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Purpose: Robot-assisted radical cystectomy (RARC) is known to have less postoperative morbidity and complications than open radical cystectomy. However, various complications not yet have been reported after RARC. In this study, we aimed to identify the predictors of complications following RARC. Patients and methods: From August 2008 to November 2017, we retrospectively reviewed 126 patients who underwent RARC with extracorporeal urinary diversion. Overall perioperative complications were examined, and factors that may affect complications were analyzed using a logistic regression model. Complications were classified according to the Clavien-Dindo system. Results: Overall postoperative complications occurred in 78 (61.9%) of 126 patients. Whereas the rate of minor complications was 58.0% (grade I=15.9% (n=20), grade II=42.1% (n=53)), the rate of major complications was very low (grade IIIa=1.6% (n=2), grade IIIb =2.4% (n=3)). No fatal complications more than grade IV were developed. Notably, transfusions (27.0%), urinary tract infection (15.9%), anastomosis site leakage (14.3%), and ileus (10.3%) were the most common complications after RARC. In the multivariate regression model, previous intravesical instillation (odds ration [OR]=3.374), preoperative hemoglobin (OR=0.751), and estimated blood loss (EBL) (OR=3.949) were identified as the predictors of postoperative complications. Conclusion: In sum, our data showed the rates of major complications were comparable after RARC with extracorporeal urinary diversion compared as reported in previous studies and lower major than minor complications following RARC. Moreover, we identified the independent predictors of postoperative complications, such as preoperative hemoglobin, intravesical instillation, and EBL.
RESUMEN
OBJECTIVE: To determine whether the penile cuff test can predict surgical outcomes prior to Holmium laser enucleation of the prostate for benign prostatic obstruction. METHODS: Men scheduled to undergo Holmium laser enucleation of the prostate were enrolled in this study, and all patients underwent the penile cuff test prior to and 3 months after surgery. Patients were categorized as obstructed, nonobstructed, or uncertain by nomogram. Surgical outcomes were assessed by evaluating changes in their international prostate symptom score, quality of life index, and maximum flow rate preoperatively and 3 months postoperatively. The proportion of patients with good outcomes was compared among nomogram-classified groups, and postoperative changes in position on the nomogram were assessed. RESULTS: A total of 125 patients were analyzed. After surgery, the overall treatment efficacy and symptomatic treatment efficacy were not different between obstructed and nonobstructed patients. However, the maximum flow rate and quality of life score were significantly higher after surgery in obstructed patients compared to nonobstructed patients. After surgery, 75.7% of patients with obstruction and 63.6% of patients categorized as uncertain for obstruction transitioned to the nonobstructed group, while 77.3% of nonobstructed patients remained in the nonobstructed group. CONCLUSION: The penile cuff test can be used in patients with bladder outlet obstruction to predict good functional outcome and improved quality of life following treatment with Holmium laser enucleation. After Holmium laser enucleation of the prostate, the majority of patients were classified as nonobstructed.