RESUMO
Ureteral stenosis is typically seen in the setting of genitourinary tract manipulation or nephrolithiasis. Bilateral idiopathic ureteral stenosis is an exceedingly rare clinical entity that has been described in only a small number of cases. More specifically, we describe a case of idiopathic bilateral, distal ureteral stenosis resulting in hydronephrosis and deterioration of renal function in an adolescent patient. The patient was successfully treated with robotic bilateral ureteral implants. This case brings to light a rare, but clinically relevant, cause of hydronephrosis, highlights the importance of early intervention in minimizing renal dysfunction, and describes a novel treatment option.
RESUMO
Background: Trocar-site hernia (TSH) is an uncommon complication following laparoscopic surgery and a potential cause of significant morbidity if bowel incarceration or strangulation occurs. Lateral trocar sites are intrinsically less susceptible to hernia development and traditionally do not mandate fascial closure. We present an unusual case involving an incarcerated TSH from a 12-mm right lateral port after robotic prostatectomy. Case Presentation: The patient is a 76-year-old man with localized intermediate risk, high-volume prostate cancer who underwent a robot-assisted, laparoscopic prostatectomy. He developed generalized malaise and no flatus or bowel movements at 7 days postoperatively. Cross-sectional imaging revealed small bowel dilatation with a transition point along the right lateral 12-mm trocar site. A minilaparotomy (extension of lateral port incision) confirmed incarcerated but viable small bowel. This was reduced and fascia closed without surgical resection. Conclusion: While rare, TSH is an important clinical entity to recognize after minimally invasive surgery. It is critical to properly review trocar technique and maintain a low threshold for close postoperative follow-up, if there is clinical concern for a trocar hernia.