V08-08 ENDOSCOPIC URETHRAL STUMP CLOSURE WITH A NOVEL SUTURE DEVICE

Abstract

You have accessJournal of UrologyCME1 Apr 2023V08-08 ENDOSCOPIC URETHRAL STUMP CLOSURE WITH A NOVEL SUTURE DEVICE Bridget l. Findlay, jayson P. Kemble, Felicia L. Balzano, and Jonathan N. Warner Bridget l. FindlayBridget l. Findlay More articles by this author , jayson P. Kemblejayson P. Kemble More articles by this author , Felicia L. BalzanoFelicia L. Balzano More articles by this author , and Jonathan N. WarnerJonathan N. Warner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Symptomatic lymphoceles are a rare occurrence following pelvic lymph node dissection. Persistent lymphoceles can affect scarring and closure of the urethral stump following radical cystectomy. While this is a rare occurrence, traditional management includes endoscopic fulguration of the proximal urethral stump. Herein, we aim to describe a novel endoscopic technique for urethral stump closure in a patient with persistent urethral drainage in the setting of a recurrent pelvic lymphocele following radical cystectomy. METHODS: A 60-year-old male with history of muscle invasive small cell carcinoma of the bladder underwent robotic assisted radical cystectomy with pelvic and para-aortic lymph node dissection and Indiana pouch creation in November 2021 following neoadjuvant chemotherapy. He developed a symptomatic lymphocele in February 2022 with persistent urethral drainage. He underwent aspiration of the pelvic fluid collection and endoscopic urethral fulguration without improvement. He was then referred for second opinion, where he elected to proceed with endoscopic fulguration and closure using a laparoscopic suture device (RD-180; LSI Solutions, Rochester, NY) and novel endoscopic sheath (JNW UrtractTM; LSI Solutions, Rochester, NY). Prior to surgery, a pigtail drain was placed in the pelvic fluid collection. The proximal stump was fulgurated using the bipolar plasma band via a 27 Fr cystourethroscope (Olympus Surgical Technologies America, Westborough, MA) to facilitate scarring. The stump was closed using the RD-180 under direct visualization in a figure of eight fashion both proximally at the opening and 1cm distally. Knots were fashioned using the Ti-Knot fastener (LSI Solutions, Rochester, NY). RESULTS: Total operative time was 37 minutes and the patient discharged same day. His follow-up CT scan locally 2 months postoperatively demonstrated resolution of the pelvic fluid collection, and his drain was removed. He remains asymptomatic without recurrence of urethral drainage 4 months postoperatively. CONCLUSIONS: To our knowledge, this is the first described case of endoscopic closure of a urethral stump in the setting of persistent drainage from a pelvic lymphocele. Fulguration with endoscopic closure using a novel device is both a safe and efficacious alternative to performing urethral fulguration alone. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e751 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bridget l. Findlay More articles by this author jayson P. Kemble More articles by this author Felicia L. Balzano More articles by this author Jonathan N. Warner More articles by this author Expand All Advertisement PDF downloadLoading ...