Intravesical Ureterocele Research Articles

Endoscopic incision of ureterocele

Ureterocele is a cystic dilatation of the intravesical submucosal ureter, with an obstructed orifice. Endoscopic treatment is one of the most common option for surgical treatment. In intravesical ureterocele, the punctures must be made just above the junction between the ureterocele and the bladder floor. We commonly use a 8-9.8 Fr cystoscope, with a 5 Fr working channel, a metallic needle for bulking agent injection 3.7 Fr. In selected cases we also use electric or laser probes to decompress the ureterocele. When evidence of decompression is verified and vesicoureteral reflux is excluded, antibiotic prophylaxis is stopped. If, despite decompression, a large ureterocele is subsequently obstructing the bladder neck a surgical excision is necessary. Forty-four patients (92%) were treated endoscopically. Ureterocele puncture was performed with a metallic needle for bulking agent injection in 30 cases (63%), with a laser fiber in 7 cases (15%), with an electrified ureteral catheter in 4 cases (8%), and with Bugbee in 3 cases (6%). A success rate after one procedure was achieved in 40 children (83%). Adequate opening of the ureterocele with complete decompression of the reno-ureteral system is the goal of endoscopic treatment. An overaggressive incision or puncture could result in an increased chance of secondary vesicoureteral reflux.

An alternative lower tract approach to ectopic duplex system ureteroceles feasible in young children

The best surgical approach to ectopic ureters and ureteroceles is yet to be determined. The objective of this study is to provide an alternative lower tract surgical approach to ectopic ureters and duplex system ureteroceles that can be safely performed in young children. The "in-and-out" bladder approach was performed via an open intravesical incision. The upper and lower pole ureters were mobilized and brought into the bladder. The dilated ureter/ureterocele was cut open, and the distal part was deuroepithelialized. Subsequently, common sheath reimplantation was performed. The ureterocele wall was not involved during the whole procedure. We retrospectively reviewed all patients who underwent surgery for ureteroceles and ectopic ureters between January 1, 2004, and December 31, 2019. Patients with intravesical ureteroceles were excluded. Outcome parameters included the presence of hydronephrosis or reflux, split renal function on DMSA scan, incidence of urinary tract infection, and urinary incontinence. A total of 32 patients with ectopic duplex system ureterocele who underwent the "in-and-out" bladder approach between 2004 and 2019 were included in the retrospective study. The median age at operation was 7.8 months (range: 1.5 months-3.0 years). The median length of follow-up was 6.1 years (range: 1.0 years-14.3 years). Sixteen patients (55%) had ipsilateral vesicoureteral reflux. Five patients postoperatively developed a urinary tract infection within 1-3 years. No patients required further endoscopic treatment or surgeries. During long-term follow-up, two patients (6.3%) had intermittent day wetting at the ages of 4 and 5 years and were managed conservatively. The symptoms of intermittent day wetting subsided during follow-up. The "in-and-out bladder" approach can be performed in complex duplex system ureteroceles and enables early intervention; it is a single and simple operation with a satisfactory long-term continence rate.

Ectopic ureterocele

Ectopic ureterocele

MP51-09 ROLE OF NON-OPERATIVE MANAGEMENT OF URETEROCELES: SHOULD WE PUNCTURE ALL URETEROCELES?

