Robot‑assisted laparoscopic partial cystectomy for urachal carcinoma: A case report

Abstract

Urachal carcinoma is a rare and aggressive malignancy with an unknown aetiology and poor prognosis. The present case report described a 31-year-old male patient who initially presented with a 5-day history of haematuria. FDG-PET/CT demonstrated nodules in the anterior wall of the bladder with increased glucose metabolism, which were suggestive of malignancy. A cystoscopic biopsy confirmed the diagnosis of urachal carcinoma. The patient underwent en bloc robot-assisted laparoscopic modified partial cystectomy, along the umbilicus and urachus resection, and pelvic lymph node dissection. The patient recovered within 2 weeks postoperatively, with complete tumour resection confirmed by pathological analysis, which showed negative margins and no recurrence was detected during a 5-month follow-up. The current case highlighted the potential of robot-assisted laparoscopic surgery as an effective treatment option for urachal carcinoma, offering insights for further optimization and broader clinical application, and reviewed the currently available literature.

Keywords: cystectomy; robot-assisted laparoscopic; urachal carcinoma.

Figure 1.

Preoperative ¹⁸F-FDG-PET/CT results showed a 1.9×1.8 cm hypermetabolic nodule at the bladder dome. Standardized Uptake Value maximum=20.4 on delayed imaging). No regional lymphadenopathy or distant metastases were detected.

Figure 2.

Port-site locations for robot-assisted laparoscopic surgery. The blue circle labelled 1 is the location of a 12-mm observation port placed 2 cm above the umbilicus for camera insertion. The orange circles labelled 2, 3 and 4 are locations of 8-mm robotic arm ports. The yellow circle labelled 5 is the location of an assistant suction port.

Figure 3.

Intraoperative images of robot-assisted laparoscopic partial cystectomy for urachal carcinoma. (A) Confirmation of the location of the urachal carcinoma. (B) Removal of part of the bladder 3 cm from the tumour margin.

Figure 4.

Representative images of immunohistochemistry results. (A) H&E staining (magnification, ×10; scale bar, 300 µm). (B) H&E staining (magnification, ×20; scale bar, 200 µm). (C) Positive expression of CK20 (magnification, ×20; scale bar, 200 µm). (D) Positive expression of caudal type homeobox 2 (magnification, ×20; scale bar, 200 µm). (E) Ki-67 staining demonstrates ~50% positive cells in the hot-spot area (magnification, ×20; scale bar, 200 µm). (F) Positive membrane-bound expression of β-catenin (magnification, ×20; scale bar, 200 µm). H&E, hematoxylin and eosin.