Single-port (SP) robotic transvesical radical prostatectomy in patients with prior kidney transplantation: Technique description and early results

Abstract

Introduction

Transvesical radical prostatectomy allows for direct access to the bladder and prostate that completely avoids the peritoneal cavity and allows for minimal disturbance to the extraperitoneal space or the iliac fossa. We sought to evaluate the safety and effectiveness of a single-port transvesical approach in the treatment of patients with prior kidney transplantation.

Methods

Single port transvesical radical prostatectomy was performed on two patients with prior kidney transplantation, including one patient with two prior kidney transplants. Flexible cystoscopy was used for assistance in accessing the bladder intraoperatively in the patient with two prior transplants to avoid injury to either transplant ureteral orifice.

Results

Both patients had similar preoperative pathology, operative times, estimated blood loss (EBL), and hospital stay. There were no intraoperative or postoperative complications in either patient. While both patients showed high-risk pathology, surgical margins were negative in both cases and the latest postoperative PSA at 6 weeks was undetectable. Both patients had good recovery of continence after surgery, with 0 and 1 pads per day at a 6-week follow-up.

Conclusion

Single port transvesical radical prostatectomy is safe and feasible in patients with prior renal transplantation. No biochemical recurrence was recorded on the latest follow-up.

Objective

To demonstrate the safety and technique of Transvesical (TV) Single-Port (SP) robot-assisted radical prostatectomy (RARP) in patients with prior kidney transplantation (KT).

Patients and surgical procedure

Between 2022 and 2023, we performed SP TV RARP on two patients with prior KT who were diagnosed with clinically significant prostate cancer. The technique was demonstrated in a 62-year-old male patient with two prior KT. Flexible cystoscopy was used to evaluate the bladder intraoperatively to avoid injury to the transplant and native ureteral orifices.

Results

Both procedures were completed without any evidence of perioperative complications. Patients 1 and 2 who underwent SP TV RARP had overall similar operative times i.e. 193 and 173 min respectively, and estimated blood loss (EBL), i.e. 100 ml and 50 ml respectively. They were discharged within 24 h of hospital stay. There were no intraoperative or postoperative complications in the cohort.

The final pathology showed high-risk Gleason Grade (GG) 4 prostate cancer, surgical margins were negative in both cases. The latest postoperative prostate-specific antigen (PSA) at 6 weeks was undetectable. Both patients had good recovery of continence after surgery, with 0 and 1 pads per day at a 6-week follow-up.

Conclusion

SP TV RARP is safe and feasible in patients with prior KT. No biochemical recurrence (BCR) was recorded on the latest follow-up.