Introduction & Objective : In this video,we aimed to present our experience with pediatric laparoscopic radical prostatectomy for a prostate-derived embryonal rhabdomyosarcoma(PDERMS).
Methods : A 2-year old male patient admitted to emergency room for urinary retention was found to have papillary lesions on the prostatic urethra,had TUR biopsy which revealed PDERMS.MRI showed diffusely enlarged prostatic mass lesion continuing through the bladder neck and base,causing dilatation on the left ureter with accompanying iliac and inguinal lymph nodes.After receiving 4 cycles of CEVAIE chemotherapy,control MRI showed a decrease in prostatic size and accompanying lesions.Laparoscopic radical prostatectomy was planned.
The patient was placed in supine position.Pneumoperitoneum was created.Total of 5 ports in inverse V shape were placed.Bilateral endopelvic fascia were incised.Muscles forming the external urethral sphincter were removed on the apical,lateral and posterior border with scissors.Further dissection was carried out according to descending technique starting from the bladder neck.Bilateral vas deferens and seminal vesicles were freed and vascular structures were clipped.After opening the Denonvillier’s fascia,bilateral prostatic pedicles were dissected.Then the dorsal vein complex was controlled from the anterior aspect and cut then urethra was reached and divided.Prostate was placed in an endobag.Urethrovesical anastomosis was performeded with Van Velthoven technique.A drain was placed and the specimen was removed from the optic trocar site.
Results : Gas insufflation duration and estimated blood loss was 140 minutes and 100cc. respectively.Pathologic examination revealed no tumor in prostate with fibrosis and hyalinization on some parts secondary to regressed tumor.
Conclusions : Laparoscopic radical prostatectomy may safely be utilized in experienced hands for rare cases of PDERMS to spare the bladder.
Ender Ozden– Professor in Urology, Ondokuz Mayis University, School of Medicine, Department of Urology, Atakum, Samsun, Turkey
Murat Gulsen– Atakum, Samsun, Turkey
Suleyman Oner– atakum, Samsun, Turkey
Firat Akdeniz– Trabzon, Trabzon, Turkey
Yakup Bostanci– Atakum, Samsun, Turkey
Yarkın Kamil Yakupoglu– Atakum, Samsun, Turkey
Ayhan Dagdemir– Atakum, Samsun, Turkey
Ibrahim Kartal– Atakum, Samsun, Turkey
Ali faik Yilmaz– Atakum, Samsun, Turkey
Professor in Urology
Ondokuz Mayis University, School of Medicine, Department of Urology
Atakum, Samsun, Turkey