologic abnormalities are rare. Often associated with ipsilateral renal agenesis in a symptomatic patient. In symptomatic patients open surgical excision is the treatment of choice. The laparoscopic approach is a less invasive option. Recently robot-assisted management has gained a primary role for the treatment of this condition.

Robotic pyelolithotomy for the treatment of large renal stones: a single-center experience.

BACKGROUND: Few studies have reported robotic pyelolithotomy (RPL) series; furthermore, the most of all have reported small and single-center series. Herein we report our experience from 70 cases of complex kidney stones treated with RPL at our surgical center; this study reports the largest series of RPL in a minimal invasive experienced center. METHODS: Between February 2016 and March 2018, 70 patients with complex renal stones (Guy's Stone Score: 4) underwent RPL and included in a prospectively maintained institutional database. Baseline characteristics, clinical data, perioperative data, postoperative data and stone free status were assessed by descriptive statistics. RESULTS: Of 70 patients, 72.85% presented renal pelvis stones. The mean maximum stone diameter was 33.1±14.5 mm (median 30 mm; interquartile range 22-40 mm). Mean total operative duration was 122.5±34.4 min (median 120 min; interquartile range 105-135 min). In two patients (2.8%), a grade III complications were noted; no major complications (grade IV-V) were noted. The complete SFR, after a single robotic procedure, was 92.8%. CONCLUSIONS: Our findings suggest that RPL is a safe, reproducible and minimally invasive approach as treatment of large renal stones when endoscopic treatment failed or was not available. RPL permits to achieve an excellent stone free status, in a single definitive procedure.

Prognostic role of cell apoptotic rate in prostate cancer: outcome of a long-time follow-up study.

The tumour apoptotic pattern is described as a good predictor of outcome in patients with prostate cancer (PCa). So far no authors have evaluated the role of apoptotic characteristics in patients who have undergone radical prostatectomy (RRP) alone. The aim of the present study is to estimate the prognostic role of the apoptotic index (AI) in a group of patients with prostatic adenocarcinoma subjected to RRP with no adjuvant therapy. Fifty patients underwent RRP according to standardised techniques and the surgical specimens were analysed histologically. In order to evaluate the AI and correlate these results with the follow-up data, we used a standardised apoptotic regulatory terminal deoxynucleotidyl transferase-mediated biotinylated deoxyuridine-triphosphate-biotin nick end-labelling technique (Becton Dickinson Immunocytometry Systems, San Jose, CA, USA). The mean follow-up period was 66 months. Significant correlations were found between the AI and pathological features, such as stage (p<0.001) and grade (p<0.001). Out of 50 patients, 13 (26%) had biochemical recurrence and clinical disease progression, with an AI of 1.93 (range, 0.76-5.22), while 37 patients (74%) who did not report any disease progression, had an AI of 0.58 (range, 0.1-3.12). Furthermore, the AI significantly correlated with status at the end of follow-up (r=0.75, p=0.002), these data being confirmed by Kaplan-Meier curve analysis (p<0.001). On multivariate analysis, the AI proved to be an independent prognostic factor of progression-free probability (p<0.001). Our results highlight the utility of AI analysis in assessing the probability risk of clinical progression in PCa patients who are treated with RRP.

Bilateral nerve sparing robotic-assisted radical prostatectomy is associated with faster continence recovery but not with erectile function recovery compared with retropubic open prostatectomy: the need for accurate selection of patients.

Robotic-assisted radical prostatectomy (RARP) shows measurable advantages, compared to conventional open surgery, even if some aspects are, still, under debate. The aim of this study was to compare the potency recovery rate of patients with clinically localised prostate cancer treated by bilateral nerve-sparing (BNS) RARP or retropubic radical prostatectomy (RRP), and secondarily, the urinary continence recovery evaluation and the oncological efficacy. All patients treated with BNS-RARP or BNS-RRP for clinically localised prostate cancer, performed by a single dedicated surgeon, between January 2004 and December 2008, were enrolled in this non-randomised prospective comparative study. The International Index of Erectile Function (IIEF) and erection hardness score (EHS), in the form of a questionnaire, were self-administered to each patient pre-operatively and after 12 months. The presence of surgical margins was considered as oncological outcome measure. Eighty-two patients underwent BNS-RARP while 48 underwent BNS-RRP. For BNS-RARP and BNS-RRP the median operative time was 221 and 103 min, respectively (P<0.001; df=128; t=721.43),and intra-operative blood loss was 280 and 565 ml, respectively (P<0.001; df=128; t=1742.44). At a mean follow-up period of 12.4±2.3 months, 12 patients (25%) in the BNS-RRP group and 22 (26.8%) in the BNS-RARP group were considered potent with or without drugs (P=0.81). Moreover, we did not find any statistically significant difference between the 2 groups in terms of IEFF and EHS scores after treatment (17.21 vs. 16.98; P=0.16 and 2.1 vs. 2.0; P=0.54). On the other hand, statistically significant differences between the 2 groups were found in terms of faster urinary continence recovery and the presence of positive surgical margins (P<0.001, P=0.009). Shorter catheterization duration (7 vs. 3 days) and post-operative hospital stays (8 vs. 4 days; P<0.001) were found in the BNS-RARP group compared to the BNS-RRP group. In conclusion, our results demonstrate that BNS-RARP does not improve erectile function recovery compared to open radical prostatectomy; however, it significantly improves urinary continence and decreases the presence of positive surgical margins.