Transvesical bladder diverticulectomy via bladder neck opening during robot-assisted radical prostatectomy.

INTRODUCTION: As bladder diverticula in older adults are often secondary to bladder outlet obstruction, bladder diverticulectomy is often performed with prostate treatment. Cases of sequentially performed robot-assisted bladder diverticulectomy and prostatectomy have been reported; however, performing cystotomy for each procedure may increase the risk of complications and prolong operative time. MATERIALS AND SURGICAL TECHNIQUE: We reported the cases of three patients who underwent diverticulectomy without additional cystotomy via the bladder opening during robot-assisted laparoscopic radical prostatectomy in our hospital. DISCUSSION: This technique corresponds to a transvesical approach through the bladder neck opening. Hence, it is especially useful for well-visualized diverticula close to the ureteral orifice or on the posterior wall. Although other approaches may be better depending on the location of the diverticulum, it is considered a reasonable approach that does not require an additional cystotomy.

Pre- and postnatal findings with rare congenital anomalies of urinary bladder.

Bladder duplication and congenital bladder diverticulum are rare anomalies. We described two boys with rare bladder anomalies found on prenatal ultrasounds. Postnatal investigations and surgical findings confirmed these bladder anomalies. The malformation was associated with other system anomalies. This report of pre- and postnatal imaging with surgical correlation contributes to our understanding about these rare bladder anomalies.

A case report of melanosis of the bladder within a bladder diverticulum and associated Aerococcus urinary infection.

Background: Melanosis vesicae is a rare condition characterized by the deposition of melanin within the bladder urothelium. Case presentation: We present a case of a 72-year-old male with a history of recurrent urinary retention, bladder diverticula, and concurrent Aerococcus urinary tract infection who presented with left-sided abdominal pain. Cystoscopy revealed diffuse black splotch lesions throughout the bladder and two diverticula. Histopathological examination confirmed the diagnosis of melanosis vesicae. The patient ultimately underwent an open bladder diverticulectomy. Conclusion: The potential associations between melanosis vesicae, urinary tract malignancies and concurrent conditions such as bladder diverticula and urinary infections warrant further investigation.

Ureteral obstruction following transurethral resection of bladder cancer within the Hutch's diverticulum.

Here, we report a rare case of bladder cancer within the left congenital periureteral diverticulum, termed the Hutch's diverticulum. Following transurethral resection of the bladder tumor, repeated pyelonephritis was caused by stricture of the diverticulum orifice and ureter. We attempted transurethral dilation and ureteral stenting, but the obstruction did not improve. The patient's renal dysfunction showed gradual progression due to recurrent left pyelonephritis as well as the ureteral obstruction. Therefore, we finally performed a partial cystectomy, involving stricture and ureteral reimplantation. No tumor recurrence was observed over 39 months, and renal dysfunction did not progress following partial cystectomy.

Diagnostic Challenges in Pediatric Urology: A Case Report and Literature Review on Hourglass Bladder.

Hourglass bladder is a definition used to describe a particular configuration of the urinary bladder, divided into two compartments, upper and lower, communicating through a narrowed segment resembling an hourglass. It may be due to various conditions, such as bladder diverticula, bladder neck obstruction, neurogenic bladder, or other abnormalities. Congenital hourglass bladder is an extremely rare anomaly. To the best of our knowledge, only 24 cases have been reported. We present the case of a 2-year-old male, probably the youngest patient with congenital hourglass bladder ever recorded. We aim to increase knowledge about the incidence of this likely underdiagnosed condition and its management and stress the importance of long-term follow-up.

Giant stone in a urinary bladder diverticulum in a 69-year-old male: a case report.

The stone formation could occur due to urine stasis in the bladder diverticulum. However, the stones are usually smaller in size and can pass spontaneously. However, a giant stone inside vesical diverticulum is considered a rare entity. We report a 69-year-old male, with a two-year history of lower urinary tract symptoms along with a recurrence of urinary tract infection. An abdominal computed tomography scan revealed the presence of a giant bladder diverticulum and a large bladder stone. The patient underwent a transurethral bladder neck incision followed by diverticulectomy with stone extraction. The diverticulum size measures 6x4x3.8 cm and diverticulum stone size of 4x3x3 cm. Fortunately, the patient recovered well after the operation. In conclusion, giant stones inside large vesical diverticulum are a rare occurrence and should be considered in patients with lower urinary tract symptoms. Early diagnosis and optimal management of the obstruction are the principles to prevent long-term complications.

