Diverticulum Research Articles

V08-02 ROBOTIC ASSISTED LAPAROSCOPIC PARTIAL CYSTECTOMY USING THE DA-VINCI SINGLE-PORT ROBOTIC SYSTEM

You have accessJournal of UrologyNOTES/LESS (V08)1 Sep 2021V08-02 ROBOTIC ASSISTED LAPAROSCOPIC PARTIAL CYSTECTOMY USING THE DA-VINCI SINGLE-PORT ROBOTIC SYSTEM Michael Tonzi, and Amar Singh Michael TonziMichael Tonzi More articles by this author , and Amar SinghAmar Singh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002041.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To report the initial case of an extraperitoneal, trans-vesicle robotic assisted laparoscopic partial cystectomy including en-bloc excision of a bladder diverticulum with urothelial carcinoma using the da Vinci Single Port robotic system. METHODS: A 64-year-old male with a history of urothelial carcinoma was found to have recurrence of his disease inside of a narrow neck bladder diverticulum on surveillance cystoscopy. Remaining bladder was evaluated with random biopsies and there was no evidence of urothelial carcinoma in the rest of the bladder. The da Vinci Single Port robotic system was used to perform an extraperitoneal, trans-vesicle partial cystectomy with en-bloc resection. The bladder was entered extra-peritoneally, and the robotic port was docked directly within the bladder using a small Gelport. The diverticulum containing the tumor was excised en-bloc from within the bladder circumferentially and the defect closed. RESULTS: The patient tolerated the procedure uneventfully. The total operative time was 112 minutes. The patient was discharged on postoperative day one. At follow up, cystography demonstrated no contrast extravasation and his urethral catheter was removed on post-operative day eight. Final pathology revealed negative surgical margins. CONCLUSIONS: This is the initial report of a trans vesicle robotic assisted en-bloc partial cystectomy for a recurrent urothelial carcinoma in a bladder diverticulum using the da Vinci Single Port robotic system. This provides an alternative to traditional minimally invasive approaches not amenable to trans-urethral resection. Source of Funding: NA © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e601-e601 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Tonzi More articles by this author Amar Singh More articles by this author Expand All Advertisement Loading ...

Ultrasonographic Features of Hypertrophic Interureteral Cristae in Transabdominal and Transrectal Ultrasonography.

The aim of this study was to determine the value of transrectal ultrasound in the definitive diagnosis of hypertrophic interureteral cristae and to provide a definitive diagnostic basis for clinical treatment. When the patient's bladder fills moderately, the ultrasound physician uses the transabdominal ultrasound probe to examine the patient's bladder and prostate carefully, focusing on bilateral ureterovesical portals, a cord-like hyperechoic structure visible between the bilateral ureterovesical portals. For further detailed observation, transrectal probe was used to measure the size of Hypertrophic Interureteral Cristae and describe the shape and internal echo. After the examination, the residual urine volume of bladder was measured after one-time urination. Hypertrophic interureteral cristae was a trilinear structure with a "high-low-high" echo. All the 33 patients had bladder wall thickening. In 9 cases of overfilling of bladder, there were slightly dilated ureterovesical portals at both ends of hypertrophic interureteral cristae. Thirty cases of benign prostatic hyperplasia, 11 patients who had undergone prostate hyperplasia surgery, 26 cases with different degrees trabecular and reticular hyperplasia of bladder wall, there were 9 cases with bladder diverticulum and 23 cases with mild hydronephrosis. Transrectal ultrasound can confirm the diagnosis of Hypertrophic Interureteral Cristae.

A Coin Trapped in Meckel’s Diverticulum

A Coin Trapped in Meckel’s Diverticulum

Is intravesical prostatic protrusion associated with more complications in benign prostatic hyperplasia patients?

