Challenging Case: Robot-Assisted Laparoscopic Prostatectomy After Prior Suprapubic Open Prostatectomy

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Robot-assisted laparoscopic prostatectomy (RALP) is increasingly used for localized prostate cancer.
• Challenging RALP cases arise from factors like prior surgery, radiation, or difficult anatomy.
• This report details a RALP case following a prior suprapubic simple prostatectomy for benign prostatic hyperplasia (BPH).

Observation:

• A 61-year-old male with Gleason 8 prostate cancer had a history of suprapubic prostatectomy over a decade prior.
• RALP was performed, requiring extensive lysis of adhesions and careful dissection due to distorted anatomical planes.
• The patient experienced no operative or postoperative complications.

Findings:

• The patient achieved full urinary continence and erectile function at 3-month follow-up.
• Prostate-specific antigen (PSA) levels were <0.1 ng/mL, with a final pathology of Gleason 6 disease and negative surgical margins.
• This is only the second reported case of RALP after suprapubic prostatectomy in the literature.

Implications:

• RALP can be a safe and effective treatment for prostate cancer in patients with a history of suprapubic prostatectomy.
• Surgeon experience with complex anatomy is crucial for successful outcomes in such cases.
• RALP offers both oncologic control and functional recovery, even in previously operated patients.