You have accessJournal of UrologyPediatric Urology IV (MP51)1 Sep 2021MP51-09 ROLE OF NON-OPERATIVE MANAGEMENT OF URETEROCELES: SHOULD WE PUNCTURE ALL URETEROCELES? Aznive Aghababian, Sameer Mittal, Sahar Eftekharzadeh, John Weaver, Katherine Fischer, Christopher Long, Dana Weiss, Jason Van Batavia, Mark Zaontz, Thomas Kolon, Stephen Zderic, Douglas Canning, Aseem Shukla, and Arun Srinivasan Aznive AghababianAznive Aghababian More articles by this author , Sameer MittalSameer Mittal More articles by this author , Sahar EftekharzadehSahar Eftekharzadeh More articles by this author , John WeaverJohn Weaver More articles by this author , Katherine FischerKatherine Fischer More articles by this author , Christopher LongChristopher Long More articles by this author , Dana WeissDana Weiss More articles by this author , Jason Van BataviaJason Van Batavia More articles by this author , Mark ZaontzMark Zaontz More articles by this author , Thomas KolonThomas Kolon More articles by this author , Stephen ZdericStephen Zderic More articles by this author , Douglas CanningDouglas Canning More articles by this author , Aseem ShuklaAseem Shukla More articles by this author , and Arun SrinivasanArun Srinivasan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002077.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The optimal management for ureteroceles has long been under debate, due to the anatomic variability and severity of this entity. Treatment strategies range from upper pole heminephrectomy or major bladder reconstruction, to isolated endoscopic incision. We hypothesize that a carefully selected group of ureteroceles can be successfully managed without surgical intervention. METHODS: We retrospectively reviewed medical records of all patients with a diagnosis of ureterocele who were managed at our institution from 2010-2019. Patients were categorized into two groups: non-surgical management and surgical management. Non-surgical management included those who had at least 6-month follow-up with no interventions including ureterocele puncture. We analyzed baseline demographics, clinical presentation, imaging details, history of urinary tract infection (UTI), and if any procedures were performed during the follow-up period. RESULTS: We identified 240 ureteroceles in 231 patients: 56 (23%) were managed without immediate puncture and 184 (77%) surgically. Patients who underwent non-puncture management were more likely to have an intravesical ureterocele, ipsilateral multi-cystic dysplastic kidney, and were unlikely to have hydronephrosis and/or reflux on the ipsilateral side. Of 56 patients in the non-incision cohort, 6 (10%) required surgery after a median observation of 2.5 years (IQR 2.1-4.5), with 4 ureteroceles associated with a duplex system (3 intravesical and 1 ectopic) and the other 2 associated with absent kidney and an ectopic insertion. The remaining 50 (90%) did not require any surgical intervention during a median follow-up of 2.4 years (IQR 0.9-4.6). In the cohort of 50 patients who did not undergo intervention, 35 (70%) were on antibiotic prophylaxis, and febrile UTIs occurred in 12 (24%) patients from this group. Multivariate regression analysis showed that intravesical ureteroceles were more likely to be successfully managed non-operatively than ectopic ureteroceles (OR: 103.6, 95% CI: 1.4–733.5). CONCLUSIONS: Children with ureteroceles without evidence of obstruction, and/or functional renal tissue can be successfully managed without puncturing the ureterocele. An intravesical ureterocele in these children may be a predictor of success. Source of Funding: NA © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e899-e899 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aznive Aghababian More articles by this author Sameer Mittal More articles by this author Sahar Eftekharzadeh More articles by this author John Weaver More articles by this author Katherine Fischer More articles by this author Christopher Long More articles by this author Dana Weiss More articles by this author Jason Van Batavia More articles by this author Mark Zaontz More articles by this author Thomas Kolon More articles by this author Stephen Zderic More articles by this author Douglas Canning More articles by this author Aseem Shukla More articles by this author Arun Srinivasan More articles by this author Expand All Advertisement PDF downloadLoading ...

Management and outcomes of ureteroceles in children: An experience of 25 years.

Introduction:Ureterocele is a rare urogenital malformation. The treatment is variable and complicated as it depends on several factors. The aim of this study was to evaluate the management and outcomes of children with ureterocele and to compare single system and duplex system ureteroceles.Materials and Methods:A retrospective study was conducted and all patients with ureterocele operated from January 1992 to December 2018 were included. The records of those included were assessed, and a detailed case record sheet was filled. The outcome parameters assessed were the persistence of symptoms and additional surgical procedure performed.Results:Forty-seven patients (28 boys and 19 girls) with a median age of presentation of 21 months were included. Four patients had bilateral ureterocele. Overall, 51 renal units with ureterocele were studied. Twenty renal units of the 31 renal units with duplex system underwent cystoscopic decompression, and of these, 8 (40%) needed a second procedure. Fourteen renal units of the remaining 20 renal units with single system underwent cystoscopy and decompression, and of these, 1 (7%) required another procedure (P = 0.024). Sixteen renal units had ectopic ureterocele, of which 9 (56%) underwent heminephrectomy/nephrectomy. Intravesical ureterocele was present in 35 renal units, of which only 2 (5.7%) underwent nephrectomy or heminephrectomy (P < 0.001).Conclusion:Duplex system ureteroceles are more likely to require a second procedure following an endoscopic puncture. Units with ectopic ureterocele were more likely to need nephrectomy.

