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Neuberger M, Kowalewski KF, Simon V, von Hardenberg J, Siegel F, Wessels F, Worst TS, Michel MS, Westhoff N, Kriegmair MC, Honeck P, Nuhn P. Peritoneal Flap for Lymphocele Prophylaxis Following Robotic-assisted Radical Prostatectomy with Lymph Node Dissection: The Randomised Controlled Phase 3 PELYCAN Trial. Eur Urol Oncol 2024; 7:53-62. [PMID: 37543465 DOI: 10.1016/j.euo.2023.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/14/2023] [Accepted: 07/12/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Symptomatic lymphoceles (SLCs) after transperitoneal robotic-assisted radical prostatectomy with pelvic lymph node dissection (PLND) are common. Evidence from randomised controlled trials (RCTs) on the impact of peritoneal flaps (PFs) on lymphocele (LC) reduction is inconclusive. OBJECTIVE To show that addition of PFs leads to a reduction of postoperative SLCs. DESIGN, SETTING, AND PARTICIPANTS An investigator-initiated, prospective, parallel, double-blinded, adaptive, phase 3 RCT was conducted. Recruitment took place from September 2019 until December 2021; 6-month written survey-based follow-up was recorded. Stratification was carried out according to potential LC risk factors (extended PLND, diabetes mellitus, and anticoagulation) and surgeons; 1:1 block randomisation was used. Surgeons were informed about allocation after completion of the last surgical step. INTERVENTION To create PFs, the ventral peritoneum was incised bilaterally and fixated to the pelvic floor. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was SLCs. Secondary endpoints included asymptomatic lymphoceles (ALCs), perioperative parameters, and postoperative complications. RESULTS AND LIMITATIONS In total, 860 men were screened and 551 randomised. Significant reductions of SLCs (from 9.1% to 3.7%, p = 0.005) and ALCs (27.2% to 10.3%, p < 0.001) over the follow-up period of 6 mo were observed in the intention-to-treat analysis. Operating time was 11 min longer (p < 0.001) in the intervention group; no significant differences in amount (80 vs 103, p = 0.879) and severity (p = 0.182) of postoperative complications (excluding LCs) were observed. The survey-based follow-up might be a limitation. CONCLUSIONS This is the largest RCT evaluating PF creation for LC prevention and met its primary endpoint, the reduction of SLCs. The results were consistent among all subgroup analyses including ALCs. Owing to the subsequent reduction of burden for patients and the healthcare system, establishing PFs should become the new standard of care. PATIENT SUMMARY A new technique-creation of bilateral peritoneal flaps-was added to the standard procedure of robotic-assisted prostatectomy for lymph node removal. It was safe and decreased lymphocele development, a common postoperative complication and morbidity. Hence, it should become a standard procedure.
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Affiliation(s)
- Manuel Neuberger
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Karl-Friedrich Kowalewski
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Valentin Simon
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jost von Hardenberg
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Fabian Siegel
- Department of Biomedical Informatics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frederik Wessels
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Thomas S Worst
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maurice Stephan Michel
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Niklas Westhoff
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Patrick Honeck
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Nuhn
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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de Vasconcelos Silva ACP, Araujo BM, Spiegel T, da Cunha Reis A. May value-based healthcare practices contribute to comprehensive care for cancer patients? A systematic literature review. J Cancer Policy 2022; 34:100350. [DOI: 10.1016/j.jcpo.2022.100350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/28/2022] [Accepted: 07/30/2022] [Indexed: 12/30/2022]
