Robotically assisted radical laparoscopic prostatectomy in a patient with ectopic ureteral insertion into the prostate

Robotically assisted laparoscopic radical prostatectomy (RaLRP) has become an alternative surgical treatment option for patients with localized prostate cancer. Rare anatomic variations result in modification of established techniques. We describe the first successful completion of RaLRP for localized prostate cancer in a patient with coexisting complete left ureteral duplication and ectopic insertion of the upper pole moiety ureter into the prostatic urethra. After standard radical prostate excision and vesicourethral anastomosis, the unique anatomy in this case required additional reconstructive maneuvers including construction of a Y-type conjoined ureteral anastomosis and ureteroneocystotomy. The procedure was safely completed without open conversion. Operative time was 420 min and EBL was 200 mL. Ureteral stents were removed in six weeks and IVP showed no evidence of obstruction. When faced with a ureteral anomaly, RaLRP can be safely completed. Robotic technology is helpful in performing additional delicate reconstructive maneuvers.