Laser-puncture of the ureterocele in neonatal patients significantly decreases an incidence of de novo vesico-ureteral reflux than electrosurgical incision

Endoscopic laser-puncture or electrosurgical incision are the most commonly used minimaly invasive approaches for the treatment of the ureterocele. Both techniques are mainly successful in decompressing of ureteroceles, but the consequence of such treatment may be formation of de novo vesicoureteral reflux and febrile urinary tract infection which could impact the final results. To compare outcomes of treatment of two endoscopic techniques used in management of neonatal patients with intravesical ureterocele. A case records of 64 neonates who underwent endoscopic procedures for intravesical ureterocele, performed at our institution from January 2005 to January 2021, were retrospectively reviewed. The patients were divided in two groups depending on used endoscopic procedure. The first group (n=41) consisted of patients who underwent electrosurgical incision of the ureterocele, while the second group (n=23) consisted of patients in whom 6 to 8 laser-punctures of the ureterocele were performed. The groups were compared in regards to outcomes of treatment, with special emphasis on de novo vesicoureteral reflux and the need for further treatment and surgery. Median follow-up was 7.5 (IQR 3, 11.5) and 3.5 (IQR 1.5, 5) years in the electroincision and laser-puncture groups, respectively (P=0.017). No significant differences between the groups in regards to medians of duration of surgery (12min vs. 11 min, P=0.670), length of hospital stay (2 days in both groups, P=0.988) or postoperative obstruction (n=1 vs. n=0, P>0.999) were recorded. Ureterocele decompression was achieved after endoscopic treatment in 87.9% and 100% of the patients in electrosurgery and laser-puncture groups, respectively (P=0.150). Five patients (12.1%) from electrosurgery group required endoscopic retreatment. The laser-puncture group had a significantly decreased rate of de novo vesicoureteral reflux (8.7% vs. 58.5%; P=0.0001) and lower incidence of subsequent surgery due to de novo vesicoureteral reflux (50% vs. 62.5%; P=0.727). Both electrosurgical incision and laser-puncture endoscopic techniques are safe and effective in relieving the obstruction. Laser-puncture technique is associated with significantly lower incidence of de novo vesicoureteral reflux and accordingly fewer invasive procedures for neonatal patients.

Effectiveness of endoscopic treatment of duplex system ureteroceles in children

Objective. The aim of this study is to evaluate the efficiency of transurethral incision of ureteroceles and incidence of vesicoureteral reflux in pediatric patients with duplex system ureterocele.&#x0D; Materials and methods. This is a retrospective study of 155 pediatric patients with duplex system ureterocele. The age of patients at the time of surgery ranged from 5 days to 17 years (median 8.0 months). Intravesical ureterocele had 108 patients (69.8%), extravesical 47 (30.2%).&#x0D; Results. Complications occurred in 2 patients (1.3%), recurrence obstruction was in 1 case (0.6%). Ipsilateral vesicoureteral reflux after surgery had 112 patients (72.3%): in the upper pole 51 cases (32.9%), in the lower pole 32 (20.6%), in both ureters 29 (18.7%). In the long-term period after transurethral incision of ureteroceles 97 patients (62.5%) needed reoperation due to infection and voiding dysfunction. Statistically significant risk factors associated with the need for reoperation were the presence of vesicoureteral reflux on the ureteroceles side and non-functioning upper pole of the kidney.&#x0D; Conclusion. Transurethral incision of ureteroceles for duplex system ureterocele is a safe and effective minimally invasive method of primary resolving of the obstruction. Vesicoureteral reflux on the ureterocele side after surgery had 72.3% of patients; reoperation in the long term was necessary in 62.5% cases. The main risk factor reoperation is vesicoureteral reflux on the ureterocele side.

Giant ureterocele management in an adult male: A rare case report

Ureterocele is dilatation of lower ureter at its entry into the urinary bladder. It is classified into the single or duplex system and acquired or congenital. Acquired type is rare and seen in adults. We report the case of a 23-year-old male presented with voiding lower urinary tract symptoms and intermittent flank pain. He had a history of frequent spontaneous stone passage with right colicky pain 2 years back. On ultrasonogram and magnetic resonance urogram, diagnosis was made as right renal hydronephrosis with hydroureter due to right side giant intravesical ureterocele. The patient was managed by endoscopic transurethral incision and excision of ureterocele. It is the first case ever reported in the literature, where in giant ureterocele was completely removed by total endoscopic approach.

