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Oamen E, Lowrey T, Tran H, Patel S, Rensing A. Robot-assisted Laparoscopic Urethral Diverticulectomy in a Pediatric Patient. Urology 2023; 177:181-183. [PMID: 37044311 DOI: 10.1016/j.urology.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023]
Abstract
Urethral diverticula are rare in children, especially in the absence of trauma. We present a case of a 9-year-old girl with pain with micturition, incontinence, and recurrent urinary tract infections. Diagnosis of urethral diverticulum was made by magnetic resonance imaging. A robot-assisted transabdominal laparoscopic diverticulectomy was performed without complication. The patient experienced a significant improvement in symptoms.
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Affiliation(s)
| | - Thomas Lowrey
- OU College of Medicine Department of Urology, Oklahoma City, OK
| | - Hanh Tran
- Oklahoma Children's Hospital OU Health, Oklahoma City, OK
| | - Sanjay Patel
- OU College of Medicine Department of Urology, Oklahoma City, OK
| | - Adam Rensing
- OU College of Medicine Department of Urology, Oklahoma City, OK; Oklahoma Children's Hospital OU Health, Oklahoma City, OK.
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Recently Described Innovative Reconstruction in Neurogenic Bladder: a Review. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00656-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bowen DK, Cheng EY, Hirsch J, Huang J, Meyer T, Rosoklija I, Chu DI, Yerkes EB. A fresh "slant" on modified Mitchell bladder neck reconstruction: A contemporary single-institution experience. Front Pediatr 2022; 10:933481. [PMID: 36120660 PMCID: PMC9478545 DOI: 10.3389/fped.2022.933481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Patients with neurogenic urinary incontinence due to an incompetent outlet may be offered bladder neck reconstruction, but the quest for the perfect surgical-outlet procedure continues. Our aim was to characterize continence and complications after modified Mitchell urethral lengthening/bladder neck reconstruction (MMBNR) with sling and to introduce a modification of exposure that facilitates subsequent steps of MMBNR. METHODS A single-institution, retrospective cohort study of patients who underwent primary MMBNR between May 2011 and July 2019 was performed. Data on demographics, urodynamic testing, operative details, unanticipated events, continence, bladder changes, and additional procedures were collected. A 2013 modification that permits identification of the incompetent bladder neck prior to urethral unroofing was applied to the last 17 patients. The trigone and bladder neck are exposed via an oblique low anterolateral incision on the bladder. Ureteral reimplantation is not routinely performed. Focal incision of the endopelvic fascia after posterior plate creation limits breadth of blunt dissection for sling placement. Descriptive statistics were utilized. RESULTS A total of 25 patients (13 females) had MMBNR with sling at a median age of 10 years [interquartile range (IQR) 8-11]. Bladder augmentation was performed concurrently in 14/25 (56%) patients. At a median of 5.0 (IQR 3.9-7.5) years follow-up after MMBNR, 9/11 (82%) without bladder augmentation and 13/14 (93%) with bladder augmentation had no leakage per urethra during the day without further continence procedures. Of the three patients with persistent incontinence, two achieved continence with bladder wall Botox injection (overall continence 24/25, 96%). New and recurrent vesicoureteral reflux was noted in five patients and one patient, respectively. Two patients required subsequent bladder augmentation for pressures and one other will likely require it. None have required bladder neck closure or revision. CONCLUSION MMBNR with sling provides promising continence per urethra in neurogenic bladder with low need for secondary continence procedures. Ongoing modifications may achieve elusive total continence.
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Affiliation(s)
- Diana K Bowen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Earl Y Cheng
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Josephine Hirsch
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Jason Huang
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Theresa Meyer
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Ilina Rosoklija
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - David I Chu
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Elizabeth B Yerkes
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
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Esposito C, Autorino G, Castagnetti M, Cerulo M, Coppola V, Cardone R, Esposito G, Borgogni R, Escolino M. Robotics and future technical developments in pediatric urology. Semin Pediatr Surg 2021; 30:151082. [PMID: 34412879 DOI: 10.1016/j.sempedsurg.2021.151082] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Minimally invasive surgery (MIS) has represented the main innovation in the field of pediatric surgery and urology over the last 30 years. Pediatric MIS is a wide field, ranging from the standard laparoscopic surgery using 3-mm ports to robotics mainly adopted for pediatric urology indications. The aim of this paper was to summarize the current status of robotic surgery in pediatric urology and to evaluate possible future technical developments for this technique. In pediatric urology, many procedures are challenged by the narrow working space available in smaller children, the difficulty to perform complex and long suture lines to repair complex urinary malformations, and the challenge to remove renal or adrenal tumors. The main characteristic of robotic surgery is that the robotic instruments inserted into the abdominal cavity are remotely controlled by the surgeon, who is sitting at a console next to the patient or even far away, avoiding human tremor during complex suturing. Due to the magnification of the operative field view and the six degrees of freedom of the robotic instruments compared to conventional laparoscopic instruments, providing enhanced 3D vision and improved surgeon ergonomics, robot-assisted surgery appears to be beneficial over conventional MIS, especially in complex reconstructive procedures. Currently, there are two robotic systems available on the market and certified for robotic surgery in children: the DaVinci (Intuitive Surgical, since 2001) and Senhance (Transenterix, since 2020). However, almost the totality of papers published in the international literature are focused on robotic procedures using the DaVinci platform. Analyzing the current literature, there is no evidence about the indications where robotics are preferable to conventional MIS approaches. Currently, the main indications of robotic surgery in pediatric urology are: pyeloplasty for ureteropelvic junction obstruction (UPJO), ureteral reimplantation according to Lich Gregoire technique, Mitrofanoff procedure, nephrectomy or partial nephrectomy for oncological indications, removal of renal cysts, bladder neck reconstruction or removal of urinary tract stones. The future developments in this field are certainly represented by intraoperative use of indocyanine green (ICG) fluorescence imaging that permits to have a better vision of vascular anatomy or clearly identify nodes in case of tumors, and by development of 5G technology. The main limitation of robotic surgery today remains the excessive cost of the machine itself and the limited lifespan of robotic instruments. We believe that robotic surgery will surely represent the new field of development in pediatric surgery, but its widespread application will depend on the introduction of new robotic platforms in the market, that will certainly low the costs, and also to the development of smaller size instruments more suitable for pediatric use.
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Affiliation(s)
- Ciro Esposito
- Pediatric Surgery Unit, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy.
| | - Giuseppe Autorino
- Pediatric Surgery Unit, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Marco Castagnetti
- Division of Pediatric Urology, Medical University of Padua, Padua, Italy
| | - Mariapina Cerulo
- Pediatric Surgery Unit, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Vincenzo Coppola
- Pediatric Surgery Unit, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Roberto Cardone
- Pediatric Surgery Unit, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Giorgia Esposito
- Pediatric Surgery Unit, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Rachele Borgogni
- Pediatric Surgery Unit, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Maria Escolino
- Pediatric Surgery Unit, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
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Silay MS. The sky is clear: robotic surgery is now a valuable player in pediatric urology practice. World J Urol 2020; 38:1819-1820. [PMID: 32621029 DOI: 10.1007/s00345-020-03336-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Mesrur Selcuk Silay
- Division of Pediatric Urology, Department of Urology, School of Medicine, Biruni University, Istanbul, Turkey.
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