Partial nephrectomy should be classified as an inpatient procedure: Results from a statewide quality improvement collaborative.

OBJECTIVES: To examine length of stay (LOS) and readmission rates for all minimally-invasive partial nephrectomy (MIPN) and MI radical nephrectomy (MIRN) performed for localized renal masses ≤7 cm in size (cT1RM) within 12 Michigan urology practices. Both RN and PN are commonly performed in treating cT1RM. Although technically more complex and associated with higher complication rates, Centers for Medicare & Medicaid Services considers MIPN an outpatient procedure and MIRN is inpatient. METHODS: We collected data for renal surgeries for cT1RM at MUSIC-KIDNEY practices between May 2017-February 2020. Data abstractors recorded clinical, radiographic, pathologic, surgical, and short-term follow-up data into the registry for cT1RM patients. RESULTS: Within MUSIC-KIDNEY, 807 patients underwent MI renal surgery at 12 practices. Median LOS for cT1RM patients after MIPN (n = 531, 66%) was 2 days and after MIRN (n = 276, 34%) was also 2 days. Among patients undergoing laparoscopic or robotic PN, 171 (32%), 230 (43%), and 130 (24%) stayed ≤1, 2, ≥3 days. Among patients undergoing laparoscopic or robotic RN, 81 (29%), 112 (41%), and 83 (30%) stayed ≤1, 2, ≥3 days. No significant difference was observed between MIPN and MIRN on LOS commensurate with outpatient surgery (≤1-day, OR = 0.97, P = 0.87). CONCLUSIONS: Less than one-third of patients had a LOS ≤1-day and LOS was comparable for MIPN and MIRN. Centers for Medicare & Medicaid Services should be advised that MIPN is a more complex surgery than MIRN, most patients receiving a MIPN will require a ≥2-day hospital stay and it would be more appropriate to classify MIPN an inpatient procedure with MIRN.

Radical prostatectomy: a single surgeon comparison of retropubic, perineal, and robotic approaches.

OBJECTIVE: To compare perioperative, functional and oncological outcomes of a single surgeon's experience with retropubic (RRP), perineal (RPP), and robotic assisted (RARP) radical prostatectomy. METHODS: Results from 150 radical prostatectomies performed by a single surgeon were compared. The groups consisted of the last 50 consecutive RRP (group 1) and RPP patients (group 2) and his first 50 RARP patients (group 3). He had significant experience in RRP and RPP and extensive training prior to performing RARP. The data was obtained from record review and patient survey. Patient demographics, operative parameters, pathological characteristics, complications, and functional outcomes were compared between groups. RESULTS: The groups were comparable with respect to patient demographics. Hospital stay, blood loss, and transfusion requirements were significantly better in the robotic group. Complications were least in the robotic group. Urinary continence (one pad or less) at 12 months was 96% in RRP, 96% in RPP, and 96% in RARP group. Positive surgical margins in organ confined disease were significantly lower for RARP although overall positive margins were similar. Potency data was still maturing and was not included in this analysis. CONCLUSIONS: There were no major differences in outcomes between the RRP and RPP groups. The RARP group had equal or better perioperative outcomes in all analyzed categories with the least complications. Urinary function outcomes were excellent in all groups. Prior open experience and extensive training facilitate encouraging outcomes for robotic prostatectomy even in a surgeon's initial series of patients.

Iliac artery aneurysm: a fatal cause of urinary retention.

Our institution recently encountered two patients with ruptured iliac artery aneurysms. The first patient died, but as a result of our increased awareness, the second patient's aneurysm was diagnosed immediately and operated on successfully. The urologic findings provided subtle clues to this life-threatening condition. We present these two cases with the hope that urologic surgeons will include this condition in their differential diagnosis when evaluating patients with uncharacteristic abdominal pain and urinary symptoms.