Antenatally detected ureterocele: Associated anomalies and postnatal prognosis

ObjectiveWe purposed to review prenatal diagnoses of ureterocele, to determine the sonographic findings and additional abnormalities, and to illustrate the pregnancy outcomes of these patients. Material and methodsWe reviewed the records of 24 patients with the diagnosis of ureterocele in our referral center between January 2010–March 2017. Prenatal sonographic findings, antenatal course, and postnatal follow-up were obtained. ResultsThe mean gestational age at first US diagnosis was 24.5 ± 2.9 weeks. 13 (54.1%) of fetuses were female, and 11 (45.9%) were male. Ureterocele was associated with the duplex kidney in 17 (70.8%), MCDK in 5 (20.8%) and hydronephrosis with a single system in 1 (4.2%) and pelvic kidney in 1 (4.2%) fetuses. Postnatal follow-up was achieved in 22 of 24 (91.6%) cases, and mean follow-up interval was 56 ± 14.2. Months. The diagnosis of ureterocele was confirmed in 22 (91.6%) cases postnatally. 15 of 22 (68%) cases were classified as extravesical ureterocele, and 7 (32%) cases were intravesical ureterocele. Postnatal confirmation of duplex kidney achieved in 16 of 17 (94.1%) patients. 17 (77.2%) patients were required surgical intervention, and 5 (22.8%) cases were managed conservatively. 15 of 16 (93.7%) cases who were diagnosed duplex kidney underwent surgery however 2 of 5 (40%) cases which were confirmed MCDK required an operation. Cystoscopic ureterocele incision was the initial approach for the surgical management and performed all of the cases which required surgery. It was curative in 10 of 17 (58.8%) patients and 7 (41.2%) cases needed to further operations. Ureteroselectomy and common-sheath ureteroneocystostomy was performed in 5 (29.1%) cases and. 2 (%11.7%) cases underwent partial nephrectomy. ConclusionUreterocele can be accurately diagnosed by prenatal sonography, and it is a significant clue for the diagnosis of a duplex kidney. Postnatal prognosis depends on associated anomaly and presence of reflux and upper pole function.

Ipsilateral ureteroureterostomy for ureteral duplication anomalies: predictors of adverse outcomes

Ipsilateral ureteroureterostomy (UU) has gained popularity for treating ureteral duplication (UD) associated with obstruction or vesicoureteral reflux (VUR). Several studies have demonstrated its high success rate and low morbidity. This study aimed to identify the predictors of adverse outcomes associated with UU. A retrospective chart review was conducted for patients with UD treated with UU at the study institution. Patients with less than 6 months of follow-up were excluded. Charts were reviewed for demographics, pre-operative imaging, surgical indications, operative notes, and follow-up data. Pre-operative and intra-operative variables were tested for association with adverse outcomes includingunplanned surgery, worsening hydronephrosis, and febrile UTI recurrence. A total of 35 patients underwent UU for UD between 2009 and 2017at the study institution. The majority (33/35) had a distal anastomosis. A concomitant re-implantation of the recipient ureter was performed in 9 (25.7%) patients. After a median follow-up of 36.7 months, adverse outcomes developed in 9 patients (25.7%). No further surgery was required in 88.6% of the subjects. Adverse outcomes were associated with female gender (p=0.048) and hydronephrosis of both upper and lower moieties (p=0.015)and were more likely associated with ectopic ureteroceles (50%, p=0.074) and having a concomitant re-implant performed (44.4%, p=0.19) (table). In this study, the low re-operation rates of UU for treating UD in patients with ectopic ureters or intravesical ureteroceles was demonstrated. The majority of patients with ectopic ureteroceles treated with UU and concomitant ureteral re-implantation had worsening hydronephrosis of both moieties and recurrent febrile UTI in the absence of mechanical obstruction. Interestingly, some of them had progression of hydronephrosis after excision of the upper pole. While worsening of hydronephrosis of the recipient moiety after UU was historically attributed to yo-yo reflux, most of the study patients did not have worsening hydronephrosis despite having distal anastomosis. Therefore, mechanical obstruction should be ruled out, and any underlying bladder dysfunction should be aggressively managed in patients with worsening hydronephrosis or recurrent UTI after UU before considering additional surgery. Ureteroureterostomy is a successful option for UD with a low risk of adverse events in patients with ectopic ureters or intravesical ureteroceles. However, it should be cautiously considered in patients with hydronephrosis of both moieties, with ectopic ureteroceles, or if a concomitant re-implant is needed.

