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Kajaia D, Hager B, Kliebisch S, Weingärtner K, Seggewiss-Bernhardt R, Zugor V. [Robot-assisted laparoscopic bladder diverticulum resection (RABDR)]. Aktuelle Urol 2022; 53:254-261. [PMID: 33975364 DOI: 10.1055/a-1327-5509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS Since October 2018, urinary bladder diverticulum resections at our Department of Urology have been carried out with robot assistance and with minimal invasivion, Paediatrical urological and robot-assisted minimally invasive urological surgery for the Bamberg Social Foundation were performed with the DaVinci robotic systemTM. The aim of the present study was to record the surgical results of our patients and to compare these if necessary with available data on optimal diagnostic and therapy. METHODS In this retrospective analysis, we included all patients who received RAHDR between October 2018 and March 2020. The primary endpoints were postoperative blood loss (postoperative haemoglobin decrease), the operation time (min), complications according to the Clavien-Dindo classification, length of hospital stay (days), postoperative residual urine, postoperative urine extravasation at the anastomosis of the bladder, postoperative quality of life and postoperative satisfaction with micturition. RESULTS We reviewed a total of 11 patients, all of whom were male. Mean age was 64.8 years (52-82). Average BMI was 26.5 (19-37). 3 patients were ranked with ASA score III, 5 with II and 3 with I. The average residual urine value preoperatively was 183 ml (90-240). A cystogram to rule out extravasation was performed on day 6 postoperatively. The mean duration of surgery was 212 min (148-294) and the mean duration of hospitalisation was 7.6 days (6-10). The mean residual urinary value after surgery was 25 ml (10-60). The mean postoperative maximum of flow was measured at 27.7 ml/s (11-55). No contrast agent extravasation in the cystogram was detected in any of the patients. The complications according to Clavien were not measurable. The mean postoperative haemoglobin decrease was 1.61 g/dl (0-3. 2). CONCLUSIONS In most cases, the removal of one or more bladder diverticula is possible using the minimally invasive robotic technique. Various surgeries such as YV-bladder neck plastic, prostate adenoma enucleation, bladder stone restoration, and inguinal herniotomy can be carried out simultaneously. A robot-assisted urinary bladder diverticulum resection is an effective and gentle procedure. However, it must be considered that it brings financial disadvantages due to the lack of adequate representation within the German DRG-system (Diagnosis Related Groups).
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Affiliation(s)
- David Kajaia
- Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg
| | - Benjamin Hager
- Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg
| | - Stefan Kliebisch
- Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg
| | - Karl Weingärtner
- Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg
| | - Ruth Seggewiss-Bernhardt
- Sozialstiftung Bamberg, Medizinische Klinik V, Hämatologie und Internistische Onkologie, Bamberg
| | - Vahudin Zugor
- Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg
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Zheng Y, Major N, Rovner E. Shortness of Breath Secondary to a Massive Bladder Diverticulum: A Unique Transvesical Repair. Urology 2020; 142:e1-e3. [DOI: 10.1016/j.urology.2020.04.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/21/2020] [Accepted: 04/29/2020] [Indexed: 11/16/2022]
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Kang Q, Kang B, Yu Y, Yang B. Transurethral enucleation of the prostate combined with laparoscopic bladder diverticulectomy. MINIM INVASIV THER 2020; 31:144-148. [PMID: 32432482 DOI: 10.1080/13645706.2020.1768123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: We present a one-session procedure for treating bladder diverticula combined with benign prostatic hyperplasia (BPH).Material and methods: Between January 2015 and April 2019, transurethral plasmakinetic enucleation of the prostate (TUEP) followed by laparoscopic bladder diverticulectomy (LD) were performed in 12 patients at our institution, in four of them combined with bladder stone(s) and in one patient combined with diverticular tumor. Clinical data were retrospectively collected.Results: The mean size of the prostate was 137.3 ± 96.3 (65.5-403.3) ml. The mean maximal diameter of the diverticulum was 8.0 ± 2.7 (3.2-12.0) cm. The mean total operation time was 214.2 ± 69.0 (120-300) min, and the mean enucleation time was 23.2 ± 6.4 (12-35) min. The mean intraoperative blood loss was 52.1 ± 14.9 (30-80) ml. The average pre- and post-operative maximum flow rate was 5.1 ± 1.4 (2.4-8.5) ml/s and 12.8 ± 2.3 (9.6-17.1) ml/s. Except for urinary infection in one patient, no other severe peri- or postoperative complications were observed.Conclusions: TUEP accompanied by LD in one session provides an effective and minimally invasive surgical treatment for bladder diverticula combined with BPH, with or without bladder stones, and permits reasonable operation time and rapid discharge.
