A New Technical Approach for Extraperitoneal Laparoscopic Bladder Diverticulectomy

Flaskó, Tibor; Tóth, György; Benyó, Mátyás; Farkas, Antal; Berczi, Csaba

doi:10.1089/lap.2006.0235

Cited by 12 publications

(7 citation statements)

References 5 publications

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“…The diverticulum is flattened due to pneumoperitoneum, challenging easy recognition. Several maneuvers and techniques have been defined to facilitate the identification of the diverticulum during the procedure [5,6,10,11,12,13,14,15]. Moore et al [10] instilled methylene blue into the bladder to aid in intra-abdominal identification of the diverticular neck.…”

Section: Discussionmentioning

confidence: 99%

“…Nadler et al [12] placed a home-made balloon catheter inside the diverticulum and inflated the balloon in the diverticulum. Flasko et al [13 ]also placed a home-made balloon into the diverticulum, but through the working channel of a nephroscope. Shah et al [14 ]and Khonsari et al [15 ]inserted a guide wire into the diverticulum and placed catheters over the guide wire.…”

Section: Discussionmentioning

confidence: 99%

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Robot-Assisted Bladder Diverticulectomy with Concurrent Management of Bladder Outlet Obstruction

et al. 2016

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Introduction: Robot-assisted bladder diverticulectomy (RABD) through a technique for easier identification of diverticulum along with concomitant management of bladder outlet obstruction (BOO) utilizing a combination of transurethral prostatectomy (TUR-P) and photoselective vaporization of prostate (PVP) is presented. Materials and Methods: Between 2008 and 2015, 9 patients underwent RABD with concurrent treatment of BOO. Diverticula were identified by a technique of catheterizing the diverticulum and the bladder simultaneously and individually. Results: Mean patient age was 62 ± 9.8 and prostate volume was 70 ± 26 ml. Mean time for endourological procedure was 77 ± 35, mean console and total operative times were 108 ± 38 and 186 ± 56 min, respectively. Mean estimated blood loss was 71 ± 37 ml. All diverticula were excised and BOO treated successfully. Bladder irrigation was not necessary in any patient. Mean hospitalization and catheter removal time was 5 ± 3 and 8 ± 3 days, respectively. No complications were observed. Conclusions: BOO is the main cause of acquired bladder diverticula and is largely due to benign prostatic hyperplasia. Concomitant performance of TUR-P and PVP along with RABD is feasible and safe. Individual catheterization of the diverticulum and bladder facilitates the identification of diverticulum even in the presence of multiple diverticula.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Robot-Assisted Bladder Diverticulectomy with Concurrent Management of Bladder Outlet Obstruction

et al. 2016

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“…Laparoscopic or robotic diverticulectomy is the preferred method due to excellent efficiency and minimal invasiveness and morbidity. Laparoscopy can be extraperitoneal [ 6 , 8 ], intraperitoneal (= transperitoneal) [ 2 , 3 ] or suprapubic transvesical [ 18 – 20 ]. Pure laparoscopy can be replaced by robotic-assisted bladder diverticulectomy [ 1 , 9 , 11 , 12 , 14 , 18 , 19 , 21 – 23 ].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic urinary bladder diverticulectomy combined with photoselective vaporisation of the prostate

Hora¹,

Eret²,

Stránský³

et al. 2015

wiitm

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IntroductionPseudodiverticulum of the urinary bladder is mostly a complication of subvesical obstruction (SO). The gold standard of treatment was open diverticulectomy with adenectomy. A more contemporary resolution is endoscopic, in two steps: the first transurethral resection of the prostate (TURP), the second laparoscopic diverticulectomy (LD).AimTo present a one-session procedure – photoselective vaporisation of the prostate (PVP) with LD.Material and methodsFrom 1/2011 to 6/2014, 14 LDs were performed: 1 LD only, 1 with laparoscopic radical prostatectomy, 12 combined with treatment of benign prostatic hyperplasia (BPH), 4 cases of TURP and LD in the second period. In 8 cases, PVP and LD in one session were combined. These 8 cases are presented. 3D CT cystography was used as a gold standard for assessment of diverticulum.ResultsThe mean age was 66.5 ±5.5 (57.3–75.1) years, the mean size of the diverticulum 61.8 ±22.1 (26–90) mm. The procedure starts in the lithotomy position. It includes PVP and stenting of the ureter(s). Changing of position and laparoscopy follows: four ports, transperitoneal extravesical approach. Photoselective vaporisation of the prostate was performed using the Green Light Laser HPS (1x) or XPS with cooled fibre MoXy (7x). The mean delivered energy in PVP was 205.1 ±106.4 (120–458) kJ. The mean time of operation was 165.0 ±48.5 (90–255) min. No postoperative complications were observed. One patient underwent TUR incision after 1 year for sclerosis of the bladder neck.ConclusionsPseudodiverticulum of the urinary bladder (with or without SO) is a relatively rare disease. One session of PVP (Green Light Laser XPS, MoXy fibre) and laparoscopic (transperitoneal extravesical) diverticulectomy is the preferred method for treatment of subvesical obstruction due to BPH and bladder diverticulum at our institution.

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“…While there have been several reports of laparoscopic bladder diverticulectomy in adults [13][14][15][16][17][18], we have located only one previous report on pediatric laparoscopic extravesical bladder diverticulectomy in the literature that also described concurrent nephroureterectomy in a 6-year-old child [19]. In this approach, identification of the diverticulum from outside of the bladder can be difficult [15].…”

Section: Extravesical Laparoscopic Surgerymentioning

confidence: 95%

“…Rebouças et al reported that the concomitant use of cystoscopy facilitates the identification and location of the diverticulum, thereby minimizing dissection of the bladder and decreasing operative time [17]. Flasko et al reported that the introduction of a balloon into the diverticulum makes the operation easier during laparoscopic extravesical bladder diverticulectomy [18].…”

Section: Extravesical Laparoscopic Surgerymentioning

confidence: 99%

Management of Bladder Diverticula in the Pediatric Population

Baek

Sılay

Koh

2016

Curr Bladder Dysfunct Rep

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Bladder diverticula represent protrusion of the urothelial mucosa through the bladder muscular layers and may be either congenital or acquired. Congenital bladder diverticula are usually located adjacent to the ureteral orifices and often are associated with vesicoureteral reflux. Acquired bladder diverticula are usually multiple in nature and are secondary to bladder outlet obstruction or neurogenic bladder. When bladder diverticula are small and do not cause symptoms, non-surgical observation is an acceptable management strategy. The absolute need for surgical intervention of bladder diverticula remains a controversial topic, where current surgical indications for bladder diverticula include diverticula larger than 3 cm, recurrent urinary tract infections, associated severe vesicoureteral reflux, voiding dysfunction, urinary retention, bladder stones, and lower urinary tract symptoms that are persistent after conservative treatment. Open surgical repair has traditionally been the primary treatment choice for bladder diverticula. However, recent advancements in laparoscopic and robotic technology have led to minimally invasive surgical treatment options as alternatives to open surgery with similar success rates, but with reduced morbidity, decreased hospital stay lengths, reduced pain medication requirements, and improved cosmesis.

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A New Technical Approach for Extraperitoneal Laparoscopic Bladder Diverticulectomy

Cited by 12 publications

References 5 publications

Robot-Assisted Bladder Diverticulectomy with Concurrent Management of Bladder Outlet Obstruction

Robot-Assisted Bladder Diverticulectomy with Concurrent Management of Bladder Outlet Obstruction

Laparoscopic urinary bladder diverticulectomy combined with photoselective vaporisation of the prostate

Management of Bladder Diverticula in the Pediatric Population

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