Abstract
Clinical History:
A 44-year-old gentleman presented with a 4 year history of voiding and storage lower urinary tract symptoms in the setting of multiple interventions (transrectal and open).
Physical Examination:
A well-healed suprapubic catheter site was noted on the lower abdomen. External genitalia were normal. Rectal examination revealed a boggy smooth swelling anterior to the rectum.
Diagnosis:
MRI pelvis revealed a multiloculated cystic lesion without solid elements occupying the pelvis. On voiding cystourethrogram, the alignment of the posterior urethra was displaced to the right.
Intervention:
Cystoscopy revealed obliteration of the urethral lumen caused by extrinsic compression beyond the bulbar urethra. On laparoscopy the peritoneal fold overlying the cyst was incised and vas cleared to reveal the cyst wall that was incised, producing clear fluid for aspiration. The cyst was circumferentially mobilized amidst dense adhesions using sharp and blunt dissection. During mobilization of the cyst wall off of the posterior urethra, an iatrogenic urethral injury was noted and repaired over a 16F Foley catheter. Total operative time was 5 hours with blood loss of 500 mL.
Follow-Up/Outcomes:
Micturating cystourethrogram/retrograde urethrogram performed at 4 weeks revealed no extravasation. The histopathology report suggested benign characteristics. Three-month follow-up revealed no recurrent LUTS. Treatment refractory seminal vesicle cysts are challenging because of their rarity and distortion of anatomy caused by multiple interventions. Patients may be at high risk for iatrogenic injuries caused by desmoplasia from prior treatment; however, with meticulous dissection complete laparoscopic excision can result in durable outcomes even in treatment refractory cases.
No competing financial interests exist.
Written informed consent was taken from the patient explaining the risks of the procedure and explicitly stating that the findings from his case may be used for academic purposes anonymously.Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. No commercial associations to disclose.
Runtime of video: 4 mins 55 secs
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