Robot assisted radical prostatectomy in kidney transplant recipients: The initial experience in a high volume centre

PE69 Robot assisted radical prostatectomy in kidney transplant recipients: The initial experience in a high volume centre Mistretta F.A., Musi G., Serino A., Cozzi G., Ferro M., Bianchi R., Tringali V., Cordima G., Bottero D., Matei D.V., Brescia A., Incarbone G., Mazzoleni F., Cioffi A., De Cobelli O. IRCCS European Institute of Oncology, Dept. of Urology, Milan, Italy INTRODUCTION & OBJECTIVES: Performing the radical prostatectomy in a kidney transplant recipient could result in a more difficult procedure due to the presence of the graft in the iliac fossa. Aim of this study was to evaluate surgical, oncologic and functional outcomes of Robot-Assisted Radical Prostatectomy (RARP) in this category of patients MATERIAL & METHODS: We retrospectively identified 1205 patients who underwent RARP for localized prostate cancer from January 2014 to April 2016 at a single high volume institution. Out of them, four patients were renal transplant recipients. A standardized four-arm robotic configuration was used in all patients. The first or third arm placement was modified, medially and cranially respect to the standard set, in the renal transplant recipients to avoid trauma to the graft. In two transplant recipients the bedside assistant, usually on the right side of the patient, stood on the left side to avoid trauma to the right positioned kidney graft. Baseline demographic features, complication rate, oncologic and functional outcomes were reviewed RESULTS: Patient age at surgery was (mean ± SD) 61 ± 6.4 years, with an interval between renal transplantation and RARP of 10 ± 10.6 years. In three patients the graft was in the right iliac fossa, for one in the left. Mean PSA was 6 ± 1.14 ng/mL, while the clinical stage was T1c in one patient and T2a in the other three. At the prostate biopsy the preoperative Gleason score was 6 (3+3) in two patients and 7 (3+4) in the other two. No patient was subjected to neoadjuvant therapies. Only one patient was subjected to haemodialysis the day before the radical prostatectomy because of preoperative creatinine level of 6.7 mg/dL. Mean creatinine level was 2.65 ± 2.71 mg/dL and 2.78 ± 3.18 mg/dL before and after surgery, respectively. No intra- or postoperative complications were reported. Mean operating time was 167 ± 25 minutes, with an estimated blood loss of 137.5 ± 111 mL. Mean prostate weigh was 38 ± 7 g. Pathological analysis reported Gleason score 6 (3+3) in one patient and 7 (3+4) in the other three, one patient was pT2a and the other three pT2c. No positive surgical margins were described. Nor biochemical recurrence have been described neither adjuvant therapies have been required. The mean hospital stay was 4.75 ± 1.5 days, while the day of catheterization were 7.25 ± 3.3 days. Out of all patients only three reached at least 6 months of follow up; all of them were continent, two of them reached a potency recovery with administration of PDE-5 inhibitors sufficient to have a sexual intercourse CONCLUSIONS: Our series suggests that RARP is a safe and feasible technique in renal transplant recipients for localized prostate cancer. Further studies and a larger population are needed, but good oncological and functional outcomes, no intra- or postoperative complications or impairment on renal graft function were reported in our series

Eur Urol Suppl 2016; 15(7):284