Urinary Recovery Research Articles

#5535 CALCIUM EXCRETION FRACTION AS AN EMERGING PARAMETER FOR AN ACCURATE DIFFERENTIAL DIAGNOSIS OF ACUTE KIDNEY INJURY

Abstract Background and Aims Urinary parameter determination is an essential tool for differentiating acute kidney injury (AKI) etiology. The most used ion in clinical practice is sodium (and its excretion fraction, NaEF), followed by urea (UreaEF) (that is useful in certain circumstances such as diuretic treatment). However, tubular transport includes other anions and cations that have not been widely studied. In the present study, we aim to evaluate the relation between AKI etiology (i.e. functional vs acute tubular necrosis) and calcium excretion fraction (CaEF). Method This is a transversal study including consecutive patients with diagnosis of AKI. Patients with suspicion of non-functional or ATN etiology (such as those with proteinuria, hematuria) were excluded. At admission, we collected epidemiological data, comorbidities and active treatments. AKI etiology was determined based on urinary parameters (sodium, urea) and recovery pattern of kidney function after treatment instauration. We compared CaEF in patients with ATN and functional AKI in the whole sample and among patients with and without previous CKD and diuretic prescription. Results We included 94 AKI episodes (55% female, 76±15 years). Forty-five (48%) patients had chronic kidney disease (CKD) at baseline and 56 (60%) were receiving treatment with diuretics. Of the 94 AKI, 78 (83%) presented a functional etiology and 16 (17%) were catalogued as ATN. Median CaEF was 1.09 (0.63-2.58) %. CaEF was associated to the etiology of AKI. In patients with functional AKI, median of CaEF was 0.95 (0.60-1.84) % in contrast to ATN (2.33 [1.22-7.27] %)(p<0.001). CaEF presented a positive and significant correlation to NaEF (ρ 0.574, p<0.001) and UreaEF (ρ 0.409, p<0.001). An adjusted regression model including the presence of CKD at baseline and diuretic treatment showed that CaEF independently predicted ATN (OR per 1% increase 1.42, 95%CI [1.16-1.75), p<0.001]. In patients without CKD, CaEF predicted ATN (OR 1.61, 95%CI [1.13-2.28], p = 0.008), in contrast to the cohort with CKD where only a trend was demonstrated (OR 1.29, 95%CI [0.99-1.69], p = 0.057) (Figure 1). CaEF also predicted ATN irrespective of the diuretic prescription at baseline (OR 1.35, 95%CI [1.05-1.74], p = 0.018 for diuretic users and OR 1.57, 95%CI [1.06-2.32], p = 0.025 for non-diuretic users) (Figure 1). Receiving operator curves (ROC) demonstrated a 0,712 area under the curve (AUC) of CaEF >1.6% for ATN, that was the best value for diagnosis in terms of sensitivity and specificity. CaEF>1,6% predicted ATN (OR 8.09, 95%CI [2.32-28.2], p = 0.001) after adjusting for the presence of CKD at baseline and diuretic treatment. Conclusion CaEF could help in the identification of the AKI etiology as higher values (i.e. >1.6%) are independently associated with ATN.

THE IMPORTANCE OF URINE RECOVERY FROM MUNICIPAL WASTEWATER

Urine contains a high concentration of nutrients that could increase water pollution and corrosion in the sewerage system. Along with the decrease in global phosphorus reserves, this condition may aggravate the worldwide population’s vulnerability in food security, drinking water, sanitation, and hygiene. This paper aims to gain more knowledge on the importance of urine recovery from municipal wastewater. The previous implementation of the urine separation system, the importance of urine diversion, the potential product, and technologies for urine recovery was briefly described. Overall, urine diversion is expected to address those environmental problems by reducing water pollution and organic loading in wastewater treatment plants, providing valuable nutrients for agricultural production, and lessening the economic cost of improper sanitation.

86 - Correlation between urinary continence recovery and length of spared urethra after robotic radical prostatectomy: A prospective multi centre study

86 - Correlation between urinary continence recovery and length of spared urethra after robotic radical prostatectomy: A prospective multi centre study

Visual Analogue Scale and Expanded Prostate Cancer Index Composite-26 in the Evaluation of Urinary Continence Recovery After Three-Dimensional Laparoscopic Radical Prostatectomy, a Single-Center Prospective Registered Study

To assess the correlation between the Visual Analogue Scale (VAS) and the Expanded Prostate Cancer Index Composite (EPIC)-26 in the evaluation of urinary continence (UC) recovery after 3-dimensional laparoscopic radical prostatectomy (3D-LRP). 105 men underwent 3D-LRP in Seinäjoki Central Hospital Finland between November 2018 and February 2021. VAS forms and EPIC-26 questionnaires were used to assess UC preoperatively and at 6 weeks, 3-, 6-, 9-, 12-, 15-, 18-, 21-, and 24 months postoperatively. On the VAS form, the patient put a mark on the 10cm long horizontal line in place, which described his experienced degree of UC (0cm; fully incontinent-10cm; fully continent). The scores for the urinary incontinence domain of EPIC-26 (UI-EPIC-26) were calculated and transformed to a scale of 0-100. Spearman´s rank correlation coefficient was used to evaluate the correlation between the VAS and UI-EPIC-26. A total of 915 VAS forms and 909 EPIC-26 questionnaires were evaluable. UC improved significantly during the first year but not after that. The medians for UI-EPIC-26 and VAS were 50.8 (0-100) and 7.2cm (0-10cm) at 3 months, 76.8 (14.5-100) and 8.7cm (1.7-10cm) at 12 months and 79.6 (8.25-100) and 9.0cm (2.7-10cm) at 24 months. The correlation coefficient (95% confidence interval) between VAS and UI-EPIC-26 preoperatively, at 12 months and at 24 months was 0.639 (0.505-0.743), 0.807 (0.716-0.871), and 0.831 (0.735-0.894), respectively (P<0.001). The VAS can be utilized as an easy-to-use alternative to the EPIC-26 when evaluating UC recovery after 3D-LRP.

