V07-07 WIRE-GUIDED EXTRAVESICAL ROBOT-ASSISTED BLADDER DIVERTICULECTOMY AND Y-V PLASTY FOR RECURRENT BLADDER NECK STRICTURE

Abstract

You have accessJournal of UrologyCME1 Apr 2023V07-07 WIRE-GUIDED EXTRAVESICAL ROBOT-ASSISTED BLADDER DIVERTICULECTOMY AND Y-V PLASTY FOR RECURRENT BLADDER NECK STRICTURE Francesco Ditonno, Alessandro Veccia, Giovanni Novella, Lorenzo De Bon, Paola Irene Ornaghi, and Alessandro Antonelli Francesco DitonnoFrancesco Ditonno More articles by this author , Alessandro VecciaAlessandro Veccia More articles by this author , Giovanni NovellaGiovanni Novella More articles by this author , Lorenzo De BonLorenzo De Bon More articles by this author , Paola Irene OrnaghiPaola Irene Ornaghi More articles by this author , and Alessandro AntonelliAlessandro Antonelli More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To present the surgical technique for robot-assisted wire-guided extravesical bladder diverticulectomy and simultaneous Y-V plasty for recurrent bladder neck stricture. METHODS: A 58-year-old man referred to our center for recurrent LUTS after TURP. Thereafter, the patient underwent TUIP and 2 endoscopic bladder neck incisions, unsuccesfully. A CT scan showed two bladder diverticula of 4 and 8 cm located on the right and left postero-lateral wall, respectively. The patient was scheduled for robot-assisted bladder diverticulectomy and Y-V plasty for recurrent bladder neck stricture. As first step, a double J stent was placed bilaterally and a guidewire was inserted in the lumen of each diverticulum to facilitate their identification and handling. The robotic stage was performed with Da Vinci Xi platform, with the patient in supine position, with a 25 degrees Trendelemburg. Six ports were placed across the lower abdomen, transperitoneally: four 8 mm robotic trocars and 2 assistant trocars (12 and 5 mm). The peritoneum was incised to expose posterolateral bladder wall. Perivesical fat was dissected and protruding mucosa of the diverticula isolated. A blunt dissection was mostly used, detaching the mucosa from the bladder wall. Once completely isolated, bladder mucosa was entirely excised and the neck of the diverticulum closed with a triple-layer continuous 3-0 monofilament absorbable suture. Retzius space was then opened and prostatic defatting was performed. The bladder neck was incised obtaining a Y-shaped flap. Two stay 3-0 monofilament sutures were placed at the end of the two branches of the Y. The flap was advanced and the margins closed with a double-layer emicontinuous 3-0 barbed absorbable suture. RESULTS: Operative time was 318 min. Estimated blood loss was 200 mL. There were no perioperative or postoperative complications. A voiding cystourethrogram before catheter removal, after 12 days, showing almost complete resolution of diverticular protrusion. Ureteral stents were removed 30 days post-operatively. CONCLUSIONS: Robot-assisted extravesical diverticulectomy and simultaneous Y-V plasty of the bladder neck is a safe and feasible procedure. Endoscopic guide-wire insertion into the diverticulum allowed for easier traction and dissection of the tissues. Advantages of the procedure consist of avoidance of cystotomy, easy individuation and excision of diverticular mucosa and concomitant resolution of relapsing cervico-urethral obstruction. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e597 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesco Ditonno More articles by this author Alessandro Veccia More articles by this author Giovanni Novella More articles by this author Lorenzo De Bon More articles by this author Paola Irene Ornaghi More articles by this author Alessandro Antonelli More articles by this author Expand All Advertisement PDF downloadLoading ...