Transvesicoscopic Robotic-Assisted excision of giant ureterocele and bladder neck reconstruction: A novel approach in pediatric and young adult patients

Introduction and Objective

Complex ureteroceles in children and young adults, particularly those previously treated in infancy, often present later with voiding dysfunction, high-pressure bladder, and upper tract deterioration. We present a video-based case series demonstrating a novel transvesicoscopic robotic approach for complete ureterocele resection and bladder floor reconstruction.

Methods

We describe four patients (ages 14–20) with recurrent urinary tract infections, high-grade hydronephrosis, and bladder outlet dysfunction after initial ureterocele treatment in infancy. All underwent robotic-assisted transvesical excision of ureterocele remnants and bladder neck reconstruction. One case included ureteral reimplantation and Mitrofanoff revision.

Results

All procedures were completed robotically with operative times ranging from 210 to 300 min. Postoperative recovery was uneventful with minimal blood loss, early discharge (day 3), and catheter removal between days 6 and 18. Follow-up at 8 weeks to 2 years showed restoration of voiding function, stabilization of renal function, and resolution of urinary symptoms.

Conclusions

Transvesicoscopic robotic-assisted reconstruction offers a safe, precise, and minimally invasive alternative to treat complex ureterocele sequelae in adolescents and young adults. This technique enables direct access to the bladder floor with excellent visualization and reconstructive control, surpassing limitations of conventional laparoscopy or open surgery.