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Hu JJ, Zhao YW, Tu L, He TQ, Chen YF, Wen R, Peng QL. Clinical Application of Ureteroscope-Assisted Laparoscopic Surgery for Prostatic Utricle in Children. J Laparoendosc Adv Surg Tech A 2024; 34:182-188. [PMID: 37902957 PMCID: PMC10875244 DOI: 10.1089/lap.2023.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
Purpose: To investigate the use of ureteroscope-assisted laparoscopic surgery (UALS) in treating symptomatic prostatic utricle (PU) in children. Materials and Methods: Data on surgically treated cases of PU at the Department of Urology in Hunan Children's Hospital between September 2014 and September 2022 were retrospectively collected and analyzed. The diagnosis was confirmed by cystourethroscopy followed by ureteroscopy, and PU was excised by ureteroscope-assisted laparoscopy. Results: A total of 21 patients with PU were enrolled in this study. The median age of the patients at surgery was 8.1 (4.6-11.5) years. Karyotyping was available for 15 children: 13 (86.7%) were 46XY, 1 (6.7%) was 45X/46XY, and 1 (6.7%) was 45X/46XY/47XYY. The median length of the PU was 5.0 (4.1-7.1) cm. Nineteen patients underwent only ureteroscope-assisted laparoscopic excision, whereas 2 also had a perineal incision. All excisions were successfully performed. The median intraoperative blood loss was 25.0 (20.0-37.5) mL. The median hospital stay and follow-up durations were 18.0 (14.5-25.0) days and 24.0 (13.5-49.0) months, respectively. The patients reported no postoperative clinical symptoms. Conclusion: UALS allows for accurate patient positioning and thorough exposure of the anatomical structures, and it is a safe, effective, and minimally invasive treatment for PU in children.
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Affiliation(s)
- Jian-Jun Hu
- Department of Urology and Hunan Children's Hospital, Changsha, China
| | - Yao-Wang Zhao
- Department of Urology and Hunan Children's Hospital, Changsha, China
| | - Lei Tu
- Department of Urology and Hunan Children's Hospital, Changsha, China
| | - Tian-Qu He
- Department of Urology and Hunan Children's Hospital, Changsha, China
| | - Yi-Fu Chen
- Department of Urology and Hunan Children's Hospital, Changsha, China
| | - Rong Wen
- Department of Pathology, Hunan Children's Hospital, Changsha, China
| | - Qian-Long Peng
- Department of Urology and Hunan Children's Hospital, Changsha, China
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O'Brien LP, Hannan E, Antao B, Peirce C. Paediatric robotic surgery: a narrative review. J Robot Surg 2023; 17:1171-1179. [PMID: 36645643 PMCID: PMC10374698 DOI: 10.1007/s11701-023-01523-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/02/2023] [Indexed: 01/17/2023]
Abstract
The benefits of minimally invasive surgery (MIS) compared with traditional open surgery, including reduced postoperative pain and a reduced length of stay, are well recognised. A significant barrier for MIS in paediatric populations has been the technical challenge posed by laparoscopic surgery in small working spaces, where rigid instruments and restrictive working angles act as barriers to safe dissection. Thus, open surgery remains commonplace in paediatrics, particularly for complex major surgery and for surgical oncology. Robotic surgical platforms have been designed to overcome the limitations of laparoscopic surgery by offering a stable 3-dimensional view, improved ergonomics and greater range of motion. Such advantages may be particularly beneficial in paediatric surgery by empowering the surgeon to perform MIS in the smaller working spaces found in children, particularly in cases that may demand intracorporeal suturing and anastomosis. However, some reservations have been raised regarding the utilisation of robotic platforms in children, including elevated cost, an increased operative time and a lack of dedicated paediatric equipment. This article aims to review the current role of robotics within the field of paediatric surgery.
