Transvesical Approach in Robot-Assisted Bladder Diverticulectomy: Surgical Technique and Outcome

Treatment for bladder diverticula may become necessary in case of incomplete bladder emptying or recurrent urinary tract infections (UTI). 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. We retrospectively analysed 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 visualized. 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. Median age was 66 years [Interquartile range (IQR) 60-69)]. The number of diverticula removed ranged from 1 to 3. 10 patients were treated with diverticulectomy alone, 12 underwent a simultaneous adenomectomy, 1 a radical prostatectomy. Median operative was 140 min (IQR 120-180), median estimated blood loss was 250 cc (IQR 28-438). Median catheterization time was 2 days (IQR 1-5), median hospitalization time 3 days (IQR 2-4). 1 patient developed urinary leakage after catheter removal, 1 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 cc (IQR 0 to 111), with a median decline of 120cc (IQR -402 to -33). Transvesical approach for RABD is a safe and reliable technique which gives the advantage of a quick localization of the diverticulum and orifices, and direct access to the prostate when simultaneous desobstruction is necessary. Catheterisation time is short. No relapse has been observed.