Robotic Assisted Right Laparoscopic Ureterectomy of a Refluxing, Retroiliac Ureter
Megan Amber Stout, MD, Alyssa Lombardo, MD, Molly Fuchs, MD, Daniel Dajusta, MD, Christina Ching, MD.
Nationwide Children's Hospital, Columbus, OH, USA.
BACKGROUND: We present an interesting case of a blind ending retroiliac ureter. Urology was consulted on a newborn former 31 week male with presumed VACTERL syndrome for possible urinary tract anomaly. Initial postnatal renal ultrasound demonstrated a normal left kidney with an empty right renal fossa. There was an apparent fluid-filled structure located posterior to the bladder. The bladder was otherwise normal in contour and appearance. VCUG was obtained showing reflux into the presumed dilated right ureter. MRU showed an ectatic tubular structure located within the right abdominopelvic cavity with a refluxing, dilated ureter. No right reniform tissue was present. The patient was followed conservatively on antibiotic prophylaxis. He had periodic renal ultrasounds showing persistence of the presumed dilated right ureter. Due to concerns for the refluxing ureteral segment to be a reservoir of bacterial colonization, right ureterectomy with possible nephrectomy of any residual right reniform tissue was planned.
METHODS: We proceeded with a robotic approach. The patient was given perioperative antibiotics, placed in supine position, and foley catheter was placed at the start of the case. The abdomen was accessed through open hasson technique at the umbilicus with right robotic arm placement subxiphoid, and left robotic arm in the midline suprapubically. The right dilated ureter was immediately apparent upon access to the abdomen, and proximally appeared to be coursing directly behind the right iliac artery. The proximal portion was blind-ending, with no residual right renal tissue present. The ureter was removed in its entirety up to the level of the bladder, transected, and removed. The bladder was closed in two layers with 4-0 vicryl suture.
RESULTS: The patient tolerated the procedure well. He was discharged home on post-operative day two with an indwelling foley catheter that was removed one week later.
CONCLUSIONS: He was kept on his antibiotic prophylaxis until he followed up one month later with a renal ultrasound showing absence of the fluid filled structure.
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