Robotic excision and ureteroureterostomy of blind-ending ureteral ‘Duplication’

Abstract

Duplicated ureteral anatomy can be a reconstructive challenge. Blind-ending ureteral duplication has been reported with recommendations for surgical excision. This video reviews the importance of exposure of anatomic landmarks in surgical excision of a blind-ending ureteral duplication. This is a retrospective case report of a patient who presented with a blind-ending ureteral duplication. A 13-year-old female presented with a right-sided abdominal mass. Abdominal and pelvic imaging revealed a tubular structure adjacent to and below the right kidney, possibly connecting to the right lower pole. While initially observed, the patient re-presented with urosepsis. A retrograde pyelogram showed no connection between the right ureter and this structure. The patient underwent robotic-assisted excision of this structure. Intra-operatively, it was connected to the right lower pole calyces. A ureteroureterostomy to the orthotopic ureter was performed. Although the structure was adjacent to the bladder dome, there was no communication distally. Postoperatively, the patient did well; follow-up imaging showed a non-dilated lower pole. The pathology of this structure was benign urothelium. Surgical management of aberrant ureteral duplications should focus on identifying known landmarksand should be considered to prevent symptomatic infections and renal scarring.