Transurethral treatment of bladder diverticula alternative to open diverticulectomy

Since October, 1980, we have used transurethral fulguration of the diverticular mucosa and incision of the diverticular neck in combination with electrohydraulic lithotripsy of bladder stones and transurethral prostatic resection to treat all aspects of diverticula in 11 patients. In comparing the results with those of open diverticulectomy, we found the transurethral procedure to be equally effective while being safer, faster, and less expensive.     

Transurethral treatment of urethral diverticula in women.

Six women with urethral diverticulitis and a history of having had previous operations for diverticula were subjected to transurethral diverticulotomy with a knife electrode. Each patient had multiple diverticula, some compartmented, located in the mid or most proximal segments of the urethra. All patients have been relieved of the symptoms and infection during the postoperative period, varying from 1 1/2 to 7 years.     

Transurethral treatment of bladder diverticulum

13 patients with bladder diverticula underwent transurethral diverticulectomy. Follow-up cystograms were obtained six months after surgery. The diverticulum had shrunk in all cases and had totally disappeared in 11 (85%). Transurethral diverticulectomy is a simple, effective, and safe procedure. It takes only a short time and can easily be combined with transurethral operations for obstructions of the lower urinary tract.     

The treatment of large bladder diverticula

Thirty-eight cases of large bladder diverticula treated surgically between 1970 and 1979 were reviewed. Twenty-two underwent diverticulectomy alone and 19 of these had no further trouble during a follow-up period averaging 4.5 years. Three other patients who had undergone resection of a small prostate gland prior to diverticulectomy might also have been cured by diverticulectomy alone. In at least half of the patients presenting with large bladder diverticula no obstructive factor was present and it is concluded that primary diverticula are more common than was previously thought. Clinically, primary diverticula may be distinguished from secondary on the basis of symptoms, cystoscopic findings of trabeculation and urodynamic studies. A more extensive application of the transperitoneal approach in performing diverticulectomy is recommended.     

Transurethral treatment of bladder diverticulum.

Transurethral resection of the bladder diverticular neck and fulguration of the diverticular mucosa were performed in 31 diverticula. Cystograms showed that 26 of the 31 diverticula had disappeared completely after 1 month. Follow-up cystograms have shown no recurrence, and no further surgical procedures were required. Therefore, we conclude that resection of the diverticular neck from 4 to 8 o'clock to even the gap between the bladder mucosa and diverticular wall in conjunction with transurethral treatment of the prostate, if required, is a safe, fast and effective method.     

Transurethral laser treatment in bladder neoplasms

Within one year 38 patients with bladder tumors--most malignant--were treated by argon-laserbeam (6 Watt and 15 Watt). We now survey altogether 45 endoscopic operations. To bring the laserbeam into the waterfilled bladder, we use a special light-conductor and a normal operation-cystoscope. Laser therapy takes place after conventional electro-resection (TUR) by coagulation of the tumor ground or independently by destroying small relapses of tumors. We have observed some advantages of argon-laser treatment compared to electro-surgery: 1. No convulsions of bladder muscle with the danger of perforation, sometimes produced by current impulses. 2. Painlessness. Laser treatment is possible without anesthesia. 3. More therapeutic range. 4. Cases of absence of recidivation. We hope that the new therapy will be able to reduce the recidivation of bladder tumors and to improve the poor results of operative treatment.     

Surgical treatment of bladder diverticula: laparoscopic approach

BACKGROUND AND PURPOSE: 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. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.     

腹腔镜下膀胱部分切除治疗膀胱憩室癌

目的 总结腹腔镜下膀胱部分切除术治疗膀胱憩室癌的可行性及疗效.方法 本组21例膀胱憩室癌患者,均行腹腔镜下膀胱部分切除术治疗,回顾性分析其临床资料及随访结果.结果 患者年龄69±7.2(59 ～78)岁,女15例,男6例,肉眼或镜下血尿入院19例,并膀胱结石2例.憩室大小6.1±2.5(3.4～8.9)cm,所有患者术前均行MRI结合其他影像学分期为≤T2N0M0,膀胱镜检成功17例,其余4例通过脱落细胞学获取明确诊断均为TCC.所有病例均行腹腔镜下包含憩室的膀胱部分切除术,术后即刻丝裂霉素膀胱灌注(病理为高危险者维持灌注).术后分期≤T2,分级≤Ⅱ级.随访6个月～2年,复发2例,其中进展1例.结论 腹腔镜下膀胱部分切除术治疗膀胱憩室癌效果良好,是一种安全可行的微创治疗手段.     

Neoplasms in bladder diverticula

Four cases of transitional-cell carcinoma arising in bladder diverticula have been presented. Attention is drawn to the mode of presentation as neurogenic bladders. Incidence, diagnosis, development of recurrences, and treatment are discussed. Prognosis is generally poor, and aggressive therapy is urged.     

Transurethral laser coagulation for treatment of urinary bladder tumors

Between September 1979 and December 1982, 230 cases of tubal reconstructive surgery were followed for 2 years. An analysis of these cases showed 75% to have had more than one procedure performed. There were 91 pregnancies in this group. In the bipolar disease population, 36% achieved an intrauterine pregnancy. Tubal reversal procedure resulted in comparable rates when compared to conventional surgery (71%). The ectopic pregnancy rate was 4.4%, and spontaneous abortion rate was 6.6%. The carbon dioxide laser appears to have a place in the armamentarium of the microsurgeon.     

老年男性膀胱颈硬化症的腔内治疗

目的探讨经尿道电切术治疗老年男性膀胱颈硬化症的疗效. 方法回顾分析我院2000年2～9月36例经尿道电切术治疗老年男性膀胱颈硬化症的临床资料,以术前后排尿困难症状改善、残余尿量、最大尿流率评价疗效. 结果30例随访3～18个月,平均7个月,有效率86.7%(26/30),无严重并发症发生. 结论经尿道电切术是治疗老年男性膀胱颈硬化症有效的腔内治疗方法.     

