Laparoscopic bladder diverticulectomycombined with photoselective vaporisation (PVP) of prostate

Hora Milan,

Dept. of Urology, Faculty Hospital in Pilsen and Charles University Prague, Medical Faculty Pilsen, CZ

Introduction: Pseudodiverticulum of the urinary bladder is mostly complication of subvesical obstruction (SO). The gold standard treatment was open diverticulectomy with adenectomy. More contemporary resolution is endoscopic, two steps. The first TURP, the second session laparoscopic diverticulectomy (LD). We present one step procedure – PVP with LD.

Material: From 1/2011 to4/2014, 13 LDs were performed. One LD only, one with laparoscopic radical prostatectomy, 11 combined with treatment of BPH. Four cases TURP and LD in the second period. In In seven cases, PVP and LD at one session werecombined. These 7 cases are presented. 3D CT cystography is used as a gold standard for assessment of diverticulum.

Results: The mean age was 66.0 ± 5.7 years (57.3-75.1), the mean size of diverticulum 61.4 ± 23.6 (26-90) mm. Procedure starts in lithotomy position: It includes PVP, stenting of ureter(-s). Changing of position and laparoscopy follow: four ports, transperitonealextravesicalapproach.PVP was performed with machine Green Light Laser® HPS (1x) or XPS with cooled fibre MoXy® (6x). The mean delivered energy in PVP was 195.8 ± 110.7 (120-458) kJ. The mean time of operation was 152.1 ± 37.0 (90-205) minutes. No postoperative complications. One patient underwent TUR incision in year for sclerosis of bladder neck.

Conclusion: Pseudiverticulum of bladder neck (with or without subvesical obstruction) is a relatively rare disease. One session of PVP (Green Light Laser®XPS, MoXy®fibre) and laparoscopic (transperitonealextravesical) diverticulectomy is preferred method for treatment of subvesical obstruction due to BPH and bladder diverticulum at our institution.
Supported by the project Ministry of Health, Czech Republic for conceptual development of research organization 00669806 – Faculty Hospital in Pilsen, Czech Republic