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11–14 APRIL, 2018, HELSINKI, FINLAND
VD-8 (VS without presentation)
ONE-STAGE Y-TYPE URETHRAL DUPLICATION REPAIR
WITH PERINEAL SKIN FLAP
Diana K. BOWEN
1
and Arun K. SRINIVASAN
2
1) The Children's Hospital of Philadelphia, Division of Urology, Department of Pediatric Surgery, Philadelphia, USA -
2) The Children's Hospital of Philadelphia, Division of Pediatric Urology, Department of Surgery, Philadelphia, USA
PURPOSE
Urethral duplication of the Y subtype is a rare anomaly. Many techniques have been described in
case reports, most including two-staged repairs for long urethral defects. Our aim is to demonstrate
a prone approach with a one-stage substitution urethroplasty using a perineal skin flap.
PATIENTS AND METHODS
The patient was a 20 month old male who had previously undergone circumcision and correc-
tion of scrotal transposition but was subsequently found to have a Y-type duplicated urethra. The
dorsal urethra extended to an orthotopic meatus but was narrow and stenotic, while the supple
ventral urethra coursed from the posterior urethra to the perineum adjacent to the anal verge in the
midline. Given the nature of this fistulous Y-duplication, reconstruction was necessary. Exam under
anesthesia revealed an intact rectal sphincter separate from the ventral urethra. After placement
of a suprapubic catheter, surgery was approached in the prone position. The ventral urethra was
separated from the anterior rectal wall and the midline incision was continued through the perineum
anteriorly. A 2 cm x 1.5 cm perineal skin flap attached to the urethra was developed for use in
reconstruction. Dissection revealed an atretic 3 cm segment of the dorsal urethra that transitioned
to a normal tube within the pendulous urethra. The healthy ventral urethra with skin flap served
as the rotated substitution urethra and onlay flap to reconstruct the channel over a 10 Charriere
catheter in a tension-free manner.
RESULTS
The patient did well postoperatively with cystogram and retrograde urethrogram at 4 weeks confirm-
ing patency and remained clinically well at 7 month follow up.
CONCLUSIONS
We describe a one-stage technique for Y subtype urethral duplication in the prone position by rota-
tion of the ventral urethra with perineal skin flap to a tension-free anastomosis. As always, long term
follow-up is paramount.
VD-9 (VS without presentation)
RETROPERITONEAL ROBOT-ASSISTED LAPAROSCOPIC
REPAIR FOR URETEROPELVIC JUNCTION OBSTRUCTION
Thomas BLANC, Pauline CLERMIDI, Henri LOTTMANN, Nathalie BOTTO, Luca PIO
and Yves AIGRAIN
Hôpital Necker - Enfants Malades, Department of Pediatric Surgery and Urology, Paris, FRANCE
PURPOSE
Robot-assisted laparoscopic pyeloplasty (RALP) has been gaining acceptance among pediatric
urologists. Few studies have evaluated the retroperitoneal approach of RALP. This video demon-
strates a pyeloplasty for ureteropelvic junction obstruction with polar vessel.