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Affiliation(s)
- Qianyu Kang
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Bin Kang
- Department of General Surgery, the Third People's Hospital of Ningxia, Yinchuan, China
| | - Yang Yu
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Bo Yang
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
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Cacciamani G, De Luyk N, De Marco V, Sebben M, Bizzotto L, De Marchi D, Cerruto MA, Siracusano S, Benito Porcaro A, Artibani W. Robotic bladder diverticulectomy: step-by-step extravesical posterior approach - technique and outcomes. Scand J Urol 2018; 52:285-290. [PMID: 30339480 DOI: 10.1080/21681805.2018.1492965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the feasibility of robotic extravesical posterior surgical bladder diverticulectomy for treatment of symptomatic bladder diverticula (BD). MATERIALS AND METHODS Data from patients with posterior BD who consecutively underwent robotic bladder diverticulectomy (RBD) from 2013 to 2016 in Azienda Ospedaliera Universitaria Integrata, Verona, were retrospectively reviewed. Baseline characteristics, perioperative outcomes including operative time (OT), estimated blood loss (EBL), postoperative transfusion rate and length of hospital stay (LOS), and early (30 days) and late (90 days) postoperative complications were recorded and analysed. RESULTS Six patients underwent RBD. Storage, voiding and postvoiding lower urinary tract symptoms (LUTS) were reported by 33.3%, 100% and 33.3% of patients, respectively. The median [interquartile range (IQR)] BD diameter was 7.1 (5.5-9.5) cm; median (IQR) preoperative postvoiding residual volume (PVR) was 300 (90-395) ml. The median (IQR) OT was 112.5 (83.7-133.7) min and median (IQR) EBL was 25.8 (0-50) ml. The median (IQR) LOS was 7 (4.7-9.0) days. One patient (16.7%) reported early minor postoperative complication. No patient showed early or late major postoperative complications. At 2 month follow-up, all patients underwent a lower abdomen ultrasound and minimal or no postoperative PVR was found. At 6 month follow-up no LUTS were reported. CONCLUSIONS RBD appears to be a safe treatment for posterior BD with excellent perioperative and functional outcomes. The three-dimensional visualization, greater magnification and wristed instrumentation with seven degrees of freedom allow precise dissection of BD and reconstruction of the bladder wall.
