Comparing preoperative screening tools for elective urologic cancer surgery: insights from a cluster analysis.

INTRODUCTION: The aim of this study is to evaluate the features and benefits of different geriatric screening tools for enhancing the perioperative care of patients who undergo elective cancer surgery using cluster analysis. METHODS: This study was a retrospective, observational analysis of 1019 consecutive patients who had elective major cancer surgery in the urology department of our hospital from October 2019 to January 2023. Before the surgery, a trained nurse screened the patients using six tools: Eastern Clinical Oncology Group performance status (ECOG-PS), flemish version of the triage risk screening tool (fTRST), geriatric-8 (G8), instrumental activities of daily living (IADL), patient health questionnaire-2 (PHQ-2), and simple questionnaire to rapidly diagnose sarcopenia (SARC-F). The study grouped the patients into four clusters based on their scores on these tools and compared their outcomes after the surgery. The outcomes included overall survival, ambulation failure, delirium, and severe complications. The study also examined how each screening tool was associated with the outcomes. RESULTS: Based on their clinical data and screening results, we classified the patients into four groups: Healthy (73%), Depressive (11%), Intermediate (11%), and Unhealthy (5%). The Unhealthy group had the worst outcomes in overall survival (OS), ambulation failure, and delirium, followed by the Intermediate group. In addition, fTRST and SARC-F emerged as significant predictors of OS; ECOG-PS, fTRST, G8 and SARC-F of ambulation failure; ECOG-PS, fTRST and G8 of delirium; and G8 of severe complications. CONCLUSION: Various geriatric screening tools were found to have the potential to forecast diverse postoperative outcomes.

Value of Flemish Version of the Triage Risk Screening Tool in Predicting Unfavorable Outcomes after Elective Cancer Surgery: A Propensity Score-Matched Retrospective Cohort Study.

Introduction: The Flemish version of the Triage Risk Screening Tool (fTRST), derived from the Triage Risk Screening Tool for assessing risk of readmission to the emergency department, is increasingly used as a simple screening tool in oncology. This study aimed to evaluate the utility of the fTRST in the context of elective surgical treatment for urologic cancer patients. Methods: We included 886 patients who underwent major urologic cancer surgery at our institution between 2020 and 2022 and underwent preoperative screening, including fTRST. We set the fTRST cutoff at 2 and used propensity score matching and multivariate regression analysis to assess how fTRST affected two postoperative outcomes: ambulation failure and delirium. Results: Of the 886 patients, 693 (78%) had an fTRST score <2, and 193 (22%) had an fTRST score ≥2 (high likelihood of frailty). After matching the groups by propensity scores, we compared the outcomes of 131 patients in each group. We found that the group with fTRST ≥2 had significantly higher rates of ambulation failure (15 vs. 11%, p = 0.03) and delirium (16 vs. 11%, p = 0.008) than the group with fTRST <2. Multivariate logistic regression analysis showed that fTRST score ≥2 was an independent risk factor for postoperative ambulation failure (odds ratio [OR] = 4.05, p = 0.02), along with age ≥75 years (OR = 6.62, p = 0.02), preoperative benzodiazepine medications (OR = 5.12, p = 0.01), and receiving radical cystectomy (OR = 9.30, p = 0.02). Similarly, for delirium, fTRST score ≥2 was an independent risk factor (OR = 2.88, p = 0.03), along with preoperative benzodiazepine medications (OR = 4.38, p = 0.002). Conclusion: The fTRST might be a screening tool with great potential for identifying patients at high risk for unfavorable postoperative outcomes in elective urologic cancer surgery.

An exploratory study on the heterogeneity of postoperative delirium: Preoperative cognitive screening does not detect hallucinatory delirium risk.

INTRODUCTION: This study compared the clinical characteristics of patients who had hallucinations and those who did not during delirium after elective cancer surgery. MATERIALS AND METHODS: This study retrospectively observed 1137 consecutive patients who had preoperative screening by a trained nurse before elective major urologic cancer surgery in our department. We compared the patient characteristics, including mini-cognitive assessment instrument (Mini-Cog) and Geriatric-8 (G8) scores, between those who developed postoperative delirium and those who did not, and also between those who had hallucinations and those who did not during delirium. RESULTS: Out of 1137 patients, 68 developed postoperative delirium, and 12 of them had hallucinations. A hierarchical cluster analysis based on the G8 and Mini-Cog scores divided the patients into two groups: one with high G8 and cognitive function (36 patients) and one with low G8 and cognitive function (32 patients). Hallucinations during delirium were more frequent in the high G8 and cognitive function group (11 out of 36 patients) than in the low G8 and cognitive function group (one out of 32 patients). Patients who had hallucinations during delirium also had higher preoperative Mini-Cog scores (P = 0.002) and G8 scores (P = 0.03) than those who did not, indicating better cognitive function and less frailty. DISCUSSIONS: We identified a patient population that is prone to hallucinations that preoperative screening tools cannot detect. This suggests the heterogeneity of postoperative delirium and the need for further research.

