V04-07 ROBOTIC ASSISTED SIDE-TO-SIDE REFLUXING NON-DISMEMBERED URETEROCYSTOTOMY FOR MANAGEMENT OF AN OBSTRUCTED MEGAURETER

Abstract

You have accessJournal of UrologyCME1 Apr 2023V04-07 ROBOTIC ASSISTED SIDE-TO-SIDE REFLUXING NON-DISMEMBERED URETEROCYSTOTOMY FOR MANAGEMENT OF AN OBSTRUCTED MEGAURETER Hailey Silverii, Xinyuan Zhang, and Nicolas Fernandez Hailey SilveriiHailey Silverii More articles by this author , Xinyuan ZhangXinyuan Zhang More articles by this author , and Nicolas FernandezNicolas Fernandez More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003252.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Obstructed megaureters can often be safely observed; however, when there are associated changes in renal function or recurrent infections, surgical intervention is indicated. Surgical management options include: endoscopic intervention, diversion with cutaneous ureterostomy, non-refluxing ureteral reimplantation, or refluxing ureteral reimplantation with an end-to-side or side-to-side approach. Determining factors for management include the circumstance for which intervention is indicated, age and size of the patient, degree of ureteral dilation and obstruction, and bladder size. In this video, we present a robotic assisted side-to-side refluxing non-dismembered ureterocystotomy for an infant with a ureterovesical junction (UVJ) obstruction. METHODS: A 4-month-old, 6.6 kg male with a history of antenatally diagnosed hydroureteronephrosis presents with a 3 month interval renal ultrasound demonstrating worsened degree of right hydroureteronephrosis with debris and increased parenchymal thinning. He has no prior history of urinary tract infections. A MAG3 renal scan demonstrated normal differential function and an obstruction at the level of the right UVJ. Given the patient’s young age and small bladder capacity, a non-refluxing ureteral reimplantation was not felt to be a feasible option. A side-to-side ureterocystotomy was recommended to which the family consented. After further counseling, a robotic approach was agreed upon and completed with the assistance of the Da Vinci XI platform (Intuitive Surgical, Sunnyvale, CA). RESULTS: The case began with a cystoscopy and right retrograde pyelogram which confirmed the level of the obstruction at the UVJ. Three supraumbilical 8 mm ports were placed prior to docking the Da Vinci system. Console time was 60 minutes. The tension free side-to-side anastomosis was completed in an interrupted fashion between the bladder and the dilated distal ureter. Estimated blood loss was less than 5 cc. The patient was discharged on post-operative day one after Foley catheter removal and the patient is doing very well. CONCLUSIONS: In conclusion, a robotic approach to a refluxing non-dismembered ureterocystotomy can safely be employed in small infants with adaptations in port placement, dissection, and anastomosis given small working space and risk to injuring nearby structures. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e340 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hailey Silverii More articles by this author Xinyuan Zhang More articles by this author Nicolas Fernandez More articles by this author Expand All Advertisement PDF downloadLoading ...