AUA 2018: Inferior Vena Cava Level II Tumor Thrombectomy: Which is Best: Robot or Open?
San Francisco, CA (UroToday.com) In this plenary session, Drs. Leibovich and Gill once again debated the best approach to a Level II Tumor Thrombus. Mark Soloway introduced the topic. He made some important baseline points: This is one of the most complex procedures we do in Urology – and morbidity can be high in inexperienced hands. The key to success is preparation, experience, exposure and vascular control. He provided guidance regarding liver mobilization for level II and III thrombi and emphasized the need for a multi-disciplinary team.
AUA 2017: Trends in surgical approach and outcomes for radical cystectomy: a contemporary population-based analysis
Boston, MA (UroToday.com) This population based analysis using the Premier Healthcare Database identified 71,844 patients undergoing RC from 2003-2015. Of these, 9218 underwent RARC. There was an increase from 0.1% to 33.9% usage rate for RARC during the study period.
AUA 2017: Impact of prostate involvement on outcomes in patients treated with radical cystoprostatectomy for bladder cancer
Boston, MA (UroToday.com) This single-institutional retrospective study found prostatic stromal invasion by urothelial carcinoma to be associated with worse survival outcomes. In 893 men undergoing RC, 181 were found to have prostatic urethral involvement.
AUA 2017: Bladder cancers are not all the same: de novo muscle invasive disease has improved survival compared to invasive disease progressing after intravesical therapy
Boston, MA (UroToday.com) The concept of progressive MIBC (P-MIBC) has been recently identified to be a risk factor for cancer specific death. This is a subset of patients who progress from NMIBC to MIBC following intravesical therapy.
AUA 2017: Comparison of total 90 day costs for open versus robotic cystectomy
Boston, MA (UroToday.com) In this study analyzing the cost of extirpative treatment for bladder cancer, the investigators from UT MD Anderson Cancer Center retrospectively analyzed the cost of surgery and postoperative care in 100 pair wise matched open vs. robotic assisted radical cystectomy patients. The two groups had similar clinicopathologic features, neoadjuvant chemotherapy rates, and pathologic staging at RC.
AUA 2017: Venous thromboembolism rates following radical cystectomy stratified by method of prophylaxis
Boston, MA (UroToday.com) In this study, the authors set to assess whether the method of VTE prophylaxis was associated with the incidence of symptomatic VTE. At USC, the philosophy on VTE prophylaxis has been separated into two eras. In the first, prophylaxis was achieved using a 10mg loading dose of warfarin, followed by adjustments to achieve a goal INR of 2.0. No VTE prophylaxis was given after discharge.
AUA 2017: Restrictive transfusion in radical cystectomy is safe
Boston, MA (UroToday.com) Moffat et al and Linder et al have shown the benefit of restricted perioperative transfusion after radical cystectomy. Some of the proposed mechanisms of action include immunomodulation vs. increased comorbidity in patients who received perioperative transfusion. The authors evaluated patients who were subjected to restricted perioperative transfusion protocols vs. those in whom transfusion was not limited.