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Objectives: Although prostate cancer is probably the most frequent cancer in men, little is known about its etiology. Clear evidence exists about variations in the incidence of prostate cancer between populations living in different countries. These variations could be explained by differences in lifestyle and a possible association with a set of substances that are able to intervene in the origin of the disease., Methods: The reason that lifestyle may be the cause of prostate cancer is related to endocrine disruptors. These are a group of chemical substances that can mimic or alter hormone signaling. These disruptors are able to exert their effect at very low doses and act insidiously over the years, even being able to pass their effect on from one generation to the next. Cholesterol is an essential precursor in the synthesis of androgens, estrogens and other substances that are active in prostate cancer. Cholesterol is a central metabolite in lipid metabolism, the inflammatory response and other elements involved in the formation and progression of cancer. High cholesterol concentrations can give rise to the accumulation of androgens in tumor cells. Additionally, endocrine disruptors have been identified as being responsible for processes related with fertility, genital malformations and various hormonedependent cancers. Disruptors already identified include diethylstilbestrol, dichlorodiphenyltrichloroethane (DDT), polychlorinated biphenyls and dioxins., Results: Though no clear direct association has yet been found in humans between most endocrine disruptors and prostate cancer, evidence suggests that an inadequate diet and contact with certain toxic agents predisposes to the disease. These disruptors are known to be especially relevant at particular times, such as during pregnancy, neonatal stages and puberty., Conclusions: The problem with these toxic agents is that their peculiarities and way of acting over time make their study difficult. Nonetheless, research must be encouraged given their importance.

Purposes: To evaluate in an animal model the feasibility of a novel concept of hand-assisted surgery consisting of inserting two hands into the abdomen instead of one. The chosen procedure was retroperitoneal lymph node dissection (L-RPLND) that was performed in five pigs., Surgical Technique: A Pfannestiel and a transverse epigastric incisions were made through which both hands were introduced. The scope was inserted through the umbilicus. The colon was moved medially and the dissection was performed as in open surgery using short conventional surgical instruments., Comments: The surgery was fulfilled easily and safely in quite a similar way as in open surgery. Two-handed laparoscopy may be indicated in cases that still today require an open approach as apparently makes the operation easier and significantly shortens the surgery time. However, new opinions and trials are required.

Purpose: We describe and evaluate a new transperineal laparoscopic approach for male patients, designed to facilitate laparoscopic prostatectomy and cystectomy., Patients and Methods: We operated on 12 patients. We did three laparoscopic prostatectomies and nine laparoscopic cystectomies. On five, an ileal conduit was made, and on the other four, an orthotopic bladder was constructed. An incision was made in the perineum. A space was bluntly created between the rectum and the prostate. A cannula was then introduced up to the Douglas pouch, which was opened to enter the peritoneal cavity., Results: One patient of the three prostatectomies needed incontinence pads. None of the four orthotopic bladder cases presented daytime incontinence. The urethra of one of the patients who had an ileal conduit was injured. No other significant complications occurred., Conclusion: Transperineal laparoscopy in male patients is a feasible technique that may be an alternative for natural orifice translumenal endoscopic surgery in women, but further assessment is required.

Objectives: The American cranberry proanthocyanidins (PACs) are the main responsible for its efficacy in urinary tract infections. Their mechanism of action is related to inhibition of Escherichia coli to urothelial cells. Cysticlean contains an extract of American cranberry which provides 118 mg of PACs per dose. The activity of Cysticlean tablets on Escherichia Coli adherence to bladder epithelial cells has been studied in vitro. Moreover, the activity of Cistyclean both in powder for oral suspension and tablets has been compared ex-vivo., Methods: The rats received both Cysticlean preparations per orem, and urine from each animal was collected during the following 16 hours and preincubated with E. coli. Subsequently, bacteria were incubated with T24 cells. After 1 hour the number of bacteria adhered per cell was calculated. For the in vitro study, E. Coli preincubated at various concentrations of the products were incubated with T24 cells and the same process previously referred was carried out., Results: Urine samples from rats taking Cysticlean powder for oral suspension and tablets (118 mg PACs/animal) showed an important inhibition of E. Coli adherence (83% and 52%respectively). The inferior dose of 59 mg PACs/animal also showed marked inhibition of E. Coli adherence (29% after Cysticlean tablets intake and 40% for powder). In vitro, Cysticlean showed inhibition of bacterial adherence in all tested concentrations: 5, 25 and 75 PACs mg/ml, diminishing the number og bacteria adhered to epithelial cells by 25%, 36% and 34% respectively., Conclusions: Cysticlean shows a significant inhibition of E. Coli adherence to urothelial cells. Cysticlean powder for suspensión preparation is more effective tha tablets. Cysticlean powder for suspensión is well tolerated, and compliance has been observed. Its use is very recommendable in pediatric urinary tract infection prophylaxis. Due to the variety of products with American cranberry extracts in the market, with different proanthocyanidins declared content, it would be interesting to compare their activity using established pharmacological methods.

