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Robotic augmentation ileocystoplasty with bilateral ureteric reimplantation in a young child with neuropathic bladder.

Chowdhary SK, Kandpal DK, Agarwal D, Sibal A, Srivastava RN - J Indian Assoc Pediatr Surg (2014)

Bottom Line: The management starts early in life.The open surgery has proven safety and success over many decades.The emergence of robotic technology has revived the interest in minimally invasive approach for complex pediatric urological reconstructions.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Urology and Pediatric Surgery, Indraprastha Apollo Hospitals, New Delhi, India.

ABSTRACT
Neuropathic bladder in children is most commonly secondary to spina bifida. The management starts early in life. The modalities of treatment vary depending on the severity of the symptoms. A proportion of children inspite of adequate medical management need augmentation ileocystoplasty later in life. The open surgery has proven safety and success over many decades. Earlier attempts to perform augmentation cystoplasty by the laparoscopic approach were limited by steep learning curve, long operating times, and technical difficulties in intracorporeal anastomosis. The emergence of robotic technology has revived the interest in minimally invasive approach for complex pediatric urological reconstructions. In the recent times, there has been only one reported case report and small series of pediatric robotic augmentation cystoplasty from Chicago. We report the first minimally invasive robotic reconstruction in a child with neuropathic bladder and early renal decompensation despite appropriate medical treatment, from our country.

No MeSH data available.


Related in: MedlinePlus

Preoperative cystometry showing functional bladder capacity of 40 ml with high detrusor pressure
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Figure 1: Preoperative cystometry showing functional bladder capacity of 40 ml with high detrusor pressure

Mentions: A thorough and complete workup of the child was carried out. Renal function tests were in the normal range. Routine examination of urine revealed pus cells in full field. Ultrasound of the abdomen revealed right-sided hydroureteronephrosis with thinned out renal parenchyma and thick-walled bladder. Micturating cystourethrogram revealed a small capacity trabeculated bladder with right-sided grade V reflux and left-sided grade III reflux. The bladder capacity was only 30 ml and bilateral reflux appeared at this volume. DMSA renal scan was suggestive of right scarred kidney with severely impaired cortical function (DRF 18%) and left kidney with significant cortical volume loss in upper half with upper pole scarring. MRI spine was suggestive of spina bifida at L5-S3 level with tethering of spinal cord. Neurosurgical consultation was done and their opinion was that there was going to be no benefit from any further spinal surgery. Urodynamic study showed that his functional bladder capacity was only 40 ml against an expected bladder capacity of 100 ml. The detrusor pressures were crossing 50-cm water with fill of above 25 ml [Figure 1]. Cystoscopy revealed normal anterior and posterior urethra, severely trabeculated bladder mucosa and golf hole-like ureteric orifices. The bladder neck was closing satisfactorily on withdrawing the scope precluding the need for adding any bladder outlet procedure.


Robotic augmentation ileocystoplasty with bilateral ureteric reimplantation in a young child with neuropathic bladder.

Chowdhary SK, Kandpal DK, Agarwal D, Sibal A, Srivastava RN - J Indian Assoc Pediatr Surg (2014)

Preoperative cystometry showing functional bladder capacity of 40 ml with high detrusor pressure
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4155634&req=5

Figure 1: Preoperative cystometry showing functional bladder capacity of 40 ml with high detrusor pressure
Mentions: A thorough and complete workup of the child was carried out. Renal function tests were in the normal range. Routine examination of urine revealed pus cells in full field. Ultrasound of the abdomen revealed right-sided hydroureteronephrosis with thinned out renal parenchyma and thick-walled bladder. Micturating cystourethrogram revealed a small capacity trabeculated bladder with right-sided grade V reflux and left-sided grade III reflux. The bladder capacity was only 30 ml and bilateral reflux appeared at this volume. DMSA renal scan was suggestive of right scarred kidney with severely impaired cortical function (DRF 18%) and left kidney with significant cortical volume loss in upper half with upper pole scarring. MRI spine was suggestive of spina bifida at L5-S3 level with tethering of spinal cord. Neurosurgical consultation was done and their opinion was that there was going to be no benefit from any further spinal surgery. Urodynamic study showed that his functional bladder capacity was only 40 ml against an expected bladder capacity of 100 ml. The detrusor pressures were crossing 50-cm water with fill of above 25 ml [Figure 1]. Cystoscopy revealed normal anterior and posterior urethra, severely trabeculated bladder mucosa and golf hole-like ureteric orifices. The bladder neck was closing satisfactorily on withdrawing the scope precluding the need for adding any bladder outlet procedure.

Bottom Line: The management starts early in life.The open surgery has proven safety and success over many decades.The emergence of robotic technology has revived the interest in minimally invasive approach for complex pediatric urological reconstructions.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Urology and Pediatric Surgery, Indraprastha Apollo Hospitals, New Delhi, India.

ABSTRACT
Neuropathic bladder in children is most commonly secondary to spina bifida. The management starts early in life. The modalities of treatment vary depending on the severity of the symptoms. A proportion of children inspite of adequate medical management need augmentation ileocystoplasty later in life. The open surgery has proven safety and success over many decades. Earlier attempts to perform augmentation cystoplasty by the laparoscopic approach were limited by steep learning curve, long operating times, and technical difficulties in intracorporeal anastomosis. The emergence of robotic technology has revived the interest in minimally invasive approach for complex pediatric urological reconstructions. In the recent times, there has been only one reported case report and small series of pediatric robotic augmentation cystoplasty from Chicago. We report the first minimally invasive robotic reconstruction in a child with neuropathic bladder and early renal decompensation despite appropriate medical treatment, from our country.

No MeSH data available.


Related in: MedlinePlus