(325) SINGLE-PORT ROBOTIC APPROACH TO RETRIEVAL OF MIGRATED INTRAVESICAL INFLATABLE PENILE PROSTHESIS RESERVOIR

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Abstract Introduction Migration of an IPP reservoir into the bladder is a rare, but known complication of penile prosthesis surgery with few documented cases over the past 25 years. Management options include retrograde removal via a penoscrotal/infrapubic approach without cystotomy closure and prolonged foley placement, versus an antegrade, open approach via an open cystotomy, closure of the bladder defect, and a similarly prolonged foley placement. The patient is a 67-year-old male with a non-functional IPP. He underwent a complete IPP explanation and replacement with a new device via a penoscrotal approach. The surgery was uncomplicated, and the patient was discharged home on post-operative day 1. The patient presented to the Emergency Department 4 days later with erythema spreading from the surgical site, concerning for cellulitis and possible infection. A CT scan demonstrated significant soft tissue changes as well as migration of the IPP reservoir into the urinary bladder. The decision was made to proceed with complete explantation of the penile prosthesis. Due to the complexity of the patient’s surgical history, body habitus, and the reservoir location, we proceeded with robotic-assisted laparoscopy via a transvesical approach using the Da Vinci SP platform. Objective We present a novel approach for removal of an intravesical IPP reservoir and cystotomy closure using the Da Vinci SP platform. Methods This video details the surgical approach to IPP explantation and removal of migrated intravesical IPP reservoir. The Single-Port Da Vinci robotic system was used for an intravesical approach to removal of the migrated reservoir and closure of the iatrogenic cystotomy. Results Post-operatively, the patient’s hospital course was complicated by an ileus which resolved with 3 days of nasogastric tube and bowel rest, as well as a popliteal DVT for which he was started on Eliquis. He was discharged on post-operative day 7 and foley catheter was removed post-operative day 10. Conclusions There were several benefits to using the single-port robotic approach. We had better visualization of the iatrogenic cystotomy than would have been possible via an open or laparoscopic approach. The single-port robot also required a much smaller incision than an open approach, allowing decreased morbidity of the procedure. Finally, there was the benefit of shorter foley catheter duration, as it was removed after 10 days. In conclusion, the single-port robotic approach was a successful and less morbid approach to retrieval of a migrated intravesical IPP reservoir. Disclosure No.