Holmium Laser Enucleation of the Prostate Is Associated with Complications and Sequelae Even in the Hands of an Experienced Surgeon Following Completion of the Learning Curve

BackgroundHolmium laser enucleation of the prostate (HoLEP) is considered a challenging procedure even for surgeons who have completed the learning curve. ObjectivesTo assess outcomes and complications following HoLEP performed by a highly experienced surgeon. Design, setting, and participantsThis was a single-institution prospective study (NCT03583034) performed at a tertiary referral centre that included 243 consecutive patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) treated with HoLEP by a single experienced surgeon (>1600 cases). Outcome measurements and statistical analysisPatients were assessed using validated questionnaires and uroflowmetry at baseline and several follow-up dates. Intraoperative and postoperative complications were recorded. Kaplan-Meier analysis was used to estimate recovery rates for urinary continence and erectile function. Logistic regression models were constructed to assess predictors of postoperative complications. Results and limitationsOf the 243 patients, 78 (32.1%) had an indwelling urethral catheter. The median prostate volume (PV) was 87 cm3 (interquartile range 60–115) and 146 patients (59.8%) had PV >80 cm3. At 3-mo follow-up, 219 patients (90.1%) had a peak flow rate >20 ml/s and 182 (74.9%) had no postvoid residual urine. The improvement in subjective symptoms was significant at 1-mo follow-up and was maintained until 12 mo after surgery. Urinary continence recovery was slow, with an estimated rate of 68% (95% confidence interval [CI] 62–74%) at 1 mo and 94% (95% CI 91–97%) at 12 mo after HoLEP. The recovery rate for erectile function was 53% (95% CI 46–61%) at 1 mo and 85% (95% CI 77–90%) at 12 mo. Postoperative complications occurred in 36 patients (14.8%) during their hospital stay, in 34 (14%) within 1 mo following discharge from hospital, and in ten (4.1%) at later follow-up dates. Clinically significant complications (Clavien-Dindo ≥2) were observed in 44 cases (18%) and were more common for patients with an indwelling catheter at baseline (odds ratio 5.05; p = 0.006). ConclusionsHoLEP is an effective procedure for treating LUTS due to BPE, although it is not devoid of complications and sequelae, even in the hands of a highly experienced surgeon. Patient summaryHolmium laser treatment of the prostate to reduce its size has positive results for urinary function when performed by an experienced surgeon, even in complex cases, although there can be complications.

Accelerated rehabilitation after hysterectomy in reproductive age patients

Background and aims. The principles of enhanced recovery in operative gynecology, comorbidity, and a multimodal approach in perioperative support require comprehensive study and optimization, and the ambiguity of literature reports determines the relevance of this study. The aim of this study was to evaluate the parameters of perioperative monitoring after hysterectomy for uterine leiomyoma in patients of reproductive age using enhanced recovery after surgery protocols and their impact on quality of life indicators. Materials and methods. To evaluate the effectiveness of the enhanced recovery protocol after hysterectomy, two groups were formed: the main prospective group, which included 46 patients, who underwent vaginal hysterectomy without appendages and 36 patients with abdominal hysterectomy, who used enhanced recovery after surgery (ERAS) protocols. The comparison group (group of standard management) included 44 patients who underwent vaginal hysterectomy without appendages and 34 patients with abdominal hysterectomy. The main parameters of monitoring were the postoperative pain level, intraoperative blood loss, diuresis rate, the timing of urinary catheter removal and recovery of peristalsis, as well as individual activation of motor activity. Results. When using the principles of ERAS, the quantitative assessment of pain level (“absence of pain”) was 1.6 times more severe compared to the data of the comparison group; the timing of urinary catheter removal was 2.0 times shorter, drain removal – 2.7 times shorter, recovery of peristalsis – 1.9 times shorter and individual activation of motor activity – 2.9 times earlier than in patients of the comparison group. Conclusions. Studies have demonstrated the feasibility of using laparoscopic technology in combination with the ERAS, which demonstrates a fall in the volume of intraoperative blood loss, a decrease in blood and fluid balance, a shortening of the time of invasive intravascular intervention, allows to improve the course of the early postoperative period, relieve postoperative pain syndrome, reduce the risk of intestinal paresis, shorten the rehabilitation period, and, as a result, improve quality of life indicators.

MP80-16 BLACK PATIENTS HAVE WORSE CONTINENCE OUTCOMES AT 12 MONTHS FOLLOWING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP80-16 BLACK PATIENTS HAVE WORSE CONTINENCE OUTCOMES AT 12 MONTHS FOLLOWING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY Findlay MacAskill, Majed Shabbir, Arun Sahai, Cathcart Paul, and Noel Jonathan Findlay MacAskillFindlay MacAskill More articles by this author , Majed ShabbirMajed Shabbir More articles by this author , Arun SahaiArun Sahai More articles by this author , Cathcart PaulCathcart Paul More articles by this author , and Noel JonathanNoel Jonathan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It is known that racial disparities exist for oncological outcomes following prostate cancer, with black patients having a higher mortality. There remains a paucity of specific data regarding functional outcomes and ethnicity in robotic-assisted radical prostatectomy (RARP). The aim of this study was to investigate if racial disparity exists in outcomes following RARP at our institution, which covers a diverse population. METHODS: This single site study utilised an institution approved (10128) prospective database of patients that underwent primary RARP from 2020-2021 with a minimum follow up of 12 months. All 5 surgeons perform a retropubic approach. Logistic regression was performed to investigate the continence rate at 3, 6 and 12 months for significance (p<0.05). Continence is defined as 0 pads/24 hours. Further analysis was performed using propensity score matching for 12-month continence rate only. RESULTS: In this study, 232 men were included of which 37% (86) were black. On average black men underwent surgery at a younger age (59 versus 63 year). However, no difference was observed between black and white men for mean prostate volume, ISUP grade or T stage. While difference in urinary continence recovery was not significant at 3 months (36% versus 52%) and 6 months (49% versus 63%), recovery of urinary continence recovery was inferior for black men at 12 months after surgery (57% versus 75%, p=0.01). After propensity score matching, 95 white and 95 black patients were evaluated. Mean age was 61 (44-67) and 59 (43-73) years, ISUP grade 2.55 and 2.6, MRI 39 (16-112) and 28 (12-112) cc for white and black patients, respectively. Continence rate at 12 months was 76% and 60% (p=0.02), for respectively. CONCLUSIONS: The study demonstrates a racial disparity for return of urinary continence following robotic-assisted laparoscopic prostatectomy with black men having inferior recovery of urinary continence. Further work is required to investigate the reasons for the different outcome. Source of Funding: FM, MS and AS have received an unrestricted educational grant from Boston Scientific © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1159 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Findlay MacAskill More articles by this author Majed Shabbir More articles by this author Arun Sahai More articles by this author Cathcart Paul More articles by this author Noel Jonathan More articles by this author Expand All Advertisement PDF downloadLoading ...

