Robot-assisted Excission of prostatic cyst

Abstract

Background

Giant multilocular prostatic cystadenoma is a very rare benign tumor of the prostate gland. It is composed of a fibrous stroma into the pelvis including cystic enlarged prostatic glands. The large size at the time of diagnosis is a consequence of unspecified symptoms which often are linked to common prostatic hyperplasia or irritable bowel syndrome. The diagnosis before histological examination of a surgical specimen is often difficult and based on digital rectal expression, trans-rectal ultra sound (TRUS) and MRI. Here, we present a case involving a largest giant multilocular prostatic cystadenomas and discuss preoperative diagnoses and appropriate surgical approaches for this rare retroperitoneal tumor.

Case presentation

A 42 years-old man, with no remote pathological history and no smoking habits, presented multiple episodes of acute urinary retention (AUR), and a pre-catheterization Qmax of 18.4 ml/sec with 243 ml of volume voided followed by an acute episode of septic shock and MOF (anuria, acute renal injury and liver failure) with no symptoms of bowel obstruction. Digital rectal examination was positive for palpable intraluminal mass and sovrapubic ultrasound (US) shown a prostatic abscesses of 65 ml. Serum prostate-specific antigen (PSA) was 4.32 ng/ml at diagnosis. Enhanced CT showed a large retroperitoneal mass measuring 10 × 8 cm in size with multiple septations and displacing the bladder, prostate, and seminal vesicle and MRI showed a cystic mass composed of 9 cm with solid components. Trans-urethral resection of prostate was negative at histological examination for prostate cancer. Complete robot-assisted enucleation of the tumor was performed performing a novel surgical technique. The tumor contained a large cavity with infected material inside and measured 9 × 7 cm. Histologically, the tumor was composed of benign neoformation of prostate consisting of numerous cysts lined by two layers of epithelial cells included in a fibrous and fibromuscular stroma without atypia. Post-operative course was characterized by improvement in terms of LUTS and no changing in erectile function.

Conclusions

Our treatment for large giant multilocular prostatic cystadenomas is presented. Robot-assisted surgery for the treatment of GMPC provides another choice for simultaneous attention to disease-control and postoperative quality of life.