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Wolffi an duct derivative anomalies: technical considerations when encountered during robot-assisted radical prostatectomy

Sujeet S. Acharya, Mohan S. Gundeti, Gregory P. Zagaja, Arieh L. Shalhav, Kevin C. Zorn

Department of Surgery, Section of Urology, The University of Chicago Medical Center, Chicago, Illinois, USA
Address correspondence to Dr. Sujeet S. Acharya, Department of Surgery – Section of Urology, The University of Chicago Medical Center, 5841 South Maryland Avenue – MC6038, Chicago, IL, 60637 USA

Canadian Journal of Urology 2009, 16(2), 4601-4606.

Abstract

Background: Although malformations of the genitourinary tract are typically identified during childhood, they can remain silent until incidental detection in evaluation and treatment of other pathologies during adulthood. The advent of the minimally invasive era in urologic surgery has given rise to unique challenges in the surgical management of anomalies of the genitourinary tract.
Objective: This article reviews the embryology of anomalies of Wolffian duct (WD) derivatives with specific attention to the seminal vesicles, vas deferens, ureter, and kidneys. This is followed by a discussion of the history of the laparoscopic approach to WD derivative anomalies. Finally, we present two cases to describe technical considerations when managing these anomalies when encountered during robotic-assisted radical prostatectomy.
Design, setting, and participants: The University of Chicago Robotic Laparoscopic Radical Prostatectomy (RLRP) database was reviewed for cases where anomalies of WD derivatives were encountered. We describe how modifications in technique allowed for completion of the procedure without difficulty.
Measurements: None
Results and limitations: Of the 1230 RLRP procedures performed at our institution by three surgeons, only two cases (0.16%) have been noted to have a WD anomaly. These cases were able to be completed without difficulty by making simple modifications in technique.
Conclusions: Although uncommon, it is important for the urologist to be familiar with the origin and surgical management of WD anomalies, particularly when detected incidentally during surgery. Simple modifications in technique allow for completion of RLRP without difficulty.

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