A novel combined laparoscopic and transurethral resection technique for urachal adenocarcinoma: technique description and literature review

Abstract

Urachal adenocarcinoma is a rare malignancy representing a small percentage of all bladder adenocarcinomas. While open surgery with partial cystectomy and en bloc resection of the umbilicus remains the gold standard, minimally invasive approaches are gaining traction. This report presents a novel combined laparoscopic and transurethral resection technique for urachal carcinoma, detailing its feasibility, minimal morbidity, and long-term outcomes. We describe the case of a 60-year-old male who presented with frank hematuria and was found to have a 1.5 cm domal bladder mass, later confirmed as urachal adenocarcinoma. The patient underwent a combined laparoscopic and transurethral resection, wherein the tumor was first resected transurethrally with laparoscopic monitoring, followed by laparoscopic dissection along the urachal tract. The bladder was then repaired laparoscopically. This approach allowed for complete tumor resection with clear surgical margins and minimal blood loss. The patient experienced no postoperative complications and demonstrated no evidence of recurrence after 12 years of follow-up. A review of the existing literature highlights the diverse clinical presentations of urachal adenocarcinoma, the lack of a standardized staging system, and the evolving role of minimally invasive surgery. While open surgery remains the preferred approach in many cases, our experience, along with other emerging evidence, suggests that a combined laparoscopic and transurethral resection can be a safe and effective alternative for selected patients. This technique warrants further investigation in larger studies to confirm its long-term oncological efficacy.
Keywords: Uracus carcinoma, laparoscopic resection, transurethral