V07-11: Robotic Transvesical Excision of a Mullerian Duct Remnant
Although mullerian duct remnants are rare, they may present with a wide range of symptoms including lower urinary tract symptoms, post void dribbling, urinary tract infections, and pelvic pain. Complete surgical excision remains the most definitive treatment. We describe robotic transvesical excision of a mullerian duct remnant in a pediatric patient.
A 17-year-old boy with a congenital solitary right kidney was noted to have a midline pelvic mass on ultrasound during workup of a urinary tract infection and pelvic pain. The patient had normal external genitalia, and digital rectal exam was consistent with a soft and fluctuant prostatic mass. Magnetic resonance imaging demonstrated a 4.3 centimeter serpiginous soft tissue mass extending from the prostate to the bladder. Cystoscopy demonstrated a normal appearing prostatic urethra with no visible tract to the mullerian duct remnant.
Operative time was 205 minutes, estimated blood loss was 25 milliliters, and length of stay was 1 day. The Foley catheter was removed on postoperative day 6. Pathologic analysis demonstrated a mullerian duct cyst. At 6 week follow up, the patient did not have any lower urinary tract symptoms and had normal erectile function.
The robotic transvesical approach is well-suited for excision of mullerian duct remnants. It is a direct approach that allows for excellent access to and visualization of the bladder and prostate. Also, it minimizes manipulation of the neurovascular bundles and vas deferens/seminal vesicles, reducing the potential for injury to erectile and ejaculatory function, respectively.