Combined robotic and open approach to excision of accessory bladder and urethral triplication

Abstract

Management of urethral and bladder duplication anomalies centers on prevention of recurrent infections and preservation of renal function. We present a surgical approach to urethral triplication and bladder duplication utilizing a combined robotic and open approach. A 17-year-old male presenting with fevers and abdominal pain was found to have two accessory urethras dorsal to a normal orthotopic ventral meatus. A large cavity anterior to the bladder was identified on a computed tomography scan and drained of purulent fluid. After improvement with antibiotics, endoscopic evaluation revealed no distinct connection between the cavities. The patient subsequently underwent open excision of the urethral triplication followed by robotic excision of the accessory bladder. Total console time for the robotic portion was 2 hours 18 minutes and estimated blood loss was 30mL. The dissection was difficult due to reaction from prior infections, but the accessory bladder was able to be dissected off without opening the native bladder. The accessory bladder specimen was consistent with a urothelial lining exhibiting reactive changes. To our knowledge, robotic excision of a urethral/bladder duplication anomaly has not yet been described in the literature. The robotic approach allowed for excellent visualization and is technically feasible.