Pacella Mauro, Mantica Guglielmo, Maffezzini Massimo, Justich Matteo, Traverso Paolo, De Angelis Paolo, Gallo Fabio, Ackermann Hilgard, Zaramella Stefano, Terrone Carlo
a Department of Urology , Ospedale Policlinico San Martino, Istituto di Ricerca e Cura a Carattere Scientifico per l'oncologia, University of Genova , Genoa , Italy.
b Department of Urology , Stellenbosch University and Tygerberg Hospital , Cape Town , South Africa.
Scand J Urol. 2018 Apr;52(2):134-138. doi: 10.1080/21681805.2017.1422014. Epub 2018 Jan 8.
The treatment of bladder diverticula consists of diverticulectomy, mainly by a laparoscopic approach or transurethral resection of the diverticular neck and fulguration of the mucosa. The endoscopic approach is generally dedicated to small diverticula. The aim of this study was to compare laparoscopic diverticulectomy versus endoscopic fulguration for bladder diverticula larger than 4 cm.
A retrospective review of the medical records of consecutive patients undergoing endoscopic or laparoscopic treatment for bladder diverticula larger than 4 cm at two tertiary hospitals was performed. Therapeutic success was defined as either complete resolution or a decrease of at least 80% in the size of the diverticulum. Complications were recorded and graded according to the Clavien-Dindo classification.
All patients were treated with transurethral resection of the prostate in the same operative session. The endoscopic group included a cohort of 20 male patients. The median age, diverticular diameter and operative time were 65 years, 7 cm and 62.5 min, respectively. No early postoperative complications were observed. Therapeutic success was achieved in 15 cases (75%). The laparoscopic group included a cohort of 13 male patients with a median age of 63 years and median diverticular diameter of 7.0 cm. The median operative time was 185 min (p < 0.0001). Two grade III postoperative complications were observed (15.3%). Therapeutic success was achieved in all patients (100%).
Acquired bladder diverticula larger than 4 cm can be effectively managed either by a laparoscopic approach or by endoscopic fulguration.
膀胱憩室的治疗包括憩室切除术，主要通过腹腔镜手术或经尿道切除憩室颈部并电灼黏膜。内镜治疗方法一般适用于较小的憩室。本研究的目的是比较腹腔镜憩室切除术与内镜电灼术治疗直径大于4 cm的膀胱憩室的效果。
对两家三级医院连续接受内镜或腹腔镜治疗直径大于4 cm膀胱憩室的患者的病历进行回顾性分析。治疗成功定义为憩室完全消失或大小至少缩小8０%。根据Clavien-Dindo分类法记录并分级并发症。
所有患者均在同一手术中接受经尿道前列腺切除术。内镜组包括２０例男性患者。中位年龄、憩室直径和手术时间分别为65岁、7 cm和62.5分钟。未观察到早期术后并发症。15例（75%）患者治疗成功。腹腔镜组包括13例男性患者，中位年龄63岁，中位憩室直径7.0 cm。中位手术时间为185分钟（P<0.0001）。观察到2例III级术后并发症（15.3%）。所有患者（100%）治疗成功。
直径大于4 cm的后天性膀胱憩室可通过腹腔镜手术或内镜电灼术有效治疗。
