Department of Urology, Jan Biziel Medical University Hospital, Bydgoszcz, Poland (Drs Jarzemski P, Listopadzki, and Jarzemski M).

Department of Urology, Medical University of Gdańsk, Gdańsk, Poland (Drs Markuszewski and Roslan).

ABSTRACT

Background and Objectives: Minimally invasive techniques have been introduced to decrease the morbidity related to standard laparoscopic procedures. One such approach is transvesical laparoendoscopic single-site surgery (T-LESS). We describe our clinical experience of using this technique for vesicorectal fistula (VRF) repair.

Description: In October 2013, we performed the T-LESS repair of a vesicorectal fistula of 5 mm diameter in a 72-year-old man, in whom conservative treatment with temporary colostomy and Foley catheter placement had failed. The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device via a 15 mm incision made 20 mm above the pubic symphysis. Standard 10 mm optic and straight laparoscopic instruments were used. The fistulous tract was dissected and closed in two layers with a running, absorbable, barbed suture. A cystostomy tube was left in place for 22 days, and a Foley catheter for 1 week.

Results: The operation lasted 155 min. Blood loss was minimal. No complications were observed. The postoperative period was uneventful. During a 5-week follow-up, the patient reported no involuntary discharge of urine into the rectum. A voiding cystourethrogram revealed no presence of VRF, and laboratory examination results were all within the normal range. The colostomy was closed after 4 months, and a 12-month follow-up confirmed the integrity of both the urinary and digestive tracts.

Conclusion: Although substantial development of the instruments and skills is needed, the T-LESS VRF repair appears to be feasible and safe. Nevertheless, further experience and observations are necessary.

Key Words: Laparoscopic surgery, Prostate cancer, Vesicorectal fistula.

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Department of Urology, Memorial Sisli Hospital, Okmeydanı, Sis¸li-; Istanbul, Turkey (Drs. Alkan, Balbay). Department of Anesthesiology, Memorial Sisli Hospital, Okmeydanı, Sisli-; Istanbul, Turkey (Dr. Ozkanli).

ABSTRACT

Introduction: We present the feasibility of flexible ureteroscopic lithotripsy concomitant with robot-assisted radical prostatectomy and bilaterally extended pelvic lymphadenectomy.

Methods: Two patients underwent flexible ureteroscopic lithotripsy, robot-assisted radical prostatectomy, and pelvic lymphadenectomy at one anesthesia session. Flexible ureteroscopic lithotripsy was performed first. Later, robotic prostatectomy and lymphadenectomy were performed with the patient in the exaggerated 30° Trendelenburg position. All relevant preoperative clinical details, intraoperative details, problems encountered, complications, hospital stay, postoperative recovery, pathologic findings, and clinical follow-up were assessed.

Results: Both patients were discharged uneventfully from the hospital on the third postoperative day. In the postoperative first month, the double-J stents were removed. Both patients were prescribed hormonal treatment and were also referred for radiotherapy due to final pathology and postoperative prostate-specific antigen levels.

Conclusion: Combining robot-assisted radical prostatectomy and flexible ureteroscopy is feasible in patients with urinary stone disease and prostate cancer concomitantly.

Key Words: Flexible ureterorenoscopy, Urolithiasis, Robotic surgery, Prostate cancer, One anesthesia session.

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