Housework participation and mortality in Japanese male patients undergoing cancer surgery: A propensity score-matched study.

BACKGROUND: Participation in housework and meal preparation are instrumental activity of daily living (IADL) evaluation items that is known to predict prognosis and complications in cancer care. However, these items are often assessed only for females, not for males, in IADL. METHODS: We examined the impact of habit of housework and meal preparation on overall survival (OS) in 1025 Japanese male patients who underwent elective urologic cancer surgery at our institution. The study also used a cohort that was matched by propensity score. RESULTS: We found that patients who did not prepare meals or do housework had significantly shorter OS (hazard ratio [HR] = 3.34, P = 0.005; HR = 5.01, P < 0.001, respectively). Even in the cohort of 448 patients matched by propensity score and adjusted for age, body mass index, comorbidities, performance status, living status, cancer type, stage groups of cancer, and surgical approach, lack of participation in housework was associated with shorter OS (HR = 2.92, P = 0.04) and was an independent predictor of worse OS in multivariable analysis (HR = 5.13, P = 0.008). CONCLUSIONS: Males who did not regularly do household chores before elective cancer surgery had worse life outcomes. Doing more daily physical activities, such as household chores like making the bed and cleaning the room, might have a positive impact on survival when fighting cancer.

Value of Cystatin C-Based Sarcopenia Index in Patients Undergoing Surgery for Renal Tumors.

INTRODUCTION: Sarcopenia is a condition of low muscle strength and quantity, severe if low physical performances. The sarcopenia index (SI), calculated by blood levels of creatinine and cystatin C, had been reported to be correlated with skeletal muscle mass and is a potential simple screening tool for sarcopenia. We hypothesized that patients with a low SI, meaning low muscle mass, would have an inflated estimated glomerular filtration rate (eGFR) value based on serum creatinine levels. We also tested the prognostic value of the SI in a cohort of patients who had surgery for renal malignancies. PATIENTS AND METHODS: We conducted a retrospective, observational study of 322 patients that had surgery for renal tumors in National Cancer Center Hospital East (Kashiwa, Chiba) between April 2017 and June 2023. We assessed sarcopenia measuring psoas muscle index (PMI), psoas muscle density (PMD), and skeletal muscle area (SMA) by computed tomography. We assessed the association between SI and eGFR before and after surgery. We also assessed the association between SI and postoperative outcome, including overall survival. RESULTS: Of the 322 patients, 211 (66%) were males, with a median age of 69 years. SI had a weak correlation with both PMI and PMD in males (PMI: ρ = 0.25; PMD: ρ = 0.21). In females, SI and PMD exhibited a low correlation (ρ = 0.26), while SI and PMI displayed an insignificant correlation (ρ = 0.19). The correlation between SMA and SI was moderate for both males and females (males: ρ = 0.51; females: ρ = 0.46). After radical nephrectomy, eGFR decreased in 98% of patients with high SI, compared to 69% of patients with low SI. We also demonstrated that low SI predicted poor prognosis. CONCLUSIONS: Clinicians can recognize the possibility of overestimated eGFR in the low SI group by measuring SI around the surgery. Low SI may also help predict poor prognosis.

Laparoscopic total pelvic exenteration combined with transanal total mesorectal excision for locally advanced prostate cancer with rectal infiltration.