经尿道电切术治疗中晚期浸润性膀胱癌的探讨

目的 探讨经尿道电切术治疗中晚期浸润性膀胱癌的疗效.方法 对81例中晚期膀胱癌患者施行了经尿道膀胱肿瘤电切术(TURBT),手术参照根治性TURBT原则,切除深度均达深肌层或膀胱壁外脂肪层,术后给予卡介苗(BCG)膀胱灌注化疗或放疗,随访3～24个月.结果 复发32例,复发率39.5%(32/81),对复发者再次行TURBT.死亡18例,死亡率22.2%(18/81).结论 对年老体弱不能耐受或不愿意接受膀胱全切的中晚期膀胱癌患者可施行TURBT,以达到延长生命,提高生活质量的目的 .     

小儿先天性膀胱憩室

目的 总结先天性膀胱憩室患儿的诊疗特点.方法 回顾性分析22例先天性膀胱憩室患儿的临床资料.均为男童,年龄7 d～12岁,平均3.5岁.临床表现排尿困难、尿潴留、反复尿路感染等症状,均经排尿性膀胱尿道造影检查确诊.18例25根输尿管合并膀胱输尿管反流,术前18例行IVU检查,上尿路正常7例,上尿路扩张积水10例,右肾发育不良1例.结果 22例均行憩室切除、膀胱修复术,合并膀胱输尿管反流者同期行输尿管膀胱再吻合术.17例随访6个月～11年,平均4.5年,患儿临床症状均消失,憩室无复发.14例原膀胱输尿管反流者,反流消失12例,1例有Ⅰ度反流者,保守治疗半年反流消失,1例仍有双侧膀胱输尿管反流,行膀胱造瘘术后半年,目前仍在随访中.IVU复查12例,上尿路积水好转7例,积水无变化3例,2例左肾不显影者术后仍不显影.结论 小儿先天性膀胱憩室较少见,但可引起上尿路严重损害甚至危及生命,早期诊断、早期合理治疗是提高疗效的关键.     

Congenital bladder diverticula in children

BACKGROUND/PURPOSE: The authors report their experience with the management of congenital bladder diverticula in children. METHODS: The authors reviewed the histories of six boys (mean age, 4.4 years) in whom congenital bladder diverticula was treated from 1980 to 1996. Diverticula were unilateral in four patients and bilateral in two patients. All patients presented recurrent urinary tract infection, and two boys had several episodes of urinary retention. Secondary kidney damage was present in two patients with ureteral obstruction and one with vesicoureteral reflux. Surgical treatment was undertaken in all patients. RESULTS: After surgical treatment, none of the patients has had recurrence of the diverticula, and all remain asymptomatic. CONCLUSIONS: Congenital bladder diverticula have a wide clinical spectrum and could lead to severe kidney damage. Urinary tract infection and urinary retention are the most frequent presentation forms. Surgical treatment should be indicated in all symptomatic cases according to each anatomic and functional situation.     

经尿道膀胱颈电切术治疗慢性前列腺炎合并膀胱颈梗阻

目的探讨经尿道膀胱颈电切术治疗慢性前列腺炎合并膀胱颈梗阻的临床效果。方法经尿道膀胱颈部电切术治疗慢性前列腺炎合并膀胱颈梗阻23例,并进行术前术后临床症状和尿流动力学检查及对比。结果所有患者术后排尿通畅,效果满意。随访1～3个月,最大尿流率由（10．78±1．35）mL／s上升至（21．30±0．63）mL／s,差异有统计学意义（P〈0．05）;前列腺液及精液检查正常。结论对于慢性前列腺炎合并膀胱颈梗阻患者经药物治疗无效后,可选用经尿道膀胱颈部电切术治疗膀胱颈梗阻。     

Transurethral suturing of bladder following transurethral excision of female vesico-urachal diverticula: a novel technique with long-term follow-up results

Backgrounds

This study aims to describe and evaluate outcomes of transurethral surgery-natural orifice transluminal endoscopic surgery (TUS-Notes) technique in patients treated with transurethral excision of vesico-urachal diverticula (VD).

Methods

Patients who underwent TUS-Notes following transurethral VD excision due to recurrent urinary tract infection (rUTI) since 2013 were included in this prospective non-randomized cohort study. Under cystoscopic guidance VD and surrounding bladder wall was resected until the fatty tissue using monopolar resectoscope. The specimen was removed with a grasper through the cystoscope.

TUS-Notes technique was performed with Minimal Suturing Device (MSD-Ney®). The needle of the suture was shaped according to suturing position and loaded into MSD-Ney. They were inserted into the bladder under cystoscopic guidance transurethrally. Once the defect was sutured properly, an extracorporeal knot was prepared and tied.

The length of the operation (LOO), and perioperative complications according to the Clavien–Dindo grading system were noted. The integrity of the bladder was checked with cystography to assess objective cure. Subjective cure was evaluated with Patient Global Impression of Improvement (PGI-I) scale.

Results

The follow-up period of 65 participants varied from three months to eight years. The median LOO was 37 min. A Clavien grade-3 complication was observed in one patient. Peroperative failure was not noted.

The median duration of hospital stays, and catheterization time was three days. Objective cure rate and subjective cure rates were 100%. UTI was not noted after surgery.

Conclusions

Transurethral complete excision of VD is an acceptable technique to prevent rUTI. The TUS-Notes technique provides a successful minimal invasive treatment option for the treatment of bladder defects.

Concise

Transurethral suturing of urinary bladder.