Category: Laparoscopic/ Robotic: Bladder

VS18-5 - Robotic Extravesical Diverticulectomy

Sun, Sep 23
2:00 PM - 4:00 PM

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.


Methods :

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.


Results :

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.


Conclusions :

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.