Augmentation Enterocystoplasty is considered a final-stage surgical intervention for refractory neurogenic detrusor overactivity. We report a case of a fully intracorporeal, robot-assisted supratrigonal cystectomy and augmentation ileocystoplasty, combined with an autologous fascial sling for the management of concomitant stress urinary incontinence.

A 30-year-old female presented with neurogenic lower urinary tract dysfunction secondary to a perimedullary hematoma following pediatric scoliosis surgery. She was under intermittent self-catheterisatoin and her urge symptoms were refractory to maximal dose of intradetrusor botox injections. She also complained of bothersome stress urinary incontinence. Following a multidisciplinary team meeting, she was decided for a supratrigonal cystectomy, augmentation ileocystoplasty, and an autologous sling.

The procedure was performed with a multiport Da Vinci Xi using a 4 arm configuration. 
First, a 10 by 1cm autologous aponeurotic fascial sling from the rectus abdominis muscle was harvested through a midline incision. Then, the fascia and the subcutaneous tissue and skin were closed and the patient was placed in into 23 degrees Trendelenburg position. 
After trocart insertion, vesico vaginal dissection undertaken down to the bladder neck. Vesico-vaginal fascia is bilaterally opened to allow for the sling to pass behind the bladder neck. 
The autologous sling is fixed bilaterally to the pectineal (Cooper’s) ligaments using non-absorbable sutures. 
The bladder was opened longitudinally. After identification of ureteral orifices, they were catheterized with JJ stents. A supra-trigonal cystectomy was performed. 
For the reservoir, 30-cm of ileum were selected, 15cm away from the ileo-cecal valve.
This segment was detubularized and reconfigured using the Hautmann W-shaped technique to ensure a low-pressure high volume reservoir. The reservoir was then anastomosed to the trigonal remnant using continuous V-Loc barbed sutures. 
After insertion of a 22Fr catheter, a watertight test was performed to check for the integrity of the neobladder, not showing any leak. The reservoir was then extraperitonealized and a Blake drain was positioned in the pre-vesical space. 
The total operative time was 320 minutes with a total estimated blood loss of less than 200 mL, and the surgery proceeded without any peroperative complications. Postoperatively, The enterocystoplasty catheter was left in place for two weeks, after which the patient resumed self-catheterization every two hours for one month.

This case illustrates the feasibility of an intracorporeal robotic approach for enterocystoplasty with an autologous sling. Robotic assistance, in expert hands, offers particularly beneficial advantages for neuro-urological patients, whose recovery is often slower.