Single-Port Transvesical Robotic Radical Prostatectomy in a Patient with Hostile Abdomen.

INTRODUCTION: Robotic Radical Prostatectomy using the Da-Vinci Single-Port (SP) robot can provide comparable functional and oncological outcomes with potential advantages pertaining to peri-operative morbidity, especially in patients with an extensive history of prior abdominal surgeries (1, 2). MATERIALS AND METHODS: Our case is a 74-year-old male with a history of diabetes, cardiac bypass, hypertension, and hyperlipidemia, presenting with a PSA of 7.2. His MRI showed a PIRADS-5 lesion in the left apex and mid-gland peripheral zone, and he was diagnosed with unfavorable intermediate-risk prostate cancer after MRI guided fusion biopsy. His BMI was 31, and past surgical history was pertinent for two exploratory laparotomies due to gunshot wounds and a colostomy creation followed by reversal. The standardized steps of robotic radical prostatectomy were carried out using SP robotic platform performed by author SH (3, 4). RESULTS: Total operative time and estimated blood loss were 210 minutes and 150mL respectively. The patient was discharged on postoperative day one and final pathology showed adenocarcinoma of the prostate Gleason score 4+3=7, pT2NxR0 and negative surgical margins. The patient was continent four weeks after surgery and the PSA continues to be undetectable after three months. CONCLUSION: Transvesical Radical prostatectomy using the single port platform provides acceptable oncological and functional outcomes and quicker recovery given decreased risk of ileus and peritoneal irritation. Given that the abdominal cavity is not violated, the risk of bowel or vascular injury is mitigated, especially in patients with a hostile abdomen.

Single-Port Robot assisted partial cystectomy for urachal adenocarcinoma.

OBJECTIVE: We present a novel technique to perform single-port (SP) robot-assisted partial cystectomy with excision of the urachal remnant and bilateral pelvic lymph node dissection for urachal adenocarcinoma (1-7). MATERIALS AND METHODS: A 41-year-old male presented to the clinic for multiple episodes of hematuria and mucousuria. Office cystoscopy revealed a small solitary tumor at the dome of the bladder, with a diagnostic bladder biopsy revealing a tubule-villous bladder adenoma. Cross-sectional imaging of the chest/abdomen/pelvis revealed a 4.5 cm cystic mass arising from the urachus without evidence of local invasion and metastatic spread. He underwent SP robotic-assisted partial cystectomy with excision of the urachal remnant and bilateral pelvic lymph node dissection. Surgical steps include: 1) peritoneal incision to release the urachus and drop bladder 2) identification of urachal tumor 3) intraoperative live cystoscopic identification of bladder mass and scoring of tumor margins using Toggle Pro feature 4) tumor excision with partial cystectomy 5) cystorrhaphy 6) bilateral pelvic lymph node dissection 7) peritoneal interposition flap to mitigate lymphocele formation. RESULTS: Surgery was successful, with no intraoperative complications, an operative time of 100 minutes, and estimated blood loss of 20 mL. The patient was discharged on post-op day one, and the Foley catheter removed one week after surgery. Final pathology revealed a 7.5 cm infiltrating urachal muscle-invasive adenocarcinoma of the bladder (pT2b). Negative surgical margins were achieved. CONCLUSIONS: Single-port robot-assisted partial cystectomy for urachal adenocarcinoma is safe and can achieve equivalent oncologic outcomes to the standard of care with minimally invasive and open techniques.

Evaluation of Renal Function after Percutaneous Nephrolithotomy-Does the Number of Percutaneous Access Tracts Matter?

PURPOSE: Renal function following percutaneous nephrolithotomy has long been a concern to urologists, especially in the setting of multi-tract access. We determined whether the risk of renal injury after multi-tract percutaneous nephrolithotomy was greater than after a single access approach. MATERIALS AND METHODS: We retrospectively reviewed the records of 307 consecutive patients treated with percutaneous nephrolithotomy from 2011 to 2012 at Wake Forest Health. Perioperative (99m)Tc-mercaptoacetyltriglycine nuclear renogram parameters along with serum creatinine values were assessed within 1 year of the procedure. Patients were stratified by single access vs multi-access (2 or more). RESULTS: We identified 110 cases in which renography was done before and after percutaneous nephrolithotomy. A total of 74 patients (67.3%) underwent single access percutaneous nephrolithotomy while 36 (32.7%) underwent multi-access percutaneous nephrolithotomy. Serum creatinine did not significantly differ between the 2 cohorts postoperatively (p = 0.09). There was a significant 2.28% decrease in renal function based on mercaptoacetyltriglycine nuclear renogram results after percutaneous nephrolithotomy of the affected kidney in patients with multiple accesses (p <0.01). This relationship was not observed when patients were stratified by multiple comorbidities associated with nephrolithiasis. CONCLUSIONS: Multi-access percutaneous nephrolithotomy is associated with a small reduction in the function of the targeted kidney compared to a single access approach.

