This case report deals with a 79-year-old patient with a gastrointestinal stromal tumor (GIST) of the anterior rectal wall which was unusually located between the rectum and the prostate gland. In addition, this patient suffered from subvesical obstruction accompanied by an elevated PSA level. These circumstances led to our decision to operate on the tumor via simultaneous radical retropubic prostatectomy. In our opinion this resection technique was easier and less traumatic for the patient compared to procedures performed via the abdomen and perineum. This case report demonstrates that in the case of tumors located between the rectum and the prostate gland the differential diagnosis should include not only prostate carcinoma but also rare tumor entities such as GIST.

Open reconstructive surgery of the lower ureteral segments in adults requires wide exposure as the basic prerequisite for such complex procedures. Thus, open surgical reconstruction in this area is an invasive procedure for the patient. Nevertheless, during the last few years robot-assisted laparoscopic techniques have emerged and have also already been used successfully for minimally invasive complex reconstructive procedures in urology. We present the medical histories, descriptions of the surgical procedures, and the postoperative data for adult patients undergoing robot-assisted surgery of the lower ureteral segments. Between July 2009 and July 2010, three surgeons performed nine robot-assisted reconstructive operations of the lower ureteral segments including five segmental ureteral resections combined with the psoas hitch procedures in three cases and, in addition, a Boari flap in one of them, one ureteric stricture resection with end-to-end anastomosis, one extravesical ureteral reimplantation because of vesicorenal reflux, one bilateral intravesical ureteral reimplantation because of bilateral ureteral ectopia, and one ureterolysis with omental wrap in a patient with pelvic endometriosis. We observed no intraoperative complications. Postoperative complications occurred in six patients (Clavien Grad I n = 1, II n = 4, IVa n = 1). During a median follow up of five months all affected renal units remained asymptomatic and were free from hydronephrosis. Our data illustrate that robot-assisted surgery of the lower ureter is feasible and support the growing evidence from the literature that it can be successfully used for complex ureteric reconstruction.

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