Leaving the renal bed unsutured met its noninferiority margin — in one surgeon's hands

The edition in brief

Sutureless off-clamp robotic partial nephrectomy leaves the renal defect unsutured, on the reasoning that renorrhaphy itself destroys functioning parenchyma. In a single-centre, single-surgeon randomised trial of 248 patients with cT1-2N0M0 tumours, Trifecta at discharge was 93% sutureless against 95% with renorrhaphy, absolute difference −2.4% (90% CI −7.4 to 2.6), meeting a prespecified −10% noninferiority margin. Transfusion and acute kidney injury were rare. Nine urinary fistulae occurred, all stented, with a numerically higher rate in the sutureless arm that did not reach significance (p = 0.08). One-year recurrence-free survival was 99% in both. A phase 2 trial of intravesical mitomycin-C given immediately before resection rather than after, now at five years of follow-up, reports three-year recurrence-free survival of 90.7% against 78.6% for resection alone, multivariable hazard ratio 0.266 — on 71 patients in total, which is the caveat that governs everything else. Among 7,252 Medicare beneficiaries having an artificial urinary sphincter or male sling, frailty predicted 30-day complications independently of age and comorbidity, adjusted relative risk 2.5 in the frailest group, and also predicted device revision or removal within a year. The FDA has classified as Class II an ongoing recall of bulk sildenafil citrate and tadalafil for prescription compounding, for good manufacturing practice deviations found at inspection — finished proprietary tablets are not covered. And the ProBIOPSY Delphi reached consensus on 29 of 36 stems for prostate biopsy, endorsing both biparametric and multiparametric MRI where quality is adequate, and targeted plus perilesional sampling for most decisions.