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Edwins R, Bettis A, Harris AM. Evaluating Factors That Influence Healthcare Resource Utilization in Transurethral Resection of Prostate. J Endourol 2022; 36:1322-1330. [PMID: 35708111 DOI: 10.1089/end.2022.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Transurethral resection of prostate (TURP) remains the gold standard for treatment of benign prostatic hyperplasia (BPH) but is associated with complications. The association of healthcare resource utilization (HRU) and TURP has been poorly studied. We seek to evaluate HRU in patients undergoing TURP and identify factors contributing to outcomes. METHODS The National Surgical Quality Improvement Program (NSQIP) database was reviewed from 2012-2018 for TURP by CPT code. HRU was defined as discharge to continued care, unplanned readmission within 30 days, or prolonged length of stay (>75th percentile). We included preoperative variables, including age, BMI, diabetes, and ASA class. OD was broken into deciles by minutes. Preoperative characteristics and outcomes were compared against OD. Predictors of HRU were found using a stepwise multivariate logistic regression. RESULTS 38,749 patients were included. Variables significantly associated with OD (values are 3 shortest and 3 longest deciles, respectively): any HRU (35.9%, 32.4%, 31.4% and 32.4%, 33.7%, 37.6%), and prolonged length of stay (31.3%, 27.6%, 26.5% and 28.0%, 30.4%, 34.1%). Findings in the first decile seemed to be an outlier, shown in Figure 1. Complications associated with OD are shown in Figure 2. On multivariable analysis, patients with OD > 58 minutes were more likely to have increased HRU, OR 1.22, 1.33, 1.54, 1.78 for deciles 58-66, 67-78, 78-99 and >100, respectively, p<0.005. Preoperative variables associated with HRU on multivariable analysis include age 71-80 and >80, COPD, dyspnea, hypertension, diabetes, not functionally independent, ASA class III and IV-V, and dirty/infected wound class, p<0.005. CONCLUSIONS OD is an independent predictor of HRU in patients undergoing TURP and is more modifiable than other preoperative variables associated with increased HRU. Patients in the longest decile were more likely to have complications and increased HRU. Further study is needed to evaluate causation.
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Affiliation(s)
- Rebecca Edwins
- University of Kentucky, 4530, College of Medicine, 800 Rose St., Lexington, Lexington, Kentucky, United States, 40506;
| | - Amber Bettis
- University of Kentucky, 4530, Department of Surgery, Lexington, Kentucky, United States;
| | - Andrew Mitchell Harris
- University of Kentucky Medical Center, 12253, Urology, 800 Rose St., Room MS237, Lexington, Kentucky, United States, 40536-0293;
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Rashid Kazi R, Jung M, Kelly T, Xiong Y, Harris A. Frequency and timing of emergency department visits and hospital admissions in stented patients following common stone procedures. Urolithiasis 2022; 50:381-387. [PMID: 35133494 DOI: 10.1007/s00240-022-01313-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/22/2022] [Indexed: 11/25/2022]
Abstract
Emergency department (ED) visits and hospital admissions (HA) following urologic procedures are a concern for payors, providers, and patients. We seek to quantify ED visits and HA after urologic stone procedures. This is a retrospective cohort study using claims data from the IBM MarketScan Commercial and Medicare Supplement database. Adults with a urologic stone diagnosis and no history of stone procedure in prior 12 months who underwent stone procedures with ureteral stent codes between 2012 and 2017 were included. All-cause vs genitourinary (GU)-related ED visits and HA were evaluated during 30, 60, 90, and 120-day periods following the index urologic stone procedure. 88,047 patients were included in the analytic cohort. For inpatients, rate of all-cause vs GU-related ED visits was 10% vs 9% at 30 days and 19% vs 15% at 120 days. For outpatients, rate of all-cause vs GU-related ED visits was 9% vs 8% at 30 days and 15% vs 12% at 120 days. A similar trend was found when examining HA. Younger patients (18-44 years old) had higher rates of all-cause ED visits following inpatient index stone procedure (13% vs 10% at 30 days, p ≤ 0.0001). Twenty percent of patients have an ED visit or HA up to 120 days after having a stone procedure with most returning with GU-related complaint. Younger patients had the greatest burden among the study cohort. Further studies need to determine causation of these unplanned visits to guide appropriate intervention.
