Biochemical recurrence after robot-assisted extended pelvic lymphadenectomy for prostate cancer.

INTRODUCTION: Extended lymph node dissection (ELND) compared to limited lymph node dissection (LLND) at time of prostatectomy improves staging and lymph node (LN) yield. The effect on biochemical recurrence (BCR) and survival is less well understood. We sought to evaluate the benefit of robotic ELND and LLND with respect to BCR. MATERIALS AND METHODS: Between 2008-2012, 584 consecutive men with intermediate or high risk clinically localized adenocarcinoma of the prostate underwent robotic assisted radical prostatectomy (RARP) with concomitant LLND (n = 326) or ELND (n = 258). Survival estimates were made using the Kaplan-Meier method. Log-rank statistic was used for comparison of curves. BCR predictors were determined with multivariable Cox regression analysis. Chi-square and Wilcoxon rank-sum tests were used to compare discrete and continuous variables, respectively, across the two groups. RESULTS: Median follow up for ELND and LLND patients was 46 and 54 months, respectively. ELND yielded more LNs (20 versus 6, p < 0.0001) and had higher node positivity (15.1% versus 3.4%, p < 0.0001). BCR free survival (BCRFS) at 3 and 5 years for ELND and LLND was 85% and 75% (p = 0.01), and 76% and 67% (p = 0.10), respectively. In subgroup analysis, ELND was associated with higher 5 year BCRFS in node-negative patients (84% versus 68%, p = 0.0005) and in intermediate risk patients (93% versus 80%, p = 0.0002). In multivariable analysis, ELND was a significant predictor of BCRFS in node-negative (HR = 0.50, p = 0.003) and intermediate risk patients (HR = 0.54, p = 0.03). CONCLUSIONS: ELND improves LN yield and detection of positive nodes. BCR analysis suggests a reduced risk of PSA failure for robotic ELND in intermediate risk and node-negative patients.

An Analysis of Google Trends During COVID-19: Determining Public Urological Cancer Concerns.

Background The COVID-19 pandemic put a massive strain on the healthcare system as patients avoided the hospital, elective cases were postponed, and general medical anxiety was increased. We aimed to capture public interest in urological cancers during this massive shock to the medical field. Methodology A total of 12 keywords related to the three most prevalent urological cancers (prostate, bladder, and kidney) were searched using Google Trends from 2018 to 2022. The search volume index of these 12 keywords was extracted to assess public interest before and after the pandemic. Results There was a reduction in search volume for "prostate, bladder, and kidney cancer" and "kidney cancer treatment" after the postponement of elective surgeries. However, there was an increase in search volume for "prostate, bladder, and kidney cancer survival rates" and "prostate cancer symptoms" after this period. There was no change in search volume for bladder cancer symptoms, bladder cancer treatment, or kidney cancer symptoms. Conclusions Public interest in urological cancers decreased after COVID, while interest in survival rates across all three cancers increased. Future research is needed to investigate the effects of changing priorities and delays in medical care on patients' experiences with urological cancers.

Robotic-Assisted Urologic Surgery in Infants: Positioning, Trocar Placement, and Physiological Considerations.

Pediatric robotic-assisted laparoscopic procedures are becoming increasingly common. They have been shown to be safe in younger patients, including infants. Successful adoption of robotic-assisted surgery in infants requires an understanding of the technical factors unique to this patient population. This review will delineate the specific considerations to safely perform robotic-assisted laparoscopic procedures in infants, including physiological changes associated with pneumoperitoneum in infants, positioning, trocar placement, and docking.

Critical Analysis of Hospital Readmission and Cost Burden After Robot-Assisted Radical Cystectomy.

OBJECTIVE: To examine the occurrence and cost burden of hospital readmission within 90 days of robot-assisted radical cystectomy (RARC). Subjects/Patients (or Materials) and Methods: From 2003 to 2012, 247 patients underwent RARC with extracorporeal urinary reconstruction at a single categorical cancer hospital. Continent diversions were performed in 67% of patients. All readmissions within 90 days were included. Readmissions were defined as early (<30 days) and late (31-90 days) with multiple readmissions captured as separate events. Cost analysis was performed using average direct hospital cost. The Fisher exact test was used to determine differences in proportion of readmissions between patient groups, while logistic regression was used to identify predictors for readmission. RESULTS: Ninety-eight (40%) patients were readmitted to the hospital at least once within 90 days after RARC, of which 77% occurred within 30 days. Twenty-seven (11%) required two or more readmissions. Readmissions took place at a median of 13 days after initial discharge. The most common reasons for initial readmission were infections (41%) and dehydration (19%). Stratified by urinary reconstruction type, ileal conduit (dehydration), Indiana pouch (urinary-tract infection without sepsis), and Studer neobladder (sepsis and pelvic abscess) differed by readmission reason. In a multivariable analysis, estimated blood loss was a predictor for readmission (p = 0.05). Patients readmitted to the hospital had direct costs that were 1.42× those who did not require readmission. Readmissions for ileus contributed to the highest cost of readmission, although ureteral stricture, pelvic abscess, and sepsis were the most costly per day of hospitalization. Limitations include retrospective analysis as well as variable thresholds for readmission and costs. CONCLUSIONS: Hospital readmission rates after RARC are high and costs of readmission are significant. Most patients are readmitted within 30 days and infection and dehydration are common causes. Clinicians should be aware of diversion-specific readmission causes.