A 14-month-old girl from the United Arab Emirates, who had to urinate through her flanks because of blocked urinary tract upon birth, can now relieve herself normally, thanks to operation at Asan Medical Center.

A team led by Professor Kim Kun-suk of the Pediatric Urological Department at AMC, has successfully removed narrowed ureter and extended the urine path of Naema Mohamed Alkaabi suffering from hydronephrosis, the hospital said on Thursday.

Asan Medical Center Professor Kim Kun-suk (right) celebrates the successful operation of Naema and discharge from the hospital before her family returns to the United Arab Emirates.

Naema, the 14-month-old UAE girl had had her renal pelvis, a path where urine travels, artificially connected to the skin, and urine frequently came out through fistula. Her condition caused her to always wear diapers up to her sides. After the operation, however, the fistula was removed, and she now can normally urinate and wear diapers just like any other girl of her age.

Naema was diagnosed with ureteral stricture and severe hydronephrosis from sonography even before she was born. Her ureter was blocked and caused the urine to fill the kidney. A UAE medical team decided that Naema needs immediate treatment and gave birth to the eight-month-old fetus in Dec 2018. She was transferred from the delivery room to the operating room even before a day passed after her birth. The medical team thought Naema was missing the renal pelvis and connected it to the skin.

Although she could urinate roundabout, her problems with the urinary tract could not be solved. As a result, the UAE team requested Asan Medical Center, which has rich experience and good outcome of urinary obstruction and hydronephrosis.

Naema needed an operation to cut the narrowed ureter and connect them to her bladder, extend the urinal path, and remove renal pelvis and skin fistula.

In late November, Professor Kim performed a bilateral bladder ureter reconstruction and left pyeloplasty to Naema, and right pyeloplasty a month later. Surgery to remove the fistula in the flanks and skin of the renal pelvis proceeded simultaneously with pyeloplasty.

Every surgery was successful, and Naema urinated through the urethra for the first time in her life as she became a year old. She returned to the UAE without complications after receiving treatment in Korea for two months.

"We visited Asan Medical Center with little hope to cure her illness, but thanks to A MC, my child has recovered incredibly," said her father, Mohamed Alkaabi.

Professor Kim said that his team was not sure of the operation result when he received a request from the UAE medical team because he could not know the exact condition of Naema's ureter.

"Based on the rich experience of fetal sonography and urinary obstruction, however, we could diagnose her condition and complete the surgery successfully," Professor Kim said.

Pediatric hydronephrosis accounts for around 50 percent of the congenital malformations of the genitourinary system. Ureteropelvic junction stricture accounts for about 40 to 60 percent of the causes of pediatric hydronephrosis. Asan Medical Center has played as a leader in treating pediatric hydronephrosis and treated more than 300 patients. In 2013, robotic neoplasty was performed for the first time in Korea, and all pediatric patients who received surgery recovered fully without complications such as bleeding.

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