The First Robotic Day Care Procedure in the Management of Testicular Vein Syndrome: A Rare Cause of Hydroureteronephrosis

Abstract

Clinical History: A 46-year-old gentleman with no comorbidities presented with dull aching pain in the left loin for 6 months. Physical Examination: Examination was unremarkable. Diagnosis: He was evaluated with contrast-enhanced CT scan of the urinary tract that revealed left gross hydroureteronephrosis secondary to midureteral stricture caused by compression of the left testicular vein. Renogram (diethylenetriamine pentaacetate scan) was performed that showed 44% split renal function of the left kidney with a glomerular filtration rate of 86 mL/min. Intervention: He underwent a day-case robotic ureteroureterostomy and intraoperatively the upper ureter was dilated with testicular vein transposing above the midureter that had a stricture, causing dilatation of proximal ureter with hydronephrosis. Upper ureter was transected above the stricture and brought anterior to the testicular vein and the constricted segment was excised. Ureteroureterostomy was performed over 5F/26 cm Double-J stenting using 2-0 Stratafix suture. Outcomes: Follow-up included stent removal at 6 weeks and serial creatinine thereafter has been normal. Follow-up imaging was done in the form of ultrasonography that showed resolution of hydronephrosis at 3 months and 6 months. Patient Consent Statement: Written informed consent was obtained from the patient to publish this research. No competing financial interests exist.This research received no specific grant from any funding agency, commercial or nonprofit sectors. All authors confirm that they have been involved in the conception and design of the study, drafting of the study for intellectual content, and are accountable to the accuracy of all aspects of the content.Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure Runtime of video: 4 mins 17 secs