Intraoperative catheter management during laparoscopic excision of a giant bladder diverticulum.
BACKGROUND
Massive bladder diverticula present a technical challenge to the laparoscopic surgeon. We describe a laparoscopic approach to transperitoneal diverticulectomy, using a specific catheter arrangement to allow excellent control of the various portions of the procedure.


METHODS
A 49-year-old male with longstanding frequency was diagnosed with a 1000 cc bladder diverticulum and bladder neck outlet obstruction. Laparoscopic transperitoneal diverticulectomy was performed using a triple catheter arrangement: endoscopic placement of a Councill catheter in the diverticulum, fluoroscopic positioning of an occlusion balloon catheter in the renal pelvis, and placement of a Cope loop suprapubic tube. Additionally, a transurethral incision of the prostate was performed.


RESULTS
The procedure was completed laparoscopically using a four port transperitoneal approach. During the procedure, the diverticulum could be filled and emptied as needed; the catheter across the diverticular neck facilitated subsequent closure of the bladder wall defect. The diverticulum was completely excised. The remaining defect in the bladder was then closed in 2 layers. The patient was discharged on postoperative day 3.


CONCLUSIONS
Careful planning and arrangement of catheters in the bladder, ureter, and diverticulum facilitates laparoscopic transperitoneal diverticulectomy of even a very large volume diverticulum.
Khonsari
Sepehr
S
Department of Urology, University of California, Irvine College of Medicine, Irvine, California, USA.
Lee
David I
DI
Basillote
Jay B
JB
McDougall
Elspeth M
EM
Clayman
Ralph V
RV
D015653:Cystectomy / Q000379:methods*; D004240:Diverticulum / Q000150:complications / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000150:complications / Q000601:surgery*; D001748:Urinary Bladder Neck Obstruction / Q000150:complications / Q000601:surgery*; D014546:Urinary Catheterization / Q000379:methods*