Gokhan Berktug Bahadir; Bahadir Caliskan; Sevim Ecem Unlu Balli; Huseyin Emre Atasever; Gulenay Korkmaz; Ervin Mambet; Mustafa Kemal Aslan; Ilhami Surer; Suzi Demirbag; Gulhane Training and Research Hospital, Pediatric Surgery
Aim: The aim of this study is to share of robotic ureteroneocystostomy and ureteral narrowing performed for iatrogenic ureterovesical stenosis.
Case: Stage four vesicourethral reflux was detected in a three-years-old boy who was followed for antenatal hydronephrosis and had recurrent urinary tract infection. Previously subureteric injections were performed in an external center. Radiological and scintigraphic examination revealed decreased right renal function (11%), severe hydroureteronephrosis and ureterovesical stenosis. The patient underwent robotic ureteroneocystostomy and ureteral narrowing. The patient was discharged on the 8th postoperative day and has been followed up for 11 months. The patient no longer had urinary tract infection and renal function was found to be 16%.
Discussion: Ureteral injection is a minimally invasive method commonly used in the treatment of vesicourethral reflux. However, it can cause serious complications. In problematic cases, robotic surgery can be performed safely and more easily compared to open surgery.
Good day. I will present you the robotic surgery for iatrogenic ureteral vesicle stenosis. A 3-year-old boy who was followed for antenatal hydronephrosis and who had performed 2 times subureteric injection in the other center due to vesicoureter reflux was admitted. Severe right ureteral vesicular stenosis was detected on an MR ururography of the child with recurrent urinary tract infections. Right kidney function was calculated as 11th% in DMSA. Laparoscopic assisted robotic right ureteral tapering with reimplantation was planned to the patient at the picture operating room set up as shown. Unlike conventional laparoscopic surgery, the camera trocar was placed at approximately 3 cents above the umbilicus in the midline. Right and left 8 millimeter robotic working ports were placed where the umbilicus level and the front axillary line cross. A 10 millimeter assistant trocar was placed between the camera trochar and the left robotic trocar. Heather was fixed to the abdominal wall with two roans chewed. Severe right ureteral dilatation was observed, and the ureter was dissected until the urethral vesicle junction. The ureter is suspended by using plastic tape, and not to dissection, the urethro vesicle junction was found to be extremely fibrotic and stenotic. Previously performed injection materials were cleaned from the area. Ural vesicle junction was transected. However, no leakage was observed from the filled bladder. The serotoma line was marked to be 4 centimeters in length. The ureter was fixed to the abdominal wall to make the tapering process easier. Ural tapering was performed rapidly and comfortably due to unique advantages of robotic arms. Uterral reimplantation was performed in continuous fashion with 5 or vaquill. A double J catheter was inserted when the posterior urethral vesicle anastomosis was completed. The tussography was performed continuous fashion with 4 over water. Leakage control was performed by Saen and no leakage was observed. The patient was discharged on post-operative day 8. During the follow-up period, no urinary infection was observed. Right renal function was calculated on the DMSA at 16% in 2nd year. Thanks for listening.
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