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Affiliation(s)
- Giovanni Cacciamani
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Nicolò De Luyk
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Vincenzo De Marco
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Marco Sebben
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Leonardo Bizzotto
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Davide De Marchi
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Maria Angela Cerruto
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Salvatore Siracusano
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Antonio Benito Porcaro
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Walter Artibani
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
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Yu Y, Guan S, Shen C, Yang B. Sequential transurethral enucleation of the prostate and laparoscopic bladder diverticulectomy. MINIM INVASIV THER 2016; 25:222-4. [PMID: 27249185 DOI: 10.1080/13645706.2016.1181091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Transurethral endoscopic technique and standard laparoscopic technique are surgical options for the management of benign prostatic hyperplasia (BPH) associated with urinary bladder diverticuli (UBD). In this article, we report laparoscopic diverticulectomy (LD) and transurethral plasmakinetic enucleation of the prostate (TUEP) in the same patient sequentially. To the best of our knowledge, this is the first case report of LD combined with TUEP. An 82-year-old patient with benign prostatic hyperplasia and two secondary large bladder diverticuli underwent sequential TUEP and LD. After completion of the TUEP procedure, the detached adenoma was pushed into the bladder as a whole. Then laparoscopic transperitoneal extravesical diverticulectomy assisted by cystoscopic transillumination was performed immediately, and the enucleated prostate was removed via the neck of the diverticulum. The enucleation time and diverticulectomy time was 18 minutes and 108 minutes, respectively. The catheter was removed on the tenth postoperative day. Transurethral endoscopic surgery combined with LD is a good choice in treating BPH and UBD in one session. But the combined procedure is time-consuming, especially for fragmentation of the prostate. TUEP can greatly reduce the operative time of the combined procedure.
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Affiliation(s)
- Yang Yu
- a Department of Urology , The Second Hospital of Dalian Medical University , DaLian , LiaoNing Province , China
| | - Sheng Guan
- a Department of Urology , The Second Hospital of Dalian Medical University , DaLian , LiaoNing Province , China
| | - Chen Shen
- a Department of Urology , The Second Hospital of Dalian Medical University , DaLian , LiaoNing Province , China
| | - Bo Yang
- a Department of Urology , The Second Hospital of Dalian Medical University , DaLian , LiaoNing Province , China
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de Castro Abreu AL, Chopra S, Dharmaraja A, Djaladat H, Aron M, Ukimura O, Desai MM, Gill IS, Aron M. Robot-Assisted Bladder Diverticulectomy. J Endourol 2014; 28:1159-64. [DOI: 10.1089/end.2014.0149] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Andre Luis de Castro Abreu
- USC Institute of Urology, Center for Advanced Robotic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Sameer Chopra
- USC Institute of Urology, Center for Advanced Robotic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Arjuna Dharmaraja
- USC Institute of Urology, Center for Advanced Robotic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Hooman Djaladat
- USC Institute of Urology, Center for Advanced Robotic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Manju Aron
- USC Institute of Urology, Center for Advanced Robotic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Osamu Ukimura
- USC Institute of Urology, Center for Advanced Robotic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mihir M. Desai
- USC Institute of Urology, Center for Advanced Robotic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Inderbir S. Gill
- USC Institute of Urology, Center for Advanced Robotic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Monish Aron
- USC Institute of Urology, Center for Advanced Robotic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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Bishoff JT. Editorial comment for de Castro Abreu et al. J Endourol 2014; 28:1164. [PMID: 24983304 DOI: 10.1089/end.2014.0483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Moore CR, Shirodkar SP, Avallone MA, Castle SM, Gorin MA, Gorbatiy V, Leveillee RJ. Intravesical Methylene Blue Facilitates Precise Identification of the Diverticular Neck During Robot-Assisted Laparoscopic Bladder Diverticulectomy. J Laparoendosc Adv Surg Tech A 2012; 22:492-5. [DOI: 10.1089/lap.2011.0405] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Charles R. Moore
- Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Samir P. Shirodkar
- Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Michael A. Avallone
- Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Scott M. Castle
- Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Michael A. Gorin
- Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Vladislav Gorbatiy
- Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Raymond J. Leveillee
- Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
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Thiel DD, Young PR, Wehle MJ, Broderick GA, Petrou SP, Igel TC. Robotic-assisted bladder diverticulectomy: tips and tricks. Urology 2011; 77:1238-42. [PMID: 21256564 DOI: 10.1016/j.urology.2010.07.542] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 07/23/2010] [Accepted: 07/23/2010] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The da Vinci Surgical System has become extremely popular in the field of urology for procedures requiring complex reconstructive maneuvers, such as radical prostatectomy and pyeloplasty. A natural extension of these procedures is the use of the da Vinci system for complex urinary tract reconstruction deep in the pelvis, such as bladder diverticulectomy. TECHNICAL CONSIDERATIONS In our report and accompanying Video, we have demonstrated some technical tips and tricks with regard to patient selection, preoperative imaging, patient positioning, port placement, intraoperative diverticulum recognition/excision, and cystotomy repair that the surgeon might find beneficial for successful completion of robotic-assisted bladder diverticulectomy. CONCLUSIONS The tips and tricks we have presented might aid in the successful completion of robotic bladder diverticulectomy.
