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Anatomic considerations for radical retropubic prostatectomy in an achondroplastic dwarf
Dennis Gyomber1, David Angus, Nathan Lawrentschuk
1Surgery and Urology, University of Melbourne, Studley Road, Heidelberg, Australia. dennisg17@optusnet.com.au
Thescientificworldjournal
|April 7, 2009
Summary
Radical retropubic prostatectomy (RRP) is challenging in achondroplasia due to pelvic anatomy. This report details a successful RRP in an achondroplastic dwarf, emphasizing careful surgical planning.
Area of Science:
- Urology
- Surgical Oncology
- Medical Genetics
Background:
- Achondroplasia (ACH) presents unique anatomical challenges, particularly in the pelvis.
- Radical retropubic prostatectomy (RRP) has not been previously reported in achondroplastic dwarfs.
- Literature review indicates general, urological, and orthopedic abnormalities associated with ACH.
Observation:
- A 62-year-old achondroplastic dwarf with Gleason 3+4 prostate cancer underwent RRP.
- Significant lumbar lordosis in ACH resulted in a narrow anteroposterior pelvic dimension, complicating surgical access.
- Computed tomography (CT) was utilized for preoperative surgical planning.
Findings:
- The RRP was technically difficult but achievable despite the narrow pelvic dimensions.
- Histological analysis confirmed multifocal prostate cancer with negative surgical margins and no extraprostatic extension.
- This represents the first reported case of a successful RRP in an achondroplastic dwarf.
Implications:
- RRP in achondroplastic patients is feasible but requires extreme caution and meticulous planning.
- Informed consent must include the possibility of surgical abandonment due to anatomical difficulties.
- Preoperative CT imaging is crucial for surgical planning in patients with ACH-related pelvic anomalies.
