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Orsini A, Digiacomo A, Ferretti S, Tamborino F, Basconi M, Cicchetti R, Litterio G, Dello Stritto G, Salzano G, Marchioni M, Schips L. Robotic bladder diverticulectomy with concurrent management of bladder outlet obstruction: A choice to consider. Urologia 2024:3915603241258107. [PMID: 38886984 DOI: 10.1177/03915603241258107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Acquired bladder diverticula (BD) are associated with bladder outlet obstruction. The aim of our study is to analyse the improvement in lower urinary tract symptoms (LUTS) in patients who underwent robot-assisted bladder diverticulectomy (RABD) combined with transurethral prostatectomy (TURP). MATERIAL AND METHODS A prospectively single-centre, single surgeon cohort of four patients with posterolateral BD due to bladder outlet obstruction (BOO) undergoing RABD combined with TURP between 2018 and 2023 was analysed. RESULTS Median age and maximum BD diameter were 73.5 years and 16 cm, respectively. All patients had severe LUTS and elevated postvoid residual (PVR). Preliminary uroflowmetry revealed bladder outlet obstruction with a median of maximum urine flow rate of 8.5 ml/s. The median operative time and blood loss were 212 min and 100 ml, respectively. No intraoperative complications were recorded. The median length of stay was 4 days. The International Prostate Symptom Score (IPSS) and PVR were compared between baseline, 1 month and 6 months after surgery. IPSS significantly decreased from 24 (IQR 24-25) preoperatively compared to the postoperative, at 1 month follow up 7 (IQR 6-8) (p < 0.0001). PVR significantly decreased too from 165 (IQR 150-187) to 35 ml (IQR 25-42) (p < 0.0001). In transitioning from the 1-month follow-up to the 6-month follow-up, no substantial statistical improvement was observed. CONCLUSION Concomitant performance of TURP with RABD is feasible and safe. Diverticulectomy in addiction at the endoscopic procedure should be discussed with patients who have obstructive lower urinary tract symptoms as viable alternative to single procedure individually performed.
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Affiliation(s)
- Angelo Orsini
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Alessio Digiacomo
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Simone Ferretti
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Flavia Tamborino
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Martina Basconi
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Rossella Cicchetti
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Giulio Litterio
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Guglielmo Dello Stritto
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Gaetano Salzano
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Michele Marchioni
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Luigi Schips
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
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Aijaz P, Farooqi Baloch K, Faiz H, Durvesh AK, Tirmizi SJ, Khan M, Sohail H, Khalid S, Niazi MA, Kamran A. Clinical Presentation, Tumor Characteristics, and Management of Intradiverticular Transitional Cell Carcinoma of the Urinary Bladder: A Systematic Review. Cureus 2024; 16:e62974. [PMID: 38912078 PMCID: PMC11194034 DOI: 10.7759/cureus.62974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2024] [Indexed: 06/25/2024] Open
Abstract
Intradiverticular transitional cell carcinoma (TCC) of the bladder poses unique challenges due to its presentation within the bladder diverticula. This review synthesizes current knowledge on the diagnosis and management of this condition, emphasizing the need for early detection to optimize patient outcomes. The literature underscores the importance of tailored treatment strategies, ranging from radical surgeries to adjuvant chemotherapy, to combat the aggressive nature of intradiverticular TCC. Additionally, stringent post-treatment surveillance protocols are vital in addressing high recurrence rates. Future research directions include biomarker identification, comparative efficacy studies of treatment modalities, and the exploration of innovative therapeutic approaches such as immunotherapy. Longitudinal studies analyzing patient outcomes will provide valuable insights into survival rates and quality of life post-treatment, informing future clinical guidelines. This comprehensive review aims to enhance understanding and management strategies for intradiverticular TCC, paving the way for improved patient care and outcomes in this challenging form of bladder cancer.
