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Objective To assess the effect of race and gender on complications after urologic surgeries. Materials and Methods The American College of Surgeons’ National Surgical Quality Improvement Program data was utilized for patients undergoing urologic surgeries. Patient demographics and comorbidities were analyzed. Postoperative complications occurring in a 30-day postoperative period were noted and classified per the Clavien-Dindo classification. Results From 2008-2018, 284,050 patients underwent urologic surgery. The majority were men (80%) and identified as non-Hispanic white (80%). Complications occurred in 12%, including 9% minor, 5% major, and mortality in 0.6%. Univariate analysis found female gender, non-Hispanic black and Native American race, and patient comorbidities (hypertension, diabetes, heart failure, lung disease, chronic kidney disease) to be associated with increased risk of complications. Female gender remained a significant predictor on multivariable logistic regression, and Hispanic race was found to be an independent negative predictor of postoperative complications, although these results did not appear clinically significant. On exclusion of gender-specific urologic surgeries, female gender was associated with higher likelihood of minor complications, but male gender was associated with higher likelihood of major complications or mortality. Conclusion Race was not associated with postoperative complication rate. Patient comorbidities are associated with an increased risk of 30-day postoperative complications. Females were more likely to have minor and males were more likely to major complications. Optimizing patient comorbidities preoperatively is key to improving postoperative outcomes.

Objectives The aim of this study is to assess the course and management of poorly differentiated bladder urothelial carcinoma (UC), including plasmacytoid UC (PUC), in our local area. Although bladder cancer is relatively common, PUC is a rare and aggressive subtype with a poor prognosis that is still poorly understood. Materials and Methods A retrospective assessment of all poorly differentiated high‐grade UC over the last 15 years (2005–2020) in the Hunter New England area was completed. In total, 37 patients were included, and PUC variant was compared with the remaining poorly differentiated UC. Results Of the included cases, eight were PUC, nine squamous variant, two neuroendocrine, and one sarcomatoid. Overall, 23 cases proceeded to cystectomy, 15 had chemotherapy (six neoadjuvant), and 11 had radiation therapy. In the PUC subgroup, three had metastatic disease at diagnosis (37.5%). Of the three PUC patients who underwent cystectomy, all were upstaged. Two PUC cases had adjuvant chemotherapy, and one case had radiation. Within the follow‐up period, the PUC group had a cause‐specific mortality of 50% with a mean survival in these patients of 202 days, compared with 37.9% cause‐specific mortality with survival of 671.55 days (p = 0.23) in all other undifferentiated UC cases; 5‐year cause‐specific mortality with Kaplan–Meier analysis was estimated at 26% compared with 59%, respectively (p = 0.058). Conclusion Poorly differentiated UC is demonstrated to have a poor prognosis with a high mortality rate, particularly when PUC is present. Given the rarity of these variants, further studies are necessary to explore the impact of current treatment options.

Background Diabetes mellitus (DM) has detrimental effects on the function of microvascular beds, resulting in blood–brain barrier (BBB) dysfunction. The objective of the study was to investigate whether DM affects the brain physiology through composition of cerebrospinal fluid (CSF) and compare gas tension and electrolyte levels in CSF between the diabetic and nondiabetic populations. Methods Patients aged between 20 and 70 years scheduled for elective orthopedic or urologic surgery requiring spinal anesthesia were enrolled. They were assigned to either of the two groups (control or type 2 DM). Gas tension and electrolytes in the CSF and whole blood samples were measured in both groups. Results All 49 enrolled patients (24 in the control and 25 in the DM group) completed the study. The concentrations of Na+ and Mg2+ in the blood were significantly lower in the DM group than those in the control. The levels of pCO2 and HCO 3 − {\text{HCO}}_{3}^{-} in the CSF were lower in the DM group than in the control group. In addition, there was a marked increase in the glucose level in both the blood and CSF in the DM group. Conclusion The results show that there were some homeostatic changes in blood and CSF in patients with DM.

ARTS will be the first trial to compare anticoagulation with a direct oral anticoagulant (apixaban) versus no anticoagulation among patients undergoing intra-abdominal, gynecologic, or urologic surgery at sufficiently similar risk of deep vein thrombosis or pulmonary embolism and major bleeding.

Most urological interventions are now performed with minimally invasive surgery techniques such as laparoscopic surgery. Combining ERAS protocols with minimally invasive surgery techniques may be the best option to reduce hospital length-of-stay and post-operative complications. We designed this study to test the hypothesis that using low intra-abdominal pressures (IAP) during laparoscopy may reduce post-operative complications, especially those related to reduced intra-operative splanchnic perfusion or increased splanchnic congestion. We applied a complete neuromuscular blockade (NMB) to maintain an optimal space and surgical view. We compared 115 patients treated with standard IAP and moderate NMB with 148 patients treated with low IAP and complete NMB undergoing major urologic surgery. Low IAP in combination with complete NMB was associated with fewer total post-operative complications than standard IAP with moderate NMB (22.3% vs. 41.2%, p < 0.001), with a reduction in all medical post-operative complications (17 vs. 34, p < 0.001). The post-operative complications mostly reduced were acute kidney injury (15.5% vs. 30.4%, p = 0.004), anemia (6.8% vs. 16.5%, p = 0.049) and reoperation (2% vs. 7.8%, p = 0.035). The intra-operative management of laparoscopic interventions for major urologic surgeries with low IAP and complete NMB is feasible without hindering surgical conditions and might reduce most medical post-operative complications.

