Peritoneal and port site seeding of an undiagnosed urothelial carcinoma of the bladder after robot-assisted laparoscopic prostatectomy

Laparoscopic prostatectomy and robot-assisted laparoscopic prostatectomy are common procedure performed for the treatment of localized prostate cancer. Port site and peritoneal seeding is an exceedingly rare but known complications associated with this procedure. We present a case of a 71-year old male with low-intermediate risk prostate adenocarcinoma who underwent a robot-assisted laparoscopic prostatectomy. Pathology at that time was negative for extraprostatic extension, seminal vesicle invasion, or margins. Seven months later, the patient presented with gross hematuria and was found to have multiple superficial tumors of the bladder urothelium consistent with high-grade papillary urothelial carcinoma. He then began to experience increasing lower abdominal pain and a palpable, right anterior abdominal mass. Computed tomography-guided biopsy revealed high-grade papillary urothelial carcinoma which strongly suggests peritoneal seeding from his recent robot-assisted laparoscopic prostatectomy. Despite its rarity, the morbidity associated with this phenomenon could help justify a recommendation of careful pathologic examination of each prostate specimen for a second urothelial primary with subsequent cystoscopy if one is found.