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Affiliation(s)
- Parisa Aijaz
- Internal Medicine, Charleston Area Medical Center, Charleston, USA
| | | | - Haseeb Faiz
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | | | | | - Maimoona Khan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Hassan Sohail
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Saad Khalid
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Muhammad A Niazi
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Amir Kamran
- Hematology and Oncology, Charleston Area Medical Center, Charleston, USA
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Janardanan S, Nigam A, Moschonas D, Perry M, Patil K. Urinary Bladder Diverticulum: A Single-Center Experience in the Management of Refractory Lower Urinary Symptoms Using a Robotic Platform. Cureus 2023; 15:e42354. [PMID: 37621793 PMCID: PMC10445242 DOI: 10.7759/cureus.42354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction Urinary bladder diverticulum (UBD) is commonly seen in urological practice and, in most cases, does not need treatment specifically directed towards it. However, it can give rise to symptoms that are not distinct from this finding. This makes the evaluation and management of this complex patient group challenging. We present our experience with robotic bladder diverticulectomy (RBD) for acquired bladder diverticulum to assess the outcomes and safety of this procedure when patient symptoms have failed to respond to either medical or surgical treatment directed at other associated contributing factors. Methods We retrospectively collected data on all patients who underwent RBD for persistent lower urinary tract symptoms (LUTS) at Royal Surrey County Hospital, Guildford, between 2016 and 2021, including baseline characteristics, urodynamic findings, intraoperative and postoperative outcomes, and a six-month follow-up. Patients who were diagnosed with cancer in the diverticulum, associated pathology that may contribute to their symptoms, or who had concomitant procedures at the time of RBD were excluded from this study. Results We had six patients who underwent RBD; the median age and body mass index (BMI) were 63.8 years (range 48-73) and 27.1 kg/m2 (range 24-32), respectively. The most common presenting symptoms were refractory LUTS and recurrent urinary tract infections (UTIs). The urodynamic evaluation revealed varying findings like bladder outlet obstruction (BOO), poor compliance, and equivocal readings in these patients. All patients reported incomplete bladder emptying and double voiding, with half practicing clean intermittent self-catheterization (CISC). Diverticulum size averaged 9.4 cm (range 8.5-12). The median operative time and blood loss were 166 mins (range 150-180) and 75 mls (range 50-100), respectively. The average length of stay was 1.6 days (range 1-3). Three patients developed UTIs within a month after surgery, requiring a course of oral antibiotics. Post-void residual (PVR) measured an average of 32.6 mls (range 0-161) postoperatively compared to a preoperative average of 249 mls (range 125-400), showing a two-tailed p-value of 0.016. The International Prostate Symptom Score (IPSS) score for these patients showed an average of 27.83 (range 24-31) preoperatively compared to the postoperative average of eight (range 7-12), showing a two-tailed p-value of 0.0001. Final histology showed no malignancy, and all patients reported symptom improvement, with none requiring CISC after surgery. Conclusion RBD is a safe and effective procedure in carefully selected patients with refractory LUTS and UTIs showing good postoperative and functional outcomes. The presence of a large diverticulum can have a complex effect on bladder dynamics. In the era of robotic surgery and enhanced recovery, discussion about diverticulectomy should be encouraged after proper evaluation and counseling for patients who have failed to improve with other measures of treatment for their symptoms.