Intravesical Ureterocele into Childhoods: Report of Two Cases and Review of Literature

Intravesical Ureterocele into Childhoods: Report of Two Cases and Review of Literature

Introduction to Ureteroceles: Presentation, Diagnosis, and Initial Management

The diagnosis and treatment of ureteroceles continue to evolve. Not only are the majority of patients diagnosed prenatally, but a significant proportion of cases can be dealt with in a minimally invasive, endoscopic fashion. Although a single treatment strategy for all ureteroceles is an unrealistic expectation, more valuable to the practicing urologist is an understanding of the variable anatomy and presentation of this entity and an appreciation for the breadth of treatment options at his or her disposal. This, the first of our two reviews on ureteroceles, provides the necessary background. This review contains 10 figures, 6 tables and 35 references Key words: bladder trigone, cecoureterocele, ectopic ureterocele, extravesical ureterocele, intravesical ureterocele, lower tract approach, obstructed ureterocele, reflux, transurethral incision, transurethral puncture, upper tract approach, ureterocele, ureterocele algorithm

Introduction to Ureteroceles: Presentation, Diagnosis, and Initial Management

The diagnosis and treatment of ureteroceles continue to evolve. Not only are the majority of patients diagnosed prenatally, but a significant proportion of cases can be dealt with in a minimally invasive, endoscopic fashion. Although a single treatment strategy for all ureteroceles is an unrealistic expectation, more valuable to the practicing urologist is an understanding of the variable anatomy and presentation of this entity and an appreciation for the breadth of treatment options at his or her disposal. This, the first of our two reviews on ureteroceles, provides the necessary background. This review contains 10 figures, 6 tables and 35 references Key words: bladder trigone, cecoureterocele, ectopic ureterocele, extravesical ureterocele, intravesical ureterocele, lower tract approach, obstructed ureterocele, reflux, transurethral incision, transurethral puncture, upper tract approach, ureterocele, ureterocele algorithm

The "cyst within cyst" sign of intravesical ureterocele.

The "cyst within cyst" sign of intravesical ureterocele.

Laser-puncture Versus Electrosurgery-incision of the Ureterocele in Neonatal Patients.

Purpose: To compare the holmium-laser puncture and electrosurgery-incision in neonates with intravesical ureterocele. Materials and Methods: We retrospectively analyzed the results of laser-puncture of ureterocele (LP group) in 12 patients (mean age 9.8 days, range 4-28) and electrosurgery-incision in 20 patients (ES group) (mean age 10.2 days, range 6-28), treated at our institution. Patients had their records reviewed for preoperative findings, endoscopic procedure description, and postoperative outcomes. Results: There was the need for retreatment in one (8.3%) patient in LP group and in four (20%) patients in ES group (P = .626). Duration of general anesthesia in LP and ES groups was 16 (range, 10-24) minutes and 15 (range, 10-20) minutes, respectively (P = .355). There was no statistically significant difference in terms of hospitalization (LF group one day, ES group 1.35 days) (P = .286). Complications were not found in LP group. There were two (10%) patients with pyelonephritis after the treatment in ES group (P = .516). After one month, obstruction was observed on ultarsound examination in one (8.3%) and two (10%) patients, respectively. After three months, obstruction was not found in any patient in both groups. After six months, vesicoureteral reflux was found in one (8.3%) patient after laser-puncture of the ureterocele and in 13 (65%) patients after electrosurgery-incision (P = .003). Conclusion: Both laser-puncture and electrosurgery-incision endoscopic techniques are highly effective in relieving the obstruction. There is no significant difference regarding hospitalization, need for retreatment and the occurrence of complications. The incidence of de novo vesicoureteral reflux is significantly lower in patients treated with holmium-laser, as well as the need for upper pole partial nephrectomy.

Transurethral incision of ureteroceles in paediatric age group.