Impact of family history on prostate cancer mortality in white men undergoing prostate specific antigen based screening.

PURPOSE: We assessed whether prostate cancer screening would decrease prostate cancer mortality in white men with a family history of prostate cancer. MATERIALS AND METHODS: Data from the PLCO cancer screening trial were used to compare the screening and usual care arms in the subset of men with and without a family history of prostate cancer. Univariate and multivariate Cox regression analysis, and log rank analysis of Kaplan-Meier curves were done to examine the data for differences in prostate cancer specific survival. RESULTS: A total of 65,179 white subjects were included in the prostate specific antigen screening trial, of whom 7,314 (11.2%) were diagnosed with prostate cancer. Only 4,833 white men (7.4%) had a family history of prostate cancer. Those with a positive family history had a significantly higher incidence of prostate cancer (16.9% vs 10.8%) and higher prostate cancer specific mortality (0.56% vs 0.37%, each p <0.01). On multivariate analysis this trended toward significance (HR 1.47, 95% CI 0.98-2.21, p = 0.06). Screening in men with a positive family history also showed a trend toward decreased prostate cancer specific mortality (HR 0.49, 95% CI 0.22-1.1, p = 0.08) and decreased time to death from prostate cancer (log rank p = 0.05). CONCLUSIONS: White men with a family history of prostate cancer are at increased risk for being diagnosed with and subsequently dying of prostate cancer. Yearly digital rectal examination and prostate specific antigen testing may decrease prostate cancer death in these individuals.

Virtual Reality as an Adjunct to Traditional Patient Counseling in Patients With Newly Diagnosed Localized Prostate Cancer.

OBJECTIVE: To determine the utility of a virtual reality (VR) model constructed using patient-derived clinical imaging to improve patient understanding of localized prostate cancer (PCa) diagnosis and surgical plan. METHODS: Patients undergoing robotic radical prostatectomy were selected and demographic data recorded. Patients completed a questionnaire to assess baseline knowledge of their diagnosis after consultation and shared-decision making with their surgeon. A trained non-clinical staff member then guided the patient through a VR experience to view patient-specific anatomy in a 3-dimensional space. Patients then completed the same questionnaire, followed by an additional post-VR questionnaire evaluating patient satisfaction. Questions 1-7 (patient understanding of prostate cancer and treatment plan) and 11-17 (patient opinion of VR) used a standard Likert scale and Questions 8-10 were multiple choice with 1 correct answer. RESULTS: In total, 15 patients were included with an average age of 64.1 years. 6 of 7 questions showed an improvement after VR (P <.001). The percentage of correct responses on Questions 8-10 was higher after VR but not statistically significant (P >.13). Mean responses range from 4.3 to 4.8 (Likert scale, 1 through 5) for the post-VR questionnaire, with a mean total of 31.9 out of 35. CONCLUSION: This small preliminary investigation of a novel technology to improve the patient experience showed potential as an adjunct to traditional patient counseling. However, due the small sample size and study design, further research is needed to determine the value VR adds to prostate cancer surgical counseling.

Automated Capture of Intraoperative Adverse Events Using Artificial Intelligence: A Systematic Review and Meta-Analysis.

Intraoperative adverse events (iAEs) impact the outcomes of surgery, and yet are not routinely collected, graded, and reported. Advancements in artificial intelligence (AI) have the potential to power real-time, automatic detection of these events and disrupt the landscape of surgical safety through the prediction and mitigation of iAEs. We sought to understand the current implementation of AI in this space. A literature review was performed to PRISMA-DTA standards. Included articles were from all surgical specialties and reported the automatic identification of iAEs in real-time. Details on surgical specialty, adverse events, technology used for detecting iAEs, AI algorithm/validation, and reference standards/conventional parameters were extracted. A meta-analysis of algorithms with available data was conducted using a hierarchical summary receiver operating characteristic curve (ROC). The QUADAS-2 tool was used to assess the article risk of bias and clinical applicability. A total of 2982 studies were identified by searching PubMed, Scopus, Web of Science, and IEEE Xplore, with 13 articles included for data extraction. The AI algorithms detected bleeding (n = 7), vessel injury (n = 1), perfusion deficiencies (n = 1), thermal damage (n = 1), and EMG abnormalities (n = 1), among other iAEs. Nine of the thirteen articles described at least one validation method for the detection system; five explained using cross-validation and seven divided the dataset into training and validation cohorts. Meta-analysis showed the algorithms were both sensitive and specific across included iAEs (detection OR 14.74, CI 4.7-46.2). There was heterogeneity in reported outcome statistics and article bias risk. There is a need for standardization of iAE definitions, detection, and reporting to enhance surgical care for all patients. The heterogeneous applications of AI in the literature highlights the pluripotent nature of this technology. Applications of these algorithms across a breadth of urologic procedures should be investigated to assess the generalizability of these data.

