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11–14 APRIL, 2018, HELSINKI, FINLAND
PATIENTS AND METHODS
An 11 year old male with a 5 month history of episodic flank pain and emesis was found to have
left primary obstructive megaureter and underwent surgical correction. Two 5 mm instruments are
used for the entirety of the procedure with an 8.5 mm camera port and no assistant port. A retro-
grade pyelogram is performed and double-J stent is placed prior to the robotic procedure. After
dissection of the ureter, the detrusor tunnel is created with blunt dissection and judicious use of
monopolar cautery, leading to the stenotic ureteral segment. The ureter is completely transected
distal to the stenotic segment at the level of the ureterovesical junction first. This allows the ureter
to be straightened, eliminating the tortuosity, and the redundant ureter excised to ensure a straight
ureteral course to the bladder. The anastomosis is started with an absorbable 3–0 V-lock suture
at 6 o’clock that holds the ureter on tension and defines the amount of ureteral tailoring necessary,
facilitating ureteral tapering. The detrusor tunnel is then closed over the ureter after the anastomosis
is completed with monocryl suture.
RESULTS
The patient was discharged on post-operative day 2, he remained symptom-free, and ultrasound
four months post-operatively revealed minimal residual hydronephrosis and no ureterectasis.
CONCLUSIONS
Dismembered ureteral reimplantation with intracorporeal tapering for obstructive megaureter is
advantageous with the robotic approach. In particular, our technique utilizes 5 mm instruments and
does not require an assistant port, and addresses both the ureteral dilation as well as the tortuosity
and redundancy of the ureter effectively.
VD-6 (VS without presentation)
MICROPERCTM KIT (POLYDIAGNOST, GERMANY) USED
TO TREAT A URETERIC STONE IN A CHILD
Erika LLORENS DE KNECHT
1
and Anna BUJONS
2
1) FUNDACIO PUIGVERT, Pediatric Urology Department, Barcelona, SPAIN - 2) Fundacio Puigvert, Pediatric Urolofy
Department, Barcelona, SPAIN
PURPOSE
Minimally invasive interventions and the use of smaller caliber ureteroscopes in the treatment of
ureteral stones decreases complication rates in children, for that reason are strongly preferred in
urolithiasis during childhood. There exist multiple indications for the micropercutaneous nephroli-
thotomy set (MicroPerc
TM
, (PolyDiagnost, Germany); unusual indications were described showing
that it can be useful to treat lower ureteric calculi, without the need for ureteric dilation.
MATERIAL AND METHODS
We present the case of a 5-year-old male with a right pelvic stone of 1 cm. As the guidelines say,
a pelvic stone of 10 to 20 mm can be treated with SWL as a first option. We performed a first shock
wave lithotripsy session. The US control described low ectasia due to a distal ureteric fragment. We
offered after no ejection, an active treatment and we performed a Micro-ureteroscopy. To performe
it we used the MicroPerc
TM
, kit, (PolyDiagnost, Germany) consisting in a 4.85F "All-Seeing Needle"
that could easily pass through the meatus without dilatation, and the 3 ways connector that allowed
the insertion of a 0.9 mm flexible micro-optic, irrigation system and a laser fiber. To achieve the
stone fragmentation, we used a 200-μm Holmium:YAG laser fiber with settings of 0.8 J–12Hz.
During the procedure, a C-arm fluoroscopy device was set.
RESULTS
The patient was discharged the day after the microURS, ejecting fragments, without any ureteric
stent, hematuria neither pain.