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VR-16
(VS)
PEDIATRIC ROBOT-ASSISTED LAPAROSCOPIC UPPER POLE PYELOPLASTY AFTER
URETEROURETEROSTOMY
Patricia CHO, Ashley WIETSMA, Michael HOLLIS and Richard YU
Boston Children's Hospital, Harvard Medical School, Urology, 02115, USA
INTRODUCTION
In the pediatric population, robotic-assisted laparoscopic pyeloplasty after previous failed open repair has demonstrated
feasibility, safety, and clinical improvement. Pyeloplasty for ureteropelvic junction obstruction in complete duplex
systems can be performed minimally invasively, but renal tissue preservation may be more challenging due to aberrant
anatomy and after prior open surgery. We present a case of robotic-assisted laparoscopic upper pole pyeloplasty after
failed open ureteroureterostomy.
METHODS
The patient is a 2 year old female (13.4kg) with a left duplex kidney associated with upper pole hydronephrosis for
which an open left ureteroureteroscopy was performed one year prior. Following this surgery, hydronephrosis persisted.
Renal ultrasound and MR urogram demonstrated severe left upper pole pelviectasis secondary to vascular compression.
The left upper pole accounted for 19% of renal function with 36% for the left lower pole and 45% for the right kidney. A
robotic-assisted laparoscopic left upper pole pyeloplasty with cystoscopy and retrograde pyelogram was performed.
RESULTS
The previous ureteroureterostomy site was found to be widely patent, but the upper pole UPJ was extrinsically
compressed by flanking renal arteries. A dismembered pyeloplasty with ureteral stent placement was accomplished.
There were no intraoperative or postoperative complications. The patient was discharged on postoperative day 1
following removal of the urethral Foley catheter. The ureteral stent was removed 8 weeks postoperatively. Renal
ultrasounds at 3 and 15 months postoperatively demonstrated very mild hydronephrosis.
CONCLUSIONS
Robotic-assisted laparoscopic pyeloplasty can be utilized safely and effectively even in young children for redo repair
with aberrant renal anatomy.