Category: Laparoscopic/ Robotic: Bladder
Introduction & Objective :
Bladder diverticulae are not common conditions, typically caused by bladder outlet
obstruction. Mostly they do not require management, unless they're retentive and cause recurrent urinary tract infections (UTIs), or if
they're the site of urothelial tumor. Retention complications usually managed by relieving the outlet obstruction. If complications
persist after outlet procedure, the diverticulum is excised. The case presented here is an example of altering the traditional
sequence of management where the diverticulum was excised first, providing video of Robotic Assisted Extravesical
Diverticulectomy, ureteral re-implant was anticipated but was not required after dissection and resection.
69 years old male with Chronic retention. Cystoscopy revealed 1 liter diverticulum off the right lateral wall
above the right ureteral orifice with relatively narrow neck, no mucosal lesions. Pressure flow study revealed > 1 Liter capacity and
no significant detrusor contractility during voiding phase. His prostate Total and transitional zone volumes were 30 and 20
consecutively. PSA 1.9 ng/ml, serum creatinin 0.8 mg/dL. Despite regular clean Intermittent Catheterization, he continued to get
recurrent UTIs as the diverticulum was not emptying with the catheterization and was believed to alter his urodynamics results due
to its massive capacity. This video demonstrates extravesical Robotic Assisted Diverticulectomy prior to an outlet procedure.
Pressure flow study was repeated 3 months following the diverticulectomy and revealed high pressure, low flow voiding pattern with
410 cc bladder capacity. the patient underwent bipolar Trans Urethral Resection of the Prostate.
Patient's recurrent UTIs have resolved following the excision of the diverticulum while still self catheterizing,
following the TURP, the patient was able to void spontaneously with Qmax 16ml/s, Qave 9ml/s & PVR of 83 ml. He no longer
needed self catheterization.
Usually Bladder diverticulae require excision only if relieving the bladder outlet obstruction is not
adequate to eliminate symptoms and, or complications. however in select clinical scenarios, altering the sequence of treatment may
be necessary, as demonstrated in this case.
Khaled Fareed– Assistant Professor, Cleveland Clinic, Cleveland, Ohio
Khaled Fareed, MD
Assistant Professor of Urology, Lerner College of Medicine at Case Western Reserve University and Staff Urologist at Glickman Urological & Kidney Institiue at Cleveland Clinic
Graduated from Assiut University Medical School, Egypt in 1994, completed 2 years residency training in Assiut University Hospital. finished 2 years Research fellowship at the University of Texas, Southwestern Medical Center, and Residency training in urology at the same center. joined Cleveland Clinic in 2007 and been on staff. interests in EndoUrology, Advanced laparoscopy, image-guided Therapy, Robotics and BPH, Mens voiding dysfunction.