V7-11: Pediatric Robot-Assisted Laparoscopic Excision of Ectopic Distal Ureteral Stump
Ectopic ureter development occurs due to abnormal caudal migration of the ureteric bud during insertion into the bladder. In males, the distal ureter may insert into the bladder neck, posterior urethra, seminal vesicle, vas deferens, ejaculatory duct, or epididymis. The robotic approach provides enhanced visualization and greater dexterity for manipulating deep pelvic structures. We aim to demonstrate the application and safety of a robotic approach to the ectopic distal ureterectomy procedure in the pediatric population.
A 15 year old male with a history of posterior urethral valves and associated severe left vesicoureteral reflux and renal dysplasia underwent a left nephrectomy at age 1. Follow-up ultrasound revealed distal ureteral dilation, with progressive enlargement on serial ultrasounds. MRI demonstrated a narrow connection between the left distal ureter and seminal vesicle. Due to concerns for future fertility, a pre-operative semen analysis was performed and revealed normal parameters at baseline. The patient underwent a robot-assisted excision of the ectopic distal ureteral stump.
The left distal ureter was excised without perioperative complications. Pathology revealed a segment of ureter with mild chronic mucosal inflammation, smooth muscle hypertrophy, and focal fibrosis. Bladder ultrasound at 2 months post op revealed absence of the left ureteral stump and a normal bladder wall. The patient recovered well and follow-up semen analysis is scheduled for 6 months post-op.
The robot-assisted laparoscopic excision of ectopic distal ureter inserted into a seminal vesicle is feasible and successful in the pediatric population. The robotic approach allows for excellent visualization, dissection, and suturing of deep pelvic structures, but requires an appreciation for the individualized anatomy._x000D_