title: Simultaneous robot-assisted nephroureterectomy and cystectomy in patients with uremia and multifocal urothelial carcinoma.
abstract: OBJECTIVE
  In Taiwan, patients with uremia have a high risk of the development of multifocal urothelial carcinoma. We report on eight patients with uremia and urothelial carcinoma who underwent simultaneous robot-assisted laparoscopic nephroureterectomy and radical cystectomy (RANUC).
  
  
  METHODS
  Between April 2006 and August 2010, eight patients with uremia (five women, three men; mean age 66.9  y) who were receiving dialysis underwent RANUC. Patients were classified into two groups: Group I, cases 1 to 4 occurring between April 2006 and June 2009; and group II, cases 5 to 8 occurring between July 2009 and August 2010.
  
  
  RESULTS
  The mean operative time was significantly shorter in group II (252.5±35.0  min vs 360±25.8  min; P=0.029). The estimated blood loss was also significantly less in group II (332.5±53.8  mL vs 660±137.4  mL; P=0.029). The blood transfusion rate was 75% in group I and 0% in group II. The postoperative stay was reduced from 8.5 days for group I to 7 days for group II. No perioperative morbidity and mortality were noted in either group. None of the patients had died at the short- and intermediate-term mean follow-up of 28.1 months (range 2-54  mos).
  
  
  CONCLUSIONS
  Simultaneous RANUC are feasible and can be performed safely. Long-term oncologic data are awaited; however, at intermediate-term oncologic follow-up, results are satisfactory. RANUC for uremic patients with multifocal urothelial carcinoma necessitating complete urinary tract exenteration is a viable option and patients experience a rapid convalescence.
authors.affiliation: Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan. ycou228@gmail.com
authors.forename: Yen-Chuan
authors.initials: YC
authors.lastname: Ou
authors.forename: Chi-Rei
authors.initials: CR
authors.lastname: Yang
authors.forename: Chun-Kuang
authors.initials: CK
authors.lastname: Yang
authors.forename: Chen-Li
authors.initials: CL
authors.lastname: Cheng
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Hemal
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods*; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D009873:Operating Rooms; D019990:Perioperative Care; D012371:Robotics; D013525:Surgical Instruments; D014511:Uremia / Q000150:complications / Q000601:surgery*; D014513:Ureter / Q000601:surgery*; D014571:Urologic Neoplasms / Q000150:complications / Q000601:surgery*; D019459:Urothelium / Q000473:pathology* / Q000601:surgery