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Affiliation(s)
- Rohail Rashid Kazi
- Department of Urology, University of Kentucky, 800 Rose Street, MS274, Lexington, KY, 40536, USA.
| | - Molly Jung
- Becton-Dickinson, Franklin Lakes, NJ, USA
| | | | - Yan Xiong
- Becton-Dickinson, Franklin Lakes, NJ, USA
| | - Andrew Harris
- Lexington VA Medical Center, University of Kentucky, Lexington, USA
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Wei Y, Ji Q, Zuo W, Wang S, Wang X, Zhu Q. Efficacy and safety of single port robotic radical prostatectomy and multiport robotic radical prostatectomy: a systematic review and meta-analysis. Transl Androl Urol 2022; 10:4402-4411. [PMID: 35070822 PMCID: PMC8749066 DOI: 10.21037/tau-21-850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022] Open
Abstract
Background The purpose of this study is to compare the clinical efficacy and safety of single port (SP) robot radical prostatectomy and multiport (MP) robot radical prostatectomy. Methods Using the China National Knowledge database, EMBASE, Cochrane library, PubMed, and other databases to obtain relevant research, SP robot radical prostatectomy and MP robot radical prostatectomy were comprehensively evaluated. The software used to evaluate the impact of the results in the selected articles was Review Manager 5.2. Deviation analysis, forest plot analysis, and sensitivity analysis were carried out for the collected data. Results A total of 7 related studies that met the criteria were finally included. The data showed that the operation time of MP in the control group was significantly longer than that in the SP group [mean difference (MD) =−13.29; 95% confidence interval (CI): (−17.35, −9.23); P<0.00001; I2=50%]. The duration of intensive care unit (ICU) stay for SP surgery was shorter than that for MP surgery [MD =−18.30; 95% CI: (−29.17, −7.42); P=0.0010; I2=94%]. The blood loss of SP surgery was less than that of MP surgery [MD =−15.54; 95% CI: (−28.37, −2.71); the total effective rate was 0.02; I2=0%]. There was no significant difference in the incidence of postoperative complications between SP and MP surgery [risk ratio (RR) =0.95; 95% CI: (0.55, 1.63); P=0.85; I2=0%]. At the same time, the sensitivity analysis and funnel plot showed that this study was robust and publication bias was limited. Discussion Our results show that SP robotic radical prostatectomy is superior to MP robotic radical prostatectomy in terms of efficacy and safety. SP robot radical prostatectomy is worthy of wide promotion.
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Affiliation(s)
- Yong Wei
- Department of Urology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.,Department of Urology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qianying Ji
- Department of Urology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenren Zuo
- Department of Urology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Shiyan Wang
- Department of Urology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xinyi Wang
- Department of Urology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Qingyi Zhu
- Department of Urology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.,Department of Urology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Shapiro DD, Davis JW, Williams WH, Chapin BF, Ward JF, Pettaway CA, Gregg JR. Increased body mass index is associated with operative difficulty during robot‐assisted radical prostatectomy. BJUI COMPASS 2021; 3:68-74. [PMID: 35475154 PMCID: PMC8988518 DOI: 10.1002/bco2.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/01/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to identify factors associated with surgeon perception of robot‐assisted radical prostatectomy (RARP) difficulty. Patients and Methods This study surveyed surgeons performing RARP between 2017 and 2018 and asked them to rate operative conditions and difficulty as optimal, good, acceptable, or poor. These answers were stratified as optimal or suboptimal for this study. Associations between surgeon responses and variables hypothesized to affect surgical difficulty, including anatomic factors such as pelvic diameter and prostate volume:pelvic diameter ratio, were assessed. Results Between November 2017 and September 2018, a total of 100 patients were prospectively enrolled in the study of which 58 cases were rated as optimal and 42 were rated as suboptimal. Of the evaluated variables, only increasing clinical T stage (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.03–2.15, p = 0.03) and increasing body mass index (BMI) (OR 1.14, 95% CI 1.03–1.26, p = 0.01) were associated with increased difficulty; 90‐day complication rates were similar between the optimal and suboptimal cohorts (17.3% vs. 23.8%, respectively; p = 0.5). The number of patients with previous surgery, pelvic diameter, and prostate size:pelvic diameter ratio were not significantly different between cohorts (p > 0.05 for all). Operative time (ρ = 0.23, p = 0.02) and estimated blood loss (EBL) (ρ = 0.38, p = 0.0001) were correlated with suboptimal difficulty. Conclusion The factors associated with surgeon‐reported RARP difficulty were patient BMI and clinical T stage among surgeons with significant RARP experience. These data should be incorporated into surgical decision making and patient counseling prior to performing a RARP.
