title: Laparoscopic urinary bladder diverticulectomy combined with photoselective vaporisation of the prostate.
abstract: BACKGROUND
  Pseudodiverticulum of the urinary bladder is mostly a complication of subvesical obstruction (SO). The gold standard of treatment was open diverticulectomy with adenectomy. A more contemporary resolution is endoscopic, in two steps: the first transurethral resection of the prostate (TURP), the second laparoscopic diverticulectomy (LD).
  
  
  OBJECTIVE
  To present a one-session procedure - photoselective vaporisation of the prostate (PVP) with LD.
  
  
  METHODS
  From 1/2011 to 6/2014, 14 LDs were performed: 1 LD only, 1 with laparoscopic radical prostatectomy, 12 combined with treatment of benign prostatic hyperplasia (BPH), 4 cases of TURP and LD in the second period. In 8 cases, PVP and LD in one session were combined. These 8 cases are presented. 3D CT cystography was used as a gold standard for assessment of diverticulum.
  
  
  RESULTS
  The mean age was 66.5 ±5.5 (57.3-75.1) years, the mean size of the diverticulum 61.8 ±22.1 (26-90) mm. The procedure starts in the lithotomy position. It includes PVP and stenting of the ureter(s). Changing of position and laparoscopy follows: four ports, transperitoneal extravesical approach. Photoselective vaporisation of the prostate was performed using the Green Light Laser HPS (1x) or XPS with cooled fibre MoXy (7x). The mean delivered energy in PVP was 205.1 ±106.4 (120-458) kJ. The mean time of operation was 165.0 ±48.5 (90-255) min. No postoperative complications were observed. One patient underwent TUR incision after 1 year for sclerosis of the bladder neck.
  
  
  CONCLUSIONS
  Pseudodiverticulum of the urinary bladder (with or without SO) is a relatively rare disease. One session of PVP (Green Light Laser XPS, MoXy fibre) and laparoscopic (transperitoneal extravesical) diverticulectomy is the preferred method for treatment of subvesical obstruction due to BPH and bladder diverticulum at our institution.
authors.affiliation: Department of Urology, Faculty Hospital in Pilsen, Czech Republic ; Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic.
authors.forename: Milan
authors.initials: M
authors.lastname: Hora
authors.affiliation: Department of Urology, Faculty Hospital in Pilsen, Czech Republic ; Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic.
authors.forename: Viktor
authors.initials: V
authors.lastname: Eret
authors.affiliation: Department of Urology, Faculty Hospital in Pilsen, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Stránský
authors.affiliation: Department of Urology, Faculty Hospital in Pilsen, Czech Republic ; Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic.
authors.forename: Ivan
authors.initials: I
authors.lastname: Trávníček
authors.affiliation: Department of Urology, Faculty Hospital in Pilsen, Czech Republic ; Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic.
authors.forename: Olga
authors.initials: O
authors.lastname: Dolejšová
authors.affiliation: Department of Radiology, Faculty Hospital, Pilsen, Czech Republic.
authors.forename: Zdeněk
authors.initials: Z
authors.lastname: Chudáček
authors.affiliation: Department of Pathology, National University Health System, Singapore.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Petersson
authors.affiliation: Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic ; Department of Pathology, Faculty Hospital in Pilsen, Czech Republic.
authors.forename: Ondřej
authors.initials: O
authors.lastname: Hes
authors.affiliation: Department of Urology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Chłosta
keywords: benign prostatic hyperplasia; laparoscopic diverticulectomy; photoselective vaporisation of the prostate