Transperineal vs transrectal magnetic resonance and ultrasound image fusion prostate biopsy: a pair-matched comparison.

The objective of this study was to compare transperineal (TP) versus transrectal (TR) magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion prostate biopsy (PBx). Consecutive men who underwent prostate MRI followed by a systematic biopsy. Additional target biopsies were performed from Prostate Imaging Reporting & Data System (PIRADS) 3-5 lesions. Men who underwent TP PBx were matched 1:2 with a synchronous cohort undergoing TR PBx by PSA, Prostate volume (PV) and PIRADS score. Endpoint of the study was the detection of clinically significant prostate cancer (CSPCa; Grade Group ≥ 2). Univariate and multivariable analyses were performed. Results were considered statistically significant if p < 0.05. Overall, 504 patients met the inclusion criteria. A total of 168 TP PBx were pair-matched to 336 TR PBx patients. Baseline demographics and imaging characteristics were similar between the groups. Per patient, the CSPCa detection was 2.1% vs 6.3% (p = 0.4) for PIRADS 1-2, and 59% vs 60% (p = 0.9) for PIRADS 3-5, on TP vs TR PBx, respectively. Per lesion, the CSPCa detection for PIRADS 3 (21% vs 16%; p = 0.4), PIRADS 4 (51% vs 44%; p = 0.8) and PIRADS 5 (76% vs 84%; p = 0.3) was similar for TP vs TR PBx, respectively. However, the TP PBx showed a longer maximum cancer core length (11 vs 9 mm; p = 0.02) and higher cancer core involvement (83% vs 65%; p < 0.001) than TR PBx. Independent predictors for CSPCa detection were age, PSA, PV, abnormal digital rectal examination findings, and PIRADS 3-5. Our study demonstrated transperineal MRI/TRUS fusion PBx provides similar CSPCa detection, with larger prostate cancer core length and percent of core involvement, than transrectal PBx.

If You Know Them, You Avoid Them: The Imperative Need to Improve the Narrative Regarding Perioperative Adverse Events.

There are few things in life as exciting as growing up in the countryside [...].

Strategies for Improving the Standardization of Perioperative Adverse Events in Surgery and Anesthesiology: "The Long Road from Assessment to Collection, Grading and Reporting".

The assessment, collection, and reporting of all aspects of surgical procedures are crucial for optimizing patient safety and improving surgical/procedural quality [...].

The Performance and Optimum Cutoff Value for Pelvic Cavity Index as a Predictor of Early Continence After Extraperitoneal Single-Port Robotic Radical Prostatectomy: Role of Pelvic Anatomical Characteristics.

Purpose: The aim of this study was to assess the value of the pelvic cavity index (PCI), as an objective pelvimetry feature, to predict operative time, margin status, and early urine continence after extraperitoneal single-port robotic radical prostatectomy (RP). We sought to define an optimal cutoff point for PCI in predicting postoperative outcomes. Methods: A total of 94 patients who underwent extraperitoneal single-port robotic RP and preoperative cross-sectional imaging were enrolled. PCI was calculated as follows: Pelvicinletdiameter×PelvicoutletdiameterPelvicdepth. The predictive value of PCI for operative time, surgical margin status, and 3-month urinary continence recovery was assessed using regression models. To report the optimum cutoff value, on receiver operating characteristic (ROC) analysis, we calculated the performance of PCI cutoff points ranging from 5.56 to 10.80 cm by every 0.01 increment. Results: No significant associations were noted between clinical characteristics (including PCI) and operative time. Similarly, other than pathological stage, no clinical variables (including PCI) were predictive of the positive surgical margin. However, a higher PCI was associated with a significantly higher rate of continence 3 months after surgery [odds ratio 2.44 (1.75-5.33); p = 0.01]. On ROC analysis, a PCI cutoff value = 8.21 cm yielded the best accuracy (area under the curve = 0.733, 95% confidence interval 0.615-0.851; p = 0.001). No association was noted between variables and 6-month continence rates. Conclusions: With a single-port robotic system, the operative time, positive surgical margin rate, and long-term continence after prostatectomy would be independent of the bony pelvic cavity. However, a higher PCI is associated with a higher rate of early continence after surgery. PCI at a cutoff of 8.21 cm has the optimum performance to predict postoperative urine continence recovery. If validated, this information may be helpful regarding patient counseling before single-port robotic RP.

