[Endoscopic treatment of bladder diverticula]

Area of Science:

• Urology
• Minimally Invasive Surgery
• Endourology

Background:

• Bladder diverticula can cause voiding dysfunction and are often associated with benign prostatic hyperplasia or bladder neck sclerosis.
• Radical surgical correction of bladder diverticula is frequently contraindicated in elderly patients with significant comorbidities due to high anesthesia risk.
• Transurethral endoscopic approaches offer a less invasive alternative for managing bladder diverticula in high-risk patient populations.

Observation:

• This study evaluated transurethral endoscopic incision of the bladder's diverticular neck in 29 patients (mean age 65 years), 86.2% with high anesthesia risk.
• Procedures were performed under epidural anesthesia, often combined with transurethral resection (TUR) of benign prostatic hyperplasia (18 patients) or bladder neck sclerosis (11 patients).
• Additional procedures included TUR of the bladder for cancer (2 cases) and cystolithotripsy (6 cases).

Findings:

• Postoperative uroflowmetry showed a significant increase in maximal urinary flow rate (Qmax) from 2.1-5.3 ml/s to 14.1-23.0 ml/s.
• Follow-up (6-48 months) revealed complete resolution of diverticula in 13 patients and diminished size in 16 others.
• Residual urine was significantly reduced, with a maximum of 50 ml in large diverticula.

Implications:

• Transurethral incision of the bladder diverticular neck is a safe and effective treatment, particularly for patients unsuitable for open surgery.
• This technique can be performed concurrently with other transurethral procedures, improving surgical efficiency.
• It offers a valuable alternative to open diverticulectomy, with a low complication rate and good long-term functional outcomes.