V05-04: Robotic Assisted Posterior Urethroplasty for Traumatic Urethral Transection
Posterior urethroplasty has traditionally been performed via an open perineal approach. No documented cases of robotic assisted transabdominal and transvesical repair for traumatic posterior urethral injuries were identified in the literature. In the accompanying video, we present a novel technique for robotic assisted posterior urethroplasty.
A 26 year old male was found to have a total prostatic urethral disruption following two gunshot wounds to the buttock. A suprapubic catheter was initially placed for urinary diversion. Subsequent cystoscopy and retrograde urethrogram revealed an obliterated posterior urethra distal to bladder neck and proximal to the verumontanum. Four months following his trauma, the patient underwent posterior urethroplasty with robotic assistance. Simultaneous retrograde urethroscopy assisted in identifying the viable posterior urethral segment during dissection.
Operative time was 155 minutes with estimated blood loss of 50mL. There were no operative complications. Patient was discharged on post-op day one with a foley and suprapubic tube. Post-operative cystogram and VCUG at 3 weeks revealed open bladder neck and posterior urethra without evidence of leak. Foley and suprapubic tube were removed. On follow up assessment, patient denied issues with voiding and reported strong voided stream.
Robotic assisted transabdominal primary anastomotic posterior urethroplasty is a safe and technically feasible alternative to open repair. Laparoscopy offers shorter hospital stay and faster recovery compared to traditional techniques. Further experience and assessment of this approach can reveal additional advantages.