John Jesitus

John Jesitus is a medical writer based in Westminster, CO.

While cost remains a concern, incorporating robotics into urologic laparoscopy appears to improve the experience for patients and physicians alike, according to several abstracts being presented at the 2012 AUA annual meeting. 

"Whether you're a proponent of the robot or not, it's becoming very clear that it's putting minimally invasive urologic surgery into more hands" than would perform it if the robot weren't available, Dr. Wolf said. 

"Those of us who have done both types of surgery know that we don't hurt as much after doing robotic surgery," said Dr. Wolf. Indeed, investigators observed that robotic surgery produced lower scores than did standard laparoscopy in all variables studied. 

"This research further supports the concept that for the physician, surgery is a contact sport. It takes a toll on your body, and the robot makes it a little bit easier on you." 

Dr. Wolf also suggested that robotic assistance might extend the careers of experienced urologic surgeons who otherwise might retire or reduce their workload. Keeping experienced surgeons working could increase access to care and the safety of care provided, he said. 

Articles

While cost remains a concern, incorporating robotics into urologic laparoscopy appears to improve the experience for patients and physicians alike.

Robotic urologic surgery shows benefits for both physician, patient

Several abstracts from this year's AUA annual meeting suggest that, just as bacteria alter their host environment to their benefit, treatments for infection and inflammation may counter by changing the host environment to pathogens' detriment. 

"We used to think that these were predominantly reinfections by bacteria entering the urinary tract from the outside-in," said Dr. Schaeffer. "But these papers begin to support the concept of relapse from within due to modulation of host defenses. Emerging evidence shows that some bacteria are able to establish a pod or colony within the surface or deeper transitional epithelium, where they can reside until they re-emerge and cause a recurring infection from within the urinary tract." 

"B1 cells in turn suppress the neutrophil influx, decreasing bacterial clearance. Here, the bacterium is skewing the Th2 cytokine response to provide an environment that allows it to persist within the urinary tract. This is one of the prerequisites for establishing an intercellular pod," Dr. Schaeffer said. 

Another abstract may explain through an animal model why diabetic patients have difficulty resisting and clearing bladder infections, said Dr. Schaeffer. 

"These researchers showed that delayed clearance in diabetic mice occurred due to a lower, postponed expression of other cytokines-macrophage inflammatory protein-2 and monocyte chemotactic protein-1-which are normally proactive in clearing the urinary tract of pathogens," he said. Due to low levels of these cytokines, investigators concluded, diabetic mice experienced impaired neutrophil recruitment and therefore took much longer than controls to clear induced cystitis. 

Subsequently, the guanosine triphosphate hydrolase (GTPase) Rab27b allows uropathogenic 

 to gain access to urothelial cells because it mediates adherence, invasion, and trafficking within these cells, according to a third abstract he highlighted. 

"These investigators postulate that this process is also modified by genetic factors. Individuals who are more susceptible to infections may have increased expression of this molecule, which accentuates a pathogenic invasion," he said. 

Several abstracts from this year's AUA annual meeting suggest that, just as bacteria alter their host environment to their benefit, treatments for infection and inflammation may counter by changing the host environment to pathogens' detriment.

Author | John Jesitus

Articles

Robotic urologic surgery shows benefits for both physician, patient

Treatments for urologic infections may change host environment