Introduction: Neurogenic bladder and bowel dysfunction from spinal dysraphisms frequently require complex reconstructive procedures for renal preservation and social continence. While traditionally performed via an open approach, laparoscopic and robotic-assisted laparoscopic reconstruction have been performed with increasing frequency, and may provide patients with the benefits of minimally invasive surgery. We present the first video, to our knowledge, of intracorporeal concomitant RALIMA, bladder neck reconstruction, and cecal flap ACE channel creation, and demonstrate the salient techniques.
Methods: An 11-year-old female with a history of spina bifida meningomyelocele and prior ventriculo-peritoneal (VP) shunt placement, presented to our clinic with recurrent urinary tract infections (UTI), incontinence, and severe constipation requiring chronic enema use. Renal ultrasound revealed a thick-walled bladder with minimal bilateral hydronephrosis. Urodynamic testing confirmed a small capacity, poorly compliant, high-pressure bladder with detrusor leak point pressure of 8 cm of water, consistent with neurogenic bladder with bladder neck incompetence. She failed conservative management and subsequently underwent RALIMA, bladder neck reconstruction, and ACE channel creation with cecal flap.
Results: Operative time was 615 minutes, estimated blood loss was 50 milliliters, and length of stay was 6 days. Her suprapubic catheters and Mitrofanoff stent were sequentially removed at 4 and 6 week follow up, and she began to self-catheterize her channel at 6 weeks. At 3-month follow up, she is fully continent, and catheterizing her appendicovesicostomy without issue.
Conclusions: Major genitourinary reconstruction, including bladder augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy, bladder neck reconstruction, and cecal flap antegrade colonic enema channel creation, can be safely performed concurrently using minimally invasive, robotic-assisted laparoscopy.
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