Robotic-assisted pyeloplasty in a five-day-old infant with severely infected hydronephrosis: The very young case report and review of literature

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INTRODUCTION: Postnatal management of newborns with antenatal hydronephrosis remains controversy. Most of the newborns with antenatal hydronephrosis are asymptomatic with only rare ones who develop renal insufficiency. We described a pediatric robotic assisted pyeloplasty for treating a five-day-old infant, who was diagnosed as left-sided hydronephrosis with infection two months before birth. CASE PRESENTATION: A Da Vinci robotic surgical system with three arms and 5 mm trocar was used, providing free rotation of the robotic arm with different degree and making the anastomosis easier. The surgery lasted for 235 min, was uneventful and successful. The infant received postoperative management, including anti-infection measures and nutritional support. The follow up renal ultrasonography at 4 months (12.7 mm) and 17 months (9.6 mm) indicated progressive reducing anteroposterior diameters of renal pelvis. The scar was satisfactory due to better cosmetic results of robotic-assisted pyeloplasty. CLINICAL DISCUSSION: Robotic pyeloplasty is becoming the standard of treating children hydronephrosis owning to its minimally invasive access, faster recovery time and better cosmetic results. This article reported a very young hydronephrosis case with infection and presented a brief review of former reports to improve the understanding of rare hydronephrosis caused by antenatal hydronephrosis, and its potential treatment managements. CONCLUSION: To our knowledge, this case is unique and may be the youngest reported instance worldwide via a Da Vinci robotic surgical system in a child with hydronephrosis, which enhances the safe applicability of robotic pyeloplasty in the very young infant.

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