Adult metaplastic hutch diverticulum with robotic-assisted diverticulectomy and reconstruction: A case report

BACKGROUND Hutch diverticulum arises from the compromised muscular development at the ureteral orifice. It is a congenital disease and extremely rare in adult, only accounting for about 3% occurrence worldwide. It can be either symptomatic or asymptomatic, and relies on image tools for diagnosis and preoperative planning. Indications for surgery are dependent on the complications from the diverticulum. Metaplasia is about 10% among those with hutch diverticulum, and it still has chances turning into malignancy, especially urothelial cell carcinoma. CASE SUMMARY A 27-year-old man was presented with frequently recurrent urinary tract infection for one year, and had suffered from intermittent right flank pain for 3 mo. No past medical histories were recorded before. No obvious abnormalities on laboratory data and urine examination were found. Under ultrasound, right hydronephrosis was seen and an anatomical abnormality was observed on intravenous pyelography. Further computed tomography urogram showed one diverticulum seated at superolateral side of right ureteral orifice. Cystoscopy was done and biopsy results showed focal metaplasia. After discussing with him, robotic-assisted diverticulectomy with reconstruction was performed. Right hydronephrosis was greatly improved after surgery. He has completed his 1.5-year follow-ups, and no malignancies were seen from urine cytology and image of intravenous pyelography. CONCLUSION Robotic-assisted diverticulectomy and reconstruction to hutch diverticulum is a safe and efficient operation, providing several advantages over open and laparoscopic ones.