Robot-Assisted Radical Prostatectomy After Rezūm: A Case Report and Literature Review

TL;DR

This case report describes the first robot-assisted prostate cancer surgery after a patient had Rezūm therapy for an enlarged prostate.

Contribution

The paper presents the first documented case of robot-assisted radical prostatectomy following Rezūm therapy.

Findings

RARP after Rezūm is technically feasible but requires careful dissection due to fibrosis and altered anatomy.

No prior cases of RARP after Rezūm were found in the literature.

RARP after TURP is associated with increased surgical challenges but similar long-term outcomes.

Abstract

Minimally invasive surgical therapies (MISTs), such as Rezūm™ Water Vapor Therapy, are emerging treatment options for benign prostatic obstruction (BPO). When prostate cancer is subsequently diagnosed, radical prostatectomy may still be indicated. However, evidence regarding intraoperative challenges and the surgical and functional outcomes of robot-assisted radical prostatectomy (RARP) following Rezūm remains limited. We report the first documented case of RARP following Rezūm in a 68-year-old man. He initially underwent Rezūm for symptomatic BPO. Due to rising PSA, a suspicious lesion on MRI, and a biopsy-confirmed high-risk prostate carcinoma, radical surgery was performed. Intraoperatively, dense fibrosis and altered tissue planes required precise dissection and a level 2 bilateral nerve-sparing approach. A systematic review revealed no previously published cases of RARP after Rezūm. On the other hand, RARP after transurethral resection of the prostate (TURP) is associated with increased operative time, blood loss, and bladder neck reconstruction, though late continence and biochemical recurrence rates are similar to those in treatment-naïve patients. In conclusion, RARP after ablative BPO therapies is feasible but may present unique technical challenges. Larger prospective studies are needed to develop standardized management strategies.

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