Surgical Treatment of Primary Obstructive Megaureter with Robotic Ureteral Tapering and Ureteroneocystostomy

Introduction:

Our aim is to present the details of robotic ureteral tapering and ureteroneocystostomy (UNC) in a child with symptomatic primary obstructive megaureter through a video presentation.

Materials and Methods:

An 8-month-old male infant, who was followed up for left hydronephrosis diagnosed prenatally, showed on postnatal imaging a thinned left renal parenchyma (4 mm), dilatation of the pelvicalyceal system with a renal pelvic AP diameter of 20 mm, and ureteral dilatation throughout its course, measuring 14 mm distally. Functional evaluation revealed that the left kidney had supranormal function (57%), and the drainage curve was obstructive. Voiding cystourethrography showed no vesicoureteral reflux. Continuous antibiotic prophylaxis was initiated after birth. Despite prophylaxis, one febrile urinary tract infection requiring hospitalization was documented. Following confirmation of sterile urine culture, the patient was diagnosed with an obstructive megaureter and robotic ureteral tapering, and UNC was performed.

Results:

The total mean operative time and the surgeon’s console time were 110 and 65 min, respectively, with an estimated blood loss of <15 mL. The patient began oral feeding on the fourth postoperative hour. Routine analgesic use continued for 48 h (paracetamol 10 mg/kg ×4). The urethral catheter and drain were removed on the second day, and the child was discharged on the third day. The postoperative course was uneventful, with no symptomatic urinary tract infections. Prior to double-J stent removal, preoperative urine culture yielded 70,000 CFU of Enterococcus, and appropriate antibiotic therapy was administered. The stent was removed at 1 month. One month later, urinary ultrasound demonstrated increased left renal parenchymal thickness to 7 mm and a decrease in renal pelvic anteroposterior diameter to 6 mm. Follow-up is ongoing.

Conclusion:

In patients where ureteral dilation is thought to impact the effectiveness of the submucosal tunnel, robotic ureteral tapering followed by reimplantation of the ureter, with reduction of ureteral caliber, can be performed safely and effectively. The presence of ureteral dilation should not be considered a contraindication for robotic surgery.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

This work originated from Istanbul University—Cerrahpasa, Cerrahpasa Faculty of Medicine, Urology Department. The authors declare that there are no conflicts of interest or obligations related to this study.

The authors have no commercial associations or financial relationships during the last 3 years that might create a conflict of interest in connection with this video.

All authors read and approved the final article.