ENDOUROLOGY & LAPAROSCOPY

Laparoscopic radical prostatectomy in renal transplant recipients
Robert G, Elkentaoui H, Pasticier G, Couzi L, Merville P, Ravaud A, Ballanger P, Ferrière JM, Wallerand H
Department of Urology, Bordeaux University Hospital, Bordeaux, France; University Victor Segalen Bordeaux 2, Bordeaux, France
Urology. 2009 [Epub ahead of print]

• Objectives: To report our experience with 9 consecutive laparoscopic radical prostatectomy (LRP) on renal transplant recipients (RTR) and to compare it with other LRPs performed during the same period by the same surgeons. Retropubic radical prostatectomy has widely been described in RTR, whereas LRP has rarely been studied.
• Methods: Between January 2007 and December 2008, all clinical data from patients undergoing radical prostatectomy were prospectively collected in a database. The database was searched to find information of LRP on RTR. We compared RTR and other patients for all relevant clinical data and for surgical complications.
• Results: A total of 9 LRP on RTR (5.8%) and other 164 LRP were performed. LRP on RTR were compared with other LRP. No statistically relevant difference was observed in patient characteristics, biopsy core pathologic analysis, prostate specimen pathologic analysis, and oncologic outcomes. Surgical procedure was also achieved under the same conditions in RTR than in other patients (surgical time, blood loss, transfusion rate, bladder injury). Rectal injury rate was significantly higher in RTR than in other patients (22.2% vs 1.8%, P = .022).
• Conclusions: LRP in RTR is feasible. The procedure can be managed the same way as LRP on other patients, but special care must be taken to avoid rectal injury. In our experience, the dissection of the posterior side of the prostate was more difficult on RTR than on other patients.

• Editorial Comment
  The authors described a difficult procedure, that is laparoscopic radical prostatectomy (LRP) in a population that has a complex medical history. Moreover, the possible anatomical challenges may cause an increase in morbidity. When cadaveric grafts are used, the immune system may alter the course of wound healing and increase not only the morbidity but also the mortality due to postoperative complications.
  I congratulate the authors for sharing their experience describing a significant increase in rectal injury due to the anatomical challenges due to prior renal transplantation, the million dollar question is whether these patients can better served by other methods of therapy and ablation, such as, cryoablation of the prostate under transrectal ultrasonography.

Dr. Fernando J. Kim
Chief of Urology, Denver Health Med. Ctr.
Associate Professor, Univ. Colorado Health Sci. Ctr.
Denver, Colorado, USA
E-mail: fernando.kim@dhha.org