Objectives Since the introduction of the first master–slave robotic platform for surgical procedures, there have been ongoing modifications and development of new platforms, but there is still a paucity of commercially available systems. Our study aims to identify all master–slave robotic surgical platforms currently commercially available or in development around the world with applications in urologic surgery. Methods A scoping literature search was performed using PRISMA methodology to identify all relevant publications in English in PubMed, PubMed Central, and Embase, with additional information being obtained from official company websites. Results Ten robotic platforms with either proven or potential application in urologic surgery were identified: the da Vinci surgical system (Intuitive), Senhance surgical system (Transentrix), Versius Surgical (CMR Ltd), Enos surgical system (Titan Medical), Revo –I (Meere Company), MiroSurge (DLR), Avatera System (Avatera Medical), Hugo Surgical Robot (Medtronic), Ottava (J&J, Ethicon, Areus), and Hinotori (Medicaroid Corporation). Conclusions This review highlights the distinct features of emerging master–slave robotic platforms with applications in urologic surgery. Research and development are now focused on finding wider applications, improving outcomes, increasing availability, and reducing cost. Additional research is required comparing newly developed master–slave robotic platforms with those already well established.

Objectives To identify the effect of duration of surgical antibiotic prophylaxis (SAP) and other variables on infectious postsurgical complications in patients with asymptomatic bacteriuria (ASB) undergoing urological surgery. Methods We conducted an observational study of a cohort of patients with ASB scheduled for urologic surgery at three health service providers in Colombia. The study population comprised all patients with planned urologic surgery who had ASB prior to surgery from April 2018 to January 2019. The intervention evaluated was the duration of preoperative SAP, and the outcome variable was the development of any postoperative infectious complications for up to 30 days after the procedure. Results The present study included 184 patients with ASB scheduled for urologic surgery.The median duration of preoperative SAP (p = 0.49) or of 1 dose SAP (risk ratio [RR] = 1.24; 95% confidence interval [CI]: 0.45–3.39) were not statistically different in patients with postsurgical infectious complications. Infectious complications were more frequent among patients with benign prostatic hyperplasia (RR = 6.57; 95%CI: 1.98–21.76) and hospitalization in the preceding 3 months (RR = 8.32; 95%CI: 2.69–25.71). Conclusion One dose of antimicrobial therapy is sufficient to avoid infectious complications in patients with ASB. There were other factors associated with postsurgical infectious complications, such as benign prostatic hyperplasia and hospitalization in the preceding 3 months.

Augmentation cystoplasty is an exemplary multiorgan intervention in urology which is particularly associated with microvascular damage. Our aim was to review the available intravital imaging techniques and data obtained from clinical and experimental microcirculatory studies involving the most important donor organs applied in bladder augmentation. Although numerous direct or indirect methods are available to assess the condition of microvessels the implementation of microcirculatory diagnostic methods in humans is still challenging and the assessment of organ microcirculation in the operating theatre has limitations. Nevertheless, preclinical studies generally report good internal validity and although prospective human protocols with reduced variability are needed, a possible positive impact of microcirculatory diagnostics on the clinical outcomes of urologic surgery can be anticipated.

The following discussion aims to provide a review of current trends in the subspeciality of pediatric regional anesthesia, highlighting recent evidence-based literature, especially with respect to improved outcomes with newer techniques. Much of the recent literature focuses on novel truncal blocks and alternate approaches to regional anesthesia for urologic surgery. In many cases, these newer techniques have been shown to improve postoperative pain scores and lower rescue analgesic requirements. Current trends in pediatric regional anesthesia are focused on providing innovative and alternative approaches to pain relief that are patient-specific and tailored to surgical needs. A variety of new blocks expand the regionalist’s ability to offer better analgesia to children and improve parental satisfaction. As more regional block options become available, the iterative process of making changes and assessing outcomes facilitates our ability to continue providing high quality care to children.

To assess prescribing and refilling trends of narcotics in postoperative urology patients at our institution. Although the opioid epidemic remains a public health threat, no series has assessed prescribing patterns across urologic surgery disciplines following discharge.All urologic surgeries were retrospectively reviewed from May 2017-April 2018. Demographics, comorbidities, and postoperative pain management strategies were analyzed. Narcotics usage following surgery were reported in total morphine equivalents (TME). Opioid refill rate was characterized by medical specialty and stratified by urologic discipline.817 cases were reviewed. Mean age and TME at discharge was 57±15.6 years and 35.43±19.5 mg, respectively. 13.6% (mean age 55±15.9) received a narcotic refill following discharge (mean TME/refill 37.7±28.9 mg). A higher proportion of patients with a pre-operative opioid prescription received a refill compared to opioid naïve patients (38.2% vs 21.6%, P.01). Refill rate did not differ between urologic subspecialties (P = .3). Urologists were only responsible for 20.4% of all refills filled, despite all patients continuing follow-up with their surgeon. Procedures with the highest rates of post-operative refills were in oncology, male reconstruction/trauma and endourology. Patients with a history of chronic pain (OR 1.9, CI 1.1-3.3) preoperative narcotic prescription (OR 1.6, CI 1.0-2.6), and higher ASA score (OR 1.8, CI 1.6-2.8) were more likely to obtain a postoperative opioid prescription refill.Approximately 1 in 7 postoperative urology patients receive a postoperative narcotics refill; however, nearly two-thirds receive refills exclusively from non-urologic providers. Attempts to avoid overprescribing of postoperative narcotics need to account for both surgeon and nonsurgeon sources of opioid refills.

