Treatment for urolithiasis in patients with urinary diversion is associated with high re-treatment and complication rates. Percutaneous nephrolithotomy achieves a better stone-free outcome than ureteroscopy or shock wave lithotripsy. However, there is no difference in ancillary procedures or complication rates among the 3 treatment modalities.
Objective To evaluate for potential predictors of intraoperative conversion from robotic sacrocolpopexy (RSC) to open abdominal sacrocolpopexy.Patients and Methods We identified 83 consecutive patients from 2002-2012 with symptomatic high-grade post-hysterectomy vaginal vault prolapse that underwent RSC. Multiple clinical variables including patient age, comorbidities (body-mass index [BMI], hypertension, diabetes mellitus, tobacco use), prior intra-abdominal surgery and year of surgery were evaluated for potential association with conversion.Results Overall, 14/83 cases (17%) required conversion to an open sacrocolpopexy. Patients requiring conversion were found to have a significantly higher BMI compared to those who did not (median 30.2kg/m2 versus 25.8kg/m2; p=0.003). Other medical and surgical factors evaluated were similar between the cohorts. When stratified by increasing BMI, conversion remained associated with an increased BMI. That is, conversion occurred in 3.8% (1/26) of patients with BMI ≤25 kg/m2, 14.7% (5/34) with BMI 25-29.9 kg/m2 and 34.7% (8/23) with BMI ≥30 kg/m2 (p=0.004). When evaluated as a continuous variable, BMI was also associated with a significantly increased risk of conversion to an open procedure (OR 1.18, p=0.004).Conclusions Higher BMI was the only clinical factor associated with a significantly increased risk of intra-operative conversion during robotic sacrocolpopexy. Recognition of this may aid in pre-operative counseling and surgical patient selection.
Introduction and Objectives: Primary squamous cell carcinoma of the female urethra is rare. Given the small number of cases seen, no uniform regimen for optimal treatment has been identified. We set out to review the outcomes of women with advanced urethral squamous cell carcinoma treated with a multimodality approach in order to gain insight into the optimal treatment of this rare malignancy. Methods: We identified five women with advanced urethral squamous cell carcinoma treated by a single surgeon (RJK). After obtaining IRB approval, a retrospective chart review was performed and treatment strategies and outcomes were analyzed. Results: We report on 5 cases of squamous cell carcinoma of the female urethra treated utilizing a multimodal approach. Surgical therapy included anterior exenteration in two patients, partial urethrectomy in two patients and transurethral resection in one. Patients were treated with radiation in a neoadjuvant (2 cases), adjuvant (2 cases), or definitive (1 case) fashion. Four of five patients received chemotherapy. With a mean follow-up of 39 months (range 3 to 50), 4 patients remain without evidence of disease while one patient developed lung metastases 33 months after treatment. None had a locoregional tumor recurrence. Conclusion: Multi-modality approach combining surgery, radiotherapy, and chemotherapy can be effective therapeutic intervention for locally advanced, squamous cell carcinoma of the female urethra. For patients who have a significant surgical risk or desire to pursue an organ-preservation strategy, a trimodality approach of limited surgical excision combined with radiotherapy plus chemotherapy may be a reasonable alternative to anterior pelvic exenteration
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