Introduction: Intensive treatment is typically considered for very high-risk patients with locally advanced prostate cancer and an expected survival time of 5 years or longer. Herein, we report a case of locally advanced prostate cancer with rectal infiltration treated with laparoscopic total pelvic exenteration combined with transanal total mesorectal excision. Case presentation: A 73-year-old man presented with a ring-shaped mass around the rectum. He was diagnosed with prostate cancer with rectal infiltration and underwent laparoscopic total pelvic exenteration combined with transanal total mesorectal excision following neoadjuvant androgen deprivation therapy. Twenty-two months postoperatively during ongoing androgen deprivation therapy, no biochemical recurrence was observed. Conclusion: To our knowledge, this is the first report of a laparoscopic total pelvic exenteration combined with transanal total mesorectal excision for prostate cancer with rectal infiltration. We believe this surgery may be considered a new option for high-risk prostate cancer patients with rectal infiltration.

Control of bleeding from a recurrent tumor at a uretero-ileal anastomosis by electrocoagulation via an ileal conduit.

Introduction: Bladder cancer is characterized by spatial and temporal recurrence in the urinary tract. We describe a case of recurrence at a uretero-ileal anastomosis after radical cystectomy and nephroureterectomy. It was difficult to control bleeding from the tumor, but hemostasis was achieved. Case presentation: A 73-year-old man with a history of radical cystectomy and reconstruction of the ileal conduit and right nephroureterectomy was diagnosed with recurrence at the uretero-ileal anastomosis site. Bleeding from the tumor could not be controlled by flexible gastrointestinal endoscopy. The patient underwent coagulation via an ileal conduit approach using a rigid scope and bipolar electrocautery, which is usually a modality for transurethral resection. Conclusion: This is the first report in which a modality normally used for transurethral resection was used to control bleeding in a patient with an ileal conduit. This application is useful in cases open surgery or additional irradiation might be difficult.

Association of the Controlling Nutritional Status Score with the Development of Postoperative Paralytic Ileus After Radical Cystectomy: Retrospective Cohort Study.

OBJECTIVE: Postoperative paralytic ileus is a major adverse event of radical cystectomy, causing prolonged hospitalization. The controlling nutritional status score, consisting of serum albumin, total lymphocyte count, and total cholesterol, indicates the nutritional status and may evaluate gastrointestinal status. This study aimed to clarify the association between the controlling nutritional status score and the development of postoperative paralytic ileus in patients who underwent radical cystectomy with ileal conduit or ileal neobladder. MATERIALS AND METHODS: We retrospectively analyzed the clinical features of patients who underwent open radical cystectomy or robotic assisted laparoscopic radical cystectomy with ileal conduit or ileal neobladder for bladder cancer between April 2011 and May 2021. The association between clinical variables, including the controlling nutritional status score and the development of postoperative paralytic ileus, was examined. RESULTS: Out of 133 patients, 34 (26%) developed postoperative paralytic ileus. The patients who developed postoperative paralytic ileus were likely to have a higher controlling nutritional status score (P = .055) compared to those who did not develop postoperative paralytic ileus. Multivariate analysis revealed that a preoperative controlling nutritional status score of ≥1 (odds ratio: 2.90, 95% CI: 1.08-7.80, P = .034) and longer operating time (odds ratio: 3.02, 95% CI: 1.13-8.11, P = .027) were significant independent factors for postoperative paralytic ileus development. CONCLUSION: A high controlling nutritional status score and long operating time may be risk factors for developing postoperative paralytic ileus in patients who underwent radical cystectomy with ileal conduit or ileal neobladder for bladder cancer. Preoperative controlling nutritional status may be able to predict postoperative paralytic ileus development.

Prevalence and characteristics of patients with upper urinary tract urothelial carcinoma having potential Lynch syndrome identified by immunohistochemical universal screening and Amsterdam criteria II.

BACKGROUND: This study aimed to identify patients with upper urinary tract urothelial carcinoma (UTUC) having potential Lynch syndrome (pLS) by immunohistochemistry (IHC) of DNA mismatch repair gene-related proteins (MMRPs) and Amsterdam criteria II and explore their clinical characteristics. METHODS: We retrospectively collected the clinical data of 150 consecutive patients with UTUC who underwent surgical resection at our institution between February 2012 and December 2020, and immunohistochemistry (IHC) of four MMRPs (MLH1, MSH2, MSH6, and PMS2) on all UTUC specimens was performed. Patients who tested positive for Amsterdam criteria (AMS) II and/or IHC screening were classified as having pLS and others as non-pLS, and their characteristics were explored. RESULTS: In this study, 5 (3%) and 6 (4%) patients were positive for AMS II and IHC screening, respectively. Two patient were positive for both AMS II and IHC screening, resulting in 9 (6%) patients with pLS. The pLS group was predominantly female (67% vs. 36%; p = 0.0093) and had more right-sided tumors (100% vs. 43%; p = 0.0009) than the non-pLS group. Of the 6 patients who were positive for IHC screening, 4 showed a combined loss of MSH2/MSH6 (n = 3) and MLH1/PMS2 (n = 1). Other two patients showed single loss of MSH6 and PSM2. CONCLUSIONS: AMS II and IHC screening identified pLS in 6% of patients with UTUC. The IHC screening-positive group tends to have relatively high rate of combined loss, but some patients have single loss. AMS II may overlook patients with LS, and a universal screening may be required for patients with UTUC as well as those with colorectal and endometrial cancer.

