Meningomyelocele (MMC) is the most common spinal dysraphism in children and is often associated with a neurogenic bladder. 20 to 30% of neurogenic bladder patients might need a bladder augmentation, with enterocystoplasty being the golden standard. Ureterocystoplasty is a good alternative when a large dilated ureter is available. Hidden incision endoscopic surgery (HIDES) has emerged as an alternative approach with better a cosmetic effect. All port sites are hidden at the level of a Pfannenstiel incision, thus rendering them invisible. In this step-by-step video, we aim to describe the first case of HIDES for an ureterocystoplasty.
A 15 year-old girl with a lumbosacral MMC corrected at birth and a previous ventriculoperitoneal (VP) shunt had a clinical history of recurrent urinary tract infections in early childhood. She regularly took antibiotic prophylaxis and performed clean intermittent catheterization (CIC) every 3 hours with low volumes, and had incontinence during the intervals. She was prescribed oxybutinin 5 mg 3x/day. Ultrasonography demonstrated a right ureterohydronephrosis with severe parenchymal thinning. Voiding cystourethrogram demonstrated vesicoureteral reflux grade V and a neurogenic bladder. A dimercaptosuccinic acid (DMSA) scan depicted a non-functioning right kidney. Urodynamics demonstrated a low compliance bladder, continuous leakage at maximum bladder capacity and inability to void. Ureterocystoplasty was performed using the HIDES technique, operative time was 130 min and the patient was discharged on the 2nd postoperative day. The patient is completely continent performing CIC every 4 hours with normal volumes (400 cc).
HIDES ureterocystoplasty should be considered for selected cases. This approach combines the advantages of open and laparoscopic approaches described for augmentation, with a better cosmetic result.