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Affiliation(s)
- David D Thiel
- Department of Urology, Mayo Clinic Jacksonville, Jacksonville, Florida 32224, USA.
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Treatment of bladder diverticula, impaired detrusor contractility, and low bladder compliance. Urol Clin North Am 2009; 36:511-25, vii. [PMID: 19942049 DOI: 10.1016/j.ucl.2009.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Bladder diverticula are common enough to be encountered by most urologists in practice but are reported less frequently in the literature than they were 50 years ago. Some patients can be managed nonoperatively, whereas others will need surgical intervention consisting of bladder outlet reduction and possibly removal of the diverticulum itself. In addition to the decision to operate, the timing of each intervention deserves careful consideration. Cystoscopy, computed tomography with contrast, urodynamic studies, cytology, and voiding cystourethrography play important roles in informing the clinician. Many new techniques for treatment of the bladder outlet and the diverticulum are available, such as laparoscopy and robotic surgery.
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Kural AR, Atug F, Akpinar H, Tufek I. Robot-Assisted Laparoscopic Bladder Diverticulectomy Combined with Photoselective Vaporization of Prostate: A Case Report and Review of Literature. J Endourol 2009; 23:1281-5. [DOI: 10.1089/end.2008.0674] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Ali Riza Kural
- Department of Urology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Fatih Atug
- Department of Urology, Istanbul Bilim University School of Medicine, Istanbul, Turkey
| | - Haluk Akpinar
- Department of Urology, Istanbul Bilim University School of Medicine, Istanbul, Turkey
| | - Ilter Tufek
- Department of Urology, Istanbul Bilim University School of Medicine, Istanbul, Turkey
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Meeks JJ, Hagerty JA, Lindgren BW. Pediatric Robotic-Assisted Laparoscopic Diverticulectomy. Urology 2009; 73:299-301; discussion 301. [DOI: 10.1016/j.urology.2008.06.068] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 06/09/2008] [Accepted: 06/11/2008] [Indexed: 11/25/2022]
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Kim SW, Jung JW, Cho HJ, Kim JC, Hwang TK, Park YH, Hong SH. Laparoscopic Excision of a Giant Bladder Diverticulum. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.4.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sun Wook Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Woo Jung
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk Jin Cho
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Chul Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Kon Hwang
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Hyun Park
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Hoo Hong
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Robotic assisted laparoscopic bladder diverticulectomy. J Urol 2007; 178:2406-10; discussion 2410. [PMID: 17937944 DOI: 10.1016/j.juro.2007.08.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Indexed: 12/19/2022]
Abstract
PURPOSE Surgical management for bladder diverticuli includes open, endoscopic and standard laparoscopic techniques. To our knowledge we report the first series of robotic assisted laparoscopic bladder diverticulectomies. MATERIALS AND METHODS Five patients underwent robotic assisted laparoscopic bladder diverticulectomy between December 2004 and December 2006, as performed by a single surgeon using the da Vinci robotic system for symptomatic diverticuli. The records were reviewed, the surgical technique is described and a review of the literature was performed. RESULTS All patients underwent cystoscopy, ureteral stent placement and placement of an angiographic catheter to distend the diverticulum. The diverticulum was approached transperitoneally, mobilized and transected at its neck, and the bladder was closed in 2 layers. One patient underwent ureteral reimplantation for a Hutch diverticulum. Median total operative time was 178 minutes (range 163 to 235) and robotic operative time was 83 minutes (range 63 to 143). Length of stay was 3 days (range 1 to 6). Two patients who underwent transurethral prostate resection before diverticulum resection did well. Two patients in whom medical management failed ultimately underwent transurethral prostate resection and 1 patient continued on medical therapy with regular followup. CONCLUSIONS Robotic assisted laparoscopic bladder diverticulectomy is safe and effective for patients with a large bladder diverticulum and small prostate. Perioperative surgical outcomes rival those of previously reported open, endoscopic and laparoscopic diverticulectomies.
