Researcher: Balbay, Mevlana Derya
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Balbay, Mevlana Derya
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Publication Metadata only Fluorescence-guided extended pelvic lymphadenectomy during robotic radical prostatectomy(Springernature) N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; Özkan, Arif; Köseoğlu, Ersin; Canda, Abdullah Erdem; Çil, Barbaros Erhan; Aykanat, İbrahim Can; Sarıkaya, Ahmet Furkan; Tarım, Kayhan; Armutlu, Ayşe; Kulaç, İbrahim; Barçın, Erinç; Falay, Fikri Okan; Kordan, Yakup; Baydar, Dilek Ertoy; Balbay, Mevlana Derya; Esen, Tarık; Doctor; Faculty Member; Faculty Member; Faculty Member; Doctor; Researcher; Researcher; Teaching Faculty; Faculty Member; Undergraduate Student; Teaching Faculty; Faculty Member; Faculty Member; Faculty Member; Faculty Member; N/A; School of Medicine; School of Medicine; School of Medicine; N/A; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; N/A; N/A; N/A; Koç University Hospital; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; 350876; 116202; 169993; N/A; 327615; 327605; 133567; 170305; N/A; 246484; 157552; 8025; 153320; 50536We evaluated and described the impact of prostatic indocyanine green (ICG) injection on extended pelvic lymph node (LN) dissection (ePLND) in robotic-assisted radical prostatectomy (RARP). Between January 2019 and December 2021, we included consecutive 50 PCa patients who underwent ePLND during RARP with (n = 25) or without (n = 25) prostatic ICG injection. ICG injection was performed during abdominal port placement and robot docking. Pelvic LNs reflecting green color were initially excised and then the template was completed. The outcomes of two groups were compared. Overall, nine (36%) and five (20%) of the patients had metastatic LN involvement in the ICG and non-ICG groups, respectively. Of the 509 dissected LNs in the ICG group, 122 (23.9%) were fluorescence active. 20 LNs (3.9%) were metastatic in this group, 9 (45%) of which were ICG+. 408 LNs were resected on the non-ICG group with 8(1.9%) being metastatic. Eight (88.9%) of nine pN+ patients were florescent positive in the ICG group. Out of six patients with pN+ disease, Ga68 PSMA-PET/CT detected positive LNs preoperatively. In addition to preoperative Ga68 PSMA-PET/CT investigation, ICG-guided ePLND might increase identification and removal of metastatic LNs duirng RARP. Improvements in staging and oncologic outcomes may also be seen in intermediate- and high-risk patients.Publication Metadata only Minimally invasive management of zinner's syndrome with same-session robot-assisted seminal vesiculectomy and ipsilateral nephroureterectomy using a single geometry of trocars(Mary Ann Liebert, Inc., 2018) Sağ, Alan Alper; Kılıç, Mert; N/A; Kiremit, Murat Can; Acar, Ömer; Köseoğlu, Ersin; Kordan, Yakup; Balbay, Mevlana Derya; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; N/A; Koç University Hospital; N/A; N/A; 222920; 237530; 350876; 350876; 153320Background: seminal vesicle cyst is an extremely rare condition, which is frequently congenital and associated with Zinner's syndrome. This syndrome represents a constellation of seminal vesicle cyst, ipsilateral or contralateral renal agenesis or renal dysplasia, ureteral ectopia, and ejaculatory duct obstruction. We report a young symptomatic patient undergoing robot-assisted laparoscopic excision of a huge seminal vesicle cyst during which an atrophic ipsilateral kidney was discovered incidentally and managed by nephroureterectomy in the same session without changing trocar positions. Case Presentation: a 23-year-old male patient presented with a 2-year history of lower urinary tract symptoms, perineal pain, and recurrent urinary tract infections. Ultrasonography revealed the absence of left kidney and a fluid-filled cystic lesion located behind the bladder on the left side, which was consistent with cystic