V09-05: Robotic Assisted Laparoscopic Urogenital Sinus Mobilization and Bladder Neck Sling
Persistent urogenital (UG) sinus represents one of the most complex conditions faced by pediatric urologists. Associated anomalies often provide further challenge in genitourinary reconstruction for these patients. Here, we present the case of a 12-year-old female with imperforate anus and common UG sinus managed with intermittent catheterization, bothered by persistent urinary tract infections and urinary leakage. She underwent robotic assisted laparoscopic mobilization of her UG sinus with bladder neck sling, posterior sagittal anorectoplasty and vaginoplasty.
Using the DaVinciXI Robotic System, we utilized standard pelvic port placement with the patient in the modified dorsal lithotomy position. The peritoneum over the bladder and vagina was opened and dissection carried out until the sinus between the bladder and vagina was identified. This was circumferentially dissected, ligated and transected. The vagina and bladder were then mobilized to the endopelvic fascia. Next the bladder was dropped and the space of retzius entered so that the bladder neck could be dissected out circumferentially. A graft of SIS was then passed around the bladder neck and secured to the pubic bone in a crossing fashion to ensure good coaptation of the bladder neck. The robotic system was then undocked and the patient placed into the prone position for posterior sagittal anorectoplasty and vagoinoplasty.
The patient tolerated the procedure well and was discharged home after an uncomplicated post op course with foley catheter in place. She did require a return to the operating room for replacement of foley catheter after having difficulty with intermittent catheterizations due to false passage. On long term follow up the patient is doing well with absence of urinary tract infections, excellent continence and cosmetic results.
Anterior mobilization of a common UG sinus is possible via a robotic assisted laparoscopic approach and may facilitate a posterior repair. Placement of an obstructing bladder neck sling is similarly possible via a robotic approach.