Case report: robot-assisted laparoscopic radical prostatectomy in patient with large median lobe

Introduction. The case of a robot-assisted laparoscopic radical prostatectomy in a patient with an 81-gram prostate with a large medial lobe (39-gram) is presented. We describe the technique of operation, show the main perioperative indications and summarize the rehabilitation period.

The aim of the study is to detect possible technical difficulties of this operation, to attract the interest of urologist to this topic and to share our experience.

Materials and methods. А 73-year-old male presented to the urology clinic because of elevated PSA level (18 ng/ml); transrectal ultrasound-guided biopsy of the prostate revealed a Gleason score 6 (3 + 3) acinar adenocarcinoma involving left lateral and medial zone; according to the magnetic resonance scan prostate size is 81 g, asymmetric with a prevalence of the left lobe, median lobe size is about 39 g, median lobe prolapses into the bladder for 4,6 cm, the prostatic part of the urethra is shifted to the left, there is no data for extracapsular extension, the lymph nodes haven’t got any changes, there are no signs of specific bone damage according to the bone scan. The patient underwent robot-assisted laparoscopic radical prostatectomy with bilateral nerve sparing.

Results. The procedure length was about 200 min; console time — 155 min. Blood loss was 120 ml. The hemoglobin level decreased by 7.6 % of the initial value. Pelvic drain removed on 2rd day. The urethral catheter was removed on 7th day. On the 8th day patient was discharged from hospital.

Conclusions. A robot-assisted laparoscopic radical prostatectomy in a patient with a large medial lobe give to the operative surgeon several problems: the large size of the prostate, the difficulty of bladder neck reconstruction, special attention on the stage of mobilization of the ureteral opening.

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