Category: Laparoscopic/ Robotic: Bladder

VS12-1 - Minimally invasive management of pan-urothelial malignancy - A rarity in urology

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

Panurothelial malignancy is Transitional cell carcinoma involving the bladder and two other extra-vesical sites. It is quite rare even in modern day urological practice. We present our series on this topic and a demonstrative video of minimally invasive, laparoscopic/robotic management of synchronous bladder and bilateral upper tract tumors.


Methods :

Hematuria and flank pain were the predominant symptoms of these patients. Patients were evaluated with non-contrast/contrast CT depending on the clinical scenario. Biopsy was not done for upper tracts with those with typical imaging findings, whereas, flexible ureteroscopy and biopsy was done otherwise. Multidisciplinary consult and fitness was taken in all these cases. All patients underwent simultaneous laparoscopic bilateral nephro-ureterectomy and laparoscopic/robotic cysto-prostatectomy with standard port placement. Due care was given to maintain zero contact of the urothelium to the peritoneal cavity and the specimen was retrieved through a small pfannensteil incision. Patients were initiated on hemodialysis in the perioperative period. Systemic adjuvant therapy was advised in accordance with the histo-pathological report.


Results :

We have treated 3 patients of pan-urothelial disease with minimally invasive nephroureterectomy and cystoprostatectomy. Mean operative time, hemoglobin drop and hospital stay were 340±35 minutes, 4 gm% and 8 days respectively. No patient required open conversion and 1 required blood transfusion. The demonstrative case turned out to be pT3 disease in both the upper tracts and pCIS in the bladder. Post-operative adjuvant treatment is required as per the stage of the disease and the demonstrative case was put on immunotherapy with Pembrolizumab, and is currently doing well without clinical progression at 9 months follow up.


Conclusions :

Radical surgical resection is still the only option of cure for pan-urothelial malignancy. Very few literatures exist on systemic adjuvant treatment post resection or advanced cases. Further multicentric trials are required to formulate ideal treatment strategy.

Sudharsan Balaji

Fellow in Endourology, Laparoscopy and Robotics
Dr.
Nadiad, Gujarat, India

I am Dr. Sudharsan Balaji, MBBS MS MRCS DNB (Urology), working as a Fellow in Endourology, laparoscopy and Robotics in Muljibhai Patel Urological Hospital, Nadiad, India. I finished my Undergraduation and Postgraduation from Stanley Medical College, Chennai in 2009 and 2013 respectively. I finished ny Urological degree from my almamater MPUH, Nadiad in 2017 and was awarded the Endourological Society Fellowship on the same year. I have 15 publications to my credit, authored 3 book chapters and associate editor of a book titled "Monograph Series in Urology - Endourology and laparoscopy". I have so far 14 national and international presentations in various urological conferences till date. I was offered a visiting Scholarship in Pediatric Urology in Cincinnati Childrens' Hospital in 2015. I have specific interests in Endourology, Transplant and Minimally invasive pediatric urology. I see myself as laparoscopic/Robotic pediatric reconstruction in the future, which is my area of interest and expertise.

Mohankumar Vijayakumar

Fellow in Endourology, Laparoscopy and Robotics
Dr.
Nadiad, Gujarat, India

Abhishek Singh

Junior consultant
Muljibhai Patel Urological Hospital
Nadiad, Gujarat, India

Arvind Ganpule

Vice Chairman
Muljibhai Patel Urological Hospital
Nadiad, Gujarat, India

Ravindra Sabnis

Chairman
Muljibhai Patel Urological Hospital
Nadiad, Gujarat, India

Mahesh Desai

Consultant Urologist and Managing Trustee
Muljibhai Patel Urological Hospital
Nadiad, Gujarat, India