The effects of bladder diverticulum on the pathophysiology of bladder outlet obstruction: An experimental study in guinea pigs

Karadag, Aslıhan

doi:10.14744/semb.2020.45389

Cited by 2 publications

(3 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although these patients presented with varying symptoms, the predominant one in three (50%) of them was voiding, with an average maximum flow rate (Q max) of seven (range [3][4][5][6][7][8][9][10][11]. Two (33.33%) patients suffered from recurrent urinary tract infections (UTI), and one (16.66%) presented mainly with refractory storage LUTS.…”

Section: Resultsmentioning

confidence: 99%

“…The information gained from a urodynamic evaluation is important for counseling the patient on possible outcomes after surgery. A recently performed animal study reported a further reduction in compliance in addition to the effects of pre-existing BOO due to the presence of bladder diverticulum [ 6 ]. As most patients show good improvement with measures tailored to any contributing factors like BOO, this should be addressed first.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Janardanan¹,

Nigam²,

Moschonas³

et al. 2023

Cureus

View full text Add to dashboard Cite

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/m 2 (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 pat...

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Janardanan¹,

Nigam²,

Moschonas³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…[ 2 ] Acquired BD are commonly associated with bladder outlet obstruction (BOO), as are benign prostatic hyperplasia and recurrent infections. [ 3 ] Currently, little is known about the diagnosis and treatment of BD, and reports on the efficacy of treating diverticula combined with BOO are limited, [ 4 ] with posterior BD being even rarer. Over the past few years, surgical treatment of BD has been attempted using various approaches, including open, endoscopic, and laparoscopic techniques.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic surgery for female posterior urethral bladder diverticulum with bladder outlet obstruction: A case report

Liao,

He,

Wang

et al. 2023

Medicine

View full text Add to dashboard Cite

Introduction: Bladder diverticula (BD) can be classified into congenital and acquired forms, with the latter accounting for approximately 90% of all cases, primarily among male patients. Although BD-associated anatomical bladder outlet obstruction (BOO) is uncommon, existing literature suggests that congenital BD are more frequently observed in male children and rarely in female children. While around 70% of acquired BD are linked to BOO secondary to benign prostatic hyperplasia in male patients, clinical reports of female BD are less common. Furthermore, cases of female BD located posterior to the urethra, which lead to voiding difficulties, are exceedingly rare. Case presentation: Herein, we present a case of laparoscopic treatment in a 53-year-old female patient diagnosed with congenital bladder diverticulum causing progressively worsening dysuria. Voiding cystourethrography revealed a soft cystic protrusion of the posterior urethral wall during voiding, which reinforced the patient’s symptoms. Urodynamic examination showed elevated detrusor muscle contraction during voiding, a reduced urinary flow rate, and P/Q values indicative of significant BOO. Considering the patient’s clinical condition, we performed laparoscopic bladder diverticulectomy, partial urethral croppingplasty, and cystoplasty. Results: The laparoscopic bladder diverticulectomy, partial urethral croppingplasty, and cystoplasty procedures were completed thoroughly and with great success. However, complete removal of the diverticular epithelium proved challenging, resulting in an overall operative time of approximately 3 hours and 32 minutes. At the postoperative follow-up, the patient presented with symptoms of a lower urinary tract infection for a week, which were effectively resolved with oral antibiotics. At the 8-month follow-up, the patient reported normal urination and the absence of any discomfort during urination. Conclusion: Female bladder outlet obstruction resulting from posterior urethral BD can be challenging to visualize during transurethral cystoscopy, especially with limited angulation, and may even be overlooked. Furthermore, conventional transvaginal diverticulectomy is often difficult to perform effectively. Therefore, laparoscopic bladder diverticulectomy, partial urethral croppingplasty, and cystoplasty are considered appropriate treatment options for such cases.

show abstract

The effects of bladder diverticulum on the pathophysiology of bladder outlet obstruction: An experimental study in guinea pigs

Cited by 2 publications

References 18 publications

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

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

Laparoscopic surgery for female posterior urethral bladder diverticulum with bladder outlet obstruction: A case report

Contact Info

Product

Resources

About