Introduction: Patients undergoing urinary diversions are at an increased risk(3-43%) of urolithiasis. Penile fractures are almost unheard of after cystectomy. Upper tract recurrence occurs in 5-10% of carcinoma bladder. Our index case underwent nerve sparing radical cystectomy, had recurrent stone formations, penile fracture repair and radical nephroureterectomy with conduit stone removal in the fifth year of follow-up. Clinical findings: A 40-year-old man underwent an uneventful nsRARC +IC 5 years ago. Bricker uretero-ileal anastomoses were performed. On follow-up, was found to have a lower ureteric calculus, for which he underwent flexible lithotripsy. After 2 years, he had a penile fracture with a 1 cm corporal defect with urethral involvement. After further 2 years, he had a recurrence in the left renal pelvis and 2cm stone in the ileal conduit, for which he underwent laparoscopic radical nephroureterectomy, ileal cuff excision and stone removal. Diagnosis & Treatment: Intraoperatively, laparoscopic nephroureterectomy was performed. Using a midline incision, challenging adhesiolysis was done to identify the conduit, dissect the left ureter, dismember the ureteroileal anastomosis with a cuff and remove the stone. The ileal defect was repaired in 2 layers. Right ureteric anastomosis left undisturbed. Total intraoperative time was 175 minutes. Patient is doing well 3 weeks post-operatively. Conclusions: A careful nsRARC can preserve potency, as evidenced by the penile fracture, a first to be reported to the best of our knowledge. A longer than usual length(30cm) of conduit can promote stone formation. Bricker ureteroileal anastomosis has the advantage over Wallace technique in such cases.

An eventful 5 year follow up of robotic radical cystectomy and ileal conduit involving recurrent stone surgeries, penile fracture repair with urethroplasty and laparoscopic assisted radical nephroureterectomy