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.