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

Abstract

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.

A prospective comparative analysis of robot‐assisted vs open simple prostatectomy for benign prostatic hyperplasia

“…The robot‐assisted procedures were performed with the use of the Da Vinci Si system (Intuitive Surgical, Sunnyvale, CA, USA) using a transperitoneal approach. The port placement was the same as with the robot‐assisted radical prostatectomy procedure . The operation started with the ‘bladder drop’ and continued with a vertical bladder and prostatic capsule incision, starting just above the prostate‐vesical junction.…”

Surgical treatment of bladder diverticulum with radical prostatectomy. A case report and literature review

“…In 2008, Magera et al [10] performed simple prostatectomy with robot assisted diverticulectomy having postoperative two days hospital stay and fourteen days catheterization time. Tufek et al [11] in 2016, studied 9 patients undergoing surgery, combination of TURP and photo selective vaporization of prostate for bladder outlet obstruction with robot assisted diverticulectomy. According to the authors, postoperative continuous bladder irrigation was not needed after operation due to combination of TURP and PVP.…”

The underactive bladder: diagnosis and surgical treatment options

“…Open surgery was the standard approach when it was first described by Hugh Hampton Young. More recently, it has been replaced by laparoscopic and robotic assisted laparoscopic surgery (22,23). The latter techniques have the advantages of reduced post-operative pain, smaller incisions and reduced hospital stay (23).…”

“…More recently, it has been replaced by laparoscopic and robotic assisted laparoscopic surgery (22,23). The latter techniques have the advantages of reduced post-operative pain, smaller incisions and reduced hospital stay (23). As most bladder diverticula arise at the ureterovesical hiatus, care must be taken not to damage the ureter.…”