Krzysztof Szkarłat, Piotr Jarecki
Urological Department, Hospital Koscierzyna, Poland
Bladder diverticulosis is most commonly caused by longstanding bladder outlet obstruction (BOO). Some of the diverticula’s are asymptomatic and do not required any treatment. When symptoms occurs, treatment of BOO and diverticulectomy have to improve function of lover urinary tract.
The aim of the study is to present the patient with BOO and vesical diverticulosis treated using minimally invasive surgery.
Patient PR aged 30 diagnosed for dysuria. Ultrasound examination revealed 3 bladder diverticula (on posterior and right side of the bladder). Post voiding residual volume 400. BOO was confirmed in uroflowmetry (Qmax 4 ml/s). After radiologic examination (IVU, cystography) and cystoscopy, as a first step transurethral incision of bladder neck was performed. In spite of very good outcome of BOO treating (Qmax 30 ml/s), post voiding urine retention in diverticula’s was observed. Using endoscopic and laparoscopic equipment, 5 and 10 mm trocars were inserted through anterior bladder wall into the bladder. After incision of diverticula’s neck each of them was excised. Bladder defect after diverticulectomy was provided by one layer continuous suture. Transurethral bladder drainage using Folley catheter finished the procedure.
In case of posterior localization of bladder diverticula’s transvesical surgery seem to be an alternative method to retroperitoneoscopic or transperitoneal access.