Summary
Introduction
Robotic technology has gained popularity allowing performance of several complex and
difficult reconstructive procedures. This video demonstrates the advantages of the
robotic approach for a “keel” bladder neck construction in an obese patient.
Material and methods
A 13 year-old-girl (BMI = 28) already treated elsewhere for a uro-genital sinus (Total
Urogenital Mobilization) has been evaluated for disturbing persistent total urinary
incontinence. Cisto-colposcopy revealed an extremely short and tortuous urethra. Bladder
neck was wide open and incompetent. Video-Urodynamic evaluation showed a bladder with
a capacity of 280 mL with low voiding pressures (14–16 cmH20) and continuous urinary
leakage. MAG3 scan confirmed normal renal function. Thus, the girl underwent a laparoscopic
robotic-assisted “keel” bladder neck construction.
Results
The patient was discharged on 5th post-operative day without complications. After
4 years she is voiding spontaneously (300 cc) without post-void residuals. She has
presented a persistent mild stress incontinence successfully treated with subsequent
endoscopic bulking agent injection.
Conclusions
Robotic access to the bladder neck region is an excellent option with ideal anatomical
exposure compared to conventional open surgery, especially in obese patients. The
“keel” procedure allows to reconfigure and tubularize a wide and incompetent bladder
neck creating a continent funnel without the absolute need of concomitant ureteric
reimplantation.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Robotic assisted “keel” bladder neck construction in an obese patient with uro-genital sinus. 165-166 S15-9 (VP).in: Abstract book 28th congress of the European society for pediatric urology. ESPU) Barcelona, 2017
- Mattioli G. Petralia P. Robotic bladder outlet procedures in pediatric robotic surgery. Springer, 2017: 109-120
- Surgical treatment of urinary incontinence in children chairmen.in: Incontinence: 2nd international consultation on Incontinence paris, July 1-3, 2001 Editors: Abrams, cardozo, Khoury, Wein. 2nd ed. 2002
Article info
Publication history
Published online: October 05, 2020
Accepted:
September 28,
2020
Received in revised form:
August 15,
2020
Received:
June 19,
2020
Identification
Copyright
© 2020 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
