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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

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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.

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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.