To determine the rate of and predictors for guideline-discordant preoperative gentamicin dosing in urologic surgery and to assess the risk of nephrotoxicity in patients who receive the recommended high-dose prophylaxis.We retrospectively reviewed all adult patients who received preoperative gentamicin for urologic surgery from January 1, 2017 - October 3, 2019. Doses were categorized as guideline-concordant or -discordant using a cutoff of 4.5 mg/kg dosing weight. We used multivariable logistic regression to identify predictors for guideline-discordant dosing. Postoperative kidney injury was assessed using RIFLE criteria.Among 2134 patients, 89% received a preoperative dose ≤ 4.5 mg/kg. Older age (70+ years) and endoscopic surgery were significant risk factors for guideline-discordant dosing (OR 2.54, P0.001; OR 6.21, P0.001). Among 735 patients with complete data, there was no significant difference in the risk of kidney injury between those who received a dose less than 4.5 mg/kg and those who received a higher dose (OR 0.89, 95% CI: 0.26 - 2.99, P = 0.75).Preoperative gentamicin is commonly administered at lower than recommended doses for urologic surgery. Older age and endoscopic surgery are significant predictors of guideline-discordant dosing. The risk of kidney injury following high-dose preoperative gentamicin for urologic procedures is likely comparable to the risk at lower doses.

As computational power has improved over the past 20 years, the daily application of machine learning methods has become more prevalent in daily life. Additionally, there is increasing interest in the clinical application of machine learning techniques. We sought to review the current literature regarding machine learning applications for patient-specific urologic surgical care. We performed a broad search of the current literature via the PubMed-Medline and Google Scholar databases up to Dec 2020. The search terms “urologic surgery” as well as “artificial intelligence”, “machine learning”, “neural network”, and “automation” were used. The focus of machine learning applications for patient counseling is disease-specific. For stone disease, multiple studies focused on the prediction of stone-free rate based on preoperative characteristics of clinical and imaging data. For kidney cancer, many studies focused on advanced imaging analysis to predict renal mass pathology preoperatively. Machine learning applications in prostate cancer could provide for treatment counseling as well as prediction of disease-specific outcomes. Furthermore, for bladder cancer, the reviewed studies focus on staging via imaging, to better counsel patients towards neoadjuvant chemotherapy. Additionally, there have been many efforts on automatically segmenting and matching preoperative imaging with intraoperative anatomy. Machine learning techniques can be implemented to assist patient-centered surgical care and increase patient engagement within their decision-making processes. As data sets improve and expand, especially with the transition to large-scale EHR usage, these tools will improve in efficacy and be utilized more frequently.

Purpose Preoperative deep vein thrombosis (pre-DVT) is a risk of symptomatic venous thromboembolism (VTE) and a serious postoperative surgical complication. However, little is known about pre-DVT in patients undergoing surgery. This study aimed to investigate the incidence and screening criteria of pre-DVT in patients undergoing urological surgery. Materials and methods Between 2015 and 2017, 320 patients admitted to our hospital for urological surgery were included in this retrospective study. All patients underwent preoperative D-dimer testing. Patients with elevated D-dimer (≥1.0 μg/mL) levels underwent lower-limb compression ultrasonography (CUS). Clinical parameters were analyzed as predictors of pre-DVT, and modest cutoff value of D-dimer to predict pre-DVT were evaluated. Results Of 320 patients, preoperative elevated D-dimer levels and DVT were found in 81 (25.3%) and 20 (6.3%) patients, respectively. The positive predictive value (PPV) was 24.7% (20/81). ROC curve analysis revealed a cutoff D-dimer level of 1.8 μg/mL, yielding a PPV of 40.7% for pre-DVT among patients with elevated D-dimer levels. Preoperative DVT was detected in 16 (7.6%, n=210) patients with malignancy, 3 (5.7%, n=53) with adrenal tumors, and in 1 (1.8%, n=57) kidney donor. An age of >70 years was significantly associated with risk for pre-DVT (odds ratio, 2.81; 95% confidence interval, 1.12-7.19; p=0.0270). During a postoperative follow-up period of 90 days, no patient developed symptomatic VTE. Conclusions The incidence of pre-DVT was 6.3% in patients undergoing urological surgery. Elderly patients and/or a cutoff D-dimer level of 1.8 μg/mL might be good indications for pre-DVT screening by CUS.

Background: Trocar-site hernias (TSHs) are an uncommon but potentially severe complication of robot-assisted urologic surgery, with an incidence of incarcerated hernias varying from 0.4% to 0.66%. Currently, there are no standardized guidelines on trocar site fascial closure. Although it is widely recommended to close the midline 12-mm port site, there is no agreement on the need for fascial closure of lateral port sites, especially if ≤12 mm. Cases Presentation: We report three cases of incarcerated intestinal TSHs in the past 10 years in our institution. All were from lateral abdominal ports (two 12 and one 8 mm), after robot-assisted radical prostatectomy. Patients were Caucasian and from 60 to 71 years; symptoms varied widely from obstinate hiccups, abdominal distention with fever, to acute abdomen. In all cases reduction of the herniated loop from the outside, using a minilaparotomy over the port site, was safe and effective. However, in one case bowel resection for bowel ischemic necrosis was necessary. No specific clinical risk factors could be identified in our cases. Conclusion: Incarcerated TSH after robotic urologic surgery may arise from any trocar site, regardless of size and location. This could be treated effectively with a minilaparotomy over the trocar site, to avoid more serious life-threatening consequences such as bowel necrosis and perforation. No risk factor seems to be predictive of TSHs.

