Laparoscopic cystoprostatectomy in a heart transplant recipient

Area of Science:

• Urology
• Oncology
• Transplant Surgery

Background:

• Squamous cell carcinoma (SCC) can affect various organs, including the urinary bladder, particularly in immunocompromised individuals.
• Cardiac transplant recipients with a history of cutaneous SCC are at increased risk for other malignancies.
• Invasive bladder SCC presents unique surgical challenges, especially in patients with complex medical histories.

Observation:

• A 72-year-old male, post-orthotopic cardiac transplant and with a history of multiple cutaneous SCC resections, presented with invasive urinary bladder SCC.
• The patient experienced clot retention, necessitating clot evacuation and continuous bladder irrigation prior to surgical dissection.
• Surgical management involved a laparoscopic cystoprostatectomy, bilateral pelvic lymph node dissection, and extracorporeal ileal conduit urinary diversion.

Findings:

• The laparoscopic approach, completed in 6 hours, minimized blood loss and allowed for cardiovascular stabilization.
• Final pathology confirmed SCC with perivesical fat invasion.
• The patient remained disease-free at the 2-month follow-up, indicating successful surgical resection.

Implications:

• Minimally invasive surgical techniques are feasible and effective for managing invasive bladder SCC in complex transplant patients.
• Aggressive surgical management can lead to favorable outcomes, even in immunocompromised individuals with advanced disease.
• This case highlights the importance of vigilant surveillance for secondary malignancies in transplant recipients.