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1.
Bladder diverticulectomy is a surgical operation for symptomatic or large bladder diverticula. Typically, bladder diverticula are because of infravesical obstruction, although congenital diverticula can occur that may be large and symptomatic. The ability to excise the diverticulum completely, avoid important adjacent structures, and close the bladder defect in a watertight fashion are key fundamentals to this operation. Traditionally done via an open extravesical, intravesical, or combined approach, bladder diverticulectomy can now be done in a minimally invasive fashion. Both laparoscopic and robot-assisted methods have clear advantages over open surgery, including smaller incision, reduced pain, improved cosmesis, and reduced blood loss, with an equivalent functional result. Large bladder diverticula, particularly those involving the ureteric orifice which required ureteric reimplantation, were often considered beyond the scope of conventional laparoscopy. Recently, use of robotic technology as a means of facilitating laparoscopic excision of bladder diverticula has provided the ability to treat large and more complex diverticula. Advantages of the robotic approach are the finer precision and dexterity of the instruments coupled with three-dimensional imaging. Although there are several case reports describing pure laparoscopic diverticulectomy, as far as we are aware there are no published reports of robotic bladder diverticulectomy. This paper will outline a safe and reproducible surgical technique for performing robotic bladder diverticulectomy using the da Vinci-S surgical system.  相似文献   

2.
Dalpiaz O  Curti P 《Neurourology and urodynamics》2006,25(4):301-6; discussion 307
AIMS: A review of the international literature on urogynecology was performed to focus on the actual role of perineal ultrasound. It is an increasingly used tool for the assessment of pelvic floor dysfunction and incontinence. In recent years ultrasound studies have predominated but there is little information on normal values and confusion on methodology and measurements. The aim of this study is to report the data available in the Literature about ultrasound as investigational evaluation helpful in diagnosing of urinary incontinence and urethral hypermobility, to document pelvic floor anatomy and to assess anatomic and functional changes after surgery. METHODS: A MEDLINE search was conducted using combinations of heading terms: perineal, ultrasound, pelvic floor, urinary incontinence, pelvic organ prolapse. RESULTS: Ultrasound has become an indispensable diagnostic procedure in urogynecology. Perineal, introital, and endoanal ultrasound are the most recommended techniques and the results comprise qualitative and quantitative findings. These are important for determining the localization of the bladder neck and vesico-urethral junction and also for pre- and postoperative comparisons, and moreover for clinical applications and scientific investigations. CONCLUSIONS: There are as yet little data and there is a need to find in the near future more standard and objective parameters for the diagnosis of urinary incontinence. They will be obtained by means of more accurate analysis and comparison of the parameters, leading to a more clinically useful diagnostic test and assuring reliable and reproducible results.  相似文献   

3.
探讨通过三维肛管直肠腔内超声及直肠排粪造影检查评价三维肛管直肠腔内超声对耻骨直肠肌综合征的临床诊断价值。对200例耻骨直肠肌综合征患者进行三维肛管直肠腔内超声与直肠排粪造影检查,对两种检查结果进行回顾性分析。结果表明,肛肠三维肛管直肠腔内超声检查能准确地诊断耻骨直肠肌综合征,为临床提供客观可靠的依据。  相似文献   

4.
Tumour development in a bladder diverticulum can cause diagnostic difficulties. We report a case of carcinoma in a diverticulum evaluated by transurethral ultrasonography. Based on the reported case, we would recommend transurethral ultrasonography of the bladder in patients with diverticula and haematuria of unknown cause.  相似文献   

5.
At the time of urodynamic assessment, 91 patients were examined by transvaginal echography. Two urethral diverticula were detected, one of which was only detected by ultrasound. Transvaginal echography clearly showed the size and anatomical relationship of the diverticulum to the bladder. We conclude that the procedure is a useful adjunct to routine testing for the detection of urethral diverticula.  相似文献   

6.
Objectives  The purpose of the study is to present the authors’ clinical and surgical experience with congenital bladder diverticula in nine pediatric patients at a developing world tertiary care center. Patients and methods  Records of nine patients diagnosed and treated as congenital bladder diverticula from 2000 to 2007 were retrospectively reviewed for age, sex, chief complaints, associated anomalies, investigative work-up, operative notes, and postoperative follow-up. Results  All were males. Age at presentation ranged from six months to eight years (mean three years). All were diagnosed postnatally by ultrasound and/or voiding cystourethrography (VCUG) and confirmed on urethrocystoscopy. Open surgical excision of diverticulum was done in all the patients. Ureteral reimplantation was simultaneously done only in three patients with VCUG-documented high-grade vesicoureteral reflux (VUR). With an average follow-up of four years, gradual resolution of symptoms was seen in seven of nine patients whose postoperative follow up records were available. There was no diverticulum recurrence at the defined mean follow-up. Conclusion  Pediatric patients with recurrent urinary tract infections and voiding dysfunction should always be evaluated for congenital bladder diverticulum. Although investigations such as intravenous urography (IVU), urodynamic studies, nuclear renal scanning, and, sometimes, CT scan and MRI, form an important part of preoperative diagnostic work-up and postoperative follow up, USG and VCUG may be enough when availability and cost are the constraints. Diverticulectomy, with ureteral reimplantation for high-grade reflux, provides good results without recurrence.  相似文献   

