Marcin Słojewski, Adam Goł±b, Andrzej Sikorski
- Katedra i Klinika Urologii PAM w Szczecinie
- Introduction. Bladder diverticula can be of congenital or acquired origin. More common problem in adults urology are lesions formed as a result of bladder outlet obstruction. The surgical treatment of bladder diverticula consists of diverticular excision by open approach with simultaneously (adenomectomy) or previously (TUR-P) performed ablation of prostatic adenoma. An interesting alternative for conventional surgery, especially in cases of large diverticulas, can be laparoscopic diverticulectomy (LD). LD has been performed since 1992 and technically it is a reproduction of open procedure.
- Objectives. The objective is to present our own experience with LD.
- Materials and methods. Between March 2003 and December 2005 four male patients aged 54 to 72 (mean 62.2) were treated laparoscopically. The first operation was performed in man with small congenital diverticula localized near the ureteral orifice. In the other three cases diverticulas were the result of long lasting bladder outlet obstruction therefore in all cases TUR-P were initially performed. All patients were diagnosed with urography. Pre and postoperative cystography was done in last three patients. All procedures were performed under general anesthesia with three-ports and transperitoneal access. Diverticulas were localized with catheter balloon placed in diverticular neck or during intraoperative cystoscopy. The bladder was then closed with one layer absorbable running suture.
- Results. All procedures were completed successfully. No conversion to open surgery was necessary. No intra- or postoperative complications were observed. The duration of procedure was 90 to 160 min. (mean 130) and estimated blood loss was 0-300 ml (mean 120). The hospital stay was 3, 3, 5, and 10 days respectively (mean 5.2). Prolonged hospitalization in the last patient was caused by the drain leakage. Bladder catheterization time was 7 to 14 days (av. 12). Cystography performed in three men with largest diverticulas confirmed the good result of surgery. All patients were asymptomatic postoperatively.
- Conclusions. Laparoscopic bladder diverticulectomy is a feasible procedure. Associated pathologies in urinary tract, diverticulum size and localization and surgical history of the patient should be taken into consideration when indications are to be established.