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Flasko T, Toth G, Benyo M, Farkas A, Berczi C. A New Technical Approach for Extraperitoneal Laparoscopic Bladder Diverticulectomy. J Laparoendosc Adv Surg Tech A 2007; 17:659-61. [PMID: 17907983 DOI: 10.1089/lap.2006.0235] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this paper, the authors report on a new, modified laparoscopic technique to remove a large bladder diverticulum. A 26-year-old male with a urinary problem underwent an ultrasound, as well as intravenous urography and cystoscopy examinations, which showed a large bladder diverticulum. The diverticulum was operated upon laparoscopically. The extraperitoneal laparoscopic intervention was facilitated by balloon placed into the diverticulum. The new technique for the laparoscopic diverticulumectomy procedure was successful and the operating time was 140 minutes. There were no perioperative complications. In conclusion, the laparoscopic removal of the bladder diverticulum is a safe and minimally invasive intervention. The introduction of a balloon into the diverticulum makes the operation easier.
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Affiliation(s)
- Tibor Flasko
- Department of Urology, University of Debrecen, Debrecen, Hungary
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Abstract
PURPOSE We report our initial experience with 13 cases of laparoscopic vesical diverticulectomy done via an extravesical approach between November 2002 and October 2004. PATIENTS AND METHODS All patients were male, with a mean age of 53 years and a mean body mass index of 26.2 kg/m2. A transperitoneal approach was preferred. The diverticulum was of the primary type in three patients and of the secondary type resulting from benign prostatic hyperplasia in seven patients and a longstanding urethral stricture in three patients. RESULTS The mean operative time was 265 minutes with a mean blood loss of <100 mL and a mean postoperative hemoglobin decline of 1.1 g/dL. The urethral catheter was removed on day 7 postoperatively in the patients with a primary diverticulum, whereas it was left for 11 to 14 days in patients with secondary bladder diverticula. Postoperative complications occurred in only one patient with a primary diverticulum, taking the form of extravasation from the suture line in the control gravity-fill cystogram that was done routinely prior to urethral-catheter removal. Leakage resolved with urethral catheterization for 2 more weeks. The postoperative stay was 3 to 4 days. CONCLUSION Laparoscopic diverticulectomy is technically feasible and safe and may represent an alternative to the standard open procedure.
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Shah HN, Shah H, Shah RH, Shah R, Hegde SS, Hegde S, Shah JN, Shah J, Bansal MB, Bansal M. Sequential Holmium Laser Enucleation of the Prostate and Laparoscopic Extraperitoneal Bladder Diverticulectomy: Initial Experience and Review of Literature. J Endourol 2006; 20:346-50. [PMID: 16724908 DOI: 10.1089/end.2006.20.346] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Urologic applications of laparoscopy and the holmium laser have increased exponentially in the past few years. We present our experience with sequential holmium laser enucleation of the prostate (HoLEP) and extraperitoneal laparoscopic diverticulectomy for a large symptomatic bladder diverticulum and associated bladder outlet obstruction. PATIENTS AND METHOD From June 2004 to June 2005, three patients with benign prostatic hyperplasia (BPH) and a large secondary bladder diverticulum were offered sequential HoLEP and laparoscopic extraperitoneal bladder diverticulectomy. Demographic data and perioperative outcomes were recorded. A review of the literature was performed to determine the present role of laparoscopic diverticulectomy. RESULTS All patients underwent the planned procedure successfully. The mean operating time was 63.33 minutes for HoLEP and 246.6 minutes for diverticulectomy. Oral intake was resumed after a mean of 8.6 hours. The mean postoperative analgesia required was 146 mg of parecoxib sodium, and the mean drop in hemoglobin was 1.13 g/dL. Patients were discharged after an average of 66.6 hours. At 1-month follow-up, the average American Urological Association Score had improved from 13 to 6, the post-void [corrected] residual urine volume had decreased from 997 mL to 164 mL, and the peak uroflow rate had improved from 4.9 mL/sec to 10.4 mL/sec. These measures showed further improvement on later follow-up. A total of 30 cases of laparoscopic diverticulectomy have been reported in literature [corrected] of which only two were done extraperitoneally. CONCLUSION Simultaneous HoLEP and laparoscopic extraperitoneal diverticulectomy is an effective strategy for the treatment of BPH with associated large bladder diverticulum.