MP61-11 RETZIUS-SPARING ROBOT-ASSISTED RADICAL PROSTATECTOMY AFTER PREVIOUS TRANS-URETHRAL RESECTION OF THE PROSTATE: ASSESSMENT OF FUNCTIONAL AND ONCOLOGICAL OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023MP61-11 RETZIUS-SPARING ROBOT-ASSISTED RADICAL PROSTATECTOMY AFTER PREVIOUS TRANS-URETHRAL RESECTION OF THE PROSTATE: ASSESSMENT OF FUNCTIONAL AND ONCOLOGICAL OUTCOMES Stefano Tappero, Enrico Vecchio, Erika Palagonia, Giorgia Granelli, Marco Martiriggiano, Ofir Maltzman, Alberto Olivero, Silvia Secco, Aldo Massimo Bocciardi, Antonio Galfano, and Paolo Dell'oglio Stefano TapperoStefano Tappero More articles by this author , Enrico VecchioEnrico Vecchio More articles by this author , Erika PalagoniaErika Palagonia More articles by this author , Giorgia GranelliGiorgia Granelli More articles by this author , Marco MartiriggianoMarco Martiriggiano More articles by this author , Ofir MaltzmanOfir Maltzman More articles by this author , Alberto OliveroAlberto Olivero More articles by this author , Silvia SeccoSilvia Secco More articles by this author , Aldo Massimo BocciardiAldo Massimo Bocciardi More articles by this author , Antonio GalfanoAntonio Galfano More articles by this author , and Paolo Dell'oglioPaolo Dell'oglio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To date, no data exist concerning functional and oncological outcomes of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) in patients previously treated with trans-urethral resection of the prostate (p-TURP) for benign prostate obstruction. The current study aimed to address the impact of p-TURP on immediate and 12-months urinary continence recovery (UCR), as well as perioperative outcomes and surgical margins after RS-RARP. METHODS: Patients treated with RS-RARP for prostate cancer at a single high-volume European institution were identified and stratified according to p-TURP. Intraoperative and postoperative complications were reported according to EAU guidelines standardized methodology. Univariable and multivariable logistic, Poisson log-linear and Cox regression models were performed. RESULTS: Of 1,386 RS-RARP patients, 99 (7%) had history of p-TURP. According to EAU intraoperative adverse events classification (EAUiaiC), the most common intraoperative complications were EAUiaiC grade 1 (n=26/31, 84%). The most common postoperative complications were Clavien-Dindo grade 2 (n=67/174, 39%), and the most common reason of readmission was infected lymphocele (n=8/16, 50%). Between p-TURP and no-TURP patients no differences were detected in terms of rates of intraoperative complications (2 vs 2%), in-hospital postoperative complications (12 vs 11%), and readmissions (1 vs 1%; all p values≥0.8). At catheter removal, the rates of immediate UCR were 40 vs 67% in p-TURP vs no-TURP patients (p<0.001). At 12 months from RS-RARP, the rates of UCR were 68 vs 94% in p-TURP vs no-TURP patients (p<0.001). At multivariable logistic and Cox regression models, p-TURP was independently associated, respectively, with lower immediate (odds ratio [OR]: 0.32, p<0.001) and 12-months UCR (hazard ratio: 0.54, p<0.001). At multivariable Poisson analyses, p-TURP predicted longer operative time (rate ratio: 1.08, p<0.001) but not longer length of stay or time to catheter removal (p values>0.05). Positive surgical margins rates were 23 vs 17% in p-TURP vs no-TURP patients (p=0.1), which translated in a non significant multivariable OR of 1.14 (p=0.58). CONCLUSIONS: RS-RARP in patients with history of TURP for BPO may be longer and associated with worse urinary continence recovery both at bladder catheter removal and at subsequent time-points. In the current series, p-TURP patients harbored low complication rates, and surgical margins rates comparable to their no-TURP counterparts. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e856 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stefano Tappero More articles by this author Enrico Vecchio More articles by this author Erika Palagonia More articles by this author Giorgia Granelli More articles by this author Marco Martiriggiano More articles by this author Ofir Maltzman More articles by this author Alberto Olivero More articles by this author Silvia Secco More articles by this author Aldo Massimo Bocciardi More articles by this author Antonio Galfano More articles by this author Paolo Dell'oglio More articles by this author Expand All Advertisement PDF downloadLoading ...

