Robotic management of urinary fistula

Objectives:To highlight critical preoperative and intraoperative considerations in approaching fistula repair robotically.Methods:A search of the literature was conducted to identify relevant articles pertaining to robotic management of urinary fistulae.Results:Fistulae of the genitourinary tract can be a challenging dilemma for urologists,as definitive management may require surgical intervention.Pathogenesis of both enteric and non-enteric fistulae are multifactorial,and successful repair hinges on the meticulous perioperative evaluation,planning,and execution.Traditional open techniques can subject patients to increased morbidity and prolonged hospitalizations.Since its introduction,the robotic surgical platform has continued to expand its indications.Its three-dimensional visualization and tremor free wristed instrument movements have made the robotic platform an attractive option for genitourinary fistula reconstruction.Conclusion:Robotic management of complex urinary fistulae is feasible in expert hands;more studies are needed to define its role in the treatment algorithm of this devastating conditions.

Artificial intelligence for renal cancer:From imaging to histology and beyond

Artificial intelligence(AI)has made considerable progress within the last decade and is the subject of contemporary literature.This trend is driven by improved computational abilities and increasing amounts of complex data that allow for new approaches in analysis and interpretation.Renal cell carcinoma(RCC)has a rising incidence since most tumors are now detected at an earlier stage due to improved imaging.This creates considerable challenges as approximately 10%e17%of kidney tumors are designated as benign in histopathological evaluation;however,certain co-morbid populations(the obese and elderly)have an increased peri-interventional risk.AI offers an alternative solution by helping to optimize precision and guidance for diagnostic and therapeutic decisions.The narrative review introduced basic principles and provide a comprehensive overview of current AI techniques for RCC.Currently,AI applications can be found in any aspect of RCC management including diagnostics,perioperative care,pathology,and follow-up.Most commonly applied models include neural networks,random forest,support vector machines,and regression.However,for implementation in daily practice,health care providers need to develop a basic understanding and establish interdisciplinary collaborations in order to standardize datasets,define meaningful endpoints,and unify interpretation.

New imaging technologies for robotic kidney cancer surgery

Objective:Kidney cancers account for approximately 2%of all newly diagnosed cancer in 2020.Among the primary treatment options for kidney cancer,urologist may choose between radical or partial nephrectomy,or ablative therapies.Nowadays,robotic-assisted partial nephrectomy(RAPN)for the management of renal cancers has gained popularity,up to being considered the gold standard.However,RAPN is a challenging procedure with a steep learning curve.Methods:In this narrative review,different imaging technologies used to guide and aid RAPN are discussed.Results:Three-dimensional visualization technology has been extensively discussed in RAPN,showing its value in enhancing robotic-surgery training,patient counseling,surgical planning,and intraoperative guidance.Intraoperative imaging technologies such as intracorporeal ultrasound,near-infrared fluorescent imaging,and intraoperative pathological examination can also be used to improve the outcomes following RAPN.Finally,artificial intelligence may play a role in the field of RAPN soon.Conclusion:RAPN is a complex surgery;however,many imaging technologies may play an important role in facilitating it.

High body mass index predicts multiple prostate cancer lymph node metastases after radical prostatectomy and extended pelvic lymph node dissection

Our aim is to evaluate the association between body mass index(BMI)and preoperative total testosterone(TT)levels with the risk of single and multiple metastatic lymph node invasion(LNI)in prostate cancer patients undergoing radical prostatectomy and extended pelvic lymph node dissection.Preoperative BMI,basal levels of TT,and prostate-specific antigen(PSA)were evaluated in 361 consecutive patients undergoing radical prostatectomy with extended pelvic lymph node dissection between 2014 and 2017・Patients were grouped into either nonmetastatic,one,or more than one metastatic lymph node invasion groups.The association among clinical factors and LNI was evaluated.LNI was detected in 52(14.4%)patients:28(7.8%)cases had one metastatic node and 24(6.6%)had more than one metastatic node.In the overall study population,BMI correlated inversely with TT(r=-0.256;P<0.0001).In patients without metastases,BMI inversely correlated with TT(r=-0.282;P<0.0001).In patients with metastasis,this correlation was lost.In the overall study population,BMI(odds ratio[OR]=1.268;P=0.005)was the only in dependent clinical factor associated with the risk of multiple metastatic LNI compared to cases with one metastatic node.In the nonmetastatic group,TT was lower in patients with BMI>28 kg m^2(P<0.0001).In patients with any LNI,this association was lost(P=0.232).The median number of positive nodes was higher in patients with BMI>28 kg m^2(P-0.048).In our study,overweight and obese patients had a higher risk of harboring multiple prostate cancer lymph node metastases and lower TT levels when compared to patients with normal BMI.