Prostate size influenced total operative times and the bladder neck reconstruction and anastomosis time. Our data support the use of preoperative TRUS to estimate PV and recommendations for surgeons starting on their LC to choose glands less than 60 cc.

Recurrent disease following primary radiotherapy for localized prostate cancer is a common problem, occurring in up to 46% of patients. For these patients, therapeutic options include salvage prostatectomy, salvage cryotherapy, salvage high-intensity focused ultrasound (HIFU), hormonal therapy or observation. This review will focus on the emerging evidence for salvage HIFU. There are no randomized or prospective studies in this area. Efficacy results of 17-57% have been reported from retrospective case series, with reported toxicity including rectal fistula in 0-16%, and incontinence in 10-50%. The ideal patient, while yet to be clearly defined, should have preradiotherapy low or intermediate risk disease. Salvage HIFU appears most appropriate for those patients with histologically proven local recurrence only, with a life expectancy of at least 5 years and with some medical comorbidities rendering them not ideal for salvage prostatectomy.

Intravesical chemotherapy after transurethral resection of a bladder tumour (TURBT) has been observed to significantly decrease recurrence rates compared to TURBT alone. Though immediate postoperative intravesical treatment with chemotherapeutic agents after transurethral resection for superficial bladder carcinoma is generally considered a safe and effective adjunctive therapy in decreasing recurrence rates, its instillation is not always completely innocuous. Lately, a more serious complication of bladder perforation associated with immediate instillation of intravesical mitomycin C (MMC) after TURBT was reported. We report our own experience of a male patient with bladder perforation after an early instillation of a single dose of MMC. In this case, systemic toxicity occurred which required intensive care after surgical repair.Can Urol Assoc J 2010;4(1):E1-E3

Patient selection is the key to success with cryoablation, in both the primary and salvage setting. The modality can offer long-term cancer control in carefully selected patient with properly executed techniques.

Introduction: Previous studies of robotic-assisted radical prostatectomy (RARP) have suggested that obesity is a risk factor for worse perioperative outcomes. We evaluated whether body mass index (BMI) adversely affected perioperative outcomes. Methods: A prospective database of 153 RARP (single surgeon) was analyzed. Obesity was defined as BMI ≥ 30 kg/m 2 ; normal BMI < 25 kg/m 2 ; and overweight as 25 to 30 kg/m 2 . Two separate analyses were performed: the first 50 cases (the initial learning curve) and the entire cohort of 153 RARP. Results: In the initial cohort of 50 cases (14 obese patients), there was no statistically significant difference with regards to operative times, port-placement times and estimated blood loss (EBL). Length of stay (LOS) was longer in the obese group (4.3 vs. 2.9 days); BMI remained an independent predictor of increased LOS on multivariate linear regression analysis (p = 0.002). There was no statistically significant difference in the postoperative outcomes of leak rates, margin rates and incisional herniae. In the entire cohort, when comparing obese patients to those with a normal BMI, there was no statistically significant difference in operative times, EBL, LOS, or immediate postoperative outcomes. However, on multivariate linear regression analysis, BMI was an independent predictor of increased operative time (p = 0.007). Conclusion: Obese patients do not have an increased risk of blood loss, positive margins or the postoperative complications of incisional hernia and leak during the learning curve. They do, however, have slightly longer operative times; we also noted an increased LOS in our first 50 cases. RésuméIntroduction : Des études antérieures sur la prostatectomie radicale assistée par robot (PRAR) ont laissé entendre que l'obésité était un facteur de risque de complications périopératoires. Nous avons évalué si l'indice de masse corporelle (IMC) affectait de façon négative les résultats de l'opération. Méthodologie : Une base de données prospective comptant 153 PRAR (effectuées par un seul chirurgien) a été analysée. On a défini l'obésité comme un IMC ≥ 30 kg/m 2 , un IMC normal étant < 25 kg/m 2 , et un IMC entre 25 et 30 kg/m 2 représentant un surplus de poids. Deux analyses distinctes ont été réalisées : les 50 premiers cas (courbe d'apprentissage initiale) et la cohorte entière des 153 patients ayant subi une PRAR. Résultats :Dans la cohorte initiale de 50 cas (dont 14 patients obèses), on n'a noté aucune différence significative sur le plan statistique en ce qui concerne la durée de l'opération, le temps requis pour installer l'accès vasculaire et la perte de sang approximative. La durée du séjour était plus longue dans le groupe des patients obèses (4,3 contre 2,9 jours), et l'IMC est demeuré un facteur indépendant de prédiction d'une durée prolongée du séjour lors de l'analyse de régression linéaire multivariée (p = 0,002). Aucune différence significative sur le plan statistique n'a été notée dans les résultats postopératoires quant aux taux de fuite, ...