Placenta percreta is a rare life-threatening condition associated with high morbidity and mortality due to severe obstetric hemorrhage. It can be associated with bladder invasion which leads to hematuria. Treatment is decided on a case-to-case basis, and there have been no guidelines proposed so far. Strategies include obstetric hysterectomy, leaving the placenta in situ with postoperative methotrexate therapy and removal of the placenta with bladder reconstruction in a single stage. An unusual case of a patient with placenta percreta and bladder invasion who presented with delayed hematuria after the placenta was left in situ has been reported. The patient was managed conservatively for 10 days postdelivery after which a decision to do an obstetric hysterectomy with focal cystectomy was taken in view of persistent hematuria. An algorithm for managing cases of placenta percreta with bladder invasion has been proposed to manage these difficult situations.

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ObjectiveWe aimed to give a comprehensive outcome analysis of robot assisted laparoscopic prostatectomies (RALP) performed by a single surgeon and compared it to retropubic radical prostatectomies (RRP) done by the same surgeon in a high-volume center. Materials and MethodsPreoperative, perioperative, and postoperative data were collected prospectively and compared with retrospective retropubic radical prostatectomy data. Perioperative, oncological data and functional results in the rst year were compared between the two groups. There were 547 RARPs between 4 th August 2011 to 31 st December 2018, and 428 RRPs between 1 st January 1996 to 31 st December 2009 which were included in this review. ResultsWhile the operation time was in favor of the open group (196 vs 160 min, p<0.01), the estimated blood loss (188 vs 316ml, p<0.01), blood transfusion rate (3% vs 7% p=0.021), hospital stay (4 days vs 7 days) and mean catheter duration (12 vs 15 days) were in favor of the robotic group. Majority of the complications belonged to Clavien-Dindo group II in both groups and rates were not signi cantly different. (p=0.33) 12-month continence rate was in favor of RALP group (98.3% vs 99.2%, p <0.01).

ObjectiveWe aimed to give a comprehensive outcome analysis of robot assisted laparoscopic prostatectomies (RALP) performed by a single surgeon and compared it to retropubic radical prostatectomies (RRP) done by the same surgeon in a high-volume center.Materials and MethodsPreoperative, perioperative, and postoperative data were collected prospectively and compared with retrospective retropubic radical prostatectomy data. Perioperative, oncological data and functional results in the first year were compared between the two groups. There were 547 RARPs between 4th August 2011 to 31st December 2018, and 428 RRPs between 1st January 1996 to 31st December 2009 which were included in this review.ResultsWhile the operation time was in favor of the open group (196 vs 160 min, p<0.01), the estimated blood loss (188 vs 316ml, p<0.01), blood transfusion rate (3% vs 7% p=0.021), hospital stay (4 days vs 7 days) and mean catheter duration (12 vs 15 days) were in favor of the robotic group. Majority of the complications belonged to Clavien-Dindo group II in both groups and rates were not significantly different. (p=0.33) 12-month continence rate was in favor of RALP group (98.3% vs 99.2%, p <0.01). Overall survival of the RALP cohort at 24 months was 99.8%, 60 months 96.1%, 84 months 87.3% , 96 months 81.3%), 108 months was 79.5%. Overall survival at 24 months was 99.8%, 60 months 96.1%, 84 months 87.3%, 96 months 81.3%, and 108 months was 79.5%.ConclusionRALP is a safe, minimally invasive technically feasible procedure with comparable functional and oncological outcomes. Our study showed superior perioperative and continence outcomes in RALP. However, despite its growing popularity, RRP still remains the gold standard in India due to its affordability and accessibility.