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Affiliation(s)
- Sarosh Janardanan
- Department of Urology, Ashford and St Peter's National Health Services Foundation Trust, Chertsey, GBR
- Department of Urology, Royal Surrey County Hospital, Guildford, GBR
| | - Anurag Nigam
- Department of Urology, Royal Surrey County Hospital, Guildford, GBR
| | | | - Matthew Perry
- Department of Urology, Royal Surrey County Hospital, Guildford, GBR
| | - Krishna Patil
- Department of Urology, Royal Surrey County Hospital, Guildford, GBR
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Katsimperis S, Tzelves L, Bellos T, Angelopoulos P, Tsikopoulos I, Mitsogiannis I, Papatsoris A. Diagnosis and management of intradiverticular bladder tumours: A pooled analysis of 498 cases. Arch Ital Urol Androl 2022; 94:486-491. [PMID: 36576457 DOI: 10.4081/aiua.2022.4.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/07/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Intradiverticular bladder tumors (IDBT) are uncommon clinical entities. We reviewed the literature for clinical presentation, diagnosis and therapeutic options to establish recommendations for diagnostic and therapeutic management. METHODS Bibliographic research was performed using PubMed from database inception until October 15, 2022. A pooled analysis was performed of 498 patients with IDBT presented in the literature. The evaluation included patient sex, age, diagnostic methods, symptoms, localization of the tumor, tumor staging, tumor histopathology, treatment, and the presence of recurrence. To express results, descriptive statistics were used appropriately. RESULTS The mean age at diagnosis was 64.81 years (range 49 days to 84 years). The ratio between men and women was ≈ 24:1, suggesting a male predominance (85% male, 3.6% female). The most common presenting symptom was gross hematuria (60.88%). Most of the patients had cystoscopy (56.85%) and intravenous or computed tomography urography (52.01%). Regarding tumor staging, most of the patients were diagnosed with pT1 tumors. For the histopathology of IDBT, 87.95% of the specimens were transitional cell carcinomas and in 10.84% there were concomitant CIS. Regarding the treatment, radical cystectomy was chosen in 34.34%, partial cystectomy in 26.66%, diverticulectomy in 15.95% and transurethral resection of bladder tumour (TURBT) in 16.36% of the patients. CONCLUSIONS Most common diagnostic tool for IDBT seems to be cystoscopy followed by computerized tomography urogram. Due to the absence of muscle layer in the diverticulum and the highgrade histology of most of them at diagnosis, cystectomy is the first therapeutic choice. However, for patients that are not considered appropriate candidates or for those presenting with lowgrade and low volume tumors, TURBT is a good option.
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Affiliation(s)
- Stamatios Katsimperis
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens.
| | - Lazaros Tzelves
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens.
| | - Themistoklis Bellos
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens.
| | - Panagiotis Angelopoulos
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens.
| | - Ioannis Tsikopoulos
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens.
| | - Iraklis Mitsogiannis
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens.
| | - Athanasios Papatsoris
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens.
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Cacciamani G, De Luyk N, De Marco V, Sebben M, Bizzotto L, De Marchi D, Cerruto MA, Siracusano S, Benito Porcaro A, Artibani W. Robotic bladder diverticulectomy: step-by-step extravesical posterior approach - technique and outcomes. Scand J Urol 2018; 52:285-290. [PMID: 30339480 DOI: 10.1080/21681805.2018.1492965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the feasibility of robotic extravesical posterior surgical bladder diverticulectomy for treatment of symptomatic bladder diverticula (BD). MATERIALS AND METHODS Data from patients with posterior BD who consecutively underwent robotic bladder diverticulectomy (RBD) from 2013 to 2016 in Azienda Ospedaliera Universitaria Integrata, Verona, were retrospectively reviewed. Baseline characteristics, perioperative outcomes including operative time (OT), estimated blood loss (EBL), postoperative transfusion rate and length of hospital stay (LOS), and early (30 days) and late (90 days) postoperative complications were recorded and analysed. RESULTS Six patients underwent RBD. Storage, voiding and postvoiding lower urinary tract symptoms (LUTS) were reported by 33.3%, 100% and 33.3% of patients, respectively. The median [interquartile range (IQR)] BD diameter was 7.1 (5.5-9.5) cm; median (IQR) preoperative postvoiding residual volume (PVR) was 300 (90-395) ml. The median (IQR) OT was 112.5 (83.7-133.7) min and median (IQR) EBL was 25.8 (0-50) ml. The median (IQR) LOS was 7 (4.7-9.0) days. One patient (16.7%) reported early minor postoperative complication. No patient showed early or late major postoperative complications. At 2 month follow-up, all patients underwent a lower abdomen ultrasound and minimal or no postoperative PVR was found. At 6 month follow-up no LUTS were reported. CONCLUSIONS RBD appears to be a safe treatment for posterior BD with excellent perioperative and functional outcomes. The three-dimensional visualization, greater magnification and wristed instrumentation with seven degrees of freedom allow precise dissection of BD and reconstruction of the bladder wall.
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Affiliation(s)
- Giovanni Cacciamani
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Nicolò De Luyk
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Vincenzo De Marco
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Marco Sebben
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Leonardo Bizzotto
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Davide De Marchi
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Maria Angela Cerruto
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Salvatore Siracusano
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Antonio Benito Porcaro
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Walter Artibani
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
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