V10-03 OUTCOMES OF PRECISION PROSTATECTOMY PROCEDURE FOR LOCALIZED PROSTATE CANCER, AND STEP-BY-STEP TECHNIQUE OF SINGLE PORT TRANSVESICAL PRECISION PROSTATECTOMY

Abstract

You have accessJournal of UrologyCME1 Apr 2023V10-03 OUTCOMES OF PRECISION PROSTATECTOMY PROCEDURE FOR LOCALIZED PROSTATE CANCER, AND STEP-BY-STEP TECHNIQUE OF SINGLE PORT TRANSVESICAL PRECISION PROSTATECTOMY Sohrab Arora, Samantha Wilder, Mohit Butaney, Craig Rogers, and Wooju Jeong Sohrab AroraSohrab Arora More articles by this author , Samantha WilderSamantha Wilder More articles by this author , Mohit ButaneyMohit Butaney More articles by this author , Craig RogersCraig Rogers More articles by this author , and Wooju JeongWooju Jeong More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003328.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Whole-gland therapy is the mainstay of treatment for high-volume, low risk patients with prostate cancer (PCa), however it is associated with functional side effects. Precision prostatectomy is a surgical technique that removes >90% of prostatic tissue while preserving functional recovery. We describe a case of single port transvesical precision prostatectomy and report outcomes of patients who have received multiport precision prostatectomy at our institution. METHODS: A 72-year-old man with prior appendectomy and umbilical and hernia repair on active surveillance for left Grade Group 2 PCa elected to undergo surgery due to rising PSA. The following surgical steps are described: (1) transvesical access and robot docking, (2) anterograde bladder neck dissection, (3) standard dissection and nerve sparing on radical side, (4) development of precision plane, (5) apical dissection, (6) urethral transection, (7) posterior reconstruction, and (8) urethrovesical anastomosis. Oncological and functional outcomes of 88 patients with localized PCa undergoing multiport precision prostatectomy are reported. RESULTS: The patient underwent an uncomplicated single port transvesical precision prostatectomy, was discharged on post op day (POD) 1, and passed trial of void on POD 8. He was fully continent by 4 weeks post foley removal. The patient has not yet tried sexual activity postoperatively due to life events. 11-month follow-up shows a stable PSA of 0.7. All 88 patients undergoing multiport precision prostatectomy were alive and metastasis free at a median follow up of 25 months. At 36 months, 93% of patients were free from clinically significant residual PCa, 91% had not undergone additional treatment, and 100% were alive and metastasis-free. Two patients had biochemical failure according to Phoenix criteria, and 25 using the more stringent AUA post-RP criterion. However, detectable PSA was due to prostate cancer in only 10 patients as detected on biopsy of the remnant. Six patients underwent removal of the remnant and were free from biochemical failure at median follow-up of 10.2 months. At 12 months, 91% of patients were pad free, and 90% of the preoperatively potent patients had a SHIM score of 17+. CONCLUSIONS: Precision prostatectomy offers excellent postoperative functional results while minimizing PCa undertreatment. Single port transvesical precision prostatectomy is feasible and safe in select patients. Close patient follow-up and investigation into long-term oncological outcomes are necessary. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e926 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sohrab Arora More articles by this author Samantha Wilder More articles by this author Mohit Butaney More articles by this author Craig Rogers More articles by this author Wooju Jeong More articles by this author Expand All Advertisement PDF downloadLoading ...