One-Step Robot-Assisted Complete Urinary Tract Extirpation in Man with End-Stage Renal Disease on Dialysis: The First Case Report

SIMPLE SUMMARY: If patients with end-stage renal disease under dialysis suffered from urothelial carcinoma, extirpating the whole urothelium of urinary tracts in one-stage surgery could offer benefits of removing highly suspicious recurrent cancers in the future in advance and simplifying the bothersome monitoring strategies. Postoperative infection could be lowered if dialysis was carried out via autogenous vascular fistula, rather than temporary catheters. However, it was possible that autogenous vascular fistula became dysfunctional and required surgical revisions. For patients after extirpating the whole urinary tracts, kidney transplants with ileal conduits were feasible to re-establish the filtration system of the bodies. However, this choice was reserved for those without lymph nodes involvement or metastasis. ABSTRACT: Urothelial carcinoma (UC) could be observed in urinary bladder (UBUC) and upper urinary tracts (UTUC). In the National Comprehensive Cancer Network guidelines for bladder cancer, extirpative surgery is indicated in certain cases. However, some extreme cases might also need the extirpation of the majority of the urinary tract, which is called complete urinary tract extirpation (CUTE). We present a patient diagnosed with high-grade UBUC and UTUC. He underwent dialysis for end-stage renal disease (ESRD) at the same time. Considering his non-functional kidneys and removing his high-risk urothelium at the same time, we performed robot-assisted CUTE to extirpate both his upper urinary tracts, urinary bladder, and prostate. In our experience, the console time was not significantly elongated, and the perioperative course was uneventful. To our knowledge, this is the first case report adopting a robotic system in such an extreme case. We conclude that robot-assisted CUTE is worth further study regarding its oncological survival outcomes and perioperative safety in patients with ESRD on dialysis.