Combined robot-assisted surgery of upper and lower genitourinary tract with excellent early functional and oncological outcome – a case report of a concomitant nerve-sparing radical prostatectomy, diverticulectomy and ureterectomy

Abstract

INTRODUCTION AND IMPORTANCE: "Congenital anomalies of the kidney and urinary tract" (CAKUT) represent a heterogeneous and rare group of disorders affecting the urinary tract. Despite the widespread availability of ultrasound, the diagnosis of congenital urinary tract malformations is often made in adulthood. As a result, CAKUT are typically incidental findings during imaging investigations. This case report represents the first description of a simultaneous surgical therapy of CAKUT and nerve-sparing-prostatectomy, demonstrating that concomitant surgery does not present disadvantages and that a successful nerve-sparing radical prostatectomy can still be performed under NeuroSAFE control. CASE PRESENTATION: In this report, we describe a patient with prostate adenocarcinoma who had an incidental finding of left-sided CAKUT, including kidney aplasia, ureterocele, and bladder diverticulum. The patient underwent a simultaneous nerve-sparing radical prostatectomy, ureterectomy, and diverticulectomy. After catheter removal on day 10 after surgery, the patient demonstrated adequate continence (6gr in 24 h pad test, 450 ml voiding volume, no residual urine). The pathological examination revealed a pT2c pN0 (0/5) R0, GS 3 + 4 = 7a adenocarcinoma of the prostate. The patient expressed high satisfaction with the surgery and its outcomes. CONCLUSION: This case demonstrates for the first time that a combined approach to complex surgeries of both the upper and lower genitourinary tracts, addressing oncological considerations, can be performed safely without compromising early functional or early oncological outcomes.