Migration of a bladder diverticulum stone into the rectum revealing an advanced rectal process.

Rectovesical fistulas are rare and typically result from inflammatory or neoplastic conditions in the small pelvis. They occur within a pelvic region that has been altered by local inflammatory or neoplastic processes. This explains the challenges in detecting these fistulas using conventional imaging techniques, despite the effectiveness of CT and MRI. Colonic diverticulosis is the primary cause of colovesical fistulas. To date, there have been no reported cases of a rectovesical fistula associated with a bladder diverticulum in the literature. We present a case of a patient who presented with a large stone within a bladder diverticulum. The migration of this stone into the rectum revealed an advanced rectal tumor. The unique aspect of our case is primarily the presence of a rectovesical fistula arising from a lateral bladder diverticulum. Additionally, we observed the migration of the diverticular calculus from the bladder to the rectum.

Inguinal Bladder Hernia Indirectly Treated With Prostate Artery Embolization.

An inguinal bladder hernia (IBH) is an abnormal protrusion of the bladder into the inguinal canal accompanied by a peritoneum sheath that creates the hernia sac. Clinical presentations vary greatly from lower urinary tract symptoms (LUTS) and reduction in scrotal size after voiding to being entirely asymptomatic. Since inguinal bladder hernias are uncommon and often accompanied by varied and nonspecific symptoms, it is challenging to diagnose and rarely included in differentials. Currently, computerized tomography (CT) imaging with contrast or voiding cystourethrography is recommended for diagnosis. There is no consensus on the best treatment for inguinal bladder hernias, with options ranging from laparoscopic repair to catheterization. In this study, we report the case of inguinal bladder hernia in an 86-year-old male presenting with symptoms of recurrent hematuria and two failed voiding trials after a Foley catheter placement from prostatomegaly resulting in bladder diverticula, and IBH. He was treated with prostate artery embolization (PAE) to address LUTS related to benign prostatic hyperplasia (BPH). The resultant decreased prostatic volume resolved his symptoms of IBH, hematuria, and urinary retention.

Look Beyond Syncope: A Positive Outcome in the Management of Multiple Bladder Diverticuli-Associated Enterococcus faecium Urinary Tract Infection.

Enterococcus faecium is a Gram-positive flora bacterium home to the gastrointestinal tracts of humans. A true ubiquitous pathogen and a member of the intestinal microbiome, formerly known as group D streptococci, this pathogen has been around for over 10 centuries. Enterococcus faecium thrives in the presence of stool and sewage. The ability to cause endocarditis and urinary tract infections (UTIs) has led to morbidity and mortality in the adult population. We report a case of an elderly woman who presented with multiple falls to our trauma bay area. She was initially managed as trauma during multiple visits with superficial scalp lacerations. However, with multiple falls, she was subsequently transferred to medicine to rule out cardiogenic versus neurogenic syncope. She was admitted to the telemetry unit, and a cardiologist was consulted. Orthostatic vitals were negative, and she had no fever or leukocytosis. Abdominal computed tomography (CT) done as part of the standard trauma workup revealed an interesting finding of multiple bladder diverticula.

Spontaneous Rupture of a Urinary Bladder Diverticulum in Women: A Rare Cause of an Acute Abdomen.

A bladder diverticulum (BD) is an abnormal pouch protruding from the bladder wall, which can be congenital or acquired. Acquired diverticula are more common, usually secondary to outflow obstruction or neurogenic bladder. Spontaneous rupture of a BD is rare, particularly in women. This report is about a female patient who develops abdominal pain and dysuria, progressing to an acute abdomen. The diagnosis of spontaneous rupture of a BD was suspected in pelvic ultrasound and confirmed in computed tomography (CT) cystography. The patient was submitted to diverticulectomy and bladder wall reconstruction. Although rare, this entity should be considered in patients with acute abdomen with unclear etiology, even in women with no evident risk factors for a BD or its rupture.

