Robotic assisted transvesical excision of recurrent bladder leiomyoma with intraoperative ultrasound guidance

Abstract

Leiomyoma of the urinary bladder is uncommon benign tumor with a wide range of clinical presentations. Surgical excision remains the definitive treatment of leiomyoma with excellent outcomes. Seldom literatures reported the use of robotic-assisted surgical techniques for its excision. A 51-year-old woman presented with frequent episodes of visible hematuria in consistence with lower urinary tract symptoms. The initial diagnosis was a urinary tract infection. However, symptoms did not resolve even with the proper antibiotics. After further investigations a soft tissue density mass measuring 20 × 23 × 20 mm within the left posterior wall of the urinary bladder extending towards the bladder neck was found. The histological finding of the transurethral resected biopsy of the mass revealed a benign submucosal leiomyoma of the bladder with no evidence of any malignancy. Using the Intuitive Da Vinci X system the tumor was excised using the ultrasound guidance to define the tumour margins, sparing the left ureteric orifice and ureter. The patient was discharged home on the day of surgery, with a urethral catheter in place. The catheter was successfully removed after 10 days, with cystogram prior confirming no leakage. The ureteric stent was removed by flexible cystoscopy two weeks later. The final histology was reported as a bladder leiomyoma with no evidence of malignant features and negative circumferential resection margins. Herein, in the current case we present a safe and effective technique for the excision of recurrent bladder leiomyoma using the robotic-assisted transvesical approach with intraoperative ultrasound guidance.