MP68-18 END TO END ASSESSMENT OF SUTURING EXPERTISE (EASE) IN VIRTUAL REALITY SURGICAL SIMULATION WITH ASSOCIATED CLINICAL OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023MP68-18 END TO END ASSESSMENT OF SUTURING EXPERTISE (EASE) IN VIRTUAL REALITY SURGICAL SIMULATION WITH ASSOCIATED CLINICAL OUTCOMES Timothy N. Chu, Runzhuo Ma, Alvin Hui, Oscar Gomez, Cherine H. Yang, Istabraq S. Dalieh, Elyssa Y. Wong, Ahmed Ghazi, John W. Davis, Brian J. Miles, Clayton Lau, and Andrew J. Hung Timothy N. ChuTimothy N. Chu More articles by this author , Runzhuo MaRunzhuo Ma More articles by this author , Alvin HuiAlvin Hui More articles by this author , Oscar GomezOscar Gomez More articles by this author , Cherine H. YangCherine H. Yang More articles by this author , Istabraq S. DaliehIstabraq S. Dalieh More articles by this author , Elyssa Y. WongElyssa Y. Wong More articles by this author , Ahmed GhaziAhmed Ghazi More articles by this author , John W. DavisJohn W. Davis More articles by this author , Brian J. MilesBrian J. Miles More articles by this author , Clayton LauClayton Lau More articles by this author , and Andrew J. HungAndrew J. Hung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003331.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Virtual reality (VR) provides a standardized setting for surgical skill assessment but currently lacks high-level multi-institutional evidence to validate the predictive value of VR. We have previously developed a granular suturing assessment tool (EASE), which can accurately distinguish surgeon experience in live surgery. This present study aims to further validate EASE in a VR environment and evaluate the utility of VR as a tool to predict clinical outcomes. METHODS: 21 surgeons in this prospective five-center study completed VR simulation suturing exercises on the Surgical Science™ Flex VR simulator (Fig 1A). 5 independent and blinded graders received standardized training and provided technical skill assessment for VR using EASE. EASE was adapted to be relevant for a simulated environment (EASE-VR). Inter-rater reliability was measured using prevalence-adjusted bias-adjusted kappa (PABAK) with agreement >0.6 in all graded subskills. Expert (>100 robotic cases) and trainee (<100 cases) scores were compared using generalized estimating equation. Correlations for expert surgeon EASE-VR scores and post-surgical clinical outcomes were calculated using Cox regression while controlling for patient factors (age, BMI, preoperative PSA, biopsy Gleason Score, pathological tumor stage). RESULTS: 7 trainees (median caseload 60, range 0-80) and 14 expert surgeons (1500, range 275-3000) participated in this study. In VR, experts had significantly better Needle Handling (hold anglep=0.048) and Needle Driving (wrist rotation p=0.014) scores compared to trainees. There were no statistically significant differences in all other domains (p>0.05). For expert surgeons, Needle Driving (wrist rotation) was not significantly associated with urinary continence recovery. Expert Needle Handling (hold angle) scores were found to have a significant positive association with urinary continence recovery (Hazard Ratio 2.11, 95% Confidence Interval 1.44-3.09, p<0.001) (Fig 1B). CONCLUSIONS: EASE-VR can distinguish surgical experience in VR simulation exercises. Our results suggest that expert surgeon EASE-VR scores have positive association with post-surgical clinical outcomes. Source of Funding: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R01CA251579. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e960 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Timothy N. Chu More articles by this author Runzhuo Ma More articles by this author Alvin Hui More articles by this author Oscar Gomez More articles by this author Cherine H. Yang More articles by this author Istabraq S. Dalieh More articles by this author Elyssa Y. Wong More articles by this author Ahmed Ghazi More articles by this author John W. Davis More articles by this author Brian J. Miles More articles by this author Clayton Lau More articles by this author Andrew J. Hung More articles by this author Expand All Advertisement PDF downloadLoading ...

MP67-08 SURGICAL OUTCOMES OF ROBOT-ASSISTED RADICAL PROSTATECTOMY WITH THE NOVEL "HUGO" ROBOTIC SYSTEM: INITIAL 100 CASES PERFORMED AT A TERTIARY REFERRAL ROBOTIC CENTER CENTER

You have accessJournal of UrologyCME1 Apr 2023MP67-08 SURGICAL OUTCOMES OF ROBOT-ASSISTED RADICAL PROSTATECTOMY WITH THE NOVEL "HUGO" ROBOTIC SYSTEM: INITIAL 100 CASES PERFORMED AT A TERTIARY REFERRAL ROBOTIC CENTER CENTER Marco Paciotti, Carlo Bravi, Angelo Mottaran, Adele Piro, Luca Sarchi, Maria Peraire Lores, Eleonora Balestrazzi, Luigi Nocera, Federico Piramide, Ruben De Groote, Geert De Naeyer, Frederiek D'Hondt, and Alexandre Mottrie Marco PaciottiMarco Paciotti More articles by this author , Carlo BraviCarlo Bravi More articles by this author , Angelo MottaranAngelo Mottaran More articles by this author , Adele PiroAdele Piro More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Maria Peraire LoresMaria Peraire Lores More articles by this author , Eleonora BalestrazziEleonora Balestrazzi More articles by this author , Luigi NoceraLuigi Nocera More articles by this author , Federico PiramideFederico Piramide More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , Frederiek D'HondtFrederiek D'Hondt More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003330.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: HUGO Robot-Assisted Surgery (RAS) system (Medtronic©, USA) has recently received CE mark approval for urological procedures. Herein, we described clinical outcomes of the first case series of robot-assisted radical prostatectomy (RARP) with the HUGO RAS system. METHODS: We analyzed data of 107 patients who received RARP±extended pelvic lymph-node dissection (ePLND) at OLV hospital (Aalst, Belgium). All procedures were performed by experienced robotic surgeons. We described peri-, post-operative and functional outcomes. Final pathology results were available for 100 patients. Continence was defined as the use of no/one safety pad. RESULTS: Median (interquartile range [IQR]) age was 65 (60, 70) years. Median (IQR) preoperative PSA level was 7.8 (5.6, 10.2) ng/ml. A total of 36 (34%) patients had International Society of Urologic Pathology (ISUP) group 3-5 tumors on prostate biopsy. On preoperative MRI, median (IQR) prostate volume was 40 (32, 55) ml, and twenty patients (19%) had a suspicion of extra-prostatic disease. All twelve validated steps of the procedure were completed, with no need for conversion or for additional ports placement. 28 (26%) patients received an ePLND. No intraoperative complication was recorded. Median (IQR) operative and console time were 180 (140, 200) and 150 (110, 180) minutes, respectively. Median (IQR) estimated blood loss was 450 (250, 550) ml. Median (IQR) postoperative day of removal of urethral catheter was 2 (2, 2) days. After surgery, one patient experienced an acute urinary retention that was treated with re-catheterization. Two patients had a Clavien-Dindo ≥2 postoperative complications. Median (IQR) length of stay was 3 (3, 4) days. On final pathology, 42 (42%) and 28 (28%) patients had ISUP group 3-5 tumors and evidence of extraprostatic extension, respectively. A total of 8 (8%) patients had positive surgical margins. A total of 77 and 45 patients had available data on urinary continence recovery at one and three months after surgery, respectively. One month after surgery, 49/77 (64%) patients were continent, whereas 41/45 (91%) recovered urinary continence 3 months after surgery. CONCLUSIONS: In this clinical investigation, we showed that RARP performed with the novel HUGO RAS system achieves optimal oncologic and functional outcomes. Further, multi-centric data are awaited to confirm these findings at longer follow-up, with respect to biochemical recurrence and erectile function recovery after surgery. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e946 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marco Paciotti More articles by this author Carlo Bravi More articles by this author Angelo Mottaran More articles by this author Adele Piro More articles by this author Luca Sarchi More articles by this author Maria Peraire Lores More articles by this author Eleonora Balestrazzi More articles by this author Luigi Nocera More articles by this author Federico Piramide More articles by this author Ruben De Groote More articles by this author Geert De Naeyer More articles by this author Frederiek D'Hondt More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement PDF downloadLoading ...

