Abstract
Clinical History:
We have a 70-year-old male that presented with 2 L of chronic urinary retention, lower urinary tract symptoms, prostatomegaly, and large bladder diverticulae. He initially underwent greenlight laser photovapourization of the prostate and then a second-stage robotic bladder diverticulectomy. After this second procedure, he developed perineal pain with Enterococcus faecalis demonstrated on urine culture on postoperative day 7.
Physical Exam:
On examination, the patient had tenderness in the pubic symphysis and perineum on palpation. He also had difficulty with mobilization.
Diagnosis:
A pelvis MRI confirmed a diagnosis of osteomyelitis of the pubic symphysis, with a fistula tract extending from the anterior prostate to the pubic symphysis. The patient then failed conservative urethral catheter bladder drainage and intravenous antibiotics.
Intervention:
Our video demonstrates the successful implementation of a robotic V-Y plasty fistula repair technique with a urachus interposition flap. Initially the prostate was separated from the pubic symphysis with endopelvic fascia dissection. The fistula tract was then identified, and the pubic bone was debrided. A V-Y plasty was performed, which closed over the fistula defect. The urachus was mobilized and brought down into the pelvis. This flap was sutured over the V-Y plasty reconstruction site.
Follow-up/Outcomes:
Our patient made a good postoperative recovery. He had a negative cystogram and passed a trial of void on day 14. He had a prolonged course of oral antibiotics. Follow-up CT and MRI imaging scans showed resolution of the fistula. At the 1-year follow-up, he had no further pain or lower urinary tract symptoms.
Statements and Declarations:
The authors have no disclosures, no acknowledgements, and no conflicts of interest.
The authors declare no external funding for this study.
The authors have received and archived patient consent for video/recording of surgical procedure.
Runtime of video: 4 mins 45 secs.
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