Robotic Assisted Paraurethral Fibroid Excisions via Retropubic Space Dissection.

Abstract

Objective: To demonstrate surgical treatment of a paraurethral fibroid utilizing robotic dissection of the retropubic space and to highlight key anatomical structures associated with this space.

Setting: This is a video demonstration and description of a surgical procedure to treat paraurethral fibroids which took place at a tertiary academic center. Paraurethral fibroids are rare with a reported incidence of 5% of urethral masses. They are often asymptomatic, but may present with urinary retention, vaginal bulge and dyspareunia. The recommended treatment is surgical excision, which may be performed with a vaginal or abdominal approach. We utilize robotically assisted retropubic space dissection and highlight important structures within this region.

Participants: In this video we describe a case of a 47 yo with symptomatic proximal paraurethral fibroid.

Interventions: Robotic assisted retropubic space dissection was utilized for paraurethral fibroid excision. We highlight techniques for entering the retropubic space and safely identifying all borders and vasculature. The borders of the retropubic space are highlighted, including the pubic symphysis ventrally, the bladder dorsally, the urethra and pubocervical fascia caudally and the arcus tendinous fascia laterally. Knowledge of these structures is important when working within this space to avoid important vasculature, such as the dorsal vein of the clitoris, internal obturator vessels, and the paravaginal venous plexus known as the veins of Santorini. We identify the fibroid mass and review surgical technique for safe excision.

Conclusion: Surgical excision is the recommended treatment of paraurethral urethral fibroids. In this video we demonstrate a safe and successful approach utilizing robotic assisted retropubic space dissection.