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VR-42
(VS)
PRE-TRANSPLANT ROBOTIC ASSISTED LAPAROSCOPIC SIMPLE NEPHRECTOMY
WITH CREATION OF CATHETERIZABLE URETERAL STOMA
Paul KOKOROWSKI and Roger DE FILIPPO
Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Urology, Los Angeles,
USA
PURPOSE
Pre-transplant creation of a catheterizable urinary stoma is commonly recommended for boys with poor bladder
emptying secondary to posterior urethral valves. We describe a minimally invasive use of the native ureter as a
catheterizable channel in a boy with chronic renal disease and neurogenic bladder secondary to posterior urethral
valves.
MATERIAL AND METHODS
The patient is a 7-year-old boy with a history of stage IV chronic kidney disease secondary to posterior urethral valves
and bilateral high-grade vesicoureteral reflux, which resolved on the left side and persisted into a small dysplastic right
kidney. He was on intermittent catheterization with good capacity and compliance, but poor emptying. His GFR was
estimated at 15-29 ml/min with minimal function from the right kidney. Pre-transplant nephrectomy with catheterizable
vesicostomy was recommended and discussed with the family.
RESULTS
We placed a 12mm umbilical camera port, two 8mm robotic arm ports and one 5mm assistant port. A right nephrectomy
was performed and the ureter transected proximally. The robot was repositioned for the ureteral reimplantation with
vesicostomy creation. A submucosal tunnel was made along the right bladder wall. The detrusor muscle was re-
approximated as an anti-reflux valve and the proximal ureter brought out through the right lower quadrant. Continence
of the vesicostomy was tested and a drain positioned. Post-operative course was uneventful and the patient is
completely continent.
CONCLUSIONS
Robotic assisted laparoscopic simple nephrectomy with creation of a continent native ureter stoma is a feasible
minimally invasive method for creating a catheterizable vesicostomy in carefully selected patients.