Bladder Diverticulectomy

What is it?

Bladder diverticulectomy is the procedure by which a bladder diverticulum is surgically excised. The surgery is indicated if they are associated with persistent symptoms, recurrent infections, obstruction, stones, malignant disease or other complicating factors such as ipsilateral vesicoureteral reflux.

Thus it is indicated for the treatment of symptoms related to the diverticulum or for the major complications directly related to it, including chronic relapsing urinary tract infection, stones within the diverticulum, carcinoma or premalignant change and upper urinary tract deterioration as a result of obstruction or reflux.

How it is done?

Bladder diverticulectomy can be done by Open, Laparoscopic or Robotic assisted Laparoscopic techniques. During excision of the diverticulum utmost care is taken to separate all the adjacent structures including bowel, ureter and vas deferens. The diverticulum is divided at the level of the neck and the defect on the bladder wall is closed in layers with absorbable sutures.

In the laparoscopic technique, the patient is anesthesized and three to four ports are placed in the abdomen using small 5 to 10 mm incisions. The camera and instruments are inserted into the ports. The surgeon uses these instruments to free the bladder from its surrounding structures and isolate the diverticulum. The diverticulum is then excised with lap scissors, and the bladder is sewn back up (reconstructed) using sutures just as in open surgery, but through tiny incisions, after which the closure is tested by filling up the bladder with saline. The excised diverticulum is then sent to the pathologist for evaluation, and a catheter is left in place for several days to ensure healing.

While laparoscopy relies on a two-dimensional image to guide the surgeon, robotic assisted laparoscopy provides 3-D visualization of the operating site and also allows significantly easier and more precise suturing. Bladder diverticulectomy performed using the open technique requires an incision measuring 10 to 15 centimeters. Laparoscopy thus allows the same operation to be done with minimal incisions resulting in less pain and lower wound related complications.