Concurrent robotic simple prostatectomy and reimplant of ectopic ureter

You have accessJournal of UrologyBPH & Infection & Imaging (V06)1 Sep 2021V06-10 CONCURRENT ROBOTIC SIMPLE PROSTATECTOMY AND REIMPLANT OF ECTOPIC URETER Kirolos N. Meilika, Michael Wilson, Kennedy Okhawere, Talia Korn, and Ketan Badani Kirolos N. MeilikaKirolos N. Meilika More articles by this author , Michael WilsonMichael Wilson More articles by this author , Kennedy OkhawereKennedy Okhawere More articles by this author , Talia KornTalia Korn More articles by this author , and Ketan BadaniKetan Badani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002021.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ectopic ureters are a rare anatomical anomaly and can be challenging to maneuver during robotic surgery. In this video, we are demonstrating the surgical steps of robotic simple prostatectomy concurrently with the reimplantation of the right ureter, as it was previously ectopically inserted into the right prostatic lobe. METHODS: The patient is a 63-year-old male with prostate size of 105 cc. The CT Urogram showed the right ureter is inserted into the right lobe of the prostate. A robotic transperitoneal and transvesical approach was used. After insufflation of bladder with air, the transvesical exposure is achieved by applying four Marionette sutures to the cystotomy edges and securing them to the peritoneum using sliding hem-o-lok clips.Urine draining from the right ureteric orifice was noted, indicating the ureter was inserting into the right prostatic lobe. The enlarged median prostatic lobe was grasped and the overlying mucosa is carefully incised and dissected to prevent ureteral injury. The plane between the adenoma and the capsule is identified and dissection is carried out circumferentially. After removal of the adenoma, the fossa is checked for any source of bleeding.A right ureteroneocystostomy is then performed within the bladder and a ureteral stent was easily placed. Complete circumferential mucosa to mucosa anastomosis between the bladder neck and the urethra was performed.The Marionette sutures are then removed one at a time and the cystotomy is closed in 2 layers. RESULTS: The operative time was 97 minutes and the estimated blood loss was 100 ml. The hospital stay was 22 hours. KUB was performed to confirm normal anatomic position of the intraoperatively inserted ureteral stent. The urethral catheter was removed seven days post operatively. CONCLUSIONS: The robotic approach to complex reconstructive procedures is feasible and provides excellent operative outcomes. Training and experience with this complex case is crucial to provide proper management. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e451-e452 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kirolos N. Meilika More articles by this author Michael Wilson More articles by this author Kennedy Okhawere More articles by this author Talia Korn More articles by this author Ketan Badani More articles by this author Expand All Advertisement Loading ...