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19–22 APRIL, 2017, BARCELONA, SPAIN
RESULTS
An infant diagnosed in utero with hypertrophied bladder with dilatation of both urinary tracts. After
72 hours of the birth, the patient underwent a VCUG that confirmed the hypothesis of PUV and
showed severe ureterohydronephrosis. The neonate underwent primary fulguration of PUV using
StoneLight™ Holmium Laser with 5 days old.
CONCLUSIONS
PUV ablation using laser energy is a safe, feasible and effective alternative for endoscopic tran-
surethral treatment.
VS-17 (VS without presentation)
VAS JOINING THE URETER – MANAGEMENT DILEMMA
AT UNDESCENDED TESTIS SURGERY
Venkat SRIPATHI
1
, Aparajita MITRA
1
, Rajiv PADANKATTI
2
and Kj RAGHUNATH
3
1) Apollo Children's Hospital, Pediatric Urology, Chennai, INDIA - 2) Apollo Children's Hospital, Pediatric Surgery,
Chennai, INDIA - 3) Apollo Children's Hospital, General Surgery, Chennai, INDIA
PURPOSE
Ectopic vasal insertion is an exceptionally rare entity with only 27 cases reported till date. These
may be explained by Stephens’ Proximal Vas precursor concept i.e. encroachment of the process of
ureterisation towards the Wolffian duct area. Vasal ectopia (into the ureter) seen in an undescended
testis has never been reported in literature. The ensuing video presentation of the surgery is also
the first of its kind.
MATERIAL AND METHODS
A 5 year old presented with a right impalpable testis. An ultrasound had reported an intra-abdominal
testis near the internal ring and a right dysplastic kidney. DMSA revealed a single left function-
ing kidney. During laparoscopy, the vas was seen coursing upwards. Dissection showed that it
terminated in a ureter attached to a dysplastic low placed kidney. In view of this unexpected devel-
opment, parents were appraised and consent sought for dysplastic kidney removal. The parents
were adamant that the testis be preserved at all costs. Since the vessels to the testis had been
ligated in preparation for a stage I Fowler-Stephens orchidopexy, the gubernacular attachment was
preserved and testis positioned in the scrotum.
RESULTS
Follow up six months later showed a well located testis though a Doppler ultrasound is awaited. The
dysplastic renal moiety along with the ureter and ectopic vas were excised.
CONCLUSIONS
This report represents an unusual embryological malformation during a commonly performed pro-
cedure. We believe that the possibility of an ectopic vasal insertion of an impalpable undescended
testis should be kept in mind and an algorithm for management evolved. We hope our presentation
will help in its evolution.