Robot-assisted ureteroureterostomy in a child with mid-ureteral stricture: a case report

Congenital ureteral stricture in the mid-portion is a rare cause of upper urinary tract obstruction in children, and currently no established protocols for its surgical treatment exist. A retrospectively analyzed medical history is presented of a 2-year-old patient diagnosed with right mid-ureteral stricture, accompanied by impaired urinary outflow and reduced renal function. Ultrasound scanning and contrast-enhanced computed tomography were used to establish the diagnosis. Surgical treatment was performed using robotic assistance with resection of the stenotic segment and ureteroureterostomy. Intraoperatively, the proximal ureter was transected at the level of the narrowing toward the distal portion. The length of the resected healthy ureter corresponded to the diameter of the dilated segment. The ureteral anastomosis was created over a stent previously placed in the renal pelvis by cystoscopy. After preparation of the ureteral ends, the anastomosis was completed with subsequent drainage. The procedure was successful, with no intraoperative complications. Total operative time was 180 minutes, including 15 minutes for robotic docking. The entire operation was performed robotically without conversion to laparoscopy or open surgery. The stenotic segment measured approximately 8 mm. Postoperatively, the patient was monitored in the intensive care unit for 12 hours. He was discharged home 10 days after surgery, one day after Foley catheter removal. Histological examination of the stenotic segment revealed expansion of the submucosa with fibrosis, lymphocytic inflammation, and thickening of the muscular layer with fiber destruction. Four weeks after surgery, the ureteral stent was successfully removed by cystoscopy. In the long-term postoperative period, ultrasound examination revealed narrowing of the upper ureter to 4 mm. No stenosis was detected at the site of the ureteroureterostomy during follow-up. Robot-assisted laparoscopic ureteroureterostomy is a reliable and effective minimally invasive approach to the treatment of congenital mid-ureteral stricture, with no adverse short- or long-term outcomes during follow-up.