Category: Robotic Surgery: New Techniques - Benign

VS18-9 - Robot Assisted Bladder Neck Reconstruction Using Indocyanine Green Assistance

Sun, Sep 23
2:00 PM - 4:00 PM

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.

Alp Tuna Beksac

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

Endourological Society Fellow in Minimally Invasive and Robotic Surgery at Icahn School of Medicine at Mount Sinai.

Alberto Martini

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

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