dilatation of the left seminal vesicle. MRI confirmed the diagnosis of a huge cystic structure originating from the left seminal vesicle and identified the presence of a rudimentary left ureter without an associated renal unit. Cystoscopy revealed bulging of the bladder neck at 6 o'clock position and the ureteral orifices at normal positions and configurations. Based on these findings, the clinical diagnosis was established as Zinner's syndrome. The present case was performed by Da Vinci Si robotic platform using the 5-trocar technique. Conclusion: robot-assisted laparoscopic excision is a safe and feasible option to treat large seminal vesicle cysts, which may be a component of Zinner's syndrome. Simultaneous upper urinary tract interventions, such as nephroureterectomy, can be employed by redocking the robot and repositioning the patient, using the same layout of robotic trocars.Publication Metadata only A risk grouping algorithm for predicting factors of persistently elevated prostate-specific antigen in patients following robot-assisted radical prostatectomy(Wiley, 2021) Micoogullari, Uygar; Cakici, Mehmet Caglar; Kisa, Erdem; Kilic, Furkan Umut; Ardicoglu, Arslan; Altinova, Serkan; Atmaca, Ali Fuat; Akbulut, Ziya; N/A; Balbay, Mevlana Derya; Canda, Abdullah Erdem; Faculty Member; Faculty Member; School of Medicine; School of Medicine; 153320; 116202Objective: After radical prostatectomy, prostate-specific antigen(PSA) value measuring >= 0.1 ng/mL is defined as persistent PSA(pPSA) and in many studies, it was found to be associated with aggressive disease and poor prognosis. Our aim in this study is to point out the pathological and clinical factors affecting pPSA among the patients who underwent robot-assisted radical prostatectomy(RARP) in an experienced academic centre and to make a useful risk grouping algorithm that can predict pPSA value based on operative data. Methods: We examined records of 1273 patients who underwent RARP retrospectively. Preoperative, operative and postoperative data were collected. Based on the PSA values (ng/mL) measured after 4-to-8 weeks of RARP, patients were divided into two groups as pPSA group (Group1)(n = 97) with PSA values >= 0.1 ng/mL and undetectable PSA group (Group2)(n = 778) with PSA values <0.1 ng/mL. Later on, Group1 was further divided into Group1a (PSA:0.1-0.2 ng/mL) and Group 1b (PSA >= 0.2 ng/mL) to evaluate biochemical recurrence(BCR). Results: Multivariate logistic regression analyses of the collected data revealed that preoperative PSA >= 20 ng/mL, operation time, a postoperative international society of urological pathology (ISUP) grade of >= 4, pT 3-4 and pN were independently associated with pPSA. Based on these results, a risk grouping algorithm predicting pPSA was developed. By looking at the risk grouping algorithm pPSA was found in 98.9% of the cases with a preoperative PSA value of >= 20 ng/mL, an operation time of 150 min, a postoperative ISUP grade of 4-5, a positive lymphovascular invasion (LVI) status, pT3-T4, and pN+; while pPSA was found in 25.5% of the cases with a preoperative PSA value of <20 ng/mL, an operation time of 100 min, a postoperative ISUP grade of <4-5, a negative LVI status, pT<3-4 and pN-. The estimated BCR-free survival time was 16.3 months in Group 1a and 57.0 months in Group2 (P < .001). Adjuvant treatment ratio was 64.9% in Group1 and 7.1% in Group2 (P < .001). Conclusion: For the patients who underwent RARP, factors associated with aggressive disease can predict the PSA persistence. To plan our treatment modalities accurately, an applicable risk grouping algorithm in daily practice would be useful.Publication Metadata only Endopelvic fascia sparing robotic radical cystectomy with intracorporeal studer pouch with Balbay's technique(Society of Laparoscopic and Robotic Surgeons, 2022) Kilic, Mert; Musaoglu, Ahmet; N/A; N/A; N/A; N/A; N/A; N/A; N/A; Balbay, Mevlana