Intravesical prostatic protrusion (IPP) is a noninvasive parameter that can predict disease progression and development of complications in benign prostatic hyperplasia (BPH). This study was to determine the relationship between IPP and the presence of complications in BPH patients. This was a cross-sectional study of BPH patients at Enugu State University of Science and Technology Teaching Hospital, Enugu. Patients were assessed for acute urinary retention (AUR), chronic urinary retention (CUR), epididymoorchitis, hematuria, hernia, urinary tract infection (UTI), serum creatinine, and prostate-specific antigen (PSA). They also had abdominal ultrasonography assessments for IPP, total prostate volume, bladder wall thickness (BWT), postvoid residual (PVR), hydronephrosis, bladder diverticulum, and urolithiasis using Sonoscape S11 with an abdominal-probe frequency of 3.5 MHz. IPP was measured in millimeter and divided into <10 mm and ≥10 mm. Data were analyzed using SPSS version 21 and were subjected to 1-way analysis of variance, chi-square test, and Pearson correlation. The odds ratios of development of complications at an IPP cutoff of 10 mm were calculated. P < .05 was considered significant. A total of 118 patients with a mean age of 64.18 ± 10.96 years and a mean IPP of 14.29 ± 10.20 mm were included. Forty-eight patients had IPP < 10 mm and seventy patients ≥10 mm. Patients with IPP ≥10 mm had significantly higher mean BWT, International Prostate Symptom Score (IPSS), PSA, and PVR (P ≤ .05) and significantly more AUR, CUR, hematuria, hydronephrosis, and UTI (P ≤ .01). Patients with IPP ≥ 10 mm have a significantly higher incidence of some complications.

High-grade intradiverticulum bladder tumor: A case report.

Introduction and importanceBladder diverticula are mucosal outpunching of the bladder without a muscle layer. It could be detected incidentally or by giving symptoms of its complications.Case presentationA 59-year-old male patient presented with painless gross hematuria. A primary tumor arising in a bladder diverticulum was detected with computed tomography. Partial cystectomy with para-aortic lymph node dissection was performed. The pathology report showed high-grade papillary transitional cell carcinoma (PT3). Unfortunately, the patient died of an acute cardiac event and sepsis after one month postoperative.Clinical discussionOnce patient had a bladder diverticulum, we should expect the patient to have complications. One of that is intradiverticulum bladder malignancy. Imaging studies such computed tomography with contrast should be performed to confirm the diagnosis. Surgical interventions play a major role in the treatment. Most patients present with late, so the survival rate is poor in general.ConclusionIntradiverticulum bladder tumors are a major challenge in urological practice and need multiple investigations to be detected. These types of bladder tumors have high mortality rate.

Large congenital bladder diverticula in children.

Large congenital bladder diverticula (LCBD), congenital bladder diverticula (CBD) larger than 2 cm diameter, is a rare anomaly. The aim of this study was to report long-term surgical and clinical outcomes of children with LCBD. Medical charts of all children who were diagnosed with LCBD at our institution between April 2005 and December 2017, with at least 2 year follow-up were retrospectively reviewed. Patients' demographics, symptoms, operative technique, diverticulum size and localization, surgical outcomes and complications were recorded. Fourteen patients with 18 LCBD, all male and age between 7 and 240 months (mean age: 53.5 months) were included in the study. Urinary tract infection was the main complaint in 10. Vesicoureteral reflux was detected in eight patients. Diverticula were 2-5.5 cm (mean 3.3 cm) in size. All diverticulectomies were performed transvesically and ureteroneocystostomy was added in 12 patients, 5 of whom were bilateral. No postoperative infection or recurrent reflux were observed. The median follow-up period was 4.5 years (2-12 years). Treatment of LCBD is mostly surgical and transvesical approach for diverticulectomy was found to be a safe and effective surgical procedure in long term follow-up.

Robot-assisted laparoscopic bladder diverticulum resection (RABDR)

Since October 2018, urinary bladder diverticulum resections at our Department of Urology have been carried out with robot assistance and with minimal invasivion, Paediatrical urological and robot-assisted minimally invasive urological surgery for the Bamberg Social Foundation were performed with the DaVinci robotic systemTM. The aim of the present study was to record the surgical results of our patients and to compare these if necessary with available data on optimal diagnostic and therapy. In this retrospective analysis, we included all patients who received RAHDR between October 2018 and March 2020. The primary endpoints were postoperative blood loss (postoperative haemoglobin decrease), the operation time (min), complications according to the Clavien-Dindo classification, length of hospital stay (days), postoperative residual urine, postoperative urine extravasation at the anastomosis of the bladder, postoperative quality of life and postoperative satisfaction with micturition. We reviewed a total of 11 patients, all of whom were male. Mean age was 64.8 years (52-82). Average BMI was 26.5 (19-37). 3 patients were ranked with ASA score III, 5 with II and 3 with I. The average residual urine value preoperatively was 183 ml (90-240). A cystogram to rule out extravasation was performed on day 6 postoperatively. The mean duration of surgery was 212 min (148-294) and the mean duration of hospitalisation was 7.6 days (6-10). The mean residual urinary value after surgery was 25 ml (10-60). The mean postoperative maximum of flow was measured at 27.7 ml/s (11-55). No contrast agent extravasation in the cystogram was detected in any of the patients. The complications according to Clavien were not measurable. The mean postoperative haemoglobin decrease was 1.61 g/dl (0-3. 2). In most cases, the removal of one or more bladder diverticula is possible using the minimally invasive robotic technique. Various surgeries such as YV-bladder neck plastic, prostate adenoma enucleation, bladder stone restoration, and inguinal herniotomy can be carried out simultaneously. A robot-assisted urinary bladder diverticulum resection is an effective and gentle procedure. However, it must be considered that it brings financial disadvantages due to the lack of adequate representation within the German DRG-system (Diagnosis Related Groups).

