Robotic Bladder Neck Reconstruction With Mitrofanoff Appendicovesicostomy in a Neurogenic Bladder Patient

Robot-assisted laparoscopic (RAL) techniques for the management of neurogenic bladder involves complex procedures using lower urinary tract and bowel. When medical therapy fails, surgery aims to preserve upper tract function and social continence.¹ Traditionally, the procedure was performed in an open approach, but newer minimally-invasive techniques offer improved cosmesis, reduced pain and length of stay.² A series of 38 cases showed the feasibility and safety of this approach.³ Here, we describe a RAL bladder neck reconstruction with appendicovesicostomy in a 7-year-old with neurogenic bladder (Fig. 1).

The patient was placed in a lithotomy position followed by double-J and Foley catheter placement. With an open Hasson technique, a 12-mm, two 8-mm, and a 5-mm port were positioned. The bladder is prefilled with saline (80 mL) and a cystotomy is performed. The tubularization is completed in 2 layers achieving a 3-cm tunnel (Figs. 2-3). The appendix is implanted in the posterior wall of the bladder with a submucosal tunnel. Ultimately, 2 suprapubic tubes are placed and the bladder is closed in a single layer.

No complications reported, operative time was 5 hours and estimated blood loss was 50 mL. At 1-month follow-up, double-J stents were removed and the patient reported catheterizing well with good continence and well-healed incisions.

Robotic continence procedures have demonstrated to be a safe and effective alternative. Here, we presented a satisfactory outcome using RAL bladder neck reconstruction with appendicovesicostomy in a 7 years old with persistent incontinence, despite untethering and maximal anticholinergic therapy.