The conservative management of upper tract urothelial carcinoma (UTUC) has historically been offered to patients with imperative indications. The recent International Consultation on Urologic Diseases publication on UTUC stratified treatment allocations based on high and low-risk groups. The risk-stratified approach allows selective patients who could benefit from kidney preserving procedures (KPP) with oncological outcomes similar to radical nephroureterectomy (RNU) with bladder cuff excision. There are no prospective randomized controlled studies to support management guidelines. Recent developments in imaging, minimally invasive techniques, multi-modality approaches, adjuvant topical and systemic chemotherapeutic regimens and bladder cancer prevention raise the hope for improved risk stratification and treatments with superior oncological outcomes.
With more than 60% of radical prostatectomies being performed robotically, robotic-assisted laparoscopic prostatectomy (RALP) has largely replaced the open and laparoscopic approaches and has become the standard of care surgical treatment option for localized prostate cancer in the United States. Accomplishing negative surgical margins while preserving functional outcomes of sexual function and continence play a significant role in determining the success of surgical intervention, particularly since the advent of nerve-sparing (NS) robotic prostatectomy. Recent evidence suggests that NS surgery improves continence in addition to sexual function. In this review, we describe the neuroanatomical concepts and recent developments in the NS technique of RALP with a view to improving the “trifecta” outcomes.
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