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Affiliation(s)
- Lukas Padraig O'Brien
- Department of Paediatric Surgery, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Enda Hannan
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Co Limerick, Ireland.
| | - Brice Antao
- Department of Paediatric Surgery, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Colin Peirce
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Co Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
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Acimi S, Abderrahmane N, Debbous L, Benabadji N, Acimi MA. Enlarged prostatic utricle and vagina masculinus in boys with disorders of sex development. World J Urol 2023; 41:595-600. [PMID: 36592176 DOI: 10.1007/s00345-022-04273-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/22/2022] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To determine the prevalence, radiological characteristics, and clinical symptomatology of enlarged prostatic utricles and vagina masculinus in boys with disorders of sex development. METHODS Over 10 years (from February 2012 to March 2022), 102 boys with severe hypospadias underwent voiding cystourethrography. All patients presented with disorders of sex development and Y material in the karyotype (46,XY karyotype, 46,XY/45,X mosaic, etc.). The age of the patients at the first examination ranged from 4 days to 27 months (mean age 2.7 months). RESULTS Voiding cystourethrography revealed the presence of a cyst posterior to the urethra in 66 patients (64.7% of cases). There were 15 cases of "vagina masculinus" and 51 of enlarged prostatic utricles. These dilations were classified according to the Ikoma classification and cyst size. In more than 2/3 of cases, the cysts were small (less than 20 mm), and in less than 8% of cases, these cysts were large. In addition, retrograde opacification revealed the presence of vesicoureteral reflux in 20% of boys with a male vagina. The most severe hypospadias with a scrotal or perineal meatus are most at risk of developing an enlarged prostatic utricle, and 80% of patients with Ikoma Grade III had a scrotal or perineal meatus. CONCLUSION This study shows that the prevalence of enlarged prostatic utricles and vagina masculinus is high in patients with severe hypospadias. Therefore, their search should be systematic, and for clinical and therapeutic interest, the enlarged prostatic utricles should be classified according to cyst size.
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Affiliation(s)
- Smail Acimi
- Department of Visceral Surgery, Faculty of Medicine, Children's Hospital Canastel, University of Oran, Oran, Algeria.
| | - Naima Abderrahmane
- Department of Visceral Surgery, Faculty of Medicine, Children's Hospital Canastel, University of Oran, Oran, Algeria
| | - Lamia Debbous
- Department of Visceral Surgery, Faculty of Medicine, Children's Hospital Canastel, University of Oran, Oran, Algeria
| | - Nadjia Benabadji
- Department of Endocrinology, Faculty of Medicine, CHU of Oran, University of Oran, Oran, Algeria
| | - Mohammed Ali Acimi
- Department of Urology, Faculty of Medicine, EHU of Oran, University of Oran, Oran, Algeria
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Singh P, Kumar S, Panaiyadiyan S, Dogra PN. Robotic excision of vaginal pouch in ovotesticular disorder of sexual development. Int Braz J Urol 2022; 48:994-995. [DOI: 10.1590/s1677-5538.ibju.2022.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/26/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - Prem Nath Dogra
- All India Institute of Medical Sciences, India; Sir Ganga Ram Hospital, India
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Angotti R, Raffaele A, Molinaro F, Riccipetitoni G, Chiesa PL, Lisi G, Mattioli G, Alberti D, Boroni G, Mariscoli F, Martino A, Pelizzo G, Maffi M, Messina M, Lima M. Rise of pediatric robotic surgery in Italy: a multicenter observational retrospective study. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-021-00144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The minimally invasive surgery (MIS) in term of robot-assisted surgery changed in a dramatic way the surgical approach either in adults or children. For many specialties (urology, gynecology, general surgery) robotic surgery rapidly became the gold standard for some procedures, while the experience in pediatric population is not wide for some reasons. The aim of this study is to retrospective analyze trends of application of robotic surgery in pediatric patients across the country, focusing on indications, limitations, development, and training acquired by national experience and in comparison to the literature.
Methods
We made a retrospective multicenter study on behalf of Italian Society of Pediatric Surgery. We performed a census among all pediatric surgery units in the country to enroll those performing robotic surgery on children between 2013 and 2019.
Results
We enrolled 7 pediatric surgery referral Centers (Ancona, Bologna, Brescia, Genova, Pavia, Pescara, Siena). A total of 303 patients were included in the study, 164 males (54%) and 139 females (46%). The most commonly performed interventions for each anatomic area were respectively atypical pulmonary resection (38%), pyeloplasty (49%), and fundoplication (30%).
Conclusions
Since its first application in Italy, about 10 years ago, several considerations were made about application and feasibility of robotics in children.
