ESPU Congress 2018 - Abstract Book

199 11–14 APRIL, 2018, HELSINKI, FINLAND PATIENTS AND METHODS An 11 year old male with a 5 month history of episodic flank pain and emesis was found to have left primary obstructive megaureter and underwent surgical correction. Two 5 mm instruments are used for the entirety of the procedure with an 8.5 mm camera port and no assistant port. A retro- grade pyelogram is performed and double-J stent is placed prior to the robotic procedure. After dissection of the ureter, the detrusor tunnel is created with blunt dissection and judicious use of monopolar cautery, leading to the stenotic ureteral segment. The ureter is completely transected distal to the stenotic segment at the level of the ureterovesical junction first. This allows the ureter to be straightened, eliminating the tortuosity, and the redundant ureter excised to ensure a straight ureteral course to the bladder. The anastomosis is started with an absorbable 3–0 V-lock suture at 6 o’clock that holds the ureter on tension and defines the amount of ureteral tailoring necessary, facilitating ureteral tapering. The detrusor tunnel is then closed over the ureter after the anastomosis is completed with monocryl suture. RESULTS The patient was discharged on post-operative day 2, he remained symptom-free, and ultrasound four months post-operatively revealed minimal residual hydronephrosis and no ureterectasis. CONCLUSIONS Dismembered ureteral reimplantation with intracorporeal tapering for obstructive megaureter is advantageous with the robotic approach. In particular, our technique utilizes 5 mm instruments and does not require an assistant port, and addresses both the ureteral dilation as well as the tortuosity and redundancy of the ureter effectively. VD-6 (VS without presentation) MICROPERCTM KIT (POLYDIAGNOST, GERMANY) USED TO TREAT A URETERIC STONE IN A CHILD Erika LLORENS DE KNECHT  1 and Anna BUJONS  2 1) FUNDACIO PUIGVERT, Pediatric Urology Department, Barcelona, SPAIN - 2) Fundacio Puigvert, Pediatric Urolofy Department, Barcelona, SPAIN PURPOSE Minimally invasive interventions and the use of smaller caliber ureteroscopes in the treatment of ureteral stones decreases complication rates in children, for that reason are strongly preferred in urolithiasis during childhood. There exist multiple indications for the micropercutaneous nephroli- thotomy set (MicroPerc TM , (PolyDiagnost, Germany); unusual indications were described showing that it can be useful to treat lower ureteric calculi, without the need for ureteric dilation. MATERIAL AND METHODS We present the case of a 5-year-old male with a right pelvic stone of 1 cm. As the guidelines say, a pelvic stone of 10 to 20 mm can be treated with SWL as a first option. We performed a first shock wave lithotripsy session. The US control described low ectasia due to a distal ureteric fragment. We offered after no ejection, an active treatment and we performed a Micro-ureteroscopy. To performe it we used the MicroPerc TM , kit, (PolyDiagnost, Germany) consisting in a 4.85F "All-Seeing Needle" that could easily pass through the meatus without dilatation, and the 3 ways connector that allowed the insertion of a 0.9 mm flexible micro-optic, irrigation system and a laser fiber. To achieve the stone fragmentation, we used a 200-μm Holmium:YAG laser fiber with settings of 0.8 J–12Hz. During the procedure, a C-arm fluoroscopy device was set. RESULTS The patient was discharged the day after the microURS, ejecting fragments, without any ureteric stent, hematuria neither pain.