Ureteroceles are a great clinical challenge because of variations in anatomy and clinical presentations. We present our experience with primary transurethral incision of ureteroceles in children. Data of thirteen children managed for ureterocele from 2009 to 2016 was retrospectively analyzed with respect to age, sex, clinical presentation and symptomatology, type and localization of ureterocele, investigations, surgical management and follow-up. A total of 13 patients with ureteroceles were managed. There were 7 males and 6 females. Six were neonates with antenatal diagnosis of ureteroceles. Five patients presented with urinary tract infection and two were diagnosed during ultrasound for abdominal pain. The ureteroceles were on the right side in 7 patients and left in 6 patients. Six patients had a duplex system-five on right side and bilateral in one. Two patients had ureteroceles in solitary kidney. Four patients had associated hydronephrosis and hydroureter and two had only hydronephrosis alone. One patient had bilateral grade III reflux in the bilateral lower moieties of the patient with bilateral duplex system. Two patients had poorly functioning kidney on radionuclide scan. All patients underwent cystoscopic incision of the ureteroceles. Eleven had intravesical ureteroceles and two had large caeco-ureteroceles. Two patients required ureteric reimplantation during follow-up. Though the approach of managing a patient with ureterocele should be individualized, transurethral incision remains valuable as a primary intervention with regular follow up. It may even prove to be the only intervention required in most of the patients.

Anastomosis ureteroureteral: una alternativa para pacientes con enfermedad asociada a doble sistema colector

Introduction and objectivesDuplicated collecting system is a common congenital renal disorder and has an incidence of 0.8%. There are several treatment options available for the severely dilated ureter or reflux associated with a duplicated system, including hemi-nephrectomy, uretero-ureteral anastomosis, and ureteroneocystostomy. The aim of this article is to present our experience of the uretero-ureteral anastomosis as an alternative for patients with renal pathology associated with duplicated collecting system. Materials and methodsA retrospective review was performed, between July 2011 and April 2014, on the medical records of patients with duplicated collecting system and associated disorders and who underwent uretero-ureteral anastomosis. Demographics, such as age, sex, laterality and postoperative outcomes were analysed. ResultsA total of 10 patients underwent uretero-ureteral anastomosis, of whom 7 were female and 3 were male. The mean age of patients was 5 years (1-13 years). There were 6 patients with right pathology; 9 patients had urinary tract infection, and one had permanent urinary incontinence. Ectopic ureter was diagnosed in 4 patients, 3 patients had intravesical ureterocele and 3 had vesicoureteral reflux to the lower system. Seven upper to the lower anastomosis system and 3 lower to the upper system anastomosis were performed. All were made by 2cm inguinal incision, and all patients had a double J catheter bypass. ConclusionsThe uretero-ureteral anastomosis is a reliable and safe alternative with low morbidity. It is effective for the treatment of patients with duplicated collecting system associated to renal pathology.

Bilateral giant orthotopic ureterocele appearing as kissing cobra in a Nigerian child

The cobra head sign is classically seen when a unilateral intravesical ureterocele is present. This type of ureterocele is also termed orthotopic. Orthotopic ureteroceles are usually unilateral and commoner in females, but bilateral in 10% of cases.The cobra head sign is characterised by bulbous dilatation of the distal end of the ureter with a surrounding radiolucent halo seen within the contrast-filled urinary bladder on intravenous urograms. Although, the cobra head sign is classic for an intravesical ureterocele, only about 50% of cases show this sign. This is a rare case of an eleven-year old boy with giant bilateral ureterocele touching each other on intravenous urogram, hence appearing as 'kissing cobra'.