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Lim X, Rai R, Chandran S, Jacobsen AS. Klinefelter syndrome presenting with perinatal ascites associated with unilateral renal agenesis and a prostatic utricle cyst. BMJ Case Rep 2022; 15:e246955. [PMID: 35064039 PMCID: PMC8785177 DOI: 10.1136/bcr-2021-246955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 11/04/2022] Open
Abstract
We present a rare case of Klinefelter syndrome who presented with perinatal ascites, unilateral renal agenesis and a prostatic utricle cyst. The patient was born at term via emergency Caesarean section with gross abdominal distension. Antenatally, amniocentesis revealed a fetal karyotype of Klinefelter syndrome (47, XXY), and the 34-week ultrasound scan showed a cyst measuring 17×21×27 mm located inferior-posterior to the bladder. There was no ascites noted then, but a small left pelvic kidney was present. Ultrasound kidney, ureter and bladder as well as CT scan of the thorax, abdomen and pelvis done at birth showed a solitary right kidney with large-volume ascites and no evidence of a cyst adjacent to the bladder. These findings suggest urinary ascites from an involuting left renal system or a ruptured prostatic utricle cyst. We report the first case of Klinefelter syndrome associated with a prostatic utricle cyst and unilateral renal agenesis, presenting with neonatal ascites.
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Affiliation(s)
- Xuxin Lim
- Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Rambha Rai
- Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Suresh Chandran
- Neonatology, KK Women's and Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
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Salkini MW. Robotic surgery in pediatric urology. Urol Ann 2022; 14:314-316. [PMID: 36505985 PMCID: PMC9731187 DOI: 10.4103/ua.ua_36_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/21/2022] [Indexed: 12/15/2022] Open
Abstract
Robotic surgery revolutionized minimally invasive surgery. Urology is the widest surgical field in implementing robotic technology. Pediatric urology followed the footsteps of adult urology in utilizing da Vinci™ surgical system for urinary tract reconstruction. Indeed, day after day robotics is gaining more applications and popularity in pediatric urology due to the need for less invasive approach to reconstruct the urinary tract in pediatric population. In this manuscript, we reviewed in this article the steps of evolution of robotic pediatric urology.
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Affiliation(s)
- Mohamad Waseem Salkini
- Department of Urology, West Virginia University, Morgantown, WV, USA,Address for correspondence: Prof. Mohamad Waseem Salkini, Department of Urology, West Virginia University, Morgantown, WV 26505, USA. E-mail:
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Lu J, Cen J, Wang W, Zhao H, Li P, Mo J, Chen Z, Tang Y, Wei J, Luo J, Huang S, Fang Y. Localization of external urethral orifice in coronary sulcus during urethroplasty in case of severe hypospadias accompanied by prostatic utricle cyst. BMC Urol 2021; 21:149. [PMID: 34736451 PMCID: PMC8569993 DOI: 10.1186/s12894-021-00913-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To explore whether opening the external urethral orifice in the coronal sulcus can reduce the incidence of epididymitis after operating on hypospadias with prostatic utricle cyst (PUC) connecting to the vas deferens. Group A consisted of 3 patients with severe hypospadias and PUC undergoing cystostomy, hypospadias correction and urethroplasty, along with the relocation of the external orifice of the urethra to the coronal sulcus. Group B consisted of 4 patients having initial hypospadias repaired with meatus in the orthotopic position in the glans, presenting with multiple epididymitis after hypospadias surgery and unsuccessful conservative treatment. MR confirmed that all the Group B patients had PUC connecting to the vas deferens. Group B patients underwent urethral dilatation along with urethral catheterization, cutting of the original corpus cavernosum that encapsulated the urethra, and extension of the position of the external urethral orifice to the coronal sulcus. RESULTS In group A, 3 children underwent bladder fistula removal 2 weeks after the operation. The penis developed normally without any complications. Four children in group B underwent stent removal 12 weeks after operation, and one patient was still stenosed and dilated again. All patients in group B were followed without epididymitis recurrence. CONCLUSIONS For patients with hypospadias complicating with a PUC, connecting to one side of the vas deferens, the positioning of the external urethral orifice in the coronary sulcus would be helpful to reduce the occurrence of epididymitis.
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Affiliation(s)
- Jun Lu
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Junjie Cen
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Wenwei Wang
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Hongwei Zhao
- Department of Urology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, 264000, Shandong, People's Republic of China
| | - Pengju Li
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Jiacong Mo
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Zhenhua Chen
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Yiming Tang
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Jinhuan Wei
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Junhang Luo
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Shiying Huang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, 510515, People's Republic of China.
| | - Yong Fang
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China.
