Translational andrology and urology · 2026
Successful treatment by gasless single-port robot-assisted perineal secondary urethrectomy combined with adjuvant therapy for urethral recurrence after radical cystectomy: a case report of an elderly male patient with 16-month follow-up.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Zhang Xin-Le, Zhang Xiang, Zhou Xue-Jian, Shao Yuan, Pan Jun-Wei
Аннотация
BACKGROUND: Secondary urethrectomy is recommended for managing the recurrence of invasive tumor after radical cystectomy. The anatomical changes (such as adhesions around the urethral stump, the direct contact between urethral stump and intestine, etc.) influence the procedure, which is more complex in males than in females. There are several methods available for performing secondary urethrectomy. In this report, we present a case in which a gasless single-port (SP) robotic perineal approach was used to resect the proximal portion of the urethra for an elderly male.
CASE DESCRIPTION: The case involved a male patient who had undergone transurethral resection of bladder tumor followed by laparoscopic radical cystectomy with Bricker intracorporeal ileal conduit urinary diversion in 2018, with six cycles of an adjuvant gemcitabine-cisplatin (GC) regimen being administered. The patient experienced urethral bleeding in January 2025, which was diagnosed by urethroscopy and imaging as tumor recurrence in the anterior urethra. On February 18, 2025, a secondary urethrectomy of the proximal urethra was conducted through the use of a SP robotic system via a gasless perineal approach. The operation was completed successfully, and the patient was discharged 5 days after the surgery, with no severe complications, except a dull pain in the perineum. Pathological test results indicated muscle-invasive high-grade urothelial carcinoma (pT2), with a positive proximal margin, negative distal margin, and intravascular tumoral thrombus. After one cycle of adjuvant GC therapy, the patient was switched to immunotherapy (toripalimab), and no recurrence was found on imaging after a follow-up of 16 months.
CONCLUSIONS: The gasless SP robot-assisted perineal approach may be a technically feasible option for secondary urethrectomy in selected patients. However, further study is needed to confirm its advantages and disadvantages.
CASE DESCRIPTION: The case involved a male patient who had undergone transurethral resection of bladder tumor followed by laparoscopic radical cystectomy with Bricker intracorporeal ileal conduit urinary diversion in 2018, with six cycles of an adjuvant gemcitabine-cisplatin (GC) regimen being administered. The patient experienced urethral bleeding in January 2025, which was diagnosed by urethroscopy and imaging as tumor recurrence in the anterior urethra. On February 18, 2025, a secondary urethrectomy of the proximal urethra was conducted through the use of a SP robotic system via a gasless perineal approach. The operation was completed successfully, and the patient was discharged 5 days after the surgery, with no severe complications, except a dull pain in the perineum. Pathological test results indicated muscle-invasive high-grade urothelial carcinoma (pT2), with a positive proximal margin, negative distal margin, and intravascular tumoral thrombus. After one cycle of adjuvant GC therapy, the patient was switched to immunotherapy (toripalimab), and no recurrence was found on imaging after a follow-up of 16 months.
CONCLUSIONS: The gasless SP robot-assisted perineal approach may be a technically feasible option for secondary urethrectomy in selected patients. However, further study is needed to confirm its advantages and disadvantages.