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Purpose: Placement of a drain during robotic assisted partial nephrectomy (RAPN) and robotic assisted radical prostatectomy (RARP) is standard practice for many urologists and can aid in assessment and management of complications such as urine leak, lymphocele, or bleeding. However, drain placement can cause discomfort and delay patient discharge, with questionable benefit. We aim to assess the correlation between drain placement with post operative complications., Methods: The NSQIP targeted database was queried for patients who underwent RAPN or RARP from 2019 to 2021. Our primary outcomes included 30-day complication rates stratified by intraoperative drain placement. Secondary outcomes included procedure-specific complications, length of stay (LOS), and readmissions. Multivariable regression analyses, with Bonferroni correction, were performed for each post-operative complication., Results: We identified 4738 and 13,948 patients who underwent RAPN and RARP, respectively. Drains were not placed in 2258 (47.7%) and 6700 (48%) patients, respectively. On adjusted multivariable analysis in the RAPN cohort, omission of drain placement was associated with decreased LOS (β -0.45; 99.58% CI [-0.59, -0.32]) but no difference in overall complication rates. After adjusted analysis in the RARP cohort, omission of drain placement was associated with decreased risk of any complication (OR 0.73 [0.62-0.87]), infectious complication (OR 0.66 [0.49-0.89]), and LOS (β -0.30 [-0.37, -0.24])., Conclusions: Using a large contemporary database, this study demonstrates that omission of drains during RAPN and RARP was safe without increased risk of postoperative complications. Despite inherent selection bias in this cohort, our data suggests that routine drain placement is not necessary for these procedures., (© 2024. The Author(s).)

While the gold-standard for management of localized renal cell carcinoma (RCC) is partial nephrectomy, recent ablative strategies are emerging as alternatives with comparable rates of complications and oncologic outcomes. Thermal ablation, in the form of radiofrequency ablation and cryoablation, is being increasingly accepted by professional societies, and is particularly recommended in patients with a significant comorbidity burden, renal impairment, old age, or in those unwilling to undergo surgery. Maturation of long-term oncologic outcomes has further allowed increased confidence in these management strategies. New and exciting ablation technologies such as microwave ablation, stereotactic body radiotherapy, and irreversible electroporation are emerging. In this article, we review the existing management options for localized RCC, with specific focus on the oncologic outcomes associated with the various ablation modalities. [ABSTRACT FROM AUTHOR]

Simple Summary: Cytoreductive surgery (CS) is performed to remove the primary tumor in the setting of metastatic disease. In metastatic renal cell carcinoma (mRCC), the role of cytoreductive nephrectomy (CN) in the treatment paradigm has evolved, adjusting to new changes in systemic therapy agents. In particular, immunotherapeutic agents, which utilize the body's own immune system to attack cancerous cells, have improved over the past decade. Newer immunotherapy agents offer more effective treatments in mRCC, with the goal of more tolerable side effect profiles. However, now urologic and medical oncologists must reframe the role of CN in the context of these new systemic therapies. This review will discuss the current data on this topic as well as the historical context in which it is being studied. The role of CN in the treatment of metastatic renal cell carcinoma (mRCC) has been studied over the course of the past few decades. With the advent of immuno-oncologic (IO) agents, there has been a paradigm shift in the treatment of RCC. Within this new era of cancer care, the role of CN is unclear. There are several studies currently underway that aim to assess the role of CN in combination with these therapies. We reviewed articles examining CN, both historically and in the modern immunotherapy era. While immune-oncologic agents are relatively new and large clinical trials have yet to be completed, data thus far is promising that CN may provide clinical benefit. Multiple ongoing trials may clarify the role of CN in this new era of cancer care. [ABSTRACT FROM AUTHOR]

The intraoperative placement of surgical drains often represents routine practice for most major urologic procedures to drain lymphatic fluid, blood, or urine postoperatively. However, placement of drains may increase patient discomfort and has questionable benefits. Our study aims to correlate drain placement (vs. no drain placement) with postoperative complications following major urologic oncology operations. The National Surgical Quality Improvement Program database included 35,065 patients undergoing major surgery for urologic malignancies from 2019 to 2021. Baseline characteristics and complication rates were stratified by urologic procedure and intraoperative drain placement. Statistical endpoints included thirty-day complications, length of stay (LOS), readmissions, and mortality. Univariable analyses were performed to determine factors associated with postoperative morbidity. Significant variables were retained and backward elimination multivariable regression analyses were performed to characterize if intraoperative drain placement added a significant benefit in patient risk for each postoperative complication. A total of 4,235 (96.29%), 3,640 (57.27%), 1,487 (20.38%), and 9,648 (56.71%) of patients undergoing radical cystectomy, partial nephrectomy, radical nephrectomy, and radical prostatectomy, respectively, had an intraoperative drain placed (Table 1). On multivariable analysis, no drain placement during radical cystectomy was associated with increased LOS (β=0.95; 95% CI 0.33-1.57) and increased wound complications (OR=1.63; 95% CI 1.06-2.50). Patients without a drain placed experienced a decreased rate of any postoperative complication for partial nephrectomy (OR=0.78; 95% CI 0.66-0.92), radical nephrectomy (OR=0.70; 95% CI 0.60-0.82), and radical prostatectomy (OR=0.76; 95% CI 0.68-0.84).;No drain placement was also associated with decreased infectious complications following radical nephrectomy (OR=0.51; 95% CI 0.38-0.69) and radical prostatectomy (OR=0.73; 95% CI 0.60-0.88) (Table 2). The absence of an intraoperative drain following major urologic procedures did not increase 30-day complication rates or hospital readmissions following partial nephrectomy, radical nephrectomy, and radical prostatectomy. Drainless procedures in selected patients may not add to postoperative morbidity and may increase patient recovery. Further analysis regarding the association with drain placement and complications should be completed. [ABSTRACT FROM AUTHOR]