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Este mes en... Current Urology Reports

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Este mes en... Current Urology Reports:

  • Cost Analysis of Open Radical Cystectomy Versus Robot-assisted Radical Cystectomy

    Abstract  
    Bladder cancer is the fourth and ninth most common malignancy in males and females, respectively, in the U.S. and one of the most costly cancers to manage. With the current economic condition, physicians will need to become more aware of cost-effective therapies for the treatment of various malignancies. Robot-assisted radical cystectomy (RARC) is the latest minimally invasive surgical option for muscle-invasive bladder cancer. Current reports have shown less blood loss, a shorter hospital stay, and a lower morbidity with RARC, as compared with the traditional open radical cystectomy (ORC), although long-term oncologic results of RARC are still maturing. There are few studies that have assessed the cost outcomes of RARC as compared with ORC. Currently, ORC appears to offer a direct cost advantage due to the high purchase and maintenance cost of the robotic platform, although when the indirect costs of complications and extended hospital stay with ORC are considered, RARC may be less expensive than the traditional open procedure. In order to accurately evaluate the cost effectiveness of RARC versus ORC, prospective randomized trials between the two surgical techniques with long-term oncologic efficacy are needed.

    • Content Type Journal Article
    • Category New Imaging Techniques (A Atala, Section Editor)
    • Pages 1-6
    • DOI 10.1007/s11934-012-0292-7
    • Authors
      • Chinedu O. Mmeje, Urology Department, Mayo Clinic, Phoenix, AZ, USA
      • Aaron D. Martin, Urology Department, Mayo Clinic, Phoenix, AZ, USA
      • Rafael Nunez-Nateras, Urology Department, Mayo Clinic, Phoenix, AZ, USA
      • Alexander S. Parker, Department of Health Science Research, Mayo Clinic, Jacksonville, FL, USA
      • David D. Thiel, Urology Department, Mayo Clinic, Jacksonville, FL, USA
      • Erik P. Castle, Urology Department, Mayo Clinic, Phoenix, AZ, USA
  • Robot-Assisted Laparoscopic Bladder Diverticulectomy

    Abstract  
    Robot-assisted laparoscopic bladder diverticulectomy (RALBD) has been increasingly reported in recent years. We review the technique of RALBD and the perioperative outcomes. We searched online databases to identify original articles related to RALBD. In the Method section, we describe our technique and reviewe several techniques for identification and robotic management of bladder diverticula. We identified 13 retrospective studies that met our criteria, with a total of 44 patients. The mean diverticulum size was 8.3 ± 3.6 cm, mean operative time was 186 ± 68 min, mean estimated blood loss was 86 ± 64 ml, and mean length of stay was 2.4 ± 1.7 days. In the majority of cases, patients with acquired diverticula underwent urethral catheter removal between 7 and 14 postoperative days while in the pediatric population with congenital bladder diverticula, Foley catheter removal usually occurred on postoperative day one. We conclude that a robotic technique is a feasible minimally invasive approach for bladder diverticulectomy. Potential benefits may include precise dissection of adjacent structures, as well as easier intracorporeal suturing. Further studies are needed to compare outcomes and costs versus other existing procedures.

    • Content Type Journal Article
    • Category New Imaging Techniques (A Atala, Section Editor)
    • Pages 1-6
    • DOI 10.1007/s11934-012-0290-9
    • Authors
      • R. Eyraud, Section of Robotic and Image-Guided Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
      • H. Laydner, Section of Robotic and Image-Guided Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
      • R. Autorino, Section of Robotic and Image-Guided Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
      • K. Panumatrassamee, Section of Robotic and Image-Guided Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
      • G. P. Haber, Section of Robotic and Image-Guided Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
      • R. J. Stein, Section of Robotic and Image-Guided Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
  • The Role of Claudin in Hypercalciuric Nephrolithiasis

    Abstract  
    Calcium nephrolithiasis is a common condition. Family-based genetic linkage studies and genome-wide association studies (GWASs) have uncovered a run of important candidate genes involved in renal Ca++ disorders and kidney stone diseases. The susceptible genes include NKCC2, ROMK and ClCkb/Barttin that underlie renal salt excretion; claudin-14, -16 and -19 that underlie renal Ca++ excretion; and CaSR that provides a sensing mechanism for the kidney to regulate salt, water and Ca++ homeostasis. Biological and physiological analyses have revealed the cellular mechanism for transepithelial Ca++ transport in the kidney that depends on the concerted action of these gene products. Although the individual pathogenic weight of the susceptible genes in nephrolithiasis remains unclear, perturbation of their expression or function compromises the different steps within the integrated pathway for Ca++ reabsorption, providing a physiological basis for diagnosing and managing kidney stone diseases.

    • Content Type Journal Article
    • Category Kidney Diseases (G Ciancio, Section Editor)
    • Pages 1-8
    • DOI 10.1007/s11934-012-0289-2
    • Authors
      • Jianghui Hou, Washington University Renal Division, 660 South Euclid Avenue, St. Louis, MO 63110, USA
  • Lymphadenectomy with Robotic Cystectomy

    Abstract  
    It is now established that an experienced, dedicated robotic surgeon can perform a high quality extended template pelvic lymph node dissection at the time of robot-assisted radical cystectomy. The evidence for this conclusion can be seen in comparing absolute lymph node counts, percent positive lymph nodes, and oncologic outcomes from N1 patients. In this report, we outline the endpoints of study for this question, and report recent data on efforts to advance robot-assisted urinary diversion, cost-focused studies, and standardized complication reporting. These studies demonstrate maintenance of adequate lymph node dissections while advancing the goal of reducing morbidity for patients needing radical cystectomy for invasive disease.

    • Content Type Journal Article
    • Category New Imaging Techniques (A Atala, Section Editor)
    • Pages 1-5
    • DOI 10.1007/s11934-012-0288-3
    • Authors
      • John W. Davis, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030, USA
      • Ashish M. Kamat, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030, USA
 

 

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