Background:Duplex collecting systems pose the difficulty of often combining different problems such as reflux, obstruction and the presence of ureterocele. In the setting of poor functioning upper pole moieties, there are different strategies that can be used including ureteroureterostomy or heminephrectomy. In those cases, incomplete resection of the distal ureter and the ureterocele can lead to stump syndrome and often carry the need for additional procedures. The objective of this video to demonstrate the robotic approach is a safe and effective strategy to completely excise the distal ureter and ureterocele in patients with duplex collecting systems
MethodsCase series of patients with duplex collecting systems in which complete resection of the upper pole ureter and ureterocele was performed through a robotic approach.
Results2 patients with right duplex collecting system and ureterocele underwent extended ureterectomy and ureterocele resection through a robotic approach. Patient A was a 15-month-old boy with a non functioning right kidney and high grade reflux to the lower pole. Patient B was a 2 year old female patient with non functioning right upper pole and no vesicoureteral reflux. The procedure was done robotically in both cases after initial cystoscopy. There were no intraoperative complications. Time to Foley removal and length of stay was 3 days for patient A and 2 days for patient B.
ConclusionsThis video demonstrates that the robotic assisted approach can be used safely for the resection of the distal upper pole ureter and the ureterocele, which is fundamental to prevent complications from retained stump, thus avoiding additional procedures. Furthermore, it allows the combination of an upper urinary tract procedure with the total reconstruction of the lower urinary tract using small incisions. Further studies are needed in the future.