Single-Port Donor Nephrectomy via Modified Pfannenstiel Incision: Initial Preclinical Experience in a Cadaveric Model and Description of Technique.

Objective: To describe the surgical technique for the single-port (SP) transperitoneal donor nephrectomy (DN) through a modified Pfannenstiel incision using the Da Vinci SP® surgical system (Intuitive Surgical, Sunnyvale, CA) on a cadaver. Patients and Methods: In a male cadaver, the SP surgical system was used to perform transperitoneal DN. A 3-cm modified Pfannenstiel incision was made. Through the incision GelPOINT mini (Applied Medical, Rancho Santa Margarita, CA) was inserted. The floating docking technique was used. Through the gel port, the dedicated 25-mm multichannel port and a 12-mm assistant port were introduced. The surgical steps for DN were performed in the following order: (1) mobilization of the colon, (2) identification of psoas muscle, ureter, and the gonadal vein, (3) hilum dissection, (4) perirenal dissection, (5) stapling the renal artery and renal vein, and (6) removal of the kidney through the enlarged incision. Results: Transperitoneal SP DN was completed without any complications or capsulotomy. Additional ports were not needed. The total operative time was 63 minutes and 54 seconds. A good-quality kidney was harvested. Renal artery length was 4 cm. Conclusion: We demonstrated the feasibility of SP transperitoneal DN through modified Pfannenstiel incision, using the novel SP robotic platform. Further assessment is necessary in a clinical setting.

Redo Robotic Partial Nephrectomy for Recurrent Renal Tumors: A Multi-Institutional Analysis.

Introduction: As the experience with robot-assisted partial nephrectomy (RAPN) grows, the indications have expanded to incorporate previously operated ipsilateral kidneys with recurrent renal masses. We sought to analyze the outcomes of redo RAPN in patients with a recurrent renal mass. Methods: Using a multi-institutional series, the data of 72 patients who underwent RAPN for a recurrent renal mass between 2010 and 2020 were retrospectively analyzed. Patients with familial renal cell carcinoma and multiple renal tumors were excluded. Major complication was defined by Clavien grade ≥3. The median follow-up was 28.5 months. Baseline demographics, clinical and tumor characteristics, and perioperative and postoperative outcomes are reported. Results: Our cohort consisted of a combination of previous thermal ablation (19.6%), laparoscopic (19.6%), open (26.1%), and robotic (34.8%) partial nephrectomy. The median R.E.N.A.L. score was 8. Twenty percent had hilar tumors and 9.7% had a solitary kidney. RAPN was completed in all cases. Two cases (2.8%) were converted to open surgery. None of the cases were converted to radical nephrectomy intraoperatively. One patient underwent radical nephrectomy postoperatively because of bleeding. Transfusion rate was 5.9% and major complication rate was 8.3%. Median length of stay was 3 days. Estimated glomerular filtration rate preservation was 78.7% at discharge and 90.8% at 1-year follow-up. Positive surgical margin rate was 8.3%. Overall, distant recurrence was seen in 11 patients (15.3%), however, only 1 patient had local progression (1.4%). Conclusion: In experienced hands, RAPN is an effective approach to treat select cases of locally recurrent renal masses with promising perioperative and functional outcomes. Patients should be carefully monitored for distant recurrence.

Management of a Prostate Cancer Patient With Inherited Germline BRCA1 and BRCA2 Mutations: A Case Report.

The Breast Cancer Gene (BRCA) confers an 8.6-fold higher risk of developing prostate cancer in men ≤ 65 years of age and portends a worse prognosis as compared to noncarriers even in patients with low volume, localized disease. The BRCA2 gene, in particular, imparts a more biologically aggressive form of prostate cancer and a higher prostate cancer specific mortality. From a treatment standpoint, this translates to worse overall clinical outcomes for such patients. The most appropriate screening and management strategy for germline BRCA mutation carriers with prostate cancer is not known. Herein, we present an incidentally discovered prostate cancer in a 61-year-old BRCA1 and BRCA2 germline mutation carrier who was screened and managed using an individualized treatment approach.