Urinary Bladder Diverticulum: A Single-Center Experience in the Management of Refractory Lower Urinary Symptoms Using a Robotic Platform.

Introduction Urinary bladder diverticulum (UBD) is commonly seen in urological practice and, in most cases, does not need treatment specifically directed towards it. However, it can give rise to symptoms that are not distinct from this finding. This makes the evaluation and management of this complex patient group challenging. We present our experience with robotic bladder diverticulectomy (RBD) for acquired bladder diverticulum to assess the outcomes and safety of this procedure when patient symptoms have failed to respond to either medical or surgical treatment directed at other associated contributing factors. Methods We retrospectively collected data on all patients who underwent RBD for persistent lower urinary tract symptoms (LUTS) at Royal Surrey County Hospital, Guildford, between 2016 and 2021, including baseline characteristics, urodynamic findings, intraoperative and postoperative outcomes, and a six-month follow-up. Patients who were diagnosed with cancer in the diverticulum, associated pathology that may contribute to their symptoms, or who had concomitant procedures at the time of RBD were excluded from this study. Results We had six patients who underwent RBD; the median age and body mass index (BMI) were 63.8 years (range 48-73) and 27.1 kg/m2 (range 24-32), respectively. The most common presenting symptoms were refractory LUTS and recurrent urinary tract infections (UTIs). The urodynamic evaluation revealed varying findings like bladder outlet obstruction (BOO), poor compliance, and equivocal readings in these patients. All patients reported incomplete bladder emptying and double voiding, with half practicing clean intermittent self-catheterization (CISC). Diverticulum size averaged 9.4 cm (range 8.5-12). The median operative time and blood loss were 166 mins (range 150-180) and 75 mls (range 50-100), respectively. The average length of stay was 1.6 days (range 1-3). Three patients developed UTIs within a month after surgery, requiring a course of oral antibiotics. Post-void residual (PVR) measured an average of 32.6 mls (range 0-161) postoperatively compared to a preoperative average of 249 mls (range 125-400), showing a two-tailed p-value of 0.016. The International Prostate Symptom Score (IPSS) score for these patients showed an average of 27.83 (range 24-31) preoperatively compared to the postoperative average of eight (range 7-12), showing a two-tailed p-value of 0.0001. Final histology showed no malignancy, and all patients reported symptom improvement, with none requiring CISC after surgery. Conclusion RBD is a safe and effective procedure in carefully selected patients with refractory LUTS and UTIs showing good postoperative and functional outcomes. The presence of a large diverticulum can have a complex effect on bladder dynamics. In the era of robotic surgery and enhanced recovery, discussion about diverticulectomy should be encouraged after proper evaluation and counseling for patients who have failed to improve with other measures of treatment for their symptoms.

A Validation Study of cT-Categories in the Swedish National Urinary Bladder Cancer Register-Norrland University Hospital.

BACKGROUND: In Sweden, all patients with urinary bladder cancer (UBC) are recorded in the Swedish National Register for Urinary Bladder Cancer (SNRUBC). The purpose of this study was to validate the registered clinical tumour categories (cT-categories) in the SNRUBC for Norrland University Hospital, Sweden, from 2009 to 2020, inclusive. METHODS: The medical records of all 295 patients who underwent radical cystectomy for the treatment of UBC were reviewed retrospectively. Possible factors impacting the cT-categories were identified. To optimise cT-classification, computed tomography urography of all patients with suspected tumour-associated hydronephrosis (TAH) or suspected tumour in bladder diverticulum (TIBD) were retrospectively reviewed by a radiologist. Discrepancy was tested with a logistic regression model. RESULTS: cT-categories differed in 87 cases (29.5%). Adjusted logistic regression analysis found TIBD and TAH as significant predictors for incorrect registration; OR = 7.71 (p < 0.001), and OR = 17.7, (p < 0.001), respectively. In total, 48 patients (68.6%) with TAH and 12 patients (52.2%) with TIBD showed discrepancy regarding the cT-category. Incorrect registration was mostly observed during the years 2009-2012. CONCLUSION: The study revealed substantial incorrect registration of cT-categories in SNRUBC. A major part of the misclassifications was related to TAH and TIBD. Registration of these variables in the SNRUBC might be considered to improve correct cT-classification.