MP46-13 ROBOT-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL PADUA ILEAL NEOBLADDER: LONG-TERM FUNCTIONAL OUTCOMES AND CONTINENCE PREDICTORS ASSESSMENT FROM A HIGH-VOLUME CENTER LARGE CONSECUTIVE SERIES

You have accessJournal of UrologyCME1 Apr 2023MP46-13 ROBOT-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL PADUA ILEAL NEOBLADDER: LONG-TERM FUNCTIONAL OUTCOMES AND CONTINENCE PREDICTORS ASSESSMENT FROM A HIGH-VOLUME CENTER LARGE CONSECUTIVE SERIES Gabriele Tuderti, Riccardo Mastroianni, Umberto Anceschi, Alfredo Maria Bove, Aldo Brassetti, Mariaconsiglia Ferriero, Leonardo Misuraca, Salvatore Guaglianone, Michele Gallucci, and Giuseppe Simone Gabriele TudertiGabriele Tuderti More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Michele GallucciMichele Gallucci More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Daytime urinary continence recovery following robot assisted radical cystectomy with intracorporeal orthotopic neobladder (RARC-iON) has been poorly investigated. In this study we reported long-term functional outcomes of RARC-iON and assessed the predictors of daytime urinary continence recovery. METHODS: Our single center IRB approved bladder cancer database was queried for “RARC” and “iON”.All patients treated between January 2012 and September 2020, with a minimum 1-yr follow-up were included. Baseline demographic, clinical, perioperative and pathologic data were reported. Functional outcomes included: renal function modification over time, neobladder stone formation, development of uretero-ileal anastomosis strictures, need for self-catheterization and Trifecta achievement (defined as the coexistence of daytime continence, Clavien-Dindo ≥3 complication-free and recurrence-free status, all assessed at 1 year).Day- and night-time continence recovery probabilities were assessed with Kaplan-Meier method; univariable and multivariable analyses were performed to identify predictors of day-time continence. RESULTS: Overall, 192 patients were included, 146 were male (76%).Mean baseline eGFR was 83.5 ml/min (± 23.5). At a median follow- up of 41 months (IQR 21-60), mean last eGFR was 63.8 ml/min (± 22.1).The incidence of significant renal function deterioration (newly onset CKD stage ≥3b) was 16.1%. Neobladder stones were reported in 16 patients (8.3%), all of which successfully treated as outpatient endoscopic procedure. Incidence of ureteroileal anastomosis stricture was 22.4%. Trifecta was achieved in 64.1% of cases. One-yr day- and night-time continence rates were 78.6 % and 48.3 %, respectively. At multivariable analysis age, female gender and severe 30-d complications occurrence were identified as independent predictors of lower day-time continence recovery probabilities. CONCLUSIONS: We reported functional outcomes of a large single center consecutive series of RARC-iON. Male, young and those patients who did not experience severe perioperative complications had significantly higher likelihood of recovering daytime urinary continence. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e636 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gabriele Tuderti More articles by this author Riccardo Mastroianni More articles by this author Umberto Anceschi More articles by this author Alfredo Maria Bove More articles by this author Aldo Brassetti More articles by this author Mariaconsiglia Ferriero More articles by this author Leonardo Misuraca More articles by this author Salvatore Guaglianone More articles by this author Michele Gallucci More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...