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Affiliation(s)
- Daniel D. Shapiro
- Department of Urology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - John W. Davis
- Department of Urology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Wendell H. Williams
- Department of Anesthesiology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Brian F. Chapin
- Department of Urology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - John F. Ward
- Department of Urology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Curtis A. Pettaway
- Department of Urology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Justin R. Gregg
- Department of Urology The University of Texas MD Anderson Cancer Center Houston Texas USA
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Rodrigues Martins YM, Romanelli de Castro P, Drummond Lage AP, Alves Wainstein AJ, de Vasconcellos Santos FA. Robotic surgery costs: Revealing the real villains. Int J Med Robot 2021; 17:e2311. [PMID: 34268880 DOI: 10.1002/rcs.2311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/25/2021] [Accepted: 07/09/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study aimed to evaluate the main drivers of robot assisted radical prostatectomy (RARP) hospitalization costs, in addition to assess perioperative predictors that impact costs. METHODS Overall, 474 RARP were analyzed between February 2018 and December 2019. The association between perioperative variables and total direct costs was analyzed by simple and multiple linear regression. DISCUSSION The main drivers of RARP hospitalization costs were robotic surgical supplies. Costs increased with American Society of Anesthesiologists score 3, a one-hour increase in OR time, increased utilization of polymeric clip packs and longer length of hospital stay. There was a 11.5% reduction in costs with the use of four robotic instruments instead of five. CONCLUSION Costs of hospitalization were mainly influenced by the OR time, use of surgical supplies and length of hospital stay. Reducing the number of robotic instruments used in RARP represented the potentially modifiable factor with the greatest impact on cost reduction.
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Zanotto BS, Etges APBDS, Marcolino MAZ, Polanczyk CA. Value-Based Healthcare Initiatives in Practice: A Systematic Review. J Healthc Manag 2021; 66:340-365. [PMID: 34192716 PMCID: PMC8423138 DOI: 10.1097/jhm-d-20-00283] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
EXECUTIVE SUMMARY Value-based initiatives are growing in importance as strategic models of healthcare management, prompting the need for an in-depth exploration of their outcome measures. This systematic review aimed to identify measures that are being used in the application of the value agenda. Multiple electronic databases (PubMed/MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials) were searched. Eligible studies reported various implementations of value-based healthcare initiatives. A qualitative approach was used to analyze their outcome measurements. Outcomes were classified according to a tier-level hierarchy. In a radar chart, we compared literature to cases from Harvard Business Publishing. The value agenda effect reported was described in terms of its impact on each domain of the value equation. A total of 7,195 records were retrieved; 47 studies were included. Forty studies used electronic health record systems for data origin. Only 16 used patient-reported outcome surveys to cover outcome tiers that are important to patients, and 3 reported outcomes to all 6 levels of our outcome measures hierarchy. A considerable proportion of the studies (36%) reported results that contributed to value-based financial outcomes focused on cost savings. However, a gap remains in measuring outcomes that matter to patients. A more complete application of the value agenda by health organizations requires advances in technology and culture change management.
