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      Laparoscopic urinary bladder diverticulectomy combined with photoselective vaporisation of the prostate

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          Abstract

          Introduction

          Pseudodiverticulum of the urinary bladder is mostly a complication of subvesical obstruction (SO). The gold standard of treatment was open diverticulectomy with adenectomy. A more contemporary resolution is endoscopic, in two steps: the first transurethral resection of the prostate (TURP), the second laparoscopic diverticulectomy (LD).

          Aim

          To present a one-session procedure – photoselective vaporisation of the prostate (PVP) with LD.

          Material and methods

          From 1/2011 to 6/2014, 14 LDs were performed: 1 LD only, 1 with laparoscopic radical prostatectomy, 12 combined with treatment of benign prostatic hyperplasia (BPH), 4 cases of TURP and LD in the second period. In 8 cases, PVP and LD in one session were combined. These 8 cases are presented. 3D CT cystography was used as a gold standard for assessment of diverticulum.

          Results

          The mean age was 66.5 ±5.5 (57.3–75.1) years, the mean size of the diverticulum 61.8 ±22.1 (26–90) mm. The procedure starts in the lithotomy position. It includes PVP and stenting of the ureter(s). Changing of position and laparoscopy follows: four ports, transperitoneal extravesical approach. Photoselective vaporisation of the prostate was performed using the Green Light Laser HPS (1x) or XPS with cooled fibre MoXy (7x). The mean delivered energy in PVP was 205.1 ±106.4 (120–458) kJ. The mean time of operation was 165.0 ±48.5 (90–255) min. No postoperative complications were observed. One patient underwent TUR incision after 1 year for sclerosis of the bladder neck.

          Conclusions

          Pseudodiverticulum of the urinary bladder (with or without SO) is a relatively rare disease. One session of PVP (Green Light Laser XPS, MoXy fibre) and laparoscopic (transperitoneal extravesical) diverticulectomy is the preferred method for treatment of subvesical obstruction due to BPH and bladder diverticulum at our institution.

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          Most cited references32

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          180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European Multicentre Randomised Trial--the GOLIATH study.

          The comparative outcome with GreenLight (GL) photoselective vaporisation of the prostate and transurethral resection of the prostate (TURP) in men with lower urinary tract symptoms due to benign prostatic obstruction (BPO) has been questioned.
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            Robotic assisted laparoscopic bladder diverticulectomy.

            Surgical management for bladder diverticuli includes open, endoscopic and standard laparoscopic techniques. To our knowledge we report the first series of robotic assisted laparoscopic bladder diverticulectomies. Five patients underwent robotic assisted laparoscopic bladder diverticulectomy between December 2004 and December 2006, as performed by a single surgeon using the da Vinci robotic system for symptomatic diverticuli. The records were reviewed, the surgical technique is described and a review of the literature was performed. All patients underwent cystoscopy, ureteral stent placement and placement of an angiographic catheter to distend the diverticulum. The diverticulum was approached transperitoneally, mobilized and transected at its neck, and the bladder was closed in 2 layers. One patient underwent ureteral reimplantation for a Hutch diverticulum. Median total operative time was 178 minutes (range 163 to 235) and robotic operative time was 83 minutes (range 63 to 143). Length of stay was 3 days (range 1 to 6). Two patients who underwent transurethral prostate resection before diverticulum resection did well. Two patients in whom medical management failed ultimately underwent transurethral prostate resection and 1 patient continued on medical therapy with regular followup. Robotic assisted laparoscopic bladder diverticulectomy is safe and effective for patients with a large bladder diverticulum and small prostate. Perioperative surgical outcomes rival those of previously reported open, endoscopic and laparoscopic diverticulectomies.
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              Robot-assisted bladder diverticulectomy in the pediatric population.

              Surgical intervention is warranted for symptomatic congenital bladder diverticula (CBD) in children. We hypothesized that a robot-assisted approach to bladder diverticulectomy could be performed with safety and with good efficacy. Descriptions of our approach and results with robot-assisted laparoscopic bladder diverticulectomy (RALBD) are presented.
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                Author and article information

                Journal
                Wideochir Inne Tech Malo Inwazyjne
                Wideochir Inne Tech Malo Inwazyjne
                WIITM
                Videosurgery and other Miniinvasive Techniques
                Termedia Publishing House
                1895-4588
                2299-0054
                10 March 2015
                April 2015
                : 10
                : 1
                : 62-67
                Affiliations
                [1 ]Department of Urology, Faculty Hospital in Pilsen, Czech Republic
                [2 ]Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic
                [3 ]Department of Radiology, Faculty Hospital, Pilsen, Czech Republic
                [4 ]Department of Pathology, National University Health System, Singapore
                [5 ]Department of Pathology, Faculty Hospital in Pilsen, Czech Republic
                [6 ]Department of Urology, Jagiellonian University Medical College, Krakow, Poland
                Author notes
                Address for correspondence: Prof. Milan Hora MD, PhD, Department of Urology, Faculty Hospital in Pilsen, Czech Republic and Faculty of Medicine in Pilsen, Charles University in Prague, 13 E. Benese St, 30599 Pilsen, Czech Republic. phone: +42 0377402225, +42 0602950086, fax: +42 0377402171. e-mail: horam@ 123456fnplzen.cz
                Article
                24798
                10.5114/wiitm.2015.49671
                4414110
                eaec88d0-232c-4f94-bdb9-b09b468710bb
                Copyright © 2015 Sekcja Wideochirurgii TChP

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 31 July 2014
                : 05 September 2014
                : 21 January 2015
                Categories
                Original Paper

                Surgery
                laparoscopic diverticulectomy,photoselective vaporisation of the prostate,benign prostatic hyperplasia

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