A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications:Large tumors(cT2-T3),solitary kidney,completely endophytic,hilar,recurrent,and multiple renal tumors

Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses.The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses,large tumors(cT2-T3),renal cell carcinoma in solitary kidney,recurrent tumors,completely endophytic and hilar masses,and simultaneous and multiple tumors.Methods:A comprehensive search in the PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers.The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered.The secondary endpoint was to evaluate the surgical and functional outcomes.Results:After screening 1250 records,43 full-text manuscripts were selected,comprising over 8500 patients.Twelve and thirteen studies reported data for endophytic and hilar renal masses,respectively.Five and three studies reported outcomes for cT2-T3 and solitary kidney patients,respectively.Four studies focused on redo-RAPN for recurrent tumors.Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney.Conclusion:Over the past decade,evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown.Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes,the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result.Certainly,a higher likelihood of complication might be expected when facing extremely challenging cases.However,none of these indications should be considered per se an exclusion criterion for performing RAPN.Ultimately,a risk-adapted approach should be employed.

A narrative review of outcomes following metoidioplasty:complications and satisfaction

Metoidioplasty consists of lengthening and straightening the hormonally hypertrophied clitoris.The goals of the procedure include masculinizing the external genitalia and enabling standing micturition.Metoidioplasty may be performed as a stand-alone procedure or an interval procedure prior to phalloplasty.While most often performed with urethral lengthening,metoidioplasty may also be performed as a“simple release”(i.e.,without urethral lengthening).Secondary procedures typically include scrotoplasty and placement of testicular implants.While satisfaction with this procedure is high,complications can occur.Complications are commonly categorized as either urologic(i.e.,strictures and fistula)or wound healing(i.e.,wound disruption,infection,bleeding,etc.).This narrative review discusses postoperative outcomes,including both satisfaction and complications.Published data on complications include fistula and stricture rates from 0%-50% and 0%-63%,respectively.Overall satisfaction with appearance ranges from 48%-100%,and patient ability to void while standing ranges from 67%-100%.Metoidioplasty is a safe and effective procedure for transgender men.Further research regarding surgical techniques and outcomes will help reduce complications and improve overall patient satisfaction.