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Affiliation(s)
- Hemendra N Shah
- Department of Urology, R.G. Stone Urological Research Institute, Mumbai, India.
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Porpiglia F, Terrone C, Cossu M, Renard J, Grande S, Scarpa RM. Real time ultrasound in laparoscopic bladder diverticulectomy. Int J Urol 2005; 12:933-5. [PMID: 16323993 DOI: 10.1111/j.1442-2042.2005.01180.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe our technique of laparoscopic diverticulectomy under ultrasound (US) guidance after a transurethral resection of prostate (TURP) in the treatment of patients with benign prostatic hyperplasia and bladder diverticulum. A standard TURP is performed with an Iglesias resectoscope. A 12-Fr Foley catheter is positioned in the diverticulum and the catheter balloon is then inflated with 30 mL of water; then a Tiemann catheter is placed through the urethra into the bladder. A US probe is inserted through the 12 mm port placed in the right side by the surgeon, then laparoscopic transperitoneal bladder diverticulectomy is performed under US guidance. In our experience, the use of endolaparoscopic US makes identification and dissection of the diverticulum easy, safe and effective, even when the procedure has to be performed in disadvantageous anatomic conditions such as lateral-posterior diverticulum or post-TURP imbibition of pelvic tissue.
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Affiliation(s)
- Francesco Porpiglia
- Divisione Universitaria di Urologia, Dipartimento di Scienze Cliniche e Biologiche, Azienda Ospedaliera S. Luigi, Orbassano Torino, Italy.
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Juan YS, Li CC, Shen JT, Jang MY, Wu WJ, Wang CJ, Huang CH. Laparoscopic Bladder Diverticulectomy for Large Bladder Diverticulum: A Case Report. Kaohsiung J Med Sci 2004; 20:563-6. [PMID: 15620121 DOI: 10.1016/s1607-551x(09)70259-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Bladder diverticula are herniations of the bladder mucosa through the bladder wall musculature. Acquired bladder diverticula are the result of outlet obstruction, mostly benign prostate enlargement, infections, or urethral stricture. Traditionally, bladder diverticulum was excised by the open method. However, the laparoscopic technique has been widely used to treat many urologic diseases, including bladder diverticulum. Laparoscopic diverticulectomy can be performed transperitoneally or extraperitoneally. We report our initial experience with laparoscopic transperitoneal diverticulectomy for a large bladder diverticulum caused by bladder outlet obstruction. The patient had satisfactory micturition and was discharged on the eighth postoperative day.
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Affiliation(s)
- Yung-Shun Juan
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan.