The Clinical and Pathologic Relevance of a Prostate MRI Diagnosis of "Prostatitis".

OBJECTIVE: To investigate the relationship between magnetic resonance imaging evidence of prostatitis with clinical symptomatology. Non-malignant abnormalities in peripheral zone are common in prostate multiparametric prostate magnetic resonance imaging (mpMRI). These findings are sometimes reported as "prostatitis" or "inflammation" and lead to patient anxiety and urologic referral. METHODS: Retrospective review of patients undergoing prostate mpMRI (2016-2017) was performed. Two cohort groups based on the presence of "prostatitis" or "inflammation" in the radiology report were identified. Clinical characteristics included age, prostate specific antigen, biopsy/intervention history, true lower urinary tract symptoms (LUTS), pain, use of urologic medications, prostate volume, and PIRADS score. Pathologic finding of inflammation was recorded. Groups were compared using chi-square for dichotomous variables and t-tests for continuous variables. RESULTS: One hundred and four patients were identified with "prostatitis/inflammation" and 273 without. Report of LUTS was high in both groups (58% and 62% for prostatitis and no prostatitis respectively, P= .49), though report of moderate/severe LUTS (physician description or IPSS of 8-19 and 20+) was more common in the no prostatitis group (7% vs 18%, P= .008). Use of urologic medication was similar between the 2 groups (31% and 37% for prostatitis and no prostatitis respectively, P = .23). Biopsy finding of inflammation was more common in the prostatitis group (57% vs 43% P = .027). Reports of pelvic pain, dysuria, or urinary findings of inflammation were uncommon in both groups. CONCLUSION: While mpMRI findings of prostatitis may indicate NIH Category IV prostatitis, there is no evidence of correlation with categories I, II or III prostatitis nor with symptomatic LUTS, and patients should be reassured that further investigation is not warranted.

Single-Port Transvesical Robotic Radical Prostatectomy in a Patient with Hostile Abdomen

ABSTRACT Introduction: Robotic Radical Prostatectomy using the Da-Vinci Single-Port (SP) robot can provide comparable functional and oncological outcomes with potential advantages pertaining to peri-operative morbidity, especially in patients with an extensive history of prior abdominal surgeries (1, 2). Materials and Methods: Our case is a 74-year-old male with a history of diabetes, cardiac bypass, hypertension, and hyperlipidemia, presenting with a PSA of 7.2. His MRI showed a PIRADS-5 lesion in the left apex and mid-gland peripheral zone, and he was diagnosed with unfavorable intermediate-risk prostate cancer after MRI guided fusion biopsy. His BMI was 31, and past surgical history was pertinent for two exploratory laparotomies due to gunshot wounds and a colostomy creation followed by reversal. The standardized steps of robotic radical prostatectomy were carried out using SP robotic platform performed by author SH (3, 4). Results: Total operative time and estimated blood loss were 210 minutes and 150mL respectively. The patient was discharged on postoperative day one and final pathology showed adenocarcinoma of the prostate Gleason score 4+3=7, pT2NxR0 and negative surgical margins. The patient was continent four weeks after surgery and the PSA continues to be undetectable after three months. Conclusion: Transvesical Radical prostatectomy using the single port platform provides acceptable oncological and functional outcomes and quicker recovery given decreased risk of ileus and peritoneal irritation. Given that the abdominal cavity is not violated, the risk of bowel or vascular injury is mitigated, especially in patients with a hostile abdomen.

