Conquering new battlegrounds: Successful management of isolated giant retrovesical hydatid cyst with robotic assistance

doi:10.1016/j.ajur.2019.12.006

Asian Journal of Urology, 2021, 8 (3): 327-331 doi: 10.1016/j.ajur.2019.12.006

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Conquering new battlegrounds: Successful management of isolated giant retrovesical hydatid cyst with robotic assistance

Santosh Kumar(

),Abhishek Chandna,Vignesh Manoharan,Kalpesh M. Parmar,Subhajit Mandal

Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

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Abstract

Hydatid disease (HD) is an accidental human parasitic infestation by cestodes and is most commonly caused by Echinococcus granulosus. Liver happens to be the most common site of involvement, although involvement of other organ symptoms is not uncommon. Involvement of the retrovesical pouch by hydatidosis is generally secondary in nature with an incidence of 0.1%-0.5% only. Primary retrovesical hydatid cyst (RVHC) is extremely rare with only few cases in existing literature. RVHC can present with a wide gamut of symptoms ranging from asymptomatic to obstructive uropathy. A 38-year-old male presented to us with complaints of lower urinary tract symptoms (LUTS) and was found to have an isolated primary retrovesical hydatid cyst on evaluation. The RVHC had compressed the right ureter leading to a grossly hydronephrotic non-functional right kidney. The patient was started on albendazole therapy and underwent robot assisted right nephroureterectomy and partial pericystectomy for the RVHC. The postoperative period was uneventful with resolution of symptoms. This report highlights the various clinical presentations of RVHC as well as the minimal invasive management of this rare entity.

Key words： Retrovesical hydatid cyst Robotic pericystectomy Hydatid disease

Received: 05 April 2019 Available online: 13 December 2019

Corresponding Authors: Santosh Kumar E-mail: santoshsp1967jaimatadi@yahoo.co.in

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Cite this article:

Santosh Kumar,Abhishek Chandna,Vignesh Manoharan, et al. Conquering new battlegrounds: Successful management of isolated giant retrovesical hydatid cyst with robotic assistance[J]. Asian Journal of Urology, 2021, 8(3): 327-331.

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http://www.ajurology.com/EN/10.1016/j.ajur.2019.12.006 OR http://www.ajurology.com/EN/Y2021/V8/I3/327

Contrast enhanced computed tomography (CECT) of the abdomen and pelvis. (A) Right kidney with gross hydroureteronephrosis and thinned out renal parenchyma; (B) Relation of the retrovesical hydatid cyst with the urinary bladder and dense adhesions between the two, displacing the bladder anteriorly; (C) Hypodense retrovesical hydatid cyst with multiple daughter cysts causing displacement of the bladder; (D) Relation of the cyst deep down in the pelvis with dense adhesions with the surrounding structures.

Operative findings. (A) Port placement—12 mm camera port in the supraumblical region around 5 cm from the umbilicus; two 8 mm ports in the mid clavicular line along the rectus sheath on both sides. Additional port was inserted between the camera port and robotic port for assistance; (B) Dense adhesions between the parietal abdominal wall, sigmoid colon and bladder; (C) Filling of the urinary bladder with saline to appropriately judge the relationship and displacement of the urinay bladder to retrovesical hydatid cyst; (D) Punction, irrigation and aspiration of the cyst after placing 10% betadine soaked gauges; (E) Creation of limited cystotomy; (F) Suctioning of cyst contents with laparoscopic suction tip; (G) Suctioning of cyst with suction tip tubing with the aid of the robotic arm, increasing maneuverability; (H) Deroofing of the superior surface of the cyst; (I) Placement of omentum and drain into the cyst cavity after inspection and betadine wash.

Resected specimens. (A) Resected nephroureterectomy specimen; (B) Cyst wall; (C) Cyst contents including multiple daughter cysts.

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