MP80-20 FUNCTIONAL OUTCOMES OF LAPAROSCOPIC VS ROBOT-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP80-20 FUNCTIONAL OUTCOMES OF LAPAROSCOPIC VS ROBOT-ASSISTED RADICAL PROSTATECTOMY Marco Paciotti, Luigi Nocera, Carlo Andrea Bravi, Cesare Saitta, Adele Piro, Luca Sarchi, Roberto Contieri, Mottaran Angelo, Maria Peraire Lores, Eleonora Balestrazzi, Federico Piramide, Ruben De Groote, Geert De Naeyer, Paolo Casale, Rozzano, Giovanni Lughezzani, Alexandre Mottrie, and Nicolò Maria Buffi Marco PaciottiMarco Paciotti More articles by this author , Luigi NoceraLuigi Nocera More articles by this author , Carlo Andrea BraviCarlo Andrea Bravi More articles by this author , Cesare SaittaCesare Saitta More articles by this author , Adele PiroAdele Piro More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Roberto ContieriRoberto Contieri More articles by this author , Mottaran AngeloMottaran Angelo More articles by this author , Maria Peraire LoresMaria Peraire Lores More articles by this author , Eleonora BalestrazziEleonora Balestrazzi More articles by this author , Federico PiramideFederico Piramide More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , Paolo CasalePaolo Casale More articles by this author , Rozzano Rozzano More articles by this author , Giovanni LughezzaniGiovanni Lughezzani More articles by this author , Alexandre MottrieAlexandre Mottrie More articles by this author , and Nicolò Maria BuffiNicolò Maria Buffi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We entered the third decade of the robotic era in prostate cancer (PCa) surgery, and robotic platforms are increasingly spreading worldwide. Robotic surgery is usually believed to facilitate critical steps of the prostatectomy, increasing the precision of the surgical act and optimizing the probability of favorable outcomes. However, strong evidence supporting superiority of robotic vs laparoscopic prostatectomy (LRP) in terms of functional results are still missing. We performed a systematic review (SR) and meta-analysis (MA) to assess the functional outcomes of LRP vs robot-assisted radical prostatectomy (RARP). METHODS: We searched for all the studies comparing LRP and RARP in Medline, Embase, the Cochrane Central Register of Controlled Trials, and abstracts from the AUA and EAU meetings up to October 2022. Results were independently reviewed by two authors following the PRISMA guidelines. A SR+MA were performed. We followed a predefined PICOS approach: (P) patients affected by PCa (I) LRP (C) RARP (O) continence and potency recovery and (S) randomized controlled trials (RCTs). Continence was defined as using no pads or one safety pad per day. Potency was defined either as IIEF-5 score >17 or capability of intercourse. Effect measures for the outcomes were relative risk (RR) and 95% CI. Random-effect models were utilized to report RR. The RoB 2 was used to assess the risk of bias. RESULTS: Three RCTs were included in this SR. A total of 966 patients undergoing RARP for localized PCa were included in the three studies. The number of patients undergoing LRP vs RARP was 60 vs 60, and 586 vs 196, and 64 vs 64 in the #1, #2 and #3 RCT, respectively. Continence recovery and erectile function (EF) at 3 months were the most reported outcomes. Across the three studies, the pooled RR for 3 months continence was 1.15 (1.06-1.24), while the pooled RR for 3 months EF was 1.55 (1.23-1.95), both in favor of robotic surgery (Table 1). Therefore, we found a significant Risk of bias was assessed for all the three studies and determined as follows: “unclear risk of bias”. CONCLUSIONS: This MA found a higher EF and urinary continence recovery rate in patients who underwent RARP vs LRP for localized PCa. Therefore, evidence from RCTs demonstrated that robotic surgery offers a significant advantage in terms of functional outcomes in these patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1161 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marco Paciotti More articles by this author Luigi Nocera More articles by this author Carlo Andrea Bravi More articles by this author Cesare Saitta More articles by this author Adele Piro More articles by this author Luca Sarchi More articles by this author Roberto Contieri More articles by this author Mottaran Angelo More articles by this author Maria Peraire Lores More articles by this author Eleonora Balestrazzi More articles by this author Federico Piramide More articles by this author Ruben De Groote More articles by this author Geert De Naeyer More articles by this author Paolo Casale More articles by this author Rozzano More articles by this author Giovanni Lughezzani More articles by this author Alexandre Mottrie More articles by this author Nicolò Maria Buffi More articles by this author Expand All Advertisement PDF downloadLoading ...

Creatinine recovery from bovine urine under the effect of different times and temperatures of storage.

Creatinine is a urinary marker used widely in ruminant's experimental trials. However, despite its great importance no data were found in the literature about the best way to store bovine urine samples. In the sheep urine, was observed an increase in the urinary concentration of creatinine when it was stored acidified (pH 2.5 to 3.5) at a temperature of 28 to 39 °C for 150 days of storage. Nevertheless, urine should be stored acidified (pH below 3) to avoid purine derivative degradation, So, aimed to evaluate creatinine recovery in bovine urine as a function of storage time and temperature. A total of 25 animals' urine (10 Nellore cattle and 15 Holstein cattle) were collected. The urine (40 mL) was diluted in 160 mL of distilled water and its pH was corrected to a value lower than 3 using sulfuric acid drops. A sample of the diluted urine was analyzed to obtain the creatinine concentration reference value on the collection day. The remaining urine was fractionated and preserved at room temperature, cooled (4 °C) or frozen (-20 °C and -40 °C). In the urine of five Holstein cattle was added creatine solutions (20, 40 and 60 mg/dL) to evaluate the creatine to creatinine conservation. These urine samples were analyzed on different days after collection (1, 3, 7, 15, 30 and 45 days). The urine without any added creatine was analyzed on Days 1, 3, 7, 10, 15, 30, 45, 60, 90, 120, and 150 of storage. The addition of creatine in the urine caused an increase in the creatinine concentration (P < 0.05) after 30 days of storage at room temperature and under refrigeration (4 °C). In frozen samples, there was no change in creatinine concentration (P > 0.05). However, creatinine recovery was constant (P > 0.05) until day 15 of storage, regardless of the temperature used, when creatine was not added. After 30 days of storage, an effect of time and/or temperature was observed on creatinine recovery (P < 0.05). Urine samples can be stored at any temperature for up to 15 days after collection to estimate the creatinine concentration. Samples that need storage times longer than 15 days should be frozen (at -20 °C and -40 °C) to avoid creatinine concentration variation.

Gastrointestinal permeability and inflammatory status of preweaning dairy calves in response to decreasing the ratio of n-6 to n-3 fatty acid in milk replacer

The ratio of n-6 to n-3 fatty acid (FA) is between 2 and 10 times higher in milk replacer (MR) than in whole milk, which may promote inflammation and compromise the integrity of the intestinal epithelium. To evaluate how decreasing the n-6:n-3 FA ratio of MR affects gastrointestinal (GIT) permeability and inflammatory status, 30 dairy calves (2.8 ± 1.06 d of age; mean ± standard deviation) were randomly assigned to be fed an MR with an n-6:n-3 FA ratio of 40:1 (CON; 29.3% crude fat of DM; n = 15) or 6.5:1 (n-3; 29.1% crude fat of DM; n = 15). Calves were fed 7.0 L/d in 2 meals. Calves were weighed and fecal consistency was analyzed weekly. On d 22, calves were administered Cr-EDTA, lactulose, and d-mannitol to assess GIT permeability. Blood and total urine were sequentially collected for 6 and 24 h, respectively, and analyzed for marker content. Whole blood collected 4 h after the meal was subjected to an ex vivo lipopolysaccharide (LPS) challenge to evaluate cytokine secretion from blood cells. Calves were euthanized on d 25 for collection of intestinal tissue samples. Tissue samples were processed to assess FA composition by gas chromatography, histomorphology by bright-field microscopy, and gene expression of tight junction proteins, lipid metabolism enzymes, and immune molecules by real-time quantitative PCR. Data were analyzed using PROC GLIMMIX in SAS (version 9.4, SAS Institute Inc.). Growth performance and fecal consistency were unaffected. Calves fed MR with a lower ratio of n-6 to n-3 FA had 2-fold higher n-3 FA contents and 2-fold lower ratios of n-6 to n-3 FA in proximal jejunum and ileum tissues. Total urinary recovery (0-24 h relative to marker administration) and plasma concentrations of the markers were unaffected. Expression of TJP1 tended to be higher in proximal jejunum tissue and lower in ileum tissue of n-3 calves. The expression of TLR4 and TNFA tended to be higher and CD14 was higher in ileum tissue of n-3 calves. Plasma concentrations of interleukin-4 were decreased in response to the ex vivo LPS challenge in n-3 calves. Histomorphology and GIT permeability were largely unaffected by treatment. Furthermore, the inclusion of linseed and algae oil may promote inflammation, as suggested by greater concentrations of the acute-phase proteins haptoglobin and serum amyloid A postprandially, demonstrating that fat sources should be evaluated for their suitability for MR formulations. Understanding how MR composition affects dairy calf health may improve nutritional strategies on farm.