Objective Design a care protocol to restart scheduled surgical activity in a Urology service of a third level hospital in the Community of Madrid, in a safe way for our patients and professionals in the context of the SARS-CoV-2 coronavirus epidemic Material and methods A multidisciplinary group reviewed the different recommendations of the literature, national and international health organizations and scientific societies, as well as their application to our environment Once scheduled surgery has restarted, the patients undergoing surgery for complications related to COVID-19 are being followed up Results Since the resumption of surgical activity, 19 patients have been scheduled, of which 2 have been suspended for presenting COVID-19, one diagnosed by positive PCR for SARS-CoV-2, and another by laboratory and imaging findings compatible with this infection With a median follow-up of 10 days (4–14 days), no complications related to COVID-19 were detected Conclusions Preliminary results indicate that the protocol designed to ensure the correct application of preventive measures against the transmission of coronavirus infection is being safe and effective Resumen Objetivo Disenar un protocolo asistencial para reiniciar la actividad quirurgica programada en un servicio de Urologia de un hospital de tercer nivel de la Comunidad de Madrid, de manera segura para nuestros pacientes y profesionales en el contexto de la epidemia por coronavirus SARS-CoV-2 Material y metodos Constituimos un grupo multidisciplinar que se encargo de analizar las diferentes recomendaciones de la literatura, organizaciones sanitarias nacionales e internacionales y sociedades cientificas, asi como de su aplicacion a nuestro medio Una vez reiniciada la cirugia programada, se esta llevando a cabo un seguimiento de los pacientes intervenidos en cuanto a complicaciones relacionadas con COVID-19 Resultados Desde el reinicio de la actividad quirurgica se han programado 19 pacientes, de los cuales 2 han sido suspendidos por presentar COVID-19, diagnosticado uno por PCR positiva para SARS-CoV-2, y otro por alteraciones analiticas y radiologicas compatibles con esta infeccion En el seguimiento realizado no se han detectado complicaciones relacionadas con COVID-19, con una mediana de seguimiento de 10 dias (4-14 dias) Conclusiones Resultados preliminares indican que el protocolo disenado para asegurar la correcta aplicacion de medidas de prevencion de transmision de la infeccion por coronavirus esta siendo seguro y efectivo

Introduction:Intraoperative surgical outcomes are influenced by a wide variety of environmental, provider and institutional factors. There is little in the current literature that provides ...

It is well established that resident’s exposure and training are of primary importance and positively correlated with patient and health quality outcomes. We aimed to compare and contrast urology residents’ self-reported perspectives and attitudes toward exposure and education of andrology and male infertility during residency in both the United States and Europe. We performed a cross-sectional design study using a survey that was distributed to a representative sample of American and European urology residents. The survey included questions regarding demographics, and the residents’ perception and description of their training in this specific subspecialty. Response data were analyzed using Chi-square tests. Sixty-five percent of European and thirty-five percent American urology residents reported feeling uncomfortable in a new consultation evaluating an infertile patient and interpreting semen analyses. Surprisingly, more than half of responders replied that they would not go to their own training institutions seeking for male fertility care (78% US and 58% Europeans). In the comparative analysis, although no differences were observed in the very low number (18%) of hospitals that offer formal microsurgical training for urology residents between the US and Europe, more US institutions were reported to have an operating microscope for urology (68% vs. 41%), and more US residents replied reported participating in at least one urologic surgery using the microscope (65% vs. 34%). In conclusion, both American and European residents shared the same frustration regarding their education and exposure to andrology and male infertility during residency training. Collaborative efforts between stakeholders are needed to establish a clear and focused curriculum and training objectives to eliminate this educational gap.

We developed evidence-based guidelines for postoperative opioid prescribing after urologic surgery and assessed changes in prescribing after implementation.Prescribing data for adults who underwent 21 urologic procedures were used to derive a four-tiered guideline for postoperative opioid prescribing. This was implemented on January 1, 2018, and prescribing patterns including quantity of opioids prescribed (oral morphine equivalents; OME) and refill rates were compared between patients undergoing surgery prior to (January-April, 2017; n equals 1732) and after (January-April, 2018; n equals1376) implementation.The median OME (IQR) prescribed was significantly lower for 2018 compared with 2017 [100 (0; 175) versus 150 (60; 225); p .0001]. The median prescribed OME decreased in 14/21 procedures (67%). The refill rates did not significantly change. Guideline adherence rates after implementation, based on individual procedures, ranged from 33 to 95%.Fewer opioids were prescribed after implementing a prescribing guideline. Additional study is required to assess patient opioid utilization.

Introduction: On 21 February 2020, ‘Luigi Sacco’ Hospital was identified as a Covid-19 referral Hospital in Lombardy. The Department of Urology of our Healthcare Institution consists of two Urology Units, one at ‘L.Sacco’ Hospital (hereinafter referred to as Covid-19 hospital) and one at ‘Fatebenefratelli’ Hospital (hereinafter referred to as Covid-19-free hospital). The Healthcare System’s Administration communicated to all personnel the implementation of a planned ‘biological risk protocol’ at the Covid-19 hospital, while the Covid-19-free hospital followed regular government recommendations. We evaluated the risk of Sars-Cov-2 infection in the patients treated for surgical or invasive urologic procedures during the epidemic in the two different hospitals. Materials and methods: At the Covid-19 hospital, 12 patients underwent surgery and 51 patients invasive diagnostic procedures between 22 February and 8 March 2020; in the same period, at the Covid-19-free hospital, 21 patients underwent surgery and 56 patients invasive diagnostic procedures. We compared the incidence of Sars-Cov-2 infection among the patients who were accessed in the two Urology Units in the period of different restrictive measures after the outbreak of the epidemic. Results: We registered no cases of Sars-Cov-2 infection in the patients hospitalized in that period in Covid-19 hospital, despite three cases of swab positivity in the Covid-19-free hospital. Conclusion: The early implementation of extraordinary measures to restrict the spread of the virus offers a good protection also in a Covid-19 referral Hospital. The adoption of safety measures may be considered even after the end of the pandemic in all the health systems.

