Sequential Holmium Laser Enucleation of the Prostate and Laparoscopic Extraperitoneal Bladder Diverticulectomy: Initial Experience and Review of Literature

Abstract

Urologic applications of laparoscopy and the holmium laser have increased exponentially in the past few years. We present our experience with sequential holmium laser enucleation of the prostate (HoLEP) and extraperitoneal laparoscopic diverticulectomy for a large symptomatic bladder diverticulum and associated bladder outlet obstruction. From June 2004 to June 2005, three patients with benign prostatic hyperplasia (BPH) and a large secondary bladder diverticulum were offered sequential HoLEP and laparoscopic extraperitoneal bladder diverticulectomy. Demographic data and perioperative outcomes were recorded. A review of the literature was performed to determine the present role of laparoscopic diverticulectomy. All patients underwent the planned procedure successfully. The mean operating time was 63.33 minutes for HoLEP and 246.6 minutes for diverticulectomy. Oral intake was resumed after a mean of 8.6 hours. The mean postoperative analgesia required was 146 mg of parecoxib sodium, and the mean drop in hemoglobin was 1.13 g/dL. Patients were discharged after an average of 66.6 hours. At 1-month follow-up, the average American Urological Association Score had improved from 13 to 6, the post-void [corrected] residual urine volume had decreased from 997 mL to 164 mL, and the peak uroflow rate had improved from 4.9 mL/sec to 10.4 mL/sec. These measures showed further improvement on later follow-up. A total of 30 cases of laparoscopic diverticulectomy have been reported in literature [corrected] of which only two were done extraperitoneally. Simultaneous HoLEP and laparoscopic extraperitoneal diverticulectomy is an effective strategy for the treatment of BPH with associated large bladder diverticulum.