Эффективность трехмерной системы визуализации при выполнении лапароскопической радикальной простатэктомии.

Introduction. The three-dimensional (3D) imaging during laparoscopic procedures can improve the quality of that surgeries. There is a shortage of publications about the potential benefits of 3D navigation in laparoscopic surgery with urological diseases. Radical prostatectomy (RPE) is known as the gold standard of treatment of localized prostate cancer (PC), and investigation of imaging technologies in laparoscopic surgery in PC patients is a hot topic. Aim. To compare the perioperative outcomes of laparoscopic RPE performed with 3D and two-dimensional (2D) imaging. Materials and methods. We performed retrospective analysis of perioperative outcomes in 146 patients who had undergone radical surgery with localized PC. All the patients were divided into 4 groups by the surgery features: 1) 2D imaging with the technique for neurovascular bundles preservation (TNVBP) (n=52); 2) 2D without TNVBP (n=46); 3) 3D with TNVBP (n=23); 4) 3D without TNVBP (n=25). We assessed operative time, intraoperative blood loss volume (IBLV), duration of the bladder drainage, positive surgical margin (PSM) detection rate, duration of the postoperative inpatient period, urinary continence recovery rate, erectile function recovery (EFR) rate. Results and discussion. In groups 1, 2, 3, 4 the operative time was 171,4±21,1, 168,3±23,2, 98,7±17,3, 92,2±22,2 min, and the IBLV was 294,2±62,1, 281,2±53,2, 144,2±31,7, 148,5±33,0 mL, respectively. PSM detection rate was 1,92±0,11%, 2,17±0,04% in groups 1, 2, while PSM had not been detected in groups 3, 4. In all the participants, duration of the bladder drainage was 5–7 days, and the full recovery of urinary continence was detected at both 6 and 12 months after the surgery. The postoperative inpatient period was 8–10 days in groups 1, 2, and 8–9 days in groups 3, 4. The EFR at 3 months after the surgery was detected in 38,4%, 28,3%, 34.8%, 28.0% of patients, while at 12 months it was detected in 59,6%, 41,3%, 82,6%, 56,0% of patients in groups 1, 2, 3, 4, respectively. Conclusion. We revealed the following features of perioperative period of laparoscopic RPE performed with 3D imaging compared to 2D: 1) the operative time was reduced by 42–45% (р&lt;0,05); 2) the IBLV was reduced by 47–51% (р&lt;0,05); 3) the PSM had not been detected; 4) there was the tendency to the shorter postoperative inpatient period; 5) the EFR rate was increased by 1,3–1,4 times (р&lt;0,05), and the best EFR outcomes were obtained via 3D imaging together with TNVBP. Thus, our study demonstrates the advisability of usage of both 3D imaging and TNVBP during the laparoscopic RPE.

Experience with an innovative surgical approach: 321 cases modified extraperitoneal single-incision robot-assisted laparoscopic radical prostatectomy without dedicated PORT based on Da Vinci SI system.

To summarize surgical experiences with a new modified technique involving extraperitoneal single-incision robot-assisted laparoscopic radical prostatectomy based on Da Vinci SI system by reviewing case data, including follow ups, and to evaluate the safety and clinical efficacy of the surgical procedure. The case data from December 2020 to September 2022 of 321 patients undergoing modified single incision (without dedicated PORT) robotic-assisted laparoscopic radical prostatectomy via an extraperitoneal approach were reviewed. All procedures were performed by the same surgeon at our center. Perioperative data and postoperative urinary control, tumor control, and erectile function recovery were assessed. The immediate, 3-months, 6-months, 12-months, 18-months and 24-months complete urinary control rates were 34.3%, 56.6%, 79.7%, 85.7%, 89.6% and 90.7%, respectively; the 3-months, 6-months, 12-months, 18-months and 24-months biochemical recurrence rates were 3.4%, 5.2%, 9.1%, 21.7% and 30.2%, respectively; and for those with normal preoperative erectile function, the 3-months, 6-months, 12-months, 18-months and 24-months postoperative erectile function recovery rates were 52.2%, 60.0%, 70.7%, 72.2% and 73.9%, respectively. The new modified technique involving extraperitoneal single-incision robotic-assisted laparoscopic radical prostatectomy is safe and feasible. This technique has satisfactory surgical results, and this new method results in satisfactory urinary control, tumor control and recovery of erectile function. In addition, this new method is not limited to specific dedicated access devices, which facilitates its application.

