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Objective: Treatment for bladder diverticula may become necessary in case of incomplete bladder emptying or recurrent urinary tract infections (UTIs). When bladder outlet obstruction is present, a simultaneous desobstructive procedure can be performed. In this video, we present our technique for a transvesical approach in robot-assisted bladder diverticulectomy (RABD) and discuss its outcomes. Patients and Surgical Procedure: We retrospectively analyzed the outcomes of 23 patients who underwent a transvesical RABD between March 2015 and May 2020 at the OLV hospital of Aalst. After retrograde filling, a cystotomy is performed. The orifices are identified and the bladder diverticulum is observed. The mucosa covering the diverticular neck is incised and the plane between the mucosa and the muscularis is identified. The mucosa is separated from the surrounding structures. The base of the diverticulum is transected using cautery. The defect is closed with a barbed suture. Results: Median age was 66 years (interquartile range [IQR] 60–69). The number of diverticula removed ranged from 1 to 3. Ten patients were treated with diverticulectomy alone, 12 underwent a simultaneous adenomectomy, 1 a radical prostatectomy. Median operative was 140 minutes (IQR 120–180), median estimated blood loss was 250 mL (IQR 28–438). Median catheterization time was 2 days (IQR 1–5), median hospitalization time 3 days (IQR 2–4). One patient developed urinary leakage after catheter removal, one patient developed a UTI. Median follow-up was 9 months (IQR 3.5–14). No late postoperative complications nor relapse were recorded. Average postvoid residual was 42 mL (IQR 0–111), with a median decline of 120 mL (IQR −402 to −33). Conclusions: Transvesical approach for RABD is a safe and reliable technique that gives the advantage of a quick localization of the diverticulum and orifices, and direct access to the prostate when simultaneous desobstruction is necessary. Catheterization time is short. No relapse has been observed. [ABSTRACT FROM AUTHOR]

Bladder diverticula can be a congenital condition or a secondary process due to benign prostatic hyperplasia (BPH) with bladder outlet obstruction. Its presence could be a source of high postvoid residual prompting surgical intervention. We describe a step-by-step approach of simultaneous laparoscopic bladder diverticulectomy (LBD) and holmium laser enucleation of the prostate (HoLEP). To the best of our knowledge, this is the first case report of LBD combined with HoLEP done simultaneously.

Objective: The treatment of bladder diverticula consists of diverticulectomy, mainly by a laparoscopic approach or transurethral resection of the diverticular neck and fulguration of the mucosa. The endoscopic approach is generally dedicated to small diverticula. The aim of this study was to compare laparoscopic diverticulectomy versus endoscopic fulguration for bladder diverticula larger than 4 cm. Materials and methods: A retrospective review of the medical records of consecutive patients undergoing endoscopic or laparoscopic treatment for bladder diverticula larger than 4 cm at two tertiary hospitals was performed. Therapeutic success was defined as either complete resolution or a decrease of at least 80% in the size of the diverticulum. Complications were recorded and graded according to the Clavien-Dindo classification. Results: All patients were treated with transurethral resection of the prostate in the same operative session. The endoscopic group included a cohort of 20 male patients. The median age, diverticular diameter and operative time were 65 years, 7 cm and 62.5 min, respectively. No early postoperative complications were observed. Therapeutic success was achieved in 15 cases (75%). The laparoscopic group included a cohort of 13 male patients with a median age of 63 years and median diverticular diameter of 7.0 cm. The median operative time was 185 min (p < 0.0001). Two grade III postoperative complications were observed (15.3%). Therapeutic success was achieved in all patients (100%). Conclusions: Acquired bladder diverticula larger than 4 cm can be effectively managed either by a laparoscopic approach or by endoscopic fulguration. [ABSTRACT FROM AUTHOR]

Background: Acquired bladder diverticula (BD) are a possible complication of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE). Robot-assisted bladder diverticulectomy (RABD) has been proposed as an alternative to open removal; however, only a few small series have been published., Objective: To describe our surgical technique for RABD and to assess perioperative results and functional outcomes at 6-mo follow-up., Design Setting and Participants: A prospective single-centre, single-surgeon cohort of 16 consecutive men with posterior or posterolateral BD due to BOO/BPE undergoing RABD between May 2017 and December 2021 was analysed., Surgical Procedure: RABD was performed with a four-arm robotic system via a transperitoneal approach. BD were identified intraoperatively via bladder distension with saline solution through an indwelling catheter with or without concomitant illumination using flexible cystoscopy and fluorescence imaging. Extravesical BD dissection and removal were performed., Outcome Measurements and Statistical Analysis: Operating room time, estimated blood loss, intraoperative and postoperative complications, indwelling catheter time, and timing of associated procedures for BOO/BPE were assessed. The International Prostate Symptom Score (IPSS) and postvoid residual volume (PVR) were compared between baseline and 6 mo after surgery., Results and Limitations: Median age and maximum BD diameter were 68 yr (interquartile range [IQR] 54-74) and 69 mm (IQR 51-82), respectively. The median operative time was 126 min (IQR 92-167) and the median estimated blood loss was 20 ml (IQR 15-40). No intraoperative complications were recorded. The urethral catheter was removed on median postoperative day 5 (IQR 5-7). Two men experienced 90-d postoperative complications (persistent urinary infection requiring prolonged antimicrobial therapy). Bipolar transurethral resection of the prostate was performed 3 wk before RABD in seven men and concomitant to RABD in nine men. Median IPSS significantly decreased from 25 (IQR 21-30) to 5 (IQR 5-6), and median PVR from 195 ml (IQR 140-210 ml) to 30 (IQR 28-40) ml (both p  < 0.001) at 6-mo follow-up in comparison to baseline. A limitation is the rather small cohort with no control group., Conclusions: RABD is a safe and effective minimally invasive option for treatment of acquired BD in men with BOO/BPE. Validation of our results in larger series with longer follow-up is warranted., Patient Summary: We describe our surgical technique for robot-assisted removal of pouches in the bladder wall (called diverticula) in men with bladder outlet obstruction caused by benign prostate enlargement, and report functional results at 6 months after the operation. This minimally invasive technique was found to be safe and effective., (© 2022 The Author(s).)

