Laparoscopic undiversion in a child with sacral agenesis into augmentation cystoplasty

Abstract

Introduction: In neurogenic bladder with compromised renal function or when complex reconstruction is not preferred, ileal conduit is considered. Undiversion is performed when the patient prefers the procedure, once the renal function improves, or when complications resulting from diversion are present.

Case description: We present the case of a 10-y-old boy with sacral agenesis, who underwent laparoscopic-assisted ileal conduit diversion in 2006, because he had a grossly unstable, small-capacity bladder and was not compliant with intermittent self-catheterization. At present, he preferred not to have a conduit.

Discussion: Laparoscopic undiversion with ileal augmentation cystoplasty was performed. The postoperative course was uneventful, and he is now on intermittent self-catheterization with healthy renal function. Laparoscopic undiversion is technically challenging, yet feasible, and is an effective option in children. To our knowledge, this is the first such case reported.

Figure 1.

CT urogram showing the conduit and both kidneys (note the thin parenchyma in the left kidney).

Figure 2.

Image showing port positions.

Figure 3.

Stoma being released.

Figure 4.

Ileo cystoplasty (anastomosis in progress).

Figure 5.

Completed augmented cystoplasty (note the suprapubic Foley catheter).

Figure 6.

Postoperative cystogram.