ADLs, as measured by the MDS-ADL Long Form score, worsen after RC. This should be an important part of the risks and benefits conversation with patients, their families, and caregivers.
Compared to other treatment modalities, surgery, either radical cystectomy or partial cystectomy, offers the best OS and CSS for men aged 80 years or older with T2 bladder cancer.
Robot-assisted laparoscopic radical cystectomy (RALRC) is increasingly being performed for the treatment of muscle-invasive bladder cancer. There is increased tension while performing the ureteroileal anastomosis through a small incision. Patients are at risk to suffer wound and skin complications perioperatively due to possible contamination with bowel contents. The Alexis retractor helps with retraction of small incisions potentially reducing tension and also reduces wound infection rates as reported in the colorectal literature. This pilot study evaluates the use of the Alexis wound protector (WP) in RALRC with ileal conduit (IC). The WP was used in 15 consecutive patients at a single institution who all underwent RALRC with IC. All patients had preoperative bowel preparations, antibiotics, and had surgical preparation with chlorhexidine with alcohol in the standard fashion. The Alexis device was placed following RALRC to protect the skin and fascia during ileal conduit formation. The ileal conduit was then created extracorporeally through the WP in the standard fashion. RALRC with IC was successfully completed in all 15 patients. Patients had no wound complications defined as documentation of cellulitis or hernia on progress or follow-up notes. Using our technique with the WP we had no cases of surgical site infection. Wound barrier protection has been recommended for use in colorectal surgery and we believe that these recommendations translate to RALRC with IC due to the use of bowel to form the urinary diversion. Further studies with the use of WP in this procedure are necessary to validate our findings.
RESULTS: As demonstrated in Figure 1 for the validation cohort, there was a strong relationship between expected 24-hour urine creatinine based on lean body mass and the measured urinary creatinine (r 2 ¼0.7, p<0.01), which was stronger than the relationship between measured urinary creatinine and weight (r 2 ¼0.5, p<0.01). Using the traditional metric of Cr/Kg, 38% of patients in our cohort were considered to have an inadequate 24-hour urine collection (Figure 1a), and there more dispersion among inadequate specimens. Using the regression model on the validation set (Figure 1b), 15% of specimens were considered inadequate, and the majority were due to under collection.CONCLUSIONS: Urinary creatinine is more strongly correlated to an individuals muscle mass rather than body weight. Our regression model demonstrated the utility of a lean body mass based 24-hour creatinine estimator that improves the ability to determine the adequacy of a 24-hour urine collection.
We report on a 43-year-old, asymptomatic female who presented with incidental finding of left adrenal mass. MRI gave concerns for possible pheochromocytoma but markers for pheochromocytoma were not elevated as expected. 24-hour urine dopamine levels (6988 μg/day) were significantly elevated. The patient successfully underwent robotic assisted radical left adrenalectomy and was diagnosed with a dopamine secreting pheochromocytoma. Pathology revealed increased malignant potential associated with the tumor. The patient underwent full metastatic workup, which was negative. At two years of follow-up there was no recurrence and normalization of lab values.
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