The Early Experience of the Transpubic Approach for Excision of Prostatic and/or Bladder Rhabdomyosarcoma in Children

Abstract

Purpose To report the early experience of the transpubic approach for excision of prostate/ bladder RMS. Material and Methods Retrospective review of all consecutive bladder/prostate RMS excisions between June 2004 and June 2009. Outcome measures examined were completeness of excision, morbidity and mortality, and details of reconstructive/diversion surgery. Results Fourteen children, aged 4 months to 11 years, presented for excision of RMS of the prostate/bladder base (13 embryonal, 1 alveolar). Four had a retropubic procedure and 10 had the transpubic approach. The latter group presented with primary RMS in nine and relapsed RMS after chemo-and radiotherapy induced remission in one. Eight had localized disease and two metastatic disease. The operative procedures performed included: radical prostatectomy with partial cystectomy and cysto-urethral anastomosis (n = 6), partial cystectomy with cysto-urethral anastomosis (n = 1) and subtotal cystourethrectomy with vesicostomy (n = 2). The child with tumour relapse underwent radical cystoprostatectomy with formation of ileal conduit. Complete excision was confirmed histologically in all but one child, who had tumour thrombus in the iliac vein. Localised haemorrhage occurred in one child on anti-coagulant therapy, transient ureteric obstruction in two, and a temporary leak was seen at the cysto-urethral anastomosis in three. All children except one have completed treatment and are disease free at a median follow-up of 7 months (range 4 to 9 months). One child has died from recurrent metastatic RMS. Conclusions The transpubic approach uses a simple symphysiotomy to provide excellent exposure of the bladder base, prostate, membranous urethra and pelvic floor. This facilitates complete tumour excision and cysto-urethral anastomosis where appropriate.