V541 ROBOTIC INTRAVESICAL URETEROCELE EXCISION

You have accessJournal of UrologyPediatrics1 Apr 2012V541 ROBOTIC INTRAVESICAL URETEROCELE EXCISION Brian Rosman, Courtney Rowe, Alan Retik, and Hiep Nguyen Brian RosmanBrian Rosman Boston, MA More articles by this author , Courtney RoweCourtney Rowe Boston, MA More articles by this author , Alan RetikAlan Retik Boston, MA More articles by this author , and Hiep NguyenHiep Nguyen Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.615AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureterocele excision is a procedure that is typically performed in an open fashion. The robotic approach has many challenges associated with it, as well as many advantages. This video will demonstrate several techniques, including bladder fixation and port closure techniques, which can make a robotic approach a feasible, safe, and effective option for ureterocele excision. METHODS A suitable patient was selected that had a large enough bladder, clinical indication for ureterocele excision, and interest in a robotic approach. The patient had a right sided congenital multicystic kidney without much function, and underwent a right nephroureterectomy previously. He had recurrent episodes of hematuria, and a ureterocele was identified. The ureterocele was a simple orthotopic stenotic ureterocele, seen on VCUG as a filling defect, and confirmed cystoscopically. The decision was made to definitively treat the ureterocele after cystoscopic de-roofing failed to relieve the symptoms. After cystoscopy was performed, two stay sutures were placed through the rectus muscle and all bladder layers to hitch the bladder to the abdominal wall during the procedure. This prevented the bladder from falling away from the abdominal wall during surgery, and pulling out the robotic ports. The ports were placed, along with a Veress needle. The bladder was drained of urine and insufflated, and the camera and instruments placed. The ureterocele was identified, and excised with monopolar scissors. The defect in the detrusor muscle was closed in two layers. This patient had a previous nephroureterectomy on the ipsilateral side, therefore no re-implant was required. The ports were removed, and the port holes closed using a “suture suspension disc”. This disc was used before port placement, and acts as a stencil for proper port and suture placement, ensuring that the preplaced sutures are able to tightly close the port site. RESULTS This patient did very well post-operatively, with minimal pain, quick return to eating and drinking and ambulating, and was discharged from the hospital 24 hours after his procedure. He had no further hematuria or obstructive symptoms on repeat follow-up examinations. CONCLUSIONS With the techniques detailed in this video, the difficulties of robotic ureterocele excision can be easily overcome, allowing the benefits of the minimally invasive approach to be applied to intravesical ureterocele excision. Robotic intravesical ureterocele excision is a safe and effective procedure. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e222 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian Rosman Boston, MA More articles by this author Courtney Rowe Boston, MA More articles by this author Alan Retik Boston, MA More articles by this author Hiep Nguyen Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Robotic Intravesical Ureterocele Excision

Introduction: Ureterocele excision is a procedure that is typically performed in an open fashion. The robotic approach has many challenges associated with it, as well as many advantages. This video will demonstrate a robotic intravesical ureterocele excision, highlighting several novel techniques to aid the procedure, including bladder fixation to the rectus muscle and a unique approach to effective and watertight port closure, which can make a robotic approach a feasible, safe, and effective approach to ureterocele excision. Methods: A suitable patient was selected who had a large enough bladder, clinical indication for ureterocele excision, and interest in a robotic approach. The patient had congenital multicystic kidney without much function, and underwent a right nephroureterectomy previously. He had recurrent episodes of hematuria, and a ureterocele was identified via voiding cystourethrogram (VCUG). The ureterocele was a simple orthotopic stenotic ureterocele, seen on VCUG as a filling defect, and confirmed cystoscopically. The decision was made to definitively treat the ureterocele after an attempt at cystoscopic de-roofing failed to relieve the symptoms. After initial cystoscopy was performed, two stay sutures were placed through the rectus muscle and all bladder layers to hitch the bladder to the abdominal wall during the procedure. This prevented the bladder from falling away from the abdominal wall during surgery, and pulling out the robotic ports, and was performed under cystoscopic observation. The robotic ports were placed, along with a Veress needle. The bladder was drained of urine and insufflated, and the camera and instruments placed. The ureterocele was identified, and excised with monopolar scissors. The defect in the detrusor muscle was closed in two layers with vicryl and chromic gut sutures. This patient had a previous nephroureterectomy on the ipsilateral side; therefore, no re-implant was required after the excision. The ports were removed, and the port holes closed using a suture suspension disc. This disc was used as a guide before port placement, and acts as a stencil for proper port and suture placement, ensuring that the preplaced sutures are in the correct position to be able to tightly close the port site. Results: This patient did very well postoperatively, with minimal pain and quick return to eating and drinking and ambulating, and was discharged from the hospital 24 hours after his procedure. He had no further hematuria or obstructive symptoms on repeat follow-up examinations. Conclusions: With the techniques detailed in this video, the difficulties of robotic ureterocele excision can be easily overcome, allowing the benefits of the minimally invasive approach to be applied to intravesical ureterocele excision. Robotic intravesical ureterocele excision is a safe and effective procedure. The authors have no professional or financial conflicts of interest to disclose regarding this video or procedure. Runtime of video: 7 mins 03 secs