Robotic treatment of a rare paramedian cystic lesion of the lower male urogenital tract

Abstract

Objectives: To report the diagnosis and the mini-invasive treatment of a rare paramedian cystic lesion of the lower male urogenital tract (CLMGU). Material and methods: This is a case of a 46 old male with low urinary tract symptoms, azoospermia and mild erectile dysfunction. MRI Imaging showed a midline high signal intensity cystic lesion of a tear drop shape, extending above the base of the prostate to the level of the seminal vesicles. The lesion was located between the seminal vesicles and the urinary bladder. A direct communication of the intra-abdominal portion of both vas deferens with the cyst was found. MRI also showed small solid nodule within the upper portion of the cyst. The patient underwent a robotic surgery of the CLMGU. A Retzius-sparing approach was used to gain access to the seminal vesicles in order to carefully dissect and excise the lesion without any dissection of the anterior compartment. The CLMGU was excised with a nerve sparing technique. Results: Operative time was 115 min. Blood loss was minimal. Length of stay was three days. No post-operative complications occurred. One month after surgery patient's IPSS improved considerably. Final pathology showed a cystic lesion containing papillary projections with squamous metaplasia. At 2 months follow up, urinary symptoms improved with no postoperative complications. Conclusion: Robotic surgery allows a direct access to the Douglas space with an easy removal of the neoplasia. Our video represents a case of possible application of robotic surgery to improve dissection, overall surgical precision and functional outcomes.

Keywords

• Paramedian cystic lesion
• Robotic surgery
• Nerve sparing
• Cysts/complications/diagnostic imaging