Ureteroceles are typically diagnosed in childhood and are commonly associated with complete duplex collecting systems. Adult presentations are uncommon, with prolapsed ureteroceles being particularly rare. This video case highlights a unique adult presentation of a prolapsed ureterocele causing obstruction of both moieties, manifesting as an introitus mass with urosepsis. We describe the successful management of this complex dual obstruction using a robotic reconstructive approach.

A 64-year-old female with no significant medical or urological history, presented with one week of dysuria, incomplete voiding, fever and a new introitus mass. Point-of-care ultrasound revealed right-sided hydronephrosis. CT urography confirmed complete duplex right kidney with obstruction of both upper and lower moieties at the level of the bladder. As the patient remained febrile despite bladder catheterization and broad-spectrum antibiotics, percutaneous nephrostomy tubes were placed into both moieties for decompression. Following clinical stabilization, cystoscopy confirmed a prolapsed ureterocele. Considering reasonably preserved renal function in both moieties, a decision was made for robotic-assisted ureteric reimplantation of both upper and lower moiety ureters, with interval excision of prolapsed ureterocele tissue at a later stage.

The robotic procedure was completed successfully with an operative time of 201 minutes with minimal blood loss. Post-operatively, the patient required only non-opioid oral analgesia and was discharged on postoperative day 2 without complications. By the time of stent removal, the prolapsed ureterocele had completely regressed and required no further intervention. At 4-month follow-up, imaging confirmed resolution of hydronephrosis and unobstructed drainage from both moieties. The patient remained symptom-free with stable renal function.

Robotic ureteric reimplantation was a safe and effective treatment in this rare case of a prolapsed ureterocele with dual moiety obstruction from a complete duplex system. This case underscores the importance of considering congenital anomalies in adult urology and adapting surgical strategies accordingly. It also adds to the growing evidence supporting robotic approaches in managing complex ureteric anatomy.