Zhengqiang Wan, Yinglei Wang, Cheng Li, Dongbing Zheng
Department of Urology, The Second Clinical Medical College of Binzhou Medical University, Shandong, China.
The Second Ward of Urology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China.
Front Med (Lausanne). 2022 Oct 25;9:1036222. doi: 10.3389/fmed.2022.1036222. eCollection 2022.
Bladder diverticulum is due to the abnormal arrangement of congenital bladder wall muscle fibers, weak limitations, combined with lower urinary tract obstruction, increased intravesical pressure, and protruding between the self-separated detrusor muscle bundles of the bladder wall. Giant bladder diverticulum refers to 10*8 cm or diverticulum over 150 ml in volume.
An 80-year-old male patient was admitted to our hospital on August 14, 2020, the preoperative diagnosis was: bladder diverticulum, bladder diverticulum calculi, multiple bladder stones and prostatic hyperplasia. On August 18, 2020, one-stage laparoscopic bladder diverticulectomy + diverticulum neck incision for stone removal + cystopuncture fistula + transurethral bladder stone removal + transurethral resection of the prostate (TURP) under general anesthesia. First, the bladder diverticulum was separated under laparoscopy, the diverticulum was incised, the diverticulum calculi were taken out, and then the diverticulum was completely removed, and the neck of the diverticulum was extended by 1.5 cm, and the large calculus of about 2.7*3.6 cm was completely removed, and then cystostomy + transurethral Bladder stone removal + TURP. There was no bleeding from the bladder suture during the operation. 200 ml of urine was drained from the extraperitoneal drainage tube, and 20 ml of urine was drained from the abdominal drainage tube during the operation, the urination is smooth, and the general condition can be discharged. The patient's general condition is good after follow-up.
One-stage laparoscopic treatment of bladder diverticulectomy + diverticulum neck incision for stone extraction + cystopuncture fistula + transurethral bladder stone extraction + TURP surgery. There is no report at home and abroad, which can provide diagnosis and treatment ideas and surgical methods for urological colleagues to deal with such diseases.
膀胱憩室是由于先天性膀胱壁肌纤维排列异常、局限性薄弱，合并下尿路梗阻、膀胱内压升高，膀胱壁自分离的逼尿肌束之间向外突出所致。巨大膀胱憩室是指直径达10×8cm或容积超过150ml的憩室。
一名80岁男性患者于2020年8月14日入院，术前诊断为：膀胱憩室、膀胱憩室结石、多发膀胱结石及前列腺增生。2020年8月18日，在全身麻醉下行一期腹腔镜膀胱憩室切除术+憩室颈部切开取石+膀胱穿刺造瘘+经尿道膀胱结石取出术+经尿道前列腺电切术（TURP）。首先在腹腔镜下分离膀胱憩室，切开憩室，取出憩室结石，然后完整切除憩室，将憩室颈部延长1.5cm，完整取出约2.7×3.6cm的大结石，接着行膀胱造瘘+经尿道膀胱结石取出+TURP。术中膀胱缝合处无出血。术中经腹膜外引流管引出尿液200ml，经腹腔引流管引出尿液20ml，排尿通畅，一般情况可出院。随访患者一般情况良好。
一期腹腔镜下膀胱憩室切除术+憩室颈部切开取石+膀胱穿刺造瘘+经尿道膀胱结石取出+TURP手术。国内外未见报道，可为泌尿外科同仁处理此类疾病提供诊断思路及手术方法。