7.
Transvaginal ultrasound for the diagnosis of urethral diverticulum   总被引:1,自引:0,他引:1  
PURPOSE: We reviewed our experience with urethral diverticula and transvaginal ultrasound to evaluate female patients with this condition. MATERIALS AND METHODS: All female patients who underwent transvaginal ultrasound during evaluation for urethral diverticulum at our institution between May 1995 and April 2002 were identified by searching a data base. We reviewed the diagnostic evaluation and compared diagnostic techniques with transvaginal ultrasound for diagnosing urethral diverticulum. RESULTS: Of the 25 patients with suspected urethral diverticulum who underwent transvaginal ultrasound as a diagnostic procedure 10 (40%) were diagnosed with urethral diverticulum, including 10 in whom it was confirmed by surgery or other diagnostic procedures. Transvaginal ultrasound was less expensive than the other diagnostic modalities and in no case did it miss a urethral diverticulum that was identified by another diagnostic technique. Urethral diverticulum was detected on 1 of 3 voiding cystourethrograms (33%) and this study missed the diagnosis in 1 case that was diagnosed by transvaginal ultrasound. Three cases of urethral diverticulum were noted on transvaginal ultrasound after they were missed by cystoscopy. Videourodynamics were unable to diagnose urethral diverticulum. CONCLUSIONS: Transvaginal ultrasound is effective for evaluating patients with suspected urethral diverticulum. It is less expensive and may identify diverticula missed by other diagnostic modalities.  相似文献   

8.
Surgeon-performed ultrasound: endorectal ultrasound   总被引:4,自引:0,他引:4  
Endorectal (ERUS) and endoanal (EAUS) ultrasound imaging is increasingly being performed by surgeons in the office and outpatient setting for the assessment of both benign and malignant disease.Multiple studies have demonstrated the accuracy of these modalities in identifying pertinent anatomy and anatomic abnormalities.The ultrasound is easily tolerated by most patients, and is easily performed with minimal preparation on the patient's part. The ability of the surgeon to perform and interpret this straight forward diagnostic procedure allows for the simplification of the diagnostic process and a more rapid determination of treatment options for the patient.  相似文献   

9.
Diagnosis and Therapy of the Female Urethral Diverticula   总被引:1,自引:0,他引:1  
The various diagnostic and therapeutic modalities currently in use for urethral diverticula are reviewed. Various radiographic techniques have been reported, but only voiding cystourethrography (VCUG) and positive-pressure urethrography (PPU) are currently utilized. Urethroscopy is another suitable technique for diagnosis. Various sonographic techniques have been proposed, but their sensitivity is improved only by the transvaginal approach and magnetic resonance imaging (MRI). Various treatment methods have been proposed. The standard operative approach is surgical, through the vagina. The techniques currently in use to treat urethral diverticula are the Spence procedure, the typical urethral diverticulectomy, and the Tancer partial ablation technique. A full history, and physical examination is the first step in screening. When the diagnosis is suspected ultrasound and radiological imaging is necessary. Sonography is the first non-invasive examination to be performed. In negative cases it is imperative to perform a PPU or MRI. Symptomatic and very large diverticula must be treated in the easiest way possible. The best treatment, except for complicated and infected diverticula, is excision.  相似文献   

10.
This review article depicts the technique of virtual uro-endoscopy and its diagnostic value and highlights future aspects. The raw data are acquired using CT, MR, or ultrasound. Sufficient contrast between the wall of the hollow organ and its interior is reached by administering gas or contrast medium into the bladder or injecting contrast media i.v. After processing of these data, virtual endoscopic procedures can be watched on a screen in the same way as a cine-film of a conventional endoscopic operation. Virtual endoscopy is a reliable method with a high sensitivity for pathologies larger than 0.5 cm. It is not invasive, and there are situations that cause difficulties in conventional endoscopy (e.g. gross hematuria, diverticula, strictures) that cause no technical problems in virtual endoscopy. Problems encountered in virtual endoscopy are due to its poor sensitivity for pathologies smaller than 0.5 cm, for carcinoma in situ, and for ureteral calculi. So far there are no routine-indications for virtual endoscopy in urology. Nevertheless, it can be of additional value in diagnosis providing the indications are carefully controlled. In future, virtual endoscopy will probably become integrated into the spectrum of urologic diagnostics investigations.  相似文献   

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