V2-09: Electrovaporization of Large Bladder Diverticulum
A bladder diverticulum which causes urinary complications requires intervention. There are several options for treatment. This is a case where we used a minimally invasive transurethral technique with electrovaporization of the diverticular mucosa as the primary treatment for an acquired bladder diverticulum due to an obstructive pubovaginal sling in a female patient._x000D_ _x000D_
A 63-year-old female presented to our institution in 2013 with complaints of incomplete bladder emptying, difficulty of urination with voiding only in a bent-over position, pelvic pain, and recurrent urinary tract infection (UTI). Her past surgical history included vaginal hysterectomy, rectocele repair with perineoplasty, placement of a pubovaginal sling with autologous fascia, and cystocele repair at an outside institution in 2001._x000D_ _x000D_ Pelvic examination was unremarkable. Flexible cystoscopy revealed a normal urethra and a large left lateral wall diverticulum. The mouth of the diverticulum was wide and showed no abnormalities. Fluorourodynamic images re-demonstrated the large diverticulum which balllooned during voiding. The bladder emptied to completion while the diverticulum retained the contrast. The diagnosis was that of bladder outlet obstruction at the mid-urethral level. Follow up residual urine measurements showed higher volumes of 400mL which could be attributed to the growing diverticulum._x000D_ _x000D_ The patient underwent partial urethrolysis with excision of the fascial sling. Her urination became easier and did not require changing position. She continued, however, to have incomplete bladder emptying and recurrent UTI due to the diverticulum. Electrovaporization was performed of the entire diverticular mucosa utilizing a bipolar button vaporization electrode. Only the coagulation setting was used at a power of 160 watts. There was no evidence of bleeding or perforation during the operation. Total electrovaporization time lasted thirty minutes. An indwelling urethral catheter was placed at the end of the case and left in for a total of six weeks._x000D_ _x000D_
The patient did well postoperatively. Voiding cystourethrogram at six weeks showed a significant reduction in diverticular size. The Foley catheter was removed and the patient was able to void without difficulty with minimal residual urine and no urinary tract infections._x000D_
Electrovaproization of a bladder diverticulum is a minimally invasive technique with similar clinical outcome to open and laparoscopic diverticulectomy. Its ease of surgery with a faster operating and recovery time exemplifies its usefulness in the clinical setting.