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Laparoscopic robotic-assisted "keel" bladder neck construction.
D G Minoli1, E A De Marco1, M Gnech2
1Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Via Della Commenda 10, 20122, Milan, Italy.
Journal of Pediatric Urology
|October 20, 2020
Summary
Robotic-assisted "keel" bladder neck construction effectively treated urinary incontinence in an obese adolescent. This minimally invasive approach offers excellent anatomical exposure and successful long-term outcomes.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Robotic Surgery
Background:
- Persistent urinary incontinence in adolescents can significantly impact quality of life.
- Previous treatments for uro-genital sinus anomalies may lead to complex anatomical challenges.
- Obesity presents additional difficulties in surgical access and execution.
Observation:
- A 13-year-old obese female with a history of Total Urogenital Mobilization presented with severe urinary incontinence.
- Diagnostic evaluations revealed a short, tortuous urethra and an incompetent bladder neck.
- Video-urodynamics confirmed low bladder voiding pressures and continuous leakage.
Findings:
- Laparoscopic robotic-assisted "keel" bladder neck construction was successfully performed.
- The patient experienced no post-operative complications and was discharged on the 5th day.
- Four years post-surgery, the patient achieved spontaneous voiding with normal bladder capacity and no post-void residuals.
Implications:
- Robotic surgery provides superior anatomical visualization for complex bladder neck reconstruction, especially in obese patients.
- The "keel" procedure effectively reconstructs wide, incompetent bladder necks into a continent funnel.
- This technique offers a viable, minimally invasive alternative to open surgery for pediatric urinary incontinence.