Objectives: Five or six perforations of the abdominal wall increase the possibilities of organ injury, infection, or hernia. Laparoscopy originally offered great advantages and significant progress. Multiple abdominal ports are now considered superfluous, excessively traumatic and, today, hardly merit the term 'minimally-invasive-surgery'. All that led us to design a device to help surgeons meet new standards that can have several uses., Methods: The instrument is a 4 cm diameter, 5 cm long cannula. The superior extremity or lid has five 5 mm sealed openings, one for the telescope and four for instruments. Below the lid and its notched retaining screw is the tap to insufflate the operating field. The peripheral flange limits insertion depth and seals the skin wound. Lids with more or less openings are available. The device has been proven first in a simulator, and then five pigs between 20 and 30 kg have been operated. In the first two cases the cannula was introduced through the umbilicus and a cystostomy with suture was carried out. In the other three cases nephrectomy was performed inserting the cannula through the flank. RESULT The experimental series has allowed us to get adapted to the cannula; we have verified that diameter and length of the device are optimal, and vision is excellent. Also the device is hermetic, since there is no loss of gas and the instruments are not trapped inside, what has allowed us to work and to suture without special difficulty., Discussion: A single port through the abdomen or even transvaginally represent a real challenge to laparoscopy because in the 21st century to make 5 or 6 perforations in the abdominal wall appear untenable. Finally, with this system there are enormous possibilities for robotization with only one arm that includes the telescope and instruments, that sooner that we might imagine is going to revolutionize surgical practice.

Objective: We describe a most unusual urological emergency: a firearm wound in which the blunt-nosed hand-gun bullet was lodged in the prostate. A bibliographic search of the literature revealed no similar case., Methods: The patient was admitted presenting a gunshot wound with the entrance hole on the right buttock. There was no exit wound. An X-ray revealed the bullet behind the pubic symphysis. We introduced a suprapubic catheter and then carried out a laparotomy making a discharge colostomy Urethrogram revealed a pathway of contrast to the rectum. Several days later, we reached the bladder with an urethrotome and introduced an 18 Fr catheter. Under radiological control we made an open approach to the retropubic space, palpated the bullet within the prostate and then removed it., Discussion/conclusions: The velocity of a rifle or hand-gun bullet is the main determinant of the severity of this type of injury. As there was no exit wound, we knew that the entrance velocity was low, therefore tissue damage would probably be small. In these cases, a preparatory suprapubic cystostomy is essential to be able to carry out a urethral reconstruction later. Radiological control during the procedure proved extremely useful to precisely locate the bullet. Our conservative approach of simply leaving in place the catheter helped us later to avoid a difficult repair of a recto-urethral fistula.

Objectives: The author describes his first steps in laparoscopic surgery and the sources of some of his ideas. He thanks his father's influence and the technical stimuli that catalysed his scientific curiosity. For the benefit of young urologists at the beginning of their careers he shows how the frustrations of working with the early instruments became the vital challenges that inspired creative solutions., Methods: His urological surgeon father inspired in his young son a passion for his calling. He developed an immediate and compelling interest in the shape and function of urological instruments like, for example, Freyer's lithotripter and the Iglesias resectoscope. Books of urological history and the works of pioneer urologists fascinated him. Watching José María Gil Vernet operate particularly impressed him and he says that Gil Vernet was the first urologist he saw using a laparoscope to diagnose an abdominal testicle. While working in an Oxford University hospital in 1985, he designed a balloon device to dissect the retropubic space. This procedure was the precursor of what several years later became extraperitoneal surgery The following year, he read the manual of Semm's laparoscopy and later described a laparoscopic varicocelectomy. In 1993, he published the first description of a laparoscopic radical cystectomy and ileal conduit. In 1997, he adapted a surgical robotic system with a master-slave arm to carry out firstly a transurethral resection., Results/conclusions: He says that a good idea is beyond price because it helps the inspired individual to make true a long-held ambition and achieve the signal success that lifts him out of the mud of mediocrity.