The article discusses the planning and preparation of transperitoneal transvesical robot-assisted laparoscopic bladder diverticulectomy. It says that the indications to conduct surgery for large bladder diverticula are the same for open or laparoscopic surgery cases. It notes the required materials and equipment for the procedure including binocular telescope, robotic instruments, and trocars.

This paper is a systematic review of the current literature in minimally invasive reconstructive urological surgery. It focuses on the commonest reconstructive procedures in both the upper and lower urinary tracts including laparoscopic and robotic pyeloplasty for ureteropelvic junction obstruction, laparoscopic and robotic bladder diverticulectomy, laparoscopic and robotic partial cystectomy with urinary diversion, laparoscopic and robotic cystoplasty, repair of colovesical fistula, and, in urogynaecology, repair of vesicovaginal fistula. To evaluate the development, current status, feasibility, and safety of minimally invasive surgery (MIS) in reconstructive urology the literature on the topic was collated and reviewed. [ABSTRACT FROM AUTHOR]

Acquired bladder diverticula are often associated with bladder outlet obstruction (BOO). The increased voiding pressures required to overcome the BOO attenuate the detrusor and promote formation of diverticula. These patients may develop urinary tract infections, bladder stones, and incomplete bladder emptying. Effective treatment must address both the bladder diverticula and BOO. Reports of laparoscopic bladder diverticulectomy with concurrent transurethral resection of the prostate have demonstrated the feasibility of this minimally invasive approach. However, due to longer operative times and technical difficulty of the procedure, the gold-standard treatment remains the open surgical approach of bladder diverticulectomy and transvesical prostatectomy. With the advent of robotic-assisted laparoscopic surgery, application of open surgical principles is increasingly translated to the minimally invasive laparoscopic approach. We report, to our knowledge, the first case of robot-assisted laparoscopic transvesical diverticulectomy and concurrent transvesical simple prostatectomy. [ABSTRACT FROM AUTHOR]

Bladder diverticulectomy is a surgical operation for symptomatic or large bladder diverticula. Typically, bladder diverticula are because of infravesical obstruction, although congenital diverticula can occur that may be large and symptomatic. The ability to excise the diverticulum completely, avoid important adjacent structures, and close the bladder defect in a watertight fashion are key fundamentals to this operation. Traditionally done via an open extravesical, intravesical, or combined approach, bladder diverticulectomy can now be done in a minimally invasive fashion. Both laparoscopic and robot-assisted methods have clear advantages over open surgery, including smaller incision, reduced pain, improved cosmesis, and reduced blood loss, with an equivalent functional result. Large bladder diverticula, particularly those involving the ureteric orifice which required ureteric reimplantation, were often considered beyond the scope of conventional laparoscopy. Recently, use of robotic technology as a means of facilitating laparoscopic excision of bladder diverticula has provided the ability to treat large and more complex diverticula. Advantages of the robotic approach are the finer precision and dexterity of the instruments coupled with three-dimensional imaging. Although there are several case reports describing pure laparoscopic diverticulectomy, as far as we are aware there are no published reports of robotic bladder diverticulectomy. This paper will outline a safe and reproducible surgical technique for performing robotic bladder diverticulectomy using the da Vinci-S surgical system. [ABSTRACT FROM AUTHOR]

We describe our technique of laparoscopic diverticulectomy under ultrasound (US) guidance after a transurethral resection of prostate (TURP) in the treatment of patients with benign prostatic hyperplasia and bladder diverticulum. A standard TURP is performed with an Iglesias resectoscope. A 12-Fr Foley catheter is positioned in the diverticulum and the catheter balloon is then inflated with 30 mL of water; then a Tiemann catheter is placed through the urethra into the bladder. A US probe is inserted through the 12 mm port placed in the right side by the surgeon, then laparoscopic transperitoneal bladder diverticulectomy is performed under US guidance. In our experience, the use of endolaparoscopic US makes identification and dissection of the diverticulum easy, safe and effective, even when the procedure has to be performed in disadvantageous anatomic conditions such as lateral-posterior diverticulum or post-TURP imbibition of pelvic tissue. [ABSTRACT FROM AUTHOR]

An 81-year-old male patient presented to the department of gastroenterology with increasing lower abdominal pain for 2 years, aggravated with bloody stool for 1 month. Computed tomographic examination revealed a huge cyst (207 × 93 × 208 mm 3 ) in the abdominal cavity, absence of bladder, thickening and strengthening of the rectal wall, and benign prostatic hyperplasia. Colonoscopy showed colon cancer and surgery was planned. Interestingly, after magnetic resonance imaging and cystography, we found colon cancer and a large bladder diverticulum rather than tumor metastasis or others. Severe bacteremia occurred in the elderly chronic obstructive pulmonary disease patient before operation. After careful consideration, we decided to take a large risk and combined urology and gastrointestinal surgery professionals to carry out bladder diverticulectomy, cystostomy, radical resection of rectal carcinoma, and so on. Fortunately, the patient recovered well after the operation. In addition to the common tumor metastasis and cystadenoma, the abdominal mass should also be alert to the rare bladder diverticulum, which eventually leads to diagnostic confusion. Multidisciplinary diagnosis and treatment has become an important treatment for complex diseases., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

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