Hora Milan, Eret Viktor, Stránský Petr, Trávníček Ivan, Dolejšová Olga, Chudáček Zdeněk, Petersson Fredrik, Hes Ondřej, Chłosta Piotr
Department of Urology, Faculty Hospital in Pilsen, Czech Republic ; Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic.
Department of Urology, Faculty Hospital in Pilsen, Czech Republic.
Wideochir Inne Tech Maloinwazyjne. 2015 Apr;10(1):62-7. doi: 10.5114/wiitm.2015.49671. Epub 2015 Mar 10.
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).
To present a one-session procedure - photoselective vaporisation of the prostate (PVP) with LD.
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.
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.
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.
膀胱假性憩室大多是膀胱下梗阻（SO）的并发症。治疗的金标准是开放性憩室切除术加腺体切除术。一种更现代的解决方法是分两步进行内镜治疗：第一步经尿道前列腺切除术（TURP），第二步腹腔镜憩室切除术（LD）。
介绍一种一次性手术——前列腺光选择性汽化术（PVP）联合LD。
2011年1月至2014年6月，共进行了14例LD手术：1例单纯LD，1例联合腹腔镜根治性前列腺切除术，12例联合治疗良性前列腺增生（BPH），4例在第二期进行TURP和LD。8例患者进行了PVP和LD一次性联合手术。现介绍这8例病例。采用三维CT膀胱造影作为评估憩室的金标准。
平均年龄为66.5±5.5（57.3 - 75.1）岁，憩室平均大小为61.8±22.1（26 - 90）mm。手术从截石位开始。包括PVP和输尿管支架置入。然后改变体位并进行腹腔镜手术：四个切口，经腹膜外膀胱外入路。使用Green Light Laser HPS（1例）或带冷却光纤MoXy的XPS（7例）进行前列腺光选择性汽化术。PVP的平均输送能量为205.1±106.4（120 - 458）kJ。平均手术时间为165.0±48.5（90 - 255）分钟。未观察到术后并发症。1例患者在1年后因膀胱颈硬化接受了TUR切开术。
膀胱假性憩室（伴或不伴SO）是一种相对罕见的疾病。在我们机构，一次性进行PVP（Green Light Laser XPS，MoXy光纤）和腹腔镜（经腹膜外膀胱外）憩室切除术是治疗因BPH和膀胱憩室导致的膀胱下梗阻的首选方法。
