Laparoscopic urinary bladder diverticulectomy combined with photoselective vaporisation of the prostate

Abstract

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.

The safety and feasibility of the simultaneous use of 180-W GreenLight laser for prostate vaporization during concomitant surgery

“…This finding corroborates those of smaller and/or more historical series. (19). Taken together, our study as well as those previously discussed, show the feasibility of laser surgery and more specifically of GL-180-W PVP concomitantly with other procedures (9,10,(18)(19)(20).…”

“…(19). Taken together, our study as well as those previously discussed, show the feasibility of laser surgery and more specifically of GL-180-W PVP concomitantly with other procedures (9,10,(18)(19)(20). Third, despite the fact that preoperative IPSS was similar in a concomitant procedure compared to the standard, ∆IPSS was wider in the concomitant procedure compared to the standard procedure (-20 vs. -18).…”

Management of Bladder Diverticula in the Pediatric Population

“…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].…”

Sequential transurethral enucleation of the prostate and laparoscopic bladder diverticulectomy

“…Some authors prefer the combination of PVP and mini-invasive diverticulectomy because of the hemostatic properties of potassiumtitanyl-phosphate laser (3,4).…”

“…One-or two-step procedure? (2)(3)(4) A more contemporary solution is an endoscopic procedure performed in one session: transurethral resection of the prostate (TURP) or Holmium laser enucleation of the prostate (HoLEP) followed by laparoscopic diverticulectomy (LD) (2,5,6).…”