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Robotic surgery is “innovation without evaluation”

In an editorial in BMJ (2013), Paul et al discuss the introduction of robotic surgery without prior evaluation. More than 360,000 robotic surgical procedures were carried out worldwide in 2011, using the only licensed robotic system; the da Vinci system developed by Intuitive Surgical. Urologists and Gynaecologists were early adopters of the technology and in 2011 more than 100,000 radical prostatectomies and 125,000 hysterectomies were performed robotically. In USA robotic surgery has become a symbol for advanced care, however it is a very expensive technology and evidence that its use improves outcomes is scarce at best.

Results from UK robotic prostatectomy

In an article published by Bishop et al in JCU (2013), the authors discuss the results of 100 robotic radical prostatectomies (RALP). Positive margin rate was 22% overall, with 17% for T2 disease and 50% for T3 and T4 disease. 12 month continence rates were 82%. This is the first published report of results for robotic prostatectomy from a UK district general hospital.


At the Staffordshire Urology Clinic our current standard approach to surgery is laparoscopic (keyhole) rather than robotic. Our overall positive margin rate after keyhole radical prostatectomy is lower at 15%, and incontinence rates also lower than reported in this study.

Finasteride has no effect on prostate cancer survival

At the ASCO (American Society of Clinical Oncology) Genitourinary Cancers Symposium in February 2013, Goodman and colleagues presented a paper that summarized the long-term follow-up outcomes from the Prostate Cancer Prevention Trial. The original study was conducted from 1993 to 1997 and randomly assigned men to receive either 5 mg of finasteride or placebo, with the hope of reducing the odds of developing prostate cancer. Longterm follow-up, now at 15 years, showed no significant prostate cancer survival difference between patients treated with active drug or placebo. A subset analysis of men with low risk prostate cancer that had received finasteride did, however, have a better survival, although the cause of this effect was unclear.

Success in laparoscopic pyeloplsty

In an article by Ramsden and Seels published in BJUI (2011) the authors argue that there is not a literature standard for defining success in laparoscopic pyeloplasty. Studies that define success on the basis of resolution of function have success rates in excess of 95%, whereas those that use imgaing aswell have a lower rate. When success is defined strictly as resolution of pain and preserved renographic function (Derriford criteria), literature success rates range form 77-98%. The authors success rates are 85.1%