Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

VR-31

(VS)

ROBOTIC-ASSISTED PARTIAL CYSTO-PROSTATECTOMY FOR EMBRYONAL

RHABDOMYOSARCOMA

Dario Guido MINOLI

, Bernardo ROCCO

, Giancarlo ALBO

, Santiago VALLASCIANI

, Alfredo BERRETTINI

and

Gianantonio MANZONI

1) Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico - Milano, Pediatric Urology, Milano, ITALY - 2)

Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico - Milano, Urology, Milano, ITALY

PURPOSE

Robotic surgery can open new horizons and strategies as a minimally-invasive approach for situations generally

considered the exclusive preserve of open surgery

MATERIAL AND METHODS

A 2-year-old child was admitted to our hospital with acute renal failure, bilateral hydro-uretero-nephrosis and

suprapubic mass. After initial treatment (bilateral nephrostomy, haemodialysis) further analysis confirmed an embryonal

rhabdomyosarcoma originating from bladder base/prostate with regional infiltration.

According to EpSSG RSM 2005 protocol, chemo- and targeted radiotherapy resulted in good local regression but left a

residual neoplastic mass involving the bladder base and prostate. A trans-vesical partial cysto-prostatectomy, without

ureteric reimplantation was performed with DaVinci robot resulting in the complete removal of residual tumour tissue.

Histology revealed absence of neoplastic cells including the resection margins.

Ureteral stents were removed after two months. The child underwent adjuvant chemotherapy and three monthly

endoscopic and MRI follow-up evaluation

RESULTS

After 18 months, the child has autonomous micturition, complete bladder emptying and preserved continence. Mild left

vesico-ureteric reflux is present without clinical symptoms. Endoscopy and imaging are negative for tumour recurrence

CONCLUSIONS

This case describes a laparoscopic robotically-assisted approach to bladder/prostate rhabdomyosarcoma in a child,

previously unreported in the literature. Robotic surgery allowed precise and complete local excision of residual mass

which would have been impossible by conventional open surgery, thereby avoiding the need for radical cystectomy and

more complex and demanding substitutive procedures. Such progress underlines the need for such cases to be managed

in highly specialised multi-disciplinary centres; further experience and follow-up are necessary to confirm the validity of

this innovative approach