Cystoscopic and robotic-assisted laparoscopic excision of a rare urachus neoplasm by partial cystectomy

Abstract

The urachus is a remnant of the embryological allantois and usually regresses before birth. Persisting urachal abnormalities can lead to infection or even malignancy. Because malignant deterioration becomes more likely with age, resection is advised in adults. The spectrum of urachus neoplasms consists of benign to borderline benign mucinous cystic tumors, to low-grade malignant or malignant mucinous cystadenocarcinomata. There are several surgical procedures for dissection an urachus remnant. We performed a robot-assisted laparoscopic partial cystectomy with simultaneous cystoscopy for a lesion at the dome of the urinary bladder. We present a case of a 59-year-old woman who was diagnosed with recurrent breast carcinoma. A staging PET-CT revealed a mass at the dome of the urinary bladder. We performed a robot-assisted laparoscopic partial cystectomy with cystoscopic guidance. The lesion was excised en-bloc with the median umbilical ligament. The patient was discharged one day after surgery, there were no complications. The Foley bladder catheter was removed five days postoperatively, after cystography showed no extravasation. Histopathological diagnosis reported a rare mucinous cystic tumor of low malignant potential. The patient experienced no change in micturition six weeks after surgery. A robot-assisted laparoscopy with cystoscopic assistance is a safe and feasible technique for a maximal bladder-sparing partial cystectomy.