Derya; Köseoğlu, Ersin; Canda, Abdullah Erdem; Özkan, Arif; Kiremit, Murat Can; Tarım, Kayhan; Sarıkaya, Ahmet Furkan; Faculty Member; Faculty Member; Faculty Member; Doctor; Faculty Member; Researcher; Researcher; School of Medicine; School of Medicine; School of Medicine; N/A; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; 153320; 350876; 116202; 289255; 222920; 327605; 327615Background and Objectives: Robotic radical cystec-tomy (RARC) with intracorporeal urinary diversion is a technically complicated, time-consuming procedure. The aim of this study was to present the operative, pathologi-cal, oncological, and functional outcomes of patients who underwent endopelvic fascia sparing (EPFS) RARC with intracorporeal Studer pouch formation. To the best of our knowledge, this is first series in the literature that includes EPFS RARC.Methods: Between October 1, 2019 and April 30, 2022, 10 bladder cancer patients underwent EPFS RARC, bilat-eral extended pelvic lymph node dissection with intra-corporeal Studer pouch reconstruction with Balbay's technique. Patient demographics, operative, and post-operative parameters were recorded.Results: Among 10 patients, 8 were male and 2 were female. Mean operative time, median estimated blood loss, and median duration of hospital stay was 530 minutes, 316 ml, and 8 days, respectively. One month postoperatively, the mean maximum flow, average flow rate, mean voided, and post-voided urine volume were 20.2 ml/sec, 4.4 ml/sec, 273.6 ml, and 3.5 ml, respectively. All of the patients were fully continent during day-time, three had mild night-time incontinence requiring pad use (both patients 1 pad per night). During a mean 11.5 months of follow up, zero patients died. One patient with a pathological, stage 4 tumor, had nodal recurrence at six months postoperatively. No distant metastasis were detected. Conclusion: Endopelvic fascia sparing RARC has very promising early functional results with safe oncological outcomes and low complication rates.Publication Metadata only We investigated the impact of transurethral resection of the prostate (TUR-P) on perioperative outcomes in patients who underwent robot assisted radical prostatectomy (RARP)(Avrasya Üroonkoloji Derneği, 2019) Keske, Murat; Atmaca, Ali Fuat; Hamidi, Nurullah; N/A; N/A; Canda, Abdullah Erdem; Balbay, Mevlana Derya; Faculty Member; Faculty Member; School of Medicine; School of Medicine; 116202; 153320We investigated the impact of transurethral resection of the prostate (TUR-P) on perioperative outcomes in patients who underwent robot assisted radical prostatectomy (RARP). Material and Methods: A total of 752 cases performed by 3 surgeons between February 2009 and December 2017 were reviewed retrospectively. First 100 cases of each surgeon were not included to exclude the learning curve effect. All patients (n = 452) were divided into two groups according to having a previous TUR-P history as Group 1 = patients with TUR-P history (n = 38), Group 2 = patients without TUR-P history (n = 414). Results: Mean patient age was 68.3± 5.9 versus 63.3±6.8 years p=0.00; mean console time was 144.3±37.1 versus 124.6±24.0 minutes, p=0.02; bladder neck reconstruction was 31.6% versus 16.7%, p=0.02; transurethral catheter removal time was 11.3±5.1 versus 8.6±2.7 days, p=0.00; for groups 1 and 2, respectively. Positive surgical margin rates were 26.3% versus 27.3%, p=0.897; erectile function (IIEF≥17) rates on postoperative 12th-month were 60% versus 67%, p=0.644 for groups 1 and 2, respectively. First 3 months continence rates were 52.6% versus 72%, p=0.035 for groups 1 and group 2, respectively. Postoperative 12. month continence rates were similar for group 1 and 2(94.7% vs 97.3% ; p=0.562). Conclusion: RARP after TUR-P has similar oncological outcomes, longer operative time, worse postoperative early continence acquisition rates and longer urethral catheter removal time. / Öz: Bu