Many conditions can be treated through minimally invasive surgery. Here are some of the conditions I see in my pediatric urology practice and the surgeries that can repair them.
Ureteropelvic junction obstruction (UPJ obstruction)
This is a condition where there is impaired drainage from one or both kidneys. It may be detected by swelling inside the kidney on prenatal ultrasound or can present with back pain, vomiting, or infection after birth. Pyeloplasty is an operation that fixes this blockage. Minimally invasive surgical options I offer correct this condition include robotic pyeloplasty or laparoscopic pyeloplasty.
Renal duplication abnormalities
Usually, kidneys have one ureter tube that drains the kidney. Sometimes, a kidney can have two separate parts with two different ureters that drain it. This can be associated with blockage of a portion of the kidney that can interfere with kidney function or cause infection or rarely incontinence, which is the inability to control one’s urination. Minimally invasive surgical options I offer to correct renal duplication abnormalities include robotic partial nephrectomy (removing a portion of the kidney) and robotic or laparoscopic ureteroureterostomy (attaching one ureter to another).
Non-functioning dysplastic kidneys
In either boys or girls, a kidney may not have developed properly during development. These non-functioning kidneys may lead to static urine, which stands still and is not eliminated effectively due to an obstruction or an inherent muscular problem with the bladder or ureters. As a result, the urine becomes stagnant and this increases the chances for infection. Static urine can cause pain, chronic infection, kidney stones, and rarely, high blood pressure. These unhealthy kidneys may be removed laparoscopically (laparoscopic nephrectomy) or robotically (robotic nephrectomy).
Renal tumors
Abnormal growths in the kidney may be either benign or malign. Although rare in children, renal tumors may be removed successfully in a minimally invasive fashion either robotically or laparoscopically. Depending on the size and location of the tumor, either a partial nephrectomy or radical nephrectomy will be needed. When a partial nephrectomy is performed, only the tumor is removed. When a radical nephrectomy is performed, the entire kidney is removed.
Vesicoureteral reflux (VUR)
Normally, the kidneys make urine and it only travels from the kidney down to the bladder. In children with vesicoureteral reflux, urine also travels from the bladder back up to the kidneys. This can result in kidney infections and permanent kidney damage or scarring. Minimally invasive surgical options I offer to correct this condition include subureteric injection (otherwise known as Deflux) and robotic ureteral reimplantation. Robotic ureteral reimplantation changes how the ureteral tunnels lie within the bladder so the urine no longer travels back to the kidney from the bladder.
Neurogenic Bladder
Neurogenic means caused or affected by the nerves or nervous system. Children with certain medical conditions or spinal cord abnormalities such as spina bifida can have significant bladder problems that can cause kidney damage and urinary incontinence. Traditionally, correcting these problems could only be done with a large abdominal incision. I offer the following minimally invasive surgical options for children with neurogenic bladder problems:
• Robotic appendicovesicostomy: Otherwise known as a Mitrofanoff procedure, this procedure attaches the appendix to the bladder so children can usually catheterize their bladder through their belly button. This makes it easier to drain the bladder in children who must perform catheterization to empty their bladders.
• Robotic bladder neck reconstruction/bladder neck sling placements: Some children do not have normal function of the urinary sphincter that holds urine inside the bladder. These procedures can help prevent urine from leaking out of the bladder.
• Robotic bladder augmentation: For some children, their bladder is too small to hold urine in a healthy fashion. This procedure uses bowel to increase the size of the bladder.
Bladder diverticulum
A bladder diverticulum is a pouch in the bladder wall that a person may either be born with (congenital) or get later (acquired). A congenital bladder diverticulum forms when some of the bladder lining pokes through a weak part in the bladder wall. Acquired bladder diverticulum is often caused by a block in the bladder outlet, the bladder not working well because of nerve injury or, rarely, from prior bladder surgery. The standard treatment of congenital bladder diverticulum is open surgical excision. Though laparoscopic diverticulectomy has been described in children, this procedure is technically difficult. Robotic diverticulectomy can be a good option.
Urachal abnormalities
The urachus is a connection between the bladder and the belly button that normally closes before birth. If it does not close or only partially closes, then urine may drain from the belly button or a cavity that is at risk for infection and possibly cancer in the future. I offer robotic or laparoscopic urachal excision as a minimally invasive surgical option to correct these conditions.
Undescended testes
In boys, the testicles (or testes) start out in the abdomen (belly) and typically descend into the scrotum before birth. Sometimes they stop short; sometimes don’t even make it out of the abdomen. This can place testes at risk for cancer and decreased fertility in the future. I offer laparoscopic orchiopexy as a minimally invasive technique to bring testes in the abdomen down to the scrotum where they belong.