Dieser Ubersichtsartikel gibt einen Uberblick uber die Epidemiologie urologischer Gefaskomplikationen und diskutiert fur das jeweilige betroffene Gefasgebiet das intraoperative Komplikationsmanagement. Es werden Techniken zur Exposition der relevantesten Gefase (Arterien und Venen) und Tricks zur Gefasreparatur erlautert. Insgesamt sind Gefasverletzungen wahrend urologischer Operationen selten, aber dennoch, wenn solche Komplikationen eintreten, eine haufige Ursache fur eine kritische Morbiditat und Mortalitat in der perioperativen Phase. Spezielle Pradispositionen, wie z. B. ausgedehnte Tumorresektionen und Revisionsoperationen, erhohen das Risiko fur Gefaskomplikationen. Das Spektrum der Verletzungen ist breit – von der Arosion bis zum kompletten Gefasabriss. Analog dazu ist die Therapie von der einfachen Naht bis hin zur komplexen endovaskularen Reparatur bzw. offenem prothetischem Gefasersatz breit gefachert. Fur das optimale Blutungsmanagement muss visuelle Ubersicht geschaffen werden und schnellstmogliche Reparationsstrategien eingeleitet werden. Ziel ist die Schadensbegrenzung und Stabilisierung des Patienten. Bereits die Operationsplanung und die Zuhilfenahme erfahrener Kollegen sind weitere Eckpunkte eines erfolgreichen Komplikationsmanagements. Desastrose Blutungen sollen kontrolliert werden und im Falle von arteriellen Verletzungen idealerweise die Perfusion wiederhergestellt werden. Hierfur werden Gefasanastomosierungen angestrebt, aber auch Patch-Angioplastien oder Interponate konnen notwendig sein. Direktnahtverfahren fuhren haufig zu Gefasstenosen; ggf. mussen die Gefase noch ausreichend prapariert werden, um adaquate Gefasklemmen vor der Reparatur zu platzieren. Die meisten Venen konnen dauerhaft z. B. mittels Ligatur unterbrochen werden. Auch endovaskulare Verfahren konnen zum Einsatz kommen, um die Blutung zu stoppen oder aber komplementar verwendet werden. So konnen z. B. aortale Blutungen mittels Ballonokklusion kontrolliert werden und zur Stabilisierung des Patienten fuhren, um dann die Gefasrekonstruktion vorzunehmen. Schwere Blutungen kommen meist retroperitoneal im Bereich der Aorta, Viszeralarterien und Iliakalarterien sowie den entsprechenden Venen bei Lymphadenektomien, Nephrektomien und Prostatektomien vor. Sogar beim laparoskopischen Zugangsweg treten Blutungskomplikationen auf.

Urologic surgeries are widely performed, and the cases have increased owing to the fact that the elderly population is growing. The narrow and limited surgical space is a challenge in performing most urologic surgeries. Additionally, the elderly population is exposed to the risk of perioperative complications; therefore, a comprehensive understanding and approach are required to provide optimized anesthesia during surgery. We have searched the literature on anesthesia for urologic surgeries and summarized the anesthetic considerations for urologic surgeries.

Robotic assisted radical cystectomy (RARC) has gained popularity within minimally-invasive urologic surgery, and has been shown to be a safe procedure with similar oncologic outcomes when compared to the conventional open standard. While initial RARC feasibility and outcomes studies were performed with extracorporeal urinary diversion, intracorporeal urinary diversion (ICUD) is becoming increasingly utilized. Reported benefits of an intracorporeal approach include decreased blood loss and a lower incidence of ureteral strictures. While ICUD is technically challenging, many have overcome the learning curve associated with this procedure via a mentorship model and a dedicated operative team. Techniques vary between institutions, and ileal conduit, continent cutaneous and orthotopic continent (neobladder) diversions have all been performed. Herein, we describe the learning curve, technical points, and unique complications associated with ICUD.

This study assessed the ability of the LACE + [Length of stay, Acuity of admission, Charlson Comorbidity Index (CCI) score, and Emergency department visits in the past 6 months] index to predict adverse outcomes after urologic surgery. LACE + scores were retrospectively calculated for all consecutive patients (n = 9824) who received urologic surgery at one multi-center health system over 2 years (2016–2018). Coarsened exact matching was employed to sort patient data before analysis; matching criteria included duration of surgery, BMI, and race among others. Outcomes including unplanned hospital readmission, emergency room visits, and reoperation were compared for patients with different LACE + quartiles. 722 patients were matched between Q1 and Q4; 1120 patients were matched between Q2 and Q4; 2550 patients were matched between Q3 and Q4. Higher LACE + score significantly predicted readmission within 90 days (90D) of discharge for Q1 vs Q4 and Q2 vs Q4. Increased LACE + score also significantly predicted 90D emergency room visits for Q1 vs Q4, Q2 vs Q4, and Q3 vs Q4. LACE + score was also significantly predictive of 90D reoperation for Q1 vs Q4. LACE + score did not predict 90D reoperation for Q2 vs Q4 or Q3 vs Q4 or 90D readmission for Q3 vs. Q4. These results suggest that LACE + may be a suitable prediction model for important patient outcomes after urologic surgery.