Retzius-sparing robot-assisted radical prostatectomy after previous trans-urethral resection of the prostate: Assessment of functional and oncological outcomes

Backgroundno data exist concerning functional and oncological outcomes of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP), in patients previously treated with trans-urethral resection of the prostate (p-TURP), for benign prostate obstruction. Our study addressed the impact of p-TURP on immediate and 12-months urinary continence recovery (UCR), as well as peri-operative outcomes and surgical margins, after RS-RARP. Methodsall patients treated with RS-RARP for prostate cancer at a single high-volume European institution, between 2010 and 2021, were identified and stratified according to p-TURP status. Logistic, Poisson and Cox regression models were performed. ResultsOf 1386 RS-RARP patients, 99 (7%) had history of p-TURP. Between p-TURP and no-TURP patients no differences were detected regarding both intra- and post-operative complications (p values = 0.9). The rates of immediate UCR were 40 vs 67% in p-TURP vs no-TURP patients (p < 0.001). At 12 months from RS-RARP, the rates of UCR were 68 vs 94% in p-TURP vs no-TURP patients (p < 0.001). At multivariable logistic and Cox regression models, p-TURP was independently associated, respectively, with lower immediate (odds ratio [OR]: 0.32, p < 0.001) and 12-months UCR (hazard ratio: 0.54, p < 0.001). At multivariable Poisson analyses, p-TURP predicted longer operative time (rate ratio: 1.08, p < 0.001) but not longer length of stay or time to catheter removal (p values > 0.05). Positive surgical margins rates were 23 vs 17% in p-TURP vs no-TURP patients (p = 0.1), which translated in a non-statistically significant multivariable OR of 1.14 (p = 0.6). Conclusionsp-TURP does not increase surgical morbidity but portends longer operative time and worse urinary continence after RS-RARP.

R-LESS-RP versus C-LESS-RP: a single-institution retrospective comparative study

This study aimed to compare the peri- and postoperative outcomes of patients treated with conventional versus robot-assisted laparoendoscopic single-site radical prostatectomy (C-LESS-RP vs. R-LESS-RP). Data of patients with prostate cancer (106 who underwent C-LESS-RP, 124 underwent R-LESS-RP) were retrospectively collected and analyzed. All operations were performed by the same surgeon from January 8, 2018, to January 6, 2021, in the same institution. Information on clinical characteristics and perioperative outcomes was obtained from records at the medical institution. Postoperative outcomes were acquired from follow-up. Intergroup differences were retrospectively analyzed and compared. All patients had similar clinical characteristics in meaningful aspects. The perioperative outcomes were better with R-LESS-RP than with C-LESS-RP in terms of operation time (120 min vs. 150 min, p < 0.05), estimated blood loss (17.68 ml vs. 33.68 ml, p < 0.05), and analgesic duration (0 days vs. 1 days, p < 0.05). The drainage tube duration and postoperative stay did not differ significantly between groups. However, R-LESS-RP was more expensive than C-LESS-RP (56559.510 CNY vs. 44818.27 CNY, p < 0.05). The patients who underwent R-LESS-RP had better urinary incontinence recovery and higher European quality of life visual analog scale scores than those who underwent C-LESS-RP. However, no significant intergroup difference was noted in biochemical recurrence. In conclusion, R-LESS-RP could achieve better perioperative outcomes, especially for those skilled surgeons who have mastered C-LESS-RP. Additionally, R-LESS-RP accelerated the recovery from urinary incontinence effectively and presented some benefits in health-related quality of life with additional costs.

Gastrointestinal structure and function of preweaning dairy calves fed a whole milk powder or a milk replacer high in fat

The composition of milk replacer (MR) for calves greatly differs from that of bovine whole milk, which may affect gastrointestinal development of young calves. In this light, the objective of the current study was to compare gastrointestinal tract structure and function in response to feeding liquid diets having a same macronutrient profile (e.g., fat, lactose, protein) in calves in the first month of life. Eighteen male Holstein calves (46.6 ± 5.12 kg; 1.4 ± 0.50 d of age at arrival; mean ± standard deviation) were housed individually. Upon arrival, calves were blocked based on age and arrival day, and, within a block, calves were randomly assigned to either a whole milk powder (WP; 26% fat, DM basis, n = 9) or a MR high in fat (25% fat, n = 9) fed 3.0 L 3 times daily (9 L total per day) at 135 g/L through teat buckets. On d 21, gut permeability was assessed with indigestible permeability markers [chromium (Cr)-EDTA, lactulose, and d-mannitol]. On d 32 after arrival, calves were slaughtered. The weight of the total forestomach without contents was greater in WP-fed calves. Furthermore, duodenum and ileum weights were similar between treatment groups, but jejunum and total small intestine weights were greater in WP-fed calves. The surface area of the duodenum and ileum did not differ between treatment groups, but the surface area of the proximal jejunum was greater in calves fed WP. Urinary lactulose and Cr-EDTA recoveries were greater in calves fed WP in the first 6 h post marker administration. Tight junction protein gene expression in the proximal jejunum or ileum did not differ between treatments. The free fatty acid and phospholipid fatty acid profiles in the proximal jejunum and ileum differed between treatments and generally reflected the fatty acid profile of each liquid diet. Feeding WP or MR altered gut permeability and fatty acid composition of the gastrointestinal tract and further investigation are needed to understand the biological relevance of the observed differences.

Postoperative functional and cancer control evaluation of conventional and Retzius-sparing robot-assisted radical prostatectomy: Comparison of selected cases by propensity score matching.

Although many reports have shown that Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) is effective for postoperative urinary continence, the postoperative voiding status and sexual function associated with this technique have not yet been adequately compared with those associated with conventional RARP (C-RARP). In this study, the lower urinary tract function, erectile function, and cancer control after C-RARP and RS-RARP were compared chronologically. We selected 50 cases of C-RARP and RS-RARP each by propensity score matching and evaluated them over time using various questionnaires. Urinary continence recovery rates and biochemical recurrence (BCR)-free survival rates were calculated using the Kaplan-Meier method and compared between the two groups using the log-rank test. When urinary continence was defined as 0 pads per day, 0 pads per day + 1 security linear, or ≤1 pad per day, the postoperative improvement in urinary continence was better with RS-RARP over the course of up to 1 year for all definitions. The International Consultation on Incontinence Questionnaire-Short Form total scores and the Overactive Bladder Symptom Scores were better in the postoperative RS-RARP group. There were no significant differences in the International Prostate Symptom Score total score, QOL score, and erectile hardness score between the two groups during the observation period. The BCR-free survival did not differ significantly between the two groups CONCLUSIONS: Postoperative urinary continence was better in the RS-RARP group than in the C-RARP group; however, the voiding function, erectile function, and cancer control did not differ significantly.