Pediatric Robot-Assisted Laparoscopic Excision of Multifocal Ureteral Polyps

Abstract

Introduction: Fibroepithelial polyps are a rare cause of upper urinary tract obstruction in children. Although endoscopic management is preferred in many cases,1,2 large or multifocal polyps may preclude endoscopic management. Presented here is a case of a 9-year-old boy with large, multifocal obstructive ureteral and renal pelvis polyps managed with robot-assisted excision. Patient and Methods: Previous evaluation with a retrograde pyelogram confirmed the presence of obstructive polyps that precluded ureteroscopy. Given the numerous large polyps seen on fluoroscopy, a robot-assisted approach was chosen over an attempt at endoscopic management. A standard robotic setup for upper urinary tract surgery was planned, utilizing two robotic surgeon arms and a working port for the bedside assistant. A ureterotomy was made in the proximal ureter, exposing the ureteral polyps. Counter-incisions were made distally on the ureter to identify additional polyps and the anterior portion of the ureter was opened to expose all involved urothelium. More than 20 polyps were identified spanning the ureteropelvic junction to the pelvic brim. Polyps were excised with electrocautery. Intracorporeal ureteroscopy confirmed the excision of all significant disease. The ureterotomy was closed in a water-tight, running anastomosis over a ureteral stent. The operative time was 5 hours 28 minutes and the estimated blood loss was 25 mL. Results: Final pathology analysis confirmed the presence of fibroepithelial polyps of the urinary tract. The patient is currently without signs or symptoms of recurrent obstruction. An ultrasonography 7 months postoperatively shows near complete resolution of his hydronephrosis. Conclusions: Robot-assisted laparoscopy is a safe and feasible alternative to endoscopic treatment of fibroepithelial ureteral polyps. The robotic platform may be especially applicable for large or multifocal polyps of the ureter or renal pelvis. No competing financial interests exist. Runtime of video: 4 mins 58 secs A version of this video abstract was presented at the 2015 Western Section AUA Meeting in Indian Wells, CA, on October 25, 2015.