V4-01: Pediatric Robotic Intracorporeal Ureteral Tapering and Extravesical Reimplantation for a Single-system Ectopic Obstructing Megaureter
VideoIntroductions and Objectives
In this study, we present techniques for robotic intracorporeal ureteral tapering and extravesical reimplantation as a treatment modality for a single-system ectopic obstructing megaureter.
The medical records and clinical workup of a pediatric patient undergoing robotic ureteral tapering and extravesical reimplantation were reviewed and analyzed. Video recording from the surgery was also obtained.
Left hydronephrosis was detected on prenatal ultrasonograpy in an otherwise normal female fetus. Prophylactic antibiotics were administered in the immediate post-natal period. One month renal ultrasound demonstrated severe left hydroureteronephrosis. No vesicoureteral reflux was demonstrated on VCUG performed at one month. A mag 3 nuclear renal scan with furosemide at 6 months demonstrated high grade left ureteral obstruction and nearly even split renal function. Cystoscopy shortly thereafter revealed a single right ureteral orifice in normal position, and a single left ectopic ureteral orifice the urethra proximal to the urethral sphincter. Incision, tapering, and extravesical reimplantation of the left ureter was successfully performed using a robot-assisted approach. The uterus and vagina were reflected anteriorly and to the right using suture retraction via the broad ligament for adequate exposure. A small pelvic drain was placed. Total anesthesia time was five hours, and estimated blood loss was less than five milliliters. The drain was discontinued and the patient was discharged to home on postoperative day one.
A robot-assisted approach is a feasible and safe method for reconstruction of ectopic obstructing megaureter in the pediatric population.