Robotic Dorsal-Onlay Urethroplasty: A Case Report

Abstract

Urethroplasty is considered the gold standard treatment for urethral stricture disease with over 90% success rate. Dorsal-onlay urethroplasty using buccal or skin grafts is a crucial technique for managing long anterior strictures. We report here the feasibility of performing robotic dorsal-onlay urethroplasty utilizing preputial graft. A 63-year-old man was referred for radical prostatectomy. Initial retrograde urethrogram showed urethral stricture within the membranous portion of the urethra extending into the bulbar urethra. Plan of conservative management of the prostate cancer, in addition to robotic urethroplasty utilizing a dorsal-onlay preputial skin graft. A preputial graft was harvested and placed dorsally into the bulbomembranous urethra using the Da Vinci Si system. Operative time was 2 hours, and postoperative course was uneventful. After 7.5-year follow-up, the patient remained asymptomatic and no evidence of stricture recurrence on cystoscopy. The patient did not require any intervention for either his stricture disease or prostate cancer, which did not progress on follow-up MR-US Fusion biopsies. Robotic dorsal-onlay urethroplasty is feasible and can be performed without prolonging the length of the surgery. Future directions should focus on performing this surgery using smaller incisions. Case Report | WVMJ OA