Robot-assisted bilateral ureteric stone removal with tailored ureteral reimplantation for congenital megaureter

INTRODUCTION AND OBJECTIVE: Primary obstructive megaureter (POMU) is uncommon in adults. Stone formation may uncover the underlying congenital abnormality in these patients. We present a case of bilateral congenital megaureter with lower ureteric stones in an adult and illustrating a minimally-invasive approach for surgical correction.

METHODS: A 30-year-old female presented in emergency with uremic features with creatinine of 13.4 mg/dl. Bilateral percutaneous nephrostomies were placed and the patient improved gradually, serum creatinine came down to 1.6 mg/dl. Renal dynamic scan showed differential function of right kidney – 80% and left kidney – 20% function with bilateral delayed clearance, GFR was 40 ml/min. Nephrostogran revealed bilateral hydroureteronephrosis with large calculi in lower ureters. Robot-assisted bilateral ureterolithotomy, excisional tailoring of ureters, and bilateral ureteric reimplantation was done using extravesical modified Lich- Gregoir method.

RESULTS: The total operative time was 240 minutes, with an estimated blood loss of 200 mL. The patient’s hospital course was uneventful. Postoperative diuretic renogram at 3 months showed bilateral non obstructive drainage. After one year, serum creatinine is stable at 1.4 mg/dl and diuretic renogram shows bilateral non obstructive drainage.

CONCLUSIONS: We have demonstrated a technique for robot-assisted bilateral ureteric stone removal with tailored ureteral reimplantation for congenital megaureter. Robotic assisted approach for ureteral reconstruction is safe and effective while minimizing morbidity and achieves similar results as open surgery.

Video presentation, narrated,with PPT’s, CT Scans, X-rays, Nephrostograms, photos and robotic surgery videos, 07:43

A KS Robotic Surgery Video Awards Finalist, Robotic Surgeons Council of India.