Robotic-assisted bladder diverticulectomy: point of technique to identify the diverticulum.

We aim to outline our technique of performing a robotic-assisted bladder diverticulectomy at our institution and report our surgical outcomes. We report the cases of three robotic-assisted bladder diverticulectomies, performed at the Royal Surrey County Hospital during the period of January 2014 to December 2015. Patient was positioned in low dorsal lithotomy position. A 6Fr double-J stent was prophylactically inserted at the start of the procedure. Foley catheter was placed over guide wire into the diverticulum and balloon inflated on the diverticulum neck. We used a transperitoneal extravesical approach to mobilise the distended bladder diverticulum, dissected en bloc and transected at the diverticulum neck in all cases. The bladder was closed in two layers with absorbable sutures. The procedures were uneventful, without post-operative complications and minimal blood loss. The median length of stay was 3 days and all three patients reported a significant improvement in all symptoms with non-significant post-void residuals. Robotic-assisted bladder diverticulectomy is a safe and effective procedure that results in both symptom relief and minimal post-void residuals.

BCG therapy in NMIBC: How much and for how long?. / Terapia BCG en CVNMI: ?cuánto y por cuánto tiempo?.

Since its introduction in 1976 Bacille Calmette- Guerin (BCG) has become the standard of care in high risk non-muscle-invasive bladder cancer (NMIBC). Despite more than 40 years of experience, we do not know the most optimal BCG dose to maximize effectiveness whilst minimizing side effects. There is universal agreement that an initial induction course of BCG should consist of 6 weekly instillations if tolerated. However, with regards to the actual dose, data on the comparative effectiveness of one third dose versus full dose BCG is inconclusive. Similarly, whilst there is strong evidence supporting the use of BCG maintenance, this has not been universally adopted. The optimal maintenance regimen is unknown but the minimum length for effective maintenance BCG therapy seems to be 12 months whilst there is no evidence to support BCG maintenance beyond 36 months. Given the precarious state of worldwide BCG supplies in the last few years, it is imperative that high quality randomized trials are carried out to determine the minimum dose and length of BCG treatment in patients with NMIBC.

Robotic assisted radical prostatectomy for localised prostate cancer in thalidomide generation.

Thalidomide was used in the late 1950s and early 1960s as a sedative for morning sickness in pregnant women. It resulted in thousands of babies being born with various congenital anomalies, such as phocomelia. Subsequently, the drug was banned for this indication. Most of the survivors have become thalidomide adults and now they are in their fifties. We report the first case of a robot-assisted radical prostatectomy in a 54-year-old male with prostate cancer and phocomelia as a result of thalidomide embryopathy. He presented with a PSA of 3.3 and was diagnosed with Gleason 3 + 4 prostate cancer. An extra peritoneal approach was chosen due to his body habitus and to avoid extreme Trendelenburg tilt. Side docking with the da Vinci robot was employed and the prostatectomy was carried out in the standard extra peritoneal fashion. At 6 months' follow-up his PSA is unrecordable and he is voiding well with minimal urinary incontinence, requiring 1 pad/day. We aim to outline our approach and highlight the technical modifications in this rare physically disabling condition.