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We investigate the safety and efficacy of pharmacological venous thromboembolism prophylaxis in patients treated with robotic partial nephrectomy at our center.We retrospectively examined our robotic partial nephrectomy database for cases performed between 2006 and 2014. Clinical venous thromboembolism episodes within 6 months from surgery were documented. Patients were stratified according to the administration of pharmacological venous thromboembolism prophylaxis into pharmacological prophylaxis (222) and no pharmacological prophylaxis (762) groups. The groups were compared in terms of perioperative outcomes, complications and adverse hemorrhagic events defined as the administration of 2 or more units of red blood cells, the need for vascular embolization or any procedures related to blood loss.There were no differences between the pharmacological prophylaxis and no pharmacological prophylaxis groups regarding mean operation time, median warm ischemia time and estimated blood loss. The rates of venous thromboembolism events were comparable between the groups (pharmacological prophylaxis 1.8% vs no pharmacological prophylaxis 2.1%, p=0.75). Overall 90% of venous thromboembolism events occurred within the first postoperative month. In the multivariable regression analysis encompassing pharmacological prophylaxis, perioperative aspirin intake, body mass index, operation time, Charlson comorbidity index, fellowship training and tumor complexity, operation time (OR 1.06, p=0.009) and Charlson comorbidity index (OR 1.28, p0.0001) were associated with adverse hemorrhagic events.The administration of pharmacological prophylaxis did not increase the rate of adverse hemorrhagic events. Isolated inpatient administration of pharmacological prophylaxis after robotic partial nephrectomy does not appear to protect against venous thromboembolism postoperatively in that the majority of venous thromboembolism events occurred within the first 30 days after surgery. Longer duration of pharmacological prophylaxis for the prevention of venous thromboembolism after robotic partial nephrectomy should be considered.

With the incidence of renal cell carcinoma on the rise treatment options for the small renal mass have broadened. Cryoablation is increasingly used as a therapeutic option for renal tumors in select cases. However, studies with long-term oncologic outcomes are sparse. We evaluated the long-term oncologic outcomes of laparoscopic renal mass cryoablation.We reviewed our laparoscopic cryoablation database for patients treated with laparoscopic cryoablation from October 1997 to February 2005. Patients with less than 3 months of followup were excluded from study. Patient and tumor characteristics, and perioperative outcomes, including complications, were recorded. Recurrence-free, cancer specific and overall survival was analyzed using Kaplan-Meier curves.A total of 142 tumors in 138 consecutive patients were treated with laparoscopic cryoablation. Mean age of the cohort was 66.35 years. Of the patients 99 (71.7%) were male and 39 (28.3%) were female. Mean body mass index was 29.15 kg/m(2) and median ASA score was 3. A solitary kidney was present in 23 patients (16.2%). Mean tumor size on cross-sectional imaging was 2.4 cm. The mean preoperative and postoperative estimated glomerular filtration rate was 66.72 and 61.00 ml per minute, respectively. The postoperative estimated glomerular filtration rate was determined at a mean ± SD of 15.17 ± 10.99 months of followup. The median R.E.N.A.L. nephrometry score was 5. Of the 142 tumors 100 were diagnosed as renal cell carcinoma after histopathological examination of the biopsy specimen. At 3, 5 and 10 years in patients diagnosed with renal cell carcinoma estimated recurrence-free survival was 91.4%, 86.5% and 86.5%, estimated cancer specific survival was 96.8%, 96.8% and 92.6%, and estimated overall survival was 88.7%, 79.1% and 53.8%, respectively. Mean followup was 98.8 ± 54.2 months in those diagnosed with renal cell carcinoma. Mean time to recurrence was 2.3 years. The latest experienced recurrence was 4.4 years after laparoscopic cryoablation. There was a postoperative complication rate of 10.6% with a total of 15 complications.Laparoscopic cryoablation achieves good long-term oncologic outcomes for localized small renal masses. It can safely be used in patients who cannot undergo or are unwilling to accept the risks of partial nephrectomy. Mean time to recurrence was 2.3 years and all recurrences developed within 4.4 years of initial treatment.

RESULTS: The median age at the time of surgery was 62 years (inter-quartile range 53-70), 67% were men. The average tumor size ( standard deviation) was 3.3cm ( 1.4), in a range of 1-8cm. Local recurrence was found in 20 patients (2.8%) at an average of 31.5 ( 26.6) months after surgery. Among these, renal local recurrence was found in 18 (90%) patients, peri-renal in 5 (25%), and in 3 patients (15%) a combined recurrence. 16 (80%) and 3 (15%) of the patients with local recurrence were treated with radical and partial nephrectomy respectively. The last patient was treated medically only. Moreover, among these 20 patients, in 6 patients a metastatic progression was found. In 3 patients at the time of local recurrence and in 3 patients after 24-45 months after the local recurrence. Local recurrence was not significantly related to positive surgical margins (p1⁄40.10), histological type (p1⁄40.26), Age (p1⁄40.88), and gender (p1⁄40.41), but was significantly related to the tumor stage (p1⁄40.001) and grade (p

