Laparoscopic robotic takedown ureterostomy with extravesical cross-trigonal reimplantation after end cutaneous ureterostomy

Abstract

Introduction: The main goal of managing an obstructed megaureter (OMU) is to preserve the function of the affected kidney. To preserve the upper urinary tract, end cutaneous ureterostomy (ECU) seems to be a promising temporizing option. We aimed to evaluate our experience with ECU in patients with primary and secondary OMU and to demonstrate an efficacy of robot-assisted laparoscopic takedown ureterostomy and subsequent extravesical ureteric reimplantation.

Materials and methods: Retrospective analysis of patients that underwent ECU due to primary or secondary megaureter between 2003 and 2020. Nineteen patients (12 males, 7 females) with a mean age of 4.2 ± 3.5 months (mean ± standard deviation) underwent ECU of 27 renal units. Of those, 11 (57.9%) had primary OMU and 8 (42.1%) had secondary OMU. Undiversion was performed in 16 (84%) out of 19 patients (20 renal units out of 27 [74%]).

Results: In the vast majority of the cases, we have observed improvement in the hydronephrosis and renal function after ureterostomy. After reimplantation ultrasonography showed either stable or further improvement in hydronephrosis in 80% of patients. Robot-assisted laparoscopic patients had shorter admission period and indwelling catheter time after the surgery.

Conclusions: End cutaneous ureterostomy is a safe and effective temporary procedure for the treatment of progressive primary and secondary megaureters. Robot-assisted laparoscopic takedown of ureterostomy with subsequent reimplantation seems to be a good alternative for undiversion and subsequent reimplantation in these patients.

Keywords

Megaureter / Ureterostomy / Robotic surgery / Ureteral reimplantation

Acknowledgments

None.

Statement of ethics

This study was performed in accordance with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Sharee Zedek Medical Center (0115-20-SZMC), which waived the need for informed consent given the study's retrospective nature and examination of anonymized data.

Conflict of interest statement

The authors have no relevant financial or nonfinancial interests to disclose.

Funding source

The authors declare that no funds, grants, or other support was received for this study.

Author contributions

All authors contributed to the study conception and design and performed the material preparation, data collection, and analysis. The first draft of the article was written by Dr. Binyamin Neeman, and all authors commented on its previous versions. All authors have read and approved the final article.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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