機器手臂輸尿管對接手術治療成人異位雙套輸尿管合併輸尿管囊腫：病例報告

吳昊勳¹、李淑文¹、薛又仁²、邱文祥³

¹臺北市立聯合醫院仁愛院區外科部泌尿科

²臺北市立聯合醫院和平婦幼院區外科部泌尿科

³新光醫療財團法人新光吳火獅紀念醫院外科部泌尿科

Robotic Ureteroureterostomy for Ectopic Duplicated Ureter with Ureterocele in an Adult Male: A Case Report

Hao-Hsun Wu ¹, Shu-Wen Li ¹, Thomas Y. Hsueh ², Allen W. Chiu ³

¹ Division of Urology, Department of Surgery, Renai Branch, Taipei City Hospital

² Division of Urology, Department of Surgery, Heping Fuyou Branch, Taipei City Hospital

³ Division of Urology, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital

Introduction:

Complete ureteral duplication is an uncommon congenital anomaly resulting from the development of two separate ureteric buds. According to the Weigert–Meyer rule, the upper pole moiety ureter typically inserts ectopically and is prone to obstruction, whereas the lower pole ureter is more commonly associated with vesicoureteral reflux.

Ectopic ureteral insertion in males is rare and often presents with nonspecific symptoms, such as recurrent urinary tract infections or lower urinary tract symptoms, leading to delayed diagnosis. Ureterocele is frequently associated with duplicated systems and may further contribute to urinary stasis, obstruction, and infection. Herein, we report a rare case of a middle-aged man with a complete duplicated ureter, ectopic insertion into the prostatic urethra, and associated ureterocele, successfully treated with robotic ureteroureterostomy.

Case presentation:

A 49-year-old man with no significant past medical history presented with several months of intermittent fever and dysuria. Despite multiple courses of antibiotic therapy, he experienced recurrent urinary tract infections. Renal ultrasonography revealed left-sided hydronephrosis. Further evaluation with contrast-enhanced CT demonstrated a complete duplicated ureter on the left side. The upper pole moiety ureter was markedly dilated, showing hydroureter and an associated ureterocele. In contrast, the lower pole moiety ureter appeared unremarkable. After referral to our institution, surgical intervention with robotic ureteroureterostomy was recommended. During surgery, cystoscopic examination revealed that the orifice of the upper pole moiety ureter was ectopically located in the prostatic urethra near the verumontanum. Due to the unfavorable angle, advancement of the ureteroscope into the upper pole ureter was not feasible, precluding complete endoscopic evaluation. The lower pole moiety ureteral orifice was identified in its normal anatomical position at the bladder trigone. Using the da Vinci robotic surgical system, transection of the upper third of the upper pole moiety ureter was performed. The proximal segment was then anastomosed to the lower pole moiety ureter in an end-to-side fashion. Following completion of the anastomosis, a double-J ureteral stent was placed into the upper pole renal pelvis. The patient had an uneventful postoperative course, with no evidence of hematuria, urine leakage, or other surgical complications. At one-month follow-up, KUB radiography demonstrated significant improvement in hydronephrosis.

Conclusion:

This case demonstrates that robotic ureteroureterostomy is a feasible and effective treatment for complex duplicated ureter anomalies with ectopic insertion and ureterocele. Early recognition and individualized surgical planning are essential to relieve obstruction, prevent recurrent infections, and preserve renal function.

Discussion:

In duplicated collecting systems, the upper pole moiety is particularly vulnerable to obstruction due to ectopic insertion and ureterocele formation, which may lead to hydroureter, hydronephrosis, and recurrent infections. In male patients, ectopic ureters are uncommon and often diagnosed later in life because of subtle or atypical presentations.Treatment strategies depend on symptom severity, anatomical features, and preservation of renal function. When the upper pole renal unit remains functional, reconstructive approaches are preferred. Ureteroureterostomy enables preservation of renal parenchyma while bypassing the obstructed or ectopic segment and is an effective surgical option. Robotic-assisted techniques offer enhanced visualization and dexterity, facilitating precise dissection and intracorporeal suturing. Increasing evidence supports robotic ureteroureterostomy as a safe and effective minimally invasive approach with favorable outcomes.

Reference:

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2.      Melissa Angela Chionardes, Aldrich Kurniawan Liemarto, Siska Liana Gunardi. Unilateral duplicated collecting system and ureter with severe hydroureteronephrosis and ectopic ureter insertion of upper pole moiety: A case report. Ann Med Surg (Lond). 2022 Jan 10;74:103255

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