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Bayne AP, Austin JC, Seideman CA. Robotic assisted retrovesical approach to prostatic utricle excision and other complex pelvic pathology in children is safe and feasible. J Pediatr Urol 2021; 17:710-715. [PMID: 34511376 DOI: 10.1016/j.jpurol.2021.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/29/2021] [Accepted: 08/06/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Excision of the prostatic utricle has been a challenging surgical problem due to the location deep in the pelvis between the rectum and bladder. Robotic-assisted laparoscopic surgery allows minimally invasive access to this location. OBJECTIVE To describe the robotic surgical outcomes and important techniques associated with robotic excision of the prostatic utricle and explain how these techniques apply to similar pediatric pelvic pathology. STUDY DESIGN Retrospective chart evaluation of patients treated at a single institution with robotic excision of a prostatic utricle as well as two other patients in which the similar approach was employed. RESULTS 4 patients underwent robotic excision of a prostatic utricle. A fifth patient underwent excision of urethral diverticulum that was the remnant of an ectopic ureter. The sixth patient had a high urogenital sinus that required laparoscopic assisted vaginoplasty approached in a similar manner to the above listed cases. Mean age at surgery was 35.5 months for the utricle patients. Mean follow-up duration for the utricle patients was 30.75 months. Average hospital stay for the utricle patients was one day. In the utricle patients one patient developed transient urinary retention and one had a postoperative urinary tract infection. Concomitant cystoscopy used in the two non-utricle patients was a key step in defining the proper location of dissection. DISCUSSION Robotic-assisted laparoscopic retrovesical excision of the prostatic utricle is a safe operation that requires a skill set that can be readily applied to other complex pelvic pathology such as the ectopic ureter, urethral diverticulum, and urogenital sinus. Concomitant cystoscopy can aid significantly in defining the location and limits of dissection.
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Affiliation(s)
- Aaron P Bayne
- Oregon Health and Science University, Portland, OR, USA.
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10
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Abstract
Almost 30 years have passed since the inception of minimally invasive surgery in urology and specifically in pediatric urology. Laparoscopy has now become an essential tool in the pediatric urologic armamentarium. The application of robot-assisted surgery in pediatrics has allowed for widespread utilization for common reconstructive procedures such as pyeloplasty and ureteral reimplantation. Understanding the implementation, technical considerations, and outcomes are critical for continued success and adoption. This has allowed for increased use in more complex urologic procedures such as redo pyeloplasty, dismembered ureteral reimplantation, catheterizable channel creation, and bladder augmentation.
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Affiliation(s)
- Sameer Mittal
- Division of Urology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Arun Srinivasan
- Division of Urology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Babu R, Chandrasekharam V. Cystoscopic Management of Prostatic Utricles. Urology 2020; 149:e52-e55. [PMID: 32949553 DOI: 10.1016/j.urology.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/27/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022]
Abstract
In this case series (n = 7) on prostatic utricles (PU), retention of urine was seen in 5 of 7, urinary tract infection (4 of 7), recurrent epidydymo-orchitis (3 of 7), and scrotal sinus (1 of 7). Voiding cystourethrogram established diagnosis in 3 of 7 patients while CT/MRI in 4 of 7 patients. Four patients were primarily managed by cystoscopic widening of mouth of PU. Three with large PU underwent initial open (2) or laparoscopic (1) excision but later warranted cystoscopic widening for residual PU. Excision (open/laparoscopic) has risk of damage to adjacent structures (nerves/vas/seminal vesicles) or leaving behind a residual PU. Cystoscopic management (primary/salvage) has less morbidity and relieves recurrent symptoms due to stasis of urine in PU.
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Affiliation(s)
- Ramesh Babu
- Department of Pediatric Urology, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.
| | - Vvs Chandrasekharam
- Department of Pediatric Surgery, Pediatric Urology & MAS, Ankura Children's Hospital, Hyderabad, India
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Videourology Abstracts. J Endourol 2018; 32:1173-1176. [PMID: 30307744 DOI: 10.1089/end.2018.29048.vid] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Abstract
A review of the current status of robotic surgery use in paediatrics.
