Chun-Te Wu

Lin YH, et al. Investig Clin Urol. 2026 Jan;67(1):108-111. https://doi.org/10.4111/icu.20250449

The DAVINCI SP system is an advanced robotic surgery platform allowing an endoscope and three articulated instruments to enter the body through a single incision while maintaining workspace triangulation. This open-label, single-arm clinical trial (ClinicalTrials.gov Identifier: NCT05403190 18/05/2022) evaluates the feasibility of using the DAVINVI SP system for extraperitoneal-approach robot-assisted radical prostatectomy (RaRP) in Taiwan. Two surgical techniques, the conventional anterior approach and the Hood technique, were used for RaRP. The primary endpoint was the success rate of RaRP with the DAVINCI SP system without conversion to multiport RaRP or open surgery. Secondary endpoints included perioperative variables, oncological outcomes, and functional outcomes. The study achieved a 100% success rate for the primary endpoint. Patients who underwent RaRP with the DAVINCI SP system had lower postoperative pain scores and shorter hospital stays. Additionally, 93.33% did not require a drain tube post-surgery, 80% achieved undetectable PSA levels at six months, and 96.67% regained continence within three months. The oncologic and continence outcomes are comparable between patients receiving conventional anterior approach or Hood technique. In conclusion, the DAVINCI SP system allows an effective extraperitoneal-approach RaRP, offering reduced pain, shorter hospital stays, and low drain tube placement rates. Trial registration: ClinicalTrials.gov (Identifier: NCT05403190 18/05/2022).

Background: Artificial urinary sphincter (AUS) implantation is the gold standard for managing persistent stress urinary incontinence after prostate cancer treatment. However, data on long-term outcomes and risk factors in Asian populations remain limited. Methods: We conducted a multi-institutional retrospective cohort study using the Chang Gung Research Database, the largest healthcare system in Taiwan, to evaluate clinical outcomes and predictors of device survival in men receiving AUS (AMS 800) implantation for incontinence after prostate cancer treatment. Baseline characteristics, perioperative factors, and comorbidities were analyzed. Device failure was defined as explantation, revision, or persistent incontinence. Logistic regression and Cox proportional hazards models were used to identify significant predictors. A nomogram for 5-year device survival was developed and internally validated. Results: A total of 50 patients were included from seven branch hospitals, with a median follow-up of 126.5 months. 5-year and 10-year device survival rates were 94% and 40%, respectively. On multivariable analysis, diabetes was consistently associated with an increased risk of device failure (HR 2.966, 95% CI 1.114–7.900). Lower BMI showed an inverse association in logistic regression (OR 0.608, 95% CI 0.397–0.932), but this did not remain significant in Cox analysis. Prior radiotherapy was not a significant risk factor (HR 0.760, 95% CI 0.264—2.190; OR 0.709, 95% CI 0.074—6.828). The nomogram demonstrated good predictive accuracy for 5-year device survival. Conclusions: AUS implantation demonstrates excellent long-term durability in Taiwanese men with incontinence after prostate cancer treatment. Diabetes consistently predicted device failure, while the role of BMI was less certain. These findings provide valuable long-term evidence on AUS outcomes in an Asian population.

Background: Stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) are common disorders that impair quality of life. While transobturator tension-free vaginal tape (TVT-O) is established for SUI, outcomes in MUI remain uncertain. Methods: We analyzed 111 women who underwent TVT-O at Keelung Chang Gung Memorial Hospital. Baseline data included demographics, Overactive Bladder Symptom Score (OABSS), uroflowmetry [peak flow rate (PFR), residual urine (RU)], and Pelvic Organ Prolapse Quantification (POP-Q) stage. The primary outcome was OABSS improvement (≥1-point reduction); secondary outcomes were longitudinal OABSS, uroflowmetry, pad usage, and POP-Q stage. Results: At 3 months, 31.5% (35/111) met responder criteria. Symptom improvement occurred more often in MUI than in SUI, with about half of women with MUI (48.6%) and one quarter of those with SUI (27.4%) reporting subjective improvement (p = 0.018). OABSS improved in MUI (7.92 → 7.18, p = 0.001) but worsened in SUI (6.84 → 7.52, p < 0.001). In SUI, PFR increased (p = 0.001) and RU decreased (p = 0.029); no significant changes occurred in MUI. MUI independently predicted response (OR, 2.59; 95% CI, 1.10–6.14) and greater ΔOABSS (β = −1.391, p < 0.001); higher baseline OABSS also predicted improvement (β = −0.093, p = 0.049). For pad usage, MUI was associated with persistence (OR, 3.855, p = 0.010). ROC analysis showed modest discrimination for MUI (AUC 0.626, p = 0.034). Conclusions: TVT-O provided symptom relief, with about half of the women with MUI, and one quarter of those with SUI experienced subjective improvement. Women with MUI and higher baseline OABSS were more likely to improve, but these findings should be interpreted with caution, given the modest sample size.

Purpose Robotic-assisted partial nephrectomy has emerged as the standard surgical procedure for managing localized kidney cancers, with bleeding risk being a primary clinical consideration. This investigation seeks to establish simple predictive indicators for hemorrhage-related adverse events. Materials and methods We performed a retrospective review of sequential patients undergoing robotic-assisted partial nephrectomy at a single tertiary medical center. Patient records and radiographic studies were analyzed to obtain clinical parameters. Tumor characteristics (size, infiltration depth, and standardized nephrometry measurements) were assessed by an experienced radiologist. Bleeding-related outcomes included surgical blood loss, transfusion requirements, reoperation, and need for angiographic intervention. Predictive factors for hemorrhagic events were examined statistically. Results The study included 260 participants. Median nephrometry scores were 8.5 (PADUA) and 7.0 (RENAL). The average tumor size measured 39.1 mm with a mean penetration depth of 2.02 mm, and the median renal ischemia duration was 25.5 min. Mean operative hemorrhage volume was 147 ml. Transfusion was administered to 12.7% of cases, with 3.5% experiencing significant hemorrhagic complications. Tumor size independently predicted both intraoperative bleeding and transfusion needs, while invasion depth showed a strong association with severe bleeding events. Conclusions Compared to comprehensive nephrometry systems, basic tumor measurements (diameter and depth) effectively anticipate bleeding risks. These straightforward parameters enable clinicians to identify high-risk patients and initiate preventive measures.