Modification of Laparoscopic Radical Prostatectomy in Prostate Cancer Patient with Giant Median Lobe

Abstract

Introduction and Purpose: Prostate cancer is the second most common cancer in men and its incidence increases with age. There are different treatment modalities in localized and locally advanced prostate cancers, and curative results can be obtained if early diagnosis is made. In this presentation, we discussed the combined transurethral resection (TUR)-prostatectomy and laparoscopic radical prostatectomy surgery method in a case with localized prostate cancer with a large median lobe. Summary: Multiparametric magnetic resonance imaging findings of a 62-year-old male patient with prostate-specific antigen (PSA) 9.8 showed linear and faint hypodensities in the peripheral zone and were consistent with pi-rads two (prostate imaging reporting and data system). After the transrectal ultrasound biopsy revealed (three+three) adenocarcinoma in three foci on the right quadrant, laparoscopic radical prostatectomy was planned for the patient. The patient, whose median lobe was prominent and indented into the bladder, was first placed in the lithotomy position and prepared for TUR-prostatectomy. The patient's cystourethroscopy was normal and both orifices could not be seen because of the large median lobe. First, the resection anastomosis line was determined by cauterization with a Collins Knife. Median lobe resection was then performed. After the median lobe was completely resected, bilateral orifices were seen. Finally, the anastomosis line was rebuilt for laparoscopic radical prostatectomy, and the procedure was terminated. A three-way urethral catheter was inserted into the patient and continuous bladder irrigation was performed. The surgical time was 70 minutes and the removed tissue was 50 grams. Immediately afterward, laparoscopic radical prostatectomy was performed in the supine position. During laparoscopy, a vesicourethral anastomosis was performed using the border created as the anastomosis line made during the TUR-prostatectomy. The procedure was terminated without complications by placing a drainage catheter in the patient. The procedure time was 4 hours and the removed tissue was 130 grams. The patient's hospital stay was 4 days, with a drainage catheter 6 days, with a urethral catheter 14 days. Since there was no extravasation in the cystogram taken on the 14th postoperative day, the urethral catheter was removed. The PSA value obtained at the postoperative second month was found to be <0.006. Whereas the median lobe resection result was reported as benign prostate tissue in the pathology report, the radical prostatectomy material was reported as (three+three) adenocarcinoma in the right anterior quadrant and right posterior quadrant. Conclusion: In selected cases with prostate cancer with a large median lobe, median lobe TUR-prostatectomy, and laparoscopic radical prostatectomy can be combined first. No competing financial interests exist. Runtime of video: 2 mins 40 secs Patient Consent: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.