Journal of endourology
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Journal of endourology · Feb 2016
Comparative StudyInguinal Hernia Repair During Extraperitoneal Robot-Assisted Laparoscopic Radical Prostatectomy.
One third of men undergoing radical prostatectomy have a comorbid inguinal hernia (IH). Previous studies have shown that adding total extraperitoneal (TEP) IH repair to extraperitoneal laparoscopic radical prostatectomy (LRP) lacks adverse effects. However, outcomes of extraperitoneal robot-assisted laparoscopic radical prostatectomy (RALP) and TEP are unknown. We compared RALP+TEP with LRP+TEP and also with RALP alone. ⋯ Unilateral and bilateral TEP added operative time to RALP but had equivalent outcomes to both LRP+TEP and RALP alone. This is likely due to the similar surgical space used for RALP and TEP, which obviates the need for substantial further dissection. For men with prostate cancer and comorbid IH, combined RALP+TEP appears to be an appropriate surgical combination.
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Journal of endourology · Jan 2016
Critical Analysis of Hospital Readmission and Cost Burden After Robot-Assisted Radical Cystectomy.
To examine the occurrence and cost burden of hospital readmission within 90 days of robot-assisted radical cystectomy (RARC). Subjects/Patients (or Materials) and Methods: From 2003 to 2012, 247 patients underwent RARC with extracorporeal urinary reconstruction at a single categorical cancer hospital. Continent diversions were performed in 67% of patients. All readmissions within 90 days were included. Readmissions were defined as early (<30 days) and late (31-90 days) with multiple readmissions captured as separate events. Cost analysis was performed using average direct hospital cost. The Fisher exact test was used to determine differences in proportion of readmissions between patient groups, while logistic regression was used to identify predictors for readmission. ⋯ Hospital readmission rates after RARC are high and costs of readmission are significant. Most patients are readmitted within 30 days and infection and dehydration are common causes. Clinicians should be aware of diversion-specific readmission causes.
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Journal of endourology · Nov 2015
Review Meta AnalysisThe Prognostic Role of Ki-67/MIB-1 in Upper Urinary-Tract Urothelial Carcinomas: A Systematic Review and Meta-Analysis.
Upper urinary-tract urothelial carcinomas (UTUC) constitute 5% of urothelial malignancies. Prognostic biomarkers would allow lower risk surgical approaches for less aggressive UTUCs. One biomarker-Ki-67/mindbomb E3 ubiquitin protein ligase 1 (Ki-67/MIB-1)-shows promise in UTUC, but there have been conflicting findings regarding its prognostic role. The systematic review and meta-analysis aim to determine the prognostic value of Ki-67/MIB-1 in UTUC in terms of UTUC-specific mortality rate, 5-year disease-free survival, and 5-year overall survival (including disease-specific survival). ⋯ Ki-67/MIB-1 overexpression shows promise as a prognostic biomarker for UTUC patients and requires further investigation.
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Journal of endourology · Nov 2015
Crowd-Sourced Assessment of Technical Skill: A Valid Method for Discriminating Basic Robotic Surgery Skills.
A surgeon's skill in the operating room has been shown to correlate with a patient's clinical outcome. The prompt accurate assessment of surgical skill remains a challenge, in part, because expert faculty reviewers are often unavailable. By harnessing the power of large readily available crowds through the Internet, rapid, accurate, and low-cost assessments may be achieved. We hypothesized that assessments provided by crowd workers highly correlate with expert surgeons' assessments. ⋯ The assessment of surgical skill by crowd workers resulted in a high degree of agreement with the scores provided by expert surgeons in the evaluation of basic robotic surgical dry-laboratory tasks. Crowd responses cost less and were much faster to acquire. This study provides evidence that crowds may provide an adjunctive method for rapidly providing feedback of skills to training and practicing surgeons.
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Journal of endourology · Nov 2015
Observational StudyPerioperative Management of Antiplatelets and Anticoagulants Among Patients Undergoing Elective Transurethral Resection of the Prostate--A Single Institution Experience.
To evaluate current practice in the perioperative management of antiplatelets (AP) and anticoagulants (AC) among men undergoing elective transurethral resection of the prostate (TURP), as well as the associated perioperative bleeding and thromboembolic complications. ⋯ Perioperative management of AP/AC should be based on the indications and the American College of Chest Physicians thromboembolic risk stratification. Regular AC users who had enoxaparin bridging are at increased risk of both perioperative bleeding and thromboembolic complications.