Simultaneous robot-assisted laparoscopic radical prostatectomy and inguinal hernia repair using a polypropylene mesh: Report of two cases.

Introduction: We report two cases where robotic-assisted laparoscopic radical prostatectomy and inguinal hernia repair were performed simultaneously. Case presentation: In case one, hernia repair was performed by implantation of 3D Max™ mesh and closure of the peritoneum. Total console time was 156 min, of which hernia repair took 21 min. In case two, hernia repair was performed using Ventralight™ ST mesh. Total console time was 181 min, of which hernia repair took 23 min. Pelvic lymph node dissection was performed in case two but not in case one. Both patients were discharged 7 days postoperatively without severe complications or mesh infection. Conclusion: It may be possible to perform robotic-assisted laparoscopic radical prostatectomy and inguinal hernia repair simultaneously.

The significance of SARC-F scores in predicting postoperative outcomes of older adults undergoing elective major surgery for urologic cancer.

BACKGROUND & AIMS: Recently, the strength, assistance with walking, rise from a chair, climb stairs, and falls (SARC-F) questionnaire has been developed to screen patients with signs of sarcopenia. However, its clinical benefit remains uncertain in elderly patients undergoing elective major surgeries. This study aimed to explore the role of the SARC-F questionnaire as a screening tool for patients who plan to undergo elective major surgery for urologic cancer and to also evaluate correlations of SARC-F scores with established indicators of sarcopenia. METHODS: This retrospective observational study enrolled 815 patients over 40 years of age undergoing elective major surgery for urologic cancer and who were screened with the SARC-F questionnaire, preoperatively. The primary endpoint was an association between SARC-F scores and postoperative ambulation failure. Here we define postoperative ambulation failure as a condition where a patient is unable to walk independently within 2 days after surgery and required physical rehabilitation or was transferred to other hospitals in a bedridden state. The secondary endpoint was an association between SARC-F scores and overall survival (OS). Psoas muscle density (PMD) and psoas muscle index (PMI) were calculated from abdominal computed tomography images, and their correlations with SARC-F scores grouped by sex. RESULTS: Of the 815 patients, 738 (91%) were male and the median age was 72 years. Although SARC-F scores weakly correlated with PMD in males and moderately correlated in females (ρ = -0.222 and ρ = -0.474, respectively), their correlation with PMI was negligible (ρ = -0.179 and ρ = -0.084, respectively). SARC-F scores successfully discriminate postoperative ambulation failure in both males and females with the respective area under the receiver operating characteristic curve of 0.856 and 0.813. Multivariate analysis also showed that SARC-F scores greater than 4 are an independent risk factor of postoperative ambulation failure along with older age, lower PMD, and poor performance status. SARC-F scores greater than 4 were significantly associated with a shorter OS in the whole cohort (P < 0.001) and a subgroup of patients undergoing radical cystectomy (P = 0.03; median follow-up of 515 days). CONCLUSIONS: The SARC-F questionnaire might be applicable to identify elderly patients at a higher risk of unfavourable outcomes after major urologic cancer surgery. A randomised controlled trial is necessary to confirm this finding.

Salvage Robot-Assisted Radical Prostatectomy (sRARP) for Radiation-Recurrent Prostate Cancer: a Single-Center Experience.

This case series reported on five patients with radiation-recurrent localized prostate cancer (PCa) who underwent salvage robot-assisted radical prostatectomy (sRARP). Median postoperative follow-up period was 8 months. Median (range) peri-operative parameters such as operative time, the estimated blood loss, and length of hospital stay were 127 min (113-158), 61 ml (54-111), and 9 days (8-11), respectively. None of the five patients required conversion to an open approach or required a blood transfusion, or experienced a rectal/ureteral injury. Urinary leakage was present in one patient (20%) at the initial cystogram. Transurethral electrocoagulation under spinal anesthesia was required to control hematuria in one patient (20%). Two patients (40%) experienced biochemical progression; no patient died from PCa or other causes during the follow-up period. Of five patients, three (60%) were continent. For patients with radiation-recurrent localized PCa, sRARP might become a feasible surgical option with acceptable outcomes.