Objectives: In endoscopic subcutaneous surgical procedures, new to Urology, the subcutaneous tissues are insufflated with carbon dioxide through a trocar to create working space without a surgical incision. Although this technique now predominates in surgery of the face, neck and breast, from the literature it appears that it has not yet been adopted for surgery in the region of the inguinal canal or in the scrotum. We describe these approaches., Methods: To carry out the inguinal canal approach we introduced three 5mm trocars and dissected the external oblique fascia until we identified the superficial inguinal ring and gained access to the scrotum. The scrotal approach is directly into the scrotum. To date, we have only used the scrotal approach to treat hydroceles. We carefully detached the tunica vaginalis from the scrotal wall and kept the tunica intact before puncturing it to empty the fluid contents. The tunica was then resected and withdrawn through a trocar., Results: We have removed three cysts and one solid tumor of the spermatic cord with the inguinal approach. With the scrotal approach we have treated six hydroceles. Our experience with these two small series allows us to confidently state that the procedure offers no particular technical difficulty; that operating times are short and that post-operative pain is very probably less than usual., Conclusions: Although endoscopic subcutaneous surgery in Urology is in its infancy, our results until now have been excellent and permit us to conclude that in the future there will be more indications for this type of surgery.

Objectives: Most advances in Surgery can now be seen to have been preceded by the invention of new instruments. Conventional surgery progressed as new instruments became available. Transurethral resections became routine following the introduction 80 years ago of the resectoscope: a highly revolutionary instrument at that time. Ureterorenoscopes and nephros- copes opened new windows of opportunity for urologists. When the therapeutic potential of extracorporeal lithotripsy, was first mentioned in the literature most surgeons thought it was mere science-fiction fantasy. Very soon however, this new technique, the fruit of close collaboration between urologists and engineers, became a common-place reality. Laparoscopy met with similar disbelief and the early applications gave rise to controversy and even consternation, yet only a few years later most of our urological surgical procedures have adopted this technique., Methods: At the beginning of the 20th century the astounding advances in engineering led many to forecast that before its end those systems might mimic human intelligence. However, many attempts to construct a rational thinking device revealed that even today this ambitious project was a still an unattainable dream. Consequently, attempts to design an autonomous urological surgical robot that might carry out unsupervised transurethral resections were unfruitful because the inherent and unpredictable complexity of surgical procedures obliges close and rigorous control by the surgeon. This important limitation led to the creation of 'master-slave' systems similar to those designed by our team in 1998 for transurethral resection. These are relatively simple tools and are infinitely safer than autonomous robots because they aim to effectively help the surgeon rather than replace him., Results/conclusions: The oft-repeated argument about whether or not a robot might ever replace the surgeon now has little sense because today it is merely a tool, an instrument for the surgeon's hands. The devices available today lack the all-important tactile feedback and to use them effectively, the surgeon is obliged to serve a new and arduous apprenticeship and the learning curve is unavoidably steep. Consequently, many prestigious authors understandably feel unable to recommend their use. Our accumulated experience with master-slave manipulators stimulates us to confidently predict that sooner than later, whether we like it or not, surgical robots will evolve to become indispensable tools that enhance the surgeon's skill, precision and speed in many surgical procedures.

Following the induction of experimental diabetes in two groups of rats using an isograft model, a comparative study was made of two types of pancreas transplants in which several procedures were employed. The vascular anastomosis in one group were to the renal artery and vein, and in the other, to the iliac vessels. The pancreatic ducts in one subgroup were ligated, in another, they were diverted to the urinary system; in a third sub-group, they were diverted to the intestine. The results obtained for the sub-group with the transplant anastomosed to the renal vessels were the best. It is suggested that this was due to two factors: the simplicity of the technique and the short operating times. In this present work the two best methods of dealing with the exocrine secretion were diversion to the ureter and ligation of the common bile duct. The worst results were in the group with duodeno-cystostomy.

