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ADOLESCENT HINMAN'S SYNDROME : A ROBOTIC CHALLENGE
Dario Guido MINOLI
1
, Bernardo ROCCO
2
, Santiago VALLASCIANI
1
, Alfredo BERRETTINI
1
and Gianantonio MANZONI
1
1) Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico - Milano, Pediatric Urology, Milano, ITALY - 2)
Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico - Milano, Urology, Milano, ITALY
PURPOSE
The advent of robotic surgery has radically changed the surgical and reconstructive strategy in pediatric urology. This
video demonstrates the advantages of a robotic approach in an adolescent with Hinman Syndrome (non-neurogenic
neurogenic bladder).
MATERIAL AND METHODS
A 13-year-old boy weighing 31Kg was admitted to our hospital with fever, acute urinary retention, renal failure and
bilateral massive hydro-ureteronephrosis. In the past few months he had developed progressive voiding disturbance,
urinary incontinence and severe constipation.
Immediate treatment consisted of continuous urinary drainage (initially trans-urethrally then with suprapubic
cystostomy) and homeostasis. Further studies (US, VCUG, MRI, DMSA renal scan, cysto-urethroscopy) confirmed
bilateral massive vesico-ureteric reflux, poor right renal function, a huge thick walled trabeculated bladder and a normal
urethra. A final diagnosis of non-neurogenic neurogenic bladder was confirmed. Trans-urethral catheterisation (CIC) was
refused and the creation of a catheterisable channel was mandatory.
A robotic assisted reconstructive treatment was achieved: a Mitrofanoff channel was created using the distal part of the
right ureter (following extra-vesical reimplantation) along with a right-to-left trans-uretero-ureterostomy. A VQZ stoma
completed the procedure.
RESULTS
He was discharged home after 2 days with an uneventful recovery. He is presently performing self-CIC with no
difficulties and the bilateral hydro-ureteronephrosis has resolved.
CONCLUSIONS
A complex and demanding situation in a difficult adolescent was successfully managed with a minimally invasive
approach. The robotic reconstruction was also fundamental in the persuasion and consent process of an extremely
difficult psychological scenario