Robot-assisted laparoscopic anterior urethral diverticulectomy

Introduction and hypothesis A 31-year-old patient with a history of fetal sacrococcygeal teratoma requiring tumor resection and pelvic reconstruction in infancy presented with a 3-year history of recurrent vulvar abscesses and voiding dysfunction. Magnetic resonance imaging demonstrated a fluid coll...

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Bibliographic Details
Published in:International Urogynecology Journal 2023-02, Vol.34 (2), p.589-592
Main Authors: O’Shea, Michele, Routh, Jonathan C., Siddiqui, Nazema Y.
Format: Article
Language:English
Subjects:
Abscess
Abscesses
Adult
Diverticulum - surgery
Female
Gynecology
Humans
IUJ Video
Laparoscopy
Laparoscopy - methods
Medicine
Medicine & Public Health
Robotics
Robots
Urethra - pathology
Urethral Diseases - surgery
Urology
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Summary:Introduction and hypothesis A 31-year-old patient with a history of fetal sacrococcygeal teratoma requiring tumor resection and pelvic reconstruction in infancy presented with a 3-year history of recurrent vulvar abscesses and voiding dysfunction. Magnetic resonance imaging demonstrated a fluid collection posterior to the pubic bone and inferior to the bladder. The objective was to demonstrate the key steps in the resection and repair of an anterior urethral diverticulum via robot-assisted laparoscopic approach. Methods Cystoscopy followed by robot-assisted laparoscopic retropubic dissection was used for resection of an anterior urethral diverticulum followed by urethral reconstruction. Results Cystoscopy revealed a large anterior cavity at the midpoint of the urethra consistent with an anterior urethral diverticulum. This likely tracked inferiorly toward her vulva during repeated episodes of infection expressing through her recurrent abscesses. Retropubic space exploration revealed dense fibrotic tissue adherent to the underside of the pubic tubercule contiguous with the anterior urethral diverticulum, which was successfully resected. Conclusions Female anterior urethral diverticulum is a rare entity. A robot-assisted laparoscopic approach can be safely utilized to identify and resect an anterior urethral diverticulum. Key points include optimization of port placement, use of a council-tip catheter to facilitate bladder drainage in the setting of distorted pelvic anatomy, and multi-layered tension-free urethral closure with flap placement.
ISSN:0937-3462
1433-3023
DOI:10.1007/s00192-022-05355-7