In this case study, we present the successful use of a staged robotic approach to bilateral ureteral un-diversion for safe bladder re-functionalization in an 11-month-old male. The patient had a history of posterior urethral valves and underwent bilateral cutaneous ureterostomies during the neonatal period to treat bladder outlet obstruction. By the time of initial evaluation, his bladder capacity had significantly reduced to 15 ml, and attempts to increase capacity through bladder cycling using a suprapubic tube were unsuccessful. Consequently, the patient was recommended for a two-stage robot-assisted ureteral side-to-side ureterocystostomy while maintaining his cutaneous ureterostomies.
The first stage, focusing on the left ureterocystostomy, was performed with a console time of 90 minutes and was safely completed. Six months postoperatively, the patient’s ultrasound showed stable hydronephrosis with some urine accumulating in the partially distended bladder. After 10 months, the patient underwent the second stage, which involved videourodynamics, ligation of the left ureterostomy, and completion of the right side-to-side ureterocystostomy while maintaining the right ureterostomy. At this point, urodynamics demonstrated a bladder capacity increase to 50 ml, up from 15 ml. The second surgery had a console time of 105 minutes and was successfully completed. Four weeks later, a follow-up ultrasound showed a stable upper urinary tract and a distended bladder, with no compromise to kidney function. Importantly, the patient’s bladder began cycling naturally without discomfort, and he showed signs of volitional voiding.
This staged approach resulted in a threefold increase in bladder capacity and illustrated the potential for safe and effective bladder re-functionalization through robot-assisted surgery in carefully selected patients.
