Pd56-11 Does Prior Robotic Prostatectomy Complicate Subsequent Renal Transplantation?

You have accessJournal of UrologyTransplantation & Vascular Surgery II (PD56)1 May 2024PD56-11 DOES PRIOR ROBOTIC PROSTATECTOMY COMPLICATE SUBSEQUENT RENAL TRANSPLANTATION? Ala'a Farkouh, Cheryl Wang, Matthew Buell, Akin S. Amasyali, Kai Wen Cheng, Sikai Song, Ruby Kuang, and D. Duane Baldwin Ala'a FarkouhAla'a Farkouh , Cheryl WangCheryl Wang , Matthew BuellMatthew Buell , Akin S. AmasyaliAkin S. Amasyali , Kai Wen ChengKai Wen Cheng , Sikai SongSikai Song , Ruby KuangRuby Kuang , and D. Duane BaldwinD. Duane Baldwin View All Author Informationhttps://doi.org/10.1097/01.JU.0001008928.01012.0d.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with end stage renal disease (ESRD) who are candidates for transplantation are often screened and treated for prostate cancer prior to renal transplant. Robot assisted laparoscopic prostatectomy (RALP) is sometimes performed in these patients, but the effect on subsequent renal transplant is unknown. The purpose of this study was to review the surgical outcomes in patients undergoing renal transplant following RALP. METHODS: A review of prostate cancer patients with ESRD, who underwent RALP at a single institution followed by renal transplant between 2013 and 2023, was performed. For all patients, oncologic and surgical outcomes were recorded. Particular attention was paid to challenges arising from the prior RALP at the time of transplant. These patients were compared to a matched group of male patients with no prostate cancer or prior pelvic surgery who underwent renal transplant in the same timeframe. Mann-Whitney U and Chi-square tests were used. RESULTS: Sixteen patients with prior RALP underwent kidney transplant with a mean duration between RALP and transplant of 38 months (range: 6-130). On prior RALP specimens, all tumors were localized (T2-T3) and N0, and no recurrence was reported (mean follow-up 66 mos). There was no difference in age at time of transplant (62.8 vs 61.2 years; p=0.6) or pretransplant anuria (50% for both) between the RALP and matched cohorts, respectively. Transplant operative time was longer but not statistically significant with prior RALP (304 vs 260 min; p=0.2). Urology was consulted intraoperatively during transplant for 7 patients (44%) with prior RALP and 1 patient (6%) without RALP (p=0.01). In prior RALP patients, 25% required urologic assistance for catheterization and 25% required assistance in identifying and mobilizing the bladder. Challenges in bladder identification and mobilization were reported by transplant surgeons at a significantly higher rate in patients with prior RALP (63% vs 19%; p=0.01). New onset posttransplant voiding dysfunction was reported in 4 patients with prior RALP (2 stress incontinence, 1 urge incontinence, and 1 stricture) and in 3 patients without prior RALP (all BPH) and was higher in those with pretransplant anuria (OR=3.2). CONCLUSIONS: RALP is a suitable treatment option for patients with localized prostate cancer and ESRD, but may complicate subsequent renal transplant. New onset voiding dysfunction may present following transplantation, particularly in previously anuric patients. By anticipating these challenges, transplant surgeons and urologists can collaborate to optimize patient outcomes. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1206 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ala'a Farkouh More articles by this author Cheryl Wang More articles by this author Matthew Buell More articles by this author Akin S. Amasyali More articles by this author Kai Wen Cheng More articles by this author Sikai Song More articles by this author Ruby Kuang More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement PDF downloadLoading ...