V3-02: Robotic-Assisted Laparoscopic Management of an Upper Pole Ectopic Ureter with Lower Pole Vesicoureteral Reflux

Video

Introductions and Objectives
Pediatric urologists frequently encounter patients with duplicated renal collecting systems. While there are different anatomical variations of these duplex systems, an ectopic upper pole ureter is commonly encountered. Vesicoureteral reflux (VUR) may also be found in the associated lower pole ureter. This video illustrates how an ectopic upper pole ureter and a refluxing lower pole ureter may both be repaired using the same setup by a robotic assisted laparoscopic ipsilateral upper to lower pole ureteroureterostomy and lower pole extravesical ureteral reimplant.

Methods
This child initially presented to our clinic when he was 5-weeks-old for consultation regarding left antenatally diagnosed hydronephrosis. Postnatal imaging demonstrated minimal hydronephrosis of the left lower pole and a duplicated right renal collecting system with ectopic upper pole megaureter. Further work-up demonstrated grade 3-like VUR into the right lower pole and into both poles of a duplicated left collecting system. The family elected to proceed with surgical intervention aimed at preserving as much future renal function as possible.

Results
A robotic assisted laparoscopic right ipsilateral upper to lower ureteroureterostomy and bilateral extravesical ureteral reimplants were successfully completed. The right lower pole ureter was reimplanted and the left side was done as a common sheath reimplant. The patient did well post-operatively with improvement in the right upper pole hydroureteronephrosis. There was also resolution of the bilateral VUR.

Conclusions
This video demonstrates how both an ipsilateral ureteroureterostomy and extravesical ureteral reimplant may be safely performed during the same procedure using the standard robotic port positioning for an extravesical ureteral reimplant.

Funding: None