165 / 330
165
19–22 APRIL, 2017, BARCELONA, SPAIN
RESULTS
Over a 16-year period, 111 HN were performed: 51 RH and 61 LH. Upper Moiety (UM) was removed
in 86 and Lower Moiety (LM) in 25. Median age at surgery: 20.4 months (2-168 months). Mean
operative time: 141min (57-327min).
Overall incidence of polar cysts at resection margin:38.7%, with 23(27%) UM and 20(80%) LM
cysts. Endoloop technique was employed in 39 to transect the renal parenchyma, 34RH and 5LH.
Polar cysts were seen in 26/34RH and 4/5LH. The incidence of cysts with endoloop was 77%.
Resolution was noted in 4.
Harmonic scalpel was used in 67, in whom 9/55LH and none of the 12RH had residual cysts. The
incidence of cysts was 13% and resolution was noted in 3.
36 had minimum of 24months follow-up. 29 patients were discharged in whom the cysts: disap-
peared in 7, unchanged in 16, decreased in size 5 and 1 had no further USS. No cyst required
surgical management. 2 were lost from F/U.
CONCLUSIONS
The incidence of polar cysts after heminephrectomy is significantly higher when LM is involved and
with the use of endoloop to transect the renal parenchyma. Although cyst formation is common, it is
highly unlikely to require further intervention. Therefore, serial USS follow-up is no longer indicated.
11:09–11:14
S15-9 (VP)
★
ROBOTIC ASSISTED “KEEL” BLADDER NECK
CONSTRUCTION IN AN OBESE PATIENT WITH
URO‑GENITAL SINUS
Dario Guido MINOLI
1
, Alfredo BERRETTINI
2
, Erika Adalgisa DE MARCO
2
,
Mirella MOGIATTI
2
, Bernardo ROCCO
3
and Gianantonio MANZONI
2
1) Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, UOSD Urologia Pediatrica, Milano, ITALY
- 2) Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, UOSD Urologia Pediatrica, Milano, ITALY -
3) Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Urologia, Milano, ITALY
PURPOSE
In the last years the use of robotic technology has gained popularity, allowing performance of the
most difficult reconstructive procedures. This video demonstrates the advantages of the robotic
approach for a “keel” bladder neck construction in an obese adolescent girl.
MATERIAL AND METHODS
A 13 year-old-girl (BMI 28) already treated elsewhere for a uro-genital sinus (Total Urogenital
Mobilization and VUR endoscopic correction) has been evaluated for persistent total urinary in-
continence. Cisto-colposcopy revealed a mild introital vaginal stenosis and an extremely short and
tortuous urethra. Bladder neck was wide open and patulous. MCU and Urodynamic evaluation
showed a bladder with a capacity of 280 ml without developing high voiding pressures (14-16 cm
H20) with continuous and persistent urinary leakage. Normal renal function was confirmed with
a MAG3 renal scan. Thus, the girl underwent a laparoscopic robotic-assisted “keel” bladder neck
construction.
RESULTS
The patient was discharged on 5
th
post-operative day without complications. After 9 months she
is voiding spontaneously (volume 230cc) without post-void residuals. She still presents with minor
leakages (stress incontinence/urgency). A recent cystoscopy has been performed with bulking
agent injection in the neo-bladder neck with initial improvement of her continence.