Technique for ureteral stent placement during robot-assisted radical prostatectomy: safety measure during vesicourethral anastomosis when ureteral orifices are too close for comfort.

摘要

DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY (RARP), bladder neck transection is one of the more challenging portions of the procedure. Experienced robotic surgeons have developed several techniques to precisely identify the junction of the prostate and the bladder to help avoid entering the prostate or making the cystotomy too large. This can be especially difficult in the early experience of novice robotic surgeons and for patients with distorted anatomy caused by a median lobe or asymmetric lateral lobe hypertrophy. Men who have previously undergone transurethral procedures for an enlarged prostate may also have complex bladder neck anatomy. One of the possible complications of dividing the posterior bladder neck is injury to the ureteral orifices (UO). Even when the UOs are intact, they may be very close to the edge of the cystotomy. In this situation, there is potential for injury to the UOs and distal ureter during the vesicourethral anastomosis (VUA), leading to urinary obstruction, leakage with urinoma or fistula formation, or stricture.