Staged Robot-Assisted Bilateral Ureterostomy for Safe Bladder Re-Functionalization

This case study presents a staged robotic approach to ureteral un-diversion in an 11-month-old male patient with a history of posterior urethral valves and bilateral end cutaneous ureterostomies. Initially, the patient’s bladder capacity was severely limited at 15 ml. After unsuccessful bladder cycling via suprapubic tube, a staged robot-assisted ureteral side-to-side ureterocystostomy was performed while preserving cutaneous ureterostomies. The first stage involved successfully completing the left ureterocystostomy, leading to stable bladder distension and hydronephrosis. In the second stage, ligation of the left ureterostomy and right ureterocystostomy were performed, resulting in an increased bladder capacity of 50 ml. The patient achieved natural bladder cycling and volitional voiding, demonstrating the feasibility of this approach for bladder re-functionalization.