Category: Robotic Surgery: New Techniques - Benign

Introduction & Objective :

In this video, we present a case of a bladder neck reconstruction of a 46 year old male. The patient has a history of prostate cancer treated with primary radiotherapy. 14 years after radiation, patient received treatment for benign prostatic hyperplasia. He developed stress urinary incontinence, nocturia and recurrent urinary tract infections following treatment. 2 years after bph treatment, patient developed acute urinary retention. He was catheterized suprapubically. Flexible cystoscopy revealed completely obliterated bladder neck. Patient had no evidence of recurrent prostate cancer.

Methods : The patient was positioned in the low lithotomy position. We started the case with mobilization of the bladder. Following mobilization, bladder was dissected towards the endopelvic fascia. Bladder was incised from the midline, and the obliterated urethrovesical junction was observed. A flexible cystoscope was inserted into the urethra and immunofluoresence guidance was used to create the passage. Urethral foley catheter was inserted using glidewire assistance. The fibrotic tissue in the bladder neck was excised. Bilateral bladder flaps were used from the proximal side of the bladder. Healthy urethral tissue was advanced toward the bladder neck and posterior plate was formed. Healthy proximal bladder tissue was used to reconstruct the lateral and anterior bladder surface. Running barbed sutures were used for anostomosis. Finally, the cystotomy was closed with running suture.

Results : Surgery was completed in 2:17 hours, with an estimated blood loss of 50 mL. Drain was removed at day 1 and patient was discharged on POD 1 without complications. Foley catheter was removed at postoperative 10 days. Patient was able to urinate without intervention.

Conclusions : This video demonstrates a stepwise technique for the challenging scenario of radiation induced bladder neck stricture. Immunofluorescence can a useful tool in identification of the urethra in patients with an obliterated bladder neck.

Presenting Author(s)

• 

  Alp Tuna Beksac

  – Fellow, Icahn School of Medicine at Mount Sinai, New York, New York

Author(s)

• AM

  Alberto Martini

  – Fellow, Icahn School of Medicine at Mount Sinai, New York, New York
• RP

  Rajveer Purohit

  – Associate Professor, Icahn School of Medicine at Mount Sinai, New York, New York
• 

  Ketan Badani

  – Professor of Urology, Icahn School of Medicine at Mount Sinai, New York, New York