ObjectiveTo assess provider and practice characteristics that drive opioid prescription behavior using the American Urological Association census data.MethodsStratified weighted analysis using 1,157 census samples was performed to represent 12,660 urologists who practiced in the United States in 2018. We compared urologists according to their opioid prescription patterns to evaluate factors and motivations behind opioid use in the post-operative setting.ResultsOverall, 11,205 (88.5%) urologists prescribe opioids in the post-operative setting. The presence of procedure-specific institutional prescribing guidelines was associated with a greater tendency to prescribe ≤10 pills, and lesser tendency to prescribe 11 to 49 and ≥50 tablets following open abdominal (P=.003), laparoscopic (P < .001), scrotal (P < .001), and endoscopic surgeries (P < .001). The presence of institutional prescribing guidelines was associated with decreasing opioid prescriptions over a three-year period whereas not having guidelines was associated with an unchanged prescription practice over time. Basing current prescriptions on what was given to prior patients was reported by 85% and was more likely to result in an unchanged amount of prescriptions over time (29.2% vs 13.3%, P=.007). Motivations to avoid patient phone calls were reported by 23.8% and were more likely to increase the opioids provided within the next 3 years (3.2% vs 0.1%, P < .001).ConclusionPractitioners who endorsed using institutional guidelines prescribed fewer opioids following all types of surgery and were more likely to decrease their prescription behavior over time. This data supports continued efforts to provide urologists with more evidence-based guidance on best practice opioid prescribing in the future.

Among the various robotic devices that exist for urologic surgery, the most common are synergistic telemanipulator systems. Several have achieved clinical feasibility and have been licensed for use in humans: the standard da Vinci, Avatera, Hinotori, Revo-i, Senhance, Versius, and Surgenius. Handheld and hands-on synergistic systems are also clinically relevant for use in urologic surgeries, including minimally invasive and endoscopic approaches. Future trends of robotic innovation include an exploration of more robust haptic systems that offer kinesthetic and tactile feedback; miniaturization and microrobotics; enhanced visual feedback with greater magnification and higher fidelity detail; and autonomous robots.

Purpose: To describe the anatomy of the swine urinary system using computed tomography and to discuss the role of this animal as an experimental model for urological procedures. Methods: Three male Landrace pigs underwent computed tomography and the anatomy of the urinary system and renal circulation was analyzed and described. Results: In all animals, 2 kidneys, 2 ureters and one bladder were identified. Each kidney presented a single renal artery vascularization, with a mean diameter on the right of 4.45 and 5.31 mm on the left (p < 0.0001) and single renal vein drainage, with a mean diameter on the right of 5.78 and 5.82 mm on the left (p = 0.0336). The average renal length was 9.85 cm on the right and 10.30 cm on the left (p < 0.0001). The average renal volume was 113.70 cm3 on the right and 109.70 cm3 on the left (p < 0.0001). The average length of the ureter was 19.78 cm on the right and 22.08 cm on the left (p < 0.0001). The average bladder volume was 423.70 cm3. Conclusions: The data obtained show similarities with human anatomy, suggesting the viability of the swine model for planning preclinical trials, basic research, refinement in experimental surgery and surgical training for urological procedures.

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic prompted a transition to telehealth in Urology. No study has analyzed urologic surgical outcomes among patients evaluated preoperatively via telehealth only. We compared surgical outcomes between patients who had telehealth only versus in-person preoperative visits prior to urologic surgery. METHODS: Retrospective single center review of all urologic surgeries from April-December 2020. Cases were classified based on whether patients visited preoperatively in person or via telehealth. Major exclusion criteria included having both preoperative in person and telehealth visits. Cases were stratified into four categories for analysis based on CPT coding: Upper Tract Endoscopic (UTE), Lower Tract Endoscopic (LTE), Major Abdominal (MA) (Open/ Laparoscopic/Robotic), and Lower Tract Reconstructive (LTR). Covariates of interest included age, sex, race, ASA status, and distance from hospital. Outcomes included need for blood products, complications, operative time, and length of stay (LOS). Complications were identified using reported morbidity and mortality data and organized based on the Clavien-Dindo scale;scores >2 were considered major complications. RESULTS: Table 1 displays demographic and outcomes of interest. 1,405 patients met inclusion criteria with 101 visits being telehealth only. There was no difference in sex, race, and ASA status. Telehealth patients were younger and lived farther away from the hospital and more likely to undergo UTE or MA surgeries compared to in person visits. There was no difference in perioperative complications or transfusion events between groups. Stratified by procedure type, there was no difference operative time or LOS between cohorts for UTE, MA, or LTE surgeries. LTR surgeries were associated with shorter operative times for telehealth patients, but no difference in LOS. CONCLUSIONS: Patients seen preoperatively by telehealth alone experienced no difference in complications or length of stay when undergoing urologic surgery, including major abdominal surgery. Despite limitations in selection bias and its retrospective nature, our study suggests that telehealth based preoperative evaluation is feasible and safe in appropriately selected patients undergoing urologic surgery.

INTRODUCTION AND OBJECTIVE:In efforts to judiciously utilize resources and contain cost, there has been increasing efforts to reduce postoperative length of stay, resulting in several groups promot...

INTRODUCTION AND OBJECTIVE:Opioid related mortality is a leading cause of death in the United States (US). Post-operative prescriptions provide a significant source of opioids in the community and ...

INTRODUCTION AND OBJECTIVE:Surgical medical missions allow for the global transfer of surgical skills, knowledge, and resources between high and low to middle-income countries to the benefit of bot...

Introduction and Objectives: Hem-O-Lok Weck Clip (HOLC) is widely used to achieve athermal hemostasis during minimal access urologic surgery, most commonly during prostatectomy and nephrec...

Adequate pain management is important for successful postoperative recovery after any surgical procedure. Unfortunately, the USA and many other parts of the world are in the midst of an opioid epidemic, and healthcare providers are thus tasked with balancing the comfort and recovery of their patients after an operation against the individual and societal harms of the over-prescription of opioids. The goal of this article is to discuss the range of opioid formulations currently in use, examine why this may be problematic, and explore alternatives that provide similar efficacy and may improve overall safety in the pediatric population after urologic surgery. Improving the way opioids are prescribed through clinical practice guidelines as well as considering alternatives to opioids can ensure patients have access to safer and more effective pain treatments and potentially reduce opioid misuse.