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Background: Τhe adherence of p-fimbriated Escherichia coli (E. coli) to urothelial cells leading to recurrent urinary tract infections (rUTIs) may be prevented by proanthocyanidins (PACs) contained in American cranberries., Purpose: The purpose of this clinical trial was to assess the clinical utility of prophylactic use of high-dose PACs daily in women with a history of rUTIs., Materials and Methods: 172 adult women with a history of rUTIs, defined as ≥ 2 within a 6-month period or ≥ 3 within a 12-month period were enrolled and randomized in two groups to receive either Cysticlean™ 240 mg or placebo for a 12-month period. Urine samples, vaginal and rectal swabs were collected at initial and quarterly study visits. The primary study endpoints were the number of urinary tract infections (UTIs) and changes in Quality of Life (QoL), assessed by the 36-Item Short Form Survey (SF-36) questionnaire., Results: 160 adult women of median age 40 years old (range 19-82) were finally analyzed in this randomized, placebo-controlled, double-blinded clinical trial. In response to intervention, the number of UTIs was significantly lower (Incidence rate ratio IRR 0.49, p < 0.001) and QoL was slightly improved. The numbers of E. coli isolates detected in vaginal (IRR 0.71, p value < 0.001) and in rectal swabs (IRR 0.87, p value < 0.001) were also significantly decreased. No adverse events were reported., Conclusion: The daily use of Cysticlean™ 240 mg was associated with a reduction of UTIs and a prolongation of UTI-free survival compared to placebo treatment, supporting its use as prophylaxis in this patient population., Trial Registration: Clinicaltrials.gov, identifier NCT03032003., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Anatomical fusion abnormalities of the urinary system and ureters are not uncommon. However, triplication of the ureter is very rare. A boy with this abnormality is being presented in view of its rarity. The importance of a thorough preoperative evaluation is being projected that may help us to choose the best management avenue. [ABSTRACT FROM AUTHOR]

Despite the fact that the estrogenic effects of bisphenols were first described 80 years ago, recent data about its potential negative impact on birth outcome parameters raises a strong rationale to investigate further. The adverse health effects of plastics recommend to measure the impacts of endocrine‐disrupting compounds (EDCs) such as bisphenols (BPA, BPS, BPF), bis(2‐ethylhexyl) phthalate, and dibutyl phthalate (DBP) in human health. Exposure to these compounds in utero may program the diseases of the testis, prostate, kidney and abnormalities in the immune system, and cause tumors, uterine hemorrhage during pregnancy and polycystic ovary. These compounds also control the processes of epigenetic transgenerational inheritance of adult‐onset diseases by modulating DNA methylation and epimutations in reproductive cells. The early developmental stage is the most susceptible window for developmental and genomic programming. The critical stages of the events for a normal human birth lie between the many transitions occurring between spermatogenesis, egg fertilization and the fully formed fetus. As the cells begin to grow and differentiate, there are critical balances of hormones, and protein synthesis. Data are emerging on how these plastic‐derived compounds affect embryogenesis, placentation and feto‐placental development since pregnant women and unborn fetuses are often exposed to these factors during preconception and throughout gestation. Impaired early development that ultimately influences fetal outcomes is at the center of many developmental disorders and contributes an independent risk factor for adult chronic diseases. This review will summarize the current status on the impact of exposure to plastic derived EDCs on the growth, gene expression, epigenetic and angiogenic activities of the early fetal development process and their possible effects on birth outcomes. [ABSTRACT FROM AUTHOR]

In the present work, cell lines of different origin were exposed to BPA levels from food intake reported elsewhere. Specifically, we used an in vitro assay to determine cytotoxicity of BPA in three cell lines: MCF7 (breast cancer), PC3 (prostate cancer) and 3T3-L1 (mouse fibroblast). Cytotoxic effects were observed at concentrations higher than 50 μg/mL which is above the involuntary exposure level of BPA described before in fresh, canned and frozen foods and beverages. Furthermore, medial inhibitory concentrations (IC50) of 85.17 μg/mL and 88.48 μg/mL were observed for PC3 and 3T3-L1, respectively, and a slightly lower IC50 of 64.67 μg/mL for MCF7. These results highlight BPA's toxicity potential at current levels from food intake. The cell line-dependent divergent response to BPA reported herein is discussed. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to describe our initial Australian single surgeon experience with robotic‐assisted radical cystectomy (RARC) and intracorporeal urinary diversion (ICUD) and to compare the outcomes with open radical cystectomy (ORC). Methods: Between January 2014 and June 2016, consecutive patients diagnosed with muscle invasive and high‐risk non‐muscle invasive bladder cancer undergoing radical cystectomy were included. Treatment modalities included either RARC with ICUD or ORC. ICUD consisted of either intracorporeal ileal conduit or orthotopic neobladder formation. Prospectively collected perioperative and oncological outcomes were analysed. Results: Twenty‐six RARC and 13 ORC were performed. Median operating times were 362 and 240 min for RARC and ORC, respectively (P < 0.001). Estimated blood loss for RARC was 300 mL compared with 500 mL for ORC (P = 0.01). Post‐operative haemoglobin drop was less in the RARC cohort (20% versus 24%, P = 0.03). There was no statistical difference in overall 90‐day complication rates (81% versus 62%, P = 0.25) and 90‐day major complication rates (19% versus 23%, P = 0.67) between the RARC and ORC groups, respectively. Positive surgical margins for RARC were 4% and 8% for ORC (P = 1.0). Conclusion: Early results demonstrate that the safe introduction of RARC with ICUD in Australia is potentially feasible without compromising perioperative and oncological outcomes. Future randomized trial with larger numbers will be required for further analysis in the Australian setting. [ABSTRACT FROM AUTHOR]