Single-Port Robot assisted partial cystectomy for urachal adenocarcinoma

ABSTRACT Objective: We present a novel technique to perform single-port (SP) robot-assisted partial cystectomy with excision of the urachal remnant and bilateral pelvic lymph node dissection for urachal adenocarcinoma (1-7). Materials and Methods: A 41-year-old male presented to the clinic for multiple episodes of hematuria and mucousuria. Office cystoscopy revealed a small solitary tumor at the dome of the bladder, with a diagnostic bladder biopsy revealing a tubule-villous bladder adenoma. Cross-sectional imaging of the chest/abdomen/pelvis revealed a 4.5 cm cystic mass arising from the urachus without evidence of local invasion and metastatic spread. He underwent SP robotic-assisted partial cystectomy with excision of the urachal remnant and bilateral pelvic lymph node dissection. Surgical steps include: 1) peritoneal incision to release the urachus and drop bladder 2) identification of urachal tumor 3) intraoperative live cystoscopic identification of bladder mass and scoring of tumor margins using Toggle Pro feature 4) tumor excision with partial cystectomy 5) cystorrhaphy 6) bilateral pelvic lymph node dissection 7) peritoneal interposition flap to mitigate lymphocele formation. Results: Surgery was successful, with no intraoperative complications, an operative time of 100 minutes, and estimated blood loss of 20 mL. The patient was discharged on post-op day one, and the Foley catheter removed one week after surgery. Final pathology revealed a 7.5 cm infiltrating urachal muscle-invasive adenocarcinoma of the bladder (pT2b). Negative surgical margins were achieved. Conclusions: Single-port robot-assisted partial cystectomy for urachal adenocarcinoma is safe and can achieve equivalent oncologic outcomes to the standard of care with minimally invasive and open techniques.

Robot-assisted ureteral reconstruction - current status and future directions.

Robotic surgery in the treatment in certain urological diseases has become a mainstay. With the increasing use of the robotic platform, some surgeries which were historically performed open have transitioned to a minimally invasive technique. Recently, the robotic approach has become more utilized for ureteral reconstruction. In this article, the authors review the surgical techniques for a number of major ureteral reconstuctive surgeries and briefly discuss the outcomes reported in the literature.

The Digital Footprint of Academic Urologists: Where Do we Stand?

OBJECTIVE: To characterize the digital footprint of academic urologists by examining their web search results and identifying patterns within them. MATERIALS AND METHODS: Faculty lists were obtained from the top 10 ranked Urology residency program websites. A standardized Google search for "First Name Last Name Degree" was then completed for each staff physician. The total number of results and type of sites returned were recorded and patterns contained within identified. RESULTS: A total of 247 staff physicians were identified, with 13-36 per institution. A median of 11 (interquartile range: 10-12) search results returned for each person. Most (number = 231) staff had at least 1 rating site returned, with a mean of 3.50 (standard deviation: 1.45) noted. Overall, 3.44 (1.39) pages related to the practice were listed. Social media use was poorly visible, with a median 0 [0-1] results listed and only 7 Twitter accounts observed. More than half of sites, 6.34 (1.87) on average, were physician-controllable content. Having certain types of results was significantly associated with fewer ratings sites. Having an additional degree was also associated with significantly fewer ratings sites and more sites with physician-controllable content. CONCLUSION: The digital footprint of academic urologists contains more physician-controllable content than noncontrollable information; however, social media visibility in this group is poor. Optimization of the digital identity of academic urologists may be possible by exploiting the patterns observed in this study.

Risk factors for infectious readmissions following radical cystectomy: results from a prospective multicenter dataset.

INTRODUCTION: Radical cystectomy (RC) is the gold standard treatment for muscle-invasive bladder cancer. This procedure has a high rate of perioperative complications, many of which are infectious in nature. The objective of our study was to evaluate demographic, intrinsic and extrinsic patient variables associated with developing readmission within 30 days due to infectious complications following RC. METHODS: We acquired data available from the American College of Surgeons National Surgical Quality Improvement Program. We queried this dataset to identify all patients who underwent RC for muscle-invasive malignant disease (CPT 188.x) in 2012 based on CPT coding. Logistic regression analysis was used to investigate the relationship between preoperative variables and readmissions for infectious complications. RESULTS: Of the 961 patients undergoing cystectomy for malignancy, 159 (17%) required readmission for any indications at a median of 16 days (interquartile range 13-22 days) postoperatively. We identified 71 of a total of 159 (45%) readmissions, which were due to infectious complications. Smoking was more prevalent in the patient population readmitted for an infectious complication compared with the patient population readmitted for a non-infectious complication (37% versus 25%; p = 0.03). Using logistic regression analysis smoking was associated with a significant risk for readmission due to an infectious cause (odds ratio 2.28, 95% confidence interval 1.82-2.97, p = 0.02). Readmission due to an infectious etiology was not associated with other perioperative factors including type of urinary diversion, sex, duration of operation, hypertension, or recent weight loss. CONCLUSION: Readmission following RC is a common occurrence and infectious complications drive readmission in almost half of the cases. Current smoking was the only independent risk factor for an infectious readmission. Counseling patients in smoking cessation prior to the procedure may provide an avenue for quality improvement to limit readmissions.