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

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III (MP58)1 May 2024MP58-19 10 YEAR EXPERIENCE OF ROBOTIC ASSISTED LAPAROSCOPIC PROSTATECTOMY (RALP) IN PATIENTS WITH ATYPICAL ANATOMY AND PATHOLOGY: PRE-OPERATIVE CYSTOSCOPY SERVING AS A THIRD EYE Aravindh Rathinam, Sneha V. Parekh, Shirin Razdan, and Sanjay Razdan Aravindh RathinamAravindh Rathinam , Sneha V. ParekhSneha V. Parekh , Shirin RazdanShirin Razdan , and Sanjay RazdanSanjay Razdan View All Author Informationhttps://doi.org/10.1097/01.JU.0001008852.83523.41.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: 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 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e955 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Aravindh Rathinam More articles by this author Sneha V. Parekh More articles by this author Shirin Razdan More articles by this author Sanjay Razdan More articles by this author Expand All Advertisement PDF downloadLoading ...