ABDOMEN ULTRASONOGRAPHIC EXAMINATION ANALYSIS IN THE CASE OF URINARY BLADDER DIVERTICULA AT CILEGON HOSPITAL

ABSTRACT&#x0D; Diverticulum is outpouching of hollow (or fluid-filled) structures, which can form in various organs in the body. Increased intravesical pressure (3-5 times) causes the bladder mucosa to infiltrate itself between the bladder muscle bundles which results in the development of extravasational sacs or saccules which subsequently results in diverticulum formation. The sonographic diagnosis of bladder diverticula depends on the demonstration of communication between the bladder and the mass. When such communication, or estuary, is not seen during ultrasound examination, the bladder diverticulum can look like any other type of cystic pelvic mass.&#x0D; The approach used is descriptive qualitative. This study aims to analyze the examination of the USG Abdomen with clinical bladder diverticula to get an appropriate picture of USG so that the diagnosis can be established. The study population was patients who performed an abdominal USG examination at the Cilegon Regional General Hospital. The sample of this study were 1 (one) patient. The method used in collecting data in this study is observation, documentation, and literature study.&#x0D; Keywords: Ultrasound, Urinary Bladder, Diverticula

SPECTRUM OF BLADDER DIVERTICULI PRESENTING WITH UNUSUAL SYMPTOMS: A CASE SERIES STUDY

Diverticula of the urinary bladder can occasionally appear as complex pelvic masses not obviously connected to the bladder. Such presentations can lead to diagnostic confusion and interpretative error. Sonographic ndings and clinical histories were reviewed in 10 patients in whom bladder diverticula were initially mistaken for other types of pathologic pelvic processes. Sonographic techniques that were helpful in elucidating the true nature of the lesions included scanning from different perspectives with increasing increments of bladder distension, post void images, colour Doppler interrogation and Valsalva manoeuvre. The sonographic ndings were correlated with micturating cystourethrogram and CT nding. The diagnosis of bladder diverticula should be considered and actively pursued when sonologists are confronted with pelvic masses of ambiguous origin.

A rare case of bladder diverticulum causing acute intestinal obstruction: Case report

We report a case of 50 years male who presented with Abdominal pain and Distension for 2 days, Associated with several episode of vomting and constipation. X-Ray Abdomen showed multiple air fluid levels. CT Abdomen suggestive of small bowel obstruction with a band arising from dome of the urinary bladder and extending up to mid ileum causing obstruction and gangrene of 30 cm Ileo-ceacal junction. Emergency Laparotomy proceeded and a thick short band connecting Ileo-ceacal junction and bladder was identified.

Спайкова кишкова непрохідність як ускладнення дивертикула Меккеля в дітей

Meckel’s diverticulum (DM) is a formation of the ileum caused by incomplete obliteration of the omphalomesenteric duct in the developing embryo. This is one of the most common anomalies of the digestive tract in children. Most DM develops completely asymptomatically. Clinical symptoms develop in only 16% of cases, and 50–60% of them are children under 10 years, an average of 2.5 years of age. The severity of clinical symptoms in DM is associated with the development of complications: intestinal bleeding, intestinal obstruction (intussusception, strangulation intestinal obstruction), diverticulitis with perforation and peritonitis, etc. The article presents a clinical case of adhesive intestinal obstruction in an 8-year-old, which occurred after DM in the anamnesis. As the adhesive intestinal obstruction is an extremely rare complication of DM in children, the presence of patients with acute surgical pathology of the abdominal cavity requires pediatric surgeons to clearly understand the occurrence of such complications in the perspective of the development of intestinal tube defect – DM and the need for the immediate radical treatment tactics in the event of this problem. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: children, Meckel’s diverticulum, complications, adhesive intestinal obstruction.

