Robotic excision of a calcified urachal cyst: A video case report

Abstract

BackgroundUrachal cysts are an uncommon congenital abnormality that result from the incomplete obliteration of the urachus [1]. Typical presentation is in childhood, and previous pediatric autopsy studies have shown an incidence to be 1 in 5000 cases [2]. These urachal cysts are frequently asymptomatic, however, some patients can present with symptoms of lower abdominal pain, features of urinary tract infection, a painful abdominal lump, and/ or hematuria [3]. Differential diagnosis for an uninfected urachal cyst includes a bladder diverticulum, vitelline cyst, mesenteric cyst, Meckel diverticulum, and an umbilical hernia. Bladder adenocarcinoma should be considered as a differential diagnosis for an infected urachal cyst. ObjectiveTo share the surgical case of a robot-assisted excision of a calcified urachal cyst. Methods/materialsWe present the case of a 50-year-old previously healthy female who presented with intermittent gross hematuria for 1 year. CT Urogram demonstrated a urachal sinus cystic and calcified mass. Cystoscopy performed in clinic showed no obvious connection from the bladder to the urachus. The decision was made to proceed with a robot-assisted excision of the calcified urachal cyst. ResultsIntra-operatively, there was an obvious urachal cyst identified several centimeters superior to the decompressed bladder. The cyst was excised with a circumferential margin, and the resulting bladder defect was closed in two layers using 3–0 V-lock. The bladder was filled to demonstrate there was no leak. The urachal cyst was removed without complication. ConclusionUrachal cysts are a rare anomaly with a heterogenous clinical presentation. Robot-assisted surgery provides a minimally invasive technique for excision of a urachal cyst when indicated.