一名腎臟移植接受者接受Retzius 保留機械手臂輔助攝護腺根除手術

吳志緯¹、何承勳¹

1. 新光吳火獅紀念醫院外科部泌尿科

Retzius-Sparing Robotic-Assisted Radical Prostatectomy in a Renal Transplant Recipient

Chih-Wei Wu ¹, Chen-Hsun Ho ¹

1.Divisions of Urology, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

Purpose:

Retzius-sparing robotic-assisted radical prostatectomy (rsRARP) is an established technique for managing localized prostate cancer, offering improved early continence outcomes compared with the conventional approach. Performing rsRARP in renal transplant recipients poses unique challenges due to altered pelvic anatomy and the proximity of the graft kidney and ureter. We demonstrated the surgical steps and feasibility of rsRARP in a renal transplant recipient diagnosed with prostate cancer.

Materials and Methods:

A 60-year-old male with a history of renal transplantation 20 years earlier presented with a rising serum prostate-specific antigen (PSA) level. Magnetic resonance imaging revealed a suspicious lesion in the right lobe of the prostate and confirmed the graft kidney in the right iliac fossa. A transperineal ultrasound-guided biopsy confirmed prostate adenocarcinoma, Gleason score 3+3. We performed rsRARP, which is considered to reduce the risk of injury to the graft kidney and ureter. The trocar placement was modified accordingly to accommodate the position of the transplanted kidney.

Results:

The operation was completed successfully without intraoperative complications. Total operative time was 180 minutes, and blood loss was minimal. The postoperative course was uneventful. The urethral catheter was removed on postoperative day 9, and the patient achieved complete urinary continence immediately. Final pathology revealed organ-confined adenocarcinoma, Gleason 3+3, pathological stage pT2, with negative surgical margins.

Conclusion:

rsRARP is a feasible and safe surgical option for renal transplant recipients with localized prostate cancer, minimizing the risk of graft injury while achieving excellent functional and oncological outcomes.