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Affiliation(s)
- Bruna Stella Zanotto
- National Institute of Health Technology Assessment and Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana Paula Beck da Silva Etges
- National Institute of Health Technology Assessment, Federal University of Rio Grande do Sul, and Pontifical Catholic University of Rio Grande do Sul Polytechnic School, Porto Alegre, Brazil
| | - Miriam Allein Zago Marcolino
- National Institute of Health Technology Assessment, Federal University of Rio Grande do Sul and Graduate Program in Epidemiology, Federal University of Rio Grande do Sul; and
| | - Carisi Anne Polanczyk
- National Institute of Health Technology Assessment, Federal University of Rio Grande do Sul, and Graduate Programs in Epidemiology and Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul
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Luzzago S, Palumbo C, Rosiello G, Pecoraro A, Deuker M, Stolzenbach F, Mistretta FA, Tian Z, Musi G, Montanari E, Shariat SF, Saad F, Briganti A, de Cobelli O, Karakiewicz PI. Metabolic syndrome predicts worse perioperative outcomes in patients treated with radical prostatectomy for non-metastatic prostate cancer. Surg Oncol 2021; 37:101519. [DOI: 10.1016/j.suronc.2020.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 11/09/2020] [Accepted: 12/27/2020] [Indexed: 12/12/2022]
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Rosiello G, Gandaglia G, Scuderi S, Barletta F, Fossati N, Stabile A, Gallina A, Mazzone E, Vitale LM, Pellegrino A, Bravi C, Martini A, Cucchiara V, Karakiewicz PI, Mottrie A, Briganti A, Montorsi F. Reducing the Risk of Postoperative Complications After Robot-assisted Radical Prostatectomy in Prostate Cancer Patients: Results of an Audit and Feedback Intervention Following the Implementation of Prospective Data Collection. Eur Urol Focus 2021; 8:431-437. [PMID: 33879394 DOI: 10.1016/j.euf.2021.03.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/11/2021] [Accepted: 03/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prospective data collection for perioperative outcomes might increase awareness of surgical results obtained for patients with prostate cancer (PCa) undergoing robot-assisted radical prostatectomy (RARP). This would prompt the implementation of measures aimed at reducing the risk of adverse outcomes. OBJECTIVE To assess the efficacy of an audit and feedback process aimed at identifying the most common complications after RARP and at implementing measures to improve outcomes. DESIGN, SETTING, AND PARTICIPANTS Overall, 415 patients treated with RARP by a high-volume surgeon were included. Perioperative outcomes for 187 patients treated between September 2016 and December 2017 were prospectively collected at 30 d according to the European Association of Urology guideline recommendations (group 1). An audit and feedback process was implemented in January 2018 whereby the most common complication (anastomotic leak) was identified and measures aimed at improving outcomes (changes in the anastomotic technique) were implemented. The outcomes for group 1 were then compared to 228 patients treated after implementation of the modified surgical technique (group 2). SURGICAL PROCEDURE A novel technique for posterior reconstruction and urethrovesical anastomosis was introduced. MEASUREMENTS Perioperative outcomes included blood loss, operative time, length of stay, and 30-d postoperative complications. Logistic regression models tested the effect of the novel surgical technique on anastomotic leaks. RESULTS AND LIMITATIONS Overall, 97 patients (23%) experienced postoperative complications at 30 d. The rate of anastomotic leaks was significantly lower in group 2 compared to group 1 (3.1% vs 9.6%; p < 0.01). Similarly, overall and Clavien-Dindo grade ≥2 complication rates were lower in group 2 versus group 1 (17% vs 31%, and 6% vs 20%; both p ≤ 0.001). In multivariable analyses, treatment after implementation of changes in the anastomotic technique independently predicted a lower risk of complications (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.38-0.89) and of anastomotic leaks (OR 0.43, 95% CI 0.17-0.97). The lack of randomization represents the main limitation. CONCLUSIONS Implementation of changes in the urethrovesical anastomosis technique arising from increased awareness of surgical outcomes reduced the risk of anastomotic leaks. These findings highlight the importance of audit and feedback processes using a standardized method for reporting surgical morbidity. PATIENT SUMMARY Increased awareness of surgical outcomes prompted us to change our technique for connecting the bladder to the urethra during robot-assisted surgery to remove the prostate in patients with prostate cancer. These changes resulted in significant improvements in surgical outcomes.