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Affiliation(s)
- Joshua Cave
- Chelsea and Westminster NHS Foundation Trust
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14
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Nguyen A, Arora H, Reese J, Kaouk J, Rhee A. Robot-assisted laparoscopic excision of prostatic utricle in a 3-year old. J Pediatr Urol 2018; 14:343-344. [PMID: 30396603 DOI: 10.1016/j.jpurol.2018.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 07/22/2018] [Indexed: 11/25/2022]
Abstract
Prostatic utricles have traditionally been excised via the open approach or laparoscopically. Recently, the robot-assisted laparoscopic approach has been described in a 19-year-old male. the case of a 3-year-old male with a disorder of sex development (mosaic 45X/46 XY), with multiple associated anomalies, who presented with recurrent UTI is presented. Renal/bladder ultrasound revealed normal bilateral kidneys, and a 4.3 × 2.8 × 3.3 cm cystic mass in the midline posterior to the bladder. Voiding cystourethrogram demonstrated a large cystic mass behind the bladder, concerning for large prostatic utricle. The patient was brought to the operating room and placed in lithotomy. The urethra was examined cystoscopically. The os of the utricle was identified, an open-ended catheter was advanced, the cystoscope was removed, and a Foley was placed. The camera port was introduced supraumbilically, and robotic ports were introduced inferolaterally. Irrigation of the catheter and distension of the utricle allowed manipulation of the utricle to facilitate identification of a plane of dissection. The neck of the utricle was identified and incised. The catheter was removed, transection was completed, and the stump was oversewn. CONCLUSION: Combined cystoscopic and robotic approach to prostatic utricle excision is feasible, safe, and effective in this patient population.
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Affiliation(s)
- A Nguyen
- Cleveland Clinic Glickman Urological and Kidney Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - H Arora
- Cleveland Clinic Glickman Urological and Kidney Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - J Reese
- Foothills Urology, 400 Indiana Street, Suite 300, Golden, CO, 80401, USA.
| | - J Kaouk
- Cleveland Clinic Glickman Urological and Kidney Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - A Rhee
- Cleveland Clinic Glickman Urological and Kidney Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Kumar V, Punatar C, Jadhav K, Sagade S. Accidental cystectomy during laparoscopic excision of prostatic utricle cyst - a rare complication. Int Braz J Urol 2018; 44:826-830. [PMID: 29368875 PMCID: PMC6092668 DOI: 10.1590/s1677-5538.ibju.2017.0284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/08/2017] [Indexed: 11/22/2022] Open
Abstract
Prostatic utricle cyst is a rare congenital anomaly. Symptomatic cysts require treatment. Surgical excision is the treatment of choice, but is challenging due to close proximity to vas deferens, ejaculatory ducts, bladder, prostate, rectum and pelvic nerves. Complications include rectal injury, ureteral injury, impotence, infertility and faecal incontinence. We here report a rare complication in which bladder was accidentally removed during laparoscopic excision of prostatic utricle cyst. To best of our knowledge such a complication has never been reported previously. We also describe the possible cause of this accident and suggest ways to prevent this disastrous complication.
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Affiliation(s)
- Vikash Kumar
- Department of Urology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Chirag Punatar
- Department of Urology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Kunal Jadhav
- Department of Urology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Sharad Sagade
- Department of Urology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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Hester AG, Kogan SJ. The prostatic utricle: An under-recognized condition resulting in significant morbidity in boys with both hypospadias and normal external genitalia. J Pediatr Urol 2017; 13:492.e1-492.e5. [PMID: 28319024 DOI: 10.1016/j.jpurol.2017.01.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 01/03/2017] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Pediatric presentations of a prostatic utricle have received only scant attention. Though recognized with increased frequency in boys with hypospadias, little is described about their incidence and potential for morbidity in boys with normal external genitalia. METHODS We initially reviewed a cohort of 64 patients with hypospadias seen over a 3-year period to determine the frequency of investigative lower urinary tract studies and utricle identification. Children with disorders of sexual differentiation were excluded from this review. A subsequent group of 70 boys with hypospadias and 23 boys with normal external genitalia presenting with lower urinary tract symptoms (LUTS) who were found to have an unsuspected utricle were reviewed. This comparative group was investigated since symptomatology was the indication for evaluation, contrasting with those in the hypospadias group who were investigated because of hypospadias presence alone. RESULTS In our initial review of 64 patients only 24 (37.5%) underwent an investigative study and six (9.4%) had a utricle. Three (50%) required surgical excision, allowing their hypospadias repair to proceed. Results in the subsequent group with hypospadias confirmed these findings with increased rates of investigation and identification. The boys with normal external male genitalia all required surgery since symptoms were the result of the utricle alone. Penile pain with voiding, hematuria, epididymitis, and urinary infection were the most common causes for interventions. CONCLUSIONS The prostatic utricle should be considered as a cause of morbidity in boys with both normal external genitalia and those with hypospadias. Endoscopic or radiological evaluation (see Figure) should be undertaken in all boys with proximal hypospadias, boys with hypospadias and associated cryptorchidism, and those with hypospadias with associated urinary symptoms. Boys with normal external genitalia with lower urinary tract symptoms not explained with imaging should undergo cystoscopy, as an unidentified unsuspected utricle may be the underlying cause.
