Category: Laparoscopic/ Robotic: Prostate
Introduction & Objective : Renal failure patients with prostate cancer do not routinely undergo radical prostatectomy due to a ˂10 year life expectancy. However, receiving a renal transplant will increase life expectancy to >10 years. Subsequently, in our institution, end-stage renal disease (ESRD) prostate cancer patients that are candidates for renal transplantation are offered RALP. After RALP, patients with negative margins, low or moderate risk disease and undetectable PSA are immediately cleared for listing. The purpose of this study is to review outcomes of RALP in patients with ESRD and evaluate outcomes of these patients following renal transplantation.
Methods : A retrospective review of 45 patients with ESRD who underwent RALP for prostate cancer between 2008 and 2017 was performed. Patients that underwent subsequent renal transplantation were further reviewed to determine oncologic and renal functional outcomes following transplant. Continence was defined as 0-1 security pads/day. Postoperative complications were graded with the Clavien-Dindo scale.
In ESRD patients undergoing RALP, the mean BMI was 29.1 (range 19.5-39.3 mg/kg2) and mean age was 60.9 (range 40-75 years). The mean preoperative PSA was 5.3 (range 1-19 units). Four patients (8.2%) had positive margins (3 apex, 1 bladder neck). There were 2 UTIs (Clavien-Dindo I) within 30 days of surgery. All 45 patients had an undetectable ultrasensitive PSA at latest follow-up. Following RALP, 15 patients underwent renal transplantation. At transplant, 2 patients required intraoperative urologic consultation to localize the contracted bladder. Another anuric patient had a bladder neck contracture, required urethral dilation, and remains continent with no recurrent stricture at 72 months. One patient (6.6%) was incontinent at 12 months following RALP and two additional patients, who were dry prior to renal transplant (1L urine production per day), developed incontinence after transplant. The mean creatinine at one month post-transplant was 1.9 mg/dL. Mean follow-up time is 7.9 years post-RALP. Three patients who did not receive transplant (survival 6.3 years) and 1 patient (6.7%) who received transplant died at 3.9 years. No patients have metastatic or recurrent prostatic cancer.
Conclusions : ESRD patients undergoing RALP have excellent oncologic outcomes, acceptable morbidity, and, following transplant, a potential 10-year survival.
Mohammad Hajiha– clinical instructor , LOMA LINDA UNIVERSITY MEDICAL CENTER│Department of Urology, Loma Linda, California
Hillary Wagner– Loma Linda, California
Julie W. Cheng– Loma Linda, California
Zahabiya Campwala– Loma Linda, California
Phillip K. Stokes– Loma Linda, California
Muhannad Alsyouf– Resident Physician, LOMA LINDA UNIVERSITY MEDICAL CENTER │ Department of Urology, Loma Linda, California
Maher Blaibel– Loma Linda, California
Michael Wilkinson– Loma Linda, California
Samuel Abourbih– Loma Linda, California
Akin Soner Amasyali– Loma Linda, California
Duane Baldwin– Professor, Director of Urologic Research, Loma Linda University Medical Center, Loma Linda, California
LOMA LINDA UNIVERSITY MEDICAL CENTER│Department of Urology
Loma Linda, California
LOMA LINDA UNIVERSITY MEDICAL CENTER │ Department of Urology
Loma Linda, California
Urology Resident at Loma Linda University Medical Center, California USA
Professor, Director of Urologic Research
Loma Linda University Medical Center
Loma Linda, California
Dr. Duane Baldwin is Professor of Endourology and Director of the Endourology Fellowship and Living Donor Program at the Department of Urology, Loma Linda University School of Medicine. He specializes in endourology, laparoscopy, and robotic surgery. He also directs the research program for the urology residency program.
Dr. Baldwin received his M.D. degree from Loma Linda University School of Medicine in 1991 followed by his urology residency training that he completed in 1997, also at Loma Linda University. He was a member of the United States Air Force and attended the School of Aerospace Medicine in 1988. He was stationed at Andrews Air Force Base for four years from 1997-2001 and was a faculty member at the Uniformed Services University of the Health Sciences. He completed an endourology fellowship in 2002 at Vanderbilt University under Dr. Elspeth McDougal and Dr. Duke Herrell. He returned to Loma Linda University in 2002 and is currently also on staff at Arrowhead Regional Medical Center, Riverside University Health System, the Jerry L. Pettis Memorial Veterans Medical Center, and Highland Springs Surgical Center.
His current research interests are broad and include efforts to reduce the invasiveness of donor nephrectomy, LESS nephrectomy and NOTES surgery. He also has published extensively in the field of urinary stone disease. He is an advocate for reduced radiation exposure to patients and surgeons and he has been invited to present this work at the national and international level.