Applicability and feasibility of robot-assisted cystectomy and intracorporeal urinary diversion in a patient with right renal pelvic ectopia

ABSTRACT

Background:

The ectopic pelvic kidney, a common renal anomaly, is often smaller and malformed, with a shorter and sometimes tortuous ureter (¹). Muscle-invasive bladder cancer (MIBC), constituting 15-25% of bladder cancer cases (²), mandates radical cystectomy with a 50% 5-year survival rate (²). Despite the growing use of robot-assisted radical cystectomy (RARC) (³, ⁴), there is limited data on its application in ectopic kidneys. Only one RARC case has been reported (⁵), in contrast to numerous open radical cystectomies (¹, ⁶) involving an ectopic kidney.

Patient and methods:

After being diagnosed with T2 high-grade urothelial carcinoma, the 66-year-old patient, previously treated with multiple transurethral resections and adjuvant BCG therapy, received neoadjuvant chemotherapy. Preoperative staging CT revealed a 2.6 x 2.2 cm bladder neoformation and an ectopic right pelvic kidney.

Results:

Using the da Vinci Surgical System, radical cystectomy with ileal conduit (sec Wallace II) and lymphadenectomy were performed. During the demolition phase, the shorter right ureter was dissected with care to avoid damage to the renal pedicle. The reconstructive phase included intracorporeal urinary diversion (ICUD) and uretero-ileal anastomosis, facilitated by the favorable position of the kidney. The 8-hour console surgery resulted in minimal blood loss. Discharged on day 16 due to COVID-19, the patient exhibited positive outcomes. A 2-month CT follow-up revealed no cancer recurrence, metastasis, hydronephrosis, and complete regression of the lymphocele. Imaging follow-up continues without postoperative adjuvant chemotherapy.

Conclusion:

Robotic surgery with intracorporeal urinary diversion holds potential for right-sided pelvic kidney cases, but additional studies are necessary for validation.

Available at: http://www.intbrazjurol.com.br/video-section/20230608_Puliatti_et_al

Int Braz J Urol. 2024; 50 (Video #3): 227-8

ACKNOWLEDGEMENTS

Stefano Puliatti, Stefania Ferretti contributed similarly as first author

REFERENCES

• ¹
  Quek ML, Basrawala Z, McClung C, Flanigan RC. Radical cystectomy with extended lymphadenectomy in the presence of a pelvic kidney. Urology. 2006;68:672.e21-2.
• ²
  Compérat E, Larré S, Roupret M, Neuzillet Y, Pignot G, Quintens H, et al. Clinicopathological characteristics of urothelial bladder cancer in patients less than 40 years old. Virchows Arch. 2015;466:589-94.
• ³
  Gaya JM, Uleri A, Sanz I, Basile G, Verri P, Hernandez P, et al. Robot-assisted radical cystectomy and ileal conduit with HugoTM RAS system: feasibility, setting and perioperative outcomes. Int Braz J Urol. 2023;49:787-8.
• ⁴
  Rocco B, Assumma S, Calcagnile T, Sangalli M, Turri F, Micali S, et al. Reproducibility of a modified posterior reconstruction during robotic intracorporeal neobladder reconfiguration. Int Braz J Urol. 2022;49:136-42.
• ⁵
  Edamura K, Sadahira T, Hara J, Iwata T, Ando W, Horii S, et al. Feasibility of robot-assisted radical cystectomy in a patient with an ectopic kidney: A case report. Med Int (Lond). 2022;3:1.
• ⁶
  Adamakis I, Pournaras C, Katafigiotis I, Kousournas G, Fragkiadis E, Leotsakos I, et al. Radical cystectomy and lymphadenectomy to two patients with pelvic kidney: surgical pitfalls and considerations. Case Rep Med. 2013;2013:841806.

Publication Dates

• Publication in this collection
  05 Apr 2024
• Date of issue
  Mar-Apr 2024

History

• Received
  13 Dec 2023
• Accepted
  02 Jan 2024
• Published
  31 Jan 2024