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Affiliation(s)
- Austin G Hester
- Department of Urology, Wake Forest University, Winston-Salem, NC, USA.
| | - Stanley J Kogan
- Department of Urology, Wake Forest University, Winston-Salem, NC, USA
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Role of Robotics in Children: A brave New World! Eur Urol Focus 2017; 3:172-180. [PMID: 28889938 DOI: 10.1016/j.euf.2017.08.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/31/2017] [Accepted: 08/31/2017] [Indexed: 12/11/2022]
Abstract
CONTEXT The key in the evolution towards minimally invasive surgery is the availability of appropriate equipment, especially when procedures involve children. While robotic procedures in adults continue to struggle to prove measurable advantages compared with open or classical laparoscopic ones, the use of the robotic platform (RP) in pediatric urology is steadily increasing. OBJECTIVE To review the contemporary literature regarding the use of robotic-assisted (RA) urologic interventions in children. EVIDENCE ACQUISITION A nonsystematic review of the literature was conducted through PubMed database between 2002 and 2017, with an emphasis on large series. EVIDENCE SYNTHESIS A few major challenges must be considered before using the RP in children: anesthesia, placement of trocars, and technical difficulties related to small space. To date, only the robot-assisted pyeloplasty is recognized as safe and efficient with an equivalent outcome compared to the open or classical laparoscopy; this was supported by large multicentric studies, which are not available for most of the other procedures. CONCLUSIONS RA procedure in children has been proven safe and effective. Still in its infancy, further data over time is likely to prove different RA procedures to be equivalent to open or laparoscopy in terms of outcome. PATIENT SUMMARY The advent of the robotic platform means an evolution towards minimizing surgical trauma for the child. Currently, the available platforms designed for adults are adapted to work in children. However, it might be expected in the future that new technologies will improve the technical possibilities to improve the robotic platform for minimally invasive surgery in children. To date, a few applications are considered safe and efficient (in experienced hands), considering that the team has to be aware of some challenges to overcome regarding anesthesia, material, and technique adaptation to the patient. The most accepted robotic applications in children comprises of the robot-assisted pyeloplasty, hemi-nephrectomy, and ureteric reimplantation.
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Howe A, Kozel Z, Palmer L. Robotic surgery in pediatric urology. Asian J Urol 2016; 4:55-67. [PMID: 29264208 PMCID: PMC5730905 DOI: 10.1016/j.ajur.2016.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 06/22/2016] [Indexed: 12/21/2022] Open
Abstract
While robotic surgery has shown clear utility and advantages in the adult population, its role in pediatrics remains controversial. Pediatric-sized robotic instruments and equipment are not readily available yet, so certain modifications can be made in order to make robotic surgery successful in children. While the cost of robotic surgery remains high compared to open procedures, patients experience greater satisfaction and quality of life with robotic surgery. Robotic pyeloplasty is a standard of care in older children, and has even been performed in infants and re-do surgery. Other robotic procedures performed in children include heminephroureterectomy, ureteroureterostomy, ureteral reimplantation, urachal cyst excision, bladder diverticulectomy, and bladder reconstructive procedures such as augmentation, appendicovesicostomy, antegrade continence enema, bladder neck reconstruction and sling, as well as other procedures. Robotic surgery has also been used in oncologic cases such as partial nephrectomy and retroperitoneal lymph node dissection. Future improvements in technology with production of pediatric-sized robotic instruments, along with increases in robotic-trained pediatric urologists and surgeon experience along each's learning curve, will help to further advance the field of robotic surgery in pediatric urology.
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Affiliation(s)
- Adam Howe
- Steven and Alexandra Cohen Children's Medical Center Ringgold Standard Institution - Pediatric Urology, Center for Advanced Medicine Smith Institute for Urology, New Hyde Park, NY, USA
| | - Zachary Kozel
- Long Island Jewish Medical Center Ringgold Standard Institution - Urology, Center for Advanced Medicine Smith Institute for Urology, New Hyde Park, NY, USA
| | - Lane Palmer
- Steven and Alexandra Cohen Children's Medical Center Ringgold Standard Institution - Pediatric Urology, Pediatric Urology Associates, New Hyde Park, NY, USA
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