Laparoscopic bladder diverticulectomy assisted by cystoscopic transillumination

Inroduction Acquired bladder diverticula are herniations of the bladder mucosa through detrusor muscle. Due to the ineffective emptying of the bladder diverticulum, urine accumulation may lead to urinary tract infection, stone disease, and lower urinary tract malignancy in the diverticulum (1). The...

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Principais autores: Rebouças, Rafael B., Monteiro, Rodrigo C., Souza, Thiago N. S. de, Burity, Camila R. T., Lisboa, João B. R. M., Pequeno, Giovanna B. M., Figueiredo, Luciano G. de, Silva, Emanuel R. M., Britto, Cesar Araujo
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Idioma:pt_BR
Publicado em: International Braz J Urol
Assuntos:
cystoscopy
laparoscopic
laparoscopic bladder diverticulectomy
Endereço do item:https://repositorio.ufrn.br/handle/123456789/52748
https://doi.org/10.1590/S1677-5538.IBJU.2014.02.22
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spelling ri-123456789-527482023-06-19T16:28:15Z Laparoscopic bladder diverticulectomy assisted by cystoscopic transillumination Rebouças, Rafael B. Monteiro, Rodrigo C. Souza, Thiago N. S. de Burity, Camila R. T. Lisboa, João B. R. M. Pequeno, Giovanna B. M. Figueiredo, Luciano G. de Silva, Emanuel R. M. Britto, Cesar Araujo cystoscopy laparoscopic laparoscopic bladder diverticulectomy Inroduction Acquired bladder diverticula are herniations of the bladder mucosa through detrusor muscle. Due to the ineffective emptying of the bladder diverticulum, urine accumulation may lead to urinary tract infection, stone disease, and lower urinary tract malignancy in the diverticulum (1). The symptomatic bladder diverticula may require surgical treatment. Surgical approaches include open operation via an extravesical or a transvesical approach for large diverticula or endoscopically with transurethral fulguration for small diverticula (2). Herein, we present a video of a Laparoscopic Bladder Diverticulectomy for recurrent urinary tract infection, aided by concurrent cystoscopy. Materials and methods Female patient, 37 years old, complaining of recurrent urinary tract infection for three years. A bladder diverticulum was found on ultrasonography. Cystoscopy revealed a posterior right-side diverticulum next to the ipsilateral ureteral ostium. A laparoscopic bladder diverticulectomy with the aid of intraoperative cystoscopy was proposed. Surgical Technique Under general anesthesia, the patient was placed in lithotomy and Trendelenburg position. An umbilical incision was used for pneumoperitoneum creation and insertion of a 10mm trocar. Three other 5mm trocars were inserted at positions equidistant between the navel and the pubis, and between the umbilicus and the iliac crests bilaterally. Concomitant cystoscopy was performed for location of the diverticulum by transillumination and help to identify the diverticular neck. The diverticulum was dissected both sharply and bluntly until the whole diverticulum was freed. After completion the ressection, a catheter was inserted in the right ureter near the diverticulum to assess inadvertent lesions. The mouth of the diverticulum was closed by 2-0 double-layered absorbable running suture and a suction drain was placed through a lateral 5mm port. RESULTS The surgery was uneventful. The operative time was 120 minutes with minimal blood loss. There was no postoperative leakage, the drain was removed after 24 hours and the patient discharged. The indwelling catheter was removed after 7 days and the patient progresses without voiding complaints or new infectious episodes in a follow-up of 10 months. Conclusions Laparoscopic diverticulectomy is technically feasible and safe. The concomitant use of cystoscopy facilitates the identification and location of the diverticulum, thereby minimizing dissection of the bladder and decreasing operative time. Cystoscopy may also be useful in the delineation of margins in cases of neoplasia within the diverticulum. 2023-06-19T16:27:58Z 2023-06-19T16:27:58Z 2014-03 article REBOUÇAS, Rafael B.; MONTEIRO, Rodrigo C.; SOUZA, Thiago N. S. de; BURITY, Camila R. T.; LISBOA, João B. R. M.; PEQUENO, Giovanna B. M.; FIGUEIREDO, Luciano G. de; SILVA, Emanuel R. M.; BRITTO, Cesar A.. Laparoscopic bladder diverticulectomy assisted by cystoscopic transillumination. International Braz J Urol, [S.L.], v. 40, n. 2, p. 281-282, abr. 2014. FapUNIFESP (SciELO). http://dx.doi.org/10.1590/s1677-5538.ibju.2014.02.22. Disponível em: https://www.scielo.br/j/ibju/a/FgsP47GMy5x6wn3M8Fh9Zsd/?lang=en. Acesso em: 19 jun. 2023. https://repositorio.ufrn.br/handle/123456789/52748 https://doi.org/10.1590/S1677-5538.IBJU.2014.02.22 pt_BR Attribution-NonCommercial 3.0 Brazil http://creativecommons.org/licenses/by-nc/3.0/br/ application/pdf International Braz J Urol
institution Repositório Institucional
collection RI - UFRN
language pt_BR
topic cystoscopy
laparoscopic
laparoscopic bladder diverticulectomy
spellingShingle cystoscopy
laparoscopic
laparoscopic bladder diverticulectomy
Rebouças, Rafael B.