çalışmada robot yardımlı radikal prostatektomi (RYRP) yapılan hastalarda geçirilmiş transüretral prostat rezeksiyonu (TUR-P) cerrahisinin perioperatif sonuçlar üzerine etkisi araştırılmıştır. Gereç ve Yöntemler: Şubat 2009-Aralık 2017 arasında 3 cerrah tarafından gerçekleştirilen toplam 752 vakanın verileri retrospektif olarak incelendi. Her bir cerrahın ilk 100 vakası öğrenme eğrisi nedeniyle çalışma dışı bırakıldı. Tüm hastalar (n=452) RYRP öncesinde TUR-P öyküsü olup olmamasına göre iki gruba ayrıldı. Grup 1=TUR-P öyküsü olanlar (n=38), Grup 2=TUR-P öyküsü olmayanlar, (n=414). Bulgular: Sırasıyla grup 1 ve 2’de ortalama hasta yaşı 68.3± 5.9 ve 63.3±6.8 yıl p=0.00; ortalama konsol süresi 144.3±37.1 ve 124.6±24.0 dakika, p=0.02; mesane boynu rekonstrüksiyon gereksinim oranı %31.6 ve %16.7, p=0.02; ortalama transüretral kateter kalış süresi 11.3±5.1 ve 8.6±2.7 gün, p=0.00 saptanmıştır. Sırasıyla grup 1 ve 2’de, pozitif cerrahi sınır, grup 1’de %26.3, grup 2’de %27.3, p=0.897 ve erektil fonksiyon oranları (IIEF≥17) (postoperatif 12. ay grup 1’de %60, grup 2’de %67, p=0.644) benzer saptanmıştır. Erken dönemde (3. ay) kontinans oranları grup 1 ve grup 2 de sırasıyla %52.6 ve %72 olarak bulunmuştur (p=0.035). 12. ay sonunda kontinans oranları açısından iki grupta %94.7 ve %97.3 olarak birbirine benzer sonuçlar elde edilmiştir (p=0.562). Sonuç: TUR-P sonrası RYRP ameliyatı yapılması, TUR-P geçirmeyen hastalara göre benzer onkolojik sonuçları olan, daha uzun ameliyat süresi olan, postoperatif erken kontinans kazanılması oranları daha az olan ve daha uzun süre idrar sondası takılması gerektiren bir ameliyattır.Publication Metadata only The role of the size and number of index lesion in the diagnosis of clinically significant prostate cancer in patients with PI-RADS 4 lesions who underwent in-bore MRI-guided prostate biopsy(Springer, 2023) Kilic, Mert; Madendere, Serdar; Vural, Metin; N/A; Köseoğlu, Ersin; Esen, Tarık; Balbay, Mevlana Derya; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; 350876; 50536; 153320Purpose To evaluate the contribution of the size and number of the sampled lesions to the diagnosis of clinically significant prostate cancer (CSPC) in patients who had PI-RADS 4 lesions. Methods In this retrospective study, a total of 159 patients who had PI-RADS 4 lesions and underwent In-bore MRI-Guided prostate biopsy were included. Patients with a lesion classified as Grade Group 2 and above were considered to have CSPC. Univariate and multivariate regression analyses were used to evaluate the factors affecting the diagnosis of prostate cancer (PCa) and CSPC. Results A great majority (86.8%) of the patients were biopsy-naive. About three-fourths (71.7%) had PCa, and half (54.1%) had CSPC. When the patients were divided into three groups according to the index lesion size (< 5 mm, 5-10 mm, and > 10 mm), the prevalence of PCa was 64.3, 67.5, and 82.4% and the prevalence of CSPC was 42.9, 51.2, and 64.7%, respectively. In multivariate analysis, age, index lesion size, prostate volume (< 50 ml) and being biopsy-naive were found significant for PCa, while age and prostate volume (< 50 ml) were significant for CSPC. Conclusion The number of lesions was found to be insignificant in predicting PCa and CSPC. While the size of PI-RADS 4 lesions was significant in predicting PCa, it had no significance in detecting CSPC.Publication Metadata only Is robotic transperitoneal partial nephrectomy safe in the management of cystic renal cell masses? Outcomes of an ERUS multicenter study including 216 patients(ELSEVIER, 2021) Mottrie, A.; Challacombe, B.; Montorsi, F.; Ener, K.; Ploumidis, A.; Larcher, A.; Decaestecker, K.; De Luyk, N.; Buffi, N.; Uleri, A.; Gallina, A.; De Naeyer, G.; Guazzoni, G.; Fernando, A.; Briganti, A.; Cestari, A.; Catterwell, R.; Van Praet, C.; Capitanio, U.; Pappas, A.; N/A; Canda, Abdullah Erdem; Kordan, Yakup; Esen, Tarık; Balbay, Mevlana