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Combined robotic and open approach to excision of accessory bladder and urethral triplication

  • Diana K. Bowen
    Affiliations
    Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, USA

    Department of Urology, Feinberg School of Medicine, Northwestern University, USA
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  • Alexander P. Glaser
    Affiliations
    Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, USA

    Department of Urology, Feinberg School of Medicine, Northwestern University, USA
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  • Jonathan W. Bush
    Affiliations
    Department of Pathology, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, USA
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  • Earl Y. Cheng
    Affiliations
    Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, USA

    Department of Urology, Feinberg School of Medicine, Northwestern University, USA
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  • Edward M. Gong
    Correspondence
    Correspondence to: E.M. Gong, 225 East Chicago Ave, Box 24, Chicago, IL, 60611, USA. Tel.: +1 312 227 6340; fax: +1 312 227 9412
    Affiliations
    Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, USA

    Department of Urology, Feinberg School of Medicine, Northwestern University, USA
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Published:February 05, 2015DOI:https://doi.org/10.1016/j.jpurol.2014.11.009

      Summary

      Background

      Management of urethral and bladder duplication anomalies centers on prevention of recurrent infections and preservation of renal function. We present a surgical approach to urethral triplication and bladder duplication utilizing a combined robotic and open approach.

      Methods

      A 17-year-old male presenting with fevers and abdominal pain was found to have two accessory urethras dorsal to a normal orthotopic ventral meatus. A large cavity anterior to the bladder was identified on a computed tomography scan and drained of purulent fluid. After improvement with antibiotics, endoscopic evaluation revealed no distinct connection between the cavities. The patient subsequently underwent open excision of the urethral triplication followed by robotic excision of the accessory bladder.

      Results

      Total console time for the robotic portion was 2 hours 18 minutes and estimated blood loss was 30 mL. The dissection was difficult due to reaction from prior infections, but the accessory bladder was able to be dissected off without opening the native bladder. The accessory bladder specimen was consistent with a urothelial lining exhibiting reactive changes.

      Conclusion

      To our knowledge, robotic excision of a urethral/bladder duplication anomaly has not yet been described in the literature. The robotic approach allowed for excellent visualization and is technically feasible.
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