V7-07: Combined Robotic and Open Approach to Excision of Accessory Bladder and Urethral Triplication
VideoIntroductions and Objectives
Management of urethral and bladder duplication anomalies focuses on prevention of recurrent infections and preservation of renal function. We describe a case of urethral triplication and bladder duplication, and the combined robotic and open approach to surgical excision.
A 17 year-old male presented with ten days of intermittent fevers and abdominal pain. He was found to have two accessory urethras – both along the dorsal penile shaft – in addition to a normal orthotopic ventral meatus. A large cavity anterior to the bladder was identified on CT scan and a drain was placed by interventional radiology with return of purulent fluid. He was placed on culture-directed antibiotics and improved.
Cystoscopy revealed two accessory urethral channels that were both blind-ending, the more proximal one just under the pubic symphysis. The patient then underwent open excision of the urethral triplication followed by robotic excision of the bladder duplication. Total console time for the robotic portion was 2 hours 18 minutes and estimated blood loss was 30 ml. Final pathology revealed non-keratinizing squamous lining of the accessory urethras, with chronic inflammation and marked fibrosis of the distal-most channel, but acute inflammation of the proximal channel. The accessory bladder specimen had a urothelial lining with reactive changes and inflammation within the lamina propria.
To our knowledge, this is the first reported case of robotic excision of a urethral/bladder duplication anomaly. There was significant scarring due to the patient’s prior recurrent infections, but visualization with the robotic approach was excellent and the patient healed well with a short recovery time. We conclude that robotic excision of a bladder duplication anomaly is a technically feasible operation.