Endocrine-disrupting chemicals (EDCs) are man-made chemicals that interfere with hormonal signalling pathways. They are used in, for example, production of common household materials, in resin-based medical supplies and in pesticides. Thus, they are environmentally ubiquitous and human beings and wildlife are exposed to them on a daily basis. Early-life exposure to EDCs has been associated with later-life adversities such as obesity, diabetes and cancer. Mechanisms underlying such associations are unknown but are likely to be mediated by epigenetic changes induced by EDCs. Epigenetics is the study of changes in gene function that are heritable but do not entail a change in DNA sequence. EDCs have been shown to affect epigenetic marks such as DNA methylation and histone modifications. The scope of this article was to review today's knowledge about mechanisms involved in EDC-induced epigenetic changes and to discuss how this knowledge could be used for designing novel methods addressing epigenetic effects of EDCs. [ABSTRACT FROM AUTHOR]

The resistance to antibiotics in clinically important bacteria is one of the major global health concerns. Phage therapy could be one reliable alternative therapeutic strategy to combat these superbugs. In this study, we assessed host range of a novel bacteriophage, JHP, and characterized for its potential use in phage therapy. The bacteriophage demonstrated infectivity over a broad range of genera including multidrug resistant clinical isolates of Pseudomonas aeruginosa, members of family Enterobacteracae, and other important human pathogens. The antibacterial activity was highest at pH 7, and at temperature of 37 °C. The phage lytic activity gradually decreased till 60 °C and showed no activity when temperature was further raised. The bacteriophage could safely be stored at 4 °C or −20 °C. The latent period of the bacteriophage was 25 min and showed a burst size of 433 virions per cell. The size of JHP genome was approximately 30 kb. Family, Siphoviridae was assigned to JHP based on its icosahedral head with non-contractile tail. The diameter of JHP head and tail length was found 115 and 152 nm, respectively. To sum up, the broad spectrum Siphoviridae phage JHP is an ingenious candidate for phage therapy. [ABSTRACT FROM AUTHOR]

