Pejman Shadpour1, Masoud Etemadian. 1. Department of Laparoscopic Surgery, Hasheminejad Kidney Center (HKC), Iran University of Medical Science, Tehran, Iran. pshadpour@gmail.com
Abstract
INTRODUCTION: Secondary diverticula initially serve as a pop-off mechanism in high-pressure voiding. Large diverticula, however, have been implicated in bladder-neck and ureteral obstruction and frequently demand definitive treatment, which, so far, has usually meant excision. We present this first report on using the diverticulum for laparoscopic urothelialized bladder augmentation as a novel procedure. PATIENTS AND METHODS: We performed laparoscopic freehand sutured diverticulocystoplasty in 3 adult male patients suffering from low-capacity, low-compliance bladders accompanied by hydroureteronephrosis. All 3 patients had a dominant large diverticulum with very poor drainage by voiding and catheterization. The technique is described in detail. Patients were followed for upper tract changes and bladder anatomy by cystogram, sonography antegrade pyelography (per case), and laboratory studies. RESULTS: The procedures lasted 114-152 minutes. Patients were discharged uneventfully on postoperative day 3. At the 9-month follow-up, mean functional bladder capacity had increased by 266% (range, 195-351), and mean maximum detrusor pressure had dropped by 190% (range, 167-234). At 15-32 months, upper tract dilation has improved in all 3 patients. All patients remain on intermittent catheterization, though with far less frequency than before surgery. CONCLUSION: When there is a dominant bladder diverticulum with poor evacuation, and the bladder is noncompliant, laparoscopic bladder augmentation by the diverticulum (instead of standard diverticulectomy) can afford functional improvement with minimal morbidity.
INTRODUCTION: Secondary diverticula initially serve as a pop-off mechanism in high-pressure voiding. Large diverticula, however, have been implicated in bladder-neck and ureteral obstruction and frequently demand definitive treatment, which, so far, has usually meant excision. We present this first report on using the diverticulum for laparoscopic urothelialized bladder augmentation as a novel procedure. PATIENTS AND METHODS: We performed laparoscopic freehand sutured diverticulocystoplasty in 3 adult male patients suffering from low-capacity, low-compliance bladders accompanied by hydroureteronephrosis. All 3 patients had a dominant large diverticulum with very poor drainage by voiding and catheterization. The technique is described in detail. Patients were followed for upper tract changes and bladder anatomy by cystogram, sonography antegrade pyelography (per case), and laboratory studies. RESULTS: The procedures lasted 114-152 minutes. Patients were discharged uneventfully on postoperative day 3. At the 9-month follow-up, mean functional bladder capacity had increased by 266% (range, 195-351), and mean maximum detrusor pressure had dropped by 190% (range, 167-234). At 15-32 months, upper tract dilation has improved in all 3 patients. All patients remain on intermittent catheterization, though with far less frequency than before surgery. CONCLUSION: When there is a dominant bladder diverticulum with poor evacuation, and the bladder is noncompliant, laparoscopic bladder augmentation by the diverticulum (instead of standard diverticulectomy) can afford functional improvement with minimal morbidity.