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Introduction When laparoscopic radical prostatectomy (LRP) was introduced as a novel treatment option for prostate cancer, it had to compete with the established open techniques. The short- and intermediate-term oncologic and functional outcomes were encouraging and comparable to those with retropubic radical prostatectomy. However, the long-term oncologic safety for LRP has yet to be fully elucidated. We evaluated the long-term oncologic outcomes of an initial series of patients who had undergone LRP. Patients and Methods An initial unselected and consecutive series of 100 patients who had undergone LRP for clinically localized prostate cancer from 1999 to 2001 was identified. The pre-, intra-, and postoperative data were collected. Biochemical recurrence (BCR) was defined as a prostate-specific antigen (PSA) value of ≥ 0.2 ng/mL. The outcome measures were cancer control (CC), BCR-free survival (BCRFS), cancer-specific survival (CSS), and overall survival (OS). Results The mean patient age was 64 ± 7 years, and the mean preoperative PSA level was 9.6 ± 8.3 ng/mL. Of the 100 patients, 79 (79%) had stage pT2 and 15 (15%) had stage pT3 disease. Positive surgical margins were found in 25 patients (25%; 16.4% for pT2 and 40% for pT3). The median follow-up time was 126 months (range, 60-176 months). The 5-year CC rate was 82%. The estimated 10-year BCRFS was 83% and 80% for patients with stage pT2 and pT3 tumors, respectively. The median time to BCR was 52 months (range, 6-144 months). The estimated 10-year CSS and OS was 98% and 93%, respectively. Conclusion Our long-term follow-up data from an initial unselected patient cohort have indicated that LRP offers excellent long-term oncologic control for patients with localized prostate cancer.

Objective To present a series of 15 laparoscopic and robot-assisted Mitrofanoff and Yang-Monti vesicostomies in an adult population, and to assess the feasibility and safety of these minimally invasive approaches. Patients and Methods Between 2009 and 2012, 15 patients underwent laparoscopic (n = 11) or robot-assisted (n = 4) construction of vesicostomy by a single surgeon (D.R.): Mitrofanoff appendicovesicostomy (n = 11) or double Yang-Monti ileal conduit (n = 4). Fourteen patients underwent concomitant augmentation enterocystoplasty. Indications for surgery included neurogenic bladder (n = 11) and urethral dysfunction (n = 4). The patients were evaluated postoperatively using cystography. Quality of life (QoL) was evaluated using an internally developed questionnaire. Results All surgeries were successfully completed with no conversions. Operating time was always

serum level in prostate cancer patients before treatment is associated with poor prognosis. Moreover, there is accumulating evidences that Gleason 7 prostate cancer shows heterogeneous behavior with Gleason 3 4 and 4 3 tumors conferring different prostate cancer specific mortality. The aim of this observational study was to characterize the aggressiveness of the prostate cancer assessed by the predominant Gleason pattern (pGP), in relation to preoperative testosterone serum concentration. METHODS: 786 patients, referred to our Department (from 03/2007 to 09/2012) for a radical prostatectomy, had preoperative TT and Bioavailable Testosterone (samplings between 7 and 10 am) serum determinations (radio-immuno assayed in a central laboratory). GS and pGP was determined in prostate biopsies and prostate tissue specimens. RESULTS: In prostate specimens, a GS7 was observed in 538 (68.4%) of the patients; 195 (24.8%) had a pGP4. Comparing the 195 patients with a pGP4 to the 343 with a pGP3, TT was lower (4.23 1.63 vs. 4.73 1.70 ng/mL, p 0.0009) and PSA higher (10.2 vs. 8.0 ng/mL, p 0.0001). Hypogonadism was more frequent (26% vs. 9%, p 0.0003). Extra prostatic extension was more frequently observed (22.5% versus 10.5%, p 0.0002). The 80 patients with TT 3.0 ng/mL were bigger ( 8kg, p 0.0001) with a BMI highier ( 2.7 kg/m, p 0.0001). They had a higher percent of GS with a pGP4: 55.0% vs. 33.0% (p 0.0002). CONCLUSIONS: The pGP in prostate specimens is of paramount importance, especially in case of a Gleason 7, to appreciate the outcomes and to choose the treatment. In cancer Gleason 7 in radical prostatectomy specimens, pGP4 is more frequent in hypogonadal patients. Preoperative testosterone should be used to improve the management of prostate cancer.

Objective To report the feasibility of a novel robotic technique for intracorporeal construction of a double Yang-Monti ileal conduit with bladder augmentation in an adult patient. Methods The Yang-Monti procedure can be considered as an alternative to Mitrofanoff appendicovesicostomy when the appendix is not available or in obese patients. To date, the robotic approach has not been described. We have described all the steps of our surgery, performed on a 35-year-old obese patient with post-traumatic paraplegia and a neurogenic bladder. We focused on the technical tips and highlighted all the differences with the standard open technique. Results Our technique provided satisfactory results. No intraoperative complications occurred. The operative time was 250 minutes, and the intraoperative blood loss was 200 mL. The clinical course was uneventful. Conclusion We have shown that robotic intracorporeal realization of a double Yang-Monti ileal conduit with bladder augmentation is feasible, extending the potential indications of robot-assisted surgery. The evaluation of more cases is advised.

To present a series of 15 laparoscopic and robot-assisted Mitrofanoff and Yang-Monti vesicostomies in an adult population, and to assess the feasibility and safety of these minimally invasive approaches.Between 2009 and 2012, 15 patients underwent laparoscopic (n = 11) or robot-assisted (n = 4) construction of vesicostomy by a single surgeon (D.R.): Mitrofanoff appendicovesicostomy (n = 11) or double Yang-Monti ileal conduit (n = 4). Fourteen patients underwent concomitant augmentation enterocystoplasty. Indications for surgery included neurogenic bladder (n = 11) and urethral dysfunction (n = 4). The patients were evaluated postoperatively using cystography. Quality of life (QoL) was evaluated using an internally developed questionnaire.All surgeries were successfully completed with no conversions. Operating time was always5 h. The mean estimated blood loss was 150 mL and the mean follow-up was 22 months. Early postoperative complications included deep retrovesical abscess (n = 2) and upper urinary tract infections (n = 4), and one patient had peri-operative cardiac failure. Late postoperative complications included stomal stenosis (n = 2), persistent low-pressure bladder incontinence (n = 1) and recurrent infections (n = 1). Surgical excision of the conduit was necessary in one patient. Postoperatively, patients showed complete bladder emptying and no leak on follow-up cystography. According to our QoL questionnaire, 13/15 patients did not regret the surgery.While a longer follow-up is needed to assess the durability of our results, this series shows that the laparoscopic and robot-assisted approaches for the construction of continent urinary diversions are feasible and safe in an adult population.