The COVID-19 pandemic induced a global emergency that overwhelmed most hospitals around the world. Access to Hospitals has been restricted to selective oncological and urgent patients to minimize surgeries requiring Intensive Care Unit care. All other kind of non- urgent and benign surgeries have been rescheduled. The burden of oncological and urgent cases on the healthcare system has increased. We have been asked to become the referral center for major oncological and urgent urological surgeries, increasing our surgical volume. Through meticulous hospital protocols on PPE, use of nasopharyngeal swabs, controlled hospital access and the prompt management of suspected/positive cases, we were able to perform 31% more urological surgical procedures during the COVID-19 pandemic compared to the same period in 2019. We observed a 72% increase in oncological surgical procedures and 150% in urgent procedures. Our experience shows how the management of oncological and urgent cases can be maintained during unexpected, global emergencies, such as COVID-19.

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To examine the potential of LACE+ scores, in patients undergoing urologic surgery, to predict short-term undesirable outcomes.Coarsened exact matching was used to assess the predictive value of the LACE+ index among all urologic surgery cases over a 2-year period (2016-2018) at 1 health system (n = 9824). Study subjects were matched on characteristics not assessed by LACE+, including duration of surgery and race, among others. For comparison of outcomes, matched populations were compared by LACE+ quartile with Q4 as the referent group: Q4 vs Q1, Q4 vs Q2, Q4 vs Q3.Seven hundred and twenty-two patients were matched for Q1-Q4; 1120 patients were matched for Q2-Q4; 2550 patients were matched for Q3-Q4. Escalating LACE+ score significantly predicted increased readmission (2.86% vs 4.91% for Q2 vs Q4; P = .012) and Emergency Room (ER) visits at 30 days postop (5.69% vs 11.37% for Q1 vs Q4, 4.11% vs 11.45% for Q2 vs Q4, 8.29% vs 13.32% for Q3 vs Q4; P.001 for all). Increasing LACE score did not predict reoperation within 30 days or rate of death over follow-up within 30 postoperative days.The results of this study suggest that the LACE+ index is suitable as a prediction model for important patient outcomes in a urologic surgery population including unanticipated readmission and ER evaluation.

The present study aimed to evaluate the effect of Benson's muscle relaxation on postoperative spinal anesthesia-induced pain.Randomized clinical trial.Sixty-four patients were randomly assigned to intervention and control groups. Benson's muscle relaxation was performed on the intervention group for 10 to 20 minutes based on the patients' tolerance. Before and after the intervention, the two groups were assessed using the visual analog scale and compared. SPSS version 23 was used to analyze data.The mean pain score in the control group before and after the intervention was 5.34 and 5.62, respectively (P.003), and in the intervention group, 5.28 and 4.03, respectively (P.001).Benson's relaxation technique effectively influenced the intensity of postoperative spinal anesthesia-induced pain. Therefore, it can be used by nurses as a safe, simple, and inexpensive nonmedicinal treatment method to relieve spinal anesthesia-induced pain.

Introduction With the advanced laparoscopic and robotic surgery, thromboembolic prophy-laxis in urologic procedures has traditionally been based on the experience of other surgicalspecialties. This paper aims to analyze the current recommendations, through a detailed studyof the European clinical guidelines and bibliography, applying the recommendations of throm-boprophylaxis to the daily urological practice. Objectives To elaborate general recommendations to surgical patients in Urology, avoidingthe risk of perioperative thromboembolic events. Optimize medication in chronic patients andaccurately classify who are eligible for bridge therapy. Material and methods A review of the available literature and the European clinical guidelineswas carried out. We analyzed the most recent consensus articles by studying the availablebibliography, trials and reviews on which the European guidelines for thromboprophylaxis inurology are based. Results Thromboembolic prophylaxis should be targeted towards surgeries that require abdo-minal approaches, prolonged bed rest or oncological pathologies. Bridge therapies with lowmolecular weight heparins should be limited. Patients undergoing treatment for chronic condi-tions can benefit from bridge therapies in specific cases. Conclusions According to the current guidelines, there might be an overuse of heparins in thedaily clinical practice. The development of -direct oral- anticoagulants have shown to reducethe time to reintroduction of medication for chronic conditions as well as a more effectivebleeding management.

The appropriate use of the robot in surgery continues to evolve. Robotic operations (RO) are particularly advantageous for deep pelvic and retroperitoneal procedures, but the implementation of RO is unknown. We aimed to examine regional variation for the most commonly performed RO in general, gynecologic, and urologic surgery. A three-state inpatient database from 2008 to 2011 was used. Nine common robotic inpatient general, gynecologic and urologic surgery procedures were analyzed. States were divided into hospital service areas (HSAs). The percentage of RO was calculated for each operation. Hospital service areas that had 50% or 150% of the RO average were outliers. Hospital service areas were compared based on demographics, patterns of adoption, variation in usage, and association with population, physician and hospital density. Hysterectomies were the procedure that was performed most often robotically. Over 50% of radical prostatectomies were performed robotically. Procedures with the highest rate of RO performance were performed with the least variation. Characteristics that were significantly correlated with RO included provider and hospital density. Variation in the utilization of RO is common and differs by operation. Physician density impacts access to care and is associated with the variation in use of RO depending on procedure type. Further research is needed to understand the causes of variation and adoption of RO.

