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Symphysiotomy: a valuable approach in children with prostate rhabdomyosarcoma
Rafael V Pieretti1, Daniel P Ryan, Alberto Pieretti
1Section of Pediatric Urology, Department of Pediatric Surgery, MassGeneral Hospital for Children, Boston, USA. rpieretti@partners.org
Insights
Pubic symphysiotomy offers excellent surgical exposure for large pediatric prostate rhabdomyosarcoma, facilitating radical prostatectomy with bladder preservation and no orthopedic complications.
Area of Science:
- Pediatric Surgery
- Pediatric Oncology
- Surgical Oncology
Background:
- Rhabdomyosarcoma is a common pediatric soft tissue sarcoma.
- Large prostate rhabdomyosarcoma presents surgical challenges in pediatric patients.
- Radical prostatectomy with bladder preservation is the goal for these tumors.
Observation:
- A pubic symphysiotomy approach was utilized in two pediatric patients with large prostate rhabdomyosarcoma.
- Initial lower midline incisions were converted to symphysiotomy due to tumor size and technical difficulties.
- The symphysiotomy provided excellent surgical exposure, enabling radical prostatectomy and bladder preservation.
Findings:
- Both patients achieved complete tumor resection.
- Follow-up periods of 6 years and 26 months showed no tumor recurrence.
- No orthopedic complications were observed post-symphysiotomy.
Implications:
- Pubic symphysiotomy is a valuable surgical technique for managing large pediatric prostate rhabdomyosarcoma.
- This approach facilitates radical prostatectomy while preserving the bladder.
- The technique appears safe, with no reported orthopedic complications in the long term.
Abstract:
Surgery for large prostate rhabdoyasarcoma in children is a challenging procedure. We discussed the value of pubic symphysiotomy in affected patients. The symphysiotomy approach was used in two children with a large rhabdomyosarcoma of the prostate. In each case, the initial exposure was obtained through a lower midline incision, but, due to technical difficulties, resulting from the size of the tumor, surgery was completed via a symphysiotomy approach. In each case, the bladder was preserved and a radical prostatectomy was facilitated by the excellent exposure provided by the symphysiotomy. The patients have been followed for 6 years and 26 months, respectively. Both are tumor free. Neither has developed orthopedic complications. In conclusion, the symphysiotomy approach, for large prostate rhabdomyosarcoma in children, results in an excellent surgical exposure, thus, facilitating the performance of a radical prostatectomy with bladder preservation. Orthopedic complications have not developed throughout the follow up period.
