Robotic retropubic erythrolysis and labial fat pad into position for a current urinary retention following a BIRCWH procedure. A six-year-old woman presents to our center with incomplete emptying in January of 2018. Patient has to squat and leans forward to void, needs to do intermittent catheterization to empty her bladder with voids less than 100 cc's and PVRs in 4 to 600 cc range. Of note, in 2008, she underwent a BIRCWH procedure and a hysterectomy for fibroids. Immediately following this, she needed to do clean intermittent catheterization to empty her bladder. Prior to this surgery, she had no voiding issues whatsoever. In 2010, she then underwent a transvaginal erythrolysis, but continued to do CIC following this. In 2012, she had a cystocereal repair, but continued to do CIC following this. In 2013, she underwent a retropubic erythrolysis at an outside center and she had improvement in her symptoms and stopped catheterizing. Unfortunately, within six months, she had incomplete emptying recurred and she started to do CIC again. Upon examination, her pelvic exam demonstrated no prolapse, but the urethra was non-mobile. Cystoscopy was performed and demonstrated that the bladder neck was hypersuspended. Urodynamics demonstrated an obstructive pattern with the intrusive pressure maxed via 65 centimeters of water with a flow of 3 mils per second. The patient desires intervention so she can stop catheterizing. She undergoes pelvic floor physical therapy without success. She is consented for a combined transvaginal, transabdominal erythrolysis and a labial fat pad interposition. The SI robot is docked. In arm three, a fenestrated grasper is placed. In arm two, a PK is placed. In arm one, a scissors is placed. Prior to this, a transvaginal erythrolysis has been performed and we've come the whole way around the urethra and a Penrose drain has been placed between the urethra and the pubic bone. Also, a labial fat pad has been harvested. The retropubic space is then entered. We come down and develop a plane to Cooper's ligament on the left side where we identify two green sutures that are marked with arrows that were not removed from the last urethrolysis that had been performed. The retropubic space is opened. You can see the bladder inferiorly and the pubic bone is directly ahead. Upon dissection of the bladder on the right side, we then come down upon another green suture which was left in place from the previous urethrolysis. The arrows show where these two sutures are. A finger is placed into the retropubic space transvaginally, but the fascia is not disrupted at this stage, but you can see the finger moving behind. The fascia is then opened and you can see a finger coming through from the transvaginal area. The sutures on the left and right are removed and the fascia is taken down. The fascia is then detached and you can see the finger in the vagina. A penrose drain has been placed and it is between the pubic bone and the anterior aspect of the urethra. The fascia is taken down both on the left and right side and the sutures are removed. The fascia is then detached and the fascia is taken down both on the left and right side and the sutures are removed. We now can see the penrose drain around the urethra. A labial fat pad is then brought up and it is sutured in place between the urethra and the pubic bone. The labial fat pad was placed since the patient had a prior urethrolysis and developed recurrent urinary retention. The labial fat pad was placed since the patient had a prior urethrolysis and developed recurrent urinary retention. The labial fat pad was placed since the patient had a prior urethrolysis and developed recurrent urinary retention. The labial fat pad was placed since the patient had a prior urethrolysis and developed recurrent urinary retention. The peritoneum is closed with a 2-0 V-lock suture. One year following the procedure, the patient is confident of urine, has a post-void residual of 50 cc and voids well and is no longer requiring intermittent catheterization. Robotic retropubic urethrolysis with labial fat pad interposition is a feasible treatment option for recurrent urinary retention following a BIRCWH procedure.

urinary retention

BIRCWH procedure

hysterectomy

cystocerebral repair

intermittent catheterization