V11-13: Robotic-assisted excision of an infected seminal vesicle remnant following radical retropubic prostatectomy in a patient with kidney transplant and inflatable penile prosthesis.

Video

Introductions and Objectives
It is not uncommon that seminal vesicle tissue is retained during radical prostatectomy. Remnant seminal vesicle is a rare cause of morbidity following radical prostatectomy, but such morbidity may be severe in presentation. We report the case of a 72-year-old male with a history of heart transplant, kidney transplant, and radical retropubic prostatectomy with subsequent inflatable penile prosthesis placement who presented with lower urinary tract symptoms, severe pelvic pain, and recurrent urinary tract infections. His workup revealed a ring-enhancing, pelvic fluid collection. In this video, we demonstrate a method of robot-assisted, laparoscopic excision of an infected, retained seminal vesicle cyst.

Methods
The patient was positioned on the operating table in exaggerated Trendelenburg. The trochar positions adhered to the standard robotic prostatectomy template with one exception. The assistant trochar site was positioned medially in order to accommodate the position of the patient’s transplanted kidney. The fourth arm was used to provide retraction of the rectum to a cephalad position. Following incision of the peritoneum, the cyst was dissected circumferentially. The densely adhered anterior surface was dissected caudally, and the structure was transected at its base. Hemostasis was achieved, and the base of the cyst was fulgurated in order to ensure that no viable mucosa remained.

Results
The infected cyst was excised without complication. The specimen pathology was consistent with benign seminal vesicle remnant. The patient recovered uneventfully over the course of his hospitalization and continues to be symptom free.

Conclusions
Robot-assisted laparoscopy provides an excellent surgical approach for the excision of a seminal vesicle remnant cyst following radical retropubic prostatectomy. This is evidenced by its success even in a pelvis that is crowded by a transplanted kidney and the reservoir of an inflatable penile prosthesis.

Funding: None.