Derya; Faculty Member; Faculty Member; Faculty Member; Faculty Member; N/A; School of Medicine; School of Medicine; School of Medicine; School of Medicine; N/A; 116202; 157552; 50536; 153320N/APublication Metadata only PSA change after antibiotic treatment should not affect decision-making on performing a prostate biopsy(TÜBİTAK , 2023) Kayali, Yunus; Ilktac, Abdullah; Ersoz, Cevper; Toprak, Hueseyin; Akcay, Muzaffer; Dogan, Bayram; N/A; Balbay, Mevlana Derya; Tarım, Kayhan; Baygül, Arzu Eden; Faculty Member; Researcher; Faculty Member; School of Medicine; School of Medicine; School of Medicine; 153320; 327605; 272290Background/aim: To investigate the effect of antibiotic treatment on PSA when deciding on prostate biopsy.Materials and methods: A total of 206 patients with an elevated PSA level (2.5-30) were included. Mp-MRI could be done on 129 patients. Patients were given ciprofloxacin (500 mg, b.i.d. p.o.) for 4 weeks and PSA measurements were repeated. Systematic prostate biopsy was performed regardless of PSA changes on all patients. Additionally, cognitive biopsies were performed from PI-RADs III, IV, and V lesions.Results: Prostate cancer was detected in 36.4% of patients. 53.3% had Gleason score of 3+3, 46.7% had Gleason score >= 3+4. PSA values decreased in 56.3% and in 43.7% and remained the same or increased but cancer detection rates were not different: 34.5% vs. 38.9%, respectively (p = 0.514). PSA change in whole group was significant (6.38 ng/mL vs. 5.95 ng/mL, respectively (p = 0.01). No significant PSA decrease was observed in cancer patients (7.1 ng/mL vs. 7.05 ng/mL, p = 0.09), whereas PSA decrease was significant in patients with benign pathology (6.1 ng/mL vs. 5.5 ng/mL, p = 0.01). In patients with PI-RADs IV-V lesions, adenocarcinoma was present in 33.9% and 30.4% with or without PSA decrease, respectively (p = 0.209). Clinically significant cancer was higher in patients with after antibiotherapy PSA values >4 ng/mL regardless of PI-RADs grouping (p = 0.08). Addition of any PSA value to PI-RADs grouping did not have any significant effect on the detection of cancer.Conclusion: PSA change after antibiotic treatment has no effect in detecting cancer and should not delay performing a biopsy.Publication Metadata only Comparison of the oncological outcomes of patients who underwent radical and partial nephrectomy due to renal cell cancer(Sakarya Üniversitesi, 2019) Gök, Bahri; Ener, Kemal; Atmaca, Ali Fuat; Altınova, Serkan; Akbulut, Ziya; N/A; Canda, Abdullah Erdem; Balbay, Mevlana Derya; Faculty Member; Faculty Member; School of Medicine; School of Medicine; 116202; 153320Objective In this study, we aimed to compare the oncologic results of patients who underwent radical and partial nephrectomy due to renal cell carcinoma (RCC). The effects of clinicopathological features on recurrence-free survival and cancer-specific survival were investigated. ( Sakarya Med J 2019, 9(2):326-336 ). Materialsand Method We retrospectively analyzed the data of 200 patients who underwent partial / radical nephrectomy T3a and under between 2004-2012. Kaplan Meier survival analysis was used to evaluate the clinical effects of the clinicopathological features on survival by Log-Rank test. 1 - 3 and 5 - year survival rates, mean survival time and 95% confidence intervals for this time were calculated. Results When all the cases were evaluated, 1 - 3 and 5 - year recurrence - free survival was 95.5%, 90.5 and 85.5, cancer - specific survival was 98.8%, 96.4 and 92.3%. Recurrence-free survival between groups was statistically higher at PN (p = 0.014), but not differences were in cancer-specific survival. Recurrence-free and cancer-specific survival according to the stages was higher in T1a, T1b and T3a than T2a and T2b (p=0,023 ve p<0.001 ). 