Surgical treatment of bladder diverticula: laparoscopic approach.

Abstract

Bladder diverticulectomy is classically performed by open surgery (extravesical, intravesical, or combined) or, less frequently, by an endoscopic approach for small diverticula. We used a celioscopic approach to diverticulectomy in order to assess its feasibility and the operative and postoperative complications. Five patients aged 55 to 76 years (mean 64.2 years) were treated by celioscopy between October 1999 and October 2001. All the diverticula had occurred as a result of infravesical obstruction by benign prostatic hyperplasia, which was treated at the same time by endoscopic resection of the prostate. An ipsilateral ureteral catheter was inserted during endoscopy. After creation of an umbilical minilaparotomy with the patient in the dorsal decubitus position, a 10-mm optical trocar was inserted, then two 5-mm trocars into the right and left iliac fossae, and a 10-mm subpubic trocar. Diverticular dissection was performed with a peritoneal approach in order to free the diverticular neck. After resection, the neck was closed in two planes by interrupted absorbable sutures, and a tightness test was performed. The average operating time was 160 minutes (range 120-230 minutes), and the average blood loss was 150 mL (range 80-200 mL). There was no conversion to open surgery. The probe was removed on day 5 (range 3-7 days). No complication occurred, and the mean hospital stay was 5 days (range 4-6 days) with resumption of satisfactory micturation. This technique is a promising alternative to classical surgery, as it is less aggressive and uses a smaller incision. Operative bleeding is minimal, and the technique is reproducible in experienced hands. However, the indications are limited with regard to the associated pathologies (size of the prostate in the present cases), the morphology, the site of the diverticulum, and the surgical history of the patient.