Robotic-assisted vs. open ureteral reimplantation: a multicentre comparison.

PURPOSE: Open ureteral reimplantation is considered the standard surgical approach to treat distal ureteral strictures or injuries. These procedures are increasingly performed in a minimally invasive and robotic-assisted manner. Notably, no series comparing perioperative outcomes and safety of the open vs. robotic approach are available so far. METHODS: In this retrospective multi-center study, we compared data from 51 robotic ureteral reimplantations (RUR) with 79 open ureteral reimplantations (OUR). Both cohorts were comparatively assessed using different baseline characteristics and perioperative outcomes. Moreover, a multivariate logistic regression for independent predictors was performed. RESULTS: Surgery time, length of hospital stay and dwell time of bladder catheter were shorter in the robotic cohort, whereas estimated blood loss, postoperative blood transfusion rate and postoperative complications were lower than in the open cohort. In the multivariate linear regression analysis, robotic approach was an independent predictor for a shorter operation time (coefficient - 0.254, 95% confidence interval [CI] - 0.342 to - 0.166; p < 0.001), a lower estimated blood loss (coefficient - 0.390, 95% CI - 0.549 to - 0.231, p < 0.001) and a shorter length of hospital stay (coefficient - 0.455, 95% CI - 0.552 to - 0.358, p < 0.001). Moreover, robotic surgery was an independent predictor for a shorter dwell time of bladder catheter (coefficient - 0.210, 95% CI - 0.278 to - 0.142, p < 0.001). CONCLUSION: RUR represents a safe alternative to OUR, with a shorter operative time, decreased blood loss and length of hospital stay. Prospective research are needed to further define the extent of the advantages of the robotic approach over open surgery.

Clinical Impact and Management of Incidental Renal Findings on Pre-TAVI CT Scan from the Urologist's Perspective.

INTRODUCTION: The aim of the study was to investigate prevalence and impact of incidental renal masses (IRMs) accompanying increasing computed tomography (CT) work-up for symptomatic aortic valve stenosis (sAVS) of the elderly with regard to the relevance of urological consultation for overall survival (OS). METHODS: A retrospective analysis of pre-transcatheter aortic-valve implantations (TAVIs) CT scans of patients with sAVS (N = 1,253) harboring IRM was performed for 2014-2019. According to the clinical management, groups 1 (urologic consultation) and 2 (findings ignored) were formed and analyzed in terms of OS. RESULTS: The prevalence of IRM was 9% (119/1,253). In 19% (23/119), urological advice was sought (group 1). At baseline, group 1 showed a significantly higher rate of malignancy-specific lesions compared to 2 (p < 0.01). Other clinical parameters (e.g., age, cardiological scores, comorbidities) did not differ between groups (p > 0.05). In group 1, 4 (17%) findings were histologically confirmed, of which 3 (13%) underwent surgery. There was no significant difference in median OS at a median follow-up of 24.7 months between groups 1 and 2 with 35.7 (95% CI, 5.9; 65.4) and 47.4 months (95% CI, 33.0; 61.7), respectively (p = 0.4). In Cox regression analysis, chronic kidney disease but not urologic work-up or chronic obstructive pulmonary disease or heart failure emerged as an independent unfavorable predictor of OS (HR 2.44, 95% CI 1.37; 4.36, p = 0.003). CONCLUSION: For the first time, a TAVI population with IRM was analyzed from the urologist's perspective. Urologic co-evaluation and work-up does not confer a significant benefit in terms of OS in this particular population.

Development of symptomatic lymphoceles after radical prostatectomy and pelvic lymph node dissection is independent of surgical approach: a single-center analysis.

PURPOSE: Lymphocele (LC) is the most common adverse sequela of pelvic lymphadenectomy (PLND) during radical prostatectomy for prostate cancer. Current evidence on comparison between robotic (RARP) and open retropubic prostatectomy (RRP) in terms of the development of symptomatic LCs (SLCs) is conflicting. Moreover, no single-center assessment has illuminated the impact of the anterior vs. posterior approach of RARP on the rate of SLCs yet. We aimed to compare RRP and transperitoneal RARP for the SLC development and associated clinical risk factors. METHODS: Patients treated with RRP or transperitoneal RARP (both with standard PLND) were included. Univariate comparisons and multivariate logistic regression analysis were utilized to compare the cohorts and define independent predictive variables for the development of SLCs. RESULTS: Five hundred and ninety-five consecutive PCa patients underwent RRP and 277 ones RARP (76 anterior and 201 posterior approaches). The incidence of SLCs did not differ between both cohorts. Age and lymph node yield were independent predictors for the development of SLCs after RRP. There was a trend for a longer median time to development of SLCs after RARP as compared to RRP. Median duration of percutaneous drainage tended to be higher after RRP then after RARP. Failure rate of lymphocele drainage was comparable between both techniques. CONCLUSIONS: RRP and RARP are associated with the same risk for the development of a SLC. Posterior approach does not reduce the SLC formation compared to the anterior technique. Patients' age and LN yield are predictive for the SLC occurrence in patients treated with RRP.