INTRODUCTION AND OBJECTIVES: Extirpative treatment of Upper Urinary Tract Urothelial Carcinoma (UTUC) has long been the standard of care regardless of tumor grade. We herein stratify oncologic outcomes based on tumor grade with implications for the role of systemic chemotherapy. We present long-term oncologic outcomes of all patients treated with nephroureterectomy (NU) for UTUC over a 15 year time period. METHODS: All patients (N1⁄480) were treated by a single surgeon with extirpative surgery for UTUC as a primary treatment. The majority (90%) underwent laparoscopic NU via a retroperitoneal approach, with transurethral incision of the ureteric orifice and then open bladder-cuff excision through a Gibson incision. The open surgical approach was used in 6 (7.5%) cases and distal/ segmental ureterectomy only was used sparingly (2.5%). Data was prospectively collected and concurrent outpatient follow up data were retrospectively reviewed. Statistical analysis was performed using Kaplan Meier methodology to calculate overall survival (OS), cancer specific survival (CSS), and metastasis-free survival (MFS). RESULTS: The mean age of patients was 72.5 (range 46-90), 50 male (62.5%) and mean Charlston Comorbidity Index of 5.1 (range 0-13). Mean follow-up time was 30.4 months (range 1-185.3) with median overall survival 109.2 months. Twenty-three patients (28.8%) with low grade tumors, treated with primary NU, had 2-, 5-, and 10-year OS of 100, 88, 73%. In contrast, 57 (71.3%) with high grade tumors had a lower 2-, 5-, and 10-year OS of 83, 68, 0%. Table 1 summarizes the oncologic outcomes based on histologic grade. Lymph node positive disease portends a particularly grim prognosis with 2and 5-year OS and CSS of 24 and 0% respectively CONCLUSIONS: Grade is a significant predictor of OS, CSS, and MFS in patients treated with nephroureterectomy for UTUC. Extirpative therapy was found to result in relatively poor long-term CSS in patients with high grade disease, underscoring the need for adjuvant or neoadjuvant therapies.

Fig. 2. Comparison of microvascular remodeling in the urinary bladder of control, interstitial cystitis/painful bladder syndrome (IC/PBS) and Ketamine-induced cystitis (KC) patients under electron microscopy. (A) Controls, basement membrane (arrowheads), (i) Small vessel, and (ii) Greater vessel. (B) IC/PBS, basement membrane (arrowheads) and mast cells (long arrow), (i) Small vessel, and (ii) Greater vessel. (C) KC, duplication of basement membrane (arrowheads) (i) Small vessel, and (ii) Greater vessel. (A)(B)(C) Red bar 1⁄4 2mm.

clamp. In our experience with hilar lesions, only the renal artery is clamped while the renal vein remains open throughout the procedure. Reconstruction of the kidney is performed with care not to obstruct the renal pelvis post operatively. CONCLUSIONS: Robotic-assisted laparoscopic partial nephrectomy is a safe and feasible option for the treatment of complex renal masses including hilar tumors.

several years (Hexvix) and has recently been approved in the US (Cysview) and is being used by select centers. In the video we demonstrate use of Cysview for detection of NMIBC. METHODS: From August 2012 to August 2013, 96 patients scheduled for TURBT at our institution have undergone instillation of Cysview and cystoscopy under blue light. Several cases are highlighted in the video demonstrating cystosocpic view under normal and blue light with pathology results. RESULTS: Use of Cysview to detect NIMBC is demonstrated in 2 select cases as seen in figure 1. The top images are under normal cystoscopy and the bottom images demonstrate the same view under blue light cystoscopy following administration of Cysview. The fluorescent areas were biopsied and revealed high-grade pT1 in the patient on the left and high grade pT1 and CIS in the patient on the right. CONCLUSIONS: Use of Cysview can help with the detection of NMIBC as well as CIS in patients undergoing TURBT for bladder cancer.

INTRODUCTION AND OBJECTIVES: Since 2009, Centers for Medicare and Medicaid Services (CMS) began publishing 30-day readmission data for selected medical diseases. The Readmission Reduction Program went into effect on October 1st, 2012 and hospitals are now financially penalized for excess readmissions. The purpose of this study is to identify factors associated with 30-day readmission after robotic partial nephrectomy (RPN). METHODS: We retrospectively reviewed our Institutional ReviewBoard approveddatabase of RPN.Demographics and perioperative parameters were analyzed. Comparisons between both groups were evaluated using Wilcoxon rank-sum test for continuous variables, while chi-square test, or Fisher’s exact test (if events number were small) were used for categorical variables. Simple or multivariable logistic regression analysis was applied to identify factors associated with readmission. Results were considered significant when p value was

cation to include complex cases such as nerve-sparing radical prostatectomy. We present our experience with athermal nerve-sparing RLESS radical prostatectomy and describe our technique. METHODS: Between May 2008 and May 2010. A total of 20 R-LESS radical prostatectomies were performed, including 3 using an athermal nerve-sparing technique. We demonstrate the steps of this procedure in video format including: 1) Placement of the single port access device, 2) Description of necessary equipment 3) Mobilization of the bladder 4) Incision of the endopelvic fascia 5) Ligation of the dorsal venous complex 6) Dissection of the bladder neck 7) Dissection of the seminal vesicles 8) Control of the vascular pedicles 9) Antegrade dissection of the neurovascular bundles from the prostate, 10) Antegrade dissection of the prostate from the rectum 11) Transection of the dorsal venous complex and urethra 12) Entrapment of the prostate, and 13) Vesico-urethral anastamosis. Additionally we present our cumulative outcomes including: demographics, perioperative data, pathology, margin status, postoperative SHIM score, and continence rates. RESULTS: All three athermal nerve-sparing R-LESS radical prostatectomies were performed without the addition of extra ports. Demographics and postoperative outcomes are seen in the table. The mean operative time was 170 minutes and estimated blood loss was 100ml. Visual analogue pain scale scores was 1/10. Mean follow up was 6 months. CONCLUSIONS: Robotic laparoendoscopic single-site surgery continues to evolve and with refinements, complex procedures such as athermal nerve-sparing radical prostatectomy are possible. Our early results are promising but prospective comparisons to standard nervesparing RALP are needed.