The urinary tract reconstruction in a robot-assisted surgery for rectal malignancy with combined prostate and seminal vesicle resection

Introduction

In certain cases of rectal malignancy in which invasion is confined to the prostate and/or seminal vesicles, bladder-sparing surgery may be chosen instead of total pelvic exenteration. However, even if the bladder is preserved, postoperative urinary dysfunction and vesicourethral anastomotic leakage are concern.

Materials and Surgical Technique

We employ various techniques based on robot-assisted radical prostatectomy for reconstructing the urinary tract. These techniques include advanced reconstruction of vesicourethral support, total anatomical reconstruction, and a method called anterior reconstruction. In addition, suture fixation of bladder to the anterior abdominal wall, and re-approximation of bladder by peritoneal suture were done.

Discussion

Reliable robot-assisted vesicourethral anastomosis and reinforcement of the anastomotic wall could potentially enhance the self-voiding rate and decrease the risk of anastomotic failure.