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Pneumovesicoscopic treatment of congenital bladder diverticula in children: our experience
Antonio Marte1, Maria D Sabatino, Micaela Borrelli
1Department of Pediatric Surgery, Second University of Naples, Naples, Italy. antonio.marte@unina2.it
Insights
Pneumovesicoscopic diverticulectomy is a safe and effective minimally invasive surgical technique for treating symptomatic congenital bladder diverticula in children. This approach offers a valid alternative to open surgery with good cosmetic outcomes.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Congenital Abnormalities
Background:
- Congenital bladder diverticula can cause significant symptoms in children.
- Surgical intervention, such as diverticulectomy, is often necessary for symptomatic cases.
- Traditional open or laparoscopic approaches have been used, but minimally invasive options are sought.
Purpose of the Study:
- To evaluate the safety and efficacy of pneumovesicoscopic diverticulectomy for symptomatic congenital bladder diverticula in children.
- To report the surgical experience and outcomes of this technique.
Main Methods:
- Six boys aged 4-8 years underwent pneumovesicoscopic diverticulectomy.
- The procedure involved cystoscopic control, cystopexy, and trocar insertion for carbon dioxide insufflation.
- Diverticula were inverted, circumcised, and sutured; bladder drainage was achieved with catheters.
Main Results:
- Mean operative time was 110 minutes.
- No major complications occurred; one case of gas leakage was managed.
- Postoperative imaging confirmed complete resolution of diverticula in all patients.
Conclusions:
- Pneumovesicoscopic diverticulectomy is an easy and safe procedure for pediatric bladder diverticula.
- It serves as a viable alternative to open and laparoscopic methods.
- The technique offers minimal postoperative discomfort and excellent cosmetic results.
Aim:
In this article, we report our experience with diverticulectomies of symptomatic congenital bladder diverticula in children, which was performed by utilizing pneumovesicoscopy.
Materials And Methods:
Six boys, 4-8 years of age (mean, 5.6) underwent pneumovesicoscopic diverticulectomy at our institution from June 2007 to June 2008. There were 4 right-single diverticula and 2 double-left diverticula. Under cystoscopic control, after the cystopexy to the abdominal wall, a midline 5-mm trocar for a 0-degree telescope and two lateral 3-mm reusable trocars through the anterolateral wall of the bladder in the midclavicular line were introduced, insufflating the bladder with carbondioxide to 10-12 mm Hg pressure. The diverticulum/a were inverted into the bladder and the mucosa around the neck was circumcized by using scissors and a monopolar hook. The defect was sutured with interrupted sutures and the bladder was drained with a Foley catheter, which was introduced at the site of the 5-mm port, and a urethral catheter.
Results:
Mean operative time was 110 minutes. No major peri- or postoperative complications were recorded, except that the displacement of one of the lateral trocars that resulted in gas leakage in 1 case. The trocar was replaced and the procedure was completed. An ultrasound and a voiding cystourethrogram, performed from 3 to 6 months after the operation, showed the disappearance of the diverticulum/a.
Conclusions:
In our experience, pneumovesicoscopic diverticulectomy is an easy, safe procedure and can be considered a valid alternative to the open or laparoscopic procedures. It also provides no postoperative discomfort and a good cosmetic result.
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