Endoscopic Urethral Stump Closure with a Novel Suture Device

Clinical History:

A 60-year-old man with a history of muscle invasive small cell carcinoma of the bladder underwent robot-assisted radical cystectomy with pelvic lymph node dissection and Indiana pouch creation. He underwent aspiration and endoscopic urethral fulguration for a symptomatic lymphocele without improvement.

Physical Examination:

Clear fluid draining per urethra. CT of abdomen/pelvis showed unchanged loculated fluid collections within the dependent pelvis 2 months after aspiration and urethral fulguration.

Diagnosis:

Pelvic lymphocele with drainage per urethra.

Intervention:

Fulguration and closure of the urethral stump using a laparoscopic suture device (RD-180; LSI Solutions, Rochester, NY) and novel endoscopic sheath (JNW Urtract^TM; LSI Solutions). Before surgery, a pigtail drain was placed in the pelvic fluid collection. The proximal stump was fulgurated using the bipolar plasma band through a 27F cystourethroscope (Olympus Surgical Technologies America, Westborough, MA) to facilitate scarring. The stump was closed using the RD-180 under direct observation in a figure of eight manner both proximally at the opening and 1 cm distally. Knots were fashioned using the Ti-Knot fastener (LSI Solutions). Total operative time 37 minutes.

Follow-Up/Outcomes:

Patient was dismissed same-day following surgery. CT scan 2 months postoperatively demonstrated resolution of pelvic fluid collection, and his drain was removed. He remains asymptomatic without recurrence or urethral drainage 4 months postoperatively. To our knowledge, this is the first described case of endoscopic closure of a urethral stump in the setting of persistent drainage from a pelvic lymphocele. Fulguration with endoscopic closure using a novel device is both a safe and efficacious alternative to performing urethral fulguration alone.

No competing financial interests exist.

No funding was received for this article.

Patient consent statement:

Patient consented to the use of nonidentifiable intraoperative photography and video recording for the purpose of medical education and publication in professional journals.

Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

Music:

All music was from Pixabay.com, royalty free.

Runtime of video: 4 mins 4 secs