Description of a novel robotic early post-prostatectomy anastomotic repair technique and institutional outcomes

Objective:A vesicourethral anastomotic leak(VUAL)is a known complication following robotic-assisted radical prostatectomy.The natural history of a VUAL has been well described and is frequently managed with prolonged catheterization.With increasing emphasis on patient reported outcomes,catheter duration and VUAL are associated with significant short-term quality of life impairment.We aimed to present a case series of our robotic early post-prostatectomy anastomotic repair technique,defined as revision within 6 weeks from index surgery.Methods:A single institution prospective database identified eleven patients with a VUAL from July 2016 to October 2022 who underwent robotic early post-prostatectomy anastomotic repair by a single surgeon.Patients were diagnosed with a VUAL on pre-operative CT urogram or CT/fluoroscopic cystogram.The primary outcome was resolution of the anastomotic leak,defined as no contrast extravasation on post-operative cystography.Secondary outcomes included post-repair catheter duration and continence on the last follow-up defined as pad(s)per day.Results:The mean time to intervention after robotic-assisted radical prostatectomy was 21 days.Eight of the eleven(72.7%)patients had no evidence of extravasation on postrepair cystogram.The range from intervention to first cystogram was 7e20 days.The median catheter duration for those with successful intervention was 10 days.The median catheter duration for those with the leak on initial post-operative cystogram was 20 days.At a mean follow-up time of 25 months,eight(72.7%)patients reported using no pads per day,and three(27.3%)patients reported one pad per day.Conclusion:Management of a VUAL has traditionally relied on prolonged catheter drainage and the tincture of time.As the role of robotic reconstruction has been shown to be a viable modality for management of bladder neck contracture,it is important to reconsider prior dogmas of urologic care.Our case series suggests that an early repair is safe and has a high success rate.Early robotic intervention gives providers an additional tool in aiding patient recovery.

Targeting Phosphodiesterase 4 to Block the Link between Acute Exacerbation of Chronic Obstructive Pulmonary Disease and the Metabolic Complications

The metabolic disorders such as obesity and diabetes are found to be more frequent in chronic obstructive pulmonary disease (COPD). The chronic systemic inflammation orchestrated by macrophages constitutes one critical pathophysiological process underlying both acute exacerbation of COPD (AECOPD) and its metabolic complications such as obesity and diabetes. The cyclic adenosine monophosphate (cAMP) signaling controlled by phosphodiesterase (PDE) 4 is a pivotal intracellular modulator for macrophages functions in immune inflammatory response underlying AECOPD as well as obesity and diabetes. Targeting PDE4/cAMP signaling has been suggested to be effective in treating AECOPD or the metabolic disorders of obesity and diabetes. It is therefore reasonable to hypothesize that the chronic systemic inflammation can be a critical link between AECOPD and the metabolic disorders and targeting the PDE4/cAMP signaling can be effective to block this link between AECOPD and the associated metabolic complications.