V02-09 ROBOTIC EXTRAVESICAL MULLERIAN DUCT REMNANT EXCISION

Abstract

You have accessJournal of UrologyMisc. Benign Disease & Transplant & Renovascular (V02)1 Sep 2021V02-09 ROBOTIC EXTRAVESICAL MULLERIAN DUCT REMNANT EXCISION Laura Kidd, Chinonyerem Okoro, and Daniel Eun Laura KiddLaura Kidd More articles by this author , Chinonyerem OkoroChinonyerem Okoro More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001979.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We present a 13-year-old male with history of mixed gonadal dysgenesis who presented with abdominal pain and urinary frequency. He was admitted for work-up, which revealed a negative urine culture but a 13.9 cm Mullerian duct remnant (MDR). The patient underwent cystoscopic drainage, which provided temporary relief, but seven months later his pain recurred and he developed gross hematuria. Repeat imaging showed the same MDR, now 10 cm in size. He was referred for robotic surgical repair. METHODS: Cystourethroscopy showed a mound of heaped of tissue at 6 o’clock in the prostatic urethra, corresponding to the opening of the remnant. This was not cannulated, to avoid draining the remnant prior to its dissection. The patient was placed in steep Trendelenburg and a three-port configuration was used (right, camera, left), with no assistant port. The bladder was filled and the vesicouterine plane was carefully developed, taking care to control any encountered vessels feeding the MDR. The remnant was dissected down to its neck. Near infrared fluoroscopy (NIF) and white light from the cystoscope in the urethra was used to confirm the exact insertion point. This was also visualized by the bedside assistant in the cystoscopic view, with gentle prodding from the robotic instrument. The MDR was then amputated at the insertion point and the defect was closed in a single layer. Intraoperative cystoscopy confirmed excellent closure with no luminal narrowing or back-wall suture bites. A coude catheter was placed to end the case. RESULTS: Estimated blood loss was 50cc, total operative time was 97 minutes. No complications were encountered. The patient was discharged on post-operative day 0. Pathology was consistent with Mullerian duct remnant. Catheter was removed at 2 weeks and he continues to do well at 2-month follow-up. CONCLUSIONS: Mullerian duct remnants are rare and presenting symptoms can vary. Endoscopic management can be attempted, but failure often necessitates more definitive repair. This can safely be performed robotically, and intraoperative urethroscopy can help identify the urethral insertion point if cannulation of the remnant is not, or cannot be, performed pre-operatively. In the limited literature, as well as in our experience, perioperative outcomes are favorable. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e136-e136 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Kidd More articles by this author Chinonyerem Okoro More articles by this author Daniel Eun More articles by this author Expand All Advertisement Loading ...