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Affiliation(s)
- Giuseppe Rosiello
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simone Scuderi
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Barletta
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Fossati
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Armando Stabile
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Gallina
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elio Mazzone
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Maria Vitale
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antony Pellegrino
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Bravi
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Martini
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vito Cucchiara
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Roumiguié M, Xylinas E, Brisuda A, Burger M, Mostafid H, Colombel M, Babjuk M, Palou Redorta J, Witjes F, Malavaud B. Consensus Definition and Prediction of Complexity in Transurethral Resection or Bladder Endoscopic Dissection of Bladder Tumours. Cancers (Basel) 2020; 12:cancers12103063. [PMID: 33092240 PMCID: PMC7589904 DOI: 10.3390/cancers12103063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Transurethral resection of bladder tumours may be technically challenging. Complexity was defined by consensus from the literature by a panel of ten senior urologists as “any TURBT/En-bloc dissection that results in incomplete resection and/or prolonged surgery (>1 h) and/or significant (Clavien-Dindo ≥ 3) perioperative complications”. Patient and tumour’s characteristics that suggested to by the panel to relate to complex surgery were collected and then ranked by Delphi consensus. They were tested in the prediction of complexity in 150 clinical scenarios. After univariate and logistic regression analyses, significant characteristics were organized into a checklist that predicts complexity. Receiver operating characteristics (ROC) curves of the regression model and the corresponding calibration curve showed adequate discrimination (AUC = 0.916) and good calibration. The resulting Bladder Complexity Checklist can be used to deliver optimal preoperative information and personalise the organisation of surgery. Abstract Ten senior urologists were interrogated to develop a predictive model based on factors from which they could anticipate complex transurethral resection of bladder tumours (TURBT). Complexity was defined by consensus. Panel members then used a five-point Likert scale to grade those factors that, in their opinion, drove complexity. Consensual factors were highlighted through two Delphi rounds. Respective contributions to complexity were quantitated by the median values of their scores. Multivariate analysis with complexity as a dependent variable tested their independence in clinical scenarios obtained by random allocation of the factors. The consensus definition of complexity was “any TURBT/En-bloc dissection that results in incomplete resection and/or prolonged surgery (>1 h) and/or significant (Clavien-Dindo ≥ 3) perioperative complications”. Logistic regression highlighted five domains as independent predictors: patient’s history, tumour number, location, and size and access to the bladder. Receiver operating characteristic (ROC) analysis confirmed good discrimination (AUC = 0.92). The sum of the scores of the five domains adjusted to their regression coefficients or Bladder Complexity Score yielded comparable performance (AUC = 0.91, C-statistics, p = 0.94) and good calibration. As a whole, preoperative factors identified by expert judgement were organized to quantitate the risk of a complex TURBT, a crucial requisite to personalise patient information, adapt human and technical resources to individual situations and address TURBT variability in clinical trials.
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Affiliation(s)
- Mathieu Roumiguié
- Department of Urology, Institut Universitaire du Cancer, 31059 Toulouse CEDEX 9, France;
| | | | - Antonin Brisuda
- Department of Urology, 2nd Faculty of Medicine, Charles University, Teaching Hospital Motol, 15006 Prague, Czech Republic; (A.B.); (M.B.)
| | - Maximillian Burger
- St. Josef, Klinik für Urologie, Caritas-Krankenhaus, 93053 Regensburg, Germany;
| | - Hugh Mostafid
- Department of Urology, Royal Surrey County Hospital, Surrey, Guildford GU2 7RF, UK;
| | - Marc Colombel
- Department of Urology, Hôpital Edouard Herriot, 69437 Lyon, France;
| | - Marek Babjuk
- Department of Urology, 2nd Faculty of Medicine, Charles University, Teaching Hospital Motol, 15006 Prague, Czech Republic; (A.B.); (M.B.)
| | | | - Fred Witjes
- Department of Urology, Radboud UMC, 6525 GA Nijmegen, The Netherlands;
| | - Bernard Malavaud
- Department of Urology, Institut Universitaire du Cancer, 31059 Toulouse CEDEX 9, France;
- Correspondence:
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Luzzago S, Rosiello G, Pecoraro A, Deuker M, Stolzenbach F, Mistretta FA, Tian Z, Musi G, Montanari E, Shariat SF, Saad F, Briganti A, de Cobelli O, Karakiewicz PI. Contemporary Rates and Predictors of Open Conversion During Minimally Invasive Radical Prostatectomy for Nonmetastatic Prostate Cancer. J Endourol 2020; 34:600-607. [DOI: 10.1089/end.2020.0074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Stefano Luzzago
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Giuseppe Rosiello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Angela Pecoraro
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
- Department of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Marina Deuker
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Franziska Stolzenbach
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
- Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francesco Alessandro Mistretta
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, IRCCS Fondazione Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Shahrokh F. Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Departments of Urology, Weill Cornell Medical College, New York, New York
- Department of Urology, University of Texas Southwestern, Dallas, Texas
- Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Alberto Briganti
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
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Increased Operative Duration of Minimally Invasive Prostatectomy is Associated with Significantly Increased Risk of 30-Day Morbidity. UROLOGY PRACTICE 2020. [DOI: 10.1097/upj.0000000000000068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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