ROBOT-ASSISTED URETEROLITHOTOMY AND URETEROPLASTY IN A CHILD WITH A URETERAL STONE

Introduction. In this study, we demonstrate a case of robotic ureteral stone removal and provide a literature review on the use of robot-assisted surgery for the treatment of urolithiasis in children.

Material and methods. The authors of this study performed a retrospective review of the case history of a child with urolithiasis accompanied by an obstructive lesion of the left ureter. Surgery was performed using robot-assisted technology. A 11-year-old boy was admitted to a children's hospital with complaints of recurrent urinary tract infections and pain in the left flank during the last year of life. A CT scan revealed a stone located at the level of the proximal left ureter. A detailed examination of the scans indicated the presence of a ureteral stricture located just above the stone. The child underwent robot-assisted ureterolithotomy and ureteroplasty. During the surgery, intraoperative contact ultrasound was used to determine the location of the stone. After dissection of the ureteral wall above the stone, the stone was grasped with a clamp and removed externally. The longitudinal ureterotomy was closed transversely using single absorbable sutures. Data collection included the patient's medical history and demographic data, diagnosis, type of surgery, duration of surgery, outcome of the surgery, and anatomical and functional state of the kidney during follow-up.

Results. The robotic procedure was performed without perioperative difficulties and complications. The duration of the surgery was 135 minutes. Of this, the duration of robot installation (docking time) took 15 minutes. The main console time was 120 minutes. The Foley catheter was removed on the next postoperative day. In the postoperative period, the patient stayed in the intensive care unit for 12 hours. The drainage catheter was removed on the 2nd postoperative day after a control ultrasound. The patient was discharged home on the 5th postoperative day when he tolerated the prescribed diet well and was free from postoperative pain. The stent remained in the ureter until its removal 4 weeks after surgery. A repeat ultrasound examination performed 6 months after surgery demonstrated a decrease in the dilation of the renal pelvis and ureter to 10 and 6 mm, respectively, and no signs of stone formation.

Conclusion. In summary, our study showed that robotic-assisted surgery is a feasible, safe, and effective treatment option for urinary tract stones in children in selected cases, such as upper urinary tract stones that are accompanied by urinary tract obstruction and require simultaneous ureterolithotomy and ureteroplasty.