DIAGNOSTIC UROLOGY, URINARY DIVERSION AND PERIOPERATIVE CARE
The debate rages on between the pros and cons of robotic radical cystectomy.1 With prospective randomized trial NCT01157676 Parekh et al will help to elucidate the oncologic efficacy of this procedure (https://clinicaltrials.gov/ct2/show/NCT01157676). Although theoretical concerns may exist, none have been proved for other cancer types. This important study evaluates complications at a single center and uses different surgeons for the extirpative portion of the procedure but the same surgeon for the reconstruction portion of the proceduredmany times conjectured to be the “cause” of the majority of complications. As with every procedure we perform, competing factors influence the decisions we make with our patients, including oncologic outcomes, perioperative variables such as time and estimated blood loss and transfusion requirements, our individual skill and experience with the technology, costs, and patient history and desires. Currently I represent an amalgam of this study as more than 75% of the cystectomies I perform are robotic and I perform open urinary diversion. Sam S. Chang, MD 1. Johar RS, Hayn MH, Stegemann AP et al: Complications after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol 2013; 64: 52.
Suggested Reading Zhumkhawala A, Kozinn S, Chan K et al: A decade of robotic cystectomy: surgical characteristics and oncologic outcomes. J Urol, suppl., 2015; 193: e856. abstract MP67e18.
Diagnostic Urology, Urinary Diversion and Perioperative Care Re: Health-Related Quality of Life after Radical Cystectomy and Neobladder Reconstruction in Women: Impact of Voiding and Continence Status M. H. Zahran, A. S. El-Hefnawy, E. M. Zidan, M. A. El-Bilsha, D. E. Taha and B. Ali-El-Dein Urology and Nephrology Center, Mansoura University, Mansoura, Egypt Int J Urol 2014; 21: 887e892.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.09.015 available at http://jurology.com/ Editorial Comment: This retrospective study examined quality of life and incontinence in 74 women who underwent cystectomy with orthotopic neobladder. Of the patients only 18 (24%) were continent with normal voiding. Chronic urinary retention occurred in 27 patients (36%), while 29 (39%) had nighttime incontinence. Overall the cohort of patients had a lower quality of life compared to an age matched control population. Also nighttime incontinence had a more negative impact on quality of life than did chronic urinary retention. This study is useful in counselling women before undergoing radical cystectomy with orthotopic neobladder. It is noteworthy that only 24% of patients voided spontaneously without nighttime incontinence. David S. Wang, MD
Re: Impact of Surgeon Volume on the Morbidity and Costs of Radical Cystectomy in the USA: A Contemporary Population-Based Analysis J. J. Leow, S. Reese, Q. D. Trinh, J. Bellmunt, B. I. Chung, A. S. Kibel and S. L. Chang Center for Surgery and Public Health, and Division of Urology, Brigham and Women’s Hospital, Boston, Massachusetts BJU Int 2015; 115: 713e721.