Minerva Urology and Nephrology最新文献

Minimally invasive surgery like robotic surgery is known to yield better outcomes in terms of blood loss, blood transfusion, and length of stay, and robot-assisted radical prostatectomy provides a clear example compared to open surgery. It is still constrained by issues related to platform availability and cost-effectiveness. Introducing new robotic platforms, such as the HUGO^™ Robot-Assisted Surgery (RAS) System, could lead to longer operating times caused by the surgeon's learning curve, system configuration, adjustment of robotic devices, and robotic docking. Several studies have assessed the influence of resident physicians on outcomes in urological surgeries. Our main objective was to evaluate the learning curve of the docking time for 195 radical prostatectomies performed in our hospital. The results of our research indicate that the setup and docking process with the HUGO RAS system can be accomplished with ease, and the learning curve for robotic docking is consistent with the available data for other robotic platforms. Our training facilitated a rapid docking process and seamless completion of the surgery.

Background: The aim of this study was to describe the technique and initial outcomes of robot-assisted T-plasty for recalcitrant bladder neck stenosis.

Methods: Patients who underwent robot-assisted T-plasty for recalcitrant bladder neck stenosis in a single center were included. Presence of bladder neck stenosis was preoperatively confirmed by the combination of retrograde urethrography with voiding cysto-urethrography and flexible urethroscopy. Follow-up visits were performed with history taking, uroflowmetry and echographic residual urine measurement. Complications were graded according to the Clavien-Dindo classification. Patients without urinary symptoms and with a maximum uroflow of no less than 15mL/s were considered as successfully treated. Otherwise, cystoscopy would be performed, and recurrence was defined as the inability to pass a 14 French cystoscope through the bladder neck.

Results: Since 2018, seven patients were treated. The etiologies were transurethral resection of the prostate and simple prostatectomy in respectively 6 patients and 1 patient. Cystoscopy was able to diagnose bladder neck stenosis in all cases whereas urethrography was equivocal in 3 out of 7 cases. Median (range) age at surgery was 60 (54-75) years, and median number of prior endoscopic treatment for bladder neck stenosis was 3 (1-16). The median operative time was 123 (110-159) minutes. No intraoperative complications were reported. Three patients suffered a grade 2 complication. After a median follow-up of 27 (4-74) months, the recurrence-free rate was 100% with no evidence of de-novo incontinence or erectile dysfunction.

Conclusions: In our series, robot-assisted T-plasty suggests positive and safe outcomes in treating recalcitrant bladder neck stenosis with a good patency rate and low incontinence rate. Additionally, cystoscopy is reliable in the diagnosis of patients with inconclusive urethrography results.

Background: Urethral stricture is an abnormal narrowing of the urethra and occurs in anterior urethra for 92% of cases. Although open surgery is considered the gold standard for this type of disease, endoscopic procedures are the most commonly used. The Optilume^® Drug Coated Balloon (DCB) (Urotronic, Inc., Plymouth, MN, USA) is the first DCB intended for the treatment of male urethral strictures. Here we report the results of a multicenter Italian real-life study.

Methods: We collected data from nine Italian centers. Patients with urethral strictures or bladder neck stricture were treated with the Optilume^© DCB. We evaluated variation in IPSS, QoL and IIEF5 score, QMax, PVR, and freedom from repeat intervention.

Results: Overall, 130 subjects were treated; median follow-up was six months. Mean age and prostate volume were 64 and 45 mL. Total median operative time was 15 minutes whereas the median time of Optilume application was 7 minutes. IPSS and QoL changed from a mean of 24 and 4 points at baseline to 10 and 1 points respectively at the last follow-up (P<0.001). We have also recorded a significant improvement in Qmax and PVR from 8 mL/s and 100 mL at baseline to 17.8 mL/s and 0 mL at the last follow-up (P<0.001). Intra and post operative not serious complications occurred in 3 and 10 patients, respectively. Six patients underwent reoperation during follow-up.

Conclusions: In our experience, the Optilume^© represents a valid option in the management of patients with urethral stricture, with or without previous surgery.