V7-09: MINIMALLY INVASIVE APPROACH TO Y-TYPE URETHRAL DUPLICATION.
Urethral duplication is a rare congenital anomaly and typically occurs in the sagittal plane. Management of these patients remains difficult as no consensus has been established. We present a case of a paramedian Y-type urethral duplication and our minimally invasive approach to management including a novel robotic assisted laparoscopic approach in its repair.
A 14-year-old male presenting with peri-anal drainage during voiding and intermittent episodes of irritative voiding symptoms was found to have a fistulous connection from the prostatic urethra to the right perianal region consistent with a Y-type urethral duplication. Endoscopic evaluation revealed the origin of the duplication to be the right of midline in the proximal prostatic urethra. An initial attempt at endoscopic management was made with injection of bulking agent at the proximal orifice followed by fulguration after inadequate coaptation was observed. These approaches failed with leakage one week following the procedure. The patient subsequently underwent robotic excision of the proximal ostium.
Total console time for the robotic portion of the procedure was 50 minutes with minimal blood loss. The foley catheter was removed on postoperative day one, and the patient was discharged home. At extended follow up, the patient was voiding normally and completely asymptomatic.
Management of Y-type urethral duplication in certain cases can safely be repaired via a transperitoneal robotic approach.