# Robot-assisted radical nephroureterectomy for right renal pelvic tumor post sacrocolpopexy with mesh: A case report

## TL;DR

This case report describes the first robot-assisted kidney and ureter surgery performed after a prior pelvic mesh surgery, showing it is feasible despite complex adhesions.

## Contribution

The first reported case of robot-assisted radical nephroureterectomy following sacrocolpopexy with mesh.

## Key findings

- Robot-assisted nephroureterectomy was successfully performed despite dense pelvic adhesions.
- The procedure was completed without complications and the patient was discharged on day 7.
- The case suggests RANU is a viable option for patients with prior pelvic mesh surgery.

## Abstract

Robot-assisted nephroureterectomy for upper tract urothelial carcinoma has been increasingly performed as a minimally invasive procedure recently. However, there are concerns regarding its adoption in highly complex cases with dense adhesions.

An 86-year-old woman presented to our hospital with gross hematuria one year after having undergone robot-assisted sacrocolpopexy using a mesh for pelvic organ prolapse. Cystoscopy revealed hematuria from the right ureteral orifice. Computed tomography suggested right hydronephrosis; retrograde pyelography showed a defect in the right renal pelvis with class V urine cytology of the urine from the right kidney. Based on these findings, a right renal pelvic tumor was diagnosed, and robot-assisted nephroureterectomy was performed. The patient was discharged on postoperative day 7 without complications.

To the best of our knowledge, this is the first case report in which robot-assisted radical nephroureterectomy was performed after robot-assisted sacrocolpopexy with a mesh. Dense tissue adhesions are encountered not only between the bladder and the anterior vaginal wall but also around the right ureter in the pelvis. In this case, dense adhesions were confirmed around the right ureter in the pelvis.

Robot-assisted nephroureterectomy may be considered an option for minimally invasive surgery in cases with a history of pelvic organ prolapse surgery using mesh.

•This is the first case report wherein RANU was performed after RSC with a mesh.•Dense tissue adhesions can appear around the right ureter in the pelvis.•RANU may be considered for cases with a history of POP surgery using mesh.

This is the first case report wherein RANU was performed after RSC with a mesh.

Dense tissue adhesions can appear around the right ureter in the pelvis.

RANU may be considered for cases with a history of POP surgery using mesh.