Background Although only a limited number of medical schools require a formal educational rotation in urologic surgery, urology as a medical specialty continues to attract a large number of students into the match each year. The purpose of this study was to describe medical student awareness, perception, and knowledge of urology, to determine factors influencing students’ consideration of urology as a career, and to determine if prior urology clerkship experience is associated with differences in these variables. Methods In this cross-sectional study, medical students were electronically surveyed in 07/2016. Self-reported and question-based knowledge of urology were determined. A total of 25 factors were assessed with a five-point Likert scale to determine their influence on students’ consideration of urology as a career. Data analysis was performed using R. Results The survey was completed by 114 students (13.5% of all medical students). A total of 11(9.65%)students had previously participated in a urology clerkship. All students reported awareness of urology; however, only 74 students (64.9%) correctly identified the training pathway and job duties of urologists. Self-perceived knowledge of urology was poor but improved with increased medical school training. Question-based assessment also demonstrated increased knowledge with advanced medical school training (27% per year; p Conclusions Although medical students are aware of urology as a specialty, they perceive their knowledge of urology as poor. However, knowledge of urology increases throughout medical school training. Multiple factors influence students’ consideration of urology as a career choice. Additional studies are needed to further explore how participation in a formal urology experience alters students’ perceptions and influences their consideration of urology as a career choice. Trial registration Retrospectively registered.

Despite the current era of precision surgery in robotics, an unmet need still remains for optimal surgical planning and navigation for most genitourinary diseases. 3D virtual reconstruction of 2D cross-sectional imaging has been increasingly adopted to help surgeons better understand the surgical anatomy. To provide a short overview of the most recent evidence on current applications of 3D imaging in robotic urologic surgery. A non-systematic review of the literature was performed. Medline, PubMed, the Cochrane Database and Embase were screened for studies regarding the use of 3D models in robotic urology. 3D reconstruction technology creates 3D virtual and printed models that first appeared in urology to aid surgical planning and intraoperative navigation, especially in the treatment of oncological diseases of the prostate and kidneys. The latest revolution in the field involves models overlapping onto the real anatomy and performing augmented reality procedures. 3D virtual/printing technology has entered daily practice in some tertiary centres, especially for the management of urological tumours. The 3D models can be virtual or printed, and can help the surgeon in surgical planning, physician education and training, and patient counselling. Moreover, integration of robotic platforms with the 3D models and the possibility of performing augmented reality surgeries increase the surgeon’s confidence with the pathology, with potential benefits in precision and tailoring of the procedures.

To evaluate the literature assessing postoperative urinary retention (POUR) after non-urologic surgeries, including risk factors, as well as short- and long-term consequences. POUR is multifactorial; however, several risk factors, such as male sex, advanced age, and preexisting lower urinary tract symptoms are well established. Procedures that do not involve damage to the urinary or nervous system are rarely associated with long-term consequences, as opposed to colorectal surgery in which long-term voiding dysfunction may be experienced. Improved surgical technique may improve results in these cases. Various preventive methods have been studied. While medical prevention has been efficacious in some cases, physical, noninvasive interventions failed to show a benefit. While general risk factors for POUR are known, the literature assessing these factors varies widely and, in many cases, with conflicting results. With the expansion of ambulatory surgery, it is expected that the POUR will become more frequent. Prospective, well-designed studies are needed to guide the management in these cases.

A mobile application (app) designed on the basis of a literature review and interviews with urologic oncologists was created to help streamline robot-assisted radical prostatectomy care and in compliance with quality indicators. Use of the app was limited to English-speaking men with iPhones; 20 of 43 men approached (47%) agreed to participate. Lack of an iPhone was the most common reason for non-enrollment (52%). Preoperatively, men received daily push notifications to perform Kegel exercises and 19 men (95%) completed an Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) questionnaire using the app. After hospital discharge, men completed a postoperative pain questionnaire and received push notifications to ambulate and increase their fluid intake. After catheter removal, daily notifications to perform Kegel exercises and complete weekly EPIC-CP surveys were pushed to monitor recovery of functional outcomes. EPIC-CP and postoperative pain assessment response rates were 75% and 90%, respectively. 85% of the men complied with notifications to ambulate, hydrate, and perform Kegel exercises. The 15 men (75%) who completed the satisfaction survey found the app easy to use and understand, which suggests that mobile apps can be easily implemented perioperatively. Mobile apps have the potential to improve compliance with perioperative instructions and allow more frequent capture of patient-reported outcomes with minimal resource utilization. Patient summary: We examined the use of a mobile application designed to capture patient-reported outcomes and guide postoperative care after major urologic surgery. Mobile apps can be implemented with relative ease and high patient satisfaction.

Background: Benign prostatic hyperplasia is the most prevalent non-malignant prostate disease affecting over 50% of the aging male population. Transurethral prostate resection (TURP) is the standard reference (i.e. the most effective endoscopic surgical procedure for this disorder). Aim of the study: To compare the effectiveness and safety of normal saline vs sterile distilled water in massive irrigation in urological endoscopic surgery (TURP) as regards electrolytedisturbance (Na+ level), serum creatinine and occurrence of TURP syndrome. Patients and Methods: This study included fifty male patients with benign prostatic hyperplasia, aging 50-70 years old, admitted to operating room in Ain Shams University hospitals for TURP. The patients were divided into two equal groups, Group 1: underwent endoscopic urological surgery (TURP) with normal saline wash using bipolar resectoscope, Group 2: underwent endoscopic urological surgery (TURP) with distilled water wash using monopolar resectoscope. Results: The current study showed significant decrease in serum Na+ level in distilled water group than in normal saline group in both postoperative and 24 hr later. Also, we found significant decrease in hemoglobin level at 24hr postoperative in distilled water group compared to saline group.Conclusion: Our results demonstrate that normal saline wash during TURP causes less drop-in serum sodium and Hb level, less fluid overload, less incidence of TURP syndrome and decreased need for blood transfusion than using distilled water as irrigant.