Potretzke, Aaron M.

Objectives: To identify correlates of survival and perioperative outcomes of upper tract urothelial carcinoma (UTUC) patients undergoing open (ORNU), laparoscopic (LRNU), and robotic (RRNU) radical nephroureterectomy (RNU). Methods: We conducted a retrospective, multicenter study that included non-metastatic UTUC patients who underwent RNU between 1990–2020. Multiple imputation by chained equations was used to impute missing data. Patients were divided into three groups based on their surgical treatment and were adjusted by 1:1:1 propensity score matching (PSM). Survival outcomes per group were estimated for recurrence-free survival (RFS), bladder recurrence-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS). Perioperative outcomes: Intraoperative blood loss, hospital length of stay (LOS), and overall (OPC) and major postoperative complications (MPCs; defined as Clavien–Dindo > 3) were assessed between groups. Results: Of the 2434 patients included, 756 remained after PSM with 252 in each group. The three groups had similar baseline clinicopathological characteristics. The median follow-up was 32 months. Kaplan–Meier and log-rank tests demonstrated similar RFS, CSS, and OS between groups. BRFS was found to be superior with ORNU. Using multivariable regression analyses, LRNU and RRNU were independently associated with worse BRFS (HR 1.66, 95% CI 1.22–2.28, p = 0.001 and HR 1.73, 95%CI 1.22–2.47, p = 0.002, respectively). LRNU and RRNU were associated with a significantly shorter LOS (beta −1.1, 95% CI −2.2–0.02, p = 0.047 and beta −6.1, 95% CI −7.2–5.0, p < 0.001, respectively) and fewer MPCs (OR 0.5, 95% CI 0.31–0.79, p = 0.003 and OR 0.27, 95% CI 0.16–0.46, p < 0.001, respectively). Conclusions: In this large international cohort, we demonstrated similar RFS, CSS, and OS among ORNU, LRNU, and RRNU. However, LRNU and RRNU were associated with significantly worse BRFS, but a shorter LOS and fewer MPCs.

Objectives To compare the carbon footprint and environmental impact of single‐use and reusable flexible cystoscopes. Materials and Methods We analysed the expected clinical lifecycle of single‐use (Ambu aScope™ 4 Cysto) and reusable (Olympus CYF‐V2) flexible cystoscopes, from manufacture to disposal. Performance data on cumulative procedures between repairs and before decommissioning were derived from a high‐volume multispecialty practice. We estimated carbon expenditures per‐case using published data on endoscope manufacturing, energy consumption during transportation and reprocessing, and solid waste disposal. Results A fleet of 16 reusable cystoscopes in service for up to 135 months averaged 207 cases between repairs and 3920 cases per lifecycle. Based on a manufacturing carbon footprint of 11.49 kg CO 2 /kg device for reusable flexible endoscopes and 8.54 kg CO 2 /kg device for single‐use endoscopes, the per‐case manufacturing cost was 1.37 kg CO 2 for single‐use devices and 0.0017 kg CO 2 for reusable devices. The solid mass of single‐use and reusable devices was 0.16 and 0.57 kg, respectively. For reusable devices, the energy consumption of reusable device reprocessing using an automated endoscope reprocessor was 0.20 kg CO 2 , and per‐case costs of device repackaging and repair were 0.005 and 0.02 kg CO 2 , respectively. The total estimated per‐case carbon footprint of single‐use and reusable devices was 2.40 and 0.53 kg CO 2 , respectively, favouring reusable devices. Conclusion In this lifecycle analysis, the environmental impact of reusable flexible cystoscopes is markedly less than single‐use cystoscopes. The primary contributor to the per‐case carbon cost of reusable devices is energy consumption of reprocessing.