Monteiro, Rodrigo C.
Souza, Thiago N. S. de
Burity, Camila R. T.
Lisboa, João B. R. M.
Pequeno, Giovanna B. M.
Figueiredo, Luciano G. de
Silva, Emanuel R. M.
Britto, Cesar Araujo
Laparoscopic bladder diverticulectomy assisted by cystoscopic transillumination
description Inroduction Acquired bladder diverticula are herniations of the bladder mucosa through detrusor muscle. Due to the ineffective emptying of the bladder diverticulum, urine accumulation may lead to urinary tract infection, stone disease, and lower urinary tract malignancy in the diverticulum (1). The symptomatic bladder diverticula may require surgical treatment. Surgical approaches include open operation via an extravesical or a transvesical approach for large diverticula or endoscopically with transurethral fulguration for small diverticula (2). Herein, we present a video of a Laparoscopic Bladder Diverticulectomy for recurrent urinary tract infection, aided by concurrent cystoscopy. Materials and methods Female patient, 37 years old, complaining of recurrent urinary tract infection for three years. A bladder diverticulum was found on ultrasonography. Cystoscopy revealed a posterior right-side diverticulum next to the ipsilateral ureteral ostium. A laparoscopic bladder diverticulectomy with the aid of intraoperative cystoscopy was proposed. Surgical Technique Under general anesthesia, the patient was placed in lithotomy and Trendelenburg position. An umbilical incision was used for pneumoperitoneum creation and insertion of a 10mm trocar. Three other 5mm trocars were inserted at positions equidistant between the navel and the pubis, and between the umbilicus and the iliac crests bilaterally. Concomitant cystoscopy was performed for location of the diverticulum by transillumination and help to identify the diverticular neck. The diverticulum was dissected both sharply and bluntly until the whole diverticulum was freed. After completion the ressection, a catheter was inserted in the right ureter near the diverticulum to assess inadvertent lesions. The mouth of the diverticulum was closed by 2-0 double-layered absorbable running suture and a suction drain was placed through a lateral 5mm port. RESULTS The surgery was uneventful. The operative time was 120 minutes with minimal blood loss. There was no postoperative leakage, the drain was removed after 24 hours and the patient discharged. The indwelling catheter was removed after 7 days and the patient progresses without voiding complaints or new infectious episodes in a follow-up of 10 months. Conclusions Laparoscopic diverticulectomy is technically feasible and safe. The concomitant use of cystoscopy facilitates the identification and location of the diverticulum, thereby minimizing dissection of the bladder and decreasing operative time. Cystoscopy may also be useful in the delineation of margins in cases of neoplasia within the diverticulum.
format article
author Rebouças, Rafael B.
Monteiro, Rodrigo C.
Souza, Thiago N. S. de
Burity, Camila R. T.
Lisboa, João B. R. M.
Pequeno, Giovanna B. M.
Figueiredo, Luciano G. de
Silva, Emanuel R. M.
Britto, Cesar Araujo
author_facet Rebouças, Rafael B.
Monteiro, Rodrigo C.
Souza, Thiago N. S. de
Burity, Camila R. T.
Lisboa, João B. R. M.
Pequeno, Giovanna B. M.
Figueiredo, Luciano G. de
Silva, Emanuel R. M.
Britto, Cesar Araujo
author_sort Rebouças, Rafael B.
title Laparoscopic bladder diverticulectomy assisted by cystoscopic transillumination
title_short Laparoscopic bladder diverticulectomy assisted by cystoscopic transillumination
title_full Laparoscopic bladder diverticulectomy assisted by cystoscopic transillumination
title_fullStr Laparoscopic bladder diverticulectomy assisted by cystoscopic transillumination
title_full_unstemmed Laparoscopic bladder diverticulectomy assisted by cystoscopic transillumination
title_sort laparoscopic bladder diverticulectomy assisted by cystoscopic transillumination
publisher International Braz J Urol
publishDate 2023
url https://repositorio.ufrn.br/handle/123456789/52748
https://doi.org/10.1590/S1677-5538.IBJU.2014.02.22
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