V7-10: Robotic assisted laparoscopic dismembered tapered ureteral reimplantation for megaureter
Children with megaureters may have elements of obstruction, reflux, or both and are at risk for upper tract deterioration if left uncorrected. We present a series of 5 pediatric patients ranging from 14 months old to 11 years old with symptomatic megaureter and describe a novel technique for surgical correction involving a minimally-invasive, robotic-assisted approach with a dismembered extravesical ureteroneocystostomy following extracorporeal ureteral tapering.
We retrospectively reviewed 5 pediatric cases of megaureter managed in similar fashion with a novel surgical technique. Outcomes were assessed via chart review with a focus on postoperative improvement in clinical symptoms and in radiographic findings.
After a mean follow up of 24 months, all patients have demonstrated clinical improvement in their symptoms, radiographic improvement of hydronephrosis, or both. This pattern persists in the two patients with longest follow ups of 44 and 54 months. Repeat voiding cystourethrogram following surgery is done as clinically indicated and has not yet been performed in all patients who had preoperative reflux.
In conclusion, robotic-assisted laparoscopic dismembered ureteroneocystostomy with extracorporeal ureteral tapering is a feasible, minimally-invasive method for managing patients with symptomatic megaureter who have components of obstruction, reflux, or both.