NE-AUA 2006 Annual Meeting, September 28 - 30, 2006, The Westin Hotel & Rhode Island Convention Center Providence, Rhode Island
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Robotic-Assisted Laparoscopic Bladder Diverticulectomy
Edward G. Myer, MD, Joseph R. Wagner, MD.
Hartford Hospital/University of Connecticut, Hartford, CT,

Background: Reported techniques of surgical management of bladder diverticuli include open (intravesical, extravesical, and combined), endoscopic (fulguration or neck resection), and standard laparoscopic (transperitoneal and extraperitoneal) approaches. We report the first series of robotic-assisted laparoscopic bladder diverticulectomies.
Methods: Four patients underwent robotic-assisted laparoscopic bladder diverticulectomy between December 2004 and March 2006 by a single surgeon. Their records were reviewed, the surgical technique is described, and a review of the literature was performed.
Results: Four patients were evaluated for symptomatic bladder neck obstruction, including lower urinary tract symptoms (3) and recurrent urinary tract infections (1). Median post void residual was 388 (range 300-558). All patients had small prostates and large posterior vesical diverticuli which were a median of 10.2 cm in greatest dimension (range 4.7-11cm). Two patients underwent transurethral resection of the prostate (TURP) prior to their diverticulectomy. At the time of surgery, all patients underwent cystoscopy, ureteral stent placement, and placement of an angiographic catheter to distend the diverticulum. The diverticulum was approached transperitoneally, mobilized, excised at its neck, and the bladder closed in two layers. Post operatively, one patient required ureteroscopic retrieval of a stent which migrated into the ureter. There were no other complications. Length of stay was a median 2.5 days (range 1-6). Catheter was removed at a median of 25 days (range 23-32) when cystogram showed no leak. The two patients who underwent TURP prior to diverticulum resection did well. One patient required intermittent catherization for persistently high residuals and ultimately underwent TURP, and one patient continues on maximal medical therapy with urodynamic studies scheduled 6 months postoperatively.
Conclusions: Robotic-assisted laparoscopic bladder diverticulectomy is safe and effective for patients with large bladder diverticula and small prostates. Perioperative surgical outcomes rival previously reported open and laparoscopic diverticulectomies.


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