Pelvic lymphadenectomy is the cause of a relevant number of perioperative complications in patients undergoing radical retropubic prostatectomy. Lymphocele formation, and the associated re-interventions and thromboembolic sequelae account for by far the highest percent of these complications. In the current study lymphocele formation depended on the extent of pelvic lymphadenectomy, the number of lymph nodes removed and the operating surgeon.

Objective To evaluate early postoperative morbidity in patients undergoing either robot‐assisted (RARC) or open radical cystectomy (ORC) for bladder cancer. Patients and Methods A total of 100 patients underwent RARC (between August 2009 and August 2012) and 42 underwent ORC (between October 2007 and July 2009) as treatment for bladder cancer. Data on the patients' peri‐operative course were collected prospectively up to the 90th postoperative day for the RARC group and up to the 60th postoperative day for the ORC group. Postoperative complications were recorded based on the Clavien–Dindo classification system. Both groups were compared with regard to patient and tumour characteristics, surgical and peri‐operative outcomes. Results The RARC and ORC groups were well matched with regard to age, body mass index, gender distribution, type of urinary diversion and pathological tumour characteristics (all P > 0.1), but patients in the RARC group had more serious comorbidities according to the Charlson comorbidity index (P = 0.034). Although surgical duration was longer in the RARC group (P < 0.001) the estimated blood loss was lower (P < 0.001) and transfusion requirement was less (P < 0.001). Overall 59 patients (59%) in the RARC group and 39 patients (93%) in the ORC group experienced postoperative complications of any Clavien–Dindo grade <90 days and <60 days after surgery, respectively (P < 0.001; relative risk reduction 0.36). Major complications (grades 3a–5) were also less frequent after RARC (24 [24%] vs 18 patients [43%]; P = 0.029) with a relative risk reduction of 0.44. In the subgroup of patients with an ileum conduit as a urinary diversion (RARC, n = 76 vs ORC, n = 31) the overall rate of complications (43 [57%] vs 28 [90%] patients; P < 0.001) and the rate of major complications (17 [22%] vs 15 [48%] patients; P = 0.011) were lower in the RARC group with relative risk reductions of 0.37 and 0.54, respectively. Conclusions A significant reduction in early postoperative morbidity was associated with the robotic approach. Despite more serious comorbidities and a 30‐day longer follow‐up in the RARC group, patients in the RARC group experienced fewer postoperative complications than those in the ORC group. Major complications, in particular, were less frequent after RARC.

Study Type – Therapy (case series)
Level of Evidence 4 OBJECTIVE To describe the reconstruction of long ureteric strictures using buccal mucosal patch grafts and to report the intermediate‐term functional outcome. PATIENTS AND METHODS Between November 2000 and October 2006 reconstruction of seven long ureteric strictures using buccal mucosal patch grafts and omental wrapping was performed in five women (one with bilateral strictures) and one man. The surgical steps of stricture reconstruction and wrapping with omentum are described in detail. Stricture recurrence was defined as persistent impaired ureteric drainage as displayed by imaging techniques or the necessity to prolong JJ stenting. Patency rates and stricture recurrence‐free survival rates are provided. RESULTS With a median follow up of 18 months five of the seven strictures were recurrence‐free. Graft take was good in all patients. In one asymptomatic patient, there was impaired ureteric drainage on the reconstructed side, and in one patient with reconstruction of both ureters prolonged JJ stenting of one side was necessary. In both patients, the impaired drainage was caused by persistent stricture below the reconstructed ureteric segments. CONCLUSIONS At intermediate‐term follow‐up in a small group of patients with long ureteric strictures, treatment with buccal mucosal patch grafts and omental wrapping showed good functional outcome.

No abstract

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? The marked increase in life expectancy in recent years calls for reconsideration of the decision‐making process for the treatment of prostate cancer, a condition particularly affecting the elderly. To date the general approach in elderly patients has tended to be more conservative, not least as it is generally thought that prostate cancer in these patients is less biologically aggressive. The present data showed that patients aged ≥70 years had biologically more aggressive tumours significantly more often than those aged <70 years. Nevertheless, advanced age itself was not an independent predictor of survival after retropubic radical prostatectomy, whereas adverse prostate cancer features and severe comorbidities were. OBJECTIVE To investigate the effect of advanced age (≥70 years) on prostate cancer characteristics, oncological and functional outcomes in patients undergoing retropubic radical prostatectomy (RP). PATIENTS AND METHODS Between June 1997 and September 2009, 1636 patients underwent RP at one institution. Of these patients, 1225 were aged < 70 years and 411 ≥70 years. Both groups were compared for prostate cancer characteristics, oncological and functional outcomes. Multivariate analyses were used to estimate the effect of advanced age on overall survival (OS), cancer‐specific survival (CSS), biochemical recurrence‐free survival (BFS) and postoperative continence. RESULTS The median (range) age of the patients aged ≥ 70 years was 72 (70–85) years and for those aged < 70 years was 64 (40–69) years (P < 0.001), respectively. The patients aged ≥ 70 years were assigned higher American Society of Anesthesiologists (ASA) classes (P < 0.001) reflecting a higher rate of severe comorbidities in this group. In the patients aged ≥ 70 years there were significantly more clinically palpable and pathologically non‐organ‐confined tumours (P= 0.030 and P= 0.026, respectively), and higher biopsy and RP Gleason scores (P= 0.002 and P= 0.004, respectively). Accordingly, patients aged ≥ 70 years presented with a higher proportion of high‐risk prostate cancer, although the difference was not significant (P= 0.060). There were no differences between the groups for preoperative prostate‐specific antigen level (P= 0.898), rate of pelvic lymph node dissection (P= 0.231), pN+ (P= 0.526) and R+ status (P= 0.590). Kaplan–Meier curves showed a significantly lower 10‐year OS (67 vs 82%; P= 0.017) and a trend towards a lower 10‐year CSS (70 vs 83%; P= 0.057) in patients aged ≥ 70 years. However, on multivariate analysis advanced age was not an independent predictor of OS (P= 0.102) or CSS (P= 0.195), whereas pN+ status (both P < 0.001), RP Gleason scores 8–10 (both P < 0.001) and ASA classes 3–4 (P= 0.037 and P= 0.028, respectively) were. The 2‐year postoperative continence rates was comparable between the groups (International Continence Society [ICS] male incontinence symptom score 2.10 vs 2.01; P= 0.984). In mult...