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Unusual Case of an Ectopic Clitoris
ESPU Programme 2010
S93
# V-4 (V) ROBOTIC-ASSISTED APPROACH IN RELAPSED URETEROPELVIC JUNCTION OBSTRUCTION ´ Marı´a GARAT1 and Anna BUJONS1, Guillermo URDANETA2, Miriam SERRANO2, Jorge CAFFARATTI2, Lluis GAUSA2, Jose 2 Humberto VILLAVICENCIO 1
Fundacio´ Puigvert, Pediatric Urology, Barcelona, SPAIN, 2Fundacio´ Puigvert, Urology, Barcelona, SPAIN
PURPOSE Ureteropelvic junction syndrome (UPJS) is the most frequent cause of ureteral obstruction in children. Since our robotic experience starts in 2006 with da Vinci surgical systemâ, we initiate a series thinking about the benefits in terms of surgical precision and outcomes. We present the clinical case of a patient with relapsed ureteropelvic junction obstruction treated by means of a roboticassisted approach.
who complains of right low back pain since several months. A renogram with obstructive pattern and an abdominal computed tomography (CT) with three-dimensional (3D) image reconstruction, reported a proximal ureteral stenosis secondary to a polar vessel. A robotic-assisted transperitoneal pyeloplasty is performed with the use of 3 robotic trocars and a 5 mm. trocar for the assistant. The ureteral suture is done using 6-0 Monocrylâ
RESULTS MATERIAL AND METHODS We present a 21 years old patient with history of open right pyeloplasty at 9 years,
Total surgical time was 180 minutes with a console time of 110 minutes. Blood loss was insignificant and patient was discharged
48 hours after surgery with a double J stent, which was removed 4 weeks later with sedative medication. A renogram indicated 3 months postoperatively conforms absence of obstruction.
CONCLUSIONS Robotic approach allows a good surgical performance, comfortable for the surgeon with 3D vision; enabling an excellent dissection and reconstruction (anastomosis) in tissues already injured. The patient’s recovery is fast with satisfactory esthetic and functional outcomes.
# V-5 (V) UNUSUAL CASE OF AN ECTOPIC CLITORIS Nenad DJAKOVIC, Alev OEZTUERK, Boris HADASCHIK, Joan NYARANGI-DIX, Jesco PFITZENMAIER, Sascha PAHERNIK, Axel HAFERKAMP and Markus HOHENFELLNER University of Heidelberg, Urology, Heidelberg, GERMANY
PURPOSE An ectopic clitoris is an extremely rare condition which is usually associated with severe defects of the urinary tract. Variances of this anomaly as a bifid clitoris are usually seen in epispadias-extrophy in girls with cloacal anomalies. There are only a few reports of an ectopic clitoris in the current literature.
MATERIAL AND METHODS We present the case of an 11 year-old girl who underwent operative correction of anal atresia as a newborn. She was referred to our department for further evaluation because of an unusual appearance of the
external genitalia. Clinical examination revealed malposition of the labia minora and absence of a clitoris. On the inner part of the left thigh a structure was seen which could be identified as an ectopic clitoris. X-Ray examination showed a 2 cm diastasis of pubic symphysis. During surgery the ectopic clitoris was completely mobilized and a neurovascular bundle with a single cavernous body was identified. The glans clitoridis and the neurovascular bundle were dissected from the cavernous body and the latter was transsected at the level of the left pubic ramus. Using a subcutaneous tunnel the clitoris was adapted tension free and brought to its correct anatomical position. The impression of the mons pubis was
corrected with two overlapping subcutaneous flaps.
RESULTS Six months postoperatively a very good cosmetic and functional result was achieved.
CONCLUSIONS We present the successful correction of an extremely rare genital anomaly in a female patient. In evaluating the relevant literature, we did not find a comparable case describing the surgical management.
S93
# V-4 (V) ROBOTIC-ASSISTED APPROACH IN RELAPSED URETEROPELVIC JUNCTION OBSTRUCTION ´ Marı´a GARAT1 and Anna BUJONS1, Guillermo URDANETA2, Miriam SERRANO2, Jorge CAFFARATTI2, Lluis GAUSA2, Jose 2 Humberto VILLAVICENCIO 1
Fundacio´ Puigvert, Pediatric Urology, Barcelona, SPAIN, 2Fundacio´ Puigvert, Urology, Barcelona, SPAIN
PURPOSE Ureteropelvic junction syndrome (UPJS) is the most frequent cause of ureteral obstruction in children. Since our robotic experience starts in 2006 with da Vinci surgical systemâ, we initiate a series thinking about the benefits in terms of surgical precision and outcomes. We present the clinical case of a patient with relapsed ureteropelvic junction obstruction treated by means of a roboticassisted approach.
who complains of right low back pain since several months. A renogram with obstructive pattern and an abdominal computed tomography (CT) with three-dimensional (3D) image reconstruction, reported a proximal ureteral stenosis secondary to a polar vessel. A robotic-assisted transperitoneal pyeloplasty is performed with the use of 3 robotic trocars and a 5 mm. trocar for the assistant. The ureteral suture is done using 6-0 Monocrylâ
RESULTS MATERIAL AND METHODS We present a 21 years old patient with history of open right pyeloplasty at 9 years,
Total surgical time was 180 minutes with a console time of 110 minutes. Blood loss was insignificant and patient was discharged
48 hours after surgery with a double J stent, which was removed 4 weeks later with sedative medication. A renogram indicated 3 months postoperatively conforms absence of obstruction.
CONCLUSIONS Robotic approach allows a good surgical performance, comfortable for the surgeon with 3D vision; enabling an excellent dissection and reconstruction (anastomosis) in tissues already injured. The patient’s recovery is fast with satisfactory esthetic and functional outcomes.
# V-5 (V) UNUSUAL CASE OF AN ECTOPIC CLITORIS Nenad DJAKOVIC, Alev OEZTUERK, Boris HADASCHIK, Joan NYARANGI-DIX, Jesco PFITZENMAIER, Sascha PAHERNIK, Axel HAFERKAMP and Markus HOHENFELLNER University of Heidelberg, Urology, Heidelberg, GERMANY
PURPOSE An ectopic clitoris is an extremely rare condition which is usually associated with severe defects of the urinary tract. Variances of this anomaly as a bifid clitoris are usually seen in epispadias-extrophy in girls with cloacal anomalies. There are only a few reports of an ectopic clitoris in the current literature.
MATERIAL AND METHODS We present the case of an 11 year-old girl who underwent operative correction of anal atresia as a newborn. She was referred to our department for further evaluation because of an unusual appearance of the
external genitalia. Clinical examination revealed malposition of the labia minora and absence of a clitoris. On the inner part of the left thigh a structure was seen which could be identified as an ectopic clitoris. X-Ray examination showed a 2 cm diastasis of pubic symphysis. During surgery the ectopic clitoris was completely mobilized and a neurovascular bundle with a single cavernous body was identified. The glans clitoridis and the neurovascular bundle were dissected from the cavernous body and the latter was transsected at the level of the left pubic ramus. Using a subcutaneous tunnel the clitoris was adapted tension free and brought to its correct anatomical position. The impression of the mons pubis was
corrected with two overlapping subcutaneous flaps.
RESULTS Six months postoperatively a very good cosmetic and functional result was achieved.
CONCLUSIONS We present the successful correction of an extremely rare genital anomaly in a female patient. In evaluating the relevant literature, we did not find a comparable case describing the surgical management.