V10-08: Combined Robotic Assisted Bladder Diverticulectomy and Photoselective Vaporization of the Prostate
The standard management of large bladder diverticula (BD) with bladder outlet obstruction (BOO) is open surgery, but recent reports describe a robotic approach for diverticulectomy. However, robotic management of BOO in small prostates is technically difficult. Therefore, we describe a novel combination of photoselective vaporization of the prostate (PVP), and robotic assisted bladder diverticulectomy (RABD) for BD.
Prior to RABD or at the same time as RABD, a PVP was performed transurethrally to the prostate capsule. Ureteral stents are placed if BD was close to the ureteral orifice. At the conclusion of RABD, the peritoneum is repaired so the bladder is in the retroperitoneal position. A cystogram is performed 5-7 days just prior to catheter removal. A retrospective review of PVP and RABD for benign BD was performed identifying patient characteristics, lasing time, joules, operative time, estimated blood loss (EBL), and length of stay (LOS).
A total of 10 patients underwent both PVP and RABD: 5 with PVP and RABD in separate settings and 5 received PVP and RABD together. The results are summarized in the table below. No significant differences were identified between the PVP performed separately vs. same time as RABD.
Combination photoselective vaporization of the prostate (PVP), and robotic assisted bladder diverticulectomy (RABD) for bladder diverticula is an effective treatment regardless of prostate size. This combination can be considered in the same setting with no significant changes in outcome.