V07-10: Full urethral preservation during Laparoscopic radical prostatectomy (FUP-LRP)

Catarina Tinoco*, Andreia Cardoso, Ricardo Matos Rodrigues, Sara Anacleto, Ana Sofia Araújo, Mário Cerqueira Alves, Emanuel Carvalho-Dias, Braga, Portugal

Introduction: One of the main complications of radical prostatectomy remains urinary incontinence. Urethral length preservation is characterized in the urological literature as a main determinant of early continence. Our objective is to demonstrate the feasibility and safety of a new technique: full urethral preservation during laparoscopic radical prostatectomy.

Methods: We demonstrate our technique of laparoscopic radical prostatectomy with full urethral preservation. The usual steps of laparoscopic radical prostatectomy were followed, diverging only when usually we divide the urethra. Instead, the urethra was preserved, and completely dissected from the prostate. After completing the dissection, the urethra was divided and sent with the prostatectomy specimen to histological analysis, to evaluate the oncological safety of the procedure. Lastly, we performed a vesicourethral anastomosis.

Results: We present the case of a 53-year-old male with EAU low-risk localized prostate cancer (PSA 4.28, cT1, Gleason score 6 (3+3)) which was submitted to a nerve-sparing laparoscopic radical prostatectomy. A novel technique of full urethral preservation was performed, in which the urethra was carefully dissected from the prostate. The patient had no post-operative complications and was discharged after 2 days. The urinary catheter was removed after 10 days. The pathologic report revealed a prostatic adenocarcinoma Gleason 6(3+3), with no urethral invasion by the tumour - pT2cNxMxR0. Post-prostatectomy PSA was <0.01 ng/mL. At last follow-up, the patient had full continence and good erectile function with daily tadalafil (5mg).

Conclusions: Full urethral preservation is feasible during laparoscopic radical prostatectomy. However, its execution is technically difficult. Pathology of the urethra showed no tumoral invasion, showing its oncological safety as previously reported in the literature. This technique may be useful in selected patients with localized peripheral prostate cancer, but prospective studies are needed to evaluate the impact of this technique in continence maintenance.

Source of Funding: None