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Introduction: Despite the potential clinical advantages of holmium laser enucleation of the prostate (HoLEP), there has been reluctance of the urologic community to adopt the procedure, as a result of a perceived steep learning curve. Thus, we sought to design and develop a transurethral endoscopic robotic platform for HoLEP. Materials and Methods: We developed a novel transurethral, concentric tube robotic platform for HoLEP. We conducted magnetic tracking experiments to compare movements of the end effectors of the robot with those of a rigid endoscope. Additionally, we tested the robot on an HoLEP simulator and with a human cadaveric prostate to assess its ability to maneuver within a small working space. Results: In the prostate scanning experiment, the area reached by the robot represents a 65% improvement vs the area accessible by a rigid endoscope without tissue deformation. Additionally, the robot performed well within the confines of the prostatic urethra and was able to successfully complete prostate lobe enucleation, on both the HoLEP simulator and with a human cadaveric prostate. Conclusions: We have developed a concentric tube robotic platform that is passed through a standard endoscope that is capable of producing complex movements of the end effectors. We have shown that these movements of the concentric tube manipulators are capable of performing tasks that may eventually translate into improved ease of performing HoLEP. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Turgut Ozal Medical Center is the property of Annals of Medical Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and Purpose: Laparoscopy is a common approach to manage varicoceles in both the adult and pediatric population. The purpose of this study is to report our experience and compare outcomes between conventional laparoscopy and laparoendoscopic single-site (LESS) surgery for varicocelectomy in the pediatric population. Patients and Methods: A retrospective cohort study was performed of all patients who underwent conventional laparoscopic varicocelectomy (LV) and laparoendoscopic single-site varicocelectomy (LESSV) at a single pediatric institution from December 2007 to March 2012. Patient demographics, intraoperative details, narcotic use, and complications were reviewed. Results: LV was performed in 32 patients and LESSV in 11 patients. None had conversion to open surgery. Median age was 16 years for LV (range 12-23) and 15 years for LESSV (range 12-20), P=0.061. Median operative time was 55 minutes for LV (range 28-90) and 46 minutes for LESSV (range 33-59), P=0.037. Nine (81.8%) patients in the LESSV group and 10 (31.2%) patients in the LV group were administered narcotics in the recovery room, P=0.005. One (3.1%) patient in the LV group was administered ketorolac in the recovery room, P=1. Five patients in each group, LESSV (45.5%) and LV (15.6%), received acetaminophen in the recovery room, P=0.092. All procedures were performed on an outpatient basis except for one because of a concomitant procedure. Median follow-up was 22 months in LV and 15 months in LESSV, P=0.015. One (3.1%) postoperative hydrocele was noted after LV and 1 (9.1%) after LESSV, P=0.451. All varicoceles were clinically resolved in both groups. Conclusions: LESSV is comparable to LV in the pediatric population. Our initial experience indicates that the LESS approach may be more painful in the immediate postoperative period than conventional laparoscopy. The LESS technique warrants further evaluation to determine if one approach is clearly more advantageous. [ABSTRACT FROM AUTHOR]

Introduction: We report the oncological outcome after laparoscopic radical cystectomy (LRC) and standard laparoscopic pelvic lymph node dissection (PLND) without neoadjuvant or adjuvant therapy in the treatment of bladder cancer with a median follow-up of 32 months. Materials and Methods: From September 2006 to January 2011, 40 consecutive patients underwent an LRC and standard laparoscopic PLND, and were included in this prospective observational cohort study. No patient received neoadjuvant or adjuvant therapy. Demographic, perioperative, complication, histopathologic and survival data were collected and analyzed. Results: The 2002 TNM staging for the tumors were: pT0, 4 cases; pTis, 5 cases; pT1, 4 cases; pT2, 7 cases; pT3, 13 cases; pT4, 7 cases. Positive surgical margins were reported in 3 patients (7.5%) and lymph node involvement in 9 patients (23.7%). No patient was lost to follow-up. The overall, cancer-specific and recurrence-free survival rates were 53, 73 and 70% with a median follow-up of 32 months. Eleven patients (27.5%) died of metastatic disease or local recurrence. Nonorgan-confined disease (≥pT3) and primary lymph node involvement (pN+) were significantly associated with worse overall, cancer-specific and recurrence-free survival rates. Conclusion: We report acceptable mid-term and promising long-term oncological outcome after LRC and standard laparoscopic PLND without neoadjuvant or adjuvant therapy. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: Robotic-assisted radical cystectomy (RARC) is a less invasive means of performing the radical cystectomy operation, which holds promise for improved patient morbidity. We review the history, technique and current literature pertaining to RARC and place the current results in context with the open procedure. Methods: All articles regarding RARC found in PubMed after January 2000 were examined. We selected articles that appeared in high-impact journals, had large patient population size (>80 patients), or were novel in technique or findings. We chose key laparoscopic articles to give reference to the history in transition to robotic radical cystectomy. In addition, we chose classic articles from open radical cystectomy to give reference regarding the newer robotic perioperative outcomes. Results: Studies suggest that a 20-patient learning curve is needed to reach an operative time of 6.5 h, with 30 surgeries performed to reach lymph node counts in excess of 20 (International Robotic Cystectomy Consortium). The only randomized surgical trial comparing open and robotic techniques showed equivalent lymph node yield, which may be surgeon and volume dependent. Literature demonstrates lower estimated blood loss, transfusion rates, early return of bowel function and decreased complications in early small series. Conclusion: RARC and urinary diversion are still early in development and limited to centers with extensive robotic experience and volume, although adoption of the robotic approach is becoming more common. Early studies have shown promise to reduce complications with equivalent oncologic results. [ABSTRACT FROM AUTHOR]