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Optimal management of node-positive prostate cancer patients after prostatectomy remains a challenge. We evaluated clinically localized patients who demonstrated node positivity and identified predictors for secondary treatment. From 2010 to 2015, clinically localized prostate cancer patients who underwent robot prostatectomy with extended lymphadenectomy and node-positive disease on pathologic analysis were identified. Clinical N1, M1 or salvage cases were excluded. Patients were stratified based on secondary treatments. Kaplan–Meier method was used to determine the time to biochemical and metastatic recurrence. Multivariate logistic regression was used to identify predictors for additional treatment. 145 patients (45 no additional therapy, 47 adjuvant, 53 salvage) had a median follow-up of 31.2 months. Salvage patients had higher median pre-operative prostate-specific antigen (10.8 vs. 9.7 vs. 8.2, p = 0.1), higher percentage of pathologic Gleason ≥8 (50.9 vs. 38.3% and 22.2%, p

Objective To report our experience with ureteroenteric anastomotic revision as initial treatment of stricture after urinary diversion. Methods An institutional review board-approved retrospective study was carried out. A total of 41 patients who underwent primary ureteroenteric anastamotic revision were identified between 2007 and 2015. Data analyzed included patient characteristics, type of diversion, estimated blood loss, operative time, change in renal function, length of stay, postoperative complications and time with nephrostomy/stent. Success of revision was defined as an improvement in hydronephrosis on radiographic imaging and/or reflux during pouchogram. Predictors of length of stay and complications were analyzed using analysis of covariance. Results A total of 50 renal units were revised with a success rate of 100%. The median length of stay was 6 days (2-16 days). There were a total of 15 complications (one major, 14 minor) in 14 patients (33% 30-day complication rate). The most common were wound infection (n = 4) and arrhythmia (n = 4). Robotic revision (n = 5) had a median length of stay of 3 days (2-4) with no complications. Conclusions Primary ureteroenteric anastomotic revisions have an excellent success rate at an experienced center and might obviate the need for multiple interventions. Open revision is associated with mostly minor complications. Robotic revision might reduce the morbidity of open revision in select cases.

Diseases of the adrenal gland have been treated surgically since the nineteenth century. Since the first planned adrenalectomy by Sargent in 1914 for a large adenoma, various approaches to this operation have been developed. Open techniques have paved the way for less invasive approaches. In 1992, Gagner et al. [1] reported their initial experience with transperitoneal laparoscopic adrenalectomy. Since then, minimally invasive techniques have gained wide adoption, partly due to decreased postoperative pain, lessened morbidity, and quicker patient recovery. The advent of robot-assisted techniques has overcome many of the limitations of traditional laparoscopy. In 2001, Horgan et al. [2] first reported their experience using a da Vinci® robotic system to perform adrenalectomy. Contemporary literature continues to support the use of robot-assisted techniques to treat adrenal pathology [3–6]. When planning for surgeries of the adrenal gland, complete imaging and endocrine workup is warranted to achieve an accurate preoperative clinical diagnosis.

In the United States, the annual incidence of renal cancers is approximately 61,560, and 14,080 die of the disease. The lifetime probability of developing invasive renal cancer is 2% in males and 1.2% in females [1]. Although recent advances in systemic and targeted immunotherapies have improved long-term survival in patients, surgical extirpation still offers the best chance for cure in localized disease. Other treatment approaches such as active surveillance, radiofrequency ablation, and cryotherapy may be appropriate for patients who are unfit for surgery or who have competing comorbidities. Surgical options for renal tumors include partial and radical nephrectomy. Nephron-sparing surgery (NSS), as allowed by the tumor characteristics and patient comorbidities, is the preferred approach for small renal masses. NSS may delay the onset of chronic kidney disease, associated cardiovascular events, and mortality, while providing equivalent oncologic results [2, 3]. Partial nephrectomy has become the standard of care for T1 tumors (≤7 cm in size).