A case report of simultaneous robot-assisted nephroureterectomy and robot-assisted total laparoscopic hysterectomy.

Introduction: Robot-assisted surgery is spreading across surgical specialities as a less invasive alternative to conventional laparoscopic and open surgery. Case presentation: In this report, robot-assisted total laparoscopic hysterectomy and robot-assisted nephroureterectomy were performed simultaneously for a 69-year-old Japanese female with giant cervical polyp and ureteral cancer. All specimens could be removed from the vagina. The operative time was 379 min, the estimated intraoperative blood loss was 29 mL, and the patient was discharged on the sixth postoperative day without complications. Conclusion: We reported our experience with simultaneous robot-assisted nephroureterectomy and robot-assisted total laparoscopic hysterectomy. To our knowledge, this is the first report of simultaneous robot-assisted nephroureterectomy and robot-assisted total laparoscopic hysterectomy surgery.

Rapid geriatric screening tools predict inability to manage stoma by oneself after urinary diversion: G8 and IADL-modified G8.

INTRODUCTION: This study aimed to evaluate whether functional screening, as assessed by the Geriatric-8 (G8) and the instrumental activities of daily living (IADL)-modified G8, are associated with the inability to manage a stoma by themselves in patients with bladder cancer who underwent robot-assisted radical cystectomy. MATERIALS AND METHODS: We analyzed a total of 110 consecutive patients with bladder cancer who underwent robot-assisted radical cystectomy and were screened preoperatively using the G8 and the IADL-modified G8 at our institution between January 2020 and December 2022. Patients who could not undergo geriatric screening at the preoperative clinic before surgery and patients who underwent orthotopic neobladder construction were excluded. We evaluated the association between clinical factors, including scores of G8 and IADL-modified G8, and the inability to manage a stoma by oneself. For both G8 and IADL-modified G8, a cutoff value of ≤14 was set. RESULTS: Of the 110 patients, the median age was 77 years, 92 (84%) patients were male and 47 (43%) patients were unable to manage a stoma by themselves. The geriatric assessment indicated that 64 patients (58%) were classified in the low G8 (≤14) group and 66 patients (60%) were classified in the low IADL-modified G8 (≤14) group. The values of area under the receiver operating characteristic curve for predicting inability to manage stoma by oneself were 0.725 for the G8 and 0.734 for the IADL-modified G8, respectively. Multivariate analysis including the G8 revealed that age ≥ 80, Charlson comorbidity index of ≥3, and G8 ≤ 14 (odds ratio [OR] = 4.9; 95% confidence interval [CI] = 1.8-13.0; P = 0.002) were independent risk factors for inability to manage a stoma by oneself. Likewise, multivariate analysis including the IADL-modified G8 revealed that age ≥ 80, Charlson comorbidity index of ≥3, and IADL-modified G8 ≤ 14 (OR = 5.4; 95% CI = 1.9-14.0; P = 0.001) were independent risk factors for inability to manage a stoma by oneself. DISCUSSION: Screening using G8 and IADL-modified G8 may predict patients who have difficulty self-managing their stomas.

Impact of perinephric fat volume and the Mayo Adhesive Probability score on time to clamping in robot-assisted partial nephrectomy.

