Publications (2)6.44 Total impact
-
Article: Risk and Prevention of Acute Urinary Retention After Robotic Prostatectomy.
[show abstract] [hide abstract]
ABSTRACT: PURPOSE: Acute urinary retention (AUR) following catheter removal is a recognized complication after open or robot-assisted radical prostatectomy (RARP). We evaluated patient and surgery-related risk factors to determine if AUR can be prevented, which has not previously been done for prostatectomy by any technique. METHODS: We reviewed a single-surgeon RARP database of patients treated between February 2008 and June 2011 for AUR following catheter removal, which was routinely performed 3 to 7 days postoperatively. Characteristics of patients with and without AUR were compared. RESULTS: Of 1026 patients, 25 (2.4%) experienced AUR. There was no difference between patients with and without AUR in mean age, BMI, blood loss, or prostate size, nor any difference in the frequency of bladder neck reconstruction or nerve-sparing. Catheter removal occurred on average on postoperative day (POD) 4.1 vs. 5.7 in patients with and without AUR. Of 25 patients with AUR, 22 (88%) underwent catheter removal on POD 3 or 4. Although only 3 of 381 patients (0.8%) had a leak on cystogram on POD 3 or 4, the AUR rate when the catheter was removed on day 3 or 4 was 5.8% (22/381), which was several times higher than in those who wore the catheter for >4 days (3/645 or 0.5%). CONCLUSIONS: AUR after robotic prostatectomy occurs infrequently. No patient-related risk factors were identified beyond catheterization time. Although the catheter may be removed after 3-4 days with rare leaks, AUR risk was much less when the catheter was left in place at least 5 days.The Journal of urology 09/2012; · 4.02 Impact Factor -
Article: Robotic partial nephrectomy without renal ischemia.
[show abstract] [hide abstract]
ABSTRACT: To evaluate our outcomes of robotic partial nephrectomy (RPN) without renal artery clamping (off-clamp), in order to avoid ischemic renal injury, using cold-scissor tumor excision and sutured reconstruction without ablation or other regional hypoperfusion. Between September 2009 and October 2010, patients who underwent off-clamp RPN for ≥1 tumors were reviewed from a prospective database. All procedures were performed by a single surgeon experienced in RPN. Indications included solitary kidney, multiple tumors in the same kidney, or electively when they it was possible. Twenty-eight off-clamp RPNs were performed in 22 patients. Mean age and body mass index were 55 years (range 24-73) and 31 kg/m(2). Mean operative time was 183 minutes with mean blood loss of 274 mL. One patient required transfusion and was the only patient with Clavien grade II or higher complications (4.5%). Mean ± SD off-clamp tumor size on final pathology was 2.1 ± 1.1 cm (range 0.8-4.9) with mean RENAL nephrometry score of 6.25 (4a-9ph). For patients with additional tumors undergoing RPN with clamping, mean warm ischemia time was 12.1 minutes (range 7-19.3) for tumors of 4.6-10.5 cm. Twenty patients (91%) were discharged on postoperative day 1. All had negative margins. Mean preoperative, immediate postoperative, and 6-month postoperative estimated glomerular filtration rate were 89.8, 77.5, and 86.5 mL/min, respectively. For selected patients and tumors, RPN without ischemia is feasible without ablation, energy resection, or regional hypoperfusion. Further experience is necessary to determine which patients are ideally suited.Urology 04/2012; 79(6):1296-301. · 2.43 Impact Factor