1- 3 and 5-year recurrence-free survival and cancer-specific survival were similar in T1a and T1b stages and this stages are not associated with clinicopathological features. In all cases of pathologic tumor size (p = 0.026) was observed to affect recurrence-free survival. In all cases multivariate analysis, of the age (p = 0.010) and pathological tumor size (p = 0.018) was observed to affect cancer-specific survival. Conclusion Recurrence-Free and Cancer-Specific Survival rates were similar between patients who underwent radical nephrectomy and partial nephrectomy for T1a and T1b renal cell carcinoma and was not affected by any of the clinicopathological prognostic feature. Clinicopathological and demographic characteristics may be associated with survival in advanced stages. / Öz: Amaç Bu çalışmada renal hücreli karsinom (RHK) nedeniyle radikal ve parsiyel nefrektomi yapılan hastaların evrelere göre onkolojik sonuçlarının karşılaştırılması amaçlanmıştır. Bu amaçla klinikopatolojik özelliklerin rekürrenssiz sağkalım ve kansere özgü sağkalım üzerine etkileri incelendi. ( Sakarya Tıp Dergisi 2019, 9(2):326-336 ) Gereç ve Yöntem 2004-2012 tarihleri arasında renal kitle nedeniyle kliniğimizde parsiyel/radikal nefrektomi uygulanan T3a ve altındaki 200 hastanın verilerini retrospektif olarak inceledik. Klinikopatolojik özelliklerin sağkalımlar üzerine istatistiksel etkileri olup olmadığı Log-Rank testi kullanılarak Kaplan Meier sağkalım analizi ile değerlendirildi. Her bir değişkene ilişkin 1- 3 ve 5 yıllık sağkalım hızları, ortalama yaşam süresi ve bu süreyle ilişkili %95 güven aralıkları hesaplandı. Bulgular Tüm olgular içerisinde 1- 3 ve 5 yıllık rekürrenssiz sağkalım % 95.5, 90.5 ve 85.5, kansere özgü sağkalım % 98.8, 96.4 ve 92.3 olarak tespit edildi. PN grubunda RN grubuna göre rekürrenssiz sağkalım istatistiksel olarak daha yüksekti (p=0,014) ama kansere özgü sağkalımda fark gözlenmedi. Evrelere göre T1a, T1b ve T3a’ da rekürrrenssiz sağkalım ve kansere özgü sağkalım T2a ve T2b’ den daha yüksekti (p=0,023 ve p<0.01) T1a ve T1b evrelerinde 1- 3 ve 5 yıllık rekürrenssiz sağkalım ve kansere özgü sağkalım benzer olarak bulundu ve klinikopatolojik özelliklerle istatistiksel olarak ilişki tespit edilmedi. Tüm olgular içerisinde patolojik tümör boyutu (p=0,026)’ nun rekürrenssiz sağkalımı etkilediği görüldü. Tüm olgular içerisinde multivariate analizlerde yaş (p=0,010) ve patolojik tümör boyutunun (p=0,018) kansere özgü sağkalımı etkilediği görüldü. Sonuç T1a ve T1b böbrek tümörlerinde parsiyel nefrektomi ve radikal nefrektomi yapılan hastalar arasında rekürrenssiz ve kansere özgü sağkalımların benzer olduğu gözlendi ve prognozunun herhangi bir klinikopatolojik özellikten etkilenmediği gözlendi. Klinikopatolojik ve demografik özelliklerin ileri evrelerde sağkalımla ilişkili olabileceği düşünüldü.Publication Metadata only Management of ureteric duplications identified during robotic cystectomy and intracorporeal urinary diversion(Edizioni Minerva Medica, 2018) Koç, Erdem; Atmaca, Ali F.; Asil, Erem; Gök, Bahri; Canda, Abdullah Erdem; Balbay, Mevlana Derya; Faculty Member; Faculty Member; School of Medicine; School of Medicine; 116202; 153320Ureteral duplication is rarely seen malformation that could be diagnosed during radiological imaging. Herein, we present 5 patients with ureteral duplication who underwent robotic radical cystectomy with intracorporeal urinary diversion for bladder cancer. Preoperative computerized tomography did not show presence of a ureteral duplication in any patient and all were identified intraoperatively. A Wallace type uretero-ureteral anastomosis was performed in all patients. During the follow-up period, we did not detect any ureterointestinal anastomotic strictures or complication related to the presence of a ureteral duplication following robotic cystectomy. We conclude that ureteral duplication might be missed during preoperative radiological imaging, might be a surprising and challenging issue for the robotic surgeon that could be safely managed intraoperatively.