V12-10 TIPS AND TRICKS IN SALVAGE RALP POST FOCAL THERAPY FAILURE FOR PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Oncology I (Prostatectomy) (V12)1 Sep 2021V12-10 TIPS AND TRICKS IN SALVAGE RALP POST FOCAL THERAPY FAILURE FOR PROSTATE CANCER Seetharam Bhat Kulthe Ramesh, Marcio Moschovas, Jonathan Noel, Sunil Reddy, Travis Rogers, and Vipul Patel Seetharam Bhat Kulthe RameshSeetharam Bhat Kulthe Ramesh More articles by this author , Marcio MoschovasMarcio Moschovas More articles by this author , Jonathan NoelJonathan Noel More articles by this author , Sunil ReddySunil Reddy More articles by this author , Travis RogersTravis Rogers More articles by this author , and Vipul PatelVipul Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002093.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Salvage robot-assisted laparoscopic prostatectomy (sRALP) is a technically demanding after focal therapy (FT) due to collateral fibrosis and anatomical disruptions of the anatomical landmarks. Some of the more popular focal therapies include cryotherapy, high intensity focused ultrasound (HIFU), and focal laser ablation (FLA). The failure rate of partial gland ablation ranges between 35%-42% with about 14% in-field recurrence(1,2). In this video, we present the challenges associated with sRALP following FT and describe key points in their management. METHODS: Between 2008 and 2018, 53 patients underwent sRALP by a single experienced surgeon in our institution. 7 patients had two FTs All procedures were performed using a transperitoneal six-port technique. Difficulties caused by focal therapies at were identified and key points in their management are presented here. RESULTS: Case 1- Bilateral pelvic side-wall fibrosis were common after HIFU ablation. The endopelvic fascia is relatively preserved at the prostate base whereas there is more fibrosis at the apex. Non-focal collateral fibrosis can make nerve sparing challenging. Case 2- Apical dissection around the sphincter was typically difficult in brachytherapy patients because transperineal route used to place brachytherapy seeds. Ipsilateral fibrosis and contralateral recurrence may prevent full nerve preservation on the contralateral side. Case 3- Patient had fibrosis posteriorly resulting in severe perirectal fibrosis and adhesions. Serosal surture may be required.Case 4- Focal laser ablation can lead to anatomical disruptions. The patient developed posterior urethral diverticulum making sRALP challenging. We go behind the posterior urethral diverticulum by lifting the median lobe. Posterior dissection is then carried on behind the diverticulum to include it along with the prostate.Similar to regular RALP, sRALP following FT leads to poorer functional outcomes when come primary RALP. CONCLUSIONS: sRALP should be performed by experienced surgeons due to severe collateral fibrosis, contralateral recurrence, anatomical disruptions etc irrespective of modality used for focal therapy. The surgeon should be familiar with challenges specific to different FTs and its routes. Despite the targeted nature of FT, significant non-focal collateral damage contralateral recurrence, anatomical disruptions lead to poorer functional outcomes post salvage RALP. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1027-e1027 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seetharam Bhat Kulthe Ramesh More articles by this author Marcio Moschovas More articles by this author Jonathan Noel More articles by this author Sunil Reddy More articles by this author Travis Rogers More articles by this author Vipul Patel More articles by this author Expand All Advertisement Loading ...