Purpose
Neurogenic lower urinary tract dysfunction refractory to conservative management often requires
surgical intervention to preserve renal function and improve quality of life. While radical cystectomy is
standard for malignancy, simple cystectomy with ileal conduit diversion is an effective "last resort" for
benign neurogenic conditions to avoid complications of a retained, non-functional bladder. We report the
feasibility of a sexual-sparing approach using the Hugo Ras System (Medtronic), focusing on functional
preservation through intracorporal anastomosis and diversion.

Materials and Methods
58y female known case of Multiple sclerosis had bilateral hydronephrosis small contracted high
intravesical pressure with capacity of 40ml . Patient has recurrent urinary tract infections with
monthly hospital admissions and ICU admission for urosepsis. with peri vesical abcess collection,
which wad drained . patient had bilateral nephrostomy and counselled for cystectomy and ileal
conduit.
The procedure was performed using the modular , four independent arm carts of Hugo Ras
System to provide optimal dexterity in the narrow pelvis. The sexual-sparing technique
involved meticulous dissection to preserve female genital organs.
The procedure began with pelvic adhesiolysis, followed by dissection of the paravesical spaces,
which showed alot of pus infected pockets which were removed. The ureters were identified and
isolated. The crucial sexual-sparing step involved developing the plane between the bladder and
the anterior vaginal wall, preserving the uterine vessels and utero-vaginal plexus. The urethra
was divided at the bladder neck. A 15–20 cm segment of distal ileum was isolated using a
laparoscopic stapler (controlled by the assistant). The ileal-ileal anastomosis was performed
using the Hugo™ robotic instruments. A Wallace-type ileal conduit was constructed, and ureteroenteric anastomoses were performed using 4-0 V-Loc sutures. The specimen was removed, and
the conduit was delivered through a 4 cm, stoma site

Results
The surgery was completed successfully without conversion to open surgery or major
intraoperative complications. Total operative time was 540 minutes, with minimal blood loss of
200 ml. Postoperative recovery was unremarkable, with a 10-day hospital stay. Pathology
confirmed chronic cystitis with no malignancy. At 3-month follow-up, the patient reported high
satisfaction with the cosmetic results of the stoma, improved quality of life, and preserved sexual
function.

Conclusions
Sexual-sparing simple cystectomy and total intracorporeal ileal conduit with the Hugo™ RAS
system is a safe, feasible, and effective minimally invasive approach for treating female
neurogenic bladder. The modular design of the Hugo™ system provides excellent precision,
allowing for meticulous nerve-sparing and complex intracorporeal reconstruction

Makedon AM, Sadowsky A, Johnson BA, Walker DT, Lloyd GL. A Novel Technique of Robotic-Assisted Simple Cystectomy During Urinary Diversion for Benign Indications. Urology. 2023 Feb;172:234. doi: 10.1016/j.urology.2022.11.013. Epub 2022 Dec 1. PMID: 36462582.
Menon M, Hemal AK, Tewari A, Shrivastava A, Shoma AM, Abol-Ein H, Ghoneim MA. Robot-assisted radical cystectomy and urinary diversion in female patients: technique with preservation of the uterus and vagina. J Am Coll Surg. 2004 Mar;198(3):386-93. doi: 10.1016/j.jamcollsurg.2003.11.010. PMID: 14992741.