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Robot-assisted Bladder Diverticulectomy Using a Transperitoneal Extravesical Approach.

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Robot-assisted bladder diverticulectomy (RABD) offers a safe and effective minimally invasive treatment for acquired bladder diverticula in men with benign prostate enlargement. This approach significantly improves urinary symptoms and reduces post-void residual volumes within six months.

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Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Robotic Surgery

Background:

  • Acquired bladder diverticula (BD) are a recognized complication of bladder outlet obstruction (BOO) secondary to benign prostate enlargement (BPE).
  • Robot-assisted bladder diverticulectomy (RABD) presents a minimally invasive alternative to open surgical excision, though limited data exists.

Purpose of the Study:

  • To detail the surgical technique for RABD.
  • To evaluate the perioperative outcomes and functional results at a 6-month follow-up period.

Main Methods:

  • A prospective cohort of 16 men with posterior or posterolateral BD due to BOO/BPE underwent RABD using a four-arm robotic system.
  • Intraoperative identification of BD was achieved via bladder distension and flexible cystoscopy with fluorescence imaging.
  • Dissection and removal of extravesical BD were performed, with assessment of operative time, blood loss, complications, and catheter duration.

Main Results:

  • The median operative time was 126 minutes with a median estimated blood loss of 20 ml; no intraoperative complications occurred.
  • Postoperative complications were observed in two patients (urinary infection).
  • Significant improvements were noted in International Prostate Symptom Score (IPSS) (25 to 5) and post-void residual volume (PVR) (195 ml to 30 ml) at 6 months (p < 0.001).

Conclusions:

  • RABD is a safe and effective minimally invasive surgical option for managing acquired bladder diverticula in men with BOO/BPE.
  • Further validation in larger patient cohorts with extended follow-up is recommended.