The aim of this study is to evaluate the association of perinephric fat volume (PNFV) and the Mayo Adhesive Probability (MAP) score with time to clamping (TTC) in robot-assisted partial nephrectomy (RAPN). The study subjects consisted of 73 tumors in 72 patients who underwent transperitoneal RAPN at a single cancer center between February 2020 and July 2022. Clinical characteristics including R.E.N.A.L. nephrometry score, MAP score and PNFV were evaluated in a multivariate analysis in relation to TTC, which was classified into two groups based on median TTC. PNFV and MAP score were analyzed separately. PNFVs were measured by SYNAPSE VINCENT® by a single expert urologist. Median TTC was 67 (range: 36-119) min. Spearman's rank correlation analysis indicated that a significant correlation was observed between PNFV and MAP score with a value of 0.81 (p < 0.0001). Univariate analysis revealed that R.E.N.A.L. nephrometry score ≥ 7 (p = 0.036), posterior tumor location (p = 0.033), MAP score ≥ 3 (p = 0.02) and PNFV ≥ 250 ml (p = 0.02) were significant factors for prolonged TTC. In a multivariate analysis including PNFV (analysis 1), R.E.N.A.L. nephrometry score ≥ 7 (OR 3.54, p = 0.018) and PNFV ≥ 250cm3 (OR 3.94, p = 0.010) were independent factors for prolonged TTC. Similarly for MAP score (analysis 2), R.E.N.A.L. nephrometry score ≥ 7 (OR 3.54, p = 0.018) and MAP score ≥ 3 (OR 3.94, p = 0.010) were independent factors for prolonged TTC. Both MAP score and PNFV may have a significant impact on TTC.

Simultaneous robot-assisted nephroureterectomy and radical cystectomy.

Introduction: We present a case of simultaneous robot-assisted radical nephroureterectomy (RANU) and robot-assisted radical cystectomy (RARC) for muscle-invasive bladder cancer with concomitant upper urinary tract urothelial carcinoma. Case presentation: A 59-year-old Japanese man was diagnosed with right ureteral cancer and muscle-invasive bladder cancer. We performed RANU and RARC simultaneously; three of the ports used for RANU were diverted to RARC. Console times for RANU and RARC were 66 and 207 minutes, respectively. Total operative time was 386 minutes. The intraoperative blood loss was estimated 255 ml. The patient was discharged on postoperative day 18 without complications. Conclusion: We reported our experience with simultaneous RANU and RARC for muscle-invasive bladder cancer with concomitant right ureteral cancer. To the best of our knowledge, this is the first report of its kind in Japan.

A novel predictive model for postoperative delirium using multiple geriatric screening factors.

OBJECTIVES: The purpose of this study was to develop a new composite score to accurately predict postoperative delirium (POD) after major urological cancer surgery. METHODS: Our retrospective analysis included, in total, 449 consecutive patients who experienced major urological cancer surgery and a preoperative geriatric functional assessment at our institution (development cohort). Geriatric functional assessments included Geriatric 8, Instrumental Activities of Daily Living, and mini-cognitive assessment instrument (Mini-Cog). Multivariate analysis was used to identify factors related to POD and combined to create a predictive score. The composite score was externally validated using a cohort of 92 consecutive pancreatic cancer patients who underwent pancreaticoduodenectomy and a preoperative geriatric functional assessment (validation cohort). The predictive accuracy and performance of the composite score were evaluated using the area under the receiver operating characteristic curves (AUC) and calibration plots. RESULTS: In multivariate analysis of a development cohort, the following factors were significantly associated with POD: a Mini-Cog score of <3 (odds ratio [OR] = 9.5; p < 0.001), disability in the responsibility for medication (OR = 4.1; p = 0.03), and the preoperative use of benzodiazepine (OR = 6.4; p < 0.001). The composite score of these three factors showed excellent discrimination in predicting POD, with AUC values of 0.819 and 0.804 in development and validation cohorts, respectively. Calibration plots showing predicted probability and actual observation in both cohorts showed good agreement. CONCLUSIONS: A combined model of Mini-Cog, a disability in the responsibility for medication, and preoperative benzodiazepine use showed excellent discriminative power in predicting POD.

Initial Experience of Hybrid Technique in Robot-Assisted Intracorporeal Ileal Conduit.

OBJECTIVE: This study was designed to describe our hybrid approach to intracorporeal urinary diversion and evaluate surgical experience during initial induction. MATERIAL AND METHODS: Clinical data from 38 patients with bladder cancer undergoing robot-assisted radical cystectomy with ileal conduit hybrid approach to intracorporeal urinary diversion at our institution between May 2020 and January 2022 were reviewed. The hybrid approach to intracorporeal urinary diversion pro cedure involved the following: radical cystectomy, removing a specimen through a 4- to 6-cm skin incision, harvesting an ileal conduit, redocking the robot, and uretero-uretero anastomosis. The relationship between surgical experience and operative time and a Clavien-Dindo classification of grade >3 was evaluated. RESULTS: Of the 38 patients, 30 (79%) were male, and the median age was 75 years (interquartile range, 71-80 years). The total operative time was 384 minutes (interquartile range, 348-409 minutes). The estimated blood loss was 244 mL (interquartile range, 124-445 mL). No bowel injuries or conversions to laparoscopy or laparotomy were encountered. High-grade postoperative complications (Clavien-Dindo classification grade > 3) occurred in 7 cases (19%). The overall 90-day readmission rate following discharge after surgery was 5%. The relationship between surgical experience and operative time was nonlinear. A plateau was not reached in all 38 patients. CONCLUSION: Our hybrid approach to intracorporeal urinary diversion technique can be accomplished safely with acceptable operative times, even with little surgical experience. This procedure might be a safe treat ment option that is relatively easy to perform, particularly in an institution that has not yet introduced intra corporeal urinary diversion. Future randomized trials with larger samples and longer follow-up periods are required to confirm our findings.

