ESPU Congress 2018 - Abstract Book

202 29 th CONGRESS OF THE ESPU MATERIAL AND METHODS We performed a retroperitoneal robot-assisted laparoscopic in a 13-year-old boy (40 kg) with no past medical history. The child turned to be symptomatic (flank pain). The diagnosis of UPJO was confirmed by renal ultrasound (60 mm pyelocaliceal dilatation) and MAG-3 renal scan (severe impairment of renal function). The child was positioned laterally. A15 mm incision was made just above the iliac crest in the anterior axillary line. The retroperitoneal space was entered and created with the camera (8-mm; O°). Two other 8-mm robotic trocars were placed, with one assistant trocart. After opening Gerota’s fascia, minimal dissection was done just to free the UPJ, and a traction suture, placed at the junction, was inserted through the abdominal wall. Due to aberrant polar vessels, the ureter was completely divided and the UPJ and the pelvis were delivered anterior to the vessels with the help of the traction suture. Then the ureteropelvic anastomosis (Anderson-Hynes pyeloplasty) was performed, using a 6–0 monofilament absorbable suture with a 3/8 circle needle. After stent placement, the posterior part of the anastomosis was completed. No drainage tube was left in situ. RESULTS Set-up time, from skin incision until the end of docking, was 54 min. Surgeon’s console time was 141 min. Total operating time was 195 minutes with no resultant blood loss. He recovered well and was discharged home on postoperative day 1. At 6 months, the patient remains without symptoms. CONCLUSIONS Retroperitoneal robot-assisted laparoscopic is feasible, safe and effective. It is an excellent option with ideal anatomical exposure. VD-10 (VS without presentation) TECHNICAL ADVANCEMENTS IN SCROTAL MOBILIZATION FOR CORRECTION OF PENILE CONCEALMENT Gregory MCMAHON  1 , Zarine BALSARA  2 and Gregory DEAN  2 1) Rowan University, Urology, Stratford, USA - 2) Urology For Children, Temple For Urology, St Christopher's Hospital for Children, Pediatric Urology, Voorhees, USA PURPOSE We have previously described a technique to correct penoscrotal webbing associated with penile concealment. Division of midline scrotal fat permits posterior scrotal repositioning and effectively eliminates the penoscrotal web without dividing it. The distal foreskin unfurls providing ventral shaft skin. We have modified this technique to achieve enhanced cosmesis. MATERIAL AND METHODS The penile base and penoscrotal junction are first carefully marked to ensure accurate placement of prepubic tacking sutures to achieve a normal penopubic junction. Leaving a generous 1.5 cm mucosal collar eliminates the risk of incorporating cicatrix in the shaft. Next, a ventral incision is made from the mucosal collar to insertion of the scrotal web without dividing the web. The penis is degloved to penopubic and penoscrotal junctions. Scrotal retraction exposes midline scrotal fat which is incised enabling posterior scrotal repositioning. Penopubic and penoscrotal junctions are defined and fixed with sutures ~ 4.5 cm from the tip of the glans. Scrotal repositioning unfurls ventral skin yielding appropriate coverage. Byars' flaps are created dorsally and sutured to the collar followed by ventral closure. Lateral skin is excised and the circumcision is completed with monofilament quadrant sutures followed by Dermabond.