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Porpiglia F, Tarabuzzi R, Cossu M, Vacca F, Terrone C, Fiori C, Scarpa RM. Is laparoscopic bladder diverticulectomy after transurethral resection of the prostate safe and effective? Comparison with open surgery. J Endourol 2004; 18:73-6. [PMID: 15006059 DOI: 10.1089/089277904322836721] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE In a retrospective nonrandomized study, we compared our experience with transurethral resection of the prostate (TURP) plus sequential laparoscopic bladder diverticulectomy with a series of combined open bladder diverticulectomies with transvesical prostatectomy. PATIENTS AND METHODS We considered 12 consecutive patients (group A) having 16 diverticula who underwent sequential TURP and transperitoneal laparoscopic bladder diverticulectomy and 13 consecutive patients (group B) having 13 diverticula who underwent open bladder diverticulectomy and transvesical prostatectomy. We evaluated the size and position of the diverticulum, adenoma volume, operative time, postoperative hemoglobin variations, analgesia requirement, complications, postoperative hospital stay, and uroflowmetry results. RESULTS No statistically significant differences existed between the groups in adenoma volume or diverticulum size or position. However, a significantly longer operative time was recorded in group A. The endolaparoscopic approach proved to be statistically superior to open surgery regarding blood loss, postoperative analgesia requirement, and hospital stay. No intraoperative complications were recorded. In addition, no statistically significant difference was found in uroflowmetry results. CONCLUSIONS In our experience, the endolaparoscopic approach has proved to be safe, effective, and minimally invasive and therefore superior to transvesical prostatectomy and open bladder diverticulectomy. Its only disadvantage is the longer operative time.
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Affiliation(s)
- F Porpiglia
- Divisione Universitaria di Urologia, Dipartimento di Scienze Cliniche e Biologiche, Azienda Ospedaliera S Luigi, Orbassano, Torino, Italy.
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Abstract
Vesical diverticula refer to hernias of the vesical mucous membrane in the detrusor. The diverticulum wall is therefore constituted by the chorion urothelium. The muscular dehiscence that is at the origin of the diverticulum may be either congenital or degenerative. Two important complications of the diverticulum-that are sometimes interwoven-may occur: a draining defect (responsible for infections, lithiasis, and functional signs of the lower urinary tract), and the development of an urothelial tumour in the diverticulum cavity. For such complicated diverticula, surgery is indicated, by endoscopic or retropubic approach. Results may be excellent, provided the surgical intervention focuses at the same time on the management of the associated sub-vesical obstacle in case of acquired diverticulum.
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Affiliation(s)
- C Linke
- Service d'urologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France.
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Khonsari S, Lee DI, Basillote JB, McDougall EM, Clayman RV. Intraoperative Catheter Management During Laparoscopic Excision of a Giant Bladder Diverticulum. J Laparoendosc Adv Surg Tech A 2004; 14:47-50. [PMID: 15035845 DOI: 10.1089/109264204322862360] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Massive bladder diverticula present a technical challenge to the laparoscopic surgeon. We describe a laparoscopic approach to transperitoneal diverticulectomy, using a specific catheter arrangement to allow excellent control of the various portions of the procedure. METHODS A 49-year-old male with longstanding frequency was diagnosed with a 1000 cc bladder diverticulum and bladder neck outlet obstruction. Laparoscopic transperitoneal diverticulectomy was performed using a triple catheter arrangement: endoscopic placement of a Councill catheter in the diverticulum, fluoroscopic positioning of an occlusion balloon catheter in the renal pelvis, and placement of a Cope loop suprapubic tube. Additionally, a transurethral incision of the prostate was performed. RESULTS The procedure was completed laparoscopically using a four port transperitoneal approach. During the procedure, the diverticulum could be filled and emptied as needed; the catheter across the diverticular neck facilitated subsequent closure of the bladder wall defect. The diverticulum was completely excised. The remaining defect in the bladder was then closed in 2 layers. The patient was discharged on postoperative day 3. CONCLUSION Careful planning and arrangement of catheters in the bladder, ureter, and diverticulum facilitates laparoscopic transperitoneal diverticulectomy of even a very large volume diverticulum.
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Affiliation(s)
- Sepehr Khonsari
- Department of Urology, University of California, Irvine College of Medicine, Irvine, California, USA
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