Purpose It is not yet possible to estimate the number of cases required for a beginner to become expert in laparoscopic radical prostatectomy. We estimated the learning curve of laparoscopic radical prostatectomy for positive surgical margins compared to a published learning curve for open radical prostatectomy. Materials and Methods We reviewed records from 8,544 consecutive patients with prostate cancer treated laparoscopically by 51 surgeons at 14 academic institutions in Europe and the United States. The probability of a positive surgical margin was calculated as a function of surgeon experience with adjustment for pathological stage, Gleason score and prostate specific antigen. A second model incorporated prior experience with open radical prostatectomy and surgeon generation. Results Positive surgical margins occurred in 1,862 patients (22%). There was an apparent improvement in surgical margin rates up to a plateau at 200 to 250 surgeries. Changes in margin rates once this plateau was reached were relatively minimal relative to the CIs. The absolute risk difference for 10 vs 250 prior surgeries was 4.8% (95% CI 1.5, 8.5). Neither surgeon generation nor prior open radical prostatectomy experience was statistically significant when added to the model. The rate of decrease in positive surgical margins was more rapid in the open vs laparoscopic learning curve. Conclusions The learning curve for surgical margins after laparoscopic radical prostatectomy plateaus at approximately 200 to 250 cases. Prior open experience and surgeon generation do not improve the margin rate, suggesting that the rate is primarily a function of specifically laparoscopic training and experience.

At our institution and during the study period laparoscopic radical prostatectomy and retropubic radical prostatectomy provided comparable oncological efficacy. Laparoscopic radical prostatectomy was associated with less blood loss and a lower transfusion rate, and higher postoperative hospital visits and readmission rate. While the recovery of potency was equivalent, that of continence was superior after retropubic radical prostatectomy.

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Standard lymph node dissection yields positive nodes more frequently and retrieves a higher total nodal count than the often performed pelvic lymph node dissection limited to the external iliac nodes. Standard pelvic lymph node dissection is feasible through a transperitoneal laparoscopic approach.

Injuries are the cause of significant morbidity among rugby players in Argentina. A more thorough investigation and a greater understanding of the mechanisms are crucial in order to update the rugby laws and reduce this high injury incidence.

Most transplant nephrectomies were performed within 2 years of the transplant date and almost half were done within year 1 after the return to dialysis. The advent of cyclosporine significantly decreased the transplant nephrectomy rate at the expense of fewer graft failures but not at the expense of a lower amount of graft related symptoms after patients returned to dialysis. Bleeding was the leading cause of morbidity and infection was the main cause of mortality. Considering the high morbidity and mortality of transplant nephrectomy, and the potential benefits of leaving nonfunctioning grafts in situ our current policy is to remove the graft only in cases of failed transplants that cause intractable complications.

Purpose-Renal cell carcinoma (RCC) is rare in patients <40 years old and conflicting data regarding presentation and outcome are present in the literature. We reviewed our experience with young RCC patients comparing them to older counterparts.Methods-We identified 1,720 patients 18-79 years old managed with partial or radical nephrectomy for RCC between 1989 and 2005. Patients were grouped according to age and outcome analyses were conducted.Results-Among the 1,720 RCC patients, there were 89 (5%), 672 (39%), and 959 (56%) patients aged <40, 40-59, and 60-79 years old, respectively. There were no significant differences in sex, tumor size, TNM stage, or multifocality by age group. However, patients <40 years old were significantly more likely to present with symptomatic tumors (p=0.028). Additionally, there were significant differences in histology by age (p<0.001); chromophobe histology decreased while papillary histology increased with age. Despite similar tumor sizes in each age group, the percentage of patients treated with partial nephrectomy declined with age; 49% of patients <40 years old were treated with partial nephrectomy compared with 35% and 30% of patients aged 40-59 and 60-79 years old, respectively (p<0.001). With a median follow-up of 2.6 years (range 0-14.5), we did not observe a significant difference in cancer-specific survival according to age (p=0.17).Conclusions-Younger RCC patients are more likely to have symptomatic tumors with chromophobe histology although prognosis appears similar across age groups. Older patients are more likely to be treated with radical nephrectomy and this requires careful scrutiny for current clinical practice.

Objective We analyzed the oncological outcome after laparoscopic radical prostatectomy (LRP) in a consecutive series of patients with prostate cancer. Material and Methods from 1998 to 2007, 1564 consecutive patients (median age 61 years, IQ range 56, 66) with clinically localized prostate cancer (cT1c-cT3a) were treated with LRP by two surgeons either at IMM (Paris, France) or MSKCC (New York, USA). Progression of disease was defined as a PSA of 0.1 ng/ml or greater with confirmatory rise, or initiation of secondary therapy and the information was available for 1422 patients. Patients were stratified as low, intermediate or high risk based on the pretreatment prostate cancer nomogram progression free probability of >90%, 89% to 71% and < 70% respectively. Results The overall 5-year and 8-year probability of freedom from progression was 78% (95% CI 74%–82%) and 71% (95% CI 63%, 78%) respectively. For low, intermediate and high risk cancer, the 5-year progression free probability was 91% (95% CI 85%–95%), 77% (95% CI 71%–82%) and 53% (95% CI 40%–65%) respectively. Surgical margins were positive in 13% of cases. The 5-year progression free probability was 49% (95%C.I. 35%– 61%) when the surgical margins were positive vs. 83% (95%C.I. 79%– 86%) in negative surgical margins cases. Nodal metastases were detected in 3% of the patients after limited pelvic lymph node dissection and in 10% after a standard pelvic lymph node dissection (p<0.001). The 3 year probability of freedom from progression for node positive patients was 49%. There were 22 overall deaths and 2 deaths from prostate cancer. Conclusion Laparoscopic radical prostatectomy provided 5 and 8-year cancer control in 78 and 71% of patients with clinically localized prostate cancer and 53% of those with high risk cancers at 5 years. A pelvic lymph node dissection limited to the external iliac nodal group is inadequate for detecting nodal metastases.