Abstract
Patients with a renal transplant present unique anatomical challenges during pelvic surgery. The graft is typically located in the iliac fossa with vascular anastomoses to the iliac vessels and a short ureter implanted into the bladder. These features increase the risk of graft injury during radical prostatectomy, especially when lymph node dissection is planned. This case describes the experience in one of the few cases performed in our department. A 66-year-old man with localized prostate cancer (Gleason 3 + 4 = 7a) and a functioning renal transplant in the right iliac fossa. His history included end-stage renal disease due to IgA nephropathy (retroperitoneal transplants in 1990 on the left side and 2009 on the right side), coronary artery disease with stenting, and atrial fibrillation on new oral anticoagulation (NOAC). He underwent nerve-sparing robot-assisted radical prostatectomy (RARP) with bilateral pelvic lymphadenectomy. Histopathology confirmed organ-confined acinar adenocarcinoma (pT2c) with negative margins and no lymph node metastases. Postoperative cystogram confirmed a satisfactory vesicourethral anastomosis. When the intraoperatively inserted suprapubic catheter was clamped to enable natural urination, renal parameters temporarily increased. This was resolved after reopening the catheter for a few days. Ultrasound showed preserved graft perfusion without hydronephrosis or lymphocele. This case supports the feasibility of RARP in renal transplant recipients when meticulous technique is used to protect graft function.