Severe urinary tract damage secondary to primary bladder neck obstruction in women.

To present the clinical and radiological characteristics of women with severe structural deterioration of the bladder and upper urinary tract secondary to Primary Bladder Neck Obstruction (PBNO), and their outcomes after bladder neck incision (BNI). Retrospective evaluation of adult women who underwent BNI for PBNO at one institution. Patients were assessed for symptoms, renal function, structural abnormalities of the urinary tract and video-urodynamics. PBNO diagnosis was confirmed with video-urodynamics in all patients. BNI was performed at the 4-5 and/or 7-8 o'clock positions. Postoperative symptoms, PVR, uroflowmetry and renal function were evaluated and compared to baseline. Median patient age was 56.5 years (range 40-80). All presented with urinary retention-four were on clean intermittent Catheterization (CIC) and two with a Foley catheter. All patients had bladder wall thickening and diverticula. Four women had elevated creatinine levels, bilateral hydronephrosis was present in five (83.3%). After BNI, all patients resumed spontaneous voiding without the need for CIC. Median Qmax significantly improved from 2.0 [1.0-4.0] mL/s to 15 [10-22.7] mL/s (p = 0.031). Median PVR decreased from 150 to 46 [22-76] mL (p = 0.031). There were no postoperative complications. Creatinine levels returned to normal in 3/4 (75%) patients. PBNO in women may result in severe damage to the bladder and upper urinary tract. Despite severe structural abnormalities of the bladder, BNI was effective in reducing symptoms and improving structural and functional abnormalities of the lower and upper urinary tract.

Возможности пневмовезикоско-пического доступа при коррекции патологии уретеровезикального сегмента мочеточника и мочевого пузыря у детей

Background pneumovesicoscopic approach gives new possibilities for endovideosurgical correction of congenital ureteral and bladder pathology. Aim To increase the efficiency of ureteral reimplantation in patients with vesicoureteral reflux (VUR), obstructive megaureter and bladder pathology by using pneumovesicoscopic access. Materials and methods For the period 2014 - 2020 a total of 52 children aged from 10 months up to 15 years (median 2.5 years) were treated. In all patients, pneumovesicoscopic ureteral reimplantation according to the Cohen technique was performed, and in six cases bilateral procedure was done. 30 patients with obstructive megaureter (32 ureters) were treated, and intravesical suturing with ureteral plication was performed in 9 patients. Reimplantation for grade 3-5 VUR was performed in 22 patients (26 ureters), in combination with excision of the bladder diverticulum was done in 3 patients, while 3 children were undergone to simultaneous excision of the ureterocele. An original technique for fixation of the mobilized dilated ureter with a ligature to the bladder neck is proposed to simplify its intravesical suturing according to the Starr technique. Results The mean operation time was 142 (83-235 minutes). Conversion to open surgery was required in 1 (1.9%) child during the learning curve. The length of stay was 5-6 days, with an average of 5.21 days. According to ultrasound data, after 1, 3, 6 months there was a decrease in the size of the collecting system and ureter in all cases. At cystography after 6-12 months, VUR was detected in 3 (5.7%) children: in 2 (9%) patients with grade 3-5 VUR and in 1 (3.3%) patient with obstructive megaureter and ureteral suturing. Conclusion Pneumovesicoscopic access for ureteral reimplantation in patients with VUR, obstructive megaureter, bladder diverticulum and ureterocele has proven its efficiency and reliability with a minimal complication rate (5.7%). Our proposed method of fixing the mobilized ureter with a ligature to the bladder neck helps to simplify the suturing of the ureter and to shorten the operation time.

An Incidental Finding of Bladder Diverticulum With Entrapped Radioactive Urine Demonstrated on FDG PET/CT

An Incidental Finding of Bladder Diverticulum With Entrapped Radioactive Urine Demonstrated on FDG PET/CT

Art in Endoscopy: "The smiling diverticulum".

Art in Endoscopy: "The smiling diverticulum".