A novel endoscopic approach for management of hutch diverticulum concomitant vesicoureteral reflux with dextranomer/hyaluronic acid copolymer injection.

INTRODUCTION: There are various treatment options for symptomatic bladder diverticulum, including robotic-assisted laparoscopic bladder diverticulectomy, open and endoscopic techniques. But, to date, the optimal surgical technique remains unclear. OBJECTIVE: To present the preliminary long-term follow-up results of a novel technique of dextranomer/hyaluronic acid copolymer (Deflux) plus autologous blood injection for correction of hutch diverticulum in patients with concomitant vesicoureteral reflux (VUR). PATIENT AND METHOD: We retrospectively reviewed four patients who had hutch diverticulum with concomitant VUR and had undergone submucosal Deflux following autologous blood injection. Patients with neurogenic bladder, posterior urethral valve, or voiding dysfunction were excluded from the study. Success was defined as the resolution of the diverticulum, hydronephrosis, and hydroureter on ultrasonography at a 3-month follow-up and long-term symptom-free period. RESULTS: Four patients with hutch diverticula were included. The median age at the time of surgery was 6.1 (range 3-8) years. Three of them had unilateral VUR, and one had bilateral VUR. During the procedure, a mean of 0.625 ml Deflux plus a mean of 1.25 ml autologous blood were injected submucosally for correction of VUR. Additionally, a mean of 1.62 ml Deflux plus a mean of 1.75 ml autologous blood were injected submucosally to occlude the diverticulum. The median follow-up was 4.6 (range 4-8) years. This method had excellent success in all patients in the current study with no postoperative complications such as febrile urinary tract infection, or diverticulum, hydroureter, or hydronephrosis in follow-up ultrasounds. CONCLUSIONS: Submucosal injection of Deflux plus autologous blood injection can be a successful endoscopic intervention for treatments of hutch diverticulum in patients with concomitant VUR. Deflux injection can be a simple and cost-effective technique.

Urothelial carcinoma in a urinary bladder diverticulum: A case report and review of the literature.

Bladder diverticula are defined as an outpouching of the mucosa into the muscle layer of the bladder wall. There is a well-known link between urinary bladder diverticula and tumors arising within the diverticula. They are rare with an incidence rate of 0.8%-10%. We report an intradiverticular urothelial carcinoma in a 72-year-old man with a known history of multiple episodes of acute urinary retention and urinary tract infections, followed by transurethral resection of the benign prostatic hyperplasia.

Progress in the treatment of bladder diverticulum / 中华泌尿外科杂志

Bladder diverticulum is a hernia formed by the protrusion of the mucosa through the weak muscularis propria of the bladder wall. It can be divided into congenital and acquired. Most patients are asymptomatic, and be found by physical examination or incidentally during the diagnosis and treatment of other diseases. The majority of bladder diverticula occur in male patients, mostly due to lower urinary tract obstruction. Severe diverticula may cause recurrent urinary tract infection or even malignant transformation, which requiring surgical treatment.

Irreducible Hernia With Unusual Content.

Chronic increase in the intravesical pressure secondary to bladder outlet obstruction can lead to the formation of bladder diverticulum. Bladder diverticulum may get pulled into the hernial sac and may become a component of the hernia. Here, we report the case of an elderly male who had an unusual presentation of urinary bladder diverticulum as the content in an obstructed inguinal hernia. Upon exploration, the bladder diverticulum was released from the inguinal canal and returned to the peritoneal cavity, following which conventional hernioplasty was done. Inguinal herniation of bladder diverticulum is an uncommon condition and can be perilous during surgery if not diagnosed preoperatively.