Validity and Safety of Robot-Assisted Laparoscopic Radical Cystectomy for the Elderly: Results of Perioperative Outcomes in Patients Aged ≥80 Years.

OBJECTIVE: To improve perioperative outcomes, robot-assisted radical cystectomy has gained increasing interest. This study aimed to assess the detailed perioperative complications of robot-assisted radical cystectomy in elderly aged ≥80 years and compare them with those of non-elderly. MATERIAL AND METHODS: We retrospectively analyzed the clinical features of 74 patients who underwent robotassisted radical cystectomy for bladder cancer between September 2018 and September 2021. Perioperative complication was classified by the Clavien-Dindo classification and organ system-based categories. We assessed the relationship between age or Charlson comorbidity index score (≥3 or <3) and the incidence of perioperative complication or rehospitalization rate within 90 days postoperatively. RESULTS: Of the 74 patients, perioperative complication of all grades and grade ≥IIIa occurred in 54 (73%) and 15 (20%) patients, respectively. The postoperative rehospitalization rate was 20%, and the perioperative mortality rate was 0%. Elderly (n = 20) showed no difference in the incidence of perioperative complication of all grades or grade ≥IIIa compared with non-elderly, and no organ system-based category had a higher incidence in elderly than that in non-elderly. Gastrointestinal tract-related perioperative complication incidence was higher in non-elderly and those with Charlson comorbidity index ≥3 (P = .044, .039, respectively); cardi ovasc ular- relat ed perioperative complication incidence was higher in those with Charlson comorbidity index ≥ 3 (P = .0068). CONCLUSION: The incidence perioperative complication of robot-assisted radical cystectomy in elderly was not different from those in non-elderly, suggesting that robot-assisted radical cystectomy may be an option for the treatment of bladder cancer in elderly as well as non-elderly.

Significance of postoperative membranous urethral length and position of vesicourethral anastomosis for short-term continence recovery following robot-assisted laparoscopic radical prostatectomy.

BACKGROUND: We assess whether short-term recovery of urinary incontinence following robot-assisted laparoscopic radical prostatectomy (RARP) is associated with postoperative membranous urethral length (MUL) and position of vesico-urethral anastomosis (PVUA). METHODS: Clinical variables including PVUA and pre-and postoperative MUL were evaluated in 251 patients who underwent RARP from August 2019 to February 2021. Continence recovery was defined as no pad or one security liner per day assessed by patient interview at least 6 months follow-up. Univariate and multivariate logistic regression analyses were used to assess variables associated with continence recovery at 3 months after the operation. RESULTS: Continence recovery rates at 3 and 6 months were 75% and 84%, respectively. Lower BMI (< 25 kg/m2) (p = 0.040), longer preoperative MUL (≥ 9.5 mm) (p = 0.013), longer postoperative MUL (≥ 9 mm) (p < 0.001), higher PVUA (< 14.5 mm) (p = 0.019) and shorter operating time (< 170 min) (p = 0.013) were significantly associated with continence recovery at 3 months in univariate analysis. Multivariate analysis revealed that postoperative MUL (OR 3.75, 95% CI 1.90-7.40, p < 0.001) and higher PVUA (OR 2.02, 95% CI 1.07-3.82, p = 0.032) were independent factors for continence recovery. Patients were divided into 3 groups based on the multivariate analysis, with urinary continence recovery rates found to have increased in turn with rates of 43.7% versus 68.2% versus 85.0% (p < 0.001) at 3 months. CONCLUSIONS: PVUA and postoperative MUL were significant factors for short-term continence recovery. Preservation of urethral length might contribute to continence recovery after RARP.