Ureteral reimplantation aligned laparoscopically: Pneumovesicoscopic Politano-Leadbetter reimplantation in children

Ureteroneocsytostomy is a well-established procedure for correction of certain ureterovesical conditions like vesicoureteral reflux and ureterevesical obstruction. Amazing developments in technology paved the way for minimally invasive surgery and conventional procedures are increasingly being performed minimal invasively during the recent decades. Although Politano-Leadbetter ureteroneocystostomy is an anatomical repair, lost its popularity against Cohen's technique as it is more challenging to perform and requires extravesical dissection which may increase the complication rates. In this study, we evaluated our results and feasibility of laparoscopic intravesical (pneumovesicoscopic) repair of certain ureterovesical conditions by Politano-Leadbetter principle in children. Twenty one children who underwent pneumovesicoscopic uretero-neocystostomy are enrolled in the study. Surgical procedure is described and surgical duration, complications, conversion rate and success rates are evaluated. Fourteen (67%) of the patients were girls and 7 were boys (33%). Median age at operation was 6 years (1.5-15 years). Main indications for surgery were vesicoureteral reflux, megaureter and bladder diverticulum. Fourteen of the patients underwent bilateral (67%) intervention while the 5 left (24%) and 2 right (9%). Four patients were converted to open surgery (16%; 4/25). Median surgical duration was 265min (190-320min) for bilateral and 180min (115-260min) for unilateral procedures. Success rates confirmed by a contrast study were 92% for VUR. It appears that minimally invasive intravesical surgery fails to keep up with the other minimally invasive procedures secondary to restricted working field in the bladder, technically demanding procedures and well-documented high succes rates of open counterpart techniques. Although developing relatively slower, minimally invasive technology offers better vision, better cosmesis, lesser pain and lesser tissue disturbance. Although cross-trigonal reimplantation is the most popular technique, Politano-Leadbetter technique provides an anatomical alignment of ureters and is a good option for caudally located ectopic ureters. In our study, pneumovesicoscopic approach provided anatomical reimplantation, identification and sparing of vas deferens and better cosmesis. Major limitations of our study are the limited number of cases, longer operation times, higher complication rates and short follow up duration which we hope to improve with increasing experience. Although not brilliant as its open counterpart yet, initial results of pneumovesicoscopic reimplantation with Politano-Leadbetter technique is promising and growing experience would further improve the results and lower the complication and conversion rates.

A Novel Method of Laparoscopic Approach in a Giant Bladder Diverticulum with Renal Cell Carcinoma "Double Trouble"

A Novel Method of Laparoscopic Approach in a Giant Bladder Diverticulum with Renal Cell Carcinoma "Double Trouble"

A Novel Method of Laparoscopic Approach in A Giant Bladder Diverticulum With Renal Cell Carcinoma "Double Trouble" - Literature Review and Case Study

A Novel Method of Laparoscopic Approach in A Giant Bladder Diverticulum With Renal Cell Carcinoma "Double Trouble" - Literature Review and Case Study

Bilateral Hutch diverticula in an elderly male: Revelation of an unknown past.

Hutch diverticulum is a congenital diverticulum of the urinary bladder, reported infrequently in children and rare amongst adults. We present a 60-year-old male patient with bilateral Hutch diverticula, detected incidentally during an abdominal ultrasound examination performed for blunt abdominal trauma. This rare case highlights an unusual incidental presentation and opportunity to learn how to differentiate it from acquired bladder diverticula. The available treatment options are also discussed varying from simple follow-up to aggressive surgery.

Spontaneous Intraperitoneal Rupture of Bladder Diverticulum: A Rare Cause of Peritonitis

Spontaneous rupture of acquired bladder diverticulum in an adult patient is an extremely rare pathological entity with only 15 cases reported in the available literature. Etiologies are dominated by bladder outlet obstruction, represented mainly by benign prostatic hypertrophy (BPH) in elderly men. Clinical presentation is nonspecific, leading to delayed diagnosis and treatment. Surgical management is the standard approach for intraperitoneal rupture of bladder diverticulum. The prognosis depends on the earliness of treatment, associated comorbidity, and the nature of underlying diseases. Herein, we report a rare case of a 65-year-old male patient, who presented a spontaneous rupture of a large acquired bladder diverticulum, secondary to acute urinary retention complicating benign prostatic hypertrophy. The diagnosis was suspected in the presence of generalized peritonitis associated with lower urinary tract symptoms (LUTS) and was confirmed accurately and promptly by a computed tomography (CT) of the abdomen and pelvis. The patient underwent a successful surgical excision of the diverticulum and bladder repair without delay. The postoperative course was uneventful, and he was discharged from the hospital without any complication.