Robot-assisted Laparoscopic Urethral Diverticulectomy in a Pediatric Patient

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.

Case Report: Pediatric Robotic Adrenalectomy for Virilizing Adrenal Tumor in a 4-year-old Female

Adrenocortical tumors in children are rare, with approximately 90% of children presenting with endocrine syndromes, most commonly virilization. The standard treatment remains an open resection, although there is increasing use of the minimally invasive approach. With the advent of robotic surgery, its advantages over open and conventional laparoscopy make it a viable option in select patients. Despite the adoption of robot-assisted surgery in pediatric urology, limited literature regarding robotic pediatric adrenal surgery exists, with only a few small case series. We present a female child with virilizing features due to a large functional adrenal tumor managed by robot-assisted adrenalectomy.

Bilateral Robot-Assisted Laparoscopic Orchiopexy for Undescended Testes

OBJECTIVE

To describe our technique for surgically treating cryptorchidism with bilateral robot-assisted laparoscopic orchiopexy.

BACKGROUND

Nonpalpable, undescended testes are commonly seen by the pediatric urologist. It is recommended to surgically bring the testis into the scrotum early in life to decrease the higher risk of future testicular carcinomas seen in abdominal testes. Diagnostic laparoscopy with laparoscopic orchiopexy for viable, intraabdominal testes is the current standard of treatment.

MATERIALS AND METHODS

After confirming viable, intraabdominal testes with diagnostic laparoscopy, we used an umbilical camera port and docked the robot with two additional 8-mm ports one handsbreadth to the right and left of the umbilicus. We first mobilized the right testis due to its more proximal location. We incised the gubernaculum distally, and then dissected the vas deferens medially. We carried this mobilization to the left side and mobilized the left testis in a similar fashion. After incising the peritoneum and confirming adequate testicular laxity, we made two transscrotal incisions and pulled either testis into its respective hemiscrotum with a laparoscopic grasper and placed them into a subdartos pouch.

RESULTS

This technique demonstrated that robot-assisted laparoscopic orchiopexy is feasible when treating cryptorchidism. This is most applicable at institutions that already have robotic surgery capacity and are comfortable operating robotically. Limitations include that use of the robot usually increases the operative time and therefore length of anesthesia for the patient. There does not appear to be a significant difference in cost associated with robotic versus laparoscopic orchiopexy at our institution, though this may not be the case everywhere.

CONCLUSION

Here we demonstrate successful use of bilateral robot-assisted laparoscopic orchiopexy to treat bilateral undescended testes in a pediatric male. Pediatric urologists can consider using this technique instead of traditional laparoscopic orchiopexy.

A Rare Case of T-Cell Lymphoma Presenting With Bilateral Nephrolithiasis and Acute Renal Failure

We present the rare case of a young boy who was found to have T-cell lymphoma after presenting with flank pain and bilateral nephrolithiasis. He initially underwent bilateral ureteral stent placement but returned with oliguria and acute renal failure. His subsequent workup revealed lymphoma involving both kidneys. He was started on chemotherapy for his lymphoma and dialysis for his renal failure. His stones ultimately dissolved with aggressive hydration and correction of serum uric acid levels. In this report, we discuss the identification and management of this rare condition.

Cellular immune reactivity to recombinant OspA and flagellin from Borrelia burgdorferi in patients with Lyme borreliosis. Complexity of humoral and cellular immune responses

Patients with Lyme borreliosis (LB) usually develop a vigorous T cell response against the causative pathogen Borrelia burgdorferi, but little is known about the antigens recognized in the cellular response. Therefore, T cell reactivities against whole bacteria, recombinant 31-kD (outer surface protein A, [OspA]), and 41-kD proteins (flagellin) from B. burgdorferi were studied in patients with LB, non-LB patients, and healthy donors. In parallel, specific antibodies were determined by Western blot analysis. Virtually all patients with LB exhibited marked cellular responses to whole B. burgdorferi, which were significantly elevated compared with the control groups in both early and late disease stages. However, analyses using the purified antigens OspA and flagellin revealed considerable heterogeneity in the cellular reactivities among individuals as well as variations during the course of infection. T cell responses to OspA were significantly increased in patients with early LB compared with both control groups whereas in late-stage disease responses only exceeded those of non-LB patients and were not different from normal donors. Cellular immune reactivities to flagellin were significantly higher only in early LB compared with both control groups. Reciprocally, several control subjects demonstrated marked cellular responses to OspA and flagellin, suggesting that reactions to these proteins may not always be related to LB. T cell reactivity did not correlate well with the presence of specific antibodies. Almost all seropositive patients in both early and late stage LB had serum antibodies against flagellin, but antibodies to OspA were detectable only in a subset of late LB sera. These data demonstrate the complexity of the humoral and the cellular immune responses to components of B. burgdorferi.