Ureteric duplication is not a contraindication for robot-assisted laparoscopic radical cystoprostatectomy and intracorporeal Studer pouch formation.
OBJECTIVE
Ureteric duplication is a rarely seen malformation of the urinary tract more commonly seen in females.


METHODS
We report 2 cases of robot-assisted laparoscopic radical cystoprostatectomy (RALRCP) with bilateral extended pelvic lymph node dissection and intracorporeal Studer pouch formation in patients with duplicated right ureters.


RESULTS
Two male patients (53 and 68 years old) underwent transurethral resection of a bladder tumor that revealed high-grade muscle invasive transitional cell carcinoma, with no metastases. We performed RALRCP and intracorporeal Studer pouch formation. A duplicated right ureter was observed during the procedures in both patients. Left ureter distal segment was spatulated 2cm long and anastomosed using running 4/0 Vicryl to the right ureter at its bifurcation where it forms a single lumen without spatulation. All 3 ureters were catheterized individually. A Wallace type uretero-ileal anastomosis was performed between the ureters and the proximal part of the Studer pouch chimney. Although ureteric frozen section analysis suggested ureteric carcinoma in situ in patient 1, postoperative pathologic evaluation was normal. Frozen section and final postoperative pathologic evaluations were normal in patient 2.


CONCLUSIONS
Duplicated ureters might be underdiagnosed on CT. The presence of a duplicated ureter is not a contraindication to RALRCP and intracorporeal Studer pouch formation. The da Vinci-S surgical robot is very safe for performing this complicated procedure. Frozen section analysis of ureters during radical cystectomy for bladder cancer might not reliably diagnose the pathologic condition and might overestimate the disease in the ureters.
Ankara Ataturk Training and Research Hospital, Ankara, Turkey. erdemcanda@yahoo.com
Abdullah Erdem
AE
Canda
Bayram
B
Dogan
Ali Fuat
AF
Atmaca
Ziya
Z
Akbulut
Mevlana Derya
MD
Balbay
D000368:Aged; D001706:Biopsy; D039021:Colonic Pouches; D015653:Cystectomy / Q000379:methods*; D006801:Humans; D007049:Iatrogenic Disease; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011468:Prostatectomy / Q000379:methods*; D012371:Robotics / Q000379:methods*; D014513:Ureter / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014684:Venae Cavae / Q000293:injuries