Purpose We aimed to investigate the association of obesity with nocturia using a nationally representative sample of adults from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2012. Methods A total of 14,135 participants were included in this study. We performed a multivariate logistic regression analysis to find the odds ratio (OR) of obesity for nocturia. Furthermore, the OR of BMI for nocturia was analyzed using restricted cubic splines (RCS) with five knots. We conducted subgroup analysis according to age, sex, hypertension, and diabetes mellitus (DM) and further analysis with 1:1 matching data with propensity score. Results The participants who had body mass index (BMI) above 30 kg/m 2 had a significantly higher OR for nocturia (OR, 1.39; 95% CI, 1.28–1.50) than those without obesity. RCS showed a dose-dependent relationship between BMI and OR for nocturia. Subgroup analysis by age, sex, hypertension, and DM showed similar results. Further analysis with 1:1 matching data showed a significant association of obesity with the prevalence of nocturia (OR, 1.25; 95% CI, 1.10–1.41). Conclusions This study reported that obesity was significant association with the prevalence of nocturia with dose-dependent manner, regardless of age, sex, hypertension, and DM after taking major confounding factors into account.

Objective Previous studies on the association between urinary incontinence (UI) and falls have reported conflicting results. We, therefore, aimed to evaluate and clarify this association through a systematic review and meta-analysis of relevant studies. Methods We performed a literature search for relevant studies in databases including PubMed and EMBASE from inception up to December 13, 2020, using several search terms related to UI and falls. Based on the data reported in these studies, we calculated the pooled odds ratios (ORs) for falls and the corresponding 95% confidence intervals (CIs) using the Mantel–Haenszel method. Results This meta-analysis included 38 articles and a total of 230,129 participants. UI was significantly associated with falls (OR, 1.62; 95% CI, 1.45–1.83). Subgroup analyses based on the age and sex of the participants revealed a significant association between UI and falls in older (≥65 years) participants (OR, 1.59; 95% CI, 1.31–1.93), and in both men (OR, 1.88; 95% CI, 1.57–2.25) and women (OR, 1.41; 95% CI, 1.29–1.54). Subgroup analysis based on the definition of falls revealed a significant association between UI and falls (≥1 fall event) (OR, 1.61; 95% CI, 1.42–1.82) and recurrent falls (≥2 fall events) (OR, 1.63; 95% CI, 1.49–1.78). According to the UI type, a significant association between UI and falls was observed in patients with urgency UI (OR, 1.76; 95% CI, 1.15–1.70) and those with stress UI (OR, 1.73; 95% CI, 1.39–2.15). Conclusions This meta-analysis, which was based on evidence from a review of the published literature, clearly demonstrated that UI is an important risk factor for falls in both general and older populations.

Objectives To investigate the oncological significance of a robot‐assisted radical cystectomy (RARC)‐related pentafecta in patients with bladder cancer. Patients and Methods Using the KORARC database, which includes data from 12 centres, data from 730 patients who underwent RARC between April 2007 and May 2019 were prospectively collected and retrospectively analysed. Pentafecta was achieved if patients met all of the following criteria: (i) negative soft tissue surgical margin; (ii) ≥16 lymph nodes removed; (iii) no major complications (Clavien–Dindo grade 3–5) within 90 days; (iv) no clinical recurrence within the first 12 months; and (v) no ureteroenteric stricture. Patients were divided into two groups according to pentafecta attainment, and a comparison of overall survival (OS) and cancer‐specific survival (CSS) using multivariate Cox proportional analysis was then carried out. Results Of the 730 patients included in this analysis, 208 (28.5%) attained the RARC pentafecta; the remaining 522 (71.5%) did not. The mean age of the patients was 64.67 years, 85.1% were men, 53.6% received a conduit, 37.7% received orthotopic neobladders and the total complication rate was 57.8%. Those who attained the pentafecta received more neobladders (P = 0.039), were more likely to be treated with the intracorporeal technique (P < 0.001), had longer operating times (P = 0.020) and had longer console time (P = 0.021) compared with those who did not attain the pentafecta. Over a mean of 31.1 months of follow‐up, the pentafecta attainment group had significantly higher OS and CSS rates compared with the non‐attainment group (10‐year OS 70.4% vs 58.1%, respectively [P = 0.016]; 10‐year CSS 87.8% vs 70.0%, respectively [P = 0.036]). Multivariate analysis showed that the RARC pentafecta was a significant predictor of overall mortality (hazard ratio 0.561; P = 0.038). Conclusions Patients who attained the RARC pentafecta had significantly better survival outcomes compared with those who did not. These criteria could be used to standardize assessment of the surgical quality of RARC. In the future, a similar study using an independent cohort is warranted to confirm our results.

Our initial experience with RARC appears to be favorable with acceptable operative, pathologic, and short-term clinical outcomes. The current series suggests that RARC is becoming more prevalent, not only in Western countries, but also in Asian countries, just as robot-assisted radical prostatectomy has also gained widespread acceptance. Data from long-term, large, prospective, multicenter, ideally randomized comparative studies with open radical cystectomy are needed to confirm the outcome of the novel operation reported here.

Background: The reliability of pulse pressure variation (PPV) and stroke volume variation (SVV) is controversial under pneumoperitoneum. In addition, the usefulness of these indices is being called into question with the increasing adoption of lung-protective ventilation using low tidal volume (V T) in surgical patients. A recent study indicated that changes in PPV or SVV obtained by transiently increasing V T (V T challenge) accurately predicted fluid responsiveness even in critically ill patients receiving low V T. We evaluated whether the changes in PPV and SVV induced by a V T challenge predicted fluid responsiveness during pneumoperitoneum. Methods: We performed an interventional prospective study in patients undergoing robot-assisted laparoscopic surgery in the Trendelenburg position under lung-protective ventilation. PPV, SVV, and the stroke volume index (SVI) were measured at a V T of 6 mL/kg and 3 min after increasing the V T to 8 mL/kg. The V T was reduced to 6 mL/kg, and measurements were performed before and 5 min after volume expansion (infusing 6% hydroxyethyl starch 6 ml/kg over 10 min). Fluid responsiveness was defined as ≥15% increase in the SVI. Results: Twenty-four of the 38 patients enrolled in the study were responders. In the receiver operating characteristic curve analysis, an increase in PPV > 1% after the V T challenge showed excellent predictive capability for fluid responsiveness, with an area under the curve (AUC) of 0.95 [95% confidence interval (CI), 0.83-0.99, P < 0.0001; sensitivity 92%, specificity 86%]. An increase in SVV > 2% after the V T challenge predicted fluid responsiveness, but showed only fair predictive capability, with an AUC of 0.76 (95% CI, 0.60-0.89, P < 0.0006; sensitivity 46%, specificity 100%). The augmented values of PPV and SVV following V T challenge also showed the improved predictability of fluid responsiveness compared to PPV and SVV values (as measured by V T) of 6 ml/kg. Conclusions: The change in PPV following the V T challenge has excellent reliability in predicting fluid responsiveness in our surgical population. The change in SVV and augmented values of PPV and SVV following this test are also reliable. Trial registration: This trial was registered with Clinicaltrials.gov, NCT03467711, 10th March 2018.