No abstract

<b><i>Introduction:</i></b> Limitations in tumor staging and the heterogeneous natural evolution of pT1 urothelial bladder carcinoma (UBC) make the choice of treatment challenging. We evaluated if histopathological substaging (pT1a, pT1b, and pT1c) helps predict disease recurrence, progression, and overall survival following transurethral resection of the bladder (TURB). <b><i>Methods:</i></b> We included 239 consecutive patients diagnosed with pT1 UBC at TURB in a single institution since 2001. Each sample was interpreted by our specialized uropathologists trained to subclassify pT1 stage. Three groups were distinguished according to the degree of invasion: T1a (up to the muscularis mucosae [MM]), T1b (into the MM), and T1c (beyond the MM). <b><i>Results:</i></b> T1 substaging was possible in 217/239 (90%) patients. pT1a, b, and c occurred in 124 (57), 59 (27), and 34 (16%), respectively. The median follow-up was 3.1 years, with a cumulative recurrence rate of 52%, progression rate of 20%, and survival rate of 54%. Recurrence was not significantly associated with tumor substage (<i>p</i> = 0.61). However, the Kaplan-Meier survival analysis showed a significantly higher progression rate among T1b (31) and T1c (26%) tumors than T1a (13%) (log-rank test: <i>p</i> = 0.001) stages. In a multivariable model including gender, age, ASA score, smoking, tumor grade, and presence of carcinoma in situ, T1 substage was the single variable significantly associated with progression-free survival (HR 1.7, <i>p</i> = 0.005). Nineteen patients (9%) needed radical cystectomy; among them, 12/19 (63%) had an invasive tumor. Overall survival was significantly associated with tumor substaging (<i>p</i> = 0.001). <b><i>Conclusion:</i></b> Histopathological substaging of pT1 UBC is significantly associated with tumor progression and overall survival and therefore appears to be a useful prognostic tool to counsel patients about treatment options.

No abstract

No abstract

Background We lack data regarding the economic cost of robot‐assisted surgical procedures in urology. We aimed to assess the medico‐economic impact of onco‐urological robot‐assisted surgery. Methods All patients who underwent robot‐assisted radical prostatectomy (RARP) or robot‐assisted partial nephrectomy (RAPN) in 2019 were included. Cost assessment included the costs of surgery, hospital stay, and complications. Global cost was calculated and compared with open and laparoscopic procedures. Results Overall, 126 (48%) RAPN and 135 (52%) RARP were included. Total cost per patient was 6857€ for RARP and 6034€ for RAPN. Costs of surgery, hospital stay, and complications represented 76.2%, 21.5%, and 2.3%, respectively, of the total cost per patient for RAPN, and 74.1%, 25.9%, and 0% for RARP. Compared to the open approach, RAPN was 6% cheaper and RARP was 10% more expensive per patient. Standard laparoscopic procedures were cheaper. Conclusions Robotic procedures were associated with increased costs of surgical procedures, but with reduction in morbidity and hospital stay costs.

No abstract

Purpose of review Robot-assisted laparoscopic simple prostatectomy (RASP) is being used increasingly for the surgical treatment of benign prostatic obstruction (BPO). Our purpose is to review the main outcomes of RASP for the management of BPO. Recent findings A computerised bibliographic search of Medline was performed for articles that included detailed results of RASP, published over the past 2 years. Although RASP seems to be associated with better perioperative and functional outcomes, this procedure remains expensive when compared to open or endoscopic surgery. However, considering the enhanced safety of RASP compared to open simple prostatectomy and its favourable learning-curve when compared to endoscopic laser enucleation, RASP seems to be a good and effective option in centres with extended robotic expertise. Single-port robotic surgery appeared to be safe and effective in two preliminary studies. Other studies reported interesting and improved results for the preservation of ejaculatory function. Summary Many RASP techniques have been developed, with the common goal of improving the quality of life of patients. Although the cost of RASP is higher than open surgery, the perioperative benefits of the robotic approach make RASP a favourable option in centres with extended robotic expertise.

No abstract