MP58-19: 10 year experience of robotic assisted laparoscopic prostatectomy (RALP) in patients with atypical anatomy and pathology: pre-operative cystoscopy serving as a third eye.
Sunday, May 5, 2024 1:00 PM to 3:00 PM · 2 hr. (US/Central)
221C
Abstract
Information
Full Abstract and Figures
Author Block
Aravindh Rathinam*, Doral, FL, Sneha V Parekh, Hialeah, FL, Shirin Razdan, New York, NY, Sanjay Razdan, DORAL, FL
Introduction
While performing robotic assisted laparoscopic prostatectomy (RALP), urologists often confront significant challenges when tending to patients exhibiting atypical presentations like large median lobe with close proximity of ureteric orifice, post TURP status and bladder tumors. that are often not identified on mpMRI (multiparametric MRI). We describe our experience of preoperative cystoscopy aiding as an adjunct to RALP in circumventing these challenges.
Methods
Following IRB approval, a prospective analysis of randomly selected 411 patients undergoing RALP with maximal urethral length preservation (MULP) over a period of 10 years was done. 183 patients had findings of atypical characteristics pre-operative cystoscopy. Surgical, oncological, and functional outcomes were analyzed.
Results
The median age was 65.62 years and pre-operative PSA was 6.92 ng/dl. Pre-operative cystoscopy identified bladder tumors in 5.86% of patients, who subsequently underwent transurethral resection of the bladder tumor before RALP. Large median lobe was found in 30.4% cases, 11.4% cases had ureteric orifices very close to the bladder neck and post-TURP anatomical changes were noted in 33% cases. Bladder neck reconstruction had a 100% success rate without complications. Median blood loss was 110 cc, positive surgical margin (PSM) rate at the bladder neck was 2.78%. Median console time in patients with atypical features was increased by a median of 10±9 minutes in patients with atypical features. No intra-operative complications were present. Continence was achieved in all patients by 6 months post-RALP. The biochemical recurrence rate was 1.3%.
Conclusions
Pre-operative cystoscopy guided the surgeon in our practice acquire a more comprehensive understanding of the lower urinary tract anatomy prior to formulating the surgical dissection strategies. This approach helped us avoid adverse intraoperative events and achieve optimal functional and oncological outcomes. Our results need further validation with large randomized controlled trials.
Source Of Funding
None.
Author Block
Aravindh Rathinam*, Doral, FL, Sneha V Parekh, Hialeah, FL, Shirin Razdan, New York, NY, Sanjay Razdan, DORAL, FL
Introduction
While performing robotic assisted laparoscopic prostatectomy (RALP), urologists often confront significant challenges when tending to patients exhibiting atypical presentations like large median lobe with close proximity of ureteric orifice, post TURP status and bladder tumors. that are often not identified on mpMRI (multiparametric MRI). We describe our experience of preoperative cystoscopy aiding as an adjunct to RALP in circumventing these challenges.
Methods
Following IRB approval, a prospective analysis of randomly selected 411 patients undergoing RALP with maximal urethral length preservation (MULP) over a period of 10 years was done. 183 patients had findings of atypical characteristics pre-operative cystoscopy. Surgical, oncological, and functional outcomes were analyzed.
Results
The median age was 65.62 years and pre-operative PSA was 6.92 ng/dl. Pre-operative cystoscopy identified bladder tumors in 5.86% of patients, who subsequently underwent transurethral resection of the bladder tumor before RALP. Large median lobe was found in 30.4% cases, 11.4% cases had ureteric orifices very close to the bladder neck and post-TURP anatomical changes were noted in 33% cases. Bladder neck reconstruction had a 100% success rate without complications. Median blood loss was 110 cc, positive surgical margin (PSM) rate at the bladder neck was 2.78%. Median console time in patients with atypical features was increased by a median of 10±9 minutes in patients with atypical features. No intra-operative complications were present. Continence was achieved in all patients by 6 months post-RALP. The biochemical recurrence rate was 1.3%.
Conclusions
Pre-operative cystoscopy guided the surgeon in our practice acquire a more comprehensive understanding of the lower urinary tract anatomy prior to formulating the surgical dissection strategies. This approach helped us avoid adverse intraoperative events and achieve optimal functional and oncological outcomes. Our results need further validation with large randomized controlled trials.
Source Of Funding
None.