Robot-assisted transvesical partial cystectomy for leiomyoma of bladder trigone

ABSTRACT

Introduction and objective

Leiomyomas of the urinary bladder are very rare neoplasms and are the most common benign mesenchymal tumors of the bladder, accounting for 35% of these. Treatment of leiomyomas is mainly surgical and approaches range from transurethral resection to open segmental resection or laparoscopic partial cystectomy. We sought to present the surgical technique of robot-assisted transvesical partial cystectomy for bladder leiomyoma.

Materials and methods

A 25-year-old man presented to urology department with urinary frequency and urgency. Ultrasound and MRI examinations revealed a 30x20mm oval mass in the posterolateral aspect of bladder wall suggestive of bladder leiomyoma. Patient was submitted to cystoscopy with placement of a right ureteral stent and lesion demarcation, ans then a robot-assisted partial cystectomy with the following steps was performed: opening of peritoneum over bladder dome and dissection of perivesical fat, opening of bladder wall, incision of bladder mucosa, sharp and blunt dissection of lesion, closure of bladder layers with a knotless closure device.

Results

Procedure was performed in 2 hours and there were no complications. Blood loss was minimal (50ml), patient was discharged after 24 hours and bladder catheter was removed after 5 days. Histopathological evaluation revealed a bladder leiomyoma with negative surgical margins.

Conclusion

Robot-assisted partial cystectomy is a feasible modality for treatment of intravesical bladder leiomyomas, facilitating transvesical resection and reconstruction.